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Background:  The shape of the forehead is primarily determined by the frontal bone, which holds significance for health and aesthetics. This study evaluated the morphology of the frontal bone in different age groups and genders using computed tomography (CT)., Methods:  This cross-sectional study was conducted on CT scan results of 220 patients divided into three age groups: 20-29.27, 29.27-47.54, and 47.54-95 years. The investigation explored the lower and upper angles compared with the Sella-Nasion (SN) line, the maximum frontal projection with Nasion in the SN plan, and the variations in frontal thickness across different angles (15, 30, 45, 60, 75, and 90 degrees) relative to the SN plane. All data were analyzed using R software, considering the significance level p  < 0.05., Results:  Of 220 patients, 119 were men, and the mean age of the participants was 41.09 ± 18.06 years. The average upper frontal slope (UFS) angle was 56.96 ± 8.17 degrees, which was 59.35 ± 7.92 degrees in females and 54.94 ± 7.86 degrees in males. The mean lower frontal slope (LFS) angle was 86.30 ± 7.96 degrees, which was 90.71 ± 6.67 degrees in females and 82.55 ± 7.00 degrees in males. The average contour nasion (C-N) distance was 7.51 ± 3.72 mm. Also, the frontal thickness at an angle of 15 degrees had the highest value of 13.08 ± 2.68 mm and at 30 degrees had the lowest value of 5.81 ± 1.56 mm. A significant difference was observed between the UFS and LFS among males and females ( p  < 0.001). Across all age groups, men exhibited a steeper angle, indicating a greater posterior inclination than women. Moreover, males with upper ages reported a significant increase in C-N distance and frontal projection ( p  < 0.05)., Conclusion:  Our findings emphasize the importance of considering gender-specific variations in frontal bone structure when planning cosmetic or reconstructive procedures involving the forehead., Competing Interests: None declared., (Thieme. All rights reserved.)

Objectives: Understanding the shape and size of the sella turcica may help predict future orthodontic treatment needs related to skeletal malocclusion. This study aims to assess different morphological types of the sella turcica in lateral cephalometric radiographs and its correlation with malocclusion, as well as the relationship between gender and linear measurements of sella turcica., Materials and Methods: The lateral cephalometric radiographs of 410 volunteers (111 men and 299 women) aged 8 to 30 years were evaluated. The patients were divided into three groups based on their skeletal growth patterns (cl I, II, and III). Then the anatomical shape and linear dimensions of sella turcica were assessed. Measurements were made using Adobe Photoshop Version: 20.0.0 software, and data analysis was performed by IBM SPSS Statistics version 25., Results: The following morphologies were observed: normal (37.8%), oblique anterior wall (9.3%), double contour of the floor (21.5%), sella turcica bridge (8.8%), irregularity (notching) in the posterior part of sella turcica (16.6%), and pyramidal shape of the dorsum sellae (6.1%). No statistically significant relationship was found between sella turcica variations and skeletal malocclusion. The correlation between female sex with the diameter (p=0.027) and depth values (p=0.035) of sella turcica was statistically significant. There was no statistically significant difference (p>0.05) in length based on gender., Conclusion: The most morphological type reported was normal sella turcica (37.8%). Anatomical variations of sella turcica had no association with malocclusion. The most considerable depth and diameter of sella turcica were found in women., Competing Interests: Conflicts of Interest: The authors declare no conflict of interest., (University of Zagreb School of Dental Medicine.)

Background: The transcutaneous electrical nerve stimulation (TENS) stimulus inhibits the activity of nociceptive neurons of the central nervous system. Pain relief is achieved by increasing the pulse amplitude of TENS to induce a non-painful paranesthesia beneath the electrodes. This study aimed to assess the effect of TENS on acute pain, edema, and trismus after surgical removal of impacted third molars., Material and Methods: This randomized, double blind, split-mouth clinical trial was conducted on 37 patients with bilaterally impacted mandibular third molars. The angle and body of mandible at the site of surgery in one randomly selected quadrant underwent TENS immediately after surgery (50 Hz, 100-µs short pulse, 15 minutes for 6 days). The TENS stimulator device was used in off mode for the placebo quadrant. The pain score (primary outcome) was measured for 7 days postoperatively, and edema and trismus (secondary outcomes) were assessed at 2, 4 and 7 days, postoperatively. The results were analyzed by repeated measures ANOVA using R software (alpha=0.05)., Results: The overall mean pain score was significantly lower in the TENS than the placebo group (P<0.05). The number of taken analgesics in the first 3 days was significantly lower in the TENS group (P<0.001). Postoperative edema in the TENS group was lower than the placebo group but only the difference was not statistically significant (P>.05). The inter-incisal distance, as an index to assess trismus, was not significantly different between the two group at day 2, but it was significantly higher in the TENS group after the second day (P<0.001)., Conclusions: TENS effectively decreased pain and trismus following impacted third molar surgery, and may be recommended as a non-pharmaceutical method to relieve postoperative symptoms.

This study aimed to assess the relationship between skeletal malocclusion and radiomorphometric indices of the mandible in long face patients. This cross-sectional study evaluated 174 lateral cephalograms and panoramic radiographs of long face patients between the ages of 17 and 30 presenting at the Orthodontics Department of Qazvin Dental School. The gonial angle, antegonial angle, type of antegonial notch, and depth of antegonial notch were measured bilaterally on panoramic radiographs. The correlation between the radiomorphometric parameters and the type of occlusion was analyzed using one-way ANOVA, independent t -test, Chi-square test, and Fisher's exact test (alpha = 0.05). The mean size of gonial angle was significantly different among the three classes of occlusion ( p = 0.046), while the difference was not significant regarding the antegonial angle size and antegonial notch depth ( p > 0.05). An independent t -test showed that the mean sizes of gonial angle ( p = 0.026) and antegonial angle ( p = 0.036), and the antegonial notch depth ( p = 0.046) in males, were significantly greater than the values in females. According to the Chi-square and Fisher's exact test, the right antegonial notch type was significantly different among the three classes of malocclusion ( p = 0.006), while this difference was not significant in the left side ( p = 0.318). The right antegonial notch type II was more common in males, while the right antegonial notch type I was more common in females ( p = 0.014). According to the results, the indices of gonial angle and type of antegonial notch can be clinically useful for predicting the growth rate of the mandible and designing the appropriate treatment in long face patients.

