Aim: To compare the levels of gingival crevicular fluid (GCF) interleukin-6 (IL-6) with and without adjunctive injectable platelet-rich fibrin (i-PRF) after scaling and root planing (SRP) in chronic periodontitis patients with type II diabetes. Materials and methods: This was a split-mouth, double-blinded study conducted on 35 chronic periodontitis patients with well-controlled type II diabetes [glycated hemoglobin (HbA1C) value 6.5–7.5%]. The sites were randomly allocated into two groups—group I, i-PRF adjunct to scaling and root planning, and group II, scaling and root planning alone. The clinical attachment level (CAL), probing pocket depth (PPD), gingival bleeding index (GBI), and plaque index (PlI) were recorded at baseline, 1 month, and 3 months. GCF was collected at baseline and 1 month and subjected to enzyme-linked immunosorbent assay (ELISA) for the evaluation of IL-6 levels. Data were statistically analyzed using Jeffreys's Amazing Statistics Program (JASP) version 14. Results: On intergroup comparison, the clinical parameters showed statistically significant results when compared to baseline, 1 month, and 3 months. On intragroup comparison, the mean CAL for group I reduced from 5.09 ± 0.45 to 2.60 ± 0.55, and for group II, it reduced from 5.03 ± 0.57 to 3.63 ± 0.77. The mean PPD for group I reduced from 5.03 ± 0.57 to 2.60 ± 0.55, and for group II, it reduced from 4.94 ± 0.48 to 3.63 ± 0.77. A significant reduction in mean GBI score and PlI score was observed. The mean IL-6 level showed significant improvement within the groups and was not significant when compared between groups I and II. Conclusion: The i-PRF as an adjunct to SRP provided better results when compared with SRP alone in chronic periodontitis patients with type II diabetes. Clinical significance: The i-PRF is an innovative advancement in the field of dentistry. Due to its easy availability and better properties, it can be implemented in various periodontal procedures and in other fields of dentistry.

Introduction: Needle and dental phobia is very common. While topical anesthetic spray has been routinely employed in general practice before the administration of local anesthesia, several other methods for the reduction of pain have been employed with superior success. Objectives: To compare the efficacy of the mucosal vibration technique and topical anesthetic spray technique to reduce pain during the administration of local anesthesia. Materials and methods: This randomized controlled trial (split-mouth design) was done among 15 patients aged between 14 and 45 years requiring extraction of maxillary premolars for orthodontic treatment. On one side, extraction was performed using topical anesthesia, and on the other side, mucosal vibrations were used. Buccal and palatal infiltration injections were given before the extraction of teeth. The pain was recorded using Wong–Baker Faces Pain Rating Scale (WBFPRS) and Face, Legs, Activity, Cry, and Consolability (FLACC) pain scales. The study protocol has been registered in the Clinical Trial Registry of India (CTRI/2020/09/028135). Results: It was observed that the mucosal vibration technique caused a significant reduction in pain perceived compared to the topical anesthetic spray technique (p < 0.05) during the administration of local anesthesia in both buccal and palatal aspects. Conclusion: Mucosal vibrations were found to be effective in reducing discomfort during the administration of local anesthesia and can be used to assist the dentist in treating apprehensive patients effectively.

Aim: To evaluate the efficacy of removal of bioceramic (BC) sealers using rotary retreatment files supplemented with passive ultrasonic activation (PUA). Materials and methods: A total of 72 freshly extracted human single-rooted teeth were used in this study. Root canal preparation was done using ProTaper Universal (PTU) rotary files. Teeth were decoronated to get a uniform length of 16 mm and were divided into four retreatment groups based on the technique used for retreatment. Group I: obturation done with AH plus followed by retreatment with rotary file (n = 18); group II: obturation done with AH plus sealer followed by retreatment with rotary file using passive ultrasonic activation (PUA) (n = 18); group III: obturation done with BC sealer followed by retreatment with rotary file (n = 18); group IV: obturation done with BC sealer followed by retreatment with rotary file using PUA (n = 18). Teeth were stored in an incubator for 30 days to allow sealer to set after which the retreatment of the specimens was carried as per the group allocation. Sectioning of the specimens was done buccolingually for examination under the stereomicroscope and photographed. Statistical analysis was done by using parametric analysis of variance (ANOVA) followed by Tukey honestly significant difference (HSD) post hoc test. Results: There was a statistically significant difference seen for the residual root canal filler (RCF) material values between the groups (p < 0.01) for area of remaining filling material with higher values in group I. In group II, supplemental PUA was found to be effective for removal of the obturating material when compared to group I. It was observed that rotary retreatment files (group III) were more effective in removing the filling materials in roots obturated with BC sealer when compared to group IV (supplementary PUA) which showed higher remnants of filling. The pairwise Tukey HSD post hoc test showed a statistically significant difference between group I and groups II and III. Conclusion: In the present study, it was observed that supplementary use of PUA was not effective for removal of BC sealer. Rotary retreatment files without PUA were more efficacious in removal of the root canal filling materials. However, PUA of solvent enhanced the removal of filling materials obturated with AH plus sealer. Clinical significance: Application of PUA may not be effective in the removal of gutta-percha (GP) obturation in conjunction with BC sealers. PUA is more effective in canals obturated with AH plus sealer for removal of sealer remnant during retreatment cases.

