Alexandria Dental Journal (2016) Vol.41 Issue (3)

Contents

THE CLINICAL EFFICIENCY OF PLATELET RICH PLASMA IN THE TREATMENT OF TEMPOROMANDIBULAR JOINT DISORDERS

Elham F Hassan, Tarek M Ali , Nevein S Abdulla

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INTRODUCTION: Temporomandibular joint dysfunction (TMD) is a clinically significant condition which can be a source of acute or chronic orofacial pain and dysfunction including limitation of mandibular movement. Platelet-rich plasma (PRP) is a blood product that allows in a simple, low cost, and minimally invasive way to obtain a concentration of many growth factors when activated. Many researchers proved PRP safety and efficacy in the management of musculo articular disorders.
OBJECTIVES: to evaluate the efficiency of intra-articular PRP injection in comparison with conventional arthrocentesis in the treatment of TMD.
MATERIALS AND METHODS: Twenty patients suffering from TMD were included in the study diagnosed according to The Research Diagnostic Criteria for Temporomandibular disorders (RDC/TMD) and divided into two groups as follow; ten patients underwent intra-articular injections of 2 ml PRP into the temporomandibular joint (TMJ) (study group) and the other ten patients were treated by the conventional arthrocentesis using Ringer’s solution (control group). The patients were clinically evaluated preoperatively and postoperatively at the intervals of 1week, 3, and 6 months.
RESULTS: The differences between the two groups in all the measured parameters were statistically insignificant throughout the postoperative period. But PRP group showed superior result than arthrocentesis group regarding pain and tenderness, and inferior result in clicking.
CONCLUSIONS: PRP injection is a safe and effective method in the treatment of TMDs.
KEY WORDS: TMJ, TMDs, PRP, Arthrocentesis.


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ULTRASTRUCTURAL STUDY OF THE EFFECT OF ZINC OXIDE NANOPARTICLES ON RAT PAROTID SALIVARY GLANDS AND THE PROTECTIVE ROLE OF QUERCETIN

Sara A. Hamza,Hanaa M. Aly, Samia O. Soliman, Dina M. Abdallah

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INTRODUCTION: Nanotechnology is the technology of diagnosing, treating, and preventing diseases using nanoscale structured materials. Zinc oxide nanoparticles (ZnO NPs) have useful effects for their less environmental hazards and for their application usages: tooth pastes, biomedicine and food as zinc supplements. On the other hand, ZnO NPs have toxic effect due to their tissue accumulation ability. Quercetin (Qc) is an antioxidant, categorized as a flavonol. Its beneficial effects are attributed to its phenolic hydroxyl groups. It has antioxidant and anti-inflammatory activities.
OBJECTIVES: To evaluate the effect of ZnO NPs on rat parotid salivary glands and to investigate the possible protective role of Qc.
MATERIALS AND METHODS: Twenty-four adult male albino rats were divided into three equal groups: group (I) control, group (II) received ZnO NPs 300 mg/kg and group (III) received ZnO NPs 300 mg/kg + Qc 200 mg/kg for 28 days. At the end of the experiment, animals were euthanized and the parotid glands were dissected out. The effect of ZnO NPs on the parotid glands as well as the protective role of Qc were assessed by transmission electron microscopy.
RESULTS: In group(II) the acinar cells showed signs of toxicity as apoptotic nuclei, degenerated mitochondria, dilated rough endoplasmic reticulum and vacuolization in the cytoplasm. Group (III) parotid glands exhibited remarkable improvement in the ultrastructure of their acinar cells and duct system. This appearance was near to that of control group.
CONCLUSIONS: The study proved ZnO NPs toxicity and revealed that oral administration of Qc effectively prevented the toxicity associated with ZnO NPs administration in rat models. Thus, Qc might be used as a prophylactic treatment to prevent ZnO NPs toxicity.
KEYWORDS: Zinc Oxide Nanoparticles, Quercetin, Parotid Salivary Glands.


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A COMPARATIVE STUDY OF APICAL TRANSPORTATION AND STRAIGHTENING OF TWO ROTARY NICKEL-TITANIUM SYSTEMS WHEN USING FINAL APICAL BRUSHING

Heba A. Abdalla, Sybel M. Moussa S, Nayera A. Mokhless N

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INTRODUCTION: Apical transportation results in an inadequately clean apical area and makes apical seal more difficult thus affecting the final outcome and may lead to failure.
OBJECTIVES: The aim of this study was to compare between the effect of two rotary nickel titanium systems after using final apical strokes on canal transportation and apical straightening of the canal.
MATERIALS AND METHODS: Sixty mesiobuccal canals of extracted mandibular first molars with root canal curvature angle (25 to 45 degree) were selected. Canals were divided into two groups (n=30). In group I canals were prepared with OneShape file, while in group II, canals were prepared with Revo-S system. Each group was then sub-divided into two sub-groups according to the motion used (pecking or circumferential filing). Sub group Ia (OneShape file) and sub group Ib (Revo-S system) were prepared with pecking motion while sub group II an and sub group II b were prepared with circumferential filing motion. A radiographic platform was used to obtain accurate radiographs. All specimens were radiographed from proximal and mesiodistal views. To measure apical transportation, the pre and post-instrumentation radiographs were exported from the Kodak software into Photoshop program. Then a grading system was used to assess the amount of transportation. Based on apical curvature measured before and after instrumentation (using Image J program), canal straightening was determined as the difference between these two measurements.
RESULTS: Regarding apical transportation, no statistical significance was found between both groups and the sub groups. Apical straightening was evaluated, and no statistical significance was found between the groups. However, circumferential filing produced more straightening.
CONCLUSIONS: OneShape file and Revo-S system maintained the original canal curvature with no significant differences between the files. Circumferential filing motion with both systems resulted in higher values of straightening when compared to pecking motion.
KEYWORDS: Apical canal transportation, canal straightening, rotary nickel titanium, single file.


