Modern Research in Dentistry

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EISSN : 2637-7764
Published by: Crimson Publishers (10.31031)
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Zac Morse
Published: 18 December 2020
Modern Research in Dentistry, Volume 6, pp 551-554; doi:10.31031/mrd.2020.06.000626

Abstract:
Zac Morse1* and Keith Tudor2 1Professor, Department of Oral Health, School of Clinical Sciences, Auckland University of Technology, Auckland, Aotearoa New Zealand 2Professor, Department of Psychotherapy and Counselling, School of Clinical Sciences, Auckland University of Technology, Auckland, Aotearoa New Zealand *Corresponding author: Zac Morse, Department of Oral Health, School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, Aotearoa, New Zealand Submission: November 28, 2020;Published: December 18, 2020 DOI: 10.31031/MRD.2020.06.000626 ISSN:2637-7764Volume6 Issue1 This article offers an initial mini-review of dental anxiety and identifies future directions for research into nonpharmacological, therapeutic approaches to addressing this significant health issue. Keywords: Dental anxiety; Nonpharmacological; Therapeutic approaches; Interprofessional; Oral health; Psychotherapy; Eye movement desensitisation reprocessing Question: What do you get when you cross (or at least introduce) a professor of oral health with a professor of psychotherapy? Answer: A common interest in psychological health and dental anxiety. This mini-review arose from a meeting of the two authors and our obvious identification of dental anxiety as a focus for joint research and research supervision. We emphasise health before illness as we both agree that just as mental health is critical to general health [1,2], so there can be no general health without oral health [3]. Dental anxiety and fear are a significant public health problem in Aotearoa New Zealand, affecting one in eight of the population. Global estimates of this form of anxiety are comparable in other countries [4,5]. Dental anxiety is a significant barrier to oral health services that adversely affects the oral health of affected individuals and is recognised to have a multifactorial aetiology [6]. However, to date, the standard response to and management of this health issue is predominantly pharmacological, with sedation and general anaesthesia being common. This practice is cumbersome, expensive and requires a high standard of care to be administered safely but does not provide a cure for the underlying anxiety or phobia. Also, patients with dental anxiety are perceived as complex and thus consume disproportionate healthcare time and resources. Moreover, given the higher rates of tooth decay, dental pain and treatments requiring general anaesthesia in both Māori and Pasifika populations in Aotearoa New Zealand, any interventions that reduce dental anxiety particularly in these populations would redress significant inequities in this aspect of this country’s population health. Nonpharmacological responses and interventions for dental anxiety and phobia have included hypnosis and hypnotherapy [7]; eye movement desensitisation reprocessing (EMDR) [8]; cognitive behavioural therapy (CBT) [9]; and exposure treatment [10]. While patients and clients may be discussing this form of anxiety in personal therapy, we consider this is unlikely, and, in any case, it is not reported in the psychotherapeutic literature. A search of the Psychoanalytic Electronic Publishing database (comprising over 100,000 articles) returned only one match on the subject and that being from the 1940s [11]. EMDR has gained empirical support in the areas of post-traumatic stress disorder (PTSD) and anxiety across the lifespan and is recommended by the UK’s National Institute of Clinical Excellence (NICE) as an empirically supported PTSD and phobia treatment. Research applying EMDR to dental anxiety is however sparse, though two reports in the literature on a limited number of patients promisingly showed the efficacy of EMDR in reducing dental anxiety in patients undergoing dental treatments [6,12]. Moreover, NICE is arguably biased against therapeutic approaches other than CBT, i.e., those based on psychoanalytic/psychodynamic and humanistic therapies, so we do not have any robust evidence of possible comparative therapeutic intervention efficacy or otherwise. As a result of this mini-review, the planned research will be undertaken in two phases, both of which will be examples of interdisciplinary professionals working in the health sector, which is not only promoted at our own university, the Auckland University of Technology (AUT), but also through a review by the Health and Disability Commissioner [13] which identified that many complaints to the Commissioner arise from failures in teamwork across professions and hence all New Zealand health care practitioners are obligated to practice collaboratively in order to improve health outcomes as enshrined (from 2019) in the Health Practitioners Competence Assurance Amendment Act [14]. The first phase is a scoping review, in effect, a “mapping” of key nonpharmacological/therapeutic responses to dental anxiety, first globally, and then nationally with regard to their availability in Aotearoa New Zealand. According to Wilson et al., scoping reviews map important ideas supporting a research area and the main sources and types of evidence available [15]. As this includes locating a varied set of sources, such as qualitative research studies, textbooks, reports, and what is referred to as “grey” literature, this analysis aligns with the aim of this project to identify and map the “scope” of literature in the broader sense than that of a systematic review [16]. This phase will commence with the joint supervision of an undergraduate Summer studentship. The second phase will compare the efficacy of different therapeutic interventions such as hypnotherapy, EMDR, CBT and other, more generic psychotherapeutic approaches in reducing or curing dental anxiety. Dental anxiety is a major barrier to dental services and considering it is a complex health issue, will require wellcoordinated interprofessional collaboration to inform treatment....