Background: Orthodontic treatment planning for an impacted canine tooth requires accurate information about its position. The aim of this study was to compare the diagnostic accuracy of two conventional orthodontic radiographic modalities with cone-beam computed tomography (CBCT) for localization of impacted maxillary canine teeth., Materials and Methods: Panoramic radiographs, lateral cephalograms, and CBCT scans of 30 patients with unilaterally impacted maxillary canine teeth were retrieved from the archives. Eight expert orthodontists evaluated the parameters related to the location of impacted canine teeth by using panoramic radiographs and lateral cephalograms of patients. After 4 weeks, the same parameters were evaluated on CBCT scans of patients. The diagnostic accuracy of conventional modalities and CBCT was compared with each other and also with the gold standard., Results: The conventional radiographic modalities and CBCT had similar accuracy for assessment of the overall inclination ( p  = 0.11), apex morphology ( p  = 0.18), and mesiodistal position of the apex ( p  = 0.12). CBCT had significantly higher accuracy for determination of incisal tip location ( p  = 0.001), labiopalatal ( p  = 0.001) and vertical ( p  = 0.01) position of the crown tip, minimum bone thickness covering the crown ( p  = 0.001), and root resorption of the adjacent tooth ( p  = 0.001)., Conclusion: The combination of panoramic radiographs and lateral cephalograms was sufficiently accurate to assess some diagnostic parameters such as overall inclination, apex morphology, and mesiodistal apex location of impacted canine teeth., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: This study aimed to assess the effect of premolar extraction and anchorage type for orthodontic space closure on upper airway dimensions and position of hyoid bone in adults by cephalometric assessment., Methods: This retrospective study was conducted on 142 cephalograms of patients who underwent orthodontic treatment with premolar extraction in four groups of (I) 40 class I patients with bimaxillary protrusion and maximum anchorage, (II) 40 class I patients with moderate crowding and anchorage, (III) 40 class II patients with maximum anchorage, and (IV) 22 skeletal class III patients with maximum anchorage. The dimensions of the nasopharynx, velopharynx, oropharynx, and hypopharynx, and hyoid bone position were assessed on pre- and postoperative lateral cephalograms using AudaxCeph v6.1.4.3951 software. Data were analyzed by the Chi-square test, paired t-test, and Pearson's correlation test (alpha = 0.05)., Results: A significant reduction in oropharyngeal, velopharyngeal, and hypopharyngeal airway dimensions was noted in groups I, III, and IV ( P  < 0.001), which was correlated with the magnitude of retraction of upper and lower incisors ( r  = 0.6 - 0.8). In group II, a significant increase was observed in oropharyngeal and velopharyngeal dimensions ( P  < 0.001). A significant increase in nasopharyngeal dimensions occurred in all groups ( P  < 0.001). Also, in groups I and III, the position of hyoid bone changed downwards and backwards, which was correlated with reduction in airway dimensions ( r  = 0.4 - 0.6)., Conclusion: According to the present results, extraction orthodontic treatment affects upper airway dimensions and hyoid bone position. Maximum anchorage decreases airway dimensions while moderate anchorage increases airway dimensions., Competing Interests: The authors declare there are no competing interests., (©2023 Mortezai et al.)

This study aimed to assess the relationship of the morphology and size of the sella turcica (ST) with dental anomalies and skeletal malocclusions. This cross-sectional study was conducted on records of fixed orthodontic patients treated between 2013 and 2022. Cephalometric analysis was performed to determine the anteroposterior and vertical skeletal patterns. Preoperative panoramic radiographs and lateral cephalograms, intraoral photographs, and primary dental casts of patients were used to detect dental anomalies. Gender, sagittal and vertical skeletal patterns, dental anomalies, and dimensions (length, depth, and diameter), and morphology of the ST were all recorded according to the lateral cephalograms of patients. Data were analyzed using independent t-test, one-way and two-way ANOVA, Chi-square test, and log rank test (alpha = 0.05). The depth and diameter of the ST had no significant correlation with gender ( p > 0.05); however, the length of the ST was significantly longer in males than females ( p < 0.05). The morphology of the ST had a significant correlation with gender ( p < 0.05). The ST morphology had a significant correlation with the anteroposterior skeletal pattern, microdontia, and tooth impaction as well ( p < 0.05). The present results revealed a significant correlation of the ST morphology with the anteroposterior skeletal pattern, microdontia, and tooth impaction.

Objectives: Due to the emphasis on the protective and antimicrobial role of Nitric Oxide against gastrointestinal diseases, investigating its relationship with dental caries is a right topic. Therefore, this research has investigated the amount of saliva Nitric Oxide in different volumes of DMFT indicator in adults., Material and Methods: In this descriptive- analytical cross-sectional study, 80 participants (20-35 years old), without a history of systemic disease and drug use participated as research samples, (53.8% of the participants in the study were women). Participants were selected from patients who had visited dental Department. The participants were divided in four groups based on DMFT (DMFT=0, 1≤DMFT≤3, 3

This study aimed to assess the qualitative changes in the saliva during the process of primary teeth eruption. This cross-sectional study was conducted on 147 children from 2 to 48 months, of which 49 were in group A (no erupted primary teeth), 53 were in group B (at least one active erupting primary tooth), and 45 were in group C (eruption of all 20 primary teeth was completed). Salivary proteins were evaluated by sodium dodecyl sulfate electrophoresis with polyacrylamide gel, while the concentrations of salivary sodium, potassium, chloride, and calcium ions were evaluated by ion selective electrodes. The data were analyzed using ANOVA and Bonferroni tests (alpha = 0.05). The concentration of proteins with molecular weights of 20-30 KDa was significantly higher in group A, and it gradually decreased with age. The concentration of proteins with molecular weights of 50-60 KDa in group B was significantly lower than those of groups A and C. The calcium ion concentration in group A was significantly higher than that of the other groups. The concentration of potassium ions was minimal in group C. The proteins and electrolyte profiles of the subjects' saliva changed in the process of primary tooth eruption. The highest concentrations of proteins such as statherin, histatin, P-B peptide, and cystatin and the lowest concentrations of proteins such as amylase were present in group B.

