Aim: The aim of this study was to identify the influence of dental fear, pain, and impaired oral health-related quality of life (OHRQoL) on patients seeking care in a German emergency dental service.

Materials and methods: Patients attending the emergency dental service at the University of Leipzig (Germany) were consecutively recruited and completed three questionnaires, including a visual analog scale for pain, the dental fear survey (DFS), and the oral health impact profile (OHIP–49).

Results: A total of 307 patients attended the emergency dental service and 286 agreed to take part in the study. The mean age was 41.7 years (50.4% males). The pain was reported by 87.2 % of the subjects, and their main reason for seeking care was a toothache (52.6 %). Regarding psychosocial characteristics, the mean OHIP and DFS scores were 40.0 and 47.6, respectively. For dentally fearful patients, a significantly higher impairment of OHRQoL was identified than for subjects with less or no fear. 33.2% of the participants irregularly consulted a dentist, and 58.4% of these patients were categorized as dentally fearful.

Conclusion: The current investigation identified a high pain intensity as well as a high prevalence of dental fear, and a high impairment of OHRQoL in patients seeking care in an emergency dental service.

Clinical significance: The results of the current study might help to develop specific services for patients with dental fear, which can successively reduce the number of emergency dental treatments.

Aim: To evaluate the correlation between age and caries development in permanent teeth, as well as to show the trends of decayed, missing, and filled teeth (DMFT) index in Albania.

Materials and methods: Subsequent observations hold from July 2016–July 2018. Our study included 393 children of the age range of 7–10 years old. The children in the survey were divided into four groups according to their ages 7, 8, 9 and 10 years and these groups were considered separately. For the age group 7 years old we observed 110 children (28.13%), for the age group 8 years old we observed 106 children (27.11%), while for the age groups 9 years and 10 years old we observed 88 (22.35%) and 89 (22.41%) children, respectively.

Results: In our study, 393 children were selected and a total of 3128 molars were observed during 2 years time period. The strong influence on caries of the age group 9–10 years old is confirmed by p value 0.002. The results of our study show that the influence in caries manifestation decreases more at the age of 8–9 years old with a p = 0.014. Caries prevalence was 28.3% in permanent dentition in children 7–10 years old, while the DMFT index of our results was 3.46.

Conclusion: O ur r esults s howed a p revalence o f c arious teeth at the age group 9–10 years old compared with the age group 8–9 years old. To reduce dental caries development and its increment in children of the age class 7–10 years old we recommend the use of fluoride, a healthy non-cariogenic diet, and dental routine check-ups.

Clinical significance: Age has an important role in evaluating caries prevalence and DMFT index. Based on age, caries is more prevalent in children 9–10 years old, and the DMFT index resulted to be in high values equal to 3.46.

Aim: To verify the immunization status of dental students against HBV using an immunochromatographic rapid test and explore its associated protective and preventive effects against the disease.

Material and methods: This transversal epidemiological study was conducted in a public dental school in Brazil. A total of 263 dental students who were at clinical practice were invited to participate in the study. A semi-structured questionnaire that investigated the issues related to the theme was created for data collection. An immunochromatographic test for the detection of anti-Hepatitis B surface antigen was used to verify the immunization status. Data were analyzed using the Statistical Package for the Social Sciences (SPSS).

Results: Approximately 59.2% of the participants did not know the etiological agent of hepatitis B infection, and 36.6% did not know the number of doses of hepatitis B vaccines. Furthermore, 53.2% of the participants were immunized against HBV. Logistic regression showed that those who received less than three doses of the vaccine (OR = 2.539) or did not know how many doses they received (OR = 3.022) had higher risks of not developing the immunity. Moreover, age (OR = 0.834) was a protective factor against non-immunization.

Conclusion: There was a low prevalence of dental students who were immunized against HBV. The number of vaccine doses received and the participants’ age had significant associations with the immunization status.

Clinical significance: Deals with an issue of major impact on the public health because of the high rates of hepatitis B in the general population, as well as the lack of knowledge of the subject by a large part of dental surgeons and dental students.

Aim: This study compared the tissue reaction of 80 wt% of White Portland cement (WPC) mixed with 20 wt% of three radiopacifying agents: Bismuth oxide/Iodoform/Zirconium oxide with MTA in rat subcutaneous connective tissue.

