Aim: The present study aims to investigate the effect of stress-decreasing resin (SDR) thickness as an intermediate layer in class II restoration. Materials and methods: Forty human maxillary premolar teeth were obtained and divided into four groups: G1, G2, G3, and G4. G1 to G3 were restored using SDR as an intermediate layer and overlayed with packable composite, and G4 was restored only using packable composite. All teeth were stored in the saline solution for 24 hours and subjected to 250 thermal cycles. The fracture strength of the teeth was tested in a universal testing machine. Results: No statistically significant effect was observed on the fracture resistance of class II restoration restored using different SDR thickness as intermediate layer (p < 0.05). A 4-mm SDR thickness group showed the highest fracture resistance among other groups. Conclusion: Using SDR thickness as the intermediate layer will affect the fracture resistance of class II restoration, but it is not statistically significant. A 4-mm SDR thickness showed good result as an intermediate layer in a restoration. Clinical significance: Stress-decreasing resin used as an intermediate layer can increase fracture resistance in class II composite restoration.

Aim: This study aimed to assess the correlation between cortical and mandibular trabeculae quality with beta-crosslaps (β-CTx) levels in postmenopausal women. Materials and methods: This study analyzed both sites of cortical and trabecular mandibular below mental foramen obtained from 17 cone-beam computed tomography (CBCT) radiographs of postmenopausal women. The cortical parameters measured consisted of computed tomography index superior (CTI-S), computed tomography index inferior (CTI-I), and computed tomography mental index (CTMI); while the trabecular parameters consisted of bone volume fraction (BV/TV), trabecular thickness (Tb.Th), and trabecular space (Tb.Sp). The β-CTx level was examined, and then the results were correlated with the three parameters, each from both cortical and trabecular bones. Results: Both trabecular (r = 0.477; p = 0.049) and cortical (r = 0.411; p = 0.038) parameters had positive and significant correlations (p < 0.05) toward the β-CTx levels. Conclusion: Cone-beam computed tomography was able to assess cortical bone and mandibular trabeculae quality, which was correlated with the β-CTx level of postmenopausal women. Clinical significance: This study can be used as a consideration in detecting the decreased quality of the trabecular and cortical mandibular bones in postmenopausal women using CBCT and the β-CTx level before the severity occur.

Aims: To predict the number of overhanging dental restorations (ODRs) using an artificial neural network (ANN) and determine the most important predictive variables. Materials and methods: Patient- and restoration-related data were used as input variables to construct two networks, with (network 1) and without (network 2) the number of secondary caries lesions (SCLs) as input data. Output data were the number of ODRs. Of the 502 participants, data of the first 100 were used to build/train the model. Those of the remaining 402 were used to test the model for prediction accuracy. Results: Model accuracy notably increased after training. Prediction of ODRs was more accurate in network 1. Allowing for an error of ±1, network 1 predicted the number of ODRs with an accuracy of 85.6%, whereas that of network 2 was only 82.1% accurate. The number of old fillings was the most important input variable, while gender was the least important. Conclusion: Within the study limits, the ANN model predicted ODRs with more than 85% accuracy. The number of old fillings was the most important predictive variable. Clinical significance: Making use of ANN analyses can help periodontists and general dentists predict the occurrence of ODRs, formulate effective treatment planning, and reduce patient discomfort and unnecessary costs.

Aim: The study was aimed at evaluating and comparing the rate of canine retraction using piezocision (PZ) and micro-osteoperforation (MOP). Materials and methods: A split-mouth study design was used in which the canine of each side of the arch of each subject was divided into the PZ side and the MOP side. After first premolar extraction, PZ was performed on one side and MOP was performed on the contralateral side. Canine retraction on both sides was performed using NiTi closed coil springs. All the measurements were performed by a direct technique with the help of a digital Vernier caliper on stone casts obtained before canine retraction (T0) and after the completion (T1) of retraction. This data of the rate of individual canine retraction in the PZ and MOP groups obtained were subjected to the statistical analysis. Results: The mean rate of canine retraction was 1.64 ± 0.43 mm/month for the PZ group and 1.34 ± 0.51 mm/month for the MOP group. The paired difference in the rates of the canine retraction was 0.39 ± 0.26 mm/month, which was statistically significant (p < 0.05). Canine retraction on the PZ was seen to be 1.22 folds faster than the MOP side. Conclusion: Piezocision showed a significant increase in the rate of canine retraction whereas MOP showed a nominal increase in the rate of canine retraction. Piezocision increased the rate of canine retraction by 1.2 folds compared to MOP. Clinical significance: The need to reduce the duration of treatment and the associated factors is the need of the hour. There is therefore a need to find the best and most feasible approach to accelerate tooth movement with existing biomechanical systems.

