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The present study evaluated the effect of ultrasonic agitation on the porosity distribution of BioRoot RCS/single gutta-percha cone (BR/SC) and MTA Flow (MF) root canals fillings used as apical plugs in moderately curved and apically perforated roots. Eighty mesial root canals of mandibular first molars were enlarged up to ProTaper NEXT X5 rotary instrument 2 mm beyond the apical foramen, simulating apical perforations. Specimens were randomly divided into four experimental groups (20 canals per group) according to the material and technique used for root canal obturation: BR/SC, BR/SC with ultrasonic agitation (BR/SC-UA), MF and MF with ultrasonic agitation (MF-UA). The ultrasonic tip was passively inserted into the root canal after the injection of flowable cement and activated for 10 s. The specimens were scanned before and after obturation with a high-resolution micro-computed tomography scanner, and the porosity of the apical plugs was assessed. The differences between groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests, with the significance level set at 5%. None of the obturation materials and techniques used in this study was able to provide a pore-free root canal filling in the apical 5 mm. Considerably higher percentages of open and closed pores were observed in the MF and MF-UA groups, with the highest porosity being in the MF-UA group (p &lt, 0.05). No significant differences were observed between the BR/SC and BR/SC-UA groups, where the quantity of open and closed pores remained similar (p &gt, 0.05).

The objective of this study was to assess the porosity distribution of BioRoot RCS/single gutta-percha point root-canal fillings performed by a general dental practitioner and endodontist. Fourteen plastic models of maxillary premolars with two roots were selected and shaped with HyFlex EDM instruments to a size 40/0.04 taper and randomly divided into two experimental groups. A total of 14 canals in each group were obturated by two different operators with one HyFlex EDM size 40 gutta-percha point and BioRoot RCS sealer. The specimens were scanned with a high-resolution micro-computed tomography scanner, and the porosity of the fillings at the coronal, middle, and apical thirds of the root canals was qualified and quantified. The differences between groups and root-canal thirds were compared using Mann–Whitney, Friedman, and Wilcoxon tests with the significance level set at p &lt, 0.05. The highest number of pores was observed in the apical third of root-canal fillings in both groups, however, the porosity distribution between the two groups was not significantly different in the apical and middle thirds (p &gt, 0.05). Statistically significant differences were determined only in the coronal third (p &lt, 0.05). The predominance of open pores was detected in all root-canal thirds and groups, with no significant differences in the number of open pores between the coronal and middle thirds (p &gt, 0.05).

The present study evaluated the obturation quality of root canals filled with BioRoot RCS sealer and single gutta-percha point by undergraduate student (US), postgraduate student (PS) and endodontist (ED). Twenty-one plastic models of upper premolars were enlarged with HyFlex EDM instruments to a size 40/0.04 taper and randomly divided into three groups (7 teeth/14 canals per group): US, PS and ED. After the obturation of root canals with BioRoot RCS and one HyFlex EDM size 40 gutta-percha point, plastic models were scanned using micro-computed tomography scanner (µCT) SkyScan 1272 at isotropic resolution of 10 µm. The porosity distribution was evaluated separately for the apical, middle and coronal thirds. The Kruskal–Wallis, Mann–Whitney, Friedman and Wilcoxon tests with the significance level set at 5% were used for data analysis. The µCT evaluation revealed open pores being the dominant type of porosity in all experimental groups and root canal thirds, with the highest percentage of pores in the apical third of root canal fillings. The quality and homogeneity of single cone root canals fillings remained similar between the groups in the apical and middle thirds (p &gt, 0.05). Significant differences were observed only in the coronal third (p &lt, 0.05).

The better understanding of the clinically important behavioral features of new instrument systems has an important significance for the clinical endodontics. This study aimed to investigate the shaping and centering ability as well as cyclic fatigue resistance of HyFlex CM (CM), HyFlex EDM (EDM) and EdgeFile (EF) thermally treated nickel&ndash, titanium (NiTi) endodontic instrument systems. Sixty curved root canals of the mesial roots of mandibular molars were randomly assigned into three groups (n = 20) and shaped using CM, EDM and EF files up to the size 40 and taper 04 of the instruments. &micro, CT scanning of the specimens before and after preparation was performed and the morphometric 2D and 3D parameters were evaluated in the apical, middle and coronal thirds of root canals. In each group, 40.04 instruments (n = 20) were subjected to the cyclic fatigue resistance test in artificial root canals at 37 &deg, C temperature until fractures occurred, and the number of cycles to failure (NCF) was calculated. The fractographic analysis was performed using a scanning electron microscope, evaluating topographic features and surface profiles of the separated instruments. The one-way analysis of variance with post hoc Tuckey&rsquo, s test was used for statistical analysis of the data, the significance level was set at 5%. All systems prepared the comparable percentage of root canal surface with the similar magnitude of canal transportation in all root thirds (p &gt, 0.05), but demonstrated significantly different resistance to cyclic fatigue (p &lt, 0.05). The most resistant to fracture was EF, followed by EDM and CM. The length of the fractured fragments was not significantly different between the groups, and fractographic analysis by SEM detected the typical topographic features of separated thermally treated NiTi instrument surfaces.

