Aim: To determine the level of knowledge, awareness, practice, and associated factors about the coronavirus disease 2019 (COVID-19) outbreak in undergraduate dental students at a Peruvian public university. Materials and methods: An observational, prospective, cross-sectional, and descriptive study was carried out. The population consists of all undergraduate students of the Faculty of Dentistry of the Universidad Nacional Federico Villarreal (UNFV) duly enrolled in the academic year 2021–2022. The previously validated and structured questionnaire consisting of 31 predefined answers, including the level of knowledge, awareness, practice, and attitudes in different evaluation sections, was used. The data were analyzed using Stata® 15.0 statistical software. Finally, the associated factors were analyzed by establishing the best Logit model, and a significance level of p < 0.05 was established. Results: In the logistic regression analysis, no variables were found to be associated with the knowledge and awareness, practices, and attitudes of undergraduate dental students regarding the COVID-19 outbreak. The following results were obtained: sex [odds ratio (OR) = 0.49; 95% confidence interval (CI): 0.24–1.0], age (OR = 1.06; CI: 0.92–1.21), cycle (OR = 0.94; CI: 0.81–1.09), origin (OR = 0.45; CI: 0.29–60.3). Conclusion: Peruvian dental students at a Peruvian public university had knowledge, practices, and attitudes about the COVID-19 outbreak. Furthermore, none of the associated factors examined were significant in this relationship. Clinical significance: This research has clinical relevance because it allowed us to identify the factors that influence the level of knowledge, practices, and attitudes of undergraduate dental students in order to establish strategies to address this problem.

Aim: To compare the effect of sealing dentinal caries [International Caries Detection and Assessment System (ICDAS) codes 4 and 5] by high viscosity glass ionomer cement (GIC) vs application of 38% silver diamine fluoride (SDF) in primary molars over a period of 6 months. Materials and method: This study was conducted over a period of 6 months and included 50 primary molars with active dentinal occlusal lesions, aged 3–5 years, having ICDAS codes 4 and 5. Children were randomly assigned to group I: SDF application (n = 27) or group II: high viscosity GIC treatment (n = 23). Lesions were assessed clinically for any progression of caries extent by using International Caries Diagnosis and Assessment System II, topography of lesion and radiographically by International Caries Classification and Management System (ICCMS) criteria after 6 months of intervention compared to baseline. Further, the evaluation of SDF-treated lesion status was by lesion texture and GIC restoration status was evaluated by caries-associated restorations and sealants (CARS) criteria. Results: After 6 months evaluation period, statistically significant, less progression of cases was observed in 7% of lesions after SDF application as compared to 39% in high-viscosity GIC group. Chairside time was statistically significant in between both the groups (p-value = 0.039). Conclusion: Techniques with minimal intervention, namely 38% SDF and high viscosity GIC for the occlusal surface cavity, appear to be effective in arresting the progress of dentinal caries in primary teeth. Clinical significance: Silver diamine fluoride (SDF) application stops the progression of dentinal lesions with less chairside time, being economical and can be used in patients of uncooperative behavior, including those with special healthcare needs.

Aim: This research aims to assess the cytotoxicity of Triplex Hot, Trevalon H, and dental products of India (DPI) heat cure acrylic resins by comparing their optical density at 1, 24, and 72 hours and evaluating the residual monomer's effect on fibroblast cells. Materials and methods: A total of 90 heat-cured acrylic resin specimens (30 each of Trevalon H, Triplex Hot, and DPI) were divided into three groups. HT-1080 fibroblasts were cultured, and resin samples were introduced into respective wells. The inflammatory response was assessed after 1, 24, and 72 hours of incubation. Cell vitality was measured using an 3-(4,5-dimethylthiazol-2-yl)—2,5-diphenyl tetrazolium bromide (MTT) assay and spectrophotometer. Statistical analysis included one-way analysis of variance (ANOVA) and post hoc Tukey's test. Results: All three groups have displayed cytotoxicity at varied levels after 1 hour, 24 hours, and 72 hours, but with no significant difference among groups after 24 hours, increasing safety concerns towards their usage. H3 samples showed a higher level of cytotoxicity in general when compared with H1 and H2. Conclusion: It has been concluded that levels of cytotoxicity were found to be higher and lower after 1 hour and 72 hours incubation period respectively, whereas all the resins displayed similar levels of cytotoxicity after 24 hours explaining that the residual monomers will percolate maximum within the first 24 hours after processing of dentures. Clinical significance: It was discovered that resin had varying degrees of cytotoxic effects, raising concerns about the safe clinical application of these materials. Hence proper care should be taken during the selection of resin materials to prevent adverse effects on operators and patients.

