Journal of Isfahan Dental School
Year:2017 | Volume:12 | Issue:4|Papers Count:19

Introduction: Currently the vast use of fixed orthodontic treatment in order to resolve dentoalveolar irregularities has led to oral mucosal lesions. The aim of this study was to evaluate the prevalence of oral mucosal lesions due to fixed orthodontic treatments in order to adopt proper strategies to decrease these lesions during orthodontic treatment.Materials& Methods: In this cross-sectional study, 56 patients referring for fixed orthodontic treatment to the Faculty of Dentistry, Islamic Azad University Isfahan (Khorasgan) Branch, completed a questionnaire in relation to the absence of systemic diseases and any drug consumption. The patients were examined to assess the oral mucosa and any lesion and pain caused by lesions before treatment and two and four weeks after treatment were recorded in each patient's record. Data were analyzed with the Cochrane statistical methods; pain was determined and analyzed with repeated measures ANOVA (a=0.05).Results: The results showed that two and four weeks after treatment, the frequencies of different lesions were as follows, respectively: recurrent aphthous lesions (p value=0.002, p value=1), allergic ulcers (p value=0.06, p value=0.95), lichenoid reactions (p value=0.92, p value=1), exophitic lesions (irritation fibroma and pyogenic granuloma, p value<0.001, p value<0.001), traumatic ulcers (p value<0.001, p value=0.003), intraoral recurrent herpes (p value=0.25, p value=0.92), candidiasis (p value=0.25, p value=1) and pain (p value<0.001, p value<0.001). The frequencies of lesions increased two weeks after treatment and the increase was significant in all the lesions except for lichenoid reactions, intraoral recurrent herpes and candidiasis. The rates of allergic ulcers, exophitic lesions, traumatic injuries, intraoral recurrent herpes and pain four weeks after treatment were higher than those before treatment. This increase was significant in case of exophitic and traumatic lesions.Conclusion: Based on the results of this study, it appears some oral mucosal lesions increase following fixed orthodontic treatment. Thus, it is necessary to evaluate the oral mucosa of patients undergoing fixed orthodontic treatment for diagnosis and treatment of these lesions.

Introduction: Polymerization shrinkage and the resultant microleakage are still the problems with composite resin restorations. To overcome these problems, new lowshrinkage composite resins have been introduced by different manufacturers. The aim of this study was to compare microleakage in two low-shrinkage composite resin, Filtek-Silorane and GC-Kalore with two conventional composite resins, Filtek-Z250 and GC-Gradia.Materials& Methods: In this experimental study, round cavities 5 mm in diameter and 1 mm in depth, were prepared on the middle of the buccal surfaces of 40 human third molars and divided into 4 groups (n=10). In group 1, the cavities were filled with Filteksilorane composite resin and the relevant adhesive. In groups 2, 3 and 4, the cavities were filled with Filtek-Z250, GC-Kalore and GC-Gradia composite resins, using Adper Single Bond Plus bonding agent. After thermocycling and immersion in AgNO3, the samples were sectioned to evaluate dye penetration under a stereomicroscope (×10) at enamel margins and at cervical dentin contacting cementum. Data were statistically analysed with Kruskal-Wallis, Wilcoxon and Mann-Whitney tests (a=0.05).Results: There were not significant differences at enamel margins between the 4 groups.However, at cervical margins, microleakage in Filtek-Silorane composite resin was significantly lower than Z250 and Gradia composite resins (p value=0.05).Microleakage with Kalore was significantly less than that with Gradia composite resin. In all the 4 groups, microleakage at cervical margins was significantly higher than that at occlusal margins.Conclusion: There were no significant differences in microleakage at occlusal margins between all the composite resins. The highest and lowest microleakage at dentin margins was related to GC-Gradia and Filtek-Silorane silorane, respectively.

