Aim: This retrospective cross-sectional study investigated the dimensional and positional associations between the mandibular condyle and glenoid fossa (GF) using cone-beam computed tomography (CBCT). Materials and methods: Seventy female subjects [140 temporomandibular joints (TMJs)] were divided into two groups. Group I included 35 subjects with normal facial profiles (NFPs) in which the soft tissue glabella, subnasal point, and the soft tissue chin are almost in the same straight line, while the 35 subjects in group II had abnormal facial profiles (AFPs) in which the same imaginary line is either convex or concave indicating variation from standard norms. Three-dimensional volume analyses were performed on CBCT images by digitizing all landmarks in three orthogonal planes to measure the dimensional and positional parameters of the condyle and GF. Then the Pearson's correlation coefficient was used to identify associations between different condyle and GF parameters. Results: Sagittal condylar surface area was significantly associated with all dimensional parameters of the GF (GF height, width, and surface area, condylar width, and the GF width and between the axial and coronal condylar surface area with GF height and GF width) on the right and left sides of both groups (p values ranging from 0.000 to 0.028). Positional associations were detected between the anteroposterior and mediolateral GF positions and the corresponding position of the mandibular condyles and between the anteroposterior condylar position and the vertical GF position on both sides of both groups (p values ranged from 0.000 to 0.015). Conclusion: There is a strong association between the mandibular condyle and GF in both positional and dimensional measurements in patients with normal and abnormal facial profiles. Clinical significance: Understanding the associations between the mandibular condyle and GF facilitates optimization of the treatment outcomes by increasing occlusal harmony and stability after orthodontic treatment, orthognathic surgery, or any prosthetic replacement.

Aim: The aim was to evaluate and compare the therapeutic effect of sodium hyaluronate (SH) and corticosteroids (CS) on pain and temporomandibular dysfunction (TMD). Materials and methods: Thirty patients with TMD [characterized by painful symptoms, affectations, and limitations of the mandibular movement and noises or clicks in the temporomandibular joint (TMJ)] were selected and divided into two equal groups nonrandomized. The clinical questionnaire was applied to each patient before performing the clinical procedures and included a visual analog scale with progressive values from 0 to 10 for the measurement of pain and clinical examination: maximum oral aperture (MOA), mandibular laterotrusive movement (MLM), and maximum protrusion (MP), before and after infiltration intra-articular with SH and CS up to 2 months. Results: Both groups described benefits from treatment at the 1st and 2nd weeks, and at 1 and 2 months of follow-up, presenting a reduction in TMJ pain, and improvement in mandibular mobility with an increase of the MOA, lateralities, and protrusion. No statistically significant difference was found among these variables between the two drugs. However, SH showed a greater therapeutic effect in relation to a reduction in joint noises compared to CS. Conclusion: Intra-articular infiltration with SH and CS in TMD is effective for the relief of TMJ pain and also reduces joint noises and improves mandibular mobility. Both drugs can be used with similar optimal results in the treatment of TMD. Clinical significance: This research allows to know what is the therapeutic impact of injectable CS on the TMJ.

Aim: To assess the sealing ability of two calcium silicate-based materials in the treatment of iatrogenic furcal perforations using a dye-penetration leakage model. Materials and methods: Furcation perforations were performed using a size 12 round burr on the pulp chamber floor of 20 first mandibular molars. The teeth were then randomly divided into two groups, two additional molars served as negative controls. The defects were then filled with mineral trioxide aggregate (MTA) Angelus in the first group and Biodentine in the second group. Leakage at the repaired sites was then evaluated using the methylene blue dye penetration technique. Results: Significant differences in microleakage were found between the two groups at 72 hours (p < 0.001). MTA Angelus had greater dye penetration than Biodentine with a statistically significant difference. Subsequently, the sealing ability of Biodentine was significantly better than MTA Angelus (p < 0.001). However, the mean values of leakage and inadequate adhesion were significantly different from the theoretical value for both the MTA Angelus (p < 0.001) and Biodentine (p < 0.001). Conclusion: The current results suggested that Biodentine possesses higher sealing quality than MTA Angelus. Yet, both materials are not ideal and still need improvement to ensure perfect adhesion in case of furcal perforation. Clinical significance: This article aims to compare the sealing ability of one dental repair material over another, after iatrogenically producing a furcal perforation. Leakage resistance and sealing ability are important factors in favoring the outcome of an endodontic treatment of a tooth that could otherwise be condemned for extraction.

