Al-Rafidain Dental Journal

The management of patients with severe worn dentition due to bruxism often necessitates an esthetic and functional approach. It is often challenging for the dentist, the dental technician, and the patient because of the loss of occlusal vertical dimension, loss of tooth structure, incorrect plane of occlusion, and para-functional habits.
Bruxism has a considerable negative impact on teeth and increases odds of failure for ceramic restorations, especially fracture and chipping failures. The choice of an appropriate material is essential to improving treatment prognosis and should be guided by mechanical and aesthetic properties. In This clinical report, we describe the successful use after two years of a CAD/CAM monolithic Zirconia as a permanent solution for a female patient with severe bruxism.

Aims: Assessment of Biphasic Calcium Phosphate mixed with injectable platelet rich fibrin (i-PRF) on healing of surgically created bone defects in a sheep animal model. Materials and Methods: In each tibia / radius of five sheep, three defects each measuring 7mm in diameter and 4mm in depth were created. The defects were filled with study materials and in the following order: from a proximal to distal orientation; first defect was filled with biphasic calcium phosphate alone, second left empty to be filled by physiological clot and the third with i-PRF mixed with biphasic calcium phosphate. Histological examination of bone defects was made to assess bone formation at fourtime intervals (two, four, six and eight weeks) post-surgically. Results: Regarding bone formation, histological findings showed the presence of a significant difference within the time intervals in the BCP+i-PRF group and in the BCP group when compared with control group with the highest mean being at eight weeks post-surgery in the BCP+i-PRF group. Conclusions: Both BCP and i-PRF, enhanced bone formation when compared to the control group and throughout the period of study and as disclosed by histological findings.

Aims: To assess bone density means with Biphasic calcium phosphate alone or mixed with injectable platelet rich fibrin in bone defects created surgically in sheep’s tibia / radius using standard radiographic assessment. Materials and Methods: Three bony defects of 4mm full and 7 mm in diameter were created in every tibias/radius of five sheep. The defects were stuffed within the following order: from a proximal to distal orientation; 1st defect was full of biphasic calcium phosphate alone, second left empty to be filled by physiological clot and also the third with i-PRF mixed with BCP and covered with absorbable collagen membrane for tissue guiding and then sutured. Densitometric analysis of bone defects was made to measure density of bone at four-time intervals (two, four, six and eight weeks) post-surgically. Results: Densitometric analysis results showed a major distinction within the BCP+i-PRF group and BCP group compared with the control one and at all-time intervals with the best density being in the 1st group followed by the BCP alone group and least in the control group. Conclusions: BCP and i-PRF, both of them increased and sustained bone density (synergistic effect) throughout the study period and as revealed by densitometric data.

Aims: The current study aimed to evaluate and compare the effects of the herbal medicaments (Neem, Ginger, Green tea, Clove oil, and peppermint oil) and traditional fluoride gel on the surface roughness of the eroded enamel samples of permanent teeth in vitro study. Materials and methods: A total of (80) sound maxillary permanent first premolars were used in the study. Enamel blocks were prepared and divided into eight groups: Negative control group (C-ve) (n=10) not exposed to Pepsi drink. The remaining samples exposed to Pepsi drink then subdivided into (7) subgroups: Positive control group (C+ve) (Pepsi group), the remaining groups representing different experimental remineralizing agents used as follows: Group 3 (NaF gel), Group 4 (Neem), Group 5 (Ginger+ Manuka honey), Group 6 (Green tea), group 7 (Clove oil) and group 8 (Peppermint oil). The Roughness of enamel surface blocks was measured before and after the PH cycle by using a measurement machine. Results: The surface roughness of all study groups was increased after eroding by Pepsi drink due to the demineralization, then decreased after treatment with remineralizing agents but the highest decrease of the surface roughness measurements belonged to the NaF group followed by Neem and Ginger +manuka honey groups, while the control negative group of deionized water which not exposed to Pepsi drink had no change in the surface roughness measurements. Conclusions: NaF gel group was significantly better than other groups against demineralization and preserving enamel roughness.

