Aim: This study evaluated the reliability of a new rapid biological spore test (BST) for determining the sterilization efficacy of dental steam autoclaves within 20 minutes, as compared to a conventional BST requiring 2 days of incubation after autoclave exposure. Materials and methods: A total of 177 pairs of BST, each composed of a rapid test (Celerity™ 20 Steam Biologic Indicator, Steris) and a conventional BST (Attest™ 1262 Biological Indicator, 3M), both containing Geobacillus stearothermophilus spores, were placed into steam autoclaves loaded with instruments, and subjected to either sterilizing (157 pairs) or non-sterilizing conditions (20 pairs). Celerity™ BST was then incubated for 20 minutes at 57°C, with the growth medium evaluated spectrophotometrically for fluorescent α-glucosidase signal changes (no change with successful sterilization; increased fluorescence after failed sterilization). Attest™ BST was incubated for 48 hours at 57°C, after which a pH-based color change in the culture broth was visually assessed (no change in purple color with successful sterilization; change to yellow color with failed sterilization). Results: Celerity™ and Attest™ BST both accurately identified successful sterilization, with no G. stearothermophilus spore growth from either BST after exposure to sterilizing steam autoclave conditions (100% agreement between 157 pairs of each BST). Both BST also accurately detected unsuccessful sterilization, with all tested ampoules positive for G. stearothermophilus spore germination after non-sterilizing steam autoclave time periods. Both BST exhibited 100% sensitivity, specificity, and accuracy for detection of sterilizing steam autoclave conditions. Conclusion: Celerity™ BST, after only 20 minutes incubation, performed equally as well as a BST requiring 48 hours incubation in determining the sterilization efficacy of dental steam autoclaves. Clinical significance: Rapid BST offer earlier detection of sterilization failure before potentially contaminated dental instruments are used in clinical patient care.

Aim: The purpose of this study was to assess the overall satisfaction of a new learning experience and evaluate the outcome of LLUSD's educational teledentistry initiative through a survey based on Kirkpatrick's multidimensional model of training evaluation. Materials and methods: An IRB application was approved (#5210385) for a cross-sectional study that included Loma Linda University School of Dentistry (LLUSD) dental students of the class of 2022 and 2023. The 9-question survey consisted of three sections. The first section included demographic questions on gender and the graduating class. The second section was related to perceived teaching effectiveness, attitude, behavior, and significance. The third section included an open-ended question. The survey was distributed by three student investigators. Descriptive statistics were calculated, and categorical variables were compared using the Chi-squared test (χ² test). Results: The perceived teaching effectiveness of the newly implemented educational initiative was high for increasing the ability to communicate with patients and for screening and identifying the need for referrals. A majority of students believed that teledentistry is an important means to improve patients’ access to dental care and that the School has been providing a good educational environment in providing teledentistry sessions to patients. There were no significant differences in the frequencies of positive and negative responses to all questions (N = 6) by gender and by class (p >0.05, in all instances). Conclusions: Teledentistry eVisits allowed the continuation of patient contact and initial assimilation of patient information. There is potential for this educational initiative to be more actively and comprehensively implemented in the future. Clinical significance: New educational initiatives allow the continuation of patient contact that will ensure that students will graduate as competent oral health care providers despite challenges imposed by the pandemic.