Gender determination is the first step in forensic identification, followed by age and height determination, which are both affected by gender. This study assessed the accuracy of gender estimation using mandibular morphometric indices on panoramic radiographs of an Iranian population. This retrospective study evaluated 290 panoramic radiographs (145 males and 145 females). The maximum and minimum ramus width, coronoid height, condylar height, antegonial angle, antegonial depth, gonial angle, and the superior border of mental foramen were bilaterally measured as well as bicondylar and bigonial breadths using Scanora Lite. Correlation of parameters with gender was analyzed by univariate, multiple, and best models. All indices except for gonial angle were significantly different between males and females and can be used for gender determination according to univariate model. Condylar height, coronoid height, and superior border of mental foramen and ramus were still significantly greater in males than in females after controlling for the effect of confounders ( p < 0.05). Based on the best model, a formula including five indices of bicondylar breadth, condylar height, coronoid height, minimum ramus width, and superior border of mental foramen was used for gender determination. Values higher than 56% indicate male gender, while lower values indicate female gender, with 81.38% specificity for correct detection of females and 88.97% sensitivity for correct detection of males. Despite the satisfactory results, future research should focus on larger populations to verify the accuracy of the present findings.

Background: Normal airways are a key factor during the craniofacial growth of the young. Therefore, sleep-disordered breathing (SDB) without treatment can have harmful consequences for development and health., Objectives: This study aimed to evaluate the cephalometric characteristics in non-snoring individuals and snoring subjects, and investigate differences in the pharyngeal airway space between the 2 groups., Material and Methods: This case-control study included 70 patients aged over 18 years, selected from a radiology center. The patients were divided into 2 groups: case (35 patients with a history of habitual snoring); and control (35 healthy patients). The Berlin sleep questionnaire was administered to the parents of the patients. The nasopharyngeal airway was measured according to the analysis of Linder-Aronson (1970), and 4 indices were measured and analyzed in each of the lateral cephalometric radiographs., Results: No statistically significant differences were observed in the pharyngeal measurements between the 2 groups, although all means in the control group were higher than in the experimental group. However, there was a significant relationship between gender and the Ba-S-PNS and PNS-AD2 indices., Conclusions: Although the patients with nocturnal snoring had smaller airway dimensions, their pharyngeal measurements were not significantly different from the control group.

Introduction: A sealer's ability to effectively and stably penetrate the dentinal tubules is an essential factor for selecting an effective root canal obturation material. Evaluation of the sealers' penetration into the dentinal tubules provides valuable data in the endodontic treatment outcome., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study aimed to compare the accuracy of three types of apex locators versus digital radiography for working length (WL) determination. This experimental study was conducted on 58 extracted maxillary premolars. The teeth were decoronated, the access cavity was prepared, and WL was determined using a #15 K-file to serve as reference. The WL was then measured by Woodpex V, Woodpex III, and Root ZX apex locators in the presence of 0.9% saline, and also on a photostimulable phosphor plate (PSP) digital radiograph taken by the parallel technique. The values were compared with the actual WL using the paired t-test (alpha = 0.05). Digital radiography, Root ZX, Woodpex V, and Woodpex III determined the WL within ±0.5 mm from the actual value in 84.48%, 100%, 89.66%, and 87.93% of the cases, respectively. Woodpex V (p = 0.039), Woodpex III (p = 0.001), and Root ZX (p = 0.001) significantly over-estimated the WL. The WL measured on digital radiographs was not significantly different from the actual WL (p = 0.213). The position of the apical foramen (central/lateral) had no significant effect on the accuracy of WL determination by different techniques (p >0.05). Within the limitations of this in vitro study, all the tested modalities showed acceptable accuracy for WL determination in maxillary premolars.

This study assessed the relationship between posterior permanent dentition and radiographic changes of the mandibular condyle. This descriptive, cross-sectional study was conducted on 300 panoramic radiographs of patients over 40 years of age (188 females and 112 males). Panoramic radiographs were evaluated for condylar changes such as flattening, subcortical sclerosis, subcortical cyst, erosion, osteophytes, and generalized sclerosis. Presence of muscle pain and temporomandibular joint (TMJ) pain and sounds, and history of TMJ trauma were also assessed. The occlusal scheme of posterior teeth was analyzed according to the Eichner's index. The frequency of condylar changes was calculated in the right and left sides, and their association with posterior permanent dentition was analyzed by the Chi-square test (alpha = 0.05). The frequency of flattening, muscle pain, TMJ sounds, and erosion was 11.7%, 9.7%, 5.7%, and 3.7% in the right side, respectively. The frequency of flattening, muscle pain, erosion, and subcortical cyst was 12%, 9.3%, 5%, and 5% in the left side, respectively. The frequency of bilateral muscle pain, flattening, TMJ sounds, and TMJ pain was 18%, 16.7%, 11.7%, and 9.3%, respectively. Cases with TMJ trauma, generalized sclerosis, and osteophytes were few. According to the Eichner's index, most patients with condylar changes had classes A and B, and a smaller percentage had class C. No significant difference was noted between healthy individuals and those with condylar changes regarding dentition patterns. No relationship existed between condylar changes and posterior permanent dentition pattern.

