Evaluation of the bisphenol released in the saliva after residual adhesive removal in orthodontic patients by using ultrasonic scaling and rotary system: A single-center randomized clinical trial.

INTRODUCTION: Bisphenol A (BPA) is a substance commonly used in dental materials with noxious properties. Monomers of this substance may be dissolved in the saliva and cause adverse effects. This study aimed to evaluate the amount of BPA released in the saliva after residual adhesive removal in orthodontic patients using an ultrasonic scaler (US) and tungsten carbide bur (TCB). METHODS: This single-center randomized clinical trial was conducted on 40 subjects whose stainless-steel brackets were bonded directly with light-cured bonding and composite. The subjects were randomly divided into 2 equal groups (n = 20) of TCB or US according to the adhesive removal method. The salivary BPA level was determined using high-performance liquid chromatography-mass spectrometry. And adhesive cleaning time was measured by a stopwatch. Data were analyzed by SPSS using an independent t test and paired-samples t test (P <0.05). RESULTS: The mean salivary BPA level was significantly lower in the TCB method than in the US method. (1.008 ± 0.061 µg/mL and 2.83 ± 0.24 µg/mL, respectively) (P <0.001). The mean adhesive cleanup time was significantly shorter in the TCB method than in the US method (8.86 ± 0.83 minutes and 13.20±1.02 minutes, respectively) (P <0.001). CONCLUSIONS: According to the results, residual adhesive removal with TCB released less BPA in saliva and shortened the adhesive cleaning time than the US method. TRIAL REGISTRATION: The trial was registered at the Iranian Registry of Clinical Trials (IRCT20200702047988N1). PROTOCOL: The protocol was not published before trial commencement.

On the effect of antiresorptive drugs on the bone remodeling of the mandible after dental implantation: a mathematical model.

Bone remodeling identifies the process of permanent bone change with new bone formation and old bone resorption. Understanding this process is essential in many applications, such as optimizing the treatment of diseases like osteoporosis, maintaining bone density in long-term periods of disuse, or assessing the long-term evolution of the bone surrounding prostheses after implantation. A particular case of study is the bone remodeling process after dental implantation. Despite the overall success of this type of implants, the increasing life expectancy in developed countries has boosted the demand for dental implants in patients with osteoporosis. Although several studies demonstrate a high success rate of dental implants in osteoporotic patients, it is also known that the healing time and the failure rate increase, necessitating the adoption of pharmacological measures to improve bone quality in those patients. However, the general efficacy of these antiresorptive drugs for osteoporotic patients is still controversial, requiring more experimental and clinical studies. In this work, we investigate the effect of different doses of several drugs, used nowadays in osteoporotic patients, on the evolution of bone density after dental implantation. With this aim, we use a pharmacokinetic-pharmacodynamic (PK/PD) mathematical model that includes the effect of antiresorptive drugs on the RANK/RANK-L/OPG pathway, as well as the mechano-chemical coupling with external mechanical loads. This mechano-PK/PD model is then used to analyze the evolution of bone in normal and osteoporotic mandibles after dental implantation with different drug dosages. We show that using antiresorptive agents such as bisphosphonates or denosumab increases bone density and the associated mechanical properties, but at the same time, it also increases bone brittleness. We conclude that, despite the many limitations of these very complex models, the one presented here is capable of predicting qualitatively the evolution of some of the main biological and chemical variables associated with the process of bone remodeling in patients receiving drugs for osteoporosis, so it could be used to optimize dental implant design and coating for osteoporotic patients, as well as the drug dosage protocol for patient-specific treatments.

Finite element comparison of the effect of absorbers' design in the surrounding bone of dental implants.

Despite the high success rate achieved in current dental implantation, there are still important problems to solve like incomplete early osteointegration, bone damage, and long-term implant loosening. Highly compliant stress absorbers are a possible solution to these problems. Although several works examined the stress-strain distribution in bone without and with absorbers to show their favorable results, none of them analyzed their impact on long-term remodeling. Here, we analyze this effect by comparing the evolution of stress and bone mass density without and with different designs of absorbers with those of the healthy tooth. Several finite element models with ABAQUS, corresponding to each design considered, were built to obtain the mechanical conditions in bone and implant. Then a mechanobiological bone remodeling model that considers damage accumulation and its repair during the remodeling process was used to compute the bone density redistribution. This approach allows assessing both the short-term density loss and the relative micromovement between bone and implant. We analyze the stress distributions in both bone and implant as well as the relative micromovement of the implant. We also present the evolution of damage and bone volume fraction. These results show that the addition of absorbers can reduce the stress in the bone around the implant. The obtained results also show that using stress absorbers reduces damage in bone, while increasing the number of absorbers does not necessarily improves damage reduction. We conclude that using implants with a correct design of absorbers prevents damage and stress shielding, reducing implant loosening.

