Aim: The purpose of this study is to compare the clinical performance of an organo-selenium-containing pit and fissure sealant with that of a selenium-free sealant for clinical retention and prevention of plaque and caries development around the sealants. Materials and methods: Following an in vitro study confirming the antimicrobial effect of an organo-selenium-containing pit/fissure sealant [DenteShield™ (DS)], 120 adolescents (7–20 years old) at varying caries risk status had DS sealant applied to a single tooth on the left or the right side of the dentition and UltraSeal™ XT Plus (UXT) on a corresponding tooth on the opposite side. Sealants’ assessment was performed quarterly for 1 year for clinical retention, plaque, and caries formation around the sealant. Each sealant lost was replaced but considered as a failure in further analysis. McNemar's test was used to statistically analyze the outcome variables at each assessment time point. Results: While 7% and 12% plaque growth was observed around the UXT sealant at 9th and 12th months, respectively, DS exhibited 100% prevention of plaque growth. Both sealants exhibited 100% caries prevention. Clinical retention did not significantly differ between DS and UXT at all assessment time points except at 12 months when DS showed statistically significantly (p < 0.001) better retention (96%) than UXT (81%). Conclusion: In this study, while both sealants are equally effective in caries prevention, DS completely prevented plaque growth around it with better clinical retention than UXT that offered only limited protection against plaque growth. Clinical significance: Being antimicrobial, DS pit and fissure sealant may be the best sealant option for patients whose caries risk status is due to poor oral hygiene.

Aim: The aim of this study is to investigate the caries situation in a group of Swedish adolescents, who were scheduled for orthodontic treatment with fixed appliances. Materials and methods: An age- and gender-matched control group was selected from the same city (Malmö, Sweden). Caries and fillings on smooth surfaces and fillings on occlusal surfaces were diagnosed clinically and caries and fillings on approximal surfaces by bitewings. Numbers of mutans streptococci (MS) and lactobacilli (LB) were analyzed in saliva. Results: There were no significant differences regarding manifest caries lesions and fillings on smooth surfaces. Numbers of occlusal-filled surfaces (FS) and approximal decayed and filled surfaces were around 10%, but did not differ between the groups. However, 53% had approximal enamel caries lesions in the test group and 46% in the control group. The prevalence of approximal decayed surfaces (DS) and FS was low in both groups, 0.57 ± 1.41 in the test group and 0.65 ± 1.38 in the control group (p > 0.05), i.e., somewhat more DS in the control group (p < 0.05). Most individuals had low/medium counts of cariogenic bacteria in their saliva and less than 10% high counts in both groups. Conclusion: Most Swedish adolescents who have been scheduled for treatment with fixed appliances appear to have a low-to-medium caries risk nowadays. However, around 10% of all approximal tooth surfaces of premolars/molars had enamel caries and one-third of the individuals had medium/high counts of cariogenic bacteria in their saliva, which may be risk factors for future caries during orthodontic treatment. Clinical significance: Bitewing radiographs are important before starting orthodontic treatment and approximal caries and many cariogenic bacteria may be risk factors for orthodontic treatment.

Aim: The aim of this study is to survey the opinion of endodontists in the United States regarding their approach to treatment of cracked teeth. Materials and methods: A survey assessing the opinions of 3,500 endodontists in the United States was administered over a 4-week period. It consisted of a hypothetical clinical case and eight different treatment scenarios. Participants were asked to select one of the two treatment options: (A) informing the patient of the presence of a crack, reinforcing the tooth, and continuing with endodontic treatment; and (B) extraction of the tooth followed by replacement with an implant supported crown or fixed partial denture. Results: When the crack extended across the distal marginal ridge with no associated probing depths, 92.65% endodontists preferred to continue with endodontic treatment and reenforcing the tooth. When the crack extended across the distal marginal ridge and was associated with a probing depth of 6 mm, 80% preferred extraction of the tooth. When the crack extended across the mesial marginal ridge up to the orifice of the mesiolingual canal with no associated probing depth, 82.78% preferred to continue with the treatment. When the crack was associated with a 6-mm probing depth, 83.79% preferred tooth extraction. When the crack extended across the mesial marginal ridge and down into the mesiolingual canal with/without associated probing depth, 91.13% and 63.54% preferred tooth extraction, respectively. When the crack involved both mesial and distal marginal ridges and extended across the pulp chamber, 79.74% preferred tooth extraction. When a split tooth was presented, 98.48% preferred tooth extraction. Conclusion: It appears that the presence of a 6-mm periodontal pocket is considered an important factor by most American endodontists when deciding whether to preserve the cracked tooth or extract it. Clinical significance: There is no consensus among dentists regarding the best approach to treat cracked teeth. Conclusive studies evaluating clinical approaches of endodontists regarding treatment of cracked teeth are lacking. Therefore, surveyed opinion of endodontists in the United States regarding their approach to treatment of cracked teeth was done to try to reach the best clinical decision regarding this dilemma.

