Tamer Tüzüner

Antibacterial Activity and Physical Properties of Conventional Glass‐ionomer Cements Containing Chlorhexidine Diacetate/Cetrimide Mixtures

STATEMENT OF THE PROBLEM Hand excavation instruments are not as efficient as that with rotary burs in atraumatic restorative treatment (ART). PURPOSE To evaluate the antibacterial activity (ABA), microhardness numbers (VHN), and cumulative fluoride releasing (CFR) patterns of conventional GICs (Fuji IX (FX) and Ketac Molar (KM)) containing chlorhexidine diacetate/cetrimide mixtures (2.5%/2.5%) (AB). MATERIALS AND METHODS The powders of ABs were added to powders of FX and KM selected as experimental groups (EXPs). FX and KM were assigned as controls (CNTs). ABA against S.mutans (MS) and L.casei (LB) were examined between 1-90 days. VHN were calculated after 24 hours and CFR patterns measured between 1-30 days. Analysis of variance was used for comparison (p<0.05) RESULTS Differences were found between EXPs regarding MS levels at days 1, 7 and 60 as well as for LB at all time periods (p<0.05). VHN decreased in EXPs compared to CNTs (p<0.05), and no differences were found between EXPs (p>0.05). CFR patterns tended to decrease in EXPs compared to the CNTs, but no differences were found between EXPs (p>0.05) CLINICAL SIGNIFICANCE These mixtures could be recommended for ART procedures to provide beneficial antibacterial effects without seriously deteriorating the physical properties of selected GICs.

Clinical and radiographic outcomes of calcium hydroxide and formocresol pulpotomies performed by dental students

OBJECTIVE The aim of this study was to compare the clinical and radiographic success rates of 3 pulpotomy techniques: formocresol, calcium hydroxide, and calcium hydroxide/iodoform. STUDY DESIGN The pulpotomies were performed by fifth-year undergraduate dental students. Members of senior staff at the clinics supervised all of the procedures. Informed consent was obtained from each childs parents. The teeth were randomly assigned to the experimental (calcium hydroxide and calcium hydroxide/iodoform) or control (formocresol) groups. After coronal pulp removal and hemostasis, remaining pulp tissue was covered with calcium hydroxide or calcium hydroxide/iodoform paste in the experimental groups. In the control group, formocresol was placed with a cotton pellet over the pulp tissue for 5 minutes and removed; the pulp tissue was then covered with zinc oxide-eugenol. All teeth were restored with stainless-steel crowns. Clinical and radiographic successes and failures were recorded at 1-, 3-, 6-, and 12-month follow-ups by the authors. Data were statistically analyzed using chi-squared tests. RESULTS The follow-up evaluations revealed that the clinical success rates were 89.7% for formocresol, 33.3% for calcium hydroxide, and 17.2% for calcium hydroxide/iodoform. The radiographic success rates were 89.7% for formocresol, 33.3% for calcium hydroxide, and 13.8% for calcium hydroxide/iodoform. CONCLUSIONS Formocresol was superior to calcium hydroxide and calcium hydroxide/iodoform pastes for primary molar pulpotomies. Internal resorption was the most common radiographic failure in all 3 pulpotomy techniques.

Effect of antibacterial agents on the surface hardness of a conventional glass-ionomer cement

In atraumatic restorative treatment (ART), caries removal with hand excavation instruments is not as efficient as that with rotary burs in eliminating bacteria under the glass ionomer cements (GICs). Thus, different antibacterial agents have been used in recent studies to enhance the antibacterial properties of the GICs, without jeopardizing their basic physical properties. Objective The objective of this study was to evaluate the effect of antibacterial agents on the surface hardness of a conventional GIC (Fuji IX) using Vickers microhardness [Vickers hardness number (VHN)] test. Material and Methods Cetrimide (CT), cetylpyridinium chloride (CPC) and chlorhexidine (CHX) were added to the powder and benzalkonium chloride (BC) was added to the liquid of Fuji IX in concentrations of 1% and 2%, and served as the experimental groups. A control group containing no additive was also prepared. After the completion of setting reaction, VHN measurements were recorded at 1, 7, 15, 30, 60, and 90 days after storage in 37ºC distilled water. A one-way ANOVA was performed followed by a Dunnett t test and Tamhane T2 tests and also repeated measurements ANOVA was used for multiple comparisons in 95% confidence interval. Results VHN results showed significant differences between the control and the experimental groups at all time periods (p<0.05 for all). Significant differences were observed between all study periods for individual groups (p<0.05). After 7 days, VHNs were decreased in all experimental groups while they continued to increase in the control group. BC and CHX groups demonstrated the least whereas CT and CPC groups exhibited most adverse effect on the hardness of set cements. Conclusions Despite the decreased microhardness values in all experimental groups compared to the controls after 7 up to 90 days, incorporating certain antibacterial agents into Fuji IX GIC showed tolerable microhardness alterations within the limitations of this in vitro study.

