Aims and background: Dental caries is a complex condition that predominantly affects children globally. Poor oral health causes microbial infection, which lowers children's quality of life. The World Health Organization (WHO) endorses silver diamine fluoride (SDF) as a vital medication for dental caries. Nevertheless, the SDF mechanism responsible for microbial inhibition remains under investigation. This study aims to conduct computational investigations to assess the efficacy of SDF against key microbes that are commonly associated with the risk of dental caries in children. Materials and methods: The preliminary phase of investigation involves metagenome analysis on 16S rRNA-sequenced data PRJNA822409 retrieved from National Center for Biotechnology Information (NCBI) repositories, classified into low caries risk (LCR) and high caries risk (HCR) participants. Results: The analysis reveals Streptococcus as the most dominant microbe at the genus level in HCR compared to LCR individuals. Subsequently, through literature mining, five therapeutic targets against Streptococcus were identified: SMU.2055, Sortase A, glucosyltransferase-S, MurA enzyme, and VicK protein, and subjected to docking with the SDF. The glucosyltransferase-S target exhibited the highest binding affinity (–6.996 kcal/mol) with SDF among the analyzed targets. Conversely, the Sortase A protein exhibited a low binding energy of –2.655 kcal/mol with SDF. Finally, the molecular dynamic simulation was performed, which established the structural stability of SDF with the glucosyltransferase-S target. Conclusion: This study demonstrates the SDF inhibitory mechanism of Streptococcus through the glucosyltransferase-S target. Clinical significance: SDF application can be utilized in the treatment of dental caries in the pediatric population.

Aim and background: The aim of the current study is to evaluate the efficacy of using patient-specific zirconium dioxide (ZrO₂) implant vs patient-specific titanium implant for the management of chronic condylar dislocation. Materials and methods: A randomized controlled trial was conducted on 14 patients (a total of 28 joints) who were diagnosed with chronic recurrent dislocation of the temporomandibular joint (TMJ). In the study group, seven patients were treated with patient-specific zirconia eminoplasty bilaterally, while in the control group, seven patients were treated with patient-specific titanium eminoplasty bilaterally. The assessment included measuring the maximum incisal opening in millimeters and evaluating pain intensity using a visual analog scale (VAS) from 0 to 10. The data were recorded and statistically analyzed. Results: In the study group, the mean value of the difference in maximal interincisal opening was (14.86 ± 2.54) mm, while in the control group it was (16.29 ± 2.50) mm, and the difference was not statistically significant (p = 0.312). In the study group, the mean value of postoperative pain was (3.57 ± 1.13), while in the control group it was (6.71 ± 1.70), and the difference was statistically significant (p = 0.002). Conclusion: Both groups are considered effective treatment options for chronic recurrent TMJ dislocation in terms of achieving maximum interincisal opening (MIO) reduction. The study group experienced lower levels of postoperative pain compared to the control group. Clinical significance: The purpose of this study is to introduce a biologically compatible inert ZrO₂ implant, which may provide an acceptable new alternative in the surgical management of chronic condylar dislocation alongside materials recorded in the literature. Moreover, this material may be of clinical value when implemented in other craniomaxillofacial applications in future studies.

Aim: The aim of this study was to evaluate and compare microhardness in bleached enamel using nano silver fluoride (NSF) and casein phosphopeptide–amorphous calcium phosphate fluoride (CPP–ACPF) as remineralizing agents. Materials and methods: The study population consisted of premolar teeth, which were subsequently divided into two distinct groups. Initially, the baseline surface microhardness of tooth samples was assessed using a Vickers microhardness tester, applying a 300 gm load. Within each group, the samples underwent a bleaching procedure with 35% hydrogen peroxide. Following the postbleaching microhardness assessment, one group received treatment with CPP–ACPF, while the other group was treated with NSF. Subsequently, the microhardness test was repeated for further analysis. Results: After bleaching, the surface microhardness of the teeth was reduced, and microhardness increased significantly after remineralization with CPP–ACPF and NSF. Conclusion: The enamel hardness of bleached teeth increased after remineralization with both CPP–ACPF and NSF, and no significant difference was observed between the two groups. Clinical significance: Bleaching is the best conservative treatment for a discolored tooth. Hence, as it reduces microhardness of teeth, it is important to apply a remineralizing agent after bleaching.

