The effect of radiotherapy delivery time and obturation materials on the fracture resistance of mandibular premolars

Objectives

This ex vivo study was performed to investigate the effect of radiotherapy (RT) delivery time on fracture resistance of mandibular premolars filled with Biodentine or gutta-percha/sealer (GPS).

Materials and methods

Seventy-two mandibular premolars were used in this study. Randomly selected 24 teeth were kept intact for the control groups (with and without irradiation). Then, the remaining 48 teeth were randomly assigned into 4 groups (n = 12) according to RT delivery time (irradiated before or after root canal treatment) and obturation materials as follows: Group RT + GPS, Group: GPS + RT, Group RT + Biodentine and Group Biodentine + RT. The samples were either initially endodontically treated and then irradiated or initially irradiated and then endodontically treated with one of the abovementioned materials. The samples were irradiated at 2 Gy per fraction, 5 times a week for a total dose of 60 Gy in 30 fractions over 6 weeks. The roots were embedded in self-polymerizing acrylic resin. The fracture resistance was evaluated in a universal testing machine. Data was analyzed by one-way ANOVA and Games-Howell post hoc test at p < 0.05.

Results

Radiation therapy significantly reduced fracture resistance of intact teeth (p < 0.05). The highest fracture resistance was observed in intact/non-irradiated teeth and the lowest fracture resistance in Biodentine + RT group (p < 0.05). The effect of RT delivery time was insignificant when GPS was preferred as the root canal filling material (p > 0.05); it was significant when preferring Biodentine (p < 0.05). When RT was applied to the teeth after Biodentine obturation, the fracture resistance decreased significantly compared to the teeth that were obturated with GPS after or before RT application (p < 0.05).

Conclusion

Both RT time and obturation materials (Biodentine or gutta-percha/sealer) affect the fracture resistance of the endodontically treated teeth.

Clinical relevance

Endodontic treatment could be completed with both materials after RT; however, when the endodontic treatment was initially completed and the teeth were subsequently exposed to RT, it was shown that the reinforcement effect of Biodentine decreased.

     

Antimicrobial effect of bioceramic cements on multispecies microcosm biofilm: a confocal laser microscopy study

Objectives

To assess the viability of multispecies microcosm biofilm after contact with NeoMTA Plus, Biodentine, and MTA Angelus.

Materials and methods

Fifty-four human dentin blocks (4 × 5 × 4 mm) were allocated to Hawley retainers, worn by six volunteers for 72 h. The blocks were then individually incubated in BHI broth for 21 days at 37 °C. At the end of experimental time for biofilm growth, the samples were randomly divided into four groups (n = 12): NeoMTA Plus, Biodentine, MTA Angelus, and negative control. The materials were placed in contact with the blocks. All samples were placed in cell-culture plate wells and incubated in BHI broth for 7 days at 37 °C. One sample from each volunteer (n = 6) was analyzed by SEM to describe the biofilm morphology. CLSM was performed to determine the percentage of viable biofilm biovolume. The data were statistically analyzed by one-way ANOVA and Tukey’s multiple comparison test (α = 5%).

Results

SEM showed biofilm formed by spherical and rod-shaped bacteria surrounded by an extracellular matrix. No material was able to kill all biofilm cells, and all groups had more than 50% of viable bacteria. NeoMTA Plus was significantly different from the negative control group (P < .05).

Conclusions

All tested materials were not effective against multispecies microcosm biofilm.

Clinical relevance

NeoMTA Plus, Biodentine, and MTA Angelus were not effective against multispecies microcosm biofilm. It is essential to understand that these bioceramic cements are indicated for infected clinical situations. Thus, complementary disinfection procedures should be conducted prior to filling with these materials.

     

Mineral density changes in bovine carious dentin after treatment with bioactive dental cements: a comparative micro-CT study

Objectives

To evaluate the potential of conventional glass ionomer cement (GIC), Biodentine™, MTA, and Portland cement to induce mineral density changes in carious dentin compared to zinc oxide eugenol control cement (ZOE).

