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Numerous surgical techniques have been developed as effective means to facilitate orthodontic treatment, but they may cause significant postoperative discomfort. Piezocision was established as a flapless and minimally invasive technique to accelerate orthodontic tooth movement by combining small vertical incisions and piezoelectric corticotomies. Computed tomography is combined with the Piezocision technique to fabricate CAD/CAM surgical guides to prevent iatrogenic damage. A method to combine computer-assisted dynamic navigation with Piezocision is introduced here. CBCT was combined with motion-tracking technology to allow real-time tracing of the piezoelectric instruments during the surgical procedure. This technique delivers the location of the piezoelectric knife in regard to roots and important anatomical structures to increase the safety and accuracy during corticotimies. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate four decontamination strategies utilizing enzymatic agents available in most clinical settings to determine (1) the amount of biomaterial that can be removed in a group of previously used healing abutments (uHAs) and (2) the degree to which the decontaminated HAs are capable of inducing an inflammatory response in vitro compared to new HAs. Materials and Methods: In total, 50 HAs were collected following 2 to 4 weeks of intraoral use and distributed randomly into five test groups (groups A-E; n = 10 per group). Group A used enzymatic cleaner foam and an autoclave. Group B used an ultrasonic bath with enzymatic cleaner and an autoclave. Group C used a prophy jet, enzymatic cleaner foam, and an autoclave. Group D used a prophy jet, an ultrasonic bath with enzymatic cleaner, and an autoclave. Lastly, group E used a prophy jet and an autoclave. The control group consisted of 10 new and sterile HAs. Residual protein concentration was determined by a Micro BCA protein assay (Thermo Fisher Scientific), while HAs from each group were stained with Phloxine B and macroscopically examined for the presence of debris. To examine the inflammatory potential, human primary macrophages were exposed to HAs, and supernatant levels of nine cytokine and chemokine profiles were analyzed using a multiplex bead assay. Results: All test groups showed differences in the degree of visual decontamination compared to controls. Groups D and E displayed the most effective surface debris removal and reduced protein concentration, while group A was the least effective. However, compared to controls, all test groups showed high levels of inflammatory cytokine secretion via multiplex assay for up to 5 days. Conclusions: Our study found that decontamination of uHAs utilizing enzymatic cleaners failed to reestablish inert HA surfaces and prevent an inflammatory immune response in vitro. Clinicians should not reuse HAs even after attempts to decontaminate and sterilize HA surfaces. [ABSTRACT FROM AUTHOR]

Surface contaminants on customized implant abutments could trigger an inflammatory response in the peri-implant tissues. The aim of this randomized controlled study was to assess the radiographic bone changes around implants restored with customized, platform-switched abutments, with and without autoclave treatment, 12 months after definitive restoration. Dental implants were placed 1 mm subcrestally in 64 systemically healthy patients (mean age: 63.3 ± 10.0 years; 31 patients had a history of periodontitis) to replace single or multiple missing teeth. According to a randomization list, abutments were subjected to steam and autoclave sterilization (43 implants, test group) or steam cleaning alone (44 implants, control group). Periapical standardized radiographs were taken at implant placement, prosthetic abutment connection, and 12 months after definitive cement-retained restoration. All implants were clinically stable without any sign of infection at the 12-month follow-up. An average marginal bone loss of 0.25 ± 0.19 mm was found in the test group compared to 0.35 ± 0.23 mm in the control group (no statistically significant difference), while the percentage of bleeding sites was significantly higher in the control group (8.7% ± 13.1% vs 19.1% ± 19.8%; P = .035). Autoclave treatment of customized abutments seems to reduce the inflammatory response around subcrestally placed implants. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to evaluate the polymerization efficiency of different bulk-fill resin-based composites cured by monowave and polywave light-curing units, by assessment of the degree of conversion and Vickers microhardness at different depths. Method and materials: Two commercially available bulk-fill resin-based composites were used: Filtek One Bulk Fill Restorative (3M ESPE) and Tetric N-Ceram Bulk Fill (Ivoclar Vivadent). The light-curing units utilized were two LED light-curing units: a monowave LED light-curing unit (BlueLEX LD-105, Monitex) and a polywave LED light-curing unit (Twin Wave GT-2000, Monitex). For each test, 20 cylindrical specimens (4 mm diameter, 4 mm thickness) were prepared from each bulk-fill resin-based composite using a split Teflon mold. Ten specimens were light-cured by the monowave light-curing unit and the other ten were light-cured by the polywave light-curing unit according to the manufacturer's recommendations. Attenuated total reflectance-Fourier transform infrared spectroscopy (ATRFTIR) was used to assess the degree of conversion, and a Vickers microhardness tester was used to assess Vickers microhardness. Statistical analysis was performed using three-way ANOVA and Tukey post-hoc tests (P < .05). Results: The degree of conversion and Vickers microhardness in bulk-fill resin-based composites containing only camphorquinone as photoinitiator were similar when cured with either monowave or polywave light-curing units. However, bulk-fill resin-based composites containing a combination of photoinitiators exhibited significantly higher degree of conversion and Vickers microhardness when cured with a polywave light-curing unit. Although all groups showed statistically significant differences between the top and bottom surfaces regarding degree of conversion and Vickers microhardness, all of them showed bottom/top ratios > 80% regarding degree of conversion and Vickers microhardness. Conclusion: The polywave light-curing unit enhanced the polymerization efficiency of bulk-fill resin-based composites especially when the latter contained a combination of photoinitiators, but does not prevent the use of a monowave light-curing unit. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of sonic oscillation on penetration depth and marginal adaptation of resin-based fissure sealants. Method and materials: Thirty-six extracted human third molars were randomized into three groups: in the HF group, teeth were sealed with a filled-resin-based sealant (Helioseal F); in the Sonic-HF group, teeth were sealed with Helioseal F and subjected to sonic oscillation (Compothixo Device, 140 Hz vibration frequency and ± 150 µm amplitude) before curing; in the CO group, teeth were sealed with an unfilled-resin-based sealant (Clinpro). All teeth were thermocycled for 1,500 cycles at 5°C and 55°C, then sectioned buccolingually into four sections (mesial, two middle, and distal). Sections were evaluated under SEM for marginal adaptation and scored. For penetration depth, three independent measurements from each tooth were recorded under SEM, and data were subjected to statistical analysis. Results: The group subjected to sonic oscillation (Sonic HF) resulted in significantly superior penetration depth and marginal adaptation compared with the HF group, but with no significant difference compared with the CO group. Conclusions: Sonic activation of resin-based sealant increased penetration depth into fissures and marginal adaptation to the enamel wall without decreasing filler load or compromising sealant mechanical properties. [ABSTRACT FROM AUTHOR]

Bariatric dentistry is the branch of dental medicine focused on preventive and comprehensive oral health care of overweight or obese patients. Obesity is an increasing US and international health problem and is a condition characterized by abnormal or excessive fat accumulation in the adipose tissue and is categorized by body mass index (BMI) according to the World Health Organization (WHO). With the increase of morbid obesity worldwide and the unfavorable effect on the overall health and life expectancy, it is necessary that proper accommodations are made for accessible dental care of this vulnerable population of patients. The following case report details the emergency and the subsequent elective dental treatment of a patient with a morbid obesity and demonstrates the importance of necessary equipment, a multidisciplinary approach, and broad networking communication needed to treat bariatric patients. The aim of the present case report was to bring awareness and start professional discussions on the importance of dental practitioners in the community and dental academic programs working together to assure access for primary oral health for bariatric patients. [ABSTRACT FROM AUTHOR]

Diode lasers are increasingly being utilized as an alternative to conventional soft tissue surgery. Diode lasers originally referred to wavelengths ranging from 810 to 980 nm, but a visible diode laser with a 445-nm wavelength has emerged as an additional wavelength for soft tissue surgery. The goal of this case series was to demonstrate the clinical results of both visible and nearinfrared (NIR) wavelengths when utilized for stage-two implant surgery. Ten patients with 23 implants were treated at Stony Brook University, Department of Periodontics and Endodontics and Faculty Practice, for implant uncovering using both visible and nonvisible (NIR) diode lasers. The uncovering was performed utilizing 445-, 970-, and 980-nm wavelengths at a power setting of 2 W in either continuous or pulsed modes. The fiberoptic tips were initiated using blue articulating paper. Either topical benzocaine or infiltration anesthesia was utilized prior to soft tissue removal with the initiated tip. All patients healed uneventfully without any postoperative complications. Visible and NIR diode lasers provide an alternative and safe method to uncover submerged implants at stage-two surgery. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of supragingival scaling on the clinical outcomes of subgingival instrumentation completed after 1 week. Method and materials: In 27 patients with Stage II and Stage III periodontitis, pairs of contralateral quadrants were randomly assigned into test group 1 (single sitting scaling and root planing) and test group 2 (supragingival scaling followed by subgingival instrumentation after lweek). Periodontal parameters were recorded at baseline, 2, 4, and 6months; Gingival crevicular fluid vascular endothelial growth factor (VEGF) estimation was done at baseline in both groups and 7 days after supragingival scaling in test group 2. Results: At 6 months, significantly better improvement in test group 1 at sites with periodontal probing depth (PPD)>5mm; (APPD = 2.32 mm vs 1.41 mm, P= .001; Aclinical attachmen level [CAL] = 2.34 mm vs 1.39 mm, P=.001) was observed. Supragingival scaling resulted in significant reduction in gingival crevicular fluid VEGF (42.46 to 27.88 pg/site) after lweek. Regression analysis explained 14% variance in VEGF to baseline PPD at sites with PPD>4 mm; and 21% variance in CAL improvement to VEGF at sites with PPD>5mm. The percentage of sites with PPD = 5 to 8 mm reachingthe clinical endpoint was 52% and 40%fortest group 1 and test group 2, respectively. Better results were noticed in bleeding on pocket probing-positive sites in both groups. Conclusion: The sites with PPD > 5 mm where supragingival scaling was followed by subgingival instrumentation after 1 weekresulted in less favourable treatment outcomes. [ABSTRACT FROM AUTHOR]

