Background: Carnitine is effective in preventing the accumulation of end products related to lipid peroxidation due to its anti-inflammatory and antioxidant effects. Carnitine also exerts a significant anti-inflammatory role through the downregulation of the nuclear factor kappa beta pathway, which leads to a decrease in the expression of pro-inflammatory cytokines.The aim of the study was to estimate the L-carnitine (L-C) levels in diabetic completely edentulous patients. Materials and Methods: A cross-sectional study was conducted after the selection of 60 samples based on the inclusion and exclusion criteria. The collected saliva samples were utilized to measure the levels of L-C using the sandwich enzyme-linked immunosorbent assay (ELISA) method. One hundred microliters of sample was applied to a particular row of wells and incubated for an hour as part of the sandwich ELISA procedure. After the wells had been cleaned, a second batch of monoclonal L-C was added, and they were once more incubated for an hour. The horseradish peroxidase substrate was then applied after washing the second batch as well. To allow the blue-to-yellow color transition, the wells were kept steady. Following the observation of the color shift, the OD was measured, and the concentration was determined using the sandwich ELISA kit's standard curve as an intercept. The data were statistically analyzed using the independent t-test (significant level P < 0.05) and were tabulated. Results: The L-C levels have higher levels in nondiabetic patients than in diabetic patients. The difference in the baseline mean value between the groups was statistically significant (P = 0.00). Although it is statistically significant (P = 0.00), the mean value for diabetic individuals is 0.19 as opposed to 0.29 for nondiabetic patients. Conclusion: Based on the findings, it can be concluded that L-C improves insulin sensitivity and glucose disposal in diabetic completely edentulous patients.

Background: In general, bioactive glasses (BAGs) can react with tissue minerals and promote remineralization. However, the application of BAG in bonding agents and its impact on bond strength remain uncertain due to insufficient information and limited research in this area. Materials and Methods: This study employed a randomized controlled design to assess the effects of composite-bonding agents with varying BAG contents on shear bond strength and fracture pattern in sound and demineralized teeth, with and without thermocycling. Thus, 80 healthy third molars were randomly divided into two groups: sound teeth and demineralized teeth. Five bonding agents were applied to the prepared dentin surfaces, including four experimental composite-bonding agents with varying BAG content (0, 0.2, 0.5, and 2 wt%) and the Adper Single Bond commercial bonding as control. The shear bond strength of all samples was measured using a universal tester. The type of failure of each specimen was determined using a stereomicroscope. Kruskal–Wallis nonparametric test was performed on the obtained shear bond strength data followed by Mann–Whitney post hoc test with Bonferroni correction to determine statistical significance. The level of significance was considered P ≤ 0.05 for all tests and was adjusted by Bonferroni correction. Results: Demineralization significantly decreased shear bond strength in the teeth samples. Adper Single Bond exhibited the highest shear bond strength values. The addition of BAG did not have a significant influence on shear bond strength, regardless of demineralization or thermocycling condition. Adhesive failure was the predominant type of failure in all groups. Conclusion: The incorporation of BAG filler up to 2 wt% did not result in significant changes in shear bond strength. Experimental adhesive bonding agents with 2 wt% BAG content demonstrated shear bond strengths comparable to the commercial bonding agent in sound nontreated, sound thermocycled, demineralized nontreated, and demineralized thermocycled groups.

Background: Root canal obturation is an important step in endodontic treatment, which is performed aiming to three-dimensionally seal the canal and prevent microleakage, reentry, and proliferation of microorganisms in the root canal system. On the other hand, microleakage eventually leads to root canal treatment failure. Sealing ability is an important property of endodontic sealers. This in vitro study aimed to compare the quality of apical seals obtained by three endodontic sealers. Materials and Methods: This in vitro experimental study evaluated 48 extracted single-canal maxillary incisors. Hard- and soft-tissue residues were removed and the teeth were immersed in 5.25% of sodium hypochlorite for disinfection. The teeth were decoronated at the cementoenamel junction with a diamond disc such that 10 mm of root length remained. Canal patency was ensured using a #10 K-file. The canals were then instrumented with ProTaper rotary system. The canals were randomly divided into three experimental groups for the application of Adseal, Proseal, and AH26 sealers, and positive and negative control groups. Sealers were applied in the canals using lateral compaction technique. The external root surfaces were then coated with two layers of nail varnish except for the apical 3 mm. The amount of microleakage was quantified using the dye-penetration technique. The Tukey's test was used to compare the microleakage between the experimental and control groups. The Kruskal–Wallis test was applied to compare the microleakage of experimental groups (P < 0.05). Results: The amount of microleakage in canals filled with Adseal, Proseal, and AH26 sealers with lateral compaction technique was 2.33 ± 0.64, 2.2 ± 0.81, and 2.22 ± 0.71 μm, respectively. No significant difference was noted among the three sealers regarding microleakage (P = 0.84). However, the amount of microleakage in the sealer groups was significantly lower than that in the control group (P < 0.001). Conclusion: The application of Adseal, Proseal, and AH26 had equal efficacy for the provision of optimal apical seal in filling of root canals with lateral compaction technique. The application of sealers yielded a significantly superior apical seal compared with the control group.

Background: Since general dentists (GDs) usually act as the primary referral source for the patients in need of orthodontic treatments, having the proper knowledge and understanding of the accurate diagnosis of clinical situations is very important. The aim of this study was to assess GDs about the identification of orthodontic treatment needs and their referral practices. Materials and Methods: This descriptive and analytical cross-sectional study was carried out in Iran 2020. A questionnaire consisting of three main parts was designed and distributed electronically among GDs. The first section included 11 image and scenario-based questions meant to assess the ability of GDs to correctly diagnose the orthodontic treatment needs of the patients. The next two parts were to assess the dentists' knowledge of the necessity of referral to an orthodontist with 11 questions, and the proper timing of orthodontic treatments with 8 questions. Data were analyzed using SPSS 26, by conducting Mann–Whitney, Kruskal–Wallis, and correlation tests α = 0.05. Results: Among 384 participated dentists, 50.3% (193) were female. The mean score of knowledge was 17.3 ± 3.5 out of 30. The highest percentage of good knowledge (70% of range) was related to the diagnosis of orthodontic problems, while the lowest one belonged to the referring pattern. There was a weak positive correlation between the working experience and the proper timing of referral (R = 0.15, P = 0.004 (. Kruskal–Wallis test also showed a significant difference between the total knowledge scores (P = 0.04) and the knowledge of the proper timing of treatment (P = 0.04) based on the age groups of participants. Eighty-seven percentage (n = 334) reported that they would refer the patients in need of orthodontic treatment. Conclusion: The knowledge level of orthodontic treatment needs among GDs was moderate, thus emphasizing the importance of planning more educational courses for them to improve their knowledge, thus reducing the possible detriments of postponed or inaccurate treatments.

Background: Diagnosis of dental caries using cone-beam computed tomography (CBCT) may be hindered due to several introduced and inherent artifacts. The aim of this study was to evaluate the effect of amalgam fillings on the accuracy of diagnosis of proximal caries in CBCT. Materials and Methods: In this in vitro study, 102 extracted human teeth (mandibular and maxillary molars and premolars) were used. Six molars were chosen for mesio-occluso-distal amalgam restorations. Before obtaining the CBCT images, the 96 remaining teeth were stabilized in dental sockets of six dry human skulls in a way that the proximal contacts re-established. Thereafter, six of the molar teeth were replaced by the amalgam-restored teeth and the second group of images was then obtained. All images were evaluated by two independent observers in the panorama view and the presence or absence of caries was recorded. For histopathologic investigations, the teeth were cut and assessed by an oral pathologist using a stereomicroscope. The McNemar test was used for comparison between CBCT assessments and histopathologic evaluations (P < 0.05 was considered statistically significant). In addition, the receiver operating characteristics curve was utilized to evaluate the diagnostic accuracy in different sections of imaging. Results: The result sensitivity and specificity of CBCT imaging in the first group of images before placement of the restored teeth were 0.96 and 0.36, respectively. In the second group of images after placement of the restored teeth, these values were 0.78 and 0.18, respectively. Moreover, statistical analysis showed that there is a good agreement in interproximal caries diagnosis between histopathologic and CBCT imaging findings without placement of amalgam restorations (P < 0.001). However, this agreement does not exist after amalgam restorations (P = 0.84). Conclusion: Diagnosis of proximal caries using CBCT is not an efficient method where there are amalgam restorations adjacent to the suspected teeth.

Background: Shock wave-enhanced emission photoacoustic streaming (SWEEPS) is a novel irrigation activation method based on photoacoustic streaming. The aim of this study was to look into the impact of SWEEPS on the attachment and survival of dental pulp stem cells (DPSCs). Materials and Methods: In this in vitro study, 34 standardized root segments were randomly allocated into two groups: SWEEPS and the conventional conditioning group. After the irrigation human DPSCs were seeded on the internal walls of these samples, and the attachment and survival of 30 of them were assessed on different days. The remaining two samples were observed using a scanning electron microscope (SEM). Independent sample t-test, Mann–Whitney U-test, one-way ANOVA, Kruskal–Wallis, and two-way ANOVA were used for data analysis with the level of significance = 0.05. Results: The viability of DPSCs was significantly greater in the SWEEPS group in comparison with the conventional conditioning group (P = 0.029). Both groups have shown a significant increase in the viability of DPSCs over time (P = 0.0001, P = 0.003). SEM results have shown a smear layer-free surface with firmly attached DPSCs in the SWEEPS group. Conclusion: The results of this study indicated that active irrigation using SWEEPS could provide a superior surface in terms of viability and attachment of DPSCs compared to the conventional conditioning method.

Background: This study assessed the diagnostic accuracy of cone-beam computed tomography (CBCT) with a modified grayscale range for the detection of buccal cortical plate defects adjacent to dental implants. Materials and Methods: In this in vitro experimental study, titanium implants were inserted in 168 fresh bovine bone blocks with 1–1.5 mm of buccal cortical plate thickness. The blocks were randomly divided into four groups (n = 42). No defect was created in the control blocks. In the three experimental groups, cortical plate defects were randomly created in the cervical, middle, or apical third by a round bur with a 2-mm diameter (n = 42). All blocks underwent CBCT with and without change in the grayscale range. Two observers evaluated all images regarding the presence/absence of defects. Kappa test is used for the agreement of the observers. The diagnostic accuracy of the two modalities was compared by calculating the area under the receiver operating characteristic curve (AUC) (P ≤ 0.05). The sensitivity and specificity values were also compared. Results: The AUC was not significantly different between the two modalities with and without altered grayscale range (0.754 vs. 0.762, respectively, P = 0.716). The diagnostic sensitivity of CBCT with and without change in the grayscale range was 51% and 52%, respectively, with a specificity of 100% for both. The diagnostic accuracy of CBCT with and without altered grayscale range had no significant difference for apical and middle third defects (P > 0.05) and was significantly higher than that for the cervical third defects (P < 0.05). Conclusion: Changing the grayscale range does not improve the diagnostic accuracy of CBCT for the detection of buccal cortical plate defects adjacent to dental implants.

Background: This study aimed to compare the effects of laser photodynamic therapy (PDT) with methylene blue (MB) or aminolevulinic acid (ALA) on the oral squamous cell carcinoma (OSCC) cell line. Materials and Methods: In this in vitro experimental study, the C152 (KB) OSCC cell line was cultured in a culture medium containing 10% fetal bovine serum. The cells were exposed to 0.1, 0.2, 0.5, 1, 2, 5, and 10 mM concentrations of MB and ALA alone and combined with diode laser irradiation with 660 nm wavelength, 40 mW power, and 10 J/cm² energy density in continuous-wave mode perpendicular to the surface. Cell viability was assessed using the methyl thiazolyl tetrazolium assay and compared among the groups by the Kruskal–Wallis test. Results: The results showed that the reduction in cell viability in the MB + laser and ALA + laser groups was greater than that in the MB and ALA groups without laser (P < 0.001). Significant differences were noted in cell viability in the presence of some different concentrations of MB and ALA (P < 0.05), such that by an increase in their concentration, cell viability decreased. Cell viability in the MB + laser group was significantly lower than that in the ALA + laser group in some photosensitizer concentrations (P < 0.05). Conclusion: Within the limitations of this in vitro study, the results showed that laser PDT with MB (high concentrations) was more effective than laser PDT with ALA against the OSCC cell line.

Background: This study aims to investigate the color stability of feldspathic porcelains with different concentrations of silver nanoparticles (AgNPs). Materials and Methods: In this experimental study, feldspathic porcelain disks with AgNPs of 0 parts per million (ppm), 250 ppm, and 500 ppm were used (sample size = 180). These ceramic discs were subjected to thermocycling in tea, orange juice, and artificial saliva. The optical parameters of disks were measured before and after being immersed in the solutions. Then, the color change (ΔE 00) of the samples was measured by using the CIEDE 2000 formula. The data were analyzed by one-way analysis of variance (ANOVA) and Tukey's post hoc test. The level of significance was determined to be 0.05. Results: The results of the ANOVA test show that there was a significant difference in ΔE 00 (P ≤ 0.05). The maximum ΔE 00 was visible in the samples with AgNPs 0 ppm that were exposed to orange juice, and the minimum ΔE 00 was related to the disks with AgNPs 500 ppm in artificial saliva. Conclusion: Based on the results of this study, adding AgNPs to feldspathic porcelain increases the color stability of the ceramic discs.

Background: Chairside fabrication of provisional restorations using three-dimensional (3D) printers is rising in digital dentistry. The purpose of this research was to compare the marginal and internal adaptation of provisional polymethyl methacrylate (PMMA) restorations fabricated by two different 3D printers. Materials and Methods: In this in vitro investigation, an intact maxillary 1st molar acrylic model was first digitalized by a laboratory scanner. It was then prepared for an all-ceramic restoration and scanned again by the same scanner. The final restoration was designed in Exocad according to the scan files with a 50 μm cement gap. PMMA restorations were printed by two 3D printers; Group 1: Asiga (n = 10) and Group 2: Digident (n = 10). The replica technique was used to assess the marginal and internal fit of the restorations, and one-way ANOVA was used to analyze the data. P <0.05 was regarded as statistically significant. Results: The mean marginal gap of crowns in Group 1 was significantly lower than that of Group 2 (75 vs. 195 μ, P = 0.001). Regarding internal adaptation, no significant difference was found between the axial gap values in both groups (P > 0.05). The mean occluso-axial gap (90 vs. 140 μ, P = 0.026) and the mean occlusal gap (116 vs. 300 μ, P = 0.001) of crowns in Group 1 were significantly smaller compared to the equivalent values in Group 2. Conclusion: Provisional PMMA crowns fabricated by the Asiga printer showed significantly higher marginal and internal adaptation than those manufactured by Digident at all points except for the axial surface.

Background: Fracture is the most common reason for the failure of provisional restorations. This study aimed to assess the effects of the fabrication method (conventional, computer-aided design/computer-aided manufacturing [CAD/CAM] milling, three-dimensional [3D] printing) and material type on the fracture strength of provisional restorations. Materials and Methods: In this in vitro study, 60 provisional restorations were made through the conventional (Tempron and Master Dent), CAD/CAM milling (Ceramill and breCAM.HIPC) and 3D Printing (3D Max Temp) methods based on a scanned master model. The provisional restorations were designed by the CAD unit and fabricated with milling or 3D printing. Then, an index was made based on the CAD/CAM milling specimen and used for fabricating manual provisional restorations. To assess the fracture resistance, a standard force was applied by a universal testing machine until the fracture occurred. One-way ANOVA and Tukey's test were used to compare the groups (α = 0.05). Results: The mean fracture strength was significantly different among the five groups (P < 0.001), being significantly higher in the breCAM.HIPC group (P < 0.001), followed by the Tempron group (P < 0.05). However, the three other groups were not significantly different (P < 0.05). Conclusion: Despite the statistical superiority of some bis-acrylics over methacrylate resins, the results are material specific rather than category specific. Besides, the material type and properties might be more determined than the manufacturing method.

Background: Patient demand for esthetic dental treatments is increasing, and among different techniques, tooth bleaching is a popular procedure for smile improvement. There is a controversy over the demineralizing effect of hydrogen peroxide (HP) containing bleaching agents on tooth enamel. The aim of this study was to evaluate the effect of HP and its combinations with hydroxyapatite (HA) and bioactive glass (BG) on enamel demineralization and tooth color changes. Materials and Methods: Three groups of 20 teeth were used. Bleaching regimens included HP alone, HP + HA, and HP + BG. Bleaching was repeated at six periods of 15 min. Energy dispersive spectrometry was performed to evaluate calcium, phosphorus, sodium, magnesium, and fluoride content of superficial enamel before and after bleaching. Tooth color was evaluated by spectrophotometer before and after bleaching and ΔE values were calculated. Data were statistically analyzed using SPSS version 17. Results: Ca and P content was increased significantly in group HP + BG (P < 0.05). There was no significant difference in ΔE values between the three groups (P > 0.05).(p value = 0.34). Conclusion: Addition of BG to HP can increase superficial enamel mineral content after bleaching and has no effect on tooth color changes in comparison to HP alone.

Background: This study evaluated the interface between fresh eugenol/bioceramic sealer-conditioned coronal dentin and high-viscous glass-ionomer cement (HVGIC), treated with various dentin conditioners (saline, 10% polyacrylic acid, and 37% phosphoric acid). Materials and Methods: Standard endodontic access preparation and instrumentation were done in 21 freshly extracted mandibular molar teeth in this in vitro study. Teeth were divided into two interventional groups (n = 9/group), based on the type of sealer (zinc oxide eugenol [ZOE]/bioceramic [BioRoot RCS] sealer) used for obturation. Samples were further subdivided based on the type of dentin-conditioning procedures performed (saline/10% polyacrylic acid/37% phosphoric acid). Post dentin conditioning, the access cavity was sealed with HVGIC. Later, material-dentin interfacial analysis and elemental analysis were done using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy. Results: The interfacial SEM images of HVGIC layered over B-RCS/ZOE sealer-conditioned dentin, treated with saline, showed predominantly adhesive debonding failures, whereas cohesive debonding was observed with polyacrylic and phosphoric acid. In the elemental analysis, the intensity of zirconium (depicting the residue of B-RCS)/zinc (depicting ZOE sealer) was very high on the dentin side treated with saline, in comparison to the dentin treated with polyacrylic and phosphoric acid. Furthermore, the intensity of elements from HVGIC was low on the dentin side of the groups with saline, whereas these elements showed maximum penetration into the dentin when treated with phosphoric acid. Conclusion: Conditioning of the endodontic access cavity using 37% phosphoric acid immediately postobturation resulted in higher penetration of HVGIC into the dentin, in comparison to the other dentin conditioners.

Background: This study compared postoperative pain after endodontic treatment of mandibular molars with asymptomatic irreversible pulpitis with the RaCe rotary system and the crown-down versus the step-down technique. Materials and Methods: In this randomized clinical trial, 70 mandibular 1^st and 2^nd molars with asymptomatic irreversible pulpitis and normal periradicular state were randomly assigned to two groups for single-visit endodontic treatment with RaCe rotary system and the crown-down and the step-down technique (n = 35). Postoperative pain was assessed at 6, 12, 24, 48, 72, and 168 h postoperatively, using a Visual Analog Scale. Data were analyzed using SPSS 17 by repeated measures ANOVA, Chi-square test, independent sample t-test, and lLeast sSignificant Ddifference test. P < 0.05 was considered statistically significant. Results: The two groups were not significantly different regarding the pain scores at any time point (P > 0.05). Within-group comparisons showed a significant reduction in pain score over time, starting from 12 to 168 h, postoperatively (P < 0.05). Conclusion: The crown-down and step-down techniques had no significant difference regarding postoperative pain after endodontic treatment of mandibular molars with asymptomatic irreversible pulpitis with the RaCe rotary system.

Background: Porcelain fracture or chipping is one of the limitations of all ceramic restorations. This study investigated the shear bond strength (SBS) of composite resins to lithium disilicate ceramics using universal bondings and different methods of surface preparation. Materials and Methods: In this experimental study, 72 specimens of e.max computer-aided design and computer-aided manufacturing (CAD/CAM) ceramic blocks were divided into six groups of 12 according to surface treatment: Group I-Hydrofluoric (HF) acid etching + All-Bond Universal bonding (ABU), Group II-Bur roughening (BR) + HF + ABU, Group III-BR + HF + Bis-Silane (Si) + ABU, Group IV-Sandblasting (SB) + ABU, Group V-SB + HF + ABU, Group VI-SB + HF + Si + ABU. After bonding of composite resin to the prepared ceramic surface and storage of samples in distilled water for 24 h, SBS test was done using the universal testing machine at a crosshead speed of 0.5 mm/min. Data were analyzed using the analysis of variance and Tukey's post hoc test (α = 0.05). Results: The mean values of SBS in six studied groups were 6.65 ± 2.78 MPa, 8.56 ± 2.69 MPa, 8.49 ± 2.14 MPa, 3.13 ± 1.66 MPa, 7.94 ± 2.4 MPa, and 10.04 ± 2.47 MPa, respectively. The mean values of SBS were significantly different (P < 0.001). The highest value of SBS was observed in Group VI and the lowest in Group IV. Conclusion: Ceramic sandblasting followed by HF etching, Bis Si, and ABU resulted in a higher SBS of composite resins to lithium disilicate ceramics.

Background: Recently, the role of biochemical factors in the etiology of oral squamous cell carcinoma (OSCC) has attracted some attention. Serum levels of biochemical factors may change in cancer patients. This study aimed to assess the serum level of folate, Vitamin B12, homocysteine, iron, copper, and selenium in patients with OSCC. Materials and Methods: This descriptive analytical study was conducted on 30 primary OSCC patients (15 males and 15 females) presenting to Imam Khomeini Cancer Institute, who had not yet undergone treatment. Blood samples were taken and serum levels of folate, Vitamin B12, homocysteine, iron, copper, and selenium were measured. Serum levels of micronutrients in patients with different tumor sizes were analyzed by one-way ANOVA. Serum levels of micronutrients were compared among groups with and without metastasis and lymph node involvement using Student's t-test (P < 0.05). Results: Serum levels of B12, folic acid, homocysteine, copper, iron, and selenium were 232.5 ± 102.68, 8.66 ± 4.06, 18.87 ± 8.81, 96.0 ± 22.64, 55.27 ± 40.58, and 92.47 ± 18.83 ng/mL, respectively. Relatively similar values were measured in patients with different tumor sizes with and without lymph node involvement and presence or absence distant metastasis. However, the serum level of folic acid in OSCC patients without lymph node involvement was significantly higher than that in OSCC patients with lymph node involvement (P < 0.05). Conclusion: Despite some variations, serum levels of micronutrients in OSCC patients were within the normal limits. Considering the variations in serum level of copper in OSCC patients, it may be used as a diagnostic marker. However, further studies are warranted in this respect.

