Journal of Dental Medicine

Background and Aims: The dentist's attire and appearance affects his/her relationships with the patients. It is also essential to sync the professional attire in dentistry with the habits and Islamic culture of Islamic Republic of Iran, meet the patients' desires, and pay attention to the infection-control-requirements as well.The objective of the present study was to determine the patients' viewpoints about the professional appearance of the dentists at Tehran University of Medical Sciences, Dental School in 1395-96.
Materials and Methods: In this descriptive cross-sectional study, 103 patients (54 females and 49 males) were studied. (=α0.05 and standard variation=4.5). The questionnaire were included color photographies of a female dentist and a male dentist dressed in different attires. The patients were asked to select the cleanest, and the most trustable, competent, and experienced dentist according to the 4 different attires. The frequencies and percentages of the participants’ answers to the questionaire were descriptively reported.
Results: All patients preferred dentists to use white coat during their treatment. For the male dentists, most patients (45.6%) favored simple hair model. For the female dentists, most patients (35.9%) considered veil as the more acceptable Hejaband, and 54.4% of them preferred light makeup.
Conclusion: All patients preferred their dentists to dress in the professional attire with a white coat. They believed that wearing formal-professional-dressing by the dentists may show them look cleaner, and more trustable, more competent, and experienced.

Background and Aims: The purpose of this study was to investigate the application of nanoparticles in orthodontics.
Materials and Methods: This study was conducted using a review method by searching Scopous, Google Scholar and Web of science. Key words (Nano silver, Nano ZnO, Nano Chitosan, Nano Curcumin and Nanoparticles) were used. These searches were limited to the English ariticles after the year 2010.
Conclusion: According to the published studies, silver nanoparticles, curcumin, titanium oxide, chitosan, zinc oxide, quaternary ammonium derivatives exhibit appropriate antibacterial properties. Further studies are recommended to investigate the effect of each of these nanoparticles on the bond strength. In order to reduce the decay, there is lack of evidences regarding the addition of ACP nanoparticles and nanoparticles of calcium- phosphate and fluoride. Therefore, further studies are recommended. Studies have shown that the addition of zinc oxide nanoparticles to orthodontic wires could reduce the friction between the wire and the bracket. While, adding titanium oxide nanoparticles to bracket increased the friction. Although, evidences in this regard are inadequate but it seems that nanoparticulates are less toxic than conventional materials.aa

Background and Aims: In recent years, the dentistry workflow has developed considerably. By the introduction of computers and their various applications, the effectiveness and efficiency of treatment has increased enormously. Considering engineering concepts in the workflow, it is necessary for participants to assess different steps and data transferring between various software and hardware devices. This research investigated the interaction between dentists, laboratories and production centers through the required steps for accomplishing treatment by different applications of software and digital hardware devices.
Materials and Methods: Review in this article was based on searching Google scholar database considering key words: digital dentistry, workflow, computer aided design and manufacturing, dental CAD/CAM. This search was limited to the English articles published after the year 2000.

Conclusion: It is necessary in dentistry to use digital technologies to improve the efficiency of treatments. Thus, the participants in this field must have appropriate knowledge to choose and apply these tools. Moreover, the participant should help providers of digital solutions for better development of software packages and related hardwares.a

Background and Aims: In endodontically treated teeth, the fiber posts are used to retain a core restoration. The purpose of this study was to evaluate the effect of different resin cements on the bond strength of fiber reinforced composite posts to root canal dentin, and comparing the bond strength in different sections of root.
Materials and Methods: In this in-vitro experimental study, 48 extracted single-canal central incisors were endodontically treated. For the push out test, the posts were divided into 3 groups according to one of the following three different cement materials (n=16) (Bifix SE, Bifix QM, Rebilda). Three slices with a thickness of 2-mm were prepared of each root. The push-out tests were performed at a cross-head speed of 1 mm/minute using a universal testing machine. Data were analyzed by two-way and one-way ANOVA test followed by Tukey post hoc test (α=0.05).
Results: There was no significant differences between the mean push out bond strength of three experimental groups (P=0.650), but there were significant differences between the mean push out bond strength of root dentin regions (P<0.001).
Conclusion: Under the conditions of this study, there was no significant difference between the mean push out bond strength of 3 different resin cement systems. The coronal region of root dentin showed significantly higher mean bond strength values than that of the middle and apical thirds.

