Aim and objective: To evaluate the awareness, knowledge, attitude, and practices in the management of biomedical waste (BMW) by multivariate analysis of associated factors in Peruvian dentistry students. Materials and methods: A cross-sectional, descriptive, analytical-multivariate study was conducted to evaluate the entire population of undergraduate dentistry students of the Universidad Nacional Mayor de San Marcos (N = 254) from April to October 2019. The variables analyzed were gender (X1), age (X2), year of study (X3), and marital status (X4). The Logit model was implemented including all risk factors to explain which variables significantly influence the dependent variable. The crude odd ratio (OR) was used with a level of significance p < 0.05. Results: The Logit model showed that age, gender, year of study and marital status do not significantly influence awareness, knowledge, attitude, and practices in the management of BMW, showing a crude OR of 1.0 95% confidence interval (CI) [0.89–1.14]; 1.1 95% CI [0.68–2.02]; 0.8 95% CI [0.64–1.10] and 1.2 95% CI [0.37–3.93] respectively. Conclusion: The variables age, gender, year of study and marital status do not significantly influence the awareness, knowledge, attitude, and practices in the management BMW of Peruvian dental students. Clinical significance: This research allows to know the knowledge about the management of biomedical waste of Peruvian dental students.

Aims and objectives: To assess and compare the functional load distribution pattern in dental implants with different thread designs (V-shaped, square, and reverse buttress), length (long = 12–13 mm, short = 8 mm), diameter (narrow = 3.75 mm, wide = 4.9–5 mm), and splinting condition (splinted or non-splinted) using photoelastic analysis. Materials and methods: Eight epoxy resin-based photoelastic models using a custom-designed acrylic mould measuring 75 mm × 12 mm × 30 mm were prepared, with three implants in each of the models. Dental implants were placed vertically and parallel to each other using a holding device and a surveyor. A polariscope was employed to view the fringes before and after applying the load. Fringe orders were observed and principal stress was calculated. Data was statistically analyzed using factorial ANOVA. Results: In splinted and non-splinted conditions, the least principal stress (1.111–2.286 N/fringe/mm² and 1.363–3.082 N/fringe/mm², respectively) was associated with V thread dental implants. Square thread (splinted 1.814–2.852 N/fringe/mm², non-splinted 1.866–3.336 N/fringe/mm²) and reverse buttress thread (splinted 1.981–3.040 N/fringe/mm², non-splinted 1.971–3.586 N/fringe/mm²) dental implants showed comparatively higher stress. Long and wide dental implants showed lesser principal stress when compared to short and narrow dental implants. Splinted dental implants presented lesser principal stress (2.021 N/fringe/mm²) in comparison to non-splinted dental implants (2.731 N/fringe/mm²). Conclusions: Thread design, dimension and splinting condition of the implants plays a significant role in reducing bone stress. Clinically, to enhance the long-term success of implant therapy, V thread design, longer (≥12–13 mm) and wider (≥4.9–5 mm) implants shall be preferred over square or reverse buttress thread design, shorter (≤8 mm) and narrower (≤3.75 mm) implants. Splinting of dental implants effectively reduces principal stresses in the surrounding bone. Clinical significance: Clinicians shall be able to use the findings of this study when selecting dental implants based on thread design, dimension, and the need to splint the dental implants for predictable treatment outcomes.

Aim and objective: The purpose of this study was to assess and compare the interleukin 6 levels in gingival crevicular fluid and periodontal ligament before and after application of the orthodontic force. Materials and methods: It is a split mouth study where the gingival crevicular fluid (GCF) and periodontal ligament (PDL) samples of 20 individuals were collected from control and experimental site. GCF samples were collected using 1–5 μL calibrated volumetric microcapillary pipette. PDL samples were collected from the extracted tooth, and PDL tissue was scraped using Gracey curette and was immediately transferred to Eppendorf microcentrifuge tubes (Sigma–Aldrich; St. Louis, MO, USA). The collected samples were stored at −80°C for further analysis using ELISA kit (Human IL-6 ELISA MAX^TM Delux-5 plates) and the optical density was recorded at 450 nm. Result: In the study it was observed that there was an increase in IL-6 concentration in the PDL in the experimental group (3rd day of force application). The concentration of IL-6 was recorded after 3rd day of force application between the experimental groups of PDL and GCF and an increase in the levels of IL-6 was noted. The increase in the level of IL-6 in these groups was statistically insignificant. Conclusion: The study depicted similar concentration level of IL-6 in GCF and PDL on the 3rd day of application of orthodontic force. Therefore, GCF can be used as a biomarker in the assessment of IL-6 for up to 3 days of force application instead of PDL. Clinical significance: GCF can be assessed to know the concentration of cytokines (IL-6) upto 3 days of force application in the PDL, as collection of GCF is a non-invasive technique.