Background: Oral squamous cell carcinoma (SCC) is one of the most common malignancies in oral cavity. Hence, presenting methods for early diagnosis and find the etiologic factors of oral SCC are important. Saliva analysis can be used to discover various conditions because of its noninvasive methods. Copper as a useful metal has been used by men since ancient times. The level of copper increases when the cancerous changes occur in addition to biopsy, an alternative method for examining oral lesions is exfoliative cytology. The primary objective of this study was to determine the salivary copper level and cytomorphologic changes of oral mucosa among three study groups. Materials and Methods: This cross-sectional study included 15 individuals with oral SCC, 15 workers exposed to copper, and 15 healthy individuals. Saliva samples were collected and analyzed by atomic absorption spectrophotometer. The exfoliative smears were prepared by brush biopsy and stained by Papanicolaou and argyrophilic nucleolar organizer region (AgNOR) staining methods. Data analysis using one-way ANOVA and Kruskal–Wallis test. P < 0.05 was considered significant. Results: There was a significant difference in mean salivary copper (P = 0.008), cytomorphology of oral mucosa, and AgNOR among the three groups (P < 0.001). Conclusion: The results suggested that occupational exposure to copper increases the salivary levels of this element and causes changes in mucosal cells. Since this increase was very high and evidence of nuclear activity was seen in this group and in oral SCC patients, exposure to copper should be considered an important risk factor for oral mucosal changes.

Background: Radiotherapy is a common treatment for head-and-neck malignancies and causes complications such as oral candidiasis and the change of oral Candida species from albicans to nonalbicans. Voriconazole has acceptable antifungal effect. The aim of this study was to determine and compare the antifungal effect of nystatin with voriconazole on these species. Materials and Methods: The samples used in this in vitro study were identified by polymerase chain reaction-restriction fragment length polymorphism from patients before and 2 weeks after head-and-neck radiotherapy in Seyed Al-Shohada Hospital. The antifungal effect of nystatin and voriconazole was determined by microdilution method and measurement of the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration, and the results were analyzed by Mann–Whitney analysis. Results: The results showed that all species before and after radiotherapy showed 100% sensitivity to nystatin. Prior to radiotherapy, 57.1% of albicans species isolated were in the sensitive range (MIC ≤1) and 42.9% were in the dose-dependent range (MIC = 2) to voriconazole. After radiotherapy, 58.3% of albicans species were in the sensitive range and 41.7% of these species were in the dose-dependent range to voriconazole. Conclusion: The results of the present study showed that before radiotherapy, all species were sensitive to nystatin, while a percentage of albicans and nonalbicans were resistant to voriconazole. In the 2^nd week of radiotherapy similar to prior to radiotherapy, all species isolated from patients were sensitive to nystatin, while a percentage of albicans and nonalbicans were resistant to voriconazole.

Background: The objective of the study is to compare stress distribution in a tooth restored with everstick post and sharonlay by means of three-dimensional finite element analysis (3D-FEA). Materials and Methods: An experimental original study was carried out in which two 3D-FEA models were constructed: (1) tooth restored with everstick post and metal ceramic crown and (2) tooth restored with sharonlay. The material properties were assigned and a force of 100N, 200N, 300N, and 400N was applied to the centric stop of the occlusal surface in centric occlusion at a 45° inclination in a linguolabial direction to the long axis of the tooth. Analysis was run and the stress distribution pattern was studied. As all stress distribution analysis was performed with the Ansys 11.0 software (Inventor AutoCAD 2010; Autodesk) program, the significance of P value or tests for statistical analysis was considered. Results: Sharonlay showed more total deformation, larger stress, and strain concentration than that of everstick post. Conclusion: Tooth restored with sharonlay showed greater chances of deformation than everstick post. It also showed maximum strain concentration near the apical portion of the remaining tooth structure and more stress in the cervical third of the postsystem than everstick post.

Ameloblastoma is the second most common benign odontogenic tumor with various histopathologic features. Except for the unicystic type of ameloblastoma, the different microscopic patterns of this tumor show no significant correlation with long-term clinical behavior. During recent decades, additional challenging subtypes of ameloblastoma, including “Keratoameloblastoma” (KA), have been introduced in the literature. Here, we present a case of KA and discuss the important diagnostic microscopic features.

Background: Electrochemical disinfection of the root canal system (RCS) is introduced as an alternative to conventional irrigation. The aim of this study was to assess the efficacy of depotphoresis method in the disinfection of accessible and inaccessible RCSs. Materials and Methods: In this comparative in vitro study disinfection of Enterococcus faecalis-infected RCS using two methods, (1) depotphoresis and (2) sodium hypochlorite (NaOCl) irrigation plus passive ultrasonic agitation (PUA) took place on 40 extracted maxillary anterior teeth. Decoronation was done with a diamond disc, and the canals were instrumented. The roots were divided into two phases: the specimens with canal obstruction and the specimens without canal obstruction. The smear layer was removed, and the specimens were infected for 21 days with E. faecalis. After disinfection procedures, bacterial samples were taken using two sterile #35 paper points, and colony-forming units (CFU) were counted. Data were analyzed statistically using the Kruskal–Wallis test, with a significance level at P < 0.05, to indicate differences between depotphoresis and NaOCl plus PUA groups. Results: In both phases, Log CFU after depotphoresis treatment was significantly lower than NaOCl irrigation plus PUA treatment (P < 0.05). Conclusion: Treatment with depotphoresis was significantly more effective than NaOCl irrigation plus PUA treatment.

Successful management of pain during endodontic treatment is essential for both patients and dentists. Achieving adequate pulp anesthesia in mandibular molars is a significant concern for patients with irreversible pulpitis during endodontic treatment. The increased sensitization of nociceptors due to inflammation decreases the success of inferior alveolar nerve block (IANB). The main focus is on reducing inflammation before delivery of local anesthesia to increase the success of anesthetic drugs. This umbrella review aimed to revise, qualify and summarize the existing body of evidence on the effect of premedication on IANB in patients with irreversible pulpitis. A literature search was conducted using electronic databases (PubMed, Scopus, the Web of Science, and the Cochrane Library) with no date restriction until September 2021 to identify the relevant studies. All the cross-references of the selected studies and grey literature were also screened. Four systematic reviews assessing the effect of premedication on the success of IANB were selected. A conclusion was drawn that premedication with >400 mg of ibuprofen can positively affect the success of IANB.

Background: The literature on the effect of bleaching on stainability and color stability of any composites is scarce and controversial. In the case of some composites and/or bleaching agents or staining solutions, there is no previous study. Therefore, this rather large study was conducted for the first time to examine simultaneously the effects of bleaching and 3 staining solutions on 3 composite types. Materials and Methods: This 3-phase experimental in vitro study was performed on 18 groups of 5 specimens each: 90 composite discs with 10 mm diameter and 1 mm thickness were fabricated from 3 resin composites (microhybrid, nanohybrid, and nanofilled). Forty-five discs underwent bleaching with 15% carbamide peroxide, and the remaining 45 were immersed in distilled water at room temperature. The color assessment was performed before and after this step, and Δa, Δb, and ΔL color parameters were calculated for each specimen. The specimens were then immersed in coffee, cola, and red grape juice for 2 weeks, and underwent colorimetry again. The simultaneous effects of bleaching and staining agents and composite types on ΔE (color changes) of composite specimens were analyzed using an independent-samples t-test, a Mann–Whitney U-test, and two-way and one-way analysis of variances followed by a Tukey and a Dunnett's T3 tests (α = 0.05). Results: Bleaching had no significant effect on color changes of microhybrid, nanohybrid, or nanofilled composites (P > 0.05). The stainability of composites did not increase after bleaching (P > 0.05). Regardless of the composite type and the presence of bleaching, coffee had the worst effect on color of composite specimens, while cola had the smallest staining effect (P < 0.05). Conclusion: Stainability of microhybrid/nanohybrid/nanofilled composites did not increase after bleaching with 15% carbamide peroxide. Coffee should be consumed with care, as far as composite coloring is a concern, regardless of the type of composite in use or its bleaching history. Cola was the weakest stainer. Coffee always caused perceptible staining (ΔE >3.7), regardless of the composite in use or its bleaching history. Red grape juice caused such perceptible colorations in most cases. Cola did not cause any perceptible discoloration in most cases.

Background: Diabetes mellitus is a dominant metabolic disorder in the current fast paced culture; its prevalence is escalating worldwide and among all age groups. Guidelines recommend universal screening for diabetes; however, the uptake of these tests in individuals suggests challenges owing to invasive nature of blood collection. Thus, there arises the need for a noninvasive investigation for diabetes screening with a minimum paraphilia and for all medical settings. Materials and Methods: We have thus conducted a systematic review and meta-analysis according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, to quantify the association between diabetes and effectiveness of periodic acid–Schiff staining of exfoliative cytology as a screening method. MEDLINE, EMBASE, Cochrane, Scopus, Web of science, CINAHL, and Google Scholar were searched systematically for publications dated till July 20, 2022. Six studies (case–control cross-sectional) were selected and evaluated in depth. The statistical evaluation was done with a forest plot with odds ratio and weightage examined. Results: It was proved that exfoliative cytology with periodic acid–Schiff (PAS) staining can be used as a screening test for diabetic status evaluation. The findings suggest that the aforesaid noninvasive test is a conclusive screening practice for diabetics. Conclusion: This systematic review and meta-analysis suggest that PAS staining in exfoliative cytology can be used as a noninvasive screening in diabetic individuals to assess the current level of blood glucose. Given the increased risk of diabetes worldwide, higher quality prospective evidence is suggested in larger sample sizes with other metabolic disorders, ethnicity, and oral disorders to further evaluate the plausibility of the results.

Impression making in compromised residual alveolar ridge is a regular challenge in rehabilitating patients with conventional removable complete dentures. In patients who cannot afford implant-supported dentures, specialized impression technique is a viable and justified option for fabrication of complete dentures. More often, the stability of denture in such patients becomes a deciding factor between failure and success. Furthermore, increased interarch space may result in increased height of maxillary and/or mandibular dentures with corresponding increase in weight, which further compromises the retention and stability of the prosthesis. This article describes an amalgamation of Hobkirk's impression technique in a case of resorbed maxillary residual alveolar ridge with a flabby anterior segment and fabrication of hollow maxillary dentures using a “three-dimensional printed dental spacer” with a “double-flask technique.” The weight of the final prosthesis was reduced therefore contributing to improved retention and stability of the final prosthesis.

Background: This study investigated the number of bacterial colonies in four types of suture threads, including silk, nylon, monocryl, and monocryl plus after periodontal surgery in patients with moderate-to-severe periodontitis. Materials and Methods: In this single-blind randomized clinical trial, a total of 12 patients with periodontitis who required periodontal flap surgery in all quadrants were included. One type of suture, either silk, nylon, monocryl, or monocryl plus (coated with triclosan), was used following each surgery in each quadrant. Sutures (3 mm) were removed from the mid, posterior, and anterior regions of the flap 7 days postoperatively, and placed in a tube-containing buffer medium to transfer to the culture medium in a laboratory. Then, the bacterial colonies on each culture medium were counted manually. Finally, the mean number of grown colonies (anaerobic and aerobic) was computed and compared in each group of sutures. Data were analyzed by SPSS (Version 20) using the repeated measures ANOVA and least significant difference follow-up tests (α = 0.05). Results: The findings of this study indicated a significantly higher mean number of aerobic, anaerobic, and aerobic-anaerobic colonies in silk suture than in the other three types of sutures (P < 0.05). However, no significant difference was observed among other types of sutures (P > 0.05). Conclusion: The results of this study showed that silk suture had a higher bacterial adhesion (aerobic, anaerobic, and aerobic-anaerobic) than monofilament sutures, including nylon, monocryl, and monocryl plus. Moreover, no significant difference was found among the monofilament sutures in the number of colonies grown on them.

Background: Plant compounds such as Aloe vera, green tea, and chamomile have been increasingly used in recent years to achieve oral health. This study aimed to determine the antimicrobial effect of chamomile (Matrika), A. vera-green tea, and chlorhexidine (CHX) mouthwashes on some oral bacterial species. Materials and Methods: This prospective experimental study investigated the antimicrobial properties of three mouthwashes, including chamomile (Matrika), A. vera -green tea, and CHX as well as distilled water as control on five bacterial species, including Streptococcus Oralis, Streptococcus sanguis, and Streptococcus mutans as primary colonizers and Porphyromonas gingivalis and Eikenella corrodens as secondary colonizers. Colony-forming unit was used to count the colonies and disc diffusion and well diffusion methods were used to measure the diameter of zone of inhibition. Data were analyzed by SPSS (version 22) software using descriptive statistics, ANOVA, Tukey, Kruskal–Wallis, and Mann–Whitney tests (α = 0.05). Results: CHX had a significantly higher antibacterial effect than the other two mouthwashes in all three methods (P < 0.001). Further, the herbal mouthwashes in all three methods had a statistically significant effect on the bacterial species (P < 0.001). A. vera-green tea mouthwash had a significantly higher effect than chamomile mouthwash (Matrika) on all bacterial species except for S. sanguis (P < 0.05). Conclusion: The findings showed that herbal mouthwashes had potentially antibacterial effects, but these effects were significantly lower than that of CHX. However, more clinical studies are needed to prove the current findings.

Background: Visual and advanced instrumental methods are the most common tools for shade selection. The instrumental methods are considered reliable and provide quantifiable values, but the high cost puts them out of the reach of most dentists. Light-correcting devices provide an economical alternative for clinical shade selection. The aim of this study was to assess the reliability of the light-correcting device in clinical shade selection. Materials and Methods: The in vivo experimental prospective study sample included 60 volunteers aged 18–25 years, with no severe enamel pigmentation or anomaly in anterior maxillary teeth. Two observers performed visual shade matching of the maxillary right central incisor without a light-correcting device and later with a light-correcting device at the same time of the day at an interval of 1 week. The shades were confirmed with the control value obtained by using a spectrophotometer. Each observer was blinded to the shade color selected by the other examiner. The data collected were subjected to the statistical analysis. The shade measured with the light-correcting device and without its use was compared with the control shade obtained by the spectrophotometer. The value closer to the control shade value was considered accurate, and the method used for shade matching would be considered reliable. The Fleiss kappa statistical test was used to assess the reliability of each method. P ≤ 0.05 was considered statistically significant. Results: Using a light-correcting device significantly increased the reliability of the visual shade selection method. When compared to the shades recorded by the spectrophotometer (control), the use of a light-correcting device as an aid in visual shade selection showed more accurate and reliable results as compared to the visual shade selection without a light-correcting device (P < 0.05). Conclusion: Light-correcting devices can assist in reliable shade selection and allow better communication with the dental laboratory technician to provide predictable esthetic results.

Background: This study compared the diagnostic efficacy of VistaCam iX infrared camera, visual inspection, and bitewing-radiographs for the detection of primary occlusal caries of permanent teeth. Materials and Methods: In this in vitro experimental study, 80 extracted human premolars were evaluated. The occlusal surfaces of these teeth were demineralized by immersion in a demineralizing agent. Then, the International Caries Detection and Assessment System (ICDAS II), bitewing-radiography, and Proxi head of VistaCam iX were used to inspect them. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each diagnostic modality. Data were analyzed using SPSS. Twenty-five at P < 0.05 level of significance with one-way analysis of variance and Games–Howell test. Results: Bitewing-radiography had significantly lower sensitivity than ICDAS II and VistaCam (P < 0.05). ICDAS II was comparable to VistaCam, with no significant difference in sensitivity (P > 0.05). ICDAS II had a significantly higher PPV than bitewing-radiography and VistaCam (P < 0.05). The sensitivity of bitewing radiography was significantly lower than that of ICDAS II and VistaCam (P < 0.05). ICDAS II was comparable to that of VistaCam with no significant differences in sensitivity (P > 0.05). ICDAS II had a considerably higher PPV than bitewing-radiography and VistaCam (P < 0.05). The NPV of ICDAS II visual inspection was significantly higher than that of bitewing-radiography and VistaCam (P < 0.05). The ICDASS II and VistaCam had a repeatability coefficient of 47.4%. For bitewing-radiography and VistaCam, this value was 44.2% and 83.4% for ICDAS II and bitewing-radiography. Conclusion: Visual inspection seems to be superior to bitewing-radiography and VistaCam in detecting primary occlusal caries of permanent teeth.

Background: Despite the improvements in optical properties of composite resins, their color stability is still a matter of concern. This study aimed to assess the curing time and intensity and polishing technique on color stability of bleach-shade composite resins. Materials and Methods: In this in vitro, experimental study, 128 discs (1 mm × 8 mm) were fabricated from two composite resins. The specimens fabricated from each composite were assigned to 8 subgroups (n = 8) based on the curing time and intensity and polishing with polishing points or discs. After polishing, the color parameters of specimens were measured by EasyShade spectrophotometer according to the CIEL* a*b* color system. The specimens were then immersed in tea solution, and their color parameters were measured again. Color change (ΔE) was calculated and analyzed at 0.05 level of significance. SPSS 25 was used for data analysis. Univariate four-way ANOVA was applied to assess the effects of composite type, curing time, curing intensity, and technique of polishing on ΔE of composite resins. Since the interaction effects were significant, subgroup analysis was performed by t-test. The level of significance for this test was set at 0.05. Results: The effects of curing intensity and polishing technique were significant on ΔE (P < 0.05). Filtek Z350 XBW composite specimens polished by polishing points experienced lower color change than those polished with discs. The minimum ΔE of Gradia XBW composite was recorded in specimens that underwent high-intensity curing for 20 s and were polished with polishing points while the maximum ΔE was recorded in specimens that underwent high-intensity curing for 20 s and were polished with discs. Conclusion: In all groups except on (Filtek, polishing with Disk, curing time = 20 s), high-intensity curing and polishing with polishing points were more effective and caused lower color change compared with low-intensity curing and polishing with discs.

Background: Dentists are at an increased risk of encountering cross-infections because of working in close proximity with oral mucosa and saliva making use of high-speed rotary instruments during treatment generating large amount of aerosols and splatter which in turn increases the probability of nosocomial spread of infections. The present study aimed to evaluate the knowledge, attitudes, and practices of dentists after the COVID-19 pandemic. Materials and Methods: The present cross-sectional study was conducted using Google Forms wherein a well-structured questionnaire composed of a total of 25 closed-ended questions was distributed among practicing dentists through online mode. Step-wise linear regression analysis was done to determine the influence of independent variables on the knowledge, attitude, and practice scores of the participants. P < 0.05 was considered statistically significant. Results: On analyzing the results, multiple linear regression analysis revealed no significant difference in the knowledge scores among the participants, while good attitude and practice scores were significantly associated with higher qualification of the participants. Another noteworthy finding in the study was the significant correlation observed between the various components of the knowledge, attitude, and practice scores among the participants (P < 0.05). Conclusion: It could be concluded from the findings of the present survey that dentists were found to have good knowledge scores about the COVID-19 pandemic. They should, however, pay more emphasis on practicing tele-triaging and proper screening and should follow various guidelines and advisories issued from time to time by the competent authorities.

Background: Dental caries is a disease which is caused by the acidic by-products of the metabolic processes of dental plaque. Silver components are one of the clinical solutions to prevent caries. This study aimed to investigate the effect of silver diamine fluoride (SDF) application on the shear bond strength of glass ionomer to primary teeth enamel. Materials and Methods: In this in vitro study, a total of 48 anterior sound primary teeth were randomly divided into four groups (n = 12). The control group (G1) consisted of healthy primary teeth, and the three experimental groups (G2–G4) were composed of demineralized primary teeth. The second group did not undergo SDF treatment, the third group underwent SDF treatment, and the fourth group underwent SDF treatment plus polishing. Glass ionomer cylinders were bonded to all specimens and subsequently tested by a universal testing machine to measure the glass ionomer shear bond strength. The type of fracture was examined by a stereomicroscope. Data analysis was carried out using the SPSS 22 statistical software. Data were analyzed by one-way analysis of variance and posthoc Tukey tests (α =0.05). Results: The mean shear bond strength of the glass ionomer was significantly higher in the control group than in the other three groups (P < 0.05). The mean shear bond strength of glass ionomer was significantly higher in the SDF-treated group than in the non-SDF treated and SDF-treated and polished groups (P < 0.05). Conclusion: Although the glass ionomer bond strength to sound enamel was higher than other groups by a significant margin, the application of SDF increases the shear bond strength of the glass ionomer to remineralized white spot enamel in primary teeth.

Background: Children with attention-deficit/hyperactivity disorder (ADHD) are more prone to tooth decay. In this regard, parents, especially their mothers, play a major role in the oral health of their children. Materials and Methods: The present study was a cross-sectional descriptive study. The population of this study was 64 children with ADHD referred to pediatric psychiatric clinics in Isfahan. Inclusion criteria include willingness to participate in research. At least 6 months has passed since their child was diagnosed with the disorder and their child is receiving treatment.Lack of obvious physical disorders, psychotic disorders, mental retardation and chronic diseases in children with attention deficit/hyperactivity disorder with the approval of a psychiatrist. Collaboration for dental examination by a dentist. Exclusion criteria include obvious physical and mental disorders in mothers of children with attention-deficit/hyperactivity disorder. Simultaneous participation in a study similar to the present study due to the possibility of errors in the results. Dissatisfaction with participating in the study and leaving the study during the study. The data collection tool was interview-questionnaire-examination. Clinical interviews were conducted using the Kiddie Schedule for Affective Disorders and Schizophrenia to confirm ADHD and rule out other psychiatric illnesses. Information on decayed, missing, and filled teeth (DMFT) of permanent teeth and dmft of deciduous teeth is recorded separately. The score of each index (D, M, F), (f, m, d) as well as the total index (DMFT), (dmft) is calculated for each person. Data were entered into SPSS software version 26 by descriptive statistical methods, one-way analysis of variance, t-test, and calculation of Spearman correlation coefficient. P < 0.05 was considered statistically significant. Results: The oral health status of children with ADHD did not show a significant relationship with the total score of attitude and knowledge of oral health behaviors of mothers (P > 0.05). The results showed a significant positive relationship between the level of knowledge of the participants and their education level (P < 0.05). Conclusion: The results revealed that mothers' knowledge and attitude about oral health and dental health of children with ADHD were generally at an undesirable level.

Background: Patients undergoing head-and-neck radiotherapy are susceptible to Candida colonization and infection. This study aimed to identify oral Candida species type (ST), colony count (CC), and oropharyngeal candidiasis (OPC) in head-and-neck cancer patients, undergoing radiotherapy, before and 2 weeks after radiation. Materials and Methods: In this quasi-experimental study, head-and-neck cancer patients undergoing radiotherapy (up to 6000 cGy) were recruited. Samples were taken before and 2 weeks after radiation therapy (RT). CC was assigned using Sabouraud dextrose agar culture medium and morphological studies were performed to confirm OPC. For identification, polymerase chain reaction–restriction fragment length polymorphism was performed. Data were analyzed using Chi-square-test and kappa coefficient. P < 0.05 was considered statistically significant. Results: Twenty-one of 33 patients were Candida positive. The detected fungal species included Candida albicans (60%), Candida tropicalis (22%), Candida glabrata (9%), and other species (9%). Following RT, OPC and CC changed significantly (P = 0.003 and P = 0.001, respectively), whereas ST did not significantly change (P = 0.081). Two new species (Candida krusei and Candida parapsilosis) were detected after the intervention. The OPC, CC, and ST changes after RT were not significantly related to malignancy site or radiation dose (P > 0.05). Conclusion: The present study showed that OPC, CC, and ST were not related to the malignancy site. Following RT, OPC and CC changed significantly, while ST showed no significant change. The radiation dose and malignancy site had no effects on the OPC, CC, or ST alterations following RT.