Numerical simulation of hydro-mechanical coupling of periodontal ligament.

Orthodontic tooth movement in the alveolar bone is due to the mechanical response of periodontal ligament to applied forces. Definition of a proper constitutive model of the periodontal ligament to investigate its response to orthodontic loading is required. For this purpose, a three-dimensional finite element model of incisor tooth, periodontal ligament, and bone was built utilizing the hydro-mechanical coupling theory. Tooth displacement in response to orthodontic loading was then investigated, and the effect of different mechanical behaviors assigned to the solid phase of the periodontal ligament was compared. Results showed that where the periodontal ligament was placed in tension, pore volume was filled with fluid intake from the bone, but fluid flow direction was from the periodontal ligament toward the bone where the periodontal ligament was placed in compression. Because of the existence of interaction between solid and fluid phases of the periodontal ligament, considering biphasic material formulation was capable to address its microscopic behavior as well as time-dependent and large deformation behaviors. This article provides beneficial biomechanical data for future dental studies in determination of optimal orthodontic force.

Assessment of Factors Affecting Adolescent Patients' Compliance with Hawley and Vacuum Formed Retainers.

INTRODUCTION: Success of orthodontic retention with removable retainers almost entirely depends on patients' compliance. AIM: This study was carried out to investigate the relationship between adolescent orthodontic patients' compliance and various clinical and social factors. MATERIALS AND METHODS: The data were collected from 77 orthodontic patients aged 7-11 years old who had finished the full fixed appliance therapy. Hawley's retainers were used in 34 patients and 43 patients used Vacuum Formed Retainers (VFRs). The subjects completed a questionnaire including several identifiers allowing the respondents to be classified into subgroups. They were also asked to indicate how long they wore their retainers during the day, by writing the number of hours in the report-card for the next three months. Comparison of the results was performed by one-way ANOVA and independent sample-t tests. RESULTS: No significant differences were found between males and females. Type of the retainer, patients' grade of study, mothers' occupation, clinicians' and parents' attitudes and filling the report cards had significant effect on mean wear hours per day. When compliance of the patients was assessed according to treatment location, Living place, parents' educational degrees and ethnicity, no significant differences could be found. CONCLUSION: The adolescent patients' compliance was greater with VFRs than with Hawley's retainers. Parental attitude and doctor-patient relationship had a great impact on adolescent patients' compliance.

Shear bond strength and debonding characteristics of metal and ceramic brackets bonded with conventional acid-etch and self-etch primer systems: An in-vivo study.

BACKGROUND: Different in-vitro studies have reported various results regarding shear bond strength (SBS) of orthodontic brackets when SEP technique is compared to conventional system. This in-vivo study was designed to compare the effect of conventional acid-etching and self-etching primer adhesive (SEP) systems on SBS and debonding characteristics of metal and ceramic orthodontic brackets. MATERIAL AND METHODS: 120 intact first maxillary and mandibular premolars of 30 orthodontic patients were selected and bonded with metal and ceramic brackets using conventional acid-etch or self-etch primer system. The bonded brackets were incorporated into the wire during the study period to simulate the real orthodontic treatment condition. The teeth were extracted and debonded after 30 days. The SBS, debonding characteristics and adhesive remnant indices (ARI) were determined in all groups. RESULTS: The mean SBS of metal brackets was 10.63±1.42 MPa in conventional and 9.38±1.53 MPa in SEP system, (P=0.004). No statistically significant difference was noted between conventional and SEP systems in ceramic brackets. The frequency of 1, 2 and 3 ARI scores and debonding within the adhesive were the most common among all groups. No statistically significant difference was observed regarding ARI or failure mode of debonded specimens in different brackets or bonding systems. CONCLUSIONS: The SBS of metal brackets bonded using conventional system was significantly higher than SEP system, although the SBS of SEP system was clinically acceptable. No significant difference was found between conventional and SEP systems used with ceramic brackets. Total SBS of metal brackets was significantly higher than ceramic brackets. Due to adequate SBS of SEP system in bonding the metal brackets, it can be used as an alternative for conventional system. KEY WORDS: Shear bond strength, Orthodontic brackets, Adhesive remnant index, self-etch.

Effect of surface treatment on stress distribution in immediately loaded dental implants--a 3D finite element analysis.

