Journal of Clinical and Experimental Dentistry. 2018. Vol. 10, no. 4

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    A pragmatic evidence-based clinical management algorithm for burning mouth syndrome
    (2018) Kim, Yohanan; Yoo, Timothy; Han, Peter; Liu, Yuan; Inman, Jared C.
    Burning mouth syndrome is a poorly understood disease process with no current standard of treatment. The goal of this article is to provide an evidence-based, practical, clinical algorithm as a guideline for the treatment of burning mouth syndrome. Using available evidence and clinical experience, a multi-step management algorithm was developed. A retrospective cohort study was then performed, following STROBE statement guidelines, comparing outcomes of patients who were managed using the algorithm and those who were managed without. Forty-seven patients were included in the study, with 21 (45%) managed using the algorithm and 26 (55%) managed without. The mean age overall was 60.4 ±16.5 years, and most patients (39, 83%) were female. Cohorts showed no statistical difference in age, sex, overall follow-up time, dysgeusia, geographic tongue, or psychiatric disorder; xerostomia, however, was significantly different, skewed toward the algorithm group. Significantly more non-algorithm patients did not continue care (69% vs. 29%, p=0.001). The odds ratio of not continuing care for the non-algorithm group compared to the algorithm group was 5.6 [1.6, 19.8]. Improvement in pain was significantly more likely in the algorithm group (p=0.001), with an odds ratio of 27.5 [3.1, 242.0]. We present a basic clinical management algorithm for burning mouth syndrome which may increase the likelihood of pain improvement and patient follow-up.
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    Effect of surface treatments with acid solutions on the surface roughness of an Yttrium-Tetragonal Zirconia Polycrystal
    (2018) Goyatá, Frederico; Galvão, Yvna; Simões, Thamyryz-Rafaela; Goyatá, Luiz-Felipe; Arruda, José A.; Moreno, Amália
    The purpose of this in vitro study was to evaluate the effect of conventional surface treatment with acid solutions on the surface roughness of a zirconia-based ceramic. Specimens of yttrium-tetragonal zirconia polycrystal (Y-TZP) -based ceramic were fabricated (5.0 x 5.0 x 2.0 mm, n=40). The specimens were submitted to the tested surface treatment method and divided into 4 groups (n=10): no treatment-control (GI), airborne 110 µm aluminum oxide particle abrasion for 1 minute-conventional method (GII); etching with 48% hydrofluoric acid for 2 minutes (GIII), and nitric acid/hydrofluoric acid etching for 2 minutes (GIV). The surface roughness (Ra) test was performed, followed by AFM analysis. The results were analyzed by ANOVA and the Tukey test, with the level of significance set at a=.05. The surface treatment with acid solutions (0.16 ± 0.02-GIII; 0.11 ± 0.01-GIV) promoted a significant increase in roughness, with higher mean Ra values of Y-TZP (?m) compared to control (0.06 ± 0.01-GI) (p >.05), and lower values compared to the conventional method (0.21 ± 0.06-GII). The aluminum oxide particle treatment resulted in deep microretentions forming sharp Y-TZP peaks compared to only microretentions with acid solution treatments. All Y-TZP treatments effectively promoted microretention in the ceramic. Hydrofluoric acid (48%) proved to be more effective in increasing the Ra of Y-TZP than the nitric acid/hydrofluoric acid treatment. Atomic force microscopy images revealed that both acid solutions modified the surface of the Y-TZP in a uniform manner.
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    Relationship between resolution and accuracy of four intraoral scanners in complete-arch impressions
    (2018) Medina-Sotomayor, Priscilla; Pascual Moscardó, Agustín; Camps Alemany, Isabel
    The scanner does not measure the dental surface continually. Instead, it generates a point cloud, and these points are then joined to form the scanned object. This approximation will depend on the number of points generated (resolution), which can lead to low accuracy (trueness and precision) when fewer points are obtained. The purpose of this study is to determine the resolution of four intraoral digital imaging systems and to demonstrate the relationship between accuracy and resolution of the intraoral scanner in impressions of a complete dental arch. A master cast of the complete maxillary arch was prepared with different dental preparations. Using four digital impression systems, the cast was scanned inside of a black methacrylate box, obtaining a total of 40 digital impressions from each scanner. The resolution was obtained by dividing the number of points of each digital impression by the total surface area of the cast. Accuracy was evaluated using a three-dimensional measurement software, using the ?best alignment? method of the casts with a highly faithful reference model obtained from an industrial scanner. Pearson correlation was used for statistical analysis of the data. Of the intraoral scanners, Omnicam is the system with the best resolution, with 79.82 points per mm2, followed by True Definition with 54.68 points per mm2, Trios with 41.21 points per mm2, and iTero with 34.20 points per mm2. However, the study found no relationship between resolution and accuracy of the study digital impression systems (P >0.05), except for Omnicam and its precision. The resolution of the digital impression systems has no relationship with the accuracy they achieve in the impression of a complete dental arch. The study found that the Omnicam scanner is the system that obtains the best resolution, and that as the resolution increases, its precision increases.