The article presents the results of our study of protective cermet coatings obtained by the method of electric spark alloying on a dental instrument (excavator) using SHS (self-propagating high-temperature synthesis) electrodes based on TiC-NiCr. The influence of discharge energy during electric spark alloying on the roughness, thickness, and proportion of the TiC carbide phase in the cermet coating has been established. It has been shown that during electric spark alloying, the material of the used SHS electrode and the surface of the substrate melt, their convective mixing occurs, and during crystallization, coatings are formed that consist of a strengthening phase TiC and iron-based solid solutions: Fe 9.64 Ti 0.36 , F 1.88 C 0.12 , and Cr-Ni-Fe-C. It has been found that the maximum size of TiC grains is formed on the surface of the cermet coating, and as they approach the substrate, their size decreases to less than 10 nm. It has been found that the microhardness of the surface of the resulting cermet coatings increased to 6.2 times compared to the microhardness of the original metal base, which was 2 GPa. The results of scanning electron microscopy and energy dispersive analysis of the surface of samples with and without cermet coating before and after corrosion tests are presented. The influence of disinfectants (2 and 100 % Trilox, Wendelin, MegaDes-ortho) on the corrosion resistance of samples with and without developed protective cermet coatings at room and elevated temperatures up to 50 °C and their exposure for 120 h has been established. [ABSTRACT FROM AUTHOR]

Background: Nickel titanium (NiTi) rotary files have drastically altered the treatment protocol in endodontics, allowing for faster and easier preparation and more thorough irrigation of the root canal system. Despite the advantages of the NiTi files, instrument separation still remains a major concern. The aim of this study was to compare the cyclic fatigue resistance of three different single-file NiTi systems after clinical use: WaveOne Gold (WOG, Dentsply Maillefer, Ballaigues, Switzerland), One Curve (OC, Micro Mega, Besancon, France), and Reciproc Blue (RPC Blue, VDW, Munich, Germany). Methods: A total of 120 patients requiring endodontic treatment to first or second mandibular molars, were randomly divided into three groups (patient n = 40) and root canals were prepared with WOG, OC or RPC Blue. Each group consists of 2 subgroups: first use (file n = 10, patient n = 10) and third use of file (file n = 10, patient n = 30). In control group, files were subjected to cyclic fatigue test without use (file n = 10). Cyclic fatigue resistance of files was assessed by groove method. The data was evaluated by two-way ANOVA, Games & Howell post hoc and Weibull reliability analyses (p <.05). Results: RPC Blue files showed the highest failure time value in all groups. In third use group, OC and RPC Blue files showed significantly higher failure time values compared to WOG files (p <.05). In general, RPC Blue files show the highest values in terms of number of cycles to fracture (NCF) in all groups, while OC and WOG files follow RPC Blue files respectively. There was statistically significant difference among groups considering the fragment length (p <.05). Conclusions: Within the limitations of this study, RPC Blue files exhibited highest cyclic fatigue resistance after clinical use. [ABSTRACT FROM AUTHOR]

Background: An Oral irrigator, known as a dental waterjet (DWJ), is an adjunctive oral hygiene tool to remove dental plaque. The aim of this study was to systematically evaluate the effectiveness of oral irrigators on orthodontic patients' oral hygiene and periodontal status. Methods: A comprehensive search was undertaken in five electronic databases (PubMed, EMBASE, Web of Science, Scopus, and Cochrane) up to 1 May 2024. Clinical trials comparing DWJ with other adjunctive tools or no adjunctive in healthy orthodontic patients were included. The outcome was periodontal health condition measured by periodontal indexes. The risk of bias of the included studies was assessed using the Cochrane risk of bias tool. Random- effects meta- analyses of mean differences (MD) with their 95% confidence intervals (CI) were conducted and the overall quality of evidence was evaluated by GRADE approach. Results: Seven trials were included in the meta-analysis (Two with low, and others with unclear risk of bias). There was no statistically significant difference between automatic toothbrush (ATB) with DWJ and ATB alone in the gingival index (GI) (MD = 0.00; 95% CI -0.17- 0.18) (low quality of evidence). No statistically significant differences were found between (ATB + DWJ) and manual toothbrush (MTB) alone in the GI (MD= -0.11; 95% CI -0.31- 0.09) (very low quality of evidence). Also, no significant difference was detected between the two groups in the Plaque index (PI) (MD= -0.12; 95% CI -0.36- 0.11) (very low quality of evidence). There was no statistically significant difference between (MTB + DWJ) and MTB alone in the GI (MD= -0.06; 95% CI -0.16- 0.03) (very low quality of evidence). No statistically significant differences were revealed between the two groups in the PI (MD= -0.33; 95% CI -0.97- 0.32) (very low quality of evidence). No statistically significant improvements were found between these two groups in bleeding index (BI) (MD= -0.05; 95% CI − 0.12 − 0.01) (low quality of evidence). Conclusions: Adding DWJ to either manual or automatic toothbrushes did not significantly enhance oral health of orthodontic patients. Orthodontists could recommend their patients to use either of these toothbrushes with or without DWJ. Further clinical trials are needed. Trial registration number: The protocol of this study was registered on PROSPERO with the ID # CRD42023465849. [ABSTRACT FROM AUTHOR]

Objectives: The purposes of this study were to classify the described digital facebow techniques for transferring the maxillary cast into the semi‐adjustable virtual articulator based on the digital data acquisition technology used and to review the reported accuracy values of the different digital facebow methods described. Overview: Digital data acquisition technologies, including digital photographs, facial scanners, cone beam computed tomography (CBCT) imaging, and jaw tracking systems, can be used to transfer the maxillary cast into the virtual articulator. The reported techniques are reviewed, as well as the reported accuracy values of the different digital facebow methods. Conclusions: Digital photographs can be used to transfer the maxillary cast into the virtual articulator using the true horizontal reference plane, but limited studies have assessed the accuracy of this method. Facial scanning and CBCT techniques can be used to transfer the maxillary cast into the virtual articulator, in which the most frequently selected references planes are the Frankfort horizontal, axis orbital, and true horizontal planes. Studies analyzing the accuracy of the maxillary cast transfer by using facial scanning and CBCT techniques are restricted. Lastly, optical jaw trackers can be selected for transferring the maxillary cast into the virtual articulator by using the axis orbital or true horizontal planes, yet the accuracy of these systems is unknown. Clinical Implications: Digital data acquisition technologies, including digital photographs, facial scanning methods, CBCTs, and optical jaw tracking systems, can be used to transfer the maxillary cast into the virtual articulator. Studies are needed to assess the accuracy of these digital data acquisition technologies for transferring the maxillary cast into the virtual articulator. [ABSTRACT FROM AUTHOR]

