Evaluation of pH and calcium ion release of new root-end filling materials

Objective. The purpose of this study was to evaluate the pH and calcium ion release of 6 materials used for root-end filling and perforation repair. Study design. Gray ProRoot MTA, gray MTA-Angelus, white MTA-Angelus, and CPM were compared to 2 experimental ones: MTA-exp, also based in Portland cement with a modified mixing liquid, and MBPc, an epoxy-resin based cement containing calcium hydroxide. After 3, 24, 72, and 168 hours the water in which each sample had been immersed was tested to determine the ph and calcium ion release. Results. All the analyzed materials showed alkaline pH and capacity to release calcium ions; however, a tendency of reduction of these characteristics was noted for all the analyzed materials, except for the MBPc, which showed a slight increase of pH among the 3 initial periods. Conclusion. The results suggest that all materials investigated presented alkaline pH and ability of release of calcium ions. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 135-139)

Biocompatibility evaluation of alendronate paste in rat`s subcutaneous tissue

Alendronate is a known inhibitor of root resorption and the development of alendronate paste would enhance its utilization as intracanal medication. Therefore, this study aimed to investigate the biocompatibility of experimental alendronate paste in subcutaneous tissue of rats, for utilization in teeth susceptible to root resorption. The study was conducted on 15 male rats, weighing similar to 180-200 grams. The rats` dorsal regions were submitted to one incision on the median region and, laterally to the incision, the subcutaneous tissue was raised and gently dissected for introduction of two tubes, in each rat. The tubes were sealed at one end with gutta-percha and taken as control. The tubes were filled with experimental alendronate paste. The animals were killed at 7, 15 and 45 days after surgery and the specimens were processed in laboratory. The histological sections were stained with hematoxylin-eosin and analyzed by light microscopy. Scores were assigned to the in. ammatory process and statistically compared by the Tukey test (P < 0.05). Alendronate paste promoted severe inflammation process at 7 days, with statistically significant difference compared to the control (P < 0.05%). However, at 15 days, there was a regression of in. ammation and the presence of connective tissue with collagen fibers, fibroblasts and blood vessels was observed. After 45 days, it was observed the presence of well-organized connective tissue, with collagen fibers and fibroblasts, and few in. ammatory cells. No statistical difference was observed between the control and experimental paste at 15 and 45 days. The experimental alendronate paste was considered biocompatible with subcutaneous tissue of rat.

Evaluation of the temperature of different refrigerant sprays used as a pulpal test

The temperature of different refrigerant sprays (Endo-Ice, Endo-Frost, Coolermatic and Sprayon Contact and Tuner Cleaner) used as pulpal tests were evaluated in vitro. A thermocouple placed inside the pulp chamber of a maxillary central incisor was used to register the temperature changes when the refrigerant sprays were applied with a cotton swab, for 10 s. Results indicate that Endo-Ice and Endo-Frost presented the lowest temperatures among the refrigerant sprays tested. Temperatures measured inside the pulp chamber, however, were statistically similar in all groups.

Bacterial leakage in root canals obturated by different techniques. Part 1: microbiologic evaluation

Objective. This study compared the coronal bacterial leakage of root canals obturated by different techniques and with different lengths of obturation. Study design. The canals of palatal roots of 160 maxillary molars were instrumented and divided into different groups according to the obturation technique used (lateral condensation, Microseal system, Touch `n Heat + Ultrafil system, or Tagger`s hybrid technique) and the length of obturation (5 mm or 10 mm). The roots were impermeabilized, sterilized in ethylene oxide, and mounted on a device for evaluation of the bacterial leakage. Results. Tagger`s hybrid technique produced a statistically greater number of specimens with coronal leakage than the other techniques. There was no statistically significant difference between the lateral condensation, Touch `n Heat + Ultrafil, and Microseal groups. Root canals with 10 mm of obturation produced a statistically significantly smaller number of specimens with leakage than root canals with 5 mm of obturation. Conclusion. Tagger`s hybrid technique produced a greater number of specimens with coronal leakage than the other techniques, and a greater number of root canals with 5 mm of obturation leaked than root canals with 10 mm of obturation.

