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Objective: The aim of this study was to evaluate the usage of caries risk assessment (CRA) by Croatian general practitioners and evaluate their knowledge and attitudes towards CRA. Material and methods: A link to an online questionnaire was sent via e-mail to a sample of 1,500 general dentists in Croatia. The obtained data were analyzed using descriptive statistics, logistic regression analyses and chi-square tests. Results: Of 257 respondents, 47% performed CRA routinely, but only 4.5% of them used a specific CRA form. The significance of different actors in the development of a treat-ment plan varied considerably among respondents. Furthermore, in 77% of the respondents CRA was a basis for planning individual caries prevention (ICP). The association between CRA and ICP, and be-tween CRA and treatment planning was statistically significant (p=0.001). The practitioners doing CRA more often plan their treatment and ICP according to CRA. The use of CRA was not influenced by specialty and dentists’ experience. Conclusions: In a considerable percentage (53%) of Croatian general dentists, CRA is not part of their routine practice, and there is a strong association between the use of CRA and treatment plans and ICP. There is a need to promote the use of CRA in daily dental practice in Croatia.

Cilj: Obaviti narativni pregled predloženih preoperativnih protokola za ispiranje usne šupljine prije oralno-kirurških zahvata da bi se u aerosolu suzbila pojavnosti virusa SARS-CoV-2. Izvori: Pretražene su znanstvene baze podataka PubMed, MedLine, CINAHN i Scopus kako bi se pronašli relevantni radovi objavljeni do trećeg tjedna travnja 2020. godine. Ovo istraživanje dopunjeno je pretraživanjem putem internetske tražilice te ručnim pretraživanjem međunarodnih i nacionalnih smjernica. Odabir istraživanja: Uključena su istraživanja i protokoli u kojima se predlaže preoperativno ispiranje usta kao mjera tijekom pandemije virusa COVID-19. S obzirom na to da je dostupan mali broj istraživanja, obavljen je pregled narativne literature. Ukupno se 15 referencija (11 članaka i 4 smjernice) smatralo mjerodavnima i kritički je analizirano. Zaključak: Rezultati pokazuju visoku heterogenost u predloženim protokolima. Potrebna su daljnja istraživanja da bi se bolje razumjele značajke i epidemiološka obilježja novog virusa te da bi se ispitala učinkovitost uobičajenih antiseptika protiv virusa SARS-CoV-2 u budućim kliničkim ispitivanjima. No upotreba klorheksidina, vodikova peroksida, providon-jodida i cetilpiridinijeva klorida, sa svrhom prevencije širenja bolesti uzrokovane virusom COVID-19, u različitim je časopisima opisana kao poželjna., Objective: To provide a narrative review of the preprocedural mouth rinse protocols suggested for oral surgery in order to contrast the presence of SARS-CoV-2 in aerosol. Sources and Methods: Electronic searches were performed in medical databases PubMed, Medline, CINAHN and Scopus to identify relevant studies published up until the third week of April 2020. This research was supplemented by exploration through a web-based search engine as well as a manual search for international and national guidelines. Studies and protocols which suggested preoperative mouth rinsing as a recommended measure during the COVID-19 outbreak were included. Given the small number of studies, a narrative literature review was conducted. In total, 15 references (11 articles and 4 guidelines) were considered relevant and were critically analysed. Conclusion: The findings show a high heterogeneity in the protocols suggested. Further research is required to better understand the viral features and epidemiologic characteristics of this new virus and to test the efficacy of commonly used antiseptics against SARS-CoV-2 in future clinical trials. However, the use of chlorhexidine, hydrogen peroxide, PVP-I and cetylpyridinium chloride in contrasting the spread of Covid-19 is described as advisable and substantial in different publications.

Este artículo se encuentra disponible en la siguiente URL: https://www.mdpi.com/1996-1944/14/21/6272 En este artículo de investigación también participan: Avijit Banerjee y Hervé Tassery. Este artículo de investigación pertenece al número especial "Bioactive Materials in Dentistry". The contemporary approach for operative caries management emphasizes personalized interventions for each patient, dependent upon the individual’s caries susceptibility/risk, the stage of the carious lesion and its activity. The clinician’s challenge is to optimize the extent of cavity preparation and the choice of dental restorative biomaterials, appreciating the benefits offered by ionreleasing restorative materials. There is a growing application of bioactive/bio-interactive materials in minimally invasive operative dentistry, as they may help with tissue recovery by ion release. In case of moderate or extensive occlusal cavitation, the clinical criteria include the individual caries susceptibility and carious lesion activity. In high caries risk cases, ion-releasing biomaterials (IRB) can be used, as well as for active carious lesions. In proximal lesions, the clinical criteria include the individual caries susceptibility, the lesion activity and presence of cavities with little or no enamel at the gingival margin. This article aims to discuss the restorative ion-releasing options, according to different clinical situations, and the caries susceptibility to manage cavitated carious lesions in permanent adult teeth.

