Micro-CT analysis and leakage of bioceramic retrofillings after ultrasonic and Er:YAG laser cavity preparations: an in vitro study.

The purpose of the study was to determine the influence of preparation techniques on marginal adaptation and sealing of Biodentine™ and TotalFill® RRM bioceramic retrograde fillings. Fifty-two single-root teeth extracted for periodontal reasons were used. Root canals were instrumented using Reciproc Blue #25 and obturated using a single cone technique with an AH Plus® root canal sealer. Retrograde cavities were prepared with Piezomed device (Piezo), Er:YAG laser in short-pulse(SP) and quantum square pulse(QSP) modes and filled with Biodentine™ (BD) or TotalFill® RRM (TF). There were 6 groups (n=8): (1) Piezo BD, (2) Piezo TF, (3) SP BD, (4) SP TF, (5) QSP BD, and (6) QSP TF, and positive and negative controls (n=2). Micro-CT analysis was performed on two samples from each group. Percentage volumes of internal and external voids in apical 1.5 mm were determined. Rhodamine B dye leakage was done on six samples. The samples were cut longitudinally and examined under a stereomicroscope. Digital recordings were analyzed in ImageJ software. The deepest penetration of color in mm was recorded. The data were statistically analyzed using ANOVA and Duncan's test at the level of significance α=0.05. TotalFill® RRM performed significantly better than Biodentine™ in terms of sealing (p<0.05) and marginal adaptation, as evaluated by micro-CT. Sealing was significantly better in SP compared to QSP mode preparations (p<0.05). Differences between Piezomed and laser modes were not significantly different (p>0.05). Sealing was statistically significantly better with TotalFill® RRM compared to Biodentine™ and in Er:YAG SP preparations compared to Er:YAG QSP.

Efficiency Evaluation of Various Solvents in Retreatment of Endodontic Filling in Extracted Teeth.

Objectives: The aim of this study was to evaluate the retreatment duration and efficacy of eucalyptol and tea tree oil in engine driven and manual retreatment of epoxy resin based endodontic filling in extracted human teeth. Methods and materials: Sixty human single rooted teeth were randomly divided into two groups. The first group was prepared using hand files, and the second one using Reciproc system. Root canals were filled with gutta-percha points and AH Plus sealer. Retreatment was performed using K-reamers and Hedström files for the first group, and Reciproc instruments for the second group. Each group was divided into two subgroups (n=15) according to the retreatment solvent used (eucalyptol or tea tree oil). Root canals were longitudinaly split and analized with stereomicroscope (15x magnification). The surface of the remaining filling material was measured using an image processing software. Results: There were no statistically significant differences in the area of residual filling material among used solvents, nor in applied technique. Retreatment with Reciproc instruments was significantly faster compared to retreatment using hand files. The manual retreatment technique was faster when tea tree essential oil was used as a solvent compared to eucalyptol. Conclusions: Australian tea tree oil and eucalyptus oil were equally effective in removing endodontic filling material, but none of canals were completely free of the residual filling material. Retreatment with Reciproc instruments was faster compared to retreatment using hand files. The manual retreatment technique is faster when tea tree essential oil is used as a solvent compared to eucalyptol.

Efficacy of Reciprocating Instruments in Retreatment of Bioactive and Resin-Based Root Canal Sealers.