OBJECTIVE To evaluate the amount of residual cement after cementation of implant crown abutments with rubber dam and retraction cord with copy abutments techniques. MATERIAL AND METHODS Thirty single posterior metal-ceramic implant-supported restorations were delivered to 20 patients. The crowns were fabricated with occlusal openings obturated with composite, and then luted with resin-reinforced glass-ionomer cement on customised standard abutments. The cementation procedure was performed twice in the same specimens using rubber dam (group 1) and retraction cord with copy abutment (group 2). If no cement remnants were seen on periapical radiographs after cleaning, the crown-abutment unit was dismounted. All quadrants of the specimens were photographed to calculate the percentage proportions of residual cement area. Mann-Whitney and Kruskal-Wallis tests were used for statistical analysis. RESULTS In each group, 120 measurements were performed (30 implants, 4 surfaces each). The median percentage ratio with interquartile range (IQR) between the cement remnant area and total specimen area was 1.39% (IQR 0.77%-2.29%) and 0.58% (IQR 0.31%-1.33%) in groups 1 and 2, respectively. Lesser cement remnants were found in group 2 with a statistically significant difference (p

The present study evaluated the porosity distribution of BioRoot RCS/single gutta-percha point (BR/SC) and MTA flow (MF) fillings, which were used as plugs for the apical perforation repair in curved canals of extracted mandibular molars using micro-computed tomography (&mu, CT). Forty mesial root canals of mandibular first molars were shaped with ProTaper NEXT X1&ndash, X5 files 2 mm beyond the apex to simulate apical perforations that were randomly divided into two groups (n = 20) according to the material and technique used for the apical plug: BR/SC or MF. The specimens were scanned before and after canal filling at an isotropic resolution of 9.9 &mu, m. The volumetric analysis of voids in the apical 5 mm of the fillings was performed. Data were analyzed using one-way ANOVA with Bonferroni correction (p &lt, 0.05). Micro-computed tomography (&micro, CT) evaluation revealed significant differences between the groups in terms of porosity: the total volume and percentage volume of voids was lower in the BR/SC group in comparison with the MF group (p &lt, 0.05), with the predominance of open pores in both groups. Neither of the materials and/or application techniques were able to produce void-free root fillings in the apical region of artificially perforated curved roots of mandibular molars.

Objective: To find a correlation between the severity of enamel microcracks (EMCs) and their increase during debonding and residual adhesive removal (RAR). Materials and Methods: Following their examination with scanning electron microscopy (SEM), 90 extracted human premolars were divided into three groups of 30: group 1, teeth having pronounced EMCs (visible with the naked eye under normal room illumination); group 2, teeth showing weak EMCs (not apparent under normal room illumination but visible by SEM); and group 3, a control group. EMCs have been classified into weak and pronounced, based on their visibility. Metal brackets (MB) and ceramic brackets (CB), 15 of each type, were bonded to all the teeth from groups 1 and 2. Debonding was performed with pliers, followed by RAR. The location, length, and width of the longest EMCs were measured using SEM before and after debonding. Results: The mean overall width (Woverall) was higher for pronounced EMCs before and after debonding CB (P < .05), and after the removal of MB. Pronounced EMCs showed greater length values using both types of brackets. After debonding, the increase in Woverall of pronounced EMCs was 0.57 µm with MB (P < .05) and 0.30 µm with CB; for weak EMCs, − 0.32 µm with MB and 0.30 µm with CB. Conclusions: Although the teeth having pronounced EMCs showed higher width and length values, this did not predispose to greater EMCs increase after debonding MB and CB followed by RAR.

Menopause affects the bone quality and quantity of jaw bone. The aim of this study was to evaluate the validity of mandibular cortical measurements in the diagnosis of low bone mineral density (BMD) in postmenopausal women.A total of 113 postmenopausal women (mean age 63.15±6.05 years), living in Lithuania, were examined. Participants were categorized as either normal BMD, or low BMD according to the WHO classification in relation to their spine BMD determined by dual energy x-ray absorptiometry. None of the participants were known to have endocrine, metabolic or skeletal disorders. BMD was measured in the spine lumbar area L2-L4. The mandibles were examined on panoramic x-ray images. The following radiomorphometric indices were measured: the height of the mandibular inferior cortex below foramen mentalae (IC) and cortical thickness at the angle of the mandible (Panoramic Angular Index (PA)). Receiver operating characteristics (ROC) curve analysis was used to determine the validity of cortical measurements in the diagnosis of low BMD obtained and the area under the ROC curve (AUC) was calculated.Significant associations were found between IC and PA, and low BMD. The areas under the ROC (AUC) of PA was 0.753 (95% CI, 0.645-0.861) and of IC was 0.709 (95% CI, 0.601-0.816). High levels of intra- and interobserver agreement were demonstrated.Postmenopausal women with spinal low BMD can be identified moderately accurately by mandibular cortical findings.

