Maxillary Implant Placement in a Limited Residual Bone Height

The limitation of residual bone height (RBH) and vital structures such as sinuses in the maxillary often make the implant placement procedure becomes complicated. Clinicians may perform sinus elevation prior to implant placement to accommodate the length of the implant fixture. Sinus elevation is an invasive procedure and complication may occur during the surgery including the most frequent complication is perforation of Schneiderian membrane. Objectives: To discuss a comprehensive management of implant placement and its complication step by step from surgical procedures to crown placement Case Report: 67-year-old female patient with partial edentulism in the right maxillary region, presence of sinus septum, and RBH was 4mm. The patient was planned to do sinus elevation surgery prior to implant placement, perforation of the Schneiderian membrane occurred while surgery performed and pericardium membrane was attached around the perforation site. Sinus re-entry and implant placement were performed after 3 months followed by prosthetics procedures in the next 6 month. Conclusion: Dental implant is a complicated treatment and complication may occur during the placement, thus a comprehensive management is very essential to minimize the risk of complications.

Interrelationship Between Orthodontics and Implantology in Anterior Aesthetic Rehabilitation: A Case Report

The rehabilitation of complex cases in the anterior region of the maxilla may require knowledge of several dental specialties. when dental involvement also causes bone and gingival involvement, management usually requires adjustment of gingival zenitis and bone graft to compensate for bone loss. Objective: to discuss a case of previous orthodontic treatment for implant-prosthetic rehabilitation in the anterior region. Case report: This case report describes a 40-year-old patient who came with the intention of extracting the tooth and installing a bridge. The implant-prosthetic treatment was performed after previous orthodontic treatment to adapt the gingiva and space. Conclusion: The interrelationship of specialists in oral rehabilitation improved the aesthetic and functional result of this complex case. Orthodontic mechanics and periodontics adapted the space and improved the periodontal condition before the implant was installed, resulting in a very satisfactory aesthetic, improving the patient’s selfesteem

Effect of Natural and Industrial Juices on Surface Microhardness of Microhybrid and Nanohybrid Composites

Numerous studies have been conducted on the effect of various beverages on the mechanical properties of toothcolored materials, however, little is known about the effects of these materials on composites, particularly newer types such as nanocomposites. Objectives: This study aimed to evaluate the surface microhardness of two types of composites, micro-hybrid (point 4) and nanohybrid (premise), after exposure to natural and industrial juices. Methods: In this experimental study, 90 disc-shaped specimens with a thickness of 2 mm and a diameter of 10 mm were taken from two composites, micro-hybrid Point4 (Kerr) and nanohybrid premise (kerr) (two groups of 45). Then, the specimens of each group were divided into 5 subgroups of 9 and were immersed for 7 days for 6 hours in 5 solutions of industrial orange juice, natural orange juice, industrial pomegranate juice, natural pomegranate juice, and distilled water (control group). Surface microhardness of specimens was measured by Vickers device at baseline, one day and one week after immersing. Data was measured by ANOVA, repeated measure test, and independent t-test. A significant level of α was 0.05. Results: The surface microhardness of two types of composites exposed to beverages was reduced significantly. However, no significant difference was found between natural and industrial juices in none of the composites. Conclusions: Natural and industrial juices can affect the surface microhardness of composites, which varies depending on the type of composite and the type of juice and immersion time.

Comparison of Shaping Ability between Continuous Rotary and Manual Instrumentations in Pediatric Endodontics

Objective: The aim of this in vitro study was to evaluate the efficacy of rotary EndoArt Ni-Ti Gold Pedo Kit and K-files in shaping ability, canal transportation, centering ability and instrumentation time in primary molars. Methods: For the study total of 30 extracted primary molars root with minimum 7mm root length were selected. Shaping of root canals in primary molars were done using the two systems, and CBCT and specialized software were used for scanning and analysis of pre-operative and post-operative to evaluate the groups for their shaping properties, apical transportation and preparation time in primary root canals. Results: No differences were found in canal transportation measures and instrumentation time between the two groups (p>0.05). The EndoArt group removed more dentin compared to K-file in all sides of the root curvature. The statistical differences were significant for coronal and middle third of the root (p<0.05). Conclusions: Under the conditions of this study, rotary EndoArt Ni-Ti Gold Pedo Kit provided more conical canals than K-files in primary teeth.

