Aim: The aim of this research was to determine whether sterilization and reutilization of impression copings had an impact on the accuracy of casts made for multiimplant restorations. Materials and methods: Four master casts embedded with five implant analogs were fabricated. Polyvinyl siloxane (PVS) impressions of the master cast with copings attached to the analogs were made and poured in dental stone. The impression copings were subjected to cleaning and sterilization. These processes were repeated 30 cycles for each of the two groups of five impression copings: one without modification and one with modification that included air abrasion and PVS adhesive. A coordinate measuring machine (CMM) was used to measure relative angles and distances between the reference analog and analogs. The relative angles and distances measured on the stone casts were compared to the master resin cast to obtain positional and angular displacements. Results: For impression copings that were not modified, a significant difference was detected for both positional and angular displacements. For impression copings that were modified, a significant change was observed only for positional displacement. The maximum discrepancies measured for positional and angular displacements after 30 cycles of reuse were only 81 μm and 0.46°, respectively, regardless of the modification. Conclusion: Within the limitations of this study, unmodified impression copings that have undergone 30 cycles of cleaning and sterilization appeared to incur more impression inaccuracy than those impression copings that were modified by airborne-particle abrasion and PVS adhesive. Clinical significance: Impression copings used in this study can likely be recycled up to 30 times without reducing the accuracy of the impression to a level that may be considered clinically significant.

Aim: To compare the effect of erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser at different irradiation parameters and acid etching on the shear bond strength (SBS) of orthodontic brackets to enamel. Materials and methods: Forty bovine incisors were randomly distributed into groups (n = 10): GI: 37% phosphoric acid etching; GII: Er,Cr:YSGG laser etching 19.1 J/cm²; GIII: Er,Cr:YSGG, 29.3 J/cm²; and GIV: Er,Cr:YSGG, 42.4 J/cm². After treatments, metallic brackets were bonded using Transbond XT adhesive system. After light curing, the samples were subjected to 500 thermal cycles, debonded with a universal testing machine, and the SBS values were recorded. After debonding, surface morphology was evaluated using scanning electron microscopy (SEM) and optical coherence tomography (OCT). The values of SBS testing were analyzed by one-way analysis of variance (ANOVA) and Tukey post hoc test, at 5% significance level. Results: The mean SBS values of GI, GII, GIII, and GIV groups were 6.2 ± 1.7 MPa, 4.6 ± 2.5 MPa, 7.0 ± 2.2 MPa, and 8.0 ± 3.6 MPa, respectively. Laser irradiation promoted rough surfaces in all parameters used, and the OCT analysis revealed higher optical changes on lased groups when compared with phosphoric acid. Conclusion: Er,Cr:YSGG laser irradiation operated at 42.4 J/cm² and 29.3 J/cm² is a better alternative for etching enamel prior to the orthodontic treatment than the phosphoric acid. Clinical significance: Er,Cr:YSGG laser irradiation is better than the phosphoric acid for etching enamel prior to the orthodontic treatment because laser irradiation promotes similar SBSs and preventing demineralization around orthodontic brackets.

Aim: The aim of this study was to assess the impact of acidic drink on the microhardness of different esthetic restorative materials. Materials and methods: Sixty samples (20 samples of each group) were prepared. group I: nanohybrid ormocer-based composite, group II: glasiosite compomer, and group III: nanoceramic composite. A cylindrical aluminum mold of 5 mm depth and 10 mm internal diameter was used to prepare the samples. All the esthetic restorative samples were submerged in 25 mL of acidic drink (Coca-Cola) for 10 minutes each day up to 15 days. The microhardness of each sample was measured using a Vickers diamond intender. These values were matched with baseline, 7th day, and 15th day for final microhardness values. Results: The mean surface microhardness of 61.13 ± 0.82 was shown by group I, which was slightly more than that in group II (59.65 ± 1.16) and group III (59.22 ± 1.30). Analysis of covariance did not show any statistically significant difference between the groups. The samples in group III showed the highest reduction in surface microhardness value after immersion into acidic drink, followed by group II and group I on 7th day and 15th day. A statistically significant difference (p < 0.001) was found on 7th day. Conclusion: The present study concludes that the esthetic restorative material—nanohybrid ormocer-based composite—showed the finest behavior both before and after being dipped in the acidic drink followed next by glasiosite compomer and nanoceramic composite. Clinical significance: The various esthetic restorative materials with different physical characteristics and colors are marketed in numerous ways. Nevertheless, all dental restorative materials show surface degradation under acidic conditions over a period of time. So, it helps to know the surface microhardness changes of various esthetic restorative materials upon repeated exposure to acidic beverages.