To evaluate the root canal surfaces in teeth previously treated using RF resin by SEM.20 distal roots of mandibular molars with typical discoloration of tooth crown were used in this study: 10 brownish - red and 10 non-colored roots. The roots were removed from the crowns, splinted longitudinally and subjected to SEM in a back-scattered electron mode.In discolored root samples canal walls appeared without smear layer and varying amount of remaining debris, the observed morphology of dentine was ordinary. In the non-colored root samples the dentin profile revealed: in coronal third of the root just few open dentinal tubules were detected, while in the middle and apical thirds no open dentinal tubules were observed, dentin profile was similar to sclerotic dentin. The multiple dentinal defects were detected in all samples, however significantly more dentinal defects were found in the colored roots. The RF paste was well adhered to the root canal dentine and multiple tags of RF resin penetrating deeply into the dentinal tubules were detected.The surfaces of the root canal walls of the teeth treated using RF paste exhibits usual appearance and ordinary dentin morphology in colored roots while the dentin of non-colored samples has the profile of sclerotic dentin. Multiple dentinal defects could be determined by damaging effect of RF resin on dentin. The adaptation and adhesion of RF paste to the dentin, capability to penetrate into dentinal tubules is comparable with the modern resin based sealers.

Management of patients with hereditary bleeding disorders in dentistry causes considerable problems. This study examined different aspects of dental health or disease of Lithuanian children and adults with haemophilia and compared them with the general population. Two study groups of cases and controls were formed. Cases were recruited through census sampling and controls were randomly chosen from the general population matched for gender, age and place of residence. Dental health of permanent and deciduous dentitions was assessed by one examiner employing the WHO Criteria for Oral Health Surveys. The following aspects of dental health/disease were considered: overall caries experience, treatment experience, unmet dental treatment needs and the presence of functional dentition. Data were collected from 76 patients with haemophilia among which 27 were children and 49 were adults and a control group of 76 subjects comprising 30 children and 46 adults. Children with haemophilia had a significantly lower overall caries experience and less unmet dental treatment needs in deciduous teeth as compared to healthy children. In permanent dentitions, overall caries experience, unmet dental treatment needs or treatment experience did not differ between cases and controls either in older children or adult cohorts. There were no differences between the study groups regarding the functional dentition-related indices. Healthier deciduous teeth were observed in children with haemophilia than in children without haemophilia, but other dental health or disease-related outcomes did not differ between cases and controls.

Background The depth of the cementation margin has an influence on the amount of cement remnants around implants. However, the role of other clinical factors is still not clarified. Purpose The aim of the study was to evaluate the correlation between undetected cement and (i) location of the implant, (ii) implant diameter, and (iii) undercut. Materials and Methods Sixty-five patients were treated with single metal-ceramic restorations on implants. The undercut between the restoration and the tissue was measured. After cementation, the restoration-abutment unit was unscrewed. All quadrants of the specimens were photographed and analyzed. The ratio between total restoration area/peri-implant tissue area and area of cement remnants was calculated in pixels. Significance was set to 0.05. Results Sixty-five metal-ceramic restorations were placed on 65 implants (39 molars, 22 premolars, 4 anteriors; 21 implants had a diameter of 3.5 mm, 34 of 4.0 mm, 10 of 5.0 mm). An undercut of 1 mm was found in 118 sites, 2 mm in 96 sites, and 3 mm in 46. The percentages of soft tissue and restoration, respectively, covered by cement were as follows: molars 4% and 7%; premolars 3.8% and 7.3%; anteriors 3% and 3.4%; 3.5 mm diameter 3.3% and 7.4%; 4.0 mm 7.7% and 7.7%; 5.0 mm 3.9% and 2.1%; 1-mm undercut 3.5% and 5.4%; 2-mm 4% and 8.1%; 3-mm 4.8% and 8.4%. The relationship between amount of cement remnants and implant location was insignificant (p > 0.05) for both soft tissue and the specimen, but significant relationships with amount of cement remnants were found for diameter (p = 0.026 for soft tissue, p = 0.600 for specimen) and undercut (p = 0.004 for soft tissue, p = 0.046 for specimen). Conclusion If cemented crown restoration is desired, undercuts should be reduced to a minimum for better removal of cement excess, irrespective of the diameter and location of the implants in the mouth.

Background It has been shown that thin mucosal tissues may be an important factor in crestal bone loss etiology. Thus, it is possible that mucosal tissue thickening with allogenic membrane might reduce crestal bone loss. Purpose The purpose of this study was to evaluate how implants with traditional connection maintain crestal bone level after soft tissue thickening with allogenic membrane. Materials and Methods One hundred three patients received 103 internal hex implants of 4.6 mm diameter with regular connection. According to gingiva thickness, patients were assigned into A (thin tissues, n = 34), B (thin, thickened with allogenic membrane, n = 35), and C group (thick tissues, n = 34). Groups A and C had one-stage approach, and in group B, implants were placed in two stages. Radiographic examination was performed after implant placement, 2 months after healing, after restoration, and after 1-year follow-up. Crestal bone loss was calculated medially and distally. Significance was set to 0.05. Results After 1-year follow-up, implants in group A had 1.65 ± 0.08-mm bone loss mesially and 1.81 ± 0.06 mm distally. Group B had 0.31 ± 0.05 mm mesially and 0.34 ± 0.05 mm distally. C group implants experienced bone loss of 0.44 ± 0.06 mm mesially and 0.47 ± 0.07 mm distally. Differences between A and B, and A and C were significant (p = .000) both mesially and distally, whereas differences between B and C were not significant mesially (p = .166) and distally (p = .255). Conclusions It can be concluded that thin mucosal tissues may cause early crestal bone loss, but their thickening with allogenic membrane may significantly reduce bone resorption. Implants in naturally thick soft tissues experienced minor bone remodeling.