Background and Aims: The structural distinction of primary teeth compared to the permanent teeth leads to a faster penetration of the caries into the pulp, which makes effective treatment necessary. The aim of this study was to determine the success rate of pulpotomy in primary molar teeth and its effective factors using formocresol by students and residents at the department of pediatric dentistry of Hamedan dental school.
Materials and Methods: In this cross-sectional study, 113 children who previously had pulpotomy by formecresol in their primary molars (30 children by residents and 83 children by the students) were randomly evaluated based on referral time (at least 12 months after treatment) in terms of clinical and radiographic success rates. Data were analyzed by SPSS20 software using Chi-square and descriptive statistics.
Results: The success of the pulpotomy of primary molar teeth was 81.7%. The success rates of the general students and residents were 79.3% and 87.3%, respectively. The percentage of successful pulpotomy was significantly higher in general students at Stainless Steel Crown (S.S.C), second molar in maxilla (P<0.05), but did not have a significant relationship with age and sex (P>0.05). The percentage of pulpotomy success performed by residents did not have a significant correlation with gender, age, type of repair, type of teeth and jaws (P>0.05). In general, the percentage of success in S.S.C, the second molar and maxillary jaw was higher. Also, the success rate of pulpotomy by residents was significantly higher than that of general- students (P<0.05). The highest rates of pulpotomy failure were related to internal analysis.
Conclusion: Formocresol pulpotomy using S.S.C in the maxillary second molar teeth had higher success rate.

Background and Aims: The systemic and topical preventive effect of fluoride on tooth decay has been reported. The aim of the present study was to determine the fluoride level in imported and national fluoridated dentifrices in the Iranian market.
Materials and Methods: Sampling was randomly performed from the main market centers and pharmacies in Tehran. The total fluoride (TF) and total soluble fluoride (TSF) concentrations were determined by ion specific electrode potentiometer method. The samples were coded and one trained researcher performed the analysis. Descriptive statistics as percentage and analytical statistics reported as independent t-test were reported.
Results: In adults’ toothpastes, the total fluoride ranged from 191 to 1601.9 ppm with the mean of 911.2 (SD=331.4) ppm. The total soluble fluoride ranged from 322.8 to 1518.8 ppm with the mean of 1021 (SD=279.8) ppm. In children’s toothpaste total fluoride ranged from 236.3 to 1163.7 ppm and the total fluoride of 594 (SD=375). Total soluble fluoride in children’s toothpaste ranged 655.6-1102.6 with the mean of 879.1 (SD=316.07). Analysis of the total fluoride (TF) and total soluble fluoride (TSF) showed that there was no significant difference between the local and imported toothpastes (P>0.05).
Conclusion: The fluoride level of Iranian toothpaste was similar to that of the imported toothpastes, however there was variation in the level of fluoride in products.

