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  • ISSN: 2333-7133
    Bisphenol A in Dental Materials: A Review
    Authors: Liang Chen* and Byoung In Suh
    Abstract: Objective: To review scientific literature on BPA in dental materials, introducing the chemistry of BPA and its derivatives, and evaluating the BPA release and exposure from dental materials and the potential human health risks. Materials & methods: A search of English peer-reviewed dental literature from Pub Med and MEDLINE databases was conducted, and the key words included bisphenol A and BPA.
    Clinical Case Presentation: Challenging the American Board of Operative Dentistry Certification Examination
    Authors: Michael J. Metz1* and Cynthia J. Miller2
    Challenging The American Board of Operative Dentistry Certification (ABOD) was one of the most humbling, challenging and gratifying experiences of my dental career. To say that it is an honor to join the elite names on that list would be a serious understatement.
    Applications of Cone Beam Computed Tomography (CBCT) in Implant Treatment Planning
    Authors: Vandana Kumar1* and Keerthana Satheesh2
    The objective of this article is to review the literature which describes the evolving role of cone-beam computed tomography in dental implant treatment planning. The literature supports the use of CBCT in dental implant treatment planning particularly in regards to linear measurements.
    Effect of Light Curing Tip Distance and Immersion Media on the Degree of Conversion, Sorption and Solubility of Methacylate and Silorane-Based Composites
    Authors: Diogo de Azevedo Miranda1*, Nubia Pavesi Pini2, Glaucia Maria Bovi Ambrosano3, Flavio Henrique Baggio Aguiar3, Debora Alves Nunes Leite Lima3 and Jose Roberto Lovadino4
    The Effect of Home-Bleaching Agents on Surface Roughness of Restorative Materials
    Authors: Dionysopoulos D*, Koliniotou-Koumpia E, Gerasimou P and Papadopoulos C
    The purpose of this study was to evaluate the effect of two home-bleaching agents (10 and 20% carbamide peroxide) on the surface roughness of four tooth-colored restorative materials over time.
    Latest Articles
    Review Article
    Ronaldo Silva Cruz, Victor Eduardo de Souza Batista, Cleidiel Aparecido Araujo Lemos, Hiskell Francine Fernandes Oliveira, and Fellippo RamosVerri*
    Denture base fractures are a common problem in diary clinics. This article describes a simple technique to make cast metal reinforcement with Co-Cr dental alloy to be incorporated inner denture base maintaining the esthetic. This technique represents a rehabilitation option to help clinicians saving time for treatment that involves recurrent fractures of denture base without spend of time with recurrent appointments. This technique decreases patient dissatisfaction providing better resistance and stability for complete dentures.
    Maatouk Fethi*, Ayadi Abdessslem Ines, Masmoudi Fatma, Chemli Med Ali, and Ghedira Hichem
    Many studies reported the importance of the deciduous dentition and its rich pathology. A close relationship was also noted between occlusion in deciduous and in permanent dentitions. A literature review reported that the flush terminal plane relationship was accepted as the norm in the complete deciduous dentition, but some authors did not support this view.
    Aim: The purpose of this study conducted in Tunisian preschoolers was to assess the oral health and the occlusal patterns in primary dentition.
    Material and methods: The study consisted of a cross sectional survey covering 392 preschool children; 197 females (50.3%) and 195 males (49.7%) aged from 3 to 5 years in the kindergarten of Moknine (Tunisia). Oral examination was carried out in order to assess the oral health status and the occlusion characteristics.
    Results: Dental caries affected 140 children (35.7%). A mean dmft of 1.12 1.97 was noted with 426 decayed teeth (mean 1.10 1.0), five-missed (mean 0.01 0.8) and 9 filled (mean 0.01 0.05); the Significant Caries Index value (SiC) was about 5.57 2.26 dmft. Among 326 children in deciduous dentition, 68.7% presented spaced teeth. The dental eruption was earlier in girls. The prevalence of malocclusion was about 24.7% and the flush plane was the most frequent type of terminal molar relationship in deciduous dentition, followed by the mesial step than the distal step with 81%, 15% and 4% respectively.