Materials and methods

Fifty blocks of bovine root dentin were prepared and a biofilm model using ATCC strains of S.mutans, S.sobrinus, and L.casei was used to promote artificial dentin lesions. After demineralization, the blocks were randomly divided into the five cement groups. Half of the surface of each specimen received the tested material and the other half was covered with wax (control). Samples were stored in phosphate buffered saline solution for 30 days and after that were scanned in a micro-CT with standardized parameters. Dentin mineral density changes were calculated using differences in plot profiles of the exposed and control carious dentin. Friedman’s test, followed by Wilcoxon signed-rank test was used with 5% significance.

Results

Mean ΔZ values for the cements were 48.63 ± 19.09 for the control (ZOE), 63.31 ± 32.59 for Biodentine™, 114.63 ± 72.92 for GIC, 109.56 ± 66.28 for MTA, and 106.88 ± 66.02 for Portland cement. All cements showed a statistically significant increase in ΔZ values compared to the control, but Biodentine™ values were statistically significantly lower compared to GIC and the other calcium silicate cements.

Conclusions

Tested materials present potential to induce mineral density changes in carious bovine dentin. MTA, Portland, and GIC showed higher bioactivity potential than Biodentine™.

Clinical relevance

Based on minimally invasive concept, materials with remineralization potential can be used to preserve diseased but still repairable dental tissue.

     

Fracture resistance of simulated immature roots using Biodentine and fiber post compared with different canal-filling materials under aging conditions

Objective

The aim of this study was to evaluate the fracture resistance of simulated immature roots using Biodentine (BD) and fiber post (FP) compared with different root canal-filling materials under aging conditions.

Materials and methods

One hundred and forty maxillary central anterior teeth were randomly divided into seven groups (n = 20/group). Negative control received no treatment. In the other groups, the root canals were prepared to simulate immature teeth. The root canals were filled with a 4-mm apical plug of BD and restored intraradicular with BD, BD + FP, composite resin (CR), CR + FP, and gutta-percha (GP). Positive controls were instrumented but without restoration. Teeth were subjected to thermocycling and received cyclic loading before fracture resistance test. Fracture resistance was conducted using a universal testing machine with a crosshead speed of 0.5 mm/min until fracture. Load to fracture was recorded in newtons (N). Data were statistically analyzed using one-way analysis of variance and Tukey’s test at P < 0.05.

Results

Root canals restored intraradicular with BD + FP and CR + FP showed the highest fracture resistance compared with the other experimental groups (P < 0.001). There was no significant difference in the fracture resistance between CR and BD groups (P = 0.998). GP and positive control groups were significantly lower resistance to fracture than the other groups (P < 0.001).

Conclusions

Intraradicular reinforcement with BD + FP and CR + FP enhanced the fracture resistance of simulated immature teeth than the other experimental groups.

Clinical relevance

Biodentine or composite resin combined with fiber post could be used to reinforce immature teeth with an apical Biodentine plug.

     

Chemical analysis of in vivo–irradiated dentine of head and neck cancer patients by ATR-FTIR and Raman spectroscopy

Objectives

To evaluate the effect of in vivo radiotherapy on the chemical properties of human dentine by Fourier-transform infrared spectroscopy (FTIR) and Raman analysis.

Materials and methods

Chemical composition was evaluated comparing control and irradiated group (n = 8). Irradiated teeth were obtained from radiotherapy patients subjected to fractionated X-ray radiation of 1.8 Gy daily totaling 72 Gy. The teeth were sectioned according to the type of dentine (crown or root dentine), obtaining 3-mm dentine cervical slices. The analyzed parameters by FTIR and Raman spectroscopies were mineral/matrix ratio (M:M), carbonate/mineral ratio (C:M), amide I/amide III ratio, and amide I/CH₂ ratio. Raman also calculated the phosphate and carbonate crystallinity.

Results

FTIR revealed that M:M had a decrease in both factors (p = 0.008; p = 0.043, respectively) and root dentine showed a lower C:M in the irradiated group (p = 0.003). Raman revealed a higher phosphate crystallinity and a lower carbonate crystallinity in crown dentine of irradiated group (p = 0.021; p = 0.039). For amide I/amide III, the irradiated showed a lower ratio when compared to the control group (FTIR p = 0.002; Raman p = 0.017). For amide I/CH₂, the root dentine showed a higher ratio than the crown dentine in both methods (p < 0.001).

