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Statement of problem: Many efforts have been made to solve the problem of composite resin adaptation and reduce microleakage. Objective: The aim of the present study was to evaluate the effect of preheating of silorane-based composite resins before photo-polymerization on gap formation at the margins of Class V restorations. Materials and Methods: Standard Class V cavities were prepared on the labial surfaces of 46 sound bovine incisor teeth. The teeth were divided into two groups. In group 1, after application of the bonding agent of the silorane system, the cavities were restored with Filtek silorane-based composite resin stored at room temperature. In group 2, before restoring the cavities, the silorane-based composite resin was heated in a warm water bath at 54ºC for 10 minutes. After 48 hours of storage in distilled water, teeth were thermocycled and sectioned bucco-lingually. Then the gaps of tooth‒restoration interfaces in both incisal and gingival margins at three external, middle and internal areas were measured using a stereomicroscope. After calculation of means and standard deviations, data were analyzed with two-factor ANOVA at α=0.05. Results: The mean marginal gaps in non-preheated and preheated groups were 10.66±2.39 and 7.62±2.05 µm, respectively, with a statistically significant difference (P

Competing Interests: The authors declare that they have no financial and non-financial competing interests with regard to the publication of their work.

Genetic factors may influence sleep bruxism's pathogenesis. Even though the association between the, 5-hydroxytryptamine 2A (5-HTR2A) serotonin receptor gene polymorphism and sleep bruxism has been investigated, inconsistent findings have been discovered. As a result, meta-analysis was performed to gather complete results on this topic. PubMed, Web of Science, Embase, and Scopus databases were searched for all papers containing English abstracts until April 2022. Medical Subject Heading (MESH) terms plus unrestricted keywords were used in the searches. The Cochrane test and the I 2 statistic were used to determine the heterogeneity percentage in numerous researches. Comprehensive Meta-analysis v.2.0 software was used to conduct the analyses. Five properly fitting papers were chosen for meta-analysis from the 39 articles acquired during the initial search. The meta-analysis revealed that the 5-HTR2A polymorphism has no link with sleep bruxism susceptibility across the models studied (P-Value > 0.05). The combined odds ratio analysis revealed no statistically significant association between the 5-HTR2A gene polymorphism with sleep bruxism. Nonetheless, these findings require confirmation through researches with large sample sizes. Identifying genetic markers for sleep bruxism may help clarify and expand our current knowledge of bruxism physiopathology., Competing Interests: Conflicting Interest None., (Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

This systematic review and network meta-analysis is aimed at investigating the effect of common surface treatments on the long-term repair bond strength of aged resin composite restorations and to rank and compare these surface treatments. In vitro studies evaluating the methacrylate-based resin composites subjected to rigorous aging protocols before and after being repaired with a new composite were included. A frequentist network meta-analysis was carried out using a random effects model. P scores were used to rank the efficacy of the surface treatments. Also, the global and node-split inconsistencies were evaluated. Web of Science, PubMed/Medline, Scopus, and Embase databases were searched until July 07, 2022. Twenty-six studies were included in the meta-analysis. The results showed that the application of silane and a total-etch (shear MD 32.35 MPa, 95% CI: 18.25 to 46.40, P score 0.95; tensile MD 33.25 MPa, 95% CI: 25.07 to 41.44; P score 0.77) or a self-etch (shear MD 38.87 MPa, 95% CI: 21.60 to 56.14, P score 0.99; tensile MD 32.52 MPa, 95% CI: 23.74 to 41.29; P score 0.73) adhesion protocol subsequent to the roughening with diamond bur produced the highest (micro)tensile and (micro)shear bond strengths compared to diamond bur alone as the control group. There was no difference between self- and total-etch adhesive protocols. Mechanical surface treatments yielded greater bond strength when used alongside the chemical adhesive agents. Further, it is possible to achieve acceptable repair bond strength using common dental clinic equipment. Therefore, clinicians could consider repairing old resin composites rather than replacing them., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2022 Mahdi Hadilou et al.)

Objectives: The present study aimed to investigate the effect of preheating on the color stability and surface roughness of a silorane-based composite resin. Materials and Methods: A total of 44 Filtek P90 composite resin disks, (10mm×1mm), were fabricated using plastic molds and were divided into two groups. In group 2, the composite resin syringes were placed in a thermostatically controlled water bath at 55‒60°C before preparing the disks. After polishing the samples with silicon carbide papers, they were stored in distilled water for 48 hours. Roughness and color parameters were then measured in two stages: immediately after retrieval from distilled water and after 40 days of storage in tea solution. Finally, the differences in roughness and color parameters were recorded. Independent sample t-test and regression analysis were used at a significance level of P<0.05. Results: Based on the findings of the present study, there was no significant difference among the mean ∆E values (P=0.4); however, a significant difference in mean surface roughness (P=0.01) was found between the two groups. Regression analysis showed a significant relationship between the study groups in terms of surface roughness and ΔE values​ (preheated: r 2 = 0.73; non-preheated: r 2 = 0.76). Conclusion: Filtek P90 silorane-base composite showed ΔE>3.3 and surface roughness above 0.2µ under preheated and non-preheated conditions and discoloration increased following preheating., (Copyright © 2022 The Authors. Published by Tehran University of Medical Sciences.)

