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A THREE DIMENSIONAL COMPUTED TOMOGRAPHY (3D-CT) STUDY OF MAXILLARY SINUS IN MALAYS

Ahmed Atta Ode El-MasriMSc (Dentistry) – Orthodontics

School of Dental Science, Universiti Sains Malaysia, Health Campus, 16150 Kelantan, Malaysia

Introduction: The development pattern of themaxillarysinusvarieswidelyaccordingtotheindividualandtheage.Eveninthesameperson,bothmaxillarysinusesmaydevelopinadifferentways.Understandingthemaxillarysinussize in different ages is important formany clinicians. Thisinformationcanbeusedinthefutureasabaselinereferencedata for diagnosis and management of maxillary sinusabnormalities.3D-CTofferstheabilityofobservingmaxillarysinus fromseveralviewingangleswith interactiveandrapidrepositioningofthe3Dimages.Objective: To study the size of the maxillary sinus whichincludes linear and volume measurements in Malays atspecificallyselectedagecategories. Methods: Three dimensional computed tomography(3D-CT) images of 144Malays (288maxillary sinuses)withno clinical evidence of craniofacial and maxillary sinusabnormalities were selected. The subjects aged from 0.4to 30 years (Mean= 13.7, SD= 8.53 years), underwent theCT scanning using General Electric (GE) Light Speed PlusCT Scanner System (Wisconsin, USA) at the Radiologydepartment,HUSMforreasonsotherthanresearchpurposes.The initial 2D formats were then reconstructed into 3DutilisingOsiriXV3.7 (Geneva, Switzerland) software. Lineardimensionsandvolumeofmaxillarysinusweremeasuredforeachsubjectindifferentagecategoriesandgender. Results: The maxillary sinus increased in sizes andvolumefrombirthto30yearsofage.Femalesdemonstratedtohavesignificantly largermaxillarysinuswidth(P=0.02),height (P = 0.04) and depth (P < 0.01) than males in 0to 6 years age category. The male’s maxillary sinus widthand height were significantly larger than females in 7 to 12(P < 0.01) and 21 to 30 (P = 0.02) years age categories.Moreover,maxillarysinusdepthwerefoundtobesignificantlylarger inmales than females in 21 to 30 years age category(P<0.01).Malesalsoexhibitedsignificantlylargermaxillarysinus volume than females in 7 to 12 (P < 0.01) and 21 to30 (P < 0.01) years age categories. No significant different(P<0.05)betweentherightandleftmaxillarysinusinmostagecategories.Significantcorrelationsweredetectedbetweenthemaxillarysinus,nasalcavityandmaxillafromtheage0to12years.Nosignificantcorrelationswereobservedbeyondtheage12years.

Conclusion: Themaxillary sinus size showed sexualdimorphism at most age categories. Gender considerationshould be taken into account in clinical assessment andprocedureswhichmayaffectthemaxillarysinus.

Supervisor:Dr Asilah YusofCo-Supervisor:Associate Professor Dr Rozita Hassan

EVALUATION OF SHEAR BOND STRENGTH OF RESIN MODIFIED GLASS IONOMER CEMENT AND ENAMEL SURFACE CONDITION WITH DIFFERENT SURFACE PREPARATION: IN VITRO STUDY

Ayman Anaam Saied El NafarMSc (Dentistry) – Orthodontics

School of Dental Science, Universiti Sains Malaysia, Health Campus, 16150 Kelantan, Malaysia