Aim: The aim of this study is to evaluate the potential of deoxyribonucleic acid (DNA) recovery from bite marks in foods, in different collection types, from DNA quantification. Materials and methods: The sample consisted of 80 swabs, obtained from 20 cheese pieces, bitten by the same person, using the double-swab technique in the center and the periphery of the bite. A statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) statistical software version 20.0, with values of p < 0.05 being considered statistically significant. Results: The DNA was recovered in all cheese pieces, regardless of the collection types and the bite region. However, the comparative analysis of DNA recovery potential in the four swabs allowed us to infer that the collections in the central region of the bite (DC and WC) were the ones that presented better precision, in addition to extracting a higher DNA concentration, the dry swab being in the center of the bite which presented better results. Conclusion: The results proved the effectiveness of the double-swab technique for collecting genetic materials in bite marks; however, in the food used, a single collection at the center of the bite would be enough, optimizing the resources and time needed for the analysis. Clinical significance: Due to the difficulties of physically comparing a site of a skin lesion and the dental arches of the suspect, the evidence of DNA in saliva has been used to indicate the perpetrator of the bite. In addition, the collection, preservation, and isolation of saliva DNA can be done at low cost and provide flexibility for clinical and laboratory workflow.

Aim: To evaluate the performance of three cone beam computed tomography (CBCT) machines in detecting vertical root fractures (VRFs) in teeth filled with different sealers. Materials and methods: A total of 80 single-rooted premolars were subjected to instrumentation and restoration with gutta-percha + AH Plus sealer, gutta-percha + sealer 26, gutta-percha + fill canal, and gutta-percha without sealer as the control. Half of the samples were randomly subjected to root fracture and all the teeth were scanned by i-CAT (Imaging Sciences International, Hatfield, USA), PreXion (PreXion Inc., San Mateo, USA), and OrthoPhos XG (Sirona Dental System, Bensheim, Germany). Three examiners analyzed the images for the presence of fractures Results: The highest accuracy was obtained with the PreXion device, with Az = 0.85, while the i-CAT device provided higher sensitivity (0.93). The specificity values observed ranged between 0.75 and 0.70. Chi-squared tests (p > 0.05) demonstrated that the sealers did not exert a significant influence on the diagnosis of VRF. Conclusion: It may be concluded that endodontic sealers do not influence the detection of VRF. The PreXion device was the most accurate, having the highest specificity value. Clinical significance: Radiopaque materials might affect the diagnosis of VRFs because they can simulate fracture lines, leading to false-positive results. Moreover, CBCT machines present different specificities that could exert some influence on that.

Aim: The aim of the present study was to evaluate the wettability of three saliva substitutes on heat-polymerized acrylic resin. Materials and methods: Heat-cured acrylic resins 150 were made and divided into three groups containing 50 samples each, i.e., group 1 Aqwet, group 2 Biotene, and group 3 Mouthkote. The prepared wax pattern was cut using 30 × 30-mm two square glass plates along the sides using a sharp carver. The uniformity of the wax samples was checked using the wax gauge. The wax samples were invested using dental plaster in varsity flasks. The samples were prepared using conventional heat-cure denture base acrylic resin. A goniometer was used to calculate receding and advancing contact angles for dynamic contact angle analysis. Results: The least mean value of advancing and receding contact angles was seen in group 1 Aqwet (68.12 ± 1.30 and 58.56 ± 0.10) followed by group 2 Biotene (81.64 ± 0.88 and 74.89 ± 0.45), and group 3 Mouthkote (85.76 ± 1.02 and 80.63 ± 0.66). A significant difference was found between the groups statistically with a p value of 0.001. A significant difference was found on multiple comparisons between group 1 vs group 3 and group 1 vs group 2 with different receding and advancing contact angles of saliva substitutes analyzed with Turkey's post hoc test. Conclusion: The lowest advancing and receding contact angle values were significantly seen in the Aqwet saliva substitute followed by Biotene and Mouthkote on heat-polymerized acrylic resin. Clinical significance: The clinical significance of the saliva substitute's good wetting property on acrylic denture base. The quality of life of the patients with xerostomia can be improved using a suitable saliva substitute.

