Rapid palatal expansion to treat nocturnal enuretic children: a systematic review and meta-analysis

Statement of the Problem: Refractory nocturnal enuresis possesses a heavy psychosocial burden for the affected child. Only a 15% spontaneous annual cure rate is reported

Purpose: This patient-level meta-analysis aimed to evaluate the efficacy of rapid palatal expansion to treat nocturnal enuresis among children

Materials and Method: A sensitive search of electronic databases of PubMed [since 1966], SCOPUS [containing EMBASE, since 1980], Cochrane Central Register of Controlled Trials, CINAHL and EBSCO till Jan 2014 was performed. A set of regular terms was used for searching in data banks except for PubMed, for which medical subject headings [MeSH] keywords were used. Children aged at least six years old at the time of recruitment of either gender who underwent rapid palatal expansion and had attempted any type of pharmacotherapy prior to orthodontic intervention were included

Results: Six non-randomized clinical trials were found relevant, of which five studies had no control group. Eighty children were investigated with the mean age of 118 [28.12] months ranged from 74 to 185 months. The median time to become completely dry was 2.87 months [confidence interval [CI] 95% 2.07-2.93 months]. After one year, the average rate of becoming complete dry was 31%. The presence of posterior cross bite [relative risk [RR]: 0.31, CI 95%: 0.12-0.79] and signs of upper respiratory obstruction during sleep [RR: 5.1, CI 95%: 1.44-18.04] significantly decreased and increased the chance of improvement, respectively. Meanwhile, the other predictors did not significantly predict the outcome after simultaneous adjustment in Cox regression model

Conclusion: Rapid palatal expansion may be considered when other treatment modalities have failed. The 31% rate of cure is promising when compared to the spontaneous cure rate. Though, high-level evidence from the rigorous randomized controlled trials is scarce [Level of evidence: C]

Assessment of protective effect of amorphous calcium phosphate-caseine phosphopeptide and silicone oil against the erosive property of iron drop: an in-vitro investigation in primary teeth

One of the complications of Iron drop recommended for 6-24 months children is the potential reduction in microhardness of primary tooth enamel because of low pH. The objective of this study is to assess the protective effect of amorphous calcium phosphate caseine phosphopeptide [ACP-CPP] and silicone oil in primary teeth. Thirty extracted primary anterior teeth were divided into three equal groups. The initial micro hardness was measured by Vicker's microhardness tester. The first group without a protective layer and the second and third group after application of ACP-CPP and silicone oil respectively, were immersed in iron drop. Microhardness was remeasured. One tooth in each group along with a tooth not exposed to iron drop were randomly chosen for SEM qualitative analysis. Analysis was performed with Repeated measures ANOVA with SPSS-18. All groups exhibited significant decrease of micro hardness [p=0.001], however, no contrasting pattern was found between various groups. Neither ACP-CPP nor silicone oil could not provide a significant protection against micro hardness reduction after exposure to iron drop

Root-crown ratio in permanent dentition using panoramic radiography in a selected Iranian population

Statement of the Problem: Determining the crown-root ratio is crucial in many dental clinical decisions. There are no reliable data presented for Iranian population

Purpose: The aim of this study was to assess the root-crown ratio of permanent teeth with regards to the relationship of gender and jaw type using panoramic radiographs. The reliability of method was also assessed

Materials and Method: The crown and root lengths of teeth were measured by a digital caliper on panoramic radiographs of 185 individuals except for the third molars. A total of 1994 teeth was studied and 50.8% of the teeth belonged to males and 49.2% belonged to females. The modified Lind method was applied

Results: The highest mean root-crown ratios in both arches of both genders were obtained in the second premolars, followed by the first premolars and canines. In both genders, the lowest root-crown ratios were found in the maxillary central incisors. In male patients, the mean root-crown ratio was higher [p= 0.003] than that of females. Using Bland-Altman analysis, a non-significant difference of 0.006 [95% CI: -0.012-0.024] and 0.0002 [95% CI: -0.011-0.011] were found for intra-observer and inter-observer agreement, respectively

Conclusion: Assessment of the root-crown ratio in permanent dentition could be performed on panoramic radiographs with acceptable reproducibility in an Iranian Population. Considering observed differences, our findings suggest that for the accurate assessment, this ratio must be calculated for male and female patients and also for the upper and lower jaws, separately

Assessment of radiopacity of restorative composite resins with various target distances and exposure times and a modified aluminum step wedge