Conclusions

Radiotherapy altered the chemical composition of human dentine. The exchange of phosphate-carbonate ions in the hydroxyapatite and higher concentration of organic components was found after radiotherapy.

Clinical relevance

The increased risk of radiation-related caries in patients undergoing head and neck radiotherapy is due not only to salivary, dietary, and microbiological changes but also to changes in tooth chemical composition.

     

Influence of Preoperative Pulp Inflammation in the Outcome of Full Pulpotomy Using a Dog Model

IntroductionThis study aimed to evaluate the impact of preoperative pulp inflammation on the histologic outcome of full pulpotomy performed in mature permanent posterior teeth using 4 different biomaterials.MethodsFive beagle dogs (providing a total of 120 roots) were selected. Dentin exposure was performed in teeth from the second and third quadrants. One week later, full pulpotomy procedures were performed using 4 different bioactive materials (ProRoot MTA [MTA], TotalFill BC Putty [BC], Biodentine [BIO], and an experimental cement [ie, pulp capping material]). The hemostasis time was registered. After 14 weeks, the animals were killed. Pulp-dentin tissues were histologically and radiographically assessed. The significance level was set at .05.ResultsTeeth with previously exposed dentin revealed a statistically significant increase in the time required to achieve hemostasis (P < .001), therefore confirming the pulp inflammation status induced by 1-week exposure of occlusal dentin before performing full pulpotomy. There was no radiographic evidence of root resorption, periapical radiolucency, or lamina dura alterations. No statistically significant differences were observed between normal and inflamed pulp regardless of the evaluated histologic parameters. Moreover, histologic data concerning calcified barrier formation and the pulp tissue response show better results for BIO without statistical differences compared with MTA or BC (P > .05). The pulp capping material presented a lower performance, with statistically significant differences being detected in regard to the remaining 3 tested materials (P < .001).ConclusionsRadiographic and histologic outcomes of full pulpotomy are not jeopardized by short-term preoperative pulp inflammation. Moreover, BIO, MTA, and BC cements present suitable alternatives to be used as pulp capping agents.     

iRoot BP Plus用于外伤露髓年轻恒牙活髓切断术对牙齿变色率及根管钙化的影响

目的 研究iRoot BP Plus用于外伤露髓年轻恒牙活髓切断术对牙齿变色率及根管钙化的影响。方法 选取2018年1月至2020年6月于本院行活髓切断术的82例患儿,随机分为对照组(使用MTA盖髓材料)和观察组(使用iRoot BP Plus盖髓材料)各41例,随访1年,比较两组不同时间的手术疗效、根管钙化和牙齿变色情况,以及手术时间、肿胀时间和疼痛持续时间、牙齿功能和美观度,并记录两组患儿术后并发症。结果 两组术后3个月、末次随访的疗效差异无统计学意义(P>0.05);观察组肿胀时间、术后疼痛持续时间短于对照组(P<0.05);观察组的舒适、固定和美观评分高于对照组(P<0.05);术后6个月及末次随访观察组的根管钙化和牙齿变色率低于对照组(P <0.05);观察组的并发症发生率为2.44%,低于对照组的14.63%(P<0.05)。结论 iRoot BP Plus与MTA均能较好地用于外伤露髓年轻恒牙的牙髓切断术,其中iRoot BP Plus能减少根管钙化、牙齿变色情况,应用前景良好。     

Oral health-related impact profile in full-mouth restored patients with two different tooth-colored restoration materials

Objectives

To analyze the change of oral health impact profile (OHIP) in patients with full-mouth rehabilitations due to moderate/severe tooth wear dependent on different restorative materials (ceramic/experimental CAD/CAM composite).