Materials and methods: The study was performed in 18 albino rats by implanting the WPC mixed with radiopacifying agents loaded in a polyethylene tube. Empty tubes were used as a control. At the end of 7, 30 and 60 days excisional biopsy of the implant along with surrounding tissues was done and sent for histological examination.

Results: In the 7 days experimental period there was no significant difference between groups in terms of the tissue response. In 30 and 60 days period significant difference was seen between the control (empty tube) and the other groups. But there was no significant difference between WPC mixed with radiopacifiers BiO/Iodoform/ZrO₂ and MTA.

Conclusion: The tissue reaction of the tested materials, White Portland cement (WPC) + Bismuth oxide, WPC + Iodoform, and WPC + Zirconium dioxide were similar to MTA (Pro Root MTA) in all experimental periods 7 days, 30 days and 60 days.

Aim: The study aims to assess recall practice among dental practitioners in Riyadh, Saudi Arabia.

Materials and methods: A 24-item questionnaire was used to collect information about the general practice, knowledge of dental recall, and factors affecting dental recall from general dental practitioners in Riyadh. The questionnaire elicited data on personal information (8 items), practice information (3 items), knowledge about the dental recall (3 items), recall practice (6 items), and patient factors that might influence recall (4 items). A five-point Likert scale showed the level of agreement in cases that required recall visits, reasons for patients not returning for recall, and techniques to encourage return for recall.

Results: A total of 315 questionnaires were analyzed (response rate = 46.3%). The mean age of participants was 32.4 years old and 52.4% of participants were male. Eighty-four percent of respondents reported that they routinely perform regular recall with their patients. Recall practice was significantly associated with practitioner experience, country of graduation, and workplace. Practitioners who graduated from Saudi universities were found to be less likely to practice regular recall visits compared to others (p <0.01). On the other hand, practitioners who are working in university hospitals are more likely to practice dental recall compared to those who are working only in dental clinics (p = 0.02).

Conclusion: A low percentage of dentists advocated and practiced regular recall visits in their private practice. Efforts should be undertaken to educate the practitioners on the importance of regular recall visits in their healthcare settings.

Clinical significance: Scheduling appropriate recall visits is an essential component for achieving successful treatment outcomes. This study highlights the poor recall practice among dentists and the need to raise the awareness of the importance of recall visits.

Aim: This study aimed to compare the dentoskeletal and soft tissue changes promoted by the Distal Jet and Pendulum, followed by fixed appliances, in class II malocclusion treatment, evaluated in relation to an untreated control group.

Materials and methods: Group 1 comprised 20 patients (15 female; 5 male) with class II malocclusion, at an initial mean age of 12.77 years. These patients were treated with the Distal Jet followed by fixed appliances for a mean period of 4.15 years. Group 2 consisted of 15 patients (10 female; 5 male) with class II malocclusion, at an initial mean age of 13.42 years, treated with the Pendulum followed by fixed appliances for a mean period of 4.41 years. Group 3 comprised 16 subjects (8 female; 8 male), with class II malocclusion, not submitted to any orthodontic treatment. This group had an initial mean age of 12.25 years. The mean observation period was 3.73 years. Comparison of the three groups was performed by one-way ANOVA followed by Tukey tests.

Results: The Distal Jet appliance showed more palatal tipping of the maxillary incisors than the Pendulum. The treated groups showed more overjet reduction and improvement of molar relationship than the control group.

Conclusion: It was concluded that the effects of these two appliances in Class II malocclusion correction are very similar.

Clinical significance: Both Distal Jet and Pendulum appliances corrected the class II malocclusion with similar cephalometric treatment changes.

Aim: To evaluate the antimicrobial effectiveness of Propolis, Morinda citrifolia juice, Sodium hypochlorite and Chlorhexidine on Enterococcus feacalis (E. feacalis) and Candida albicans (C. albicans), as endodontic irrigants.

Materials and methods: Four clinical isolates and one standard ATCC sample (29212) of E. feacalis and ATCC sample (90028) of C. albicans were inoculated into 5ml of peptone water each and incubated at 37° C for 3 to 4 hours to attain the turbidity corresponding to 0.5 McFarland standard CFU. We followed Disc and well diffusion Kirby–Bauer method to attain the zones of inhibition.