Polymethyl methacrylate (PMMA) is widely used to manufacture removable orthodontic appliances. However, since the porous structure, cold-curing acrylic resins are susceptible to bacterial adhesion and colonization. The aim of this study was to investigate the antibacterial and mechanical properties of a cold-curing PMMA resin containing ZnO and TiO 2 nanoparticles supported on the 4A zeolite. ZnO and TiO 2 nanoparticles supported on the 4A zeolite were synthesized. Nanoparticles were added in three compositions as ZnO/4A, TiO 2 /4A, and ZnO/TiO 2 /4A at 2wt% and 4wt% concentrations to cold-curing acrylic resin powder (SR Triplex® Cold Ivoclar Vivadent AG, FL-9494 Schaan/Liechtenstein). X-ray diffraction (XRD), Field Emission Scanning Electron Microscopy (FE-SEM), energy dispersive X-ray (EDX), transmission electron microscopy (TEM), and dynamic light scattering (DLS) were performed to investigate the nanocomposite characteristics. A direct test method was used to assess the antibacterial properties against Streptococcus mutans, Klebsiella pneumoniae, and Escherichia coli . The surface roughness of acrylic samples was measured with a profilometer. Flexural strength was evaluated by a three-point bending test, and one-way ANOVA and Tukey's post hoc tests were used for statistical evaluation of the data. A p value of less than 0.05 was considered statistically significant. XRD confirmed the accurate crystalline structure of synthesized nanoparticles; FE-SEM images showed nanoparticle dispersion within polymerized acryl. The addition of 2 and 4 wt% of ZnO/4A, TiO 2 /4A, and ZnO/TiO 2 /4A caused colony reduction in all types of tested microorganisms more than 99% and 100%, respectively. The mean flexural strengths of acrylic specimens containing 2wt% and 4wt% of synthesized nanoparticles were significantly lower than those of the resin without nanoparticles. Fabricated samples showed favorable antibacterial properties but decreased flexural strength., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Mahdiyeh Esmaeilzadeh et al.)

Demand for dental implants has increased in recent years and the use of conscious sedation for this type of surgery can be of great benefit. Therefore, the aim of this systematic review was to evaluate the scientific literature related to the effect of conscious sedation on the reduction of anxiety, and patient and surgeon satisfaction. The Embase, PubMed, ProQuest, Scopus, Ovid, and Cochrane databases were searched without limitations. According to the inclusion and exclusion criteria determined for the study, 10 articles were selected for the final review during several screening stages. These studies were reviewed in their full-text form by the research team and the intended data was extracted. The risk of bias was assessed for each of the selected articles. Five studies were ultimately included. Two of the them compared local anesthesia and conscious sedation, while another 2 compared the consequences of different types of conscious sedation. The anxiety reduction and patient and surgeon satisfaction data was collated. Midazolam was the most frequently used agent. After a thorough review of the final articles extracted based on the study protocol, it was concluded that the use of conscious sedation during implant surgery reduces patient anxiety, and also increases the satisfaction of the patient and surgeon.

Ki-67 is a marker of cell proliferation, used as an important diagnostic marker in the pathologic differentiation of various lesions. It is also relevant for developing targeted molecular therapies. We carried out a systematic review to assess the Ki-67 labeling index (LI) in odontogenic cysts and tumors. Databases were searched, including PubMed (MEDLINE), Scopus, CINHAL, PsycoInfo, the Cochrane Library, and Proquest. The meta-analysis was carried out based on the data of 608 lesions. When a 5% cut-off point was set, ki-67 LI of all benign odontogenic tumors dropped below this point. All the malignant tumors demonstrated an LI of over 15.3%; a significantly higher Ki-67 LI in malignant odontogenic lesions (17.59±2.80) was observed. Among benign tumors, the largest and the smallest Ki-67 LIs were seen in ameloblastoma (4.39±0.47) and adenomatoid odontogenic tumor (0.91±1.71). The mean values of Ki-67 LI in tumors and cysts were 4.23 (0.38) and 1.04 (0.07), respectively. Among odontogenic cysts, the highest Ki-67 LI was found in odontogenic keratocyst (OKC) (3.58±0.51), and the lowest in the radicular cyst (1.29±0.62%). Ki-67 LIs in all odontogenic cysts were <3%, except for OKC. This controversial lesion seems to have a profile more similar to a tumor, and a treatment plan similar to tumors might be suggested. We found that odontogenic lesions have diverse proliferative activities that help differentiate between various lesions and suggest therapeutic plans., (© 2021 The Author(s).)

Objectives: The aim of this study was to evaluate the influence of varying dentin and enamel layer thicknesses of two nano-composite resins on color match of composite resins and lithium disilicate dental ceramic. Materials and Methods: Twenty-six specimens of two types of nano-composite resins, Opallis and Vittra, were fabricated using the two-layered technique with different thickness ratios of enamel and dentin composites (A2 shade) with a total thickness of 1.2mm. Thirteen discs of the same shade and thickness of IPS e.max Press LT (low translucency) lithium disilicate dental ceramic were also fabricated. Specimen color was measured with a spectrophotometer. The difference in color (ΔE 00 ) of composite and ceramic specimens, and the translucency parameter (TP) of all specimens were calculated. Data were analyzed using multi-factor ANOVA (P<0.05). Results: The color difference (ΔE 00 ) values of composites and ceramic were not clinically acceptable in any areas of either of the two composites (ΔE 00 >2.25). But ΔE 00 between the two composite resins was in the clinically acceptable range (ΔE 00 <2.25). The mean TP value of IPS e.max Press was greater than that of Vittra and lower than that of Opallis. Conclusion: In similar thicknesses, composite resins with any enamel/dentin thickness ratio could not successfully simulate the color and translucency of IPS e.max Press LT ceramic., (Copyright © 2021 The Authors. Published by Tehran University of Medical Sciences.)

Objectives : This study aimed to evaluate the thermal stability and monomer elution of bulk fill composite resins cured at different irradiation distances. Materials and Methods: Forty cylindrical-shaped (3×4mm) specimens were fabricated from two composite resins (X-tra fil, X-tra base) and cured from 0 and 7mm distances. In 9 specimens, the degree of conversion was determined by the release of monomers. For this purpose, after curing of composites, they were immersed in 5 mL of 99.9% methanol and stored at 37°C for 24h. The eluted monomer was then analyzed by gas chromatography (GC). Also, thermal stability of one sample from each group was assessed by thermogravimetric analysis (TGA) at a rate of 10°C/min. Data were analyzed using two-way ANOVA and Tukey's post-hoc test (P<0.05). Results: X-tra fil had significantly higher degree of conversion than X-tra base (P=0.001). Specimens cured at 7mm distance had significantly lower degree of conversion compared with those cured at 0 mm distance (P=0.001). The interaction effect of composite type and distance of light curing unit from the surface of samples was statistically significant (P=0.001). Regarding the TGA results, the lowest and the highest percentages of weight loss were detected in X-tra fil cured at 0 mm distance and X-tra base cured at 7mm distance, respectively. Conclusion: X-tra fil composite cured at 0mm distance had the highest degree of conversion and thermal stability, and X-tra base composite cured at 7mm distance had the lowest values., (Copyright © 2021 The Authors. Published by Tehran University of Medical Sciences.)

