Repeatability and Reproducibility of a Modified Lekholm and Zarb Bone Quality Classification Based on Cone Beam Computed Tomography: An Observatsion Study.

Aim: We propose a modified Lekholm and Zarb classification that considers all possible combinations of cortical and cancellous bone to provide parameters that favor greater repeatability and reproducibility. Materials and Methods: This observational and analytical study consisted of a sample of 50 cone beam computed tomography (CBCT) scans. Two new types (V and VI), three subtypes to type II (II-A, II-B, and II-C), and two subtypes to type III (III-A and III-B) were added to the original bone quality classification. The new types refer to regenerated bone (type V) and bone with some pathology (type VI). The subtypes are described as type II-A: thick cortical surrounding the abundant cancellous bone with sharp trabeculae throughout the image and presence of small and visible medullary spaces; type II-B: thick cortical surrounding the abundant cancellous bone with predominance of diffuse trabeculae in the basal bone and predominant presence of wide and visible medullary spaces; type II-C: thick cortical surrounding the abundant cancellous bone with predominance of very thick and sharp trabeculae in the basal third as well as presence of small and visible medullary spaces; type III-A: thin cortical surrounding the abundant cancellous bone with sharp trabeculae throughout the image and presence of small and visible medullary spaces; type III-B: thin cortical surrounding the abundant cancellous bone with predominance of diffuse trabeculae and presence of diffuse medullary spaces. Five dental specialists were trained in the use of the modified classification and were provided with CBCT-sectioned images of edentulous jaws for classification. Each specialist classified the images twice at a 7-day interval. The strength of intra-examiner and inter-examiner agreement was measured with Cohen's and Fleiss' kappa index, respectively. In addition, the agreement between both classifications was analyzed. All data were analyzed at a 95% confidence level, considering a P-value <0.05. Results: According to the modified Lekholm and Zarb classification, an almost perfect intra-examiner agreement was significant (P < 0.05) in all five specialists, with the kappa index [k] ranging from 0.91 [95% confidence interval (CI): 0.82-0.99) to 0.95 (95% CI: 0.89-1.00). Furthermore, substantial inter-examiner concordance (k=0.76; 95% CI: 0.73-0.79) was significant (P < 0.05). Conclusion: The high repeatability and reproducibility of the modified Lekholm and Zarb classification on CBCT suggest its applicability to distinguish between the various combinations of cortical and cancellous bone and help to define treatment appropriately to optimize results.

Antifungal Activity of Morinda citrifolia Methanolic Extract against Candida albicans: An In Vitro Study.

Aim: Natural medicine used as an alternative and/or complementary treatment to counteract diseases is of great importance in public health. Therefore, the purpose of the present study was to assess the in vitro antifungal activity of Morinda citrifolia methanolic extract of peel, pulp, and seed against Candida albicans. Materials and Methods: The present study was experimental in vitro and cross-sectional. Eight replicates were prepared in Sabouraud dextrose agar with five wells each, where 0.12% chlorhexidine, distilled water, and methanolic extract of seed, peel, and pulp of Morinda citrifolia fruit were placed at concentrations of 10,690, 8,270, and 6,430 mg/mL, respectively, to evaluate sensitivity according to Duraffourd's scale. In addition, the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) were determined by dilution and agar seeding method. Statistical analysis was performed by analysis of variance (ANOVA) and Tukey's post hoc test, considering a significance level of P < 0.05. Results: The inhibition halos of Morinda citrifolia methanolic extract of seed, peel, and pulp against Candida albicans measured on average 15.94, 11.94, and 11.56 mm, respectively. The MIC of seed, peel, and pulp extract were 1366.25, 2067.5, and 1607.5 mg/mL respectively, whereas the MFC for seed, peel, and pulp extract were 2672.50, 2067.5, and 3215 mg/mL, respectively. Moreover, seed extract presented significantly higher antifungal activity than peel and pulp (P < 0.001). Conclusions: Morinda citrifolia methanolic extract of peel, pulp, and seed showed fungistatic and fungicidal effect against Candida albicans, being this very sensitive to seed extract with a MIC of 1366.25 mg/mL and a MFC of 2672.5 mg/mL, which allows recommending the development of effective pharmacological formulations for the control of candidiasis.