Background and Aims: The cell phone has played a significant role in the transmission of microbial contamination as a public tool. The present study was conducted to determine the degree of contamination of mobile phones of students and staff of the dental school of Isfahan University of Medical Sciences.
Materials and Methods: In a cross-sectional study, 60 samples were taken from 60 cell phones belonging to students, staff and faculty members of the Isfahan Dental School, the samples were cultured in the laboratory for microbial contamination of the phone. The behavioral characteristics of the subjects were also determined using a cell phone special questionnaire. Data were analyzed by SPSS version 24 using descriptive statistics, one-way AVONA, T-test and Chi square.
Results: Among the 60 cultured samples, 11 (18.3%) did not grow any bacteria. In 31 cases (51.7%), Staphylococcus epidermidis, 14 cases (23.3%) Staphylococcus aureus susceptible to methicillin and in 4 (6.7%) methicillin resistant staphylococcus aurous were grown. The mean of bacteria colonization was 18±12.2 and there was not any relation between the colonization and kind of bacteria (P=0.78) and studied groups (P=0.43). Also, there was a significant difference between the sanitary conditions and the type of bacteria grown in the culture medium (P=0.04).
Conclusion: According to the results of the study, the cell phones belonging to the students, lecturers and faculty staff were contaminated by harmful bacteria such as staph aurous. These bacteria are the most important of nosocomial infections and may be led to a wide areas of infections from simple to serious types.

Background and Aims: Caregivers’ oral health literacy (OHL) can be effective in increasing their children’s knowledge, and can improve their oral health-related behaviors. This study aimed to investigate the relationship between mothers’ OHL and children’s oral health status.
Materials and Methods: We conducted a cross-sectional study on 202 6-year child/mother dyads in Semirom, Iran, applying a cluster sampling method. Self-administered questionnaires (Oral Health Literacy-Adult Questionnaire) requested information about mothers’ OHL. Children’s oral health status (dmft and pufa) was recorded via clinical examination. Pearson correlation coefficient, spearman correlation coefficient, independent T-test, and a linear regression model were used for statistical analysis.
Results: Among 202 pre-school children, 99 were girls (49%). The mean OHL score of mothers was 63.2 (Max achievable score=100, SD=18.9). Higher score of OHL among mothers was associated with their children’s less missing teeth (mt) and more filled teeth (ft) (P<0.05). No significant the association existed between the mothers OHL and their children’s dt, dmft, and pufa. Childrens of younger mothers, more educated mothers, and those with better oral health behaviors in terms of daily flossing and tooth brushing, showed lower scores of dmft and pufa (P<0.05).
Conclusion: A significant association revealed between mothers’ OHL and the oral health status of their children. Thus, it is recommended to increase mothers’ OHL to improve their children’s oral health status.

Background and Aims: Color is the most important and complicated part of aesthetic dentistry. The tooth color matching of restorations is considered as one of the most difficult tasks in the restorative dentistry. The aim of this study to evaluate the effect of two training methods on the dental students’ ability in determining tooth color matching.
Materials and Methods: In this study, 40 dentistry students participated which randomly allocated into two groups. The first group consisted of students who learned teeth color matching methods practically. In the second group, training booklet was used for learning. Using Vita Classic shade guide series, 4 color samples were chosen and the students of each group were asked to determine samples’ color, before, after and one month after the training.
Results: Booklet learning group was more successful in determining fourth color sample. However, in no studied group and no used samples, the results of one month after learning were not better than that of before learning. Also generally, no significant relationship was found between the color matching accuracy, using glasses, and sex of participants.
Conclusion: The use of booklet learning was more effective than practical learning in color matching accuracy for dental students. Also, using glasses and sex were not effective on their color matching accuracy.

Background and Aims: Cleft lip and palate is among challenging dentistry problems that calls for a multidisciplinary treatment approach. The treatment protocols in adults aims to improve function, appearance, and psychological conditions. The present article aimed in introducing the procedure of conventional prosthesis application for treatment of an adult patient focusing on complicated intra-operatory challenges.
Materials and Methods: A 52-year-old male patient was referred for correcting his functional deficiency resulted from bilateral cleft lip and palate. After surgical stent fabrication and vestibuloplasty, transitional prosthesis was fabricated using “Melted-sugar method”. Six month later, Richmond copings and fixed prostheses were made and the treatment was completed by delivery of mandibular removable partial prosthesis and maxillary obturator. Finding the correct position of hard palate, not interfering with normal phonetic, and hollowing his obturator, along with stablishing correct vertical dimension were among several challenges call for special considerations.
Conclusion: Following sound procedure, the conventional prosthetic treatment could be considered as an acceptable and applicable treatment option for adults suffering from untreated cleft palate, who are not good candidates for more complicated treatment procedures.

