Aim: To evaluate the antibacterial efficacy of desensitizing dentifrices. Material and methods: An experimental, in vitro, longitudinal, analytical, and prospective study was carried out. Subsequently, the following groups were formed: Streptococcus mutans vs Vitis® Sensible. S. mutans vs Sensodyne® Repair and Protect. Also, S. mutans vs Colgate® Sensitive Pro-Relief^TM and S. mutans vs Colgate Total 12® at 100, 50, 25, and 12.5%. Each Petri dish was properly labeled with the letter corresponding to the toothpaste and was placed in the incubator for 24 hours at 37°C. A 0.12% chlorhexidine solution was used as a positive control and distilled water as a negative control. The manuscript was written following the checklist for reporting in vitro studies (CRIS) guidelines. Results: It was found that when comparing the inhibition halos of the desensitizing toothpaste against S. mutans, Colgate® Sensitive Pro-Relief^TM 100% paste had the highest efficacy at 24 and 48 hours with an average of 25.2 ± 1.0 and 23.5 ± 1.1 mm, respectively. On the other way, Sensodyne paste had no efficacy at any of its concentrations 100, 50, 25, and 12.5%. Finally, it was found that there were statistically significant differences between each of the groups evaluated with a p < 0.001. Conclusions: It was concluded that mainly the 100% pure concentrations of the desensitizing pastes had antibacterial efficacy against S. mutans. However, Sensodyne® Repair and Protect paste had no effect. Clinical significance: This research has clinical relevance because the use of desensitizing pastes is highly frequent. Therefore, it is necessary to know if these pastes offer an efficient antibacterial effect to control the main microorganisms of the oral cavity.

Aim: The study aimed to investigate the bond strength of epoxy resin-based sealer following five different calcium hydroxide paste removal methods in oval-shaped root canals. Materials and methods: Sixty single-rooted human mandibular premolars having an oval-shaped root canal as evidenced by radiographs were decoronated and instrumented to size 40/0.04, medicated with calcium hydroxide paste for 7 days, before being randomly assigned to the conventional needle irrigation (CNI), manual dynamic agitation (MDA), sonic irrigation (SI), passive ultrasonic irrigation (PUI), and XP-endo Finisher (XP) groups to be irrigated using different irrigation systems. All specimens were then obturated using an epoxy resin-based root canal sealer and warm vertical compaction obturation technique. After 7 days, each specimen was sectioned into 1 mm root slices at the coronal, middle, and apical third of the root canal and tested for the push-out bond strength using a universal testing machine. Results: The XP group was the only group that had comparable bond strength to the control group at every level of the root canal following removal of calcium hydroxide medicament (p >0.05). The control group had higher bond strength than the CNI group at every level of the root canal (p < 0.05). Conclusion: Calcium hydroxide interfered with the bonding of epoxy resin-based sealer to root canal walls. Irrigation with the XP increased the bonding sealer at every level of the root canal. Clinical significance: The XP was efficacious as a final rinse agitation technique to promote the bonding of the epoxy resin-based sealer at every level of the root canal following calcium hydroxide medication.