Jawbone quality classification in dental implant planning and placement studies. A scoping review.

Aim: Cone beam computed tomography has become an attractive method for implant planning. However, in most cases, not all the information is taken advantage of and often the radiographic evaluation of bone quality is based on subjective assessment by the individual clinician. Therefore, the aim of this study was to examine classifications of bone tissue characteristics and methods for assessing them in dental implant planning and placement studies. Materials and Methods: Three databases (Pubmed, Scopus, Web of Science) were searched using specific index terms: "Bone quality, bone quantity, bone density, cone-beam CT and cone-beam computed tomography". Three reviewers selected titles and analyzed abstracts according to inclusion and exclusion criteria. Some descriptions of bone tissue characteristics (bone quality, density, and quantity) used before or during dental implant placement were selected and categorized. Results: The search yielded 442 titles. A total of 32 articles were selected and read in full text. Seventeen articles were considered relevant. Different classification systems were found to evaluate bone tissue characteristics as well as different examination protocols. Thirteen publications included in this review reported on bone quality and quantity using the Lekholm and Zarb classification. However, only four studies implemented and/or proposed modifications of the Lekholm and Zarb system. Four other publications described bone quality according to different classification systems such as Misch, University of California Los Angeles (UCLA), or Trisi and Rao. The assessment methods were often briefly described (or not described at all in one publication). Of the articles analyzed, five presented observer performance, whereas three presented diagnostic accuracy of the assessment method. Conclusion: Currently, there are different classification systems applied to dental implant planning and placement, particularly regarding whether bone quality or quantity affects treatment outcomes. However, most authors have not validated the diagnostic accuracy and reproducibility of the classification used. Therefore, it is necessary to develop a classification system consistent with characteristics of bone tissue, taking into consideration an adequate description of bone tissue assessment methods, their diagnostic accuracy, and observer performance.

Tensile Strength and Elastic Modulus of Gutta-percha Cones Disinfected with Sodium Hypochlorite at Different Immersion Times: An In Vitro Comparative Study.

Aim: The tensile strength and modulus of elasticity of gutta-percha cones can be chemically altered due to disinfectant solutions. Therefore, the aim of the present study was to compare tensile strength and elastic modulus of gutta-percha cones subjected to sodium hypochlorite (NaOCl) disinfection at different times. Materials and Methods: This in vitro and longitudinal experimental study consisted of 45 gutta-percha cones, divided equally into three groups: Group 1 (disinfection with 2.5% NaOCl), Group 2 (disinfection with 5.25% NaOCl), and control group. All groups were subdivided according to immersion times for 1, 5, and 10 minutes. Tensile strength and elastic modulus were measured with a universal testing machine. For comparing more than two independent groups, parametric analysis of variance test with Sheffe's post hoc was used and for multivariate analysis, and multivariate analysis of variance test based on Pillai's Trace was used. In all statistical analysis, a significance level P ≤ 0.05 was considered. Results: When comparing the tensile strength of gutta-percha cones, no significant differences were observed after being immersed at 1, 5, and 10 minutes in NaOCl 2.5% (P = 0.715) and 5.25% (P = 0.585). Regarding the elastic modulus, a significant decrease (P < 0.05) was observed in those that were immersed in NaOCl 2.5% and 5.25% for 1, 5, and 10 minutes. Furthermore, increased NaOCl concentration significantly reduced the elastic modulus (P < 0.001). However, there were no significant differences in tensile strength (P > 0.05) and elastic modulus (P > 0.05), when evaluating the interaction between NaOCl concentration and time. Conclusion: Increasing NaOCl concentration significantly reduced the modulus of elasticity without affecting the tensile strength of gutta-percha cones, regardless of immersion time. Furthermore, the interaction of time and NaOCl concentration did not significantly affect the tensile strength and elastic modulus.