Introduction: One of the concerns of dentists is to take an impression of a number of implants simultaneously in order to fabricate a prosthetic appliance. One of the methods for taking high-precision impressions and achieving a good fit for dentures is to use dental splinting, but what is important is the choice of the material for the preparation of splints. What is important is stability in splint sizes to better match the prosthesis. In this study, the effects of using self-cured Duralay acrylic resin and light-cured ImplaFix acrylic resin as two splint materials for angular implant impressions were evaluated.Materials& Methods: In this experimental laboratory study, the main model used was made of epoxy resin. Three fixtures were placed 15 mm apart. The central implant was placed at a right angle and the two lateral implants were placed at 15o angle relative to the central implant. Impression copings were placed and splints were prepared with ImplaFix or Duralay acrylic resins. After 14 impression taking procedures, the dimensional changes in the casts were determined with a CMM machine in three axes (z, y, x). Mann-Whitney test was used for data analysis (α=0.05).Results: Evaluations were carried out on 14 samples, including 7 Duralay acrylic resin and 7 ImplaFix samples. This study showed that change in Duralay acrylic resin in the three axes (x, y and z) were more than those in ImplaFix. The difference in y axis was not statistically significant but the changes in x and z axes were statistically significant based on results of Mann-Whitney test (p value<0.05 in x axis, and p value<0.07 in z axis).Conclusion: The use of ImplaFix is recommended due to lower dimensional changes and ease of use compared to Duralay acrylic resin.

Introduction: Awareness of root canal anatomy and morphology of the teeth is important in endodontic treatment. It is possible to evaluate root canal anatomy in three spatial planes with the use of cone-beam computed tomography. The aim of this study was to evaluate the prevalence of different configurations of root canal anatomy of mandibular premolar teeth using cone-beam computed tomography.Materials& Methods: In this retrospective descriptive study, CBCT images of 61 patients, including 150 mandibular premolars (75 first premolars and 75 second premolars) were selected.Axial sections with 1-mm slice thickness and distance were reconstructed. One endodontist and one radiologist evaluated the root canal morphology of the teeth on the images. Weine classification of root canal configuration, consisting of four groups was used. Data were collected and the frequency of different configurations of root canal morphology of mandibular premolar teeth was determined using descriptive statistics.Results: Of 75 mandibular first premolars, 72 teeth (96%) were type I, 2 teeth (2.665%) were type II and 1 tooth (1.335%) was type III. Of 75 mandibular second premolars, 73 teeth (97.33%) were type I, 2 teeth (2.665%) were type II. Type III and IV were not seen in mandibular seconds premolars.Conclusion: Based on the results of the present study, type I of Weine classification was the most frequent root canal morphology in mandibular first and second premolars. In addition, type IV was the least frequent root canal morphology of mandibular premolars.

Introduction: Ever-increasing use of dental implants and the changes they have brought about in patients’ lives have prompted many studies on dental implants. The aim of this study was to investigate the effect of a 100-mpascal force at different load angles on stress distribution in implant‒jaw assembly, using finite element analysis.Materials& Methods: In this experimental analytical study, a three dimensional model consisting of the mandible and a narrow-neck ITI implant was used. Peri-implant stress was evaluated at three points of A (implant neck), B (the middle of the implant) and C (implant apex). The load was applied from 0 o to 30 o on the implant with a 5o increase rate of the angle. Analysis of data was carried out with one-way ANOVA and Friedman test (a=0.05).Results: Increasing the angle of load from 0W to 30° increased the stress around the implant. At all the angles the amount of stress in the implant neck was higher than the middle area, which in turn was higher than the apical area.Conclusion: An increase in the load angle resulted in the highest amount of stress in the implant neck, i.e. the closest area to the force application site and away from the center of resistance, with the least stress in the apical area.