The objective of this in vitro study was to evaluate the effect of the enamel cracks on the tooth damage during the debonding. Measurements of the cracks characteristics (visibility, direction, length, and location) were performed utilizing a scanning electron microscopy (SEM) technique and mathematically derived formulas (x=h/30, l=n*x) before and following the removal of mechanically retained metal and ceramic brackets. The likelihood of having greater extent enamel defects was higher for the teeth with pronounced cracks (odds vatios, OR=3.728), increased when the crack was located in more than one zone of the tooth (OR=1.998), and the inclination did not exceed 30-45° (OR=0.505). Using ceramic brackets the risk of greater amount tooth structure defects raised 1.45 times (OR=1.450). Enamel crack showing all these characteristics at the beginning of the orthodontic treatment and the use of ceramic brackets might predispose to higher risk of greater extent tooth surface damage after the debonding by 20.4%.

The purpose of this study was to evaluate and compare enamel micro-crack characteristics of adult patients before and after removal of metal brackets. After the examination with scanning electron microscopy (SEM), 45 extracted human teeth were divided into three groups of equal size: group 1, the teeth having enamel micro-cracks, group 2, the teeth without initial enamel micro-cracks, and group 3, control group to study the effect of dehydration on existing micro-cracks or formation of new ones. For all the teeth in groups 1 and 2, the same bonding and debonding procedures of metal brackets were conducted. The length and width of the longest enamel micro-crack were measured for all the teeth before and after removal of metal brackets. The changes in the location of the micro-cracks were also evaluated. In group 3, teeth were subjected to the same analysis but not bonded. The mean overall width of micro-cracks after removal of metal brackets was 3.82 μm greater than before bonding procedure (P < 0.05). Also, a significant difference was noticed between the width of micro-cracks in first zone (cervical third) and third zone (occlusal third) after debonding procedure (P < 0.05). New enamel micro-cracks were found in 6 of 15 (40 per cent) examined teeth. Greatest changes in the width of enamel micro-cracks after debonding procedure appear in the cervical third of the tooth. On the basis of this result, the dentist must pay extra care and attention to this specific area of enamel during removal of metal brackets in adult patients.

Objectives The aim of this study was to evaluate the amount of the residual cement excess after cementation and cleaning of implant-supported restorations with various positions of the margins. Material and methods Twenty-five casts with embedded implant analogs and flexible soft-tissue imitation were used in the study. Individual abutments with different position of the margin - from 1 mm supragingivally to 3 mm below the gingival level - were modelled and divided equally into five groups. The same amount of polished metal crowns was luted to prosthetic abutments, excess cement was cleaned and the restorations were removed for evaluation of the undetected cement remnants. All quadrants of each specimen were photographed for calculation of the ratio between the cement remnants area and the total specimen area using Adobe Photoshop. Afterwards, cement remnants were cleared from each specimen and weighed with analytical balances. Results The measurements in all the groups consisted of (1) the relation between the cement remnants area and the total area of the specimen; and (2) cement excess weight in grams after cleaning: group 1 (0.0111 ± 0.021; 0.0003 ± 0.0001 g); group 2 (0.0165 ± 0.019; 0.0008 ± 0.0003 g); group 3 (0.0572 ± 0.028; 0.0013 ± 0.0005 g); group 4 (0.1158 ± 0.054; 0.0051 ± 0.0013 g); and group 5 (0.1171 ± 0.059; 0.0063 ± 0.0021 g). Results showed significant increase of undetected cement quantity, as the restoration margins were located deeper subgingivally, using weighting (P=0) and calculation of proportion (P=0). There was a significant correlation between evaluation techniques (r=0.889; P=0). Conclusions The amount of residual cement after cleaning increased as the restoration margins were located more subgingivally.