Materials and methods

Twenty-nine healthy patients (15 male/14 female, age 44.6 ± 28.4 years) requiring full-mouth rehabilitation due to different degrees of tooth wear were instructed to fill the German version OHIP-G49 questionnaire before (baseline) and 30 days after prosthetic treatment with ceramic (n = 17) or experimental CAD/CAM composite (n = 12) restorations. Questions were divided into five dimensions: appearance, oral functions, psychosocial impact, linguistic limitations, and orofacial pain; changes between both OHIP-questionnaires for each question and patient were dissected by difference values, separately. Data were analyzed with the Kolmogorov–Smirnov, Wilcoxon’s signed-rank, Kruskal–Wallis, Mann–Whitney, and Cronbach’s alpha tests (significance level p = 0.01).

Results

The appearance dimension showed the highest results (p < 0.001, 100% improvement with all values > 0); the linguistic limitations dimension presented the lowest improvement (p < 0.001). The other three dimensions were not statistically different. No statistical differences between the two materials depending on OHIP questionnaire results occurred.

Conclusions

The esthetic appearance of the patients was influenced positively by full-mouth rehabilitation, irrespective of the material used. Improvements were also made in the parameters “toothache” and “problem of food intake.” No statements could be made for the parameter “language.”

Clinical relevance

With an increasing number of patients with moderate/severe tooth wear, thorough knowledge about the improvement of OHIP is important. This information is advantageous for the consultation and handling of patients when complex treatments are planned.

     

Clinical evaluation of non-surgical cleaning modalities on titanium dental implants during maintenance care: a 1-year follow-up on prosthodontic superstructures

Objectives

To investigate tissue health around implants with newly attached superstructures over 12 months of preventive maintenance appointments and instrumentation when necessary.

Material and methods

In a randomized, split-mouth study 32 implants (8 participants with 4 implants each) received followed-up care every 3 months after superstructure attachment. Implants and superstructures were randomly assigned to four treatment groups and treated if necessary: (1) titanium curettes (TC), (2) stainless steel ultrasonic tip (PS), (3) erythritol air-polishing powder (EP), or (4) rubber cup polishing (CON). Probing depths (PDs), bleeding on probing (BOP), modified gingival (mucosal) bleeding index (GBI) around implants, and full-mouth Plaque Control Record (PCR) were measured every 3 months. Clinical attachment levels (CALs) and height of keratinized mucosa (KM)/gingival margins (GMs) for implants/teeth and PD, BOP, and GBI for teeth were documented at baseline, 6 months, and 12 months. Matrix metalloproteinase 8 (MMP-8) and periopathogens were measured at baseline and 12 months.

Results

Participants exhibited minimal signs of periodontal inflammation with statistically significant PD improvement (3.0 ± 0.2 to 2.8 ± 0.3 mm; p = 0.022) and overall CAL (4.3 ± 0.8 to 4.0 ± 0.7 mm; p = 0.048) after 1 year. Implants showed no statistically significant differences (p > 0.05) between or within groups at baseline or 12 months for any parameter, except MMP-8 decreased significantly for PS (14.50 ± 17.58 to 4.63 ± 7.56 ng; p = 0.044), and after 12 months, PCR showed a significant difference between TC and PS (p = 0.018).

Conclusions

Treatment was necessary as inflammation was observed around newly placed superstructures within the first year of maintenance care. All tested treatment modalities yielded comparable clinical improvements.

Clinical relevance

Early assessment and diagnosis of mucositis and regular maintenance can promote long-lasting implant health.

     

Comparison of the success rate of a bioactive dentin substitute with those of other root restoration materials in pulpotomy of primary teeth: Systematic review and meta-analysis