Cytotoxic Evaluation of Mala aluation of Malaysian K ysian Kelulut Hone elulut Honey on Human y on Human Gingival Fibr al Fibroblast Cell Line using M oblast Cell Line using MTT Assay

Kelulut honey or stingless bee honey is a type of honey produced by stingless bees of the Trigona species where the nest is found in living trees. Objective: The aim of this study was to evaluate the cytotoxic potential of Malaysian Kelulut honey by employing MTT assay on a human gingival fibroblast cell line. Methods: Human gingival fibroblast cell line was cultured in minimal essential medium alpha (α-MEM) with 10% foetal bovine serum and 1% penicillin-streptomycin solution in a 5% CO2 incubator at 37°C in a humidified atmosphere. The cells were seeded at a cell density of 5x103 cells/well in a 96-well culture plate for 24 hours. The cells were treated with seven different concentrations (200, 100, 50, 25, 12.5, 6.25, and 3.125mg/ml) of Malaysian Kelulut honey and incubated in a CO2 incubator. The negative control comprised cells treated with growth media alone. The cell viability was assessed using MTT assay at 24, 48, and 72 hours. The test plate was shaken using a microplate shaker and the absorbance of the solution was measured at 570nm using an ELISA reader with the Magellan software. Statistical analysis of the data was carried out using Kruskal-Wallis test and SPSS 24.0.0 for Windows. A p value <0.05 was considered as statistically significant. Results: There was no cytotoxic effect of Malaysian Kelulut honey on HGF-1 based on the MTT assay at different concentrations and at different time points tested as the cell viability was above 70%. The highest percentage of cell viability at all three different durations of treatment were observed at 3.125mg/ml, whereas the lowest cell viability was observed at 200mg/ml of Kelulut honey concentration. However, statistically significant differences were seen between some of the concentrations at various time points. Conclusion: Since the cell viability of HGF-1 treated with Malaysian Kelulut honey was more than 70% at all concentrations ranging from 3.125mg/ml to 200mg/ml at three different time points (24, 48 and 72 hours), Malaysian Kelulut honey can be considered as non-cytotoxic on human gingival fibroblasts based on MTT assay under the present test conditions

Approaches of General and Specialist Dentists to Deep Caries Management: A Cr Management: A Cross-Sectional Study fr oss-Sectional Study from Turkey

Objective: To determine the differences in treatment strategies and material preferences for deep dentine carious lesions (DDCLs) management among general and specialist dentists. Methods: Dentists working in universities, oral and dental health centers, or private practice were administered a 14-item web-based questionnaire regarding demographic and occupational characteristics, approaches to DDLCs, pulp capping methods, and preferences for restorative materials. The data were examined using descriptive statistical analysis and Pearson’s chi-square tests. Results: The study enrolled 298 general and 265 specialist dentists among whom 67.1% were female and 73.3% were aged 25 to 35 years. Total excavation and permanent restoration of DDCLs were the commonly preferred treatments (67.0%), although the pediatric dentists tended toward selective caries removal in these lesions. Mineral trioxide aggregate was used more regularly by the pediatric dentists and endodontists. The pediatric dentists exhibited statistically significantly lower preference for canal treatment than general dentists and endodontists as treatment option for mature teeth with DDCLs (p<0.05). Conclusion: Conservative treatment approaches and material preferences of specialists and general dentists in DDCLs are generally different. The age of dentists, the time since their graduation, place of work and the number of patients they have seen daily may affect the approaches and preferences.

