Dental Journal

Planning for success: Full mouth rehabilitation with different fixed restorations

Muhamad Faizran Loo Szen Bin Fadly Loo — Tue, 25 Mar 2025 00:00:00 +0700

Background: A minimally invasive approach in a full mouth rehabilitation is preferred, especially in a younger patient, as it is reversible, in line with the European Consensus Statement. Purpose: This case report aims to highlight the importance of detailed planning of a full mouth rehabilitation involving different fixed restorations, including direct composite restoration, indirect posterior onlays, and the replacement of an unrestorable tooth with a dental implant. Case: A 52-year-old gentleman presented with severe generalized non-carious tooth surface loss (NCTSL), planned for full mouth rehabilitation in a reorganized approach. His treatment was complicated by subgingival restorative margins and an unrestorable tooth, requiring replacement. Case management: Periodontal disease was stabilized, and the full mouth rehabilitation was initiated with direct composite restoration of the anterior teeth using the injection molding technique (IMT), followed by the implant placement protocol and extraction of unrestorable tooth 24. The final implant abutment and restoration were digitally designed and delivered with high accuracy. Conclusion: Full mouth rehabilitation requires detailed planning and can be complicated by the replacement of missing teeth with dental implants. However, digital technology and good communication with the dental technologist can help to deliver the prosthodontically driven implant restoration with good accuracy.

Odontogenic maxillary sinusitis and oroantral communication: A case report

Tue, 25 Mar 2025 00:00:00 +0700

Background: Odontogenic maxillary sinusitis (OMS) and oroantral communication (OAC) have been well recognized in oral and maxillofacial surgery. The treatment ranges from non-surgical treatment to surgical treatment. Purpose: This case report discusses the management of OMS and OAC through a non-surgical approach. Case: A female patient presented to our department after being referred from a different department. After informed consent was obtained, her tooth was extracted. Unfortunately, the maxillary sinus was exposed, and OMS was suspected after pus leakage occurred into the oral cavity prior to tooth extraction. The communication was found at the mesiobuccal region with a 3 mm diameter and distobuccal region with a 2 mm diameter. Case management: Due to the small size of the OAC, it was decided to close the communication using the figure-of-eight suture technique, and an absorbable gelatin sponge was placed inside the socket. Odontogenic maxillary sinusitis was treated with a combination of pharmacological therapy and dental therapy, including the removal of the source of infection and a prescription of antibiotics and nasal decongestant due to the OAC. Finally, the patient was educated about the sinus precaution step. Conclusion: Good healing of the lesion was noted in this report. Non-surgical treatment such as dental therapy and pharmacological therapy can, therefore, be considered to treat OMS. Closure of the OAC using a suture technique and a gelatin sponge can treat small-sized communication.

Impact of chitosan modification on the material properties of acrylic resin base

Ihssan F. Al-Takai, Luma Al-Nema , Fawzi H. Jabrail — Sat, 15 Mar 2025 00:00:00 +0700

Background: 3D-printed polymethyl methacrylate is a light-cured commercial resin used in the 3D printing sector due to its affordability, good adaptability, minimal odor, and low irritation. Purpose: To investigate the impact of modified chitosan on the surface hardness and flexural strength of printed dental resin. Methods: A modified chitosan solution was cross-linked with adipic acid at concentrations of 0.1, 0.05, and 0.01 wt.% and then added to 3D-printable acrylic resin at 2, 5, and 10 wt.%. After addition, samples were prepared to test surface hardness and flexural strength. A total of 100 specimens were used in the research, grouped into 10 sets. Five specimens were prepared for each additive percentage, and five specimens served as a control group (3D-printable resin without modification) for each test. Results: The results showed that the (adipic acid/chitosan) 0.1/2 wt.% group had the highest flexural strength (134.370 MPa) and surface hardness (32.46 VHN), while the lowest flexural strength (49.198 MPa) and surface hardness (21.22 VHN) were observed in the (adipic acid/chitosan) 0.01/10 wt.% group. Conclusion: Modification of chitosan with adipic acid positively influences the flexural strength and surface hardness of 3D-printed denture bases. However, increasing the chitosan content beyond 2 wt.% reduces both surface hardness and flexural strength in modified 3D-printed polymers.

