Dental Area Research Articles

"OPERATIVE DENTISTRY: The Vanishing Discipline," a reprint with Foreword.

"OPERATIVE DENTISTRY: The Vanishing Discipline," a reprint with Foreword.

Finite-Element Analysis of the Effect of Utilizing Various Material Assemblies in “All on Four” on the Stresses on Mandible Bone and Prosthetic Parts

Background. Fixed prostheses often utilize the “All-on-four” technique, in which four implants are inserted into the jaw bone, and a framework supports them. Titanium is usually used in the fabrication of “All-on-four” parts, due to its superior mechanical properties; however, it has drawbacks such as aesthetic impairment, casting issues, stress shielding, and incompatibility with imaging techniques. These drawbacks have motivated researchers to find alternative materials such as polymers. Recently, the new polymeric material PEEK has a major role in most areas of dentistry, and therefore, it can represent an alternative biomaterial to overcome the drawbacks of titanium. The density of bone is expected to influence the choice of “All-on-four” materials. Purpose. This research applied finite-element investigations to evaluate the stresses on bone tissues and prosthetic parts in “All on four,” utilizing three assemblies of materials, in normal and low bone densities. These assemblies were titanium (Type 1), titanium/PEEK (Type 2), and PEEK (Type 3). Materials and Methods. A 3D Mandibular model was constructed with a fixed prosthesis, and three assemblies of materials were stimulated, under 300 N unilateral force. The von Mises stresses were computed for the prosthetic parts and mucosa, while the maximum and minimum principal stresses/strains were computed for bone tissues due to their brittle and ductile properties. Moreover, the displacements of implants were extracted to check the prosthesis stability. Results. Type 2 and Type 3 minimized the stresses on frameworks, implants, abutments, and bone tissues, however, increased the mucosal stress, in comparison to Type 1. In the low-density model, Type 3 was recommended to reduce the stresses/strains on bone tissues and decrease the implant displacement, avoiding bone failure and increasing prosthesis stability. Conclusions. The bone density influenced the choice of “All-on-four” assembly. Moreover, further research on PEEK implants and abutments is required in the future.

Factors Affecting Career Satisfaction among Dentists of Pakistan

Background: career satisfaction is considered as the amount or degree of gratification and contentment that a dentist fosters towards his/her overall job, factoring into that equation his/her satisfaction with the job itself, the peers at the job, the supervisors, and the policies at work. Aim: To identify the factors that hinder dentists’ jobs and their satisfaction levels. Methods: The study was conducted over the period of two and half months at Lahore University College of Medicine and Dentistry. Sample size 194 was calculated and data were analyzed with simple descriptive statistics. This study was approved ethically by the ethical review committee of the University College of Dentistry, University of Lahore. Results: Results showed there were some areas of dentistry that requires new policies for improvement. Conclusion: Time to incorporate new technologies, learning new skills, and career aspirations show a high level of satisfaction while leisure time, income and opportunities for quality care are the least satisfying areas. Keywords: career, satisfaction, dentistry,

Comparison Of An Experimental Root Canal Irrigant (Sapindus Mukorossi) And Ethylenediaminetetraacetic Acid On Microhardness Of Human Dentin.

The treatment of infected root canals is one of the most essential areas in dentistry. The endodontic therapy comprises of a sequence of steps that includes the purging of disease and infectious tissues from the root canal system. The objective of the study is to compare the effect of an experimental herbal root canal irrigant (Sapindus mukorossi) and Ethylenediaminetetraacetic acid, on the micro hardness of human dentin. Ninety single rooted teeth were collected displayed intact external morphology the selected teeth were than divided randomly into 3 groups (n=30); 1 control and 2 experimental groups: Group A consisted of specimen treated with Ethanolic extract of Sapindus mukorossi. Group B consisted of specimen treated with 17% Ethylenediaminetetraacetic acid and Group C (control group) consisted of specimen of roots were sectioned immersed in distilled water. After the removal of crowns, the roots were sectioned embedded in the polymer resin leaving the root dentine exposed, the micro hardness was determined. Then, the samples from each group were treated with respective irrigant solution for 15 minutes and then observation regarding the micro hardness were noted again by using Vickers micro hardness tester. Analysis of data were obtained by application of Wilcoxon signed rank test. The study revealed that there was no significant difference noted in dentin microhardness of group "A" sample after dipping in experimental irrigant solution (Sapindus mukorossi). However, the study found significant difference in context of decrease in dentin microhardness after dipping a sample in a group "B" irrigant solution (17% Ethylenediaminetetraacetic acid). In order to preserve the strength of dentin that will ultimately be beneficial for increase in survival of teeth in function, probably the herbal extract of Sapindus mukorossi would be better candidate for future endeavour and presented as an economic and effective alternative amongst root canal irrigants.

