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  Abstracts 11

Hydrolytic Stability of Self-etch Adhesives Bonded to Dentin 
Does Periodontal Treatment Improve Glycemic Control in Diabetic Patients?
Assessment of three-dimensional X-Ray images
The minimum clinically significant difference in patient-assigned numeric scores for pain 
Porphyromonas gingivalis affects host collagen degradation by affecting expression
Effects of intracanal carbon dioxide laser irradiation on cultured human fibroblasts 
Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant
A Comparison of Three Techniques to Obtain Root Coverage on Mandibular Incisors
Long-term evolution of a case of direct pulp capping by adhesion to dentin 
Squamous Cell Carcinoma Presenting as an Endodontic-Periodontic Lesion

RESEARCH REPORT
Biomaterials & Bioengineering

Hydrolytic Stability of Self-etch Adhesives Bonded to Dentin

S. Inoue1,2, K. Koshiro3, Y. Yoshida4, J. De Munck2, K. Nagakane5, K. Suzuki4, H. Sano3, and B. Van Meerbeek2,* 1 Division for General Dentistry, Center for Dental Clinics, Hokkaido University Hospital, Kita 13 Nishi 7, Kita-ku,Sapporo 060-8586, Japan; 2 Leuven BIOMAT Research Cluster, Department of Conservative Dentistry, School of Dentistry, Oral Pathology and Maxillo -facial Surgery, Catholic University of Leuven, Kapucijnenvoer 7, B-3000 Leuven, Belgium; 3 Department of Conservative Dentistry, Hokkaido University Graduate School of Dental Medicine, Kita 13 Nishi 7, Kita-ku,Sapporo 060-8586, Japan; 4 Department of Biomaterials, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, and Research Center for Biomedical Engineering, Okayama University, 2-5-1 Shikata-cho, Okayama 700-8525, Japan; and 5 Department of Biomaterials Science, Hiroshima University Graduate School of Dentistry, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan; * corresponding author, bart.vanmeerbeek@med.kuleuven.ac.be Functional monomers chemically interact with hydroxyapatite that remains within submicron hybrid layers produced by mild self-etch adhesives. The functional monomer 10-MDP interacts most intensively with hydroxyapatite, and its calcium salt appeared most hydrolytically stable, as compared with 4-MET and phenyl-P. We investigated the hypothesis that additional chemical interaction of self-etch adhesives improves bond stability. The micro-tensile bond strength (µTBS) of the 10-MDP -based adhesive did not decrease significantly after 100,000 cycles, but did after 50,000 and 30,000 cycles, respectively, for the 4-MET-based and the phenyl-P-based adhesives. Likewise, the interfacial ultrastructure was unchanged after 100,000 thermocycles for the 10-MDP-based adhesive, while that of both the 4-MET- and phenyl-P-based adhesives contained voids and less-defined collagen. The findings of this study support the concept that long-term durability of adhesive-dentin bonds depends on the chemical bonding potential of the functional monomer. KEY WORDS: hydrolytic stability • self-etch adhesive • durability • functional monomer • dentin RESEARCH REPORT Clinical

Does Periodontal Treatment Improve Glycemic Control in Diabetic Patients? A Meta-analysis of Intervention Studies

S.-J. Janket1,2,*, A. Wightman3, A.E. Baird4, T.E. Van Dyke5, and J.A. Jones1,6 1 Department of General Dentistry, Boston University, Goldman School of Dental Medicine, 100 East Newton Street, Boston, MA 02118, USA; 2 Harvard School of Public Health, Department of Nutrition, Boston, MA, USA; 3 US Air Force 59th Dental Squadron, San Antonio, TX, USA; 4 Stroke Neuroscience Unit, NINDS, National Institutes of Health, Bethesda, MD, USA; 5 Clinical Research Center/Periodontology and Oral Biology, Boston University Goldman School of Dental Medicine, Boston, MA, USA; and 6 VA Center for Health Quality, Outcomes and Economic Research, Bedford, MA, USA * corresponding author, sjanket@post.harvard.edu Previous analyses regarding effects of periodontal treatment on glycemic control included studies where causal association might not be assumed, or the results were reported non-quantitatively. We initiated this meta-analysis of 10 intervention studies to quantify the effects of periodontal treatment on HbA1c level among diabetic patients, to explore possible causes for the discrepant reports, and to make recommendations for future studies. Data sources were MEDLINE (January, 1980, to January, 2005), the EBMR, Cochrane Register, and bibliographies of the published articles. Three investigators extracted data regarding intervention, outcomes, and effect size. A total of 456 patients was included in this analysis, with periodontal treatment as predictor and the actual change in hemoglobin A1c level as the outcome. The weighted average decrease in actual HbA1c level was 0.38% for all studies, 0.66% when restricted to type 2 diabetic patients, and 0.71% if antibiotics were given to them. However, none was statistically significant. KEY WORDS: meta-analysis • inflammatory mediators • hemoglobin A1c • non-surgical periodontal treatment • antibiotics treatment American Academy of Implant Dentistry Journal 31:234–241 (2005) DOI: 10.1563/1548-1336(2005)31[234:AOTXIR]2.0.CO;2 Journal of Oral Implantology: Vol. 31, No. 5, pp. 234–241.

