Key Engineering Materials Vol. 829

Abstract: Orthodontic appliances can be linked to a lack of proper oral hygiene which is commonly associated with gingivitis incidence. Gingivitis treatment is required to prevent further periodontal diseases such as periodontitis, pocket formation, tooth luxation, and tooth loss. Papain is known for its anti-inflammatory, antibacterial and antioxidant effects, while arginine is known for its capability to inhibit biofilm formation and interfering plaque stability. This study aimed to demonstrate the effect of papain-arginine gel on gingivitis caused by orthodontic appliances. The gel was prepared from CMC-Na as the polymer. The papain and arginine powder was successfully dissolved homogenously into the CMC-Na in aquadest 50 mL at 25°C. Papain-arginine gel showed good stability in room temperature with pH 7. Therefore, the gel is suitable for oral application. Twenty-seven adult Sprague dawleyrats weighing ± 250–300 g were included in this study. A closing loop was placed in the margin gingiva of animal’s upper incisor to generate orthodontic force and develop reproducible gingivitis. After 7 days of orthodontic tooth movement, animals were randomly divided into three groups; the papain-arginine gel group, the chlorhexidine gel group, and the untreated group. Three rats in every group were conducted clinical observation on its gingival index (GI) and periodontal pocket depths (PPD) before and at 1, 3 and 7 days after treatment. The number of newly-formed capillaries, neutrophils and macrophages proliferation were evaluated using haematoxylin-eosin staining. The clinical response such as increasing GI and decreasing PPD on the treatment did not appear significant difference (P> .05); while the histopathological analysis showed neutrophil and macrophage proliferation were significantly higher andreached its peak on day 3 after papain-arginine and chlorhexidine gel application(P < .05).A considerably larger number of newly-formed capillary formed, and the smaller number of neutrophils and macrophages were noticed significantly at 7 days after papain-arginine and chlorhexidine gel treatment (P> .05). In early gingivitis lesion, gingiva may appear clinically healthy. However, previous studies suggested that inflammatory cells decrease indicates the process of gingivitis healing. Treatment with papain-arginine gel compared to the untreated group significantly diminished the process of inflammation. Hence, it can be concluded that papain-arginine gel was efficient in treating gingivitis caused by orthodontic appliances.

Abstract: Chronic periodontitis characterized by a periodontal pocket over 5 mm, alveolar bone resorption accompanied by tooth mobility, requires periodontal surgical treatment. Conventional surgical treatment can not achieve the regeneration of periodontal tissue and thus requires regenerative procedures, such as with the addition of PRF. PDGF-BB is a growth factor that plays an important role in wound healing. Developments in additional bioactive ingredients in surgical procedures are used to regulate inflammation and increase the speed of the healing process. The purpose of this study was to determine the effect of PRF and bone graft (carbonate apatite) on PDGF-BB levels post-surgical flap in patients with chronic periodontitis. The experimental study with open label and consecutive sampling was conducted on 10 subjects of chronic periodontitis who received surgical flap treatment with bone graft and PRF; and 10 subjects without PRF. GCF samples were collected immediately before surgery and 7 days post flap surgery for examination of PDGF-BB levels by ELISA method. The data were calculated statistically by Mann-Whitney test (p <0.05). The results showed that the mean difference of PDGF-BB level in PRF group was 9.44 pg/ml (-1.20 – 37.79 pg/ml) with p value (0.013) and Non-PRF group was 7.97 pg/ml (-6.62 - 44.42 pg/ml) with p value (0.059). The p value in the PRF group > 0.05 means a significant increase in PDGF-BB levels on the 7^th day post flap surgery. Examination of PDGF levels, especially PDGF-BB, should be done in each healing phase of the wound from the inflammatory phase to the maturation and remodeling phase, for example on the 3^rd, 7^th, 14^th and 28^th days when PDGF levels approach zero and the healing process it's almost over, referring to the results of Alzahrani's research (2018) and also Matsuoka and Grotendorst (1989) which showed higher levels of PDGF-BB and VEGF in GCF on days 1, 3, 7 and 14 after surgery with minimally invasive surgery (MIS) technique. The conclusions of this study showed that the application of Platelet Rich Fibrin (PRF) and bone graft had an effect on the level of Platelet Derived Growth Factor (PDGF-BB) post-surgical flap in patients with chronic periodontitis, and elevated levels of PDGF-BB post-surgical flap with PRF application higher than surgical flap without the PRF application. Increased levels of PGDF-BB in the group applied to the PRF were higher than those that were not applied PRF, although statistically significant differences were not found, there was a tendency for the healing process of the PRF group to be better than the Non PRF group.