Objectives: We assessed the cost-effectiveness of two amalgam alternatives, glass hybrid (GH) and composite (CO) in a multi-country randomized controlled split-mouth trial. Materials: University clinics in Croatia, Serbia, Italy and Turkey participated. Pairs of GH (EQUIA Forte, GC) and a nano-hybrid CO (TetricEvoCeram, IvoclarVivadent) were randomly placed in occlusal-proximal two-surfaced cavities in permanent molars of adults (n = 180/360 patients/molars). We used 3-years interim data for this evaluation. FDI-2 criteria were applied and teeth requiring repair, re-restoration, endodontic treatment or extraction recorded. Our outcome was the time until any or major complications (requiring endodontic treatment or extraction) occurred. Costs were calculated in US Dollar (USD) 2018, with the local currencies being converted using Purchasing Power Parities. To estimate initial and re-treatment costs, a payers’ perspective was taken and direct medical costs estimated from fee item catalogues. Incremental-cost-effectiveness ratios (ICER) were used to express the cost difference per gained or lost effectiveness. Results: Overall costs were lower for GH than CO in Croatia, Turkey and Serbia, while this difference was minimal in Italy. GH tended to survive longer than CO in Croatia and Italy, and shorter in Serbia and Turkey; overall survival time was not significantly different (p = 0.67/log-rank). The cost-effectiveness differences indicated CO to be more expensive at limited (ICER: 268.5 USD/month without any complications) or no benefit at all (-186.2 USD/month without major complications). Conclusions: GH was less costly than CO both initially and over 3 years. Efficacy differences were extremely limited. Clinical significance: Given their low initial costs and as efficacy between GH and CO did not differ significantly, GH had a high chance of being more cost-effective within this specific trial. © 2021 The Author(s), Sveu?ilište u Zagrebu GC Europe, This original study was supported by a grant from the University of Zagreb (2015 and 2017) . We thank GC Europe for providing the materials free of charge. Design, conduct, and reporting of this study was fully independent., This original study was supported by a grant from the University of Zagreb (2015 and 2017). We thank GC Europe for providing the materials free of charge. Design, conduct, and reporting of this study was fully independent.

The objective of this study was to evaluate the efficacy of reciprocating instruments in the removal of bioceramic and epoxy resin-based sealers using micro-CT analysis. Root canals of 40 extracted human teeth were instrumented with a size R25 Reciproc instrument. Specimens were randomly divided into two groups (n = 20) according to the root canal filling material. In the first group, root canals were obturated with AH Plus sealer and Reciproc R25 gutta-percha. In the second group, a combination of bioceramic gutta-percha (TotalFill BC) and bioceramic sealer (TotalFill BC) was used. After one week, the retreatment of all specimens was performed using Reciproc instruments. To analyze the differences in the filling remnants, specimens were scanned in a micro-CT device after obturation and after the retreatment procedure. Statistical analysis was performed using the Mann–Whitney U test (p &lt, 0.05). A combination of bioceramic sealer and bioceramic gutta-percha was more effectively removed from canals using a reciprocating instrument, with a filling remnants volume of 4.01 ± 3.13 mm3, in comparison to the combination of epoxy resin-based sealer and gutta-percha (6.96 ± 2.70 mm3) (p &lt, 0.05). A reciprocating instrument was more effective in removing bioceramic sealers than epoxy resin-based sealers, although none of the root canal filling materials were completely removed from the root canals.

Objectives: We assessed the long-term cost-effectiveness of glass hybrid (GH) versus composite (CO) for restoring permanent molars using a health economic modelling approach. Methods: A multi-national (Croatia, Serbia, Italy, Turkey) split-mouth randomized trial comparing GH and CO in occlusal-proximal two-surfaced cavities in permanent molars (n=180/360 patients/molars) provided data on restoration failure and allocation probabilities (i.e. failure requiring re-restoration, repair or endodontic therapy). Using Markov modelling, we followed molars over the lifetime of an initially 12-years-old individual. Our health outcome was the time a tooth was retained. A mixed-payers' perspective within German healthcare was used to determine costs (in Euro 2018) using fee item catalogues. Monte-Carlo-microsimulations, univariate and probabilistic sensitivity analyses were conducted. Incremental cost-effectiveness ratios (ICER)s and costeffectiveness-acceptability were quantified. Results: In the base-case scenario, CO was more effective (tooth retention for a mean (SD) 54.4 (1.7) years) but also more costly (694 (54) Euro) than GH (53.9 (1.7) years; 614 (56 Euro). The ICER was 158 Euro/year, i.e. payers needed to be willing to invest 158 Euro per additional year of tooth retention when using CO. In a sensitivity analysis, this finding was confirmed or GH found more effective and less costly. Conclusion: CO was more costly and limitedly more effective than GH, and while there is uncertainty around our findings, GH is likely a cost-effectiveness option for restoring permanent molars. Clinical significance: When considering the long-term (life-time) cost-effectiveness, GH showed cost savings but CO was limitedly more effective. Overall, cost-effectiveness differences seems limited or in favour of GH., University of Zagreb, This original study was supported by a grant from the University of Zagreb (2015 and 2017).

Objectives The aim of this study was to evaluate the effect of photon induced photoacoustic streaming (PIPS) technique in combination with EDTA on bond strength of gutta-percha/AH Plus and Resilon/RealSeal SE root canal fillings to root dentine. Materials and Methods Forty freshly extracted human maxillary anterior teeth with intact straight roots, were instrumented endodontically with rotating ProTaper instruments and randomly divided into two experimental groups. In group 1 (n = 20), root canals were rinsed for 1 minute with 2 ml of 17% EDTA. In group 2 (n = 20), Er:YAG laser, with a 14 mm long 400 μ diameter tapered PIPS tip, was used for 1 minute with 2 ml of 17% EDTA. The laser parameters used were: 20 mJ per pulse, 15 Hz, 50 microsecond. In each experimental group, half of the root canals (n = 10) were obturated with gutta-percha/AH Plus and other half (n = 10) with Resilon/RealSeal SE. A micropush-out test was performed on sectiond specimens of the filled roots using a universal testing machine and resistance to failure plus failure modes were determined. Results Both gutta-percha/AH Plus groups had higher bond strength to root dentin than the Resilon/RealSeal SE groups (P 0.05). Conclusion Within the limitations of this study, it was found that the application of the PIPS technique did not have an affect on the push-out bond strength of Resilon/RealSeal SE root canal filling to dentin nor on the gutta-percha/AH Plus. A significant difference in bond strength was noted between the two root canal filling materials. Lasers Surg. Med. © 2016 Wiley Periodicals, Inc.