ASSESSMENT OF THREE-DIMENSIONAL X-RAY IMAGES: RECONSTRUCTION FROM CONVENTIONAL TOMOGRAMS, COMPACT COMPUTERIZED TOMOGRAPHY IMAGES, AND MULTISLICE HELICAL COMPUTERIZED TOMOGRAPHY IMAGES

Munetaka Naitoh, DDS, PhD Akitoshi Katsumata, DDS, PhD Yukinobu Kubota, DDS Eiichiro Ariji, DDS, PhD Tomography Compact computerized tomography Multislice helical computerized tomography Three-dimensional image Dental implant Three-dimensional X-ray images (3D images) were used for imaging diagnosis in the oral and maxillofacial region. These images could be fundamentally reconstructed from various tomograms, though clinical 3D images were mainly reconstructed from computerized tomography (CT) images. In this investigation, 3D images were reconstructed from conventional tomograms with a panoramic unit, compact CT images, and multislice helical CT images, and the usefulness of each system was subjectively assessed for dental implant treatment. Three hemilateral dried human mandibles were used and were examined by linear tomography with a panoramic unit, compact CT, and multislice helical CT, and 3D images were reconstructed by using the rendering software for each system. The 3D images were visually evaluated on a 5-point scale covering the alveolar ridge, buccal and lingual bone surface, mental foramen, and tooth sockets. As a result, 3D images reconstructed from conventional tomograms with the panoramic unit were assessed as fair to unsure, compact CT 3D images were assessed as unsure to good, and multislice helical CT 3D images were assessed as good to excellent. It was concluded that compact CT 3D images and multislice helical CT 3D images were useful in dental implant treatment.

The minimum clinically significant difference in patient-assigned numeric scores for pain

This paper was presented at the American College of Emergency Physicians Research Forum, San Francisco, Calif, October 2004. Dawn B. Kendrick MD and Tania D. Strout RN, BSN, Department of Emergency Medicine, Maine Medical Center, Portland, ME 04102, USA Study Group Authorship: DBK and TDS conceived the study and designed the trial. DBK and TDS supervised the conduct of the trial and data collection. DBK and TDS both participated in subject identification and enrollment. TDS undertook data management. DBK and TDS performed data analysis. DBK and TDS drafted the manuscript and both authors contributed substantially to its revision. TDS takes responsibility for the paper as a whole.. Available online 13 November 2005. Abstract Objective To determine the minimum clinically significant difference (MCSD) in patient-assigned, 11-point numeric rating scale (NRS-11) scores for pain and to determine if the MCSD varied with demographic characteristics. Methods Eligible emergency department patients presenting with pain were asked to rate their pain on the NRS-11 every 20 minutes. Subjects compared pain intensity by choosing from the following verbal descriptor responses: “a lot more,” “a little more, ” “about the same,” “a little less,” or “a lot less” pain. The MCSD was defined as the difference between scores rated “a little more” or “a little less” severe. Results Three hundred fifty-four subjects were enrolled. The MCSD was 1.39 ± 1.05 (95% confidence interval, 1.27-1.51). No statistically significant difference based on sex or pain etiology was noted. Conclusions Findings suggest that a change of 1.39 ± 1.05 (95% confidence interval, 1.27-1.51) on the NRS-11 is clinically significant when measuring pain. Journal of Periodontal Research Online Early doi:10.1111/j.1600-0765.2005.00835.x Volume 0 Issue 0

Porphyromonas gingivalis affects host collagen degradation by affecting expression, activation, and inhibition of matrix metalloproteinases

