Journal of Dental Medicine

A report on the significance of ethics in dental research in Iran

Shahroo Etemad- Moghadam

Morality and ethics constitute fundamental principles of professional, educational and investigational aspects of medicine and all its branches, including dentistry. There are specific considerations in dental research which could significantly affect the design and progress of scientific projects performed in this field. The aim of the current study was to present an overview of ethical concepts governing dental research and to provide examples of common issues raised during dentistry-related investigations. Establishment of human tooth banks in major research and training centers is suggested to enhance the process of conducting more substantial research in dentistry.

The use of dental radiography in age determination: Concepts and methods

Razieh Jabbarian

The need to identify and determine the age of the unidentified dead person s or accident victims of natural disasters is clear. Also, some remedial measures in the field of orthodontics and pediatric dentistry depend on knowing the patient’s physiological age. Previous studies suggested that dental age have a good correlation with physiological age more than skeletal or o ther common methods of age determination. Among the various methods used to determine dental age , dental radiography provides wide facilities for clinicians. Being noninvasive and the ability of performing the technique on live subjects as well as simplicity and low cost and reliable results , have led researchers to investigate further on that . The formation and calcification process of teeth and changes during aging has been regarded by many, leading to introduce various methods in which the field. In this study, 36 related articles were achieved by searching PUBMED, Science Direct and Google Scholar resources and discussed. Provided what diversified means of determining age using dental radiographs is encouraged , it is recommended to be not restricted to use only one of the methods because the multilateral approach is more reliable.

Evaluation of fixed orthodontic patients' compliance in the clinic of Shiraz dental school: A cross-sectional study

Hooman Zarif Najafi

Background and Aims: Orthodontic patients’ cooperation is a determining factor in treatment outcomes. The aim of this study was to evaluate the relationship between patient cooperation during orthodontic treatment with variables such as age, sex, life setting, treatment duration and functional and social discomfort experienced.

Materials and Methods: Specimens were consisted of 100 orthodontic patients (36 males and 64 females) between 13-35 years old (average age: 22.57±1.69 years). Patients’ demographic traits, treatment duration and
functional-social discomfort by the orthodontic treatment were evaluated using a questionnaire answered by the patients or their parents. The degree of patient cooperation was assessed by the modified cooperation questionnaire (Orthodontic Patient Cooperation Scale [OPCS]) which was completed by an orthodontist. Data were analyzed using One-way ANOVA, T-test, intraclass correlation coefficient and Pearson Correlation.

Results: No significant difference was found between the cooperation of male and female patients (P=0.867) and also between the cooperation of the patients who lived in the urban and rural setting (P=0.613). Treatment duration and compliance showed a low negative correlation which was not statistically significant (r=-0.155, P=0.127). Functional-social discomfort and compliance showed a low negative correlation which was not statistically significant (r=-0.118, P=0.244). No significant correlations were found between the compliance and age (r=0.002, P=0.988) and also the treatment duration and functional-social discomfort experienced
(r=0.164, P=0.105).

Conclusion: Patient compliance appears to be a complex issue that cannot easily be predicted only by factors such as age, gender, life setting, treatment duration and functional-social discomfort experienced.

Evaluation of radiographic quality of root canal therapy performed by dental students at Yazd dental school during 2010-2012

Ali Gharaati Jahromi

Background and Aims: Root canal therapy is one of the most important parts of a general dentist's profession. The aim of this study was to evaluate the radiographic quality of root canal therapy performed by under graduated students at Yazd dental school.

Materials and Methods: Records of patients, who were referred to the endodontic department during 2010-2012 and treated by undergraduated students, were divided into three groups by the numbers of canals and 80 specimens from each group were randomly evaluated. For the assessment, the quality of accomplished treatments, the indices: length, taper, and density of obturation were used and the errors during root treatment were recorded. Data were analyzed using Fisher's exact test and Chi-square.

Results: According to the results, 155 (64.6%) records had appropriate filling length, whereas 55 (22.9%) were underfilled and 30 (12.5%) were overfilled. The acquired difference was statistically significant among three groups. (P<0.001). 187 (77.9%) records had adequate taper and 157 (65.4%) records had adequate density. The difference in the evaluating of taper (P=0.976) and density (P=0.879) was not significant. Totally, 39.2% of specimens had all the properties of an appropriate root canal treatment.

Conclusion: The results of the present study can be used to identify weaknesses in the treatment of different educational groups and help them to achieve a proper planning to improve the quality of endodontic treatments.

