Background: Documentation of nursing care is one of the most important professional responsibilities of nurses and one of the major components of medical care and patient record documentation. Objectives: The present study was performed to determine the effect of problem, intervention, evaluation (PIE) training on the quality of nursing students’ documentation. Methods: In this semi-experimental single-group study with a pretest-posttest design, a total of 28 nursing students were selected by simple random sampling. The data collection tools included a demographic questionnaire, PIE documentation form, and documentation quality checklist. First, the students were asked to write two reports using the traditional or narrative method. Then, a training workshop was organized about PIE documentation, and the students were asked to use this method and write two more reports about the same patient on two consecutive days; overall, each student presented four reports. A total of 112 reports were analyzed using descriptive statistics and paired t test in SPSS. Results: Basedontheresultsof paired t test,therewasasignificantdifferenceinthemeanscoreof documentationqualitybetween the pretest and posttest (P < 0.001). Also, there was a significant difference in the mean score of documentation quality between the pretest and posttest in terms of both report structure and content (P < 0.001). Conclusions: Useof PIEreportingsystemimprovesthequalityof nursingdocumentation. Therefore,itcanbeasuitablealternative for the current narrative or traditional method.

Objectives: Bone quality and quantity assessment is one of the most important steps in implant treatment planning. Different methods such as computed tomography (CT) and recently suggested cone beam computed tomography (CBCT) with lower radiation dose and less time and cost are used for bone density assessment. This in vitro study aimed to compare the tissue density values in Hounsfield units (HUs) in CBCT and CT scans of different tissue phantoms with two different thicknesses, two different image acquisition settings and in three locations in the phantoms. Materials and Methods: Four different tissue phantoms namely hard tissue, soft tissue, air and water were scanned by three different CBCT and a CT system in two thicknesses (full and half) and two image acquisition settings (high and low kVp and mA). The images were analyzed at three sites (middle, periphery and intermediate) using eFilm software. The difference in density values was analyzed by ANOVA and correction coefficient test (P<0.05). Results: There was a significant difference between density values in CBCT and CT scans in most situations, and CBCT values were not similar to CT values in any of the phantoms in different thicknesses and acquisition parameters or the three different sites. The correction coefficients confirmed the results. Conclusions: CBCT is not reliable for tissue density assessment. The results were not affected by changes in thickness, acquisition parameters or locations.

Introduction: Annually ~2 million permanent teeth are lost in public dental clinics in Iran. Many of these losses are caused by difficulties in provision of timely root canal treatment (RCT) or their low quality. The present guideline aimed to find and recommend the best treatment options for management of vital permanent teeth with carious exposure. Materials and Methods: The guideline domain was examined and treatment options were determined as scenarios comprised of indications and possible interventions. Two main indications including carious pulp exposure with or without irreversible pulpitis in open-apex and in closed-apex permanent teeth were included. Nine treatment options were found for each indication based on the available literature. Exhaustive search was performed to find the current evidence and the retrieved studies were critically reviewed. Treatment options and their supporting evidence were extracted. Search for the side effects and benefits of each treatment option was also performed. The expenses regarding each treatment were then determined and treatment options with Level of Evidence (LOE) I and LOE II evidence were presented to an expert panel for each indication. Each clinical scenario was examined and rated by each member considering six aspects: effectiveness of the intervention, costs, side effects, side benefits, applicability of the scenario and generalizability of the treatment. The best scenarios were chosen based on the expert panel ratings and the recommendations were extracted. Results: Based on the present guideline, full pulpotomy with calcium enriched mixture (CEM) cement is recommended in vital permanent teeth with open- or closed-apex, with or without irreversible pulpitis, following carious pulp exposure (Grade A recommendation). Conclusion: Adherence to the present guideline may help preserve pulp vitality and decrease the risk of loss of vital permanent teeth with carious pulp exposure

