Aim: The aim of this study was to examine the thickness and the formation of connective tissue in the healing process on days 7 and 14 after the administration of aloe vera extract on the buccal mucosa of rats. Materials and methods: This research was an experimental study with a posttest only control design. A total of 24 rats were used and divided into four groups—groups A (day 7) and B (day 14) were untreated (control), whereas groups C (day 7) and D (day 14) were topically applied with aloe vera extract. The wound in the buccal mucosa was made, followed by the application of aloe vera extract twice a day for 7 and 14 days. The mucosa tissues were collected on days 7 and 14 to subsequently prepare for hematoxylin-eosin (H&E) staining. The thickness of the tissues was observed using a microscope with 100× magnification. Results: The result showed a significantly different thickness of connective tissue in the treated group compared to the control at day 7. The treated groups demonstrated dense and thin connective tissue on days 7 and 14. Otherwise, the thick but loose tissues were observed in the control group both at 7 and 14 days. However, no significant difference in the tissue thickness in the treated and the untreated groups was found on days 14. Interestingly, there was a significantly different value of the wound closure in the control compared with the treated groups on day 7 but not on day 14. Conclusion: These findings conclude that aloe vera extract was involved in the formation of connective tissue in the wound healing of oral mucosa. Aloe vera also contributes to tissue thickness during the healing process. Moreover, aloe vera could accelerate the wound closure of buccal mucosa in white rats. Clinical significance: Aloe vera extract can be a novel therapeutic agent to stimulate the wound healing of oral mucosa, thus benefitting use in tissue regeneration. It may become an alternative therapy to treat tissue injury in the mucosa or oral ulcer. This herb can be further applied clinically in dental treatment relating to oral tissue healing.

Background: Dental pulp stem cells (DPSC) represent a unique population of multipotent stem cells derived from diverse parts of a tooth. Objective: This study examined the effects of metformin (Met) on restoring the regenerative potential of stem cells treated with gingival crevicular fluid (GCF) from periodontitis patients. Materials and methods: Dental pulp stem cells (DPSC) were isolated from healthy human teeth. GCF was collected from patients with periodontitis, and cytokine levels were assessed. A cytotoxicity assay was done to examine the impact of Met on DPSCs with and without osteogenic induction. Mesenchymal stem cell surface markers and differentiation assays were performed. Results: The stem cells showed typical mesenchymal stem cell-like morphology and were 85% positive for CD105, CD90, and CD73 and negative for major histocompatibility complex (MHC) class II antigen (Ag) human leukocyte Ag-DR isotype. They could be differentiated into osteoinductive, chondroinductive, and adipocyte-inducing cell types. The cytotoxicity assay showed Met tolerance for up to 7 days. The GCF contained significant levels of proinflammatory cytokines. Its effect on stem cells caused a reduction in the expression of osteogenic/odontogenic genes, namely RUNX2, ALP, OCN, DSPP, and DMP1. Conclusion: Treatment with Met reversed this effect and resulted in higher expression of most of the downregulated genes and an increase in the formation of mineralized nodules by the treated cells. Met may serve as a stem cell modulator in tissue-engineering cases. Clinical significance: Metformin (Met) combined with DPSC could have potential applications in therapeutic, regenerative medicine due to its positive effects on stem cells.

Aim: To evaluate and compare marginal integrity and casting defects using indirect sprue design, clockwise sprue design, and anticlockwise spiral sprue design. Materials and methods: A total of 60 wax patterns for casting were milled, simulating a single unit fixed dental prosthesis. They were randomly divided into the indirect spruing technique group (n = 20), clockwise spiral spruing technique group (n = 20) and anticlockwise spiral spruing technique group (n = 20). Test samples were then placed on the nickel–chromium (Ni–Cr) master die and checked for marginal fit under a stereomicroscope. Completeness of casting was checked visually. The comparison of mean values of marginal fit (in microns) between all three groups was done by applying student's unpaired ‘t’-test at 5% (p = 0.05) and 1% (p = 0.01) level of significance. Results: Mean marginal values of 135.73, 116.73, and 100.01 were found for indirect, clockwise spiral, and anticlockwise spiral sprue design, respectively. A statistically significant difference was seen in the mean marginal values between the spiral spruing technique—clockwise and anticlockwise—and the indirect group, while there was no significant difference between the clockwise spiral and anticlockwise spiral sprue technique. There was no statistically significant difference in the completeness of casing between all three groups. Conclusion: Indirect spruing technique, clockwise spiral spruing technique, and anticlockwise spiral spruing technique can be used in the laboratory for the fabrication of prosthesis as all the samples showed a marginal gap that was acceptable. Clinical significance: The spiral spruing technique reduces the marginal discrepancy in comparison to other spruing techniques. The direction in which the spiral is created has the least amount of significance in relation to casting defects and marginal discrepancy. Less amount of marginal discrepancy leads to a reduced amount of plaque accumulation and, in turn, increases the longevity of the prosthesis.