Antibacterial activity, surface roughness, flexural strength, and solubility of conventional luting cements containing chlorhexidine diacetate/cetrimide mixtures

STATEMENT OF PROBLEM The failure of fixed dental restorations is commonly associated with caries. The use of conventional luting cements containing antibacterial agents may overcome this problem. PURPOSE The purpose of this study was to evaluate the antibacterial activity (ABA), surface roughness (Ra), flexural strength (FS), and solubility (SL) patterns of the conventional dental luting cements zinc phosphate (ZP), zinc polycarboxylate (PC), and glass ionomer (GIC) after the addition of 5% chlorhexidine diacetate/cetrimide (CHX+CT). MATERIAL AND METHODS Antibacterial agents with a total concentration of 5% (2.5% CHX+2.5% CT) were added to antibacterial agent-free conventional luting cement powders (ZPC, PCC, and GICC) and designated as experimental groups (ZPE, PCE, and GICE). ABA against Streptococcus mutans (SM) and Lactobacillus casei (LB) was examined by using the agar diffusion test method. Ra, FS, and SL values were obtained after storage in distilled water at 37°C for 24 hours. The Kruskal-Wallis and Mann Whitney U with Bonferroni correction tests were used to test for agar diffusion (α=.05) and 2-way ANOVA and Fisher Least Significant Difference (LSD) test were used to measure Ra, FS, and SL (α=.05). RESULTS The control groups exhibited limited ABA. With the exception of PCE>PCC on day 1 for SM, all experimental groups showed significantly greater and longer-lasting protection against SM and LB bacteria for up to 180 days than their controls (P<.05). Ra values decreased (ZPC>ZPE; P>.05, PCC>PCE; P<.05) except that GICE>GICC (P>.05) when compared with their individual controls. Control groups exhibited higher FS values than did the experimental groups (ZPC>ZPE; P<.05, PCC>PCE; P<.05, GICC>GICE; P>.05). The experimental groups exhibited higher solubilities than did their controls in the ZPC (P>.05) and GICC groups (P<.05) but were lower in PCC group (P<.05). CONCLUSIONS Incorporating a 5% CHX+CT mixture into conventional dental luting cements and altering their Ra, FS, and SL values may provide greater antibacterial protection against SM and LB.

Comparison of pre-emptive ibuprofen, paracetamol, and placebo administration in reducing post-operative pain in primary tooth extraction

BACKGROUND This study investigates preliminary investigations that a pre-emptive analgesia administration may reduce post-extraction pain. AIM This prospective, placebo-controlled, randomized, double-blind trial was planned to compare the efficacy of the pre-emptive administration of ibuprofen, paracetamol, and placebo in reducing post-extraction pain in children. DESIGN Forty-five children, ages 6-12, who needed primary mandibular molar tooth extraction were treated in paediatric dental clinics, with treatment preceded by local anaesthesia and analgesic drugs during the preoperative period. A five-face scale was used to evaluate pain reaction during the injection, extraction, and post-operative period. Self-report scores were recorded when the local anaesthesia had been administered in soft tissues and both before and after the extraction was completed. The Kruskal-Wallis and Mann-Whitney U tests (with Bonferroni correction paired t-test as the post hoc test) were used at a confidence level of 95%. RESULTS The use of pre-emptive analgesics showed lower scores compared to the placebo, irrespective of the age, weight, gender of the child, and the number of teeth extracted during the study period. Additionally, ibuprofen exhibited lower pain scores (P < 0.05) compared to paracetamol at the 15-min (P < 0.001) and 4-h (P < 0.009) periods. CONCLUSIONS Preoperative use of ibuprofen and paracetamol may provide a pre-emptive analgesic effect in paediatric patients who receive adequate analgesia during mandibular primary tooth extraction.

Conversion degree, microhardness, microleakage and fluoride release of different fissure sealants

The purpose of this study was to determine the degree of conversion (DC), microhardness, microleakage and fluoride release of a nano-filled resin based fissure sealant (Grandio Seal, GS) and compare it with an un-filled resin based fissure sealant (Clinpro, CL) and a glass-ionomer based fissure sealant (Fuji Triage, FT). Disk shaped specimens were prepared from tested fissure sealants to determine the DC, Vicker hardness (VHN) and fluoride release (FR). The DC and VHN of each material was evaluated after 24 h. The cumulative fluoride concentrations were evaluated at 1 h, 6 h, 12 h, 1, 7, 15 and 30 days. For microleakage evaluation, fissure sealants were applied to the etched and dried enamel surfaces of sound third molar teeth according to the manufacturers instructions (n=10). After the thermocycling and mechanical loading procedures, microleakage assessments were carried out. Data were analyzed using one-way ANOVA followed by a post hoc Tukey test, the Kruskal Wallis and Mann-Whitney U test (p<0.05). Results revealed differences regarding DC between all groups: FT (89%) > GS (55.02%) > CL (%51.10) (p<0.05). The VHN values were significantly different among all groups in the following order: GS > FT > CL (p<0.05). FT exhibited significantly higher microleakage scores compared to the CL and GS sealants (p<0.05). The FR of FT was significantly greater than CL and GS (p<0.05). Nano-filled resin based sealant can be used as an alternative to other fissure sealant materials because of its superior hardness results and feasible sealing ability.