Aim: The objective of this study was to assess apical extrusion after filling material removal using two systems, one rotary and one reciprocating. Materials and methods: A total of 34 extracted mandibular premolars with single roots were selected and, posteriorly, prepared and filled. Following material aging for 60 days, teeth were divided into two groups, according to the method used to remove root filling material: group I, ProTaper® Universal Retreatment instruments plus refining with the Hero 642® sequence and group II, WaveOne® instruments. The teeth were fixed in an apparatus designed to collect the extruded material during removal procedure. Data on the amount of debris extruded (mg/weight) were analyzed using the Student's t test with a significance level of 5%. Results: No significant differences were found between the groups with regard to the amount of material extruded during root canal retreatment. Conclusion: The present findings suggest that the extrusion of debris during apical root canal retreatment does not depend on the instrument design or the protocol employed. Clinical significance: Regardless of root canal clearance techniques, debris extrusion eventually occurs during endodontic retreatment and may be related to postoperative pain.

Aim: To determine the effect of three different cavity disinfectants (2% chlorhexidine gluconate, 2.5% sodium hypochlorite, and 2% iodine solution) on microleakage in a seventh-generation dentin-bonding system. Materials and methods: Class V cavity was prepared on 50 extracted molars (n = 50). The respective experimental groups were treated with cavity disinfectants and Adper Easy One Bond. Preparations without cavity disinfectants worked as negative control and those with neither disinfectant nor dentin-bonding resin application worked as positive controls. After the cavity preparations were restored with resin composite (Filtek™ Z 350), the teeth were then subjected to dye leakage tests. Microleakage was assessed for both occlusal and gingival margins, using a stereomicroscope. Data were analyzed using (ANOVA; Kruskal–Wallis) test. Results: No statistically significant differences were observed among 2% chlorhexidine gluconate, 2.5% sodium hypochlorite, and 2% iodine and also no statistically significant differences were observed between occlusal and gingival margins of groups. Conclusion: (1) 2% chlorhexidine gluconate, 2.5% sodium hypochlorite, and 2% iodine produced significantly higher microleakage when used with seventh-generation dentin-bonding agent. (2) 2% chlorhexidine gluconate produced lesser microleakage in comparison with 2.5% sodium hypochlorite and 2% iodine. (3) The gingival margins exhibited greater microleakage than occlusal margins. Clinical significance: The application of cavity disinfectants on prepared tooth before the application of dentin-bonding agent could help to reduce the potential risk of residual caries and postoperative sensitivity.

Aim: The purpose of this study was to survey all United States Air Force (USAF) general dentists regarding their experience with computer-aided design/computer-aided manufacturing (CAD/CAM) while in a dental school. Dental school graduation year and location was compared to the type and amount of CAD/CAM training and clinical experience during dental school to better understand the differences and influence of this technology. Materials and methods: A survey consisting of six questions was sent through e-mail to 546 general dentists in the AF Dental Corps in 2018 of which 306 replied (56% response rate). Results: Dentists who graduated in 2005 or earlier and between 2006 and 2009 stated they did not receive CAD/CAM training in dental school, while more respondents in the group of graduation years 2014–2017 stated that they did receive training. About 11% of the respondents who graduated in 2014–2017 completed 6–10 restorations and 9% completed 11 or more restorations compared to the other year groups. More respondents who graduated from a dental school in the southwest and southeast regions of the United States reported completing more restorations compared to other school regions. Conclusion: Computer-aided design/computer-aided manufacturing is now becoming a prevalent curriculum in US dental schools, both as a core requirement and an elective. Its training platforms varied from lectures and literature reviews to preclinical laboratory. Clinical significance: More respondents in the groups of graduation years 2014–2017 had completed more CAD/CAM restorations compared to other year groups; however, most of the respondents did not feel their training was sufficient enough to use CAD/CAM technology independently.