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    Comparison of the effect of pharmacotherapy and neuro-feedback therapy on oral health of children with attention deficit hyperactivity disorder
    (2018) Vafaei, Ali; Vafaei, Iman; Noorazar, Gholamreza; Akbarzadeh, Rafegh; Erfanparast, Leila; Shirazi, Sajjad
    Attention deficit hyperactivity disorder (ADHD) is a chronic and progressive mental disorder related to the childhood period. This study aims to compare the oral health of two groups of ADHD children: those under pharmacotherapy and those under neuro-feedback therapy. 72 ADHD children (aged 6?12) were divided into two 36 member groups: The pharmacotherapy group and the neuro-feedback therapy group. Unstimulated salivary flow (USF), DMFT, and plaque index were assessed in these children. Statistical analysis was carried out on the data with the independent t-test, which was performed using SPSS 16. The significance level of the study was p<0.05. In this study, the USF of ADHD children who used Ritalin was found to be significantly less than that of the neuro-feedback group (1.25 ± 1.21 vs. 1.91 ± 1.16 ml/min; p=0.002). Also, the plaque index (5.9 ± 3.1 vs. 3.94 ± 1.9; p=0.018) and DMFT scores (39% ± 9% vs. 31% ± 9%; p=0.018) were significantly higher for the pharmacotherapy group. Neuro-feedback therapy is preferable to Ritalin treatment for ADHD children in terms of their oral health status.
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    Incidence, severity and orthodontic treatment difficulty index of impacted canines in Saudi population
    (2018) Alhammadi, Maged-Sultan; Asiri, Hanan-Ahmed; Almashraqi, Abeer-Abdulkarem
    The objective of this study was to assess the incidence, severity and orthodontic treatment difficulty of impacted maxillary canines in Saudi population. This retrospective study included an investigation of panoramic radiographs for patients attended College of Dentistry, Jazan University, Saudi Arabia. The incidence of canine impaction and orthodontic treatment difficulty index of maxillary canine impaction was assessed based on; (1) patient age, (2) vertical position, (3) buccolingual position, (4) horizontal position, (5) incisors alignment, (6) canine space, (7) midline coincidence, (8) rotation of impacted tooth. Statistical analyses were calculated by independent Chi-Square test. A P value of less than 0.05 was considered significant. Canine impaction was found in (1.9%) of the population. Bilateral canine impaction was present in 22.3% of the patient with impacted canines. Ninety two percent had impacted maxillary canines only while 7.5% had impacted maxillary canines with other impacted teeth. The ratio of maxillary to mandibular impaction was about 10:1. Females (69.4%) had more impacted canines than males (30.6%) with no significant sex predilection. Orthodontic treatment difficulty index was statistically significant (P ?0.05) in males more than females. Males revealed statistically significant (P ?0.05) difficulty regarding canine angulation and the vertical position while females showed significant difficulty regarding dental midline and incisors irregularity or crowding of incisor segment. Prevalence of maxillary canine impaction in Jazan is within the range of impacted canine in other populations. Females showed more canine impactions than males while the orthodontic treatment difficulty index is more in males than females.
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    Risk factors of Oral cancer- A hospital based case control study
    (2018) Azhar, Natasha; Sohail, Maheen; Ahmad, Fareeha; Fareeha, Shaheen; Jamil, Soofia; Mughal, Nouman; Salam, Hira
    Oral cancer is a highly prevalent malignancy in Pakistan. Among various risk factors associated with this neoplasm, habits such as smoked and smokeless tobacco usage, betel quid, and betel nut consumption are the major culprits in our society. In the present study, we aimed to ascertain prevalent risk factors for OC in our population and to compare our findings with healthy controls to establish their significance. A hospital-based case control study was conducted at Dow University of Health Sciences, Pakistan from January 2015 ? September 2016. Information pertaining to unhealthy oral habits was obtained from 62 oral cancer patients (cases) and 62 healthy controls on specifically designed proforma by the principal investigator. Smokeless tobacco is strong, independent risk factor for oral cancer development in our study population. Buccal mucosa is the predominantly affected site (71%) which corresponds with high smokeless tobacco use. All studied habits increase risk of oral cancer as demonstrated by high odds ratio. Despite advancement in our knowledge and understanding of carcinogenic potential of these hazardous substances not enough efforts have been put forth to effectively control their widespread sale and consumption, particularly by the youth in our society.
