Dentistry Journal — Open Access Journal

The transcription factor Twist1 is known to be closely associated with the formation of bone by mesenchymal stem cells and osteoblasts; however, the role of Twist1 in cementogenesis has not yet been determined. This study was undertaken to elucidate the roles of Twist1 in cementoblast differentiation by means of the gain- or loss-of-function method. We used alkaline phosphatase (ALP) and alizarin red S staining and quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR) to determine whether the forced transient expression or knock-down of Twist1 in a mouse cementoblast cell line, OCCM-30, could affect cementogenic differentiation. Silencing Twist1 with small interference RNA (siRNA) enhanced the formation of mineralized tissue. The expression of several cementogenesis markers, such as bone sialoprotein (BSP), osteopontin (OPN), dentin matrix protein1 (DMP1), and dentin sialophosphoprotein (DSPP) mRNA, were upregulated. Transient Twist1 overexpression in OCCM-30 consistently suppressed mineralization capacity and downregulated the differentiation markers. These results suggest that the Twist1 transcription factor may play a role in regulating cementoblast differentiation. Full article

Oral health behaviours of children are formulated from a very young age. Formation of those behaviours among very young children is dependent on their mothers/caregivers who may themselves require support from the health profession or laypersons. The study aimed to investigate if early life visits for check-up and dental advice and perceived support improved oral health behaviours as practiced by mothers of toddlers aged 24–30 months old. Data from a population-base birth cohort study in South Australia was used. The study recruited and followed mothers of newborn children from birth to age 24–30 months. Parental questionnaires collected information about socioeconomic factors, dental visiting patterns, and oral health behaviours as practiced by the mothers for their child. Self-reported putting a child to bed with a bottle and brushing a child’s teeth were the outcome variables. The two main exposures of this study were (1) early visiting for a dental advice, and (2) layperson support that a mother received in the first two years of having the child. Data were analysed progressively from bivariate to multivariable regression models. A total of 1183 mother/child dyads had complete data. The retained sample was representative of the population. Approximately 36% of mothers put their child to bed with a bottle and 26% of mothers did not brush their child’s teeth the night before. Around 29% of children had a visit for dental check-up and 80% of mothers reported having lay support. There were gradients in the outcome variables by socioeconomic factors and the main exposures. Multivariable regression models reported that having no dental visit for advice and having no lay support were associated with 1.30 and 1.21 imes higher rates of putting a child to bed with a bottle, respectively. Having no dental visit for advice was associated with a 1.37-times higher rate of not brushing a child’s teeth, controlling for other factors. This population-based birth cohort study confirmed importance of early life dental visit for check-up and support for mothers of young children in establishing oral health behaviours of young children. Full article

The objective of this study was to evaluate the effect of radiant exposure on the chemical and physical properties of four commercial dental resin composites. The four dental resin composites used were Kalore, Admira, Tetric N-Ceram Bulk Fill, and Filtek Z350 XT. The composites were subjected to three curing protocols: 1000 mW/cm² for 5 s, 1000 mW/cm² for 10 s, and 400 mW/cm² for 25 s. The flexural strength, elastic modulus, water sorption, water solubility, degree of conversion, and polymerization shrinkage were evaluated. The results were analyzed by means of ANOVA and Tukey tests. For Admira and Kalore, significant differences between light exposure protocols were observed for the elastic modulus (p < 0.001), which was higher when a higher amount of radiant exposure was used. For Filtek Z350, differences were only observed for the degree of conversion (p < 0.001), and a higher amount of radiant exposure allowed us to obtain higher values. The Tetric N-Ceram Bulk Fill analysis showed significant differences for the elastic modulus and water sorption (p < 0.001), and specimens that had been subject to a radiant exposure of 10 J/cm² showed a higher elastic modulus. In most cases, the physical and mechanical properties analyzed were not affected by different radiant exposure values. Other resin-based composite (RBC) characteristics seem to have a greater influence on material properties. Full article