Background: Of the most important implications and complaints in the elderly group of the population, is oral and dental health problems. This study aimed to assess oral health- related quality of life in older people., Methods: To data collection, databases were searched including PubMed, EMBASE, Scopus, SID, MagIran, Cochrane Central Register of Controlled Trials and scholar google The keywords were "older adults", "Geriatric" Elderly", "Older", "Aged", "Ageing", "Oral health", "Oral hygiene" and "Quality of life", "QOL. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Studies from 1st Jan 2000 to 30 th Jan 2017 were included. Studies were subjected to meta-analysis to calculate indexes, using CMA:2 (Comprehensive Meta-Analysis) software., Results: Totally, 3707 articles were searched that 48 of them were subjected to the oral and dental health-related quality of life in 59 groups of the elderly population with the mean age of 73.57+6.62 in the 26 countries. The obtained percentage values of dental and oral health were 80.2% (0-60), 14.8% (0-12), 16.4% (0-70), 22% (0-14 or 0-59) and 19.2% (0-196) for GOHAI with the additive method, GOHAI with Simple Count Method, OHIP-14 with the additive method, OHIP-14 with Simple Count method and OHIP-49 with additive method indexes, respectively., Conclusion: The elderly group of the population had no proper oral health-related quality of life. Regarding the importance and necessity of oral and dental health and its effect on general health care in the target group, it is recommended to improve dental hygiene in the mentioned group of population., Competing Interests: Conflict of interest The authors declare no conflicts of interest., (Copyright © 2021 Azami-Aghdash et al. Published by Tehran University of Medical Sciences.)

In recent years, high atomic number nanoparticles (NPs) have emerged as promising radio-enhancer agents for cancer radiation therapy due to their unique properties. Multi-disciplinary studies have demonstrated the potential of NPs-based radio-sensitizers to improve cancer therapy and tumor control at cellular and molecular levels. However, studies have shown that the dose enhancement effect of the NPs depends on the beam energy, NPs type, NPs size, NPs concentration, cell lines, and NPs delivery system. It has been believed that radiation dose enhancement of NPs is due to the three main mechanisms, but the results of some simulation studies failed to comply well with the experimental findings. Thus, this study aimed to quantitatively evaluate the physical, chemical, and biological factors of the NPs. An organized search of PubMed/Medline, Embase, ProQuest, Scopus, Cochrane and Google Scholar was performed. In total, 77 articles were thoroughly reviewed and analyzed. The studies investigated 44 different cell lines through 70 in-vitro and 4 in-vivo studies. A total of 32 different types of single or core-shell NPs in different sizes and concentrations have been used in the studies., (© 2021 The Authors.)

Statement of the Problem: Many efforts have been made to improve the properties of mineral trioxide aggregate (MTA), including the incorporation of nanoparticles., Purpose: The aim of this study was to investigate the incorporation of zinc oxide and hydroxyapatite nanoparticles on the compressive strength of white MTA (WMTA)., Materials and Method: In this in vitro study, the following materials were evaluated: MTA, MTA+5% zinc oxide (ZnO) nanoparticles, MTA+10% zinc oxide nanoparticles, MTA+5% hydroxyapatite (HA) nanoparticles, MTA+10% zinc oxide nanoparticles. The compressive strength of the groups under investigation was measured on days 4 and 21 after mixing the MTA using a universal testing machine. Two-way ANOVA test was used to compare the groups and determine the significance of the effect of time and material on the compressive strength ( p <0.05)., Results: The highest and lowest compressive strength values were respectively measured for the second group, MTA/21 days, and the fourth group, MTA+Nano ZnO/4 days. Two-way ANOVA indicated that incorporation of zinc oxide and hydroxyapatite nanoparticles into MTA did not have a significant effect on compressive strength ( p = 0.05). Compressive strength in all the groups increased over time from day 4 to day 21. However, this increase was not statistically significant ( p = 0.06) except for the MTA group, which exhibited significant increase in compressive strength over time from day 4 to day 21 ( p =0.007)., Conclusion: Incorporation of HA and ZnO nanoparticles into MTA had no detrimental effects on its strength and these nanoparticles can be used to improve the other properties of MTA., (Copyright: © Journal of Dentistry.)

Background: Oral lichen planus (OLP) is known to be a chronic inflammatory disease associated with various other systemic disorders. Studies have shown that vitamin D deficiency can be involved in the pathogenesis of lichen planus. The aim of this study was to investigate the role of vitamin D and vitamin D receptor in OLP., Methods: In this review study, all English and Persian articles were searched by relevant keywords from the Google scholar, PubMed, science direct, Cochrane, Scopus and Sid databases until January 2020., Results: From the 16 articles obtained after reviewing the abstracts, finally 14 appropriate articles were included in this study., Conclusion: According to the results of the studies, vitamin D deficiency may be associated with an increased risk of OLP lesions., (Copyright: © 2020 Paria M., et al.)

Background: The main objective of thissystematic review wasto identify the hemodynamic effects of intravenous sedatives used in dental implant surgeries., Methods: Embase, PubMed, ProQuest, Scopus, Ovid, and Cochrane databases were searched with no limitations. Of 59 studies obtained, 50 studies were excluded due to incompatibility with the subject. The remaining studies were reviewed in full text and assessed for the risk of bias individually. The included studies were reviewed by the research team, and the necessary data were extracted., Results: Four studies were finally included. Two of the studies compared local anesthesia and intravenous sedation, while the other two compared the consequences of different types of intravenous sedation. By comparing the hemodynamic effects, the systolic and diastolic blood pressure and the heart rate data were collated. Midazolam was the most frequently used intravenous sedative, and Dexmedetomidine affected hemodynamics the most., Conclusion: Intravenous sedation leads to decreased heart rate and blood pressure. Better hemodynamic outcomes improve the patients' cooperation by decreasing stress and anxiety. Dexmedetomidine seems to be the first choice for intravenous sedation., Competing Interests: The authors declare that they have no competing interests with regards to authorship and/or publication of this paper., (© 2019 The Author(s).)