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    Three dimensional reliability analyses of currently used methods for assessment of sagittal jaw discrepancy
    (2018) Almaqrami, Bushra-Sufyan; Alhammadi, Maged-Sultan; Cao, BaoChang
    The objective of this study was to analyse three dimensionally the reliability and correlation of angular and linear measurements in assessment of anteroposterior skeletal discrepancy. In this retrospective cross sectional study, a sample of 213 subjects were three-dimensionally analysed from cone-beam computed tomography scans. The sample was divided according to three dimensional measurement of anteroposterior relation (ANB angle) into three groups (skeletal Class I, Class II and Class III). The anterior-posterior cephalometric indicators were measured on volumetric images using Anatomage software (InVivo5.2). These measurements included three angular and seven linear measurements. Cross tabulations were performed to correlate the ANB angle with each method. Intra-class Correlation Coefficient (ICC) test was applied for the difference between the two reliability measurements. P value of < 0.05 was considered significant. There was a statistically significant (P<0.05) agreement between all methods used with variability in assessment of different anteroposterior relations. The highest correlation was between ANB and DSOJ (0.913), strong correlation with AB/FH, AB/SN/, MM bisector, AB/PP, Wits appraisal (0.896, 0.890, 0.878, 0.867,and 0.858, respectively), moderate with AD/SN and Beta angle (0.787 and 0.760), and weak correlation with corrected ANB angle (0.550). Conjunctive usage of ANB angle with DSOJ, AB/FH, AB/SN/, MM bisector, AB/PP and Wits appraisal in 3D cephalometric analysis provide a more reliable and valid indicator of the skeletal anteroposterior relationship. Clinical relevance: Most of orthodontic literature depends on single method (ANB) with its drawbacks in assessment of skeletal discrepancy which is a cardinal factors for proper treatment planning, this study assessed three dimensionally the degree of correlation between all available methods to make clinical judgement more accurate based on more than one method of assessment.
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    Antibacterial potency and fluoride release of a glass ionomer restorative material containing different concentrations of natural and chemical products : an in-vitro comparative study
    (2018) Elgamily, Hanaa; Ghallab, Omaima; El-Sayed, Hoda; Nasr, Maha
    This study investigated the antibacterial efficacy against Streptococcus mutans and fluoride release of a conventional glass ionomer (GI) contained natural and chemical agents. Two hundred and ten GI specimens were divided into ten groups (n=21) according to the concentrations of the additives as; Propolis extract containing GI (Groups 1, 2, 3) with concentrations of 0.25%, 0.75% and 1.25% respectively, Miswak extract containing GI (Groups 4, 5, 6) and Chlorhexidine containing GI (Groups 7, 8, 9) with the same concentrations. The prepared specimens were subjected to antimicrobial activity by well diffusion, bacterial adherence, and fluoride release (from 2 to 72 hours) assessments. A higher statistically significant antibacterial activity was found in (Groups 2, 3) compared to (Groups 8, 9), while (Groups 1, 4, 5, 6, 7, 10) no antibacterial efficacy was reported. For (Groups 2, 3) had a higher statistically significant anti-adherence effect compared to the other tested groups. Enhanced ascending increase in fluoride release was observed for (Groups 3, 4) compared to (GI). The increased concentration of propolis extract had a synergistic effect on the antimicrobial activity of the tested GI. Additive concentrations of 0.25% Miswak and 1.25% propolis could enhance the fluoride-releasing ability of the tested GI.
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    Evaluation of accuracy of various impression techniques and impression materials in recording multiple implants placed unilaterally in a partially edentulous mandible- An in vitro study
    (2018) Parameshwari, G.; Chittaranjan, B.; Sudhir, N.; Anulekha-Avinash, C.-K.; Taruna, M.; Ramureddy, M.