Evaluation of proximal caries in images resulting from different modes of radiographic digitalization

Objective: The aim of this study was to evaluate the performances of observers in diagnosing proximal caries in digital images obtained from digital bitewing radiographs using two scanners and four digital cameras in Joint Photographic Experts Group (JPEG) and tagged image file format (TIFF) files, and comparing them with the original conventional radiographs. Method: In total, 56 extracted teeth were radiographed with Kodak Insight film (Eastman Kodak, Rochester, NY) in a Kaycor Yoshida X-ray device (Kaycor X-707;Yoshida Dental Manufacturing Co., Tokyo, Japan) operating at 70 kV and 7 mA with an exposure time of 0.40 s. The radiographs were obtained and scanned by CanonScan D646U (Canon USA Inc., Newport News, VA) and Genius ColorPage HR7X (KYE Systems Corp. America, Doral, FL) scanners, and by Canon Powershot G2 (Canon USA Inc.), Canon RebelXT (Canon USA Inc.), Nikon Coolpix 8700 (Nikon Inc., Melville, NY), and Nikon D70s (Nikon Inc.) digital cameras in JPEG and TIFF formats. Three observers evaluated the images. The teeth were then observed under the microscope in polarized light for the verification of the presence and depth of the carious lesions. Results: The probability of no diagnosis ranged from 1.34% (Insight film) to 52.83% (CanonScan/JPEG). The sensitivity ranged from 0.24 (Canon RebelXT/JPEG) to 0.53 (Insight film), the specificity ranged from 0.93 (Nikon Coolpix/JPEG, Canon Powershot/TIFF, Canon RebelXT/JPEG and TIFF) to 0.97 (CanonScan/TIFF and JPEG) and the accuracy ranged from 0.82 (Canon RebelXT/JPEG) to 0.91 (CanonScan/JPEG). Conclusion: The carious lesion diagnosis did not change in either of the file formats (JPEG and TIFF) in which the images were saved for any of the equipment used. Only the CanonScan scanner did not have adequate performance in radiography digitalization for caries diagnosis and it is not recommended for this purpose. Dentomaxillofacial Radiology (2011) 40, 338-343. doi: 10.1259/dmfr/67185962

Evaluation of sutures after immersion in nonalcoholic benzydamine hydrochloride mouthrinse by scanning electron microscopy

This study evaluated the surface integrity of sutures after immersion in mouthrinse or water, by scanning electron microscopy (SEM) analysis. Pieces of resorbable suture remaining after oral surgery were immediately collected. Twelve pieces each of catgut, chromed catgut, and polyglactin 910 were divided into four groups and immersed in pure mouthrinse, mouthrinse diluted in water at 1:1 and 1:2, or water (positive control), for 24 h. Three pieces each of new sutures were used as negative control. Specimens were placed on stubs and sputter coated with gold for SEM analysis. Observation of experimental groups and comparison with controls revealed that immersion in the mouthrinse at different dilutions did not alter their surface; slight, nonsignificant changes were found in some experimental specimens yet also in the positive control group. It was concluded that immersion of resorbable sutures in water or non-alcoholic benzydamine hydrochloride mouthrinse did not produce any significant change; therefore, this mouthrinse may be safely employed after oral surgery.

Management of a permanent tooth after trauma to deciduous predecessor: an evaluation by cone-beam computed tomography