Background . The current study aimed at identifying the color agreement between try-in pastes and the respective resin cements and investigated the effect of thickness and regions of Ultra-Translucent Multilayered Zirconia Veneers. Methods . A total of 90 cubic zirconia discs were prepared at two different thicknesses (0.5 mm and 0.7 mm) (n=45) in five groups in terms of the shade of the try-in paste and resin cement as follows: Universal, Clear, Brown, White and Opaque. Try-in paste and the respective resin cement were applied between the specimens and composite substrate, respectively, and colorimetric evaluation was carried out using CIE-Lab system. For each specimen, ΔE between the try-in paste and cement was calculated. Data were analyzed with SPSS 17 using Multifactor ANOVA (P<0.05). Results . Multifactor ANOVA results showed that ΔE values were significantly affected by the resin cement shade and the thickness of ceramic veneer (P<0.05). The results showed better shade agreement between the try-in paste and the respective resin cement with thicker ceramic veneers. The results of Tukey HSD revealed that ΔE values for the Clear, Universal and Brown shades were less than those of the White and Opaque shades. Lighter shades exhibited better agreement between the try-in paste and the respective resin cement. Conclusion . Perceptible color difference was found between the try-in pastes and the respective resin cement in most colors investigated. Although, the agreement of the try-in pastes and the respective resin cement was affected by the thickness of zirconia veneers, the different regions of multilayered ultra-translucent zirconia ceramic showed no significant effect.

Introduction: It has been shown that the mechanical and physical properties of Calcium Enriched Mixture (CEM) cement are influenced by the mixing methods. Despite several studies conducted on different mixing methods of CEM cement, there is no systematic review to summarize the results. This systematic review was conducted to investigate the effect of different mixing techniques on mechanical and physical characteristics of CEM cement., Methods and Materials: A professional librarian with skills in informatics conducted a systematic search by searching electronic databases PubMed/MEDLINE, Scopus and Ovid for English language peer-reviewed articles published between 1992 and April 2019., Results: Initial searches from all sources identified 1175 references. Two of the authors examined the titles, abstracts of these articles and the full reports of 20 studies were obtained, and data extraction was performed. Seven studies satisfied the eligibility criteria for the review. The effect of different mixing methods was investigated on bacterial microleakage, push-out bond strength, flow rate, compressive strength, solubility, pH, film thickness, dimensional changes, working time, setting time and quality of the apical plug., Conclusion: Based on the results of this systematic review, some of the important properties of CEM cement were affected by different mixing methods. Although none of these mixing methods could improve all the properties, mechanical and manual methods were more effective compared to ultrasonic method., Competing Interests: ‘None declared’.

Background & Aims: Evaluating the effect of Kangaroo Mother Care (KMC) on breastfeeding success shows conflicting results. Regarding the importance of breastfeeding and uncertainties about its effect, this study intended to conduct a systematic review and meta-analysis of randomised controlled trials on the effect of KMC on success of breastfeeding., Methods: In this systematic review and meta-analysis study, required data were collected by searching the following keywords: breastfeeding, Breast-Feeding, "skin-to-skin", "Kangaroo Mother Care", randomized clinical trial. The following databases were searched: Google Scholar, PubMed, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials. Two authors independently extracted the data. To estimate the Breast-Feeding outcome variables, CMA2 software was used. The risk of bias of studies was assessed with the criteria developed in the Cochrane Handbook., Results: Twenty articles were included. In the KMC and CNC groups, 1,432 and 1,410 neonates were examined. Breastfeeding success rate was higher in the KMC group within different time slots, however this difference was not statistically significant (RR=1.11(95CI, 0.93-1.34) and RR=1.13(95%CI, 0.92-1.34) based on the time slot and birth weight, respectively). The inter-groups differences in the mean scores of Infant Breast-Feeding Assessment Tool (IBFAT) were statistically significant (P<0.05). Breastfeeding was initiated very sooner in the KMC group, suggesting a statistically significant inter-groups difference -0.72(95%CI, from -0.92 to -0.53) (P<0.05). Majority of the studies had a high risk of bias., Conclusion: Findings indicated a superiority of KMC over CNC in terms of breastfeeding success. Assessment of the complications and costs of KMC implementation is recommended., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background. This study was undertaken to evaluate the repair bond strength of lithium disilicate glass ceramic to a silorane-based composite resin after surface preparation with Nd:YAG and Er,Cr:YSGG lasers. Methods. A total of 102 lithium disilicate glass ceramic samples (IPS e.max Press), measuring 5 mm in diameter and 4 mm in thickness, were randomly assigned to 6 groups (n=17): group 1, no surface preparation (control); group 2, acid etching with 9.5% hydrofluoric acid (HF); group 3, surface preparation with 4.5-W Nd:YAG laser; group 4, surface preparation with 6-W Nd:YAG laser; group 5, surface preparation with 1.5-W Er,Cr:YSGG laser; and group 6, surface preparation with 6-W Er,Cr:YSGG laser. After preparation of surfaces and application of silane, all the samples were repaired with the use of a silorane-based composite resin, followed by storage in distilled water at a temperature of 37°C for 24 hours and thermocycling. Finally, the samples were subjected to a shearing bond strength test; the fracture modes were determined under a stereomi-croscope. Results. There were significant differences between the HF group and the other groups (P=0.000). Two-by-two comparisons of the other groups revealed no significant differences (P>0.05). Conclusion. Use of HF proved the most effective surface preparation technique to increase the repair bond strength between lithium disilicate glass ceramic and silorane-based composite resin; compared to the control group.

