Assessment of the biointeractivity of a novel vital pulp therapy agent derived from eggshell biowaste: An in vitro study.

This study aimed to assess the calcium (Ca2+) and hydroxyl (OH-) ion-releasing ability, namely the biointeractivity of eggshell-derived hydroxyapatite (ESDHA) in comparison with mineral trioxide aggregate (MTA) and calcium hydroxide (CH). ESDHA, MTA and CH samples (n = 10; 8 × 1.6 mm) were immersed in 10 mL of deionised water (37°C, pH 6.8). Ca2+ and OH- ion releases were detected in 1, 7 and 21 days. Scanning electron microscopy and Fourier transform infrared spectroscopy analyses were also conducted. IBM SPSS 20.0 was used for statistical analyses. The cumulative Ca2+ ions (56.22 ± 11.28 ppm) were detected as most significant in ESDHA (day 21; p < 0.05). The OH- ion values of the ESDHA group were statistically higher than MTA and CH (days 1 and 7; p < 0.05). ESDHA and CH showed a similar pattern with sharp peaks in Ca2+, oxygen and carbon elements. ESDHA being a sustainable material with a high ion-releasing ability may be a preferable alternative to the commercial vital pulp therapy agents.

Evaluation of the knowledge level of pediatricians on dental trauma and their awareness of the ToothSOS mobile application: A cross sectional study.

BACKGROUND/AIM: Pediatricians play an essential role in managing pediatric oral emergencies; hence, they should have accurate information on dental injuries. This study aimed to assess the knowledge level of pediatricians regarding traumatic dental injuries (TDI) and their awareness of the ToothSOS mobile application. MATERIALS AND METHODS: A survey comprising 10 questions was created on Google forms, and the links were sent to the participants via electronic mail and a mobile application. The demographic characteristics and the knowledge level of pediatricians about TDI and their awareness of the ToothSOS mobile application were evaluated. The questions were prepared by following similar studies and the current guidelines of the International Association of Dental Traumatology. RESULTS: A total of 229 pediatricians (74.2% female) participated in this study. The correct answer rates revealed statistical differences in terms of profession and experience on the following issues: the most frequently traumatized tooth, the preference of the antibiotic agent, and the management of avulsed primary tooth (p < .05). The decision to consult a dentist revealed statistical differences in the profession (p = .001). The correct answers on the correlation between the age group and dental trauma accompanied by soft tissue injuries showed statistical differences in experience (p = .005). Although none of the participants knew the ToothSOS application, 91.7% of them preferred using this tool in future practices. This rate was statistically higher in participants with an experience of more than 10 years (p = .013). CONCLUSIONS: The knowledge level of pediatricians regarding dental trauma was found to be sufficient, except for the questions on avulsion injuries. However, the fact that the participants were unaware of the ToothSOS mobile application was the most considerable result of the study, and this finding highlighted the importance of informing pediatricians dealing with oral injuries regarding the latest updates on dental traumatology.

In vitro caries-preventive effect of a mineralization-promoting peptide combined with fluoride gel on sound primary teeth.

BACKGROUND: Mineralization-promoting peptide-3 (MPP3) is a new biomimetic remineralization agent. AIM: To assess the remineralization efficiency of MPP3, either alone or in combination with fluoride gel. DESIGN: The samples were divided into four groups: control, 1.23% fluoride gel, 10% MPP3 gel, and 1.23% fluoride gel + 10% MPP3. Following the application of remineralization agents (4 min), the samples remained in a pH-cycling model (37°C, 4 weeks). Microhardness, microcomputed tomography (micro-CT), polarized light microscopy (PLM), and field emission scanning electron microscopy (FE-SEM) analysis were conducted. RM-ANOVA, one-way ANOVA, and intraclass correlation coefficient (ICC) were used for statistical analysis, and a significance level of p < .05 was employed. RESULTS: Mineralization-promoting peptide 3 and fluoride gel + MPP3 increased the microhardness of the enamel compared with initial values in each group (p < .05). Mineralization-promoting peptide 3 successfully maintained the mineral density of enamel, although the cariogenic pH-cycling and PLM results indicated that the lesion depth (µm) was significantly lower in the fluoride gel + MPP3 group (27.0336 ± 12.53650) than in the control group (37.3907 ± 12.76002, p < .05). CONCLUSION: The combined use of MPP3 with fluoride gel enhanced the caries-protective and mineralization-promoting effects of fluoride. Mineralization-promoting peptide 3 may be a potential agent that can be employed to improve the physical properties of enamel.