Aims: To assess the fluoride concentration in water sources and its association with caries index in children living in Tripoli, Lebanon. Materials and methods: The concentration of fluoride was measured in tap and bottled water using ion chromatography. For tap water, eight water sources were evaluated before and after domestic distribution during June and November 2016. For bottled water, seven brands available on the market were tested. Caries were recorded in 402 children using DMFT/dmft indices. A questionnaire was distributed to parents to gather information about sociodemographic characteristics, the source of water consumed, the consumption of fluoride supplements, fluoridate salt, tea and sweets, and the frequency of toothbrushing. Results: The fluoride concentration in tap water was not significantly different from the optimal concentration (p value > 0.05). However, the amount of fluoride in bottled water (0.14 ± 0.698 mg/L) was significantly lower than the optimal amount of fluoride recommended by the World Health Organization for decay prevention (0.5–1 mg/L) (p value < 0.001). The prevalence of caries was elevated in children aged 5 years (90.5%) and 12 years (89.6%). The carious indices were lower in children who consume tap water, tea, and fluoridated salt and those who consume less sweet. Conclusion: Additional studies covering all Lebanese regions should be performed to develop a national policy concerning fluoride-based scientific evidences. Clinical significance: Pedodontists should take in consideration the source of water consumed by the patient before prescribing a fluoride supplementation to avoid an overconsumption. They should promote effective oral hygiene methods and nutritional education and encourage regular tea consumption as an affordable source of fluoride to prevent caries.

Aim: This study highlights the use of electronic dental record (EDR) of a dental college at the University of Hail. This study has examined the perceptions of the stakeholders in regard to the objective mentioned above. Materials and methods: It was a cross-sectional survey. The present study collected data from participants working in the dental clinics at the University of Hail. Face- and content-validated questionnaire was used as a study tool. The data were displayed in numbers and percentages. A Chi-squared test was used to measure the statistical significance. The p value < 0.05 was considered significant. Results: There were 166 respondents, out of which 92 (55.4%) were male and 74 (44.6%) were female participants. A highly significant result recorded for age group and rank/position for a variable that says using EDR will add to the skills of the dentists. Results showed that using EDR would not slow down the work. A need for a comprehensive training and the interference with the performance of dentists found as two main barriers towards the use of EDR. Conclusion: This study has pioneered the idea of checking on the perceptions of stakeholders to enquire about the use of EDR in clinics in the Kingdom of Saudi Arabia. It has been reiterated by all the participants that EDR is a need for the clinics in the kingdom but some have reservations about the tedious nature of its use while some were worried about the excessive training they will need to overcome the difficulty of using it. It is observed from the stakeholders’ replies that the use of EDR will slow down the work nature in clinics. Clinical significance: The EDR is commonly used in many developed countries. The proficiency of its use is quite acceptable. The use of EDR in Kingdom of Saudi Arabia is relatively new. The present study measures the perception of its easiness and efficiency in dental practice.

