Evaluation of Glass-Ionomer versus Bulk-Fill Resin Composite: A Two-Year Randomized Clinical Study.

Background: The aim of this split-mouth design research was to compare the clinical performance of a glass-ionomer cement system on Class I/II cavities against the clinical performance of bulk-fill resin composite restoration materials. Methods: Thirty-five patients were randomized and enrolled in the study, aged between 10 and 12 years, all of whom had a matched pair of permanent mandibular carious molars with similar Class I/II. A total of 70 restoration placements were performed. The patients were each given two restorations consisting of either a glass-ionomer cement with a nano-filled coating or a bulk-fill resin composite after the use of a self-etch adhesive. The cumulative survival rates were estimated using log-rank test and the Kaplan−Meier method. For comparison of the restorative materials in line with the modified Ryge, the McNemar test and the Wilcoxon signed rank test were employed. Results: With regard to retention, the glass-ionomer cement system and bulk-fill resin composite performed similarly in permanent molars in Class I/II cavities over a period of up to 24-months (p > 0.05). Over the 24-month period, Class I restorations showed statistically better survival rates than Class II restorations (p < 0.05). In the case of glass-ionomer cement systems, over the two-year period, more common chipping and surface degradations were observed. Conclusions: The glass-ionomer cement system and bulk-fill resin composite restorative materials display good clinical performance over a period of 24-months.

Caries-Preventive Effect and Retention of Glass-Ionomer and Resin-Based Sealants: A Randomized Clinical Comparative Evaluation.

Background: Deep fissures are highly unprotected from the development of caries. Resin-based materials and glass-ionomer cements for sealing fissures are useful in caries control through physical barrier formation, which prohibits metabolic exchange between fissure microorganisms. Retention is one of the most critical properties of fissure sealants. This in vivo study is aimed at comparing and evaluating the clinical efficacy of resin and glass ionomer-based fissure sealants on first permanent molars with follow-ups at 6-, 12-, and 18-month intervals. Methods: A randomized split-mouth design clinical study was conducted after obtaining the ethical committee approval. A total of 50 patients, aged between 7 and 12 years, were randomized and enrolled in the study to perform a total of 200 sealant placements on all four caries-free and hypoplasia-free first permanent molars having deep fissures, which are susceptible to caries, were included in this study. The four permanent molars were divided into the following four groups: group A (control), B (Grandioseal, Voco, Germany), C (Smartseal & Loc, Detax Gmbh & Co, Germany), and D (Fuji triage capsule, GC, Belgium). The sealed molars were clinically evaluated at intervals of 6, 12, and 18 months to assess sealant retention, surface roughness, marginal coloration, and caries status through visual evaluation of the sealant by two evaluators. Results: Concerning retention, there were statistically significant differences between the sealants in terms of the survival of partial and fully retained sealants as well as in the survival of caries-free teeth. Two resin-based (Smartseal & Loc) and glass-ionomer cement (Fuji triage) sealants showed significantly similar performances in permanent molars for up to 18 months. In terms of retention, one of the resin-based (Grandioseal) sealants performed better as compared to the others and showed better caries prevention in deep fissures. Conclusion: It is concluded that both the sealants had comparable retention and caries-preventive effects in 7 to 12-year-old children and can be considered as suitable sealants for a period of at least 18 months in moderate caries risk patients.

