Comparison of photoinactivation of T. rubrum by new methylene blue (NMB) and indocyanine green (EmunDo®).

BACKGROUND: Superficial mycotic skin infections which are predominantly caused by Trichophyton rubrum, poorly responsd to conventional therapies. A great amount of attention has focused on finding more effective treatments. The current work is aimed to compare the effectiveness of phoinactivation of Trichophyton rubrum by two relatively new photosensitizers: a phenothiazinium dye(New methylene blue) and Indocyanine green (EmunDo®). MATERIALS AND METHODS: A Final inoculum of T. rubrum which corresponded to 106 colony forming unit per milliliter (CFUml-1) was prepared. Antimicrobial Photodynamic treatment (aPDT) of T. rubrum was carried out by either EmunDo® (1mg/ml, Infra-red laser (IRL, λ=810nm, Energy Density 55J/cm2)) or NMB (10µM, Red laser (RL), λ=630nm, Energy Density of 5J/cm2). The suspensions thereafter were subcultured on Sabouraud dextrose agar (SDA) and were counted on due time. based on colony-forming unit per milliliter (CFU/ml). RESULTS: aPDT with either EmunDo® (E) or NMB (N) considerably diminished the viability of inoculated T. rubrum with respective reduction of 0.64 log and 0.4 log compared to the control group (P<0.001). No significant difference was found between two laser only groups (P=0.79) and two aPDT groups (P=0.73), however significant reduction of T. rubrum in red laser only group (P=0.04) and EmunDo® only group (P=0.04) was found as compared to the control group (P<0.05). CONCLUSION: The study provides evidence regarding satisfactory photodynamic inactivation of T. rubrum with EmunDo® or NMB as photosensitizers. Irradiation by only red laser source was found superior to only infra-red laser source. Dark toxicity of EmunDo® was more successful than new methylene blue dye.

Individual scoring and mapping of hard and soft tissues of the anterior hard palate for orthodontic miniscrew insertion.

AIM: The aim of the present study was to introduce a scoring system to select optimal sites to insert a miniscrew in a hard palate. METHODS: The present study consisted of 37 adult patients (21 females and 16 males) aged between 20 and 50 years, with a mean age of 34.81 (±9.52) years. Hard and soft tissues of the anterior hard palate were assessed using cone-beam computed tomography. The scoring system was as follows: mucosal thickness: 0-2 mm (2 points), 2-4 mm (1 point), and 4-6 mm (0 points); total bone vertical height: ≥5 mm (1 point) and <5 mm (0 points); and palatal cortical thickness: ≥1 mm (1 point) and <1 mm (0 points). RESULTS: Significant variability was found between the individuals. Total vertical bone height decreased posteriorly and laterally. Mucosal thickness decreased posteriorly, but increased laterally. Palatal cortical thicknesses were higher than the nasal cortical thicknesses. The most balanced sites (highest point) were the midpalatal suture, followed by paramedian points located 3 mm lateral to the midline and 4 mm posterior to the incisive canal. CONCLUSIONS: Considering that both hard and soft tissue parameters are crucial to obtain the best possible success rates, careful investigation is recommended prior to clinical decisions being made.

Monocortical versus bicortical hard palate anchorage with the same total available cortical thickness: a finite element study.

OBJECTIVE: We aimed to compare the bicortical fixation of a palatal miniscrew in comparison to monocortical anchorage when total anchored cortical layer thicknesses are the same. MATERIALS AND METHODS: Six models were designed: I, monocortical, 1.1 mm palatal cortical thickness, 8.5 mm bone height; II, bicortical, 0.4 mm palatal, 0.7 mm nasal cortical thickness, 8 mm bone height; III, bicortical, 0.7 mm palatal and 0.4 mm nasal cortical thickness, 8 mm bone height; IV, monocortical, 1.1 mm palatal cortical thickness, 7 mm bone height; V, bicortical, 0.4 mm palatal, 0.7 mm nasal cortical thickness, 7 mm bone height; VI, bicortical, 0.7 mm palatal and 0.4 mm nasal cortical thickness, 8.5 mm bone height. An 8 mm miniscrew was fully engaged in the bone and was subjected to vertical pull out until displaced 0.01 mm and 0.05 mm or horizontal traction load of 2 N. RESULTS: Monocortical fixation provides higher retention in comparison to bicortical fixations with the same total cortical thicknesses in terms of vertical pull-out test. Models with bicortical fixation and thicker nasal cortex sustained lower strain energy when subjected to horizontal traction load. CONCLUSION: Bicortical fixation of hard palate exhibit different reactions to vertical and horizontal tractions.