Introduction: The aim of this study was to evaluate susceptibility of predominant endodontic pathogens isolated from teeth with symptomatic apical periodontitis to most commonly prescribed antibiotics. Methods: Among 58 patients with symptomatic apical periodontitis, 47 and 11 cases were caused by primary and secondary root canal infection, respectively. The microbial samples were taken either from the root canals (35 cases) or by aspiration from apical abscesses (23 cases). Culture methods were used to identify the microorganisms present in the samples. Antibiotic susceptibilities of all isolates were evaluated by using the E-test method. Results: Microorganisms were isolated from 49 of the 58 samples studied and included facultative and obligate anaerobes. Streptococci and obligate anaerobes were the predominant microorganisms in cases of primary infection. Enterococcus faecalis dominated in cases of secondary infection. All tested microorganisms were highly sensitive to penicillin G, amoxicillin, and ampicillin. Susceptibilities to clindamycin and erythromycin were 73.8% and 54.7%, respectively. About 40% of the isolates were resistant to tetracycline. Morethan50% ofall anaerobes wereresistant to metronidazole. All E. faecalis isolates were resistant to clindamycin. Conclusions: Based on the study results, penicillin and amoxicillin are suitable antibiotics for treatment of endodontic infection when conventional root canal treatment alone is insufficient. Clindamycin could be advised for penicillin-allergic patients with primary endodontic infections. (J Endod 2010;-:1‐6)

The aim was to overview the oral health aspects in hemophilia patients.An electronic search of Medline (Pub Med), Cochrane, SSCI (Social Citation Index), SCI (Science Citation Index) databases from 1982 to the present, using the following search words: hemophilia, oral health, dental caries, dental caries prevalence, gingivitis, periodontitis, primary dentition, permanent dentition, dental treatment and review, was performed. The search yielded 196 titles and abstracts on chosen words. All articles were full-text reviewed and 40 of publications were included.Nowadays coagulation factor abnormalities are the most common of inherited bleeding disorders, but occur much less frequently approximating 10000-50000 male births than acquired coagulation defects. Von Willebrand disease, Hemophilia A and Hemophilia B account for 95-97% of all coagulation deficiencies. Hemophilias A and B are subdivided according to the factor's activity levels in the blood: mild, moderate or severe. The two main oral diseases affecting patients with hemophilia are the same as for the rest of population, i.e. dental caries and gingivitis/periodontitis. Only a few studies concerning oral health aspects in hemophilia patients were carried out. Some controversy exists concerning caries prevalence in both primary and permanent dentitions in children with hemophilia. People with congenital hemorrhagic diatheses constitute a very small proportion of the total population. Due to that fact treatment of such patients becomes a challenge to the most of dentists due to the fact that most of them have no experience in dealing with dental problems in such patients.There is a lack of epidemiological studies in oral health status of hemophilia patient.

The aim was to overview the etiology, prevalence and possible outcomes of dental trauma.An electronic search of Medline (PubMed), Cochrane, SSCI (Social Citation Index), SCI (Science Citation Index) databases from 1995 to the present, using the following search words: tooth injuries, tooth trauma, traumatized teeth, dental trauma, dentoalveolar trauma, oral trauma, epidemiology, etiology, prevalence, prevention, pulp necrosis, inflammatory resorption, ankylosis, cervical resorption, was performed.During last decade traumatic dental injuries were recognized as public dental health problem worldwide. Prevalence of traumatic dental injuries varies between countries. According to the existing data they are more prevalent in permanent than in primary dentition. All treatment procedures in case of dental trauma are directed to minimize undesired consequences despite that treatment of traumatic dental injuries in the young patient is often complicated and can continue during the rest of his/her life. The changing lifestyle and requirements of modern society lead to an emergence of new patterns of dental trauma. A regular update of knowledge in dental traumatology is required.

Background: The present survey explored the current employment profile and future career intentions of Lithuanian general dentists and specialists. Methods: A census sampling method was employed with data collected by means of a structured questionnaire that inquired about demographics, different employment-related aspects (practice type and location, working hours, perceived lack of patients, etc.), and future career intentions (intent to emigrate, to change profession, or the timing of retirement). The final response rate was 67.6% corresponding to 2,008 respondents. Results: The majority of all dentists work full or part-time in the private dental sector, more than one third of them owns a private practice or rents a dental chair. A minority of dentists works in the public dental sector. According to the survey, 26.6% of general dentists and 39.2% of dental specialists works overtime (>40 hours per week; P 0.05). The majority (68.9% of general dentists and 65.9% of dental specialists) plans to work after the retirement age (P >0.05). Emigration as an option for their professional career is being considered by 10.8% of general dentists and 8.3% of dental specialists (P >0.05). Working either full or part-time in private practices (OR = 4.3) and younger age (≤35 years; OR = 2.2) are the two strongest predictors for a perceived insufficient number of patients. Conclusions: One third of dentists in Lithuania work long hours and lack patients. Many dentists practice in multiple locations and plan to retire after the official retirement age. Some dentists and dental specialists plan to emigrate. The perceived shortcomings within the dental care system and workforce planning of dentists need to be addressed.

