Vol 15, No 1 (2018)

Original Article

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    Objectives: Enterococcus faecalis (E. faecalis) is the most commonly isolated microorganism from teeth with postoperative infection. Triple antibiotic paste (TAP) has the ability to eradicate microorganisms from the root canal system when used as an intracanal medicament. The aim of this study was to determine the minimum duration of application of TAP required for elimination of E. faecalis from the root canal system and its minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) in an ex-vivo model.
    Materials and Methods: Root canals of 34 extracted human single canal teeth were inoculated with E. Faecalis after instrumentation, and then 4 g of TAP (ciprofloxacin, metronidazole and doxycycline) was mixed with 4.5 mL of saline and applied as intracanal medicament. The teeth were sectioned longitudinally and dentin chips were collected and evaluated to determine the count of bacterial colonies. Micro-dilution broth test was used to assess the MIC and MBC of TAP. Data were analyzed using SPSS version 22 via the Wilcoxon signed rank test.
    Results: After seven days of application of TAP as intracanal medicament, E. faecalis was eliminated from the dentinal tubules of the apical half of root canal up to 400 µ depth. The MIC and MBC of TAP in its original concentration were both found to be 16 µg/mL.  
    Conclusions: The original concentration of TAP was found to be 5×104 times its MIC. Considering the risk of coronal discoloration of teeth following the use of TAP, application of its lower concentrations is recommended.

  • XML | PDF | downloads: 305 | views: 653 | pages: 10-19

    Objectives: The position of dental implants in the alveolar bone can affect the surrounding bone from biomechanical and biological aspects. The purpose of this study was to evaluate the effect of implant position on stress and strain distribution in the surrounding bone by using finite element analysis (FEA).
    Materials and Methods: Thirteen computerized models of a 3.8-mm-diameter XiVE implant with the abutment and crown of a mandibular second premolar in a mandibular bone segment were designed. In the reference model, the implant was placed at the center of the alveolar ridge with its crest module located above the alveolar crest. In the other models, the implants were positioned buccally, lingually, coronally or apically by 0.5, 1 or 1.5mm. By using the ANSYS software program, a 100-N load was applied to the buccal cusp parallel to and at a 30-degree angle relative to the longitudinal axis of the fixture. The models were analyzed in terms of the distribution of stress and strain in the bone.
    Results: The different implant positions induced nonlinear stress and strain changes in the bone. The central, 1.5-mm apical, and 1.5-mm coronal implant positions induced high amounts of stress and strain under off-axial loads.
    Conclusions: Within the limitations of this study, the results showed that the stress and strain in the bone around the implant undergo small nonlinear changes with buccolingual and apicocoronal shifting of the implant and can be affected by the configuration of the implant in contact with the bone.

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    Objectives: The aim of this study was to compare the efficacy of bovine bone substitute (Compact Bone B. ®) alone versus bovine bone substitute and simvastatin for human maxillary sinus augmentation.
    Materials and Methods: This study was conducted on 16 sinuses in eight patients. Radiographic assessments were done preoperatively (T0), immediately (T1) and at nine months after sinus grafting (T2). Alveolar bone height and density were assessed on cone beam computed tomography (CBCT) scans using Planmeca Romexis™ Imaging Software 2.2.
    Results: The change in alveolar bone height and density between T0, T1 and T2 was significant in both groups. Alveolar bone height (h0, h1, h2) and vertical height of the grafted bone (g1, g2) in three lines (anterior, middle and posterior) were not significantly different between groups. The grafted bone height shrinkage (%) in the anterior, middle and posterior limits of the augmented area were not significantly different between groups. The existing alveolar and grafted bone density increased significantly in both groups between T1 and T2, except for the existing alveolar bone density in the control group. There were no statistically significant differences between the alveolar bone density values obtained in TI and T2 between groups, except for the existing alveolar bone density at T1.
    Conclusions: This study did not show any significant positive effect for simvastatin in maxillary sinus augmentation based on radiographic examination.

  • XML | PDF | downloads: 230 | views: 392 | pages: 30-40

    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.