Aim: The aim of the study was to evaluate serum lactate dehydrogenase (LDH) levels in tobacco users without oral lesions. Materials and methods: The study involved a total of 20 subjects, ranging in age from 18 to 60 years, divided into four groups based on tobacco use habits, group I—tobacco chewers, group II—tobacco smokers, group III—individuals who both smoked and chewed tobacco, and group IV (control)—healthy individuals with no history of tobacco use (control group). Participants were selected based on a minimum of 6 months of tobacco use without oral mucosal lesions. Medically compromised patients and those with a history of cancer treatment were excluded from the study. Serum LDH levels were evaluated using a blood sample collected via venipuncture from the antecubital vein. The sample was processed by centrifugation to separate the serum, which was then analyzed for LDH levels within 2 hours of collection. Serum LDH levels across different groups of tobacco users and healthy controls were evaluated and compared using statistical analysis. Results: The mean serum LDH levels were compared among four groups. The mean LDH levels for each group were group I (tobacco chewers): 198.17 U/L; group II (tobacco smokers): 225.11 U/L; group III (tobacco chewers and smokers): 217.22 U/L, and group IV (control group): 165.69 U/L. Analysis of variance (ANOVA) analysis revealed a significant statistical difference (p < 0.05) among the four groups. The serum LDH levels were higher in tobacco users than in healthy controls. The serum LDH levels were higher in tobacco smokers than in tobacco chewers. The mean LDH levels were significantly greater in group III (tobacco chewers and smokers) compared to the control group (group IV). Conclusion: The study findings indicated that tobacco use is associated with elevated serum LDH levels with the highest levels observed in individuals who both smoke and chew tobacco. Clinical significance: This research on LDH levels sought to address the importance of early detection of cancer-related changes at the cellular level in tobacco users to combat the menace of oral cancer. Serum LDH levels can also be used to motivate tobacco users to quit their tobacco habit.

Aim: The study aims to estimate the prevalence of patients at risk for a sleep-related breathing disorder (SRBD) and to explore whether there is a correlation between SRBD and attention deficit hyperactivity disorder (ADHD) related symptoms in pediatric patients aged 3–12 years who were referred to dental centers. Materials and methods: A total of 555 patients were enrolled in this cross-sectional study. After registration at the clinics, parents or guardians randomly selected through odd-numbered patients aged 3–12 years were asked to finish the 22-question pediatric sleep questionnaire (PSQ) as an added section to the medical regimen history examination. Results: Within this sample, 14.1% (78 patients) had eight or more “yes” answers to the PSQ, suggesting that their PSQ test inspection was affirmative for a raised risk of having a SRBD. Sex and age were not considered confounding variables for a positive PSQ test score, with the female patients having a higher chance of earning such scores than the male patients. Conclusion: With the limitations of this study, based on our findings, it appears that 14.1% of children may be at an increased risk for SRBD. The PSQ could be applied as a supplement to a comprehensive clinical exam to identify patients with an increased risk of SRBD. According to this study, 17.15% of the questionnaire test scores were positive for questions related to symptoms of ADHD. Incorporating discussions with parents about ADHD-associated symptoms, snoring, and daytime sleepiness might help to identify patients at increased risk of SRBD. Clinical significance: This study is considered one of the first studies about the prevalence of pediatric patients at risk of sleep apnea in our region, as most studies were conducted on the adult population. The pediatric care provider must be aware of SRBD and ADHD-related symptoms in children. Although evidence is insufficient to conclude the relationship between ADHD and obstructive sleep apnea in children, it is worth discussing ADHD-related symptoms, snoring, and daytime sleepiness with parents. This discussion might be beneficial in identifying patients at increased risk of SRBD. The pediatric care provider can easily identify patients at increased risk of SRBD by using the 22-question PSQ as part of the routine medical history examination, and facilitate referring patients at risk for further clinical examination.