Impaction of permanent teeth represents a clinical challenge with regard to diagnosis, treatment plan, and prognosis. There is a close relationship between deciduous teeth and permanent teeth germ, and any injury in the deciduous dentition may influence the permanent teeth eruption. The extent of the damage caused to the permanent teeth germ depends on the patient age at the time of injury, type of trauma, severity, and direction of the impact. Conventional radiographic images are frequently used for diagnosis; however, recent developments in three-dimensional (3D) imaging systems have enabled dentistry to visualize structural changes effectively, with better contrast and more details, close to the reality. The cone-beam computed tomography (CBCT) has been used in the diagnosis and treatment plan of these impacted teeth. The purpose of the present case report is to describe a successful conservative management of a retained permanent maxillary lateral incisor with delayed root development after a trauma through the deciduous predecessor in a 9 year-old patient. After clinical and radiographic examination, a CBCT examination of the maxilla was requested to complement the diagnosis, providing an accurate 3D position of the retained tooth and its relationship to adjacent structures. The proposed treatment plan was the surgical exposure and orthodontic traction of the retained tooth. The lateral incisor spontaneously erupted after 6 months. Therefore, this case report suggests that permanent teeth with incomplete root formation have a great potential for spontaneous eruption because no tooth malposition or mechanical obstacles are observed.

Cephalometric evaluation in different phases of Jasper jumper therapy

Introduction: The aim of this study was to evaluate the dentoskeletal and soft-tissue effects of Class II malocclusion treatment with the Jasper jumper followed by Class II elastics at the different stages of therapy. Methods: The sample comprised 24 patients of both sexes (11 boys, 13 girls) with an initial age of 12.58 years, treated for a mean period of 2.15 years. Four lateral cephalograms were obtained of each patient in these stages of orthodontic treatment: at pretreatment (T1), after leveling and alignment (T2), after the use of the Jasper jumper appliance and before the use of Class II intermaxillary elastics (T3), and at posttreatment (T4). Thus, 3 treatment phases could be evaluated: leveling and alignment (T1-T2), use of the Jasper jumper (T2-T3), and use of Class II elastics (T3-T4). Dependent analysis of variance (ANOVA) and Tukey tests were used to compare the durations of the 3 treatment phases and for intragroup comparisons of the 4 treatment stages. Results: The alignment phase showed correction of the anteroposterior relationship, protrusion and labial inclination of the maxillary incisors, and reduction of overbite. The Jasper jumper phase demonstrated labial inclination, protrusion and intrusion of the mandibular incisors, mesialization and extrusion of the mandibular molars, reduction of overjet and overbite, molar relationship improvement, and reduction in facial convexity. The Class II elastics phase showed labial inclination of the maxillary incisors; retrusion, uprighting, and extrusion of the mandibular incisors; and overjet and overbite increases. Conclusions: The greatest amount of the Class II malocclusion anteroposterior discrepancy was corrected with the Jasper jumper appliance. Part of the correction was lost during Class II intermaxillary elastics use after use of the Jasper jumper appliance. (Am J Orthod Dentofacial Orthop 2011;140:e77-e84)

Evaluation of anterior open-bite treatment with occlusal adjustment

Introduction: The purpose of this study was to evaluate the cephalometric and occlusal changes, the functional occlusion, and the dentinal sensitivity of anterior open-bite treatment with occlusal adjustment. Methods: The sample comprised 20 patients who experienced relapse of the anterior open bite (mean, -1.06 mm). Occlusal adjustment was performed until a positive overbite was established. Cephalometric changes were evaluated on lateral cephalograms taken before and after the occlusal adjustment. The functional occlusion analysis consisted of evaluating immediate anterior and canine guidance and the number of teeth in contact before and after the procedure. Dentinal sensitivity was evaluated before, shortly after, and 4.61 months after the occlusal adjustment. Pretreatment and posttreatment cephalometric changes and the number of teeth in contact were compared with dependent t tests. Percentages of anterior and canine guidance before and after the adjustment procedure were compared with the McNemar test. To compare dentinal sensitivity at several stages, the nonparametric Friedman test was used, followed by the Wilcoxon test. Results: Significant increases in overbite and mandibular protrusion were seen, as were significant decreases in apical base discrepancy, facial convexity, and growth pattern angles. The percentages of immediate anterior and canine guidance increased significantly, as did the number of teeth with occlusal contacts. Dentinal sensitivity increased immediately after the adjustment but decreased to normal levels after 4.61 months. Conclusions: Occlusal adjustment is a viable treatment alternative for some open-bite patients; it establishes positive vertical overbite and improves the functional occlusion with only transient dentinal sensitivity.

