International Poster Journal of Dentistry and Oral Medicine, 04/2014

The discovery of ancient mandibles exposes, sometimes, an incomplete or distorted morphology. From this comes the question of their restoration. The objective of this research is to provide assistance both for anthropologists and forensic scientists in the area of dento-skeletal mandibular reconstruction and for odontologists in terms of prosthetics. Solutions can be proposed from metric and angular measures by using geometric links connecting mandibular morphology and occlusal organization. The study material consists of two collections, proposed in DICOM data, from different periods, from the Natural History Museum of Vienna. - Wiesbach (WB): 211 available half-mandibles (150 years old) - Hainburg (HB): 58 available half-mandibles (4000 years old) Using these 3D data, the method is based on the positional search for three points of the same half-mandible, in a sagittal view, using the software Avizo ®: - The canine tip - The tip of the second mandibular molar distal buccal cusp - The most anterior point of the condylar head Finding these three points enables the calculation of the metric value of the curve of Spee as well as the angular value of the Balkwill angle. The results of the study provide, on average: - A curve of Spee with a radius of 79 ± 8 mm for Wiesbach and 81 ± 7 mm for Hainburg - A Balkwill angle with a measure of 22 ± 2 degrees for Wiesbach and 20 ± 2 degrees for Hainburg Combining these results allows us to consider a dento-skeletal mandibular reconstruction compatible from an anthropological and dento-prosthetic point of view despite the absence of one of these three components: mandibular condyle, posterior teeth or anterior teeth. Keywords: spee, balkwill, mandible, occlusal plane

Introduction: There is no safe level of secondhand smoke and conclusive evidence exists about the association between life threatening disease and passive smoking. Breathing even a little secondhand smoke can be dangerous. Secondhand smoke contains over 4,000 chemicals, 200 of which are toxins and 43 are carcinogens. Those who have heart disease and/or asthma are particularly susceptible to exposure to secondhand smoke exposure (US Surgeon General report 2006). Passive smoking, according to the recent global assessment of the burden of environmental tobacco smoke (ETS), is still one of the most important threats to public health (Oberget al., 2011) Materials and Methods: This study examined smoking rates and attitudes towards second hand smoke among Dental faculty at SEGi University, Malaysia. An anonymous survey questionnaire was distributed to all students, academic and non academic staff. Results: The response rate was 88.0% (147 Individuals) and 6.1% respondents had smoked more than 100 cigarettes in their life and 3.4% were current smokers. Current smokers averaged 6.4 cigarettes per day and smoked 2.6 per day on campus. A majority of respondents believed air quality to be fair (45.6%) while 34.7% stated it was poor. and Almost 40% of respondents said that they smell second hand smoke very frequently or frequently (38.8%). On the other hand, a large majority (78.9%) said that a smoking ban would greatly improve the public image of University and a majority (64.6%) believed it will greatly improve their job or academic performance. There is strong agreement that tobacco smoke is dangerous for smokers and nonsmokers' health (93.9%), and 89.4% would like to see university going smoke free but there was a mixed opinion about how a smoke free policy might be enforced. Conclusion: It is clear that there is considerable support for a smoke free policy in the university but there must be adequate education and consultation. Keywords: smoking, second hand smoke, smoke free

Aim: This study aimed to evaluate the reproducibility of the ICDAS visual classification system in clinical setting along with conventional dental charting. Materials and Methods: Thirty adult patients attending SEGI University dental clinic were screened using ICDAS detection codes along with conventional dental charting. Three clinicians, 2 Dental Public Health Specialists (KCG, DD) and 1 Oral Medicine specialist (AM) with previous training in ICDAS, screened these patients separately under same clinical setting. The teeth were visually examined after air-drying with 3 way syringe and the codes per tooth were recorded on new clinical chart which includes ICDAS score per tooth and conventional dental chart. Kappa analysis was done to calculate the inter-examiner reproducibility. Results: Kappa values for inter-examiner reproducibility were calculated to assess reproducibility of the examiners. The inter-examiner reproducibility between KCG-DD ranged from 0.775 to 0.852, from 0.740 to 0.827 between AM-DD and from 0.768 to 0.849 between observers KCG-AM. The time difference in the charting was found to be not significant Conclusion: The ICDAS system has demonstrated reproducibility and diagnostic accuracy for the detection of caries at varying stages of the disease process. Combining conventional dental charting along with ICDAS showed no significant time difference in charting. The ICDAS system achieved substantial to good agreement between examiners, is practical in clinical dental practice with training and can be improved with experience. Keywords: ICDAS, inter-examiner, calibration

