Background: There have been numerous researches on elastomeric ligatures, but clinical conditions in different stages of treatment are not exactly similar to laboratory conditions. The aim of this in vitro study was to simulate clinical conditions and evaluate the effect of three stretching patterns on the amount of force, tensile strength (TS) and extension to TS of the elastomers during 8 weeks. Materials and Methods: Forces, TS and extension to TS of two different brands of elastomers were measured at initial, 24 h and 2, 4, and 8-week intervals using a testing machine. During the study period, the elastomers were stored in three different types of jig (uniform stretching, 1 and 3 mm point stretching) designed by the computer-aided design and computer-aided manufacturing technique in order to simulate the different stages of orthodontic treatment. Results: The elastomeric ligatures under study exhibited a similar force decay pattern. The maximum force decay occurred during the first 24 h (49.9% ± 15%) and the amount of force decay was 75.7% ± 8% after 8 weeks. In general, the TS decreased during the study period, and the amount of extension to TS increased. Conclusion: Although the elastic behavior of all ligatures under study was similar, the amount of residual force, TS and extension to TS increased in elastomers under point stretching pattern.

Background: This study was designed to assess the microleakage of glass-ionomer (GI), mineral trioxide aggregate (MTA), and calcium-enriched mixture (CEM) cement as coronal orifice barrier during walking bleaching. Materials and Methods: In this experimental study, endodontic treatment was done for 70 extracted human incisors without canal calcification, caries, restoration, resorption, or cracks. The teeth were then divided into three experimental using "Simple randomization allocation" (n = 20) and two control groups (n = 5). The three cements were applied as 3-mm intra-orifice barrier in test groups, and bleaching process was then conducted using a mixture of sodium perborate powder and distilled water, for 9 days. For leakage evaluation, bovine serum albumin marker was traced in a dual-chamber technique with Bradford indicator. The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis. Results: The mean ± standard deviation leakage of samples from negative control, positive control, GI, MTA, and CEM cement groups were 0.0, 8.9 ± 0.03, 0.47 ± 0.02, 0.48 ± 0.02, and 0.49 ± 0.02 mg/mL, respectively. Statistical analysis showed no significant difference between three experimental groups (P > 0.05). Conclusion: It is concluded that GI, MTA, and CEM cements are considered as suitable intra-orifice barrier to provide coronal seal during walking bleaching.

Background: This study was designed to compare the clinical performance of composite, strip crowns, biological restoration, and composite with stainless steel band when used for the coronal build-up of anterior teeth. Materials and Methods: A total of 20 patients aged 3-6 years presenting with mutilated primary anterior teeth due to caries or trauma were selected for the study using randomized simple sampling. A total of 52 primary anterior teeth were randomly divided into four equal groups having 13 teeth in each group. Teeth in Group I were restored with composite, in Group II with strip crowns, in Group III with biologic restoration and with stainless steel band reinforced composite in group IV. The restorations were evaluated for color match, retention, surface texture, and anatomic form according to Ryge's Direct (US Public Health Service) evaluation criteria at baseline (immediate postoperative), after 48 h, 3, 6, and 9 months. The data obtained were statistically analyzed using Chi-square test, and level of significance, that is, P value was determined. Results: At baseline, none of the groups showed any color changes. Other than Group III all other groups showed highly significant changes (P < 0.05) in color after 3 months. Loss of retention was seen in both Groups I and IV after 3 months. After 6 months, retention loss was seen in all the groups except Group II, in which loss was seen after 9 months (P > 0.05). Deterioration in surface texture was exhibited maximum by restorations in Group IV followed by Group I at 3 months. Whereas, no surface changes were seen in Group II and III. Only Group I and IV showed discontinuity in anatomic form after 3 months. After 6 months, except in Group II, discontinuity in anatomic form was observed in all the groups. Discontinuity in anatomic form was seen in all the 4 groups after 9 months although the difference was not significant (P > 0.05). Conclusion: Biological restoration was found to be most satisfying esthetically owing to color compatibility with the patient's tooth. Thus, it has a great potential to be used as esthetic restorative option in primary anteriors.

Background: An anti-cariogenic diet containing probiotics can be effective in caries prevention. This animal study compared the effects of milk and yogurt on Streptococcus sobrinus counts and caries score. Materials and Methods: A total of 36 male rats were infected with S. sobrinus (27,607) and divided into three groups. Group A and B received 200 mL of milk and 100 g of yogurt per day, respectively, and a control group received 2.5 mL of NCP number 2 diet twice daily for 21 days. After killing the animals, their lower left jaws were removed and sonicated to quantify the colonies of S. sobrinus. Dental caries was scored using Keyes technique. Data were analyzed using ANOVA and Kruskal-Wallis, Mann-Whitney and Wilcoxon-Signed Rank tests. Statistical significance was set at P < 0.05. Results: The mean (±standard error of the mean) of S. sobrinus colonies in the milk, yogurt and control groups were determined at 119666.67 (±20733), 46416.666 (±12846) and 163,250 (±33493), respectively. Microbial counts decreased in the yogurt group compared with the milk and control groups (P = 0.004 and P = 0.000; respectively). There were significant differences between caries scores of smooth surfaces in the milk and yogurt groups compared with the control group (P = 0.000 and P = 0.000, respectively). Both milk and yogurt significantly reduced caries score of fissured surfaces compared with controls (P = 0.004 and P = 0.000, respectively). Conclusion: Considering the limitations of this study, yogurt administration reduces S. sobrinus counts. In addition, yogurt and milk regimens reduce the caries scores of smooth and fissured surfaces.

Background: Although studies have shown that porcelain veneers are very efficient for treating discolored teeth, they did not address in particular the minimum thickness of a multilayer IPS e.max Press (IvoclarVivadent, Schaan, Liechtenstein) restoration required to mask discolored tooth. The aim of this study was to determine the minimum thickness of a multilayer porcelain restoration required for masking severe tooth discoloration. Materials and Methods: A total of 24 disk-shaped multilayer specimens were prepared from IPS e.max Press with the diameter of 13 mm and four different thicknesses (core/veneer: 0.4/0.4 mm, 0.5/0.5 mm, 0.6/0.6 mm and 0.8/0.7 mm). Two backgrounds, C4-shade body porcelain and an opaque background from the selected IPS e.max ceramic itself were fabricated to mimic a discolored or stained natural tooth structure and to determine the masking ability. After applying the resin cement layer (Panavia F2.0) with 0.01 mm thickness on each background, all specimens were measured on both background using a spectrophotometer and values of L*, a* and b* were calculated to determine the color differences (ΔE^*_ab). One-way ANOVA and post-hoc tests of specimen average one-to-one comparison (Tukey HSD) were conducted and P ≤ 0.05 was set as the level of significance. Results: ΔE^*_ab of all groups were within the range of the clinically acceptable color difference (ΔE ≤3.3), thus all the groups could mask the C4 background even group 1 with only 0.8 mm thickness. A trend was shown in the results as by increasing the thickness, ΔE^*_ab is was decreased. The mean ΔE ^*_1*a*b between different thicknesses were statistically significant (P < 0.05) only between group 4 with groups 1 and 2, respectively. Conclusion: Within the limitations of this study, all studied thicknesses could mask the C4 background. However, the minimum thickness of a multilayer porcelain restoration (IPS e.max Press) required for masking severe tooth discoloration was 0.8 mm.

Background: Repair bond strength of different composite resins has been assessed in few studies. In addition, reports on the efficacy of surface treatments are debated. Therefore, this in vitro study was conducted to evaluate the effect of three surface treatments on two nanocomposites versus a microhybrid composite. Materials and Methods: In this experimental study, 135 composite blocks (45 specimens per composite) of microhybrid (Filtek Supreme Z250, 3M ESPE, USA), nanohybrid (Filtek Supreme XT, 3M ESPE), and nanofilled (Filtek Supreme Z350, 3M ESPE) were thermocycled (5000 rounds) and then surface roughened (except in a control group of 9 specimens of three composite types). Each composite type was divided into three subgroups of surface treatments: (1) Bur abrading and phosphoric acid (PA) etching, (2) sandblasting and PA etching, and (3) hydrofluoric etching and silane application (n = 15 × 9, complying with ISO TR11405). Composite blocks were repaired with the same composite type but of a different color. Microtensile bond strength and modes of failure were analyzed statistically using two-way analyses of variance, Tukey and Chi-square tests (α = 0.05). Results: There were significant differences between three composite resins (P < 0.0001) and treatment techniques (P < 0.0001). Their interaction was nonsignificant (P = 0.228). The difference between nanofilled and nanohybrid was not significant. However, the microhybrid composite showed a significantly higher bond strength (Tukey P < 0.05). Sandblasting was significantly superior to the other two methods, which were not different from each other. Conclusion: Within the limitations of this in vitro study, it seems that microhybrid composite might have higher repair strengths than two evaluated nanocomposites. Among the assessed preparation techniques, sandblasting followed by PA etching might produce the highest bond strength.

Background: Localized alveolar ridge defect may create physiological and pathological problems. Developments in surgical techniques have made it simpler to change the configuration of a ridge to create a more aesthetic and more easily cleansable shape. The purpose of this study was to compare the efficacy of alveolar ridge augmentation using a subepithelial connective tissue graft in pouch and modified connective tissue graft technique. Materials and Methods: In this randomized, double blind, parallel and prospective study, 40 non-smoker individuals with 40 class III alveolar ridge defects in maxillary anterior were randomly divided in two groups. Group I received modified connective tissue graft, while group II were treated with subepithelial connective tissue graft in pouch technique. The defect size was measured in its horizontal and vertical dimension by utilizing a periodontal probe in a stone cast at base line, after 3 months, and 6 months post surgically. Analysis of variance and Bonferroni post-hoc test were used for statistical analysis. A two-tailed P < 0.05 was considered to be statistically significant. Results: Mean values in horizontal width after 6 months were 4.70 ± 0.87 mm, and 4.05 ± 0.89 mm for group I and II, respectively. Regarding vertical heights, obtained mean values were 4.75 ± 0.97 mm and 3.70 ± 0.92 mm for group I and group II, respectively. Conclusion: Within the limitations of this study, connective tissue graft proposed significantly more improvement as compare to connective tissue graft in pouch.

Background: Rheumatoid arthritis (RA) is the most prevalent chronic inflammatory disease of the joints. It is correlated with periodontal disease due to similar factors that exist in both diseases. The present study assessed the relationship of periodontal disease with RA and juvenile idiopathic arthritis (JIA). Materials and Methods: In this case-control study, 30 RA and 30 JIA patients along with similar number of matched controls were selected among patients referred to Imam Khomeini Hospital, Tehran, Iran. Periodontal parameters including pocket depth (PD), clinical attachment level (CAL), O'Leary and Bay plaque index (PI) and bleeding on probing (BOP) were determined in cases and controls. Erythrocyte sedimentation rate, number of painful and inflamed joints and severity of disease were evaluated in RA and JIA patients. Mann-Whitney U-test nonparametric, Spearman and Pearson's correlation coefficients, and Chi-square tests were used as statistical analysis (α = 0.05). Results: PD (4.17 vs. 3.6 mm; P < 0.0001), CAL (4.89 vs. 4.18 mm; P < 0.002), percentage of sites with PD >4 mm (58.83% vs. 44.33%; P < 0.002), percentage of sites with CAL >3 mm (74.13% vs. 64.4%; P < 0.001), percentage of sites with BOP (9.67% vs. 6.87%; P < 0.0001) and PI index (85.73% vs. 80.63%; P < 0.0001) were significantly higher in RA patients than controls. In this group, direct and significant correlations were found between serologic findings, disease severity and number of painful and inflamed joints with periodontal factors. In JIA patients, no significant relationships were found between JIA findings and periodontal parameters. Conclusion: Considering the limitations of this study, there was a relationship between RA and periodontal disease. Severity of periodontal disease increases in patients with RA, while no increased risk of periodontal disease or its severity was observed among JIA patients.

Background: Nickel-titanium (NiTi) rotary instrumentation carries a risk of fracture, mainly as a result of flexural (fatigue fracture) and torsional (shear failure) stresses. This risk might be reduced by creating a glide path before NiTi rotary instrumentation. The aim of this study was to compare various root canal parameters with the new WaveOne single-file reciprocating system in mesial canals of mandibular molars with and without glide path using cone beam computed tomography (CBCT). Materials and Methods: One hundred mandibular molar teeth with canal curvature between 20° and 30° were divided into two groups of 50 teeth each. In Group 1, no glide path was created, whereas in Group 2, a glide path was created with PathFiles at working length (WL). In both groups, canals were shaped with WaveOne primary reciprocating files to the WL. Canals were scanned in a CBCT unit before and after instrumentation. Postinstrumentation changes in canal curvature, cross-sectional area, centric ability, residual dentin thickness, and the extent of canal transportation were calculated using image analysis software and subjected to statistical analysis. Data were analyzed using Student's t-test and Mann-Whitney U-test (P < 0.05). Results: The mean difference of root canal curvature, cross-sectional area, centric ability, and residual dentin thickness increased, whereas it reduced significantly for canal transportation in Group 2. Conclusion: WaveOne NiTi files appeared to maintain the original canal anatomy and the presence of a glide path further improves their performance and was found to be beneficial for all the parameters tested in this study.

Background: Dental anxiety is a relatively frequent problem that can lead to more serious problems such as a child entering a vicious cycle as he/she becomes reluctant to accept the required dental treatments. The aim of this randomized double-blind clinical trial study was to evaluate the anxiolytic and sedative effect of pregabalin in children. Materials and Methods: Twenty-five children were randomized to a double-blind placebo-controlled crossover clinical trial. Two visits were scheduled for each patient. At the first visit, 75 mg pregabalin or placebo was given randomly, and the alternative was administered at the next visit. Anxiolytic and sedative effects were measured using the visual analogue scale. The child's behavior was rated with the Frankl behavioral rating scale and the sedation level during the dental procedure was scored using the Ramsay sedation scale. The unpaired, two-tailed Student's t-test was used to compare the mean changes of visual analog scale (VAS) for anxiety in the pregabalin group with that of the placebo group. A repeated measures MANOVA model was used to detect differences in sedation level in the pregabalin and placebo groups regarding the interaction of 3-time measurements; sub-group analysis was performed using Student's t-test. The Mann-Whitney U-test was used to analyze the nonparametric data of the Frankl and Ramsay scales. A P < 0.05 was considered significant. Results: The reduction of the VAS-anxiety score from 2 h post-dose was statistically significant in the pregabalin group. From 2 h to 4 h post-dose, the VAS-sedation score increased significantly in the pregabalin group. The child's behavior rating was not significantly different between the groups. The number of "successful" treatment visits was higher in the pregabalin group compared to the placebo group. Conclusion: Significant anxiolytic and sedative effects can be anticipated 2 h after oral administration of pregabalin without serious side effects.

Objective: The aim of this study is to evaluate the effect of slice thickness on the visibility of inferior alveolar canal (IAC) in cone-beam computed tomography (CBCT) images. Materials and Methods: CBCT images of thirty patients (15 male and 15 female) with an age range between 40–50 years old were used. Cross-sectional images were obtained with 0.5, 1, and 2 mm slice thickness and 2 mm interval. Two oral radiologists with at least 5 years' of experience observed all of the 90 images and rated the images based on the visibility of IAC in a 4-score classification (highly visible, visible, nearly visible, nearly invisible). Friedman test was used for the comparison of visibility of IAC in different slice thicknesses. To do the above test, the average of the scores of two examiners was calculated. A P. value below 0.05 was considered significant. Results: Visibility of IAC in different slice thicknesses of both raters showed no significant difference (P = 0.20). Conclusion: Within the limitations of this study the slice thickness has no effect on visibility of IAC in cross-sectional images. Future studies on other multiplanar images are recommended.

Background: The study was undertaken to correlate epithelial surface pattern changes of oral exfoliated cells of tobacco smokers and betel nut chewers and also to compare them with patients of oral squamous cell carcinoma (OSCC) and healthy individuals. Materials and Methods: In this cross-sectional study, a total of fifty persons were included in the study, out of which thirty formed the study group (15 each tobacco smokers and betel nut chewers) and twenty formed the control group (ten each of OSCC patients – positive control and ten normal buccal mucosa – negative control). Their oral exfoliated cells were scraped, fixed, and studied under scanning electron microscope (SEM). The statistical analysis was determined using ANOVA, Tukey honestly significant difference, Chi-square test, and statistical SPASS software,P< 0.05. Results: OSCC, Individual cell modifications, intercellular relationships and surface characteristics observed by scanning electron microscopy between OSCC, tobacco smokers, betel nut chewers compared to normal oral mucosa have been tabulated. Conclusion: In normal oral mucosa, cell surface morphology depends on the state of keratinization of the tissue. Thus, it could prove helpful in detecting any carcinomatous change at its incipient stage and also give an insight into the ultra-structural details of cellular differentiations in epithelial tissues.

Background: Volume fraction (V_f) and location of internal voids and gaps in relation to material type and cavity dimensions in ultraconservative restorations were investigated in this study. Materials and Methods: Forty-eight round cavities of 1.3 mm mean diameter and 2.6 mm mean depth were made on buccal and lingual surfaces of recently extracted human teeth. These were filled and thermocycled with two low viscosity composites (AeliteFlo LV [AF], PermaFlo [PF]), one high viscosity composite (Aelite aesthetic enamel [AA]) and one glass-ionomer (GCFuji IX GP). X-ray microtomography, following a specific procedure, was applied to all cavities before and after their restoration, using SkyScan-1072 microtomographer. V_f percent (V_f%) and location of voids and gaps were recorded and analysed statistically at a = 0.05. Kruskal-Wallis nonparametric analysis of variance, post-hoc analysis, Mann-Whitney test, Spearman's correlation analysis were used to analyze data. Results: Cavities filled with AF and PF showed significantly lower V _f % of voids and gaps than all other restorations (P < 0.05). Only for the cavities filled with AA, cavity width and depth was significantly correlated with V _f % (P < 0.05). 50-75% of the filled cavities contained internal voids regardless of the restorative material (P > 0.05). The proportion of cavities with gaps at the bottom and side walls was lower in those filled with AF and PF (P < 0.05). Conclusion: Cavities filled with low viscosity composites presented the lowest amount of internal voids and gaps. Glass-ionomer and high viscosity composite restorative materials showed the highest amount of interfacial gaps. Only in the high viscosity composite restorations the amount of voids and gaps correlated with the cavity depth, width and volume.

Background: This study aimed to evaluate the effect of different percentages of ethanol solvent of an experimental methacrylate-based dentin bonding agent containing polyhedral oligomeric silsesquioxanes (POSS) on the microleakage of resin composite restorations. Materials and Methods: In this experimental study, 42 extracted human premolar teeth used and 84 standard Class V cavities were prepared on the buccal and lingual surfaces of the teeth. The teeth were divided into 6 groups of 7. Experimental bonding agents with different percentages of solvent were used in 5 groups and Single Bond^® as a control. The teeth were restored with resin composite and subjected to thermal cycling test. Teeth were then immersed in a solution of 2% basic fuchsine dye for 24 h and sectioned buccolingually and scored using stereomicroscope with ×32 magnification. Microleakage data were analyzed using the Kruskal–Wallis, Mann–Whitney U, and Wilcoxon tests. Results: There were significant differences between the microleakage enamel margins (P = 0.036) and dentinal margins (P = 0.008) in all the groups. These significant differences were seen between the control group and groups containing 46 wt% solvent (P = 0.011), 46 wt% and 31 wt% solvent in dentinal (P = 0.027), 31 wt% and 0 wt% in enamel (P = 0.021), also 0 wt% and control in enamel (P = 0.039), and dentinal margins microleakage (P = 0.004). The microleakage in dentinal margins was higher than enamel margins (P < 0.001). In the groups with 46 wt% solvent (P = 0.103), 0 wt% (P = 0.122), and control group (P = 0.096), however, this difference was not significant. Conclusion: The adhesive containing 31 wt% solvent showed the least marginal microleakage, presence of POSS filler may also result in the reduction of microleakage.

Background: The incidence of dentinal defects may influence the outcome of root canal treatment. The aims of this study were to evaluate and compare the incidence of dentinal defects following root canal obturation with two different techniques. Materials and Methods: A total of 110 mesial roots of human mandibular first molars were selected. Twenty-seven roots were left unprepared as negative controls (NCs). The mesiobuccal canals of 83 roots were prepared using rotary instruments. Twenty-seven roots were left unobturated as positive controls (PCs). Twenty-eight roots were obturated with cold lateral compaction (CLC) technique and the others were obturated with mechanical lateral compaction (MLC) technique. In the CLC and MLC groups, spreader penetration depth was measured by an electromechanical testing machine in canals containing master Gutta-percha cones. After root canal obturation, all the roots were sectioned horizontally at four levels from the apex and evaluated under a stereomicroscope at a magnification of ×40. The presence of dentinal defects was noted. Data were analyzed using the Chi-square and t-tests. Results: The number of defects was not significantly different between the CLC, MLC, and PC groups. The CLC, MLC, and PC groups had significantly more defects compared to the NC group. Conclusion: According to the results of this study, the MLC and CLC techniques were the same in producing dentinal defects.

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, affecting 4-18% of them. Previous studies also showed that periodontal diseases are associated with different components of the metabolic syndrome. The aim of this study is to determine the association between PCOS and periodontal diseases. Materials and Methods: A total of 196 women (98 with PCOS and 98 healthy controls) were enrolled. PCOS diagnosis was confirmed by history, clinical signs, physical examination, laboratory parameters, and ultrasound studies. Both cases and controls were examined by the same periodontist. Periodontal parameters including bleeding on probing (BOP), probing depth, clinical attachment loss (CAL), plaque index, and tooth loss were investigated in all participants. Pregnant women, smokers, individuals with a history of malignancy or osteoporosis, and those taking prophylactic antibiotics for dental procedures or receiving periodontal treatment during the 6-month period before examination were excluded. Data were analyzed using t-test, Chi-square test, and linear regression. Statistical significance was set at P < 0.05. Results: CAL and sites with BOP were significantly higher in women with PCOS (P < 0.05). However, no significant difference was observed in the tooth loss rate between PCOS and non-PCOS participants (P = 0.384). Conclusion: The prevalence of periodontal disease seems to be higher in women with PCOS. This may be related to the role of chronic systemic inflammation in the pathophysiology of both PCOS and periodontal diseases.

Cyclosporine is a selective immunosuppressant that has a variety of applications in medical practice. Like phenytoin and the calcium channel blockers, the drug is associated with gingival overgrowth. This review considers the pharmacokinetics, pharmacodynamics, and unwanted effects of cyclosporine, in particular the action of the drug on the gingival tissues. In addition, elucidates the current concepts in mechanisms of cyclosporine-induced gingival overgrowth. Clinical and cell culture studies suggest that the mechanism of gingival overgrowth is a result of the interaction between the drug and its metabolites with susceptible gingival fibroblasts. Plaque-induced gingival inflammation appears to enhance this interaction. However, understanding of the pathogenesis of gingival overgrowth is incomplete at best. Hence, it would be pertinent to identify and explore possible risk factors relating to both prevalence and severity of drug-induced gingival overgrowth. Newer molecular approaches are needed to clearly establish the pathogenesis of gingival overgrowth and to provide novel information for the design of future preventive and therapeutic modalities.

Sialolithiasis is a common disease of the major salivary glands, characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions. Sialoliths usually measure from 1 mm to <10 mm. They rarely measure more than 15 mm, and infrequently giant salivary gland calculi >15 mm have been reported in the literature. The submandibular gland and its duct appear to be the most susceptible sites for this disease. In this article, we report two unique cases, including a giant bilateral case, measuring 50 mm in length and 5 mm in width on the right side and one, 30 mm in length, and 5 mm in width on the left side; and another case, measuring 83 mm in length. The diagnostic and therapeutic approaches consisted of transocclusal radiography with the conservative transoral surgical technique in both cases. The follow-up showed the normal function of the relevant salivary glands. To the best of our knowledge and belief, similar cases have not been reported in the literature.

Resorption of tooth structures can occur as a result of physiological, pathological, and idiopathic factors. Early diagnosis and appropriate treatment can prevent its serious complications. This case report presents surgical endodontic management of a trauma-induced perforating external root resorption, which was diagnosed with the help of cone beam computed tomography. Following root canal treatment, intentional replantation of the tooth was performed so as to expose the opening of the resorption defect to allow for complete debridement and closure. Eighteen months follow-up showed arrest of root resorption, and progressive healing of the defect.

Background: Antidepressant drugs such as fluoxetine are of the most commonly used drugs among the public. These drugs may impact the regulation of bone cell functioning, and thus affect orthodontic tooth movement. The aim of this study was to determine the effect of fluoxetine on tooth movements during orthodontic treatment in rats. Materials and Methods: In this study, 30 male rats were randomly assigned into two groups and injected with fluoxetine 10 mg/kg (experimental group) and normal saline (control group) for a period of 1-month intraperitoneally 5 times/week. Then, the rats were anesthetized and a nickel-titanium closed-coil spring was placed between the left maxillary first molar and left maxillary central incisors of all samples, and then fluoxetine (experimental group) and normal saline (control group) were injected for another 3 weeks by the same method. After measuring tooth movements, rats were sacrificed, and histomorphometric analyses were conducted and the obtained data were statistically analyzed using independent t-test and the significance was set at 0.05. Results: Following the fluoxetine injection, the mean amount of tooth movements in the experimental group was reduced compared to the control group, which was not statistically significant (P = 0.14). There was no significant difference between the two groups regarding bone apposition rate (P = 0.83), external root resorption rate (P = 0.1), and mean number of root resorption lacunae (P = 0.16). Conclusion: Within the limitations of this study, systemic use of fluoxetine may cause insignificant reduction of tooth movement rate in rats; however, this subject needs more evaluations.

Background: Oral diseases are common chronic diseases that are affected by human health behavior. One-way to promote health behaviors can be achieved through education. The present study aims to assess the effect of an oral health education program using motivational interviewing (MI) method on oral health status of preschool children. Materials and Methods: This study recruited 222 volunteer children and their parents from 10 elementary schools into a community trial. At baseline, plaque, gingival and decayed, missing, and filled teeth indexes were measured in the children. They were randomly allocated into test groups where they and their parents received oral health education using MI and the control group received traditional oral health education. The test group had recall and postal reminder during 6 months of the study, but there was no reminder for the control group. After 6 months, the same oral health indexes were measured. Data were analyzed using SPSS version 20 (SPSS Inc., Chicago, IL, USA) by t-test, Mann-Whitney and Wilcoxon signed ranks test. P < 0.05 was considered as significant. Results: The results showed that after both oral health education programs, differences of plaque index (PI) (P = 0.000) and gingival index (P = 0.000) were significant between the two groups. The number of children with healthy gingiva and low PI were more frequent in the test group after intervention. Conclusion: Considering the limitations of this study, oral health status of children after education of parents using MI was observed, and it should be considered in oral health education programs.

Background: The surface energy of titanium (Ti) implants is very important when determining hydrophilicity or hydrophobicity, which is vital in osseointegration. The purpose of this study was to determine how Ti plates with an alkaline treatment (NaOH) affect the adhesion and proliferation of human periodontal ligament fibroblasts (HPLF). Materials and Methods: In vitro experimental study was carried out. Type 1 commercially pure Ti plates were analyzed with atomic force microscopy to evaluate surface roughness. The plates were treated ultrasonically with NaOH at 5 M (pH 13.7) for 45 s. HPLF previously established from periodontal tissue was inoculated on the treated Ti plates. The adhered and proliferated viable cell numbers were determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide method for 60 min and 24 h, respectively. The data were analyzed using Kruskal–Wallis tests and multiple comparisons of the Mann–Whitney U-test,P value was fixed at 0.05. Results: The mean roughness values equaled 0.04 μm with an almost flat surface and some grooves. The alkaline treatment of Ti plates caused significantly (P < 0.05) more pronounced HPLF adhesion and proliferation compared to untreated Ti plates. Conclusion: The treatment of Ti plates with NaOH enhances cell adhesion and the proliferation of HPLF cells. Clinically, the alkaline treatment of Ti-based implants could be an option to improve and accelerate osseointegration.

Background: Oral pathology, a branch of dentistry which is often termed as a nonclinical branch deserves a better description as fundamental knowledge of oral pathology is essential to become a successful dental clinician. This study was conducted to analyze the approach toward Oral Pathology and Histology as a subject and profession among dental undergraduates. Materials and Methods: A questionnaire-based, cross-sectional study was conducted among 200 students which included the 3^rd year, 4^th year and interns studying in a Dental College in Gurugram, Haryana. The questionnaire comprised 14 close-ended questions, divided under three parameters which included demographic characteristics, students' perception about the Oral Pathology and Histology as a subject, and willingness to choose it as a career option. The data recorded was subjected to statistical analysis using the Chi-square test. The level of statistical significance was set at P≤ 0.05. Results: Among all the participants, 53 (26.5%) were males and 147 (73.5%) were females. It was found that 33.5% of the total students find the subject interesting, but 24.5% students reported their main focus on just passing this subject. Although they reported liking toward the subject, majority of them (64%) did not express their interest to pursue it as their postgraduation specialty. Conclusion: The present scenario of Oral Pathology and Histology as a subject is alarming and in that scenario it should be our prime concern to change the attitude of students toward the subject who perceive it as a nonclinical subject having a lesser scope for practice with a need to broaden the scope of the specialty and to make it more practical.