Results: Overall comparison of reagents revealed a significant difference among zones of inhibition. The standard concentration of 5% sodium hypochlorite, 2% chlorhexidine, 10% Propolis and 100% Morinda citrifolia juice illustrated the maximum inhibition zone for both test organisms.

Conclusion: All four reagents had an antimicrobial effect on the microorganisms tested. Sodium hypochlorite and Chlorhexidine were more effectual than Propolis and Morinda citrifolia juice and there was increased antimicrobial efficacy with increasing concentrations.

Clinical significance: A study for finding safe herbal agents that can be used as endodontic irrigants revealed that Propolis, Morinda citrifolia juice has antibiotic properties and can replace routinely used agents thereby limiting the side effects.

Aim: Present study was planned to assess the impact of various root canal irrigants on the adhesion of different Enterococcus faecalis (E. faecalis) strains to the dentinal surface.

Materials and methods: A total of 80 freshly extracted first and second molars were used in the present study. Preparation of dentin discs was done followed by a random division into four study groups and one control group. Four study groups included; 2.5 % sodium hypochlorite (NaOCl) , 2 % chlorhexidine (CHX), 2.5 % NaOCl + saline + 2 percent CHX and 2.5 % NaOCl + 17 % ethylene diamine tetra-acetate (EDTA) + 2.5 % NaOCl group respectively. In the control group (E), sterilized dentin discs were incubated with sterile TSB solution. Division of all the groups into two subgroups were done depending upon the type of strain of E. faecalis used. Incubation of all the specimens was done followed by assessment with XTT assay and measurement of Optical density (OD). All the results were compiled and analyzed by Statistical Package for the Social Sciences (SPSS) software.

Results: Among the groups containing gelatinase producing strains; maximum score was exhibited by 2.5 percent sodium hypochlorite solution followed by 2.5 % NaOCl + 17 % Ethylene Diamine tetra-acetate (EDTA) + 2.5 % NaOCl group (group D). On comparing the OD values among various study groups incubated with Gelatinase producing strain, significant results were obtained. Gelatinase-producing E. faecalis showed a s ignificantly h igher amount of a dherence to dentin, in comparison to the gelatinase-deficient E. faecalis strains.

Conclusion: Lesser quantity of bacteria is recovered from specimens in whom CHX was added to the irrigation protocol.

Clinical significance: Production of gelatinase by E. faecalis might lead to an increase in adhesiveness of E. faecalis to the dentin.

Aim: Osteoporosis is one of the diseases which show significant bone mass reduction especially in post menopausal women. The present study was conducted to determine the effect of Bisphosphonates (BP) on alveolar bone and dental implant therapy in women after menopause.

Materials and methods: The present study was conducted on 30 postmenopausal women who received at least one dental implant in the last 5 years. Group I comprised of 15 patients who were on BP therapy for 1.5 years, and group II consisted of 15 patients who were on parathyroid hormone (PTH). Bone mineral density (BMD) and bone thickness were assessed in both groups.

Results: Group I had 3.85% and group II had 3.15% of dental implants failures. BMD of cortical bone was 1552± 145 mg/mL and 1012 ± 94 mg/mL in groups I and II respectively. BMD of cancellous bone was 80 ± 15 mg/mL and 104 ± 72 mg/mL in group I and group II respectively. The difference was significant (p < 0.05). Cortical bone thickness was 2.5 ± 0.6 mm in group I and 2.2 ± 0.8 mm in group II. The difference was non-significant (p >0.05). There was a reduction in BMD (mg/mL) of cortical and cancellous bone. There was an increase in cortical bone thickness with the use of BPs over the years. The difference was significant (p < 0.05).

Conclusion: There was a decrease in bone mineral density of both cortical and cancellous bone in both groups. There was increase cortical bone thickness on prolonging use of BPs.

Clinical significance: Patients on BPs therapy should be carefully evaluated both clinically and radiographically before dental implant treatment as these agents affect the quantity and quality of cortical bone especially in the posterior mandibular region in patients with osteoporosis.

Aim: To evaluate the fracture resistance and failure pattern of custom made computer-aided design & computer-aided manufacturing (CAD/CAM) post and cores using a fiber reinforced composite material (FRC) and a high-density-polymer.