Introduction: Following the removal of cysts of the jaw, the resultant bone defect is filled or left unfilled depending on its size. There is, however, no universal standard defining the volume above which a bone defect should be filled. The objective of this study was therefore to determine a threshold for bone defect filling and to assess whether this threshold value can be used for preoperative planning. Methods: We analysed cone-beam computed tomography (CBCT) and computed tomography (CT) data from 88 patients who presented with a jaw cyst. First we determined cyst volumes on the basis of CBCT and CT datasets and then we assessed the volume above which defects were filled. Results: We were able to identify a suitable threshold for bone defect filling which correlates well with the cyst diameter described in the German literature by Partsch for deciding whether to perform cyst marsupialisation or enucleation. Conclusion: The preoperative assessment of cyst volume is a simple and effective method of obtaining information about the necessity of filling bone defects and is thus a useful and reasonably accurate tool for surgical planning. Keywords: mandibular cyst, defect reconstruction, cyst enucleation, cyst volume assessment

Background: Periodontitis has been described as a chronic inflammatory disease which is triggered by specific host dependent immune response. It is established that the immune response is influenced among others by a genetic predisposition. In recent times it was shown, that the gene expression is affected also by epigenetic modifications. Therefore, we investigated the CpG methylation pattern of 22 inflammatory candidate genes (ATF2, CCL25, CXCL14, CXCL3, CXCL5, CXCL6, FADD, GATA3, IL10RA, IL12A, IL12B, IL13, IL13RA1, IL15, IL17C, IL17RA, IL4R, IL6R, IL6ST, IL7, INHA, TYK2) in dependence of the periodontal status. Patients and methods: In this preliminary study 11 patients with aggressive periodontitis (54.5% males, 40.6+11.5years) and 10 periodontal healthy persons (40% males, 37.7+17.1years) were included. Gingival biopsies were obtained and immediately frozen in liquid nitrogen. After DNA isolation (QIAamp® DNA Micro Kit) the methylation pattern was quantified using EpiTect® Methyl II Signature PCR Array Human Inflammatory Response (Qiagen). Results: In gingival inflamed tissues of patients with aggressive periodontitis there was a significant reduction in CpG methylation pattern of interleukin 17C compared with tissues of periodontal healthy persons (6.1% vs. 26.4%, p=0.007). The methylation pattern of all other genes investigated was not significantly modified regarding periodontal inflammation. Discussion: In our study we show for the first time a differential methylation pattern for IL17C in periodontitis. Interleukin 17C is an essential autocrine cytokine that regulates innate epithelial immune responses induced by bacterial challenge and inflammatory stimuli. The decrease in CpG methylation is presumably accompanied by an increase in gene expression. This could lead to a greater availability of interleukin 17C and the induction of epithelial immune response in inflamed oral tissue. Keywords: epigenetics, periodontitis

Objective: The purpose of this prospective randomized clinical study was to compare the clinical performance of the self-etching adhesive system Futurabond DC in combination with the composite GrandiSO and the influence of the additional application of the flowable resin composite GradioSO Heavy Flow after six months. Method: In 50 patients 32 class I and 68 class II cavities were placed with at least two restorations per patient. The adhesive system Futurabond DC was used for all the restorations. In one of the two fillings in each patient, an additional layer of the flowable resin composite GrandioSO Heavy Flow was applied in the entire cavity and separately light-cured. The fillings were placed under rubber dam. All materials were used as recommended by the manufacturer. Two clinicians evaluated the restorations at baseline, two week following placement, and at the six month recall visit according to the modified clinical criteria of Ryge. For this sensitivity, hypersensitivity, marginal discoloration, marginal adaption, recurrent caries, surface, color match, proximal contact and filling integrity were considered. All data were analyzed by Man-Whitney-U-test. Result: After six months 50 patients could be re-examined. All teeth remained vital and did not show any signs of postoperative sensitivity. Marginal adaption code Bravo could be evaluated in one filling (with flowable liner). In three teeth a marginal discoloration was scored as Bravo (two with and one without fowable liner). None of the teeth showed signs of secondary caries. Statistical analysis showed no significant difference between techniques for any of the evaluation criteria (p>0.05, Man-Whitney-U-test). Conclusion: After six months the use of a flowable composite showed no significant impact on the clinical performance of class-I and -II restorations. The self-etch adhesive Futurabond DC might be a promising alternative to other systems. This study was supported by Voco GmbH, Germany. Keywords: clinical study, composite, direct restorations, flowable composite

