Previously, it was reported that human amniotic membrane (AM) induced stem cells from human deciduous exfoliated teeth (SHED) endothelial-like-cell differentiation. This interesting effect of AM matrix on SHED demands further elucidation. Objective of this in vitro work was to study the effect of 24-h VEGF induced on SHED endothelial differentiation when seeded on acellular stromal side (SS) of AM matrix. Stemness of SHED was identified by flow cytometry. Cell attachment and morphological changes towards the matrix was observed by scanning electron microscopy. Protein expression of endothelial marker was examined by Western blot. The expression of stem cells and endothelial-specific gene markers of VEGF-induced SHED cultured on human AM was inspected via reverse transcriptase-polymerase chain reaction. Results showed SHED at both passages retain stemness property. Ang-1 protein was expressed in SHED. Cells treated with VEGF and cultured on AM transformed attached well to AM. VEGF-induced SHED expressed both stem cell and endothelial-specific markers throughout the treatments and timeline. Interestingly, prolonged VEGF treatment increased the expression of Cox-2 and VE-Cadherin genes in all treated groups when compared to SHED. It was concluded that the VEGF-induced SHED showed better expression of endothelial-specific markers when cultured on SS of AM, with prolonged VEGF treatment.
Inductively Coupled Argon Plasma Atomic Emission Spectroscopy (ICP-AES) has been used to determine Pb, Zn and Cu levels in 47 exfoliated human teeth (all of which required extraction for orthodontic reasons). Lead concentrations for the group were 1.7 microg (g tooth mass)(-1) to 40.5 microg (g tooth mass)(-1). with a median of 9.8 microg (g tooth mass)(-1). A median lead level in excess of the group value was found for the teeth of six lorry drivers who were included in the study. A more significant enhancement was found for the seven subjects whose age was in excess of 60 years. The median values for Zn and Cu were 123.0 and 0.6 microg (g tooth mass)(-1) respectively. Present values for tooth-Zn are lower than published data for other ethnic groups.
Tooth wear is the non-carious loss of tooth tissue due to attrition, erosion and/or abrasion. The amount of wear that accelerates physiological tooth wear is referred as pathological tooth wear. This study aims to determine the prevalence and mean scores according to mouth quadrant of raw tooth wear (RTW) and pathological tooth wear (PTW) and investigate sex association with PTW among 16-year-old secondary school children in Kota Bharu, Kelantan. This cross-sectional study involves 688 participants randomly selected from eight government secondary schools. The Smith and Knight Tooth Wear Index (TWI) was used. Data were analyzed using a simplified Microsoft Excel program developed based on the index to quantify PTW. Bar graphs were plotted to highlight the mean scores according to mouth quadrant. About 44% of participants were male and 56% were female. The prevalence of RTW and PTW among subjects was 100% and 20.1% respectively. It was found that 32.8% of tooth surfaces were affected with RTW and 0.7% of study subjects already had exposed dentine. The most affected quadrant for RTW and PTW was the upper and lower incisal quadrant respectively. Males had 92% more odds of developing tooth wear compared to females. In conclusion, all subjects have some degree of wear. About one-fifth of the study subjects were affected by PTW. The patterns of wear were similar to those encountered in the Western societies. There was statistically significant association between sex and PTW.
The replacement of missing teeth with implant borne restorations has become a treatment modality accepted by the scientific community for fully and partially edentulous patients. Recent developments in oral implantology involve the use of immediate implant placement technique that significantly reduces waiting time. This case report describes the management of an anterior missing tooth using immediate implant. The result was good, which further validate the use of this technique for suitable patient management.
The purpose of this study was to evaluate hardness (indicator for polymerization) and thickness of two types of resin cement at coronal, middle and apical level of tooth root canal. Ten extracted maxillary incisors were instrumented and post space was prepared for cementation of titanium post. Samples were divided into two groups and each group was cemented either of the two types of resin cements; Panavia F [dual-cured (PF)] and Rely X Luting 2 [self-cured (RL)]. The teeth were longitudinally sectioned; hardness and thickness was measured using Vickers hardness tester and a microscope (Leica DMLM). SEM observations along the cement line at the 3 different root levels were performed. Statistical analysis was performed to test significance of differences in hardness and thickness of the two types of cement (t-test; p= 0.05) and at different levels of the same type (one-way ANOVA followed by multiple comparison; p= 0.05). Significant difference of hardness was found at the apical level between the two groups and between the coronal and apical level of PF (p0.05). Moreover, voids were more obvious within the dual-cured group of cement. Dual-cured resin cement was found to be less polymerized than self-cured type at apical level. Increased thicknesses of resin cements in comparison to post space size were observed in both groups. Use of metallic post with resin cements needs further evaluation.