    Various factors like implant angulation, type of impression material and tray type affects the implant impression accuracy. To date limited in-vitro studies were carried out on the implant impression accuracy of unilateral partially edentulous arches. The aim of this research was to evaluate the effects of 0o, 15o and 25o implant angulations on impression accuracy in simulated master casts of unilateral partially edentulous situation using different impression materials and tray selections. 30 replicas (N = 30) of a resin matrix (control) containing four implant analogues placed unilaterally from the midline till the region of second molar at an angulation of 00, 00, 150 and 250 to the vertical axis of the ridge respectively were obtained by using three impression techniques (stock metal tray, closed custom tray, and open nonsplinted custom tray) and two different impression materials (Polyvinyl-siloxane and polyether). Specific dimensions of the resultant casts were measured using coordinated measuring microscope. Mean linear changes were calculated and statistically analyzed using analysis of variance (ANOVA) and Tukey?s post-hoc procedures (p< 0.05). The casts obtained from all three impression techniques had significant differences in dimensions (p<0.05) as compared to that of master model irrespective of impression materials. Comparing the techniques with regard to the parallel implants, no statistical significant difference (p<0.05) was observed with custom tray techniques (closed/open). Whereas while comparing parallel versus non parallel, open tray technique showed superior accuracy compared to closed tray technique as the angulation increased more than 15 degrees. The influence of material and technique appeared to be significant for highly non axial implant angulations (p< 0.05), and increased angulation tended to decrease impression accuracy. The open tray technique was more accurate with highly nonaxially oriented implants for the small sample size investigated.
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    Effect of cusp coverage and water storage on compressive strength of composite restorations of premolars
    (2018) Emamieh, Shila; Hojati, Parvaneh; Ghasemi, Amir; Torabzadeh, Hasan
    The aim of this study was to assess the effect of cusp coverage and water storage on compressive strength of composite restorations. This in vitro experimental study was conducted on 40 extracted human maxillary premolar teeth, which were randomly divided into four groups of 10. Mesio-occluso-distal (MOD) cavities were prepared in all teeth. The thickness of composite for cusp coverage was 1.5 mm in groups 1 and 3 and 2.5 mm in groups 2 and 4. Compressive strength (CS) was measured after 24 hours in groups 1 and 2 and after six months of water storage in groups 3 and 4. Two-way ANOVA was used to statistically analyze the data. The mean and standard error (SE) of compressive strength was 795.23 ± 35.18N in Group 1, 1232.52 ± 78.01N in Group 2, 617.18 ± 40.19N in Group 3 and 963.22 ± 50.05N in Group 4. Statistical analysis showed a significant difference in compressive strength measured after 24 hours (groups 1 and 3) and after six months of water storage (groups 2 and 4). The compressive strength of groups with 2.5 mm cusp coverage was significantly greater than that of groups with 1.5 mm cusp coverage.
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    Evaluation of the erosive capacity of children?s beverages on primary teeth enamel : an in vitro study
    (2018) Tocolini, Daniel-Gheur; Dalledone, Mariana; Brancher, João Armando; de Souza, Juliana-Feltrin; Gonzaga, Carla Castiglia
    The consumption of acidified beverages, associated with lower mineralization of primary enamel, is the ideal combination for the development and progression of dental erosion. The objective of this study is to analyze the erosive capacity and the surface roughness of primary teeth enamel after exposure to three different brands of grape juices. Forty enamel blocks of primary teeth were obtained, attened and polished. They were submitted to initial surface roughness analysis (baseline), and randomly assigned into four groups (n = 10): NAT: natural grape juice (Campo Largo); IND: industrialized grape juice (Dell Vale Kapo); SOY: soy-based grape juice (Ades); and CONT (control): artificial saliva. Blocks were immersed for 2 min, 3 times per day, for 9 days. During the whole time of the experiment, the enamel blocks were stored in artificial saliva. After the 9 days, the roughness parameters were determined again. The beverages were analyzed for pH and titratable acidity. Data were statistically analyzed (? = 0.05). The surface roughness did not differ significantly among groups (p > 0.05). However, after the immersion in the different grape juices, the surface roughness values increased significantly (p< 0.05). The pH values were weakly correlated to acidity values; NAT showed the highest titratable acidity values than the other juices (p<0.05). Although the surface roughness values of the experimental groups did not differ from the control group, there was a difference in initial and final roughness in all groups. Grape juices, especially natural, may have an erosive capacity, changing the surface roughness of primary dental enamel.