Aims: To assess the staining efficacy of the innovative “Pravara” stain on ground sections of human teeth under a stereomicroscope. In this study, the ground sections were stained with the innovative stain. The stain is obtained from a leafless tree called Terminalia chebula. Terminalia chebula, commonly known as Harad, is found in South Asia from India. Few species are found in the Pravara region of Maharashtra, India. Materials and methods: A total of 40 extracted teeth were collected and ground sections of each tooth were prepared. The samples were randomly divided into two groups: group I—control (without stain), group II—study group (the samples in this group were stained with the help of innovative “Pravara” stain). The sections were graded from I to III according to the differentiation and contrast of tissues. Results: The ground sections in group II stained with Pravara stain demonstrated better contrast for structures within sections under a microscope in comparison with group I (control group). Conclusion: The study demonstrates the efficacy of a new innovative Pravara stain, which is a simple, economical, quick, and effective staining method for the ground sections of the teeth. Clinical significance: This innovative Pravara stain is cost-effective, saves time, ecofriendly, and highlights the anatomical structures more effectively and does not fade easily with time.

Aim: The aim of this in vitro research was to study the effect of etching by phosphoric acid with rubbing technique on the shear bond strength (SBS) of adhesive universal to enamel. Materials and methods: Sixty extracted teeth were obtained. Three application methods (self-etch, etch-and-rinse, and etch-and-rinse with rubbing technique) were performed to bond the enamel surfaces by a universal adhesive. After 24 hours of immersion in water at 37°C, the specimens were prepared for the SBS test. Scanning electron microscopy was performed to observe the adhesive–enamel interfaces. Optical numeric microscope was used to observe the failure style. Statistical analyses were done with one-way analysis of variance test. Results: Statistically significant higher bond strength values were observed for etch-and-rinse mode with rubbing technique (25.98 ± 5.70) MPa then for the etch-and-rinse without rubbing (22.07 ± 5.27) MPa and self-etch modes (9.96 ± 2.98) MPa. Conclusion: Enamel etched by 37% phosphoric acid with rubbing technique for 20 seconds showed an increase in the SBS of the universal adhesive to enamel surfaces. The tags of the adhesive can be presented more efficiently by rubbing the acid before the bonding process, consequently, an optimal interface for the bonding. Clinical significance: According to the results of this in vitro study, the selective enamel etching mode with rubbing technique is advisable when using the universal adhesive, as it significantly increased the bond strength of this adhesive to enamel surfaces. The clinician should etch the enamel using phosphoric acid with rubbing technique for 20 seconds to promote the bond strength of the universal adhesive system.

Aim: To explore the impact of socioeconomic status (SES) and/on the awareness of ill effects of tobacco on oral and general health and to evaluate the effectiveness of pictorial warning on tobacco cessation in a semi-urban population of South Chennai. Materials and methods: This cross-sectional survey for 1 week was conducted using a two-stage sampling design, with a sample size of 300. New op patients constitute the first sampling design, and patients with history of any form of tobacco constituted second sampling design for the second part of the study. Following an informed consent in patient's own language, and as per inclusion criteria's, new op patient was interviewed with questionnaire 1, which comprised 27 closed-ended questions to assess subject's general awareness on tobacco, awareness of ill effects of tobacco on oral and general health, and their SES. Sociodemographic information such as age, sex, marital status, occupation, address, educational level, and family income per month was also recorded. Response categories for each of the questions were “yes”, “no”, and “don\'t know”. The Questionnaire-2 comprised 8 closed-ended questions that assessed the subject's willingness to quit and to evaluate the effectiveness of pictorial warning on tobacco cessation, which was subjected only to those patients who had a history of tobacco usage which was recorded after completing the Questionnaire-1. This group formed the secondary sampling unit. Questionnaire-2 also included an individual suggestion for the preference of type of warning sign on the tobacco packet/sachet in the end. Statistically, Cronbach's α coefficient, one-way analysis of variance, Tukey HSD post hoc tests, and Chi-square test were used. Results: On the whole, this study reported good awareness about harmful effects of tobacco. In all, 33.2% of respondents could not change after noticing the warning ads, 90.3% of our respondents are not aware that a professional help is available to motivate quitting. Smokers were more aware than smokeless tobacco users, and tobacco users recommended a greater area to be covered for pictorial warnings and to increase the frequency to change the pictorial warning signs. Conclusion: Alarmingly high statistics and delayed presentation of oral and health hazards at the time of primary diagnosis underscores the need for an extensive awareness campaign on the issues related to ill effects of tobacco more focused on tobacco user's perspective and feedback. Clinical significance: Health awareness programs related to awareness of ill effects of tobacco should be tailor-made to the targeted population and should be more focused on the control of specific risk factors. Health warnings on tobacco packages that combine text and pictures, along with the frequent role of impact of mass media and campaigns on mouth self-examination and improvement in quality of life can effectively increase the general public awareness of the serious and deleterious health risks of tobacco use and to reduce its consumption.

