Journal of Dental Medicine

Statement of Problem: Despite the improvements achieved in the field of dental composites, their strength, longevity, and service life specially in high stress areas is not confirmed. Finding better fillers can be a promising step in this task.

Purpose: The purpose of this study was to investigate the effect of the filler type on the mechanical properties of a new experimental dental composite and compare these with the properties of composite containing conventional glass filler.

Materials and Methods: Experimental composites were prepared by mixing silane-treated fillers with monomers, composed of 70% Bis-GMA and 30% TEGDMA by weight. Fillers were different among the groups. Glass, leucite ceramic and lithium disilicate were prepared as different filler types. All three groups contained 73% wt filler. Comphorquinone and amines were chosen as photo initiator system. Post curing was done for all groups. Diametral tensile strength (DTS), flexural strength and flexural modulus were measured and compared among groups. Data were analyzed with SPSS package using one-way ANOVA test with P<0.05 as the limit of significance.

Results: The results showed that the stronger ceramic fillers have positive effect on the flexural strength. Ceramic fillers increased the flexural strength significantly. No significant differences could be determined in DTS among the groups. Flexural modulus can be affected and increased by using ceramic fillers.

Conclusion: Flexural strength is one of the most significant properties of restorative dental materials. The higher flexural strength and flexural modulus can be achieved by stronger ceramic fillers. Any further investigation in this field would be beneficial in the development of restorative dental materials.

Statement of Problem: Ceramic restorations are popular because they can provide the most natural replacement for teeth. However, the brittleness of ceramics is a primary disadvantage. There are various methods for strengthening ceramics such as metal framework, ceramic cores, and surface strengthening mechanisms through glazing, work hardening and ion exchange.

Purpose: The purpose of this study was to evaluate the effect of polish on flexural strength of feldspathic porcelain and to compare it with overglaze and autoglaze.

Materials and Methods: In this experimental study, one brand of feldspathic porcelain (colorlogic, Ceramco) was used and forty bars (25×6×3 mm) were prepared according to ISO 6872 and ADA No. 69. The specimens were randomly divided into four groups: overglazed, auto glazed, fine polish and coarse polish (clinic polish). Flexural strength of each specimen was determined by three point bending test (Universal Testing Machine, Zwick 1494, Germany). Collected data was analyzed by ANOVA and post-hoc test with P<0.05 as the limit of significance.

Results: A significant difference was observed among the studied groups (P<0.0001). According to post-hoc test, flexural strength in overglaze and fine polish group were significantly stronger than clinic polish and autoglaze group (P<0.001). Although the mean value for overglazed group was higher than fine polish group, this was not statistically significant (P=0.9). Also no statistical difference was seen between autoglazed and coarse polish group (P=0.2).

Conclusion: Based on the findings of this study, flexural strength achieved by fine polish (used in this study) can compete with overglazing the feldespathic porcelains. It also can be concluded that a final finishing procedure that involves fine polishing may be preferred to simple staining followed by self-glazing.

Background and Aim: Along with higher usage of dental local anesthesia with risks to people health together with their positive role, the important goal of dentistry, patients’ health, has been stressed repeatedly nowadays. This study was conducted to compare O2 saturation, respiratory rate and heart rate of patients following injection of anesthetic containing vasoconstrictor (lidocaine 2%) and without vasoconstrictor (Mepivacaine).

Materials and Methods: This experimental study was conducted on 32 healthy humans (16 females and 16 males) with 25-50 years age range and no history of drug usage. Cases were classified into two matched groups. O2 saturation, heart and respiratory rate were recorded before extraction of a mandibular posterior tooth. In the first group, 3.6 ml lidocaine 2% with 1:80,000 epinephrine and in the second group Mepivacaine 3% was injected, using inferior alveolar dental nerve block with aspiration. Variables were measured and recorded. Tooth extraction was performed and the mentioned variables were recorded again. Data were analyzed with SPSS software using t and Paired t-test with P<0.05 as the limit of significance.

Results: After injection of lidocaine, the heart rate was increased (12.25±1.75 bpm), and the time to reach the maximum rate was 64.75±11.26 seconds. After extraction of tooth, heart rate in both groups was increased not considering the type of injection.