BackgroundSeveral root canal restoration materials can be used after pulpotomy in primary teeth; however, it is unclear which is the most successful. The authors’ aim in this systematic review and meta-analysis was to compare the radiographic and clinical failure rates of a calcium silicate-based bioactive material (Biodentine, Septodont) with those of other root restoration materials such as mineral trioxide aggregate (MTA), formocresol, and ferric sulfate.Types of Studies ReviewedOn the basis of the determined study strategy, the authors performed a comprehensive search of the MEDLINE, Web of Science, Embase, and Cochrane Central Register of Controlled Trials online databases. The authors considered only randomized controlled trials. In the included studies, the authors compared the clinical and radiographic failure rates at different follow-up times of the pulpotomy of primary teeth with extensive caries treated by using Biodentine and other root restoration materials.ResultsAll of the included studies had an unknown or high risk of bias. On the basis of the Grading of Recommendations Assessment, Development and Evaluation scale, the quality of evidence for the comparison of MTA and Biodentine was moderate. Biodentine had a statically significantly higher radiographic failure rate than did MTA at 6 and at 9 through 12 months after pulpotomy. The authors found no substantial differences between the clinical failure rates of Biodentine and MTA and the radiographic or clinical failure rates of Biodentine and formocresol or of Biodentine and ferric sulfate.Conclusions and Practical ImplicationsMTA has a significantly lower radiographic failure rate than does Biodentine but no difference in clinical failure rates. On the basis of this result, the dentist can weigh the advantages and disadvantages of using Biodentine, MTA, ferric sulfate, and formocresol and can make a more informed decision about using the proper root restoration material.     

The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial

Objectives

The purpose of the study is to evaluate and compare the effectiveness of honey mouthwash and an oral care protocol on mucositis and weight loss in patients with acute myeloid leukemia receiving chemotherapy.

Materials and methods

In this single-blind clinical trial, 53 acute myeloid leukemia (AML) patients receiving chemotherapy were randomly assigned into three groups: honey mouthwash (n = 17), oral care (n = 17), and control (n = 19). The severity of mucositis and weights was examined blindly at the baseline and 4-week follow-up.

Results

The prevalence of grades of mucositis in the study groups was significant at the end of the third (p = 0.002) and fourth (p < 0.001) weeks. The mucositis severity decreased at the end of the third and fourth weeks in the honey mouthwash group (p < 0.05), whereas it increased in the control group (p < 0.001). The difference in the weight was significant between the honey mouthwash and the control groups (p < 0.05, MD = 1.95) at the end of the third week, and between the honey mouthwash group with the control (p < 0.01, MD = 2.92) and oral care groups (p < 0.05, MD = 1.95) at the end of the fourth week.

Conclusions

Honey mouthwash is effective in preventing and reducing the severity of mucositis, and weight loss and can be recommended for patients undergoing chemotherapy.

Clinical relevance

The results of this study suggest that honey mouthwash can reduce the incidence and severity of mucositis in patients, reduce or eliminate the possibility of weight loss in them, as well as encourage some weight gain. Compared to routine oral care, honey mouthwash is also easier to use and handle.

Trial registration

IRCT2015121419919N7

     

Evaluation of the protective effects of non-thermal atmospheric plasma on alveolar bone loss in experimental periodontitis

Objectives

The inhibition of bone destruction is one of the main goals of periodontitis treatment. The aim of this study was to investigate the protective effects of non-thermal atmospheric plasma (NTAP) on alveolar bone loss radiographically, histomorphometrically, and histologically in experimental periodontitis in rats.

Materials and methods

A total of twenty-eight rats were randomly divided into three groups: control group (CG) (n = 8), periodontitis group (PG) (n = 10), and NTAP group (NTAPG) (n = 10). In PG and NTAPG, experimental periodontitis was created with ligating. The kINPen 11 plasma jet was applied around the ligatured teeth in NTAPG. The samples from each group were radiographically assessed with microcomputed tomography (micro-CT); then, histological (presence of osteoclasts and inflammatory cells) and immunohistochemical (immunoreactive of OCN and ALP) findings were compared.

Results

The results revealed a significant increase in alveolar bone loss in the PG compared with CG and NTAPG (p < 0.05). Inflammation, alveolar resorption, and cement damage were reduced significantly in the group treated with NTAP compared to the PG (p < 0.05). Significantly higher levels of osteoclasts were detected in the PG in comparison with both CG and NTAPG (p < 0.05). The lowest osteocalcin and ALP values were determined in PG, and the differences between PG and both groups were also significant (p < 0.05).

Conclusion

Within the limitations of the present study, we can say that NTAP may enhance the bone remodeling process by inhibiting inflammation and preventing alveolar bone destruction.

Clinical relevance

NTAP has clinical potential for accelerating and treating periodontitis with the inflammatory response modulation, osteoblast differentiation, and alveolar bone loss reduction.