    Conclusion: The present paper gave an outline onto oral health status and occlusal patterns in Tunisian preschool children. The spaced dentition seemed more frequent than closed dentition and the flush plane was the most frequent type of terminal molar relationship in deciduous dentition.
    Research Article
    Masae Ishihara*, Yuji Sato, Noboru Kitagawa, and Momoe Nakatsu
    Purpose: Various aspects of the retention of mandibular complete dentures are unclear, as no evaluation method has been established to date. This study aimed to clarify the effect of suitable mouth opening, the shape of the residual ridge, and the form of the denture on retention when measuring retention of mandibular complete dentures.
    Methods: The subjects were 37 individuals wearing mandibular complete dentures. The central incisor was loaded 45 downward toward the occlusal plane. The force needed to dislodge the denture was measured using a digital force gauge. The size of the mouth opening was defined as 1, 2, and 3 cm, and was measured four times. Retention forces were compared based on the shape of the molar residual ridge and the relative position of the anterior residual ridge crest.
    Results: As the size of the mouth opening increased, the retention decreased (P<.05). The variation index was the lowest when the mouth was opened to 1 cm. Denture retention increased as the viscosity of the oral moisturizer increased (P<.05). Retention decreased when the residual ridge in the anterior mandibular region was positioned relatively backward (r = -0.608, P<.01). There was a significant relationship between the height of the residual ridge in the molar region and denture retention.
    Conclusions: As the viscosity of the oral moisturizer increased, denture retention increased. The size of mouth opening needs to be defined when measuring retention. The size of mouth opening is stable at 1 cm; therefore, this is the optimal size. Retention was associated with the height of the molar region residual ridge and the relative position of the crest of the anterior residual ridge.
    Kensuke Tsubakida*, Yuuji Sato, Noboru Kitagawa, Momoe Nakatsu, Takeda Kana, Kakuda Takuya, Takayama Mari, and Ishihara Masae
    No previous study has clarified the experience of using adhesives/moisturizers by comparing them to subjective evaluations of patient satisfaction.
    In an ultra-aged society, most elderly individuals experience many oral problems. Particularly, xerostomia and mal adaptation to dentures may lead to poor retention of maxillary complete dentures. Many patients use denture adhesives; however, the effects of these adhesives on denture cleaning and denture function are not well understood in many cases. Therefore, oral moisturizers are often recommended instead of denture adhesives. The purpose of this study was to clarify the selection criteria for denture adhesives or oral moisturizers in wearers of maxillary complete dentures.
    Twenty-five maxillary edentulous subjects were enrolled in this study. A denture adhesive and three oral moisturizers (liquid, gel, and spray) were administered for 3 days each. Patients were surveyed after each treatment ("the after-use questionnaire") and at the end of the study ("the final questionnaire").
    In the after-use questionnaire, the denture adhesive was evaluated highly for "stability," "chewing," "fitting," and "retention" (P <0.05). On the final questionnaire, the denture adhesive was selected by 14 and the oral moisturizers by 11 of 25 subjects. Patients who selected the denture adhesive evaluated its "stability" and lack of an "uncomfortable feeling" highly; patients who selected the oral moisturizers evaluated the lack of a "dry feeling" highly (P <0.05).
    These results suggest that "stability," an "uncomfortable feeling," and a "dry feeling" were the driving criteria in choosing either the denture adhesive or an oral moisturizer.
    Ambarkova Vesna*
    The optimal amount of fluoride in drinking water is just one of the factors that positively influence the occurrence of dental caries and has an effect on the oral health of the population of the Republic of Macedonia. The correlation existing between dental fluorosis and fluorine concentration in water is based on average water consumption, a condition that depends directly from air temperature and local climate conditions. The climate in the Republic of Macedonia is characterized by the interweaving of Mediterranean and continental influences, and on very specific way the mild Mediterranean climate collide with the harsh continental climate. Mediterranean influences create a dry and hot summer, and continental influences cold and wet winter.