Objective: Matrix metallo-proteinases play a key role in the pathogenesis of periodontitis. Specifically, active MMP-8 (aMMP-8) concentrations increase during degradation of collagenic fibers. Therefore, it was the aim of this investigation to obtain a full-mouth profile of active MMP-8 in untreated chronic periodontitis patients and to investigate the association between these biomarker values, pocket depths, bleeding and plaque. Method: In this mono-center cross-sectional study, 10 male patients who had untreated chronic periodontitis were included. Sulcus fluid was gathered at four sites of every tooth. After air drying, paper strips were inserted 2 mm into the sulcus, remained there for 30 s and were stored in tubes at -20°C. In the laboratory, aMMP-8 was extracted, linked to antibodies, and dyed. Active MMP-8 concentration was measured via optical density. Probing depths, bleeding on probing, plaque and gingival indices were documented at the same sites as aMMP-8 samples were taken. Descriptive statistics and multiple linear regression analyses for the prediction of PD or aMMP-8, espectively, were performed. Results: Participants were on average 47.1 years old (range 31-67). Mean aMMP-8 concentrations per patient ranged from .69 to 29.03ng/ml. Only one patient had a concentration lower than 10 ng/ml and four patients had values higher than 24ng/ml. Three of the four patients who had the highest aMMP-8 concentrations were smokers. Standard deviations were high between patients and within the dentition of a patient. Mean pocket depths ranged between 3.56 and 5.01mm, mean BOP between 42% and 89%. Plaque index varied between 0.81 and 1.82, gingival index between 1.25 and 1.60. The multiple regression analysis did not reveal statistically significant predictions for neither PD nor aMMP-8. Conclusion: Considerable intraindividual and interindividual differences concerning aMMP-8 values existed in this sample of male periodontitis patients. No relationship between aMMP-8 and PD was proven. Keywords: matrix metalloproteinase 8, periodontitis, biomarker, pocket depth

Introduction: Indirect composite restorations are alternative technical approaches of posterior teeth rehabilitation, in certain clinical conditions. Objective: The aim of this report is to describe two clinical cases in which composite inlay/onlay, made by the dentist in-office, was used to rehabilitate posterior tooth structures considering two strategies, such as large and multi-surface restorations. Clinical/radiographic findings and treatment are presented and discussed with the literature evidence. Material and Methods: Two patients presenting different restorative problems were selected. Two clinical conditions are reported: (1) the 2.6 tooth showed a large extension composite restoration with loss of marginal integrity and cusp involvement (2) the 2.6 and 2.5 teeth with secondary caries/amalgam restorations (ICDAS 44 code) and proximal contact. Coronal rehabilitation with composite inlay/onlay made indirectly by the dentist was proposed for both clinical conditions. Cavity preparation and alginate impression were done. A silicone cast was performed to apply the nanostructured composite GrandioSO (Inlay System; Voco) that was incrementally applied and light-cured (1200mW/cm2, 20 seconds). Inlays/onlays were bonded with self-etch adhesive strategy (Futurabond DC) with enamel pre-etching and Bifix SE resin cement. Inlays/onlays occlusal/proximal adjustments, finishing and polishing were performed. Results: This indirect technique approach with composite provided an easy, convenient and efficient method to restore neighbouring teeth, to create adequate proximal contacts without having to use the time-consuming and expensive matrix systems and to better perform occlusal/proximal anatomy by extraoral modelling. Discussion and Conclusions: The indirect application of a composite is a predictable and economic approach to perform stress-free fabrication of tooth-coloured and durable restorations even in patients who are low- or non-compliant. This indirect rehabilitation is an aesthetic, functional and biological alternative face to direct techniques in coronal extensively weakened and multisurface restorations of posterior teeth, providing a refreshing alternative that can be processed in dental office by the dentist. Keywords: inlays, onlays, posterior restoration, resin-based composite, indirect restoration technique, operative dentistry