YouTube™ as a source of parents' information for craniosynostosis.

OBJECTIVE: This study aimed to evaluate the content, reliability and quality levels of YouTube™ videos regarding craniosynostosis for parents' information. METHODS: A keyword search for 'craniosynostosis' was conducted on YouTube, and the uniform resource locators of the first 160 videos were initially recorded and evaluated. Ninety-four videos that met the inclusion criteria were analysed. Each video received a score ranging from 0 to 9 points, classifying them as low-content (0-3), moderate-content (4-6) and high-content (7-9). The reliability scores adapted from DISCERN and Global Quality Scale (GQS) scores were recorded. RESULTS: The median content score for the videos was 4. According to the content scores, 34% of included videos (n = 32) were classified as low-content, 60.6% (n = 57) as moderate-content, and 5.3% (n = 5) as high-content. The median reliability score for the videos was 3, and the median GQS score was 3. The reliability and quality levels of videos classified as high-content and moderate-content were significantly superior to low-content videos (P < .05). Laypersons were identified as the most frequent source of information in the videos. However, most of the videos lacked information about syndromic/non-syndromic forms and specific complications. The importance of early referral/timing of surgery and minimally invasive surgical treatment techniques was mentioned in all high-content videos. CONCLUSION: The results of the present study suggest that YouTube™ in its current format, is not a fully trustable source for parents seeking information on craniosynostosis. Craniofacial units must increase the content, quality and reliability level of videos on craniosynostosis.

The effect of aging on the mechanical properties of 3-dimensional printed biocompatible resin materials used in dental applications: An in vitro study.

INTRODUCTION: The mechanical properties of biocompatible printable resin materials in an intraoral environment is still being investigated. This study aimed to assess the effect of the aging process on the mechanical properties of resin samples produced by stereolithography appearance (SLA) and digital light processing (DLP) 3-dimensional printer systems. METHODS: The cylindrical sample (4.00 × 20.00 mm) was designed by software, and the data were transformed into digital format. A DLP printer (n = 40) and an SLA printer (n = 40) carried out the printing process. The aging procedure was applied to 20 samples from each group using a thermocycling device. After the aging procedure, the samples were placed in the universal testing device for the 3-point bending test. RESULTS: This study showed that the aging procedure decreased maximum load, bending stress, and Young's modulus values and increased maximum deflection values of the DLP group (P <0.01). However, no statistical difference was detected in the parameters compared with the SLA group except for the maximum deflection values. Furthermore, statistically significant differences were found between maximum deflection and Young's module values of SLA and DLP control and study groups (P <0.05). CONCLUSIONS: This in vitro study revealed that the biocompatible printable resin materials produced by DLP and SLA printers had the mechanical strength to resist the values resembling the physiological occlusal forces even after the aging procedure and could produce intraoral appliances.

Comparing the physical and mechanical properties of different biocompatible three-dimensional resin materials in possible use of dental appliances: An in vitro study.

