Aim: To compare the mechanical properties of four different types of contemporary fissure sealants before and after water storage employing a modern instrumented indentation testing (IIT) method. Materials and methods: Four different types of materials used in everyday practice were deliberately selected. Fissurit (FIS) is a highly filled resin, Embrace (EMB) is a bisphenol A (BPA)-free unfilled resin, Helioseal (HEL) is an unfilled resin, and Riva Protect (RIV) is a glass-ionomer material. Six cylindrical specimens from each material were prepared (h: 3 mm, O: 15 mm), and Martens hardness (HM), elastic modulus (E_IT), elastic index (ƒÅ_IT), and Vickers hardness (HV) were determined employing an IIT machine according to International Organization for Standardization (ISO) 14577:2015. Then, the samples were stored in water at 37°C for 48 hours and measured again at the same surface. The mechanical properties tested (HM, E_IT, ƒÅ_IT, and HV) were statistically analyzed by two-way repeated measurements analysis of variance (ANOVA) employing materials and conditions as discriminating variables. Statistically significant differences were identified by Tukey's post hoc multiple comparison test. In all cases, a 95% level of significance was set (p = 0.05). Results: Statistically significant differences in selected mechanical properties were allocated among materials tested. The artificial aging had a detrimental effect on HM, E_IT, and HV apart from ç_IT for FIS, EMB, and HEL. In contrast, no significant differences were identified for RIV before and after water storage for all aforementioned properties apart from ç_IT. Conclusion: Significant differences were identified in mechanical properties among materials tested and thus differences in their clinical behavior are anticipated Clinical significance: This study contributes to the understanding of the mechanical properties of different dental sealants with respect to water contact, which may influence the choice by the therapist

Aim: The aim of this study is to assess three protocols for removing a eugenol-based filling endodontic sealer from root dentin and the bond strength of fiberglass posts luted with resin cement. Materials and methods: Sixty single-rooted bovine teeth were prepared and filled with the Endofill endodontic sealer and gutta-percha cones. After 7 days, 9 mm of the filling was removed and divided into five groups (n = 12) according to the cleaning protocol: G1 (negative control), unfilled; G2 (positive control), saline solution; G3, 95% alcohol; G4, amyl acetate; and G5, Largo bur. The canals were hybridized and fiberglass posts were luted with resin cement. They were cross-sectioned in slices of 1 mm and subjected to the push-out test. The other samples were sectioned longitudinally and visualized in a scanning electron microscope (SEM), and the existing chemical elements were quantified by energy dispersive spectroscopy (EDS). The statistical analysis used variance analysis (ANOVA)-one way and Fisher's test, at a 5% significance level. Results: The 95% alcohol was more effective for cleaning the canal, resulting in a clean dentinal surface and bond strength statistically similar to the negative control. The Largo bur was also statistically similar to the negative control, with only a few debris impregnated on the wall. Amyl acetate showed more sealer residues on the canal walls, with a consequent lower bond strength value than the other groups, only higher than the positive control. Conclusion: The 95% alcohol and Largo burs may be used after removing the canal filling, so that the bond strength is improved when using the eugenol-based sealer.

Aim: Cone beam computed tomography (CBCT) is the most refined and affordable method available today for the examination of an incoming patient for different dental pathologies. The aim of this paper is to evaluate the significance of some factors influencing the prevalence of apical periodontitis. Materials and methods: An ortopantomography (OPT) and CBCT scan of the dental arches were examined for each of the selected 45 patients. The presence of apical periodontitis (AP) was compared for CBCT and OPT examination. Sensitivity, specificity, predictive values, and accuracy were calculated for CBCT, using OPT as a reference. The impact of protective/risk factors on the development of AP was examined. Results: CBCT showed higher sensitivity (250%), predictive values (111%), accuracy (111%), and specificity (101%) than OPT. It was found to have higher sensitivity in all the dentition areas, especially where empty anatomical spaces or more radiotransparent structures have a strict relationship with the tooth apex and periapical structures like upper front area, premolar areas, and, especially, in the upper molar area. The prevalence of AP increased from 16 to 17% in the case of insufficient conservative restoration or 25% in the case of microleakage, 35–42% in the case of prosthetic restoration, 56–67% for posts, and 60 and 85%, respectively, for inadequate endodontic treatment and missed canals. Conclusion: CBCT plays a decisive role in the evaluation of molar areas and in the endodontic treatment planning, when a close relationship between the apex and important anatomical structures exists. Different risk factors with different relevance are identified. Clinical significance: As CBCT-examined results show, coronal restorations are moderate-risk factors, while insufficient endodontic treatments and posts are high-risk factors for the development of AP.