    The average annual temperature in our country is 11, 5C. The warmest month of the year is July, with an average air temperature of 22, 2C, while the coldest is January with an average temperature of 0, 3C.
    Former Yugoslav Republic of Macedonia expand between 40 50 and 42 20 north geographic latitude and 20 27 and 23 05 east geographic length. To provide protection against dental caries, we need to determine the optimal concentration of fluoride in drinking water using the mean annual air temperature. The majority of the population in the Republic of Macedonia used is supplied by drinking water from groundwater, from carbonates springs.
    Special Issue on Oral health of children with special health care needs (SHCN)
    Editorial
    Kowash M*
    Children with special health care needs (SHCN) are individuals with a medical, physical, psychological and/or social condition that requires individualization of dental treatment. They are one of the neediest, yet most underserved groups of dental patients.
    Review Article
    Dina Mansoor, Manal Al Halabi, and Kowash M*
    Globally 1 in every 68 child is diagnosed with Autism. Autism spectrum disorder (ASD) or Autism is a group of neurodevelopmental disorders, affecting the normal development and functioning of the brain in three core domains; reciprocal social interactions, verbal and non-verbal communication and the presence of restricted or repetitive behaviors. Typically it appears in the first three years of life and affects males four times more than females but females are more likely to show more signs of mental retardation. Other medical problems can co-exist along with Autism such as psychiatric illnesses, epilepsy; sleep disturbances, feeding problems, gastrointestinal problems and voiding problems. Autism cannot be cured, but the earlier the intervention the better the results. Medications, therapies and behavioral interventions can only alleviate Autism related symptoms and cause substantial improvement. Autism characteristics can have an impact on three different perspectives of dental care, which are oral care at home, oral care at the dentist and access to oral care. This paper aims to review and discuss the literature on the general and oral characteristics of children with Autism Spectrum Disorder in order to help the dental practitioners as well as the medical professionals in providing them with better oral and health services.
    Batool Ghaith, Manal Al Halabi, and Mawlood Kowash*
    A literature search was conducted to identify the key oral and dental manifestations of DS. These findings are discussed and used to suggest recommendations for treatment planning in DS patients for the practicing dental practitioner and also to help other medical professionals in understanding the oral health status of DS patients and the importance of liaison with dental professionals.
    Haifa Alhashmi, Mawlood Kowash*, and Manal Al Halabi
    Cerebral palsy (CP) is a group of neuromuscular disorders that affects the development of movement and posture, causing activity limitations. CP is classified into three main groups: spastic, dyskinetic and ataxic. Population-based studies from around the world report estimates of CP prevalence ranging from 1.5 to more than 4 per 1,000 live births. The commonest cause of CP remains unknown in 50% of the cases; prematurity remains the common asterisk factor. CP children suffer from numerous problems and potential disabilities such as mental retardation, epilepsy, feeding difficulties, and ophthalmologic and hearing impairments. This paper reviews and critically discusses the definition, epidemiology, aetiology, classifications, treatments and associated manifestation and complications of CP.
    Haifa Alhashmi, Mawlood Kowash*, and Manal Al Halabi
    Cerebral palsy (CP) is a group of neuromuscular disorders that affects the development of movement and posture, causing activity limitations. CP is classified into three main groups: spastic, dyskinetic and ataxic. Population-based studies from around the world report estimates of CP prevalence ranging from 1.5 to more than 4 per 1,000 live births. CP children suffer from numerous problems and potential disabilities such as mental retardation, epilepsy, feeding difficulties, and ophthalmologic and hearing impairments. Intra orally, Patients with cerebral palsy are reported to have several oral health problems such as poor oral hygiene, bruxism, drooling, traumatic dental injuries, and malocclusion.