A unique functional craniofacial suture that may normally never ossify: A cone-beam computed tomography-based report of two cases.

The premise of complete ossification of midpalatal suture in early adulthood still has its popularity, though conflicting data are emerging in the literature. A 49-year-old male and a 54-year-old female Iranian patient, both dentulous, were referred to a Maxillofacial Radiology Center to be evaluated for implant insertion. In cone-beam computed tomography (CBCT) evaluation, an in-ossified suture was found in anterior two-third of midpalatal region of both individuals. The application of clinical vignettes from CBCT findings for maxillofacial orthodontic and orthopedic purposes is of value. Existing cases of successful nonsurgical rapid palatal expansion of maxilla in adults could surrogate this dogma about timing for ossification of midpalatal suture which is considered as a purely chronologic-related phenomenon and transmitted masticatory forces may be one possible cause (functional hypothesis).

Should the orthodontic brackets always be removed prior to magnetic resonance imaging (MRI)?

Request for temporary removal of orthodontic appliances due to medical conditions that require magnetic resonance (MR) imaging is not uncommon in daily practice in the field of orthodontics. This may be at the expense of time and cost. Metal Orthodontic appliances cause more signal loss and image distortion as compared to ceramic and titanium ones. Stainless steel and large brackets in addition to the oriented miniscrews in relation to the axis of magnetic field may cause severe signal loss and image distortion. Moreover, gradient echo and frequency-selective fat saturation MR protocols are more susceptible to metal artifacts. The spin echo and fat-suppression protocols, low magnetic field strength (e.g., 1.5 Tesla vs. 3 Tesla), small field of view, high-resolution matrix, thin slice, increased echo train length and increased receiver band width could be applied to lessen the metal artifacts in MR images. The larger the distance between an appliance and desired location to be imaged, the lower the distortion and signal loss. Decision to remove brackets should be made based on its composition and desired anatomic location. In this review, first the principles of MR imaging are introduced (Part-I) and then the interactions of orthodontic appliances and magnetic field are farther discussed (Part-II).

The Effect of Topical Glycerol Trinitrate on Laser-Aided Facial Hair Removal: A Triple-Blinded Randomized Clinical Trial.

OBJECTIVE: Our purpose in this study was to assess the effect of topical glyceryl trinitrate on the efficacy of long-term white hair removal aided by laser therapy in hirsute women. BACKGROUND DATA: Nitric oxide (NO) induces vasorelaxation and augmented perfusion when released from endothelial cells or from an alternatively provided exogenous source. Separately, vascular endothelial growth factor (VEGF)-mediated angiogenesis during the anagen phase, the phase most susceptible to laser elimination, and modulation of VEGF by NO, has been discussed previously, but there are limited data regarding an efficient method for long-term white hair removal. METHODS AND MATERIALS: We conducted a triple-blinded randomized controlled clinical trial. Hirsute women with excess facial hair without a known allergy to nitroglycerin derivatives were recruited, and randomly allocated to receive either premedication with 2 g glycerol trinitrate 3 days before the laser sessions once a day, or placebo. All the participants underwent six laser sessions with 1-month intervals. Baseline hair numbers were counted before, 3, 6, and 12 months after the first session. Data were analyzed with repeated measures ANOVA test. RESULTS: A total of 83 patients were enrolled in control (43) and case (40) groups. The trends for hair reduction in both studied groups were significant (p < 0.001), but there were no significant differences between the case and control groups during the study period. CONCLUSIONS: According to our findings, all patients, regardless of whether or not they used trinitrate, had significant success with hair removal. This study could not differentiate hair removal efficacy between the study groups. Studies with other laser types and larger sample sizes are suggested to investigate the effect of NO on hair production.

