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Background: The dual-silane (trialkoxysilane/aminosilane) universal adhesive (UA) is claimed for its enhanced priming capacity of glass-ceramics. Objective: This study evaluated the effect of organofunctional trialkoxysilane- and organofunctional trialkoxysilane/aminosilane-containing UAs on the long-term resin–ceramic microtensile bond strength (μTBS) and wettability of ceramic. Methods: Hydrofluoric acid-etched lithium disilicate discs were distributed into four groups as follows: (control), no priming was performed; (MBN), primed using a silane-based primer (Monobond N); (SBU), primed using a trialkoxysilane-containing UA (Single Bond Universal Adhesive) and (SBP), primed using a trialkoxysilane/aminosilane-containing UA (Scotchbond Universal Plus Adhesive). Ceramic discs were cemented into blocks then sectioned into microbeams stored in distilled water at 37° for 1 year. The μTBS was evaluated followed by assessment of the failure modes. The contact angle of the two UAs was measured with a goniometer using the sessile drop technique. Results: MBN significantly improved the resin-ceramic μTBS (31.71 ± 6.33 MPa) compared to the control group. The resin-ceramic μTBS obtained after priming using SBP (22.83 ± 3.42 MPa) was comparable to those of MBN. SBU showed significantly inferior resin-ceramic μTBS (16.02 ± 6.28 MPa) compared with MBN. Mixed failures mode patterns were the most frequent in the groups. The ceramic wettability of both UAs did not significantly differ. Conclusion: Ceramic priming using a UA with dual-silane monomers (organofunctional trialkoxysilane/aminosilane) resulted in long-term adhesion comparable to a silane-containing primer. Incorporating aminosilane monomer in UA formulation did not affect the wetting of characteristics of the UA solution and enhanced its glass-ceramic priming capacity. Clinical significance: The use of UA with optimized silane content as a primer for glass-ceramics simplifies clinical adhesive procedures including resin cementation and repair of ceramic restorations.

Abstract Background Dental implants emerge as a dependable and efficacious alternative for patients experiencing partial or complete tooth loss. The stability of these implants is influenced by surface topography and macro-level design. In cases where the height of the maxillary posterior region is diminished, employing short implants can prove advantageous. With the aim of examining the distribution of von Mises stress, strain, and micromovement in D4 bone quality surrounding platform-switched short implants, measuring 6 mm in length and featuring diameters ranging from 4 to 6 mm, as well as different thread designs, an in-depth finite element analysis was conducted under immediate loading conditions. Methodology A 3D finite element model was constructed to simulate maxillary molar crowns, incorporating an implant with a length of 6 mm and varying diameters and thread designs. The diameters utilized were 4/3.6 mm, 5/4 mm, and 6/4.8 mm, while the thread designs included buttress, square, and triangle patterns. Each model underwent analysis with a 100 N force applied in two directions: vertical and oblique, relative to the long axis of the implant. Stress, strain, and micromovement in the peri-implant region were recorded, employing the Ansys Workbench R v.18.1 software for modelling and analysis. Results When comparing all three diameters, the wide diameter (6 mm threads) exhibited the lowest values of peri-implant von Mises stresses (3.3 MPa and 35.1 MPa), strains (194 Ɛ and 484 Ɛ), and micromovements (0.7 μm and 1.3 Ɛ) subjected to axial and non-axial loading of a 100 N force. Notably, square microthreads yielded the most favorable stress parameters among the different thread shapes, manifesting the minimum values of stress, strains, and micromovements in their vicinity. Conclusion For the treatment of atrophic ridges or in scenarios necessitating extensive surgical preparation of the implant site, a combination of short implants, wide diameters, and platform switching can be employed. In situations with reduced bone height and the requirement for an implant-supported prosthesis to replace a missing permanent maxillary molar, the utilization of wide-diameter platform-switched short implants measuring 6 mm in length, featuring a square thread design, should be taken into consideration.

