The Association of Early Childhood Caries with Salivary Antimicrobial Peptide LL37 and Mutans Streptococci.

PURPOSE: This study aims to determine the relation of salivary LL37 level and mutans streptococci levels in early childhood caries (ECC). STUDY DESIGN: A case-control study was performed in children ≤71 months old. Unstimulated whole saliva was collected and the level of salivary LL37 was measured using an enzyme-linked immunosorbent assay kit. The mutans streptococci oral bacteria were isolated from saliva and identified using a modified SB-20 culture medium (SB-20M). Data were analyzed using descriptive statistics, bivariate, and Spearman's rank correlation analysis. RESULTS: The was a variability of salivary LL37 level among the children and the level was significantly associated with age and races. The median (IQR) value of salivary LL37 in caries-free (CF) children was significantly higher 393.50 (580.55) ng/mL compared to 172.50 (234.65) ng/mL in the ECC group. The ECC children exhibited a significantly higher count of S. mutans and S. sobrinus compared to the CF children. An inverse weak correlation between salivary LL37 and dmft was also observed. CONCLUSIONS: The low salivary LL37 level and higher S. mutans and S. sobrinus count in ECC supported the protective role of salivary LL37 against dental caries. Further studies are required to explore the definite relation between salivary LL37 levels and dental caries.

Serum and Saliva 25(OH)D Levels in Relation to Dental Caries in Young Children.

OBJECTIVE: Several studies have reported that low levels of vitamin D (25(OH)D) are associated with an increased risk of dental caries and that optimal levels may offer protection This study aimed to assess the relationship between serum and saliva 25(OH)D levels and caries among young children. STUDY DESIGN: A total of 120 healthy children were recruited; 93 with caries and 27 caries-free. Dental caries status was evaluated using decayed, missing and filled in primary teeth (dmft) index. Blood and unstimulated whole saliva samples were collected. Laboratory analysis was performed using Enzyme-Linked Immunosorbent Assay Kit. Data were analyzed with descriptive statistics, bivariate and Spearman's rank correlation analysis. RESULTS: There were no significant associations between serum and saliva 25(OH)D levels and caries status (P > 0.05). Levels of 25(OH)D in serum were significantly higher than levels found in saliva (P < 0.05), and a correlation between serum and saliva 25(OH)D levels was observed (P < 0.05). CONCLUSIONS: The association between serum and saliva 25(OH)D and dental caries in young children was inconclusive. However, a positive and significant correlation was observed between serum and saliva 25(OH)D levels. Further studies are warranted to investigate the definite relation between 25(OH)D levels and dental caries and using saliva 25(OH)D as a non-invasive alternative method over blood samples.

Dental caries and vitamin D status in children in Asia.

Dental caries and vitamin D inadequacy are known to affect children worldwide. Vitamin D has a vital role in tooth formation. There is growing evidence linking suboptimal serum vitamin D level with dental caries in children. This paper reviews the literature on both the prevalence of dental caries and of vitamin D deficiency in children in four Asian regions, discusses their associated risk factors, and reviews the global evidence on the association between dental caries and vitamin D in children. Caries prevalence in children ranged from 40% to 97% in Eastern Asia, 38-73.7% in Southern Asia, and 26.5-74.7% in Western Asian countries. Moreover, a higher prevalence of vitamin D deficiency in Asian children was identified, even in countries in equatorial regions, ranging from 2.8% to 65.3% in Eastern Asia, 5-66.7% in Southern Asia, 4-45.5% in Western Asia and 38.1-78.7% in Central Asian countries. Obesity, age, female gender, higher latitude, season, darker skin pigmentation, sunlight protection behaviors, less sunlight exposure and low intake of food containing vitamin D were important factors associated with lower serum vitamin D in Asia. Suboptimal vitamin D level in children may be a significant risk factor for dental caries, and requires further research to ascertain such an association in children in Asia, as well as to understand its exact influence on caries risk and development.

Efficacy of bisphosphonate as an adjunct to nonsurgical periodontal therapy in the management of periodontal disease: a systematic review.

