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    ABSTRACT: Aim The aim of the present study was to measure the accuracy and reproducibility of probe forces in simulated assessments of periodontal pocket depth. The study included experienced and inexperienced examiners and used manual and pressure-sensitive probes. Materials and Methods Sixty-one participants were divided into seven groups and asked to probe selected anterior and posterior sites with three different probes (Williams 14W, Chapple UB-CF-15, and Vivacare TPS probes). The model was positioned on a digital electronic balance to measure force, which was recorded initially and after 15 minutes. Probe preferences were recorded. Accuracy was measured by comparing to a standardized 25 g force, and reproducibility was calculated for all duplicate measurements. Results The Vivacare probe produced the most accurate and most reproducible forces, whereas the Williams probe produced the least accurate and least reproducible forces. Probe forces were lighter at anterior sites compared to posterior sites at baseline. Probe forces were reduced at both sites after 15 minutes compared to baseline. Conclusions Vivacare TPS periodontal probes are more accurate and reproducible than Chapple and Williams probes. Many clinicians in this study preferred the Chapple probe.
    Saudi Dental Journal 04/2014; 26(2). DOI:10.1016/j.sdentj.2014.02.001
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    ABSTRACT: SrO and SrF2 are widely used to replace CaO and CaF2 in ionomer glasses to produce radiopaque glass ionomer cements (GIC). The purpose of this study was to evaluate the effects of this substitution on release of ions from GIC as well as its effect on esthetics (translucency) and radiopacity. Cements were produced from ionomer glasses with varying content of Sr, Ca and F. The cements were stored in dilute acetic acid (pH 4.0) for up to 7 days at 37°C. Thereafter, the cements were removed and the solution was tested for F(-), Sr(2+), Ca(2+), and Al(3+) release. Radiopacity and translucency were measured according to BS EN ISO 9917-1:2003. Ion release was linear to t(1/2) suggesting that this is a diffusion controlled mechanism rather than dissolution. The fluoride release from the cements is enhanced where some or all calcium is replaced by strontium. Radiopacity shows a strong linear correlation with Sr content. All cements were more opaque than the C0.70 0.55 standard but less opaque than the C0.70 0.90 standard which is the limit for the ISO requirement for acceptance. This study shows that the replacement of calcium by strontium in a glass ionomer glass produces the expected increase in radiopacity of the cement without adverse effects on visual properties of the cement. The fluoride release from the cements is enhanced where some or all calcium is replaced by strontium.
    Dental materials: official publication of the Academy of Dental Materials 01/2014; DOI:10.1016/j.dental.2013.12.003
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    ABSTRACT: Crohn's disease presents in the orofacial region with a characteristic lip swelling that can progress to facial disfigurement.1 ,2 To date, assessments of these changes are based on clinical observation together with patient satisfaction reports and semiquantitative methods. Although useful, the development of an analytical approach that permits objective, reproducible and quantitative evaluation of morphological changes is required. We report the use of facial biometrics to objectively quantify changes associated with orofacial Crohn's disease in a 28-year-old woman.3 The patient was referred by the gastroenterologist for treatment of repeated upper lip swelling. In this patient a baseline facial scan was acquired when minimal lip swelling was present (figure 1A). Two months later she represented with markedly increased perioral swelling and a second scan was captured (figure 1B). Utilising coordinate metrology, figure 1A,B were identically positioned and registered. This allowed areas of swelling to be visualised (figure 1b) and a defined patient-specific template (highlighted in figure 1b–e) to be generated. An initial intralesional triamcinolone injection (40 mg/mL) resulted in some resolution of the swelling; a volume reduction of 6540.8 mm3 (figure 1c) postregistration of the third scan (figure 1C) against the second was noted. Four months after the third scan, the upper lip swelling recurred (figure 1D), with the right side more severely affected (figure 1d). This informed the precise position (* in figure 1D) for guided infiltration of intralesional triamcinolone (40 mg/mL). Two weeks post-treatment, registration of figure 1D,E revealed a volume reduction of 9656.4 mm3. At this point she reported considerable satisfaction with the outcome of treatment.
