Search results for: dental implants

Authors: Ayda Khosravanihaghighi, Pramod Koshy, Bill Walsh, Vedran Lovric, Charles Christopher Sorrell

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There is an increasing demand for orthopedic implants owing to the increasing numbers of the aging population. Titanium alloy (Ti6Al4V) is a common material used for orthopedic implants owing to its advantageous properties in terms of good corrosion resistance, minimal elastic modulus mismatch with bone, bio-inertness, and high mechanical strength. However, it is important to improve the bioactivity and osseointegration of the titanium alloy and this can be achieved by coating the implant surface with suitable ceramic materials. In the present work, pure and doped-ceria (CeO₂) coatings were deposited by spin coating on the titanium alloy surface in order to enhance the biological interactions between the surface of the implant and the surrounding tissue. In order to examine the bone-binding ability of an implant, simulated body fluid (SBF) tests were conducted in order to assess the capability of apatite layer formation on the surface and thus predict in vivo bone bioactivity. Characterization was done using scanning electron microscopy (SEM) and X-ray diffraction (XRD) analyses to determine the extent of apatite formation. Preliminary tests showed that the CeO₂ coatings were biocompatible and that the extent of apatite formation and its characteristics can be enhanced by doping with suitable metal ions.

Keywords: apatite layer, biocompatibility, ceria, orthopaedic implant, SBF, spin coater, Ti-implant

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Authors: Recep Duzsoz, Ozlem Gormez, Umit Memis, Selma Demer, Hikmet Orhan

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Stylohyoid ligament is a connective tissue extending from apex of the styloid process to small horn of the hyoid bone. The normal length of styloid process ranges from 20 to 30 mm and measurements more than 30 mm is named stylohyoid ligament calcification (SLC). Fluorosis is a health problem that arises in individuals who intake large amounts of fluor long periods of time. The aim of this study was to investigate the effects of fluorosis on SLC. This study has been conducted on 100 patients who had SLC detected on panoramic radiograph. The study group was consisted of 50 patients with dental fluorosis and control group was consisted of 50 patients without dental fluorosis. Length and thickness of SLC were measured and the type of SLC was determined on panoramic radiographs. There was no statistically significant differences between the study and control group for SLC length, thickness and type. The thickness of left and right SLC of severe dental fluorosis group was statistically significant higher than moderate dental fluorosis group (p < 0,05). Cervicopharyngeal trauma, tonsillectomy, endocrine disease in menopause, persistent mesenchymal tissue, mechanical stress have reported as etiology of SLC in the literature and studies are still ongoing. It was reported that fluorosis as a factor on calcification of some ligaments in body (posterior longitudunal ligament, ligamentum flavum and transverse atlantal ligament) previously but relationship between fluorosis with SLC was not investigated. Our study is unique because it is the first study on SLC thickness measurements on panoramic radiographs and the relationship between fluorosis and SLC to our knowledge. According to the obtained results, it is thought that fluorosis may have an effect on SLC in thickness due to the relationship between dental fluorosis severity with SLC thickness and this study will contribute to the progress of the future studies.

Keywords: calcification, fluorosis, ligament, stylohyoid

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Authors: Daeung Jung

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Background: In case of patients with missing teeth, multiple implant restoration has been widely used and is inevitable. To increase its survival rate, it is important to understand the influence of different implant designs on inter-implant crestal bone resorption. There are several implant systems designed to minimize loss of crestal bone, and the Astra Tech and Brånemark Implant are two of them. Aim/Hypothesis: The aim of this 10-year study was to compare the height of inter-implant bone crest in two implant systems; the Astra Tech and the Brånemark implant system. Material and Methods: In this retrospective study, 40 consecutively treated patients were utilized; 23 patients with 30 sites for Astra Tech system and 17 patients with 20 sites for Brånemark system. The implant restoration was comprised of splinted crown in partially edentulous patients. Radiographs were taken immediately after 1st surgery, at impression making, at prosthetics setting, and annually after loading. Lateral distance from implant to bone crest, inter-implant distance was gauged, and crestal bone height was measured from the implant shoulder to the first bone contact. Calibrations were performed with known length of thread pitch distance for vertical measurement, and known diameter of abutment or fixture for horizontal measurement using ImageJ. Results: After 10 years, patients treated with Astra Tech implant system demonstrated less inter-implant crestal bone resorption when implants had a distance of 3mm or less between them. In cases of implants that had a greater than 3 mm distance between them, however, there appeared to be no statistically significant difference in crestal bone loss between two systems. Conclusion and clinical implications: In the situation of partially edentulous patients planning to have more than two implants, the inter-implant distance is one of the most important factors to be considered. If it is impossible to make sure of having sufficient inter-implant distance, the implants with less micro gap in the fixture-abutment junction, less traumatic 2nd surgery approach, and the adequate surface topography would be choice of appropriate options to minimize inter-implant crestal bone resorption.

Keywords: implant design, crestal bone loss, inter-implant distance, 10-year retrospective study

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Authors: Seham A. S. Mohamed, Sarah R. Baker, Christopher Deery, Mario V. Vettore

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Background: The link between oral health conditions and school performance and attendance remain unclear among Middle Eastern children. The association has been studied extensively in the Western region; however, several concerns have been raised regarding the reliability and validity of measures, low quality of studies, inadequate inclusion of potential confounders, and the lack of a conceptual framework. These limitations have meant that, to date, there has been no detailed understanding of the association or of the key social, clinical, behavioural and parental factors which may impact the association. Aim: To examine the association between oral health conditions and children’s school performance and attendance at Grade 2 in Muharraq city in the Kingdom of Bahrain using Heilmann et al.’s (2015) life course framework for oral health. Objectives: To (1) describe the prevalence of oral health conditions among 7-8 years old schoolchildren in the city of Muharraq; (2) analyse the social, biological, behavioural, and parental pathways that link early and current life exposures with children’s current oral health status; (3) examine the association between oral health conditions and school performance and attendance among schoolchildren; (4) explore the early and current life course social, biological, behavioural and parental factors associated with children’s school outcomes. Design: A time-ordered-cross-sectional study was conducted with 466 schoolchildren aged 7-8 years and their parents from Muharraq city in KoB. Data were collected through parents’ self-administered questionnaires, children’s face-face interviews, and dental clinical examinations. Outcome variables, including school performance and school attendance data, were obtained from the parents and school records. The data were analysed using structural equation modelling (SEM). Results: Dental caries, the consequence of dental caries (PUFA/pufa), and enamel developmental defects (EDD) prevalence were 93.4%, 25.7%, and 17.2%, respectively. The findings from the SEM showed that children born in families with high SES were less likely to suffer from dentine dental caries (β= -0.248) and more likely to earn high school performance (β= 0.136) at 7-8 years of age in Muharraq. From the current life course of children, the dental plaque was associated significantly and directly with enamel caries (β= 0.094), dentine caries (β= 0.364), treated teeth (filled or extracted because of dental caries) (β= 0.121), and indirectly associated with dental pain (β= 0.057). Further, dentine dental caries was associated significantly and directly with low school performance (β= -0.155). At the same time, the dental plaque was indirectly associated with low school performance via dental caries (β = −0.044). Conversely, treated teeth were associated directly with high school performance (β= 0.100). Notably, none of the OHCs, biological, SES, behavioural, or parental conditions was related to school attendance in children. Conclusion: The life course approach was adequate to examine the role of OHCs on children’s school performance and attendance. Birth and current (7-8-year-olds) social factors were significant predictors of poor OH and poor school performance.

