Journal of Dental Medicine

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Normal 0 false false false EN-US X-NONE AR-SA Recurrent aphthous is a painful condition with 10-12% prevalence in the world. Considerable evidence are existed about the relationship between cellular immune response and recurrent aphthous .In this regard, present study carried out to analyze lymphocyte phenotype in patients with aphthous stomatitis in both active and remission phases of the disease . The results showed CD4 T-lymphocytes are decreased during active phase while there were insignificant changes in CD3 and CD8 T-lymphocytes count compared to normal population. CD4/CD8 ratio was also decreased (P≤0.05). CD16 killer lymphocytes and CD19 cells were increased significantly in active phase of the disease (P≤0.05).

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The purpose of this study was to evaluate Y shape appliance for expansion on maxillary arch of patients in their mixed dentition age. Eight patients, 6 girls and 2 boys, with maxillary constriction, retrusion of maxillary anteriors, and space deficiency of upper canine were treated by Y-plate expansion. For each patient 8 parameters on upper cast and 7 parameters on lower cast were measured. Statistical analysis was conducted by calculating the mean, standard deviation and p-value, of parameters. Since these parameters change during natural growth, the results were compared to normal growth changes of similar patients group form another study as control. Results showed significant increase in maxillary and mandibular cervical and coronal intercanine and intermolar width (P<0.005). The results also showed significant increase in maxillary arch length and perimeter.

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Statement of Problem: Treatment of gingival recession defect and covering denuded root surfaces is one of the goals in periodontal therapy and several surgical techniques have been suggested in this field.
Purpose: The aim of this study was to perform a comparison on coronaliy repositioned flap procedure with and without the use of ethylenediaminoteraacetic acid (EDTA. 24%, pH=7) in the treatment of recession defects.
Material and Methods: In this randomized clinical trial study, 16 patients, aged 17-60 years, with a total of 27 miller class 1 isolated buccal gingival recession type defects of at least 2mm depth, and based on special criteria were investigated. After initial therapy, surgical recession coverage was performed as coronaliy advanced flap technique and EDTA gel conditioning (test) or coronaliy advanced flap alone (control). Clinical examination including assessments of oral hygiene, recession depth (RD), recession width (RW), width of keratinized tissue (KT), probing depth (PD) and probing attachment level (PAL)were performed before and 1, 2, 3 months after surgical treatment.
Results: The mean of initial RD, RW, KT, PT and PAL in the test group was 2.73, 3.17, 3.13, 1.1 and 3.83mm respectively and in the control group was 2.56, 3.03, 3.67, 1.25, 3.92mm respectively. The mean of these parameters 3 months after treatment in the test group were changed to 0.46, 1.97, 2.65, 0.67, 1.1 mm, corresponding figures for control teeth were 0.85, 2.98, 2.75, 1, 1.94, respectively. At 3 months after treatment the mean root coverage amounted to 83% (test) and 67% (control) which was a statistically significant difference (P=0.0067). Although a significant clinical difference was observed regarinding root coverage level, all other clinical variables were not statistically different, with the exception of probing attachment level (P=0.005).
Conclusion: It was suggested that EDTA gel (24%, PLT=7) for 3 minutes as root conditioner and the coronaliy advanced flap procedure can be used as a predictable and successful method in the treatment of miller class I buccal gingiva! recession type defects.

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Statement of Problem: Giant cell granuloma (G.C.G) is a reactive lesion which affects the jaws and oral mucosa of gingiva.This lesion is classified to central and peripheral ones. The histopathologic aspects of central and peripheral G.C.G is the same. The central lesions are aggressive and cause osseous destruction. The peripheral G.C.G produces ulcerative swellings similar to pyogenic granuloma or peripheral ossifying fibroma. Since the peripheral and central G.C.G are common lesions, the awareness of dentists of different aspect of G.C.G is very important.

