Vol. 5 (2024): Journal of Medical and Dental Investigations

Introduction: This study evaluated the effects of glycolic acid (GA) and ethylenediaminetetraacetic acid (EDTA) chelation solutions on the push-out bond strength of AH Plus Bioceramic Sealer when activated using passive ultrasonic irrigation (PUI) and XP-endo Finisher (XPF) activation protocols. Materials and Methods: A total of 48 similarly sized extracted mandibular premolars were randomly assigned to four groups (n = 12). All canals were prepared using Reciproc (25.08) instruments. Irrigation was performed using 5 ml of 5% sodium hypochlorite (NaOCl) between instruments, totaling 20 ml of NaOCl per canal. The teeth were divided into four groups for the final irrigation: Group 1: GA+PUI; Group 2: GA+XPF; Group 3: EDTA+PUI; and Group 4: EDTA+XPF. NaOCl was activated for 1 minute in all groups, followed by chelator activation for 30 seconds with the designated activation system. Canals were filled using the single-cone technique and AH Plus Bioceramic Sealer. The samples were incubated for one week. A single horizontal middle dentin section of 2 ± 0.1 mm thickness was prepared from each root. Push-out bond strength was tested using a universal testing machine with a loading rate of 0.5 mm/min. The data were analyzed using the Kruskal–Wallis H and Mann–Whitney U tests, with a p < 0.05 significance level. Results: There were no statistically significant differences among the GA+PUI, GA+XPF, EDTA+PUI, and EDTA+XPF groups (p > 0.05). Conclusion: Both EDTA and GA showed similar bond strength effectiveness when activated by either irrigation activation system.   How to cite this article: Batur M, Kılıvan H, Yeniçeri Özata M, Tellioğlu Avcı GR. Effects of two different chelation solutions and activation protocols on the push-out bond strength of a bioceramic sealer. J Med Dent Invest 2024;5:e240342. https://doi.org/10.5577/jomdi.e240342

Aim: Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, which typically begins in adolescence but can occur at any age throughout life. The role of lipid metabolism in sebum synthesis in sebaceous glands in the pathogenesis of acne vulgaris is still being studied. This study aims to investigate the relationship between lipid profiles and inflammatory markers in patients with acne vulgaris and those without. Methods: This study is designed as a retrospective study where the medical records of patients were reviewed. A total of 71 individuals, aged between 12 and 30, who applied to the Dermatology Clinic of Mardin Training and Research Hospital between January 1, 2022, and February 31, 2024, were included. Of these, 48 individuals were diagnosed with acne vulgaris and had not received any treatment, while 23 individuals were healthy controls with no history of chronic inflammatory systemic diseases or endocrine pathology. Demographic information (age, gender), lipid profile (cholesterol; CHO, triglycerides; TG, low-density lipoprotein; LDL, high-density lipoprotein; HDL), and inflammatory parameters (mean platelet volume; MPV, immature granulocyte; IG, platelet-large cell ratio; P-LCR, neutrophil-lymphocyte ratio; NLR, platelet-lymphocyte ratio; PLR, monocyte-lymphocyte ratio; MLR, and systemic immune-inflammation index; SII) were recorded. Appropriate statistical methods were used to evaluate the relationship between demographic characteristics, lipid profiles, and inflammatory parameters, depending on the type and distribution of the data. A p-value of <0.05 was considered statistically significant. Results: No significant difference was observed in terms of demographic data between the patient groups. When lipid profiles and inflammatory parameters were compared between patients with acne vulgaris and the control group, TG levels were significantly higher in the patient group compared to the control group (p = 0.039). However, no statistically significant differences were found between the groups in terms of CHO, HDL, LDL, MPV, IG, P-LCR, NLR, PLR, MLR, and SII parameters (p > 0.05). According to Pearson correlation analysis, a positive correlation was found between P-LCR and CHO (R: 0.399, p = 0.001) and HDL (R: 0.279, p = 0.022), while a negative correlation was reported between P-LCR and LDL (R: -0.317, p = 0.000). Conclusion: In our study, TG levels were found to be significantly higher in patients with acne vulgaris, and a correlation between P-LCR and lipid profile was reported. Our findings emphasize the necessity of considering the interaction between lipid profiles and inflammatory parameters in the treatment approach of patients with acne vulgaris.