Aim: The reliability of panoramic radiograph (OPG) in treatment planning for dental implant placement is questionable. To assess the reproducibility and accuracy of panoramic imaging by evaluating the vertical and horizontal magnification factor (MF) at different regions of maxilla and mandible in manual and digital OPG. Materials and methods: The MF of the OPG at incisor, premolar, and molar regions taken through manual and digital radiograph unit with Asahi unit (MF 1.2–1.3×) and Planmeca unit (MF 1.2×), respectively, was assessed both horizontally and vertically. The measurement was made using Vernier caliper for manual and Microdicom Otic software for digital OPG. Measurements were done using two observers. Results: Mean vertical MF determined using digital OPG was found to be constant and similar to manufacturer's MF in molar and premolar regions; but in the incisor region, it was less than manufacturer's MF value, while manual OPG showed significant difference in vertical MF (t test). Mean horizontal MF of digital OPG was lower than the manufacturer's listed factor; while in manual OPG, it was within the manufacturer's specification in molar and premolar regions but the range was wide. Conclusion: The present study shows vertical MF was constant with digital OPG, while horizontal MF was similar to manufacturer's specification in manual OPG, especially in molar and premolar regions. Clinical significance: Magnification of image is normal occurrence in any radiographic image. In panoramic image where the focal spot–film distance is specific, the manufacturer's MF could be used appropriately to minimize errors.

Aim: The present study aimed to assess the knowledge, awareness, and attitude of general population in Saudi Arabia toward the use of dental implants for substitution of missing teeth. Materials and methods: This cross-sectional descriptive study was completed over a duration of 2 months. A questionnaire was designed, and a pilot test was done on 20 subjects to assess the validity and effectiveness of the questionnaire. Post this, the survey was initiated for a duration of 2 months and finally involved 302 participants. The questions were separated into three parts. Part I: four questions related to demographic data. Part II: four questions to explore the level of awareness and knowledge regarding dental implants. Part III: four questions to evaluate the attitude of responders to dental implants. Descriptive statistics and association was checked using the Chi-square test. A p value of less than 0.05 was measured as statistically significant. Results: Totally, 302 participants answered the questionnaire, in which 175 (57.9%) were females and 127 (42.1%) were males. About 249 (82.5%) had heard about dental implants; 176 (58.3%) subjects thought implant will last lifelong. Majority of the responders [284 (94%)] thought implants required superior cleanliness and care and that they cannot be cleansed like natural dentition. A statistically significant relationship between source of information and education was found. Conclusion: Our study concluded that an acceptable level of knowledge and awareness was found regarding dental implants in selected Saudi Arabia population. The attitude of subjects toward dental implants is appreciable. Clinical significance: At present, dental implants are commonly recognized as a prosthetic treatment for partially or completely edentulous subjects. The dentist plays a major role in this aspect, and this can be achieved by conducting education programmers for patients and having advisory hubs on dental implant use, which will discuss benefits and likely complications so as to spread awareness among public.

Aim: This study was aimed to clinically assess the two inlay retained bridges (tub- and inlay-shaped designs) in missing posterior teeth cases. Materials and methods: Thirty cases with missing single posterior tooth were included in the trial and divided into two main groups with a 1:1 allocation ratio (n = 15 for each group). Group I (the control group) received an inlay-retained bridge with inlay design on both abutments. Group II (the intervention group) received an inlay-retained bridge with tub design on both abutments. The inlay-retained bridges were fabricated from monolithic zirconia and bonded using dual-cured self-adhesive resin cement after treating the fitting surfaces mechanically and chemically. The clinical evaluation of the retention, marginal adaptation, and secondary caries occurrence was commenced following the Modified United States Public Health Service (MUSPHS) criteria 12 months after cementation. Results: The results show that the difference was not statistically significant between both groups regarding retention, marginal adaptation, and secondary caries occurrence after 12 months of cementation, with 0.05 statistical significance level and confidence interval of 95%. Conclusion: Within the limitations of this trial, the retention, the marginal adaptation, and the secondary caries for both inlay-retained bridge designs exhibited comparable outcomes. Clinical significance: The use of the inlay-retained bridges with tub design can be superior to the inlay-retained bridges with inlay design regarding the conservation of the tooth structure with the same retention rate, marginal adaptation, and occurrence of secondary caries in missed posterior tooth cases.