The depth of the cementation margin has an influence on the amount of cement remnants around implants. However, the role of other clinical factors is still not clarified.The aim of the study was to evaluate the correlation between undetected cement and (i) location of the implant, (ii) implant diameter, and (iii) undercut.Sixty-five patients were treated with single metal-ceramic restorations on implants. The undercut between the restoration and the tissue was measured. After cementation, the restoration-abutment unit was unscrewed. All quadrants of the specimens were photographed and analyzed. The ratio between total restoration area/peri-implant tissue area and area of cement remnants was calculated in pixels. Significance was set to 0.05.Sixty-five metal-ceramic restorations were placed on 65 implants (39 molars, 22 premolars, 4 anteriors; 21 implants had a diameter of 3.5 mm, 34 of 4.0 mm, 10 of 5.0 mm). An undercut of 1 mm was found in 118 sites, 2 mm in 96 sites, and 3 mm in 46. The percentages of soft tissue and restoration, respectively, covered by cement were as follows: molars 4% and 7%; premolars 3.8% and 7.3%; anteriors 3% and 3.4%; 3.5 mm diameter 3.3% and 7.4%; 4.0 mm 7.7% and 7.7%; 5.0 mm 3.9% and 2.1%; 1-mm undercut 3.5% and 5.4%; 2-mm 4% and 8.1%; 3-mm 4.8% and 8.4%. The relationship between amount of cement remnants and implant location was insignificant (p 0.05) for both soft tissue and the specimen, but significant relationships with amount of cement remnants were found for diameter (p = 0.026 for soft tissue, p = 0.600 for specimen) and undercut (p = 0.004 for soft tissue, p = 0.046 for specimen).If cemented crown restoration is desired, undercuts should be reduced to a minimum for better removal of cement excess, irrespective of the diameter and location of the implants in the mouth.

It has been shown that thin mucosal tissues may be an important factor in crestal bone loss etiology. Thus, it is possible that mucosal tissue thickening with allogenic membrane might reduce crestal bone loss.The purpose of this study was to evaluate how implants with traditional connection maintain crestal bone level after soft tissue thickening with allogenic membrane.One hundred three patients received 103 internal hex implants of 4.6 mm diameter with regular connection. According to gingiva thickness, patients were assigned into A (thin tissues, n = 34), B (thin, thickened with allogenic membrane, n = 35), and C group (thick tissues, n = 34). Groups A and C had one-stage approach, and in group B, implants were placed in two stages. Radiographic examination was performed after implant placement, 2 months after healing, after restoration, and after 1-year follow-up. Crestal bone loss was calculated medially and distally. Significance was set to 0.05.After 1-year follow-up, implants in group A had 1.65 ± 0.08-mm bone loss mesially and 1.81 ± 0.06 mm distally. Group B had 0.31 ± 0.05 mm mesially and 0.34 ± 0.05 mm distally. C group implants experienced bone loss of 0.44 ± 0.06 mm mesially and 0.47 ± 0.07 mm distally. Differences between A and B, and A and C were significant (p = .000) both mesially and distally, whereas differences between B and C were not significant mesially (p = .166) and distally (p = .255).It can be concluded that thin mucosal tissues may cause early crestal bone loss, but their thickening with allogenic membrane may significantly reduce bone resorption. Implants in naturally thick soft tissues experienced minor bone remodeling.

To analyze the need for referral to a specialist and to identify the reasons of referrals among Lithuanian general dental practitioners.Questionnaires were sent to all 2879 Lithuanian dental practitioners registered on the Lithuanian Dental Chamber license registry. The questionnaire was made with multiple-choice answers. Respondents were asked to choose only one category of answer that best fitted their clinical attitude. Questions included in the questionnaire concerned general and specific information regarding the need and main reasons for endodontic referral.Of the 2879 questionnaires mailed, 1532 questionnaires containing useful information were returned. The response rate was 53.2%. Of the 1532 respondents, 1431 were general dental practitioners. Majority (72.1%) of the respondents performed complicated root canal treatment by themselves. Almost half (49.6%) of them would like to refer patients to an endodontist. Two of the reasons, which restricted their decision, were the shortage of endodontists and high cost of the procedures in the specialized clinics. Approximately 19% of the respondents referred patients to an endodontist. The main reasons for referral were fractured instruments (86.6%), dental trauma (83.6%), difficulties in diagnostics (79%) followed by persistent symptoms (78.1%).The findings of the present study suggest that the need for referral of patients to an endodontist among Lithuanian dental practitioners exists. The main reasons for referrals were complications of endodontic treatment, traumatic injuries, difficulties in diagnostic procedures, and persistent symptoms.

Air-abrasion can be used for enamel preparation before fissure sealing as well as acid etching which is the evidence-based method for enamel preparation before sealing.The aim of this study is to evaluate the status of sealed occlusal surfaces of the first permanent molars after one, two, and five years and to compare consequence of using the two different methods for enamel preparation before sealing.At the baseline of the study 88 children of the age from 6 to 9 with caries-free permanent molars randomly received 185 sealants after using the air-abrasion system KCP 2000 PLUS (ADT Inc.) and 121 sealants using the acid etching method with Vococid (VoCo). Fissurit F (VoCo) was used for sealing. The status of occlusal surfaces of molars was scored as caries- free or decayed/restored by visual clinical assessment evaluation after one, two, and five years.The sealants retention rate was 97.2%, 91.9%, 61.2% in the air-abrasion group and 96.3%, 92.6%, 62.4% in the acid etching group after one, two, and five years, respectively. The results showed 98.2%, 98.0%, 89.8% caries free occlusal surfaces of molars prepared with air-abrasion method and 100%, 100%, 94.6% caries free occlusal surfaces of molars prepared with acid etching method after one, two, and five years respectively.The differences between the two methods: air-abrasion and acid etching in terms of sealant retention rate and caries development appeared to be statistically insignificant (p0.05).

