Journal of Dental Medicine

Background and Aim: The aim of this clinical study was to determine the effectiveness of progressive loading procedures on preserving crestal bone height and improving peri-implant bone density around maxillary implants restored with single crowns by an accurate longitudinal radiographic assessment technique.

Materials and Methods: Eleven Micro-Thread Osseo Speed dental implants were placed in 11 subjects and permitted to heal for 6 weeks before surgical uncovering. Following an 8-week healing period, implants underwent a progressive loading protocol by increasing the height of the occlusal table in increments from adding acrylic resin to an acrylic crown. The progressively loaded crowns were placed in 2 mm infraocclusion for the first 2 months, light occlusion for the second 2 months, and full occlusion for the third 2 months. At forth 2 months, a metal ceramic crown replaced the acrylic crown. Digital radiographs of each implant were made at the time of restoration, then after 2, 4, 6, 8, and 12 months of function. Digital image analysis was done to measure changes in crestal bone height and peri-implant bone density.

Results: The mean values of crestal bone loss at 12 months were 0.11 ± 0.19 mm, and when tested with Friedman across the time periods, the differences were not statistically significant (p> 0.05). The mean values of bone density in the crestal, middle, and apical area were tested with Repeated Measure ANOVA across the time periods, the differences were statistically significant (p<0.05).

Conclusion: Progressive loading doesn’t cause crestal bone loss. The peri-implant density measurements of the progressively loaded implants show continuous increase in crestal, middle and apical peri-implant bone density by time.

Background and Aims: Metal-free and fiber-reinforced composite (FRC) restorations have drawn considerable attention and interest in recent years for restoring in the posterior area due to their improved esthetics. Fracture resistance is one of the most important mechanical properties of materials because of 500-600 N load of occlusion. The restorations should tolerate this load. The purpose of this in vitro study was to compare the fracture resistance of FRC with that of zirconia all-ceramic for posterior partial dentures.

Materials and Methods: Forty extracted human intact teeth (20 first premolars and 20 first molars) selected for fabricating 10 pairs of fiber-reinforced composite and 10 pairs of zirconia all-ceramic bridges. After receiving standard tooth preparation, the teeth were mounted with 7.5 mm distance between each other. The bridges were made and cemented on the teeth. Then the restorations were stored in 37ºC water for 30 days. The fracture resistance was measured using mechanical testing machine with cross-head speed of 1mm/min. Data were evaluated by Independent Sample T test.

Results: The mean fracture resistance in the ceramic group was 1329.41 N and for the F.R.C group was 1118.528 N with significant differences between them (P=0.034). The failure modes were mainly cohesive at pontic area for ceramic samples, but adhesive for FRC samples at pontic area.

Conclusion: Both systems showed sufficient fracture resistance for using in posterior area.

Microstomia is defined as an abnormally small oral orifice. Microstomia can occur as a result of trauma from electrical and thermal lesions, chemical burns and trauma from surgeries. Prosthetic rehabilitation of microstomia patients presents difficulties at all stages, from the preliminary impressions to fabrication of prosthesis. For impression procedures different treatment methods have been suggested. Swing hinge and collapsible dentures are used to provide prosthodontic treatment to patients with microstomia. Not only is such a prosthesis difficult to fabricate, but may be expensive. The literature contains reports on the fabrication of sectional denture with the denture pieces connected by different designs. This article describes a simple method of fabricating a 2-pieces denture using removeable partial denture metal framework to connect the sections, for a patient with limited oral opening. Combination of metal framework and sectional complete denture for a patient with limited oral opening is an acceptable, effective and available method.

A procedure was explained to fabricate a surgical stent to aid the placement of maxillofacial implants for prosthetic auricular rehabilitation. An impression of the defect was made, and a wax pattern of the missing ear completed and evaluated on the patient. The definitive wax prosthesis was processed in clear acrylic resin. Also an occlusal maxillary splint was fabricated and joined to the acrylic resin ear by using an extraoral acrylic resin bar. Surgical stent provides proper orientation of the acrylic resin ear while remaining attached to the maxillary arch. This surgical stent can also be used for radiographic examination.

Background and Aims: Radiographic examination prior to implant placement is often complemented with tomography for location of vital anatomic structures and evaluation of bone volume. The aim of this study was to evaluate the accuracy of Photostimulable Phosphor Plate system with that of conventional film-screen in mandibular pre-implant linear tomography

Materials and Methods: In this test evaluation study, tomograms of 2 dry human mandibles were taken using the both film-screen and Photostimulable Phosphor Plate. 10 sites were selected in each mandible and marked with gutta-percha. Distance of superior border to the mandibular canal and the total height and width of mandible were measured on the tomograms and also on the mandibles after sectioning. The radiographic values were compared with real ones.