Aim: The aim of our study is to determine the possible role of plasma amino acids before and after treatment in Hashimoto’s thyroiditis (HT) patients, to reveal the profile of amino acid metabolites in the development of thyroid autoantibodies and thyroid disease. Methods: Thirty HT patients and thirty healthy individuals were included in this study. Demographic data of the patients were recorded. Plasma amino acid profile was measured with 8045 LC-MS/MS device. Multivariate statistical analysis of the studied parameters was performed. Results: In our study, average levels of alanine, arginin, aspartic acid, citrulline, glutamine, glutamic acid, glycine, histidine, leucine, isoleucine, alloisoleucine, lysine, methionine, phenylalanine, proline, serine, tryptophan, tyrosine, valine, alpha amino pimelic acid, anserine, argininosuccinic acid, beta and gamma amino butyric acid, 1-3 methylhistidine, hydroxy proline, cystine, homocystine, ethanolamine, 5-OH-tryptophan alpha amino adipic acid and taurine were found to be significantly lower in HT group who did not receive treatment than the control group ( p <0.05). Other amino acids levels such as arginine, citrulline, glutamic acid, glycine, histidine, leucine, isoleucine, lysine, methionine, phenylalanine, proline, tryptophan, tyrosine, valine, alpha amino adipic acid, alpha amino pimelic acid, anserine, argininosuccinic acid, beta and gamma amino butyric acid, hydroxyproline, cystine, homocystine, allo-isoleucine, ethanolamine, 5-oh-trp and taurine were found to be significantly low at post treatment. The except was serine which its level was significantly higher than the control group ( p <0.001). Conclusion: In our study, the amino acid profile may be a potential biomarker in diagnosis, therapy, follow-up and prognosis of HT. This study also provides the relationship between amino acid profiles and HT. More basic studies are needed for the real mechanism of amino acids in elucidation of HT.   How to cite: Bayraktar M, Eren MA, Bayraktar N. Examination of the plasma amino acid profiles in Hashimoto’s thyroiditis patients. J Med Dent Invest 2024;5:e240354. https://doi.org/10.5577/jomdi.e240354

Aim: The objective of this study was to analyze the stress distribution of root canal treated teeth under occlusal forces and aid in the selection of appropriate materials for teeth with root tip resorption and crown destruction, using the finite element stress analysis method (FEM). Methods: The study was conducted on two-rooted lower molar teeth, divided into five groups. The root length was 14 mm, the crown length was 7.5 mm, and the total length was 21.5 mm. It was assumed that the distal canals were resorbed by 4 mm. Group 1 consisted of untreated intact teeth. Group 2 involved filling the mesial canals with gutta-percha, filling the apical part of the distal canal with 4 mm Mineral Trioxide Aggregate (MTA), and fabricating the crown using glass fiber post and IPS e.max materials. Group 3 involved filling the mesial canals with gutta-percha, filling the apical part of the distal canal with 4 mm Biodentin, and manufacturing the crown using glass fiber post and IPS e.max materials. Group 4: The canals were filled with MTA, and an IPS e.max endocrown was used. Group 5: The canals were filled with Biodentin and an IPS e.max endocrown was used. The study examined the effect of a 100 Newton force applied in the occlusal direction on dental tissues using finite element stress analysis. Results: The study found that the application of fiber posts resulted in less stress accumulation in tooth tissues compared to endocrown. Conclusion: The use of Biodentin or MTA in endocrown teeth did not affect the stress in tooth tissues caused by applied force. In conclusion, while fiber posts increase durability by reducing stress in root-end resorbed teeth, the effect of Biodentin or MTA on stress resistance in dental tissues is limited.   How to cite this article: Duran S, Şirin DA, Topbaş C. Finite element stress analysis in mandibular molars with apical root resorption and crown destruction after root canal treatment using various materials. J Med Dent Invest 2024;5:e240320. https://doi.org/10.5577/jomdi.e240320      

