To compare the plaque inhibition efficacy of a sodium fluoride/potassium nitrate (NaF/KNO₃ with 1450 ppm F) test dentifrice to a 0.454% stannous fluoride/sodium hexametaphosphate/sodium fluoride positive control dentifrice (SnF₂/SHMP with 1450 ppm F).

Twenty-five subjects were randomized to a two-period, two-treatment, double blind crossover sequence using NaF/KNO₃ (Sensodyne^® ProNamel™ dentifrice) and SnF₂/SHMP (blend-a-med^®* EXPERT GUMS PROTECTION dentifrice). Each treatment was conducted with a standard manual toothbrush (Oral-B^® P35 Indicator). Digital plaque image analysis (DPIA) was used on three consecutive days to evaluate: (a) overnight plaque formation (A.M. pre-brushing); (b) following 40 seconds of brushing with the test product (A.M. post-brushing); and (c) mid-afternoon (P.M.). Images were analysed using an objective computer algorithm to calculate the total area of visible plaque. A four-day washout period was instituted for the crossover phase.

All 25 subjects completed the study. The SnF₂/SHMP positive control dentifrice provided statistically significantly lower levels of plaque area coverage versus the NaF/KNO₃ test dentifrice at each timepoint. For the SnF₂/SHMP dentifrice, plaque coverage was 23.0% lower (p<0.0001) at A.M. pre-brushing, 17.3% (p=0.0163) lower at A.M. post-brushing, and 22.6% (p= 0.0004) lower at the P.M. measure relative to the NaF/KNO₃ dentifrice.

The SnF₂/SHMP dentifrice (blend-a-med^® EXPERT GUMS PROTECTION) inhibits plaque regrowth both overnight and during the day to a significantly greater degree than the NaF/KNO₃ dentifrice (Sensodyne^® ProNamel™).

Dentists recommending an effective home use dentifrice for patients experiencing dentinal hypersensitivity and/or dental erosion may previously have needed to compromise on other key benefits, such as plaque control. blend-a-med^® EXPERT GUMS PROTECTION is a dentifrice when integrated into an oral hygiene routine can provide a proven treatment for hypersensitivity, dental erosion, and a reduction in the regrowth of plaque.

Bellamy PG, Khera N, Day TN, Barker ML, Mussett AJ. A Randomized Clinical Trial to Compare Plaque Inhibition of a Sodium Fluoride/Potassium Nitrate Dentifrice versus a Stabilized Stannous Fluoride/ Sodium Hexametaphosphate Dentifrice. J Contemp Dent Pract 2009 March; (10)2:001-009.

* Also branded Crest^® and Ipana, depending on the country.

The aim of this study was to evaluate the correlation between capillary blood glucose levels (CBGLs) and sulcular blood glucose levels (SBGLs) using blood obtained from gingival tissue during routine periodontal examinations to determine if sulcular blood samples can be used as a non-invasive means to diagnosis blood glucose levels.

Thirty non-diabetics and 30 diabetic patients with moderate to severe periodontitis were included in the study and subjected to routine clinical periodontal examinations. Blood was collected using a 1.6-1.8 mm diameter micro bite collection tube to transport the sample from the gingival sulci of anterior teeth following periodontal pocket probing to a test strip of a glucose self-monitoring device. As a control, capillary blood was taken with a finger-stick. Statistical analysis was performed using the Pearson's correlation coefficient and a t-test.

The blood glucose levels in patients ranged from 58 mg/dl to 477 mg/dl, and the values of blood samples taken from gingival sulcus or finger tip of the same patient showed a very high intra-patient correlation (r =0.99, p< 0.0001).

The results of this study suggest sulcular blood from a routine periodontal examination may be used for diabetes mellitus screening.

Considering 50% of diabetics remain undiagnosed, testing sulcular blood may provide a suitable method for identifying potential diabetic patients during routine dental visits since there is a correlation with capillary blood. Appropriate referrals to a physician can then be made when warranted.

Ardakani MRT, Moeintaghavi A, Haerian A, Ardakani MA, Hashemzadeh M. Correlation between Levels of Sulcular and Capillary Blood Glucose. J Contemp Dent Pract 2009 March; (10)2:010-017.