Long-term Dental Anomalies after Pediatric Cancer Treatment in Children

Objective: The aim of this study is to determine the frequency of dental anomalies (DAs) (microdontia, hypodontia, hyperdontia, enamel defect, root malformation) in pediatric cancer patients at the ages <5 years and between 5 and 7 years, and understand their relationship with the received therapy. Materials and Methods: Pediatric patients who were diagnosed with cancer and treated before the age of 7 years were investigated in a case- control design. The study included 93 pediatric patients whose ages at diagnosis were between 9 months and 7 years and whose treatments were completed before 5-8 years. Group A consisted of patients in the age range of 9 months to 4 years and Group B consisted of patients in the age range of 5-7 years. Seventy-two siblings with compatible dental age ranges were included in the control group. For both groups, intraoral examinations were performed and panoramic radiographs were taken. Results: Among the 93 pediatric patients, the mean age was 9.54±1.25 (range: 8-13 years) and 48 (51.6%) patients were male. The most common diagnosis was hematologic malignancy with a rate of 65.5%. At least one DA was detected in 7 (9.7%) individuals of the control group and in 78 (83.9%) of the patient group. While the patients in the study group had all kinds of DAs, those in the control group had only enamel defects. The rates of microdontia (p=0.077) and hypodontia (p=0.058) were detected to be significantly higher in Group A than in Group B. Root malformation was more common in patients receiving chemotherapy and radiotherapy than in those receiving only chemotherapy (p=0.006). Conclusion: In this study it was found that the pediatric patients who received cancer treatment before the age of 7 years constituted a high-risk group for DAs. The frequencies of microdontia and hypodontia were increased even more when the patient was treated for cancer before 5 years of age.

Plaque Accumulation and Inflammation Adjacent to Restorations of Amorphous Calcium Phosphate-containing Composite in Early Childhood Caries.

PURPOSE: To evaluate the clinical, biochemical, and microbiological reactions to nanocomposite containing amorphous calcium phosphate (ACP) in comparison to a traditional composite restorative material in early childhood caries. MATERIALS AND METHODS: Eighteen teeth were restored with the test material (ACP-containing resin) and 18 teeth were restored with the control material (traditional composite, TC) in fourteen paediatric patients using a split-mouth design. One caries- and restoration-free intact tooth in each patient was selected as the healthy control. Gingival crevicular fluid (GCF) and supragingival plaque samples were collected at baseline before the treatment and also on days 1, 7, 14 and 30 after treatment. Unstimulated whole saliva samples were obtained from each patient at baseline, and 1 and 6 months after restoration. GCF and saliva samples were assayed for IL-17A, IL-17F IL-17A/F, IL-17E, OPG and RANKL levels by ELISA, and plaque composition was assessed using RT-PCR. RESULTS: Clinical evaluation indicated no statistically significant differences between the two restorative materials according to the FDI criteria surface lustre, material retention and marginal adaptation properties. Pro-inflammatory IL-17 levels decreased statistically significantly at 6 months compared to baseline and 1-month values (p < 0.05). The baseline pro-inflammatory IL-17 cytokine levels in GCF samples around the carious teeth were higher than those obtained around the healthy teeth (p < 0.05), but similar in GCF from the ACP-test and TC teeth. Microbiological findings were similar in the ACP and T groups. CONCLUSION: It may be suggested that both ACP-containing and traditional resin composites show similar antimicrobial and biochemical effects in early childhood caries.

Color assessment after bleaching with hydrogen peroxide versus ozone: a randomized controlled clinical trial.

This randomized controlled clinical trial evaluated the color change of teeth bleached with either hydrogen peroxide (HP) or ozone (OZ). A total of 26 patients with a mean age of 36.2 years (SD, 8.7 years) who met the inclusion criteria were enrolled in the study. The subjects were randomly assigned to receive chairside bleaching using 40% HP or gaseous OZ. Maxillary dental arch vacuum trays were constructed with circumferential openings in the middle portion of the maxillary incisors at their labial surfaces. These trays were used for measuring color-first at baseline and then immediately and 48 hours after postbleaching-and were not used in bleaching. Changes in color were determined using CIE L*a*b* coordinates. Analysis of the data revealed that, while overall color change (ΔE*) values of the HP and OZ groups did not show statistically significant differences immediately after bleaching (P = 0.114), ΔE* values were significantly different 48 hours postbleaching (P = 0.00). Visible color changes were not obtained with either HP or OZ immediately postbleaching. The greatest visible color change occurred with HP 48 hours postbleaching.

Does casein phosphopeptid amorphous calcium phosphate provide remineralization on white spot lesions and inhibition of Streptococcus mutans?

