The Effect of Ultrasonic Agitation on the Porosity Distribution in Apically Perforated Root Canals Filled with Different Bioceramic Materials and Techniques: A Micro-CT Assessment.

The present study evaluated the effect of ultrasonic agitation on the porosity distribution of BioRoot RCS/single gutta-percha cone (BR/SC) and MTA Flow (MF) root canals fillings used as apical plugs in moderately curved and apically perforated roots. Eighty mesial root canals of mandibular first molars were enlarged up to ProTaper NEXT X5 rotary instrument 2 mm beyond the apical foramen, simulating apical perforations. Specimens were randomly divided into four experimental groups (20 canals per group) according to the material and technique used for root canal obturation: BR/SC, BR/SC with ultrasonic agitation (BR/SC-UA), MF and MF with ultrasonic agitation (MF-UA). The ultrasonic tip was passively inserted into the root canal after the injection of flowable cement and activated for 10 s. The specimens were scanned before and after obturation with a high-resolution micro-computed tomography scanner, and the porosity of the apical plugs was assessed. The differences between groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests, with the significance level set at 5%. None of the obturation materials and techniques used in this study was able to provide a pore-free root canal filling in the apical 5 mm. Considerably higher percentages of open and closed pores were observed in the MF and MF-UA groups, with the highest porosity being in the MF-UA group (p < 0.05). No significant differences were observed between the BR/SC and BR/SC-UA groups, where the quantity of open and closed pores remained similar (p > 0.05).

Porosity Distribution in Single Cone Root Canal Fillings Performed by Operators with Different Clinical Experience: A microCT Assessment.

The objective of this study was to assess the porosity distribution of BioRoot RCS/single gutta-percha point root-canal fillings performed by a general dental practitioner and endodontist. Fourteen plastic models of maxillary premolars with two roots were selected and shaped with HyFlex EDM instruments to a size 40/0.04 taper and randomly divided into two experimental groups. A total of 14 canals in each group were obturated by two different operators with one HyFlex EDM size 40 gutta-percha point and BioRoot RCS sealer. The specimens were scanned with a high-resolution micro-computed tomography scanner, and the porosity of the fillings at the coronal, middle, and apical thirds of the root canals was qualified and quantified. The differences between groups and root-canal thirds were compared using Mann-Whitney, Friedman, and Wilcoxon tests with the significance level set at p < 0.05. The highest number of pores was observed in the apical third of root-canal fillings in both groups; however, the porosity distribution between the two groups was not significantly different in the apical and middle thirds (p > 0.05). Statistically significant differences were determined only in the coronal third (p < 0.05). The predominance of open pores was detected in all root-canal thirds and groups, with no significant differences in the number of open pores between the coronal and middle thirds (p > 0.05).

Microcomputed Tomographic Assessment of the Single Cone Root Canal Fillings Performed by Undergraduate Student, Postgraduate Student and Specialist Endodontist.

The present study evaluated the obturation quality of root canals filled with BioRoot RCS sealer and single gutta-percha point by undergraduate student (US), postgraduate student (PS) and endodontist (ED). Twenty-one plastic models of upper premolars were enlarged with HyFlex EDM instruments to a size 40/0.04 taper and randomly divided into three groups (7 teeth/14 canals per group): US, PS and ED. After the obturation of root canals with BioRoot RCS and one HyFlex EDM size 40 gutta-percha point, plastic models were scanned using micro-computed tomography scanner (µCT) SkyScan 1272 at isotropic resolution of 10 µm. The porosity distribution was evaluated separately for the apical, middle and coronal thirds. The Kruskal-Wallis, Mann-Whitney, Friedman and Wilcoxon tests with the significance level set at 5% were used for data analysis. The µCT evaluation revealed open pores being the dominant type of porosity in all experimental groups and root canal thirds, with the highest percentage of pores in the apical third of root canal fillings. The quality and homogeneity of single cone root canals fillings remained similar between the groups in the apical and middle thirds (p > 0.05). Significant differences were observed only in the coronal third (p < 0.05).

Comparing effectiveness of rubber dam and gingival displacement cord with copy abutment in reducing residual cement in cement-retained implant crowns: A crossover RCT.

