Background: Pulpotomy is the most common pulp treatment of primary molars, where surgical amputation of infected coronal pulp results in preserving the vitality and function of radicular pulp. With introduction of newer materials, the emphasis has shifted towards regeneration, in this scenario; novel materials such as platelet derived growth factor (PDGF) and propolis (PS) have been considered. Materials and Methods: This was a single-blind in vivo study; ninety human primary teeth from children aged between 5 and 10 years were divided into three equal groups in whom pulpotomy procedure was performed and they were recalled after 3- and 6-month interval for histological evaluation. Observations were subjected to statistical analysis using Pearson's Chi-square test. Results: No statistically significant difference was found between the three materials with respect to inflammatory response, soft-tissue organization, and dentin bridge formation (P > 0.05). Majority of the samples in both growth factor and propolis exhibited dentin bridges at the interface of the exposed pulp, bringing or attempting to bridge the site exposed to the pulpotomy material. The ability of the material to evoke a foreign and inflammatory cell response in the pulpal tissue was not significant. The samples of both formocresol and growth factor group showed signs of pulpal necrosis which revealed the presence of a mild necrotic zone in one specimen at 3 months. One specimen from the propolis group showed mild areas of necrosis at the end of 6 months, where none of the specimens in the growth factor group showed areas of necrosis at the end of 6 months. Conclusion: The results of the present study showed a positive outcome for growth factor and propolis groups. Further clinical trials with a larger sample size and long-term review have to be conducted for the material to be used widely.

Background: There are controversies on the analgesic and anti-inflammatory effects of low-level laser therapy on pain, edema, and trismus after mandibular third molar extraction surgery. This study aimed to evaluate the efficacy of low-level laser therapy (LLLT) on discomforts occurring after the mandibular wisdom tooth removal. Materials and Methods: This double-blind, split-mouth design, randomized clinical trial study was performed on 36 healthy controls with bilateral symmetrical mandibular third molar referred to the Department of Oral and Maxillofacial Surgery of Dental Faculty from January to November 2019. After surgical extraction, the laser group underwent laser (Ga-Al-As diode laser, 808 nm, 200 mW) intraorally and extraorally just after surgery and 24 h after surgery. For the placebo group, the handpiece was inserted without laser irradiation. The pain level was assessed by Baker Wong scale at 2, 4, 6, 12, 24, 36, 48, and 60 h postoperatively, and the edema and the extent of mouth opening were examined before surgery, at the 1^st and 7^th days after surgery. The data were collected and analyzed by SPSS at the significant level of 0.05. Results: The statistical analysis of 32 participants' data (laser group: n = 32, placebo group: n = 32) indicated that the mean score of pain in 3 days after surgery in the interventional group was significantly lower than the score of the placebo group (P < 0.001). Furthermore, the swelling and the extent of the mouth opening differed significantly between the two groups at 1^st and 7^th days after the procedure (P < 0.001). Conclusion: Our findings showed that the LLLT had beneficial effects on the management of pain, edema, and trismus following after 3^rd molar extraction surgery.

Background: The fetal amniotic membrane is a biological graft with unique qualities which all lead to wound protection, reducing discomfort, and achieving adequate epithelialization. Materials and Methods: In this animal study, the second and third premolars of the mandible of 4 dogs were extracted. After 4 weeks, 20 mm of mandibular premolar site area were resected on both sides. The created defects on both sides were filled with xenograft. On one side, an amniotic membrane was placed over the graft particles and the reflected flap was sutured. The amount of bone formation in the defects was measured after 4 weeks for two of the dogs and after 8 weeks for the other two, using a caliper. Three histopathological samples from both sides were taken. The collected data were subjected to statistical analysis (Wilcoxon signed-rank and paired sample t-test) using SPSS software at a significant P = 0.05. Results: In the test group, the quantity of bone was 56.81, whereas in the control group bone quantity was 37.38 with statistically significant differences (P = 0.025). In the amniotic membrane group, the inflammation intensity after the graft procedure was moderate (50%) in comparison to the control group where the inflammation was severe (62.5%) (P = 0.041). Conclusion: The amniotic membrane can induce positive osteoinduction effects and be helpful in repairmen of bone defects such as the natural periosteum.

