Introduction: Bruxism is one of the mounting questions in contemporary dentistry due to its high prevalence, various clinical presentations, difficulties in diagnostics and treatment, demanding a complex approach from doctors of different specialties. Aim: The aim of the current study was to describe the electromyographic values of chewing muscles in healthy persons and patients with bruxism and to find the biomarkers for early diagnostics of bruxism. Materials and methods: During retrospective investigation patients with bruxism were divided into two groups: group botox and bruxism. The control group was named the group-no complain. Results: Remarkable differences were found in group botox (no complain) in tests, rest and pressing in occlusion for chewing muscles symmetry index (CMSI%). Conclusion: As a result, we revealed a total bio-electric muscle activity index (BMIAI) in healthy patients and patients with bruxism in tests with pressing in occlusion, grinding and rest. All the values received to hold a high-reliability index, which makes them useful for everyday clinical practice. Clinical significance: Definition of electromyography (EMG) values impact index of chewing muscles in healthy and bruxing conditions allows to carry out early diagnostics of bruxism and to evaluate the effectiveness of mio relaxation therapy.

The most common method for the removal of all-ceramic restorations is to use a highspeed handpiece with a stone or bur. Unfortunately, this process can be difficult, time-consuming and may lead to the loss of healthy tooth structures. Lasers have been suggested and used to remove ceramic orthodontic brackets, laminate veneers and full anatomical crowns. Aim: Aim of the present study was to evaluate the debonding effect of erbium, chromium-doped yttrium, scandium, gallium and garnet (ErCr:YSGG) on Computer-aided design and computer-aided manufacturing (CAD/CAM) end crown restorations. Materials and methods: Overall, 30 molar samples were prepared for this study and divided into two groups as follows:   Group A–(n = 15): Endocrowns subjected to ErCr:YSGG laser application.   Group B–(n = 15): Endocrowns not subjected to the laser (control). Endocrowns were fabricated from lithium disilicate ceramics and manufactured using a CAD/CAM machine. Cementation was done using Bisco Duo Link Universal^™ resin cement. ErCr:YSGG laser was used with wavelength 2780 nm, 0.3J energy, 10 Hz frequency and 1000 μm tip size. Pull out test was done using a universal testing machine. Results: It was found that Non-laser group recorded statistically significant (p < 0.05) higher mean value (258.14 ± 63.43 N) for debonding than Laser group mean value (156.66 ± 32.89 N) as indicated by student t-test. Additionally, no carbonization at the dentin/cement interface was observed. Conclusion: According to the results of this study, ErCr: YSGG application can be considered a conservative method for the debonding of all ceramic endocrowns. Clinical significance: Some practitioners have been against the use of endocrown restorations due to the difficulty faced in removal and retrieval, the use of laser is an alternative, effective and conservative method.

Aim: Aim of the study was to evaluate the efficacy of manual toothbrush (STIM^® 42 Orthodontic toothbrush) with or without an interdental brush (IDB) (STIM^® PROXA-Extra fine) on gingival status in patients undergoing fixed orthodontic therapy. Materials and methods: In a randomized control trial of 60 subjects undergoing orthodontic therapy with Begg's appliance enrolled for the study. They were placed in a maintenance regimen with (STIM^® 42 orthodontic toothbrush) after thorough scaling and root planning (SRP) for four weeks before the commencement of the study. This was done to attain uniformity and avoid bias in both the groups at the baseline. At the end of four weeks, subjects were randomly divided into two groups, group I–30 subjects used STIM^® 42 Orthodontic toothbrush only and group II–30 subjects used STIM^® PROXA-extra fine as an adjunct to STIM^® 42 Orthodontic toothbrush for four weeks. Clinical parameters such as bonded bracket plaque index (BBPI), gingival index (GI), and gingival bleeding index (GBI) were recorded at baseline, 1, 2 and 4 weeks. Analysis of data was done using repeated measures analysis of variance (ANOVA) and unpaired student t-test using Statistical Package for the Social Sciences (SPSS) 22 software. Results: Result of the study showed a statistically significant reduction (p < 0.001) in BBPI, GI and GBI in group. II subjects when compared to group. I. Conclusion: Manual orthodontic brush along with IDB proved to be superior, in controlling plaque, gingival inflammation and gingival bleeding in subjects undergoing fixed orthodontic treatment. Clinical significance: Our study supports the use of interdental brushes along with manual toothbrush during fixed orthodontic treatment. It can significantly improve plaque control, thereby improving gingival health. To promote gingival health dentists need to motivate and reinforce this beneficial practice among their patients undergoing fixed orthodontic treatment.