Aim: The study was conducted with the aim to compare the efficacy of sodium monofluorophosphate and nanohydroxyapatite-containing toothpaste in remineralizing artificial caries on extracted primary teeth using the Vickers surface microhardness test. Materials and methods: This experimental in vitro study was conducted on 30 freshly extracted primary teeth from individuals requiring extractions as part of their dental treatment. The lottery method was used to randomly divide the samples into two groups remineralization using nanohydroxyapatite (nano-HA) group (coded group I) and remineralization using the sodium monofluorophosphate group (group II). All the samples were subjected to a demineralization regimen using a demineralizing agent for 48 hours. Then all the samples were subjected to remineralizing regime using sodium fluoride (NaF) toothpaste (226 ppm) and nano-HA toothpaste for 28 days. Surface microhardness for remineralized samples was recorded using the Vickers microhardness test by utilizing a 25 gm load for a duration of 5 seconds. The results were statistically analyzed using the analysis of variance test and post hoc test at a 5% level of significance. Results: The baseline microhardness expressed as Vickers hardness number (VHN) for the nano-HA group (group I) was 341.73 ± 5.07; 256.54 ± 5.10 VHN after demineralization and 321.27 ± 6.48 VHN after remineralization, respectively. For the sodium monofluorophosphate group (group II), the microhardness value was found to be 365.56 ± 5.69 VHN at baseline, 275.65 ± 5.22 VHN after demineralization, and 313.10 ± 8.02 VHN postremineralization. Conclusion: Nanohydroxyapatite (nano-HA) causes remineralization and increases the microhardness of the tooth at the microstructural level. Therefore, it is a novel method to remineralize initial carious lesions. Clinical significance: Remineralization therapy is a contemporary approach for carious lesions in early detection and a noninvasive or minimally invasive treatment approach, which is crucial for the dental profession in shifting their therapeutic approach to a new paradigm. The present study showed that nano-HA toothpaste has the potential to remineralize the artificial carious lesion.

Aim: To assess the function and three-dimensional position of the condyle in unilateral horizontally unfavorable mandibular angle fracture preoperatively and 1-year postoperatively using the Helkimo clinical dysfunction index and computed tomography (CT), respectively. Materials and methods: A total of 10 patients with unilateral horizontal unfavorable angle fractures were subjected to clinical and radiographic assessment before and 1-year after surgical management. The position of the condyle was evaluated through CT and compared between the following groups—group I, preoperative fractured vs nonfractured side; group II, postoperative fractured vs nonfractured side; group III, preoperative vs postoperative fractured side. Statistical analysis was done with the Chi-square and paired student t-test. Results: Clinical evaluation showed severe dysfunction in 80% of patients preoperatively and showed no dysfunction in 80% of patients postoperatively (p = 0.001). CT evaluation in groups I and III showed changes in superior joint space (S1) and condylar angulation (CA) which was statistically significant (p < 0.05). Conclusion: This study has given insight into the potential long-term changes in the position and function of the condyle in unilateral unfavorable angle fractures. Though CT evaluation showed changes, its implications in terms of clinical symptoms were minimal. Clinical significance: From this study, it is understood that angle fracture influences condylar position in the sagittal and axial plane. Operating surgeons should remember that in a continuous bone-like mandible, a fracture of one part can impact the other. Therefore, appropriate fixation of angle fracture following protocols is paramount to avoid long-term Tempero Mandibular Joint (TMJ) dysfunction.

