Low-level laser therapy with 940 nm diode laser on stability of dental implants: a randomized controlled clinical trial.

Low-level laser therapy (LLLT) is a non-invasive modality to promote osteoblastic activity and tissue healing. The aim of this study was to evaluate the efficacy of LLLT for improvement of dental implant stability. This randomized controlled clinical trial was performed on 80 dental implants placed in 19 patients. Implants were randomly divided into two groups (n = 40). Seven sessions of LLLT (940 nm diode laser) were scheduled for the test group implants during 2 weeks. Laser was irradiated to the buccal and palatal sides. The same procedure was performed for the control group implants with laser hand piece in "off" mode. Implant stability was measured by Osstell Mentor device in implant stability quotient (ISQ) value immediately after surgery and 10 days and 3, 6, and 12 weeks later. Repeated measures ANOVA was used to compare the mean ISQ values (implant stability) in the test and control groups. Statistical test revealed no significant difference in the mean values of implant stability between the test and control groups over time (P = 0.557). Although the mean values of implant stability changed significantly in both groups over time (P < 0.05). Although the trend of reduction in stability was slower in the laser group in the first weeks and increased from the 6th to 12th week, LLLT had no significant effect on dental implant stability.

CO2 laser surface treatment of failed dental implants for re-implantation: an animal study.

The aim of the present study was to evaluate the success rate of failed implants re-implanted after surface treatment with CO2 laser. Despite the widespread use of dental implants, there are many incidents of failures. It is believed that lasers can be applied to decontaminate the implant surface without damaging the implant. Ten dental implants that had failed for various reasons other than fracture or surface abrasion were subjected to CO2 laser surface treatment and randomly placed in the maxillae of dogs. Three failed implants were also placed as the negative controls after irrigation with saline solution without laser surface treatment. The stability of the implants was evaluated by the use of the Periotest values (PTVs) on the first day after surgery and at 1, 3, and 6 months post-operatively. The mean PTVs of treated implants increased at the first month interval, indicating a decrease in implant stability due to inflammation followed by healing of the tissue. At 3 and 6 months, the mean PTVs decreased compared to the 1-month interval (P < 0.05), indicating improved implant stability. The mean PTVs increased in the negative control group compared to baseline (P < 0.05). Independent t-test showed that the mean PTVs of treated implants were significantly lower than control group at 3 and 6 months after implant placement (P < 0.05). Based on the PTVs, re-implantation of failed implants in Jack Russell Terrier dogs after CO2 laser surface debridement is associated with a high success rate in terms of implant stability.

The antibacterial properties of composite resin containing nanosilver against Streptococcus mutans and Lactobacillus.

AIM: The aim was to evaluate the antibacterial properties of composite resin containing nanosilver against Streptococcus mutans (SM) and Lactobacillus (L). MATERIALS AND METHODS: Nanosilver was added to Z250 composite at 0.5 and 1% by weight. In order to confirm the homogenous distribution of the nanoparticles in the composite resin, SEM-EDX analysis was performed on one sample in each group. Z250 composite without nanosilver was used as control. Direct contact test was used to test the antibacterial properties of nanoparticle-loaded composites: 0.001 ml of 0.5 Mc Farland suspension of MS and L was placed on composite disks, and incubated for 1 hour in 5 to 10% CO2 incubator at 37°C. Samples were placed in 0.5 ml of sterile BHI broth and incubated for 2 hours in CO2 incubator. Afterwards, 0.001 ml liquid from each medium was distributed on blood agar plates and incubated for 48 hours in CO2 incubator. The numbers of bacterial colonies were counted visually. Data were analyzed using Two-way ANOVA and Tukey HSD test. Significance level was set at 0.05. RESULTS: Addition of nanosilver to composite resin had a significant effect on reduction of the number of SM and L colonies (p = 0.000). The antibacterial properties of composite resins are different depending on the concentration of nanosilver (p = 0.014). Tukey test indicated that increase in the concentration of nanosilver caused the increase in antibacterial properties of composite resin. CONCLUSION: Addition of silver nanoparticles to Z250 composite could significantly inhibit the growth of Streptococcus mutans and Lactobacillus on the surface of this composite. CLINICAL SIGNIFICANCE: The addition of nanosilver to Z250 composite could inhibit the growth of SM and L on the surface of the restoration and therefore prevent the occurrence of secondary caries.