Aims: The study aimed to evaluate and compare the effects of the herbal medicaments (Neem, Ginger, Green tea, Clove oil, and peppermint oil) and traditional fluoride gel on the surface microhardness of the eroded enamel samples of permanent teeth in vitro study. Materials and methods: A total of (80) sound maxillary first premolars were used in the study. Enamel blocks were prepared and divided into eight groups: Negative control group (C-ve) (n=10) not exposed to Pepsi drink. The remaining samples exposed to Pepsi drink then subdivided into (7) subgroups: Positive control group (C+ve) (Pepsi group), the remaining groups representing different experimental remineralizing agents used as follows: Group 3 (NaF gel), Group 4 (Neem), Group 5 (Ginger+Honey), Group 6 (Green tea), group 7 (Clove oil) and group 8 (Peppermint oil). The Microhardness of enamel blocks was measured before and after the PH cycle by using a Vickers microhardness measurement machine. Results: The microhardness of enamel surface in all study groups was decreased after eroding Pepsi drink due to the demineralization, then increased after treatment with remineralizing agents but the highest increase of the surface microhardness measurements belonged to the Ginger+Manuka group followed by Neem and NaF group, while the control negative group of deionized water which not exposed to Pepsi drink had the minimum decrease in the surface microhardness measurements. Conclusions: Ginger+Manuka honey was significantly better than other groups against demineralization and preserving enamel microhardness.

Aims: To evaluate in vivo the biocompatibility of newly prepared calcium oxide based nanosealer. Materials and Methods: Twenty albino healthy male rabbits were used, each received three polyethylene tubes; one filled with BioRoot sealer (+ve control), one received the newly prepared nanosealer, and the last left empty served as (-ve control) were implanted in the corresponding skin pockets made at the dorsal skin of the anesthetized rabbits. Then the rabbits divided into four equal groups according to the observation periods. Tissue biopsies were collected at (3, 7, 14, and 28) day after the implantation. The specimens were processed and stained with hematoxylin and eosin and examined microscopically. Statistical analysis was performed by Kruskal Wallis and Mann-Whitney tests for analyses the inflammatory tissues response of each group at observation times. Results: Histopathologically; at 3 days (-ve) and (+ve) control groups revealed sever inflammatory reaction, while the experimental group represented moderate tissues inflammation. These inflammatory tissues reactions were reduced over times for all group until subsided completely at 28 days but still faster for experimental sealer. All groups revealed thin full organized fibrous capsule at 28 days representing the tissues tolerance of implanted materials. Statistically the experimental nanosealer represented the least inflammatory tissue reaction among groups. There were no statistically significance differences in fibrous capsule thickness among the groups. Conclusions: The prepared nanosealer represented high biocompatibility than other groups.

Aims: Evaluation of the surface hardness of heat-treated acrylic resin after modifying it with three different techniques. Materials and Methods: Heat-cured acrylic resin was modified by: (a) The copolymerization of acrylic resin with 5% and 10% of acrylic acid (AA), (b) The addition of 5% and 10% thermally activated zinc oxide (ZnO) and (c) The chemical bonding or engagement of Zinc ions into the polymer chain by an organic link, zinc diacrylate (ZDA) in 5% and 10%, to get a copolymer. The acrylic specimens have dimensions of (30, 15 and 3) ± 0.2 mm. Surface hardness was determined using a Durometer (Shore D) hardness tester. Results: There was general increase of the surface hardness of the experimental (modified) groups. A statical significant increase in the hardness of both acrylic groups modified by 10% ZnO and 10% ZDA compared to the control group and the remaining modified samples. Conclusion: Two techniques had significantly improved the hardness of heat cured acrylic resin; either by adding 10% by weight of thermally activated ZnO or by copolymerizing it with 10% by weight of ZDA to get poly (methyl methacrylate -co-zinc acrylate) copolymer.

Aims: To evaluate the efficiency of Er,Cr: YSGG laser in debonding of veneers made of lithium disilicate (E-max®) as measured with the shear bond strength(SBS), determine the impact of two laser powers on the SBS required to debond veneers, and finally determining the mode of failure for each group. Materials and methods: Thirty ceramic discs (1mm in thickness and 5mm in diameter) were prepared according to the manufacturer’s instructions. The facial surfaces of enamel for thirty bovine teeth were prepared smooth and the discs cemented onto these prepared surfaces by using G-Cem™ veneer light cure adhesive cement. Specimens were stored in distilled water for 48hours, after which they were divided randomly into three equal groups (n=10) according to the laser power used as follows: Cont.: Control group that wasn't subjected to laser irradiation; L3: Group irradiated at 3 watt (60 sec.); L5: Group irradiated at 5 watt (60 sec.). SBS was measured by “Instron universal testing machine” and the mode of failure was assessed using stereomicroscope. Results: Both laser irradiated groups showed significant difference in reducing the SBS (p=.000), some of discs debonded during laser irradiation. However, there was no significant difference between the two laser powers used (p=.418). Conclusions: Er, Cr: YSGG could be a safe, effective, fast, and harmless method for reducing SBS of bonded E-max® laminate veneers, without affecting the tooth and the veneer itself. Since there was no significant difference between the two laser powers used, it is advocated to use 3 watts.