Bond Strength and Failure Mode of Glass Fiber Posts with Different Surface Treatments Prior to Silanization: An In Vitro Comparative Study.

Aim: The use of chemical agents in the surface treatment of glass fiber posts can improve their bond strength to the root canal. The aim of this study was to assess the bond strength and failure mode of glass fiber posts that received different surface treatments prior to silanization. Materials and Methods: In this cross-sectional and in vitro experimental study, 50 human lower premolar roots were randomly divided into five groups and subsequently prepared to receive the cementation of a fiberglass post prior to silanization. They were distributed as group 1 (with 24% hydrogen peroxide), group 2 (with 37% phosphoric acid), group 3 (with 1.23% acidulated phosphate fluoride for 2 minutes), group 4 (with 1.23% acidulated phosphate fluoride for 6 minutes), and group 5 (without pretreatment). After cementation, the roots were sectioned into two discs for each cervical, middle, and apical region. Bond strength was assessed using the push out technique. Adhesive, mixed, and cohesive failure modes were also assessed. For data analysis, ANOVA and Tukey's post hoc tests were used, as well as Pearson's chi-square test. A significance of P < 0.05 was considered in all statistical analyses. Results: When comparing the bond strength of root regions, significant differences were obtained in groups pretreated with phosphoric acid (P = 0.018) and acidulated phosphate fluoride for 2 and 6 minutes (P = 0.001 and P = 0.000, respectively). Furthermore, significant differences were obtained between posts treated only with silane and those that received phosphoric acid pretreatment (P = 0.006) and acidulated phosphate fluoride for 6 minutes (P = 0.001). Significant association of mixed failure mode was observed with hydrogen peroxide (P = 0.014) and phosphoric acid (P = 0.006) pretreatments. Cohesive failure was significantly associated with acidulated phosphate fluoride pretreatment for 2 minutes (P = 0.032) and with posts that did not receive treatment prior to silanization (P = 0.000). Conclusion: Posts treated only with silane and pretreated with hydrogen peroxide and acidulated phosphate fluoride for 2 minutes presented significantly higher bond strength with respect to those pretreated with phosphoric acid and acidulated phosphate fluoride for 6 minutes. However, acidulated phosphate fluoride for 2 minutes and silane were associated with a better bonding type.

Predictability and Accuracy of the Short-Form Fonseca Anamnestic Index in Relation to the Modified Helkimo Index for the Diagnosis of Temporomandibular Disorders: A Cross-Sectional Study.

Aim: The aim of this study was to evaluate the predictability and accuracy of the Short-Form Fonseca Anamnestic Index (SFAI) in relation to the modified Helkimo Index for the diagnosis of temporomandibular disorders (TMDs). Materials and Methods: A cross-sectional, prospective, and analytical predictive study was conducted in 240 students of a public institute of higher technological education in Ica, Peru during the months of February to May 2018. The SFAI of 10 closed questions and the Helkimo Index modified by Maglione (gold standard) were used as instruments to diagnose TMDs. For the analysis of concordance between both instruments, Cohen's Kappa Index was applied. To evaluate the association according to gender and age group, Pearson's chi-square test was used. For validity of the SFAI in relation to accuracy, sensitivity and specificity were calculated, and they were verified by receiver operating characteristics (ROC) to determine the best cutoff points (area under the curve [AUC]) considering a P value < 0.05. Regarding the predictability of the SFAI, the positive and negative predictive value was calculated by applying Bayes' theorem. Results: The SFAI was highly significantly associated with the modified Helkimo Index according to gender (P < 0.001), age group (P < 0.001), and overall (P < 0.001) moderate overall agreement (k = 0.416; 95% confidence interval [CI] = 0.287-0.545); better concordance was obtained in individuals older than 20 years (k = 0.490, CI = 0.302-0.679) and women (k = 0.565, CI = 0.371-0.759). The ROC curve analysis of the SFAI showed good accuracy (0.852, CI = 0.800-0.905) and was highly significant (P < 0.001), with an optimal cutoff point of 17.5 and good sensitivity (80.10%) and specificity (74.36%). In addition, a very good positive predictive value (PPV) (94.15%) and a fair negative predictive value (NPV) (42.02%) were obtained. Conclusions: Although there was moderate concordance between the SFAI and the modified Helkimo Index for the diagnosis of TMDs, the SFAI obtained good accuracy in the overall analysis of sensitivity and specificity. In addition, it demonstrated a high predictive efficacy for detecting positive TMD cases, whereas its ability to rule out positive cases was fair.