Effects of C-Factor on Bond Strength of Universal Adhesives to Floor and Wall Dentin in Class-I Composite Restorations.

PURPOSE: To evaluate the effects of C-factor on the bond strength of universal adhesives to floor and wall dentin in class-I composite restorations using a bulk-fill composite. MATERIALS AND METHODS: 108 non-carious humans third molars were randomly divided into four groups as follows: flat wall, flat floor, cavity wall, and cavity floor (n = 36). Then, each group was subdivided into three subgroups according to the type of adhesive used: Single Bond Universal, G-premio Bond (both universal adhesives), or Adper Single Bond 2 (an etch-and-rinse adhesive). After the bonding procedure, X-tra fill resin composite was applied in bulk to build up the flat surfaces or fill the cavities.Then the teeth were sectioned into 1-mm2 sticks and microtensile bond strength (µTBS) was measured using a universal testing machine. µTBS (MPa) was analyzed by one-way, two-way, and three-way ANOVA using SPSS Version 23 (a = 0.05). RESULTS: Interactions between adhesives and bonding surfaces, as well as C-factor and bonding surfaces showed statistically significant differences, but the interaction between the C-factor and type of adhesive was not statistically significant. The comparison of bonded surfaces including the flat wall and the flat floor in Adper Single Bond 2 was statistically significant (p < 0.05), except for the cavity wall and cavity floor. CONCLUSION: Regardless of the type of adhesives, the C-factor reduced the µTBS of the composite resin to dentin. Adper Single Bond 2 mediated higher µTBS than did the universal adhesives G-premio Bond and Single Bond Universal.

Effects of 3 different light-curing units on the physico-mechanical properties of bleach-shade resin composites.

Objectives: This study investigated the microhardness, flexural strength, and color stability of bleach-shade resin composites cured with 3 different light-curing units. Materials and Methods: In this in vitro experimental study, 270 samples were fabricated of bleach and A2 shades of 3 commercial resin composites (Point 4, G-aenial Anterior, and Estelite Sigma Quick). Samples (n = 5 for each trial) were cured with Bluephase N, Woodpecker LED.D, and Optilux 501 units and underwent Vickers microhardness and flexural strength tests. The samples were tested after 24 hours of storage in distilled water. Color was assessed using a spectrophotometer immediately after preparation and 24 hours after curing. Data were analyzed using 3-way analysis of variance and the Tukey test (p ≤ 0.001). Results: Samples cured with Optilux exhibited the highest and those cured with LED.D exhibited the lowest microhardness (p = 0.023). The bleach shade of Point 4 composite cured with Optilux displayed the highest flexural strength, while the same composite and shade cured with Sigma Quick exhibited the lowest (p ≤ 0.001). The color change after 24 hours was greatest for the bleach shade of G-aenial cured with Bluephase N and least for the A2 shade of Sigma Quick cured with Optilux (p ≤ 0.001). Conclusions: Light curing with polywave light-emitting diode (LED) yielded results between or statistically similar to those of quartz-tungsten-halogen and monowave LED in the microhardness and flexural strength of both A2 and bleach shades of resin composites. However, the brands of light-curing devices showed significant differences in color stability.

In vitro comparison of microleakage of posterior resin composites with and without liner using two-step etch-and-rinse and self-etch dentin adhesive systems.

