Aim: The purpose of this study is to correlate the role of serum vitamin D levels associated with crestal bone in dental implant patients using cone-beam computed tomography (CBCT). Materials and methods: This retrospective study enrolled patients among whom implants were placed after a detailed planning using CBCT and the delayed loading protocol was followed. After 3 months and 6 months of loading, CBCT evaluations were carried out, serum vitamin D levels were also tested at the end of 6 months of loading. A total of 30 patients were recruited with 15 patients in each group based on normal and deficient levels of vitamin D to correlate with crestal bone levels using CBCT. Results: Clinically acceptable crestal bone loss (CBL) was visible with all the implants at different time intervals. Statistical analysis was done for intergroup and intragroup comparisons which showed significant p-value (< 0.05) for CBL at the time of loading, at 3 months, and at 6 months follow-up for both normal and deficient serum values. In the deficient group, the mean value at baseline was 9.69 mm ± 1.10 and the CBL at 6 months follow-up was 8.80 mm ± 1.10 whereas for the normal group at baseline, the mean was 9.08 mm ± 1.21 and at 6 months follow-up was 8.12 mm ± 1.25 which showed meaningful difference. Conclusion: There is a positive correlation seen between CBL on CBCT and vitamin D serum levels. The success of the implant is significantly affected by vitamin D as it regulates the bone physiology and has systemic effects on accelerating bone formation around titanium implants. Clinical significance: Vitamin D is essential in maintaining the balance of bone minerals and assists to preserve the crestal bone level making the implant treatment more predictable and successful.

Aim: The aim of this in vitro study was to determine the effectiveness of 1,1,1,2-tetrafluoroethane (TFE) intracanal cryotherapy for external root surface temperature control during thermoplastic obturation. Materials and methods: Thirty extracted adult single-rooted mandibular incisors were selected for this study. Endodontic shaping was performed until size X3 Protaper Next Rotary endodontic file. The teeth were divided into three groups: Group I—Control group wherein conventional irrigation was done using physiologic saline stored at room temperature, Group II—Irrigational Cryotherapy group using physiologic saline at 2.5°C, and Group III—Intracanal TFE cryotherapy group with intracanal refrigerant TFE application. Temperatures were recorded in the apical 3 mm before and after completion of each intervention and post thermoplastic obturation using a noncontact digital laser infrared thermometer. Results: Intracanal cryotherapy with TFE resulted in a mean decrease of 9.27°C compared with conventional irrigation that exhibited in a mean decrease of 2.13°C. Also, in intracanal cryotherapy group with TFE application, compared with the baseline (24.50°C), no significant differences were observed post obturation (24.61°C) with high-temperature-injectable gutta percha technique indicating good control of temperature rise on the external root surface. Conclusion: Intracanal cryotherapy with refrigerant TFE was highly effective in controlling temperature rise on the external root surface during injectable thermoplastic obturation technique. Clinical significance: Minimizing deleterious effects due to high temperatures generated during the thermoplastic obturation is critical. Clinically feasible measures to reduce the transmission of heat generated during thermoplastic obturation have been searched since long. In this regard, intracanal cryotherapy with TFE can be effectively used to control the rise of temperature on the external root surface when employing thermoplastic obturation technique.

Aim: To evaluate and compare skeletal, dental, and soft tissue parameters by therapeutic extraction of first premolar and nonextraction distalization of maxillary and mandibular arches in bimaxillary proclination using the skeletal anchorage system. Materials and methods: About 40 orthodontic patients undergoing extraction or nonextraction treatment are enrolled in a randomized clinical trial. Participants are randomly assigned to either the extraction or nonextraction group and receive treatment augmented with skeletal anchorage. Mini implants were placed in the extraction group for retraction and infra-zygomatic crest (IZC) and buccal shelf screws were placed in the nonextraction group for distalization. Observations and results: Comparison between the ages of the patients among both Groups showed no significant difference. A significant difference is observed in dental and soft tissue parameters before and after the treatment in group A, whereas skeletal parameters also showed significant changes along with dental and soft tissue parameters in group B. Conclusion: There is a significant change in the position of incisors by retraction and facial profile improves gradually in group A while for group B, a marked change in lower facial height was even seen. On comparing both the groups, a highly significant difference can be seen with respect to the amount of incisor retraction and change in molar inclination. The time taken for retraction of incisors is less in comparison to distalization. Clinical significance: With this, we can easily avoid premolar extraction, and in cases of impacted third molars distalization as when indicated can be helpful as a part of the nonextraction treatment plan.

