Knowledge and Attitudes towards Medical Emergencies among Dentists in Iași, Romania.

The aim of this study was to evaluate the level of knowledge of resident dentists and new graduates regarding the etiology, clinical diagnosis, and treatment of the main medical emergency conditions. The study included a sample of 152 new graduates and residents in the first, second, and third year of training in Prosthodontics and General Dentistry from the Faculty of Dental Medicine in Iasi, Romania. Their level of knowledge and the attitudes were assessed using a questionnaire with 24 questions, divided into four sections. The differences among groups were identified using the chi-square test (p < 0.05). A high level of knowledge was found among the three groups of subjects for the questions regarding the recognition of clinical signs in hypoglycemic crisis (88-100%), in anaphylactic shock (83.3-94.5%), and the treatment of angina pectoris (76.2-84.2%). In contrast, a low level of knowledge was found for the questions regarding pulse evaluation in the case of an emergency (26.3-35.7%), the parameters of normal breathing (28.9-43%), and the treatment of hypoglycemic crisis (27.8-44.8%). The study indicated that the dentists had a moderate understanding of dental office medical emergencies and preferred practical training over theoretical courses.

The Evaluation of the Cervical Marginal Sealing of Direct vs. Indirect Composite Resin Restorations in MOD Cavities.

INTRODUCTION: The aim of this in vitro study was to compare the quality of marginal sealing at the cervical margins of indirect and direct composite resin restorations in mesio-occluso-distal (MOD) cavities. MATERIAL AND METHOD: MOD preparations were performed on 30 extracted teeth. The mesial cervical margin of each tooth was relocated using a flow composite resin (Enamel Plus HRi Flow, Micerium, Avegno, GE, Italy), then the samples were divided into three groups. In group A, the cavities were directly restored using a nanohybrid composite resin (Miris 2 Coltène Whaledent, Altstaetten, Switzerland) and a universal adhesive (ScotchBond Universal, 3M ESPE, St. Paul, MN, USA) by the etch-and-rinse strategy, for group B, the restoration procedure was similar but the self-etch strategy was used, and the samples in group C were filled using the inlay technique. Each sample was stored for 48 h in a 2% methylene blue solution, then it was cut in a mesio-distal direction using a Struers Secotom 50 device (Cleveland, OH, USA). The marginal sealing and adhesive interface were assessed for each sample at the cervical margin by optical microscopy (OM) and scanning electron microscopy (SEM). One-way ANOVA and Bonferroni post-hoc tests were used with a significance level of 0.05. RESULTS: Significant differences were recorded within groups A and C, between mesial and distal margins (p = 0.02 in group A and p = 0.043 in group C). CONCLUSIONS: The marginal sealing is more effective in MOD inlay restoration compared to direct restorations. Relocation of the cervical margin with flow composite resin and the use of different adhesive strategies do not improve the marginal sealing.

The Influence of Chlorhexidine Gluconate Dentine Pre-Treatment on Adhesive Interface and Marginal Sealing.

Background and Objectives: The aim of this in vitro study was to evaluate the combined effect of a 2% chlorhexidine aqueous solution and a universal adhesive system applied in self-etch and etch-and-rinse strategies on the composite resin-dentin interface. Materials and Methods: Class V cavities were prepared on the facial and lingual surfaces of forty caries-free molars extracted for orthodontic reasons. The samples were randomly divided into two groups corresponding to the used etching protocol: I-etch-and-rinse; II-self-etch. In each tooth, one cavity was assigned for the control subgroups -IA (n = 20) and IIA (n = 20)-adhesive only, and the opposite cavity was pretreated with a 2% chlorhexidine solution-Gluco CHeX Cerkamed-subgroups IB (n = 20) and IIB (n = 20). Both sets of groups were restored using a universal adhesive system (Single Bond Universal Adhesive, 3M-ESPE) and a bulk-fill composite resin (Filtek One Bulk Fill Restorative, 3M-ESPE). The roots and the pulp tissue were then removed, and a needle connected to a perfusor with 100 mL saline solution was used for pulp pressure simulation with a hydrostatic pressure of 20 cm H2O. Cariogenic attack was simulated using a demineralizing solution for 3 days at a constant temperature of 25 °C. The teeth were then sectioned in a facial-lingual direction and the microleakages at the occlusal and cervical margins were registered and scored using an optical Carl-Zeiss AXIO Imager A1m microscope (Carl-Zeiss). The composite resin-dentin interface was analyzed using a SEM Vega Tescan LMH II. Statistical analysis was performed using the Kruskal-Wallis test with a significance level of p < 0.05. Results: Microleakage evaluation showed no significant differences among the study groups (p > 0.05). In subgroup IA, significant differences were recorded between occlusal and cervical margins (p < 0.05). Conclusions: Application of chlorhexidine on tooth substrate before using a universal bonding system in total etch or self-etch mode has no influence on the adhesive interface in the condition of cariogenic attack. The thickness of the adhesive resin layer seems to be less uniform when using chlorhexidine, but the morphological differences at the adhesive interface have no influence on the sealing capacity of the universal bonding system, regardless of the etching strategy.