OBJECTIVE: The aim of this study was to evaluate the remineralization effect of Casein Phosphopeptid Amorphous Calcium Phosphate (CPP-ACP) on white spot lesions (WSL) and its inhibitory effect on Streptococcus mutans colonization. STUDY DESIGN: The study group consisted of 60 children exhibiting at least 1-WSL. Subjects were randomly divided into 2 groups: a test group of using CPP-ACP cream (Tooth Mousse, GC Europe N.V., Leuven, Belgium) and a control group using only fluoride containing toothpaste for a period of 3-months. Baseline WSLs were scored using DIAGNOdent device (KaVo Germany) and the saliva samples were collected to measure S. mutans counts. After the 3-month period the WSLs were again recorded and the saliva sample collection was repeated. Wilcoxon Signed Ranks Test was used for statistical analysis. RESULTS: DIAGNOdent measurements were increased by time (p = 0.002) in control group and no statistically significant diference (p = 0.217) was found in test group by the 3-month period. In both groups, the mutans counts were decreased in 3-month experimental period. CONCLUSIONS: These clinical and laboratory results suggested that CPP-ACP containing cream had a slight remineralization effect on the WSL in the 3-month evaluation period however longer observation is recommended to confirm whether the greater change in WSLs is maintained.

Antibacterial efficacy of prophylactic ozone treatment on patients with fixed orthodontic appliances.

OBJECTIVE: This study investigated the efficacy of ozone on microflora of patients with fixed orthodontic appliances. MATERIALS AND METHODS: Ten subjects undergoing fixed appliance therapy were enrolled in the study. Before any application, two elastic ligatures were removed with the aid of a sterile probe from the premolar brackets on the upper right and lower left jaws for baseline bacteriological counts. Then ozone gas was applied for 180 s by running the device on prophylaxis mode with included mouth tray according to the manufacturer's recommendations on all brackets. After the ozone application, two other elastic ligatures were removed from the opposite sides of the mouth of the patients. One week after the application two more elastic samples, which were not changed in the previous session, were collected from the upper right and lower left premolar brackets. The elastic ligatures were immersed in transfer solutions and cultured to determine the Streptococcus mutans and Lactobacillus acidophilus. Statistical analysis of the data was obtained by paired Student's t-tests. RESULTS: The ozone treatment reduced the S. mutans and L. acidophilus immediately after the application and these reductions were found to be statistically significant (p = 0.038 and p = 0.020). Both the S. mutans and L. acidophilus values increased by the 1-week period and the S. mutans values were significantly higher than the baseline values (p = 0.01). CONCLUSION: It can be concluded that the ozone treatment may have an instantaneous lethal effect on S. mutans and L. acidophilus; however, within the limitations of this study, a long-term preventive effect could not be observed.

Biocompatibility of glass ionomer cements with and without chlorhexidine.

OBJECTIVE: The aim of the present study is to evaluate the biocompatibility of glass ionomer cements (GICs) with and without chlorhexidine (CHX) as well as coated with varnish or not using in vitro cytotoxicity test. MATERIALS AND METHODS: Biocompatibility of Fuji IX, Fuji IX with varnish, Fuji IX with 1% CHX diacetate and Fuji IX with 1% CHX diacetate with varnish was determined with in vitro cytotoxicity assay by using L929 mouse connective tissue fibroblasts. After 72 h, cell viabilities were evaluated by MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] assay to determine the effects of the cements on the mitochondrial function and microscopic images were taken by scanning electron microscopy. RESULTS: Statistical analysis was performed by one-way analysis of variance followed by the Bonferroni post-hoc test at a significance level of P < 0.05. 72 h after treatment, there were statistically significant differences between Fuji IX and Fuji IX-CHX (P < 0.001). In addition, the reduction of the cytotoxicity by coating the GICs with varnish was indicative and increased the cell viability ratio (P < 0.001). CONCLUSIONS: Fuji IX coated with varnish was found to be the most biocompatible one among others. Thus adding CHX significantly reduced the cell viability, it is assumed that, due to the leakage of CHX and the other components of the GICs to the cell culture medium, the cell viabilities were decreased, so it is highly recommended to use varnish not only to reduce the water loss from the GICs, but also to reduce the cytotoxicity of the GICs.