Background: Stresses on prosthetic crown directly influences the survival rate of implants hence it should be considered while selecting prosthetic material. The aim of the study is to evaluate stress analysis on implant, abutment and peripheral bone with change in different abutment and different crown materials by 3D finite element study. Materials and Methods: A numerical procedure based on finite element method was adopted to investigate the influence of different prosthetic materials and abutment materials on stress situation. Eight different three-dimensional (3D) models of a bone-level implant system and an abutment were created by using the standard tessellation language (STL) data of original implant components. Combinations included of abutment materials i.e., Titanium (Ti), Polyetheretherketone (PEEK), Polyetherketoneketone (PEKK), Polymer infilterated hybrid ceramic (TZI) along with different restoration materials Monolithic Zirconia (MZ) and lithium disilicate glass ceramic (IPS e-max). In each model, the implants were loaded obliquely (150 N). The stress distribution in the implant, Abutment and peripheral bone was evaluated through the von Mises stress analysis. Results: Higher stresses were found on neck of implants irrespective of abutment material and restorative material. Highest stress was found with PEEK material. The pattern of stress distribution in implant and peripheral bone was similar in all models. Conclusion: There is no difference in stresses with the change in restorative material but the change in abutment material has effect on stresses on implants.

Background: Mineral trioxide aggregate (MTA) becomes a hard mass after setting and making it difficult to remove and can cause significant problems in the retreatment process. The aim of this study was to evaluate the effect of different concentrations of hydrochloric acid (HCl) on MTA dissolution and its effect on dentin. Materials and Methods: In this in vitro study, 45 single-root premolars were selected. Artificially open apex was created in all samples with similar process. The samples were randomly divided into 4 experimental groups of 10, and a control group of 5. Four-millimeter thick apical plugs of Root MTA were placed in all samples in an orthograde manner. HCl was used at concentrations of 3.75%, 7.5%, 15%, and 22.5% (w/v) for the experimental groups and normal saline for the control group. Each sample was exposed to the desired solution for 15 min. Then, MTA retrieval and reaching the working length were attempted with k-file # 30. The times of each sample were recorded. Furthermore, after longitudinal incision of the roots with a disc, the dentin surfaces of canals were examined with a Dino-Lite microscope (×50). Results were analyzed by Shapiro–Wilk test and one-way analysis of variance tests. The level of significance P value was set at 0.05. Results: The lowest average time of reaching working length was observed with group 22.5% that was significantly lower than 15% and 7.5% concentrations (P = 0.005 and P = 0.011). Furthermore, by examining with ×50 of Dino-Lite microscope, no difference was observed on the canal walls. Conclusion: The optimum concentration of HCl was 7.5%. Furthermore, different concentrations of HCl had no significantly different effect on the dentinal canal wall using Dino-Lite microscope with ×50.

Background: Bone grafting is the primary treatment for the alveolar cleft. Due to the reduced complications by the sealant materials, this study aimed to evaluate fibrin glue's effect on the success rate of unilateral alveolar bone grafting. Materials and Methods: This study was a single-blind clinical trial performed on 20 patients with a unilateral alveolar cleft. Patients were randomly divided into groups: group A patients as a control group underwent bone grafting without fibrin glue, and in Group B, patients were grafted using fibrin glue. The subject was followed up through routine examination and the cone-beam computed tomography systems technique for up to 4 months. Paired t-test and Chi-square tests were used to analyze the data and the P < 0.05 was considered the significance threshold. Results: The mean age, gender, and cleft side distribution did not represent significant differences. Before surgery, the average alveolar cleft volume in Group A and B patients was 0.95 ± 0.25 cm³ and 0.99 ± 0.22 cm³, respectively, which was not statistically different. After the surgery procedure, the alveolar cleft volume in Group A and B patients was determined to be 0.31 ± 0.10 cm³ and 0.23 ± 0.11 cm³, which represented 66.7% ± 8.9% cm³ and 76.2 ± 11.4 cm³ bone formation, respectively, with no remarkable difference. Our examination did not reveal any necrosis and infection in both groups. However, despite no dehiscence observation in fibrin glue treatment patients, one subject showed dehiscence complication in the control group. Conclusion: According to results, fibrin glue may increase the percentage of bone volume formed and prevent dehiscence.

Background: The purpose of this study was to evaluate the effect of different surface treatments on the microshear bond strength (μSBS) of resin cement to zirconia-reinforced lithium silicate ceramic and to compare it with lithium disilicate ceramic. Materials and Methods: In this in vitro study, 80 specimens containing two glass ceramics of IPS e.max press and VITA SUPRINITY were prepared and categorized into four groups according to the surface treatments (n = 10) as Group 1 (C): no treatment (control); Group 2 (HF): etching with 9% hydrofluoric acid (HF) for 90 s followed by silane application; Group 3 (SPH): sandblasting with Al₂O₃ particles (50 μm), etching with 35% phosphoric acid for 40 s followed by application of silane and adhesive (Clearfil liner bond F); and Group 4 (SB): sandblasting with Al₂O₃ followed by silanization. Then, a resin cement (Panavia F2) was applied to the prepared ceramic surfaces. All samples were subjected to thermal aging (5000 cycles, 5–55). The μSBS test was evaluated and failure modes were recorded. Data were analyzed using the Shapiro–Wilk, two-way analysis of variance and Tukey's Honest Significant Difference post hoc tests (P < 0.05). Results: IPS e.max press samples revealed significantly higher μSBS values compared to VITA SUPRINITY (P < 0.001), in whole surface treatments. The HF group showed the highest μSBS value, followed by the SPH and SB groups, respectively (P < 0.001). Adhesive failure was recorded as a predominant failure mode. Conclusion: The adhesion performance of IPS e.max press was significantly higher than VITA SUPRINITY. The common surface treatment protocol including HF application followed by silanization was the most effective surface treatment for both glass ceramics.

Background: This study aimed to evaluate the reaction of the periapical tissue to Cold ceramic and mineral trioxide aggregate (MTA) following periapical endodontic surgery. Materials and Methods: In this experimental study, a total of 12 mandibular first, second, and third premolars of two male dogs were selected. All procedures were performed under general anesthesia. The access cavities were prepared, and the length of canals was determined. Root canal treatment was performed. A week later, periradicular surgery was performed. After osteotomy, 3 mm of the root end was cut. Then, a 3-mm cavity was created by an ultrasonic. The teeth were randomly divided into two groups (n = 12). The root-end cavities were filled with MTA in the first group and with Cold ceramic in the second group. After 4 months, the animals were scarified. Histological evaluation of the periapical tissues was performed. Data were analyzed using SPSS 22 and Chi-square test and P = 0.05. Results: The findings showed 87.5% and 58.3% cementum formation in MTA and Cold ceramic groups, respectively, indicating a significant difference (P < 0.001). In addition, the results showed 91.7% and 83.3% bone formation in MTA and Cold ceramic groups, respectively, but the difference was not statistically significant (P = 0.6). Furthermore, the findings revealed 87.5% and 58.3% periodontal ligament (PDL) formation in MTA and Cold ceramic groups, respectively (P = 0.05). Conclusion: Cold ceramic was able to induce the regeneration of cementum, bone, and PDL; hence, it can be considered as a biocompatible root-end filling material in endodontic surgery.

Background: As more recent implant biomaterials, Zirconia ceramic and glass or carbon fibre reinforced PEEK composites have been introduced. In this study, bone stress and deformation caused by titanium, carbon fiber-reinforced polyetheretherketone (CFRPEEK), and zirconia ceramic implants were compared. Materials and Methods: In this in vitro finite element analysis study, a geometric model of mandibular molar replaced with implant supported crown was generated. The study used an implant that was 5 mm diameter and 11.5 length. Three implant assemblies made of CFR- polyetheretherketone (PEEK), zirconium, and titanium were created using finite element analysis (FEM). On the implant's long axis, 150 N loads were applied both vertically and obliquely. ANSYS Workbench 18.0 and finite element software were used to compare the Von Mises stresses and deformation produced with a significance level of P < 0.05. Results: With no discernible differences, all three implant assemblies that is CFR-PEEK, titanium, and zirconia demonstrated similar stresses and deformation in bone. Conclusion: It was determined that zirconia and PEEK and reinforced with carban fibres (CFR-PEEK) can be used as titanium-free implant biomaterial substitutes.

Background: Due to the increasing prevalence of oral squamous cell carcinoma (OSCC) in Iran and especially in young people, this study aimed to identify human papillomavirus (HPV) using p16 in OSCC. Materials and Methods: In this descriptive-analytical cross-sectional study, 40 samples from the archives of the Pathology Department of Kashani Hospital were selected by a definitive diagnosis of OSCC with neck dissection. Demographic information including age, gender, location, and size of the lesion was obtained. Samples were divided into two groups based on lymph node (LN) metastasis. Immunohistochemical staining was performed for p16. Data were entered into SPSS 24 software and statistically analyzed by t-test, ANOVA, and Spearman nonparametric test. P <0.05 was statistically significant. Results: The mean age of patients was 59.7 ± 17.11 which in terms of age and gender there was no significant difference between the two groups including with and without cervical LN metastasis (P > 0.05). There was no significant difference between the two groups based on the grade of tumor, perninural invasion, tumor size and location (P > 0.05). The only significant difference between the two groups was based on lymphovascular invasion and disease stage (P < 0.05). The p16 expression also showed a significant difference between the two groups (P < 0.05). Conclusion: In OSCCs without cervical LN metastasis, a significant increase in p16 expression was observed compared to samples with cervical LNs metastasis. The presence of HPV was higher in samples with less LNs metastasis and possibly a better prognosis.

Background: The aim of this study was to investigate and compare the cytotoxicity and gene expression of Bio-C Repair, Mineral Trioxide Aggregate (MTA) HP Repair, and Biodentine on stem cells derived from exfoliated deciduous teeth. Materials and Methods: In this in vitro study MTT assay was used to assess the cellular viability at three different dilutions. The gene expression of Runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP), osteocalcin [OCN], and dentin matrix protein-1 (DMP-1) was measured with real-time polymerase chain reaction after 7 days, 14 days, and 21 days of incubation. One-way analysis of variance and Bonferroni posttest were used for statistical analysis (p=o.o5). Results: After 72 h of incubation at dilution 1:4, stem cells derived from human exfoliated deciduous teeth (SHEDs) cultivated in Biodentine, followed by Bio-C Repair and MTA Repair HP reported with highest cellular viability. The highest mRNA expression of Runx2, ALP, OCN, and DMP-1 was reported in SHEDs cultured in Biodentine (after 21 days of incubation). Conclusion: Bio-C Repair and MTA HP Repair are biocompatible and capable of odontogenic differentiation similar to Biodentine when cultured in stem cells derived from exfoliated primary teeth.

Background: In endodontics, glide path creation has been extensively considered a mandatory clinical step to improve the safety and efficiency of rotary nickel–titanium instruments. The high anatomic variations in the mesiobuccal (MB) root of the maxillary molars are observed in the form of canal configuration, number, and position.The aim of this study was to evaluate the negotiability of MB canals in maxillary molars using different pathfiling systems (ProGlider, R-pilot, HyFlex electrical discharge machining [EDM], WaveOne Gold Glider, and C-Pilot). Materials and Methods: This in vitro study included 125 maxillary first molars with closed apex. Before preparation, all teeth were scanned by periapical radiograph for review of the presence of second MB (MB2) canals, without any resorption or calcification, and moderate curve of MB root canal. Subsequently, the access cavity was prepared with a Diamond Fissure Bur. Then, the samples were divided into five groups (ProGlider, R-pilot, HyFlex EDM, WaveOne Gold Glider, and C-Pilot). Certain relevant indices were recorded for analysis, such as the negotiability of the glide path file in the MB canals, file fracture rate, and negotiation speed. The level of significance P value was set at 0.05. Results: In this study, HyFlex EDM was the only path file that could not reach the full working length (WL) in some cases. The highest frequency of file fracture in the MB2 was observed with HyFlex EDM (24%); nevertheless, R-Pilot presented an intermediate fracture rate (16%), and both ProGlider and WaveOne Gold Glider were the safest files (4%) in this regard. However, there were no significant differences between the groups (P = 0.065). The lowest and the highest average time of reaching full WL was observed with WaveOne Gold Glider and HyFlex EDM; nonetheless, there was no significant difference between the four rotary groups. The average number of pecks in HyFlex EDM was significantly higher in comparison to those reported for WaveOne Gold Glider and ProGlider. Conclusion: Path files used for glide path preparation in the MB2 canals of maxillary molars should be flexible with low taper. The use of HyFlex EDM in the MB2 canals is not recommended due to its high taper.

Materials and Methods: This in vitro, experimental study evaluated 20 endocrowns, of which 10 were fabricated by 3D printing and 10 were fabricated by the conventional wax-up technique. The marginal gap was measured at 8 points under a stereomicroscope. The results were analyzed using the Shapiro–Wilk test, paired t-test, independent t-test, and one-way analysis of variance (α = 0.05). Results: The mean marginal gap was maximum at the distal point, and minimum at the buccal point for the conventionally fabricated endocrowns with an overall mean marginal gap of 99.67 ± 4.59 μm. The mean marginal gap was maximum at the mesiobuccal and minimum at the buccal point before pressing (overall mean of 103.92 ± 2.19 μm) before pressing, and maximum at the distobuccal and minimum at the mesiobuccal point after pressing (overall mean of 117.67 ± 2.87 μm). According to paired t-test, the mean marginal gap of endocrowns fabricated by 3D printing significantly increased after pressing at all 8 points and also in general, compared with before pressing (P < 0.001). Furthermore, the mean marginal gap at all points was significantly greater in endocrowns fabricated by 3D printing compared with those fabricated by the conventional method (independent t-test, P < 0.001). Conclusion: Within the limitations of this in vitro study, the results showed that endocrowns fabricated by the conventional method had significantly superior marginal fit than those fabricated by 3D printing. Background: Marginal fit is a key factor in success of prosthetic restorations. This study aimed to assess and compare the marginal fit of endocrowns fabricated by three-dimensional (3D) printing and the conventional method.

Background: These days minimally invasive micro-osteoperforation (MOPs) has accelerated orthodontic tooth movement (OTM). However, there are some conflicting reports about their various impacts; hence, the present systematic review study aimed to evaluate the effect of MOP on root resorption, pulp vitality, and the biological changes of teeth subjected to OTM. Materials and Methods: Search in electronic databases of English literature including PubMed, Scopus, Web of sciences, Cochrane, and Google scholar as well as a manual search was performed from 2013 to 2022. Most of the studies included in this article were randomized controlled trials. Results: From the total number of 321 found articles, 31 duplicated and 268 irrelevant articles were excluded regarding the defined inclusion and exclusion criteria. Consequently, 22 articles were subjected to the quality assessment process, and finally, 18 articles were selected for the review phase. Root resorption during tooth movement using the MOP approach was reported only in one study. Besides, except for two animal studies, all of the relevant included articles showed that MOPs significantly increased the expression of some inflammatory biomarkers known to recruit osteoclast precursors and increase the number of osteoclast cells. On the other hand, two animal studies showed no differences in osteoclast counts by using MOPs in comparison to their control groups, which was consequently the result of biologic variability between animal and human and also probably the small sample sizes of these two studies. Conclusion: In this systematic review, according to the adverse effects of MOP on root resorption, one study showed higher levels of root resorption among patients undergoing MOP. However, this outcome was due to the different methods used to evaluate the effect of MOPs on root resorption. Moreover, a high certainty of evidence supports that MOP causes biological changes and an elevation in cytokines, chemokines, and other biomarkers that stimulates osteoclasts differentiation which in turn accelerate OTM. There was no change in pulp vitality status based on available evidence.

Background: Dentists play an important role in caries prevention by delivering preventive care, educating patients, and buying related products; it is critical to recognize what they know and believe about caries prevention, as well as how they use caries prevention interventions. Materials and Methods: A descriptive cross-sectional study was conducted in South India between January 2021 and February 2021 to determine the dentists' knowledge, attitude, and practice of prescribing preventive strategies and remineralizing agents for caries prevention. A questionnaire including 11 self-administered, prestructured questions was made and distributed through electronic media. Chi-square test was done. The test significance value was taken as 0.05. Results: A total of 252 dental practitioners participated in the study. The majority of general dentists and specialists followed all the measures such as pit and fissure sealants, fluoride application, counseling patients about oral hygiene maintenance, and regular recall after 6 months to 1 year (P > 0.05). Fluoridated remineralization strategy was found to be the most prescribed (69%) strategy for caries prevention. A significant number of dentists think fluoridated mineralization strategies will remain prevalent (P < 0.05). Younger dentists find practicing preventive dentistry more feasible compared to dentists with greater years of experience (P < 0.05). Conclusion: Dentists across the country are well aware, have sufficient knowledge, and prescribe preventive strategies such as fluoride application, pit and fissure sealants, regular oral health checkups, and counsel the patients about the importance of oral health but there is a lack of implementation of these preventive strategies in everyday practice.

Background: Emergence of nystatin-resistant Candida albicans (C. albicans) strains has raised some concerns in the recent years. Recent scientific evidence proves that turmeric, especially curcumin, has anti-inflammatory and anti-fungal activity. The aim of this study was the investigation of the antifungal effects of curcumin against nystatin-resistant C. albicans. Materials and Methods: This in vitro, experimental study evaluated standard-strain (ATCC 16201) and 10 nystatin-resistant C. albicans strains. The antifungal activity and minimum inhibitory concentration (MIC) of curcumin were evaluated using the CLSI-M27-A3, and the MIC of curcumin was compared with that of nystatin. The results were analyzed using the one-way ANOVA. Results: The MIC of curcumin was 15.6, 32.25, 15.6, 7.8, 32.25, 15.6, 15.6, 15.6, 32.25, and 15.6 μg/mL for the 10 resistant strains and 62.5 μg/mL for the standard strain of C. albicans. Curcumin in the above-mentioned concentrations significantly inhibited the proliferation of nystatin-resistant C. albicans strains (P < 0.001). Conclusion: According to this research, it was shown that curcumin with MIC value of 7.8–32.25 μg/mL has inhibitory effects on nystatin-resistant C. albicans strains.

Background: Oral health plays a key role in people's overall health. Dental caries is the most important problem in children's oral health. Despite significant advances made in the area of oral health around the world, there is inequality in access to oral health within Iran and abroad, and this is considered a public health challenge. This study was conducted to investigate the access barriers to children's oral health services from the perspective of parents attending the health centers of Kerman, Iran. Materials and Methods: The present descriptive-analytical study was carried out, as a cross-sectional survey, on 410 parents of children living in Kerman, Iran. The data were collected by access barriers questionnaire, and then were analyzed by SPSS software using descriptive statistical methods and the multiple linear regression test. Confidence interval (CI) in this study was 95% (95% CI). Results: The most common access barrier to children's oral health was the high treatment cost. The access barriers to children's oral health services were significantly associated with parental education (P = 0.00), maternal employment (P = 0.04), supplementary insurance (P = 0.00), and family income (P = 0.01). Parental satisfaction was also significantly correlated to the child's sex (P = 0.04), supplementary insurance (P = 0.04), and number of filled teeth (P = 0.04). The mean score of parental satisfaction was 1.83 ± 0.34; within the range of 1–3 from satisfied to dissatisfied. Conclusion: The cost of dental treatment services high and there are many barriers to accessing children's oral health.

Background: Increasing antibiotic resistance to pathogenic microorganisms (Streptococci) has led scientists around the world to turn to medicinal plants. In this study, the effects of aqueous and alcoholic extracts of Zataria multiflora on the in vitro growth of Streptococcus mutans and Streptococcus sanguis have been considered and compared with 0.2% chlorhexidine mouthwash. Materials and Methods: In this in vitro study, the inhibitory growth zone was accessed by the disc diffusion method after 48 h of incubation at 37 C. To find out the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of treatments, colony counts of cultured bacteria on nutrient agar have been considered at serial dilution at 1/2-1/1024 dilution rates. An independent t-test was used to compare the antibacterial effects of extracts while the level of significance of was considered to be 5% (P < 0.05). Results: The inhibitory growth zones of aqueous and alcoholic extracts on S. mutans were 26.8 mm and 35.8 mm, respectively, whereas growth zones for S. sanguis were considered as 25.8 mm and 33.2 mm, sequentially. Comparisons showed better effects of alcohol compared to aqueous extract (P > 0.05). The MIC and MBC assessments showed the same results (P > 0.05). In all comparisons, the effects of 0.2% chlorhexidine mouthwash were significantly better than both Z. multiflora aqueous and alcoholic extracts (P > 0.05). Conclusion: The different solvents may have contributed to the better effects of an alcoholic to aqueous extract of Z. multiflora on the growth of both bacteria. These two extracts could be used for early inhibition of the growth of the planktonic phase, as well as for better oral taste after chlorhexidine applications.

Background: At present, the status of oral and maxillofacial pathology (OMFP) in the country is not properly good. This study aimed to investigate the current status and develop practical approaches to improve occupational condition of the specialty in the future from the viewpoint of the beneficiaries. Materials and Methods: This was a descriptive cross-sectional study. The participants were oral and maxillofacial pathologists of the country (200 individuals), OMFP residents (9 individuals), and final year dental students at six dentistry school of the country at 2020 (200 individuals) through multicenter design. At the first phase, the related questionnaires were developed and assessed psychometrically. Reliability of the questionnaires, internal consistency, and repeatability were computed and confirmed. At the second phase, the survey questionnaires on the current and future condition were sent electronically to the study groups. The data were analyzed using descriptive statistical tests (mean, standard deviation, percentage) and the Pearson test using SPSS. Results: At the first phase, after primary design of the study too, 23 variables with content validity ratio below 0.56 and content validity index (CVI) below 0.79 were omitted. The questionnaire for the specialists was confirmed with Cronbach's alpha of 0.75 and intraclass correlation coefficient (ICC) as 0.83, and the questionnaire for the students and the residents were confirmed with Cronbach's alpha of 0.95 and ICC of 0.80. Results of the second phase showed that score of tendency of students to select OMFP specialty to continue education was 1.58 ± 0.57 from 5. Satisfaction score of specialists on specialized activity of this specialty is 2.7 ± 1.52 from 5. The most important reason for the students to select this specialty was “interest in being faculty member,” and the “difficulty of the specialty” was the most probable reason for not selecting this specialty. The most important priority of the residents was “interest in specialty” and for the specialists was “being faculty member.” The most important reason to change attitude regarding the specialty by the specialists was mentioned as “high occupational and profession responsibility as well as low income” with the score of 1.38 ± 3.99. “Fundamental revision in the educational curriculum of the specialty” with a score of 4.60 ± 0.93 from 5 was considered as the most important revisionary approach from the viewpoint of specialists. Conclusion: At present, the main problem regarding the OMPF specialty in the country is “high number of graduates and lack of the present occupational opportunities.” Evaluation and validation of the relevant specialized departments, producing occupational opportunities, and fundamental revision in the educational curriculum to train well-powered specialists are necessary.