Keywords: dental caries, life course, Bahrain, school outcomes

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Authors: Sahar Heidary, Ramin Ghasemi Shayan

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The recent coronavirus disease 2019 (COVID-19) occurrence has carried considerabletrials to the world health system, comprising the training of dental and maxillofacial radiology (DMFR). DMFR will keep avital role in healthcare throughout this disaster. Severe acute breathing disease coronavirus 2 (SARS-CoV-2), the virus producing the current coronavirus disease 2019 (COVID-19) pandemic, is not only extremely contagious but can make solemn consequences in susceptible persons comprising dental patients and dental health care personnel (DHCPs). Reactions to COVID-19 have been available by the Cores for Infection Switch and Inhibition and the American Dental Association, but a more detailed answer is necessary for the harmless preparation of oral and maxillofacial radiology. Our goal is to evaluation the existing information just how the illness threatens patients and DHCPs and how to define which patients are possible to be SARS-CoV-2 infected; study how the usage of private shielding utensils and contamination control measures based on recent top observes, and knowledge can decrease the danger of virus spread in radiologic trials; and scrutinize how intraoral radiography, with its actually superior danger of scattering the infection, might be changed by extraoralradiographic methods for definite diagnostic jobs. In the pandemic, teleradiology has been extensively recycled for diagnostic determinations of COVID-19 patients, for discussions with radiologists in crisis cases, or managing of distance among radiology clinics. Dentists can have the digital radiographic images of their emergency patients through online service area also by electronic message or messaging applications to view in their smart phones, laptops, or other electronic devices.

Keywords: radiology, dental, oral, COVID-19, infection

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Authors: David Parmenter, Brian Millar

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Obstructive sleep apnoea is a common condition which is generally under-diagnosed. Poorly managed obstructive sleep apnoea carries serious health risks and can greatly impact on the sufferer's quality of life. This publication covers the aetiology, symptoms, and treatment of sleep apnoea. The treatment of Obstructive Sleep Apnoea is an emerging field, and the useful role of the Dental Team is relatively unknown, therefor this paper will highlight the role of the dental team in its treatment. The concept of mandibular advancement appliances, along with the clinical and laboratory stages for constructing them, are documented. It is the hope of the author that this publication will educate healthcare professionals on the role of dental practitioners in the multidisciplinary team for treating sleep apnoea. Objective: Individuals should be more aware of the demographic of patients at risk of sleep apnoea, how it is diagnosed and which group of sleep apnoea patients are suitable to refer for mandibular appliance therapy. Individuals should also be aware of what a mandibular advancement appliance is and how it helps treat obstructive sleep apnoea.

Keywords: sleep apnoea, snoring, sleep appliances, mandibular advancement appliance

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Authors: A. Flaviana da Silva, B. Jenifer Apriani Ximenes, C. Efigenia dos Santos Pereira

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The World Health Organization's 2022 Global Oral Health Status Report reveals a staggering statistic: more than 3.5 billion people, or half of the world's population, currently suffer from untreated oral diseases, encompassing issues like tooth loss, gum disease, and oral cancers. Among these, dental caries, commonly known as tooth decay, affects over 2.5 billion people globally. Dental caries result from acid erosion of teeth due to plaque build-up and consumption of free sugars. Despite being preventable through basic measures such as regular tooth-brushing with fluoride toothpaste and reduced sugar intake, untreated dental caries poses a significant and growing public health crisis. In children, dental caries stands as the most prevalent non-communicable disease worldwide, affecting 60-90% of school children to some extent. This condition severely impacts their physical, emotional, and social well-being, hindering essential activities and overall quality of life. Timor-Leste, a small nation in South-east Asia, grapples with the escalating problem of childhood dental caries, exacerbated by its unique challenges including poor access to healthcare services and limited resources. Methods: This study analysed Secondary, cross-sectional data collected by Maluk Timor in 2022 during the School Outreach Program. A total of 1,008 children aged 4-16 from eight primary schools in the Bazartete administrative post were examined for dental caries in their primary and permanent teeth. All students were invited to participate, and consent was obtained from parents and children. A team comprising one dentist and two dental nurses conducted health promotion sessions, dental examinations, and SDF treatment. A screening form based on WHO guidelines collected demographic data and caries diagnosis, categorized as decayed or healthy. Data analysis involved entering the data into Google Sheets, verifying its accuracy, and importing it into Microsoft Excel for analysis. Variables were created to identify students with carious lesions, and prevalence tables were generated, stratified by age group, gender, and location. Results: Among the 1,008 children analysed, 58.3% had dental caries. Caries prevalence was higher in primary teeth (36.7%) compared to permanent teeth (29.5%). Conclusion: In summary, this report highlights the alarming prevalence of dental caries among children in Timor-Leste and the efforts of Maluk Timor's School Outreach Program in addressing this critical issue. The results emphasize the need for effective preventive measures and improved access to oral healthcare in this region.