Background: Coronally advanced flap (CAF) has been shown to effectively treat gingival recession. Platelet rich plasma (PRP), containing autologous growth factors, has been shown to promote soft tissue healing. The aim of this clinical study was to determine whether the addition of an autologous PRP to a CAF when compared to a CAF alone would improve the clinical outcome for treatment of multiple gingival recessions. Materials and Methods: Thirty patients with Miller's class I and class II buccal recession defect were randomly assigned to control (CAF alone) or test (CAF with PRP) groups. Recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue, wound healing index, percentage of root coverage was assessed. Patients were followed at 2, 4, 12 and 16 weeks post-surgery. Statistical analysis for intra and inter group comparisons was done using Wilcoxon sign rank and Wilcoxon rank sum tests respectively. P < 0.05 denoted statistical significance. Results: The differences between the test and control groups were not significant with respect to all the clinical variables. The RD at 16 weeks was significantly reduced from 2.88 ± 0.69 to 0.76 ± 0.24 mm in control group (P < 0.05) and from 2.95 ± 0.43 to 0.76 ± 0.35 mm in the test group (P < 0.05). The mean percentage of root coverage was 73.1 ± 7.3 in the control group and 75.0 ± 8.3 in test group (P < 0.05). The CAL gain was 3.17 ± 0.84 mm within the control group and 3.17 ± 0.79 mm within test group. Conclusion: Within the limitations of this study, PRP with CAF can provide an early healing of soft tissues, but does not provide clinically measurable improvement in the final therapeutics outcome in CAF.

Background: A longitudinal study design was conducted to assess the mandibular cortical shape index (CI) in panoramic radiographs retrospectively. An association between age and a deterioration of different radiological parameters on panoramic radiographs was stated in cross-sectional studies. As longitudinal studies are rare, this one is designed to assess radiological changes over time. Materials and Methods: In this longitudinal study, The archive of the dentomaxillofacial radiology department was searched for panoramic radiographs of patients who have two radiographs with a time lapse of at least 15 years between both. The radiographs were then examined and the CI was categorized into three categories: normal, mild, and severely eroded. The following factors were examined to determine if they had an effect on possible changes of the CI using the Chi-square test: The time period between both radiographs, the gender and the age of the subjects when both radiographs were made also compared using the Kolmogorov–Smirnov test. Results: Ninety radiographs met the inclusion criteria. The mean age, when the 1^st radiograph and the 2^nd radiograph were made, was 48.7 and 66.9 years, respectively. A deterioration of the CI over time was observed and only 31.1% of the radiographs remained in the same CI category while 57.8% dropped down by one category and 11.1% dropped down by two. The change of CI was significant (P < 0.001 using the McNemar's test). Conclusion: In this longitudinally designed study, a deterioration of the CI over time when assessing the nonstandardized panoramic radiographs could be confirmed. This study shows that 68.9% of the patients had CI deterioration of at least one category over the average time of 17.96 years. This is the first study to quantify the CI deterioration over time to our knowledge.

Background: Use of smokeless tobacco in the form of moist snuff placed in the oral cavity is popular in rural India. The aim of the present cross-sectional study was to determine the effect of snuff on periodontitis by assessing interleukin (IL)-1 β and IL-8 levels in gingival crevicular fluid. Materials and Methods: A total of 60 subjects were selected for this study. 40 subjects presented with periodontitis, which included 20 snuff users (SP) and 20 nonsnuff users (NS). 20 periodontally healthy patients formed the controls (healthy control: HC). The clinical parameters recorded were gingival index (GI), plaque index, calculus index, bleeding on probing (BOP), probing depth (PD), recession (RC), and clinical attachment level (CAL). The IL-1 β and IL-8 levels were assessed through enzyme-linked immunosorbent assay (Quantikine ^®). Analysis of variance (ANOVA), post-hoc Tukey's, Kruskal-Walli's ANOVA and Mann-Whitney test was used for comparison among groups and P > 0.05 was considered statistically significant. Results: No significant difference was seen in levels of IL-1 β and IL-8 between SP and NS groups (P = 0.16, 0.97). However, both the periodontitis groups (SP and NS) had increased IL-β levels when compared to HC group (P = 0.01, 0.001). The snuff users showed significant increase in GI, BOP, RC, and CAL when compared with NS (P = 0.002, 0.001, 0.012, 0.002) whereas NS group had significant increase in PD (P = 0.003). Conclusion: Within the limitations of this study, use of snuff does not affect the host inflammatory response associated with periodontitis and leads to RC and increased CAL due to local irritant effect.

Background: This study aimed to evaluate the relationship of the level of salivary peptides human neutrophil defensin (HNP) 1–3 in children with and without early childhood caries (ECC). Materials and Methods: This in vitro study was conducted among 86 children of age 3–6 years who were divided into two groups: Group 1 – children with ECC (n = 43) and Group 2 – children without ECC (n = 43). Saliva samples were collected, and salivary peptide HNP1–3 levels were analyzed using enzyme-linked immunosorbent assay. The data collected were subjected to appropriate statistical analysis. Independent sample t-test was used to compare the mean salivary peptide levels of HNP1–3 in children with and without ECC. One-way ANOVA was used for intragroup comparison of the mean peptide levels between the ages. P < 0.05 was considered statistically significant. Results: The mean age of the children in Group 1 and Group 2 was 5.12 ± 0.851 and 4.88 ± 0.879 years, respectively. A statistically significant decrease was seen in salivary peptide HNP1–3 levels in children with ECC (1.44 ng/ml) when compared to children without ECC (6.04 ng/ml) with P < 0.001. There were no statistically significant differences in the gender- and age-based comparisons. Conclusion: A decrease in salivary peptide HNP1–3 levels might be a biological factor for predisposition to ECC and hence can be used as a predictive and a preventive tool in caries prevention.

Background: Aphthous lesions are one of the most common diseases of the oral cavity. They can cause severe pain, and there is no definite treatment. The purpose of this study was to determine the efficacy of Zataria multiflora (ZM, a thyme-like plant) essential oil for the control and treatment of aphthous lesions. Materials and Methods: This Triple blind clinical trial study was performed on 28 patients who were divided into two groups (eight men and six women in each group) and given ZM or placebo (control). The healing time, pain intensity, and aphthous zone diameter were recorded for each patient and followed for 6-month. Data were analyzed using Mann-Whitney and Friedman tests (P < 0.05). Results: After 6-month of follow-up, 4 patients in the placebo group and 6 patients in the ZM group suffered from recurrent aphthous lesions. The average complete healing time and duration of burning sensation were significantly lower in the ZM group (P < 0.05). Significant difference was observed between the two groups with regard to the diameter of lesions and halo of the lesions (P < 0.05). Conclusion: Within the limitations of this study, ZM shortened the healing period compared to placebo.

Background: The aim of this study was to compare conventional and microwave-assisted decalcification of sheep bone with and without teeth and to detect any difference in tissue detail preservation, staining quality, and rate of decalcification. Materials and Methods: In this method analysis study, twenty-four specimens consisting of 12 blocks of mandibular molars with their surrounding bone and 12 blocks of mandibular osseous tissue were allocated into two microwave or routine decalcification groups using 5% nitric or formic acid as decalcifying agents. In addition to decalcification rate, a number of variables were used to assess staining quality and tissue detail preservation which were compared between the two groups using Mann–Whitney test (P < 0.05). Results: Time to complete decalcification was significantly reduced in the microwave-treated samples as compared to the conventional method, regardless of the decalcifying agent (P = 0.025). For both acids, most variables related to staining quality and tissue detail preservation were similar between the techniques (P > 0.05). Patchy staining in bone samples and tissue tears in bone + teeth specimens were more common in the routine method when using nitric acid (NAc) (P = 0.046) and formic acid (FAc) (P = 0.046), respectively. In comparing acids, the performance of FAc was slightly inferior to that of NAc, especially for specimens containing both tooth and bone. Conclusion: The use of microwave technology can accelerate decalcification of bone and teeth of sheep mandibles and at the same time preserve tissue structure and staining quality. Further studies are required to help select the best demineralizing agent, especially in specimens containing bone and teeth.

Background: Type 2 diabetes mellitus (T2DM) and periodontitis are inflammatory conditions with a bidirectional association. This pilot study aimed to evaluate whether T2DM and glycemic control interfere in inflammatory markers profiles in gingival crevicular fluid (GCF) in periodontitis patients. Materials and Methods: Fourteen diabetic periodontitis patients were enrolled in this study, seven with adequate glycemic control (glycated hemoglobin [HbA1c] <8.0%) (DMA + P) and seven with inadequate control (HbA1c ≥8.0%) (DMI + P). Seven chronic periodontitis patients without diabetes formed the control group (P). GCF was obtained from diseased sites (probing depth >6 mm) of an entirely hemiarch, pooled and cytokines levels determined using multiplex beads immunoassay. Clinical periodontal parameters were analyzed by Mann-Whitney test and levels of cytokines by Kruskal-Wallis and Dunn's multiple comparison tests with confidence level of 95% (P < 0.05). Results: Cytokines profile of GCF obtained from deep periodontal pockets presented high levels of inflammatory cytokines, and there were no statistical differences between levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-α according to presence of diabetes or percentage of HbA1c among the groups, despite groups with T2DM and periodontitis exhibit higher levels of PD. Conclusion: Within the limitations of this study, inflammatory mediators in GCF are dependent to the local response and do not correlate with the diabetic status.

Background: The aim of this study was to assess the discoloration of coronal tooth structure irrigated with different irrigation solutions and filled with calcium silicate-based materials containing bismuth oxide or calciumzirconia complex as radiopacifier. Materials and Methods: In this ex vivo study, 72 bovine enamel-dentin blocks were prepared and divided into three groups. The dentinal cavities in each group were irrigated with 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX), or normal saline for 30 min. After that, irrigation solutions were removed using a cotton pellet. Each group was then randomly divided into two subgroups according to the cavity-filling materials (ProRoot mineral trioxide aggregate [MTA] and RetroMTA). The color assessments were performed before filling the cavities and 1 month and 6 months after filling the cavities. Data were analyzed with two-way ANOVA. The level of statistical significance was set at P < 0.05. Results: The effect of irrigation solution on the color change of calcium silicate-based materials was not statistically significant at none of the time intervals (P = 0.334 and P= 0.252, respectively, for ProRoot MTA and RetroMTA). ProRoot MTA caused a significantly higher color change compared with RetroMTA exposed to different irrigation solutions at each time interval (P < 0.001). Color change of both materials exposed to each irrigation solution significantly increased over time (P < 0.05). Conclusion: Under the condition of this ex vivo study, irrigation of dentin with NaOCl and CHX and then removing the excess solution might be ineffective in increasing the tooth color change potential of either bismuth oxide or zirconium-containing calcium silicate-based materials. Furthermore, calcium silicate-based material, which contained bismuth oxide, caused higher tooth discoloration.

Background: Correlation between chronological age at different stages of cervical vertebral maturation (CVM) is important in clinical orthodontic practice. The objective of this study was to evaluate the correlation between CVM stage and chronological age in a group of Iranian female patients. Materials and Methods: This study was conducted on 196 digital lateral cephalometry of female patients with the age ranged 9-14 years. The CVM stage was determined with two calibrated examiners, using the method developed by Baccetti and its correlation with mean chronological age was assessed by the Spearman rank-order. The intra and inter-agreements were evaluated by weighted Kappa statistics in overall diagnosis of stages, in addition to determination of presence or absent of concavities at the lower border of second, third and fourth cervical vertebrae and the shapes of the third and fourth vertebrae. P < 0.05 was considered as significant. Results: The correlation coefficient between CVM stages and chronological age was relatively low (r = 0.62). The least amount of inter-observer agreement was determined to be at the clinical decision of the shape of the fourth vertebra. Conclusion: Regarding the low reported correlation, the concomitant usage of other skeletal indicators seems necessary for precise determination of physiological age of the patients.

Background: High percentage of biomechanical complications such as screw loosening in dental implants can be related to implant–abutment (I/A) connection properties which affect the behavior of implant assembly against functional loads in the oral cavity. The aims of the present study were to compare the reverse torque values (RTVs) and failure loads of three abutment types with internal Morse taper connection. Materials and Methods: In this experimental in vitro study, eighteen implants (4.5 mm × 10 mm bone level implants, Implantium, Dentium Co, Seoul, South Korea) were divided into three groups with different abutments: two-piece (TP) abutment, one-piece (OP) abutment, and screw abutment (SA), mounted in stainless-steel blocks according to ISO 14801. After completion the torque/detorque protocol, a compressive load (1 mm/min) was applied at 30° off-axis until failure. Mean reverse torque/tightening torque (RT/TT) values and failure loads were analyzed with one-way ANOVA test and Tukey's honest significant difference (α = 0.05). Failure modes were evaluated by radiography and stereomicroscopy. Results: RT/TT values in the TP group were lower than those in other groups (P < 0.001). Highest failure loads were observed in SA group (P = 0.002). In radiographic evaluation, all specimens showed deformation in I/A interface. Conclusion: I/A connections with larger surface areas may lead to higher RTVs (e.g., OP and SA groups). Use of an additional screw and indexed area in TP group did not reduce the bending resistance under static loading.

Background: One of the methods used for joining metals together is welding, which can be carried out using different techniques such as electric spot welding. This study evaluated the effect of electric spot welding on the load deflection rate of stainless steel and chromium-cobalt orthodontic wires. Materials and Methods: In this experimental-laboratory study, load deflection rate of 0.016 × 0.022 inch stainless steel and chromium cobalt wires were evaluated in five groups (n =18): group one: Stainless steel wires, group two: chromium-cobalt wires, group three: stainless steel wires welded to stainless steel wires, group four: Stainless steel wires welded to chromium-cobalt wires, group five: chromium-cobalt wire welded to chromium-cobalt wires. Afterward, the forces induced by the samples in 0.5 mm, 1 mm, 1.5 mm deflection were measured using a universal testing machine. Then mean force measured for each group was compared with other groups. The data were analyzed using repeated measure analysis of variance (ANOVA), one-way ANOVA, and paired t-test by the SPSS software. The significance level was set as 0.05. Results: The Tukey test showed that there were significant differences between the load deflection rates of welded groups compared to control ones (P < 0.001). Conclusion: Considering the limitation of this study, the electric spot welding process performed on stainless steel and chromium-cobalt wires increased their load deflection rates.

Bone formation in small deposits following the loss of part of the mandible has often been reported in the literature, but the long-term follow-up reports of bone regeneration extending over the mandible are rare. Even rarer, are reports on the behavior of such new bone in terms of facial development, over a long period and the effect of load on it. A unique case of bone regeneration after resection of a large portion of the mandible in a 9-year-old male patient with myxofibrosarcoma in the body of the mandible is presented here. Intermaxillary fixation and insertion of reconstruction plate after resection without continuity defect were employed. Spontaneous bone regeneration was noted 8 weeks after surgery, and the resected portion of the mandible was regenerated when the patient was seen again 7 years later. Mandibular growth was not significantly affected and almost 7 years after his treatment, without relapsing of pathologic condition, the shape of the mandible is satisfactory without any evidence of bone resorption.

Background: Given the importance of primary dental caries, assessment of new preventive/therapeutic materials is necessary. In light of the scarcity of such studies on the role of new agents in primary dentition, this study assessed the efficacy of three commercial toothpastes with different ingredients on remineralization of early caries in the primary dentition. Materials and Methods: Thirty-nine intact primary canines were used in this in vitro experimental study. The baseline microhardness of enamel was measured. Particular demineralizer was used for 96 h and then secondary microhardness was measured. Then, samples were divided into three groups treated by toothpastes with sodium fluoride, chitosan, and casein phosphopeptide-amorphous calcium phosphate and sodium monofluorophosphate (CPP-ACP+SMFP). Each group was incubated and pH-cycled. Subsequently, they were demineralized and remineralized using toothpastes. Eventually, tertiary microhardness was measured. Percent of enamel microhardness recovery (EMHR%) and efficacy of toothpastes in remineralization were established. Data were analyzed using paired t-test, repeated-measures test, Kruskal–Wallis, and Mann–Whitney U-test (α = 0.05, 0.017). Results: Demineralization significantly reduced microhardness from 316.2 to 248.5 Vickers hardness number (VHN) (P = 0.000). All toothpastes succeeded to remineralize the enamel significantly (P = 0.000). The efficacies of toothpastes differed significantly (P < 0.05). Mean EMHR percentages of toothpastes incorporating NaF, chitosan, and CPP-ACP+SMFP were 75.1%, 52.5%, and 55.8%, respectively. The highest increases in enamel microhardness were observed after using NaF-containing toothpaste (~53 VHN) which was significantly superior to other toothpastes (P ≤ 0.001). However, there was no statistically significant difference between EMHR percentages of toothpastes including chitosan and CPP-ACP+SMFP (P = 0.739). Conclusion: Although all three toothpastes could increase the microhardness of primary enamel, NaF toothpaste was superior to others. Toothpastes having chitosan and CPP-ACP+SMFP acted rather similarly.

Background: Accurate impression making is an essential prerequisite for achieving a passive fit between the implant and the superstructure. The aim of this in vitro study was to compare the three-dimensional accuracy of open-tray and three closed-tray impression techniques. Materials and Methods: Three acrylic resin mandibular master models with four parallel implants were used: Biohorizons (BIO), Straumann tissue-level (STL), and Straumann bone-level (SBL). Forty-two putty/wash polyvinyl siloxane impressions of the models were made using open-tray and closed-tray techniques. Closed-tray impressions were made using snap-on (STL model), transfer coping (TC) (BIO model) and TC plus plastic cap (TC-Cap) (SBL model). The impressions were poured with type IV stone, and the positional accuracy of the implant analog heads in each dimension (x, y and z axes), and the linear displacement (ΔR) were evaluated using a coordinate measuring machine. Data were analyzed using ANOVA and post-hoc Tukey tests (α = 0.05). Results: The ΔR values of the snap-on technique were significantly lower than those of TC and TC-Cap techniques (P < 0.001). No significant differences were found between closed and open impression techniques for STL in Δx, Δy, Δz and ΔR values (P = 0.444, P = 0.181, P = 0.835 and P = 0.911, respectively). Conclusion: Considering the limitations of this study, the snap-on implant-level impression technique resulted in more three-dimensional accuracy than TC and TC-Cap, but it was similar to the open-tray technique.

Background: Prefabricated band and loops require only one appointment, are quickly placed in a session, and do not require laboratory work; thus, they need less time and cost. The aim of this study was to evaluate the survival rate of prefabricated band and loops in space maintenance of primary teeth and compare them with conventional band and loops. Materials and Methods: In this prospective clinical trial study 4–9-year-old patients, who met the requirements of the present study, were divided into two groups. The first group conventional band and loops and the second group prefabricated band and loops were placed. The patients were evaluated for cement dissolving. Failure of soldering (SF), breakdown, and deformation of each component of the band and loops, survival rate, and gingival health at the 1^st, 3^rd, 6^th, and 9^th-month Wilcoxon test, Fisher's exact test, Mann–Whitney test, Friedman test, and Kaplan–Meier test. Was used The level of statistical significance was set at P ≤ 0.05. Results: The two groups were not significantly different at the 1^st, 3^rd, 6^th, and 9^th-month recalls in cement solution, SF, breakdown, and deformation of each component of the band and loops. The survival rate of the conventional and prefabricated band and loops was 92% in the 9 months, and no significant difference was witnessed in survival rates between the two groups. The prevalence of gingivitis in prefabricated band and loops and conventional band and loops in the 9^th month was statistically insignificant (P = 0.03). Conclusion: There is a similar success rate for the conventional and prefabricated band and loops.

Background: The aim of this study was to assess the influence of temperature on the viscosity of different endodontic irrigants. Materials and Methods: The measurements of viscosity of 3% hydrogen peroxide, 0.9% sodium chloride, aqueous solution of 0.2% chlorhexidine (CHX) and 0.2% cetrimide, 5% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA) at different temperatures (22°C, 30°C, 40°C, 50°C and 60°C) were obtained using Mohr balance and Ostwald viscometer. The Shapiro-Wilk test and Mann-Whitney U-tests were used for the statistical analysis. (α = 0.05). Results: No significant differences were recorded at each temperature among 3% hydrogen peroxide, 0.9% sodium chloride and aqueous solution of 0.2% CHX and 0.2% cetrimide. 5% NaOCl and 17% EDTA showed the higher values. Viscosity statistically decreased with increasing temperature. Conclusion: Within the limitations of this study, 5% NaOCl and 17% EDTA are significantly viscous at room temperature and their viscosity reduces with elevating temperature.

Background: Dentin-bonding agents should have good biocompatibility as they come into close and prolonged contact with vital dentin. The present study aimed to evaluate and compare the cytotoxicity of total etch and self-etch dentin bonding systems with two different dentin thickness on L929 cell line. Materials and Methods: In this in vitro study 80 Class I cavities were prepared on the occlusal surfaces. The teeth were randomly divided to two groups of 40 each based on two RDT 0.5 mm and 1.5 mm. Samples were further subdivided into four subgroups of 10. Group 1: Adper Scotch bond Multi-Purpose (SBMP), Group 2: Adper Single Bond Plus (SBP), Group 3: Adper Scotch bond SE (SSE) and Group 4: Adper Easy One (EO). Group 1 and 2 were total-etch and Group 3 and 4 were self-etch. The cavities were sealed after applying of dentin bonding. Then crowns were immersed in culture medium for 24 hours and the cytotoxicity of resultant toxic extraction was measured with 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay in 4 serial dilutions (neat,1/2 ,1/10 ,1/100). Data were analyzed by Two-way ANOVA and t-test. Results: For all the dilutions, cytotoxicity was significantly higher with 0.5 mm remaining dentin thickness (RDT) relative to 1.5 mm RDT (P ≤ 0.05). In neat dilution for both RDTs, cytotoxicity was different among all the four dentin bondings. Expression in decreasing order of cytotoxicity was SBP > SBMP > SSE > EO for both RDTs in neat dilution (P < 0.05). For all the dilutions, cytotoxicity was significantly lower for self-etch bonding systems in comparison with total-etch bonding systems (P < 0.05). Conclusion: In the present study, lower cytotoxicity was found with an increase in the dilution of toxic extract and also cytotoxicity decreased with an increased dentin thickness. The adhesive systems had degrees of cytotoxic effects on cultured L929 compared to the control, except for the EO group.

Background: Chronic periodontitis (CP) is one of the most prevalent diseases of the oral cavity with various biological and behavioral risk factors. We aimed to evaluate the association between the salivary cortisol level (SCL) of unstimulated saliva and CP in patients referred to Isfahan Dental Faculty. Materials and Methods: In this analytic cross-sectional study, 90 patients were selected based on the presence of periodontitis and were divided into two groups: with periodontitis and without periodontitis (n = 45). First, by evaluating the level of anxiety with Spielberger State-Trait Anxiety Inventory questionnaire, each group was divided into three subgroups, each containing 15 persons. To measure the SCL in all subgroups by the enzyme-linked immunosorbent assay method, saliva samples were collected with unstimulated spitting method between 9 and 11 AM. Periodontal evaluation was done using the mean probing depth (PD), plaque index, and bleeding on probing. The obtained data were analyzed using SPSS software (version 20, IBM Corp., Armonk, N.Y., USA) and analysis of variance, independent t-test, Chi-square, Mann–Whitney, Spearman correlation, and Pearson correlation coefficient tests (α = 0.05). Results: The mean level of salivary cortisol (P = 0.048) and PD (P = 0.009) in patients with periodontitis was significantly higher than those without periodontitis. There was a direct and meaningful correlation between PD and SCL (P < 0.001, r = 0.363). In both groups of participants with (P < 0.001) and without periodontitis (P < 0.001), the mean SCL in patients with high anxiety was significantly more than patients with medium and low anxiety. Conclusion: Our results showed that there is an increased level of salivary cortisol (as anxiety index) in patients with CP. Therefore, it seems that the probability of the occurrence of periodontitis is higher in those with increased cortisol level.

Background: Various materials and techniques have been developed to facilitate bone healing process and reduce its healing period. In recent studies, it is pointed out that, platelet-rich fibrin (PRF) which is derived autogenously from the own blood of the individuals, increase regeneration and accelerate the healing of the wound, due to the consisting various growing factors. The aim of the experimental study is to evaluate the efficiency of PRF and PRF/autogenous graft combination on bone healing in different time intervals. Materials and Methods: A total of 24 skeletally mature New Zealand rabbits were used. Animals were divided randomly into two groups. Two bone defects with a diameter 3, 3 mm were created on the right and left tibia in all group animals. Only particulate autogeneous bone graft, only PRF, combination of PRF and autogeneous bone graft and empty bone cavity, were performed to all animals. The animals in the first experimental group were sacrificed after 30 days. The animals in the second experimental group were sacrificed after 60 days from the operation. Histomorphometrical and statistical analysis was performed. The data were analyzed using Tukey test (P < 0.05 for osteoblast number, P < 0.01 for osteoclast and new bone area values). Results: Histomorphometrical analyzes showed that either PRF used alone or used in conjuction with autogenous bone graft, PRF accelerated the healing of the bone defects. There were statistically significant differences in osteoblast, osteoblast and new bone area values in PRF alone and autogenous graft with PRF than the other groups. Conclusion: Our preliminary result demonstrated that PRF increase new bone formation and has a positive effect on early bone healing.

Background: Endodontically treated teeth with extensive structural damage present higher fragility due to the low amount and worse quality of the reminiscent tissues of the crown. Materials and Methods: The present in vitro study evaluated the effect of different intraradicular retainers and cementation agents on the fracture resistance of devitalized teeth. Incisive teeth (n = 40) of bovine mandibles were used. After preparation of the root canals, they were immersed in polyether, in a polyvinyl chloride cylinder containing acrylic resin, to simulate the periodontal ligament. The specimens were randomly divided into four groups (n = 10), according to the type of retainer (anatomical or main with accessory posts) and resin cement used (conventional resin cement – RelyX ARC or self-adhesive resin cement – RelyX U200). The specimens were stored in distilled water at 37°C and submitted to fracture resistance testing. ANOVA and Tukey's test were applied for data analysis, with significance level set at 5%. Results: There was no interaction between cement type and intraradicular retainers (P = 0.56) or even between the types of cement used (P = 0.65). However, in the variation of the types of retainers, the group using main with accessory posts presented greater resistance to the fracture than the anatomical post (P = 0.04). Conclusion: Different cementing agents have no effect on the fracture strength of devitalized teeth, unlike the use of posts, in which the use of accessory post proved more resistant when compared to the anatomical post.

Background: A precise transfer of the position of an implant to the working cast is particularly important to achieve an optimal fit of the final restoration. Different variables affect the accuracy of implant impression. The purpose of the present study is to compare the accuracy of open-tray and snap-on impression techniques in implants with different angulations. Materials and Methods: In this experimental study: A reference acrylic resin model of the mandible was fabricated. Four implants were positioned with the angles of 0°, 10°, 15°, and 25° in the model. Ten impressions were prepared with open-tray technique and ten impressions were made using snap-on technique. All impressions were made from vinyl polysiloxane impression material. Linear (Δx, Δy, and Δr) and angular displacements (Δθ) of implants were evaluated using a coordinate measuring machine. Measured data were then analyzed using two-way analysis of variance and Tukey's test (α = 0.05). Results: The results showed that the accuracy of open-tray impression technique is significantly different from snap-on technique in Δx (P = 0.003), Δy (P = 0.000), Δr (P = 0.000), and Δθ (P = 0.000). Implants with 25° angulation are significantly less accurate than 0°, 10°, and 15° implants in Δx, Δy, Δr, and Δθ. Fifteen-degree implants are less accurate than 0° and 10° ones in Δθ. Conclusion: Regarding the findings of this study, it can be concluded that snap-on technique is less accurate than open-tray technique, and the accuracy of 25° implant is less than that of 0°, 10°, and 15° implants.

Background: The aim of this study was to assess the fracture resistance of pulpotomized primary molars restored with incremental and bulk-fill composite application techniques. Materials and Methods: In this in-vitro experimental study, 36 extracted primary molars were nonrandomly (selectively) divided into three groups of 12 each. All teeth underwent conventional pulpotomy treatment, and mesio-occluso-distal cavities were prepared in such a way that the buccolingual width of the preparation was two-thirds of the intercuspal distance, and the depth of the buccal and lingual walls was 4 mm. The teeth were then restored as follows: Group 1 (control) was restored with amalgam, Group 2 was restored with Tetric N-Ceram composite using the incremental technique, and Group 3 was restored with Tetric N-Ceram composite using the bulk-fill technique. The restored teeth were subjected to thermocycling and then underwent fracture resistance testing in a universal testing machine at a crosshead speed of 1 mm/min. Fracture resistance of groups was compared using the one-way ANOVA and Tukey's honestly significant difference test. Results: The mean fracture resistance was 1291.47 ± 603.88 N in the amalgam, 1283.08 ± 594.57 N in the Tetric N-Ceram incremental, and 1939.06 ± 134.47 N in the Tetric N-Ceram bulk-fill group. The difference in this regard between Group 3 and Groups 1 and 2 was statistically significant (P = 0.019 and P= 0.035, respectively). Conclusion: Bulk-fill composite is recommended for reinforcing the remaining tooth structure after the primary molar pulpotomy procedure. Time-saving characteristics of this material are clinically important for reducing appointment time for children.

Background: The aim of the study was to evaluate the accuracy of iPex and Vdw gold apex locators in detecting simulated root perforations in curved canals in the presence of 3% sodium hypochlorite (NaOCl) and 2% chlorhexidine (CHX). Materials and Methods: In this comparative in vitro study Twenty mandibular molars with curved mesial roots were selected and perforation was made in the danger zone 4 mm from the furcation area. The actual length of the perforation site was measured using stereomicroscope software using a #15 K file, following which the teeth were embedded in alginate molds. The perforation site was electronically measured using two apex locators, iPex and Vdw gold in dry condition and in the presence of 3% NaOCl and 2% CHX. The values obtained were compared using the Friedman and Wilcoxon signed-rank test with level of statistical significance set at P ≤ 0.05. Results: In dry condition, Vdw gold showed near accurate values, i.e., 0.25 mm from the manual value whereas iPex showed a significant difference (P < 0.05) of 0.76 mm from the manual value. In the presence of 3% NaOCl, both the apex locators showed a significant difference (P < 0.05) from the manual value with iPex showing a difference of 0.70 mm and Vdw gold showing a difference of 0.74 mm. The most accurate values were determined by both the apex locators in the presence of 2% CHX with iPex showing a deviation of 0.13 mm and Vdw gold showing a deviation of 0.39 mm from the manual. Conclusion: In dry condition, Vdw group showed better results than iPex in determining the length of the root perforation. In wet condition, in the presence of 2% CHX, both the apex locators accurately measured the perforation site, whereas in the presence of 3% NaOCl, both the apex locators showed a significant difference (P < 0.05) from the manual value in detecting the root perforation.

