Aim: Evaluate the effect of three whitening mouthwashes on tooth enamel color and mineralization. Materials and methods: A total of 66 premolars were prepared and immersed for 3 days in black tea to homogenize the initial color of the teeth. The samples were randomly assigned to six groups (n = 11)—GO: Opalescence Go; LW: Listerine whitening extreme; CL: Colgate Luminous White; OB: Oral-B 3D White; CP: 10% carbamide peroxide; and C: control group. GO was treated with 10% hydrogen peroxide for 60 minutes per 10 days; LW, CL, OB with their respective mouthwash for 2 minutes during 28 days; CP used 10% carbamide peroxide for 8 hours per 14 days. The C group was kept in artificial saliva for 28 days. The color was measured with a spectrophotometer after staining and after exposure to bleaching agents. The relative amount of minerals in the teeth was evaluated using Raman spectroscopy. The data were analyzed with analysis of variance (ANOVA) and Kruskal–Wallis statistical test (a = 0.05). Results: Color variation (ΔE-ΔE00) before and after bleaching showed no significant differences between GO and CP; and the mouthwashes had no significant differences between them. L after treatment was statistically greater in CP and GO. Saturation of a and b decreased in all groups after exposure. There were no significant differences regarding the mineral content. Conclusion: The evaluated mouthwashes have a perceptible bleaching effect, without differences between them; however, they do not reach results as professional treatments with carbamide peroxide or hydrogen peroxide. The use of these products does not generate mineral loss. Clinical significance: Whitening mouthwashes can be used as a complement for professional treatments and are safe since no mineral loss was detected.

Aim: To determine the efficacy of 0.25% sodium hypochlorite as a subgingival irrigant twice weekly for 3 months in patients with chronic periodontitis and to assess alterations in periodontal parameters and subgingival bacteria at baseline and 3-month intervals. Materials and methods: The study included 20 patients suffering from chronic periodontitis who were randomly divided into the test group (n = 10) and the control group (n = 10). Professional subgingival irrigation into the periodontal pocket was done with 0.25% sodium hypochlorite in the test group and 0.9% saline in the control group at 2-week intervals for 3 months. Periodontal parameters such as plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline and at 3 months. Subgingival plaque samples were collected, and microbiological analysis was done using multiplex polymerase chain for the detection of subgingival bacteria like Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola at baseline and at 3 months. Results: The results of the present study showed significant improvement in mean periodontal parameters was noted from baseline to 3 months in the test group than in the control group. The mean log colony-forming units (CFU) of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were reduced from baseline to 3 months in the test group than in the control group. The difference between the groups was statistically significant with p ≤ 0.05. Conclusion: Periodontal treatment can be benefited from the use of subgingival irrigation of sodium hypochlorite in the prevention and management of chronic periodontitis. Clinical significance: The use of subgingival irrigation provides additional benefits in the management of chronic periodontitis patients by the resolution of gingival inflammation with improvement in periodontal parameters and reduction in the number of subgingival bacteria. The “site-precise” method of periodontal treatment with locally administered antimicrobial agents offers added advantages.

Aim: The occurrence of ectopic eruption (EE) among permanent molars might be a source of premature loss of primary molars and produce malocclusion. The present radiographic and retrospective cross-sectional study aims to evaluate the incidence and degree of severity of EE occurring in the first permanent molars. Materials and methods: This is a radiographic and retrospective cross-sectional study using panoramic radiographs. A number of 1,266 panoramic radiographs of young children aged 5–10 years old were collected. The Statistical Package for the Social Sciences was used to analyze the data with a 5% significance level. We used Chi-square to assess the significant differences in the prevalence between some data, such as gender, type, and side of impaction. A Kruskal–Wallis test was applied to report on the differences between the three categories of resorption on the deciduous second molars. Results: There were 673 (53.2%) males and 593 (46.8%) females with a mean age of 7.6 years (±1.6 years). The prevalence of EE among first permanent molars was 2.7%. Most cases occurred in the maxillary arch (91.2%). The irreversible type (73.5%) occurred more than the reversible type (26.5%). The occurrence of moderate resorption was significantly higher than mild and severe resorptions. Conclusion: The current prevalence rate of EE in permanent first molars was 2.7%. The EE was significantly greater, in number and severity, in the upper arch than in the lower arch. The implication of early diagnosis and periodic monitoring of ectopic erupting molars are essential for providing proper management and reducing dental complications. Clinical significance: To maintain good oral condition for young children, awareness must be raised regarding EE among permanent first molars. The EE of permanent first molars can lead to early loss of primary second molars and space loss for permanent premolars, which might cause crowding during the late mixed dentition period.