Aim: The aim of this study is to assess the epidemiological profile of 12- to 16-year-old adolescents with Down syndrome in the Special Basic Education Center in Lima—Peru. Materials and methods: A cross-sectional descriptive study was performed, where the epidemiological profile was determined through the DMF-T index, oral hygiene index (OHI), and the gingival index from Silness and Löe. A sample of 107 adolescents with Down syndrome in a Peruvian rural population were considered who were evaluated with the formula of proportion estimation, of which 48 (44.8%) were females and 55 (59%) males. Results: Patients with mild to moderate Down syndrome were with a caries prevalence of 42 and 27.1%, respectively. Likewise, class III malocclusion was present in 42.9 and 25.2%. The most prevalent OHI was the regular category with 66.2%. Results: Patients with mild to moderate Down syndrome were with a caries prevalence of 42 and 27.1%, respectively. Likewise, class III malocclusion was present in 42.9 and 25.2%. The most prevalent OHI was the regular category with 66.2%. Conclusion: It was evident in mild Down syndrome adolescents, a higher prevalence of the indexes: dental caries, malocclusion, periodontal disease, and oral hygiene, moderate to severe.

Aim: The present study aims to assess the efficacy of non-resorbable and bioabsorbable guided tissue regeneration (GTR) membrane periodontal tissue regenerative methods. Materials and methods: Thirty teeth taken from 20 patients (8 males and 12 females) within the age range of 20–55 years having chronic periodontitis were enrolled in this trial. All the enrolled patients underwent phase I therapy which included scaling and root planing performed in two sittings by a single practitioner. Patients who fulfilled the selection criteria entered the study and were randomly allocated to the three groups. Group I: control group, group II: patients who received a non-resorbable GTR membrane, and group III: patients who received a bioabsorbable GTR membrane. The clinical parameters that were documented at baseline, 3 months, and 6 months postoperatively were the gingival index, plaque index, and probing depth (vertical and horizontal) for all the three groups. Results: The mean gingival index score was 1.64 ± 0.32 in group III at baseline, which decreased to 1.20 ± 0.10 at 6 months postoperatively. The plaque index reduced from 1.36 ± 0.46 at baseline to 1.04 ± 0.01 at 6 months postoperatively. The vertical and horizontal probing depths demonstrated a statistically significant difference between all the three groups. Conclusion: The present study established that both membranes resulted in clinically and statistically significant improvements in the treatment of grade II furcation defects.

Aim: The aim of this study is to evaluate and compare the shaping ability of HyFlex™ EDM (HFEDM) and ProTaper Next (PTN) rotary instruments in curved root canals by using micro-computed tomography (micro-CT) imaging. Materials and methods: A total of 22 mandibular molar teeth having separate mesial canals with 20 to 30° curvatures were randomly divided into two groups and instrumented with HFEDM (OneFile) or PTN (X1 and X2). Pre- and post-instrumentation micro-CT scans were obtained. Mesiodistal canal transportation and centering ability were evaluated in four cross-sections (2, 4, 6, and 8 mm from apex). Changes in canal volume and surface area were measured for a 10-mm standardized area of interest. Kolmogorov–Smirnov and Shapiro–Wilk tests were used to assess the normality and homogeneity. Independent and paired t tests and one-way ANOVA were used to analyze data at the p < 0.05 level. Results: Compared to PTN, HFEDM showed significantly less mesiodistal canal transportation and improved centering ability in cross-section L6 (p < 0.05). The instruments showed similar increases in volume and surface area of the canals, with minor insignificant differences. Conclusion: HFEDM and PTN files were safe to use in curved canals and showed similar shaping ability, while respecting the original anatomies. HFEDM OneFile performed better at the vicinity of the danger zone in terms of mesiodistal canal transportation and centering ability.