Background: The goal of this study is to determine the effect of different sandblasting particles and dental adhesive systems on the repair strength of dimethacrylate-based composite resins. Materials and Methods: In this in-vitro study, 96 specimens of X-trafil composite blocks were prepared and divided into eight groups (n = 12). Four groups were sandblasted with Aluminum Oxide (AL) and four other groups with Bio-Active Glass particles (BAG). A two-component silane was applied on the surface of all the samples after phosphoric acid etching and rinsing. Two groups of the sandblasted specimens were treated with Clearfil SE Bond (CSB) and the other two groups were treated with Single Bond Universal (SBU) and new composite was bonded to the prepared surfaces. Half of the specimens in each group were thermocycled. Shear force was applied to the bonded composite using a universal testing machine with a crosshead speed of 0.5 mm/min and mean shear bond strength (MSBS) was calculated (MPa). The data was analyzed using Kruskal–Wallis and Man–Whitney U-tests with the significance level of 0.05. Results: Significant differences were observed between different groups (P < 0.001). The highest and the lowest MSBS of the thermocycled samples were reported 18.88 MPa with application of AL and SBU and 11.46 MPa with the application of AL and CSB, respectively. No significant difference was observed with application of BAG particles after thermocycling. Conclusion: Effect of AL on repair shear bond strength of composite resins is affected by bonding type. Bonding type did not affect repair shear bond strength of BAG. Thermocycling reduced bond strength in all groups.

Background: The aim of this study was to assess the effect of incorporation of zinc oxide nanoparticles (ZnO-NPs) to glass-ionomer cement (GIC) (Fuji II SC, GC Corp., Tokyo, Japan) on subgingival accumulation of mutans streptococci and lactobacilli under orthodontic bands. Materials and Methods: In order to conduct this in vivo split-mouth study, 20 patients aged between 7 and 10 years who required lingual holding arch on their mandibular first molars were divided into two groups. In one group, Fuji II SC GIC was used for cementation of the right molar band, and the same cement containing 2 wt% ZnO-NPs was used for the left one. The opposite was performed for the second group while the operator was blinded to the cement types. Subgingival microbial sampling was performed 16 weeks after cementation of lingual arch. Mutans streptococci and lactobacilli colony counts were compared. Paired t-test was used to compare the two cement groups. Data were analyzed using SPSS version 21, and P ≤ 0.05 was considered statistically significant. Results: The mean colony counts of mutans streptococci, lactobacilli, and total bacterial count in Fuji II SC containing ZnO-NPs were significantly lower than the corresponding values in plain Fuji II SC group. Conclusion: Incorporation of ZnO-NPs into GIC reveals antimicrobial features against mutans streptococci and lactobacilli under orthodontic bands.

Background: This study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine. Materials and Methods: The current randomized controlled clinical trial was conducted on 100 patients in two groups (n = 50). Standard injection of IAN block (IANB) was performed using two cartridges of 3% mepivacaine plain in the first group and using two cartridges of 3% prilocaine with 0.03 IU felypressin in the second group. Fifteen minutes after injection, the patients were asked about lip anesthesia. In case of a positive answer, the tooth was isolated with a rubber dam. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation, entry into the pulp chamber, and initial instrumentation. Data were analyzed with SPSS 17 using the Chi-square test, and P < 0.05 was set as statistically significant. Results: The patients' pain severities during the three stages were significantly different (P = 0.001, 0.0001, and 0.001, respectively). The success rate of IANB during access cavity preparation was 88% with prilocaine and 68% with mepivacaine. This rate during entry into the pulp chamber was 78% and 24%, respectively, which was 3.25 times higher with prilocaine than mepivacaine. The success rates during instrumentation were 32% and 10%, respectively, which was 3.2 times higher with prilocaine than mepivacaine. Conclusion: The success rate of IANB in the teeth with symptomatic irreversible pulpitis was higher using 3% prilocaine with felypressin than using 3% mepivacaine.

Background: Rheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases. Previous studies have reported an association between stress and salivary alpha-amylase. The aim of this study was to investigate the concentration of salivary alpha-amylase in patients with RA (by elimination of stress factor). Materials and Methods: In this case–control study, we enrolled 50 patients with RA and 48 healthy patients as the control group. The perceived stress scale questionnaire was used to evaluate scores of stress in both case and control groups, and then the participants with high scores of stress were excluded from the study. Moreover, the alpha-amylase activity kit was used for the assessment of the levels of salivary alpha-amylase. In all analyses, the significance level was considered to be < 0.05. Finally, the obtained data were analyzed by SPSS22. Results: Our results indicated a high score of stress in the case group (19.42 ± 5.83 units) compared with the control group (18.02 ± 6.07 units) which was not statistically significant (P < 0.248). Moreover, we demonstrated a high salivary alpha-amylase concentration in the case group (340.65 ± 38.04 units) compared to the control group (302.62 ± 58.72 units), which was statistically significant (P < 0.001). The sensitivity and specificity of this method, at >312 alpha-amylase concentrations, were 80% and 46%, respectively. Conclusion: In general, we indicated that the alpha-amylase concentration in patients with RA is higher than the healthy controls, and can be used as a codiagnostic factor.

Background: Cleft lip (CL) and cleft palate (CP) are among the most common birth defects in the craniofacial region affected by various environmental and genetic factors. The prevalence of these abnormalities varies in races and countries. Therefore, it is a necessity to design a website to register newborns with CL ± CP in Iran. This study aimed to design a website to record the characteristics of children with CL ± CP. Materials and Methods: First, a website was designed to register the characteristics of children with CL ± CP. To evaluate the accuracy of the website, the characteristics of all children (n = 31) with CL ± CP were recorded and analyzed. Results: Due to the capability of the website to print and create reports in Excel format, the data of registered patients were analyzed. Conclusion: As CL ± CP are very common defects around the world including Iran, it is necessary to design a website to record all information about these children in Iran. Hope this website helps the public health authorities to improve program effectiveness to treat these children.

Background: An ever-increasing demand is seen for clear aligners and transparent vacuum-formed retainers. They are esthetic and convenient. However, the biomaterials used in these appliances might pose biological safety and biocompatibility threats in terms of their bisphenol-A (BPA) release, cytotoxicity, adverse effects, and estrogenic effects. Due to the controversial results and the lack of any systematic reviews in this regard, we conducted this systematic review. Materials and Methods: Web of Science, PubMed, Cochrane, Scopus, and Google Scholar as well as references of the found articles were searched (independently by 3 researchers) up to December 22, 2021, to find studies relevant to the biocompatibility of clear aligners and thermoplastic retainers. The search keywords were a combination of the following (and more): Essix, vacuum-formed aligner, thermoplastic aligner, clear aligner, Invisalign, vacuum-formed retainer, BPA release, monomer release, cytotoxicity, estrogenicity, biocompatibility, chemical properties, and oral epithelial cell. As eligibility criteria, articles in all languages would be included as long as their text could be translated clearly using online translators or by professional translators; all types of publications (article, book, and thesis) would be included if containing relevant studies and information; they should have been on clear liners or thermoplastic retainers; and they should have been on biocompatibility, safety, cytotoxicity, or estrogenicity of clear aligners or thermoplastic retainers. There were no restrictions on the type of study (randomized clinical trials, experimental in vitro studies). Studies focusing merely on the mechanical properties of clear aligners or thermoplastic retainers (without examining their chemical properties) would be excluded. The risk of bias was assessed. Results: The risk of bias was rather low. However, the methodologies of the studies were quite different. Overall, 16 articles (1 randomized clinical trial and 15 in vitro studies) were identified. The data for BPA release were reported in four articles (1 clinical trial and 3 in vitro studies). Quantitatively speaking, the amount of released BPA reported by in vitro studies was very low, if not zero. However, the BPA level was very high in the only randomized clinical trial. Many adverse effects were linked to using clear aligners or transparent retainers, including pain and soft-tissue issues such as burning, tingling, sore tongue, lip swelling, blisters, ulceration, dry mouth, periodontal problems, and even systemic problems such as difficulty in breathing. Besides these biological adverse effects, oral dysfunctions and speech difficulties and tooth damage may be associated with clear aligners and should as well be taken into consideration. Conclusion: Given the very high levels of BPA leach observed in the only clinical trial and considering other possible dangers of small traces of BPA (even at low doses) and also given the numerous adverse events linked to clear aligners or transparent retainers, it seems that safety of these appliances might be questionable and more clinical studies of biocompatibility are needed in this regard.

Background: The digital dentistry, requires materials with wo opposite properties of machining ability and also enough hardness. The main objective of this experimental study was to investigate the fabrication feasibility of the lithium metasilicate glass-ceramic in partially crystalized stated using the spark plasma sintering (SPS) method. Materials and Methods: In this study, SPS for the first time was used to fabricate primary lithium metasilicate glass-ceramic (LMGC) blocks. The raw materials were mixed and melted and then quenched in water and the resulted frits were grinded. The resulting powder was sintered by SPS at 660, 680, and 700°C. Results: Scanning Electron Microscope (SEM), X-ray diffraction (XRD), and Vicker's microhardness assay were used to evaluate the properties of samples. Statistical comparison of the obtained data was performed by ANOVA, followed by the post hoc test of Duncan. Microstructural studies by SEM and XRD showed that all samples were composed of lithium metasilicate phase in a glassy matrix. With increasing the sintering temperature, the number and size of lithium metasilicate particles increased and higher mechanical properties have been achieved. However, the sintered sample at 700°C has less processing ability than the samples sintered at 660 and 680°C. Conclusion: The optimum sintering temperature for glass frit consolidation was determined by SPS at 680°C.

Background: Different studies about the effects of mouthwashes on force reduction by elastomeric chains are reported in the literature. Hence, this review was done for the assessment of force degradation in the elastomeric chains in different mouthwash compositions. This study helps to improve the clinical performance of elastomeric chains used in orthodontics, reducing force degradation, and finally assisting clinicians in choosing better and more efficient methods for their treatments. Materials and Methods: In this review article, an extensive search was performed in the electronic databases of Cochrane Library, Web of Science, PubMed, and Scopus from the year 1990–2020. No language restriction was considered and manually investigated the reference lists of all articles related to the title. Out of 450 obtained articles, 14 in vitro studies were chosen based on the inclusion criteria, and their quality was assessed using modified CONSORT. This systematic review was limited and written based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Results: Based on the results achieved, mouthwashes containing alcohol caused considerable force degradation in the elastomeric chains compared to the alcohol-free ones and mouthwashes with fluoride caused lesser force degradation compared to other types.

Background: Biodegradable hydrogel scaffold is one of the crucial characteristics that determine the success of pulp regeneration. The degradation should be suitable for the growth of new tissue establishment. The aim of this study is to synthesize and compare the novel biodegradable hydrogel scaffold based on hydroxyapatite (HAp) eggshell, collagen, and epigallocatechin-3-gallate (HAp-Col-EGCG) with different HAp concentrations in vitro. Materials and Methods: This study is original research. HAp-Col-EGCG hydrogel scaffolds were prepared using 1:1, 1:2, and 1:4 ratios of collagen and HAp with 10 μmol/L EGCG. The samples were freeze-dried and immersed in phosphate buffer saline containing lysozyme enzyme. The dried samples were weighed to determine the percentage of biodegradation value (P < 0.05). Results: The result showed HAp-Col-EGCG was biodegradable but it has not been concluded that it can be completely eliminated. The data were analyzed by one-way analysis of variance and it indicated significant differences in percentage values. Conclusion: Hydrogel scaffold based on HAp-Col-EGCG can be degraded and have the potential to be used as a biodegradable scaffold in supporting tissue regeneration.

Background: Polymethyl methacrylate resin is widely used in orthodontic treatments. Graphene oxide (GO) has reactive functional groups on its surface that facilitate binding to various materials such as polymers, biomolecules, DNA, and proteins. This study aimed to investigate the impact of adding functionalized GO nanosheets on the physical, mechanical, cytotoxicity, and anti-biofilm properties of acrylic resin. Materials and Methods: In this experimental study, fifty samples (for each test) were divided into groups of 10, in the form of acrylic resin discs with concentrations of 0, 0.25, 0.5, 1, and 2 weight percentage (wt%) of functionalized GO nanosheets and also the control group. Samples were evaluated in terms of physical properties (surface hardness, surface roughness, compressive strength, fracture toughness, and flexural strength), anti-biofilm properties (On four groups of micro-organisms, including Streptococcus mutans, Streptococcus sanguis, Staphylococcus aureus, and Candida albicans), and cytotoxicity. Data were analyzed using SPSS software version 22, descriptive statistics, one-way analysis of variance test, and Tukey post hoc test. The significance level was considered P < 0.05. Results: No significant difference was observed between the different groups with weight percentages of 0.25, 0.5, 1, and 2% nano GO (nGO) and the control group (without nGO) in terms of surface roughness and toughness. However, compressive strength, three-point flexural strength, and surface hardness showed significant differences between the groups. Furthermore, the degree of cytotoxicity increased by increasing the weight percentage of nano-GO. Conclusion: The addition of functionalized nGO in appropriate concentrations to polymethyl methacrylate can improve the anti-bacterial and anti-fungal biofilm properties without changing or increasing their physical and mechanical properties.

Background: The prevalence of oral squamous cell carcinoma (OSCC) has increased in recent years. With the development of various treatments, the mortality rate has decreased and more people are living with the consequences of the disease and its treatment, which can have a great impact on the quality of life. Some questionnaires measure the impact of the disease on daily activities and patient behavior. In this study, the oral health-related quality of life (OHRQOL) was assessed through the Oral Health Impact Profile (OHIP)-14 questionnaire between the OSCC patient and control groups. Materials and Methods: In this cross-sectional study, the OHIP-14 questionnaire was given to 51 OSCC patients who had completed the treatment at least 6 months before participating in this study and 51 healthy individuals, and we used the Chi-square test, independent sample t-test, one-way ANOVA, and linear regression in three models. P = 0.05 was considered statistically significant. Results: The mean age of patients was 55.86 ± 15.04 years and the control group was 54.96 ± 14.08 years. Women made up 51% of patients. The mean OHIP score was 22.84 ± 11.42 in the patient group and 17.92 ± 9.23 in the control group, which indicates a significant (P = 0.005) difference between the two groups according to the independent sample t-test. Conclusion: The OHRQOL of patients has significantly decreased compared to the control group. Surgery had the lowest quality reduction, and combined surgical treatment with radiotherapy and chemotherapy had the highest reduction in the OHRQOL. It is recommended to have regular follow-up sessions and to have a proper diet during and after treatment.

Background: Surface smoothness considered to be a significant part of the appearance and success of the restorative materials. The aim of this study was to assess the influence of four different polishing systems on surface roughness of four resin composite materials when subjected to thermocycling. Materials and Methods: This research was designed as a comparative study. Four resin composites were used which are: Nanofill composite (Filtek Supreme XT), nanohybrid composite (Tetric EvoCeram), microfill composite (Renamel Microfill), and microhybrid composite (Filtek Z250). Sixty disk-shaped specimens of each resin composite were prepared then divided into four groups according to the polishing system (n = 15); which were Sof-Lex Spiral, Diatech Shapeguard, Venus Supra, and Astropol. The specimens of each group were polished following the manufactures' instructions, then surface roughness, R_a values in μm were measured initially and after the specimens subjected to thermal cycling. The influence of resin composites, polishing systems, thermocycling, and their interaction effects on surface roughness (R_a mean values) was statistically analyzed mainly by using the repeated measures two-way analysis of variance test, whereas the Bonferroni''s post hoc test was applied for pair-wise comparisons. P ≤ 0.05 was used as the significant level. Results: The results of this study revealed that Filtek Supreme XT recorded significantly the lowest mean surface roughness (R_a) of 0.2533 ± 0.073 μm (P < 0.001). The Sof-Lex Spiral polishing system revealed significantly the lowest mean surface roughness (Ra) of 0.2734 ± 0.0903 μm (P = 0.004). Regardless of composite type and polishing system, there was a statistically significant increase in mean surface roughness values (R_a) in μm after thermocycling (0.2251 ± 0.0496 μm and 0.3506 ± 0.0868 μm, respectively) (P < 0.001). Conclusion: Resin composite type, polishing method, and thermocycling aging significantly affected the surface roughness of composites; Nanofill composite and Sof-Lex Spiral polishing system provided the lowest values of surface roughness which increased after thermocycling.

Transplantation of one tooth to another site in the same individual can be considered an attractive alternative to dental implants or fixed prostheses. This study reports the treatment results of a 16-year-old female with severe crowding in upper and lower arches and a fractured mandibular premolar with a poor prognosis. The crowding of the lower left quadrant was relieved by the extraction of the first premolar. This extracted tooth with a complete root was transplanted to the right quadrant with the fractured tooth. Platelet-rich fibrin can stimulate and accelerate periodontal healing. The platelet concentrate of this patient was prepared and applied to the socket wall at the time of surgery. The acceptable occlusion and the excellent 4-year prognosis of the transplanted tooth are presented.

Background: Occlusal loading of osseointegrated implants is believed to be an essential determining factor in the long-term success of an implant treatment. Numerous studies have been conducted on the evaluation of stress distribution by definitive restoration materials for Implant-supported fixed prosthesis, but very few have evaluated provisional restoration materials for the same. This study aims to evaluate the influence of provisional restoration material – Milled Polymethylmethacrylate (PMMA) and Milled Polyetheretherketone (PEEK), over stress distribution on the peri-implant bone around an implant-supported three-unit, fixed dental prosthesis using finite element analysis method. Materials and Methods: Three-dimensional models of a pair of bone-level implant system and titanium base abutments were created using the standard tessellation language data of original implant components. A bone block representing the mandibular posterior area was created, and the implants were placed in the bone block with 100% osseointegration in the 2nd premolar to 2nd molar region. A superstructure of an implant-supported 3-unit bridge was modeled on top of the abutments, each crown to be 8 mm in height and with an outer diameter of 6 mm in 2^nd premolar region and 10 mm in 1^st molar and 2^nd molar region. Two different models were created according to combinations of provisional restoration materials, namely, Milled PMMA and Milled PEEK based on. In each model, the implants were loaded vertically (300 N) and obliquely (150 N at 30°). The stress distribution in the cortical bone, cancellous bone, and implant was evaluated through the von Mises stress analysis. Results: The results showed no difference in stress distribution due to the different provisional restorations – Milled PMMA and Milled PEEK. In addition, the vertical load resulted in higher stress values in the implant components, cortical bone, and cancellous bone in both PEEK and PMMA models as compared to oblique loading. Conclusion: The new polymer, PEEK was seen to provide comparable stress generation in the current study without exceeding the physiological limits of peri-implant bone. Thus, it can be considered as a good alternative to PMMA resin as a provisional crown material since it provides certain additional benefits.

Background: The burden of oral diseases is increasing, which constitute a major public health problem. The use of probiotics as an adjuvant, along with routine dental care practice by an individual, can produce additional benefits in the maintenance of one's oral health. The study aimed to investigate the effect of Bifidobacterium as a probiotic on oral health. Material and Methods: Six databases and registers were searched from the start of the database to December 2021 without any restrictions. Randomized controlled trials (RCTs) evaluating the clinical effects of Bifidobacterium as a probiotic on oral health were included in the study. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed to conduct this systematic review. The included studies were analyzed for the risk of bias using the Cochrane risk-of-bias tool for randomized trial (RoB 2) tool as well as quality of available evidence using GRADE criteria. Results: From the 22 qualified studies, four studies showed non-significant results. There was a high risk of bias in 13 studies and some concerns of bias in nine studies. No adverse effects were reported, and the quality of available evidence was moderate. Conclusion: The effect of Bifidobacterium on oral health is questionable. Further high-quality RCTs are required on the clinical effects of bifidobacteria and also the optimum level of probiotic needed, and ideal mode of administration to provide oral health benefits. Furthermore, synergistic effects of the combined use of various strains of probiotics need to be studied.

Root perforation may occur at any stage of endodontic treatment and is mostly due to iatrogenic injury and may compromise the outcome of endodontic treatment. Repairing a perforation is difficult and the prognosis depends on various factors such as time, site and size of perforation, and the patient's overall health status. Hence, choosing the most appropriate material can be critical for the dentist. In this case report of a strip-perforation repair, an mineral trioxide aggregate-like material (cold ceramic) that has been shown in previous studies to have favorable properties, was successfully used.

Background: Dentistry practice has become more complex and challenging in the recent years. The clinical decision-making process has experienced many problems due to changing socioeconomic patterns, knowledgeable patients, rapid technological advances, and information explosion. The present study reviewed the status of the attitude toward evidence-based dentistry (EBD) among dental students of Iran Universities. The effect of the educational intervention was also assessed. Materials and Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic review and Meta-Analysis checklist. Search strategy was developed by Medical Subject Headings terms and keywords surfing electronic available databases including Medline/PubMed and Google Scholar and local databases such as Scientific Information Database (SID) and Magiran. Two reviewers read the abstracts of all eligible papers and excluded the duplicates. They extracted the information of the full-text of the studies included in the review and assessed the quality by Joanna Briggs Institute critical appraisal checklist. Results: Ten studies including 8 cross-sectional and 2 interventional studies met the criteria. The assessment of the attitude of 937 dental students from a different region of the country toward EBD showed moderate to acceptable status using 3 different tools. In regard to educational interventions, 2 studies were successful to improve their attitude. Conclusion: Although the researchers presented good scores on the attitude questionnaires, the quality of the study tools, the eligible criteria for recruiting the participants and the method of evaluating the construct of attitude should be investigated in future studies.

Background: This in vitro study aimed to compare the fracture resistance of fiber post and reversed-oriented metal post in the restoration of severely decayed primary incisors. Materials and Methods: In this in vitro study, forty extracted human primary incisors were sectioned horizontally 1 mm above the CEJ and randomly divided into four groups – Group 1: Central incisors restored with reverse-oriented metal post, Group 2: Lateral incisors restored with reverse-oriented metal post, Group 3: Central incisors restored with fiber post, and Group 4: Lateral incisors restored with fiber post. The coronary portion of the teeth was then restored with nanohybrid universal composite. The fracture resistance was measured using universal testing machine. The type of fracture was determined by employing a stereomicroscope. Data were analyzed using two-way ANOVA test. The level of significance was considered at P < 0.05. Results: The mean fracture resistance of glass fiber posts (208.00 ± 73.19) was higher than the reverse-oriented metal posts (190.37 ± 56.36); however, there was no significant difference between any of the groups (P = 0.353). Conclusion: Within the limitations of this study, it can be concluded that both types of posts studied in the present research can be successfully used in the restoration of severely damaged primary incisors.