Aims: The objective of this study was to compare wound healing potential between black silk suture and bioadhesive glue after induced surgical intraoral mucosal incisions in rabbits and assessed histologically. Materials and methods: The study was conducted on (18) male New Zealand rabbits, randomly divided into two groups (9 animals per group) according to the healing periods (1st,3rd, and 7th) days. Two incisions were made on the buccal mucosa of each rabbit bilaterally. For the first group, the defect was sutured with black silk suture, and adhesive glue Derma + Flex for the second group applied post operatively. Three rabbits were randomly selected from each group at the (1st,3rd, 7th) days, and biopsies were taken. The biopsy specimens were subjected to histological assessment to assess the healing parameters of the primary wound healing process. Results: Inflammatory cell infiltration grading in day 1and day 3 group I was the highest and on day 7 was the lowest in both groups. Granulation tissue formation in day 1 and day 3 was the same but high in group II day 7. Re-epithelization scoring was highest at day 7 for both groups. According to the time period, there were no significant differences in group versus group (within the same day). Conclusions: Use of bioadhesive Derma+Flex® glue for closure of primary wounds gave a satisfied result for better healing and isolation to avoid of infection in appropriate time with less equipment’s in comparison with black silk suture.

Aims: To assess and report the surface roughness incidence in fissure system of the dental enamel in human next Er, Cr: YSGG laser and Diode laser applications in order to examine anti-cariogenic impact and to compare the obtained results between the two laser types. Materials and Methods: Forty extracted impacted lower third molars teeth used in the experiment that should have an obvious occlusal fissure. Intact lower third molar were collected, which were free from caries .Teeth roots cut from crowns and crowns were divided bucco - lingually to two parts equally which were applied in 4 category included control group without any treatment, acid group only immersed in demineralizing solution, Diode laser group in which samples subjected to Diode laser (at wavelength 980nm, power 5 watt, mode P3, the time was 30 second) then immersed in demineralizing solution PH 4.4 for 96 hr., and Er, Cr: YSGG laser group in which samples subjected to Er, Cr: YSGG laser (wave length 2780nm, pulse energy20 Hz with pulse mode (H-mode), time 10 second) then immersed in demineralizing solution pH 4.4 for 96 hr. Results: both types of lasers resulted in a less surface roughness of enamel at fissure area as compared to the acid group, and Diode laser had better effect than Er, Cr: YSGG. The differences were statistically significant among the four groups at p≤ 0.01. Conclusions: Diode and Er, Cr: YSGG lasers improved the enamel surface roughness when compared to acid group.

Aims: Mothers play primary role in the health of their children and the oral health of the mother is a crucial part of her general health and could have an effect on the baby’s health. This study aimed to determine the relationship between maternal dental caries and the health status of newborns using Apgar scores in relation to maternal dental status by using DMFT index. Materials and Methods: The case group included (one hundred) pregnant women with periodontal disease, while the control group included (one hundred) pregnant women without periodontal disease. In both groups, DMFT (decay, missing and filled teeth), and Apgar scores were recorded. Mann-Whitney Test and Spearman’s correlation coefficient were used investigate the relationship between DMFT on one hand and an Apgar score on the other. Results: No significant relationship was found between Apgar scores and DMFT index scores were discovered. Conclusions: Within all limitations of this study, it was concluded that there was no direct relationship between the maternal dental caries and infant health status.

Aims: Mothers play primary role in the health of their children and the oral health of the mother is a crucial part of her general health and could have an effect on the baby’s health. The study aimed to determine the relationship between maternal periodontal disease and the health status of newborns using Apgar scores in relation to maternal oral/periodontal parameters (loss of attachment, pocket depth, and bleeding on probing). Materials and Methods: The case group included 100 pregnant women with periodontal disease, while the control group included 100 pregnant women without periodontal disease. In both groups, periodontal parameters such as loss of attachment (LoA), pocket depth (PD), bleeding on probing (BoP), and Apgar scores were recorded. Mann-Whitney Test and Spearman’s correlation coefficient were used investigate the relationship between periodontal parameters LoA, PD, and BoP on one hand and Apgar score on the other. Results: No significant associations between Apgar scores and maternal periodontal index scores were discovered. Conclusions: Within all limitations of this study, it was concluded that there was no direct relationship between maternal periodontal health and infant health status was found.

