Aim: The aim of this trial was to compare the semilunar coronally position flap (SCPF) and the conventional coronally advanced flap (CAF) regarding the applied modifications in treating gingival recession. Materials and methods: Sample consisted of 16 patients with bilateral class I gingival recessions, they were treated with SCPF or CAF. Two modifications were applied: a root surface biomodification with tetracycline (TTC) and suture anchors on the contact points of the tooth. Clinical parameters and a questionnaire were used as measures to evaluate the trial. Wilcoxon test was used for statistical analysis. Results: The mean percentage of root coverage (RC) and complete RC (CRC) was 82.3 ± 15.6% (31.3%, n = 5/16) and 79.8 ± 27.7% (43.8%, n = 7/16), respectively, using SCPF and CAF. Statistically significant differences were observed in the intergroup width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), vestibular depth (VD), and position of the mucogingival junction (MGJ). A significant difference was observed in wound healing index (WHI) 1 week postoperative. Full root coverage esthetic score (RES) was achieved in four teeth using SCPF and in two teeth using CAF. No statistically significant differences were observed in the intergroup in the postoperative pain and root sensitivity during the follow-up. Conclusion: Both SCPF and CAF with the mentioned modifications were effective in managing shallow gingival recessions. However, SCPF’s results showed a significant gain in WKT, TKT, and VD. Clinical significance: Our findings confirm that both procedures with the mentioned modifications can be used to treat gingival recession with effectively and satisfied results for periodontist and patient. Our results suggest it is preferable to use the SCPF in case of a shallow oral vestibulum and high demanded for esthetic.

Aim: The purpose of this study was to achieve maximum anesthetic success using different volumes of articaine as inferior alveolar nerve block (IANB) and ketorolac with/without buccal infiltration (BI) when treating molars with symptomatic irreversible pulpitis (IP). Materials and methods: A total of 160 mandibular molars with symptomatic IP randomly received conventional IANB either with one (1.8 mL) or two cartridges (3.6 mL) of 4% articaine after ketorolac oral premedication. Each group was further divided into two subgroups: one with BI with 1.8 mL articaine and the other with mock BI. Patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation using a Heft–Parker visual analog scale (HP VAS). No or mild pain was considered as successful anesthesia. Results: A statistical analysis demonstrated that double-volume (3.6 mL) articaine and ketorolac with or without BI (87.5% and 80%, respectively) has a higher success rate when compared with single-volume (1.8 mL) articaine and ketorolac with and without BI (75% and 42%, respectively). Conclusion: Double-volume articaine with oral premedication and BI resulted in a significantly higher success rate when compared with singlevolume articaine and oral ketorolac premedication. The addition of BI to double/single-volume articaine IANB resulted in a higher success rate. Clinical significance: Double-volume articaine and infiltration with ketorolac premedication resulted in a higher success rate than single-volume articaine in mandibular teeth with IP.

Aim: To evaluate the genotoxic effects of X-rays on epithelial cells during panoramic dental radiography on the cells of the oral mucosa by micronucleus assay. It also aimed to evaluate the time period required by the cells of the oral mucosa of these patients to recover from these genotoxic effects. Materials and methods: Patients were divided into two age groups. Group I included subjects aged from 15 years to 25 years, while group II included subjects 40 to 50 years of age. Each group had 50 subjects. The histopathological sample was obtained with the help of a wooden spatula in both keratinized and non-keratinized mucosa pre-exposure, 10th day and 21st day post-exposure, respectively, and micronuclei were calculated. Results: There was a statistically significant increase in micronuclei on 10th day and a statistically significant decrease in micronuclei on 21st day post-exposure in both keratinized and non-keratinized mucosa and when compared with pre-exposure. It revealed more marked effect on keratinized mucosa. Furthermore, in group II, no statistically significant differences were noted at the time of pre-exposure and on the 10th day post-exposure as well as on the 21st day post-exposure. Conclusion: Genotoxic effects do take place due to panoramic radiography; it has also been seen that these genotoxic effects are reversible as these cells tend to recover from the effects. Clinical significance: Since radiography is an integral part of day-to-day dental practice and patients are frequently exposed to panoramic radiography, it is emphasized that panoramic radiography may be done only when necessary after weighing the benefits against the risks. X-rays being ionizing radiation are well known as mutagens and carcinogens in the human population. Thus, it becomes important that to detect the radiation effects of low-dose diagnostic radiographic exposures, a sensitive analysis and specific approach is needed.