Cytotoxicity of Silver-Containing Coatings Used in Dentistry, a Systematic Review

Silver is an element that has been widely used in medicine. As a result of its remarkable properties, this metal is now extensively used in virtually all areas of dentistry. Its anti-caries and antibacterial properties are used in (but not limited to) periodontal therapy or during endodontic treatment. The addition of silver ions to materials, such as cements and substances used for fillings, proved to increase their flexural strength and surface microhardness. This element has also found use in orthodontics, e.g., as a material covering components of fixed braces or in implantology as one of the components of coatings applied to dental implants. The following systematic review aims to find and analyze available studies that evaluate silver according to cytotoxicity. For this purpose, information was gathered from three databases: PubMed, Web of Science, and Scopus. This was followed by the Risk of Bias (RoB) analysis and the GRADE analysis of selected articles in which cytotoxicity was tested on human gingival fibroblasts (HGFs). A total of 387 articles were evaluated using required criteria, and, 13 papers were selected for final review. As all studies were evaluated to be of relatively good quality, it may be concluded that silver used in dentistry in low concentrations is free of significant cytotoxicity, and its use helps to improve the properties of the materials used.

Extra-Oral Three-Dimensional (3D) Scanning Evaluation of Three Different Impression Materials-An In Vitro Study.

Impression materials are used to record and reproduce the exact morphology of the patient’s oral cavity. The dimensional stability of a material is its ability to maintain the accuracy of recording the details of the oral cavity for a longer period of time, including the time during imprinting and immediately after. The aim of this study was to evaluate the accuracy of three different impression materials commonly used in the dental practice with the aid of an extra-oral three-dimensional (3D) scanner using an in vitro analysis. A typodont tooth model of the maxillary dental arch and mandibular dental arch, containing 16 permanent teeth, was used for evaluation. With the aid of three different impression materials, this model was imprinted fifteen times, resulting in fifteen different plaster models. A capsule extra-oral scanner device was used to digitalize the models and the same device was later used to align, compare, and measure scanned model surfaces. After performing the Kruskal–Wallis test for each measurement category (model), only two out of the fifteen measurements showed statistically significant differences between the material groups: vestibular-oral and mesial-distal width. Post hoc analysis showed that the alginate model (mean range = 29.13) had significantly higher bias scores than the addition silicone model (mean range = 16.75) (z = 2.501, p = 0.037). The difference between the average values of the model bias made from condensation-based silicone and addition-based silicone was initially significant, but after applying the Bonferroni correction for further comparisons, this relationship did not remain significant (z = 2.197, p = 0.084). Addition-based silicone models had the highest accuracy in terms of fidelity, followed by condensation-based silicones, and then by alginate models. Silicone-based impression materials improved over time, being highly used in all areas of dentistry. Alginate impressions had the lowest pattern of accuracy among those studied.

Evaluation of Shear Bond Strength of Various Orthodontic Bracket Bonding Agents

Due to the development of properties of adhesive materials currently used in dentistry, the bonding ability between the brackets and the tooth enamel has been greatly improved. In general, in situations where cooperation can be obtained, adhesion of the orthodontic bracket through the conventional three-step process can show excellent bonding strength. However, if it is difficult to expect patient cooperation, as in the pediatric dentistry area, or if moisture isolation is not properly performed, the binding strength that does not reach the expected effect. As a result, various products that simplify the process for adhesion are being developed. The aim of this study was to evaluate and compare the shear bonding strength between the conventional 3-step adhesion system, self-etching primer system and one-step adhesion system that reduces the priming process. A total of 60 human maxillary, mandibular premolars were prepared. Group I (control group) were followed conventional 3-step bonding process. Group II were conditioned with self-etching primer. Group III were etched with 37% phosphoric acid and brackets were bonded with self-priming adhesive. The resultant shear bond strength of each group was measured and an adhesive remnant index (ARI) was recorded. The mean shear bond strength of group I, II, III were 14.69 MPa, 11.21 MPa and 12.21 MPa respectively. Significant differences could only be found between group I, II and group I, III (p < 0.05). The ARI indicated no significant difference among all groups.