Introduction: Given the prevalence and unique clinical features of ameloblastoma, several studies have been conducted on it. The aim of this study was to evaluate some of the clinical and histological characteristics of ameloblastoma in important academic centers in Iran and make comparisons with similar studies in a long period of time.Materials& Methods: In this descriptive cross-sectional study, 256 files of patients with ameloblastoma, referring to the oral pathogy departments of Qazvin, Isfahan, Shiraz and Shahid Beheshti Faculties of Dentistry, were evaluated. Patient information, including gender, age, tumor location (mandible, maxilla, anterior or posterior region), the clinical and radiographic diagnosis (unicystic, multicystic), histological subtype (follicular, plexiform, mural, luminal, intraluminal), the affected jaw and recurrence, were extracted. Data were analyzed with SPSS 21 and descriptive and analytical statictics, including means and standard deviations and chi-squared test, to determine the relationships between the variables (α=0.01).Results: The mean age of the patients was 31±14 years and 51.4% were female. The prevalence of unicystic ameloblastoma was higher (52.7%). In Qazvin, Shiraz the prevalence of unicystic ameloblastoma was higher. The frequency of mural subtype was higher than other subtypes. In the all the cities studied, ameloblastoma in the mandible was more prevalent, with 58.2% on the right side.Furthermore, the body of the mandible was the most affected area.Conclusion: Although the results of this study are consistent with studies in Iran and abroad in some cases, it seems there are differences in the clinical and histological aspects.Attention to these differences can be helpful for researchers and clinicians.

Introduction: Non-pathological facial asymmetries are usually due to differences in sizes of the right and left sides. This study investigated normal facial asymmetry in individuals with Cl II and III malocclusion to clarify facial laterality and its relationship with the right-handedness or left-handedness.Materials& Methods: In this cross-sectional descriptive-analytical study, frontal-view digital photographs were taken of 66 subjects (43 Cl II and 23 Cl III) referring to the Department of Orthodontics, Faculty of Dentistry, Khorasgan University. The patients were questioned about the main chewing function side and their right- or left-handedness. On the photographs, the facial midline and menton point on the chin were drawn; the distance between the midline and the left and right sides were measured on the photographs using Photoshop software program. In addition, the distance between the menton point and the midline was measured.Data were analyzed with independent t-test (α=0.05).Results: In 51.2% of Cl II and 47.8% of Cl III subjects the right side of the face (p value= 0.85) was wider than the left side and in 48.8% of Cl II and 52.2% of Cl III subjects the left side of the face (p value=0.79) was wider than the right side, with no significant relationship between dental occlusion and face width. In addition, 62.1% subjects exhibited deviation of the chin to the left side (p value< 0.001). In 58.2% of right-handed and in 90.9% of left-handed subjects the right and left side of the face was wider, respectively (p value=0.003). In addition, there was no significant relationship between the main chewing function side and laterality of the face.Conclusion: Cl II and Cl III malocclusion exhibited no effect on face laterality and the facial half width; however, right-handedness and left-handedness affected face laterality.

Introduction: Dentists are prone to occupational burnout due to the nature of their stressful profession. The aim of this study was to determine the level of occupational burnout among dentists in Isfahan in 2013.Materials& Methods: In this descriptive cross-sectional study, 300 dentists working in Isfahan were recruited by simple random sampling. The Persian version of Maslach Burnout Questionnaire was used for data collection; the validity and reliability of the questionnaire have been confirmed. The questions of the questionnaire are in three sections of emotional exhaustion (9 items), depersonalization (5 items), and a sense of personal accomplishment failure (8 questions). Data were analyzed with descriptive statistics, chi-squared test, t-test and ANOVA, using SPSS 18 (α=0.05).Results: The mean scores of frequency and severity of burnout among dentists were 36.6±20.3 (range: 0‒132) and 75.5±16.2 (range: 0‒154), respectively. In subdomains the mean scores of emotional exhaustion, depersonalization and personal feeling of accomplishment failure among dentists were 20.1±12.2 (range: 0‒63), 3.7±4.2 (range: 0‒35) and 14.7±9.1 (range: 0‒54), respectively. The frequencies and intensity of emotional exhaustion and depersonalization were higher in males (p value<0.05). In addition, the frequency of a feeling of personal accomplishment failure was higher in unmarried subjects (p value= 0.02). The frequencies of depersonalization and a feeling of personal accomplishment failure were higher in young dentists (p value<0.05).Conclusion: Based on the results, occupational burnout among dentists in Isfahan was low in frequency and intensity. Females, the married and subjects with more experience exhibited less occupational burnout. Further studies are suggested for detecting effective factors and the extent of their effects.

