Clinical and Radiographic Evaluation of the Effectiveness of Formocresol, Mineral Trioxide Aggregate, Portland Cement, and Enamel Matrix Derivative in Primary Teeth Pulpotomies: A Two Year Follow-Up.

OBJECTIVE: The aim of this study was to evaluate and to compare clinical and radiographic outcomes of 4 materials (formocresol, mineral trioxide aggregate (MTA), Portland cement and enamel matrix derivative) using in primary teeth pulpotomies. STUDY DESIGN: Sixty-five patients aged 5-9 years (32 female, 33 male) were included in this study. A total of 140 primary first and second molars with deep caries were treated with pulpotomy. All teeth were then restored with stainless steel crowns. The treated teeth were evaluated clinically and radiographically at 3, 6, 12, 18 and 24 months. RESULTS: At 24 months, the clinical success rates of formocresol, MTA, Portland cement, and enamel matrix derivative were 96.9%, 100%, 93.9%, and 93.3%, respectively. The corresponding radiographic success rates were 84.4%, 93.9%, 86.7% and 78.1%, respectively. CONCLUSION: Although there were no statistically significant differences in clinical and radiographic success rates among the 4 groups, MTA appears to be superior to formocresol, Portland cement, and enamel matrix derivative as a pulpotomy agent in primary teeth.

Residual HEMA and TEGDMA release and cytotoxicity evaluation of resin-modified glass ionomer cement and compomers cured with different light sources.

The purpose of this study was first to evaluate the elution of 2-hydroxyethyl methacrylate (HEMA) and triethylene glycol dimethacrylate (TEGDMA) monomers from resin-modified glass ionomer cement (RMGIC) and compomers cured with halogen and light-emitting diode (LED) light-curing units (LCUs). The effect of cured materials on the viability of L929 fibroblast cells was also evaluated. One RMGIC (Ketac N100) and two compomers (Dyract Extra and Twinkystar) were tested. Materials were prepared in teflon disks and light-cured with LED or halogen LCUs. The residual monomers of resin materials in solution were identified using high-performance liquid chromatography. The fibroblast cells' viability was analyzed using MTT assay. The type of LCU did not have a significant effect on the elution of HEMA and TEGDMA. A greater amount of HEMA than TEGMDA was eluted. The amount of TEGDMA eluted from Twinkystar was greater than Dyract Extra (P < 0.05) when cured with a halogen LCU. All material-LCU combinations decreased the fibroblast cells' viability more than the control group (P < 0.01), except for Dyract Extra cured with a halogen LCU (P > 0.05). Curing with the LED LCU decreased the cells' viability more than curing with the halogen LCU for compomers. For Ketac N100, the halogen LCU decreased the cells' viability more than the LED LCU.

Turkish women's self-reported knowledge and behavior towards oral health during pregnancy.

OBJECTIVES: The purpose of this study was to evaluate oral health care knowledge and behavior of women during pregnancy. SUBJECTS AND METHODS: The study population consisted of 351 mothers with children under 3 months of age who presented at Gülhane Medical Academy's Department of Pediatrics for a routine child check-up. Mothers were asked to complete a questionnaire about their knowledge and behavior regarding dental care during pregnancy. RESULTS: All the women who participated in the study had dental insurance, and most of them had high levels of education. Of the 351 mothers, 263 (75%) had heard about possible connections between oral health and pregnancy outcome, and 165 (47%) believed tooth and periodontal problems could affect pregnancy outcome. However, 256 (73%) women still believed that calcium would be drawn out of their teeth by the developing baby, and 151 (43%) believed in the erroneous statement 'A tooth for a baby'. 241 (68.7%) women had experienced oral health problems during pregnancy; however, only 48 (13.7%) visited a dentist during their pregnancy. CONCLUSIONS: Turkish women, despite having knowledge that adverse pregnancy events may be related to dental and periodontal problems, did not seek oral health care during pregnancy. This suggests the need to better educate medical providers to inform pregnant women to obtain oral health care during pregnancy.

Ribbond for treatment of complicated crown fractures: report of 3 cases.