     

Comparison of two surgical techniques (HOO vs. BSSO) for mandibular osteotomies in orthognathic surgery—a 10-year retrospective study

Purpose

To retrospectively compare the high-angled sagittal split osteotomy (HOO) and the bilateral sagittal split osteotomy (BSSO) for the correction of skeletal dysgnathias regarding intra- and postoperative complications.

Methods

The electronic medical records of all patients treated with an orthognathic surgery at the Department for Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Germany, between the years 2009 and 2019 were retrospectively reviewed.

Results

Two hundred ninety-one patients were included. The overall complication rates were 19.78% (BSSO) compared to 12.5% (HOO) (p = 0.14). Significant differences were found regarding the operation time (HOO < BSSO, p = 0.02), material failure (HOO > BSSO, p = 0.04), and early recurrence requiring revision surgery (HOO < BSSO, p = 0.002). The use of a ramus plate significantly reduced the risk of plate failure (2.8% < 13.6%, p = 0.05). More bad splits (p = 0.08) and early sensory disorders (p = 0.07) occurred in the BSSO group.

Conclusion

The HOO presents a possible alternative to the BSSO since newly developed osteosynthesis material significantly reduces the risk of material failure. The BSSO is accompanied by higher risks of developing complications like a bad split and sensory disorders but, however, remains the standard for large anterior–posterior transpositions of the mandible.

     

Predictors of dental plaque and gingivitis in patients receiving integrated dental treatment—a longitudinal retrospective study

Objectives

The identification of predictors of supragingival biofilm accumulation may improve the results of therapeutic strategies for dental caries and periodontal diseases in general clinical practice. This study aimed to determine predictors of changes in visible plaque (VP) and gingival bleeding (GB) during integrated dental care.

Materials and methods

A retrospective longitudinal study was conducted by a census of patients receiving integrated dental care in a general clinical practice ambulatory at the Federal University of Rio Grande do Sul (Brazil). The sample comprised 91 charts of patients attended over a 6-months period. Gender, age, patient’s main complaint, oral hygiene pattern, and clinical data were recorded from charts for the last two dental visits in the ambulatory. Changes in VP and GB were modeled by multiple linear regression and beta coefficients (b) were reported.

Results

The mean follow-up time was 13 months. Significant reductions in VP (32.8 ± 27.9 to 17.4 ± 19.4%; p < 0.001) and GB (27.1 ± 23.8 to 18.5 ± 17.3%; p < 0.001) were observed. Higher plaque reductions were predicted by higher baseline VP levels (p = 0.02), shorter time (< 12 months) elapsed between VP recordings (b = 14.1%, p = 0.02), interproximal cleansing (b = 11.9%, p = 0.03), lower number of sessions for oral hygiene instruction (b = 13.7%, p = 0.02), and presence of pockets ≥ 6 mm (b = − 12.4%, p = 0.02). GB was predicted by time of follow-up > 12 months and baseline VP.

Conclusions

Plaque and gingivitis improved in patients under integrated dental care. Factors related to motivation, oral hygiene practices, and baseline periodontal status might be used as predictors of VP and GB changes.

Clinical relevance

Visible plaque and gingivitis reduced in a sample of patients treated under integrated dental care. Some predictors may determine for which patients the treatment may be maximize and those who will need greater efforts to achieve the therapeutic goal for oral hygiene.

     

Bleaching of simulated stained-remineralized caries lesions in vitro

Objective

Non-invasive esthetic treatment options for stained arrested caries lesions have not been explored. This study aimed to develop laboratory models to create stained-remineralized caries-like lesions (s-RCLs) and to test the efficacy of bleaching on their esthetic treatment.

Materials and methods

One hundred twelve enamel/dentin specimens were prepared from human molars, embedded, and had their color measured spectrophotometrically at baseline and after demineralization. They were randomly divided into four groups (n = 14) based on the staining/remineralization protocols for a total of 5 days: G1, no staining/no remineralization; G2, no staining/remineralization in artificial saliva (AS); G3, non-metallic staining/remineralization with sodium fluoride/AS; and G4, metallic staining/remineralization with silver diamine fluoride/AS. The lesion mineral loss (ΔZ) and depth (L) were measured using transverse microradiography along with color change (ΔE). Specimens were bleached and color was re-evaluated. Data were analyzed using ANOVA models followed by Fisher’s PLSD tests (α = 0.05).