Materials and methods: Thirty extracted mandibular second premolars were selected, endodontically treated and prepared to receive the posts. The specimens were randomly divided into three groups (n = 10) according to each material: group 1 (RXP) : fiber posts (Rely X, 3M-ESPE) with composite core build-up (Filtek Bulk Fill Posterior, 3M-ESPE) as a control group; group 2 (BLC): one-piece milled post and core from fiber reinforced composite blocks (Trilor, Bioloren); and group 3 (AMC): one-piece milled post and core from hybrid ceramic disks (Ambarino, Creamed). All the posts were cemented using a self-adhesive resin cement (Rely X U200, 3M ESPE). Fracture resistance was tested using a universal testing machine, failure patterns were then observed visually and radiographically then evaluated under SEM. Data was analyzed using One-way analysis of variance (ANOVA) followed by Tamhane post-hoc test in order to determine significant differences among groups (α = 0.05).

Results: The mean fracture resistance values were: 426.08 ± 128.26 N for group 1 (R X P), 367.06 ± 72.34N for group 2 (BLC), and 620.02 ± 5 4.29N f or g roup 3 ( AMC). S tatistical analysis revealed that group 3 (AMC) had the highest mean load to fracture in comparison to the other groups (p = 0.000). failures were cohesive in group 2 and 3 and mixed in group 1 with no catastrophic failures reported in all groups.

Conclusion: All systems evaluated presented sufficient mean load-to-failure values for endodontically treated teeth restorations.CAD/CAM post and cores made from high-density-polymer showed a better performance than prefabricated fiber posts.

Aim: The aim of this in vitro investigation was to assess the impact of various anti-oxidants namely 5% proanthocyanidin, 10% sodium ascorbate, 10% alpha tocopherol, and 10% green tea on the bond strength of resin-based composite on bleached enamel.

Materials and methods: One hundred twenty human maxillary central incisors which were freshly extracted for periodontal reasons, having intact labial surface were us ed in this study. Specimens were randomly divided into six groups (n = 20). Group A: negative control–no bleaching treatment, group B–positive control –bleaching, group C–bleaching + 5% proanthocyanidins, group D–bleaching +10% green tea, group E - bleaching +10% alpha –tocopherol, group F–bleaching + 10% sodium ascorbate. Surfaces were etched followed by application of total-etch bonding system, and composite resin cylinders were bonded. Specimens were tested for shear bond strength using the universal testing machine .

Statistical analysis used: The data obtained were subjected to ANOVA and post hoc Tukey’s test for statistical analysis.

Results: After using bleaching agents and antioxidants for the different groups, Group A has the highest bond strength and group B has the lowest bond strength. Amongst the antioxidants group D showed significantly higher bond strength as compared group C, group E, and group F.

Clinical significance: Use of antioxidants instantly following the bleaching procedure and before resin bonding reverses the compromised bond strength of composite resin on bleached enamel without sitting tight for a time of one day to one month.

Conclusion: Bleaching of enamel reduced the shear bond strength. All the antioxidants used in this study increased the bond strength of bleached enamel. Among the antioxidant groups, green tea extract showed significantly higher bond strength compared to proanthocyanidin, tocopherol, and sodium ascorbate.

Aim: To assess and compare the impact and flexural strength of heat cure acrylic resin polymerized by microwave and conventional methods after immersion in artificial saliva for 2 days, 60 days, 90 days and 120 days.

Materials and methods: The present study was carried out on 160 specimens. They were categorized into two groups. Each group consisted of 80 specimens, polymerized either by conventional or microwave methods. All the specimens were immersed in artificial saliva, for varying periods of 2 days, 60 days, 90 days and 120 days. Flexural strength was measured by a universal testing machine and impact strength by Izod impact test. Analysis of the results was done by Statistical Package for the Social Services version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, SPSS version 20.0. Armonk, NY: USA, IBM Corp) for Windows software.

Results: Conventionally cured resin had the highest flexural and impact strength values after 2 days of immersion in artificial saliva. There was a significant decrease in strength as the number of days of immersion increased (p < 0.001).

Conclusion: Conventional acrylic resin polymerized in a water bath exhibited better flexural, and impact strength values than microwave cured the resin. All the samples cured by both methods showed a significant reduction in strength when immersed for a period of 60–90 days and thereafter became static over 120 days.

