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Published: 3 December 2020
Modern Research in Dentistry; doi:10.31031/mrd

I-Ping Chen, Do Hyeon Kim, Bruce Cha, Jin Jiang
Published: 19 August 2020
Modern Research in Dentistry, Volume 5, pp 506-512; doi:10.31031/mrd.2020.05.000614

Abstract:
Do Hyeon Kim1, Bruce Cha2, Jin Jiang2 and I-Ping Chen2* 1Private Practice, Bridgeport, CT, USA 2Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT, USA *Corresponding author: I-Ping Chen, D.D.S., Ph.D., Associate Professor, University of Connecticut Health Division of Endodontology, Department of Oral Health and Diagnostic Sciences, 263 Farmington Avenue Farmington, CT 06030-3705, USA Submission: July 28, 2020;Published: August 19, 2020 DOI: 10.31031/MRD.2020.05.000614 ISSN:2637-7764Volume5 Issue3 Thorough understanding of root canal anatomy is a prerequisite for successful endodontic treatment. The failure of root canal treatment of maxillary molars is highly associated with missing the second mesiobuccal (MB2) canals. Aim: we aim to assess the prevalence and morphology of MB2 canals of first (1st) and second (2nd) maxillary molars based on CBCT images. We further compared the treatment rate of MB2 canals to the rate identified from CBCT imaging analysis. Methodology: Pre-operative CBCT images of 400 maxillary 1st molars and 264 maxillary 2nd molars in a cohort of 661 subjects were examined. Parameters studied were: Result: 99% of maxillary 1st and 89.77% of 2nd molars had three separate roots with 2nd molars showing higher morphological variability. MB2 canals were found in 77% of maxillary 1st molars and 46.9% of 2nd In 3-rooted molars, the most common Vertucci classifications for MB canals in 1st molars were Type II (37.63%) and in 2nd molars Type I (47.26%). When MB2 orifices were not at the pulpal floor level (~50% of cases), the average distance below the pulp floor was 0.94mm in maxillary 1st molars and 0.92mm in 2nd molars. Clinically, the rates of MB2 canals being treated of 1st and 2nd molars were 67% and 37.8%, respectively. With MB2 identified in CBCT images, 86.6% were obturated in maxillary 1st and 80.64% in maxillary 2nd molars. Conclusion: Despite the resolution limit, CBCT remains a widely accepted non-destructive tool to study canal morphology and is readily available to many endodontists. When it is beneficial to patients and cost or radiation exposure is not a concern, pre-operative CBCT images should be thoroughly analyzed before treatment to ensure treatment quality and to limit iatrogenic complications. Keywords: CBCT imaging; MB2 canals; Maxillary molars; Fused roots The morphology of maxillary molars has been extensively studied, particularly the prevalence of a second mesiobuccal (MB2) root canal. Despite of this effort, the high failure rate of root canal treated maxillary molars remains tightly associated with untreated MB2 canals. There is a significant increase in the incidence of MB2 canals in retreatment cases, suggesting that these canals are frequently missed in the initial treatment [1]. Moreover, maxillary 1st molars with missed MB2 canals were 4.38 times more likely to be associated with a periapical lesion and, surprisingly, MB2 canals were unfilled in almost half of endodontic cases (46.5%) [2]. To maximize the success rate of root canal treatment, it is important for endodontists to be aware of anatomic variations. Since the first report of MB2 canals in maxillary molars in 1925 [3], the prevalence of MB2 canals has been examined by many techniques, which may explain the variable results between studies. Some commonly used methods include clearing and staining of extracted teeth [4], various sectioning techniques [5,6], conventional/digital radiographs [7,8], root canal treatment under microscope in vitro [9], and micro-computed tomographic imaging [10]. The incidence of MB2 canals in the literature ranges from 18-96% [11]. Studies using clearing and staining techniques of extracted teeth revealed that more than 90% of maxillary molars have multiple canals in MB roots [12,13]. On the other hand, clinical studies reported lower incidence (18-73%) of MB2 canals [14-16]. Such discrepancies could also be attributed to different selection criteria of sample population, such as ethnic background or age. Numerous studies have been conducted to establish a reliable and efficient clinical method to help locate MB2 canals [16-18]. In recent years, 3-dimensional cone-beam computed tomography (CBCT) has been used for identifying root canal configurations [10,19,20]. It can confirm the presence of MB2 canals as well as locate and orient a canal in relation to MB1, distobuccal, and palatal canals [19,21]. As a non-destructive tool, CBCT imaging offers not only high-resolution images in all spatial planes with minimal distortion but also reconstructs the volumetric images [22,23]. The aim of this study is to investigate the root and canal morphology of maxillary 1st and 2nd molars based on pre-operative CBCT images and associate the MB2 detection rate of CBCT with those being treated in clinic. Subjects The protocol of this study was approved by the Pearl Institutional Review Board, Indiana, USA (19-KIM- 101). The study included pre-operative CBCT images of 400 maxillary 1st and 264 maxillary 2nd molars taken from 661 subjects between August 2014 and March 2019 for diagnostic purposes. The number of CBCT scans to be included in the study was determined by a power analysis using a sample size calculator (www.qualtrics.com) with a significant level of 0.05 and 99% power. Inclusion criteria for CBCT images were as follows: Pre-operative evaluation of CBCT images CBCT images were taken with a Carestream CS 9000 3D (Carestream Dental, Atlanta, GA) using the following parameters: 70kVp, 10mA, 10.8 second exposure time, 76mm voxel size, and 50mm x37mm scan field of view. Images were viewed with a 27-inch monitor (Samsung T27B350ND) at a screen resolution of 1920x1080 and luminance of 300cd/m². Serial sagittal, coronal, and axial views of CBCT images were evaluated. In axial view, the axis of slicing was rotated to intersect with the long axis of the root. The presence of additional...
Anuradha G, Arvind Muthukrishnan, Vishnupriya Veeraraghavan, Gautham Kumar N
Published: 12 August 2020
Modern Research in Dentistry, Volume 5, pp 504-505; doi:10.31031/mrd.2020.05.000613

Abstract:
Anuradha G1*, Arvind Muthukrishnan2, Vishnupriya Veeraraghavan3 and Gautham Kumar N4 1Prof & Head, Dept of Oral Medicine & Radiology, Madha Dental College, Chennai, India 2Prof & Head, Dept of Oral Medicine & Radiology, Saveetha Dental College, Chennai, India 3Prof, Dept of Biochemistry, Sabetha Dental College, Chennai, India 4Prof, Dept of Periodontics & Implantology, Madha Dental College & Hospital, Chennai, India *Corresponding author: Anuradha G, Prof & Head, Dept of Oral Medicine & Radiology, Madha Dental College, Chennai, India Submission: June 08, 2020;Published: August 12, 2020 DOI: 10.31031/MRD.2020.05.000613 ISSN:2637-7764Volume5 Issue3 Diabetes mellitus is a metabolic disorder characterized by hyperglycemia due to insulin deficiency or its ineffectiveness. Successful management of diabetes involves constant monitoring of the glycemic status of the patient which is usually done by estimating the glucose concentration in blood. However, drawing blood is always an invasive procedure which has prompted researchers to look at alternative biofluids as a reliable substitute to blood for glucose estimation. This mini review examines various biofluids including urine, tears, sweat, and saliva as possible candidates for glucose estimation in diabetic patients. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from an absolute deficiency of insulin secretion and/or reduction in the biological effectiveness of insulin or both [1]. Due to the burden of this disease across the globe, diabetes mellitus is considered as one of the priority non communicable diseases and various measures have been put forward for an effective screening, diagnosing and monitoring the diabetic status in patients [2]. The classic symptoms of untreated diabetes are unintended weight loss, polyuria, polydipsia, polyphagia and other symptoms of diabetes include tiredness, blurred vision, fatigue, headache, slow healing of wounds and itchy skin. Diabetic retinopathy, neuropathy, nephropathy and microvascular angiopathy leading to cardiovascular diseases are long term complications [3]. The estimation of blood sugar levels have always been the gold standard in estimating the diabetic status of individuals. Since blood testing is invasive, painful and also leads to anxiety, risk of infection and also needs a skilled phlebotomist to withdraw blood, blood testing may result in noncompliance with healthcare services to perform a blood test to diagnose or monitor the glycaemia status in patients [4]. So recent advances focus on various biological fluids other than blood in diagnosing and monitoring the blood glucose level in patients [5]. Since 1841, urine has been used as a diagnostic fluid for diabetes assessment. It has been extensively studied as it is very easy to collect and is composed of metabolites such as glucose, proteins and other dissolved salts [6]. Glucose can be found in urine when it is excreted from blood in elevated levels and as a result, this fluid has been investigated for the diagnosis of diabetes [7]. But the main disadvantage of using urinary glucose in diagnosis and screening of diabetes mellitus includes marked individual variations in the renal threshold for glucose, poor reflection of changing levels of hyperglycemia and lack of specificity and sensitivity of various qualitative and semi quantitative procedures [8]. The other physiological fluid used in monitoring glucose levels is the interstitial fluid, Blood and surrounding vascularized tissue readily exchange biological analytes and small molecules by diffusion with the interstitial fluid. Methods of monitoring glucose via the skin has become popular and counteract the challenges associated with patient compliance and invasive monitoring. The Glucowatch was developed as a wearable device which used reverse iontophoresis to extract interstitial fluid through skin and measure glucose levels [9]. Although Glucowatch was a considerable advancement towards noninvasive and continuous glucose monitoring, the approach was hampered by the need of periodic recalibration, thereby resulting in increase in cost for testing equipment and patient care. Other drawbacks include long warm up times, sweating and skin rash with irritation which subsequently resulted in product removal from the market [10]. Sweat was also tried for diagnostic purposes in diabetes mellitus but the analytes contained in sweat varied significantly between basal and exercising states as well as between individuals [11]. There are various researches including eye glasses bio sensor system, watch sensing platform for glucose sensing in sweat, glucose sensor integrated into a wearable wrist band for monitoring glucose levels using sweat. Although sweat sensing for diagnosis is very promising there are also some concerns associated with this sensing fluid [12]. The main challenges include limited fundamental knowledge about this sensing fluid compared to blood, sampling issues associated with sweat production by exercising, surface contamination due to skin impurities and variability in the rate of sweat production. Ocular fluids have also been analysed and this fluid is excreted from the body in the form of tears. Analytes found in this fluid includes glucose, ascorbic lactate, proteins, hormones and can offer great insight into individuals health status [13]. As a result, ocular fluid was investigated for noninvasive and continuous glucose monitoring. A smart contact lens was created and was correlated with the blood glucose levels in diabetic patients. Using contact lens as a sensing platform had many advantages including real time continuous and noninvasive glucose monitoring. However, the disadvantages include production of corrosive hydrogen peroxide as a bi product in the electrochemical sensing approach used in the smart lens and blinking causing artefact in the sensor signal. The human saliva, an exocrine fluid secretion has high...
Tzanakakis Emmanouil-Georgios
Modern Research in Dentistry, Volume 5, pp 496-503; doi:10.31031/mrd.2020.05.000612

Abstract:
Dr.Tzanakakis Emmanouil-Georgios* Department of Operative Dentistry, Dental School of Athens, National and Kapodistrian University of Athens, Greece *Corresponding author: Dr.Tzanakakis Emmanouil-Georgios, Department of Operative Dentistry, Dental School of Athens, National and Kapodistrian University of Athens, Greece Submission: June 25, 2020;Published: July 22, 2020 DOI: 10.31031/MRD.2020.05.000612 ISSN:2637-7764Volume5 Issue3 Restoring extremely abraded dentition is considered as one of the most demanding and time consuming clinical challenges. Patients are often unaware of the complexity of these treatment plans and are usually reluctant to accept major prosthetic interventions. Proper coordination of the clinicians involved in the treatment plan is essential and saves valuable clinical time. This clinical report describes thoroughly a complicated treatment plan that involves periodontic and endodontic treatment, dental implants, orthodontic extrusion and a full-mouth rehabilitation with a combination of all-ceramic and metal-ceramic restorations. In this case report the role of temporary restorations in increased VDO is emphasized and with an extended discussion on clinical steps. Keywords: Abraded dentition; VDO; Bruxism; Metal-ceramic; All-ceramic Abbreviations: TMJ: Temporomandibular Joint; VDO: Vertical Dimension of Occlusion; RPD: Removable Partial Denture The management of complicated cases of extremely abraded dentition is a difficult task for the clinician. It has a negative impact on quality of life comparable with that of edentulousness [1]. The reconstruction of dental arches requires extensive restorative treatment [2,3]. Every patient requires unique treatment, however most of them at the beginning of treatment are not aware of the cost and time that is necessary for a proper and long term treatment plan and postpone the therapeutic interventions. Moreover they are usually confused because specialized clinicians may propose different treatment plans. A team of experienced clinicians can suggest an appropriate treatment planning [2]. Nowadays, the increase of mechanical strength and adhesive potential of new dental materials may offer new possibilities in reconstructive techniques and digital workflow can minimize invasive tooth preparations [4,5]. Bruxism is a repetitive parafunctional activity and the main cause for temporo-mandibular disorders (TMD) [6]. Wear facets along with masseter muscle hypertrophy other clinical are common findings that indicate the presence of bruxism [6]. Masticatory forces in bruxing patients are much higher than maximum biting forces measured during chewing cycles, which partially explains the catastrophic impact to dental restorative materials. It is widely considered that bruxism has also a negative impact on the periodontal tissues and is a main cause of loss of osseointegration of dental implants [7-9]. Loss of posterior support causes difficulty in mastication especially in young and middle aged population. In these patients, anterior teeth are overloaded. The results are either tooth mobility or extensive wear of the clinical crown. Restoration of posterior support is necessary as early as possible with provisional restorations to restore periodontic and mechanical overload of the remaining dentition [2]. Fixed implants restorations are more attractive for the patients especially when the alternative treatment plan includes a removable device. If a patient can afford the increased cost and accepts the minor surgical procedure, implants are a reliable solution to partial edentulism [10]. The aim of this case report was to analyze the therapeutic management of a patient presenting generalized excessive tooth wear in the mandibular dentition involving decreased VDO and loss of posterior support. The treatment included a combination of periodontic and endodontic therapies, implants placement, minor orthodontic treatment and optimum prosthodontic rehabilitation with fixed dental prostheses, cast posts and all ceramic veneers in increased VDO. Patient presentation The Caucasian 53-year-old male patient was seeking treatment. His chief complaint was difficulty in chewing and his anticipation for a fixed restoration (Figure 1). Figure 1: Preoperative intraoral frontal view. Initial clinical situation, radiographic examination Figure 2: Preoperative panoramic radiograph. The patient reported a free medical history, but admitted smoking habit (20+cig/day). He was not taking any medication and reported pain in facial muscles during stressful periods. The patient was subjected to thorough clinical and radiographic examination (panoramic x-ray) (Figure 2). Intraorally, he presented severe abrasion most observed in mandibulary dentition, reduced VDO, and several missing mandibular teeth (#44,45,46,47 and 36,37). In the maxilla, a 4-unit metal ceramic bridge with a cantilever was found on the incisors {12-11-21-(22)}, and one 4-unit metal-acrylic bridge in the posterior segment {23-(24)-(26)-27}. The visible diastemmas between #12,#13 and #13,#14 were due to a missing premolar #15 which probably caused distal migration of #14 and 13 (Figure 3-5). The smile line was evaluated as medium (Figure 6). Secondary caries was visible in amalgam restorations in #14 and #16 and was inspected under the abutment #12. A significant change in the occlusal plane was obvious, defined by significant protrusion of #13, #14 and #16. In the mandible acrylic crowns were positioned in #44, 33, 34. Initial radiographic examination revealed endodontic therapies in #12, 34, 35, 42 and #43 and it was estimated that the bone level averaged at 70%. Clinical examination of the stomatognathic system revealed bilateral myalgia of the lateral pterygoid muscles on palpation, unilateral clicking on the left TMJ and limitation in mouth opening. All other masseter muscles were free of symptoms. Figure 3: Preoperative occlusal view of the maxilla. Figure 4: Preoperative intraoral...
Elodie Terrer, Oumarou Hama H, Gouriet F, Habib G, Catherine Jh, Raskin A, Lan R, Hadj Said M, Aboudharam G, Terrer E, et al.
Modern Research in Dentistry, Volume 5, pp 486-489; doi:10.31031/mrd.2020.05.000610

Abstract:
Oumarou Hama H1,2, Gouriet F1,5, Catherine JH3,4,5, Habib G1,5, Raskin A3,4,5, Hadj Said M3,5, Lan R3,4,5, Aboudharam G2,3,5, Drancourt M1,2,5 and Terrer E2,3,5* 1IHU Méditerranée Infection, Marseille, France 2Aix-Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France 3Aix-Marseille Université, UFR Odontologie, Marseille, France 4Aix-Marseille Université, Anthropologie bioculturelle Droit Ethique Santé, Marseille, France 5APHM, Hôpital Timone, Marseille, France *Corresponding author: Elodie Terrer, Aix-Marseille University, MEPHI, IHU Méditerranée-Infection 19-21 Boulevard Jean Moulin, 13005 Marseille, France Submission: July 08, 2020;Published: July 20, 2020 DOI: 10.31031/MRD.2020.05.000610 ISSN:2637-7764Volume5 Issue2 Objective: Dental pulp is acknowledged to be an organic tissue sample on which the microbiological diagnosis of blood-borne pathogens, including those responsible for infectious endocarditis, can be based. Method: Molecular detection of aureus was performed in the dental pulp extracted from one tooth collected in a patient firmly diagnosed with S. aureus infectious endocarditis. Result: We report on one patient diagnosed with Staphylococcus aureus endocarditis in whom aureus DNA was further detected by PCR in the dental pulp. We advocate not throwing away extracted teeth, appropriate microbial investigations of which may reveal bacteraemic pathogens not otherwise detectable. Keywords: Bacteremia; Tooth; MALDI TOF MS; Microbiology; Diagnosis; Cardiology Dental pulp is acknowledged to be a suitable organic tissue upon which to base the microbiological diagnosis of blood-borne pathogens, including those responsible for infectious endocarditis [1,2]. Non-exposed dental pulp can be invaded by bacteria with predominance of aero-intolerant bacteria of the genera Eubacterium, Propionibacterium and Actinomyces [3]. Furthermore, molecular approaches have made it possible to detect the DNA of Coxiella burnetii, a pathogen responsible for endocarditis [4] in the dental pulp of experimentally-infected guinea pigs [5], as well as HIV DNA in a seropositive patient [6]. In addition, one case of Bartonella quintana bacteraemia has been detected by PCR in the dental pulp sample collected from a patient who had been diagnosed with B. quintana bacteraemia six months previously but who was not longer bacteraemic when the tooth was extracted [1]. Infectious endocarditis (IE) is mainly caused by streptococci, staphylococci and enterococci and, rarely, by fungi [7,8]. Staphylococcus aureus (S. aureus) is one of the pathogens most frequently involved in blood-borne infections, including IE [9,10]. In this paper, we report on one patient diagnosed with S. aureus endocarditis in whom S. aureus DNA was further detected by PCR in the dental pulp. In April 2019, a 54-year-old patient was admitted to the emergency department of the Timone hospital (Marseille, France) with fever, confusion and tetraparesia. A cerebral scan found multiple left hypodense fronto-parietal and left occipital lesions. Blood and the cerebrospinal fluid cultured methicillin-susceptible S. aureus. Empiric antibiotic therapy combining amoxicillin, gentamycin and acyclovir was then changed for cefazolin, 12g/day and clindamycin 600mg four times/day. A transthoracic echocardiography found vegetation on the native bicuspid aortic valve and a moderate aortic insufficiency. The patient was then diagnosed with S. aureus infectious endocarditis. A total body scan found bilateral renal, splenic and hepatic embolisms. Brain magnetic resonance imaging found several right frontal, left occipital, temporal, thalamic and bilateral cerebellar hyper signals with haemorrhagic organisation in the right frontal and occipital lesion. Five days later, the patient presented with septic shock and was admitted to the cardiologic intensive care unit. Antibiotic therapy was changed for intravenous sulfamethoxazole 4,800mg/day, clindamycin 1,800mg/day, gentamycin 160mg/day and rifampicin 1,800mg/day. Laboratory tests showed leucocytosis at 19G/L, haemoglobin at 10.4g/dL, platelets at 180G/L, and protein C-reactive at 95.5mg/L. 18fluorodeoxyglucose-positron emission tomography/computed tomography showed multiple hypermetabolic foci in the lymph nodes, liver, muscles and bones. Spinal magnetic resonance imaging showed a lumbar L4-L5 and cervical C5-C6 spondylodiscitis. Initial clinical and biological evolution was favourable, however, three weeks later the cardiac lesion worsened with severe aortic valve insufficiency. Cardiac surgery was performed and the patient underwent an aortic bio prosthesis. Culture of the explanted cardiac valve remained sterile and PCR-based tests for the pan bacterial 16S RNA gene, Enterococcus faecalis, Enterococcus faecium, S. aureus, Coxiella burnetii and Bartonella spp. were negative. Histological examination of the explanted valve showed a valvular tissue largely destroyed by a dense, non-specific and polymorphic inflammatory reaction, with many neutrophils. As part of the routine management of patients with IE, 13 teeth with infectious foci of endodontic or periodontal origin were extracted using amoxicillin antibiotic prophylaxis according to the recommendations of the Haute Autorité de Santé (HAS) and the Agence Nationale de Sécurité du Médicament (ANSM). After obtaining the patient’s informed consent, the teeth were microbiologically investigated in line with advice from the IHU Mediterranean Infection Ethics Committee (Advice, 05/29/2018). The evolution of the patient was favourable at the six-month follow-up consultation. Six of the 13 extracted teeth (n°13, n°24, n°25, n°35, n°36, n°37) were used for bacteriology investigation. Teeth were decontaminated with 1% chlorhexidine (MP Biomedicals, Illkirch, France), washed with UltraPure™...
Eric Z Shapira
Modern Research in Dentistry, Volume 5, pp 490-495; doi:10.31031/mrd.2020.05.000611