Vital pulp therapy (VPT) is a biologic and conservative treatment modality to preserve the vitality and function of the coronal or remaining radicular pulp tissue in vital permanent teeth. A search was conducted via the Cochrane database, PubMed, MEDLINE, and Ovid for any articles with the criteria for "pulp-capping," or "pulp-capping materials" and "VPT outcomes" from 1978 to mid 2014. All articles were evaluated and the valid papers were selected. The outcomes of various VPT techniques, including indirect pulp treatment, direct pulp treatment, partial pulpotomy, and complete pulpotomy in vital permanent teeth were extracted. Although various studies have different research approach, most studies noted a favorable treatment outcome. Mineral trioxide aggregate (MTA) appears to be more effective than calcium hydroxide (Ca(OH) ₂ ) for maintaining long-term pulp vitality after indirect and direct pulp-capping. However, it seems that the success rate for partial pulpotomy and pulpotomy with Ca(OH) ₂ is similar to MTA.

Anterior teeth fracture is a common form of dental trauma that mainly affects children and adolescents. Maxillary incisors are the most commonly affected teeth. Loss of coronal tooth structure might affect esthetics and function. In recent decades, dentistry has shown many scientific and technological advances in restorative materials. However, no synthetic restorative material can replicate the natural tooth structure. Hence, the use of natural tooth as a restorative material has been suggested in literature and is termed as a biological restoration. The present case report represents the successful use of biological post and crown and was adequate with respect to adhesion, function, and esthetics with the follow-up period of 1 year. Hence, it may be concluded that the biological restoration, if feasible, is a cost-effective way to restore a damaged tooth with acceptable esthetics and tooth functions in the stomatognathic system.

Background: Constraints in dental access and limitations associated with service delivery necessitate the use of an appointment system in patient care. This research aimed to identify association between treatment appointments and oral health-related quality of life (OHRQOL) in dental patients at the Lagos State University Teaching Hospital. Materials and Methods: This was a descriptive study that surveyed 412 individuals. Socio-demographic, clinical history, and OHRQOL data was collected using a structured interviewer administered questionnaire. Visual analog scale (VAS) was used to assess inconvenience while the oral health impact profile-14 was used for OHRQOL assessment at baseline and at review. Data entry and analysis was done using SPSS while ANOVA and Chi-square tests were used to determined significant association. P < 0.05 was considered significant. Results: Most (175; 45.2%) dental appointments were within a month although 59 (15.2%) individuals had to wait for more than 6 months. Using VAS, 87 (22.5%) individuals were moderately inconvenienced while 68 (17.6%) were extremely inconvenienced. At baseline, the most commonly reported oral health quality of life impacts were within the dimensions “physical pain” and “psychological discomfort.” At review, there was increase in OHRQOL scores in the subdomains of pain (2.27 ± 1.80), self-consciousness (1.67 ± 1.15), discomfort on chewing (1.61 ± 1.13), and pronouncing words (1.49 ± 2.21). The highest mean impact score (2.27 ± 1.80) was observed in the subdomain of painful aching in the mouth. Conclusion: Dental appointments appear to result in worse OHRQOL. Since the appointment systems in public oral health facilities may have a direct bearing on OHRQOL of patients, quality control standards on dental appointments should be established and enforced.

Background: Despite many advantages of lasers and reduction of the risk of surface bonding errors with newer self-etch systems, they have not been thoroughly researched. This study was done to evaluate the effect of Er:YAG laser cavity preparation on the microtensile bond strength of 2-hydroxyethyl methacrylate (HEMA)-rich and HEMA-free one-step self-etch adhesive systems. Materials and Methods: In this in vitro study, eighty freshly extracted human premolars were collected. Cavities were prepared in 40 teeth with carbide bur (Group 1) and in other 40 teeth with Er:YAG LASER (490 mJ and 15 Hz) (Group 2). Subgroups of twenty teeth each were made according to the adhesive systems used. After placement of restoration, the mean values of the bond strength were calculated using universal testing machine. Data were then tabulated and analyzed using descriptive statistics (Significant at P < 0.05). Results: The overall microtensile bonding strength was higher when the cavities were prepared with bur compared to those with Er:YAG laser. Mean bond strengths of single-bottle self-etching seventh-generation dentin bonding agents to bur-prepared cavities were higher than those to laser-prepared cavities irrespective of the adhesive system (P = 0.01). No statistically significant difference was observed between HEMA-free and HEMA-rich self-etch adhesive systems. Conclusion: The effect of Er:YAG laser for cavity preparation did not show improved performance when evaluated using microtensile bond strength with seventh-generation bonding agents, Adper Easy One and G-Bond. More studies are required to assess the effect of lasers.

Glutathione, considered to be the master antioxidant (AO), is the most-important redox regulator that controls inflammatory processes, and thus damage to the periodontium. Periodontitis patients have reduced total AO capacity in whole saliva, and lower concentrations of reduced glutathione (GSH) in serum and gingival crevicular fluid, and periodontal therapy restores the redox balance. Therapeutic considerations for the adjunctive use of glutathione in management of periodontitis, in limiting the tissue damage associated with oxidative stress, and enhancing wound healing cannot be underestimated, but need to be evaluated further through multi-centered randomized controlled trials.

Background: Anterior open bite (AOB) is noteworthy because it is a complex dysplasia, and clinical studies on this malocclusion are usually epidemiological studies or experimental models with small samples and no control group, which renders the data on AOB incomplete and therefore inconclusive. The objective this study was to assess the risk factors involved in developing AOB. Materials and Methods: A case–control study was provided with a total of 96 lateral cephalometric radiographs of male and female patients aged between 8 and 14 years were used, regardless of facial type. The dependent variable was the presence or absence of AOB, which divided the participants into case and control groups, respectively; these groups were matched for gender and age. The case and control groups data were analyzed by descriptive and inferential analysis by binary logistic regression using at the 5% significance level Results: The occurrence of AOB was associated with the presence of deleterious oral habits (P = 0.014; Chi-square test) and was approximately three times (odds ratio = 3.04) more likely to occur in participants with AOB. No significant association between the presence of mouth breathing and the occurrence of AOB was found (P = 0.151; Chi-square test). The odds associated with tongue interposition were 10.51 times higher than those of participants with no such deglutition. The odds associated with the dolichofacial pattern were 5.74 times those of participants with a nondolichofacial pattern. Conclusion: Tongue interposition and dolichocephalic facial pattern were risk factors for developing AOB.

Mandibular canal is the most important anatomical landmark in the body of mandible which always must be considered for implant surgery in posterior mandibular region. Damage to vessels and inferior alveolar nerve that passes through the mandibular canal can cause problems such as hemorrhage and neurosensory disturbances. Damage to the mandibular canal can occur during implant surgery. Depending on the severity of injuries, it would result in temporary or permanent neurosensory disturbances. We have reported a case that mandibular canal narrowing occurred following implant surgery and resulted in anesthetic and hypoesthetic areas in the lower lip. Patient had a history of implant surgery in the region of teeth numbered 30 and numbered 31. The inserted implant failed after 6 years, and reimplantation was done in this area, but due to lower lip numbness in the right side, the second implant was removed, and another implant was inserted in the region of the tooth numbered 32. After 2 years, right lower lip numbness was reported again by the patient. Cone beam computed tomography images showed canal narrowing in the region of the tooth numbered 31 where the second implant was inserted. It seems that the main cause for anesthesia and hypoesthesia in this patient is canal narrowing due to damage during implant replacement and removal.

Background: Artifacts, artificial structures at microscopic section, may lead to incorrect diagnosis and wrong treatment of a pathological entity. The aim of this study was to evaluate the frequency of various artifacts found in oral and maxillofacial histopathologic sections. Materials and Methods: In this cross-sectional study, the specimens included the histopathologic sections along with their diagnosis that were collected from the archive of Isfahan Oral and Maxillofacial Pathology Department using systematic sampling method over a 10-year period. These histopathologic sections were studied by two oral pathologists and an expert laboratory technician for the presence or absence of various artifacts, and the specimens from inside and outside the university were compared. The data were analyzed by SPSS software using independent t-test at significance level α = 0.05. Results: From among 237 specimens studied, 235 specimens (99.15%) had artifacts and two specimens had no artifacts. From among 21 different types of artifacts, folding (n = 158) and throughout cleft (n = 149) artifacts had the highest frequency. There was no significant difference between the specimens of inside and outside the university (P = 0.125). Conclusion: The results of this study showed a high number of artifacts in the histopathologic sections, the most frequent artifact being reported for the folding artifact. It seems adequate control of specimens and preventing technical errors can reduce the number of artifacts.

Background: The presence of dentoalveolar lesions such as fenestration and dehiscence has great clinical importance. This study was designed to determine the incidence of bony fenestrations and dehiscences associated with the anterior teeth by using cone-beam computed tomography images. Materials and Methods: A total of 216 images (1189 teeth) were included in this cross-sectional study. The presence of fenestration and dehiscence at the buccal and lingual/palatal surfaces and also their relative levels on the roots of the teeth were determined. McNemar's, Chi-square, and Cochran's Q tests were used for data analysis. A value of P < 0.05 was considered to be statistically significant. Results: The incidence of fenestration and dehiscence was 17.6% and 3.9%, respectively with the maxillary fenestrations being more prevalent (P < 0.0001). No significant differences were observed in the incidence of dehiscences between the jaws (P = 0.824) and among the tooth types (P = 0.689). The lesions were more frequent at the buccal surfaces (80%–92.5%). About 85.9% of the fenestrations occurred in the apical root thirds, whereas dehiscences had the highest prevalence in the cervical thirds. Fenestration and dehiscence incidences were significantly higher in females (P < 0.05). There was no significant difference among the age groups regarding these lesions. Conclusion: Fenestration and dehiscence were observed more on the buccal surfaces and also in the apical and cervical root thirds, respectively. Age had no significant influence on the occurrence of these lesions in contrast to the sex.

Tea is the second most consumed beverage. Polyphenolic catechins of green tea have a number of beneficial effects in oral cavity. This study aims to evaluate the clinical effects of green tea on halitosis through a systematic review of available literature. All available randomized, clinical trials – with a relevant subject that met the inclusion criteria – were included by searching PubMed, Cochrane, ProQuest, and Google Scholar, and Scopus databases. To score the selected articles, 27 items of CONSORT 2010 checklist were considered. Each article was reviewed by all the authors. Searching the PubMed database yielded 42 articles, 2 of which met the inclusion criteria. None of the 12 articles were obtained through Cochrane library, and 85 articles retrieved from ProQuest database met the inclusion criteria. Three hundred and five articles were obtained from Google Scholar, three of which fulfilled the inclusion criteria. Two articles were omitted because they were duplicated, and the rest were excluded. Searching the Scopus database yielded 270 articles, 2 of which met the inclusion criteria, but they were also duplicated. Finally, two studies were selected according to the inclusion criteria of the study. In both of the included articles, the early effect of green tea use was statistically significant in comparison with baseline. One of the studies showed the long-term effect of green tea mouthwash. Green tea can reduce halitosis through rinsing and antimicrobial effect.

Background: With the introduction of skeletal anchorage system, recently it is possible to successfully intrude molar teeth. On the other hand, there have been concerns about periodontal changes associated with intrusion and there are few studies on this topic, especially for posterior teeth. Materials and Methods: Ten female patients were enrolled in this study. Maxillary molar intrusion was achieved by inserting two miniscrews and a 17 × 25 titanium molybdenum alloy spring. Crestal height changes were evaluated at three intervals including: Baseline (T0), end of active treatment (T1) and 6 months after retention (T2). Other variables including probing depth, gingival recession, attachment level and bleeding on probing were evaluated by clinical measurements in the three above mentioned intervals. One-sample Kolmogrov-Smirnov test ascertained the normality of the data. For all patients, the changes in tooth position and crestal height were evaluated using one-sample t-test. (P < 0.05) Results: Supra-erupted molars were successfully intruded a mean of 2.1 ± 0.9 mm during active treatment (T0-T1). A mean bone resorption of 0.9 ± 0.9 mm in mesial crest and 1 ± 0.8 mm in distal crest had occurred in total treatment (T0-T2). A mean of 0.6 ± 1.4 mm bone was deposited on mesial crest during the retention period (T1-T2) following tooth relapse. On average, 0.8 ± 0.4 mm attachment gain was obtained. Gingival margin coronalized a mean of 0.8 ± 0.6 mm throughout the entire treatment. Probing depth showed no significant change during treatment. Conclusion: Within the limitations of this study, these results suggest that not only periodontal status was not negatively affected by intrusion, but also there were signs of periodontal improvement including attachment gain and shortening of clinical crown height.

Background: Calcium silicate cements in treatments such as revascularization and apexogenesis are adjacent to blood and pulp tissues. This study evaluated tooth discoloration after treatment with mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement, and Biodentine^® in the presence and absence of blood using spectrophotometric analysis. Materials and Methods: In this experimental study, A total of 68 extracted permanent anterior teeth were prepared and randomly divided into two groups as follows: the sponge embedded in access cavities was saturated with fresh blood or normal saline using insulin syringe, and then each group was subdivided into the following three cement subgroups: MTA-Angelus^®, CEM cement, and Biodentine; these materials with a thickness of 3 mm were placed in the access cavity on the sponge. In the control group, the sponges were saturated in saline and blood in the absence of cements. Discoloration rate was measured by spectrophotometer within the following four intervals: after preparing the cavity and 1 day, 1 month, and 6 months after material placement. ANOVA and Tukey's test were used to assess the effect of blood and materials and time on discoloration. (P < 0.05). Results: In general, discoloration rate is significantly higher in blood group than saline group (P < 0.05) and an increase in Δ E is observed over time for the materials in all groups. In this study, discoloration rate in the presence and absence of blood in Biodentine group was lower, and this difference was statistically significant compared to that of MTA group (P < 0.05) but not significant compared to that of the CEM group. Conclusion: This study indicated that Biodentine induces the lowest tooth discoloration in the presence and absence of blood, and its discoloration rate is significantly lower than that of MTA. Therefore, it can be suggested that Biodentine can be used more confidently for endodontic treatments with coronal blood contamination such as regeneration and cervical perforation repair in esthetic zone of teeth.

Adenoid ameloblastoma with dentinoid is a rare odontogenic tumor. Granular cell ameloblastoma also is a less common histological subtype of ameloblastoma. In this report, the patient was a 31-year-old male. The lesion was located in the right mandible and was unicystic with well-defined borders. The tumor tissue was showing a combination of follicular, plexiform, and desmoplastic patterns of ameloblastoma with wide areas of granular cells, fibrous stroma, glandular pattern, and dentinoid calcified. Very few cases of distinct forms of ameloblastoma that show the formation of dentinoid has been reported. However, there are no cases of adenoid granular cell ameloblastoma with dentinoid reported.

Background: The aim of the study was to assess the relationship between height and dental caries among 13-year-old adolescents in schools of Bangalore, India. Materials and Methods: A cross-sectional study was undertaken on 1900 schoolchildren aged 13 years from both government and private schools of Bangalore using stratified random sampling. Demographic data; family-related factors; and general and oral health-related factors such as frequency of sugar consumption, dietary habits, oral hygiene practices, and dental attendance were interviewed using both open-ended and close-ended questions. Anthropometric measurements for height and weight were performed. Clinical examination was done and caries was recorded using the decayed, missing, and filled teeth (DMFT) index (WHO criteria, 1997). Data were analyzed using SPSS version 21.0, and descriptive statistics including percentages, mean, and frequencies were performed. Student's t-test and ANOVA were applied to find the significant differences between mean DMFT among groups. Categorical data were analyzed by Chi-square test for differences between groups. Pearson correlation coefficient was used to find the correlation among dental caries and height and body mass index (BMI).P value was set at a statistical significance level of 0.05. Results: The prevalence of dental caries among the study population was 36.3% which was higher among girls as compared to boys. Dental caries was found to be significantly associated with socioeconomic status, family structure, birth order, use of oral hygiene aids, mouthrinsing, last dental visit, weight, and BMI. Height and BMI showed a strong negative correlation with dental caries. Conclusion: The present study showed a significant negative correlation between height and dental caries. However, since both caries and height are a dynamic phenomenon, hence a longitudinal study exploring the possible relationship should be considered.

Background: Self-disinfecting impression materials would reduce time and energy needed for impression disinfecting process in clinic. The aim of this study was to evaluate the antimicrobial effect of alginate mixed with nanosilver solution at a concentration of 500 ppm and 1000 ppm on common oral microorganisms and assess changes in working time, setting time, and surface detail reproduction. Materials and Methods: In this in vitro study, three groups were assigned. The first group was alginate, the second group was alginate mixed with 500 ppm nanosilver, and the third group was alginate mixed with 1000 ppm nanosilver. Antimicrobial effect on Escherichia coli, Staphylococcus aureus, and Candida albicans was studied using direct contact test in each group (n = 10). Working time (n = 10), setting time (n = 10), and surface detail reproduction (n = 10) were evaluated separately using the ISO 21563 protocol. Descriptive tables were used to describe the data. Kruskal–Wallis test used to determine significant differences in the number of colonies was counted in antimicrobial test (α = 0.05). Results: No adverse effects observed in working time, setting time, and surface detail reproduction of alginate impressions. Alginate mixed with silver nanoparticles showed no inhibitory effect on S. aureus and C. albicans, but the number of E. coli colonies were counted in the group 1000 ppm was significantly lower than 500 ppm (P = 0.001). Conclusion: Antimicrobial effect of alginate mixed with silver nanoparticles is not clinically indicated. Nevertheless, its physical features did not change significantly.

Background: The aim of this study is to quantitatively evaluate the remineralization potential of three remineralizing systems as follows: fluoride, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and CPP-ACP with fluoride, under scanning electron microscope with energy-dispersive X-ray analysis. Materials and Methods: In this in vitro study A total of 40 enamel specimens were prepared from the buccal or lingual surfaces of human premolars extracted for orthodontic reason. Specimens were then placed in demineralizing solution for 96 h, to produce artificial caries-like lesion. Calcium and phosphate weight percentage of demineralized specimens was measured. Specimens were divided into four groups as follows: (a) control, (b) CPP-ACP, (c) CPP-ACP with fluoride, and (d) fluoride varnish. Except for the control group, the entire specimens were subjected to remineralization using respective remineralizing agents of their groups. The prepared specimens were assessed for calcium and phosphate weight percentage using scanning electron microscopy-energy dispersive X-ray spectroscopy. One way analysis of variance (ANOVA), followed by Tukey's test, was performed with the help of critical difference (CD) or least significant difference at 5% and 1% level of significance. P ≤ 0.05 was taken to be statistically significant and P < 0.001 as statistically highly significant. Results: The mean weight percentage of calcium and phosphorus of specimens treated with CPP-amorphous calcium phosphate nanocomplexes plus fluoride (ACPF) was significantly higher than other groups. Conclusion: All the groups showed statistically significant remineralization. However, because of added benefit of fluoride, CPP-ACPF showed statistically significant amount of remineralization than CPP-ACP.

Background: This study was to assess and compare the marginal and internal fit of stainless steel crowns (SSCs) with those of preveneered SSCs and zirconia crowns using different luting cements. Materials and Methods: In this in vitro study, 36 primary first molars were divided into three groups (n = 12) each prepared to receive different crowns (SSCs, preveneered SSCs, or zirconia crowns). Each group was further subgrouped (n = 4) according to the luting cement (resin cement, glass ionomer cement [GIC], or resin-modified GIC [RMGIC]). After cementation, the teeth were sectioned in the buccolingual direction to assess the marginal and internal fit. The results were analyzed using ANOVA and Bonferroni statistical tests. The level of significance was set at P < 0.05. Results: Zirconia crowns, especially those cemented with resin cement, were associated with the lowest marginal and internal gap width. Regardless of the luting cement, no significant difference was observed between all three crowns tested in terms of marginal gap (P > 0.05); however, zirconia crowns cemented with resin cement had significantly lower internal gap than preveneered SSCs and SSCs cemented with resin cement. In addition, those cemented with RMGIC had significantly lower internal gap than preveneered SSCs cemented with that cement (P < 0.05). Conclusion: Zirconia crowns cemented with resin cement were the most accurately fitted internally, while marginally, they were not significantly different from the rest of crown-luting cement combinations tested.

Background: The treatment of furcation area defects remained as a challenging issue in periodontal treatments. Regeneration treatment of furcation defects is the most discussed periodontal treatment. Although not completely hopeless in prognosis, the presence of the furcation involvement significantly increases the chance of tooth loss. The current research was conductedeto compare theeadditive effect of combined guided tissue regeneration (GTR) and platelet-rich growth factor (PRGF) on the treatment of furcation bony defects. Materials and Methods: A randomized, triple-blinded, split-mouth study was designed. It included patients with a moderate to severe chronic periodontitis with bilateral Grade II furcation involvement of first or second mandibular molars. Each side of mouth was randomly allocated for the treatment with either Bio-Gide American Society of Anesthesiologists GTR or a PRGF or PRGF by itself. Plaque index, gingival index, vertical clinical attachment level, vertical probing depth, recession depth (REC), horizontal probing depth, fornix to alveolar crest (FAC), fornix to base of defect (FBD), furcation vertical component and furcation horizontal component (FHC) were recorded. The current research was conducted to compare the additive effect of combined GTR and PRGF on treatment of furcation bony defects. Altman's nomogram, Kolmogorov–Smirnov test, Friedman test, general linear model, repeated measures, and paired t-test were used as statistical analysis in this research. P < 0.05 was considered statistically significant. Results: Eight patients were finally enrolled for this study. Overly, general and specific clinical and furcation parameters were improved except REC that was deteriorated insignificantly and FAC improved not significantly. Intergroup comparison revealed better improvement of FHC in GTR/PRGF group (P = 0.02). Conclusion: A significant improvement in the Grade II furcation defects treated with either GTR or PRGF/GTR was noticed. Further large-scale trials are needed to reveal differences of mentioned treatment in more details.

Background: Application of hemostatic agents can negatively affect the bond strength of adhesive systems to dental substrate. This study aimed to assess the effect of ferric sulfate on microshear bond strength of four total- and self-etch adhesives to dentin after water storage. Materials and Methods: In this in vitro study, 192 dentin slices with 2 mm thickness were made of 64 extracted sound human third molars. The samples were divided into 8 groups (n = 24) as follows: G1: Scotchbond Multi-Purpose, G2: hemostatic agent + Scotchbond, G3: Adper Single Bond, G4: hemostatic agent + Adper, G5: Clearfil SE Bond, G6: hemostatic agent + Clearfil, G7: Single Bond Universal, and G8: hemostatic agent + Single Bond Universal. Composite cylinders with 0.7 mm diameter and 1 mm height were bonded to the surfaces. Each group was then divided into two subgroups (n = 12) for water storage for 24 h and 3 months. The microshear bond strength was then measured. Data were analyzed using the Shapiro–Wilk test, three-way ANOVA, one-way ANOVA, and Tukey's test (P < 0.05). Results: Application of ferric sulfate decreased the bond strength of all bonding agents after both 24 h and 3 months of storage; but, this reduction was not statistically significant (P > 0.05). Single Bond Universal at 24 h showed the highest and Adper Single Bond at 3 months showed the lowest bond strength (P < 0.001). Conclusion: Dentin contamination with hemostatic agents negatively affects the bond strength of total- and self-etch adhesives.

Background: Patients with psychiatric disorders can be vulnerable to oral diseases due to the adverse effects of medications and disease per se. The aim of this study is to assess oral health status, self-perceived dental needs, and barriers to utilization of dental services along with evaluation of intervention urgency among psychiatric patients. Materials and Methods: In this cross-sectional study, 165 individuals were examined at the psychiatric outpatient department of a tertiary care center. Clinical examination [dentition status and community periodontal index (CPI) modified] was done according to the World Health Organization Basic Oral Health Surveys, 2013. Other information was collected by direct interview and all the data were recorded on a prestructured, validated pro forma. Data were analyzed using SPSS Software. The statistical significance was determined by analysis of variance (ANOVA) and level of significance was set at P < 0.05. Results: Although decayed, missing, and filled teeth (DMFT) and CPI-modified scores increased with increase in duration of illness, the difference was not statistically significant. Evaluation of self-reported attributes revealed that the majority of the individuals had reported dental pain (34.6%) as their dental problem, 39.6% visit dentist only when there is a dental problem, and 41.7% did not felt any need to visit dentist. The ANOVA of DMFT in relation to duration of illness (P > 0.062) and CPI-modified scores (P > 0.078) were not statistically significant. Although when intervention urgency was evaluated, 70.3% needed prompt treatment depending on their oral health assessment. Conclusion: The findings of this study suggest that oral health concerns of this marginalized section of the population are unrecognized and should be given prominence by psychiatrists.

Agenesis of permanent canines is a rare condition, and that of both maxillary and mandibular permanent canines is extremely rare. It may occur either isolated or in association with other dental anomalies. Reports of such cases are very scarce in the literature. Need for early diagnosis of such conditions should be emphasized because of functional, esthetic, and psychological problems which should be evaluated and treated appropriately. The present paper presents a report of bilaterally missing permanent maxillary and mandibular canines. This case might contribute in the future studies of incidence of agenesis of permanent canines.

Pharmacological sedation is one of the effective ways of prevention of gag reflex development in patients experiencing anxiety and fright before dental treatment. We are reporting a case where we could successfully eliminate exaggerated gag reflex (intravenous [IV] Gagging Severity Index) in a dental patient using IV sedation with dexmedetomidine. IV administration of dexmedetomidine provided elimination of gag reflex at a depth of sedation for the patient with the Richmond Agitation-Sedation Scale score of −2 and −1. The patient received dexmedetomidine 1.0 μg/kg for 10 min and then a continuous infusion of dexmedetomidine 0.4 μg/kg/h. The use of dexmedetomidine for sedation may be an alternative to other pharmacological agents in patients with dental anxiety accompanied by exaggerated gag reflex.

Background: Studies show that fluoride (F) and nano-hydroxyapatite (nano-HA) would result in remineralization of white spot lesions (WSLs), which are among the most prevalent consequences of fixed orthodontic treatment. The present study evaluates and compares the clinical effects of an Iranian toothpaste containing nano-HA with F-containing one on early enamel lesions. Materials and Methods: In this randomized clinical trial study, 50 patients who had received fixed orthodontic treatment were recruited immediately after debonding. Three photographs, including frontal, lateral right and left views of occlusion, were obtained. Moreover, surfaces with WSLs were recorded using DIAGNOdent. Plaque index of each patient determined using disclosing agents. At first visit, each patient was asked to select one type of toothpaste (nano-HA containing vs. F containing named A or B), randomly and were instructed how to brush their teeth (25 patients in each group). Examination was done at 1, 3, and 6 months' intervals. Finally, photographs were analyzed by Digimizer (V5) software, and the lesion extent was recorded in pixels. SAS 9.4 was used to analyze data and was set at 0.05. Results: According to data, lesion extent showed a significant decrease (P < 0.001). At baseline, the difference between the two groups regarding the lesion extent was 268 pixels while it dropped to 89 pixels after 6 months. DIAGNOdent results showed that at baseline, fluorescence difference was 0.3 while it reached the number of 0.8 after 6 months, indicating the outperformance of nano-HA containing toothpaste. Conclusion: The Iranian nano-HA containing toothpaste performed better than F-containing one in terms of the amount of remineralization and diminishing the lesion extent.

Background: In this study, we aimed at evaluating the frequency of chemoradiotherapy-induced mucositis (CIM, RIM) and its related risk factors in patients with the head-and-neck cancers (HNCs). Materials and Methods: In this cross-sectional prospective descriptive study, we evaluated a total of 54 HNCs patients referred to the Oncology Chemoradiotherapy Department of Razi and Amiralmomenin University Hospitals of Rasht, for site and grade (WHO classification) of CIM/RIM, based on their demographic features and possible risk factors. SPSS software version 18 and statistical tests (i.e., Fisher's exact test) were used, and the level of significance was considered as P < 0.05. Results: Finally, patients enrolled in the study were 34 men and 20 women (40–72-year-old), of which 43 cases (79.6%) showed signs and symptoms of CIM/RIM (mostly aged 60–69-year-old). Grade 2 mucositis was the most frequent type (18 cases: 33.3%) and mouth floor was the most common site of CIM/RIM (15 patients: 34.9%). Age (P = 0.023), gender (P = 0.012), and the severity of pain (P = 0.018) were significantly related to mucositis in patients with HNCs who underwent chemotherapy or radiotherapy. Conclusion: Mucositis, especially in the oral cavity, is a common complication of chemoradiotherapy in HNCs patients. Age, gender, and the severity of pain are significantly associated with the frequency of CIM/RIM.

Background: The aim of this study was to evaluate the hypothesis that budesonide increases the susceptibility of teeth to root resorption during the course of orthodontic treatment. Materials and Methods: A randomized controlled trial design (animal study) was employed. Budesonide was administered in test group for 14 days during which orthodontic force was applied to upper right molar. Afterwards, root resorption was measured on mesio-cervical and disto-apical parts of the mesial root on transverse histological sections. ANOVA and Bonfferoni tests were used. Statistical significance was considered to be P ≤ 0.05. Results: In general, the subgroups in which the force was applied showed significantly greater root resorption. Where force was applied there was no significant difference, whether budesonide was administered or not. While where there was no force, a group who received budesonide showed significantly greater root resorption than the other, unless at the coronal level where the difference was not significant. Conclusion: Within the limitations of this study, it seems budesonide could increase root resorption, but in the presence of orthodontic force this effect is negligible.