BACKGROUND AND AIMS: Composite restorations frequently have gingival margins apical to the cemento-enamel junction (CEJ). Microleakage at the cementodentinal margins is one of the most important causes of failure in these restorations. The current study evaluated microleakage at the occlusal and gingival margins of Class II packable composite restorations using resin-modified glass ionomer and flowable composite as liners, using the two-step etch-and-rinse and self-etch dentin-bonding systems. MATERIALS AND METHODS: This in vitro study was carried out on 48 intact human premolars. Class II preparations were made with the gingival margins placed 1.0 mm apical to the CEJ. The teeth were randomly assigned to six groups of 16 boxes and restored using the following techniques: Group 1: Single Bond (3M ESPE) + Filtek P60 (3M ESPE); Group 2: Clearfil SE Bond (Kuraray) + Filtek P60; Group 3: Single Bond + Filtek Flow (3M ESPE) + Filtek P60; Group 4: Clearfil SE Bond + Filtek Flow + Filtek P60. Group 5: Single Bond + Fuji II LC (GC) + Filtek P60; Group 6: Clearfil SE Bond + Fuji II LC + Filtek P60. The restorations were thermocycled for 1000 cycles at 5{degree sign}C and 55°C, soaked in 2% methylene blue for 48 hours, then sectioned mesiodistally and viewed under a stereomicroscope for leakage at the gingival margin. The data were statistically analyzed using the Kruskal-Wallis, two-way ANOVA and Mann-Whitney U-tests. RESULTS: The resin-modified glass-ionomer liner demonstrated significantly less leakage than flowable composite (p<0.05). There was no difference between restorations with flowable resin composite liners and those without the liner; in addition, no significant difference was observed between the two kinds of adhesive systems. CONCLUSIONS: The current study supports the use of resin-modified glass ionomer as a liner in closed-sandwich technique to decrease microleakage of Class II packable composite restorations, applying either the two-step etch-and-rinse or the self-etch dentin adhesive system.

Rehardening of Eroded Enamel with CPP-ACFP Paste and CO2 Laser Treatment.

BACKGROUND: Diet and lifestyle can destroy tooth structure due to the dissolution of enamel by acidic beverages. The present study evaluated the effect of CO2 laser irradiation and CPP-ACFP (casein phosphopeptide and amorphous calcium phosphate with fluoride) paste on the remineralization of enamel eroded by carbonated soft drinks. METHODS: In the present in vitro study, 46 human sound premolar teeth were sectioned mesiodistally to achieve 84 samples. Fourteen samples were assigned to the positive control group (G1), and the remaining samples were immersed in 500 mL of cola drink for 2 minutes, followed by rinsing with distilled water for 10 seconds. This procedure was carried out three times to create erosive lesions. Then, the 60 eroded samples were randomly assigned to five groups of G2 to G6 in terms of the treatment as follows: negative control (G2), CO2 laser irradiation (G3), CPP-ACFP paste (G4), CO2 laser irradiation followed by CPP-ACFP paste application (G5), and CPP-ACFP paste application followed by CO2 laser irradiation (G6). The mean surface microhardness of the enamel surface was evaluated and determined at three points for each sample. Data were analyzed with one-way ANOVA and Tukey HSD tests (α = 0.05). RESULTS: The highest and the lowest hardness values were recorded in the G1 (314 ± 12 kg/mm2) and G2 (213.7 ± 12 kg/mm2) groups, respectively. ANOVA revealed significant differences between the study groups (P < 0.001). Two-by-two comparisons showed significant differences between the G2 group and the other groups, indicating the efficacy of all the treatment modalities in tooth remineralization and rehardening procedures (P < 0.05). Only in group G6, the enamel microhardness was not significantly different from the G1 positive control group (P > 0.05). CONCLUSION: Considering the parameters used in the present study, CO2 laser irradiation or CPP-ACFP paste application alone increased eroded enamel's surface hardness; however, their sequential application was more effective in rehardening the eroded enamel's surface to near-normal levels.

Phosphate Ion Release and Alkalizing Potential of Three Bioactive Dental Materials in Comparison with Composite Resin.

AIM: Several new bioactive compounds were recently introduced to the market with favorable ion release, tooth remineralization, and alkalizing potential. This study sought to compare the phosphate ion release and alkalizing potential of three bioactive materials in comparison with composite resin. METHODS: Thirty-six discs (2 × 6 mm) were fabricated from Fuji II LC resin modified glass ionomer (RMGI), Activa BioActive, Cention N, and Z250 composite in plastic molds. The specimens were stored in distilled water for 24 and 48 h and 6 months. Half of the specimens were used to assess the phosphate ion release while the other half were used to assess the alkalizing potential 1 h after pH drop from 6.8 to 4. Phosphate ion release was quantified by a spectrophotometer while the pH value was measured by a pH meter. Data were analyzed using two-way ANOVA, one-way ANOVA, and Tukey's HSD test (for pairwise comparisons) at 0.05 level of significance. RESULTS: At 24 h, the maximum phosphate ion release in distilled water occurred in the Fuji II LC group followed by Cention N, Activa BioActive, and Z250. At 6 months, Cention N followed by Activa BioActive showed higher phosphate ion release than Fuji II LC and Z250. No significant difference was noted between Activa BioActive and Cention N at any time point. All materials, except for Z250, increased the pH of the environment. Fuji II LC had maximum alkalizing effect at all time points followed by Cention N and Activa BioActive. CONCLUSION: Use of bioactive compounds is a promising method to ensure phosphate ion release, and can have a positive effect on tooth remineralization over time. Also, bioactive compounds can alkalize an acidic environment.

