MBRU Theses & Dissertations

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Treatment Outcomes of Pre-Surgical Infant Orthopedicsin Patients with Non-Syndromic Cleft Lip and/Or Palate: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
(2016) Hosseini, Hamid
Aim: To investigate the effectiveness of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate and evaluate the quality of the available evidence. Materials and methods: An electronic search without restrictions for published and unpublished literature, together with hand searching, was carried out. Randomized controlled trials (RCTs) investigating the effects of pre-surgical infant orthopedic appliances reviewed. The risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias assessment tool for RCTs and the quality of evidence assessed according the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Results: The initially identified 1,043 records were finally reduced to 20 full-text reports concerning a total of 118 patients with unilateral complete cleft lip and palate and 16 with cleft of the soft and at least two thirds of the hard palate. Eighteen of the eligible records comprised a part of a larger trial. Eight publications were considered as being of low, four of unclear and eight of high risk of bias. iii In general, the investigated appliances did not present significant effects when compared to each other or to no treatment in terms of feeding characteristics and general body growth, facial esthetics, cephalometric variables, maxillary dentoalveolar variables and dental arch relationships, speech and language related variables, caregiver-reported outcomes, economic evaluation related outcomes, as well as, adverse effects and problems related to the appliances or the applied procedures. Overall, the quality of the available evidence was considered low. Conclusions: The aforementioned findings could provide initial guidance in the clinical setting. However, given the multitude of parameters which may have affected the results, good practice would suggest further research in the respective field, in order to arrive at more robust relevant recommendations for management decisions in individual cases.
Overall and Anterior Tooth Size Ratios In A Group of Emiratis
(2016) Mohammad, Moaza
Aims: 1- To study overall and anterior tooth size ratios in a group of Emiratis with Class I normal occlusion. 2- To estimate overall and anterior tooth size ratios in different malocclusion groups of Emiratis. 3- To compare overall and anterior tooth size ratios of a group of Emiratis, with Class I normal occlusion, with the Bolton standards. 4- To determine the distribution of overall and anterior tooth size ratios ± 2 SD from Bolton mean values in all occlusion groups. Materials and Methods: Consecutive patients’ files, including dental casts, were selected from the archives of the governmental orthodontic clinics of the Dubai Health Authority located in Bur Dubai and Bur Deira. The final sample was formed following the application of specific inclusion criteria: healthy patients, age from 13-18 years, Emirati origin, complete permanent dentition, in which, however, second and third molars may be absent, normal tooth crown morphology, no dental anomalies in tooth shape, tooth size and tooth number, no history of interproximal reduction, no restorations altering mesiodistal tooth crown width, complete record files and excellent quality of study models. The exclusion criteria were: history of systemic diseases, craniofacial anomalies, medical history contributory to dental and jaw development, mixed Emirati origin, mixed dentition, presence of dental anomalies in tooth shape, tooth size and tooth number, history of interproximal reduction, restorations altering mesiodistal tooth crown width, congenital missing teeth, incomplete record files and poor quality of study models. The sample consisted of 521 pairs of dental casts representing both sexes (males: 188; females: 333) and different occlusion groups (Class I malocclusion: 288; Class II malocclusion 110; Class malocclusion: 30; Class I normal occlusion: 93). The mean age of patients whose dental casts were utilized in this study was 16.18 years for Class I malocclusion, 15.73 years for Class II malocclusion, 15.83 years for Class III malocclusion and 16.55 years for Class I normal occlusion. The dental casts were selected, scanned using Ortho Insight 3D laser scanner (3D Motion View, Chattanooga, Tennessee, USA) and digitized by the author using the Ortho Insight 3D laser scanner (3D Motion View Software). Measurements were made regarding maxillary and mandibular sums of mesiodistal tooth dimension of the overall (6-6) and anterior (3-3) groups of teeth. In order to test the intra-examiner reliability, the author re-measured 50 pairs of casts, which were randomly selected from the original sample one week after the initial measurement. The intra-examiner reliability was assessed using paired t-test. Statistical analysis included descriptive statistics, paired t-test and analysis of variance (ANOVA). The level of significance was set at p<0.05. Results: No statistically significant differences were found between the first and the second sets of measurements thus, confirming the intra-examiner reliability. The mean values of overall ratios were 91.57 for Class I malocclusion, 91.54 for Class II malocclusion, 90.21 for Class III malocclusion and 91.41 for Class I normal occlusion. In addition, the mean values of anterior ratios were 78.05 for Class I malocclusion, 79.14 for Class II malocclusion, 77.54 for Class III malocclusion and 77.54 Class I normal occlusion. There was a statistically significant difference among malocclusion groups. Comparison of overall and anterior tooth size ratios between the III sample of this investigation with Class I normal occlusion and the Bolton standards showed no statistically significant differences. Only five cases in Class II malocclusion presented an anterior tooth size discrepancy outside plus 2 SD from Bolton mean values and one case in Class I malocclusion presented with an overall tooth size discrepancy outside plus 2 SD from Bolton mean values. Conclusions: Based on the finding of this investigation the following conclusions could be presented regarding the Emirati sample which was studied: - • Class I normal occlusion cases presented similar overall and anterior tooth size ratios to Bolton standards. • Overall and anterior tooth size ratios among occlusion and different malocclusion groups exhibited statistically significant differences. • Five cases in Class II malocclusion presented an anterior tooth size discrepancy outside plus 2 SD from Bolton mean values. • One case in Class I malocclusion presented with an overall tooth size discrepancy outside plus 2 SD from Bolton mean values.
