Background: Oral health-related quality of life (OHRQoL) assesses the subjective perception of oral health and its impact on the quality of life. The aim of this study is to measure the OHRQoL and its determinants among adult people living in Kerman, Iran. Materials and Methods: In this cross-sectional study, a total of 5657 adult people (18–64 years) residing in the Kerman district, both in the rural and urban areas, were enrolled in the study between September 2014 and April 2018. The Oral Health Impact Profile (OHIP-14) and the oral health indices, such as the total decayed, missing, filled teeth (DMFT), community periodontal index (CPI), gingival index (GI), and xerostomia, were measured by an experienced dentist. The demographic variables of gender, age, educational status, and marital status were also recorded. The impact of the studied variables on OHRQoL was evaluated with multiple logistic regression. Results: Participants were 2239 (39.58%) men, and average age was 45.39. The mean scores for OHRQoL, DMFT, CPI and GI were respectively: 24.07 (7.76), 10.7 (6.86), 0.76 (0.96), 0.63 (0.8). The frequency of people with xerostomia was 37.4. 301 (53.3%) of people had poor quality of life related to oral health. In multivariable analysis, there was a statistically significant increase in OHRQoL with an increase in the DMFT (P < 0.001), xerostomia (P < 0.001), CPI, (P < 0.001). Men had a significantly higher OHIP score than women (P < 0.001). Conclusion: According to the results of this study, DMFT, xerostomia, and CPI scores are strongly related to OHIP scores. In addition, between CPI and GI scores, the CPI score is the better predictor.

Ewing's sarcoma (ES) is an aggressive, poorly differentiated round cell tumor in bone or soft tissues. This rare neoplasm is found primarily in the long bones of limbs and flat bone of pelvis with a predilection in the second decade in life. Primary ES of the maxillofacial region is exceptional and constitute 1% ± 4% of all cases. This case report is aimed at highlighting a very rare clinical presentation of extraosseous ES of the chin region-a first of its kind.

Background: This systematic review aimed to evaluate the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACPF) varnish for remineralization of white spot lesions (WSLs) “in vitro” in human teeth. Materials and Methods: Literature search included three databases, namely Medline (via PubMed), The Cochrane Controlled Clinical Trials Register, and Google Scholar from 2010 to January 2021. The studies assessing WSL depth, calcium, phosphate ion release, and microhardness due to artificial demineralization or remineralization were considered for review. Reference articles were retrieved, and a customized risk assessment tool was used. The Cochrane risk of bias assessment tool was used to generate the risk of bias summary graph. Meta-analysis was performed using RevMan 5.4. Heterogeneity was evaluated by Cochrane's test, and random effects model was used to pool estimate of effect and its 95% confidence intervals (CIs) for surface microhardness. Results: Eighteen studies were selected for review based on the eligibility criteria. Four studies showed superior remineralizing effect of CPP-ACPF compared to fluoride varnishes. Four studies involving 120 human permanent teeth samples were included in the meta-analysis. Efficacy of CPP-ACPF varnish was equivalent to other fluoride varnishes in improving surface microhardness after remineralization during 7-day period (mean surface microhardness: 3.94, 95% CI [−9.08–1.21], I^2: 75%, P = 0.13). Major risks of bias associated with the studies included in the review were inadequate sample size, improper sample preparation, and unexplained blinding. Conclusion: CPP-ACPF varnish appears to be equally effective as other fluoride varnishes in remineralizing artificially induced WSLs, but quality of evidence is low.

Child's uncooperative behavior can impede the efficient delivery of dental care. Therefore, in spite of exceeding availability of behavior management techniques there is a need to search for a psychological behavior management technique that effectively reduces fear and anxiety during dental treatment and instill a change in child's attitude toward the treatment and is also acceptable by the parents. The aim of our systematic review is to determine the efficacy of various psychological behavior management techniques in managing a child's behavior in pediatric dentistry by assessing the fear and anxiety levels, ease of use by the clinician, application in various operative procedures, and parental acceptance. A systematic search was conducted by two reviewers in databases PubMed, Google Scholar, Scopus, Web of Science, and Cochrane for the studies published from January 1, 2011, to December 31, 2020. Studies included were clinical studies which evaluated the efficacy of various psychological behavior management techniques by evaluating the fear and anxiety levels and the changes in behavior during dental treatment in children aged between 4 and 14 years. The studies selected were then assessed for quality with the help of predetermined criteria which categorized the studies into high, medium, and low. Through search strategy, 7147 articles were yielded. After screening through titles and abstracts, 60 nonduplicated articles were selected which were further screened for full text. At the end, 15 articles were included in systematic review and 3 articles for meta-analysis. It was concluded that all the psychological behavior management techniques aided in reduction of fear and anxiety. In noninvasive procedures, conventional psychological behavior management techniques can be effective but in invasive procedures other newer psychological behavior management techniques showed better results. The aspect of parental acceptance regarding various techniques was not discussed in any of the included studies.

Background: The aim of this study was to evaluate the rate of apical microleakage following the fracture of five types of nickel–titanium rotary file systems (ProTaper Universal, Mtwo, RaCe, Revo-s, HeroShaper) in the apical one-third of the canal. Materials and Methods: In this laboratory experiment, 49 mandibular premolars were collected and randomly divided into seven groups. Root canal treatment was performed by five different rotary file systems with different cross-sections. All files, except in the control groups, were scratched at the 3-mm end by a handpiece. After separation of the apical end of the file in the root canal, the apical seal was measured, using the fluid infiltration technique. Data were analyzed in SPSS, using one-way ANOVA and Tamhane's T2 tests at P < 0.05. Results: The Hero Shaper and RaCe files showed the highest (3.14 μL/min) and the lowest (2.51 μL/min) rates of microleakage over time, respectively. There were significant differences between the Hero Shaper and RaCe files and between Hero Shaper and ProTaper files in terms of microleakage (Tamhane's T2 tests, P < 0.05) Conclusion: The presence of a separated file and its cross-section type affects the apical microleakage.

Background: Polyether ether ketone (PEEK) was recently introduced to dentistry. However, difficulty in provision of a strong durable bond is its main drawback. Thus, precise surface treatment and use of a suitable luting agent are imperative for bonding of PEEK restorations. This study aimed to assess the effect of type of luting agent on shear bond strength (SBS) of PEEK. Materials and Methods: In this in vitro study, 60 square-shaped PEEK samples were fabricated and sandblasted with 110 μm Al₂O₃ particles. The samples were then divided into four groups based on the type of cement used (n = 15): zinc phosphate cement, Panavia F2, Panavia V5, and resin-modified glass-ionomer (RMGI) cement. After bonding, the samples were thermocycled for 5000 cycles. The SBS was measured by a universal testing machine. The surface of samples was inspected under a video measuring machine to determine the mode of failure. Data were analyzed using the Kruskal–Wallis test via SPSS version 24 (α = 0.05). Results: RMGI did not bond to PEEK. The SBS values were 4.02 ± 2.87 megapascals (MPa) for Panavia V5, 10.84 ± 6.05 MPa for Panavia F2, and 10.50 ± 2.88 MPa for zinc phosphate. The SBS in the Panavia V5 group was significantly lower than that in the Panavia F2 (P = 0.001) and zinc phosphate (P < 0.001) groups. No significant difference existed between the Panavia F2 and zinc phosphate groups in this respect (P > 0.05). Conclusion: Panavia F2 resin cement and zinc phosphate conventional cement provided the highest bond strength to PEEK, while RMGI did not bond to PEEK.

Background: Considering the increasing demand for tooth-colored restorations, this study sought to assess the micro-shear bond strength (μSBS) of composite to deep dentin by using mild and ultra-mild universal adhesives. Materials and Methods: This in vitro, experimental study evaluated 75 sound third molar teeth randomized into five groups (n = 15) of Clearfil self-etch (SE) Bond (control), Tokuyama Universal Bond (TUB), and All-Bond Universal (ABU) in etch and rinse (E and R) and SE modes. The occlusal surfaces of the teeth were trimmed to expose deep dentin at 0.5 mm distance from the pulp chamber. Adhesives were applied on the dentin surface according to the manufacturers' instructions, and Z350XT composite cylinders were bonded to dentin using Tygon tubes (0.9 mm internal diameter, 2 mm height). After incubation at 37°C and 100% humidity for 24 h, the teeth underwent μSBS test in a universal testing machine. The mode of failure was also determined under a stereomicroscope. Analysis of variance, Bonferroni test, and Fisher's exact test were applied for data analysis (alpha = 0.05). Results: TUB in E and R mode (13.78 MPa) and ABU in SE mode (7.85 MPa) yielded the maximum and minimum μSBS values, respectively. No significant difference was noted in μSBS of tested universal adhesives in E and R and SE modes to deep dentin (P > 0.05). TUB yielded significantly higher μSBS than ABU (P < 0.05). No significant difference was noted in mode of failure of the groups (P > 0.05). Conclusion: Type of adhesive affected the μSBS but etching mode of universal adhesives had no significant effect on their μSBS to deep dentin.