Background: The aim of this study was to investigate the effect of bleaching agent, sodium ascorbate as an antioxidant, and delay time on the shear bond strength (SBS) of orthodontic brackets to enamel using Transbond XT and universal adhesive. Materials and Methods: In this in vitro experimental study, 80 extracted maxillary premolars without any defect or decay were randomly divided into eight groups of 1: no bleaching + Transbond XT (NB/TX) bonding agent, 2: no bleaching + All-Bond Universal (NB/AB), 3: bleaching + Transbond XT (B/TX), 4: bleaching + All-Bond Universal (B/AB), 5: bleaching + sodium ascorbate + Transbond XT (B/SA/TX), 6: bleaching + sodium ascorbate + All-Bond Universal (B/SA/AB), 7: bleaching + Transbond XT after a 3-week delay (B/3W/TX), and 8: bleaching + All-Bond Universal after a 3-week delay (B/3W/AB). After thermocycling (1000 cycles, 5–55°C), the SBS was measured, and the adhesive remnant index scores were determined to assess the failure mode. Data were analyzed by one-way analysis of variance, Tamhane's post hoc test, Kruskal–Wallis, and Mann–Whitney U-test at the significance level of P < 0.05. Results: The mean SBS range was 5.5–29.78 MPa. The highest SBS values were related to Group 2 (NB/AB) which were significantly higher than all groups (P < 0.05) and the lowest values were observed in Group 5 (B/SA/TX) which were significantly lower than all groups except Group 3 (B/TX) (P < 0.05). Conclusion: Bleaching with 40% hydrogen peroxide significantly decreased the SBS of orthodontic brackets, and 10% sodium ascorbate could not reverse the adverse effect of bleaching on SBS. Delaying the bonding procedure by 3 weeks using Universal adhesive considerably decreased the adverse effect of bleaching on SBS and increased the SBS to a clinically acceptable level for orthodontic treatment.

Background: Panoramic radiography is a standard diagnostic imaging method for dentists. However, it is challenging to detect mandibular trauma and fractures in panoramic radiographs due to the superimposed facial skeleton structures. The objective of this study was to develop a deep learning algorithm that is capable of detecting mandibular fractures and trauma automatically and compare its performance with general dentists. Materials and Methods: This is a retrospective diagnostic test accuracy study. This study used a two-stage deep learning framework. To train the model, 190 panoramic images were collected from four different sources. The mandible was first segmented using a U-net model. Then, to detect fractures, a model named Faster region-based convolutional neural network was applied. In the end, a comparison was made between the accuracy, specificity, and sensitivity of artificial intelligence and general dentists in trauma diagnosis. Results: The mAP50 and mAP75 for object detection were 98.66% and 57.90%, respectively. The classification accuracy of the model was 91.67%. The sensitivity and specificity of the model were 100% and 83.33%, respectively. On the other hand, human-level diagnostic accuracy, sensitivity, and specificity were 87.22 ± 8.91, 82.22 ± 16.39, and 92.22 ± 6.33, respectively. Conclusion: Our framework can provide a level of performance better than general dentists when it comes to diagnosing trauma or fractures.

Background: The aim of this study was to compare the clinical, histological, and histomorphometrical outcomes of CenoBone^® allograft with and without plasma rich in growth factor (PRGF) for the preservation of edentulous ridge in the dental sockets. Materials and Methods: This study is experimental clinical trial that 14 dental sockets were included the sockets required ridge preservation followed by implant placement in the premolar and molar of the mandible. After extraction of the teeth, the CenoBone^® allograft and PRGF were used in the test group and CenoBone^® allograft was used alone in the control group. During the first stage of surgery and 5 months later, in the second stage of surgery (implant placement), the vertical changes of the ridge were measured. Furthermore, using Core-Biopsy in the second stage of surgery, criteria of histologic and histomorphometric were determined. Data were analyzed with t-test, Mann–Whitney U-test, and Fisher's exact test at the level of significance of P < 0.05. Results: The mean trabecular thickness in the test group (52.18 ± 5.53) was significantly higher than that in the control group (41.53 ± 10.40) (P = 0.344). However, there were no significant differences in the mean values of vertical bone absorption, bone percentage, remaining biomaterials, inflammation, and blood vessels between the two groups. There was no case of foreign body reaction and the bone was vital in all the cases and in direct contact with the biomaterial. Conclusion: Although CenoBone^® allograft with PRGF was effective in some histomorphometric factors such as trabecular thickness, it did not lead to significant clinical changes.

Background: During the orthodontic bonding process, the need for repositioning or rebonding of orthodontic brackets on the enamel surface occurs frequently. The aim of this study is to compare the shear bond strength (SBS) in rebonding orthodontic stainless steel brackets with three different methods of enamel surface conditioning methods. Materials and Methods: In this in vitro study, 80 human premolars that were extracted for orthodontic purposes were randomly divided into four groups and underwent orthodontic bonding procedure (N = 20). Except for the control group, three other groups underwent debonding and rebonding process in which after removing the remaining adhesive with tungsten-carbide bur, enamel surface conditioned by three different methods including re-etching with phosphoric acid, sandblasting + acid etching, and Erbium-doped Yttrium–Aluminum–Garnet laser. Then, the SBS of the bracket to the enamel surface was compared between different groups. Scanning Electron microscopy images were also obtained from a number of samples. Statistical analysis was performed by Kruskal–Wallis and Mann–Whitney tests. Results: The highest SBS was observed in the primary bond (control group) with an average of 29,440 MPa. There was a significant difference between the studied groups (P < 0.001) and only the group that was re-etched with phosphoric acid had no significant difference with the control group (P = 0.708) ∝ =0.05. Conclusion: Rebonding of brackets using phosphoric acid for reconditioning of the enamel surface creates bond strength comparable to the primary bond. Other groups had significantly lower SBS than the control group.

Background: This study aimed to assess the effect of laser irradiation and Tooth Mousse on tooth hypersensitivity (TH) after office bleaching (OB). Materials and Methods: This clinical trial, parallel-design split-mouth nonrandomized was conducted on 30 patients requiring OB. After scaling and fabrication of a custom tray, 35% hydrogen peroxide was applied on all teeth, and 940 nm diode laser (10 W, Class IV, 110–240 V) was irradiated to the upper and lower right quadrants. Laser in off mode was used for the left quadrants. Bleaching agent was then reapplied. After completion of bleaching, a custom tray containing tooth Mousse was placed on the maxillary arch while the tray was used without the paste for the mandibular arch. A visual analog scale was used to assess the degree of TH at 15 min and 24 h after OB. Data were compared using t-test, paired t-test, and analysis of variance. Significance level was set at α = 0.05. Results: Comparison of TH at 15 min and 24 h after OB showed a significantly lower TH score in the left upper quadrant (tooth Mousse alone) than right upper quadrant (both laser and Tooth Mousse) (P < 0.05). The TH score in the right upper quadrant was significantly lower than that in the right lower quadrant (laser only) (P < 0.05). The mean TH score in the left upper quadrant was insignificantly lower than that in the left lower quadrant (no intervention) (P > 0.05). Conclusion: The use of 940 nm diode laser for OB increases the postoperative TH. The application of Tooth Mousse can effectively decrease TH after OB with/without laser irradiation.

Background: Bonded composites may increase bacterial accumulation and caries formation risk. Therefore, assessment of methods to decrease bacterial activity around them would be valuable. The literature on the efficacy of adding silver nanoparticles to fiber-reinforced composite (FRC) or adding them to bonding agents in terms of their antibacterial activity and/or shear bond strength (SBS) is scarce. Thus, we aimed to assess the antibacterial activity of flowable composites and bonding agents containing various percentages of experimental silver nanoparticles (nanosilver) against S. mutans and to evaluate the SBS of FRC and bonding agents containing different amounts of nanosilver to enamel. Materials and Methods: In this preliminary study, 0% (control), 0.5%, 1%, 2.5%, and 5% nanosilver were added to flowable composite and bonding agent. Syntheses of nanosilver and nanosilver-incorporated composite specimens were approved using X-ray diffraction spectroscopy and scanning electron microscopy. Antibacterial effects of the produced materials on S. mutans were evaluated by colony count with serial dilution method (n = 7 groups × 10 [n = 70] specimens) and agar disc diffusion test (n = 6 groups × 5 [n = 30] composite specimens + n = 6 groups × 5 [n = 30] light-cured bonding + n = 6 groups × 5 [n = 30] uncured bonding) against negative control and cefotaxime antibiotic. Moreover, SBS values of various FRC blocks bonded to enamel using various bonding agents were measured (n = 9 groups × 6 [n = 54] human premolars). Data were analyzed using Kruskal–Wallis, Dunn, two-way analysis of variance, and Tukey's tests (α = 0.05). Results: Composite discs containing all concentrations of nanosilver reduced S. mutans colony counts (P < 0.05); bacterial growth was ceased at samples containing 2.5% and 5% of nanosilver. The reduction in the SBS of FRCs was significant only for 5% nanosilver (P < 0.05). Conclusion: Adding 0.5%, 1%, and 2.5% nanosilver to composite and 0.5% or 1% nanosilver to bonding agent led to a significant antibacterial behavior against S. mutans while not significantly affecting the SBS of FRC.

Background: The temporary cement remaining inside the dental prosthesis can act as a source of microbial colonization and contamination and decrease the final cement retention. Consequently, complete removal of temporary cement before permanent cementation is suggested. This study aimed to assess the effect of different cleaning methods for removing temporary cement on the tensile bond force (TBF) of permanently cemented implant-supported zirconia copings. Materials and Methods: In this in vitro study fifty titanium abutments were screwed onto 50 analogs with 30 Ncm torque into in acrylic resin blocks. Each abutment was scanned separately, and 50 zirconia copings were designed and milled. Permanent resin cement was used to cement copings of control group (N = 10). Copings were divided into two temporary cementation types that in each group, two cleansing methods were used: Temp-S (temporary cement with eugenol and sandblasted after debonding), Samples of the control group were placed in the universal testing machine, and the TBF values were recorded. Samples of the test groups after debonding and cleaning the abutments were subjected to cement with permanent resin cement, aging, and removing. Levene test, two-way analysis of variance (ANOVA), and Tamhane post hoc tests were applied. α = 0.05. Results: The highest and lowest TBF values were found for the TempNE-SU (554.7 ± 31.5 N) and Temp-S (492.2 ± 48 N) groups, respectively. The two groups of isopropyl alcohol baths in ultrasonics in combination with sandblasting showed statistically higher TBF values than the other two groups that used only sandblasting (P < 0.001) and had similar values compared to the control group. Conclusion: Sandblasting combined with immersion in an ultrasonic bath containing isopropyl alcohol resulted in statistically similar values to the values of cementation with resin cement from the beginning. However, cleaning the inside of the copings only by sandblasting method reduced the values of the final retention force in comparison to cement with permanent resin cement from the beginning.

Background: The use of a rubber dam is more important than ever in today's COVID-19 era to limit cross infections. In children, the placement of the metal clamp to retain the rubber dam is perceived to be painful and often requiring a local anesthetic injection. This dissuades many clinicians from placing the rubber dam. Hence, this study evaluated the pain response of children to a SoftClamp^™ compared to the conventional metal clamp. Materials and Methods: This was a randomized controlled, equal allocation ratio, split-mouth clinical trial. Forty-two children aged between 8 and 12 years, having two permanent mandibular molars in need of sealants, were divided into Groups A and B (metal clamp and SoftClamp^™, respectively). The pain response was recorded using both an objective and a subjective scale i.e., the Faces Legs Activity Cry Consolability (FLACC) scale and the Wong Baker Faces Pain Rating Scale (WBFPRS). The level of significance was set at 5% (P < 0.05). The pain response recorded from the WBFPRS and the FLACC scale for the metal and the SoftClamp^™ were analyzed using the Wilcoxon signed rank test. The difference in pain response between genders and between two age groups (below and above 10 years of age) was analyzed using the Mann–Whitney U-test. Results: The children reported mild discomfort to clamp placement in both the scales. The P values for the FLACC and WBFPRS scores comparing the pain response to the metal and SoftClamp^™ were 0.311 and 0.149, respectively. Conclusion: There was no significant difference in the pain response of children to both the clamps. Good rubber dam application practices in children through the use of behavior guidance and a proper topical anesthesia technique may play a far more important role regardless of the clamp used. But the SoftClamp^™, with its more child friendly appearance could be a viable alternative to the metal clamp in children.

Background: The demand for an ideal root canal filling material in primary teeth with maximum antibacterial properties keeps escalating to improve the success rate of root canal treatment in primary teeth. Hence, the present study was conducted to determine the antimicrobial efficacy of the different concentrations of a novel root canal filling material. Materials and Methods: An in vitro study was designed to compare the antimicrobial efficacy of different concentrations of the novel obturating material for primary teeth. Different concentrations of the novel obturating material were prepared using calcium hydroxide, zinc oxide cement, and metronidazole and were tested for its antimicrobial efficacy against Streptococcus mutans and Enterococcus faecalis using Mueller–Hinton Agar for 24 h at 37°C. The zone of inhibition was measured in millimeters after 24 h. The values were entered into a Microsoft Excel spreadsheet and subjected to statistical analysis. Descriptive statistics were used for data summarization and presentation. Friedman test and Kruskal–Wallis test were used to compare the different concentrations of the novel obturating materials against S. mutans and E. faecalis. P < 0.05 was considered to be significant. Results: Against S. mutans at 1% concentration, the zone of inhibition was statistically greater at 50 μl and at 2% and 3%, the zone of inhibition was greater at 100 μl. Similarly, against E. faecalis, the zone of inhibition was statistically greater at 100 μl at 2% and no significant difference was noted at 1% and 3%. Comparison between the groups at 25, 50, and 100 μl shows no significant difference against S. mutans between 1%, 2%, and 3% of 60–40 concentration. However, 3% 60–40 concentration at 50 μl shows significantly increased zone of inhibition against E. faecalis. Conclusion: Two percentage metronidazole at 60–40 (calcium hydroxide–zinc oxide) concentration of the novel obturating material at 100 μl has better antibacterial properties against both S. mutans and E. faecalis.

Background: The present study was conducted to develop a standard questionnaire to assess the knowledge and practice of prosthodontists regarding the diagnosis and treatment of obstructive sleep apnea syndrome (OSA). Materials and Methods: This study had questionnaire designing and cross-sectional-descriptive phases. Questionnaire domains were identified by a panel of eight experts. The face and content validity of the questionnaire was assessed by experts and four laypeople. The internal consistency reliability of the questionnaire was checked using Cronbach's alpha coefficient. Moreover, its stability was tested using the test–retest method. The questionnaire was completed online by 282 Iranian prosthodontists and the relationship between different variables and scores of knowledge and practice of them with simple and multiple linear regression tests was were analyzed. Results: A 32-item questionnaire was designed. The Scale Content Validity Index was >0.8 for clarity, simplicity, and necessity in all domains and the content validity of all questions was above 0.8. As for reliability, Cronbach's alpha coefficient was above 0.7 on average. Faculty members had more knowledge (P = 0.04) and better practice (P = 0.001) compared to others. Prosthodontists who participated in sleep disorders training courses had higher scores in knowledge (P = 0.001) and practice (P = 0.001). Prosthodontists who referred patients to sleep disorders clinics had higher knowledge (P = 0.001) and practice (P = 0.001) than those who did not. Conclusion: The questionnaire developed in this study can be considered a comprehensive and executable scale with appropriate reliability and validity. There is a positive relationship between being exposed to information and the level of knowledge and practice of prosthodontists about OSA.

Background: Minimally invasive techniques should be employed to maintain pulp vitality without affecting physiological tooth resorption for pediatric patients. This study aims to evaluate clinical and radiographic success of light cure calcium silicate and resin-modified glass ionomer (RMGI) as indirect pulp-capping agent in primary molars in children between 5 and 9 years. Materials and Methods: In this randomized clinical trial study, 40 primary molars with the International Caries Detection and Assessment System criteria 4–6 score were divided randomly into two groups after computerized randomization method. After caries excavation by minimally invasive dentistry principle, affected dentin was lined by either light cure calcium silicate (Group I) or RMGI (Group II) liner followed by composite restoration. Clinical success was determined with the absence of symptoms and bitewing radiographs were taken at baseline, 3, and 6 months' interval to measure increase in dentin increment using ImageJ software. Statistical analysis for intergroup comparison was done using Paired t-test, and Independent t-test was used for intragroup comparison. The level of statistical significance was set at P < 0.05. Results: Change in dentin increment seen from baseline to 6 months in Group I was 0.19 mm and in Group II was 0.20 mm (P = 0.924). Intragroup increment was statistically significant during all follow-up intervals for both the groups (Group I – P ≤ 0.001, Group II – P = 0.009). For baseline remaining dentin thickness >1.5 mm, statistically significant increase was observed in the dentin increment at 3 months' interval between both the groups. Conclusion: Both TheraCal LC and Vitrebond show acceptable clinical and radiographic results when used in primary molars as indirect pulp treatment agents. Both the liners are equivalent to each other in terms of feasibility and cost-effectiveness but TheraCal LC can be preferred due to better handling and avoiding the manipulation step thereby reducing treatment time.

Background: Pain following surgical removal of impacted molars has remained a principal concern among practitioners. Since green tea has anti-inflammatory and anti-bacterial properties, the current study aimed to evaluate the efficacy of green tea extract local application in controlling postoperative pain following surgical extraction of the impacted mandibular third molar teeth. Materials and Methods: In a double-blinded randomized controlled trial study with a split-mouth design, 32 patients underwent bilateral removal of impacted third molars in a 2-month time interval; afterward, the sterile gauzes impregnated with green tea extract and saline were applied randomly to the surgical sites. Postoperative pain was evaluated 6, 12, 24, and 48 h after surgery using a questionnaire based on the Visual Analog Scale (VAS) and the number of analgesics used after surgery. Data were subjected to exact and Chi-square tests with the significance level set at 0.05. Results: There was a decrease in the mean scores of the VAS and the mean number of analgesic consumptions in the first 2 days after surgery. Chi-square test results showed a significant reduction in the VAS scores after applying the green tea extract only 6 and 12 h after surgery (P < 0.05). Moreover, the number of analgesic consumptions was significantly lower in the green tea group compared to the control group. Conclusion: Green tea extract may be an appropriate and safe choice for postoperative pain control after surgical extraction of the impacted mandibular third molar teeth.

Background: Xenogeneic grafts have gained attention due to advantages in compare of autografts. This study aimed to compare Xeno (ostrich) Acellular Dermal Matrix (XADM) with the free gingival graft (FGG) to increase the width of Keratinized gingiva (KGW) in dogs. Materials and Methods: This split mouth animal study was performed on 10 mixed breed dogs. The upper second premolar sites were randomly selected for grafting by XADM (test) or FGG (control). Measurements of KGW were recorded before surgery, 1, 3, and 6 months after surgery. Biopsies from grafted sites for histologic and histomorphometric evaluations were harvested 6 months after surgery. Data were analyzed by repeated measured, paired samples t-test, and Wilcoxon Signed rank test. P < 0.05 was considered statistically significant. Results: KGW increased in the two study groups after surgery with no significant statistical difference between them at any time intervals (P > 0.05). The graft shrinkage was 23% and 21% for the test and control groups, respectively, without statistically significant difference (P > 0.05). Histomorphometric evaluation showed no significant difference between the two study groups. Foreign body reaction was not seen in any of the study groups. Conclusion: Increased KWG was similar between the two study groups. With regard to FGG limitations, XADM may be assumed as a suitable alternative for FGG. It should be noted that this research was an animal study and clinical trials on human should be performed to approve the efficacy and safety of this material.

Background: Pulpotomy is the most common pulp treatment of primary molars, where surgical amputation of infected coronal pulp results in preserving the vitality and function of radicular pulp. With introduction of newer materials, the emphasis has shifted towards regeneration, in this scenario; novel materials such as platelet derived growth factor (PDGF) and propolis (PS) have been considered. Materials and Methods: This was a single-blind in vivo study; ninety human primary teeth from children aged between 5 and 10 years were divided into three equal groups in whom pulpotomy procedure was performed and they were recalled after 3- and 6-month interval for histological evaluation. Observations were subjected to statistical analysis using Pearson's Chi-square test. Results: No statistically significant difference was found between the three materials with respect to inflammatory response, soft-tissue organization, and dentin bridge formation (P > 0.05). Majority of the samples in both growth factor and propolis exhibited dentin bridges at the interface of the exposed pulp, bringing or attempting to bridge the site exposed to the pulpotomy material. The ability of the material to evoke a foreign and inflammatory cell response in the pulpal tissue was not significant. The samples of both formocresol and growth factor group showed signs of pulpal necrosis which revealed the presence of a mild necrotic zone in one specimen at 3 months. One specimen from the propolis group showed mild areas of necrosis at the end of 6 months, where none of the specimens in the growth factor group showed areas of necrosis at the end of 6 months. Conclusion: The results of the present study showed a positive outcome for growth factor and propolis groups. Further clinical trials with a larger sample size and long-term review have to be conducted for the material to be used widely.

Background: There are controversies on the analgesic and anti-inflammatory effects of low-level laser therapy on pain, edema, and trismus after mandibular third molar extraction surgery. This study aimed to evaluate the efficacy of low-level laser therapy (LLLT) on discomforts occurring after the mandibular wisdom tooth removal. Materials and Methods: This double-blind, split-mouth design, randomized clinical trial study was performed on 36 healthy controls with bilateral symmetrical mandibular third molar referred to the Department of Oral and Maxillofacial Surgery of Dental Faculty from January to November 2019. After surgical extraction, the laser group underwent laser (Ga-Al-As diode laser, 808 nm, 200 mW) intraorally and extraorally just after surgery and 24 h after surgery. For the placebo group, the handpiece was inserted without laser irradiation. The pain level was assessed by Baker Wong scale at 2, 4, 6, 12, 24, 36, 48, and 60 h postoperatively, and the edema and the extent of mouth opening were examined before surgery, at the 1^st and 7^th days after surgery. The data were collected and analyzed by SPSS at the significant level of 0.05. Results: The statistical analysis of 32 participants' data (laser group: n = 32, placebo group: n = 32) indicated that the mean score of pain in 3 days after surgery in the interventional group was significantly lower than the score of the placebo group (P < 0.001). Furthermore, the swelling and the extent of the mouth opening differed significantly between the two groups at 1^st and 7^th days after the procedure (P < 0.001). Conclusion: Our findings showed that the LLLT had beneficial effects on the management of pain, edema, and trismus following after 3^rd molar extraction surgery.

Background: The fetal amniotic membrane is a biological graft with unique qualities which all lead to wound protection, reducing discomfort, and achieving adequate epithelialization. Materials and Methods: In this animal study, the second and third premolars of the mandible of 4 dogs were extracted. After 4 weeks, 20 mm of mandibular premolar site area were resected on both sides. The created defects on both sides were filled with xenograft. On one side, an amniotic membrane was placed over the graft particles and the reflected flap was sutured. The amount of bone formation in the defects was measured after 4 weeks for two of the dogs and after 8 weeks for the other two, using a caliper. Three histopathological samples from both sides were taken. The collected data were subjected to statistical analysis (Wilcoxon signed-rank and paired sample t-test) using SPSS software at a significant P = 0.05. Results: In the test group, the quantity of bone was 56.81, whereas in the control group bone quantity was 37.38 with statistically significant differences (P = 0.025). In the amniotic membrane group, the inflammation intensity after the graft procedure was moderate (50%) in comparison to the control group where the inflammation was severe (62.5%) (P = 0.041). Conclusion: The amniotic membrane can induce positive osteoinduction effects and be helpful in repairmen of bone defects such as the natural periosteum.