Occlusal Outcome Assessment of Orthodontic Treatments Performed at An Educational Institute in Dubai
(2016) Elshafee, Fadi
Aim: To assess occlusal outcome of comprehensive orthodontic treatments performed by postgraduate students at an educational institute in Dubai. Materials and Methods: Consecutive patients’ files, including dental casts, were selected from the archives of the Boston University – Dubai (BU-D) (2008-2012), which have been transferred to the Hamdan Bin Mohammed College of Dental Medicine. The final sample was formed following application of certain inclusion criteria and consisted of 30 patients with permanent dentition who received comprehensive orthodontic treatment by means of fixed appliances in both dental arches. All pre- and post-treatment dental casts were blindly assessed by the author using the Peer Assessment Rating (PAR) and Index of Complexity, and Need (ICON) indices. In order to test the intraexaminer reliability, the examiner re-assessed 15 cases, which were randomly selected from the original sample, one week after the initial examinations. Statistical analysis included descriptive statistics, paired t-test, Neymman Pearson correlation coefficient and linear regression. The level of significance was set at p <0.05 The intra-examiner reliability was assessed using paired t-test and found high. Results: Occlusal outcome related to orthodontic care provided was characterized by significant improvement. Mean PAR changed from 19.43 before treatment to 4.63 after (p<0.001). Mean ICON changed from 53.96 before treatment to 19.06 after (p <0.001). According to PAR 46.67% of patients “greatly improved” and 36.67% “improved”, respectively. According to ICON 23.33% of patients “greatly improved”, 20% “substantially improved” and 36.67% “moderately improved”, respectively. Conclusions: Patients treated at the Postgraduate Orthodontic Program of BU-D demonstrated significant improvement of their occlusion.
Oral Health Problems in Leukaemic Paediatric Patients in the United Arab Emirates: A Retrospective Study
(2016-08) Alnuaimi, Eman
Aims: The aim of this study was to estimate the prevalence of oral health problems in leukaemic paediatric patients in the United Arab Emirates (UAE) and correlate it to the phase of chemotherapy. Materials and Methods: Medical records of 120 of paediatric leukaemic patients (age below 15) in the UAE were reviewed for the occurrence of oral health problems. Records from the three main hospitals that provide cancer therapy were accessed after obtaining the required ethical approvals. Results: The overall oral sequelae prevalence in leukaemic patients in our study was 60%. The most common oral health problem recorded in the patients’ records was oral mucositis and ulceration followed by dental caries and oral candidiasis that accounted for 52.4%, 18.3%, and 14.2% of reported cases respectively. Other oral health problems recorded were gingivitis and gingival bleeding, herpetic gingivostomatitis, dental caries, poor oral hygiene, and facial palsy. The peak incidence of occurrence of most oral problems was during phase IV (maintenance). Conclusion: Our study highlighted important oral complications of leukaemic paediatric patients in the UAE that were not studied previously. Oral health problems as a result of leukaemia and its management are variable and are unavoidable. Close liaison between the oncology and dental teams is essential. Moreover, this study highlighted the importance of supportive care for this group of patients that can help minimize the oral adverse effects of the disease and its treatment, thus improving the oral health-related quality of life (H-RQL) of these patients.
Dental Caries Experience and Oral Health in Down Syndrome Children In Dubai, United Arab Emirates: A Case Control Study
(2016-08) Ghaith, Batool
Aims: The purpose of this study was to assess the oral health status in Down syndrome (DS) children in Dubai, United Arab Emirates (UAE). Materials and Methods: A total of 106 DS children (mean age = 9.3 ± 2.8)and 125 healthy children (mean age = 11.7 ± 4.4) were recruited from both special needs centres and private/public schools in Dubai. A dental examination including caries assessment using dmft/DMFT indices, oral hygiene assessment using the Simplified Oral Hygiene Index, an assessment of occlusal anomalies, dentofacial abnormalities, soft tissue abnormalities and erosion were conducted. Results: The mean number of DMFT in DS children was significantly higher than that in healthy children (3.32 ± 4.62 vs. 2.16 ± 2.86). The dmft scores were highest among the youngest age groups in DS with primary dentition compared to their controls. The Met Need Index (MNI) and Restorative Index (RI) were calculated from the mean dmft/DMFT of the studied DS sample. DS children in the primary dentition group had higher RI and MNI scores than the control group (RI= 27% and MNI= 40%vs RI= 2.52% and MNI= 2.54%). On the other hand, Calculus Index (CI) was found to be significantly higher among children with DS (0.25±0.52) compared with healthy controls (0.07±0.27) (p-value < 0.004).DS subjects had a significantly higher proportion of open bite compared to the controlgroup (40% vs 11.2%), crossbite (42% vs. 28%), scissor bite (9.5% vs 2.4%), anterior spacing (45.3% vs 32%) and posterior spacing (20.8% vs. 8%). Class IIImolar Angle malocclusion was significantly higher in DS (66%) compared to controls (11.2%). DS individuals had remarkably increased frequencies of dentofacial anomalies such as shovel shaped incisors, high arched palate and microdontia compared to controls. In addition, erosion was significantly higher among DS children compared to healthy control(34% vs. 15.3%). Conclusions: Individuals with DS feature unique medical and orofacial characteristics that might interfere with their oral health. This current study had concluded thatDS children in Dubai had higher caries rate compared to healthy children. Despite the high caries rate among DS subjects, they received more restorations and dental treatment compared to the controlgroup.DS subjectsin Dubai demonstrated most of the dentofacial anomalies usually seen in DS individuals.