Advances in adhesive dentistry have led to increased use of indirect restorations. In some situations, indirect composite techniques are more advantageous than direct composite filling techniques, such as establishing proper occlusal and interproximal anatomy, reducing polymerization shrinkage stress, and promoting the degree of conversion. This article presents a case about restoring the lower right first molar with extensive loss of tooth structure by the composite onlay to achieve a proper anatomic form and rehabilitate chewing function. This one-year clinical case encourages clinicians to manage large decay of posterior tooth conservatively. The given functional and esthetic outcomes demonstrate the promising applicability of the indirect composite technique. Full article

Background: Glycogen storage diseases (GSDs) are genetic disorders that result from defects in the processing of glycogen synthesis or breakdown within muscles, liver, and other cell types. It also manifests with impaired neutrophil chemotaxis and neutropenic episodes which results in severe destruction of the supporting dental tissues, namely the periodontium. Although GSD Type Ib cannot be cured, associated symptoms and debilitating oral manifestations of the disease can be managed through collaborative medical and dental care where early detection and intervention is of key importance. This objective of the case report was to describe a child with GSD Ib and its associated oral manifestations with microbial, immunological and histological appearances. Case Presentation: An eight-year-old Hispanic male with a history of GSD type Ib presented with extensive intraoral generalized inflammation of the gingiva, ulcerations and bleeding, and intraoral radiographic evidence of bone loss. Tannerella forsythia was readily identifiable from the biofilm samples. Peripheral blood neutrophils were isolated and a deficient host response was observed by impaired neutrophil migration. Histological evaluation of the soft and hard tissues of the periodontally affected primary teeth showed unaffected dentin and cementum. Conclusions: This case illustrates the association between GSD Ib and oral manifestations of the disease. A multi-disciplinary treatment approach was developed in order to establish healthy intraoral conditions for the patient. Review of the literature identified several cases describing GSD and its clinical and radiographic oral manifestations; however, none was identified where also microbial, immunological, and histological appearances were described. Full article

Background. Tooth bleaching is the most frequently employed whitening procedure in clinics. The major side effect of tooth bleaching is dental sensitivity during and after the treatment. Here, we evaluated whether the administration of amorphous calcium phosphate (ACP), during in-office and at-home procedures may impact on dental sensitivity. Methods. Eighty patients, responding to the study requirements were enrolled according to the following criteria. Group 1 (n = 40), received in-office, 10% ACP prior to 30% professional hydrogen peroxide application. The whitening procedure continued at home using 10% carbamide peroxide with 15% ACP for 15 days. Group 2 (n = 40) received only 30% hydrogen peroxide application and continued the whitening procedures at home, using 10% carbamide hydroxide, without ACP- Casein phosphopeptides (CPP), for 15 days. Dental sensitivity was recorded with a visual analogue scale (VAS) at baseline, immediately after, and at 15 days after treatment in the two groups. Results. We observed that patients receiving ACP in the bleaching mixture experienced decreased dental sensitivity (* p ≤ 0.05), as detected by VAS scale analysis immediately following the procedures. Patients receiving ACP-CPP during at-home procedures showed a statistically significant (*** p ≤ 0.0001) reduction of dental sensitivity. Conclusions. We demonstrated that ACP-CPP administration, while exerting the same whitening effects as in control subjects receiving potassium fluoride (PF), had an impact on the reduction of dental sensitivity, improving patient compliance. Full article

