Erbil Dental Journal (EDJ)

Serum Muscle Enzymes as Indicator for Gingival Wound Healing in Rabbits Orally Receiving Pomegranate Peel Extract

Bakhtiar Muhialdin Ahmed — 2024-12-06

Background and Objectives: Pomegranate, Punica granatum, is known to possess a powerful ability for accelerating wound healing. The aim of this study is to evaluate serum muscle enzymes; Creatine phospho kinase (CPK), aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and Lactate dehydrogenase (LDH) activities in gingival wound healing process in rabbits orally administrated pomegranate peel extract (PPE).

Methods: This study included 55 rabbits that were divided into 3 groups; baseline group consisted of 5 rabbits without creating buccal gingival injury, and the study group included 25 (5 rabbits per each time interval) with creation of gingival injury that received (PPE). The third group; the control group (25 rabbits) was treated as the study group, except they didn’t receive the extract. At the lower right central incisor, a gingival injury was created, seven days after the operation the sutured was removed. At time intervals (0, 3h, 1, 3, 7 and 10 days) after the operation, blood was withdrawn through cardiocentesis. Blood samples were used for serum CPK, AST, ALT, LDH activities determination.

Results: In the rabbits receiving PPE (study group), the activities of muscle enzymes; AST, ALT, LDH increased significantly at time intervals of one and three days after gingival injury (except CPK which increased 3 hours, 1 and 3 days after surgery), then declined and nearly returned back to baseline values, 10 days after gingival injury incision. Whereas, in the control group, a significant increase in the serum activities of CPK and AST (compared to baseline values) were observed at all time intervals after gingival injury, while for ALT and LDH, their activities significantly increased one day and after.

Conclusions: Serum muscle enzymes activities may be used as a marker for the gingival wound healing process in rabbits supplemented with PPE.

Detection and Severity Assessment of Temporomandibular Joint Osteoarthritic Changes in Patients with Temporomandibular Disorders Using CBCT

Kharman Khidhr Rahman — 2024-12-06

Background and objectives: Osteoarthritis refers to a non-inflammatory condition often linked to aging. It involves the gradual breakdown of bone, cartilage, and surrounding soft tissues around the joints. The aim of this study is to detect osteoarthritic change in patients with temporomandibular disorder, to determine the severity of osteoarthritic changes, and to assess the relation of gender and age with the severity prevalence of temporomandibular joint osteoarthritis.

Material and method: This retrospective, cross-sectional study analyzed 100 cone beam computed tomography (CBCT) scans of the temporomandibular joint from patients diagnosed with temporomandibular disorder. To assess osteoarthritis in the temporomandibular joint, the study applied the research diagnostic criteria specific to temporomandibular disorder. The presence of osseous modifications, such erosion, flattening, sclerosis, subcortical, osteophyte, and resorption, was evaluated for condylar head and articular eminence. The impact of osteoarthritic alterations was assessed for each joint.

Result: The prevalence of osteoarthritic change in patients with temporomandibular disorder was 70%. A significant correlation was found in the prevalence of AO and age. The prevalence of OA was 90.6% among those aged less than 25 years old, and the lowest prevalence (53.8%) was in the age group 25–34. No significant association was detected between gender and the prevalence of OA: 72.7% in males and 68.7% in females. Erosion (65%) and flattening (64%), the most common findings of osteoarthritic changes of the condyle, the association between age and condylar osseous changes was not significant. There is no significant association between osteoarthritic change severity and gender or age. No significant association was detected between age and changes in articular eminence.

Conclusion: There is a high prevalence of osteoarthritic change among patients with temporomandibular disorder. The prevalence and severity of degenerative bone changes don’t increase with age; they can occur in any age group.

The Effect of Sandblast and Plasma Surface Treatment of Titanium Abutment on Tensile Bond Strength with Ultra-translucent Zirconia Crown: A Comparative Study

Amani Abduljabar Altaie — 2024-12-06

Aim: Assess the tensile bond strength of the zirconia crown that has been surface treated with sandblast and plasma on a titanium implant abutment both before and after the surface treatment.