Oral Manifestations and Dentofacial Anomalies in Beta Thalassaemia Major Children in Dubai (UAE): A Case Control Study 2015
(2016-08) Al Raeesi, Shaikha,
Aims: The purpose of this study was to identify special oral and dentofacial manifestations peculiar to beta thalassaemia major children in Dubai, United Arab Emirates (UAE). Materials and Methods: A total of 38 Emirati children with beta thalassaemia major (mean age =10.18 ± 3.19) and 76 healthy Emirati children (mean age = 10.79 ± 3.54) were recruited from Dubai Genetic & Thalassaemia Centre, along with public schools in Dubai. A dental examination including caries assessment using dmft/DMFT indices, oral hygiene assessment using the Simplified Oral Hygiene Index, an assessment of occlusal anomalies, dentofacial abnormalities and soft tissue abnormalities was conducted. Results: There was a clear and statistically significant difference in caries experience amongst thalassaemia children compared to the healthy controls with DMFT (2.73 ± 0.22 vs 0.21 ± 0.56, p-value = 0.017). The Met Need Index (MNI) and the Restorative Index (RI) were calculated from the mean dmft/DMFT of the studied sample. Children in the thalassaemia group received less treatment than their controls in all age groups; however, this was not shown to be statistically significant. Calculus Index (CI) was found to be significantly higher among children with beta thalassaemia (0.27 ± 0.43) compared with healthy controls (0.09 ± 0.32) p-value 0.002. Conversely, the proportion of gingivitis was found to be significantly lower among children with thalassaemia compared with that of the healthy controls 44.7% and 69.7% respectively ( p-value = 0.009). On the other hand, beta thalassaemia subjects had a higher proportion of class II Molar Angle Malocclusion (40%) compared to the healthy controls class II (25%). Children with thalassaemia had significantly higher proportion of retained primary teeth compared with healthy controls (18.4% vs. 0%, p-value = 0.001). It was obsereved that gingival pigmentation in children with thalassaemia was significantly higher compared with healthy controls (23.7% vs 0%, p-value = 0.001). Conclusions: The findings of this study concluded that children with thalassaemia in Dubai had higher caries rate compared to healthy children. Other oral and dentofacial anomalies were observed in the group. There is a need to implement awareness programs to alert patients’ parents and caretakers of the need to provide better care.
The Prevalence and Severity of Molar Incisor Hypomineralisation In Dubai, UAE, A Cross Sectional Study
(2016-08) Hussain, Ghada
Aim: The aim of this study was to evaluate the prevalence and severity of Molar Incisor Hypominerlisation (MIH) among school children in Dubai, United Arab Emirates (UAE). Materials and Methods: A randomised cluster sample of 8 to 12 year-old children had their first permanent molars and permanent incisors (index teeth) evaluated for prevalence and severity of MIH using the criteria of the European Academy of Paediatric Dentistry. The examinations were conducted at public schools by two calibrated examiners. A total of 342 children (mean age = 9.46) were randomly selected from public schools in Dubai and Hatta (rural area). Results: The prevalence of MIH was 27.2 % in Dubai, (93 out of 342 children); there were no significant differences between Dubai and Hatta. The prevalence of MIH was significantly greater in girls (32.6%) compared to (18.1%) in boys with a p-value of 0.002. The prevalence of MH was higher than MIH: 61 out of 93 children (65.6%) had MH, compared to 32 out of 93 children (34.4%) who had MIH. MH in maxillary molars was significantly higher than mandibular molars, 20.8% compared to 14.6% (p= <0.005). Maxillary incisors were effected more by MIH 8.8% compare to mandibular incisors (0.9%) (p= <0.001). The presence of demarcated opacities was significantly higher in girls than boys (p = 0.002). Moreover, a large majority of the children with MIH in the present study (53%) presented with mild defects, (17%) moderate defect and (30%) severe defects. Conclusions: The prevalence of MIH in school children in Dubai was 27.2 percent. Location and age appeared to have no significant correlation with MIH except in gender. Girls had more MIH than boys (P=0.002), which warrants further research.
Knowledge, Attitude and Practices of Mothers toward their Pre-School Children’s Oral Health: A Questionnaire Survey among a Subpopulation in Sharjah, United Arab Emirates.
(2016-08) Mahoud, Noura
Background: Parental knowledge and beliefs may have a possibly detrimental effect on young children’s oral health. Oral hygiene and healthy eating habits in children is significantly affected by their parent’s knowledge and awareness of the importance of dental health. Particularly crucial in the preventative cycle is the positive attitude toward good dental care as displayed by the parents. A positive correlation has been determined between parents’ attitudes towards dentistry and better dental health of their children. Objective: To assess the knowledge, attitude and practices of mothers toward their children’s oral health in Sharjah, United Arab Emirates (UAE). Materials and Methods: A cross-sectional study was conducted among 383mothers (average age of the mothers was 36.61 (+7.86 years), of preschool children average age 3.49 (+1.63 years) who attended Sharjah Dental Center, UAE. Data were collected through an interview, using a structured preform. Results: Adequate knowledge was found among (58.2%), and poor knowledge was found among (41.8%);(99% ) of the mothers exhibited excellent attitude and only (20%) were following good practices towards their children’s oral health. Poor knowledge and practices of mothers toward their children’s oral health was significantly associated with mothers’ occupation and education. Employed mothers scored significantly higher mean of knowledge than the others. Mothers with secondary level of education and university qualification had significantly higher scores of practice compared with mothers with primary education. Employed and student mothers had higher scores of attitude higher than unemployed mothers and mothers owning their own businesses. These differences were statistically significant. There were no significant differences in attitudes of mothers from different educational backgrounds. Conclusions & Recommendation: This study demonstrated that although mothers had better than average knowledge and excellent attitude towards their children’s oral health issues; most of them carried out improper practices towards their children’s oral health. The results also demonstrated differences in mothers’ knowledge, attitude and practices according to their educational and employment backgrounds. The data suggested the need for an establishment of awareness programs in order to improve knowledge and practices of the mothers towards their children’s oral health.