Cone beam computed tomography in detecting the second mesiobuccal canal in the upper molars: A pilot study

Noor Ilyani Othman — Sat, 15 Mar 2025 00:00:00 +0700

Background: Root canal treatment aims to heal and/or prevent apical periodontitis. It is accomplished by removing inflamed or necrotic pulp, followed by sealing with the appropriate materials. Studies show that the endodontic treatment of the maxillary molars has the highest failure rate because of anatomical variations in the mesiobuccal (MB) roots. Purpose: This study aims to evaluate cone beam computed tomography (CBCT) to accurately identify the second mesiobuccal (MBII) canal in human maxillary first molars. Methods: The investigation was approved by the Research Ethics Committee of the Research Management Institute, Universiti Teknologi MARA (UiTM). Images were sourced from the Radiology Unit of the Centre for Oral Radiology Studies, Faculty of Dentistry, UiTM. CBCT images of permanent maxillary molars (n = 24) were selected. The images were of intact permanent maxillary first molars with complete root formation, with or without the presence of obturation material. The presence or absence of the MBII canals was analyzed by three examiners, and the data were recorded. Results: The MBII canals were present in 86% (n = 19) of the investigated upper first molars. All of the previously endodontically treated teeth (n = 10) revealed the presence of MBII canals, which were not obturated. Seventy-five percent (n = 3) of the patients exhibited four canals in both the right and left upper first molars. Conclusion: The MB roots of maxillary molar teeth have more variations in their canal system than the other two roots. CBCT is a good diagnostic tool for detecting and mapping the MB root-canal system and can potentially improve the quality of endodontic treatment.

In vitro evaluation of the effectiveness of pediatric drugs and tooth brushing on the surface roughness of different restorative dental materials used in pedodontics

Şemsettin Yildiz, Osman Ataş — Sat, 15 Mar 2025 00:00:00 +0700

Background: Liquid oral drugs are frequently used in children. Knowing the effects of these drugs and individual oral hygiene brushing on the surface roughness (SR) of dental restorative materials with different contents used in pediatric dentistry is clinically important. Purpose: The aim is to assess the effects of various drugs and toothbrushes used in children on the SR of dental restorative materials. Methods: A total of 60 samples of different dental filling materials (polyacid-modified composite resin [compomer], glass ionomer cement [GIC], and composite resin) were prepared. The specimens were divided into six solution groups (distilled water, antibiotics, analgesics, antiepileptics, bronchodilators, and anti-allergic drugs). For each group (n = 5), two subgroups (brushing and non-brushing) were created. Surface roughness values (Ra) were measured at baseline and at the first and fourth weeks using a profilometer. The data were analyzed using analysis of variance, post-hoc analysis, and the Bonferroni test (p < 0.05). Results: The highest roughness value among all drug groups was detected in the non-resin-containing traditional GIC material. In addition, the brushing condition had a statistically significant effect on SR values (p < 0.05). The smallest change in roughness from baseline to the fourth week was observed in the non-brushed composite material in the Amoklavin group, whereas the largest change was observed in the brushed GIC material in the Depakin solution. Conclusion: Drug solutions and brushing affect the SR of restorative materials, with resin-containing materials being less affected than GIC.

Bacterial profile and antibiotic sensitivity in silk sutures following odontectomy