Six-year evaluation of the atraumatic restorative treatment approach in permanent-tooth Class III restorations

Purpose: The aim of this study was to assess the 6-year performance of the ART (atraumatic restorative treatment) approach in Class III restorations in permanent teeth. Materials and Methods: A total of 127 ART Class III restorations, using Ketac-Molar (3M ESPE) ionomer cement, was performed in 58 adult patients by one experienced operator in 1998. After a 6 years, 34 patients and 65 restorations were evaluated according to ART criteria. Two calibrated examiners carried out the evaluation. Data were analyzed by exact 95% Confidence Interval and Survival Analysis using the Jackknife method for standard error determination. Results: Among assessed restorations, 73.8% (95% CI = 61.5% to 86.2%) were in good condition and classified as successful, with a 67.6% (95% CI = 54.4% to 80.7%) cumulative survival rate. Failed restorations included 13.9% completely or partially missing restorations, 9.2% restorations that had been replaced by other treatment, 1.5% restorations with a large defect at the margin, and 1.5% restorations that presented high wear on the surface. No caries was observed even in those teeth in which restorations were absent. Conclusion: The 6-year success rate of the ART approach in anterior permanent teeth (Class III) was considered high.

A Randomized Clinical Evaluation of a One- and Two-step Self-etch Adhesive Over 24 Months

Objective: To evaluate the performance of All Bond SE used in a one- or two-step protocol in a 24-month randomized clinical study. Methods: Thirty-three patients with two similarly sized non-carious cervical lesions participated in this study. A total of 66 restorations were placed, half using the one-step All Bond SE protocol (SE-1) and the other half using the two-step All Bond SE protocol (SE-2). The restorations were evaluated at baseline and after 6, 12 and 24 months following the modified USPHS criteria and analyzed by the McNemar`s test and Fisher`s exact test (alpha=0.05). Results: After 24 months, six SE-1 and four SE-2 restorations were rated as Bravo in marginal discoloration The retention rates for SE-1 and SE-2 were 84.8% and 90.9%, respectively, after 24 months. Compared to baseline, the retention rate for SE-1 was statistically lower. Conclusions: All Bond SE used in the one- or two-step protocol resulted in high retention rates after 24 months.

Evaluation of the presence or absence of papilla between tooth and implant

Objective: The purpose of this study was to evaluate the papilla level adjacent to single-tooth implants in the maxillary anterior region in individuals with cleft lip, alveolus, and palate to verify whether there is correlation among the vertical distance, horizontal distance, dental/prosthetic crown shape, and periodontal/peri-implant biotype with the presence of interproximal papilla. Design: Cross-sectional. Setting: Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (HRAC/USP). Patients: 77 papillae in 40 patients. Interventions: The periodontal/peri-implant biotype was clinically evaluated and characterized as thin or thick. Intraoral photographs were used to evaluate the presence or absence of papilla. Main Outcome Measures: Classification in scores (0 to 3) and determination of length (CL) and width (CW) of crowns adjacent to papillae. The CW/CL ratio was calculated for each crown in order to characterize it as square-shaped or triangular-shaped. The vertical and horizontal distances were obtained by radiographic evaluation. Results: The correlations between vertical distance and papilla score and horizontal distance and papilla score were statistically significant (p= .02 and p = .01). There was no significant difference between crown shape and periodontal/peri-implant biotype in distinct correlations with the papilla score (p = .41 and p = .07). Conclusion: The results suggest that the vertical and horizontal distances may have independent or combined relationship with the existence of interproximal papilla; the periodontal/peri-implant biotype (phenotype) was not correlated with the presence or absence of papilla, as well as the shape of the dental/prosthetic crown.