    A literature search was conducted to identify the key oral and dental manifestations of CP. These findings are discussed and utilized to suggest recommendations for treatment planning in CP patients for the dental practitioner. The findings might also help other medical professionals in understanding the oral health status of CP patients and the importance of liaison with dental professionals.
    Mawlood Kowash*
    The management of children with special health care needs (SHCN) creates hesitation and anxiety among health professionals including dentists because it requires specialized knowledge acquired through special training, increased awareness, accommodative measures and resources. A literature search was conducted to identify updated and evidence-based recommendations and dental management options available for children with SHCN. These recommendations will assist dentists in determining the most appropriate dental management and also help other medical professionals in understanding the need to maintain optimaloral health for children with SHCN and the importance of liaison with dental professionals.
    Shaikha Al Raeesi, Mawlood Kowash*, and Manal Al Halabi
    Thalassemia is one of the most common inherited haemoglobinopathies characterized by either a partial or a complete suppression in the production of normal haemoglobin as a result of defective synthesis of one or more of the globins chains. Thalassemia is the most widely distributed genetic disorder. Approximately 5 % of the worlds population was found to have a globin variant, with only 1.7 % having an alpha or beta thalassemia trait. The Mediterranean region, the Middle East, the Indian subcontinent and Far East Asia show the highest rates of prevalence of beta thalassemia. Beta thalassemia is considered to be a major public health issue, as well as a life threating condition characterized by severe anaemia, hepatosplenomegaly, growth retardation, endocrine dysfunction, cardiac failure and skeletal changes.
    Shaikha Al Raeesi, Mawlood Kowash*, and Manal Al Halabi
    Thalassaemia, one of the most common genetic disorders, often causes serious medical, social, and psychological problems. Beta thalassaemia major is a life-threatening disorder that presents with a vast variability in the systemic signs and symptoms. In addition, orofacial and dental tissues are also affected. The common orofacial features among thalassaemic patients include: frontal bossing, skeletal overgrowth with characteristic appearances known as chipmunk faces, upper lip retraction, protrusion of pre maxilla bone associated with alveolar enlargement that causes malocclusion in the dentition with the clinical appearance of protrusion, flaring, spacing of anterior teeth and anterior open bite. The oral mucosa appears pale or a lemon yellow colour due to deposition of bilirubin pigmentation and anaemia. Sometimes the gingival colour tends to be dark, caused by high ferritin level in the blood.
    Current reports show a significant improvement in thalassaemia major patients survival rates. With increased life expectancy, the need for improved oral healthcare is very important to ensure a high quality of life for this patient population.
    This paper reviews the literatures and discusses briefly the dento-facial manifestations, radiographic features, dental caries, periodontal and soft tissue conditions related to beta thalassaemia major as well as dental management and considerations of thalassaemia patients.
    Research Article
    Fatema Al Muheiri and Carolina Duarte*
    Supernumerary teeth are teeth that exceed the normal dental formula. They have variable characteristics and may cause a number of clinical complications. In the Middle East, a prevalence of 0.3 - 2.14% has been observed; however, the number of studies of this condition is limited in the region. This study examined the prevalence and characteristics of supernumerary teeth in patients from RAK College of Dental Sciences Dental Clinic. A total of 2,925 panoramic radiographs were analyzed and demographic-clinical data was extracted from patient files. A prevalence of 0.75% was observed. Affected patients were predominantly South Asian males. The teeth were mostly supplemental, Para-premolars and impacted with low incidence of disto-molars and no difference in occurrence in the maxilla or mandible. Occurrence of multiple supernumerary teeth was low and restricted to one jaw. This study suggests that one of every 133 patients will have impacted supernumerary teeth that can be expected in the premolar area of the maxilla/mandible, which should be considered when planning community oral health diagnosis and dental treatment strategies.