Background: There are some factors which can affect preoperative patient anxiety such as the necessity of procedure, postoperative pain, and patient's conception of his body image. The aim of this study was to assess the relation of patients' preoperative anxiety and postoperative patients' satisfaction in dental implant surgery. Materials and Methods: Dental implants were placed in 40 patients (19 male and 21 female) who were referred to Dental Implant Surgery Department in Imam Reza clinic, during March–December of 2014 in Shiraz. The procedures were performed with or without bone regeneration. Preoperative anxiety was evaluated using Corah Dental Anxiety Scale, and postoperative satisfaction was determined on the basis of pain intensity, bleeding tendency, inability to eating, and overall satisfaction by filling a questionnaire in the 2^nd or 3^rd week after surgery. Data were collected and analyzed using Mann-Whitney test. Results: Preoperative anxiety was detected as high in 10%, mild in 85%, and moderate in 5% of patients. Anxiety and depression score did not differ in both genders. There was no statistical difference between neither level of anxiety nor depression in both high and low educated patients. Postoperative bleeding, difficulty in eating, and overall satisfaction was nearly the same in both genders. Statistical analysis demonstrated a lower pain level and higher pain threshold in men than women (P = 0.007). Patients' age was not related to anxiety, depression, amount of bleeding, pain, and difficulty in eating. Overall dental care satisfaction was similar in both men and women. Conclusion: The results of the study indicated that while anxiety does play a role in the perception of pain by patients undergoing implant surgery, overall patient satisfaction and post surgical outcomes did not significantly differ.

Background: Elastomeric chains are commonly used in orthodontics. Force decay in these materials poses clinical problems. The aim of this study was to evaluate the effects of three different mouthwashes on the force decay of orthodontic chains. Materials and Methods: In this experimental study, elastomeric chains with two different configurations were divided into eight groups (two control and six test groups). After 10 s of prestretching up to 100% of their initial length, the chains were stretched for 25 mm on jig pins and then immersed in artificial saliva, persica, chlorhexidine 0.2% and sodium fluoride 0.05% mouthwashes. Ten cycles of thermocycling between 5°C and 55°C were conducted daily during the test period. In order to reach a 200-g initial force, seven loop closed chains, and five-loop short chains were selected. Forces were recorded by digital force gauge (Lutron) at initial, 24 h, 1, 2, 3 and 4 weeks for all groups. The amount of force loss was compared among different mouthwashes and times using one-way analysis of variance (post-hoc, Tukey, α = 0.05). Results: About 20% of the force decay occurred during the first 24 h, but after that and up to the 4 ^th week the rate of force loss was gradual and steady. After 4 weeks, persica and chlorhexidine caused the lowest and the highest percentage of force loss, respectively. These two mouthwashes showed statistically significant differences at all points of time (P < 0.05). Conclusion: Within the limitations of this study, during the orthodontic treatment, persica is preferred to chlorhexidine for oral health control.

Background: The aim of the present study was to compare the antibacterial effects of coffee extract with those of 0.2% sodium fluoride and chlorhexidine (CHX) mouthrinses on Streptococcus mutans and Lactobacillus plantarum in vitro. Materials and Methods: In this experimental in vitro study, the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and disk diffusion method were determined for different concentrations of coffee extract, 0.2% CHX, and 0.2% fluoride against S. mutans and L. plantrum. Data were analyzed using Kruskal–Wallis analysis. Statistical significance level was established at P < 0.05. Results: The MIC of coffee was achieved at 62.5 and 500 mg/mL against S. mutans and L. plantarum, respectively. The MBC against S. mutans was 125 mg/mL. The diameter of the zone of inhibition around S. mutans for pure coffee extract (100%), CHX (0.2%), and fluoride was 19.8 mm, 9.92 mm, and 0, respectively. At a concentration of 6.25%–100%, coffee had a significantly larger zone of inhibition compared to CHX and fluoride)P= 0.01). The MBC of coffee and fluoride was 0 against L. plantarum. The lowest inhibitory concentration belongs to CHX (MIC: 0.624 mg/ml for L. plantarum and 0.125 mg/ml for S. mutans). Conclusion: The coffee had an antibacterial effect against S. mutans on 62.5–1000 mg/ml concentrations. The zone of inhibition around S. mutans for higher concentrations of coffee (6.25%–100%) was significantly higher than that of CHX and fluoride 0.2%. Bacteriostatic effect of coffee against L. plantarum was obtained at 500–1000 mg/ml. However, coffee and fluoride did not show any bactericidal effects against L. plantarum.

Background: The aim of this study was to compare microbial microleakage of class V cavities restored with different materials and techniques using a microbial leakage assessment method. Materials and Methods: One hundred extracted, caries-free, human maxillary premolars were randomly divided into five groups. Group 1: Resin-modified glass ionomer (RMGI), Group 2: Closed sandwich with flowable composite + nanohybrid composite, Group 3: Nanohybrid composite, Group 4: Closed sandwich with RMGI + nanohybrid composite, and Group 5: Flowable composite + nanohybrid composite that were co-cured together (“snow-plow” technique). A microbial penetration method utilizing Streptococcus mutans as an indicator was tested for leakage assessment. Data were analyzed and the significance level was α =0.05. Results: The log-rank test indicated a statistically significant difference in leakage rates among the five groups (P = 0.008). Mantel–Cox log-rank test indicated statistically significant differences in microleakage rates between Groups 1 and 3 (P = 0.029), between Groups 2 and 5 (P = 0.005), and between Groups 3 and 5 (P = 0.002). Conclusion: With respect to the limitations of an in vitro study, our findings suggest that adding a thin layer of flowable composite or RMGI under nanohybrid composite in class V cavities did not decrease the bacterial leakage rate, whereas use of the “snow-plow” technique caused an increase in the microleakage rate.

Background: Keratocystic odontogenic tumor (KCOT) is a developmental odontogenic cyst on which various investigations have been focused due to its biological activities, high tendency to recur and different growth mechanisms in comparison with other cystic lesions. Previous studies have shown different biological and proliferative activities for the lining epithelium of KCOT. The aim of this study was immunohistochemical evaluation of Bcl-2 and epidermal growth factor receptor (EGFR) expression in KCOT compared with dentigerous cyst and ameloblastoma. Materials and Methods: Formalin-fixed and paraffin-embedded tissue sections of 16 cases of KCOT, 16 cases of dentigerous cyst and 16 cases of ameloblastoma were immunohistochemically analyzed to determine Bcl-2 and EGFR proteins' expression. Biotin-Stereotavidin method was used. It was observed by two oral pathologists separately, and the data were analyzed by Mann-Whitney and Kruskul-Wallis. P < 0.05 was considered as significant. Results: Regardless of staining intensity, all cases of ameloblastoma and KCOT except dentigerous cases were positively stained for Bcl-2. Expression of Bcl-2 was higher in the peripheral layer of ameloblastoma and basal layer of KCOT. Furthermore, all cases of ameloblastoma and dentigerous cysts except KCOT samples were positively stained for EGFR. Expression of EGFR was higher in the peripheral layer of ameloblastoma and basal layer of dentigerous cysts. Conclusion: According to the expression of - Bcl-2 in ameloblastoma and KCOT, and no expression of EGFR in KCOT, it can be concluded that the biological activity and growth mechanisms of KCOT are different compared with other cystic lesions. However, the aggressive potential of KCOT is not as severe as that of a neoplasm such as ameloblastoma.

Background: The study's purpose was to study buccal pouch grafting (BPG) with xenograft, freeze-dried bone allograft (FDBA), or FDBA + decalcified FDBA (DFDBA) on alveolar ridge width preservation and overlying soft tissue thickness at dog premolar extraction sites. Materials and Methods: In this animal study, 4 dogs had their mandibular first premolar (P1) and distal roots of P2, P3, and P4 extracted (after endodontic treatment of the mesial roots) bilaterally. A small buccal pouch was created at each extraction socket and four treatments tested: nothing, xenograft, FDBA, or FDBA + DFDBA. Casts made pretreatment and at 1 and 3 months after treatment allowed measurements of buccolingual alveolar ridge width (BLRW), while overlying buccal soft tissue thicknesses were measured clinically. Data were assessed using analysis of variance to compare changes in soft tissue thickness and BLRW between times and treatments. Tukey–Kramer adjustment for multiple comparisons was applied for doing post hoc, pairwise comparisons. Results were considered significant if P < 0.05. Results: Control sites showed significant (P = 0.0067) decreases in soft tissue thickness over time while there was a trend for increased soft tissue thickness at all grafted sites. There were significant losses in BLRW over time for control (P = 0.0032) and FDBA groups (P = 0.015) with a trend for loss with FDBA + DFDBA. Pairwise comparison using Tukey–Kramer adjustment revealed significant increases in BLRW from T1 to T3 for the xenograft group relative to all the others. Conclusion: BPG using xenograft is effective in maintaining hard and soft tissue stability following tooth extraction.

Background: Glass ionomer cement is a common material used in pediatric dentistry. The aim of this study was to evaluate the microleakage of high-viscosity glass ionomer restorations in deciduous teeth after conditioning with four different conditioners. Materials and Methods: Fifty intact primary canines were collected. Standard Class V cavities (2 mm × 1.5 mm × 3 mm) were prepared by one operator on all buccal tooth surfaces, including both enamel and dentin. The samples were divided into five groups with different conditioners (no conditioner, 20% acrylic acid, 35% phosphoric acid, 12% citric acid, and 17% ethylenediaminetetraacetic acid [EDTA]). Two-way - ANOVA, Kruskal-Wallis and Mann-Whitney tests were used to compare the means of microleakage between the five groups. The significance level was set at P < 0.05. Results: There was no significant difference between the means of microleakage in incisal (enamel) and gingival (dentin) margins (P = 0.34). Furthermore, there was no significant difference between the means of microleakage in enamel and dentin margins (P = 0.4). There was a significant difference between the means of microleakage in different groups (P = 0.03). Conclusion: Within the limitations of this study, it is suggested that 20% acrylic acid and 17% EDTA be used for cavity conditioning which can result in better chemical and micromechanical adhesion.

Background: This study was carried out to evaluate the effect of root canal filling on the bond strength of three intracanal posts in the primary incisors. Materials and Methods: Sixty primary incisors were prepared and then divided into two groups (n = 30). The first group canals obturated with zinc oxide eugenol (ZOE) and Group 2 canals obturated with Metapex. Further, the two group categories were divided into three subgroups (n = 10): (1) short composite post (SCP), (2) glass fiber posts (GFPs) cemented with flowable composite, and (3) GFP with glass ionomer cement (GFP + GIC). The push-out test was performed with a universal testing machine. The results were statistically analyzed with two-way analysis of variance.(α = 0.05). Results: The mean bond strength of the first group obturated with ZOE was lower than that of the second group obturated with Metapex (P = 0.046). Moreover, from a statistical point of view, in all three subgroups, the correlation of mean push-out bond strength between SCP and GFP coated with flowable composite was not substantial at P = 0.97. However, the mean bond strength of SCP was in fact significantly greater than that of the GFP coated with GIC since P = 0.034. Conclusion: Using ZOE resulted in the significant reduction of the mean bond strength of the intracanal posts when utilized in the primary anterior teeth. Likewise, SCP and GFP coated with flowable composite showed higher push-out bond strengths for restoring primary anterior teeth.

Background: Liver transplantation has turn into a standard management for chronic liver failure (CLF), and the number of recipients increased during the last few years. Enterococci are progressively related to nosocomial and opportunistic infections. Oral cavity may act as a reservoir for this species, especially in cases with oral infection. Immunocompromised patients are prone to serious enterococci-related disease. This study investigated the prevalence of Enterococcus faecalis in the saliva samples of patient candidates for liver transplantation. Materials and Methods: In this cross-sectional study the saliva samples of 100 patient candidates for liver transplantation and 100 age- and sex-matched healthy control group were collected. Bacterial DNA was extracted from the samples and E. faecalis was detected using polymerase chain reaction test. Fisher's exact test and Mann–Whitney test were used to correlate the positive and negative cases with the disease. Statistically, a significant difference was considered when P < 0.05. Results: There was no significant difference between both groups for the presence of E. faecalis. This bacterium isolated from the saliva of two cases in the study group and only one healthy control. The higher rate of carious teeth were detected in the oral cavity of CLF cases than control group (P = 0.001). Conclusion: Patients with chronic liver diseases assessed in this research showed a higher incidence of poor oral health and caries compared with the healthy controls, but there was no statistical difference in the presence of E. faecalis in saliva samples of each group. Complete oral examination, dental treatment, and oral hygiene instruction are necessary for all these cases before liver transplantation.

Background: The aim of this study was to assess the effect of increasing the drilling speed and depth during implant site preparation on bone viability. Materials and Methods: In this prospective cohort study, participants were divided into four groups based on the speed and depth of drilling at the first molar site in the mandible. Participants underwent drilling at Group 1: 1000 rpm and 10 mm depth, Group 2: 1500 rpm and 10 mm, Group 3: 1000 rpm and 13 mm, and Group 4: 1500 rpm and 13 mm. Obtained specimens were assessed histologically to the qualitative measurement of bone viability, and the percentage of vital bone were evaluated by histomorphometric analysis. ANOVA was used to compare age and the mean percentage of vital bone and Tukey's test as post hoc was applied for pairwise comparison of groups. Results: A total of 100 participants were studied in four groups (25 subjects in each group). Histological evaluation revealed a low level of bone viability maintenance in all groups. Histomorphometric analysis showed the mean percentage of vital bone was 9.5 ± 3.91% in Group 1, 8.86 ± 3.84% in Group 2, 8.32 ± 3.80% in Group 3, and 4.27 ± 3.22% in Group 4. A significant difference was noted in the mean percentage of bone viability among the four groups (P = 0.001). Conclusion: It seems that increasing the drilling speed or depth during dental implant site preparation does not affect the mean percentage of cell viability, while the increase in both depth and speed may decrease the percentage of viable cells.

Background: The aim of this study was to evaluate and compare the in vitro biofilm forming capacity of Enterococcus faecalis on Gutta-percha points disinfected with four disinfectants. Materials and Methods: A total of 50 Gutta-percha points used in this study were divided into four test groups based on disinfectant (5.25% sodium hypochlorite, 2% chlorhexidine gluconate, 20% neem, 13% benzalkonium chloride [BAK]), and one control group. The Gutta-percha points were initially treated with corresponding disinfectants followed by anaerobic incubation in Brain Heart Infusion broth suspended with human serum and E. faecalis strain for 14 days. After incubation, these Gutta-percha points were stained with Acridine Orange (Sigma - Aldrich Co., St. Louis, MO, USA) and 0.5 mm thick cross section samples were prepared. The biofilm thickness of E. faecalis was analyzed quantitatively using a confocal scanning laser microscope. Results statistically analyzed using analysis of variance. P < 0.05 was considered to be significant. Results: Confocal scanning laser microscope showed reduced amount of E. faecalis biofilm on Gutta-percha points treated with BAK and sodium hypochlorite. Post-hoc (least square differences) test revealed that there is no statistically significant difference between BAK and sodium hypochlorite groups (P > 0.05). Conclusion: This study illustrates that the Gutta-percha points disinfected with sodium hypochlorite and BAK showed minimal biofilm growth on its surface.

Background: Nowadays, different clinical behaviors of odontogenic cysts, little information about their biological agents, importance of diagnosis, and early diagnosis of these lesions have encouraged the researchers to conduct new studies. JunB acts as a regulator of vascular endothelial growth factor (VEGF) protein production and affects vessel proliferation and tissue angiogenesis. Hence, this study was conducted to compare angiogenesis through VEGF and JunB expression in odontogenic keratocysts (OKCs) and dentigerous cysts (DCs). Materials and Methods: A total of 25 paraffin blocks of OKCs and 25 DCs were included in this experimental descriptive cross-sectional study, and immunohistochemical expression of VEGF and JunB was evaluated. Percentage and score of expression were recorded for each sample, and independent t-test, Mann–Whitney U, and Spearman statistical tests were run to analyze the data. The statistical significance level was set at <0.05. Results: From 50 studied samples, 39.6% belonged to women and 60.4% belonged to men, with mean age of 34.2 ± 1.7 years. The mean percentages of JunB expression were 52.88 ± 17.35 and 74.6 ± 18.55 for DC and OKC samples, respectively. This expression was significantly higher in OKC than DC, and it had significantly higher scores as well (P= P = 0.0001 and 0.00033, respectively). The means of VEGF were 20.2% ±11.86 and 52.6% ±19.98 in DC and OKC samples, respectively. The mean VEGF expression was significantly higher in OKC than DC (P = 0.045), and it had significantly higher scores, too (P = 0.000). Furthermore, there was a significant correlation between VEGF and JunB expression in the studied samples (r_s = 0.3 and P= 0.005). Conclusion: Based on the results of this study, it seems evaluation of angiogenesis through JunB expression can be helpful in the prediction of more aggressive behavior in pathologic lesions such as OKC.

Background: Elastomeric chains are of clinical importance to orthodontics. Therefore, their behavior should be assessed under different conditions. Some of their critical aspects remain unstudied (including effects of different elongations and chain forms on their force properties). Therefore, we aimed to assess these factors. Materials and Methods: This in vitro study was performed on 540 observations: first, 90 chains (10 specimens per subgroup of three brands [American Orthodontics, Ortho Technology (OT), and G&H], each from three chain types [closed, short, and long]) were stretched for three extents (40%, 60%, and 100%) and their forces were measured using a universal testing machine. Afterward, 270 new chains of the same brands/types were stretched for the same extents by installing them onto pairs of pins with different interpin distances. Plates holding pins/chains were incubated in artificial saliva at 37°C for 4 weeks. Afterward, their forces were measured and analyzed using partial correlation coefficient, three-way analysis of variance (ANOVA), Tukey, Student's t, and Mann–Whitney tests (α = 0.001). Results: Forces degraded significantly from an overall mean of 3.97 ± 0.97 N to 1.29 ± 0.39 N after 4 weeks (all P = 0.000, t-test/Mann–Whitney). ANOVA showed highly significant differences among brands, types, and elongations, in terms of “initial force, force decay, and residual force” (all P = 0.000). Almost all post hoc pairwise comparisons were significant (Tukey P = 0.000). There was a strong positive correlation between elongation extent and force loss (r = 0.846, P = 0.000). Conclusion: OT might be the most preferable brand. Closed chains might usually show better results, especially in OT chains. Instead of using chains half of the size of the space (to elongate for 100%), longer chains should be used to stretch for lesser extents.

Background: Surface roughness associated with improper finishing/polishing of restorations can result in plaque accumulation, gingival irritation, surface staining, and poor esthetic of restored teeth. The study aimed to evaluate the efficiency of various finishing and polishing systems and time using various procedures on surface roughness of some esthetic restorative materials. Materials and Methods: In this in vitro study, samples of two composite materials, compomer and glass ionomer cement (GIC) materials, were fabricated. Finishing and polishing were done immediately (n = 40) and after 1 week (n = 40) using four systems (diamond bur + soflex discs; diamond bur + Astropol polishing brush; tungsten carbide bur + soflex discs; tungsten carbide bur + Astropol polishing brush). Surface roughness was measured using surface profilometer. Data were statistically analyzed by t-test (for each material and time period) and one-way analysis of variance followed by Tukey's post hoc (for finishing and polishing systems) at a significant level of P < 0.05. Results: Analysis of time period, irrespective of finishing and polishing system showed that Ra values were greater (P < 0.05) in delayed polishing in GIC > Z100 > Filtek P90 > Dyract AP, suggesting immediate polishing is better. Among the materials, Filtek P90 had the least Ra values indicating the smoothest surface among all materials, followed by Z100, Dyract AP, and GIC. Comparison of polishing and finishing systems irrespective of materials showed that Ra values were lower (P > 0.05) in diamond + Astropol combination whereas diamond + soflex had the greatest Ra values. Conclusion: It might be concluded that: (i) Filtek P90 showed least Ra values followed by < Z100 < Dyract < GIC; (ii) immediate (24 h) finishing/polishing of materials is better than delayed; and (iii) among all these polishing systems, diamond bur–Astropol and Astrobrush showed good surface finish.

Background: According to the development of resistant strains of pathogenic bacteria following treatment with antimicrobial chemotherapeutic agents, alternative approaches such as lethal photosensitization are being used. The aim of this study was to evaluate the effect of visible light and laser beam radiation in conjugation with three different photosensitizers on the survival of two main periodontopathogenic bacteria including Porphyromonas gingivalis and Fusobacterium nucleatum in different exposure periods. Materials and Methods: In this in vitro prospective study, strains of P. gingivalis and F. nucleatum were exposed to visible light at wavelengths of 440 nm and diode laser light, Gallium-Arsenide, at wavelength of 830 nm in the presence of a photosensitizer (erythrosine, curcuma, or hydrogen peroxide). They were exposed 1-5 min to each light. Each experiment was repeated 3 times for each strain of bacteria. Data were analyzed by two-ways ANOVA and least significant difference post-hoc tests. P < 0.05 was considered as significant. After 4 days the colonies were counted. Results: Viability of P. gingivalis was reduced 10% and 20% subsequent to exposure to visible light and diode laser, respectively. The values were 65% and 75% for F. nucleatum in a period of 5-min, respectively. Exposure to visible light or laser beam in conjugation with the photosensitizers suspension caused significant reduction in the number of P. gingivalis in duration of 5-min, suggesting a synergic phototoxic effect. However, the survival rate of F. nucleatum following the exposure to laser with hydrogen peroxide, erythrosine and rhizome of Curcuma longa (curcumin) after 5-min was 10%, 20% and 90% respectively. Conclusion: Within the limitations of this study, the synergic phototoxic effect of visible light in combination with each of the photosensitizers on P. gingivalis and F. nucleatum. However, the synergic phototoxic effect of laser exposure and hydrogen peroxide and curcumin as photosensitizers on F. nucleatum was not shown.

Background: Different techniques are used to evaluate the anatomy of root canal system. The present study was aimed to evaluate the root canal morphology of mandibular premolars using clearing and cone beam computed tomography (CBCT) techniques. Materials and Methods: A total of 182 mandibular first and second premolars were evaluated in vitro using 100 μm CBCT cross sections. The root canal morphology of the teeth was determined based on Vertucci classification in relation to the prevalence of C-shaped canals, lateral canals, and furcation location. Having removed the pulp tissue with NaOCl solution and staining the root canals with India ink, the samples were decalcified with 5% nitric acid and dehydrated with isopropyl alcohol. Finally, the samples were cleared with methyl salicylate. Data were analyzed by SPSS 16 software using McNamara, t-test, and Kappa coefficient. Results: After Type I, the most frequent morphologies in both first and second premolars were Type V followed by Type IV. The prevalence rates of C-shaped morphology in first premolars using clearing and CBCT were 4.4% and 6.6%, respectively. However, no C-shaped morphology was found in second premolars. The maximum and minimum levels of agreement between the two techniques were observed in Type IV and Type V root canal morphologies, respectively. Extra root canals were identified in 25% and 13% of the first and second premolars, respectively. Conclusion: CBCT showed a higher accuracy in determining C-shaped root canal morphology than the clearing technique. It also showed the least accuracy in diagnosing lateral root canals.

Background: In this study, the effect of adding purified powder of Salvia officinalis on the mechanical properties and bonding ability of resin-modified glass ionomer (RMGI) cement is investigated. Materials and Methods: In this in vitro study Purified powder of S. officinalis with particles smaller than 50 μ, in weight percentages of 0.5%, 0.75%, 1%, and 1.25%, was added to RMGI powder (GC Fuji II LC, GC USA). Fifty samples in five groups of control and percentages that considered, from the powder of GI combined with liquid, according to the manufacturer instructions and prepared samples with 4 mm × 6 mm dimensions and placing in distilled water in an incubator with temperature 37°C for 24 h. Fifty sound extracted upper premolars were collected and divided into five groups. The dentinal cross-sections on the occlusal surfaces of teeth were prepared and assessed under a stereomicroscope with ×16. Then, samples with 2 × 4 dimensions from RMGI was prepared on dentin surface and keeping in moisture environment in an incubator with temperature 37°C for 24 h. Compressive strength and shear bond strength test done with a universal testing machine at the rate of 0.5 mm/min. For the assessment of mode of failure, stereomicroscope with a digital camera and ×20 was used, and photographs from bonding surface were taken. After collecting data, the ANOVA test was used for comparing shear bond strength between groups and Kruskal–Wallis test was used for comparing compressive strength. The Chi-square test was used for comparing the mode of failure between groups. The significance level for all tests was considered 5%. Results: According to the statistical analysis, compressive strength (P = 0.486) and shear bond strength (P = 0.076) were not significantly different between the five groups. The distribution of mode of failure was not significantly different between groups (P = 0.663). Conclusion: The addition of purified powder of S. officinalis to RMGI powder does not affect compressive strength and shear bond strength of RMGI cement.

Background: Silane promotes bonding between ceramic and resin cement. Silane function could be improved by heat treatment and adding 4-Methacryloxyethyl trimellitate anhydride (4-META). The aim of this study was to assess the effect of heat treatment and adding 4-META to silanes on the microtensile bond strength of IPS e.max CAD ceramic and resin cement. Materials and Methods: In this in vitro study, 32 IPS e.max CAD blocks (6 mm × 6 mm × 4 mm) were randomly divided into 8 groups of 4. The ceramic surfaces were etched by 10% hydrofluoric (HF) for 20 s, and Clearfil Ceramic Primer Plus, Clearfil Porcelain Bond Activator (CPA) +4-META, CPA + Clearfil SE Bond (CPA + SE), and Bis-Silane with and without Oven drying at 100°C for 5 min were applied on the ceramic surfaces as silanes, and then, the ceramics were bonded to composite disks by dual-cured resin cements. Ultimately, a total of 120 sticks ( 1 mm × 1 mm × 8 mm) were subjected to microtensile bond strength test (15 sticks from each group) and the failure types were assessed by stereomicroscope at 40x. Data were analyzed by two-sided analysis of variance test and Student's t-test the P values were considered to be < 0.05. Results: The Bis Silane group (two bottles) showed maximum bond strength (P = 0.009). Heat treatment significantly reduced the bond strength in Bis Silane (P = 0.0001); but, in other groups, it did not show significant effect on the bond strength. Adding 4-META to CPA did not significantly affect the microtensile bond strength of IPS e.max CAD ceramic to resin cement, and there was no difference in mode of failure between groups. Conclusion: The effect of silane type was significant on the microtensile bond strength of the ceramic to resin cement. The effect of 4-META on the bond strength was not significant. The interaction between silane type and heat treatment on the bond strength of ceramic to resin cement was also significant.

Background: A precise impression is mandatory to obtain passive fit in implant-supported prostheses. The aim of this study was to compare the accuracy of three impression materials in both parallel and nonparallel implant positions. Materials and Methods: In this experimental study, two partial dentate maxillary acrylic models with four implant analogues in canines and lateral incisors areas were used. One model was simulating the parallel condition and the other nonparallel one, in which implants were tilted 30° bucally and 20° in either mesial or distal directions. Thirty stone casts were made from each model using polyether (Impregum), additional silicone (Monopren) and vinyl siloxanether (Identium), with open tray technique. The distortion values in three-dimensions (X, Y and Z-axis) were measured by coordinate measuring machine. Two-way analysis of variance (ANOVA), one-way ANOVA and Tukey tests were used for data analysis (α = 0.05). Results: Under parallel condition, all the materials showed comparable, accurate casts (P = 0.74). In the presence of angulated implants, while Monopren showed more accurate results compared to Impregum (P = 0.01), Identium yielded almost similar results to those produced by Impregum (P = 0.27) and Monopren (P = 0.26). Conclusion: Within the limitations of this study, in parallel conditions, the type of impression material cannot affect the accuracy of the implant impressions; however, in nonparallel conditions, polyvinyl siloxane is shown to be a better choice, followed by vinyl siloxanether and polyether respectively.

Background: Oral submucous fibrosis (OSMF) is a chronic debilitating disease of the oral cavity having premalignant potential and unclear pathogenesis. Recently, myofibroblast has been postulated to play an important role in its pathogenesis and in the process of carcinogenesis. The purpose of this study was to evaluate and compare the presence of myofibroblasts in normal mucosa, different grades of OSMF, and oral squamous cell carcinoma (OSCC). Materials and Methods: The present in vitro cross-sectional descriptive study sample consisted of three groups, including 40 OSCCs, 40 OSMF, and 10 sections of normal oral epithelium taken as control group. Alpha-smooth muscle actin was used to identify myofibroblasts using immunohistochemical technique. P < 0.05 was taken as statistically significant. Results: The presence of myofibroblasts was significantly higher in OSMF cases when compared with normal epithelium specimens. The presence of myofibroblasts was significantly higher in OSCC compared to OSMF cases. A significant difference was not observed between the different grades of OSCC. Conclusion: These findings favor the possibility that OSMF actually represents an abnormal healing process in response irritation caused by areca nut. A significant increase in myofibroblasts in OSCC as compared to OSMF also highlights the possible role it may play in the malignant transformation of OSMF.