Health-related behaviors are influenced by knowledge and awareness, with oral health being no exception. It is well-known that oral diseases are influenced by social determinants. There is an association between the oral health knowledge of mothers and the status of their children’s oral health. In Qatar, the knowledge and practices of oral health in preschool children have not been previously reported. The aim of this study was to assess the knowledge, attitude, and related practices of mothers of preschool children about oral health in Qatar. A total of 400 questionnaires were distributed by the principals of kindergarten to mothers of children attending 16 government kindergartens in Qatar. The questionnaire included 38 close-ended questions grouped into nine categories, addressing different aspects of knowledge and practices related to early childhood oral health. The questionnaire was constructed in English, before being translated into Arabic, which is the local language in Qatar. The questionnaire instrument was pre-tested on mothers with demographic characteristics matching the main population. These participants were not included in the main study. The questionnaire study was associated with a clinical epidemiological study to assess dental caries and enamel defects of the sampled children. The dmft caries index (decayed, missing and filled teeth) was used for that purpose according to the World Health Organization criteria. For the questionnaire administered to mothers with clinical survey variables, a binary logistic regression analysis was performed to determine the associations between the measures of oral health status (dmft, Dental index) and mothers’ oral health knowledge and practices. A total of 48% mothers thought that children should have their teeth brushed from the age of three years and 42% chose younger than two years as a starting age for brushing. More than half (54%) of the mothers thought that children should not have their teeth flossed. In general, no significant statistical association was found between dmft and any other variables, except for whether or not the child had visited the dentist. Logistic regression analyses were performed to determine the association between the measures of oral health status (dmft, DI) and mothers’ oral health knowledge and practices. After controlling for the other independent variables included in this model, the test of the model was not statistically significant, which indicated that none of the variables represent a significant risk for occurrence of caries. The only exception was whether or not the child had visited the dentist (odds ratio = 2.51, 95% confidence interval 1.091–5.774). Despite the existence of good knowledge of oral health care, there were deficiencies in the oral health care provided to children. This may reflect that seeking dental care is either not very important or it is challenging to obtain access to a child-friendly dentist in the public health system in Qatar. The results of this study suggest that there is a need for an oral health promotion program to fill the gaps in knowledge for mothers regarding oral health care for young children. Full article

Clinically, periodontal regeneration may be achieved by the application of barrier membranes, grafts, wound-healing modifiers, and their combinations. Combination therapy refers to the simultaneous application of various periodontal reconstructive treatment alternatives to obtain additive effects. This approach may lead to assemblage of different regenerative principles, such as conductivity and inductivity, space provision and wound stability, matrix development and cell differentiation. The application of autogenous connective tissue grafts during periodontal regenerative treatment with enamel matrix proteins derivative (EMD) has been previously reported. The present case series present a modified approach for treatment of severe periodontally involved lower incisors presenting with thin gingival biotype, gingival recession, minimal attached and keratinized gingiva width and muscle and/or frenum pull. In all cases a combination therapy consisting of a single buccal access flap, root conditioning, EMD application on the denuded root surfaces and a free connective tissue graft was performed. Clinical and radiographic outcomes were consistently satisfactory, leading to probing depth reduction, clinical attachment gain, minimal gingival recession, increased attached and keratinizing gingival width, elimination of frenum and/or muscle pull together with radiographic bone fill of the defects. It may be concluded that the present combination therapy for reconstructive periodontal treatment in the lower anterior area is a valuable alternative for indicated cases. Full article

The microbiota of the oral cavity plays a significant role in pulpal and periapical diseases. Historically, 100 years ago little was known on microbiota, but after a century of investigations, only now can many of the intimate secrets of microbial growth, expansion, persistence, communal activities, and virulence be revealed. However, with the capabilities of the microbiota for mutation, quorum sensing, and information transference, researchers are hard-pressed to keep up with both the changes and challenges that an amazingly wide range of bacterial species pose for both the scientist and clinician. Fortunately, the development and expansion of a vast array of molecular biological investigative techniques have enabled dentistry and its associated medical fields to attempt to keep pace with the wide and fascinating world of oral microbiology. Full article

The aim of this study is to compare the osteogenic differentiation capacity of the dental pulp pluripotent-like stem cells (DPPSCs) using conditional media pretreated with ProRoot-MTA, Biodentine (BD) or the newly manufactured pure Portland cement Med-PZ (MZ). DPPSCs, isolated from human third molars, are the most relevant cell model to draw conclusions about the role of biomaterials on dental tissue regeneration. Cytotoxicity, alkaline phosphatase (ALP) activity, and calcium deposition analysis were evaluated at different differentiation time points. Gene expression of key osteogenic markers (RUNX2, Collagen I and Osteocalcin) was determined by qRT-PCR analysis. The osteogenic capacity of cells cultured in conditioned media prepared from MZ or MTA cements was comparable. BD conditioned media supported cell proliferation but failed to induce osteogenesis. Relative to controls and other cements, high osteogenic gene expression was observed in cultures pre-treated with the novel endodontic cement MZ. In conclusion, the in vitro behavior of a MZ- endodontic cement was evaluated, showing similar enhanced cell proliferation compared to other commercially available cements but with an enhanced osteogenic capacity with prospective potential as a novel cement for endodontic treatments. Full article