To date probing of the furcation using sounding has been one of the reliable methods to assess horizontal component of furcation in multirooted teeth. A more precise and reliable measurement of this horizontal component of furcation involves using a fixed reference point providing stability and reproducibility of measurements. A custom stent is used to provide a fixed reference point and can be used pre- and postsurgically without re-entry. Therefore, the purposes of this study were to (1) assess the reliability of furcation measurements by direct probing (without stent) and with the use of a newly designed furcation stent and (2) to assess the furcation measurements in relation to gingival margin position pre- and post-operatively.

Forty-three chronic periodontitis patients with buccal grade II furcation involvement in maxillary or mandibular molars were included. The furcation involvement was measured by direct probing using a UNC-15 calibrated probe with and without using a custom stent. The furcation involvement and gingival margin position were measured pre- and post-surgically.

There was a significant reduction in plaque (PI) and gingival inflammation (GI) during the study period. The reduction in plaque index and gingival index was observed from 1.75 ± 0.35 to 0.92 ± 0.30, 1.88 ± 0.35 to 0.98 ± 0.29, respectively. Complete agreement was found between the first and the second measurement for about 74% of sites without the custom stent, whereas 86% of the sites measured using the stent had complete agreement. The differences never exceeded 1 mm for any of the sites. There was significant (t = 2.49; p<0.05) difference observed at complete agreement level (‘0’ difference).

It may be concluded the clinical attachment level-H of the furcation involvement using a PCP UNC-15 probe and a custom designed stent provides reproducible information about the furcation depth in multirooted teeth.

Use of a simple modified furcation stent has shown greater reproducibility of furcal depth measurements than direct probing without the stent. The furcation stent definitely addresses the problems of existing methods of horizontal furcal depth measurements reported in the literature. The major advantages of the newly designed stent are the simple construction and non-invasive application which translates to wide practical applications.

Laxman VK, Khatri M, Devaraj CG, Reddy K, Reddy R. Evaluation of a New Furcation Stent as a Fixed Reference Point for Class II Furcation Measurements. J Contemp Dent Pract 2009 March; (10)2:018-025.

The aim of this study was to investigate the microleakage of pit and fissure sealants in primary teeth and to determine if multi-step methods should produce better results in terms of microleakage prevention.

A total of 40 intact primary molars were randomly assigned to one of four sealant groups: resin based sealant Ultraseal XT (US – Ultradent) (Group 1, n=10); adhesive system Scotchbond Multi Purpose Plus (SBMP - 3M/ESPE) used as a sealant (Group 2, n=10); primer (SBMP) and US (Group 3, n=10); and primer, bond (SBMP) and US (Group 4, n=10). After thermocycling (x700, 5-55°C) all teeth surfaces were made impermeable with the exception of the occlusal surface. Samples were immersed in 50% silver nitrate for 8 hours, sectioned longitudinally with two cuts in the central fissure pit, and then immersed in photo development solution followed by 16 hours in fluorescent light. Pictures were obtained by light microscope (x40) and the degree of microleakage was evaluated by three blinded evaluators. The data were analyzed using the Kruskal Wallis test.

Significant statistical differences (p<.05) were observed between Groups 1-3, Groups 2-3, Groups 2-4, and Groups 3-4. Group 3 showed higher microleakage scores.

The adhesive system and the resin based sealant demonstrated similar microleakage properties, suggesting the possibility that adhesives can be used in a clinical setting. Additionally, the increase in the number of clinical steps required by common application of resin based sealant, including use of primer or primer and bond, did not lead to better results in preventing microleakage.

The adhesive system can be used as a sealant without increasing the microleakage. Thus, the use of the adhesive system before the application of the sealant is not necessary to reduce the microleakage, although further research is warranted to support this conclusion.

Bonifacio CC, Navarro RS, Sardenberg F, Imparato JCP, Carvalho RCR, Raggio DP. Microleakage of an Adhesive System used as a Fissure Sealant. J Contemp Dent Pract 2009 March; (10)2:026-033.

The purpose of this study was to examine the impact of psychological states, self-rated oral health, and oral health behavior on hopelessness.

A cross-sectional study design was used. Data were collected between September and November 2006. The sample consisted of 233 Romanian adults (mean age 47.3 years; 65.6% women; 65.8% married). The questionnaire included information about demographic, psychological, self-reported oral health, and oral health related behavior items.