Aim: To evaluate and compare the apical debris extrusion and percentage of remaining filling material following the retreatment of a bioceramic-based sealer using rotary and various supplementary retreatment techniques. Materials and methods: About 50 single-rooted mandibular premolar teeth were instrumented with Hyflex CM and obturated with Angelus Bio-C sealer in a single-cone technique. The primary retreatment was done with the XP system, and based on the supplementary instrumentation, teeth were grouped into five (n = 10): (1) control (with no supplementary instrumentation), (2) plastic files, (3) passive ultrasonic irrigation (PUI), (4) EndoActivator, and (5) Rinsendo. The apical debris extrusion (in gm) was determined with a modified Myers and Montgomery model, and the remaining canal debris was calculated using AutoCAD imaging software. The data were analyzed by ANOVA test. Results: Significant differences were found in apical debris extrusion and remaining filling material (p < 0.05). Among the supplementary techniques, Rinsendo resulted in the highest amount of apically extruded debris, while PUI resulted in the lowest percentage of residual filling material. Conclusion: Rinsendo resulted in the most apical extrusion, while PUI provided the cleanest canals among the supplementary techniques. Clinical significance: A supplementary step in the removal of bioceramic sealer can be recommended to enhance the canal's cleanliness. PUI had the least remaining canal material and minimal apical debris extrusion.

Aim: This retrospective observational study evaluated soft tissue thickness at midline and bilateral landmarks in adult patients with varying vertical skeletal patterns. Materials and methods: Eighty-four patient cone-beam computed tomography (CBCT) scans were divided into three groups, with 28 in each group, based on their mandibular plane angle to the sella-nasion plane: average (28–34°), vertical (≤35°), and horizontal (≤27°). Carestream (CS) three-dimensional (3D) imaging software was used to import and access the CBCT images on the personal computer. Facial soft tissue thickness (FSTT) measurements at 34 craniofacial landmarks were made using Digital Imaging and Communications in Medicine (DICOM) software, which enabled viewing the image in different slices. A 3D cephalometric tool in the software facilitated measurements after landmark identification on bone and subsequent soft tissue visualization through image enhancement. Results: Reduced STT was observed in the hyperdivergent (vertical) group at five bilateral landmarks: rhinion, mid-ramus, mid-mandibular border, gonion, and inframolar (p < 0.05). No significant differences in STT were found among the three groups at the following bilateral landmarks: zygion, mid-infraorbital, mid-supraorbital, supra-molar, alar curvature point, and supracanine. Conclusion: Notable differences in STT were observed among the three vertical skeletal patterns, with the vertical group exhibiting reduced tissue thickness at specific landmarks. Clinical significance: These findings highlight the importance of considering vertical skeletal patterns when assessing STT for treatment planning, particularly in orthognathic surgery and orthodontic treatment involving soft tissue manipulation. Variations in STT can influence treatment outcomes and should be factored into individualized treatment approaches.

Aim: This study evaluates the clinical and radiographic outcomes of pulpotomy using a diode laser with Biodentine and platelet-rich fibrin (PRF) in permanent teeth with symptoms of irreversible pulpitis, determining the most effective pulpotomy agent and quantifying dentinal bridge formation over 12 months. Materials and methods: Patients with symptomatic irreversible pulpitis were randomly assigned to four groups: Biodentine only, Biodentine with laser, Biodentine with PRF, and Biodentine with PRF and laser. Clinical and radiographic evaluations were conducted at 3, 6, 9, and 12 months. Data were analyzed using Friedman's analysis of variance (ANOVA) and the Kruskal–Wallis test at an alpha level of 5%. Results: Significant differences in dentinal bridge thickness were observed among groups over time (p < 0.001). Group IV showed the highest dentinal bridge formation at 12 months. Age and gender did not significantly influence outcomes. Conclusion: Diode laser-assisted pulpotomy with Biodentine, with or without PRF, shows promise for managing irreversible pulpitis in permanent teeth, promoting dentinogenesis and pulp healing. Further studies should explore long-term efficacy and compare outcomes with other treatments. Clinical significance: This study demonstrates that diode laser-assisted pulpotomy with Biodentine and PRF significantly improves dentinal bridge formation and treatment success in irreversible pulpitis. Combining diode lasers and PRF enhances pulp repair compared to Biodentine alone, highlighting their effectiveness in modern endodontics.