Abstract Background The surface treatment to improve the repair bond strength may vary because CAD/CAM provisional restoration polymers exhibit a variety of microstructures. This study was conducted to evaluate the effect of surface treatments on the repairability of three different CAD/CAM polymers for long-term provisional restorations. Methods Thirty specimens from each provisional restorative materials (CAD-Temp, Everest C-Temp, and PEEK) were divided into three groups: C: surfaces received no treatment; SB: surfaces were airborne particle abraded with 50 μm aluminum oxide; SB-T: surfaces received the same conditions as group SB in addition to thermocycling before and after treatment. Primer and nanohybrid repair resin composite were applied to the prepared CAD /CAM surfaces. The shear bond strength and the mode of failure were assessed. ANOVA and Tukey’s significant difference tests were used to evaluate the data. Results The SB group had significantly higher repair SBS values (p

In recent years, CAD/CAM technology has allowed indirect ceramic restorations to become a part of everyday chairside clinical practice. Therefore, the impact of different cavity-preparation designs on the fracture resistance of CAD/CAM fabricated ceramics was assessed in this study. Three designs of cuspal covering (none, palatal, and entire) and two widths of the occlusal isthmus (75% and 100% of the intercuspal distance) were used for the preparation of inlays and onlays to form six groups (n = 10/group). Moreover, thermomechanical cyclic loading was applied to every tooth under a chewing simulator. A universal testing machine was used to measure each group’s fracture resistance. The tested specimens were inspected for any signs of fractures and cracks to categorize failure patterns. Thereby, the values of fracture strength showed that there were statistically nonsignificant differences between the tested groups (p < 0.05). However, a significant difference (p = 0.01) was found between group 1 (inlays) (1950 ± 405) and group 6 (onlays) (3900 ± 770). Type III or type IV fracture modes were seen in the majority of the specimens. In conclusion, inlays and onlays made of zirconia using CAD/CAM technology were deemed reliable for restoring premolars, irrespective of the cavity-preparation design, except for inlays with a 75% intercuspal distance.

Objective: This study assessed the influence of chitosan nanoparticles on the fluoride-releasing ability of 4 glass ionomer cement (GIC) through an in vitro analysis. Methods: Four types of GIC (type II light cure universal restorative, type II universal restorative, GC Fuji VII, and type IX) were modified with nanochitosan particles; 10% chitosan was added to the glass ionomer liquid. Six specimens for each of the 4 groups were created, using expendable Teflon moulds. Discs of each type of GIC (n = 6) were immersed in deionised water at various time intervals. Electrodes selective for fluoride ions were employed to analyse the amount of released fluoride at 1, 7, 14, 21, and 28 days. Results: Chitosan-modified GICs showed greater fluoride release than conventional GICs at all time points. All samples showed an initial high release of fluoride that tapered off with time. The total amount of fluoride released increased from the 1st day to the 28th day on adding chitosan to all the 4 types of GIC. Amongst those, type IX high-strength posterior extra with chitosan released a considerably higher quantity of fluoride at all time intervals. Conclusions: In all the experimental groups, adding chitosan to the glass ionomer liquid had an accelerating effect on its fluoride-releasing property.

Abstract Background Over the past years, polysaccharide-based scaffolds have emerged as the most promising material for tissue engineering. In the present study, carrageenan, an injectable scaffold has been used owing to its advantage and superior property. Cissus quadrangularis, a natural agent was incorporated into the carrageenan scaffold. Therefore, the present study aimed to assess the antioxidant activity and biocompatibility of this novel material. Methods The present in vitro study comprised of four study groups each constituting a sample of 15 with a total sample size of sixty (n = 60). The carrageenan hydrogel devoid of Cissus quadrangularis acted as the control group (Group-I). Based on the concentration of aqueous extract of Cissus quadrangularis (10% w/v, 20% w/v and 30% w/v) in carrageenan hydrogel, respective study groups namely II, III and IV were considered. Antioxidant activity was assessed using a 1,1-diphenyl-2-picrylhydrazyl radical scavenging assay, whereas the biocompatibility test was performed using a brine shrimp lethality assay. The microstructure and surface morphology of the hydrogel samples containing different concentrations of Cissus quadrangularis aqueous extract was investigated using SEM. One-way ANOVA with the post hoc tukey test was performed using SPSS software v22. Results A significant difference (P