BACKGROUND:Radiographs, adjunct to clinical examination are always valuable complementary methods for dental caries detection. Recently, progressing in digital imaging system provides possibility of software designing for automatically dental caries detection.OBJECTIVES:The aim of this study was to develop and assess the function of diagnostic computer software designed for evaluation of approximal caries in posterior teeth. This software should be able to indicate the depth and location of caries on digital radiographic images.MATERIALS AND METHODS:Digital radiographs were obtained of 93 teeth including 183 proximal surfaces. These images were used as a database for designing the software and training the software designer. In the design phase, considering the summed density of pixels in rows and columns of the images, the teeth were separated from each other and the unnecessary regions; for example, the root area in the alveolar bone was eliminated. Therefore, based on summed intensities, each image was segmented such that each segment contained only one tooth. Subsequently, based on the fuzzy logic, a well-known data-clustering algorithm named fuzzy c-means (FCM) was applied to the images to cluster or segment each tooth. This algorithm is referred to as a soft clustering method, which assigns data elements to one or more clusters with a specific membership function. Using the extracted clusters, the tooth border was determined and assessed for cavity. The results of histological analysis were used as the gold standard for comparison with the results obtained from the software. Depth of caries was measured, and finally Intraclass Correlation Coefficient (ICC) and Bland-Altman plot were used to show the agreement between the methods.RESULTS:The software diagnosed 60% of enamel caries. The ICC (for detection of enamel caries) between the computer software and histological analysis results was determined as 0.609 (95% confidence interval [CI] = 0.159-0.849) (P = 0.006). Also, the computer program diagnosed 97% of dentin caries and the ICC between the software and histological analysis results for dentin caries was determined as 0.937 (95% CI=0.906-0.958) (P < 0.001). Bland-Altman plot showed an acceptable agreement for measuring the depth of caries in enamel and dentin.CONCLUSIONS:The designed software was able to detect a significant number of dentin caries and acceptable measuring of the depth of carious lesions in enamel and dentin. However, the software had limited ability in detecting enamel lesions.

BACKGROUND:Current methods of closure of the cleft palate result in the formation of scars and impairment of growth. Distraction osteogenesis (DO) might be an effective means to repair or at least reduce the size of wide clefts. This study investigates the biomechanical aspects of this process.MATERIALS AND METHODS:DO simulation was applied to reduce the size of a unilateral hard palate cleft on a three-dimensional (3D) model of the maxilla. For the position of osteotomy lines, two different models were assumed, with the osteotomy line on the affected side in model A and on the intact side in model B. In each model, DO screws were placed on two different positions, anteriorly (models A1 and B1) and posteriorly (models A2 and B2). Displacement pattern of the bony island in each of the four models, reaction forces at DO locations, and von Mises stress were estimated. Mesh generation and data processing were carried out in the 3D finite element analysis package (ABAQUS V6.7-1; Simulia Corp., Providence, RI, USA).RESULTS:In model B2, the island moved almost evenly, assuring a more complete closure of the cleft. The most uniform stress distribution was found in model B1.CONCLUSION:The results suggest that the best positions for the DO screw and the osteotomy line for closure of the cleft palate are posteriorly and on the intact side, respectively.

Objective: The aim of this study was to comparatively assess the fracture resistance of the cementum-extended and conventional composite fillings with or without intracanal composite posts in severely damaged deciduous incisors. Materials and Methods: This in vitro study was performed on 60 extracted deciduous maxillary incisors that were randomly divided into four groups: Group 1: Composite filling (CF); Group 2: Composite filling with composite posts (CF + CP); Group 3: Composite filling extended 0.5 mm to cementum (ceCF); Group 4: Composite filling extended 0.5 mm to cementum with composite posts (ceCF + CP). The fracture resistance was assessed by exerting a progressively increasing load with a cross-head speed of 0.5 mm/min in a Universal Testing Machine. Statistical Analysis: Data were analyzed by SPSS-18 using one-way analysis of variance at α < 0.05. Results: The mean fracture resistance (MFR) values of the experimental groups were 410.57 ± 139.44 N, 564.44 ± 92.63 N, 507.5 ± 76.37 N and 601.08 ± 96.04 N. A significant difference was found between the MFR of Groups 1 and 2, Groups 1 and 4 and Groups 3 and 4 (P < 0.05). Conclusion: A superior outcome was achieved by intracanal composite posts in both conventional and cementum-extended composite fillings.