Aim: To evaluate and compare sorption and solubility of traditional glass ionomer luting cement, resin-modified glass ionomer luting cement, and resin luting cement in distilled water (control group) and artificial saliva at varied time intervals at 37°C. Materials and method: Sixty disk-shaped specimens, divided into 20 specimens each, were fabricated with traditional glass ionomer luting cement, resin-modified glass ionomer luting cement, and resin luting cement, respectively, using a plastic mold. Ten specimens each from the respective groups were immersed in distilled water and artificial saliva, respectively. These specimens were assessed at time interval of 1 day, 1 week, 2 weeks, 3 weeks, and 4 weeks to evaluate sorption and solubility, during which period they were kept in the incubator and desiccator, respectively. The results were recorded, tabulated, and subjected to statistical analysis. Results: Conventional glass ionomer luting cement (GC Gold Label 1) showed the highest solubility followed by resin-modified glass ionomer luting cement (RelyX Luting 2) and the least soluble was resin-luting cement (Maxcem Elite). The interaction between the luting cement and storage media was statistically significant. Conclusion: The composition of the luting cement and the storage media significantly affected the sorption and solubility rate in the studied luting cements. Clinical significance: Water sorption and solubility of dental luting cements have a great clinical significance that cannot be overlooked. The extensive amount of solubility and sorption of luting cements in turn affects their durability and clinical performance. It may lead to reduced strength of the cement and eventually failure of the fixed dental prosthesis.

Aim: To investigate the relationship of maxillary posterior teeth to maxillary sinus in different facial biotypes by using cone-beam computed tomography (CBCT). Materials and methods: In this cross-sectional study, 99 subjects were divided into three facial biotypes—leptoprosopic (LP), mesoprosopic, and euryprosopic facial types. From CBCT images, distances from maxillary posterior roots apices to the sinus floor maxillary posterior roots apices to sinus distance (MSD) were measured and the relationship of each root to maxillary sinus was evaluated using New Net Technologies (NNT) software. Results: Altogether, 1,584 roots of 99 subjects with a mean age of 26.45 ± 6.78 years met the inclusion criteria. Mesoprosopic facial biotypes have significantly lesser MSD than euryprosopic facial types for palatal (P) root of first molar, mesiobuccal (MB), and distobuccal (DB) root of second molar (p < 0.05). Similarly, the LP facial biotypes have significantly lesser MSD than euryprosopic facial biotype for the P root of the first molar and DB root of the second molar (p < 0.05). The mesoprosopic facial biotype has the highest frequency of roots that touch or protrude the sinus (58.1%), followed by LP (45.5%) and euryprosopic (40.1%) facial biotypes. Males have significantly lesser MSD than females for the P root of the first molar, P root of the second molar, and MB root of the second molar (p < 0.05) and have a higher frequency of roots that protrude or touch the sinus (males, 52.5%; females 38.8%). Conclusion: The MSDs and frequency of roots touching or protruding the maxillary sinus vary with different facial biotypes. Mesoprosopic facial biotypes and males tend to have the least MSD and the highest frequency of roots that touch or protrude the maxillary sinus floor (MSF). Clinical significance: These inferences have several implications in dentistry, including root canal therapy, endodontic surgeries, oral surgery, and orthodontics tooth movement and placement of miniscrews.