Aim: The study aimed to compare and evaluate the physical properties, such as compressive strength, diametral tensile strength, setting time, and surface hardness of mineral trioxide aggregate (MTA) after the incorporation of titanium tetrafluoride. Materials and methods: A total of 196 samples were made, comprising (n = 49) group I: MTA; group II: MTA with 1% TiF₄; group III: MTA with 2% TiF₄; group IV: MTA with 3% TiF₄. The specimens were prepared using stainless steel molds of recommended dimensions for testing the physical properties considered. While the compressive strength (MPa) and the diametral tensile strength (MPa) were evaluated using a universal testing machine, setting time (minute) was measured using a Gillmore needle, and surface hardness (VHN) was measured using a Vickers microhardness tester. Data were collected at two different time periods, day 1 and day 21, for the tests except for surface hardness, and were statistically analyzed. The level of statistical significance was determined at p ≤ 0.05. Results: The mean values on day 21 were found to be highest in group IIIa for compressive strength (50.28 ± 0.48 MPa), diametral tensile strength (8.21 ± 0.12 MPa), and surface hardness (34.31 ± 0.99 VHN), while the shortest setting time was in group Ic (155.00 ± 0.81 minutes) and the longest time was in group IVc (162.42 ± 1.27 min). The mean difference between the four groups was found to be statistically significant (p < 0.05). Conclusion: MTA, when incorporated with 1 wt% and 2 wt% TiF₄, showed enhanced physical properties, whereas the addition of 3 wt% TiF₄ to MTA compromised the mechanical properties and prolonged the setting time. Clinical significance: Continuous advancement in the field of dental materials has revolutionized the field of dentistry. MTA, a widely used material, possesses several advantages over its precursors. However, it is limited by several challenges, such as discoloration, longer setting time, and decreased compressive and flexural strength. Hence, to address these setbacks, the addition of materials to positively alter the physical and chemical properties of MTA can be attempted for better clinical practice.

Aim: The aim of this study was to characterize the properties of polyvinyl alcohol-chitosan (PVA-CS) coated magnesium (Mg) substrate to study its potential use as a bio-implant. Materials and methods: The present study coated pure Mg substrate by immersion in the PVA-CS solution. The coated samples were evaluated using contact angle measurements, atomic force microscopy (AFM), scanning electron microscopy (SEM), energy dispersive X-ray analysis (EDAX), infrared spectroscopy (IR), and cytotoxicity in the presence of MG63 cells. An uncoated sample of pure Mg was used as a negative control for comparison in all the tests. The parameters mentioned were used to characterize the surface interactions and properties of the Mg samples in the presence of PVA-CS coating. Results: The presence of coating on the substrate was confirmed by EDAX analysis and its elemental composition was noted, confirming the presence of PVA-CS coating on Mg substrate. The PVA-CS coated surface displayed a higher contact angle (105.7°) than the uncoated sample (74.2°). Reduction in average surface roughness was noted following the PVA-CS coating on Mg substrate (uncoated Mg 419 nm, PVA-CS coated Mg 157 nm). Cell viability of the PVA-CS coated Mg indicated low toxicity in biological tissue. Conclusion: PVA-CS coating on Mg substrate indicated greater contact angle, with a homogenous surface topography, significant biocompatibility, and low toxicity in comparison to the uncoated Mg substrate. Clinical significance: Coating on pure Mg with PVA-CS has demonstrated properties superior to the uncoated Mg sample. Additional in vitro and clinical studies are required to study the performance of the coated material to evaluate its potential use as a bio-implant material.