IN VITRO MODELING FOR THE EVALUATION OF BIOPHARMACEUTICAL PARAMETERS OF PHASE INVERSION-BASED DENTAL IN SITU IMPLANTS

Abstract. Postoperative therapy is one of the least developed areas of modern dentistry in terms of the breadth of the segment of dosage forms used. Dental in situ implants are an innovative dosage form proposed for use in post-resection therapy, which eliminates a number of disadvantages inherent in existing pharmaceuticals. Phase inversion-based in situ implants are of the greatest interest in the study, since they have the properties necessary for dental implantation and advantages over alternative in situ systems. However, the development of such innovative delivery systems is complicated by the lack of available, verified and biorelevant methods for evaluating the biopharmaceutical parameters of the dosage form at the screening stage. To solve this problem, it is possible to use in vitro modeling. The aim of this study was to determine the applicability of using an in vitro agar gingiva model to evaluate a dosage form qualitatively and quantitatively for a number of critical parameters with the intention of improving formulation, adjusting active ingredient release kinetics under near real conditions, and predicting in vivo behavior. The maximum in vitro/in vivo correlation was achieved due to the presence of a standard identical to the real tooth socket in anatomical shape and volume and the correspondence of the created model to the actual physiological parameters. For a more accurate evaluation, in addition to the agar model, a 3D-gingiva model was also used as part of the in vitro simulation. The data obtained in in vitro studies made it possible to assess the compliance of the dosage form with the specified requirements, and also, in cases of discrepancy, correct its composition at the early stages of development.

An overview of three-dimensional imaging devices in dentistry.

To review four types of three-dimensional imaging devices: intraoral scanners, extraoral scanners, cone-beam computed tomography (CBCT), and facial scanners, in terms of their development, technologies, advantages, disadvantages, accuracy, influencing factors, and applications in dentistry. PubMed (National Library of Medicine) and Google Scholar databases were searched. Additionally, the scanner manufacturers' websites were accessed to obtain relevant data. Four authors independently selected the articles, books, and websites. To exclude duplicates and scrutinize the data, they were uploaded to Mendeley Data. In total, 135 articles, two books, and 17 websites were included. Research and clinical practice have shown that oral and facial scanners and CBCT can be used widely in various areas of dentistry with high accuracy. Although further advancement of these devices is desirable, there is no doubt that digital technology represents the future of dentistry. Furthermore, the combined use of different devices may bring dentistry into a new era. These four devices will play a significant role in clinical utility with high accuracy. The combined use of these devices should be explored further. The four devices will play a significant role in clinical use with high accuracy. The combined use of these devices should be explored further.

Rate of use of the clinic dental materials of dentistry faculty of the University of Cuenca

Aim: To determine the rate of use of the dental materials in the areas of dental surgery, prosthodontics, periodontics, surgery, pediatric dentistry and orthodontics of Dentistry Faculty of the University of Cuenca, Ecuador. Materials and methods: We analyzed the rate of use of 43 dental materials of the clinic of Dentistry Faculty of the University of Cuenca, the weight of these dental materials was obtained by a precision electronic scale to determine the number of doses, price per serving and usage fee. Results: The rate of use of the glass ionomer for light-cured restoration in powder presentation is 5.6%, while in its liquid proportion its rate of use is 3.1%. Regarding to the composite resin, it has a paste form presentation, which has a 1.3% rate of use, in addition, the prophylactic paste and chlorhexidine at a concentration of 0.12%, have a rate of use of 0.5% and 0.1%, respectively. Conclusions: Knowing the rate of use and price per portion of dental materials is very useful to take advantage of the materials performance, set appropriate prices for treatments and avoid high costs for patients.