Aim: To evaluate patient-perceived postcementation sensitivity of class II metal inlays cemented using resin-modified glass ionomer (RMGI) and self-adhesive resin luting cement preoperatively, immediately after cementation, 1 week, and 1 month after cementation. Materials and methods: A total of 40 posterior teeth in patients aged between 20 and 50 years were selected and divided randomly into two groups of 20 each. Cast gold inlay restorations were fabricated and cemented with two different luting cements. The adapted criteria to measure the sensitivity of teeth were an objective examination for sensitivity using compressed air, cold water, and biting pressure tests. The data collected were evaluated using the student t-test with p < 0.05 as the level of significance. Results: The patients with restorations cemented with self-adhesive resin luting cement demonstrated less postoperative sensitivity when compared with RMGI luting cement with all three tests used. This difference was nonsignificant (p > 0.05) when compressed air and bite test were used and was significant (p < 0.05) when cold water was used immediately and 1 week after inlay cementation. Conclusion: The patients having restorations cemented with self-adhesive resin cement (SARC) revealed the least postoperative sensitivity at all the time intervals assessed by different tests. Clinical significance: Postcementation hypersensitivity is a common complaint with indirect restorations therefore its cementation with good luting cement is of paramount importance in clinical dentistry.

Aim: To compare the level of dental anxiety and pain perception following single and two-visit root surface debridement (RSD) in patients with chronic periodontitis. Materials and methods: A total of 30 patients with chronic periodontitis who required RSD were included in this study. Patients were divided into two groups. Group I—RSD with a single-visit (n = 15) and group II—RSD with two-visits (n = 15). Patients in group I received treatment in a single-visit, while those in group II received treatment over the course of two sessions separated by 1 week. A visual analog scale (VAS) was used to assess postoperative pain perception, and a questionnaire was used to assess preoperative anxiety. Results: Both the single- and two-visit groups had statistically significant differences in pain perception and anxiety levels (p < 0.05). Within group II, there was a statistically significant difference in pain perception and anxiety levels between the visits. The mean anxiety levels and pain scores were reduced on the second-visit when compared with the first-visit in group II. The mean anxiety scores reduced from 16 to 8.2 and the mean pain scores reduced from 2.5 to 0.8 between two-visits (p < 0.05). Conclusion: From the above results, the present study concluded that the two-visits of RSD tend to make the procedure more comfortable, which lowered the anxiety level and pain perception. Clinical significance: Patients with two-visits to RSD have reduced anxiety levels. Thus, in the management of highly anxious patients, two-visits to RSD can help in lowering the anxiety levels and pain perception.

Aim: To assess the primary teeth exfoliation and permanent teeth emergence sequence of children belonging to Dakshina Kannada district, Karnataka, India. Materials and methods: According to the inclusion and exclusion criteria, a cross-sectional study was conducted on 700 children aged 18 months to 14 years, belonging to the Dakshina Kannada district, Karnataka, India. The record of the teeth that emerged was done through intraoral examination. Age, gender, and date/year of birth were noted and correlated with the sequence of emergence using probit regression analysis. Results: The sequence of emergence in the maxilla was predominantly first molar (M1), central incisor (CI), lateral incisor (LI), first premolar (PM1), second premolar (PM2), canine (C), and second molar (M2) in males and females. However, polymorphisms in the eruption sequence of CI and LI were noted. The sequence of emergence in the mandible was M1, CI, LI, PM1, C, PM2, and M2 in both males and females. The shedding pattern in the maxilla was CI, LI, M1, C, and M2; and in the mandible was CI, LI, C, M1, and M2. Conclusion: Tooth emergence and exfoliation sequence is largely population-based and is dependent on numerous factors. The sequence of permanent tooth emergence in the Dakshina Kannada population was unique and showed some variations as reported by researchers from other parts of India. To the best of our knowledge, this is the first study to report the deciduous tooth-shedding pattern in maxilla and mandible in this population. Clinical significance: Knowing the population-based primary teeth exfoliation and permanent teeth emergence sequence is of clinical importance for accurate diagnosis and appropriate treatment planning. It may also help the clinician in correlating dental age estimation with the maturation status of the individual. These may be useful not only in treatment planning but also in forensic dentistry. While the present study sheds light on the primary tooth exfoliation sequence and permanent teeth emergence sequence of the Dakshina Kannada population, it has certain limitations.