Aim: The interrelationships between dental prostheses, abutments, and supporting periodontal tissue are dynamic. Clinical studies assessing the quality and associated complications of fixed dental prostheses (FDPs) in the Saudi population are scarce. The aims of this project were to assess the location and accuracy of marginal adaptation and proximal contact quality of FDPs provided by dentists in the Kingdom of Saudi Arabia and to assess the impact of these factors on the health of the periodontium and caries susceptibility. Materials and methods: This retrospective cohort study collected demographic, dental, and social history data from patients with FDPs. Fixed dental prostheses quality was assessed using the United States Public Health Service Criteria, and periodontal health indices were measured. Descriptive and inferential statistics were used for data analysis. Logistic and multiple linear regression analyses were performed to assess predictors of caries risk and periodontal disease, respectively. Results: Sixty-two patients with 62 FDPs were assessed. The mean patient age was 32.45 ± 9.0 (19–61) years with a male-to-female ratio of 3:1. On the assessment, 74.2% had marginal discrepancy, 54.8% had subgingival margins, 22.6% had open or tight proximal contacts, and 8.1% had marginal caries. Well-adapted margins promoted periodontal health, and inadequate proximal contact increased the risk of marginal caries. Conclusion: This study suggests that 26% of FDPs provided by dental practitioners in the Western province, Kingdom of Saudi Arabia, were of high marginal fit and proximal contact quality. Clinical significance: Constructing FDPs with high-quality marginal fit and proximal contact promotes periodontal health and reduces caries risk, thereby improving FDP outcome.

Aim and objective: The aim and objective of the present study was to assess the flexural strength of denture base resin based on surface treatment with different acrylic resin repair materials. Materials and methods: Totally, 120 heat-polymerized polymethyl methacrylate denture base resin materials which are rectangular shaped with the size of 65 mm × 10 mm × 2.5 mm were fabricated. 150 μm-sized alumina used for surface treatment. All the 120 heat-cured, surface-treated acrylic denture base resin samples were randomly divided into three groups. Group I: glass-fiber-reinforced auto-polymerizing acrylic resin, group II: auto-polymerizing acrylic resin, and group III: light-cured acrylic resin. A universal testing machine was used to test the flexural strength of the repaired specimens. Results: A highest mean flexural strength (88.96 ± 0.31) was demonstrated by group I, followed by group II (72.18 ± 1.86) and group III (66.30 ± 1.02). ANOVA demonstrated a statistically significant inter-group difference. On multiple comparisons, using Tukey's post hoc test a statistically significant difference between groups I and II and between groups I and III was found. Conclusion: After considering the limitations, the present study concluded that the highest flexural strength is shown by glass-fiber-reinforced auto-polymerizing acrylic resin than by auto-polymerizing acrylic resin and light-cured acrylic resin. Clinical significance: Denture repair comprises of joining two fractured parts of a denture with a denture repair material. The success of denture repair depends on the adhesion phenomenon. The treatment of the surface can be accomplished using a suitable material which changes chemically and morphologically and thus promotes better adhesion.