Aim: To compare the clinical parameters, glycemic status [glycated hemoglobin (HbA1c)], and full mouth scaling and root planing (FMSRP) with conventional staged scaling and root planing (CSSRP) in subjects with generalized chronic periodontitis (GCP) and type 2 diabetes mellitus (T2DM) administering doxycycline as a systemic antibiotic. Materials and methods: A total of 30 patients consisting of 15 subjects each in group I and group II with GCP [clinical attachment loss (CAL) of ≥3 mm observed in >30% of the teeth] with T2DM (HbA1c level of ≥7%) receiving FMSRP for group I in <24 hours with systemic doxycycline 100 mg for 14 days and group II undertaking systemic doxycycline 100 mg (CSSRP) for 14 days and receiving CSSRP in 21 days were taken into consideration. Both the groups underwent periodontal assessment of the variables, such as CAL, plaque index (PI), bleeding index (BI), probing depth (PD), and HbA1c on 0 day (baseline), 3rd, and 6th month. Results: Intragroup and intergroup comparisons of PI, BI, PD, CAL, and HbA1c scores between groups I and II, showed that the reduction was greater in group I (FMSRP group) compared to group II (CSSRP) at every standardized and designated time point (p < 0.001). Intergroup comparison of HbA1c also turned out to be significant at various time points (p < 0.001). Conclusion: Full mouth scaling and root planing (FMSRP) with doxycycline provides a valuable treatment option along with better glycemic control in treating GCP in subjects having T2DM. Clinical significance: The present study has been done to check the significance of periodontal treatment with respect to “FMSRP” on the metabolic aspects of DM patients with chronic periodontitis disease so as to emphasize the importance of periodontal health maintenance in these patients.

Aim: The aim of this study was to determine whether the parental data can be used in the prediction of the soft tissue growth in offspring, which can guide in forecasting the growth pattern and the degree of similarity in parents and offspring. This study focuses on whether parental data can be a deciding factor in orthodontic treatment planning. Materials and methods: A sample consisting of 40 class I and II cases aged 9–14 years based on Angle's classification was taken. Frontal and profile photographs of the subjects, along with the photographs of the parents, were taken in a standardized position according to ABO guidelines. The photographs were analyzed using custom-made software for various frontal and profile analyzes to check for the degree of similarity by heritability coefficient and Pearson correlation test. Results: The results revealed a degree of similarity between offspring and parents, which was statistically significant. Class I males and females, class II females had the greater resemblance of the facial features with their father as compared to their mother having a total of 9, 5, and 9 positive correlations, respectively while class II males had more resemblance toward mothers with four positive correlation and higher heritable coefficient. Conclusion: Parental data can be effectively used for predicting facial soft tissue growth in offspring and can serve as a guide in treatment planning in orthodontics. This study can be useful in forensic sciences also, apart from Orthodontic treatment planning. Clinical significance: The results of this study signify that growth forecasting and treatment planning in growing children requiring orthodontic treatment can be done by analyzing the parental data at the start of treatment.

Aim: The aim of the study was to compare the anesthetic efficacy of 2% lignocaine with buffered 2% lignocaine in the inferior alveolar nerve block (IANB) during periodontal flap surgery. Materials and methods: A total of 80 patients were included in the study and 0.6 mL of 8.4% sodium bicarbonate was added to 3 mL of LA solution and IANB was given. The parameters observed were onset of action duration of action and pain on injection, and the efficacy of lignocaine combined with sodium bicarbonate during the flap surgeries was determined. Results: For the onset of action, duration of action and pain on injection, the p-values are 0.4154, 0.673, and 0.897, respectively, which are >0.05, implying no statistically significant difference. Conclusion: The results have concluded that there was reduced pain on injection with a faster onset of action. Clinical relevance: Buffered lignocaine was effective in reducing pain on injection and prolonging the duration of action during periodontal flap surgery.

Aim: To evaluate the shear bond strength (SBS) values of commercially veneering ceramics and composite resin layered to zirconia (Zr) core and compare the results with that of porcelain fused to metal (PFM) samples. Materials and methods: Schmitz–Schulmeyer test was used to determine the SBS. A total of 30 Zr blocks of dimensions 10 × 5 × 5 mm were divided into three groups (I, II, and III) of 10 samples each. Group I samples were veneered with IPS e.max Ceram, group II with Zr reinforced feldspar (Zr-FS), and group III with composite. Group IV consisted of PFM blocks as the control group. The fabricated samples were then subjected to thermocycling and evaluated for SBS in a universal testing machine. The values were then statistically analyzed using an independent sample t-test. Result: The results of the current study showed that the SBS value of PFM blocks (19.51 MPa) was the highest, and that of Zr composite (7.03 MPa) was the least among all the four groups. IPS e.max and Zr-FS veneering ceramics showed similar strength values (9.32 and 9.46 MPa, respectively). Conclusion: This in vitro study revealed that the PFM group exhibited the highest SBS, while the Zr-composite the least among all the groups tested. Clinical significance: This study will aid in the clinical selection of the core veneer material depending on the esthetic need and functional requirements. Greater translucency and comparable strength exhibited by the Zr core ceramic veneer make it a valuable alternative in the anterior esthetic region due to the reduced bite forces involved.

