Aim and objective: The objective of this study was to monitor the pH stability over a period of 6 months of two-bottle self-etching (SE) primers. Materials and methods: Four commercially available two-bottle SE primer solutions, Adhese SE (Ivoclar Vivadent; Schaan, Liechtenstein), Clearfil SE (Kuraray; Tokyo, Japan), Contax Primer (DMG; Hamburg, Germany), and Enabond SE (Micerium; Avegno (Ge), Italy), containing water as the main solvent were selected. The pH values during a 6-month storage period at intermittent temperature were daily measured by means of a microprocessor-based pH/temperature meter and hence recorded, tabulated, and analyzed. Results: The mean values of overall pH measurements and standard deviation for Adhese SE, Clearfil SE, Contax Primer, and Enabond SE are, respectively, 1.70 (±0.01), 1.72 (±0.01), 1.20 (±0.01), 1.80 (±0.01). One-way ANOVA did not detect any significant change of the mean pH values of all measurements over time. Conclusion: The conventional 6-months storage did not affect the pH values of the water-containing primers of two-bottle SE adhesives. Clinical significance: This study provides evidence that conventional storage under adequate conditions did not affect the pH values of the water-containing primers of two-bottle SE adhesives with different monomer formulations. Clinicians may rely on the known pH value of the selected SE adhesive during shelf-life.

Background: Previous evidence indicated that musculoskeletal disorders (MSDs) are highly prevalent among dentists. However, limited data are available on the prevalence and predictors for cervical and lumbar pain, the two most common subtypes of MSDs reported internationally. Aim and objective: The aim and objective of this nationwide cross-sectional study was to assess the prevalence and predictors of cervical and lumbar pain among dental interns in Saudi Arabia. Materials and methods: Data were collected using an online survey that was distributed to dental interns who graduated during the 2018–2019 academic year from all dental schools in Saudi Arabia. The survey included questions related to sociodemographic characteristics, symptoms of MSDs, and ergonomic preventive practices. Bivariate and multivariate logistic regression analyses were performed to assess several predictors of cervical and lumbar pain among our sample population. Results: Of the 1,552 eligible interns, 889 (57%) completed the survey (mean age: 24.8 years, 55% female), with 65% enrolled at public universities. The overall prevalence of cervical pain was 41%, and the corresponding prevalence for lumbar pain was 32%. Female participants had significantly higher odds of reporting cervical pain [odds ratio (OR): 2.02, p <0.001]. Participants who typically avoid excessive bending and twisting were significantly less likely to report cervical pain and lumbar pain (OR: 0.51, p <0.001, and 0.46, p <0.0001, respectively). Conclusion: Cervical pain and lumbar pain are highly prevalent among Saudi dental interns. Female sex was identified as a potential risk factor for cervical pain, and avoiding bending and twisting during dental work was identified as a protective factor for cervical and lumbar pain. Clinical significance: Our results indicate that cervical and lumbar pain represent relevant health issues for dental students. Our data add further support to the notion that dental schools should consider enhancing training on dental ergonomics, enabling healthier careers for future dentists in Saudi Arabia.