Background: Odontogenic keratocyst (OKC) is one of the most common jaw cysts with high recurrence rate. Some possible factors affecting recurrence that have not been evaluated in previous studies are examined in this study. This study aimed to predict the recurrence rate of OKC and more viable treatment of OKC. Materials and Methods: In this descriptive, analytical, and cross-sectional study, 10 recurrent OKCs, which both slides before and after recurrence were accessible, were collected from oral and maxillofacial pathology department's archive. First, they were evaluated based on common histopathologic features. In the second phase, the frequency of these findings in 36 OKCs (24 samples with recurrence and 12 without recurrence after 5 years) was evaluated based on clinical, radiological, and histopathologic features. Data were analyzed by SPSS, Wilcoxon signed-rank test, McNamara, t-test, Chi-square, Mann–Whitney, Fisher's exact test, Cohen's kappa coefficient, and odds ratio (P < 0/05). Results: According to this study, OKC in women, with multilocular radiolucency and mitosis in basal layer of epithelium as well as diffused inflammation, were statistically associated with probability of recurrence (P = 0.05, 0.035, 0.033, and 0.045, respectively). The corrugated surface, reverse polarity, hypercellularity in parabasal, and satellite cysts can affect the recurrence of OKC with odds ratios = 2.364, 2.364, 1.190, and 1.500, respectively). Conclusion: Gender (women), multilocular radiolucency, diffused inflammation in stroma, and mitosis in basal layer of epithelial lining, can statically predict the possibility of recurrence rate. In addition, findings regarding the age (in younger patients), corrugated surface, reverse polarity, and sub-basal cleft can be helpful in predicting recurrence.

Background: Dental anxiety has negative effects on dentists' pain management. Patients have different levels of pain tolerance. Therefore, providing psychological interventions can reduce treatment avoidance and promote oral health. This study compared the effect of acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) on pain coping strategies and pain perception intensity in patients with dental anxiety. Materials and Methods: This clinical trial with a pretest–posttest control group design and a 3-month follow-up period was performed on 45 patients with dental anxiety. They were randomly selected by convenience sampling method and assigned to two experimental groups and one control group. The first experimental group underwent 10 sessions of ACT, the second experimental group underwent 10 sessions of CBT, and the control group underwent oral care training. Data were collected by the Rosenstiel and Keefe's Coping Strategies Questionnaire and McGill Pain Questionnaire and analyzed by SPSS (version 24) software. The considered significance level is 0.05. Results: The results showed no significant difference between ACT and CBT in pain coping strategies and pain perception intensity (P < 0.05) but indicated a significant difference between the treatment groups and the control group. Moreover, the results showed a significant difference between posttest and follow-up and pretest in pain coping strategies and pain perception intensity (P < 0.01) but indicated no significant difference between posttest and follow-up (P < 0.05). Conclusion: ACT and CBT can play an important role in the sustainable improvement of pain coping strategies and pain perception intensity in patients with dental anxiety.

Ameloblastoma is a benign tumor of odontogenic epithelium which is slow growing, locally invasive, expansive that may result with asymmetries of the face. Conservative treatment of odontogenic tumors with marsupialization is not common but can be done successfully in those with cystic pattern. The aim of this case and literature review is to propose marsupialization as an initial procedure for its treatment. We have presented a case of an ameloblastoma involving 56-year-old male patient. Orthopantomography and computed tomography showed the lesion extended between the right molar region and left molar region of mandible with both buccal and lingual expansion and root resorptions. On clinical examination, expansions of mandible and slight tooth mobilities were seen. An incisional biopsy was carried out and histopathologic examination revealed ameloblastoma although clinical features of lesion were more suggestive of cyst. Our case was treated by obturator marsupialization with a good healing. This case and review of the literature discusses the available treatment option according to macroscopic features of jaw lesions and emphasizes on the importance of the most conservative treatment option. Conservative treatment preserves integrity of bones while radical treatment can leave major cosmetic and functional sequelae such as pathologic fractures, complication with reconstruction plates.