Effect of orthodontic appliances on oral microbiota--6 month follow-up.

OBJECTIVE: This study investigates the effect of fixed and removable orthodontic appliances among children on salivary Streptococcus mutans, Lactobacillus sp. and Candida albicans. STUDY DESIGN: The study was conducted on 69 patients aged between 6-17 years who used fixed or removable orthodontic appliances. Five ml samples of unstimulated saliva from each patient were collected at baseline and at the 1, 3 and 6 month periodic controls. Samples were diluted and plated on Mitis Salivarus Agar (MSA), Man Rogosa Sharp Agar (MRS) and Saboroud Dextrose Agar (SDA). The growths on the plates were examined under a stereomicroscope. Numbers of colony forming units (CFU) per plate were counted. For statistical analysis, the paired t test and Chi-Square were used. RESULTS: S mutans and Lactobacillus sp counts increased significantly 6 months after the insertion of fixed/removable orthodontic appliances in the oral cavity. A significant increase for C albicans presence was noted after 3 months compared with baseline for fixed appliances. CONCLUSION: Long-term utilization of orthodontic appliances may have a negative effect on microbial flora and increase the risk of new carious lesions and periodontal problems. Patients should be recalled within short time intervals to be motivated for oral hygiene during their orthodontic therapy.

Comparison of conventional versus colored compomers for class II restorations in primary molars: a 12-month clinical study.

OBJECTIVE: To evaluate the 12-month clinical performance of conventional (Compoglass F) and colored (Twinky Star) compomer restorative materials in class II restorations of primary molars. MATERIALS AND METHODS: A total of 196 restorations were placed in 98 children aged between 5 and 10 years (mean age: 7.43 +/- 1.31 years) who had bilateral matched pairs of carious posterior class II primary molars. A split-mouth design was used in which 2 materials (Compoglass F, Twinky Star) were randomly placed on contralateral sides by 3 dentists. At baseline, after 6 and after 12 months, the restorations were evaluated using modified US Public Health Service criteria for: secondary caries, marginal integrity, marginal discoloration, anatomic form and surface texture. The Alpha and Bravo scores were considered as clinical success. The data were subjected to statistical analysis by the Wilcoxon and McNemar tests (p < 0.05). The Kaplan-Meier survival method was applied to estimate survival percentages. RESULTS: No significant difference was found among the groups at all recalls regarding marginal integrity, marginal discoloration, anatomic form, secondary caries and surface texture. The 12-month mean cumulative survival rate of Compoglass F was 95.7%, while in the Twinky Star group, the survival rate was 93% in class II restorations with no significant difference between the groups for either material. CONCLUSION: Both conventional and colored compomer materials are suitable restorative materials for primary teeth for at least 12 months. Colored compomers could also be a good alternative to tooth-colored compomers in the restoration of primary molars.

Monomer Release from Resin Based Dental Materials Cured With LED and Halogen Lights.

OBJECTIVES: To measure the release of TEGDMA and BisGMA from two commercially available composite resins; Filtek Z 250 (3M ESPE, Germany), Leaddent (Leaddent, Germany) and two fissure sealants; Helioseal F (3M ESPE, Germany) Enamel Loc (Premiere Rev, USA) over 1, 3 and 7 days after polymerization with standard quartz-tungsten halogen Coltolux II (QHL) (Coltene Switzerland) and a standard blue light emitting diode Elipar Freelight 2 (3M ESPE, Germany). METHODS: 9 samples of each material were placed in disc shaped specimens in 1 mm of thickness and 10 mm in diameter (n=36). Each material was polymerized using LED for 20 s (n=12), 40 s (n=12) and halogen for 40 s (n=12), respectively. High Performance Liquid Chromatography (HPLC) was used to measure the amount of monomers released over 1, 3 and 7 days. Data was analyzed using one way ANOVA and Bonferroni test for multiple comparisons with a significance level of .05. RESULTS: LED 20 sec group showed the highest release of monomers at 1, 3 and 7 days in sealant groups. Halogen 40 sec group resulted highest release of monomers for Leaddent at all time intervals (P<.05) CONCLUSIONS: Efficiency of the curing unit and applying the recommended curing time of the light activated resin based dental materials is very important to protect the patient from potential hazards of residual monomers.