Laura Mendoza Oropeza
Published: 16 December 2020
Modern Research in Dentistry, Volume 5, pp 551-554; doi:10.31031/mrd.2020.05.000625

Abstract:
Laura Mendoza Oropeza * Professor of Orthodontics, Faculty of Dentistry, UNAM, Mexico *Corresponding author: Laura Mendoza Oropeza, Professor of Orthodontics, Faculty of Dentistry, UNAM, Mexico Submission: November 26, 2020;Published: December 16, 2020 DOI: 10.31031/MRD.2020.05.000625 ISSN:2637-7764Volume5 Issue5 In recent years, has sought to develop and use the Virtual Reality third dimension as a teaching-learning tool to strengthen student learning. Virtual Reality (RV) in the teaching of the Dentistry degree has consisted of creating 3D models, as well as three-dimensional stereoscopic images and videos of different subjects; This is achieved through two images with different perspectives that reach each of our eyes so that they can be visualized through special lenses, allowing the student to integrate them into a single 3D image with depth. The objective of the study is to know the benefit of this tool in the learning process of the students. The study was carried out in a group of 4th year of the degree of Dentist Surgeon of the Faculty of Dentistry of the UNAM, it was divided in two groups; one was given the class in a traditional way, while the other was through stereoscopic images and videos in 3D, later they were given a questionnaire to let us know about the learning. The results that were observed was that the 3D group obtained a higher score compared to the traditional teaching group. Therefore, it can be concluded that the use of Virtual Reality in teaching allows for greater retention of concepts. In addition, it is an intuitive technology in terms of its use since it facilitates the explanation of complex or abstract concepts. Keywords: Virtual Reality; Learning; 3D; Dentistry students Virtual reality provides new forms and methods of visualization, engaging the strengths of visual representations that allow learning, especially in students who learn through the sense of sight (visual learning) [1]. At present virtual reality encompasses a set of technologies related to each other, among these technologies are 3D models that, from a technical point of view, is a set of geometries representing an "object" in three dimensions, ie: width, length and depth [2]. These models allow to be rotated and observed from any point of view. 3D models can be used in conjunction with various visualization technologies, such as: Immersive virtual reality: a three-dimensional environment is created by a computer and can be manipulated through the use of helmets, gloves or other devices (oculus) [3] that capture the position and rotation of different parts of the human body (Figure 1); It is currently used for 3D environments as a support tool in academic activities, for teaching-learning at the UNAM (IXTLI room) [4,5]. Figure 1: The non-immersive: augmented reality and 3D created from stereoscopic images and videos, in which it is possible to interact in real time with different people, spaces and environments from a distance, without the use of additional devices on the computer; one of the advantages is that it requires fewer resources to generate it, such as the one used in the Faculty of Dentistry (Margarita Chorné y Salazar room). This technology is applied in various subjects such as Orthodontics (Preventive and Interceptive), Human and Dental Anatomy, Oral Health Education, Preventive Dentistry, Oral Public Health, Occlusion, Anesthesia, Endodontics and Maxillofacial Surgery, using special attachments such as lenses (Figure 2) [6]. Figure 2: 3D volumetric representation. Stereoscopy takes advantage of human binocular vision. The brain receives two different images (representing the angle of view of each eye) and analyzes them. Subsequently, the brain generates in the viewer's senses a sensation of immersion within different scenarios of a reality-generated by a computer - in which the relief and depth within a three-dimensional world can be perceived [7]. The objective of this study is to compare the learning outcome of a 4th year group of students, using virtual reality didactic materials such as 3D images and stereoscopic videos based on the contents of the 4th year Orthodontic unit program of the degree of Dentist Surgeon taught by the Faculty of Dentistry (FD) of the National Autonomous University of Mexico (UNAM). The Virtual Reality didactic material used in the 3D room, is elaborated with the aim to educate the student by facilitating learning through the simulation of reality. A disadvantage of this tool is the high costs involved (computers, scanners, cameras, software programs); however, this technique reduces clinical risk during student-patient training (Figure 3) [8]. Figure 3: Cleft palate, anteroposterior view of a skull and model of a toothless patient with an open mouth. A prospective cross-sectional study was carried out in 35 4th year students of the Dental Surgeon degree of the FD, UNAM who took the Orthodontics subject. Traditional teaching was compared with teaching through virtual reality as a learning tool. It was evaluated by means of a questionnaire, which contained the questions related to the topic, previously validated by a group of experts applying before (pre-test) and after (post-test) teaching the class in a traditional way and in 3D [8-10]. The students were divided into two groups for their study in a random way: 18 for the traditional group and 17 for the VR group. The data obtained was processed with the SSPP 20 software. The results obtained in terms of gender distribution were: 23 women and 12 men with an average age of: 12 of 21, 11 of 22, 10 of 23 and 2 of 24 (Graph 1). Graph 1: Age distribution of the students. The average obtained by the traditional method was: 4.62+/-0.9141, Me 4.34 with 95.46% confidence (before) and an average of 6.64+/-1.2413, Me 6.665 with 93.83% confidence (after) for the 18 students who formed that group (Table 1). Table 1: Learning outcomes by the traditional method. A linear regression was carried out...