Jing Zhou, L. Jack Windsor Zhou J, Windsor L. J: Porphyromonas gingivalis affects host collagen degradation by affecting expression, activation, and inhibition of matrix metalloproteinases. J Periodont Res 2005; doi: 10.1111/j.1600-0765.2005.00835.x.©Blackwell Munksgaard 2005. Objective: Studies have shown that Porphyromonas gingivalis and host matrix metalloproteinases (MMPs) play important roles in the tissue destruction associated with periodontal disease. It is still unclear which MMPs or their inhibitors are regulated by P. gingivalis at the transcriptional and/or at the protein levels. Therefore, this study was conducted to determine what effects P. gingivalis supernatant has on the collagen degrading ability of human gingival fibroblasts (HGFs) and how it regulates the activation, mRNA expression, and inhibition of MMPs. Methods: Culture supernatant from P. gingivalis ATCC 33277 was added to HGFs cultured in six-well plates coated with Type I collagen. At certain time intervals, the cell conditioned media was collected for zymography and/or western blot analyses to determine the MMP and tissue inhibitor of MMPs (TIMP) protein levels. The cells were then removed and the collagen cleavage visualized by Coomassie blue staining. The mRNA expression of multiple MMPs and TIMPs by the treated and untreated HGFs was determined by reverse transcription–polymerase chain reaction. Results: The collagen in the six-well plates was degraded more rapidly by the HGFs treated with 10% v/v P. gingivalis supernatant. More active MMP-1, MMP-2, MMP-3, and MMP-14 were detected in the conditioned media from the HGFs treated with the P. gingivalis supernatant. TIMP-1, but not TIMP-2, was decreased in the presence of the P. gingivalis supernatant. MMP-1 mRNA expression by the treated HGFs increased more than two-fold over the untreated HGFs. MMP-3 mRNA was unchanged, MMP-2 mRNA had a slight increase, MMP-14 mRNA decreased, and MMP-15 increased. MMP-12 mRNA was induced in the P. gingivalis treated HGFs. TIMP-1 and TIMP-2 mRNA had a slight increase with P. gingivalis treatment. Conclusion: Porphyromonas gingivalis increased the collagen degrading ability of HGFs, in part, by increasing MMP activation and by lowering the TIMP-1 protein level, as well as by affecting the mRNA expression of multiple MMPs and TIMPs.

Endodontology : Effects of intracanal carbon dioxide laser irradiation on cultured human fibroblasts

Naoki Horiba DDS, PhDa, , , Ayako Itoh DDS, PhDa, Masataka Yamaguchi DDS, PhDa, Toru Matsumoto DDS, PhDa, Akira Senda DDS, PhDb and Hiroshi Nakamura DDS, PhDc aDepartment of Endodontics, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan bDepartment of Operative Dentistry, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan cResearch Institute of Advanced Oral Science, Aichi-Gakuin University, and Department of Endodontics, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan Received 6 December 2004; accepted 6 January 2005. Nagoya, Japan AICHI-GAKUIN UNIVERSITY. Available online 11 April 2005. Objective The purpose of this study was to evaluate, under various conditions, the damage that might occur to viable cells after CO2 laser irradiation of the root canal. Study design A laser tip was placed within the root canal of extracted human teeth that were positioned above cultured fibroblasts (NB cells), and then irradiation was applied. The irradiation modes used were either pulse (40 pps) or super-pulse (151 pps). The laser energy was set at 32 J in both modes, and the tip of the laser beam was positioned to a point 2 mm from the fibroblasts. Results When the pulse mode irradiation was applied, there was significant difference (P < .05) in the percentage of viable cells between teeth with closed apical foramen (1-mm wall between root canal and root apex) and the #15 group (No. 15 K-file used), #30 group (No. 30 K-file), or #50 group (No. 50 K-file). The difference between the #30 group and the #50 group (P < .05) was also significant. The larger the diameter of the apical foramen became, the lower was the percentage of viable cells. Conclusion If a CO2 laser irradiates a root canal system enlarged to within 1 mm of the root canal length, little damage to the periapical tissues would be expected to occur.
Endodontology

Effectiveness of a calcium hydroxide and chlorhexidine digluconate mixture as disinfectant during retreatment of failed endodontic cases