Aim: To analyze the reliability of the Pont's index in a mixed-race young adult population of the National University of Chimborazo (UNACH). Materials and methods: The research was descriptive and cross-sectional. The observation was applied as a technique, including the registration form as an instrument. A total of 44 dental models of students between 19 and 25 years of age were donated by the Dental Clinic UNACH, Riobamba, considering all the selection criteria in the research. The real transverse diameters of the study models were taken at the interpremolar, upper and lower intermolar, and the mesiodistal width of the four upper incisors. Pont's index was applied with a digital caliper to take the odontometric measurements. Results: In the two nonparametric tests for the variables that did not meet the normality tests, the actual mean maxillary intermolar width and Pont's one were not equal, as well as the real measurement of the average maxillary intermolar width and Pont's one. The means of the size were not similar in the real measures of the maxillary interpremolar width and Pont's maxillary interpremolar width. The means of measurement were the same in the mandibular interpremolar width and Pont's maxillary interpremolar width. Conclusion: The means between the real values of the upper and lower interpremolar width and the values of the Pont's index are not equal. It means that Pont's index is unreliable in studies applied to people of mixed-race ethnicity. Clinical significance: It is well known to professionals, especially in orthodontics, that health sciences are constantly updated, and the Pont's index is still used. However, it is necessary to understand its reliability according to the population and the ethnic group they belong to.

Aim: To assess and compare the carbon monoxide (CO) levels in smokers and nonsmokers. Materials and methods: The CO levels of 200 participants (150 smokers and 50 nonsmokers) who visited the tobacco cessation center (TCC) at the Sibar Institute of Dental Sciences (SIDS), Guntur, Andhra Pradesh, India, were analyzed. Results: The exhaled CO levels of smokers and nonsmokers were 7.40 ± 5.90 and 1.06 ± 0.71, respectively. A cutoff of 2.5 ppm or above was given with 81% sensitivity and 72% specificity to distinguish smokers from nonsmokers. There was also a significant positive correlation between CO levels and daily cigarette consumption and CO levels and duration of smoking, with r = 0.63, p = 0.0001 and r = 0.272, p = 0.001, respectively. Conclusion: The purpose of the current study is to educate people regarding the ill effects caused by smoking and emphasize the role of using a breath analyzer to determine one's smoking status by providing visual proof of CO exposure and the necessity of quitting. Clinical significance: To educate and create awareness among smokers through behavior counseling and CO breath analyzers as well as to enhance the lifestyle by preventing the ill effects of CO on the respiratory system and the environment.

Aim: To determine the in vitro cytocompatibility of new dental restorative composite resin (RCR) copolymers containing photodimerized cinnamyl methacrylate (PD-CMA) crosslinker using human pulpal fibroblasts (HPF) by tetrazolium (MTT) assay. Materials and methods: Three research groups were based on the composition of the copolymer. There was a negative control (NC) group only with the cell culture. A total of 27 disk-shaped specimens (n = 9 per group) were prepared. Group C0 (control) consisted of photopolymerized specimens made of base matrix-formers (B), a diluent (D), and without PD-CMA [P(BD)]; experimental groups E10 and E20 consisted of copolymers P(BD-Co-CMA) with 10 wt% PD-CMA substituting D and P(B-Co-CMA) with 20 wt% PD-CMA replacing D, respectively. The specimens were eluted, and an MTT assay was performed. The obtained optical density (OD) values in absorbance unit (AU) were subjected to statistical analysis. Results: The mean OD of C0, E10, and E20 was 0.79, 0.92, and 1.18 AU, respectively. The difference between C0 and E10 was not significant (p = 0.067). The comparisons C0-E20 and E10-E20 were statistically significant (p < 0.05). The order of cytocompatibility was C0 = E10 < E20. Conclusion: The new P(B-Co-CMA) was the most cytocompatible copolymer with HPF in vitro when compared to the P(BD-Co-CMA) and P(BD). Clinical significance: The low-viscosity PD-CMA can eschew the toxic effects of the triethylene glycol dimethacrylate (TEGDMA) by replacing it. Nevertheless, the new copolymer P(B-Co-CMA) with hydrophobic PD-CMA crosslinker would not induce pulpal inflammation and necrosis by preserving the intracellular glutathione and preventing the formation of reactive oxygen species.