Objective: To compare the effectiveness of reciprocating instruments in removing gutta-percha and bioactive-based (BioRoot RCS and MTA Fillapex) and epoxy resin-based (AH Plus) sealers from root canals based on filling residues and the time required for root canal revision. Material and methods: Root canals of 90 teeth were instrumented with Reciproc R40. All root canals were obturated using the single-cone technique with Reciproc R40 gutta-percha and with one of the selected sealers. Samples with oval, straight canals were used and randomly divided into three groups: (i) filled with AH Plus sealer and gutta-percha (n=30); (ii) filled with MTA Fillapex and gutta-percha (n=30); (iii) filled with BioRoot RCS and gutta-percha (n=30). Each group was divided into two subgroups (n=15) according to the retreatment instrument used (Reciproc M-Wire R25/R40 or Reciproc blue RB25/RB40). Root canals were longitudinally split and analyzed with a stereomicroscope at 15 × magnifications in the coronal, middle, and apical third. Computational analyses were performed with the Image J software. Data were compared using the Kruskal-Wallis test and Mann-Whitney U test. Results: While no statistically significant differences in the residual material surface were found for Reciproc Blue, Reciproc M-Wire showed significantly higher residual material surface for AH Plus and MTA Fillapex compared to BioRoot RCS. For AH plus. Residual material surface was significantly lower for Reciproc Blue than for Reciproc M-Wire. In contrast, BioRoot RCS showed a significantly higher residual material surface for Reciproc Blue. Conclusions: Calcium silicate-containing sealers were more retrievable compared to AH Plus, with fewer sealer remnants and shorter retreatment time. Retreatment with Reciproc M-Wire instruments was superior to Reciproc blue instruments in retreatment of BioRoot RCS. However, none of the sealers were removed completely.

Impact of oral hygiene instructions on plaque index in adolescents.

OBJECTIVE: The objective of the study, which consisted of a motivational lecture and hands-on training, was to evaluate the role of oral hygiene education for adolescents. METHODS: The study population included sixty-two high school students between fourteen and fifteen years of age (thirty males and thirty-two females). The response rate was 76.5%. The measurement of oral hygiene level was performed using the modified Green Vermilion Index (GVI). The values were recorded at baseline, one week, three months, and six months after education through motivational lecture and hands-on training was performed. Descriptive and nonparametric statistical methods were used in statistical analysis. Level of significance was 0.05. RESULTS: At the beginning of the study, the GVI of all examined subjects was 3.52 (SD = 0.70). One week after the motivational lecture and training, it decreased to 2.64 (SD = 0.69). Three months later, the level of plaque index had the lowest value (1.44; SD = 0.66). At the end of the study the level of plaque index increased to 2.52 (SD = 0.86). CONCLUSIONS: A significant oral hygiene improvement in adolescents as a result of education was presented. However, due to a decline in oral hygiene level six months after the education, there is a need for educational programmes continuity.

Electric pulp test threshold responses in healthy incisors, canines, premolars and molars.

The purpose of this study was to determine the range of threshold responses of healthy dental pulps and test the reproducibility of the electric pulp test (EPT). Forty-nine dental students participated in the study. Sound teeth in both arches, except third molars, were included. The teeth were isolated using cotton rolls and dried with compressed air, and the threshold responses were recorded. Participants stopped the stimulus increase by pressing the switch at the first sensation of discomfort. The measurements were repeated after 30 days. The obtained data were analysed using SPSS® 16.0. The mean thresholds for the maxillary incisors, canines, premolars and molars were 10.77, 21.07, 21.88 and 34.07 µA, and for mandibular incisors, canines, premolars and molars 9.81, 18.7, 19.24 and 30.1 µA respectively. The differences between the two measurements were statistically significant for teeth 32, 31, 41 and 42. The EPT was shown to be reproducible for all the teeth tested except mandibular incisors.

Adverse Effects of Antiepileptic Drug Lamotrigine and Oral Implications: Case Report.

Here, we report on a patient who presented with extensive oral lesions. The treatment with lamotrigine is described.The patient presented with bilateral facial swellings and mental space swelling with actively draining extra oral sinus tract in the central chin area. Dental medicine professionals should be aware of the risks involved with using this medication, and should recognize the population at risk among patients suffering from epilepsy, bipolar and neurologic disorders.

Ablative Potential of Er:YAG Laser in Dentin: Quantum Versus Variable Square Pulse.