Assessment of the Knowledge of United Arab Emirates Dentists of Child Maltreatment, Protection and Safeguarding
(2016-08) Al Hajeri, Hind
Background: Child safeguarding, governed by international, national and local laws, is the responsibility of all members of society. Members of the dental team are in a unique position to recognize Child Abuse and Neglect (CAN) in dental practice and in the wider society. Objective: To assess the awareness of dentists in the United Arab Emirates (UAE) with regards to child maltreatment, child protection and child safeguarding. Materials and Methods: A cross-sectional survey of 381 UAE dentists was conducted. Questions related to the knowledge and practice of CAN and related safeguarding issues were tabled and cross tabulated against demographic variables. Statistical analysis was carried out using Chi-square, t-test, ANOVA and Pearson’s correlation test. Statistical significance was set as p <0.05. Results: 39.4 %(n=152) of the participants had suspected CAN (mean1.3 CAN cases in the last 5 years); male dentists suspected more CAN than female dentists, however, orthodontists, paediatric dentists (p=0.000) and female dentists (p=0.001) were more knowledgeable about diagnosing CAN. Paediatric dentists attended more CAN-related postgraduate training (p=0.000) than other specialties. Amongst other results, 53.5% (n=204) were not aware of child protection guidelines,58.1% (n=224) and 54.1% (n=206) had undergraduate and postgraduate training about CAN issues respectively and 90.8% (n=346) believed that CAN should be addressed. Barriers to dentists referring CAN cases for child protection were; fear of family violence (59.6%, n=227), lack of knowledge of referral process (60.2%,n=228) and lack of diagnosis certainty (54.9%, n=206).UAE dentists qualified in Western and Asian countries had significantly fewer barriers for child protection (p=0.022)than the Arab and Gulf Cooperation Council qualified dentists. Conclusions: The UAE dentists surveyed witnessed CAN with an average of 1.3 cases in the last 5 years. Many variables (such as gender, specialty, and country of qualification) affected the dentist’s knowledge of CAN and the practice of child safeguarding. Despite agreeing that CAN is an issue that should be addressed, a majority were not aware of the local child protection guidelines and had perceived barriers preventing them from arranging a child protection referral. Female dentists, orthodontists and paediatric dentists scored significantly higher in recognizing CAN cases compared to male dentists and other specialties (general dental practitioners, restorative dentists and oral surgeons).Training and practice recommendations were made. Knowledge of CAN did not necessarily mean more practice of child protection. There was no correlation between those who scored high in CAN knowledge and the CAN practice scores.
Oral Health Status among Children with Cerebral Palsy in Dubai United Arab Emirates: A Case Control Study
(2016-08) Alhashmi, Haifa
Aim: The purpose of this study was to assess the oral health status of children with Cerebral Palsy (CP) in Dubai, United Arab Emirates (UAE). Materials and Methods: 84 CP children (mean age =9.33 ±3.89) and 125 healthy children (mean age =9.30 ± 2.68) were recruited from special needs centres, along with private/public schools in Dubai. A dental examination including caries assessment using dmft/DMFT indices, oral hygiene assessment using the Simplified Oral Hygiene Index, calculus index and oral debris index was conducted. In addition, assessments of occlusal anomalies, dentofacial abnormalities, soft tissue abnormalities, and erosion were conducted. Results: The mean number of DMFT/dmft scores of CP children were comparable to that of healthy children. The Met Need Index (MNI) and Restorative Index (RI) in the CP group with mixed dentition scored the lowest compared with the control group. Calculus Index (CI) was found to be significantly higher among children with CP (0.56±0.78) compared with controls (0.07±0.27)(p-value < 0.001).The proportion of debris was significantly lower among children with CP;57(69.5%) compared with 110(88%) in the healthy controls(p-value =0.001).CP subjects had a significantly higher proportion of anterior open bite compared to the control group (29.3% vs 11.2%, respectively) (p value=0.001), anterior spacing (50% vs 32%)(p value=0.007)and trauma(31.7% vs3.2%) (p value <0.001).Class II molar Angle malocclusion was significantly higher in CP(80.7%) compared to controls (25.5%)(p value <0.001).CP individuals had remarkably increased frequencies of dentofacial anomalies such as high arched palate, tongue thrust, and lymphadenopathy compared to controls. In addition, CP subjects had significantly higher proportion of oral soft tissues’ anomalies such as angular cheilitis, macroglossia, and drooling. Moreover, erosion was significantly higher among CP children relative to healthy controls (42.7% vs15.2%, p-value< 0.001) Conclusions: The findings of this study revealed that CP patients had a tendency toward lower rates of caries compared to healthy children, along with lower rates of restorative and dental care. Significantly higher calculus deposits, lower debris index, and comparable oral hygiene index were also observed. Further, different forms of malocclusion in CP children exceeded those of children without disabilities.