Materials and methods: Forty samples of implant analog and prefabricated titanium implant abutment of Dentium system with diameter (3.5mm) and height (5.5mm) were embedded vertically in auto-polymerizing acrylic resin blocks, were divided into five groups according to type of crown and abutment surface treatment (10 samples for each group) : Group I titanium abutments and zirconia crowns without any surface treatment, Group II sandblast treated abutments, Group III plasma surface treatment for both titanium abutments, Group IV combine sandblast and plasma treated titanium abutments. Forty zirconia crowns fabricated with CAD/CAM system and all crowns cemented to titanium abutment with Allcem resin cement dual cure, then stored in (5000) cycles of thermocycling between (5^c-55^c) degree, after that all samples evaluated it is tensile bond strength with universal testing machine. An analysis of variance (ANOVA test), Duncan's multiple range test and t-test at (p-value < 0.01) were used for a statistical analysis for data obtain from universal testing machine.

Results: Group IV (combined sandblast and plasma treatment for titanium abutments) had the highest tensile strength value, followed by Group II (sandblast treated abutment) and Group III (plasma surface treatment for abutments). Tensile bond strength increased following sandblast and plasma surface treatment. The control group's tensile strength was lower.

Conclusion: Sandblast and plasma surface treatment had significant effect on retentive force between titanium abutment and zirconia crown, sandblast was the higher effect on tensile bond strength than plasma.

Radiographic Evaluation of The Bone Density Around Tooth-Anchored One-Piece Immediate-Loading Dental Implant

Bangen Mohammed Karam — 2024-12-06

Introduction: Immediate loading of dental implants has gained attention for its potential to enhance patient satisfaction and reduce treatment time. However, limited data exists on its effects on bone density around tooth-anchored, one-piece compressive implants. This study evaluates the impact of immediate functional loading on bone density changes using radiographic grayscale and texture analysis over one year.

Materials and Methods: A total of 68 patients (mean age: 56 ±8.2 years) received 89 distal implants in free-end partial edentulous sites. Cone beam computed tomography (CBCT) was used for treatment planning, and intra-oral digital radiographs were taken at baseline (T0), six months (T1), and one year (T2). Functional loading began seven days post-implantation using fixed porcelain-fused-to-metal (PFM) prostheses. Grayscale values and texture parameters, including mean, standard deviation (SD), and coefficient of variation (CV), were analyzed in regions of interest (ROIs) around the implants.

Results: Significant increases in bone density were observed across all ROIs between T0 and T1 and T0 and T2 (P<0.05). Between T1 and T2, differences were less pronounced but still indicated stabilization.

Upper ROIs: Significant changes (P<0.05) were observed across all time intervals except CV between T1 and T2 (P>0.05).

Lower ROIs: Consistently significant improvements (P<0.05) at all time intervals.

Mesial ROIs: Significant differences in SD and CV across all intervals (P<0.05), with notable mean changes between T0 and T2.

Distal ROIs: Early significant changes (T0-T1, P<0.05) in SD and CV, with stabilization by T2 (P>0.05).

Conclusion: Immediate functional loading enhances bone density, particularly within the first six months, with continued stability over one year, demonstrating its effectiveness for tooth-anchored one-piece compressive dental implants.

Prevalence of Oral Lesions Biopsies Among Different Laboratories

Layla Muhamad — 2024-12-06

Background: The oral cavity and jaws can be a host of multiple pathological lesions, which could be tumors, reactionary lesions, or cystic lesions.

Aims and Objectives: To evaluate the age and gender distribution of the oral lesions, as well as their types and relative frequencies.

Method: The data were collected from the private laboratories in Erbil city during a period from January 2018 to January 2023. Data related to the patient's age and gender, as well as the type, site, and histopathology diagnosis of the lesions, were evaluated.

Results: Oral lesions were more common in females (57.3%), malignant lesions represented 89 (30.4%) cases, and benign lesions prevalence was 28.7%. (84 cases), reactionary lesions were 59 (20. %) cases, cystic lesions were 49 (16.7%) cases, and immunologically mediated lesions were only 3.8%.

Conclusions: The results showed a high frequency of malignant tumors, which need more evaluation of etiological factors.