Results: After correction of tomographic values by the magnification factor of the unit, the mean of absolute differences with reality in linear tomography using film-screen and Photostimulable Phosphor Plate for height of mandible were 0.59mm (SD=0.54) and 0.65mm (SD=0.72), respectively. The mean of absolute differences with reality in linear tomography using film-screen and Photostimulable Phosphor Plate for width of mandible were 0.34mm (SD=0.33) and 0.31mm (SD=0.33), respectively. In localization of the mandibular canal, the mean of absolute differences with reality were 0.54mm (SD=0.30 ) and 0.52mm (SD=0.56) for linear tomography using film-screen and Photostimulable Phosphor Plate, respectively. In linear tomography using film-screen, 100% of measurements for localization of the canal, 80% of height and 95% of width were with in ± 1mm error limits. In linear tomography using Photostimulable Phosphor Plate, 75% of measurements for localization of the canal, 75% of height and 95% of width were within ± 1mm error limits. There was no significant difference between linear tomography using film-screen and Photostimulable Phosphor Plate in localizing the mandibular canal and height and width estimation (P>0.05).

Conclusion: The accuracy of linear tomography using film-screen and Photostimulable Phosphor Plate in height and width estimation and localization of the canal is within acceptable limits.

Background and Aims: Selecting an appropriate treatment plan is one of the most critical aspects of dental treatments. The purpose of this study was to compare multimedia system and conventional method in patients' selecting prosthetic treatment and the time consumed.
Materials and Methods: Ninety patients were randomly divided into three groups. Patients in group A, once were instructed using the conventional method of dental office and once multimedia system and time was measured in seconds from the beginning of the instruction till the patient had came to decision. The patients were asked about the satisfaction of the method used for them. In group B, patients were only instructed using the conventional method, whereas they were only exposed to soft ware in group C. The data were analyzed with Paired-T-test (in group A) and T-test and Mann-Whitney test (in groups B and C).
Result: There was a significant difference between multimedia system and conventional method in group A and also between groups B and C (P<0.001). In group A and between groups B and C, patient's satisfaction about multimedia system was better. However, in comparison between groups B and C, multimedia system did not have a significant effect in treatment selection score (P=0.08).
Conclusion: Using multimedia system is recommended due to its high ability in giving answers to a large number of patient's questions as well as in terms of marketing.

Background and Aims: Nowadays, calcium hydroxide is used as a dressing for canal sterilization and repair progression of apical lesions. The aim of this study was to investigate the effect of calcium hydroxide as an intracanal medicament on the apical microleakage of root filling.
Materials and Methods: In this experimental study, 46 extracted single-rooted human teeth were instrumented with step-back technique to master apical file (MAF) size 35. Specimens were randomly divided into 2 groups (n = 20). In group 1, the specimens were treated with calcium hydroxide intracanal medication and in group 2, the samples did not receive any medication. The teeth were incubated in 100% humidity at 37°C for one week. After that, calcium hydroxide was removed using irrigation with normal saline and reaming with MAF. The root canals were obturated with gutta- percha and AH26 sealer using lateral compaction technique. Specimens were incubated in 100% humility at 37°C for 72 hours and then immersed in India ink for 1 week. Finally, the teeth were cleared and the maximum linear dye penetration was measured under a stereomicroscope at 4X magnification. The data were analyzed by T-test and Chi-square.
Results: There was no significant difference between the two experimental groups (P=0.068).
Conclusion: The findings of this study indicated that using calcium hydroxide as an intracanal medicament did not influence the apical microleakage after final obturation of the root canal system.

Background and Aims: Working length determination and remaining this length is of great importance in root canal therapy. Recently, electronic apex locators are being used to determine working length and decrease the number of radiographs. The purpose of this study was to compare the sensitivity of Root ZX and Novapex electronic apex locators with radiography in a clinical study.

Materials and Methods: In this study, 73 single-canalled teeth of the patients referred to the endodontic department of the Yazd Dental School were evaluated. The access cavity was prepared and working length of the root canals were measured by using the apex locators: Root ZX and Novapex. The file was placed in the root canal and a periapical radiograph was taken using parallel technique. The working lengths obtained by apex locators were recorded and compared with those of radiographs. The data were analyzed by Pearson's correlation coefficient, Wilcoxon test and paired t-test.