AIMS: The aim of this systematic review was to assess the efficacy of bisphosphonate therapy as an adjunct to scaling and root planing (SRP) in the management of periodontitis. METHODS: Databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) were searched up to and including July 2016. The primary outcome was probing depth (PD), and the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. The mean differences (MD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. RESULTS: Eight clinical studies were included. Seven studies used alendronate as an adjunct to SRP; of these, four studies used topical application and three used oral alendronate. Considering the effects of adjunctive bisphosphonates as compared to SRP alone, a high degree of heterogeneity for PD (Q value = 39.6, P < 0.0001, I2  = 87.38%), CAL (Q value = 13.65, P = 0.008, I2  = 70.71%), and BD fill (Q value = 53.26, P < 0.0001, I2  = 92.49%) was noticed among both the groups. Meta-analysis showed a statistically significant PD reduction (MD = -1.18, 95% CI = -1.91 to -0.44, P = 0.002), CAL gain (MD = -0.69, 95% CI = -1.20 to -0.18, P = 0.008) and BD fill (MD = -2.36, 95% CI = -3.64 to -1.08, P < 0.001) for SRP + bisphosphonate treatment vs. SRP alone. CONCLUSIONS: Adjunctive bisphosphonate therapy appears to be effective in managing periodontitis, however, due to the potential risk of osteonecrosis of the jaws and short-term follow-up of the studies, their clinical application is debatable.

Crestal bone loss and periimplant inflammatory parameters around zirconia implants: A systematic review.

STATEMENT OF PROBLEM: Zirconia implants have been used for oral rehabilitation; however, evidence of their ability to maintain crestal bone and periimplant soft tissue health is not clear. PURPOSE: The purpose of this systematic review was to evaluate crestal bone loss (CBL) around zirconia dental implants and clinical periimplant inflammatory parameters. MATERIAL AND METHODS: The focus question addressed was, "Do zirconia implants maintain crestal bone levels and periimplant soft tissue health?" Databases were searched for articles from 1977 through September 2014 with different combinations of the following MeSH terms: "dental implants," "zirconium," "alveolar bone loss," "periodontal attachment loss," "periodontal pocket," "periodontal index." Letters to the editor, case reports, commentaries, review articles, and articles published in languages other than English were excluded. RESULTS: Thirteen clinical studies were included. In 8 of the studies, the CBL around zirconia implants was comparable between baseline and follow-up. In the other 5 studies, the CBL around zirconia implants was significantly higher at follow-up. Among the studies that used titanium implants as controls, 2 studies showed significantly higher CBL around zirconia implants, and in 1 study, the CBL around zirconia and titanium implants was comparable. The reported implant survival rates for zirconia implants ranged between 67.6% and 100%. Eleven studies selectively reported the periimplant inflammatory parameters. CONCLUSIONS: Because of the variations in study design and methodology, it was difficult to reach a consensus regarding the efficacy of zirconia implants in maintaining crestal bone levels and periimplant soft tissue health.

Efficacy of mechanical debridement with adjunct antimicrobial photodynamic therapy for the management of peri-implant diseases: a systematic review.

The aim was to assess whether or not mechanical debridement with adjunct antimicrobial photodynamic therapy (aPDT) is effective for the management of peri-implant diseases. The addressed focused question was "Is mechanical debridement with adjunct aPDT more effective in treating peri-implant diseases as compared to when mechanical debridement is used alone?" PubMed/MEDLINE and Google-Scholar databases were searched from 1994 till April 2014 using different combinations of the following keywords: antimicrobial photodynamic therapy; bone loss; light activated disinfection; mechanical debridement; and peri-implant diseases. Review articles, case-reports, commentaries, letters to the editor, unpublished articles and articles published in languages other than English were excluded. Twelve studies (six clinical and six experimental) were included. In the clinical and experimental studies, 15-80 implants and 18-150 implants respectively were used. Laser wavelengths, duration of irradiation and power output ranged between 625 nm-830 nm, 10 s-300 s, and 30 mW-200 mW, respectively. Four studies reported mechanical debridement with adjunct aPDT to be effective in the treatment of peri-implant diseases; however, the benefits of aPDT were comparable with conventional treatments. Two studies reported aPDT to reduce bacteria more than when the laser and the photosensitizer were applied alone. In two studies, chemical disinfection and aPDT showed comparable outcomes in terms of bacterial disinfection. In two experimental studies, aPDT was shown to improve bone to implant contact and re-osseointegration. Efficacy of mechanical debridement with adjunct aPDT for the management of peri-implant diseases remains debatable.

Antibacterial effectiveness of different zinc salts on Streptococcus mutans and Streptococcus sobrinus: An in-vitro study.

