Frontiers in Dentistry

Objectives: Pentraxin-3 (PTX3) and interleukin-6 (IL-6) are two of the most important inflammatory cytokines produced by cells in periodontal tissues. The present study aims to evaluate the levels of PTX3 and IL-6 in serum and gingival crevicular fluid (GCF) in patients with generalized periodontitis stages II and III, grades A and B, and periodontal health individuals before and after scaling and root planing (SRP).

Materials and Methods: In this study, 22 patients with periodontitis (12 males and 10 females) and 22 periodontal health controls (11 males and 11 females) were selected. All patients underwent full-mouth SRP. Serum and GCF samples were collected before and one month after SRP. PTX3 and IL-6 levels in serum and GCF samples were evaluated by enzyme-linked immunosorbent assay. Data analysis was performed using Mann-Whitney U and Wilcoxon tests (P<0.05).

Results: Serum levels of PTX3 were significantly higher in the periodontitis group than the controls (P<0.05). GCF PTX3 levels and serum and GCF IL-6 levels were not significantly different between the groups. Furthermore, this study did not show any significant changes in the levels of these cytokines before and after SRP.

Conclusion: Among the studied cytokines and media, only serum PTX3 levels showed a significant difference between periodontitis patients and healthy controls and could serve as a diagnostic marker of periodontal inflammation. SRP did not affect the levels of these cytokines, suggesting that other inflammatory factors may be involved in disease process. However, additional longitudinal prospective studies are needed to confirm these results.

Objectives: The purpose of this study was to investigate the effect of laser etching, air bone particle abrasion and acid etching on shear bond strength between re-cast Nickel Chromium alloy and dental ceramics.

Materials and Methods: A master die was made according to ISO 9693; TR (11406). A total of 40 samples were fabricated with 50%w nickel-chromium alloy and 50%w previously casted nickel-chromium alloy. The samples were divided into four groups based on the surface treatment applied. Group 1 served as the untreated control, Group 2 underwent etching with 10% hydrochloric acid (HCl), Group 3 received surface treatment via air-borne particle abrasion, while Group 4 was conditioned using a pulsed Nd:YAG laser. Shear bond strength between ceramic and metal was tested using a universal testing machine and the mode of debonding was evaluated using scanning electron microscope. The obtained values were statistically analyzed using one-way ANOVA and Tukey’s HSD Post Hoc test.

Results: The mean values of shear bond strength for Group 1 was 22.69±2.63Mpa, Group 2 was 27.05±2.15Mpa, Group 3 was 34.46±2.46Mpa and Group 4 was 39.54±2.16Mpa. The difference among the groups was significant (P<0.001). Hence there was a statistical difference seen in shear bond strength between control and acid etching, air borne particle abrasion and laser etching.

Conclusion: Laser surface conditioning produced more surface roughness compared to acid etching and air bone particle abrasion on re-cast Nickel Chromium alloy which increased the shear bond strength markedly between recast nickel-chromium alloy and dental Ceramic.

Objectives: Despite the recent advances in orthodontic appliances, color change of elastomeric ligatures over time remains a problem causing patient dissatisfaction. This study aimed to assess the color stability of different types of orthodontic elastomeric ligatures in the oral environment.

Materials and Methods: This clinical trial was conducted on 67 patients. After applying the exclusion criteria, 11 participants were excluded, and 56 remained. Four different brands of elastomeric ligatures namely Ortho Technology, Ortho Organizers, American Orthodontics, and SIA were randomly used in the four quadrants of each patient (n=14 from each brand). Discoloration of ligatures was scored in the oral cavity by orthodontists and patients on the day of placement (T0) and 28 days later (T1). Photography and CIE L*a*b* color space were used to assess the color change (∆E). Data were analyzed by the Kruskal-Wallis and Bonferroni tests.

Results: All brands showed discoloration. The highest ∆E was identified in SIA and Ortho Technology, while the lowest was recorded in Ortho Organizers. The lowest ∆b (yellowness) and the greatest reduction in L* (lightness) and ∆a (redness) were observed in Ortho Organizers. According to the opinion of patients and orthodontists at T0 and T1, SIA was the least visible followed by Ortho Technology. No significant difference was found between orthodontists and patients at T0 and T1 regarding the visibility of ligatures (P>0.05).

Conclusion: After 28 days, all brands of elastomeric ligatures showed considerable discoloration. Ortho Organizers showed the highest color stability.

Objectives: This study evaluated the effect of ozone water disinfection on dimensional stability and accuracy of silicone impression materials.