OBJECTIVE: This study aimed to assess the colour stability, water sorption, microhardness and water contact angle of two different 3D printing systems (SLA and DLP) in a possible use of producing paediatric and orthodontic dental appliances. MATERIALS AND METHODS: SLA and DLP printer systems produced a total of 160 disk samples with a diameter of 15.00 mm and a height of 2.00 mm. Colour changes of 64 samples were assessed in distilled water, coffee, coke and cherry juice and Vicker's microhardness tests were also conducted. Solubility and water sorption were held following the water contact angle assessment. Statistical analyses were performed using the SPSS software. Mann-Whitney-U test, Friedman test and Bonferroni post hoc Multiple Comparison Test were performed. RESULTS: In DLP and SLA groups, coffee had a statistically significant colouring effect regarding the assessment periods (P = .001, 20.09 ± 2.96, 22.09 ± 3.51, respectively), and the discolouration effect of coffee was higher in the SLA group at all endpoints (P < .05). At the same time, DLP was more affected by coke solution in T0-T1 and T0-T7 (P < .05). The values of water sorption showed statistically significant differences in the group of DLP compared to the SLA (P = .01, 121.11 ± 10.54, 92.78 ± 8.70, respectively). No statistical significance was detected between the solubility values and water contact angle of SLA and DLP groups. The SLA printer's microhardness values revealed statistically significantly higher values than the DLP group (P = .001) and a decrease was detected following the immersion period in the microhardness values of the SLA group (P = .022). CONCLUSION: The compared groups exposed to staining solutions revealed colour changes above the clinically acceptable values at all periods (ΔE00 = 2.25).

Anti-microbial efficiency of gaseous ozone's combined use with fluoride and chlorhexidine on time-related oral biofilm: an in situ study on pediatric patients.

Oral biofilm formation is the main reason for both caries progression and soft tissue diseases. Preventing the formation and promotion of biofilm has been known as the first attempt to prevent the development of caries and soft tissue problems in the oral cavity. The present study aimed to assess the effect of ozone and its combined use with chlorhexidine (CHX) and fluoride on the complex biofilm formation of pediatric patients under in situ conditions. Extracted bovine teeth were sterilized and cut into 2 × 3 mm2 sections. The samples were placed in removable maxillary plates and 10 healthy individuals (6 boys, 4 girls; aged 7-14 years) were asked to wear these plates for 6, 24 and 48 hours. Afterwards, the tooth samples were removed, and anti-plaque agents were applied to the time-related plaque formation. Plaque thickness and viable bacterial percentages were detected by confocal laser scanning microscopy. All materials used in the study decreased the plaque formation and the percentage of viable microorganisms compared with the control group (physiological saline). In 6- and 24-hour biofilm evaluations, ozone-CHX was the most effective group in decreasing the plaque thickness (P > 0.05). Ozone-CHX and Ozone-Fluoride groups were found to be better in 48-hour biofilm assessments in caries-free group (P > 0.05). Ozone-CHX group showed a better inhibitory effect on the viability of microorganisms in 6-, 24- and 48-hour biofilm formations (P < 0.05). Although CHX has been known as the gold standard for inhibiting the oral biofilm formation, according to the results of the study, gaseous ozone and its combined use with CHX have shown better results in reducing the biofilm thickness and viable bacterial percentages of in situ formed time-related biofilm formation in pediatric patients. The use of gaseous ozone can be preferred in clinical conditions in pediatric patients instead of the CHX agents.

Effects of a mineralization-promoting peptide on the physical and chemical properties of mineral trioxide aggregate.