The effect of a 16% carbamide peroxide gel on mercury and silver ion release from admixed and spherical dental amalgams.

AIM: The aim of this study was to investigate the effect of 16 percent carbamide peroxide gel on mercury and silver ions released from admixed and spherical dental amalgams. METHODS AND MATERIALS: A total of 96 amalgam discs were prepared from two different types and brands of dental amalgam (admixed and spherical). The samples were stored at room temperature in glass tubes containing distilled water for 24 hours. The specimens were then polished and again immersed in distilled water at room temperature and stored for one month. Samples of both types of dental amalgam were treated with carbamide peroxide 16 percent gel (Nite White, Discus Dental, Inc., Culver City, CA, USA) for 14 and 28 hours (experimental group) and compared to samples not exposed to the bleaching agent but stored continuously in distilled water. Mercury and silver levels of each solution were measured using the VAV-440 analyzer system. RESULTS: Mercury and silver ions released from the experimental group were significantly greater than from the control group (p<0.001). There was no significant difference between the mean levels of mercury and silver ions in the two kinds of amalgams after treatment with 16 percent carbamide peroxide (p=0.119 for mercury and p=0.199 for silver). Increasing the storage time in the carbamide peroxide gel from 14 to 28 hours did not result in significant changes in the amount of ions released (p=0.329 for mercury and p=0.082 for silver). Also, the interaction effect between amalgam particles' shape (admixed and spherical) versus storage time (14 versus 28 hours) was not statistically significant (p=0.901 for mercury and p=0.951 for silver). CONCLUSION: Treatment with 16 percent carbamide peroxide gel increased mercury and silver ions released from admixed and spherical amalgams, compared to samples in the control group, but the difference between the two amalgams was not statistically significant. CLINICAL SIGNIFICANCE: The amount of mercury and silver ions released from high-copper dental amalgams during bleaching with 16 percent carbamide peroxide is in the safe range of mercury intake for patients.

Comparison of the effects of toothpastes containing nanohydroxyapatite and fluoride on white spot lesions in orthodontic patients: A randomized clinical trial.

BACKGROUND: Studies show that fluoride (F) and nano-hydroxyapatite (nano-HA) would result in remineralization of white spot lesions (WSLs), which are among the most prevalent consequences of fixed orthodontic treatment. The present study evaluates and compares the clinical effects of an Iranian toothpaste containing nano-HA with F-containing one on early enamel lesions. MATERIALS AND METHODS: In this randomized clinical trial study, 50 patients who had received fixed orthodontic treatment were recruited immediately after debonding. Three photographs, including frontal, lateral right and left views of occlusion, were obtained. Moreover, surfaces with WSLs were recorded using DIAGNOdent. Plaque index of each patient determined using disclosing agents. At first visit, each patient was asked to select one type of toothpaste (nano-HA containing vs. F containing named A or B), randomly and were instructed how to brush their teeth (25 patients in each group). Examination was done at 1, 3, and 6 months' intervals. Finally, photographs were analyzed by Digimizer (V5) software, and the lesion extent was recorded in pixels. SAS 9.4 was used to analyze data and was set at 0.05. RESULTS: According to data, lesion extent showed a significant decrease (P < 0.001). At baseline, the difference between the two groups regarding the lesion extent was 268 pixels while it dropped to 89 pixels after 6 months. DIAGNOdent results showed that at baseline, fluorescence difference was 0.3 while it reached the number of 0.8 after 6 months, indicating the outperformance of nano-HA containing toothpaste. CONCLUSION: The Iranian nano-HA containing toothpaste performed better than F-containing one in terms of the amount of remineralization and diminishing the lesion extent.