Background: Odontogenic keratocyst (OKC) is one of the most common jaw cysts with high recurrence rate. Some possible factors affecting recurrence that have not been evaluated in previous studies are examined in this study. This study aimed to predict the recurrence rate of OKC and more viable treatment of OKC. Materials and Methods: In this descriptive, analytical, and cross-sectional study, 10 recurrent OKCs, which both slides before and after recurrence were accessible, were collected from oral and maxillofacial pathology department's archive. First, they were evaluated based on common histopathologic features. In the second phase, the frequency of these findings in 36 OKCs (24 samples with recurrence and 12 without recurrence after 5 years) was evaluated based on clinical, radiological, and histopathologic features. Data were analyzed by SPSS, Wilcoxon signed-rank test, McNamara, t-test, Chi-square, Mann–Whitney, Fisher's exact test, Cohen's kappa coefficient, and odds ratio (P < 0/05). Results: According to this study, OKC in women, with multilocular radiolucency and mitosis in basal layer of epithelium as well as diffused inflammation, were statistically associated with probability of recurrence (P = 0.05, 0.035, 0.033, and 0.045, respectively). The corrugated surface, reverse polarity, hypercellularity in parabasal, and satellite cysts can affect the recurrence of OKC with odds ratios = 2.364, 2.364, 1.190, and 1.500, respectively). Conclusion: Gender (women), multilocular radiolucency, diffused inflammation in stroma, and mitosis in basal layer of epithelial lining, can statically predict the possibility of recurrence rate. In addition, findings regarding the age (in younger patients), corrugated surface, reverse polarity, and sub-basal cleft can be helpful in predicting recurrence.

Background: Dental anxiety has negative effects on dentists' pain management. Patients have different levels of pain tolerance. Therefore, providing psychological interventions can reduce treatment avoidance and promote oral health. This study compared the effect of acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) on pain coping strategies and pain perception intensity in patients with dental anxiety. Materials and Methods: This clinical trial with a pretest–posttest control group design and a 3-month follow-up period was performed on 45 patients with dental anxiety. They were randomly selected by convenience sampling method and assigned to two experimental groups and one control group. The first experimental group underwent 10 sessions of ACT, the second experimental group underwent 10 sessions of CBT, and the control group underwent oral care training. Data were collected by the Rosenstiel and Keefe's Coping Strategies Questionnaire and McGill Pain Questionnaire and analyzed by SPSS (version 24) software. The considered significance level is 0.05. Results: The results showed no significant difference between ACT and CBT in pain coping strategies and pain perception intensity (P < 0.05) but indicated a significant difference between the treatment groups and the control group. Moreover, the results showed a significant difference between posttest and follow-up and pretest in pain coping strategies and pain perception intensity (P < 0.01) but indicated no significant difference between posttest and follow-up (P < 0.05). Conclusion: ACT and CBT can play an important role in the sustainable improvement of pain coping strategies and pain perception intensity in patients with dental anxiety.

Ameloblastoma is a benign tumor of odontogenic epithelium which is slow growing, locally invasive, expansive that may result with asymmetries of the face. Conservative treatment of odontogenic tumors with marsupialization is not common but can be done successfully in those with cystic pattern. The aim of this case and literature review is to propose marsupialization as an initial procedure for its treatment. We have presented a case of an ameloblastoma involving 56-year-old male patient. Orthopantomography and computed tomography showed the lesion extended between the right molar region and left molar region of mandible with both buccal and lingual expansion and root resorptions. On clinical examination, expansions of mandible and slight tooth mobilities were seen. An incisional biopsy was carried out and histopathologic examination revealed ameloblastoma although clinical features of lesion were more suggestive of cyst. Our case was treated by obturator marsupialization with a good healing. This case and review of the literature discusses the available treatment option according to macroscopic features of jaw lesions and emphasizes on the importance of the most conservative treatment option. Conservative treatment preserves integrity of bones while radical treatment can leave major cosmetic and functional sequelae such as pathologic fractures, complication with reconstruction plates.

Background: General anesthesia in dentistry has been widely utilized in cases of uncontrollable fear/anxiety and uncooperative patients, patients of young age, and those allergic to local anesthesia and with other existing systemic diseases. These people usually require re-treatment owing to their weak immunity. Our study investigates the frequency and the prevalence of re-treatment in patients and candidates for dental procedure under general anesthesia in Isfahan during 1393–1396. Materials and Methods: The present cross-sectional study randomly chose 162 patients who were candidates for dental procedures. Patients who came in for re-treatment twice or more during this period were identified and their records were requested from the archives. Demographic data, reason for using general anesthesia, underlying disease, physical condition, and mental condition were all gathered through a questionnaire. The causative etiology of re-treatment was identified by examining the patients' medical records including restorations, denervation, tooth extraction, filling, and pulpotomy. Statistical analysis was performed using the SPSS software (version 25) and tests such as Kolmogorov–Smirnov Z-test, Spearman, and Chi-square test. P < 0.05 was considered statistically significant. Results: The findings of the present study showed that 92.25% of patients needed dental re-treatment during their second visit. The most needed treatment was in the second repair session and the least was related to prosthetics. It was also noted that 42.15% of patients needed dental treatment at the third visit and the highest need for treatment was in the third prosthesis session and the lowest reason was related to tooth restoration and extraction. Conclusion: The most needed treatment was in the second session of endodontic treatment, and in the third session, tooth extraction was one of the required treatments, which indicates the progression of dental problems in the interval between treatments.

Background: This study presented a cleaning method for orthodontic NiTi-closed coils and evaluated its effect on the force characteristics of these coils. Materials and Methods: In this in vitro study, 160 orthodontic NiTi-closed coils, 160 orthodontic NiTi-closed coils (9 mm) from two brands G and H and DB, randomly assigned into four groups. Group 1: Three times of immersion in the 10% hydrochloric acid (HCI) solution for 1 min followed by the immersion in 5.25% sodium hypochlorite solution for 5 min. Group 2: Three times autoclave sterilization. Group 3: Three times of immersion in 10% HCI solution for 1 min, followed by the immersion in 5.25% sodium hypochlorite solution for 5 min and autoclave sterilization. Group 4: No immersion and no sterilization. The forces of coils were measured at 25, 23, 21, 19, and 17 mm extension. To measure the force characteristics of coils, an electromechanical universal testing machine was used. For the statistical analysis, Kolmogorov–Smirnov, Kruskal–Wallis, and Mann–Whitney U-tests were used at 0.05 significance level. Results: In G and H coils, no significant differences between the mean forces of different groups were found in any extensions. In DB coils, only in 25 mm extension, there were no significant differences between the groups (P = 0.144). In 17-, 19-, and 21-mm extensions, significant differences (P < 0.001) were found like in 23 mm extension (P = 0.05). In both brands, more extension makes significant more forces statistically (P < 0.01). In all extensions, G and H coils have significant less forces (P < 0.001). Conclusion: Immersion in HCl, 10% for 1 min followed by the immersion in NaOCl, 5.25% for 5 min followed by autoclave sterilization, even three times repeating of this process, did not result in significant changes in the force characteristics of A-NiTi-closed coils.

Background: Infants and children who experience pain in early life, show long-term changes in terms of pain perception and related behaviors. Local anesthesia is integral to the practice of painless dentistry but the pain of injection itself is deterrent to successful administration of local anesthesia and can be a most anxiety-provoking procedure. Distraction as a behavior management technique is successfully known to reduce pain and manage children's dental behavior by diverting their attention away from painful stimuli during invasive dental procedure. This study aimed to compare the pain associated with local anesthetic injection delivered with and without the use of distraction as a behavior management technique in 6–8-year-old children. Materials and Methods: In this randomized, clinical, in vivo study with a split-mouth design we compared the pain of 30 children (6–8-year-old), requiring dental treatment necessitating the use of local anesthesia bilaterally in either of their maxillary and mandibular arches. Treatment was done in two visits, 1 week apart. Children were randomly assigned to receive the distraction (iPad) at one visit while no distraction in other visits. Two different pain assessment scales were used: Wong-Baker faces pain scale (FPS) and FPS-Revised. The Chi-square test was used for statistical analysis. P ≤ 0.05 was considered to be statistical significance. Results: Children who received local anesthesia with audiovisual distraction had lower pain rating scores than those who received local anesthesia with no distraction. Conclusion: Audiovisual distraction significantly reduces pain associated with injection of local anesthesia.

Background: Zinc oxide (ZnO) and graphene oxide (GO) nanoparticles (NPs) have antimicrobial properties. The present study was undertaken to evaluate the effects of incorporating these NPs and their chemical and physical blends on abrasion, translucency, and microhardness of flowable composite resin. Materials and Methods: In the present in vitro study, flowable composite resin samples (Grandio Flow, VOCO, Germany) were evaluated in 5 groups and the sample size was 10 for each group of each experiment (n = 10) as follows: Group 1, without NPs; Group 2, with ZnO NPs; Group 3, with GO NPs; Group 4, containing a physical mixture of GO and ZnO; and Group 5, containing a chemical mixture of GO and ZnO NPs. In all the groups, 1 wt% of the NPs were incorporate into flowable composite resin. Abrasion, translucency, and microhardness of the samples were evaluated. Data were analyzed with analysis of variance, followed by post hoc Tukey's tests at the level of significance of P < 0.05. Results: In Groups 2, 4, and 5 (all the groups containing ZnO), a significant decrease in abrasion and microhardness of flowable composite resin was observed compared to the control group. Incorporation of NPs in all the groups resulted in a significant decrease in translucency compared to the control group. Conclusion: Incorporation of NPs into flowable composite resin resulted in a decrease in translucency. The microhardness was reduced in groups containing ZnO, but the abrasion was also reduced in these groups. The incorporation of GO did not significantly alter the abrasion and microhardness of the composite resin.

Background: This study aimed to assess the microshear bond strength (micro-SBS) of two universal adhesives with different pH values in etch-and-rinse (E and R) and self-etch (SE) modes to superficial dentin. Materials and Methods: This in vitro experimental study evaluated 75 extracted sound human third molars. Superficial dentin was exposed by trimming the enamel and removing 0.5–1 mm of tooth structure beyond the dentinoenamel junction. A 600-grit abrasive paper was used to create smear layer. The teeth were randomly divided into five groups (n = 15). All-Bond Universal and G-Premio Bond were applied in E and R and SE modes in four groups. Clearfil SE Bond was used in the control group. Z350XT composite cylinders (0.9 mm diameter and 1.5 mm height) were then bonded to the prepared surface. The teeth were incubated at 37°C and 100% humidity for 24 h. Micro-SBS was measured by a universal testing machine, and the mode of failure was determined under a stereomicroscope. Data were analyzed using ANOVA, Bonferroni test, and Fisher's exact test (alpha = 0.05). Results: The micro-SBS of Clearfil SE Bond was significantly lower than all other groups (P < 0.05). All-Bond Universal yielded the maximum micro-SBS in SE and minimum micro-SBS in E and R mode. All-Bond Universal showed significantly lower micro-SBS in E and R mode than SE mode (P < 0.05). No other significant differences were noted. The mode of failure was also significantly different among the groups (P < 0.05). Mixed failure had the highest frequency in G-Premio in E and R mode. Conclusion: Type of adhesive and application mode affected the micro-shear bond strength to superficial dentin.

Background: Periodontitis, the second most common reason for tooth loss in adults, is a chronic inflammatory condition that increases the prevalence of cancer by inhibiting apoptosis and promoting tumor cell growth. However, it is still debatable if tooth loss is an important risk factor in oral cancer (OC). The aim of this systematic review is to analyze the relationship between tooth loss and the probability of developing head-and-neck cancer and also to see if there is an association between tooth loss, periodontitis, and the risk of OC. Materials and Methods: Studies that depicted a link between tooth loss and OC (till 2017) were searched from online databases accompanied by a thorough manual search of relevant journals. Data were collected from eligible studies, and meta-analysis was carried out using the Meta-Analysis software. The effect of various inclusions was assessed by sensitivity and subgroup analysis. Publication bias was also evaluated. Results: The meta-analysis consisted of 15 publications. When the number of teeth lost was counted, there was significant variability (I2 = 98.7%, P = 0.0001). When more than 15 teeth were missing in a subgroup analysis, there was a 2.4 times greater risk of OC (odds ratio: 2.496, 95% confidence interval [CI] = 2.067–3.015, P = 0.001) with no heterogeneity (I2 = 0.00%, 95% CI for I2 = 0.00–68.98). Subgroup analysis revealed that there was no evidence of publication bias. Conclusion: It was concluded that tooth loss can increase the OC risk by nearly 2 folds. However, large-scale population-based studies are needed to substantiate the findings.

Background: The aim of the current study was to evaluate the outcomes and complications of three-unit porcelain-fused-to-metal tooth-implant-supported prostheses in comparison with implant-supported prostheses. Materials and Methods: In this review article, the electronic databases, PubMed, Scopus, LILACS, Web of Science, EBSCO, LIVIVO, and Embase were searched over the past 20 years until December 2021. Risk ratio with 95% confidence interval (CI), fixed effect model, and Mantel–Haenszel method was calculated. The meta-analysis was performed with the statistical software Stata/MP v. 16. Results: Two hundred and three studies were selected for reviewing the abstracts, from which the full texts of 16 studies were reviewed. Finally, five studies were selected. The risk ratio of prosthesis failure between the tooth-implant-supported prosthesis and the implant-supported prosthesis was RR (Risk Ratio)= 1.83 (0.79, 4.24), (P = 0.16) and for prosthesis complication, it was RR = 0.61 (0.35, 1.06), (P = 0.08). Risk ratio of implant failure between the mentioned groups was RR = 2.33 (0.84, 6.41), (P = 0.10), and for implant complications, this rate was 0.09 (RR, 0.09 95% CI − 1.30, 1.48; P = 0.90). Conclusion: The meta-analysis of the present study showed that there was no significant difference between the two groups (three-unit porcelain-fused-to-metal tooth-implant-supported prosthesis and implant-supported prosthesis reconstruction) in terms of the total failure of implants and prostheses and the complication rate of implants and prostheses.

Background: The aim of the study was to compare the root reinforcement potential of different light cured intraorifice barriers (TheraCal, lime-lite, Ionoseal and resin-modified glass-ionomer [RMGI] [Fuji II LC]) with or without bonding agent placed in the orifice of endodontically treated and bleached teeth. Materials and Methods: In this experimental in vitro study, single-rooted bovine teeth were instrumented and obturated with gutta-percha. Except the control group, in other specimens, gutta-percha was removed 3 mm under cementoenamel junction. Then, the specimens were divided into seven groups according to the bases was applied: TheraCal LC, TheraCal LC with bonding agent, Lime-Lite, Lime-Lite with bonding agent, Ionoseal, Ionoseal with bonding agent, and RMGI (Fuji II LC). After internal bleaching, the teeth were decoronated. Then, all the groups were subjected to fracture resistance testing using Universal Testing Machine. For evaluating fracture resistance, analysis of variance and Tukey's test were used and for comparing the mode of fracture fisher test was applied in SPSS software. The significance was determined at (α = 0.05) confidence interval. Results: The group of TheraCal LC with bonding agent showed better fracture resistance as compared to the control group (P = 0.004). Although there was no statistically significant difference in the pairwise comparison between the other groups. Conclusion: TheraCal LC with bonding agent can be used as intraorifice barriers with good fracture resistance in endodontically treated and bleached teeth.

Background: The use of photodynamic therapy (PDT) has been evaluated as an adjunctive technique for bacterial decontamination of implants with peri-implantitis. Given the controversies over the efficacy of the application of PDT to treat peri-implant diseases, the present clinical study aimed to evaluate the posttherapeutic clinical parameters and cytokine levels in peri-implant crevicular fluid in patients with peri-implant mucosal inflammation, receiving mechanical debridement (MD) alone or in association with PDT. Materials and Methods: In this double-blinded randomized clinical trial, 52 patients with peri-implant mucosal inflammation were selected and they were randomly assigned to 2 treatment groups: a MD group and an MD + PDT group using an 805 nm laser and indocyanine green (ICG). Although the decrease in bleeding on probing was the primary outcome, pocket depth, PUS, pain on probing, clinical attachment level, gingival recession, tumor necrosis factor-α, interleukin (IL)-1β, IL-6 and matrix metalloproteinase-8 were also evaluated at baseline, 2-week, and 3-month postintervention. Repeated measure analysis of variance was used to analyze inter-group differences and a P ≤ 0.05 was considered for significant differences between tested parameters. Results: Statistically significant improvements (P < 0.001) were detected for all variables after comparison of baseline data with those collected at each time interval of the study. Nevertheless, the inter-group comparisons of these variables between the baseline, 2-week, and 3-month intervals did not reveal any significant decrease in sites treated with either MD alone or MD + PDT. Conclusion: The application of PDT using 805-nm laser and ICG as an adjunct therapy to MD did not provide any additional improvements in the clinical or biologic parameters of peri-implant mucosal inflammation.

Background: Decontaminating the implant surface, exposed to bacterial biofilm, is a concern in the treatment of peri-implant inflammatory disease. The aim of this study was to compare the effect of several methods on reduction of the bacterial load, colonized on the surfaces of titanium discs. Materials and Methods: In this in vivo study, seven titanium discs with Sandblasted, Large-grit, acid-etched (SLA) surface were placed in the mouth of each of ten patients with chronic periodontitis by an intra-oral maxillary splint for 24 h. In each patient, the contaminated discs, except for the negative control ones, were randomly treated by one of the six antiseptic methods including sterile normal saline, plastic curette, air polisher, hydrogen peroxide, 980 nm diode laser, and Er-YAG laser. A spectrophotometer was used to measure Optical Density (OD) in case of aerobic microorganisms. Colony-Forming Units (CFUs) were used for anaerobic bacteria. Data were analyzed through Kruskal–Wallis and Mann–Whitney Tests at a significance level of α =0.05 by SPSS software. Results: Statistical analysis showed a significant decrease in OD of aerobic bacteria among the seven groups during a 0–24 h time interval (P < 0.001). Furthermore, these tests showed a significant difference in the CFU (P < 0.001) for anaerobic bacteria after 48 h. Conclusion: The results of this study showed that all of the adopted methods significantly reduced microbial colonies on the surfaces of titanium discs with SLA surface. Er: YAG laser and normal saline had the highest and the lowest effects, respectively.

Background: There is some concern that root resection may alter the surface features and crack formation of the previously set orthograde material. The aim of this in vitro study was to evaluate the crack formation in orthograde mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) plugs after root resection. Materials and Methods: This in vitro study was conducted on 170 extracted human maxillary anterior teeth. The teeth were randomly divided three experimental (n = 50) and control (n = 20) groups. In Group 1, after root canal treatment, half of the roots were cut with a bur, and the other half with an ultrasonic cutter. In Groups 2 and 3, after the 4-mm CEM and MTA plugs were placed and set, the root ends of half of the samples were cut with a bur and the other half by an ultrasonic cutter. The prevalence of cracks in the dentin and orthograde apical plugs of MTA and CEM was then assessed by scanning electron microscopy. Data were analyzed using the McNemar's, Chi-square, and Fisher's exact tests at P ≤ 0.05 level of significance. Results: In general, the prevalence of crack in dentin in Groups 2 and 3 was significantly higher than in the plug (P < 0.05). There was no significant difference in the prevalence of dentin crack in the studied groups (P > 0.05). The prevalence of crack in dentin was lower when the bur was used to cut off the end of the root, although the difference was not significant. The prevalence of crack in the plug was similar in CEM and MTA. Conclusion: Based on the results of this study, the prevalence of crack in dentin is always significantly higher than its prevalence in the plug, and the prevalence of crack in the plug was similar in CEM and MTA; then, when there is an orthograde access to the root canal and surgery is likely in future, MTA and CEM can be placed in an orthograde technique and it just resects the root during surgery.

Background: Comparing the net setting time and radiopacity of an Iranian glass ionomer cement (GIC) and Fuji II (GC, Japan) according to ISO 9917-1:2007 standard. Materials and Methods: In this experimental/in vitro study, for both tests, we prepared 20 samples of Fuji II glass ionomer (self-cure restorative glass ionomer, batch number: 1608031, GC Corporation, Tokyo, Japan) and Iranian glass ionomer (Ava Tajhiz Dandan-Iran) at P/L of 2/7:1. Then, to determine the net setting time, we prepared a metal mold with dimensions of 10 mm in length, 8 mm in width, and 5 mm in height. Ninety seconds after mixing, the surface of the sample was subjected to the indenter, and the net setting time was recorded as the time elapsed between the end of the mixing and the time needle stopped making a complete circular indentation. To determine radiopacity, the specimens were poured into a mold with a diameter of 15 mm and thickness of 1 mm. Samples and a step wedge were irradiated with X-rays. Particle size analysis and Energy-dispersive X-ray spectroscopy (EDS) analysis were also done for both cements. Test results were investigated with SPSS and through independent t-test (P < 0.05). Results: The mean value of net setting time for Fuji II was 4.83 min and for the Iranian Glass ionomer was 3.83 min (P < 0.05). The mean value of radiopacity for Fuji II was 2.3 mmAL and for Iranian Glass ionomer was 1.9 mmAl (P < 0.05). Conclusion: Net setting time and radiopacity of the glass ionomers were within the range of ISO 9917-1:2007. If all properties of the Iranian cement are set appropriately in future investigations, we propose to use it instead of Fuji II GIC. This has the additional benefit of being cost-efficient as Iranian cement costs less than Fuji II cement.

It is a major concern to select a proper ceramic with acceptable strength and esthetic and minimum antagonist wear. Therefore, different ceramics were introduced to obtain these advantages with various surface treatments. The aim of this study is to evaluate and report the wear behavior of polished and glazed feldspathic and zirconia crowns in published articles up to 2020. Five electronic databases which were used in this research were MEDLINE (via PubMed), Web of Science, Cochrane Library, Embase, and Scopus from the starting date of databases to January 2020. The Keywords “zirconia,” “feldspathic,” “dental ceramic,” “enamel,” “Y-TZP,” “wear,” “glazed,” and “polished” were used. English articles were selected in this paper. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used as a reporting template as much as possible. Among the initially 133 articles, 59 duplicated articles were removed, and finally, 52 articles were screened and among them, only 16 articles remained for full-text regaining. The results showed that zirconia had significantly less antagonist wear than feldspathic groups, and polishing had less enamel wear than other types of surface treatment like glazing. Only one study showed that glazed zirconia can have more antagonist wear than feldspathic porcelain. Monolithic zirconia had less enamel wear than conventional zirconia and low-fusing feldspathic porcelain showed lower antagonist wear in comparing with other types of feldspathic porcelains.