Optimizing Soft Tissue Emergence Profile Around One-Piece Dental Implants

Abduljaleel Azad Samad — 2024-12-06

Background and Objective: One-piece implants were introduced many years ago, however, in the last years, they have gained acceptance as a therapeutic alternative for many clinical cases. The soft tissue surrounding the neck of one-piece implants, particularly in the esthetic zone, is a cause for concern despite the clinical effectiveness of these implants. The purpose of this study is to propose a simple way for optimizing soft tissue around one-piece dental implants.

Material and Methods: Between January 2022 and January 2024, a total of 137 patients were treated with single-piece dental implants that were placed in the aesthetic anterior region of the mouth. A temporary crown in the office was created using a flowable composite that was temporary in nature using the mold of the Cervico system (VP Innovato Holdings Ltd, Lemessos, Cyprus). After three months, the patients' rates of success, failure, and complications were evaluated. The Jemt Papillary Index was employed to assess the papilla following the placement of the final prosthesis, a Satisfaction Visual Analog Scale (VAS system) was created to gauge the patient's satisfaction. The data was evaluated by means of descriptive statistics utilizing the SPSS (version 30) package of software.

Results: The mean age of all cases was 32.10 years, with 78 (56.9%) male cases and 59 (43.1%) female cases. After 3 months among 137 inserted implants; 97.8% of the implants were successfully osseointegrated. After removal of the temporary crown a very nice anatomical emergence profile created and the results of papilla index after three months showed that the majority of the cases (84 cases comprises 61.3%) ended with score number 3, which means Optimal soft tissue contour and the papillae fill up the entire proximal space. Finaly the results of Satisfaction Visual Analog Scale (VAS) showed that 120 cases (87.6%) were have most positive response to the dental implant treatment.

Conclusion and Clinical implications: We concluded that using of a customized composite temporary crown fabricated by Cervico system offers a very simple and time-saving technique for the clinician, aiding in splinting the implants and obtaining nice emergence profile around one-piece implants.

Clinical Outcomes of Mandibular Angle Fractures Treated by Single-Versus Double Miniplates

Mustafa Rasul Muhammed — 2024-12-06

Background: Angle fractures represent the highest percentage of mandibular fractures. The purpose of this study was to compare the effectiveness of two miniplates fixation versus one plate fixation in the treatment of angle fractures.

Material and Methods: The present study was carried out on 40 patients with fractures of the mandible angle region treated by open reduction and internal fixation with 2.0mm standard conventional mini plates. Subjects were selected and randomly assigned to one of the 2 groups, 20 patients for each. Group I, patients were treated by single miniplate at superior border of mandible by intraoral approach; Group II, patients were treated by one miniplate like in group I, plus another plate at the lateral aspect of angle, trans buccally by trocar and cannula. The patients were evaluated for duration of surgery, post operative infection, wound healing, neurosensory disturbance, occlusion, malunion, and hardware failure.

Results: The complications were more in group 2 than in group 1. Disturbed occlusion was noted in 2 patients in group 2 and 3 patients of group 1. Infection occurred in 1 patient in group 1 and 2 patients in group 2. Preoperative/postoperative anesthesia was reported in 4/6 patients in group 1 and 5/7 patients of group2. No wound breakdown was seen in both groups. Screw loosening, necessitates removal of the plate, was noted in 3 patients of group 1 and one patient of group 2. Two patients’ group 1 showed delayed union and none of the patients in group 2 develop such complication. The difference in the complications between the two groups was not significant.

Conclusions: There was no difference between the single- and double plate fixation regarding disturbed occlusion, infection, wound break down, lip paresthesia, hardware failure and malunion.

A New Complexity Index in Implant Dentistry: Position Statement of the Implant Dentistry Study Consortium

Souheil Hussaini — 2024-12-06

Background: The growing complexity of implant dentistry necessitates advanced frameworks to guide treatment planning, enhance clinical outcomes, and streamline surgical execution. This article proposes the IDSC Complexity Index, a novel classification system.