Aim: To determine whether photobiomodulation (PBM) therapy could increase the depth of analgesia during endodontic therapy of teeth affected with symptomatic irreversible pulpitis. Materials and methods: Forty-nine patients with symptomatic irreversible pulpitis were randomized into two groups. In the laser group, before administering anesthesia, the lower molars’ crowns were continuously treated with a diode laser (980 nm) for 20 s with a low-level laser tip in the buccal aspect close to the gingival margin. While the teeth of the second group who was blinded to the type of treatment received placebo treatment wherein the laser device was switched off. The visual analogue scale (VAS) was used to assess pain in both groups before the endodontic procedure, during dentin cutting, and at dropping pulp, wherein, the success was defined as no or mild pain. The Chi-square and independent sample t-tests were used to assess the data. Results: During dentin cutting and pulp dropping, the group receiving the laser therapy presented with less mean pain score than the placebo group which was statistically significant. Additionally, it was observed that the need for supplementary injection was less frequent in the laser-treated group than in the placebo group (p = 0.01). Conclusion: The irradiation by diode laser (980 nm) prior to administration of local anesthesia appears to be useful in minimizing discomfort and additional injection during root canal therapy (RCT). Clinical Significance: Pain management is essential for providing the best possible treatment to patients before, during, and after endodontic therapy. Adequate pain control during treatment also aids in reducing postoperative discomfort. This implies the need for additional methods to reduce discomfort during endodontic treatment; hence, adjuncts are crucial to achieving this goal. Photobiomodulation may be used as an adjuvant to reduce discomfort and supplementary injections during RCT.

Aim: The present study was carried out to compare the effectiveness of leukocyte platelet-rich fibrin (L-PRF) membrane and polylactic acid-polyglycolic acid (PLA–PGA) membrane along with hydroxyapatite crystal collagen fibers bone graft in the treatment of human infrabony defects using cone beam computed tomography. Materials and methods: A total of 28 systemically healthy patients was chosen which were found appropriate after initial therapy. Each group comprises of 14 defects, according to randomized parallel design. The group A was managed by hydroxyapatite crystal collagen fibers bone graft in conjunction with L-PRF membrane, while group B was treated by hydroxyapatite crystal collagen fibers bone graft in conjunction with PLA–PGA membrane. Clinical and radiographic measurements were recorded at baseline and 6 months postoperatively. Results: Statically significant difference was seen in mean probing pocket depth (PPD), mean R-CAL, and DD from baseline to 6 months in group A and group B but there was no statically significant difference in mean PPD reduction (0.35 ± 1.90 mm), mean R-CAL gain (0.28 ± 1.85 mm) and DD reduction (0.12 ± 1.42 mm) seen at 6 months when compared between both the groups. Conclusion: At 6 months post-surgery both treatment modalities demonstrated statistically significant improvements with regards to CAL gains, PPD reduction, and reduction in radiographic defect depth. Clinical significance: Platelet-rich fibrin (PRF) membrane and PLA–PGA membrane along with hydroxyapatite crystal collagen fibers bone graft are useful in the treatment of infrabony defect. Platelet-rich fibrin membrane with hydroxyapatite crystal collagen fibers bone graft have shown to be better in regeneration of bony defect as PRF membrane has growth factors which help in bone regeneration.