Aim: The success of the manufactured veneers depends significantly on their margin. The aim of this study was to evaluate the marginal and internal fit of composite veneer made by conventional computer-aided design/computer-aided manufacturing (CAD/CAM) milling and three-dimensional (3D) printing technique and cemented with two types of composite resin cement was the focus of this in vitro study. Materials and methods: Around 10 composite veneers were fabricated from Ivoclar Vivadent Tetric N-Ceram composite material, 10 veneers were milled from composite blank bredent UK, and 10 veneers were 3D printed from Aqua Ivory 4K composite resin material. Veneers were cemented to composite resin dies using either RelyX veneer cement (3M ESPE RelyX U200) or Panavia cement (Kuraray Panavia SA). The specimens were sectioned incisogingivally followed by the scanning electron microscope examination for the internal gap and marginal discrepancy at three different locations. Results: The difference between the groups was examined using Tukey multiple comparisons and two-way analysis of variance (ANOVA). Veneers fabricated with conventional layering technique showed significant differences in better marginal and internal adaptation (IA) compared to veneers fabricated by CAD/CAM milling and 3D printing technique (p < 0.001). Gaps at the cervical position were significantly lower than gaps at the incisal position. Conclusion: Smaller marginal and internal discrepancies were recorded for veneers fabricated by using the conventional technique compared with milled and 3D-printed veneers. Larger discrepancies were present initially than cervically. Clinical significance: Marginal and IA of composite veneer largely determines their long-term success.

Aim: To compare the efficacy of different remineralizing agents and to evaluate the beneficial role of iontophoresis along with remineralizing agents. Materials and methods: A total of 120 specimens were divided into four groups—control group (n = 15), demineralized group (n = 15), remineralized group (n = 45), and remineralized + iontophoresis group (n = 45). The remineralized group was further divided into subgroup A = casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (n = 15), subgroup B = 8% grape seed extract (GSE) (n = 15), and subgroup C = NovaMin (n = 15). The remineralized + iontophoresis group was also divided into three subgroups—subgroup A1 = CPP-ACP + iontophoresis (n = 15), subgroup B1 = GSE + iontophoresis (n = 15), and subgroup C1 = NovaMin + iontophoresis (n = 15). Vickers microhardness test was used to measure the changes in the hardness of enamel, which occurred in three phases (i.e., control, after demineralization, and after treatment). Data was recorded and statistically analyzed. Results: The mean microhardness for the control group was highest (359.72 kg/mm² ± 15.3), while the demineralized group had the lowest value (294.2 kg/mm² ± 16.3), which was statistically significant. Among the remineralizing agents, results were nonsignificant; however, CPP-ACP (330.4 ± 11.3 kg/mm²) had shown the highest mean microhardness values. On intragroup comparison, data was statistically significant for each group, with an increase in microhardness values in the remineralized + iontophoresis group compared to using remineralizing agent alone. Conclusion: Mean microhardness values in descending order—control group > remineralized + iontophoresis group > remineralized group > demineralized group. CPP-ACP application, along with iontophoresis, had superior remineralizing efficiency compared to other groups. Clinical significance: A pivotal goal of modern dentistry is to manage the noncavitated lesions noninvasively through the remineralization process in order to prevent disease progression and to improve esthetics, strength, and function. Iontophoresis has been shown to effectively accelerate the remineralization speed by driving the remineralizing agents deep into the subsurface enamel lesion in less time, leading to optimal enamel surface hardness.