Materials and Methods: According to ISO-4823, a stainless-steel die was fabricated for this in vitro study. Three horizontal parallel lines, namely x, y, and z (25, 50, and 75µm in width and 25mm in length) running perpendicular to two vertical lines, namely D1 and D2 (0.075±0.008mm wide), were created on the superior surface of the die. Group A served as the control group with no disinfection. Disinfection was performed with 2% glutaraldehyde in group B, 5.25% sodium hypochlorite in group C, and ozone water in group D for 10 minutes. Totally, 60 samples were fabricated. The silicone impression samples were allowed to polymerize in a thermostatically controlled water bath at 35±1ºC for 10 minutes. The dimensional stability and accuracy of the silicone impression samples were evaluated by using a video measuring microscope and an optical microscope. Data were analyzed by two-way ANOVA followed by post-hoc analysis with the Scheffe test (alpha=0.05).

Results: The highest dimensional stability (25.01mm) and accuracy (25.02µm) were seen in addition silicone putty and light body impression with ozone water disinfection, and the lowest parameters were seen in condensation silicon putty and light body disinfected with 2% glutaraldehyde (24.87mm and 24.88 µm, respectively); this difference was statistically significant (P<0.001).

Conclusion: Ozone water disinfection caused minimal changes in dimensional stability and accuracy when compared to 2% glutaraldehyde and 5.25% sodium hypochlorite disinfection

Objectives: Repair of composite resin restorations is a challenge specially when the restoration undergoes aging; thus, this study aimed to assess the effect of aging and different surface treatments on the repair microshear bond strength of IPS Empress Direct nanohybrid composite resin.

Materials and Methods: This in vitro, experimental study evaluated 48 IPS Empress Direct composite resin samples in two groups of aged and nonaged (n=24). The samples in both groups were finished and polished with Sof-Lex discs. Composite samples in the aged group were subjected to 5000 thermal cycles. The two groups were then divided into two subgroups (n=12) for surface roughening by a diamond bur or sandblasting with aluminum oxide particles. Composite cylinders were then bonded to the composite samples, and underwent microshear bond strength test in a universal testing machine. Data were analyzed by two-way ANOVA and t-test (alpha=0.05).

Results: The results showed no significant difference in the microshear bond strength of bur and sandblasted subgroups, irrespective of aging (P>0.05). In the aged subgroups, however, irrespective of the method of surface treatment, the bond strength was significantly lower than that in the subgroups that did not undergo the aging process (P<0.05).

Conclusion: Micromechanical retention is the most reliable method to achieve a high repair bond strength in IPS Empress Direct composite resin. Surface roughening by bur is safe and cost-effective, and can be used instead of sandblasting for composite restoration repair.

Objectives: Amniotic membrane (AM) is an allograft obtained from humans that contains a variety of growth factors, and has outstanding healing qualities. This study aimed to assess the efficacy of amniotic allograft with coronally advanced flap (CAF) for root coverage.

Materials and Methods: This randomized controlled clinical trial comprised 24 individuals with Miller's Class I and II root resorption defects. Each patient received treatment using the CAF approach, with the test group receiving a combined therapy using an AM. Measurements were made at baseline and 6 months after surgery for gingival biotype (GB), dentin hypersensitivity (DH), recession depth (RD), recession width (RW), gingival recession total surface area (GRTSA), keratinized tissue width (KTW) and probing depth (PD).

Results: There was a statistically significant reduction in RD (from 2.83 mm to 0.92 mm), a significant increase in KTW (from 3.17 mm to 4.25 mm), improvement in GB, and a reduction in DH in the test group compared to the control group (P<0.05).

Conclusion: Miller’s Class I and II root recession defects can be effectively treated with a CAF. Application of AM under the CAF improved root coverage and GB, and further increased the KTW after 6 months, compared to CAF alone.

Objectives: This study compared the antifungal efficacy of curcumin plus nystatin versus nystatin monotherapy for treatment of denture stomatitis.

Materials and Methods: This single-blind clinical trial evaluated 32 patients with types II and III denture stomatitis. Microbial samples were collected from the patients’ palate to count the Candida albicans (C. albicans) colonies. Erythema of the palate was quantified by measuring the surface area of the erythematous sites. The patients were randomly assigned to two groups (n=16). The control group received nystatin suspension while the test group received a curcumin mouthwash plus nystatin suspension. The number of C. albicans colony forming units (CFUs) and the surface area of the erythematous sites were calculated again after 14 days. Data were analyzed using t-test and Wilcoxon signed-rank test (alpha=0.05).

Results: Both groups experienced a significant reduction in C. albicans colony count after the intervention (P<0.001). There was no significant difference in reduction of colony count between the two groups (P=0.341). Both groups experienced a significant reduction in the size of erythema (P=0.001 for the nystatin and P<0.001 for the nystatin plus curcumin). The two groups were not significantly different regarding the size of erythema at baseline (P=0.956) or after the intervention (P=0.491).