Background: General anesthesia in dentistry has been widely utilized in cases of uncontrollable fear/anxiety and uncooperative patients, patients of young age, and those allergic to local anesthesia and with other existing systemic diseases. These people usually require re-treatment owing to their weak immunity. Our study investigates the frequency and the prevalence of re-treatment in patients and candidates for dental procedure under general anesthesia in Isfahan during 1393–1396. Materials and Methods: The present cross-sectional study randomly chose 162 patients who were candidates for dental procedures. Patients who came in for re-treatment twice or more during this period were identified and their records were requested from the archives. Demographic data, reason for using general anesthesia, underlying disease, physical condition, and mental condition were all gathered through a questionnaire. The causative etiology of re-treatment was identified by examining the patients' medical records including restorations, denervation, tooth extraction, filling, and pulpotomy. Statistical analysis was performed using the SPSS software (version 25) and tests such as Kolmogorov–Smirnov Z-test, Spearman, and Chi-square test. P < 0.05 was considered statistically significant. Results: The findings of the present study showed that 92.25% of patients needed dental re-treatment during their second visit. The most needed treatment was in the second repair session and the least was related to prosthetics. It was also noted that 42.15% of patients needed dental treatment at the third visit and the highest need for treatment was in the third prosthesis session and the lowest reason was related to tooth restoration and extraction. Conclusion: The most needed treatment was in the second session of endodontic treatment, and in the third session, tooth extraction was one of the required treatments, which indicates the progression of dental problems in the interval between treatments.

Background: This study presented a cleaning method for orthodontic NiTi-closed coils and evaluated its effect on the force characteristics of these coils. Materials and Methods: In this in vitro study, 160 orthodontic NiTi-closed coils, 160 orthodontic NiTi-closed coils (9 mm) from two brands G and H and DB, randomly assigned into four groups. Group 1: Three times of immersion in the 10% hydrochloric acid (HCI) solution for 1 min followed by the immersion in 5.25% sodium hypochlorite solution for 5 min. Group 2: Three times autoclave sterilization. Group 3: Three times of immersion in 10% HCI solution for 1 min, followed by the immersion in 5.25% sodium hypochlorite solution for 5 min and autoclave sterilization. Group 4: No immersion and no sterilization. The forces of coils were measured at 25, 23, 21, 19, and 17 mm extension. To measure the force characteristics of coils, an electromechanical universal testing machine was used. For the statistical analysis, Kolmogorov–Smirnov, Kruskal–Wallis, and Mann–Whitney U-tests were used at 0.05 significance level. Results: In G and H coils, no significant differences between the mean forces of different groups were found in any extensions. In DB coils, only in 25 mm extension, there were no significant differences between the groups (P = 0.144). In 17-, 19-, and 21-mm extensions, significant differences (P < 0.001) were found like in 23 mm extension (P = 0.05). In both brands, more extension makes significant more forces statistically (P < 0.01). In all extensions, G and H coils have significant less forces (P < 0.001). Conclusion: Immersion in HCl, 10% for 1 min followed by the immersion in NaOCl, 5.25% for 5 min followed by autoclave sterilization, even three times repeating of this process, did not result in significant changes in the force characteristics of A-NiTi-closed coils.

Background: Infants and children who experience pain in early life, show long-term changes in terms of pain perception and related behaviors. Local anesthesia is integral to the practice of painless dentistry but the pain of injection itself is deterrent to successful administration of local anesthesia and can be a most anxiety-provoking procedure. Distraction as a behavior management technique is successfully known to reduce pain and manage children's dental behavior by diverting their attention away from painful stimuli during invasive dental procedure. This study aimed to compare the pain associated with local anesthetic injection delivered with and without the use of distraction as a behavior management technique in 6–8-year-old children. Materials and Methods: In this randomized, clinical, in vivo study with a split-mouth design we compared the pain of 30 children (6–8-year-old), requiring dental treatment necessitating the use of local anesthesia bilaterally in either of their maxillary and mandibular arches. Treatment was done in two visits, 1 week apart. Children were randomly assigned to receive the distraction (iPad) at one visit while no distraction in other visits. Two different pain assessment scales were used: Wong-Baker faces pain scale (FPS) and FPS-Revised. The Chi-square test was used for statistical analysis. P ≤ 0.05 was considered to be statistical significance. Results: Children who received local anesthesia with audiovisual distraction had lower pain rating scores than those who received local anesthesia with no distraction. Conclusion: Audiovisual distraction significantly reduces pain associated with injection of local anesthesia.