OBJECTIVE: The primary objective of this study was to compare the dentin ablation volume and ablation rate of quantum square pulse (QSP), using two different pulse energy settings plus a new digitally controlled dental laser handpiece (X-Runner), with those of variable square pulse (VSP), using three different pulse durations. The secondary objective was to examine, by scanning electron microscopy (SEM), the surface effects of ablation with the different Er:YAG laser modes on the dentin surfaces. BACKGROUND DATA: The available literature has limited data on the efficiency of different operating modes, pulse durations, and the new digitally controlled handpiece of the Er:YAG laser on human dentin. MATERIALS AND METHODS: Freshly extracted human molars (n = 72) were divided into two experimental groups (n = 36 each): (1) QSP group, and (2) VSP group. Each group was randomly divided into three subgroups (n = 12 each). In the QSP group, preparations in dentin were performed using 250 and 500 mJ of pulse energy with the conventional handpiece, and with the X-Runner handpiece set at 250 mJ pulse energy. In the VSP group, cavity preparations were performed using three pulse variables: super short pulse (SSP), micro short pulse (MSP), and short pulse (SP). Cavity preparations were made in dentin at time intervals of 1, 2, and 5 sec. A laser triangulation profilometer was used to determine cavity volumes. Surface analysis of the ablated dentin specimens was performed by SEM. RESULTS: For time intervals of 1 and 2 sec, ablated volume and ablation rate for QSP-500 mJ were significantly higher than for all other groups (p < 0.0001). For the 5-sec time interval, X-Runner and QSP-500 mJ were the most efficient in dentin ablation (p < 0.0001). Dentin surfaces were free of smear layer in all groups. CONCLUSIONS: The most efficient modes of dentin ablation in the study were the QSP-500 mJ and X-Runner groups. Dentin surfaces were free of smear layer in all groups.

Knowledge, Attitudes and Habits Regarding Oral Health in First- and Final-Year Dental Students

The purpose of the research was to compare oral health behavior and plaque indices between Croatian first-year and final-year dental students. Therefore, 46.9% of first-year and 47% of final-year dental students were surveyed using the Hiroshima University Dental Behavior Inventory (HU-DBI) questionnaire and had their plaque indices determined. Descriptive statistics analysis, nonparametric tests, and correlation analysis were performed (p<0.05). Sixth-year students had a significantly better mean HU-DBI score (8.06) than first-year students (6.45). Significantly more first-year students thought that they could not help having false teeth at their old age (p=0.007), had never been taught professionally how to brush (p=0.019), and used a toothbrush with hard bristles (p=0.001). Significantly more final-year students brushed each of their teeth carefully (p=0.008), thought they could clean their teeth well without using tooth paste (p=0.000), used a dye to see how clean their teeth were (p=0.002), and had their dentist telling them they brushed very well (p=0.028). Plaque index values were significantly lower (p<0.05) among first-year (7.94±0.72) than among final-year (9.13±0.77) students. With advancement in dental training, oral health attitudes improved, but the level of dental students' oral hygiene decreased.

Radiomorphometric indices of mandibular bones in an 18th century population.

OBJECTIVE: To estimate four radiomorphometric indices of mandibular bones in an 18th century population sample, and possibly associate the findings with bone mass loss related to sex, age, nutritional habits and pathologies reflecting on the bone. DESIGN: Thirty-six sculls (31 males, 5 females), recovered from the crypt of Pozega Cathedral in Croatia were analyzed. Age estimation was based on tooth wear, and Eichner class was determined according to the number of occlusal supporting zones. The parameters in recording analogue orthopantomographs were set to constant current of 16 mA, exposure time of 14.1s, and voltage between 62-78 kV. Films were processed in an automatic dark chamber processor for 12 min, and digitized at 8-bit, 300 dpi. The thickness of the mandibular cortex was assessed below the mental foramen (MI), at antegonion (AI), at gonion (GI). Qualitative mandibular cortical index (MCI) was assessed. RESULTS: Average values of MI, AI and GI were 3.97 ± 0.94 mm, 2.98 ± 0.56 mm, and 1.99 ± 0.55 mm, respectively. Statistically significant differences between males and females were found for AI right (p=0.014), GI left (p=0.010) and GI average (p=0.006), and were in all cases higher in males. There were no statistically significant differences between age groups for either index (p>0.05). Considering Eichner classification the differences were not significant for MI (p=0.422), AI (p=0.516), and GI (p=0.443), but in Eichner classes II, MCI was significantly higher (p=0.02). CONCLUSION: The obtained data does not suggest generalized malnutrition or calcium, phosphorus and vitamin D deprivation in the historic population studied.