The success rates of a glass ionomer cement and a resin-based fissure sealant placed by fifth-year undergraduate dental students.

AIM: To evaluate retention and caries prevention of a glass-ionomer cement (GIC) and a resin-based fissure sealant placed by fifth-year undergraduate dental students. METHODS: The study was conducted according to a split-mouth, randomised clinical trial. Children with at least one pair of caries-free permanent first molars with deep pits and fissures were included in the study. The children were selected from a population that had a high risk for dental caries. Sealant materials were applied by fifth-year undergraduate dental students on 346 fissures of the first permanent molars in 173 children. The ages of the children ranged from 7–15 years (mean 9.4). Two researchers at the clinics supervised all of the procedures. Intra-examiner reproducibility and inter-examiner reproducibility were 0.90 and 0.86, respectively, for the clinical assessment of sealant retention and caries evaluation. RESULTS: GIC sealants were completely lost in 31.9% and resin-based sealants in 16.6% (p<0.05). The total retention rates of GIC sealants and resin-based sealants were 13.8% and 20.8%, respectively. After 24 months, the caries increment was 3.4% for GIC sealants and 4.8% for resin-based sealants (p>0.05). CONCLUSIONS: The retention of GIC sealants was markedly inferior to the retention of resin-based sealants; however, GIC when used as a pit and fissure sealant was slightly more effective in preventing occlusal caries.

Comparison of combined application treatment with one-visit varnish treatments in an orthodontic population

Objective: To evaluate the effect of chlorhexidine-thymol varnish alone, its combination with chlorhexidine-fluoride containing dentifrice and fluoride varnish on oral hygiene and caries prevention in orthodontic patients. Study design: Sixty patients, aged 12-18, with orthodontic fixed appliances were randomly assigned into three groups as follows: Group 1 (n=20): 1% chlorhexidine and 1% thymol varnish (Cervitec®Plus); Group 2 (n=20): Cervitec®Plus+ 0.2% chlorhexidine and 0.2% sodium fluoride (900 ppm fluoride) (Cervitec®Gel)); and Group 3 (n=20): 0.1% fluoride varnish (Fluor Protector®). Mutans streptococci (MS), lactobacilli (LB) levels, buffering capacity (BC), visible plaque index (VPI), and gingival bleeding index (GBI) scores were evaluated at four stages: T0, before orthodontic bonding; T1, one week after orthodontic bonding; T2, one week; and T3, four weeks after the first application, respectively. Inter and intra group comparisons were made by the Kruskal-Wallis, Mann-Whitney U, Friedman and Wilcoxon Signed-Rank tests with Bonferroni step-down correction (P<0.017). Results: Significantly lower MS and LB levels were found in Group 2 than Group 1 (T2) and 3 (T2, T3) (P<0.017). Groups 1-2 (T2) showed significantly higher BC (P<0.017) and lower VPI and GBI (P<0.017) scores compared with Group 3. Decreased MS levels at T2 (P<0.017) and T3 (P>0.017) were found in Group1-2 compared with T0. Significantly lower LB levels were recorded in Group 2 at T2 compared with T0 (P<0.017) while no significant differences were seen in Group 1 and 3 (P>0.017). Conclusions: Addition of Cervitec®Plus+Cervitec®Gel combination to the standard oral hygiene regimen may be beneficial for orthodontic patients for maintaining oral health by reducing bacterial colonisation and gingivitis. Key words:Chlorhexidine, flouride, mutans streptococci, lactobacilli, antibacterial effect, plaque, gingivitis, orthodontic treatment.

Evaluation of sedation in oral and maxillofacial surgery in ambulatory patients: failure and complications

OBJECTIVES This study evaluated the failure and complication rates of sedation in ambulatory patients undergoing oral and maxillofacial surgery. MATERIALS AND METHODS This retrospective cohort study was carried out among 619 patients who had undergone maxillofacial surgical procedures under intravenous sedation with midazolam and fentanyl. Each patients age, American Society of Anesthesiologists (ASA) classification, systemic condition, surgical procedure, complications, and failures were recorded for evaluation. RESULTS A total of 400 patients with ASA I, 199 with ASA II, and 20 with ASA III between the ages of 9 months and 84 years were included in the study. The most common systemic disorders in our patients were mental retardation (35%), hypertension (19%), and epilepsy (15%). Evaluation of the cases revealed 9 complications (1.4%) and 9 sedation failures (1.4%). The complications were bradycardia, postoperative agitation and hallucination, drug reaction, vomiting and nausea, desaturation, and hypotension. CONCLUSIONS Our results in the oral and maxillofacial surgery clinic revealed low complication and failure rates.

Temporary management of permanent central incisors loss caused by trauma in primary dentition with natural crowns: a case report.

Primary teeth injuries may cause developmental disturbances in the permanent dentition and loss of permanent incisors could be treated with different options. In this case report, an 11-year-old boy, with a history of trauma at the age of 4 years, is presented. Premature loss of permanent upper right central and upper left central teeth because of the mobility and arrest in root development were treated using patients own natural crowns on a removable appliance. This treatment option could be considered as an esthetic and functional temporary management of permanent central incisors loss until the definitive treatment will be completed in the future.