Results: The exact measurement without any fault was 46.6% for Root ZX and 20.5% for Novapex compared to radiography. In the range of 0.5 mm fault, the results were 91.8% for Root ZX and 64.4% for Novapex compared to radiographic measurements. The difference between the average of the measured lengths by Root ZX and radiography was not significant (P=0.17). On the other hand, the results showed significant difference between the average of the measured lengths by Novapex and radiography (P=0.017). The difference between two apex locators was not significant (P=0.061).

Conclusion: Root ZX and Novapex with high accuracy are useful for determining working length of the root canals in pregnant patients with special anatomic conditions and patients with muscle disharmony. Therefore, the use of these apex locators combined with radiography is recommended in root canal treatment.

Background and Aims: The purpose of this experimental study was to investigate the shear bond strength of three new adhesive systems to enamel and dentin of permanent human teeth using three new etch and rinse and self-etch adhesive systems.
Materials and Methods: Sixty intact caries-free third molars were selected and randomly divided into 6 groups. Flat buccal and lingual enamel and dentin surfaces were prepared and mounted in the acrylic resin perpendicular to the plan of the horizon. Adhesives used in this study were Tetric N-Bond, AdheSE and AdheSE-One F (Ivoclar/Vivadent, Schaan, Liechtenstein). The adhesives were applied on the surfaces and cured with quartz tungsten halogen curing unit (600 mW/cm² intensity) for 20 s. After attaching composite to the surfaces and thermocycling (500 cycles, 5-55ºC), shear bond strength was measured using a universal testing machine at a crosshead speed of 0.5 mm/min. The failure modes were examined under a stereomicroscope. The data were statistically analyzed using T-test, one-way ANOVA, Tukey and Fisher's exact tests.
Results: In enamel, Tetric N-Bond (28.57±4.58 MPa) and AdheSE (21.97±7.6 MPa) had significantly higher bond strength than AdheSE-One F (7.16±2.09 MPa) (P<0.0001). Tetric N-Bond had higher bond strength than AdheSE but there was not any significant difference between them (P=0.093). In dentin, there were significantly differences among all adhesives (P<0.001). Tetric N-Bond (20.62±3.03 MPa) showed the highest and AdheSE-One F (6.54±1.13 MPa) had the lowest value. The bond strength in enamel was higher than that observed in dentin and the difference was significant in Tetric N-Bond (P=0.044) and AdheSE (P=0.000) groups. There were no significant differences in the mode of failures among groups (P>0.05).
Conclusion: Shear bond strength to dentin in Tetric N-Bond (etch and rinse system( was higher than self-etch adhesives (AdheSE and AdheSE-One F). The bond strength to enamel and dentin in two-step self-etch (AdheSE) was higher than one-step self-etch (AdheSE-One F).

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: The vitality pulp tests are necessary for diagnosis of pulpal disease and differentiation between endodontic and non-endodontic diseases. Thermal and electrical tests are conventional methods for evaluation of pulp vitality. The purpose of this study was to evaluate the effect of thermal changes on the tooth response to the electric pulp tester.

Materials and Methods: In this study, 160 intact maxillary central incisors of 40 voluntaries were evaluated. After isolation, electric pulpal response threshold in patients were recorded. After heat and cold tests, the electrical pulp test was repeated. The degree of response was recorded. The data were analyzed using pair T-test and independent T-test.

Results: The result of this study demonstrated that the average of teeth response to the electric pulp tester before and after cold test was 1.3 and 1.7, respectively. The average was 1.4 and 1.7 before and after heat test, respectively. There was no significant difference (P<0.001) between the pulpal response before and after thermal tests (heat and cold tests). In addition, no significant difference was found between pulpal response after heat and cold tests (P=0.25).

Conclusion: The response of tooth to the electric pulp tester was influenced by heat and cold tests.

Background and Aims: One of the decisive factors on the final esthetic results of implant treatment is the abutment material. Ceramic abutments are nowadays very popular in this regard. The purpose of this study was to compare the fracture resistance of three zirconia abutments with titanium abutment.

Materials and Methods: Four groups of abutments (five specimens in each) were prepared. The abutments were prefabricated titanium, prefabricated zirconia, zirconia-metal, and copy-milled zirconia abutment. After securing the abutments to the implant using a torque of 24 Ncm, they were mounted into a mounting jig using the 30º tilt. The force was applied on the assembly till the failure occured. Facture resistance and mode of failure were recorded for each specimen. The data were analyzed using One-way ANOVA.

Results: The mean values recorded for fracture resistance of different zirconia abutments varied between 426 to 688 N however, there was no significant differences among the groups (P=0.14). Body fracture was observed only in prefabricated zirconia abutments. Screw fracture and screw bending were the common failures observed in other groups.

Conclusion: Zirconia abutments of any type could be successfully used in regular plateform implants.

  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.