Aim: The aim of the present study is to evaluate the effect of Ag–Au NPs formulation as surface pretreatment by assessing the microshear bond strength, ultra-morphological, and elemental characteristics of gold–silver nanoparticle-treated dentin to resin composite with different adhesive modes. Materials and methods: A total of 60 extracted sound human permanent molars were selected to test the microshear bond strength of composite resin to dentin (40 teeth) and 20 molars were used to assess the ultramorphological and elemental characteristics of silver–gold nanoparticles using environmental scanning electron microscope (ESEM) with energy-dispersive X-ray (EDX) analyzer. The specimens were randomly divided into two main groups according to measured tests either microshear bond strength or elemental analysis. For the bond-strength testing group, 40 teeth were equally distributed into two main groups (20 each) according to dentin-surface pretreatment with or without the use of silver–gold nanoparticles. Then, each group was further divided into two subgroups (10 specimens for each) according to adhesive mode. For ultramorphological and elemental analysis, 20 teeth were equally divided into similar previously mentioned groups according to treatment modalities (5 teeth per group). The multimode bonding agent used in this study was single-bond universal, 3M. The data were collected and statistically analyzed. The significance level was set at p ≤0.05. Results: The results showed that different etching modes had no statistically significant effect. Also, pretreatment had no statistically significant effect. The interaction between the two variables also had no statistically significant effect. Majority of samples in all groups had mixed failure mode. Ultramorphological examination of the tested samples treated with silver–gold nanoparticles revealed proper dispersion of nanoparticles in dentin. Conclusions: The new formulation of silver–gold nanoparticles did not interfere with the bond strength and sealing ability of resin composite restoration in different adhesion modes. Clinical significance: The cavity disinfection with silver–gold nanoparticles did not affect the marginal integrity of resin composite restoration. Further studies should be done to evaluate the impact of application of silver–gold nanoparticles in long duration with other adhesive systems in the clinical scenario.

Aim: The purpose of this study is to evaluate presurgical computerized volumetric analysis in secondary alveolar cleft bone grafting (SABG) and the time taken for calculation using cone–beam computed tomography (CBCT) via two different software programs. Materials and methods: Twelve patients with unilateral alveolar clefts were investigated using CBCT. Two independent investigators did presurgical volumetric analysis for each patient's CBCT data using two different methods. Method A involved On-Demand 3D software (Cybermed Inc., Korea), while method B involved InVesalius 3 software (CTI, Brazil). The volume outcomes and time spent for measurements were compared between both software programs. Interobserver reliability and descriptive and t-test statistics were computed, and statistical significance was considered when p ≤ 0.05. Results: There was not a statistically significant difference between clefts’ volumetric measurements by the two methods via both investigators (p = 0.186 and 0.069). However, the difference in time taken for these measurements between the two methods was statistically significant (p < 0.001). Intraclass correlation coefficient (ICC) values indicated excellent interobserver reliability for measurements by method A (ICC ~ 0.998), and moderate reliability for method B (ICC ~ 0.626). Conclusions: Both software programs used in this study had comparable volumetric computation. Method B took much less calculating time than method A. The interobserver reliability was high for both methods. Clinical significance: These both investigated software programs may show a clinical implication for presurgical alveolar cleft volume measurement, thus reducing the surgical operating time and adequately selecting a donor site with a congruent sufficient amount of bone grafts.

Aim: The purpose of the study was to evaluate the stress on the implant and to assess the denture displacement for locator and bar and clip attachment types in implant-assisted obturators. Materials and methods: A maxillary edentulous experimental model with a maxillectomy defect was made along with an opposing edentulous mandibular model with self-cure acrylic. Two endosseous implants were placed in the maxillary model. Corresponding obturator complete denture was fabricated for the maxillary model and a complete denture for the mandibular. The attachments were positioned on the implants in maxillary model, and their sleeve/clip was placed on intaglio surface of the dentures. The mounted articulator was placed on a loading apparatus, and force was incrementally applied to it. The strain and displacement for both the attachment types were measured and compared using Digital Image Correlation (DIC). Results: Locator attachment showed the least stress and minimal displacement as compared to bar and clip attachment. Conclusion: The stresses around the implants and displacement of the obturator are affected by the attachment type used. It was found that bar and clip (splinted) showed the maximum stresses around the implant and maximum denture displacement. Locator attachment is the better choice over bar and clip because of its additional retentive features. Clinical significance: The advantage of using DIC over the conventional strain gauge analysis is that a full-field data of displacement and strain can be obtained instead of getting a mean value on the small surface where the strain gauge is positioned.