PURPOSE: ANSI/ADA has established standards for adequate radiopacity. This study was aimed to assess the changes in radiopacity of composite resins according to various tube-target distances and exposure times. MATERIALS AND METHODS: Five 1-mm thick samples of Filtek P60 and Clearfil composite resins were prepared and exposed with six tube-target distance/exposure time setups (i.e., 40 cm, 0.2 seconds; 30 cm, 0.2 seconds; 30 cm, 0.16 seconds, 30 cm, 0.12 seconds; 15 cm, 0.2 seconds; 15 cm, 0.12 seconds) performing at 70 kVp and 7 mA along with a 12-step aluminum stepwedge (1 mm incremental steps) using a PSP digital sensor. Thereafter, the radiopacities measured with Digora for Windows software 2.5 were converted to absorbencies (i.e., A=-log (1-G/255)), where A is the absorbency and G is the measured gray scale). Furthermore, the linear regression model of aluminum thickness and absorbency was developed and used to convert the radiopacity of dental materials to the equivalent aluminum thickness. In addition, all calculations were compared with those obtained from a modified 3-step stepwedge (i.e., using data for the 2nd, 5th, and 8th steps). RESULTS: The radiopacities of the composite resins differed significantly with various setups (p<0.001) and between the materials (p<0.001). The best predicted model was obtained for the 30 cm 0.2 seconds setup (R2=0.999). Data from the reduced modified stepwedge was remarkable and comparable with the 12-step stepwedge. CONCLUSION: Within the limits of the present study, our findings support that various setups might influence the radiopacity of dental materials on digital radiographs.

How does duration of curing affect the radiopacity of dental materials?

PURPOSE: Clinicians commonly encounter cases in which it is difficult to determine whether adjacent radiopacities are normal or pathologic. The ideal radiopacity of composite resin is equal to or higher than that of the same thickness of aluminum. We aimed to investigate the possible effects of different curing times on the post-24-hour radiopacity of composite resins on digital radiographs. MATERIALS AND METHODS: One mm thick samples of Filtek P60 and Clearfil resin composites were prepared and cured with three regimens of continuous 400 mW/cm2 irradiance for 10, 20 and 30 seconds. Along with a 12-step aluminum step wedge, digital radiographs were captured and the radiopacities were transformed to the equivalent aluminum thicknesses. Data were compared by a general linear model and repeated-measures of ANOVA. RESULTS: Overall, the calculated equivalent aluminum thicknesses of composite resins were increased significantly by doubling and tripling the curing times (F(2,8)=8.94, p=0.002). Notably, Bonferroni post-hoc tests confirmed that the radiopacity of the cured Filtek P60 was significantly higher at 30 seconds compared with 10 seconds (p=0.04). Although the higher radiopacity was observed by increasing the time, other comparisons showed no statistical significance (p>0.05). CONCLUSION: These results supported the hypothesis that the radiopacity of resin composites might be related to the duration of light curing. In addition to the current standards for radiopacity of digital images, defining a standard protocol for curing of dental materials should be considered, and it is suggested that they should be added to the current requirements for dental material.

New predictors for advanced retinopathy of prematurity among neonates in Tehran/Iran

Since a new epidemic [third wave] of retinopathy of prematurity [ROP] sensed throughout the world in recent years, we aimed to assess newer risk factors for advanced ROP which needs treatment in Iranian neonates as a new target output of various neonatal care for this serious disease of newborn infants especially those born prematurely. In an analytic cross-sectional study all neonates <1500 g birth weight and/or <32 weeks gestational age admitted to our NICU as a tertiary level intensive care unit in Milad Hospital, Tehran, Iran during June 2006-June 2007 were included. All data were extracted from medical records and compared in two groups with or without treatment. Seventy one neonate infants entered our study. Twelve neonates [16.9%] progressed to advanced ROP. Final multivariate analysis model revealed that mean leukocyte counts during first 14 days of life [P=0.04], transfusions number [P=0.01] and hypocapnic episodes during first 14 days of life [P=0.02] were significantly different between the two groups of infants independently, even after simultaneous adjustment. Based on our findings, more amenable risk factors should be approached regarding more careful modulation of such overlooked risk factors which may lessen the burden of prematurity

Evaluation of the possible antioxidative role of bilirubin protecting from free radical related illnesses in neonates