Background: In dentistry, anthropometric measurements of the face are commonly used for the oral rehabilitation process, with the belief that these structures are constant. However, if with age, there are morphological changes, then these may not be valid landmarks. The human tragus is one such landmark which is extensively used by dentists to locate the occlusal plane, draw the eye–ear reference plane, and mark the arbitrary hinge axis point. It was concluded in a study by Tan et al. in 1997 that anatomical variables of the ear, especially the ear circumference, had a higher correlation with age except the tragus. Thus, in prosthodontia, tragus has been a valuable asset. Aim: To assess the age changes in the tragus and the reliability of its use in anthropometric measurements in prosthodontia. Materials and methods: A total of 100 subjects were selected from the age-group of 50–80 years of age. The ear and tragus, in particular, were traced by a single operator using a transparent sheet stabilized with a holder. The shape of the tragus was drawn from the crus of the helix, passing through the superior border, middle portion, and inferior border to terminate at the lower border of the antihelix up to the antitragus. The tragus forms were then grouped as rudimentary, rounded, pointed, and notched. The superior border of the tragus was also traced and grouped into ill-defined, rounded, or notched. Results: Among the subjects from the Dakshin Kannada population, a significant difference was seen between the right and left side tragus forms in males, whereas in females, no such difference was seen. Nearly all the subjects showed senile changes in the tragus. The effects of senility on the tragus shape were seen more in males than females. Conclusion: The tragus form and shape may change with age; thus, additional reference planes must be evaluated before the construction of the denture. Clinical significance: The ala-tragal line is most important during the maxillomandibular relations. So, the operator has to be cautious while using the tragal line, especially in patients with long-standing edentulousness.

Aim: The primary objective of this study was to assess the anti-inflammatory activity and cytotoxicity of a dental varnish formulated using titanium oxide (TiO₂) nanoparticles (NPs) mediated by ginger and rosemary. Materials and methods: A dental varnish was formulated using ginger and rosemary extracts mediated by titanium dioxide NPs. To assess its cytotoxicity and anti-inflammatory activity, tests like brine shrimp lethality assay, bovine serum, and egg albumin assays were conducted at varying concentrations of 10, 20, 30, 40, and 50 µL. The data was collected, and Chi-squared statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) software. Results: In the bovine serum albumin (BSA) assay, the inhibition percentages were 43, 57, 69, 75, and 80% at 10, 20, 30, 40, and 50 µL, respectively, compared to an 84% inhibition at the standard concentration. Regarding cytotoxicity, on day 1, all nauplii remained alive at all concentrations. However, on day 2, as the concentration increased, cytotoxicity also increased, with varying survival rates. Conclusion: The results indicated that the NPs inhibited inflammation at higher concentrations, and cytotoxicity increased as the NP concentration increased. Overall, the study suggests that ginger and rosemary-mediated TiO₂ NPs have the potential to be used as an anti-inflammatory agent. Clinical significance: The research highlights the promising role of ginger and rosemary-assisted TiO₂ NPs as effective anti-inflammatory agents. This holds significant promise for advancing dental therapies aimed at addressing oral conditions.