Dental trauma is relatively common and can occur secondary to sporting injuries, falls, fights, or accidents. According to the International Association of Dental Traumatology, 50% of children experience dental trauma between the ages of 8 to 12. There are many options for endodontic and restorative treatments of traumatized teeth. Ribbond, which was introduced in the market in 1992, consists of bondable, reinforced ultra-high strength polyethylene fibers. Ribbond may be an option for the treatment of traumatized teeth because of its aesthetic properties; absence of additional tooth preparation; and its high resistance to traction, which allows it to easily adapt to tooth morphology. In this report, we describe endodontic and restorative treatments using Ribbond for 3 female patients with horizontal complicated crown fractures of the maxillary incisors.

In vitro evaluation of matched-taper single-cone obturation with a fluid filtration method.

OBJECTIVE: Widespread use of rotary nickel-titanium systems has caused manufacturers to produce gutta-percha cones that match the taper of the canals prepared with these systems. Obturations with these cones may provide 3-dimensional obturation of the root canal in less time. The aim of this study was to use a fluid filtration method to compare the apical sealing ability of matched-taper single-cone, Thermafil and lateral condensation obturations. MATERIALS AND METHODS: Sixty-six extracted human lower premolar teeth were instrumented to size F3 with ProTaper instruments. The teeth were divided into 3 groups and obturated with matched-taper single-cone, Thermafil and lateral condensation techniques. AH Plus was used as a sealer. Six teeth were used as positive and negative controls. A fluid filtration system was used to evaluate the apical seal. Measurements were made at 2-minute intervals for 8 minutes and the average of these values was recorded. One-way analysis of variance test was used for statistical analysis. RESULTS: Mean leakage values for the lateral condensation, single-cone and Thermafil groups were 0.49 +/- 0.37 microL min(-1), 0.39 +/- 0.24 microL min(-1) and 0.44 +/- 0.25 microL min(-1), respectively. The difference between the groups was not statistically significant (p > 0.05). CONCLUSIONS: The apical sealing ability of matched-taper single-cone obturation was comparable with that of lateral condensation and Thermafil techniques.

Traumatic injuries to permanent teeth in Turkish children, Ankara.

The aim of this study was to identify the types and etiologies of dento-alveolar injuries among patients who were treated for injuries to maxillary and/or mandibular permanent teeth at the Gulhane Medical Academy, Department of Pediatric Dentistry, Center of Dental Sciences in Ankara, Turkey to provide a basis for determining optimal treatment approaches and educational needs. From a total of 4956 children aged 6-12 years (mean age: 8.91 +/- 1.95) applying to the Center, 472 children (9.5%) were found to have suffered dental injuries during a period of 2 years. Injuries were classified according to drawings and texts based on the WHO classification system, as modified by Andreasen and Andreasen. Injury rates were highest among children age 6 and ages 8-10. The most frequently injured permanent teeth were the maxillary central incisors (88.2%), and the maxillary right central permanent incisor made up 47.2% of all injured teeth. The most common cause of dental trauma was falling while walking or running (40.3%). Most injuries involved a single tooth (64.8%). The most common type of injury was enamel fracture (44.6%). There was a significant difference in gender, where boys more often suffered from a dental hard tissue and pulp injury than girls (P = 0.019), whereas there was no difference in gender (P = 0.248) in the distribution of periodontal injuries. Injuries were found to occur more frequently during the summer (P < 0.001). Children with increased overjet were 2.19 times more likely to have dental injuries than other children. Considering that the incidence of traumatic dental injury is highest among children ages 6 and ages 8-10 as well as the fact that patients with increased overjet are more prone to dental trauma, preventive orthodontic treatment in early mixed dentition may play an important role in reducing traumatic dental injuries.

Supernumerary teeth in a Turkish population.