Abstract:
Eric Z Shapira* Professor of Geriatric Medicine and Dentistry *Corresponding author: Eric Z Shapira, Professor of Geriatric Medicine and Dentistry, USA Submission: February 17, 2020;Published: July 20, 2020 DOI: 10.31031/MRD.2020.05.000611 ISSN:2637-7764Volume5 Issue3 Today, people are living longer and hopefully keeping their teeth longer. There are modalities of dental treatment that can correct tooth loss and bone loss with adequate substitutes that emulate “the real thing.” Bone loss, a disease symptom which can occur from multi-variants, can lead to subsequent tooth loss and an inability to replace these lost teeth. Dentists have long attempted to find ways of replacing missing teeth with endosseous, as well as subperiosteal implant techniques. Blade implants were the treatment of the 1950’s; whereby a small length-wise slit was made on the edentulous ridge to a depth conducive to “tapping” a stainless steel, flat fixture into the bone. Depending upon the width and depth of the surrounding bone, the blade implant could be used to hold single and/or multiple crowns. Trial and error led to the advent of the cylindrical, square, peg-shaped or rounded and oblong implants made of titanium and other osseo-integrative materials. Eventually, hydroxyl-appetite coated implants came into use and proved more successful than the standard blade type implant. The “coated” implants were more predictable and lasted longer, especially when coated with “plasma spray”. Older individuals with more discretionary income, who may have been conditioned and committed to saving their teeth, were the more obvious patients opting for implant tooth replacement. Many factors that figured into the equation of whether the implant would “take” or not had to be considered before an implant could be delivered as the treatment of choice. Today, in conjunction with these various factors of viability and disease, considerations for recommending an implant as a replacement for a missing tooth should be given the highest and priority as it has become the Standard of Care. Aging brings change to everything. Therefore, the human body is subject to many stressors, including stress itself, disease, time, the normal aging process, and physical injury of one kind or another. All of these aforementioned entities potentiate change and either allows the human body to adapt physiologically or forcibly exerts this change unconsciously or consciously depending upon the type of insult one is trying to cope with at the time. The older one gets, the more difficult this process is and the slower the process becomes. Patients on multiple drug therapies, patients with various systemic disease states, patients with emotional stress, one Dementia of another, personality disorders and various metabolic problems should be examined thoroughly, both dentally and medically, prior to any implant placement. One should go as far as getting a Medical Clearance for an elderly, medically compromised patient to have the surgical placement of an implant. The human body is susceptible to rapid changes that may be slow to expose symptoms which may be indicative of subliminal disease states. Many diseases today can and should preclude one from having a dental implant due to the high risk of potential failure. Some of these disease states might include: osteopenia, osteoporosis, diabetes, auto-immune diseases, diseases related to material allergies, xerostomia, stressrelated bruxism, chronic advanced periodontal disease and the loss of mental cognition, which would limit eventual home care and recall visits post implant placement; ultimately leading to failure. This author believes that our greatest challenge as dental practitioners is to get the patient, especially the older patient, who needs implant therapy to want an implant procedure; and for that matter, anything else that demands a choice in restoring a patients’ mouth to optimum health. That is: Our greatest challenge in dental practice is to get the patient to want what “we” think they need. All too often there remains a plethora of variables that can confound the choices we all make as patients. However, from experience, the biggest stopgap seems to be their abilities to afford implant therapy. There is no question in the mind of a person who for all their life has taken care of their mouth and the rest of their body, using self-efficacy as their guide, to want the best possible options to keep their dentition working in an ideal manner. There is no “hard sell” for the patient who knows what is best for themselves; but, for those patients who have difficulty making a decision for implant care, education seems to be at the core of this process. The question remains: Is it necessity, financial ability, rationalization through education or desire that helps in the process of getting to “yes?” Clinical examples can show how the prospective implant therapy for an elder can enhance their ability to function with embellished ability, a minimum of sideeffects and unnecessary angst about discomfort, ability to eat and other concerns (Table 1). Table 1: A step-wise system of learning. From Geriatric lectures of Eric Shapira, D.D.S. Avram King circa 1980’s©. In the 1980’s, a psychologist by the name of Avram [1] developed the Step-Wise System of Learning [1]. This table shows how one comes to making a decision given information that they did not have before. The persons’ ability to choose is influenced by how the message is delivered of course, what kind of message it is e.g. didactive or guilt-inducing with judgment injected into the equation by the receiver. With the mixing of information, emotions, judgment and empathic or sympathetic words, a persons’ level of commitment is born. The commitment can be getting to “yes” or ending in “no.” This...
Foti Vincenzo
Modern Research in Dentistry, Volume 5, pp 476-485; doi:10.31031/mrd.2020.05.000609

Abstract:
Foti Vincenzo* and Rossi Roberto Private practice, Genova, Italy *Corresponding author: Foti Vincenzo, Private practice, Piazza Borgo Pila 40, Genova, Italy Submission: June 09, 2020;Published: July 08, 2020 DOI: 10.31031/MRD.2020.05.000609 ISSN:2637-7764Volume5 Issue2 Guided bone regeneration is a technique widely known, clinicians know very well indications and limitations of this technique. One of the principles to achieve bone augmentation and formation resides in the stability of the blood clot forming under a barrier membrane. The technique proposed in this article has the goal of providing stabilization to the bone graft by adding fibrin sealant (FS) to the bone graft and also using the fibrin sealant to attach a bone membrane (cortical lamina) to the recipient site. This simple modification of the technique of guided bone regeneration is presented in two successful cases. Keywords: Cortical lamina; Fibrinogen; Fibrin sealant; Guided bone regeneration; Implants Fibrin Sealant Fibrin sealant (FS) is a medical device derived from human blood, used in surgery and in specialties since 1975 for his hemostatic and ahesive properties. The first application in the dental field dates to the 80’, in oral surgery for those patients with disorders of hemostasis [1]. In periodontology Pini Prato GP et al [1]. in 1988 treated infra-bony defects by using FS to stabilize membranes in guided tissue regeneration procedures [2]. The first application in guided bone regeneration was reported by Wittkampf in 1989. He described a simple way to handle granules of HA in the reconstruction of narrow alveolar ridges using the FS to keep the particles together [3]. Hotz [4] used FS as a biological resorbable glue (thrombin was diluted to 1U/ml) in socket preservation. The glue would keep the granules of HA in solid form until keratinized gingiva had sealed the socket [4]. Three years of clinical experience demonstrated the efficacy of the complex HA/FS in pre-prosthetic and reconstructive surgery [5]. The clinical study that demonstrated and a new peri-implant regenerative technique by adding the FS was the one of Corrente et al. [6]. The authors achieved supra-crestal regeneration without the use of a barrier membrane. The average vertical gain was 2.05mm and histology showed newly formed trabecular bone [6]. Cardaropoli D et al. [7] 2013 modified the technique of Corrente by adding a collagen membrane, with this addition they reported a mean vertical gain of 3.95mm [7]. In regenerative procedures, FS adds an excellent physical quality to the bone grafts, making them sticky, moldable and easy to adapt to local anathomy, without any waste of granules [8]. FS demonstrates an osteoinductive capacity when mixed with osteoconductive bio-materials [9-11]. Furthermore favors angiogenesis, thanks to the link of fibrinogen with VEGF growth factor, stimulating proliferation of endothelial cells [12]. Fibrinogen also induces formation of extracellular matrix to support blood supply, connective tissue and bone [13]. Linsley in 2012 demonstrated that fibrinogen induces growth of mesenchimal cells and their differentiation into osteoblasts [14]. One last effect of FS is to enhance and accelerate wound healing and closure [15]. Cortical Lamina The cortical lamina (Cortical Lamina Osteobiol, by Tecnoss, Coazze, Italy) is a membrane used in GBR made of collagenated porcine bone. This membrane is very versatile because is produced in three different versions, curved, soft and bone layer. These three version satisfy all the different applications in GBR whether we are dealing with horizontal, vertical or three-dimensional defects [16]. Rossi et al. [17] carried out a clinical and histological study on humans, a series of patients with severely resorbed mandibles were first treated by means of the cortical lamina associated with collagenated porcine bone xenograft (GenOs Osteobiol By Tecnoss, Coazze, Italy) mixed with the patient’s own blood clot. The lamina was positioned on top of the grafted edentulous ridge in the attempt of increasing the width and height. After healing periods of 6/8 months implants were inserted in the areas where the ridge augmentation took place, and careful biopsies were taken before inserting the fixtures. All implants achieved osseointegration and up to one year after final restoration did not show any modification of the crestal level. Biopsies showed that all areas augmented had live mineralized bone [17]. If curved lamina because of its stiffness and flexibility can be adjusted to local anatomy just by means of sutures, the soft lamina behaves like any resorbable membrane but, being made of bone, maintains a certain elasticity and needs to be fixed by pins or tacks. Same can be said for the bone layer that needs screws to keep it in place. Cortical lamina proves to be a reliable device to perform ridge augmentation, the application of FS to the soft lamina became crucial in the development of the F.I.R.S.T. technique. I.R.S.T In 2016 authors found in the FS the ideal material to achieve a perfect fixation of the cortical lamina, preventing the use of screws. The objective was to create a system where the bone graft and the cortical lamina become one whole complex. Stability of the graft represents one of the key factors in GBR [18]. Aside from that the hypothesis was that FS would improve regeneration through the osteoinductive activity of fibrinogen. The name “Fibrinogen-Induced Regeneration Sealing Technique” object of this paper generated from this thought. The patient was a woman 64-year-old with history of periodontal disease. Non-smoker, in good general health, she did not report allergies or intolerances to anesthetics and drugs. She presented with stage IV periodontitis and partial edentulism in the second quadrant with a horizontal bony deficiency. The first step represented full-mouth disinfection and systemic therapy with Metronidazole and Amoxicillin for...
Youjian Peng
Modern Research in Dentistry, Volume 5, pp 473-475; doi:10.31031/mrd.2020.05.000608

Abstract:
Jiehua Zhang and Youjian Peng* Department of Stomatology, Renmin Hospital of Wuhan University, China *Corresponding author: Youjian Peng, Department of Stomatology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang District, Wuhan, Hubei, China Submission: May 25, 2020;Published: July 02, 2020 DOI: 10.31031/MRD.2020.05.000608 ISSN:2637-7764Volume5 Issue2 The objective of this article is to describe the treatment of an 8-year-old boy with anterior crossbite and premature loss of the second primary molar due to the ectopic eruption of the maxillary first permanent molar. A modified Nance appliance was used to distalize the maxillary first permanent molar. And the crossbite of the anterior region was corrected by two-by-four (2×4) appliance. Satisfactory function was achieved for this patient, which greatly simplified the subsequent treatment in the permanent teeth. Keywords: Ectopic Eruption; Crossbite; Modified Nance appliance The prevalence of ectopic maxillary first permanent molars in children has been reported as 3%-4% [1-3]. The etiology of ectopic eruption is related to genetic and environmental factors. The latter ones include small arches or a short maxillary length, significantly larger maxillary first permanent molars and maxillary second primary molars, a more mesial eruptive path of the permanent molar, and abnormal angulation of eruption of the maxillary first permanent molars. The ectopic eruption of a maxillary first permanent molar is frequently ignored and extremely challenging in dental practice. However, as the key to occlusion, the first permanent molars play a vital role in balanced occlusion. Failure to treat ectopic eruption could result in a local malocclusion. So early diagnosis and treatment can prevent a more complicated malocclusion. Figure 1: Pretreatment intraoral photographs. An 8-year-old boy sought orthodontic treatment at the office of our hospital in Wuhan, China. His chief complaint was to correct his anterior crossbite. He had a symmetrical face with a slightly concave profile. His facial midline was coincident with the dental midline. He was in a period of mixed dentition. The first maxillary molars presented a Class II molar relationship on both sides, with a crossbite of lateral incisors. He had a space of 2mm between the right permanent maxillary first molar and premolar resulted from the early loss of the second primary premolar (Figure 1&2A). The panoramic radiograph that was taken at the age of 5 years showed that atypical resorption of the second primary molar was caused by the mesial ectopic eruption of his right permanent maxillary first molar (Figure 2B). Figure 2: A. Pretreatment panoramic radiograph at the age of 8; B. Pretreatment panoramic radiograph at the age of 5. Figure 3: Treatment progress: A. 2 months after the start of orthodontic treatment; B. 5 months after the start of orthodontic treatment. Figure 4: Posttreatment intraoral photographs. 0.012NiTi (NIC, Suhang, China) were placed and bonded on maxillary arch for alignment and crossbite correction in the anterior region. To reopen the space for the maxillary right second premolar, a modified Nance appliance was placed on the maxillary first permanent molars and the first premolars (Figure 3A). The crossbite was corrected after two months of treatment. At the end of the third month, 7mm space was opened for the second premolar. The maxillary right second premolar erupted after a 5-month treatment (Figure 3B). The results maintained for 3 months and the active treatment ended. The posttreatment records showed that the treatment objectives were achieved (Figure 4). The facial photographs showed acceptable overbite and overjet were achieved. A Class I molar relationship was established. Abnormal mesial eruption of a maxillary first permanent molar may result in early loss of the second primary molar and incidence of the impaction in the second premolar. Except for allowing the selfcorrect and erupt into occlusion [3,4], possible treatment options include extraction of the second primary molar, a sectional fixed appliance, orthodontic separators (elastomeric, brass wire and pre-fabricated clip separators), or custom-made appliances [5,6]. In this case, a modified Nance appliance was used to regain lost space, upright the maxillary first permanent molar, and preserve arch length. Successful early intervention in the mixed dentition ensures proper full eruption of the permanent second premolar, which simplifies or even avoids comprehensive treatment of the malocclusion. © 2020 Youjian Peng. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.
Jurandi Nery Pereira
Modern Research in Dentistry, Volume 5, pp 470-472; doi:10.31031/mrd.2020.05.000607

Abstract:
Jurandi Nery Pereira* and Thaís Brito Oliveira Filho State Universty of Feira de Santana, Feira de Santana, Bahia, Brasil Federal Universty of Bahia, Salvador, Bahia, Brasil *Corresponding author: Jurandi Nery Pereira, Filho State Universty of Feira de Santana, Feira de Santana, Bahia, Brasil Submission: May 05, 2020;Published: June 23, 2020 DOI: 10.31031/MRD.2020.05.000607 ISSN:2637-7764Volume5 Issue2 As a chemical control, 0.12% chlorhexidine digluconate is the most widespread in the lineage of mouthwashes. In addition to the effective action of chlorhexidine in dental biofilm, its use is also indicated for oral mucositis, as it acts in reducing the severity of injuries, providing more comfort and avoiding secondary infections. However, the use of chlorhexidine for prolonged periods is contraindicated, as it induces side effects such as discoloration of the teeth, peeling of the mucosa, altered taste and unpleasant taste. In our literature review work, we concluded that 0.12% chlorhexidine digluconate is an excellent antimicrobial agent, but its use should be done with discretion, as it has significant adverse effects. In times of pandemic, health and hygiene care must be doubled. A healthy body helps the immune system to prevent infections. Therefore, the concern of health authorities regarding the new coronavirus (Sars-Cov-2) is justified. In this sense, attention to oral hygiene is of fundamental importance since the mouth is the gateway for numerous infectious agents. The use of chemical adjuvants is recommended, as it reduces the microbial load to which the organism is subjected. However, the use of such substances can cause some undesired effects, which we will see below in relation to 0.12% chlorhexidine digluconate, considered the “gold standard” of mouthwashes [1]. As a chemical control, 0.12% chlorhexidine digluconate is the most widespread in the lineage of mouthwashes [1]. In addition to the effective action of chlorhexidine on dental biofilm, its use is also indicated for oral mucositis, as it acts in reducing the severity of injuries, providing more comfort and avoiding secondary infections [2]. Chlorhexidine has a substantivity in the oral cavity for approximately 12 hours, inhibiting the adhesion and colonization of microorganisms to dental elements. Thus, it can be emphasized that it exerts bactericidal action when used in high concentrations and bacteriostatic in low doses, paralyzing and killing bacteria [1-3]. However, even with numerous beneficial effects, some adverse effects have been observed in the literature regarding its use, such as: alteration in the coloration of dental elements, restorations, prostheses and tongue, formation of supragingival calculus, loss of taste, burns in tissue soft, pain, dry mouth, and unpleasant aftertaste in the mouth. Mucosal ulcerations, reversible swelling of the lips and parotid glands, scaly lesions, urticaria, dyspnea and anaphylactic shock can rarely occur [4-6]. Chlorhexidine is an antimicrobial and antiseptic agent widely used in the health area, however, it can cause oral changes such as: changes in the color of the dental elements, loss of taste, soft tissue burns, pain, dry mouth, scaly lesions, mucosal ulcerations and unpleasant aftertaste in the mouth [4]. According to Zanatta & Rösing [4], the change in dental color (Figure 1), which is reported by most users, is strongly associated with its prolonged use, concentration and high volume, affecting mainly the cervical face of the crown and the proximal areas of the dental elements. However, these stains are easily removed with the use of ultrasound (Figure 2). these authors also address hypotheses about the factors that lead to staining, such as the ability of chlorhexidine to denature proteins, form ferric and stony sulfite, or even with the association of colored foods, however for Bohner [7] the staining is caused by diet dyes, which react with the mouthwash, forming colored elements. Berton et al. [5] describe the clinical management of unilateral parotid edema caused by the use of chlorhexidine in a 66-year-old patient who used the substance continuously. Figure 1: Teeth stained by 0.12% chlorhexidine digluconate. Figure 2: Appearance after ultrasound treatment. According to Torres et al. [8] it is necessary for the professional to make a correct anamnesis and clinical diagnosis of the patient in order to be more careful when performing invasive procedures in patients with systemic diseases and heart valves, so avoiding compromising the patient’s health. It is necessary in the preoperative period to perform extra-oral asepsis and rinse with chlorhexidine, as well as to use it in the postoperative period to prevent the development of infections, always guiding the patient on the form and days of use to avoid effects collaterals in the oral cavity. The most widely used form of chlorhexidine at a concentration of 0.12% in dentistry is through mouthwash, the amount of which is 15ml, twice a day, rinsing for 60 seconds [1,2,4]. In a recent study, Ambhore and Padhye showed the effectiveness of using chlorhexidine in gel form [9]. On the other hand, Campos et al. [10] reported the use of chlorhexidine by the medical team three times a day and mouthwash with 10 ml of 0.12% chlorhexidine solution for 60 seconds. The use in high doses, acts in the coagulation of cytoplasmic proteins and bacterial death, in low doses, it causes a change in the cell membrane and extravasation of low molecular weight bacteria [2,4]. As emphasized by Franco et al. [11], chlorhexidine acts in two ways, when used in low concentrations, it has bacteriostatic action, paralyzing the bacterium, through the alteration of the osmotic balance and the loss of intracellular substances. Already in high concentrations it has bactericidal action, which ends up destroying the cell. Chlorhexidine is also effective in preventing and treating mucositis in patients undergoing...
Alvydas Gleiznys
Modern Research in Dentistry, Volume 5, pp 467-469; doi:10.31031/mrd.2020.05.000606