Aim: To investigate and compare the levels of dental anxiety (DA) in relation to khat and non-khat chewer subjects of both genders from Jazan subpopulation, Kingdom of Saudi Arabia (KSA). Materials and methods: A cross-sectional study was conducted to assess DA using the modified dental anxiety scale (MDAS). A total of 352 subjects from the city of Jazan who attended dental clinics for regular treatment were recruited for this study. A questionnaire was used to collect the required information, which consisted of three parts. Descriptive statistics including means, standard deviations, and percentages were calculated. Multiple group comparisons were analyzed using Chi-square tests using the Statistical Package for Social Science (SPSS) program. p < 0.05 was considered as the significance level. Results: Among the participants, 75.6% was male, while 71.3% khat chewers, and most of them were male (91.2%). The percentage of the overall mean of MDAS was low; 40% to moderate; 38%, while sever anxiety were present in 4% only. Anxiety related to endodontic treatments represents 33.8% in both genders and 34.3% among the khat chewers, while fear was 42.1% among males and 45.4% among khat chewers. The local anesthesia injection in the gum and tooth drilling items of MDAS were represented by 36.6% for both khat and gender groups and resulted in a fairly and extremely anxious situation during dental treatments. All variables were significantly different. Conclusion: The overall DA level was low to moderate among the majority of the assessed subjects. Endodontic treatments were the first type of dental treatments for the subjects, while fear of pain was the most common cause of irregular dental visits. Significant differences were detected between khat and non-khat chewers and between genders in relation to anesthesia injection, and drilling of teeth in the MDAS items. Clinical significance: Community programs focusing on the high DA levels caused by khat chewing might be important in order to minimize the fear of dental treatments and improve and regularize the overall dental treatments.

Aim: To compare the application of silane in the bond strength of fiberglass posts in different thirds of the cemented root with a self-adhesive system in an ex vivo study. Materials and methods: Freshly extracted teeth were collected, which had indication of extraction for periodontal or orthodontic reasons. The study evaluated n = 42 specimens that were divided into two large groups: I (control, without silane) and II (with silane); the resistance to adhesion in the respective thirds of the root (cervical, middle, and apical) was also evaluated. The prefabricated fiberglass posts were cemented with and without silane according to the manufacturer's instructions and were cemented with a resin-based cementing agent. The adhesion strength test was evaluated by the universal testing machine. Results: According to the results of this experimental trial, the fiberglass posts that did not receive silane had the highest adhesion strength of 26.5 ± 10.6 MPa, while silane-cemented posts only had 21.7 ± 8.1 MPa. The statistical analysis was performed using the Kruskal–Wallis test and work with a level of significance of p < 0.05. Conclusion: The use of silane as part of the cementing protocol in fiberglass posts does not influence the adhesion strength between the surfaces of the posts and the resin cement because there were statistically significant differences between both adhesion protocols. Clinical significance: This study has a great impact because according to the results, clinical decisions can be made when cementing the fiberglass posts through the application of silane or not.

Aim: To compare the efficacy of casein phosphopeptide–amorphous calcium phosphate–fluoride (CPP-ACP-F) paste and 0.2% sodium fluoride mouthwash in the prevention of dental erosion using profilometer. Materials and methods: The buccal surfaces of 36 premolar sound teeth were ground and polished to achieve a flat surface with silicone disks. Samples were allocated in three groups randomly. Group I was pretreated for 5 days four times a day with CPP-ACP-F paste. Group II was pretreated for 5 days with 0.2% sodium fluoride mouthwash four times a day. Group III remained as the control group without any pretreatment. In the next step, all the samples were exposed four times a day for 3 days to carbonated beverages. The samples were rinsed with saline after each erosive cycle and stored in artificial saliva. The profilometer was used to determine the surface loss. The data collected were evaluated using one-way analysis of variance (ANOVA) along with post hoc test. Results: The erosion of group I (CPP-ACP-F paste) and group II (0.2% sodium fluoride mouthwash) was significantly less than that of group III (control group). The erosion in group II was significantly lower than in group I. Conclusion: Both sodium fluoride mouthwash and CPP-ACP-F paste are effective in the prevention of dental erosion. Sodium fluoride mouthwash shows higher reduction in dental erosion when compared with CPP-ACP-F paste. Clinical significance: This study contributes to the understanding of the efficacy of CPP-ACP-F paste and 0.2% sodium fluoride mouthwash in the prevention of dental erosion.