Andrzej Wojtowicz
Published: 4 December 2020
Modern Research in Dentistry, Volume 5, pp 543-548; doi:10.31031/mrd.2020.05.000623

Abstract:
Witold Tomkiewicz and Andrzej Wojtowicz* Department of Oral Surgery, Warsaw Medical Univeristy, Polish Association in Implantology *Corresponding author: Andrzej Wojtowicz,Department of Oral Surgery, Warsaw Medical University, Polish Association in Implantology Submission: November 23, 2020;Published: December 04, 2020 DOI: 10.31031/MRD.2020.05.000623 ISSN:2637-7764Volume5 Issue5 Continuous effort to safely apply occlusal load immediately, or as early as possible, led thru improved titanium surfaces to give more rapid osseointegration on a bigger implant surface (BIC). Around year 2000 increasing implant roughness became a key with a wish to inoculate active, bone growing factors in it. Surprisingly after few years a totally new phenomenon of progressive bone loss around implants was observed and coined ‘peri-implantitis’ as a parallel to ‘periodontitis’. Similar pathogens became a suspect however exposed rough surface is the main trigger. Retrospective studies of machined implants led to hybrid implant design on one hand and recommendations of subcrestal placement of fully rough implants on the other(Figure 1). Additionally, more emphasis has been put on surgical technique and timing. Albrektsson et al. [1] Already in 2013 note that making a direct parallel between marginal bone loss around dental implants in peri-implantitis and bone loss around teeth in periodontitis is a wrong track. It is therefore not a biofilm-mediated infectious processes, but tissue reactions coupled to the foreign body response. The initial foreign body response to an implant can be modulated (aggravated) by implant hardware characteristics, surgical technique and patients reparative and compliance capacity. This marginal bone loss, also related to as ‘remodeling’ process, was well known and described as normal or physiological in the literature by Branemark implants authors as the resorption to the 1st thread during the 1st year after abutment placement. Then the bone level became stable. Once achieved this dynamic equilibrium is not a given’ forever but a subject to many dis-balancing risk factors at any given point in time. Further Albrektsson et al. Indicate that once severe marginal bone loss is developed, a secondary biofilm‐mediated infection may follow as a complication to the already established bone loss. The extend of this infection and subsequent bone loss was related to the implant roughness by Albouy, Abrahamsson and Berglundh [2-5] in their experimental study of ligature induced peri-implantitis in dogs. The researchers conclude that the amount of bone loss that occurred during the plaque accumulation period after ligature removal was significantly larger at implants with a rough (TiUnite surface) than at implants with a machined (turned) surface. The histological analysis revealed that the vertical dimensions of the lesion, the pocket epithelium and the apical extension of the biofilm were also significantly larger at rough implants. Another words, when the ligature was removed on machined implants the bone loss was stopped while it continued on the rough surface. Schwarz et al. [6] have quite extensively presented and published follow ups of periimplantitis treatment where they compared different methods of surface decontamination as an add-on to standard surgical treatment of implantoplasty. Although laser decontamination did not prove to be any better than saline solution in their study the overall treatment success of stopping progression of periimplantitis was achieved in over 80% of cases. The result therefore could only be attributed to standard implantoplasty which is grinding exposed contaminated surface of an implant with a dimond drill on high speed. The roughness of the surface after implantoplasty is very similar to machined surface and also interestingly among the implants treated there were no machined (Branemark) implants but only implants with rough surface. The risk of rough surface to form biofilm has already been indicated in 1993 by Dennis P Tarnow [7] who already then suggested a hybrid implant with a machined titanium surface in the coronal half and a rough titanium surface in the apical half. ‘This will theoretically allow for minimal plaque accumulation at the crest if the implant becomes exposed to the oral environment’. Tarnow’s idea for hybrid implants have become materialised after 25 years by Massimo Simion [8] who has also demonstrated that the rough surface is not any better forming bone than ‘old’ machined surface (Figure 1). Figure 1: A prototype of a 3-hybrid implant with surfaces dedicated to 3 different tissue compartments. Additionally, implant coated with double covalent layer of hyaluronic acid and its geometry modified with vertical grove to shred more bone chips during insertion. Simion et al. [8] conclude that ‘the surface roughness may not be a key factor for successful osseointegration of immediately or early loaded implants’ and that ‘osseointegration follows a similar healing pattern with machined and oxidized implant surfaces. This common healing healing pattern observed by Simion et al. [8] in their histologic study was early bone formation around the bone chips which appear to be foci of osteogenesis. They observed that the bone began to grow on an implant surface if there was a bone chip there irrespective of the surface: machined or rough. Considering above findings and high incidence of periimplantitis reported in the last decade-surgical technique changed towards limiting the risk of rough implant surface exposure. This includes subcrestal placement of fully rough implants as well as minimally invasive approach with one-time abutment concept. Also, palatal implant positioning and preventive tissue augmentations are the present measures to limit the risk of periimplantitis. Hybrid implants open a new perspective of applying surfaces dedicated...
Klaudia Suligowska
Published: 4 December 2020
Modern Research in Dentistry, Volume 5, pp 549-550; doi:10.31031/mrd.2020.05.000624

Abstract:
Klaudia Suligowska * Department of Dental Technology & Masticatory Apparatus Disfunctions, Medical University of Gdańsk, Poland *Corresponding author: Klaudia Suligowska, Department of Dental Technology & Masticatory Apparatus Disfunctions, Medical University of Gdańsk, Poland Submission: November 18, 2020;Published: December 04, 2020 DOI: 10.31031/MRD.2020.05.000624 ISSN:2637-7764Volume5 Issue5 The problem of caries disease has become one of the major challenges for public health in countries around the world, while becoming one of the most worrying health phenomena in the world. It is obvious that caries is a pathological process of local nature, leading to decalcification of enamel and dentin, decomposition of hard tooth tissues and, consequently, formation of a cavity, but also a serious risk factor for other diseases. Many studies have shown a significant relationship between periapical tissue inflammation and cardiovascular disease [1-3], diabetes [4,5] and systemic oxidative stress [6]. In the Global Burden of Disease 2015 study, caries in permanent teeth is the most common disease (2.3 billion people) and the 12th for deciduous teeth (560 million children). It is assumed that the disease accounts for 5-10% of healthcare budgets in industrialized countries [7]. Due to the significant negative impact of caries on the general health of a person, the dissemination of the phenomenon and its impact on the country's economy, it is extremely important to constantly and intensively implement preventive programs towards caries. In recent years, many recommendations regarding preventive measures for children and adolescents have been published. We will not find in them one best set of actions that should be taken as part of preventive actions, but we will find many identical recommendations in them [8-11]. We can state that preventive measures should be aimed at children and adolescents aged 6 months to 18 years. The recommendations indicate that dental risk assessment should be carried out on the basis of child's age, social / biological factors, protective factors, and clinical findings. Experts also point to the need for health education in the field of proper oral hygiene techniques, nutrition (with a strong emphasis on reducing free sugar), risk factors, the need for follow-up visits and the health consequences of untreated caries. It is also recommended to perform fluoridation, tooth varnishing and sealing in children and adolescents, as well as the use of pastes, gels and rinses at home [8-11]. © 2020 Andrzej Wojtowicz. 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.