Purpose: The aim of this study was a statistical evaluation of variables such as age, gender and location of peripheral and central G.C.G in oral and maxillofacial pathology department of Dental Faculty of Tehran University of Medical Sciences.

Materials and Methods: This study was a cross-sectional, case series one. The medical records of oral and maxillofacial pathology department of Dental Faculty of Tehran University of Medical Sciences was assessed in two steps: In the first stage, the medical records of patients with pathologic report of peripheral and central G.C.G were selected and reviewed. In the next step, the informations such as age, gender and location of peripheral and central G.C.G were registered in data forms. The obtained data were analyzed by SPSS statistical software.

Results: The results showed that the age range in peripheral and central G.C.G were 2- 90 and 4-70 years, respectively. The peak incidence of peripheral and central G.C.G was in the third and second decades, respectively. The peripheral G.C.G was more common in men (52.70%) than women (47.30%). This finding in central G.C.G was 37.19% for men and 62.88% for women. 57.06% of peripheral G.C.G cases were in mandible and 42.94% in maxilla. The occurrence of central G.C.G was 67.07% in mandible and 32.93 % in maxilla.

Conclusion: Based on this study, the peripheral lesions were more frequent in men, third decade and mandible and the central lesions in women, second decade and mandible.

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Langerhans cell histiocytosis (LCH) is a rare disease with formation of granulomatous infiltrations consisting of Langerhans cells, histiocytes, lymphocytes and eosinophilic granulocytes. The ethiopathogenesis of the disease has not been fully clarified yet. It can occur as focal or disseminated form - acute or chronic. Oral manifestations may be the first signs. This article reports a case of a 3 year old boy with LCH suffering from severe dental mobility and foul breathe. Radiographically, the lesions appeared as well-defined radiolucent defects in maxilla and mandible. The microscopic findings consisted of sheet like arrangements of histiocytes with a mixture of eosinophils and other inflammatory cells. Biochemical tests were within normal limits.

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Odontomas are benign tumors of odontogenic origin characterized by their slow growth. They are considered to be a common type of odontogenic tumor, but rarely occur in the primary dentition.The etiology of odontomas is unknown, although local trauma, infection and genetic factors have been suggested. Odontomas often cause disturbances in the eruption of teeth such as, impaction or delayed eruption, and retention of primary teeth and abnormalities in the position of teeth such as tipping or displacement of adjacent teeth. In this paper, a case of unerupted right mandibular primary cuspid in a 5 years old girl due to the presence of a compound odontoma is presented.

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Background and Aim: Among different treatments of patients with Class III malocclusion , orthopedic protraction of maxilla has been known as an effective method in mixed dentition period. The aim of this study was to evaluate the cephalometric changes of Cl III patients in mixed dentition period following face mask therapy and slow maxillary expansion.

Materials and Methods: This was a before-after study which was conducted on 10 children in mixed dentition period, who had class III malocclusion and maxillary deficiency according to the Stiener and Mc Namara's analysis. The patients were all treated by protraction face mask and slow maxillary expansion. The cephalometric changes of maxilla , mandible and dental relations during the treatment were analyzed by Paired sample T Test. P<0.05 was considered as the level of significant.

Results: The overjet increasement was 1.7mm. Co. ANS distance improvement was 5.6mm, Ptm.ANS distance increasing was 3mm, and ultimately improvement of Gf.s distance was 1.5mm which were all statistically significant (p<0.05).

Conclusion: Based on the results of this study, face mask therapy with slow maxillary expansion is able to improve the horizotal position of maxilla, in patients with Cl III malocclusion , in mixed dentition period.

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Background and Aims: Normative need assessments should be substituted or integrated by patient-based outcome measures regarding their shortages in health-oriented approach . This study aimed to assess and compare the ability of  an index of oral health-related quality of life measured by Child Oral Health Impact Profile (COHIP) questionnaire and the Aesthetic Component of Index of Orthodontic Treatment Need (AC-IOTN) to identify the normative need to orthodontic treatment using Dental Health Component-IOTN in a sample of the Iranian adolescents.