Background: Given the importance of having valid information about the prevalence and reasons of self-medication among pregnant women for preventing self-medication during this period, this study aimed to systematically review and perform a meta-analysis on the prevalence and reasons of self-medication during pregnancy., Methods: This systematic review and meta-analysis was conducted in 2018 to estimate the overall self-medication prevalence based on the database sources PubMed, Scopus, Google Scholar, MagIran, IranMedex and SID. Required data were collected using keywords: medication, self-medication, over-the-counter, non-prescription, prevalence, etiology, and occurrence and pregnant. Descriptive and cross-sectional studies in English and Persian languages were included. There was no time limitation for search. R software was applied for meta-analysis. Random-effects model was applied to estimate the self-medication prevalence with 95% confidence interval. Q statistics and I2 were used to measure the heterogeneity., Results: Out of 490 retrieved articles, finally 13 studies were included in meta-analysis, 6 studies of which reported the cause of self-medication. The overall estimated prevalence of self-medication based on the random effect model was 32% (95% CI, 22% - 44%). The most important reasons of self-medication were previous experience of the disease. The most important group of disease in which patients self-medicated was anemia. Also, the most important group of medication was herbal., Conclusion: The results of this study showed that the prevalence of self-medication among pregnant women was relatively high and required effective interventions to reduce and prevent self-medication among this group. Providing required information and raising awareness about complications resulting from self-medication, in particular herbal medicines and dietary supplements, should be taken into account.

Objective: Due to extensive literature on colorectal cancer and their heterogeneous results, this study aimed to summarize the systematic reviews which review the cost-effectiveness studies on different aspects of colorectal cancer., Methods: The required data were collected by searching the following key words according to MeSH: "colorectal cancer," "colorectal oncology," "colorectal carcinoma," "colorectal neoplasm," "colorectal tumors," "cost-effectiveness," "systematic review," and "meta-analysis." The following databases were searched: PubMed, Cochrane, Google Scholar, and Scopus. Two reviewers evaluated the articles according to the checklist of "assessment of multiple systematic reviews" (AMSTAR) tool., Results: Finally, eight systematic reviews were included in the study. The Drummond checklist was mostly used for assessing the quality of the articles. The main perspective was related to the payer and the least was relevant to the social. The majority of the cases referred to sensitivity analysis (in 76% of the cases) and the lowest point also was allocated to discounting (in 37% of cases). The Markov model was used most widely in the studies. Treatment methods examined in the studies were not cost-effective in comparison with the studied units. Among the screening methods, computerized tomographic colonography and fecal DNA were cost-effective. The average score of the articles' qualities was high (9.8 out of 11)., Conclusions: The community perspective should be taken into consideration at large in the studies. It is necessary to pay more attention to discounting subject in studies. More frequent application of the Markov model is recommended., Competing Interests: There are no conflicts of interest.

Introduction: This study aimed at evaluating knowledge and awareness of hypertension and the risk factors for hypertension among hypertensive patients. Methods: In this study, 110 hypertensive patients were enrolled and filled out two self-administered questionnaires. The first questionnaire was about the demographic characteristics and the second one was about the knowledge (n = 10), attitude (n = 9) and practice (n = 8). The internal consistency and the stability of the questionnaires were approved. The Mann-Whitney U test and Kruskal-Wallis and Spearman correlation coefficient were used for statistical analysis. Results: Seventy-three percent of participants know the normal range of hypertension. Most of the participants truly knew that stress (87.3%), obesity (70.9%) and aging (48.2%) are risk factors for hypertension. About 60% of participants knew the complications of uncontrolled hypertension. About 82.7% of participants believed that after adaptation of body to hypertension, there is no need to use antihypertensive drug. About 13.6% of participants measured their blood pressure daily and 11.8% of them measured it once a month. The educational level of participants was significantly associated with knowledge score ( P = 0.01). There was a significant correlation between knowledge ( P < 0.001) and attitude and also attitude and practice ( P < 0.001) scores. Conclusion: These findings have important implications for developing proper and continuous self-management hypertension education programs in Iran which should mostly emphasize on the practical information about control and prevention programs.

Background and Aim: Entonox was one of the important methods for pain management in the delivery process. In previous years some studies have assessed the effect of this method in Iran. In this regard, the aim of this study was to systematically review studies addressing the effect of Entonox for pain management in labor., Methods: This systematic review and meta-analysis study was conducted in 2016. The required data was collected using keywords such as "Entonox", "nitrous oxide", "vaginal delivery", "pain relief", "obstetric", "labor pain", and "labor analgesia", from databases including Google scholar, PubMed, Science Direct, Magiran, SID, and Scopus, and hand-searching of related and valid journals and references of articles. Articles published from 2000 to 2016 were searched. To conduct meta-analysis, CMA:2 (Comprehensive Meta-analysis) was used., Results: Finally, 14 articles were included in the study. Pain relief standard difference in mean between-groups was -1.01 (95% CI: -1.59 to -0.43, Q=148.5, df=8, p=0.02, I 2 =76) this difference was significant (p<0.05). The overall Apgar score standard difference in mean between-groups (Entonox vs. comparison) was 0.12 (95% CI: 0.01 to 0.23, Q=109.4, df=16, p=0.00, I 2 =85.3) this difference was significant (p<0.05). The results of mothers' satisfaction rate show that mothers in Entonox group has a high level of satisfaction rate., Conclusion: According to results of studies published in Iran, it seems that Entonox is an effective method for pain relief in vaginal delivery, as well as for improving infant Apgar score and mothers' satisfaction rate. Pain relief through Entonox can be used as a strategy for cesarean section reduction plan in Iran., Competing Interests: Conflict of Interest: There is no conflict of interest to be declared.