Aims and objective: The drawback of poly-methyl-methacrylate (PMMA) is the absence of adaptation accuracy in acrylic resin affected by polymerization shrinkage and resin flask method. The present study was conducted to compare adaptation of acrylic resin cured by injection moulded technique and microwave energy. Materials and methods: 40 standardized maxillary record bases (2 mm thick) were processed from 40 maxillary master casts. SR-Ivocap High Impact Resin was used for injection moulding technique and microwaveable acrylic resin (Onda-Cryl, Artigos Odontológicos, Clássico Ltd, Sao-Paulo, SP, Brazil) was cured by microwave energy (320 W for 3 minutes + 0 W for 3 minutes + 720 W for 3 minutes). These specimens were divided into two groups. Group I: 20 maxillary record bases were fabricated using injection moulding technique. Group II: 20 maxillary record bases were fabricated using microwave energy (320 W for 3 minutes + 0 W for 3 minutes + 720 W for 3 minutes). The base/cast sets were sliced transversally in the posterior palatal seal zone. The gap between the resin base and casts was evaluated at the right marginal limit, left marginal limit, right ridge crest, left ridge crest and the palatal midline. The adaptation accuracy was examined utilizing a stereomicroscope. Results: There was a significant difference between the microwaveable acrylic resin (Onda-Cryl) cured by microwave energy (320 W for 3 minutes + 0 W for 3 minutes + 720 W for 3 minutes) and the SR-Ivocap high impact resin cured by injection moulding technique. Conclusion: The microwaveable acrylic resin (Onda-Cryl) cured by microwave energy (320 W for 3 minutes + 0 W for 3 minutes + 720 W for 3 minutes) showed fewer adaptation inaccuracies and more accurate denture base than injection moulding techniques. Clinical significance: The microwaveable acrylic resin (Onda-Cryl) cured by microwave energy (320 W for 3 minutes + 0 W for 3 minutes + 720 W for 3 minutes) have more accurate denture bases when differentiated to those polymerized by injection moulding techniques. Therefore microwaveable acrylic resin (Onda-Cryl) cured by microwave energy (320 W for 3 minutes + 0 W for 3 minutes + 720 W for 3 minutes) can be a viable option for fabrication of dentures.

Aim: To find whether there is an association of clinical parameters, dental attendance pattern, oral hygiene, and dietary practices with the presence of active caries lesions among children with early childhood caries (ECC). Materials and methods: In this cross-sectional study, 171 children of 3–5 years of age with at least one decayed/filled tooth surface were examined. The presence or absence of visible plaque and decayed, missing, or filled-surface (dmfs) score were recorded. Each tooth surface was scored as per International Caries Detection and Assessment System (ICDAS) II criteria followed by supplemental lesion activity assessment (LAA) criteria, which was used to classify the lesions as active/inactive. A structured questionnaire regarding oral hygiene, dietary practices, and dental visit frequency was filled by parents of the children. Results: Of the 740 surfaces examined, 82.6% were active caries lesions. Previous dental visit, sweet score, presence of visible plaque, and ICDAS score above 4 were significantly associated with active carious surfaces. Conclusion: Factors associated with active caries lesions are the presence of visible plaque on the tooth surface, cavitation extending to dentin, and higher frequency of sugar consumption by the child. Clinical significance: Improper oral health practices can contribute to the activity of the caries lesions. Parental education on oral health practices, particularly plaque control measures, decreasing sugar exposures in the diet, and regular visits to the dentist for completion of the restorative therapy may help to render the lesions inactive.