Aim and objective: To evaluate the internal symmetry of roots and root canals of permanent maxillary and mandibular teeth. This study used cone-beam computed tomography (CBCT) to examine the bilateral symmetry of root canals, their configuration, and the number of roots in a Saudi Arabian population. Materials and methods: CBCT images of 5,223 teeth from records of 208 patients (age of 28.74 ± 9.56 years) were analyzed using i-Dixel 3D imaging software. Sagittal, axial, and coronal serial sections were used to examine the root canal configuration, the number of roots, and the number of canals of all the teeth in the maxilla and mandible and compare them with the contralateral side for symmetry. Frequencies and percentages were used to represent the results. Cohen's Kappa test was employed to examine bilateral symmetry. The significance level was set at p <0.05 for all statistical tests. Results: Bilateral symmetry of the number of roots was 100% in maxillary central incisors, laterals, canines, first molars, and second molars. The mandibular arch showed greater variation with the roots of the central incisors and second premolars being 100% symmetrical. Maxillary first premolars were frequently asymmetrical (14.9%). Maxillary central and lateral incisors showed 100% bilateral symmetry of the canals. The number of canals in the maxillary second molars showed asymmetry (18.9%). For canal configuration, the bilateral symmetry was found 100% in maxillary central and lateral incisors. Maxillary second premolars (32.2%) showed frequent asymmetry in the canal configuration. Conclusion: The mandibular arch showed greater asymmetry than the maxillary arch. Internal canal configurations displayed the highest bilateral asymmetry, followed by the number of canals. Bilateral symmetry was most evident in the number of roots present. Clinical significance: The findings of this study will enable clinicians to anticipate the variations in canal morphology in both maxillary and mandibular teeth and be cognizant of the contralateral variations in canal contours and anatomy that affect endodontic therapy.

Aim and objective: This study aimed to evaluate the effect of ozonated water used as an irrigant and dentin-cleaning solution on the bond strength of fiberglass pins in vitro, comparing it with the commonly used solutions. Material and methods: Seventy-seven bovine roots were randomly divided into seven groups according to the irrigant and dentin-cleaning solution to be used: HP/HP, 2.5% sodium hypochlorite; DA/DA, distilled water; CHX/CHX, 2% chlorhexidine; OA/OA, 4 ppm ozonated water; HP/DA; HP/CHX; and HP/OA. In each group, the root canals were endodontically prepared by using the corresponding irrigant and stored in DA; after 7 days, they were cleared and cleaned with the corresponding cleaning solution. The fiberglass pins were cemented by using self-adhesive cement. After 7 days, the roots were sectioned (six discs each) and submitted to the push-out test. The type of fracture was analyzed with a 4.5× stereoscopic magnifying glass. The data were analyzed by the analysis of variance and the Tukey test at a 5% significance level. Results: The OA/OA (11.67), HP/HP (11.21), and HP/OA (9.71) groups showed the highest mean push-out bond strength (MPa) in the cervical third. The same trend was maintained in the middle and apical thirds. Conclusion: Ozonated water and 2.5% sodium hypochlorite are the most relevant solutions for root dentin treatment. Clinical relevance: Teeth treated with ozonated water, sodium hypochlorite, and a combination of the two showed greater bond strength than those treated with other solutions.

Aim and objective: The study was conducted to evaluate the effects of N-acetylcysteine (NAC) on the propagation and differentiation of stem cells from human exfoliated deciduous teeth(SHED). Materials and methods: SHEDs were isolated by explant culture method and characterized for stem cell properties using flow cytometry method. MTT assay and Cell Counting Kit-8 (CCK-8) assay were used to examine the viability and proliferation of the SHEDs. The effects of NAC-induced osteo/odontoblastic differentiation of SHEDs were determined by functional staining for mineralization, and the gene expression of osteo/odontoblastic transcription factors and proteins was evaluated by real-time quantitative reverse transcription-polymerase chain reaction (qRT-PCR) analyses. Protein levels of collagen type 1 (COL1), dentin sialophosphoprotein (DSPP), and dentin matrix acidic phosphoprotein 1(DMP-1) were calculated by the Western blot method to assess the osteo/odontogenic differentiation. Results: SHEDs presented mesenchymal stem cell (MSC)-like characteristics on flow cytometric analysis. The cell viability and metabolic activity of SHEDs were increased with an increase in the concentrations of NAC from 0.5 to 10 nM. However, the concentrations of NAC from 0.5 to 2.5 mM did not affect cell proliferation. NAC incorporated at a concentration of 2.5 mM showed higher mineralization and considerably increased gene expression levels of runt-related transcription factor 2 (RUNX2), COL1A1, DSPP, and DMP-1. It significantly increased the protein expression of odontoblast-related matrix proteins like COL1, DSPP, and DMP-1. Conclusion: NAC regulates the healthy propagation of dental stem cells in vitro. Its effects on the differentiation of dental pulp SHEDs remain unidentified. This study explores that NAC can encourage the mineralization of SHEDs and differentiate them into the odontoblastic lineage. Clinical significance: The results propose that NAC could have a significant pharmacological role in activating and enhancing odontogenic differentiation of dental stem cells and possibly a prospect in regenerative dentistry.

