Al-Rafidain Dental Journal

Aims: To evaluate volumetric amount of endodontic obturating materials remnants after endodontic retreatment using two retreatment rotary systems (R-Endo and EdgefileXR)with and without supplementary retreatment(XP-Endo Finisher), in teeth obturated by Sure-Seal Root TM (Bioceramic sealer). Materials and Methods: Twenty human mandibular premolars with single straight root canals were prepared using a 2Shape endodontic rotary system with a file size of 25/0.04. All teeth were obturated using gutta-percha and Sure-Seal Root TM (Bioceramic sealer) using the single cone technique. The samples were then divided into two groups according to the retreatment system used (n=10). After retreating all samples with different rotary systems, the samples were evaluated using CBCT images. CBCT images of each sample were taken and evaluated in axial, coronal and sagittal planes to determine the obturating material remnants after retreatment. Then, all samples retreated with two retreatment systems (R-Endo and EdgefileXR) underwent supplementary retreatment with XP-Endo Finisher. Second CBCT images for each sample were taken and the volume of the remnant material inside the canal walls was analyzed. Data were analyzed statistically using one-way ANOVA analysis of variance, Duncan’s multiple analysis rang test and independent t-test. Results: EdgeFileXR and R-Endo were significantly different and XP-Endo Finisher improved the removal of obturating materials in both groups. Conclusions: The retreatment system had a significant effect on the amount of endodontic obturating material remnants after endodontic retreatment and XP-Endo Finisher had a supplementary removal effect

Aims: To evaluate the volumetric amount of endodontic obturating materials remains after endodontic retreatment with and without complementary retreatment(XP-Endo Finisher) utilizing two retreatment rotary systems (R-Endo and EdgefileXR).Materials and Methods: Twenty human mandibular premolars with single straight root canals were prepared using a 2Shape endodontic rotary system with a file size of 25/0.04. Gutta-percha and T-Seal (Epoxy resin sealer) were used to obtain all the teeth using a single cone technique. Samples were then divided into two groups based on the retreatment system used (n=10). CBCT images of each sample were taken and analyzed in axial, coronal, and sagittal planes to determine the obturating material remnants after retreatment. Then, all samples retreated by two retreatment systems (R-Endo and EdgefileXR) were subjected to supplementary retreatment by the XP-Endo Finisher. Second CBCT evaluation were performed to determine the XP-Endp Finisher effect. The data were statistically analyzed using one-way ANOVA analysis of variance, independent t-test, and Duncan’s multiple analysis rang test. Results: EdgeFileXR and R-Endo were significantly different, EdgefileXR is more effective and XP-Endo Finisher improved removal of obturating materials in both groups. Conclusions: The retreatment system had a significant effect on the amount of endodontic obturating materials remnants, XP-Endo Finisher show a supplementary removal effect.

Aims: This study was aimed to evaluate the efficacy of self-assembling peptide, fluoride varnish, and their combination to remineralize the artificial carious lesion in vitro. Materials and methods: Sixty extracted sound premolars were randomly divided into four groups. The artificial carious lesion was created by immersion the specimens in the demineralizing solution. The enamel surface treated with: Group1: (n=15) artificial saliva alone, group2: (n=15) fluoride varnish, group3: (n=15) self-assembling peptide, group4: (n=15) self-assembling peptide + fluoride varnish. The enamel surface was assessed by Vickers surface microhardness at the baseline, after demineralization, 1-week, and 4-weeks after remineralization. Results: all four groups exhibited high statistically significant differences between the different times of test periods, In 1 and 4-weeks after remineralization, the greatest surface microhardness mean value was seen in the self-assembling peptide + fluoride varnish group followed by self-assembling peptide group then fluoride varnish group while the artificial saliva group showed the least surface microhardness mean value with a highly statistically significant difference between them. Conclusions: self-assembling peptide superior to fluoride varnish in remineralization ability and this potential is boosted when they combined together. Relating to surface microhardness, remineralization is a dynamic process that increases with time.

