Evolution of Chewing Force in Geriatric Edentulous Patients

Objective The aim of this study was to assess the evolution of chewing force in edentulous geriatric patients rehabilitated with complete dentures. Chewing function is compromised in individuals who lose all their teeth, as well as in those with complete dentures. The maintenance and recovery of the chewing function in these patients require replacement of the lost natural teeth. Materials and Methods In this study, the chewing force was evaluated by electromyographic analysis of the temporalis and masseter muscle endings in 120 patients with old and new bimaxillary complete dentures. Results Replacement of complete dentures was shown to improve stability, retention, occlusion, and support of the prosthesis. All jaw movements were evaluated using electromyography to assess the evolution of chewing force with and without occlusal adjustment, identify premature contact points, identify occlusal interference, respect the balanced occlusal scheme, and assess the increase in muscle strength. This study found that muscle strength in patients with prosthesis without occlusal adjustment was 527.1 N but was higher for prostheses with occlusal adjustment at 614.7 N, and this strength of 614.7 N was maintained after 1 month of control. Conclusion The chewing force evolved in patients with complete dentures, and an increase was observed when occlusal adjustment was performed.

Perception, Knowledge, and Professional Behavior of Dentists about Silver Diamine Flouride: A Nationwide Survey

Objectives The aim of this study was to survey the educational experiences, knowledge, and attitude of dentists in Pakistan about the professional use of silver diamine fluoride (SDF). This study also aimed to determine if SDF educational experience at the undergraduate level can result in a more positive attitude and increased clinical usage of SDF. Materials and Methods This was a cross-sectional survey, conducted at multiple dental institutes across Pakistan using a pre-validated questionnaire to assess the knowledge, experience, and professional expertise of dentists regarding the use of SDF. The data were entered and analyzed using the SPSS (version 23.0) data management software by IBM. Results The results of this study were deemed significant in terms of achievement of the study aims. The majority of the responders, 178 (79.8%), reported online resources to be the main source of information about SDF treatment, whereas 103 (46.1%) responders gained information from a dental journal. A higher number of consultants were reported to be well educated regarding SDF treatment during their residency training as compared with demonstrators, house officers, and postgraduate trainees (p < 0.001). About 64 (28.7%) responders agreed that SDF is a better alternative treatment for children with behavioral issues, 74 (33.2%) agreed that it is a better treatment option for medically fragile patients, and 79 (35.4%) agreed that it can be used as an alternative for patients with dental anxiety. It was agreed by 82 (36.8%) responders that SDF is a good treatment option for patients who recently have received chemotherapy radiation therapy. Conclusion It is the need of time to put all educational efforts together to enhance knowledge regarding the use, advantages, and potential problems of SDF.

Salivary Atopy Biomarkers in Patients with Geographic Tongue

Objectives Geographic tongue is the mucositis of the dorsal surface of the tongue with no definite etiology, although it may be associated with atopic conditions. In this study, the salivary immunoglobulin E (IgE) and eosinophilic cationic protein (ECP) levels were assessed in patients with geographic tongue to examine the relationship between this condition and allergy-related biomarkers. Materials and Methods In this case-control study, unstimulated saliva was collected from 45 geographic tongue patients and 45 controls, and the salivary IgE and ECP levels were assessed. The data were analyzed with SPSS 20.0 using the Mann–Whitney test with a significance level of p < 0.05. Results The salivary IgE level in the case and control groups was 123.76 ± 8.1 and 74.34 ± 6.2 IU/mL, respectively, and the salivary ECP level was 9.4 ± 6.0 and 7.6 ± 3.2 ng/mL, respectively. There was a statistically significant difference between the two groups in terms of salivary IgE (p = 0.007) and ECP (p = 0.001) levels. Conclusion Salivary IgE and ECP levels increase in patients with geographic tongue. They can, therefore, be used for the initial diagnostic workup and to investigate the possible association of geographic tongue with allergic reactions.

Push-Out Bond Strength of Composite Polymerization Methods with Universal Adhesive to Coronal Dentin

Objective This in vitro study was aimed to determine the effect of composite polymerization methods with universal adhesive on push-out bond strength in coronal dentin. Materials and Methods Using 48 healthy premolar teeth, the almost conical access cavities were excised to the canal entry. Cavity preparations were treated with a universal adhesive in the self-etch mode. Teeth were randomly divided into four groups (n = 12). It was used to restore the cavities with a bulk-fill composite; Tetric N-Ceram, a conventional composite; Filtek Z250, a dual-cure composite; Rebilda DC VOCO, and chemical cure composite; Master-Dent. After applying 10,000 thermal cycles, 1-mm incisions were made in coronal dentin, and slices were placed in a UTM machine in a special jig and tested for push-out bond strength at a crosshead speed of 0.5 mm/min. Data were analyzed using one-way analysis of variance and Games–Howell tests (p < 0.05). Results The highest mean bond strength was of the conventional composite (18.36 ± 5.63) and the lowest mean of bond strength was for the dual-cure composite (5.10 ± 2.74). There was a significant difference among the means of bond strength for various composite resins curing (p < 0.001). Conclusion The bulk-fill and conventional light-cured composites had higher bond strength than self- and dual-cured composite resins.