Oral Health Challenges Facing the Autistic Child in Dubai: A Survey
(2016-08) Mansoor, Dina
Aims: The aim of this study was to investigate the challenges faced by the autistic children and their families in Dubai from three different perspectives of dental care: oral care at home, oral care at the dentist and access to oral care, and to compare the results to their normally developing peers. Materials and Methods: This is a case control comparative study, of 84 autistic and 53 healthy 2 to 18 year old children who were recruited from autistic children attending special needs centers in Dubai and from schools in the same geographic areas including siblings of the autistic children whenever available. Data collection was by way of a survey questionnaire sent to the parents or guardians through the centers and school administrations. The data analysis was done using SPSS statistical system using frequency distributions, descriptive analysis and T-test analysis for comparison. Results: Significantly more parents of autistic children compared to parents of healthy children reported difficulty across almost all oral care variables explored, including oral care at home, oral care at the dentist and access to oral care. The autistic children experienced more difficulty in tooth brushing at home and needed to be physically restrained for it. Their uncooperative behavior and sensory sensitivities increased more during their dental visits, which discouraged their parents from taking them for regular dental checkups. More autistic children had never been to a dentist before due to their uncooperative behavior. Conclusion: This study indicates that autistic children in Dubai experience more challenges and barriers to oral care than their typically developing healthy peers.
Dentists’ Knowledge and Application of the Guidelines for the Management of Traumatic Dental Injuries in the United Arab Emirates
(2016-08) Alyasi, Mediya
Purpose/Aim: The aim of this study was to assess and to compare the level of general dental practitioners’ (GDPs) knowledge within the United Arab Emirates (UAE) regarding the ways to manage traumatic dental injuries, and to compare their level of knowledge with that of paediatric dentists’ (PDs). Materials and Methods: A two-part questionnaire consisted of seven questions relating to the participants’ demographic data and alongside thirteen questions demonstrating trauma case scenarios. The questionnaires were distributed among dentists’ electronic mail as well as in two local conferences. A total of 296questionnaires were received and data were statistically analysed to identify GDPs’ knowledge regarding how to manage dental trauma cases, and to henceforth compare the score of GDPs’ knowledge with that of PDs’. Results: Out of a total top score of 13 the mean score for GDPs’ knowledge was 4.87±1.82 which illustrated poor knowledge. This means that only 37.5% of the total of the 13 questions was answered correctly. The mean knowledge score of paediatric dentists was 5.56±1.47, which is also poor with 42.8% correct answers. However, the difference in knowledge between GDPs and PDs was statistically significant (p-value =0.005). Conclusions: This survey demonstrates poor knowledge of dental trauma management among the surveyed GDPs as well as PDs, and highlights the need to develop strategies to improve the knowledge base in this area of dentistry. Keywords: Traumatic dental injuries, knowledge, guidelines, general dental practitioners, paediatric dentists, United Arab Emirates.
Tooth-Implant Combination Vs. Implant-Implant in Fixed Dental Prostheses; A Systematic Review & Meta-Analysis of the Long Term Complications
(2016-08) Tufenkeji, Nadia
Abstract: The connection of teeth to dental implants within an FDP (fixed dental prosthesis) has broadened treatment-planning possibilities in implant dentistry worldwide. Nevertheless, concerns have arisen regarding rigidly splinting teeth to implants due to a sum of complications that have been associated with these “combination prostheses”. On the other hand, many studies claim that the complications that occur with tooth-to implant prostheses also occur with implant-to-implant prostheses, or that no complications occur at all. The aim of this systematic review is to state the long-term complications mentioned in the literature about combinations of tooth-implant FDPs, when compared with implant-implant FDPs. A comprehensive electronic search in the literature between the period of 1960 to 2015 using the following search engines: Medline, Pubmed, OvidMD Plus, was done to gather the data in the literature. The results of this study show that the incidence of complications was significantly worse for Implant-Tooth FDPs group than the Implant-Implant group in regards to “Implant loss” and “Failed FDP” type of complications. However, the conclusion is that more thorough clinical documentation must be done to be able to extract valid data in future studies on this topic, otherwise it would be impossible to attain valid quantitative data from these studies.
Cytotoxicity and estrogenicity of Vivera® retainers
(2016-12) Al Naqbi, Shaima
Aims: The aim of the present study is to investigate the cytotoxicity and estrogenicity of Vivera® retainers by assessing their biological behavioral effects: as-received from the manufacturers, and after retrieval from patients. The null hypothesis of this study is that Vivera® retainers, both as-received or after retrieval from patients, have no cytotoxic or estrogenic effect. Materials and Methods: The study sample consisted of six sets of Vivera® retainers, three as-received from the manufacturer and three retrieved from three consecutive patients of the Postgraduate Orthodontic Clinic, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates. All participants agreed to their inclusion in this research study. With regard to the retrieved retainers, these were retrieved from the patients after four weeks of use. All sets in the study consisted of a maxillary and a mandibular appliances. The evaluation of the cytotoxicity and estrogenicity of all retainers took place in the Laboratory of Cell Proliferation and Ageing, Institute of Biosciences and Applications, National Center for Scientific Research “Demokritos”, Athens, Greece. The retainers were transferred from Dubai to the laboratory in Athens by one member of the research team in a way that ensured that their physical condition remained unchanged from the time they were removed from the patients or delivered by the company. All retrieved retainers were divided in two equal parts randomly regardless of being upper or lower component. Each one subjected to either mode of sterilization procedures, i.e. gamma-irradiation or autoclaving. The as-received retainers were divided into three equal parts randomly as well. Two parts were sterilized, with each part using one of the above-mentioned procedures, while the third part of as-received retainers was not subjected to any sterilization mode, so as to test the effects