Aim: The study tests the correlation between the enlargement of the nasal cavity width, interglenoid fossa distance, and intercondylar distance after rapid maxillary expansion (RME) in growing patients. Materials and methods: Cone beam computed tomography (CBCT) was performed for 25 patients presenting a bilateral crossbite (11 males, 14 females, and mean age 11.6 ± 1.6 years) at baseline (T0) and at 6 months after RME (T2), T1 being the end of expander activation. Images were digitized for linear measurements using specific software. Values were compared at the nasal width, interglenoid fossa distance, and intercondylar distance to test the correlation in the transverse dimension. Results: At T0, a correlation already existing between the interglenoid fossa distance and the intercondylar distance persisted at T2. The correlation between the nasal cavity width and interglenoid fossa distance nonexistent at T0 ended toward statistically significant at T2. Additionally, the lateral position of the condyles was not correlated with the nasal cavity width neither at T0 or T2. Conclusion: A correlation between the interglenoid fossa distance and intercondylar distance was exhibited 6 months after RME. The correlation between the nasal cavity width and interglenoid fossa distance was close to significant at T2.

Aim: Oral cancer ranks in top three of all cancers in India and accounts for over 30% of all cancers reported in the country. The present study aims at an in vivo cytogenetic analysis to assess the applicability of the micronucleus test in diagnosing early detection of dysplastic changes. Materials and methods: Exfoliated scrape smears were collected from 75 patients suffering from premalignant lesions. The wet-fixed smears were stained by adopting Papanicolaou's staining protocol. The analysis of variance (ANOVA) test was used to analyze the data statistically. Results: The results of the above study give a fair assessment of the amount of nuclear alterations seen in individuals exposed to genotoxic agents, such as tobacco, and also to a certain extent, an insight into the expected biological behavior of the lesions present in such individuals. Detection of micronuclei and their assay is an upcoming research domain in the field of cancer detection and therapeutics. These miniature nuclear offshoots if properly identified can turn out to be important biomarkers with huge potential for screening and predicting patients with oral precancers and also can act as risk assessors in patient's ongoing treatment for invasive cancers. Conclusion: The frequency of micronucleated cells has been observed to be in increasing order with the increase in the age-groups and from control to precancerous cases significantly in both sexes.

Aim: This study aims to investigate the influence of temperatures of 20 °C and 37 °C on the resistance to cyclic fatigue of NiTi instruments with different heat treatments, as tested in severely curved simulated canals. Materials and methods: Seventy-two instruments were distributed according to the temperature used (20 °C and 37 °C): XP-endo Shaper (30/0.01), ProDesign Logic (30/0.05), and iRaCe (30/0.04). The instruments were rotated freely until the occurrence of fracture inside an artificial severely curved stainless steel canal, which had a 90° angle of curvature and a curvature radius of 5 mm. Kolmogorov–Smirnov, Wilcoxon, ANOVA, and Kruskal–Wallis tests were performed. A p value of <0.05 was considered statistically significant. Results: XP-endo Shaper instruments presented higher NCF values and time to failure compared with ProDesign Logic and iRaCe instruments at 20 °C and 37 °C (p < 0.001). Conclusion: Within the limitations of this study, the results show that the body temperature (37 °C) significantly lowers the resistance to cyclic fatigue of all instruments compared with 20 °C.