Comparative Assessment of Cuspal Deflection in Premolars Restored with Bulk-Fill and Conventional Composite Resins.

OBJECTIVES: It has been reported that bulk-fill composites simplify tooth restoration with no adverse effect on the success rate. This study sought to assess the cuspal deflection of premolars with mesio-occluso-distal (MOD) cavities restored with bulk-fill and conventional posterior composite resins. MATERIALS AND METHODS: This in-vitro experimental study was conducted on 64 human maxillary premolars. MOD cavities were prepared on teeth and restored with Filtek P60 conventional composite and Filtek Bulk Fill flowable, X-tra fill, and X-tra base bulk-fill composites in four groups (n=16). Distance between the cusp tips was measured before, five minutes, 24 hours, 48 hours, and one week after restoration. The data were analyzed using repeated-measures analysis of variance (ANOVA) and Tukey's test (α=0.05). RESULTS: The mean±standard deviation (SD) of cuspal deflection at five minutes after the restoration was 13.5±5.3, 12.2±3.5, 11.3±4.4, and 10.4±3.7 µm for Filtek P60, Filtek Bulk Fill, X-tra fill, and X-tra base, respectively. ANOVA showed that bulk-fill composites did not cause a significant reduction in cuspal deflection compared to P60 (P>0.05). Cuspal deflection in all groups significantly decreased with time (P<0.05). CONCLUSION: Bulk-fill composites have no superiority over P60 in the reduction of cuspal deflection. The cuspal deflection was variable at different time points in all groups and decreased over time.

Effect of 940nm Diode Laser Irradiation on Microtensile Bond Strength of an Etch and Rinse Adhesive (Single Bond 2) to Dentin.

STATEMENT OF THE PROBLEM: Laser can influence bonding mechanism by increasing the penetration depth of adhesive in smear layer. The effect of 940 nm diode laser on microtensile bond strength of adhesive to dentin has not been investigated in previous studies. PURPOSE: The aim of this study was to evaluate the effect of 940 nm diode laser irradiation on microtensile bond strength of Single Bond 2 to dentin. MATERIALS AND METHOD: Thirty sound premolars extracted for orthodontic reasons were randomly divided into five groups as follows: G1 or control: etching+ Single Bond2 (SB); G2: diode laser (940 nm wavelength, 1W power, continuous mode)+ etching+ SB; G3: etching+ laser irradiation+ SB; G4: etching+ SB+ laser irradiation+ adhesive curing; G5: etching+ laser irradiation+ SB +laser irradiation +adhesive curing. After the bonding procedure, Z250 composite resin was applied on the dentin surface in three layers of 2 mm thickness. After 24 hours of immersion in distilled water at 37°C and thermocycling for 1000 thermal cycles, the teeth were sectioned into 1mm2 sticks. The microtensile bond strength was measured using a universal testing machine. Bond strength (MPs) was analyzed by one-way ANOVA followed by HSD post hoc Tukey's test (α=0.05). RESULTS: G4 (38.35±8.99) showed the significant highest bond strength compared to other groups (p= 0.000). G5 (25.16±6.14) showed significantly higher bondstrength than the control group (18.85±4.79) (p= 0.032).Bond strength of G2 (23.39±6.07) and G3 (22.85±5.11) groups was the same and similar to that in the control group (p> 0.05). CONCLUSION: Based on the results of this study, it may be concluded that dentin surface irradiation with 940 nm diode laser after adhesive application and prior to curing can significantly increase the bond strength of composite to dentin.

The effect of dentin pre-treatment with activated riboflavin on the bond strength of a two-step self-etch adhesive system.