Background: Over the past year, patients infected by severe acute respiratory syndrome coronavirus-2 presented with severe gustatory dysfunction, the prevalence of which varies among different populations. Furthermore, there have been sporadic reports of oral ulceration observed in coronavirus disease-19 (COVID-19) patients due to varied reasons. The aim of this study was to investigate and characterize the presence of gustatory disorders, oral ulceration, and other oral changes in patients with laboratory-confirmed COVID-19 infection. Materials and Methods: In this cross-sectional observational study, a total of 402 participants who were detected COVID-19 positive by reverse transcription–polymerase chain reaction were included. Their demographic and clinical data were recorded through hospital records. The participants were interviewed either in person or on the telephone to record any change in taste and/or changes within the oral cavity. t-test for independent means was used to compare mean age, while other characteristics were compared by Chi-square test and Z-score test. P < 0.05 was taken as significant. Results: Out of the total sample of 402 individuals, 262 were male and 140 were female. The prevalence of gustatory dysfunction and oral ulceration was 43.53% and 15.67%, respectively, in the studied sample. Significantly more females had gustatory dysfunction than males and older subjects more commonly than younger. The symptom of loss/change of taste and oral ulceration were more probable to occur together. In addition, the tongue was the most common site for ulceration in our studied sample. Conclusion: Loss of taste is a common symptom of COVID-19 patients, whereas oral ulceration is not so commonly reported. However, the presence of both these symptoms could impair the quality of life of patients and hamper adequate nutritional uptake.

Background: Dental trauma is a common problem in children, which mostly occurs at school. Traumatic dental injuries often cause unpleasant experiences for children, and immediate and appropriate measures are needed. Its prognosis depends on immediate posttraumatic measures, and schoolteachers can play a key role in the treatment of children. The current study aimed to investigate teachers' knowledge about dental injuries in primary school children in the city of Isfahan. Materials and Methods: Following a cross-sectional design, the current study was conducted on 248 elementary school teachers who were selected using the simple two-stage random cluster. Then the teachers' knowledge was measured based on a four-choice questionnaire consisted of two parts. According to this questionnaire, teachers were divided into five categories based on their knowledge score which was consist of strongly high knowledge, high knowledge, average knowledge, low awareness, and strongly low knowledge. Data were analyzed using the Spearman correlation coefficient and independent t-test. Statistical significance was considered when P < 0.05. Results: The total knowledge score of teachers was 45.9%. About 61% of the teachers had a history of exposure to dental injuries. Furthermore, 49.6% of them believed milk was the best environment to keep the avulsed teeth. There was no significant association between teachers' knowledge and education level, history of previous trauma, or participation in a training course, but there was a direct association between teachers' knowledge and their work experience (P < 0.05). Female teachers' knowledge score was significantly higher than their male counterparts (P < 0.001). Conclusion: Participants had a moderate level of knowledge about the management of dental traumas. Hence, it is suggested to develop educational programs to increase teachers' awareness about this issue.

Background: This study aimed to assess the relationship between the osteoporotic condition and periodontitis in postmenopausal women. Materials and Methods: Ninety-four women aged 50–80 years were studied in this cross-sectional study. Bone mineral density (BMD) of lumbar vertebra BMD (LBMD), total hip BMD (HBMD), and neck of femur BMD (NBMD) was assessed using standardized dual-energy X-ray absorptiometry (DXA) (normal: T-score ≥−1, osteopenic: −2.5 ≤ t-score <−1, osteoporotic: T-score <−2.5). Bleeding point index (BI), O'Leary plaque index (PI), and clinical attachment loss (CAL) were recorded. Cementoenamel junction, alveolar-crest distance (CEJ-AC) was measured from cone-beam computed tomography images. Periodontitis severity was represented by CAL and CEJ-AC distance. One-way analysis of variance followed by Post hoc Tukey was performed for examining differences among the groups for different variables. Pearson correlation coefficient® and backward regression analysis were used to investigate the effect of confounding variables on CEJ-AC as the dependent variable. Significance was considered at P < 0.05. Results: Mean CEJ-AC was significantly higher in the osteoporotic and osteopenic groups compared to the normal group (P = 0.001). There was a significant positive correlation between CEJ-AC and NBMD and LBMD (P < 0.001). The associations between LBMD and CEJ-AC existed even after adjusting for confounding factors (P = 0.002). The differences in BI, PI, and CAL were not statistically different between the groups (P > 0.05). Conclusion: Although osteoporosis is not the main cause of periodontitis, it can indirectly affect periodontal status by increasing CEJ-AC. Early diagnosis of osteoporosis followed by early referral to a dentist for the treatment of potential existing periodontal diseases is important to avoid complications among postmenopausal women

Background: This study clinically and histologically compared the human pulp response to direct pulp capping (DPC) with mineral trioxide aggregate (MTA), Biodentine, and propolis in 2 months. Materials and Methods: In this clinical trial evaluated 41 premolars candidate for extraction due to orthodontic purposes of patients between 15 and 25 years of age. A group of 5 was separated randomly as the negative control. The remaining teeth were randomly divided into three experimental groups of 12 after mechanical exposure of the pulp by bur in high-speed handpiece under air and water spray. The exposed areas were capped with MTA, Biodentine, or propolis. Glass ionomer was applied as base over the cap. The teeth were restored with composite resin. Patients were recalled in 2 months for clinical and radiographic examinations and also pulp vitality test. Teeth were then extracted. Slides were prepared and tissue sections were evaluated for the presence and severity of inflammation, dentinal bridge, and continuity. Data were analyzed using the Chi-square and Fisher's exact tests. Results: The clinical success rate was 100% in the MTA and 91.7% in both the propolis and Biodentine groups. The presence and severity of pulpal inflammation and dentinal bridge formation were similar in all the experimental groups (P > 0.05). Dentinal bridge formation was similar in the MTA and Biodentine groups and was higher than in the propolis group. Continuation of dentinal bridge in the MTA group was significantly higher than that in the Biodentine and propolis groups (P < 0.05). Conclusion: MTA, Biodentine, and propolis are equally effective for DPC.

Background: MicroRNAs are a class of small noncoding ribonucleic acids that perform a critical role in adjustment of gene expression. miRNAs-155 (miR-155) participates in controlling inflammation. Periodontitis is defined as inflammatory disorder of tissues surrounding the teeth. In this study, the expression levels of miR-155 and its target genes, tumor necrotizing factor alpha (TNF-α), and interleukin-6 (IL-6) were evaluated in a group of Iranian patients. Materials and Methods: This sectional study was performed on 10 healthy controls and 10 individuals with chronic periodontitis by means of polymerase chain reaction (PCR) test. For each individual, clinical parameters including probing depth and clinical attachment loss and blood samples were measured. Levels of miR-155, TNF-α, and IL-6 were quantified using real-time PCR (α=0/05) and the results were analyzed by Mann–Whitney U test. Results: The level of miR-155 was significantly higher in patients with chronic periodontitis (P < 0.001). A positive correlation was observed between the level of miR-155 and clinical parameters (P < 0.05). Level of miR-155 in tissue samples was correlated with blood samples although the expression level was higher in blood samples. Conclusion: As the expression level of miR-155, TNF-α, and IL-6 genes was higher in subjects with chronic periodontitis than healthy individuals, it might suggest a role for miR-155 in patients with chronic periodontitis.

Crouzon syndrome is an autosomal dominant trait, leading to midface deficiency, undeveloped orbits, short nasal dorsum, and exophthalmos as the typical clinical features. Early correction of craniofacial problems can improve patients' quality of life, but many of these patients with Crouzon syndrome are seeking treatment in older ages when they are missed for multidisciplinary management and distraction technique in proper timing. Modified LeFort III osteotomy is one of the treatment options that can be used for proper resolution in adult patients. The present case report study aims to describe a patient with midface deficiency due to the Crouzon syndrome who has undergone a combination of modified LeFort III osteotomy with the periocular approach and LeFort I osteotomy, nasal dorsum augmentation accompanied by genioplasty, wholly as a single surgical procedure which has been shown that can result in highly satisfactory outcomes for both patient and surgeon.