Rajni Nagpal, Meenal Agarwal, Nida Mehmood, Udai Pratap Singh
Published: 24 November 2020
Modern Research in Dentistry, Volume 5, pp 543-548; doi:10.31031/mrd.2020.05.000622

Abstract:
Rajni Nagpal1*, Meenal Agarwal2, Nida Mehmood2 and Udai Pratap Singh3 1Professor, Department of Conservative Dentistry and Endodontics, Kothiwal Dental College and Research Centre, Moradabad, 244001, UP, India 2PG Student, Department of Conservative Dentistry and Endodontics, Kothiwal Dental College and Research Centre, Moradabad, 244001, UP, India 3Professor and Head, Department of Conservative Dentistry and Endodontics, Kothiwal Dental College and Research Centre, Moradabad, 244001, UP, India *Corresponding author: Rajni Nagpal, Department of Conservative Dentistry and Endodontics,Kothiwal Dental College and Research Centre, Moradabad, UP 244001, India Submission: March 06, 2020;Published: November 24, 2020 DOI: 10.31031/MRD.2020.05.000622 ISSN:2637-7764Volume5 Issue5 Majority of esthetic restorations are currently done using resin composites. It is important to have a stable adhesion between tooth substrate and adhesive resin in order to have clinically successful composite restorations over long term. Even though adhesive systems have significantly improved, still the bonded interface remains the weakest area of resinous restorations. This has been attributed mainly to degradation of exposed collagen at the base of hybrid layer leading to deterioration of resin-dentin bond. Various dentin biomodifiers are currently under research to reduce the enzymatic breakdown of collagen and improve their mechanical stability. Dentin biomodification involves use of matrix metalloproteinase inhibitors and collagen cross linkers on acid conditioned dentin. Although only preliminary research is available, dentin biomodification appears to be a promising approach to stabilize the resin-dentin bond. This paper briefly reviews different dentin biomodifying agents, their mechanism of action and their role in improving the resin-dentin durability. Keywords: Resin-dentin bond; Matrix metalloproteinase inhibitors;Collagen cross linkers;Bond durability Dental caries is prevalent all around the world, and resin composites are widely used as filling materials [1]. However, longevity of resinous restorations is not satisfactory with failure rate ranging from 15% to 50% [2]. In addition, resin-dentin bonds are less durable than resin-enamel bonds, because of the heterogeneity of the structure and composition of dentin [3]. The failure of resin-dentin bonding results in microleakage, staining, recurrent caries, and postoperative sensitivity [4], and the interaction of these situations can further accelerate the degradation of the bond. Even though adhesive systems have significantly improved, the bonded interface remains the weakest area of resinous restorations [5]. Improving the chemical and mechanical stability of the collagen fibrils within the hybrid layer may be of clinical importance to enhance resin-dentin bond durability. This may be achieved by stabilization of dentin collagen with biocompatible cross-linking agents to increase mechanical properties and decrease enzymatic degradation with matrix metalloproteinase inhibitors (MMPI). Therefore, the aim of this paper is to discuss factors related to failure of resin-dentin bond along with various dentin biomodifying agents currently under research to optimize the longevity of resin dentin bond. Factors leading to resin- dentin bond failure Discrepancy between adhesive resin infiltration and dentin demineralization depth: With the etch and rinse systems, the difference between penetration of the adhesive and action of the acid etchant leads to an incomplete hybridization of the exposed collagen network. Therefore, at the base of hybrid layer, collagen fibrils remain uninfused, being more susceptible to hydrolytic degradation. The inability of resin monomers to replace both free and collagen-bound water present in the inter and intrafibrillar compartments does not allow to achieve a complete and stable hybrid layer. Additionally, highly hydrated proteoglycan hydrogels found in interfibrillar spaces, act as filters that trap the monomers of large molecules, such as BisGMA, and only allow the passage of small monomers, such as HEMA, toward the base of the hybrid layer. HEMA produces weak linear chains that, when subjected to stresses, lead to failure due to cyclic fatigue of the collagen chains [6]. Degradation of exposed collagen: Demineralized dentin collagen matrix acts as a scaffold for resin infiltration during the resin-dentin bonding procedure, forming the hybrid layer [7]. Degradation of collagen matrices by matrix metalloproteinases (MMPs) and cysteine cathepsins is believed to be among the major reasons for the failure of resin restorations [8]. MMPs and cysteine cathepsins can attack type I collagen, the most abundant organic component of dentin. They can be activated by proteinases, chemical agents, low pH, heat treatment, as well as mechanical stress [8]. Acid-etchants used in dentin bonding can uncover and activate matrix-bound MMPs. Incomplete resin infiltration also contributes to their activation. The exposed dentin collagen loses its protective triple helical conformation and presents the recognizable and available cleavage sites, becoming more vulnerable to MMPs and cathepsins [9]. Degradation of the Adhesive Resin: The use of hydrophilic monomers in adhesive systems, such as 2-hydroxyethylmethacrylate (HEMA), seeks to improve infiltration of the exposed collagen network, which is inherently humid. This results in an immediate improvement in bond strength [10], but the longevity of this dentin-resin bond is compromised. A weak hybrid layer is generated at the adhesive interface in the presence of water, in which the phenomena of hydrolysis and leaching of resin adhesives occur. Current adhesives include hydrophilic and hydrophobic components that, in aqueous solution, produce nano phase separation of adhesives. The hydrophilic elements penetrate the interior of the hybrid layer, while the hydrophobic monomers remain on the surface...