Aim The parapetrosal triangle, which is one of the landmarks and regions determined to provide orientation to the skull base has the importance is that it can guide the topographic anatomy of the paraclival region from an exocranial perspective. The aim of the study was to determine the topographic anatomy of the parapetrosal region and to determine the relations between the distances between the foramina within the triangle. Methodology The study was carried out on a total of 17 bones belonging to 34 sides. Eighteen parameters were determined to be examined on digital images and all measurements were carried out by the same researcher for both sides. We compared the morphometric features of the right and left sides via Student's T test and Mann-Whitney U test. We evaluated the relationship between variables through Pearson and Spearman correlation analyses. We developed equations to estimate the morphometric features located in the parapetrosal triangle using the bispinal line. Results It was observed that there was no difference between the sides for any variable. We found the distance between the HS and midline 5.37±0.68 cm for the right side and 5.39±0.60 cm for the left side. We found the bispinal distance value obtained by adding the right and left midline distances, and this was determined to be 10.76±1.22 cm on average. We found the spinopterygoidal line distance 6.70±0.81 cm and 6.75±0.86 cm for the right and left sides respectively. We developed equations to estimate the location of the some anatomical structures using Henle’s spine. The equation was; the distance between the HS and midline = 0.005 + (0.005 x length of the bispinal line); Adjusted R value was 0.899. Conclusion As a result of the high-reliability models that we created by taking the parapetrosal triangle as a reference, we showed that Henle's spine is a reliable reference point by the literature with a different method. We believe that the study will be an important guide for surgeons.   How to cite this article: Tuncel Çini N, Doğru Yuvarlakbaş S, Babacan S. Topographic and morphometric feature of the anatomical structures located in the parapetrosal triangle borderlines. J Med Dent Invest 2024;5:e240387. https://doi.org/10.5577/jomdi.e240387

Aim:  In this study, we aimed to compare venous Hemoglobin (Hb) and Hematocrit (Hct) values measured by bedside blood gas analyzer with standard laboratory auto-analyzer values in multiple trauma patients and to investigate if lactate level is adequate in this correlation. Methodology: Vascular access was obtained in the antecubital regions of the patients. Simultaneous venous blood samples were drawn, and a blood gas analyzer measured Hb, Hct, and lactate values, and Hb and Hct values were also measured by a laboratory auto-analyzer in the emergency laboratory. The correlation between the values was calculated. In addition, the prediction of laboratory auto-analyzer values from venous blood gas analyzer values was performed using linear regression equations (Regression Equation (y) = a + bx). Results: A total of 51 patients were included in the study. The median difference between peripheral vein laboratory auto-analyzer values and venous blood gas analyzer values was 0.40 g/dL for Hb and 1.10% for Hct. There were high and very high positive correlations between peripheral vein laboratory auto-analyzer values and venous blood gas analyzer values, with correlation coefficients of 0.693 and 0.862 for Hb and Hct, respectively. The correlation coefficient for Hb increased from 0.693 to 0.827 in 26 patients with lactate values below the 2.5 mmol/L cut-off limit. We also measured Hb and Hct by laboratory auto-analyzer and blood gas analyzer from simultaneous femoral artery-sourced samples from 40 patients. The median difference between femoral artery-sourced laboratory auto-analyzer values and femoral artery-sourced blood gas analyzer values was 0.20 g/dL for Hb and 0.80% for Hct. There were very high positive correlations between femoral artery-sourced laboratory auto-analyzer values and arterial blood gas analyzer Hb value and femoral artery-sourced laboratory auto-analyzer and arterial blood gas Hct value with correlation coefficients of 0.949 and 0.851, respectively. Conclusion: In both venous and arterial samples, the differences between the laboratory auto-analyzer and the blood gas analyzer are limited, and the correlations between them are significantly high. Furthermore, the correlation between the venous blood gas auto-analyzer value and the laboratory auto-analyzer value for Hb is even higher when the lactate value is below the 2.5 mmol/L cut-off limit.   How to cite this article: Avcı M. Comparison of hemoglobin, hematocrit, and lactate values measured by bedside blood gas analyzer with laboratory auto-analyzer values and investigation of their correlations in multiple trauma patients. J Med Dent Invest 2024;5:e240394. https://doi.org/10.5577/jomdi.e240394