Introduction: This is a cross-sectional research on the impact of academic stress to which Peruvian students of dentistry are exposed and the various risk factors that affect academic performance and clinical and preclinical training. Aim: The aim of this study is to determine the association of the perceptions of stress and the risk factors in students who take preclinical and clinical courses of a Peruvian private university. Materials and methods: This cross-sectional study evaluated 222 students of the School of Dental Medicine at the Universidad Privada de Ciencias Aplicadas (UPC). To measure stress levels, we used the Dental Environment Stress (DES) questionnaire that was previously validated in Spanish. Data, such as age, sex, and year of study, were collected in a file made for this study. The students belonged to the 1st and the 5th year of study and authorized their participation through informed consent. In the data analysis, the odds ratio and the Chi-square test were used. Results: We found that clinical students have 2.96 times higher risk of having stress than preclinical students. Within these categories, in the preclinical level, the first-year students show the higher stress levels (68.2% in moderately stressful and very stressful 15.1%), while in the clinical level, the third-year students had a higher stress level (80.9% in moderately stressful and 19% in very stressful). Our data show no association between sex and stress levels of the students (p = 0.508). Conclusion: Clinical students show more stress level with 2.96 times higher risk for stress compared to preclinical students. In the preclinical level, the first-year students showed a higher stress level, while in the clinical level, third-year students had a higher stress level. Our data show no association between sex and stress levels of students. Clinical significance: The impact of stress on dentistry students significantly influences their performance at the time of performing dental treatment protocols. This research shows the direct relationship that exists between these variables.

Aim: The aim of the study is to evaluate fracture resistance of nanocomposites with and without fiber reinforcement with different cavity designs used for obliquely fractured incisal edge restoration. Materials and methods: In the present study, 60 sound extracted maxillary central incisors were mounted on autopolymerizable acrylic resin up to the cementoenamel junction, out of which, 10 intact teeth were kept as control (group 1) and the remaining 50 samples were reduced incisally in an oblique manner up to 3 mm. All incisally reduced samples were divided into five groups (n = 10) based on the restoration techniques as follows: group 2 (conventional bevel), group 3 (single central palatal slot on the incisal edge), group 4 (single palatal slot with central 2 mm fiber), group 5 (two palatal slots on the incisal edge with a distance of 0.5 mm to 1 mm between them), and group 6 (two slots on the incisal edge with two 2 mm fibers). All samples were built incrementally with nanocomposites followed by finishing and polishing. All samples including control were then stored in distilled water before their fracture resistance was measured using a universal testing machine. Failure modes were visually examined and the results were subjected to statistical analysis. Results: The mean fracture resistance among the experimental groups was observed, group 4 with single fiber in the central position had the highest (832.68 N) followed by group 3 (490.84 N), group 5 (446.175), and group 2 (270.1359), and the least in group 6 (223.443). The mean fracture resistance of group 4 is comparable to intact teeth, i.e., group 1 (1096.40). The mean of all samples was compared using the one-way Anova test, and it was found that there is statistically significant difference in fracture resistance among groups (p < 0.001**). Conclusion: Fibers certainly have the reinforcing effect and the position of fibers determines their reinforcing effects. A single central slot with fiber (Ribbond) showed maximum fracture resistance almost equivalent to natural teeth. Modifying conventional beveled cavity design with an additional slot in the center also increases the fractural strength of restoration. Clinical significance: Nanocomposites reinforced with single fiber in the central palatal slot used for restoring fractured incisors provide strength almost equivalent to natural teeth. In case when the fiber is not available for preparing a single palatal slot also, we can increase the fracture resistance.