Sat, 15 Mar 2025 00:00:00 +0700

Background: Impacted teeth, hindered from erupting normally due to space constraints, obstruction by neighboring teeth, or an abnormal eruption pathway, often necessitate surgical intervention known as odontectomy. Silk sutures are commonly used in this procedure, yet they may serve as sites for bacterial colonization, potentially leading to infection. Following odontectomy, antibiotics are typically prescribed. Purpose: This study aims to identify the bacterial profile adhering to silk sutures and analyze antibiotic sensitivity patterns in patients undergoing odontectomy. Methods: A descriptive study employing consecutive sampling of patients after odontectomy was conducted between May and November 2021 at Arifin Achmad General Hospital, Riau Province, Indonesia. Sutures were removed within 14 days of surgery, after which the silk was identified and subjected to antibiotic sensitivity testing using the Kirby–Bauer method. Results: Of the bacteria detected in the silk sutures, 53.7% were Gram positive, including Streptococcus sp. (33.3%) and Staphylococcus aureus (13%), and 46.3% were Gram negative, such as Enterobacter sp. (20.4%) and Klebsiella sp. (16.7%). Among the multi-resistant strains, methicillin-resistant S. aureus (MRSA) accounted for 57.1%. The Gram-positive bacteria exhibited the highest sensitivity to levofloxacin, whereas the Gram-negative bacteria showed sensitivity to ceftazidime, levofloxacin, and meropenem. Conclusion: The most dominant Gram-positive bacteria were Streptococcus sp. and S. aureus, whereas the most dominant Gram-negative bacteria were Enterobacter sp. and Klebsiella sp. Levofloxacin, ceftazidime, and meropenem emerged as the most effective antibiotics following odontectomy. Multidrug-resistant bacteria, exemplified by MRSA, were identified within the oral cavity.

Characteristics of chitosan from Penaeus monodon on chitosan-gelatin suspension viscosity

Sat, 15 Mar 2025 00:00:00 +0700

Background: Chitosan synthesized from Penaeus monodon shells was developed into a chitosan-gelatin suspension as an injectable bone substitute for socket preservation. Purpose: To investigate the characteristics of chitosan from P. monodon shells and their influence on the viscosity of a chitosan-gelatin suspension. Methods: P. monodon shells from Tarakan Waters were prepared using three methods: Group 1) deproteinization-depigmentation-deacetylation, Group 2) demineralization-depigmentation-deacetylation, and Group 3) deproteinization-demineralization-depigmentation-deacetylation. The chitosan was characterized by morphology, moisture and ash content, molecular weight (MW), deacetylation degree (DD), and viscosity. This chitosan was made into a chitosan-gelatin suspension with a ratio of 45:55 (w/w%) (95 ml:110 ml). The differences in viscosity of the chitosan-gelatin suspension were determined using Kruskal–Wallis and Mann–Whitney tests. The effects of the chitosan’s MW and DD on the viscosity of the chitosan-gelatin suspension were analyzed using Spearman’s correlation. Results: Group 2 had the highest moisture content (10.63%), MW (159.68 kDa), viscosity of the chitosan powder (5.53 dPa.s), and viscosity of the chitosan-gelatin suspension (40.20 cps). Group 1 had the highest ash content (27.83%) and DD (93.72%). Group 3 showed the lowest ash content (1.06%), MW (37.12 kDa), and DD (86.22%), but it had good viscosity of the chitosan-gelatin suspension (37.25 cps). A significant difference in viscosity was found between the chitosan-gelatin suspension groups. Spearman’s correlation coefficients between the viscosity of the chitosan-gelatin suspension and MW and between the viscosity of the chitosan-gelatin suspension and DD were 0.389 and −0.195, respectively. Conclusion: The viscosity of a chitosan-gelatin suspension is influenced by the MW and DD of the chitosan powder. Chitosan from P. monodon can potentially be an injectable bone substitute in socket preservation.

Immuno-expression analysis of VEGF and CD34 related to histological types of mandibular ameloblastoma

Sat, 15 Mar 2025 00:00:00 +0700

Background: Increased expression of vascular endothelial growth factor (VEGF) and cluster of difference 34 (CD34) in ameloblastoma has been noted. Both proteins are markers of angiogenesis that play a role in supporting the growth of ameloblastoma. The existence of histopathological types of ameloblastoma allows for differences in behavioral and growth characteristics. Purpose: To evaluate the differences and correlation of VEGF and CD34 expression in histological types of ameloblastoma. Methods: This laboratory cross-sectional study uses total sampling from histological slides of mandibular ameloblastoma. Two observers manually quantified the immunohistochemical expression. The comparative data were analyzed statistically with the Kruskal–Wallis test (p < 0.05), while the correlative data were analyzed with Spearman’s rho (p<0.01). Results: 32 samples were obtained according to the inclusion criteria. The Kruskal–Wallis test showed significant differences in VEGF expression (p = 0.003) and CD34 expression (p = 0.026). The pairwise comparison test showed that VEGF expression in follicular ameloblastoma significantly differed from plexiform (p = 0.001) and combination (p = 0.002). The pairwise comparison test for CD34 expression showed a significant difference between follicular and combination ameloblastoma (p = 0.007). Spearman’s rho test showed a positive correlation (p = 0.001, r = 0.565) between markers. Conclusion: Follicular ameloblastoma expressed higher VEGF than plexiform and combination ameloblastoma. Follicular ameloblastoma expressed higher CD34 than combination types. CD34 expression is associated with VEGF in histological types of ameloblastoma.

