Journal of Dental Medicine

Recently, inductive materials have been used for accelerating pulp cells and differentiation of odontoblast cells for regenerating secondary dentin. Bone Morphogenic Protein (BMP) is one of these materials. Endochondral Bone Matrix Gelatin (Ec BMG) has been used less than others. This study was designed to evaluate dentin formation by Ec BMG in rabbit. Ec BMG was prepared"from tibia and femur of 4 Deutsche-Poland rabbits with average ages of 4-6 months. In this research, 12 rabbits were divided randomly to two groups (8 and 4 rabbits, respectively). In the first group, incisive tooth in one side was considered as experimental group and in other side as control group. In experimental group, pulp was exposed and Ec BMG was put in it. But, in control group, after exposing the pulp, tooth was dressed. In the second group, the rabbits were kept like the first group. They were killed in 28 and 60 days period time and their natural dentin was used for comparison of their calcium and phosphor with the first group. The light microscope and scanning electron microscopic study were performed on days of 28 and 60 after operation. Also, new secreted matrix was analyzed for measuring calcium and phosphor on all groups. The histological results on day 28 showed secondary' dentin and osteodentin formation in experimental group. The scanning electron microscopic observation on 60th days after operation in experimental group showed mineralized mass on site of Ec BMG implantation. In contrast, in control and second groups, no mineralized mass was observed. Analyzing of new secreted matrix in experimental group showed the high deposition of calcium and phosphate on Ec BMG implantation site. But, the amount of calcium and phosphate in experimental group was the same as the second group. Results of present investigation indicated that, implantation of Ec BMG in pulp cavity could induce pulp cells, secondary dentin and osteodentin in rabbit. So, Ec BMG can be effective in repairing of dentin related defects.

Statement of Problem: The pulp may be exposed during remove of caries or by traumatic and iatrogenic injuries. The material used to DPC, must be biocompatible, scalable and prevent bacterial leakage.Furthermore, it is better to stimulate dentinogenesis. Calcium hydroxide is most usual material for DPC. But it cannot provide a suitablcbiologic seal. Mineral irioxide aggregate (MTA) is also a suitable material for DPC.
Purpose: The aim of this study was to compare the clinical success of DPC done with MTA or calcium hydroxide cement.

Materials and Methods: In this study eighteen posterior teeth without previous spontaneous pain that involved mechanicaly exposure was randomly selected and capped with MTA or calcium hydroxide. These teeth were evaluated by clinical vitality test and radiograph after 3 and 12 months, and patients were questioned about irritative or spontancus pain in this period. Statistical analysis was carried out by Usher exact
test (a-0.05).
Results: This study showed that in calcium hydroxid groud three had irreversible pulpitis and two teeth had symptom and signs of reversible pulpitis. While, In MTA group all cases were normaL and no clinical sign was evident.
Conclusion: MTA exhibited better results than calcium hydroxide cement for the capping of the pulp in human

Background and Aim: With the introduction of different bondable restorative materials in dentistry, various methods have been suggested to enhance the polymerization and shear bond strength of these materials. The aim of this study was to determine the effects of different methods of enamel conditioning on bond strength of orthodontic brackets and on the bracket/ adhesive failure mode.

Materials and Methods: In this experimental in vitro study, brackets were bonded to thirty-six bovine incisor teeth with different protocols according to the manufacturer's instructions as follows: Group 1: conventional multistep adhesive (n=12) Group 2: self-etching primer system (n=12) Group 3: acid+self-etching primer system (n=12). Specimens were loaded in a universal testing machine (Instron, Canton and Mass) and the mode of failure was recorded. Data were analyzed by ANOVA and Kruskall-Wallis tests with p<0.05 as the limit of significance.

Results: The mean shear bond strength was 11.7 ± 4.2, 10.5 ± 4.4, and 10.9 ± 4.8 MPa for group 1, 2, and 3 respectively. There was no significant difference in bond strength among the three groups (P=0.800). No significant difference was observed among the three groups with respect to residual adhesive on the enamel surfaces (P=0.554).

Conclusion: Based on the results of the present study, the use of self-etching primers may be an alternative to conventional phosphoric acid pre-treatment in orthodontic bonding.

Background and Aim: A single nucleotide polymorphism at codon 72 of the p53 gene alters the p53 protein structure and affects its activity. This polymorphism depends on geographic regions and race. Also its association with some cancers has been reported. The aim of this study was to investigate this polymorphism in well differentiated oral SCC and normal population in the city of Isfahan.