Conclusion: Addition of curcumin to nystatin suspension did not add any significant advantage with regard to reduction of C. albicans colony count or erythema of the palate, and both interventions were equally effective.

Objectives: The present study was conducted to compare the flexural strength of a bioactive composite and a reinforced hybrid glass ionomer (GI).

Materials and Methods: In this in vitro experimental study, 10 rectangular-shaped specimens were fabricated from Activa Bioactive composite (N=5) and EQUIA Forte Coat GI (N=5) using stainless steel molds with internal dimensions of 2×2×25mm according to the manufacturers’ instructions. The flexural strength of the specimens was measured with a universal testing machine with the three-point bending test using a load of 50±16N/min at a crosshead speed of 0.75±0.25mm/min. The data were analyzed using the Mann-Whitney U          test (α=0.05).

Results: The mean flexural strength was 57.91MPa for the bioactive composite and 19.20MPa for the reinforced hybrid GI. The mean flexural strength of the bioactive composite was significantly higher than that of hybrid GI (P=0.008).

Conclusion: Within the limitations of this in vitro study, the results indicate that the Activa Bioactive composite exhibits greater flexural strength compared to EQUIA Forte Coat GI.

Objectives: Oral mucositis is a common side effect of cancer chemotherapy. Traditionally, black mulberry or Morus nigra L. (M. nigra) fruit is used for treatment of oral inflammatory conditions. The aim of the present study was to evaluate the efficacy of black mulberry mouthwash for prevention of oral mucositis caused by 5-fluorouracil.

Materials and Methods: This double-blind clinical trial was performed on 62 patients with colon adenocarcinoma undergoing chemotherapy with 5-fluorouracil. The patients were randomly divided into two groups (n=31) to receive 10mL of 1% black mulberry juice (BMJ) or the placebo mouthwash, 3 times a day for 2 weeks. The patients were followed up for 7 and 14 days after the treatment onset to record the degree of mucositis according to the World Health Organization (WHO) criteria. Spectrophotometric assays were conducted for quantitative analysis of the bioactive compounds in the composition of BMJ. Data were analyzed with the Chi-square and Fisher’s exact tests (alpha=0.05).

Results: The severity of oral mucositis was slightly, but not significantly, lower in the follow-up sessions in the BMJ mouthwash group (P>0.05). The total anthocyanin content of the BMJ was calculated to be 506.5±3.51 and 476.2±7.99mg cyanidin 3-glucoside equivalent per 100g of dried juice, before and after the sterilization process, respectively.

Conclusion: The present results showed that the BMJ mouthwash can be effective as an adjunct treatment to reduce the incidence and severity of mucositis in patients undergoing chemotherapy. Anthocyanins appear to be mainly involved in the observed effect.

Objectives: Retained cement is an idiopathic factor contributing to early implant loss, making the selection of cement with minimal toxicity to peri-implant hard and soft tissues crucial. This study aimed to evaluate the cytotoxicity of three types of temporary cements and titanium specimens cemented with each, following direct exposure to human gingival fibroblasts (HGF) and MG-63 osteoblast-like cells.

Materials and Methods: In this in vitro study, zinc oxide-eugenol (ZOE), eugenol-free zinc oxide (ZONE), and resin (R) cements were prepared in cylindrical forms of similar dimensions. Each cement was applied to titanium disks to create cemented titanium samples. Cytotoxicity was evaluated using the MTT assay at 24 hours, 72 hours, and 7 days. Cytotoxicity was assessed on HGF and MG-63 osteoblast-like cells using the MTT assay at 24, 72 hours, and 7 days. Data analysis involved two-way and one-way ANOVA, with Tukey's post-hoc tests, and statistical significance was defined as P<0.05.

Results: All cements significantly reduced cell viability in both cell lines. None of the cements demonstrated cellular viability percentages above the minimum threshold (70%) required for biocompatibility. The cytotoxicity of the cemented titanium disks was not significantly different from that of the cement-only samples (P>0.05). Additionally, there were no significant differences in the sensitivity of MG-63 osteoblast-like cells and HGF cells to the evaluated cements.

Conclusion: The composition of the cement played a significant role in the host cell response. This study demonstrated that dental cements could induce tissue toxicity in the gingiva and bones, ultimately affecting implant survival.

Objectives: The increasing applications of composite resins and the need for correction of defects developed over time call for strategies to increase the bond strength of new repair composite resin to old (aged) composite resin. Thus, this study aimed to assess the effect of erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation with various power levels on shear bond strength (SBS) of repair to aged nanofilled composite resin.