Aim: To evaluate the efficiency of debris removal from the mesial root canals and isthmus of mesial roots of mandibular molars after final irrigant agitation with XP-endo Shaper, EndoVac (EV), plastic finishing file, and conventional needle irrigation. Methods and materials: Forty extracted human mandibular first molar teeth with the isthmus between the mesial roots were selected, access cavities were prepared and distal roots were decoronated. All the mesial root specimens were mounted in acrylic, sectioned at the coronal, middle, and apical thirds, along with the resin block, and examined for debris in the canals and isthmus before the start of the procedure using a stereomicroscope and were mounted back in a custom-made jig. After determination of the working length, they were allocated to the following four different irrigant activation groups (n = 10): Group I—XP-endo Finisher; group II—EndoVac; group III—plastic finishing file; and group IV— standard needle irrigation. After biomechanical preparation (BMP) till F3, final agitation was done for debris removal with the respective agitating devices, and all the samples were examined under a stereomicroscope for the amount of debris in the canal after final agitation. Results: Of all the irrigation devices used, the XP-endo Finisher and EV showed more debris removal when compared to other groups (p < 0.05). The plastic finishing file in continuous rotation was more efficient in cleaning debris compared with conventional needle irrigation (p < 0.05). Conclusion: The XP-endo Finisher and EV showed a significant difference in cleaning efficacy than the plastic finishing files. So, these can be used as adjunctive for agitating the final irrigant. Clinical significance: The irrigant agitation devices promote the penetration of irrigants into the intricate root canal anatomy and increase their antibacterial and tissue-dissolving effectiveness thereby improving the success rate and treatment outcome.

Aim: The present study was designed to investigate the difference in the effectiveness of a 3 day postoperative course and a single perioperative dose of antibiotics on the incidence of postoperative infection in the management of maxillofacial trauma patients. Materials and methods: About 183 maxillofacial trauma patients requiring open reduction and internal fixation (ORIF) under general anesthesia were divided based on the type of fracture sustained, i.e., mandibular fractures, Le Fort fractures, and zygomaticomaxillary complex fractures. Patients from each fracture type were randomized into two groups, A and B. All patients were administered amoxicillin/clavulanate 1.2 grams intravenously 8 hours from the time of admission till the patient was taken up for surgery. Once the patients were taken up for surgery, a perioperative dose was administered. No antibiotics beyond this point were given to patients in Group A. Patients in Group B were administered the same antibiotic for 3 postoperative days additionally. Outcomes in terms of purulent discharge from the surgical site, an abscess or any other sign of infection, and wound dehiscence requiring reopening of the surgical site were considered. Patients were reviewed at 1 week, 2 weeks, 1 month, 2 months, and 3 months. Results: No statistically significant difference was found between the two groups across all three fracture types in terms of postoperative outcomes. However, increased numbers of complications were noted in the patients treated with an intra-oral approach in each fracture type irrespective of group. All complications were managed with local measures. Conclusion: A single perioperative dose of antibiotics is effective in minimizing postoperative complications following ORIF of maxillofacial fractures and there is no significant benefit in prolonging the course of antibiotics postoperatively with the need for further studies to be conducted considering comminuted, complex fractures and old fractures. Clinical significance: In maxillofacial trauma, fractures frequently communicate with contaminated indigenous flora on the skin surface, oral cavities, or sinus cavities. Surgery is frequently performed using an approach across a contaminated area, even in closed fractures. Postoperative infections can be significantly decreased by using antibiotics in surgical procedures to treat facial fractures.

Aim: The aim of this in vitro study was to evaluate the effectiveness of the combination of garlic extract in combination with magnesium oxide (MgO) for use as an endodontic irrigant at various contact times. Materials and methods: All 48 teeth were divided into 6 groups according to irrigation used after inoculation with Enterococcus faecalis and incubation. The control groups consisted of saline and sodium hypochlorite (NaOCl) used as irrigants and the test groups employed garlic extract combined with nano-magnesium oxide (nano-MgO) used as irrigant with two contact times, namely, 2 and 5 minutes, and garlic extract and nano-MgO used solely for 5 minutes each. Colony-forming units (CFUs) were counted after plating and incubation. Results: In NaOCl, and in both combination groups, there was a significant reduction in CFU counts. The saline group showed no decrease. Statistical analysis showed no difference in efficacy between NaOCl and the two combination groups. There was a statistical difference between the combination group and garlic/nano-MgO alone at both 2 and 5 minutes. Conclusions: Under the conditions of this study, a novel irrigant, a combination of nanoparticles of MgO and garlic extract was as effective as NaOCl against E. faecalis in an in vitro model at two tested contact times. Clinical significance: Combination of MgO nanoparticles and garlic extract achieves disinfection comparable to gold standard NaOCl without harmful caustic effects of hypochlorite.