Rapid Palatal Expansion to Treat Nocturnal Enuretic Children: a Systematic Review and Meta-Analysis.

STATEMENT OF THE PROBLEM: Refractory nocturnal enuresis possesses a heavy psychosocial burden for the affected child. Only a 15% spontaneous annual cure rate is reported. PURPOSE: This patient-level meta-analysis aimed to evaluate the efficacy of rapid palatal expansion to treat nocturnal enuresis among children. MATERIALS AND METHOD: A sensitive search of electronic databases of PubMed (since 1966), SCOPUS (containing EMBASE, since 1980), Cochrane Central Register of Controlled Trials, CINAHL and EBSCO till Jan 2014 was performed. A set of regular terms was used for searching in data banks except for PubMed, for which medical subject headings (MeSH) keywords were used. Children aged at least six years old at the time of recruitment of either gender who underwent rapid palatal expansion and had attempted any type of pharmacotherapy prior to orthodontic intervention were included. RESULTS: Six non-randomized clinical trials were found relevant, of which five studies had no control group. Eighty children were investigated with the mean age of 118 (28.12) months ranged from 74 to 185 months. The median time to become completely dry was 2.87 months [confidence interval (CI) 95% 2.07-2.93 months]. After one year, the average rate of becoming complete dry was 31%. The presence of posterior cross bite [relative risk (RR): 0.31, CI 95%: 0.12-0.79] and signs of upper respiratory obstruction during sleep (RR: 5.1, CI 95%: 1.44-18.04) significantly decreased and increased the chance of improvement, respectively. Meanwhile, the other predictors did not significantly predict the outcome after simultaneous adjustment in Cox regression model. CONCLUSION: Rapid palatal expansion may be considered when other treatment modalities have failed. The 31% rate of cure is promising when compared to the spontaneous cure rate. Though, high-level evidence from the rigorous randomized controlled trials is scarce (Level of evidence: C).

Accessory mental foramina, incisive nerve plexus and lingual canals with unusual emergence paths: Report of two rare cases.

Being knowledgeable of neurovascularization of anterior mandible is crucial for successful local anesthesia and for safe minor and major oral surgeries of this part. The first case was 62 years old and was found to have two accessory mental foramina with buccal emergence on the left side and two accessory mental foramina with buccal and lingual emergence paths on the right side (overall five mental foramina). Incisive nerve plexus with multiple cephalic branching was obvious on both sides. The second case was 60 years of age and had two lingual foramina on the lingual side with two accessory foramina on the buccal side of the symphysis. Considering our findings, a pre-operation limited cone beam computed tomography is suggested to avoid inadvertent damage, especially when planning a surgery in the mandibular inter-mental region.

In vitro photodynamic inactivation of Candida albicans by phenothiazine dye (new methylene blue) and Indocyanine green (EmunDo®).

BACKGROUND: The application of a new generation of photosensitizers to increase the efficacy of antifungal photodynamic therapy (aPDT) is an important aspect of PDT. Thus, this in vitro study is aimed to evaluate the antifungal efficacy of the photo-elimination of Candida albicans with photothermal and antifungal photodynamic therapy. METHOD AND MATERIAL: aPDT with new methylene blue and photothermal therapy with EmunDo® were applied to a fungal suspension, which was then subcultured in Sabouraud dextrose agar (SDA). The C. albicans colonies were counted and are expressed as colony-forming unit per milliliter (CFU/ml). RESULTS: aPDT with either EmunDo® or new methylene blue (NMB) considerably diminished the viability of inoculated C. albicans (P<0.001) by log reduction of 1.9 and 3.37, respectively, compared with the control group respectively, compared with the control group. The antifungal potency or dark toxicity of the two photosensitizers alone did not significantly differ (P=0.70). The same trend was observed for the light sources (λ: 810nm vs. λ: 630nm), which also did not significantly differ (P=0.78). CONCLUSION: The photo-elimination of C. albicans with either new methylene blue or EmunDo® as a photosensitizer can reduce the viability of fungal cells. Although the result of this study is encouraging, further investigations are warranted to determine clear protocols for the reliable and safe application of this method in clinical practice.