Aim: The study aims to assess the gingival health around cervical lesions restored with calcium silicate-based cement (Biodentine™) compared to treatment with glass-ionomer cement (GIC). Materials and methods: A total of 28 healthy subjects with carious lesions on the cervical third of the buccal surfaces of posterior teeth (class V—Black's classification) have participated and were distributed over two equal groups. The participants in each group received one type of the tested cements: Biodentine™ or GIC. The oral hygiene and the gingival health of the restored teeth were evaluated clinically at 1, 3, and 6 month intervals. Results: Comparing clinical parameters of gingival and periodontal tissues adjacent to cervical restorations indicated significant differences. Plaque index (PI) and gingival index (GI) were higher in the Biodentine™ group at 1, 3, and 6 months of evaluation with a significant difference (p < 0.05), a rise in pocket depth has been noticed at 3 and 6 months (p < 005). Gingival recession (GR) did not show any difference between groups (p > 0.05). Moreover, bleeding on probing (BOP) values were higher for Biodentine™ restorations compared with GIC with a significant difference (p < 0.05). Conclusion: Cervical restorations of Biodentine™ were associated with more plaque accumulation with a higher degree of gingival inflammation in comparison with GIC.

Aim: The purpose of this research is to compare peri-implant bone level in immediate and conventionally loaded implants using flap and flapless techniques. Materials and methods: Forty patients were selected and were subjected into four groups. Group A: 10 patients with immediate loading (IL) by raising the flap. Group B: 10 patients with IL without raising the flap. Group C: 10 patients with conventional loading by raising the flap. Group D: 10 patients with conventional loading without raising the flap. Results: It was observed that for most of the flapless techniques with IL cases, the bone loss settled at first thread or just below the implant collar after 6 months. Conclusion: It was seen that the crestal bone height was reduced in both flap and flapless techniques by immediate and conventional loading, respectively. On comparing the bone loss, the flapless approach by IL showed statistically significant lesser reduction as determined by radiovisiography. Clinical significance: Postoperative pain was less in the flapless technique as compared to the traditional flap technique. IL minimizes invasiveness, complexity, and also improves acceptance by patients.

Aim: The aim of this study is to evaluate the anticandidal effects of essential oils derived from fennel (Foeniculum vulgare) and cumin (Cuminum cyminum) on Candida strains isolated from edentulous patients. Materials and methods: Candida samples were isolated from 30 edentulous patients and the strains were identified using the CHROMagar method. Using the macro-broth dilution method and punched-hole tests, the effectiveness of fennel and cumin essential oils (prepared through distillation by water) was clarified. Nystatin was used as a positive control. Results: Nystatin (44 ìg/mL) had the strongest antifungal effect, followed by cumin [minimum inhibitory concentration (MIC) = 662 ìg/mL; minimum fungicidal concentration (MFC) = 630 ìg/mL] and fennel (MIC = 1,074 ìg/mL; MFC = 1,227 ìg/mL). The average diameter of the fungal growth inhibition zone was 23 mm for Nystatin, 14 mm for cumin essential oil, and 5 mm for fennel essential oil. Conclusion: The anti-Candida effects of fennel and cumin show promise as alternatives to conventional drugs for the treatment of Candida infections.

Aim: The aim of this study is to evaluate and compare the regenerative potential of natural scaffold [platelet-rich fibrin (PRF)] and artificial scaffolds (commercially available collagen, placentrex, and chitosan) in necrotic immature permanent teeth. Materials and methods: Necrotic immature permanent maxillary incisors with or without radiographic evidence of periapical lesion were included. Access opening was done under rubber dam isolation. Canal disinfection was done using minimal instrumentation, copious irrigation, and double antibiotic paste as interappointment medicament for 4 weeks. After 4 weeks, asymptomatic teeth were divided into four groups on the basis of scaffolds used for the revascularization procedure: group I (PRF); group II (collagen); group III (placentrex); group IV (chitosan). The clinical and radiographic evaluations of teeth were done at 3, 6, and 12 months after the procedure and compared with baseline records. Results: Clinically, patients were completely asymptomatic throughout the study period. Radiographically, all cases showed an improvement in terms of periapical healing, apical closure, root lengthening, and dentinal wall thickening. PRF and collagen gave better results than placentrex and chitosan in terms of periapical healing, apical closure, and dentinal wall thickening. Conclusion: Revascularization procedure is more effective and conservative over apexification in the management of necrotic immature permanent teeth. This study has shown that PRF and collagen are better scaffolds than placentrex and chitosan for inducing apexogenesis in immature necrotic permanent teeth.