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TRANSCRESTAL SINUS LIFT AND IMPLANT PLACEMENT USING THE SINUS BALLOON TECHNIQUE

Ashraf A. Elbareki , Sameh A. Darwish , Ragab S. Hassan

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INTRODUCTION: Rehabilitation of the edentulous posterior maxilla with dental implants is challenging. The deficient alveolar ridge interferes with implant insertion of adequate length placed in the correct position and with the accurate inclination. The transcrestal sinus elevation procedure has become an important preprosthetic surgical procedure for bone creation in the posterior maxilla prior to implant placement.
OBJECTIVES: Clinical and radiographic evaluation of using ballooning technique for sinus lift simultaneous with implant placement.
MATERIALS AND METHODS: A randomized clinical trial was conducted on fourteen patients who were divided into two groups. Patients, with limited bone height below the floor of the maxillary sinus, were selected on the basis of history, clinical and radiographic examination using cone beam computed tomography. In group A, elevation of sinus membrane using ballooning technique without graft material and implants were placed simultaneously. While in group B, after sinus membrane elevation using ballooning technique, augmentation using biphasic calcium phosphate simultaneously with the implant placement were done. The bone density was measured in Hounsfield unit using ondemand3d software of the cone beam computed tomography. Also, the bone height was measured using cone beam computed tomography.
RESULTS: Successful sinus membrane balloon lifting procedures were performed in 14 cases; in both groups there was no sinus membrane perforation. A total of 14 implants were placed. The radiographic examination showed the mean elevated height after 6 months by balloon in group A was 10.43 with SD ±1. 56mm.while in group B was10.31 ± 1.86.
CONCLUSIONS: The use of balloon technique to elevate the sinus membrane is a minimally invasive technique and is associated with very little discomfort and complication.
KEY WORDS: Transcrestal Sinus lift, balloon, implant, tenting-pole, Biphasic calcium phosphate (BCP).


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A COMPARATIVE STUDY BETWEEN 3-D PLATES AND CONVENTIONAL MINIPLATES FOR INTERNAL FIXATION OF ANTERIOR MANDIBULAR FRACTURES

Norhan A. El Nakeeb, Mostafa M. El Dibany, Mohamed M. Shokry

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INTRODUCTION: The management of facial trauma is one of the most demanding aspects of oral and maxillofacial surgery. Being the most prominent mobile bone of the facial skeleton, mandible fracture occurs more frequently than any other facial fracture.
OBJECTIVES: To compare between the effect of three dimensional (3D) plates and conventional miniplates for internal fixation of anterior mandibular fractures.
MATERIALS AND METHODS: This was a controlled and randomized clinical trial. A total of 20 patients; aged between 21-50 years, who had symphyseal or parasymphseal mandibular fracture were randomly selected for this study from the outpatient clinic of Oral and Maxillofacial Surgery Department, Faculty of dentistry, Alexandria University. In this study, open reduction and internal fixation were performed for mandibular symphyseal and parasymphyseal region fractures using one three dimensional (3D) plate in 10 patients as study group and using two miniplates in 10 patients as control group. Clinical and radiographical evaluation were made. Each patient was evaluated: 1- clinically for infection, pain, swelling, malocclusion, wound healing, sensory disturbance, primary stability of the fracture segment, maximum mouth opening and masticatory efficiency using pressure indicating film. 2- Radiological: cone beam computed tomography (CBCT) images were taken to evaluate reduction of the fractured segment, malunion/non-union and bone density within the fracture line. The data collected was subjected to statistical analysis.
RESULTS: There was an improvement in wound healing, oedema, occlusion and sensory disturbance in both groups. There was no statistical significant difference between the two groups regarding pain, maximum mouth opening, bite force or bone density.
CONCLUSIONS: Three dimensional plate is effective in the treatment of anterior mandibular fractures as well as conventional miniplates. Ease of application and shorter working time are its advantages over conventional miniplates.
KEY WORDS: 3D plate, Miniplates, Symphyseal, Parasymphyseal, mandibular fracture.