Aim and objective: The present cross-sectional survey was conducted to assess the prevalence and the type of dental injury along with the awareness and use of mouthguards among the athletes of Riyadh, Saudi Arabia. Materials and methods: This questionnaire-based survey included four major sports clubs in Riyadh city (AlHilal, AlNassr, AlShabab, AlRiyadh), Saudi Arabia where 300 questionnaires were distributed. Participants who engaged in direct, indirect, and no/minimal contact sports such as taekwondo, soccer, and volleyball, respectively were explained about the importance of the study and its significance. The questionnaire was divided into three parts covering the demographic details, sports-related injury, mouthguard awareness, and its use. Data from completely filled questionnaire were collected, tabulated, and analyzed. Descriptive statistics and Pearson Chi-square tests were considered for statistical analysis. Result: A total of 234 athletes (104 football/soccer, 57 volleyball, and 73 taekwondo) participated in the study with a response rate of 78%. Taekwondo and football athletes experienced more dental trauma than volleyball players. Dental trauma was highest in taekwondo (56.2%), followed by football (52.9%) and volleyball (31.6%) athletes. Crown fractures (43.6%) were the most common dental injury reported followed by mobility (18%). Taekwondo athletes were better aware regarding mouthguard (83.6%) and used it during practice (43.8%) when compared to football and volleyball athletes. Conclusion: It was observed that athletes of direct and indirect contact sports (taekwondo and soccer) were at greater risk of dental trauma thereby emphasizing the importance of prevention strategies. Though a significant proportion of athletes were aware of mouthguard, its types, and its role in the prevention of dental trauma, only a handful of them regularly used it. Clinical significance: Sport-related dental injuries though prevalent among athletes, measures to curb them are limited. These injuries may directly or indirectly hamper the performance of the player and affect their career. Therefore, combined efforts from dentist, coach, and sport physician are required to educate, enhance awareness, and encourage the use of mouthguards in contact sports.

Aim and objective: To evaluate patients presenting to a Dental Hospital's healthcare facility for the factors linked with the development of high-risk obstructive sleep apnea (OSA) through oral and radiographic examination. Materials and methods: A cross-sectional study was performed to identify the patients at high risk of OSA. The patients were screened with the Snoring, Tired, Observed, and Blood Pressure (STOP)—BANG questionnaire, followed by oropharyngeal examination and lateral cephalography. Results: Three hundred patients were screened for the risk of OSA out of which 194 (64.6%) were men and 106 (35.3%) were women. One hundred twenty-four (41.3%) belonged to the high-risk group and 176 (58.6%) to the low-risk (control) group. Logistic regression analysis confirmed that in the high-risk OSA group, neck circumference, class 3 or 4 Mallampati scores, temporomandibular disorder (TMD), bruxism, wide tongue, and deep palatal vault were all often seen parameters and were independent indications of developing high risk of OSA. The cephalometric analysis revealed decreased airway spaces in the high-risk group with downward displacement of the hyoid bone. In the high-risk OSA group, neck circumference, class 3 or 4 Mallampati scores, TMD, bruxism, wide tongue, and deep palatal vault were all often seen parameters and were independent indications of developing high risk of OSA. Conclusion: This study throws light on the imperative role of orofacial features in screening high-risk OSA patients. Dental sleep medicine is an upcoming branch with diversified treatment modalities. Because OSA has been related to the development of fatal medical disorders, it is critical to educate patients about sleep problems and their consequences. Clinical significance: Oral and radiographic findings can play a pivotal role in identifying patients at risk for OSA. As the general population is unaware about the systemic implications of OSA, the screening for OSA should be conducted as a routine procedure by oral physicians. Oral examination can be a cost-effective tool in screening OSA.