    Granados JM, Rifaey H, Safavi K, Tadinada A, and Chen IP*
    Aims: Conservative endodontic access (CEA), which removes the least tooth structure necessary, has become a popular alternative to traditional endodontic access (TEA). This study aims to examine whether CEA affects endodontic referrals and whether CBCT can guide CEA. Methodology: A survey of general dentists (n=129) was conducted to determine the impact of CEA on endodontic referrals. To assess the effects of CBCT on CEA, 45 extracted molars were accessed by TEA (group A), CEA (group B) or CEA with pre-operative CBCT images provided (group C). The ratios of surface areas of coronal access to pulp floor were quantified and the time for access preparation was recorded. Statistics was performed using Graph Pad Prism 5. Results: While 81% of general dentists preferred CEA, only 33% considered it a determining factor for their endodontic referrals. TEA resulted in statistically significantly more coronal dentin removed than CEA with or without CBCT (surface area ratio: groups A: B: C= 1.37±0.38*: 0.88±0.42: 0.65±0.14; mean ± SD, *p<0.05, one-way ANOVA). There was no difference in operation time among three groups.
    Conclusions: CBCT has great potential to guide CEA preparation for beginners and CEA is a preferred access form to general dentists but is not a determining factor on endodontic referrals.
    Abeer Basunbul* and Stanley A. Alexander
    Purpose: The purpose of this in vitro study is to evaluate the efficacy of fluoride varnish in preventing enamel demineralization lesions adjacent to orthodontic brackets.
    Methods: Brackets were bonded to 60 extracted human premolars with traditional composite resin and resin modified glass ionomer cement (Both without fluoride) and 15 teeth were randomly assigned to four equal test groups. Demineralization of enamel was evaluated in longitudinal buccolingual tooth sections using polarized light microscopy.
    Results: ANOVA (P < 0.05) indicated significant differences in depth and area of demineralized enamel in all the groups. Those teeth treated with fluoride varnish exhibited 50% less demineralization than the control teeth in both the composite and the resin modified glass ionomer cement groups.
    Conclusion: Fluoride varnishes should be considered for use as a preventive adjunct to reduce enamel demineralization adjacent to orthodontic brackets, particularly in patients who exhibit poor compliance with oral hygiene and home fluoride use.
    Review Article
    Michel Goldberg*
    The anatomy and biology of dentin tissues vary according their different location in the teeth. Beneath the thin mantle dentin, distinct layers include a primary dentin (tubular or orthodentin), a secondary dentin (reparative osteodentin), and a tertiary dentin (or reactionary dentin) [1-3]. Depending on the coronal and radicular parts of the tooth, substantial differences have been actually identified. In the dental pulp chamber, cell-free and cell-rich zones constitute two superficial layers located at the periphery of the central pulp. These outer layers are lining the roof, floor, mesial, distal, labial, and buccal surfaces. In the crown, fibrosis of the pulp, true and false dental stones and dystrophic calcifications contribute to pulp inflammation and repair. In the root canal, pulp cells (also called pulpoblasts) and fibers have structural incidences (e.g. Type I and type III collagens) [1,2]. Adhesive molecules, including fibronectin, laminine, vitronectine and thrombospondin are determining factors implicated in the root canal composition. Elastase and cathepsin G contribute to serine proteases and metalloproteinase's (MMP-2, MMP-9, MMP-3). Altogether, they are implicated in the biological parameters of the pulp canal. Proteolytically cleaved into DSP, DGP and DPP, DSPP is synthesized by secretory odontoblasts. Cbfa-1 is critical for the root canal biology. Proteoglycans such as HSP90, KS, CS are modulating the root canal response. Osteocalcin is a non-phosphorylated molecule contributing to the root canal condition. In addition, stem cells (DPSCs, SHED and SCAP) are involved in the recruitment and differentiation of cells located in the pulp root canal [4]. The anatomic complexity and the biology of the root canal have therapeutic occurrences.