Conclusion: The study showed that the injection of lidocaine (containing epinephrine) in patients without contraindication has no risk. Also, possible increase in heart rate is not risky and is not associated with O2 saturation decrease and respiratory interruption.

Background and Aim: Several factories produce dental cartridge in the world. In Iran, Daroupakhsh company is responsible for this task. The aim of this study was evaluate some properties of daroupakhsh cartridge and compare them with two imported ones: Ecocaine (made in Italy) and Septodont (made in France).

Materials and Methods: In this experimental study, 70 healthy patients from maxillofacial clinic of Shariaty hospital were selected. After obtaining informed consent, 0.1 cc of each carpule was injected to the patients' frontal region and the extent of anesthesia was measured at different time intervals. Also the quality of injections was evaluated by 11 surgeons. The dimensions of the three cartridges were also measured and compared together. Data were analyzed by repeated measure ANOVA and Friedman with p<0.05 as the limit of significance. Results: There was no significant difference in extent and duration of anesthesia among the studied cartridges. Surgeons were equally satisfied of all three kinds of cartridges. All of the cartridges were aspirable.

Conclusion: Based on the results of this study, the three studied cartridges had similar properties.

Background and Aim: Dentists are exposed to mercury from dental amalgam in their routine occupational practice. Excess exposure to mercury is harmful and the measurement of mercury content of urine is a reliable and valid assessment of the level of mercury exposure from dental amalgam. The aim of this study was the measurement of urine mercury in dentists of Tehran and assessment of some possible related factors.

Materials and Methods: This cross-sectional study was performed randomly on 211 dentists in all regions in Tehran city (center, north, south, west, and east) between 1381 and 1383. Dentists were asked to give a sample of urine in the day of visit and to complete a questionnaire consisting of variables such as age, working history, handling of amalgam, environmental parameters and general health situation. Urine samples were analyzed by cold vapour atomic absorption spectrophotometry. Data were analyzed by Kruskall Walis, Kendall and Mann Whitney tests, with p<0.05 as the limit of significance.

Results: The mean of urine mercury content in Tehran dentists was 3.1 (± 3.95) which was lower than the international TLV (Threshold Limit Value). There was a significant relation between urine mercury level and working hours per day (P=0.006). This relation was observed with working hours per week too (P=0.006). In general dentists, there was a positive relation between urine mercury and age (0.008) as well as the practicing years (P=0.034). A significant relation was found between urine mercury and the number of amalgam repairs and replacements in restorative specialists (p=0.039). There was a significant relation between the number of amalgam fillings in the mouth and urine mercury in general practitioners (p=0.027). The type of amalgam (predosed capsules or bulk powder) had a significant effect on the urine mercury content (P=0.001). There was no significant relation between urine mercury and other variables of the study such as the squeezing of triturated amalgam, storage method of residual amalgam, method of storing mercury and office ventilation.

Conclusion: Based on the results of this study, the mean urine mercury content of dentists of Tehran was below the international TLV. The use of precapsulated amalgams had significant effect on the urine mercury. Most of the dentists were working in public or semiprivate clinics, so it is concluded that the level of general hygiene and specially mercury hygiene in these centers seems to be acceptable.

Background and Aim: Although toothbrushing is still the most effective method in plaque reduction, it is insufficient for total plaque removal. Considering this limitation, it is suggested that toothbrushing could be aided by chemical methods. For this purpose, it is advised to use some kind of mouthrinses before toothbrushing to increase the rate of microbial plaque removal. Several prebrushing mouthrinses are available in the market and comparing their efficiency is valuable for dentists. The aim of this study was to investigate and compare the effect of two prebrushing mouthrinses, Plax and Irsha, on dental plaque reduction.

Materials and Methods: This clinical trial was carried out as an interventional and triple blind protocol, using completely random block design. For this purpose, questionnaire and initial examination chart was filled for 50 healthy volunteers between the age of 18 and 40 years and finally 30 individuals were selected based on the inclusion/exclusion criteria. If scaling and polishing was necessary, it was performed at least 2 weeks before starting the main program. Then, each volunteer participated in a 4 steps program, including one step toothbrushing without use of mouthrinse and three steps toothbrushing after use of one of the mouthrinses (Plax, Irsha, Placebo). Data were analyzed by SPSS software using factorial analysis, ANOVA and Tukey’s multiple comparison tests with p<0.05 as the limit of significance.