Aim: To assess the relations between the divergence angle of the maxillary molar roots and their proximity to the maxillary sinus floor using CBCT. Method: This study comprised CBCT scans of the maxilla, including at least the inferior one-third of the maxillary sinus and at least one molar present in any quadrant with complete eruption and root formation. Evaluation included the vertical relations between the maxillary molar root apices and the maxillary sinus floor (MSF), and the root divergence was measured from the root apices to the floor of the pulp chamber. The chi-square test was used for the associations between the study parameters. For the correlation between root divergence angles and MSF vertical relationship types, the Spearman test was used. A P-value 45⁰ angle groups, and a higher prevalence of the Type I relationship was found in the 21-45⁰ angle group. For the distobuccal-palatal angle groups, higher percentages of the MSF Type II relationship were found in the three angle groups. For all teeth, there was a significant positive correlation between the MSF vertical relationship and the mesiobuccal-palatal angle (r = 0.116; P = 0.039). Conclusion: There was a positive correlation between the divergence angle of the roots and their vertical relationship with the MSF. Clinicians should assess the divergence between the roots before performing extraction or endodontic treatments.

(1) Background: A newer class of flowable bulk-fill resin-based composite (BF–RBC) materials requires no capping layer (Palfique Bulk flow, PaBF, Tokuyama Dental, Tokyo, Japan). The objective of this study was to assess the flexural strength, microhardness, surface roughness, and color stability of PaBF compared to two BF-RBCs with different consistencies. (2) Methods: PaBF, SDR Flow composite (SDRf: Charlotte, NC, USA) and One Bulk fill (OneBF: 3M, St. Paul, MN, USA) were evaluated for flexural strength with a universal testing machine, surface microhardness using a pyramidal Vickers indenter, and surface roughness using a high-resolution three-dimensional non-contact optical profiler, a and clinical spectrophotometer to measure the color stability of each BF–RBC material. (3) Results: OneBF presented statistically higher flexural strength and microhardness than PaBF or SDRf. Both PaBF and SDRf presented significantly less surface roughness compared with OneBF. Water storage significantly reduced the flexural strength and increased the surface roughness of all tested materials. Only SDRf showed significant color change after water storage. (4) Conclusions: The physico-mechanical properties of PaBF do not support its use without a capping layer in the stress bearing areas. PaBF showed less flexural strength compared with OneBF. Therefore, its use should be limited to a small restoration with minimal occlusal stresses.

Background and objectives: Even with the demand for high esthetics, the strength of the material for esthetic applications continues to be important. In this study, monolith zirconia (MZi) crowns fabricated using CAD/CAM were tested for fracture resistance (FR) in teeth with class II cavity designs with varying proximal depths, restored through a deep marginal elevation technique (DME). Materials and Methods: Forty premolars were randomly divided into four groups of ten teeth. In Group A, tooth preparation was conducted and MZi crowns were fabricated. In Group B, mesio-occluso-distal (MOD) cavities were prepared and restored with microhybrid composites before tooth preparation and the fabrication of MZi crowns. In Groups C and D, MOD cavities were prepared, differentiated by the depth of the gingival seat, 2 mm and 4 mm below the cemento-enamel junction (CEJ). Microhybrid composite resin was used for DME on the CEJ and for the restoration of the MOD cavities; beforehand, tooth preparations were conducted and MZi crowns were and cemented using resin cement. The maximum load to fracture (in newtons (N)) and FR (in megapascals (MPa)) were measured using the universal testing machine. Results: The average scores indicate a gradual decrease in the load required to fracture the samples from Groups A to D, with mean values of 3415.61 N, 2494.11 N, 2108.25 N and 1891.95 N, respectively. ANOVA revealed highly significant differences between the groups. Multiple group comparisons using the Tukey HSD post hoc test revealed that Group D had greater DME depths and showed significant differences compared with Group B. Conclusions: FR in teeth decreased when more tooth structure was involved, even with MZi crowns. However, DME up to 2 mm below the CEJ did not negatively influence the FR. Strengthening the DME-treated teeth with MZi crowns could be a reasonable clinical option, as the force required to fracture the samples far exceeded the maximum recorded biting force for posterior teeth.