Background: Dental implants are known as a widely accepted and predictable method to replace missing teeth. Many factors, including using a class of drugs, such as β-blockers, can improve the osseointegration of dental implants. This study aimed to investigate the relationship between administrating propranolol and osseointegration in dental implants. Materials and Methods: This experimental animal study was performed on four native male street dogs of 11–13 kg of weight and 16–20 months of age. The specimens underwent teeth extraction. After that, the dogs were randomly divided into two groups. The first group contains two control dogs which would receive oral saline. The second contains two dogs which would receive oral tablets of propranolol daily. After a period of healing, three titanium implants were inserted in each of speciments' left mandibular quadrant, and treatment was resumed with propranolol and saline administration in case and control group, respectively. After 4 weeks, one of control group dogs and one of case group were anesthetized, and dental implants were removed alongside the peripheral bone marrow using a trephine drill. Meanwhile, the other two dogs (1 control and 1 propranolol administered dogs) were anesthetized after 9 weeks of implant placement, and the same procedure was carried out. Results: Due to the histomorphometric assessment, the mean score of bone implant contact (BIC) in week 4 was significantly higher in case group compared to control one (68.33% vs. 20.22%). In week 9, the mean BIC score was higher in case group compared to control group (68.60% vs. 50.17%); meanwhile, in contrast to week 4, it was not statistically significant. In both case and control groups, the formation of woven and lamellar bone was more significant in week 4 rather than week 9. Conclusion: Administration of systemic β-blockers can improve dental implants osseointegration process.

Background: The reduction of Streptococcus mutans from the oral cavity or its adherence to tooth surfaces can prevent or decrease the progression of caries. In this study, the antimicrobial and anti-adherence properties of Pistacia atlantica (P. atlantica) resin (Essential oil [EO] and methanolic extract [ME]) were investigated on S. mutans strains. Materials and Methods: In this in vitro experimental study, the growth rate, biofilm formation ability, and antibiotic susceptibility profile of S. mutans ATCC35668 and 3 strains isolated from caries lesions were studied. The EO and ME of P. atlantica resin were prepared. The anti-bacterial and anti-adherence properties of them were evaluated using microdilution and microplate adherence tests, respectively. The data were statistically analyzed using SPSS with one-way and two-way analysis variance. Direct comparisons between the groups were made using the Wilcoxon W-Mann–Whitney U-test. Statistical significance was set at P < 0.05. Results: All target strains showed the same growth rate and antibiotic susceptibility profile and were found strongly adherent. Both EO and ME showed moderate anti-bacterial properties (growth reduction up to 47.1% and 39.1%, respectively) against S. mutans, while the anti-bacterial effect of EO was higher than ME, significantly (P < 0.05). In all tested concentrations, EO showed a significantly stronger anti-adherence activity (50%–80%) than ME. Conclusion: The results showed an anti-cariogenic effect of EO extracted from P. Atlantica resin. Considering that S. mutans adhesion is a necessary step in the beginning and progression of dental caries, this study can suggest the use of such extract in mouthwashes or toothpaste as an alternative agent for preventing bacterial attachment and biofilm formation.

Background: Accurate shade matching of metal-ceramic restorations with natural teeth is one of the most challenging aspects of dental restorations and esthetic dentistry. The aim of this study was to evaluate of the color parameters of two types of porcelain systems VMK Master and VM13 porcelain with VITA 3D-master shade guide. Materials and Methods: In this in vitro study a total of 56 metal discs (10 mm diameter and 2 mm thickness) were fabricated. Each of the disks was veneered with porcelain (Vita Zahnfabrik, Bad Sackingen, Germany) of the VITA shade. The discs were randomly divided into four groups (2M2 and 3M2 from VM13, 2M2 and 3M2 from VMK master) of 14 (n = 14). The spectrophotometer was used for taking color measurements based on the numerical color data of the CIELAB color system. Data analysis was performed by t-test (P < 0.05). Results: Comparison of color parameters in different porcelain showed that the type of porcelain caused a significant difference in color parameters (L, a, and b) (P < 0.05). The degree of translucency (L*) or glaze of VMK porcelains was higher than VM13, but the parameters a* and b* were higher in VM13 porcelains than VMK (P < 0.05). Furthermore, the color difference of two porcelain in 2M2 (1.63 ± 0.84) and 3M2 (1.71 ± 0.96) shades was within the acceptable clinical limit. Considering the total color difference (ΔE), there were no significant differences between the ΔE values produced by any of shades (P > 0.05). Conclusion: In the present study, the spectrophotometric analysis revealed that the porcelain shade type causes a change in the color parameters, but the color difference between two porcelains VMK and VM13 is within the acceptable range of clinical color. Therefore, both porcelain systems with 2M2 and 3M2 shades are suitable for enhancing the results of restorative dentistry.

Background: In Iran, the inequitable distribution of health-care staff, especially dental practitioners between rural and urban areas has a major impact on the delivery of care for those living in rural communities. This study investigated the factors affecting the retention of dental practitioners to stay in the rural areas. Materials and Methods: This is a cross-sectional study conducted in 2019. All dental practitioners working in health services centers covering a population lower than 20,000 people in Kerman province participated in this study (n = 81). A researcher-designed questionnaire was used for the data collection. The data were analyzed using the descriptive statistics and logistic regression through the SPSS software. Results: The mean age of the participants was 29.2 ± 6.5 and 39.5% were female. The results showed that about two-thirds of native dentists (with local origin), 73.3% of married dentists, and all dental practitioners who had no children or had a child under the age of six were willing to continue working with their current Comprehensive centers of health services compared to other dentists. Univariate and multivariate logistic regression showed that there was a significant relationship among dentists' age, monthly salary, and facilities available in the area (place of residence, availability of vehicles, etc.), view of dental practitioners on living in a rural area, and view of dentists' families on living and working in the area (p < 0.05). Conclusion: More than half of the dental practitioners declared their willingness to stay in rural areas, although, in practice, this amount of presence in rural areas does not meet the needs of residents. Financial issues, amenities, and facilities in the rural areas can have a positive impact on the retention of dental practitioners.

Background: The mechanical and thermal properties of polymethyl methacrylate, as the most commonly used material for the fabrication of dental prostheses, should be improved due to its structural weaknesses. The present study aimed to compare the flexural strength and thermal conduction of two heat-cured and self-cured acrylic resins reinforced with aluminum oxide nanoparticles. Materials and Methods: In this in vitro study, a total of 114 samples consisting of heat- and self-cured three subgroups (1% and 3% Al₂O₃ and the control) with 66 samples for the thermal conduction (n = 11) and 48 samples for the flexural strength (n = 8) tests were prepared. Flexural strength was assessed with a three-point bending test using a universal testing machine. One-way ANOVA was applied for data analysis, followed by post hoc Tukey paired group comparison tests (P < 0.05). Results: An increase in the aluminum oxide nanoparticle percentage in acrylic resins increased the thermal conduction in heat-cured acrylic resin from 2.142 ± 0.0298 to 2.487 ± 0.0359 m (2)/sec and in self-cured acrylic resin from 2.0150 ± 0.02646 to 2.1475 ± 0.04031 m (2)/sec and decreased the flexural strength in heat-cured acrylic resin from 60.521 ± 8.9278 to 49.747 ± 4.4729 MPa and in self-cured acrylic resin from 37.573 ± 10.9237 to 35.569 ± 6.1531 MPa (P < 0.05). Conclusion: The incorporation of aluminum oxide nanoparticles adversely affected acrylic resin flexural strength; however, it increased the thermal conduction.

Background: Considering the studies on the effects of bleaching materials on properties of dental materials, The aims of this in vitro study were to evaluate the effects of two different concentrations of bleaching agents on flexural strength and microhardness of VITA ENAMIC. Materials and Methods: In this experimental in vitro study, 30 rectangular-shaped specimens (2 mm width × 2 mm height × 12 mm length) for flexural strength and 30 specimens (5 mm width × 5 mm length × 2 mm height) for microhardness tests were prepared from VITA ENAMIC blocks 12 × 14 × 18 mm. The specimens were polished using silicon-carbide sandpapers 400, 600, 800, 1200, 2000 under flow of water for 60 s each. The prepared samples for flexural strength and microhardness were divided into 3 subgroups (n = 10): control group (C), samples bleached using Opalescence PF 15% (B15), and samples bleached with Opalescence Xtra Boost 40% (B40). Flexural strength measurement was done using a universal testing machine, and microhardness test was done using Vickers. Data were analyzed using analysis of variance and post hoc tests and P < 0.05 was considered significant. Results: The mean microhardness values of C, B15, and B40 groups were 255.46 ± 3.02, 249.86 ± 4.18, and 235.53 ± 4.61 kgf/mm². Opalescence PF 15% and Opalescence Xtra Boost 40% affected microhardness of ENAMIC significantly (P < 0.05). The mean flexural strength values of C, B15, and B40 groups were 155.26 ± 16.13, 142.14 ± 11.52, and 133.39 ± 16.13 MPa. A significant decrease in flexural strength was found between the C and B40 groups (P = 0.007). However, the difference between flexural strength of the C and B15 groups was not significant (P > 0.05). Conclusion: Our study showed that both concentrations of bleaching agents can affect microhardness of ENAMIC. Moreover, hydrogen peroxide 40% has a negative effect on the flexural strength of ENAMIC.