Aim: To evaluate color stability (ΔE 00 ), translucency (TP), and surface roughness (Ra) of zirconia-reinforced lithium silicate (ZLS) with lithium disilicate (LS) against different mouth rinses after thermocycling. Methods: A total of 270 specimens were prepared: LS (IPS Emax CAD (group EC)), ZLS-1 (Vita Suprinity (group VS)), and ZLS-2 (Celtra Duo (group CD)). For each specimen, ΔE 00 , TP, and Ra measurements were recorded with a clinical spectrophotometer (CM-3600A) and a 3D non-contact profilometer (AEP Nanomap-1000WLI), respectively, between baseline and after 10000 cycles of thermal cycling. Each group was divided into six subgroups (n=15) according to the immersion solution: five mouthwashes (Meridol, Klorhex, Listerine Cool Mint, Listerine Healthy White Natural Lemon&Salt, and Curasept ADS 212), and distilled water for 72 hours. Statistical analysis was performed by using a three-way robust ANOVA with Tukey HSD test (α=0.05). Results: Listerine Lemon&Salt and Cool Mint caused the highest ΔE 00 and Ra values, while TP values of tested mouthwashes were similar ( p =0.051). Group EC had the highest ΔE 00 and Ra values with the lowest TP values against mouthwashes ( p <0.05). Conclusion: Prolonged use of mouthwashes may cause color change and increased surface roughness in LS more than ZLS. Patients should be advised to use alcohol-containing mouthwashes with caution in daily use.

Aim: The aim of this study was to examine the structures, roots and canal numbers of mandibular anterior teeth using cone-beam computed tomography (CBCT). Methods: The study evaluated 4830 fully developed mandibular anterior teeth from 953 CBCT scans. The final sample consisted of 515 scans of females and 438 scans from males, with ages ranging from 17 to 69 years. Among the assessed teeth, 2475 were located on the right side and 2355 on the left, including 2614 from females and 2216 from men. The teeth were free of any fillings, resorption, or cracks in the root or crown. The study analyzed the numbers of roots and root canals, location of the apical foramen, and canal type according to Vertucci’s classification. Results: 82.7% of teeth had single-root canals, whereas four lateral teeth (0.2%) and 42 lower canines (2.4%) had two-roots. The apical foramen was located centrally in 80.9% of the teeth (n = 3909), followed by buccal (8.8%), distal (4.2%), lingual (3.4%), and mesial (2.7%) positions. Using Vertucci’s classification of root canal types, type-I was the most prevalent (65.3%), followed in order by types-III (28.6%), II (4.2%), V (1.5%), and VI (0.4%). Conclusion: Turkish mandibular anterior teeth have intricate anatomy. To enhance comprehension of the complex anatomy of Turkish mandibular incisors and canines, including the numbers of canals and roots and canal configurations, further studies of more patients from diverse regions of Türkiye are needed. The tooth configuration was influenced by gender rather than by tooth position.   How to cite this article:   Topbaş C, Atav A. Root canal configuration in mandibular anterior teeth: Insights from cone-beam computed tomography in a Turkish subpopulation. J Med Dent Invest 2024;5:e240362. https://doi.org/10.5577/jomdi.e240362  