The Guided Bone Regeneration (GBR) treatment concept advocates that regeneration of osseous defects is predictably attainable via the application of occlusive membranes, which mechanically exclude non-osteogenic cell populations from the surrounding soft tissues, thereby allowing osteogenic cell populations originating from the parent bone to inhabit the osseous wound. The use of membrane to exclude non-osteogenic cells, is a key principle of guided bone regeneration. A large number of membranes have been evaluated in clinical and experimental studies. The object of this study was to review the literature regarding guided bone regeneration and all types of membranes that were used in this technique. 72 articles between the years 1968 through the 2016 from PubMed, Medline and Google Scholar using the related keywords, were selected. Finally, we concluded that the modification of mechanical and physico-chemical properties of membranes could improve the process of new bone growth. However, determination of the exact role of membrane porosity in this process, still needs to be clarified. Optimization the chemical composition of membrane with the focus and attention to obstructive property and bioactivity, is an important point in this research field. Various factors such as flexibility, mechanical strength and degradation rate determine the type of membrane used for bone tissue regeneration.

Background and Aims: Lichen planus is a chronic inflammatory mucocutaneous disease with unknown etiology. One of the most common manifestations of patients with oral lichen planus is gingival involvement in the form of generalized erythematous areas. The aim of this study was to review the articles evaluating the role of plaque control on the gingival manifestations of oral lichen planus.
Materials and Methods: Motor searches of Ovid Medline and EM base databases, PubMed, Google Scholar, and Science Direct were searched for article published between January 1990 and December 2017 using of relevant key words. After reviewing the abstracts of articles, 20 full articles were selected and among them, 7 relevant articles were reviewed in this study.
Conclusion: From the literature, it was concluded that effective plaque control is the main part of lesions treatment and improvement of symptoms and gingival manifestations of oral Lichen planus.

Background and Aims: Glass ionomer cements are among direct restorative materials which are used in an environment saturated with moisture. Therefore, having the ability to prevent water contamination is crucial. The aim of this study was to determine the water sorption and solubility of five glass ionomer restoratives with and without two nanofilled resin coating agents.
Materials and Methods: Five glass ionomer cements (Fuji BULK/GC, EQUIA Forte Fil/GC, Fuji II LC/GC, riva self cure/SDI, riva light cure/SDI) and two resin-based coating (G-COAT PLUS/GC and EQUIA Forte Coat/GC) were used in this study. Water sorption and solubility were measured in accordance with the ISO 4049's. For each material, 15 disc-shaped specimens were prepared using a polyethelyn mould. The specimens of each material were randomly divided into two groups: 10 coated and 5 uncoated. For the coated groups of each material, 5 specimens were coated with G-COAT PLUS, and 5 with EQUIA Forte Coat. Data were analyzed using SPSS software version 18 (SPSS Inc., Chicago, IL, USA). Two-way ANOVA was applied to investigate if there were any interactions between materials and coatings. One-way ANOVA was used to compare different variables between the materials, and post-hoc Tukey’s test was performed to show significant differences in subgroup comparisons.
Results: A significant interaction effect was obsevred between materials and coatings (P<0.05) using two-way ANOVA. The uncoated groups showed higher mean sorption and solubility values compared to the coated groups, and the groups coated by G-COAT PLUS showed less mean sorption and solubility values than that of EQUIA Forte Coat. In general, the lowest mean sorption and solubility values among glass ionomer cements belonged to Fuji BULK.
Conclusion: The water sorption and solubility values of glass ionomer cements could be reduced by the use of a protective coating.