Aim: To evaluate the pushout bond strength of three calcium silicate-based materials used as furcal perforation repair materials and the effect of root canal irrigants on the pushout strength of the tested repair materials. Materials and methods: Furcal perforations measuring 1.3 mm in diameter were made in the center of the furcation area of 90 extracted human mandibular molars. The teeth were then randomly divided into three groups (n = 30) according to the repair material: Biodentine (Septodont, St-Maur-des-Fossés, France), PD-MTA White (Produits Dentaires, Vevey, Switzerland), and K-Biocer (REKITA, Lebanon). The specimens were stored at 100% humidity at 37°C for 72 hours. They were later divided into three subgroups (n = 10) based on the irrigation protocol: 2.5% sodium hypochlorite, BioAKT (Metabolic substrate, New Tech Solutions s.r.l., Brescia, Italy), and a control group. After incubation for 48 hours, the dislodgement resistance of the samples was measured using a universal testing machine. Results: The mean bond strength was significantly different between repair materials in the irrigation control group (p-value <0.001). With PD-MTA White and K-Biocer, the mean bond strength was not significantly different between irrigation groups (p-value = 0.681). The mean bond strength of Biodentine was significantly different between irrigation groups (p-value = 0.002); it was the highest with BioAKT. Conclusion: Biodentine showed a high performance as a perforation repair material and its resistance to dislocation increased after being exposed to BioAKT. K-Biocer had the lowest pushout bond strength. PD-MTA White showed intermediate bond strength and was not affected by the tested irrigants. Clinical significance: The bond strength of endodontic materials to root dentin is an important factor to consider for long-term clinical success since the teeth are constantly subjected to masticatory forces.

Background: Digitalization of education became a need of the hour when the COVID-19 pandemic affected the traditional modalities of learning, and it was widely implemented in various fields including dentistry. Aims: The aim of this study was to assess the effectiveness of online learning against traditional learning systems among dental students in Chennai. Methods and materials: A Google Form questionnaire comprising 29 dental learning-based questions was designed and distributed to dental students across colleges in Chennai using online distribution platforms. The study responses were closed after the stipulated period of 1 month. The data were analyzed using SPSS software version 17. Results: The survey was answered by 834 participants comprising 76.9% females and 22.3% males. Of the total study population, 71.1% of them did not have previous online learning experiences. Approximately, 15.5% of the study population were not satisfied with the facilities provided by the online learning platforms. Also, one-third of the study population reported difficulty during the presentation. Three-fourths of the study participants did not prefer online learning over traditional learning and reported that the attention span and communication between the students and teachers were lower in online classes. Overall, 43% of the study participants rated the quality of online video-based learning to be good and 8.5% found it to be poor. Conclusion: Online-based learning systems are evolving and can provide a wide array of knowledge from global experts. However, structured planning and technique may be needed for the dental curriculum.

Aim: The present study was conducted to test the salivary levels of Cu, Zn, Fe, and Cu/Zn ratio in oral submucous fibrosis (OSF) patients. Materials and methods: Thirty-eight patients, aged 18–60 years who were clinically diagnosed with OSF, were considered as cases (group A). Thirty-eight patients without any signs of OSF were considered as controls (group B). History of tobacco habits, both smoking and chewing, was recorded. Salivary trace elements were analyzed using atomic absorption spectrometry and a differential pulse anodic stripping voltmeter (DPASV). Statistical Package for the Social Sciences (SPSS, Version 23; Chicago Inc., Illinois, USA) was used for analysis of data. Results: Significant differences were noted between cases and controls. While Zn and Fe levels were decreased in cases, copper levels and copper/zinc ratio were enhanced in OSF affected individuals. Conclusion: Trace elements in saliva showed significant difference between OSF cases and healthy counterparts and are thus regarded as possible predictors for diagnosis of oral submucous fibrosis. Clinical significance: The current study results clearly suggest an interaction of trace elements with OSF. Trace elements in saliva can be considered as a reliable, noninvasive diagnostic marker in OSF patients. Early diagnosis of these lesions can facilitate the provision of prompt treatment by the clinicians, for successful reversal and treatment.