Background: Zinc oxide (ZnO) and graphene oxide (GO) nanoparticles (NPs) have antimicrobial properties. The present study was undertaken to evaluate the effects of incorporating these NPs and their chemical and physical blends on abrasion, translucency, and microhardness of flowable composite resin. Materials and Methods: In the present in vitro study, flowable composite resin samples (Grandio Flow, VOCO, Germany) were evaluated in 5 groups and the sample size was 10 for each group of each experiment (n = 10) as follows: Group 1, without NPs; Group 2, with ZnO NPs; Group 3, with GO NPs; Group 4, containing a physical mixture of GO and ZnO; and Group 5, containing a chemical mixture of GO and ZnO NPs. In all the groups, 1 wt% of the NPs were incorporate into flowable composite resin. Abrasion, translucency, and microhardness of the samples were evaluated. Data were analyzed with analysis of variance, followed by post hoc Tukey's tests at the level of significance of P < 0.05. Results: In Groups 2, 4, and 5 (all the groups containing ZnO), a significant decrease in abrasion and microhardness of flowable composite resin was observed compared to the control group. Incorporation of NPs in all the groups resulted in a significant decrease in translucency compared to the control group. Conclusion: Incorporation of NPs into flowable composite resin resulted in a decrease in translucency. The microhardness was reduced in groups containing ZnO, but the abrasion was also reduced in these groups. The incorporation of GO did not significantly alter the abrasion and microhardness of the composite resin.

Background: This study aimed to assess the microshear bond strength (micro-SBS) of two universal adhesives with different pH values in etch-and-rinse (E and R) and self-etch (SE) modes to superficial dentin. Materials and Methods: This in vitro experimental study evaluated 75 extracted sound human third molars. Superficial dentin was exposed by trimming the enamel and removing 0.5–1 mm of tooth structure beyond the dentinoenamel junction. A 600-grit abrasive paper was used to create smear layer. The teeth were randomly divided into five groups (n = 15). All-Bond Universal and G-Premio Bond were applied in E and R and SE modes in four groups. Clearfil SE Bond was used in the control group. Z350XT composite cylinders (0.9 mm diameter and 1.5 mm height) were then bonded to the prepared surface. The teeth were incubated at 37°C and 100% humidity for 24 h. Micro-SBS was measured by a universal testing machine, and the mode of failure was determined under a stereomicroscope. Data were analyzed using ANOVA, Bonferroni test, and Fisher's exact test (alpha = 0.05). Results: The micro-SBS of Clearfil SE Bond was significantly lower than all other groups (P < 0.05). All-Bond Universal yielded the maximum micro-SBS in SE and minimum micro-SBS in E and R mode. All-Bond Universal showed significantly lower micro-SBS in E and R mode than SE mode (P < 0.05). No other significant differences were noted. The mode of failure was also significantly different among the groups (P < 0.05). Mixed failure had the highest frequency in G-Premio in E and R mode. Conclusion: Type of adhesive and application mode affected the micro-shear bond strength to superficial dentin.

Background: Periodontitis, the second most common reason for tooth loss in adults, is a chronic inflammatory condition that increases the prevalence of cancer by inhibiting apoptosis and promoting tumor cell growth. However, it is still debatable if tooth loss is an important risk factor in oral cancer (OC). The aim of this systematic review is to analyze the relationship between tooth loss and the probability of developing head-and-neck cancer and also to see if there is an association between tooth loss, periodontitis, and the risk of OC. Materials and Methods: Studies that depicted a link between tooth loss and OC (till 2017) were searched from online databases accompanied by a thorough manual search of relevant journals. Data were collected from eligible studies, and meta-analysis was carried out using the Meta-Analysis software. The effect of various inclusions was assessed by sensitivity and subgroup analysis. Publication bias was also evaluated. Results: The meta-analysis consisted of 15 publications. When the number of teeth lost was counted, there was significant variability (I2 = 98.7%, P = 0.0001). When more than 15 teeth were missing in a subgroup analysis, there was a 2.4 times greater risk of OC (odds ratio: 2.496, 95% confidence interval [CI] = 2.067–3.015, P = 0.001) with no heterogeneity (I2 = 0.00%, 95% CI for I2 = 0.00–68.98). Subgroup analysis revealed that there was no evidence of publication bias. Conclusion: It was concluded that tooth loss can increase the OC risk by nearly 2 folds. However, large-scale population-based studies are needed to substantiate the findings.