The primary objective of this in vitro study was to evaluate the efficiency of removal of cariogenic bacteria and carious dentin by ablation using two lasers: fluorescence-feedback controlled (FFC) Er:YAG laser and different pulses of Er:YAG laser based on variable square pulse technology (VSPt). The secondary objective was to measure the temperature during laser ablation of carious tissue. Seventy-two extracted human molars were used in this study. Sixty teeth with carious dentin were randomly divided into four experimental groups according to the treatment for caries removal: group 1: 400 ms (FFC group) ; group 2: super short pulse (SSP group, 50 ms pulse) ; group 3: medium short pulse (MSP group, 100 ms pulse) ; group 4: short pulse (SP group, 300 ms pulse) and one positive control group with no treatment. Twelve teeth without carious lesion were used as a negative control group. After caries removal, swabs were taken with cotton pellets and real-time PCR analysis was performed. During caries ablation, a thermal infrared camera was used to measure the temperature changes. In all experimental groups, specimens were free of bacterial contamination after the treatment. In the SSP, MSP and SP groups, temperatures measured during caries ablation were significantly higher compared to temperatures in the FFC group (Po0.001). In this in vitro study, laser treatment for removal of carious dentin and cariogenic bacteria was an efficient treatment modality without causing excessive temperatures that might adversely affect pulp vitality.

Objective The aim of this study was to evaluate the bond strength of three calcium silicate- based root-end filling materials. Materials and methods The root canals of 30 single-rooted teeth were endodontically treated ; their root ends were resected and root-end cavities were prepared using ultrasonic tip.Theteethwererandomlydividedintothreegroupsa ccordingtothematerial:(1)Micro- Megamineraltrioxideaggregate (MM- MTA), (2) Biodentine, and (3) TotalFill root repair material (RRM). Push-out test was performed using universal testing machine, and failure mode was analyzed by stereomicroscope. The data were statistically analyzed using KruskalWallis and Man-Whitney post hoc tests. All p values

The primary objective of this study was to compare the dentin ablation volume and ablation rate of quantum square pulse (QSP), using two different pulse energy settings plus a new digitally controlled dental laser handpiece (X-Runner), with those of variable square pulse (VSP), using three different pulse durations. The secondary objective was to examine, by scanning electron microscopy (SEM), the surface effects of ablation with the different Er:YAG laser modes on the dentin surfaces.The available literature has limited data on the efficiency of different operating modes, pulse durations, and the new digitally controlled handpiece of the Er:YAG laser on human dentin.Freshly extracted human molars (n = 72) were divided into two experimental groups (n = 36 each): (1) QSP group, and (2) VSP group. Each group was randomly divided into three subgroups (n = 12 each). In the QSP group, preparations in dentin were performed using 250 and 500 mJ of pulse energy with the conventional handpiece, and with the X-Runner handpiece set at 250 mJ pulse energy. In the VSP group, cavity preparations were performed using three pulse variables: super short pulse (SSP), micro short pulse (MSP), and short pulse (SP). Cavity preparations were made in dentin at time intervals of 1, 2, and 5 sec. A laser triangulation profilometer was used to determine cavity volumes. Surface analysis of the ablated dentin specimens was performed by SEM.For time intervals of 1 and 2 sec, ablated volume and ablation rate for QSP-500 mJ were significantly higher than for all other groups (p 0.0001). For the 5-sec time interval, X-Runner and QSP-500 mJ were the most efficient in dentin ablation (p 0.0001). Dentin surfaces were free of smear layer in all groups.The most efficient modes of dentin ablation in the study were the QSP-500 mJ and X-Runner groups. Dentin surfaces were free of smear layer in all groups.

The aim of the study was to evaluate the ablation rate of caries in dentin with fluorescence-feedback controlled Er:YAG, Variable Square Pulse technology (VSPt) based Er:YAG working in different pulse durations, and steel bur.Sixty human molar teeth with caries in dentin, extracted for periodontal reasons, were selected for this study. All selected teeth were randomly divided into five groups, each containing twelve specimens: (1) group FFC, fluorescence feedback-controlled Er:YAG laser; (2) group SSP (super short pulse: 50 μs); (3) group MSP (medium short pulse; 100 μs); (4) group SP (short pulse; 300 μs); and (5) group SB, steel bur in a slow-speed hand piece. A profilometer was used to determine the volume of the ablated caries in dentin. The clinical and real ablation rates of caries in dentin were calculated. Two specimens from each experimental group were selected randomly and subjected to SEM examination.The volumes of the ablated caries in dentin in the SSP and SB groups were statistically significantly different in comparison with other experimental groups (p0.05). The clinical and real ablation rate of caries in dentin was the highest for the SSP group (0.15±0.05 and 0.17±0.05 mm(3)/sec, respectively) and statistically significantly different in comparison with the MSP and SB groups (p0.05). The SB and FFC groups revealed a dentin surface with a smear layer and closed dentinal tubules on SEM micrographs. In the SSP, MSP, and SP groups, an irregular surface without a smear layer was found.Taking into consideration the experimental conditions of the present study, SSP was the most efficient in ablation of caries in dentin, providing a smear layer-free surface with open dentinal tubules.