Aims: This study aimed to evaluate the efficacy of self-assembling peptide, fluoride varnish, and their combination to remineralize the artificial carious lesion in vitro. Materials and methods: Sixty extracted sound premolars were randomly divided into four groups. The artificial carious lesion was created by immersion the specimens in the demineralizing solution. The enamel surface was treated with: Group1: (n=15) artificial saliva alone, group2: (n=15) fluoride varnish, group3: (n=15) self-assembling peptide, group4: (n=15) self-assembling peptide + fluoride varnish. The enamel surface was assessed by a profilometer at the baseline, after demineralization, 1-week, and 4-weeks after remineralization. Results: all four groups exhibited high statistically significant differences between the different times of test periods, In 1 and 4 weeks after remineralization, the least surface roughness mean value was seen in the self-assembling peptide + fluoride varnish group followed by self-assembling peptide group then fluoride varnish group while the artificial saliva showed the greatest surface roughness mean value with a highly statistically significant difference between groups. Conclusions: self-assembling peptide superior to fluoride varnish in remineralization ability and this potential is boosted when they combined together.

Aims: The current study aims to assess the levels of patients’ anxiety towards simple tooth extraction, and the difference in pre-extraction anxiety levels; if present; between genders and among different age groups. Materials and Methods: Two hundred and ninety-two patients who presented for simple tooth extraction were recruited. Each participant filled a self-administrated questionnaire; the tooth-extraction anxiety (TEA) scale and asked to rate the amount of their anxiety toward tooth extraction on 11- point Numeric Rating Scale (NRS). Results: Two hundred and sixty-three patients (90.07%) filled-out the questionnaire completely. Cronbach’s α for the present sample was 0.84 correlated significantly with NRS (0.48, P<0.01). Anxiety among patients was moderate, and mean scores of 4.68 and 2.76 were recorded on NRS and TEA scale respectively. The scores of anxiety in female patients was slightly higher than in male patients but without statistical significance. When considering the age groups of participants, significantly higher anxiety was depicted in the young and old adult age groups than in middle-age adult group of patients. Conclusions: Anxiety may be more predicted in female, young, and old-adult patients.

Aims: This study was aimed to evaluate the effect of azithromycin in reducing pathological gingival enlargement. Materials and methods: twelve adult New Zealand male rabbits weighing (900gm-1250mg) and almost the same in age and circumstance were chosen in this study. All animals with pathological gingival enlargement were clinically examined by using a periodontal probe and measuring their gingival sulcus depth. Then, six of them were slaughtered and considered the control group and the other six were experimental group, and at the end of study a specimens of oral mucosa were taken for immunohistochemical examinations. Results: Clinical examination shows there is no reduction in gingival enlargement in the control group while this enlargement decreased in the experimental group after use of azithromycin. Immunohistochemical analysis shows mild matrix metalloproteinase-1(MMP1) expression in the control group and moderate to strong MMP1 expression in sub-epithelial of gingiva in the experimental group. Conclusion: This study establishes that azithromycin is clinically and immunohistochemically effective in the reduction of pathological gingival enlargement