Aim: The aim of this study was to measure the stress distributions on the temporomandibular joint (TMJ) due to the face mask appliance using different levels of forces and different angulations. Material and methods: A three-dimensional finite element model of the craniofacial complex was constructed from a cone-beam computed tomography (CBCT) scan of a patient, with the help of the Mimics software. The forces were applied on the hooks and the anchorage was taken from the chin and the forehead. Four different force directions were applied—0, 10, 20, and 30° from the occlusal plane with each having three different force levels, 800 g, 1000 g, and 1200 g (combined force on both sides). The stress distribution of TMJ was analyzed. Results: The results indicate that the maxillary protraction appliance has a reactionary force on TMJ. Maximum stress was observed with 1200 g load and at the 0° angulation condition and the minimum stress was observed for 800 g load and at an angulation of 30°. Conclusion: On the articular disk, condylar cartilage, glenoid fossa, and condyle, stresses increased with increase in load. However, with an increase in angulation for the given load, the stresses reduced gradually. Clinical significance: The results indicate that the maxillary protraction appliance has a reactionary force on TMJ. Stresses induced by facemask appliance due to increased forces with low angulation could be a factor in temporomandibular joint disorders (TMDs).

Aim: Temporomandibular disorders (TMDs) represent disorders causing abnormality and impairment in the functionality of the temporomandibular joint (TMJ). The aim of this study was to assess the prevalence and severity of TMDs among the dental students of Qassim University using a Fonseca's questionnaire. Material and methods: The Fonseca's questionnaire was distributed through university email to undergraduate dental students in Qassim University, and participants were briefed about the procedure for completing it. The questionnaire contained 10 questions that were related to the signs and symptoms of TMD. The subjects were instructed to answer each question with “yes,” “no,” or “sometimes.” Scores were given, and the value was used to calculate the severity of TMD. Results: The study showed that out of 200 students, 110 students (55%) were found to have no TMD. Regarding the presence of TMD, about 45% of the students were found to have signs and symptoms, in which 33% had mild TMD, 5% had moderate TMD, and 7% had severe TMD. The number of students who reported mild types of TMD (33%) was significantly higher than those who reported moderate or severe types of TMD. Regarding the correlation of gender to the presence of TMD, 52% of female students showed some degree of TMD vs 42% of the male students. Conclusion: The present study shows that a mild-to-moderate prevalence of TMD appears to be evident among the dental students of Qassim University. Future research should, however, focus on longitudinal studies to identify and follow-up with TMD patients. Clinical significance: This study highlighted the importance for the early diagnosis of the TMD and its relation to stress.

Aims: The study aims to evaluate and compare cervical maturation stage using lateral cephalogram, cone-beam computed tomography (CBCT), and skeletal maturation using hand-wrist radiograph. Materials and methods: Forty-eight patients of circumpubertal Dravidian population were chosen. Subjects were advised to take CBCT of cervical region, lateral cephalogram, and hand-wrist radiograph with adequate protective measures. The CBCT and lateral cephalogram were evaluated using the Lamparski index modified by Hassel and Farman as a reference to determine skeletal maturity using cervical vertebra. Hand-wrist radiograph was evaluated for different stages of maturation according to Fishman's index. Stages of maturity between hand-wrist radiograph, lateral cephalogram and CBCT were evaluated in circumpubertal male and female subjects for reliability and accuracy. Results: When evaluating skeletal maturity indicator using these three diagnostic aids, it was found that all three were reliable with p value <0.05 in all groups. The accuracy between CBCT, lateral cephalogram, and hand-wrist shows skeletal maturity indicator using CBCT was highly accurate than lateral cephalogram and hand-wrist radiographs. Conclusion: Cervical vertebrae maturation index (CVMI) using lateral cephalogram and CBCT shows high reliability in prepubertal, pubertal, and post-pubertal male and female subjects. The skeletal maturity indicator using hand-wrist shows reliable tool for skeletal maturity. When the accuracy between the aids was compared, it revealed that CBCT is the most accurate diagnostic aid in assessing skeletal maturity indicator. Clinical significance: The results of this study suggest that CBCT can be used to assess skeletal maturity and, therefore, we can avoid an additional radiogram (hand-wrist radiography) whenever CBCT is considered as an investigating tool for orthodontic patients.

Aim: This study investigates the influence of ozonized water disinfection on flexural strength, surface roughness, and surface microhardness of heat-cured denture base material [(polymethyl methacrylate (PMMA)]. Materials and methods: A total number of 90 specimens were prepared from heat-cured denture base material. In the control group (n = 30), 10 specimens from each test were immersed only in distilled water at 37°C for 48 hours before testing. For the two experimental groups (n = 60), 10 specimens of each group in each test were immersed in 2% chlorhexidine for 10 minutes and another 10 specimens were immersed in ozonized water with a concentration of 10 mg/L for 30 minutes. In the flexural strength test, specimens were subjected to three-point loading at a crosshead speed of 5 mm/minute of a universal testing machine. Hardness measurements using Vickers microhardness tester and roughness measurements by the Surftest analyzer were performed. Measurements of flexural strength, surface roughness (R_a, μm), and hardness (kg/mm²) were analyzed using one-way analysis of variance (ANOVA) and Tukey least significant difference (LSD) test (α = 0.05). Results: Flexural strength values of ozonized water-disinfected specimens were insignificantly decreased. However, the use of ozonized water disinfection significantly increased roughness values. At the same time, microhardness values significantly decreased. Conclusion: The use of ozonized water in disinfecting heat-cured denture base resin did not exhibit a deleterious effect on its strength nor surface roughness. Thus, it may be a much more safe disinfection method rather than chlorhexidine chemical disinfectant. Clinical significance: Disinfection of heat-cured PMMA denture base resin using ozonized water may be a more valuable hygienic method compared to chlorhexidine, the most common chemical disinfectant.