Introduction: Brackets in orthodontic needs a longlasting durability under the influence of different stresses;therefore, itmustpossess a clinically acceptable shearbondstrength(SBS) towithstandorthodonticmovement force,aswellasadditionalforces. Objective: To evaluate the shear bond strength oforthodonticbracketbondingwithRMGICindifferentenamelsurfacepreparation.Inaddition,theadhesiveremnantindex(ARI) after orthodontic bracket debonding and the enamelsurface roughness after removal of bonding residues werestudied. Methods:Onehundredfortyfour(144)teethextracteddue to orthodontic and/or periodontal problems werecollected and divided randomly into four groups, with fourdifferentsurfacepreparations.GroupI (controlgroup):37%Phosphoric acid; Group II (control group): sandblasting;Group III (experimental group): sodium hypochlorite and37% phosphoric acid; and Group IV (experimental group):sodium hypochlorite and sandblasting. Orthodontic bracketbondingweredonebyRMGIC.InstronmachinewasusedtomeasuretheshearbondstrengthinMegaPascal(MPa).Afterbracketdebondingforallgroups,theadhesiveremnantindexof the remnant adhesivewas calculated, the enamel surfaceroughness after cleanup with tungsten carbide bur in lowspeedhandpieceandsandblasting,27μmparticlesizewith80persquareinch(Psi)wasmeasured,andsurfacemorphologywasobservedusingascanningelectronmicroscope. Result: The results showed that the mean valuesofSBSforgroupsI, II, III,andIVwere13.86,9.08,17,and9.63 MPa, respectively. The mean percentages (%) of the

Abstracts Abstracts of Theses Approved for the PhD/ MSc at the School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia

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adhesiveremnantonthetoothsurfacewere11.16,2.06,20.66,and3.73.Themedianand interquartileRange (IQR)of thesurfaceroughnessaftercleanupwithTCBandSBrepresentedbyRa(arithmeticalaverageroughnessheight) forallgroupswereas follows:Group1:TCBwere0.65 (0.53),0.85 (0.55),4.41(2.85),andSBwere0.70(0.58),0.90(0.65),5.00(3.20),respectively. Group 2: TCB were 0.70 (0.53), 0.90 (0.63),5.0 (3.20), and SB 0.85 (0.48), 1.05 (0.55), 5.45 (3.00),respectively.Group3:TCBwere0.70(0.11),0.91(0.19),4.85(1.92), and SB were 0.75 (0.28), 1.00 (0.28), 5.65 (2.65),respectively. Group 4: TCB were 0.70 (0.10), 0.95 (0.17),5.70 (2.13), and SB 0.80 (0.20), 1.00 (0.10), 5.50 (0.30),respectively.Scanningelectronmicroscope (SD)revealednodifferenceinmorphologybetweenallgroups. Conclusion: Applying 5.25% NaOCL to the enamelsurface eliminates the organic elements, allowing the acidetchanttopenetratemoreeffectivelyintotheenamel,creatingtype1and2etchingpatterns.Theincreasedbondingstrengthallows the orthodontist to use fluoride- releasing RMGICsas bonding adhesivesto possibly protect the enamel fromdeveloping white spot lesion, a major iatrogenic effect oforthodontic treatment. Combining the clinical aims andexperience with the best available evidence should be animportant goalof every clinician.In conclusion, theadditionofNaOCLpriortoacidetchandorthodonticbracketbondingusing RMGIC increased the shear bond strength as well asutilisingfluoridereleasingeffect,withhigherARI.

Supervisor:Dr Mohammad Khursheed AlamCo-Supervisor:Associate Professor Dr Rozita Hassan

DENTAL CARIES AND SALIVARY PARAMETERS OF DOWN SYNDROME CHILDREN IN KOTA BHARU, KELANTAN

Fatema Khalfan Mohamed Ibraheem AlhammadMSc (Dentistry) – Community Dentistry

School of Dental Science, Universiti Sains Malaysia, Health Campus, 16150 Kelantan, Malaysia

Introduction: Down syndrome (DS) is a geneticdisordercausedbyalterationofchromosome21witharangeof 1: 800 to 1:1000 live births. Several studies showed thatchildren with DS have low caries experience due to bettersalivaryparameters,howeverthefindingsareinconclusive. Objectives: This study aimed to determine theprevalence of dental caries and caries experience inDS andnormal children. It also aimed to determine and comparethe salivary pH, salivary buffering capacity and salivaryimmunoglobulinA (SIgA)between thesegroupsofchildren.ThefactorsassociatedwithcariesexperienceinDSandnormalchildrenwerealsodetermined. Methods: A comparative cross sectional study was