Joseph A. Zerella DMD, MDSa, , , Ashraf F. Fouad BDS, DDS, MSb and Larz S.W. Spångberg DDS, PhDc aFormer Resident and Postgraduate Student in Endodontology, Department of Endodontology, School of Dental Medicine, University of Connecticut bAssociate Professor and Chairman, Department of Endodontics, Prosthodontics and Operative Dentistry, Baltimore College of Dental Surgery, University of Maryland cProfessor of Endodontology, Department of Endodontology, School of Dental Medicine, University of Connecticut Received 10 October 2003; revised 15 January 2004; accepted 17 May 2005. Farmington, Conn, and Baltimore, Md UNIVERSITY OF CONNECTICUT AND UNIVERSITY OF MARYLAND. Available online 12 October 2005. Objective The purpose of this in vivo investigation is to compare the effect of a slurry of Ca(OH)2 mixed in aqueous 2% chlorhexidine (CHX) versus aqueous Ca(OH)2 slurry alone on the disinfection of the pulp space of failed root-filled teeth during endodontic retreatment. Study design Forty single-rooted previously root-filled teeth with associated periradicular lesions were included. The teeth were nonsurgically retreated and medicated over 3 treatment visits with 7-10-day intervals with either Ca(OH)2 in water or Ca(OH)2 in 2% aqueous CHX. Root canal cultures were collected in fluid thioglycollate, and bacterial growth was assessed by turbidity daily for 1 week, then weekly for an additional 3 weeks. The presence of enterococci in the root canals at the initial treatment session was determined. Results Of the total sample population, 12 of 40 (30%) were positive for bacteria before root filling. The control medication disinfected 12 of 20 (60%) teeth including 2 of 4 teeth originally diagnosed with enterococci. The experimental medication resulted in disinfected 16 of 20 (80%) teeth at the beginning of the third appointment. None of the teeth originally containing enterococci showed remaining growth. This difference between the overall positive cultures was not statistically significant (P > .05). Conclusions Canal dressing with a mixture of 2% CHX and Ca(OH)2 slurry is as efficacious as aqueous Ca(OH)2 on the disinfection of failed root-filled teeth.
Abstract Journal of Periodontology 2005, Vol. 76, No. 10, Pages 1758-1767 (doi:10.1902/jop.2005.76.10.1758)

A Comparison of Three Techniques to Obtain Root Coverage on Mandibular Incisors

Randall J. Harris,* ­Laura Harris Miller, ­Christopher R. Harris, and ­Richard J. Miller­ *Currently, retired; previously, private practice, Reno, NV. †Currently, resident, Periodontology, University of Nebraska, Lincoln, NE; previously, Marquette Dental School, Marquette University, Milwaukee, WI. ‡Currently, resident, Oral and Maxillofacial Surgery, Baylor University, Dallas, TX; previously, Oral Surgery Internship, University of Nebraska. Correspondence to: Correspondence: Dr. Laura H. Miller, 6591 Breckenridge Court, Reno, NV 89523. E-mail: rjmandlhm@yahoo.com. Background: Multiple variations on the subepithelial connective tissue graft have been shown to produce good clinical results. The goal of this study was to compare three variations in the treatment of recession on mandibular incisors. Methods: An a priori analysis was done to determine the sample size. Three groups of patients received root coverage procedures on mandibular incisors. Each group was treated with a different variation of a subepithelial graft. The first group received a connective tissue (CT) graft with a coronally positioned flap (CPF) (CPF + CT). The second group received a connective tissue graft with a double pedicle (DP) graft (DP + CT). The third group received a connective tissue graft with a tunneling (TUN) procedure and a laterally positioned (LAT) pedicle (TUN-LAT + CT). The clinical results of these procedures were compared to determine if one procedure offered an advantage over the other procedures. Results: All of the procedures produced a statistically significant improvement in the clinical parameters. The groups treated with the DP + CT and TUN-LAT + CT had greater mean root coverage (95.5% and 90.5%, respectively) than the CPF + CT group (80.2%). Additionally, DP + CT produced a greater increase in keratinized tissue (3 mm) than CPF + CT (1.4 mm) or TUN-LAT + CT (1.9 mm). There was no statistically significant difference in the mean root coverage of any technique treating defects <3 mm deep (CPF + CT, 90.9%; DP + CT, 96.4%; and TUN-LAT + CT, 92.1%) or the defects >3 mm deep treated with DP + CT (95.4%) or TUN-LAT + CT (88.3%). However, the CPF + CT produced less mean root coverage (68.4%) when treating defects =3 mm deep. When defects treated as isolated defects were compared to cases where multiple defects were treated, the cases with multiple defects treated with the CPF + CT had less mean root coverage (77%) than cases where single defects were treated with the CPF + CT (90.3%), DP + CT (isolated, 96.7% and multiple, 95.6%), and TUN-LAT + CT (isolated, 97.2% and multiple, 87.8%). Conclusions: All three of the procedures were effective in obtaining root coverage and improved clinical parameters on mandibular incisors. Overall, the DP + CT and TUN-LAT + CT procedures had greater mean root coverage than the CPF + CT technique. Based on this study, when treating defects =3 mm deep, one should consider using the DP + CT or TUN-LAT + CT rather than the CPF + CT. Additionally, when treating multiple defects at a time, one should consider using the DP + CT or TUN-LAT + CT rather than the CPF + CT. In cases where an increased amount of keratinized tissue is desired, based on this study, the DP + CT may be the best procedure to use. KEYWORDS: Connective tissue/surgery, gingival recession/surgery, surgical flaps, tooth root/surgery Publication: Quintessence International November 2005 Volume 36 , Issue 10 Long-term evolution of a case of direct pulp capping by adhesion to dentin Santiago Gonzalez-Lopez MD, PhD/Victoria Bolaños-Carmona MD, PhD This article presents the long-term follow-up of a female patient who suffered pulp exposure during removal of a large caries lesion from the mandibular right first molar. The clinical decision to perform direct pulp capping was made. The tooth was treated with 5% chlorhexidine, etched with 37% phosphoric acid, and then restored with Heliomolar composite after application of Gluma dentin adhesive. The patient was followed for more than 8 years. (Quintessence Int 2005;36:797–803) Key words: clinical follow-up, clinical report, compound resins, conservative treatment, dentin adhesion, direct pulp capping, pulp exposure, pulp vitality Abstract Journal of Periodontology 2005, Vol. 76, No. 10, Pages 1798-1804 (doi:10.1902/jop.2005.76.10.1798)