Aim and objective: The aim of this study was to evaluate the depth of penetration as well as the microleakage of three different pit and fissure sealant materials employing the dye penetration method. Materials and methods: Sixty healthy human mandibular premolar teeth without dental caries that were extracted for orthodontic treatment constituted the study samples. These 60 premolar samples were subjected to an equal division (20 in every group) into three groups. Group I: self-adhering flowable composite, group II: flowable nanocomposites, group III: classical pit and fissure sealants. Every sample tooth underwent thermocycling amid 4°C ± 2°C and 60°C ± 2°C for 1,000 cycles. The samples were placed in 1% methylene blue solution for 24 hours to permit diffusion of the dye into probable gaps in between the restoration and the tooth. The teeth were sectioned and evaluated below a stereomicroscope at 10× magnification with image analysis software. Results: Flowable nanocomposites (3.69 ± 0.10) exhibited a slightly greater mean depth of penetration as compared to classical pit and fissure sealants (3.58 ± 0.16) and self-adhering flowable composites (3.51 ± 0.13) in that order. This difference between the three sealants was not significant statistical. Amid the three sealant study groups, the lowest mean marginal microleakage was exhibited by the flowable nanocomposites (1.06 ± 0.03), followed by self-adhering flowable composites (1.98 ± 0.06), and classical pit and fissure sealants (2.74 ± 0.11). Analysis of variance revealed statistically significant differences among the three sealants that were studied. Conclusion: This study concludes that flowable nanocomposites depicted enhanced penetration and reduced marginal leakage as compared to the self-adhering flowable composites and classical pit and fissure sealants. Clinical significance: An efficient approach to preventing dental caries on the occlusal surfaces of teeth is the use of pit and fissure sealants. The efficiency of sealants chiefly depends on the morphological characteristics of the fissures and properties of dental materials used.

Aim and objective: The aim of the study was to evaluate the satisfaction of an oral health promotion program among parents and caregivers of children with special healthcare needs (CSHCN) in Riyadh, Saudi Arabia. Materials and methods: A digital survey using Google forms was used during an event to commemorate the World Disability Day. Stalls for oral health education and training were set up at Disabled Children Society, Riyadh, Saudi Arabia. Oral health education was carried out using written pamphlets, brochures, and videos. Live demonstration on dental models was used for tooth-brushing training using a powered toothbrush. Parents and caregivers were asked to complete a survey about oral health education during the event. An overall 189 parents and caregivers of CSHCN including 62 males and 127 females completed the survey. The responses were entered digitally prior to being evaluated. Results: The respondents were parents and/or caregivers of children mostly having cerebral palsy followed by autism. Females consisted of 67% of the respondents. Eight-one percent of respondents rated it as highly satisfied. Ninety-one percent of the respondents perceived that the information provided was new for them regarding oral healthcare for CSHCN. Ninety-eight percent of respondents were likely to attend a similar event in the future. Conclusion: Majority of parents and caregivers of CSHCN were highly satisfied by the oral health education during the event. They felt that they can take better care of the oral health of their CSHCN after the oral health education and training. Clinical significance: Oral health among CSHCN is neglected when compared to children among the general population. CSHCN exhibit many barriers to oral health care. Oral health promotion among CSHCN is important as they have a high unmet oral health need.