The aim of this study was to evaluate the ability of visual examination (International Caries Detection and Assessment System—ICDAS II), light-emitting diodes (LED) fluorescence (SPECTRA), laser fluorescence (DIAGNODent, DD), photothermal radiometry and modulated luminescence (PTR-LUM, The Canary System, CS) to detect natural decay beneath resin-modified glass ionomer (RMGIC) and compomer restorations in vitro. Twenty-seven extracted human molars and premolars, consisting of 2 control teeth, 10 visually healthy/sound and 15 teeth with natural cavitated lesions, were selected. For the carious teeth, caries was removed leaving some carious tissue on one wall of the preparation. For the sound teeth, 3 mm deep cavity preparations were made. All cavities were restored with RMGIC or compomer restorative materials. Sixty-eight sites (4 sites on sound unrestored teeth, 21 sound sites and 43 carious sites with restorations) were selected. CS and DD triplicate measurements were done at 2, 1.5, 0.5, and 0 mm away from the margin of the restoration (MOR). SPECTRA images were taken, and two dentists provided ICDAS II scoring for the restored surfaces. The SPECTRA data and images were inconclusive due to signal interference from the restorations. Visual examinations of the restored tooth surfaces were able to identify 5 of the 15 teeth with caries. In these situations, the teeth were ranked as having ICDAS II 1 or 2 rankings, but they could not identify the location of the caries or depth of the lesion. CS and DD were able to differentiate between sound and carious tissue at the MOR, but larger variation in measurement, and poorer accuracy, was observed for DD. It was concluded that the CS has the potential to detect secondary caries around RMGIC and compomer restorations more accurately than the other modalities used in this study. Full article

This study investigated which preparation strategy for root canals leads to the best technical preparation quality, and moreover, which is perceived to be performed best by novice students. Sixty-four students were recruited to prepare one simulated root canal with each of the following: FlexMaster files (F), Mtwo files (M), and Reciproc files (R). After preparation, the students assessed the different instrument systems through a questionnaire. The technical quality of the root canal preparations was evaluated by the centering ratio of the preparation. A total of 186 prepared root canals were submitted for evaluation. With R, significantly better centered preparations were achieved when compared to M and F (p < 0.001). The students evaluated R faster than M and F, and evaluated F significantly (p < 0.05) slower than R and M. M was rated as the easiest system to learn and to handle, as well as the best at reaching the working length; therefore, it was evaluated as the overall favorite of the students. A difference was found between the students’ perceptions and their achieved technical quality of root canal preparations. Full article

This study compared the effects of a conventional endodontic needle with an agitation system on a novel tricalcium silicate-based sealer (NTS) in terms of dentinal tubule penetration and interfacial adaptation to a root canal. Fifty single-rooted, recently-extracted human maxillary central incisors were randomly distributed into two homogeneous groups characterized by two different final cleansing systems: Conventional endodontic needle, or EndoActivator^®. After instrumentation, all the teeth were filled with the gutta-percha single cone technique in conjunction with the novel tricalcium silicate-based sealer. Teeth were horizontally sectioned at 1 and 5 mm from the apex and were observed under a confocal laser scanning microscope (CLSM) at five magnifications. The maximum, mean, and the circumferential percentage of the sealer penetration inside the tubules were measured. Moreover, the gap width was evaluated using Image J software (National Institutes of Health, Bethesda, MD). EndoActivator^® did not result in a significantly higher circumferential percentage of sealer penetration than conventional irrigation (p > 0.05). However, the gap width was significantly lower with EndoActivator^®, compared to conventional needles at both 1 mm (p = 0.035) and 5 mm (p = 0.038). The EndoActivator^® irrigation system did not significantly improve the NTS penetration, as compared to the conventional endodontic needle irrigation. Activation of the irrigation reduced the gap width significantly. Full article