Aim: The internal fit and resistance to fracture of resin ceramics are to be evaluated compared to that of lithium disilicate as the control group. Materials and methods: Four groups of 20 crowns each (GC Cerasmart, Vita Enamic, Coltène Brilliant Crios, and e.max CAD) were cemented on identical metal dies. Marginal gaps were measured before cementation and load to fracture was applied after cementation, half of each group was thermodynamically aged (3,000 cycles of 5° to 55° immersion followed by 200,000 cycles of 100 N load), finally the crowns were loaded until fracture in a universal testing machine. Statistical package for social sciences (SPSS) package 23 was used for statistical work. Results: Marginal gaps ranged between 68.5 ± 23.8 ìm and 87 ± 29.1 ìm while occlusal gaps ranged from 220.7 ± 33.3 ìm to 275.5 ± 46.5 ìm and were not significantly different between groups. Fracture loads ranged from 633.8 ± 127.3 N to 1596.4 ± 497.7 N with lithium disilicate glass ceramics (LDGCs) and Enamic having higher values than resin nano-ceramics (RNCs). The fracture resistance was more related to material than aging and gap value. Conclusion: The margin adaptation of resin ceramics was comparable to lithium disilicate with no significant difference. Lithium disilicate showed a higher resistance than resin ceramics and there was a higher resistance to fracture for polymer-infiltrated ceramic-network (PICN) than RNCs. Clinical significance: Resin ceramics can have marginal adaptation and fracture resistance within clinical acceptance; therefore, they can be a good chair-side solution achieved in a single appointment session.

Aim: Immunohistochemical expression of survivin was analyzed among the three histological grades (well differentiated, moderately differentiated, and poorly differentiated) of oral squamous cell carcinoma (OSCC). Materials and methods: The study material consisted of 60 formalin-fixed paraffin-embedded tissue samples: 15 cases each of well, moderate, and poorly differentiated OSCC and normal oral mucosal (NOM) tissues as the control. Survivin expression was evaluated immunohistochemically and statistical analysis of data was performed using Fisher's Chi-square and analysis of variance (ANOVA) tests. Results: Survivin was expressed in all grades of OSCC, but absent in normal oral tissue samples. Poorly differentiated OSCC exhibited 51 to 75% immunopositivity (53.3%) and severe staining intensity (46.7%) for survivin, predominantly in nuclear areas. While moderately differentiated OSCC had 26 to 50% immunopositivity (40%) and moderate staining intensity (80%), 5 to 25% immunopositivity (40%) with moderate staining intensity (86.7%) was observed in well-differentiated OSCC. Overall, there was a statistically significant difference among the three grades of OSCC in relation to survivin immunopositivity and immunoreactivity (p < 0.01). Conclusion: This study supports the use of survivin as a potent diagnostic and prognostic marker for OSCC. Clinical significance: Increased survivin expression and its nuclear localization appeared to correlate with a higher grade of malignancy suggesting unfavorable prognosis.

Aim: Documentation of marginal bone resorption caused by implant-supported mandibular overdentures is scarce. This study sought to evaluate marginal bone resorption, survival rate, patient satisfaction, peri-implant soft tissue status, and prosthetic aftercare of mandibular overdentures supported by two vs four implants. Materials and methods: This retrospective cohort study evaluated 92 edentulous patients presented to the Implant Center of Tehran University of Medical Sciences; out of which, 46 patients received overdentures supported by two Implantium implants (group A), while the remaining 46 received overdentures supported by four Implantium implants (group B). Standard radiographic indices were assessed following the delivery of overdenture and after 2 years of functional loading. Clinical evaluation was performed after 2 years of function. Data were analyzed using the t test (for continuous variables) and the Mann–Whitney test (for ordinal variables). Results: In group A, two implants were lost in one patient. The groups were not significantly different in terms of clinical or radiographic parameters (p > 0.05). Patient satisfaction and prosthetic aftercare were not significantly different in groups A and B (p > 0.05). Conclusions: During the 2-year evaluation period, the clinical and radiographic parameters were the same in patients who received overdentures supported by two or four implants. Clinical significance: Successful results may be obtained by the use of mandibular overdentures supported by two or four implants.