In Vitro Evaluation of Gastric Acid and Toothbrushing Effect on the Surface State of Different Types of Composite Resins.

Background and Objectives: The aim of this in vitro study was to evaluate the effect of gastric acid associated with the effect of toothbrushing on the surface roughness of different types of composite resin used for direct restorations. Materials and Methods: The materials used in this study were two microhybrid (Filtek Z250, Herculite XRV) and two nanohybrid (Filtek Z550, Herculite XRV Ultra) composite resins. Two hundred and forty cylindrical samples with a height of 2 mm and a diameter of 6 mm were divided into four groups (groups A, B, C and D) corresponding to each tested material (n = 60). Each group was divided in two subgroups: subgroup I-the samples were submersed in hydrochloric acid and immediately submitted to toothbrushing; subgroup II-the samples were submitted only to toothbrushing. The simulation of the acid attack was performed by immersing the samples in a 0.01 M hydrochloric acid solution for 90 min. This procedure was followed immediately by toothbrushing simulation with 10,000 cycles. The acid attack and toothbrushing simulation were performed for two times. The surface roughness evaluation was performed with a Proscan 2100 profilometer. Repeated Measures ANOVA and Bonferroni post-hoc tests were used to perform the statistical analysis. Results: Simulation of one year of toothbrushing associated or not to hydrochloric acid exposure increases the surface roughness of microhybrid and nanohybrid composite resins. Six months of toothbrushing associated to six months of hydrochloric acid exposure increase the surface roughness of nanohybrid composite resins. Conclusions: Microhybrid composite resins surface becomes rougher after toothbrush and acid submersion when comparing to nanohybrid composite resins.

Host Response Modulation Therapy in the Diabetes Mellitus-Periodontitis Conjuncture: A Narrative Review.

The inflammatory response of the host in periodontitis is the phenomenon that underlies the onset and evolution of periodontal destructive phenomena. A number of systemic factors, such as diabetes mellitus (DM), can negatively affect the patient with periodontitis, just as the periodontal disease can aggravate the status of the DM patient. Host response modulation therapy involves the use of anti-inflammatory and anti-oxidant products aimed at resolving inflammation, stopping destructive processes, and promoting periodontal healing, all important aspects in patients with high tissue loss rates, such as diabetic patients. This paper reviews the data available in the literature on the relationship between DM and periodontitis, the main substances modulating the inflammatory response (nonsteroidal anti-inflammatory drugs, sub-antimicrobial doses of doxycycline, or omega-3 fatty acids and their products, specialized pro-resolving mediators), as well as their application in diabetic patients.

Atomic force microscopy study regarding the influence of etching on affected and sclerotic dentine.

UNLABELLED: Aim of study is to compare the effect of etching with ortho-phosphoric acid on sound dentine, affected dentine and sclerotic dentine through AFM analysis. MATERIAL AND METHODS: The group study included 30 extracted third molars, 20 with acute and chronic carious lesions and 10 intact teeth. Teeth were sectioned in long axe to prepare sections with carious lesions surrounded by sound dentine. The sound teeth were sectioned to a depth of dentine comparable with carious lesions depth. The sections were etched with 37% ortho-phosphoric acid. The surface roughness was determined initially and after etching using AFM analysis. The results were expressed as relative variation of squared roughness. RESULTS: The values of relative roughness indices were between 2.78 and 3 for sclerotic dentine, 3.18 and 3.26 for sound dentine, 3.32 and 3.38 for affected dentine. The highest values of roughness index were recorded for the affected dentine samples. Significant statistically values were recorded when comparing relative roughness indices for sclerotic dentine with relative roughness indices for affected dentine and sound dentine. CONCLUSIONS: clerotic dentine has significant higher resistance to the action of ortho-phosphoric acid than affected dentine and sound dentine. The lowest resistance to the action of etching agent was recorded for the affected dentine.