Aim and objective: To evaluate the bactericidal effect of silver nanoparticles and silver nanoparticles in combination with Nd-YAG laser against Enterococcus faecalis. Materials and methods: A solution containing 100 μg of silver nanoparticles in 1 mL was prepared by adding 5 mL of 10⁻⁴ M solution of AgNO₃ with 5 mL of 0.1 M sodium tricitrate. Synthesized silver nanoparticles were characterized using UV-visible spectrophotometer for optical studies and the transmission electron microscopic analysis for determining the size and shape of the nanoparticles. Groups are as follows: group I—silver nanoparticles against E. faecalis, group II—silver nanoparticles in combination with Nd-YAG laser against E. faecalis, group III—control, E. faecalis bacterial culture alone. Optical density was measured periodically at half an hour interval in spectrophotometer in a 96 well plate and statistically analyzed using one-way ANOVA. Results: The optical density and turbidity of groups I and II began to decrease in 2 hours in comparison with the control. There was a significant difference in mean optical density among the three groups after 1½ hours onward. The study also demonstrated the minimal bactericidal concentration (MBC) as 100 μg/mL of Ag nanoparticles with a size of 15 nm were effective against E. faecalis. Conclusion: The study concluded that silver nanoparticles individually and in conjunction with Nd:YAG laser irradiation would be an effective protocol against E. faecalis. Clinical significance: The combined effect of silver nanoparticles and laser disinfection against E. faecalis holds a promising treatment modality for eradicating resistant pathogens and biofilms embedded deep inside the dentinal tubules that are not amenable to conventional disinfection protocols in root canals.

Aim and objective: To compare the efficacy of 2% lignocaine and 4% articaine in the extraction of mandibular molars. Materials and methods: This study was conducted on 120 patients requiring surgical removal of tooth. Patients were categorized into 2 groups with 60 samples each. Group I patients were administered 2% lignocaine with 1:50,000 epinephrine and group II patients were administered 4% articaine with 1:100,000 epinephrine for the extraction of mandibular molar. Inferior alveolar nerve, lingual, and buccal nerve block used in both groups to anesthetize the area. Results: The mean onset of action in group I was 85.2 seconds and in group II was 52.6 seconds, duration of anesthesia in group I was 170.2 minutes and in group II was 226.8 minutes, duration of procedure was 30.4 minutes in group I and 32.6 minutes in group II, pain during procedure in group I was 2.75 and in group II was 1.42, pain after procedure was 1.41 in group I and 0.82 in group II, pain during anesthesia insertion was 1.52 in group I and 1.04 in group II. Forty-six (76.7%) patients in group I and 52 (86.7%) patients in group II did not require re-anesthesia, while 12 (20%) in group I and 8 (13.3%) in group II required 1 time re-anesthesia and 2 (3.3%) patients required 2 times re-anesthesia in group I. Conclusion: Articaine can be effectively used in oral surgical procedures as there is early onset of action, longer duration of anesthesia, and less need of re-anesthesia. Clinical significance: Articaine is more effective compared to lignocaine, hence it can be recommended alternatively for tooth extraction and other oral surgical procedures.

Aim and objective: The present study evaluated the effects of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser on the weight percentage of mineral content of enamel when etched at three different power settings. Materials and methods: Total 20 extracted molar teeth were taken as samples. Enamel slabs were prepared by sectioning the crown from the buccal and lingual aspect with a double-sided diamond disk at slow speed. The 40 specimens were divided into four groups, i.e., control, 1 W, 2 W, and 3 W of 10 specimens each and then irradiation by Er,Cr:YSGG was done. The elements evaluated were calcium (Ca), potassium (K), magnesium (Mg), sodium (Na), and phosphorus (P). The mean weights of these minerals and the Ca:P ratio in each slab were measured by energy-dispersive X-ray spectroscopy analysis (EDAX). One-way analysis of variance (ANOVA) followed by the Turkey's test was performed with the help of critical difference (CD) or least significant difference (LSD) at 5 and 1% level of significance. Results: There was no significant differences among the four groups for the five minerals and for the calcium:phosphorous ratio (p > 0.05). Photomicrographs by scanning electron microscopy observations revealed that the surfaces exposed to a 3 watt irradiation showed more roughness than those of the 1 watt and 2 watt groups. Conclusion: The Er,Cr:YSGG irradiation of enamel at 1 W, 2 W, and 3 W had no significant effect on the mean percentage weights of Ca, K, Mg, Na, and P or the Ca/P ratio in any group. Clinical significance: Constriction with conviction is the new motto of restorative dentistry. Er,Cr:YSGG not only fulfills the aim but also is proving to alter the surface properties by recrystallization and change in composition making the prepared surface caries resistant.