Aim: The study aims to assess the effect of bleaching on the fracture toughness of two nanohybrid composites. Materials and methods: A total of 64 composite specimens were prepared using the single-edge notch method. Specimens were divided into four groups (16 per group). Out of 32 specimens of Tetric^® N-Ceram Bulk Fill composite (Ivoclar Vivadent, Schaan, Liechtenstein) and Brilliant™ NG composite (Coltene, Whaledent AG) composites, 16 specimens were control and the remaining 16 were included in the test group. The test specimens were exposed to a Pola office (SDI, Victoria, Australia) bleaching agent. Two sets of applications were done as per the manufacturer's instructions. Specimens were rinsed and stored in distilled water for 1 week. Subsequently, the fracture toughness was evaluated using a universal testing machine. Statistical analysis was done using one-way analysis of variance (ANOVA) for comparison between the four groups. Multiple comparison was done using the Bonferroni multiple comparison test. Results: The mean fracture toughness values were the highest for the Brilliant™ NG composite (control group) and the least for the Tetric^® N-Ceram Bulk Fill composite group after bleaching. The fracture toughness values were significantly different between control groups and bleaching groups for both the universal nanohybrid composites tested. Conclusion: In the present study, the bleaching procedure significantly affected the fracture toughness of both tested composites. Tetric^® N-Ceram Bulk Fill composite group postbleach showed detrimental changes with the lowest fracture toughness values. Clinical significance: Reduced values of fracture toughness may lead to restoration failure and thus, clinicians must be aware of the detrimental changes that may occur associated with the use of bleaching agents.

Aim: This research aimed to evaluate the marginal micro gap of class II composite resin restorations sealed with bioactive calcium (Ca) phosphate (P)—based fluoride (F) varnish using the scanning electron microscope (SEM) at 200× magnification. Materials and methods: Box-only cavities were prepared in 24 samples and restored with prewarmed bulk-fill composite. Samples in the control group (n = 12) were left intact as a conventional restorative protocol. Cavosurface margins of restorations in the test group (n = 12) were sealed with casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) varnish (MI varnish, GC America). After the thermocycling procedure for 500 cycles, samples were stored in artificial saliva for 30 days. Then washed samples were dried and sectioned mesiodistally and observed under SEM at 200× for marginal micro gap and mineral deposition along the cavosurface margin with energy-dispersive X-ray analysis (EDAX). Samples were scored according to Blunck and Zaslansky's criteria. Results were statistically analyzed with a Fisher's exact test and Mann–Whitney U test. Results: Fisher's exact test showed a significant difference between the control group and test group between the buccal wall (p = 0.02), base (gingival wall) (p = 0.05), and palatal wall (p = 0.02) for the marginal micro gap. The mean Ca/P ratios of the CPP-ACPF varnish group, that is, the test group were higher than the control group, without statistically significant differences regarding the mineral analysis. Conclusion: The test group with CPP-ACPF application showed a lesser marginal micro gap with statistically significant results than the control group. Clinical significance: The application of bioactive varnish along the cavosurface margins reduces the marginal micro gap. This might prevent postoperative sensitivity and secondary caries leading to long-term clinical success.

Aim: To study the effectiveness of dexmedetomidine and fentanyl as anesthetic medication in managing uncooperative children who attend dental clinics. Materials and methods: A total of 20 uncooperative pediatric patients of age range 3–7 years who had to undergo minor dental procedures were taken as study samples falling in Frankl behaviour rating scale (FBRS) were grouped into receiving dexmedetomidine (group D) and fentanyl (group F) as anesthetic-coinduction medication. Patients were prepared, and the drugs were introduced, following which various parameters such as heart rate, oxygen saturation (SpO₂), and systolic and diastolic blood were measured at baseline, onset, 10, 20, 30, 40, 50, and 60 minutes postoperatively. Sedation was evaluated by using the Ramsay sedation score, and pain was measured with the visual analog scale (VAS). Complaints of any side effects like nausea, vomiting, or any behavioral changes were evaluated and compared. Results: The mean FBRS was observed to be 1.6 and 1.4 in group D and group F, and the mean Ramsay score was 2.3 and 2.5, respectively. In group D, there was a decrease in mean heart rate from baseline to 60 minutes except at onset. There was a decrease in systolic blood pressure (SBP) in group D, whereas an increase was seen in group F, whereas a decrease in the diastolic blood pressure (DBP) in both groups. Conclusion: The effectiveness of dexmedetomidine and fentanyl as anesthetic medication in uncooperative pediatric dental patients was of similar results in terms of sedation, and the level of postoperative pain was less in children treated under dexmedetomidine. However, posttreatment complications were more common in children treated with fentanyl. Clinical significance: Both drugs showed similar results in terms of sedation. The critical value of preference for one drug over another depends on various criteria, and one such is the level of postoperative pain management that has a significant impact on the children's recovery; hence, the prevention and management of such untoward outcomes has to be met with utmost importance. However, the various drug interactions and adverse effects of using the drugs should be known to the dentist.