Baraba A, Želježic D, Kopjar N, Mladinic M, Anic I, Miletic I. Evaluation of cytotoxic and genotoxic effects of two resin-based root-canal sealers and their components on human leucocytes in vitro. International Endodontic Journal, 44, 652–661, 2011. Abstract Aim To evaluate the in vitro genotoxicity and cytotoxicity of two resin-based root canal sealers and to determine the type of cell death they induce. Methodology The sealers tested were Epiphany and RealSeal. Each component of the material (Epiphany Primer, Epiphany Thinning Resin, Epiphany Sealant, RealSeal Primer, RealSeal Thinning Resin and RealSeal Root Canal Sealant), components in permutual combinations and all components mixed together were tested on human peripheral blood leucocytes using ethidium bromide/acridine orange viability staining and comet assay. Simultaneously, untreated negative control cultures were analysed in the same manner. DNA damage was evaluated following 4 h of treatment and after 24 h in the absence of the components of the materials. Results After 4 h of treatment, except thinning resin, each individual component and the different combinations of components induced a significant increase in DNA migration ability (P

The purpose was to measure and analyse the vertical force and torque developed in the wider and narrower root canals during hand ProTaper instrumentation. Twenty human incisors were divided in two groups. Upper incisors were experimental model for the wide, while the lower incisors for the narrow root canals. Measurements of the force and torque were done by a device constructed for this purpose. Differences between the groups were statistically analysed by Mann–Whitney U-test with the significance level set to P

Epiphany/Resilon™ und GuttaFlow® sind neu entwickelte Methoden zur Obturation des Wurzelkanalsystems. Epiphany/Resilon™ ist ein thermoplastisches, synthetisches Wurzelfullungsmaterial auf Polymerbasis, mit dem eine Haftung am Dentin der Wurzelkanalwand ermoglicht werden soll. GuttaFlow® ist ein Kaltfullsystem fur Wurzelkanale, welches Sealer und Guttapercha in einem Produkt vereint. Es wurde untersucht, ob mit Epiphany/Resilon™ oder GuttaFlow® eine dichtere Wurzelkanalfullung erzielt werden kann als mit der lateralen Kondensation von Guttapercha. Fur diese Studie wurden 45 extrahierte menschliche Zahne verwendet, welche zuerst alle chemomechanisch aufbereitet wurden und anschliesend in drei Gruppen aufgeteilt und mit folgenden Materialien gefullt: Guttapercha/AH Plus, Epiphany/Resilon™ und GuttaFlow®. Beim Farbstoffpenetrationstest wurden alle Zahne bei 400 U/min 3 Min. lang mit 1 ml 2 % Methylenblau zentrifugiert und 3 Tage in Salpetersaure 65 % gelegt, um sie aufzulosen. Danach wurde die Menge des in Losung gegangenen Farbstoffs im Photometer bestimmt. Wurzelkanalfullungen mit Epiphany/Resilon™ zeigten weniger Farbstoffpenetration als Wurzelkanalfullungen mit lateraler Kondensation von Guttapercha und GuttaFlow®. Epiphany/Resilon™ ist hervorragend als Wurzelkanalfullmaterial geeignet.

Lasers are becoming widely used in medicine and dentistry due to their beneficial effects such as: coagulation properties (less postoperative bleeding), less pain and edema. Lasers also allow good and rapid healing, a very low level of discomfort both during and after intervention and a rapid disappearance of symptoms.Laser technology has certain advantages such as accuracy of the incision, absence of vibration and manual pressure during use ; this is also true for Er: YAG laser application. Due to laser positive coagulation effects during surgical procedure, better sight of the work field is obtained.Lasers have played an integral part in the evolution of oral and maxillofacial surgery (OMS) ; and rapidly became the standard of care for many procedures performed by oral surgeons.The reason for this transition is simple: many procedures can be executed more efficiently and with less morbidity using lasers when compared with scalpel, electrocautery or high frequency devices.Laser surgery has emerged as an established method in advanced medicine. Laser- induced remote tissue treatment provides a number of advantages: controllable coagulation and cutting of surgical tissues with wavelength tissue-specific cutting efficiency.

Background and Objectives Variable square pulse (VSP) Er:YAG laser should be quicker than older Er:YAG lasers. The objectives were: (1) comparison of VSP laser and mechanical handpiece efficacy for apicectomy and (2) determination of optimal pulse width/energy/frequency combination. Study Design/Materials and Methods Sixty extracted, single-rooted mature human teeth with round apical parts were instrumented, root filled, cleaned, and divided into four groups. Apical 2 mm of each root were apicectomized with mechanical handpiece and Er:YAG laser with three different settings (LaserA = 200 mJ/300 microseconds/ 8 Hz; LaserB = 200 mJ/100 microseconds/8 Hz; LaserC = 380 mJ/100 microseconds/20 Hz). Timing results were statistically compared. Results LaserC was the most efficient setting. Differences between groups were significant except between LaserC–Mechanical and LaserA–LaserC (P

AIM To examine the use of an Nd:YAG laser in removing gutta-percha fillings from root canals when used in conjunction with eucalyptol, dimethylformamide (DMF) or no solvent. METHODOLOGY Root-canal fillings (sealer and gutta-percha) were removed with laser irradiation of 20 Hz/1.5 W from 30 roots randomly divided in three groups. In group 1, the solvent was eucalyptol; in group 2, the solvent was DMF; and in group 3, no solvent was used. Laser irradiation was performed until the temperature measured on the root surface increased by 4 degrees C over room temperature. The treatment was deemed complete when the apical foramen was reached with the optical fibre and a reamer. The samples were split longitudinally, and the area of remaining gutta-percha on the root-canal walls was determined with the aid of a computer program. The total number of laser pulses to achieve length and the highest temperature recorded was determined for each tooth. The results were statistically analysed using Student's t-test (P < 0.05) for independent samples. RESULTS The average temperature increase in group 1 was 9.17 +/- 0.56 degrees C; in group 2, 9.56 +/- 0.28 degrees C; and in group 3, 8.29 +/- 0.41 degrees C. The shortest time to achieve length was in group 3 (6.4 +/- 0.49 min), then in group 1 (6.7 +/- 0.85 min) and group 2 (7.05 +/- 0.79 min). The area of remaining gutta-percha was the largest in group 2 (6.13 +/- 5.76%), whilst the smallest was for group 3 (4.69 +/- 4.03%), but the difference was not statistically significant. The number of pulses was not statistically significant between the groups. CONCLUSIONS Use of an Nd:YAG laser alone is capable of softening gutta-percha. The addition of solvents did not improve the retreatment, either in terms of the time required for the procedure or in terms of the area of remaining gutta-percha on root-canal walls.