Results: Toothbrushing without use of mouthrinse decreased the amount of plaque, significantly (P<0.0001). Use of mouthrinse without toothbrushing decreased the amount of plaque significantly (P<0.0001). The amount of plaque reduction after use of various mouthrinses (Plax, Irsha, Placebo) showed no statistical differences (P=0.761). Use of the mouthrinses before toothbrushing, had no statistically significant effect on the final results after toothbrushing (P=0.331).

Conclusion: According to the findings of the present study, although using mouthrinses decrease the amount of dental plaque significantly, but the prebrushing mouthrinse didn't show statistically significant effect on final result after toothbrushing.

Background and Aim: Dental Amalgam is a common restorative material for posterior teeth. Because of Hg content in the composition of amalgam, during the handling of material, mercury may release as vapor in the environment. Excess amount of mercury vapor can cause serious health problems in dental personnel. The aim of this investigation was to determine mercury vapor concentration in working environment of dentists in Tehran.

Materials and Methods: 211 dental clinics were participated in this cross-sectional study. The clinics were randomly selected from different regions of Tehran (north, center, south, east and west). The dentists were asked to complete a questionnaire including items on demographic characteristics such as age, sex and work history, method of handling of amalgam, environmental characteristics and general health conditions. Environmental measurements of mercury vapor in dentists’ offices were done by mercury absorption tubes (Hydrar) and personal pumps (SKC, 222-3, England) as suggested in NIOSH method. Analysis of air samples was done by atomic absorption spectrophotometery (cold vapor). The data were analyzed by non-parametric tests (Kruskall Wallis, Mann-Whitney and Kendall).P<0.05 as the level of significance.

Results: The mean mercury vapor concentration in dentists’ offices was 8.39(±9.68) µg/m³.There was no significant relationship between the urine mercury of dentists (3.107±3.95) and the air Hg vapor concentration of their offices. Using precapsulated amalgam showed significantly less Hg vapor than bulk amalgam (P=0.034). Also the surface area of working room and air Hg vapor (P=0.009) had a significant relationship (P=0.009 r=0.81). There was not any significant correlation between mercury vapor and other factors such as working hours per day and working days per week, squeezing of triturated amalgam or not, storage medium of set amalgam (water or fixer solution), mercury storage method and type of ventilation.

Conclusion: The concentration of mercury vapor in dental offices' environment was lower than threshold limit value. Based on this study the type of amalgam (precapsulated or not) and area of the working room had significant effect on the mercury vapor concentration of environment.

Background and Aim: Patients always complain about metallic color of amalgam restorations. Covering amalgam by composite can solve this problem. Since polymerization shrinkage is a serious shortcoming in composites, application of the combined amalgam and composite restoration is one of the methods to reduce leakage in the cervical margins of posterior restorations. The aim of this invitro study was to evaluate the microleakage of amalgam/composite interface when Rely-X ARC adhesive resin cement was used in the joint.

Materials and Methods: Twenty-four sound extracted premolars were chosen. Mesial and distal class II conventional cavities were prepared and the samples were divided into 4 groups of 12. In all groups, the bases of the cavities were restored with amalgam and then the remaining part was filled by composite resin. Specimens in groups 1 and 2 were restored with composite-resin, immediately after condensing amalgam without or with application of Rely-X ARC (3M, ESPE) respectively. In groups 3 and 4, composite resin were applied 24 hours after condensation of amalgam, without or with application of Rely-X ARC respectively. After polishing and thermocycling, all specimens were prepared for dye penetration and the degree of leakage was scored and analyzed using Kruskall Wallis test with p<0.05 as the level of significance.

Results: The frequency of dye penetration in different groups was obtained. The most and the least scores were observed in groups 3 and 4 respectively. No statistically significant difference was observed in different methods.

Conclusion: None of the methods in this study could seal the amalgam/composite-resin interface.

Background and Aim: Accurate measurement of bone height and width is essential prior to dental implant placement. The method of surgery as well as, the type and size of implants are determined according to dimensions of the residual bone. The purpose of this study was to evaluate the accuracy of linear tomography in localization of the floor of nasal fossa and maxillary sinus, and to determine the width of maxillary bone at the designated site for implant placement.