Objective: Effective tools and methods are applied during root canal retreatment to eliminate root canal obturation materials and preserve the initial root canal anatomy. The present study compared the efficacy of Reciproc, Neoniti, ProTaper, and Hedstrom files in the retreatment of curved root canals., Material and Methods: In the present in vitro study, 100 root canals with 25‒45º curvatures were used. After the samples were initially prepared and examined by CBCT, the root canals were obturated with gutta-percha and randomly assigned to four groups (n=25). A retreatment was carried out in each group with NeoNiTi, ProTaper, Reciproc, and Hedstrom files. CBCT examinations were carried out again under the same conditions. The samples were evaluated at 3-, 6-, and 9-mm distances from the apex on the first and the second CBCT image for root canal transportation and remaining gutta-percha in the root canals. The time required for retreating each canal in each sample was recorded. One-way ANOVA and corresponding non-parametric tests were applied for data analysis., Results: The root canal transportation in the NeoNiTi group was lower than that in the other groups and significantly different from the ProTaper group (P<0.05). There was a remaining gutta-percha after retreatments in all the four groups, which was not statistically significant (P>0.05)., Conclusion: Despite the fact that the NeoNiTi file produced less transportation than other file systems evaluated in the retreatment of curved root canals, all the files were very effective at the clinically acceptable levels., Competing Interests: Conflict of interest The authors declare no conflict of interest

Introduction: Pimpinellaanisum is a medicinal plant with antimicrobial, antifungal, and anti-oxidative properties. Limited studies have assessed the antibacterial properties of Pimpinellaanisum on oral and dental pathogens., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The pattern of expansion of endodontic lesions in the jaws has been less commonly addressed in the literature. For this reason, the aim of this study is to assess the pattern of endodontic lesions of maxillary and mandibular posterior teeth using cone-beam computed tomography (CBCT). This cross-sectional study was conducted on 317 endodontic lesions of posterior teeth on CBCT scans retrieved from a radiology center in Qazvin, Iran, from 2020 to 2022. Endodontic lesions were assessed on sagittal, coronal, and axial sections by an endodontist and dental student using the Romexis software. The largest lesion diameter was measured occluso-apically, mesiodistally, and buccolingually. Lesion size was analyzed based on age, gender, jaw, tooth type, and presence/absence of root filling by independent samples t-tests and a one-way Analysis Of Variannce (ANOVA). The largest diameter of lesions in the maxilla and mandible was recorded in the occluso-apical dimension followed by buccolingual and mesiodistal dimensions (p > 0.05). The pattern of lesions was the same in teeth with and without endodontic treatment, but it was significantly different in maxillary and mandibular endodontically treated teeth in the occluso-apical and buccolingual dimensions (p < 0.05). No significant correlation was noted with tooth type or jaw except for maxillary and mandibular first molar lesions, which were significantly different in the occluso-apical dimension (p < 0.05). Lesion size in all three dimensions was significantly greater in males than females (p < 0.05), and was the highest in the occluso-apical dimension in both genders. In the maxilla, the mean lesion size significantly decreased in the mesiodistal dimension with age (p < 0.05). In conclusion, the largest lesion diameter in the maxilla and mandible was found in the occluso-apical dimension, indicating the role of bone density in the pattern of lesions.

This study assessed the correlation of radiomorphometric indices of the mandible and mandibular angle fractures (MAFs) in an Iranian population. This retrospective study was conducted on 3D computed tomography (CT) scans of 118 patients between 18 to 60 years. The images were divided into two groups with MAFs and other types of mandibular fractures (non-MAF). The gonial angle, ramus height, condylar neck width, minimum ramus width, and mandibular length were all measured using MARCO PACS software. Age, gender, and presence and eruption status of third molar at the fracture side were all recorded. The correlation between these parameters and MAF was analyzed using R software (alpha = 0.05). Of all patients, 41 samples had MAF. The two groups were not significantly different regarding the mean age and gender (P > 0.05). The mean size of gonial angle and ramus height in the MAF group were significantly larger, and smaller than the corresponding values in the non-MAF group, respectively (P < 0.001). The median minimum ramus width in the MAF group was significantly smaller than that in the non-MAF group (P = 0.001). Patients with a large gonial angle had 6.6 times higher odds of MAF compared with other fracture types (P = 0.046). Condylar neck width, mandibular length, and erupted third molars had no significant correlation with type of fracture. Presence of impacted third molar increased the odds of MAF by 5.55 times. Patients with a large gonial angle, short ramus height, minimum ramus width, and impacted third molar are more susceptible to MAF. Surgeons can use these indices to predict the risk of MAF in trauma patients with such facial characteristics, and make a diagnosis by radiographic modalities., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors.)

Rehabilitation of an edentulous posterior maxilla with dental implants is challenging, and sinus floor augmentation could be considered as an important surgical procedure for bone augmentation in this region before implant placement. Platelet-rich fibrin (PRF) is a new-generation platelet concentrate with simplified processing: its application in sinus floor augmentation has been widely investigated in literature. However, the biological properties and actual efficacy of this product remain controversial. This study assessed the effect of sinus floor augmentation with PRF versus freeze-dried bone allograft (FDBA) on stability of one-stage dental implants. This split-mouth randomized clinical trial evaluated 10 patients who required bilateral sinus floor augmentation. PRF and L-PRF membrane were used in one quadrant while FDBA and collagen membrane were used in the other quadrant. Implant stability was assessed by resonance frequency analysis (RFA) immediately, and 2, 4, and 6 months after implant placement. The implant stability quotient (ISQ) was compared over time and between the two groups using repeated measures ANOVA and independent sample t-test. The mean ISQ significantly increased over time in both groups (p < 0.001). The increase was greater in the PRF group (p < 0.05). Within the limitations of this study, PRF yielded superior results compared with FDBA regarding the stability of one-stage dental implants.