Abstract:
Alvydas Gleiznys1* and Zivile Zidonyte2 1Department of Prosthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Lithuania 2Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Lithuania *Corresponding author: Alvydas Gleiznys, Department of Prosthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Lithuania Submission: March 19, 2020;Published: May 29, 2020 DOI: 10.31031/MRD.2020.05.000606 ISSN:2637-7764Volume5 Issue2 Bell’s palsy is an idiopathic neuropathy of the facial nerve, meaning that a cause is unknown. It is usually recognized as an acute weakness and disability to move one side of the entire face. Problems of speech, swallowing and eating occur and the chance of the quick recovery takes 6 months (85% of patients) or is impossible at all. However, it is inevitable to restore patient’s masticatory system and to return the ability to live a comprehensive life. The purpose of the work is to report a case of Bell’s Palsy, reveal advices and difficulties that were met during this treatment. Methods: A clinical and radiographic examination for the 51-year-old patient was made in accordance with neurologist, otorhinolaryngologist and general doctor. Accordingly, an electronic research was performed on databases such as The Cochrane Library, EMBASE via Science Direct, MEDLINE via PubMed in order to collect as much information as possible. All selected data was summarized and the protocol of treatment for a patient was determined. Result: A clinical case presents our findings and the protocol of the treatment, replenished with data from scientific literature. The main aspects are mentioned with our plans to continue our research how to improve prosthodontic treatment for patients with facial paralysis. Conclusion: Clinical and radiographic analysis has showed a need for a specific treatment. According to the clinical case, the main anatomical structures were marked according which a required border molding has to be reached for all types of patients and have distinguished the ones that are inherent for patients with Bell’s palsy. Keywords: Bell’s palsy; Complete dentures; Border molding; Custom trays Bell’s palsy is known as facial paralysis that has an idiopathic cause. This severe condition can appear because of unknown conditions and complicates one’s life [1]. The main features of the Bell’s palsy are: Many different treatment approaches have been offered by neurologist to the resolution for such one side paralysis and a patient was motivated to accept dental treatment to recover his masticatory system. In prosthodontics it appears indispensable to transfer the view from the mouth to the casts. Sometimes mistakes occur and collaboration between dental technician and a dentist interrupts, wherefore appropriate treatment cannot be accomplished [4-9]. Accordingly, one of the most important factors how to maintain this professional communication is taking into account the correct determination of custom tray borders, border molding and impressions [4-8]. Treatment becomes especially difficult in edentulous patients with health disorders, so that we have decided to announce our clinical case. The purpose of this case report study was to perform an objective treatment for a patient with one side facial paralysis, to determine the borders of an upper jaw custom tray and to assure impression is ready to be sent to the laboratory [7,9,10]. The case presented is of a 51-year-old male patient who came to our Clinic with a medical history of Bell’s palsy. Treatment plan was based on electronic research and the experience our doctors. The research was based on three databases (The Cochrane Library, EMBASE via Science Direct, MEDLINE via PubMed). It was performed by using keywords: “complete dentures”, “border molding”, “and custom trays”, “ Bell ’s palsy”. As inclusion criteria we have chosen clinical cases on humans, English language, articles that have proven statistically confirmed value. After screening the literature, detailed information was used for the treatment. It was decided to extract teeth that cannot be restored. After 4 weeks, preliminary impressions were made with alginate and poured in Type III dental stone (Figure 1). After fabricating primary casts, custom acrylic resin trays were made and single-step border molding was done (Figure 2). Figure 1: Primary casts. Figure 2: Upper jaw custom tray. By customizing individual trays and taking trial impressions, a few main structures have shown a need to be checked whether custom tray border molding is correct. After corrections and single-step border molding, a final impression was taken. Accordingly, an asymmetry of polyvinyl siloxane impression between both sides has shown manifesting differences between normal and paralyzed sides (Figure 3). From the photo it is clear that a deviation of the labial frenum is linked to the paralyzed side, right buccal frenum is not expressed enough and the right labial and buccal sulcus take less space than the left ones. However, other structures are similar in both sides (Figure 4). On the active side we could make functional moves in order to show off muscle and mucous membrane activity, whilst the passive one only showed us a regular anatomy without expressed amplitude of intraoral structures and soft tissues. Even though a patient was incapable of moving the right side of his face, during functional impressions his right side of the case was manipulated by a doctor in order to achieve the best retention and stability. Further treatment protocol steps were made the same as for conventional complete dentures. Denture bases and wax rims were made to record maxilla mandibular relationship. VDO (vertical dimension of occlusion) was determined to be 2-3mm less than VDR (vertical...
Guaracilei Maciel Vidigal Junior
Modern Research in Dentistry, Volume 5, pp 464-466; doi:10.31031/mrd.2020.05.000605

Abstract:
Guaracilei Maciel Vidigal Junior1* and Luiz Roberto Figueiredo Dantas2 1Adjunct Professor, Department of Clinical Integrated Procedures, Rio de Janeiro State University (UERJ), Brazil 2Associate Researcher, Rio de Janeiro State University (UERJ), Brazil *Corresponding author: Guaracilei Maciel Vidigal Junior, Adjunct Professor, Faculty of Dentistry, Department of Clinical Integrated Procedures, Universidade do Estado do Rio de Janeiro (UERJ) Av. 28 de setembro 157, Vila Isabel, Rio de Janeiro, ZIP: 20551-030, RJ, Brazil Submission: April 24,2020;Published: May 08, 2020 DOI: 10.31031/MRD.2020.05.000605 ISSN:2637-7764Volume5 Issue1 Prosthetically-driven alveolar reconstruction (PDAR) technique [1] is a method for alveolar ridge preservation/regeneration after tooth extraction without flaps, membranes or grafts with optimum aesthetic results. This case report presents a clinical situation where an upper right pre-molar exhibits an extensive buccal bone plate loss related to a late paraendodontic surgery failure. Using the PDAR technique complete bone regeneration was achieved using a minimally invasive procedure with optimum aesthetic results. Keywords: Alveolar bone preservation/regeneration; Extraction socket; Coagulum; Fixed provisional prosthesis Prosthetically-driven alveolar reconstruction (PDAR) technique [1] is a method for alveolar ridge preservation/regeneration after tooth extraction and is indicated for extraction sockets with the absence of one bone wall (Figure 1) or even for an intact alveolus. It is based on alveolar occlusion, using a fixed provisional prosthesis with a specially designed pontic to provide stability to the coagulum and mechanical support to the gingival margin, preventing mucoperiosteal collapsing. There are some prerequisites when performing PDAR: teeth neighboring the compromised tooth area should be healthy and without proximal bone loss, and in esthetic areas, the gingival margin should be in harmony with the surrounding teeth and its contralateral counterpart. PDAR has a number of advantages, such as preservation of the preexisting alveolar bone by avoiding realizing incisions and flaps; regeneration of lost alveolar bone without the use of grafts or membrane barriers; and new bone formation in the space left by the tooth root using a minimally invasive procedure. In this clinical case, the first upper right pre-molar presented recurrent abscess in the buccal aspect, associate to the failure of a paraendodontic surgery performed 6 years ago (Figure 2). To perform the PDAR technique, a provisional fixed prosthesis (which can be adhesive) was created using a working cast. The gingival margin of the tooth to be removed (Figure 3) was marked with a 0.5mm tip pencil. Then, the compromised tooth was removed from the cast and the “subgingival” area was excavated by approximately 3mm (Figure 4), preserving the gingival margins of the area previously marked in pencil, creating a cylindrical niche. The pontic was then created, completely filling the excavated subgingival area. Subsequently, a 1mm high and deep concavity was made in the intermediate subgingival millimeter, giving the subgingival area an hourglass shape (Figure 5). This concavity of the pontic is located subgingivally and will prevent gingival margin retraction. Ovoid pontics, by contrast, cause retraction of the gingival margin and failure of the procedure. The prosthesis disinfection should be performed by overnight immersion in 2% chlorhexidine solution. Figure 1: CBCT cross-sectional image of the tooth showing the complete loss of the buccal bone wall. The initial buccal bone height was of 5.66mm (magenta) and the crestal bone thickness was of 1.47mm (orange). Figure 2: The mucosa presented redness and edema caused by an endoperiodontal abscess. Figure 3: On the working cast the gingival margins were marked with a 0.5mm tip pencil. Figure 4: The tooth was removed, and a 3mm subgingival niche was excavated in the working cast. Figure 5: The pontic completely fills the excavated subgingival area and have a 1mm high and deep concavity made in the intermediate subgingival millimeter. Figure 6: 6-month clinical control. Figure 7: CBCT cross-sectional image shows a final buccal bone height of 14.74mm (green) and a crestal bone thickness of 9.16mm (orange) obtained without the use of grafts, membranes or flaps. One hour before the surgery, the prosthesis should be immersed and kept in saline solution. It is extremely important that the whole subgingival area is rounded, with no sharp angles, well-polished and not over contoured, as this will cause recession of the mucosal margin, which may cause the procedure failure. Extraction was performed carefully using periotomes, without performing relaxing incisions and flaps. Before installation, the provisional prosthesis was tested to avoid direct contact with the bone, which can prevent its settlement into position. The provisional prosthesis was installed just after the tooth extraction using a fluid photopolymerizable resin (“Flow”). The patient was instructed not to floss in the pontic area. At the end of the healing period (Figure 6), after 6 months, a new cone beam computed tomography (CBCT) was performed to evaluate new bone formation (Figure 7). Traditional alveolar ridge regeneration techniques involve more invasive procedures with greater morbidity for patients (edema, pain, bruising). Traditional bone regeneration techniques may also involve other surgical sites, such as the donor area, or also higher costs for involving the use of biomaterials, such as grafts and membranes. Thus, PDAR is a less-invasive alternative, with no need for grafts or membranes, resulting in complete reconstruction of the alveolar ridge with optimum aesthetic results. © 2020 Guaracilei Maciel Vidigal Junior. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits...
Discepoli Nicola, Discepoli N, Mirra R, Marruganti C
Modern Research in Dentistry, Volume 5, pp 462-463; doi:10.31031/mrd.2020.05.000604

Abstract:
Discepoli N1*, Mirra R1 and Marruganti C2 1Department of Medical Biotechnologies, University of Siena, Italy 2Undergraduate Program in Dentistry, University of Siena, Italy *Corresponding author: Discepoli Nicola, Department of Medical Biotechnologies, Unit of Periodontics, University of Siena, Siena, Italy Submission: March 16, 2020;Published: May 07, 2020 DOI: 10.31031/MRD.2020.05.000604 ISSN:2637-7764Volume5 Issue1 Periodontal diseases are a group of inflammatory/infectious, multifactorial, diseases. The periodontal tissues house both microbial dysbiosis and host response dysregulation [1]. The most recent hypothesis about the pathogenesis of periodontal disease deals with the biological transition from a healthy periodontal tissue to a pathological one (characterized by inflammation and loss of clinical attachment). This transition is mediated by the dysregulation of the inflammatory response, caused by the presence of keystone pathogens. These bacteria (i.e. Porphyromonas gingivalis) differ from normal commensal bacteria: they are able to alter the inflammatory response even in minimal quantities [2,3]. In fact, the proactivity of these species (keystone) increases the nososymbiocity of the dental biofilm without increasing its biomass [4]. This outbreak of the inflammatory response represents the pathological mechanism underlying periodontal disease. Individual variability in host response pathways may result in variations on the degree of inflammation, both in terms of response and resolution [5]. This feature, together with patient’s behavioral habits, determine the heterogenic nuances (i.e. disease phenotypes) noticeable among individuals. Loss of clinical attachment (CAL loss) represents the pathognomonic sign of periodontitis: it yields two different clinical scenarios namely pocketing and gingival recession. Younger individuals seem to express loss of attachment through the latter mechanism, while pocketing becomes the main mode of disease progression as subjects get older [6]. Many longitudinal studies, dealing with the natural history of periodontal disease and carried out among different untreated populations, have highlighted a common pattern of disease progression [7-9]. Usually, it is relatively slow and site-specific: interproximal sites are more prone to be affected by pocketing, whilst mid-buccal and mid-lingual sites mainly through recession [10]. Previous studies have reported that patients showing a high level of gingival inflammation and chronic bleeding on probing are more likely to develop destructive periodontal disease, while further relapses of the disease are best predicted by the current signs and symptoms [11]. The effectiveness of clinical diagnostic procedures for intercepting disease progression is minimal. The progression of Periodontitis, indeed, is not linear. Since the 80’s, results from longitudinal studies on untreated subjects suggested the so called “Burst hypothesis”, as a possible explanation to how clinical attachment loss takes place over time. This model describes the development of loss of attachment as an asynchronous alternance between sudden tissue loss (“burst”) and phases of stability [12]. Recently, a new model was proposed to interpret disease progression [13,14]. It is based on a Linear Mixed Model (LMM) analysis that is supposed to overcome some short comings (site and patient level source of errors, reliability) of the previously proposed model. Considering the clinical and methodological features of the existing procedures, the therapist is called to face a disease without the tools for pinpointing a true state of “activity” of the disease. In fact, the evaluation of clinical attachment loss (CAL loss) identifies sites that have already experienced disease. CAL loss, measured by probing pocket depth and recession, represents the history of the disease experienced by the patient, but it holds very low reliability regarding the current and future course of the disease. Due to its chronic nature, an early detection of disease and disease activity is of paramount importance. In this perspective, recent scientific evidence suggests how saliva and gingival crevicular fluid (GCF) could contribute to its early detection. These fluids are a copious source of biological biomarkers eventually able to identify, way before clinical diagnosis, an imbalance between the host response and the biofilm. That being said, which biomarkers are suitable to help the clinician? In this perspective, scientific community has paid close attention to both saliva and GCF. In 2018, a new classification system for periodontal diseases was introduced. The newly proposed framework entails the incorporation of future potential biomarkers in order to integrate the information provided by the standard clinical measures. A recent systematic review [15] analyzed 32 biomarkers through a meta-analytical approach to test their diagnostic ability: sensitivity and specificity were collected in otherwise healthy subjects. The most frequently studied salivary biomarkers were MMP-8, IL-1 beta, IL-6, MMP-9 and Hb. They all showed a good capability to detect periodontitis, highlighted by a sensitivity value of more than 70%. Furthermore, IL1 b and MMP-9 displayed also a good specificity (around 80%). Among these bio products, MMP-8 deserves special interest. It is probably the most investigated marker. Moreover the market offers a chair side/point of care oral fluid test, based on the detection of MMP-8, that has shown promising results in identifying active periodontal tissue destruction among populations of different ethnicities and with comorbidities [16-18]. Recently, the saliva concentration of MMP-8 was also directly related to staging and grading [19]. The MMP-8 levels in mouth rinse were significantly lower among healthy patients compared to individuals with advanced periodontal destruction. The scenario regarding...
Hadi Gholami, Gholamali Gholami, Dieter Bosshardt, Reza Amid, Mahdieh Mirakhori
Modern Research in Dentistry, Volume 5, pp 453-461; doi:10.31031/mrd.2020.05.000603

Abstract:
GholamAli Gholami1, Dieter Bosshardt2, Reza Amid3, Hadi Gholami4* and Mahdieh Mirakhori5 1Professor, Department of Periodontics, School of dentistry, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran 2Professor, Head of the Robert K. Schenk Laboratory of Oral Histology, School of Dental Medicine, University of Bern, Switzerland 3Associate Professor, Department of Periodontics, Research Institute for Dental Sciences, School of dentistry, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran 4Assistant Professor, Department of Prosthodontics, Tufts University, School of Dental Medicine, Boston, MA, USA 5Dental Research Center, Research Institute for Dental Sciences, School of dentistry, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran 6GPR Dental resident at West LA VA hospital, Los Angeles, CA, USA *Corresponding author: Hadi Gholami, Assistant Professor, Department of Prosthodontics, Tufts University, School of Dental Medicine, 1 Kneeland St 02111 Boston, MA, USA Submission: February 28, 2020;Published: April 13, 2020 DOI: 10.31031/MRD.2020.05.000603 ISSN:2637-7764Volume5 Issue1 Objectives: To determine clinical, histological, and histomorphometrial results following ridge preservation via contour augmentation with high resistance biomaterials. Material and Methods: A 54-year-old female was referred by her general dentist due to her crowded and periodontally hopeless maxillary right canine and premolar teeth. Two dental implants were surgically placed in palatal positions. The exposed implant surfaces were covered with a slowly-resorbable, synthetic, nanocrystalline hydroxyapatite bone substitute and overbuilding was done with porous titanium granules (PTGs) mixed with the patient’s blood. A long-lasting collagen membrane was fixed over the graft sites. Patient was recalled six months later for the second-phase surgery. At that time, a core biopsy from the augmentation site was taken. Result: The patient’s cone beam computed tomography scan showed that hard tissue width and height increased from 8.4 and 10.6mm to 9.2 and 12.3mm, respectively. The histological sections revealed that new bone was bridging between the PTGs and neighboring particles. The new bone matrix consisted of 12.41% mineralized bone matrix and 2.82% osteoid. Concerning the osteoconductivity of PTGs, 27.0% new mineralized bone, 10.2% osteoid, and 62.8% soft tissue were found covering the titanium particles. Conclusion: Overbuilding the ridge via contour augmentation with non-resorbable titanium granules could serve as a valid approach based on optimal clinical and biological results. Clinical Relevance: Immediate implant placement and use of PTGs and collagen membrane all at the same time can improve clinical periodontal parameters and implant stability in the short-term. Keywords: Guided Bone Regeneration; Contour Augmentation; Ridge preservation; Titanium Granules Tooth extraction causes inevitable changes in the supporting structures, which may lead to complications for dental implant placement [1]. Since the 1960s, many studies have been conducted to assess the loss of hard and soft tissues after tooth extraction, and innumerable efforts have been made to prevent or minimize bone loss [2]. Different methods have been suggested to preserve and reconstruct bone volume and prevent alveolar ridge resorption following traumatic events such as tooth extraction. The guided bone regeneration (GBR) technique has presented promising results in repairing bone defects. Autogenous bone grafts are considered the gold standard for GBR, due to their osteoconductive, osteoinductive, and osteogenic properties [3,4]. Despite their high efficacy for bone reconstruction, the need for a second surgical site, unpredictable remodeling rate and bone loss have been regarded as their main disadvantages. Thus, more recent studies have aimed to find a suitable alternative for autogenous bone grafts. Bone substitutes have found their niche within the field of dentistry and have shown promising results [5-7]. Hydroxyapatite-based materials are commonly used for this purpose. Rothamel et al. [8] evaluated the efficacy of nanocrystalline hydroxyapatite paste; however, he claimed that it is not efficient for ridge preservation due to its unpredictable resorption pattern. Since nonresorbable materials can withstand external loads and are resistant to deformation, they can be used with high success rate in bone defect reconstruction, especially for contour augmentation [5, 7,9-11]. The biocompatibility of titanium has been proven in the recent years, and its use in implant dentistry and orthopedics is widely growing. Titanium is highly resistant to corrosion in body fluids. Furthermore, it is considered a potentially appropriate bone substitute material due to its nonresorbable properties [10,11]. Titanium particles can stimulate the activation of complement system and platelets and can consequently increase the level of platelet-derived growth factor (PDGF). PDGF has been shown to promote bone growth, and this capability along with large surface area is advantageous for bone reconstruction [12]. Porous titanium granules (PTG) (Natix™, Tigran Technologies AB, Malmo, Sweden) possess these properties and contain 700-1000μm diameter granules. The porous nature of these granules enables bone infiltration between the particles. PTGs consist of irregular, highly porous, nonresorbable granules of commercially pure titanium; they were first introduced for treatment of peri-implant defects. When implanted, the granules are able to interlock with each other, providing a suitable environment for intra- and inter-granule osteogenesis. A stable porous structure is formed as such, which provides an optimal environment for bone ingrowth. Moreover, PTGs have been successfully used in different circumstances within the specialty of implant dentistry. They have also been suggested for management...
Jieun Lee
Modern Research in Dentistry, Volume 5, pp 453-456; doi:10.31031/mrd.2020.05.000602