Aim: The aim of the investigation was to investigate the anteroposterior (AP) position of upper anteriors with respect to the forehead in Bengali females. Materials and methods: The sample frame of the study group was formed from profile smiling pictures of 50 nongrowing Bengali females who visited the department for orthodontic therapy. They had proclined upper anteriors that they considered unesthetic. They were compared with the control sample, which consisted of profile smiling pictures with upper anteriors visible of 50 nongrowing Bengali females whose pictures were considered pleasing to the investigators. They had not undergone any previous orthodontic treatment and had a well-aligned upper arch. To evaluate the most favorable AP position of the upper central incisor and the upper jaw with reference to the forehead, reference lines were drawn and measurements were done. Results: Most of the individuals in the control sample had their upper anteriors placed between the forehead facial axis (FFA) and glabella, whereas in the study sample, most of the individuals had their anteriors placed in front of the glabella. No significant correlation was found between the forehead inclination and incisor position in both the study and control groups. Conclusion: The present study concluded that the most favorable position of upper centrals is between the glabella and FFA. Hence, markers on the forehead can play an important role in deciding the position of upper anteriors for patients undergoing orthodontic therapy. Clinical significance: Orthodontic diagnosis and therapy planning need evaluation of the soft tissues of the external face. Modern orthodontics is placing more focus on enhancing facial esthetics. Rather than only focusing on the cephalometric markers and values, lateral photographic evaluation of the face is important to deliver an overall esthetic appearance to the patient.

Aim: To compare and evaluate the microleakage in the apical portion after placement of apical plug using Portland cement, mineral trioxide aggregate (MTA), and Biodentine. Materials and methods: About 36 maxillary central incisors were disinfected with 5.25% NaOCl. The apices were trimmed by 3 mm, and the coronal portions were reduced to a 15 mm working length. Canals were prepared with ISO #80 K-file and step back to ISO #120 K-file, irrigated with 3% NaOCl, 17% ethylenediaminetetraacetic acid (EDTA), and saline. The samples were subsequently categorized into three distinct groups: group I = 4 mm apical plug with Portland cement, group II = 4 mm apical plug with MTA, group III = 4 mm apical plug with Biodentine. After setting, canals were obturated using gutta-percha and AH Plus sealer, and access cavities were restored with glass ionomer cement (GIC). Teeth were stored in 100% humidity, submerged in 2% methylene blue for 72 hours, and thereafter divided into sections to assess dye penetration using a stereomicroscope. One-way ANOVA was used in the statistical analysis to identify significant differences among the groups at an alpha level of 5%. Results: Biodentine (0.38 ± 0.27 mm) demonstrated superior performance to stop microleakage in comparison to Portland cement (2.1 ± 0.74 mm) and MTA (1.1 ± 0.42 mm).

Aim: The purpose of this study is to evaluate and compare the effectiveness of three pulpotomy medications used in primary molars: mineral trioxide aggregate (MTA), formocresol (FC), and green tea. Materials and methods: The study included children aged 4–8 who presented to the Department of Pedodontics and Preventive Dentistry with decayed primary molar teeth. The children were screened for inclusion. A total of 90 primary molars were selected and divided into three groups of 30 teeth each: group I (green tea), group II (FC), and group III (MTA). A standardized pulpotomy procedure was performed on each group, and the teeth were evaluated clinically and radiographically at 1, 3, and 6 months posttreatment. The results were subsequently subjected to statistical analysis. Results: At the end of 3 months, the green tea, FC, and MTA groups achieved success rates of 94.6, 88, and 100%, respectively. The effectiveness rates were 89, 83.3, and 97% at 6 months. Success rates among the three categories were significantly different (p < 0.05), as indicated by statistical analysis. Conclusion: The results of this investigation indicate that, despite the efficacy of all three medications, there are substantial variations in their clinical and radiographic results over time. Clinical significance: This investigation provides valuable insights into the comparative efficacy of various pulpotomy medicaments in primary molars. According to the results, MTA may be the most dependable choice for long-term results, while green tea appears to be a safer alternative.