Background: Setting of condylar inclination is inaccurate in nonarcon articulators because of alteration of the angle between the upper member and condylar track. This article presents a device which can be attached to a nonarcon articulator to rectify errors related to alterations of maxillary occlusal plane-horizontal condylar guidance relation in nonarcon articulators. Materials and Methods: The device provides tight connection of condylar axis to condylar track by mechanical interdigitation of fragments which are placed on condylar axis and condylar track. Condylar track rotates coordinated with condylar axis. Fragments consist of medial fragments placed on medial surface of articular fossa analogs, lateral fragments placed on lateral surface of articular fossa analogs, and condylar axis fragments placed on condylar axis. The device can be used during condylar inclination adjustment by interocclusal records, changing vertical dimension of occlusion, and occlusal adjustment of restorations. Initial evaluation of the device was performed during an opening hinge movement in a single experiment. The angle between condylar track and the upper member of the articulator was determined by calculation before and after applying hinge movement and with and without the device. Results: When the device was not used, the postexperimental condylar inclination was 7.31° higher than preexperimental value. Using the device, discrepancy reached 2.17°. Conclusion: Using this device may lead to more accurate condylar inclination adjustment which is followed by more accurate prosthetic teeth.

Background: A carious lesion is the accumulation of numerous episodes of demineralization and remineralization, rather than a unidirectional demineralization process. Tooth destruction can be arrested or reversed by the frequent delivery of fluoride or calcium/phosphorous ions to the tooth surface. Nanohydroxyapatite particle-containing dentifrices are the newer generation of products which claim to remineralize enamel lesions effectively. The aim of this study was to evaluate and compare the remineralization ability of dentifrices containing nanohydroxyapatite, NovaMin, and amine fluoride on artificial enamel caries. Materials and Methods: In this in vitro study, extracted sound premolars were placed in a demineralizing solution to produce deep artificial carious lesions. The teeth were then sectioned longitudinally and divided into three groups (n = 16 in each group): Group A (nanohydroxyapatite), Group B (NovaMin), and Group C (fluoride). The sections were then subjected to pH cycling for 7 days. Polarized light microscopy was utilized to record the depth of the lesions before and after treatment with the selected dentifrices. Changes in the mean lesion depth were statistically analyzed by one-way ANOVA and t-test. The level of significance was assessed at P < 0.05. Results: The lesion depth decreased significantly by 10.56% in Group A, 6.73% in Group B, and 9.58% in Group C (paired t-test, P < 0.001). When comparisons were made across the groups, no statistical significance was found between the Groups A, B, and C (ANOVA test, P > 0.05). Conclusion: All three dentifrices were found to be effective in remineralizing artificial carious lesions. Nanohydroxyapatite dentifrice produced significantly better results compared to fluoride- and NovaMin-containing dentifrices, instigating for its use in the management of early carious lesions.

Background: Orthodontic therapy has oral ecological changes causing increased numbers of mutans streptococci in saliva and plaque. The purpose of this study was to estimate counts and colonization pattern of Streptococcus mutans after application of fixed orthodontic appliances. Materials and Methods: Plaque samples of randomly selected sixty patients were collected before placement of orthodontic appliances from buccal and labial aspects of the anterior teeth and four first molars and readings were recorded as T₀. After placement of appliances (0.22 MBT preadjusted Gemini), i.e., 2^nd and 3^rd month, the plaque samples were collected again from same site and readings were recorded as T₁and T₂, respectively. Counts of S. mutans in these patients were determined by using DM Strips (Orion Diagnostic, Espoo, Finland). Kruskal–Wallis test and Mann–Whitney U-test were used to find out significant differences between different time interval for Dentocult score for S. mutans in orthodontic patients (P < 0.001). Results: Prior to the treatment, 46 patients (76%) showed mild and 14 patients (24%) showed moderate colonization of S. mutans. After treatment, the severity of colonization increased showing fifty patients (84%) moderate and six patients (10%) showing severe colonization of S. mutans at T₁, which further increased in severity at T₂with 54 patients (90%) showing severe colonization with S. mutans. Conclusion: Results showed that fixed orthodontic appliance increases colonization of S. mutans during orthodontic treatment.

Background: Adequate seal of the root canal is necessary to prevent recontamination and ensure the long-term clinical success. The aim of this study was to evaluate the sealing ability of ProRoot mineral trioxide aggregate (MTA), Biodentine, and Ortho MTA as the root canal obturation materials using the fluid infiltration method. Materials and Methods: In this invitro study a total of 66 extracted human mandibular premolars were randomly divided into five groups according to the material used for the root canal obturation. Group I - ProRoot MTA (20 samples), Group II - Biodentine (20 samples), Group III - Ortho MTA (20 samples), Group IV - negative group (3 samples), and Group V-positive group (3 samples). MTA, Biodentine, and Ortho MTA were applied using a cotton-tipped K-file #30 and hand plugger into the root canals of each group. In Group 4 (negative control), no filling material was used. In Group 5 (positive control), a single gutta-percha size #40 was inserted into the root canal without using a sealer. The teeth were mounted and exposed to the fluid infiltrarion system. Statistical analysis was performed using Kruskal–Wallis test the level of significance was set at α = 0.05. Results: Mean values of microleakage in MTA ProRoot, Biodentine and Ortho MTA groups were 1.83 ± 0.62, 1.95 ± 1.27 and 1.72 ± 0.83 μL in 8 minutes. No statistically significant difference was observed between the sealing ability of ProRoot MTA, Biodentine, and Ortho MTA (P = 0.091). Conclusion: Within the limitations of this study, microleakage values were similar to MTA ProRoot, Biodentine, and Ortho MTA using the fluid infiltration technique.

Background: The role of retinoblastoma (Rb) protein in cell cycle regulation prompted us to take up this study with the aim of assessing its role in the progression of oral cancer and to correlate with various clinicopathological parameters, including habits such as smoking, Paan chewing, and alcoholism. Materials and Methods: This observational study included surgical specimens from 10 apparently normal oral mucosa, 14 oral reactive lesions (ORL), 29 precancerous lesions and 43 oral cancers. The expression of Rb protein in tissue samples were evaluated by immunohistochemistry and correlated with clinicopathological data. The percentage and mean expression of Rb protein were statistically analyzed using Student's t-test and P < 0.05 was considered as statistically significant difference. Results: The expression of Rb protein was found to increase from normal, ORL, precancerous lesions to cancers. A consistently high expression of Rb protein was seen in oral cancers, with an increase in well-differentiated and moderately differentiated tumors. Patients with combined habits of Paan chewing, smoking, and alcohol consumption had a higher expression compared with those without habits. Conclusion: Within the limitations of this study, it seems that overexpression of Rb protein noted in oral cancer, with an increase in well and moderately differentiated tumors suggest a possible role of Rb in differentiation. The high expression of Rb in patients with combined habits of Paan chewing, smoking and alcohol consumption indicates that Rb pathway may be altered in habit-related oral malignancies.

Background: Nitric oxide (NO) has many functions in wound healing and bone metabolism. This study sought to assess the local effect of aminoguanidine (AG), a selective inducible NO synthase (iNOS) inhibitor, on the rate of bone healing. Materials and Methods: This experimental interventional study was conducted on 36 rats, which were randomly divided into three groups of control, placebo, and AG. Bone defects measuring 5 mm × 5 mm were created in the femur. In control group, bone defects remained empty. A placebo gel was applied to defects in the placebo group. AG gel was placed in bone defects in AG group. New bone formation and healing were assessed using histological and histomorphometric analyses. The healing score and the percentage of new bone formation (total bone mass, immature bone, and mature bone) were compared among the three groups using the Kruskal–Wallis test and analysis of variance, respectively. A P < 0.05 was statistically significant. Results: The mean healing score in AG group (3.17 ± 0.577) was significantly higher than that in control (2.67 ± 0.49) and the placebo (2.58 ± 0.515) groups (P = 0.036). The percentage of new mature (lamellar) bone in AG group (22.06 ± 1.90) was significantly higher than that in control (20.94 ± 2.03) and the placebo (20.53 ± 1.20) groups (P = 0.008). Conclusion: The rate of bone healing was faster in the AG compared to the other two groups. Local application of selective iNOS inhibitors like AG may be efficient as an adjunct in the clinical setting where local bone formation is required.

Background: Titanium alloys are widely used in dental applications as they have good mechanical and biological properties. Implant failure is more likely to occur in inflammatory diseases related to acidic pH. The aim of the present study was to assess the effect of erbium chromium-doped yttrium-scandium-gallium-garnet 2780 nm laser surface treatment on the electrochemical behavior of titanium alloy (Ti-6Al-4V) at acidic pH. Materials and Methods: In this in vitro study, a total of 20 discs of titanium alloy (Ti-6Al-4V) were used. First group, ten discs were irradiated with Er, Cr: YSGG laser which was operating in a normal room atmosphere and temperature at power 2W for 20 s at a constant distance of 0.5–1 mm with the laser system. The second group, ten discs untreated. The electrochemical behavior for both groups was investigated in simulated body fluid at pH 5.20 for up to 864 h at 192, 360, 696, and 864 h intervals using potentiodynamic polarization test and electrochemical impedance spectroscopy to evaluate the corrosion resistance. Results: Laser-treated Ti-6Al-4V showed higher corrosion resistance at pH 5.20 compared to the untreated alloy. Immersion time affected the electrochemical behavior. Conclusion: Er, Cr: YSGG laser could improve the corrosion resistance of Ti–6Al–4V at acidic pH.

Background: The second processing cycle for adding the artificial teeth to heat-polymerized acrylic resin denture bases may result in dimensional changes of the denture bases. The aim of this study was to evaluate the dimensional changes of the heat-polymerized acrylic resin denture bases with one and two-cycle processing methods. Materials and Methods: A metal edentulous maxillary arch was used for making 40 stone casts. Maxillary complete dentures were made with heat-polymerized acrylic resins (Meliodent and Acropars) with one and two stage processing methods (n = 10 for each group). Linear dimensional changes in anteroposterior and mediolateral distances and vertical changes in the first molar region were measured following each processing cycle, using a digital caliper. Mean percentage of the dimensional changes were subjected to two-way analysis of variance and Tukey honest significant difference tests (α = 0.05). Results: Postpolymerization contraction occurred in both anteroposterior and mediolateral directions in all studied groups; however, the vertical dimension was increased. Acropars acrylic resin showed the highest dimensional changes and the second processing cycle significantly affected the measured distances (P < 0.05). Meliodent acrylic resin was not significantly influenced by the processing method. Conclusion: Reheating of the acrylic resin denture bases for the addition of denture teeth result in linear dimensional changes, which can be clinically significant based on the acrylic resin used.

Background: There is a two-way relationship between periodontal disease and diabetes. The purpose of this study was to evaluate the clinical and metabolic effects of a xanthan-based chlorhexidine (CHX) gel used as an adjunct to nonsurgical periodontal therapy in Type II diabetic patients with chronic periodontitis. Materials and Methods: Sixty-eight diabetic patients with moderate to advanced periodontitis and glycated hemoglobin (HbA1c) ≥6% were selected. The test group (n = 34) received scaling and root planning (SRP) plus xanthan-based CHX gel. The control group (n = 34) received single SRP. Fasting blood sugar (FBS) and HbA1c tests were done at the baseline and after 3 and 6 months. Data from the study were analyzed using descriptive statistics (mean ± standard deviation and frequency), ANOVA test by SPSS.15 software (SPSS Inc. Chicago, IL, USA). P < 0.05 was considered statistically significant. Results: Patients in test group exhibited a decrease in FBS from the baseline (227 ± 64.97) to the 3 and 6 months follow-up (208 ± 61.95 and 201 ± 61.33; P < 0.001). HbA1cb levels decreased from 7.72 ± 0.99 to 6.20 ± 0.97 and 6.06 ± 1.04 after 3 and 6 months follow-up (P < 0.001), respectively. Reduction of FBS and HbA1c was statistically significant after 3 and 6 months in the control group (P < 0.001). Conclusion: Considering the limitations of this study, the application of CHX gel might improve the effects of nonsurgical periodontal treatment in diabetic patients with periodontitis.

Background: The purpose of this study was to evaluate the bond strength between two porcelains (VITA VMK Master and VITA VM13) and two types of base metal alloys (Ceramill Sintron and Verabond). Materials and Methods: In an experimental study, 20 rectangular strips (25 mm × 4 mm × 0.5 mm) of each base metal alloy (Ceramill Sintron and Verabond) were fabricated according to the manufacturer's instructions. After sandblasting and polishing, the samples were placed in an ultrasonic device to remove surface contaminants. A surface of 8 mm × 4 mm × 1 mm of samples was veneered with Vita VM13 and VITA VMK Master. The samples were divided into four groups (n = 10 each group; VM13/Ceramill, VMK Master/Ceramill, VM13/Verabond, and VMK Master/Verabond), and bond strength was evaluated by three-point bending test with a universal testing machine. Two-way ANOVA was used for comparison in each group, post hoc Scheffe's test was used for analyzing data between groups, and the Kolmogorov–Smirnov test was used for the normality (P < 0.05). Results: The maximum bond strength was related to Verabond/VM13 (44.35 ± 7.9 MPa) and then the Ceramill Sintron/VM13 (39.33 ± 4.43 MPa), and the lowest was related to the Ceramill Sintron/VMK Master (29.75 ± 3.2 MPa). There was no significant difference between bond strength of VM13 with the two alloy groups (P > 0.05), and bond strength of VMK Master to Ceramill Sintron CAD/CAM alloy was less than the conventional Verabond alloy (P < 0.05); however, bond strength of all the groups was above the standard threshold (25 MPa). Conclusion: Based on the results of this study, the bond strength of the porcelain to Verabond was better, but the bond strength of the porcelain to Ceramill Sintron also was not less than the standard threshold; thus, this new CAD/CAM alloy can be an alternative to the conventional base metal alloys in the metal-ceramic restorations.

Background: This study was done to evaluate remineralizing potential of bioactive glasses (BAGs) and amorphous calcium phosphate-casein phosphopeptide (ACP-CPP) on early enamel lesion. Materials and Methods: Twenty freshly extracted mandibular premolars were sectioned sagittally. The buccal half was impregnated in acrylic resin blocks and treated with 37% phosphoric acid in liquid form, to demineralize enamel surface to simulate early enamel lesion. The samples were divided into two groups. The samples in Group I were treated with ACP-CPP (GC Tooth Mousse) and in Group II with BAG (Sensodyne Repair and Protect) and stored in saliva to prevent dehydration. The samples were tested for microhardness. The data obtained was analyzed using ANOVA post hoc multiple comparison and independent sample t- test and presented as a mean and standard deviation. Results: All the samples showed a decrease in the microhardness after demineralization. After application of remineralizing agents, Group II showed a highly significant increase in the microhardness (P < 0.05) after 10 days, while Group I showed a significant increase in microhardness after 15 days (P < 0.05). Conclusion: Both the remineralizing agents tested in this study can be considered effective in repair and prevention of demineralization. BAG showed better results initially, but eventually both have similar remineralizing potential.

Implant surgery in mandibular anterior region may turn from an easy minor surgery into a complicated one for the surgeon, due to inadequate knowledge of the anatomy of the surgical area and/or ignorance toward the required surgical protocol. Hence, the purpose of this article is to present an overview on the: (a) Incidence of massive bleeding and its consequences after implant placement in mandibular anterior region. (b) Its etiology, the precautionary measures to be taken to avoid such an incidence in clinical practice and management of such a hemorrhage if at all happens. An inclusion criterion for selection of article was defined, and an electronic Medline search through different database using different keywords and manual search in journals and books was executed. Relevant articles were selected based upon inclusion criteria to form the valid protocols for implant surgery in the anterior mandible. Further, from the selected articles, 21 articles describing case reports were summarized separately in a table to alert the dental surgeons about the morbidity they could come across while operating in this region. If all the required adequate measures for diagnosis and treatment planning are taken and appropriate surgical protocol is followed, mandibular anterior region is no doubt a preferable area for implant placement.

Background: Even though there are diverse varieties of teaching methods to motivate and educate students, not many are used in dental institutions, where most rely only on traditional lectures. Hence, the objective of this study was to compare traditional lectures with newer teaching methods, specifically the flipped classroom and spaced learning method. Materials and Methods: In this prospective cohort study Students were randomized to one of the teaching methods, and their short-term (immediately after teaching) and long-term (i.e., 6 months later) knowledge retention was assessed through multiple choice questions, followed by students feedback which was obtained using Trierer Inventar zur Lehrevaluation questionnaire. P≤ 0.05 was considered statistically significant. Results: For short-term learning gains, spaced learning group (165.85) showed highest mean scores, followed by the traditional lecture group (163.70) and flipped classroom group (153.25).P value acquired through the Kruskal–Wallis ANOVA was statistically significant (0.003). For long-term knowledge retention, traditional lecture group has highest mean scores (147.50), followed by spaced learning group (146.90) and flipped classroom group (145.05) with no significant difference (P = 0.657). Conclusion: Spaced learning methodology was better than the traditional lecture method and the flipped classroom concerning knowledge gains when measured immediately after the application of learning method. For long-term knowledge retention, both the flipped classroom and spaced learning teaching methods were comparable to the traditional lecture method.

Background: Wound tooth extraction is a mechanical injury that traumatizes adjacent tissue. Sponge amnion contains growth factors that can promote postextraction wound healing. Amnion membranes can be transformed into sponge form rendering it easier to use. The aim of this study is to analyze interleukin-6 (IL-6) and bone morphogenetic protein-2 (BMP-2) expression in postextraction wound healing on the 1^st and 7^th day after sponge amnion application. Materials and Methods: Twenty-eight Wistar rats were used in this experimental descriptive analytical study. Fourteen animals' first right anterior mandible tooth was extracted; then, the socket applied by sponge amnion and sutured (treatment group), while 14 others only sutured (as control group). The alveolar bone tissue of animal was observed 1^st and 7^th days after extraction and then was analyzed using immunohistostaining to identify the expression of IL-6 and BMP-2. Statistical analysis was performed using one-way ANOVA with the level of significance (P < 0.05). Results: IL-6 expression in the treatment group was significantly lower than the control group on the 1^st and 7^th days (P = 0.000). BMP-2 expression in the treatment group was significantly higher than the control group on the 1^st and 7^th days (P = 0.000). Conclusion: Sponge amnion can promote the healing process by increasing the expression of BMP-2 and decreasing IL-6 expression.

Background: Oral lichen planus (OLP) is a chronic disease without any definitive treatment. Local corticosteroids are often prescribed, but their efficacy has been questioned by many studies. The purpose of this study was to investigate the effect of nano-based triamcinolone acetonide gel (NT) and compare it with conventional triamcinolone gel (CT) on OLP. Materials and Methods: In this triple-blind randomized clinical trial study, 40 patients with Erosive OLP were divided into two groups receiving (CT) and (NT). The patients were requested to apply them four times a day for 2 weeks. The severity of pain was evaluated through visual analog scale, the size of lesions was measured with paper lace, and the appearance of lesions was examined adopting Thongprasom scale . Findings will be significant via independent t-test or Chi-square test with P < 0.05. Results: The severity of pain in NT group was 4.9 ± 0.7 cm before the treatment and 1.5 ± 0.9 after that, whereas in CT group, it was 4.9 ± 0.8 and 1.8 ± 0.9, respectively . The mean size of the lesions in NT group was 2.1 ± 1.1 cm before the treatment and 0.8 ± 1.1 afterward, whereas in CT group, was 2.2 ± 1.1 and 1.3 ± 1.1, respectively. The OLP appearance before and after the study in NT group was 4.5 ± 0.5 and 0.8 ± 0.6, respectively, whereas in CT group was 4.6 ± 0.5 and 0.9 ± 0.7 (P = 0.3). Among these variables, only Thongprasom scale on the 6^th and 14^th days had a significant reduction in NT group in comparison with CT group. Conclusion: NT has a better impact on OLP in comparison with CT, but this difference is not statistically significant.

Background: One of the most important factors in restoration failure is microleakage at the restoration interface. Furthermore, a new generation of bonding, Scotchbond Universal (multi-mode adhesive), has been introduced to facilitate the bonding steps. The aim of this study was to compare the microleakage of Class V cavities restored using Scotchbond™ Universal with Scotchbond Multi-Purpose in two procedures. Materials and Methods: Eighteen freshly extracted human molars were used in this study. Thirty-six standardized Class V cavities were prepared on the buccal and lingual surfaces. The teeth were divided into three groups: (1) Group A: Scotchbond Universal with “self-etching” procedure and nanohybrid composite Filtek Z350. (2) Group B: Scotchbond Universal with “total etching” procedure and Filtek Z350. (3) Group C: Scotchbond Multi-Purpose and Filtek Z350. Microleakage at enamel and dentinal margins was evaluated after thermocycling under 5000 cycles by two methods of microleakage assay: swept source optical coherence tomography (OCT) and dye penetration. Wilcoxon's signed-rank test and Kruskal–Wallis test were used to analyze microleakage. Results: In silver nitrate dye penetration method, group A exhibited the minimum microleakage at dentin margins and group C exhibited the minimum microleakage at enamel margins (P < 0.05). Furthermore, in OCT method, group C demonstrated the minimum microleakage at enamel margins (P = 0.047), with no difference in the microleakage rate at dentin margins. Conclusion: Scotchbond Universal with “self-etching” procedure at dentin margin exhibited more acceptable performance compared to the Scotchbond Multi-Purpose with the two methods.

Background: Dental status is one of the main indicators of overall health. We examined it in children aged 6–15 years who live in conditions of biogeochemical fluorine and iodine deficiency (Transcarpathian region, Ukraine), to improve the quality of dental care. Materials and Methods: In this cross sectional study To assess the state of teeth, we used indicators recommended by the WHO Expert Committee. The prevalence and intensity of dental caries, periodontal status, oral hygiene status and dentoalveolar anomalies were determined using a questionnaire and descriptive analyses was done (P < 0.05). Results: The total prevalence of caries in deciduous teeth in children was 57.86% ± 1.56%, with intensity of 2.61 ± 0.6. The total prevalence of caries in permanent teeth was 71.45% ± 1.31%, with intensity of 2.36 ± 0.52. Analysis of the results showed a high prevalence of periodontal disease, which increases with age. The level of oral hygiene was evaluated as unsatisfactory. Studying the prevalence of dentoalveolar anomalies showed the lowest prevalence (40.05% ± 2.56%) at the age of 6 years and the maximum value at 12 years (77.20% ± 2.75%). In addition, we found poor hygienic knowledge of the parents, lack of medical activity of parents to preserve dental health of the child, lack of dentists' work on hygiene education, and public health education for prevention of dental diseases. On the other hand, a high level of confidence was revealed in the information received from dentists. Conclusion: The high prevalence of leading dental diseases requires modernization of the existing prevention programs for children.

Background: Knowledge about the effect of bleaching on behavior of composite resins is important to find a suitable composite resin for restoration of teeth undergoing bleaching. This study aimed to assess the effect of different bleaching protocols on surface roughness and biofilm formation on a silorane-based composite resin. Materials and Methods: In this in vitro experimental study, 60 silorane-based composite resin samples measuring 3 mm in thickness and 6 mm in diameter were fabricated and polished. They were then randomly divided into four groups (n = 15). In Group 1, samples were stored in distilled water as control. Samples in Groups 2, 3, and 4 were subjected to bleaching with 15% carbamide peroxide, 35% hydrogen peroxide, and 35% hydrogen peroxide activated by light, respectively. Surface roughness was measured using a profilometer. Streptococcus mutans cultured in brain-heart infusion broth was used for the assessment of biofilm formation on the samples. The bacterial colonies were counted using the pure-plate technique. Data were analyzed using one-way ANOVA and post hoc Tukey's tests. Regression model was used to assess the association between surface roughness and biofilm formation (P < 0.05). Results: The mean surface roughness of the four groups was not significantly different (P = 0.11); however, a significant difference was noted in the mean biofilm formation among the groups (P = 0.00). Conclusion: Bleaching decreased biofilm formation. The lowest biofilm formation was noted in the group subjected to light-activated 35% hydrogen peroxide. Increased surface roughness enhanced biofilm formation to a certain level; excessive roughness did not increase biofilm formation.

Background: The aim of the present study was to compare the marginal seal of self-adhering flowable composite resin with three universal bonding systems using the self-etch technique in Cl V cavities at enamel and dentin margins. Materials and Methods: In this in vitro study, Cl V cavities were prepared on the buccal surfaces of forty premolars, with the occlusal margin of each cavity on enamel and gingival margin on dentin. The teeth were divided into four groups (n = 10) in terms of the adhesive used; Group 1: Vertise Flow (VF) self-adhering composite resin, Group 2: Clearfil S3 Bond Universal (CS3BU), Group 3: G-Premio Bond (GPB), Group 4: Single Bond Universal (SBU). In Groups 2, 3, and 4, Z350 flowable composite resin was used to restore the cavities. After thermocycling, the samples were immersed in 10% methylene blue for 24 h and evaluated under a stereomicroscope after buccolingual sectioning; microleakage at enamel and dentin margins was recorded. Kruskal–Wallis and Mann–Whitney tests were used for statistical analyses. Statistical significance was set at P < 0.5. Results: Vertis Flow self-adhering composite resin exhibited significantly higher microleakage at enamel and dentin margins compared to SBU and CS3BU; however, it had significantly less microleakage at enamel margin compared to GPB (P < 0.05). At the enamel and dentin margins, the minimum microleakage values were recorded at SBU and CS3BU margins, respectively. GPB exhibited the highest microleakage values among the groups evaluated and in all the groups, microleakage at dentin and enamel margins was significantly different (P < 0.05) except for SBU group. Conclusion: The marginal sealing ability of self-adhering flowable composite resin at enamel and dentin margins was poor compared to the majority of bonding agents evaluated.

Background: This study aimed to determine the perception of institutionalized (G1) and noninstitutionalized (G2) elderly people on oral health and quality of life (QOL). Materials and Methods: This cross-sectional, exploratory study applied two instruments – the Geriatric Oral Health Assessment Index (GOHAI) and the World Health Organization QOL-Bref (WHOQOL-BREF) – in two cities of the state of Sao Paulo, Brazil. Among the institutionalized elderly, G1 (n = 150), 50% were not mentally able to answer the questions correctly, 12% did not answer all the questions, and 7.34% refused to take part in the research or were too frail or dependent, resulting in 31 institutionalized participants. In the noninstitutionalized group, G2 (n = 80), 52.50% refused to take part in the research, resulting in 38 noninstitutionalized participants. The elderly individuals (i) who did not respond to three or more questions of the GOHAI, (ii) those who did not answer all the questions of the WHOQOL-Bref, and (iii) those who did not consent to participate in the research study were excluded from the study population (P < 0.05 consider significant). Results: The oral health of both groups minimally affected the QOL of the elderly. The WHOQOL-Bref score varied between the two study groups mainly in terms of physical domain and self-perception of QOL. The study groups showed differences in some variables: self-perception of QOL (P = 0.0209), mobility (P = 0.0057), and access to health services (P = 0.0252). G2 presented the best conditions. Conclusion: The oral health condition of both groups minimally affected the QOL of the participants; however, differences in the self-perception of QOL were significant, mainly in the physical domain.

Background: The mucous membrane of the maxillary sinus is very sensitive to foreign bodies and infections. Any triggering may lead to mucous membrane thickening (MMT). Residual bone thickness (RBT) is the remaining bone apical to the periodontal defect until the floor of the maxillary sinus acts as a barrier for the periodontal infections to reach the sinus. The aim of our current study was to evaluate the minimal RBT to prevent periodontal infection to reach Schneiderian membrane using cone-beam computed tomography (CBCT). Materials and Methods: In this descriptive study, 144 maxillary sinus exposure records of 100 patients were collected retrospectively. Patients with minimum one sinus exposure were considered. MMT and RBT were calculated with the CBCT assistance. Statistical analysis was done using Mann–Whitney U-test , Kruskal–Wallis and Chi-square test. (P < 0.05) was considered as statistically significant. Results: Significant difference (P < 0.001) was observed in MMT among three RBT groups. Significantly, higher mean MMT was observed with <2 mm and 2–4 mm RBT groups. The prevalence of MMT with >4 mm group is less (7%) compared to <2 mm group and 2–4 mm RBT groups (91.2% and 90.2%, respectively). Furthermore, there is no significant difference in MMT between angular and furcation defects (P = 0.890). Conclusion: Probability of MMT was increased if RBT is <4 mm. Early detection and prompt periodontal treatments associated with regenerative procedures can be instituted wherever possible to improve RBT and to reduce MMT. Further, microbiological studies are required to confirm the analysis.

Background: This study investigated the effect of two different methods of bleaching during orthodontic treatment on bracket bond strength. Materials and Methods: A total of 45 extracted premolar teeth were selected in this experimental study and divided into three groups (office bleaching with 35% hydrogen peroxide, home bleaching with 22% carbamide peroxide, and control). The color of the teeth was assessed initially before the application of bleaching agents and Thermocycling. Orthodontic brackets were subsequently bonded on the treated surfaces. Bleaching procedures were then performed. A final color measurement was performed at two points on the buccal surface both underneath and adjacent to the bracket base. The initial and final color measurements and the bond strengths were compared between the groups using the analysis of variance. P < 0.05 was considered as statistically significant. Results: Bracket bond strength was significantly reduced in both bleaching groups compared with the control group (P < 0.01). The color difference before and after the bleaching procedures was significant in the office bleaching group (P < 0.01), while the control group did not demonstrate a statistical difference between initial and final color assessments (P > 0.05). Conclusion: Bleaching procedures performed during orthodontic treatment reduce bond strength. Enamel beneath the bracket base experiences a whitening effect though to a lesser degree compared with an uncovered surface.

Background: The aim of this study was to compare shear bond strength (SBS) and enamel surface changing of two methods of bonding in rebonding of orthodontic brackets. Materials and Methods: In this in vitro study, 30 human premolars were randomly classified into three equal groups. Two bonding systems were applied. At first bonding, Group 1 and 2 were bonded by conventional etching and primer technique (CEP) and Group 3 by self-etching primer (SEP). Thermocycling for 5000 cycles was done. Then, 30 brackets were debonded and SBS and Adhesive remnant index (ARI) were evaluated. One sample was selected from each group, for SEM, 30 new brackets were used for rebonding. Group 1 was bonded by CEP method and Group 2 and 3 were bonded by SEP method. Thermocycling, SBS, ARI, and scanning electron microscope (SEM) were done in the same protocol of the first bonding. One-way ANOVA, two-sample t-test, and Mann–Whitney U-test were used for statistical analysis. P < 0.05 was considered statistically significant. Results: The mean SBS values were not significantly different between the three groups in the first bonding and rebonding stages (P = 0.22 and 0.24). Further, there was no significant difference between the first bonding and rebonding in SBS values of Groups 1, 2 and 3 (P = 0.44, P = 0.60, and P = 0.56). SEM examination showed obvious differences in the enamel surface between CEP and SEP samples in both first bonding and rebonding. Conclusion: With regard to the advantages of SEP methods, it seems this method can be properly used for rebonding of orthodontic brackets.