PURPOSE:The aim of this in vitro study was to compare the accuracy of implant impressions in parallel and nonparallel implants of All-on-Four treatment plan.MATERIALS AND METHODS:A reference model containing 4 internal-connection implant analogs was fabricated according to All-on-Four treatment plan (2 anterior implants at 0 degree and 2 posterior implants at 30 degrees in relation to the perpendicular line). Twenty impressions of this model were made using open-tray impression technique. Impressions were poured with American Dental Association type 4 stone, and the positional accuracy of the implant replica heads in x-, y-, and z- axes was evaluated using a coordinate measuring machine. These measurements were compared with the obtained measurements from the reference model that served as control, and data were analyzed using independent test (α = 0.05).RESULTS:The results showed that the accuracy of the implant impressions did not show any significant difference between the tilted and straight implants except in y-coordinate (P = 0.012).CONCLUSION:Within the limitations of this study, the accuracy of the implant impressions did not differ for different implant angulations in All-on-Four treatment plan.

OBJECTIVE:The purpose of this study was to evaluate the effectiveness of the erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser in removing debris and the smear layer using two different output powers on the apical, middle, and coronal segments of root canal walls.BACKGROUND DATA:Previous literature has failed to evaluate the exclusive effect of Er,Cr:YSGG laser on the quality of smear layer and debris removal in all three segments of the root canal space.METHODS:Sixty extracted teeth were included in the study. After instrumentation, samples were divided into three experimental groups and one positive control group with no further treatment. In group 1, a final irrigation was performed using ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl), sequentially. In group 2, the samples were treated with a 2.78 μm Er,Cr:YSGG laser with an output power of 1.5 W. The same laser was used in group 3, but with an output power of 2.5 W. Scanning electron microscope (SEM) images from the coronal, middle, and apical thirds of the roots were prepared and evaluated for both smear layer and debris removal by three blinded observers.RESULTS:The results showed no differences between groups 1 and 2 regarding the quality of smear layer removal in all areas. However, the 2.5 W laser failed to remove the smear layer effectively. Regarding debris removal, the EDTA and NaOCl irrigation showed significantly better outcomes (adjusted p<0.05) in all areas.CONCLUSIONS:This study raises questions about the overall cleaning abilities of Er,Cr:YSGG lasers.

PURPOSEAccurate recording of implant locations is essential for precise passively fitting prostheses with proper support. This in vitro study evaluated the accuracy of impressions made of parallel and nonparallel implants with different lengths of impression coping connections.MATERIALS AND METHODSA reference model containing four internal-connection implant analogs (two at 0 degrees and two at 30 degrees in relation to the perpendicular line) was fabricated. Thirty medium-consistency silicon impressions of this model were made using the open-tray impression technique. Three groups of 10 specimens each were made with different impression coping connection lengths (2, 1.5, or 1 mm). Impressions were poured with type IV stone. The positional accuracy of the implant replica heads in the x-, y-, and z-axes was evaluated using a coordinate measuring machine, and measurements were compared with the obtained dimensions from the reference model. Data were analyzed with two-way analysis of variance (α = .05).RESULTSThere was no significant difference in impression accuracy, regardless of the lengths of the impression connections. Additionally, there was no significant difference between the impression accuracy of inclined and straight implants, except in the y-axis (P = .006).CONCLUSIONSWithin the limitations of this study, the accuracy of implant impressions did not differ for different lengths of transfer coping connections of inclined and straight implants.

Background Considerable variations in the development stage among patients of the same chronological age have led to introduce the concept of the developmental age based on the maturation of different organs such as cervical vertebrae or teeth. Objectives The purpose of this study was to investigate the correlation between the stages of tooth calcification and the cervical vertebral maturation in Iranian females. Patients and Methods Four hundred females (age range, 8 to 14 years) participated in the study. To determine the dental maturational stage, calcification of the mandibular teeth except for third molars were rated according to the method suggested by Demirjian et al. To evaluate the stage of skeletal maturation, cervical vertebral morphologic changes were assessed on lateral cephalometric radiographs according to the method explained by Baccetti et al. Correlations between bone maturation and teeth calcification were showed by Spearman's correlation and Kendall’s tau-b coefficients. The relevant associations were investigated by ordinal logistic regression models. Results Correlations between the two stages were observed in the first and second premolars, canine and central incisors. All these correlations were significant. The association between cervical vertebral maturation and tooth calcification was greatest in the lateral incisor (odds ratio (OR) = 11, 95% confidence interval (CI): 6.6-18.3). However, considering the 95% CI for OR, no significant difference was detected among the second molar, first molar and lateral incisor. Conclusion The relationship between calcification of teeth and maturation of cervical bones was significant. Bone maturation can be predicted by using teeth calcification stages, especially in the second molar, first molar and lateral incisor.