Materials and Methods: Target population of this cross-sectional analytic study was 597 of the 13 to 18 year-old schoolchildren enrolled in middle and high schools of the city of Isfahan, Iran. They completed the COHIP questionnaire and then were examined by two calibrated trained dentists (agreement coefficient:0.9) to record the DHC grading. The students scored their AC in according to the images of the scale. The association between subjective indicators and clinically defined need were evaluated by the correlation analysis and the statistics for the diagnostic validity of tests.

Results: Of 568 examined students, 16.7% and 2.1% had definite need according to DHC and AC criteria, respectively. 10% of orthodontic patients had perceived distinct impact on their quality of life. The significant association (P=0.001) between the severity of malocclusion and quality of life was at moderate level by AC (R=0.37), but it was not convincing enough by DHC (R=0.16). The specificity of AC to detect the healthy ones showed to be excellent but its low sensitivity disabled the recognition of patients, precisely.

Conclusion: The considered patient-based indices did not meet the competencies to define the orthodontic need in the adolescents, but it could be employed to identify the persons with impaired quality of life and it would probably benefit  the process of prioritization.

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Background and Aims: Increasing demands for health care's services on one hand and limited resources on the other hand brings about pressure over governments to find out a mechanism for fair and appropriate distribution of resources. Economic analysis is one of the appropriate tools for policy making on this priority. The aim of this study was to assess capital and consumption of oral health units of health care centers in Yazd city and comparing it with revenue of these centers and determining of cost effectiveness.
Materials and Methods: In this descriptive cross sectional study, all health care centers of Yazd city with active dentistry department were evaluated.  The data has been extracted from current documents in health care center of county based issued receipts and daily information registers.
Results: Expended cost for providing of oral hygiene services in second half of 2008 in 13 medical health centers of Yazd included active dentistry section was 557.887.500 Rials and revenue to cost ratio was about 34%. The most provided service was related to tooth extraction and the average of tooth restoration in each working day was 0.48.
Conclusion: With attention to low tariffs of dentistry services in medical health centers and paying subsidy to target groups, expenses of oral hygiene are always more than its revenue.

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Background and Aims: Nursing Caries (NC) is a destructive form of caries because of incorrect nutritional habits in infants that affects deciduous teeth after eruption. Familiarity with the pattern of this type of caries and evaluation of its symmetrical or asymmetrical pattern is necessary for effective and scientific diagnosis and treatment. The aim was to assess the symmetrical or asymmetrical aspects of Nursing Caries in children between 3-5 years old.

Materials and Methods: In this cross-sectional study, 10 kindergartens were randomly selected by the Tehran Welfare Organization. 115 children with NC caries entered to study after examination. Written consents were obtained from the parents. The dmfs in upper primary incisors and upper and lower primary canines, as well as the first primary molars were assessed and the caries pattern in terms of symmetrical or asymmetrical aspects was evaluated. The data were analyzed by ANOVA, LSD, Chi-square and Fisher tests.

Results: In 53.9% of the children with NC, the anterior teeth were affected symmetrically, while 46.1% indicated an asymmetrical pattern. In general, 32.2% of the teeth were affected in a symmetrical pattern and 67.8% of them in an asymmetrical pattern. About the relationship between the breastfeeding from the right or left breast and the symmetrical pattern of the NC, 51% of the children were equally breastfed from both breasts. However, in the asymmetrical NC pattern with more impact in the right side of dentition, 50% of the children had been breastfed from the left side and in children with more caries  in the left side of dentition, 50% of them had been breastfed from the right side (P=0.01).

Conclusion: NC has symmetrical and asymmetrical patterns. Direction of mother for breastfeeding affects the symmetrical and asymmetrical pattern of NC.

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Background and Aims: Discoloration of resin composites is considered to be the major factor in esthetic restoration failures. The aim of this study was to evaluate the color stability of resin composites after rebonding with two different adhesive materials.