Keywords: dental caries, timor-leste, oral health, children, public health, primary health care, teeth

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Authors: Priyajeet Kaur Kaleka

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Introduction: A dentist is often the first responder in the battle for a patient’s healthy body and maybe the first health professional to observe signs of child abuse, be it physical, emotional, and/or sexual mistreatment. Therefore, it is an ethical responsibility for the dental clinician to detect and report suspected cases of child abuse and neglect (CAN). The main reasons for not reporting suspected cases of CAN, with special emphasis on the third: 1) Uncertainty of the diagnosis, 2) Lack of knowledge of the reporting procedure, and 3) Child abuse and neglect somewhat remained the subject of ignorance among dental professionals because of a lack of advance clinical training. Given these epidemic proportions, there is a scope of further research about dental school curriculum design. Purpose: This study aimed to assess the knowledge and attitude of dentists in Canada regarding signs and symptoms of child abuse and neglect (CAN), reporting procedures, and whether educational strategies followed by dental schools address this sensitive issue. In pursuit of that aim, this abstract summarizes the evidence related to this question. Materials and Methods: Data was collected through a specially designed questionnaire adapted and modified from the author’s previous cross-sectional study on (CAN), which was conducted in Pune, India, in 2016 and is available on the database of PubMed. Design: A random sample was drawn from the targeted population of registered dentists and dental students in Canada regarding their knowledge, professional responsibilities, and behavior concerning child abuse. Questionnaire data were distributed to 200 members. Out of which, a total number of 157 subjects were in the final sample for statistical analysis, yielding response of 78.5%. Results: Despite having theoretical information on signs and symptoms, 55% of the participants indicated they are not confident to detect child physical abuse cases. 90% of respondents believed that recognition and handling the CAN cases should be a part of undergraduate training. Only 4.5% of the participants have correctly identified all signs of abuse due to inadequate formal training in dental schools and workplaces. Although nearly 96.3% agreed that it is a dentist’s legal responsibility to report CAN, only a small percentage of the participants reported an abuse case in the past. While 72% stated that the most common factor that might prevent a dentist from reporting a case was doubt over the diagnosis. Conclusion: The goal is to motivate dental schools to deal with this critical issue and provide their students with consummate training to strengthen their capability to care for and protect children. The educational institutions should make efforts to spread awareness among dental students regarding the management and tackling of CAN. Clinical Significance: There should be modifications in the dental school curriculum focusing on problem-based learning models to assist graduates to fulfill their legal and professional responsibilities. CAN literacy should be incorporated into the dental curriculum, which will eventually benefit future dentists to break this intergenerational cycle of violence.

Keywords: abuse, child abuse and neglect, dentist knowledge, dental school curriculum, problem-based learning

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Authors: J. Palán, M. Zemko

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COMTES FHT has been active in a field of research and development of high-strength wires for quite some time. The main material was pure titanium. The primary goal of this effort is to develop a continuous production process for ultrafine and nanostructured materials with the aid of severe plastic deformation (SPD). This article outlines mechanical and microstructural properties of the materials and the options available for testing the components made of these materials. Ti Grade 2 and Grade 4 wires are the key products of interest. Ti Grade 2 with ultrafine to nano-sized grain shows ultimate strength of up to 1050 MPa. Ti Grade 4 reaches ultimate strengths of up to 1250 MPa. These values are twice or three times as higher as those found in the unprocessed material. For those fields of medicine where implantable metallic materials are used, bulk ultrafine to nanostructured titanium is available. It is manufactured by SPD techniques. These processes leave the chemical properties of the initial material unchanged but markedly improve its final mechanical properties, in particular, the strength. Ultrafine to nanostructured titanium retains all the significant and, from the biological viewpoint, desirable properties that are important for its use in medicine, i.e. those properties which made pure titanium the preferred material also for dental implants.

Keywords: CONFORM, ECAP, rotary swaging, titanium

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Authors: Ayhan Eymirli, Sila N. Usta

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The aim of this study is the comparison of the cyclic fatigue resistance of EndoArt Gold (EAG, Inci Dental, Istanbul, Turkey), EndoArt Blue (EAB, Inci Dental, Istanbul, Turkey), ProTaper Universal (PTU, Dentsply Tulsa Dental Specialties), and ProTaper Gold (PTG, Dentsply Tulsa Dental Specialties) files at body temperature. Twelve instruments of each EAG, EAB, PTU, PTG file system were included in this study. All selected files were rotated in the artificial canals, which have a 60° angle and a 5-mm radius of curvature until fracture occurred. The time to fracture (Ttf) was measured in seconds by a chronometer in the control panel that presents in the cyclic fatigue testing device when a fracture was detected visually and/or audibly. The lengths of the fractured fragments (FL) were also measured with a digital microcaliper. The data of Ttf and FL were analyzed using Kruskal-Wallis, one-way ANOVA and post hoc Bonferroni tests at the 5% significance level. There was a statistically significant difference among the file systems (p < 0.05). EAB had the statistically highest fatigue resistance, and PTU had the statistically lowest fatigue resistance (p < 0.05). PTG system had a statistically higher FL means than EAB and PTU file systems (p < 0.05). EAB had the greatest cyclic fatigue resistance amongst the other file systems. It can be stated that heat treatments may be a factor that increases fatigue resistance.

Keywords: cyclic fatigue resistance, Endo art blue, Endo art gold, pro taper gold, pro taper universal

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Authors: Ravi Sheshala, Annie Lee, Ai Lin Ong, Ling Ling Cheu, Thiagarajan Madheswaran, Thankur R. R. Singh

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The objectives of the present research work were to develop and characterize biodegradable controlled release photo cross-linked implants of Triamcinolone Acetonide (TA) for the treatment of chronic ocular diseases. The photo cross-linked implants were prepared using film casting technique by mixing TA (2.5%) polyethylene glycol diacrylate (PEGDA 700), pore formers (mannitol, maltose, and gelatin) and the photoinitiator (Irgacure 2959). The resulting mixture was injected into moulds using 21 G and subjected to photocrosslinking at 365 nm. Scanning electron microscopy results demonstrated that more pores were formed in the films with the increase in the concentration of pore formers from 2%-10%. The maximum force required to break the films containing 2-10% of pore formers were determined in both dry and wet conditions using texture analyzer and found that films in a dry condition required a higher force to break compared to wet condition and blank films. In vitro drug release from photo cross-linked films were determined by incubating samples in 50 ml PBS pH 7.4 at 37 C and the samples were analyzed for drug release by HPLC. The films demonstrated a biphasic release profile i.e. an initial burst release (<20%) on the first day followed by a constant and continuous drug release in a controlled manner for 42 days. The drug release from all formulations followed the first-order release pattern and the combination of diffusion and erosion release mechanism. In conclusion, the developed formulations were able to provide controlled drug delivery to treat the chronic ocular diseases.