Aim: The study's aim was to assess and compare the clinical parameters, plasma reactive oxygen metabolites (ROM) levels, gingival crevicular fluid (GCF) resistin, serum resistin values, and red complex bacteria in obese or overweight subjects with and without periodontitis and also to determine the effect of non-surgical periodontal therapy (NSPT) on plasma ROM, serum, and GCF resistin values in obese or overweight subjects with chronic periodontitis. Material and methods: A total of 160 subjects were recruited and designated into four groups with 40 subjects each as group I – obese with chronic periodontitis; group II – normal weight subjects with chronic periodontitis; group III – obese subjects with healthy periodontium; and group IV – normal weight subjects with healthy periodontium. The periodontal parameters, plasma ROM, GCF resistin and serum resistin, and red complex bacteria levels were estimated at baseline. After baseline assessment, scaling and root planing (SRP) were done in the patients of groups I and II. Two months after the completion of SRP, clinical parameters such as plaque index (PI), probing pocket depth (PPD), gingival index (GI), and clinical attachment loss (CAL), plasma ROM levels, serum resistin, and GCF resistin levels were analyzed. Results: An increase in plasma ROM, GCF resistin, and red complex bacteria levels was observed in obese subjects with periodontal disease and the increase was noted in obese subjects with healthy periodontium. Comparing plasma ROM, GCF resistin values between groups I and II, 2 months after SRP, a decrease in these levels were observed in group II. Conclusion: Our study results depict that obesity can be considered as a risk indicator for periodontal disease. Clinical significance: Obesity has a negative impact on both general health and oral health. Promoting appropriate physical activity, healthy eating behavior, and oral hygiene practice are fundamental elements of the prevention of both obesity and periodontal disease.

Aim: The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has currently been proposed as an indicator of inflammation. The aim of the present study was to assess the relationship between the monocyte-to-high-density lipoprotein cholesterol ratio and periodontal health and disease. Materials and methods: A total of 90 patients were selected for the study – 30 healthy patients (group I) and 60 periodontitis patients (groups II and III). All the patients were subjected to blood sampling and serum malondialdehyde (MDA), high-density lipoprotein cholesterol (HDL) levels and monocyte counts were estimated. Results: Monocyte-to-high-density lipoprotein cholesterol ratio was 80.64 ± 28.71 for patients with moderate periodontitis (group II), 95.14 ± 53.21 in severe periodontitis (group III), and 14.28 ± 16.05 for the healthy patients. Monocyte-to-high-density lipoprotein cholesterol ratio values were found to be statistically significantly higher than the control group (p < 0.001). Monocyte-to-high-density lipoprotein cholesterol ratio also showed significantly positive correlation with the severity of periodontitis. Conclusion: Malondialdehyde and MHR are increased in periodontal disease and correlate with severity of the periodontal disease. Clinical significance: Monocyte-to-high-density lipoprotein cholesterol ratio is a novel, readily available inflammatory and oxidative stress marker in patients with periodontitis and can be useful to evaluate periodontitis and disease severity.

Aim: The aim of this study is to identify the prevalence of C-shaped root canal systems in mandibular first and second molars in a Lebanese population, and to determine the relationship between C-shaped root canal systems and different factors (age, gender, and tooth location) and to examine the root canal system's morphology along the root. Materials and methods: The presence of C-shaped root canal systems in 648 mandibular molars from 257 patients was analyzed using cone–beam computed tomography (CBCT). The sample included 296 and 352 mandibular first and second molars, respectively. The frequency of C-shaped canals, their relationship to gender, age, and tooth location, and unilateral or bilateral occurrences were noted. A 3D Slicer 4.10.1 was then used to classify teeth with identified C-shaped anatomy according to Fan's configuration and to determine the distance between the orifice and the cementoenamel junction (CEJ). Results: C-shaped root canal systems were detected in 1.01 and 9.09% of mandibular first and second molars, respectively. In mandibular second molars, the most prevalent configurations were as follows: C1 at the orifice level, C3 at orifice-2 mm, C2 and C3 in the middle third, and C3 at the apical level. There was no correlation with age, gender, and tooth position. The bilateral occurrence happened in 60% of cases. Orifices were at a mean distance of 3.32 mm below the CEJ. The deepest groove was mostly lingual. Conclusion: The prevalence of C-shaped root canal systems in the Lebanese population is 1.01 and 9.09% in the first and second mandibular molars, respectively. The CBCT slices showed that the configuration varies along the root and that the orifices are at various distances below the CEJ. Therefore, pre-operatory scans can be beneficial for better understanding and preparation of root canal treatment. Clinical significance: In the Lebanese population, C-shaped mandibular molars are not a rare finding. Clinicians should consider the different configurations and the possible changes along the root.