Aim: The purpose of this study was to examine the prevalence of dental caries in school children visiting a dental college and hospital and investigate the associated risk factors. Materials and methods: Eighty children were recruited in this study between the ages of 6–12 years. The caries prevalence of decayed, missing, filled teeth (DMFT) was recorded using an evaluation form. A structured questionnaire was used to understand the associated risk factors. Results: The caries prevalence in the population was found to be at 91.25%. There was a strong negative correlation between age and dental caries and the results were statistically significant with p-value being less than 0.0001. The duration of bottle and breastfeeding, frequency of teeth brushing, adult supervision during brushing, consumption frequency of sweets, and the frequency or timing of children's dental visits were found to be positively associated with dental caries and these results were statistically significant with p-value being less than 0.05. Conclusion: A high prevalence of dental caries was observed among the population visiting the dental college and hospital. Encouraging dental health education, including promoting the significance of good oral hygiene practices, is crucial. Clinical significance: The study emphasizes the rising prevalence of dental caries and underscores the need for dental health education and the promotion of good oral hygiene practices to prevent complications and reduce their prevalence.

Aim: The purpose of the current study was to evaluate the erosive impact of various beverages on the esthetic restorative materials utilized in primary teeth. Materials and methods: One hundred and twenty primary molars indicated for serial extraction or over-retention reason with sound buccal surfaces were collected. One millimeter above the cemento-enamel junction, standard Class V cavities were prepared. Following cavity preparation, all teeth were randomly assigned (20 samples per group for each beverage) to one of the three experimental groups based on the type of filling materials: group I: resin-modified glass ionomer cement (GC), group II: nanocomposite resin and group III nanohybrid ormocer-based composite. The samples were kept suspended in various containers containing 250 mL of each orange juice and cola at a temperature of 37°C for three hours per day and rest of day in distilled water. This procedure was repeated for 15 days. Using a 3D optical profilometer, a profilometric reading was recorded for each specimen. Results: The minimum surface roughness was found in nanohybrid ormocer-based composite (1.816 ± 0.16 and 1.302 ± 0.08) followed by resin-modified glass ionomer cement (3.101 ± 0.12 and 2.946 ± 0.09) and nanocomposite resin (5.242 ± 0.20 and 4.488 ± 0.16) after immersed in the cola and orange juice, respectively. And there was a statistically significant difference found between the different esthetic restorative materials in both media. Conclusion: On conclusion, the current investigation demonstrates that when exposed to both beverages, the erosive effect was much lesser in nanohybrid ormocer-based composite, followed by resin-modified glass ionomer cement and nanocomposite resin. Clinical significance: Consuming high-calorie, low pH acidic foods and beverages such as carbonated beverages and fruit juices can lead to erosion, a frequent condition that results in irreparable damage to dental hard tissues and early deterioration of dental restorations.

Aim: The purpose of the current study was to investigate the presence of the ponticulus posticus (PP) frequently encountered in lateral cephalograms. Materials and methods: About 500 patients of age 12–40 years were selected whose digital lateral cephalogram was recorded and traced to confirm the presence of the PP and categorize as: (A) Absent, as evidenced by lateral cephalograms. (B) Complete PP evidenced by the presence of circumferential bone bridge that connected the upper articular process to the atlas's posterior arch. (C) Partial PP: presented as a bone spike that protruded from the top articular process or the posterior arch of the atlas and extended above the vertebral artery sulcus. Symptoms of migraine, shoulder discomfort, orofacial pain, and headache were also evaluated on interaction with the patients. Using the Chi-square test, the relationship between the patient's gender and the presence of the PP was assessed. A p-value of 0.05 or less was regarded as statistically significant. Results: About 10% of the patients reported with the presence of complete variant, 70% with partial variant and rest 20% of patients with neither a partial nor a complete form of PP. There was no statistically significant association between the PP and gender, as indicated by the Chi-square values (3.146; p = 0.526). Conclusion: On conclusion, according to the findings of the current study, patients with a complete form of PP experience more symptoms than those with a partial form of PP. In both groups, the PP frequency was higher in females. Clinical significance: In lateral cephalograms, the cervical spine region is typically ignored and given little weight. A common variation of atlas vertebrae is the PP, which is located in the posterior arch of the atlas. The PP exacerbates symptoms, such as migraine, tension headaches, shoulder pain, double vision, vertigo, stroke, and pain in the neck and orofacial region. Therefore, orthodontic specialists serve as initial diagnosticians and direct the patients to qualified physicians so that they can experience symptom relief.