Keywords: controlled release, ophthalmic, PEGDA, photocrosslinking, pore formers

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Authors: Marios Loucas, Rafael Loucas, Oliver Muensterer

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Aim of the Study: Over the last two years, there has been a substantial rise of refugees entering Germany, of which approximately one-third are underage. Little is known about the general state of health such as nutrition, dental status and post-traumatic stress disorder among underage refugees. Our study assesses the general health status of underage refugees based on a large sample cohort. Methods: After ethics board approval, we used a structured questionnaire to collect demographic information and health-related elements in 3 large refugee accommodation centers, focusing on nutritional and dental status, as well as symptoms of posttraumatic stress disorder. Main results: A total of 461 minor refugees were included. The majority were boys (54.5%), average age was 8 years. Out of the 8 recorded countries of origin, most children came from Syria (33.6%), followed by Afghanistan (23.2%). Of the participants, 50.3% reported DSM-5 criteria of Posttraumatic stress disorder and presented mental health-related problems. The most frequently reported mental abnormalities were concentration disturbances (15.2%), sleep disorders (6.9%), unclear headaches (5.4%). The majority of the participants showed an unfavorable nutritional and dental status. According to the family, the majority of the children rarely eat healthy foods such as fruits, vegetables and fish. However, the majority of these children (over 90%) consume a large quantity of sugary foods and sweetened drinks such as soft drinks and confectionery at least daily. Caries was found in 63% of the minor children included in the study. A large proportion (47%) reported never brushing their teeth. According to the family, 78.3% of refugee children have never been evaluated by a dentist in Germany. The remainder visited a dentist mainly because of unbearable toothache. Conclusions: Minor refugees have specific psychological, nutritional and dental problems that must be considered in order to ensure appropriate medical care. Posttraumatic stress disorder is mainly caused by physical and emotional trauma suffered either during the flight or in the refugee camp in Germany. These data call for widespread screening of psychological, dental and nutritional problems in underage refugees. Dental care of this cohort is completely inadequate. Nutritional programs should focus on educating the families and providing the means to obtain healthy foods for these children.

Keywords: children, nutrition, posttraumatic stress disorder, refugee

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Authors: Ghazal Mortazavi, S. M. J. Mortazavi

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Electricians, power line engineers and power station workers, welders, aluminum reduction workers, MRI operators and railway workers are occupationally exposed to different levels of electromagnetic fields. Mercury is among the most toxic metals. Dental amalgam fillings cause significant exposure to elemental mercury vapour in the general population. Today, substantial evidence indicates that mercury even at low doses may lead to toxicity. Increased release of mercury from dental amalgam fillings after exposure to MRI or microwave radiation emitted by mobile phones has been previously shown by our team. Moreover, our recent studies on the effects of stronger magnetic fields entirely confirmed our previous findings. From the other point of view, we have also shown that papers which reported no increased release of mercury after MRI, may have some methodological flaws. Over the past several years, our lab has focused on the health effects of exposure of laboratory animals and humans to different sources of electromagnetic fields such as mobile phones and their base stations, mobile phone jammers, laptop computers, radars, dentistry cavitrons, and MRI. As a strong association between exposure to electromagnetic fields and mercury level has been found in our studies, our findings lead us to this conclusion that occupational exposure to electromagnetic fields in workers with dental amalgam fillings can lead to elevated levels of mercury. Studies which reported that exposure to mercury can be a risk factor of Alzheimer’s disease (AD) due to the accumulation of amyloid beta protein (Aβ) in the brain and those reported that long-term occupational exposure to high levels of electromagnetic fields can increase the risk of Alzheimer's disease and dementia in male workers support our concept and confirm the significant role of the occupational exposure to electromagnetic fields in increasing the mercury level in workers with amalgam fillings.

Keywords: occupational exposure, electromagnetic fields, workers, mercury release, dental amalgam, restorative dentistry

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Authors: Fatemeh Jannesarvatan, Ghazaal Parastooei, Jimmy frerejan, Saedeh Mokhtari, Peter Van Rosmalen

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Medical and dental education increasingly emphasizes the acquisition, integration, and coordination of complex knowledge, skills, and attitudes that can be applied in practical situations. Instructional design approaches have focused on using real-life tasks in order to facilitate complex learning in both real and simulated environments. The Four component instructional design (4C/ID) model has become a useful guideline for designing instructional materials that improve learning transfer, especially in health profession education. The objective of this study was to apply the 4C/ID model in the creation of virtual patients (VPs) that dental students can use to practice their clinical management and clinical reasoning skills. The study first explored the context and concept of complication factors and common errors for novices and how they can affect the design of a virtual patient program. The study then selected key dental information and considered the content needs of dental students. The design of virtual patients was based on the 4C/ID model's fundamental principles, which included: Designing learning tasks that reflect real patient scenarios and applying different levels of task complexity to challenge students to apply their knowledge and skills in different contexts. Creating varied learning materials that support students during the VP program and are closely integrated with the learning tasks and students' curricula. Cognitive feedback was provided at different levels of the program. Providing procedural information where students followed a step-by-step process from history taking to writing a comprehensive treatment plan. Four virtual patients were designed using the 4C/ID model's principles, and an experimental design was used to test the effectiveness of the principles in achieving the intended educational outcomes. The 4C/ID model provides an effective framework for designing engaging and successful virtual patients that support the transfer of knowledge and skills for dental students. However, there are some challenges and pitfalls that instructional designers should take into account when developing these educational tools.