Introduction: Successful repair of composite restorations depends on a strong bond between the old composite and the repair composite. This study sought to assess the repair shear bond strength of aged silorane-based composite following surface treatment with Nd:YAG, Er,Cr:YSGG and CO2 lasers. Methods: Seventy-six Filtek silorane composite cylinders were fabricated and aged by 2 months of water storage at 37°C. The samples were randomly divided into 4 groups (n=19) of no surface treatment (group 1) and surface treatment with Er,Cr:YSGG (group 2), Nd:YAG (group 3) and CO2 (group 4) lasers. The repair composite was applied and the shear bond strength was measured. The data were analyzed using one-way analysis of variance (ANOVA) and Tukey posthoc test. Prior to the application of the repair composite, 2 samples were randomly selected from each group and topographic changes on their surfaces following laser irradiation were studied using a scanning electron microscope (SEM). Seventeen other samples were also fabricated for assessment of cohesive strength of composite. Results: The highest and the lowest mean bond strength values were 8.99 MPa and 6.69 MPa for Er,Cr:YSGG and control groups, respectively. The difference in the repair bond strength was statistically significant between the Er,Cr:YSGG and other groups. Bond strength of the control, Nd:YAG and CO2 groups was not significantly different. The SEM micrographs revealed variable degrees of ablation and surface roughness in laser-treated groups. Conclusion: Surface treatment with Er,Cr:YSGG laser significantly increase the repair bond strength of aged silorane-based composite resin.

Background: Due to extensive literature in the field of lung cancer and their heterogeneous results, the aim of this study was to systematically review of systematic reviews studies which reviewed the cost-effectiveness of various lung cancer screening and treatment methods., Methods: In this systematic review of systematic reviews study, required data were collected searching the following key words which selected from Mesh: "lung cancer", "lung oncology", "lung Carcinoma", "lung neoplasm", "lung tumors", "cost- effectiveness", "systematic review" and "Meta-analysis". The following databases were searched: PubMed, Cochrane Library electronic databases, Google Scholar, and Scopus. Two reviewers (RA and A-AS) evaluated the articles according to the checklist of "assessment of multiple systematic reviews" (AMSTAR) tool., Results: Overall, information of 110 papers was discussed in eight systematic reviews. Authors focused on cost-effectiveness of lung cancer treatments in five systematic reviews. Targeted therapy options (bevacizumab, Erlotinib and Crizotinib) show an acceptable cost-effectiveness. Results of three studies failed to show cost-effectiveness of screening methods. None of the studies had used the meta-analysis method. The Quality of Health Economic Studies (QHES) tool and Drummond checklist were mostly used in assessing the quality of articles. Most perspective was related to the Payer (64 times) and the lowest was related to Social (11times). Most cases referred to Incremental analysis (82%) and also the lowest point of referral was related to Discounting (in 49% of the cases). The average quality score of included studies was calculated 9.2% from 11., Conclusions: Targeted therapy can be an option for the treatment of lung cancer. Evaluation of the cost-effectiveness of computerized tomographic colonography (CTC) in lung cancer screening is recommended. The perspective of the community should be more taken into consideration in studies of cost-effectiveness. Paying more attention to the topic of Discounting will be necessary in the studies.

Background. This study evaluated the effect of two prophylaxis techniques on the marginal gap of CI V resin-modified glass-ionomer restorations. Methods. Standard Cl V cavities were prepared on the buccal surfaces of 48 sound bovine mandibular incisors in this in vitro study. After restoration of the cavities with GC Fuji II LC resin-modified glass-ionomer, the samples were randomly assigned to 3 groups of 16. In group 1, the prophylactic procedures were carried out with rubber cup and pumice powder and in group 2 with air-powder polishing device (APD). In group 3 (control), the samples did not undergo any prophylactic procedures. Then the marginal gaps were measured. Two-way ANOVA was used to compare marginal gaps at the occlusal and gingival margins between the groups. Post hoc Tukey test was used for two-by-two comparisons. Statistical significance was set at P < 0.05. Results. There were significant differences in the means of marginal gaps in terms of prophylactic techniques (P < 0.001), with significantly larger marginal gaps in the APD group compared to the pumice and rubber cup group, which in turn exhibited significantly larger marginal gaps compared to the control group (P < 0.0005). In addition, the means of marginal gaps were significant in terms of the margin type (P < 0.001), with significantly larger gaps at gingival margins compared to the occlusal margins (P < 0.0005). Conclusion. The prophylactic techniques used in this study had a negative effect on the marginal gaps of Cl V resin-modified glass-ionomer restorations.

Mental disorders have been shown to affect children's oral health. This study was carried out to investigate the oral health status, dental anxiety (DA), and behavior-management problems (BMPs) during dental treatment in 6- to 9-yr-old children with oppositional defiant disorder (ODD)/attention-deficit hyperactivity disorder (ADHD). The study and control groups included 40 children with ODD/ADHD and 80 normal children, respectively. All participants received an amalgam restoration. During the procedure, the children's behavior was assessed using the Frankl Rating Scale and the Verbal Skill Scale. Parents rated their children's DA using the parental version of the Children's Fear Survey Schedule-Dental subscale (CFSS-DS). Comorbid anxiety disorders were assessed using the Kiddie-Sads-Present and Lifetime Version questionnaire. Oral health status was assessed using the gingival index and the decayed, missing, and filled teeth score for permanent (DMFT) and primary (dmft) teeth. The findings showed that DA and BMPs were significantly higher in children with ODD/ADHD than in the controls. Furthermore, the frequency of DA and BMPs was higher in children with both ODD/ADHD and a comorbid anxiety disorder than in those without comorbid anxiety disorder. Children with ODD/ADHD had significantly higher DMFT/dmft scores than those in the control group, whereas the difference in gingival index was not statistically significant. In conclusion, children with ODD/ADHD had higher levels of DA, BMP and poorer oral health status., (© 2015 Eur J Oral Sci.)