Aim: The aim of the study was to evaluate the morphological variation in different parts of the mandible in subjects with the orthognathic and retrognathic mandible. Materials and methods: A total of 100 subjects were selected, aged between 18 and 30 years. The subjects were divided into the orthognathic mandible (group I) and the retrognathic mandible (group II) group based on the lateral cephalometric measurements. The mandibular morphology, that is, body, ramus, condyle, chin size, anterior and posterior dental height, and gonial angle (upper and lower gonial angle), were assessed using lateral cephalogram in both group I and group II individuals. Results: Statistically significant smaller mandibular body length, ramus height, ramus width, chin size, and posterior dentoalveolar height were observed in the retrognathic mandibular subjects compared to the orthognathic mandible subjects. Condylar process height, condyle width, lower anterior dental height, gonial angle, upper gonial angle, and lower gonial angle did not show statistically significant differences between the groups. Conclusion: The results showed that mandibular body length, ramus height, ramus width, chin size, and posterior dentoalveolar height were smaller in retrognathic mandibular subjects when compared to the orthognathic mandible subjects and were statistically significant. Clinical significance: Assessment of morphological characteristics of the mandible in different skeletal malocclusion will provide a better guide in clinical diagnosis and treatment planning and thus help to evaluate the prognosis of orthodontic treatment.

Aim: To evaluate the knowledge and attitude of dentists toward geriatric dental care during the coronavirus 2019 (COVID-19) pandemic. Materials and methods: An online questionnaire survey was conducted among a self-selected sample of dentists from different parts of India. The first part of the questionnaire comprised 12 items that collected information regarding knowledge, and the second part comprised 14 items that assessed the attitude of participants toward geriatric dental care during the COVID-19 pandemic. Results: Evaluating knowledge–65% of participants were aware of guidelines by the Ministry of Health and Family Welfare (MOHFW) for dentists that should be practiced during the COVID-19 pandemic, and 93.6% were aware of post-COVID complications present in older adults after recovering from the acute phase of the disease. Evaluating attitude: A total of 69.8% of them found it difficult to deliver dental care to geriatric patients after following all the COVID-19 practice guidelines, and 97.1% of participants were willing to treat a post-COVID older adult in the dental clinic. Conclusion: A total of 69.8% of them found it difficult to deliver dental care to geriatric patients after following all the COVID-19 practice guidelines. Around 31.4% of dentists were not aware of the precautions to be taken to treat older adults with post-COVID complications. Hence there is a need for further studies on post-COVID complications and guidelines for treating the elderly during the pandemic. Clinical significance: As a consequence of newly emerged barriers and post-COVID complications, much poorer oral health outcomes might occur among geriatric patients in the near future. Hence it is important to understand the knowledge and attitude of dentists towards geriatric dental care in order to equip the already small workforce interested in geriatric oral health care.

Aim: To compare the tensile bond strength (TBS) of an indigenously developed hydrogel denture adhesive with that of three commercially available denture adhesives under dry and wet conditions. Materials and methods: The test group consisted of an indigenously prepared hydrogel-based denture adhesive composed of chitosan-pectin (CSP) dopamine. The comparator group consisted of three commercially available denture adhesives (Fixon, Denofit, and Effergrip). The outcome measurement was TBS of the denture adhesives. A total of 56 samples were tested for the study and divided into four groups (hydrogel, Fixon, Denofit, and Effergrip) of 14 each. Each group was further divided into two groups (I and II) of seven samples each. Group I was tested under normal atmospheric conditions and group II was tested under artificial saliva. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20 for Windows. Student's paired t-test, repeated measures design analysis of variance (ANOVA) among each group, and two-factor design ANOVA (adhesive by saliva treatment) were performed to determine the significance among mean values and different treatments. Results: For hydrogels, it was observed that there was a statistically significant difference with tensile strength being lower in artificial saliva. Fixon did not show a statistically significant change between the two conditions at any time point. At time points 6, 12, and 24 hours, the difference in tensile strength was statistically significant for all materials except Fixon under artificial saliva. Conclusion: The TBS was significantly greater in indigenously made hydrogel for 5 minutes, 3, and 6 hours both in normal atmospheric conditions and samples immersed in saliva. But after 24 hours, it showed the least strength. For all samples, TBS was found to be decreasing as the time interval increased. After 12 and 24 hours, Effergrip showed the highest TBS. The least strength was for Denofit. Clinical significance: A new hydrogel-based denture adhesive was tested against three commercially available denture adhesives, and it showed better initial bond strength under normal and wet conditions.