The objectives of this study were to determine the normal mean value of the root-crown (R/C ratios) in Malay patients and their variations by gender and dental arch from orthopantomogram radiographs (OPGs). Two thousand nine hundred and twenty teeth with fully developed roots were measured from 112 OPGs. Subjects with history of maxillofacial trauma or orthodontic therapy were excluded. The mean age of the subjects was 19.1 (SD 2.08) years old for males while females 18.9 (SD 2.19) years old in the range from 15 to 22 years old. The intra-examiner reproducibility of the assessment method was good (Intraclass correlation coefficient 0.81). Results of this study showed that there was no significant difference between R/C ratios of males and females groups. However, the ratios of the antagonist teeth for both males and females were significantly greater in the mandible than in the maxilla (p
Study site: Dental clinic, Hospital Universiti Sains Malaysia
Endodontically treated teeth are generally weaker than sound teeth. The study objective was to compare the fracture resistance of endodontically treated teeth restored with different restorative techniques. Fifty extracted human maxillary central incisors of similar size were divided into five groups of 10 teeth. Group 1 was left intact as the control group. Other groups (Groups 2, 3, 4 and 5) were all endodontically treated followed by restorations using different restorative techniques; light cured composite resin (CR), CR and crown, post and CR, and post-CR core and crown respectively. The specimens were loaded in a universal testing machine with a static force at a crosshead speed of 0.5mm/min at 135 ° to the long axis of the root until failure. The means and the standard deviations of the maximum load at failure for groups 1, 2, 3, 4 and 5 were 1259.11N (379.12N), 578.63N (196.70N), 667.13N (298.72N), 1247.65N (294.48N) and 623.60N (193.75N) respectively. The results of one-way ANOVA showed statistically significant differences existed among the groups tested (p
Tooth wear is the loss of tooth tissue and structures not due to caries. It can occur in various forms either attrition, abrasion, erosion, noncaries cervical lesion (NCCL) or a combination of two or more forms. The objective of this study was to determine the patterns and associated aetiologies of tooth wear among adults in Kelantan, Malaysia. This crosssectional study involved 81 adults with tooth wear which was visually assessed using the Smith and Knight Tooth Wear Index (TWI). A questionnaire was used to seek putative aetiologies of the wear. Data were analyzed and the results were expressed as frequencies and percentages. Six thousand three hundred and eighty four tooth surfaces were examined in 1596 teeth. 17.4% surfaces had tooth wear; 80% scored 1, 18% scored 2 and 2% scored 3. Among the 81 cases of tooth wear, 29 (35.8%) had abrasion; 25 (30.9%) had attrition; 1(1.2%) had erosion while 26 (32.1%) had the combined type. Among those with abrasion, majority had the habit of eating freshwater clams (Corbicula fluminea) as local delicacy where most of the times people use their teeth to pry open the clam shells. Erosion was related to the pooling of carbonated drinks or beverages in the mouth before swallowing. In conclusion, most adults experienced abrasion and the most common possible associated aetiology is the way of eating clams.
Use of synthetic hydroxyapatite (HA) in biomedical applications is well warranted. It has shown to have an excellent biocompatibility in human tooth and bones. Additionally it has been documented to possess antibacterial potentials. The present study was conducted to assess the presence of any such potential in locally produced (HA) using Streptococcus mutans, a common pathogen in the oral cavity. The study was carried out using 50, 100, 150, 200, 300, 400 and 800 mg/ml concentration of HA. The antibacterial property of HA was assessed using Miles and Misra method. Our studies showed that bacterial growth inhibitions of S. mutans occurred from 50 mg/ml, and complete inhibition was perceived at concentrations at 200mg/ml of HA. The antibacterial property HA should be used to good advantage as a bioactive biomaterial in dental and maxillofacial applications.
Pathologic tooth migration (PTM) is a common complication following moderate to severe chronic periodontitis, which lead to the undesirable consequences such as traumatic occlusion and impaired aesthetic appearance. Multidisciplinary approach had been successfully used in overcoming the problem. However, since periodontal tissue support is reduced in PTM, further migration of teeth may occur as they were always subjected to the external forces such as occlusion and soft tissue pressure during function. This case report described a 41 year-old male with a further migration of his upper right central incisor after periodontal therapy. After multidisciplinary approach was carried out to overcome the problem and the tooth was on stable condition, permanent splinting was placed to secure the tooth.