Comparitive evaluation of antimicrobial effectiveness of titanium oxide coatings on different types of ceramic brackets against Streptococcus mutans

Nanomaterials are widely used in modern clinical dentistry. They improve various properties, such as antimicrobial properties, durability of materials. These particles do not exceed 100 nm, due to they obtain a better ratio between the surface and mass. Nanomaterials are used in many areas of dentistry, such as conservative dentistry, endodontics, oral, and maxillofacial surgery, periodontics, orthodontics, and prosthetics. One of the most important complications of fixed orthodontic treatment is enamel demineralization. Brackets and orthodontic accessories facilitate plaque accumulation and compromise oral hygiene maintenance which lead to an increase in oral bacteria count during orthodontic treatment. 30 MBT 0.022’’ monocrystalline ceramic brackets and 30 MBT 0.022’’ polycrystalline ceramic brackets (Metro Orthodontics) which are randomly divided into 4 groups: 2 control groups (group-1=15 uncoated monocrystalline and group-2=15 uncoated polycrystalline) and 2 experimental groups (group-3=15 silver oxide coated monocrystalline and group-4=15 silver oxide coated polycrystalline). S.mutans counts were significantly less in the experimental groups than control groups. Titanium oxide coatings on ceramic brackets reduced the colony forming units of S. mutans. Reduced number of colony forming units was seen in both the monocrystalline and polycrystalline coated brackets than their control groups.

Application of Binary Response Regression Models to Detect Factors Influencing the Occurrence of Infection in Dental Surgeries

Postoperative infection is common in dental surgery, for example, in the removal of the third molar. To control these and other postoperative complications, various studies have reported the use of some drug protocols, namely the prophylact and the preemptive ones, using drugs such as dexamethasone and betamethasone. In this work, we used the generalized linear model via logistic regression to verify whether, in addition to the medicaments mentioned, some covariates that are frequently used in dental surgeries influence the occurrence, or not, of postoperative infection in surgeries for removal of the third molar. One of the main reasons that led us to employ such a model is because the response variable (having or not having infection) presents values of the binary type, in addition to being one of the most applied models in the area of health, among them, the dentistry area. The application of descriptive methods and analysis of association via statistical tests were also used to choose other factors that influence the response variable infection in addition to medications. The AIC (Akaike Information Criterion) selection criterion, analysis of the difeerence in the deviations, and the analysis of residual using the half-normal plot for selection and the assumption of the proposed model were employed. The data set under analysis consists of 113 patients submitted to dental surgery in a specialized clinic in the city of Piracicaba, SP-Brazil between 2003 and 2018. Through the proposed model, some important information the covariates in relation to the patients submitted to dental surgery. One of the key information is that characteristics as Age and Dental extractions are associated with the inflammatory processes after surgery. This relationship indicates that the older the patient, the chance of having an infection after surgery increases. The analysis is similar to the Number of extractions.

Correlation between periodontal disease and complications due Covid-19

COVID-19 became a pandemic that affected all health sectors, both public and private. In the area of dentistry, the main concern is centred on the growing dangers of the production of aerosols by dental procedures in daily practice. In addition to this, the scientific community has recently analysed the direct potential risk of the presence of periodontal disease with the increase in the severity of COVID-19. The objective of this work is to talk about a new SARS-CoV-2 virus, delving into those risk indicators as main elements to understand the role of the virus in the pathogenesis of periodontitis, remembering that periodontitis is the second leading cause of tooth loss in adults. This work aims at updating health professionals, retaking the importance of prevention and control of oral health, as well as of COVID-19. There are few findings in the literature on the direct relationship between both diseases, taking into account the different strains of the virus discovered and its changing symptomatology, scientific and clinical research has had delays in accessing more extensive information regarding this subject; however, one of the main pieces of evidence lies in the role that the oral cavity plays in the periodontal health of the patient's tissues, since these could serve as entrances for the severe acute respiratory syndrome coronavirus SARS-CoV-2, in addition to the pro-inflammatory state subdued by cytokines within periodontal disease that could contribute to the development of severe forms of COVID-19.