Introduction: Chemokines are chemotactic cytokines that draw particular leukocyte subsets into inflammatory tissues. The gingival crevicular fluid (GCF) serves as a diagnostic fluid to measure these biomarkers released during inflammation. The aim of this study was to evaluate the presence of macrophage inflammatory protein (MIP) 1α and 1β in children with stainless steel crowns (SSC). Materials and methods: A total of 20 molars in children aged 6–10 years requiring SSC were included in this study (primary and permanent). A total of 20 teeth (control)—same tooth with clinically healthy gingiva before tooth preparation for stainless steel crown. A total of 20 teeth (control)—One month after placing the stainless-steel crown. Gingival crevicular fluid (GCF) samples were collected using microcapillary pipettes from standardized sites of each molar, and quantitative measurement was done. Using the enzyme-linked immunosorbent assay (ELISA) kit, MIP-1α and 1β levels were determined. Results: Results showed statistically significant differences between both groups (p-value of <0.005). The highest mean concentration of the cytokines was found in group II. It was present at a much lesser concentration in group I, confirming the association of these cytokines with inflammation. Conclusion: Improperly placed or ill-fitting stainless-steel crowns often predispose to gingival inflammation, recruiting leukocytes into the gingival crevice. In children with SSC, GCF is a noninvasive diagnostic fluid for measuring chemokines like MIP-1α and 1β, which are biomarkers for identifying underlying inflammation.

Aim: The regulation of inflammation and the host immune response relies significantly on apoptosis. It aids in tissue homeostasis, and a disruption of this is frequently linked to disease. The use of histochemical stains like hematoxylin and eosin (H&E) and Feulgen reaction for DNA can provide a simple and cost-effective method for the detection of apoptotic cells. The aim of this study was to analyze the expression of apoptosis in the gingival epithelium of gingivitis subjects and in patients with chronic periodontitis, using H&E and Feulgen reaction for DNA, aided by immunohistochemistry (IHC). Materials and methods: A total of 20 gingival biopsies were harvested from gingivitis subjects (n = 10) and 10 subjects who suffered from chronic periodontitis (n = 10). On the day the samples were collected, a University of North Carolina (UNC) 15 periodontal probe was used to record the periodontal data which includes the bleeding index, plaque index, gingival index, probing depth, and attachment loss. Apoptotic cells were analyzed using Feulgen reaction for DNA and H&E under light microscopy. This was followed by immunohistochemical analysis of p53 and Bcl-2 biomarkers. Results: Apoptotic cell count was higher in the chronic periodontitis group with a mean apoptotic index (AI) of 15.00 compared to gingivitis the group where the mean AI was 7.48. The mean difference was found to be −7.52, however the difference was not statistically significant (p = 0.18). Conclusion: p53 plays a pivotal role in periodontal ligament cell homeostasis and seems to be upregulated in oral inflammatory diseases. Bcl-2 being an antiapoptotic marker was associated more with gingivitis as compared to chronic periodontitis.