Aims: To analyse the effects of the incorporation of Zinc Oxide nanoparticles (ZnO NPs) with actual size (10-30 nm) at one concentration (1%) and compare it with milling CAD/CAM and non-modified heat cure denture base materials on the flexural strength and impact strength. Materials and methods: samples' number were 60, which was divided into thirty specimens for each test and sub-grouped into 10 for each group (control, 1 % ZnO NPs, CAD/CAM). Using the SPSS program, the statistical analysis was carried out using ANOVA, descriptive statistics, and Duncan's test at a significant p ≤ 0.05. Results: The findings showed a substantial difference between the groups. Moreover, milled CAD/CAM PMMA material had the highest flexural strength and impact strength than groups. Morever, Flexural strength and impact strength for the PMMA-ZnO nanocomposite at ZnO nanoparticles (1%) increased significantly, when compared to control. Conclusions: For edentulous patients, milled CAD/CAM dentures are more suitable because of their improved mechanical properties. in addition, that use of ZnO nanoparticles as dental fillers at 1% by weight significantly increased the PMMA denture base material's flexural and impact strength.

Aims: The objective of this study was to compare the histological wound healing potential between black silk suture and bioadhesive glue after induced surgical skin incisions. Materials and methods: The study was conducted on (18) male New Zealand rabbits, randomly divided into two groups (9 animals per group) according to the healing periods (1st,3rd, and 7th) days. Two incisions were made on the back skin of each rabbit bilaterally. In the first group, the defect was sutured with black silk suture, and adhesive glue Derma + Flex for the second group applied post operatively. Three rabbits were randomly selected from each group at the (1st,3rd, 7th) days, and biopsies were taken. The biopsy specimens were subjected to histological assessment to assess the healing parameters of the primary wound healing process. Results: The results of inflammatory cells infiltration grading showed that in day 1 group II and day 3 group I was the highest and at day 7 was the lowest in both groups. For granulation tissue formation, the results showed that at day 1 and day 3 was the same but high in group II day 7. Re-epithelization scoring was highest in group II day 3 and day 7. According to the time period, there were no significant differences in group versus group (within the same day). A very close activity of the two methods of wound closure in relation to their use in primary wounds in skin was noticed. Conclusions: The use of bioadhesive Derma + Flex® glue for closure of primary wounds in skin gives a satisfying result, for better healing and isolation to avoid infection in the appropriate time with less equipment’s in comparison with black silk suture.

Aims: Tooth surface roughness is a fundamental feature that impact on the foreign materials retention and caries progression, as well is considered an effective tool for checking the efficacy of various remineralizing agents and evaluating the activity of the carious lesion, so the aim of this study is to test the effectiveness of various remineralizing agents (varnishes) and compare their efficiency on tooth surface roughness. The main ingredient of the used varnishes was (BioActive Glass: BAG), (Casein Phosphopeptide Amorphous Calcium Phosphate: CPP-ACP), (Silver Diamine Fluoride: SDF), and (5% Sodium Fluoride: NaF). Materials and Methods: Samples used in the experiment were (50) maxillary primary canine teeth, which were distributed randomly in 5 groups, each group has 10 teeth. Groups were: Group A: SDF, Group B: BAG, Group C: CPP-ACP, Group D: NaF, Group E: Control (just preserved in artificial saliva). The measurement of the surface roughness was achieved at 3 intervals: baseline reading, the 2nd reading was after immersing for 3 days in demineralizing solution and the final measurement was after 2 weeks of varnishes application. Results: The results revealed that Group C significantly decrease the surface roughness, followed by D, B Groups, with insignificant effect in Group A. Conclusions: Based on the findings of this study, varnish made up of CPP-ACP was the most efficacious one in reducing the surface roughness. The addition of Potassium Iodide to Silver Diamine Fluoride could diminish its capacity for surface roughness improvement.

Aims: the current study aimed to add two concentrations of zirconium oxide nanoparticles (1.0 percent and 2.0 percent) to "heat-cured PMMA" in order to improve its characteristics such as transverse strength and impact strength. Materials and Methods: The particle size of Zirconium Oxide ZrO2 is 20nm. The ZrO2 nanoparticles were added to the "heat-cured PMMA" resin base at 1.0 percent and 2.0 percent by weight, respectively, to create a PMMA-ZrO2 nanocomposite of two various percentages to compare to PMMA without additives. For the transvers strength test and impact strength test, the traditional heat-curing technique was used with a water bath to polymerize the specimens. The data of the study were evaluated using a one-way ANOVA and a Duncan multiple range test with a significant P-value of (0.05). Results: An increase in transversal and impact strength for PMMA-ZrO2 nanocomposite of 1.0 and 2.0 percentages was noticed after comparison of the findings at (p0.05). Conclusion: By using Zirconium Oxide nanoparticles as dental filler at 1% and 2% by weight, the transverse strength and impact strength of PMMA denture base material were enhanced.