Microleakage in class II restorations of two bulk fill resin composites and a conventional nanohybrid resin composite: an in vitro study at 10,000 thermocycles.

BACKGROUND: The contraction presented by resin composites causes an increase in stress at the tooth-resin interface, causing micro-gaps that allow microleakage. This study aims to evaluate the degree of in vitro marginal microleakage in class II restorations with two bulk fill resin composites compared to a conventional nanohybrid resin composite. METHODS: The present study was an in vitro experimental design. A total of 30 standardized class II cavities were prepared in 15 human molars (mesially and distally). These cavities were later distributed in 3 groups according to the type of resin. Groups A and B were restored with bulk fill resin composites (Filtek-3 M/ESPE and Tetric N-Ceram-Ivoclar/Vivadent respectively) in a single increment of 4 mm. Group C was restored with the Filtek Z350 XT - 3 M/ESPE resin composite and two increments of 2 mm. Later, the restorations were subjected to 10,000 thermocycles between 5 °C to 55 °C and immersed in a silver nitrate solution (1 M for 24 h). The crowns were then sectioned mesiodistally and observed under the stereomicroscope to determine the degree of marginal microleakage at the occlusal and cervical areas. The results were analyzed with the Kruskal-Wallis and the Mann-Whitney U statistical tests. RESULTS: There were no statistically significant differences regarding the degree of microleakage between the three types of resin composites in the occlusal and cervical areas (p > 0.05). Similarly, there were no significant differences after comparing each resin type in its occlusal and cervical area (p > 0.05). CONCLUSION: Filtek Bulk Fill and Tetric N-Ceram Bulk Fill resin composites showed no statistically significant differences with the conventional nanohybrid resin composite Filtek Z350XT at both occlusal and cervical areas.

Cleaning of endodontic files with and without enzymatic detergent by means of the manual method versus the ultrasonic method: An experimental study.

AIM: The aim of this article is to evaluate the cleanliness level achieved with and without the application of enzymatic detergent for the manual method versus the ultrasonic method, applied to Flexoreamer K-type files No. 25, No. 30, and No. 35. MATERIALS AND METHODS: 192 K-type Flexoreamer files were divided into four categories: A1 (ultrasonic method with enzymatic detergent), A2 (ultrasonic method without enzymatic detergent), B1 (manual method with enzymatic detergent), and B2 (manual method without enzymatic detergent). Each category was randomly distributed in three groups of 16 files each (No. 25, No. 30, and No. 35). The files were used for biomechanical instrumentation of the root canal in premolars. The active part of the files was examined under a stereomicroscope, considering four cleaning levels: 4 (100% cleanliness), 3 (95-99% cleanliness), 2 (85-94% cleanliness), 1 (75-84% cleanliness), and 0 (less than 75% cleanliness). For hypothesis testing, the Mann-Whitney U-test was used to differentiate between techniques, and the Kruskal-Wallis multiple comparison test was used to compare pairs of files within each cleaning method. RESULTS: When using enzymatic detergents, the manual and ultrasonic methods did not show significant differences when comparing each group of the files analyzed (P > 0.05). However, when comparing the cleaning level without enzymatic detergent between the manual and ultrasonic methods, we observed that it obtained a superior result when compared with the manual method for each type of file: No. 25 (P = 0.021), No. 30 (P < 0.001), and No. 35 (P < 0.001). Both methods achieved a significantly higher level of cleaning with the application of the enzymatic detergent (P < 0.05) than without applying it. CONCLUSION: The ultrasonic cleaning method proved to be the most effective method for the removal of biologic waste when compared with the manual method using a nylon brush. However, there was no significant difference between these two methods when enzymatic detergent was used.