Background: Various techniques have been advocated for over half a century for the fabrication of transfer trays for indirect orthodontic bonding. Authors have aimed to provide better light curing and accuracy of bracket positioning to avoid bracket failure and get the best possible results. Aim: This study is aimed to compare bracket failure rate when transfer trays were fabricated with a glue gun material and polylactic acid (PLA) filament for an indirect bonding procedure. Materials and methods: Customized transfer trays were fabricated using a glue gun material and PLA filament, and an indirect bonding procedure was performed. Bracket failure was assessed at regular intervals with adhesive remnant index (ARI) scoring, and reasons for bracket failure were assessed. Results: Kolmogorov–Smirnov test was employed to test the normality of data. A Chi-square test was performed for the quantitative variables. Results showed higher bracket failure in the PLA transfer tray groups and in the mandibular arch, especially in the posterior region. Adhesive remnant index scores of 2 followed by 3 were prevalent, and the most common reason for bracket failure was an excessive force during PLA transfer tray retrieval followed by masticatory forces. Conclusions: Both the transfer tray methods are effective for an indirect bonding procedure. Polylactic acid transfer trays showed more bracket failure as compared to glue gun transfer trays, especially in the mandibular posterior region due to excessive force applied during tray retrieval. Clinical significance: This study aims to provide valuable information regarding the efficiency of various in-house methods of fabricating customized transfer trays and their effect on bracket failure rates.

Aims: This study aimed to investigate the incidence and severity of malocclusion and orthodontic treatment needs among randomly selected high school students. Methods: A multistage stratified random-sampling study was conducted on 1,036 high school students in Sanaa city. The World Dental Federation and World Health Organization method of occlusal traits and the index of orthodontic treatment need were adopted for measurements. Clinically, the molar relationship and facial profile were examined. Assessment of whether examiner or subject perceived the need for orthodontic treatment was made using the esthetic component index. All data were analyzed using the Chi-square test with a significance level of p <0.05. Results: Normal, convex, and concave facial-profile measurements were found in 81.9, 12.1, and 6.15% of sampled students, respectively. Asymmetrical molar relationship was observed in 16.1% of samples, and most of them were of class I/class II relationships. Increased overjet was noticed in 90.9% of students. Anterior crossbite, deepbite, anterior openbite, posterior openbite, posterior crossbite, and scissor bite accounted for 12.2, 12.8, 3.5, 1.3, 6.6, and 0.6%, respectively. According to the index orthodontic treatment need, 38.9% of students needed some form of orthodontic treatment. Among these cases, 24.3% “definitely” needed treatment, and 59.9% of students needed orthodontic treatment. Conclusion: Our findings suggested a call for a more conservative treatment approach in dealing with malocclusion problems among high school students in all zones of Sanaa governorate, Yemen. Clinical significance: A limited number of surveys were performed in Sanaa Governorate to investigate orthodontic treatment needs, facial profiles, and occlusal features among adolescents. The results of this study could guide us to develop a preventive system that minimizes its adverse effects and the need for costly orthodontic treatments.

Aim: The red complex includes Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia, which are recognized as the most important pathogens and are the indicators of infection in chronic periodontal disease. This study was to assess the levels of red complex bacteria in chronic periodontitis patients following treatment with probiotic mouthwash. Materials and methods: Twenty chronic periodontitis patients with ages ranging from 18 to 55 years were recruited for the study. The control group was given placebo mouthwash and the study group was given probiotic mouthwash. After clinical monitoring and scaling and root planing, the collected plaque samples at baseline and 14th day were transferred for microbiological analysis by transport media for Conventional Multiplex Polymerase Chain Reaction. Results: On the 14th day, all the clinical parameters were significantly reduced in the study group with gingival index (p = 0.003 HS) and plaque index (p = 0.001 VHS). In the study group, there was significant bacterial cell reduction with T. denticola (p = 0.041 S) and T. forsythia (p = 0.037 S). Conclusion: In patients with chronic periodontitis, treatment with probiotic mouthwash significantly reduces the levels of red complex bacteria. Clinical significance: The use of probiotic mouthwash could be a useful adjunct to scaling and root planing in chronic periodontitis.