Aims: to compare the marginal fit of copings produced by Direct Metal Laser Sintering (DMLS), Hard metal CAM (Computer Assisted Milling), and conventional casting techniques. Materials and Methods: An implant abutment was used as ideal model which was scanned by 3D scanner and 8 copings of each group were fabricated from a single STL file. Each specimen was cross-sectioned into two halves and 2 points on each half were measured with digital microscope and image processing software, Readings were statistically analyzed with ANOVA test and Duncan’s multiple range test. Results: Significant difference was found between the groups in both marginal and internal gaps. The hard metal milling group showed significantly smaller gaps than the other two groups, while no significant difference was found in fit between DMLS and conventional casting groups Conclusions: within the limitations of this study, hard metal milled copings were found to have the superior fit compared to the other two groups, however, all copings in all three groups were found to have gaps within the clinically acceptable range of marginal fitness.

Aims: this study aims to evaluate the effect of adding two concentrations of zirconium oxide nanoparticles (1.0% and 2.0%) to "heat-cured PMMA" in order to improve its mechanical properties such as transverse strength and impact strength. Materials and Methods: The particle size of Zirconium Oxide ZrO2 was 20nm. The ZrO2 nanoparticles were added to the "heat-cured PMMA" resin base at 1.0% and 2.0% by weight, respectively, to create a PMMA-ZrO2 nanocomposite with two various percentages compared to PMMA without additives. For the transverse strength and impact strength tests, the traditional heat-curing technique was cured with a water bath to polymerize the specimens. The results of the study were statistically analyzed by using one-way ANOVA and Duncan's multiple range test with a significant P-value of 0.05. Results: The results showed that there was an increase in the transversal and impact strength for the PMMA-ZrO2 nanocomposite at concentrations of 1.0% and 2.0% respectively, after comparison of the findings at 0.05. Conclusions: The use of Zirconium Oxide nanoparticles as dental fillers at 1% and 2% by weight improved the transverse strength and impact strength of PMMA denture base material.

Aims A variety of the indicators have been the proposed method in-order to assist orthodontic diagnosis and treatment planning. This study aimed to appraise the applicability. the index of the Korkhaus to Iraqi persons, and to know if patients that having crowding of teeth have increase in arch length. Material and Methods: The sample consisted of (131) persons their age between (15-20) years, (64) boys and (67) girls, all of Iraqi origin, and live in the centre of Mosul city. All the individuals have Class I molar. relation. The sample consisted of three groups: Normal occlusion group with well aligned teeth (20) boys and (20) girls. Patients had moderate crowding, 2.5 - 4.5mm, (19) boys and (23) girls and severe crowding group, over 5mm, (23) boys and (26) girls. A linear distance was measured on a figure of the scanned study models for upper dental arches by Dimaxis program. statistical analysis with (SPSS) program at the level of P≤0.05 include: comparison between genders using in-depended t-test and, Pearson correlation coefficient among all the variables. Results: The results showed that the measurements (Sum of Incisors, Vertical, Measured Premolar value, measured molar value, Calculated Premolar Value, Calculated Molar Value) in normal occlusion had significantly higher mean Values in males than females. Also, there is a correlation coefficient between the sum of teeth width of four anterior and the posterior arch width which is significant for normal occlusion, but there is no such relation in the most crowding sample. Conclusions: Korkhaus index can be used to determine arch width in Iraqi individuals with normal occlusion, patients with crowded teeth had slight proclination of incisors that is not significant other than normal occlusion. So Korkhaus analysis is considered to be valid for Iraqi class I normal and crowded occlusion.

Aims: the present study aimed to analyze the effects of the incorporation of Zinc Oxide nano-fillers (ZnO NPs) with size (10-30 nm) at one concentration (1%) on color change and porosity and FTIR compared to milled CAD/CAM and conventional denture base materials. Materials and methods: the number of samples were 53 which divided into twenty samples for color change test (control, 1 % ZnO NPs), thirty samples for porosity test and three specimens for FTIR test for (control, 1 % ZnO NPs,CAD/CAM ) . Results: the results demonstrated that there was a significant change in color, with comparable FTIR spectra for the PMMA-ZnO nanocomposite at ZnO nanoparticles (1%), when compared to control and non-significant reduction to porosity test. CAD/CAM denture base showed significant low mean value as compared between control and (1%) zinc oxide group and also showed similar with non- significant difference spectra on FTIR test as compared to the control group. Conclusions: there is unacceptable color change in addition that use of ZnO nanoparticles as dental fillers at 1% by weight of PMMA denture base material and no chemical interaction between zno nanoparticles and CAD/CAM PMMA denture base which has superiority in porosity test.