Rabia Sannam Khan, Yasser Ali H Almoshawah, Hafsah Akhtar, Fahad H Alhamoudi
Published: 20 November 2020
Modern Research in Dentistry, Volume 5, pp 541-542; doi:10.31031/mrd.2020.05.000621

Abstract:
Rabia Sannam Khan1*, Yasser Ali H Almoshawah2, Hafsah Akhtar3 and Fahad H Alhamoudi4 1Rabia Sannam Khan, PhD scholar, ICE Postgraduate Dental Institute and Hospital, 24 Furness Quay, Salford, UK 2Yasser Ali H Almoshawah, Lecturer, Department of Mechanical Engineering, Shaqra University, Saudi Arabia 3Hafsah Akhtar, PhD Scholar, Department of Material Science and Engineering, University of Sheffield, UK 4Fahad Hussain, Lecturer, Department of Dental Technology, King Khalid University, Saudi Arabia *Corresponding author: Rabia Sannam Khan, ICE Postgraduate Dental Institute and Hospital, 24 Furness Quay, Salford, UK Submission: November 11, 2020;Published: November 20, 2020 DOI: 10.31031/MRD.2020.05.000621 ISSN:2637-7764Volume5 Issue5 The global pandemic COVID-19 has brought devastating health, social and economic effects that drastically impacts the health services delivery. The route of entry of the SARS-COV-2 is respiratory system where it disturbs the equilibrium. The miscommunication between the adaptive and innate immunity is the indirect cause of death in patients suffering from COVID-19 severe symptoms. The failure in the production of effective antibodies against the virus causes the mortality. This shows that the adaptive immune response takes longer than the innate immune response. It is proposed that bacterial biofilms can be similar to viral biofilms representing the viral communities with augmented infectious capacity [1]. Biofilms occurs when the microorganisms accumulate and binds to a surface, and forms layers and hence stabilizes the bacterial infections and associated resistance. Biofilms causes not only bacterial infectious diseases but also viral diseases. Biofilms accumulate in viral infections and despite having the common features between bacterial and viral biofilms the major difference is being that the matrix of viral assembly is formed by the infected cell whereas the bacterial biofilm matrix is formed by the microbe itself. Biofilms can be found in different environments such as in teeth, stomach where the bacteria start to cause an infection [2]. SARS-COV-2 transmission is relying on the production of extracellular viral particles and the concentration, structure, function and composition of the viral particles are similar to those of the bacterial biofilms. SARS-COV-2 is an RNA virus which is encapsulated with proteins and lipid layer. The virus floats in air and attach to surfaces due to the lipid membranes that altogether makes very frail membranes, therefore, if the virus were single having no poli-viral support, it won’t survive in the conditions. It is 50 to 200nm in diameter and it contains the spike, envelope, membrane and nucleocapsid proteins. The spike protein attaches and fuses and triggers the viral host cell membranes. The S1 subunit of spike protein further engages the host cell receptor, the S1 receptor binding domain undergoes conformational motions. The host cell receptor is angiotensin converting enzyme 2, which has the higher affinity to SARS-COV-2 in comparison to SARS-COV. The protease domain of angiotensin converting enzyme engages the alpha 1 helix, in the recognition of receptor binding domain and engages with minor contribution from alpha2 helix and beta 3 and 4 sheets [3,4]. These undergoing processes allows to suspect the inter viral membrane activity that makes the viral biofilm possibility and hence, the membrane destruction might leads to shorter viral life span and viral isolation. This also allows virus to infect other tissues such as liver cells, erythrocytes, nephrons, neurons and many more [4]. The better understanding concentration of accumulated mutant viral particles beneath each layer of biofilm is important. Further investigation is required to identify the biofilm formation possibility for SARS-COV-2. © 2020 Rabia Sannam Khan. 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.
Viresh Chopra
Published: 13 November 2020
Modern Research in Dentistry, Volume 5, pp 536-540; doi:10.31031/mrd.2020.05.000620

Abstract:
Viresh Chopra* Senior Lecturer in Oman Dental College, Muscat, Oman Course leader, Endodontology, Oman dental College, Muscat Private practice limited to microscopic Endodontics *Corresponding author: Viresh Chopra, Senior Lecturer in Oman Dental College, Muscat, Oman Submission: June 10, 2020;Published: November 13, 2020 DOI: 10.31031/MRD.2020.05.000620 ISSN:2637-7764Volume5 Issue4 Case of failed root canal treatment associated with a previous inadequate root canal treatment and faulty post placement. The patient reported with symptomatic apical periodontitis. Patient information Tooth Figure 1:Periapical radiograph inadequate root canal treatment in 46. Periapical radiolucency associated with the mesial roots can be seen. Metallic threaded post can be seen in the distal canal. The patient was informed about the problem and advised retreatment in 46. Patient advised about post removal to be done, presence of cracks to be explored and retreatment to be done along with location of missed canals will be attempted. Treatment plan Procedures in the first visit: Buccal infiltration anesthesia was administered, and the tooth was isolated with rubber dam isolation. The retreatment was initiated under microscope. Occlusal surface showed resin composite restoration along with metallic post head (Figure 2). Figure 2: Rubber dam isolation of tooth 46. Occlusal surface with resin composite and head of the metallic threaded post. The first step was to remove resin composite restoration and expose the occlusal part of the metallic post. (Figure 3a&3b) Once the occlusal part of the post is exposed, Endodontic ultrasonic tips were used to unscrew/loosen the post and facilitate its removal from the canal (Figure 4). The post was loosened with the help of ultrasonic tips and removed from the canal (Figure 5a&5b). Figure 3: Removal of resin composite restoration to expose the head and further the occlusal part of the metallic post. Figure 4: Post removal with the help of Endodontic ultrasonic tips. Figure 5: a. The distal canal after removal of the metallic post. b. Metallic post after removal. Treatment procedure for the second appointment: Removal of gutta percha from the pulp chamber and the canals was planned in the second appointment. Also, exploration of the access cavity was done for presence of any cracks or extra canals present. Removal of previous gutta percha from the canals was done by using Endoshaper file from FKG. The gutta percha was first softened with the use of gutta percha solvent and then endo shaper file was introduced at 2500rpm to facilitate the removal of gutta percha from the canal (Figure 6a&6b). Figure 6: a. Gutta percha removed from the pulp chamber. b. Gutta percha removed from the canals. In addition to the removal of gutta perchas, final cleaning and shaping of the canal was planned in this