The Pattern of Antibiotic Prescribing by Dental Practitioners in Zagreb, Croatia.

BACKGROUND: Bacterial resistance is considered a consequence of misuse or overuse of antibiotics. Dentistry significantly contributes to this increasing public health problem. The aim of this cross-sectional study was to examine the pattern of antibiotics prescribed by Croatian dentists in Zagreb area. METHODS: Out of 220 Doctors of Dental Medicine (DMDs) from Zagreb 110 responded to survey. Prior to the research an ethical approval was obtained. Participants were directly contacted. The questionnaire consisted of two parts: general data on DMDs and the part concerning indications, duration, type and dosage of antibiotic therapy. Data were processed using MS Excel and SPSS for Windows, Version 17.0. Statistical significance was tested by Fisher's exact test, chi-square test, Mann-Whitney U test and Spearman's rank correlation at the level of statistical significance p<0.05. RESULTS: During the period of two months, the doctors prescribed antibiotics to 1,500 patients, 690 (46%) were men and 810 (54%) women. The most often prescribed antibiotics were penicillin (72.5% of patients), represented mostly by amoxicillin in combination with clavulanic acid (57.6%). The most common indication for the prescribed antibiotics was periapical or periodontal abscess (44%). Definite clinical indication (71.2%) was stated as the most common reason for antibiotic prescription. Antibiotic therapy usually lasted 7 days (62.9%). The doctors prescribed daily doses of antibiotics according to the instructions for the use of specific drugs. CONCLUSION: The examined subjects prescribe antibiotics according to the curriculum taught at the School of Dental Medicine for majority of types, doses and duration of the treatments, although antibiotics over-prescription in cases without medical indication was observed. The national guidelines on antibiotic regimens are required in order to reduce unnecessary antibiotic use.

Proteomics profiling of keratocystic odontogenic tumours reveals AIDA as novel biomarker candidate.

BACKGROUND: Keratocystic odontogenic tumour (KCOT) is a benign, yet aggressive odontogenic tumour. Herein, proteome analysis of KCOT lesions in comparison with control patient-matched tissue unaffected by the disease and with inflammatory odontogenic cysts, namely radicular cysts is presented. METHODS: For the proteomics profiling, two complementary proteomics techniques MALDI-MS/MS and LC-ESI-MS/MS were employed. Potential candidate biomarkers were validated by immunohistochemistry. RESULTS: More than 43 proteins were found to be differentially expressed or up-regulated in KCOT lesions in comparison with patient-matched unaffected oral mucosa. These proteins bear important biological functions and are involved in cell proliferation, cytoskeletal re-organization, transcription, cellular motility and apoptosis. In particular, a number of differentially expressed proteins participate in autocrine regulation and signalization within JNK and p38 MAPK signalling pathways. CONCLUSIONS: Immunohistochemical validation of chosen putative biomarkers revealed axin interaction partner and dorsalization-antagonist (AIDA), known as a protein that blocks activation of JNK signalling pathway, as a differential biomarker for KCOT lesions on an independent cohort of KCOT tissue samples in comparison with most prevalent intra-oseal lesions inflammatory odontogenic cysts.