Squamous Cell Carcinoma Presenting as an Endodontic-Periodontic Lesion

Paul A. Levi Jr.,* ­David M. Kim, ­Scott L. Harsfield,§ and ­Erica R. Jacobson­ *Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA. †Private practice, Burlington, VT. ‡Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA. §Private practice, Sharon, MA. Department of Pathology, University of Vermont College of Medicine, Burlington, VT. Correspondence to: Correspondence: Dr. Paul A. Levi Jr., Department of Periodontology, Tufts School of Dental Medicine, One Kneeland St., Boston, MA 02111. Fax: 617/636-0911; e-mail: levishuman@aol.com. Background: Regardless of advances in diagnosis and treatment during the past 40 years, the overall 5-year survival rates oral and oropharyngeal squamous cancers have only slightly improved and remain around 50%. Thus, the early diagnosis and treatment of carcinoma by health care providers are essential in achieving a good prognosis. We report a case of invasive squamous cell carcinoma that presented as a benign endodontic-periodontic lesion with a 7-mm periodontal pocket on tooth #15 in a 40-year-old, non-smoking woman. The subsequent management of the case is also discussed. The study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2000. Methods: Our patient was seen for a comprehensive periodontal examination including a periodontal charting, occlusal analysis, study casts, electronic pulp test for tooth #15, and complete mouth periapical radiographs. As there was a periapical radiolucency, an endodontic consultation was obtained. A periodontal flap surgical procedure was performed on teeth #13 to #15, and as there was bone erosion into the maxillary sinus, a biopsy of the soft tissue was submitted to the local hospital for histological analysis. Results: The biopsied lesion was diagnosed as invasive, moderately differentiated squamous cell carcinoma with focal spindle and clear cell differentiation (grade II to III of IV). Bone invasion was also identified. The treatment of the carcinoma involved a hemimaxillectomy with the removal of the maxillary left posterior teeth. The patient remained free of tumor for 5 years after the initial presentation. Conclusions: Patient education and periodic oral cancer examinations by dental professionals are necessary to reduce diagnostic delay and improve prognosis. This case report emphasizes the important role of dental professionals, especially periodontists and endodontists, of being aware that squamous cell carcinoma may manifest itself clinically and/or radiographically as a common periodontal or endodontic lesion. KEYWORDS: Diagnosis, maxillary sinus, periodontitis, squamous cell carcinoma