Supernumerary tooth (ST) is a developmental anomaly and has been argued to arise from multiple etiologies. These teeth may remain embedded in the alveolar bone or can erupt into the oral cavity. When it remains embedded, it may cause disturbance to the developing teeth. The erupted supernumerary tooth might cause aesthetic and/or functional problems especially if it is situated in the maxillary anterior region. A case of supernumerary teeth is presented where the teeth have been left in place and which later gave rise to some problems. The patient had history of trauma and requested orthodontic treatment for the misalignment of his anterior teeth. The treatment options are further discussed.
his study assesses inter-examiner reproducibility in recording various malocclusion parameters and Index of Orthodontic Treatment Need (IOTN) grade during patient examination by utilising the kappa statistic. Five previously calibrated orthodontists clinically examined 233 non-orthodontically treated schoolchildren aged 14-17 years for recording various malocclusion parameters. The examination was repeated twice, thirty days apart and precluded the use of study-models or radiographs. Although good inter-examiner reproducibility was observed in recording incisor class, IOTN dental health grade, type of posterior crossbite, and excellent for parameters with absolute criteria like
erupted supernumeraries, etc, substantial examiner variation resulted in only fair reproducibility for recording IOTN esthetic category, canine class, overbite category, traumatic overbite and upper centre-line shift of two millimetres or more from the facial midline. Reproducibility for detecting occlusal displacement in the presence of crossbite was poor, and kappa statistic was incalculable for recording openbite and number of upper incisors rotated 30° or more. Kappa was also incalculable for recording IOTN dental health subcategory due to the creation of asymmetric tables caused by rarely chosen subcategory options. Despite prior agreement between previously calibrated examiners on evaluation criteria, detection of certain malocclusion parameters during an epidemiological examination can prove to be challenging. Epidemiological studies that report on prevalence of malocclusion in the population should always report on the kappa reproducibility, especially if the study is carried out by multiple examiners.
Replacing a single missing anterior tooth can be a challenge. Many factors need to be considered when choosing the appropriate treatment. Several treatment options are well established. This case report is to present the use of a cast cobalt chrome partial denture with custom made porcelain tooth to improve aesthetic. The overall shade of the artificial tooth were nicely matched with the adjacent teeth and definite enamel translucency could be achieved which would not be possible with acrylic or even with readymade porcelain tooth.
Sufficient knowledge on the root and root canal anatomy is essential for practicing root canal treatment. The mesiobuccal roots of maxillary molar teeth present an endodontic challenge due to their wide variability and complexity of their internal morphological landmarks. A review on the literature indicates that the prevalence of a third mesiobuccal root canal in the mesiobuccal root of maxillary molar teeth may reach 9%, and the root canal configuration usually is type XV (3-2). These reported data reveal the importance of absolute awareness for this anatomical aberration that requires special attention from dental practitioners while commencing root canal treatment in maxillary molar teeth. Hence, this article aims to report and describe the management of a maxillary first molar tooth with three mesiobuccal root canals, but with an unusual configuration.
Rubinstein-Taybi syndrome is a multiple anomalies congenital disorder characterised by broad thumb and halluces, facial dysmorphism with mental and growth retardation. Oral features include small mouth, retro and micronagthic jaws, highly arched and narrow palate. Dental anomalies such as teeth with talon cusps and screwdriver shaped permanent incisors together with crowded teeth are common features in these patients. Although hyperdontia is said to be one of the features of this condition, nevertheless, presence of multiple supernumerary teeth has never been documented. This report highlighted a case of an eleven-year-old boy with Rubinstein-Taybi syndrome referred for unerupted permanent incisors who exhibited multiple supernumerary teeth radiographically.
Dental caries is the main oral health problem in hearing-impaired (HI) children and remains the most neglected need. The present study aimed to determine caries prevalence and treatment needs in HI children and the association with salivary parameters. A cross-sectional study was conducted on 63 HI children aged between 7-14 years who attended a special school for the deaf. Clinical oral examination was done and salivary parameters (resting flow rate and resting pH) were measured. Caries experience was charted using the index of decay-filled teeth (dft) and Decay-Missing-Filled Teeth (DMFT) for primary and permanent dentition respectively. Data were analysed using SPSS version 12.0. The mean age was 11.5 (SD 2.39) years and 53.8% were female. Dental caries prevalence was 88.0% (95% Cl: 73.0, 100.0) in primary dentition and 85.0% (95% Cl: 73.0, 96.0) in permanent dentition. The mean dft was 6.1 (SD 4.14) and the mean DMFT was 4.9 (SD 3.28). The mean resting flow rate was 0.14 (SD 0.08) ml/min while mean pH was 6.8 (SD 0.79). Both pit and fissure sealants and restorations were the highest (83.1%) treatment needs. Only 3.1% of the children did not require any treatment. There were no significant association between both salivary flow rate and salivary pH with caries experience in the primary (p=0.342, p=0.610 respectively) and permanent (p= 0.99, p=0.70 respectively) teeth. In conclusion, children with HI have high caries prevalence and unmet need for dental treatments. Salivary pH and resting flow rate of the children were not associated with their caries experience.