Aims: The current study aimed to compare bone density means around dental implants covered with one of two platelet rich fibrin preparation protocols (Standard-Platelet Rich Fibrin and Advanced-Platelet Rich Fibrin) using standard intraoral digital periapical radiographs. Materials and methods: A total of ten male patients with an age range of 28-51 years participated in this split-mouth clinical study. The patients were divided into two groups based on the platelet rich fibrin (PRF) protocol to be used with dental implant insertion into positive control (S-PRF) and study group (A-PRF). Each patient represented the two groups in which he received 2 dental implants; ten implants for each group (a total of 20 dental implants) of standard length and diameter in the posterior mandibular extraction sites of ipsilateral or contralateral side. In the positive control group, the standard PRF protocol was to be used to prepare the PRF clot. In the study group, the advanced PRF protocol was to be used to prepare the PRF clot. Both PRF membranes were to be instilled inside the osteotomy bed during dental fixture installation. Following the installation of dental implants and as a basis for comparison between both groups, densitometric analysis of bone around dental implants at immediate, four, eight and twelve weeks scheduled visits were made. Results: Total densitometric analysis results showed no significant difference within S-PRF group, within A-PRF group and between both groups, with the highest mean (167.07) being at twelve weeks after surgery in the A-PRF group. Conclusions: Both S-PRF and A-PRF, similarly enhanced and maintained bone density (synergistic effect) throughout the of study and as disclosed by densitometric values. The use of PRF in its current forms seems to be an accepted minimally invasive approach with good clinical results.

Platelets contain a reservoir of growth factors that have numerous biological activities such as assisting in chemotaxis, cell differentiation, proliferation, and angiogenesis which all are pivotal in the wound healing process. From this, platelet concentrates have been described in the literature beginning from the first generation to the second generation both of which have a beneficial impact on the healing of soft and hard tissue following oral surgical procedures. The following review will illustrate the evolution of platelet concentrates and the current classification of the marketed products available.

Aims: The aim of this study was to compare the push-out bond strength values between four different types of sealers. Materials and method: Forty extracted straight, single-rooted, sound human mandibular first premolar teeth were selected for this study. The crown portion of each tooth was decoronated to the level of the cement-enamel junction (CEJ) to standardize the root length to 16 mm. The working length was measured and the canals were instrumented using Nickel-Titanium ProTaper Universal Rotary System up to size F3. The canals were rinsed with 2.5% sodium hypochlorite followed by 17% EDTA, then the samples were divided into four groups (n=10) according to the sealer to be used with F3 gutta-percha. These are (AH Plus, GuttaFlow 2, GuttaFlow Bioseal and MTA Fillapex) sealers. The push-out bond strength test was performed and the data were analyzed using one way ANOVA, and post hoc Duncan’s multiple range tests at (p ≤ 0.05). Results: There was a statistically significant difference in the push-out bond strength among the four sealers’ groups at (p ≤ 0.05). The highest mean value of bond strength (3.605) MPa was shown in the AH Plus group. Bioseal group produced (1.833) MPa followed by (0.822) MPa for GuttaFlow2 group. The lowest value (0.645) MPa was shown in MTA Fillapex group. Conclusion: Based on the findings of this study, AH Plus sealer revealed the highest bond-strength value followed by GuttaFlow Bioseal and GuttaFlow 2, whereas MTA Fillapex showed the least bond value

Aims: The study aimed to evaluate the effect of smear layer on the push-out bond strength of silicone-based root canal sealers. Materials and methods: Sixty extracted, single-rooted, sound human mandibular first premolar teeth were selected for this study. The Crown portion of each tooth was decoronated to the level of cement-enamel junction to standardize the root length to 16 mm. The working length was measured by subtracting 1mm from the visually determined canal length and the canals were instrumented using ProTaper universal rotary system up to size F3. The canals were divided into two groups according to the irrigating solutions used. Group.1 was rinsed with 2.5% sodium hypochlorite followed by 17% EDTA to ensure complete smear layer removal. Group.2 was rinsed using 0.9% normal saline to keep the smear layer. Then the samples were subdivided into three subgroups according to the sealer used with gutta-percha. These include AH Plus, GuttaFlow 2, and GuttaFlow Bioseal groups. The push-out bond strength test was performed using the universal testing machine and the data were analyzed using independent sample T-test at (p ≤ 0.05) to compare the results of each sealer group in the presence and absence of the smear layer. Results: For all sealers’ groups the results has shown a statistically significant difference in the bond strength at (p ≤ 0.05) between group 1 (without smear layer) and group 2 (with smear layer). The smear layer removal produced higher bond strength in AH Plus sealer, whereas the bond strength of both GuttaFlow 2 and GuttaFlow Bioseal was decreased when the smear layer was removed. Conclusion: Smear layer removal has a positive effect on the bond strength value of AH Plus sealer. The bond strength of GuttaFlow 2 and GuttaFlow Bioseal was not improved following smear layer removal.