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EVALUATION OF RESORBABLE MESH AND PLATE WITH ULTRASONIC WELDED PINS IN THE MANAGEMENT OF MANDIBULAR FRACTURES IN CHILDREN (A COMPARATIVE CLINICAL STUDY)

Marwa G. Noureldin, Abdelaziz F. Khalil, Ahmed R. Kotb, Magued H. Fahmy Salah Eldin D. Abo Eleneen

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INTRODUCTION: SonicWeld Rx® system (KLS Martin) uses an ultrasonic sonotrode unit to bond a Resorb-X® pin to the Resorb-X® mesh and plates and underlying bone preclude the need to tap and decrease the time needed for fixation. Moreover, there is no second surgery needed for its removal.
OBJECTIVES: This study compared the use of resorbable mesh and plates with ultrasonic welded pins in management of mandibular fractures in children.
MATERIALS AND METHODS: This prospective comparative study was conducted on 20 children aged 6-12 years with mandibular fracture divided into 2 groups, group I was fixed with resorbable meshes and group II was fixed with resorbable plates. All patients were followed up clinically at the 2nd, 7th, 10th and 14th day postoperatively. Radiographically, all patients were examined by ultrasound(US) at 3, 6, 9 months postoperatively and by cone beam computed tomography(CBCT) at 6 months.
RESULTS: Comparing the two groups clinically, there was no statistically significant difference at all stages of follow up. Radiographically, the difference in the mean thickness between the two groups was statistically insignificant at 3, 6, 9 months postoperatively. CBCT evaluation of bone density showed comparable results in both groups.
CONCLUSIONS: The SonicWeld Rx® system either the mesh or the plate were found to be satisfactory in the treatment of pediatric mandibular fractures, however proper case selection is essential criteria to make them successful. Ultrasonographic aid has proved an essential diagnostic aid in assessing the biodegradation process of the resorbable material over a period of 9 months in the present study.
KEYWORDS: resorbable material, SonicWeld Rx® system, pediatric mandibular fractures, ultrasound imaging


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EVALUATION OF RESORBABLE PLATES WITH ULTRASONIC WELDED PINS IN THE MANAGEMENT OF MIDFACE FRACTURES (CLINICAL, HISTOLOGICAL, AND BIOMECHANICAL STUDY)

Ahmed O. Sweedan , Nagy E. Hassan, Samraa A. El-Sheikh, Riham M. El-Dibany, Khadiga Y. Kawana

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INTRODUCTION: The use of biodegradable screws has a number of limiting factors including poor mechanical stability, difficult handling properties, and time-consuming fixation. A new application system by welding a special configured resorbable pin through ultrasound may overcome the disadvantages of thread tapping.
OBJECTIVES: Was to evaluate resorbable plates with ultrasonic welded pins in management of midface fracture.
MATERIALS AND METHODS: Was conducted clinically on 20 midface fracture cases fixed with resorbable plates with ultrasonic welded pins, histologically on 4 healthy adult mongrel dogs, and biomechanically on 15 specimens tested for tension, bending, and torsion stiffness of this system.
RESULTS: Clinically intraoperative handling showed 13% failure rate for the total number of pins placed for all cases, with stability failure in 10% of cases, and mean time needed for fixation of each plate was 10.6 minutes, however postoperative clinical results were normal with no significant complications. Radiographically; adequate bone healing with delayed resorption of pins was observed during follow-up phase which was continued till 12th week postoperatively. Histological study revealed woven bone growing in the defect area and development of new bone, osteocytes and osteoblasts seen on bone surface. Biomechanical study showed mean tensile stiffness 498.982 N/mm while mean bending stiffness was 1.176 N/mm and mean torsion stiffness was 0.342 N/mm.
CONCLUSIONS: This retrospective study shows the general feasibility, sufficient mechanical stability, and efficient intraoperative handling of resorbable plates with ultrasonic welded pins in management of midface fractures.
KEY WORDS: Resorbable plate, Ultrasound welded pin, Midface fracture, SonicWeld Rx


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EVALUATION OF PANORAMIC X-RAY VERSUS CONE BEAM COMPUTERIZED TOMOGRAPHY IN SURGICAL REMOVAL OF HORIZONTALLY IMPACTED MANDIBULAR THIRD MOLARS

Ingy N. Badawy, Nagy H. El Prince, Adham A. El Ashwah

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INTRODUCTION: Computerized scanning technology has been in use for 30 years. Originally, it was called Computerized Axial Tomography or CAT. Today, with advances in miniaturization and computer software and a revolution in imaging, CAT scan technology has been moved from the hospital to the private dental office in the form of Cone Beam Computerized Tomography (CBCT), which will be an alternative radiographic study over the standard panoramic images.
OBJECTIVES: This study evaluated the advantage of CBCT over panoramic X-ray in surgical removal of horizontally impacted mandibular third molars.
MATERIALS AND METHODS: This study was conducted on twenty patients selected from the Out-patient Clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University, diagnosed by horizontally impacted mandibular third molar class II position B. All patients were diagnosed clinically and radiographically. Patients were divided randomly in two groups, 10 patients were diagnosed preoperatively by CBCT film (study group) and the other 10 patients were diagnosed by panoramic radiographic film (control group). Intraoperative and postoperative evaluation was carried out to monitor postoperative pain, inferior alveolar nerve paresthesia, trismus and postoperative edema at 3rd, 7th and 15th day.
RESULTS: Patients in the study group experienced statistically significant less pain and less postoperative edema than those in the control group (p=0.05, and p=0.048 respectively). There was no statistically significant difference between the two groups regarding the trismus and no patients in both groups suffered of alveolar nerve paresthesia.
Less postoperative pain was diagnosed in the study group than in the control group. No inferior alveolar nerve paresthesia was found in the two groups. There was no significant difference between the two groups regarding the trismus. Less postoperative edema was found in the study group than in the control group.
CONCLUSIONS: CBCT showed higher specificity to the inferior alveolar nerve localization as compared to panoramic x-ray. Hence, it is recommended that CBCT imaging is to be considered included in the diagnostic work-up prior to surgical removal of deeply impacted third molars.
KEY WORDS: mandibular third molar impaction, horizontal impaction, Cone Beam Computed tomography.