Aim: To determine, if any, the percentage impact of low-level laser therapy (LLLT) administration on the length of orthodontic treatment and to test the hypothesis that the pace of orthodontic tooth movement (OTM) is accelerated when mechanical forces are paired with LLLT. Materials and methods: In this study, 10 healthy orthodontic patients were selected consisting of five men and five women. A split-mouth design was used for the examination. The right and left quadrants were randomly designated as two groups. Group I served as the control side and group II represented the experimental side. Irradiation of the tissues was performed with a laser device having a continuous wavelength of 980 nm, an output power of 100 mW, a dose of 10 J/cm², and an exposure time of 10 seconds. Segmental T-Loop (17 × 25 TMA wire) was used for canine retraction. In the 1st month, laser therapy was performed on days 0, 1, 3, 7, and 14. Subsequent irradiations were carried out on the experimental side every 15 days until full extraction space closure. Results: The study revealed a greater net decrease in the mean distance between the canine and first molar in the maxilla in combination with the faster rate of maxillary canine retraction. For the intragroup comparison as well as the intergroup comparison, using the Chi-squared (χ²) test, for each period, the difference in the probing depth (PD) score (PD 1–2/2–3 mm) showed an insignificant (p > 0.05) difference. Moreover, the radiographic evaluation showed an overall decline in trabecular percentage in both the maxillary and the mandibular extraction spaces. Conclusion: Low-level laser treatment (LLLT) statistically boosts the orthodontic movement of the canines during the first retraction phase. The study's irradiation settings and procedure were successful in reducing treatment time. Clinical significance: With the potential to shorten the course of treatment, LLLT is a superb adjunct treatment option for orthodontic care.

Aim: The aim of this study was to determine the embryonic toxicology of dental varnish using titanium oxide (TiO₂) nanoparticles (NPs) synthesized using ginger and rosemary. Materials and methods: The study was conducted in a span of 2 weeks, involving zebrafish embryos, NP synthesis, and dental varnish formulation. Ginger and rosemary extracts were prepared by shaking powdered forms in distilled water, followed by filtration. Random sampling ensures an unbiased dispersion of NPs. TiO₂ NPs were synthesized by heating a solution of TiO₂ and plant extract filtrate. Zebrafish embryonic toxicology studies adhered to Organization for Economic Co-operation and Development (OECD) guidelines. Embryos were exposed to dental varnish-containing NPs across various concentrations (1, 2, 4, 8, and 16 µL) and incubation durations (24–96 hours postfertilization) with developmental toxicity effects assessed via hatching rates, viability, and morphology. Data was statically analyzed using one-way analysis of variance (ANOVA) and post hoc Tukey's test employing Statistical Package for the Social Sciences (SPSS) software. Results: The results obtained showed the highest percentage of viability at 100% in 1 and 2 µL and the least viability at 80% in 16 µL concentration of the prepared extract. In contrast, the hatching rate exhibited a descending trend, with the most substantial rate (85%) manifesting at the 1 µL concentration, succeeded by 2 µL (75%), 4 µL (71%), 8 µL (68%), 16 µL (65%), and the control group at 100%. Conclusion: Herbally mediated TiO₂ NPs mouthwash can be researched in order to prepare higher nontoxic concentrations with respect to different organisms in order to broaden the spectrum of action. Clinical significance: The investigation significantly impacts the progression of dental varnish formulations, distinguished by their integration of herbal ingredients and NP interventions. This pivotal research aims to cultivate safer and more efficacious formulations, thereby elevating patient care and safety in the domain of oral health treatments. In addition to modern NP approaches, this study also acknowledges the relevance of herbal formulations and traditional agents, emphasizing a comprehensive exploration of both innovative and time-honored avenues toward refining dental varnishes.