Image quality assessment and medical physics evaluation of different portable dental X-ray units

Introduction: Recently developed portable dental X-ray units increase the mobility of the forensic odontologists and allow more efficient X-ray work in a disaster field, especially when used in combination with digital sensors. This type of machines might also have potential for application in remote areas, military and humanitarian missions, dental care of patients with mobility limitation, as well as imaging in operating rooms. Objective: To evaluate radiographic image quality acquired by three portable X-ray devices in combination with four image receptors and to evaluate their medical physics parameters. Materials and methods: Images of five samples consisting of four teeth and one formalin-fixed mandible were acquired by one conventional wall-mounted X-ray unit, MinRay (R) 60/70 kVp, used as a clinical standard, and three portable dental X-ray devices: AnyRay (R) 60 kVp, Nomad (R) 60 kVp and Rextar (R) 70 kVp, in combination with a phosphor image plate (PSP), a CCD, or a CMOS sensor. Three observers evaluated images for standard image quality besides forensic diagnostic quality on a 4-point rating scale. Furthermore, all machines underwent tests for occupational as well as patient dosimetry. Results: Statistical analysis showed good quality imaging for all system, with the combination of Nomad (R) and PSP yielding the best score. A significant difference in image quality between the combination of the four X-ray devices and four sensors was established (p < 0.05). For patient safety, the exposure rate was determined and exit dose rates for MinRay (R) at 60 kVp, MinRay (R) at 70 kVp, AnyRay (R), Nomad (R) and Rextar (R) were 3.4 mGy/s, 4.5 mGy/s, 13.5 mGy/s, 3.8 mGy/s and 2.6 mGy/s respectively. The kVp of the AnyRay (R) system was the most stable, with a ripple of 3.7%. Short-term variations in the tube output of all the devices were less than 10%. AnyRay (R) presented higher estimated effective dose than other machines. Occupational dosimetry showed doses at the operator`s hand being lowest with protective shielding (Nomad (R): 0.1 mu Gy). It was also low while using remote control (distance > 1 m: Rextar (R) < 0.2 mu Gy, MinRay (R) < 0.1 mu Gy). Conclusions: The present study demonstrated the feasibility of three portable X-ray systems to be used for specific indications, based on acceptable image quality and sufficient accuracy of the machines and following the standard guidelines for radiation hygiene. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Evaluation of distances between the mandibular teeth and the alveolar process in Brazilians with normal occlusion

Introduction: The aims of this study were to evaluate the distances between the mandibular permanent teeth and the alveolar process in Brazilians with normal occlusion and to compare them with normal American values. Methods: We used 59 mandibular casts from untreated subjects who had permanent dentition and the 6 keys to normal occlusion. A computer program was used to calculate the distances between the dental reference points and the alveolar process for each tooth. The mean values were then compared to the normal values by applying the Student t test at a significance level of 0.05. Results: The results showed a progressive increase of these distances from the anterior region (incisors) to the posterior region (molars), from 0.00 to 2.49 mm. All measurements had statistically significant differences from the American sample, except for the values for canines and first premolars. Conclusions: Brazilians with normal occlusion have more lingual crown positions for the incisors, second premolars, and molars compared with Americans with normal occlusion. Although these findings were statistically significant, they are unlikely to be clinically significant. (Am J Orthod Dentofacial Orthop 2010; 137: 308.e1-308.e4)

Bacterial leakage evaluation of root canals filled with different endodontic sealers

Objective. The objective of this study was to evaluate the sealing ability of AH Plus, Epiphany, Acroseal, Endofill, and Polifil after active lateral condensation technique, by using a bacterial test, during 64 days. Study design. One hundred bovine incisors were cleaned and shaped; then they were filled with the endodontic sealers and adapted into a microcentrifuge tube. The setup root/microcentrifuge tube was added to glass flasks containing Brain Heart Infusion broth. A culture of Enterococcus faecalis was inserted into the upper chamber of each assembly. Daily leakage was evaluated through the broth turbidity. Results. The results were submitted to statistical analysis (Kaplan-Meier method, Kruskal-Wallis and Dunn tests). Conclusions. AH Plus and Endofill had the worst sealing ability when compared with Polifil, which showed the least leakage. Acroseal and Epiphany showed a tendency toward having an intermediate behavior; however, there was no significant difference among Acroseal, Epiphany, and the other sealers. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: e56-e60)