Aim: Algan Hemostatic Agent (AHA) is a plant-based material effective in hemostasis. The purpose of this study was to compare the hemostatic efficacy and acute histopathological effects of liquid and powder forms of AHA in rat model of experimental liver lobectomy. Methods: Twenty-four male Wistar albino rats, 10-12 weeks old, were randomly divided into three groups (n=8): control (physiologic saline), AHA-liquid, and AHA-powder. Following the resection of the outer one-third of the left hepatic lobe, physiological saline, liquid and powder, was administered to the injured area for twenty seconds. At the tenth minute, all animals were sacrificed through intra-abdominal bleeding. Liver tissues from all groups were excised for histopathological analysis. Results: Bleeding control success rates of the first application results of AHA-liquid were higher than those of AHA-powder. Success rates of the second application of AHA liquid (66.6%) and AHA powder (50%) were substantially higher than those of the control group. The liver parenchyma was intact, and a dense fibrous tissue capsule was noted at the wound site of the liquid group. In powder group, late granulation tissue was observed along with moderate lymphocyte infiltration and some powder remnants. Conclusion: The present study showed that herb-based AHA is an effective material for controlling blood loss in liver lobectomy model. It formed a stable clot without causing damage to liver tissue, especially when administered in liquid form. AHA could be a preferred and promising option for managing hemorrhage during crucial operations due to its biocompatibility and rapid efficacy.   How to cite this article: Şener Akçora D, Mavuş D, Miko M, Gökçe K. Comparison of hemostatic and acute histopathological effects of Algan Hemostatic Agent in experimental liver lobectomy model in rats. J Med Dent Invest. 2024; 5: e240372.

Aim: The purpose of this study is to compare the cyclic fatigue resistance of the TruNatomy and ProTaper Next file systems, which work rotational movements, and Reciproc and WaveOne Gold file systems, which work reciprocal movements. Methods: ProTaper Next X2 (25/.06), WaveOne Gold Primary (25/.07), Reciproc R25 (25/.08), and TruNatomy Prime (26/.04) files were used in the cyclic fatigue test. Four groups, 15 files from each group and a total of 60 files, were rotated in an artificial canal made of curved stainless steel with a curvature angle of 60 degrees, an inner diameter of 1.5 mm, and a radius of curvature of 3 mm. The breaking times of the files were determined with a digital stopwatch, and this value was converted into the number of cycles until breaking. Compliance with normal distribution was examined with the Shapiro‒Wilk test. The number of cycles until fracture for the respective files, which did not follow a normal distribution, were compared using the Kruskal‒Wallis test and multiple comparisons were made with the Dunn test. The analysis results were presented as mean ± standard deviation and median (minimum-maximum). The significance level was taken as p <0.050. Results: While the TruNatomy system had the highest number of cycles until fracture occurred, no statistically significant difference was found between the Reciproc and WaveOne Gold systems. The ProTaper Next system showed the lowest cyclic fatigue resistance. Conclusion: Within the limitations of the present in vitro study, TruNatomy, which makes rotational motion, showed the best cyclic fatigue resistance. The ProTaper Next system was the file with the lowest cyclic fatigue resistance. Obtaining similar results for files produced in different shapes and with different movement kinematics allowed us to conclude that cyclic fatigue is multifactorial.   How to cite this article: Akın Tartuk G, Kaya S, Al Tai TN. Comparison of cyclic fatigue resistance of different rotational and reciprocal file systems. J Med Dent Invest 2024;5:e240347. https://doi.org/10.5577/jomdi.e240347

Aim: This study was conducted to compare vitamin D levels in primary infertile patients with vitamin D levels in fertile women. Methods: This study was composed of 75 unexplained primary infertile and 75 fertile patients who applied to the hospital between 1 June 2022 and 31 March 2023 at Harran University Faculty of Medicine, Department of Obstetrics and Gynecology, prospectively. Two milliliters of blood samples were obtained from women with unexplained primary infertility and from fertile women. All venous blood specimens were centrifuged at 4000 rpm for 10 min. The plasma derived from the samples was evaluated for 25-hydroxy vitamin levels using LS-MS 8045 and subsequently compared. The plasma derived from the samples was examined for levels of AMH, TSH, prolactin, progesterone, estrogen, LH, and FSH. Results: The mean of vitamin D in the unexplained primary infertile group was 5.35 ± 1.81 ng/mL while the mean of vitamin D in fertile women was 12.6 ± 4.44 ng/mL. It was determined that there was a significant difference between vitamin D levels according to the study groups. Conclusion: We think that vitamin D supplementation is important in infertile women because the levels of vitamin D in the unexplained primary infertile group were lower than those in the fertile group. There is a need for more comprehensive multicenter studies showing the relationship between vitamin D levels and infertility related to the current study.   How to cite this article: Kada Düken R, Sak S, Barut MU, Sak ME. Comparison of vitamin D levels in primary infertility and infertile female patients. J Med Dent Invest. 2024; 5: e240379.