Introduction: Given the great advantages in Iran, including low cost and specialist human resources in the health sector, Iran is planning fundamental programs in the tourism industry. With respect to the identification of capabilities and potentials in different parts of the country, this study was undertaken to determine the impact of clinical capabilities of dentists on Isfahan dental tourism development from the perspective of dental specialists.Materials& Methods: The descriptive and analytical study was carried out using a questionnaire which included demographic characteristics, foreign tourists' characteristics to receive dental services, quality and quantity of services that can be offered and the capabilities of the dental human resources. Likert’s 5-score scale was used for determining scores. After studying a pre-test with 30 dental specialists and confirming the reliability and validity of the questionnaire, it was randomly handed in to 62 dentistry experts in Isfahan. Data was analyzed with SPSS 19, using descriptive statistical methods, t-test, Kruskal-Wallis, Spearman’s and Pearson’s correlation coefficients and factor analysis (a=0.05).Results: Variable means for human resource capabilities and dental service quality were 4.09±.338 and 3.34±.501, respectively. Factor analysis showed that human resource capabilities are the most important and most effective variable with a variance of 39.778.Conclusion: Capabilities of human resources, affordable costs of dental services, high quality of services and use of proper equipment are important factors influencing dental tourism development. Recording tourists’ data, use of publicity packages at airports and hotels, establishing websites for dentists and finally determining target markets of dental tourism are suitable strategies to develop dental tourism industry.

Introduction: The mental foramen is a prominent anatomical landmark of the mandible. The mental nerve might be damaged in several procedures, such as periapical surgeries, extraction of impacted teeth, enucleation of cysts and tumors and endodontic surgeries, leading to paresthesia and anesthesia. The aim of the present study was to determine the position of the mental foramen using conebeam computed tomography (CBCT) images.Materials& Methods: In this cross-sectional descriptive/observational study, 100 CBCT images (belonging to 50 males and 50 females) in cross-sectional and tangential views were selected from the archives of the Department of Radiology, Isfahan Faculty of Dentistry, in order to determine the location of the mental foramen and determine its distance from the root apices of the first and second premolars and mesial root of first molar, and also from the lower boarder of the mandible. Data was analyzed with SPSS, using t-test and chi-squared test (a=0.05).Results: In 59.6% of the cases the mental foramen was located between the first and second premolars, and in 38.4% of the cases it was located between the second premolar and the mesial root of the first molar. The mean distances between the mental foramen and root apices of the first and second premolars and the first molar were 7.85, 6.27 7.99 mm, respectively, with a mean distance of 11.35 mm from the inferior border of the mandible.Conclusion: The most common position for the mental foramen in this Iranian sample was between the first and second premolars, followed by between the second premolar and the first molar.

Introduction: Smoking is one of the most important environmental factors in the initiation of gingival pigmentation. Most studies have reported the effect of active smoking and environmental tobacco smoke (ETS) on gingival pigmentation. The aim of this study was to compare the gingival pigmentation in children exposed to environmental tobacco smoke with children who are not at risk.Materials& Methods: In this case-control stud, 76 children aged 9-16 years were studied. The subjects were divided that into two equal groups based on being affected by environmental smoke or not. In both groups, gingival pigmentation index (GPI) was determined by clinical examination and in recorded in a questionnaire; salivary levels of cotinine enzyme were determined using ELISA. Data were analyzed with Mann–Whitney test, independent t-test, and Pearson’s and Spearman’s correlation coefficients (α=0.05).Results: The means of salivary cotinine enzyme levels and gingival pigmentation index (GPI) were significantly higher in children affected by environmental tobacco smoke compared to those who were not (p value< 0.001). In addition, there was a significant relationship between the number of cigarettes smoked per day by the parents and salivary cotinine levels and GPI in the case group (p value<0.01 and p value<0.001). Furthermore, there was a significant relationship between pigmentation intensity and salivary cotinine levels in the case group (p value=0.005).Conclusion: The results suggested a relationship between an increase in gingival pigmentation and salivary cotinine levels in children exposed to environmental tobacco smoke.