    Case Reports 11/2013; 2013(nov20_1). DOI:10.1136/bcr-2013-010460
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    ABSTRACT: To identify the timing of significant arch dimensional increases during orthodontic alignment involving round and rectangular nickel-titanium (NiTi) wires and rectangular stainless steel (SS). A secondary aim was to compare the timing of changes occurring with conventional and self-ligating fixed appliance systems. Additional data from a multicenter randomized trial initially involving 96 patients, aged 16 years and above, were analyzed. The main outcome measures were the magnitude and timing of maxillary intercanine, interpremolar, and intermolar dimensions. Each participant underwent alignment with a standard Damon (Ormco, Orange, Calif) wire sequence for a minimum of 34 weeks. Blinding of clinicians and patients was not possible; however, outcome assessors and data analysts were kept blind to the appliance type during data analysis. Complete data were obtained from 71 subjects. Significant arch dimensional changes were observed relatively early in treatment. In particular, changes in maxillary inter-first and second premolar dimensions occurred after alignment with an 0.014" NiTi wire (P< 0.05). No statistical differences in transverse dimensions were found between rectangular NiTi and working SS wires for each transverse dimension (P> 0.05). Bracket type had no significant effect on the timing of the transverse dimensional changes. Arch dimensional changes were found to occur relatively early in treatment, irrespective of the appliance type. Nickel-Titanium wires may have a more profound effect on transverse dimensions than previously believed.
    Journal of dentistry 11/2013; 42(1). DOI:10.1016/j.jdent.2013.11.010
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    ABSTRACT: The complex biological, physicochemical process of human dental enamel formation begins in utero and for most teeth takes several years to complete. Lost enamel tissue cannot regenerate, therefore a better understanding of the spatial and temporal progression of mineralization of this tissue is needed in order to design improved in vivo mineral growth processes for regenerative dentistry and allow the possibility to grow a synthetic whole or partial tooth. Human dental enamel samples across a range of developmental stages available through archaeological collections have been used to explore the spatial and temporal progression of enamel biomineralization. Position sensitive synchrotron X-ray diffraction was used to quantify spatial and temporal variations in crystallite organization, lattice parameters and crystallite thickness at three different stages in enamel maturation. In addition X-ray microtomography was used to study mineral content distributions. An inverse correlation was found between the spatial variation in mineral content and the distribution of crystallite organization and thickness as a function of time during enamel maturation. Combined X-ray microtomography and synchrotron X-ray diffraction results show that as enamel matures the mineral content increases and the mineral density distribution becomes more homogeneous. Starting concurrently but proceeding at a slower rate, the enamel crystallites become more oriented and larger; and the crystallite organization becomes spatially more complex and heterogeneous. During the mineralization of human dental enamel, the rate of mineral formation and mineral organization are not identical. Whilst the processes start simultaneously, full mineral content is achieved earlier, and crystallite organization is slower and continues for longer. These findings provide detailed insights into mineral development in human dental enamel which can inform synthetic biomimetic approaches for the benefit of clinical dentistry.
    Archives of oral biology 11/2013; 58(11):1726-1734. DOI:10.1016/j.archoralbio.2013.08.012
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    ABSTRACT: The prevalence of waterpipe tobacco smoking (WPTS) is increasing worldwide. The aims of this study were (a) to evaluate the psychometric properties of the Lebanon Waterpipe Dependence Scale (LWDS-11) and (b) to assess, estimate, and identify factors associated with waterpipe tobacco dependence symptoms among U.K. male adult resident waterpipe tobacco smokers. A total of 180 waterpipe tobacco smokers were recruited during random visits to 7 outlets serving waterpipe tobacco. Data were collected via face-to-face interviews using the WPTS module of the Global Adult Tobacco Survey and the LWDS-11. Descriptive statistics, exploratory psychometric, univariate, and Poisson regression analysis were employed. Participants' M/SD age was 29.46/±9.41 years, Arabic ethnicity accounted for 58.3%, and 53.9% had completed above secondary education. Psychometric analyses for the LWDS-10, after removing 1 item from the generic scale, revealed Cronbach's alpha coefficient = 0.74. About 47% of the sample demonstrated waterpipe tobacco dependence. Being Arab (p = .040, OR = 2.63, 95% CI = 1.05-6.62), smoking waterpipe daily in the past (p = .003, OR = 2.13, 95% CI = 1.30-3.49), and an increase in length in the last session of WPTS (p = .044, OR = 1.15, 95% CI = 1.00-1.32) were identified as risk factors for waterpipe tobacco dependence. This study demonstrated the potential of LWDS-11 and revealed 2 domains, positive and negative reinforcement and physiological dependence. Results indicated that waterpipe tobacco smokers in the United Kingdom demonstrated tobacco dependence symptoms, which were associated with socio-behavioral factors. Generalizability of these findings and their implications in public health are yet to be investigated.
    Nicotine & Tobacco Research 10/2013; 16(3). DOI:10.1093/ntr/ntt148
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    ABSTRACT: Background: The optimal long-term management of the congenitally missing maxillary lateral incisor continues to cause controversy within the specialty. The Angle Society of Europe meeting 2012 dedicated a day to address some of the current controversies relating to the management of these missing lateral incisors. Findings: The format of the day consisted of morning presentations and afternoon breakout sessions to discuss a variety of questions related to the management of missing lateral incisors. Conclusions: The consensus viewpoint from this day was that the care of patients with congenitally missing lateral incisors is best achieved through a multi-disciplinary approach. The current evidence base is weak, and further well-designed, prospective trials are needed.