Materials and Methods: Forty five composite disc samples were divided into three groups (n=15). The surface of specimens was finished by polishing disc and rubber. In group 1, any additional phase was not performed. In group 2, composite discs were etched by %37 orthophosphoric acid, then Margin- bond was used for rebonding. In group 3, the etching procedure was in the same manner used for group 2, but Permaseal was used after etching. After the first phase of spectrophotometric measurement, the specimens were dipped in coffee mix for 3 weeks for aging the specimens. Then the second phase of spectrophotometric evaluation was performed. Collected data was analyzed using one-way ANOVA test followed by Tukey test. P<0.05 was considered as the level of significance.

Results: The mean total color difference (∆E) observed in groups 1 to 3 were 1.4±0.34, 5.24±1.51, and 7.44±1.34, respectively. Statistical significant differences were shown between the groups (P<0.001).

Conclusion: Rebonding with adhesive materials used in this study did not increase the color stability of composite restorations.

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Background and Aims: Successful pediatric dentistry depends not only on the dentist's technical skills, but also on his ability to acquire and maintain a child's cooperation. The correction of dentist’ action in this area affects the view of parents and increases the quality of dental services. The objective of this study was to evaluate the attitudes of general dentists toward methods of controlling pediatrics’ behavior in Isfahan.

Materials and Methods: This study is descriptive, analytic, and cross-sectional. For this research, 100 general dentists of Isfahan city were selected with simple random sampling technique and were asked to complete the questionnaire which was included four different management techniques. The data were analyzed with t-test, P earson’s correlation , ANOVA and Kruskal-Wallis.

Results: The methods accepted by dentists were Tell-Show-Do (4.0 ± 0.5), Voice control (3.5 ± 0.4), active restraint (3.0 ± 0.5) and Hand-Over-Mouth (2.9 ± 0.5) respectively. The mean score of female dentists’ attitudes was more toward the method of active restraint and less toward Hand-Over-Mouth technique. Also the average score of middle aged dentists’ attitudes toward Voice Control method was less than young dentists and toward Hand-Over-Mouth was higher. The general dentists with more number of pediatric patients had less consent on the method of Hand-Over-Mouth (P=0.004) and active restraint (P=0.034).

Conclusion: There were significant correlation between attitude of general dentists toward behavior management techniques with age, gender, clinical experience and the number of pediatric patients. General dentists have fewer tendencies to aggressive behavior management techniques.

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  Background and Aims: Oral health prepares us for daily activities without discomfort, and dissatisfaction. In this research, agreement level between parents and children aged 11-14 year-old in reporting child oral health-related quality of life was studied in Isfahan city.

  Materials and Methods: In this descriptive, analytical and cross-sectional study 128 pairs of parents and children aged 11-14 were selected with random sampling technique from schools in Isfahan and were asked to complete the relevant questionnaires. The questionnaires evaluated quality of life in four fields of oral signs, functional deficits and emotional and social health. In order to evaluate child-parent agreement, intra-correlation coefficient (ICC), Pearson’s correlation coefficient, Spearman’s correlation coefficient and intra-class correlation coefficient (ICC) were used (α=0.05).

  Results: The agreements between PPQ_11-14 (parent perception questionnaire), CPQ_11-14 (child perception questionnaire) and the related fields were 0.81, -0.67. The highest agreement level (ICC=0.83) was related to emotional health (excellent), followed by functional deficits (ICC=0.80), social health (ICC=0.69) and oral signs (ICC=0.64). Pearson's test showed significant correlations between CPQ_11-14 and PPQ_11-14 (r=0.81) (P<0.01).

  Conclusion: Although parents, especially mothers, may be used as proxies for their children in relation to quality of life and related fields, the views of both should be obtained in order to fully represent child oral health-related quality of life issues.