Abstract: Abstract. Green betel leaf gel (Piper betle leaf) has an antimicrobial, antiseptic and antioxidant activity. An imbalance between antioxidants and ROS in the oral cavity have been implicated as one of the progressive or pathogenic factor for periodontal disease. Antimicrobial topical agent delivery may be provided as a supportive therapy for periodontal treatment after scaling and root planing. The purpose of this research is to analyze the effect of green betle leaf gel (Piper betle leaf) to Total Antioxidant Capacity (TAC) level gingival crevicular fluids after scaling and root planing treatment in chronic periodontitis patients. This research is a quasi experimental with pretest and posttest, split mouth. A total of 14 subjects followed this study. The parameters measured were TAC levels gingival crevicular fluids before and after treatment with ELISA examination. Green betel leaf gel was applied to the pocket on the test side after scaling and root planing. Data analysis using Wilcoxon test with p <0.05, and Mann-Whitney test with p <0.05. TAC levels of gingival crevicular fluids increased on day 14 on both sides, on the test side there was a significant increase (p = 0.002) while on the control side the increase was not significant. Green betel leaf gel has an effect to increase TAC level gingival crevicular fluids after scaling and root planing in chronic periodontitis patients.

Abstract: Calcium hydroxide [Ca(OH)₂] has been widely used as an intracanal medicament especially in treatment of periapical lesion. This case report will discuss about calcium hydroxide as intracanal medicament in a periapical lesion of an upper left central incisor. This case describes about treatment of periapical lesion with suspect of infected cyst with symptoms and root resorption. Root canal preparation was done by crown down technique using protaper hands universal from S1/27mm until F5/27mm. Calcium hydroxide paste was continuously applicated every 2 weeks as intracanal medicament until the periapical index (PAI) of lesion decrease, in this case PAI decreased from scale 5 until scale 2 during three months recall. Calcium hydroxide supports tissue repair, stimulates fibroblast formation and damage the cytoplasmic membrane of bacteria, denature their proteins or damage the DNA by its alkaline property. As conclusion, the use of calcium hydroxide successfully decrease the periapical lesion index in the periapical radiograph examination and can be considered as a simple and effective medicament for endodontic infection.

Abstract: Iatrogenic perforation is a common complication in endodontic treatment or restoration procedure. Recent developments in dentistry have improved tooth perforation prognosis. MTA (Mineral Trioxide Aggregate) is one of the chosen materials to seal tooth perforation. This case report discuss the management of an iatrogenic furcal perforation using White Angelus MTA to seal the furcal perforation on tooth 26 and its final restoration. Furcal perforation accured while removing the calcification in the mesio buccal canal using Protapper Next rotary file after sealing the perforation site, further root canal preparation was carried on, and root canals were medicated by Calcium Hydroxide. After 2 weeks root canal were obturated with Gutta Percha. After one week observation post obturation patient had no complain, and radiographic evaluation show good sealing by MTA. In Conclusion Angelus MTA have good sealing ability marginal adaptation, and the absence of calcium sulfate had reduced the setting time of the material. It is a suitable material to seal iatrogenic furcal perforation due to its biocompatibility, antimicrobial, good sealing ability, and low solubility.

Abstract: Dental implant failure started with a resorption on alveolar crest. Resorption occurred if the stress is greater than the strength threshold (ultimate strength). Bones carrying mechanical loads adapt their strength to the load applied on it by bone modelling or remodelling; by apposition or destruction depends on internal stress level distributed on the bones. This research was conducted using FEM on a CBCT image of model which were implanted and converted into computerized 3D finite element digital model. The model was given material properties, fixed support, and being simulated on occlusal loads of 87 N and friction loads of 29 N for 0,7 seconds.Maximum princip al loads on alveolar bone of implant model was 41 Mpa and still below the ultimate strength (69 MPa). Based on the stress level above, it may be concluded that alveolar bone on implant model has good resistance towards resorption.

Abstract: This paper presents the preliminary results from the experiment of making lab putty from glutinous rice. The experiment aims to use natural, safe, and cheap ingredients to synthesis reliable products of making direct palatal matrix index of class IV dental composite restoration, by characterizing the particle morphology and how each element binds to one another as well as its compositions. Hand manipulation on lab putty was carried out on two different samples accompanied by two fabricated samples with size of 4x2 cm. Particle morphology was characterized with JEOL Scanning Electron Microscope (SEM) and sample composition confirmed using Electron Dispersive Spectroscopy (EDS). The SEM result revealed that sample A shows smooth morphology from well-mixed glutinous rice tend bind with silicon rubber paste and bovine gelatin. Meanwhile, sample B shows hexagonal and polyhedral morphology that appears to be similar agglomerated form to the sample that marketed available (sample C and D). From the EDS result, it can be confirmed that compositionally, the four samples are similar. To conclude, lab putty made from glutinous rice can be considered as an option of low cost and safe palatal matrix index for class IV composite restoration. Better development of mechanical properties shall be conducted by future research.