OBJECTIVE: To investigate, by means of FE analysis, the effect of surface roughness treatments on the distribution of stresses at the bone-implant interface in immediately loaded mandibular implants. MATERIALS AND METHODS: An accurate, high resolution, digital replica model of bone structure (cortical and trabecular components) supporting an implant was created using CT scan data and image processing software (Mimics 13.1; Materialize, Leuven, Belgium). An anatomically accurate 3D model of a mandibular-implant complex was created using a professional 3D-CAD modeller (SolidWorks, DassaultSystèmes Solid Works Corp; 2011). Finite element models were created with one of the four roughness treatments on the implant fixture surface. Of these, three were surface treated to create a uniform coating determined by the coefficient of friction (µ); these were either (1) plasma sprayed or porous-beaded (µ=1.0), (2) sandblasted (µ=0.68) or (3) polished (µ=0.4). The fourth implant had a novel two-part surface roughness consisting of a coronal polished component (µ=0.4) interfacing with the cortical bone, and a body plasma treated surface component (µ=1) interfacing with the trabecular bone. Finite element stress analysis was carried out under vertical and lateral forces. RESULTS: This investigation showed that the type of surface treatment on the implant fixture affects the stress at the bone-implant interface of an immediately loaded implant complex. Von Mises stress data showed that the two-part surface treatment created the better stress distribution at the implant-bone interface. SIGNIFICANCE: The results from this FE computational analysis suggest that the proposed two-part surface treatment for IL implants creates lower stresses than single uniform treatments at the bone-implant interface, which might decrease peri-implant bone loss. Future investigations should focus on mechanical and clinical validation of these FE results.

Fracture strength of machined ceramic crowns as a function of tooth preparation design and the elastic modulus of the cement.

OBJECTIVES: To determine, by means of static fracture testing the effect of the tooth preparation design and the elastic modulus of the cement on the structural integrity of the cemented machined ceramic crown-tooth complex. METHODS: Human maxillary extracted premolar teeth were prepared for all-ceramic crowns using two preparation designs; a standard preparation in accordance with established protocols and a novel design with a flat occlusal design. All-ceramic feldspathic (Vita MK II) crowns were milled for all the preparations using a CAD/CAM system (CEREC-3). The machined all-ceramic crowns were resin bonded to the tooth structure using one of three cements with different elastic moduli: Super-Bond C&B, Rely X Unicem and Panavia F 2.0. The specimens were subjected to compressive force through a 4mm diameter steel ball at a crosshead speed of 1mm/min using a universal test machine (Loyds Instrument Model LRX.). The load at the fracture point was recorded for each specimen in Newtons (N). These values were compared to a control group of unprepared/unrestored teeth. RESULTS: There was a significant difference between the control group, with higher fracture strength, and the cemented samples regardless of the occlusal design and the type of resin cement. There was no significant difference in mean fracture load between the two designs of occlusal preparation using Super-Bond C&B. For the Rely X Unicem and Panavia F 2.0 cements, the proposed preparation design with a flat occlusal morphology provides a system with increased fracture strength. SIGNIFICANCE: The proposed novel flat design showed less dependency on the resin cement selection in relation to the fracture strength of the restored tooth. The choice of the cement resin, with respect to its modulus of elasticity, is more important in the anatomic design than in the flat design.

Effect of the crown design and interface lute parameters on the stress-state of a machined crown-tooth system: a finite element analysis.

The effect of preparation design and the physical properties of the interface lute on the restored machined ceramic crown-tooth complex are poorly understood. The aim of this work was to determine, by means of three-dimensional finite element analysis (3D FEA) the effect of the tooth preparation design and the elastic modulus of the cement on the stress state of the cemented machined ceramic crown-tooth complex. The three-dimensional structure of human premolar teeth, restored with adhesively cemented machined ceramic crowns, was digitized with a micro-CT scanner. An accurate, high resolution, digital replica model of a restored tooth was created. Two preparation designs, with different occlusal morphologies, were modeled with cements of 3 different elastic moduli. Interactive medical image processing software (mimics and professional CAD modeling software) was used to create sophisticated digital models that included the supporting structures; periodontal ligament and alveolar bone. The generated models were imported into an FEA software program (hypermesh version 10.0, Altair Engineering Inc.) with all degrees of freedom constrained at the outer surface of the supporting cortical bone of the crown-tooth complex. Five different elastic moduli values were given to the adhesive cement interface 1.8GPa, 4GPa, 8GPa, 18.3GPa and 40GPa; the four lower values are representative of currently used cementing lutes and 40GPa is set as an extreme high value. The stress distribution under simulated applied loads was determined. The preparation design demonstrated an effect on the stress state of the restored tooth system. The cement elastic modulus affected the stress state in the cement and dentin structures but not in the crown, the pulp, the periodontal ligament or the cancellous and cortical bone. The results of this study suggest that both the choice of the preparation design and the cement elastic modulus can affect the stress state within the restored crown-tooth complex.

