Background: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases which are diagnosed with recurrent and painful ulcers. The possible association between psychological factors and salivary stress related factors in patients with aphthous ulcers has been discussed in various studies. The aim of this study was to evaluate salivary cortisol level, anxiety, and depression in patients with RAS. Materials and Methods: In this case control study, 30 patients with RAS and 30 healthy individuals were enrolled by matching their age and sex. Anxiety and depression were assessed by beck anxiety inventory and beck depression inventory. Unstimulated saliva of both groups were collected and then tested by DiaMetra kit and the ELISA method. Data were analyzed by SPSS using an Independent t-test and Mann–Whitney test. A statistical significance level of <0.05 was considered. Results: The mean salivary cortisol in the case group was 5.35 ng/ml and in the control group was 4.73 ng/ml which was not statistically significant (P > 0.05). There was no significant difference in anxiety and depression level between the two groups (P > 0.05). According to Spearman correlation coefficient, there was an average, negative, and significant correlation between salivary cortisol and anxiety and depression scores in the case group (P < 0.05). Conclusion: This study shows that, although the mean salivary cortisol was slightly higher in patients with aphthous lesions, anxiety, and depression were not possible factors for RAS. There was a moderate, negative correlation between salivary cortisol level and stress and anxiety in patients with RAS.

Background: To evaluate the changes in the micro-hardness and surface roughness of enamel treated with three different concentrations of in-office bleaching agents. Materials and Methods: In this in vitro study, 60 human incisors were divided into two groups (Group A and Group B). To obtain the baseline values, a Vickers tester was used to determine the surface microhardness in Group A, and a Surtronic tester was used for evaluation of surface roughness in Group B. Each group was then further subdivided into three subgroups and subjected to bleaching with Dash (Groups A1 and B1), Pola Office (Groups A2 and B2), and Opalescence Boost (Groups A3 and B3) containing 30%, 35%, and 40% hydrogen peroxide (HP), respectively. Samples were again subjected to testing to obtain the postbleaching values. Pre- and postbleaching data were analyzed by paired t-test. Intergroup comparison was carried out using one-way ANOVA (P ≤ 0.05). Results: A significant decrease in microhardness values was observed following bleaching in all the three groups, with Group A1 showing maximum percentage decrease (2.58%), followed by Group A2 (1.23%) and Group A3 (0.73%). Furthermore, an increase in surface roughness was observed following bleaching, with Group B1 showing maximum percentage increase (14.80%), followed by Group B2 (8.25%) and Group B3 (5.79%). However, there was no significant difference in either microhardness or surface roughness when comparing the postbleaching values among the three bleaching agents. Conclusion: In-office bleaching agents may adversely affect the microhardness and roughness of enamel surface which are not related to the concentration of HP used.

Background: Nickel–titanium (NiTi) instruments have represented a great technological development that enabled endodontists conforming irregular-shaped root canals. Notwithstanding, the repeated use of these instruments may lead to the fracture without any prior visible warning signs. This study aimed to evaluate how multiple clinical instrumentation/sterilization cycles of two NiTi mechanized instruments can affect their microstructural, microchemical, and mechanical characteristics. Materials and Methods: In this observational descriptive study, a total of 140 NiTi instruments, 70 ProTaper Gold^® (PTG) and 70 WaveOne Gold^® (WOG) were analyzed. For each brand system, instruments were evaluated in the as-received condition (n = 10) and after one (n = 20), two (n = 20), and three (n = 20) instrumentation/sterilization cycles. Intraoperative instrumentation parameters were recorded for all used instruments. Afterward, the files were examined using scanning electron microscopy and energy-dispersive X-ray microanalysis. All of the instruments were tensile-fatigue tested until rupture in order to calculate the mechanical tensile strength and the maximum elongation percentage for the samples. Statistical analysis was completed using Chi-square, Kruskal–Wallis H-, or Mann–Whitney U-tests with a statistical significance set at P < 0.05. Results: Significant increasing changes in surface topography (P < 0.05, Chi-square test) and chemical composition (P < 0.05, Kruskal–Wallis H-test) in both brand systems through instrumentation/sterilization cycles were detected. In addition, values of mechanical tensile strength and maximum elongation percentage increased significantly through instrumentation/sterilization cycles in the PTG group, whereas only the median values of mechanical tensile strength increased significantly in the WOG group (all P < 0.01, Kruskal–Wallis H-test). Conclusion: Although multiple instrumentation/sterilization cycles may render NiTi instruments more flexible and fatigue resistant, the significant changes detected in their surface topography and chemical composition should preclude their repeated clinical use in the routine endodontic practice as prevention for breakage.