The influence of the polishing duration on the surface roughness and gloss of nanohybrid composites using a blood cockle shell polishing paste

Wandania Farahanny, Ika Andryas, Fitri Yunita Batubara, Nevi Yanti — Sat, 15 Mar 2025 00:00:00 +0700

Background: The polishing procedure is an important stage in producing a successful restoration. Polishing involves the use of abrasive materials, and blood cockle shells contain these natural components, such as calcium carbonate, which can be used as a polishing paste. One of the factors that influences the polishing quality is the polishing duration. Purpose: This study evaluated the polishability of a nanohybrid composite using blood cockle shell polishing paste by measuring the surface roughness and gloss value, and by observing the surface qualities based on different polishing times. Methods: Ninety samples of maxillary premolars were immersed in artificial saliva in an incubator at 37°C for 24 h. A total of 45 samples were subjected to a profilometer to observe surface roughness, and the rest were subjected to a glossmeter to observe the composite resin gloss. These included blood cockle shell paste, Prisma Gloss polishing paste, and without paste for 30, 60, and 90 seconds. The data were statistically analyzed using repeated measures ANOVA and post hoc least significant difference (LSD). Results: It showed that the group of 90 seconds had the highest gloss and the lowest surface roughness in the blood cockle shells. The difference was statistically significant (p>0.05). The results of the surface roughness test of the blood cockle shells with a duration of 30 and 60 seconds were found to be not significant (p<0.05). Conclusion: There were significant differences by adding the polishing duration, which decreased the surface roughness and increased the surface gloss, in which the lowest roughness and highest glossiness was found with a polishing time of 90 seconds. The polishability of composite resin restorations in this study obtained the best gloss and smoothest surface results from the longest polishing time duration of 90 seconds with the blood cockle shell polishing paste.

The effect of Novamin on enamel content after bracket removal

Tita Ratya Utari, Bayu Ananda Paryontri, Aini Muzayyana — Sat, 15 Mar 2025 00:00:00 +0700

Background: Orthodontics is one of the dental rehabilitation treatments for malocclusion correction, such as fixed orthodontic treatment using brackets, as the use of orthodontic brackets for a prolonged period can damage the enamel. Novamin contains casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), which can be used to prevent enamel erosion. Purpose: The aim of this study is to elucidate the effect of Novamin on the enamel content and microstructure surface after bracket removal. Methods: This study used 25 human premolar teeth randomly divided into five groups: I (Control); II (Biofix etching and bracket mounting); III (Biofix-Novamin); IV (Fuji Ortho); and V (Fuji Ortho-Novamin). Results: The results represent significant differences in the average levels of calcium (Ca) and phosphorus (P) among the treatment groups (p ≤ 0.05). The changes to the enamel surface indicated the opening of enamel prisms, pits, and grooves. The levels of Ca and P increased after applying Novamin, especially in groups II and III, indicating remineralization on the enamel surface. When Novamin reacts with saliva, it starts to remineralize, and sodium ions are released. The sodium ions exchange with hydrogen cations, releasing Ca and P ions from Novamin particles. Conclusion: Novamin presented the capability to stimulate remineralization after orthodontic bracket debonding through altering the Ca and P levels on the enamel surface.