Bond strength of different dentin bonding systems to fluorotic enamel.

PURPOSE: The effect of three different bonding strategies on the shear bond strength of a resin composite to fluorotic enamel surfaces was investigated. MATERIALS AND METHODS: Thirty-six noncarious extracted human molars with fluorosis and 36 without fluorosis were scraped clean from any remaining tissue, and then were divided into three subgroups according to the tested dentin bonding systems. The resin composite was bonded to the teeth using three different adhesive systems: Peak LC Bond with an etch-and-rinse technique (Ultradent Products), Peak LC Bond with a self-etching technique using Peak SE Primer (Ultradent Products), and Xeno V (Dentsply Caulk) using a one-bottle self-etching technique. Following the photopolymerization of the resin composites, thermocycling was performed 5000 times. Shear bond strengths were tested using the Shimadzu Universal Testing Machine until failure. The analysis of the fractured enamel surfaces was performed using an optical microscope (Nikon ECLIPSE ME 600) at 10X and 1000X magnification, and the images were analyzed with an image analyzer (LUCIA 4.21). The data obtained were analyzed with two-way ANOVA and the Bonferroni test at a significance level of p < 0.05. RESULTS: Mean shear bond strengths in MPa of the groups were: Peak LC Bond, self-etching, on fluorotic enamel 13.23 +/- 2.58 and on nonfluorotic enamel 17.81 +/- 2.90; Peak LC Bond, etch-and-rinse, on fluorotic enamel 16.77 +/- 2.32 and on nonfluorotic enamel 21.13 +/- 2.74; one-bottle self-etching Xeno V on fluorotic enamel 10.79 +/- 2.14 and on nonfluorotic enamel 14.58 +/- 2.99. CONCLUSION: Fluorosis adversely affected the bonding performance of all the bonding systems to enamel. The use of the etch-and-rinse dentin bonding technique produced higher bond strengths of the resin composite tested to fluorotic and nonfluorotic enamel compared to both self-etching techniques.

Supernumerary primary tooth with facial and palatal talon cusps: a case report.

Talon cusp is a tooth anomaly originating from the tooth's lingual surface in most cases. To date, very rare cases have been reported documenting talon cusps both on the facial and palatal surface of an affected tooth in the dental literature. The purpose of this case report was to describe the facial and palatal talon cusps on an ectopic supernumerary primary maxillary tooth. A micro-CT investigation indicated no pulpal extensions within facial and palatal talon cusps.

Dental management of a patient with oculo-facio-cardio-dental syndrome.

Oculo-facio-cardio-dental (OFCD) syndrome is an X-linked dominant syndrome characterized by congenital cataract, microphtalmia, secondary glaucoma, long narrow face, high nasal bridge, pointed nose with cartilages separated at the tip, cleft palate, atrial septal defect (ASD), ventricular septal defect (VSD), radiculomegaly, delayed eruption, oligodontia, and persistence of primary teeth. The aim of this report is to indicate the importance of early diagnosis and management of oculo-facio-cardio-dental syndrome.

Multidiciplinary treatment of complicated subgingivally fractured permanent central incisors: two case reports.