Abstract:
Jieun Lee* Department of Prosthodontics, The University of Texas Health Science Center at Houston, USA *Corresponding author: Jieun Lee, Department of Prosthodontics, The University of Texas Health Science Center at Houston School of Dentistry, USA Submission: February 07, 2020;Published: March 05, 2020 DOI: 10.31031/MRD.2020.05.000602 ISSN:2637-7764Volume5 Issue1 A 69-year-old male patient reported to the UTHealth Prosthodontics with the chief complaint of decreased chewing efficiency and the instability with continuous use of his dentures. He was concerned with the functional efficiency of the dentures and not so much about esthetics. The patient was found to have a completely edentulous maxilla with a residual ridge morphology of minimal buccal vestibule and reduced hamular notch. The mandible had one root tip with a reduced residual bone height. The maxillomandibular relationship was Class III. Pt had a history of radiation in the head region with skin cancer of BCC, SCC, and Melanoma since 2008. Frequent attrition of the teeth may either be due to self-induced excessive chewing. Treatment options offered (1) denture or implant supported overdenture, (2) denture or implant supported overdenture with metal occlusal surface, and (3) implant supported fixed prosthesis. Pt chose a two-implant supported overdenture with a metal occlusal surface for the mandible. Therefore, the denture with the metal occlusal was planned to address patient's concern. It also improves the degree of masticatory ability and prevents the attrition of the teeth. This case report described a technique that uses custom made occlusal portions as the patterns for casting base metal occlusal surfaces. Metal has been reported to cause minimal wear to opposing occlusal materials. This technique is considered in cases where the prosthetic occlusion is in contact with enamel, composite resin, porcelain, metal, or a combination of such materials. Instead of individual units, a single joint unit is fabricated to improve the retention and provide easy finishing and polishing of the casting. This case report presents a simple and relatively inexpensive procedure for the construction of metal occlusal surfaces on complete dentures. Keywords: Metal occlusal; Implant; Prosthesis; Overdentures Abbreviations: BCC: Basal Cell Carcinoma; SCC: Squamous Cell Carcinoma; COPD: Chronic Obstructive Pulmonary Disease; TMJ: Temporomandibular Joint; VDO: Vertical Dimension of Occlusion; VDR: Vertical Dimension of Rest; Cr-Co: Chromium-Cobalt The use of acrylic resin denture teeth has been criticized due to the rapid occlusal wear that may lead to changes in centric occlusion, temporomandibular joint disturbances, loss in chewing efficiency [1], loss of vertical dimension of occlusion [2] and therefore can result in denture instability. The extent of wear varies depending on the clinical situation and the amount of time the prosthesis has been in use. Various articles [2,3] describe the construction of metal occlusal surfaces for the patients having the history of occlusal attrition, bruxism, orofacial tardive dyskinesia, self-induced excessive chewing, and idiopathic parafunctional mandibular movement. A metal occlusal surface may be indicated, A 69-year-old male patient reported to Advanced Prosthodontics at the University of Texas Health Science Center at Houston School of Dentistry with the chief complaint of decreased chewing efficiency and the instability with continuous use of his dentures. He was more concerned with the functional efficiency of the dentures and not so much about aesthetics. On clinical examination, the patient has a completely edentulous maxilla with a residual ridge morphology of minimal buccal vestibule and reduced hamular notch. The mandible had one root tip with a residual bone height of 11-15mm (Figure 1). The maxillomandibular relationship was Class III. History showed that the patient was wearing the complete maxillary denture and a tooth-supported mandibular overdenture. For over 25 years, he got his denture made twice due to frequent attrition of the teeth and instability of the denture. Figure 1: Patient’s maxilla and mandible in pretreatment stage. Pt recently had an extraction of the lower root tip. He also has a history of COPD, hepatitis C, hypertension, anemia, GERD, and radiation therapy in the head region with skin cancer of BCC, SCC, and Melanoma since 2008. He also was a previous smoker of 15 years. With the clinical examination and history, it was concluded that the frequent attrition of the teeth could either be due to self-induced excessive chewing, but no tenderness or discomfort of the TMJ joint or muscles of mastication. Several treatment options were described to the patient like The patient wanted an economical, with the best functional efficiency and had no time constraint. Also, he was further interested in two implant-supported overdentures for the mandible. Therefore, the metal occlusal surface denture was chosen to address the patient's concern with improved the degree of mastication and prevents the attrition of the teeth. Technique After extraction of the mandibular root tip and healing, preliminary impressions were made with alginate and poured in Type III dental stone to obtain primary casts. Custom acrylic resin trays were fabricated, and border molding was done with a green stick compound. Final impressions were made using PVS impression material for both arches, and impressions were poured with Type IV dental stone. Denture bases and wax rims were made to record face bow transfer and maxillomandibular relationship to a semi-adjustable articulator (Whip Mix). VDO was established by using two methods. In the first method, two points were marked, one on the tip of the nose and the other on an immovable part of the chin. To find the VDR position, the patient has repeated the letter 'M' several times, and then the distance between the points was measured. VDO=VDR minus...
Aylin Pasaoglu Bozkurt, Furkan Dindaroglu, Servet Dogan
Published: 25 February 2020
Modern Research in Dentistry, Volume 5, pp 1-8; doi:10.31031/mrd.2020.05.000601

Abstract:
Aylin Pasaoglu Bozkurt1*, Furkan Dindaroglu2 and Servet Dogan3 1Assistant Professor, Department of Orthodontics, Faculty of Dentistry, Beykent University, Istanbul, Turkey 2Associate Professor, Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey 3Professor, Department of Orthodontics, Faculty of Dentistry, Ege University, Izmir, Turkey *Corresponding author: Aylin Pasaoglu Bozkurt, Assistant of Professor, Beykent University Dentistry Faculty Department of Orthodontics, Buyukcekmece, 34550, Istanbul, Turkey Submission: February 07, 2020;Published: February 25, 2020 DOI: 10.31031/MRD.2020.05.000601 ISSN:2637-7764Volume5 Issue1 Objective: High-angle cases frequently show a vertical growth pattern, high mandibular plane angle and a long lower facial height. Such cases are referred to as skeletal open bite, and are most difficult to treat orthodontically, they may require skeletal anchorage or surgery. The aim of this case report is to highlight the importance of miniscrews in a severe open bite case. Method: Patient presenting with anterior and lateral open bite, long face syndrome, respiratory problems (13 years 2 months) admitted to the clinic for orthodontic evaluation. She had severe crowding, cl II skeletal relationship, proclaimed incisor, anterior and lateral open bite and gummy smile. Patient was informed about surgery, but she refused. At the beginning of the treatment leveling was carried out with extraction of four first premolars. After one appointment of applying the stabilization arc wire (17x25 SS) 4 miniscrews (2 for buccal, 2 for palatal side) was used for intrusion of maxillary molars. Also 1 miniscrew was inserted between 11-21 for controlling the elongation of incisors because of gummy smile. Result: After six months of intrusion molars, mandibular autorotation was achieved. Leveling and alignment was completed. Class I molar and canine relationship were achieved. Although we used full arch wire intrusion mechanics, gummy smile didn’t get worse. Profile was improved. Conclusion: Miniscrews are very important in orthodontic treatment for patients who refuse to have surgery. Although we obtain more aesthetic results in surgery, also miniscrews might be used for the comprehensive treatment. Keywords: Open bite; Skeletal class II; Orthodontic treatment; Miniscrew Being without vertical overlap relationship between upper and lower teeth when the jaws in the centric occlusion is defined as open bite. Genetic and environmental factors can be reason for developing anterior open bite. Sucking habits problems (finger and thumb), tongue posturing, respiratory problems related to conditions such as allergies, adenoids and tonsils, and mouth breathing can be counted as environmental factors [1]. Patients who show an excess of anterior vertical facial growth, they are more prone to have anterior open bite. These skeletal open bites cases are most difficult to treat orthodontically, they may require orthognathic surgery [2]. Orthognathic surgery may provide satisfactory results but, the complication possibility, risks, and high rate of charges of surgery have canalized doctors for searching an alternative treatments procedure [3-5]. Miniscrews can be used in orthodontics for space closure, space opening, intrusions, molar distalization, molar mesialization [6- 9]. Miniscrews were preferred because of easy insertion and removal without irreversible changes, possibility of immediate loading, low cost of the instruments, and shorter duration time of treatment [7,10]. Posterior impaction of dentition and open-bite correction through upward and forward mandibular autorotation can be done by orthodontic miniscrews [11]. Autorotating the mandible in a counterclockwise direction, can provide closing the open bite, and reducing the anterior facial height without any surgical treatment [12]. The aim of this case report is to show an alternative method to provide the demands of a severe skeletally open bite patient who refuse to have surgery and also to highlight the importance of miniscrews in patients with gummy smile. Transfer patient who was 13 years 2 months presenting with anterior and lateral open bite, long face syndrome, respiratory problems came to the Orthodontic Department of Ege University for orthodontic evaluation. She had already lower brackets when she came to our clinic. Her chief complaint was inability to close her mouth. During swallowing and conversation tongue-thrust wasn’t observed. She had a symmetrical face, bigonial and bizygomatic width proportion was harmonic. Lower third of her face was longer than the other parts (Figure 1). There was no midline discrepancy. She had gummy smile and extensive upper incisors exposure. She had a convex profile, normal nasolabial angle, shallow labiomental sulcus, normal cheekbone contour. Intraoral and dental cast examinations showed severe crowding, class I molar relationship, proclined incisor, high level upper canine, anterior and lateral open bite. The teeth were in contact at the second molars for both right and left side. Figure 1: Impression schedule. Hays nance and bolton analysis were done to define the space requirement (Figure 2). We need 9mm in the upper arch and 8,5 in the lower arch to relieve the crowding. The periodontal hygiene status was moderate. Panoramic radiography revealed no radiographic lesion or resorption around the roots (Figure 3). The pretreatment measurements showed, a class II skeletal relationship (ANB: 6.3). Maxillary (U1-SN: 115.1) and mandibular incisor inclinations (IMPA, L1-MP: 103.1) were out of normal limits (Figure 4) (Table 1). Based on these findings’ patient had skeletal class II bimaxillary retrognathia, dental class I molar and canine relationship, skeletal open bite with high angle-vertical growth pattern, increased upper incisor inclination, retrusive upper and lower soft tissue, crowding, gummy smile and convex profile. Table 1:...
Akikazu Shinya, Sakura Shiratori, Akinori Niitsuma, Minori Hatta
Published: 18 February 2020
Modern Research in Dentistry, Volume 4, pp 1-4; doi:10.31031/mrd.2020.04.000600

Abstract:
Akikazu Shinya1,2*, Sakura Shiratori3, Akinori Niitsuma3 and Minori Hatta3 1Department of Dental Materials Science, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan 2Department of Biomaterials Science and Turku Clinical Biomaterials Centre (TCBC), Institute of Dentistry, University of Turku, Finland 3Department of Crown and Bridge, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan *Corresponding author: Akikazu Shinya, DDS, PhD, Department of Dental Materials Science, School of Life Dentistry at Tokyo, The Nippon Dental University, 1-9-20 Fujimi, Chiyoda-ku, Tokyo 102-8158, Japan Submission: February 08, 2020;Published: February 18, 2020 DOI: 10.31031/MRD.2020.04.000600 ISSN:2637-7764Volume4 Issue5 The aim of this study was to evaluate the changes in the dentist’s stress caused by taking an impression, using either the optical impression technique based on digital technology or two different conventional impression techniques. The study was performed following the principles outlined in the Declaration of Helsinki on experimentation involving human subjects, and the protocol was reviewed and approved by the Ethics Committee. Three different impression techniques were used in this study. 1: Agar-alginate combined impression technique (Hydrocolloid impression). 2: Silicone single impression technique (Silicone impression). 3: Optical impression technique (optical impression). Based on these results, it can be concluded that optical impression is a lower stress technique for the operator, and more time efficient. Keywords: Intraoral scanner; Digital impression; Stress; Impression techniques The digital technology has brought many benefits to the clinic in the form of digital dentistry. In this field, optical impression taking is regarded as the most impressive technology. Optical impressions offer an easy and effective procedure that is friendly to both patient and dentist and allows for fast transfer of impression data between the dental clinic and the laboratory [1]. As the indirect technique is the most common method for the fabrication of dental restorations, taking impressions is one of the most common procedures in clinical dentistry. An accurate impression is essential for accurate manufacturing of dental restorations. Given this situation, the impression technique might be burden not only for the patient, but also for the dentist. The mental and/or physical stress caused by impression taking might lead to impaired concentration and reduced quality of clinical work. This means that this stress may lead to problems for the patient to the patient. The aim of this study was to evaluate the changes in the dentist’s stress caused by taking an impression, using either the optical impression technique based on digital technology or two different conventional impression techniques. The null hypothesis was that there would be no difference in the stress changes in operators between the three different impression techniques. The study population consisted of clinical trainee (dentists) as subjects experienced with impressions and undergraduate dental student (students) as subjects inexperienced with impressions. The study protocol was described in detail to potential subjects, and they were fully informed about the possible risks and benefits. Those who signed an informed consent form were included in the study. Twelve subjects (seven dentists and five students) who fulfilled the following criteria were recruited: good general and mental health, nonsmoking. The study was performed following the principles outlined in the Declaration of Helsinki on experimentation involving human subjects, and the protocol was reviewed and approved by the Ethics Committee of the Nippon Dental University (NDU-T2016-05). A left maxillary first premolar which was to be restored with a CAD/CAM resin composite crown was selected as the impression target. The impression was taken from patient-simulating humanoid robot, in order to have the test condition would simulate the clinical situation as closely as possible. Three different impression techniques were used in this study. 1: Agar-alginate combined impression technique (Hydrocolloid impression, Acelloid combine with Algiace Ⅱ, Dentsply Sirona, York, PA, USA). 2: Silicone single impression technique (Silicone impression, Tosicon pastel, Dentsply Sirona, York, PA, USA). 3: Optical impression technique (optical impression, CEREC Omnicam, Dentsply Sirona, York, PA, USA). The subjects had nothing eat or drink for 1 hour and sat quietly for 15 minutes before taking the impression. Saliva was collected by placing a collecting paper under the tongue for 30 seconds. Salivary amylase activity (SAA) was measured in an automatic salivary amylase activity monitor (NIPRO, Osaka, Japan), by attaching the collecting paper in contact with the reagent paper [2,3]. Subjects took impressions three times in one day, and SAA was measured before and after the first and third impressions (Figure 1). The total numbers of impressions were fifteen, taken over five consecutive days. The treatment time was measured as the time between beginning the taking of the impression and its completion. The value of the stress change (kU/L) was calculated by subtracting the SAA value before the impression from that afterwards [4]. Statistical analysis was performed as follows. The Kruskal-Wallis test followed by the Mann-Whitney U test was used to compare differences between impression methods. Treatment time and stress changes were analyzed by one-way ANOVA and Tukey’s honestly significant difference test with significance level of 0.05. Figure 1: Impression schedule. The results of the stress changes for all impression techniques are presented in Figure 2. Optical impression shows a significantly smaller stress change (p Figure 2: Stress change for all impression technique. Figure 3:Treatment time. Figure 4:Stress...
Smriti Jagdhari Golhar
Published: 28 January 2020
Modern Research in Dentistry, Volume 4, pp 1-2; doi:10.31031/mrd.2020.04.000599

Abstract:
Smriti Jagdhari Golhar* Department of Oral Medicine & Radiology, VSPM’S Dental College & Research Center, India *Corresponding author: Smriti Jagdhari Golhar, Assistant Professor, Department of Oral Medicine & Radiology, VSPM’S Dental College & Research Center, C/O Dr. Anil Golhar, 256 Ramdaspeth, Nagpur, Maharashtra, India Submission: December 14, 2019;Published: January 28 2020 DOI: 10.31031/MRD.2020.04.000599 ISSN:2637-7764Volume4 Issue5 MPDS are one of the main sources of chronic orofacial pain interfering with daily activities. These disorders also are commonly associated with other symptoms affecting the head and neck region, such as headache, ear-related symptoms, cervical spine dysfunction and altered head and cervical posture. Keywords:Myofascial Pain Dysfunction Syndrome (MPDS); Cervical pain; Craniocervical posture Abbreviations: MPDS: Myofascial Pain Dysfunction Syndrome; TMD: Temporomandibular Disorders Temporomandibular disorders (TMD) consist of a group of pathologies affecting the masticatory muscles, the temporomandibular joint, and related structures. MPDS constitute a major public health problem, as they are one of the main sources of chronic orofacial pain interfering with daily activities. These disorders also are commonly associated with other symptoms affecting the head and neck region, such as headache, ear-related symptoms, cervical spine dysfunction, and altered cervical posture [1-4]. There is a documentation of interconnection between neuroanatomy and neurophysiology and its effects on orofacial area. It is noted that change in craniocervical junction can alter the occlusion patterns and jaw position. It is also noted that the masticatory system can influence the position of the craniocervical junction. Thus, myofascial dysfunction may lead to compensatory changes in the craniocervical posture and develop the neck pain. Nicolakis et al. [5] stated in his several studies that it is postulated that posture of cervical spine and electromyographic activity of the masseter and temporalis muscles is interrelated. Shrinivas et al. [6] found 50% MPDS patients suffering from craniocervical dysfunction in his study. According to him, MPDS in TMJ region can be caused by craniocervical dysfunction and alternatively crániocervical dysfunction can be caused by MPDS in TMJ region. Study done by Okade et al. [7] showed that cervical dysfunction may be one of the extrinsic etiologic factors for MPDS. Another study was undertaken with the objective of therapeutic evaluation of cervical dysfunction in MPDS showed cervical pain showed significant improvement to physiotherapy given for MPDS patients [2]. Therefore, it is proven that there is a positive correlation between MPDS and cervical (neck) pain. Dentist as well as orthopaedic surgeon should be aware of this association for interdisciplinary approach towards patient management. © 2020 Smriti Jagdhari Golhar. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.
Csillag Maria, Amira M El Sherbini, Mohammed Abdul Rahman M, Fatma M Ibrahim
Published: 19 December 2019
Modern Research in Dentistry, Volume 4, pp 1-6; doi:10.31031/mrd.2019.04.000597

Abstract:
Csillag Maria1 and Kakar Ajay*2 1Principal Author and creator of the Smylist concept, Aesthetic Dentist, Budapest, Hungary 2Supporting contributor, Periodontist, Mumbai, India *Corresponding author: Csillag Maria, 1221 Budapest, Homezo U 40, Hungary Submission: December 17, 2019;Published: December 19, 2019 DOI: 10.31031/MRD.2019.04.000597 ISSN:2637-7764Volume4 Issue5 The musculoskeletal system of the body is connected by an intricate network of muscles and bones much like a spider’s web. A disruption at any point can lead to a series of events which can be very damaging. This article presents how a disruption in the balance with the mandible and its muscles can lead to serious unilateral knee damage through a negative cascade of events that take place. Keywords: Smylist; Mandible; Rotation; Knee; Unilateral; Joint; Deprogramming; Balance; Dentistry; Muscles; Musculoskeletal; Pain; Negative; Cascade; Events The mandible is the mobile joint in the body where the bone works as a single unit with both the joints moving optimally and simultaneously. The mandible is the topmost mobile joint in the skeletal system and has a powerful impact on the entire body. The Smylist method is the first concept in dentistry that has studied the mandible in detail in a complex way as a part of the musculo skeletal apparatus, how it effects the entire musculo skeletal system and how it can be influenced positively or negatively. Hence the name “Negative Cascade Effect” in the Smylist concept [1]. It is important to understand and learn more about how the mandible moves. How the facial and skeletal muscles associated with the mandible function during mandibular movement. The muscles directly associated with the mandible are the masticatory muscles and the mimic muscles of the face and these muscles play a very critical role in the movement of the mandible. It is also important to note that these muscles are part of the entire musculature of the body and are interlinked with the rest of the body muscles. The entire musculature is thus inter-related, and this inter-relation is one of the strong foundations of the Smylist concept. The human dentition is housed in the maxilla and the mandible. The maxillary teeth serve as a guide and stop for the mandibular teeth housed in the mandible which effectively is a guide and stop for the mandible. Ideally this movement of the mandible should be bilaterally symmetrical and all the involved muscles on the right and the left side should neither be over stretched and nor should they be in a state of spasm. If the maxillary teeth provide a stop at the right place the condyles will be appropriately placed in the fossae and the maxillary / mandibular relationship will be ideal. In this position all the involved muscles are also favorably placed. Unfortunately, the mandible is not always in such a place [2]. If the maxillary teeth do not provide an ideal stop in the right position, the mandible may get shifted to either the right or the left side. This shift or deviation is more appropriately termed as “rotated” in the Smylist concept. Since the two condyles are connected, they cannot possibly move independent of each other. Hence, a right rotated mandible will have the right condyle rotated and shifted towards the right side and the left condyle translated forward and rotated to the right side. It is also possible that the mandible may close too much if the maxillary teeth are protruded and do not provide a stop. This is an over rotated mandible. The muscles of the body from head to toe work in unison, literally like a spider’s web and hold the body in balance at all times [3]. If one muscle is over stretched, some other muscles on the opposite side will be impacted and probably will contract constantly to maintain this body balance. If some muscles get inactive some muscles will become hyperactive. A muscle in a state of spasm due to constriction of the muscle will pull the given part of the body towards itself. This will cause a breach in the body balance and other muscles will create a forced body position to somehow maintain the overall body balance. Since the entire musculo skeletal system is connected to each other, all the muscles of the body get adjusted to maintain this state of balance [4]. The right or left rotated mandible causes a disruption of the body balance. In fact, this disruption is more pronounced due to the position of the mandible in the top portion of the body. It is the first mobile joint along the vertical axis. A rotated mandible leads to its associated muscles getting unilaterally over stretched or in a state of spasm. Certain muscles also get flattened because they are not used because of the rotated mandible [5]. A right rotated mandible will cause the muscles on the left side to be overstretched. These muscles impact the face and the signs can be clearly discerned for e.g. the naso labial fold which will become horizontally displaced on the side the mandible is rotated. For the body to be balanced properly when the mandible is rotated to either the left or the right, the musculo skeletal system comes into play. A right rotated mandible, contracting the muscles on the right side, makes it a reactive reflex compensation mechanism for the neck muscles on the left side to attempt to balance the body [6]. This in turn will create a cascade of events which will affect the entire body. Human beings are two legged and upright with the centre of gravity in the middle of the abdomen. This makes it very necessary to maintain the balance of the body. The first reaction of the musculo skeletal system is to attempt bring the body into a balanced state. The imbalance is caused due to the right rotated mandible and the muscles moving and holding the mandible in the rotated position [7]. The body attempts to balance itself in two planes. These are the horizontal and the anterio posterior plane. The right rotated mandible...
Amira M El Sherbini, Mohammed Abdul Rahman M, Fatma M Ibrahim
Published: 17 December 2019
Modern Research in Dentistry, Volume 4, pp 1-6; doi:10.31031/mrd.2019.04.000596