Aim: To evaluate the canal centering ability of two heat-treated single-shaping nickel-titanium (NiTi) rotary files in simulated severely curved canals. Materials and methods: Standardized 40 resin blocks with 35° simulated curved canals were randomly divided into two groups according to the instrumentation systems, group I: TruNatomy (n = 20) and group II: XP-endo Shaper (n = 20). Before instrumentation, the resin blocks with an endodontic ruler fixed were photographed in a standardized setup at a magnification ratio (1:4). The simulated canals were instrumented according to the manufacturer's instructions for each system and irrigated in-between with normal saline. After instrumentation, resin blocks were photographed in the same preinstrumentation setup. The pre- and postinstrumentation images stored in JPEG format were sketched with Adobe Photoshop software CS5 using the filter “sketch” (green and red color, respectively). They were superimposed using the same software, and on the canal profile, 5 points of measurement were traced at 1, 2, 3, 5, and 7 mm from the apex representing the apical, middle, and coronal third, respectively. The mean canal centering ratio (CR) was compared for both groups at all the levels of measurement using a nonparametric Mann–Whitney U test. Intergroup and intragroup multiple comparisons of the mean canal CR at each of the measuring points against all the measuring points were conducted using the post hoc Tukey test. Results: The results showed that no significant statistical difference was evident within the same group and between the two groups at all the points of measurement (p > 0.05). Conclusion: TruNatomy and XP-endo Shaper showed comparable canal centering ability in severely curved canals. Clinical significance: These heat-treated single shaping files would thus empower the clinicians to adhere to the ultraconservative access designs, while achieving an adequate and predictable apical preparation within a shorter duration of time.

Aim: The aim of the study was to evaluate the effects of curcumin mouthwash and curcumin–rosemary mouthwash against Streptococcus mutans (S. mutans) colonies in patients undergoing orthodontic treatment. Materials and methods: Around 48 subjects were randomly allocated to three groups, group I (chlorhexidine mouthwash), group II (curcumin mouthwash), and group III (curcumin–rosemary mouthwash). Plaque samples were collected at three stages, T₁—before bonding, T₂—1 month after bonding orthodontic attachments, and T3—after the use of the prescribed mouthwash for a period of 1 month. The collected samples were cultured and the number of S. mutans colonies were counted. The quality of the mouthwash was assessed using a questionnaire. Since the data were normally distributed, paired t-test and one-way analysis of variance (ANOVA) were used to evaluate the difference within and among the groups, respectively. Categorical data were analyzed using the Chi-square test. Results: The results obtained showed a significant reduction in the S. mutans colonies at T3 after the use of mouthwash for 1 month in all three groups. Patients in groups II and III had temporary discoloration of the tongue, whereas patients in group I had a burning sensation in the oral mucosa on prolonged use. Conclusion: All three types of mouthwashes were effective in the reduction of S. mutans colonies in orthodontic patients. Clinical significance: The new herbal mouthwash are cost-effective and had negligible side effects when compared to chlorhexidine. Therefore, they can be used as mouthwashes for all patients regardless of socioeconomic background.

Aim: The aim of the study is to evaluate and compare the retention and sealing ability of pit and fissure sealants (PFS) with and without pretreatment of silver diamine fluoride (SDF)/potassium iodide (KI) on human molars under a stereomicroscope. Materials and methods: A total of 23 freshly extracted primary molars were randomly assigned to two groups; group I: pretreatment with SDF/KI; group II: pretreatment with placebo (tonic solution). Both group samples were acid etched, followed by the PFS application, and subjected to thermocycling for evaluation of sealant retention. The sealing ability of the samples was evaluated using rhodamine B dye and examined under a stereomicroscope with 10× magnification. Collected data were statistically analyzed using a percentage test and a Chi-squared test with α level of 0.05. Results: The rate of retention was significantly lower in group II (p < 0.05) than in group I, while, statistically, no difference in the sealing ability was observed between the groups (p = 1.000). Conclusion: Based on these findings, pretreating the fissures with SDF/KI has enhanced retention of fissure sealant, which could be used as a pretreatment before PFS and has an additional benefit of anticariogenic properties. Clinical significance: Sealants are successful in preventing cavities, but they only remain on the tooth for a long duration if they are completely attached to the tooth surface. Microleakage at the tooth-sealant interface is thought to have a substantial impact on the longevity of sealants due to their high failure rate. Hence, SDF has been used as a cariostatic agent because it may remineralize carious dentin and increase microhardness, and secondary caries is the major cause of failure. In an effort to decrease the dark staining of SDF, it was suggested to use KI to eliminate extra metallic silver after applying SDF.