Background: Familiarity with the anatomy of the arteries in the sinus wall is essential to prevent the perforation of the sinus membrane and bleeding during dental implant surgery., Objectives: The aim of the study was to evaluate the anatomical position of the posterior superior alveolar artery (PSAA), using cone-beam computed tomography (CBCT)., Material and Methods: A total of 245 CBCT scans met the eligibility criteria for this cross-sectional study. The vertical distance from the lower border of the artery to the lower border of the sinus floor, the diameter of the artery, and the type of artery (intrasinusoidal, intraosseous or superficial) in the first and second premolar and molar regions were measured. The data was analyzed with the t tests, the one-way analysis of variance (ANOVA) and the χ2 tests., Results: The maxillary PSAA was recognized in 187 (76.3%) scans. The mean distance between the artery and the floor of the sinus was 6.87 ±3.68 mm. The mean diameter of the artery was 1.37 ±0.61 mm. The greatest mean diameter of the artery was observed in the second premolar region, and the smallest in the first molar region. As many as 63.6% of the arteries were intraosseous, 28.9% intrasinusoidal, and 7.5% superficial., Conclusions: Due to the high prevalence of the intraosseous type, in most cases of sinus lift surgery there is an increased possibility of PSAA damage. As the largest diameter of the artery was observed in the second premolar region, the possibility of severe bleeding during sinus lift surgery in this area is increased. The average distance between the artery and the floor of the sinus was approx. 7 mm. Consequently, it is recommended that the lower border of the sinus access window should be as high as 7 mm to the floor of the sinus.

Objectives: The present study evaluated the association of fear of COVID-19 with dental anxiety, oral health-related quality of life (OHRQoL), and psychological distress (depression, anxiety and stress), as well as exploring the mediating role of dental anxiety in the association of fear of COVID-19 with OHRQoL and psychological distress., Methods: A cross-sectional study was conducted among adolescents in high schools of Qazvin city (Iran) from March-June 2021, recruited through a two-stage cluster sampling method. All the adolescents completed a self-administered survey assessing (i) fear of COVID-19, (ii) depression, anxiety and stress, (iii) OHRQoL, and (iv) dental anxiety. Structural equation modelling was used to evaluate all the hypothesised associations, and the model fit was estimated., Results: A total of 2429 adolescents participated in the study. The conceptual model fitted the data well. Fear of COVID-19 had a direct effect on dental anxiety (B = 0.316; bias-corrected bootstrapping 95% CI = 0.282, 0.349), depression (B = 0.302; bias-corrected bootstrapping 95% CI = 0.259, 0.347), anxiety (B = 0.289; bias-corrected bootstrapping 95% CI = 0.246, 0.334), stress (B = 0.282; bias-corrected bootstrapping 95% CI = 0.237, 0.328), and OHRQoL (B = -0.354; bias-corrected bootstrapping 95% CI = -0.530, -0.183). Also, dental anxiety mediated the association of fear of COVID-19 with depression, anxiety stress, and OHRQoL., Conclusions: High levels of fear of COVID-19 were associated with high levels of dental anxiety and poorer OHRQoL. Moreover, fear of COVID-19 was positively associated with anxiety, depression and stress. Increased levels of dental anxiety were also associated with increased anxiety, stress, depression, and poorer OHRQoL., (© 2022. The Author(s).)

Background and Aims: Considering the advantages of rotary files in instrumenting the root canals of permanent teeth and a lack of adequate data on the use of these systems in primary teeth, the present study aimed to evaluate two rotary files and compare them with hand files in the cleaning efficacy of the root canals of primary molar teeth., Materials and Methods: In the present study, three groups of teeth were prepared with Kedo-S paediatric rotary file system, RaCe (reamer with alternating cutting edges), and hand files (n = 40). The groups were evaluated under a stereomicroscope concerning the cleaning efficacy of the files after cleaning the teeth in the apical, middle, and coronal thirds. The data were analyzed with SPSS 24 (IBM Corporation, USA, 2016) using Fisher's exact test and chi-squared test; statistical significance was set at p < 0.05., Results: There were no significant differences in the apical and middle thirds between the different study groups. However, there were significant differences in the coronal third between the hand file and Kedo-S ( p = 0.016) and RaCe and Kedo-S ( p = 0.001) groups., Conclusions: The present study showed that Kedo-S files were more effective than RaCe and hand files in the coronal area than the hand and RaCe files., Competing Interests: The authors declare no conflict of interest. LT is serving as one of the Editorial Board members of this journal. We declare that LT had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to MG., (© 2022 The Author(s). Published by IMR Press.)

Objective: Recurrent aphthous stomatitis (RAS) is a highly prevalent painful inflammatory condition. Curcumin is currently used as a medicinal herb with optimal anti-inflammatory properties for many inflammatory conditions. However, due to its low water solubility and consequently low bioavailability, its nanoparticulate formulation has been considered for use. This study aimed to compare the efficacy of topical application of 1% curcumin nanomicelle gel and 2% curcumin gel for treatment of RAS., Methods: This double-blind randomized clinical trial evaluated 48 RAS patients. The patients randomly received 1% curcumin nanomicelle gel or 2% curcumin gel, and were asked to apply it 3 times/day for 1 week. The severity of pain was measured using a visual analog scale (VAS), and the size of lesions (in millimeters) was measured by a periodontal probe before (baseline), and at 4, and 7 days after treatment. Data were analyzed by repeated measures ANOVA., Results: No significant difference was noted in the pain score (P = .160) or size of lesions (P = .432) between the 2 groups at baseline. At 7 days, the pain score and size of lesions significantly decreased in both groups (P < .05). The reduction in pain score and lesion size was significantly greater in the curcumin nanomicelle gel group at both 4 and 7 days (P < .05). Also, the efficacy index (EI) was higher in curcumin nanomicelle gel group., Conclusions: The 1% curcumin nanomicelle gel can be effectively used to enhance the healing of RAS., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Early diagnosis of oral cancer is critical to improve the survival rate of patients. The current strategies for screening of patients for oral premalignant and malignant lesions unfortunately miss a significant number of involved patients. Optical coherence tomography (OCT) is an optical imaging modality that has been widely investigated in the field of oncology for identification of cancerous entities. Since the interpretation of OCT images requires professional training and OCT images contain information that cannot be inferred visually, artificial intelligence (AI) with trained algorithms has the ability to quantify visually undetectable variations, thus overcoming the barriers that have postponed the involvement of OCT in the process of screening of oral neoplastic lesions. This literature review aimed to highlight the features of precancerous and cancerous oral lesions on OCT images and specify how AI can assist in screening and diagnosis of such pathologies., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Kousar Ramezani and Maryam Tofangchiha.)