Background: Dental traumas are common among children and adolescents in many societies posing health and social problems. The aim of this study was to conduct a systematic review and meta-analysis on prevalence, etiology, types, and other epidemiologic aspects of dental trauma in children and adolescents (0-18 years old)., Methods: In this systematic meta-analytical review, data were collected searching for key words including traumatic dental injuries, dental trauma, dental injury, dental trauma, tooth injuries, tooth trauma, traumatized teeth, dentoalveolar trauma, oral trauma, epidemiology, etiology, prevalence, incidence, occurrence, child*, and adolescence in the following databases: Scopus, CINAHL, Science Direct, PubMed and Google scholar., Results: From the total of 3197 articles, 44 completely relevant papers were included in the study. The prevalence of dental trauma was variable based on geographical area and was estimated 17.5% in the population, with higher prevalence in boys. Falling was the major cause for dental trauma, and the most frequent location was home. The most frequent type of trauma was enamel fracture., Conclusion: A relatively high prevalence was detected for dental trauma, which calls for effective planning and intervention to prevent the occurrence in children and adolescents. These may include special care for children, eliminating fall-prone areas, installing safety measures at homes, using protective appliances in sports, education, and raising the knowledge and availability of services to address enamel fracture. Region-specific criteria should be taken into account in programs and interventions.

Background: Oral cancer stands among the 10 top causes of cancer death in the world. Considering the role of epidemiologic information on planning and effective interventions, the present study aimed to investigate the epidemiology of oral cancer in Iran., Materials and Methods: The required information for this systematic review study was obtained from PubMed, Google Scholar, CINAHL,SID, Medlib, Magiran and Iranmedex databases, using key words "cancer", "oral cancer", "squamous cell carcinoma", "oral cavity carcinoma" and their Persian equivalents in combination with keywords of epidemiology, prevalence, etiology, frequency, and Iran from 1990 to 2014. From 1,065 related studies found, finally 25 were included to the study., Results: The mean age of 8,248 patients in 25 studies was 54.0±15.1 years. The male/female ratio for oral cancer was 1.91. Tongue with average percentage of 29.9 was the most involved site. Regarding microscopic grade, 65.7% of cases were grade 1. SCCs, accounting for an average of 70.0%, was the most common among all types of oral cancer. In the majority of studies, smoking including cigarette, hookah, and tobacco consumption was found to be a risk factor., Conclusions: The epidemiological pattern of oral cancer in Iran is somewhat similar to that of other countries. Yet the information on hand in this field is limited and considering the role of epidemiological data we suggest conducting more accurate studies to catch data that is required for effective programs and interventions.

Rationale, Aims and Objectives: This qualitative study was designed to determine the attitudes towards and experiences of medical students on evidence-based medicine (EBM)., Methods: The study was conducted using the phenomenological method. Medical students' attitudes about and experiences with evidence-based medicine were determined through semi-structured interviews. Forty senior medical students were chosen by purposive sampling from medical sciences students of Tabriz University and Shahid Beheshti University. The context of interviews was analysed using the content analysis method., Results: Medical students' attitudes and experiences were ascertained through four main questions, and their answers were divided in to 12 categories and 31 subcategories. According to the subjects of the study, two basic concepts that they understood about EBM were its being up to date and requiring research skills. To the question what is necessary for EBM, the students' answers were summarized as follows: access to information, teamwork and faculty members who could provide modeling and organizational support. Students reported having used EBM for problem solving, thinking and self-confidence. On the other hand, lack of equipment and facilities, human factors and organizational factors were considered the main barriers to EBM use., Conclusion: According to the results of this study, providing suitable conditions and appropriate planning to address identified barriers and encouraging students can promote EBM practice. Also, more extensive EBM integration in medical curricula and clinical settings by leading faculty members would prompt medical students to use EBM in their daily practice., (© 2014 John Wiley & Sons, Ltd.)

Background and aims. Anterior esthetic restoration is challenging in pediatric dentistry, due to limited durability and poor retention of the restoration.This study assessed the effect of air abrasion on tensile failure load of composite class III restorations using different preparation techniques. Materials and methods. 100 extracted human anterior primary teeth were divided, based on the preparation methods, into four groups each consisting of 25 subjects : conventional (A), labial surface bevel (B), conventional + air abrasion (C), and labial surface bevel + air abrasion (D). After restoring cavities, tensile failure load of samples was measured in Newton by Universal testing machine at a crosshead speed of 1 mm per minute. The data were analyzed by Kruskal-Wallis and Mann Whitney U tests using SPSS software. Results. There were statistically significant differences between groups A and C (P = 0.003), groups A and B (P & 0.001), groups A and D (P & 0.001), groups B and C (P = 0.028), groups B and D (P = 0.027), and also groups C and D (P& 0.001). Group D demonstrated the highest mean tensile failure load. Conclusion. Labial surface bevel treated by air abrasion showed significantly more retention of composite restoration.

Background and aims. A proper bond must be created between the existing composite resin and the new one for successful repair. The aim of this study was to compare the effect of three mechanical surface treatments, using diamond bur, air abrasion, and Er,Cr:YSGG laser, on the repair bond strength of the silorane-based composite resin. Materials and methods. Sixty cylindrical composite resin specimens (Filtek Silorane) were fabricated and randomly divided into four groups according to surface treatment: group 1 (control group) without any mechanical surface treatment, groups 24 were treated with air abrasion, Er,Cr:YSGG laser, and diamond bur, respectively. In addition, a positive control group was assigned in order to measure the cohesive strength. Silorane bonding agent was used in groups 14 before adding the new composite resin. Then, the specimens were subjected to a shear bond strength test and data was analyzed using one-way ANOVA and post hoc Tukey tests at a significance level of P &0.05. The topographical effects of surface treatments were characterized under a scanning electron microscope. Results. There were statistically significant differences in the repair bond strength values between groups 1 and 2 and groups 3 and 4 (P &0.001). There were no significant differences between groups 1 and 2 (P = 0.98) and groups 3 and 4 (P= 0.97). Conclusion. Surface treatment using Er,Cr:YSGG laser and diamond bur were effective in silorane-based composite resin repair.