Aims: The aim of this study was to assess subject wise and tooth wise distribution and prevalence of traumatic injuries to the anterior teeth of 2- to 6-year-old children. Materials and methods: A cross-sectional survey was performed. Primary maxillary and mandibular anterior teeth of 1,800 children aged between 2 years and 6 years, who attended 20 pre-schools in National Capital Region Delhi, India, were examined by a single examiner, and a questionnaire was filled in person by the parent/guardian. Andreasen's classification was used to classify the traumatic injuries. The Chi-square test was used to statistically analyze the variation in traumatic dental injuries (TDIs) with age and gender. Multiple logistic regression was used to determine the influence of independent variables on the occurrence of TDIs. Results: The prevalence of TDIs was 17%. Significant and highly significant differences were found between boys and girls for cause and location of trauma (p < 0.05) and tooth type involved (p < 0.001) with boys being more prone to such injuries. The commonest cause of injury was due to falls and the location was playground. The teeth most commonly affected were the maxillary central incisors (36.9%) followed by maxillary lateral incisors (3.3%), and the least affected were the maxillary and mandibular canines (0.3%). Conclusion: The prevalence of traumatic injuries to the anterior teeth in 2- to 6-year-old children in National Capital Region of Delhi, India, was 17%. There is a need to run educational programs to increase parents’ awareness of the risks of dental trauma and emphasize preventive measures. Clinical significance: Parents should be made aware of the widespread prevalence, risk factors, and consequences of trauma to primary dentition, so that they can seek appropriate care timely. The time elapsed between injury and dental care is of utmost importance.

Aim: The present study aims to compare advanced platelet-rich fibrin (A-PRF) and conventional blood clot as scaffolds in the regenerative endodontic procedure (REP) and to evaluate their effectiveness in the development of traumatized nonvital immature teeth roots. Material and methods: Regenerative endodontic procedure was carried out on 20 traumatized nonvital immature maxillary incisors of 17 patients between the ages of 8 and 12 years. Irrigation with 1.5% sodium hypochlorite (NaOCl) and 17% ethylene diamine tetra-acetic acid was done following minimal mechanical debridement. Canal disinfection was achieved using calcium hydroxide paste. According to the scaffold type, teeth were randomly allocated into A-PRF (n = 10) and conventional blood-clot groups (n = 10). Apical width and root dimensions (length and thickness) were analyzed radiographically and statistically after 3-, 6-, and 12-month follow-up. Results: Fifteen patients with 18 teeth (A-PRF n = 9, blood clot n = 9) completed the follow-up, and 2 patients were excluded. Patients in both groups were asymptomatic. There was a significant increase within each group in respect to root length, root thickness at one- and two-thirds, and root apex width for all timepoints. While percent of change between the two groups was statistically insignificant. Conclusion: Regenerative endodontic procedure for traumatized immature nonvital teeth with either conventional blood clot or A-PRF as scaffold was comparable, except in cases where adequate bleeding cannot be achieved. Clinical significance: Advanced platelet-rich fibrin provides a suitable scaffold that can be used in REP of teeth with close proximity to vital structures such as inferior alveolar nerve (IAN) or mental nerve, where using a sharp instrument to induce bleeding can cause damage and also in cases where adequate bleeding cannot be achieved.