Assessment of the Working Posture among Dental Students to Prevent Musculosk ent Musculoskeletal Disor eletal Disorders

Poor working posture among dental practitioners has been known to cause musculoskeletal disorders (MSDs), which are made worse by lengthy procedures and a lack of awareness about the proper working posture. Objectives: To assess the working posture of clinical dental students to determine if interventions were needed to reduce MSDs. Methods: The working postures of 225 clinical dental students were recorded and assessed within 10 minutes into procedures from March-December 2019, using the Rapid Upper Limb Assessment (RULA) method. The results were then statistically analysed using chi-square and Fisher’s exact tests. Results: Of the 225 students observed, 64 (28.4%; 95% CI: 23.1-35.7%) were classified as having RULA scores of 1-2 and 3-4, 141 (62.7%; 95% CI: 58.4- 65.7%) had RULA scores of 5-6 and 19 (8.4%; 95% CI:5.3-12.4%) had RULA scores of 7. Only one student had a RULA score of 1-2, where posture was considered acceptable. The working postures of the students in year 4 (P<0.001) were worse than those of the students in the other clinical years. No significant difference was observed concerning gender variance. Conclusion: Students’ working postures should be evaluated frequently, and other tools, for example, dental loupes, should be provided to help them maintain good working postures

Evaluation of the Bone Thickness of Mandibular Molars using Cone Beam Computed Tomography

Objective: To investigate buccal and lingual bone thicknesses and fenestration rate of mandibular first and second molars using cone-beam computed tomography (CBCT). Methods: A total of CBCT images of 41 patients were selected and overall 120 mandibular molars were investigated. The buccal and lingual alveolar bone widths were measured at apex of the roots. The prevalence of fenestration in mandibular molars was recorded. Statistical analyses were performed. Results: The buccal bone widths of mesial root of second molars were significantly lower than the lingual (p<0.05). The lingual bone widths of mesial and distal root of second molars were lower than the buccal (p<0.05). The lowest thickness of buccal and lingual bone was observed in mesial root of first molar and distal root of second molar. The prevalence of fenestration in mandibular first and second molars was 5% and 10%. Conclusion: The buccal bone widths were lower at the first molar than the second molar. All fenestrations in first molar were in buccal aspect, in second molar were in lingual aspect. Topographical proximity of the buccal side of first molar and the lingual side of second molar to bone plate create a risky region for endodontic treatment or spread of infection.

Evaluation of the Relationship between Sella Turcica Bridging and Dental Anomalies

Objectives: This study aims to evaluate the relationship between the morphological variations of Sella Turcica (ST) and dental anomalies. Methods: This study included 765 individuals between the ages of 13 and 35. ST morphology was examined in 3 groups as no calcification, partially calcified and completely calcified according to the interclinoid ligament (ICL) on lateral cephalometric films, and it was examined and evaluated in terms of its relationship to impacted canines (unilateral and bilateral), impacted teeth (except 3rd molars), root dilaceration, tooth deficiency (upper incisor lateral - lower and upper second premolar), supernumerary tooth and taurodontism. Results: The rates of supernumerary teeth, lateral and premolar tooth deficiency and root dilaceration in total calcification of ICL were significantly higher than those in ICL with no calcification. The rates of taurodontism, unilateral and bilateral impacted canine teeth and impacted teeth in ICL with no calcification were found to be significantly lower than those in the partial and total calcification of ICL. Conclusion: In this study, a statistically significant relationship was found between ST morphology and dental anomalies. Examination of sella turcica bridging (STB) variations in a large population will be guiding for the early detection of dental anomalies.

Holistic Management F Holistic Management For Severe Oral Lichen Planus: A Case al Lichen Planus: A Case Report

Oral lichen planus (OLP) is an immunologically mediated mucocutaneous disease associated with various factors including systemic diseases, with a higher prevalence in females than males. The majority of OLP cases are accompanied by symptoms of discomfort and/or pain. Treatment of OLP can be challenging due to its unknown aetiology and involvement of multiple contributing factors. Objective: Our aim is to report a long-term follow-up case of oral lichen planus with holistic management approach. This report will provide some options to clinicians who are having difficulties in managing OLP cases especially with the medications. Case Report: This case report discusses a female patient who suffered OLP with no definitive treatment prior to referral to us. A thorough history of her problem including psychosocial factors and dietary pattern were obtained. Clinically, the oral mucosa presented characteristics similar to erosive oral lichen planus. Patient reluctance towards pharmacotherapy due to her comorbidities was a challenged in managing her OLP. Hence, a non-pharmacotherapeutic solution was offered by considering psychology and dietary pattern. Conclusion: A severe oral lichen planus with ulcerative background could be managed holistically and not just through a pharmacotherapeutic approach.