Aim: The aim of this study is to evaluate and compare the amount of radicular peroxide penetration when various concentrations of carbamide peroxide (CP) bleaching gels (10, 15, and 35%) and a mixture of 30% hydrogen peroxide (HP) with sodium perborate are used for intracoronal bleaching. Materials and methods: Fifty extracted single-rooted premolars from young adults were used. The specimens were then divided into five groups such that teeth with varying sizes were equally distributed in all groups. Group I—distilled water (control group), group II—10% CP, group III—15% CP, group IV—35% CP, and group V—30% HP with sodium perborate. Intermediate restorative material (IRM) was used to seal access cavities and left for a week at 37 °C in an incubator. Following the bleaching process, suspended teeth from plastic tubes containing distilled water were removed and the water was used to determine the amount of peroxide levels. A UV-visible spectrophotometer at a wavelength of 480 nm was used to determine the quantity of peroxide based on the optical density. Results: Results showed the highest peroxide leakage in group V, followed by group IV, and then group III, whereas the least peroxide penetration was found in group II, and the control group or group I showed no penetration. The Kruskal–Wallis test showed a significant difference between the various groups tested. The Mann–Whitney test was done to find in which pair of groups there exists a significant difference. It was found that all the groups when compared among themselves showed a significant difference. Conclusion: The present study concluded that lower concentrations of CP 10 and 15% produced lower peroxide leakage. Hence, it could be tried as an alternate to traditional agents in cases with compromised tooth which shows cervical tooth defects where the risk of external root resorption is higher. Clinical significance: The management of discolored teeth involves different techniques; among various techniques, bleaching is considered to be a safe, effective, and relatively noninvasive technique to lighten discolored teeth and it also conserves dental hard tissue.

Aim: Digital orthopantomography (OPT) is usually the first examination step in supervising an incoming patient. Cone beam computed tomography (CBCT) is the most refined and affordable method to search for different dental lesions. The aim of this paper is to evaluate the effectiveness of OPT and CBCT in detecting periapical lesions in different dental groups. Materials and methods: An OPT and a CBCT scan of the dental arches of 45 patients were examined. The presence of AP was pointed out for OPT and CBCT. Sensitivity, specificity, predictive values, and accuracy were calculated for OPT, using CBCT as the reference standard. Results: OPT showed low sensitivity (40.0), positive predictive value (90.4), negative predictive value (90.0), accuracy (90.0), and high specificity (99.2). It was found to have higher sensitivity in the lower front and premolar areas, while the lowest was found in the upper molar area. Conclusions: OPT can be used for endodontic diagnosis in the lower central and premolar sections, but CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between apex and important anatomical structures exists. Clinical significance: CBCT exposes the patient to higher doses of radiations when compared with OPT, but CBCT, with its more selective sensitivity and the possibility to offer a three-dimensional (3D) rendering of dental and periodontal structures, is an elective choice for uncertain cases and for specific dental areas.

Aim: This research aimed at evaluating the effects of the nociceptive trigeminal inhibition splint (NTIS) on electromyography (EMG) for masseter and temporalis muscles in patients with temporomandibular joint disorders (TMDs), and at detecting the discomfort degree originating from this splint. Materials and methods: The sample consisted of 15 patients having TMDs of muscular origin to be treated by NTIS. The activity degree of masseter and temporalis muscles was measured using the EMG two times: before the treatment and after 6 months. Besides, patients’ discomfort was assessed after the start of treatment four times: 1 day, 2 weeks, 1 month, and 6 months. Results: After the treatment, there was a significant decrease in masseter and temporalis muscles’ activity in both right and left sides (p < 0.001). No significant differences were observed in the electrical muscular activity mean change between the masseter muscles (-43.87 ± 26.82) and the temporalis muscles (-54.91 ± 21.16) (p = 0.082), or between the right muscles (-51.97 ± 26.30) and the left muscles (-46.81 ± 22.90) (p = 0.422). In addition, the discomfort degree gradually decreased after 2 weeks (p < 0.01). Conclusion: The use of NTIS is associated with reduction in the masseter and temporalis muscles’ activity. Also, the patients’ discomfort degree from NTIS progressively decreases after 2 weeks of treatment. Clinical significance: The NTIS is an effective therapeutic approach for patients having TMDs of muscular origin.

Aim: The primary aim of this study is to compare the chronological age with the dental age of Saudi patients with non-syndromic cleft lip and palate (CLP). The patients’ demographics (gender and age group) were analyzed further. Materials and methods: In total, 401 panoramic radiographs were assessed (195 and 206 for the control and the CLP groups, respectively). The subjects’ ages ranged from 3 to 17 years, from both genders. The root and crown developmental stages of the mandibular permanent teeth were evaluated using Demirjian's method to calculate dental age. The subjects were separated into three groups according to chronological age. One investigator collected all the data, the intra-class correlation (ICC) coefficient test showed good reliability (0.984). A paired t test was then used to determine any statistically significant difference between the mean dental and chronological ages of the control and the cleft samples. The mean difference between chronological and dental ages was then calculated for the control and the cleft groups. A Student's t test was then used to compare the two mean differences. Results: The dental age of normal subjects was ahead of their chronological age by 8.1 months. The CLP group had delayed dental development by 9.6 months (p < 0.01) when compared with normal subjects. The males with CLP had an extended delay in dental development by 6.5 months when compared with females with CLP. Conclusion: Saudi subjects affected with CLP had significantly delayed dental development when compared with the control group. Clinical significance: Dental age is commonly used to assess dental development in comparison with chronological age. Reporting dental age accuracy for CLP cases would be of value for proper management and diagnosis.