Eradication of C. albicans and T. rubrum with photoactivated indocyanine green, Citrus aurantifolia essential oil and fluconazole.

BACKGROUND: We aimed to evaluate the efficacy of alternative therapies rather than the current antifungal conventional therapy and with assessing the hypothesis of photoactivation of citrus essential oil, fluconazole and Indocyanine green to treat two common mucocutaneous fungal infections. METHODS: Suspensions of Candida albicans and Tricophyton rubrum containing 10(6)cells/ml was prepared. Equal samples were treated with infrared (IR) laser irradiation (810 nm, 55 J/cm(2)) in the presence of Indocyanine green (Emundo, 1 mg/ml) (IRLE), photoactivated Citrus aurantifolia essential oil (EO) with sequential exposure to natural and tungsten lights (CE), control non-activated essential oil (CC), laser alone (IRL), indocyanine green alone (E) and neither of treatments as the control group (C). Additional fluconazole (FL, 25.6 µg/ml) and IR activated fluconazole (IRLFL) groups were designed for T. rubrum fungi. Inoculums were serially diluted to 10(-2) and 10(-4) and streaked on Sabouraud dextrose agar plates. Final outcomes were assessed as the percent of reduction. RESULTS: Cell reduction rates (%) in C. albicans groups were 99.99 (CE), 91.67 (IRLE), 86.67 (CC), 72.37 (E) and 67.27 (RL). Whereas, a 99.99 (CE), 89.99 (CC), 74.5 (IRLE), 64.5 (E), 38.5 (IRLF), 37.5 (RL), and 31 (FL) percent eradication was achieved in T. rubrum groups. CONCLUSION: Photoactivation of Citrus EO increased the killing capability by 10-13%. A modest 7.5% augmented effect was observed with IR activation of Fluconazole. Both Citrus EO and photothermal-photodynamic therapy with ICG and IR diode laser exhibited remarkable lethal effect on fungal cells. Candida viable cells are more susceptible to laser only and ICG only treatments than Tricophyton cells.

Optimized orthodontic palatal miniscrew implant insertion angulation: a finite element analysis.

PURPOSE: There is a controversial body of evidence regarding optimal insertion angulation of an orthodontic miniscrew as a mean of skeletal anchorage. MATERIALS AND METHODS: A bracket head-type 8-mm-long miniscrew (60-degree symmetrical trapezoid thread, 0.1-mm thread fillet, 0.2-mm thread height, with 0.5-mm thread pitch) was designed and monocortically inserted at 30, 45, 55, 70, 90, 110, 125, 135, and 150 degrees of inclination to the surface of bone. A bilayer cortical (1.6 mm) and cancellous (8.5 mm) bone model was constructed, adopted from a 22-year-old male patient's cone beam computed tomography (CBCT) image of his anterior hard palate area. A horizontal force of 2 N was applied parallel to the bone surface. Bone material was simulated as normal and osteoporotic bone. The maximum equivalent von Mises stress and microstrain values were separately calculated for the miniscrew, cortical bone, and cancellous bone. Deflections of the whole bone and miniscrew were also reported. RESULTS: A significant lower stress was found in the cancellous bone compared to the cortical bone. Osteoporotic bone displayed higher strain values. Overall, 30-degree models exhibited the lowest von Mises stress and strain values for the cortical layer and miniscrew in both normal and osteoporotic models. Meanwhile, 90-degree models displayed the lowest strain values in the osteoporotic and normal cancellous bones. Minimum bone and miniscrew deflection values were related to the model of 30-degree insertion angulation. CONCLUSION: These results showed that, within the limitations of the study, the 30-degree angulation of miniscrew insertion toward the direction of applied force could lower the cortical bone stress and strain.