Background: Masking dark tooth structure or darkness of oral cavity with ceramic restorations is an important concern. The aim of this study was to determine the minimum thickness of a multilayer all-ceramic restoration (IPS-emax Press) required for a proper masking in these situations. Materials and Methods: In this experimental in vitro study, 36 multilayer ceramic disks of IPS e.max Press (IvoclarVivadent, Schaan, Liechtenstein) with the diameter of 13 mm were prepared and allocated in six groups of different core/veneer thicknesses: 0.4/0.4 mm (G1), 0.5/0.5 mm (G2), 0.6/0.6 mm (G3), 0.8/0.7 mm (G4), 1.0/0.8 mm (G5), and 1.1/0.9 mm (G6). For backgrounds, the standard black tile of spectrophotometer (B) was used to stimulate the darkness of oral cavity, and an opaque ceramic (OC) of IPS-emax Press (OC) was fabricated to determine the masking ability. CIELAB values of all disks on B and OC backgrounds were measured, and ΔE was calculated between two backings. One-way ANOVA and post hoc tukey test were used to analyze the data. ΔE ≤3.3 and P < 0.05 were considered, respectively, as the clinically acceptable limit and the level of statistical significancy. Results: The mean ΔE between B and OC of groups 4 (2.83 ± 0.80) and 5 (1.46 ± 0.36) were within the range of the clinically acceptable color difference (ΔE ≤3.3); thus these groups could properly mask the black background. A trend was existed in the results as by increasing the thickness, ΔE was decreased. Conclusion: A thickness of 1.5 mm of a multilayer ceramic restoration (IPS e.max Press) is required to mask a dark discoloration.

Background: Small chipping or fracture of ceramic restorations may be repaired by composite resin instead of replacing the restoration. This method is faster and cheaper compared to restoration replacement. Several strategies have been suggested to obtain a high repair shear bond strength (SBS). This study aimed to assess the efficacy of some new ceramic surface treatments (laser and universal adhesive) to enhance the repair bond strength of composite resin to ceramic compared to the conventional method. Materials and Methods: This in vitro study evaluated 80 IPS Empress Esthetic ceramic plates in eight groups (n = 10). The ceramic surface was polished with 320-grit silicon carbide paper under running water, rinsed with water spray for 10 s and dried. The samples were then divided into two subgroups for mechanical surface preparation with hydrofluoric (HF) acid and Er: YAG laser (2 W, 200 m J, 10 Hz, 10 s). Each group was divided into two subgroups for use/no use of silane. The conventional or universal adhesive was then applied on the samples in each subgroup. Composite cylinders were bonded to the ceramic surface using plastic tubes. The samples were stored in distilled water at 37°C for 24 h and subjected to an SBS test. Data were analyzed using one-way ANOVA (P < 0.05). Results: The interaction effect of variables on SBS was significant. Maximum SBS was noted in HF acid + silane + conventional adhesive group (mean: 12.0481 MPa). Minimum SBS was noted in the laser + conventional adhesive group (mean: 2.5766 MPa). Surface treatment with HF acid yielded significantly higher SBS than laser (P < 0.001). The interaction effect of conventional/universal adhesive and use/no use of silane on SBS was statistically significant. Conclusion: The repair SBS was higher in groups treated with HF acid compared to laser. Ceramic surface treatment with HF plus silane plus conventional adhesive yielded a higher SBS as well as HF plus Universal adhesive. Thus, the application of silane as a separate step can be omitted in the repair of ceramic restorations with universal adhesives.

The white spot lesion on the dental enamel is an optical alteration that compromises the esthetics of smile. It can be caused by many factors, among them, defects in mineralization and formation of tooth enamel. Resin infiltrants are agents that penetrate, by capillarity, through the pores of the demineralized or hypomineralized enamel, altering the refractive index (RI) of the tooth structure and totally or partially masking the appearance of the white spot. The aim of this work was to report the use of resin infiltration to minimize the visualization of white spot lesion, present in an upper central incisor, as a microinvasive approach for the esthetic treatment of deep enamel hypomineralization. A 20-year-old female patient sought care with the esthetic complaint of extensive white spot lesion on the buccal face of her upper right central incisor. The diagnosis established was a deep white stain associated with the incisor molar hypomineralization syndrome, and the treatment of choice for the resolution of the case was the application of the Icon^® resin infiltrant (DMG, Hamburg, Germany). To reach the body of the lesion, three cycles of acid erosion, using 15% HCl, were necessary to obtain a satisfactory aspect of masking the white lesion. A camouflage effect of the deep white spot lesion was achieved with the use of the resin infiltration, without the need of additional and irreversible wear of the dental structure.

Background: To compare and evaluate the strength rendering capacity of three restorative materials in tooth model simulated as immature teeth. Materials and Methods: In this in vitro study, 80 human maxillary permanent central incisors scheduled for periodontal extraction were collected, and an immature tooth model was prepared using a 3 mm twist drill. To simulate single-visit apical barrier, all the teeth were prepared with peso number 1–6. The teeth were segregated into three experimental and a control group. The experimental groups (n = 20) comprised of fiber-reinforced composite (FRC), Biodentine, and glass ionomer cement. The fracture resistance of all the teeth was tested using universal testing machine. The final reading of the applied load to cause fracture was noted and later was subjected to statistical analysis, P ≤ 0.05 was considered statistically significant, and the level of significance was fixed at 5%. Student's t-test was applied to compare values among experimental groups Results: There was a significant difference in the values of peak load resulting in fracture among experimental groups which was observed statistically (P ≤ 0.001). FRC exhibited superior reinforcing capacity (mean: 1199.7 N) among the experimental materials followed by Biodentine and Bioglass R. The lowest value to fracture was observed in control group (mean: 236.7 N). Conclusion: The results indicate that FRC could substantially contribute positively in reinforcing the simulated thin-walled immature roots.

Background: To compare the effect of different mouth washes on metallic ions release from silver-soldered and laser-welded orthodontic attachments. Materials and Methods: In this comparative in vitro study, 32 samples of molar bands without attachments were used. Sixteen samples were silver soldered to stainless steel (SS) wire and 16 samples were laser welded using laser welding device to SS wire. Each group samples were divided into four test groups and submerged in solution containing sodium fluoride (NaF), NaF + alcohol (NaF + alcohol), Chlorhexidine (CHX), and artificial saliva (AS). Samples were shaken for 24 h with an agitation rate of 60 rpm. One sample from each group was selected to study the morphologic changes on their surfaces through scanning electron microscopy (SEM), and remaining samples were studied for metal ions released and dissolved in the solutions using spectrometry. The metal ions release values of two different attachment methods in three different mouth washes and AS group were compared using the unpaired t-test. A two-way analysis of variance was used to identify the significant differences between the two types of orthodontic attachments immersed in four different types of solutions. P < 0.05 was defined to be set significant for all tests. Results: Level of metal ions released from the samples of silver soldering was higher than from laser welding. The lowest amounts of metal ions were released in CHX while highest in NaF + alcohol. The SEM images were in accordance with these findings. Conclusion: Laser welding should be preferred over silver soldering for the construction of orthodontic appliances. CHX containing mouthwashes such as Hexidine can be prescribed for the patients undergoing orthodontic treatment. More in vivo experiments will determine whether the levels of dissolved nickel ions can reach the toxic or sub-toxic concentrations or not.

Background: During the first experiences of clinical treatment, dental students face various challenges. The purpose of the study is to standardize the questionnaire as a suitable tool for quantitative and qualitative evaluation of psychosocial impact, stress levels, and learning effect of dental students during the transition from preclinical to clinical education in Persian. Materials and Methods: In this cross-sectional study a questionnaire including three areas of psychosocial impact, perceived stress, and learning effect was systematically translated. In the group of experts, face validity was examined. Then, the content validity ratio (CVR) and the content validity index (CVI) were determined. The reliability of the questionnaire was determined by the test–retest method and the Cohen's Kappa coefficient. In a cross-sectional study, the psychosocial impact, stress levels, and learning effect of all students newly admitted to the endodontic, prosthetics, periodontics, and restorative dentistry departments of Shahid Beheshti Dental School (128 people) were measured. Mann–Whitney and Spearman–Rho were used for statistical analysis (P = 0.05). Results: During the CVR and CVI evaluation, 12 statements were removed from the questionnaire, and one statement was changed. All valid statements of the questionnaire were considered reliable. The initial questionnaire was finally developed in the form of 27 items. Interest in clinical treatment and collaboration between students and faculty had the greatest psychosocial effects. The highest level of stress among students was seen in the endodontic ward (mean = 3.8). The greatest effect of learning was seen in different sections in infection control (mean >4). Conclusion: This study provided a standardized tool in Persian to evaluate the psychosocial impacts, perceived stress, and learning effect of dental students during the transition to clinical education and focused on the first clinical treatment experiences. One important psychosocial factor was collegiality between teachers and students. The ability to communicate well with the patient is thought to reduce stress.