Keywords: 4C/ID model, virtual patients, education, dental, instructional design

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Authors: Astika Swastirani

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Chronological age estimation can be done by looking at the stage of growth and development of teeth from orthopantomogram and mandibular remodeling from lateral cephalogram. Mandibular morphological changes associated with the size and remodeling during growth is a strong indicator of age estimation. These changes can be observed with lateral cephalogram. Objective: To prove the difference between chronological age and age estimation using orthopantomogram (dental age) and lateral cephalogram (skeletal age). Methods: Sample consisted of 100 medical records, 100 orthopantomograms digital and 100 lateral cephalograms digital belongs to 50 male and 50 female of Airlangga University hospital of dentistry. Orthopantomogram were matched with London atlas and lateral cephalograms were observed by digital tracing. The difference of dental age and skeletal age was analyzed by pair t –test. Result: Result of the pair t-test between chronological age and dental age in male (p-value 0.002, p<0.05), in female (p-value 0.605, p>0.05). Result of pair t-test between the chronological age and skeletal age (variable length Condylion-Gonion, Gonion-Gnathion, Condylion-Gnathion in male (p-value 0.000, p<0.05) in female (variable Condylion-Gonion length (p-value 0.000, Condylion-Gnathion length (p-value 0,040) and Gonion-Gnathion length (p-value 0.493). Conclusion: Orthopantomogram with London atlas and lateral cephalograms with Gonion- Gnathion variable can be used for age estimation in female. Orthopantomogram with London atlas and lateral cephalograms with Condylion-Gonion variable, Gonion-Gnathion variable and Condylion-Gnathion can not be used for age estimation in male.

Keywords: age estimation, chronological age, dental age, skeletal age

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Authors: Minjung Park, Jimin Park, Youngwoon Kim, Hyungseop Han, Myoungryul Ok, Hojeong Jeon, Hyunkwang Seok, Yuchan Kim

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Magnesium is an essential element in human body and has unique characteristics such as bioabsorbable and biodegradable properties. Therefore, there has been much attention on studies on the implants based on magnesium to avoid subsequent surgery. However, high amount of hydrogen gas is generated by relatively severe corrosion of magnesium especially in aqueous condition with chloride ions. And it contributes to the causes of swelling of skin and causes consequent inflammation of soft tissue where is directly in contact with implants. Therefore, there is still concern about the safety of the using biodegradable magnesium alloys, which is limited to various applications. In this study, we analyzed the influence of coenzyme on corrosion behavior of magnesium. The analysis of corrosion rate was held by using Hanks’ balanced salt solution (HBSS) as a body stimulated fluid and in condition of 37°C. Thus, with deferring the concentration of the coenzyme used in this study, corrosion rates from 0.0654ml/ cm² to 0.0438ml/cm² were observed in immersion tests. Also, comparable results were obtained in electrochemical tests. Results showed that hydrogen gas produced from corrosion of magnesium can be controlled.

Keywords: biodegradable magnesium, biomaterials, coenzyme, corrosion

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Authors: Trad Khodja Rafik, Mahtout Amine, Ghoul Rachid, Benbouali Amine, Boulahlib Amine, Hariza Abdelmalik

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Cranioplasty with custom implant realized using 3D printing technology. Cranioplasty is a surgical act that aims restoring cranial bone losses in order to protect the brain from external aggressions and to improve the patient aesthetic appearance. This objective can be achieved with taking advantage of the current technological development in computer science and biomechanics. The objective of this paper it to present an approach for the realization of high precision biocompatible cranial implants using new 3D printing technologies at the lowest cost. The proposed method is to reproduce the missing part of the skull by referring to its healthy contralateral part. Once the model is validated by the neurosurgeons, a mold is 3D printed for the production of a biocompatible implant in Poly-Methyl-Methacrylate (PMMA) acrylic cement. Using this procedure four patients underwent this procedure with excellent aesthetic results.

Keywords: cranioplasty, cranial bone loss, 3D printing technology, custom-made implants, PMMA

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Authors: Dae Kyung Choi, Won Man Park, Kyungsoo Kim, Yoon Hyuk Kim

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The interspinous process devices have been recently used due to its advantages such as minimal invasiveness and less subsidence of the implant to the osteoporotic bone. In this paper, we have analyzed the influences of ligature tightening of several interspinous process devices using finite element analysis. Four types of interspinous process implants were inserted to the L3-4 spinal motion segment based on their surgical protocols. Inferior plane of L4 vertebra was fixed and 7.5 Nm of extension moment were applied on superior plane of L3 vertebra with 400N of compressive load along follower load direction and pretension of the ligature. The stability of the spinal unit was high enough than that of intact model. The higher value of pretension in the ligature led the decrease of dynamic stabilization effect in cases of the WallisTM, DiamTM, Viking, and Spear®. The results of present study could be used to evaluate surgical option and validate the biomechanical characteristics of the spinal implants.

Keywords: interspinous process device, bone fracture risk, lumbar spine, finite element analysis

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Authors: Awais Ali, Hesham Ali

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The absence of teeth through either premature loss or developmental absence is a common condition with potentially severe impact on affected individuals. Management of these cases presents a clinical challenge which may be difficult to resolve given the effects of tooth loss or hypodontia over the course of a patient’s lifetime. Treatment of such cases is often best provided by a multi-disciplinary team, where the patient’s expectations and care delivery can be optimally managed. Orthodontic treatment is often used to prepare the dentition in advance of restorative replacement of missing teeth. Conversely, the placement of implants may precede the delivery of orthodontic treatment and indeed may function as an adjunctive orthodontic procedure. We discuss the use of both approaches here and illustrate their clinical implementation with two case reports. The first case demonstrates the use of fixed appliances to prepare the mouth for an opposing implant-retained complete denture. A second case demonstrates the use of implant-retained crowns to provide orthodontic anchorage in a partially dentate patient. We propose that complex cases such as these should always be planned and treated by a multi-disciplinary team in order to optimise the delivery of care, patient experience, and treatment outcome. The presented cases add to the body of evidence in this area.

Keywords: orthodontics, dental implantology, hypodontia, multi-disciplinary

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Authors: Athanasios Triantafyllou, Georgios Papagiannis, Vassilios Nikolaou, Panayiotis J. Papagelopoulos, George C. Babis

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In vitro measurements are widely used in order to predict THAs wear rate implementing gait kinematic and kinetic parameters. Clinical tests of materials and designs are crucial to prove the accuracy and validate such measurements. The purpose of this study is to examine the affection of THA gait kinematics and kinetics on wear during gait, the essential functional activity of humans, by comparing in vivo gait data to in vitro results. Our study hypothesis is that both implants will present the same hip joint kinematics and kinetics during gait. 127 unilateral primary cementless total hip arthroplasties were included in the research. Independent t-tests were used to identify a statistically significant difference in kinetic and kinematic data extracted from 3D gait analysis. No statistically significant differences observed at mean peak abduction, flexion and extension moments between the two groups (P.abduction= 0,125, P.flexion= 0,218, P.extension= 0,082). The kinematic measurements show no statistically significant differences too (Prom flexion-extension= 0,687, Prom abduction-adduction= 0,679). THA kinematics and kinetics during gait are important biomechanical parameters directly associated with implants wear. In vitro studies report less wear in CoC than CoXLPE when tested with the same gait cycle kinematic protocol. Our findings confirm that both implants behave identically in terms of kinematics in the clinical environment, thus strengthening in vitro results of CoC advantage. Correlated to all other significant factors that affect THA wear could address in a complete prism the wear on CoC and CoXLPE.