[The influence of hygroscopic expansion on nanohybrid composite restorations]. / Influenta expansiunii higroscopice asupra restaurarilor realizate cu un compozit nanohibrid.

UNLABELLED: Hygroscopic expansion of resin materials is a common phenomena due to water adsorption into the resin matrix. This expansion is dependent upon the chemical structure of the material. Water sorption of resin dental material may contribute to stress release immediately after polymerization shrinkage has occurred. The aim of this study was to evaluate the influence of water storage on nanohybrid composite by assessment of marginal enamel sealing of restorations. MATERIAL AND METHOD: 30 human teeth extracted for periodontal or orthodontic reasons were used in these study. Cavities were prepared and restored using a nanohybrid composite (Ceramix Mono, Dentsply DeTrey) and a total-etch adhesive system (Prime&Bond NT, Dentsply DeTrey). The teeth were then randomly divided in three groups which were stored for various times in deionized water (one hour, 24 hours and 7 days). After the storage period, the teeth were immersed in methylen blue 1% for 24 h. Then specimens were axially cut and the dye penetration within the occlusal enamel interface was evaluated using optic microscope. RESULTS: Kruskal-Wallis test showed significant differences of dye penetration between the long-term hydrated groups and the group hydrated for only one hour (p < 0.05). The mean value of dye penetration decreased from 0.04 mm to 0.1 mm after water storage for both 24 hours and 7 days. However, good sealing in enamel margins of restorations was observed even without hydration. CONCLUSION: Our results confirm that nanohybrid composites used with total etch adhesives systems have good ability to seal the enamel margins and water sorption can improve this sealing.

[Study regarding coronal fracture probability in posterior amalgam restorations]. / Studiul privind evaluarea probabilitatii de fractura coronara la restaurarile din amalgam pe dintii laterali.

Despite minimal invasive orientation in restorative dentistry, in Romania the necessary for extensive restorative treatment in posterior teeth is still high. The silver amalgam still remains a social treatment option for such situation. The purpose of this study was to analyze the efficiency of a new method for analytical determination of the volume of restoration in posterior teeth, knowing that the risk for coronal fracture depends on the size of restoration. The study correlated the results obtained through this method with the real values (mathematically determined) of restorations and the anatomical crowns volumes in order to assess the risk fracture. Amalgam restorations of different types and sizes were placed in 24 extracted premolars and molars. A good global correlation was observed between the true and calculated value (98.321%). The best correlation was observed for MOD restorations (93.042%) while the worst coefficient was obtained for MO restorations (83.378%). The medium restorations presented o correlation of 99.288% and the extensive restorations had an index around 96.957%. This method is based on physics principles and objective measurement resulting in a good correlation with the real dimensions of cavities. Therefore it could be used to assess the risk of crown fracture in teeth with amalgam restorations.

[The influence of polymerization method on the mechanical properties of dental resins composites]. / Influenta modului de polimerizare asupra proprietatilor mecanice ale materialeleor compozite.

UNLABELLED: The aim of the study was to asses the influence of the time, method and type of light curing on the compressive strength of dental composites. Dental composite resin (T-Econom, Ivoclar Vivadent) was cured for 10, 30 or 40 sec. with either a commercial conventional halogen light curing unit (LCU)--Hilux, (Benliodlu Dental Inc), or a light emitting diode (LED), LCU-Bluedent LED Smart. The compressive strengths were determined after 72 h on samples 3 mm in diameter and 7 mm high using FPZ 100/1 device. RESULTS: The samples cured with LED LCU for 40 seconds in pulse mode showed the smallest values of compressive strength (245 MPa), while those cured with LED LCU for 40 seconds in ramp mode reached the highest values (295 MPa). Similar values for compressive strength were found for the samples polymerized with conventional halogen LCU and the samples cured with LED LCU in constant mode (283 MPa and 285 MPa, respectively). CONCLUSIONS: Compressive strength depends on the light type and method. Tested LED curing light seems to induce similar compressive strengths as the halogen-based light. Using this conventional light curing unit requires at least 40 seconds of exposure in order to achieve adequate compressive strength. The LED light curing unit should be used in the ramp mode for at least 40 sec, followed by 10 sec in fast mode in order to achieve the best results.