Aim: Dental fear (DF) in children is a multifactorial problem that may affect the child's dental treatment and behavior at the dental office. This study aimed to evaluate the familial characteristics affecting DF among Arabic-speaking 12- to 15-year-old children in Jeddah, Saudi Arabia. Materials and methods: A cross-sectional study assessing 16 middle schools in Jeddah, Saudi Arabia, was performed through multistage stratified random sampling. DF among children was measured using the children fear survey schedule-dental subscale (CFSS-DS) questionnaire. A parental questionnaire was used to collect information regarding familial socioeconomic status, parental DF, and DF among siblings and friends. The data were analyzed using the t test, one-way analysis of variance (ANOVA), and multiple linear regression analysis. Results: A total of 1,522 children were included. Socioeconomic variables were not associated with DF among children. Parental DF, parental dental experiences, siblings’ DF, and friends’ DF were significantly associated with DF in children. In the regression analysis, mothers’ anxiety at the last dental visit, siblings’ DF, and friends’ DF were significant predictors of DF among children. Conclusion: DF in children is associated with mothers’ anxiety during their last dental visit and DF in siblings or friends. Clinical significance: Obtaining comprehensive dental, family, and social history from patients is as essential as asking about medical history for pediatric dentists to plan the most appropriate and effective behavioral management techniques for their pediatric patients. Understanding the etiology of DF assists clinicians to provide better oral health services for their fearful patients.

Aim: The aim of this study is to assess the influence of e-learning on dental education as perceived by predoctoral dental students. Materials and methods: In an institutional review board (IRB) approved protocol, a 14-question survey was created and electronically distributed to second-, third-, and fourth-year dental students. The participation was considered voluntary and all responses were anonymous. Results: The survey targeted 1,130 predoctoral students, of which 255 (22.6%) responded. Of the respondents, 124 students (48.6%) preferred traditional lecture mixed with online learning, while 46 students (18%) preferred only the traditional lecture style. The top three electronic resources/applications, which students perceived as having the greatest impact on their learning, were: YouTube, Bone Box, and Google. The responses also indicated that 76.5% of the students gave high credibility (scores of 4 and 5) to electronic resources recommended by faculties. Sixty percent of students spent 1 to more than 4 hours per day on electronic resources for academic performance. The most important factor for online applications influencing academic performance was “organization and logic of content” (54%). E-learning had a significant perceived effect (scores of 4/5) on didactic understanding (65.1%) and on clinical understanding (71.4%). Students observed that faculties estimated to be under 50 years of age were more likely to incorporate e-learning into courses (52.6%) and more likely to use social media for communication (41.6%). Conclusion: The results indicate that e-learning may successfully be used in a dental school's curriculum to enhance students’ perceptions of fundamental concepts and to enable students to apply this knowledge to clinical cases. Clinical significance: E-learning has recently been proposed as a basic supplementary tool to enhance medical and dental education. It is crucial to determine dental students’ preferences regarding social media, online applications, and databases in order to incorporate e-learning into dental school courses.

Aim: The aim of this study is to assess the prevalence and causes of traumatic dental injury (TDI) in 9–14 year school-going children in Mumbai, Maharashtra, India. Materials and methods: A cross-sectional study consisting of 2,055 primary and secondary school-going children aged between 9 and 14 years, from 20 municipal corporation schools of Mumbai city, was selected through a stratified random sampling technique. Children were examined clinically for any signs of TDI in the permanent anterior teeth in their respective schools by two examiners trained in using WHO criteria for oral and dental examination. Data analysis involved descriptive statistics including a frequency distribution. Results: The prevalence of TDI to anterior teeth in school children of Mumbai was 16.3%. The commonest cause of trauma was fall followed by sports activities, collision, and road traffic accidents. Conclusion: The occurrence and various etiologies of traumatic injuries to maxillary anterior teeth in school children of Mumbai were approximately the same as found in other countries. Clinical significance: The present study gives a bird's eye view on the prevalence and common etiology of TDI in school children of Mumbai.