Abstract: CBCT is a modernized technology in producing radiograph image on dentistry. The image quality excellence is very important for clinicians to interpret the image, so the result of diagnosis produced becoming more accurate, appropriate, thus minimizing the working time. This research was aimed to assess the image quality using the blank acrylic phantom polymethylmethacrylate (PMMA) (C­₅H₈O₂)_n in the density of 1.185 g/cm³ for evaluating the homogeneity and uniformity of the image produced. Acrylic phantom was supported with a tripod and laid down on the chin rest of the CBCT device, then the phantom was fixed, and the edge of the phantom was touched by the bite block. Furthermore, the exposure of the X-ray was executed toward the acrylic phantom with various kVp and mAs, from 80 until 90, with the range of 5 kV and the variation of mA was 3, 5, and 7 mA respectively. The time exposure was kept constant for 25 seconds. The samples were taken from CBCT acrylic images, then as much as 5 ROIs (Region of Interest) was chosen to be analyzed. The ROIs determination was analyzed by using the ImageJ® software for recognizing the influence of kVp and mAs towards the image uniformity, noise and SNR. The lowest kVp and mAs had the result of uniformity value, homogeneity and signal to noise ratio of 11.22; 40.35; and 5.96 respectively. Meanwhile, the highest kVp and mAs had uniformity value, homogeneity and signal to noise ratio of 16.96; 26.20; and 5.95 respectively. There were significant differences between the image uniformity and homogeneity on the lowest kVp and mAs compared to the highest kVp and mAs, as analyzed with the ANOVA statistics analysis continued with the t-student post-hoc test with α = 0.05. However, there was no significant difference in SNR as analyzed with the ANOVA statistic analysis. The usage of the higher kVp and mAs caused the improvement of the image homogeneity and uniformity compared to the lower kVp and mAs.

Abstract: Platelet-rich fibrin (PRF) was developed as a barrier membrane in periodontal regenerative therapy. It is known that PRF has a sustained released of growth factor and expected to facilitate the tissue regeneration. Since the PRF membranes have a rapid degradability (1-2 weeks), the regenerative therapy using a PRF membrane should be increased to reduce the degradability using a crosslinking agent which could provide resistance against enzymatic degradation. The aim of this study is to analyze the effect of 0.1% genipin as a crosslinking agent to degradability of PRF. PRF membranes were prepared from 20cc blood of healthy donors and immersed in 0.1% genipin solution as a test group and Phosphate Buffer Saline (PBS) solution as a control group for 2 hours and 72 hours. In order to evaluate degradability, the sample was subjected to 0.01% trypsin. Samples were weighed and the trypsin solution was refreshed every 24 hours. The difference weight represents enzymatic degradation. Degradation degree of sample PRF-crosslinked genipin 0.1% significantly decreased when it compared to the control group. Genipin reacts with primary amines in fibrin, performed a covalent coupling that improves the degradability resistance. This crosslink had to be effective to improve biomechanical properties of PRF as a membrane. This study demonstrated that 0.1% genipin as a crosslinking agent could reduce the degradation-degree of PRF.

Abstract: Exploration of natural compound for the treatment of dental-related problems are gaining of interest for enhancing therapeutic efficacy of the drugs delivery system. In this study, we have prepared terpenoid, which have been isolated from Myrmecodia pendens Merr & Perry from Papua Island, Indonesia, to be encapsulated in Polylactic-co-glycolic acid (PLGA), as the most widely used biodegradable polymer for biomedical applications, through one step single-emulsion method followed by subsequent coating by poly (vinyl alcohol) (PVA). The resultant of terpenoid-loaded PLGA microparticles were characterized systematically through scanning electron microscope and Fourier-transform infrared spectroscopy. In vitro drug release test was evaluated through dialysis method. Antibacterial test was conducted against Enterococcus faecalis as a model for persistent bacteria that causes root canal infections. The results showed that terpenoid-loaded PLGA microparticles were developed in spherical morphology with an average particle size of around 1-2μm. Terpenoid released from PLGA compartment at pH 6.5 and temperature of 37°C through a controlled-release profile mechanism with enhanced prolonged release. The bacterial assay result showed that terpenoid-loaded PLGA microparticles could reduce Enterococcus faecalis, effectively. Eventually, these result show that terpenoid-loaded PLGA microparticles as unique natural product-based extract could be developed as a potential naturally-based drug for dental-related diseases applications.