Aim: This study aimed to monitor the metabolic response of nonsurgical periodontal therapy in type-2 diabetic patients with chronic periodontitis under systemic administration of antidiabetic ayurvedic drug. Materials and methods: About 90 newly diagnosed mild-to-moderate forms of type-2 diabetes mellitus (DM) subjects with generalized chronic periodontitis were selected according to the inclusion and exclusion criteria and were randomly divided into group A and group B with 45 patients in each group. Clinical parameters, including plaque index, probing pocket depth, clinical attachment level, and glycemic status, were assessed at baseline. Following initial periodontal clinical examination, the drug Nishamalaki (NA) 2 gm twice daily for 3 months was prescribed after food by an Ayurvedic physician to all the patients enrolled in group A and group B, and scaling and root planing were completed only for group B patients. Patients were recalled for review, and all the parameters were reassessed at the end of the 1st, 2nd, and 3rd months following interventions. Results: Regarding clinical and metabolic parameters at baseline, no statistically significant differences were displayed between the two groups. However, at the 3-months follow-up period, the patients in group B demonstrated significantly better clinical and metabolic outcomes than patients in group A. Conclusion: Periodontal therapy improved glycemic control in patients with type-2 DM in both groups; however, the reduction in FBS values reached statistical significance only in the group receiving scaling and root planing alone. Clinical significance: Nonsurgical periodontal therapy may have a beneficial effect on the periodontal clinical and glycemic levels in type-2 diabetic patients with chronic periodontitis.

Aim of the study: To assess the awareness and practice of Immediate Dentures among the dentists who work in the private clinics in Khartoum state, Sudan. Materials and methods: A descriptive cross-sectional questionnaire-based study was conducted among the dental medical officers, registrars, specialists, and consultants who are working in private clinics and centers in Khartoum state and registered the private medical institutions in Sudan. The sample population was 664, using the stratified sampling technique and simple randomization within the stratum, 265 dentists were asked to participate in the study voluntarily. A self-administered questionnaire consisted of 32 closed questions and 3 sections, section (1) involved the participant's data, section (2) contained the participant's knowledge, and section (3) the participant's practice was distributed. The participant's knowledge and practice scores were calculated as percentages achieved by dividing the number of accurate answers of the participants by the total number of questions and categorized as Good (66.6–100%), Average (33.3–66.6%), and Poor (less than 33.3%). Data was collected and analyzed using a statistical package of Social Science (SPSS) computer software version 22. Chi-square was used for statistical analysis. Results: The response rate was 100%, with nearly equal distribution between males (135, 50.9%) and females (130, 49.1%). The age range is 24–39 years, with a mean of 31.65 ± 7.52 years. The majority of the participants (172, 64.9%) were freshly graduated and young practitioners, with the majority of them having experience ranging from 1 to 6 years. The result of the study revealed that 65.7% of the respondents have average knowledge about immediate denture while 8.7% expressed poor knowledge and only 25.7% had excellent knowledge. On the other hand, the majority of the participants (200,75.5%) have never constructed an immediate denture, while only 21.1% have a history of constructing 1–5 immediate dentures, 3% constructed more than 5–10 immediate dentures and only 0.4% constructed more than 10 immediate dentures. The lack of knowledge and experience was the main barrier preventing the use of immediate dentures, and the mainstream of the participants (118, 44.5%), evaluated their knowledge about the immediate denture as poor. Using the Chi-square test, the correlation between the participants’ knowledge and their gender, years of experience, and qualification was found not significant (p-values of 0.46, 027, and 0.66, respectively) while a significant correlation was found between the participants’ self-evaluation of their knowledge and their knowledge score with a p-value of 0.000*. Conclusion: Within the limitations of this study, the dental practitioners have average knowledge about the immediate denture, but the practice of the immediate denture is still very limited and requires enhancement. Clinical significance: Immediate dentures have a significant role in maintaining the patient's esthetics, phonetics, masticatory efficiency, self-esteem, and quality of life. Hence, the knowledge and practice of the different dentists about the immediate denture are of great importance to improve the standard of care provided for the patient.