This work aimed to synthesize a novel dimethacrylated-derivative of eugenol (Eg) (termed EgGAA) as potential biomaterial for certain applications such as dental fillings and adhesives. EgGAA was synthesized through a two-step reaction: (i) a mono methacrylated-eugenol (EgGMA) was produced via a ring-opening etherification of glycidyl methacrylate (GMA) with Eg; (ii) EgGMA was condensed with methacryloyl chloride into EgGAA. EgGAA was further incorporated in matrices containing BisGMA and TEGDMA (50:50 wt%) (TBEa), in which EgGAA replaced BisGMA as 0–100 wt% to get a series of unfilled resin composites (TBEa0–TBEa100), and by addition of reinforcing silica (66 wt%), a series of filled resins were also obtained (F-TBEa0–F-TBEa100). Synthesized monomers were analyzed for their structural, spectral, and thermal properties using FTIR, 1H- and 13C-NMR, mass spectrometry, TGA, and DSC. Composites rheological and DC were analyzed. The viscosity (η, Pa·s) of EgGAA (0.379) was 1533 times lower than BisGMA (581.0) and 125 times higher than TEGDMA (0.003). Rheology of unfilled resins (TBEa) indicated Newtonian fluids, with viscosity decreased from 0.164 Pa·s (TBEa0) to 0.010 Pa·s (TBEa100) when EgGAA totally replaced BisGMA. However, composites showed non-Newtonian and shear-thinning behavior, with complex viscosity (η*) being shear-independent at high angular frequencies (10–100 rad/s). The loss factor crossover points were at 45.6, 20.3, 20.4, and 25.6 rad/s, indicating a higher elastic portion for EgGAA-free composite. The DC was insignificantly decreased from 61.22% for the control to 59.85% and 59.50% for F-TBEa25 and F-TBEa50, respectively, while the difference became significant when EgGAA totally replaced BisGMA (F-TBEa100, DC = 52.54%). Accordingly, these properties could encourage further investigation of Eg-containing resin-based composite as filling materials in terms of their physicochemical, mechanical, and biological potentiality as dental material.

Titanium is the main component of dental implants. It is also routinely used as a framework material for implant-supported full-arch prostheses due to its low density, biocompatibility, and other mechanical properties. Remarkable mechanical properties such as lesser mass density and higher young’s modulus of graphene have gained popularity among scientists, improving the properties of biomedical implants. Thus, our study aimed to compare the outcome through the von Mises stresses generated on All-on-6 and All-on-3 implant models, as well as on the framework, and evaluate the effect of stress patterns on the crestal bone around implants in the mandible. FEA (Finite Element Analysis) study was carried out using edentulous mandible models. Four 3D FEA models with 3 and 6 implants were used (Model 1: Titanium bar-supported 6 straight implants; Model 2: Graphene bar-supported 6 straight implants; Model 3: Titanium bar-supported 3 implants with 30 degrees-tilted; Model 4: Graphene bar-supported 3 implants with 30 degrees-tilted) in order to simulate endosseous implant designs. The implant measuring 4.2 mm in diameter and 11.5 mm in length were used. The most distal implants in the 3-implant models were placed with angulation of 30 degrees; in 6 implants, they were vertically placed. All the models were analyzed for vertical and oblique axis with a single force magnitude of 100 N. In all four implant models and under loading conditions, the peak stress points were always on the neck of the most distal implant. von Mises stresses were within the normal stress range. In a conventional six-straight implant model supported by a titanium framework, the cortical stress in the region of implants was 25.27 MPa, whereas, in the graphene framework, it was 12.18 MPa. Under vertical load, there was a significant difference in the cortical stress around the tilted implants (30 degrees) in the 3-implant system of titanium and graphene frameworks, respectively, 70.31 MPa and 21.27 MPa. The graphene framework demonstrated better results than the titanium framework for the conventional six-implant system under vertical load, achieving stress of 30.09 MPa and 76.60 MPa, respectively. In the case of the 3-implant system, a significant difference in the bar stress was observed between graphene and titanium, respectively, 256.32 MPa and 180.1 MPa of bar stress. Within the limitation of this study, the peri-implant stresses were decreased using graphene framework models. Hence, it was possible to conclude that the best load-bearing capacity results were found in the graphene framework group compared to the titanium framework for All-on-6 and All-on-3 implant models, even though both materials are reliable options used as framework materials in implant-supported full-arch prostheses.