Aim: To compare the efficacy of aqueous tulsi extract in disinfecting the denture base and soft liner against American Type Culture Collection (ATCC) 10231 and clinical strain of Candida albicans. Materials and methods: A total of 120 samples were fabricated, with 60 of them having dimensions of 10 × 10 × 2 mm for heat cure resin and the other 60 of 10 × 1.5 mm for silicon soft liner. Surface roughness was measured using a profilometer. These samples were then inoculated with clinical and ATCC 10231 strain of C. albicans and kept at 37°C for 48 hours. The concentration of standardized cells was 1 × 10⁶ cells/mL. Tulsi extract was used to determine the minimum inhibitory concentration (MIC). The denture samples were submerged overnight in disinfecting solutions, while the soft liners were subjected to the same process for 10 minutes. Three solutions were used: 10% aqueous tulsi extract, Fittydent tabs, and distilled water. The number of colony-forming units (CFUs) before and after disinfection was assessed to evaluate the effectiveness of the disinfectants. The Kruskal–Wallis nonparametric test was used for the denture group, while analysis of variance (ANOVA) with the post hoc Tukey test was used for the soft liner group. The cytotoxicity of the disinfectants was evaluated using an MTT assay on gingival fibroblast. Results: A significant difference in disinfection ability was observed between all three groups for denture base (p < 0.001). However, there was no significant difference between the tulsi and Fittydent groups for the clinical strain of C. albicans on soft liner (p > 0.7). Soft liners significantly differed with ATCC strain across all three groups (p < 0.05). Conclusion: Around 10% aqueous tulsi extract is safe for gingival fibroblast and could effectively disinfect dentures and soft liners against clinical and ATCC strains of C. albicans. Clinical significance: Patients may use aqueous 10% tulsi disinfectant for daily denture cleaning, which has shown promising results even on soft liners for 10 minutes.

Aim: To assess the in vitro cytocompatibility of a monomethacrylate-based dental copolymer [P(MMA-Co-TATA)] containing 1,3,5-triacryloylhexahydro-1,3,5-triazine (TATA) as a cross-linking comonomer using human cells by tetrazolium (MTT) assay. Materials and methods: The research groups were categorized based on the composition of the resultant polymer formed. Nine disk-shaped specimens (n = 9) per group were prepared using the thermo-polymerization technique. Group G0 (control) consists of polymerized poly(methyl methacrylate) [P(MMA)] specimens without TATA; trial groups G10 and G20 had copolymerized specimens P(MMA-Co-TATA) with 10 and 20% TATA cross-linker (CL), respectively. Obtained eluates from the specimens were tested for in vitro cytotoxicity by MTT assay in terms of cell viability percentage (CV%) on the human keratinocytes (HK) and human gingival fibroblasts (HGF). Results: The mean CV% of G0, G10, and G20 for the HK was 72.04, 74.82, and 80.54%, respectively. Concerning HGF, the mean CV% of G0, G10, and G20 was 73.68, 80.09, and 85.00%, respectively. The descending order of cytotoxicity was G0 > G10 > G20. The CV% was statistically significant among and between the groups (p < 0.05) with both HK and HGF. Conclusion: The novel P(MMA-Co-TATA) copolymer was nontoxic to human cells in vitro when compared to the P(MMA). P(MMA-Co-TATA) with 20 wt% TATA exhibited the highest CV%. Clinical significance: Since TATA is an antimicrobial CL, the resultant dentures could possess improved mechanical properties along with resistance to microbial adhesion on the denture surface. This could reduce the perchance of denture-induced infections in debilitated senile geriatric patients.

Aim: To compare the efficacy of Icon resin infiltration and Clinpro XT varnish on microhardness, surface roughness, and penetration depth of methylene blue dye of artificially induced white spot lesions (WSL). Materials and methods: Artificial WSLs were created on a sample of 45 extracted human premolar teeth by immersing in a demineralizing solution. All samples were randomly allocated to three divisions of 15 each for evaluation of microhardness, surface roughness, and penetration depth, where group I being the control, group II is Icon resin infiltration, and group III is Clinpro XT varnish. Assessment of microhardness, surface roughness, and penetration depth of dye were done with Vickers hardness tester, atomic force microscope, and stereomicroscope, respectively. The data obtained were analyzed using Statistical Package for the Social Sciences (SPSS) software. One-way analysis of variance (ANOVA) followed by the Bonferroni multiple comparison test was applied for comparing the mean microhardness and surface roughness among three groups. The Kruskal–Wallis test followed by Bonferroni–Dunn test was applied for comparing the median penetration depth. Results: The mean microhardness and standard deviation (SD) of groups I, II, and III showed 109 ± 16.21, 203.80 ± 22.19, and 129.80 ± 27.73, respectively. Mean surface roughness (Ra) and SD of groups I, II, and III showed 217.5 ± 8.78, 28.3 ± 9.7, and 165.8 ± 13.9, respectively. The median penetration depth of dye of groups I, II, and III showed 547, 63, and 71.0, respectively. These groups demonstrated a statistically significant difference with a p-value < 0.05. Conclusion: Icon resin infiltration has shown superior microhardness, lowest surface roughness, and lower depth of penetration of dye, followed by Clinpro XT varnish group. Clinical significance: Resin infiltration may be considered a promising solution not only to restore esthetics of WSL but also to stop the progress of dental caries by occluding the pores.