Aim: The present study was done to evaluate in vivo effects of an amorphous calcium phosphate (ACP) containing adhesive in reducing enamel demineralization during the early stage of fixed orthodontic treatment. Materials and methods: A triple blinded randomized clinical trial (RCT) was conducted to evaluate enamel demineralization on 255 anterior teeth in 23 patients over a period of 6 months. A split-mouth design was used; half of the anterior teeth were bonded with the ACP containing adhesive and the contralateral teeth received regular adhesive as a control. The enamel demineralization measurements were done at three different time intervals: immediately after bonding (T0), 1 month after bonding (T1), and 6 months after bonding (T2) using the DIAGNOdent device. Results: Significant enamel demineralization variations were determined among groups (p < 0.001). The ACP containing adhesive showed significantly lower enamel demineralization than control adhesive. Conclusion: The result of this study suggests a positive effect on the reduction of enamel demineralization when using ACP containing adhesives during orthodontic treatment over regular adhesive.

Aim: In this study, we intend to compare the linear dimensional changes of interocclusal recording media by immersing them in disinfectant solutions at different time intervals. Materials and methods: Five interocclusal recording materials were used for this study and were grouped according to material types, namely wax, zinc oxide eugenol impression paste, polyether, polyvinyl siloxane, and bisacryl bite registration material. Each material was manipulated and injected into a stainless steel die. The materials were divided into 5 groups with 5 subgroups of 10 samples with a total of 250 samples. The samples were subjected to immersion in 2% glutaraldehyde and 0.5% sodium hypochlorite each for 30 and 60 minutes. Linear dimensional changes of the samples were tested by measuring the distance between points A and B at different time intervals by means of a stereomicroscope and compared with the control group. Results: Bisacryl showed the least linear dimensional change when immersed in both the solutions. Conclusion: Bisacryl (Luxabite) presented no linear dimensional change at both time intervals as opposed to the other materials, hence, it is most accurate.

Introduction: Interproximal enamel stripping is routinely used in orthodontics, different methods were utilized by clinicians to reduce the width of teeth but no previous study addressed the factors affecting the thermal safety of such systems on the dental pulp. Aim: The present study was conducted to measure thermal changes among four different interproximal reduction (IPR) systems in orthodontics. Materials and methods: A total of 130 extracted human premolar teeth were used in this study. Teeth were distributed into three experimental groups each having three subgroups and one control group. Thus, a total of 10 subgroups were created of 13 teeth each. Stripping procedures were performed using four diamond tools (burs, discs, saw, and manual strip) with different speed setup, with and without a coolant for the higher speed setup for each tool. A K-type thermocouple wire was positioned in the center of the pulp chamber and was connected to a data logger during the application of stripping procedures. Data were analyzed by the Krushkal–Wallis test using the SPSS PC+ version 21.0 statistical software. Results: There was a highly statistically significant difference in the mean ranks of temperature values among the four groups with different speed levels. Among the 10 subgroups, the higher change in temperature registered was in the bur and disc groups when operated with the highest recommended speed without a coolant. The change in temperature was statistically significantly higher than the temperature values of other groups (p < 0.001). All recorded temperatures were below the critical temperature (5.5 °C) registered. Conclusion: Based on the results of this study, IPR is a safe procedure on the dental pulp for the teeth with a medium dentin thickness with or without a coolant.