The aim of this study was to assess the relationship between sexually dimorphic traits established early in life [second to fourth digit ratio (2D:4D)] and its correlation with metabolic syndrome (MetS) and periodontitis. This was a case-control study. Subjects were divided into three groups (group A, B, C) with 150 participants (75 males and 75 females) in each group, respectively. Group A consisted of systemically and periodontally healthy individuals. Group B consisted of participants with no MetS and who have periodontitis, and group C consisted of participants with MetS and periodontitis. Measurement of 2D:4D ratio, measurement of MetS parameters, and diagnosis of periodontitis were performed. On intragroup comparison, the 2D:4D ratio for systemically and periodontally healthy individuals (group A) was 0.99 ± 0.04, while in participants with no MetS and who have periodontitis (group B), the mean was 0.99 ± 0.05, and in participants with MetS and periodontitis (group C), it was 1.00 ± 0.04, with no statistical significance. Gender-wise comparison exhibited that the digit ratios of males were lower with <1, while females had >1 digit ratios. On intergroup comparison, 2D:4D ratios were not statistically significant when participants with no MetS and who have periodontitis (group B) were compared to systemically and periodontally healthy individuals (group A) (0.0027 ± 0.0045, p = 0.932). Additionally, 2D:4D ratios were not statistically significant in participants with MetS and periodontitis (group C) compared to systemically and periodontally healthy individuals (group A) (0.0060 ± 0.0045, p = 0.542), and 2D:4D ratios were not statistically significant in participants with MetS and periodontitis (group C) compared to participants with no MetS and who have periodontitis (group B) (0.0033 ± 0.0045, p = 0.884). The 2D:4D ratio is a sexually dimorphic biometric biomarker. In the present study, there were no differences in digit ratios among systemically healthy, MetS, and periodontitis patients, and the digit ratio was predominantly less than 1 (<1) in males when compared to females, whose digit ratio was greater than 1 (>1). Clinical significance: Better preventive measures can be provided by the early detection of hormonal biomarkers in the diagnosis of MetS and periodontal diseases (PDs).

Background/aim: This study aimed to assess the components of Björk–Jarabak's cephalometric analysis and the facial profile among Yemeni adults. Methods: This retrospective research comprised 72 (36 males and 36 females) lateral cephalometric radiographs (LCRs) of adult Yemeni samples. Based on their facial profiles, each group was classified into three subgroups: straight, convex, and concave, with 12 participants in each subgroup. The LCRs were analyzed using the five Björk–Jarabak cephalometric analysis parameters via the WebCeph web artificial cephalometric analysis software for genders and subgroups. The LCRs were analyzed, assessed, and measured in terms of three angles (saddle, gonial, and articular) and two lines, namely the anterior and posterior facial heights. Statistical significance was set at p < 0.05 for all tests. Results: The participants had an overall mean age of 20.32 ± 3.55 years. The articular angle (AA) was significantly different between groups and genders (p = 0.000). Subjects in the convex group showed significantly higher values of AA compared with the concave group (150.47 ± 5.34 vs 143.75 ± 4.66). No significant differences were recorded for the saddle angle (SA), gonial angle (GA), and facial heights between groups. Conclusion: AA exhibited a considerably greater influence on the convex facial profile, and its adjustment should be evaluated during treatment planning. Higher anterior and posterior facial heights were observed among males. Clinical significance: The findings can enhance orthodontic diagnosis and treatment planning, particularly for individuals from similar ethnic backgrounds, by offering region-specific normative data and an understanding of facial esthetics.