Aim and objective: Assessment of dental caries, periodontitis, and personality trait among population of Dehradun. Materials and methods: This survey was conducted on 480 subjects age ranged 34–45 years of both genders (males—250, females—230). Decayed Missing, Filled Teeth (DMFT) index, periodontal status, and personality trait were recorded. Results: Age group 34–39 years is comprised of 130 males and 140 females and 40–45 years had 120 males and 90 females. Maximum males (120) were laborer and females were housewife (160). Commonly used method of oral hygiene practice was tooth powder by 80 males and 103 females. Maximum subjects of extroversion (180) was seen in age group 40–45 years, maximum females (110) were housewife with extroversion trait, maximum extroversion trait subjects were using tooth powder (113) and datum (100). Mean DMFT score in subjects was 2.52 and community periodontal index of treatment needs (CPITN) score was 3.41. There were 310 extroversion subjects, 120 neuroticism subjects, and 50 combinations of both extroversion and neuroticism. There was a significant difference in mean missing teeth and DMFT in subjects with different personality traits (p < 0.05). The post hoc test showed that mean missing teeth between group E and group E + N was found to be statistically significant (p < 0.05). The post hoc test showed that the mean sextant value for score 2 between group E vs N found to be statistically significant (p < 0.05). Neurotic individuals were found to have poorer periodontal health as compared to extroverts. Conclusion: Authors found that personality trait such as psychological factors have greater impact on status of dental caries and periodontitis. Extroverts had less dental caries and better periodontal status when compared to other personality traits. Clinical significance: Psychological factors have a great impact on status of dental caries and periodontitis. By assessing various psychological factors, the occurrence of both can be avoided. Thus by improving oral health, overall health of an individual can be improved.

Aim and objective: The aim of the study was to compare three different techniques using scalpel, electrosurgery, and laser for gingival depigmentation in terms of pain, discomfort, duration of procedure, wound healing, and repigmentation. Materials and methods: Thirty patients in the age range of 24–38 years were briefed about the surgical procedure and an informed consent was obtained and they were randomly allocated into three groups of 10 individuals (5 males and 5 females) each: those undergoing depigmentation with scalpel (group I), electrosurgery (group II), and diode lasers (Biolase) (group III). Individuals of all three groups were asked to describe the level of pain and discomfort by using the visual analog scale (VAS) 2 hours, 24 hours, and 1 week postoperatively. Further, the groups were compared based on duration of procedure, wound healing, and repigmentation at the end of 14 months. Results: All the groups showed a decrease in the pain levels, which was statistically highly significant 1 week postoperatively when compared 24 hours postoperatively. There was a statistically significant difference in the pain levels between the scalpel, electrosurgery, and lasers groups after 24 hours (p < 0.001), with the lasers group demonstrating significantly less pain and discomfort. There was significant difference between the groups with respect to the duration of procedure, with less mean time for completion of the procedure observed for group III. Furthermore, less time for wound healing was observed in group III as compared to other groups. Total 8 out 10 patients in group I, 7 out of 10 patients in group II, and 2 out of 10 patients in group III showed repigmentation at the end of 14 months. Conclusion: The rising concern for esthetic demand of an individual requires the removal of hyperpigmented gingival areas to create a confident and pleasing smile, which could be easily attained by using laser. Clinical significance: Laser is an effective and fast tool that causes less pain, discomfort, faster healing, and delayed repigmentation compared with scalpel or electrosurgery for gingival depigmentation.