Aim: The aim of this study was to assess the effectiveness of composite cure of many newly introduced bulk-fill composites Materials and methods: Five types of dental composite materials of A2 shade were selected for this study. Three packable bulk-fill composites: Tetric N Ceram (Ivoclar Vivadent), Filtek bulk-fill posterior composite (3M ESPE) and X-trafill bulk-fill packable composite (VOCO) and two conventional composites: Quadrant Universal L.C Composites (CAVEX) and Composan Bio-esthetic Nano-ceram Composite (PROMEDICA). Ten specimens were prepared from each type of composite material, each composite specimen was prepared by compressing sufficient amount of composite into a mold (6 mm in diameter and 4 mm in thickness) for bulk-fill composites and (6 mm in diameter and 2 mm in thickness) for conventional composites. The total fifty composite specimens (n = 50) were cured for 20 seconds from the top surface only with Woodpecker LED light curing unit by making the curing tip in intimate contact with the acetate celluloid strips covering the composite surface. After that, the composite specimens were incubated in distilled water at 37° C for 24 hours. Then the 50 composite specimens were tested with Vickers microhardness tester (Microhardness tester FM-800, FUTURE-TEC H, Japan) at 300 g load and 15 seconds according to ISO 4049 for both top and bottom surfaces by making three indentations of both surfaces and considering the mean microhardness value for each surface. The hardness ratio of each specimen was calculated by using the formula (HR {Mean Vicker's hardness of the bottom/Mean Vicker's hardness of the top} x 100). Data were statistically analyzed using mean, standard deviation, one way Analysis of variance (ANOVA) and T-test at 5% level of significance. Results: Statistical analysis of the data revealed, there was a significant difference between the five groups being tested (ANOVA, p ≤0.05). The material with the highest hardness ratio was Cavex followed by X-trafill, Composan, Filtek bulk-fill packable and Tetric N ceram which did not achieve adequate curing (80% hardness ratio). Conclusion: Composite formulation in general significantly affects the effectiveness of composite cure. Clinical significance: Inadequate curing of composite might be considered one of the main causes behind composite restoration failure by negatively affecting its physical and mechanical properties including solubility, bonding qualities and more residual monomers production that are considered highly toxic to pulpal tissue. All these problems can be avoided clinically by former assessment the effectiveness of curing related to that specific composite material being selected.

Aim: The main aim of the present study is in vitro assessment of the diffusion ability and degradation of calcium hydroxide from pastes prepared by using different vehicles to determine the influence of a vehicle on pH of calcium hydroxide [Ca(OH)₂] pastes. Materials and methods: A total of 44 single-rooted premolar teeth were used in this study. The tooth crowns were removed and the root canals were prepared. Depending on the vehicle to be used for preparing calcium hydroxide pastes, four groups were made: group I: Ca(OH)₂ saline paste (control group), group II: Ca(OH)₂ neem, group III: Ca(OH)₂ aloe vera, group IV: Ca(OH)₂ turmeric paste. After biomechanical preparation, calcium hydroxide herbal paste dressings were applied and sealed with resin-based cement. The teeth were placed in containers with distilled water, and the pH of the water was measured at regular intervals over 3, 24, and 168 hours. Results: The present study showed all herbal pastes allowed the diffusion of ions, but pastes prepared with aloe vera showed more ion diffusion and a marked increase in pH, depicting better support for calcium hydroxide action. Conclusion: Aloe vera allows better diffusion of calcium hydroxide through dentinal tubules, thus enhancing its action, and advises its use as a vehicle for placing intracanal medicament. Clinical significance: Calcium hydroxide [Ca(OH)₂] is the most common and effective intracanal medicament. However, CH is not so effective when used alone. Therefore combinations are required to enhance its clinical properties. To be effective, diffusion of hydroxyl ions are required for which vehicle plays a significant role.