Background: To establish an endodontic diagnosis, a clinician should consider a variety of factors. Various studies have failed to demonstrate a strong correlation between histological findings with clinical and radiographic assessments. This study sought to evaluate the histopathological features of reversible and irreversible pulpitis diseases and their correlation with clinical diagnosis in extracted human molar teeth. Materials and Methods: In this experimental ex vivo study, 75 molars with caries and three intact molars were used. According to the radiographic findings and clinical criteria and the need for root canal therapy, samples were categorized as having normal/reversible pulpitis and irreversible pulpitis. Immediately after extraction, an exposure was made at 2 mm below the cementoenamel junction. Formalin-fixed specimens were decalcified, sectioned and stained with hematoxylin and eosin for histological examinations using light microscopy. Variables including the type and severity of the inflammation, hyperemia, necrosis, fibrosis and the existence of an odontoblastic layer and dentin bridge were evaluated. The Fisher's exact test and the Chi-squared test were used for statistical analysis. P <0.05 was considered as significant. Results: Acute inflammation, hyperemia and pulp exposure were significantly more common among subjects with irreversible pulpitis (P < 0/005). However, fibrosis was significantly higher in the reversible group (P < 0/005). There were no statistically significant differences between the groups regarding the other variables. Conclusion: Some discrepancies between clinical, radiographic and histological findings were observed in our experimental study. Indeed, effective clinical practice requires consideration of all discrepancies found.

Background: This study aimed to assess the oral health knowledge, attitude, and performance of the parents of autistic 3–12-year-old. Materials and Methods: This descriptive cross-sectional study evaluated 50 parents of autistic 3–12-year-old in Isfahan city. The oral health knowledge, attitude, and performance of the parents were evaluated using a self-administered questionnaire with closed questions, after confirming its validity and reliability. Data were analyzed using independent t-test, one-way ANOVA, Pearson's correlation coefficient, regression analysis, and Cronbach's alpha (α =0.05). Results: Of children, 32 (64%) were males and 18 (36%) were females. A total of 28 (56%) fathers and 22 (44%) mothers participated in this study. The mean age of the children and parents was 8.12 ± 2.4 years and 39.6 ± 6.8 years, respectively. The mean age at the time of diagnosis of autism was 4.08 ± 1.33 years. Of all children, 24 (46.2%) had a previous dental history. The mean scores of the knowledge and attitude of the parents were 5.2 ± 1.7 out of 11, and 16.1 ± 3.1 out of 30, respectively. Of demographic variables, order of child birth had a significant correlation with attitude of the parents, and those with one single child had significantly higher attitude score (P = 0.03). Conclusion: The oral health knowledge, attitude, and performance of the parents of autistic children in Isfahan city were lower than expected, which calls for knowledge enhancement strategies in this respect.

Background: This study aimed to compare the antimicrobial effects of green tea, microwaving, cold boiled water, and chlorhexidine (CHX) on Streptococcus mutans and Candida albicans on silicone pacifiers. Materials and Methods: In this in vitro experimental study, 60 equal-size samples of silicone pacifiers were cut, ultraviolet sterilized, and randomly divided into two groups (n = 30) for immersion in 0.5 McFarland standard suspension of S. mutans and C. albicans. The samples in each group were then randomly divided into five subgroups (n = 6) for disinfection with 0.12% CHX, cold boiled water, green tea, microwaving for 7 min, and distilled water. The sample suspensions were cultured on blood agar (for S. mutans) and Sabouraud dextrose agar (for C. albicans) and incubated. The number of colonies was counted after 24 and 48 h. Data were analyzed using the Kruskal–Wallis and Mann–Whitney tests (P < 0.05). Results: At 24 and 48 h, the S. mutans colony count was the lowest in CHX and green tea subgroups followed by microwave, cold boiled water, and distilled water subgroups (P < 0.05). Conclusion: CHX and green tea can significantly decrease the S. mutans and C. albicans colony count on silicone pacifiers.

Background: One of the critical factors determining the success of dental implants is primary stability. This study aimed to determine the density of jawbones in the implant candidate sites via cone-beam computed tomography (CBCT) and its correlation with the values obtained from resonance frequency analysis during surgery. Materials and Methods: In this descriptive-analytic study seventeen implant sites requiring implant placement were selected. Impressions were sent to the laboratory to construct a surgical guide via the stereolithographic method. An electronic surgery was performed on the chosen implant sites according to each patient's CBCT information entered into the Kaveh surgical guide software. The bone density of the target areas was calculated using the gray value (voxel value). After preparing the final osteotomy, an implant was installed in the area according to the manufacture's recommendation. The relevant Osstell^® SmartPeg was selected and installed on the implant body to determine the primary stability. Kolmogorov–Smirnov test and the correlation pearson correlation statistical test. used for statistical analyze. P value amounts < 0.05 was considered significant. Results: The mean and standard deviation of the gray scale in this study were 563.7 ± 218.8 and 65.3 ± 7.7 implant stability quotient (ISQ) respectively. The correlation between gray scale and ISQ was evaluated by the Pearson correlation test, and the results indicated a strong correlation between the two variables. Conclusion: The voxel value and primary stability had a normal distribution and strong correlation. In other words, the gray scale determined by CBCT imaging techniques at the proposed implant site could be used to assess the bone density before the surgery.

Background: Adverse pregnancy outcome is due to deviation from the normal physiological and immunological process. There is conflicting evidence in support of maternal periodontitis as a risk factor for preterm low birth weight (PTLBW). Thus, the aim of the present study is to evaluate the correlation between PTLBW and periodontitis in postpartum mothers based on clinical and microbiological parameters. Materials and Methods: An observational retrospective study was conducted. A total of 103 women with singleton births were included in the study, which was divided into two groups, i.e., Group I-PTLBW and Group II-normal term normal birth weight (NTNBW). Clinical parameters such as oral hygiene index simplified, gingival bleeding index (BOP %), periodontal probing depth (PPD) and and clinical attachment loss (CAL) were recorded on the next day of postpartum. Two samples from each group, i.e., placental extract and the subgingival plaque were collected and transported to the laboratory in an anaerobic medium for microbiological analysis. The statistical analysis was performed using an unpaired t-test and Wilcoxon Mann–Whitney U-test. The P < 0.001 was considered statistically significant. Results: PTLBW group showed significantly higher amounts of periodontal destruction in terms of clinical parameters. The pathogens were also in higher quantities in the PTLBW group compared to the NTNBW group. Conclusion: Periodontitis is related to PTLBW in pregnant women of the studied population. Maternal oral hygiene status delivering PTLBW babies are compromised compared to mothers delivering NTNBW babies. Hence, periodontitis during pregnancy phase is an important health concern for the growing fetus.

Background: It is unclear which the material is a better choice for post and core rehabilitation systems in endodontically treated teeth. This study aimed to compare the fracture resistance of three different postcore systems. Materials and Methods: In this in vitro study, 33 extracted premolars were treated endodontically and divided into three groups, namely (A) the prefabricated fiberglass postcomposite core, (B) the Ni-Cr cast postcore, and (C) the polyetheretherketone (PEEK) postcore groups. After postcementation, the core was restored with Ni-Cr crown. By a universal testing machine, the fracture resistance of the posts was assessed. Furthermore, types of fractures were determined with radiography and confirmed objectively by cutting the acryl resin boxes. The data of the fracture resistance were analyzed using the one-way ANOVA and Tukey test, and the data of the fracture pattern were analyzed using Fisher's exact test (P < 0.05). Results: The fracture resistance was significantly higher in Group B (Ni-Cr) than in Group C (PEEK) (P = 0.001) and Group A (fiberglass) (P < 0.001). Moreover, the fracture resistance was higher in Group C (PEEK) than in Group A (fiberglass) but was not statistically significant (P = 0.405). The fracture pattern was different in all the groups based on the types of fracture (P = 0.009) and the repairability of fracture (P = 0.036). Conclusion: The present study showed that the fracture resistance was significantly higher in the Ni-Cr post than in the fiberglass and PEEK posts. Further, the fracture mode was more repairable in teeth restored with the PEEK post, as compared to the other posts.