Clinical significance: As dentures are exposed to moist environment constantly and with time, their strength gets reduced. Prosthodontists should have adequate knowledge regarding the physical properties of materials used for denture preparation and also the pros and cons of different polymerization methods. In our study, conventional acrylic resin polymerized in a microwave method exhibited lesser strength values, but they were clinically acceptable; so, this method can be used for curing dentures.

Introduction: Nowadays, implant insertion is accompanied by undesired consequences. As surgery techniques become more and more complex, an increase of intra- and post-op complications can be expected. Application of low-level laser (LLL) is one of the conservative approaches to control the complications with any side effects and low treatment costs. The present study aimed to evaluate the effect of 650 nm LLL irradiation on the reduction of complications after advanced implant surgeries.

Materials and methods: In this triple-blinded clinical trial, 30 patients aged between 25 to 65 years were in need of bone graft or sinus lift procedure for simultaneously implant insertion. In the LLL treatment group, the surgical site of each implant was treated with 650 nm laser. The same method and duration were applied in the placebo group. The pain levels, facial swelling, and wound healing were evaluated.

Results: This study indicated that pain levels were reduced in the laser group (p <0.05). Also, facial swelling in the 3rd and 7th day after the surgery relieved more in laser group. Furthermore, investigation of the surgical site showed a higher level of wound healing in the laser group (p <0.05).

Conclusion: Regarding the biological effects of advanced implant surgeries and accompanying complications, adjuvant treatment with a laser could significantly improve wound healing and reduce the severity and duration of pain and swelling.

Clinical significance: This clinical trial demonstrates reductions of the level of pain, facial swelling and improvements of wound healing are followed by the use of low-level laser therapy.

Aim: To evaluate solubility of soft denture liner material and acrylic denture base resin when stored in 8% and 50% concentration of alcohol and tea(with milk and green tea) at an interval of 4,7,11 and 15 days.

Materials and methods: An in vitro study wasdone on 75 standardized samples in disk form (15 mm × 2 mm), each for soft-liner and acrylic denture base resin. Samples were divided into 5 groups (15 per group/per material) and stored in distilled water (A), 8% alcohol (B), 50% alcohol (C), tea with milk (D) and green tea (E). Solubility was determined at each time interval by dividing difference of weight (taken after drying the sample in a desiccator) from day 1 divided by surface area of the specimen. For each day (i.e., 4, 7, 11 and 15),one-way analysis of variance (ANOVA) test was used to determine if the distribution of mean solubility was similar in five groups followed by post-hoc Tukey’s test for pair-wise comparisons.

Results: Mean solubility of soft-liner was the highest tea with milk (D) followed by green tea (E), then 50% and 8 % alcohol (C and B) and was least in group A at each time of measurement. Mean solubility of an acrylic resin was highest for 8% alcohol (B) and all other groups it was similar.

Conclusion: This study shows increased solubility for soft-liners when immersed in tea with milk, green tea, and alcohol at 8% and 50% concentration. The solubility of acrylic resin also increases at 8% alcohol concentration.

Clinical significance: Drinks/beverages used in our study are commonly consumed, the results of this study caution for restricting the frequency of intake. However, this needs to be confirmed by in-vivo studies designed to prove the association of denture life with the consumption pattern of these drinks/ beverages.

Aim: White spot lesions (WSLs) occur frequently after fixed orthodontic treatment. This in vitro study was undertaken to compare the efficacy of 2.26% fluoride varnish, 1.23% APF gel, 0.21% fluoride toothpaste and 0.04% sodium fluoride mouthwashes in preventing enamel demineralization around orthodontic brackets in extracted premolars.

Materials and methods: The sample for this study included 100 premolars free of caries and enamel cracks. They were divided into five groups of 20 samples each. Group 1 (FV): light-curable Fluoride varnish (Clinpro™ XT 3M ESPE, Pymble, New South Wales, Australia), group 2 (FG): 1.23% APF gel (Patterson NE. International, USA), group 3 (FTP): 0.21% w/w sodium fluoride toothpaste with tri-calcium phosphate (Clinpro™ Tooth Crème, 3M ESPE, Australia), group 4 (FMW): sodium fluoride 0.044% (w/v) mouthwash (Colgate® Phos-Flur® Ortho Defense Rinse, Colgate-Palmolive, NY) and group 5 (C): control. The samples were subjected to laboratory pH cycling. The demineralization changes in the enamel were assessed before the start of the experiment and after 14 days.