The purpose of this study was to determine dental practitioners’ opinions, techniques, and materials used for the restoration of endodontically treated teeth (ETT) in Saudi Arabia. A comprehensive nationwide survey regarding treatment strategies of ETT, on the post types and material used for core foundations were distributed either by email or by hard copies to general dentists in different parts of Saudi Arabia (North, South, West, East, and Center). Descriptive statistics were used to analyze the responses to the questions. A total of 164 participants were included in the survey: 72.6% of them were male, and 27.4% were female. 42.1% of the participants were Saudi dental practitioners, whereas 57.9% were non-Saudi dental practitioners. Out of the surveyed dentists, 52% consider post placement for almost every post-endodontic restoration of ETT. The majority of the dentists (54%) believe that a post strengthens ETT. Cast posts and cores were used by 55% of all the dentists, whereas 34% used prefabricated posts exclusively. Screw posts were the most popular prefabricated post type (47%). Composite resin (51%) was preferred for the core foundation, followed by glass ionomer cements (GICs) (26%). Amalgam was seldom used (0.5%). Posts were placed primarily with zinc phosphate cement (51%), followed by GIC (38%). Within the limitations of this survey-based investigation among dental practitioners in Saudi Arabia, it was concluded that the treatment strategies of ETT are in accordance with the current state of evidence-based knowledge. Full article

Implant dentistry is a growing field in the education of undergraduate dental students. The present laboratory study evaluates factors which may potentially influence the accuracy of free-hand implant insertion and the use of an orientation template. After three-dimensional planning using coDiagnostiX^TM, orientation templates, including sleeves for the pilot-drill in regions 41 and 45, were manufactured by thermoforming. Sixty-one fifth year dental students inserted one implant using the orientation template and another implant free-hand in an artificial mandible. Information regarding age, sex, handedness, education, and the time required for implant insertion were recorded. Subsequently, the mandibles were scanned using cone-beam-computed tomography and the accuracy of the implant position was assessed, while statistical analysis followed. The free-hand implant insertion resulted in a distal deviation of −1.34 ± 5.15° and a mesial mismatch of 0.06 ± 0.79 mm at the artificial bone level compared to the sleeves. When using the orientation templates, the deviation decreased to −0.67 ± 3.48° and a distal mismatch of −0.22 ± 0.62 mm was achieved. The difference was statistically significant for the mismatch (p < 0.049). Regarding the limitations of our study, it could be said that the accuracy level achieved by dental undergraduates using implant placement with orientation templates is comparable to that in other studies. Full article

The recent randomized trial, published by Raje et al., on Lancet Oncology is potentially practice changing. It proposes that denosumab is a valid alternative to zoledronic acid in the treatment of myeloma patients. However, several points need further data and more details, such as information on incidence, diagnosis, and follow-up of osteonecrosis of the jaw (ONJ) cases, observed among treated patients. Adopted definition to adjudicate ONJ cases, type of registration of potential ONJ cases, length of observation are possible causes of potential underestimation of ONJ incidence in their study. Future updated evaluations with longer follow-up, and including actuarial estimation, are required for final judgment on ONJ risk in myeloma patients receiving denosumab, and comparison with ONJ risk by zoledronic acid. Full article