OBJECTIVE: To evaluate the amount of residual cement after cementation of implant crown abutments with rubber dam and retraction cord with copy abutments techniques. MATERIAL AND METHODS: Thirty single posterior metal-ceramic implant-supported restorations were delivered to 20 patients. The crowns were fabricated with occlusal openings obturated with composite, and then luted with resin-reinforced glass-ionomer cement on customised standard abutments. The cementation procedure was performed twice in the same specimens using rubber dam (group 1) and retraction cord with copy abutment (group 2). If no cement remnants were seen on periapical radiographs after cleaning, the crown-abutment unit was dismounted. All quadrants of the specimens were photographed to calculate the percentage proportions of residual cement area. Mann-Whitney and Kruskal-Wallis tests were used for statistical analysis. RESULTS: In each group, 120 measurements were performed (30 implants, 4 surfaces each). The median percentage ratio with interquartile range (IQR) between the cement remnant area and total specimen area was 1.39% (IQR 0.77%-2.29%) and 0.58% (IQR 0.31%-1.33%) in groups 1 and 2, respectively. Lesser cement remnants were found in group 2 with a statistically significant difference (p < .001). The comparison of the mesial, distal, buccal, and lingual surfaces in each group showed no statistically significant differences between them (group 1, p = .482; group 2, p = .330). CONCLUSIONS: The retraction cord and copy abutment reduced the excess cement more efficiently than the rubber dam did. Notwithstanding, undetected cement remnants were observed with both methods, and neither should be considered reliable in clinical applications.

Shaping and Centering Ability, Cyclic Fatigue Resistance and Fractographic Analysis of Three Thermally Treated NiTi Endodontic Instrument Systems.

The better understanding of the clinically important behavioral features of new instrument systems has an important significance for the clinical endodontics. This study aimed to investigate the shaping and centering ability as well as cyclic fatigue resistance of HyFlex CM (CM), HyFlex EDM (EDM) and EdgeFile (EF) thermally treated nickel-titanium (NiTi) endodontic instrument systems. Sixty curved root canals of the mesial roots of mandibular molars were randomly assigned into three groups (n = 20) and shaped using CM, EDM and EF files up to the size 40 and taper 04 of the instruments. µCT scanning of the specimens before and after preparation was performed and the morphometric 2D and 3D parameters were evaluated in the apical, middle and coronal thirds of root canals. In each group, 40.04 instruments (n = 20) were subjected to the cyclic fatigue resistance test in artificial root canals at 37 °C temperature until fractures occurred, and the number of cycles to failure (NCF) was calculated. The fractographic analysis was performed using a scanning electron microscope, evaluating topographic features and surface profiles of the separated instruments. The one-way analysis of variance with post hoc Tuckey's test was used for statistical analysis of the data; the significance level was set at 5%. All systems prepared the comparable percentage of root canal surface with the similar magnitude of canal transportation in all root thirds (p > 0.05), but demonstrated significantly different resistance to cyclic fatigue (p < 0.05). The most resistant to fracture was EF, followed by EDM and CM. The length of the fractured fragments was not significantly different between the groups, and fractographic analysis by SEM detected the typical topographic features of separated thermally treated NiTi instrument surfaces.

Dental Trauma Experience, Attitudes and Trauma Prevention in 11- to 13-Year-Old Lithuanian Schoolchildren.

PURPOSE: To identify the prevalence and determinants of dental trauma in permanent anterior teeth among 11- to 13-year-old schoolchildren, to compare self-reported dental trauma rates with clinical examination trauma rates, and to examine mouthguard use among children engaged in contact sports. MATERIALS AND METHODS: A probability sampling scheme was used to recruit schools, with all 6th grade children in the selected schools invited to participate. A total of 2621 caregiver consent forms were sent, of which 807 were returned (31%). Caregivers were asked four trauma-related questions. Clinical examinations included assessment of dental trauma experience (trauma index with five severity codes), lip competence and incisal overjet. Child- and tooth-level analyses were performed. RESULTS: Clinical evidence of dental trauma was found in 52% of participants, 13% self-reported dental trauma, and 7% of children did not remember the occurrence of any trauma. The two most frequently self-reported reasons of dental injury were falls or collisions with objects (63%) and sport/leisure activities (32%). Nearly half of the more severe dental injuries did not receive the necessary treatments. One-third of schoolchildren participated in contact sport activities, but only 3% always used mouthguards. There was a substantial difference between the clinical and self-reported findings. Logistic regression analyses revealed no statistically significant associations between dental trauma experience and the potential determinants studied: gender, lip coverage and overjet. CONCLUSION: In this study, traumatic dental injuries were observed with 52% prevalence. A substantial discrepancy between self-reported and clinical findings was observed.