Objectives: This in-vitro study aimed to evaluate the antibacterial effects of four zinc salts namely zinc chloride, zinc sulfate, zinc citrate and zinc acetate against Streptococcus mutans (S. mutans) and Streptococcus sobrinus (S. sobrinus). Methods: Antibacterial susceptibility assay, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were undertaken to evaluate the inhibitory activities of different zinc salts against the tested bacteria. A scanning electron microscope (SEM) was used to evaluate the morphological changes of bacterial cells following exposure to zinc salts. Kruskal-Wallis and Mann-Whitney tests were used to compare the inhibitory effect of the different zinc salts. Results: All zinc salts tested against S. mutans and S. sobrinus had a statistically and significantly smaller inhibition zone when compared to chlorhexidine, (P < 0.001). However, zinc chloride had the largest inhibition zone (20 mm ± 5.5) against S. sobrinus, which was comparable to chlorhexidine (22 mm ± 4) (P > 0.05). Zinc chloride, zinc sulfate and zinc acetate demonstrated higher MIC and MBC values against S. mutans compared to S. sobrinus. However, zinc citrate revealed the highest MIC and MBC values of 1 mg/mL and > 8 mg/mL for S. sobrinus and > 8 mg/mL for S. mutans, respectively. Conclusion: Different zinc salts have displayed inhibitory growth effects against the common oral bacteria at very low concentrations except for zinc citrate which showed no inhibitory effect against these bacteria in vitro.

The antibacterial effects of vitamin D3 against mutans streptococci: an in vitro study.

PURPOSE: This study aims to evaluate the antimicrobial effects of the cholecalciferol vitamin D3 against Streptococcus sobrinus (Strep. sobrinus) and Streptococcus mutans (Strep. mutans) bacteria in vitro that is considered the main causative bacteria in dental caries development. MATERIALS AND METHODS: The antimicrobial effects of vitamin D3 were evaluated against Strep. sobrinus and Strep mutans using the agar disc diffusion method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of vitamin D3 were determined using a microdilution method following the guidelines by the Clinical Laboratory Standards Institute (CLSI). Scanning electron microscope (SEM) was used to evaluate the morphological changes of bacterial cells following exposure to vitamin D3. RESULTS: Strep. sobrinus was more sensitive to vitamin D3 compared to Strep. mutans bacteria. The MIC values of vitamin D3 against Strep. sobrinus and Strep. mutans were 60 µg/ mL and 250 µg/mL respectively whereas the MBC values were 120 µg/mL and 500 µg/mL, respectively. Moreover, significant changes in the bacterial morphology were observed in treated bacterial cells with vitamin D3 as compared to the untreated control bacteria using SEM. CONCLUSION: These findings suggested that vitamin D3 has excellent antimicrobial effects against Strep. sobrinus and Strep. mutans and may be considered as a promising compound in the prevention of dental caries in the future. Further research is recommended to elucidate the mechanism of vitamin D3 on these bacteria.

Evaluation of bone healing following immediate and delayed dental implant placement.

AIM: The purpose of this study was to compare bone healing and coronal bone remodeling following both immediate and delayed placement of titanium dental implants in extraction sockets. METHODS AND MATERIALS: The study included 49 patients (28 women, 21 men) in need of implant treatment in the anterior teeth region of either the maxilla or mandible. Twenty-three subjects received 37 immediate (Im) implants and 26 subjects received 37 delayed (De) implants. The implants were placed immediately in the alveoli following the extraction in the Im group and the implants in the De group were placed approximately six months following the extractions. The width and depth of the marginal bone defects mesial and distal to the implants were evaluated radiographically using computer software designed to measure distances in digitized radiographs. The mean reduction of bone defect over time was 48% (from 3.4 to 1.3 mm) in the Im group which was statistically significant (P <0.05) when tested using a sample t-test, while the mean reduction was 17% (from 2.1 to 1.9 mm) in the De group. CONCLUSION: The potential exists for bone healing and remodeling in fresh extraction socket defects associated with immediately placed implants. CLINICAL SIGNIFICANCE: Im implantation offers the advantages of reduced operating time and the preservation of alveolar bone volume.

Hardness, flexural strength, and flexural modulus comparisons of three differently cured denture base systems.