Aim: The aim of this study was to examine the effect of watermelon frost (WF) on the expression of substance P (SP) and alkaline phosphatase (ALP) in reversible pulpitis. Materials and methods: A total of 32 teeth of Macaca fascicularis (M. fascicularis), which were given mechanical injury until the pulp was exposed, were included in the study. Group I (without WF): 16 teeth were included in group I in which the pulp tissues were extracted and stored at −80°C until tested by enzyme-linked immunosorbent assay (ELISA). Group II (with WF): 16 teeth were included in which WF was applied and teeth extraction was performed after 3 days and pulp tissues were obtained by breaking the tooth. Pulp tissues were stored at −80°C until tested by ELISA. Independent sample t test was used to analyze the difference between the study groups. Results: The mean and standard deviation (SD) values of SP were 159.085 ± 7.104 in group I and 44.852 ± 3.708 in group II. The mean and SD values of ALP were 38.076 ± 2.991 in group I and 144.805 ± 10.959 in group II. A significant difference in the SP and ALP concentrations was observed in group I as compared to group II (p < 0.05). Conclusion: The results concluded that WF has an effect on the increasing expression of ALP and decreasing SP expression in reversible pulpitis. Clinical significance: Watermelon frost is effective for the treatment of reversible pulpitis.

Aim: This case report illustrates the management of post-traumatic malocclusion resulting from a condylar fracture during childhood using orthognathic surgery and three-dimensional virtual computer planning. Background: Condylar fractures during childhood can result in severe functional and esthetic problems. The temporomandibular joint (TMJ) is the foundation for orthognathic surgery. The management of this complex dentofacial deformity represents a challenge to the oral and maxillofacial surgeon. Case description: A 40-year-old man with a history of childhood trauma resulting in right sub-condylar fracture presented with severe facial asymmetry, canting of the occlusal plane, obstructive sleep apnea (OSA) symptoms, and limitation of his mouth opening. He underwent minimal presurgical orthodontics followed by orthognathic surgery including a LeFort 1 osteotomy, bilateral sagittal split osteotomy, and genioplasty. The occlusal plane was corrected by the counterclockwise rotation of the maxillomandibular complex (CCRMMC). A computer virtual planning facilitated the three-dimensional correction of this complex dentofacial deformity. It was possible to achieve the planned surgical movements despite difficulty in seating the condyle in the injured side. Conclusion: Post-traumatic malocclusion resulting from a condylar fracture during childhood was managed by orthognathic surgery without TMJ surgery. Clinical significance: Three-dimensional computer planning is a valuable aid in planning orthognathic surgery especially for facial asymmetry. Condylar seating during mandibular osteotomy is challenging even after years from condylar fracture. Temporomandibular joint surgery is not a necessity prior to orthognathic surgery in these cases if the patient has an acceptable mouth opening. The CCRMMC facilitated improvement in profile and OSA symptoms.

Aim: To give perspective on suture granuloma in oral biopsy specimens. Background: Suture granuloma is an uncommon finding in the oral biopsy specimens. Suture granulomas may give the impression of both benign and malignant lesions, thus posing a serious diagnostic challenge. Hence, it is very important that oral pathologists should understand pathogenesis and histopathology of this rare phenomenon. Results: Suture granuloma evokes immunological reaction with recruitment of monocyte macrophages, which ultimately forms epithelioid cells and giant cells. The pathogenetic events were driven by the factors such as interleukins, MHC class II molecules, CD4+ Th1 lymphocytes, transforming and platelet derived growth factors. Histopathologically, they are easy to identify due to characteristic appearance of granuloma surrounding the suture material. Conclusion: This paper presents a very rare occurrence of suture granuloma in an oral biopsy specimen with special emphasis on pathogenesis and histopathology. Clinical relevance: Accidental findings in oral pathologies are not very common evidence. Suture granuloma is one such phenomenon that can be mistaken for benign or malignant neoplasm. Hence, it becomes of paramount importance to realize the need of understanding this phenomenon for oral pathologists to avoid diagnostic confusion. This short communication elaborates the histomorphological appearance of suture granuloma, which will help pathologists in accurate diagnosis and hence management.