Aim: The primary objective was to determine the oral health status and treatment needs among hearing-impaired (HI) adults. Second, to assess the relationship between the oral health variables and oral health-related quality of life (OHRQoL) by using General Oral Health Assessment Index (GOHAI)-Ar questionnaire among HI adults in Riyadh city, Saudi Arabia. Materials and methods: A total of 146 HI adults between the age groups of 18–21, 22–25, and >25 years were included in the study. A convenient sampling technique was used to obtain the study sample. Oral health condition was recorded by using oral hygiene index-simplified (OHI-S), plaque index (PI), and gingival index (GI). The WHO methodology was used to record dental caries and treatment needs. The Saudi Arabian version of GOHAI-Ar questionnaire was used to gather information with regard to OHRQoL. A sign language expert communicated information between HI and investigator while answering the questionnaire. Results: More than half of the HI had fair OHI-S (55.2%) and PI score (54.2%), while 60.1% of HI had moderate gingival inflammation. The prevalence of dental caries (82.2%) and treatment needs (85.6%) were found to be high. Mean oral hygiene scores between Saudi and non-Saudi nationals [(1.64) vs (1.12), p = 0.041] showed significant differences. Missing and filled teeth showed significant differences across different age groups (p = 0.000). The mean GOHAI-Ar was found to be low (14.44 ± 9.59). Spearman's test showed a significant positive correlation between the GOHAI-Ar score and the toothbrushing method (r = 0.164, p = 0.047). Toothbrushing time, oral hygiene material, last visit to dentist, OHI-S score, PI score, decayed, missing, and decayed missing filled teeth (DMFT) scores were negatively correlated with GOHAI-Ar. Speech was the main concern for the HI. Conclusion: There was a fair oral hygiene, moderate gingival inflammation, high caries experience, and treatment needs with low GOHAI-Ar scores indicating poor OHRQoL among HI.

Aim: The aim of this study is to evaluate the efficacy of sublingual piroxicam as a preemptive analgesic agent in patients undergoing single implant surgery. Materials and methods: This was a prospective triple-blind placebo-controlled trial that involved 40 patients presented for the placement of a single endosteal implant in the posterior maxillary arch. Patients were randomly allocated to one of the following groups. Group I (study) who received sublingual piroxicam 40 mg 1 hour prior to the surgical procedure and group II (control) received placebo 1 hour before the surgery, both the groups received sublingual piroxicam 20 mg tablet twice a day on the first and the second postoperative day and once a day on the postoperative day 3. Visual analog scores for measuring pain intensity were assessed at postoperative 1 hour, 6 hours, days 1, 3, and 5. Facial swelling was measured and evaluated during the first, third, and fifth postoperative days using the digital vernier caliper. The Mann–Whitney U test was used to make between-group comparisons. The Wilcoxon-signed rank test was used to make within-group comparisons. Results: At all-time intervals, both mean pain and mean swelling scores were higher in controls as compared with those of cases. The difference between the two groups was also statistically significant at all-time intervals for both parameters except for pain at 1 hour Conclusion: Our findings suggest that preoperative sublingual piroxicam is more effective for controlling postoperative pain and swelling after surgical implant placement than only postoperative administration.

Aim: A severely atrophied maxilla presents serious limitations for conventional implant placement and the reconstruction of which requires extensive surgical treatments. This original article presents an overview of this evidence-based technique used for maxillary rehabilitation. Background: Growing patients’ needs to regain proper oral function with limited surgical effort presents a challenge to the surgeon for implant placement in harmony with the planned prosthesis. Different techniques and protocols have been put forward through the ages to improve implant survival, osseointegration, and quality of life. A new technique—Tall Tilted Pin Hole Immediate Loading (TTPHIL-ALL TILT™ technique)—utilizes angulated long bicortical tapered implants placed in a flapless way in immediate loading with screw-retained prosthetic solutions. Technique: TTPHIL-ALL TILT™ technique involves flapless subcrestal bicortical placement of a total of six tall threaded tilted implants engaging the nasal cortex and the pterygoid pillars, rigidly splinted maintaining adequate anteroposterior spread, achieving proper primary stability, fit for immediate loading. Screw-retained prosthetic solutions are provided with the elimination of distal cantilever. Conclusion: The TTPHIL-ALL TILT™ technique can facilitate surgical rehabilitation of patients with maxillary resorption, as an alternative to other graft less and grafting procedures. Clinical significance: TTPHIL-ALL TILT™ technique provides a graftless solution for the challenging resorbed maxillary edentulous ridges. By following this protocol, primary stability is achieved which gives way for immediate loading satisfying the patient's functional and aesthetic needs.