Abstract:
Amira M El Sherbini1*, Mohammed Abdul Rahman M2 and Fatma M Ibrahim3 1Lecturer in Oral Biology Department, Egypt 2Associate professor in Oral Biology Department, Egypt 3Professor in Oral Biology Department, Egypt *Corresponding author: Amira M El Sherbini, Lecturer in Oral Biology Department, Faculty of dentistry, Mansoura University, Egypt Submission: November 21, 2019;Published: December 17, 2019 DOI: 10.31031/MRD.2019.04.000596 ISSN:2637-7764Volume4 Issue5 The ultrastructure of Submandibular gland [SMG] following low dose of Biochanin a [BCA] and 17beta estradiol [E2] application was observed. The pups were allocated randomly into control, BCA, E2, Dimethyl sulphoxide [DMSO] and euthanized at the 6th, 14th, 30th, 60th postnatal days [PND]. The SMG acinar and ductal structure, in addition to telocytes, were altered with the compounds of concern. Keywords: Biochanin A; 17beta estradiol; Endocrinal disruptor Abbreviations: BCA: Biochanin A; E2: 17beta estradiol; DMSO: Dimethylsulphoxide; SMG: Submandibular Salivary Gland; ED: Endocrinal Disruptor; TE: Transmission Electron Microscope; PND: Postnatal Day; gp: Group; M: Mitochondria; N: Nuclei; L: Lumen; rER: Rough Endoplasmic Reticulum; SG: Secretory Granules Known for various biological activities, biochanin A [BCA] is a plant extract that can be found in red clover [1]. Biochanin A acts also as anti-proliferative, anti-inflammatory agent [2,3]and anti-tumorigenic effect through inhibition of several enzymatic activity and apoptosis induction [3-6]. BCA is known for its estrogenic activity because it can bind with both alpha (ERα) and beta (ERβ) estrogen receptors [7]. The 17β estradiol is the main sponsor to estrogen-dependent processes in peripheral tissues [8]. Likewise, it is the main determinant for the proliferation of breast cancer cells in vivo [9,10]. In an attempt to avoid the risks, the search for alternative therapy is justified [11]. Estrogen receptors [predominantly ERβ] are expressed in submandibular gland more than the other major salivary glands. Thus, implicating a role of salivary gland in reproductive and peripheral organ development and/ or regeneration [12]. The rodent SMG exhibits extensive development of its parenchymal elements in postnatal periods [13]. Hereby the prepubertal development of rat SMG following low dose of Biochanin a [BCA] and 17beta estradiol [E2] exposure was observed. As far as we know this is the first assessment of BCA on SMG development. Although biochanin A is thought to be better tolerated, the presented study presented damaging effect that may exceed that revealed by genistein [14] on submandibular gland. All procedures performed in studies involving animals were in accordance with the ethical standards, and approved by the Ethics Committee of Faculty of Dentistry, Mansoura University, Egypt Materials Biochanin A [BCA] and 17β estradiol [E2][[E8875] Sigma Aldrich Co. St Louis, M O, USA], dimethylsulphoxide [DMSO]; [New Test Co. Egypt, Abbiotec, San Diego]. Pregnant female pathogen free rats were acclimatized in standardized temperature, humidity and phytoestrogen-free diet conditions. To avoid xeno-hormone residues, they were housed in individual polypropylene cages. After mating and parturition ninety-six pathogen free female offspring was randomly allocated into four groups, twenty-four each. Group 1 was the control group. In the experimental groups the offspring was injected subcutaneously at [PND] 1, 5, 14, 21, 30, targeting developmental stages, with 500μg/g body weight of BCA, freshly prepared dissolved in an equal volume of DMSO [1:1] in group 2; 500 ng/g body weight of E2 dissolved in sesame oil in group3; while in group4 the corresponding volume of the vehicle was injected [11]. Offspring was euthanized on the 6th, 15th, 30th and 60th postnatal days [PND] [six for each time of euthanization]. The submandibular salivary gland pair were surgically removed and separated from sublingual gland, then processed for ultra-structural examination [15]. The procedures were done in Electron Microscopy Unit, Agriculture faculty, Mansoura University. A. The 1mm blocks were fixed primarily in glutaraldehyde 4% for 2 hours, then in osmic acid solution [1%] as a secondary fixation for one to two hours, washed in phosphate buffer after each fixation, dehydrated by series of ethanol alcohol, followed by 100%propylene oxide and then embedded in Epon 812. B. Semi thin section [1μm] were stained with toluidine blue, and then examined by light microscope to determine the spot of choice to be ultra-cut for electron microscope examination. C. The ultrathin sections [50nm], cut using the ultramicrotome, were mounted on grids and were double stained with uranyle acetate and lead citrate, then washed with N-NaoH and finally with fresh double distilled water and dried before transmission electron microscope examination. The striated duct of control group showed distinguishing features of tall columnar cells arranged around the lumen, centrally located nuclei and characteristic basal folding. The acini revealed basally located nuclei with well-defined secretory granules that differed between different age groups. The compounds of concern showed changes in cell height of ductal component compared to the control group, wide intercellular spaces mitochondrial lesions, and dilation of double membrane [rough endoplasmic reticulum] were also noted especially in the striated ducts. The nuclear changes were also prominent both in acinar and ductal structures (Figures 1-4). The acinar basement membrane integrity as well as connective tissue component like telocytes was also affected in DMSO group (Figure 5). The striated duct radial pattern of the mitochondria and the basal infoldings was more evident at 15th PND. These results were similar to those of TEM observation in mouse submandibular gland by Pícoli et al. [18]. Several groupings of secretory granules with different...
Tahir Yusuf Noorani
Published: 16 December 2019
Modern Research in Dentistry, Volume 4, pp 1-3; doi:10.31031/mrd.2019.04.000595

Abstract:
Tahir Yusuf Noorani*1,2 1Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health campus, 16150 Kubang Kerian, Kota bharu, Kelantan, Malaysia 2Conservative Dentistry Unit, Hospital Universiti Sains Malaysia, Health campus, 16150 Kubang Kerian, Kota bharu, Kelantan, Malaysia *Corresponding author: Tahir Yusuf Noorani, Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health campus, 16150 Kubang Kerian, Kota bharu, Kelantan, Malaysia Submission: December 03, 2019;Published: December 16, 2019 DOI: 10.31031/MRD.2019.04.000595 ISSN:2637-7764Volume4 Issue4 During endodontic treatment is it is nearly impossible to completely clean the root canal system, using conventional endodontic instruments and techniques. This is mainly attributed to the complex anatomy of the root canal. Irrigants such as sodium hypochlorite facilitate the cleaning of the root canal system by its tissue dissolving and antibacterial activity. However, it is effective only when it is brought in contact with the pulp tissue and microorganisms within the root canal system. Passive ultrasonic irrigation is the term used to describe the transmission of acoustic energy from an oscillating K-file or smooth wire to an irrigant in the root canal [1]. Effectiveness of proprietary ultrasonic tips such as Irrisafe ultrasonic tip (Acteon, Merignac, France) or E1 Irrisonic insert (Helse Dental Technology, Brazil) for passive ultrasonic irrigation to improve the cleaning within the root canal system is well documented [2,3]. It is the authors opinion that similar cleaning efficacy can be achieved by using K-file and any conventional ultrasonic dental scaler (Figure 1). The authors believe that this technique is a relatively inexpensive way of carrying out passive ultrasonic irrigation to ensure complete and effective cleaning of the root canal system. Figure 1: Ultrasonic dental scaler (Satelac, Acteon, France). A. Achieving anesthesia for the tooth to be treated, isolation, followed by access cavity preparation. B. Determining the working length followed by cleaning and shaping of the root canals using either crown down or step back technique. Use of sodium hypochlorite as an irrigant during cleaning and shaping is recommended. C. After completion of cleaning and shaping, the root canals are irrigated with 2.5% sodium hypochlorite solution (Figure 2). Figure 2: Tooth LR7 undergoing root canal treatment. The root canals and pulp chamber flushed with 2.5 sodium hypochlorite solution (HUSM pharmacy, Malaysia). D. A size 15K-file is inserted into the root canal 1mm short of the working length. Ultrasonic dental scaler is activated and its tip is brought in contact with the shank of the K-file inserted into the root canal (Figure 3) to transmit the ultrasonic energy to the K-file and in-turn to the irrigant present within the root canal system. Figure 3: A size 15K file (Dentsply, UK) inserted into the root canal and an activated ultrasonic tip brought in contact with the shank of the K file to carry out passive ultrasonic irrigation. E. Passive ultrasonic irrigation as mentioned in step 4 is carried out for up to 1 minute for each root canal. F. Final irrigation with EDTA solution and completion of the root canal treatment with obturation and appropriate coronal restoration. Financial support from USM short term grant no. 304/ PPSG/6315195 is highly acknowledged. Support from management of Hospital Universiti Sains Malaysia is also acknowledged. © 2019 Tahir Yusuf Noorani. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.
Arwa U AlSaggaf
Published: 11 December 2019
Modern Research in Dentistry, Volume 4, pp 1-2; doi:10.31031/mrd.2019.04.000594

Abstract:
Arwa Alsaggaf*1,2 1College of Dentistry, Umm Al Qurra University, Mecca, Saudi Arabia 2Department of Prosthodontics, King’s College London, United Kingdom *Corresponding author: Arwa U Alsaggaf, faculty member in prosthodontic department, Maxillofacial Surgery and Diagnostics Department, College of Dentistry, Umm Al Qurra University, Saudi Arabia Submission: December 05, 2019;Published: December 11, 2019 DOI: 10.31031/MRD.2019.04.000594 ISSN:2637-7764Volume4 Issue4 Dental provisional restorations have an important value in prosthodontics field. This review is an introduction of that topic. Keywords: Provisional; Temporary restoration; Prosthodontics; Dental materials Provisional restorations are employed during the transitional phase between the initial teeth preparation or implant loading and the insertion of the definitive prosthesis [1]. For this reason, provisional restorations were historically referred to as temporary restorations. However, the use of the word “temporary” is controversial [2]. Some critics consider it to be inappropriate because it represents less value than the terms provisional or interim, and it can lead to the misconception that the final prosthesis will represent an immediate and magical remedy for the poorly prepared and fabricated transitional restoration [3-5]. The time that elapses between the placement of a provisional restoration and the definitive prosthesis varies according to the situation. Although long-term use of provisional restorations is not recommended, they are required in some cases. With the implant revolution and increasing demand for periodontal and esthetic surgeries, long-term provisionalization has become mandatory. Having them in use for long time increase the demand for better mechanical properties, wear resistance and esthetics and color stability. The provisional or interim phase of the treatment is one of the most important aspects of restorative treatment. It is considered a key tool that can be employed to diagnose the success of the definitive treatment. The majority of prosthodontists won’t proceed to the definitive prosthesis without transferring the wax-up into a provisional restoration for evaluation and diagnosis purposes [6]. This allows the evaluation of the tooth preparations and its parallelism, proximal contacts, vertical dimension of occlusion, occlusal scheme, interocclusal distance, phonetics, esthetics, and patient satisfaction [2,6,7]. Provisional restoration, also, allow the clinician to identify if the preparation offers sufficient retention and resistance forms, if the final prosthesis will have good lip support, and if the anterior guidance is effective. In the same way, provisional restorations can be employed to evaluate clinicians’ and technicians’ work, they can also be used to appraise the patient’s oral hygiene and oral home care. Proper provisional restoration along with the immediate or early replacement of the missing or extracted teeth will protect the position of the adjacent, opposing, and abutment teeth. Having teeth in stabilized position will protect the occlusion, which has a main effect in mastication. Also, by ensuring that the restorations are of an adequate thickness and good marginal seal, bacterial invasion, thermal insults and salivary penetration to dentinal tubules will be prevented [2,7]. As a result, teeth will be protected from caries and pulp will be sedated and protected while the definitive prosthesis is being fabricated [7]. Regarding tissue and periodontium, provisional restorations assist the clinicians to access and view the proximal area and surgical sites during the surgery. Then, act as a healing matrix for the soft tissue that can guide the process by which the tissues are reshaped [8]. It serve as a template that can be controlled and manipulated by the dentist for tissue reshaping. This is mainly needed with implant treatment to give the wanted emergence profile [9-11] and it requires a high-quality provisional restoration [12]. Moreover, it can act as a splint for mobile teeth, by splinting mobile teeth periodontium will be protected and treatment will be facilitated. The materials that are used in provisional restorations in contemporary dental practices can be made of different materials that involve various curing and fabrication techniques. Restorations can be prefabricated or custom made. Prefabricated provisional crowns, such as aluminum shell, nickel chrome, and polycarbonate crowns, are commercially provided in kits that consist of different sizes of anterior, premolar and molar shells [13]. The sizes and shapes of the crowns are determined by the manufacturers. Before choosing the crown for the patient, the measurement of the mesiodistal dimension of the preparation should be taken. The dentist should then adjust the occlusogingival length of the prefabricated crown. Prefabricated provisional crowns are, by definition, poor fitting, especially in terms of marginal adaptation. However, due to the time required to fabricate a bespoke, wellfitting restoration, this method is often preferred by many clinicians who are aware of the fiscal and time constraints that come with running a practice. These factors combined have led to a prevalence of ill-fitting crowns that fail to achieve ideal contour or occlusal contact [2,7,14,15]. To overcome this issue, the clinician should invest time in altering, relining, and polishing the crown before it is cemented. Polymeric resin can be used during the relining process to customize the fit [2,7,15,16]. However, prosthodontists and restorative dentists prefer custom-made provisional crowns and prostheses. These crowns can be fabricated using direct (chairside), indirect-direct, or indirect (in laboratory) techniques. The materials that are most commonly used in custom-made restorations are methacrylate resins (polymethyl, polyethyl, vinyl-ethyl & butyl) and composite materials...
Omar El Mowafy
Published: 10 December 2019
Modern Research in Dentistry, Volume 4, pp 1-3; doi:10.31031/mrd.2019.04.000593

Abstract:
Omar El Mowafy1* and Nora El Mowafy2 1Professor in Restorative Dentistry, Canada 2Associate in Dentistry, Canada *Corresponding author: Omar El Mowafy, BDS, PhD, FADM, Professor in Restorative Dentistry, Director of the International Dentist Advanced Placement Program, Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, Ontario M5G 1G6, Canada Submission: December 03, 2019;Published: December 10, 2019 DOI: 10.31031/MRD.2019.04.000593 ISSN:2637-7764Volume4 Issue4 When posterior teeth, premolars and molars, develop significant carious lesions, they need to be treated through caries removal and placement of restorations. Currently, there are two widely used direct restorative materials, amalgam and resin composite, that are used by dentists globally for this purpose. However, over the last decade there has been a significant increase in the utilization of resin composite restorations on the expense of amalgam. A number of reasons led to this trend. While amalgam has been utilized by the profession as a long-lasting direct restorative material for over a century [1], however, recently there have been several concerns about its mercury content, color and restoration failures. While some amalgam restorations maintain their shiny silver appearance over the years (Figure 1), others undergo significant corrosion [2] with subsequent darkening of the restoration (Figure 2). Furthermore, the fact that there is a viable competitor, resin composite, that matches the natural color of the teeth, is a good reason for the shift. The majority of young adults of the current generation prefer to have their teeth restored with indistinguishable materials. Therefore, esthetics are a major driving force in this respect. Resin composite restorations can match the natural color of the teeth with a high level of accuracy (Figure 3). There use by dentists in North America has been constantly on the rise [3,4]. Figure 1: Large amalgam restorations on mandibular molars. These were polished well and retained their surface lustre over time Figure 2: This maxillary molar has a mesio-occluso-lingual amalgam restoration that suffered from corrosion resulting in unsightly appearance. Perhaps the alloy from which this restoration was made is to blame for the outcome Figure 3: This maxillary second premolar has a disto-occlusal resin composite restoration that is indistinguishable due to optimal color matching Dental amalgam restorations are made through mixing of an alloy powder primarily made of silver, copper and tin with liquid mercury at a ratio of 1:1 [5]. The resultant plastic mix is condensed into the prepared cavity before setting begins. Therefore, amalgam restorations have a 50% mercury content, however, in a reacted form. Mercury has been also used in several industries other than dentistry including paper mills, medical appliances as in thermometers, barometers, electrical equipment, dry batteries, semi-conductors and in paints. Recently, there has been global environmental concerns about the use of mercury in these industries. This led regulatory bodies in many parts of the world to require a number of industries to eliminate mercury, a heavy metal, from their products. This included the paints industry and manufacturers of dry batteries. In the dental profession, regulatory bodies in North America required all dental treatment facilities to have in place a special device, mercury separator, to collect elemental mercury from dental amalgam remnants as they pass through the wastewater lines. Furthermore, in 2008 in Norway, the use of amalgam restorations has been phased out [6,7]. A similar situation existed in Sweden and Denmark, while Germany has restricted the use of amalgam. In 2009, Health Canada has recommended that dentists should not place or remove amalgam restorations from the teeth of the pregnant women [8]. Amalgam restorations failures also played a role as a significant factor in the decline of their use [9]. Amalgam restorations may fail due to recurrent caries that occurs around the restoration margins (Figure 4). Another typical scenario for failure of Class 2 amalgam restorations is isthmus fracture (Figure 5). This can be caused by a variety of reasons that include: shallow cavity preparation, sharp internal lineangles and recurrent caries underneath. Furthermore, failure of amalgam restorations can be also manifested in the form of tooth fracture (Figure 6). This can be predisposed by preparing the amalgam cavities with sharp rather than rounded internal lineangles. Sharp internal lineagles tend to cause stress concentration during function with subsequent fatigue and ultimately fracture of a cusp on the long term. Special burrs with rounded corners that are pear-shaped can be useful in helping the dentist produce cavities with rounded internal lineangles. When severe, tooth fracture may render the tooth non-restorable (Figure 7). The risk of tooth fracture can be reduced when amalgam restorations are bonded to the tooth structure rather than being inserted as mere passive obturators. Figure 4: A mesio-occlusal restoration on a mandibular first molar with evidence of recurrent caries at the gingival-buccal margin of the proximal area Figure 5: Isthmus fracture of a mesio-occlusal amalgam restoration on a maxillary first molar. Figure 6: This maxillary second premolar had an mesio-occluso-distal amalgam restoration that resulted in fracture of the lingual cusp Figure 7: This maxillary second premolar had a mesio-occluso-distal amalgam restoration which caused the lingual cusp to fracture off. Because the fracture line extended subgingivally, the tooth was deemed as non-restorable and had to be extracted. This shift in utilization of amalgam to resin composite is not surprising since change due to new technological advancements is inevitable in the dental profession. For example, over that last decade in North America, there has been a shift towards digital radiography...
Antigoni Delantoni
Published: 13 November 2019
Modern Research in Dentistry, Volume 4, pp 1-3; doi:10.31031/mrd.2019.04.000592