The effect of oral contraceptives on orthodontic tooth movement in rat.

INTRODUCTION: The purpose of this study was to investigate the effect of ethinyl estradiol/norgestrel - used in some oral contraceptives- on orthodontic tooth movement in Wistar rats. MATERIAL AND METHODS: Forty eight female three-month old Wistar rats with an average weight of 250 ± 25 gr were divided into two experimental and control groups. One week prior to appliance insertion and during the appliance therapy period, 100 mcg/kg/day of ethinyl estradiol and 1 mg/kg/days of norgestrel were administered to the experimental group by gavage; meanwhile the control group received an equivalent volume of Sodium Chloride 0.9 % (Saline). Maxillary central incisors were tipped distally by insertion of springs exerting 30 g force. Two, seven and fourteen days after spring insertion animals were sacrificed. The mesioincisal distance between maxillary incisors were measured. Subsequently, histological sections were prepared for histomorphometric studies. RESULTS: 14 days after force application the orthodontic tooth movement was significantly lower in the experimental group (p<0.05). The number of osteoclasts were significantly lower in the experimental group 2, 7 and 14 days after spring insertion (p<0.05). CONCLUSION: Ethinyl estradiol/norgestrel (oral contraceptives) can significantly decrease the amount of tooth movement in the linear phase.

The effect of pregnancy on orthodontic tooth movement in rats.

INTRODUCTION: The purpose of this study was to investigate the effect of pregnancy on orthodontic tooth movement in Wistar rats. MATERIAL AND METHODS: Forty eight female three-month old Wistar rats with an average weight of 250 ± 25 gr were selected and randomly divided into two experimental (pregnant) and control groups (non-pregnant). Maxillary central incisors were tipped distally by insertion of springs exerting 30 g force. Two, seven and fourteen days after spring insertion animals were sacrificed. Then the mesioincisal distance between maxillary incisors were measured. Subsequently, histological sections were prepared to count osteoclasts under a light microscope. The data on the extent of orthodontic tooth movement, and the number of osteoclasts were analyzed by independent sample t-test. RESULTS: The results indicated that 2,7 and 14 days after force application there was no significant difference in orthodontic tooth movement between experimental and control groups (p>0.05). The number of osteoclasts were significantly lower in the experimental group 7 and 14 days after spring insertion (p<0.05). CONCLUSION: Pregnancy may decrease the amount of tooth movement in the linear phase but it is not statistically significant. The number of osteoclasts is significantly decreased during pregnancy.

Effect of self-etching primer/adhesive and conventional bonding on the shear bond strength in metallic and ceramic brackets.

INTRODUCTION: Bracket debonding from the tooth surface is a common problem in fixed orthodontics. The aims of the present study were to assess the bond strength and failure sites in two ways of bonding technique, with metallic and ceramic brackets. MATERIALS AND METHODS: One hundred premolars were assigned to 4 groups of 25 each: Group A, metallic brackets/conventional procedure; Group B, metallic brackets/Transbond XT; Group C, ceramic brackets/conventional procedure; and Group D, ceramic brackets/Transbond XT. Transbond XT composite paste was used for bracket bonding and cured by conventional light-cure device. Specimens were subjected to thermocycling. One week after bonding shearing force was applied to the bracket-tooth interface. Bonding failure site optically examined using a stereomicroscope under 10 × magnifications and scoring was done using the adhesive remnant index (ARI). Data were subjected to analysis of One-way variance, Tukey post hoc, Chi-square and Spearman's tests. RESULTS: Mean bond strength (in MPa) were: group A=9.2, group B=8.5, group C=6.2 and group D=5.7. Bond strength differences between groups A and B, and between C and D were not significant, (p<0.0005). Insignificant difference found in ARI in all groups. CONCLUSION: The bond strengths of metallic brackets were significantly higher than ceramic ones and the self-etching primer produce fewer bonds than the conventional method (clinically acceptable).A positive correlation found between changes in shearing bond strength and ARI.

Effect of psychological stress on orthodontic tooth movement in rats.