The most common orthognathic surgery approach consists of three steps: presurgical orthodontic treatment, surgery, and postsurgical orthodontic treatment. Despite its advantages, this technique has some disadvantages, too, including a long treatment period, problems in mastication and articulation, temporary worsening of the patient's appearance, and psychological problems for the patient. The introduction of the surgery-first orthognathic approach has been an attempt to overcome these problems. In this article, we wish to provide a comprehensive overview on this approach. In this approach, which consists of surgery without orthodontic preparation and a short period of orthodontic treatment after it, the overall duration of treatment decreases and the patient's appearance improves. The skeletal anchorage, placed at the time of surgery, can be used to facilitate tooth movements after surgery. Despite the advantages of this technique, it is associated with some limitations; in particular, occlusion cannot have a guiding role during surgery. Therefore, correct diagnosis, prediction of the outcomes, and simulating correction with the model setup are of crucial importance. The surgeon's knowledge and expertise have a significant role in this respect.

Background: Periostin is a protein, which is essential for periodontal tissue integrity, development and maturity. The aim of this study was to evaluate the role of gingival crevicular fluid (GCF) periostin levels in the association between coronary heart disease (CHD) and chronic periodontitis (CP). Materials and Methods: This matched case–control study was conducted on 116 participants. The participants were matched for age, gender, and body mass index and divided into four groups as follows: (1) 29 patients with CHD and sever CP (CHD-CP), (2) 29 patients with CHD and without CP (CHD-H), (3) 29 patients without CHD and with sever CP (H-CP), and (4) 29 healthy participants (H-H). The GCF periostin was collected and evaluated using the enzyme-linked immunosorbent assay (ELASA). Finally, the data were analyzed by analysis of variance using the stata software. Significance was assigned at P < 0.05. Results: The results showed that there was a significant difference in the GCF periostin levels in the four groups (P < 0.05). Moreover, according to the results of the Bonferroni's test, differences in the mean periostin levels were significant (P < 0.001) between CHD-CP and CHD-H, CHD-CP and H-CP, CHD-CP and H-H, CHD-H and H-H, and also between H-CP and H-H. Conclusion: The periostin levels reduced in the CHD patients, especially in the CHD-CP group. The findings reveal a probable role of periostin in the association between CHD and CP.

Background: To maintain the integrity of the interface between root canal filling and radicular dentin an ideal endodontic biomaterial should have good adhesion. This study was aimed to evaluate the bond strength and tubular penetration of modified bioceramic materials by indirect ultrasonic activation. Materials and Methods: In the present in vitro experimental study, 120 coronal root slices of 2 mm were prepared from mandibular premolars and randomly divided into six groups (n = 20) in accordance to placement techniques: Group I: Nano Biodentine-manual, Group II: CaCl₂ modified ProRootMTA-manual (MM), Group III: Biodentine-manual, Group IV: Nano Biodentine: Ultrasonic, Group V: CaCl₂ modified ProRootMTA-ultrasonic, and Group VI: Biodentine-ultrasonic (BDU). The samples were kept in humidifier for 4 days at 37°C and push out bond strength, sealer penetration were evaluated using an universal testing machine and confocal laser scanning microscope respectively. Data were subjected to statistical analysis using SPSS software by using One-way ANOVA for overall significance and Tukey's multiple post hoc test for intergroup comparison (P < 0.05). Results: Highest push out bond strength and greater tubular penetration were observed with Group VI (BDU), while the lowest bond strength and tubular penetration were associated with Group II (MM). Conclusion: Within the limitations of current study it was observed that Biodentine with indirect ultrasonic activation has resulted in highest pushout bond strength among all the study groups.