Aim and objective: To evaluate the effect of cervical margin relocation (CMR) for crowns designed using CAD/CAM technology and fabricated from lithium disilicate (e.max, CAD) before and after aging; and to compare the fracture forces and failure type of the tested crowns. Materials and methods: Mesio-occluso-distal(MOD) cavities 1 mm above the cementoenamel junction(CEJ) were prepared on 40 maxillary first premolars. The teeth were divided into four groups. In group A, all cervical margins (CM) were located 1 mm above the CEJ. However, in both mesial and distal proximal boxes of groups B, C, and D, in addition to the MOD cavities, the CMs were extended 2 mm on both sides below the CEJ apically to simulate the CMR technique. In group B, the mesial and distal proximal boxes were filled with flowable composite, while for group C and group D, specimens were filled with composite resin fillings. To simulate the CMR technique, the cavities were filled with composite layers of 3 mm in two increments. Using the CAD/CAM system, 40 standard crowns were prepared on premolars, then cemented using a dual-curing adhesive cement. Assessments of the marginal integrity of interfaces of the proximal boxes of the cemented crowned teeth were recorded. Statistical differences between groups were analyzed using the ANOVA and Bonferroni's posthoc test. Results: The first null hypothesis was accepted since no statistically significant differences were found in marginal integrity before and after aging (p>0.05), while the second was partially rejected since different fractured force values were recorded and a significant difference was detected between group D and group B. The third hypothesis was rejected because the catastrophic fracture rate was the highest among the four groups. Conclusion: The implementation of CMR before and after aging had a good effect on the marginal integrity of CM relocation. The CMR technique with resin luting cement of lithium disilicate crowns is effective and recommended for the restoration in deep proximal boxes of premolars or posterior teeth. Clinical significance: CAD/CAM-generated e. max all-ceramic crowns with composite as the CMR enable the reconstruction of severely destroyed teeth irrespective of the position of the cavity margins.

Aim and objective: This study aimed to compare cephalometrically the rate of maxillary incisor intrusion using mini implants, Connecticut intrusion arches, and segmental intrusion arches. Materials and methods: Thirty-two adult patients with deep bite were divided into three groups: 10 patients in mini implant and Connecticut intrusion arch group each and 12 patients in segmental intrusion arch group. Bilateral mini implants were used for intrusion in Group 1. Connecticut intrusion arch and Burstone's three-piece intrusion arch were used for intrusion in Group 2 and Group 3, respectively. Intrusion was carried out in all the patients for 4 months. Lateral cephalograms were taken just after alignment and leveling (T1) and after 4 months of intrusion (T2). Results: The mean amount of intrusion observed was 1.7 mm (0.425 mm/month) in mini implant group, 1.4 mm (0.35 mm/month) in Connecticut intrusion arch group, and 1.66 mm (0.415 mm/month) in segmental intrusion arch group. No statistically significant difference was found in the extent of incisor intrusion in the three groups (p <0.05). Conclusion: The study failed to reject the null hypothesis, and there was no statistically significant difference in the amount and rate of incisor intrusion achieved among the three groups (p >0.05). Clinical Significance: Significant amount of incisor intrusion was carried out by all the three methods. There was no statistically significant difference in the amount and rate of incisor intrusion achieved by the three methods. Clinically, mini implants can be considered superior to the conventional techniques as it provides absolute anchorage which eliminates unwanted effects of incisor intrusion.