Background: Because of the importance of the condyle, it is crucial to document all changes in its position after orthognathic surgery. Since previous studies in this regard are mostly controversial and limited by two-dimensional radiography technique, this study was conducted. Materials and Methods: This prospective clinical trial was performed on 102 measurements (17 patients, 2 condyles each, and 3 time points). Cone-beam computerized tomography imaging was done for 17 skeletal Class-III patients (10 females and 7 males, mean age, 24.05 ± 4.78 years) undergoing fixed orthodontic treatment, at three time points T0 (before surgery), T1 (immediately after surgery), and T2 (8 months after surgery). Condylar positions were measured. Position changes were evaluated during the course of the study. They were also compared between right/left sides and between men and women. Tests in use were repeated-measures one- and two-way analysis of variance and paired t-tests (α =0.05, α =0.017). Results: Alterations in various anatomical condyle parameters over the 8-month course of the study did not reach the level of significance (P ≥ 0.078). At all intervals, mean anterior-posterior index (API) remained between −12 and +12 (indicative of central position of the condyle in the glenoid fossa). Between men and women, left superior joint space, left anterior joint space, and left API differed (P ≤ 0.05). Left condyle mean superior joint space and anterior joint space were greater in men compared to women in all the three intervals; left condyle mean API was greater in women compared to men (more posterior in men, P ≤ 0.05). Conclusion: Condyles might not change significantly after 8 months post-surgery. However, small changes might be observed, and these changes might differ between the left and right sides and between males and females.

Background: This study aimed to evaluate the amount of bone regeneration in critical defects of rabbit calvaria filled with magnesium- and strontium-doped bioactive glasses. Materials and Methods: In this rabbit critical-size calvarial defects study, 12 male New Zealand white rabbits were randomly divided into two groups. On the calvaria of each rabbit, four lesions (two lesions in the frontal bone and two lesions in the peritoneal bone) were created with a diameter of 8 mm spaced apart. Each lesion was filled in with (1) strontium-doped bioactive glass, (2) magnesium-doped bioactive glass, (3) 45S5 bioactive glass, and (4) empty lesion (control). Six rabbits were sacrificed at the end of 4 weeks, and six rabbits were randomly sacrificed at the end of 8 weeks. Bone sections with a 5-μ thickness of rabbit calvary bone were prepared, and the percentage of new bone, connective tissue, and residual material were calculated in microscopic images. Statistical analysis was performed by two-way ANOVA and Bonferroni additional tests, and the level of significance was set at P < 0.05 in all categories. Results: At 4 weeks, magnesium-doped bioactive glass showed the highest new bone formation with a mean of 11.66 ± 2.64, followed by the strontium-doped bioactive glass with the mean of 11.10 ± 1.69 (P = 0.0001). While at week 8, the highest amount of new bone observed in the strontium-doped group with a mean of 28.22 ± 3.19, and then, the magnesium-doped bioactive glass with a mean of 22.55 ± 3.43 (P = 0.0001). Conclusion: Doping strontium and magnesium in the structure of bioactive glasses increases new bone regeneration in comparison with 45S5 bioactive glass.

Background: Proliferation markers have been used to determine the behavior and prognosis of benign and malignant tumors; this study was aimed to compare the immunohistochemical (IHC) expression of proliferating cell nuclear antigen (PCNA) and novel marker minichromosome maintenance complex component 7 (MCM7) in common salivary gland tumors including pleomorphic adenoma (PA), mucoepidermoid carcinoma (MEC), and adenoid cystic carcinoma (AdCC), to find a possible significant correlation between benign and malignant tumors. Materials and Methods: In this cross-sectional study, a total of 90 cases, including 30 PAs, 30 MECs, and 30 AdCCs, were collected. The IHC expressions of PCNA and MCM7 were evaluated. Their expressions were compared with each other and between benign and malignant tumors. Statistical analysis was performed by Chi-square and Tukey's test. P value was considered 0.05. Results: Out of 30 cases of PA, 28 cases (93.3%) were PCNA positive and 28 cases (93.3%) were MCM7 positive. In the AdCC cases, 29 cases (96.6%) were PCNA positive and 29 cases (96.6%) were MCM7 positive. In the MEC cases, all cases (100%) were PCNA positive and 23 cases (76.6%) were MCM7 positive. The labeling index (LI) of MCM7 and PCNA was evaluated, and this index was lower in MCM7 LI than PCNA in all tumors. The MCM7 and PCNA expression showed a significant difference in PA and MEC (P < 0.001). Conclusion: PCNA expression was higher than MCM7 expression in salivary gland tumors. However, more studies are needed to evaluate the malignant activity of these tumors with group of markers such as MCM family members.

Background: Since salivary and breast glands are both considered as a tubulo-acinar, exocrine glands, and they have a common neoplastic morphology, it is not surprising if they share a similar molecular mechanism responsible for their neoplastic transformation. From the first description of estrogen receptor-α (ER-α) in salivary tumors, tremendous attentions have been attracted to this receptor for evaluating its impact in mucoepidermoid carcinoma (MEC). Materials and Methods: In this descriptive analytics, 28 samples of MEC (14 high grade and 14 low grade) were collected from the Oral and Maxillofacial Pathology Department of Isfahan Dental School and Isfahan Alzahra Hospital. All of these samples were stained with immunohistochemical technique with ER-α marker. The expression of the receptor was evaluated by two oral and maxillofacial pathologists. Statistical data were saved at SPSS and had been analyzed by Mann–Whitney U- and independent t-tests (significance level: P ≤ 0.05). Results: The high-grade MEC was more common in patients with a higher average age (55.9); on the other hand, low-grade MEC was mostly observed in those with a mean age of 39.2 years. Moreover, high-grade MEC was more prevalent in men rather than in women. The staining intensity distribution average in high-grade MEC and low-grade MEC was 2.4 and 0.8, respectively (P = 0.48). Conclusion: The expression of ER-α in high-grade MEC was significantly more than low-grade MEC, indicating that targeting this receptor alongside surgery could bring more advantages for patients.

Background: Remifentanil is a short-acting synthetic opioid, seems to facilitate hospital discharge, induce less agitation and better recovery quality. The aim of this study was to investigate the effects of remifentanil on the quality of recovery among healthy children who were candidate for dental procedures under general anesthesia. Materials and Methods: This study was a double blind randomized controlled clinical trial on healthy children who referred to the Department of Pediatric dentistry, School of Dentistry, Isfahan University of Medical Sciences. Both groups were anaesthetized using 5 mg/kg thiopental sodium, 1 μg/kg fentanyl and 0.6 μg/kg atracurium. The first group received propofol to maintain anesthesia and the second group was given remifentanil along with propofol. Then, the time span to regain consciousness, level of agitation during recovery and time of discharge were monitored and compared between the two groups. Data were analyzed using the Mann-Whitney U-test, and the Kruskal–Wallis test at P < 0.05 level of significance. Results: Findings showed that the propofol + remifentanil group recovered faster than the propofol group. Chi-square test showed a significant difference in recovery time between the two groups (P < 0.05). About 45 min after regaining consciousness, the mean pediatric anesthesia emergence delirium score in the propofol group was 4.02 ± 2.19 and was significantly higher than the propofol + remifentanil group (3.02 ± 2.83) (P < 0.05). In addition, the mean Postanesthetic Discharge Scoring System score in the propofol group was 6.04 ± 1.74 and was significantly higher than the propofol + remifentanil group (7.58 ± 2.14) (P < 0.05). Conclusion: Combination of propofol and remifentanil significantly reduced the time taken for recovery, discharge and agitation level compared to propofol.

Background: This study aimed to compare the antibacterial effects of calcium hydroxide, curcumin, and Aloe vera as an intracanal medicament on 6-week-old Enterococcus faecalis biofilm. Materials and Methods: In this in vitro study, the solution containing E. faecalis ATCC^® 29212^™ was inserted into the canals of 72 single-rooted teeth to produce biofilm. The samples were divided into four groups, and the antibacterial agent as an intracanal drug was used for 1 week. Calcium hydroxide, curcumin, and A. vera were used as intracanal medicaments in three groups, respectively, and the fourth group was irrigated with normal saline. The collected debris was cultured by spread plate method for the bacterial count by colony count machine, and the number of bacteria in each sample per ml was reported in colony-forming unit per ml (CFU/ml). The data were analyzed using SPSS software. KruskalWallis and MannWhitney U-tests were used for comparison of CFU/ml between the study groups. P <0.05 was considered significant. Results: The mean CFU/ml in the groups of calcium hydroxide, curcumin, and A. vera were 749.44, 630.55, and 1529.16, respectively. Compared with the control group, curcumin, calcium hydroxide, and A. vera showed 99.5%, 99.41%, and 98.79% antimicrobial effects, respectively. All three groups were significantly effective than the control group (P = 0.023, P = 0.023, and P = 0.024, respectively) but were not significantly different from each other (P = 0.057). Conclusion: All three groups showed significant antibacterial activity compared to the control group, curcumin had the most significant effect, followed by calcium hydroxide and A. vera. Therefore, herbal materials can be considered safe alternatives to synthetic medicaments for intracanal usage.

Osteoblastoma (OSB) is an uncommon (3% of benign and 1% of all) primary bone neoplasm with extremely rare occurrence in head and neck, especially the maxillary bone region. OSB of the jaw mainly involves the mandible bone. We report a 10-month-old male who was admitted to the hospital because of a mass in the right maxillary jaw region. Clinicoradiopathologic features of the patient have been described. The histological examinations revealed OSB of the maxillary bone. Total surgical resection of the tumor was performed with 10 months of follow-up and there is no evidence of recurrence. To the best of our knowledge, it is the first report of maxillary OSB in an infant.