BACKGROUND: The cross-linking of collagen fibers in the hybrid layer has been suggested as a way to create more durable bonds. OBJECTIVES: This study evaluated the effect of visible light-activated riboflavin (RF) as a cross-linking agent on the durability of the dentin microtensile bond strength (µTBS) in a 2-step self-etch (SE) adhesive system. MATERIAL AND METHODS: The occlusal surfaces of 21 human premolar teeth were ground down to expose the dentin, and were then randomly divided into 3 groups. The Clearfil® SE Bond was used in the control group. In the RF/BL group, a 0.1 wt% aqueous solution of RF was applied to the dentin surface before applying the adhesive and irradiating with blue light (BL) for 2 min. In the 3rd group, the RF-P/BL group, the RF powder was added to the adhesive primer (P) at a concentration of 0.1 wt%. The teeth were built up using composite resin. After thermocycling, 14 resin-dentin beams from each group were prepared and stored in water for 3 months. The µTBS was determined and the data was analyzed using a linear model with a generalized estimating equation (GEE) (p = 0.05). RESULTS: The highest and the lowest µTBS belonged to the control group (41.15 ±3.50 MPa) and the RF-P/BL group (19.84 ±3.80 MPa), respectively. The mean µTBS in the control group was significantly higher than in the RF/BL and RF-P/BL groups (p < 0.001), but no significant difference was found between the RF/BL and RF-P/BL groups (p = 0.598). CONCLUSIONS: Pre-treatment of dentin surfaces with RF activated with BL had a negative impact on the µTBS of the Clearfil SE Bond as a 2-step SE adhesive.

Effect of Diode Laser (810 nm) Irradiation on Marginal Microleakage of Multi-mode Adhesive Resins in Class V Composite Restorations.

Introduction: Some studies have shown that laser irradiation on unpolymerized adhesives can improve composite-dentin adhesion. The aim of the present study was to evaluate the effect of the diode laser (810 nm) on the microleakage of multi-mode adhesive systems at enamel and dentin margins of composite restorations. Methods: Classic class V boxes were prepared on 48 sound premolar teeth and randomly divided into 6 groups (n=16). In the control groups, Scotchbond Universal (SBC), G-Premio (GBC), and Ambar U (AMC) were used by a self-etch mode. In the test groups (SBL, GBL, ABL), the 810 nm diode laser was irradiated (1 W) for 10 seconds before the polymerization of the adhesive. The boxes were restored by the resin composite. After finishing and polishing, the samples were thermocycled (5°C to 55°C) for 1000 cycles and then immersed in 0.1% methylene blue dye (48 hours). Dye penetration through the gingival and occlusal margins was measured by Stereomicroscope. The data were analyzed at the 5% significance level using Kruskal-Wallis and Mann-Whitney U tests. Results: Significant differences were found between the control and test groups (P < 0.05). The occlusal margins of the SBL and GBL groups and the cervical margin of the SBL group exhibited the lowest microleakage (P < 0.05). The AM control group showed maximum microleakage at cervical and occlusal margins. Conclusion: The irradiation of the 810 nm diode laser on the unpolymerized universal adhesive systems in a self-etch mode caused a significant reduction in enamel and dentin marginal microleakage of composite restorations.

Influence of CO2 Laser Irradiation and CPPACP Paste Application on Demineralized Enamel Microhardness.

Introduction: It has been suggested that the application of casein phosphopeptide-amorphous calcium phosphate paste (CPP-ACP) and CO2 laser irradiation on enamel could increase the resistance of enamel to caries and acid attacks. The aim of the current study was to compare the influence of CPP-ACP paste application and irradiation of CO2 laser on microhardness of demineralized enamel. Methods: Thirty sound maxillary extracted premolars were selected. The crowns were cut at the cervical line and were split into facial and palatal halves. Specimens were mounted in selfcure acrylic blocks in such way that the enamel surface was exposed to 4×4 mm. After a pH cycling of the specimens, they were randomly divided into 4 groups (n=15), as follows: CG: Control group, LAS: CO2 laser, CP: CPP-ACP and LASCP: laser combined CPP-ACP treatment. The Vickers microhardness of the specimens was measured (500 g load, 5 seconds, 3 points). Data were analyzed using one-way ANOVA and post hoc Tukey tests (α =0.05). Results: The lowest mean Vickers microhardness value was observed in CG group (192.57±50.87 kg/mm2 ) and the highest in LASCP group (361.86±22.22 kg/mm2 ). There were significant differences between groups (P<0.001). The pairwise comparison of the groups revealed that there were significant differences between these groups: CG versus LAS, CP, LASCP (P<0.05) and LASCP versus LAS and CP (P<0.05). No significant difference between LAS group versus CP group (P>0.05) was observed. Conclusion: The results of the current study revealed that CO2 laser and CCP-ACP were effective for improvement of enamel hardness value after demineralization. Incorporation of CO2 laser irradiation and CCP-ACP paste application provides additional remineralizing potential for demineralized enamel.