conductedon73DSchildrenandrandomlyselected73normalchildrenaged7-12yearsold.TheDSchildrenwererecruitedfromspecialclassesinnormalprimaryschools,PusatPemulihanDalamKomunitiandprivatecenterswhereasnormalchildrenweretakenfromthesameprimaryschools.Thechildrenwereaskednottoeatanhourbeforetheprocedure.Un-stimulatedsalivasampleswerecollectedfrom8:30amto10:30amfromall children.The salivarypHand salivarybuffering capacityweredeterminedat the same timeusingpHandbuffer teststripsaccordingtomanufacturer’sprotocol.Thirtytwosalivasampleswere randomly selected from each group andwerestoredunder-80°C.SIgAconcentrationwasthentestedusingcommercially available enzyme immunoassay kit, ELISA.Clinicaloralexaminationwasdoneafterthesalivacollectionprocedures using disposable probe and mouth mirror. Thecariesexperiencewaschartedusingtheindexofdecay-filled-teeth (dft) fordeciduousdentitionandDecay-Missing-FilledTeeth(DMFT)forpermanentdentition. Results:AmongtheDSchildren,cariesprevalenceofdeciduous dentition (67%) was higher compared to normalchildren (62%). While, the caries prevalence of permanentdentitionwashigheramongnormalchildren(38%)comparedto DS children (27%). Salivary parameters such as salivarypH, salivary buffering capacity and SIgA, were significantlyloweramongtheDScomparedtonormalchildren(P<0.001).AmongDSchildren,onlyageshowedpositiveassociationwithDMFTscore(P=0.016)i.e.asageincreasesbyoneyear,cariesexperience increaseby0.22.Regardingthenormalchildren,age (P <0.001) and salivarybuffering capacity (P =0.008)showednegative associationwithdft, i.e. as age increasebyoneyear,cariesexperiencedecreasesby0.88andifsalivarybufferingcapacityincreasesbyoneunitthecariesexperiencescoredecreasesby0.30.AgeshowedpositiveassociationwithDMFT(P=0.016)amongnormalchildren,aoneyearincreaseinagewillincreasethecariesexperienceby0.51. Conclusions: Higher caries prevalence in deciduousdentitionwasfoundinDS,whileforcariesprevalenceofthepermanentdentitionshowed theopposite trend.All salivaryparameters were lower among DS children compared tonormal children. Among normal children, caries experiencein deciduous dentition decreases with increase in age andsalivarybufferingcapacity.ThecariesexperienceinpermanentdentitionshowedtoincreasewithincreaseinageamongbothDS and normal children. Further research is required toincludemoreriskfactorsascariesisamultifactorialdisease.

Supervisor:Associate Professor Dr Azizah YusoffCo-Supervisor:Associate Professor Dr Normastura Abd. RahmanDr Wan Majdiah Wan Mohamad

IMMUNOGENICITY OF SYNTHETIC HYBRID PROTEIN NEURAMINIDASE OF MALAYSIAN INFLUENZA A IN BALB/c MICE

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Niswathul Haania Zain AliMSc (Dentistry) – Oral Immunology

School of Dental Science, Universiti Sains Malaysia, Health Campus, 16150 Kelantan, Malaysia

Introduction:VaccinationagainstH5N1seemstobean appropriate approach as primarymethod for preventingH5N1 and the severe complications related to the disease.Neuraminidase (NA) protein is primarily immunogenic andelicits immune response. Introduction of the recombinantsyntheticproteinasvaccinemayinducehumoralandcellularimmuneresponsesatsystemiclevel. Objective:Inthisstudy,weinvestigatedthehumoraland cellular immune response inmice after intraperitonealadministration of NA synthetic protein in the presence andabsenceofadjuvant. Methods: BALB/c mice were immunised with 5 μg,50μgand100μgofNAproteininthepresenceandabsenceof adjuvant via intraperitoneal administration followedby two booster doses at three weeks interval. Serum wascollected pre- and post- immunization before administeringbooster doses and was subjected for ELISA analyses. Themiceweresacrificedbycervicaldislocation3weeksafterfinalimmunization.Peritonealwashoutwasused formacrophagecountusingCD14-FITCviaflowcytometer.Splenocyteswereused for cell subsets analysis and cultured for proliferationassayandcytokineassay(IFN-γandIL-4). Results: The study showed that intraperitonealadministration of synthetic protein in the presence ofadjuvant,stimulatedhumoralandcellularimmuneresponses.Additionally,thepresenceofadjuvantelicitedtheTh1andTh2profile, suggesting promotion of humoral and cell-mediatedimmuneresponse.TheimmunisationofproteinaloneinducedlowantibodyresponseandTh1-typeimmuneresponse. Conclusion: The results obtained from this studyindicatethattheproteinNAisimmunogenicandispromisingforthefuturedevelopmentofpandemicinfluenzavaccine.