PURPOSE: This study compared the surface hardness, flexural strength, and flexural modulus of a light- and heat-cured urethane dimethacrylate (UDMA) to two conventional polymethyl methacrylate (PMMA) denture base resins. The effect of less-than-optimal processing condition on the hardness of internal and external surfaces of UDMA specimens was also investigated. MATERIALS AND METHODS: The materials tested were Eclipse (light- and heat-cured UDMA), Meliodent (heat-cured PMMA), and Probase Cold (auto-cured PMMA). Eclipse specimens were prepared by adapting the material onto the master cast and light curing in the processing unit for 10 minutes. Meliodent and Probase Cold specimens were prepared according to the manufacturers' instructions. Twenty rectangular specimens measuring 65 x 10 x 2.5 mm(3) were prepared for each material. They were stored in water at 37 degrees C for 30 days before testing. The surface hardness was measured using Vickers Hardness (VHN) test, and flexural strength and flexural modulus were measured using a 3-point bending test. Twenty-five additional Eclipse specimens were similarly prepared and were processed at various times of less than 20 minutes of curing. Vickers Hardness was determined on both the external and internal surfaces of specimens. Data were analyzed using a one-way ANOVA for comparisons of hardness, flexural strength, and flexural modulus between the three denture base materials and for hardness values of both the internal and external surface of Eclipse specimens with curing times. Post hoc analyses (Scheffé test) determined the difference between the groups. Student t-test was used for comparison of hardness between the external and internal surfaces of Eclipse specimens. RESULTS: The hardness (VHN) values were 19.4 +/- 0.7, 17.0 +/- 0.4, and 16.0 +/- 0.4; the flexural strengths (MPa) were 103 +/- 4, 78 +/- 3, and 63 +/- 4; and the flexural moduli (MPa) were 2498 +/- 143, 1969 +/- 55, and 1832 +/- 89 for Eclipse, Meliodent, and Probase Cold materials, respectively. A comparison among the three polymers showed there were significant differences in surface hardness, flexural strength, and flexural modulus (p < 0.05). No significant difference in surface hardness (VHN) between the internal (19.1 +/- 0.6 to 19.4 +/- 0.7) and external surfaces (18.9 +/- 0.4 to 19.2 +/- 0.6) of irradiated Eclipse specimens was observed at 10-, 12-, and 14-minute polymerization times. CONCLUSION: The surface hardness, flexural strength, and flexural modulus of light- and heat-cured UDMA (Eclipse) were significantly higher than the values obtained for heat-only cured (Meliodent) and auto-cured (Probase Cold) PMMA denture base systems.

A systematic review on antibacterial activity of zinc against Streptococcus mutans.

OBJECTIVES: The aim of this study was to systematically review the growth inhibition effectiveness of zinc against Streptococcus mutans. The main question was, "Does the zinc inhibit the growth of oral Streptococcus mutans in vitro? METHODS: Literature search on PubMed, Medline, and science direct databases was carried out for in vitro studies published in English from 1990 to 2016, and the reported outcomes of minimum inhibitory concentration (MIC), minimum bactericidal concentrations (MBC), zone of inhibition (ZOI) and bacterial count method using colony forming unit (CFU) were used to assess the antibacterial effectiveness of zinc. RESULTS: Seventeen studies were included in this review. Seven studies reported MIC and MBC. Four studies reported ZOI, and eight studies reported CFU. MIC values using zinc chloride and zinc oxide nanoparticles were ranged from 0.025 to 0.2 mM and 0.390 to 500 ±â€¯306.18 µg/ml respectively. MBC values using zinc oxide nanoparticles have ranged from 3.125 to 500 µg/ml. ZOI ranged from no inhibition zone to 21 ±â€¯1.4 mm using 23.1% zinc oxide. A considerable reduction in the bacterial count was reported after adding zinc. However, only two studies have reported no inhibitory effect of zinc. CONCLUSION: This review indicated a significant growth inhibition effectiveness of zinc even at lower concentrations which indicate it's safely to be used in oral health products.

3D TECA hydrogel reduces cellular senescence and enhances fibroblasts migration in wound healing.