Bond strength of a silicon-based soft liner to three types of denture base materials

Israa Ali Mahmood, Radhwan Himmadi Hasan — Thu, 20 Mar 2025 00:00:00 +0700

Background: Silicon-based soft liners have poor chemical adhesion to denture base resin, as they depend on mechanical interlocking. De-bonding between denture resin and soft liners is a common problem, as it shortens the life of a relined prosthesis. Purpose: The purpose of the study was to assess the tensile bond strength of three types of denture base materials—fabricated by conventional heat curing, computer-aided design/computer-aided manufacture, and three-dimensional printing, or milling—that are bonded to the silicon-based soft liner. The study also aimed to evaluate the effect of surface treatment (acetone; erbium- and chromium-doped yttrium, scandium, gallium, and garnet [Er,Cr:YSGG] laser) of denture base materials on the bonding capability of the soft liner. Methods: A total of 90 specimens were divided into three groups according to the denture base type (conventional, printed, and milled). The 30 specimens in each group were then subdivided into three sub-groups according to the surface treatment (untreated, acetone, and Er,Cr:YSGG), such that each sub-group included 10 specimens. The denture base was bonded to a ready-to-use paste of the silicon-based soft liner. The strength of the tensile bond was tested using a universal testing machine. Data were statistically analyzed using SPSS v.26 software, two-way ANOVA, and Duncan’s test at a significance level of p ≤ 0.05. Results: The milled denture base showed a higher mean tensile bonding strength compared with the conventional and printed denture base materials, at p ≤ 0.05. The surface treatment with Er,Cr:YSGG and the acetone, respectively, showed a higher mean tensile bonding strength value than the untreated group, at p ≤ 0.05. Conclusion: A milled denture is the most favorable denture base material for bonding to a silicon-based soft liner. The use of Er,Cr:YSGG and acetone surface treatment, respectively, enhances the tensile bonding strength.

Pomegranate-peel-chitosan-gelatin composite: A hemostatic dental sponge with antibacterial enhancement

Lale Rozykulyyeva, Prihartini Widiyanti, Suryani Dyah Astuti — Thu, 20 Mar 2025 00:00:00 +0700

Background: Effective post-tooth extraction bleeding management and the alleviation of patient discomfort hinge upon the careful choice and judicious application of suitable hemostatic agents. Purpose: In this study, we developed a biodegradable, porous hemostatic sponge composed of gelatin (GE) and chitosan (CS), enhanced by the incorporation of pomegranate peel extract (PE), which was designed for use in dental applications, with a focus on antibacterial properties and infection prevention. Methods: The sponge was synthesized using an environmentally friendly (green) foaming approach without a foaming agent and was fabricated by freeze-drying. The efficiency of the hemostatic sponge was evaluated using various tests, including structural analysis, mechanical strength, water absorption capacity, hydrophilicity, blood clotting time (BCT), in vitro antibacterial effectiveness, and biodegradability. Results: The calcium chloride–crosslinked CS-GE and PE-immersed (CS-GE-PE) sponges exhibited adequate tensile strengths, with CS-GE-PE at 0.776 ± 0.025 MPa. The CS-GE-PE sponge showed significant water absorption (927.1% ± 37.55%). Hydrophilicity was evident (contact angle: 45°) and decreased slightly with the addition of PE. The BCT was shorter for the CS-GE sponge (161 ± 9.644 s), and both sponges exhibited minimal hemolysis, indicating biocompatibility. The CS-GE-PE sponge exhibited slightly enhanced antibacterial properties. Conclusion: This study has successfully developed a composite sponge consisting of CS, GE, and PE that exhibits a balanced level of biodegradability, antibacterial and anti-inflammatory properties, and blood absorption properties that reduce clotting time. This innovative material has great potential for a wide range of clinical applications in dental procedures and wound care.