Background: The aim of the current study was to evaluate the outcomes and complications of three-unit porcelain-fused-to-metal tooth-implant-supported prostheses in comparison with implant-supported prostheses. Materials and Methods: In this review article, the electronic databases, PubMed, Scopus, LILACS, Web of Science, EBSCO, LIVIVO, and Embase were searched over the past 20 years until December 2021. Risk ratio with 95% confidence interval (CI), fixed effect model, and Mantel–Haenszel method was calculated. The meta-analysis was performed with the statistical software Stata/MP v. 16. Results: Two hundred and three studies were selected for reviewing the abstracts, from which the full texts of 16 studies were reviewed. Finally, five studies were selected. The risk ratio of prosthesis failure between the tooth-implant-supported prosthesis and the implant-supported prosthesis was RR (Risk Ratio)= 1.83 (0.79, 4.24), (P = 0.16) and for prosthesis complication, it was RR = 0.61 (0.35, 1.06), (P = 0.08). Risk ratio of implant failure between the mentioned groups was RR = 2.33 (0.84, 6.41), (P = 0.10), and for implant complications, this rate was 0.09 (RR, 0.09 95% CI − 1.30, 1.48; P = 0.90). Conclusion: The meta-analysis of the present study showed that there was no significant difference between the two groups (three-unit porcelain-fused-to-metal tooth-implant-supported prosthesis and implant-supported prosthesis reconstruction) in terms of the total failure of implants and prostheses and the complication rate of implants and prostheses.

Background: The aim of the study was to compare the root reinforcement potential of different light cured intraorifice barriers (TheraCal, lime-lite, Ionoseal and resin-modified glass-ionomer [RMGI] [Fuji II LC]) with or without bonding agent placed in the orifice of endodontically treated and bleached teeth. Materials and Methods: In this experimental in vitro study, single-rooted bovine teeth were instrumented and obturated with gutta-percha. Except the control group, in other specimens, gutta-percha was removed 3 mm under cementoenamel junction. Then, the specimens were divided into seven groups according to the bases was applied: TheraCal LC, TheraCal LC with bonding agent, Lime-Lite, Lime-Lite with bonding agent, Ionoseal, Ionoseal with bonding agent, and RMGI (Fuji II LC). After internal bleaching, the teeth were decoronated. Then, all the groups were subjected to fracture resistance testing using Universal Testing Machine. For evaluating fracture resistance, analysis of variance and Tukey's test were used and for comparing the mode of fracture fisher test was applied in SPSS software. The significance was determined at (α = 0.05) confidence interval. Results: The group of TheraCal LC with bonding agent showed better fracture resistance as compared to the control group (P = 0.004). Although there was no statistically significant difference in the pairwise comparison between the other groups. Conclusion: TheraCal LC with bonding agent can be used as intraorifice barriers with good fracture resistance in endodontically treated and bleached teeth.

Background: The use of photodynamic therapy (PDT) has been evaluated as an adjunctive technique for bacterial decontamination of implants with peri-implantitis. Given the controversies over the efficacy of the application of PDT to treat peri-implant diseases, the present clinical study aimed to evaluate the posttherapeutic clinical parameters and cytokine levels in peri-implant crevicular fluid in patients with peri-implant mucosal inflammation, receiving mechanical debridement (MD) alone or in association with PDT. Materials and Methods: In this double-blinded randomized clinical trial, 52 patients with peri-implant mucosal inflammation were selected and they were randomly assigned to 2 treatment groups: a MD group and an MD + PDT group using an 805 nm laser and indocyanine green (ICG). Although the decrease in bleeding on probing was the primary outcome, pocket depth, PUS, pain on probing, clinical attachment level, gingival recession, tumor necrosis factor-α, interleukin (IL)-1β, IL-6 and matrix metalloproteinase-8 were also evaluated at baseline, 2-week, and 3-month postintervention. Repeated measure analysis of variance was used to analyze inter-group differences and a P ≤ 0.05 was considered for significant differences between tested parameters. Results: Statistically significant improvements (P < 0.001) were detected for all variables after comparison of baseline data with those collected at each time interval of the study. Nevertheless, the inter-group comparisons of these variables between the baseline, 2-week, and 3-month intervals did not reveal any significant decrease in sites treated with either MD alone or MD + PDT. Conclusion: The application of PDT using 805-nm laser and ICG as an adjunct therapy to MD did not provide any additional improvements in the clinical or biologic parameters of peri-implant mucosal inflammation.