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

STATEMENT OF THE PROBLEM: Determining the crown-root ratio is crucial in many dental clinical decisions. There are no reliable data presented for Iranian population. PURPOSE: The aim of this study was to assess the root-crown ratio of permanent teeth with regards to the relationship of gender and jaw type using panoramic radiographs. The reliability of method was also assessed. MATERIALS AND METHOD: The crown and root lengths of teeth were measured by a digital caliper on panoramic radiographs of 185 individuals except for the third molars. A total of 1994 teeth was studied and 50.8% of the teeth belonged to males and 49.2% belonged to females. The modified Lind method was applied. RESULTS: The highest mean root-crown ratios in both arches of both genders were obtained in the second premolars, followed by the first premolars and canines. In both genders, the lowest root-crown ratios were found in the maxillary central incisors. In male patients, the mean root-crown ratio was higher (p= 0.003) than that of females. Using Bland-Altman analysis, a non-significant difference of 0.006 (95% CI: -0.012-0.024) and 0.0002 (95% CI: -0.011-0.011) were found for intra-observer and inter-observer agreement, respectively. CONCLUSION: Assessment of the root-crown ratio in permanent dentition could be performed on panoramic radiographs with acceptable reproducibility in an Iranian Population. Considering observed differences, our findings suggest that for the accurate assessment, this ratio must be calculated for male and female patients and also for the upper and lower jaws, separately.

Diagnostic Role of Salivary and GCF Nitrite, Nitrate and Nitric Oxide to Distinguish Healthy Periodontium from Gingivitis and Periodontitis.

Diagnosis of subclinical and early stage clinical periodontal dysfunction could prevent from further socioeconomic burden. The aim of this study was to assess the diagnostic applicability of nitric oxide and its end-metabolites in periodontal tissue health and disease. Forty-two patients were enrolled and divided into three groups according to gingivitis (GI) and clinical attachment level (CAL) indices: a healthy group (GI<1, CAL<1), b: gingivitis (GI>1, CAL>1) and c: periodontitis (CAL>1) with 14 patients in each group. Unstimulated saliva and gingival crevicular fluid (GCF) were collected. Samples were evaluated for nitrite, nitrate and total nitric oxide contents with the ELISA method. In addition, CAL, GI, plaque index (PI), decay, missing, filling (DMFT) and bleeding index (BI) scores were also recorded. Except for GCF nitrite content (P= 0.89), there was an increasing trend for measured biomarkers in both saliva and GCF (Periodontitis> gingivitis> healthy periodontium, P< 0.05). Data remained stable after simultaneous adjustment for DMFT and BI scores as confounding factors. Sensitivity, specificity, positive predictive value, negative predictive value, cut point and p- value were as the followings: GCF nitrate (0.71, 0.11, 0.29,0.43, 4.97, P= 0.04), nitric oxide GCF ( 0.64, 0.18, 0.28, 0.5, 10.12, P= 0.04), nitrite saliva (0.93, 0.96,0.93,0.96,123.48, P< 0.001), salivary nitrate (0.93, 0.96, 0.93, 0.96, 123.6, P< 0.001), salivary nitric oxide (0.93, 0.96, 0.93, 0.96, 246.65, P <0.001). Our results revealed that NO plays an important role in the process of destruction of periodontal tissues. Within the limitation of our study, detecting NO biomarker and its end metabolites in saliva is of more value to assess the periodontal health comparing to GCF.

Dentistry students ageing anxiety levels in northern Iran.