This study was designed to investigate the effect of 3D TECA hydrogel on the inflammatory-induced senescence marker, and to assess the influence of the gel on the periodontal ligament fibroblasts (PDLFs) migration in wound healing in vitro. PDLFs were cultured with 20 ng/ml TNF-α to induce inflammation in the presence and absence of 50 µM 3D TECA gel for 14 d. The gel effect on the senescence maker secretory associated-ß-galactosidase (SA-ß-gal) activity was measured by a histochemical staining. Chromatin condensation and DNA synthesis of the cells were assessed by 4',6-diamidino-2-phenylindole and 5-ethynyl-2'-deoxyuridine fluorescent staining respectively. For evaluating fibroblasts migration, scratch wound healing assay and Pro-Plus Imaging software were used. The activity of senescence marker, SA-ß-gal, was positive in the samples with TNF-α-induced inflammation. SA-ß-gal percentage is suppressed (>65%, P < 0.05) in the treated cells with TECA gel as compared to the non-treated cells. Chromatin foci were obvious in the non-treated samples. DNA synthesis was markedly recognized by the fluorescent staining in the treated compared to non-treated cultures. Scratch wound test indicated that the cells migration rate was significantly higher (14.9 µm2/h, P < 0.05) in the treated versus (11 µm2/h) for control PDLFs. The new formula of 3D TECA suppresses the inflammatory-mediated cellular senescence and enhanced fibroblasts proliferation and migration. Therefore, 3D TECA may be used as an adjunct to accelerate repair and healing of periodontal tissues.

Cytokine Profile in Chronic Periodontitis Patients with and without Obesity: A Systematic Review and Meta-Analysis.

To investigate the cytokine profile as biomarkers in the gingival crevicular fluid (GCF) of chronic periodontitis (CP) patients with and without obesity, MEDLINE/PubMed, EMBASE, ScienceDirect, and SCOPUS databases were combined with handsearching of articles published from 1977 up to May 2016 using relevant MeSH terms. Meta-analyses were conducted separately for each of the cytokines: resistin, adiponectin, TNF-α, leptin, IL-6, IL-8, and IL-1ß. Forest plots were produced reporting standardized mean difference of outcomes and 95% confidence intervals. Eleven studies were included. Three studies showed comparable levels of leptin among obese and nonobese patients with CP. Four studies reported comparable levels of interleukin- (IL-) 6 and resistin whereas five studies reported comparable levels of adiponectin. Two studies reported similar levels of CRP in patients with periodontitis with and without obesity. One study showed higher levels of tumor necrosis factor-alpha in obese patients with CP. One study showed higher levels of IL-1ß and IL-8 in obese patients with CP. The level of localized periodontal inflammation may have a greater influence on the GCF proinflammatory biomarker levels as compared to systemic obesity. Whether patients having chronic periodontitis with obesity have elevated proinflammatory GCF biomarkers levels compared to nonobese individuals remains debatable.

Effect of Andrographis paniculata leaf extract on wound healing in rats.

This work was carried out to study the effect of topical application of Andrographis paniculata on the rate of wound enclosure and its histological features. A wound was created in four groups of rat in posterior neck region. Blank placebo was applied topically to the wounds of Group 1. Groups 2 and 3 were dressed with placebo containing 5% and 10% extracts of A. paniculata, respectively. Intrasite gel was applied topically to the wounds of Group 4. Macroscopical examination revealed that the rate of wound healing was significantly accelerated in the wound dressed with A. paniculata extract compared to the blank placebo. The wounds dressed with 10% extract or Intrasite gel healed earlier compared to the wounds dressed with placebo containing 5% A. paniculata extract. Histologically, wounds dressed with A. paniculata extracts showed markedly less scar width and contained large amounts of fibroblast proliferation. More collagen and less angiogenesis with absence of inflammatory cells were seen for wounds dressed with 10% A. paniculata compared to the blank placebo. Conclusion, A. paniculata extracts significantly enhanced rate of wound healing in rats.

Gabapentin completely attenuated the acute morphine-induced c-Fos expression in the rat nucleus accumbens.

A growing body of evidence suggests the existence of a functional interaction between gabapentin (GBP)-morphine system. However, the neuro-anatomical sites and molecular mechanism of action of gabapentin-morphine interaction to prevent and reverse morphine side effects as well as enhancement of the analgesic effect of morphine is not clear. Therefore, we examined the combined effects of GBP-morphine on acute morphine-induced c-Fos expression in rat nucleus accumbens. The combined effect of GBP-morphine was examined by means of c-Fos immunohistochemistry. A single intraperitoneal injection (i.p.) of morphine (10 mg/kg), saline (control), and co-injection of GBP (150 mg/kg) with morphine (5 mg/kg) was administered under anesthesia. The deeply anesthetized rats were perfused transcardially with 4% paraformaldehyde 2 h after drugs administration. Serial 40 µm thick sections of brain were cut and processed by immunohistochemistry to locate and quantify the sites and number of neurons with c-Fos immunoreactivity. Detection of c-Fos protein was performed using the peroxidase-antiperoxidase detection protocol. The present study demonstrated that, administration of GBP (150 mg/kg, i.p.) in combination with morphine (5 mg/kg, i.p.) significantly (p < 0.01) attenuated the acute morphine (5 mg/kg, i.p.)-induced c-Fos expression in the rat nucleus accumbens shell. Present results showed that GBP-morphine combination action prevented the acute morphine-induced c-Fos expression in rat nucleus accumbens. Moreover, this study provides first evidence of neuro-anatomical site and that GBP neutralized the morphine-induced activation of rat nucleus accumbens shell.