Subgingival crown fractures with pulp exposure in permanent teeth present both endodontic and restorative problems with unfavorable prognosis. Numerous restorative techniques such as resin composite restorations with and without pins, crowns and reattachment of the fractured dental fragment could be listed as the treatment options. There are several successful cases in the literature where advantages of less microleakage and proper gingival biocompatibility in cases with reattachment of the tooth fragment were reported. Two cases of palatinal subgingival crown fractures are reported. Both had been restored by reattachment of the fragment and composite with the help of the flap surgery. Follow up visits (Case 1 for 4 years and Case 2 for 1 year) revealed satisfactory esthetics and function.

Long-term antibacterial effects and physical properties of a chlorhexidine-containing glass ionomer cement.

STATEMENT OF THE PROBLEM: Many regions in the world do not have electricity, water, or access to dental facilities that allows the treatment of caries with dental handpieces and rotary burs. For restorative techniques used in these regions, an antibacterial self-adherent glass ionomer material would contribute considerably. PURPOSE: This study aimed to test if chlorhexidine diacetate (Fluka BioChemika, Buchs, Switzerland)- or chlorhexidine digluconate (Sigma-Aldrich, Steinheim, Germany)-added ChemFil Superior glass ionomer cement (Dentsply DeTrey, Konstanz, Germany) had any long-term antibacterial effect against certain oral bacteria and to test the new formulation's physical properties. MATERIALS AND METHODS: ChemFil Superior was used as a control. Chlorhexidine diacetate (powder) was added to the powder and chlorhexidine digluconate (liquid) was mixed with the powder in order to obtain 0.5, 1.25, and 2.5% concentrations of the respective groups. Setting time, compressive strength, and acid erosion were tested according to ISO 9917-1. Working time, hardness, diametral tensile strength, and biaxial flexural strength were also determined. Long-term antimicrobial activity against S. mutans, L. acidophilus, and C. albicans were tested with the agar diffusion method. Analysis of variance (ANOVA) was used for comparison (p < 0.05). RESULTS: Regarding the immediate antibacterial effect for S. mutans, all the tested groups showed inhibitions of the strain compared with the control group (p < 0.05), with larger zones for the higher concentration groups and all the diacetates. For L. acidophilus, all the groups were effective compared with the control, but the greatest antibacterial effect was observed with the 2.5% diacetate group. The 2.5% group of chlorhexidine diacetate showed antibacterial activity up to 90 days against S. mutans and up to 60 days against L. acidophilus. The working and setting time, acid erosion test, diametral tensile strength, and biaxial flexural strength of the tested groups were not different from the control ChemFil group. However, the 1.25 and 2.5% groups of chlorhexidine diacetate had significantly lower compressive strengths than the control group. Lower hardness values were obtained with the 0.5 and 2.5% chlorhexidine digluconate groups in comparison with the control group. CLINICAL SIGNIFICANCE: The results of this in vitro investigation demonstrated that chlorhexidine diacetate or digluconate added to the ChemFil Superior glass ionomer material can exhibit long-term antibacterial effects against S. mutans and L. acidophilus without compromising the physical properties of the material.

Bond strength of glass-ceramics on the fluorosed enamel surfaces.

OBJECTIVES: Effect of different adhesive luting systems on the shear bond strength of IPS Empress 2 ceramic restorations to fluorosed enamel surface was investigated. METHODS: Forty-eight ceramic discs (2 mm x 3 mm; IPS Empress 2) were fabricated. Twenty-four non-carious extracted human molar teeth with fluorosis and 24 without fluorosis were cleaned with pumice using a plastic brush and then they were divided into two main groups. The IPS Empress 2 ceramic discs were luted to the teeth of four subgroups with two different adhesive luting systems, Variolink 2/Excite DSC (etch-and-rinse) and Clearfil Esthetic Cement/ED Primer II (self-etch), thermocycling was performed 5000 times. Shear bond strengths were tested using Shimadzu Universal Testing Machine until failure. An optical microscope and image analyzer were used at 10x and 1000x magnification to analyze the surfaces for adhesive, cohesive and mixed failure percentages. Data was analyzed with one-way ANOVA and Tukey test at a significance level of p<0.05. RESULTS: Mean shear bond strength data of the groups in MPa were; Variolink 2/Excite DSC on fluorosed enamel: 18.3+/-3.08, Variolink 2/Excite DSC on non-fluorosed enamel: 18.79+/-2.65, Clearfil Esthetic Cement/ED Primer II on fluorosed enamel: 8.43+/-2.45, Clearfil Esthetic Cement/ED Primer II on non-fluorosed enamel: 13.53+/-1.68. Mixed failure was the most prevalent type of failure in moderate fluorosed and non-fluorosed teeth with etch-and-rinse dentin bonding system, and in fluorosed teeth with self-etch dentin bonding system. CONCLUSIONS: The use of an etch-and-rinse adhesive luting procedure produced higher bond strengths of glass-ceramics bonded to fluorosed and non-fluorosed enamel surfaces than the self-etch bonding system.