Background: Sequential chemical application for irrigating a root canal during chemomechanical debridement can affect the dentin microstructure. Understanding the effects of various irrigants on chemical properties of dentin can elucidate their effects on physical properties and thereby explain the higher incidence of structural failure in endodontically treated teeth. This in vitro research aimed to compare and evaluate the effects of three different irrigating solutions on the chemical structure of root canal dentin in extracted human teeth. Methods: Forty-eight extracted single-rooted mandibular premolar teeth were sectioned at the cemento–enamel junction by a diamond disc and were then randomly assigned to four groups of twelve samples each. The groups were irrigated using 5.25% NaOCl, ozonated olive oil, silver citrate, or distilled water. Dentin sections measuring 1.5 mm were obtained from the root portion and each section and were analyzed using Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and electron-dispersive spectroscopy (EDS). FTIR and EDS values are reported as means ± standard deviations. Data were analyzed using an ANOVA and a post hoc Bonferroni test (p < 0.05). Results: A comparison of the FTIR and EDS values among the groups using ANOVA revealed statistically significant differences in the organic and inorganic peak values among the groups. An intergroup comparison between NaOCl with silver citrate and ozonated olive oil revealed significant reductions in the carbonate and phosphate peak values in the NaOCl group (p < 0.05). The EDS values tabulated for the carbon, oxygen, phosphorous, and calcium peak levels showed significant differences between the groups using an ANOVA. An SEM analysis was conducted under 1500× magnification, which revealed smear layer removal in the silver citrate group. Conclusions: The silver citrate solution and the ozonated olive oil caused less changes in the organic and mineral contents of dentin than sodium hypochlorite.

Silver diamine fluoride (SDF) has been accepted as an appropriate alternative for caries management. However, knowledge and utilization of SDF among dentists vary considerably. The authors in the present study aimed to assess the awareness, knowledge, attitudes, and use of SDF among general dentists (GD) in Saudi Arabia and to correlate the differences based on the different regions and experience levels of the dentists. In this regard, a cross-sectional web-based questionnaire was conducted, and a response was received from 311 GDs from different parts of the country. Information regarding demographic data, knowledge, attitudes, use, and barriers to SDF in dentists’ professional lives were elicited. The mean age of the participants (55.3%) was between 25–35 years. Most (92.45%) of the dentists were aware of the material and (61%) agreed that SDF could arrest carious lesions. More than half of the dentists agreed/strongly agreed that SDF was a good treatment alternative for restorations in children with behavioral issues (63.1%), medically fragile patients (53.7%), patients with severe anxiety (64.5%), patients who underwent radiation or chemotherapy (47.3%), and patients needing general anesthesia for dental treatment (74%). Comparative evaluation using ANOVA revealed regional differences based on knowledge, attitudes, and use. Tukey HSD further highlighted that the practitioners in the western region are more knowledgeable regarding its benefits and utilize it more frequently in their practice compared to other regions. On the other hand, the experience level of the GDs did not have any impact on their knowledge, attitudes, and use of SDF.

Resin-bonded fixed dental prostheses (RBFDP) are minimally invasive alternatives to traditional full-coverage fixed partial dentures as they rely on resin cements for retention. This study compared and evaluated the tensile bond strength of three different resin-bonded bridge designs, namely, three-unit fixed-fixed, two-unit cantilever single abutment, and three-unit cantilever double-abutted resin-bonded bridge. Furthermore, the study attempted to compare the tensile bond strengths of the Maryland and Rochette types of resin-bonded bridges. Based on the inclusion and exclusion criteria, a total of seventy-five extracted maxillary incisors were collected and later were mounted on the acrylic blocks. Three distinct resin-bonded metal frameworks were designed: three-unit fixed-fixed (n = 30), two-unit cantilever single abutment (n = 30), and a three-unit cantilever double abutment (n = 30). The main groups were further divided into two subgroups based on the retainer design such as Rochette and Maryland. The different prosthesis designs were cemented to the prepared teeth. Later, abutment preparations were made on all specimens keeping the preparation as minimally invasive and esthetic oriented. Impression of the preparations were made using polyvinyl siloxane impression material, followed by pouring cast using die stone. A U-shaped handle of 1.5 mm diameter sprue wax with a 3 mm hole in between was attached to the occlusal surface of each pattern. The wax patterns were sprued and cast in a cobalt–chromium alloy. The castings were cleaned by sandblasting, followed by finishing and polishing. Lastly, based on the study group, specimens for Rochette bridge were perforated to provide mechanical retention between resin cement and metal, whereas the remaining 15 specimens were sandblasted on the palatal side to provide mechanical retention (Maryland bridge). In order to evaluate the tensile bond strength, the specimens were subjected to tensile forces on a universal testing machine with a uniform crosshead speed. The fixed-fixed partial prosthesis proved superior to both cantilever designs, whereas the single abutment cantilever design showed the lowest tensile bond strength. Maryland bridges uniformly showed higher bond strengths across all framework designs. Within the limitations of this study, the three-unit fixed-fixed design and Maryland bridges had greater bond strengths, implying that they may demonstrate lower clinical failure than cantilever designs and Rochette bridges.