Materials and Methods: In this test evaluation study, the vertical distances between the alveolar crest and the floor of nasal fossa and the floor of maxillary sinus was measured by the tomographic slices in 12 sites of three dry human skulls. In addition, the width of maxillary bone was measured at the same slices. The skulls were then sectioned through the marked places. Then the radiographic values were compared with the real values of bone sections.

Results: After correction of tomographic values by the magnification factor of the unit, the mean absolute measurement error for vertical values at nasal fossa and maxillary sinus area in tomographic slices were 0.28 mm (SD= 0.24) and 1.1 mm (SD= 0.68) respectively. The mean absolute measurement error for maxillary width at the nasal fossa and maxillary sinus area were 0.65 mm (SD= 0.50) and 0.55 mm (SD= 0.45) respectively. 100 % of vertical values at nasal fossa area and 50 % of vertical values at maxillary sinus area were within ± 1 mm error limit. In addition, 50 % of width measurements at nasal fossa area and 83.3 % at maxillary sinus area were within ± 1 mm error limit.

Conclusion: The linear tomography is more accurate in height estimation at nasal fossa area and in width estimation at maxillary sinus area. The accuracy of linear tomography in height and width estimation is within acceptable limits at both nasal fossa and maxillary sinus area.

Background and Aim: The efficiency of disinfecting materials and procedures in removal of contamination from dental surfaces and equipments is essential. In authors' previous study, daily use of 2:100 dilution of 5% sodium hypochlorite in water and disposable covers were recommended since HBV contamination was found on semi-critical parts of the operative dentistry department. The aim of this study was to evaluate the HBV contamination following application of the recommended procedures.

Materials and Methods: The study was conducted in two parts. In the first cross-sectional part, samples were collected from 17 sites of dental surfaces. In the second interventional part samples were collected from 10 sites of 9 dental and 3 sites of 2 light cure units, before and after disinfection with 5% sodium hypochlorite solution diluted to 2:100. Sterile cotton swabs moistened with sterile BSAS (Bovine Serum Albumin in Sodium Chloride) solution were used for sampling. Samples were tested by PCR technique in Pasteur Institute, Iran.

Results: None of the samples collected in the first part of the study showed contamination. In the second part of the study, from 96 samples taken from various parts of dental and light cure units, before and after disinfection, there was only one HBV contaminated site before disinfection which showed no contamination after disinfection.

Conclusion: Based on the results of this study, disinfecting procedure with 5% sodium hypochlorite solution diluted to 2:100 along with using disposable covers is effective in preventing HBV contamination.

Background and Aim: Improving esthetics is a major goal in periodontal treatments and specially reconstruction of dental papilla is of great importance. Different techniques have been developed, however the results are not completely predictable. The aim of the present study was to compare the possibility of papilla reconstruction using connective tissue graft with and without Emdogain.

Materials and Methods: In this clinical trial, 40 class II lost interdental papilla (Nordland- Tarnow classification) in 18 patients (4 male and 14 female) were studied. Samples were randomly devided into two groups. Case group was treated by connective tissue graft and emdogain (Straumann-USA) and controls were treated using connective tissue graft only. Periodontal parameters including papilla height (PH), periodontal pocket depth (PPD) and clinical attachment level (CAL) were measured before surgery, and 3 and 6 months after treatment. At the tenth days and 1 month after treatment only the papilla height was measured. Repeated measures analysis was used for data analysis with p<0.05 as the level of significance.

Results: In the control group the mean papilla height changed from 3.38 0.89 to 2.85 0.93 on the 3rd month and 2.90 0.95 on the 6th month. The mean PPD changed from 2.8  0.68 to 2.55 0.70 on the 3rd month and 3.06 1.25 on the 6th month. The mean CAL changed from 3.88 1.29 to 3.79 1.25 on the 3rd month and 4.11 1.44 on the 6th month. In test group the mean papilla height changed from 2.98 0.91 to 2.45 1.55 on the 3rd month and 2.55 1.48 on the 6th month. The mean PPD changed from 2.75 1.49 to 2.63 1.38 on the 3rd month and 2.88 1.39 on the 6th month. The mean CAL changed from 3.75 1.24 to 4.01 1.45 on the 3rd month and 4.28 1.63 on the 6th month. These differences were not significant between the studied groups (P>0.05).