Keywords: total hip arthroplasty biomechanics, THA gait analysis, ceramic on ceramic kinematics, ceramic on XLPE kinetics, total hip replacement wear

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Authors: Abdulsalam A. Al-Tamimi, Chris Peach, Paulo Rui Fernandes, Paulo J. Bartolo

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Bone fixation implants currently used to treat traumatic fractured bones and to promote fracture healing are built with biocompatible metallic materials such as stainless steel, cobalt chromium and titanium and its alloys (e.g., CoCrMo and Ti6Al4V). The noticeable stiffness mismatch between current metallic implants and host bone associates with negative outcomes such as stress shielding which causes bone loss and implant loosening leading to deficient fracture treatment. This paper, part of a major research program to design the next generation of bone fixation implants, describes the combined use of three-dimensional (3D) topology optimization (TO) and additive manufacturing powder bed technology (Electron Beam Melting) to redesign and fabricate the plates based on the current standard one (i.e., locking compression plate). Topology optimization is applied with an objective function to maximize the stiffness and constraint by volume reductions (i.e., 25-75%) in order to obtain optimized implant designs with reduced stress shielding phenomenon, under different boundary conditions (i.e., tension, bending, torsion and combined loads). The stiffness of the original and optimised plates are assessed through a finite-element study. The TO results showed actual reduction in the stiffness for most of the plates due to the critical values of volume reduction. Additionally, the optimized plates fabricated using powder bed techniques proved that the integration between the TO and additive manufacturing presents the capability of producing stiff reduced plates with acceptable tolerances.

Keywords: additive manufacturing, locking compression plate, finite element, topology optimization

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Authors: Atin Adhikari, Sushma Kurella, Pratik Banerjee, Nabanita Mukherjee, Yamini M. Chandana Gollapudi, Bushra Shah

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Different sharp instruments, drilling machines, and high speed rotary instruments are routinely used in dental clinics during dental cleaning. Therefore, these cleaning procedures release a lot of oral microorganisms including bacteria in clinic air and may cause significant occupational bioaerosol exposure risks for dentists, dental hygienists, patients, and dental clinic employees. Two major goals of this study were to quantify volumetric airborne concentrations of bacteria and to assess overall microbial activity in this type of occupational environment. The study was conducted in several dental clinics of southern Georgia and 15 dental cleaning procedures were targeted for sampling of airborne bacteria and testing of overall microbial activity in settled dusts over clinic floors. For air sampling, a Biostage viable cascade impactor was utilized, which comprises an inlet cone, precision-drilled 400-hole impactor stage, and a base that holds an agar plate (Tryptic soy agar). A high-flow Quick-Take-30 pump connected to this impactor pulls microorganisms in air at 28.3 L/min flow rate through the holes (jets) where they are collected on the agar surface for approx. five minutes. After sampling, agar plates containing the samples were placed in an ice chest with blue ice and plates were incubated at 30±2°C for 24 to 72 h. Colonies were counted and converted to airborne concentrations (CFU/m3) followed by positive hole corrections. Most abundant bacterial colonies (selected by visual screening) were identified by PCR amplicon sequencing of 16S rRNA genes. For understanding overall microbial activity in clinic floors and estimating a general cleanliness of the clinic surfaces during or after dental cleaning procedures, ATP levels were determined in swabbed dust samples collected from 10 cm2 floor surfaces. Concentration of ATP may indicate both the cell viability and the metabolic status of settled microorganisms in this situation. An ATP measuring kit was used, which utilized standard luciferin-luciferase fluorescence reaction and a luminometer, which quantified ATP levels as relative light units (RLU). Three air and dust samples were collected during each cleaning procedure (at the beginning, during cleaning, and immediately after the procedure was completed (n = 45). Concentrations at the beginning, during, and after dental cleaning procedures were 671±525, 917±1203, and 899±823 CFU/m3, respectively for airborne bacteria and 91±101, 243±129, and 139±77 RLU/sample, respectively for ATP levels. The concentrations of bacteria were significantly higher than typical indoor residential environments. Although an increasing trend for airborne bacteria was observed during cleaning, the data collected at three different time points were not significantly different (ANOVA: p = 0.38) probably due to high standard deviations of data. The ATP levels, however, demonstrated a significant difference (ANOVA: p <0.05) in this scenario indicating significant change in microbial activity on floor surfaces during dental cleaning. The most common bacterial genera identified were: Neisseria sp., Streptococcus sp., Chryseobacterium sp., Paenisporosarcina sp., and Vibrio sp. in terms of frequencies of occurrences, respectively. The study concluded that bacterial exposure in dental clinics could be a notable occupational biohazard, and appropriate respiratory protections for the employees are urgently needed.

Keywords: bioaerosols, hospital hygiene, indoor air quality, occupational biohazards

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Authors: Saule Mussabekova

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Forensic investigation of human teeth plays an important role in detection of crime, particularly in cases of personal identification of dead bodies changed by putrefactive processes or skeletonized bodies as well as when finding bodies of unknown persons. 152 teeth have been investigated; 85 of them belonged to men and 67 belonged to women taken from alive people of different age. Teeth have been investigated after extraction. Two types of teeth have been investigated: teeth without integrity violation of dental crown and teeth with different degrees of its violation. Additionally, 517 teeth have been investigated that were collected from dead bodies, 252 of which belonged to women and 265 belonged to men, whatever the cause of death with death limitation from 1 month to 20 years. Isohemagglutinating serums and Coliclons of different series have been used for the research of tooth-group specificity by serological methods according to the AB0 system. Standard protocols of different techniques have been used for DNA purification from teeth (by reagent Chelex 100 produced by Bio-Rad using reagent kit 'DNA IQTM System' produced by Promega company (USA) and using columns 'QIAamp DNA Investigator Kit' produced by Qiagen company). Results of comparative forensic investigation of human teeth using serological and molecular genetic methods have shown that use of serological methods for forensic identification is sensible only in cases of preselection prior to the next molecular genetic investigation as well as in cases of impossibility of corresponding genetic investigation for different objective reasons. A number of advantages of methods of molecular genetics in the dental investigation have been marked, particularly in putrefactive changes, in personal identification. Key moments of modern condition of personal identification have been reflected according to dental state. Prospective directions of advance preparation of material have been emphasized for identification of teeth in forensic practice.