Medical emergencies, though rare, may occur unpredictably in a dental office during or after dental procedures. It may occur accidentally or subsequent to systemic problems of patients. These series of clinical events entail instantaneous management to evade any potential consequences. Basic life support measures require sufficient knowledge, expertise, skills, and equipment. Several medications and equipment are necessary to be available for immediate reach in any dental office. Health authorities of different countries usually propose these lists to dental practitioners. However, the best emergency kit is the one, which is arranged and maintained by the dentists based on their needs and easily accessible for immediate use. Considering the importance of this subject and the results yielded from the regular visits of the Dental Supervision Department (Vice Chancellor for treatment of Shiraz University of Medical Sciences) to the dental centers of Shiraz in the spring and summer of 2023, we decided to recall the importance of emergency medicines and equipment through a brief communication. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Root canal preparation with rotary files causes dentinal cracks in root canals of primary teeth affecting their longevity. Purpose: Nickel-titanium rotary files have been widely used for root canal preparation in primary teeth. The present study compared occurrence of dentinal microcracks in root canals of extracted primary molar teeth prepared using Hedstrom (H) files, ProTaper Universal rotary files, and ProTaper Next rotary file systems. Materials and Method: In this in vitro experimental study, 80 primary molar mesial root canals were randomly divided into four groups of 20 canals each (n=20). Group I was prepared with H files. Group II was prepared with ProTaper Universal rotary files using shaping files SX and S2. Group III was instrumented with ProTaper Next rotary files X1 and X2 while Group IV was left unprepared and served as control. Roots were stained with 1% methylene blue solution and sectioned perpendicular to the long axis at 2mm, 4mm, and 6mm from the apical foramen. Slices obtained were examined under the stereomicroscope. Data obtained were subjected to statistical analysis using chi square tests. Results: Dentinal microcracks were observed in groups prepared using H files, ProTaper Universal, and ProTaper Next rotary files. Highest percentage of cracked root canals (20%) was seen in Group I, prepared by H files. These cracks were complete in nature, found in apical sections and statistically significant (p= 0.016). Group III prepared with ProTaper Next showed 10% dentinal cracks, followed by ProTaper Universal group with 5% cracked root canals. Conclusion: H files may be considered more aggressive at apical third due to complete cracks produced. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate access to dental care for children in the United States. Methods: The study population included children in 48 states and the District of Columbia. Using multiple data sources, dental care access was estimated at the community level by matching dental care supply and demand using mathematical modeling accounting for access constraints. Outcome measures included percent‐met demand, travel distance, and percentage of underserved and unserved communities. Multiple scenarios to improve Medicaid/CHIP participation of dentists were evaluated. Results: Medicaid‐insured and CHIP‐insured children exhibited lower access compared to those privately insured. The percent‐met demand was lower than 50% for Medicaid‐insured children and CHIP‐insured children for 42 and 34 states, respectively. Percent‐met demand was higher than 50% for private‐insured children except for Texas and West Virginia. Increasing Medicaid/CHIP participation of dentists resulted in improving access for public‐insured children. At 100% Medicaid/CHIP participation, all states exhibited different degrees of percent‐met demand increase for publicly insured children, from 7% to 46%. The percent‐met demand across all children ranged in 23.8%–82.9% under 70% participation rate versus 22%–83% under 100% participation rate. No single participation rate improved access for all children uniformly across all states. Conclusions: This study found that dental care access was lower for children with public insurance than those with private access across all states, although states responded differently to changes in Medicaid/CHIP participation. Increasing access for children with public insurance would reduce disparities, but overall children's access to dental care would be better improved by expanding the oral health workforce. [ABSTRACT FROM AUTHOR]

Aim Methodology Results Conclusions To assess the regulation of sodium hypochlorite (NaOCl) solutions for endodontic usage in some of the world's main dental markets, in view of the European Union's recent move to classify antimicrobial root canal irrigants as high‐risk devices under their Medical Device Regulation (MDR).The authors consulted legal texts available online and communicated with local health authorities wherever necessary to assess into which medical device category NaOCl solutions intended for endodontic application were subsumed. Furthermore, it was investigated whether there were sources outside the dental market to obtain NaOCl solutions for root canal treatments.Upon completion of this text (mid 2024), NaOCl solutions for root canal irrigation had not been classified in the US and Canada, whilst in the European Union, they had just been upgraded to high‐risk medical devices, with all the consequences for the dental supply market. This MDR rule was adopted by the EU's close trading partners, the United Kingdom, Switzerland and Turkey. In Japan, the legal hurdles were already high for manufacturers and importers of endodontic NaOCl solutions. Conversely, in China, these solutions were down‐graded from a high‐risk to a medium‐risk status in 2017. A low‐medium risk category was applied in the other countries under investigation, that is, Australia, India and Brazil. In some countries there was a possibility for dentists to procure plain NaOCl solutions from pharmacies. An alternative route to avoid buying NaOCl from dental suppliers was to use (household) bleach solutions for root canal irrigation wherever this practice was not prohibited explicitly.The legal situation to produce, import and use NaOCl solutions for root canal irrigation differs vastly around the globe. A sensible approach to regulate (yet not over‐regulate) endodontic NaOCl solutions appears to be timely and necessary. [ABSTRACT FROM AUTHOR]

Objectives: Dental clinics are one of the major producers of mercury-containing waste due to the use of dental amalgam. The atmospheric transport and persistence of mercury and its compounds in the environment, coupled with their high potential for bioaccumulation and detrimental effects on human health and ecosystems, underscore the necessity for effective management of mercury waste. Due to the lack of comprehensive and integrated guidelines for the effective management of dental amalgam waste in Iran, the objective of this study was to adapt a guideline for the management of amalgam waste in dental settings within the country. Materials and Methods: The method used was based on the adaptation principles presented by the Ministry of Health and Medical Education, and included searching and reviewing guidelines related to the management of amalgam waste in developed countries, extracting recommendations, revising the recommendations considering the local infra-structures and conditions, and receiving expert opinions and reaching consensus according to the RAND/UCLA Appropriateness Method. Results: The final guideline includes 34 recommendations in 5 areas: management of the amalgam scraps, considerations for dental equipment, management of the extracted teeth containing amalgam restorations, management of the amalgam capsules, and considerations for placement and replacement of the amalgam restorations. Conclusion: The use of this guideline in medical universities, public and private dental clinics, along with the supervisory role of the Ministry of Health and Medical Education, can be a way to minimize the environmental hazards of mercury. [ABSTRACT FROM AUTHOR]

Introduction Aims Methodology Results Conclusion Competency in endodontic access cavity preparation requires key motor skills, good conceptual understanding, along with an appreciation of 3‐dimensional pulp chamber anatomy. These are traditionally learned using natural or artificial teeth (AT) mounted within a phantom head (PH). Simodont® (Nissin Dental Products INC, JPN) is a haptic virtual reality simulator (HVRS) and offers an alternative to AT for training.This study aimed to (1) evaluate the evolution in the performance of learners trained to prepare access cavities incorporating Simodont (test group) against learners trained on AT mounted within PH (control group), (2) determine learner acceptability of HVRS.Forty dental students, with no prior endodontic training, were given instruction and video demonstration of access cavity preparation using a mandibular left 1st molar AT (LL6). Thereafter, they prepared an access cavity on PH mounted AT LL6. This provided a baseline record of performance. Participants were randomly assigned to the test or control groups. The test group (n = 22) trained using Simodont: preparing a virtual tooth LL6 for a period of 60 minutes with instructor feedback. The control group (n = 18) trained using AT LL6 on a PH for 60 minutes with instructor feedback. Subsequently, learners from both groups prepared an access cavity on an AT LL6 in a PH. This provided a re‐evaluation record. Two calibrated examiners graded the teeth from the baseline and re‐evaluation using rubric criteria; assigning scores with a grading range from 0 to 17. The examiners were blinded to which group the teeth belonged. Change in performance was determined by calculating the difference in assessment grade from baseline to re‐evaluation. Scores which improved by 3 or more units were labelled improvers, all other scores were described as non‐improvers.Within the test group, the numbers of improvers were 5 (23%) versus 7 (39%) in the control group The difference failed to indicate statistical significance (p = .315). The Cohen kappa values for intra and inter‐examiner agreement were 1.00 and 0.73 respectively.The evolution of skills in learners trained using Simodont is comparable to those trained using AT. It is, therefore, reasonable to use Simodont, which was acceptable to learners, as an adjunct to AT for endodontic access cavity training. [ABSTRACT FROM AUTHOR]

Background and Aims: The present investigation was conducted on the evaluation of the microstructure, phase transformation behavior, mechanical properties, and fatigue resistance of nickeltitanium rotary endodontic files. The main purpose of this investigation was to find the effect of microstructural parameters on the performance of these files. Materials and Methods: Three rotary tools with brand names Denco, Edgeendo, and Eighteeth were studied. To evaluate the microstructure and transformation behavior of tools, metallography, X-ray diffraction, and differential scanning calorimetry methods were used. The bending test was used to check the behavior of superelasticity and memory and the microhardness test was used to evaluate the hardness of the samples. Also, cyclic fatigue behavior in a mold containing a simulated tooth canal was investigated and calculated by parametric statistical analysis. The fracture surface of the samples was also studied by scanning electron microscope. Results: Analyses revealed the existence of a high volume fraction of R phase in the microstructure of the Edgeendo file. Rotary files with higher volume fraction of martensitic phase showed higher shape memory effect and fatigue resistance. Denco and Edgeendo rotary files with better surface quality and high volume fraction of martensitic phases in the microstructure showed better fatigue resistance compared with the Eighteeth file. In all the results, the P-value was less than 0.05. Conclusion: Multiphase microstructure containing austenite and martensite together with appropriate phase transformation and hardness of the alloy have key roles on functional properties of rotary files. This study provides dentists with a deeper understanding of the fatigue behavior and mechanical properties of these files, enabling them to make more informed decisions in choosing the appropriate instruments for endodontic treatment. [ABSTRACT FROM AUTHOR]