In vitro effect of changing the horizontal angulation of X-ray beam on the detection of proximal enamel caries in bitewing radiographs.

BACKGROUND: Bitewing radiography is an important modality useful for the evaluation of teeth in patients of various ages and in different stages of tooth eruption. Clinical examination of proximal surfaces for caries may result in false negative results, especially in tight contact areas. Thus, radiography, as an adjunct to clinical examination, is used as a routine diagnostic modality for caries detection. OBJECTIVES: The objective of this study was to assess the in vitro effect of changing the horizontal angulation of X-ray beam on the detection of proximal enamel caries in bitewing radiographs. MATERIAL AND METHODS: This in vitro study was conducted on 150 caries-free human premolars (code: p/16/35/9/210). The teeth were randomly divided into 3 groups (n = 50). Group 1 served as the control group and no carious lesions were induced in this group. Teeth in groups 2 and 3 were immersed in demineralizing solution for 2 and 4 months, respectively. After induction of caries and its radiographic confirmation, the teeth were mounted in wax in groups of 3 and bitewing radiographs were obtained at 0°, 5°, 10° and 15° horizontal angles. RESULTS: The sensitivity values of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles were 88%, 90%, 88%, 92% in group 2 and 88%, 94%, 94% and 94% in group 3, respectively. The specificity values of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles were 92%, 86%, 84% and 76%. The accuracy of bitewing radiographs at 0°, 5°, 10° and 15° horizontal angles was 89.3%, 90%, 88.7% and 87.3%, respectively. The highest diagnostic accuracy was obtained at 5° horizontal angle for caries detection; however, the difference in this regard among the tested horizontal angles was not statically significant (p = 0.846). CONCLUSIONS: Based on the results of this study, changing the horizontal angulation has no significant effect on the detection of proximal enamel caries in bitewing radiographs.

Efficacy of denoising and enhancement filters for detection of approximal and occlusal caries on digital intraoral radiographs.

BACKGROUND AND OBJECTIVES: Image processing and enhancement filters can significantly improve the diagnostic value of digital radiographs. Evidence shows that increasing the contrast and filtering improve the diagnostic accuracy for caries detection. This study sought to assess the diagnostic accuracy of original and enhanced digital radiographs for the detection of approximal and occlusal caries. SUBJECTS AND METHODS: In this experimental study, incipient carious lesions were artificially created on 120 proximal and occlusal surfaces of human extracted permanent molar and premolar teeth. After mounting the teeth in wax, digital radiographs were obtained using photostimulable phosphor plates and enhanced by enhancement filters 1, 2, and 3 with/without denoising. Two oral and maxillofacial radiologists blinded to filtering viewed the radiographs and filled out a chart. A definite diagnosis was made by a pathologist by observing the samples under a stereomicroscope (gold standard). Data were analyzed using SPSS software version 16. Interobserver agreement was calculated using kappa statistics. Chi-square test was used to assess the correlation between qualitative variables. RESULTS: Assessment of sensitivity, specificity, accuracy, positive predictive value, and negative predictive value showed that enhancement filter 2 without denoising was the most efficient and original radiographs (filter free) were the least efficient radiographs for the detection of carious and sound surfaces. Application of filters significantly increased the accuracy of caries detection on digital radiographs. The lowest diagnostic accuracy was noted for the detection of enamel lesions on original radiographs (52%). Enhancement filter 2 plus denoising was the best filter for the detection of these lesions (79.25%). No significant difference was noted among different filters for detection of carious and sound surfaces but enhanced, and original radiographs were significantly different in visualization and detection of caries (P < 0.05). CONCLUSION: Application of enhancement filters, particularly enhancement filter 2 with/without denoising, increases the accuracy of caries detection on digital radiographs.

Effect of Nd:YAG and Diode Lasers on Apical Seal of Root Canals Filled with AH Plus and Mineral Trioxide Aggregate-Based Sealers.