A Case of Pott's Puffy Tumor from Odontogenic Source

Pott's puffy tumor (PPT) is a known complication of frontal sinusitis. Odontogenic maxillary sinusitis can seldomly spread to involve the frontal sinus but has not been implicated in the development of PPT. Herein, we describe a case of frontal sinusitis originating from an odontogenic source and culminating in PPT.

Effect of Eugenol on Streptococcus mutans Adhesion on NiTi Orthodontic Wires: In Vitro and In Vivo Conditions

Objective The purpose of this study was to compare the antibacterial effect of two types of Eugenol against Streptococcus mutans and then assess the effect of different concentrations of two types of Eugenol on S. mutans adhesion on Nickel-Titanium (NiTi) orthodontic wires in comparison to in vivo wires with fluoride-based hygiene regimen. Material and methods Culture of Streptococcus mutans with NiTi orthodontic wires was done. Different media were prepared by adding 100%, 50%, 25%, and 12.5% of two origins of Eugenol (one biological obtained by hydrodistillation of Syzygium aromaticum and one chemical already prepared available in drugstores for dental use (Idental, MOROCCO, lot number: UAN/17–211/1). Three sizes of NiTi wires (0.016 inch, 0.016 × 0.022 inch, 0.017 × 0.025 inch) were retrieved from adult patients undergoing orthodontic treatment after 1 month of setting them up in the mouth. After incubation, colony forming unites were calculated and a SEM analysis was done to the surface of each wire. ANOVA test was done between all groups to find statistical differences and post-hoc t-test with Bonferroni analysis was performed to elucidate differences between all groups with α = 0.05. Results Eugenol has an anti-bacterial effect against S. mutans. The biological Eugenol has greater effect than the chemical one. The same observations were done for anti-adherent effect, the biological Eugenol demonstrated the highest anti-adherent effect at all concentrations while the effect of the chemical Eugenol was the lowest. Conclusions The origin and the extraction mode of Eugenol have a crucial role in its antimicrobial and anti-adherent effect. Eugenol might constitute an alternative to Fluoride because it has an anti-adherent effect, limiting the incidence of white spot lesions.

Biomechanical Assessment of the Influence of Inlay/Onlay Design and Material on Stress Distribution in Nonvital Molars

Objectives The aim of this study was to evaluate the influence of inlays/onlays with or without pulp extension from different materials on stress distribution in endodontically treated molars by three-dimensional finite element analysis (3D FEA). Materials and Methods We used 3D mandibular molar models in this study. The models represented mesio-occluso-distal (MOD) cavities restored by inlays, onlays that covered buccal cusps, and onlays that covered all cusps with pulp extension (modified inlay/onlay) or without pulp extension (conventional inlay/onlay). Three materials (L: lithium disilicate glass-ceramic, P: polymer-infiltrated ceramic network [PICN], and C: nanofilled composite resin) were utilized. A force of 600 N was applied vertically and obliquely. Stress distribution in FEA models was analyzed using the von Mises theory. Results The results revealed that an oblique load generated higher stresses than vertical load. Composite resin restorations transmitted almost all the stress to the neighboring tooth structures, while lithium disilicate ceramic restorations absorbed most of the stresses. Moreover, modified inlays and onlays with pulp extension proved better than conventional inlays/onlays in terms of stress redistribution in dental structures. Onlays showed a better pattern of stress distribution than inlays within the restoration and the restored tooth. Conclusions According to stress distribution in dental structures, modified lithium disilicate ceramic onlays with pulp extension have been found to be the best choice to restore endodontically treated molars among the studied restorations.

