Mahidol Dental Journal

Behcet’s syndrome: a contemporary narrative review

Nuntanat Karomprach — 2025-02-26

Behcet's syndrome (BS) is a chronic inflammatory condition affecting multiple systems, primarily characterized by recurrent aphthous ulcers, genital ulcers, skin lesions, musculoskeletal issues, arthritis, and involvement of the vascular, ocular, gastrointestinal, and nervous systems. A key feature of BS is the unpredictable pattern of relapses and remissions, with oral ulcers being the most common and often the earliest sign of the disease. These painful oral ulcers can significantly impact a patient's daily functioning and quality of life. The development of BS is influenced by a combination of immune processes, environmental factors (such as viral and bacterial infections like herpes simplex virus and streptococci), hormonal changes, and genetic predisposition. Due to its multisystemic nature, a multidisciplinary approach is essential for effective management. The primary treatment goal is to control inflammation and prevent disease progression involving major organs, which can reduce the risk of mortality. Treatment options vary based on severity and organ involvement, ranging from topical therapies to systemic glucocorticoids and immunosuppressive medications.

Primary contraction of harvested palatal sub-epithelial connective tissue grafts: a pilot study

Chanutda Chatchaiyadej — 2025-02-26

Objective(s): To elucidate and compare the primary contraction of palatal sub-epithelial connective tissue grafts after harvesting at different times.

Materials and Methods: Ten patients who underwent soft tissue graft treatment, free gingival graft, or connective tissue graft. A 4-mm biopsy punch took each sample with 1 mm thickness after 1-mm-depth de-epithelialization. A total of 10 samples were recorded for graft contraction by a standardized photograph taken at 20(T1), 40(T2), 60(T3), 90(T4), 120 minutes(T5), and 24 hours(T6). Throughout the contraction investigation, the sample was incubated at 37 degrees Celsius, washed twice, and immersed in a new normal saline solution at 4 degrees Celsius between time points. The graft area was computed using ImageJ software. The graft contraction was calculated as the average percent of the original area (% of T1). Differences in graft contraction were analyzed using Friedman's Two-Way Analysis of Variance by Ranks and pairwise comparisons.

Results: Only one significant difference in graft contraction was found between T4 and T2, meaning that the graft area at 90 minutes decreased compared to the graft area at 40 minutes (p-value =0.047).

Conclusion: The harvested palatal sub-epithelial connective tissue graft size remained constant, except at 90 minutes after harvesting when it significantly decreased compared to 40 minutes. This study indicates that the sub-epithelial connective tissue graft can stay in normal saline solution outside the oral cavity with minimal contraction.

Comparison of bond strength between two resin cement systems used in modified tube technique for separated endodontic instruments removal

Sirapatra Likittummawong — 2025-02-26

Objective: The aim of this study was to compare bond strength between two resin cements including Super Bond Universal and RelyX U200 used for separated instrument removal with modified tube technique

Materials and Methods: Thirty ProTaper Next X1 NiTi rotary files were embedded into the fixing mold then cut at 5 mm from the instrument tip in order to simulate the separated instrument engaged in the root canal. The samples were divided into 2 experimental groups according to chemical agents for adhesion in tube and glue technique, Group 1: Super Bond Universal, and Group 2: RelyX U200 (n = 15/group). Resin cements were prepared and loaded into the hypodermic tube before insertion onto each separated instrument at 2 mm overlapping length. After the complete setting of the material, all samples were subjected to pull-out test at a constant speed of 2 mm/min. using the Universal Testing Machine. The failure load of each sample was recorded and the data was analyzed using Shapiro-Wilk Test and Levene’s Test to confirm the normality and homogeneity of variance following by an independent samples t-test for group comparison.

Results: Mean failure loads of group 1 and group 2 were 1.62 N and 15.50 N. The bond strength of RelyX U200 was significantly higher than Super Bond Universal (p<0.001).

Conclusion: Due to the compositions affected the molecular structure of this resin cement together with convenient application, the bond strength of RelyX U200 is significantly superior over that of Super Bond Universal.

Effect of self-assembling peptide with fluoride on remineralization of primary teeth: An in vitro study.

Ananya Udomsit — 2025-02-26

Objectives: This study aimed to assess the remineralizing potential of a self-assembling peptide with fluoride (SAPF) on primary teeth compared to fluoride varnish and no treatment (control).

Materials and Methods: Thirty sound primary incisors were used, and surface microhardness (SMH) was measured before and after creating artificial enamel caries. The teeth were divided into three groups: SAPF, fluoride varnish (F), and control. After treatment and pH-cycling, SMH values were examined, and the percentage recovery of SMH (%SMHR) was calculated.