Evaluation of the effect of patient’s age on the tooth response to electric pulp test

Mohammad Malekzadeh

Background and Aims: Electric pulp tester is a valuable instrument to examine tooth’s pulp vitality. There is no agreement about the response of immature teeth to electric pulp tester and the reason is expressed as the failure of nerve fibers’ development. The aim of this study was to investigate the effect of patient’s age on the tooth response to electric pulp tester.

Materials and Methods: In this cross-sectional study, 300 maxillary central permanent teeth in 150 volunteers were examined by using electric pulp tester. The volunteers were classified in 5 age groups of 7-8, 9-10, 11-12, 13-4, and 30-35 and teeth lacking sound and healthy pulp were excluded. Data were analyzed using SPSS-16 software, one-way analysis of variance, and Tukey post hoc test.

Results: The average response to electric pulp tester in age groups of 7-8, 9-10, 11-12, 13-4, and 30-35 years old were 2.9±0.1, 2.8±0.1, 2.3±0.1, 2.2±0.1 and 1.8±0.1 ,respectively. This indicated that by increasing teeth age, they responded to lower level of electric pulp tester. In subjects less than 14 years old, there was no significant difference between neighboring groups (P=0.3) however, a significant difference was observed between subjects less than 14 years old and adults (P<0.001).

Conclusion: This study showed that immature teeth responded at higher levels to electric test however, all teeth responded to electric pulp tester.

Accuracy of panoramic radiographs in determining the relationship of posterior root apices and maxillary sinus floor by Cone-Beam CT

Hoorieh Bashizadeh Fakhar

Background and Aims: It is crucial to verify the relationship between root apices and maxillary sinus floor in some surgical procedures like extraction and implant placement or in orthodontic movements like intrusion. Protrusion of roots into the sinus increases the risk of post extraction pneumatization which in turn decreases the available bone at the implant or denture sites. The aim of this study was to determine the panoramic radiology accuracy for defining the relationship between posterior root apices and the maxillary sinus floor by Cone Beam CT (CBCT).

Materials and Methods: Paired panoramic radiographs and CBCT images of 117 subjects were examined. 452 posterior maxillary roots including second premolar, first and second molar were classified by the means of the relationship with maxillary sinus floor. CBCT was used as Gold standard method, and the agreement of panoramic findings with CBCT was examined statistically. Data were analyzed using Chi-square and Multiple logistic regressions.

Results: Agreement of the panoramic and CBCT results were seen in 57.7% of all cases. Roots which had no contacts with the sinus floor (class 0) showed a high agreement of 89.5% between two imaging techniques. Roots in contact with sinus floor (class 1) showed 58.8 % and cases with root protrusion into sinus cavity (class 3, 4) showed 50% of agreement (P<0.001). Also in 36% of cases with no protrusion into the sinus cavity (class 0, 1, 2), panoramic showed protrusion. The agreement for the premolar was higher than molars (P<0.001)

Conclusion: The majority of roots which their images were projected on the sinus cavity had no vertical protrusion in CBCT cuts. Considering the results, in these cases CBCT can be recommended.

Evaluation of class V composite restorations microleakage in premolars with/without electric current while applying variant dentin bondings

Narges Dorri

Background and Aims: The ability of composite restorations to prevent microleakage needs desirable bonding material for proper sealing . The purpose of this study was to evaluate class V composite restorations microleakage in premolars with/without electric current while applying variant dentin bonding in vitro.

Materials and Methods: 120 non-carious human premolars were used for this study and standardized class v cavities were prepared. The tooth roots were cut by discs at a distance of 5 mm from CEJ and pulp tissue was removed. The teeth were divided into six groups of 20. In the first group, electric current was applied, Single bond (3M ESPE, St Paul, MN, USA) with a broom motion attached to the cathode and a sponge containing bonding was used as anode. The used current was 15µA and the Single bond in the second group was used without electricity. Then two bondings PQ1 (Ultradent, Germany) and Optibond solo plus (Kerr, USA) were used with and without electricity. After adhesive application and curing the bonding agents, cavities were restored by a composite (Valux Plus). The root ends were sealed by wax and all teeth surfaces, except 1 mm around the restorations were covered with a nail varnish. The specimens were thermocycled for 1000 cycles and placed in fushin for 24 hours and were then sectioned vertically and examined under a stereomicroscope. Data were scored on a 0-4 scale based on microleakage at the gingival margins and analyzed using Kruskal-Wallis and Mann-whitney test.

Results: Based on the results, the extent of microleakage in the groups of electric current was significantly less than the groups without using the electric current (P=0.05). The lowest degree of microleakage was found in PQ1 group, and the greatest difference between the groups with and without electricity was also found in PQ1 group. Single bond and Optibond Solo Plus with electric current showed a lower degree of microleakge.