Mineral trioxide aggregate (MTA) has been used widely in dentistry due to its sealing ability and biocompatibility. Delayed setting time is one of the major limitations of MTA. Various additives have been studied to further improve the properties of MTA with varied degrees of success. In this study, we have investigated the effect of a calcium phosphate mineralization promoting-peptide (MPP3) on the physical and chemical properties of MTA in comparison with Na2HPO4. Based on the reported effects of MPP3 on calcium-phosphate mineralization reaction, our hypothesis was that MPP3 may also show beneficial effects on the calcium-silicate mineralization system of MTA. Na2HPO4 was used for comparison since its setting accelerant effect on MTA has been well documented. The cements were prepared by mixing with distilled water, 0.40 mM MPP3 solution, 15% Na2HPO4 solution, and a combination of MPP3 and Na2HPO4 solution. Initial and final setting times were measured via Vicat needle. Microhardness values were measured via Vickers indenter at 1,3,7, and 28 days after hydration. Compressive strength after setting was measured via universal testing machine. Morphological and compositional analyses were performed via FESEM imaging, XRD and Raman spectroscopy. The microhardness data was evaluated via repeated-measures ANOVA. Setting time and compressive strength data were evasluated via one-way ANOVA. Initial setting time was reduced to ∼3 min in the Na2HPO4 containing groups but remained at ∼5 min in the control and MPP3 groups. Final setting times were significantly reduced in all groups compared to the control group. The reduction in the final setting times in the Na2HPO4 containing groups were significantly higher compared to the MPP3 group. Microhardness was significantly higher in the MPP3 group at all time points. No statistically significant difference in compressive strength was observed among the groups. FESEM analysis showed presence of ettringite crystals in the MPP3 group, and NaBiO3 crystals in the Na2HPO4 containing groups. XRD analysis showed a broadening of peaks at 2θ = 32° in the Na2HPO4 containing groups, possibly due to presence of NaBiO3. Raman spectroscopy showed statistically higher ettringite content in the MPP3 containing groups. Our findings indicate that MPP3 is a beneficial additive to eliminate some of the drawbacks associated with MTA with no detrimental effects on mechanical properties and without resulting in phases that potentially cause discoloration, such as NaBiO3. We propose that the reduced final setting time and increased microhardness by MPP3 may be associated with the increased ettringite content. Future studies, where wider range of MPP3 concentrations are studied may help elucidate and optimize the beneficial effects of MPP3 observed in this study.

Pemphigoid of the pulmonary system (POPS): A review of a less recognized feature.

This review of Pemphigoid of the Pulmonary System (POPS) is a comprehensive description of pulmonary involvement in patients with mucous membrane pemphigoid (MMP), which is an orphan autoimmune blistering disease. The objective of the review was to analyze clinical features of pulmonary involvement in MMP. This POPS review is a case series in which multiple search engines were utilized from inception to June 2022 for cases of MMP with biopsy and immunopathology proven tracheal and bronchial pemphigoid. Clinical profiles prior to pulmonary involvement, bronchoscopy findings, clinical course and therapy were recorded and cause of death was analyzed. Patients with documented MMP who developed tracheal, bronchial and pulmonary involvement were included in the POPS review. Histology and immunopathology documentation were essential diagnostic criteria. Comparison groups were not possible. Patients were treated with immunosuppressive therapy. Some required surgical interventions. Six of the 11 patients attained complete or partial remission on or off therapy. Five patients died from pulmonary complications. The POPS review had six females and five males. The mean age at onset was 20 years (range 4-76), while 80% of the patients were under 40 years. All had severe widespread MMP involving three to five mucosal tissues. 100% had oral, 82% had ocular and cutaneous involvement. Pulmonary involvement occurred at 24 mo (range 2-372) after the onset of MMP. Bronchoscopy revealed acute inflammation during active disease and scarring of the trachea and bronchi in the later stages. Systemic infections occurred in 45%, while pulmonary infection occurred in 36%. Mortality due to respiratory failure, at the median age of 20 years (range 18-76), occurred in 45% of the patients, and was considered disease related. In spite of the young age, while there are some similarities in the clinical profile and response to systemic therapy, there are definitive differences from other patients with MMP. Early diagnosis with appropriate management could produce better clinical outcomes and prevent mortality in this orphan disease. Consequently, there is a critical need for early identification and diagnosis of POPS.

YouTube™ for information on paediatric oral health instructions.

