Soo Hoon, Victoria Yu
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denyshv@nus.edu.sg
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Publication Specimen Shape and Elution Time Affect the Mineralization and Differentiation Potential of Dental Pulp Stem Cells to Biodentine(MDPI AG, 2024) Phang, Valene; Malhotra, Ritika; Chen, Nah Nah; Min, Kyung-San; Yu, Victoria Soo Hoon; Rosa, Vinicius; Dubey, Nileshkumar; Assoc Prof Rosa Vinicius; DENTISTRY; DEAN'S OFFICE (DENTISTRY); DEAN'S OFFICE (DUKE-NUS MEDICAL SCHOOL)The liquid extract method is commonly used to evaluate the cytotoxicity and bioactivity of materials. Although ISO has recommended guidelines for test methods, variations in elution period, and shape of samples can influence the biological outcomes. The aim of this study was to investigate the influence of material form and elution period of Biodentine on dental pulp stem cells (DPSCs)’ proliferation and mineralization. Biodentine (0.2 g) discs or powder were immersed in culture media (10 mL) for 1, 3 or 7 days (D1, D3 and D7). The eluents were filtered and used to treat DPSC. The calcium release profile and pH were determined. Cell proliferation was evaluated by MTS for 3 days, and mineralization and differentiation were assessed by alizarin red S staining (Ca2+/ng of DNA) and qRT-PCR (MEPE, DSPP, DMP-1, RUNX2, COL-I and OCN) for 14 days. Statistical analysis was performed with a one or two-way ANOVA and post hoc Tukey’s test (pH, calcium release and proliferation) or Mann–Whitney test (α = 0.05). pH and calcium ion release of powdered eluents were significantly higher than disc eluents. Powdered eluent promoted extensive cell death, while the disc form was cytocompatible. All disc eluents significantly increased the gene expression and mineralization after 14 days compared to the untreated control. D7 induced less mineralization and differentiation compared to D1 and D3. Thus, the materials’ form and elution time are critical aspects to be considered when evaluating the bioactivity of materials, since this binomial can affect positively and negatively the biological outcomes.Publication Postobturation Pain Associated with Tricalcium Silicate and Resin-based Sealer Techniques: A Randomized Clinical Trial(2020-10-22) Soo Hoon, Victoria Yu; DENTISTRYIntroduction: The incidence of immediate postobturation pain associated with 2 sealer techniques was compared and potential prognostic factors identified. Methods: Patients referred for endodontic treatment were recruited with informed consent. Root canals were debrided and teeth rendered asymptomatic before random allocation to receive TotalFill BC (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) or AH Plus sealer (Dentsply Maillefer, Ballaigues, Switzerland). Patients blinded to the sealer reported their postobturation pain experience 1, 3, and 7 days after treatment. Blinded and calibrated assessors independently reviewed treatment quality, sealer extrusion, and radiographic data under standardized conditions. Results: One hundred sixty eligible patients (163 teeth, 95.3%) returned their pain diary. No postobturation pain difference was found between the 2 sealers (P > .05), although the AH Plus sealer technique was significantly associated with extrusion beyond the apex (P < .05; odds ratio [OR] = 3.02; 95% confidence interval [CI], 1.39-6.57). Thirty-three (20.6%) patients reported pain on day 1 (median 1 = very mild pain), 16 (10.0%) on day 3 (median 1 = very mild pain), and 9 (5.6%) on day 7 (median 2 = mild pain). The prognostic factors were as follows: (1) moderate/severe preoperative pain (OR = 4.41; 95% CI, 1.42-13.76 on day 3 and OR = 5.16; 95% CI, 1.17-22.78 on day 7), (2) provoked preoperative pain (OR = 4.24; 95% CI, 1.40-12.78 on day 3 and OR = 5.35; 95% CI, 1.27-22.51 on day 7), (3) pulpless tooth (OR = 0.11; 95% CI, 0.02-0.57 on day 3), and (4) sonic activation during treatment (OR = 3.02; 95% CI, 1.39-6.57 on day 1 and OR = 3.01; 95% CI, 1.05-8.59 on day 3). Conclusions: There was no significant difference in pain experience between teeth filled using AH Plus or TotalFill BC Sealer 1, 3, and 7 days after obturation. Patient- and treatment-related factors could influence postobturation pain.Publication Understanding patients' and dentists' perspectives in dental trauma management: A mixed-methods study(WILEY, 2018-10-01) Ode, Wataru; Lopez, Violeta; Wong, Mun Loke; Schou, Lone; Yu, Victoria Soo Hoon; Assoc Prof Yu Soo Hoon, Victoria; DENTISTRY; ALICE LEE CENTRE FOR NURSING STUDIES© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Background/Aim: Patients suffering dental trauma are unprepared for the disability challenge and necessary rehabilitation, while a traumatic event places an expanded demand on the dentist who is focused on treating disease. The aim of this study was to examine the impact of traumatic dental injuries (TDI) on patients and to compare patients’ and dentists’ perceptions of the event. Material and methods: TDI patients (aged ≥ 21 years) attending a tertiary dental hospital from 2011 to 2013, and their dentists were recruited with informed consent. An exploratory sequential mixed-methods design was adopted. The Oral Health Impact Profile (OHIP-14) quantitatively identified patients with “very often,” “fairly often” or “occasionally” in at least one of the OHIP-14 questions (Phase 1) to participate in the qualitative phase of the study through focus group discussions (FGD) (Phase 2). FGD for dentists was conducted separately. Results: Quantitative analysis showed 28%-55% of TDI patients had “occasional” to “very often” discomfort during eating, increased self-consciousness and embarrassment. Qualitative analysis showed patients were concerned with aesthetic disability, treatment cost and potential tooth loss but overcame their negative outlook and accepted prescribed protective measures. Dentists appreciated patients’ concerns about aesthetics and functional disruptions but were less attuned to patients’ sense of guilt and fear of judgement. Conclusions: TDI exert functional, psychological and social impacts on patients. Patients’ and dentists’ perspectives were useful for understanding the need for continuity of care, and the findings could contribute to effective TDI management.Publication Antibiotics Used in Regenerative Endodontics Modify Immune Response of Macrophages to Bacterial Infection(American Association of Endodontists, 2019-09-19) En En Tan; Samantha Yiling Quah; Gunnar Bergenholtz; Vinicius Rosa; Victoria Soo Hoon Yu; Kai Soo Tan; DENTISTRY; DEAN'S OFFICE (DENTISTRY); MICROBIOLOGY AND IMMUNOLOGYIntroduction: Ciprofloxacin, amoxicillin and metronidazole are antibiotics used in regenerative endodontic therapy (RET). While their antimicrobial properties are well documented, there is a lack of information on the effects of these antibiotics on immune response by host macrophages, and periapical healing. This study thus has 2 objectives, (i) determine the immune response of macrophages to endodontic pathogens in response to the combination of ciprofloxacin or amoxicillin, and metronidazole, and (ii) using conditioned media produced by these macrophages to simulate the periapical microenvironment, determine the impact on the expression of extracellular matrix (ECM) components by periodontal fibroblasts. Methods: Macrophages were treated with ciprofloxacin and metronidazole, or amoxicillin and metronidazole at 10 to 1000µg/mL. The treated macrophages were exposed to lipopolysaccharide (LPS), and pro- and anti-inflammatory cytokines produced were quantified with ELISA. Periodontal fibroblasts were treated with conditioned media from these treated macrophages, and the expression of ECM genes was determined by qPCR. Results: LPS elicited production of pro-inflammatory cytokines IL-1β and TNF-α by macrophages, but this was suppressed by ciprofloxacin and metronidazole. Moreover, only conditioned media from macrophages treated with ciprofloxacin and metronidazole rescued microbial-induced down-regulation of ECM genes by periodontal fibroblasts. Specifically, ciprofloxacin was the antibiotic responsible for these observations. In contrast, these effects were not observed with amoxicillin and metronidazole. Conclusions: Apart from disinfection of the root canal system, the combination of ciprofloxacin and metronidazole also exerts an immunomodulatory effect, which may aid periapical healing.Publication Matrix metalloproteinase inhibitor as an antimicrobial agent to eradicate Enterococcus faecalis biofilm(Elsevier, 2015) Tay Chiew Xsia; Quah Yiling Samantha; Lui Jeen Nee; Yu Soo Hoon Victoria; TAN KAI SOO; DENTISTRYPublication Incidence and Impact of Painful Exacerbations in a Cohort with Post-treatment Persistent Endodontic Lesions(2012) Yu, V.S.H.; Messer, H.H.; Yee, R.; Shen, L.; DENTISTRYIntroduction: Painful exacerbations of persistent periapical lesions have unknown incidence and impact on quality of life. This study examined the incidence and impact of painful exacerbations and evaluated potential predictive factors of pain associated with root-filled teeth with persistent lesions after root canal treatment. Methods: Patients from a university hospital clinic were screened to identify root-filled teeth with periapical lesions at time of treatment and not resolved at least 4 years later. A clinical and radiographic examination and questionnaire survey were conducted. Patient and treatment characteristics and details of pain experience were studied. Statistical analysis was carried out by using SPSS (version 18). Results: One hundred twenty-seven patients with 185 persistent lesions were recruited. Median age of patients at recruitment was 56 years (range, 21-82 years). Median time since treatment was 5 years (range, 4-38 years). Overall incidence of flare-up (requiring an unscheduled dental visit) was only 5.8% 20 years after treatment. Less severe pain was more frequent, with a combined incidence of 45% pain at 20 years after treatment. Female patients (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.2-6.0; P <.05), treatment involving a mandibular molar or maxillary premolar (OR, 3.7; 95% CI, 1.6-8.6; P <.05), and preoperative pain (OR, 2.9; 95% CI, 1.3-6.7; P <.05) were significantly associated with pain after treatment. The most commonly affected activities during painful exacerbations were eating and tooth brushing, with minimal impact on daily living. Conclusions: The risk of flare-up among persistent lesions was very low. A lower degree of pain was more common, but generally with minimal impact on daily activities. Copyright © 2012 American Association of Endodontists.Publication Terminology of endodontic outcomes(2013) Messer, H.H.; Yu, V.S.H.; DENTISTRYPublication Aerosol-generating dental procedures: a reappraisal of analysis methods and infection control measures(Elsevier Ltd, 2021-11) Tan Kai Soo; CHEW REN JIE, JACOB (ZHOU RENJIE); Allen Patrick Finbarr; Soo Hoon, Victoria Yu; DENTISTRY; DEAN'S OFFICE (DENTISTRY)Background: Dental aerosol generating