Materials and Methods: A retrospective study was conducted using data collected from 4,201 patients who underwent 20,154 dental implant procedures between January 2002 and October 2024. Patients aged 18–95, including both medically healthy and compromised individuals, smokers, and diverse socioeconomic and ethnic groups, were included. Exclusions were limited to contraindications for implant surgery. The IDSC classification system divides implant sites into five zones, starting with simpler areas like the anterior mandible and progressing to the most complex regions such as the posterior maxilla with sinus lift requirement.

Results: Analysis of 20,154 samples revealed variations in implant placement by location and classification. The highest percentage of implants was in the posterior mandible (32%, Class III), while the posterior maxilla requiring sinus elevation (5%, Class V) was the lowest. Surgical time ranged from 19 minutes (Class I) to 50 minutes (Class V). Treatment costs spanned from $790 (Class I) to $1,251 (Class V). The number of procedures per implant also varied, with Class I requiring one procedure on average, increasing to 3.0 procedures for Class V, which involved the most ancillary interventions.

Conclusion: Implant placement in different areas of the oral cavity has an escalating effect on time, cost and number of ancillary procedures.

Teeth Structure Analysis of Primary Teeth in Children with Congenital Heart Disease (Ventricular Septal Defect) in Erbil City

Huda Raad Mahdi — 2024-12-06

Objective: This study is performed to find out any differences in the chemical composition of primary teeth between children with ventricular septal defect (VSD), and those without (VSD) in Erbil city.

Methods: Children enrolled in this study were divided into two groups—group I (no VSD) and Group II (VSD). The collected teeth were (n=22) in each group. The structural and chemical composition of enamel and dentin were examined by scanning electron microscope/energy-dispersive x-ray (SEM/EDEX). An unpaired t-test was used in statistical analysis. P<0.0001 was considered as significant.

Results: EDEX analysis of the enamel layer in group I showed that calcium, phosphorus, silica, oxygen, fluorine, and sodium were significantly higher (P<0.0001) while carbon ions concentration was not. In the dentin layer, only calcium, phosphorus, fluorine, and sodium components were significantly higher in group I (P<0.0001). SEM analysis showed that disruption of the enamel layer was significantly higher in group II (7.60±15.41, and 14.21 ± 46.09) respectively for groups I and II (P<0.0001). Significant differences in dentin layer thickness were found (7.32 ± 33.28 and 3.807±11.94) respectively (P<0.0001). Dentin tubule occlusion was significantly higher in group I (7.59 ±74.18) than in group II (49.51± 45.27), P<0.0001. The number of odontoblast cell layers between groups was significantly higher in group I (7.32±33.28, and 3.807±11.94) respectively(P<0.0001).

Conclusion: VSD can result in significant structural differences in the enamel and dentin layers of primary teeth. It can also cause sub-optimal concentrations of certain minerals like Ca, P, O2, Na, and Silica in primary teeth.

Comparative Evaluation of Antimicrobial Activities of Different Types of Luting Cements

Sazan Sherdl Saleem — 2024-12-06

Background and objectives: To minimize secondary caries, luting cements with antimicrobial properties are frequently used for the cementation of indirect restorations. The aim of this study was to investigate the antimicrobial effect of four dental luting cements

Materials and methods: Four luting cements (GC FUJI PLUS, GC FUJI I glass ionomer, GC Gold Label glass ionomer, and G-CEM ONE resin cement) were tested for antimicrobial activity against Streptococcus mutans and Candida albicans using agar diffusion test (ADT) (by preparation of seventy-two disc for each bacteria) and modified direct contact test (MDCT) at one hour, one day, and one-week intervals. In ADT, inhibition zones were measured in millimeters. In MDCT, bacterial suspensions were exposed to the cements, and colony-forming unit (CFU) counts were recorded at various time points to assess microbial survival.Top of Form

Results: In ADT, GC Gold Label glass ionomer exhibited the highest inhibition zones (17.75 mm) after one week, surpassing other intervals of the same cement and all other cements tested. At one hour, none showed antimicrobial activity against Candida albicans, except GC FUJI PLUS. In MDCT, none of the luting cements demonstrated growth against S. mutans, but all showed growth of Candida except for GC FUJI PLUS at one hour.

Conclusion: All evaluated luting cements exhibited antibacterial activity against S. Mutans in both tests. However, only RMGI at one hour showed antimicrobial activity against Candida Albicans. The conventional glass Ionomer cement (powder and liquid) showed superior antimicrobial activity, suggesting potential benefits for patients at high risk of caries.