INTRODUCTION: Parents and caregivers of paediatric patients usually tend to search for health information on social networks and other online platforms. At this point, the quality and reliability of these sources play an essential part in maintaining the oral health of paediatric patients. AIM: The recent study aimed to analyse the reliability, quality and content of YouTube™ videos on paediatric oral health instructions; assess the efficacy of these videos; and help health providers lead the parents accessing accurate information on the subject mentioned. DESIGN: The searching term was detected as 'children oral health' (Google Trends Application). The first 150 videos were taken into the study. Six excluding criteria were used, and 40 videos have lasted for the further examinations. Content headings were determined according to the AAPD guidelines on paediatric oral health. The content analysis scores, reliability scores and Global Quality Score were calculated for each of these 40 videos. SPSS 26 statistical software was used in the statistical analysis process of the data; p < 0.05 was considered statistically significant. RESULTS: The recent study results showed that according to content analyses, the videos were classified as 'poor' content with the mean values 4.07 (±1.32). The mean reliability score 2.96 (±0.69) has shown that the reliability of the videos was moderate. Mean Global Quality Score values were 2.95 (±0.73), which means the subjects were moderate quality. The mean reliability of the rich content videos (3.39 ± 0.59) and the Global Quality Score of them (3.43 ± 0.62) were statistically higher compared to the average values of the poor content videos (respectively; 2.73 ± 0.64; 2.69 ± 0.66) (p < 0.05) The average number of likes, dislikes, length, interaction index and viewing rate of rich content videos were higher than the same features of poor content videos (p < 0.05). The videos with rich content were determined in the first 50 videos listed for analyses, and the distribution of the included videos on the list was equally. CONCLUSION: The present study concluded that the YouTube™ videos providing oral health instructions for paediatric patients and their parents had poor content, medium quality and reliability. Although all the listed content headings were not mentioned in the videos, the content of them still may be useful and educational for individuals. However, dental hygiene practitioners and dentists should be aware of the need in this area and put more effort into improving the YouTube™ videos on children's oral health in a more detailed way regarding content headings, quality and reliability.

Does the heat generated by fluorescence-aided caries excavation system effect the pulp temperature of primary teeth irreversibly? An in-vitro evaluation of the temperature changes in the pulp chamber.

BACKGROUND: This study aimed to analyze the effect of the Fluorescence Aided Caries Excavation (FACE) and the remaining dentin thickness on the temperature changes of the pulp chamber. MATERIAL AND METHODS: Freshly extracted deciduous molars and a pulpal microcirculation model were used in the study. The sample size was calculated according to power analyses (power at 90%) based on previous studies. Thus, 40 samples were needed. Standard cavities (3x3 mm) were designed to obtain a 2 mm distance through to the pulp chamber, and in each tooth (n=10), these cavities were modified to obtain 1.5 mm, 1mm, and 0.5 mm final distance through to the pulp. Coronal parts of the teeth were placed on an acrylic plate with three gaps for feeding and extraction needles and the thermocouple. The temperature changes were recorded from the initial time to 15 s and 30 s,1 min, 1.5 min, 2 min, 2.5 min, 3 min intervals. RESULTS: The results showed that hence the thickness between cavity floor and pulp chamber was decreased, and application time of FACE was increased, an increase in temperature changes was detected. However, the recorded values were not mean to cause irreversible damages to the pulp chamber. CONCLUSIONS: The recent study showed that Face is an appropriate caries detecting system that does not affect the pulp chamber's health, and it can be safely used in the primary teeth. Key words:Caries assessment, dental caries, dental pulp, pediatric dentistry.

IgM Deficiency in Autoimmune Blistering Mucocutaneous Diseases Following Various Treatments: Long Term Follow-Up and Relevant Observations.