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    ABSTRACT: Despite the many courses of fixed orthodontic treatment being undertaken worldwide, the question of this treatment harming children's diets remains unanswered. A hospital-based prospective cohort design was adopted to investigate the effects of treatment on dietary intake and behaviour, body fat (BMI) and fat percentage in 124 patients (41.9% male) aged 11-14 (mean 13.1, SD 0.91) years, consecutively recruited to test and control groups. Both groups completed socio-demographic & food frequency questionnaires, body mass index (BMI) and body fat percentage measures at baseline and follow-up. Test patients completed follow-up pain diaries and dietary questionnaires. Both groups were comparable at baseline, with a dropout rate of 12.1%. The impact on dietary behaviour was significantly higher at 6 weeks compared to 3 months (P<0.002). Pain (biological factor), analgesic consumption or professional dietary advice (behaviour modification) had no influence whilst, a high BMI status at baseline appeared to be the only significant moderator of change in fat percentage (P<0.05) and impacts on dietary behaviour (P<0.049) at follow-up. The findings show no significant detrimental effect on dietary intake or behaviour, BMI and fat percentage, during the first 3 months, of orthodontic treatment and may impart a beneficial/protective effect.
    Journal of dentistry 09/2013; 41(11). DOI:10.1016/j.jdent.2013.08.025
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    ABSTRACT: Data sourcesThe following electronic databases were searched from 1986 to the present: Cochrane Library (Cochrane Database of Systematic Reviews, DARE and HTA Databases, and Cochrane CENTRAL Register of Controlled Trials), Medline In Process and Other Non-Indexed Citations and Medline (Ovid), Embase (Ovid), ERIC (CSA), Index to Theses (Expert Information Services), and ZETOC (British Library Electronic Table of Contents and conference proceedings). No language restrictions.Study selectionRandomised controlled trials or quasi-experimental designs were eligible which evaluated continuing professional development (CPD) interventions in dentistry (for dentists and professions complimentary to dentistry) on learning gains, behaviour change or patient outcomes. These could be compared against no intervention or another CPD intervention. There were no minimum follow up times.Data extraction and synthesisThe following data were extracted by two reviewers: bibliographic details, settings, characteristics about participants, intervention and control conditions, outcome measures, findings and conclusions. Studies were grouped thematically according to the intervention, and the studies were quality assessed using a custom system based on the CONSORT statement. The results were reported in a narrative form and no attempt was made to combine them in a meta-analysis.ResultsTen studies were included. Eight studies were judged to be of high to moderately high quality. None of the studies measured patient outcomes, but a multifaceted black box intervention resulted in self-reported patient care and face-to-face contact to change antibiotic prescribing habits showed a change in clinician behaviour. The size of this effect for both of these is not reported here. There was some effect on knowledge but not on behaviour for courses and workshops, written material, computer-assisted learning and audit and feedback.Conclusions Multi-method and multi-phased dental CPD has potential for the greatest impact on practitioner behaviour.
    Evidence-based dentistry 09/2013; 14(3):67-8. DOI:10.1038/sj.ebd.6400944
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    ABSTRACT: The effect of nutrition on the timing of human tooth formation is poorly understood. Delays and advancements in dental maturation have all been reported as well as no effect. We investigated the effect of severe malnutrition on the timing of human tooth formation in a large representative sample of North Sudanese children. The sample (1102 males, 1013 females) consisted of stratified randomly selected healthy individuals in Khartoum, Sudan, aged 2-22 years using a cross-sectional design following the STROBE statement. Nutritional status was defined using WHO criteria of height and weight. Body mass index Z-scores and height for age Z-scores of ≤-2 (cut-off) were used to identify the malnourished group (N = 474) while the normal was defined by Z-scores of ≥0 (N = 799). Clinical and radiographic examination of individuals, with known ages of birth was performed including height and weight measurements. Mandibular left permanent teeth were assessed using eight crown and seven root established tooth formation stages. Mean age at entry and mean age within tooth stages were calculated for each available tooth stage in each group and compared using a t-test. Results show the mean age at entry and mean age within tooth stages were not significantly different between groups affected by severe malnutrition and normal children (p>0.05). This remarkable finding was evident across the span of dental development. We demonstrate that there is little measurable effect of sustained malnutrition on the average timing of tooth formation. This noteworthy finding supports the notion that teeth have substantial biological stability and are insulated from extreme nutritional conditions compared to other maturing body systems.
    PLoS ONE 08/2013; 8(8):e72274. DOI:10.1371/journal.pone.0072274
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