Cephalometric Analysis in Orthodontics Using Artificial Intelligence—A Comprehensive Review

Artificial intelligence (AI) is a branch of science concerned with developing programs and computers that can gather data, reason about it, and then translate it into intelligent actions. AI is a broad area that includes reasoning, typical linguistic dispensation, machine learning, and planning. In the area of medicine and dentistry, machine learning is currently the most widely used AI application. This narrative review is aimed at giving an outline of cephalometric analysis in orthodontics using AI. Latest algorithms are developing rapidly, and computational resources are increasing, resulting in increased efficiency, accuracy, and reliability. Current techniques for completely automatic identification of cephalometric landmarks have considerably improved efficiency and growth prospects for their regular use. The primary considerations for effective orthodontic treatment are an accurate diagnosis, exceptional treatment planning, and good prognosis estimation. The main objective of the AI technique is to make dentists' work more precise and accurate. AI is increasingly being used in the area of orthodontic treatment. It has been evidenced to be a time-saving and reliable tool in many ways. AI is a promising tool for facilitating cephalometric tracing in routine clinical practice and analyzing large databases for research purposes.

A Bibliometric Analysis (2010-2020) of the Dental Scientific Literature on Chemo-Mechanical Methods of Caries Removal Using Carisolv and BRIX3000.

Reports in the literature have proposed and analyzed several minimally invasive techniques for caries removal in recent decades. In light of recent events surrounding the ongoing epidemiological context, concerns have been raised regarding the generation of aerosols during dental procedures. The aim of our research was to provide an overview of the scientific literature on the topic of chemo-mechanical caries removal (CMCR) methods, focusing on two products (Carisolv, BRIX3000), commercially available in Europe. A bibliometric analysis was used to investigate the scientific articles included in Web of Science (WoS) Core Collection database, published from January 2010 to December 2020. We analyzed the co-occurrence of all keywords (Author Keywords and the KeyWords Plus section), co-authorship and co-citation, using the free software VOSviewer. Our bibliometric analysis revealed a worldwide interest in the subject of chemo-mechanical methods of caries removal, which has transcended the area of pediatric dentistry. The analyzed studies have been conducted mainly in high-income countries that have developed sanitary policies regarding prevention and early treatment of carious lesions as a health priority.

Simultaneous Photodynamic Eradication of Tooth Biofilm and Tooth Whitening with an Aggregation-Induced Emission Luminogen.

Dental caries is among the most prevalent dental diseases globally, which arises from the formation of microbial biofilm on teeth. Besides, tooth whitening represents one of the fastest‐growing areas of cosmetic dentistry. It will thus be great if tooth biofilm eradication can be combined with tooth whitening. Herein, a highly efficient photodynamic dental therapy strategy is reported for tooth biofilm eradication and tooth discoloration by employing a photosensitizer (DTTPB) with aggregation‐induced emission characteristics. DTTPB can efficiently inactivate S. mutans, and inhibit biofilm formation by suppressing the expression of genes associated with extracellular polymeric substance synthesis, bacterial adhesion, and superoxide reduction. Its inhibition performance can be further enhanced through combined treatment with chlorhexidine. Besides, DTTPB exhibits an excellent tooth‐discoloration effect on both colored saliva‐coated hydroxyapatite and clinical teeth, with short treatment time (less than 1 h), better tooth‐whitening performance than 30% hydrogen peroxide, and almost no damage to the teeth. DTTPB also demonstrates excellent biocompatibility with neglectable hemolysis effect on mouse red blood cells and almost no killing effect on mammalian cells, which enables its potential applications for simultaneous tooth biofilm eradication and tooth whitening in clinical dentistry.

Metabolomics Research in Periodontal Disease by Mass Spectrometry.

Periodontology is a newer field relative to other areas of dentistry. Remarkable progress has been made in recent years in periodontology in terms of both research and clinical applications, with researchers worldwide now focusing on periodontology. With recent advances in mass spectrometry technology, metabolomics research is now widely conducted in various research fields. Metabolomics, which is also termed metabolomic analysis, is a technology that enables the comprehensive analysis of small-molecule metabolites in living organisms. With the development of metabolite analysis, methods using gas chromatography–mass spectrometry, liquid chromatography–mass spectrometry, capillary electrophoresis–mass spectrometry, etc. have progressed, making it possible to analyze a wider range of metabolites and to detect metabolites at lower concentrations. Metabolomics is widely used for research in the food, plant, microbial, and medical fields. This paper provides an introduction to metabolomic analysis and a review of the increasing applications of metabolomic analysis in periodontal disease research using mass spectrometry technology.