[Evaluation of caries activity using the micro-crystallization saliva index (IMK)]. / Evaluarea activitatii bolii carioase cu ajutorul indicelui de microcristalizare salivara.

The dental decay activity of a patient can be evaluated with the help of certain indirect signs that reveal the dental decay risk elements. The quantity, buffer capacity, inorganic components of the saliva are important in the pathogenesis of dental decay. The micro-crystallization saliva test (IMK) may represent an important criterion on whose basis one obtains an evaluation of the re-mineralization capacity of saliva. The purpose of this study consisted in the calculation of the IMK index on a lot of patients and its correlation to the type of dental decay activity. The study was conducted on a lot of 30 patients with ages between 18 and 45, nursed and examined every 6 months during 18 months. The attention was focused on the following parameters: the index of micro-crystallization (IMK) and the dental decay activity, calculated as rate of appearance of new dental lesions within 18 months. As a result of investigations, the authors observed the following correlations to dental decay activity: the patients with IMK = 1/0.6 did not have any new dental lesion, in the patients with IMK = 0.6/0.4 new dental lesions appeared within 12-18 months and in the patients with IMK = 0.4/0 new dental lesions appeared in less than 6 months after examination. The IMK index--indicator of the re-mineralization capacity of saliva, may be evaluated using a relatively simple methodology, accessible and at a moderate price. Research pointed out that this index may be an useful instrument when evaluating the dental decay susceptibility of patients, contributing to the identification of the dental decay risk and consecutively to the choice of individualized prophylactic and therapeutic procedures.

[Use of biopolymer membrane diplen-F in treatment of initial enamel carious lesion on smooth surfaces]. / Utilizarea membranelor biopolimerice diplen-F în tratamentul leziunilor incipiente de smalt de pe suprafetele netede.

The aim of the study was to evaluate the possibility of using a fluoride product included in a biodegradable membrane in remineralization of initial enamel carious lesions. The membrane has anti-bacterial, anti-inflammatory and remineralization properties, with a long-term effect. The efficiency of this treatment was assessed by measuring the surface of the demineralization area and its depth. The results proved that the use of this membrane in association with remineralization therapy of the initial enamel carious lesions increase the chances of success and represents a simple solution easily accepted by the patients.

[Effect of saliva contamination on microleakage around class-5 cavities restored with three different types of adhesive materials]. / Influenta contaminarii cu saliva asupra percolarii cavitatilor de clasa A V-A restaurate cu trei tipuri de materiale adezive.

The recent improvement of adhesive materials should decrease the risk related to saliva contamination. The aim of this study was to evaluate the effect of saliva contamination on the microleakage within class V cavities restored with three different types of materials: conventional glass ionomer cement, composite resin and compomer. 30 human extracted teeth were randomly divided in 3 equal groups. In each group, class V cavities were prepared on both facial and lingual surfaces (but joint for glass ionomer cement and bevelled incisal margin for composite resin and compomer). The lingual cavities were contaminated with saliva prior to restoration, while the facial cavities were not contaminated, serving as control. After water storage for 24 hours, teeth were immersed in 1% methylene blue solution for 24 hours. The axial sections were viewed under an optical microscope and the extent of dye penetration along cervical, axial and incisal margins was measured in millimetres. Statistic analysis showed that under salivary contamination, microleakage increased along the cervical margin of restoration for all three tested materials. Saliva contamination resulted in microleakage within the axial wall of the cavity only for the conventional glass ionomer cement. These data indicate that composite resin and compomer used together with new adhesives seem to be less sensitive to saliva contamination compared to conventional materials. However, under saliva contamination, cervical microleakage cannot be completely prevented and proper isolation should still be mandatory.