(1) Background: The present study aimed to examine the psychometric properties of the Persian adaptation of the Modified Dental Anxiety Scale (MDAS) in Iranian adolescents. (2) Methods: Adolescents with a mean age of 15.10 (n = 3197; 47.1% males) were recruited from Qazvin city of Iran using a stratified cluster random sampling technique. All children completed the five-item Persian MDAS and information related to background characteristics. Psychometric testing was conducted using classical test theory (CTT) and Rasch models. For CTT, an item-total correlation of >0.4 was considered satisfactory while for Rasch analysis, infit and outfit mean squares (Mnsq) ranging from 0.5-1.5 were considered satisfactory. Confirmatory Factor Analysis (CFA) was conducted to confirm the unidimensional structure of MDAS using various fit indices. Differential item functioning (DIF) was evaluated based on gender and time since last dental visit. Moreover, latent class analysis (LCA) was used to classify the participants into different levels of dental fear based on their pattern of responses. Both item level reliability using Cronbachs alpha (α) and test-reliability using intraclass correlation coefficients were evaluated. (3) Results: Item-total correlations ranged from 0.69-0.78, infit MnSq ranged from 0.80 to 1.11 and the range of outfit MnSq was 0.84-1.10. The data confirmed a one-factor structure of MDAS with satisfactory fit indices. DIF analysis indicated that the scale was interpreted similarly across the genders and time since dental visit groups. LCA analysis identified three levels, low, moderate and high levels of dental anxiety. The groups with moderate and high levels of dental anxiety had more females (44.6% and 36.7%) than the group with low level of dental anxiety (18.8%; p < 0.001). α of the total scale was 0.89 and item test-retest reliability ranged from 0.72-0.86. (4) Conclusions: The Persian MDAS was unidimensional with satisfactory psychometric properties evaluated using both CTT and Rasch analysis among Iranian adolescents. The scale was stable across the genders and individuals with different dental visiting patterns. The Persian MDAS also demonstrated excellent reliability.

The aim of the present study was to assess the positive predictive value (PPV) of panoramic radiographic signs in the assessment of the relationship between impacted mandibular third molars (IMTMs) and the mandibular canal (MC). This cross-sectional study was conducted by reviewing 102 cone-beam computed tomography (CBCT) and panoramic radiographs of patients with IMTMs and radiographic signs of the contact of the IMTMs with the MC on panoramic radiographs (i.e., root apex darkening and interference with the white line). A positive relationship of the IMTM roots with the MC based on CBCT findings was recorded as the gold standard. The PPV of panoramic radiographic signs was calculated for the detection of the relationship of the IMTM root with the MC. The IMTMs were in contact with the MC on CBCT scans in 90.1% of the cases. The PPV of root apex darkening and the interference with the white line was found to be 89.09% (95% CI: (77.75, 95.88)) and 91.48% (95% CI: (79.62, 97.63)), respectively. The MC had a buccal position in 63.7%, and a lingual position in 35.2%, of the cases. The contact of IMTMs with the MC was more commonly seen in patients with a lingual position (100% of the samples). The IMTM root apex darkening and interference with the white line of the MC on panoramic radiographs had a high PPV for determination of the contact of IMTMs with the MC. Thus, presence of the above-mentioned risk factors indicates the need for subsequent 3D radiographic assessments.

Objectives: This study aimed to assess the radiographic position of impacted mandibular third molars (IMTMs) and their association with pathological conditions., Materials and Methods: The impaction depth, relationship with ramus, and angulation of 1600 IMTMs and their association with 2 nd molar distal caries and root resorption, pathological conditions, and proximity to the mandibular canal were evaluated on panoramic radiographs. The IMTM position was determined based on the depth of impaction according to the Pell and Gregory classification, relationship with ramus according to the Pell and Gregory classification, and angulation according to the Winter's classification. The classical and Bayesian logistic regressions were applied to analyze the effect of IMTM position on the associated complications using the odds ratio (OR) and 95% confidence interval (credible interval for Bayesian models). Two-tailed P value < 0.05 was considered statistically significant., Results: Of 1600 IMTMs evaluated in this study, 195 (12.2%), 252 (15.8%), and 119 (7.4%) had caused second molar distal caries, second molar root resorption, and pathological lesions, respectively, and 872 (54.5%) had contact with the mandibular canal. Impaction angulation was a risk factor for second molar distal caries (maximum OR = 5.01, 95% CI: 3.12-8.18). Changed angulation and greater impaction depth were the risk factors for second molar root resorption (minimum OR = 1.64, 95% CI: 0.58-4.02). Decreased distance between the ramus and distal side of the second molar was a risk factor for associated pathological lesions (minimum OR = 2.73, 95% CI: 1.79-4.25). Mesioangular and horizontal angulations and greater impaction depth were the risk factors for contact with the mandibular canal (maximum OR = 3.44, 95% CI: 2.6-4.57 and minimum OR = 1.3, 95% CI: 094-1.8)., Conclusions: The frequency of complications associated with IMTMs was low, but considerable. The occurrence of these conditions might be affected by the impaction position. Thus, regular follow-ups are recommended in order to be able to surgically intervene when the first signs of pathologies arise., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2021 Zahra Haddad et al.)

Objective: The purpose of this study was to identify which diagnostic parameters related to impacted maxillary canines can be reliably detected by the conventional orthodontic radiographic modalities and which factors need to be assessed by cone-beam computed tomography (CBCT)., Design: In this cross-sectional study, 8 orthodontists evaluated 7 parameters related to the position and anatomy of the impacted canines by means of 2-dimensional (2D) records. After 1 month, the same process was repeated by means of CBCT by the same clinicians., Setting: Qazvin University of Medical Sciences., Patients and Participants: Thirty-two patients with alveolar cleft and impacted maxillary canines who had CBCT scans, lateral cephalograms, and orthopantomographs as pretreatment records., Main Outcome Measure: The diagnostic accuracy of 2D and 3-dimensional (3D) radiographic modalities was compared with each other and also with the gold standard by 3 radiologists., Results: The diagnostic accuracy of 2D and 3D imaging modalities was not significantly different regarding the mesiodistal inclination of the impacted tooth ( P = .09), apex anatomy ( P = .10), and mesiodistal position of the apex ( P = .19). Cone-beam computed tomography had significantly higher diagnostic accuracy than conventional radiographic modalities regarding overlapping the adjacent tooth ( P = .001), labio-palatal and apico-coronal position of the crown tip, and root resorption of the adjacent tooth ( P = .01)., Conclusion: The conventional orthodontic radiographic modalities were as accurate as CBCT for determination of impacted canine inclination, apex anatomy, and mesiodistal position of the apex. Cone-beam computed tomography showed higher diagnostic accuracy for other parameters.