‘Hopeless’ participants were more likely to self-evaluate their dental health as poor/very poor (P<0.001), to be less satisfied by the appearance of their teeth (P<0.05), to report more non-treated caries (P<0.01), to brush their teeth less than twice per day (P<0.01), and never use mouthrinse (P<0.05). Logistic regression analysis showed ‘hopeless’ participants were apt to have a lower educational level, brush less frequently, have higher financial problems as the reason for not visiting the dentist, and report higher anxiety (odds ratio = 5.4, 4.2, 2.6, and 12.6, respectively). Forty-seven (73.4%) of 64 ‘hopeless’ participants and 90 (80.4%) of 112 ‘non-hopeless’ participants were correctly predicted by the above four variables.

The results of this study found impaired oral health and financial problems may pose an increased risk for hopelessness.

Poor oral health can be regarded as a risk marker for the level of hopelessness.

Dumitrescu AL, Kawamura M. Exploring the Relationships between Sense of Hopelessness, Worry, Self-rated Oral Health Status, and Behavior in a Romanian Adult Population. J Contemp Dent Pract 2009 March; (10)2:034-041.

The purpose of this study was to evaluate if Knoop hardness values (KHN) for top and bottom surfaces of resin composite materials can reach a plateau within a clinically acceptable photoactivation time.

Four light-curing units (LCUs) were evaluated in this study (n=5): QTH (Optilux501: 550 mW/cm²) and LEDs (FreeLight2: 1100 mW/cm²; UltraLume5: 900 mW/cm²; and Radii: 750 mW/cm²). Composite resin discs (4 mm × 2 mm) of Heliomolar (Ivoclar/Vivadent) and Herculite XRV (Kerr) were tested using five photoactivation times (20, 40, 60, 80, and 100 seconds). KHN were obtained for each test specimen and comparisons between LCUs, depths, and photoactivation times were analyzed using two-way analysis of variance (ANOVA) and polynomial regression analysis.

Data for Heliomolar discs using linear regression found a relationship between the independent variables KHN and time with the Optilux501 at the top and bottom surfaces (r²=0.68/ r²=0.66). Radii presented a linear regression at the top surface (r²=0.75) and a quadratic regression at the bottom (r²=0.94). A quadratic regression was also detected for UltraLume5 and FreeLight2 at both top (r²=0.84/ r²=0.94) and bottom surfaces (r²=0.97/ r²=0.90), respectively, reaching a plateau at 80 seconds in all cases. For Herculite XRV, a quadratic regression was observed for all LCUs at the top and bottom surfaces and 80 seconds irradiation time was needed to reach a plateau in KHN.

There is a specific, but not clinically acceptable, photoactivation time that KHN at both top and bottom surfaces can reach a plateau and is dependent on LCUs and the resin-composite tested.

The LCUs and the resin-composite formulation affected the exposure time required to stabilize hardness values. The overall performance of LED LCUs was better than the QTH LCU regardless of the material evaluated.

Cavalcante LM, Valentino TA, Carlini B Jr, Silikas N, Pimenta LAF. Influence of Different Exposure Times Required to Stabilize Hardness Values of Composite Resin Restorations. J Contemp Dent Pract 2009 March; (10)2:042-050.

The aim of this study was to investigate the fracture resistance of two types of ceramic crowns cemented with two different cements.

Forty premolar crowns were fabricated using lithium-disilicate (IPS Empress-2) and glass-infiltrated aluminium-oxide (In-Ceram) ceramic systems. The crowns were divided into four groups (n=10) with Group 1 (IPS Empress-2) and Group 2 (In-Ceram) cemented with glass ionomer cement. Group 3 (IPS Empress-2) and Group 4 (In-Ceram) were cemented with resin cement. Crowns were tested in a universal testing machine at a compressive-load speed of 10 mm/min. Fracture modes were grouped into five categories. One way analysis of variance (ANOVA) and Bonferroni post-hoc tests were used to detect statistical significances (p<0.05).

The mean (SD) fracture resistance (Newtons) for Groups 1 to 4 were: 245.35 (82.69), 390.48 (67.03), 269.69 (10.33), and 418.36 (26.24). The cement type had no statistical significant effect (p>0.05) on fracture resistance within each ceramic system tested. In-Ceram crowns cemented with either glass ionomer or resin cements exhibited a statistically significantly higher fracture-resistance than IPS Empress-2 crowns (p<0.05). Minimal fracture in the test crowns was the common mode exhibited.

Fracture resistance of IPS Empress-2 and In-Ceram crowns was not affected by the type of cement used for luting.