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EVALUATION OF LOCAL ADMINISTRATION OF SIMVASTATIN ON HEIGHT AND WIDTH OF THE HEALING EXTRACTION SOCKET IN RAT MANDIBLE

Youmna M. Sherif , Nawal El Masry , Sahar S. Karam ,Maha A. Nasra

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INTRODUCTION: studies concerning healing of extraction sockets revealed that sockets were filled with new bone by as much as two thirds in 40 days and completely filled with new bone in 10 weeks. There have been many studies demonstrating the bone-promoting effect of simvastatin local application in animal models. Simvastatin was shown to increase bone volume, bone formation rate, and bone compressive strength. The use of statins for bone regeneration is a promising and growing area of research.
OBJECTIVES: The aim of this study was to compare between the amounts of resorption that occurs in the healing extraction socket left to heal spontaneously to the amount of resorption that occurs in the healing extraction socket filled with simvastatin gel.
MATERIALS AND METHODS: Right and left first molars were extracted from 20 rats’ mandibles’. Right side extraction sockets (Experimental) were filled with 2.5% simvastatin gel, while the left side sockets (Controls) were allowed to heal spontaneously. The rats were humanely sacrificed at 1st,2nd,3rd and 4th week postoperatively, and the specimens’ height and width were measured using a bone caliper.
RESULTS: The mid-buccal height as well as the buccolingual width of the alveolar bone on the simvastatin-treated side was relatively higher and thicker than the control side indicating that less resorption had occurred on that side.
CONCLUSIONS: The present study provided evidence that a single topical application of 2.5% simvastatin gel improve the quality of the new bone of the healing extraction socket and decreases bone resorption.
KEYWORDS: Simvastatin, Socket Healing, Bone Regeneration, Resorption.


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EFFECT OF DIFFERENT IRRIGATING PROTOCOLS ON THE BOND STRENGTH OF THE ACTIV GUTTA PERCHA ROOT CANAL OBTURATION SYSTEM(COMPARATIVE IN VITRO STUDY)

Shaimaa H Ismail , Ashraf M Zaazou , Nihal A Leheta ,Seham A Hanafy

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INTRODUCTION: Different irrigations may cause alteration in the composition of dentin, thereby affecting the adhesion of materials to dentin surfaces.
OBJECTIVES: evaluate the effect of different irrigating protocols used as final rinse on the bond strength of the ActiV gutta percha.
MATERIALS AND METHODS: Forty extracted single rooted lower premolars were used. Teeth were decoronated to standardize the root length to 15mm. The canals were instrumented using OneShape rotary system. Teeth were irrigated with 2.5% sodium hypochlorite then divided into four parallel groups according to the final rinse (n=10). GroupI: 10ml 17% Ethylene diaminetetraacetic acid, followed by 10ml of 2.5% NaOCL; GroupII: 10ml of 1.3%mixture of a tetracycline isomer, an acid and detergent (MTAD); GroupIII: 10ml of 2% chlorhexidine gluconate; GroupIV: 10ml 2.5% NaOCL(control). All the root canals were filled using ActiV GP. Slicing was done at the coronal and middle thirds for push-out test to measure bond strength. Then failure mode was evaluated under stereomicroscope. Data were analysed using t-test and one-way ANOVA test.
RESULTS: Group III yielded significantly the highest mean push-out bond strength (2.91± 0.79 MPa), followed by group II (2.39± 0.89 MPa), then group IV (1.80± 0.61MPa) and finally group I (1.61± 0.52 MPa). The bond strength values of the middle sections were significantly higher than that of the coronal sections. The failure mode was predominantly cohesive in groups II and III and adhesive in groups I and IV.
CONCLUSIONS: CHX and MTAD increased the bond strength of ActiV GP, while EDTA decreased the bond strength. The push out bond strength values were affected by the location of root segment. There was correlation between the push out bond strength values and the failure mode.
KEYWORDS: Endodontics, ActiV GP, Chlorhexidine, MTAD, EDTA, Push out bond strength.