The essential factor in determining the preservation of restoration is the marginal seal. Restoring cervical lesions with a resin composite has always been a challenge. Composite resins with various viscosities and different bonding systems are being researched to reduce the microleakage. Confocal laser scanning microscopy (CLSM) is the latest non-destructive technique for visualizing the microleakage. Objectives: To evaluate and compare the microleakage of Universal Flo composite resin (G-aenial) using etch and rinse adhesive system ER-2 steps (Adper Single Bond 2), self-etch adhesive system SE-1 step (G-Bond), and self-adhesive flowable composite resin (Constic) in Class V cavities using a confocal laser scanning microscope. Materials and Method: Class V cavities were prepared on 27 caries-free human extracted premolar teeth on the buccal and lingual surfaces with standardized dimensions of 2 mm height, width 4 mm, and a depth of 2 mm. After the cavity preparation, all teeth were randomly divided into three groups, namely Group-I: G-aenial Universal Flo with Single Bond 2 (n = 9 teeth); Group-II: G- aenial Universal Flo with G-Bond (n = 9 teeth), and Group-III: Constic (n = 9 teeth). The prepared and restored specimens were then subjected to thermocycling for 500 cycles in a water bath at 5 °C and 55 °C with a dwelling time of 30 s. The specimens were placed in 0.6% aqueous rhodamine dye for 48 h. Sectioning was carried out bucco-lingually and specimens were evaluated for microleakage under a confocal laser scanning microscope. Results: There was a significant difference (p = 0.009) in microleakage when comparing total etch and rinse, specifically between Adper Single Bond 2 ER-2 steps (fifth generation) and self-adhesive flowable composite resin, which is Constic. There was more microleakage in the self-etch bonding agent, particularly G-Bond, SE-1 step (seventh generation), when compared to ER-2 steps (fifth generation bonding agent); however, the results were not statistically significant (p = 0.468). The self-adhesive flowable composite resin showed more microleakage than SE-1 step and ER-2 steps. Conclusions: None of the adhesive systems tested were free from microleakage. However, less microleakage was observed in the total etch and rinse, especially Adper Single Bond 2 (ER-2 steps), than the self-etch adhesive system SE-1 step and self-adhesive flowable composite resin. Clinical significance: Constant research and technological advancements are taking place in dentin adhesives to improve the marginal seal. This has led to the evolution of total acid-etching dentin bonding agents termed as etch and rinse (ER)-2 steps (fifth generation dentin bonding agents) and self-etching (SE) 2 steps, and SE-1 step dentin bonding agents termed as the sixth and seventh generation bonding agents, respectively.

Background: It is essential for practicing dentists to have adequate knowledge of HIV/AIDS and its implications in the dental practice. Their attitudes should also be up to the professional expectations. This study aimed to assess knowledge of HIV/AIDS infection and attitudes towards its patients among dental students in Saudi Arabia. Methods: A questionnaire was prepared and distributed among a sample of dental students in Saudi Arabia. Twenty questions related to knowledge, attitudes, and oral manifestation of HIV were presented. Results: A total of 405 questionnaires were completed (67% response rate). Participants showed low knowledge of safety regarding HIV (39.5%) and 44.2% indicated that they would take an HIV test after needle stick injury. The proportion of correct answers regarding transmission of HIV through saliva, cardiopulmonary resuscitation, and aerosols by hand pieces was 41%, 37.5%, and 26.4%, respectively. Almost 50% of the surveyed dental students expressed unwillingness to treat HIV-positive patients. Poor knowledge was noted regarding oral manifestations of HIV (32.7%). Of the participants, 57.8% indicated that infection control procedures are very important for the treatment of HIV patients and 50.6% believed that a dentist can make a decision to reject the treatment of HIV patients. According to the participating dental students, the three major oral manifestations in HIV patients are hairy leukoplakia (47.4%), oral candidiasis (44.7%), and Kaposi’s sarcoma (43.5%). Conclusion: Inadequate knowledge and unprofessional attitude towards HIV/AIDS patients were identified among this group of dental students in Saudi Arabia. Dental educators and health care planners in Saudi Arabia should plan to promote the knowledge and attitudes of dental students in Saudi Arabia towards the treatment of HIV patients.