Keywords: dental state, forensic identification, molecular genetic analysis, teeth

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Authors: Magdalena Korytowska, Gunnar Lengstrand, Cecilia Larsson Wexell

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Background: Breast cancer (BC) is the most common cancer among women worldwide, and cases are continuing to increase in Sweden. Bone is the most common metastatic site in breast cancer patients, where > 65-75% of women with advanced breast cancer develop bone metastases during their disease. To prevent the skeletal-related events of metastases (e.g., pathological fractures, bone loss, cancer-induced bone pain, and hypercalcemia bone), two different classes of antiresorptive medications (AR), bisphosphonate and denosumab are typically administered every 3 to 4 weeks. Since 2015, adjuvant bisphosphonate treatment has been used every six months for three to five years in postmenopausal women for the prevention of skeletal metastases and improved survival. Methods: A case-control study was conducted to test the hypotheses that patients treated with high-dose AR are at higher risk of developing MRONJ than breast cancer patients with adjuvant bisphosphonate treatment at a lower dose. Medical and odontological data was collected between 2015-2020. Assessment of oral health and dental care before and during oncological treatment took place at the specialist clinic for Orofacial medicine linked to the specific hospital. Results: In total, 220 patients were included, 101 patients in the high-dose group and 119 patients in the adjuvant BP-treatment group. MRONJ was diagnosed in 13 patients (14%) in the high-dose group. The mandible was affected in most of the cases (84.6%), with a mean duration of high-dose treatment of 19.7 months. In 46.2% of cases, no dental cause of MRONJ could be identified. Overall, estrogen receptor-positive (ER+) BC was the most representative type in 172 patients (78.2%). However, this was 83.9% in the high-dose cases group. The most used drug was denosumab. Twenty-five patients (26.9%) switched their medication from ZOL to denosumab during their oncological treatment. Patients with ER+ breast cancer were reported in 88 patients (87.8%) in the adjuvant group that was treated with ZOL. Conclusions: MRONJ was diagnosed only in the high-dose AR group. Dental assessment and care of patients in the adjuvant group should be considered, with a recommendation to potentially prolong ZOL treatment from 3 to 5 years, with concomitant use of hormonal therapy in patients diagnosed with ER+ breast cancer to prevent bone loss induced by oncological treatment. A new referral for dental assessment is very important in the case of bone metastases when treatment with high dose AR will be required since it is associated with a higher risk of MRONJ.

Keywords: antiresorptive therapy, breast cancer, dental care, MRONJ

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Authors: Sonam Behl, Raju, Ginu Rajan, Paul Farrar, B. Gangadhara Prusty

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Reinforcing dental composites with micro-sized fibres can significantly improve the physio-mechanical properties of dental composites. The short fibres can be oriented randomly within dental composites, thus providing quasi-isotropic reinforcing efficiency unlike unidirectional/bidirectional fibre reinforced composites enhancing anisotropic properties. Thus, short fibres reinforced dental composites are getting popular among practitioners. However, despite their popularity, resin-based dental composites are prone to failure on account of shrinkage during photo polymerisation. The shrinkage in the structure may lead to marginal gap formation, causing secondary caries, thus ultimately inducing failure of the restoration. The traditional methods to evaluate polymerisation shrinkage using strain gauges, density-based measurements, dilatometer, or bonded-disk focuses on average value of volumetric shrinkage. Moreover, the results obtained from traditional methods are sensitive to the specimen geometry. The present research aims to evaluate the real-time shrinkage strain at selected locations in the material with the help of optical fibre Bragg grating (FBG) sensors. Due to the miniature size (diameter 250 µm) of FBG sensors, they can be easily embedded into small samples of dental composites. Furthermore, an FBG array into the system can map the real-time shrinkage strain at different regions of the composite. The evaluation of real-time monitoring of shrinkage values may help to optimise the physio-mechanical properties of composites. Previously, FBG sensors have been able to rightfully measure polymerisation strains of anisotropic (unidirectional or bidirectional) reinforced dental composites. However, very limited study exists to establish the validity of FBG based sensors to evaluate volumetric shrinkage for randomly oriented fibres reinforced composites. The present study aims to fill this research gap and is focussed on establishing the usage of FBG based sensors for evaluating the shrinkage of dental composites reinforced with randomly oriented fibres. Three groups of specimens were prepared by mixing the resin (80% UDMA/20% TEGDMA) with 55% of silane treated BaAlSiO₂ particulate fillers or by adding 5% of micro-sized fibres of diameter 5 µm, and length 250/350 µm along with 50% of silane treated BaAlSiO₂ particulate fillers into the resin. For measurement of polymerisation shrinkage strain, an array of three fibre Bragg grating sensors was embedded at a depth of 1 mm into a circular Teflon mould of diameter 15 mm and depth 2 mm. The results obtained are compared with the traditional method for evaluation of the volumetric shrinkage using density-based measurements. Degree of conversion was measured using FTIR spectroscopy (Spotlight 400 FT-IR from PerkinElmer). It is expected that the average polymerisation shrinkage strain values for dental composites reinforced with micro-sized fibres can directly correlate with the measured degree of conversion values, implying that more C=C double bond conversion to C-C single bond values also leads to higher shrinkage strain within the composite. Moreover, it could be established the photonics approach could help assess the shrinkage at any point of interest in the material, suggesting that fibre-Bragg grating sensors are a suitable means for measuring real-time polymerisation shrinkage strain for randomly fibre reinforced dental composites as well.