Introduction: The cervical dental hard tissues loss is a clinical model for evaluating the performance of adhesive restorations in non-retentive preparations. Objective: The aim of this study was to compare the clinical performance at 2-years, of Self-Etch (SE) and Etch-and-Rinse (ER) adhesives in composite restorations of non-carious cervical lesions (NCCL). Material and Methods: Prospective clinical trial, approved by UFP-FHS Ethics Committee, in 29 adult patients with 77 restorations randomly allocated according to two groups (microhybrid composite/adhesive system); SE Group: 43 restorations, Amaris®/FuturabondNR); ER Group: 34 restorations, Amaris®/SolobondM (Voco GmbH). All restorations were evaluated (aesthetic, functional and biological parameters) at baseline and at 2 years, using USPHS criteria and Hickel and colleagues (2007) recommendations, by three calibrated (ICC≥0.928) examiners. SE and ER efficacy (success rate) was evaluated at 2 years follow-up; Statistical analysis with nonparametric tests (alpha=0.05). Results: At 2 years, the SE (n=40; 7% dropout) and ER (n=34; 0% dropout) restorations showed success rates of 100% (Fisher /Chi-square tests, p>0.05), respectively. No significant differences between SE/ER (p> 0.05) regarding aesthetic, functional and biological restorations performance except for surface staining (p=0.012), for wear (p=0.012), patient's view (p=0.012) and tooth integrity (p=0.009), with less changes for ER restorations. Regarding baseline-2 years follow-up, SE and ER restorations showed significant changes in aesthetic (McNemar/Wilcoxon tests.; p0.020 and p0.008, respectively), functional (p0.012 and p0.014) and biological (p0.001 and p=0.009) parameters. Discussion and Conclusions: The effectiveness of restorations with SE and RE is high and similar at two-years follow-up. Aesthetic, functional and biological performance of restoration with ER appears to be better than with SE adhesive. However, a continuous and longer evaluation of these adhesive restorations longevity is necessary. The adhesives ER and SE in composite restorations of NCCL indicate a clinically acceptance and a comparable performance in the mean-term evaluation. Keywords: self-etch adhesives, etch-and-rinse adhesives, class V restorations, clinical trial, adhesives clinical performance, composite restorations effectiveness

Introduction: Teeth are readily accessible for examination and since no two teeth have similar morphology, they form an excellent forensic tool for sex determination. Tooth size standards based on odontometric investigations may be used in sex determination which forms one of the most important sub-disciplines of forensic odontology and is of paramount importance in medico-legal issues. Gender of an unknown person may be assessed by measuring the mesiodistal width of mandibular canine teeth as they exhibit sexual dimorphism. Aims and Objectives: 1. To record the mesiodistal width of mandibular canine teeth clinically, on plaster models and on intra oral periapical radiographs. 2. To compare and assess the reliability of each method. Materials and Methods: 100 patients belonging to Pondicherry population (50 males and 50 females) of the age group 15 to 25 years were randomly selected and the mesiodistal width of the mandibular canine teeth were measured clinically, on plaster models and on intra oral periapical radiographs. Result: In our study, comparing the three methods, statistically there was no significant difference among the three methods. There existed inter operator reliability in all the three methods as the t - value was not significant (p>0.05). Mean value of mandibular canine width in males and females on both sides was found to be statistically significant irrespective of the method used. Conclusion: From the present study, we conclude that the mandibular canine width greater than 7.3mm is suggestive of male and this helps in determining the gender of an unknown individual and it may be used as an important tool in forensic odontology. Keywords: sexual dimorphism, mandibular canine, mesiodistal width, radiomorphometric study, forensic odontology, odontometrics, pondicherry