Aim: The diagnosis of odontogenic tumors and other fibro-osseous lesions could be challenging. Use of routine histological staining procedures like hematoxylin and eosin (H&E) may not aid in providing insight into the nature and character of the hard tissues, thereby require advanced diagnostic aids like immunohistochemistry (IHC), which is technique-sensitive and expensive. Masson's trichrome (MT) stain and modified Gallego's (MG) stain can differentially stain hard tissues, such as tooth, bone, and other pathologic calcifications. The study aims to differentially stain various hard tissue structures present in normal teeth and hard tissue pathologies and compare between the routine stain H&E, MT, and MG stains. Study of oral hard tissues, comparing H&E, MT, and MG stains is the first of its kind according to our knowledge. Materials and methods: A total of 30 paraffin-embedded tissues were taken from the archives of the Department of Oral Pathology and Microbiology including 15 normal hard tissue structures comprising of 5 decalcified sections of teeth, 5 ground sections of teeth and 5 decalcified section of normal bone. Fifteen histopathologically diagnosed cases of hard tissue lesions/odontogenic lesions (odontome 3, cemento-ossifying fibroma 5, cementoblastoma 5, and central ossifying fibroma 2) were taken. Three sections were taken from each tissue block and subjected to H&E, MT, and MG stains. Results: Slides when stained with MG stain, enamel stains pink, dentine stains light green, cementum stains red, and bone stains dark green. Clinically significant result was obtained in case of modified Gallego's stain (0.001). MG > MT > H&E: 75 > 50 > 45% respectively, in comparison with other two stains. The shade of color differs with the amount of mineralization of the hard tissues. For statistical analysis, chi-square test was employed. Conclusion: Among H and E, MT, and MG stains, MG stain could be a promising differential stain in hard tissue pathologies and other fibro-osseous lesions with diagnostic dilemmas. Clinical significance: MG stain helps in diagnosis of ambiguous lesions, detection of origin/nature of lesions, differentiation of aggressive and nonaggressive lesions, thus enabling clinicians to know their biological behavior and plan adequate treatment.

Aim: This study was conducted to describe traumatic psychosocial impacts due to gingivitis and halitosis people faces and its relation to visiting dental clinics for aids from Madinah, Kingdom of Saudi Arabia. Materials and methods: The cross-sectional study was conducted in a random sample of 240 people. Among them, 9 participants were excluded because of the lack of information and total 231 participants (134 males and 97 females) included in the study. The data was collected using a pretested structured questionnaire. The questionnaire was distributed electronically among the people living all over the Madinah, Kindom of Saudi Arabia. Results: Mean age of the participant was 34.5. A maximum number of participants (70.6%) told the reason of bad odor was poor oral hygiene and could be get rid by home care (70.1%). Teeth pain (84.4%) was the main cause to visit the dentist. Males were more ashamed of bad odor compared to female, and there was a significant relationship between gender and social impact p = 0.001. Participants having gum infection were more ashamed in the society compared to the participants not having any gum infection (p = 0.001). Smokers were also more ashamed as compared to nonsmokers (p = 0.045). Conclusion: The patients who had gum diseases and smoking developed more psychosocial effect in the society, and it is due to halitosis develop either due to gum disease or smoking. So the main reason of psychosocial trauma is that indirect effect of halitosis, which produced due to gum infection. Clinical impact: People suffering from gingivitis and halitosis go to psychological trauma and they need a clinical solution to overcome from these.