Background: The main goal of management of the mandibular fracture is to obtain the pre-injury contour of the bone and pre-injury occlusion as well as regain function early. For Parasymphyseal fractures, the ideal fixation method is still debatable. It could range from rigid to semi-rigid fixation. The current study aimed to compare the clinical and radiographic effect of two miniplates, 2.3 high-profile Miniplates, and three-dimensional (3D) Miniplates for internal fixation treatment of mandibular para-symphyseal fractures. Methods: The study reviewed 240 medical records, dividing 60 patients into three treatment groups: Group I (25 patients received 2.0 mini plates), Group II (22 patients received 2.3 high profile miniplate), and Group III (13 patients received 3D miniplate). Data included demographics, fracture diagnosis, radiographs, maxillomandibular fixation use, surgical time, intervention, postoperative stability, and complications. Results: The present study included 60 patients with mandibular parasymphyseal fractures, divided into three treatment groups: Group I (n = 25, 41.67%), Group II (n = 22, 36.67%), and Group III (n = 13, 21.67%). The study found no significant differences in age and sex distribution among the three groups, but the mean surgery time varied significantly. Group II had the highest rate of complications at 22.73%, followed by Group I at 20% and Group III at 7.69%. Conclusion: In conclusion, the (3D) Miniplates could provide better internal fixation treatment of mandibular para-symphyseal fractures in terms of easy use, short surgery time and less complication such as malocclusion and infection. [ABSTRACT FROM AUTHOR]

Background: Using infection control barriers (ICBs) on light curing units (LCUs) became mandatory to achieve proper infection control measures without jeopardizing the integrity of the restorations, especially at deeper layers. This study explored the effect of two ICBs on the irradiance of the LCU, as well as the degree of conversion (DC) and flexural strength (FS) of two types of bulk-fill composites. Water vapor permeability (WVP) of both barriers was also assessed to evaluate the capability of such barriers to prevent transmission of blood and saliva droplets and aerosols. Methods: Two bulk-fill composites (X-tra fil and Tetric N- ceram) and two ICBs (Pinnacle Cure sleeve and Sanita wrapping film) were used in this study. Light irradiance was recorded per experimental condition using spectroradiometer. For DC and FS, specimens of 4 mm thickness were prepared. Each specimen was composed of two separable upper and lower layers of thickness 2 mm. DC and FS were measured using Infra-red spectroscopy and three-point loading test respectively. WVP was investigated using the cup method. Means and standard deviations were calculated, and the data were statistically analyzed using factorial analysis of variance test (α = 0.05). Results: Light irradiance showed highest values using no ICBs and lowest values using Pinnacle curing sleeve. Both bulk-fill composites showed higher DC mean values without ICBs and when using Sanita wrapping film for both upper and lower layers of the specimens compared to Pinnacle curing sleeve. The upper layers of composite specimens showed higher DC compared to lower layers for all experimental conditions. Both ICBs had no adverse effect on FS of both composites' upper layers. Pinnacle sleeve significantly reduced FS of both composites' lower layers. X-tra fil showed higher DC and FS compared to Tetric N-Ceram for all experimental conditions. Regarding WVP; the wrapping film showed higher WVP compared to the curing sleeve. Conclusions: Sanita wrapping film can be used as a successful ICB, without jeopardizing the concept of bulk-fill composites. Pinnacle cure sleeve can be considered an effective ICB, however its influence on properties and serviceability of bulk-fill composites remains questionable. [ABSTRACT FROM AUTHOR]

Today, dental tourism is regarded as one of the most important tourist industries due to its high demand and financial transactions. Sustainable development has become increasingly important because of the depletion of natural resources, health problems, and waste management. Contrary to the previous works, we firstly develop a multi-objective mathematical model seeking to reach and optimize sustainable objectives in the dental tourism supply chain. To achieve these aims, optimal locations of dental clinics and accommodation facilities and their required number and capacities are found. Besides, transportation activities and waste treatment facilities are optimized based on supply and demand. Biological risks, job vacancies creation, environmental issues, and costs and profits are considered in our work. Also, an improved goal programming is employed to solve the model. In addition, this model is implemented and analyzed by a real case study of the dental tourist industry to validate the proposed model. The government and practitioners of private sectors would derive great benefits from the real case outputs to build a thriving business from sustainable perspectives. [ABSTRACT FROM AUTHOR]

Objective: The aim of this randomized controlled trial was to assess clinical and patient reported outcomes of subgingival instrumentation (SI) with adjunctive use of diode laser (DL) versus SI alone in the treatment of periodontitis. Methods: Participants requiring non‐surgical periodontal treatment were randomly allocated into two treatment groups: SI with DL or SI alone. Clinical parameters [full mouth bleeding and plaque scores (FMBS and FMPS), probing pocket depth and clinical attachment level] were recorded at baseline, three and 6 months post‐treatment. Visual analogue scale was used to evaluate postoperative participants' perception of pain, swelling, bleeding, bruising and root sensitivity. The impact of periodontal treatment on quality of life was assessed using the General Oral Health Assessment Index (GOHAI) at 6 months. Results: A total of 22 participants with stage III/IV periodontitis completed the 6‐month follow‐up. SI with or without DL resulted in statistically significant reduction in FMBS, FMPS, PPDs, and percentage of PPDs of ≥5 mm at 3‐ and 6‐month follow‐up visits (p = 0.001 to <0.001). The participants in SI/DL group had a greater reduction in the percentage of deep PPDs (≥5 mm) compared to those receiving SI alone, but statistically significant differences between the two groups were not observed (16.40 ± 9.57 vs. 32.50 ± 38.76 at 3 months and 7.20 ± 6.86 vs. 19.50 ± 35.06 at 6 months). The difference in the mean total GOHAI scores was not statistically significant at 6 months with total GOHAI scores of 7.25 ± 2.45 and 5.40 ± 3.06 for SI and SI/DL groups, respectively. Conclusion: Within the limitations of this study, the use of DL as an adjunct to SI in the treatment of stage III/IV periodontitis did not produce significant additional improvement in clinical parameters or patient reported outcomes in the 6‐month observation period. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the temperature rise, time consuming and cut quality of apicectomy using three different methods. Materials and methods: Twenty-four single-rooted teeth were collected and divided into four groups operating apicectomy with a NINJA tip of a piezoelectric device (G1), a diamond bur with 300,000 rpm (G2), and Er: YAG laser at 200 mJ/ 30 Hz (G3) as well as 250 mJ/ 30 Hz (G4). The temperature elevation and time were recorded and the cut quality was evaluated via stereomicroscope and scanning electronic microscopy (SEM). Results: The temperature increases for G1 was significantly higher than for G2. However, there was no significant difference between G1 and G2 with laser groups respectively. The median time for apicectomy was: 100.14s for G1, 22.65s for G2, 33.58s for G3, and 21.80s for G4. G1 is the most time-consuming group and there was no statistically significance in the comparisons with G2, G3 and G4. Cut quality was assessed by crack occurrence, smear layer formation and dentinal tubules exposed. The percentage of cracked teeth in G1 and G2 was 33.33% and for laser groups the percentage was 16.67% each. SEM showed that no smear layer formed and almost all dentinal tubules were exposed on resected surfaces for G3&G4, surfaces from G2 were partly covered by smear layer, and surfaces from G1 were fully covered by smear layer and with no dentinal tubules exposed. Conclusions: Er: YAG laser and conventional rotary instruments were safe and efficient for apicectomy and with a better cut quality when compared with piezoelectric equipment. Er: YAG laser could be a promising technique for apicectomy and further studies are necessary, especially larger sample in vivo investigations, to verify the feasibility of Er: YAG laser in endodontic surgery. [ABSTRACT FROM AUTHOR]

Salvia dumetorum essential oil (SDEO) was obtained using a Clevenger apparatus by hydrodistillation approach. The chemical composition of the essential oil was determined by GC-MS analysis. In this study SDEO was screened for its antibacterial activity against Staphylococcus aureus, Bacillus subtilis, Escherichia coli, and Candida albicans and the amount of biofilm formed by Streptococcus mutans bacteria. For the first time the chemical composition of SDEO growing in Central Kazakhstan was established. The results obtained from GC-MS showed the predominance of sesquiterpenoids (54.15%). The antibacterial study results showed that SDEO exhibited strong antibacterial activity against B. subtilis and S. aureus in vitro and also demonstrated an inhibitory effect on S. mutans biofilm formation on 1% sucrose medium. During the study, no antibacterial activity was detected against E. coli and C. albicans. These results demonstrated that SDEO can be used in the development of new antibacterial and anti-caries therapeutic dental products. [ABSTRACT FROM AUTHOR]