INTRODUCTION: Our aim in this study was to investigate the frequency, distribution, sex differences, and characteristics of supernumerary teeth in a referred Turkish population. METHODS: A total of 2599 patients' panoramic radiographs (1360 girls, 1239 boys) were evaluated, including children in both the mixed and the permanent dentitions. Their mean age was 8.6 +/- 0.23 years. Number, location, classification, side, and impaction of supernumerary teeth were evaluated. Furthermore, the development of these teeth was evaluated. RESULTS: Eighty-four supernumerary teeth were found on 69 radiographs; 9 were deciduous and 75 were permanent teeth. Most supernumerary teeth were in the premaxillary region (67%). Mesiodens (n = 43) was the most frequent supernumerary tooth (51.2%). This was followed by the maxillary lateral incisor (15.5%), the mandibular premolar (14.3%), the maxillary canine (9.5%), the maxillary premolar (6%), the mandibular lateral incisor (2.4%), and the mandibular canine (1.2%). Sixty-two (73.8%) supernumerary teeth were impacted. The male-female ratio was 1.13:1, which was not statistically significant. CONCLUSIONS: The prevalence of supernumerary teeth in Turkish children was 2.7% in this study.

Human leukocyte antigen class II alleles and dental caries in a child population.

PURPOSE: The purpose of this study was to investigate a possible relationship between human leukocyte antigens (HLAs) DRB1 and DQB1, dental caries, and colonization by mutans streptococci (MS) in children. METHODS: Sixty children were clinically examined for caries in accordance with World Health Organization criteria and methods. Thereafter, subjects were assigned into 2 groups: (1) high-caries children (dft and DMFT > or = 5); and (2) caries-free children (dft and DMFT = 0). Fresh saliva samples were collected and testedfor mutans streptococci, after which the subjects were placed into 2 groups, having either high (> or =10(5) colony-forming units [CFU]/mL saliva) or low (< 10(5) CFU/mL saliva) numbers of micro-organisms in saliva. The polymerase chain reaction/sequence specific primer method was used to determine HLA DNA typing from fresh blood samples. RESULTS: There was no significant difference between the frequency of HLA alleles in high-caries and caries-free subjects. Although chi-square test suggested an association for HLA-DRB1*01 and HLA-DQB1*03 with the salivary numbers of MS (P = .026 and P = .009, respectively), these could not be confirmed by logistic regression analysis (P = .188 and P = .101, respectively). CONCLUSIONS: The results obtained fail to establish an association between human leukocyte antigen alleles DRB1 and DQB1 and salivary numbers of MS in the selected child population.

Effect of mineral trioxide aggregate cements on transforming growth factor beta1 and bone morphogenetic protein production by human fibroblasts in vitro.

The aim of this study was to evaluate and compare the effects of two commercial mineral trioxide aggregate (MTA) cements (ProRoot MTA and MTA Angelus) on transforming growth factor (TGF)-beta1 and bone morphogenetic protein (BMP)-2 levels produced by cultured human gingival fibroblasts (HGFs). Human gingival tissues were obtained from individuals with healthy periodontium. HGFs were grown at 37 degrees C in humidified atmosphere of 5% CO(2) in Dulbecco's modified Eagle's medium, supplemented with 10% fetal calf serum, penicillin, and streptomycin. After 24 and 72 hours of exposure to the MTA products, HGF viability was determined by using 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl tetrazolium bromide assay. TGF-beta1 and BMP-2 levels in cell-free culture media were determined by enzyme-linked immunosorbent assay. Cell viability of the test groups was significantly lower than that of control at 24 and 72 hours (p < 0.05) but showed an increase at 72 hours (p < 0.05). Both test groups showed increased TGF beta-1 levels at 72 hours (p < 0.05), whereas the MTA Angelus group displayed higher TGF beta-1 levels than control and ProRoot MTA groups at 24 and 72 hours (p < 0.05). At 24 hours, BMP-2 levels of the ProRoot group were significantly higher than that of MTA Angelus (p < 0.05). Both test materials increased the BMP-2 levels within time (p < 0.05) and displayed similar levels at 72 hours (p > 0.05). These results suggest that both MTA products are capable of stimulating HGF to produce BMP-2, whereas the stimulatory effect for TGF beta-1 is material dependent.

Co-expression of cyclooxygenase-2 and vascular endothelial growth factor in inflamed human pulp: an immunohistochemical study.