Aim: To determine the risk factors and prevalence of various musculoskeletal disorders (MSDs) among dental professionals. Materials and methods: A cross-sectional survey was carried out on a sample of 225 dental professionals by administering a structured questionnaire. The data collected were analyzed using descriptive statistics and binary logistic regression method. Results: A high proportion of dental professionals reported MSDs at one or the other body regions, with neck being the most affected area (48.9%) followed by lower back (46.2%) and shoulder (45.8%). Working in same position or awkward/cramped position, bending or twisting neck or back while working, etc. were some of the self-reported job risk factors among dental professionals. Females showed significantly increased risk of developing MSDs (OR = 1.53) as compared to males. Non-vegetarian diet, lack of physical activity, excess daily working hours were other predictors for MSD. Conclusion: Prevalence of MSD was high among dental professionals in the present study. Gender, diet, physical activity, working hours were found to be related with musculoskeletal pain. This calls for appropriate educational measures in ergonomics and identifying work-related and non-work–related risk factors to reduce the occurrence of MSD among dental professionals. Clinical significance: This article provides insights in understanding risks factors and possible approaches to reduce MSDs in workplace.

Aim: To compare the bond strength of fiberglass posts luted with different adhesive luting protocols. Materials and methods: Thirty bovine teeth that underwent endodontic treatment were used. The crowns were removed, and the root canals were prepared. In the first group, the posts were cemented with an etch-and-rinse protocol with universal adhesive and resin cement; for the second group, a self-etching protocol with universal adhesive and resin cement was adopted; for the third group, a protocol with self-adhesive cement was adopted. The roots of the teeth were sectioned into 2-mm thick specimens, corresponding to the middle, cervical, and apical thirds of the space prepared for the post. The specimens were pushed out using a universal testing machine. The normality of the data was tested by the Shapiro–Wilk test, and statistical analyses included ANOVA and Bonferroni test. Results: The mean adhesion force was 21.2 ± 4.7 MPa in the first group, 22.6 ± 5.1 MPa in the second, and 12.3 ± 2.1 MPa in the third group. At the cervical level, the mean adhesion force was 17.5 ± 5.2 MPa, at the level of the middle third, it was 17.7 MPa ± 5.4, and at the apical level, 21.0 ± 7.3 MPa. Conclusions: There were no significant differences in the mean adhesion's forces between groups 1 and 2, while the values of group 3 were significantly lower than those of the other groups. Clinical significance: This research allows us to know the impact of bonding systems on the different cementation protocols for fiberglass posts.

To assess and compare the cytotoxicity of different root canal irrigants, namely 25% aqueous neem leaf extract (Azadirachta indica), 2% chlorhexidine (CHX), 25% aqueous Nigella sativa extract (black seed) and 3% sodium hypochlorite (NaOCl). Dulbecco modified Eagle's medium containing glutamine, fetal bovine serum, and antibiotics were used to culture human periodontal ligament cells. After trypsinization, 1 × 10⁵ cell suspension was seeded in 24 well culture plates with 100 µL of culture medium. Then 10 µl of each irrigant was added to the wells, sealed, and incubated in an oven at 37°C in an atmosphere of 5% CO₂ and 95% humidity. Cytotoxicity was assessed at 1, 3, 6, and 24 hours by evaluating the cell viability using the trypan blue assay. A microscope was used for counting viable cells and subjected to statistical analysis. 25% aqueous Neem leaf extract was the most cytotoxic irrigant tested, followed by 2% CHX, while 25% aqueous N. sativa extract was the least cytotoxic irrigant tested. 25% aqueous N. sativa extract and 3% NaOCl solutions were significantly less toxic than 25% aqueous Neem leaf extract solution and cytotoxicity of 2% chlorhexidine was significantly more than 25% aqueous N. sativa extract and 3% NaOCl at all periods. Considering this encouraging in vitro data, herbal extracts could be an alternative root canal irrigant with the most negligible toxicity compared to conventional root canal irrigants, with undesirable effects.