Aim: There is variation in the emergence of the mental nerve through the mental foramen. Cone beam computed tomography (CBCT) is very efficient in providing variations of mental nerve. The present study was aimed to determine different patterns of mental nerve at mental foramen region with the help of CBCT. Materials and methods: One hundred and twenty CBCT images of patients requiring a dental implant in mandibular premolar region were taken with Planmeca CBCT machine. All sections were obtained. The presence of a straight pattern, an anterior loop, and the right-angled pattern was detected. Results: It included 75 males and 45 females. The difference was significant (p = 0.05). A total of 20 percent patient exhibited an anterior loop, 72% had a straight pattern, and 8% had a right-angled pattern. The difference was statistically significant (p = 0.01). The straight pattern was seen in 61 males and 25 females, anterior loop in 10 males and 14 females. The difference was statistically significant (p = 0.01). The right-angled pattern was observed in 4 males and 6 females. A straight pattern was seen mostly (59) on the left side as compared to the right side (27), on the left side, the anterior loop was seen in 13 as compared to 11 on the right side. The right-angled pattern was seen mostly on right side (7) as compared to the left side (3). Conclusion: Different patterns of mental nerve were observed. The most common pattern was straight followed by anterior loop and right angled. Three-dimensional (3D) nature of CBCT is useful in providing details. It offers less exposure to the patient as compared to computed tomography (CT). Thus, it is an effective diagnostic tool in the assessment of mental nerve. Clinical significance: The CBCT proves beneficial in assessing the different pattern of entry of mental nerve in mental foramen.

Aim: The study aims is to investigate the combined effect of the corrosion and the fretting induced by small deflections imposed on the orthodontic stainless steel and nickel-titanium arch-wire in contact with stainless steel bracket in neutral artificial and acidified saliva which simulate the aggressive conditions. Materials and methods: Electrochemical analysis of orthodontic materials has been firstly conducted in the oral environment and under the combined effect of fretting and corrosion using an experimental test bench designed for this effect. Analysis of contact area between elements has also been conducted using scanning electron microscope (SEM) and energy dispensing spectroscopy (EDS). Results: The results indicate that the pH of an oral environment has an important influence on the corrosion resistance and the effect of fretting-corrosion process affects significantly the corrosion behavior of materials tested in the oral environment. Conclusion: The combined effect of fretting and corrosion tests conducted in artificial saliva show that nickel titanium wire is more resistant than stainless steel wire in contact with stainless steel brackets after 100000 cycles. Also, the corrosion resistance in acidified saliva is very pronounced for stainless steel wire and bracket as it reported by many authors. Clinical significance: The degradation of the orthodontics materials in the oral environment can cause major problems for the patient's health.

Background: To develop broad-based treatment options for esthetics it is necessary to obtain a better understanding of the factors determining patient's satisfaction. Objective: This study was designed to identify the association between the related factors and patient's satisfaction with their dental appearance and anterior teeth restoration. Materials and methods: A cross-sectional study of 400 patients comprising of 120 males and 280 females within the age range 20 to 59 years were selected for this study from different dental clinics of Ha'il region. The data were collected based on a structured questionnaire by trained interviewers. The authors evaluate patient satisfaction with respect to demographic variables such as age, sex, educational qualification and level of income. Results: Out of 400 population, the majority of the individuals participated in this study was females (70%) as compared to males (30%). Of these participants, the individual between age range 20 to 29 years (61.2%) seemed to be more satisfied with their dental appearance which is statistically significant (p < 0.007), however, satisfaction rate among the Saudi population (64.8%) was comparatively low concerning their tooth color. Conclusion: In general, a high level of dissatisfaction with participants' teeth color were evident in this study. Based on the results, that irrespective of the age group it provides us with important information for the potential need to understand patients' perception about their teeth appearance and color. It will help the dentist to carry an adequate and appropriate treatment plan to meet the desired level of patient satisfaction. Clinical significance: The main goal of esthetic restoration is to achieve the best appearance of the teeth and at the same time preserve the vitality and function of the teeth. Appearance is considered the key element in social interaction and success nowadays. Hence, the esthetic of patients considered central to help people achieve optimum oral health without embarrassment.