Abstract:
Antigoni Delantoni* Aristotle University of Thessaloniki, Greece *Corresponding author: Antigoni Delantoni, DDS, MSc, PhD, MD, Aristotle University of Thessaloniki, Greece Submission: November 05, 2019;Published: November 13, 2019 DOI: 10.31031/MRD.2019.04.000592 ISSN:2637-7764Volume4 Issue4 The major salivary glands are superficial exocrine glands that produce saliva and keep the oral cavity moist. They are the paired parotid, submandibular, and sublingual glands. The upper aerodigestive tract mucosa is lined by hundreds of small, minor salivary glands. A connective tissue capsule surrounds the gland and extends into parenchyma, dividing the gland into groups of secretory units and ducts known as lobes and lobules. Blood vessels, lymphatic vessels and nerves that supply the gland, are present within the capsule. As superficial anatomical structures the salivary glands are easily accessible to ultrasound. Ultrasound has several advantages that make it the examination of choice in the study of their pathology [1-5]. Main advantages are the easy accessibility and the low cost of the method, the safety of technique since radiation is avoided and the excellent image analysis in real time with the newer high frequency transducers used since they provide the details of the superficial structures required for the examination [6]. It is a technique based on sound waves that acquire images after being sent to the tissues/ The response is in real time and free of radiation [7]. Diagnostic ultrasonography is the clinical use of ultrasounds using vibratory frequencies ranging from 1 to 20MHz [8-10]. In the maxillofacial region high frequency transducers are needed to provide the details required in the superficial structures of the glands. Inflammation of the salivary glands of varying aetiology is the major problem occuring in the pathology of the glands which is easily and readily diagnosed with ultrasounds [11-14]. It is the most common cause of parotid swelling in developed countries. The most frequent symptom includes non-continuous pain and fever as well as unilateral or bilateral swelling of the glandular area [15-18]. The inflammation is limited only to the area of parotid gland, without involvement of the submandibular or sublingual glands thus the word parotitis in contrast to sialadenitis which could be in all glands. It is of unknown etiology in a number of cases and the differential diagnosis include mumps or the suppurative parotitis, which is easily excluded from the clinical symptoms [19-21]. The majority of cases involve children while there is episode reduction as the children grow, and they cease near puberty or in late adolescence. The male sex is more frequently affected [21-25]. For the cases of parotitis in the past, sialography was the prime modality for glandular imaging by showing punctate or globular areas of sialectasis. Ultrasound is now the favored imaging approach. Most sonograms of parotitis show the characteristic enlarged parotid glands with multiple round, hypoechoic areas measuring 2 to 4mm in diameter, likely representing peripheral sialectasis and lymphocytic infiltration. The vascularity of the glands may increase secondary to the inflammation process [26-28]. Chronic sialadenitis may affect all the major glands and is caused by inflammation that is not treated and rests, leading to alterations of the acini and secretory function of the glands. It is attributed to bacterial or non-bacterial inflammations [29]. Clinically the patients present with swelling and pain. Causes usually include granulomatous conditions such as actinomycosis and histoplasmosis. When of granulomatous etiology, they may appear with less inflammatory image features at ultrasound and demonstrate a hypo echoic mass with poorly refined margins [30]. Bacterial gland infection is more common, usually presenting at childhood with more common ages from 2-4 years of age. With the addition of color Doppler to the images due to the inflammatory origin of the pathology the lesions do not show increased color flow (which is a differential diagnostic feature from neoplasms). Other inflammatory conditions with similar ultrasonographic features are autoimmune diseases and recurrent sialolithiasis. Sjögren’s syndrome is an autoimmune disorder that results in inflammation and destruction of the exocrine glands, primary the lacrimal and salivary glands. To avoid irradiating the patient at follow ups it is preferable to monitor them with ultrasound. The most common reason for inflammation of a single salivary gland is in 80% of cases the presence of a sialolith. Salivary stones form usually within the duct of the glands with more frequent the Wharton’s duct of the submandibular gland [31]. They are hard stone like structures, that form within the gland. They are made of mineral stones, they are slow in development and they may block the ductal system of the gland. When this happens, the drainage of the gland is blocked, the patient demonstrates pain and swelling and inflammatory features of the glandular system [32]. With the use of ultrasound, the calculus may be readily visible, but in many cases the acoustic shadow of the stone may be all that is visualized. The use of ultrasound is crucial since it visualizes the glandular parenchyma easily [33]. Sjögren’s syndrome and other autoimmune disease, including HIV, are at risk for primary lymphoma. It involves all exocrine glands and the primary diagnostic symptoms are usually from the eyes with decrease of lacrimal glands excretions. Ultrasonographic features include a generalized diffused image with infiltration and full gland involvement which results to an enlarged gland. Lesions may consist of multiple small, hypoechoic nodules or an irregularly shaped, heterogeneous mass without calcification or anechoic cystic degeneration. The imaging features are similar to lymphomas and /or adenitis. Some authors in chronic...
Andrea Pilloni, Roberto Rossi, Alessandro Conti, Davide Bertazzo
Published: 12 November 2019
Modern Research in Dentistry, Volume 4, pp 1-4; doi:10.31031/mrd.2019.04.000591

Abstract:
Roberto Rossi2, Alessandro Conti2, Davide Bertazzo3 and Andrea PILLONI*1 1University of Roma Sapienza, Italy 2Private Practice, Genova, Italy 3CDT Casale Monferrato, Italy *Corresponding author: Andrea Pilloni, Professor and Chairman of Periodontology, University of Roma ‘Sapienza’, Roma, Italy Submission: October 29, 2019;Published: November 12, 2019 DOI: 10.31031/MRD.2019.04.000591 ISSN:2637-7764Volume4 Issue4 Ridge defects are a common problem following tooth extraction, the literature shows that horizontal defects seem to be the easier to correct. Nevertheless a number of procedures, matherials and methods have been proposed to treat such problem and the use of a combination of a xenograft associated with some autogenous bone and resorbable membrane seems to be the best predictable option. The cortical lamina technique has been introduced about ten years ago and both clinica and hystological studies have validated its use. In this case presentation we will show how the cortical lamina, significantly, changed the anatomy of a severely resorbed mandible in order to accommodate and restore dental implants. Tooth loss is a common unfortunate event in dentistry, quite often following an extraction we observe a certain degree of remodeling in both the hard and soft tissue [1]. Ridge defects can also be caused by faulty extractions, traumatisms, periodontal disease and peri-implantitis. These defects can show different patterns, some with an horizontal pattern, some with a vertical component and some showing a combination of both horizontal and vertical hard and soft tissue loss. Many different surgical approaches have been offered for the resolution of such problem, and a recent systematic review done by Sanz-Sanches et al. 2015 indicated that the most reliable solution to solve horizontal defects is the combination of a xenograft associated with a resorbable membrane [2]. A new technique that is showing promising result in horizontal ridge augmentation is the cortical lamina and uses a membrane made of cortical porcine bone [3,4], several publications and reports prove its usefulness and efficacy in treating ridge defects. The Cortical lamina technique is becoming a well understood and used procedure for both horizintal and vertical bone augmentation [5,6]. It is basically a semi rigid, flexible, collagenated xenogenic bone membrane (Tecnoss, Coazze, TO, Italy) that has the advantage to integrate along with the bone graft placed underneath and to fully integrate in the area wher it is placed, reshaping and augmenting the area [5]. The case presented is of a female patient 41 years old with a failing long span bridge in the lower left quadrant. Her CBCt (Figure 1&2) shows a severe pattern of bone resorbtion, the ridge is basically knife edged and poorly represented in its cancellous component. Clinically also the soft tissue show (Figure 3) this pattern with a high insertion of the vestibule. The patient had a negative medical history and there was no contra-indication for GBR and subsequent implant treatment. After local anesthesia with Articaine 1:200.000 full thickness buccal and lingual flaps were elevated to expose the very narrow edentulous ridge (Figure 4). With the aid of a sharp piezo-surgical tip the narrow ridge was perforated in the buccal aspect to promote some bleeding from the marrow spaces and in order to hydrate the bone graft placed to its buccal aspect. It was a mix of autogenous bone scarped from the area and collagenated porcine bone (GenOs, Tecnoss, Coazze, TO, Italy), the newly shaped ridge (Figure 5) was than covered with a curved cortical lamina, cut and shaped in order to fit the area and protect the underlying grafted ridge (Figure 6). The falps were than advanced to accommodate the new volume and sutured with PTFE 4.0 sutures. 8 Months after surgery one can notice the new aspect of the ridge (Figure 7) and after flaps were opened to exposed the new ridge one can notice that the new horizontal volume coud than receive 4.2mm diameter implants (Resista, Omegna, Italy) without any problem (Figure 8). The next picture (Figure 9) shows how the two fixtures were properly adjusted to the new anatomy. Three monts later the implants were exposed, healing abutments were connected to further condition and widen the band of keratinized gingiva by apically repositioned flap (Figure 10). In the next two pictures (Figure 11&12) we can see the final restoration, a screwed in monolithic zirconia two unit bridge, that fits well the previously edentulous ridge and offers a very natural and bio-mimetic emergence profile. At last (Figure 13-16) the radiographic history of the case, with the edentulous ridge and the old long span bridge, the implants placed after ridge augmentation, its relationship to the bone crest at the time of impressions and four years after the final restoration was delivered. Figure 1: CBCT. Figure 2: Slice of CBCT. Figure 3: Appearance of the edentulous ridge. Figure 4: Extremely resorbed ridge. Figure 5: Aspect of the grafted ridge. Figure 6: application of cortical lamina. Figure 7: Healing at 8 months post op. Figure 8:Insertion of two 4.2mm fixtures. Figure 9: implants in place. Figure 10:Healing abutments. Figure 11:Final restoration in place. Figure 12:proper emergence profile. Figure 13:Initial rx. Figure 14:rx implants. Figure 15:Impression. Figure 16:Final restoration (4y). Ridge defects have always been a challenge for the clinician and many surgical options and bio-materials have been advocvated for its treatment. In recent years the cortical lamina technique has surfaced as one of the techniques that reliably works in the solution of such problem. The case presented in this article had at baseline an horizontal ridge defect that would have not suggested the use of dental implants. Following ridge augmentation with a Xenograft covered with the cortical lamina it was possible to insert standard diameter implants and later to restore...
Wan Zaripah Wan Bakar , Min Fui Chong, Nor Azira Zabidi
Published: 23 October 2019
Modern Research in Dentistry, Volume 4, pp 1-5; doi:10.31031/mrd.2019.04.000590

Abstract:
Wan Zaripah Wan Bakar1*, Min Fui Chong2 and Nor Azira Zabidi3 1Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia. 2Borneo Medical Centre, Lot 10992, Section 64, KTLD, Jalan Tun Jugah, 93350 Kuching, Sarawak, Malaysia. 3Ministry of Health, Malaysia. *Corresponding author:Wan Zaripah Wan Bakar, Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia, Email: [email protected] Submission: September 29, 2019;Published: October 23, 2019 DOI: 10.31031/MRD.2019.04.000590 ISSN:2637-7764Volume4 Issue3 Visual-tactile method is still a commonly used technique in detecting caries even the International caries detection and Assessment System (ICDAS) has been exposed among dental operators in Malaysia. However, this method has been shown to have high specificity but low sensitivity and reproducibility. This study is conducted to determine the accuracy of visual-tactile method in diagnosing early occlusal caries lesion by dental practitioners in Malaysia. Fourteen posterior teeth were selected as samples for the assessment by 95 respondents from 9 different states which diagnosed each tooth as either sound, early or advanced caries following the criteria set. DIAGNO dent pen which is known as an accurate diagnostic tool in detection occlusal caries was used as a gold standard and the result was compared with the respondent’s visual-tactile assessment. Percentage was calculated and the result shown the percentage of accurate early occlusal caries detection using visual-tactile method is 43.23% (95% CI: 39.90, 46.56). In addition, the percentage of operators who misdiagnosed advanced lesion as sound or vice versa are 34.74% (95% CI: 24.99, 44.49) for 1 misdiagnosis, 6.32% (95% CI: 1.33, 11.30) for 2 misdiagnosis and 1.05% (95% CI: -1.03, 3.14) for 3 mis diagnosis. From this study, the level of accuracy for operators in Malaysia in detecting early occlusal caries lesion using visual-tactile method is relatively low. This finding is hoped to improve clinician awareness of the visual-tactile diagnostic method limitation so they will be more concerned and other devices or systems such as ICDAS should be used. Dental caries, a chronic infectious communicable disease, is one of the most common problems encountered in clinical dentistry [1]. Although caries has affected human population since prehistoric times, the prevalence of this disease has increased greatly in modern worldwide. Statistics shows still a very high incidence of over 70% of adults in Malaysia according to the 2009 national survey. A thorough understanding of the early lesion morphology is necessary in order to determine the suitable treatment planning and appropriate type of restoration. Correct diagnosis of early caries lesion permit dentists to adopt more conservative management strategies directed at the prevention and cure of dental caries. Current concept of minimally invasive dentistry (MID) concerns about tissue preservation where the philosophies centres around entailing minimal destruction to the tooth structure by removing and replacing with as little tissue loss as possible. It does not suggest that we make small fillings to restore incipient lesion. In this case, correct diagnosis of the lesion is important so that the clinician will give a right treatment. Various methods have been used in detection of dental caries clinically which includes visual examination method with probing, ICDAS, intraoral radiographs, DIAGNOdent Pen system, fiber optic transillumination (FOTI), digital fiber optic transillumination (DIFOTI) and also Cone-Beam Computed Tomography (CBCT). Golden standard for caries assessment is histological sectioning, and study also found that Micro Computed Tomography (Micro-CT) is the best imaging method for the in vitro measurement of occlusal caries depth [2]. Kouchaji C [3] study also found that laser fluorescence DIAGNOdent pen is a reproducible and accurate diagnostic tool that may be very helpful in conjunction with visual examination in the detection of occlusal caries in permanent molars. Occlusal pits and fissures are the most susceptible sites for primary carious lesion which requiring restorative treatment. The pits and fissures provide mechanical shelter for organisms and harbor a community dominated by Streptococci sanguis [1]. Addition to this is the inaccessibility of base of fissure to tooth brush bristles following food impaction. In general, occlusal surface of the tooth can be either sound with or without stained pit and fissure; early caries lesion (discoloration or opacification of fissure) and advanced caries lesion when there is cavitation (EBD Champion Conference, American Dental Association, 2008). The International Caries Detection and Assessment System (ICDAS) has been introduced which is a clinical scoring system for use in dental education, clinical practice, research and epidemiology. It is designed to lead to better quality information to inform decisions about appropriate diagnosis, prognosis and clinical management at both the individual and public health levels. It also provides a framework to support and facilitate personalized management of the caries process and dental decay for improved long term health outcomes. Deep fissure with staining could be wrongly diagnosed as carious if the operator has a lack of knowledge for accuracy in caries diagnosis. This could lead to surgically restored of the tooth, removing sound tooth structure and is totally unnecessary. In the practice of conservative dentistry, the early caries lesion in enamel will only need preventive methods such as professional fluorides applications or fissure sealants. Remineralisation is recommended rather than restoration. Therefore, definite diagnosis of occlusal caries is crucial and distinguished lesion that can be arrested by non-invasive...
Swarga Jyoti Das
Published: 11 September 2019
Modern Research in Dentistry, Volume 4, pp 1-4; doi:10.31031/mrd.2019.04.000589

Abstract:
Swarga Jyoti Das* Department of Periodontics and Implantology, India *Corresponding author:Swarga Jyoti Das, Professor & Head, Department of Periodontics and Implantology, Regional Dental College, Guwahati-781032, Assam, India Submission: July 30, 2019;Published: September 11, 2019 DOI: 10.31031/MRD.2019.04.000589 ISSN:2637-7764Volume4 Issue3 Dental mesenchymal stem cells are an attractive source of autologous stem cells. They offer a biological solution for restoring damaged dental tissues such as vital pulp and periodontal ligament and even, generation of complete or partial tooth structures to form biological implants through tissue engineering. Thus, dental tissue engineering is a new promising therapeutic approach to replace a missing tooth or to restore the damaged dental tissues. The objective of this review article is to highlight the history of the isolation of dental-related stem cells and their various types along with their potentiality and current status of applications in the field of dentistry Tooth loss is a significant health issue currently affecting millions of people worldwide. It not only affects mastication and pronunciation but also leads to a series of physiological and psychological problems. The current gold standard therapy for tooth replacement is dental implants. However, it does not exhibit many properties of natural teeth and can be associated with certain complications, particularly periimplantitis, leading to implant failure [1]. Recent advancement in stem cell-based regenerative bioengineering therapy makes it possible to attain bioengineered tooth buds in experimental animals, which will be definitely a superior, promising, clinically relevant tooth replacement therapy [2,3]. It is well documented that innervation of teeth is essential for their function and protection. This can be also attained to the bioengineered teeth by autologous mesenchymal cells derived from the bone marrow with low or no immunogenicity expressed by Strub et al. [4]. Bioengineered tooth is one of the regenerative products where tissue engineering is carried out using stem cells. Stem cells are defined as clonogenic cells capable of both self-renewal and multi-lineage differentiation. They are also known as “progenitor or precursor” cells. A stem cell is essentially the building block of the human body. In 1868, the term “stem cell” for the first time appeared in the works of German biologist Haeckel. Wilson coined the term “stem cell” in [5]. These cells can be classified on the basis of their differentiation commitments (pleuripotent, multipotent and unipotent) and of their origin as embryonic, prenatal and postnatal stem cells. Postnatal stem cells, also known as the adult stem cells (ASCs), act as supportive cells by their regeneration capacity. They are primarily found in niches, namely bone marrow, skin, adipose tissue and teeth. More recently, another source of stem cells has been successfully generated from human somatic cells into a pluripotent stage. These induced pluripotent stem cells create patient- and disease-specific stem cells [6]. Among the adult stem cells, teeth are the most natural, noninvasive rich source of stem cells with decreased immunogenicity. They are easy, convenient, and affordable to collect, which are making them an attractive source of autologous stem cells. They are potential to differentiate into several cell types, including odontoblasts, neural progenitors, osteoblasts, chondrocytes and adipocytes. Considering their pluripotent natures, they are becoming a potential, novel, important tool of tissue engineering to develop biological substances. Thus, they offer a biological solution for restoring damaged dental tissues such as vital pulp, regeneration of periodontal tissue lost in periodontal disease, and for generation of complete or partial tooth structures to form biological implants [5]. There are several types of stem/progenitor cells existed in dental tissue. Depending on the sites of harvest, they can be grouped as [5,6] (Figure 1): A. Dental Pulp Stem Cells (DPSCs) B. Stem cells from Human Exfoliated Deciduous teeth (SHEDs) C. Periodontal Ligament Stem Cells (PDLSCs) D. Dental Follicle Precursor Cells (DFPCs) E. Stem Cells from the Apical Papilla (SCAPs) F. Stem cells from Gingiva (GSCs) Dental pulp stem cells (DPSCs): The presence of stem cells in dental pulp tissue primarily have been reported in 1985 by Yamamura. Later on, Caplan et al. have demonstrated that these cells presented osteogenic and chondrogenic potential invitro and could also differentiate into dentin invivo [7]. In 2000, Gronthos et al. [8] have isolated dental pulp stem cells from adult human dental pulp (Figure 2). They are capable to differentiate into odontoblasts, osteoblasts, muscle, adipose, neurons and chondrocytes invitro and can differentiate into dentin, invivo and also differentiate into dentin-pulp-like complex [8]. They show higher proliferation rate in vitro compared to that of the stem sells of other sites, which may be due to the fact that, third molars, the source, are the last permanent teeth regarding growth, formation and eruption and thus exhibits more primitive state compared to the mesenchymal stem cells of the bone marrow. Use of DPSCs in dental tissue engineering, the major issue is the scaffold. Researchers are still trying to find a competent scaffold to place DPSCs as well as the ideal microenvironment that will promote their differentiation. Figure 1:Sources of dental stem cells. Figure 2:Timeline that highlights the history of the isolation of dental-related stem cells. Stem cells from Human Exfoliated Deciduous teeth (SHEDs): In 2003, Miura et al. [9]have reported to isolate a stem cell population from the living pulp remnants of exfoliated deciduous teeth and they have termed the cells as stem cells from human exfoliated deciduous teeth (SHEDs) [9] (Figure 2). They have the ability to...
Koshy Philip, Zeyad Nazar Majeed, Alabsi Am, Dasan Swaminathan
Published: 3 September 2019
Modern Research in Dentistry, Volume 4, pp 1-9; doi:10.31031/mrd.2019.04.000588