Background and Aims: The aim of the present study was to evaluate the effect of applying hydrophobic resin after use of different generation of the bonding systems on nanoleakage.
Materials and Methods: 20 third molar teeth were selected. The teeth were randomly divided into 4 groups of 5, each was treated using the fourth, fifth, sixth, and seven generation of dentin bonding. Then, the crown of teeth was sectioned from the CEJ region and each specimen was divided into two halves with mesiodistal cut, one half for the application of dentin bonding without the addition of a hydrophobic resin, and the other for the same dentin bonding by the addition of a hydrophobic resin. Afterwards, the specimens were restotred by composites. After placement of specimens in silver nitrate, the amount of nanoleakage was evaluated by SEM. Data were analyzed using a repeated measurement statistical analysis (α=0.05).
Results: The use of hydrophobic resins decreased nanoleakage and range of variations in all groups (P<0.05). This reduction was greater for total-etch dentin bonding. Higher degree of nanoleakage occurred in total-etch dentin bonding in most evaluated areas. In general, Clearfil S³ bond showed the least percent of the nanoleakage.
Conclusion: All dentin bonding systems showed some degree of reduction in nanoleakage after hydrophobic layer application and the reduction was greater in Total-etch adhesives systems.

Background and Aims: Despite the increasing application of intra-oral scanners, the effect of finish line position on gingival margins adaptation is still discussed. The purpose of this clinical study was to evaluate the fitness of cobalt-chromium copings obtained from intraoral scanning in two depth of finish lines.
Materials and Methods: Thirty teeth prepared for single premolar metal-ceramic crowns were included. Fifteen teeth had supragingival and fifteen had sub-gingival finish lines. Digital impressions were made using an intraoral scanner (Trios-3shape). Computer-aided design and computer-aided manufacture (CAD/CAM) cobalt-chromium copings were fabricated from the scan files. The copings were evaluated intraorally and after adjustments, the internal and marginal discrepancy were measured using silicone replicas and a stereomicroscopy. Internal and marginal discrepancies were analyzed using the Multivariate test (P<0.05).
Results: The mean internal and marginal gap were 52.1 and 56.27μ, for supragingival group and 49.72 and 62.98μ for subgingival group, respectively. The evaluation of finish line position showed no significant effect on obtained results (P>0.05).
Conclusion: CAD/CAM chrome-cobalt copings fabricated by digital impressions provided acceptable marginal and internal precision. However, the finish line position had no significant effect on the internal and marginal adaptation.

Background and Aims: Methicillin-resistant Staphylococcus Aureus (MRSA) is an important infection source in dentistry for different disinfectants to be used to prevent its transmission. Furthermore, a variety of chemical disinfectants are developed to remove bacterial infections from the dental care workers' hands and claims are made regarding their superiority in infection control, although all requires scientific investigations. The aim of present study was to compare the effects of chemical hand-disinfectants Micro Zed HD, Aseptoman and Decosept on MRSA (methicillin resistant staphylococcus aureus) in different periods of time.
Materials and Methods: In this experimental study, the antibacterial efficacy of three hand-disinfectants on standard strain of MRSA (USA300: ATCC® BAA-1717™) was evaluated according to European standard of evaluating antiseptics (EN 1040:2005 CSN EN). First we prepared a 0.5 Mc Farland (108 CFU/ml) suspension of MRSA, and exposed to three disinfectants for 15, 30, 60 and 90 seconds. Then, they were transferred to separate plates of Mueller-Hinton medium and incubated in 37^◦C for 24 hours. The plates were compared then with control plate to evaluate the efficacy of materials on bacteria by calculating the CFU/ml of plates.
Results: Three hand-disinfectants evaluated in this study had the maximum anticabterial effect on MRSA in the minimum time of exposure (15 seconds), and we found no trace of growth in any plates.
Conclusion: The three hand-disinfectans (MicroZed HD, Aseptoman and Decosept) in the concentration suggested by their companies, showed no difference in efficacy to remove MRSA from hands.