Accomplishing painless endodontic treatment, especially in the mandibular molar region, is challenging. Hence, the aim of the study was to compare the efficacy of 2% lidocaine and 4% articaine when used as supplemental intra-ligamentary (IL) anesthesia in mandibular molars having symptomatic irreversible pulpitis with symptomatic apical periodontitis after failed Inferior Alveolar Nerve Block (IANB) injection. In this prospective study, one-hundred and forty-seven adult patients diagnosed with irreversible pulpitis in a mandibular tooth were included who received IANB with 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Patients who experienced pain were recorded using the Heft–Parker visual analog scale (HP-VAS score ≥ 55 mm) and received supplement intra-ligament injection with either4% articaine or 2% lidocaine with 1:100,000 epinephrine. Supplementary intra-ligament injections resulted in 82.6% and 91.3% of profound anesthesia in the first molar region for 2% lidocaine and 4% articaine, respectively. Similarly, an additional IL injection of articaine success percent (78.9%) in the second molar region was higher than lidocaine (63.1%). The overall success ratio revealed no significant difference in achieving profound anesthesia of either solution. In this study population, there was no difference in the success ratio of anesthesia between 2% lidocaine and 4% articaine when used as supplemental IL injection.

The success of dental restorations depends mainly on the ability to bond to other filling materials and tooth substances, in order to resist the multitude of forces acting on the bond within the oral cavity. Although the shortcomings of composite resins have been significantly reduced over the past three decades, microleakage due to shrinkage under masticatory loads is unavoidable. In order to overcome such problems, two materials laminated with matched properties can be used to achieve optimum results. The sandwich technique is an approach in which dentine is replaced by glass ionomer cement (GIC), and enamel is replaced by composite resin. In the past, numerous materials have been proposed with adequate properties to be used in this manner, but the results are conflicting in terms of bonding to the various forms of GIC, and the appearance of microcracks or gap formation during functional loading. This study aimed to evaluate the shear bond strength (SBS) and mode of failure between the following core materials: composite resins (CR) (Methacrylate Z350™, Ceram X™, and Spectrum™) with a base material of glass ionomer cement (GIC, Ketac Molar™). Eight samples were made with the help of polytetrafluoroethylene sheets (TEFLON, Wilmington, DE, USA). Each sheet consisted of holes which were 4 mm in diameter and 2 mm in thickness. The combination of materials was sandwiched. The samples were stored in distilled water and then placed in an incubator for 24 h in order to ensure complete polymerization. The samples were thermocycled for 500 cycles between 5–55 °C/ 30 s. Following thermocycling, SBS testing was performed using a universal testing machine. Additionally, scanning electron microscopy (SEM) was performed on representative samples for the bond failure analysis between GIC and the composite resins. The Ceram-X™ nanocomposite showed significantly higher bond strength than Methacrylate Z350™ or Spectrum™ (p = 0.002). The Methacrylate Z350™ and the Spectrum™ composite specimens demonstrated a similar SBS (p = 0.281). The SBS of the Ceram X™ to GIC was the highest compared to Methacrylate Z350™ and Spectrum™. Therefore Ceram X™ may produce a better bond with GIC, and may protect teeth against recurrent caries and failure of the restoration. Methacrylate Z350™ is comparable to Spectrum™ CR and can be used as an alternative. A combination of adhesive and mixed failure was observed in Methacrylate Z350™ CR and GIC, while adhesive failure was predominantly found in both Ceram X™ and Spectrum™ with GIC restorations.

Titanium hypersensitivity is rare, but it may exist among patients who need dental implant treatment. It could contribute to mild or severe peri-implant tissue hypersensitivity reactions and affect patients’ oral and general health according to some clinical reports. In extreme cases, it may lead to implant failure or extraction. In this case report, a 64-year-old Caucasian female patient received a titanium implant placement on #5. Right after the implant placement, she reported the symptoms of pain, eczema, and slight extraoral swelling, along with significant burning sensation occurring intra- and extraorally. The symptoms were not released after the systemic intervention of antibiotics for six days. On retrieving her medical history, the patient reported a previous allergic reaction to jewelry-like earrings in her childhood. The diagnosis of titanium hypersensitivity was made based on the rapid onset of symptoms and her metal allergy history. Therefore, the dental implant was removed after diagnosis, and a bone allograft was used to preserve the alveolar bone volume. Immediately after implant extraction, the swelling and burning sensation were receded. A complete recovery was achieved three weeks later. The dimension of the alveolar ridge bone was found well maintained in 10 weeks follow-up visit. Conclusion. Rapid onset of peri-implant gingival swelling may indicate a hypersensitivity to titanium implant in the clinic. For patients with a history of allergy to jewelry, the hypersensitivity tests to titanium alloy such as patch test or lymphocyte transformation test should be recommended as part of the dental implant treatment plan.