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    Hyoid bone position in different facial skeletal patterns
    (2018) Mortazavi, Samare; Asghari-Moghaddam, Hamed; Dehghani, Mahboobe; Aboutorabzade, Mohammadreza; Yaloodbardan, Banafshe; Tohidi, Elahe; Hoseini-Zarch, Seyed-Hosein
    Hyoid bone plays a significant role in physiological functions of craniofacial region and it?s position adapts to changes of the head. The purpose of this study was to determine the position of the hyoid bone among subjects with class I, class II and class III skeletal patterns and evaluate the gender differences. One hundred and ten lateral cephalograms (59 females and 51 males) from different skeletal patterns (class I, II and III) were selected. The skeletal patterns were determined according to ANB angle. Using MicroDicom software, different linear and angular measurements (6 variables) was carried out to determine the position of hyoid bone. Intraclass correlation coefficient was used to verify reliability. Descriptive statistics of the variables were calculated and analyzed using two-way ANOVA and Bonferroni statistical methods. The mean distance from the hyoid bone (H) to mandibular plane (MP), to palatal plane (PP), as well as to a third cervical vertebra (C3) was more in males than females (p=0.023, p<0.001, p<0.001 respectively). The mean H to PP distance was significantly more in skeletal class I compared to class III (P=0.01). The mean H to C3 distance was significantly more in skeletal class I compared to class II (P=0.008). The mean angle between H-MP and H-PP did not show any statistical difference among three skeletal classes (p=0.102, P=0.213) and among male and female groups (P=0.172, P=0.904). The hyoid bone is positioned more superior and posterior in females than males and its location differs among different skeletal classes. It is placed more posterior in skeletal class II patterns and more inferior and anterior in skeletal class I patterns.
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    Orofacial clinical features in Arnold Chiari type I malformation : a case series
    (2018) Arruda, José A.; Figueiredo, Eugênia; Monteiro, João-Luiz; Barbosa, Livia-Mirelle; Rodrigues, Cleomar; Vasconcelos, Belmiro Cavalcanti
    Arnold Chiari malformation (ACM) is characterized by an anatomical defect at the base of the skull where the cerebellum and the spinal cord herniate through the foramen magnum into the cervical spinal canal. Among the subtypes of the condition, ACM type I (ACM-I) is particularly outstanding because of the severity of symptoms. This study aimed to analyze the orofacial clinical manifestations of patients with ACM-I, and discuss their demographic distribution and clinical features in light of the literature. A case series with patients with ACM-I treated between 2012 and 2015 was described. The sample consisted of patients who were referred by the Department of Neurosurgery to the Oral and Maxillofacial Surgery Service of Hospital da Restauração in Brazil for the assessment of facial symptomatology. A questionnaire was applied to evaluate the presence of painful orofacial findings. Data are reported using descriptive statistical methods. Mean patient age was 39.3 years and the sample consisted mostly of male patients. A high prevalence of headache (50%) and pain in the neck (66.7%) and masticatory muscles (50%) was found. Only one patient reported difficulty in performing mandibular movements and two reported jaw clicking sounds. Mean mouth opening was 40.83 mm. ACM-I patients may exhibit orofacial symptoms which may mimic temporomandibular joint disorders. This study brings interesting information that could help clinicians and oral and maxillofacial surgeons to understand this uncommon condition and also help with the diagnosis of patients with similar physical characteristics by referring them to a neurosurgeon.
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    The effect of incorporating different concentrations of chlorhexidine digluconate on the degree of conversion of an experimental adhesive resin
    (2018) Moharam, Lamiaa M.; Salem, Haidy-Nabil; Elgamily, Hanaa-Mahmoud
    The aim of this study was to evaluate the effect of chlorhexidine digluconate incorporation on the degree of conversion of an experimental adhesive resin. The experimental resin was prepared from 70 wt% bisphenol A glycerolate dimethacrylate, 30 wt% hydroxyethyl methacrylate, silanized SiO2 nanofillers, 0.5% of camphorquinone and ethyl 4-dimethylaminebenzoate (binary photo-initiator system). Five chlorhexidine digluconate concentrations (0, 0.5, 1, 2 and 4 wt%) were then incorporated into the experimental resin. Thirty Potassium Bromide pellets were prepared then divided into six groups (n=5/group), repre¬senting the tested adhesive resins (Single Bond 2, 0, 0.5, 1, 2 and 4 wt% chlohexidine-incorporated experimental adhesive resins), that were applied to the pellets without light-curing (uncured specimens). Another 30 pellets were prepared and treated with the previous materials then light-cured using LED light-curing device (cured specimens). Degree of conversion of the uncured and the cured specimens were evaluated using FTIR analysis. Adper Single Bond 2 showed the highest degree of conversion mean values followed by 0.5 wt% chlorhexidine concentration then 2 wt% followed by 4 wt% then 1 wt% concentrations, while 0 wt% concentration showed the lowest mean values. Chlorhexidine digluconate had slight significant influence on the efficiency of polymerization of the experimental adhesive resin.