Background: The aim of this research was to assess the effectiveness of eggshell–membrane (ESM)-containing hyaluronic acid (HA) in the treatment of open gingival embrasure (OGE) following orthodontic tooth movement (OTM). Materials and Methods: This study is an in vivo quasi experimental research. A total of 24 Cavia cobaya were equally divided into two groups, treatment (10% HA injection) and control (phosphate-buffered saline [PBS]). A separator was inserted between mandibular incisors to induce an OGE. A volume of 20 μl of either PBS (n = 12) or ESM extract (n = 12) was locally injected within the interdental papilla. Decapitation of animals was made on day 1, 4, and 7 postinjection. The staining was done using hemotoxylin and eosin to observe angiogenesis and Mallory to observe the collagen density. Fourier-transform infrared spectroscopy (FTIR) and thin-layer chromatography (TLC) analysis were performed to detect the amount of HA available in ESM. The results were then compared with independent t-tests and the Mann–Whitney test. The level of statistical significance was set at 0.05. Results: The FTIR and TLC analysis showed that HA was successfully identified in the ESM samples. Local injection of 10% HA induced an increase of angiogenesis compared to the control group on day 1 and 4 postinjection (P < 0.05). Significant differences (P < 0.05) were also noted in the collagen density and the growth of interdental papilla on day 4 and 7 postinjection. Conclusion: ESM has the potential effect of regenerating the interdental papilla construction after OTM by increasing the collagen fiber density and inducing angiogenesis.

Background: To compare and evaluate the oral hygiene status among institutionalized visually impaired children using the Verbal, Braille, and Audio-Tactile method. Materials and Methods: The present study was a single-blinded, randomized clinical trial with a total of 96 visually impaired children both male and female, aged 6–16 years old were included in this study from a residential school for blind. They were divided into three groups: Group 1 − Verbal method, Group 2 − Braille method, and Group 3 − Audio-Tactile method. Baseline oral hygiene scores were recorded using the debris index, calculus index, gingival index and hand scaling was performed for all the children. Fone's brushing technique was taught to all the groups and fluoridated toothpaste was given to the children with 3 and 6 months of follow-up. Periodic reinforcement of oral hygiene instructions was done for each group. The collected data were tabulated and analyzed using the ANOVA test with (P < 0.01). Results: There was significant improvement in debris index, gingival index, and calculus index in all the three groups by the end of 6 months. All the three indices showed improvement in oral hygiene. Conclusion: Visually impaired children could maintain a respectable level of oral hygiene when taught specialized methods. However, periodic reinforcement is mandatory for good oral hygiene maintenance. Hence, it is recommended to use the combination of Verbal, Braille, and Audio-Tactile method for the best treatment outcomes in these special children.

Background: Professionalism is a multidimensional concept, defined as conducting oneself with responsibility, integrity, accountability, and excellence. This study aimed to contextualize American Dental Education Association (ADEA) tool on action on professionalism in dental education in Mashhad and apply it in a cross-sectional study. Materials and Methods: This descriptive-analytic study was conducted on all students of Mashhad School during 2018–2019. The ADEA tool for action on professionalism in dental education was applied. It was firstly contextualized, validated, and its reliability was confirmed by test–retest and Cronbach's alpha. Then, it was applied in a cross-sectional study. Data were analyzed using Lisrel, and SPSS: 16. ANOVA and Tukey's honestly significant difference tests were used to compare the study variables. Results: The tool was valid and reliable for applying in the Iranian context (x2/df <3, RMSEA ≈ 0.1 and indices of comparative fit index, incremental fit index, goodness-of-fit index, and adjusted GFI are >0.7). In the cross-sectional study for measuring professionalism, the mean score of 1^st-year dental students was significantly higher than 3^rd-year dental students (F = 2.75, P = 0.002). Furthermore, the mean score of 1^st-year dental students was also significantly higher than 6^th-year students (F = 4.53, P = 0.001). The comparison of the component of professionalism among 1^st-to 6^th-year students showed that there was no statistically significant difference between the total score of males and females. In addition, no statistically significant difference was found between the total score of local and nonlocal students. Conclusion: The Tool is valid and reliable for applying in the Iranian context. Dental students need to be trained and also practice professional behaviors during their senior years of college.

Background: Considering the important role of fluoride in preventing caries by reducing the number and activity of cariogenic bacteria and introducing new fluoride-releasing tooth-colored restorative materials, this study was performed to compare and evaluate fluoride ion release and antibacterial activity of resin-modified GI, zirconomer, giomer (Beautifil), and Cention N. Materials and Methods: In this experimental in vitro study, eighty samples (20 samples in each group) were prepared, 10 samples for fluoride testing and 10 samples for antibacterial activity. To evaluate the release of fluoride (PPM), fluoride ion-selective electrode was used on days 1^st, 3^rd, 7^th, 14^th, and 21^st; and antibacterial activities against Streptococcus mutans were examined using direct contact test by absorption of light hourly once every 5 h and days 1^st, 2^nd, and 7^th using an ELISA reader with a microplate reader of 800 TS at a wavelength of 630 nm. The results were analyzed using one-way ANOVA, Tamhane post hoc test, and paired t-test in SPSS software (IBM, Somers, NJ, USA) at a significant level of (P < 0.05). Results: The release of fluoride from materials showed a statistically significant difference (P < 0.001). The maximum mean of fluoride released during the 1^st, 3^rd and 7^th days belonged to the zirconomer group and the minimum for the giomer group. During the measurement period of light absorption from 0 to 24 h after planting, light absorption of foursubstances together was found to be statistically significant (P <.001). Zirconomer light absorption increased on the 7^th day, unlike other substances, but still, the minimum light absorption was related to zirconomer. Conclusion: The highest fluoride release was in zirconomer, Cention N, fuji II LC, and giomer, sequentially. Zirconomer showed maximum and giomer showed minimum antibacterial activities.

Background: One of the most important objectives of pediatric dentistry during dental practice is pain control and effective anesthesia. Because of the limitations of inferior alveolar nerve block (IANB), other techniques such as infiltration injection are suggested. Infiltration technique by using some other solutions such as articaine is an appropriate alteration for mandibular anesthesia. The aim of this study is to compare the efficacy of IANB using lidocaine with infiltration injection by articaine in mandibular second primary molar anesthesia in 8–11-year-old children. Materials and Methods: This is a randomized, cross-over, clinical trial that was performed on 42 children aged 8–11 years, who needed extraction of both mandibular second primary molars. After clinical and radiographic investigations, block or infiltration injection was chosen randomly and treatment was performed in one side in each session. Patient's behavior was registered in two steps of injection and extraction by SEM scores. For comparison of the two sides, Wilcoxon–signed rank test was used (P < 0.05). Results: We concluded that infiltration technique resulted in decrease of all the three SEM scores in comparison to block injection (P < 0.05). The effectiveness of two techniques during tooth extraction, although grade of lidocaine block was more than infiltrate, was not statistically significant. Conclusion: It seems that infiltration technique with articaine is a better substitute for block technique in the extraction of mandibular primary molars.

Background: Preservation of pulpal vitality is of paramount importance as the vital functioning pulp is capable of initiating a unique reparative capacity. The present study aimed to evaluate and compare four regenerative materials for pulpotomy in primary molars. Materials and Methods: This in vivo study included a total of 120 primary molars from 30 healthy children aged 3–9 years for regenerative pulpotomy procedure. The teeth were then divided by the lottery method (chits with names of materials on it) into four groups so that each child received all four of the regenerative materials; Group 1: Biodentine (BD)™, Group II: Mineral Trioxide Aggregate Plus (MTA Plus™), Group III: Retro MTA (Retro MTA^®), and Group IV: Calcium Enriched Mixture (CEM) cement. All the primary molars (1^st/2^nd molars) were evaluated clinically and radiographically at 6, 12, 18, and 24 months. Data were subjected to the statistical analysis using the Chi-square test. The level of significance was considered as P < 0.05. Results: Clinical evaluation showed 100% success with BD™ and CEM cement; whereas 96.2% success was seen with MTA Plus™ and Retro MTA^®. On radiographic evaluation, MTA Plus™ and CEM cement showed 96.2% success, whereas BD™ and Retro MTA^® showed 92.59% success rate. Conclusion: All four regenerative materials showed high success in the pulpotomy of primary molars.

Background: Despite significant improvements in the physical and esthetic properties of modern composite resins, there are still concerns about their biocompatibility. The aim of the current study was to evaluate the toxicity of X-tra fil, Grandio, and Admira Fusion composites on dental pulp stem cells (DPSCs) and human gingival fibroblast (HGF) cells. Materials and Methods: In this in vitro experimental study, 48 composite disks were made using Grandio, Admira Fusion (2 mm high and 4 mm in diameter), and X-tra fil (4 mm high and 4 mm in diameter) composites and cured for 40 s. The composite blocks were then crushed with a sterile mortar and dissolved in phosphate saline buffer solution. Tetrazolium salt (3-(4,5-dimethyl thiazol-2-yl)-2,5 diphenyltetrazolium bromide (MTT_, neutral red (NR) assay, flow cytometry, and quantitative real-time polymerase chain reaction (RT-PCR) tests (n = 5) were used to evaluate the toxicity of the composites on two cell types (HGF, DPSCs). Data were analyzed using one-way ANOVA test followed by Newman–Keuls test. Level of significance was set at P < 0.05. Results: According to the results of MTT test, only Grandio showed a significant cytotoxicity in DPSCs, but in HGF cells, Grandio and X-tra fil both showed a significant cytotoxicity. In NR test, Grandio and X-tra fil composites showed a significant cytotoxicity on both HGF and DPSC cells. RT-PCR test results on both DPSC and HGF cells indicated that bax gene expression in the Grandio composite was significant. In this test, the nonexpression of the bcl2 gene in DPSCs was significant in Grandio (100 and 200 μg/ml) and in X-tra fil (200 μg/ml). All of the tests performed in this study showed no significant toxicity of Admira fusion. Conclusion: Admira Fusion is suitable for oral cells in terms of biocompatibility and can be used as a suitable restorative material for deep restorations near the pulp or adjacent to the gums.

Background: Denture bases undergo repeated flexing during mastication leading to fatigue failure, demanding a high fatigue strength property. Flexural (transverse) strength is required high to prevent catastrophic failure under load for success. Denture base resins are fabricated by three different types of manufacturing: Compression molding, injection molding and computer-aided design (CAD/CAM) milling technique. The study was conducted to identify the denture with the highest flexural strength (Fs) from these methods. Materials and Methods: In this in vitro study. Three groups of 15 PMMA acrylic denture base resins (total 45) were processed into rectangular plates of size 65mm × 10mm × 3mm. The three groups differed in the method of processing as compression molded, injection molded, and prepolymerized CAD/CAM milled resins. A 3-point bend test was used to measure the Fs. One-way analysis of variance (ANOVA) with the Post hoc Tukey method was used for statistical analysis. Data was statistically significant with Post hoc Tukey method significance at P < 0.05. Results: The mean Fs of CAD/CAM, injection molding, and compression molding manufacturing techniques are 97.46, 84.42, and 71.72 respectively and standard deviation obtained are 9.93, 10.42, and 11.58, respectively. Statistical analysis suggested the CAD/CAM technique as the best method for the fabrication of dentures because it had the maximum mean Fs and the lowest Fs standard deviation when compared with compression molding and injection molding. Conclusion: Denture bases fabricated through CAD/CAM technique are more sustainable than the compression-molded and injection-molded denture bases.

Background: Head-and-neck radiotherapy can change oral Candida species and cause candidiasis resistance to common antifungals by making the changes to the oral cavity environment. Voriconazole is a synthetic azole with extensive antifungal activity. The current study aimed at comparing the antifungal activity of fluconazole and voriconazole on Candida species isolated from the oral cavity of patients undergoing head-and-neck radiotherapy. Materials and Methods: The present in vitro study was performed on samples isolated from patients undergoing head-and-neck radiotherapy, before and during radiotherapy. After the identification of the species, the antifungal effect of fluconazole and voriconazole was determined by the microdilution method, and the minimum inhibitory concentration (MIC), the minimum fungicidal concentration, and the antifungal susceptibility of the isolated strains were also measured. The data were analyzed by the Chi-squared and then two-sided Fisher's exact tests. P < 0.05 was considered statistically significant. Results: The study findings showed no significant difference in the susceptibility of Candida albicans to voriconazole and fluconazole before and during radiotherapy. Before radiotherapy, both voriconazole and fluconazole had similar effects on Candida tropicalis, but after radiotherapy, voriconazole was less effective. However, both before and during radiotherapy, fluconazole had a greater antifungal effect than voriconazole on Candida glabrata strains. The MICs of voriconazole and fluconazole for both Candida parapsilosis and Candida krusei isolates were within the susceptible or dose-dependent range. Conclusion: The current study results showed that voriconazole was not more effective than fluconazole in the treatment of oral candidiasis in patients undergoing head-and-neck radiotherapy.

Background: Oral lichen planus (OLP) is a chronic immune-mediated mucocutaneous disorder, with an unknown etiology. Since, both pain and discomfort are observed in patients with the erosive type, many drugs have been studied to alleviate pain and clinical symptoms. The present study aimed to assess the effectiveness of systemic Echinacea on clinical indices of OLP. Materials and Methods: In this randomized, double-blind, placebo-controlled trial, 70 patients with erosive OLP were randomly divided into two groups, and each was treated with Echinacea tablets or placebo, 3 times a day, for 35 days. In addition, betamethasone lotion (0.1%) or nystatin (100,000 units) mouthwash were used by patients. The pain severity (visual analog scale [VAS]), lesion size, and the number of lesions were assessed at baseline and on days 10, 25, and 35 after study initiation. Finally, the obtained data were analyzed by statistical software, and Mann–Whitney test, Wilcoxon test, KaplanMeier, Chi-squared, and paired t-test. Results: The VAS scores in the Echinacea group were significantly reduced at each visit compared to the placebo group (P < 0.001). We observed a significant difference between the two groups (P < 0.01). Conclusion: We showed that Echinacea is an effective and complementary therapy for OLP. Furthermore, in short-term usage, Echinacea is almost completely tolerable.

Background: Silver and zinc oxide (ZnO) nanoparticles have recently become common to coat ligatures in order to take advantage of positive properties of nanoparticles, although there are concerns about their cytotoxicity. This study tended to compare subcutaneous inflammatory response induced by elastomeric orthodontic ligatures coated with silver and ZnO nanoparticles with a control group in rats. Materials and Methods: In this in vitro and animal cross-sectional descriptive-analytical study, silver nanoparticles were synthesized by chemical reduction of silver nitrate solution in the presence of sodium borohydride and ZnO nanoparticles by the same method and by chemical reduction of zinc sulfate solution with sodium hydroxide and were coated on elastomeric ligatures. Subcutaneous inflammation degrees were assessed after 15 and 30 days and were compared in the groups by Kruskal–Wallis test and ordinal generalized estimation equation with exchangeable correlation matrix. All tests were performed with a significance level (P = 0.05). Results: There was a significant difference in terms of degrees of inflammation in the groups coated with ZnO nanoparticles (P = 0.003) and silver nanoparticles (P = 0.04) compared to the control group in 15- and 30-day samples. Zinc nanoparticles caused 3.22 times more inflammation than silver nanoparticles (P = 0.053). The decrease in inflammation was significant over time in all groups (P = 0.001). Conclusion: There was a significant more inflammation in the groups receiving ZnO and silver nanoparticles compared to the control group in 15- and 30-day samples. Silver nanoparticles are probably safer than zinc nanoparticles for tissue and a better material to choose for antibacterial effects.

Background: Dentin hypersensitivity is a prevalent problem, manifested as a short sharp pain. Researchers have used different lasers to treat this condition. The present study aimed to evaluate the effect of 980 and 810-nm high-level diode lasers on dentin hypersensitivity to determine proper laser parameters for clinical applications. Materials and Methods: In this double-blinded randomized clinical trial, seven patients with 60 teeth affected by dentin hypersensitivity were selected for the present double-blind, randomized clinical trial. The patients' teeth were randomly matched and assigned to three groups: Group 1: 980-nm diode laser; Group 2: 810-nm diode laser; and Group 3: Control, which received only the guiding beam. The laser parameters were 1-W power, continuous wave mode, a distance of 1 mm, no contact, a 45° irradiation angle, and a 30-s exposure time using to-and-fro movements. The treatment consisted of two sessions with a 1-week interval. Pain severity was determined with the visual analog scale (VAS) at all the study intervals using a dry ice spray. The data were analyzed with SPSS version 20 using one-way ANOVA, repeated measures ANOVA, and least significant difference tests. Significance level was set at α = 0.05. Results: The changes in VAS were significant only in the first stage (P = 0.046). The mean VAS scores decreased over time in the 810-nm and 980 laser groups. A comparison of VAS changes relative to the baseline revealed significant changes in VAS scores at all the time intervals with both lasers. The two 810 and 980-nm laser groups did not exhibit any significant differences for 2 months postoperatively (P = 0.098). Conclusion: The application of 810 and 980-nm diode lasers at 1-W power and an exposure time of 30 s was effective in decreasing pain in patients with dentin hypersensitivity, with no significant difference between these two lasers.

Background: A significant improvement in the nasal symmetry after presurgical nasoalveolar molding (PNAM) is seen in complete unilateral cleft lip and palate (UCLP) infants. However, the follow-up changes in the nasal symmetry before and after PNAM and surgical repair have not been well documented. Materials and Methods: The purpose of this retrospective study is to assess the progressive changes in the nasal symmetry after PNAM and primary cheiloplasty to 1 year in complete UCLP infants. Out of 28 complete UCLP patients who were given PNAM treatment during the period between January 2014 to March 2019, 19 UCLP infants could be included for the study. Submental oblique photographs at the initial visit (T1), immediately after cheiloplasty (T2), and 1 year (T3) after cheiloplasty were selected, and quantity of nasal asymmetry at each period (T1–T2; T1–T3; and T2–T3) was analyzed by paired t-test (P < 0.05). Results: The quantity of asymmetry revealed that there was a highly significant improvement (P < 0.001) in nasal asymmetry at T1–T2 and T1–T3. Nonsignificant relapse was observed at T2–T3; however, a significant relapse in nasal dome height was observed during this period. Conclusion: The improvement in the nasal symmetry after cheiloplasty in PNAM-treated patients is maintained till 1 year postsurgically though there is a nonsignificant relapse.

The aim of this article is to compare the functional efficiency of tooth-supported overdentures and implant-supported overdentures in patients requiring oral rehabilitation. The comparative quantification of the improvement in functional efficiency is very difficult to assess because of the variations in the study designs like the age of the population studied, the male-to-female ratio, the outcome measures used, the clinical setting in which the implant therapy was provided, oral status of the subjects included and the type of implant therapy provided. In this systematic review, the articles included compared the functional efficiency by assessing the bite force, chewing efficiency, electromyographic (EMG) changes measured by EMG analysis, and patient satisfaction for subjects who have been rehabilitated with either a tooth-supported overdenture or an implant-supported overdenture. This will help the clinicians to better plan the treatment, keeping in mind the long-term prognosis for that particular patient.

It may not be possible to treat large maxillofacial defects by surgical reconstruction alone. Prosthetic rehabilitation is invariably required to restore esthetics and function. Achieving adequate retention, stability, and support in these maxillofacial prostheses is a challenging task. This clinical report describes prosthetic rehabilitation of a midfacial defect following surgical resection of squamous cell carcinoma. The intraoral defect was restored with a maxillary obturator prosthesis with salivary reservoir, and the extraoral defect was restored with magnet-retained facial prosthesis having an acrylic resin framework and an overlying silicone facial prosthesis.

One of the most challenging esthetic concerns in dentistry is conservative replacement of the missing anterior teeth. Although implants are considered to be a better treatment option for rehabilitation of such patients, resin-bonded bridges (RBBs) can conservatively restore the missing teeth and have thus gained popularity over the years. It consists of an artificial tooth with a wing-like extension that is cemented to the adjacent teeth. There are various types of RBBs among which Maryland bridge is the simplest and the popular most due to its micromechanical retention enabled by acid etching of both tooth and metal retainer. It can be fabricated by various techniques and materials. In this case reports, we have discussed about two unique designs of Maryland bridge fabricated by two different materials (Porcelain-fused metal and Graphene) and utilizing two different techniques (conventional and digital).

Background: The chemical bond between the metal and the porcelain component is likely to fail in metal-porcelain restorations. This is due to the thick oxide layer that Cr–Co alloys create. This study aimed to investigate the effect of metal conditioner on controlling the oxide layer formed on the surface of the Sintron alloy and the strength of the metal–porcelain bond. Materials and Methods: In this in vitro study, 33 samples were divided into three groups based on surface treatment (n = 11). In all three groups, an oxide layer was created. In the first group, Shofu metal conditioner, in the second group, metal conditioner of Creation, and in the third group, no metal conditioner was applied. All samples were then subjected to 3000 heat cycles between 5° and 55°C with a stop time of 5 s. The specimens were then placed in a universal testing machine for shear bond testing. A force was applied between the alloy and the porcelain by a 5 kN load cell at the speed of 1 mm/min until a fraction occurred. Intergroup comparison was made by the one-way analysis of variance followed by the Tukey's multiple comparisons test (α = 0.05). Results: The mean shear bond strength of the first group was 34.93 MPa and the mean shear bond strength of the second group was 31.37 MPa. The mean shear bond strength of the first and the second group was significantly higher than the third group (23.37 MPa) (PV < 0.001). Conclusion: The use of metal conditioners between ceramill Sintron alloy and porcelain (Vita VMK MASTER) led to increasing the bond strength.

Background: Although glass-ionomer cement (GIC) has many unique properties and advantages, it still lacks favorable mechanical properties. Cention N is a recent alkasite material with excellent mechanical properties. The purpose of this study was to compare the mechanical properties (fracture toughness [FT] and flexural strength [FS]) and acid buffer capability of an alkasite material to GIC. Materials and Methods: In this in vitro study, a total of 60 samples were prepared using Cention N or GIC. Twenty specimens (n = 10) were prepared using beam-shaped Teflon molds for FS, and twenty specimens (n = 10) were prepared with a similar mold with a notch for FT. These were evaluated on a universal testing machine using a three-point bend test. Twenty (n = 10) disk-shaped specimens were prepared for acid buffer capability. The samples were stored in distilled water for a week. This was followed by immersion in lactic acid with a pH of 4 for calculation of the materials acid buffering capacity at 30 and 60 min from exposure using a pH meter. The data obtained were tabulated and subjected to Kolmogorov–Smirnov test and Shapiro–Wilk test to assess the normal distribution and further analyzed using the Student's t-test to assess the level of significance, P < 0.05 was considered statistically significant. Results: The mean FT, FS, and acid buffer capability of Cention N were significantly higher than GIC at P < 0.05. Conclusion: The present study surmised that Cention N exhibited higher FT, FS, and acid buffer capability than GIC.