INTRODUCTION: The purpose of this study was to investigate the effect of psychological stress on orthodontic tooth movement in Wistar rats. MATERIALS AND METHODS: Forty-eight female ten-week old Wistar rats with an average weight of 188 ±12 gr were selected and randomly divided into two experimental and control groups. The experimental group received crowded environment-induced and cat odour stresses 4 weeks before spring insertion. On the 29th day in both groups, maxillary incisors were moved by the insertion of springs and exactly after 7 days, 9 rats from each group and after 14 days the remaining rats were sacrificed. Then the mesioincisal distance between maxillary incisors was measured. Afterwards, histological sections were prepared to count osteoclasts under a light microscope. The data on the extent of orthodontic tooth movement and the number of osteoclasts were analyzed by independent sample t-test. RESULTS: The results indicated that on the 7th day after spring placement the orthodontic tooth movement was significantly higher in the control group compared to the experimental group (p<0.05). The number of osteoclasts at a significance level of α=0.1 in the control group was higher compared to the experimental group. On the 14th day after spring placement, the orthodontic tooth movement in the control group was significantly higher compared to the experimental group (p<0.05). However, there were no significant differences in the number of osteoclasts between the two groups. The rats experienced weight loss in the experimental group (p<0.05). CONCLUSIONS: Psychological stress led to a decrease in orthodontic tooth movement and in the number of osteoclasts around the root in the movement direction in rats, but a decrease in osteoclast counts was not parallel with time and demonstrated a nonlinear pattern. In addition, psychological stress led to weight loss in rats.

Determining tooth size ratio in an Iranian-Azari population.

AIM: The aim of this investigation was to determine the tooth size ratio in an Iranian-Azari population. METHOD AND MATERIALS: The Bolton tooth size analysis was performed on a sample of 50 plaster models (25 male subjects, 25 female subjects) of Iranian-Azari subjects. The mesiodistal widths of all teeth were obtained and the Bolton anterior ratio and overall ratio were calculated. The mean, range, and standard deviation were calculated for the anterior and overall ratio, and a coefficient of variation was obtained for the tooth size ratio. RESULTS: For the anterior ratio (3-3), the Iranian-Azari had a mean of 78.0 mm with a standard deviation of 3.1; the range was 73.68 to 84.6 mm. For the overall ratio (6-6), the mean was 92.0 mm with a standard deviation of 2.4; the range was 88.09 to 97.5 mm. CONCLUSIONS: The results from the Iranian-Azari subjects in the study are similar to Bolton's original data for an American population. These values and the degree of variation were similar to the original data by Bolton, indicating the Bolton analysis for Caucasian samples can be transferred to an Iranian-Azari population. It also confirms no relevant sexual dimorphism exists, and these values are valid for both male and female subjects.

The effect of marginal ridge thickness on the fracture resistance of endodontically-treated, composite restored maxillary premolars.

This study evaluated the effect of varying thicknesses of marginal ridge on the fracture resistance of endodontically-treated maxillary premolars restored with composite. Ninety non-carious maxillary premolars, extracted for orthodontic reasons, were selected for this experimental in vitro study. The teeth were randomly assigned to six groups (n=15). Group 1 received no preparation. In groups 2 through 6, the premolars were root filled and DO preparations were created, while MOD preparations were also created for group 2. The condition of the boxes was: the gingival seat was 1.5 mm above the CEJ and the buccolingual dimensions were 3.5 mm in gingival and 3 mm in occlusal. In groups 3 through 6, the dimensions of the mesial marginal ridge were measured using a digital caliper as follows: 2 mm, 1.5 mm, 1 mm and 0.5 mm, respectively. All samples in groups 2 through 6 were restored with a dentin bonding system (DBS: Single Bond, 3M) and resin composite (Z 250, 3M). Subsequently, premolars from all six groups were subjected to a thermocycling regimen of 500 cycles between 5 degrees C and 55oC water baths. Dwell time was 30 seconds, with a 10-second transfer time between baths. The premolars were submitted to axial compression up to failure at a 45 degrees angle to the palatal cusp in Universal Test Equipment (Tinius Olsen, Ltd, H5K-S model). The mean load necessary to fracture the samples was recorded in newtons (N), and data were subjected to analysis of variance (ANOVA) and LSD post-hoc test. According to these results, the mean loads necessary to fracture the samples in each group were (in N): group 1: 732 +/- 239, group 2:489 +/- 149, group 3: 723 +/- 147, group 4: 696 +/- 118, group 5: 654 +/- 183 and group 6: 506 +/- 192). Differences between group 1 and groups 2 and 6, and also differences between groups 3, 4 and 5 compared with group 2 and 6 were statistically significant (p < 0.05).