Results: There was a significant change in the mean Diagnodent score value (p <0.001) in all groups from day 1–day 14. The mean values were significantly different among groups at day 1 (p = 0.002), day 14 (p = 0.001) and also the change from Day 1 to Day 14 was significantly different among Groups (p = 0.001). The least change in the mean value from baseline to 14 days was seen in group 1 (FV) followed by group 3 (FTP), group 2 (FG), and group 4 (FMW) and then the group 5 (C).

Conclusion: All the topical fluorides tested were able to reduce the demineralization when compared to the control group under similar testing conditions, but to varying degrees. light-curable fluoride varnish outperformed all the topical fluorides followed by 0.21% w/w dodium fluoride toothpaste with tri-calcium phosphate, 1.23% Acidulated phosphate fluoride gel and sodium fluoride 0.044% (w/v) mouthwash. The control group where no topical fluoride was applied showed the least resistance to demineralization.

Clinical significance: Within the limitations of this study, routine application of light cured fluoride varnish (Clinpro) can be recommended to prevent enamel demineralization to prevent white spot lesions in patients receiving orthodontic treatment.

Aim: To compare and evaluate the shear bond strength of the tooth-denture base junction when three different commercially available acrylic resin base bonded to acrylic teeth with and without application of methyl methacrylate monomer on ridge lap area.

Materials and methods: A three-stepped cylindrical shaped die was customized. Sixty samples were fabricated with heat cure and self-cure acrylic resin with and without monomer application. A total of 60 samples were divided into three groups and six subgroups.

Group A–Twenty samples of Trevlon-HI heat-activated acrylic resin.

Subgroup A1–Ten samples of acrylic teeth bonded with Trevlon-HI heat- activated acrylic resin with the application of monomer on ridge lap area.

Subgroup A2–Ten samples of acrylic teeth bonded with Trevlon-HI heat-activated acrylic resin without application of monomer on ridge lap area.

Group B–Twenty samples of Trevalon heat-activated acrylic resin.

Subgroup B1–Ten samples of acrylic teeth bonded with Trevlon heat-activated acrylic resin with the application of monomer on ridge lap area.

Subgroup B2–Ten samples of acrylic teeth bonded with Trevlon heat-activated acrylic resin without application of monomer on ridge lap area.

Group C–Twenty samples of Trevlon-RR self-activated acrylic resin.

Subgroup C1–Ten samples of acrylic teeth bonded with Trevlon-RR self-activated acrylic resin with the application of monomer on ridge lap area.

Subgroup C2–Ten samples of acrylic teeth bonded with Trevlon-RR self-activated acrylic resin without monomer application on ridge lap area.

Results: Samples obtained from high impact heat cure acrylic resin with monomer application shows higher bond strength when tested under the universal testing machine.

Conclusion: With and without monomer application on high impact polymethylmethacrylate (PMMA) resin and Heat cured resin it was found that high impact shows better bond strength. Trevlon HI monomer shows a greater increase in strength due to the presence of cross-linking agents.

Clinical significance: The incorporation of mechanical surface treatments followed by monomer application significantly influences the bonding between denture teeth and denture base resin.

Aim: Waterpipe tobacco smoking (WTS) has become a global epidemic, especially among youth. WTS has not been studied like cigarette smoking. There is a dire need to study and document health effects of waterpipe smoking in general and specifically on the oral cavity.

Materials and methods: A total sample size of 400 was studied. One hundred exclusive shisha smokers, 100 exclusive cigarette smokers, 100 subjects smoking both cigarette and shisha and 100 non-smokers. We recorded and associated socio-demographical data pertaining to WTS and cigarette smoking in UAE and examining their toxic effects on the oral mucosa at a cytogenetic level by studying the micronuclei (MN) stained by Feulgen and Acridine Orange (DNA specific stains).

Results: A significant association was observed between age distribution and groups. Majority of subjects were males. Arabic nationalities were consuming a higher percentage of Waterpipe and Cigarette separately, and Indian nationality was consuming a higher percentage of waterpipe and cigarette together. Comparison of Micronuclei in Feulgen and Micronuclei in Acridine Orange group between four groups was significant. Mean micronuclei in feulgen was highest for Waterpipe and Cigarette group followed by shisha group and least for Control group. Similarly, Mean micronuclei in acridine orange was highest for waterpipe and cigarette group followed by shisha group and least for control group.