Aims: The present study aims to evaluate and compare the salivary alpha-amylase (sAA) and salivary flow rate in pre- and postmenopausal women. Background: While menopause is a common experience for all women, the age at which it occurs and the specific symptoms experienced can vary significantly from one individual to another. Menopause influences salivary constituents and its flow rate, which can lead to oral diseases. Due to hormonal changes, women in menopause frequently encounter heightened stress and mood fluctuations, highlighting the importance of assessing stress levels within this group. sAA, as a biological marker, can provide valuable insight into an individual's stress perception and potential predisposition to certain systemic diseases. Materials and methods: A case-control study was conducted on outpatients attending the Department of Oral Medicine and Radiology, Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre in Hyderabad. A total of 80 female patients between the age-group of 20–60 years were selected and divided into two groups depending upon the menopause status: the first group included 40 premenopausal women, and the second group included 40 postmenopausal women. Saliva samples were collected from both groups. Saliva flow rate was measured, and collected saliva was assessed for sAA levels by biochemical analysis. Results: The data was analyzed with the statistical software IBM SPSS (version 22). In the present study, using an independent t-test, it was found that the postmenopausal women had significantly elevated sAA levels (43.8 ± 17.9) compared to the premenopausal women (33.5 ± 10.5) with a p-value significant, p = 0.003 (<0.05). The difference in salivary flow rate levels in postmenopausal women (0.460 ± 0.1614) and premenopausal women (0.405 ± 0.0932) was statistically nonsignificant (p = 0.066; p > 0.05). Pearson's correlation was performed to correlate sAA and salivary flow rate levels in both groups. In premenopausal women, there was a mild, positive correlation between sAA and salivary flow rate, which was not statistically significant (r = 0.121, n = 40, p = 0.457). In postmenopausal women, there was a mild, negative correlation between sAA and salivary flow rate, which was statistically nonsignificant (r = –0.191, n = 40, p = 0.239). Conclusion: The study revealed that postmenopausal women have elevated mean sAA levels compared to premenopausal women, suggestive of a predisposition of this group to stress. Hence, sAA can be considered a sensitive noninvasive biomarker for stress-induced changes in the body and also a potential biomarker for certain systemic diseases like diabetes mellitus and cardiovascular risks. It was observed that mean salivary flow rates were not significantly different between the two groups, which is suggestive of normal salivary flow rates in the postmenopausal group until 60 years of age. Clinical significance: The marked increase in sAA observed in the study indicates heightened physiological stress in postmenopausal women and may also be linked to an elevated risk of systemic diseases such as diabetes mellitus, cardiovascular issues, and metabolic syndromes in this group.

Aim: The aim of this study is to assess the effectiveness of the flipped classroom on knowledge improvement in undergraduate dental students. Using a crossover randomized controlled trial, we aim to compare this approach with traditional teaching methods, providing insights for optimizing dental education strategies. Materials and methods: A total of 57 third-year dental students participated in a crossover randomized controlled trial. The students were randomly assigned to either the experimental group, where the flipped classroom method was implemented, or the control group, which followed conventional didactic teaching. The study consisted of two phases, with the groups crossing over in the second phase. Pretests and posttests were administered to assess knowledge improvement. Statistical analysis was conducted using R software. Results: The results demonstrated that the flipped classroom method led to a significant increase in posttest scores compared to pretest scores (p < 0.0001). On the other hand, the conventional didactic method showed a nonsignificant increase in posttest scores (p = 0.22544). The students’ feedback indicated positive acceptance and satisfaction with the flipped classroom approach. Conclusion: The flipped classroom method is more effective than conventional didactic teaching in enhancing the knowledge of undergraduate dental students. The students’ favorable perception of the flipped classroom suggests that it is a valuable and innovative approach to learning. Clinical significance: The need for this study lies in assessing the implementation value of the flipped classroom method in dental education. The research findings highlight its superiority over traditional teaching methods for undergraduate dental students. This holds significant implications for the transformation of dental education, potentially leading to enhanced learning experiences and improved outcomes. Integrating the flipped classroom approach promises to elevate the readiness and competence of future dental professionals, potentially contributing to advancements in patient care and oral health.