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.