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SPECTROPHOTOMETRIC ANALYSIS OF DISCOLORED ANTERIOR TEETH RESTORED WITH PREFAPRICATED COMPOSITE RESIN VENEERS

Mahmoud A Abd Elbaky, Yousreya A Shalaby, Amir S Azer, Fatma M ElSharkawy

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INTRODUCTION: Veneers are considered the least invasive most reliable solution for treatment of discolored anterior teeth. Edelweiss system is a polymerized, prefabricated, laser-machined, radiopaque, highly-filled nano-hybrid composite enamel shells with a highly glossy inorganic surface. They have a facial anatomical pattern in the shape of a thin composite shell bonded to labial surface of anterior teeth with composite resin, which allows for easy direct veneering of single and multiple anterior teeth.
OBJECTIVES Spectrophotometric analysis of discolored anterior teeth restored with Edelweiss veneer system bonded with different shades of composite resin.
MATERIALS AND METHODS: Twenty Edelweiss veneers bonded with different shades of composite resin (A2, opaque white and translucent shades) to dies of different shades. Specimens were divided into four groups, each group consists of five specimens, according to the shade of the bonding composite resin used and the shade of the dies. Spectrophotometer was used to evaluate the effect of using different shades of the bonding composite on the final shade of the restoration. Also, to assess the light reflection, transmission and absorption of the Edelweiss Veneer System.
RESULTS: The L*a*b* coordinates values of the Edelweiss Veneer Systems were affected by the shade of bonding composite (P<0.05). The use of an opaque bonding composite resulted in an increase of the color coordinates a*, b*, L*, producing the greatest effect on color change, light transmission and light reflection (P<0.05). Light absorption values of the specimens were not affected by the shade of the bonding composite. CONCLUSIONS: On using Edelweiss veneer system, the greatest color shifts and change in light transmission and light reflection were obtained when using opaque shade composite for bonding of the veneers to the substrates. While light absorption was of a non-significant value among the groups. KEYWORDS: Edelweiss veneer, ready-made veneer, spectrophotometer, discolored teeth.


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A CLINICOPATHOLOGICAL STUDY OF OROFACIAL SWELLINGS (A PROSPECTIVE STUDY)

Sarah R. Taher, Nagy E. Hassan, Sahar M. El Sheikh, Riham M. El Dibany

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INTRODUCTION: The etiology of orofacial swellings could be attributed to the presence of inflammation, congenital developmental malformations and neoplasia. Orofacial swellings may occur in the nasal cavities, paranasal sinuses, ear, eye, facial skin, oral cavity and salivary glands. Swellings of the orofacial region include cysts and tumors. Cysts are divided into developmental and inflammatory types. Tumors are divided into benign and malignant types.
OBJECTIVES: Perform clinicopathological correlation of orofacial swellings and assess the frequency of incidence regarding age, sex, site, and type of lesion.
MATERIALS AND METHODS: A clinicopathological prospective study was conducted on 100 patients suffering from swellings in the orofacial region attending the outpatient clinic of the oral and maxillofacial surgery department. The histopathological examination was done. Statistical analysis was carried out on the tabulated data using (IBM SPSS 20.0) software.
RESULTS: It was found that the incidence of all swellings in males was slightly more than females. The incidence of all swellings in the second and third decades of age. The mandible was the most frequently affected site. Using the histological classification of the World Health Organization (WHO), 32% were classified as cysts, 26% as odontogenic tumors, 25% as non-odontogenic tumors, 11% fibro-osseous lesions and 6% as salivary gland tumors.
CONCLUSIONS: Cysts are the most common oral swellings, followed by odontogenic tumors. The treatment modalities were: marsupialization, enucleation, resection, segmental mandibulectomy and hemimandibulectomy. Following surgical removal of jaw swelling, the entire surgical specimen should be examined histopathologically.
KEYWORDS: Cysts, Odontogenic tumors, Non-odontogenic tumors, Fibro-osseous lesions, Salivary gland tumors.


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EMOTIONAL INTELLIIGENCE AMONG ALEXANDRIA UNIVERSITY DENTAL INTERNS

Esraa M Bishr, Hala A Amer, Susan M Saleh

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INTRODUCTION: Emotional intelligence (EI) was reported to help in coping with stress, managing patients, improving doctor-patient relationship and trust; moreover, it leads to more successful career performance of dental students and professionals.
OBJECTIVES: To assess the EI levels of the dental interns according to socio-demographic and personal characteristics, and to some study related variables such as, reason for choosing dentistry, satisfaction with career choice and desire to enroll in a dental postgraduate sub-specialty program.
MATERIALS AND METHODS: The study was cross-sectional; it involved all Egyptian dental interns, graduated from the Faculty of Dentistry, Alexandria University, and enrolled in the internship program in the year of 2014-2015. Emotional Intelligence was assessed using the Genos, 31-item, self-reported, questionnaire, rated on a 5-point Likert scale, measuring EI across a seven subscale model and its relation to the different variables. All ethical and administrative approvals and permissions were obtained.
RESULTS: A total of 267 (157 females, 110 males) interns participated in the study, with response rate of 76.72%. Most of the respondents (84.3%) showed high EI, while 15.7% showed average EI, and none showed low EI. The highest scores were observed in ‘emotional awareness of others’ (mean%=71.2), and the least in ‘emotional self-control’ (mean%=64.5). Significantly higher EI (p<0.005) was detected in those who were males, single, chose dentistry as their own desire, were satisfied with choosing dentistry, and wanted to enroll in a postgraduate dental sub-specialty program. No significant differences were found regarding age, areas of residency, rate of internet use, type of parental education or job. CONCLUSIONS: Fresh dental graduates from Alexandria Dental University have reported high overall EI levels, which were significantly associated with gender, marital status and study related variables, more studies are needed to find the role of EI in dental student’s academic and clinical performance. KEY WORDS: Emotional intelligence, EI competencies, dental education, dental students, communication skills.


