The purpose of this paper was to review the composition, sealing ability, biocompatibility and various physical properties of cold ceramic (CC) material that potentially used as a root filling material. The review of the articles was performed by electronic and manual searching methods regarding the properties of CC from November 2000 to May 2016. The results revealed that there were many published reports carried out on the properties of CC. Only one article had extensively studied the composition of CC, five studies had investigated the sealing ability of CC, three articles had studied the biocompatibility, and some studies had investigated the radiopacity, setting time, pH value, and solubility of CC. It was concluded that CC material had good potential for endodontic use. Furthermore, clinical studies are needed in these areas.

Background: Dental implants and metal fillings may cause artifacts in cone-beam computed tomography (CBCT) images and reduce image quality and anatomic accuracy. The purposes of this study are a subjective evaluation of anatomic landmarks and linear bone measurements after applying artifact removal (low–medium) option on CBCT images. Materials and Methods: In this cross-sectional study, thirty CBCT images from thirty qualified patients were selected in a private radiology center. Low and medium artifact removal was applied to images. Three radiologists assessed the visibility of the mandibular canal, mental foramen, and lamina dura in images. Crestal width and bone length were also measured in three groups of images and was compared by exact McNemar test. ICC test (two-way random model, absolute agreement types) was calculated for comparison of linear bone measurements in three images groups. P ≤ 0.05 was considered statistically significant. Results: Percent agreement of determining mental foramen (outline and location), mandibular canal (outline and location), and lamina dura between three groups of images were 100%, 100%, 83.3%, 96.7%, and 56.6%, respectively. The results of exact McNemar test revealed that medium artifact removal group had a statistical difference in lamina dura observation with none and low artifact removal groups (P < 0.001). Intraclass correlation coefficient showed no statistical differences in crestal width and bone length between groups (P < 0.001). Conclusion: Applying artifact removal does not affect the visibility of large anatomical structures and linear bone measurements, but delicate structures such as lamina dura may become less clear after artifact removal.

Background: This clinical trial investigated the effectiveness of two remineralizing creams on regression of white spot lesions (WSLs) after orthodontic therapy. Materials and Methods: The study included patients with WSLs on their upper anterior teeth who recently completed orthodontic treatment at the Department of Orthodontics of Mashhad Dental School and two private offices. The participants were randomly assigned into three groups by treatment: (1) a 12-week regimen of a cream containing casein phosphopeptide-amorphous calcium phosphate and fluoride (MI Paste Plus); (2) a 12-week regimen of a cream containing hydroxyapatite and fluoride (Remin Pro); and (3) usual home care (control). Thirty-nine patients participated and three withdrew. The main outcomes including area, mineral content, and color of WSLs were measured at enrolment and 4, 8, and 12 weeks later, respectively. Blinding was applied for outcome assessment only. The data were analyzed by analysis of variance and repeated measures analysis at the statistical significance of P < 0.05. Results: Over a 3-month period, the application of both MI Paste Plus and Remin Pro caused significantly greater reduction in area and significantly higher increase in mineral content of WSLs compared to the control group (P < 0.05). The appearance of WSLs improved significantly in both experimental groups (P < 0.05), but not in the control group. No side effect was observed throughout the experiment. Conclusion: The application of either MI Paste Plus or Remin Pro was effective in reducing the area, increasing the mineral content and improving the appearance of demineralized enamel, indicating that these products could be recommended for managing postorthodontic WSLs.

Background: Visfatin, also known as nicotinamide phosphoribosyltransferase, has been suggested as a pro-inflammatory and immunomodulating marker for periodontitis. The aim of this study was an immunohistochemical analysis of visfatin in gingival tissues of patients with chronic periodontitis and aggressive periodontitis. Materials and Methods: In this cross-sectional study based on clinical evaluation and inclusion and exclusion criteria. Twenty patients with generalized chronic periodontitis, 13 patients with generalized aggressive periodontitis, and 20 periodontally healthy individuals enrolled. Gingival tissue samples were obtained during periodontal flap surgery and crown lengthening surgery in periodontal patients and healthy group, respectively. Tissue samples were transferred to a pathology laboratory to determine the degree of inflammatory infiltration by hematoxylin and eosin staining and the level of visfatin expression by immunohistochemistry. The data were analyzed using SPSS version 20 statistical software and paired t-test, Mann–Whitney test, and Spearman rank correlation coefficient. P < 0.05 was considered statistically significant. Results: Inflammation grading and visfatin expression were significantly higher in periodontally diseased gingiva compared to the control group (P < 0.05). However, no significant difference was found between two diseased groups. The relationship between inflammation grading and visfatin expression in aggressive periodontitis group was statistically significant, positive and relatively strong (P = 0.025, r = 0.617). However, no significant relationship has been found between visfatin expression and inflammation grading in the chronic periodontitits and control groups (P > 0.05). Conclusion: Visfatin expression was increased in gingival tissues of chronic periodontitis and aggressive periodontitis patients. Hence, visfatin may have a role in the etiopathogenesis of chronic periodontitis and aggressive periodontitis.