Biaxial flexural strength of Turkom-Cera core compared to two other all-ceramic systems.

UNLABELLED: Advances in all-ceramic systems have established predictable means of providing metal-free aesthetic and biocompatible materials. These materials must have sufficient strength to be a practical treatment alternative for the fabrication of crowns and fixed partial dentures. OBJECTIVES: The aim of this study was to compare the biaxial flexural strength of three core ceramic materials. MATERIAL AND METHODS: Three groups of 10 disc-shaped specimens (16 mm diameter x 1.2 mm thickness - in accordance with ISO-6872, 1995) were made from the following ceramic materials: Turkom-Cera Fused Alumina [(Turkom-Ceramic (M) Sdn Bhd, Puchong, Selangor, Malaysia)], In-Ceram (Vita Zahnfabrik, Bad Säckingen, Baden-Württemberg, Germany) and Vitadur-N (Vita Zahnfabrik, Bad Säckingen, Baden-Württemberg, Germany), which were sintered according to the manufacturer's recommendations. The specimens were subjected to biaxial flexural strength test in an universal testing machine at a crosshead speed of 0.5 mm/min. The definitive fracture load was recorded for each specimen and the biaxial flexural strength was calculated from an equation in accordance with ISO-6872. RESULTS: The mean biaxial flexural strength values were: Turkom-Cera: 506.8 ± 87.01 MPa, In-Ceram: 347.4 ± 28.83 MPa and Vitadur-N: 128.7 ± 12.72 MPa. The results were analyzed by the Levene's test and Dunnett's T3 post-hoc test (SPSS software V11.5.0 for Windows, SPSS, Chicago, IL, USA ) at a preset significance level of 5% because of unequal group variances (P<0.001). There was statistically significant difference between the three core ceramics (P<0.05). Turkom-Cera showed the highest biaxial flexural strength, followed by In-Ceram and Vitadur-N. CONCLUSIONS: Turkom-Cera core had significantly higher flexural strength than In-Ceram and Vitadur-N ceramic core materials.

Biaxial flexural strength of Turkom-Cera core compared to two other all-ceramic systems

Advances in all-ceramic systems have established predictable means of providing metal-free aesthetic and biocompatible materials. These materials must have sufficient strength to be a practical treatment alternative for the fabrication of crowns and fixed partial dentures. OBJECTIVES: The aim of this study was to compare the biaxial flexural strength of three core ceramic materials. MATERIAL AND METHODS: Three groups of 10 disc-shaped specimens (16 mm diameter x 1.2 mm thickness - in accordance with ISO-6872, 1995) were made from the following ceramic materials: Turkom-Cera Fused Alumina [(Turkom-Ceramic (M) Sdn Bhd, Puchong, Selangor, Malaysia)], In-Ceram (Vita Zahnfabrik, Bad Säckingen, Baden-Württemberg, Germany) and Vitadur-N (Vita Zahnfabrik, Bad Säckingen, Baden-Württemberg, Germany), which were sintered according to the manufacturer's recommendations. The specimens were subjected to biaxial flexural strength test in an universal testing machine at a crosshead speed of 0.5 mm/min. The definitive fracture load was recorded for each specimen and the biaxial flexural strength was calculated from an equation in accordance with ISO-6872. RESULTS: The mean biaxial flexural strength values were: Turkom-Cera: 506.8±87.01 MPa, In-Ceram: 347.4±28.83 MPa and Vitadur-N: 128.7±12.72 MPa. The results were analyzed by the Levene's test and Dunnett's T3 post-hoc test (SPSS software V11.5.0 for Windows, SPSS, Chicago, IL, USA ) at a preset significance level of 5 percent because of unequal group variances (P<0.001). There was statistically significant difference between the three core ceramics (P<0.05). Turkom-Cera showed the highest biaxial flexural strength, followed by In-Ceram and Vitadur-N. CONCLUSIONS: Turkom-Cera core had significantly higher flexural strength than In-Ceram and Vitadur-N ceramic core materials.