Aim: To evaluate the efficacy of an innovative herbal licorice mouthwash on reducing salivary Streptococcus mutans levels versus chlorhexidine mouthwash in high caries risk patients. Methodology: A total number of 52 high caries risk patients were assigned to this study. Patients were randomly divided into two groups (n = 26) according to the type of mouthwash (G): Patients in group G₁ used the mouthwash containing chlorhexidine, while patients in group G₂ used the mouthwash containing the innovative licorice extract. Afterward, each group was further divided into three subgroups according to the time (T): T₀ represents the baseline, T₁ represents the time immediately after using the mouthwash, and T₂ represents the time 1 week after using the mouthwash. Furthermore, pH and plaque index were recorded. Data were statistically analyzed using a Chi-square test for categorical data, Shapiro-Wilk test for numerical data, and one-way repeated measures ANOVA followed by Bonferroni post hoc test for intragroup comparisons. The significance level was set at p ≤0.05 for all tests. Statistical analysis was performed with IBM® SPSS® Statistics version 26 for Windows. Results: It was found that in high caries risk patients, there was no significant difference between licorice and chlorhexidine mouthwashes regarding Streptococcus bacterial count. Moreover, it was found that licorice mouthwash stimulates salivary flow, and thus, it raises salivary pH in patients with high caries risk. However, the plaque index of chlorhexidine showed better results. Additionally, there was a positive weak correlation between bacterial count and plaque index. Conclusions: Licorice mouthwash may demonstrate a promising antibacterial effect that can be a suitable alternative for current synthetic mouthwashes. Clinical significance: Natural herbal mouthwash could be incorporated in dental preventive measures and could be used as cavity-fighting compound. It introduces a minimal health hazard substitute for conventional synthetic preventive measures.

Aim: To analyze the clinical effectiveness of three new gingival retraction systems: knitted retraction cord, expanding polyvinyl siloxane, and aluminium chloride containing paste. Materials and methods: Twenty patients were enrolled with age-group of more than 18 years and who required fixed prosthesis with minimum of two abutments. A preliminary impression of the arch was made with a stock metal tray and irreversible hydrocolloid impression material. Group WR—impression without retraction, Group A—impression after retraction with gingival retraction cord, Group B—impression after retraction with expanding polyvinyl siloxane, and Group C—impression after retraction with aluminium chloride containing paste. A total of four impressions were made for each abutment tooth. Each impression was given a label 1WR, 1A, 1B, 1C—20WR, 20A, 20B, 20C: where 1 denoted the sample number. Comparison of the stereomicroscopic images was done using image analysis software. Time required from start of placement of gingival displacement agents till completion was recorded in seconds with the help of a stop clock. Results: The mean gingival retraction was found to be the highest for subjects of Group C followed by Group A, Group B, and Group WR. This difference was found to be statistically significant. Highly significant mean difference in time of placement was observed between Group A and Group B, between Group B and Group C, and between Group C and Group A. Conclusion: The aluminium chloride containing paste was found effective in almost all the variables considered. Clinical Significance: The choice of particular gingival retraction system/technique is dependent upon the clinical variables and on operator's preference.

Aim: The aim of the article was to evaluate the feasibility of pulp/tooth area ratio in three mandibular teeth, namely left canine, left first premolar, and left second premolar (33, 34, and 35), as an indicator of age using digital panoramic radiograph and Kvaal's parameters. The study also aimed at computing an area-specific formula for age estimation in Odisha population. Materials and methods: Observation and analysis of 50 digital orthopantomographs (OPGs) and clinical data of patients were made. These images were saved as high-resolution JPEG files. Using the Adobe Photoshop CS3 (extended) image editing software program (Adobe Systems Inc, San Jose, California, United States), the pulp/tooth area ratio of 33, 34, and 35 was analyzed. These ratios were substituted in Odisha population-specific formula, derived using principal component regression analysis. Results: The mean chronological age was 33.24 years. Principal component regression analysis was used to derive multiple regression formulae for individual teeth as well as a combined formula. R² (coefficient of determination) for combined three mandibular teeth was highest (0.7769) with a standard error of 4.5969 years and thus was a better predictor of age in the population of Odisha. In terms of an individual tooth, comparison between chronological and predicted age revealed that left second mandibular premolar (35) had highest correlation to actual age. Karl Pearson's correlation coefficient showed correlation between age and the mean of ratios from combined three mandibular teeth was stronger than that of single tooth. Conclusion: In the present study, second left mandibular premolar showed highest correlation to actual age when used alone. The use of three teeth in combination increased the correlation. This Odisha-specific formula showed promising results and can be used for forensic applications in this population. Clinical significance: Using three different teeth for age estimation proved to be a better predictor of age in the Odisha population. Moreover, the obtained formula can act as a standard and be used for anthropological or forensic investigations in the said population.