Aim The aim of this study was to examine the apical sealing ability of five root canal sealers using a fluid transport model. Methodology A comparison of root canal scalers AH26, AH Plus, Diaket, Apexit, and Ketac-Endo were tested on 60 single-rooted teeth. The coronal part of each tooth was removed at the amelo-cemento junction, and also 3 mm of the root tip. Root canals were instrumented using the 'step-back' technique with Gates Glidden drills and irrigated with 2.5% NaOCl. The specimens were divided into five groups of 10 samples each and filled with test materials and gutta-percha points by the cold lateral condensation technique. Ten teeth were used as a control group, out of which five served as negative and five as positive controls. The leakage was measured by the movement of an air bubble in a capillary glass tube connected to the experimental root section. Results The differences in leakage amongst Ketac-Endo (0.318 microL: SD 0.084), AH26 (0.319 microL; SD 0.075), AH Plus (0.330L; SD 0.085) Apexit (0.360 microL; SD 0.127) and Diaket (0.387 microL; SD 0.140) were not statistically significant (P > 0.05). Conclusions Under the conditions of this study, all five sealers produced a satisfactory seal.

The aim of the study was to evaluate the microtensile bond strength of a composite resin to dentin modified with three different pulse durations of the Er:YAG laser based on variable square pulse technology and with one self-etch adhesive.The entire occlusal enamel was removed to obtain flat dentin surface for 48 human molar teeth. The teeth were randomly divided into four experimental groups (n=12 per group), according to the pretreatment of dentin: (1) control group; (2) super short pulse (SSP) (50 μsec); (3) medium short pulse (MSP) (100 μsec); and (4) short pulse (SP) (300 μsec) with Er:YAG laser. The energy of the laser used was 80 mJ with average power of 0.8 W. The microtensile bond strength was tested with a universal testing machine. Two specimens from each experimental group were subjected to scanning electron microscopic (SEM) examination, to observe the irradiated surface.Dentin surface treated with SSP showed significantly lower microtensile bond strength values (24±9.8 MPa) in comparison with the control group and SP group (35.3±12.8 and 32.9±10.7 MPa, respectively), (p0.05). The MSP and SP groups did not show any statistically significant difference in microtensile bond strength in comparsion with the control group (p0.05).The use of SP and MSP of the Er:YAG laser with one step self-etch adhesive does not impair or improve the microtensile bond strength in dentin, whereas SSP may not be suitable for dentin surface treatment prior to bonding procedures.

Purpose: High-energy lasers have been proposed as an alternative to the conventional surgical drill in oral and maxillofacial surgery. The aims of this study were to compare thermal changes of the bone surface, procedure time, and volume of the removed bone after drilling with an erbium (Er):yttriumaluminum-garnet (YAG) laser versus a low-speed surgical drill. The bone sections were observed under light microscopy and examined histologically. Material and Methods: Thirty bone blocks were prepared from porcine ribs. On each block 2 holes (tunnel preparations) were performed using a low-speed, 1.0-mm-wide, surgical pilot drill and an Er:YAG laser (pulse energy, 1,000 mJ; pulse duration, 300 s; frequency, 20 Hz). The temperature induced by the preparation techniques was measured using an infrared camera. The removed bone volume was calculated by a modified mathematical algorithm. The time required for the preparation was measured with a digital stopwatch and a time-measurement instrument integrated within the computer program. The cortical and spongiose surfaces of the specimens were examined microscopically and histologically under a light microscope with a high-resolution camera. Results: The Er:YAG laser removed significantly more bone tissue than the drill (P .01) in a significantly shorter time (P .01). The temperature was statistically lower during the laser preparation (P .01). Cavities prepared with the laser were regular with clear sharp edges and knifelike cuts. In the drill group, the preparations exhibited irregular edges full of bone fragments and fiberlike debris. Histologic examination of the laser sides showed a 30-m-thick altered sublayer. The tissue in the drill group was covered with a smear layer without any alterations. Conclusions: The Er:YAG laser produced preparations with regular and sharp edges, without bone fragments and debris, in a shorter time, and with less generated heat. Thermal alterations in the treated surface were minimal. © 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70:2515-2521, 2012

Aim To assess Croatian dentists’ restorative treatment decisions on approximal caries lesions, including treatment threshold and restorative methods and materials. Methods Croatian translation of the questionnaire assessing restorative treatment decisions on approximal caries, previously validated and used in Norway and Sweden, was distributed to a random sample (n = 800) of Croatian dentists. A total of 307 (38%) dentists answered the questionnaire. The assessed variables were treatment threshold for hypothetical approximal caries lesion and the most favored types of restorative techniques and materials. Results A third of the respondents (39%, 95% confidence interval [CI], 34-44%) would intervene for an approximal caries lesion at the dentin-enamel junction, but a larger proportion (42%; 95% CI, 36-48%) would treat a caries lesion confined to the enamel. For restoration of approximal caries, the majority (66%; 95% CI, 61-71%) would use composite resin. Conclusion Croatian dentists tend to restore approximal caries lesions when the lesions are confined to the enamel and their development can still be arrested.