The purpose of this study was to gather information about the various aspects, technical and biological, of endodontic treatment as performed by Lithuanian general dental practitioners and to compare their choices with established endodontic treatment standards of undergraduate education.Questionnaires were sent to all 2,850 Lithuanian dental practitioners. The structured questionnaire included inquiries about gender, duration of professional activity, working environment, details about instruments and materials.From total 1532 (53.8%) questionnaires were returned. Only responses from general dental practitioners (1431) were included. Of the respondents 66% never used a rubber dam. Most practitioners relied on conventional stainless steel instruments. The NiTi hand files were often and routinely used by 32.2% of the respondents. Sodium hypochlorite was the most popular choice as a root canal irrigant. Calcium hydroxide paste was used as an inter-appointment medicament. Cold-lateral condensation root filling method was used by 72.8% of the respondents while 15.6% used a paste for the root filling.The results of this study indicate that the recently graduated dental practitioners were following the recommended standard of endodontic treatment better than those with a longer time from the graduation. It is important to improve the quality of existing courses of continuous education in endodontology in order to ensure the necessary competency in clinical practice. The low use of a rubber dam and low adoption of new technologies in Lithuania is not acceptable and needs to be changed.

The occurrence of Enterococcus faecalis in root canals of previously root filled teeth with apical periodontitis requiring retreatment was studied in Lithuanian patients. Twenty-five asymptomatic teeth were included in the study. Avoiding contamination microbiological samples were taken from the canals before and after preparation and irrigation with sodium hypochlorite and EDTA. Microbes were isolated from 20 of 25 teeth. E. faecalis was isolated from 14 of those 20 culture positive teeth, usually in pure culture or as a major component of the flora. Second samples taken after preparation revealed growth in 7 of the 20 teeth. Five of the seven cases were E. faecalis in pure culture. Isolation of E. faecalis was not related to the use of any particular root filling material in the original root filling. The results indicate that, rather than previous chemical treatment, it is the ecological conditions present in the incompletely filled root canal that are important for the presence of E. faecalis in these teeth.

To gather information about the radiographic facilities and techniques used by Lithuanian general dentists.Questionnaires were sent to all 2879 Lithuanian dental practitioners registered on the Lithuanian Dental Chamber licence registry data list. The questionnaire was made with multiple-choice answers. Respondents were invited to choose the only one category of answer that best fitted their clinical attitude. Questions included in the present survey concerned general and specific information regarding peculiarities of radiographic imaging. Only answers of respondents who are licensed as general dentists were included in this study.From the 2850 questionnaires mailed 1532 were returned. The response rate was 53.8%. Of the total responses 1431 questionnaires were received from licensed general dentists. Of total 956 dentists practiced in urban and 576 dentists in rural areas. 61.6% of respondents had access to an intra-oral radiographic unit in their practice and 91.5% of them used dental radiography always or often as the diagnostic tool. To support the film packet in the patient's mouth alternatively film holder or patient's finger was used by 48% of respondents, while film holder was used only by 19.3% of dentists.Recently graduated dental practitioners more common used diagnostic radiography in endodontic pathology than dentists with a longer time from graduation. Film holder was not a popular device among general dental practitioners to perform periapical radioraphs. It is important to improve the existing dental curriculum to ensure the necessary competency when using dental radiography and film holders routinely in clinical practice.

The aim of this study was to determine and compare the microbial leakage of roots filled with EndoREZ sealer/EndoREZ Points and AH Plus sealer/ conventional gutta-percha points.60 single-rooted teeth were prepared using step-back technique. The smear layer was removed with 18% EDTA. Teeth were divided into two experimental groups (n=25 each group) and two controls (n=5 each group). In AH Plus group root canals were obturated with AH Plus sealer/gutta-percha and in EndoREZ group with EndoREZ sealer/EndoREZ Points. Five teeth were served as negative controls and five as positive controls. All teeth were inserted into Eppendorf plastic tubes and suspended in glass bottles containing sterile Schaedler broth. The coronal chambers were filled with the mix of human saliva and broth (ratio 3:1). The medium was changed every 7 days. Microbial growth in the broth was evaluated every day up to the end of experiment.Leakage in the root canals of the teeth from experimental groups occurred between 4 and 75 days. The mean leakage in AH Plus group was 18.86 days, while in EndoREZ group it was 28.28. No statistically significant difference in microbial leakage between two tested filling materials was found.Both types of root fillings - EndoREZ sealer/EndoREZ Points and AH Plus sealer/gutta-percha points - showed microbial leakage.

Research data regarding attitudes of general dental practitioners towards endodontic therapy is rare. The present review summarizes existing literature and analyzes human factors that could potentially influence the outcome of endodontic treatment in general dental practice. Root canal treatment usually fails when treatment falls short of acceptable standards. The results of questionnaire surveys from several countries indicate that differences between daily general practice and academic teaching exist. The results of studies indicated that majority of general practitioners disregard the most basic principles of endodontic treatment. The most striking finding is the generally negative attitude amongst general dental practitioners towards performing endodontic treatment and adoption of new technologies in a daily endodontic practice. The results confirm that root canal treatment is technically demanding and in general practice is carried out under less than optimal conditions. This review shows the importance of continuous dental education for practitioners in order to update their knowledge.