Aim: The study aimed to explore the role, impact, and influence of social media on the population during the coronavirus disease-2019 (COVID-19)pandemic. Background: During pandemics, communication is an important factor to disseminate the information, create awareness and provide timely updates from authorized personnel to the masses. Social media progressed to function as a mediator of transmission of information between the government and authorities and the public during the COVID-19. Review results: Though several strengths were observed yet liabilities did not go unnoticed regarding the role essayed by social media during this pandemic period. When used responsibly, these technologies can aid in the rapid dissemination of crucial facts, important scientific discoveries, and information regarding diagnosis, treatment, and follow-up as well as comparing different strategies across the world. It is recommended to follow certain fundamental standards while exchanging information on social media networks during the COVID-19 era in order to utilize these technologies responsibly and effectively. Conclusion: In this research, we have made an attempt to synthesize the vital facts regarding the impact, benefits, and drawbacks of using social media during COVID-19. Eventually, the decision of evaluation, acceptance, and denial of the information received rests with the individual. Clinical significance: Social media use has become intangible with health care. Instead of venturing out the negative effects, we need to focus on utilizing social media for the betterment of the public and to the advantage of the public to increase awareness levels, spread knowledge, and cooperate to tap the benefits to the maximum extent possible to prevent the disease spread.

Aim: The aim of this current study was to compare and evaluate the reversal efficacy of Qmix and chitosan-based irrigation materials quantitatively through the assessment of the push-out bond strength of bioceramic sealer employing universal testing machine and to qualitatively analyze the sealer/dentin interface by scanning electron microscope (SEM) in the teeth subjected to fractioned radiation. Materials and methods: Ninety single-rooted straight human maxillary central incisors were randomly divided into six groups (n = 15) where in three groups comprise Chitosan, Qmix, and EDTA/sodium hypochlorite which were not exposed to irradiation while other three groups were challenged with irradiation protocols. Root canals were prepared with ProTaper universal system and all the samples were irrigated according to the final irrigation protocols and obturated with bioceramic sealers. Dentin slices were prepared with 1 mm thickness from each root third for the estimation of bond strength of sealers to dentin. Qualitative assessment of the sealer–dentin interface was done by scanning electron microscopy. Bond strength data were scrutinized by independent t-test and failure modes using the Chi-square test. Results: Significantly lower bond strength (p <0.05) was recorded after irradiation compared with nonirradiated group. To quantify the results irrigation protocols, Qmix had highest bond strength followed by chitosan and EDTA/sodium hypochlorite group irrespective of irradiation status. Bond strength values reduced after irradiation in all root thirds irrespective of the irrigation materials. Scanning electron microscope images revealed traces of repair process for Qmix-based irrigation materials than the chitosan-based materials for both irradiated and nonirradiated specimens. Conclusion: All the irrigation materials employed in this study had good bond strength. The specimen irrigated with Qmix had comparatively higher bond strength than the chitosan-based materials. The teeth subjected to irradiation challenge were associated with a decrease in the push-out bond strength of sealers to intraradicular dentin with formation of more gaps and fewer tags at the sealer/dentin interface. Clinical significance: Selection of ideal irrigation protocols still remains a challenge for the clinical practitioners, and this study explored the utilization of novel materials used for irrigation, especially in the teeth subjected to radiation.