Aim: The present study was conducted with an aim to assess the antimicrobial activity of ethanolic extracts of aloe vera leaf and gel against Candida albicans in vitro. Materials and methods: Fresh leaves were collected from the aloe vera plants naturally grown in Coorg. Aloe vera leaf as well as gel was separated, extracted with 95% ethanol in rotary shaker at constant temperature for 3 days, evaporated in a heating mantle, and stored in screw cap test tubes at 4°C for further analysis. Antifungal activity of aloe vera leaf and gel extracts against C. albicans was assessed by well diffusion method. Further, gel extracts of aloe vera at different dilutions (500, 400, 300, and 200 μL) were prepared and the turbidity was analyzed. Results: Results showed that the ethanolic extract of aloe vera leaf did not show antifungal activity against C. albicans. A maximum of 99.33% antifungal activity was shown by 400 μL of aloe vera gel extract. The minimum inhibitory concentration of aloe vera gel extract was 200 μL (98.2% inhibition). Conclusion: The ethanolic extract of aloe vera gel showed considerable antifungal activity against C. albicans. Clinical significance: Modalities targeted on the use of aloe vera against C. albicans can prove to be more beneficial and consistent compared to conventional antifungals for preventive and/or therapeutic purposes against a variety of oral fungal diseases.

Aim: Analysis of masking potential of the resin infiltration technique with dental milestones guaranteed caries infiltration concept (DMG ICON) on nonpitted white spot lesions due to fluorosis in newly erupted permanent maxillary incisors for better esthetics and psychological wellbeing in children. Materials and methods: This prospective interventional study was conducted on 60 newly erupted maxillary central incisors with mild, nonpitted white spot lesions of fluorosis till grade IV of the Thylstrup and Fejerskov (TF) index. The resin infiltration technique with DMG ICON (DMG, Hamburg, Germany) was used to mask lesions along with the analysis for color change using Euclidean distance, i.e., the ΔE (Delta E) unit of the CIE L*a*b* color space formula where ΔE = (ΔL2 + Δa2+ Δb2)½ using the image-analyzing software. Data were analyzed statistically by the SPSS software. Results: Fifty-one tooth samples (85%) showed complete masking of white spot lesions of fluorosis postoperatively to resin infiltration with net ΔE values less than or equal to 3.7 whereas lesions in nine tooth samples (15%) were not masked completely with net ΔE > 3.7. Statistically highly significant results were obtained with the Wilcoxon signed-ranks test (p value < 0.001). Conclusion: The minimally invasive resin infiltration technique using DMG ICON is highly efficient and satisfactory for masking of nonpitted white spot lesions of dental fluorosis in newly erupted permanent central incisors as per the analysis for color change using the image-analyzing software. Clinical significance: The outcome of masked and blended white spot lesions of fluorosis with the sound enamel in the smile zone with the resin infiltration technique was found to be a child-friendly, noninvasive, single-sitting approach with stabilized results in follow-up visits.

Aim: The study aimed to determine the perception, educational satisfaction, and attitude of dental students (fourth and fifth years) regarding the usage of rubber dam. Materials and methods: A piloted questionnaire was distributed to fourth- and fifth-dental students in Damascus (governmental) and Syrian private (private) dental schools in August 2019. Information collected included perception, educational satisfaction, and attitude to the usage of rubber dam in different operative and endodontic treatments. A data analysis was carried out using SPSS version 25. A descriptive statistical analysis was done, and a Chi-square test was performed to compare the obtained data. The data evaluation was at a significant level of p < 0.05. Results: Out of 380 questionnaires distributed, 346 were filled and returned, the response rate was 91.05%. Rubber dam was used by 91.62% of the participants (n = 317) on child patients. Rubber dam was never used by 47.11% of the participants (n = 163) when placing amalgam restorations, and by 5.50% of the participants (n = 19) when placing composite restorations. Rubber dam was used by 61.85% of the participants (n = 214) after access cavity preparation when performing root canal treatments. A total of 44.22% of the participants (n = 153) believed that their use of rubber dam will be in all indicated procedures after graduation. Conclusion: Within the limits of this study, there was still a high possibility among the undergraduate dental students that they might not practice routine placement of rubber dam after graduation. Clinical significance: A very important method to improve the clinical dental practicing is by studying how dental students looks to the details of each dental procedure, so the academic institutes can change the wrong thoughts of the future dentists from the dental student level. One of these important procedures is the rubber dam application.