    Ferraz LN, Oliveira ALBM, Grigoletto M, and Botta AC*
    The residual oxygen can negatively interfere with the adhesive polymerization, and reduce the bond strength to bleached enamel. The aim of this study was to review the literature on methods for reversing the bond strength to bleached enamel, efficacy and clinical feasibility. A waiting period, the use of dental adhesives containing organic solvents and application of organic solutions or antioxidant agents are the most used methods in an attempt to reverse bond strength to bleached enamel. Delaying bonding for 1 week after bleaching is sufficient to remove any residual oxygen and reverse the bond strength to enamel, regardless the bleaching agent used. Alcohol and acetone used as organic solutions or solvents in dental adhesives are able to increase the enamel bond strength, but not reestablish it completely. Enzymatic agents such as catalase and, peroxidase; and non-enzymatic agents such as sodium ascorbate, flavonoids and vitamin E have antioxidant properties. However, the high cost and proven efficacy only in prolonged use hamper the clinical application of antioxidant agents. The most established method for reversing the decreased bond strength to bleached enamel is the waiting period of at least one week. Further studies should be conducted to evaluate the application of alcohol, acetone, and antioxidant agents in different concentrations and for a short period of time to be clinically feasible and efficient in a short and long term.
    Case Report
    Marina Goncalves de Andrade*, Daniel Miranda de Paula, Paloma Heine Quintas, Mariana Machado Mendes de Carvalho, Braulio Carneiro Junior, and Roberto Almeida de Azevedo
    Objective: The aim of this study is to describe a case of cementoblastoma associated with a lower second molar, with its clinical features, differential diagnosis, treatment instituted and determinants of treatment success.
    Case description: A 60year-old female presented at the Maxillofacial Surgery clinic, from Dentistry School of Federal University of Bahia claiming to have an injury in the jaw, there was no significant facial asymmetry, imaging exams (CT Cone Bean) were analyzed and showed a hyperdense image associated with the roots of the tooth 37. The imaging findings suggested a cementblastoma. The lesion was excised and it was performed curettage with the extraction of the tooth 37. The histopathological analysis conclusion was cementoblastoma. After a follow-up of 12 months, the patient had no complaints and a good standard of healing.
    Discussion and conclusion: Despite being a benign tumor, with low recurrence rate and associated in most cases to the first molar, the cementoblastoma can affect any age, gender, race and teeth. Therefore, the dentist should perform an accurate diagnosis of the pathology; the lesion should be completely excised with the extraction of the associated teeth. And in order to prevent further complications such as a reoccurrence of the tumor, it is recommended a follow up the patient.
    Research Article
    Wisesphon Sutthidechanai, Nopawun Viriyasiri, and Smorntree Viteporn*
    Background: Anterior crossbite and concave facial profile are common problems in unilateral cleft lip and palate (UCLP) and skeletal Class III patients. The objectives of the study were to scrutinize the effect of early orthodontic treatment with different treatment modalities on the cleft and non-cleft patients and to compare the significant differences between the two groups.
    Material and methods: The sample was comprised 64 subjects (32 non-syndromic UCLP subjects with mean age 10.91 ± 2.00 years and 32 skeletal Class III non-cleft subjects with mean age 10.52 ± 1.65 years who were treated as a non-extraction case, main treatment mechanics were arch expansion and Class III traction in the cleft patients and protraction headgear in the non-cleft patients. Dento-skeletal and soft tissue profile changes were evaluated from lateral cephalograms before and after treatments. Paired t test and independent t test were utilized to evaluate the significant changes within and between groups, respectively.
    Results: The initial characteristics of UCLP patients were skeletal Class III maxillary retrusion and relative mandibular prognathism, retroclination and retrusion of the maxillary incisors. Treatment effects in both groups were mainly dento-alveolar effect. Significant proclination of the upper incisors following anterior crossbite correction attributed to the increase of upper lip protrusion and soft tissue convexity in both groups. Significant lower lip retrusion was found only in the non-cleft group.
    Conclusion: Early orthodontic treatment of the anterior crossbite could improve facial profile of the cleft and non-cleft patients, the cleft patients exhibited less favorable response to the treatment especially the lower lip area.
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