Aim: The aim of the study was to investigate the effect of cone-beam CT (CBCT) volume orientation on the proximity of maxillary sinus to the alveolar crest at dental implant sites. Materials and methods: CBCT images for 54 posterior maxillary implant sites were selected for the study. Vertical distance between the floor of maxillary sinus and the alveolar crest was measured in two different volume orientations: occlusal plane and mandibular base parallel to the horizontal plane. The measurements were repeated and compared using paired sample t-test. Results: The vertical distance between the floor of maxillary sinus and the alveolar crest was significantly greater when the CBCT volume was oriented with the mandibular base parallel to the horizontal plane (p ≤ 0.05). Conclusions: If the CBCT volume was oriented with the mandibular base parallel to the horizontal plane, this will result in increase of the vertical distance between the floor of maxillary sinus and the alveolar crest. Subsequently, this will lead to selecting longer dental implants. Clinical significance: CBCT volume orientation is paramount for implant planning at maxillary sinus area. Incorrect volume orientation might result in choosing implants with incorrect dimensions, this will lead to unacceptable complications at time of implants insertion.

Aim: To evaluate the effect of topical ozone therapy for wound healing after transalveolar extractions. Materials and methods: A prospective study was conducted on 72 patients who underwent transalveolar extraction procedure and were divided into 2 groups–Ozone group and the control group with 36 patients in each group. After the procedure, the patients in the ozone group, received ozonated oil and the control group received normal saline irrigation. The ozone group patients were prescribed to apply the Ozonated oil locally at the extraction site for 3 times daily for a period of 5 days. Antibiotics were not prescribed in the ozone group but were given for the control group. Analgesics were given on SOS basis in the ozone group and for 5 days in the control group. The subjects were evaluated for postoperative wound healing, pain and swelling on the 3rd and 7th day. The final POSSE score and the number of analgesics taken were recorded on the 7th day. Results: Patients in the ozone group had better wound healing on POD3 and POD7 when compared to the control group. There were decreased VAS pain, and swelling scores in the ozone group compared to the control group with statistically significant difference (p < 0.001). The patients in the ozone group took lesser analgesics than the control group. Overall post-extraction discomfort was significantly lesser in the ozone group when compared to the control group (p < 0.001). Conclusion: With the present study results, we can say that the topical ozone therapy can be used as an effective treatment modality for accelerating healing and reducing the pain after transalveolar dental extractions. Clinical significance: Dental extraction, though routinely done procedure in the clinical setting, has various postoperative complications, pain and swelling being the most common. Hence, ozone therapy can be used as an effective topical agent to manage post-extraction pain and swelling in healthy patients without the need for excess medications.

Aim: This study aims to find the data related to the use of Cocos nucifera oil for the management of post-denture insertion-related mucosal changes in removable denture wearers. Materials and methods: A total of 252 partial and complete removable denture wearers participated in the study formed the study group. A specially designed questionnaire consisting of 15 closed-ended questions was used for data collection on various aspects on usage. Statistical analysis was done using SPSS software version 21.0. Results: Approximately 97.5% of the population seek remedies for denture sores or ulcers, 95.5% prefer C. nucifera oil applications and 93.5% of them have experienced relief after the application of C. nucifera oil. Conclusion: C. nucifera oil is an effective and a safe remedy for post-denture-related mucosal changes by the patients wearing removable dentures. Clinical significance: Removable denture-induced mucosal changes were due to accumulated denture plaque, reactions to the denture base material constituents, and also due to mechanical denture injury. Local and systemic antifungal drug therapy for these post-denture insertion mucosal changes shows lower patient compliance, resistant to the drug, and threat owing to their toxicity.

Dentists play an important role in the early detection and diagnosis of oral cancer. In areas with a high prevalence of oral cancer, screening and patient education should receive much more emphasis. The dentist-patient relationship is a cornerstone of dentistry. Patients trust their dentist to be committed to their wellbeing. Thus, dental professionals carry a substantial social and ethical responsibility toward their patients. In this work, the author reports five cases of oral premalignant conditions that were missed due to dental negligence by dental interns practicing in university dental clinics. The observed passive behavior by dental interns in relation to oral cancer screening and patient education is alarming. Five cases were at high risk of delayed diagnosis because of such behavior. The finding suggests the likelihood of overlooking other similar cases, potentially drawing more attention to dentists’ responsibility toward the late diagnosis of oral cancer. This clinical series indicates that more emphasis should be placed on oral cancer examinations, as well as on the ethical and legal consequences of dental malpractice.