Aim: To characterize and identify the functional groups as evidence for copolymerization (CP) and evaluate the double bond conversion (DBC) of a novel poly(methylmethacrylate) [P(MMA)] copolymer with a spiroacetal cross-linker at 10 and 20% concentrations using Fourier-transform infrared (FTIR) spectroscopy. Materials and methods: The in vitro research consists of three groups—a control group G0 (without spiroacetal cross-linker) and two investigational groups G10 and G20 with spiroacetal cross-linker at 10 and 20 wt% concentration, respectively. This spiroacetal cross-linker was added to the powder-liquid mixture during manipulation at the predetermined trial concentrations. The CP and DBC% were determined and analyzed using infrared spectroscopy. The obtained DBC% values were submitted for statistical evaluation. Results: Incorporation of the spiroacetal cross-linker in the P(MMA) resulted in a new denture base copolymer through CP which was ascertained by the appearance of new peaks between 1075 and 1190/cm in both investigational groups. Nevertheless, the new copolymer exhibited statistically greater DBC than the P(MMA). The mean DBC% of the control, G10, and G20 groups were 62.88, 69.52, and 83.00%, respectively. Conclusion: The incorporated spiroacetal cross-linking comonomer successfully copolymerized with the denture base acrylic resulting in a new copolymer exhibiting high DBC%. Clinical significance: Existing drawbacks concerning the physicomechanical and biological properties of denture base resin can be mitigated by the new denture base copolymer containing spiroacetal cross-linker. This would benefit the elderly patient by providing prostheses with better mechanical strength, clinical longevity, and quality of life.

Aim: The aim of the present study was to evaluate and compare the antimicrobial efficacy of placentrex gel against Enterococcus faecalis (E. faecalis) in human root dentin by comparing it with two commonly accepted intracanal medicaments, that is, calcium hydroxide and 2% chlorhexidine (CHX) gluconate gel. Materials and methods: A total of 120 human-extracted, anterior, single-rooted teeth with patent root canals and fully developed root apices were used. The dentin blocks were arranged into four groups. Group I served as the control and was treated with saline. Groups II, III, and IV were tested with specific intracanal medicaments, which were placentrex gel, calcium hydroxide, and 2% CHX gel. Specimens were contaminated with a strain of E. faecalis. Antimicrobial assessment of the contaminated specimens was carried out on the 1st, 3rd, and 5th day. The collected data were analyzed using the analysis of variance (ANOVA) test followed by Tukey's post hoc test. Results: On day 1, 2% CHX gel (19%) demonstrated the strongest antimicrobial effect against E. faecalis, followed by calcium hydroxide (13%) and placentrex gel (9%). This trend persisted on days 3 and 5, with 2% CHX (day 3—16% and day 5—25%) consistently exhibiting the highest antimicrobial efficacy, followed by placentrex (day 3—9% and day 5—16%) and calcium hydroxide (day 3—6% and day 5—12%) in decreasing order. Conclusion: In the current study, 2% CHX demonstrated the highest antimicrobial efficacy, followed by placentrex, while the effectiveness of calcium hydroxide declined from the 3rd day onward. Clinical significance: The present study is clinically relevant as it addresses the critical challenge of countering E. faecalis, a key pathogen in persistent root canal infections. The results have the potential to guide clinicians in selecting optimal therapeutic agents, thereby improving the success rates of root canal treatments and enhancing overall patient outcomes in endodontic practice.