Background: The presence of Enterococcus faecalis in root canal is considered as one of the factors causing root canal treatment failure since the bacteria are capable of producing glucosyltransferase enzymes that play a role in forming endodontic biofilms. Hence, the bacteria are resistant to antibiotics. On the other hand, cocoa pod husk extract which is rich in chemical components especially flavonoids, tannins, and saponins, is thought to have an ability to inhibit Enterococcus faecalis glucosyltransferase enzyme activity. Aim: The aim of this research is to analyze the inhibitory ability of cocoa pod husk extract against E. faecalis glucosyltransferase enzyme activity. Materials and methods: A total of 27 research samples were divided into three groups, namely, positive control (chlorhexidine gluconate 2%), negative control (aquades), and cocoa pod husk extract 3.12%. Next the enzymatic activity of each sample group was calculated based on the size of the fructose area read by high-performance liquid chromatography (HPLC) expressed in percent (%) and then converted to μmol/mL fructose which was considered as 1 unit of glucosyltransferase enzyme activity. Subsequently, the data were analyzed statistically using Kruskal–Wallis test. Results: The results of data analysis using the Kruskal–Wallis test showed significant differences between groups of samples (p <0.05). Conclusion: Cocoa pod husk extract of 3.12% has inhibitory effect on E. faecalis glucosyltransferase enzyme activity. Clinical significance: The use of cocoa pod husk extract meets the requirements and is proven useful as an irrigation agent in the treatment of root canals, because it contains antibacterial properties against E. faecalis.

Aim: To evaluate the cyclic fatigue resistance of Reciproc blue (RB) 40/0.06 instruments tested at room temperature (20° ± 0.5°C) and at body temperature (37° ± 0.5°C) in a simulated stainless steel canal. Materials and methods: Twenty-four new RB 40/0.06 instruments were randomly divided into two groups (n = 12) according to the temperature used. Dynamic fatigue testing was performed using an artificial stainless steel canal with a 60° curvature angle and a 5-mm radius of curvature. The temperature was controlled throughout the experiment with an underwater thermometer and a thermostat. The data were analyzed descriptively using the IBM SPSS 23.0 program, considering p < 0.05. Results: The time to fracture of the RB instruments differed significantly between the two temperatures (1083.82 seconds at 20°C and 403.80 seconds at 37°C). No significant differences were found in fragment size. Conclusion: An increase in temperature reduces the cyclic fatigue resistance of RB 40/0.06 instruments. The results of the study suggest that an intracanal cooling system can be favorable to the fracture resistance of the tested instruments. Clinical significance: A cooling system of the root canal system is important in endodontic as it favors the cyclic fatigue resistance of Ni-Ti instruments.

Aim: The present study aimed to assess the use of various local drug delivery systems in the management of chronic periodontitis. Materials and methods: A total of 60 patients aged around 30–55 years were included. The subjects who were enrolled under took a phase I therapy that included scaling and root planing (SRP). Patients who satisfied the conditions for selection to enter the trial were assigned randomly to three groups, with each group consisting of 20 participants as follows: group I: controlled-release drugs-chlorhexidine gel, group II: metronidazole gel, group III: tetracycline fibers. The plaque index (PI), gingival index (GI), and periodontal pocket depth (PPD) were recorded after 1st week as the baseline data and were recorded again after 15 days and 30 days post-baseline. Results: The mean GI scores were 1.32 ± 0.10, 0.88 ± 0.16, and 0.76 ± 0.12, at baseline, 15 days, and 30 days, respectively, in group I. In group II, the mean GI score reduced to 1.09 ± 0.83 at 30 days from 1.48 ± 0.27 at baseline. Likewise, in group III the mean GI score reduced to 0.90 ± 0.62 at 30 days from 1.38 ± 0.06 at baseline. All the groups demonstrated a statistically significant difference at various intervals. The mean PI score decreased to 0.90 ± 0.78 at 15 days from 1.46 ± 0.22 at baseline in group III. A statistically significant difference at different intervals was seen in group III only. In all groups, the intergroup comparison of PPD was found to be statistically significant. Conclusion: This study demonstrated that although thorough SRP is an effective treatment method for elimination of chronic periodontal pockets, improved results can be obtained by adjunctive use of locally administered chlorhexidine gel, metronidazole gel, and tetracycline fibers. Clinical significance: The use of the adjunctive local drug delivery system along with mechanical cleansing in the treatment of periodontal pockets in chronic periodontitis is therapeutically beneficial.