Materials and Methods: In this case-control study, 20 paraffin blocks of non metastatic and well differentiated oral SCC were selected from the archive of oral pathology department of dental school between 2001 and 2005. 20 whole blood samples from normal people were considered as control group. After DNA extraction, p53 codon 72 polymorphism was determined by polymerase chain reaction (PCR) technique using specific primers of Arg and Pro and agarose gel electrophoresis. Data were analyzed by Fisher's exact test with p<0.05 as the level of significance.

Results: The prevalence of Arg/Arg , Arg/Pro and Pro/Pro genotypes in case group were 45%,45% and 10% respectively compared to 45%,50% and 5% in controls. There was no statistical significant difference in p53 codon 72 genotypes distribution between case and control groups.

Conclusion: Based on the results of this study, p53 polymorphism could not be considered as a genetic predisposing factor for oral SCC development in Isfahan.

Background and Aims: Composite restorative materials and dental adhesives are usually cured with light sources. The light direction may influence the bond strength of dental adhesives. The aim of this study was to evaluate the effect of light direction on the microtensile bond strength of fifth and sixth generation dental adhesives.

Materials and Methods: Prime & Bond NT and Clearfil SE bond were used with different light directions. Sixty human incisor teeth were divided into 4 groups (n=15). In groups A and C, Clearfil SE bond with light curing direction from buccal was used for bonding a composite resin to dentin. In groups B and D, Prime & Bond NT with light curing direction from composite was used. After thermocycling the specimens were subjected to tensile force until debonding occurred and values for microtensile bond strength were recorded. The data were analyzed using two-way ANOVA and Tukey post hoc test.

Results: The findings showed that the bond strength of Clearfil SE bond was significantly higher than that of Prime&Bond NT (P<0.001). There was no significant difference between light curing directions (P=0.132).

Conclusion: Light curing direction did not have significant effect on the bond strength. Sixth generation adhesives was more successful than fifth generation in terms of bond strength to dentin.

Background and Aims: When composite resin polymerizes, shrinkage stresses tend to produce gaps at the tooth/ restoration interfaces. Surface sealants may reduce or avoid problems related to the marginal interface. The aim of this study was to evaluate the effect of two different surface sealants (Fortify and Optiguard) on the microleakage of class V resin composite restorations.

Materials and Methods: Twenty three sound noncarious molars were collected. Totally, 45 Class V cavities with the occlusal margins in enamel and cervical margins in cementum were prepared in both buccal and lingual surfaces. The specimens were randomly assigned in three groups (15 cavities in each group) and then restored with a resin composite. After the finishing and polishing procedures, the restorations in each group were covered with a specific surface sealant, except for the control samples, which were not sealed. After placing restorations, the specimens were thermocycled and then immersed in a 50% silver nitrate solution (tracer agent) for four hours, sectioned longitudinally and analyzed for leakage using a stereomicroscope in a blind manner. The marginal microleakage was evaluated at the occlusal and cervical interfaces and compared among the three groups using the Kruskall-Wallis and the Mann-Whitney U tests.

Results: Microleakage was found in all groups at both occlusal and cervical margins. Significantly greater leakage was observed at the cervical margins compared to the enamel margins of the material groups (P=0.005). There was no statistically significant difference among the groups at occlusal margins (P=0.66). In the cervical region, Fortify showed improved results and statistically presented the lowest degree of microleakage (P=0.003).

Conclusion: The used sealant materials presented different rates of effectiveness and Fortify decreased marginal microleakage significantly.

Background and Aims: Calcium hydroxide has a pronounced antimicrobial activity against most of the bacterial species found in infected root canals and endodontic infections. It is one of the most frequently used intracanal medications in endodontic therapy. The objective of this study was to determine the antimicrobial efficacy of six calcium hydroxide formulations (mixed with saline, lidocaine 2%, chlorhexidine 2%, chlorhexidine 0.2%, Iodine Potassium iodide (IKI) 2%, and glycerin) on Enterococcus faecalis using agar diffusion test.
Materials and Methods: Twelve culture plates were incubated with Enterococcus faecalis. Five cavities were made in each plate with 5 mm diameter and 4 mm depth. Two plates were randomly considered for each calcium hydroxide formulation and filled completely with creamy mixture of tested materials. The plates were incubated at 37ºC for 48 hours. The diameter of inhibition zone around each well was recorded in millimetres and data were submitted to ANOVA and Tukey tests.
Results: The results of this study showed that all tested calcium hydroxide pastes had good antimicrobial activity. The antimicrobial activity of calcium hydroxide mixed with lidocaine, chlorhexidine 2% and IKI 2% were significantly greater than that of calcium hydroxide mixed with saline (P<0.001). No significant differences in the antimicrobial  were found between the other groups (P>0.01).
Conclusion: Considering the results of this study, lidocaine 2%, chlorhexidine 2% and IKI 2% are suggested to be used for preparation of calcium hydroxide paste. Further studies with different methods are needed for confirming these results.