Objective: The aim of this study was to examine the temperature changes in the pulp chamber during cavity preparation with Er:YAG laser ( =2940 nm) with a very short pulse (VSP). Materials and methods: Nine groups of 10 intact molars were used. One root of each sample was amputated and thermocouple of thermometer (Fluke 52, Fotronic, USA) was inserted in the chamber. Class V cavity preparation in enamel was prepared, and then the preparation was proceed in dentine. Enamel was lased with 400 mJ, 360 mJ and 320 mJ in contact mode using the very short pulse with duration of 100  s. Diameter of fiber tip was 950  m. Frequencies of 15 Hz, 12 Hz and 10 Hz were used, and total time of irradiation was 10 s. Dentine was irradiated with 340 mJ, 280 mJ and 200 mJ and 10 Hz, 8 Hz and 5 Hz during 7 s. Cooling was done with water spray (73 psi / 50 mL/min). The differences were tested by MANOVA and Bonforroni post hoc test. Results: The highest rise in temperature in the pulp was achieved after enamel irradiation by 400 mJ/15 Hz (1.99  0.28 C), and the lowest for the enamel after irradiation by 320 mJ/10 Hz (0.70  0.18 C). In dentine the highest temperature increase was achieved with 340 mJ/10 Hz (1.37  0.42 C), and the lowest with 200 mJ/5 Hz (0.43  0.18 C). Two-way interaction for enamel and dentine showed that influence of energy on temperature increase is stronger than the influence of frequency. Conclusion: Cavity preparation with Er:YAG laser using a VSP mode in vitro did not caused significant increase of temperature in the pulp chamber of human molars.

To evaluate the effect of leakage on differences in genotoxicity of root canal sealers ex vivo according to their main components using two different cytogenetic assays.Six materials of different composition (GuttaFlow, Epiphany, Diaket, IRM, SuperEBA and Hermetic) were tested on human peripheral blood lymphocytes using the comet assay and chromosomal aberration analysis. Prepared materials were eluted in physiological solution for 1 h, 1 day, 5 and 30 days. Thereafter cultures were treated with 8 microg, 4 microg and 2 microg of each sealer. Frequencies of chromatide and chromosome breaks and accentric fragments were determined. Comet assay was used to evaluate primary DNA damage by measuring tail length and tail intensity. Chi-square, Fisher's PLSD (Protected Least Significant Difference) and Kruskall-Wallis non parametric tests were used for statistical analysis.After 1-h elution only the highest dose of Diaket, Hermetic and SuperEBA significantly (P = 0.035, P = 0.048, P = 0.037 respectively) affected the measured cytogenetic parameters. The migration ability of DNA was more strongly affected than induction of chromosomal aberrations. After elutions longer than 24 h none of the tested sealers exhibited a genotoxic effect.Under the conditions used in the study all sealers had acceptable biocompatibility in terms of genotoxicity.

Objectives: The objectives of this study were: (1) to compare the capability of enamel ablation for the Variable Square Pulse technology (VSPt) based Er:YAG laser working in maximum speed (MAX) mode, (1000 mJ/300 µ ; ; sec/20Hz), and the high-speed handpiece, (2) to compare the capability of dentin ablation for the VSPt based Er:YAG laser working in MAX mode and the low-speed handpiece, and (3) to analyze in vitro effects of Er:YAG ablation of enamel and dentine surfaces using SEM. Background Data: A VSPt based Er:YAG laser operating in MAX mode should be appropriate for achieving the maximum ablating speed in hard dental tissues. Materials and Methods: The experiment was conducted on extracted human molar teeth that were cleaned and sterilized. Cavity preparations were made in hard dental tissues with the VSPt Er:YAG laser in MAX mode, high-speed handpiece in enamel and low-speed handpiece in dentin, at different time intervals. A laser triangulation profilometer was used to determine cavity volumes. The cavity surfaces of five specimens were examined by SEM. Results: The Er:YAG laser removed a 3.3 times larger volume of enamel in comparison to the high-speed handpiece, for the same period of time. In dentin, the Er:YAG laser removed 8-18 times more volume when compared to the steel bur, for the same period of time. The Er:YAG ablation rate in dentin was faster than in enamel. SEM of laser prepared cavities showed a well-defined surface, free of the smear layer. Conclusions: The VSP-technology based Er:YAG laser, working in MAX mode, is a more efficient alternative to mechanical drills for enamel and dentine ablation.

Background The aim of this study was to perform a clinical assessment of the association between oral lichenoid reactions (OLR) and amalgam restorations and to determine the salivary concentrations of interleukin-6 (IL-6) and IL-8 before and after replacement of the amalgam restorations. Methods The study included 20 patients with OLR and 20 healthy volunteers, who were examined between 2001 and 2005 at the Oral Medicine Unit of the Medical Faculty University of Rijeka. All patients were skin patch tested by an experienced physician. Saliva samples were collected, prepared and analysed for IL-6 and IL-8 concentrations using enzyme-linked immunosorbent assay. Results Sixteen out of 20 patch-tested patients showed a sensitization to inorganic mercury or amalgam. Total replacement of all amalgam fillings was carried out on 20 patients with fillings based on composite resin, gold, porcelain or a combination of these. Sixteen out of 20 patients showed complete healing of OLR; three patients had marked improvement, whereas one patient showed no improvement. Levels of IL-6 detected before replacement were significantly higher than IL-6 levels following the replacement ( P = 0.003). The IL-8 levels measured before replacement procedure were significantly higher than the IL8 levels after replacement of the fillings ( P < 0.001). Conclusions On the basis of clinical observations, restorative therapy resulted in tissue healing. Following the replacement of amalgam fillings with fillings based on other restorative materials, levels of both IL-6 and IL-8 shifted towards normal, as measured in healthy subjects.

Aim.The aim of this study was to determine tumor necrosis factor-alpha (TNF-α) levels in periapical exudates and to evaluate their relationship with radiological findings.Methodology.Periapical exudates were collected from root canals of 60 single-rooted teeth using absorbent paper points. TNF-αlevels were determined by enzyme-linked immunosorbent assays. The samples were divided into three groups according to the periapical radiolucent area.Results.Nonparametric Kruskal-Wallis test revealed significant differences between TNF-αconcentrations in control group (40,57±28, 15 pg/mL) and group with larger radiolucent areas (2365,79±582, 95 pg/mL), as well as between control and canals with small radiolucent areas (507,66±278, 97) (P<.05).Conclusions.The levels of TNF-αincrease significantly in teeth with periapical pathosis, from smaller to bigger lesions. This research and its results have shown that objective analysis of the TNF-αlevels enables establishment of a relationship between different concentrations of TNF-αand different radiological changes.