There are disparate data regarding whether bilirubin is protective or toxic during free radical related illness among neonates. Seventy one infants with gestational age [GA] of<32 weeks and/or birth weight [BW] of<1500 g, who survived beyond 4 weeks and completed physical examinations were enrolled in this study. The infants were divided into two groups based on the presence or absence of advanced retinopathy of prematurity [ROP], grade III intraventricular hemorrhage [IVH], grade III necrotizing enterocolitis [NEC], respiratory distress syndrome [RDS], bronchopulmonary dysplasia [BPD], sepsis or severe fungal infection [SFI]. The mean of total serum bilirubin [TSB] of the first 14 days of life were measured and compared between these two groups. A significant lower TSB were found in severe form of ROP [P<0.001], grade III NEC [P=0.008], grade III IVH [P=0.021], SFI [P=0.003] and sepsis [P=0.007] in comparison to mild or disease free status. Moreover, the cut-off point of 5.1 mg/dl for the mean of TSB had the sensitivity of 88.1% and specificity of 84.6% to detect severe grades of ROP. Also the cut-off point of 3.25 mg/dl had 97.2% sensitivity and 100% specificity in order to distinguish SFI. It is concluded that bilirubin may play an antioxidant role in vivo as in vitro; and protect preterm infant against these free radical related disorders. Our findings suggest that not only the upper limits of serum bilirubin, but also the lower limits must be taking into account in order to both preventing from neurotoxic effects and free radical based illnesses, respectively

Effect of acidulated phosphate fluoride [APF] on the microleakage of composite flow and fissure sealant restorations

A large number of investigations have revealed that physical and chemical alterations and weight loss could occur in composite materials exposed to acidic phosphate fluoride [APF] gel. The purpose of this study was to assess the microleakage of a fissure sealant and a flow composite exposed to acidulated phosphate fluoride [APF] gel. In this in vitro study, 60 intact human extracted premolar teeth were used. After preparing the occlusal groove, the teeth were divided into two groups [n=30]. Teeth were filled with either Helioseal fissure sealant [Vivadent, Germany] or Tetric flow composite [Vivadent, Germany]. After that, each group was divided into two subgroups [n=15]: 1.23% APF gel [Sultan, U.S.A] was applied in the case subgroups, while control subgroups were preserved in normal saline solution. All of teeth were covered with 2 layers of nail varnish except for the filling zone and 1mm around the border of filling. After submerging in 0.5% fushin solution, specimens were sectioned bucco-lingually. Then dye penetration through the filling and fissure sealant was assessed by means of a stereo-microscope. The depth of dye penetration was scored. The data were analyzed using One-way ANOVA and Levene test. The mean values of dye penetration were 1.26 +/- 1.09, 1.4 +/- 1.05, 1.2 +/- 1.37, and 1.4 +/- 1.35 for fissure sealant+gel, composite+gel, composite+normal saline, and normal saline groups, respectively. No significant difference was found in inter-groups [P=0.96]. Considering the result of the present research, APF gel had no significant effect on the microleakage of Tetric flow composite filling and Helioseal fissure sealant and thus, it can be applied for routine usage

potential of honey to promote wound healing in periodontology: a pilot randomized clinical trial

Honey has been used as a nutraceutical in many traditional and ancient remedies. Considering well documented benefits of honey to accelerate wound healing, for the first time we aimed to assess intra oral surgical wound healing process with honey. We designed a pilot randomized placebo controlled cross-over clinical trial. Patients who required bilateral Modified Widman Flap [MWF] surgery randomly assigned to receive either 15 cc topical Persian Thymus Vulgaris concentrated honey three times a day or normal saline as placebo with the same amount at the site of the surgery for seven consecutive days. After a 35-day wash-out period the study groups were crossed. The primary efficacy outcome was changes in healing index [Landry index] and the secondary efficacy outcome were changes in gingival and plaque indices [Loe and Sillness, Sillness and Loe indices]. It also includes safety issues consisting of any allergic reaction, delayed healing or wound dehiscence. Ten patients enrolled with the mean age of 36 [ +/- 1.5] ranged between 35-40 yrs. There was a significant improvement in wound healing considering time and treatment effects in both groups, although faster wound healing observed in honey treated patients [P<0.001]. In both groups gingival indices were noticed to be improved by the time during the first phase of the study. Both groups displayed aggravated Plaque formation; nevertheless it was merely statistically significant in the control group [F [3, 27] =12.88, P value < 0.001]. All wounds healed normally and no adverse events recorded. Our study established the safety, efficacy and feasibility of topical honey to promote periodontal surgical wound healing. [IRCT138901192547N2]