Objective: To evaluate the effects of surface treatment and repair material on the repair shear bond strength (SBS) of the bioactive restorative material. Methods: A total of 240 Activa BioActive Restorative (Activa) discs were prepared, aged, and polished, and divided randomly into eight groups ( n = 30). Groups 1–4 discs were repaired with bulk-fill flowable resin-based composite (Bulk-RBC), and Groups 5–8 discs with Activa. Surface treatment used for each repair material type were air abrasion with silica-coated 30-m Al 2 O 3 particles (air abrasion) (Groups 2 & 6), Air abrasion with universal primer (Groups 3 & 7), and Air abrasion with universal adhesive (Groups 4 & 8). Groups 1 and 5 were controls without surface treatment. SBS test was performed, and the failure mode and surface topography were assessed. Results: Surface treatment with air abrasion significantly improved the SBS for repair using both Activa and Bulk-RBC. Repair SBS using Activa was significantly higher compared with Bulk-RBC. Cohesive failure in substrate and mixed failures were most common in the surface-treated groups (2–4, 6–8). Air abrasion produced prominent surface topography changes compared with polishing. Conclusion: Air abrasion enhances the repair SBS of aged bioactive restorative material. The use of the same material (Activa) for repair affords a higher bond strength compared with the use bulk-RBC.

Conventional osteotomy techniques can, in some cases, induce higher stress on bone during implant insertion as a result of higher torque. The aim of the present study was to evaluate and compare the stress exerted on the underlying osseous tissues during the insertion of a tapered implant using different osteotomy techniques through a dynamic finite element analysis which has been widely applied to study biomedical problems through computer-aided software. In three different types of osteotomy techniques, namely conventional (B1), bone tap (B2), and countersink (B3), five models and implants designed per technique were prepared, implant insertion was simulated, and stress exerted by the implant during each was evaluated. Comparison of stress scores on the cortical and cancellous bone at different time points and time intervals from initiation of insertion to the final placement of the implant was made. There was a highly statistically significant difference between B1 and B2 (p = 0.0001) and B2 and B3 (p = 0.0001) groups. In contrast, there was no statistically significant difference in the stress scores between B1 and B3 (p = 0.3080) groups at all time points of implant placement. Overall, a highly significant difference was observed between the stresses exerted in each technique. Within the limitations of our study, bone tap significantly exerted lesser stresses on the entire bone than conventional and countersink type of osteotomy procedures. Considering the stress distribution at the crestal region, the countersink showed lower values in comparison to others.

In recent years, CAD/CAM technology has allowed indirect ceramic restorations to become a part of everyday chairside clinical practice. Therefore, the impact of different cavity-preparation designs on the fracture resistance of CAD/CAM fabricated ceramics was assessed in this study. Three designs of cuspal covering (none, palatal, and entire) and two widths of the occlusal isthmus (75% and 100% of the intercuspal distance) were used for the preparation of inlays and onlays to form six groups (n = 10/group). Moreover, thermomechanical cyclic loading was applied to every tooth under a chewing simulator. A universal testing machine was used to measure each group's fracture resistance. The tested specimens were inspected for any signs of fractures and cracks to categorize failure patterns. Thereby, the values of fracture strength showed that there were statistically nonsignificant differences between the tested groups (p < 0.05). However, a significant difference (p = 0.01) was found between group 1 (inlays) (1950 ± 405) and group 6 (onlays) (3900 ± 770). Type III or type IV fracture modes were seen in the majority of the specimens. In conclusion, inlays and onlays made of zirconia using CAD/CAM technology were deemed reliable for restoring premolars, irrespective of the cavity-preparation design, except for inlays with a 75% intercuspal distance. [ABSTRACT FROM AUTHOR]