Background: Different irrigating solutions with high antimicrobial activity have been introduced for cleaning of the root canal system. However, effects of Prangos ferulacea (PF), Ziziphora tenuior (ZT), Dracocephalum moldavica (DM), and Ferula gummosa (FG) on oral and dental pathogens have not been extensively evaluated due to their optimal biocompatibility and insignificant side effects. The aim of this study was to evaluate the antibacterial effects of essential oils of mentioned plants on Enterococcus faecalis. Materials and Methods: In this in vitro study the plants were collected from Zanjan Province, Iran. Analysis of the essential oil was carried out by gas chromatography/mass chromatography. Micro-broth dilution and disc diffusion methods were used for assessment of the antimicrobial activity, and minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were evaluated. Results: All the four essential oils had antibacterial effects on E. faecalis, and ZT had the greatest antibacterial activity. Assessment of the mean diameter of the growth inhibition zone showed higher antibacterial activity of PF and ZT than that of chlorhexidine. The MIC and MBC of ZT showed that the antimicrobial activity of ZT against E. faecalis was greater than that of other plants evaluated in this study. Conclusion: The results of this study indicated significant antibacterial effects of the mentioned plants on E. faecalis. The greatest antimicrobial activity belonged to ZT. The current study suggests extraction of effective compounds in these medicinal plants to use them in the clinical setting.

Background: Endodontic infections require effective removal of microorganisms from the root canal system for long-term prognosis. Sodium hypochlorite (NaOCl) is the most effective irrigant currently, but potential complications due to its toxicity warrant search for newer alternatives. In this study, the antimicrobial efficacy of Morinda citrifolia (MC), green tea polyphenols and Triphala was compared with 5% NaOCl against Enterococcus faecalis. Materials and Methods: In this in vitro study sixty extracted human premolar teeth were infected with E. faecalis, a Group D Streptococci for 48 h. At the end of 48 h, the vital bacterial population was assessed by counting the number of colony-forming units (CFUs) on blood agar plate. Samples were divided into five groups; Group I (distilled water), Group II (NaOCl), Group III (MC), Group IV (Triphala), and Group V (green tea polyphenols). The samples were irrigated with individual test agents and CFUs were recorded. Kruskal–Wallis test was performed as the parametric test to compare different groups. Student's t-test was used to compare mean values between groups before and after treatment with test agents (P < 0.001). Results: NaOCl was the most effective irrigant the elimination of E. faecalis reinforcing its role as the best irrigant available currently and a gold standard for comparison of the experimental groups. Its antibacterial effect was comparable to Triphala. Among the experimental groups, MC showed the minimum antibacterial effect. Conclusion: The use of herbal alternatives as a root canal irrigant might prove to be advantageous considering the several undesirable characteristics of NaOCl.

Background: Micro-computed tomography (micro-CT) has been widely described as a nondestructive in vitro imaging method although its accuracy for caries detection is still unclear. The aim of this study was to investigate the feasibility of micro-CT to detect and classify proximal caries lesions in posterior teeth, using different protocols. Materials and Methods: In this in vitro study, crowns of 122 human teeth were scanned with Skyscan 1174 (Bruker, Kontich, Belgium) using the full-scan mode (360°). Reconstruction of 900 basis images was performed using NRecon Software (Bruker, Kontich, Belgium) for the protocol 1 (full-scan mode 360°), and 450 basis images were used to reconstruct the protocol 2 (half-scan mode 180°). Three observers analyzed the reconstructed images concerning the presence and depth of proximal caries lesions (244 surfaces). To determine the presence/absence and depth of caries lesions, histological examination was conducted as reference standard level of significance McNemar and McNemar-Bowker tests compared the methods studied and the gold standard (P < 0.05). Results: The intra- and inter-observer agreement for both methods ranged from moderate to excellent. There was no difference between both micro-CT methods and histology for the presence of lesions (P > 0.05). However, both methods differed with the reference standard for depth (P < 0.05). The disagreement occurred mostly in cases of enamel lesions. The highest diagnostic values were found for 180° rotation. Micro-CT performed well in detecting caries lesions compared to histology, meanwhile the classification of their depth presented lower values. Scan mode did not influence the detection. Conclusion: Both protocols of micro-CT tested presented an overall satisfactory performance in detecting proximal caries lesions; however, for the depth classification, the method was not accurate.