Conclusion: Based on the results of this study, use of connective tissue with or without emdogain is not effective in interdental papilla reconstruction.

Background and Aim: An important criterion for success assessment of implant-supported prostheses is marginal fit. Vertical and horizontal discrepancy can result in loosening of the prosthetic screw, crestal bone resorption, peri-implantitis and loss of osseointegration. Despite careful attention to waxing, investing, and casting, marginal discrepancies are inevitable. The aim of this study was to evaluate the marginal gap and overhang in three casting methods with two different alloys in ITI implants.

Materials and Methods: In this experimental in vitro study 48 analog abutments were randomly divided into six groups as follows: 1) burn out cap + BegoStar, 2) impression cap + BegoStar, 3) conventional wax up + BegoStar, 4) burn out cap + Verabond2, 5) impression cap + Verabond2, 6) conventional wax up + Verabond2. Waxing was done in 0.7 mm thickness verified by a digital gauge and a putty index was made for all groups. Reamer was used for correction of the finish line after casting in all groups. Castings were seated on analog abutments and embedded in acrylic resin. Specimens were sectioned by isomet instrument and polished and cleaned by ultrasonic cleaner for 10 min. The marginal gap and overextended margins of castings were examined under a  Scanning Electron Microscope (SEM) (X200). The mean gap and margin overextension were calculated for each group. Data were analyzed by multivariate analysis and Bonferroni post-hoc test with p<0.05 as the level of significance.

Results: No significant difference in gap size was observed among the three casting methods with two alloys (P=0.056). The marginal gap was not different in the studied casting methods (P=0.092). Gold alloy crowns showed lower marginal gaps compared to base metal alloy crowns (P<0.001). No significant difference in overhang size was observed among casting methods with two alloys (P=0.093). Base metal alloy crowns showed less overhang compared to gold alloy crowns (P<0.001). There was a significant correlation between overhang and use of impression cap in base metal alloys (P<0.001).

Conclusion: Based on the results of this study, vertical discrepancy of frameworks made with gold alloy were less than those made with base metal alloy. Base metal alloy demonstrated less overhang. Conventional wax up or using burn out caps produced less horizontal discrepancy.

Background and Aim: According to infection possibility in high risk patients, assessment of microbial contamination in water sources utilized at medico-dental units has become a recent concern. The purpose of this study was to evaluate the microbial contamination in dental units waterlines at the department of operative dentistry, Tehran university of medical sciences in the year 2006.

Materials and Methods: In this cross-sectional study, six dental units in the department of operative dentistry were selected to assess microbial contamination in water sources. Samples were taken on Saturdays (the first working day in a week) and in the midweek, 64 and 16 hours respectively after turning the units off. Moreover, for investigating the effect of flushing, sampling was done at 30, 60, 90 and 120 seconds after flushing and were taken from three parts of each unit including air/water syringe, turbine handpiece and also cup filler water. Samples were transported in closed sterile containers to microbiology laboratory of the school pharmacy. Data were analyzed by Kruskal-Wallis and Dunn tests with p<0.05 as the level of significance.

Results: E.coli was isolated from contaminated samples. Contamination decreased by flushing. In midweek after 90 seconds flushing, water contamination disappeared. On Saturdays 2 minutes flushing decreased contamination to lower that 200 cfu/ml (the rate recommended by ADA). Samples taken from turbine handpieces showed significantly higher contamination rate compared to air/water syringe and cup filler water (p<0.001).

Conclusion: According to the results of this study, dental units waterlines showed bacterial contamination which was eliminated after 120 seconds of flushing.

Background and Aim: Oral health is a sign of overall health. Sometimes fear of dental office deprives  patients from receiving proper care. This problem decreases the self-esteem of dentists and can also reduce health indices. Understanding anxiety factors may help solve this problem. The purpose of this study was to assess anxiety in patients undergoing treatment in dental offices in the city of Hamedan.

Materials and Methods: In this analytic cross sectional study patients above 9 years old and referred to general dental offices in Hamedan were randomly selected and surveyed with questionnaires in two stages. The first questionnaire included 17 standard items based on Dental Anxiety Scale (DAS) and screened anxious patients. Then 400 anxious patients were evaluated with a questionnaire of 64 items based on Corah scale. Data were analyzed by SPSS 13 with multivariate analysis of variance. P<0.05 was considered as the level of significance.