Introduction Mandibular first molar is the most important tooth with complicated morphology. In finite element (FE) studies, investigators usually prefer to model anterior teeth with a simple and single straight root; it makes the results deviate from the actual case. The most complicated and time-consuming step in FE studies is modeling of the desired tooth, thus this study was performed to establish a finite element method (FEM) of reconstructing a mandibular first molar with the greatest precision. Materials and Methods An extracted mandibular first molar was digitized, and then radiographed from different aspects to achieve its outer and inner morphology. The solid model of tooth and root canals were constructed according to this data as well as the anatomy of mandibular first molar described in the literature. Result A three-dimensional model of mandibular first molar was created, giving special consideration to shape and root canal system dimensions. Conclusion This model may constitute a basis for investigating the effect of different clinical situations on mandibular first molars in vitro, especially on its root canal system. The method described here seems feasible and reasonably precise foundation for investigations.

INTRODUCTION:Root-end preparation and restoration with an endodontic material are required when nonsurgical endodontic retreatment has failed or is impossible. The present clinical study reports the treatment outcomes of periradicular surgery using calcium-enriched mixture (CEM) cement.MATERIALS AND METHODS:A prospective outcome study of periradicular surgery using CEM was conducted on 14 permanent teeth with persistent apical periodontitis. Using a standardized surgical protocol, 2-3 mm of the root apex was resected; approximately 3 mm deep root-end cavities were ultrasonically prepared and filled with CEM cement. All patients were available for recall.RESULTS:Clinical and radiographic examination revealed complete healing of periradicular lesions, i.e. regeneration of periodontal ligament and lamina dura in 13 teeth (93% success) during a mean time of 18 months; moreover, the teeth were functional and asymptomatic.CONCLUSION:Favorable treatment outcomes in this prospective clinical study suggested that CEM cement may be a suitable root-end filling biomaterial.

OBJECTIVE The aim of this study was to evaluate the effect of an erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser on the push-out bond strength of RealSeal Self-Etch (SE) sealer. BACKGROUND DATA Various methods are used for smear layer removal in endodontics, such as the application of Er,Cr:YSGG lasers. This laser system may influence the bond strength of resin-based sealers. METHODS Sixty single-rooted extracted teeth were selected. After root canal preparation, samples were divided into two experimental groups and one positive control group (n=20 per group). In group 1, the smear layer was removed by irrigation with ethylenediaminetetraacetic acid (EDTA) and sodium hypochlorite (NaOCl). In group 2, the smear layer was removed using a 2.78 μm Er,Cr:YSGG laser with radial firing tips (RFT3) (parameters: 1.5 W, 140 μs, 20 Hz, and 15% water to 15% air ratio), moving at 2 mm/sec in an apico-coronal direction. Group 3 served as a positive control group. Five specimens from each group were selected for scanning electron microscope (SEM) observation. The remaining 45 roots were obturated with RealSeal SE/Resilon and subjected to push-out tests. Data were analyzed using one way analysis of variance (ANOVA) and Tamhane's test. RESULTS The results showed no significant difference between push-out bond strength of root canal fillings in the EDTA+NaOCl group and the 1.5 W laser group (p>0.05). The positive control group showed the lowest push-out bond strength. CONCLUSIONS The results of the present study indicate that the application of an Er,Cr:YSGG laser with radial firing tips did not adversely affect the push-out bond strength of RealSeal SE sealer to dentin.

Asthma is a chronic inflammatory disorder of the airways, which is diagnosed by periodic symptoms of inflammation, bronchial spasm, and increased mucosal secretions. It has higher incidence among the preschool children. There are many contradictory reports based on the effect of asthma on oral health, however it has been hypothesized that asthma could lead to poor oral health. The objective of the present study was to investigate oral health indices in 44 preschool children of three to six years old with mild to moderate asthma and 46 matched healthy children in Tehran Children's Respiratory Center. Dental plaque, gingival inflammation, mouth breathing, and dental caries were evaluated by one trained examiner according to World Health Organization [WHO] criteria. Culture and colony counting of streptococcus mutans and lactobacillus species were carried out in saliva specimens of the patients. The effects of different factors on the colony counts were statistically analyzed using linear regression analysis. The level of mother’s education and preexisting asthma disease in children had significant effect on the colony counts of streptococcus species whereas no factor was found to influence the number of lactobacillus counts significantly. The results indicated no significant differences between the children with asthma and those without asthma regarding (decayed, missing, filled, teeth) dmft index (mean of 3.34 in asthmatic children and 3.0 in the control group). Therefore, it can be deduced that the presence of asthma disease did not increase the probability of tooth decay.