Aim: This study comparatively evaluated the quantum of fragility zone and nanoleakage formation at tooth-composite resin restoration interfaces following deproteinization of dentin with deproteinization agents and methylene diphosphate (MDP) and methacryloyloxydecyl dihydrogen thiophosphate (MDTP) containing bondings agent using a confocal microscope. Materials and methods: Class V cavities were prepared on the buccal surface of 40 extracted human premolars, which were considered for the present study and were randomly divided into four groups (n = 10) based on the different agents used for deproteinization. Group I: bromelain; group II: α-tocopherol; group III: 5.25% sodium hypochlorite (NaOCl); and group IV (control): MDP and MDTP containing bonding agent. After drying each tooth, a dentin-bonding agent was applied, cured with visible light, and restored with composite resin. The samples were kept in a 50% alcoholic solution of 1% wt rhodamine B fluorescent dye for 24 hours to allow dye penetration. The teeth were then cut into sections parallel to their long axes using a low-speed diamond disc, the specimens were polished with 600-grit silicon carbide paper and viewed under confocal laser scanning microscopy to analyze the dentin adhesive area. Results: The results of the present in vitro comparative study revealed that group IV (control)—exhibited a maximum reduction in nanoleakage (122.42), followed by group III— NaOCl (154.11), group I—bromelain (206.82), and group II—α-tocopherol (182.09). Conclusion: In this present study, a newer adhesive system (MDP, MDTP containing) helps in reducing fragility zone formation and nanoleakage which will significantly increase the longevity of the restoration and decrease the failure rates. Clinical significance: To reduce the failure rate of composite resin restorations by secondary caries formation and to increase the bonding between the tooth and the composite resin to minimize nanoleakage.

Aim: This study aims to evaluate the L*, a*, and b* values of different composite shades and their corresponding VITA shade tabs using digital single-lens reflex (DSLR) and cellphone images and comparing their values with a spectrophotometer. Materials and methods: Three commercially available resin composites of shades A3B, B1B, and C2B were evaluated—Estelite Σ Quick (Tokuyama, Japan), Beautiful II (Shofu, Germany), and Filtek Z350 XT (3M ESPE) along with their corresponding VITA (Vita Zahnfabrik) shade tabs. Six samples of each shade from each manufacturer were made using molds of shade tabs from VITA shade guide, using polyvinyl siloxane impression material. These molds were then filled with composite (n = 6), polymerized, and stored in a lightproof environment for 24 hours. For spectrophotometric analysis, the Commission Internationale de lEclairage (CIE) XYZ data was obtained and converted to CIE 1976 (L*, a*, b*) (CIELAB). For DSLR and cellphone, the images were captured and analyzed using graphic software. After the data collection, ΔE* for all three parameters, that is, spectrophotometer, DSLR, and cellphone, was evaluated for each shade of all the manufacturers and compared with the VITA shade tabs. Result: When ΔE values for DSLR and cellphone were compared with spectrophotometer, ΔE for spectrophotometer vs cellphone was significantly more. When the L*, a*, and b* values of different shades of 3M captured using DSLR and cellphone were compared, for shade A3, L* value was not statistically significant (p < 0.05). Similarly, when different shades of Shofu were compared, for shade A3, there was no statistical difference in L* and a* value (p < 0.05), and for shade C2, there was a nonsignificant difference in b* values (p < 0.05). Conclusion: This study showed that the use of cellphones for composite shade matching could be a reliable and easy method. Clinical significance: The study signifies the utility of cellphones during composite shade matching to make the procedure more convenient and untroublesome.