Aim: This study aimed to evaluate the effects of glycyrrhizin, as a potential therapeutic agent in endodontic surgery, on the proliferation and viability of diabetic human bone marrow-derived mesenchymal stem cells (hBM-MSCs). Materials and methods: Diabetic human bone marrow-derived mesenchymal stem cells (hBM-MSCs) were isolated and characterized by flow cytometry. The cells were treated with different concentrations of Glycyrrhizin (Gly) (12.5, 25, 50, and 100 µg/mL) and 0.1% dimethyl sulfoxide (DMSO) as the control group. MTT assay was performed to evaluate the cell proliferation and viability after 24, 48, and 72 hours of the cell treatment with Gly. The optical density (OD) was measured at 570 nm. Each assay was repeated three times. The corrected OD and cell viability were determined. ANOVA followed by the Bonferroni post hoc test evaluated the statistical significance at p < 0.05. Results: Flow cytometric analysis of the isolated cells showed positive expression of mesenchymal markers (CD105 and CD90) and negative expression of hematopoietic markers (CD34 and CD14). After 24 and 48 hours of cell treatment, Gly in 100 µg/mL concentration significantly decreased the diabetic hBM-MSC proliferation as compared with the control (p < 0.05). Gly in 12.5–50 µg/mL concentrations significantly increased the cell proliferation after 72 hours of treatment as compared with the control (p < 0.05). The diabetic hBM-MSC proliferation and viability at 12.5–50 µg/mL concentrations were significantly greater than that at 100 µg/mL concentration (p < 0.05). Conclusion: Under the present study conditions, Gly (in 12.5–50 µg/mL concentrations) did not show cytotoxicity to diabetic hBM-MSCs and enhanced their proliferation. Gly may represent a potential therapeutic agent in endodontic surgery in diabetic patients. Clinical significance: Preclinical assessment of Gly effects on diabetic hBM-MSCs is important for determining its effective concentration range, anticipating its therapeutic potential, and designing future in vivo studies.

Aim: To evaluate and compare the effectiveness of nanocrystalline hydroxyapatite (NcHA) with advanced platelet-rich fibrin (A-PRF) and hydroxyapatite-reinforced beta tricalcium phosphate (HA + β-TCP) with A-PRF in the treatment of human infrabony defects clinically and radiographically using cone-beam computed tomography (CBCT). Materials and methods: There were a total of 28 defects, with 14 defects in the test and control groups, respectively. There were total 28 patients were involved in the study. The test group (group A) was treated with NHA and A-PRF, while the control group (group B) was treated with HA + β-TCP and A-PRF. Bone defect fill was the primary result of the investigation. Periodontal pocket depth (PPD), R-CAL, papillary bleeding index (PBI), and PI were the secondary outcome. Clinical and radiographic measurements were recorded at baseline and 6 months postoperatively. Results: No significant difference was observed between the two groups in terms of PPD reduction (4.64 ± 0.74 mm vs 4.07 ± 0.99 mm), clinical attachment loss (CAL) gain (4.64 ± 0.74 mm vs 3.92 ± 0.99 mm) and radiographic defect depth reduction (2.41 ± 0.32 mm vs 2.40 ± 0.27 mm) for test and control groups, respectively. Conclusion: At 6-month post-surgery, both treatment modalities demonstrated statistically significant improvements with regard to CAL gains, PPD reduction, and reduction in radiographic defect depth. Clinical relevance: The NcHA and HA + β-TCP with A-PRF is a novel material used in the treatment of infrabony defect for periodontal regeneration. The NcHA and HA + β-TCP with A-PRF need to consider biomaterials for bone defect fill.