Abstract:
Zeyad Nazar Majeed1, Alabsi AM2, Dasan Swaminathan3 and Koshy Philip4* 1Department of Periodontology, Faculty of Dentistry, University of Babylon, Iraq 2Faculty of Dentistry, MAHSA University, Malaysia 3Department of Restorative Dentistry, Lincoln University College, Malaysia 4Lincoln University College, Petaling Jaya, Selangor, Malaysia *Corresponding author:Koshy Philip, Lincoln University College, Petaling Jaya, Selangor, Malaysia Submission: August 16, 2019;Published: September 03, 2019 DOI: 10.31031/MRD.2019.04.000588 ISSN:2637-7764Volume4 Issue3 Objectives: The aim of this study was to determine the levels of LL-37 and subgingival periodontal pathogens in the periodontal health and disease among three ethnic groups in Malaysia. Methods: Gingival crevicular fluid (GCF) and subgingival plaque samples from 28 healthy subjects (H), 30 patients with gingivitis (G) and 30 patients with chronic periodontitis (CP) were collected. The LL- 37 levels were quantified by the enzyme-linked immunosorbent assay (ELISA) while the subgingival periodontal pathogens were identified using polymerase chain reaction (PCR). Result: The LL-37 levels were significantly higher in the CP group than other groups. The detectability of LL-37 in CP group was 100%, while in H and G groups was 78.5% and 93.3% respectively. Red complex species populations in CP group are higher than in other groups. The LL-37 levels in GCF were positively correlated with red complex and A. actinomycetemcomitans species in the subgingival plaque. Moreover, there is a positive correlation between the LL-37 levels and periodontal pathogens which play major role in the initiation and progression of chronic periodontitis. Conclusion: LL-37 in GCF may be considered as relevant biomarker for chronic periodontitis. Furthermore, red complex species count can be useful in the differentiation between the different stages of periodontal disease. Keywords: Human cathelicidine LL-37; GCF; Periodontal pathogens; Biomarkers Periodontal diseases are basically classified into two types that include gingivitis and chronic periodontitis. Both diseases are essentially caused by bacteria present in the subgingival biofilm. The determination of microbial profiles that could categorize various forms of periodontal disease has not been described [1]. The complex periodontal microbiota, in addition to its great variability among the individuals, may lead to these difficulties [2,3]. Furthermore, it has been proven that there are variances in the distribution of periodontal bacteria among different populations [4]. Along with these findings, the majority of these bacterial species that are also present in the normal periodontal microbiota will further complicate the determination of microbial profiles in subgingival plaque [5]. The existence of low-level periodontal pathogens in the periodontally healthy subjects is a common finding [6].These features of periodontal microbiota which can lead to inflammation justify the needs of the development of a more accurate microbial diagnosis which can support the clinical diagnosis and lead to a better treatment plan [7]. Five microbial complexes repetitively exist in the subgingival biofilm of individuals with and without periodontal inflammation [8]. This comprises the red complex which encompasses a conglomerate of three species namely Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. The red complex has been considered as the most pathogenic bacterial complex [8,9] and may apply an inhibitory role in the colonization ability of other types of bacteria in the subgingival biofilm. Thus, they may have the ability to adjust the virulence characteristics of other subgingival biofilm communities [10]. Furthermore, Aggregatibacter actinomycetemcomitans (A.a) is considered as a causative pathogen for adult periodontitis and aggressive periodontitis. Moreover, it is suggested that A.a causes apoptosis to increase in the gingival epithelial cells [11,12]. Host defence antimicrobial peptides (AMPs) are the major components of the innate immune responses which have an essential role in human health [13]. More than 45 AMPs have been recognized in the oral cavity [14,15]. LL-37 has been distinguished as an exceptional class of peptides which has many effects including antibacterial, antiviral and antifungal functions. It also shows a chemotactic and modulatory effect and has the ability to induce wound healing, modifying apoptosis and angiogenesis. The antimicrobial action of the LL-37 occurs with other antimicrobial molecules such as histamine, defensins and enzymes that have the capacity to destroy the bacterial cell wall. Collectively, these molecules have the ability to respond rapidly and adequately to the bacterial challenges [16]. The terminology of mature cathelicidine LL-37 is derived from two leucine residues and 37 amino acids. The mass of human cathelicidine antimicrobial peptide prior to the proteolytic processing was 18 KD and this is the reason why the term hCAP-18 has been used [17]. Therefore, the extracellular processing of hCAP-18 by proteinase 3 in response to phagocytosis or neutrophils stimulation will lead to the release of mature LL- 37 [18]. The LL-37 levels in saliva and GCF present less than the minimum inhibitory concentration for oral pathogens. This led to the suggestion that the main action of LL-37 and other AMPs is a trigger to the immune system, i.e. an endogenous mediator that enhances and recruit’s antigen-presenting cells to activate the innate and adaptive immunity [19]. Previous studies have demonstrated the expression of LL-37 in different stages of the periodontal disease progression [20,21] which determined the role of LL-37 in the innate immune system. We thus hypothesized that the LL-37 levels in GCF can be used as a biomarker for periodontal diseases. The aim of the present study was to correlate the LL-37 levels to the most common periodontal...
Sawsan Tabbaa, Kaveh Baharvand Ahmadi, Peter H Buschang
Modern Research in Dentistry, Volume 4, pp 1-9; doi:10.31031/mrd.2019.04.000587

Abstract:
Kaveh Baharvand Ahmadi1, Peter H Buschang2 and Sawsan Tabbaa3* 1Kaveh Baharvand Ahmadi, Orthodontics Private Practice, Texas, USA 2Peter H Buschang, Texas Director of Orthodontic Research. A&M University College of Dentistry, USA 3Sawsan Tabbaa, Director of Orthodontic Research, School of Orthodontics, Jacksonville University, USA *Corresponding author:Sawsan Tabbaa, Associate Professor, Orthodontics Research Director, School of Orthodontics, Brooks Rehabilitation College of Health Sciences, Jacksonville University, 2800 University Blvd N. Jacksonville. Fl. 32211, USA Submission: August 01, 2019;Published: August 08, 2019 DOI: 10.31031/MRD.2019.04.000587 ISSN:2637-7764Volume4 Issue3 Introduction: The purpose of this study was to predict the lip changes in Class I adolescents and adults following non-extraction orthodontics treatment. Methods: This longitudinal retrospective study evaluated the pre- and post-treatment lateral cephalograms of 40 adults and 72 adolescents with Angle Class I molar relationships and crowding in both arches. The horizontal and vertical changes of 15 landmarks, along with lip thickness and taper, were evaluated. The sample was randomly divided into two group; 76% of the subjects were used to develop the multivariate regression formulas; the remaining 24% served as a validation sample. Result: Adolescent lips moved inferiorly and anteriorly during treatment; adult lips showed lesser inferior movement, little or no anterior movement and decreases in thickness. Males demonstrated significantly greater inferior and, mostly, greater anterior changes of lip position. The multivariate regressions explained 48-59% and 41-69% of the vertical and horizontal variation of the lip changes, respectively. When the prediction equations were applied to the validation sample, with correlations ranged from 0.60-0.84, indicating external validity. Conclusion: The lip changes of Class I adolescents and adults treated with non-extraction orthodontic treatment can be predicted with fair to moderate accuracy. Adults’ lips became compressed and thinner, while the upper lip thickness of adolescents did not change or become slightly thicker. Esthetic ideals are continuously evolving in today’s age of global media and merging cultures. It has been estimated that 3 out of 4 patients come to orthodontists to improve facial attractiveness [1]. Lips are among the most important features that determine attractiveness [2]. For example, lip thickness has been shown to be critical in the perception of beauty, [3,4] with thicker lips being positively related to higher esthetic perceptions [5]. The public notices the lip changes more than nose or chin changes [6]. It is essential for orthodontists to differentiate between lip changes due to treatment and those due to growth. For untreated subjects between 6-18 years of age, upper lip length increases approximately 4mm, thickness increases 1-2mm and protrusion decreases only slightly (0.5mm); lower lip length (9-10mm) and thickness (2-3mm) both increase [7]. Adolescents’ lips become relatively more retrusive over time, substantially longer, and somewhat thicker [8,9]. In contrast, adults show different patterns of change. Untreated adult soft tissues change at much slower rates. Their lips continue to retrude and tend to flatten, especially at the older ages [10-12]. Relationships between the lips and the underlying dental structures were demonstrated as early as 1834.7 Soft tissue changes following the orthodontic treatment are usually considered secondary to tooth and skeletal alterations [13]. Some authors have reported simple linear relationships between hard tissue and soft tissue profile changes [14,15]. Ratios, which relate lip changes to the amount of incisor retraction, have been reported to range from 1:1.75 to 1:2.2 for the upper lip, and from 1:1.2 to 1:1.4 for the lower lip [16,17]. Importantly, ratios assume that lip movements can be predicted by a single hard tissue measure, which limits their ability to predict [18,19]. Moreover, ratios imply that the relationship between hard and soft tissue changes is linear, which is not necessarily the case [8,20,21]. Ratios also provide no information about their predictive accuracy. Ratios have been reported to bias soft tissue changes, due to the fact they do not account for the effects of the other independent variables on the measured dependent variable [21]. Predicting the changes of the lips during treatment requires information from more than one variable. The changes of the lips measured from the commonly used profile planes are often confounded by growth, so that the actual changes in lip position during treatment can differ not only in magnitude, but also in direction [22]. Treatment changes in both upper and lower lip positions have been explained by a multiple regression formulas using various hard and soft tissue variables, attaining correlations of up to 0.98 [23]. While multiple regressions provide more precise estimates of soft tissue changes than ratios or bivariate regression, and are less biased, it remains controversial whether they produce clinically meaningful predictions for upper lip movements [18]. The purpose of the present study was to predict changes in lip position during non-extraction orthodontic treatment in Class I patients. Previous studies have used mixed (including more than one Angle class) samples, which could be problematic because of the different mechanics utilized could produce a wide range of incisor movements [13,24,25]. Moreover, most of the literature focuses on the prediction of the lip response in extraction cases [8,13,21]. Lip response to the non-extraction treatment, in which lips can be compressed, might be expected to be different than lip response to extraction treatment, in which the lips are relaxed [26]. There has been only one study that used a multivariate approach to predict the lip changes of a limited sample of...
Takehito Ouchi
Modern Research in Dentistry, Volume 4, pp 1-2; doi:10.31031/mrd.2019.04.000586

Abstract:
Takehito Ouchi1*, Satoru Morikawa1 and Seiji Asoda1 1Department of Dentistry and Oral Surgery, Japan *Corresponding author:Takehito Ouchi, Department of Dentistry and Oral Surgery, Shinjuku-ku, Tokyo, 160-8582, Japan Submission: July 18, 2019;Published: July 30, 2019 DOI: 10.31031/MRD.2019.04.000586 ISSN:2637-7764Volume 4 Issue 2 Histopathological diagnosis is commonly used to identify oral cancer. However, morphological diagnosis alone cannot clarify the biological malignancy and prognosis of this disease. Findings from cancer stem cell research and cancer genetic analysis help guide the design of cancer studies. In addition, the environmental niche, which includes cancer stem cells (CSCs) and/or cancer associated fibroblasts (CAFs), influences the behavior of the cancer cells and therefore the prognosis [1,2]. We utilize oral cancer samples to evaluate specific mesenchymal cell surface markers and to clarify cell properties and functions that may not be predicted by the pathological diagnosis [3]. Most cancers of the oral cavity are squamous cell carcinomas, with various degrees of malignancy. Spindle cell carcinoma (SpCC) is composed of a biphasic mixture of epithelial and mesenchymal cells [4]. SpCC is a subtype of poorly differentiated oral squamous cell carcinoma (OSCC) diagnosed by immunostaining of pathological specimens [5]. This traditional analysis can lead to diagnostic difficulties due to the range of histological patterns seen in SpCC. As it is a rarely diagnosed tumor, the characteristics of SpCC remain unclear [6]. Therefore, it is difficult for basic researchers and clinicians to determine the appropriate diagnosis and treatments. It is critical to understand the pathological and genetic characteristics of SpCC, including the gene expression patterns in the tumor microenvironment, to increase our understanding of this rare cancer. Current oral cancer treatments are organ specific and mainly use reagents that target squamous cell carcinoma in the head and neck regions. For example, the EGFR-targeting reagent cetuximab is well known for its application in malignant disease of the head and neck. However, prior research demonstrated that cetuximab is not effective in cases of recurrent or advanced SpCC [6]. This underscores the necessity of identifying other cell components that can be targeted. Our group demonstrated that a cetuximab-resistant recurrent SpCC sample expressed the mesenchymal stem cells (MSCs) markers platelet-derived growth factor receptor α (PDGFRα) and Nestin. Prospective cell analysis by using a flow cytometer revealed that recurrent SpCC cells expressed the CSC marker CD44v, which was identified in both EpCAM positive epithelial cells and PDGFRα positive mesenchymal cells. These results indicate that CSCs survived in both parenchymal and mesenchymal tissues. Cultured cells expressed legacy MSC markers such as CD73, CD90, and CD105, and they showed features such as colony forming, migration, and differentiation abilities. Our group demonstrated the utility of imatinib, which is known to inhibit the protein tyrosine kinase activity of Bcr- Abl and PDGFRα, in targeting PDGFRα-expressing stromal cells. Imatinib had a more potent inhibitory effect on the cultured cells and was more effective in inducing cell death relative to the cetuximab-treated group. In our previous study, we evaluated the characteristics of cancer cells obtained from tissues in addition to conventional pathological diagnosis. By using a flow cytometer, it was possible to analyze the expression of markers several hours later. This strategy enables early prediction of the possible effects of chemotherapy and is expected to identify new markers and help develop drugs aimed at specific molecular targets. Analysis of the proliferation and migration abilities of the cancer cells, as well as drug response tests, can be used to further determine specific patient characteristics. This information, in combination with pathological analysis, helps inform diagnostic and treatment decisions and makes it possible to further elucidate the biological malignancy and prognosis of cancers as compared with pathological diagnosis alone. Our approach can contribute to the development of disease-specific individualized treatments that are essential for rare cancers with histologic types. This work was supported by the Japan Society for the Promotion of Science KAKENHI, grant numbers 18K17034 (TO), 19K10172 (SM), and 19K10344 (SA). The authors declare no other potential conflicts of interest with respect to the authorship and/or publication of this article. © 2019 Takehito Ouchi. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.
Cristina Meniz García, Meniz García C, López Quiles J, Iglesias Velázquez O, Pérez González F, Sánchez Labrador L
Modern Research in Dentistry, Volume 4, pp 1-5; doi:10.31031/mrd.2019.04.000585

Abstract:
Meniz García C1*, Iglesias Velázquez O2, Pérez González F3, Sánchez Labrador L3 and López Quiles J1 1Professor at Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Spain 2Graduate, Faculty of Dentistry, Complutense University of Madrid, Spain 3Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Spain *Corresponding author: Cristina Meniz García, Department of Dental Clinic Specialties, Faculty of Dentistry, Plaza Ramón y Cajal S/N, 28040, Complutense University of Madrid, Spain Email: [email protected] Submission: July 03, 2019;Published: June 19, 2019 DOI: 10.31031/MRD.2019.04.000585 ISSN:2637-7764Volume4 Issue2 Background: Bisphosphonates (BP) are a group of drugs used in treatment and prevention of alterated turn-over of bone diseases. Since 2003, it is known That BP are able to develop osteonecrosis of the jaw (BRONJ: Bisphosphonate-Related Osteonecrosis of the Jaw) when they are associated to any surgical trauma, even dental implant therapy. Materials and Methods: Comprehensive research of scientific articles from ten years ago to our days in Medline (Pubmed). Results and Discussion:1090 dental implants placed patients treated with BP and 3472 dental implants placed in healthy patients had successfully rates of 97.6% and 97.9%, respectively. Therefore, implant placement in patients in treatment with BP does not reduce implant success rates. Besides, BRONJ appears before with intravenous vs oral administration of BP. Conclusion:Further well-designed long-term studies are necessary to evaluate correctly the relationship between BP and dental implants. Keywords:Dental implant; Osteonecrosis; Bisphosphonate; Bisphosphonate-related osteonecrosis of the jaw Abbreviations: BP: Bisphosphonates; BRONJ: Bisphosphonate Related Osteonecrosis of the Jaw; CTX: C Terminal Telopeptide, TCT; AAOMS: The American Association of Oral and Maxillofacial Surgeons Bisphosphonates (BP) are a group of drugs used for prevention and treatment of diseases involving bone resorption (malignant tumors such as multiple myeloma, malignant hypercalcemia and other tumors with bone metastases as breast or prostate cancer) and metabolic diseases that affect bones (osteopenia and osteoporosis, present in about 200 million people worldwide). This group of drugs, being the first line therapy in diseases such as osteoporosis, where bone quality and quantity may be affected, are especially important in oral surgery and implantology [1]. These drugs are analogs of pyrophosphate molecule, and cause inhibition of bone reabsorption due to their affinity to calcium phosphate in solid phase, which allow them to bind to bone hydroxyapatite [2,3]. BPs have two forms of administration: intravenous, producing its initial effects after a few days and oral (either daily, weekly, monthly or quarterly), beginning after a few weeks because they are more difficult to be absorbed [3]. In 2003 Marx [4] warned out dental community after noticing the occurrence of osteonecrosis associated with the intake of these drugs. Many studies suggest development of osteonecrosis depends on several factors, such as the total dose, the duration and the way of the drug administration [1,5,6]. Osteonecrosis is defined as exposed bone in the maxillofacial region for more than eight weeks, in patients treated with BPs without story of head or neck radiation, previously subjected to a dental surgery, for example an exodontia or dental implant placement. Dental implants today have become the most efficient alternative to rehabilitate missing teeth, having better results than conventional fixed and removable prosthesis. Nonetheless, the information about association between dental implants and osteonecrosis is scarce [7]. Although the mechanism of beginning and progression of osteonecrosis associated with the use of BP is unclear, there are several hypotheses suggesting that these drugs inhibit the activity of osteoclasts, suppressing bone remodeling. It seems to be related to the surgical trauma, bad hygiene or periodontal and peri implant status [5,8,9]. According to American Dental Association Council on Scientific Affairs in 2006, the incidence of osteonecrosis of the jaw associated with the use of oral BP is estimated at 0.7 cases per 100,000 persons / year of exposure [10]. The implant success depends on osseointegration, defined as the direct, structural and functional connection between the live, ordered bone and the surface of an implant under functional loading. Patients being treated with BP have an affected bone remodeling process, because of the inhibition of osteoclasts’ action. This prevents the first phase, which allows osteogenesis to occur, so a succesfully osseointegration is not expected to occur and implant prognosis is also questionable [5,8]. However, in the literature there are several studies showing beneficial effects of oral BP in osseointegration and bone healing around implants [5]. The aim of this review is to evaluate the behaviour of dental implants in patients treated with BP, and the protocol to follow with implants in patients employing BP as medication, or in patients who develop complications associated with its administration. A literature search was conducted in different digital databases like Medline (Pubmed) and Cochrane using keywords (“implant dental” AND “osteonecrosis” AND “dental implant failure”) AND (“bisphosphonate” AND “bisphosphonate-related osteonecrosis of the jaw “) until May 2019. The search was carried out by a single subject (OI). According to the keywords and search strategy, 5971 results were obtained. The search was limited to journal articles in the last 15 years and the field of Medicine, Dentistry and Pharmacology, limiting the search to 2618 publications. The selection of studies...
Manisha Koul, Arpan Debnath, Alok Pandey, Priyanka D
Modern Research in Dentistry, Volume 4, pp 1-6; doi:10.31031/mrd.2019.04.000584