Autogenous transplantation is a feasible, fast and economical option for the treatment of missing teeth when a suitable donor tooth is available. This paper presents successful autotransplantation of a hemisected mature mandibular third molar (tooth #48) with complete root development used to replace a maxillary second molar (tooth #17). The maxil- lary second molar was deemed non-restorable due to a vertical root fracture in mesial root. Root canal therapy was first performed on the mesial root of the mandibular third molar before the two extractions to minimize post-treatment irritation. After extraction of maxillary second molar, the mandibular third molar was hemisected and the mesial root was placed into the recipient site. After one year, clinical and radiographic examinations revealed satisfactory outcomes with no signs or symptoms suggestive of pathology. In selected cases, autogenous tooth transplantation, even after complete root formation of the donor tooth, may be considered a practical treatment alternative to conventional prosthetic rehabilitation or implant treatment.

This case report describes the periradicular healing and resorption of an unintentional extrusion of mineral trioxide aggregate (MTA) in an open-apex central incisor. A 22-year old female with a symptomatic open-apex right maxillary central incisor associated with a periradicular lesion was referred for evaluation and treatment. After chemomechanical debridement, the apical third of the root canal was filled with MTA to create an apical plug. Postoperative radiographs showed the extrusion of MTA into the periradicular lesion. The tooth was then restored with a post and crown. At the 2-year follow-up, the tooth was asymptomatic and radiographs revealed complete healing of the periradicular area. At the 7-year follow-up, complete resorption of the extruded MTA was evident. The results of this case study indicate that complete resorption of extruded MTA is possible in the long term; however, the extrusion of MTA in open-apex tooth should still be avoided.

OBJECTIVES:A critical issue in contemporary orthodontics is bone age estimation. The most reliable method for skeletal age evaluation is hand-wrist radiography; but it requires further radiation. There is an increasing attention for evaluating cervical vertebrae to reduce the radiation to the patients. The aim of this study was to estimate bone age by measuring 3rd and 4th cervical vertebrae (C3, C4) dimensions.MATERIALS AND METHODS:We conducted a correlational study on 91 Iranian individuals aged 8-18 years. After taking lateral cephalometry and hand-wrist radiographs, C3 and C4 were measured using Vixwin 2000 software. Hand-wrist bone age, determined on Greulich Atlas, was the reference test. Stepwise multiple linear regression model demonstrated the correlation between the two measurements.RESULTS:Anterior height of the fourth cervical vertebrae (AH4) had the strongest simple correlation with hand-wrist bone age (r=0.831, P<0.001) and was the only variable that remained in stepwise multivariate regression model. The regression model was: Bone age=0.989×AH4+3.308. Adjusted R2 was 0.686 (p<0.001).CONCLUSIONS:Lateral cephalometric radiographs are useful for bone age estimation, and might be an alternative for hand-wrist radiography, with the advantage of radiation reduction.

Proliferative periostitis is a pathologic lesion that displays an osteo-productive and proliferative inflammatory response of the periosteum to infection or other irritation. This lesion is a form of chronic osteomyelitis that is often asymptomatic, occurring primarily in children, and found only in the mandible. The lesion can be odontogenic or non-odontogenic in nature. A 12 year-old boy presented with an unusual odontogenic proliferative periostitis that originated from the lower left first molar, however, the radiographic radiolucent area and proliferative response were discovered at the apices of the lower left second molar. The periostitis was treated by single-visit non-surgical endodontic treatment of lower left first molar without antibiotic therapy. The patient has been recalled regularly; the lesion had significantly reduced in size 3-months postoperatively. Extraoral symmetry occurred at approximately one year recall. At the last visit, 2 years after initial treatment, no problems or signs of complications have occurred; the radiographic examination revealed complete resolution of the apical lesion and apical closure of the lower left second molar. Odontogenic proliferative periostitis can be observed at the adjacent normal tooth. Besides, this case demonstrates that non-surgical endodontics is a viable treatment option for management of odontogenic proliferative periostitis.