Background and Aims: Trauma to primary and permanent teeth caused post-traumatic complications affecting the health of teeth and led to specific problems in treatment. As prognosis of trauma has closed correlation with immediate and correct management after occurrence of the incident and the health educators are the first people in contact with children in this places, their awareness of how to deal with these injuries plays an important role in prevention and treatment. This study aimed to evaluate the knowledge of health educators in confrontation with dental injuries in primary schools of Sanandaj in 2018.
Materials and Methods: In this cross-sectional study, all of fifty-nine health teachers in primary schools of Sanandaj were identified after referring to education centre. The questionnaires were provided to the school health teachers after referring to schools and after completing questionnaires, collected data were analyzed. In order to test the research hypotheses, Multiple regression, Non-parametric tests of spearman correlation coefficient, Mann-Whitney and kruskal-wallis were utilized using SPSS software version 20.
Results: The mean knowledge score of fifty-nine health educators was 14.02±3.41 and knowledge score of females was higher. There was no significant statistical correlation between knowledge score, age,
work experience and education level (P>0.05). In this study, the knowledge score of experienced teachers in confrontation with injured persons and health educators who attended related training courses, was higher than others but this difference was not statistically significant (P>0.05).
Conclusion: The results indicated inadequate knowledge regarding emergency management of dental trauma. Thus strategies to improve the teachers’ knowledge about dental trauma can positively influence their knowledge and attitudes toward emergency management of dental trauma.

Background and Aims: Tooth decay is still one of the most prevalent pediatric diseases. According to the role of general dentists and importance of first dental visit in prevention, the aim of this study was to evaluate dentist’s knowledge and attitude regarding children’s first dental visit in Gorgan, Iran.
Materials and Methods: In this cross-sectional study, 140 general practitioners participated. In order to assess the level of knowledge, a questionnaire including 2 parts was used as the main tool. Data were analyzed using Mann-Whitney, Kruskal-Wallis and Pearson correlation coefficient.
Results: Our findings revealed that the level of knowledge in both sex was equal (P=0.067). There was no significant relationship between the workplace (P=0.68), age (P=0.77), work experience (P=0.84) and the level of knowledge. Interest of practitioners to get the necessary training about examination and treatment of 0-2 year-old children was medium. 51.17% of dentists, admitted the treatment of 8-12 year-old children. 34.5% of dentists revealed that misbehavior of children during treatment was the main reason for unwillingness to accept treating them. 46.9% of dentists, revealed that the most effective result of child’s dental visit at an early age is increasing parents’ knowledge about prevention of carries in primary dentition.
Conclusion: The results showed that general dental practitioners in this study had a good level of knowledge about the first dental visit. Regarding to their little tendency to treat children, it seems necessary to hold workshops and seminars for better desired motivation in this field.

Background and Aims: One of the important fields of dentistry is surgery for dental implants. In this field, dentistry has developed considerably in recent years amongst other fields of medicine from the perspective of digital device and software application. Surgical guides help dental surgeon for more precise, confident, easier and shorter surgery. Process of producing these tools are full digital and to somehow complex due to the application of many technical devices, software and protocols. To achieve efficiency, all participants in the workflow must be aware of all steps and data requirements for production of guides. This paper investigates the production process of surgical guide comprehensively, and also, encompass all the steps in process with details.
Materials and Methods: This review article was based on searching Google scholar and PupMed databases considering key words: Surgical Guide, Guided surgery, digital dentistry, dental CAD/CAM, Additive manufacturing. More than 90% of the references were in English language and published after year 2010.
Conclusion: Today dentistry uses many digital solutions for dairy workflow and most of these solutions are developed by engineers in various fields of knowledge. Thus, this information is essential for dentists, surgeon, clinician and laboratory technician, etc. for better collaboration and participation. Amongst, advances in surgery of dental implant have been highly significant and patients benefit from better treatment and less inconvenience. In addition, dentists do surgery more precise and easier because of considering all conditions before of surgery. Thus, it is substantial inform of all steps of production process.