  • XML | PDF | downloads: 242 | views: 424 | pages: 41-46

    Objectives: This study sought to assess the efficacy of modified pedicle grafting as a noninvasive technique for soft tissue augmentation around maxillary dental implants.
    Materials and Methods: This descriptive study was conducted on eight patients who met the inclusion criteria. Prior to the second-stage surgery for exposing the implants, the buccal keratinized mucosa width, vestibular depth, and mucosal thickness around the implants were measured. The same parameters were measured six months after the second-stage surgery and were compared with the baseline values. Also, the color match of the graft with the adjacent gingival and mucosal tissues was evaluated.
    Results: Forty-seven maxillary implants were evaluated. The minimum and maximum gains of keratinized mucosal width were respectively equal to 0mm and 7mm, with a mean of 4.31±1.19mm. The mean vestibular depth around the implants was 9.47±1.75mm (ranging from 5mm to 12mm) six months after the surgery. At the beginning of the study, a thin mucosa surrounded the implants, but after six months, the peri-implant keratinized mucosa width increased. The color match of the graft with the adjacent gingival and mucosal tissues was excellent based on the periodontists' opinion.
    Conclusions: Modified pedicle grafting is a safe and predictable technique for soft tissue augmentation around maxillary implants. This technique is reliable for increasing the width of keratinized mucosa in fully and partially edentulous patients with a shallow vestibular depth. The stability of the pedicle flap is achieved by fixing the flap to the tissue around the healing abutment.

  • XML | PDF | downloads: 280 | views: 542 | pages: 47-53

    Objectives: This study aimed to assess the bite force of 3-6-year-old children in primary dentition period after unilateral extraction of a primary first molar (D) and its correlation with the height, weight, gender, type of occlusion, and temporomandibular disorders (TMDs).
    Materials and Methods: Twenty children between the ages of 3 and 6 years with a unilaterally extracted D comprised our case group, and 29 age-matched children with no extracted teeth comprised the control group. The maximum bite force at the site of posterior teeth was measured using a bite force measuring device with a 0.2-mm thickness and 3-cm diameter, attached to a strain-gage sensor. Each child bit the sensor with maximum force for 3 seconds, and this was repeated three times at 10-minute intervals. The mean value was calculated. Data were analyzed using SPSS 18 software program via generalized estimating equation (GEE).
    Results: the bite force on the side of extraction was significantly lower than that on the contralateral side (P<0.05). Also, the bite force was significantly correlated with the height, gender, and age, but the correlations between the bite force and weight, type of occlusion and side of the jaw were not significant (P>0.05).
    Conclusions: Extraction of primary first molars decreases the bite force on the respective side of the jaw.

  • XML | PDF | downloads: 230 | views: 577 | pages: 54-62

    Objectives: Rebonding of isolated brackets is an economic option that can be conducted using available in-office or commercial recycling methods. Nowadays, lasers are known as an efficient modality for composite removal, but there is not much information available about using lasers for removal of adhesive remnants from the ceramic bracket base.
    Materials and Methods: Fifty human premolar teeth were divided into five groups. Samples in all groups were bonded to ceramic brackets. Brackets in four groups were debonded and the remaining adhesive was removed by Er:YAG laser, Er;Cr:YSGG laser, sandblasting or direct flame. After removing adhesives from the tooth surfaces by carbide bur, the recycled brackets were bonded again. in the control group, new ceramic brackets were bonded.  Finally, all brackets were debonded by universal testing machine and their shear bond strength (SBS) was measured. The adhesive remnant index (ARI) was calculated under a stereomicroscope at x10 magnification. Data were analyzed using one-way ANOVA and Tukey’s test.
    Results: SRS values showed no significant difference among the five groups (P=0.568). The highest SRS was noted in the control group (7.46±1.4 MPa), followed by Er:YAG laser group (7.40±1.24 Mpa) and the lowest was noted in the flame group (6.32±2.3 Mpa). ARI scores indicated that most of the adhesive remained on the tooth surface in all groups
    Conclusions: Recycling of ceramic brackets with Er:YAG laser is an efficient in-office method which causes the least damage to the bracket base. However, all methods of bracket recycling showed acceptable SBS.

Case Report

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    This case report presents a 16-year-old boy with bilateral temporomandibular joint (TMJ) bony ankylosis due to trauma. The patient had undergone several unsuccessful therapeutic surgeries and was experiencing reduced mouth opening, difficulty in eating and speaking, poor oral hygiene, snoring, and depression. Bilateral gap arthroplasty and distraction osteogenesis (DO) were performed. After the surgery, we were able to move the osteodistractors forward and prevent the upward and backward movement of the proximal mandibular segment with the use of our custom-made Sh-device, which allowed bone growth and soft-tissue matching. The mandibular deficiency was treated, and the patient's sleep quality significantly improved after three months. The physical, orthodontic and speech therapies were continued. The facial asymmetry, difficulty in sleeping, eating and speaking, and low self-esteem were completely resolved. At the 8-year follow-up, the patient's condition was satisfactory. The Sh-device can be used as a contemporary treatment modality for TMJ ankylosis.