Aim: This study was conducted to compare the efficacy of using 0.5 mg/mL povidone-iodine solution as an irrigant and coolant in reducing postoperative sequelae like swelling, trismus, and pain with the conventional normal saline irrigation during the surgical removal of the impacted lower third molar. Materials and methods: The research was conducted out toward the MES Dental College in Perinthalmanna, Kerala, in the Department of Oral and Maxillofacial Surgery. After mandibular third-molar surgical removal, researchers studied 60 individuals, 30 of whom had normal saline irrigation (group I), and 30 of whom received 0.05% povidone-iodine irrigation (group II). The postoperative discomforts were measured on the second and seventh days after surgery, respectively. After that, the data were analyzed using SPSS. The data analysis considered p-values less than 0.05 to be significant. Results: At the second postoperative visit, patients in the povidone-iodine group reported much less pain, swelling, and reduced mouth opening than those in the normal saline group. But on the seventh postoperative day, there was not much difference between either group. Conclusion: Following the surgical removal of teeth, it was revealed that povidone-iodine solution (0.5 mg/mL) was more effective as irrigation and cooling aid than regular saline solution. Clinical significance: Low-concentrated povidone-iodine is a better option in dentistry as irrigant.

Aim: Determination of age is a pivotal part of forensic dentistry. Since many dental age determination methods are invasive, Cameriere introduced a radiographic method where age evaluation was carried out using an orthopantomogram (OPG). An adaptation of the same formula was later formulated by Rai et al. for the Indian population. The aim of the study was to assess the age and to dictate the efficiency of the Indian version of Cameriere's formula in the Chennai subpopulation. Materials and methods: This study consisted of radiographs belonging to 50 individuals with an age range of 5–15 years. Radiographs were taken using the OPG and the soft copies obtained were analyzed. The variables such as seven left and right permanent mandibular teeth and the number of teeth with closed apical, and with open apical, ends of roots were examined and measured. The obtained data, after substituting in the formula was statistically analyzed using paired and unpaired t-test and Pearson's correlation coefficient test. Results: On comparing dental age and chronological age, statistically significant results were obtained on both sides of the radiograph. Between genders, both sides of the radiograph showed non-significant results. On correlating the sides, the left side showed greater accuracy in age determination compared to the right side of the OPG. Conclusion: Age estimation using Indian-specified formula provides a near good estimate and hence can be a reliable method to measure the chronological age of the participants. Clinical significance: The Indian version of the Cameriere's formula can be used as a rational tool to assess the age of young children and adolescents.

Aim: Aim of the present research was to compare the antimicrobial activity of Aloevera mouthwash with chlorhexidine mouthwash in fixed orthodontic patients. Materials and methods: A sample of 90 fixed Orthodontic patients participated in this study. Full-mouth oral prophylaxis was performed for every patient at the start of the study. Patients were advised to brush twice a day with the modified bass technique and rinse with respective mouthwashes for 20 days. Once the patients with fixed orthodontic appliances were accepted to participate in the study, they received dental prophylaxis which includes the removal of plaque, calculus, and stains from the teeth by scaling and polishing. Then they were randomly divided into the following three groups: chlorhexidine (group I), Aloevera (group II), and control (group III). A washout period of 8–10 days (baseline) was awaited post-oral prophylaxis and then the following clinical parameters were recorded: Plaque index (PI) and gingival index (GI). The data included clinical examination, inspection, and microscopic observation techniques. Results: The mean reduction of the PI score on the 20th day of group II was 0.03 ± 0.18, group I was 0.43 ± 0.49, and the control group was 1.65 ± 0.88. The mean reduction of GI score on the 20th day of group II was 0.83 ± 0.40, group I was 0.93 ± 0.55, and group III was 1.85 ± 0.77. Student's t-test had been used to evaluate within each group between day 1 and day 20, group I and group II had shown higher differences compared to control. Conclusion: In conclusion, both chlorhexidine mouthwash and Aloevera mouthwash are important chemical adjuncts in controlling gingival inflammation, gingival bleeding, and plaque accumulation in orthodontic patients. Aloevera could be an alternative to chlorhexidine in patients who are seeking a chemical-free, indigenous, and patient-friendly oral hygiene aid. Clinical significance: Chlorhexidine is known to produce temporary tooth discoloration, allergic responses, dry mouth, burning in the mouth, and transient bad taste, which deter patients from using this mouthwash. The hunt for plant extract-based antimicrobial medicines has been prompted by the emergence of medication resistance and the unfavorable side effects of several antibiotics. These natural remedies can be a valuable substitute for creating a comparable effect.