This study aimed to assess the nutritional status (BMI), oral health behaviour, sugar consumption and the associated factors with dental caries among a group of 7 to 11 years old children in Kuala Lumpur, Malaysia. Three hundred and twelve students were recruited from February to July 2013. Information gathered were their socio-demographic characteristics, body mass index, sugar consumption, oral-health behaviour, oral hygiene index and decay-missing-filled teeth (dmft) index. Anthropometry measurements and sugar intake was measured using verified tools. Meanwhile, dmft was examined using the World Health Organization (WHO) criteria. 53.7% of the children were of the normal body weight with mean sugar consumption of 31.81±4.24 g/day. Prevalence of dental caries was reported at 44.6% (95% CI: 42.2, 53.3) with a mean (SD) dmft of 1.27(1.84). No association was found between dental caries and weight status distribution. Most children tend to brush their teeth 2 times or more in a day (75%), however, they spent lesser time in tooth brushing (5.4%) and do not practice flossing (78%). Regression analysis showed that age (p
The purpose of this study was to evaluate the periodontal status distal to the adjacent second molar following the extraction of a partially or fully impacted mandibular third molar at Klinik Pergigian Pakar Hospital Universiti Sains Malaysia (KPPHUSM) from April of 2008 until June of 2008.This was a prospective study which involved the clinical and radiological study of patients. In this study, convenience sampling method had been used. The sample size was 22 patients aged 18-32 years old with inclusion criteria. The outcomes measured in this study were periodontal pocket depth (PPD), clinical attachment level (CAL) and alveolar bone height (ABH). Subjects were examined at distal surface (disto-buccal, mid-distal and disto-lingual) of second molar for PPD and CAL before and 3 months after the impacted adjacent lower third molar extraction. OPG was taken each before and after the third molar removal. These data were analyzed using SPSS version 16 and Wilcoxon-signed-ranks test was used to compare the PPD, CAL and ABH pre and post operatively. All the results were not significant with p >0.05. For PPD, median = 3mm pre and post extraction. CAL median= 2mm pre and post operatively and ABH median of 3.10mm (before) and 2.8mm (after) the third molar removal. From our study, we concluded that there were no significant changes of PPD, CAL and ABH at distal side of second molar after 3 months of the adjacent impacted lower third molar removal.
Study site: Dental clinics, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
The aim of this study was to identify the position of impacted mandibular third molars based on the classifications of Pell & Gregory and Winter, the indications for extraction, and the relation of post-operative complications and position. Records of patients who attended Hospital Universiti Sains Malaysia between January and December 2007 for surgical removal of mandibular third molars were reviewed. The angulation type, width and depth of impaction were determined by reviewing the orthopantomograms. The indications of extraction and occurrence of any post- operative complications were recorded. A total of 238 impacted teeth were surgically extracted from 194 patients (97 males, 97 females). The reasons for extraction include recurrent pericoronitis (43.1%) followed by prophylactic purposes (33.5%). Mesioangular impactions accounted for 52.3% and Class IIA position of impaction accounted for 45.7% of extractions. The most common post-operative complication was persistent pain and swelling (14.7%) followed by trismus (4.1%) and dry socket (3.0%). There was no significant relationship between the angulation, width and depth of impaction and the occurrence of complication. Mesioangular type and Class IIA position of impaction were the most common impaction. Although the association was not significant, high frequency of post-operative complications was observed in mesioangular, horizontal, IIA and IIC positions.
Presence of accessory cusp on the occlusal surface of a tooth may occasionally pose problems to dentists'. Although its presents may not be a cause for alarm in most instances, nevertheless it can lead to serious consequences if it is damaged. This report describes a rare finding of bilateral central accessory cusp seen on the occlusal surface of both the 2nd maxillary deciduous molars and the need for continuous dental surveillance and preventive measures have been highlighted.