Results: Factors related to dental office environment with 31.1%, those related to personal imaginations with 19.4% and factor concerning office management and dental treatment each with 19.1% frequency showed to be most related to anxiety in patients. Improper rest-rooms (46.3%), blood stains in the environment (44.5%) and dirty dentist's gowns (43.8%) were reported to be the most prominent environmental factors. Among the factors originated from personal imaginations, the risk of disease transmission was accounted for the most justifiable source of anxiety (67.3%). Regarding factors concerning office management, dentist's nervous behavior (47.8%) and his carelessness to the patient (46.8%) were considered as the most significant anxiety sources. Extraction, injection and root canal therapy (48.3%, 44.5%, 44.3%) were the treatment related factors of higher importance respectively. Previous painful treatment experience (47.3%) and poor oral hygiene of the dentist (34.5%) were reported to be among the other justifiable anxiety sources. In all mentioned situations, variations in anxiety factors were significantly higher in women.

Conclusion: This study showed that the main cause of anxiety in patients undergoing treatment in dental offices in Hamedan is their personal imagination which is by far more obvious in women than men.

Background and Aim: Contaminated dental handpieces have the potential to transfer infection to patients. New generation of autoclavable turbines have to some extent overcome the problem however, in clinic sometimes it is necessary to use chemical to disinfect handpieces. The aim of this study was to determine the antimicrobial effect of some routinely used disinfectant solutions on dental contaminated handpieces.

Materials and Methods: In this experimental study 35 turbines were sterilized. The turbines' heads were inserted into microbial suspension containing staphylococcus, pseudomonas and candida and then exposed to the disinfectant solutions. Inoculations into culture medium were made at different intervals. All medium was incubated for 24 hours at 37^oC followed by spectrophotometer inspection for detection of microbial growth. Serial dilutions of disinfectant agents were used to determine the highest dilution in which there was no microbial growth. Kruskal wallis test was used for statistical analysis and p<0.05 was considered as the level significance.

Results: Ethanol had antimicrobial effect on all of the tested microorganisms at dilution of 1:4. Betadine at dilution of 1:64 caused inhibition of all of the microbes except pseudomonas. Micro 10 had antimicrobial effect up to dilution of 1:256 but could not inhibit microbial growth at higher dilution. Sodium hypochlorite inhibited growth of the three microoganisms up to dilution of 1:1024.

Conclusion: Based of on the results of this study sodium hypochlorite was found to be the most effective antimicrobial agent among those used in this study, inhibiting microbial growth at the highest dilution.

Background and Aim: Today, one of the most important environmental issues is dental solid wastes which are of great importance because of the presence of hazardous, toxic and pathogen agents. In this survey, solid waste produced in Hamedan general dental offices is evaluated.

Materials and Methods: In this descriptive study, from 104 general dental offices in Hamedan , 10 offices were selected in simple random way. From each offices, 3 sample at the end of successive working day (Sunday, Monday and Tuesday) were analyzed. Samples were manually sorted into different 74 components and measured by means of laboratory scale. Then, measured components were classified in the basis of characteristic and hazardous potential as well as material type.

Results: Total annual waste produced in general dental offices in Hamadan is 14662.67 Kg (9315.45>95.0% Confidence Interval>20009.88). Production percentages of infectious, domestic type, chemical and pharmaceutical and toxic wastes were 51.93, 38.16, 9.47, 0.44 respectively. Main components of produced dental waste were 14 components that consist of more than 80 percents of total dental solid waste. So, waste reduction, separation and recycling plans in the offices must be concentrated on these main components.

Conclusion: In order to dental waste proper management, it is suggested that in addition to educate dentists for waste reduction, separation and recycling in the offices, each section of dental waste(toxic,chemical and pharmaceutical, infectious and domestic type wastes) separately and according to related criteria should be managed.

Background and Aim: It is well recognized that implant treatment is common worldwide, but the approach to success is not predictable because of bone loss that occurs around the implants. Also there are many factors affecting crestal bone loss around the implants that one of them is the surgical protocol of implant installation. The purpose of this investigation was to evaluate the amount of crestal bone loss around the Replace implants installed according to submerged and non- submerged treatment protocol.