The Oral Status of Adult Population in the Croatian Town of Knin: a Cross Sectional Study.

THE AIM: Epidemiologic studies in many countries show uneven distribution of oral diseases (primarily caries) within the population. This is why more studies are oriented towards specific regions or subpopulations instead of large scale national surveys. The major purpose of this cross sectional study was to obtain relevant data about the oral status of the population of Knin and its surroundings according to the WHO criteria. SUBJECTS AND METHODS: The study included 414 participants aged between 18 and 65. The recorded variables included general anamnestic data, extraoral status, oral mucosa status, temporomandibular joint status, dental, periodontal and prosthetic status, and the need for dental restoration. The comparison between different groups regarding age, gender, educational level and origin was made. RESULTS: DMFT index was 17.3 - with on average 1.7 caries, 6.2 fillings, and 9.4 teeth extracted. SiC index equaled 26.4. The difference was significant regarding the level of education and age (p<0.001). The percentages of individuals with the highest CPI scores from 0-4 were 27.3, 16.9, 36.5, 16.4 and 2.9%, respectively. The difference between the age groups in CPI scores was statistically significant, while the differences according to the gender and origin were not significant (p=0.001). CONCLUSION: The population of Knin and the surrounding area exhibited very bad oral status which can be attributed to the consequences of the war in the 1990-ies, the economic transition, and the lack of national program for oral health promotion.

ARTICULATOR-RELATED REGISTRATION AND ANALYSIS OF SAGITTAL CONDYLAR INCLINATION.

The purpose of this investigation was to study sagittal condylar inclination values within a uniform sample (Angle class I occlusion) using 'articulator-related registration' and Camper's plane as a reference plane. The study was performed on a sample of 58 Angle class I subjects (mean age 25.1, SD 3.1). Measurements were performed with an ultrasonic jaw tracking device with six degrees of freedom. After a paraocclusal tray was fixed in the mouth, each subject had to make three protrusive movements and three right and left laterotrusive movements. From protrusive movements the software of the device automatically calculated the left and the right sagittal condylar inclination values used for setting of the articulator. The mean sagittal condylar inclinationvalue was 41.0° (SD 10.5) for the right joint and 40.7° (SD 9.8) for the left joint. The maximum value was 65.0° for the right and 68.6° for the left joint, and the minimum value was 13.7° for the right and 21.7° for the left joint. The results of this study suggested the average articulator setting for sagittal condylar inclination for fully dentate adult subjects to be 40° in relation to Camper's plane. This is especially important for the articulators that are set up in relation to Camper's plane.

Prevalence of third molars and pathological changes related to them in dental medicine.

The purpose of this study was to determine the prevalence of third molars in terms of respondents' age. Furthermore it was desired to determine the extent of the manifestation of pathological changes, such as caries, apical lesions, and alveolar bone resorption. This study was based on 500 OPGs of patients from the Faculty of Dentistry, University of Zagreb. Patients were divided into seven age groups. The total number of molars, the number of cavities on remaining molars, the quality of endodontic treatment and the evaluation of their performance and presence of periapical lesions was analyzed. As apart of the periodontal status, the number of inadequate fillings, the number of damaged furcations and bone resorption was analyzed. The statistical analysis was performed by means of STATISTICA 7 statistical package (StatSoft, Tulsa, USA). The correlation between the total number of molars and the age of patients was analyzed by means of Spearman's correlation to the level of significance of 0.05. The number of first, second and third molars significantly decreased in higher age groups. The prevalence of caries in third molars as compared to first and second molars was generally lower, third molars were endodontic treated at least. Assessment of involved furcations showed that the lowest percentage of 8% was found in third molars. The majority of all remaining molars had bone resorption of 1-3 mm.

Marginal leakage of class V cavities restored with silorane-based and methacrylate-based resin systems.