Background: This study aimed to compare the shear bond strength (SBS) of ceramic and metal brackets bonded to the enamel using Grengloo color-change adhesive and Transbond XT conventional composite. Materials and Methods: In this in vitro, experimental study, 120 extracted human premolars were divided into four groups: (1) Grengloo with metal brackets, (2) Grengloo with ceramic brackets, (3) Transbond XT with metal brackets, and (4) Transbond XT with ceramic brackets. After bracket bonding, the teeth were subjected to 500 thermal cycles and incubated at 37°C for 24 h. The SBS was measured and the data were analyzed using two-way ANOVA. Mann–Whitney U test was used to compare the Adhesive Remnant Index (ARI) scores. was statistically significant (P < 0.001) Results: The effect of type of bracket (metal/ceramic) on SBS was not statistically significant (P = 0.368). However, the effect of type of composite on SBS was statistically significant (P < 0.001) and the SBS of Grengloo was higher than that of Transbond XT. No significant difference was found in ARI scores among the groups. Conclusion: Regarding the high SBS and the safe region of bond failure in Grengloo composite, this color-change adhesive can be a suitable alternative in cases that require high bond strength. Furthermore, the color contrast of Grengloo can make composite removal easier than Transbond XT with color match of composite and teeth.

Desmoplastic fibroma (DF) is a rare benign but aggressive fibrous lesion with an unknown etiology. It has an affinity for the mandible. DF has a high rate of recurrence after surgical resection. In this study, we report the therapeutic management of a recurrence of DF in the lower jaw in a 2-year-old boy. He responded well to second surgical intervention with wide resection and immediate reconstruction with plate. The purpose of this case report is to emphasize the particularity of the case, treatment modalities, and differential diagnosis in DF.

Background: Various nonsurgical interventions have been used for the management of patients with temporomandibular joint (TMJ) disorders, but their clinical effectiveness remains unclear. Hence, the purpose of this systematic review and meta-analyses was to assess the evidence of the effectiveness of nonsurgical interventions in the management of TMJ disorders. Materials and Methods: A literature search on five databases such as PubMed, PubMed Central Cochrane, TRIP, NGCH databases and hand searching was conducted for a period from October 1995 to 2015. Randomized control trials (RCTs) on the nonsurgical management of TMJ disorders were included and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the articles was assessed by JADAD scoring. Finally, out of 23 RCTs, 11 articles having any of the primary outcomes (pain pressure threshold [PPT], pain, maximal pain-free mouth opening, and level of dysfunction) were selected. The extracted data were analyzed using NCSS software. Results: The results showed the evidence of pain reduction (P = 0.00), maximal pain-free mouth opening (P = 0.0138), and decrease in level of dysfunction (P = 0.0007) but no improvement in PPT to a significant level (P = 0.6600). Conclusion: Our results suggest that the simplest, cost-effective nonsurgical treatments have a positive therapeutic effect on the initial management of TMJ disorders. However, a consistent methodology recording both the objective and subjective outcomes would be a better choice for added reliability.

Introduction: Ultrasonography (USG) allows to the examination of soft tissue and osseous tissues in the head-and-neck region. This study compared the accuracy of USG and computed tomography (CT) scan in the diagnosis of mandibular fractures. Materials and Methods: In this prospective observational study, spiral CT scan was prescribed for the lower face and, if necessary, midface and upper face in 42 trauma patients suspected of mandibular fractures, referring to Imam Reza Hospital in Tabriz. Two radiologists evaluated the CT scans. Then, another radiologist examined all the patients with USG with a frequency of 7–12 MHz. Ultrasonographic diagnostic results were recorded and compared with the results of the CT scan examinations. The results were reported using descriptive statistical methods Results: The specificity and sensitivity of USG were 100% and 91.1%, respectively. The USG sensitivities in the angle, condyle, condylar neck, and symphysis fractures were 100%, 91.6%, 85.7%, and 80%, respectively, and the specificity was 100% in all that anatomical regions. Among the confounding factors, the sensitivity of the USG (84.6%) was the lowest in the presence of hematoma; however, its specificity remained 100%. One case of symphysis fracture was not detected in the absence of any confounding factors in USG examination. Conclusion: Although the sensitivity, specificity, and diagnostic accuracy of the USG were at high levels, there were some limitations, making it difficult to definitively replace USG with CT scans, especially in the case of condylar fractures and in the presence of confounding factors such as hematoma and swelling.

Background: New tools have been introduced for tooth inclination measurement and assessment of its changes over time. This study aimed to measure the change in inclination of teeth after the periods of 2 and 4 years in adolescents with normal occlusion using three-dimensional (3D) software. Materials and Methods: This retrospective longitudinal study was conducted on 54 pairs of dental casts of 24 adolescents between 9 and 13 years of age with normal occlusion. The inclination of teeth was determined by 3D measurements using OrthoAid software. After scanning the casts via stereophotogrammetric scanner, the mean and standard deviation of inclination of teeth were calculated at three time points. Change in these values was calculated after 2 and 4 years. The effect of sex, duration of follow-up, and the jaw (maxilla/mandible) on change of inclination was analyzed using the Mann–Whitney and Wilcoxon tests. P < 0.05 was considered statistically significant. Results: Incisor teeth torque was positive in the maxilla (9.72 ± 8) and mandible (4.22 ± 6.09), but it was negative for the canine (–7.73 ± 6.3 for maxilla and –9.9 ± 5.22 for mandible), premolar (–10.35 ± 6.84 for maxilla and –26.51 ± 9.94 for mandible), and molar teeth (–13.23 ± 6.22 for maxilla and –39.78 ± 9.5 for mandible) in both jaws. Maxillary lateral incisor in boys showed the greatest change of inclination in both 2 and 4 years (about 7°) and the mandibular canine tooth in girls showed the least change of inclination in 4 years (4°). Conclusion: Sex significantly affected the changes in the inclination of teeth throughout the period of study. The variation of changes in torque was considerable, and no consistent pattern was defined.

Ameloblastoma is a locally invasive tumor derived from odontogenic epithelium. An uncommon variant of ameloblastoma is granular cell type, which cannot distinguish from other ameloblastoma subtypes by clinical and radiographic findings alone. Only review of it's microscopic features allows distinction from other subtypes. The purpose of this article is to present a case of granular cell ameloblastoma. This subtype should be distinguished from the other histopathologic subtypes because of it's higher recurrence rate and more aggressive biological behavior. Radiographic and histologic findings as well as treatment are also discussed.

Background: The early diagnosis of dental caries is very crucial to prevent tooth loss, which leads to serious consequences in preschool children. The aim of this study is to compare the diagnostic outcome by the World Health Organization (WHO) and WHO and early carious lesions (ECLs) (i.e., WHO + ECL) criteria for assessing early childhood caries (ECC) in preschool children. Materials and Methods: A cross-sectional, comparative study was conducted among 3–5 year old children (n = 358). Clinical examination was conducted using WHO and WHO + ECL criteria. The data were assessed using paired “t” test. P < 0.05 was considered as statistically significant. Results: There was statistically significant difference between the mean decayed, missing, or filled teeth recorded by the WHO + ECL and WHO (P < 0.05) method. Conclusion: It was concluded that WHO + ECL criteria were significant and more precise in assessing the presence of ECL in preschool children.

Background: Titanium miniscrews are used at an ever-increasing rate to provide orthodontic anchorage. The aim of this study was to evaluate the mechanical performance of miniscrews after dry and steam sterilization. Materials and Methods: In this experimental study, a total of 72 miniscrews from two different manufacturers with a diameter of 1.6 mm and height of 8 mm were divided into six groups (n = 12). One group of screws from each manufacturer was considered as the control group; the second underwent steam sterilization; and the last group was subjected to dry sterilization. Insertion and fracture torques of each miniscrew were assessed by a torque tester. Data were analyzed using the Kruskal–Wallis and Mann–Whitney tests (P < 0.05). Results: For Jeil miniscrew, no statistically significant differences were detected between the steam-sterilized and control groups in their insertion torques (P > 0.05). There was a statistically significant difference between the steam sterilized, dry sterilized and control groups with respect to their fracture torque (P < 0.001). For Hubit miniscrew, there were no significant differences between steam sterilized, dry sterilized and control groups in their insertion torque (P > 0.05) and between steam sterilized and control groups with respect to their fracture torque (P > 0.05). There were significant differences in the mean values of insertion and fracture torques between the two different manufacturers (P < 0.001). Conclusion: Steam sterilization had no detrimental effects on torque values of miniscrews, but dry heat sterilization affected their mechanical properties.

Background: Sealing ability is one of the most important features of endodontic sealers. The main goal of the present study was to compare sealing ability of mineral trioxide aggregate (MTA)-propylene glycol (PG) with two commonly used resin-based and MTA-based sealers. Materials and Methods: In This in vitro study Seventy extracted single-root teeth were used. Canal preparation was carried out using hand and RaCe rotary files. Ten teeth were used as control. The root canals in positive and negative control groups were left empty. Remaining 60 teeth were randomly divided into following four groups (n = 15): In Group 1, the canals were dried using paper cones and obturated using MTA-PG sealer. In Group 2, saline was removed from canal using a syring, but paper cones were not used. Obturation was done using MTA-PG sealer. In Groups 3 and 4, the canals were dried using paper cones and obturated with AH26 and MTA Fillapex, respectively. Two-chamber method was used to evaluate bacterial leakage using Enterococcus faecalis (ATCC 29212). Turbidity of the lower chambers was checked every day during 90 days. Chi-square, Kaplan–Meier analysis, and logrank tests were used to compare groups regarding leaked samples at the end of the study. The level of significance was set at 0.05. Results: There was no significant difference among groups regarding rate of leakage throughout the study. However, at the end of the study, the groups were statistically different regarding leaked samples (P = 0.034). MTA Fillapex and MTA-PG in dry canal showed the most and least leaked samples at the end of the study, respectively (P < 0.05). Conclusion: MTA mixed with PG has superior sealing ability than MTA Fillapex.

Background: Periodontal ligament fibroblasts (PDLF) play a key role in periodontal wound healing and tooth-supporting structures. Various approaches have been tried to enhance the fibroblastic activity such as laser irradiation or doxycycline application. The current study explored the influence of laser irradiation and doxycycline application on human PDLF. The aim of the study was the effect of low-level laser treatment and doxycycline application on the expression of collagen I and matrix metalloproteinase-8 (MMP8) from cultured human periodontal ligament cells. Materials and Methods: In this experimental study After preparation of human PDLF in three replications, they were divided into five treatment groups. The first group was day 0, which was used for standardization. The second group was the control group, which received no treatment within 4 days of the study. The third group was treated with doxycycline 30,[INSIDE:1]daily for 4 consecutive days. The fourth group was treated with diode laser 2[INSIDE:2] daily for 4 consecutive days. The fifth group was treated with both doxycycline and laser irradiation pertaining to the third and fourth groups. After 4 days of treatment, cells were tested for collagen I and MMP-8 secretion through real-time-polymerase chain reaction and ELISA reader. The data were analyzed using the ANOVA and least significant difference pair tests ( P < 0.05 ). Results: Treatment of human PDLF either with diode laser or doxycycline reduced the secretion of MMP-8 significantly. The maximum reduction was related to doxycycline application. Regarding collagen, I, only doxycycline application significantly increased collagen I secretion. Other groups showed no significant increase in collagen I secretion. Conclusion: This study showed that treatment of human PDLF either with diode laser or doxycycline significantly reduced MMP-8. Treatment with doxycycline significantly increased the secretion of collagen I.

Background: Fixed orthodontic appliances can release metal ions such as nickel, chromium, and zinc into saliva and blood, which can cause contact dermatitis, hypersensitivity, and cytotoxicity. This study was undertaken to assess the release of nickel, chromium, and zinc in saliva and serum of patients undergoing fixed orthodontic treatment. Materials and Methods: This in vivo study was conducted on 80 participants with an age range of 15–40 years. Thirty were included as controls and 50 participants were treated with fixed orthodontic appliances. Saliva and blood samples were collected at five different periods, before insertion of fixed orthodontic appliance and at 1 week, 3 months, 1 year, and 1.5 years after insertion of appliance, respectively. The metal ion content in the samples were analyzed by atomic absorption spectrophotometry. Mean levels of nickel, chromium, and zinc in saliva and serum were compared between groups using independent sample t-test and before and after results using paired t-test. P < 0.05 was considered as statistically significant. Results: At the end of 1.5 years, the mean salivary levels of nickel, chromium, and zinc in controls were 5.02 ppb, 1.27 ppb, and 10.24 ppb, respectively, as compared to 67 ppb, 30.8 ppb, and 164.7 ppb at the end of 1.5 years. This was statistically significant with P < 0.001. A significant increase in the metal ion levels were seen in participants with before and after insertion of appliance (P < 0.001). Conclusion: Orthodontic appliances do release considerable amounts of metal ions such as nickel, chromium, and zinc in saliva and serum. However, it was within permissible levels and did not reach toxic levels.

Background: Squamous cell carcinoma (SCC) is the most common cancer of the oral cavity and may be preceded by dysplastic epithelial lesion. Oral SCC (OSCC) contains a rare subset of cancer cells with self-renewal ability, termed as cancer stem cells (CSCs). CD24 and CD44 as CSC markers are cell surface glycoproteins. These markers contribute to the onset, maintenance, and extension of tumor growth, as well as angiogenesis. In the present study, these two markers were simultaneously evaluated to provide a specific phenotype for carcinogenesis process in oral cavity. Materials and Methods: In this analytical-cross-sectional study, the expression of CD24 and CD44 genes was evaluated in 45 OSCCs (20 low-grade and 25 high-grade) and 15 oral epithelial dysplasia specimens by real-time quantitative reverse transcription polymerase chain reaction. Kruskal–Wallis and Mann–Whitney U-test, Kendall, and Spearman tests were used for statistical analysis. The significance level was considered <0.05. Results: High expression of both markers genes was reported in two-thirds of samples. There was no significant difference between studied groups in gene expression of CD24 and CD44 whereas statistically significant association between CD24 and CD44 was observed in all three groups. This correlation was more significant in OSCC groups (P < 0.001). Conclusion: High expression of CSC markers in OSCC and oral epithelial dysplasia revealed the importance of accurate examination of dysplastic lesions with high expression of these markers and the possibility of malignant transformation. Regarding a significant association of two markers, further studies are necessary to provide a specific phenotype (CD44 high CD24 high) for these lesions.

Background: Literature is controversial in regard with alterations in pharyngeal airway dimensions subsequent to maxillary protraction. The correlation between maxillary protraction and sagittal airway dimension was investigated in association with tongue and soft palate position in skeletal Class III children. The results were compared with those of an untreated Class III and a Class I malocclusion control group. Materials and Methods: In this cross-sectional study pre- and post-treatment cephalometric radiographs of 19 Class III patients (6 males, 13 females; mean age, 7.93 ± 0.96 years) treated with facemask were analyzed. The correlation between treatment changes in craniofacial morphology and those in the upper airway, tongue, and soft palate was evaluated. These results were compared with those of a group of 16 Class I malocclusion patients (1 male, 15 females; mean age, 7.31 ± 0.7 years) and a group of 15 untreated Class III patients (4 males and 11 females; mean age, 7.46 ± 0.1 years). A paired t-test, the Shapiro–Wilk test and Mann–Whitney U-test was used. The level of significance was established as P < 0.05. Results: Nasopharyngeal airway measurements PNS-ad1 and PNS-ad2 significantly increased by 2 mm and 2.1 mm, respectively. Statistical analysis revealed that maxillary protraction had a positive relationship with PNS-ad1 and PNS-ad2. Conclusion: Nasopharyngeal airway dimensions can be improved in the short term with maxillary protraction in skeletal Class III children.

Background: This study aimed to assess the marginal adaptation and internal fit of cobalt-chromium copings fabricated by the selective laser melting (SLM) and conventional techniques using a profilometer. Materials and Methods: In this in vitro study sample size was calculated to be a total of 10 in two groups (n = 5). A brass model was used that had a circular cross-section with a round shoulder margin with 0.5 mm thickness and axial walls with 10 mm length and 6° taper. The copings fabricated with both techniques (SLM and casting method) were placed on the model, and vertical marginal gap was measured using a profilometer. The internal fit of copings was assessed by weighing the light-body addition silicone applied inside them, which simulated the cement. Data were analyzed through parametric (Independent t-test) and nonparametric (Mann–Whitney U-test, Bootstrap, Spearman, and Pearson Correlation) analysis. All analyses were performed at a significant level (α = 0.05) using SPSS. Results: The mean marginal gap in the casting group (132.93 ± ) was significantly higher than that in the SLM group (67.14 ± 15.67 μm) (P < 0.05). The mean weight of light-body silicone was 9.60 ± in the SLM and 8.70 ± 1.21 mg in the casting group. No significant difference was noted between the two groups regarding the internal fit (P > 0.05). Conclusion: The copings fabricated by the SLM technique showed a smaller vertical marginal gap compared to the casting group. However, the two groups were not significantly different in terms of internal fit.

Background: The ability of modern implant dentistry to achieve goals such as normal contour, function, comfort, esthetics, and health to totally or partially edentulous patients guaranteed it to be more effective and reliable method for the rehabilitation process of many challenging clinical situations. In regard to this, the current study evaluates the effect of changing implant shape design parameters on interface stress distribution within the mandible bone. Materials and Methods: A numerical procedure based on finite element (FE) method was adopted to investigate the influence of using different body design and thread depth of the inserted implant on the final stress situation. For the purpose of evaluation, a three-dimensional realistic FE models of mandible bone and inserted implant were constructed and analyzed using a pack of engineering software (Solidworks, and ANSYS). Six different commercial implant models (cylindrical and tapered) with three different V-shaped thread depths (0.25 mm, 0.35 mm, and 0.45 mm) were designed to be used in this study. The suggested implants used in this study were threaded in two different locations of mandible bone; the anterior region (Type I model) and posterior region (Type II model). A vertical static load of 250 N was directly applied to the center of the suprastructure of the implant for each model. Results: For both models, evaluations were achieved to figure out the stress distribution patterns and maximum equivalent von Mises. The results obtained after implementation of FE dental-implant models show that the highest stresses were located at the crestal cortical bone around the implant neck. In addition, the simulation study revealed that taper body implant had a higher peak value of von Mises stress than that of cylinder body implants in all types of bones. Moreover, a thread depth of 0.25 mm showed highest peak of maximum von Mises stresses for Type I and Type II models. Conclusion: The simulation results indicate that all models have the same von Mises stress distribution pattern and higher peak von Mises stresses of the cortical bone were seen in tapered implant body in contrast to the cylindrical body.

Background: Keratinocyte growth factor (KGF) is a potent epithelial mitogen that acts by binding the KGF receptors (KGFRs) expressed on epithelial cells and regulates proliferation and differentiation. The objective of this study was to investigate the expression of KGF in the epithelium in oral precancer. Materials and Methods: Archival tissues of oral submucous fibrosis (SMF) and leukoplakia were assessed for epithelial KGF expression by immunohistochemistry and real-time quantitative polymerase chain reaction. Results: KGF was predominantly expressed in the basal and parabasal cells in the epithelium of SMF tissues. KGF transcript in the epithelial cells increased with increasing severity of epithelial dysplasia in oral leukoplakia. Conclusion: Although widely reported as a product secreted by the mesenchymal cells, our data suggest that the KGF is also expressed in oral epithelial cells much like the expression in ovarian epithelial cells. Based on the localization of KGF in cells at the epithelial mesenchymal junction and that of the reported presence of KGFR in oral keratinocytes, a potential mechanism involving paracrine and autocrine interactions of KGF and KGFR in early stages of oral precancer is postulated.

Background: Dentin hypersensitivity is primarily caused due to patent or exposed dentinal tubules. Nonfluoridated-desensitizing agents deposit hydroxycarbonate apatite (HCA), within the dentinal tubules, thereby relieving hypersensitivity. Fluoride-containing bioactive glass-based agents form fluorapatite which is less soluble when compared to hydroxyapatite and HCA. Materials and Methods: In this in vitro study forty dentin specimens obtained from extracted human premolars were divided randomly into four groups (n = 10): Group 1 – fluoridated bioactive glass (FBaG); Group 2 – bioactive glass (BaG); Group 3 – arginine calcium carbonate; Group 4 – saline. 37.5% phosphoric acid was used to ensure patent dentinal tubules. Test agents from each group were applied using a rubber cup. Half the treated samples were then subjected to 6% citric acid treatment. The degree of occlusion was evaluated using the scanning electron microscope, and the microscopic images were scored before and after the citric acid challenge by two blinded endodontists. Statistical analysis was performed using SPSS, one-way ANOVA, and post hoc Tukey test (P = 0.05). Results: Group 1 demonstrated better tubule occlusion in comparison with Group 2 and a statistically significant difference when compared to Group 3 (P = 0.001). Following acid challenge, Group 2 showed significantly more occluded tubules when compared with Group 3 (P = 0.001) and comparable difference with Group 1. Conclusion: All desensitizing agents showed satisfactory dentinal tubule occlusion. While fluoridated bioactive glass demonstrated better occlusion immediately after application, Bioactive glass showed better resistance to acid treatment.

Background: The aim of this study was to evaluate the effect of ceramic material types, degree of veneer translucency, and luting cement shades on masking the underlying dark dental substrate to achieve best esthetics. Materials and Methods: In this in vitro study, 56 specimens each of 0.5-mm thickness were fabricated from two esthetic veneer materials Vita Enamic and Vita Suprinity, with two different translucencies, i.e., HT and T. To simulate the color of a dark underlying dental structure, background discs with C3 shade were fabricated using resin composite. The ceramic specimens with varying translucencies were cemented on the dark background of the resin composite with A1 and opaque white shades of resin luting cement. Color difference (ΔE) values from a reference color (A1 shade) were calculated using a spectrophotometer. The results were then statistically analyzed using three-way ANOVA test (α = 0.05). Results: The ΔE values of both ceramic systems were affected by both the degree of veneer translucency (P = 0.00) and the luting agent shade (P = 0.016). The use of an opaque luting agent and T translucency resulted in a decrease in the ΔE* values for all ceramics tested, regardless to the material type. Suprinity and Enamic showed similarity in the masking ability of dark substrate after cementation. Conclusion: None of the 0.5-mm veneers of the two ceramic systems could reach A1 shade without a detectable color difference after cementation. The change in degree of veneer translucency was more effective than the change in luting agent shade in masking the underlying dark substrate.

Background: Acute lymphoblastic leukemia (ALL), accounting for 23% of all malignancies in children, is the most prevalent pediatric malignancy. This study compared dental caries, oral hygiene status, salivary pH, and Streptococcus mutans counts in dental plaques and saliva of children with leukemia with those of healthy controls. Materials and Methods: This case–control cross-sectional study assessed 32 children with ALL and 32 healthy children (4–9-year-old) for gingival bleeding index (GBI), decayed, missing, and filled/decayed, missing, and filled surfaces (DMF/dmfs), and plaque index (PI). Sampling was performed to determine salivary pH and S. mutans counts of the participants. The two groups matched in terms of age, gender, and socioeconomic status. The groups were compared using independent t-test, Mann–Whitney test, Chi-square test, and Spearman's and Pearson's correlation analyses. Results: The mean DMF/dmfs and GBI were significantly higher in the ALL group (P_DMF/_dmfs = 0.03; P_GBI = 0.04). However, the two groups were not significantly different in the mean PI values (P = 0.47). The mean S. mutans counts in dental plaques and saliva of the children with leukemia were significantly lower than the healthy controls (P < 0.01). Moreover, the mean salivary pH was significantly lower in the ALL group compared to the control group (P < 0.01). Conclusion: Higher caries and gingival bleeding rates, higher dental plaque accumulation in children with ALL, decreased salivary pH, and cumulative effects of other risk factors highlight the significance of oral hygiene training programs (for the parents of these children) and regular dental examinations for these children.

Background: Temporomandibular disorder (TMD) is a common condition affecting the temporomandibular joint and causes pain and discomfort. However, the role of factors contributing to this problem is still controversial. The purpose of this cross-sectional study was to determine the correlation of occlusal factors and parafunctional habits with TMD and The determination of TMD prevalence among patients referring to Isfahan Dental School in 2017. Materials and Methods: In this cross-sectional study, A total of 200 patients between 20 and 50 years were examined and questioned based on the Research Diagnostic Criteria for Temporomandibular Disorders assessment instrument. The association of occlusal factors (dental relationship, lateral occlusal scheme, horizontal differences between centric occlusion and Maximum intercuspation (MI), difference between MI and mandibular resting position) and parafunctional habits (bruxism/clenching and habits) with TMD was analyzed using Chi-square tests and independent sample t-test (α = 0.05). Binomial logistic regression analysis was performed with respect to confounding variables. Results: The prevalence of TMD in the studied sample was 58.9%. Only bruxism showed a significant difference between TMD and non-TMD groups (P < 0.05). Other parafunctional and occlusal factors did not act as influential factors for TMD. Conclusion: Parafunction may play an important role in the initiation of TMD, although other habits and occlusal factors are considered as noninfluential factors. However, larger sample size and multicenter sampling are recommended for the future studies.

Background: Temporary crown and bridge materials have to fulfill a couple of important functions within the timeframe between tooth preparations until luting of the definitive restoration. The aim of the current study was to evaluate the color stability and fracture resistance of two fiber-reinforced provisional fixed partial denture (FPD) materials. Materials and Methods: In this in vitro study Using a plexiglass mold, 96 bar-shaped specimens (4 mm × 2 mm × 20 mm) were fabricated and divided into four groups (n = 24): nonreinforced composite (NRC) resin, glass fiber-reinforced composite resin (RC), nonreinforced polymethylmethacrylate (PMMA), and glass fiber-reinforced PMMA. Values of CIEL*a*b* were recorded for all the samples. Then, the samples were immersed in coffee, chlorhexidine mouthrinse, and distilled water. After 1 day and 1 and 4 weeks, CIEL*a*b* values were recorded again and color differences (ΔE) were calculated. All the specimens immersed in distilled water were then subjected to force to measure their fracture resistance. Data were analyzed with one-way ANOVA, honestly significant difference Tukey tests, and paired t-test (α = 0.05). Results: The NRC group, immersed in coffee for 1 month, exhibited the highest ΔE (17.1 ± 0.69) and the lowest ΔE belonged to the RC group immersed in water for 1 day. The RC group, immersed in water, exhibited the highest fracture resistance. Conclusion: Coffee is considered as one of the most important factors affecting color changes in provisional FPDs, either in composite resins or in PMMAs. Fracture resistance of both composite resin and PMMA FPDs revealed no significant differences between the groups; however, there were significant differences between the nonreinforced and fiber-reinforced FPDs in both groups.

Background: Imbalances between the oxidant-antioxidant status have been implicated in the pathogenesis of several diseases, including cancer. The aim of this study was to evaluate the extent of lipid peroxidation and antioxidants in the tissue samples of oral squamous cell carcinoma (OSCC) patients of different clinical stages in comparison with the healthy controls. Materials and Methods: A case-control study was designed with 20 new histopathologically proven oral carcinoma patients and an equal number of age, sex, and tobacco chewing habit matched healthy subjects. Their tissue samples were subjected to evaluation of lipid peroxidation product and antioxidant enzymes, namely, superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH), and glutathione peroxidase (GPx) using spectrophotometric methods. The data are expressed as mean ΁ standard deviation. The statistical comparisons between the study groups were performed by independent Student's unpaired t-test and one-way analysis of variance. Post-hoc analysis was performed for within study group comparisons. Karl Pearson correlation was performed for the biochemical parameters within the group and between the groups. For statistically significant correlations, simple linear regression was performed using SPSS (α=0.05). Results: Significant reduction in lipid peroxidation (P < 0.001) SOD and CAT (P < 0.001) was observed in the tissue of OSCC patients as compared with the healthy controls. On the other hand, reduced GSH and GPx were significantly increased in tumor samples. Conclusion: Reduced lipid peroxidation and increased activity of reduced GSH and GPx provides the suitable environment for the local growth and invasion of the tumor and metastasis in the later stages. Among the antioxidant enzymes, GSH reductase appears to have a profound role in carcinogenesis and thus it can be considered as potential prognostic marker.

Background: Usage of chemical mouthwashes for controlling dental caries can end to some side effects such as oral biological imbalance. Recently, using natural derivatives such as herbs, presented to overcome such adverse effects. Due to antibacterial property of olive leaf extracts (Olea europaea), this study conducted in order to evaluate bacteriocidal, anti-acid production, and anti-adhesion effects of olive leaf ethanolic, methanolic, and hydroalcoholic extracts on Streptococcus mutans. Materials and Methods: In this in vitro study, nine strains of S. mutans (PTCC1683) were used. Maceration methods were done in order to provide the olive leaf ethanolic, methanolic, and hydroalcoholic extracts. The antibacterial activities evaluated by macrodilution and disc diffusion method in different concentrations (3.25%–100%). Acid production and adhesion of bacterial strains also were evaluated. The obtained data were analyzed by analysis of variance method using SPSS software. P < 0.05 was considered as statistically significant. Results: The minimum inhibitory concentration and minimum bactericidal concentration for ethanolic, methanolic, and hydroalcoholic olive leaf extracts on S. mutans are 12%–25%, 50%–75%, and 12%–25%, respectively. In addition, inhibition zone of S. mutans significantly increased in higher concentration (ethanolic and methanolic extracts: P = 0.004; hydroalcoholic extract: P = 0.003). The acid production and adhesion significantly decreased by increase in the concentration (P < 0.001). Conclusion: In general, olive leaf ethanolic, methanolic, and hydroalcoholic extracts induce growth inhibition, acid production, and adhesion of S. mutans. Consequently, it can be used as a natural preservative in the food industry, as well as in the production of commercial products such as chewing gum, chocolate, and toothpaste to prevent dental caries.