Objectives: This study aimed to compare the coronal discoloration related to the application of two coronal sealing materials: Bioceramic (BC) root repair material (RRM) putty and mineral trioxide aggregate (MTA). Materials and methods: A total of 16 patients (divided into two subgroups, each one included 8 patients) had undergone regenerative endodontic procedures (REPs). Disinfecting the canals was achieved by the application of the double-antibiotic paste (DAP) “metronidazole and ciprofloxacin” to exclude minocycline discoloration effect; after 3 weeks, the medicament was removed, apical bleeding was induced till the formation of blood clot in the root canal, and then a coronal sealing was created. Bioceramic RRM putty was used in eight patients, while gold standard “MTA” was used in another eight patients. Finally, resin modified glass ionomer (RMGI) was applied followed with resin composite matching the shade of the treated teeth. Shades were measured immediately after procedures and through organized follow-up (3, 6, 9, and 12 months). Data were collected according to Commission International de I’Eclairage (CIE-LAB) and then ΔE values were calculated. A two-way statistical analysis of variance was performed depending on Student’s t and Chi-square tests at 95% (p = 0.05). Results: Coronal discoloration accompanied with MTA was clinically perceptible (ΔE > 3.3) through all periods. Coronal discoloration was slightly recognized in the BC group. However, there was no significant difference between the used two materials through studied periods (p > 0.05). There was incrementally increasing of discoloration through sequential organized follow-up periods. Conclusion: As a result of this study, BC RRM putty could be a good alternative material to MTA through REPs. Clinical significance: Pulp REPs are predictable therapies, but discoloration is still considered as a one of the most unfavorable complications; so, this study highlights on this outcome to obviate it.

Aim: The aim of the study was to assess the total occlusal convergence guessing by sight and ruler methods and compare with the snapshots for accuracy. Materials and methods: The methods used for total occlusal convergence (TOC) preparation were assessed among students, interns, and dental specialists after die preparation and compared with the snapshots for accuracy. Results: In all, 47% of the specialist’s observation achieved the recommended TOC angle, while 29.25% was obtained by undergraduates. Conclusion: In conclusion, specialist’s observation was better in both ruler and sight guessing methods compared to dental students and interns. Clinical significance: The abutment for dental prosthesis should have a minimal TOC, also called a taper, for adequate retention of the abutment.

Aim: This study aims to evaluate and compare the structural characteristics of platelet-rich fibrin (PRF) prepared by two different protocols in nondiabetic and controlled diabetic patients. Materials and methods: Ten milliliters of blood sample were drawn from 30 participants [nondiabetic (15), controlled diabetic (15)]. Five milliliters of blood were transferred to two dry vacutainers. For each patient two PRF clots were obtained using the standard protocol [leukocyte-rich platelet-rich fibrin (L-PRF)] and the low-speed concept [advanced platelet-rich fibrin (A-PRF)]. These were processed for light microscopy analysis to estimate the width of the fibrin meshwork. Results: In controlled diabetic patients, A-PRF showed significantly more dense fibrin network compared to those of L-PRF. The difference between L-PRF and A-PRF in nondiabetic patients was not statistically significant. Conclusion: Modification done to the standard centrifugation protocol, by increasing time and reducing speed, favors an increase in the dense fibrin network of A-PRF in diabetic patients. Clinical significance: Modified centrifugation protocol proves to be favorable in controlled diabetic patients for periodontal regeneration.