The ongoing conflict in Sudan has severely disrupted the health professions education, notably in dentistry. This study aims to explore the impact of the armed conflict on dental education and training. A mixed-method cross-sectional study encompassed 29 dental schools in Khartoum, Darfur, Kordofan States, and Merowe City. Five key informants from the Sudanese Medical Specialization Board, the Human Resource Development Administration, and a university offering clinical dental master's programs were interviewed. Quantitative data on attacks against dental schools were collected through a structured Google form, and qualitative data on postgraduate training were obtained through semi-structured key informant interviews. Findings reveal that 79.3% of dental schools faced military assaults, with 73.9% experiencing looting and 60.9% repurposed as military bases. Notably, 44.8% of schools shifted to online education,3.4% collaborated with other universities, and 27.6% adopted a combined approach. Key informants' interviews unveiled disruptions in specialty training and housemanship, limiting access to crucial training facilities. The primary proposed solution was overseas training. Recurrently emphasized strategies to enhance the resilience of the training system included establishing dental centers in all states, collaborating with external training bodies, and anticipating and preparing for potential disasters. The adverse effects of the conflict on both undergraduate and postgraduate dental education are discernible, manifested through resource limitations, a shortage of dental materials and supplies within training facilities, and direct disruptions to clinical training due to attacks on healthcare institutions. The imperative need for urgent interventions is underscored to alleviate these consequences and safeguard the continuity of educational and training efforts. [ABSTRACT FROM AUTHOR]

Introduction: Children often experience anxiety and behavioural issues when exposed to dental stimuli such as the sight, sound, and sensation of the airotor. Behaviour modification techniques that involve familiarising children with dental equipment and procedures can help reduce this anxiety. Aim: To evaluate the effectiveness of three behaviour management techniques: Tell-Show-Do (TSD), Tell-show-play-do (TSPD), and a smartphone dental game application in managing Dental Fear and Anxiety (DFA) in children aged 4-8 years. Materials and Methods: This randomised clinical study included 60 children aged 4-8 years who required Class-I restorations (ICDAS Code 2 and Code 3) in maxillary or mandibular molars. Participants were randomly assigned to one of three groups: TSD (n=20), TSPD (n=20), or the smartphone dental game app (n=20). Preoperative anxiety levels were assessed using the Children's Fear Survey Schedule Scale-Dental Subscale (CFSSDS). Anxiety levels were evaluated pre- and postoperatively using the Modified Child Dental Anxiety Scale (MCDAS-f) and the Visual Analogue Scale (VAS). Physiological parameters, including pulse rate and SpO2 levels, were measured before and after treatment. Statistical analyses included paired t-tests for pulse rate, Wilcoxon signed-rank tests for VAS and MCDAS-f scores, Kruskal-Wallis tests for intergroup comparisons, and one-way ANOVA with Bonferroni post-hoc tests. Data were analysed using SPSS version 27.00. Results: The TSPD group exhibited a significantly greater reduction in dental anxiety compared to the TSD (p=0.01) and smartphone dental game groups (p=0.05), as evidenced by MCDAS-f (p<0.001) and VAS scores (16.7%). Physiological parameters indicated significant changes in the TSPD group, with a notable decrease in pulse rate post-treatment (p=0.014) and the lowest mean SpO2 level (96.55). One-way ANOVA with Bonferroni post-hoc tests confirmed significant anxiety reduction in the TSPD group both before (p=0.048) and after treatment (p=0.009). The Wilcoxon signed-rank test demonstrated a substantial decrease in DFA, with 16.7% of children in the TSPD group no longer experiencing anxiety post-intervention (p<0.001). These findings underscore the superior efficacy of the TSPD technique in managing DFA. Conclusion: Among the three techniques, the TSPD technique was the most effective overall, while the TSD technique was the least effective. It is crucial for paediatric dentists to employ child-friendly and pain-free methods to improve children's behaviour during dental treatments. [ABSTRACT FROM AUTHOR]

Background/Aim. The most important moment in modern endodontics is the inclusion of rotating instruments made of nickel-titanium alloy in daily clinical work, which have supplanted stainless steel instruments due to their superior properties. The aim of this study was to investigate the influence of autoclave sterilization on cyclic fatigue (CF) in two types of rotating instruments produced by M-wire technology with different types of rotation. Methods. This research included two types of M-wire rotary instruments -- 48 ProTaper Next® instruments with full rotation and 48 WaveOne® Gold instruments with reciprocating rotation. Each of the two groups of instruments was divided into four additional groups of 12 instruments depending on the number of cycles of sterilization in the autoclave. The instruments were tested in an artificial canal with a 2 and 5 mm radius of curvature. Results. Statistically significantly higher resistance to CF was observed with WaveOne® Gold compared to ProTaper Next® (p < 0.001) instruments, both in the non-sterilized group and after their exposure to the first, third, and fifth cycle of sterilization. The third and fifth cycle of sterilization significantly reduced resistance to CF in the WaveOne® Gold (p < 0.001) group. There was no statistically significant difference in CF resistance between sterilized and non-sterilized instruments of the ProTaper Next® group. Conclusion. Sterilization in an autoclave for instruments based on M-wire technology did not increase resistance to CF. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the completeness and accuracy of information in LCU instruction manuals from 40 manufacturers. Materials and Methods: Instruction manuals from 40 LCUs (20 from leading manufacturers and 20 budget units) were reviewed. Twenty‐eight parameters across five categories were assessed using a binary scale (0=incorrect/missing, 1=correct). The categories and their respective evaluation scores were: LCU characteristics (43%), instructions for use (7%), safety precautions (14%), maintenance recommendations (29%), and regulatory certification (7%). These scores were combined to produce a final score. Results: Scores from leading manufacturers ranged between 46‐86%, while the budget category ranged from 18‐68%. All manuals provided information about the wavelength/spectrum of the LCU. Only Valo X and Valo Cordless reported power values and used the term "irradiance" instead of "intensity." Details such as LED type and active tip emission area were often missing. Instructions on how to use the LCU to photo‐cure resins were frequently limited. Although most manuals addressed safety precautions, several lacked details on heat issues and general health precautions. All manuals included maintenance instructions, though information on replacement parts was often missing. Among the LCUs, 85% stated they were CE certified, 32% held both FDA and CE certification, and 63% claimed compliance with ISO and/or IEC standards. Conclusions: There were notable differences in the completeness and accuracy of the instruction manuals. Manuals from major manufacturers generally provided more comprehensive information than their budget counterparts. Clinical Significance: Instruction manuals should contain accurate information to help clinicians deliver the highest standard of care. The lack of important information about the LCUs in the manuals is concerning. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of the deterioration of computer aided design/computer aided manufacturing (CAD/CAM) burs during zirconia milling, on surface roughness, contact angle, and fibroblast viability. Materials and Methods: Ceramic blocks were milled and 75 ceramic disks (8 × 1.5 mm) made and allocated into three groups (n = 25): G1‐brand new 2L and 1L burs, G2‐2L bur at the end of lifetime and brand new 1L bur and G3‐both burs at the end of their lifetimes. Roughness (Ra, Rq, and Rz) was evaluated using a 3D optical profilometer, the contact angle by the sessile drop method and the cell viability of the mouse NIH/3T3 fibroblast, using the Alamar Blue assay at intervals of 24, 48, and 72 h (ISO 10993‐5). Data were analyzed by one‐way ANOVA and Kruskal–Wallis tests (p ≤ 0.05). Results: Roughness increased as the burs deteriorated and G3 (0.27 ± 0.04) presented a higher value for Ra (p < 0.001). The highest contact angle was observed in G3 (86.2 ± 2.66) when compared with G1 (63.7 ± 12.49) and G2 (75.3 ± 6.36) (p < 0.001). Alamar Blue indicated an increase in cell proliferation, with no significant differences among the groups at 24 and 72 h (p > 0.05). Conclusions: The deterioration of the burs increased the surface roughness and decreased the wettability, but did not interfere in cell viability and proliferation. Clinical Significance: The use of custom zirconia abutments represents an effective strategy for single crowns restorations. Our findings suggest that these abutments can be efficiently milled using CAD/CAM burs within their recommended lifetime. [ABSTRACT FROM AUTHOR]

Hydroxyapatite (HA) forms an essential constituent of human teeth and bone. Its distinctive characteristic features, such as bioactivity and osteoconductivity, make it an ideal candidate to be used as an implant coating in restorative dentistry and maxillofacial surgery for bone regeneration. However, low fracture toughness and brittleness are a few of the inherent features of HA, which limit its application in load-bearing areas. The potential of HA to engage its lattice structure with either partial or complete substitution with external ions has become an increasing area of research as this phenomenon has the potential to enhance the biological and functional properties of the material. Consequently, this review aimed to highlight the role of various substituted ions in dental applications. Data indicate that the newly formed HA-substituted biomaterials demonstrate enhanced remineralization and antimicrobial activity along with improved hardness. Ion-substituted HA offers a promising strategy for future clinical research as these materials may be incorporated into various dental products for therapeutic treatments. [ABSTRACT FROM AUTHOR]