Aim: The objective of this epidemiological survey is to investigate the dental-skeletal features of subjects attending the Public Dental Service in Unità Operativa Complessa (UOC) (Orthodontic Department of “La Sapienza University of Rome”) and compare them with the existing body of evidence obtained from other surveys. Accordingly, the Index of Orthodontic Treatment Need (IOTN) was employed, in order to achieve a common framework to allow the shaping of public health prevention practices. Materials and methods: A sample of 3,491 subjects in the Orthodontic Department of “La Sapienza-University of Rome” (UOC) was evaluated with the adoption of IOTN to define malocclusion severity. Results: In the result analysis, it was observed that class II malocclusion was more frequent in the sample (40%), and a large part of the examined population also presented mandibular dental crowding (43%), increased overjet (41%), and increased overbite (38%). Only 26.44% (20.17% IOTN 4; 6.27% IOTN 5) had strong need for orthodontic treatment. Conclusion: The realization of epidemiological investigations to establish priority for treatment need is, therefore, particularly useful, not only to estimate the prevalence of some clinical conditions in the observed population, but also to plan targeted interventions, such as interceptive and corrective therapies in growing children. Clinical significance: These interventions could solve specific clinical situations and/or prevent their escalation. Only in this way, it is possible to avoid fragmentation of the limited resources available, using them for patients with an objective need.

Aim: The present case illustrates how a tooth, which had a highly questionable prognosis, was preserved by carrying out a periodontal regeneration surgery. Background: Treatment of periodontitis involves a careful consideration of all the factors that may allow the achievement of a favorable outcome; among those, the skillful use of guided tissue regeneration (GTR) membranes is of paramount importance. Case description: A 39-year-old patient presented with a mobile central upper incisor due to severe periodontitis and was treated according to GTR principles using a collagen membrane. A collagen-preserving bone graft was also used, as a scaffold for clot formation and cellular infiltration, which was covered with a second collagen membrane. The patient was contacted for follow-up assessment at 3, 6, 12, and 18 months after surgery. Follow-up radiographs showed that bone regeneration occurred around the involved tooth and very little tooth mobility was observed. The patient's masticatory function, appearance, and comfort were favorable. Conclusion: The use of two equine collagen membranes with the purpose of creating the best conditions to carry out periodontal regeneration according to GTR principles, in association with an equine, collagen-preserving, enzyme-deantigenic bone graft, allowed sufficient bone regeneration to salvage a tooth that was deemed otherwise lost because of periodontitis. Clinical significance: In cases of teeth that are severely compromised by periodontitis, the use of collagen membranes according to GTR principles can allow the regeneration of the periodontal tissues; the association with a bone substitute having well-known performance rates, covered with a collagen membrane (guided bone regeneration, GBR) can, in some cases, improve bone regeneration at the defect site.

Aim: This report describes the challenges experienced in a unique case involving dental esthetics, and the treatment provided to achieve satisfactory conservative treatment. Background: Even minor aspects of dental esthetics can significantly affect a patient's quality of life. Moreover, the patient's level of satisfaction with rehabilitative dentition and prosthetics affects oral health, daily living, and dental perceptions. It is not unusual for clinicians to encounter cases with complex esthetics that have affected the patient's life. Such cases need careful treatment planning to meet the patient's expectations. Conservative treatment should be the clinician's goal, because complex treatment may result in negative outcomes. Case description: Here, the patient exhibited severe bone loss due to cleft palate, as well as improper positioning of the teeth. He could not be treated with implants because of poor bone quality and quantity. Orthodontic treatment was performed, but did not improve the outcome. A wax-up was made for each of the three possible options, and then transferred to the patient's mouth by making a mock-up. This allowed the patient to clearly understand the results of each option. After selecting an option, we performed the procedure on the cast before it was undertaken in the patient's mouth. This helped us to precisely determine the preparation needed for all teeth. Teeth were saved where possible to preserve the remaining bone. The lost bone was replaced with pink porcelain. Treatment was conservative and the results were optimal for the patient and our clinical team. Conclusion: In some cases, clinicians may have few options available to achieve satisfactory results. However, the use of appropriate diagnostic tools, data collection, and conservative treatment procedures can help achieve these goals. Clinical significance: Fabrication of wax-ups and mock-ups can help the clinician and patient predict the results of dental treatment and ensure a conservative procedure.