Aim: The purpose of this in vitro research is to chemically characterize polymethyl methacrylate (PMMA) processed with 10% and 20% (v/v) tricyclodecane dimethanol diacrylate (TCDDMDA) comonomer. It also aimed to assess the degree of conversion (DC) and glass transition temperature (T_g) of the formed copolymers. Materials and methods: The experimental groups were processed with the TCDDMDA comonomer (10% and 20% v/v), whereas the control group was processed only with the methyl methacrylate monomer. The copolymerization was studied by nuclear magnetic resonance (NMR) spectroscopy. The surface characteristics and composition (wt%) were studied by field-emission scanning electron microscopy (FESEM) and energy dispersive X-ray (EDX) spectroscopy (cuboidal specimen; 5 mm × 5 mm × 3 mm), respectively. The DC and T_g of the formed copolymers (powdered form) were analyzed by Fourier transform infrared spectroscopy and differential scanning calorimetry, respectively. One-way analysis of variance with post hoc Bonferroni test was used to compare the mean values of DC% and T_g among the groups. Results: The newly formed copolymer [P(MMA-co-TCDDMDA)] was chemically characterized by NMR and FESEM-EDX. The DC and T_g of the experimental groups were higher than the control. Tricyclodecane dimethanol diacrylate at 20% (v/v) concentration showed the highest DC and T_g. Conclusion: The addition of TCDDMDA comonomer improved the DC and T_g of the formed copolymer. Clinical significance: The P(MMA-co-TCDDMDA) copolymer is expected to improve the mechanical properties and biocompatibility of the denture base acrylic resin. This would result in improved denture quality and durability, thereby, imparting a better quality of life to the geriatric population.

Aim: To evaluate the sealing ability of three different types of sealers using confocal laser microscopy. Materials and methods: Sixty extracted single-root premolars were selected and divided into three groups (20 teeth in each group) according to the type of sealer used, namely, mineral trioxide aggregate (MTA) Fillapex, AH Plus, and Bio C Sealer. Root canal preparation and obturation were done in all the samples. Roots was dissected transversely in apical plane. Percentage of gap from region to canal circumference was calculated using a confocal laser microscope. Samples were subjected to statistical analysis. Results: High dye penetration was seen with AH Plus compared to MTA Fillapex and least with Bio C Sealer. The AH Plus is the best sealer with respect to seal ability of all the three. Conclusion: This study helps to appraise the sealing ability of the different types of sealers using confocal laser microscopy which is useful for the success of root canal treatment. Clinical significance: As sealer has to seal voids, foramina, and canals, it should have good penetration for the success of root canal treatment.

Background: Short-fiber-reinforced resin composite (SFRC) is a direct bulk fill resin composite specially indicated in large complex cavities. It is characterized by having high fracture toughness and load bearing capacity to decrease the incidence of fracture of the restoration. Materials and methods: In two parallel groups (n = 38 restorations), 76 participants having complex proximal cavities with asymptomatic vital pulp were randomly enrolled in this trial and received either SFRC (Ever X Posterior, GC, Japan) covered by Gaenial posterior (GC, Japan) or chairside indirect restorations (Grandioso inlay system; VOCO, Germany) fabricated on a silicon die. Materials were applied according to the manufacturer instructions with the corresponding adhesive system. Only 67 participants completed the trial, which was assessed using the modified United States Public Health Service (USPHS) criteria by two independent blinded assessors at 6 months and 1 year follow-up visits. Statistical analysis: Fisher's exact and Cochran's Q tests were used to analyze inter- and intragroup comparisons, respectively. The significance level was set at p ≤ 0.05. Results: No statistically significant difference was observed between both tested groups for all USPHS criteria at different follow-up periods except for marginal integrity favoring the SFRC at 12 months when the difference became significant (p < 0.001), and color match favoring the nanohybrid indirect resin composite restorations with significant difference in scores at all follow-up intervals (p < 0.001) was found. Cochran's Q test showed significant differences within the same technique during the follow-up period for some criteria. Conclusion: Direct SFRC and indirect nanohybrid resin composite complex proximal restorations showed an acceptable clinical performance along the 1 year follow-up period. Clinical relevance: Direct SFRC restorations could be a viable treatment option for complex restorative cases.