Porosity Distribution in Apically Perforated Curved Root Canals Filled with Two Different Calcium Silicate Based Materials and Techniques: A Micro-Computed Tomography Study.

The present study evaluated the porosity distribution of BioRoot RCS/single gutta-percha point (BR/SC) and MTA flow (MF) fillings, which were used as plugs for the apical perforation repair in curved canals of extracted mandibular molars using micro-computed tomography (µCT). Forty mesial root canals of mandibular first molars were shaped with ProTaper NEXT X1-X5 files 2 mm beyond the apex to simulate apical perforations that were randomly divided into two groups (n = 20) according to the material and technique used for the apical plug: BR/SC or MF. The specimens were scanned before and after canal filling at an isotropic resolution of 9.9 µm. The volumetric analysis of voids in the apical 5 mm of the fillings was performed. Data were analyzed using one-way ANOVA with Bonferroni correction (p < 0.05). Micro-computed tomography (µCT) evaluation revealed significant differences between the groups in terms of porosity: the total volume and percentage volume of voids was lower in the BR/SC group in comparison with the MF group (p < 0.05), with the predominance of open pores in both groups. Neither of the materials and/or application techniques were able to produce void-free root fillings in the apical region of artificially perforated curved roots of mandibular molars.

Knowledge about traumatic dental injuries in the permanent dentition: A survey of Lithuanian dentists.

BACKGROUND/AIMS: In Lithuania, dental trauma cases are often treated by general dentists, but it is unknown whether their age, self-evaluation of trauma knowledge and practice location can predict their actual knowledge and management of trauma cases. The aim of this study was to evaluate whether these factors can be used to predict the actual knowledge and management of trauma cases. METHODS: A 2-part questionnaire included 17 multiple-choice questions about practitioners' demographics, their self-evaluated knowledge and how frequently they treated traumatized permanent teeth as well as 13 clinical scenarios reflecting a variety of clinical trauma cases and their complications. A total of 980 randomly selected general dentists, representing 5 Lithuanian counties, participated in the study. RESULTS: The response rate was 59.4% (n = 582). Overall, 82.3% of general dentists reported that they treated only a few dental trauma cases and 14.4% chose to refer their patients; 55.1% of dentists considered their dental traumatology knowledge to be sufficient but incomplete and 34.0% self-evaluated their knowledge as insufficient. The most knowledge (based on self-evaluation) was reported by the younger dentists (≤50 years; P = .004). The mean correct knowledge score was 7.6 ± 2.2 of the 13 clinical scenarios. Both bivariate and multivariate analyses showed that greater trauma-related knowledge was associated with a younger age. Better knowledge was observed amongst the dentists who self-evaluated their own knowledge as sufficient or as comprehensive. CONCLUSION: Lithuanian general dentists have insufficient dental traumatology knowledge. Better knowledge was observed amongst younger dentists (≤50 years).

Potential to induce dentinal cracks during retreatment procedures of teeth treated with "Russian red": An ex vivo study.