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In Vitro Comparative Efficacy of Two Techniques for Irrigant Delivery in Curved Root Canals

Raouf H. Helmy , Nayera A. Mokhless , Rania M. El Backly

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INTRODUCTION: One of the goals of conventional endodontic treatment is to minimize the amount of irritants that could be present inside the root canal system.
OBJECTIVES: This study was designed to evaluate irrigant delivery using two different techniques in curved canals.
MATERIALS AND METHODS: The mesiobuccal canals of 20 human extracted mandibular first molars were divided into two groups (n=10); Group (I) conventional syringe with side vented needle, Group (II) sonic irrigation (EndoActivator system). Contrast medium (OptirayTM 320, Mallinckrodt Inc. Hazelwood, MO, USA) was injected before, during and after canal preparation. All canals were prepared using Revo-S rotary system till reaching file AS35 using 5.25% NaOCl as an irrigant during instrumentation. Standardized preoperative, operative and postoperative digital radiographs were taken. The distance between full working length and the point of maximum irrigant penetration was measured using image editing software (DBS Win 5.3.1 and Image J). Data were then recorded and statistically analyzed.
RESULTS: Sonic irrigation showed a statistical significant difference over the conventional needle and syringe group in increasing the depth of penetration of the contrast medium.
CONCLUSIONS: the use of EndoActivator in irrigation had a superior effect in increasing the depth of penetration of irrigant when compared to conventional needle and syringe.
KEYWORDS: EndoActivator, Irrigant penetration depth, conventional side vented syringe, recent irrigation technique


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SHEAR BOND STRENGTH OF SELF ADHERING FLOWABLE COMPOSITES AFTER PRELIMINARY ACID ETCHING OF DENTIN

Hebatallah M. El-Zeiny, Wegdan M. Abd El-Fattah, Maha A. Abd-Elmotie

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INTRODUCTION: Many advances in flowable composites have been developed in the last few years, including the introduction of self-adhering flowable composites (SAFCs) that do not require the application of adhesive systems.
OBJECTIVES: The objective of this study was to evaluate the influence of preliminary etching with 37% phosphoric acid on the shear bond strengths of two SAFCs (Vertise Flow and Fusio Liquid Dentin) to dentin.
MATERIALS AND METHODS: Sixty sound human permanent molars were collected and prepared to expose the mid-coronal dentin. Dentin specimens were randomly divided into six groups (n=10) according to the material applied: (1) Vertise Flow (VF); (2) Fusio Liquid Dentin (FLD); (3) Gel Etchant/Vertise Flow (GE/VF); (4) Gel Etchant/Fusio Liquid Dentin (GE/FLD); (5) Optibond all-in-one/Premise Flowable (Opti-A/PF); (6) Gel Etchant/ Optibond all-in-one/Premise Flowable (GE/Opti-A/PF). Specimens were subjected to shear bond strength (SBS) test. Failure modes were evaluated under stereomicroscope and assessed using Adhesive Remnant Index (ARI) scores. Data were collected and statistically analyzed using ANOVA F-test and Chi-square test (p<0.05). RESULTS: Group 6 (GE/Opti-A/PF) recorded the highest mean SBS (16.39 ± 2.418 MPa), while Group 1 (VF) recorded the lowest mean SBS (4.32 ± 0.993 MPa). The one-step self-etch adhesive Optibond all-in-one with and without a separate etching step had significantly higher mean SBS than those of the two SAFCs. Preliminary etching of dentin significantly increased the SBS of only Vertise Flow. CONCLUSIONS: The bonding performance of the 1-step self-etch adhesive (SEA) (Opti-A) was considerably better than those of the two SAFCs. Preliminary acid etching of dentin enhances the bonding performance of VF. KEYWORDS: Self adhering, flowable composites, shear bond strength, all-in-one adhesives, preliminary acid etching.


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COMPARATIVE STUDY OF MICROLEAKAGE AND SHEAR BOND STRENGTH BETWEEN BULK FILL AND SELF ADHESIVE FLOWABLE COMPOSITE RESINS