Aim: The aim of this study was to evaluate the use of tobacco and its association with oral precancers and cancers. Materials and methods: Medical records of 1,007 individuals were assessed for the patterns of tobacco abuse and the presence of tobacco-related oral mucosal alterations. Results: This study comprised 1,007 individuals (M:F: 95.4%:4.6%). In the cohort, 60.1% had smoking habit and 56.1% had smokeless habit. Of the bidi smokers, 18.2% developed carcinoma, 14.3% developed leukoplakia, which is statistically significant (p < 0.001). A logistic regression analysis of the development of oral submucous fibrosis (OSMF) shows that habit of smokeless forms of tobacco has an odds ratio (OR) of 18+ when compared with smoking. Combination of bidi and gutkha had 12.3 times higher risk of developing oral cancer and 4.4 times risk of developing leukoplakia. A total of 33.3% betel quid and gutkha chewers presented with tobacco pouch keratosis, which is statistically significant. Conclusion: Smoked and smokeless forms of tobacco were equally popular among the study population. The packeted form of smokeless tobacco (gutkha) was more prevalent. Oral submucous fibrosis was more common than leukoplakia, and oral cancer developed more frequently in elderly men smoking bidis. Clinical significance: This study throws light on the fact that the use of both smoke and smokeless forms of tobacco is still prevalent, and the use of gutkha was most prevalent. These findings will help tobacco cessation and counseling centers to focus their effort in motivating people to stop gutkha chewing habit. This also brings to the forefront the need to create better treatment strategies to manage OSMF.

Aim: The objective of the present investigation is to compare the accuracy of two methods of age estimation, Cameriere's European formula and Demirjian's method, in estimating the age of mixed-dentition children in Telangana. Materials and methods: Digital orthopantomographs (OPGs) of 36 children between the age of 7 years and 12 years were subject to analysis. All the OPGs were analyzed for dental age using both Cameriere's and Demirjian's methods for mixed dentition. Chronological age was calculated by subtracting the date of births from the date on which the OPGs were taken. Statistical analysis: descriptive analysis was performed. The accuracies of both the methods (Cameriere's and Demirjian's) were evaluated by calculating the mean prediction error. Wilcoxon signed-rank test was performed for both methods of dental age estimation with chronological age and for boys and girls. Significance threshold was set at 5%. Results: Cameriere method resulted in a mean prediction error of 0.579 for girls and 0.483 for boys. Demirjian's method resulted in a mean prediction error of 2.228 for girls and 2.046 for boys. Conclusion: In conclusion, as far as accuracy is concerned, Cameriere's European formula proved to be more accurate, according to the current investigation. Significance: The significance of age estimation is reflected in various fields such as pediatric endocrinology, orthodontics, law, anthropology, archeology, and forensics where identification of unascertained human bodies is required (crime investigations, mass disasters). Demirjian's method is commonly employed for dental age estimation in pediatric dentistry, orthodontics, and forensic dentistry. Cameriere's method may serve as a more accurate and reliable method for dental age estimation.

Aim: Evaluating the association of maxillary sinus dimensions and the maxillary arch dimensions may help to understand the interrelationship between the maxillary sinus and the anatomical facial features. The study aimed to investigate the correlation of the 2-D and 3-D maxillary sinus dimensions with the linear measurement of the maxillary arch width (MAW) in adult individuals. Materials and methods: A cross-sectional observational study was conducted using 54 cone-beam computed tomography scans obtained from patients starting their treatment in dental clinics of dental college, Jazan University. Maximal vertical diameter (maximal height) of the maxillary sinus (MSH), maximal horizontal diameter (maximal width) of the maxillary sinus (MSW), maximal anteroposterior diameter (maximal length) of the maxillary sinus (MSL), MAW, and maxillary sinus volume (MSV) were measured and recorded using 3-D Slicer software. The Spearman's rank correlation coefficient (rho—ρ) was used to analyze the strength and type of the relationship between variables. Results: In both males and females, moderate to strong correlation (ρ range between 0.65 and 0.80) was observed between MSV for all linear measurements of the maxillary sinuses on both sides. The maxillary sinus length showed the weakest correlation with MAW in both genders Conclusion: The relationship of MAW with MSV on both sides shows a stronger correlation than its relationship with all 2-D linear measurements of maxillary sinuses. Clinical significance: The clinician should take into consideration the structure and function of the maxillary sinus when treating the midfacial structures for trauma or congenital malformations.