Aim: To assess residual filling material in the root canals and the tooth's resistance to fracture posttreatment utilizing retreatment files, namely Professional Taper (ProTaper), Mtwo, and NeoEndo. Materials and methods: A total of 90 human-extracted mandibular premolars with one root and a single canal were selected for this study. Samples were decoronated, followed by chemomechanical preparation, and thereafter, using the lateral compaction method, root canals were obturated. The samples were divided into three groups (n = 30)—retreatment file systems, namely ProTaper, Mtwo, and NeoEndo. All three groups were subjected to cone-beam computed tomography (CBCT) evaluation to assess remnants of obturating material inside the canals, and the same samples were further assessed for fracture resistance using the universal testing machine (UTM). The collected data was then evaluated using statistical analysis using the Kruskal–Wallis and post hoc Bonferroni tests. Results: There were significant differences among the tested groups in the cervical thirds following statistical analysis (p < 0.05). The last residual material was found using ProTaper R (0.9280 ± 0.39707), followed by NeoEndo R (1.1000 ± 0.29814), and the maximum by Mtwo R (1.3500 ± 0.21904). In terms of fracture resistance after retreatment using ProTaper, Mtwo, and NeoEndo retreatment file systems, no significant differences were observed. Conclusion: All the tested nickel-titanium (Ni-Ti) retreatment files performed satisfactorily in removing the material from the obturated canals. The filling material could not be entirely removed from any of the file systems. ProTaper R left the least amount of filling material in the cervical third. No statistically significant difference was displayed in terms of the fracture resistance among the respective groups. Clinical significance: Retreatment is necessary in order to save a tooth that has undergone erroneous root canal treatment. To save time retreatment rotary files are being widely used these days. But these files may weaken the tooth by excessive removal of tooth structure. The current study provides clinically relevant knowledge about the different retreatment file systems available, providing in-depth insight into the effective and efficient management of challenging endodontic retreatment cases.

Aim: The aim of the present study is to analyze the efficacy of root surface smear layer removal between 17% ethylenediaminetetraacetic acid (EDTA) and erbium, chromium:yttrium-scandium-gallium-garnet (ER, CR:YSGG) laser after root planing. Materials and methods: A total of 30 single-rooted teeth extracted due to periodontal disease were selected and randomly allocated into three groups (n = 10 in each group) and root planing was done at the site of interest with Gracey curettes. Group I was taken as control and treated with 10 mL of normal saline, group II was treated with 17% EDTA, and group III was treated with ER, CR:YSGG laser. The samples were processed, fixed, viewed under a field emission scanning electron microscope (FESEM), and analyzed for the presence of a smear layer. The data was statistically analyzed by applying the Kruskal–Wallis test. Results: There was a significant difference (p-value < 0.001) in the efficacy of smear layer removal between all three groups, with mean ± standard deviation of 6.30 ± 0.82 in group I, 4.20 ± 0.63 in group II, and 1.90 ± 0.74 in group III. Conclusion: The root surface smear layer removal is more efficient in the group treated with ER, CR:YSGG laser than 17% EDTA. Clinical significance: Removal of the smear layer on the root surface provides a hospitable environment for periodontal regeneration. It also exposes the collagen fibrils and opens the dentinal tubules, which favors cell migration and attachment.

Aim: This research was conducted to analyze and compare the regenerative ability of 1% alendronate (ALN) and 1% metformin (MF) in chronic periodontitis patients with infrabony defects. Materials and methods: This study had a split-mouth design in which 26 sites with infrabony defects in chronic periodontitis patients were enrolled; 13 were aggregated to the group I (1% ALN gel) and 13 to group II (1% MF gel). A follow-up period of 3 and 6 months was observed postoperatively for the clinical parameters, and a follow-up of 6 months was observed radiologically, after which the data collected was analyzed. Results: Both groups demonstrated statistically significant probing pocket depth reduction, defect depth reduction (DDR), and relative attachment level gain at an interval of 6 months. However, no statistically significant distinction was observed among the groups in both clinical and radiographic measures, as well as crestal bone loss. Conclusion: Within the constraints of our study, no difference in the efficacy of 1% MF and 1% ALN was observed in periodontal therapy of chronic periodontitis patients with infrabony defects. Clinical significance: About 1% ALN and 1% MF have been shown to regenerate periodontal structures and, hence, can be used in the treatment of periodontitis, owing to their antiresorptive and bone-stimulating ability.