Aim: The aim of this study was to evaluate and correlate the salivary cortisol levels with depression, anxiety and stress scores in patients with OLP. Background: Oral lichen planus (OLP) is an immunopathological disease where patients often relate the onset and aggravation of symptoms to increased levels of depression/anxiety/stress. Research suggests that salivary cortisol can be considered as a biomarker of stress. Psychosomatic diseases such as OLP validate the role of depression/anxiety/stress so that they can be effectively and comprehensively treated. A comprehensive electronic literature search was performed by using scientific databases MEDLINE, PubMed Central, Directory of Open Access Journal, Cochrane and Google Scholar. Studies included case control/cross-sectional studies in which the detection of salivary cortisol levels of the OLP patients and controls was assessed along with assessment of DAS with questionnaire/scales. Quality assessment was done using modified Newcastle–Ottawa Quality assessment scale (NOS) and The Joanna Briggs Institute (JBI) Critical Appraisal tool. Review results: Eleven studies comprising 260 OLP patients and 253 controls were included. The results suggest that the depression/anxiety/stress scores were higher in OLP patients than controls. The anxiety, depression and stress scores showed statistically non-significant correlation with salivary cortisol in OLP. Conclusion: The psychological factors including stress, anxiety and depression plays a crucial role in pathogenesis of OLP. So, supportive psychological treatment also needs to be considered while treating OLP patients. Clinical significance: Oral lichen planus (OLP) is a psychosomatic disorder and salivary cortisol is biomarker of stress. The psychological factors including stress, anxiety and depression play a crucial role in pathogenesis of OLP. We reported higher salivary levels of cortisol and higher scores of anxiety, depression and stress in OLP patients compared to controls. Similarly, no correlation between anxiety, depression and stress scores with salivary cortisol is established. Thus, we recommend supportive psychological treatment together with the conventional therapy could increase patients’ capability to deal with psychological instabilities that can improve the OLP healing.

Aim: This systematic review was done to evaluate Polyether Ether Ketone (PEEK) over metal-ceramic alloy as a fixed partial denture framework. Materials and methods: This review adhered to the PRISMA guidelines for conducting and reporting systematic reviews and meta-analyses. Three independent reviewers screened the literature pertinent to PEEK in fixed dental prosthetic applications with time limits from the years 1995 January to 2020 January. The search strategy was done based on PICO formulation. PICO analysis was used to create a search questionnaire, and a complete search was piloted in PubMed, Cochrane, Embase, Ovid, Science Direct databases for related manuscripts. Following screening and final selection, all the relevant information from the articles was extracted, tabulated, analyzed, and interpreted. Results: 140 papers were rejected grounded on the title and the abstract from the 165 publications found after perusing all databases. Twenty papers were eliminated based on our inclusion and exclusion criteria, leaving only five researches to be included based on their central data. Meta-analysis could not be initiated due to the heterogeneity of the selected articles. Conclusion: Based on this systematic review, PEEK-fixed partial dentures are reported to show better esthetics and despite the fact, PEEK frameworks showed equivalent mechanical properties as metal alloys, there is insufficient evidence to validate superior mechanical properties compared to its metal counterpart. Hence future studies are required in this field for further understanding and authentication. Clinical significance: PEEK can be effectively used as an appropriate superstructure for dental implants, temporary abutments, implant aided bars, framework for removable prostheses, and fixed dental prostheses.

Aim: To evaluate the level of anxiety during COVID-19 pandemic status and to investigate the association between gender, level of education, and age-group with the level of anxiety. Materials and methods: Studies measured anxiety during COVID-19 pandemic in Saudi Arabia via various social media using different indexes. Name of researcher and year of publication, gender, scale used, degree of anxiety, age-groups, and educational level were assessed. Results: Fifteen studies were involved in this review, and they showed that mild anxiety during COVID-19 was the highest among Saudi patients (54%), followed by moderate (32%) and severe (13%) anxiety. Additionally, the percentages of females, young age-groups, and educated participants were higher than those of their counterparts. Healthcare workers (HCWs) recorded a higher percentage than others during the pandemic. Conclusion: Overall, during the COVID-19 pandemic, the percentage of moderate and severe levels of anxiety were high. Females and lower age-groups recorded high levels of anxiety than others. Different healthcare and educational programs must be started to minimize the level of anxiety and number of cases. Clinical significance: To overcome this problem, HCWs should undertake educational sessions with training to help and minimize their patients’ level of anxiety. Ministry of Health and Governmental hospitals should build a treatment plan and programs that aids in treatment and recovery of the patients. Also, the importance of anxiety control measures through and for the HCW population should be focused upon.