Aim and objective: Dental professionals are more prone to get exposed to various occupational health problems. The aim is to assess various dental occupational hazards and safety measures among dentists of Odisha, India. Materials and methods: The present study was conducted among 572 dental professionals of both genders. A self-administered questionnaire which comprises name, age, gender, number of years of experience, type of occupational hazard, awareness of occupational hazards, safety measures practiced, and working hours per week was given to dental professionals and the responses were recorded. Results: 545 (95.2%) dentists were responded out of 572 participants. Age group 20–40 years had 55 males and 24 females, 40–60 years had 154 males and 84 females, and >60 years had 116 males and 60 females. 220 dentists had 10–15 years of experience, 190 had 5–10 years, 60 had <5 years, 40 had 15–20 years, and 35 had >20 years. The difference was significant (p < 0.05). The most common occupational hazard was musculoskeletal disorders seen in 480 (88%), stress in 273 (50%); maximum occupational hazard (52%) was noticed in dentists with <5 years of working experience; proper safety protocols adopted by dentists were the use of sterilized instruments 99%, gloves 98%, face mask 82%, vaccination against hepatitis 54%, head cap 51%, eyewear 12.6%, and proper waste disposal 7%. The difference was significant (p < 0.05). Conclusion: The chances of occupational hazards are more common in dentists. The prevalence was higher among dentists with less than 5 years of experience. Clinical significance: Knowledge and awareness about occupational hazards can help prevent complications due to occupational hazards in dental practice.

Aim and objective: The aim of this study was to evaluate the efficacy of novel antioxidant oregano against conventional antioxidants sodium ascorbate and green tea through comparison of the baseline weight percentage (wt%) of minerals prior to bleaching with values after bleaching protocols and antioxidant application by employing energy-dispersive X-ray spectroscopy analysis (EDAX). Materials and methods: Thirty noncarious, freshly extracted human permanent maxillary incisors without any visible defects were selected as samples. They were divided into three groups (n = 10) based on the antioxidant treatment received as follows: group I—10% sodium ascorbate solution, group II—10% green tea solution, and group III—5% oregano solution. 35% hydrogen peroxide was employed for bleaching. The wt% of teeth was calculated at three time intervals. The initial wt% was calculated prior to the bleaching procedure. The second one was calculated after subjecting to bleaching protocols, and final one was calculated after antioxidant treatment using EDAX. Results: There was a statistically significant decrease in the calcium/phosphorus ratio for the bleached samples in comparison with the sound enamel. There was a comparable and significant increase in the calcium/phosphorus ratio values after application of the antioxidant with insignificant difference among the antioxidants evaluated in the study. Conclusion: Treatment with antioxidants helped in the reversal of mineral loss, which occurred due to the bleaching procedure while the efficacy of 10% oregano on reversal of the calcium and phosphorus ratio was found to comparable to that of 10% sodium ascorbate and green tea. Clinical significance: Application of antioxidants after bleaching reduced the time delay in performing the adhesive procedures without compromising their clinical efficacy.

Aim and objective: To externally validate the performance of a novel periodontal prediction model (PPM) for identification of diabetes among Saudi adults. Materials and methods: The study was carried out among 150 adults attending primary care clinics in Riyadh (Saudi Arabia). The study adopted a temporal external validation approach, where the performance of the PPM was evaluated in the same location as the development study, but at a later time to allow for some variation between samples. A case-control approach was adopted, where diabetes status was first ascertained, followed by the completion of the Finnish Diabetes Risk Score (FINDRISC), Canadian Diabetes Risk (CANRISK) tools, and periodontal examinations. Results: The area under the curve (AUC) of the PPM (based on the number of missing teeth, the proportion of sites with pocket probing depth ≥6 mm, and mean pocket probing depth) was 0.514 (95% CI: 0.385, 0.642). The FINDRISC and CANRISK tools had AUC values of 0.871 (95% CI: 0.811–0.931) and 0.927 (95% CI: 0.884–0.971), respectively. The addition of the PPM did not improve the AUC of FINDRISC (p = 0.479) or CANRISK (p = 0.920). The decision curve analysis showed that there was no clinical benefit in adding the PPM to either tool. The PPM was updated with an overall adjustment factor for all existing predictors and three more periodontal measures. Conclusion: In an external sample, the PPM had poor performance for identification of diabetes and no added value when combined with FINDRISC and CANRISK. The performance of the PPM improved after recalibration and extension. Clinical significance: The results underscore the value of externally validating prediction models before applying them in clinical dental practice.