visit. If the patient remained comfortable throughout the appointment and if time permits obturation was also planned in the same appointment. Once the removal of gutta perchas were done. Access cavity was explored for presence of cracks and extra canals. No extra canals were found. Endodontic hand files were used to determine working length along with electronic apex locator. The working length was verified with periapical radiograph (Figure 7). The canals were finally cleaned and shaped with Hyflex CM files up to size 25/04. EDTA gel, saline, 2.5% sodium hypochlorite and EDTA liquid were used as irrigants alternatively (Figure 8). Ultrasonic agitation of the irrigates was done with Endoultra from Dentsply. Clinically the fit of the master cones was checked and the verified with a peri apical radiograph at the calculated working length (Figure 9). Total fill, a bioceramic sealer from FKG was used along with gutta-percha as the core obturating material. The premixed sealer was applied in the canals with the help of disposable dispending tips. The master cones were coated with the sealer and placed inside the canals. The gutta percha was cut at the orifice level with heated Plugger. All the canals were obturated and the pulp chamber cleaned of any gutta percha or sealer (Figure 10). Immediate postoperative radiograph was taken to verify the final obturation. Figure 7: Periapical radiograph showing working length determination after gutta percha removal. Figure 8: Clinical picture showing irrigant inside the canals and pulp chamber. Figure 9: Periapical radiograph to verify the fit of the master cones at the correct working length. Irrigation protocol Flushing with saline between irrigants is must, as it will stop the irrigants from reacting with each other. Materials used for obturation Figure 10: Immediate clinical picture showing obturation of all the canals up to the canal orifice. Total fill bioceramic sealer from FKG, Hyflex CM rotary endodontic files from Coltene. Figure 11: Immediate post-obturation periapical radiograph confirming the obturation of all the canals up to the calculated working length. Proper cleaning and shaping of the root canals along with adequate disinfection is one of the important requirements for the success of the endodontic treatment. Failure to achieve adequate disinfection through irrigation will lead to left over microorganisms or pulpal debris leading to post-treatment infections (Figure 11). Endodontic ultrasonic tips should be used to stay conservative while removing metallic posts or broken files from the root canals. Excessive removal of tooth structure might lead to fracture of the tooth due to low strength. If a post has to be placed inside the root canal, then it should be placed up to adequate length to be stable as the retention of the post inside the canal is directly proportional to the length of the post in the canal. In this case, Hyflex CM rotary files were used from Coltene. The files were used with TCA technique. According to this technique: Copious irrigation should be maintained throughout the procedure and Endodontic files should...
Alammar Am
Published: 30 October 2020
Modern Research in Dentistry, Volume 5, pp 527-529; doi:10.31031/mrd.2020.05.000619

Abstract:
Alammar AM* Graduated from Tufts University, dental school for MS & King saud university BDS, Dammam 31241, Saudi Arabia *Corresponding author: Alammar AM, Graduated from Tufts University, dental school for MS & King saud university BDS, Dammam 31241, Saudi Arabia Submission: October 08, 2020;Published: October 30, 2020 DOI: 10.31031/MRD.2020.05.000619 ISSN:2637-7764Volume5 Issue4 The management of temporomandibular disorders (TMD) associated with the purpose of the present case report is to review the etiological factors and bilateral anterior disc displacement with reduction, abnormal masticatory and cervical muscles activity, Bruxism habit and malocclusion. Patient was successfully free of pain symptoms with jaw reposition occlusal splint, night Farrar splint, medication, physical therapy, trigger point injection and at the end for orthodontic treatment. A 35-year female patient presented to the Orofacial and Temporomandibular disorder (TMD) pain management clinic referred from general dentist. Her complain more pain left side than right of the jaw extended to preauricular area, earache some time with pressure, headache worse in the morning, joint sound more left side than right (clicking), grinding teeth while sleeping, poorly sleep, tired while eating, neck and shoulder muscle tight and painful [1,2]. The problem began 7 year ago and the symptoms increasing gradually, patient had orthodontic treatment at age of 14. Nothing abnormal detected. Restriction of mouth opening the patient opened 25mm with a slight deviation to the right side. Clicking in in both temporomandibular joint (TMJ). The lateral and forward movement jaw restricted and painful [3,4]. The masticatory and cervical muscles very tender and painful to palpation. The dentation was class I right side and class II left side with notice of wear upper and lower teeth. Deep bite 3mm. Panoramic (OPG) showed slightly condyle degeneration both sides. Magnetic resonance imaging (MRI) showed anterior disc displacement with open and closed movement left and right TMJ. Myofascial pain and dysfunction (MPD). Temporomandibular disorder (TMD) with internal derangement with reduction right and left side of TMJ. Bruxism possible related to stress. Jaw shifted to left side. Phase I: Occlusal splint for upper and lower jaw, Physical therapy, Medication and Trigger point injection. Phase II: Orthodontic treatment after the patient free of symptoms to correct the occlusion and up righting post teeth to increase vertical dimension. Lower reposition appliance (LOA) to keep the mandible anteriorly positioned (none click position) the patient well wore the appliance during the day only. Upper Farrar appliance with anterior vamp for the sleeping time. Trigger point injected at temporalis, masseteric and trapezius muscle right and left sides. Medication prescribed Chlorzoxazone 250mg & Paracetamol 300mg two capsule three time a day for two weeks. Patient given physical therapy instruction and exercise to practice twice per day. The patient symptoms improved gradually she is free of pain after eight weeks, she advised to continue the upper and lower appliances. The appliances was adjust every three weeks for six months, her TMJ still clicking but free of tender and pain [5,6]. Then patient referred to orthodontic treatment to start phase II treatment. Temporomandibular disorder (TMD), Myofascial pain and dysfunction (MPD), internal derangement and bruxism remains a difficult condition to manage. However, while the bruxism was controlled the symptom of pain, fatigue, tender, earache been resolved and sleeping improved. Clicking still there without pain but it possible to disappear after correcting the deep bite and the occlusions by orthodontic treatment. © 2020 Alammar AM. 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.