Both In-Ceram and IPS Empress-2 crowns can be successfully luted with the cements tested with In-Ceram exhibiting higher fracture resistance than IPS Empress-2.

Al-Wahadni AM, Hussey DL, Grey N, Hatamleh MM. Fracture Resistance of Aluminium Oxide and Lithium Disilicate-based Crowns using Different Luting Cements: An in vitro Study. J Contemp Dent Pract 2009 March; (10)2:051-058.

The aim of this study was to evaluate the antibacterial effect of iodine-potassium iodide (IKI) and calcium hydroxide (CH) on dentinal tubules infected with Enterococcus faecalis (E. faecalis) at different time intervals.

Hollow cylinders of bovine root dentin (n=45) were infected and divided into three equal groups filled with either IKI or CH and a positive control. After placing each medicament in the infected cylinders for time periods of 10 minutes, 48 hours and 7 days, microbiological samples were analyzed. At the end of each period, four 100 μm thick inner dentin layers (400 μm thick from each specimen) were removed using dental burs of increasing diameters. Dentin powder was cultured on agar plates to quantitatively assess their infection, expressed in colony forming units (cfu).

In all layers of the positive control group, heavy bacterial infection was observed. After 10 minutes, IKI reduced the amount of viable bacteria more efficiently than CH, whereas at later time intervals CH showed the best results.

For short periods of exposure, IKI has a more efficient antibacterial effect in the dentinal tubules than CH but CH performs better after longer durations of exposure.

This research indicates the use of IKI is a better choice for disinfecting the root canal than CH if only a short duration of exposure is used because of its more efficient antibacterial effect. However, if a longer exposure time is used, then CH is a better choice because of its better disinfecting effect over time.

Lin S, Kfir A, Laviv A, Sela G, Fuss Z. The in vitro Antibacterial Effect of Iodine-potassium Iodide and Calcium Hydroxide in Infected Dentinal Tubules in Different Time Intervals. J Contemp Dent Pract 2009 March; (10)2:059-066.

The aim of this study was to evaluate the effects of multiple consecutive coatings of a one-step self-etch adhesive system (Clearfil Tri-S Bond) on the microtensile bond strength (MBS) to dentin.

Nine caries-free human lower third molars were sectioned perpendicular to the long axis to expose the mid-coronal dentin. The teeth were separated into three experimental groups (n=3) according to the number of adhesive resin coats applied. In Group 1 one layer of Clearfil Tri-S Bond was applied according to the manufacturer's instructions. In Group 2 and Group 3 the adhesive was applied in two and three layers, respectively. In these two groups the first layer was applied according to the manufacturer's instructions but the second and third layers of adhesive were not light cured after application. After the placement of the composite, the teeth were sectioned to obtain approximately 1 mm² beams for testing. Eighteen beams were prepared for each group using the ‘non-trimming’ method. The MBS values of all specimens were tested, and fracture modes were then determined using a stereomicroscope.

The mean MBS values (in MPa) of Group 1 (one coat of the adhesive) was significantly lower (p=0.04) than those of Group 3 (three applied coats of the adhesive). There were no statistically significant differences between Groups 1 and 2 and Groups 2 and 3.

Within the limitations of this in vitro study the application of multiple coats of a one-step self-etch adhesive may provide an increase in bond strength compared to the application of only one coat of adhesive.

Three consecutive coats of one-step self-etching adhesive application can improve MBS.

Arisu HD, Eligüzeloğlu E, Üçtaşli M, Ömürlü H. Effect of Multiple Consecutive Applications of One-step Self-etch Adhesive on Microtensile Bond Strength. J Contemp Dent Pract 2009 March; (10)2:067-074.

The purpose of this investigation was to evaluate the marginal adaptation of five root-end filling materials.

Fifty human single-rooted teeth were resected 3 mm from the apex. Root-end cavities were then prepared using an ultrasonic tip and filled with one of the following materials: silver amalgam without zinc, white MTA-Angelus, white Portland cement (PC), Vitremer™, and GC Fuji Ortho™ LC. The apical portion of the roots was then sectioned to obtain two 1 mm thick transversal sections. Epoxy resin replicas of these apical sections were fabricated for an analysis of marginal adaptation. Scanning electron microscopy (SEM) was used to determine gaps in the adaptation of the root-end filling materials at the interface between them and the dentin. The Kruskal-Wallis test and a multiple comparison test were used for statistical data analysis. The Spearman correlation coefficient was used to determine the correlation between the results found for teeth and replicas.