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  Background and Aims: One of the important aspects for evaluating an organization is assessing the level of satisfaction of the clients. This study was conducted to compare the level of satisfaction between traditional and new methods of delivering dental care in the clinic of Tehran University of Medical Sciences.

  Materials and Methods: A cross-sectional study was conducted on 308 patients received dental care at the dental clinics of Tehran University of Medical Sciences in spring 2010. Data were collected from Comprehensive Care Unit (CCU) in addition to 7 isolated clinics including restorative, periodontics, endodontics, radiology, and prosthodontics (fix and removable) using translated version of the Dental Satisfaction Questionnaire (DSQ), consisted of 19 questions in three main domains in addition to demographic questions. Descriptive statistics was used as percentage of answers. In order to compare the mean score between domains ANOVA test was used.

  Results: The standardized mean scores in each domain were: pain control 58±17, access 59±12, quality 68±11 and total Dental Satisfaction Index (DSI) score of 62±10. 92.5% of the respondents reported that students were very careful when examining their patients. 96.8% reported that they treat their patients with respect . The most common reasons for dissatisfaction apart from waiting time and getting appointments were not providing preventive care and pain control.

  Conclusion: The results of this study shows acceptable level of satisfaction with dental care in teaching clinics of this dental school, however efforts on implementing preventive care and pain control strategies are suggested.

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  Background and Aims: Thermal changes in the oral cavity can be transferred to the implants placed in bone and affect the prognosis of the treatments. Furthermore, some investigators proposed improvement of habitual consumption of hot or cold beverages. The aim of the present study was to measure the effect of temperature changes in the oral cavity following consumption of hot and cold drinks on the temperature of implant.

  Materials and Methods: In this clinical trial, 3 eligible patients were selected. Two months after implant insertion, temperature of the implants was measured following the drinking of hot and cold beverages using a sensor connected to a thermometer. The thermal changes of the implants through the different time intervals were analyzed using Friedman non-parametric test.

  Results: The implant temperatures were significantly increased in the time following drinking of the hot beverages (P=0.009). Furthermore, the implant temperature were statistically decreased in the time after drinking cold beverage (P=0.004). When drinking hot beverages, the maximum and minimum temperatures were 41.57 ⁰ C and 36.77 ⁰ C, respectively. The maximum and minimum temperatures of the implants were also 34.13 ⁰ C and 26.83 ⁰ C , respectively, when drinking cold beverages.

  Conclusion: It seems that the temperatures noted in the implants in the current study cannot weaken the prognosis of implant restorations however, habitual consumption of hot and cold beverages can lead to debilitating implant prognosis and therefore, should be given the necessary warnings to patients.

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  Background and Aims: Since recurrent caries are one of the major causes of failure in resin restorations, the production of antibacterial resin composites was always under investigation. The aim of this study was to evaluate the efficacy of fissure sealants containing nanosilver particles against the Streptococcus mutans.

  Materials and Methods: In this experimental study, the antibacterial properties of two sealants (with fluoride (Clinpro 3M) and without fluoride (Concise 3M) was investigated with 0, 0.01, 0.02, 0.03, 0.04, 0.05% w/w after adding nano-silver using direct contact test. Sealants formed on the walls of 500ml micro tube and after curing, they left in contact with bacterial suspension. In periods of 3, 24, 48h, a 10 µl volume of liquid medium was placed in blood agar culture and after 24 h incubation at 37ºC, the number of S.mutans colony was counted by colony counter. Data were analyzed using ANOVA and
T-test.

  Results: Results reported sealants with fluoride comparing to non fluoride ones had significant effect on inhibition of S.mutans growth (P<0.001). The direct contact test demonstrated that by increasing the amount of nano particles, the bacterial growth was significantly diminished (P<0.001).

  Conclusion: While sealants with fluoride demonstrated antibacterial effect, sealants with incorporation of higher weight percentage of nanosilver particles, had stronger and more significant antibacterial effect in direct contact test.