Background: An ideal root canal irrigant should be able to enhance the wettability of sealer to dentin walls. The aim of this study was to survey the contact angle between AH 26 sealer and dentin surface irrigated by four herbal essential oils, compared with normal saline and 5.25% sodium hypochlorite (NaOCl). Materials and Methods: In this in vitro study, 60 longitudinal dentin slices were obtained from thirty extracted single-rooted human mandibular first premolars. After smear layer removal, the samples were divided into six groups of 10 samples and irrigated for 1 min with the experimental solutions followed by distilled water: G1: Myrtus communis, G2: Cinnamomum zeylanicum, G3: Zataria multiflora (ZM), G4: Cuminum cyminum (CC), G5: normal saline, and G6: NaOCl 5.25%. The contact angle between AH 26 and the samples was measured using Motic Images Plus 2.0 software. Data were analyzed statistically using one-way analysis of variance (P < 0.05 consider significant). Results: All the herbal irrigants, except CC, increased the contact angle of AH 26 sealer (P ≤ 0.05). The least value of contact angle was seen in the samples treated with CC, and the maximum value was observed in samples treated with ZM. 5.25% NaOCl showed a slightly increased contact angle compared to normal saline; however, it was not statistically significant (P > 0.05). Conclusion: Under the experimental condition of this study, CC was able to increase dentin wettability and therefore may be regarded as a promising irrigant after careful evaluation of other properties of this irrigant.

Background: The aim of this study was to compare the cytotoxicity and the biocompatibility of three different nanofibers scaffolds after seeding of stem cells harvested from human deciduous dental pulp. Given the importance of scaffold and its features in tissue engineering, this study demonstrated the construction of polyhydroxybutyrate (PHB)/chitosan/nano-bioglass (nBG) nanocomposite scaffold using electrospinning method. Materials and Methods: This experimental study was conducted on normal exfoliated deciduous incisors obtained from 6-year-old to 11-year-old healthy children. The dental pulp was extracted from primary incisor teeth which are falling aseptically. After digesting the tissue with 4 mg/ml of type I collagenase, the cells were cultured in medium solution. Identification of stem cells from human exfoliated deciduous teeth was performed by flowcytometry using CD19, CD14, CD146, and CD90 markers. Then, 1 × 10⁴ stem cells were seeded on the scaffold with a diameter of 10 mm × 0.3 mm. Cell viability was evaluated on days 3, 5, and 7 through methyl thiazol tetrazolium techniques (P < 0.05) on different groups that they are groups included (1) PHB scaffold (G1), (2) PHB/chitosan scaffold (G2), (3) the optimal PHB/chitosan/nBG scaffold (G3), (4) mineral trioxide aggregate (MTA), and (5) the G3 + MTA scaffold (G3 + MTA). Data were analyzed with two-way ANOVA at significance level of P < 0.05. Results: The results indicated that the PHB/chitosan/nBG scaffold and PHB/chitosan/nBG scaffold + MTA groups showed significant difference compared with the PHB/chitosan scaffold and PHB scaffold groups on the 7^th day (P < 0.05). Conclusion: Thus, it can be concluded that the scaffold with nBG nanoparticles is more biocompatible than the other scaffolds and can be considered as a suitable scaffold for growth and proliferation of stem cells.

Background: Mineral trioxide aggregate (MTA) has a high biocompatibility and its physical properties could be improved by adding the containing silica fume an amorphous silicon dioxide (condensed silica fume [CSF]). The aim of this study was to evaluate the cytotoxicity of MTA mixed with CSF on the viability of L929 mouse fibroblast cell using 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide reduction assay (MTT assay). Materials and Methods: In this in vitro study white MTA was mixed with distilled water according to the manufacturer's instructions. Mixtures of White MTA with 10%, 15%, and 20% CSF by weight were prepared and mixed with distilled water. Cytotoxicity of mixtures was compared with MTT assay on L929 mouse fibroblast cell line after 24, 48, and 72 h. Differences in cytotoxicity were assessed by one-way analysis of variance (ANOVA). Results: Mean ± SD of vital cell counts cultured in MTA, MTA + 10% CSF, MTA + 15% CSF, and MTA + 20% CSF were 98% ± 6%, 97% ± 6%, 94% ± 4%, and 98% ± 4%, respectively. One-way ANOVA did not reveal any statistically significant difference between the groups (P > 0.05). Conclusion: It may be concluded that addition of CSF to MTA may not influence its cytotoxicity.

Maxillary permanent incisors have a major role in facial esthetics. Impaction of them has great adverse effect on smile and causes serious concerns in patient and parents. Physical barriers (e.g., overretained primary teeth, supernumerary teeth, and pathologic lesions), space problems, developmental abnormalities, altered eruption sequence, trauma, palatal clefts, and genetics can act as etiologic factors. Currently, the conventional technique to treatment of impacted teeth consists of a combined orthodontic and surgical approach, to guide the impacted teeth in a constant position and surrounded by normal hard and soft tissues. Treatment is challenging because of some limitations such as patient's age, cooperation, anchorage, and mechanotherapy possibilities. Hence, sophisticated treatment planning is crucial. A 9-year-old girl with horizontally impacted maxillary left central incisor treated with surgical exposure and closed orthodontic forced eruption with 2 × 4 partial setup fixed appliances. Force was applied with 0.014 inch nickel–titanium wire as elastic overlay and handmade ligated bracket. To save chair time in each appointment, the overlay was activated by twisting of ligature wire extensions around it. After 16-month treatment, impacted incisor emerged in oral cavity, with accepted alignment and inclination. Handmade ligated bracket with ligature wire extensions is useful for the treatment of impacted teeth. Due to easy activation of overlay in this method, chair time become short in each appointment.