Variation and contact time of protective surface coating on fluoride release and recharge from glass ionomer restoration

Aya Thanoon AL-Dabbagh, Raya Jasim AL-Naimi — Tue, 25 Mar 2025 00:00:00 +0700

Background: Glass ionomer cement (GIC) is an effective restorative material known for its ability to release and recharge fluoride over an extended period. The application of fluoride-containing varnish and acidulated phosphate fluoride (APF) gel can substantially enhance the fluoride release and recharge properties of GIC. These additional treatments provide an extra source of fluoride, contributing to the long-term protection and strengthening of teeth. Purpose: This study aims to investigate the fluoride release and rechargeability of a tooth-colored restorative material (glass ionomer) over different time periods following the application of fluoride varnish (F varnish) and APF gel. Methods: Seventy-two specimens were prepared and divided into three groups, each further categorized into four subgroups based on the type and duration of fluoride application. Fluoride release was measured at 24 hours, 1 week, and 1 month, while fluoride recharge was evaluated after the application of F varnish and APF gel. Results: There was no significant difference in fluoride release between 24 hours and 1 week, but a significant decrease was observed after 1 month. The highest fluoride release occurred at 24 hours, while the lowest was recorded at 1 month. After fluoride recharge, there was a significant increase in fluoride release. Conclusion: Fluoride release from glass ionomer restorations was highest at 24 hours, and the rechargeability was greater with a 24-hour F varnish application compared with 12 hours. APF gel demonstrated higher fluoride release than F varnish, and prolonged contact time between the restorative material and the recharging agent resulted in greater fluoride uptake.

The effect of non-surgical periodontal therapy on glycemic control in Indian diabetics with periodontal disease – A systematic review and meta-analysis

Tue, 25 Mar 2025 00:00:00 +0700

Background: Periodontitis is a chronic inflammatory condition that contributes to systemic complications. It is associated with an increased risk of poor glycemic control and other diabetes-related complications. Purpose: This review aimed to evaluate the effect of nonsurgical periodontal therapy (NSPT) on the metabolic level of diabetes (HbA1c) in diabetic patients with generalized chronic periodontitis (GCP) in the Indian population. Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria were followed for conducting the review. PubMed-MEDLINE, Cochrane Library, Scopus, and Google Scholar were searched from inception until January 30, 2025. The Cochrane risk of bias (ROB)-2 tool for randomized controlled trials (RCT) was used to assess quality. A p value of less than 0.05 was considered statistically significant, and the standardized mean difference (SMD) was employed as a summary statistic measure using a random effect model. Results: Eleven studies fulfilled the eligibility criteria and were included in the qualitative synthesis, of which only six studies were suitable for meta-analysis. The pooled estimate through the SMD signifies that periodontal therapy, or NSPT, had a significant reduction in the clinical parameters assessed (p < 0.05). Publication bias through the funnel plot showed symmetric distribution with the absence of systematic heterogeneity. Conclusion: This study highlights that NSPT as a standalone therapy significantly reduces metabolic markers, specifically HbA1c, in diabetic patients. Additionally, notable improvements in clinical parameters were observed following NSPT. Therefore, periodontal therapy should be considered for patients with elevated metabolic markers (HbA1c), as it may help to reduce both the inflammatory burden and HbA1c levels associated with diabetes.

Vitamin administration on orthodontic tooth movement animal model: A systematic review

Tue, 25 Mar 2025 00:00:00 +0700

Background: Duration is a very important aspect of orthodontic treatment and is still challenging for orthodontists. Numerous studies investigating the effects of biological substances, including dietary supplements, on orthodontic tooth movement (OTM) rate indicate positive results. Efforts to improve the OTM rate can be classified into four main categories: biological, biomechanical, physical, and surgical. Numerous animal studies have evaluated the impact of biological substances on the rate of OTM, yielding positive outcomes compared to those not given biological substances. Purpose: This systematic review investigated the impact of dietary supplement delivery both locally and systemically on the rate of OTM. Methods: Nine databases were searched until January 31, 2023, for animal studies evaluating the effect of supplement administration on OTM. The Systematic Review Center for Laboratory Animal Experimentation’s (SYRCLE) risk of bias tools were employed. This review’s reporting adhered to the PRISMA guidelines. Results: Sixteen studies were identified for inclusion. Local injections of vitamin D exhibited variable effects. Vitamin C and zinc, as well as vitamin A, showed insignificant effects based on the OTM rate. Vitamin E showed conflicting results. Combined prostaglandin E2 (PGE2) and calcium can increase the OTM. Effects of systemic administrations of omega-3 fatty acids can decrease the OTM in vivo. Conclusion: The pace of tooth movement in animals may vary depending on the local or systemic administration of vitamins, as applied to OTM animal models.