of the sterilization procedure Subsequently, all samples were immersed in sterile normal saline (NaCl 0.9% w/v) with each sample in different container and incubated for fourteen days at 37° C. A sample of normal saline without any retainer was incubated in the same conditions in parallel with the study samples, to be used as negative control. After sterilization, all retainers, which had been treated following specific allocation and procedures of sterilization, were aliquoted and kept at -20° C to maintain its integrity until further experimental use. Samples obtained from incubation of as-received / unsterilized retainers were considered to be identical. The estrogenicity assays involved 2 cell lines, i.e. the estrogen-sensitive MCF-7 and the estrogen-insensitive MDA-MB-231 (both from human breast adenocarcinoma), in order to exclude the possibility that a decreased proliferation of cells induced by the retainer eluent would mask a potential induction of proliferation due to estrogenicity. Cells were cultured in Dulbecco’s Modified Eagle Medium (DMEM) supplemented with 10% Fetal Bovine Serum, at 37° C, in 5% carbon dioxide, in a humidified incubator. The cells were regularly subcultured by using trypsin-citrate solution. To evaluate the estrogenicity of the samples, the cells were plated in 48-well flat-bottomed microwells (10,000 cells per well) in DMEM and 10% fetal calf serum. Twenty-four hours later, the medium was changed to phenolfree DMEM supplemented with 2% fetal calf serum pretreated with dextran-coated charcoal, along with the solutions to be tested, at concentrations varying from 5% to 20% vol/vol. βEstradiol was used as positive control, and normal saline solution was used as negative control. After six days of incubation, with the medium renewed at day three, the cells were detached using trypsin-citrate solution and counted using a Z1 Beckman-Coulter counter. The assays were performed in triplicate and the results averaged. The statistical analysis of data was performed with 2-way analysis of variance (ANOVA) with appliance and concentration as predictors. Differences were further investigated with the Tukey multiple comparison test at a 0.05 level of significance. Results: An initial experiment was performed using 3 samples, corresponding to as-received retainers, to assess the effects of the two sterilization procedures and the third served as control. None of the samples, at any concentration tested, induced a proliferation of MCF-7 cells compared to the negative control. This was in contrast to the pronounced stimulation by all three β-estradiol concentrations (within the physiological limits) tested. However, after gamma-irradiation, the retainer appearance appeared altered, having acquired a yellowish color reminiscent of the effect of ultraviolet light on plastic materials. Hence, the sterilization through gamma-irradiation was considered a possible source of damage the plastic, and autoclaving was finally chosen as the preferred mode of sterilization. IV Accordingly, 3 samples, corresponding to the retrieved retainers from the three patients were evaluated, in comparison to 2 samples from as-received retainers (either autoclaved or not). No significant MCF-7 proliferation was induced by the three samples compared either to the eluents from as-received retainers or to the negative control. As expected, β-estradiol induced a potent stimulation of MCF-7 cell proliferation, while no effect was observed on MDA-MB- 231 cells. Thus, the null hypothesis was accepted meaning that Vivera® retainers, either as-received or after retrieval from patients, possess no cytotoxic or estrogenic effects. Conclusions: Based on this study, which was performed with the aim of testing the cytotoxic and estrogenic behavior of both as-received and retrieved Vivera® retainers, there was no significant release of substances with estrogenic activity after incubation in normal saline for two weeks at body temperature.
Attitude of Ajman University Dental Undergraduate Students and Residents to Vital and Non-Vital Bleaching
(2017) Alzaabi, Aaesha
The management of tooth discoloration has become a challenge, especially as people are keeping their teeth for longer. Discoloration can affect both primary and secondary teeth alike. The causes of tooth discoloration are multifactorial with different parts of the tooth taking up different stains. Bleaching can improve the whiteness of teeth significantly and at the same time is considered to be a conservative aesthetic procedure. To evaluate the attitude of undergraduate dental students to vital and non-vital bleaching. Additionally, to review and identify the best evidence papers for single tooth bleaching. Objectives of the study was to evaluate the attitude of undergraduate dental students to vital and non-vital bleaching. Additionally, to review and identify the best evidence papers for single tooth bleaching. Materials and methods used for this study is in two parts. For the first part of the work, a 12-point questionnaire was designed and distributed among the target population of final year dental students and residents at Ajman University. As well as confidence in providing vital and non-vital bleaching, the survey also focused on a number of other issues such as opinion on delivery of bleaching by non-dental professionals and the teaching received on bleaching. The data gleaned from the questionnaire were analysed and presented in the form of tables and bar charts. Statistical tests were also applied to check for significant differences (P<0.05). The second part of the study was a comprehensive literature review to identify the best method for single tooth bleaching (intra-coronal bleaching). The results of the review were successfully applied to two single tooth bleaching cases. Results found that the completed returned questionnaires 201(100%) were analysed and the data tabulated. It was found that undergraduate dental students were more confident at providing vital than non-vital bleaching and this was statistically significant (P<0.000001). Eighty-four percent of the students agreed that vital bleaching was safe compared with 80% for non-vital bleaching. On the other hand, only 5% agreed that it was safe for beauty salons to provide bleaching. This finding was also statistically significant (P<0.00001). A literature search on intra-coronal bleaching yielded 78,588 papers. Two of these papers were deemed best evidence papers and they were clinical trials. Both papers compared the efficacy of different intra-coronal bleaching techniques. The bleaching protocols obtained from the papers was applied successfully to treating two complex cases of single tooth bleaching cases. It is concluded that undergraduate dental students were more confident in carrying out vital than non-vital bleaching. The great majority do not agree with the concept of beauty salons providing bleaching. Carbamide peroxide and sodium perborate can provide similar aesthetic results as hydrogen peroxide if applied correctly.