Introduction: Bacteria plays a principal role in the pathogenesis and progression of pulpal and periapical diseases. The chronic resistant bacterial existence in the root canals has a greater influence on the endodontic treatment outcome by the persistence of periapical tissues. Higher proportions of enterococci, ranging from 29 to 77% are found in filled root canals with the persistent periapical disease. Placement of an intracanal medicament can reduce the bacterial load. Materials and methods: Extracted and decoronated, 72 nos. single-rooted human teeth prepared to maintain the root length of 18 mm were selected for the study. After instrumentation, E. faecalis suspension was inoculated in each of the root canal and teeth were incubated at 37° C for 72 hours within the orbital incubator. Root canal samples were randomly divided into four groups. After placement of various medicaments (namely saline, triantibiotic paste, mixture of calcium hydroxide [Ca(OH)₂] and omeprazole and carnosic acid) inside the canal, teeth were divided into three subgroups of five samples and incubated at 37° C under humid conditions for the time period of 24 hours, 48 hours and 7 days within Orbital incubator. Viable cell count assay was used to see the effect of these antimicrobials on E. faecalis biofilm. Results: Results were statistically evaluated using Kruskal- Wallis one-way analysis of variance tests. A p-value < 0.05 was considered significant Conclusion: Carnosic acid showed better antimicrobial properties compared to TAP, calcium hydroxide and omeprazole over the experimental period of time. Clinical significance: A preliminary study using carnosic acid which is a plant derivative as an intracanal medicament.

Aim: To assess the oral health status and oral hygiene of mentally subnormal population of Abha, Kingdom of Saudi Arabia. Materials and methods: A cross-sectional study was conducted among 300 mentally sub-normal people of Abha, Kingdom of Saudi Arabia. All the subjects who were willing to participate and were suffering from mental retardation were included in the study. Those subjects with any other medical ailment such as epilepsy, and those having any physical disability were excluded from the study. All the subjects were examined by the investigator for dental caries experience using dental caries experience using (DMFT) (WHO 1997), type of Angle's molar relation was recorded on a recording proforma for all the study participants. Subjects' plaque score was assessed using Silness P. and Loe H. Plaque Index (1964). Results: The overall prevalence of dental caries (D) found in the present study was 82.6%. On comparing the mean DMFT scores based on different plaque scores, it was found that the subjects with plaque score as 3 had the highest mean DMFT (5.5376 ± 3.02367); those subjects with least plaque score (1) had mean DMFT of 3.9677 ± 2.31862 while those subjects with no plaque had the least mean DMFT (1.9375 ± 2.01506). A statistically significant (p = 0.000) difference was found between the mean plaque scores when compared on the basis of brushing frequency. Conclusion: It was concluded that the oral health status of the mentally subnormal study population was poor with increased mean plaque scores indicating the neglect of oral hygiene maintenance and dental care and treatment by the study population. Clinical significance: Oral health of mentally disabled persons is deteriorated owing to various reasons such as social, economic, behavioral factors, the effect of medicines and also difficulty faced by caregivers in providing oral health care including oral hygiene methods. In order to appropriately explore ways and methods for adequately reducing the disease burden on the populace, dentists essentially need to know the oral health status of disabled section thereof.

Aim: Caregiver burden refers to people's emotional response to the changes and demands of giving support to another. This study aims to highlight the burdens faced by the primary caregiver of oral cancer patients and assess which amongst them contributes to the highest stress. Materials and methods: The study was conducted at oncology ward of our hospital. The cross-sectional correlational study design was employed. The data was collected through a structured questionnaire. A total of 50 oral cancer patients' primary caregivers consented to participate in the study. Two-step data analysis was done. First descriptive statistics were used to analyze the background characteristics. Then the patient's overall burden was calculated based on the scoring system obtained from ZBI. In the second step, regression analysis was done to predict the burden degree and also to find the main cause of the burden. Results: Binary logistic regression analysis revealed the following burdens (stressed managing to balanc–0.896, embarrassed–0.896, no privacy–0.980 and uncomfortable about having friends–1.094) as statistically significant. Again with those significant variables, forward stepwise logistic regression was done which revealed the following burdens (not enough time for themselves–0.013 and uncomfortable about having friends–0.023) very significantly associated. Conclusion: This study highlights that the caregivers, though burdened to some extent, wanted to take care of their relatives till the last day. Clinical significance: The purpose of the study was to create awareness among the professionals to give more importance to the primary caregiver. The importance of primary caregiver in the life of the diseased is paramount because of the emotional attachment they share. So this inter-relationship between the doctor, the patient, and the primary caregiver will help in a significant way in the wellbeing of the patient.