This review paper aimed to evaluate the effect of oxidative stress in the prevalence of some dental diseases and the role of antioxidants in dentistry. Oxidative stress is a normal phenomenon, present in healthy human body help them to produce energy that they need for their life. During that, the formation of free radicals begins, including both reactive oxygen species "ROS" & also reactive nitrogen species "RNS". These radicals have a role in a many types of signalling pathways that regulate inflammation. Antioxidants constrain the formation of free radicals. Mitochondria, a small cell organelle acts to generate energy in the form of adenosine triphosphate "ATP". It combines oxygen & glucose to form carbon dioxide, water, & ATP. Free radicals result as by-products of this metabolic process & when natural defence apparatuses be unsuccessful, the level of free radicals begins to increase to levels where the capacity of the body is unable to neutralize them entering the body into the state of high oxidative stress, which means greater risk of numerous oral & systemic diseases. Oral tissues are liable to free radical damage in a unique manner due to the presence of mucus membranes that allow rapid absorption of constituents throughout their surfaces. In oral environment, infection of gingiva can produce oxidative stress. The rise in formation of free radicals by oxidative stress results in further destruction of cellular walls and oral tissues. The study results suggested that the use of antioxidants is an adjunct approach to dental therapy may be helpful in controlling the oral health status.

Aims: To study the effect of metal oxide nanoparticles (MgO, ZrO2, ZnO) on acrylic based soft liner surface properties and FTIR. Materials and Methods: Acrylic-based soft-liner specimens were prepared by adding three different concentrations (0.5, 1, and 2) %wt of metal oxide nanoparticles (MgO, ZrO2, ZnO). A disk-shaped specimens with 30mm diameter and 3mm thickness were prepared for shore (A) hardness test to evaluate the surface hardness of modified soft liner. The surface roughness of soft-liner samples (10X10X2mm) was tested by a profilometer. FTIR analysis was conducted to evaluate chemical reaction that may occur between acrylic-based soft liner and nanoparticles. Results: there were no chemical reaction carried out between soft liner and metal oxide nanoparticles at different concentration- surface hardness (shore A) was increased as nanoparticles concentration increased in modified resin. Nanoparticles with 1 and 2% concentration incorporated in soft liner had lower surface roughness value. Conclusions: Metal oxide nanoparticles have improved the surface texture of acrylic-based soft liner, while the hardness of modified soft liner was increased with nanoparticles concentration increases.

Aims: The aim of this study was to evaluate the antifungal effect of adding nanoparticles with different concentrations into irreversible hydrocolloid impression materials. Materials and Methods: This study evaluated the antifungal effect of MgO and ZrO2 nanoparticles by Minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) and using the Agar-Well diffusion method after incorporation of different concentrations of nanoparticles into irreversible hydrocolloid impression material. Results: The results of this study showed that MIC and MFC of magnesium oxide nanoparticles were 0.2wt% and 0.3wt% respectively and for zirconium oxide nanoparticles were 5wt% and 10wt% respectively. Conclusions: The incorporation of MgO and ZrO2 into irreversible hydrocolloid impression materials acts as antifungal agents