OBJECTIVE: The aim of this study was to compare the impact of treatment procedures on roots previously treated with resorcinol-formaldehyde resin and analyze the effectiveness of dye and magnification for the detection of dentin cracks. MATERIALS AND METHODS: Distal roots of 80 permanent first mandibular molars with a single canal were sectioned at 3mm and 9mm from the anatomical apex. Two groups were formed according to the method used for root canal penetration: group 1 (K-file and Pro Taper instruments) and group 2 (Ultrasound with Pro Ultra and Pro Taper files). Before and after the completion of procedures, photographs of the roots were taken for examination for cracks or/and infraction lines with two levels of magnification and with or without a dye. RESULTS: In groups 1 and 2, either with dye or without it, there were statistically significant differences (P<0.001) with more fractures observed in the coronal than in the apical part of specimens. Statistically significant proportional differences regarding the location of fractures were observed at both magnifications. When the dye was used, there were no statistically significant differences between the two magnifications in the detection of cracks. In the specimens where the dye was not used, differences between the groups were statistically significant at both magnifications with more complete and intra-dental fractures observed in group 2. CONCLUSIONS: Retreatment methods had a damaging effect on the root dentin of teeth previously treated with resorcinol-formaldehyde resin. At magnification ×16, the efficacy of using the dye for the detection of cracks was higher than detection without the dye.

Self-efficacy theory-based intervention in adolescents: a cluster randomized trial-focus on oral self-care practice and oral self-care skills.

AIM: The cluster randomized trial tested the efficacy of professional dental education for improving oral self-care skills (OSC-S) and oral self-care practice (OSC-P) in adolescents. DESIGN: All 15- to 16-year-old adolescents from four public schools were invited and 206 agreed to participate. Schools were randomly allocated to the intervention group and to the control group. Five sessions were given for the intervention group and one for the control group. The OSC-S and OSC-P outcomes were measured as % Oral Cleanliness Scores at the baseline, 6-month, and 12-month observations. RESULTS: OSC-S and OSC-P correlated significantly (Pearson's) at the baseline (r = 0.777, P < 0.001), at the 6-month (r = 0.745, P < 0.001), and at the 12-month (r = 0.780, P < 0.001) examinations. After the guided oral healthcare interventions, a significant time × group effect was observed (repeated-measures anova, P < 0.001 for the OSC-S (multivariate η2 = 0.355) and for the OSC-P (multivariate η2 = 0.325). CONCLUSION: (i) Oral self-care skills and oral self-care practice scores were significantly correlated, (ii) self-efficacy theory-guided intervention was superior to the conventional dental instruction to improve oral self-care in adolescents, and (iii) varying levels of oral self-care improvement were observed among the intervention group adolescents.

A theory-guided school-based intervention in order to improve adolescents' oral self-care: a cluster randomized trial.

AIM: To evaluate the efficiency of social-cognitive theory-guided oral hygiene interventions in adolescents and to identify predictors of adolescents' self-care practice. DESIGN: A cluster randomized trial included 197 15- to 16-year-olds from two secondary schools. The intervention group received three face-to-face educational hands-on sessions facilitated by a dentist and adolescents worked in pairs. Individual dental plaque levels were measured at baseline, after intervention, at six and at 12 months. The structured questionnaire inquired about gender, family socio-economic status (baseline), and different social-cognitive domain variables (baseline, six, and 12 months). RESULTS: At baseline, there were no statistically significant differences in dental plaque scores between the intervention and control groups (P = 0.183). At the 6-month follow-up, the intervention group had significantly less dental plaque than the control group (P = 0.047), but the intergroup difference in dental plaque levels was not significant at the 12-month follow-up (P = 0.400). Variations in dental plaque levels at different time periods were explained by the following predictors: family's socio-economic status, social-cognitive domain variables, group affiliation, and baseline plaque levels. CONCLUSIONS: Social-cognitive theory-guided interventions improved oral self-care of adolescents in the short term. After the intervention was discontinued, the improvement in oral self-care of adolescents lasted for another 5 months.

The prognostic value of visually assessing enamel microcracks: Do debonding and adhesive removal contribute to their increase?