UNLABELLED: The aim of this study was to compare the microleakage of class V cavities restored by silorane resin with those restored by the methacrylate resin system. Sixty standardized class V cavities were prepared on premolars. The teeth were restored with Filtek(TM) Silorane and Silorane(TM) System Adhesive, Filtek(TM) Silorane and Adper(TM) Easy One and Filtek(TM) Supreme XT and Adper(TM) Easy One. The area and the depth of dye leakage were measured. Considering dye leakage area, the best results were achieved in group I (mean-M=0.114±0.083 mm(2)), then in group III (M=0.384±0.480 mm(2)) and finally in group II (M=5.389±6.587 mm(2)). Considering the depth of dye leakage, there was a significant difference between group I (mean rank-m.r.=1.23±0.44 mm) and II (1.98±0.83 mm), group II and III (1.23±0.40 mm). In this study silorane composite and its adhesive showed less microleakage than the methacrylate composite, and it showed compatibility only with its assigned adhesive. CLINICAL SIGNIFICANCE: Less microleakage of silorane restorations could provide better and long lasting composite fillings.

Prevalence of apical periodontitis and quality of root canal fillings in population of Zagreb, Croatia: a cross-sectional study.

AIM: To determine the prevalence of apical periodontitis and assess the quality of endodontic fillings in the population of the city of Zagreb, Croatia. METHODS: A total of 1462 orthopantomograms from new patients at 6 different dental practices was analyzed during 2006 and 2007. The presence of periapical lesions was determined by using the periapical index score (PAI). The quality of endodontic fillings was assessed according to the filling length and homogenicity. Data were analyzed using t test and ANOVA with Scheffe post-hoc test. RESULTS: There were 75.9% of participants with endodontically treated teeth and 8.5% of all teeth were endodontically treated. Only 34.2% of endodontically treated roots had adequate root canal filling length, while 36.2% of root canal fillings had homogenous appearance. From the total number of teeth with intracanal post, 17.5% had no visible root canal filling. Using PAI 3 as a threshold value for apical periodontitis, periapical lesions were detected in 8.5% of teeth. Adequate quality of root canal fillings was associated with a lower prevalence of periapical lesions. CONCLUSION: We found a large proportion of endodontically treated teeth with apical periodontitis and a correlation between the quality of endodontic filling and the prevalence of periapical lesions. This all suggests that it is necessary to improve the quality of endodontic treatment in order to reduce the incidence and prevalence of apical periodontitis.

Caries prevalence and periodontal status in 18th century population of Pozega-Croatia.

OBJECTIVE: The aim was to examine dental and periodontal status of adult Croatian 18th century population and compare the results with available literature data. MATERIALS AND METHODS: 104 specimens from the crypt of Pozega cathedral were grouped into three female and three male groups according to age. Caries was determined by visual inspection and dental probe. Ante and post mortem teeth losses were recorded. Periodontal status was determined according to the length of exposed tooth root from alveolar crest to cemento-enamel junction. The presence of dehiscences and fenestrations was recorded on facial and oral plate of alveolar bone. RESULTS: The whole sample exhibited ante- and post mortem teeth loss of 19.57% and 24.91%, respectively. The teeth most frequently lost postmortem were incisors. The canines were best preserved. The frequency of caries in both jaws was the highest in molars (26.63% in maxilla and 28.10% in mandible), whilst central incisors exhibited the least carious lesions (11.59 and 1.92%). The most frequently affected surfaces were occlusal, then proximal and facio-oral. The percentage of teeth with either moderate or considerable bone loss was higher in females. The frequency of considerable bone loss increased significantly with age. The frequency of dehiscences was 3.11%. It was higher in maxilla than in the mandible. The frequency of fenestrations was 5.65% and it was significantly higher in maxilla. CONCLUSIONS: The results demonstrate poor oral health amongst 18th century population of continental Croatia, exhibiting high antemortem teeth loss, high periodontal disease frequency and occlusal and proximal caries frequency.