Introduction: Temporomandibular disorders (TMD) involve the presence of pain or dysfunction on certain areas of the Cranio-Cervico-Mandibular Complex (CCMC), such as the masticatory muscles, the temporomandibular joint (TMJ) and associated structures like the postural muscles of the cervical region, can be considered as a sub-group of musculoskeletal disorders. Wind instrument players, as a consequence of their musical performance and its relation with the CCMC, can develop a TMD associated to muscle hyperactivity of certain elevator muscles, or even an increase of the intra-articular pressure in the functioning of the TMJ throughout musical activity. Aim: The objective of this paper is to describe the necessary and elementary steps in the diagnoses and treatment of a wind instrumentalist with a temporomandibular disorder, with the introduction of infrared thermography during this procedure. This case study also has the purpose of presenting the usefulness of piezoresistive sensors in the analysis of the clarinettists’ embouchure. Methodology: A Caucasian, 30-year-old female clarinettist was assessed through a clinical examination following the Diagnostic Criteria for TMD (RDC/TMD), as a complementary tool of diagnosis, a thermal imaging infrared camera, Flir E60 (Wilsonville, OR, USA), was used in order to analyse the above referred articular and muscular regions. The complementary examination protocol implemented with this clarinet player also involved the analyses of the embouchure with the support of piezoresistive sensors. Results: The clinical outcomes resulting from this work were based on the RDC/TMD diagnoses indicated that the clarinet player had an internal derangement on both TMJ, with an osteoarthritis on the left TMJ and an anterior disc displacement with reduction on the right TMJ. The infrared thermograms that were analysed, verified the existence of a temperature differential of the anterior temporal muscle (0.1 °C), the TMJ (0.1 °C) and the masseter muscle (0.7 °C), and after the occlusal splint therapy the asymmetry related to the master muscle reduced to 0.3 °C. The high pitches can reach values of 379 g of force induced to the tooth 21 comparing to the 88 g of force applied on tooth 11. The embouchure force measurements consistently presented greater forces during the higher notes, followed by the medium notes and finally the low notes and this happened with higher pressures being transmitted always to tooth 21. Conclusion: Performing arts medicine should understand the major importance of the dentistry field in the daily life of a professional musician, and the significance of implementing routine screening procedures of dental examinations, with infrared thermograms examination of distinct areas of the CCMC, as well as the use of sensors on the analyses of an eventual asymmetrical embouchure. Employing these techniques in dentistry will create the chance of preventing the overuse of some anatomical structures, with an early diagnosis and the correct monitoring of these areas. Full article

The aim of this study was to test the effect of adding chicken eggshell powder (CESP) to conventional glass-ionomer cement (GIC) on its mechanical properties, and fluoride and calcium release. CESP was added with proportions of 3% and 5% by weight to the powder component of conventional glass-ionomer cement. The specimens were categorized into group A: GIC without CESP; group B: GIC with 3% wt. CESP; and group C: GIC with 5% wt. CESP; there were 12 specimens in each group. Groups B and C showed higher compressive strength values compared to group A. However, microhardness scores were higher in group C compared to groups A and B. As for ion-release results, group B displayed the highest values of fluoride release followed by group C at both 7 and 30 days. Group C showed the highest amount of calcium release followed by both groups B and C at 7 days, while at 30 days, groups A and B showed higher calcium release compared to group C. The mechanical properties of conventional glass-ionomer restorative material were enhanced by the addition of CESP. Moreover, fluoride and calcium release were not compromised by adding CESP. Full article

The aim of this study was to evaluate enamel roughness, quality of the enamel surfaces and time duration comparing different orthodontic adhesive removal protocols. Premolars were used to test three adhesive removal methods (n = 20): five-blade carbide bur, 30-blade carbide bur, and ultrasonic diamond bur. Bracket was bonded using Transbond^TM XT adhesive. Roughness with different parameters was measured before bracket bonding and after adhesive remnants removal. Micromorphological analysis of enamel surface (n = 5) was performed by SEM images and categorized in enamel damage index—“perfect”; “satisfying”; “imperfect”; and “unacceptable”. Time was measured in seconds. All removal methods caused increased roughness in relation to R_a, R_q, and R_z parameters (X axis) comparing to healthy enamel surface. Enamel surface resulted from removal using five-blade burs was scored as satisfactory. Carbide bur groups decreased the roughness values of R_a, R_q, and R_z parameters on the Y axis and enamel surface was considered unacceptable. The 30-blade group increased symmetry (R_sk) and flattening (R_ku) parameters of roughness and surface was scored as unsatisfactory. Diamond bur removed adhesive in 54.8 s, faster than five-blade carbide bur. The five-blade bur group resulted in less enamel roughness than the 30-blade and diamond groups. Full article