OBJECTIVES: Laser irradiation, as an adjunct to root canal preparation, may increase the success rate of endodontic treatments. This study aimed to assess the effect of neodymium-doped yttrium aluminum garnet (Nd:YAG) and diode lasers on the apical seal of the root canals filled with AH Plus® and mineral trioxide aggregate (MTA)-based sealers. MATERIALS AND METHODS: This in-vitro experimental study was conducted on 96 single-rooted, single-canal extracted human teeth with closed apices. The root canals were prepared by using ProTaper® rotary instruments and were randomly divided into six groups (n=16): 940-nm diode laser and AH Plus® sealer (group 1), Nd:YAG laser and AH Plus® sealer (group 2), AH Plus® sealer (group 3), 940-nm diode laser and MTA-based sealer (group 4), Nd:YAG laser and MTA-based sealer (group 5), MTA-based sealer (group 6), as well as positive and negative control groups. A bacterial leakage model was used for microleakage assessment. Qualitative assessment was done by using a scanning electron microscope (SEM). Data were analyzed by two-way analysis of variance (ANOVA) at the significance level of 0.05. RESULTS: There were statistically significant differences between the experimental and control groups (P=0.002). The laser-treated groups showed a lower apical microleakage compared to the non-laser-treated groups, although the difference was not statistically significant (P>0.05). No significant differences were noted between the two lasers in terms of the apical microleakage, irrespective of the type of sealer (P>0.05). CONCLUSIONS: Laser irradiation, as an adjunct to root canal preparation, has no significant effect on the level of apical microleakage.

Efficacy of Sodium Hypochlorite Activated With Laser in Intracanal Smear Layer Removal: An SEM Study.

Introduction: The purpose of the present study was to evaluate the different concentrations of sodium hypochlorite activated with laser in removing of the smear layer in the apical, middle, and coronal segments of root canal walls by scanning electron microscopy analysis. Methods: Sixty single-rooted human mandibular teeth were decoronated to a standardized length. The samples were prepared by using Race rotary system to size 40, 0.04 taper and divided into 4 equal groups (n = 15). Group 1, irrigated with EDTA 17% and 5.25% NaOCl, groups 2, 3 and 4, 1%, 2.5%, and 5% NaOCl activated with Nd:YAG laser, respectively. Teeth were split longitudinally and subjected to scanning electron microscope (SEM). Data were analyzed by Kruskal-Wallis, Mann-Whitney tests. P value of <0.05 was considered statistically significant. Results: Five percent NaOCl LAI (laser-activated irrigation) showed best smear layer removal in test groups and the difference was statistically significant (P < 0.001). Control group (EDTA 17% and 5.25% NaOCl irrigation) showed significantly better outcomes in comparative with test groups (P < 0.001). In the apical third, compared to coronal and middle third, the canal walls were often contaminated by inorganic debris and smear layer. Conclusion: All different concentrations of sodium hypochlorite activated with laser have a positive effect on removing of smear layer. Sodium hypochlorite activated with laser removed smear layer more effectively at the coronal and middle third compared to the apical third.

Comparison of Cone-Beam Computed Tomography and Intraoral Radiography in Detection of Recurrent Caries under Composite Restorations.

Secondary caries is the most common cause of dental restoration failures. This study aimed to compare the diagnostic accuracy of conventional and digital intraoral radiography and cone beam computed tomography (CBCT) for detection of recurrent caries around composite restorations. mesio-occluso-distal (MOD) cavities were prepared using bur on 45 extracted sound human molar teeth. The teeth were divided into 3 groups. In the control group, cavities were restored with composite resin after etching and bonding (n=15). In Group 2, 500-µm thick wax was placed over the buccal, lingual and gingival walls and the cavities were restored with composite resin. Group 3 specimens were subjected to pH cycling and artificial caries were created on the buccal, lingual and gingival walls. The cavities were restored with composite. Conventional and digital photo-stimulable phosphor (PSP; Optime) radiographs and two CBCTs images (NewTom 3G and Cranex 3D) were obtained from them. Presence or absence of caries in the cavity walls was assessed on these images. Data were analyzed using Kappa statistic. The diagnostic accuracy of CBCT was significantly higher than that of digital and conventional intraoral radiography (p<0.05). The accuracy was 0.83, 0.78, 0.55 and 0.49 for CBCT Cranex 3D, CBCT NewTom 3G, conventional and digital intraoral radiography, respectively. CBCT has a higher diagnostic accuracy than digital and conventional intraoral radiography for detection of secondary caries around composite restorations.