Introduction: Cone-beam computed tomography (CBCT) is one of the most important diagnostic tools in maxillofacial imaging. Nowadays different sealers are used in root canal therapy and some of them can create artifact in CBCT images. The aim of this study was to evaluate the effect of different sealers including AH-26, Diadent, and Anyseal in creation of artifact bands in the CBCT images based on voxel size., Methods and Materials: A total of 44 single rooted extracted teeth were selected. The canals were prepared by crown-down technique. All teeth were manually filed up to master apical file (MAF) size 45 and 1 mm shorter than the apical foramen. The teeth were divided into 4 equal groups. The canals were filled with gutta-percha and either of sealers AH-26, Diadent or Anyseal by lateral condensation technique. The control group were filled just with gutta-percha without any sealer. The CBCT images were taken in voxel sizes of 0.3 and 0.15. The Fisher exact and McNemar tests were used for statistical analysis., Results: Although, the control group had the lowest ratio of presence to absence of artifact, the ratio of presence to absence of artifact in voxel size of 0.3 and 0.15 mm were significantly lower in Anyseal than AH-26 ( P =0.031, P =0.020) and Diadent ( P =0.001, P =0.002). No significant difference was detected between two voxel sizes ( P >0.05)., Conclusion: In this in vitro study, all evaluated sealers induced artifacts in the CBCT images. Anyseal sealer had the lowest artifact in both evaluated voxel sizes., Competing Interests: ‘None declared’., (© The Author(s).)

Introduction: Taurodontism is an anomaly characterized by elongated crowns and consumedly apical location of the bifurcation area. This study aimed to determine the prevalence of taurodontism in molars based on digital panoramic radiographies in eight cities of Iran., Methods and Materials: This descriptive cross-sectional study was conducted on 2360 digital panoramic radiographs taken for different treatment purposes. Demographic information of patients was recorded and radiographs were evaluated for presence of taurodont molars. The prevalence rates were calculated and the data were analyzed using SPSS software version 18 via paired t -test, chi square test and ANOVA., Results: A total of 2360 panoramic radiographs (from 51.4% male and 48.6% female patients) were evaluated and the prevalence of taurodontism was reported 22.9% (22.6% in males and 23.3% in females) ( P >0.05). Its prevalence was 51.67% in the right and 48.33% in the left quadrants ( P >0.05), 34.1% in the mandible and 65.9% in the maxilla ( P =0.000) and 79.52% in the second and 20.48% in the first molar ( P =0.000). The prevalence of hypotaurodontism, mesotaurodontism and hypertaurodontism was 84.13%, 11.07% and 4.8%, respectively., Conclusion: The prevalence of taurodont molars was high in Iran and it was more common in the second molars and in the maxilla. Hypotaurodontism had the highest prevalence., Competing Interests: ‘None declared’.

Background: Successful dental root canal treatments require a complete knowledge of dental anatomy and root canal morphology., Materials and Methods: One hundred and forty-five cone beam computed tomography (CBCT) images were used to assess the anatomy and morphology of mandibular premolars based on Vertucci's classifications in a defined group of dental patients in Iran. The number of roots and root canals, root canal morphology, root and canal shape (curvature), existence of C-shaped canal, and influence of sex on each of these were evaluated. A chi-squared test was used for statistical analysis., Results: The mandibular first and second premolars had a single root in 95.97% and 100% cases, respectively. In the mandibular first premolars, 62.2% were of type I, 0.8% type II, 10.9% type III, 0.8% type IV, 20.3% type V, 4.2% type VI, and 0.8% type VII; in the second premolars, 78% of canals were of type I, 3% type II, 11% type III, 7% type V, and 1% type VI. C-shaped canals did not exist in either of the premolars. The most prevalent root and canal shape was straight. The most prevalent root curvature was a distal curvature in both premolars (71.4% and 74% of first and second premolars, resp.). The most prevalent canal curvature was lingual and buccal for the first premolars (7.6% each) and distal for the second premolars (11%). No significant difference was found between men and women in nearly all of the above ( P > 0.05)., Conclusion: The results suggest that there is a need to conduct further evaluations on finding root and canal variations among more populations to gain better knowledge prior to root canal treatment.

Objectives: The optimal goal of radiography is to provide high-quality diagnostic images with the least patient radiation dose. The aim of this study was to evaluate the accuracy of cone-beam computed tomography (CBCT) and intraoral photostimulable phosphor plate (PSP) digital and film-based conventional radiography for detection of artificial cancellous bone defects., Materials and Methods: Five dry human mandibles were used in this study. The mandibles were placed inside a water bath made of plexiglass plates; then PSP and CBCT scans were obtained. The mandibles were cut by a coping saw in buccolingual dimension and oval defects measuring 6.1×6.1 mm, 3×6.1 mm and 4×4 mm were created by a milling machine in the spongy bone. After fixing the two parts together (buccal and lingual), radiographs were repeated. Presence or absence of defects on images was evaluated and recorded by the two observers. Using SPSS 16, compatibility level, sensitivity, specificity and receiver operating curve (ROC) analysis were determined for each observer., Results: The intraobserver agreement in all three imaging modalities was low to moderate (kappa≤0.613). The inter-observer agreement in all the three imaging modalities was moderate (kappa=0.406). The area under the curve (AUC) of the imaging modalities in each observation was not significantly different. The area under the curve based on defect size for the two observers was not significantly different either., Conclusion: Defects confined to spongy bone can be identified on film and PSP radiographs and CBCT scans. However, interpretation of PSP images and CBCT scans needs greater expertise and skills.