Aim and objective: This study aims to investigate the association between parity and dental caries among US women. Materials and methods: National Health and Nutrition Examination Survey (NHANES 2001–2004) data for parous women aged 20–45 years were used for our analysis (n = 1,914). The association between parity (number of pregnancies resulted in live births) and caries experience [the decayed, missing, and filling teeth (DMFT) index] was analyzed using bivariate and multivariate regression analyses. SAS software version 9.1 was used for the statistical analyses. We used survey procedures (e.g., SURVEYFREQ, SURVEYMEANS, and SURVEYREG) that incorporate information on the appropriate weights to account for NHANES's complex sampling design. Results: The bivariate analysis showed a trend of increase in dental caries experience among parous women as the number of live births increased (p = 0.007). After adjusting for confounders, such as age, socioeconomic status (SES), dental care coverage, and utilization, a significant association was still observed between parity level and dental caries experience (p = 0.009). Conclusion: Our results suggest that higher parity can be associated with dental caries experience among US women of reproductive age. Clinical significance: Clinicians should be aware of this finding to promote better oral health care and education among women with increased parity.

Aim: Aim of this research was to evaluate the remineralizing potential of three different remineralizing pastes on enamel that has been demineralized. Materials and methods: Sixty healthy mandibular single-rooted human premolars extracted for orthodontic reasons from subjects between 18 and 25 years of age were included in this research. An area of 4 mm × 4 mm (window) was marked on the buccal surfaces of teeth samples, coated with nail varnish except for the window, which was scrutinized for changes in the values subsequent to demineralization as well as remineralization. Samples were kept in demineralizing solution for 96 hours to produce the artificial lesion in the enamel. Consequent to this process of demineralization, the 60 premolar teeth were randomly allocated to the following three groups (20 in each group) depending on the remineralizing paste used for application as group I: bioactive glass constituting remineralizing paste; group II: tricalcium phosphate (TCP) comprising remineralizing paste; and group III: calcium sucrose phosphate (CaSP) remineralizing paste. Following the pH-cycling process, the confocal laser scanning microscope was used to assess the area of demineralization and remineralization. Results: The mean areas of demineralization were slightly more (133.24 ± 0.09) in the remineralization paste comprising bioactive glass seconded by the remineralization paste having CaSP (131.39 ± 0.18), and lastly the remineralizing paste constituting TCP (129.59 ± 0.14). Maximum areas of remineralization were found in the pastes that had CaSP group (96.14 ± 0.04), next by the paste having bioactive glass group (102.18 ± 0.17), and then the remineralization paste constituting TCP (118.37 ± 0.21). The difference was statistically significant among the three remineralization pastes used. Conclusion: Amid the confines of this in vitro research, a conclusion that the remineralization pastes comprising CaSP exhibited enhanced remineralization capacity in comparison to the group having bioactive glass and TCP was established. Clinical significance: Caries is a highly prevalent multifactorial disease, but its progression can be prevented in the initial stage of demineralization through remineralization. Significantly increasing attention to the treatment of carious lesions that are not cavitated by employing noninvasive remineralization methods to achieve restoration of enamel has been rendered in the field of research.

Aim: The clinical report describes how chairside intraoral scanning can be performed while a rubber dam is in place prior to fabrication of a computer-assisted design and computer-assisted manufacture (CAD/CAM) ceramic restoration. Background: Recently, combining a chairside CAD/CAM system with rubber dam isolation in place could be used in order to both speed up the restorative process and avoid any contamination to abutment surface, which are the positive effects to patients and clinicians. Unfortunately, manufacturers do not provide guidance on how to make use of chairside CAD/CAM restorations while rubber dam isolation is in place. Case description: The chief complaint of necessitating a crown after endodontic therapy and the patient was digital restorative procedure in single visit. Intraoral scanning with rubber dam isolation in place was planned and successfully completed in order to fabricate a chairside CAD/CAM ceramic crown. The software was able to interpose the scan of the prepped tooth with rubber dam isolation into a scan made without the rubber dam from which the tooth had been erased. Conclusion: Chairside CAD/CAM system can be used to scan, design, and fabricate crowns while rubber dam is kept intraorally. Initial scan without rubber dam is needed in order to interpose the second scan with rubber dam in place. Clinical significance: Combining the advantages of intraoral scanning and rubber dam isolation in place for the fabrication of a chairside CAD/CAM ceramic crown in a single visit is feasible.