Materials containing calcium oxide (MTA and PC) showed similar results. Resin modified glass ionomer cements (GICs) presented similar variations in marginal adaptation, but Vitremer™ showed significantly greater marginal adaptation when compared to GC Fuji Ortho™ LC.

A positive and significant correlation was observed between marginal adaptation values found in the teeth and their replicas.

The use of ionomers as root-end filling materials may improve clinical outcomes in periradicular surgery.

Costa AT, Konrath F, Dedavid B, Weber JBB, Oliveira MG. Marginal Adaptation of Root-end Filling Materials: An In vitro Study with Teeth and Replicas. J Contemp Dent Pract 2009 March; (10)2:075-082.

The aim of this report is to present the management of a patient with pernicious anemia afflicted with recurrent aphthous stomatitis (RAS).

RAS is one of the most common lesions of the oral mucosa. Although the exact etiology of RAS is still unknown different hematinic deficiencies have been proposed.

Painful recurrent ulcers covered with a grayish pseudomembrane surrounded by an erythematous margin were identified on the tongue and in the buccal mucosa of a 71-year-old woman. The patient also presented with depapilation of the tongue. The clinical diagnosis was RAS. Laboratory tests including a hemogram were ordered to determine existing levels of folic acid, iron, ferritin, and vitamins B2, B6, and B12. Levels of serum vitamin B12 and serum hemoglobin were low. The laboratory investigation also showed a medium corpuscular volume of 104.1 fl. A gastroduodenoscopy revealed no macroscopic abnormality. A gastric biopsy showed mucosal atrophy in the gastric corpus with evidence of intestinal metaplasia. Antibodies against an intrinsic factor were negative. The diagnosis pernicious anemia was made, with RAS caused by vitamin B12 malabsorption. Treatment consisted of the administration of 1.0 ml of hydroxocolabamin intramuscularly twice weekly over four weeks followed by 1.0 ml once weekly for four weeks. Clinical resolution was observed after two months.

The association of RAS with vitamin B12 malabsorption is a rare event. However, along with conventional RAS clinical management, iron, folic acid, vitamin B deficiencies, and nutritional intolerance must be considered. Evaluation of the predisposing factors is imperative in treating patients with RAS including vitamin B12 malabsorption.

Determination of the levels of vitamin B12 should be the basis for replacement therapy. Such therapy can be considered a benefit to the patients with RAS as its etiology remains unclear. Clinicians must be alert to the possibility this lesion could be a signal of systemic disease.

Garcia BG, Cardoso MFP, Faria O, Gomez RS, Mesquita RA. A Case Report of Pernicious Anemia and Recurrent Aphthous Stomatitis. J Contemp Dent Pract 2009 March; (10)2:083-089.

The purpose of this case report was to describe the oral rehabilitation of a 4-year-old girl presenting early childhood caries (ECC).

ECC is highly prevalent in developing countries and its severity increases with age. This disease implies serious consequences for the development of the stomatognathic system and for the child's quality of life. As young children are usually anxious about dental treatment, their level of co-operation is limited, leading to a challenging situation.

A 4-year-old girl was brought by her mother for dental treatment with the complaint of pain. The clinical examination revealed extensive carious coronary destructions. After preventive and curative measures, the oral rehabilitation was performed; it included the use of stainless steel crowns, resin filled celluloid crowns with previous cementation of glass post pins when necessary, an amalgam restoration, orthodontic treatment, and a partial removable prosthesis. The child has been monitored in the Pediatric Dentistry Clinic at 4-monthly intervals.

The oral rehabilitation was able to reestablish the oral health in the primary arches mutilated by early childhood caries. This is important for the establishment of an adequate mixed and permanent dentition, for proper facial and maxillary growth, and to the child's psychological and social development.

The full management, including preventive, psychological, and curative measures of a young child with severe ECC was found successful after 8 months of follow up. This result can encourage the clinicians to seek a cost-effective technique such as stainless steel crowns, resin filled celluloid crowns, and partial removable prosthesis to reestablish the oral functions and improve the child's psycho-social development.

Parisotto TM, Souza-e-Silva CM, Steiner-Oliveira C, Nobre-dos-Santos M, Gavião MBD. Prosthetic Rehabilitation in a Four-year-old Child with Severe Early Childhood Caries: A Case Report. J Contemp Dent Pract 2009 March; (10)2:090-097.