Background: A successful endodontic treatment depends on efficient cleaning and shaping and effective irrigation of root canals. The irrigating solution may not be effective in some areas in the canal. The manufacturer of XP-Endo finisher claims that it can effectively clean the root canals with complex morphology. This study aimed to assess the effect of XP-Endo finisher on the amount of residual debris and smear layer on the root canal walls of mandibular second premolars. Materials and Methods: In this In vitro study Fifty extracted mandibular second premolars with a root curvature <20° were collected. Root canals were prepared using BioRaCe rotary system. The root canals were in contact with the file and different irrigating solutions for 1 min. The teeth were then randomly divided into four experimental (n = 10) and one positive control group as follows: (1) XPF + saline, (2) XPF + ethylenediaminetetraacetic acid (EDTA), (3) XPF + sodium hypochlorite (NaOCl), (4) XPF + EDTA + NaOCl and (control) EDTA + NaOCl. The teeth were longitudinally sectioned into two halves and the amount of debris and smear layer remaining in the coronal, middle, and apical thirds of the roots was quantified and scored under an electron microscope. The Kruskal–Wallis test was used to compare the groups, and P < 0.05 was considered statistically significant. Results: The highest mean amount of residual debris (2.9 ± 1.13) was noted in XPF + saline group (P < 0.05). XPF + saline and XPF + NaOCl (3.8 ± 0.60) had the lowest efficacy for smear layer removal (P < 0.05) with no significant within-group difference. No significant difference was noted between Groups 2, 3, and 4 with the positive control group regarding debris removal. Groups 2 and 4 had no significant difference with the positive control group regarding smear layer removal. Conclusion: Use of XP-Endo finisher has no superiority to the standard protocol for the use of irrigating solutions (EDTA + NaOCl) for debris and smear layer removal, but in some cases, such as second appointment of regeneration treatment we cannot use NaOCl because of its destructive effects on stem cells; thus, we can benefit from the synergistic effects of XPF and EDTA for better smear layer removal.

Background: Oral squamous cell carcinoma (SCC) is the most common oral malignancy. Some evidence indicated that there is a correlation between microRNA single nucleotide polymorphisms and the risk of oral cancer. The aim of the current study was to investigate the association between mir-499 polymorphism with the risk of oral cavity and oropharyngeal SCC in a subset of Iranian Population. Materials and Methods: In this case–control pilot study total of 112 participants including 56 histopathlogically confirmed oral and oropharyngeal SCC patients and 56 age- and sex-matched controls were included The mir-499 rs3746444 T/C polymorphism was detected using polymerase chain reaction-restriction fragment length polymorphism method. The comparisons of the distribution of the allele and genotype frequencies were performed using Chi-square test, and P < 0.05 was considered as statistically significant. Results: The result of the present study indicated that the frequency distribution of mir-499 was not significantly different between cases and controls (P > 0.05). We also did not find any significant association between the risk of the cancer and mir-499 polymorphisms in the recessive (Odds ratio [OR]: 6.60; 95% confidence interval [CI]: 0.77–56.74; P = 0.11) and dominant (OR: 1; 95% CI: 0.37–2.74; P = 1) inheritance models even after adjustment for smoking. Conclusion: The results of the present study indicated that the polymorphisms of mir-499 are not associated with the risk of oral and oropharyngeal SCC in Iranian population. However, further large scale studies are needed to validate our findings.

Background: The ideal position of the plates and the need for additional plates are discussed continuously. In mandible, the tensile forces at the fracture line should be neutralized with a tension band. This study evaluated the role of the mandibular arch bar as a tension band eliminating the need for an upper miniplate (tension band plate) in cases of parasymphysis fractures. Materials and Methods: In this randomized control trial, a total of 90 patients with mandibular parasymphysis fractures underwent treatment in two groups. Group A was treated with one titanium miniplate along with Erich's arch bar. In Group B, two titanium miniplates were placed across the fracture site along with Erich's arch bar. Then, the complications and duration of the operation time were compared between two groups. The results were considered statistically significant when the P < 0.05. Results: No significant difference was observed between the groups regarding postoperative complication rate. 1 month after surgery in Group A, number of patients with sensory impairment (17%) was significantly lower than Group B (37%) (P = 0.029). Furthermore, the operation time of Group A was significantly shorter than Group B (P < 0.001). Conclusion: In the presence of arch bar, placing one miniplate instead of the routine technique of placing two, do not increase complication rates. Furthermore, it reduces the operation time and costs and results in a better neurosensory recovery outcome in short time.

Child abuse, a reprehensible act, pervades all strata of society. Dentists are more likely to encounter such cases in their daily practice. However, such cases usually go unreported due to lack of adequate knowledge. Practitioners flinch from reporting these due to various reasons, and this sets up a vicious cycle which traps the victim leading to grave long-term consequences. This review aims to collect all literature available on PubMed, PubMed Central, MEDLINE, Google Scholar, and Google search engines on the role of dentists in child abuse identification and information and summarize these details. The review will shed light on the identification of abuse in dental settings, the various legal recourses and organizations related to it, and how dentists can better equip themselves to tackle such cases if they come across one. The review also makes certain recommendations by which dentists and healthcare providers in general can better prepare themselves for such contingencies.

Background: Dentin hypersensitivity (DH) is a common problem characterized by a short, sharp pain. Reduction of dentin permeability by occluding dentin tubules is considered as a method for treating DH. Many substances are available to decrease hypersensitivity. The aim of this study is to evaluate the ability of three different remineralizing agents for occluding dentinal tubules in comparison with positive and negative controls. Materials and Methods: In this in vitro scanning electron microscopic (SEM) study, 75 extracted premolars were cut into crown and root fragments with a bur and divided into five groups: group 1: Sodium fluoride 5% varnish was applied (positive control), Group 2: No treatment (negative control), Group 3: Treated with Remin Pro (contains hydroxyapatite and fluoride), Group 4: Treated with MI paste (contains casein phosphopeptide-amorphous calcium phosphate [CPP-ACP]) and Group 5: Treated with GC tooth mousse (contains CPP-ACP). SEM images were obtained and mean tubular diameter was measured in each group. One-way ANOVA and Duncan's tests were used for statistical analysis. A significant level of α = 0.05 was set for comparison between the groups. Results: Statistically significant difference was observed between Group 2 (negative control) and other four groups (P < 0.05). There was no significant difference between Groups 1, 3, 4, and 5 (P > 0.05). Conclusion: Under the limitations of the present in vitro study, it can be concluded that the application of a CPP-ACP paste as well as a paste which contains fluoride is effective on reduction of dentin permeability.

Background: The objective of this study was to systematically review prevalence of dental caries at different water fluoride levels and emphasize fluoride concentration of drinking water and prevalence of dental caries. Materials and Methods: A comprehensive study was conducted using PubMed database. Inclusion criteria were predefined and some articles fulfilled these criteria. Study validity was assessed by some checklists. Surveys were conducted to determine prevalence of dental caries among individuals. Results: The heterogeneity in the group of children with deciduous teeth in terms of the amount of fluoride in drinking water and social class was significant, and the results of the studies in all the subgroups could not be pooled. However, the heterogeneity of group 2 for subjects with permanent teeth in terms of the fluoride level in drinking water and social class was not significant, and the results of the studies in each subgroup could be pooled together. Conclusion: The meta-regression showed that tooth type and social class had a significant association with the difference in the prevalence of dental caries. Therefore, these variables were the sources of heterogeneity, and the studies must be grouped and subgrouped based on these variables.

Microstomic patients may experience a significant limitation in the mandibular opening. The prosthetic rehabilitation of microstomic patients presents difficulties at all stages, from preliminary impressions to prosthetic fabrication. This clinical report described the method of fabrication of sectional denture for patients with microstomia caused by burns. The denture was fabricated in two pieces, and patients inserted and removed the denture easily.

Background: Various biochemical and histological methods are available for human age determination which are invasive and may require extraction of teeth. The present study aims to assess the accuracy of age estimation from tooth-coronal index (TCI) of known age and sex individuals and to present a noninvasive method for age estimation. Materials and Methods: This retrospective study comprised 88 patients, which included 54 males and 34 females. An orthopantomogram of these individuals were taken, and premolars and molars in the same were evaluated. The height of the crown (coronal height [CH]) and the height of the coronal pulp cavity (coronal pulp cavity height [CPCH]) was digitally measured on the computer screen. The TCI given by Ikeda et al. in 1985 (TCI = [CPCH × 100]/CH.) was computed on each tooth and regressed on real age of the sample. The mean, median, range, and standard deviation of the computed index were calculated. The correlation between the actual age and the estimated age was calculated using t-test. P < 0.05 was considered significant. Results: Results revealed that there is a significant correlation between the TCI with age. Increase in TCI observed with age; however, it showed no significant sex difference. Conclusion: TCI is a precise, noninvasive and easily used reliable biomarker for age estimation and is applicable to both living and dead individuals.

Periodontal surgery associated with prior waxing, mock-up, and the use of digital tools to design the smile is the current trend of reverse planning in periodontal plastic surgery. The objective of this study is to report a surgical resolution of the gummy smile using a prior esthetic design with the use of digital tools. A digital smile design and mock-up were used for performing gingival recontouring surgery. The relationship between the facial and dental measures and the incisal plane with the horizontal facial plane of reference were evaluated. The relative dental height x width was measured, and the dental contour drawing was inserted. Complementary lines are drawn such as the gingival zenith, joining lines of the gingival and incisal battlements. The periodontal esthetic was improved according to the established design digital smile pattern. These results demonstrate the importance of surgical techniques and are well accepted by patients and are easy to perform for the professional. When properly planned, they provide the desired expectations. Periodontal Surgical procedures associated with the design digital smile facilitate the communication between the patient and the professional. It is, therefore, essential to demonstrate the reverse planning of the smile and periodontal parameters with approval by the patient to solve the esthetic problem.

Background: There has been increasing interest in the study of the association between Vitamin D receptor (VDR) gene polymorphisms and risk of chronic periodontitis. However, the results remain inconclusive. To better understand the roles of VDR polymorphisms (BsmI, TaqI, FokI, and ApaI) in chronic periodontitis susceptibility, we conducted this systematic review and meta-analysis. Materials and Methods: The PubMed, Google Scholar, and Web of Science database were systemically searched to determine all the eligible studies about VDR polymorphisms and risk of chronic periodontitis up to April 2017. Odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the associations between VDR polymorphisms and chronic periodontitis risk. All the statistical analyses were performed by Comprehensive Meta-Analysis. All P values were two-tailed with a significant level at 0.05. Results: Finally, a total of 38 case–control studies in 19 publications were identified which met our inclusion criteria. There are ten studies with 866 chronic periodontitis cases and 786 controls for BsmI, 16 studies with 1570 chronic periodontitis cases and 1676 controls for TaqI, five studies with 374 chronic periodontitis cases and 382 controls for FokI, and seven studies with 632 chronic periodontitis cases and 604 controls for ApaI. Overall, no significant association was observed between VDR gene BsmI, TaqI, FokI, and ApaI polymorphisms and risk of chronic periodontitis in any genetic model. Subgroup analysis stratified by ethnicity suggested a significant association between BsmI polymorphism and chronic periodontitis risk in the Caucasian subgroup under allele model (A vs. G: OR = 1.747, 95% CI = 1.099–2.778, P = 0.018). Further, no significant associations were observed when stratified by Hardy–Weinberg equilibrium status for BsmI, TaqI, and ApaI. Conclusion: Our results suggest that BsmI, TaqI, FokI, and ApaI polymorphisms in the VDR gene might not be associated with risk of chronic periodontitis in overall population.

Background: Recently, there has been an increasing growth in research on medical plant's effect on dental plaque bacteria. The aim of this study was to determine the antibacterial effects of Satureja hortensis extract and its essential oil (EO) on Streptococcus salivarius, Streptococcus sanguis, and Streptococcus mutans as important bacteria in early supragingival dental plaque formation. Materials and Methods: In this in vitro study, different concentrations of S. hortensis extract and its EO were prepared using double dilution method. The disc diffusion method was used to determine antibacterial activity. Based on these measurements, the minimal inhibitory concentration value was reported for each bacterium. Antibiotics used as positive controls in this study were erythromycin (15 μg) and tetracycline (30 μg). t-test and ANOVA were used for statistical analysis (P < 0.05). Results: Aqueous and methanolic extract did not show significant antibacterial activity, but the EO significantly inhibited the growth of the test bacteria compared to positive control (P < 0.05). High concentrations of EO processed greater antimicrobial effects against three oral bacteria than other low concentrations (P < 0.0001). For S. mutans, the inhibition effect of tetracycline 30 μg was similar with 50% (P = 0.789) and 25% (P = 0.158) dosages of the EO. For S. salivarius, the effect of tetracycline 30 μg was similar to 50% dosages of the EO (P = 0.122). For S. sanguis, the effect of erythromycin 15 μg was lower than 50% (P = 0.0006) and 25% (P = 0.003) dosages of the EO. The inhibition effects of all concentrations of EO were higher for S. sanguis. S. salivarius and S. sanguis are more sensitive than S. mutans to S. hortensis EO. Conclusion: Due to the strong antibacterial effect of S. hortensis EO on the oral bacteria growth, it can be served as herbal mouth rinse, while to confirm this antibacterial effect, further clinical studies are necessary.

Background: This study aimed to evaluate the effect of different coloring techniques and surface treatment methods on the surface roughness of monolithic zirconia ceramic. Materials and Methods: In this in vitro study seventy-two disk-shaped monolithic zirconia (2 mm × 10 mm) were divided into three coloring techniques groups (white, internal staining, external staining) (n = 24). Each group was subdivided into four surface treatment subgroups (n = 6), as unpolished, polished with Shofu polishing kit, polished with dental direct polishing kit, and glazed. Profilometer was used to measure the Ra (roughness average) and Rz (roughness height) surface roughness values (μm) and scanning electron microscopy (SEM) for visual inspection of the surface morphology. The surface roughness parameters were calculated and analyzed with two-way ANOVA and Tukey's post hoc test (α = 0.05). Results: The coloring technique, surface treatment method, and interaction of these two parameters significantly affected the Ra and Rz parameters (P < 0.05). Concerning the surface treatment, the Rz value was significantly higher in the unpolished subgroup, followed by the glazed and polished subgroups. However, the two polishing systems were not significantly different. The internal staining group had significantly higher Rz value than the other staining method, when the specimens were glazed or polished with Shofu kit. SEM showed multiple scratches in unpolished samples which were smoothened by glazing and specially by polishing. Conclusion: Among all the studied surface treatment methods, the lowest surface roughness was observed in highly polished monolithic zirconia, which was even less than the glazed one. The internal staining method can create a rougher surface for some of the surface treatment methods.

Background: Enterococci are the transient constituents of the oral microbiome and have been now increasingly related to oral and systemic diseases. They have now become the most notable nosocomial pathogens and also been linked to etiology of periodontitis. This study evaluates the prevalence of Enterococci in the chronic periodontitis and healthy Indian cohort in different urban socioeconomic groups. Materials and Methods: In this retrospective study, individuals in the age range of 18–75 years were included. Seventy individuals had mild-to-moderate periodontitis and 30 healthy persons were taken as controls. A questionnaire was administered. Paper point samples of gingival crevicular fluid were obtained, pooled, and sent to microbiology laboratory in a transport media. Forty-six isolates were identified as enterococci for statical analyzes Pearson's Chi-square test used and. P < 0.001 was considered to be significant. Results: The prevalence of enterococci was seen mostly in the individuals from lower socioeconomic class, having poor oral hygiene, and smokers. This was significantly different from those of upper class (P < 0.001). The predominant species isolated was Enterococcus faecalis. Conclusion: Enterococci particularly E. faecalis followed by Enterococcus faecium could play a crucial role in the severity or progression of periodontitis particularly in a favorable oral environment.

Background: The aim of this study is the effect of stress distribution within the bone with varying implant crest module designs. Materials and Methods: Finite element models of a straight two-piece 4 mm × 13 mm screw-shaped threaded implant with divergent, straight, and convergent implant crest module with their surrounding suprastructure embedded in mandibular second premolar area were created with ANSYS software. Different implant crest module designs incorporated in D2 types of bone under 100N axial and 100N at 20° oblique load were created to evaluate stress distribution in the crestal bone around implant crest module. Results: Maximum von Mises stress was observed at the crestal region of the bone and at crest module region of the implants in all the models. Divergent crest module design shows minimum von Mises stress at crestal bone during vertical loading within bone and at implant crest module. Straight crest module designs result in minimum stresses during oblique loading than vertical loading. Convergent crest module design shows maximum von Mises stress. Conclusion: Within limitations of the study, it was concluded that stress distribution in adjacent compact bone is greatly influenced by implant crest module design. Divergent crest module designs result in minimum stresses at crestal bone and in the implant crest module region, followed by straight and convergent crest module in ascending order of stress distribution.

Background: Third molar development is the only available tool for estimating the age of individuals after puberty. Since this tooth has very high interethnic variability, formulas calculated to estimate the age from its development stages cannot be generalized to other populations and should be adjusted for each region. Therefore, this study was conducted to evaluate this method in a sample of Tehran individuals for the first time, and also to compare the development of third molars across sexes and arches, and to estimate cutoff developmental stages for legal minor/major identification. Materials and Methods: A total of 150 dental patients aged between 15 and 25 years old were prospectively enrolled, and their Demirjian stages were recorded. The associations between chronological age and Demirjian stages were evaluated. Dental formation was compared between sexes and jaws. Cutoff stages were determined to identify legal minor/major cases (above or below 18 years old). Age estimation formula was found for this population. Results: Of the 150 included patients, 56 were males. The difference between the ages of males and females at each given developmental stage was nonsignificant (P > 0.05), except for the H stage. Age difference between same stage teeth of the maxilla and mandible was nonsignificant. Each of the G and H stages was significantly above 18 years old (P < 0.001). Furthermore, E and F stages were below 18 years old (P < 0.001). All the correlations between Demirjian stages and age were above 90% (all P< 0.001). Third molar development was positively affected by the chronological age (P = 0.000) and being maxillary (P = 0.000) but not sex (P = 0.113). Regression formula for age estimation was: age = 6.52+ (0.64 × sex) + (0.32 × arch) + (1.86 × Demirjian stage). Conclusion: Development of third molar might complete after the age 22. Iranian individuals with third molars at the G and H stages are likely above 18 while those at E and F are likely below 18. Pace of molar development differs for jaws, but intergender differences are open to further investigations.

Background: The aim of this in vitro study was to compare the film thickness and antibacterial properties of mineral trioxide aggregate-propylene glycol (MTA-PG) as a sealer in comparison with MTA Fillapex and AH26 sealers. Materials and Methods: In these in vitro study the antibacterial property of the sealers was evaluated using direct contact test in fresh and set states. Enterococcus faecalis was incubated in direct contact with fresh and set materials. The growth of exposed bacteria was evaluated by counting colony-forming units (CFUs) after 10 min and 1 h in the culture medium. The film thickness of sealers was measured according to the International Standard Organization 6876/2012. The data were statistically analyzed using an independent t-test and repeated measures of ANOVA. The level of significance was set at 0.05. Results: CFU means in AH26 was significantly more than other groups (P < 0.0001), but there was no difference between MTA-PG and MTA Fillapex. The mean of CFUs in set AH26 after 1 h exposure was significantly >10-min exposure (P = 0.006). The mean film thickness values of MTA Fillapex, MTA-PG, and AH26 were 57.3, 50.9, and 78.3 μm, respectively. Conclusion: MTA-Fillapex and MTA-PG showed distinct antibacterial effect. AH26 showed more antibacterial effect in fresh state in comparison with set state. The film thickness of MTA-PG and MTA-Fillapex was significantly less than AH26.

Background: Depression and anxiety are two psychosocial illnesses that mostly are comorbid. The prevalence of these diseases is increasing worldwide. Both can affect general health also oral and dental health. The effects can be physiological and behavioral. Patients with these disorders are not willing to keep oral hygiene. The purpose of this study was to investigate the association between depression/anxiety and oral health indices in the 15–75-year-old population of Kerman. Materials and Methods: This cross-sectional study recruited 5900 people aged 15–75 years through one-stage cluster sampling (Kerman coronary artery disease risk factors study, KERCADRS). Data were collected through beck questionnaires for anxiety and depression and clinical examinations. Oral health indices including decayed, missing, filled teeth, gingival index (GI), and community periodontal index (CPI) were also measured. Data were analyzed by SPSS 21 software. Chi-square, t-test and regression analysis were used to determine the relationship between the variables. P ≤0.05 was considered as the level of statistical significance. Results: In the study, 1975 (33.6%) of patients showed moderate-to-severe anxiety and 3502 (59.5%) got the scores as depressed. There was a significant difference between GI and CPI indices of the normal and depressed group (P < 0.01), but the difference in the anxious and normal group was not statistically significant (P > 0.05). Conclusion: The results of the study showed a significant relationship between depression and oral health indices but not with anxiety. Therefore, the present study suggests that more attention should be paid to the oral health of people with a history of depression.

Background: Streptococcus mutans as an acid-generator of biofilm, sugar as a caries-conducive environment, and oral hygiene have been implicated as major etiological agents in dental caries. This study was designed to assess the association and impact of S. mutans, sugar consumption, and tooth brushing on decayed, missing, and filled teeth (DMFT) score in Iranian 20–30-year-old individuals and compare the effect of the three mentioned factors to find the most effective one. Materials and Methods: In this cross-sectional study, 459 adults completed a Sugar Frequency Questionnaire and were examined for dental caries using DMFT index, sugar consumption level, and tooth brushing frequency per day. Saliva and plaque samples were collected, and the target population without Streptococcus sobrinus in their microbial oral community was selected using polymerase chain reaction technique. Data were analyzed by one-way analysis of variance and multiple linear regression tests (α = 0.05). Results: Nearly 77.1% of the study population were harboring S. mutans. Mean DMFT of the population was 6.62. Mean comparison analysis showed that there is a strong relationship between S. mutans existence in mouth flora and DMFT scores (P < 0.0001). Multiple linear regression test showed higher percentage of S. mutans contribution (28.2%) in DMFT score changes than sugar consumption (3.6%) and tooth brushing (0.7%). Conclusion: This study provides a recent report from S. mutans frequency and DMFT score in Iranian adult population. It is also the first study that shows significantly higher impact of S. mutans in microbial population of mouth microflora on caries development than sugar consumption and oral hygiene. Accordingly, S. mutans screening program should be more highlighted in preventive strategies.

Genetic disorders are showing an upward trend. The social and economic impact of genetic disorders on individual, family and society is enormous. There is an urgent need to explore alternate strategies to mitigate the burden of genetic disorders. This is especially true with regard to developing countries such as India where there is a shortage of health personnel adequately trained in genetic counseling at present. Dental professionals have a unique opportunity to observe the development of preadolescent and adolescent patients during periods when important growth and development changes occur. The objective of this study was to review the existing literature on the role of dentist in genetic counseling with a critical appraisal on the current practices among dentists on genetic services in India, the need, scope, and future requirements. The literature on genetic services and genetic counseling was identified by searching the biomedical databases for primary research material by one investigator over a period of 8 weeks. The articles related to dentist's role in genetic counseling were assessed and discussed in the present review. A total of 239 resource materials were retrieved in the initial search. The literature from these sources was thoroughly scrutinized by the authors, and the literature (review articles, descriptive studies, or any form of study) focusing on role of dentist in genetic counseling was finally considered for critical appraisal in the present review. The role of genetics in health and oral health care has not received due attention of the dental practitioners who otherwise are in a crucial position in identifying the patients with genetic disorders and offer requisite counseling and referral to designated genetic centers. The short training courses for practicing dentists, faculty members, and a small change in dental curriculum to make provision for teaching genetics to undergraduate students may go a long way in filling the void created by these obstacles.

Background: Radiologic diagnosis of external apical root resorption (EARR) is clinically important. Noise might disrupt this diagnosis. Therefore, we assessed the efficacy of noise reduction on periapical indirect digital radiography. Materials and Methods: This in vitro study as performed on 792 radiographs. A total of 66 single-rooted premolars were inserted in dried hemimandibles of sheep and fixed with modeling wax. Digital images were obtained using the parallel technique. The storage phosphor plates were processed in the DIGORA Optime scanner. The resulting images were sent to a computer using the Scanora software for radiographic analysis. The teeth were removed from the mandible, and artificial EARR defects were simulated. Afterward, the indirect digital radiographs were obtained at the same condition of the baseline. Five levels of noise reduction were applied. All images were saved in Digital Imaging and Communications in Medicine format and monitored by two observers twice over 2 weeks. Data were analyzed statistically using Cochran and McNemar tests (α = 0.05). Results: The highest sensitivity rate was found in the baseline group (0.99), and the lowest sensitivity was related to the “four-time noise reduction” method (0.91). The highest specificity rate was in the “five-times noise reduction” method (0.88) and the lowest specificity was associated with “one-time noise reduction” method (0.71). There was no statistical difference between images with/without noise reduction enhancement with varied gradation levels in terms of diagnostic accuracies of EARR (P > 0.05). Conclusion: Application of noise reduction procedure in Scanora software might have no effect on the accuracy of EARR diagnosis.

Background: Impressions taken from patients have the potential of cross-transmission of infection among dentistry personnel. The present study aimed to compare the antimicrobial activity of chlorhexidine (CHX) and silver nanoparticles (AgNPs) combined with irreversible hydrocolloid. Materials and Methods: This experimental study examined the in vitro antimicrobial effects of irreversible hydrocolloid mixed with silver nanoparticles and chlorhexidine using four groups, namely CHX (0.2%) solution and mouthwash mixed with irreversible hydrocolloid Groups 1 and 2), AgNPs (0.1 and 0.2%) (Groups 3 and 4), and specimens mixed with distilled water as a control group (Group 5) on bacterial strains, namely, Staphylococcu saureu s,Enterococcu sfaecali s,Pseudomona saeruginos a,Escherichi acoli, andStaphylococcu sepidermidi s through disc diffusion method. There were three replications per bacterial species. As data were not normally distributed, Kruskal–Wallis test was used at a significance level of 0.05. Results: No antimicrobial activity was observed in the control groups. In S. aureus, CHX mouthwash had the highest antimicrobial activity, and AgNPs 0.1% and 0.2% groups had lower antimicrobial activity, and there was a significant difference between the two concentrations of AgNPs (P < 0.05). InE.faecali s, the effects of CHX compounds and AgNPs 0.2% were similar to each other and were higher than the effect of AgNPs 0.1% (P < 0.05). In E. coli, CHX compounds exhibited the highest efficacy relative to other materials (P < 0.05), and the AgNPs had no effect. In P. aeruginosa, AgNPs showed the highest growth inhibition zone, which had a significant difference compared to other materials (P ≤ 0.01), whereas the CHX compounds were not effective. InS.epidermidi s, the effect of CHX compounds was similar to one another and was higher than the effect of AgNPs (P ≤ 0.01). Conclusion: According to our observations, the antimicrobial activity of AgNPs at 0.1 and 0.2% against five tested bacterial strains was similar to those of pure CHX 0.2% solution and CHX 0.2% mouthwash.

Background: Long-term treatments of herpes simplex with drugs such as acyclovir, the side effects to such drugs including limited usage during the lactation period, and concerns for the emergence of drug-resistant strains have given rise to a need for new medications with fewer complications. Nowadays, there is an increasing usage of herbal medicines throughout the world due to their higher effectiveness and safety. The present study aims to assess the effects of hydroalcoholic cinnamon extract on herpes simplex virus type 1 (HSV-1) in culture with vero cells. Materials and Methods: In this in vitro study Hydroalcoholic extract of cinnamon was extracted through percolation. To assess cell survival rates, the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was employed, and the tissue culture infective dose 50 assay was used to quantify the virus. Effects of the extract were evaluated in three stages, including before, during, and after viral inoculation into the culture medium. Two-way ANOVA and Post hoc analysis the test was performed in 1, 0.5, and 0.25 mg/ml concentrations of cinnamon extract in every stage (P < 0.05). Results: Over 50% of the cells survived in the 0.25 mg/ml extract concentration. Results of our viral quantification showed a viral load of 10⁵. The cinnamon extract was able to reduce the viral titer in all concentrations under study. Conclusion: Hydroalcoholic extract of cinnamon was effective in reducing the viral titer of HSV-1. This effect could have been caused by prevention of viral attachment to cells; however, further research is required to determine the exact mechanisms at play.

Background: Odontogenic keratocyst (OKC), also called keratocystic odontogenic tumor (KCOT), is a developmental lesion which should be carefully monitored and it exhibits development mechanisms and biologic behaviors different from those of other more common lesions such as dentigerous and radicular cysts. CD10 antigen is a cell surface metalloendopeptidase, which inactivates various peptides that are physiologically active. Studies have shown that increase in the expression of CD10 in the stromal cells helps the progression of the tumor. Ameloblastoma (AB) is a local invasive tumor and given the role of supporting connective tissue stroma in the aggression and progression. The aim of the present study was to comparatively evaluate the expression of CD10 in the connective tissue stroma of AB and OKC as a KCOT. Materials and Methods: In this retrospective, cross-sectional study, 14 paraffin blocks of KCOT and 9 of AB (7 multicystic and 2 unicystic) were evaluated with CD10 immunohistochemical expression in the connective tissue stroma of AB and the connective tissue wall of KCOT. The data were analyzed with Fisher's exact test (P < 0.05). Results: In 8 samples of 9 AB and in 13 samples of 14 KOT lesions, expression of CD10 was shown. Fisher's exact test did not reveal any significant differences between these two lesions in the expression of CD10 (P = 0.64). Conclusion: The results of this study propose that high expression rate of CD10 might be one of the reasons for the aggressive behavior of AB and high recurrence rate of OKC and reinforce the classification of OKC as an odontogenic tumor.