Aim: This report highlights the use of a seldom-used treatment modality to save a diseased multirooted tooth, as an alternative to extraction and implant. Background: Root-resection therapy is a simple surgical procedure performed by an endodontist or periodontist to save a multirooted tooth with furcation involvement and/or defective root. Case description: A 64-year-old female patient reported a strip perforation in the distobuccal (DB) root of the maxillary left first molar. The tooth had previously undergone endodontic treatment and had a well-fitted crown. After presenting the patient with treatment options and prognosis, a treatment plan of root amputation to save the tooth was formulated. A full mucoperiosteal flap was reflected. The DB root was amputated and GIC was placed to cover the root. Sutures were placed and the patient was given postoperative instructions. A follow-up was carried out with clinical examination, and periapical radiographs were taken at 10 months, 2 years, and 5 years after the procedure. The tooth was intact and functioning; no signs or symptoms were reported. Conclusion: Root resection has a deserved place in the modern clinical management of endodontic lesions or injuries. Conventional conservative treatment plans can succeed with proper treatment planning, diagnosis, case selection, maintenance of oral hygiene, and meticulous follow-up. Clinical significance: This case emphasizes a viable treatment procedure to manage teeth with compromised radicular or restorative presentations. Root resection is a venerable treatment option that is often ignored in the era of implants even though it shows favorable prognosis and success rates.

Aim: The aim of the present work was to explain the poor biointegration of acellular dermal xenogeneic matrix, leading to an unfavorable gingival healing following a grafting procedure for the treatment of soft tissue deficiencies. Background: Numerous works have demonstrated the successful use of acellular dermal matrix (ADM) in soft tissue augmentation procedures. However, spare human investigations reported adverse healing outcomes at microscopic level. Case description: Three patients showing various soft tissue deficiencies (recession, gingival thickening) requiring a gingival augmentation were grafted using an ADM porcine acellular dermal matrices (pADM) as a soft tissue substitute. For this purpose, appropriate soft tissue augmentation surgeries were performed and the grafted pADM was left for proper healing. Biopsies were harvested from two out of the three patients, respectively, at 11 and 27 weeks in order to conduct a histological evaluation of the pADM's doubtful biointegration. Moreover, the ultrastructural analysis of pADM was performed using scanning electron microscopy, and additional histological procedures were used to assess its ability to support human gingival fibroblast cultures. Signs of gingival inflammation persisted several months postoperatively. Histologically, numerous inflammatory cells characterized the grafted site. Indeed, the high number of foreign body giant cell granulomas and the very densified newly formed collagen fibers highlighted a fibrotic process within gingival connective tissue. The ultrastructural and histological analysis showed that pADM was characterized by very thick and dense collagen bundles demonstrating a nonphysiological collagen network organization. Cell culture experiments showed fibroblasts proliferating on the matrix surface, sparing its deeper part, even though the collagen matrix degradation seemed to occur following a gradient from the pADM surface inward. Conclusion: The unfavorable clinical results may be caused by the poor colonization of matrix cells and poor angiogenesis leading to the inadequate biointegration of pADM. Hence, the pADM structure in terms of porosity and degradability should be further investigated. Clinical significance: The present cases highlighted a poor integration of pADM following soft tissue grafting procedures, which was caused by the inadequate ultrastructure of the used pADM. Therefore, despite the utility of such tissue substitutes, their manufacturing improvement could be required to obtain a better biointegration.