Recent data from the medical literature indicates that cyclooxygenase-2 (COX-2) plays a key role in the production of vascular endothelial growth factor (VEGF), a glycoprotein that has the ability to increase the permeability of blood vessels and to induce angiogenesis. This study was undertaken to investigate the immunohistological co-expression of COX-2 and VEGF in inflamed human pulp, in conjunction with the expression of CD34, a transmembrane glycoprotein expressed in endothelial cells. Pulp tissue of extracted carious human third molars with a recent history of spontaneous pain were collected and processed for immunostaining of COX-2, VEGF, and CD34 using the biotin-streptoavidin method. Healthy pulp samples served as controls. COX-2 expression was not observed in healthy pulps, whereas all inflamed pulps demonstrated COX-2-expressing cells. Similarly, VEGF was not expressed in normal pulp tissue, but was strongly positive in inflamed pulps. CD34 was expressed in the endothelium of both normal and inflamed pulp tissues. Co-expression of COX-2 and VEGF in all consecutive sections of inflamed pulps could be suggestive of a possible release of VEGF via a COX-2-dependent pathway.

Oral and dental findings in osteopetrorickets.

While dental findings of both rickets and osteopetrosis have been reported, there is no published report on the oral and dental findings of osteopetrorickets. In this paper dental findings of osteopetrorickets were presented. A two-year-old female child was referred to the pedodontics clinic for dental examinations before bone marrow transplantation. Her teeth showed severe mobility and the eruption of the teeth were delayed. The dental findings of the patient were different from that of osteopetrosis and rickets.

Does magnetic resonance imaging affect the microleakage of amalgam restorations?

BACKGROUND: The effect of MRI on microleakage of amalgam restorations is an important health issue that should be considered. If MRI application causes increase of microleakage, amalgam fillings should be reassessed after MRI and replaced if necessary. OBJECTIVES: The aim of this study is to compare the effect of magnetic resonance imaging (MRI) on microleakage of class II bonded amalgam versus classical amalgam restorations. MATERIALS AND METHODS: Class II cavities (3 mm width × 1.5 mm depth) with gingival margins ending 1 mm below the cementoenamel junction (CEJ) were prepared in 40 permanent molar teeth. The teeth were randomly divided into four groups. Cavities in the first and second groups were restored with dentin adhesive and amalgam (bonded amalgam), and those in the third and fourth groups with amalgam only. MRI was performed with the teeth specimens from the first and third groups. All specimens were then thermocycled at 5° to 55° C with a 30-second dwell time for 1000 cycles. The samples were then immersed in 0.5% methylene blue dye for 24 hours and sectioned longitudinally. Dye penetration at the occlusal and gingival margins was quantified by 15× stereomicroscopy. IBM SPSS Statistics ver. 21.0 (IBM Corp., Released 2012., IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp.) and MS-Excel 2007 programs were used for statistical analyses and calculations. "nparLD" module was used for F2_LD_F1 design analysis at R program. P<0.05 was considered statistically significant. RESULTS: In teeth with amalgam filling, there were no significant differences of occlusal and gingival surface microleakage after MRI exposure. Occlusal and gingival surface microleakages were also similar with and without MRI in teeth with bonded amalgam filling. CONCLUSIONS: The results of this study suggest that MRI does not increase microleakage of amalgam restorations.

Combined treatment with laser sintering and zirconium: a case report of dentinogenesis imperfecta.

Osteogenesis imperfecta (OI) is a heterogeneous disorder of connective tissue that manifests mainly as skeletal deformity and bone fragility. Dentinogenesis imperfecta (DI) is sometimes an accompanying symptom of OI. The treatment protocol of these patients varies according to the clinical appearance. The case report here describes complete mouth rehabilitation of an 18-year-old male patient with OI and DI using direct metal laser sintering (DMLS) technique of metal-ceramic restorations and zirconium all-ceramic crowns. DMLS is an additive metal fabrication technology that is simpler, more precise, and healthier than conventional manufacturing and can be remarkably cost effective. Moreover, the technique affords highly accurate production of fixed partial dentures with ideal marginal fit and excellent mechanical properties. The patient was treated using a multidisciplinary strategy that focused on controlling caries, protecting teeth from further wear, obtaining an appropriate vertical dimension, and providing soft tissue support to return the facial profile to a normal appearance using new technology in the field of prosthetics.

Does a chitosan-containing dentifrice prevent demineralization around orthodontic brackets?