Aim: To compare different combinations of alendronate, platelet-rich fibrin (PRF), and hydroxyapatite in bone regeneration in endodontic surgeries using cone-beam computed tomography (CBCT). Methods and subjects: During this study, 28 patients were selected who were found to have pathology in the periapical area in the anterior region. The study subjects were categorized into four categories, each consisting of seven subjects. Category one—there was no placement of any material; category two—PRF; category three—hydroxyapatite along with PRF; category four—alendronate along with PRF. Root canal treatment followed by endodontic surgery in each patient was carried out. Volumetric analysis of the lesions was carried out before surgery and 12 months after surgery using CBCT. Analysis of variance (ANOVA) test and Tukey post-hoc test were used for statistical analysis. Results: There was a maximum change in the volume of lesions in the study subjects in which PRF was used along with hydroxyapatite in comparison to other combination of materials. There was no significant difference when PRF was placed along with alendronate in comparison to study subjects when PRF was placed alone. The difference was not significant when PRF was placed in defects of bone in comparison to study subjects when no materials were placed in the defects of bone. Conclusion: It can be concluded from the current research that PRF along with hydroxyapatite is a better option for the healing of defects of bone in surgeries performed in the area around the root apex in endodontic patients. But further studies should be carried out with a large sample size and for a longer duration. Clinical significance: It is a very important consideration that there should be healing of the lesion after surgery around the root apex by actual bone regeneration. The healing of the larger lesions does not take place easily as compared with the lesions having a small size. This is because there is healing by secondary intention where there is formation of scar instead of actual healing by formation of bone. There are several methods by which proper bone regeneration can be obtained.

Aim: The aim of the in vitro study was to comparatively evaluate the bond strength of CAD/CAM monolithic zirconia copings using three luting agents and two different finish lines. Materials and methods: For the evaluation of bond strength, 60 extracted human maxillary first premolars were prepared to receive CAD/CAM monolithic zirconia copings. They were randomly divided into six groups of 10 samples each to receive CAD/CAM monolithic zirconia copings to bond with three different luting agents on two different finish lines. The luting agents used were RelyX U200, RMGIC, and Maxcem Elite with finish lines which were incorporated were 90° shoulder and radial shoulder finish lines. The tensile bond strength for all 60 samples was tested using the universal testing machine. Results: Between and within the group differences in tensile bond strength were analyzed using one-way ANOVA test of significance with Tukey's post-hoc analysis. The statistical analysis revealed that the CAD/CAM zirconia copings used a combination of 90° shoulder and RelyX U200 as the luting agent (Group II) which offered the maximum bond strength. Conclusion: Within the constraints of this study, it could be concluded that CAD/CAM monolithic zirconia copings luted with RelyX U200 cement on a 90° shoulder finish line is the preferred method, taking the bond strength into consideration. Clinical significance: The results of this study can be extrapolated into a clinical scenario to help the clinician decide the most apt combination of finish line design and the luting agent to achieve superior bond strengths in CAD/CAM zirconia crowns and fixed dental prosthesis.

Aim/objective: The aim of this study was to evaluate the displacement of the denture base of conventional acrylic dentures and Click Fit partials in Kennedy's class I and II situations in the mandibular arch. Materials and methods: Four removable partial dentures—two conventional clasp dentures and two attachment dentures (Click Fit)—were designed. The two conventional clasp dentures were retained by C (conventional) clasps, and the two attachment dentures were retained by rigid precision attachments. The displacement of denture bases and the movements of denture bases were investigated, and the influences of denture design were studied. Result: The values obtained were statistically analyzed by using independent t-tests. For all statistical purposes, a p-value of ≤0.001 was considered significant. The results showed that mean vertical displacements (mm) of the conventional acrylic removable partial denture base for Kennedy's class I mandibular arch under 50, 75, and 100 N forces were 0.0317, 0.04377, and 0.06392, respectively, and those for Kennedy's class II mandibular arch under 50, 75, and 100 N forces were 0.04922, 0.09849, and 0.1522, respectively. Vertical displacements (mm) of the Click Fit removable partial denture base for Kennedy's class I mandibular arch under 50, 75, and 100 N forces were 0.02185, 0.03436, and 0.005365, respectively, and those for Kennedy's class II mandibular arch under 50N, 75N, and 100N forces were 0.0445, 0.07851, and 0.14457, respectively. The difference between the groups was statistically significant (p ≤0.001). Conclusion: The vertical displacement of the denture base retained by conventional C clasps was more than that of the denture base retained by rigid precision attachment. The displacement of the denture base tended to be less when the denture was designed with a rigid connection for the retainer and with cross-arch stabilization as in Kennedy's class I case. Clinical implications: This research evaluated the vertical denture base displacement using different designs and retention types. Hence, it helped predict the prognosis of different removable partial denture base designs in various clinical conditions.