Background: Self-adhesive resin cements (SARCs) are widely used for fixed prostheses, but incomplete cleaning near the gingival margin can cause inflammation. However, the factors influencing cement properties and the biological response of gingival fibroblasts to cement eluates are not well understood. This study examines the impact of two light-polymerizing units (LPUs) on the physical and chemical properties of two SARCs under simulated clinical conditions, as well as the subsequent response of human gingival fibroblasts (hGFs) to these eluates. Methods: Dental cement discs of SARCs were polymerized using Kerr DemiPlus and 3 M Elipar DeepCure-S LED LPUs with or without a 2-mm thick zirconia screen. Physical properties (microhardness, surface roughness, residual monomers) were evaluated. hGFs' cell viability, wound healing potency, and gene expression were assessed. Results: Both Maxcem and RelyX exhibited reduced microhardness and increased surface roughness when polymerized through zirconia or with DemiPlus LPU. Higher residual monomers (HEMA and GDMA in Maxcem; TEGDMA in RelyX) concentration was observed with DemiPlus and zirconia polymerization. Maxcem polymerized with DemiPlus exhibited lower cell viability, impaired healing, and altered gene expression in hGFs compared to those polymerized with Elipar LPU. Gene expression changes included downregulated NRF2 and HO-1 and upregulated CCR-3. Conclusions: Light-polymerizing Maxcem through zirconia with DemiPlus LPU compromised SARCs' properties, leading to higher residual monomers and negatively impacting hGFs' viability, healing, and gene expression. Careful material selection and polymerization techniques are crucial to minimize adverse effects on surrounding tissues. Clinical significance: Clinicians should exercise caution when using LPUs and SARCs, especially when polymerizing through zirconia. This will help optimize the physical and chemical properties of SARCs and minimize potential adverse effects on the surrounding gingival soft tissues. [ABSTRACT FROM AUTHOR]

Introduction: Endodontic treatment errors (EEs) can lead to complications and require additional follow- up care. This study aimed to investigate the prevalence of root canal treatment errors among dental students, identifying error types based on radiographic criteria, tooth type, location, and technical errors. Materials & Methods: A cross-sectional study analyzed data from 201 patients who underwent root canal treatment at Ilam University of Medical Sciences between 2021 and 2022. Inclusion criteria were confirmed root disease diagnosis, adherence to standard treatment protocol, availability of radiographs, and complete patient files. The protocol included rubber dam isolation, radiographic length determination, manual file canal preparation, irrigation, obturation with the lateral compression method, and temporary restoration. Two endodontists evaluated filling length, density, convergence, and technical errors such as floor perforation, broken instruments, transportation, ledge formation, and access cavity gouging. Results: The study included 89 male (44.3%) and 112 female (55.7%) dental students with a mean age of 25.36 years. Among the 201 patients (28.9% male, 71.1% female; mean age 35.24 years), 71.6% had fillings of appropriate length, 12.14% short, and 15.9% long. Appropriate density was observed in 67.6%, and convergence in 86.1%. Technical errors included ledge formation (8.5%), floor perforation (1%), access cavity gouging (1.5%), and broken instruments (0.5%). A significant relationship was found between density and tooth type (p<0.002) and convergence and tooth type (p < 0.009). Conclusion: Proper filling, convergence, and density were more frequent in anterior teeth. Maxillary teeth had higher rates of proper filling compared to mandibular teeth. The overall rate of treatment errors was low, likely due to professor supervision. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to compare the vertical dimension changes, before and after treatment, in two groups of growing patients, one group treated with clear aligner therapy versus a group treated with Quad-helix and bite-block therapy. Methods: The studied sample was composed of n. 40 patients (20 females and 20 males with a mean age of 8.6 ± 1.8 years), enrolled from the Department of Orthodontics at Policlinico of Rome Tor Vergata. The original sample was randomly divided into two groups: Group IF (Invisalign First) and Group BB (Quad-helix and bite block). Pre- (T0) and post-treatment (T1 after 12 months) lateral cephalograms were collected from all the selected patients. Nine cephalometric parameters, both angular and linear, were measured and recorded for each cephalogram. Results: No statistically significant changes were found between both the IF and BB groups at T0, while statistically significant changes were observed in both groups (BB and IF) between T0 and T1 (after 12 months of active therapy), p < 0.005. Conclusions: Both therapies were able to control the patient's vertical condition. To date, the use of conventional appliances seems to have slightly better efficacy in controlling the vertical dimension than aligner therapy. [ABSTRACT FROM AUTHOR]

Aims: The study aimed to investigate the role of miR‐146a‐5p in osteogenesis of hPDLSCs irradiated with low‐energy red LEDs. Methods: After irradiation with 5 J/cm2 red LED, miR‐146a‐5p expression was detected by real‐time quantitative polymerase chain reaction (RT‐qPCR), and osteogenic markers expression was determined by RT‐qPCR and Western blotting. Alkaline phosphatase (ALP) activity was assessed by ALP staining, and mineralization was assessed by Alizarin Red staining, respectively. Lentiviral vectors were designed to regulate miR‐146a‐5p expression. Dual‐luciferase reporter assay was performed to confirm the targeted relationship between miR‐146a‐5p and MAPK1. Short hairpin RNA (shRNA) was used to regulate MAPK1 expression. Results: RT‐qPCR and western blotting revealed that 5 J/cm2 irradiation elevated the levels of the osteogenic markers osterix (OSX) and bone sialoprotein (BSP) in hPDLSCs. miR‐146a‐5p is downregulated in hPDLSCs under the low‐energy red LED light irradiation. miR‐146a‐5p underexpression markedly promoted the osteogenic potential of hPDLSCs. miR‐146a‐5p targeted MAPK1. 5 J/cm2 red LED irradiation rescued the inhibitory effects of upregulated miR‐146a‐5p on osteogenic differentiation, and the positive influence of red LED irradiation could be reversed by downregulated MAPK1. Conclusion: These findings confirm that miR‐146a‐5p is involved in the effect of LED irradiation on the osteogenic differentiation of hPDLSCs by targeting MAPK1. Red LED irradiation may be a potential clinical adjunct therapy for periodontal regeneration. [ABSTRACT FROM AUTHOR]

Gingival recessions with noncarious cervical lesions (NCCLs), also called combined defects, are common problems, and patients often seek treatment due to esthetic concerns or dentin hypersensitivity. This case series evaluates the effectiveness of the non-coronally advanced flap (CAF) technique combined with restorative treatment for Miller Class III gingival recessions with NCCLs. A total of 16 combined defects were included. The combined defect height (CDH), recession depth (RD), pocket depth (PD), keratinized tissue width (KTW), and presence of dentin hypersensitivity were recorded at baseline and 6 months postsurgery. The mean root coverage (mRC) was 83%, and 50% of defects presented complete root coverage (CRC). In the group with an initial KTW = 2 mm, mRC and CRC were significantly higher. Further randomized controlled studies with larger sample sizes are needed to verify the prognostic factor of combined non-CAF techniques and restorative treatment for gingival recessions with NCCLs. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to evaluate the effect on systemic inflammation of subgingival instrumentation (SI) with or without antibiotics. Moreover, systemic parameters were compared between periodontally healthy (PH) individuals and periodontitis patients. Method and materials: Patients with generalized periodontitis: stage III and PH individuals were recruited. Forty eight periodontitis patients were randomly allocated to each treatment group; systemic antibiotics for seven days after completion of SI (AB group), or SI alone (SI group). Periodontal parameters, serum high-sensitivity C-reactive protein (hsCRP), and hematological parameters were assessed at baseline and at week 8. Multivariate analysis was applied to analyze predictive effect of treatment allocated and improvement in periodontal parameters on change in systemic parameters. Results: At baseline, hsCRP, total leukocyte count (TLC), neutrophil, and monocyte count were significantly higher in periodontitis patients. There was comparable reduction in neutrophil count in both treatment groups. At week 8, change in periodontal parameters was similar in treatment groups, except for probing pocket depth (PPD). Improvement in both PPD and clinical attachment level (CAL) and CAL alone was predictive of change in TLC and lymphocyte count, respectively. Conclusion: This study failed to demonstrate the significant benefit of systemic antibiotics as an adjuvant to SI on improvement in periodontal inflammation and systemic inflammatory parameters, despite significantly higher reduction in PPDs. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine the cutting efficiency of different diamond rotary instrument types for sectioning monolithic zirconia and lithium disilicate anatomical crowns. Materials and methods: The study used 30 diamond rotary instruments divided into three groups: Zirconia cutting diamond bur (White Z), super coarse grit diamond bur (KBlack), and medium coarse grit diamond bur (KBlue); Two subgroups were assigned based on the crown materials including monolithic zirconia (5YSZ) and lithium disilicate (e.max) ceramics. The cutting efficiency was assessed by measuring the time required to fully section the crowns, followed by scanning electron microscopy (SEM) and energy-dispersive spectroscopy (EDS) of the dental burs before use and after every sectioned crown. A three-way ANOVA examined the effects of bur type, material type, and sectioning stage. If interaction exists, one-way ANOVA was used to compare the different subgroups, followed by the Tukey post hoc test. The significance level was assigned at α ≤ 0.05. Results: The results exhibited various cutting efficiencies among diamond rotary instruments and ceramic crown materials. White Z demonstrated superior cutting efficiency of zirconia crown compared with KBlack and KBlue for the first cutting cycles (p ≤ 0.05); the results tend to be more comparable at the third cutting cycle. However, the super coarse diamond bur exhibited higher efficiency in cutting lithium disilicate crowns than white Z and KBlue burs through all three cutting cycles(p ≤ 0.05). The diamond bur-cutting efficiency diminished after each use, irrespective of the bur type or the crown material (p ≤ 0.05); this was represented by the reduction of carbon and increased nickel matrix ratio after each bur usage. Conclusion: White Z diamond bur showed higher cutting efficiency of zirconia in the first two cutting cycles; super coarse diamond bur is more efficient for cutting lithium disilicate crown in all of the cutting cycles. The amount of diamond on the burs reduced after each use, with no great impact on the material type when sectioning lithium disilicate and 5YSZ crowns. Clinical significance: This study provides valuable insights for dental practitioners in selecting the appropriate diamond rotary instrument for crown sectioning. Practitioners can minimize the risk of damage and reduce the time required for crown removal, improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background: To verify the validity of diagnosing initial caries on occlusal surface of permanent posterior teeth by laser fluorescence instrument DIAGNOdent pen. Methods: Patients from School of Stomatology in Wuhan University were selected and their posterior teeth were examined using DIAGNOdent pen and the International Caries Detection and Assessment System (ICDAS II) by an experienced dentist. After teeth extraction, histological criteria were used to determine the severity of the lesions. The sensitivity, specificity, accuracy, the area under the curve (AUC), and correlation of DIAGNOdent pen and ICDAS II were analyzed compared with histological criteria. Examiners' agreement was measured. Results: The sensitivity range was 0.440-1 while that of specificity was 0.750–0.994. The accuracy and AUC were above 80% and 0.7 respectively. Consistency of examiners' kappa values of ICDAS II, DIAGNOdent pen, and histological criteria were ranged from 0.629 to 0.840. Conclusions: ICDAS II and DIAGNOdent pen can be effectively used in tandem or independently for the assessment of initial caries. [ABSTRACT FROM AUTHOR]