procedures (AGPs) have been associated with risk for transmitting infectious agents. However, existing infection control monitoring studies potentially underestimate the extent of contamination, due to methodological inadequacies. These studies employed settle plate methodology which only captures droplets that land on agar plates, but not those suspended in air. Furthermore, bacterial culture was used to determine the extent of contamination, without accounting for non-bacterial sources of contamination. Aims: This study seeks to bridge these gaps by establishing a monitoring protocol involving active aerosol sampling and analysis of two dental AGPs, root canal treatment (RCT) and scaling. Methods: RCT and scaling were performed with standard aerosol mitigation precautions. Aerosols generated throughout each procedure were sampled using the air sampler device, while contamination of operatory fomites and personal protective equipment was sampled using surface swabs, before and post-treatment. The amount of contamination was quantified using bacterial culture and adenosine triphosphate (ATP) assay. Findings: RCT generated insignificant aerosol and splatter, supporting the infection control procedures’ effectiveness. Conversely, scaling significantly increased the amount of aerosol and splatter. When comparing bacterial culture and ATP assay, the magnitude of contamination obtained with ATP assay was greater, suggesting that ATP assay may have detected additional contamination of human origin and bacteria that was not recovered by the culture conditions employed. Conclusions: This monitoring protocol is feasible in the dental setting and determines the extent of contamination generated during AGPs. This can be adopted in future studies to overcome the limitations of the existing literature. Keywords: infection control, dentistry, aerosols, communicable diseases, disinfectants, nosocomial infectionsPublication Lesion progression in post-treatment persistent endodontic lesions(2012) Yu, V.S.H.; Messer, H.H.; Shen, L.; Yee, R.; Hsu, C.-Y.S.; DENTISTRYIntroduction: Radiographic lesions related to root-filled teeth may persist for long periods after treatment and are considered to indicate failure of initial treatment. Persistent lesions are found in a proportion of cases, but information on lesion progression is lacking. This study examined the incidence of lesion improvement, remaining unchanged, and deterioration among persistent lesions in a group of patients recruited from a university-based clinic and identified potential predictors for lesion progression. Methods: Patients of a university clinic with persistent endodontic lesions at least 4 years since treatment and with original treatment radiographs available were recruited with informed consent. Data were obtained by interview and from dental records and clinical and radiographic examinations. Univariate and multivariate statistical analyses were carried out by using SPSS (version 19). Results: One hundred fifty-one persistent lesions were identified in 114 patients. A majority of the lesions (107, 70.9%) received treatment between 4 and 5 years prior. Eighty-six lesions (57.0%) improved, 18 (11.9%) remained unchanged, and 47 (31.1%) deteriorated since treatment. Potential predictors for lesions that did not improve included recall lesion size, pain on biting at recall examination, history of a postobturation flare-up, and a non-ideal root-filling length (P <.05). Lesions that had persisted for a longer period appeared less likely to be improving (relative risk, 1.038; 95% confidence interval, 1.000-1.077). Conclusions: A specific time interval alone should not be used to conclude that a lesion will not resolve without intervention. This study identified several clinical factors that are associated with deteriorating persistent lesions, which should aid in identifying lesions that require further intervention. Copyright © 2012 American Association of Endodontists.Publication Multiple idiopathic cervical resorption: Case report and discussion of management options(2011) Yu, V.S.H.; Messer, H.H.; Tan, K.B.; RESTORATIVE DENTISTRYYu VSH, Messer HH, Tan KB. Multiple idiopathic cervical resorption: case report and discussion of management options. International Endodontic Journal, 44, 77-85, 2011.Aim To present a case of cervical root resorption affecting all teeth and resulting in multiple tooth loss.Summary A healthy 33-year-old Chinese male, with no contributory medical or family/social history, presented with generalized cervical root resorption. Lesions varied in severity amongst teeth and even involved an impacted third molar. All cervical root surfaces were affected and lesions often extended coronally, undermining enamel. CBCT demonstrated that the lesions were more extensive and more widely distributed than was seen using conventional radiography. Bone extended into many resorptive defects but without clinical evidence of ankylosis. Periodontal probing, pulp testing, percussion sound and mobility were within normal limits.Key learning points Aetiology of the generalized idiopathic cervical root resorption is uncertain. Management is complex, and options have included surgical exposure and restoration of affected sites, extraction and submergence of affected roots. A staged approach involving early intervention with restoration of resorptive defects, followed by progressive extraction and replacement with implant-supported prostheses is recommended. © 2010 International Endodontic Journal.