Keywords: dental composite, glass fibre, polymerisation shrinkage strain, fibre-Bragg grating sensors

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Authors: Dong Xie, Yuling Xu, Leah Howard

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Secondary caries is found to be one of the main reasons to the restoration failure of dental restoratives. To prevent secondary caries formation, dental restoratives ought to be made antibacterial. In this study, a natural fruit component furaneol was tethered onto polyacid, the formed polyacid was used to formulate the light-curable glass-ionomer cements, and then the effect of this new antibacterial compound on compressive strength (CS) and antibacterial activity of the formed cement was evaluated. Fuji II LC glass powders were used as fillers. Compressive strength (CS) and S. mutans viability were used to evaluate the mechanical strength and antibacterial activity of the formed cement. The experimental cement showed a significant antibacterial activity, accompanying with an initial CS reduction. Increasing the compound loading significantly decreased the S. mutans viability from 5 to 81% and also reduced the initial CS of the formed cements from 4 to 58%. The cement loading with 7% antibacterial polymer showed 168 MPa, 7.8 GPa, 243 MPa, 46 MPa, and 57 MPa in yield strength, modulus, CS, diametral tensile strength and flexural strength, respectively, as compared to 141, 6.9, 236, 42 and 53 for Fuji II LC. The cement also showed an antibacterial function to other bacteria. No human saliva effect was noticed. It is concluded that the experimental cement may potentially be developed to a permanent antibacterial cement.

Keywords: antibacterial, dental materials, strength, cell viability

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Authors: A. Srion, W. Thepsuwan, N. Monmaturapoj

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Two Lithium disilicate (LD) glass ceramics based on SiO2-Li2O-K2O-Al2O3 system were prepared through glass melting method and then fabricated into dental crowns via hot pressing at 850˚C and 900˚C in order to study the effect of the pressing temperatures on theirs phase formation and microstructure. The factor such as heat treatment temperature (as-cast glass, 600˚C and 700˚C) of the glass ceramics used to press was also investigated the effect of an initial microstructure before pressing. X-ray diffraction (XRD) and scanning electron microscopy (SEM) were used to determine phase formation and microstructure of the samples, respectively. X-ray diffraction result shows that the main crystalline structure was Li2Si2O5 by having Li3PO4, Li0.6Al0.6Si2O6, Li2SiO3, Ca5 (PO4)3F, SiO2 as minor phases. Glass compositions with different heat treatment temperatures exhibited a difference phase formation but have less effect during pressing. Scanning electron microscopy analysis showed microstructure of lath-like of Li2Si2O5 in all glasses. With increasing the initial heat treatment temperature, the longer the lath-like crystals of lithium disilicate were increased especially when using glass heat treatment at 700˚C followed by pressing at 900˚C. This could be suggested that LD1 heat treatment at 700˚C which pressing at 900˚C presented the best formation by hot pressing and compiled microstructure.

Keywords: lithium disilicate, hot pressing, dental crown, microstructure

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Authors: Edit Xhajanka, Gresa Baboci, Irene Malagnino, Mimoza Canga, Vito Antonio Malagnino

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Purpose: This study aimed at identifying dental caries increment or reduction, based on factors such as smoking, the scaling of teeth, BMI before and during pregnancy, carbohydrates consumption in relation to childbirth. Material and method: In this observational study, the sample included a total of 98 pregnant women and their age class was 18-45 years old, with a median age of 31.5 years. The setting of the participants resides in Vlora –Albania. Moreover, 64.4% were from the city and 35.6% were from the nearby villages. The study was conducted in the time period January 2018 –June 2021. Body mass index (BMI) was calculated using the standard formula (kg/m²). Maternal pre, during and post-pregnancy BMI was collected by using a validated questionnaire. Statistical analysis was performed using IBM SPSS Statistics 23.0. The significance level (α) was set at 0.05, whereas P-value and analysis of variance (ANOVA) were used to analyze the data. Results: Based on the data analysis, 44.4% of the sample declared that they did smoke before pregnancy and 55.6% not smoked during their pregnancy. As a result, no association was found between smoking and length of pregnancy P=0.95. There is also a strong relation (P=0.000) between the number of teeth with caries before pregnancy and the number of teeth with caries during pregnancy. There is a significant relationship between the scaling of teeth and childbirth, P=0.05. BMI before and during pregnancy in relation to carbohydrates consumption have a significant correlation P=0.004 and P=0.002. The values of BMI before and during pregnancy in relation to childbirth have a strong correlation: P=0.043 and P=0.040, respectively. As a result, obesity was associated with preterm birth. The percentage of children born during 34-36 weeks of pregnancy was 69%, and children born during 32-34 weeks of pregnancy were 31%. CONCLUSION: There was a positive association between dental caries experience, BMI and carbohydrates consumption. Obesity in pregnancy is increasing worldwide; that is why this study suggests the importance of an appropriate weight before and during pregnancy.

Keywords: BMI, dental caries, pregnancy, scaling, smoking

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Authors: Fernanda A. Vechietti, Natália O. B. Muniz, Laura C. Treccani, Kurosch. Rezwan, Luis Alberto dos Santos

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CoCr alloys are widely used in prosthetic implants due to their excellent mechanical properties, such as good tensile strength, elastic modulus and wear resistance. Their biocompatibility and lack of corrosion are also prominent features of this alloy. One of the most effective and simple ways to protect metal’s surfaces are treatments, such as electrochemical oxidation by passivation, which is used as a protect release of metallic ions. Another useful treatment is the electropolishing, which is used to reduce the carbide concentration and protrusion at the implanted surface. Electropolishing is a cheap and effective method for treatment of implants, which generally has complex geometries. The purpose of this study is surface modification of the alloy CoCr(ASTM F90-09) by different methods: polishing, electro polishing, passivation and heat treatment for application as biomaterials. The modification of the surface was studied and characterized by SEM, profilometry, wettability and compared to the surface of the samples untreated. The heat treatment and of passivation increased roughness (0.477 µm and 0.825 µm) the samples in relation the sample electropolished and polished(0.131 µm and 0.274 µm) and were observed the improve wettability’s with the increase the roughness.

Keywords: biomaterial, CoCr, surface treatment, heat treatment, roughness

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Authors: Ceri McIntosh

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A 25-year-old male was referred to the Maxillofacial department by his general dental practitioner with a complaint of mobile teeth. Medically he was well though he took mirtazapine for anxiety. He was found to have had previous extractions of the lower right second premolar and first molar, with grade 2 mobility of the upper right first and second molars and lower right lateral incisor. Radiographically there was significant external root resorption of these teeth, which were subsequently extracted. Over the next 18 months, the resorption continued around multiple teeth on the right side, and when the mobile teeth were removed, they showed no remaining root, including loss of coronal dentine, leaving only an enamel shell. No cause has been identified either histologically or in the patient’s blood work. A review of relevant literature will be included in this case report.

Keywords: case report, idiopathic resorption, idiopathic root resorption, external resorption

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