Aims: This study aimed to establish whether changes in setting time and solubility of the locally prepared zinc oxide-guaiacol endodontic sealer when incorporated with thymol crystals as an antibacterial agent. Materials and Methods: zinc oxide-guaiacol endodontic sealer with thymol crystals incorporated at three different concentrations (2%, 5%, and10%) were tested, For setting time test similar specimens were prepared using ring molds with an internal diameter of (10 mm) and a height of (2 mm), nearly (120±10) seconds once mixing, the sample was located on a metal block in an incubator. A Gilmore needle with a mass of (100±0.5 g) which had (2±0.1 mm measurement) was used; the period of “no indent” was noted from the start of mixing. For the solubility test, similar specimens were prepared using ring molds with an internal diameter of (20 ± 0.1 mm) and a height of (1.5 ± 0.1 mm) and digitally weighted to register the mass of each specimen before and after immersion in distilled water. Solubility was determined after 24 hours and statistically analyzed using descriptive statistics, a One-Way ANOVA test, and post-hoc Duncanʼs Multiple Range Test was used. Results: The means of setting time of three experimental sealers were decreased as thymol crystal concentrations increased and the means of solubility for three experimental sealers were increased as the concentrations of thymol crystal increased. Conclusions: This study concluded that the prepared sealers with three concentrations were still adapted within the requirements of ANSI\ADA specifications NO.57\2008 for root canal sealer materials.

The worth of using Silver Diamine Fluoride (SDF) during COVID-19 pandemic has highly increased due to its low invasiveness and non-aerosolizing technique. The blend of silver and fluoride in an alkaline solution has a great action in arresting active enamel and dentin carious lesions, also acting as a desensitizer to lessen dentine hypersensitivity in adults, this review article was conducted to highlight the SDF mechanism of action, clinical applications, and its main indications and contraindications.

Aims: Microleakage under brackets and bands are considered one of the common problems that occur during orthodontic treatments. The main objective of this paper was to review the available information regarding the factors contributing to microleakage in Orthodontics. Materials and Methods: Microleakage was defined, and reviewed and explained the factors contributing to microleakage in orthodontics. Conclusion: A considerable amount of research has been published concerning factors contributing to microleakage in orthodontics. this paper hopes to provide some information regarding this topic for both researchers and people working in clinical fields

Aims: The aim of the present study was to assess some mechanical properties of PMMA after incorporating with polyetheretherketone particles (vectrex peek polymer) (PEEK) material with a different percentage (1%, 2% and 3%). Materials and Methods: The PEEK particle size of 130μm. The PEEK of 1%, 2% and 3% wt. respectively was added to the PMMA resin base to achieve a PMMA/PEEK composite of three different particles percentage to compare with the PMMA with no additives (control). The conventional heat-curing method was applied using a water bath to polymerize the specimens for both Vickers hardness, tensile and transvers strength tests. Study data were analysed via One-way ANOVA (post-hoc/Tukey test) performed at significant P-value of (p≤0.05) and confidence. Results: After comparing the results, a significant alteration in the hardness, tensile and transvers strength of PMMA/2%PEEK composites was noticed comparing to other tested groups (p≤0.05). Conclusions: the polyetheretherketone particles used as dental filler at 1%, 2% and 3% wt. added to PMMA reduced the tensile strength and enhanced the hardness and transvers strength of PMMA denture base material

Aims: To assess water sorption and solubility of PMMA after incorporating with polyetheretherketone particles (vectrex peek polymer PEEK) material with a different percentage (1%, 2%, and 3%). Materials and Methods: The PEEK particle size of 130μm. Peek with (1%, 2%, 3%by wt.) concentrations were added to the PMMA resin base to compare with the PMMA with no additives (control). The conventional heat-curing method was applied using a water bath to polymerize the specimens and study water sorption and water solubility of prepared samples. Study data was analysed via One-way ANOVA performed at significant P-value of (p≤0.05) and confidence. Fourier transform infrared spectroscopy used to detect any chemical modification occurs. Results: After comparing the results show significant difference in Water sorption of PMMA/PEEK. Water Solubility show no significant difference comparing to other tested groups (p≤0.05). Conclusions: the PEEK particles use it as dental filler at 1%,2% and 3% wt. incorporating PMMA material with3% PEEK material have lowest mean value for water sorption and solubility