Materials and Methods: In this study, 11 patients received 34 implants. In each patient (unilateral or bilateral mandible), one of the implants was placed with submerged procedure and in the other one non- submerged procedure was used. In a period of 3 months a temporary partial denture that covered the implants was used. After 3 months the submerged fixture was exposed, impression was performed and fixed prosthesis was fabricated. Loss of crestal bone at each implant was measured. These measurements have been done at surgical times, over a period of 3 months after implant installation and 6 months after the delivery of the fixed prosthesis. The measurement was done with digital subtraction radiography. Data was analyzed by Wilcoxon Signed Ranks test.

Results: Three months after implant placement, submerged groups showed statistically more crestal bone loss (0.65±0.71) than non-submerged (0.41±0.53) group (p=0.02). After 6 months the mean value of crestal bone loss in submerged group was 0.21±0.40 mm and in non submerged group was 0.29±0.49 mm. This data indicated no statistically significant difference between the two groups of implants (p>0.05).

Conclusion: Our results are in accordance with previously published studies and confirm that the value of crestal bone loss in submerged and non-submerged groups after 3 and 6 months were similar and in acceptable limit.

Background and Aim: School health workers have an important role in education and prevention of common oral and dental diseases. An organized program can be helpful in training and shaping the proper behavior. This study has evaluated the knowledge, attitude and practice of schools health workers in Tabriz about oral and dental health in 2007-2008.
Materials and Methods: This cross-sectional and descriptive study was performed in primary schools in Tabriz. Questionnaires were sent to the schools that had health workers. Levels of the knowledge, attitude and practice of the health workers who had answered this questionnaire were evaluated. SPSS software and independent T-Test and Paired- Sample T-Test were used for analyzing the results.
Results: Fifty eight out of 64 school health workers were women. Mean age of school health workers was 45 years. Forty four of school health workers had passed special course about oral health and dental health. 49 of them had passed special educational course the mean of acquired knowledge score was 6.77 out of 10 and women's scores were significantly higher. Also women had more work experience than men. The mean of acquired attitude and practice scores were 7.42 and 7.14 out of 10, respectively.
Conclusion: Findings show that performing of the educational courses during work and experience has an effective role in the scales of the health workers. Progress in this situation can be achieved by retraining programs and accessible pamphlets.

Background and Aim: In recent decades many guidelines has been conducted by radiation protection organizations about radiation protection in dentistry. This study was designed to evaluate the observance of these guidelines in educational clinics of all dental schools in Iran.
Materials and Methods: In this cross-sectional study a questionnaire based on National Radiation Protection guidelines was conducted. The questionnaire consisted of questions about radiation protection principles in dental radiography that is needed for patients and personnel protection and quality control of radiological instruments. The questionnaires were completed by the responsible person of each radiology department of dental schools (18 schools). After gathering the data, the results were compared with radiation protection standards.
Results: There was proper condition in the case of the existence of radiation protection facilities, such as lead apron, thyroid shield and lead impacted walls. However, personnel rarely use these facilities. Usage of high speed films and existence of automatic processor in dental schools was an appreciable point. The main problem was related to the lack of regular quality control programs.
Conclusion: The observance of radiation protection regulations in radiology departments of dental schools was proper. But majority of departments had no regular quality control programs and the use of digital systems in dental radiography was not common.

Background and Aims: Soft tissue management with providing the esthetic for restoration of a single implant in the anterior maxilla is of great importance. Tissue training helps to develop a proper emergence profile and natural tooth appearance. The aim of this article was to report a nonsurgical management of undesirable contours of soft tissue around maxillary anterior implants to achieve an optimum appearance.

Materials and Methods: A 23-year-old female with congenital missing of maxillary lateral incisors, after completion of a fixed orthodontic treatment and gain enough space, received 2 dental implants. After second phase surgery and healing period, construction of the restorations was not possible through conventional method because of severe soft tissue collapse. In this case, soft tissue contours were corrected using a provisional restoration and then final restoration was made and delivered.

Conclusion: Tissue training with a provisional restoration helps to re-establish normal gingival tissue contours and interdental papillae around the restoration of maxillary anterior implants.