Background: The aim of the randomized controlled clinical trial study was to evaluate the effectiveness in reducing pathologically increased pocket probing depths (PPD > 3 mm) using the Guided Biofilm Therapy (GBT) protocol (adapted to the clinical conditions in non-surgical periodontal therapy (NSPT): staining, air-polishing, ultrasonic scaler, air-polishing) compared to conventional instrumentation (staining, hand curettes/sonic scaler, polishing with rotary instruments) both by less experienced practitioners (dental students). Methods: All patients were treated according to a split-mouth design under supervision as diseased teeth of quadrants I/III and II/IV randomly assigned to GBT or conventional treatment. In addition to the treatment time, periodontal parameters such as PPD and bleeding on probing (BOP) before NSPT (T0) and after NSPT (T1: 5 ± 2 months after T0) were documented by two calibrated and blinded examiners (Ethics vote/ Trial-register: Kiel-D509-18/ DRKS00026041). Results: Data of 60 patients were analyzed (stage III/IV: n = 36/ n = 24; grade A/ B/ C: n = 1/ n = 31/ n = 28). At T1, a PPD reduction of all diseased tooth surfaces was observed in 57.0% of the GBT group and 58.7% of the control group (p = 0.067). The target endpoint (PPD ≤ 4 mm without BOP) was achieved in 11.5% for GBT (conventional treatment: 11.2%; p = 0.714). With the exception for number of sites with BOP, which was at T1 15.9% in the GBT group and 14.3% in the control group (p < 0.05) no significant differences between the outcomes of the study were found. At 30.3(28.3) min, the treatment time was significantly shorter in GBT than in the control group at 34.6(24.5) min (p < 0.001). Conclusions: With both protocols (GBT/ conventional instrumentation) comparably good clinical treatment results can be achieve in NSPT in stage III-IV periodontitis patients. Trial registration: The study was registered before the start of the study and can be found under the number DRKS00026041 in the German Clinical Trials Register. The registration date was 19/08/2021. [ABSTRACT FROM AUTHOR]

Background: Infected dentinal tubules are a possible source of bacteria that are responsible for the failure of root canal treatment. Therefore, disinfection of dentinal tubules by increasing the penetration of the irrigation solution is important for success in retreatment cases. This study utilized confocal laser scanning microscopy (CLSM) to assess and compare the impact of XPR, ultrasonic irrigation (UI) and sonic activation (SA) on NaOCl penetration into dentinal tubules following endodontic retreatment. Methods: A total of forty mandibular premolars were enrolled in this investigation. Following root canal preparation up to ProTaper X3 file (30/0.07), root canals were obturated with gutta-percha and bioceramic root canal sealer with single cone technique. The root canal filling materials were removed using ProTaper nickel-titanium rotary retreatment files until the working length was reached. The retreatment procedure was finalized using the ProTaper Next X4 (40/0.06). The teeth were divided into four groups based on the irrigation activation technique: control (conventional needle irrigation), SA, UI and XPR. During the final irrigation procedure, Rhodamine B dye was introduced to 5% NaOCl for visualization via CLSM. Subsequent to image acquisition, the maximum penetration, penetration percentage, and penetration area were calculated. Data were statistically analyzed using the Kruskal-Wallis, Friedman, and Bonferroni Dunn multiple comparison tests through R software (p < 0.05). Results: In the middle third, UI yielded a significantly higher penetration percentage than the control group (p < 0.05). The UI and XPR groups showed increased penetration percentages in the coronal and middle thirds compared with the apical third (P < 0.05). Maximum penetration was notably reduced in the apical third than in comparison with the coronal and middle thirds in all groups (p < 0.05). In the control, SA and XP groups, the penetration area was ranked in descending order as coronal, middle and apical (p < 0.05). Conversely, in the ultrasonic group, the penetration area was significantly lower in the apical third than in the middle and coronal thirds (p < 0.05). Conclusions: UI enhanced the penetration percentage in the middle third of the root compared with that in the control group. XPR and SA showed no significant effect on NaOCl penetration following retreatment. [ABSTRACT FROM AUTHOR]

This concise review provides an update on the use of calcium-based materials for the prevention of dental caries. Some calcium-based materials promote remineralization and neutralize bacterial acids, disrupting cariogenic biofilms and inhibiting bacterial growth. Medical Subject Headings of [Dental Caries] and [Calcium] were adopted to search publications. Information related to the aim of this review was extracted and summarized. Common calcium-based materials are calcium phosphate, hydroxyapatite, calcium carbonate, calcium fluoride and casein phosphopeptide–amorphous calcium phosphate (CPP-ACP). Calcium phosphate is commonly used in toothpaste. It provides calcium and phosphate ions, enhances the incorporation of fluoride into caries lesions and increases mineral density. Hydroxyapatite is a form of calcium phosphate that is chemically similar to the mineral found in teeth. It can be applied on teeth to prevent caries. Calcium carbonate can be found in toothpastes. It neutralizes bacterial acids and acts as a calcium reservoir during remineralization. Calcium fluoride is found in dental products and promotes remineralization as a source of fluoride, which can be incorporated into tooth enamel, forming fluorapatite and increasing resistance to caries. CPP-ACP is derived from milk proteins. It contains calcium and phosphate, which help to remineralize tooth enamel. CPP-ACP inhibits cariogenic bacteria. It also interacts with bacterial biofilms and disrupts their formation. These calcium-based materials can be used to boost the preventive effect of fluorides or, alternatively, as a therapy for caries prevention. [ABSTRACT FROM AUTHOR]

Background/Aim. The clinical success of prosthetic rehabilitation that commences after the attained implant osseointegration is dependent on the influence of several factors, of which screw loosening is a frequent one, and it is highly related to inadequate tightening (torquing) using torque wrenches. Although the wrenches are initially calibrated by the manufacturer, it is of great importance to evaluate their function after usage for a certain period of time. The aim of this study was to evaluate the accuracy and repeatability of the performance of implant torque wrenches in delivering necessary torque values before and after one year of usage. Methods. Two types of wrenches were used in the study: the beam-type and the toggle-type. Four various brands of beam-type wrench were marked as Beam 1 - Beam 4, and three various brands of toggle-type wrench were marked as Toggle 1 - Toggle 3, according to their design. Torque values delivered by wrenches were measured and analyzed using the One-Sample t-test, Independent-Samples t-test, and Mann-Whitney U test. The Bland-Altman bias test was used as an index of accuracy, whereas Forkman's comparison of datasets coefficients of variation (CV) served as an index of repeatability. Results. All wrenches except new Beam 2 and Beam 3 showed differences between the average measured torque value and target torque value. Differences were found in the average measured values between all used and new wrenches. Higher bias was observed in Toggle 1, Toggle 2, and Toggle 3 brands, whereas lower bias was recorded between used and new Beam 1 and Beam 3 wrenches. When comparing the CV for used and new wrenches, Beam 1, Beam 4, Toggle 1, and Toggle 2 revealed differences, whereas the CV for Beam 2, Beam 3, and Toggle 3 did not differ significantly. Conclusion. Compared to toggle-type, the beam-type wrenches offer greater accuracy in achieving the target torque value. The torque deteriorates in all wrenches after aging/usage and is more prominent in toggle-type devices. [ABSTRACT FROM AUTHOR]