OBJECTIVE: Ageing anxiety as a specific subtype of anxiety disorder has been considered as a moderating factor on healthcare providers' professional task dealing with the elders. METHODS: A Persian translation of Ageing Anxiety Scale (AAS) (Int J Aging Hum Dev, 37, 1993, 247) was administered to the university students of a dentistry school located at northern Iran. The questionnaire consisted of twenty-five-point Likert-scale questions. RESULTS: The obtained mean score of ageing anxiety was 58.51 (±9.85), (out of a possible 100), and the questionnaire revealed a good level of internal consistency (Cronbach's alpha = 0.76). The results did not differ by gender (p = 0.22), between undergraduate or postgraduate students (p = 0.81), various postgraduate disciplines (p = 0.69), residing with an elder at home (p = 0.18) and length of time living with an elder (p = 0.81). CONCLUSION: The Persian translation of AAS showed a good level of internal consistency. The selected population with educational attainment in this research revealed a moderate ageing anxiety level.

Analgesic effect of etoricoxib compared to ibuprofen on post endodontic pain.

AIMS: Etoricoxib is a second-generation selective COX-2 inhibitor. There are a few researches investigating analgesic effect of Etoricoxib in dentistry. METHODS: This randomized, double-blind, active-control study included sixty patients with clinical pulpal diagnosis of necrosis of the first mandibular molar and an associated periapical radiolucency who experienced severe pain (more than 60 out of 100 in scale of Visual Analog Scale (VAS). The patients were equally randomized into four groups, who received 60 mg etoricoxib (group 1), 90 mg etoricoxib (group 2), 120 mg etoricoxib (group 3), and 400 mg ibuprofen (group 4). All patients randomly received a single dose of the drug after the first session of the root canal therapy. Using VAS, the severity of pain was recorded 2, 4, 6, 12, 24, 48, and 72 hours after the drug was administered. RESULTS: Changing trends of pain over the time was significant for all groups (P=0.003). In addition, there was not a significant difference between various study arms (P=0.146). CONCLUSION: The results showed that ibuprofen had a comparable effect with various dosage of etoricoxib and may remain as the choice analgesic for dental pulpal pain.

Severe Dysphagia after inferior alveolar nerve block preceded by cervical botolinum toxin injection: a case report.

A 39-year-old Iranian female patient who was a known case of primary cervical dystonia since 10 years ago presented to a private office for Dysport injection. The patients experienced severe dysphagia after inferior alveolar nerve block which was preceded by cervical botolinum toxin injection. A possible synergistic effect of botolinum toxin and lidocaine to produce severe dysphagia is presented in this case report.

The effect of different curing time regimens on immediate postpolymerization color changes of resin composites.

AIM: Light curing of resin composites may considerably change the color of resin composites. The aim of this study was to evaluate the changing pattern of resin composite's color by different curing times. MATERIALS AND METHODS: Fifteen, 1 mm-thick, samples of each A2 shade Clearfill and Filtek P60 composites were prepared. First five samples were cured for 10s (400 mW/cm2) in each pole of the rectangular samples (right upper, right lower, left lower, left upper plus central zone). Consecutive sets of samples, each consists of five, were irradiated by doubling and tripling the curing time to 20 and 30s. Color change were measured by means of CIE 1976 L*a*b system equation (ΔE) for each digitalized picture of the corresponding sample. RESULTS: Color of samples was clinically significant changed by increasing the curing time from 10 to 20s and from 20 to 30s for Clearfil (ΔE = 13.86 and 14.11 respectively,) and Filtek P60 (ΔE = 7.68 and 11.66 respectively). The 'b' component change was responsible for the most color alteration confirmed by the linear regression model (p < 0.001). CONCLUSION: This study revealed the contrasting pattern of resin composite's color change with the different curing times. Our findings support that light curing is accompanied by a higher attained blue chroma and diminished yellowness of resin composites. CLINICAL SIGNIFICANCE: A complete and proper curing of sample resin composites on buccal surface of particular tooth, as a common practice to ensure the maximize concordance composite and tooth color, is reassured according to the considerable differences of undercured and overcured in comparison to normocured composite.

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

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