Supervisor:Associate Professor Dr Azizah YusoffCo-Supervisor:Associate Professor Dr Normastura Abd RahmanDr Wan Majdiah Wan Mohamad

THE EFFECTIVENESS OF THE TREATMENT WITH REVERSE TWIN BLOCK AND REVERSE PULL FACE MASK APPLIANCES FOR CLASS III MALOCCLUSION: A RANDOMISED CLINICAL TRIAL

Osama Bahaa MohammedPhD (Orthodontic)

School of Dental Science, Universiti Sains Malaysia, Health Campus, 16150 Kelantan, Malaysia

Introduction: The effects of functional appliancesoncraniofacialmorphologyofClass IIImalocclusionamong

MalaychildreninMalaysiaremainsapuzzle. Objective:Arandomizedclinicaltrialwasundertakento evaluate the effectiveness of treatment with reverse twinblock and reverse pull face mask appliances for Class IIImalocclusionamongmalesandfemalesMalaychildrenintheearlyandlatemixeddentitionstages. Methods:A total of 97 Class IIImalocclusionMalaychildrenagedfrom8to9and10to11yearswereenrolledintotwotreatmentgroups.Nodropoutwasrecorded.49childrenweretreatedwithreversetwinblockapplianceand48childrenreceivedreversepullfacemaskapplianceforaperiodofeightmonthstherapy.Lateralcephalometricradiographsandupperandlowerimpressionsfordentalstudymodelsweretakenandquestionnairesinterviewwasdonebeforeandaftertreatment.Multiple regression analysis was used to evaluate therelationshipbetweenageandsexontheskeletalchange,dentalarches change andperception of thepatient after treatmentwithreversetwinblockandreversepullfacemaskappliances.Also, multiple regression analysis was used to compare theskeletalchanges,dentalarcheschangeandperceptionofthepatient after treatment with reverse twin block and reversepullfacemaskappliances.Thelevelofsignificancewassetat0.05. Result:Results showed that there is no relationshipbetween age and sex affecting the dentoskeletal changes forboth appliances.However, reverse pull facemask appliancehad induced more significant dentoskeletal changes thanreverse twin block appliance in this group of study amongMalay children.Assessment of post-treatment studymodelsshowed that both appliances changed the maxillary andmandibulardentalarchshapebutdonotaffecttheinter-teethdistances.However,onlythereversepullfacemaskapplianceshowed increased upper dental arch length. All patientsshowed significant satisfaction following treatment withreversepullfacemaskappliancewhencomparedwithreversetwinblockappliance.Therewerenodifferencesfoundbetweenthetreatmentresponsesinearlyorlatemixeddentitionstagesinbothmalesandfemalesinbothtreatmentgroups.Conclusion:Inconclusion,reversepullfacemaskapplianceinducedsignificantdentoskeletalchangesinthetreatmentofClassIIImalocclusionwhencomparedwithreversetwinblockappliance.