Background: It was documented that the clinical outcomes of mechanical periodontal treatment can fluctuate not merely concerning patients but equally among various tooth sites in the subject. This trial evaluates the clinical parameters related with the patient, tooth, and site that generate more changes in clinical attachment level (CAL) gain and probing depth (PD) reduction, using moxifloxacin (MOX) versus amoxicillin plus metronidazole (AMOX + ME) as adjuncts to scaling and root planing (SRP), in comparison to SRP only, post-therapy in generalized aggressive periodontitis (GAgP). Materials and Methods: The analysis of this clinical trial included 6012 tooth sites at 1002 teeth in 36 patients; they were randomly assigned to three protocols: Systemically intake of MOX or AMOX + ME plus SRP, or SRP + placebo for 7 days. The clinical effect of the patient, tooth, and site characteristics, in terms of CAL gain and PD reduction, was explored using a multilevel linear model. P < 0.05 was statistically significant. Results: Following 6 months of treatment, the differences between the groups were statistically significant, favoring the MOX and AMOX + ME protocols (P < 0.0001). Moreover, the multilevel model showed that adjunctive MOX, AMOX + ME, non-molar, and interproximal sites were the features that contribute significantly to CAL improvement, and PD decreases in GAgP (P ≤ 0.001 for all). Conclusion: The most relevant characteristics for the changes in CAL increase and PD diminution, after adjunctive antimicrobials, were ascribable to the features related to the tooth. MOX and AMOX + ME, non-multi-radicular-tooth, and interdental sites indicated superior clinical gains at the tooth and site levels in GAgP.

Background: Dental implants are widely accepted substitutes for replacing missing teeth. Many factors, including the use of specific drugs such as proton-pump inhibitors (PPIs) (omeprazole), can affect the success of dental implantations. The aim of this study was to investigate the relationship between the use of omeprazole and osseointegration of dental implants. Materials and Methods: This experimental animal study was performed on eight native male dogs weighted 11–13 kg and aged 16–20 months. The dogs were divided into two groups (receivers and nonreceivers of omeprazole). After extraction of mandibular teeth, treatment was started randomly with the administration of omeprazole and saline. After a 2-month recovery period, six titanium implants were placed in the jaws of all dogs and the administration of omeprazole was continued for 2 weeks. After 4 and 12 weeks, the dogs were anesthetized and dental implants with their bone marrow were removed. The samples were examined histomorphometrically to determine osseointegration. Data were analyzed with two-way ANOVA test for 95% confidence interval. The P value was set at 0.05. Results: In the microscopic examination of the samples in week 4, the levels of bone–implant contact (BIC) in the study group were significantly lower than the control group (46.37 vs. 64.37%). In 12 weeks, BIC was significantly lower than that of the control group (67.33 vs. 82.00%). The type of bone formed in week 4 in both the groups was more woven, and in the 12th week, it was mostly lamellar. Conclusion: Systemic administration of PPIs may interfere with osseointegration of dental implants.

Materials and Methods: In this descriptive study, a total of 768 radiographs of mandibular first molars, 384 for males and 384 for females, taken at a private radiology center in Isfahan, were assessed for the presence of middle mesial canal based on the gender of the patients. All samples had been prepared by one CBCT machine. The images were evaluated by endodontists and radiologists. Then, the morphology of first molar mesial root canals was assessed by Vertucci classification, and the obtained results were analyzed by SPSS software using a Chi-square test. The comparison was considered statistically significant at P < 0.05. Results: Twenty-four samples (3.13%) had a middle mesial canal. The prevalence rates of the middle mesial canal in the females and males were found to be 9 and 15 (2.35% vs. 3.92%), respectively, indicating no statistically significant difference (P = 0.21). Of 24 teeth with middle mesial canal, 17 samples (70.8%) were of Type XII and 7 samples (29.2%) were of Type VIII. There was no statistically significant difference between genders with regard to the prevalence of different types of middle mesial canals (P = 0.19). Conclusion: The prevalence of the middle mesial canal was rather low in this study, and it is necessary to detect additional canals in the patients under root canal treatment.

Background: Since the symptoms of child abuse and neglect often manifest in the orofacial region, the dental team has a key role in identifying children subjected to abuse. This study was aimed to explore the prevalence of failure to take history as a barrier to reporting child abuse by dentist around the world. Materials and Methods: In this systematic review and meta-analysis, PubMed, Embase, Scopus, Google Scholar, ProQuest, Cochrane, and ISI databases were searched for the cross-sectional articles in English languages on barriers to reporting child abuse and lack of knowledge about referral procedures by dentists since 1985 using Medical Subject Headings (MeSH). The full-texts of all included articles were obtained and assessed for quality according to Newcastle–Ottawa Scale adapted for cross-sectional studies. The qualified articles were then studied thoroughly and results were extracted. Data were analyzed by Comprehensive Meta-Analysis software using meta-analysis and random effects model. Heterogeneity was determined by Q-test and I-square index. Results: A total of 17 articles were included in the meta-analysis. The prevalence of lack of knowledge about referral procedures as a barrier was determined according to the meta-analysis of the number of relevant articles and was (55%, confidence interval: 0.48, 0.62). Conclusion: The analysis of various studies revealed lack of information about referral procedures as an important barrier to report child abuse by dentists.