OBJECTIVE: To find a correlation between the severity of enamel microcracks (EMCs) and their increase during debonding and residual adhesive removal (RAR). MATERIALS AND METHODS: Following their examination with scanning electron microscopy (SEM), 90 extracted human premolars were divided into three groups of 30: group 1, teeth having pronounced EMCs (visible with the naked eye under normal room illumination); group 2, teeth showing weak EMCs (not apparent under normal room illumination but visible by SEM); and group 3, a control group. EMCs have been classified into weak and pronounced, based on their visibility. Metal brackets (MB) and ceramic brackets (CB), 15 of each type, were bonded to all the teeth from groups 1 and 2. Debonding was performed with pliers, followed by RAR. The location, length, and width of the longest EMCs were measured using SEM before and after debonding. RESULTS: The mean overall width (Woverall) was higher for pronounced EMCs before and after debonding CB (P < .05), and after the removal of MB. Pronounced EMCs showed greater length values using both types of brackets. After debonding, the increase in Woverall of pronounced EMCs was 0.57 µm with MB (P < .05) and 0.30 µm with CB; for weak EMCs, - 0.32 µm with MB and 0.30 µm with CB. CONCLUSIONS: Although the teeth having pronounced EMCs showed higher width and length values, this did not predispose to greater EMCs increase after debonding MB and CB followed by RAR.

The appearance of root canal surfaces in teeth previously treated using resorcinol-formaldehyde resin: a preliminary SEM investigation.

OBJECTIVE: To evaluate the root canal surfaces in teeth previously treated using RF resin by SEM. MATERIAL AND METHODS: 20 distal roots of mandibular molars with typical discoloration of tooth crown were used in this study: 10 brownish - red and 10 non-colored roots. The roots were removed from the crowns, splinted longitudinally and subjected to SEM in a back-scattered electron mode. RESULTS: In discolored root samples canal walls appeared without smear layer and varying amount of remaining debris, the observed morphology of dentine was ordinary. In the non-colored root samples the dentin profile revealed: in coronal third of the root just few open dentinal tubules were detected, while in the middle and apical thirds no open dentinal tubules were observed, dentin profile was similar to sclerotic dentin. The multiple dentinal defects were detected in all samples, however significantly more dentinal defects were found in the colored roots. The RF paste was well adhered to the root canal dentine and multiple tags of RF resin penetrating deeply into the dentinal tubules were detected. CONCLUSIONS: The surfaces of the root canal walls of the teeth treated using RF paste exhibits usual appearance and ordinary dentin morphology in colored roots while the dentin of non-colored samples has the profile of sclerotic dentin. Multiple dentinal defects could be determined by damaging effect of RF resin on dentin. The adaptation and adhesion of RF paste to the dentin, capability to penetrate into dentinal tubules is comparable with the modern resin based sealers.

Evaluation of bone mineral density in postmenopausal women with alterations of the mandible cortical bone.

OBJECTIVE: Menopause affects the bone quality and quantity of jaw bone. The aim of this study was to evaluate the validity of mandibular cortical measurements in the diagnosis of low bone mineral density (BMD) in postmenopausal women. METHODS: A total of 113 postmenopausal women (mean age 63.15±6.05 years), living in Lithuania, were examined. Participants were categorized as either normal BMD, or low BMD according to the WHO classification in relation to their spine BMD determined by dual energy x-ray absorptiometry. None of the participants were known to have endocrine, metabolic or skeletal disorders. BMD was measured in the spine lumbar area L2-L4. The mandibles were examined on panoramic x-ray images. The following radiomorphometric indices were measured: the height of the mandibular inferior cortex below foramen mentalae (IC) and cortical thickness at the angle of the mandible (Panoramic Angular Index (PA)). Receiver operating characteristics (ROC) curve analysis was used to determine the validity of cortical measurements in the diagnosis of low BMD obtained and the area under the ROC curve (AUC) was calculated. RESULTS: Significant associations were found between IC and PA, and low BMD. The areas under the ROC (AUC) of PA was 0.753 (95% CI, 0.645-0.861) and of IC was 0.709 (95% CI, 0.601-0.816). High levels of intra- and interobserver agreement were demonstrated. CONCLUSIONS: Postmenopausal women with spinal low BMD can be identified moderately accurately by mandibular cortical findings.

Enamel cracks evaluation - A method to predict tooth surface damage during the debonding.