Evaluation of Buccal Bone Wall Thickness of Anterosuperior Teeth and Nasopalatine Duct Morphology in Cone Beam Computed Tomography of Patients Living at Different Altitudes: A Two-Year Retrospective Study.

AIM: To evaluate the buccal bone wall thickness of anterosuperior teeth and the dimension and morphology of the nasopalatine duct in cone beam computed tomography (CBCT) of patients treated in two cities at different altitudes. MATERIALS AND METHODS: In this retrospective analytical study, 79 CBCT scans were selected from a total of 347 in Juliaca, Peru (3824 m a.s.l.) and 171 CBCT scans were selected from a total of 622 in Lima, Peru (154 m a.s.l.). The buccal bone wall thickness of anterosuperior teeth was measured at 1 mm, 3 mm, and 5 mm from the alveolar crest. For the nasopalatine duct, its length and diameter were measured, and its anatomical shape was determined in coronal view. Descriptive statistical data such as mean and standard deviation were used, and Mann-Whitney U test was used for bivariate analysis. RESULTS: When comparing the CBCT scans from both cities, significant differences were observed in buccal bone wall thickness at 3 mm and 5 mm from the alveolar crest (P < 0.01 and P < 0.01, respectively); for men, at 1 mm and 3 mm (P = 0.04 and P = 0.04); for the age group from 33 to 47 years, at 3 mm and 5 mm (P < 0.01 and P < 0.01); and for the age group from 48 to 77 years, at 1 mm (P = 0.02). Regarding the nasopalatine duct, significant differences were observed in women in relation to length and nasal opening diameter (P < 0.01 and P < 0.01) and for men, in length (P < 0.01); for the age group from 18 to 32 years, in all three levels (P < 0.01); for the age group from 33 to 47 years, in length and diameter of the oral opening (P < 0.01 and P < 0.01); and for the age group from 48 to 77 years, in length and diameter of the nasal opening (P < 0.01 and P < 0.01). The most frequent nasopalatine duct shape was a single canal with more than 66% of cases, according to sex and age group. CONCLUSION: Patients living at different altitudes presented significant differences in buccal bone wall thickness according to sex and age; however, there were no differences related to dental inclination. Significant differences were found in the length and diameter of the nasopalatine duct at the nasal opening. In addition, the most frequent shape of the nasopalatine duct was the simple canal.

Periapical Lesions and Their Relationship to Schneider's Membrane in Cone-Beam Computed Tomography.

OBJECTIVE: To determine the relationship between the height of the periapical lesions adjacent to the maxillary sinus and the thickness of the Schneider membrane evaluated with cone-beam tomography. Materials and Methods. The universe was made up of 2432 tomography scans and a sample of 976, by systematic random sampling, and took into account those that presented any of the variables and/or both. For the relationship analysis, the sample was distributed according to sex, maxillary side, and age; it was formed between 18 and 86 years, in age groups of 18-36 years, 37-48 years, 49-59 years, and 60-86 years. The quantitative variables of the statistic descriptive analysis, hypothesis tests, and Spearman correlation were recorded. RESULTS: A significantly low correlation (p < 0.010) was observed between the periapical lesions and the thickness of the Schneider membrane in women (rho = 0.38) and men (rho = 0.32); in the same way, a significantly low correlation was observed in the age groups of 18-36 years (rho = 0.27) and 37-48 years (rho = 0.28), while a significantly moderate correlation was observed in the age groups of 49-59 years (rho = 0.45) and 60-86 years (rho = 0.44), and with respect to the sides, a significantly low correlation (rho = 0.28) was obtained for the right side and a significantly moderate correlation (rho = 0.45) was obtained on the left side. CONCLUSION: We found that the height of the periapical lesions and the thickness of the Schneider membrane are significantly related according to age, sex, and maxillary side, this relationship being accentuated at an older age and on the left side.