Background and Aims: Re-application of microbrush may affect the micro tensile bond strength of adhesives to dentin. The aim of this study was to evaluate the effect of re-application of microbrushes on the micro tensile bond strength of an adhesive to dentin.

Materials and Methods: Thirty freshly extracted molars teeth were collected and enamel of occlusal surface were removed to expose superficial dentin. Then superficial dentin was etched, washed and partially air dried. According to the times of application of microbrush, teeth were divided into two test groups. In group 1, new microbrushs were used, but in group 2, the ones that were already used for twice were included. Ambar dentin bonding agent (FGM/Brazil) was applied to the etched dentin with microbrushes according to the manufacturer's instructions. Then the crown of teeth was built up with LLiss (FGM/Brazil) composite resin. The teeth were sectioned in buccolingual direction to obtain 1mm slabs. Then 50 hourglass- shape samples were made from 30 teeth (25 Specimens per group). The microtensile bond strength of the specimens was tested using MTD500 (SD Mechatronik, Germany). The data were statistically analyzed by T-test.

Results: The mean values for the microtensile bond strength were 30.49±7.18 and 23.61±9.06 MPa±SD for the first and second groups, respectively. There was significant difference between the groups (P=0.005).

Conclusion: Microbrushes should not be used for more than one cavity preparation.

Background and Aims: Today, use of adhesive systems is the most common materials in restorative dental procedures. The aim of this study was to evaluate the effect of different air-drying periods on the microtensile bond strength of composite to dentin using adhesive.

Materials and Methods: 15 sound molar teeth were selected. The an occlusal surfaces of teeth were removed with silicon carbide disks (3M/USA) to reach flat surface of dentin. Then according to the air drying of solvent, the teeth were divided to five groups. After 5 sec etching and rinsing for 15 sec , the teeth were air dried for 3 sec . Then Singlebond (3M) was used with different air-drying times (0s, 2s, 5s, 10s, 30s) and cured. Then after insertion and curing of Saremco (microhybrid low shrinkage/Switzerland) composite, the teeth were thermocycled for 500 cycles. Then hour glass slabs with 1 mm² interface was created. Specimens were then subjected to µTBS force until fracture. Data were analyzed using ANOVA and Bonferroni tests.

Results: Statistical tests showed that there were significant differences between bond strength of groups (P=0.002). The mean of µTBS for the 2 Sec and 30 Sec evaporating time was the most and the least vawes, respectively.

Conclusion: An optimum air-drying time for solvent evaporation was the lowest time recommended by the manufacturer. Over and under evaporation time decreased µTBS significantly.

  Background and Aims: Different adhesives with different solvents may have different solvent evaporation rates. The purpose of this study was to evaluate the solvent evaporation in the self etch and total etch adhesive in different air drying times.

  Materials and Methods: Five adhesives were used in this study: Excite, Prime & Bond NT, UNO, Single Bond, SE Bond Primer. Twelve drops of each adhesive were used for each period of air drying (5, 15, 30 sec). The percentage of mass loss was measured during each test. Data were analized using two-way ANOVA and Tukey.

  Results: Acetone base adhesives showed more loss of mass than other adhesives (P<0.01). P&B NT showed more loss of mass than other adhesives in all air drying times (P<0.01). Adhesives showed different evaporation rates in different air times (P<0.01).

  Conclusion: Adhesives with acetone/water or alcohol/water solvent shows more stable behavior in comparison with adhesives containing pure aqueous solvents.

  Background and Aims: Bleaching agents not only affect the tooth structure, but also may alter the properties of restorative materials. The aim of this in vitro study was to evaluate the effect of different bleaching regimens on the microhardness of four tooth-colored restorative materials.

  Materials and Methods: Eighty specimens of four restorative materials (Microhybrid resin composite (Z250 (3M, ESPE), nanohybrid composite Z350 (3M, ESPE), packable composite P60 (3M, ESPE), and resin modified glass ionomer Vitremer (3M, ESPE)) were fabricated and were polished after 24 h with Soflex discs (3M,ESPE). Then the specimens were divided into two groups: In office bleach group, 40 specimens (10 of each restorative material) were bleached with hydrogen peroxide 37.5% for 30 min in two sessions with 7 days interval. In home bleaching group, 40 specimens were bleached with carbamid peroxide 22%, 6 h a day for 14 days. Vickers microhardness test were done before and after bleaching (baseline). Finally data were evaluated using analysis of Variance.