The aim of this study was to evaluate the association between lumbar spine bone mineral density and mandible cortical bone height at the mental foramen and at the angle of the jaw.A total of 130 women living in Lithuania, were examined. None of the participants were known to have endocrine, metabolic or skeletal disorders. Bone mineral density (BMD) was measured in the spine lumbar area L2-L4. The mandibles were examined on panoramic x-ray images. On each radiograph cortical thickness of mandible was measured at the mental foramen and at the angle of the jaw. The results demonstrated a tendency of high probability of osteoporosis in cases were radiomorphometric parameters are low. There was a significant difference between bone mineral density of lumbar spine and cortical bone height of mandible below the foramen mentale and at the angle of the jaw (p0.01).

A traditional concept is that apical periodontitis is the result of pathogenic effects of the microorganisms colonizing the root canal system and the response of the host defence system. The composition of the microflora of root canals differs in primary endodontic treatment and retreatment cases. Persistent disease in the periapical region after root canal treatment presents a more complex situation as it was thought earlier. Scientific evidence indicates that unsatisfactory outcome of cases in which treatment has followed the highest technical standards mainly is associated with microbial factors, comprising extraradicular and/or intraradicular infections.

The aim of this study was to investigate the technical quality of root fillings in root filled teeth, their association with periapical status and prevalence of apical periodontitis.The sample consisted of 83 subjects, presenting consecutively as new patients seeking dental care (prosthetic, endodontic and cariologic treatment) in the years 2005/2006. Clinical and radiographic examination on each patient was performed using the scoring system (Periapical index (PAI)) proposed by Ørstavik et al. From the periapical radiographs status of endodontically treated teeth was recorded. For each tooth the following items were surveyed: the presence of a root filling, its quality (lateral seal and length in the root canal) and the periapical status.Of the 2186 functional teeth, 283 had undergone root canal treatment (13%). Amongst 283 root filled teeth, 122 teeth (43.1%) had radiological signs of a periapical lesion (PAI2). Only 28.6% of the root filled teeth fulfilled the criteria of an acceptable root canal filling. Inadeguate lateral seal of root filling was observed in 165 (58.3%) of 283 endodontically treated teeth. Inadequate length of endodontic treatment was discovered in 183 (64.7%) out of 283 teeth. Root filled teeth without voids had apical periodontitis in 25 (21.0%) out of 118 of cases, whereas if voids were detected, disease was present in 97 (58.8%) out of 165 teeth (p0.001). Apical periodontitis was found in 23 (23.0%) out of 100 teeth with adequate length of root filling, whereas if the filling was too short or long, periapical lesions were present in 99 (54.0%) out of 183 teeth (p0.001).Apical periodontitis was present in 43,1% of root filled teeth. Only 28.6% of the root filled teeth fulfilled the criteria of an acceptable root canal filling. The results of this study indicate that inadequate root fillings were more often associated with an increased prevalence of apical periodontitis. On the contrary, adequate root fillings significantly reduced the prevalence of disease. Many root canal treatments were technically unsatisfactory and substantial efforts must be made to improve the standard of endodontic treatment.

Root canal retreatment in teeth restored with intraradicular posts has attracted interest due to the difficulties of their removal without weakening, perforating or fracturing the remaining root structure. The use of ultrasonic devices has been suggested by some authors to facilitate post removal, reducing the possibility of fractures or root perforations. The purpose of this study was to determine the efficacy of cast posts removal by ultrasonic device regarding post length, adaptation of post to root canal walls and cement type.Seventy-seven single rooted endodontically treated teeth restored with cast posts were included to this study. Post removal was processed with ultrasonic and time for this was recorded. The length and width of the post, quality of post adaptation, type of cement were evaluated according to radiographic findings and clinical records.Mean value of time needed for post removal was 14.15 (SD +/- 8.57) minutes. A strong correlation was observed between the time of post removal and post length (r=0.620, p=0.000). The mean time required for the removal of posts cemented with zinc phosphate was 11.36 min (SD +/- 5.84) and for the posts cemented with resin modified glass-ionomer was 15.37 min (SD +/- 3.83). Statistically significant difference in the time needed for the posts cemented with different cements was observed (p = 0.002). The mean time needed for the post removal with the inappropriate adaptation was 10.1 min (SD +/- 6.0) and the time for the post with appropriate adaptation was 15.7 min (SD +/- 8.9). Statistically significant difference between these two groups was observed for the time of posts removal (p = 0.003). According to the results of linear regression model test, 50% of variation in time needed to remove posts was explained by following variables: post length, post adaptation and the cement type. The total regression model was highly significant (p = 0.000).The time taken for post removal depended on post length, its adaptation in the root canal and on the type of luting cement. Root fractures are unlikely to occur with good case selection.