Picardo Silvana Noemi, Rodriguez Genta Sergio, Basilaki Jorge Mario, Lopreite Gustavo Horacio, Rey Eduardo
Published: 29 September 2020
Modern Research in Dentistry, Volume 5, pp 527-529; doi:10.31031/mrd.2020.05.000618

Abstract:
Picardo Silvana Noemi1*, Rodriguez Genta Sergio2, Basilaki Jorge Mario3, Lopreite Gustavo Horacio4, Rey Eduardo5 1Head of Practical Works Chair in Oral and Maxillofacial Surgery II School of Dentistry University of Buenos Aires and Department of Dentistry Favaloro Foundation University Hospital, Argentina 2Head of Practical Works Chair in Oral and Maxillofacial Surgery II School of Dentistry, University of Buenos Aires, Argentina 3Professor of Endodontics Kennedy University School of Dentistry, Former Associate professor of endodontics at the Buenos Aires School of Dentistry, Licensed teacher of the School of Dentistry of the University of Buenos Aires, Vocal Incoming President of the Sociedad De Endodoncia, Argentina 4Associate Professor of Endodontics Kennedy University School of Dentistry, Former Associate professor of endodontics at the Buenos Aires School of Dentistry, Licensed teacher of the School of Dentistry of the University of Buenos Aires, Former President of the Sociedad De Endodoncia, Argentina 5President of the National Academy of Dentistry, Consultant to the National Academy of Medicine, Former Professor of Oral and Maxillofacial Surgery School of Dentistry, University of Buenos Aires, Argentina *Corresponding author: Picardo Silvana Noemi, Head of Practical Works Chair in Oral and Maxillofacial Surgery II School of Dentistry University of Buenos Aires and Department of Dentistry Favaloro Foundation University Hospital Submission: September 17, 2020;Published: September 29, 2020 DOI: 10.31031/MRD.2020.05.000618 ISSN:2637-7764Volume5 Issue4 The American Surgery of Bone Mineral Research (ASBMR) in 2007 defined MRONJ as “necrotic bone area exposed to the oral environment with more than eight weeks of permanence, in the presence of chronic treatment with BPs, in the absence of radiation therapy to the head and neck”. In 2014 the American Association of Oral and Maxillofacial Surgeons (AAOMS) divided the MRONJ into 4 stages from 0 to 3, according to the clinical and radiological aspect of the osteonecrotic lesion: Keywords: Osteonecrotic lesion; Dental nerve; Oral-nasal; Endodontic; Bone accumulation; Pathology Abbreviations: AR: Antiresorptive; BPs: Bisphosphonates; DS: Denosumab; AD: Antiangiogenic Drugs, MRONJ: Medication Related Osteonecrosis of the Jaw; ET: Endodontic Therapy Antiresorptives (AR): Bisphosphonates (BP), Denosumab (DS) and Antiangiogenic drugs are physician indication in low in cases of Osteoporosis, Paget's Disease, Imperfect Osteogenesis and Fibrous Dysplasia and high concentration to treat Hypercalcemia associated with oncology patients [2]. It is clear from the suggested treatments that before the diagnosis of MRONJ the therapeutic attitude is consolidated in non-invasive maneuvers as endodontic therapy regarding the manipulation of bone tissue, performing the pertinent clinical controls in order to avoid systemic spread to deep planes, due to its pharmacokinetics of bone accumulation that could condition a septicemia picture in affected patients, interacting with the attending physician in the event of a certain event of exacerbation of injuries that affect the patient's general health [3]. Endodontic therapy requires adequate knowledge of the anatomy of the root canal system and its multiple variations [4-7], of the biology and pathology of the dental pulp and periradicular tissues [8]. In turn, the operative procedures require proper disinfection and chemical-mechanical preparation of the root canal, its cleaning and shaping [9-12], and its obturation by means of biocompatible materials that have the ability to stimulate the reparative process [13-15] Tissue repair is an essential process that restores tissue integrity and regular function. However, different therapeutic factors and clinical conditions can interfere in this periapical healing process [16]. This procedure pretends minimize bone injuries in incipient stages MRONJ. It is known respective surgeries are required in case MRONJ stage 3 are consolidated and non-invasive maneuvers could not be effective [1]. At present, a large part of the endodontic treatments performed in the clinic are due to pathologies that refer to the pulp and the periapic. The pulp is a richly vascularized and innervated tissue, delimited by an inextensible environment such as dentin, with terminal blood circulation and a small caliber periapic circulatory access zone. All this means that the defensive capacity of the pulp tissue is very limited against the various aggressions that it may suffer. The pulp tissue can also be affected by a retrograde infection [17], from the periodontal ligament or from the apex during a periodontitis process. Because periapical pathology almost always precedes pulp involvement. Due to the various causes that produce pulp and periapical pathology, the basic pathogenic process that develops is that of the inflammatory response. The pulp will react causing pulpitis, an inflammation that occurs in response to direct and immune mechanisms. The direct mechanisms are microorganisms, the results reach the pulp through the exposed dentin tubules, either by caries, trauma or irritating factors (bacterial products, bacterias, endotoxins, etc.), which when penetrating through the tubules dentinals, destroy the odontoblast and underlying cells [18]. Complement factors and immunoglobulins act on immune mechanisms. Endodontic therapy would be providing greater dental therapeutic benefit to compensate for the morbidity of the pathology MRONJ. There is a need not to suspend antiresorptive medication necessary according to medical criteria both in osteoporotic and oncological patients, since in that sense, according to the pharmacokinetics and pharmacodynamics of AR drugs [19,20]. © 2020 Picardo Silvana Noemi. 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...