Background: There is generally a lack of compliance in patients who report with oral candidiasis, as they are advised to temporarily stop wearing the prosthesis and are prescribed topical antifungals which are generally unpleasant to taste and follow a rigorous schedule. Furthermore, with the alarming evidence of drug resistance, there is a need for an enhanced drug and drug delivery system. The aim of the study was to determine the dose-dependent antifungal efficacy of silver-zinc zeolite nanoparticles (SZZ-NPs) when incorporated in two brands of soft denture liners against Candida albicans. Materials and Methods: A total of 72 samples were made to determine the in vitro antifungal efficacy of SZZ-NPs and fluconazole by measuring the mean inhibition diameter (MID). Two concentrations of SZZ-NPs were compared (0.5%, 2% w/w) with fluconazole 5%w/w which is routinely prescribed. The antifungals were incorporated in two types of commercially available soft denture liners (Visco gel, GC soft denture liner). The MIDs were measured at day 1, day 7, day 15, and day 30. The values obtained (P < 0.001) were analyzed with one-way ANOVA, Tukey's post hoc, and independent t-test. Results: A statistically significant difference (P < 0.001) was noted among all the antifungal agents at all the time intervals tested. The anti-fungal efficacy of SSZ-NPs 2% w/w incorporated in GC soft denture liner was significantly superior (P < 0.001) to all groups tested and it retained its antifungal efficacy even on day 30 (MID: 18.33 ± 2.44). Conclusion: SZZ-NPs 0.5%w/w, 2%w/w, and fluconazole 5%w/w can be incorporated with soft denture liners against C. albicans. Fluconazole 5%w/w is the recommended choice for short-term antifungal efficacy, while SZZ-NPs 2%w/w is recommended when long-term antifungal efficacy is needed. GC soft denture liner was the recommended choice.

Background: Oral diseases and their impact on health and quality of life have now evolved into a polarized epidemiological state in which their incidence is especially affecting the most vulnerable in the population: the elderly, especially those with low incomes economical. On the other hand, the noticeable increase observed in the proportion of older adults in developing countries such as Iraq during the last decades. Such a high proportion of older adults is causing an increase in their stomatological care needs that necessitate dentists to know precisely both the etiological factors, such as the pathogenesis and factors that determine the specificity of oral disorders at this stage of life. Only with this knowledge will professionals be able to face these patients with a modern dentistry based on prevention. The objective of the study was to show the impact of oral health on the quality of life of older adults in Iraq. Materials and Methods: A cross-sectional study was conducted in Iraqi adults focused on demographic characteristics factors, lifestyle, the Geriatric Oral Health Index, and Oral Health Diagnosis. Data were evaluated using ratios, the Chi-square analysis for the correlation among factors and odds ratios to verify statistical significance at P ≤ 0.05. Results: This research confirms the impact of oral health on the quality of life of older adults in Iraq. Endodontic problems compromise the quality of life of older adults. Conclusion: Oral health problems, especially those of traumatic, endodontic, and periodontal origin, negatively affect the quality of life of older adults in Iraq.

Background: Control of pain, fear, and anxiety of pediatric dental patients is a common concern for the parents and dental clinicians. This study aimed to compare the efficacy of audiovisual distraction (AVD) and mute-video distraction (MVD) for reduction of pain and anxiety of pediatric dental patients. Materials and Methods: This randomized split-mouth crossover clinical trial evaluated 60 systemically healthy children between 4 and 7 years requiring bilateral pulpotomy of primary maxillary first molars. The samples were randomly divided into 6 groups based on the distraction technique and sequence of its receipt: (I) control-AVD, (II) AVD-control, (III) control-MVD, (IV) MVD-control, (V) AVD-MVD, and (VI) MVD-AVD and were treated. The severity of pain and anxiety of patients during anesthetic injection was measured using physiological (pulse rate [PR]), sound, eyes, and motor (SEM) and faces pain rating (FPR) scales. Data were compared between Groups 1 and 2, 3 and 4, and 5 and 6 using crossover clinical trial analysis (P = 0.05). Results: The increase in PR and the mean FPR and SEM scales during anesthetic injection was significantly smaller in AVD than MVD (P < 0.05). No significant difference was noted between MVD and control technique regarding PR and mean FPR or SEM (P = 1.00). Conclusion: It appears that MVD has no significant efficacy for reduction of pain and anxiety of pediatric dental patients. AVD, however, can effectively decrease the pain and anxiety of pediatric dental patients during anesthetic injection.

Background: The effect of different intracanal medicaments on root fracture resistance has not been thoroughly investigated in the short and long term. To assess the effect of calcium hydroxide (CH), CH combined with Chlorhexidine (CHX), double antibiotic paste (DAP), and simvastatin as intracanal medicaments on the fracture resistance of the human root. One hundred and twenty single-rooted mandibular premolars which were extracted for periodontal reasons were collected for this in vitro study. Materials and Methods: This was an in vitro study. All teeth were decoronated. Root canals were prepared by the Pro taper system, and %2.5 NaOCl was used for irrigation. The smear layer was removed using %5.25 NaOCl and 17% ethylenediaminetetraacetic acid each for 3 min. The samples were randomly divided into five groups based on the medicament: (1) CH (2) CH + CHX (3) Simvastatin (4) DAP (5) Control group. All specimens in each group were incubated for 1 week (Subgroup A) and 1 month (Subgroup B). Then, medicaments were removed and filled with gutta-percha and AH26 sealer. All samples were tested for fracture resistance. The data were statistically evaluated with the SPSS software 17. ANOVA and Mann–Whitney U and Wilcoxon tests were used for the analysis of the data. P = 0.05 was considered statistically significant. Results: Although CH and CH + CHX increased the fracture resistance in a 1-week period, there was no significant difference between the groups after 1 month. Conclusion: Under the limitations of this study, CH and CH + CHX, DAP and simvastatin do not have a negative effect on root fracture resistance when used as intracanal medicaments for <1 month.

Background: The associations between Helicobacter pylori and human papillomavirus (HPV) with head and neck squamous cell carcinomas (HNSCCs) are approved before. However, the association between demographic, clinicopathological, and histologic characteristics of HNSCC patients and molecular detection of HPV and H. pylori has not been enough investigated. Materials and Methods: In this cross-sectional study, 62 patients with HNSCC from January 2016 to February 2020 were entered the study. For H. pylori detection 16S ribosomal RNA and glmM genes and HPV detection, MY09 and MY11 genes were used. P < 0.05 is considered as significant level. Results: There were 34 patients with advanced-stage cancer (54.8%). Grade I patients (61.3%) had the highest frequency. There were 20 (32.25%) and 7 (11.29%) patients with positive H. pylori infection among tumor tissue and healthy tissue margins, respectively. Positive HPV infections were in 8 (12.90%) and 3 (4.83%) patients, respectively, in tumor tissue and healthy tissue margins (P = 0.01). There was a significant difference between histological grade and infection to HPV among HNSCC patients (P = 0.01), and most of the positive HPV cases had well-, moderate-, and poorly-differentiated tumors, respectively. Our study showed a significant increase in HPV infection in the advanced-stage group compared to the early-stage group (P = 0.05). Conclusion: Our study findings concluded a significant relationship between HPV infection in HNSCC patients with age, stage, and grade. In summary, our findings based on polymerase chain reaction analysis concluded remarkably a potential role of HPV infection and to some extent H. pylori infection into the contribution of HNSCC malignancies.

Background: Cone-beam computed tomography (CBCT) has the highest sensitivity and specificity for the detection of vertical root fractures (VRFs). This study aimed to compare the diagnostic accuracy of CBCT with different gamma values for the detection of VRFs. Materials and Methods: In this in vitro, experimental study, multiplanar CBCT scans were obtained from 61 extracted premolars with prefabricated titanium posts using NewTom CBCT scanner. Next, VRFs were artificially induced in all teeth with a mallet, and the teeth underwent CBCT with three different gamma values. The images were evaluated by two observers twice with a 2-week interval for the presence/absence of VRFs. Data were analyzed using the kappa coefficient, McNemar test, and Chi-square test. The sensitivity, specificity, and overall accuracy of CBCT with different gamma values for the detection of VRFs were assessed by receiver operating characteristic curve. The level of significance was lesser than 0.05 (P < 0.05). Results: Changing the gamma value did not change the sensitivity, specificity, or accuracy of CBCT for the detection of VRFs. No significant difference was noted between the two observers in the detection of VRFs on CBCT scans taken with different gamma grades. The inter- and intra-observer agreement were excellent for all gamma grades. Conclusion: Any gamma value preferred by the observer can be used for the detection of VRFs on CBCT scans.