The objective of this in vitro study was to evaluate the effect of the enamel cracks on the tooth damage during the debonding. Measurements of the cracks characteristics (visibility, direction, length, and location) were performed utilizing a scanning electron microscopy (SEM) technique and mathematically derived formulas (x=h/30, l=n*x) before and following the removal of mechanically retained metal and ceramic brackets. The likelihood of having greater extent enamel defects was higher for the teeth with pronounced cracks (odds vatios, OR=3.728), increased when the crack was located in more than one zone of the tooth (OR=1.998), and the inclination did not exceed 30-45° (OR=0.505). Using ceramic brackets the risk of greater amount tooth structure defects raised 1.45 times (OR=1.450). Enamel crack showing all these characteristics at the beginning of the orthodontic treatment and the use of ceramic brackets might predispose to higher risk of greater extent tooth surface damage after the debonding by 20.4%.

Treatment procedures and referral patterns of general dentists in Lithuania.

BACKGROUND AND OBJECTIVE: The requirement for dental specialties and the number of specialists in each country depends on the content and execution of undergraduate dental education, the complex oral health care needs of the society and other factors. The aim of our study was to assess specific treatment procedures of Lithuanian general dentists and their need to refer patients to specialists. MATERIALS AND METHODS: Census sampling was employed and the data collected by means of a structured questionnaire asking dentists about the frequency of specific treatment procedures they perform and the frequency of referrals they make to different dental specialists. The results are of a self-reported nature. RESULTS: From general dental practice, 76.3% of cases needing orthodontic treatment were referred to orthodontists. About half of patients needing specialized care were referred to periodontists (50.2%), orthopedists (46.9%) and oral surgeons (45.0). More than one-third (39%) of the cases needing specialist care were referred to endodontists. Only one-third of patients were referred to pediatric dentists. In about 60% of cases needing respective care general dentists extracted teeth and roots, made incisions in acute jaw infections and treated young children; in about half of cases general dentists performed complex endodontic manipulations and treatment with fixed and removable prostheses. CONCLUSIONS: There is a clear need for Lithuanian dental practitioners to refer patients to all types of dental specialists. Undergraduate dental education program and postgraduate training should be more directed toward the extraction of teeth and roots, treatment of young children and provision of dental prostheses to patients.

Prevalence and etiology of midfacial fractures: a study of 799 cases.

BACKGROUND AND OBJECTIVE: The prevalence and etiology of midfacial fractures varies among countries. Until now, knowledge about such type of injuries in the region of the Baltic countries was rather scarce. The purpose of the study was to analyze the prevalence, etiology and localization of midfacial fractures treated at the Vilnius University Hospital Zalgiris Clinic, Vilnius, Lithuania. MATERIALS AND METHODS: The medical records of patients treated for midfacial fractures during the period January 2005 to December 2010 were analyzed for gender, age distribution, frequency and type of injury, cause of fractures, consciousness status and alcohol abuse during trauma. RESULTS: The records of 799 patients were analyzed. The male-to-female ratio was 4.4:1. The mean age of the patients was 33.16±14.0 years (min 1, max 87). As much as 68.8% of injuries were zygomatic fractures, 27.9% were maxillary, and 3.3% were isolated orbital floor fractures. The most frequent causes for injury were interpersonal violence (64%), followed by falls (16.3%) and traffic accidents (8.3%). Most midfacial fractures (65.3%) occurred between April and October (P<0.05), on weekends (58.2%; P<0.05) and at night (62.0%; P<0.05). In 14%, trauma reports indicated the abuse of alcohol. More often such persons received more than one midfacial bone fracture (P<0.05) concurrently. CONCLUSIONS: This study revealed that the main cause of midfacial fractures was assault. Male patients, aged 15-34 years, more often sustain midfacial fractures. Preventive health care programs should seek measures in the reduction of aggression and violence in close future involving family, school and community institutions.

Odontogenic Maxillofacial Infections: A Ten-Year Retrospective Analysis.