Effects of light curing method and exposure time on mechanical properties of resin based dental materials.

OBJECTIVES: The aim of this study was to investigate microhardness and compressive strength of composite resin (Tetric-Ceram, Ivoclar Vivadent), compomer (Compoglass, Ivoclar, Vivadent), and resin modified glass ionomer cement (Fuji II LC, GC Corp) polymerized using halogen light (Optilux 501, Demetron, Kerr) and LED (Bluephase C5, Ivoclar Vivadent) for different curing times. METHODS: Samples were placed in disc shaped plastic molds with uniform size of 5 mm diameter and 2 mm in thickness for surface microhardness test and placed in a diameter of 4 mm and a length of 2 mm teflon cylinders for compressive strength test. For each subgroup, 20 samples for microhardness (n=180) and 5 samples for compressive strength were prepared (n=45). In group 1, samples were polymerized using halogen light source for 40 seconds; in group 2 and 3 samples were polymerized using LED light source for 20 seconds and 40 seconds respectively. All data were analyzed by two way analysis of ANOVA and Tukey's post-hoc tests. RESULTS: Same exposure time of 40 seconds with a low intensity LED was found similar or more efficient than a high intensity halogen light unit (P>.05), however application of LED for 20 seconds was found less efficient than 40 seconds curing time (P=.03). CONCLUSIONS: It is important to increase the light curing time and use appropriate light curing devices to polymerize resin composite in deep cavities to maximize the hardness and compressive strength of restorative materials.

Combined apexification and orthodontic extrusion of a hypoplastic permanent canine.

Localized infection in the primary teeth was reported as an etiological factor in the formation of a hypoplastic defect in the underlying permanent teeth. The purpose of this report is to present the case of a 10-year-old girl with an unusual local hypoplasia in the mandibular left permanent canine and emphasize the importance of multidisciplinary management, including combined apexification and orthodontic extrusion. The 12-month recall examination revealed no pathology associated with the rehabilitation, and the patient's esthetic and functional expectations were satisfied.

The oral health status of children undergoing hemodialysis treatment.

In this study, we investigated the oral status of children suffering from end-stage renal disease (ESRD) with the aim of determining the causes of low caries prevalence in this population (using the CRT bacteria and buffer test), and compared results with a control group (n=38). In the study group, there were 38 children (aged 4-17 years) who were being treated in pediatric nephrology units at three different hospitals in Izmir, Turkey. The study and control groups did not significantly differ in daily tooth brushing frequency and periodic dental check-up frequency. Severe enamel hypoplasia was present in the study group. Dmft, DMFT, gingival and plaque indices were compared statistically in mixed dentition stage with the control group and dmft and gingival status showed a statistically significant difference (p<0.05). The differences among groups for DMFT and plaque indices were not statistically significant. In the study group, high salivary buffer capacity was found in 89.5% of patients. Salivary levels of cariogenic streptococcus mutans and lactobacilli in the study group were significantly lower than in the control group. In conclusion, probably due to increased concentrations of antibacterial chemicals such as urea in the saliva of children with ESRD, decreased levels of cariogenic microorganisms were detected. Therefore, although dental treatment need is not high, these children should receive dental health education, including oral hygiene instruction, in order to improve their overall oral health.