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  Background and Aims: Nowadays, the application of all ceramic restorations are being raised, because of their physical characteristics, such as translucency and good appearance. Numerous researchers investigated the impact of surface treatments on the bond strength of zirconia ceramic with resin cements. The aim of this study was to compare the microshear bond strength of Cercon and Zirkonzahn (two kind of zirconia) ceramics, to two types of resin cements after thermocycling.

  Materials and Methods: In this study, 24 rectangular specimens were made from each group of Cercon and Zirkonzahn ceramics. After sandblasting, these specimens were connected to 3×1 mm² composite cylinders by two resin cements (Panavia F₂ and Rely X Unicem₂). After performing a thermocycling regime for 5000 cycles (5-55 ◦ C), the microshear bond strengths were measured by a universal testing machine. The mode of failures were determined by a stereomicroscope. Data were analyzed using two-way ANOVA.

  Results: Type of ceramics had no significant impact on the microshear bond strength (P=0.317). The highest bond strengths in both ceramics were obtained with Reply X Unicem (P=0.035). The predominant failure mode was adhesive between the cement and ceramic.

  Conclusion: Type of resin cement had a significant effect on their bond strengths to zirconia ceramics.

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  Background and Aims : Free gingival graft is one of the most predictable procedures for gingival augmentation, but patient’s discomfort and pain during healing period of palatal donor site is a significant concern. The aim of this study was to evaluate the effect of 660nm low power laser on pain and healing in palatal donor sites.

  Materials and Methods: The present split mouth randomized controlled clinical trial was performed in 12 patients at the department of periodontics of Tehran University of Medical Sciences. Patients’ allocation was done by balanced block randomization (laser group and placebo group). In laser test group (wave length: 660 nm, power: 200mW, time of irradiation: 32s) was applied immediately post-surgery and in day 1, 2, 4 and 7 after that. In the control group, laser application was done with off power mode. Evaluation of epithelialization and healing was done with H₂O₂ and photograph. The number of palliative pills and bleeding was recorded. Wilcoxon test was used to analyze healing during the study. Patient’s pain during study was analyzed using repeated measure ANOVA. Mc Nemar test was used to analyze bleeding. Level of statistical significance was set at 0.05.

  Results: Laser group showed better epithelialization (P=0.02) and healing (P=0.01) in day 14 after surgery and showed better epithelialization in day 21(P=0.05). No statistically differences were observed between laser group and control group in terms of bleeding and medication (P=0.51), (P=1).

  Conclusion: According to the results of this study, the low power laser can promote palatal wound healing during the second and third week after free gingival graft procedures.

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  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.

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  Background and Aims: Considering the complications of root canal system, debridement would not be effective only by mechanical instrumentation. Therefore, root canal irrigants with the antimicrobial effect that can eliminate more microorganisms during treatment, becomes important. The aim of this study was to compare the antimicrobial effects of 2% thyme essence, 2.5% sodium hypochlorite (NaClO), and normal saline as root canal irrigants for primary molar teeth.

  Materials and Methods: This study was performed on 34 primary molars. Subjects were randomly divided into three groups (N=10). The root canals of the teeth were prepared up to the file #35 and all of the specimens were sterilized, and were then contaminated with entrococccus faecalis suspension (Enterococcus Faecalis ATTC 29212). After 48 hours of incubation, the specimens of each group were irrigated with corresponding irrigants. Then, the microbial specimens were collected with sterile paper points. After incubation, the numbers of Colony Forming Units (CFU) were counted using colony counter. Data were analyzed using Smirnov-Kolmogorov, Kruskal-Wallis and Mann-Whitney tests.

  Results: Sodium hypochlorite showed the highest antimicrobial effect and showed significant differences compared with normal saline (P<0.001). However, the differences were not significant with thyme essence 2% (P=0.3).

  Conclusion: Thyme essence could be considered as a natural irrigator with a comparable antiseptic effect to sodium hypochlorite.