Aim: The aim of the study was to evaluate the effect of mold temperature [room temperature (32°C), 450°C, and 790°C] on the fatigue deflection of clasps of commercially pure titanium. Materials and methods: Forty-five retentive wax profiles were cast in molds having three different mold temperature [room temperature (32°C), 450°C, and 790°C]. Specimens of grade 4 titanium, following the eligibility criteria, were selected. A 2-mm deflection test was done using an Instron machine and the flexibility of clasps of the respective groups was calculated. Deflection fatigue was tested using a cyclic-loaded custommade oscillating machine by calculating the number of loading cycles required to fracture the specimen. Results: The mean of flexibility of the clasp bars was observed and the difference was significant (between groups, F value was 38.49 at p = 0.0000 and within groups at p ≤ 0.01, respectively). The number of loading cycles applied to the clasp bars casted with 450°C and room temperature was more than that of 790°C, suggesting that the fatigue strength of clasps casted at 450°C and room temperature is more than that at 790°C. The mean of loading cycles of the clasp bars was observed and the difference was significant. Between groups, F value was 11.89 at p = 0.0001 and within groups at p ≤ 0.01. Conclusion: The number of loading cycles applied to the clasp bars casted with 450°C and room temperature was more than that of 790°C, and this suggests that the fatigue strength at 450°C and room temperature is more than that at 790°C. Temperature has an important role to play as the modulus of elasticity is higher at room temperature and 450°C than that at 790°C. Clinical implication: The ideal temperature for a titanium casting with relatively high fatigue strength would be 450°C mold temperature or room temperature. By investigating the fatigue deflection, it is clear that a desired undercut should be planned before clasp designing, considering the metal to be used.

Aim of the study: To evaluate the use of platelet-rich fibrin (PRF) dressing in the free gingival graft (FGG) recipient site by evaluating tissue healing and coverage of recession. Materials and methods: The study included 40 patients having at least one site with Miller’s class II recession to be treated via FGG. The participants were divided into two groups: PRF group consisted of 20 patients who had PRF dressing used over the FGG and Coe-Pak™ group comprising 20 patients who received normal dressing (Coe-Pak™). Clinical periodontal parameters, healing index, root cover, and attached gingival width (AGW) were recorded prior to treatment and at 1 and 3 months postsurgery. A statistical analysis was performed to examine the differences between the study groups. Results: The PRF group showed statistically significant differences in the level of healing index and root coverage. Conclusion: It may be concluded, within the study limits, that PRF dressing plays important role in the process of FGG healing. Clinical significance: Platelet-rich fibrin can be considered a useful reliable dressing.

Aim: This review presents an updated overview and evidences on diagnostic performances of clinical detection methods to detect noncavitated fissure caries. Background: The current body of evidence regarding the progression and arrest of dental caries has made its early detection, risk assessment, and minimally invasive management the standard of care today. Hence, its diagnosis should ideally comprise of both detection and severity measurement in the form of lesion depth, demineralization severity, and mineral density distribution. A combination of this information is essential for clinicians to make informed decisions about the management of the disease process. To address the above needs, a plethora of clinical caries detection systems are available and most demonstrate differing diagnostic performance for approximal and fissure caries. In this review, the available systems are categorized based broadly upon their mechanism of actions, under the categories of conventional, nonoptical, and optical methods. This review article sought to present the published evidence of these systems in detecting noncavitated fissure caries. As far as possible, evidence from systematic reviews were presented. In cases where systematic reviews were not available, preference had been given to the present evidence from in vitro and in vivo studies that had employed histology as the validation method. Conclusion: Based on the current evidences and reviews, except for optical coherence tomography, most devices are only able to detect and determine either lesion depth or demineralization severity but not both. Clinical significance: In order to be able to gather necessary information to formulate a treatment plan for noncavitated fissure caries and monitor its efficacy, routine visual assessment will need to be supplemented by another quantification-enabled detection device that had demonstrated reasonably high sensitivity and specificity. Current evidences seem to indicate that photothermal radiometry, near-infrared transillumination, and optical coherence tomography are systems that had demonstrated such capabilities.