Results: SMH values after pH-cycling were significantly higher in the SAPF group (180.09±7.47 VHN) and F group (186.85±10.94) compared to the control group (117.45±8.17VHN) (p<0.001), but there were no significant differences between the SAPF and F groups (p=0.313). The %SMHR increased significantly in both SAPF (21.93±4.89%) and F group (25.75±10.14%) compared to the control group (-9.93±6.86%) (p<0.001).

Conclusions: The self-assembling peptide with fluoride demonstrated efficacy in remineralizing primary teeth comparable to fluoride varnish in vitro. This suggests its potential as an alternative treatment for dental caries.

Comparing maxillary surgical accuracy in mandible-first and maxilla-first sequencing for bimaxillary orthognathic surgery: a retrospective study in facial asymmetry patients

Arisa Krueachaipinit — 2025-02-26

Objective: This study aimed to compare the surgical accuracy of the maxilla between the maxilla- and mandible-first sequence bimaxillary orthognathic surgery for facial asymmetry patients

Materials and Methods: A retrospective cohort study was conducted on forty patients with skeletal asymmetry of the jaw(s) who underwent bimaxillary orthognathic surgery. The patients were evenly divided into the maxilla-first and mandible-first sequence groups. Surgical accuracy of the maxilla was determined by comparing the maxillary position in immediate postoperative cone beam computed tomography images to the simulated surgical plans. Three linear measurements using seven reference points and three angular measurements (roll, pitch, and yaw) were performed. Statistical analysis, including the independent samples t-test and the Mann-Whitney U test, was used to compare the means and medians between the two groups. The level of significance was set at p < 0.05.

Results: The accuracy of the maxilla, as measured by linear measurements, showed no significant differences between the two groups (p = 0.05–0.92). On the other hand, significant differences were observed in the roll and yaw rotations, with p-values of 0.03 and 0.04, respectively. In the anteroposterior direction, the greatest inaccuracy was found at the MB cusp of tooth 26 in the maxilla-first group (mean deviation 1.42 ± 0.86 mm) and at the MB cusp of tooth 16 in the mandible-first group (mean deviation 1.47 ± 0.79 mm).

Conclusions: The accuracy of the maxilla after bimaxillary orthognathic surgery in patients with skeletal asymmetry was comparable between the maxilla-first and mandible-first sequencing techniques. The statistically significant differences found in the roll and yaw axes were not clinically relevant. Similar postoperative accuracy and intraoperative benefits suggest that the mandible-first sequence may be the preferred technique in patients with skeletal asymmetry.

Clove oil and supplementary irrigation techniques effectively removed parachloroaniline precipitate from root canal walls

Pornprawe Poonperm — 2025-02-28

Objectives: To compare paracholoaniline precipitate solubility of xylene, GP solvent, and clove oil and evaluate the remaining precipitate on root canal walls after irrigation with the most effective solvent combined with different supplementary irrigation techniques.

Materials and Methods: Thirty-four human mandibular premolars with single root canals were used. Fourteen-mm decoronated roots were instrumented and irrigated with NaOCl and EDTA. Specimens were irrigated with NaOCl and CHX to create paracholoaniline precipitate. Fifteen roots were divided into 3 organic solvent groups: xylene, GP solvent and clove oil. Two roots were irrigated with distilled water. Each root was split in half and mounted on customized-remountable silicone jig. Root canal wall images were captured via light microscopy, then rinsed with organic solvent and distilled water. Root pieces were remounted and post-solvent images were captured. Orange-brown precipitation area was evaluated. Data was recorded as initial and remaining precipitation area. Paracholoaniline precipitate solubility means were compared using Welch Anova followed by Games-Howell for multiple comparisons. Next, fifteen roots were divided into 3 irrigation technique groups: needle syringe, passive ultrasonic technique, and XP finisher file. Two roots were irrigated with distilled water. The most effective solvent, clove oil, was used. Roots were split, mounted and captured at coronal, middle and apical portion. Percentages of remaining precipitate median were compared using Kruskal-Wallis and Freidman tests. The significance level was set at 0.05.

Results: Clove oil, xylene and GP solvent demonstrated 99.6, 8.43, and 3.57% paracholoaniline precipitate solubility, respectively. Mean percentages were significantly different (p<0.05). Clove oil was the most effective solvent. When irrigating with different techniques, percentages of remaining precipitate were not significantly different (p>0.05).

Conclusion: Clove oil was the most effective solvent in dissolving paracholoaniline precipitate. Xylene and GP solvents have minimal solubility. Rinsing with clove oil using needle syringe dissolved the paracholoaniline comparable with other techniques.