Effectiveness of extraction of the primary canines for the interceptive management of palatally displaced permanent canines - a meta-analysis
(2017-01) Alyammahi, Ameirah
AIM: Although extraction of primary canines in the mixed dentition has been suggested as a measure to prevent impaction of palatally displaced permanent canines (PDC), the relevant evidence has been inconclusive. The aim of this study was to investigate the effectiveness of this practice. MATERIALS AND METHOD: Search without restrictions for published and unpublished literature and hand searching took place. Data on the prevalence of physiologic PDC eruption, patient reported outcomes, adverse effects and economic evaluation data from randomized controlled trials (RCTs) that compared extraction of primary canine to no treatment (including delayed treatment) were reviewed. The random effects method of combining treatment effects was used and the individual study risk of bias and the overall quality of the available evidence (confidence in the observed effect estimates) were assessed using the Cochrane Risk of Bias Tool and Grades of Recommendation, Assessment, Development and Evaluation approach, respectively. RESULTS: We initially identified 1878 references and finally included data from 5 RCTs involving 329 patients with 479 PDC in total, following them for up to 48 months post- ii intervention. One study also presented data for the 12-month evaluation. Two studies were at low and the rest at high risk of bias. At the 12-month evaluation, extraction of the primary canine does not result in a statistically significant benefit compared to no treatment [Risk Ratio (RR): 1.537; 95% Confidence Interval (CI): 0.656 – 3.601; 1 study, n = 67 participants]. Beyond 12 months, overall, there is only low quality evidence that extraction of primary canines provides a statistically significant benefit compared no treatment or delayed treatment [RR: 1.784; 95% CI: 1.376 – 2.314; 5 studies, n = 214 participants; I2 = 0%]. Analysis of the studies at low risk of bias confirmed the abovementioned result [RR: 1.713; 95% CI: 1.226 – 2.394; 2 studies, n = 91 participants; I2 = 0%]. Moreover, the intervention did not result in a statistically significant benefit compared to no treatment regarding root resorption of adjacent permanent teeth [RR: 0.602; 95% CI: 0.277 – 1.308; p = 0.200 n = 67 participants] CONCLUSIONS: Extraction of primary canines in mixed dentition may increase the chance of subsequent successful eruption of PDC in the long term. However, better study standardization and reporting of long follow-ups are necessary.
Performance of Hawley-type appliances: a systematic review of randomized clinical trials
(2017-01) Al Rahma, Wafa
BACKGROUND: Although post-treatment changes are almost inevitable, and retention has long been recognized as one of the most critical and routine problems faced by orthodontists, there remains a lack of certainty regarding the parameters of any definitive retention protocol following orthodontic treatment. AIM: To compare the performance of the Hawely-type appliances to that of the other removable appliances (clear thermoplastic appliances, tooth positioners and modifications, etc.) immediately used after completion of orthodontic treatment, together with a comparison of the effectiveness of different wearing schedules. MATERIALS AND METHODS: An electronic search without restrictions for published and unpublished literature, together with hand searching, was carried out. We reviewed randomized clinical trials (RCTs) investigating the performance of the Hawley-type appliances. The risk of bias was assessed using the Cochrane Collaboration‘s Risk of Bias ii assessment tool for RCTs and the quality of evidence assessed according the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. RESULTS: The initially identified 1174 records were finally reduced to 10 full-text reports analyzing various outcomes in 854 patients who had been followed for a maximum period of one year after the removal of the fixed orthodontic appliances. Eight of the eligible publications investigated groups of subjects using Hawley removable appliances and clear thermoplastic retainers, another study compared the Hawley appliance to positioner use during the retention period and, finally, one study involved patients allocated to groups using different wearing schedules for Hawley retention appliances. Three studies were considered as being of low risk of bias, four of unclear and three of high risk of bias. In general, few differences were observed between the comparative performance of the Hawely-type appliances and the other removable appliances (clear thermoplastic appliances, tooth positioners and modifications, etc.) used after the completion of orthodontic treatment regarding outcomes relevant to maxillary and mandibular dental arch measurements, dental arch relationships and occlusal contacts, speech evaluation, patient reported outcomes, adverse effects and problems related to the appliances, in addition to economic evaluation related outcomes. Moreover, no differences were found between different appliance wearing schedules and protocols. Overall, the quality of the available evidence was considered low. CONCLUSIONS: Based on the available data there are few differences were observed between the comparative performance of the Hawley-type appliances to the other removable appliances (clear thermoplastic appliances, tooth positioners and modifications, etc.) used after the completion of orthodontic treatment. Moreover, no differences were found between different appliance wearing schedules and protocols.
Impact of Cone Beam Computed Tomography on Treatment Planning in Endodontics
(2017-01) Mohamad, Badriya
Introduction The use of Cone Beam Computed Tomography (CBCT) is rapidly increasing in all areas of dentistry, as it provides valuable 3D information of the area under investigation in a matter of minutes. However, the radiation dosage is higher than that of conventional radiographic images. It is advisable that CBCT should be used only in cases where clinically indicated. Aim The aim of our study was to evaluate the impact of limited volume CBCT upon treatment planning as part of endodontic management of posterior teeth. Materials and Methods Thirty five patients were selected from primary care referrals to a specialist endodontic unit in a leading UK dental hospital. For each patient, a dental and medical history, an intraoral image, parallax periapical radiographs and CBCT data set were taken . Four observers, General Dental Practitioners (GDPs) were selected to examine the data. Additionally, the author of this work also independently examined all the cases in her capacity as a third year Endodontic resident. A questionnaire was designed for the observers. The information for all the 35 patients was examined by the observers on two separate dates about 3 months apart. On one date, all the information was given to them but, on the other the CBCT images were withheld. This study dealt with only three questions relating to treatment planning. Results The availability of CBCT images changed the final treatment plan for extraction, endodontic treatment, and endodontic re-treatment in a minority of cases (15% to 35%). Three out of the fours GDPs found the availability of CBCT more helpful in reaching a final treatment plan. This was, however, statistically significant with only one of the GDPs (p<0.05).The fifth observer (the third year Endodontic resident) also found CBCT helpful in reaching a final treatment plan which was statistically significant (p<0.05). Conclusion The main conclusion that follows from this work is that CBCT images are vital for certain complex endodontic treatments and should not be used routinely for all endodontic cases. The study also highlighted the need for training on the interpretation of CBCT images by dentists who use such images in their workplace.