Aim and objective: The study aimed to compare the prospective changes in mandibular third molar angulation in high anchorage cases treated with first premolar extractions vs non-extraction orthodontic treatment. Materials and methods: The sample consisted of 56 nongrowing patients: Group I had 26 patients with a high anchorage requirement who underwent first premolar extractions and group II had 30 patients who underwent non-extraction treatment. Pretreatment, mid-treatment, and posttreatment panoramic radiographs were obtained for group I and pretreatment and posttreatment for group II. Angle between M2 (second molar)-horizontal reference plane (HRP), M3 (third molar)-HRP, and M2-M3 were measured bilaterally. Data were analyzed using Student t test and ANOVA test (p value < 0.05). Results: Statistically significant increase was found between the pretreatment, mid-treatment, and posttreatment values of M2-M3 in group I (p value = 0.02 R and p value = 0.049 L) and between pretreatment to posttreatment values of M2-HRP in group II bilaterally (p value = 0.001). Significant increase was found in the M2-M3 angulations in group II on the right side (p value = 0.036). M3-HRP decreased in group I without reaching statistical significance. No statistically significant intergroup differences were found between the two groups in relation to M2-HRP, M3-HRP, and M2-M3 angulations. Conclusion: M2-M3 angulations increased significantly bilaterally in group I and on the right side in group II, indicating worsening of third molar angulation. M3-HRP worsened in group I without reaching statistical significance. Extraction therapy in high anchorage cases does not lead to an improvement in third molar angulation. Clinical significance: The extraction of first premolars in high anchorage cases does not lead to an improvement in the angulation of mandibular third molars; moreover, the angulation worsened with extraction therapy. Prospective orthodontic patients need to be cautioned against any improvement in mesioangular impaction of mandibular third molars in high anchorage premolar extraction cases.

Aim and objective: To present a growing patient with unilateral mandibular hypoplasia and microtia involved in the first and second branchial arch syndrome (FSBAS) treated with functional appliance. Background: The FSBAS comprises several developmental facial hypoplasia in ear and maxillofacial bones, resulting in hemifacial microsomia. Treatment for hemifacial microsomia varies greatly depending on the grade of mandibular deformities. Functional appliance treatment during growth period is available for mild to moderate mandibular deformities. However, there are few reports of hemifacial microsomia treated with functional appliance. Case description: The patient, an 8-year-and-5-month-old girl, had a chief complaint of mandibular deviation. She had been diagnosed with the FSBAS at birth. Her facial profile was straight and panoramic radiograph indicated that the mandibular ramal height of the affected side was about 60.4% compared to the unaffected side. The occlusal cant was 6°, and the right maxilla and mandible showed severe growth deficiency. At the age of 10 years, functional appliance with expander was used; for 2 years 6 months, the maxillomandibular growth was controlled and from panoramic radiograph, the ramus height of the affected side was increased to 65.0% compared to the unaffected left mandibular ramus. At the age of 12 years and 8 months, multibracket treatment was initiated. After 32 months of active treatment, proper occlusion with functional Class I canine and molar relationships was obtained, although facial asymmetry associated with the difference of ramus heights still existed. The resulting occlusion was stable during 1.5-year retention period. Conclusion: Our results indicated the importance of orthopedic treatment during growth period in the patient with hemifacial microsomia involving the FSBAS. Clinical significance: This report proposes an efficacy of conventional orthodontic treatment for growing patients with hemifacial microsomia involved in the FSBAS.