Monomer Release from Dental Resins: The Current Status on Study Setup, Detection and Quantification for In Vitro Testing.

Improvements in mechanical properties and a shift of focus towards esthetic dentistry led to the application of dental resins in various areas of dentistry. However, dental resins are not inert in the oral environment and may release monomers and other substances such as Bisphenol-A (BPA) due to incomplete polymerization and intraoral degradation. Current research shows that various monomers present cytotoxic, genotoxic, proinflammatory, and even mutagenic effects. Of these eluting substances, the elution of BPA in the oral environment is of particular interest due to its role as an endocrine disruptor. For this reason, the release of residual monomers and especially BPA from dental resins has been a cause for public concern. The assessment of patient exposure and potential health risks of dental monomers require a reliable experimental and analytical setup. However, the heterogeneous study design applied in current research hinders biocompatibility testing by impeding comparative analysis of different studies and transfer to the clinical situation. Therefore, this review aims to provide information on each step of a robust experimental and analytical in vitro setup that allows the collection of clinically relevant data and future meta-analytical evaluations.

Evaluation of fully automated cephalometric measurements obtained from web-based artificial intelligence driven platform

BackgroundArtificial Intelligence has created a huge impact in different areas of dentistry. Automated cephalometric analysis is one of the major applications of artificial intelligence in the field of orthodontics. Various automated cephalometric software have been developed which utilizes artificial intelligence and claim to be reliable. The purpose of this study was to compare the linear and angular cephalometric measurements obtained from web-based fully automated Artificial Intelligence (AI) driven platform “WebCeph”™ with that from manual tracing and evaluate the validity and reliability of automated cephalometric measurements obtained from “WebCeph”™.MethodsThirty pre-treatment lateral cephalograms of patients were randomly selected. For manual tracing, digital images of same cephalograms were printed using compatible X-ray printer. After calibration, a total of 18 landmarks was plotted and 12 measurements (8 angular and 4 linear) were obtained using standard protocols. The digital images of each cephalogram were uploaded to “WebCeph”™ server. After image calibration, the automated cephalometric measurements obtained through AI digitization were downloaded for each image. Intraclass correlation coefficient (ICC) was used to determine agreement between the measurements obtained from two methods. ICC value < 0.75 was considered as poor to moderate agreement while an ICC value between 0.75 and 0.90 was considered as good agreement. Agreement was rated as excellent when ICC value > 0.90 was obtained.ResultsAll the measurements had ICC value above 0.75. A higher ICC value > 0.9 was obtained for seven parameters i.e. ANB, FMA, IMPA/L1 to MP (°), LL to E-line, L1 to NB (mm), L1 to NB (°), S-N to Go-Gn whereas five parameters i.e. UL to E-line, U1 to NA (mm), SNA, SNB, U1 to NA (°) showed ICC value between 0.75 and 0.90.ConclusionA good agreement was found between the cephalometric measurements obtained from “WebCeph”™ and manual tracing.

Applications of Plasma-Activated Water in Dentistry: A Review.

The activation of water by non-thermal plasma creates a liquid with active constituents referred to as plasma-activated water (PAW). Due to its active constituents, PAW may play an important role in different fields, such as agriculture, the food industry and healthcare. Plasma liquid technology has received attention in recent years due to its versatility and good potential, mainly focused on different health care purposes. This interest has extended to dentistry, since the use of a plasma–liquid technology could bring clinical advantages, compared to direct application of non-thermal atmospheric pressure plasmas (NTAPPs). The aim of this paper is to discuss the applicability of PAW in different areas of dentistry, according to the published literature about NTAPPs and plasma–liquid technology. The direct and indirect application of NTAPPs are presented in the introduction. Posteriorly, the main reactors for generating PAW and its active constituents with a role in biomedical applications are specified, followed by a section that discusses, in detail, the use of PAW as a tool for different oral diseases.