Aim: To assess and compare the efficacy of materialise Interactive Medical Image Control System (MIMICS^®) software with ADOBE^® in determining pulp to tooth area ratio and age estimation on maxillary canines. Materials and methods: Intraoral periapical radiographs (IOPA's) of maxillary canines were taken using the paralleling technique. Radiographs were digitized using Flatbed scanner. digitized images were exported into ADOBE^® and materialise MIMICS software. Their tooth and pulpal area was calculated and age was determined. Results: The regression equation derived from ADOBE^®: age = 72 + (−282.206 × pulp to tooth area ratio from ADOBE^®). The regression equation derived from MIMICS^®: age = 77.13 + (−324.583 x pulp to tooth area ratio from MIMICS^®. Correlation coefficient of estimated age versus the actual age with ADOBE^® ‘r’ value of −0.595. The correlation coefficient of estimated age versus the actual age with MIMICS^® r-value of −0.649. Conclusion: This study showcases the use and limitations of new software MIMICS^® in measuring the tooth to the pulp area ratio. Although IOPAs failed to produce three-dimensional volumetric analysis, the applicability of this software in other areas like maxillofacial trauma management and implant planning were revealed, further opening scope for newer research Clinical significance: Materialise MIMICS^® software has various applications in dentistry. It can create a 3D surface model and give volumetric measurements, from scanned images, hence can be applied in Implantology and Oral and Maxillofacial Surgery.

Aim: The aim of the article is to describe an unusual case of a non-syndromic patient affected by three follicular cysts in the mandible and then by an inflammatory cyst. Furthermore, we describe two different surgical approaches that we have used to manage this case: marsupialization and enucleation. Background: Dentigerous cysts are usually solitary cyst, the presence of multiple cysts is often combined with systemic diseases such as mucopolysaccharidosis, cleidocranial dysplasia, and basal cell nevus syndrome. They are the second cysts in order of frequency. Because of the lack of symptoms, their diagnosis is frequently radiological, and it can be suspected by the failure of tooth eruption. Case description: Two bilateral cysts of the third lower molars and radicular cyst of the right second lower molar were treated. An excisional therapy for the two dentigerous neoformations was performed. While, as a function of the remarkable dimensions which characterized the lesion, a conservative approach by marsupialization for 8 months before, and excision after, were chosen to solve the radicular inflammatory cyst. To preserve the patency of the cystic cavity, an acrylic obturator was used. Conclusion: In t he c ase of multiple d entigerous c ysts, a deepen clinical and systematic examination should be done to rule out any associated syndrome. Nowadays in literature, there is not a single and significant orientation based on the results obtained from the various techniques, but this case report shows that it is possible to achieve the expected therapeutic success even if in the same patient. Clinical significance: The case that we have described allows us to observe how a correct study of the lesions allows us to have a more accurate, safe and predictable therapeutic approach that lasts in time.

Background: Tooth size-arch length discrepancy (TSALD) is a consequence of disharmony between the size of the teeth and the space available to accommodate them in the dental arches, they are manifested in the form of either crowding or spacing. Crowding is the deviation in tooth position such as rotation, overlapping, tooth emergence inside or outside the dental arch and impaction due to the lack of space. Crowding may occur due to different reasons, for example, growth, maturation, aging of dentition, mesial drift, soft tissue pressures, and tooth morphology. The correction of severe mandibular crowding could be carried out by extraction, distalization, surgical and non-surgical expansion of the mandible. Aim: The aim of this case report is to describe a novel method of non-surgical mandibular expansion. Case report: This case report demonstrates a non-surgical dentoalveolar expansion by the use of a translingual force mandibular expander appliance (‘TORKO’ Leone rapid micro expander screw) for the correction of severe mandibular crowding with posterior bilateral scissor bite in an adolescent patient with reduced inter canine and premolar width. This is a case report first of its kind which demonstrates a severe crowding case treated by an expansion device and outlines the challenges faced in achieving well stable results. Conclusion: The overall active orthodontic treatment lasted for 16 months, an expansion of 6 mm of inter-canine width is achieved. The one year follow up showed a stable mandibular arch following the treatment using TORKO appliance. Clinical significance: In this case report we have discussed the concept of increasing mandibular inter-canine width in an adolescent patient presenting severe lower anterior crowding and the factors affecting its stability.