Aim: This systematic review and meta-analysis were conducted to assess the effectiveness of Herbst appliances on mandibular length (Co-Gn) in patients with class II malocclusion. Background: Mandibular skeletal retrusion is the most consistent diagnostic feature in class II malocclusion. According to a recent meta-analysis, the Herbst appliance effectively treats class II malocclusions. There is currently little evidence about the effect of Herbst treatment on different facial measurements, for which stems from the rationale of this review. Review results: A total of 13 studies were included in this systematic review and meta-analysis with 355 patients who underwent Herbst appliance. Authors used review manager 5.4 to conduct quantitative data synthesis, and random-effects meta-analysis was used to assess the effect of Herbst treatment on mandibular length (Co-Gn). As part of the pooled meta-analysis, heterogeneity was assessed using an I² statistic. The funnel plot and funnel plot symmetry metrics were used to quantify publication bias. Conclusion: We demonstrated that Herbst treatment significantly increases the mandibular length Condylion Gnathion (Co-Gn). According to our findings, the Herbst appliance is effective for patients with class II malocclusion. Clinical significance: The effect of Herbst treatment in terms of increasing the mandibular length must be considered while planning treatment for individuals with class II malocclusion. The findings should be interpreted with caution due to the low quality of evidence and publication bias. The variations in observation/treatment durations may also affect and bias the findings. We recommend future high quality studies to be conducted on subjects with Herbst appliances to accurately measure and report on cephalometric changes.

Aim: This review aims to evaluate the long-term effects of rapid palatal expansion (RPE) on the pharyngeal airway and nasal cavity using three-dimensional (3D) analysis. Background: Skeletal maxillary transverse deficiency is known to be an anatomic etiological factor for developing sleep-disordered breathing in growing patients. Also, rapid palatal expanders have been used for over a century for bringing transverse skeletal expansion, but their long-term stability on the nasal cavity and pharyngeal airway remains questionable. Results: Electronic search of different databases as well as manual search from inception to December 2020 yielded 529 articles. The search included a combination of the following keywords like “rapid maxillary expansion (RME),” “pharyngeal airway,” “nasal cavity,” and “3D evaluation.” To evaluate the long-term effect of RPE, studies with minimum retention of 6 months postexpansion were only included. After screening and selection based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, nine studies were included for the final qualitative analysis. ROBINS-I tool was used to assess the risk of bias in the included studies. Meta-analysis was not performed due to heterogeneity between studies. Conclusion: The existing evidence shows that in growing children, RPE expands nasal cavity volume, improving nasal breathing, and the results are stable. However, long-term stability on increasing pharyngeal airway volume could not be sustained. Clinical significance: The evidence seems to support RPE can be a useful method for increasing the nasal cavity volume in the long-term and appears to have a clinically similar long-term effect on the pharyngeal airway as the control group. Thus, RPE can be considered an effective method for the management of pediatric obstructive sleep apnea.

Aim: To review the current data on the association between problems in a pregnant woman with metabolic syndrome (MetS) and periodontitis and to discuss the mechanisms underlying this association. Background: Periodontitis, according to some studies, has been linked to pregnancy complications such as preterm (PT) labor, reduced weight at birth, and preeclampsia (PE). MetS is a group of health factors that includes physiological, circulatory, and immunological markers. The physiologic perturbations that support MetS are constant and also include thrombotic dyslipidemia, hypertension blood pressure (BP), resistance against insulin, overweight, and prothrombotic and proinflammatory states, despite the fact that there were many interpretations used to characterize and classify MetS. Review results: Premature deliveries and other prenatal difficulties associated with MetS are linked to periodontitis. Periodontal bacteria may play a role in this process, either directly generating fetal anomalies or indirectly stimulating the inflammatory reaction and myocyte contraction, resulting in PT birth. However, there is yet no information on the effects of diverse oral microbial populations. Furthermore, current data did not provide definite answers about the effectiveness of periodontal therapy in preventing PT births and other prenatal problems associated with MetS, and definitive intervention strategies have not been created. Conclusion: Premature deliveries and other prenatal difficulties associated with MetS are linked to periodontitis, which may damage the subject throughout their life. Periodontal bacteria may play a role in this process, either directly generating fetal anomalies or indirectly stimulating the inflammatory reaction and myocyte contraction, resulting in PT. However, there is yet no information on the effects of diverse oral microbial populations. Clinical significance: Pregnant women with MetS should be encouraged to get regular dental checkups throughout their pregnancy to assess their oral health and receive periodontal disease therapy. They should be informed that such therapy during the course of gestation is effective in lowering the probability of premature delivery or newborns with low weight at birth.