BACKGROUND: To analyze treatment modalities and results in patients with severe odontogenic maxillofacial infections during a 10-y period. METHODS: Medical records of 1,077 patients hospitalized because of severe odontogenic maxillofacial infections during 2003-2012 were reviewed. The sample consisted of the records that matched inclusion criteria. For each patient the following data were collected: Age, gender, presence of systemic diseases, length of hospital stay, causal tooth, location of inflammation, treatment, results of bacteriologic sampling, and anti-bacterial susceptibility. RESULTS: Male to female ratio was 1.4:1. Two or more anatomic spaces were involved in 42.9% of cases, 37.3% of which involved the floor of the mouth. Penicillin in combination with gentamicin or metronidazole was prescribed in 69% of cases. Sixty-two different micro-organism species were identified with predominance of Streptococcus haemolyticus (42.9%). The microbial analysis showed the highest susceptibility of predominant micro-organisms to penicillin was 76.9% and the highest resistance was to metronidazole (27.9%). CONCLUSIONS: The frequency of odontogenic maxillofacial infection remained almost unchanged during a 10-y period. Single-space infections were more common (57.1%) than infections involving two or more spaces. Susceptibility to penicillin remains relatively high; therefore, penicillin can remain part of the armamentarium for treatment of odontogenic maxillofacial infections.

Do hemophiliacs have a higher risk for dental caries than the general population?

OBJECTIVE: The aim of this study was to examine if patients with hemophilia were at increased risk for dental decay as compared to the general population. MATERIALS AND METHODS: Census sampling was used in this case-control study to recruit cases (patients with hemophilia) and a control group individuals recruited randomly from the general population, which were matched with cases based on gender, age and place of residence. Clinical examinations included dental health and salivary assessments (flow rate, buffer capacity, caries-associated bacteria) and a structured questionnaire which inquired about socioeconomic status and dental health-related behaviors. RESULTS: In the deciduous dentition, the overall caries experience (dmf) differed statistically significantly (P=0.003) between the hemophiliacs (2.6±2.6) and their matched healthy controls (6.1±2.5). Bivariate analyses did not reveal significant differences between cases and controls regarding salivary functions, except that higher bacteriological counts were found in healthy controls in deciduous dentitions than in patients with hemophilia (P=0.019). Children without hemophilia were from higher socioeconomic status families than hemophiliacs (P=0.004), but such differences were not found for adults (P=0.090). When compared to healthy adults, adult hemophiliacs had more gum bleeding at rest (P<0.001) as well as during their tooth brushing (P=0.007) and they also consumed more soft drinks than controls (P=0.025). CONCLUSIONS: Better dental health was observed in children with hemophilia as compared to children without it. There were no differences in dental health between adult hemophiliacs and healthy controls from the general population. None of the linear multiple regression models confirmed hemophilia to be an additional caries risk when it was controlled for other caries determinants.

Crestal Bone Stability around Implants with Horizontally Matching Connection after Soft Tissue Thickening: A Prospective Clinical Trial.

BACKGROUND: It has been shown that thin mucosal tissues may be an important factor in crestal bone loss etiology. Thus, it is possible that mucosal tissue thickening with allogenic membrane might reduce crestal bone loss. PURPOSE: The purpose of this study was to evaluate how implants with traditional connection maintain crestal bone level after soft tissue thickening with allogenic membrane. MATERIALS AND METHODS: One hundred three patients received 103 internal hex implants of 4.6 mm diameter with regular connection. According to gingiva thickness, patients were assigned into A (thin tissues, n = 34), B (thin, thickened with allogenic membrane, n = 35), and C group (thick tissues, n = 34). Groups A and C had one-stage approach, and in group B, implants were placed in two stages. Radiographic examination was performed after implant placement, 2 months after healing, after restoration, and after 1-year follow-up. Crestal bone loss was calculated medially and distally. Significance was set to 0.05. RESULTS: After 1-year follow-up, implants in group A had 1.65 ± 0.08-mm bone loss mesially and 1.81 ± 0.06 mm distally. Group B had 0.31 ± 0.05 mm mesially and 0.34 ± 0.05 mm distally. C group implants experienced bone loss of 0.44 ± 0.06 mm mesially and 0.47 ± 0.07 mm distally. Differences between A and B, and A and C were significant (p = .000) both mesially and distally, whereas differences between B and C were not significant mesially (p = .166) and distally (p = .255). CONCLUSIONS: It can be concluded that thin mucosal tissues may cause early crestal bone loss, but their thickening with allogenic membrane may significantly reduce bone resorption. Implants in naturally thick soft tissues experienced minor bone remodeling.