Conclusion: The result showed that use of electric current during the application of dental adhesives could reduce the extent of microleakage.

Designing and assessment of accuracy of an algorithm for determining the accuracy of radiographic film density by changing exposure time

Elham Sadat Emadian Razavi

Background and Aims Bone density is frequently used in medical diagnosis and research. The current methods for determining bone density are expensive and not easily available in dental clinics. The aim of this study was to design and evaluate the accuracy of a digital method for hard tissue densitometry which could be applied on personal computers.

Materials and Methods: An aluminum step wedge was constructed. 50 E-speed Kodak films were exposed. Exposure time varied from 0.05s to 0.5 s with 0.05 s interval. Films were developed with automatic developer and fixer and digitized with 1240U photo Epson scanner. Images were cropped at 10 × 10mm size with Microsoft Office Picture Manager. By running the algorithm designed in MATLAB software, the mean pixel value of pictures was calculated.

Results: Finding of this study showed that by increasing the exposure time, the mean pixel value was decreased and at step 12, a significant discrimination was seen between the two subsequent times(P<0.001). By increasing the thickness of object, algorithm could define the density changes from step 4 in 0.3 s and 5 in 0.5 s, and it could determine the differences in the mean pixel value between the same steps of 0.3 s and 0.5 s from step 4.

Conclusion: By increasing the object thickness and exposure time, the accuracy of the algorithm for recognizing changes in density was increased. This software was able to determine the radiographic density changes of aluminum step wedge with at least 4mm thickness at exposure time of 0.3 s and 5 mm at 0.5 s.

Effect of thermo-mechanical load cycling on the fracture strength of upper central incisor restored with three different types of glass-fiber posts

Sara Majidinia

Background and Aims: The aim of this study was to evaluate the fracture strength of restored teeth with three different types of E glass-fiber posts after thermo-mechanical loading.

Materials and Methods: Sixty extracted upper central incisor human teeth, with similar size, were selected and divided into three groups (n=20). Endodontic treatment was done in all groups and crowns were sectioned from 2 mm above CEJ. Then one type of posts in each group (Anthogyr, Svensk, Hetco) cemented using Panavia cement and the crowns were restored with a composite. The specimens in each group were thermocycled for 6000 cycles (5-55°C)and subjected to 1200000 cycles of mechanical loadiong in an artificial mouth machine. Then the fracture strength was measured and data were analyzed using ANOVA and T-student test (α=0.05).

Results: The mean fracture strengths in Hetco group before and after thermomechnical loading were 581.098 ± 192.742 N and 564.74±213.59 N, in Anthogyr group were 664.358 ± 135.878 N and 629.12±390.3 N and, in Svensk group were 780.258 ± 379.133 N and 779.84±282.59 N, respectively. There was no significant difference between groups and also there was no significant difference in each group before and after thermo-mechanical loading (P>0.05).

Conclusion: Restored teeth with Hetco fiber glass post were similar in terms of the fracture strength with that of two other posts after thermo-mechnical loading.

A three-dimensional finite element study on the effect of hydroxyapatite coating thickness on the stress distribution of the surrounding dental implant-bone interface

Hadi Asgharzadeh Shirazi

Background and Aims: Hydroxyapatite coating has allocated a special place in dentistry due to its biocompatibility and bioactivity. The purpose of this study was to evaluate the relation between the hydroxyapatite thickness and stress distribution by using finite element method.

Materials and Methods: In this paper, the effect of hydroxyapatite coating thickness on dental implants was studied using finite element method in the range between 0 to 200 microns. A 3D model including one section of mandible bone was modeled by a thick layer of cortical surrounding dense cancellous and a Nobel Biocare commercial brand dental implant was simulated and analyzed under static load in the Abaqus software.

Results The diagram of maximum von Mises stress versus coating thickness was plotted for the cancellous and cortical bones in the range between 0 to 200 microns. The obtained results showed that the magnitude of maximum von Mises stress of bone decreased as the hydroxyapatite coating thickness increased. Also, the thickness of coating exhibited smoother stress distribution and milder variations of maximum von Mises stress in a range between 60 to 120 microns.

Conclusion: In present study, the stress was decreased in the mandible bone where hydroxyapatite coating was used. This stress reduction leads to a faster stabilization and fixation of implant in the mandible bone. Using hydroxyapatite coating as a biocompatible and bioactive material could play an important role in bone formation of implant- bone interface.