Conclusion: Further epidemiological studies should be undertaken to determine whether WTS is associated with the incidence of lung cancer/oral cancerous lesions.

Clinical significance: The findings of this study could be used to spread awareness that waterpipe smoking, like cigarette smoking, has the potential to cause genotoxic effects and could eventually lead to carcinogenicity based on duration and frequency.

Aim: To establish an effective combination of drying time and drying method of the tray adhesive so that maximum bond strength can be achieved between impression tray and impression material.

Materials and methods: Cylindrical specimens of auto-polymerizing resin and addition silicone impression material were made. A total of 150 specimens were tested. They were divided into two groups Dentsply and GC. Each group was further divided into five subgroups:

• Drying with compressed air for half the time as recommended by the manufacturer
• Drying with air blower for half the time as recommended by the manufacturer
• Open air drying as recommended by the manufacturer
• Open air drying for 15 minutes
• Open air drying for 1 hour
•  

The samples were tested for tensile bond strength using the universal testing machine. The results were subjected to statistical analysis.

Result: Open air drying as recommended by the manufacturer was better than drying with a blower or compressed air. There was no significant difference between open-air drying for 5 minutes and open-air drying for 15 minutes or 1 hour.

Conclusion: Open air drying as recommended by the manufacturer, i.e. 5min, showed good bond strength and drying for more than 5mins does not significantly increase bond strength.

Clinical significance: Tray adhesive should not be dried with compressed air or air blower. Tray adhesive should be applied and kept to dry according to the manufacturer’s recommended time.

Aim: To evaluate the efficacy of accelerated and non-accelerated methods of en-masse retraction of the upper anterior teeth in terms of skeletal, dental, and soft-tissue variables, as well as the duration of retraction or overall orthodontic treatment.

Materials and methods: An electronic search of PubMed and nine other major databases for randomized controlled trials (RCTs) and clinical controlled trials (CCTs) was performed between January 1990 and April 2018. The bibliography in each identified article was reviewed. In addition, manual searching was performed in the same time frame in five major orthodontic journals.The participants were patients over 14 years old undergoing fixed orthodontic treatment with extraction of maxillary or bimaxillary premolars followed by en-masse retraction of maxillary anterior teeth in both groups. Cochrane’s risk of bias tool for RCTs and methodological index for non-randomized studies (MINORS) for CCTs were used.

Results: Eight articles (six RCTs and two CCTs) were included in this review, and only five articles were suitable for quantitative synthesis. The en-masse retraction caused a decrease in the SNA and ANB angles with no significant differences between the different en-masse retraction methods. Using temporary skeletal anchorage devices (TSADs) gave significantly better results in terms of posterior anchorage in comparison with conventional anchorage(standardized mean difference (SMD) = –3.03 mm, p < 0.001). No significant difference was found between en-masse/flapless corticotomy and en-masse/control groups in terms of anterior teeth retraction (p = 0.661); while there was a significantly greater anterior teeth retraction in corticotomy with flap elevation group compared to control group (p < 0.001).

Conclusion: There is a weak to moderate evidence that using accelerated and non-accelerated methods would improve the facial profile and lead to similar skeletal corrections. There is weak to moderate evidence that using TSADs would lead to better posterior anchorage than using conventional anchorage.Moderate evidence was found regarding the benefit of using piezosurgery in achieving good incisors’ inclination. Contradictory results were found regarding the amount of achieved anterior retraction and the retraction time in the studies that evaluated acceleration methods versus the traditional methods of retraction. According to the quality of evidence, there is a need for more well-conducted RCTs, and more work to be oriented towards en-masse retraction with the use of other acceleration methods.

Clinical significance: The correction of the maxillary or bimaxillary dentoalveolar protrusion by en-masse retraction of the upper anterior teeth with/without acceleration is accompanied by aesthetic results in the facial soft tissues as well as in the underlying skeletal and dental structures. The traditional corticotomy-assisted retraction is expected to reduce the retraction time significantly. However, the strength of evidence is not strong and requires additional research work.