The Most Frequency Chief Complaint of 5.5-12.5 Years Old Patients Attending POP Department of Hawler Medical University- College of Dentistry

Manal M. Taher — 2024-12-06

Background and objective: The chief complaints of the patients are important component during taking the history and treatment planning, be useful for several reasons including monitoring of oral health services and measuring the effectiveness of oral health awareness programs. the aim of the study to evaluate and address the most common chief complaints among a patients attending College of Dentistry at Hawler Medical University in Erbil, Iraq.

Methods: A retrospective epidemiological study, the age, gender, and the chief complaints or the main reason for visit were recorded for each consecutive patient of total 324 patients who visited the oral hygiene clinics in the college of dentistry at Hawler Medical University from September 2019 to September 2020. The patients ages were between 5.5-12 years old. A chi-square test was used to test differences in categorical variables T-tests were used to test the significance of differences between numerical values. Statistical association between two variables was performed with the Chi–square test. Significant levels of p ≤0.05 and p ≤0.01 were established.

Result: Dental pain was the most common chief complaint (29.3%), followed by dental check-up (9.9%) referred from the orthodontic department (4.9%) and dental caries (3.1%). Other complaints included follow up (1.9%), food impaction (0.9%), fractured tooth (0.6%) mobile tooth (0.6%), scaling and polishing (0.6%).

Conclusion: Chief complaint is an essential component of the dental history and denotes the demand for care and thus, helps in proper planning of the public dental health care system. The reason for visit varies across different age groups, gender difference was a consideration.

Scanning Electron Microscopic Evaluation of Smear Layer Removal and Estimation of Dentin Microhardness Using TRITON Endodontic Irrigant: An In Vitro Study

Nawfal A. Zakaria — 2024-12-06

Background and objectives: Irrigation is essential in endodontic therapy, and traditional irrigation was done with NAOCl and EDTA to remove the smear layer and clean the canal, but it had several difficulties. Many solutions, such as Smearoff, Qmix and MTAD, are available as a single irrigant solution to disinfect and remove the smear layer. TRITON is a revolutionary two-in-one irrigant that can both remove smear layer and disinfect the canal. This study aims to evaluate the effect of Triton on smear layer removal and compare it with Qmix and conventional NaOCl and EDTA irrigation protocols.

Methods: Thirty extracted single canal teeth were divided into three groups; Group 1 was irrigated with NaOCl and EDTA. Group 2 received Triton treatment, but Group 3 received Qmix irrigation. Each tooth was then cut in half and subjected to Scanning electron microscope.

Results: There was no significant difference between the groups investigated, however, there was a significant difference between the middle and apical thirds in Group 2 (P=0.009).

Conclusion: Triton intracanal irrigant revealed effectual capability to eradicate smear layer from radicular dentin as conventional root canal irrigating solutions (NaOCl/EDTA). Triton can be used as an alternative to NaOCl+EDTA and Qmix as an irrigant.

Post Traumatic Impaction of Maxillary Deciduous Central Incisor: A Case Report

Bahoz Himdad Majeed — 2024-12-06

Background and Objectives: Primary tooth impaction is a rare phenomenon when compared to permanent teeth impaction, particularly in upper front teeth. The problem could be either a physical blockage of the eruption or a malfunction of the eruption process.

Methods: This case study describes a 4-year-old girl who experienced incomplete eruption of her upper right baby front tooth due to an injury. The unerupted tooth was surgically removed. Regular check-ups were recommended to monitor the development of her teeth and ensure sufficient space for her permanent front teeth.

Results: This case study describes an unusual situation where a baby's upper front tooth failed to erupt. that associated with trauma. That caused delay in progression of the permanent successor compared to the contralateral permanent central incisor. And by extracting the impacted primary tooth a path of eruption opened for the permanent successor tooth so it will accelerate the progression of erupting the permanent successor and mostly may erupt in the same time of the contralateral tooth.

Conclusions: It's crucial to closely watch the eruption of permanent and deciduous teeth to spot and address any issues with tooth eruption early on.