Aim. The aim of this study was to evaluate the presence of the cytokines tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in human periapical lesions.Subjects and methods. Samples were obtained from three groups of teeth: symptomatic teeth, asymptomatic lesions, and uninflamed periradicular tissues as a control.Results. TNF-alpha levels were significantly increased in symptomatic lesions compared to control. Group with asymptomatic lesions had significantly higher concentrations compared to control. There were no significant differences in TNF-alpha levels between symptomatic and asymptomatic lesions. In group with symptomatic lesions, IL-6 levels were significantly higher than in group with asymptomatic lesions. The IL-6 levels in symptomatic group also showed significantly higher concentration in comparison with control group. In asymptomatic group, the IL-6 level had significantly higher concentrations compared to control.Conclusion. These results indicate that symptomatic lesions represent an immunologically active stage of disease, and asymptomatic lesions are the point from which the process advances toward healing.

The aim of this study was to determine the leakage of SuperEBA and intermediate restorative material (IRM) in root canal samples, with or without orthograde filling, by evaluating bovine serum albumin (BSA) microleakage using spectrophotometry. Thirty-five single-rooted teeth were divided into five groups, instrumented, and had apices resected. Root-end cavities in groups I and II were filled with SuperEBA and IRM. The samples from the groups III, IV, and V were filled with gutta-percha and sealer. In groups IV and V, root-end cavities were filled with SuperEBA and IRM. After 60 days, the greatest microleakage of BSA was observed in group II (4.1 +/- 0.0011 ng), followed by group III (3.4 +/- 0.0064 ng), and then group I (2.6 +/- 0.0019 ng). Samples from groups IV and V leaked the least (0.7 +/- 0.0014 ng). Significantly less leakage (p < 0.05) occurred in samples filled with orthograde and root-end fillings than did in samples filled only with an orthograde approach and the samples with IRM root-end fillings.

Objective To determine the prevalence and distribution of dilaceration in all tooth groups by using radiographs. Study design The sample included 953 periapical intraoral radiographs and 488 panoramic radiographs from different caucasian patients. The ages of the patients ranged from 18-65 years. Dilaceration of the root was detected by measuring the degree of deviation from the long axis (deviation l 90°), and evaluating the “bull’s eye” appearance. The prevalence of root dilaceration for each tooth-type was expressed in percentages. Results The teeth showing the highest prevalence of root dilaceration were mandibular third molars (24.1%), maxillary first molars (15.3%), second molars (11.4%) and third molars (8.1%). In the mandible, dilacerations were less common than in the maxilla. Conclusions In the adult population examined in Croatia, dilaceration was most frequently found to affect posterior teeth.

The aim of this in vitro study was to compare the sealing effectiveness of the Erbium:YAG laser to the sealing effectiveness of an ultrasonic device in the preparation of similar retrograde cavities using different retrograde filling materials. After root-canal instrumentation and filling, apices of 60 single-rooted teeth were resected. Retrograde class I cavities 3 mm deep were prepared using an ultrasonic device (group A) and Er:YAG laser (group B). An ultrasonic unit was used with CT-5 retrotip at the frequency of 32 KHz. Laser beam parameters were a pulse of very short duration (100 μs), energy of 280 mJ, and repetition rate of 10 Hz. Cavities of each group of 10 samples were filled with mineral trioxide aggregate (MTA), Super-EBA, and IRM. Microleakage was measured using a fluid transport model. The results showed that cavities prepared with Er:YAG laser have significantly lower microleakage for all tested materials.

The aim of this study was to evaluate the cytotoxicity of the root canal sealers RoekoSeal Automix (RSA) and AH Plus in vitro on human cervical carcinoma (HeLa) cells and mouse skin fibroblasts (L929). The sealers were covered with a 3 × 10 4 cell suspension 1 h, 24 h, 48 h, 7 days and 1 month after mixing. Four samples and respective controls without sealer were prepared. After 5 days of incubation, the number of cells was determined using an electronic counter; the number of viable cells was determined under light microscopy following the addition of nigrosin dye. The experiment was repeated twice for each sealer and each period. AH Plus was significantly more cytotoxic after 1 h, 24 h, and 48 h, compared to the 7 day and 1 month setting period on both cell lines. RoekoSeal had no cytotoxic effect on either cell line at any setting time.

The aim of this study was to develop a three-dimensional (3D) finite element model (FEM) of the first maxillary premolar in order to compare the stress profiles in the buccal and palatal cervical regions. The 3D geometry of the tooth was reconstructed, the solid model was transferred into a finite element program where a 3D mesh was created, and the stress distribution analysis was performed. Two typical cases have been considered: the tooth under normal occlusion (case I) and the tooth under malocclusion (case II). In case I, larger compressive stresses were found in the cervical enamel and dentine. Tensile stresses were found in the fissure system, adjacent area, and at the vestibular surface of the buccal cusp. The peak values for the principal stress ranged from -259 to +2.25 MPa in the cervical areas. In the case II, larger compressive stresses were found in the palato-cervical enamel and dentine. Tensile stresses were found inside the enamel in the fissure system, adjacent area, at the vestibular surface of the buccal cusp, and in the bucco-cervical enamel. The peak values for the principal stress ranged from -501.947 MPa in palatal region to +82.4 MPa in the buccal region This study implies a role of occlusal forces in development of non-carious lesions. In the case of malocclusion, tensile stresses generated on the cervical areas were higher compared with the stresses generated in the case of normal occlusion and it is probably capable of producing non-carious cervical lesion.