Resin-bonded fixed dental prostheses (RBFDPs) are a commonly used precision treatment, such as fixed dental prosthesis (FDP) and implant-supported dentures. Full crown preparation of vital teeth, which is required for traditional FDPs, may result in a risk of pulp reaction as a large portion of the coronal tooth structure must be removed. RBFDP has been recognized as a non-invasive or minimally invasive treatment modality for the replacement of single missing teeth. RBFDPs require much less tooth preparation than conventional FDPs. These dental treatments are restorative solutions used to cover missing teeth and achieve an aesthetic smile. The biomechanical rules, aesthetics, polishability, and bond strength have been emphasized in RBFDP treatments. Polyetheretherketone (PEEK) is one of the most widely used biomaterials in dentistry. The material, which stands out especially with its acceptable aesthetics, biocompatibility and modulus of elasticity close to dentin, has enabled it to be used in RBFDP treatments. Since PEEK is lighter than metal alloys, patients experience less discomfort and a feeling closer to natural teeth. Furthermore, the thermoplastic properties of PEEK are claimed to provide a precise fit, allowing the restoration to better integrate into the natural tooth structure. In addition, its ability to be customized using different modern manufacturing techniques is thought to offer dentists and patients a reliable option for successful long-term treatment. Our review is about the use of PEEK material as an alternative material in RBFDPs with low negative effects on periodontal tissues and their bonding with resins.

Spinal muscular atrophy (SMA) is a disease characterized by progressive nerve cell loss in the spinal cord and brainstem. It can be fatal if left untreated, particularly in infantile forms. Nusinersen became the first disease-modifying agent to be approved in 2016 for the treatment of all types of 5q-associated SMA, across all age groups. Trials have shown that the drug has an acceptable safety profile and has significantly improved clinical care for patients; however, data on long-term risks and benefits are limited. Respiratory problems following use of the drug are an important potential complication and the mechanisms of action are not fully understood. This study reports on a patient with type 1 SMA who developed chronic respiratory failure after the first dose of nusinersen, a condition not previously reported. Although nusinersen significantly improves patients' quality of life, its long-term or rare side effects are not well understood. Patients should be closely monitored for respiratory side effects, especially after the first dose, and families should be thoroughly informed about potential respiratory complications.   How to cite this article: Orhan Ö, Talay MN, Büyükşahin HN, Demirbuğa A, Özbek MN, Özgün N. Chronic respiratory failure after the first dose of nusinersen treatment: A case report. J Med Dent Invest 2024;5:e240341. https://doi.org/10.5577/jomdi.e240341

Pelvic organ prolapse (POP) is a common issue affecting women. The development of minimally invasive surgical techniques has introduced a new era in POP treatment, with laparoscopic methods gaining popularity. This abstract highlights the simplified technique as an efficient alternative. BalsAksin technique aims to treat POP with a minimally invasive approach, eliminating the need for laparoscopic suturing. It provides a faster and more effective surgical option. In this technique, vaginally, the vesicouterine gap was opened. The mesh was fixed to the cervico-isthmic area vaginally, and the mesh arms were sent into the abdomen; then, the mesh arms were removed laparoscopically by pulling the bilateral trocar ports. The uterine position is adjusted vaginally. In summary, the BalsAksin technique offers a simplified alternative to laparoscopic suturing in pelvic organ prolapse surgery. Its ability to eliminate the need for laparoscopic suturing while reducing operation times makes it an appealing option for surgeons, ultimately improving patient care and surgical outcomes. In addition, the sending of mesh arms to the abdominal cavity through trocar ports and the strategic placement of the ports have increased the simplicity and effectiveness of the method.   How to cite this article: Balsak D, Aksin Ş, Kurnuç FZ, Yılmaz M, Batmaz İ. The simplified version of laparoscopic lateral suspension: BalsAksin technique. J Med Dent Invest 2024;5:e240389. https://doi.org/10.5577/jomdi.e240389

Letter to Editor