Supervisor:Dr Mohd. Fadhli KhamisCo-Supervisor:Professor Dato’ Dr Ab Rani SamsudinAssociate Professor Dr Noor Hayati Abdul RazakDr Norehan Mokhtar

SYNTHESIS OF SILICA NANOPARTICLES AND THEIR SURFACE MODIFICATION FOR FABRICATION OF HYBRID DENTAL NANOCOMPOSITES

Roziamarni Che Abdul AzizMSc (Dentistry) – Biomaterial

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School of Dental Sceinces, Universiti Sains Malaysia, Health Campus, 16150 Kelantan, Malaysia

Objectives: The aim of this study was to synthesissilica nanoparticles fillers for fabrication of hybrid dentalnanocomposites and to evaluate their properties, includingsurfaceroughnessandmechanicalproperties.Hybridofthreedifferentsizesofsilicananoparticlesrangingfrom10to100nmweresynthesisedviaasol-gelmethodusingthreedifferentconcentrationsofammonia.Surfacemodificationofthesilicananoparticleswascarriedoutusingγ-methacryloxypropyltrimethoxysilane(γ-MPS)asacouplingagentviaco-condensationandone-potmethod. Methods: The silica surface was modified in orderto improve interfacial adhesion between nanofiller and thematrix. The characterisations of unmodified and modifiedfillers were carried out using Transmission ElectronMicroscope(TEM),FourierTransformInfraredSpectroscopy(FTIR), Thermogravimetric analysis (TGA), BET analysis,Nuclear Magnetic Resonance (NMR) and scanningelectron microscopy equipped with energy dispersive X-rayspectroscopy(SEM-EDX). Result: The hybrid dental nanocompositeswith fillercontent of 40 wt% containing a combination of differentsizes(19.6[SD3.3],27.6[SD2.3]and64.6[SD8.2]nmforunmodifiedfiller, and 16.4 (SD5.5), 38.1 (SD8.8) and70.9(SD 15.3) nm for modified filler via one-pot method), werefabricated. The hardness, flexural strength and flexuralmoduluswere evaluated.Thehybriddentalnanocompositesreinforced by modified filler (E-P0.2) showed higherflexural strength, flexural modulus, and hardness thanthose unmodified filler. The hybrid dental nanocompositesfabricatedwith 1:2:1 (16.4;38.1; 70.9nm)fillerweight ratiohaveshownthebestmechanicalproperties. Conclusion: Based on the results obtained, themodifiedsilicananoparticlesareapromisingmaterialforthefabricationoftooth-fillingnanocomposites.

Supervisor:Profesor Ismail Ab. RahmanCo-Supervisor:Dr Dasmawati Mohamad

A PILOT STUDY OF USM TISSUE BANK PRODUCED AN-ORGANIC BOVINE BONE GRAFT POST MAXILLARY SINUS AUGMENTATION USING CONE BEAM COMPUTED TOMOGRAPHY

Usman Haider UzbekMSc (Dentistry) – Conservative

School of Dental Science, Universiti Sains Malaysia, Health Campus, 16150 Kelantan, Malaysia

Introduction: An-organic bovine bone graft is axenograftwiththepotentialofboneformation. Objective: The aimof this studywas to evaluate the

bone density using cone beam computed tomography scansaround functional endosseous implant in the regionof bothaugmentedmaxillary sinuswith thean-organicbovinebonegraftandthealveolarboneoverwhichthegraftwasplacedtoprovidespacefortheimplants. Methods: Sterile freeze dried bovine bone graft(OsteoLEMB)produced byNational TissueBank,UniversitiSainsMalaysiawasused for1-stage implantplacementwithmaxillarysinusaugmentationinatotalof19subjectswith19implants.Theageofallsubjectsrangedbetween40–60yearswithameanage51(SD4.70).Afteraperiodofoneandahalfyear,allsubjectsunderwentafollowupConebeamcomputedtomography scan using Planmeca Promax 3D®Cone beamcomputedtomographyscannerattheRadiologydepartment,Hospital Universiti Sains Malaysia. The collected data wasthen analysed to evaluate bone density inHounsfield Unitsusing Planmeca Romexis™ Imaging Software 2.2 ®whichis specialised accompanying software of the cone beamcomputedtomographymachine. Results: Therewas bone formation at the site of theaugmentedsinus.Asignificant increase(P<0.005) inbonedensitywasreportedat theaugmentedsitecomparedto thebonedensityof theexistingalveolarbone.Statisticallyboneformation at the augmented site was independent of age,gender and diameter of the implant used. In the existingalveolar bone males showed a statistically significant (P <0.005)higherdensitythanfemalesubjects. Conclusion: Our results suggest that an-organicbovinebonegraftisaviableosteoconductivegraftingmaterialwhenusedfortheprocedureofmaxillarysinusaugmentationandConebeamComputedTomographymaybeausefultoolfordeterminingtheinvivobonedensity.