Objective. The aim of this study was to evaluate the expression of estrogen receptor (ER)-α in human pulp tissue. Study Design. Tissue samples were collected from 51 teeth extracted for orthodontic reasons or from endodontically treated teeth. Immunohistochemical staining was performed with mouse antihuman ER-α 1D5 by using the alkaline phosphatase antialkaline phosphatase technique. Immunohistochemical reactivity was semiquantitatively assessed and graded on an intensity scale of 0 to 3. Results. ERs were found in odontoblasts, endothelial cells, and Schwann cells. By means of statistical analysis, ERs were found to be common in odontoblasts (1.3-1.6) and in endothelial cells (1.0-1.4), whereas in Schwann cells they were somewhat rare (0.7-1.1). Difference in expression of ERs was not found among patients in different age groups. With respect to sex, a difference in reactivity was observed in Schwann cells, which showed higher reactivity in female pulps. Conclusion. The results of this study confirm the expression of ER-α in the human dental pulp. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:340-4)

Background The aim of this study was to determine concentrations of tumor necrosis factor-α (TNF-α) in normal, painful, and asymptomatic human dental pulps. Methods Pulps were obtained from three groups of teeth, including healthy teeth, asymptomatic teeth with caries and/or large restoration, and symptomatic teeth with clinical diagnosis of irreversible pulpitis. Pulpal tissues were collected, prepared, and analyzed for TNF-α concentration by ELISA technique. Results Nonparametric Kruskal-Wallis test revealed significant differences between TNF-α concentration in normal samples (64.01 ± 53.12 pg/g) and irreversible symptomatic pulpal tissue (1,962.99 ± 1,288.75 pg/g), between irreversible symptomatic and asymptomatic (1,120.09 ± 649.72 pg/g), and between normal and irreversible asymptomatic pulpal tissue ( p = 0.000). Conclusions TNF-α may be an objective marker for determining extent of pulpal inflammation associated with irreversible pulpitis.

A fluid transport model study was used to compare the sealing ability of five root canal sealers (AH26, AH Plus, Apexit, Diaket, and Ketac-Endo) on 60 single-rooted teeth after 1 yr of storage. The root canals were prepared with Gates Glidden drills by using a step-back technique before lateral condensation of gutta-percha with the tested sealers. The specimens were stored in saline solution for 1 yr at 37 degrees C. The leakage was measured by the movement of an air bubble in a capillary glass tube connected to the experimental root section. Apexit (0.490 microl) leaked significantly more than AH Plus (0.378 microl) and Ketac-Endo (0.357 microl), whereas AH26 (0.390 microl) and Diaket (0.429 microl) showed no significant difference from either Apexit or from AH Plus and Keto-Endo.

The aim of this study was to evaluate the sealing ability of AH26 and AH Plus on the bacterial and fungal penetration of obturated root canals. The experiment was conducted on 100 single-rooted teeth. Eighty teeth were randomly divided into two groups of 40 teeth each and obturated with gutta-percha using either AH26 or AH Plus sealer. Twenty teeth were used as a control group, out of which 10 served as negative and 10 as positive controls. The root surface of each sample, except the apical 2 mm, was covered with two layers of nail varnish. The teeth were inserted into Eppendorf plastic tubes and sealed with cyanoacrylate stick and resine. The system was sterilized using ethylene oxide gas and placed in a glass bottle containing sterile Schaedler broth. Streptococcus mutans, Streptococcus mitis, Prevotella melaninogenica and Lactobacillus acidophilus were added in one group, and Candida albicans was added in the other group for both materials. The medium with microorganisms was changed every 7 days. Every 72h observation was made for bacterial or fungal growth for the tested period of 90 days. Leakage in the experimental teeth varied from 7 to 87 days. Leakage was present in 47% of all samples. From the samples with AH26, 45% leaked bacteria and 60% leaked fungi ; while from the samples with AH Plus, 50% leaked bacteria and 55% fungi. There was no statistically significant difference in penetration of bacteria and fungi for both tested materials. In this study gutta-percha and sealers AH 26 and AH Plus, in in vitro conditions, allow leakage of bacteria and fungi.

Recognition and elimination of an oral habit is of utmost importance in the treatment of periodontal disease. It is not probable that the influence of such a factor can lead to the alteration of gingival dimension, but a cofactor role of oral habits in the development of gingival recession has been acclaimed. The purpose of this study was to present cross-sectional data from an epidemiological study performed in two urban settlements in Zagreb, Croatia. The study was performed in 1025 children, in an attempt to try and discover the incidence of oral habits in children with mixed dentition, aged from 6 to 11 years. About 33.37% of the screened population exhibited oral habits, such as nail and object biting, non-nutritive sucking, simple tongue thrusting and lip or cheek biting. Chi-square test analysis showed no statistically significant differences between sex and age groups, a result that does not exclude the oral habits from aetiology of the periodontal pathology. We can conclude that oral habits are a frequent finding, although the cause relation to periodontitis has yet to be cleared completely.

The aim of this study was to evaluate the cytotoxic effect of four root canal sealers: AH26, AH Plus, Diaket and Apexit. In the experiment two cell lines, human cervical carcinoma (HeLa) cells and mouse skin fibroblasts (L929), were used. Under aseptic conditions, the sealers were prepared according to the manufacturers' directions, and 0.01 mL of each material was placed in a 24-well plate. The sealers were covered with cell suspension. The cytotoxicity was estimated by determining the number of viable cells by a light microscope, as well as the total number of cells 24 h, 48 h and 120 h after the treatment with mentioned materials. The results obtained in this study showed the high cytotoxcity of the new AH Plus root canal sealer, which was shown to be equally or more toxic to the standard AH26 and Diaket materials. Apexit was the least toxic sealer.