Introduction: Synthesis of new drugs, including GM-CSF (granulocyte-macrophage colonystimulating factor), is one of the most important use of recombinant DNA technology. GM-CSF is a Molgramostim drug that is widely used in order to reduce the side effects of chemotherapy and enhance the immune system.Treatment of dental abscesses in patients undergoing chemotherapy is one of the most common uses of this drug in dentistry. In addition, GM-CSF has a key role in the treatment of mucositis in patients undergoing chemotherapy and radiotherapy of the oral area. In this review, the different uses of the recombinant molgramostim drugs in treating different diseases were evaluated.Article Explanation: In the current review paper, relevant articles were collected from ISI Web of Science and PubMed databases by using Google Scholar search engine from 1973 to 2014. The articles were analyzed for 8 months. Articles related to the effect of recombinant GM-CSF on treating disease were included in the current paper.Conclusion: The potency of GM-CSF in inducing the production of granulocytes and macrophages in vivo shows that it can clinically increase neutrophil counts and enhance the immune system subsequent to injuries inflicted by conditions such as myelodysplastic syndrome or injuries due to chemotherapeutic agents. In addition, considering the widespread therapeutic use of GM-CSF to boost the immune system, it can be introduced as an important agent for the treatment of dental abscesses in chemotherapy patients.

Introduction: As implant treatment becomes part of the mainstream dental therapy, dental practitioners should become familiar with protocols for individualized, systematic and continuous supportive care of peri-implant tissues. The present review was undertaken to evaluate and prepare guidelines for therapeutic and care techniques after implant placement.Search strategy: All the relevant articles indexed in Pubmed, Google Scholar and Science Direct databases from 1970 to 2014 were searched. After studying 120 article abstracts, 80 articles whose full texts were accessible were selected. Based on the 2003 recommendations of American Academy of Periodontology, patients should be evaluated at regular intervals to monitor their peri-implant status and the condition of the implant-supported prostheses, for plaque control, for evaluation of occlusion and for oral hygiene. Assessment of patients’ medical and dental histories, soft tissues, plaque index, clinical probing depth, bleeding on probing, presence of keratinized tissue, mobility, occlusion and bone level are recommended during the maintenance period. In cases of peri-implantitis, the mucosal lesion is often associated with suppuration, deepening of the clinical probing depth, bleeding on probing and loss of supporting marginal bone. Care and treatment suggested include proper oral hygiene, removal of supra- and subgingival plaque and calculus, occlusal adjustment, relining of prostheses and surgery.Results: This review outlined a standardized, evidence-based assessment and intervention protocol to assist practitioners in the maintenance care of dental implants. Now that implant therapy has become a part of the mainstream dental treatment, it is important to identify patients at risk for peri-implantitis and to reinstate an appropriate maintenance protocol. It is suggested that the presence of implant mucositis lesions be determined due to the possibility of progression of this condition to peri-implantitis.

Introduction: Branchial cleft cyst is a slow-growing fluctuant mass that most commonly appears during the second and third decades of life. The most common site of this cyst is the lateral aspect of the neck and anterior to the sternocleidomastoid muscle, but it can also be found around the parotid gland, angle of the mandible and near the external ear. The cyst presented in this case report is important because of its uncommon site and its clinical presentation similar to an odontogenic abscesses, possibly leading to clinical misdiagnosis.Case Report: This report presents a case of a branchial cleft cyst which was misdiagnosed primarily as an odontogenic cyst or abscess and was treated with antibiotics for three months by a general dentist. In clinical examination there was a 5×5-cm fluctuant swelling with soft consistency in the lateral aspect of the neck and right side of submandibular area. The cyst was not tender to palpation. The panoramic view showed extensive caries of the right first molar tooth and a radiolucent lesion in the apical area of the right third molar. Following determination of the extension of this lesion by spiral CT scan, excisional biopsy was carried out under general anesthesia. Pathology report revealed branchial cleft cyst.Conclusion: The diagnosis of branchial cleft cysts mainly depends on history and clinical manifestations. CT scan is not only useful for the evaluation of the lesion but also it is useful to evaluate its relationship with adjacent structures.