Aim: To compare the outcomes of the conventional syringe and the outcomes of the vibraject-assisted injection (VAI) in terms of the pain of the needle insertion during various intraoral injections of local anesthesia in children aged 6–9 years. Materials and methods: A total number of 75 children aged 6–9 years were selected from patients visiting the pediatric dental clinic at Damascus University. The children were assigned into three equal groups (25 children each) according to the type of intraoral injection needed for the treatment: Groups [Group I: received upper buccal infiltrations (UBI), Group II: received posterior palatal infiltrations (PPI), and Group III: received inferior alveolar nerve block (IANB)]. This study was conducted considering the split-mouth design. Each child was subjected to both anesthetic injections: the conventional and the vibration-assisted in two separate dental visits 2 weeks apart. At each clinic visit, subjective and objective pain levels were assessed using the visual analog scale (VAS) and Face, Leg, Activity, Cry, Consolability (FLACC) scale. Results: Children who received local anesthesia using the Vibraject method had lower VAS and FLACC scores than those who received local anesthesia using the conventional method. Conclusion: Vibraject was more effective in reducing the pain with local anesthetic injection compared to the conventional injection technique in clinical dental procedures for children. Clinical significance: In a pediatric dental clinic, pain management is considered a pillar that influences actions. Using the VAI may achieve the ease, cooperation, and compliance during the dental care session.

Aim: To describe the diagnosis and management of mucous membrane pemphigoid (MMP) with oral and ocular presentation. Background: Mucous membrane pemphigoid constitutes a heterogeneous group of chronic, autoimmune vesiculobullous diseases characterized by blister formation that has a propensity to affect different mucous membranes of the body. The most commonly affected areas include the oral cavity, mucous membranes of the eyes, throat, genitalia, and nose. This disease usually affects elderly women with a peak incidence at around 50–70 years of age; however, rare cases have been diagnosed in children. The symptoms of MMP include recurrent blistering lesions which eventually rupture and occasionally heal with scarring that may lead to certain complications involving the eyes and throat regions. Case description: In this report, we describe a 66-year-old female patient who complained of oral and ocular lesions for a period of 2 years. Pain, burning mouth, and gingival inflammation were present. Ocular examination showed mild conjunctivitis with scar formation at the lateral canthus of the left eye. The patient also noticed periods of water-filled balloon-like formation in the gingiva that rupture spontaneously leaving sore spots. A biopsy was obtained from perilesional tissue and sent for histopathological examination, correlation of clinical and histological features directed us toward the diagnosis of MMP. The patient was treated for both oral and ocular lesions using topical corticosteroid therapy in conjunction with antifungal and antibacterial drugs. The response to local treatment was augmented via effective periodontal therapy to control the concurrent plaque-induced gingival inflammation and via using a customized application tray to sustain the drug efficacy. Conclusion: A multidisciplinary approach is often necessary in order to treat MMP lesions efficaciously. Clinical significance: Early diagnosis and effective treatment protocol using systemic or topical corticosteroid therapy along with other therapeutic means including periodontal therapy, good oral hygiene practice, and timely follow-up are very useful in preventing long-term complications due to this disease.