Background: Dentistry is a therapeutic health care profession that is related to people's health. Moreover medical emergencies often occur in dental offices that little awareness of the professional workers can have unpleasant consequences., Materials and Methods: In this interventional study, a survey of 45 final year dental students was examined. To do so, a test in terms of knowledge was taken as a standard questionnaire, and in the practical part a test was taken as on objective structured clinical examinations (OSCE) test in three stations, before and after the workshop; identification of emergency instruments, the performance of intramuscular and intravenous injections and cardiopulmonary resuscitations before and after the workshop obtained data were analyzed using, SPSS version 16, Student's t-test and paired T., Results: Using the t-test, mean score of the students' knowledge prior to and after the workshop were 51 ± 13.08 and 83.41 ± 8.65 respectively (P = 0.000). The practical score (OSCE) of dental students was 50.85 ± 13.09, which after the workshop came up to 85.73 ± 7.06 came up (P = 0.000). T-test of the performance before and after the workshop had a significant difference in each of the three stations. Significant differences between male and female students' knowledge and performance scores don't exist before and after the workshop (P > 0.05)., Conclusion: The level of knowledge and performance of students were assessed as average, therefore, training courses and revised the curriculum units are required.

Introduction: Vertical root fracture (VRF) is a complication which is chiefly diagnosed radiographically. Recently, film-based radiography has been substituted with digital radiography. At the moment, there is a wide range of monitors available in the market for viewing digital images. The present study aims to compare the diagnostic accuracy, sensitivity and specificity of medical and conventional monitors in detection of vertical root fractures., Material and Methods: In this in vitro study 228 extracted single-rooted human teeth were endodontically treated. Vertical root fractures were induced in 114 samples. The teeth were imaged by a digital charge-coupled device radiography using parallel technique. The images were evaluated by a radiologist and an endodontist on two medical and conventional liquid-crystal display (LCD) monitors twice. Z-test was used to analyze the sensitivity, accuracy and specificity of each monitor. Significance level was set at 0.05. Inter and intra observer agreements were calculated by Cohen's kappa., Results: Accuracy, specificity and sensitivity for conventional monitor were calculated as 67.5%, 72%, 62.5% respectively; and data for medical grade monitor were 67.5%, 66.5% and 68% respectively. Statistical analysis showed no significant differences in detecting VRF between the two techniques. Inter-observer agreement for conventional and medical monitor was 0.47 and 0.55 respectively (moderate). Intra-observer agreement was 0.78 for medical monitor and 0.87 for conventional one (substantial)., Conclusion: The type of monitor does not influence diagnosis of vertical root fractures.

Root fracture diagnosis is a clinical difficulty that in most cases can only be detected through radiography. The objective of this study was to compare the diagnostic accuracy of two types of digitally enhanced images (reverse-contrast and colorization) with original digital radiographies in detecting experimental root fractures. Two hundred extracted single-rooted human teeth were endodontically instrumented and then divided in two groups, one control group and one test group, including fractured teeth. Vertical root fractures were experimentally made in the fractured group. The digital image of each tooth was taken, using the paralleling technique. There were three groups of images: (i) original, (ii) reverse contrast, and (iii) colorized. Three experienced dental specialists examined the images with no prior knowledge of the distribution of the root fractures. Two-way analysis of variance was used to assess the differences in accuracy, sensitivity, and specificity of each technique in detecting root fractures. Cohen's kappa coefficients were calculated to investigate the degree of interobserver agreement. The accuracy, sensitivity, and specificity of original images were 67.4%, 66.7%, and 68%, respectively; these amounts were 61.5%, 61%, and 65.5% in reverse contrast images and 66.4%, 70.7%, and 62% in colorized digital radiography. The original images had the best inter observer kappa coefficients (between 0.45 and 0.55). The results showed that the accuracy of original images is better than reverse contrast and colorized images. Use of reverse-contrast and colorization digital images in root fracture detection should be regarded as an adjunct to other diagnostic methods not as a highly critical diagnostic aid., (© 2012 John Wiley & Sons A/S.)

Thorough knowledge of root canal morphology is essential for the endodontic therapy. There are rare variations in canal number and configuration in maxillary molars, which could affect treatment outcome. This paper presents the endodontic management of a maxillary first molar with two palatal canals in one root (Vertucci type IV) and a single buccal canal. In this paper cone-beam computed tomography was made to asses this morphology. This paper is intended to reinforce clinician's awareness of the rare morphology of root canals.

Background: Vertical root fractures (VRFs) can only be detected by radiography. In recent years, direct digital dental radiography (DDR) has become a substitute to film-based radiography. Purpose of this study was to compare accuracy and reliability of charge couple device (CCD)-based direct digital radiography with conventional radiography (CR) in VRF diagnosis., Methods and Materials: In this in vitro study, 230 extracted single-rooted human teeth were endodontically instrumented. VRFs were performed experimentally in half of the samples. Each tooth was imaged using the paralleling technique with E-speed film and a CCD-based digital image receptor. Two oral radiologists interpreted the images and repeated the procedure a month later with half of the samples. The accuracy, sensitivity, and specificity of each technique were determined. The reliability and degree of agreement were also determined by the means of Cohen's Kappa analysis. χ² test was used to compare two observers' diagnosis, considering the location of fracture line., Results: The accuracy of CR and DDR was 65% and 70% retrospectively. The sensitivity was 60% for CR, 61% for DDR and the specificity was 70% for CR, 78% for DDR, but the differences were not significant. The interobserver reliability was moderate for CR (K = 0.366, 95% CI) and fair for DDR (K = 0.538, 95% CI)., Conclusion: No significant difference was seen between the two techniques. The specificity of DDR was slightly better than CR, and their accuracy and sensitivity showed small differences., (© 2011 John Wiley & Sons A/S.)