OBJECTIVE: To test the null hypothesis that there is no significant difference between the chitosan-containing and conventional nonfluoridated dentifrices in inhibition of enamel demineralization around orthodontic brackets. MATERIALS AND METHODS: Sixteen orthodontic patients who were scheduled to have extraction of four first premolars for orthodontic reasons were divided into two groups after the power of the study was estimated. Patients in the experimental group were instructed to use chitosan-containing dentifrice (AloeDent), and patients in the control group were instructed to use nonfluoridated dentifrice (Sensodyne Mint). After 60 days, the teeth were extracted and longitudinally sectioned. The demineralization was assessed by cross-sectional microhardness. The determinations were made at the bracket edge cementing limits and at occlusal and cervical points, 100 µm and 200 µm away from the edge. In all these positions, indentations were made at depths of 10, 20, 30, 50, 70, and 90 µm from the enamel surface. Analysis of variance (ANOVA) and Tukey test were used for statistical evaluation at P < .05 level. RESULTS: ANOVA showed statistically significant differences for the factors of dentifrice type, position, and depth (P  =  .000). Statistically significant differences for microhardness values between two tested dentifrices were observed up to 20 µm of depth from the enamel surface (P < .05). Lower microhardness values were found for nonfluoridated dentifrice. Significant microhardness differences were also determined between materials at occlusal and cervical 0 µm positions (P < .05). At these positions, chitosan-containing dentifrice showed lower demineralization than the control. CONCLUSION: Chitosan-containing dentifrice may reduce the enamel decalcification found in patients with poor oral hygiene. The null hypothesis is rejected.

Oral health status of disabled individuals attending special schools.

OBJECTIVES: The purpose of this study was to determine the prevalence of the dmft-DMFT indexes and the oral hygiene status of 136 individuals attending a special school for the disabled. METHODS: Participants were grouped according to disability [Mental Retardation (MR), Cerebral Palsy (CP), Autistic Disorder (AD), Down Syndrome (DS), Other (OTH)] and age [2-6 years (n=24), 7-12 years (50 children) and 13+ years (62 children]. Caries examinations were carried out in accordance with WHO criteria and oral cleanliness was evaluated by visually assessing the presence of plaque on teeth. RESULTS: The age range of patients was 2-26 years (mean age: 11.89±5.19 years). Mean dmft and DMFT scores by age group were as follows: 2-6 years: dmft=2.04±2.24; 7-12 years: dmft=2.24±2.60, DMFT=0.98±2.58; 13+years: DMFT=2.68±2.91. Overall, 15.4% of children had no caries or fillings. While dmft and DMFT levels (P>.05) did not vary significantly by type of disability, oral cleanliness did. Children with autism were observed to maintain the best oral hygiene and those with mental retardation (MR), the poorest. CONCLUSIONS: It is important for the dentist to concentrate on a preventive approach and provide proper dental education to parents of disabled individuals. Among the children with disabilities, more attention should be paid to the oral hygiene of MR group.

Vasorelaxant effect of a self-etch adhesive system through calcium antagonistic action.

Etch-and-rinse adhesives can cause vasorelaxation via mechanisms occurring in the endothelium and smooth muscle, including the release of nitric oxide (NO). This effect might promote or aggravate bleeding if such adhesives are placed inadvertently on iatrogenic pulp microexposures. The present study assessed the vasoactive potential of a newer generation self-etch adhesive, Clearfil Protect Bond (CPB), on isolated rat aorta. Cumulative concentrations of the primer, bond, and mixture of CPB elicited concentration-dependent relaxation of phenylephrine-induced active tonus in the rat aorta, demonstrating that the tested self-etch adhesive can lead to vasorelaxation of pulp vessels that is mediated by Ca(2+) antagonistic effect. The vasorelaxant effect of CPB or its components was mediated neither via endothelium-dependent NO and prostanoid-dependent mechanisms nor by K(+) efflux through K(+) channels. Mechanical removal of the endothelium did not significantly alter the relaxation induced by CPB. Assuming these data can be extrapolated to the clinical situation, CPB, either in mixed form or by its components, can lead to vasorelaxation of pulp vessels that is mediated by a Ca(2+) antagonistic effect. If CPB is placed inadvertently on pulp microexposures during direct pulp capping, this effect might promote bleeding that might impair healing and, via plasma exatravasation, might compromise resin infiltration and polymerization.