Alessandra Rodrigues de Camargo, Sinioly Cristina Machado, Bruna De Oliveira Rech, Beatriz Álvares Cabral de Barros, Rubens Rodrigues Filho
Published: 23 September 2020
Modern Research in Dentistry, Volume 5, pp 519-525; doi:10.31031/mrd.2020.05.000617

Abstract:
Sinioly Cristina Machado1, Bruna de Oliveira Rech2, Beatriz Álvares Cabral de Barros3, Rubens Rodrigues Filho4 and Alessandra Rodrigues de Camargo5* 1Graduate student, Departament of Dentistry, School of Dentristry, University Federal of Santa Catarina, Florianópolis, Brazil 2Post graduate student, Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil 3Department of Dentistry, School of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil 4School of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil 5Department of Stomatology, School of Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil *Corresponding author: Alessandra Rodrigues de Camargo, Department of Dentistry, Health Science Center, Federal University of Santa Catarina, 88040-370, Florianópolis, Brazil Submission: June 24, 2020;Published: September 23, 2020 DOI: 10.31031/MRD.2020.05.000617 ISSN:2637-7764Volume5 Issue4 Background: Dental treatment must be effective with acceptance and safety for patients with special needs, with this option, the choosing of sedation through the technique and your sedative drug, it’s the way where treatment should be based. So, it´s important to be aware of what type of sedation we can use to make dental procedures feasible for people with disabilities. Material and method: An integrative review of literature, where research was conducted in the electronic databases: LILACS, PubMed, Scopus, Embase and Scielo. Held on May 29, 2020. Research articles in the area of patients with special needs (people with disabilities) from the last seven years who evaluated different sedation techniques. Excluding literature reviews, personal opinions and case reports. Result: In the initial research, 315 articles were found, coming from the five electronic databases. Eliminating duplicates, 189 articles remained, after reading the titles and abstracts 11 articles were selected, 2 articles were excluded, finalizing with 9 articles about sedation in patients with disabilities. Conclusion: The dentist can make use of the sedation technique to provide and enable the treatment of patients with disabilities, when cooperation is not enough, or the treatment brings insecurity or discomfort to the patient. Keywords: Patients with special needs; Conscious sedation; Sedative drugs Dental care in patients with special needs has always been challenging. According to the Dental Accreditation Commission (CODA), patients with special needs are defined as any individual who has a medical, psychological, physical or social condition, who needs individualized dental treatment [1]. Among these, neurological motor disorders such as Down Syndrome, Cerebral Palsy or even patients diagnosed with Autistic Spectrum Disorder (ASD) are often not able to have emotional control or complete intellectual development, and their ability to understand and cooperate may be affected by undergoing dental treatment [2,3]. Most of the time conditioning is the first method of choice for care, but it is not always enough. In these cases we use conscious sedation, a technique that can be performed with one or a combination of more medications that establish a state of depression of the central nervous system, effectively and safely whether performed by oral, nasal, intramuscular, intravenous (IV), subcutaneous or inhaled [4]. Thus, it allows the necessary dental treatment to be performed in a less traumatic way for the patient and more comfortable to the professional [5]. The use of conscious sedation in Dentistry is widely discussed with clinical guidelines and standards for its practice [6]. However, the biggest problem related to this type of sedation in a non-hospital environment is the rapid progression that can occur with a decrease in the level of sedation that can lead to unintentional loss of consciousness [7]. For this reason, a thorough airway assessment, appropriate fasting, pharmacodynamic understanding, wide safety margin of the drug of choice and emergency equipment readiness is necessary [8]. On the other hand, when well applied and indicated, the technique has the importance of enabling a successful dental treatment, avoiding the discomfort, and suffering of the patient [9]. A dental treatment that unites effectiveness, acceptance and safety for patients with special needs is essential. For this reason, the choice of sedation technique and the drug of choice are the basis for an equal and safe treatment. Therefore, the objective of this integrative review is to know, what type of sedation can we use in dental treatments for people with disabilities. Eligibility criteria This integrative review was written based on the items of Systematic Reviews and Meta-Analysis PRISMA Checklist. As inclusion criteria, studies were selected in the area of patients with special needs (people with disabilities), these being clinical research studies from the last seven years. As exclusion criteria, review works, personal opinions and clinical cases were excluded. Information sources The electronic search was performed in the following databases: LILACS, PubMed, Scopus, Embase and SciELO (more information about the search strategies is provided in Appendix 1). The search in all databases was carried out on May 29, 2020, without language restriction. Appendix 1: Search. Study selection The selection of studies was carried out in three phases. The first with the help of reference management software (EndNote® X7 Thomson Reuters, Philadelphia, PA) used to collect references and exclude duplicates. In the second phase, two reviewers (BOR and SCM) independently reviewed the titles and abstracts of all articles selected in the search. In this phase, articles that clearly did not fit the inclusion criteria or that fit any of the exclusion criteria were excluded. In the third phase, the remaining...
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