Supervisor:Dr Shaifulizan Ab. Rahman Co-Supervisor:Dr Zaihan AriffinDr Mohammad Khursheed Alam

ISOLATION, CHARACTERIZATION AND CYTOTOXIC EFFECTS OF SEA CUCUMBER (Bohadschia bivittata) COLLAGEN ON HUMAN PERIODONTAL LIGAMENT FIBROBLASTS CELL LINE

Yasir Dilshad SiddiquiMSc (Dentistry)

School of Dental Sceinces, Universiti Sains Malaysia, Health Campus, 16150 Kelantan, Malaysia

Introduction: About two-third of sea cucumberwall protein is composedofhighly insoluble collagenfibres.Collagen has been found to have promising role in tissuehealing and regeneration. A human periodontal ligament(HPDL) is known to be a reservoir for the tissues of theperiodontiumandsubjectedtotrauma/diseases. Objective: The aim of this study was to isolate and

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to characterise pepsin-solubilised collagen (PSC) from thebodywallofseacucumber,B. bivittata andalsotodetermineandcomparethecytotoxiceffectsofnongammaandgammairradiatedPSConHPDLFscellline. Methods: Body wall of B. bivittata were cut intosmall pieces followed by washing with distilled water andthen replaced with 4 mM ethylenediaminetetraacetic acid(EDTA),0.1MTris-HCl,pH8.0,andstirredfor3daystogetprecipitated crude collagen fibrils. Disaggregated insolublecrudecollagenfibrilsweretreatedwith0.1MSodiumhydroxide(NaOH), followed by 0.5 M acetic acid containing porcinepepsin to get PSC. The ultra-structures were analyzed byusing Quanta™ Scanning Electron Microscope (SEM),Netherlands,under130Papressure,ataworkingdistanceof6-10mmat4.0to5.0kVfrommagnification5,000×to100000×. Sodium dodecyl sulfate electrophoresis (SDS-PAGE) wasperformedby using a discontinuousTris-HCl/glycine buffersystemwith7.5%resolvinggeland4%stackinggel.PSCwasaddedinalphamodificationessentialmedium(α-MEM)andincubatedfor5daysat37oC.Atday4,theHPDLFscellswereculturedin96-wellplatesforonedayat37oCand5%Carbondioxide (CO2), and consequently the extractwasadded intothewellsatsevenserialdilutionsfor3days.Then,15μlof3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT)wasaddedfor4hours,andthereadingswererecordedusinganELISAreaderat570nmand600nmforthetestandreferencewavelengths,respectively. PSC was successfully isolated by using pepsin-solubilisedcollagenmethod,with65%yield.SEManalysisofcrudecollagendisplayedaregularlyrepeatedstriatedpattern,whereas, PSC displayed non-banded sheet like fibers withtwistedconfiguration.Accordingtotheelectrophoreticpattern,PSC was identified as type I collagen, with the molecularcomposition of (α1)2 and (α2)1 chains of approximately 138kDaeach.TheMTTassayshowedasignificantincreaseinthecellviabilityvaluesindicatingthatPSCisnon-cytotoxic.CellviabilityvaluesofHPDLFscelllinebynongammairradiatedPSCwas significantly higher than gamma irradiated PSC at50%,25%,12.5%and6.25%concentrations(P<0.05). Conclusion: In conclusion, the results indicated thatPSC extract from B. bivittata did not induce cytotoxicity toHPDLFs. As high as 65% of PSC was successfully isolatedfrom 100g ofB. bivittata bodywall pieces and classified astypeIcollagen.ThepotentialuseofthecollagenfromthebodywallofB. bivittata,asanalternativetomammaliancollagenin healing and regeneration procedures need to be furtherexplored.

Supervisor:Associate Professor Dr Erry Mochamad Arief Co-Supervisor:Associate Professor Dr Azizah YusoffAssociate Professor Dr Suzina Sheikh Abdul Hamid