Abstract:
Manisha Koul*, Arpan Debnath, Alok Pandey and Priyanka D Department of Public Health Dentistry, India *Corresponding author:Manisha Koul, Department of Public Health Dentistry, Krishnadevaraya College of Dental Sciences, Hunasamarnahalli, International Airport Road, Bangalore, India Submission: June 02, 2019;Published: July 05, 2019 DOI: 10.31031/MRD.2019.04.000584 ISSN:2637-7764Volume4 Issue2 Introduction: Probiotics have been used to provide benefit to general health, but their effect on oral health especially on dental caries is yet to be explored in detail. Green tea is exclusively known for antioxidant and antimicrobial properties. Thus, the aim of the present study was to evaluate the anti-microbial efficacy of probiotic and green tea mouth rinse on salivary Streptococcus mutans count. Methods: A triple-blinded, concurrent parallel group randomized trial was conducted which included 45 subjects, aged 21-25years. The subjects were randomly divided into three groups namely probiotic group, green tea group and chlorhexidine group. The participants were instructed to rinse their mouth once daily in the morning with the allocated mouth rinse. Unstimulated Saliva samples were collected at baseline, 30minutes post rinse and after 15 days of intervention. Microbial analysis was done to record Streptococcus mutans count. Results: There was no statistically significant difference in reduction of microbial count of Streptococcus mutans between green tea and chlorhexidine mouth rinse after 15 days specifying both are equally effective in reducing S. Mutans count. However, probiotic group showed least antibacterial effect. Conclusion: Green tea proved to be more effective in reducing Streptococcus mutans than probiotic mouth rinse. Also, the antibacterial effect of green tea was similar to that of chlorhexidine mouth rinse. Thus, green tea mouth rinse was found to be a successful alternate to chlorhexidine mouth rinse. Keywords: Probiotic; Green tea; Streptococcus mutans; Mitis salivarius bacitracin agar; Mouth rinse Dental caries is an ongoing disease with multifactorial etiology. Microorganisms like Streptococcus mutans and Lactobacillus have been shown to play a pivotal role in dental caries. Thus, reducing microbial count of these cariogenic microorganisms causes a significant decrease in dental caries. The term probiotic, as an antonym to the term antibiotic, was originally proposed in 1965 by Lilley and Stillwell [1].Probiotics are food ingredients with a sufficient number of viable microorganisms that are beneficial to the health of the host. They are especially known for improving intestinal microbial health and have been used extensively in yoghurt, cheese, capsules [2]. As the mouth represents the first part of the gastrointestinal tract there is every reason to believe that at least some probiotic mechanisms may also play a role in that part of the system [3]. Several investigations have shown reduction in the number of Mutans Streptococci in saliva after consumption of various probiotic products [4-6]. Tea is one of the most commonly consumed beverages in the world. Among various types of tea available, Green tea is known for its antimicrobial, anti-inflammatory and antioxidant properties. Certain studies have reported anticariogenic effect of green tea [7,8]. Using mouthwash is an effective and safe method for maintaining oral hygiene. Ample research has been done on antibacterial effect of green tea mouth rinse. However, data supporting the action of probiotic in the form of mouth rinse against Streptococcus mutans is still sparse. Hence, the present study was conducted to evaluate the anti-microbial efficacy of probiotic and green tea mouth rinse on salivary Streptococcus mutans count and compare it against chlorhexidine mouth rinse (control). A triple-blinded concurrent parallel arm randomized controlled trail was conducted in the Department of public health dentistry, Krishnadevaraya College of Dental Sciences and Hospital, Bengaluru. Simple random sampling technique was used to select 45 subjects. Sample size calculation was based on the proportion of reduction in colony counts as observed in pilot study. The required sample size was estimated using the following formula: Where, Zα = Z value for alpha error at 95% CI=1.96. P = The proportion of reduction in colony counts as observed in pilot study (in %)=90. q = 1‑p (in %)=10. L = Permissible error in estimation of p=10% of p=10% of 90=9. Hence sample size of 45 subjectswith 15 subjects in each group were selected among students of the dental college. Subjects aged between 20-25 years, who fulfilled the following eligibility criteria, were selected. A. Inclusion criteria a. Female subjects aged between 20-25 years. b. Adults with DMFT >3. c. Adults with no recent antibiotic therapy (within 2 weeks). B. Exclusion criteria a. Known history of allergy to any mouth rinse or drug. b. Any systemic illness. c. Using any other commercially available mouth rinse. d. History of fluoride treatment in the past 2 weeks. The study population consisted of undergraduate dental students of Krishnadevaraya College of Dental Sciences, Bangalore. To avoid the confounding effect of diet, the subjects residing in hostel having almost same dietary pattern were chosen. The study participants were also instructed to use non-fluoridated toothpaste to ensure anticariogenic effect of fluoride was eliminated. The ethical clearance was obtained from the Institutional Review Board of Krishnadevaraya College of Dental Sciences. Randomization Using random allocation rule, 45 participants were randomly divided into three groups Cards with group names were kept in sealed envelopes, and all the participants were asked to pick up the sealed envelopes. The group allocation was disclosed by principal investigator after opening the envelopes. Intervention Preparation of probiotic mouth rinse: Probiotic mouth rinse was prepared using commercially...
Ujjwal Gulati, Mehvash Gulati, Deepak Rai
Modern Research in Dentistry, Volume 4, pp 1-2; doi:10.31031/mrd.2019.04.000583

Abstract:
Ujjwal Gulati1*, Mehvash Gulati2 and Deepak Rai3 1Director and Consultant Oral and Maxillofacial Surgeon, India 2Chief Consultant General Dentistry, India 3Consulatant Orthodontist and Implantologist, India *Corresponding author:Ujjwal Gulati, Director and Consultant Oral and Maxillofacial Surgeon, INDIADENS, New Delhi, India Submission: June 03, 2019;Published: June 10, 2019 DOI: 10.31031/MRD.2019.04.000583 ISSN:2637-7764Volume4 Issue2 PRF or Platelet Rich Fibrin is an autologous meshwork of polymerised fibrinogen molecules which contains additional blood components entrapped during the process of deriving this mineral from the ore of whole blood. Blood has traditionally been known as “Elixir of life” as it supplies tissues with auto regulated elements of generation, survival and destruction of cellular and sub cellular forms. Researchers have worked for decades to strike a balance in derivation of concentrates from blood which can be applied in various aspects of regeneration of tissues including qualitative enhancement of wound healing. The first breakthrough was in 1950’s when Kingsley [1] first used the term PRP (Platelet rich plasma). Many researchers contributed to evolution of blood concentrates extraction techniques until Marx revolutionized the blood concentrates arena with his research work [2]. This sizzled a new craze across the medical fraternity and led to widespread usage of this modality. There were mixed results and then Marx et al established the norms and standards of preparation with minimum threshold of platelet count for tipping the balance in one’s favour. Not much time had passed and Choukroun et al superceeded Marx et al with making of PRF (Platelet Rich Fibrin) which was a 100 percent autologous product [3]. It required a tabletop centrifuge which had to be spun at particular rpm (rounds per minute) for a particular time (Table 1). Although the angulation of glass/silica coated tubes containing blood kept in the housing of centrifuge was specific to the unit invented for the purpose. This was followed by development of variations of this technique based on change in rpm and duration of centrifugation. Tremendous amount of research work has gone into exploration of benefits of PRF and its variants and their application in the speciality of Implantology. PRF has found and established its role as more than an adjunct in many a procedure. It has been used to fill in the extraction sockets [4]. The advantages were lesser pain and faster and better regeneration of bone. It has been used successfully as a sole biomaterial for crestal sinus lift with great success. This negated the need for a bone graft. It is also used along with alloplastic and allogenic bone in sinus lifts where greater volumes are needed [5]. PRF is shredded into tiny bits and mixed with graft particles to fill in the sinus cavity. Sustained release of growth factors helps in accelerated maturation of the graft and keeps inflammation in check. AFG and PRF membrane have been used alone and in combination for repair of sinus perforation and many authors have reported successful results [10]. PRF membranes can be used alone or in conjunction with collagen membrane in guided bone regeneration. The AFG can be used to enhance the handling characteristics of bone graft material [6]. Heap of graft material is poured with AFG and allowed to polymerise for 5-10 minutes. PRF membranes with or without heat treatment can be used to cover the raw defects arising from harvesting full thickness connective tissue grafts from palate [7]. This promotes early epithelisation and reduces postoperative pain. The big question is “Why has PRF attracted so much of an interest in various aspects of tissue regeneration?” The answer lies in its extremely low risk benefit ratio. Use of PRF has multiple advantages with very few limitations. Preparation of PRF is a simple procedure which requires the use of a tabletop centrifuge. It is 100 percent autologous product with no chance of rejection or infection from a patient’s body. Rather, it has been proven to possess antibacterial properties, which might bring down the chances of infection. It causes sustained release of growth factors entrapped within the fibrin clot as it undergoes gradual lysis [8,9]. This accelerates both soft and hard tissue regeneration and simultaneously keeps inflammatory mediators under check. It stimulates osteoblastic activity both in terms of proliferation and differentiation. PRF in membrane form has the potential to repel epithelial cells from the defect and promotes surface epithelisation making it an ideal aid for guided bone regeneration. It is biodegradable and the period may range from anywhere between 7-14 days. Heat treatment may increase the longevity for up to 28 days [10,11]. A biomaterial with all these advantages comes at a close to nil cost. The only requirement is a onetime investment into a centrifuge and every case requiring a phlebotomy set and vaccutainers. PRF definitely deserves the research attention and application craze it has attracted and has become an Indispensible tool in the armamentarium of an Implantologist. Table 1: © 2019 Ujjwal Gulati. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.
Baburoa N Chandakavathe
Modern Research in Dentistry, Volume 4, pp 1-2; doi:10.31031/mrd.2019.04.000582

Abstract:
Baburoa N Chandakavathe* DSTS Mandal’s College of pharmacy, India *Corresponding author:Baburoa N Chandakavathe, DSTS Mandal’s College of pharmacy, Solapur, Maharashtra, India Submission: June 03, 2019;Published: June 07, 2019 DOI: 10.31031/MRD.2019.04.000582 ISSN:2637-7764Volume4 Issue2 In the present scenario “periodontitis” is major dental disorder among all the dental diseases, it is also called as gum disease, periodontitis is characterized by annihilation of connective tissue and dental bone support after an inflammatory host response secondary to infection by bacteria. In its premature stage, called gingivitis, the gums become enlarged, red, and may bleed. Periodontal diseases are of several types, all of which begin with an infection of the gums that can proliferate into the bones and ligaments of the teeth. In the beginning, this disease can be detected by a dentist during regular check-ups. It is the major cause for tooth loss in children and adults. If it is not treated bone and gums seriously damaged, the teeth may fall out or has to be removed. More than 50% of adults are suffering from some form of periodontal disease and even younger population also predominantly affected. Different stages of periodontal disease so far investigated briefly explained here are; the earliest stage called gingivitis, during this stage the gums begin to swell, puffy and get red may bleed during flossing but bone remains healthy in this stage. If it is not noticed and diagnosed leads to next stage called periodontitis, in this stage the gums begin to separate from the teeth, the underlying bone is damaged, pockets form and, the gums recede [1]. plaque containing bacteria spreads into the pockets, it becomes difficult to keep tooth clean and to control the disease progress. In the final stages of the disease, the pockets continue to get deeper and further destruction of bone. Moreover, the bacteria that live in these pockets are more virulent and put in even further for the progress of the disease. If not treated, ultimately teeth will fall out and/or loosen. Major cause of periodontitis is the microorganisms present in the food plaque release toxins after metabolic reactions that irritate and inflammation of gums [2]. If plaque not removed from teeth, it becomes hard, spongy like substance known as calculus. If calculus is formed on roots of teeth just below the gums, it irritates the gums and contributes to even more accumulation of plaque and progress of disease [3]. Apart from this major cause there are infinite numbers of risk factors also contribute for periodontitis such as chewing tobacco or smoking, Poor oral hygiene, Hormonal changes in girls/women, poorly fitting bridges, genetic susceptibility, poor teeth alignment, medications, defective fillings, pregnancy, systemic diseases such as AIDS or diabetes etc. Early symptoms of this disease can be detected by a dentist, as the disease progresses other symptoms start to appear [4]. Symptoms such as bleeding of gums during brushing, swollen or red gums, loosened teeth, continuous bad breath, receded gums, changes in the way teeth fit together when eating etc. If this disease is diagnosed in early stage of gingivitis, it can be treated with a thorough cleaning by dentist or oral hygienist. If the disease has progressed beyond gingivitis, the treatment may involve a process called “deep cleaning” or “root planning,” this involves cleaning and smoothing of root surfaces of the teeth to remove calculus and bacterial deposits below the gum line so that the gums can heal around them [5]. Depending on how deep the disease has progressed, dentist or periodontist may still advice surgical treatment. The long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Some medications that are currently used are a) prescription mouth rinse containing chlorhexidine, b) small piece of gelatine filled with chlorhexidine, c) gel that contains an antibiotic called doxycycline, d) tiny round particles that contain the minocycline antibiotic, and e) low dose of the medication doxycycline that keeps destructive enzymes in check. Apart from above mentioned chemotherapy some surgical procedures are also suggested if needed arises such as flap surgery, bone surgery, and bone-tissue grafts surgery. The more popular saying quote “prevention is better than cure” so the best way to prevent periodontal disease is to practice good oral hygiene [6]. Brushing every day, taking a balanced diet and regular visits to oral hygienist are essential to keep periodontal disease away. And if you do so, you’ll increase your chances of maintaining your teeth for a lifetime. © 2019 Baburoa N Chandakavathe. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.
Jilen Patel, Robert P Anthonappa, Nigel M King
Modern Research in Dentistry, Volume 4, pp 1-2; doi:10.31031/mrd.2019.04.000581

Abstract:
Jilen Patel1*, Robert P Anthonappa2 and Nigel M King3 1Paediatric Dental Registrar, Australia 2Paediatric Dentistry, Australia 3Professor Paediatric Dentistry, Australia *Corresponding author:Jilen Patel, UWA Dental School, 17 Monash Avenue, Neelands WA 6009, Australia Submission: May 30, 2019;Published: June 06, 2019 DOI: 10.31031/MRD.2019.04.000581 ISSN:2637-7764Volume4 Issue2 Purpose: There has been a renewed interest in the use of silver diamine fluoride (SDF) in arresting caries. However, the high fluoride concentration has raised concerns when used in young children. Therefore, this study investigated the fluoride leachate profiles of SDF, 5% sodium fluoride varnish (NaF), SDF with Potassium Iodide (SDF+KI), and fluoridated toothpaste (FTP). Method: Sixty enamel specimens were randomly grouped to receive topical application of NaF, SDF, SDF+KI or FTP. Samples from each group were immersed into either neutral, basic or acidic artificial saliva solutions. Cumulative fluoride release and fluoride leachate profiles were measured at 24, 48, 96, and 168 hours post-application using a fluoride ion selective electrode. The data was analysed using oneway ANOVA and Tukey tests. Result: (i) Specimens in the NaF group exhibited a significantly higher fluoride leachate compared to SDF, SDF+KI and FTP groups (p Conclusion: NaF exhibits a more sustained fluoride leachate profile compared with SDF. The application of KI following SDF appears to reduce the total measurable soluble fluoride. Keywords: Fluoride; Silver diamine fluoride; Concentration; Leachate Recently, there has been a renewed interest in the use of silver diamine fluoride (SDF) in the management of caries especially in the high-risk groups. Clinical trials have shown SDF to be an easy to use, effective and safe topical agent with no significant adverse effects [1-4]. As a result, SDF is positioned as an efficient and equitable caries control agent that can be used to help meet the WHO Millenium oral health goals and fulfil the US Institute of Medicine’s criteria for 21st-Century medical care [1-4]. Nevertheless, the resulting black staining following topical application of SDF, as well as the fluoride concentration, potential toxicity and chemical stability of silver fluoride compounds have all been commonly reported as barriers for SDF use [1,5-7]. In an attempt to overcome the unsightly black stain, use of potassium iodide (KI) immediately following SDF application has been advocated [8]. However, to date, there is limited literature investigating the fluoride release from SDF, and to our knowledge, there are no reports investigating the effect of KI application on fluoride release [9]. Therefore, this study sought to compare the fluoride leachate profiles of 38% SDF, 38% SDF with Potassium Iodide (SDF+KI), 5% sodium fluoride varnish (NaF) and 0.32% fluoridated toothpaste (FTP). Furthermore, as fluoride release has been shown to vary depending on pH, a secondary objective of this study was to evaluate the fluoride leachate profiles of the aforementioned agents in neutral, acidic and basic artificial saliva to better reflect the oral environment. Following ethical approval (Human Research Ethics Committee, University of Western Australia) and consent from the participants, human premolars (n=30) with clinically sound enamel, which were extracted for orthodontic reasons were decoronated and sectioned bucco-lingually to produce a total of 60 enamel slabs. A double coat of red nail polish was applied leaving only a 4x4mm window of enamel exposed in the center of each slab. These 60 slabs were then allocated into four groups to receive one of the following topical fluoride agents. Group 1: 38% SDF (Riva Star, SDI, Bayswater, VIC, Australia) Group 2: 38% SDF/KI (Riva Star, SDI, Bayswater, VIC, Australia) Group 3: 5% NaF (Colgate® Duraphat® Varnish Single Dose, Colgate Palmolive, Sydney, NSW, Australia) Group 4: 0.32% Sodium Fluoride toothpaste (Colgate Total®, Colgate Palmolive, Sydney, NSW, Australia). Stratified random sampling was used to ensure that SDF was applied to one section while SDF+KI was applied to the second section of the same tooth. NaF and FTP acted as reference and control groups and similarly NaF was applied to one section while FTP was applied to the second section the same tooth to reduce sample bias. Each slab was weighed pre- and post-application of the fluoride agent using an analytical balance to an accuracy of ±0.1mg (Sartorius, Gottingen, Germany) such that the initial amount of fluoride and subsequent proportion of fluoride released could be analysed. The results of a pilot study revealed 30% difference in mean fluoride leachate with a standard deviation of 10% to be clinically relevant. Therefore, with a level of significance set at 0.05 and a power (1-β) of 0.85, five samples per sub-group would be both feasible and sufficient. This is consistent with previous studies investigating fluoride leachate [10-14]. Following fluoride application five samples from each group were immersed into 25ml of either neutral, basic or acidic artificial saliva solutions, as shown in Figure 1. The artificial saliva contained (mmoles/L): CaCl2 (0.7), MgCl2·6H2O (0.2), KH2PO4 (4.0), KCl (30), NaN3 (0.3), and HEPES buffer (20) as described by Pashley et al. [15]. The neutral solution was stabilized to pH7.0, the acidic solution buffered to pH4.4 using a lactate buffer and the basic solution buffered to pH10.4 using a glycine/sodium hydroxide buffer. After 24hours each enamel slab was removed from the artificial saliva and gently immersed into a test tube containing 25ml of new artificial saliva of matched pH. This process was repeated at 48, 96, and 168hours post-application. The concentration of fluoride in each sample of artificial saliva was measured to determine the amount of fluoride released from the enamel block. Figure 1:Sample preparation and stratification: 60 enamel slabs...
Akshara Singh
Modern Research in Dentistry, Volume 4; doi:10.31031/mrd.2019.04.000580

Aranka Ilea, Vlad Andrei, Băbțan Am, Nb Petrescu, A Soancă, Rs Câmpian, Ba Boșca, As Șovrea, Aș Mesaros
Modern Research in Dentistry, Volume 4, pp 1-10; doi:10.31031/mrd.2019.04.000576

Norhayati Luddin
Modern Research in Dentistry, Volume 3, pp 1-2; doi:10.31031/mrd.2019.03.000575

Rohini Khareedi
Modern Research in Dentistry, Volume 3, pp 1-5; doi:10.31031/mrd.2019.03.000574

Kavitha Prasad
Modern Research in Dentistry, Volume 3, pp 1-2; doi:10.31031/mrd.2019.03.000573

Chávez MMC
Modern Research in Dentistry, Volume 3, pp 1-3; doi:10.31031/mrd.2019.03.000571

Smriti Jagdhari Golhar
Modern Research in Dentistry, Volume 3, pp 1-2; doi:10.31031/mrd.2019.03.000570

FahdA AlGahtani
Modern Research in Dentistry, Volume 3, pp 1-4; doi:10.31031/mrd.2019.03.000569

Mladen Vukovic
Published: 30 January 2019
Modern Research in Dentistry, Volume 3, pp 1-9; doi:10.31031/mrd.2019.03.000568

Davudov Mm, Fathi Hr, Mammadov Jj
Published: 30 January 2019
Modern Research in Dentistry, Volume 3, pp 1-7; doi:10.31031/mrd.2019.03.000567

Fernanda Gonçalves Salum, Luísa Gallo Da, Antonia Zancanaro Fm, Karen C, Gonçalves Sf
Published: 18 January 2019
Modern Research in Dentistry, Volume 3, pp 1-10; doi:10.31031/mrd.2019.03.000566

Ratnakar R Ghorpade
Published: 3 January 2019
Modern Research in Dentistry, Volume 3, pp 1-2; doi:10.31031/mrd.2019.03.000565

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