Aim: The present manuscript aims at providing a comprehensive overview of the epidemiology, risk factors, diagnostic aids, and management of halitosis in a pediatric population. Background: Halitosis refers to bad breath from the mouth that seems unpleasant or offensive to others. This condition is prevalent worldwide, including all age-groups. However, studies on the pediatric population are limited. Self-confidence and personality development are important factors that the child builds up during their developmental stages. Halitosis may affect them both on personal and social aspects; hence, it is important to have beforehand knowledge and the modes to intercept it, paving the way to a positive growth of the child. Review results: On reviewing the literature, the common risk factors for halitosis in children constituted predominantly oral factors that varied from poor oral hygiene, gingivitis, periodontal diseases, dental caries, tongue coating, mouth breathing, and so on. Their diagnosis commonly included the organoleptic test, sulfide monitoring, and gas chromatography along with the assessment of questionnaire by the parents and older children. The management was predominantly directed toward the identified source of halitosis along with instructions and counseling on the benefits of a good oral hygiene regime. Conclusion: The importance of cultivating a day-to-day practice of oral hygiene regime in the children will not only accustom them toward the benefits of good oral health but also help them to tackle halitosis and in turn their inhibitions associated with it. Clinical significance: Halitosis, though a prevalent condition experienced at various stages of life, is crucial to identify and manage, especially in the pediatric population owing to its influence on personal and on social aspects of life.

Background: Direct orthodontic bracket bonding consumes significantly more chairside time in comparison to indirect bonding. The primary drawback of indirect bonding is incomplete penetration of the curing light through transfer trays, leading to bracket bond failure. The primary objective in a clinical setting is to minimize the chairside time. This technique of indirect bonding reduces chairside time, is economical, utilizes minimum armamentarium, and provides adequate light penetration and accuracy. Technique: Impressions were made, casts were poured and marked for the desired bracket position as per MBT prescription. Bonding agent was used to stabilize the brackets on the working model. A 3D printing pen and polylactic acid (PLA) filament were used to fabricate transfer trays for indirect bonding. The tray with brackets held in the desired position was transferred to the oral cavity and cured. Conclusions: Fabrication of complete or partial transfer trays for indirect bonding using PLA with the help of a 3D printing pen is a precise, easy-to-use, economical, and reliable method that reduces chairside time. Clinical significance: When compared with other methods of indirect bonding, the PLA transfer tray made with a 3D printing pen was easy to fabricate with brackets held firmly in the tray for a precisely desired position. The tray fit snugly and permitted light curing of composite from all surfaces of brackets and removal of flash. This method significantly reduced the overall time of the indirect bonding procedure.

Aim: The aim of the article was to provide a digital chairside method for the objective evaluation of the taper of prepared abutment teeth retaining a fixed partial denture (FPD). Background: According to research, the taper of the abutment teeth supporting an FPD has a direct effect on both retention and stress transmission to the abutment teeth. However, no approaches have been documented in the literature that objectively quantify the taper of the prepared teeth chairside, in a simple and cost-effective manner. Technique: The proposed technique utilized an intraoral camera with an on-the-go (OTG) connection, and a silicone dental bite block. The images of the prepared teeth were captured using this camera from the facial aspect. An indigenous program was developed using the MATLAB (Matrix Laboratory 2013) software for the analysis of the images and the taper of each abutment tooth was calculated in degrees using the software. Conclusion: The novel, chairside, digital technique utilizes an intraoral camera and a computer-generated software package to quantify and evaluate the taper of abutment teeth efficiently. This, in turn, can help minimize the errors in the treatment of FPD and improve the retention of the prosthesis. Clinical significance: The current technique enables the clinician to avoid over-preparation of the abutment teeth by assessing its taper chairside. This digital technique can be a beneficial alternative to the existing procedures for an accurate assessment of taper, especially for the inexperienced operator. Hence, the quality of retention, and thereby the long-term success of the crowns and FPDs, can be enhanced.