Aim: To highlight the potential difficulties in diagnosing neoplastic lesion of the head and neck in children within autism spectrum. Background: Ameloblastic fibromas are a variation of odontogenic tumors that are located in the posterior mandible in 70% of cases. The tumors may be either unilocular or multilocular when observed radiographically. Ameloblastic fibromas tend to have well-defined, scalloped margins radiographically but may also be corticated. In close to 75% of all cases, an impacted tooth is associated with the lesion. Although not confined to patients who are in their first or second decades of life, ameloblastic fibromas most often arise in this population. Case description: A 9-year-old male diagnosed with autism presented with tenderness in the left mandible. The parents were able to elucidate the child's problem as tingling rather than pain. The patient was referred for histopathological diagnosis and treatment. After evaluation and biopsy, the lesion was identified as a pediatric ameloblastic fibroma. He subsequently underwent the conservative approach of marsupialization and curettage without complication. Six-month follow-up revealed no evidence of recurrence and normal eruption patterns of the succedaneous teeth in the affected area. Conclusion: In this specific case, the conservative approach to treatment appears to have been appropriate. This may not be the appropriate course for every case; as such, each case will have an individualized approach. Earlier recognition with careful inspection can reduce potential complications. Clinical significance: We might be missing early diagnosis of ameloblastic fibroma and other significant orofacial neoplasms in patients who are nonverbal or nondescriptive such as those with autism. Moreover, careful inspection of radiographic and clinical signs cannot be overemphasized.

Aim: This study aimed to overview and collect the current trends and techniques in managing maxillary impacted canines by retrieving recent literature, in a chronological manner from the prevention to the very late stages of treatment in adults. Background: We performed a review on the recent literature regarding the current trends on the management of impacted canines. We have researched various types of available articles such as clinical trials and case presentations, meta- and systematic analyses, and literature reviews focusing on clinical management of impacted canines and their outcome evaluations. We adhered to those articles published within the last decade with a focus on treatment planning for impacted and displaced canines. Review results: Depending on the diagnosis and its timing of it, a maxillary impacted canine can be managed by either prevention or interception, surgical opening followed by autonomous eruption or orthodontically traction, autotransplantation, and at last by removal and space closure. These techniques are elaborated one by one according to the age and severity of the diagnosis. Conclusion: Impaction of the canines is a manageable abnormality which is highly dependent on the timing and localization of the displaced tooth. Early detection will give the upper hand to orthodontists to engage by either prevention through extraction of deciduous canines or intercepting via assistant devices to create more space. According to the clinical situation, open or closed surgical uncovering might be required to bond an attachment. However, generally, those techniques did not show any significant clinical distinction in the outcome assessments. Clinical significance: These approaches are highly technique sensitive and require collaborations with other specialties. Proper diagnosis and prognosis assessment are necessary before making any decision to bring an impacted canine in alignment.

Aim: Temporomandibular joint ankylosis (TMJA) management involves many surgical treatment modalities depending on the experience of the operator. A lot of literature has been published on various treatment modalities. Many systematic reviews (SRs) were published without any published prior protocol. So, the study aimed to evaluate the quality of SRs with meta-analysis of TMJA management. Materials and methods: Systematic reviews with meta-analysis were included for the quality assessment using AMSTAR (assessment of multiple SRs) and Glenny et al. checklist by two independent teams. The search was limited to the Medline database archival (from January 1980 to December 2018). Results: The primary search identified 1,507 related articles. After activation of different filters, abstracts screening, and cross-referencing, finally, a total of six studies were assessed to make the overview up-to-date. Conclusion: The articles scored 8 to 11 with AMSTAR and 7 to 13 with the Glenny et al. checklist. None of the published reviews received maximum scores. The methodology and heterogeneity are essential factors to assess the quality of the published literature. Clinical significance: None of the included meta-analysis was registered or published protocol with Prospero or Cochrane before publication for better validity of the studies. The authors are advised to follow reporting criteria so that in the future it is possible to provide the standards of care for TMJA with the highest quality of evidence.