Background: The aim of the study was to assess the opportunities and threats of e-learning in dental schools and explore the experiences of dental faculty members in the coronavirus disease-19 (COVID-19) epidemic conditions. Materials and Methods: The present study was a sequential exploratory mixed method study (quantitative-qualitative). In the quantitative phase, a survey study was conducted to investigate the perspectives of faculty members regarding the opportunities and threats of e-learning during the COVID-19 epidemic. The data were analyzed by descriptive indicators (frequency, percentage, mean, and standard deviation) and analytical tests (t-test and analysis of variance). In the qualitative phase, data were collected through semi-structured interviews. In the qualitative phase, the inductive content analysis approach of Graneheim and Lundman was used to analyze the interviews. Results: In this study, 213 faculty members of dental schools of Iran participated; among whom 100 were men (46.9%) and 133 were women (53.1%). The results indicated the mean scores of the perspectives of faculty members regarding the opportunities and threats of e-learning in dentistry (4.05 ± 0.49 out of 5). Experiences of the participants in the qualitative phase were explored in the theme of “ups and downs of e-learning in dentistry” with three categories “unaccountability of e-learning in dental education,” “challenges of human resource empowerment in the e-learning process,” and “planned education.” Conclusion: The majority of the faculty members agreed with the use of e-learning in dental education and considered it as an opportunity. However, educational design for blended learning, creation of appropriate infrastructures, and empowerment of human resources as e-teacher and e-student were emphasized as key requirements for e-learning development in dental schools.

Background: To overcome the drawbacks of sinus floor augmentation procedures newer surgical techniques to reduce sinus perforation such as crestal approach sinus kit (CAS) and piezosurgery, which are minimally invasive procedures enabling uncomplicated sinus elevation have evolved. The aim of the present study was to investigate the performance of CAS kit compared to piezosurgery during maxillary sinus membrane elevation. Materials and Methods: A total of 40 subjects requiring maxillary sinus membrane augmentation for rehabilitation with implant prosthesis in posterior maxilla were included in the study. The current study was a prospective clinical trial where osteotomy and sinus elevation was done using CAS kit in Group 1 and piezosurgery in Group 2. Platelet-rich fibrin was placed in osteotomy site and dental implants were inserted. Implant stability was evaluated at baseline and 3 months. Crestal bone loss was measured at 3, 6, and 12 months. Apical bone gain was measured at 6 and 12 months. Intragroup comparison of the study groups was done by Paired t-test, ANOVA test, and Friedman test. Intergroup comparison was done by unpaired t-test and Mann–Whitney U-test. P < 0.05 was considered statistically significant. Results: Implant stability improved in both the groups, i.e., 79.2 ± 5.02 and 79 ± 5.31 in Group 1 and Group 2, respectively, at 3 months. Intergroup comparison showed no difference in all parameters; however, crestal bone loss was greater in piezosurgery group with a mean difference of 0.74 mm. Conclusion: Both CAS and piezosurgery groups showed definitive improvement in all parameters. CAS group resulted in added benefits in terms of less crestal bone loss and intraoperative surgical time compared to piezosurgery group.

Background: The aim of the study was to compare the root coverage percentage and other clinical outcomes in Millers Class I and Class II gingival recessions (GR) treated with modified coronally advanced flap (MCAF) combined with connective tissue graft (CTG) using macro and microsurgical approaches. Materials and Methods: In this controlled clinical trial, a total of 32 Miller's Class I and Class II GR defects were randomly assigned to the control and test groups (16 in each group). All the patients were treated with MCAF with CTG as the root coverage procedure. For the control and test groups, the procedure was performed using a macro and microsurgical approach, respectively. Clinical parameters were assessed at baseline and in 6^th month. Wilcoxon signed–rank test was used to compare the values between baseline and 6 months. Statistical significance was set at P < 0.05. 1 week after surgery, wound healing index (WHI) and Visual Analog Scale (VAS) scores were recorded. Results: Intragroup comparisons revealed significant improvement in all the parameters in both the groups at 6 months. The proportion of root coverage achieved in the control and test groups was 78% and 86%, respectively. At 6 months, the root coverage percentage between the study groups showed no significant difference (P = 0.207). Intergroup analysis of WHI and VAS scores showed better healing and less postoperative pain in the microsurgical group compared to macrosurgical group (P < 0.05). Conclusion: At 6 months, there were no significant differences in root coverage percentage or other clinical parameters between the groups based on whether a macro or microsurgical method was used. However, better wound healing, less pain, and discomfort were observed in the microsurgical group.

Background: The delayed diagnosis of oral squamous cell carcinoma (OSCC) affects therapeutic and prognostic strategies, and provides regional recurrence or distant metastasis. The tumor-infiltrating lymphocytes (TILs) are known as a critical diagnostic biomarker in antitumor immune response. We evaluated the association between CD4⁺ T-lymphocyte marker, some clinicopathological indices, and the impact of TILs on the stage and grade of OSCC. Materials and Methods: In this cross-sectional study, 37 OSCC specimens including 16 early and 21 advanced stages (categorized base-on recent clinical oncology references) and their related healthy surgical margin (as internal control group) were collected. Obtained histochemical data were analyzed by SPSS V.23 software. The expression of CD4⁺ marker in tumor microenvironment (TME) was compared by nonparametric Mann–Whitney and Kruskal–Wallis as well as Fisher's exact tests. P < 0.05 was remarked statistically significant. Results: The low-grade patients represented more CD4⁺ TIL that was statistically significant (P = 0.011). However, there was no statistically significant difference in CD4⁺ TIL between various stages (P = 0.404), tumor size, and lymph node involvement (P > 0.05). Moreover, there was no significant relation between TIL infiltration, age, and tumor localization (P > 0.05), however CD4⁺ expression in women was more than men (P = 0.008). The CD4⁺ T-lymphocyte infiltration in TME was more significant than healthy surgical margin (P < 0.001). There was a statistically significant difference between healthy surgical margin and different grades and stages of OSCCs that lower grades demonstrated more CD4⁺ TIL infiltration (P < 0.001). Conclusion: The CD4⁺ T-lymphocytes may play important role in differentiation and maturity of epithelial cell, tumorigenesis, and progression of OSCC.

Background: Chronic periodontitis (CP) is characterized by an immune response, leading to the destruction of periodontal supporting tissue. The effect of inflammatory and genetic factors on periodontitis has been evaluated previously. The interleukin (IL-17) as an inflammation regulator seems to play a critical role in periodontitis pathogenesis. Here, in the current study, we aimed to investigate the association of -197 G > A (rs2275913) IL-17 gene promoter polymorphism with generalized severe CP in an Iranian population. Materials and Methods: In this case–control study, a total of 54 patients with periodontitis and 118 normals were enrolled. The polymerase chain reaction-restriction fragment length polymorphism technique was applied to detect IL-17 promoter rs2275913 genotypes in association with the susceptibility to severe CP. Chi-square test or Fisher's exact test was employed to compare genotype frequencies between groups. P < 0.05 were considered statistically significant. Results: The distribution of genotypes and alleles was in Hardy–Weinberg equilibrium. Although no significant association was observed between the risk of periodontitis and genotype frequencies under any of the inheritance models, the GG genotype was higher in healthy controls, while the AG genotype was more frequently observed in patients under the codominant model ([odd ratio [OR] = 2.14, 95% confidence interval (CI) (1.01–4.53), P = 0.13]). The frequency of AG-AA genotype was higher in patients under dominant inheritance model ([OR = 1.92, 95% CI (0.94–3.93), P = 0.068]), while GG-AA and AG genotypes were higher in healthy controls under over dominant model (OR = 0.1.95, 95% CI [0.98-3.86], P = 0.055). Conclusion: The results of this study showed that the presence of allele A and AG genotypes could be considered possible factors in increasing the risk of developing CP, although the differences of allele and genotype frequencies were remarkable but not statistically significant between the two groups.

Background: Pulpotomy is one of the common vital pulp therapy procedures for primary molars. The present trend in pulpotomy materials is to use regenerative materials that promote dentinogenesis. Mineral trioxide aggregate (MTA) is a very popular pulpotomy material. However, it has some limitations including difficult handling characteristics and long setting time. Tricalcium silicate cements evolved, in which bioceramic cements came into existence, have better properties than MTA. The aims and objectives of the study are to evaluate the efficacy of bioceramic putty with MTA as a pulp medicament in primary molars. Materials and Methods: In this randomized in vivo study, sixty primary molars in children aged 4–9 years indicated for pulpotomy were selected. They were assigned using nonprobability convenient sampling technique into two groups: test group – bioceramic putty (EndoSequence Root Repair Material) and control group – MTA (Angelus). After pulp therapy, teeth were restored with stainless steel crowns. Recall clinical and radiographic evaluation was done at 3-, 6-, and 12-month interval to assess success rate. The data were statistically analyzed using Chi-square test, and P ≤ 0.05 was set for statistical significance. Results: At 3-month interval, the success rates were 96.7% and 93.1% with bioceramic and MTA groups, respectively. At 6- and 12-month interval, the success rates were 93.3% and 93.1% with bioceramic and MTA groups, respectively. However, the difference in success rate between the groups was statistically not significant at all the time intervals (P = 0.533 at 3 months, P = 0.972 at 6 and 12 months). Conclusion: Bioceramic putty exhibited comparable results to MTA. Hence, it can be considered alternative pulpotomy agent.

The restoration of speech, deglutition, mastication, and respiration in patients with bimaxillary resection involving the maxillae, hard and soft palates, and paranasal sinuses poses a significant challenge. This clinical report describes the prosthodontic management of a patient with bilateral maxillectomy caused due to post-COVID-19 mucormycosis. A patient-specific implants (PSI) that matched the remnants of the zygoma complex was designed to improve the patient's severely impaired speech and swallowing. The patient's postsurgical anatomy was first visualized using three-dimensional computed tomography data. Following that, a customized zygoma-supported titanium framework was designed to support the prosthesis based on the data. Two weeks after the framework was installed, an open-tray impression was made and the prosthesis was fabricated. These findings suggest that PSI-retained prosthesis can be considered in cases with severely compromised maxillary bone anatomy, impaired oral functioning, and no viable conventional reconstruction options.

Background: The main drawbacks of zirconia are its high refractive index and opacity. This study aimed to assess the effect of sintering temperature on the translucency of Ivoclar e. max ZirCAD (IEZ), and White Peaks Symphony (WPS) zirconia blocks. Materials and Methods: In this in vitro experimental study, 30 IEZ and 30 WPS zirconia blocks measuring 10 mm × 10 mm × 1 mm were prepared and underwent sintering in three subgroups at 1440°C, 1500°C, and 1530°C. The specimens were then photographed against a black and a white background with a standard digital camera. The L*, a*, and b* color parameters were measured using Adobe Photoshop software, and translucency was calculated. Data were analyzed using one-way ANOVA and Tukey's test (P < 0.05). Results: In both the IEZ and WPS groups, the maximum and minimum translucency parameters were recorded in 1530°C and 1440°C subgroups, respectively. The difference in the mean translucency was significant among the three subgroups of each zirconia group (P < 0.001). The mean translucency of WPS zirconia was significantly higher than that of IEZ zirconia (P < 0.01), and maximum difference was noted at 1500°C sintering temperature. Conclusion: Increasing the sintering temperature from 1440°C to 1530°C can significantly increase the translucency of IEZ and WPS zirconia blocks, and can be considered to improve the quality of zirconia restorations.

Background: Graphene oxide (GO), a product of graphite, is a candidate for nano-reinforcing cement-based materials due to its good water dispersibility and excellent mechanical properties. On the other hand, zinc oxide (ZnO) is well-known for its antibacterial characteristics as well. Therefore, we aimed to evaluate the impacts of adding ZnO and GO nanoparticles on the antibacterial properties of flowable composites. Materials and Methods: In this, in vitro experimental study was designated into five groups containing: (1) no nanoparticles as control group, (2) 1 wt.% ZnO nanoparticle, (3) 1 wt.% GO, (4) 1 wt.% physical compound of ZnO and GO, and (5) 1 wt.% chemical compound of ZnO and GO. The antibacterial properties of composite resin discs were evaluated by direct contact test. Data were analyzed using a one-way analysis of variance, followed by Tukey's post hoc tests (P = 0.05). Results: Streptococcus mutans colony counting in the first 24 h showed the least growth rate in the chemical compound group (2.2 × 10^[5]). However, in 7 days, the least colony number was observed in the GO group (2 × 10^[3]). Moreover, the physical compound showed the least bacterial adhesion. Conclusion: Adding GO alone to composites, compared to adding ZnO or physical and chemical compounds of GO-ZnO, was more helpful to increase the antimicrobial characteristics.

Background: A new method to improve the properties of the materials is nano-encapsulation, which improves the biological properties, antibacterial activity along with reduction of toxicity. Due to the spread of nano-knowledge, the present study was performed to evaluate the antibacterial effect of nano-chlorhexidine (CHX) on Enterococcus faecalis biofilm in the root canal system. Materials and Methods: In this in vitro experimental study, 55 matured single-root mandibular premolars were decoronated and the canals were prepared by single length method up to #F3 ProTaper Universal system. Five teeth were selected as negative control. Then, the teeth were randomly divided into three experimental groups (n = 15) and a positive control group (n = 5). The experimental groups were irrigated with 2% nano- CHX gel, 2% CHX solution, and 5.25% sodium hypochlorite (NaOCl), respectively. Finally, the number of colonies was counted. Kruskal–Wallis test was used to compare the number of colonies among groups. The level of significance was set at P < 0.05. Results: The mean number of colonies in the groups of nano-CHX, NaOCl, CHX, and positive control were obtained as 17.73 ± 18.69, 35.53 ± 36.42, 38.8 ± 31.8, and 96.8 ± 22.52, respectively. There was a significant decrease in the number of colonies in all the experimental groups compared to the control group (P < 0.05). However, difference in the number of colonies among these three groups was not significant (P > 0.05). Conclusion: The use of nano-CHX in removing E. faecalis biofilm from root canal is as effective as the use of CHX and NaOCl.

Background: This study aims to compare cytotoxicity and induced apoptosis of a new bioceramic cement containing different concentrations of simvastatin on stem cells from human exfoliated deciduous teeth (SHED). Materials and Methods: This research was an in vitro study. To evaluate the cytotoxicity and induced apoptosis of the bioceramic cement containing different concentrations of simvastatin, the SHED were exposed to the cement during 1, 3, and 7 days. Pure bioceramic cement and pure simvastatin with concentrations of 1, 0.1, and 0.01 μM were also tested to evaluate the possible synergic effect. Mineral trioxide aggregate (MTA) as the gold standard of pulp dressing materials was compared. MTT assay and Annexin V assay were used to evaluate cytotoxicity and induced apoptosis, respectively. The data were analyzed using ANOVA and Tukey post hoc tests at the significance level of 0.05. Results: During 7 days, MTA, bioceramic cement, simvastatin 0.1 and 0.01 μM, and bioceramic cement containing 0.1 and 0.01 μM simvastatin increased (P < 0.05) and simvastatin with concentration of 1 μM decreased the cell viability (P < 0.05). Except for MTA and bioceramic cement containing 0.1 and 0.01 μM simvastatin, all other compounds induced apoptosis within 7 days (P < 0.05). Conclusion: After 7 days, the viability of the SHED in the presence of a new bioceramic cement containing 0.1 and 0.01 μM simvastatin was not compromised. Moreover, this cement showed superior results than MTA and provided an environment for cell proliferation. This finding appears to be due to the pharmacological effects of low concentrations of simvastatin.

Reconstruction of functional occlusion in case of a large surgical defect of the mandible involving partial mandibulectomy remains a significant challenge to the maxillofacial surgeon and prosthodontist. Removable appliances and the conventional implant-supported prosthesis are precluded in this case due to the absence of normal anatomical contours of the bone. In recent years, due to the advancement of technology, bone graft reconstruction with computer-guided rehabilitation of the functional occlusion has been advocated to reverse the debilitating effects of the hemimandibulectomy defect. This clinical report describes the prosthodontic management of fibular graft reconstructed mandible by computer-aided design–computer-aided manufacturing guided implant-supported prosthesis.

From the perspectives of longevity, mechanical performance, and economics, amalgam has long been considered the material of choice, especially for certain types of restorations in posterior teeth, including replacement therapy for existing amalgam fillings. In spite of numerous advantages over other filling materials, its use has been decreasing in recent years and the alternative tooth-colored filling materials are increasingly used. There is a trend towards minimal interventional, adhesive, techniques in dentistry, which are based on adhesion to tooth structure by chemical interaction and/or micromechanical retention. At the same time, the quality and durability of alternative materials have improved. Mercury is the metallic element of concern used in dental amalgam. Mercury is a well-documented toxicant, with reasonably well-defined characteristics for the major forms of exposure, involving elemental mercury as well as organic and inorganic mercury compounds. Looking into the kind of practice and its popularity among dentists and the patients in India, even we have to comply with the use of amalgam by implementing the best possible ways to minimize the extent of damage to nature.

Background: This study aimed to investigate the extent of apical transportation following instrumentation with EdgeEvolve rotary instruments applying single-length and crown-down techniques. Materials and Methods: In this experimental in-vitro study, 60 mandibular molars with mesiobuccal curvatures of 20°–40° were selected, and digital radiographic images were taken. Teeth were randomly assigned into two groups of single-length and crown-down preparation techniques. In both mentioned groups, EdgeEvolve rotary system was used. After preparation, the same as the previous ones, digital radiographic images were taken from the canals. The data were analyzed using Student's t-test and ShapiroWilk normality test (P = 0.05). Results: The mean standard deviation (SD) for apical transportation in the single-length and the crown-down group was 4.42 (2.9) and 7.48 (3.9) degrees, respectively (P < 0.05). The mean SD of the preparation time in the single-length and crown-down group was 135.07 (30.8) and 109.07 (20.8), respectively (P < 0.05). The apical transportation and the time of preparation between the two groups were significant. Conclusion: Using EdgeEvolve rotary instruments canal preparation with both single-length and crown-down techniques led to some degrees of apical transportation.

Many patients, particularly adults, may prefer clear aligner treatment due to its esthetics and ease of use. Some studies have shown that mechanical vibration can affect the rate of tooth movement and other aspects of orthodontic treatment. The purpose of this systematic review was to substantiate the effects of vibration as an adjunct to clear aligner treatment. A comprehensive search of the PubMed, Embase, Cochrane library, and Scopus and also hand searching of reference lists was conducted for finding published studies up to March 2021. Two authors reviewed the titles and abstracts independently to select relevant studies and the full texts where there was some skepticism. Seven papers were included in this study following removing duplicates and irrelevant studies, four of which were randomized controlled trial and three were retrospective studies. In the majority of studies, High-Frequency Vibration (HFV) has shown to be effective in accelerating tooth movement and reducing the exchange interval of aligners. Little data have advocated that HFV can increase bone density, reduce pain or root resorption. It seems that HFV is more effective than low frequency vibration in patients treated with clear aligners. Based on a low level of certainty, HFV can increase the rate of tooth movement and decrease the exchange interval of clear aligners. Further investigation is necessary to clarify the effects of vibration on pain and discomfort, bone density, and root resorption.

Background: Patient cooperation is necessary for treatment success in removable orthodontics. Every factor has an adverse effect on appliances appearance can impede appliance wearing. This study investigated the effect of immersion in household cleaner and bleach liquids on fracture resistance of self-cure orthodontic acrylic resins. Materials and Methods: This in vitro study two orthodontic acrylic resins (Megadental^® and Acropars^®) were used. Eighty identical acrylic samples (50 mm × 5 mm × 3 mm) from each acrylic resin were fabricated and divided into four groups (n = 20). For each type of acrylic resin; Group 1: 15 min immersion in household cleaner liquid (hydrochloric acid [HCl], 10%), 1 min rinsing with running water, 15 min immersion in household bleach liquid (sodium hypochlorite [NaOCl], 5.25%) and 1 min rinsing with running water were done. For Group 2, two times and for Group 3, three times immersion just like Group 1, were done. Group 4, as control, had no immersion. Fracture resistance of samples was measured with universal testing machine (Instron) in 3-point bending set-up. Data were analyzed with two-way repeated measurement ANOVA. Significance level was set at 0.05. Results: Fracture resistance of Acropars groups was greater than counterpart Megadental ones (P < 0.001). Immersion factor, alone (P = 0.375) and in combination with material (P = 0.603), did not make a significant difference among fracture resistance of each acrylic resin groups. Conclusion: 15 min immersion in household cleaner liquid (HCl acid) followed by 15 min immersion in household bleach liquid (NaOCl 5.25%) and even 3 times repetition of this process had not significant adverse effect on fracture resistance of acrylic resins.

Background: Chronic kidney disease (CKD) is a systemic disease with a major burden on several life aspects, including oral health. As life expectancy has improved in CKD patients, oral health status has become important regarding their quality of life. The aim of this study was to investigate oral health and oral health-related quality of life (OHRQoL) in CKD patients. Materials and Methods: This was a cross-sectional study. Patients' age, gender, and estimated glomerular filtration rate (eGFR) stage were recorded. Oral Health Impact Profile-14 (OHIP-14) was used to evaluate OHRQoL. Decayed, missing, and filled teeth (DMFT) index was utilized to record oral health status. SPSS software was used to analyze data. One-way ANOVA, t-test and Pearson/Spearman correlations were used. P < 0.05 was considered statistically significant. Results: One hundred and four patients participated; 60.6% male versus 39.4% female. Mean age was 52.1 ± 18.1 years. The most frequent eGFR stage was 5 (41.2%). Mean DMFT score was 18.7 ± 8.5. Mean OHIP-14 score was 14.82 ± 5.86. DMFT score was significantly correlated with OHIP-14 total score as well as its physical domains (P < 0.05). The correlation between eGFR stage and OHIP-14/DMFT score was both statistically significant (P = 0.03/P = 0.02, respectively). Conclusion: DMFT score was significantly correlated with OHRQoL in CKD patients, especially regarding its physical domains. Paying attention to fulfill dental treatment needs seems mandatory to improve OHRQoL and overall quality of life in these patients.

Pulpectomy aims at retaining the tooth in the asymptomatic state until exfoliation. Root canal obturating materials should resorb in synchronization with the primary root and get eliminated rapidly upon accidental extrusion. This systematic review aims at appraising the clinical and radiographic outcomes of Endoflas as an obturating material for primary teeth. An extensive literature search on obturating materials used for primary teeth using MeSH terms in PubMed, Cochrane library, and Ovid® from September 2002 to March 2020. Studies evaluating the clinical and radiographic success of Endoflas as an obturating material in children were included. From 45 retrieved articles, eight qualified for the systematic review. Moderate quality of evidence was elicited in this review. There was a dramatic reduction of inter radicular radiolucency in Endoflas obturated teeth compared to other root canal filling materials. Even for resorption of the extruded material beyond the apex too, Endoflas has depicted a faster clearance rate. Hence,it was concluded that, Endoflas can be a potential root canal obturating material for treating the primary teeth, even with furcal radiolucency. We recommend randomized clinical trials satisfying all the norms of CONSORT guidelines to provide a high quality of evidence.