Aim: Infra-zygomatic crest (IZC) mini-screws are an important advancement for anchorage reinforcement. There are numerous studies measuring IZC bone thickness (BT), but there is less evidence regarding the choice of a specific site for this screw placement among adults with different facial types and among periodontally compromised individuals. In the case of periodontitis, since there is alveolar bone loss, the site of choice for mini-screws will be on the extra alveolar region. This study aims to measure the IZC thickness among different growth patterns and give an optimal site for mini-implant placement. Materials and methods: This is a cross-sectional study conducted on 48 cone-beam computed tomography (CBCT) files with 24 horizontal and 24 vertical growers. The IZC thickness and insertion height (IH) in relation to the maxillary occlusal plane were measured at 70°, considering it an ideal insertion angle according to the literature. The data were recorded and statistical analysis was performed. Results: At all the three coronal slices measured, the horizontal grower group had the maximum thickness of the IZC at the measured angulation and the results were statistically significant. Regarding IH, both groups had an IH of 13–15 mm at 70° angulation with slightly more height in the vertical grower group to the occlusal plane as per our measurement parameters. At all three coronal slices within horizontal growers and within vertical growers, IZC thickness was maximum above the distal root of the first molar. Conclusion: The ideal site for the insertion of mini-implants in the IZC lies above the distal root of the maxillary first molar at an IH of 13–15 mm from the maxillary occlusal plane at an insertion angulation of 70°. Individuals with horizontal growth patterns have a thicker crestal bone when compared to individuals with vertical growth patterns. Clinical significance: Above the distal root of the maxillary first molar at an IH of 13–15 mm from the maxillary occlusal plane at an insertion angulation of 70° can be considered as an optimal insertion site for mini-screws. CBCT should be considered a significant diagnostic aid for measuring the same.

Aim: This scoping review aims to explore evidence regarding the expression of calprotectin and its constituent homodimers in periodontal health and disease and to evaluate their potential role as biomarkers of periodontal diseases. Methodology: Prominent databases such as PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed Central, Scopus, and Google Scholar were searched from January 1998 to May 2022 to collect evidence regarding the expression of calprotectin in periodontal health and disease and the potential use of this heterodimer and its constituent homodimers as biomarkers of periodontal diseases. Results: Cross-sectional studies have reported that calprotectin levels in gingival crevicular fluid, saliva, and serum are elevated in periodontal diseases than in health. It was found that calprotectin levels in oral fluids increased during the early stages of experimental gingivitis and may predict degrees of future periodontal breakdown. Experimental evidence also points out that calprotectin and its constituent homodimers in oral fluids may mirror the degree of periodontal inflammation and predict therapeutic response and disease susceptibility. Conclusion: Within the limitations of this scoping review, it can be concluded that calprotectin and its constituent homodimers have an altered expression pattern in periodontal diseases, and calprotectin in gingival crevicular fluid or saliva may be a promising biomarker of periodontal inflammation and granulocyte activity. Further, longitudinal studies are required to understand the precise role of constituent proteins of calprotectin—S100A8 and S100A9 during periodontal inflammation. Clinical significance: The diagnosis and management of periodontal diseases can be enhanced by identifying and validating a biomarker or panel that can detect disease susceptibility, early disease activity, and therapeutic response. This review elaborates on the potential of calprotectin and its subfractions as biomarkers of periodontal inflammation.