Background and Aims: The aim of the present study was to systematically review fluoride concentration of drinking waters and prevalence of fluorosis in Iran through systematically evaluating results of studies conducted in this regard., Materials and Methods: In this systematic review study, the required data was collected using keywords including drinking water fluoride, fluoride concentration, Fluorosis, dent*, Iran*, and their Persian equivalents through PubMed, ScienceDirect, IranMedex, SID, MEDLIB, and Magiran databases. Out of 617 articles, 29 articles were finally considered after excluding the remaining articles which were not related to the study objectives. Following precise studying and extraction, the relevant data were summarized in extraction tables and analyzed manually. Excel 2007 software was used to draw diagrams., Results: 4434 samples of surface, ground, and tap water resources collected within 236 months during all seasons in 17 provinces of Iran were used in 29 articles determining fluoride concentrations of drinking water. Average fluoride concentration was estimated to be 0.43 ± 0.17 ppm with zero and 3.06 as minimal and maximal values. The least concentration was seen in tap water. Fluoride concentration of only three provinces was in accordance with the global standard. According to estimations, prevalence of fluorosis was 61% with only 1% as severe fluorosis., Conclusion: Despite lower than standard concentrations of fluoride in drinking water, a relatively high level of fluorosis was seen in Iran.

Background and aims. The aim of the present study was to compare the effect ofsurface treatment with Er; Cr:YSSG, Nd:YAG, and CO2 lasers on repair shear bond strength of a silorane-based composite resin. Materials and methods. Sixty eight cylindrical samples of a silorane-based composite resin (Filtek Silorane) were pre-pared and randomly divided into 4 groups as follows: group 1: without surface treatment; groups 2, 3 and 4 with surface treatments using Er; Cr:YSSG, Nd:YAG, and CO2 lasers, respectively. A positive control group (group 5) was assigned in order to measure cohesive strength. Repair shear bond strength values were measured and data was analyzed using one-way ANOVA and a post hoc Tukey test at a significance level of α=0.05. Results. There were statistically significant differences in repair shear bond strength values between group 2 and other groups (P < 0.05); and between group 1and groups 3and 4 (P < 0.001); however, there were no significant differences be-tween groups 3 and 4 (P = 0.91). Conclusion. The repair shear bond strength of silorane-based composite resin was acceptable by surface treatment with lasers.

Background and Aims: Considering the importance of disinfecting dentin after cavity preparation and the possible effect of disinfection methods on induction of various reactions between the tooth structure and the adhesive restorative material, the aim of the present study was to evaluate microleakage of composite resin restorations after disinfecting the prepared dentin surface with Nd:YAG and Diode lasers and photodynamic therapy., Materials and Methods: Standard Class V cavities were prepared on buccal surfaces of 96 sound bovine teeth. The samples were randomly divided into 4 groups based on the disinfection method: Group 1: Nd:YAG laser; Group 2: Diode laser; Group 3: photodynamic therapy; and Group 4: the control. Self-etch bonding agent (Clearfil SE Bond) was applied and all the cavities were restored with composite resin (Z100). After thermocycling and immersing in 0.5% basic fuchsin, the samples were prepared for microleakage evaluation under a stereomicroscope. Data was analyzed with Kruskal-Wallis and Wilcoxon signed-rank tests at P<0.05., Results: There were no significant differences in the microleakage of occlusal and gingival margins between the study groups (P>0.05). There were no significant differences in microleakage between the occlusal and gingival margins in the Nd:YAG laser group (P>0.05). In the other groups, microleakage at gingival margins was significantly higher than that at the occlusal margins (P<0.05)., Conclusion: Nd:YAG and Diode lasers and photodynamic therapy can be used to disinfect cavity preparations before composite resin restorations.

Aim: This study evaluated the effect of three different contamination removal methods on bond strength of one-step self-etching adhesive to dentin contaminated with an aluminum chloride hemostatic agent., Materials and Methods: One hundred noncarious adult molars were used in this study; 2-mm-thick dentin disks were prepared and randomly assigned to 5 groups (n = 20). Group I: control; group II: hemostatic agent-contaminated; group III: hemostatic agent-contaminated and rinsing with water; group IV: hemostatic agent-contaminated and ethylene diamine tetraacetic acid (EDTA) application; and group V: hemostatic agent-contaminated and phosphoric acid application. Clearfil S3 Bond was used to bond composite to dentin surfaces. Subsequent to adding composite cylinders the shear bond strength test was performed. Data were analyzed by one-way ANOVA and Tukey test. Two additional specimens from each group were prepared and evaluated under scanning electron microscope (SEM)., Results: There were statistically significant differences in bond strength among the groups (p < 0.001). In two-by-two comparisons statistically significant differences were observed in bond strength values between all the groups (p < 0.001) except for groups I and IV (p = 0.933)., Conclusion: Aluminum chloride hemostatic agent adversely affected the bond strength of self-etch adhesive to dentin. However, application of EDTA increased the bond strength to the level of normal dentin., Clinical Significance: EDTA and phosphoric acid removed aluminum chloride hemostatic agent contamination of dentin surfaces. However, unlike EDTA phosphoric acid failed to increase the bond strength of self-etch adhesive to dentin to the level of the control group.

Background and Aims: Infection control is an important issue in dentistry, and the dentists are primarily responsible for observing the relevant procedures. Therefore, the present study evaluated knowledge, attitude, practice, and status of infection control among Iranian dentists through systematic review of published results., Materials and Methods: In this systematic review, the required data was collected searching for keywords including infection, infection control, behavior, performance, practice, attitude, knowledge, dent*, prevention, Iran* and their Persian equivalents in PubMed, Science Direct, Iranmedex, SID, Medlib, and Magiran databases with a time limit of 1985 to 2012. Out of 698 articles, 15 completely related articles were finally considered and the rest were excluded due to lake of relev-ance to the study goals. The required data were extracted and summarized in an Extraction Table and were analyzed ma-nually., Results: Evaluating the results of studies indicated inappropriate knowledge, attitude, and practice regarding infection control among Iranian dentists and dental students. Using personal protection devices and observing measures required for infection control were not in accordance with global standards., Conclusion: The knowledge, attitudes, and practice of infection control in Iranian dental settings were found to be inadequate. Therefore, dentists should be educated more on the subject and special programs should be in place to monitor the dental settings for observing infection control standards.