  Results: Two bleaching regimens were significantly decreased the microhardness values. In Z250 resin composite, the microhardness values before and after bleaching were 95.30 and 92.67 kg/mm², respectively. for office bleaching (P=0.011) and 95.38 and 92.39 kg/mm² for home bleaching (P<0.001). In Z350 resin composite, the microhardness values before and after bleaching were 98.29 and 92.41 kg/mm², for office bleaching (P<0.001) and 97.35 and 93.44 kg/mm² for home bleaching (P<0.001) respectively. In P60 resin composite, the microhardness values before and after bleaching were 103.10 and 96.16 kg/mm², respectively. for office bleaching (P=0.045) and 102.61 and 98.16 kg/mm² for home bleaching (P=0.001). In resin modified glass ionomer (Vitremer), the microhardness values before and after bleaching were 56.79 and 49.41 kg/mm², respectively. for office bleaching (P=0.004) and 54.17 and 46.50 kg/mm² for home bleaching (P<0.001). There was no significant difference between two bleaching agents (P=0.365).

  Conclusion: Dental bleaching agents decrease the microhardness of tooth-colored restorative materials.

  Background and Aims: Dental implants have been studied for replacement of missing teeth for many years. Productivity of implants is extremely related to the stability and resistance under applied loads and the minimum stress in jaw bone. The purpose of this study was to study numerically the 3D model of implant under thermal loads.

  Materials and Methods: Bone and the ITI implant were modeled in “Solidworks” software. To obtain the exact model, the bone was assumed as a linear orthotropic material. The implant system, including implant, abutment, framework and crown were modeled and located in the bone. After importing the model in Abaqus software, the material properties and boundary conditions and loads were applied and after meshing, the model was analyzed. In this analysis, the loads were applied in two steps. In the first step, the mechanical load was applied as tightening torque to the abutment and the abutment was tightened in the implant with 35 N.cm torque. In the second step, the thermal load originated from drinking cold and hot water was applied as thermal flux on the ceramic crown surface in this model.

  Results: Thermal analysis results showed that the thermal gradient in the bone was about 5.5 and 4.9 degrees of centigrade in the case of drinking cold and hot water respectively , although the maximum gradient of the whole system was reduced to 14 degrees, which occurred, in the crown by drinking cold water.

  Conclusion Thermal stresses were so small and it was because of the low thermal gradient. Maximum stresses occurred in the abutment were due to the tension preloads which were originated from the tightening torque.

  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.

  Background and Aims: The most effective preventing tooth decay method is fluoride compounds applications. Some studies suggested that APF gels caused changes on the superficial physical properties of composite. Therefore, the purpose of this study was to evaluate the marginal microleakage of class V composite restorations before and after AFP gel application.

  Materials and Methods: The class V cavities in buccal surfaces of 45 molar teeth were made in such a way that occlusal margin was placed in enamel and cervical margin in cement. In group 1, at first fluoride-therapy and then cavity preparation and restoration by composite resin was done. In group 2, at first the class V cavities were prepared and restored, then fluoride-therapy was carried out. In group 3, cavities were prepared and restored with no fluoride-therapy. The dye penetration rate in occlusal and cervical margins was examined by stereomicroscope. Data were statistically analyzed using Kruskal-Wallis and Mann-Whitney test.

  Results: There was no statistically significant difference between groups ( P=0.975).

  Conclusion: Fluoride-therapy using AFP gel before and after class V composite restorations, had no significant effect on the microleakage of dentin and enamel margins.

  Background and Aims: The purpose of the present study was to review the studies regarding serological and salivary oxidant / antioxidant status in patients with recurrent aphthous stomatitis (RAS).

  Materials and Methods: The literature was searched using key words RAS, Antioxidants, Saliva, Hematinic (s) and Hematinic Acid in the last 10 years, particularly the recent 3 years (2010-2013). At total of 37 clinical trials, 18 case-control articles were selected and evaluated fulfilling the requirements as the RAS patients having at least 3 oral aphthous attack per year. The exclusion criteria included systemic as well as periodontal diseases, iron deficiency associated anemia, medication usage and smoking.