IgM deficiency has been reported in patients with many autoimmune diseases treated with Rituximab (RTX). It has not been studied, in detail, in autoimmune mucocutaneous blistering diseases (AIMBD). Our objectives were: (i) Examine the dynamics of IgM levels in patients with and without RTX. (ii) Influence of reduced serum IgM levels on clinical and laboratory parameters. (iii) Explore the possible molecular and cellular basis for reduced serum IgM levels. This retrospective study that was conducted in a single-center from 2000 to 2020. Serial IgM levels were studied in 348 patients with five AIMBD (pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, mucous membrane pemphigoid, and ocular cicatricial pemphigoid) and found decreased in 55 patients treated with RTX, IVIG, and conventional immunosuppressive therapy (CIST). Hence the incidence of decreased serum IgM is low. The incidence of decreased IgM in patients treated with RTX was 19.6%, in patients treated with IVIG and CIST, it was 52.8% amongst the 55 patients. IgM levels in the post-RTX group were statistically significantly different from the IVIG group (p<0.018) and CIST group (p<0.001). There were no statistically significant differences between the groups in other clinical and laboratory measures. Decreased serum IgM did not affect depletion or repopulation of CD19+ B cells. Patients in the three groups achieved clinical and serological remission, in spite of decreased IgM levels. Decrease in IgM was isolated, since IgG and IgA were normal throughout the study period. Decreased IgM persisted at the same level, while the patients were in clinical remission, for several years. In spite of persistent decreased IgM levels, the patients did not develop infections, tumors, other autoimmune diseases, or warrant hospitalization. Studies on IgM deficiency in knockout mice provided valuable insights. There is no universally accepted mechanism that defines decreased IgM levels in AIMBD. The data is complex, multifactorial, sometimes contradictory, and not well understood. Nonetheless, data in this study provides novel information that enhances our understanding of the biology of IgM in health and disease.

Evaluation of calcium (Ca2+) and hydroxide (OH-) ion diffusion rates of indirect pulp capping materials.

INTRODUCTION: The aim of this study was to evaluate and compare the calcium (Ca2+) and hydroxide (OH-) ion release of 4 artificially produced pulp capping materials (MTA, Biodentin, TheraCal LC, Calsimol) used for indirect pulp capping treatment. METHODS: In total, 70 freshly extracted human third molar teeth were used for the study. Cavities of extracted teeth were prepared by round burs. The remaining dentin thickness (1 ± 0.3 mm) tissue was measured by a micrometer and cone beam computerized tomography. Indirect pulp capping was performed in the cavities using Calcimol, MTA, TheraCal LC and Biodentin. The leached Ca2+ were measured using optical emission spectrometry and the release of OH- ions using a pH meter. The measurements were performed after 24 hours, 7 days and 28 days in saline solution. Statistical analysis was performed using 1-way and 2-way analysis of variance (ANOVA) tests (p<0.05). RESULTS: Ca2+ ions were detected in treated saline solution during the experimental period for all materials. All the measurements of Biodentin and Theracal LC levels for Ca2+ ions were higher than those of the other materials (p<0.05). For all materials, Ca2+-ion release increased during the first 7 days followed by a linear decrease during the subsequent study periods. The Biodentine group showed the highest OH- ion rates compared to the other materials in the 24-hour examination period, while the scores gradually decreased during the subsequent measurement periods (p<0.05). CONCLUSIONS: Tricalcium silicate materials such as Biodentine and TheraCal LC used in this study may be preferable for indirect pulp capping because of their stimulation of hard tissue formation and ion-releasing ability.

A Novel Synthetic Route for the Preparation of an Amorphous Co/Fe Prussian Blue Coordination Compound with High Electrocatalytic Water Oxidation Activity.

Co/Fe Prussian Blue coordination networks have recently been investigated for heterogeneous water oxidation catalysis. Despite their robustness and stability in both acidic and neutral media, the relatively low current density obtained is their main drawback as a result of their low surface concentration. A novel synthetic approach was employed using a pentacyanometalate-based metallopolymer for the preparation of amorphous Co/Fe coordination polymers to overcome this problem. The surface concentration was improved approximately 7-fold, which also resulted in an increase in the catalytic activity. A current density of 1 mA·cm(-2) was obtained only at η = 510 mV, while the same current density could be obtained at higher overpotentials (>600 mV) with conventional Prussian Blue analogues. IR, X-ray photoelectron spectroscopy, and energy-dispersive X-ray spectroscopy studies were performed to investigate the stability of electrodes before and after the electrocatalytic process. The results of this study indicate that the rich and diverse chemistry of pentacyanometalates makes them potential candidates for application in heterogeneous water oxidation catalysis.