Mohamed H. Abdelrahman, Elsayed M. Mahmoud, Mona M. Ghoneim, Adel A. Kammar

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INTRODUCTION: Advances in flowable composites including self-adhesive and bulk fill flowable composite resin have been introduced for time saving and better adaptation.
OBJECTIVES: was to compare the microleakage and shear bond strength of Self-adhesive& Bulk fill flowable composite resins.
MATERIAL AND METHODS: A total of forty non carious extracted human molars were selected for this study. For microleakage test, twenty Class V cavities were prepared on labial surface. Teeth were divided into 2 groups (n=10), Group I: was treated with self-adhesive flowable composite, Group II: was treated with one step self-etch adhesive system with bulk fill flowable composite. Microleakage scores were evaluated on the occlusal and cervical walls and data was analyzed statistically. For Shear bond strength test, twenty molars were embedded in acrylic resin inside plastic molds; the occlusal portion of each tooth was removed. To standardize the bonding area, cylindrical shaped plastic matrices with 4mm internal diameter and 3mm height were used. Specimens were divided into 2 groups (n=10), Group I: was treated with self-adhesive flowable composite, Group II: was treated with one step self-etch adhesive system with bulk fill flowable composite. Shear bond strength was measured using universal testing machine.
RESULTS:The cervical margins showed a non-significant higher mean of microleakage scores than the occlusal margins in the two studied restorative materials. Filtek flowable bulk fill composite showed significantly higher mean of microleakage scores than Vertise flow at both the cervical and occlusal margins. Filtek flowable bulk fill composite showed a significantly higher mean of shear bond strength than Vertise flow.
CONCLUSIONS: All of the restorative materials used were unable to prevent microleakage. Filtek flowable bulk fill composite showed more microleakage but higher shear bond strength than Vertise flow.
KEYWORDS: Flowable bulks fill composite, Vertise flow, microleakage, shear bond strength.


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EFFECT OF AGING ON THE FLEXURAL STRENGTH AND FRACTURE TOUGHNESS OF A FIBER REINFORCED COMPOSITE RESIN VERSUS TWO NANOHYBRID COMPOSITE RESINS

Mohamed M. Abdul-Monem, Ibrahim L. El-Gayar, Fayza H. Al-Abbassy

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INTRODUCTION: It is known that posterior composite restorations have high failure rates and high frequency of replacement as shown by studies. This may be attributed to the inability of conventional fillers to withstand the forces of mastication in the posterior region. New methods of reinforcement such as glass fibers are being used to increase the mechanical properties of dental composites.
OBJECTIVES: was to compare the effect of aging in distilled water at 37°C for 1 day, 3 months and 6 months on the flexural strength and fracture toughness of a fiber reinforced composite (EverX posterior, GC, Europe), a nano-hybrid ceramic filled composite (IPS Empress Direct, Ivoclar Vivadent, Lieschtenstein) and a nano-hybrid zirconia filled composite (Z250 XT, 3M ESPE, USA).
MATERIALS AND METHODS: For each test, twenty-one specimens were fabricated from each of the three composites and were then subdivided into three subgroups of seven specimens each according to the aging period in distilled water. After each aging period, the specimens were fractured in a Universal testing machine and the results were analyzed using ANOVA and post hoc test (Fisher's LSD) at p<0.05 significance level. Following each test, the fractured surfaces of the 6 months aged specimens were examined using SEM. RESULTS: The flexural strength and fracture toughness of the fiber-reinforced composite was the highest with a statistical significance in the three aging periods followed by the nano-hybrid zirconia filled composite and the least was the nano-hybrid ceramic filled composite.SEM imaging findings were consistent with the results. CONCLUSIONS: The fiber-reinforced composite had the highest flexural strength and fracture toughness after each of the three aging periods Although aging in water decreased the mechanical properties of the fiber-reinforced composite, it still remained higher than the two nano-hybrid composites which ensures its ability to withstand forces of mastication in the posterior region. KEYWORDS: Fiber-reinforced, aging, flexural strength, fracture toughness, nano-hybrid.


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COMPARISON OF DEGREE OF CONVERSION AND MICROLEAKAGE IN BULKFILL FLOWABLE COMPOSITE AND CONVENTIONAL FLOWABLE COMPOSITE(AN IN VITRO STUDY)

Alshaimaa A. Elhawary, Ahmed S. Elkady, Adel A. Kamar

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INTRODUCTION: Composite restorative materials represent one of the many successes of modern biomaterials research, since they replace biological tissue in both appearance and function. Several aspects during selection of composite restorative materials should be considered, among which are the degree of conversion and microleakage.
OBJECTIVES: The objective of this study is to compare the degree of conversion and microleakage in bulkfill flowable and conventional flowable composite.
MATERIALS AND METHODS: Bulk-fill flowable composites (SDR, Dentsply), (Filtek Bulkfill flowable, 3M ESPE) and conventional flowable composite (X-Flow, Dentsply), (Filtekz350xt flowable, 3M ESPE) were tested. 28 cylindrical specimens were prepared from each material in Teflon mold. Degree of conversion (DC) was determined using Fourier transform infrared spectroscopy (FTIR) test. 44 non-carious molars were selected and Class V cavities were made and filled with composite in bulk increment then immersed in a basic fuschine dye. Samples were sectioned in the center of the restoration and observed with a 40x stereomicroscope; extent of dye penetration was measured. Statistical analysis of the results was performed using ANOVA and Post Hoc for DC, Kruskall-Wallis and Mann Whitney test for microleakage.
RESULTS: A statistically significant difference was recorded for the degree of conversion test between the groups with p (<0.001). Microleakage test showed no statistically significant difference between the four groups at occlusal margins with p=0.563, nor at the cervical margins with p=0.243. CONCLUSIONS: Within the limitations of the current study, it was concluded that the bulkfill flowable composite (SDR) had better DC in comparison to the other three flowable composites used in the study. It was also concluded that it had the best marginal seal in both occlusal and cervical margin among all the groups. KEY WORDS: Degree of Conversion, leakage, bulkfill flowable composite, conventional flowable composite.