The quality of dental X-ray images that are referred to oral surgeons A multinational study in the Middle East and United Kingdom
(2017-02) Sebeeh, Taghrid
Background: The dental profession is committed to delivering the highest quality of care to each of its individual patient and applying advancements in technology and science to continually improve the oral health status of the population. Several guidelines have been developed to serve as an adjunct to the dentist’s professional judgment on how to best use diagnostic imaging for a patient. Radiographs can help the dental practitioner evaluate and definitively diagnose a number of oral diseases and conditions. However, the dentist must weigh the benefits of taking dental radiographs against the risk of exposing a patient to radiation, the effects of which accumulate from multiple sources over time. The dentist, knowing the patient’s health history and vulnerability to oral disease, is in the best position to make this judgment in the interest of the patient. Objective: The purpose of this study is to evaluate the different perceptions of what makes a proper dental X-ray image, and to compare if there is a difference in dentists’ perspectives of the quality of dental X-ray images against established criteria in the “National Radiological Protection Board (NRPB)”, between dentists in the Middle East and the dentists in the United Kingdom. Material and methods: This was a cross-sectional study of a total of 400 dentists of all specialties, who were invited to participate in a survey, using a structured questionnaire shown on a tablet screen that included 10 different X-ray images of teeth intended for extraction. These images were selected for the questionnaire by expert radiologists and oral surgery consultants from a pool of referred dental X-ray images to oral surgeon in UK. The criteria used for answering the questionnaire is an adaptation of the “National Radiological Protection Board (NRPB)” criteria which uses subjective quality rating of radiographs. The criteria included two ratings (acceptable and unacceptable) for the purpose of the extraction of a tooth. All ten images were pre-evaluated by a calibrated panel of experts composed of seven specialists in the field of maxillofacial radiology. The questionnaire also included other information obtained for the purposes of comparison and description regarding the area of specialty, years of experience, location of current practice and country of qualification in dentistry. Results: A total of 342 participants were included in the study out of 400 with a response rate of 85.5%. The inclusion criteria of the selected questionnaire depended on completion of all elements of the questions included. There were 215 (62.9 %) males and 127 (37.1 %) females. The experience in dentistry ranged from 1 year to 45 years with a mean range of experience of 13.28 years. The distribution of participants according to the place of qualification was 182 (53.7%) from the Middle-East, while 160 (46.8%) were from the United Kingdom. The average of the score of reading the ten photos correctly in agreement of the panel of experts was 4.95 (S.D. 1.62) overall in both groups of participants from the Middle East and from the United Kingdom. There is no association between the number of years of experience and the score of correct answers (p-value=0.113). This study has iv revealed that there is a significant difference in the overall correct score of the questionnaire in favour of the participants group with a qualification in dentistry from the United Kingdom (p-value= 0.013). Conclusion: The participants qualified from the United Kingdom performed better than the Eastern participants in answering the questionnaire. The perception of dentists of varying specialties in the Middle East in regards to the quality of referred dental X-ray images needs to be addressed. This perception affects the quality of care that the patients receive, through either repeated X-ray exposure or by management of patients with inadequate Xray images. More attention is needed to highlight this issue and strict protocols for the quality of referred dental X-ray images must be put in place.
The Relationship Between Endodontic Case Complexity and Treatment Outcomes
(2017-08) Fezai, Hessa
Introduction: The primary goal of endodontic therapy is to prevent or heal apical periodontitis. Dental pulp has a complex internal anatomy, a thorough knowledge of both root and root canal morphology is, therefore, a fundamental prerequisite to help ensure optimal outcomes of root canal treatment. Aim: The aim of this work is to correlate between endodontic case complexities and treatment quality outcomes. Materials and Methods: A total number of 349 radiographs of patients who had received endodontic treatment during the period (2012-2015) at Hamdan Bin Mohammed College of Dental MedicineMohammed Bin Rashid University were selected. Unreadable radiographs due to technical errors, superimposed anatomical structures, and incomplete treatments were all excluded. From the original sample of 349, in total 51 radiographs were discarded. The final sample thus consisted of 298 root canal fillings of 211 patients treated by the endodontic residents. iii All radiographs were individually evaluated following the American Association of Endodontic Case Difficulty Assessment Form. Base on this, the technical quality of the root filling which depends on two main parameters density of the root filling and the distance between the end of the root filling and radiographic apex was evaluated for each individual case. Results: The sample evaluated consisted of 53% of high, 35% of moderate and 12% of minimal difficulty cases. Adequate homogeneity of root canal fillings were found in 93% of the cases. This compared with 90% of cases with adequate length of root fillings. Thus 84% (0.93x0.90=0.84) of the cases were considered to have good quality endodontic work. There were statistically significant differences between the length of root canal filling and level of difficulty (p=0.016) but, no statistically significant difference between homogeneity of root canal filling and case difficulty (p=0.794). Conclusion: The referral pattern (53% high and 35% moderate difficulty) indicates that Hamdan Bin Mohammed College of Dental Medicine is considered a secondary/tertiary referral centre. A high percentage (84%) of the cases treated were proved to be adequate in terms of length and homogeneity. There were statistically significant differences between length of root canal filling and case difficulty but, not between homogeneity and case difficulty.

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