Results

s-RCLs in G4 were significantly (p < 0.001) darker than G3, G2, and G1 regardless of substrate type and condition. s-RCLs in G2, G3, and G4 showed significantly lower ΔZ and L than G1 (all p < 0.001), confirming occurrence of remineralization. G4 exhibited significantly lower ΔZ and L compared to G2 (p < 0.001). Bleaching was more effective in non-metallic than in metallic stained lesions regardless of substrate type (p < 0.001).

Conclusion

The proposed models created distinct s-RCLs. Non-metallic s-RCLs were lighter and more responsive to bleaching compared to metallic s-RCLs.

Clinical relevance

The developed experimental models allow the further investigation of the efficacy and safety of different clinical strategies for the esthetic management of s-RCLs.

     

Comparison of Pulpal Responses to Pulpotomy and Pulp Capping with Biodentine and Mineral Trioxide Aggregate in Dogs

Introduction

This study evaluated the pulpal and periapical responses of dogs' teeth after pulpotomy and pulp capping with a new tricalcium silicate–based cement (Biodentine) when compared with mineral trioxide aggregate (MTA) by radiographic, histopathologic, and histomicrobiological analyses.

Methods

Sixty roots (30 teeth) of dogs were divided into 2 groups, Biodentine (n = 36 roots) and ProRoot MTA (control, n = 24 roots). Animals were killed after 120 days, and the teeth were subjected to histotechnical processing (hematoxylin-eosin and Brown and Brenn staining). Qualitative and quantitative histopathologic data were analyzed by Fisher exact and Mann-Whitney tests (α = 0.05).

Results

Radiographically, mineralized tissue bridge formation was observed in more specimens treated with Biodentine (96.8%) than with MTA (72.2%) (P = .02). Integrity of the lamina dura and absence of periapical bone rarefaction and root resorption (external and internal) were observed in all specimens. Histopathologic and histomicrobiological analyses revealed mineralized tissue bridge formation, pulpal vitality, odontoblast layer integrity, preserved periodontal ligament, and absence of bone or root resorption and microorganisms in both groups. Although the bridges formed at the amputation site had similar morphology, they were significantly thicker in the Biodentine group (P < .0001). Comparison between the radiographic and histopathologic results showed that radiographic visualization of more bridges in the Biodentine group was related to bridge thickness because radiographic diagnosis was flawed for bridges with thickness less than 0.5 mm. Fluorescence microscopy improved the visualization of bridge structure.

Conclusions

Biodentine presented tissue compatibility and allowed for mineralized tissue bridge formation after pulpotomy in all specimens with similar morphology and integrity to those formed with use of MTA. Periapical radiographs failed in detecting mineralized tissue bridges with thickness less than 0.5 mm.     

Outcomes of Direct Pulp Capping by Using Either ProRoot Mineral Trioxide Aggregate or Biodentine in Permanent Teeth with Carious Pulp Exposure in 6- to 18-Year-Old Patients: A Randomized Controlled Trial

Introduction

This study aimed to compare the success rates of direct pulp capping (DPC) by using either ProRoot Mineral Trioxide Aggregate (MTA) or Biodentine in the cariously exposed permanent teeth of 6- to 18-year-old patients. Gray discoloration was also evaluated.

Clinical evaluation of direct pulp capping using a calcium silicate cement—treatment outcomes over an average period of 2.3 years

Objectives

This study aims to assess the treatment outcomes of direct pulp capping with a calcium silicate cement (Biodentine) after caries excavation.

Materials and methods

A total of 245 teeth of 226 patients diagnosed to be clinical healthy or showing spontaneous pain were directly capped. The teeth were examined 0.19 to 7.4 (mean 2.3 ± 2.04) years after treatment. The following data were recorded: age and sex of the patient, type of tooth and restoration (glass ionomer cement [GIC], amalgam, composite resin, ceramic, gold) and symptoms before or after treatment. The evaluation of the treatment was carried out by sensibility and percussion testing and by the patient’s questioning. A positive sensibility test, a negative percussion test, the absence of swelling and discomfort were considered as treatment success. Survival analysis was performed using the Kaplan-Meier, log-rank, Chi-square and Fisher’s exact test, respectively.