Aim: The main purpose of the present study was to investigate the potential benefit of local use of hyaluronic acid as an adjunct to periodontal therapy, since commercial products of hyaluronic acid (HA), due to its anti-inflammatory and anti-bacterial actions and its significant role in wound repair, have been proposed as adjuncts to either nonsurgical or surgical periodontal therapy. Materials and methods: A total of 19 electronic databases were searched and the appropriate studies were identified with the use of specific eligibility criteria, according to PRISMA guidelines. Two reviewers independently screened and selected the studies and made the data extraction and the assessment of risk of bias, by using the Cochrane risk of bias tool. Results: Out of 3,186 papers, 38 randomized clinical trials (8 related to gingivitis therapy, 20 related to nonsurgical periodontal therapy, and 10 related to surgical periodontal therapy) were finally included in the review. The outcomes were categorized as primary (that answered the focus question) and secondary (regarding additional quality characteristics). The adjunct use of HA combined to all treatment modalities shows improvement of patients’ postoperative course, in terms of decreased inflammatory reactions, and changes in periodontal pocket depth and clinical attachment level. No side effects were reported in any of the included studies. Among the secondary outcomes were the variety of HA formulations and chemical forms, the variety in application, follow-up protocol and blinding design, the uneven geographic distribution of the studies, and the low bibliometric characteristics of most studies. Conclusion: Overall and despite the positive effects reported, further research is needed to define the ideal HA compound, formulation, and regimen characteristics for periodontal disease treatment. Clinical significance: The adjunct use of HA may lead in the reduction of the prescription of nonsteroid anti-inflammatory drugs and achieve improved clinical parameters, including periodontal probing depth, periodontal inflammation, and clinical attachment level.

Supplementary Appendix

Background: Esthetic satisfaction has been a prime concern for patients. This has led to a surge in the development of esthetic restorations and dental composites in the field of restorative dentistry over the past decade. Resins are the most preferred restorative material. However, their failure rate was observed to be high. Aim: This review is aimed for clinician, discussing the influence of human and bacterial enzymes on resin restorations. Review results: Composite restoration failure is multifactorial with an interplay of mechanical functions such as masticatory forces and abrasion with biological factors such as host modulated and bacterial enzymes. Salivary esterases and bacterial esterases act on the ester-link bond of resin restoration to form byproducts of methacrylic acid and Bis-hydroxy-propoxy-phenyl-propane. Salivary enzymes form microgaps between the resin–tooth interface and provide a suitable environment for bacterial growth. Bacteria colonize the resin–tooth interface to weaken the resin bond strength. The presence of bacteria draws neutrophils into the hybrid layer. The activation and degranulation of neutrophils leads to enzyme secretions that act on bacteria. However, this can also have adverse effects on resin restoration. Acids prompt the activation of matrix metalloproteinases (MMPs). Proteinases secreted by MMPs uncoil the collagen fibrils of the dentin matrix and degrade tooth structure. The salivary esterases, bacterial esterases, neutrophils, and MMPs work synergistically to degrade dental resin material, resin–tooth interface, and dentin. This causes failure of dental resin restorations and secondary caries formation. Conclusion: Biological degradation of resin restorations is inevitable irrespective of the material and techniques used. Salivary esterases such as cholesterol esterase and pseudocholinesterase and cariogenic bacterial esterase can degrade dental resin, weakening the hybrid layer at the resin–tooth interface, affecting the bond strength, and causing failure. Ester-free resin and incorporation of antimicrobial materials, esterase, and MMP inhibitors are strategies that could ameliorate degradation of the restoration.