Background: This study looks at the clinical applications of nanotechnology in dentistry, with an emphasis on implantology, preventive care, orthodontics, restorative dentistry, and endodontics. Methods: Following PRISMA criteria and registered in PROSPERO (ID: CRD 564245), a PubMed, Scopus, and Web of Science search was conducted for studies from January 2014 to April 2024. The criteria were English-language research on nanotechnology in dental coatings, with a focus on clinical trials and observational studies. The electronic database search yielded 8881 publications. Following the screening process, 17 records were selected for qualitative analysis. Results: Nanotechnology has revolutionized dentistry. In orthodontics, nanoparticles improve antibacterial characteristics, durability, and biocompatibility, lowering bacterial colonization and plaque. In preventative care, Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) combined with stannous fluoride (SnF2) and nano-sized sodium trimetaphosphate (TMPnano) substantially remineralizes enamel. Nanostructured surfaces in dental implants, particularly those containing calcium, improve osseointegration and stability. Nanoparticles in restorative dentistry improve composite and adhesive strength, aesthetics, and longevity. Conclusions: Nanotechnology improves dental materials and equipment, resulting in better treatment outcomes and increased patient comfort. Its integration provides more effective treatments, which improves dental care and patient outcomes. More research is needed to overcome present problems and expand nanotechnology's medicinal applications. [ABSTRACT FROM AUTHOR]

This article explores the impact of dental tourism on UK dentistry and the National Health Service (NHS). It acknowledges concerns about foreign nationals accessing free NHS care and British residents seeking medical treatment abroad. The article highlights the lack of data on the scale and cost of health tourism to the NHS and emphasizes the potential risks to patients and the healthcare system due to lower standards of care overseas. It also discusses the challenges faced by regulators in monitoring and enforcing standards for dental providers operating outside the UK. The article calls for better legislation, enforcement, and research to address the vulnerability of UK dentistry to dental tourists. [Extracted from the article]

This study aimed to determine the crystalline phase composition of 3–6 mol% yttria-stabilized zirconia (3–6YSZ), specifically investigating the presence of tetragonal (t), cubic (c), and/or additional yttria-rich tetragonal (t') phase. Laboratory-fabricated specimens comprising 3–5YSZ, resembling translucent dental zirconia ceramics (TZ specimens), and a blend of 3YSZ and 8YSZ, representing a c -phase reference, were prepared. Additionally, 25 dental zirconia products stabilized with 3–6 mol% yttria were analyzed. Whole X-ray diffraction (XRD) patterns were obtained for Rietveld analysis, complemented by fine scanning in the 2θ region from 72º to 76º for qualitative phase analysis. Moreover, yttria concentrations in each specimen were determined using X-ray fluorescence (XRF) spectroscopy. In the 2θ region from 72º to 76º, TZ and dental zirconia product specimens displayed four peaks attributed to t - and t' -phases, but the c -phase peak was absent. Rietveld analysis of the whole XRD patterns, utilizing a t - t' model, demonstrated the t -phase fraction ranging from 86 mass% in 3YSZ to 11 mass% in 6YSZ. Rietveld analysis appeared reliable, as the yttria contents calculated based on lattice parameters aligned well with those measured by XRF. This study established that dental 3–6YSZ consisted of yttria-lean t - and yttria-rich t' -phases. The present study enhances understanding of the crystalline structure of dental zirconia ceramics. Future crystallographic analyses of these ceramics should consider the presence of t - and t' -phases. • Examined crystalline phases of 3-6 mol% yttria-stabilized zirconia. • Applied XRD and XRF for phase and chemical composition analyses. • Identified dominant yttria-lean and yttria-rich tetragonal phases. • Demonstrated the absence of cubic phase. • Improved understanding of dental zirconia's crystalline structure. [ABSTRACT FROM AUTHOR]

Background: Occlusal contacts can be stained and thereby visualised employing occlusal indicators. Qualitative and quantitative indicators are differentiated. The hybrid system OccluSense supposedly combines analogue contact marking and digital registration of contacts. The reliability and validity of its contact marking have not yet been validated. Objectives: The aim of this controlled randomised in‐vitro study was to examine the reliability and validity of analogue contact staining with OccluSense compared to Arti‐Fol and the reference standard Gnatho‐Film. Materials and Methods: An experimental apparatus was designed to simulate static occlusion. The occlusal contacts were stained 50 times with Gnatho‐Film to determine the average number and location of contacts registered. For comparison, the contacts were pre‐stained with Gnatho‐Film and then registered with Arti‐Fol or OccluSense 50 times each. Every staining was statistically evaluated and compared to Gnatho‐Film alone, regarding the number and location of contacts. Based on the observed characteristic staining behaviour of OccluSense, a modified evaluation strategy was developed for its colour markings (OccluSense (mod.)). Results: Both evaluations of OccluSense determine that the same number of contacts was registered in over 94% of all cases. Neither OccluSense nor Arti‐Fol stain the exact same number of contacts as Gnatho‐Film, but the modified evaluation OccluSense (mod.) did improve the results for validity. Conclusion: When employing the modified evaluation strategy, OccluSense staining achieves similar reliability and validity as the reference standard. Pre‐colouring of occlusal contacts with Gnatho‐Film and the modified evaluation strategy, might become standard for analysing occlusal contacts stained by OccluSense in the future. [ABSTRACT FROM AUTHOR]

Background: The temporal tendon is a structure often compromised in patients suffering from temporomandibular disorders (TMD), yet its intraoral location makes a standardised assessment difficult. Objectives: To evaluate the variability and accuracy to target force of a newly designed intraoral extension for a palpometer device (Palpeter, Sunstar Suisse) when compared to manual palpation, in addition to clinically assessing the mechanical sensitivity and referred sensations of the temporal tendon in healthy individuals. Methods: Experiment 1: 12 individuals were asked to target on a scale 0.5, 1 and 2 kg, for 2 and 5 s by using five different methods (Palpeter, Palpeter with three different extension shapes and manual palpation). Experiment 2: 10 healthy participants were recruited for a randomised double‐blinded assessment by applying pressure of 0.5, 1 and 2 kg to the right temporal tendon with the three extensions and manual palpation. Participants rated the intensity of their sensation/pain on a 0–50–100 numeric rating scale (NRS), unpleasantness on a 0–100 NRS, and if present, they rated and drew the location of referred sensations. Repeated measures analysis of variance (ANOVA) was used in both experiments to compare differences between palpation methods. Tukey's HSD tests were used for the post hoc comparisons, and p values below.05 were considered significant. Results: Experiment 1: The extensions showed no significant differences between them regarding reliability and accuracy for all forces and durations (p >.05). The manual method was significantly less reliable and accurate when compared to the other methods (p <.05). Experiment 2: There were no significant differences between the Palpeter extensions regarding pain intensity or unpleasantness NRS scores (p >.05), but all the extensions had significantly increased pain intensity and unpleasantness when compared to manual palpation (p <.05). Similarly, the frequency of referred sensations was similar between extensions but increased when compared to manual palpation. Conclusions: The new Palpeter extensions proved to be significantly more accurate and have lower test–retest variability than the manual method in a non‐clinical setting. Clinically, they showed no significant differences in NRS scores for pain intensity nor unpleasantness, with no major differences in referred sensations, making any of the extensions suitable for clinical testing of the temporal tendon in future studies. [ABSTRACT FROM AUTHOR]

Background: Class II subdivision is a malocclusion characterized by dental and functional asymmetry that is difficult to manage. Impaired muscle function can result in asymmetrical growth, leading to occlusal instability. Objective(s): The study aimed to assess occlusal force in patients with Class II subdivision malocclusion using Innobyte. Additionally, the discrepancies of force generated at the position of maximum intercuspidation between the left and right sides of the arches were evaluated. Methods: The occlusal force of 66 patients with Class II subdivision malocclusion (group S) was measured and compared with that of 66 patients with Class I (group I) and 66 patients with Class II malocclusion (group II). The S group patients had a Class I molar on the right side and a Class II molar on the left side. ANOVA test, followed by the Games‐Howell post hoc test, was performed to compare the mean of the total force among the groups. To assess the difference in force between the right and left arches, one‐way ANOVA test followed by Tukey's post hoc comparison was performed. Finally, a boxplot was created to show the trend of occlusal force recorded in the three groups of patients. Results: The occlusal force differed significantly among the groups (p <.001). Post hoc Games‐Howell analysis showed significant differences as follows: the total force in group S was 165.24 N greater than in group II and in group I was 218.06 N greater than in group II. The difference (right–left) in total force between the groups was statistically significant (p <.001). Tukey's post hoc test showed following significant correlation: in group S was 53.51 N greater than in group II and 63.12 N greater than in group I. Conclusions: Among the analysed groups, patients with Class II malocclusion exhibited the lowest value of occlusal force. In patients with Class II subdivision malocclusion, force asymmetry, characterised by a higher value on the Class I side and a lower value on the Class II side was observed. [ABSTRACT FROM AUTHOR]