Background: Applying silver diamine fluoride (SDF) is recommended to arrest and prevent dental caries. However, it may jeopardize the bond of the restorative materials to the tooth. The aim of the present in vitro study was to evaluate the effect of the simultaneous use of the SDF and potassium iodide (KI) on shear bond strength to the sound dentin. Materials and Methods: In this in vitro study, on the buccal and lingual surfaces of the 48 human third molar teeth, dentinal surfaces with a diameter of 6 mm were created by removing the enamel. Then, the specimens were divided into four groups based on applying or not applying the KI/SDF and adhesive type (etch and rinse [E and R] or universal adhesive). Afterward, cylindrical composite restoration was made on the surfaces. Half of the specimens were subjected to 1000 cycles of thermocycling. Subsequently, the shear bond strength was evaluated by Universal testing machine. Furthermore, the type of failure was determined by a stereomicroscope. Data were analyzed by t-test and Chi-square at a significance level of P < 0.05. Results: There were statistically significant differences in shear bond strength between Groups 1 and 3 (P < 0.05), whereas the bond strength difference between Groups 2 and 4 was not statistically significant (P = 0.609). Failures were predominantly of the mixed type in almost all groups. Conclusion: Based on the results of this study, the superiority of shear bond strength of universal adhesive to the sound dentin compared to E and R adhesive was confirmed. Thus, using this type of adhesive is recommended under the condition that KI/SDF anticaries material is applied.

Background: One of the main reasons for the failure of root canal treatment is the incomplete knowledge of the root canal system. With respect to the complexity of maxillary molars root canal system, and the possibility of the relationship between the buccolingual width of the mesiobuccal root and root canal morphology in maxillary molars, the aim of this study is to determine this relationship with cone-beam computed tomography (CBCT). Materials and Methods: This in vitro study carried out on 311 CBCT scans. Maxillary first molars (n = 311) were evaluated in three sagittal, axial, and coronal planes. For each tooth the number of canals, presence of second mesiobuccal (MB2), buccolingual width of mesiobuccal root at the cementoenamel junction (CEJ), and mid-root level, and type of canals according to the Vertucci's classification were determined. Results: The results showed that 49.1% of first maxillary molars had 3 and 50.8% had four root canals. The most common canal type in the mesiobuccal root was Vertucci's Type I followed by Types II, IV, and V. The prevalence of MB2 in the Iranian subpopulation was 50.1%. In maxillary first molars with MB2, the buccolingual width of mesiobuccal root at the CEJ and mid-root level (P < 0.001) was significantly greater than the corresponding values in other one without MB2. Conclusion: The results showed that the buccolingual width of mesiobuccal root in maxillary first molars at the CEJ level and mid-root was correlated with the number of root canals.

Background: Stem cells from human exfoliated deciduous teeth (SHEDs) can transform into odontoblasts in vitro and in vivo. The role of 1α, 25-dihydroxyvitamin D3 (1α,25 vitD3) has been reported in the mineralization of hard tissues and teeth, as well as osteoblastic differentiation. This study aimed to assess the effect of different concentrations of 1α,25 vitD3 on odontogenic differentiation of SHEDs. Materials and Methods: In this experimental study, second-passage SHEDs were exposed to odontogenic medium along with 0, 10, 50, 100, and 150 nmol concentrations of in 1α, 25 vitD3 to determine its optimal concentration for odontogenic differentiation. The methyl thiazolyl tetrazolium (MTT) assay was performed. Odontogenic differentiation was evaluated by QRT- polymerase chain reaction for dentin matrix protein (DMP1) and dentin sialophosphoprotein (DSPP) genes. Morphology of differentiated cells was studied by Scanning Electron Microscopy. Data were analyzed using the Kruskal–Wallis, Mann–Whitney, Friedman, and Chi-square test. P < 0.05 is considered statistically significant. Results: MTT test result showed the two groups of odontogenic medium + 10 nm 1α,25 vitD3 and odontogenic medium + 150 nm 1α,25 vitD3 provided the most suitable conditions for cell viability at 72 h. Expression of both genes significantly increased in the presence of 1α,25 vitD3 (P < 0.001). Expression of both genes was significantly higher at 14 days compared with 7 days (P < 0.01). At both time points, expression of both genes was significantly higher in the presence of 150 nm 1α,25 vitD3 compared with 10 nm (P < 0.01). The accumulation of cells with odontoblastic morphology, cell interactions, and calcifications were evident. Conclusion: 1α,25 vitD3 upregulates DMP1 and DSPP and results in odontogenic differentiation of SHEDs in odontogenic medium. This upregulation increases with time and by an increase in concentration of 1α,25 vitD3.

The etiopathology of maxillary sinusitis of dental origin (MSDO) is well established, and chronic apical periodontitis is the second most common cause of all dental-induced sinusitis incidents. The literature presents no common treatment protocols for MSDO and very few studies address the impact of root canal treatment (RCT) in its management. The literature presents cases of maxillary sinusitis resolution after performing a multivisit nonsurgical endodontic treatment, yet none described complete healing of MSDO as a result of single-visit nonsurgical RCT. This paper reports a case series of maxillary sinusitis of endodontic origin (MSEO) associated with upper maxillary molars that were successfully treated with single-visit nonsurgical antiseptic RCT. In all cases, the clinical symptoms subsided within a week after endodontic treatment. Control cone-beam computed tomography (CBCT) scan showed healing of periapical bone and total resolution of maxillary sinusitis symptoms. MSDO treatment protocol should start with nonsurgical antiseptic RCT. Single-visit nonsurgical endodontic treatment can be effective in MSEO management. CBCT is a method of choice in MSEO diagnostics. Endodontists are well trained and well equipped to treat MSDO, and the cooperation between ear, nose, and throat specialists, maxillofacial surgeons, and endodontists is crucial for both: good diagnostics and treatment.

Background: Lichenoid reaction (LR) is a relatively common mucocutaneous disease with an unknown etiology. Since the cause of the LRs is unknown, many drugs have been studied to palliate the symptoms. Previous studies reported that corticosteroids are often effective in the management of several oral inflammatory diseases. The aim of the present study was to compare the effect of Melissa gel and triamcinolone 0.1% paste on clinical indices of oral LRs. Materials and Methods: In this randomized clinical trial, sixty patients with erosive oral LRs were randomly divided into two groups, and each group was treated with Melissa gel or triamcinolone acetonide 0.1% paste, three times a day, for 4 weeks. The recovery rate and severity of pain and burning sensation were assessed after 2 and 4 weeks. Finally, the obtained data were analyzed using SPSS software (version 20, IBM Corp., Armonk, NY, USA) and repeated measures ANCOVA, Mann–Whitney test, Chi-square test, paired t-test, and survival analysis.(α = 0.05). Results: The Visual Analog Scale scores for recovery rate, pain, and burning mouth sensation and objective scoring for oral lichen planus were significantly improved at 2 and 4 weeks in both the groups. However, the pain intensity decreased significantly in the Melissa group, as compared to the triamcinolone 1% group. Conclusion: In general, we showed that Melissa gel has a better effect than triamcinolone on pain intensity. Although Melissa gel is effective in reducing lesion size, triamcinolone significantly showed better results.

Background: This study was designed to investigate the in vitro bioactivity of a new dual cured calcium silicate cement (TheraCal PT) compared to its light cured (TheraCal LC) and chemically set (Biodentine) counterparts. Materials and Methods: The study is an in vitro original research article. Prepared cements discs were immersed in deionized water. Ca²+ release was evaluated using inductively coupled plasma-optical emission spectrometry while pH was assessed using a pH meter after 1, 14, and 28 days. Discs for surface characterization were immersed in phosphate-buffered saline (PBS) and were examined using an environmental scanning electron microscope with energy dispersive X-ray (ESEM/EDX), immediately after setting and at 1, 14, and 28 days intervals after that. Attenuated total reflectance (ATR)/Fourier transform infrared (FTIR) and Raman spectroscopy analyses were performed after setting and after 28 days storage in PBS. Statistical analysis was performed using the two-way repeated measure analysis of variance test followed by Bonferroni test for multiple comparisons (P < 0.05). Results: Biodentine exhibited the highest mean values for Ca²+ release (792,639,278 ppm) and pH (10.99, 12.7, 11.54) at all time intervals. ESEM/EDX displayed a continuous layer of calcium phosphate formed by Biodentine and TheraCal LC while TheraCal PT developed scarce interrupted precipitates after immersion in PBS. ATR/FTIR and Raman spectroscopy for the formed precipitates confirmed the presence of phosphate and Ca (OH) ₂ in Biodentine, TheraCal LC and TheraCal PT. Conclusion: TheraCal PT exhibited limited in vitro bioactivity which may limit its prognosis in clinical applications for vital pulp therapy. TheraCal LC is considered a potential bioactive calcium silicate cement despite its lower Ca²+ release compared to Biodentine. Highest bioactivity was observed in Biodentine.