  Conclusion: Almost all lipid-peroxidation studies in serum and saliva were manifested by an increase of malondialdehyde (MDA) concentration in RAS patients compared with controls. This would indicate the role of reactive oxygen species (ROS) in the etiology of the disease. Serum trace elements (Zn, Se) were reduced and Cu was increased in RAS patients in comparison with control individuals. A decreased serum superoxide dismutase (SOD) and an increased salivary SOD were observed in all RAS patients. Catalase (CAT) and uric acid (UA) analyses were non-inclusive. Levels of paraoxonase and arylesterase as well as antioxidant vitamins (A, E, C) were lower in RAS patients than that of controls.

  Background and Aims: Adequate retention has significant importance in the prognosis of implant supported cemented the restorations. Limited literature had evaluated the effect of direct wax up or use of plastic coping on the retention of these restorations. This aims of this study was to compare the retention of castings fabricated by the plastic coping and direct wax up for single crown and bridge in three implant systems.

  Materials and Methods: 28 specimens of each implant systems were randomly divided into 4 groups. Groups included wax patterns for single crowns and bridges that were made from plastic coping or direct wax up. All the wax patterns were invested and casted with base metal alloy, in similar conditions. After castings were cemented to the related abutments, the specimens were subjected to a pull out force in a universal testing machine at a cross head speed of 0.5 mm/min. The load required to decement each casting was recorded and the mean values for each group were calculated. Data were analyzed using three-way ANOVA.

  Results: Comparing the between systems in crowns fabricated from plastic coping, there was no significant difference between Replace and Implantium (P=0.124), but ITI had significantly lower values than that of other systems (P<0.001 Comparing the systems in crowns fabricated from direct wax up, Implantium had the greatest retention and ITI had the lowest retention (P<0/001). Comparing the bridges with both method, Replace had the greatest retention and ITI had the lowest retention.

  Conclusion: Implantium and Replace system exhibited the highest retention for fabricating crowns, and bridges, respectively.

  Background and Aims: Orthodontic bracket failure during treatment is a common problem. With the introduction of low shrinkage composites the question is that whether: this sufficient has coefficient bond strength for bonding bracket during orthodontic treatment. The aim of this study was to compare the shear bond strength (SBS) of silorane-based and metacrylate-based composites to metal brackets.

  Materials and Methods: 30 human premolar teeth were collected and divided into 2 groups. In group 1, 15 orthodontic brackets were bonded using silorane-based composite, in group 2, 15 orthodontic brackets were bonded using metacrylate-based composite. The shear bond strength of each specimen was determined in an Instron machine. Amount of residual adhesive remaining on each tooth was evaluated using a stereomicroscope. Data were analyzed using T-test to compare the shear bond strength between groups and LSD method to compare the Adhesive Remnant Index (ARI) scores.

  Results: There was significant difference in the SBS between the test groups (P<0.001). The mean bond strength of bonding brackets to silorane-based composite was (42.42 ± 7.03) MPa, and the mean bond strength of bonding brackets metacrylate-based composite was (21.08±2.97 ) MPa. No significant difference in the ART was found between groups (P=0.66).

  Conclusion: Silorane-based composite provided higher bond strength to orthodontic metal brackets.

  Background and Aims: The purpose of this study was to compare the effect of chlorhexidine 2%, ethanol 70% and sodium ascorbate 10% and delayed bonding for 1 week on the shear bond strength of composite resin to enamel after bleaching.

  Materials and Methods: 90 human central incisors were divided into 6 equal groups: Group 1: no bleaching Group 2: bleaching with carbamide peroxide 45% for 45 minutes Group 3: bleaching + restoring specimens in distilled water for 1 week. In group 4, 5 and 6, after bleaching, 1 cc of chlorhexidine 2%, ethanol 70% and sodium ascorbate 10% were applied for 15 minutes. Composite cylinders were bonded on the buccal surfaces. Specimens were thermocycled for 1000 cycles and the shear bond strength test was done. Specimens were examined under stereomicroscope and SEM. Data were analyzed a sign ANOVA and Bonferroni test.

  Results: The shear bond strength values were not significantly lower in the bleached teeth (group 3, 4, 5 and 6) than that of negative control group (group 1) (P=1.000, P=0.069, P=0.081, P=1.000) Bonferroni test results show significant difference between test groups (3, 4, 5 and 6) and group 2 (P<1.000, P=0.007, P=0.008, P<1.000) Under SEM, resin tags in group 2 was thinner and lesser than group 3, 4, 5 and 6. The most adhesive failures were in group 2.

  Conclusion: Bleaching with carbamide peroxide and immediate bonding of composite decreased the shear bond strength. Sodium ascorbate 10% and delayed bonding for 1 week were the most effective way.