Results

After an average period of 2.3 years, 86.0% of the teeth remained vital; the survival rate after 7.4 years was 83.4%. The treatment outcome was significantly worse for cavities restored with GIC compared to all other restorative materials (p < 0.05). All other evaluated factors had no significant influence on the success rate (p > 0.05).

Conclusion

Exposed pulps of asymptomatic vital permanent teeth and teeth with spontaneous pain before treatment can be successfully capped directly using Biodentine. A subsequent restoration with GIC does not appear to be suitable as it significantly reduces the success of the treatment.

Clinical relevance

Direct pulp capping can be done successfully with this type of calcium silicate cement.

     

Three-dimensional characterization of mandibular asymmetry in craniofacial microsomia

Objectives

This study aimed to investigate the three-dimensional (3D) mandibular asymmetry in craniofacial microsomia (CFM) and its association with the Pruzansky–Kaban classification system.

Materials and methods

Cone-beam computed tomography images of 48 adult CFM cases were collected. The asymmetry of the mandibular body and ramus was analyzed with 3D landmarks. The mirrored mandibular model was registered on the original model, yielding a color-coded distance map and an average distance (i.e., asymmetry score) to quantify the overall mandibular asymmetry.

Results

The lengths of the mandibular body and ramus were significantly shorter on the affected than the contralateral side (p < 0.001). The ANB (p = 0.009), body and ramal lengths (both p < 0.001), and body and ramal length asymmetry (both p < 0.05) were significantly different between mild (types I/IIA) and severe (types IIB/III) cases. The mandibular asymmetry score correlated with mandibular body length asymmetry (r = 0.296, p = 0.046). CFM mandibles showed high variability in shape asymmetry.

Conclusions

CFM patients showed distinct body and ramal length asymmetries. In severe cases, mandibles were smaller, more retruded, and more asymmetric in length. The mandibular shape asymmetry was highly variable regardless of the Pruzansky–Kaban types, being a determinant in the extent of overall mandibular asymmetry.

Clinical relevance

The 3D morphologic analysis provides better insights into real mandibular asymmetry. Although the Pruzansky–Kaban classification was applied, high individual variability of the mandibular morphology still existed within the types. Therefore, individualized analyses and treatment plans for CFM patients are highly recommended.

     

Clinical performance of a glass ionomer restorative system: a 6-year evaluation

Objectives

The aim of this study is to evaluate the long-term clinical performance of a glass ionomer (GI) restorative system in the restoration of posterior teeth compared with a micro-filled hybrid posterior composite.

Materials and methods

A total of 140 (80 Cl1 and 60 Cl2) lesions in 59 patients were restored with a GI system (Equia) or a micro hybrid composite (Gradia Direct). Restorations were evaluated at baseline and yearly during 6 years according to the modified-USPHS criteria. Negative replicas at each recall were observed under SEM to evaluate surface characteristics. Data were analyzed with Cohcran’s Q and McNemar’s tests (p < 0.05).

Results

One hundred fifteen (70 Cl1 and 45 Cl2) restorations were evaluated in 47 patients with a recall rate of 79.6% at 6 years. Significant differences were found in marginal adaptation and marginal discoloration for both restorative materials for Cl1 and Cl2 restorations (p < 0.05). However, none of the materials were superior to the other (p > 0.05). A significant decrease in color match was observed in Equia restorations (p < 0.05). Only one Cl2 Equia restoration was missing at 3 years and another one at 4 years. No failures were observed at 5 and 6 years. Both materials exhibited clinically successful performance after 6 years. SEM evaluations were in accordance with the clinical findings.

Conclusions

Both materials showed a good clinical performance for the restoration of posterior teeth during the 6-year evaluation.

Clinical relevance

The clinical effectiveness of Equia and Gradia Direct Posterior was acceptable in Cl1 and Cl2 cavities subsequent to 6-year evaluation.