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EFFECT OF TIME ELAPSED BETWEEN MIXING AND PHOTOACTIVATION ON DEGREE OF CONVERSION, WATER SORPTION AND WATER SOLUBILITY OF SELF-ADHESIVE RESIN CEMENTS

Doaa M. Aboul- Azm D, Ibrahim L. Elgayar, Fayza H. Al-Abbassy

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INTRODUCTION: Self-adhesive resin cements are designed to adhere to tooth structures without separate adhesive or etchant. The major benefit of these materials would appear to be simplicity of applications with the goal of optimizing adhesive cementation procedures, self-adhesive resin cements were developed to simplify the technique and reduce the possibility of failure on the part of the operator. Low degree of conversion (DC), water sorption and solubility can compromise the mechanical properties and longevity of restorations (1-6).
OBJECTIVES: Is to determine the influence of the photoactivation protocol on the degree of conversion, sorption and solubility in water of two different types of self-adhesive resin cements.
MATERIALS AND METHODS: Two different types of self-adhesive, dual cure resin cements were tested: TEGDMA (Tri-ethylene glycol di-methacrylate) based resin cement [RelyXU200 (RU), 3M ESPE] and UDMA (Urethane di- methacrylate) based resin cement [SmartCem™2 (SC2), Dentsply Caulk]. A total of one hundred and twenty cured disc shaped resin cement specimens were prepared for this study using a split teflon mold to be tested for degree of conversion, water sorption and solubility. The specimens were divided into two groups (n=60) according to the type of the cement used, group A was prepared from RU and group B was prepared from SC2. Each group was divided according to the time elapsed between handling of the resin cement and photo-activation into three subgroups (1, 2 and 3) where n=20. Half of each subgroup specimens (n=10) were used for degree of conversion test while the other half was used for water sorption and solubility test [subgroups A1 & B1 were immediately photo-activated, subgroups A2 & B2 were photo-activated 1 minute after handling the cement and subgroups A3 & B3 were photo-activated 2 minutes after handling the cement]. Ceramic disc (1.5 mm thickness and 10 mm diameter) was fabricated using copper split mold to simulate clinical condition. The specimens were irradiated for 40 seconds using LED light applied perpendicular to the specimens at zero distance between the tip of the light cure unit and the ceramic disc. Fourier transformer infrared spectroscopy (FTIR) was used to determine the degree of conversion. For the water sorption and solubility tests specimens were stored in water bath containing distilled water at 37◦C for 90 days. Data were analyzed using IBM SPSS software package version 20.0
RESULTS: UDMA based cements showed statistically lower degree of conversion for all subgroups compared to TEGDMA based cements which showed significantly higher water sorption than the UDMA based that photo activated after 2 minutes.
CONCLUSIONS: The time interval between mixing and photo activation can significantly influence the properties of the cements and modify their behavior.
KEYWORDS: Self-adhesive resin, degree of conversion, water sorption, water solubility.


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A COMPARATIVE STUDY OF MANDIBULAR CYST ENUCLEATION USING THE PIEZOELECTRIC SURGERY VERSUS THE CONVENTIONAL TECHNIQUE

Yasmine A. Ibrahim, Tarek M. Aly, Hala R. Ragab

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INTRODUCTION: piezosurgery device was originally developed for the atraumatic cutting of bone as it produces microvibrations and specific ultrasound frequency (25-29 kHz). This new ultrasonic cutting method will be an alternative to conventional methods of oral surgery.
OBJECTIVES: This study compares the use of piezosurgery and conventional technique in mandibular radicular cyst enucleation and this was estimated by clinical and radiographic analysis.
MATERIALS AND METHODS: This study was conducted on fourteen patients selected from the Out-patient Clinic of the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Alexandria University. Patients with radicular cyst in jaw region were diagnosed clinically and radiographically. The patients were randomly divided into two groups, seven patients were treated using piezosurgery and other seven patients were treated using conventional surgical procedures. Intraoperative and postoperative evaluation was carried out to monitor soft tissue damage, manipulation complexity, pain, infection and tissue dehiscence at 1st, 2nd, 7th day and after one month postoperatively. The bone healing and bone density was determined radiographically after 3 and 6 months postoperatively using Cone Beam Computed tomography.
RESULTS: no soft tissue damage or manipulation complexities were observed in both groups, less bleeding was observed intraoperatively in piezosurgery group. Healing was uneventful with no signs of dehiscence in piezosurgery group with lower pain score than in control group. There was a significant decrease in the surface area of the bone defect in the piezosurgery group compared to control group along the follow up period. The improvement in the bone density was greater in the piezosurgery group than in the control group, with percent of difference 33.42% on the 3rd month and 63.84% on the 6th month.
CONCLUSIONS: Piezosurgery is effective in cyst enucleation as it accelerates bone healing and reduces intraoperative and postoperative complications.
KEY WORDS: Piezosurgery, radicular cyst, enucleation, Cone Beam Computed tomography.


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