Influence of the Connector Area on the Chipping Rate of the VM9 Veneering Ceramic in a Posterior Four-Unit Yttria-Stabilized Tetragonal Zirconia Polycrystal Fixed Dental Prostheses: A Pilot Study

Objective The purpose of this study was to evaluate the influence of the connector area on the chipping rate of the VM9 veneering ceramic in a 4-unit yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) framework, using a novel sonographic technique. Materials and Methods The framework was designed as a 4-unit fixed dental prostheses (FDP) with two abutment teeth at the first mandibular premolar and second mandibular molar. The cross-sectional area of the connector was 7.5, 8, or 9 mm2. The prepared teeth were scanned using CAD/CAM technology, and five frameworks were prepared for each design, making a total of 15. The frameworks were divided according to the veneering ceramics: Y-TZP FDPs using Vita VM9 (12 frameworks), and porcelain fused to metal (PFM) FDPs using Vita VM13 (3 frameworks). The specimens were statically loaded until failure. To capture the initiation of the failure within the specimens, a novel sonographic technique, designed for this research, combining acoustic emission and visual monitoring during live load bearing tests, was used to determine the failure load value. Failed frameworks were inspected using a microscope, and failure patterns were identified. One-way ANOVA and Tukey HSD tests were applied for statistical analysis of the results (p-value ≤ 0.05). Results Despite the fact that the chipping strength is proportional to the cross-sectional area of the connector, the effect of the cross-sectional area on chipping load revealed no statistically significant differences, while PFMs showed superior chipping strength relative to the zirconia frameworks regardless of the connector's size. A high rate of catastrophic fracture occurred while loading the specimens. Conclusion The effect of the cross-sectional area on chipping load revealed no statistically significant differences in Y-TZP frameworks. The novel sonographic technique may be a potential method to study the behavior of dental ceramics, including chipping and fracture.

Treatment of Class II Malocclusion With Removable Functional Appliances: A Narrative Review

Around half of all malocclusions that need orthodontic treatment are class II in nature. Patients with class II malocclusion primarily seek treatment for aesthetic improvement. Most of the skeletal class II malocclusions are because of mandibular deficiency, and can be best treated during the growing phase of development by removable functional appliances. The objective of this review is to evaluate and compare skeletal and dentoalveolar effects of various removable functional appliances in the treatment of class II malocclusion. Manual and electronic databases were searched, and out of 5,711 articles, 221 abstracts were shortlisted and reviewed. A total of 19 articles that fulfilled the selection criteria were then retrieved and analyzed. A significant increase in mandibular length and dentoalveolar effects with an increase in vertical dimension in a short time were observed with Twin-Block appliance treatment, followed by Bionator appliance treatment. The long-term stability of results achieved with Twin-Block appliance treatment is still questionable. In addition, Frankel appliance treatment effects are more skeletal in nature, with better control in the vertical dimension. However, it takes a more extended treatment duration to produce similar effects. Based on available evidence, we are convinced that removable functional appliances are valuable tools for correction of the class II malocclusion at a growing age with horizontal growth pattern.

Modification of Enamel Surface Morphology and Strength Using Nd:YAG Laser with Proper and Safe Parameters

Objective The aim of this study was to determine the effect of a Nd:YAG laser on enamel surface morphology and hardness using different energies and pulses. Materials and Methods Twenty freshly extracted mature teeth were collected and sectioned. An Nd:YAG laser operating at 1,064 nm wavelength and providing up to 9 nanosecond laser pulses (1 J), with a laser spot diameter of 0.8 mm and irradiated surface area of 3 × 3 mm2, was applied to carbon black-coated teeth. The samples were randomly divided into two main groups; each group comprised 20 samples, according to the treatment parameters. The first group was further divided into subgroups A, B1, C1, and D1 using the different energies of 0, 350, 450, and 550 mJ, respectively, with 1 pulse for B1, C1, and D1. The second group was subdivided into A, B2, C2, and D2 and treated with 200 mJ, 3, 4, and 6 pulses for subgroups B2, C2 and D2, respectively. Subgroup A was the same sample for both groups as control with 0 pulses and 0 energy. Morphological features and microhardness were evaluated after laser exposure. Statistical Analysis Analysis of variance (Kruskal–Wallis test) was used to compare all subgroups, followed by the Scheefy significant difference post hoc test to determine the highest significance of the subgroups. Alpha < 0.05 was set as significant. Results The changes in the surface morphology of the enamel included increased crystal sizes, cracks, fissures, and voids with increasing energies and pulses. In group 1, the microhardness was 405.6, 562.7, 612, and 637 for energies of 0, 350, 450, and 550 mJ, respectively. In group 2, the microhardness was 405.6, 673, 866, and 1,050 for 0, 3, 4, and 6 pulses, respectively. Conclusion The Nd:YAG laser is efficient for increasing the microhardness of the enamel surface with minimum morphological damage by applying low energy with more pulses.