Background: Induction of the proliferation and differentiation of stem cells could represent a viable alternative therapeutic method for treating bone diseases. Stem cells are essential to bone tissue regeneration; although, their availability is limited. One possible method of increasing the number of stem cells and promote osteogenic differentiation is the application of red flesh dragon fruit extract supplement. The present study was performed to identify and analyze proliferation and osteogenic differentiation of bone marrow-derived mesenchymal stem cells (BMMSCs) after exposure to red flesh dragon fruit extract.Materials and Methods: This in vitro study was posttest only control group design. Red flesh dragon fruit extract was produced by means of water extraction method and subsequent dilution with different amounts of water to produce a range of concentrations. BMMSCs were obtained from the femurs of three White New Zealand rabbits. BMMSCs were then treated with 50, 100, 200, 300, and 400 μg/ml red flesh dragon fruit extract concentrations. The in vitro proliferation assay was determined by means of an 3-(4.5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Osteogenic differentiation was determined by means of the degree of nodule mineralization. There were two groups as follows: group I with the addition of 50 μg/ml of red flesh dragon fruit extract and Group II without the addition of red flesh dragon fruit. Data were analyzed using analysis of variance and the Student's t-test (P = 0.05).Results: 50, 100, 200, 300, and 400 μg/ml of red flesh dragon fruit extract demonstrated the capacity to significantly increase the proliferation of BMMSCs (P ≤ 0.05). Red flesh dragon fruit extract could significantly increase osteogenic differentiation (P ≤ 0.05).Conclusion: Red flesh dragon fruit extract enhances proliferation and osteogenic differentiation of BMMSCs.

Background: Pleomorphic adenoma (PA), mucoepidermoid carcinoma (MEC), and adenoid cystic carcinoma (AdCC) are the most common benign and malignant salivary gland tumors. Cyclooxygenase-2 (COX-2) is a key regulatory enzyme that its overexpression in various tumors is correlated with progression, metastasis, and apoptosis inhibition. Vascular endothelial growth factor (VEGF) is a potent angiogenic mediator that has an important role in neoplastic angiogenesis. The aim of this study was to immunohistochemically analyze the expression of COX-2 and VEGF and to compare the expression of benign and two malignant salivary gland tumors with varied structures. Materials and Methods: In this cross-sectional study, 90 specimens including 30 cases of each tumor were retrieved. Immunohistochemical staining of COX-2 and VEGF was performed for all the samples. The percentage of positive tumor cells and staining intensity was evaluated by two pathologists blindly. Data were analyzed by Chi-square and Gamma test and P < 0.05. Results: A statistically significant difference was noted between the expression and intensity of COX-2 and VEGF in PA, MEC, and AdCC (P < 0.05). A significant correlation was observed between COX-2 and VEGF expression in MEC and AdCC (P < 0.05). However, no significant correlation was found between the expression and intensity of COX-2 and VEGF with histologic grade and lymph node metastasis in MEC and AdCC (P < 0.05). Conclusion: High expression of VEGF and COX-2 in malignant tumors compared to PA suggested the role of both markers in malignant transformation. The significant correlation of VEGF expression with COX-2 may represent the role of COX-2 in tumor angiogenesis by modulating VEGF production.

Background: This study was performed to evaluate and compare the clinical and antimicrobial efficacy of subgingival irrigation with tetracycline and povidone-iodine as an adjunct to nonsurgical periodontal therapy. Materials and Methods: Twenty subjects with chronic moderate periodontitis were recruited in this split-mouth study with probing pocket depth of >3 and ≤5 mm and clinical attachment loss of 3-4 mm in relation to 16, 36, and 46. In each subject, three selected periodontal pockets were assigned to receive one out of three irrigants (1) sterile water (control) in 16; (2) tetracycline at 10 mg/ml in 36; (3) 2% povidone-iodine in 46, and these sites were designated as Group A, Group B, and Group C, respectively. Plaque score, gingival score, pocket probing depth, and clinical attachment level were evaluated before treatment and at 1 and 3 months posttreatment. Multiplex polymerase chain reaction was used to detect Porphyromonas gingivalis and Tannerella forsythensis which have been implicated as the major risk factors for periodontal disease. Subgingival plaque collected before treatment and at 1 and 3 months posttreatment. Data were analysed using ANOVA and repeated measure ANOVA. Results were considered significant if P < 0.05. Results: Clinical and microbiological parameters were reduced posttreatment, the reduction being significantly higher in Group B compared to Group C. Conclusion: It can be concluded that chemical and mechanical therapies were of slight benefit in the treatment of chronic moderate periodontitis, and there was an adjunctive effect of significance when scaling and root planing was combined with a single subgingival irrigation with tetracycline or povidone-iodine in lower concentration.

Background: This clinical trial investigated the effectiveness of two remineralizing creams on regression of white spot lesions (WSLs) after orthodontic therapy. Materials and Methods: The study included patients with WSLs on their upper anterior teeth who recently completed orthodontic treatment at the Department of Orthodontics of Mashhad Dental School and two private offices. The participants were randomly assigned into three groups by treatment: (1) a 12-week regimen of a cream containing casein phosphopeptide-amorphous calcium phosphate and fluoride (MI Paste Plus); (2) a 12-week regimen of a cream containing hydroxyapatite and fluoride (Remin Pro); and (3) usual home care (control). Thirty-nine patients participated and three withdrew. The main outcomes including area, mineral content, and color of WSLs were measured at enrolment and 4, 8, and 12 weeks later, respectively. Blinding was applied for outcome assessment only. The data were analyzed by analysis of variance and repeated measures analysis at the statistical significance of P < 0.05. Results: Over a 3-month period, the application of both MI Paste Plus and Remin Pro caused significantly greater reduction in area and significantly higher increase in mineral content of WSLs compared to the control group (P < 0.05). The appearance of WSLs improved significantly in both experimental groups (P < 0.05), but not in the control group. No side effect was observed throughout the experiment. Conclusion: The application of either MI Paste Plus or Remin Pro was effective in reducing the area, increasing the mineral content and improving the appearance of demineralized enamel, indicating that these products could be recommended for managing postorthodontic WSLs.

Background: Immediate dental implants placement and loading utilizing definitive abutments might save time and cost when an esthetic final result is anticipated. The objective of this prospective clinical trial was to evaluate the esthetic outcome of immediate implantation and immediate nonfunctional loading utilizing definitive abutments, with and without bony substitutes filling the peri-implant gap. Materials and Methods: In this clinical trial study a total of 11 implants were placed utilizing a flapless immediate post extraction approach in the maxilla (second premolar to second premolar). Atraumatic extraction was performed and implants were immediately placed. The gap was either left without grafting or filled with particulate bone material. Immediate nonfunctional loading was performed utilizing a definitive abutment. The pink esthetic scores (PESs) were assessed preoperatively, at 1- and 2-year follow-up periods. Dental casts were obtained at respective time intervals; scanned, registered, and closest point distances were measured. For all statistical tests, value of P = 0.05 was set as a statistical significance level. Results: The mean of PES at baseline was 9.4 ± 1.69, at 1 year was 9.5 ± 2.07, at 2 years was 10.2 ± 2.75, for the graft group 10.3 ± 2.8, and for nongrafting group was 10.2 ± 2.59. There were no statistically significant differences in PESs at baseline when compared to 1- and 2-year intervals, and for grafting group versus nongrafting group (P = 0.24). Distances between the two time points for all cases were <1 mm in all reference planes. Conclusion: Immediate placement and nonfunctional loading utilizing a definitive abutment appear to result in a stable result as far as esthetic outcome and alveolar process sufficiency are concerned.

Background: The purpose of this study was to evaluate the influence of three different luting protocols on shear bond strength of computer aided design/computer aided manufacturing (CAD/CAM) resin nanoceramic (RNC) material to dentin. Materials and Methods: In this in vitro study, 30 disks were milled from RNC blocks (Lava Ultimate/3M ESPE) with CAD/CAM technology. The disks were subsequently cemented to the exposed dentin of 30 recently extracted bovine permanent mandibular incisors. The specimens were randomly assigned into 3 groups of 10 teeth each. In Group 1, disks were cemented using a total-etch protocol (Scotchbond™ Universal Etchant phosphoric acid + Scotchbond Universal Adhesive + RelyX^™ Ultimate conventional resin cement); in Group 2, disks were cemented using a self-etch protocol (Scotchbond Universal Adhesive + RelyX^™ Ultimate conventional resin cement); in Group 3, disks were cemented using a self-adhesive protocol (RelyX^™ Unicem 2 Automix self-adhesive resin cement). All cemented specimens were placed in a universal testing machine (Instron Universal Testing Machine 3343) and submitted to a shear bond strength test to check the strength of adhesion between the two substrates, dentin, and RNC disks. Specimens were stressed at a crosshead speed of 1 mm/min. Data were analyzed with analysis of variance and post-hoc Tukey's test at a level of significance of 0.05. Results: Post-hoc Tukey testing showed that the highest shear strength values (P < 0.001) were reported in Group 2. The lowest data (P < 0.001) were recorded in Group 3. Conclusion: Within the limitations of this in vitro study, conventional resin cements (coupled with etch and rinse or self-etch adhesives) showed better shear strength values compared to self-adhesive resin cements. Furthermore, conventional resin cements used together with a self-etch adhesive reported the highest values of adhesion.

Background: Squamous-cell carcinoma (SCC) represents the most common type of malignancies in the oral cavity (O) and esophagus (E). Epidermal growth factor receptor (EGFR) plays a key role in numerous processes that affects tumor growth, progression, differentiation, invasion, metastasis, and inhibition of apoptosis. In this study, we wanted to investigate the EGFR expression in OSCC and ESCC cases. As well, another purpose was to observe if there exists any relation between its expression and clinicopathologic factors. To the best of our knowledge, this is the first study which compares the EGFR protein expression between OSCC and ESCC. Materials and Methods: This cross-sectional study was performed on 46 paraffin blocks (23 OSCC and 23 ESCC). The expression of EGFR was evaluated with immunohistochemical technique. Data analyses were done using SPSS software by Fisher's exact test. Significance was assigned at P < 0.05. Results: Out of 46 patients, 25 cases (54.3%) were male and 21 (45.7%) were female. Seventy-eight percent of OSCCs and 73.9% of ESCCs showed high expression of EGFR. No statistically significant difference was observed between the two groups (P = 0.73). There were no statistically significant correlations between EGFR expression and clinicopathologic factors (age, gender, grade, and stage) of OSCCs (P > 0.05). A statistically significant correlation was found between EGFR expression and stage in ESCCs group (P = 0.006). Conclusion: No significant correlation was found between the expression of EGFR protein in OSCCs and ESCCs. High expression of EGFR was observed in ESCCs with Stages II, III.

The purpose of this paper was to review the composition, sealing ability, biocompatibility and various physical properties of cold ceramic (CC) material that potentially used as a root filling material. The review of the articles was performed by electronic and manual searching methods regarding the properties of CC from November 2000 to May 2016. The results revealed that there were many published reports carried out on the properties of CC. Only one article had extensively studied the composition of CC, five studies had investigated the sealing ability of CC, three articles had studied the biocompatibility, and some studies had investigated the radiopacity, setting time, pH value, and solubility of CC. It was concluded that CC material had good potential for endodontic use. Furthermore, clinical studies are needed in these areas.

Rehabilitation of patients with a severe mandibular defect is challenging to prosthodontists. The esthetic and functional rehabilitation of patients with lateral mandibular resection is difficult due to the lack of supporting tissues for the prosthesis. The mandibular deviation furthermore results in facial asymmetry and unstable occlusion. This case report describes an innovative technique to rehabilitate a patient with lateral mandibular resection using customized access post attachment system to retain guide flange prosthesis for reducing mandibular deviation.

The purpose of this review is to have an overview on the applications on the autologous fibrin glue as a bone graft substitute in maxillofacial injuries and defects. A search was conducted using the databases such as Medline or PubMed and Google Scholar for articles from 1985 to 2016. The criteria were “Autograft,” “Fibrin tissue adhesive,” “Tissue engineering,” “Maxillofacial injury,” and “Regenerative medicine.” Bone tissue engineering is a new promising approach for bone defect reconstruction. In this technique, cells are combined with three-dimensional scaffolds to provide a tissue-like structure to replace lost parts of the tissue. Fibrin as a natural scaffold, because of its biocompatibility and biodegradability, and the initial stability of the grafted stem cells is introduced as an excellent scaffold for tissue engineering. It promotes cell migration, proliferation, and matrix making through acceleration in angiogenesis. Growth factors in fibrin glue can stimulate and promote tissue repair. Autologous fibrin scaffolds are excellent candidates for tissue engineering so that they can be produced faster, cheaper, and in larger quantities. In addition, they are easy to use and the probability of viral or prion transmission may be decreased. Therefore, autologous fibrin glue appears to be promising scaffold in regenerative maxillofacial surgery.

Background: The aim of this study was to determine the effect of low-level light therapy (LLLT) on orthodontic tooth movement (OTM) rate, heat shock protein 70 (HSP-70) expression, and matrix metalloproteinase 8 (MMP-8) expression. Materials and Methods: In this experimental study twenty-four male guinea pigs were randomly divided into three groups (n = 8): control group (K) without orthodontic force and LLLT; treatment group 1 (T1) with orthodontic force, and treatment group 2 (T2) with orthodontic force and LLLT. The labial surfaces of both maxillary central incisors in treatments groups were installed with single-wing bracket before being inserted with close coil spring to give 10 g/cm² orthodontic force. For the T2 group, 4 J/cm² of LLLT was administered in the mesial-distal and labial-palatal regions for 3 min every day. On day 14, the gap between teeth was measured and immunohistochemistry staining was done to determine HSP-70 and MMP-8 expression. Data were analyzed using (IBM, New York, (ANOVA), followed by Turkey's HSD test to determine the differences between groups. Nonnormal distributed data would be analyzed using Kruskal–Wallis test, followed by Mann–Whitney test with P < 0.05 being performed. Results: The gap between teeth in the T2 group was greater compared to T1 group (P = 0.00). However, there was a significant decrease of HSP-70 and MMP-8 expression in T2 group compared to T1 group in the tensile and compressive sides. Conclusion: LLLT intervention during orthodontic treatment could accelerate OTM rate and decreased HSP-70 and MMP-8 expression both in tension and in compressive side. Thus, LLLT interventions can be used as adjuvant therapy to shorten orthodontic treatment duration.

Background: The degree of tooth enamel wear is an important aspect of the clinical acceptability of all-ceramic restorations. The purpose of this study was to compare the degree of enamel wear by feldspathic porcelain and polymer-infiltrated ceramic. Materials and Methods: In this in vitro study, 10 polymer-infiltrated ceramics were prepared by creating the sections of Vita Enamic^® blocks (18 mm × 14 mm × 4 mm). A total of 10 porcelain cylinders were built, and feldspathic porcelain (VMK 95, Vita) was used and fired over the metal discs. A total of 20 human maxillary premolars were assigned as antagonist. Then, 10 teeth were arranged and placed oppose to porcelain samples and 10 others were placed oppose to polymer-infiltrated-ceramic specimens in the chewing simulator. The samples were photographed before and after the chewing simulation. The difference between the two photograph was measured by stereomicroscope and Motic Image plus software 2.0 three times, and then, the mean of these three times was recorded as the amount of wear. Data were analyzed using independent samples t-test and SPSS version 16. The level of significancy was 0.05. Results: The mean wear rate teeth oppose to the feldspathic porcelain group (377.294 μ) was significantly higher than that of the polymer-infiltrated ceramic group (101.755 μ) (P = 0.002). Conclusion: In the present study, the amount of enamel wear of the natural teeth opposed to polymer-infiltrated ceramic was significantly lower than feldspathic porcelain.

Background: One-visit apexification is a treatment of choice in necrotic immature open apex teeth. Calcium silicate base materials are suitable for this method. The purpose of this study was to investigate and compare the sealing efficiency of Biodentine, mineral trioxide aggregate (MTA) ProRoot, and calcium-enriched mixture (CEM) cement orthograde apical plug using bacterial leakage method. Materials and Methods: In this in vitro study a total of 70 extracted maxillary incisors were cleaned and shaped. A 1.1-mm standardized artificially open apex was created in all samples. The teeth were randomly divided into three experimental groups of 20, and two negative and positive control groups of 5. In experimental groups, 4-mm thick apical plugs of ProRoot MTA, CEM cement, or Biodentine were placed in an orthograde manner. Negative control samples were completely filled with MTA while positive control samples were left unfilled. Sealing efficiency was measured by bacterial leakage method, and results were analyzed by Kaplan–Meier and Chi-square tests. The level of significance was set at 0.05. Results: The highest number of turbidity was recorded for ProRoot MTA samples, while the lowest for Biodentine. There was a significant difference in the number of turbidity between ProRoot MTA and Biodentine groups (P < 0.001), but there was no significant difference between CEM cement and Biodentine (P = 0.133) and ProRoot MTA (P = 0.055). Conclusion: Within the limitation of this in vitro study, Biodentine showed promising results as a substance with good-sealing efficiency.

Background: Low levels of estrogen can cause osteoporosis and usually occur during a woman's menopausal phase. Osteoporosis can lead to bone resorption, the absence of osseointegration, and implant failure. The aim of this study is to determine the expression of transforming growth factor-beta 1 (TGF-β1), runt-related transcription factor (RUNX2), and osteoblasts in mandibular rats with low levels of estrogen. Materials and Methods: This study is an in vivo experimental research. Female Wistar rats (n = 18) were divided into two groups: (1) Postsham surgery and (2) ovariectomy group. After 12 weeks, the rats were sacrificed to identify the level of estrogen, while histological analysis was conducted to determine the level of osteoblast and the expression of TGF-β1 and RUNX2. The data were analyzed using t-test (P < 0.05). Results: There were significant lower levels of estrogen and osteoblast among the ovariectomy group compared to the postsham group (P < 0.05). RUNX2 levels were found to be significantly higher in the ovariectomy group than that in the postsham group (P < 0.05). However, there were no significant differences between TGF-β1 levels within the ovariectomy and postsham groups (P > 0.05). Conclusion: Ovariectomy can lead to decreased osteoblastogenesis in mandibular bone by the reduced level of osteoblast and the increased expression of TGF-β1 and RUNX2.

Background: The relationship between the dimensions of the cranial base and skeletal anterioposterior problem has been controversial for years. The aim of this study was to determine the relationship between the anterioposterior cephalometric indicators and the cranial base cephalometric indicators in an Iranian population. Materials and Methods: In this historical cohort cephalograms of 100 skeletal Class I patients, 101 skeletal Class II patients, and 98 skeletal Class III patients were selected. The cephalograms were traced manually and the indicators were measured. Finally, data were analyzed by SPSS software using the Mann–Whitney test and Pearson's correlation test. The significance level was set at 0.05. In cases that the correlation coefficient (r) was 0.6 or higher, linear regression was used. Results: The dimensions of the cranial base are significantly larger in men than that in women. Anterior cranial base length (SN) showed statistically significant difference between Class I and Class II groups (P < 0.05). BaSN, ArSN, and SN-FH showed statistically significant differences between Class II and Class III groups (P < 0.05). Conclusion: Smaller cranial base angle in the skeletal Class III malocclusion compared to skeletal Class II malocclusion has been demonstrated in this study. A significant correlation between the cranial base angle, the cranial base dimension, and the effective length of the maxilla was observed, and the smaller cranial base angle in Class III malocclusion was also confirmed. These findings indicate that the cranial base can affect the development of maxilla and mid-face.

Background: The use of stem cells, growth factors, and scaffolds to repair damaged tissues is a new idea in tissue engineering. The aim of the present study is the investigation of Avocado/soybean (A/S) effects on chondrogenic differentiation of human adipose-derived stem cells (hADSCs) in micromass culture to access cartilage tissue with high quality. Materials and Methods: In this an experimental study After hADSCs characterization, chondrogenic differentiation was induced using transforming growth factor beta 1 (TGF-β1) (10 ng/ml) and different concentrations (5, 10, and 20 μg/ml) of A/S in micromass culture. The efficiency of A/S on specific gene expression (types I, II, and X collagens, SOX9, and aggrecan) was evaluated using quantitative polymerase chain reaction. In addition, histological study was done using hematoxylin and eosin and toluidine blue staining all data were analyzed using one-way analysis of variance (ANOVA) and P ≤ 0.05 was considered to be statistically significant. Results: The results of this study indicated that A/S can promote chondrogenic differentiation in a dose-dependent manner. In particular, 5 ng/ml A/S showed the highest expression of type II collagen, SOX9, and aggrecan which are effective and important markers in chondrogenic differentiation. In addition, the expression of types I and X collagens which are hypertrophic and fibrous factors in chondrogenesis is lower in present of 5 ng/ml A/S compared with TGF-β1 group (P ≤ 0.05). Moreover, the sulfated glycosaminoglycans in the extracellular matrix and the presence of chondrocytes within lacuna were more prominent in 5 ng/ml A/S group than other groups. Conclusion: It can be concluded that A/S similar to TGF-β1 is able to facilitate the chondrogenic differentiation of hADSCs and do not have adverse effects of TGF-β1. Thus, TGF-β1 can be replaced by A/S in the field of tissue engineering.

Background: This study sought to assess and compare coronal discoloration following the application of white mineral trioxide aggregate, Biodentine, and calcium-enriched mixture cement in endodontically treated teeth. Materials and Methods: In this in vitro experimental study, 64 freshly extracted sound human premolars were selected, cleaned, and stored in saline. After cleaning, shaping, and obturation the root canal of the teeth, the teeth were randomly assigned to one control (n = 4) and three experimental (n = 20) groups. In the experimental groups, the cement were applied over the canal orifices in 3-mm thickness. All teeth were then restored with composite resin. Color parameters, according to the CIE L*a*b* system, were measured using Vita Easyshade spectrophotometer before application of cement and at 1 week, 1 month, 2 months, and 3 months after the application of cement. The recorded values were statistically analyzed using descriptive and analytical statistics. For analytical statistics, Kolmogorov–Smirnov test was applied to assess normal distribution of data. ANOVA was used to compare the results at baseline and repeated measures. P < 0.05 was considered statistically significant Results: Significant differences were noted in color change (ΔE) between all time points except between ΔE4 (2 months) and ΔE5 (3 months) (P < 0.01). However, tooth discoloration caused by the three cement was not significantly different (P = 0.343). Conclusion: The three tested cement were not significantly different in terms of causing coronal discoloration in endodontically treated teeth.

Background: The purpose of this study was to evaluate the effect of calcium hydroxide (Ca[OH]₂)residues on the accuracy of two electronic apex locators (EALs) (Root ZX and Raypex 6) in the presence of different irrigants. Materials and Methods: In this an in vitro study Eighty single-rooted human mandibular premolars were selected. The crowns of the teeth were removed to standardize the working lengths (WLs). Actual WLs (AWLs) were recorded, and the root canals were shaped using protaper rotary instruments up to size F3. Then, the root canals were dried and filled with injectable Ca (OH)₂paste and the access cavities were temporarily sealed. Teeth were put into four alginate boxes, including two experimental groups (n = 30) and two control groups (n = 10). The pools of alginate were wrapped in wet gazes and stored at 37°C and 100% humidity for 7 days. Then, the root canals were exposed and Ca (OH)₂paste was removed by normal saline or 5.25% sodium hypochlorite irrigation followed by 17% ethylenediaminetetraacetic acid (EDTA), and the electronic WL (EWL) was measured by Root ZX and Raypex 6. Differences of EWL from AWL were calculated. Furthermore, the percentage of acceptable measurements (tolerance limit of ± 0.5 and ± 1 mm) was calculated for each apex locator. One-way ANOVA test with post hoc paired t-test and Chi-square test was used to analyze the data (P < 0.05). Results: The results showed that there was no significant difference between the accuracy of two EALs and irrigants (P > 0.05). Conclusion: The present study revealed that no statistically significant differences were observed between the two apex locators after Ca(OH)₂paste removal with different irrigants.

Background: Bleaching may affect the bond strength of existing composite fillings and may weaken it. Hence, the aim of this study was to find the best method of in-office bleaching with the least effect on microshear bond strength (MSBS) of existing composite resin fillings to tooth structure. Materials and Methods: In this in vitro study, Class V cavities were prepared on buccal surface of 50 extracted third human sound molars. The cavities in 25 teeth had enamel axial walls, Group E, which were divided into five subgroups of E1 through E5 and in 25 teeth had dentin axial walls, Group D, which were divided into five subgroups of D1 through D5. Cavities were treated with Single Bond 2 adhesive system and restored with composite resin (Z250). The corresponding subgroups received similar bleaching methods and materials; 1 – not bleached, 2 – hydrogen peroxide (HP) 25%, 3 – HP + ultraviolet light, 4 – HP + light-emitting diode-curing device, and 5 – HP + diode laser. Teeth colors were monitored before and after bleaching, and MSBS test and failure modes were examined. Results were analyzed with one-way ANOVA and Kruskal–Wallis tests. P < 0.05 was considered significant. Results: One-way ANOVA did not show differences in MSBS of enamel subgroups but showed significant differences in dentin subgroups (P < 0.00). Adhesive fracture in all of the subgroups was the most frequent mode of failure. Kruskal–Wallis test showed that laser was the most effective instrument to change ΔE. Conclusion: Diode laser was the best method for tooth bleaching because lowering the shear bond strength between composite resin and enamel was minimum and also had the most ΔE in tooth bleaching.

Background: Dental caries is considered as one of the most serious dental diseases that results in localized dissolution and destruction of the calcified tooth tissues. As possible alternatives to conventional techniques of caries removal, chemomechanical caries removal systems have emerged. This study aims to clinically observe the advantages of chemomechanical method of caries removal over conventional technique. Materials and Methods: Inthis randomized controlled trial a total of 60 children with Class 1 open carious lesions were selected for the study. They were divided into two equal groups according to a method of caries removal (30 chemomechanical and 30 conventional on permanent molars). In Group A, caries was removed using the Carie-Care system and in Group B with the conventional drill and were restored equally with glass ionomer cement. The visual analogy face scale was used to determine the level of anxiety in children at baseline, during treatment and after treatment. Results: The results were subjected to statistical analysis using Student's unpaired t-test. It showed that though chemomechanical technique took a marginal increase in time compared to the conventional technique, it was found to be more comfortable for all the children. Conclusion: Chemomechanical technique though time-consuming is definitely superior compared to the conventional technique provided we use a less technique sensitive restorative material which retains in the oral cavity for longer period. It is definitely a better treatment protocol in school-based dental treatment and atraumatic restorative dentistry compared to the conventional technique.

Background: Since secondary caries is one of the main problems of dental composites. The creation of an antibacterial property in these composites is essential. The objective of this study was to synthesize 3-(2, 5-dimethylfuran-3-yl)-1H-pyrazole-5(4H)-one and check its biocompatibility and antibacterial properties in flowable dental composites. Materials and Methods: In this animal study, the antibacterial activity of flowable resin composites containing 0–5 wt% 3-(2,5-dimethylfuran-3-yl)-1H-pyrazole-5(4H)-one was investigated by using agar diffusion and direct contact tests on the cured resins. Statistical analysis was performed using one-way ANOVA test (P < 0.001). Thirty male albino Wistar rats were used, weighing 200–250 g. Animals were randomly divided into three groups of ten; each animal received three implants, 3-(2, 5-dimethylfuran-3-yl)-1H-pyrazole-5(4H)-one, penicillin V, and an empty polyethylene tube. A pathologist, without knowing the type of material tested and the timing of the test, examined the samples. Statistical analysis was performed using Kruskal–Wallis test (P < 0.001). Results: According to our findings, although the agar diffusion test reveals no significant difference between the groups, the direct contact test demonstrates that, by increasing the 3-(2,5-dimethylfuran-3-yl)-1H-pyrazole-5(4H)-one content, the bacterial growth was significantly diminished and the 3-(2,5-dimethylfuran-3-yl)-1H-pyrazole-5(4H)-one has a good biocompatibility (P < 0.05). Conclusion: Incorporation of 3-(2,5-dimethylfuran-3-yl)-IH-pyrazole-5(4H)-one into flowable resin composites can be useful to prevent Streptococcus mutans activity.

Background: The aim of this study is comparing the retention and caries preventive effect of the glass-ionomer fissure sealant and resin-based fissure sealant. Materials and Methods: A randomized-controlled split-mouth study was conducted to compare the retention and the caries preventive effect of light-cured resin-based sealant (3M ESPE) and glass ionomer sealant (Fuji VII). The sealants were applied to either the right or the left lower mandibular molars (7-9 yrs of age) in 120 school children, based on the randomization process. They were recalled for assessment of clinical retention at intervals of 3, 6, and 12 months. The caries-preventive effect between the two materials was tested statistically by the McNemar's test for matched pairs, and the differences observed with regard to the retention of the materials was tested by Chi-square tests. The level of significance was set to be at P < 0.05. Results: At the end of 12^th month, sealant retention is found to be higher in the resin-based sealant group compared to the glass ionomer group. In the glass ionomer sealants placed, 101 (91%) were caries-free and 10 (9%) had caries. In the resin-based sealant, 105 (94.60%) had sound teeth and 6 (5.4%) had dental caries (P = 0.34). Conclusion: The glass ionomer sealant was less retentive when compared to resin sealants. The caries incidence between the glass ionomer and resin-based sealants was not statistically significant.