Materials and Methods: Thermocycled disc-shaped (4.0×7.0mm) nanofilled composite resin specimens were randomly assigned to 4 groups (n=15): bur abrasion and 35% phosphoric acid (control group), irradiation of 1 W Er:YAG laser, irradiation of 2W Er:YAG laser, and irradiation of 4.5W Er:YAG laser. The SBS was measured after the application of repair composite and thermocycling. Specimens were observed under a stereomicroscope to determine the mode of failure. Atomic force microscopy (AFM) was used to assess the surface topography. Data were analyzed with one-way ANOVA, Games-Howell, and Fisher’s exact tests (α=0.05).

Results: The mean SBS in the 1W and 2W laser groups was significantly lower than that in the 4.5W laser and control groups (P<0.05). The difference in SBS of the 1W and 2W laser (P=0.999), and the 4.5W laser and control (P=0.999) groups was not significant.

Conclusion: Er:YAG laser irradiation with 4.5W power yielded a SBS comparable to that of the control group and significantly higher than that of the 1W and 2W laser groups.

Objectives: Oral health literacy (OHL) is a concept far beyond reading and including other skills such as numeracy skills, listening, and decision-making. Self-reported oral health(SROH) is a reliable and cost-effective measure of dental and periodontal conditions. The current study aimed to evaluate the association between various aspects of OHL and SROH.

Materials and Methods: This cross-sectional study was conducted among adults visiting a dental school. One interviewer asked each individual ”How would you describe your oral health at present?” to measure SROH. Two response categories were “good” and “poor”. OHL-AQ (Oral Health Literacy Adult Questionnaire) was used to measure different aspects of OHL (Reading comprehension and knowledge, listening, numeracy and communication, and decision-making skills). The total scores ranged from 0 and 17. To analyze the data binary logistic regression and chi-square tests were performed. (P=0.05)

Results: Totally 253 adults participated. Most participants (65.21%) were females. The numbers of subjects with good and poor SROH were 127(50.20%) and 126(49.80%) respectively. The mean age of the participants was 37.75±10.69 years and ranged from 18 to 65 years. The overall mean OHL score was 11.74±3.12. Out of the components of OHL in OHL-AQ, reading comprehension and knowledge skills (p=0.032), and decision-making skills (p=0.013) had a significant positive correlation with good SROH. In contrast, listening (p=0.955) and numeracy skills (p=0.349) did not exhibit a similar association.

Conclusion: OHL level, particularly decision-making, reading comprehension, and knowledge skills, is associated with SROH.

Objectives: This study assessed sex estimation of Iranians according to maxillary left first molar measurements made on panoramic radiographs using classical and machine-learning classifiers.

Materials and Methods: In this cross-sectional study, tooth length- and width-related variables were calculated for maxillary left first molars on 131 panoramic radiographs (65 males, 66 females; age range of 18-30 years). A subsample of the radiographs was selected and reevaluated by two examiners after 1 month. The intra-class correlation coefficient (ICC) was calculated to assess reliability. The regularized discriminant analysis (RDA), support vector machine (SVM), and cascade-forward and feed-forward neural network models were used for sex estimation. Comparisons were made with the Mann-Whitney and t tests.

Results: The intra-observer reliability was 0.9. SVM had the best performance on the test data in both classification schemes. The crown length at the cementoenamel junction (CEJL) and total crown length (CL) in the classification scheme I (sex estimation based on length and width variables), and CEJL/root length (RL), cementoenamel junction width (CEJW)/CEJL, and RL/total tooth length (TTL) in the classification scheme II (sex estimation based on the ratio of variables) were important variables for sex estimation determined by the SVM model. The CEJL had the highest discriminative potential with an area under the curve (AUC) of 78.8. The ratio of variables did not substantially improve sex estimation compared with single variables.

Conclusion: CEJL is a reliable measure for sex estimation in Iranians with values higher than 6.25 indicating the male sex and other values indicating the female sex.

Objectives: The aim of this study was to assess the color change (∆E) of teeth following the use of several bleaching protocols with power bleaching.

Materials and Methods: This in vitro study evaluated 50 sound incisors and premolars. After cleaning, the teeth were immersed in a 2g/100mL tea solution for 6 days. The samples were randomly divided into 5 bleaching groups: Snow L [containing 40% hydrogen peroxide (HP) and 20% carbamide peroxide] with 980nm diode laser, White Smile (containing 32% HP) with LED (Monitex), Boost (containing 40% HP) with 980nm diode laser, Boost (containing 40% HP) with LED (Monitex), and Boost without activation. Color parameters were measured before and after staining, immediately and 1 week after bleaching by a spectrophotometer, and their ∆E was calculated and compared by one-way ANOVA followed by the Tukey’s test.

Results: All bleaching protocols improved the color parameters. The ∆E in each group was significant after bleaching compared to before bleaching in the cervical (P<0.001), middle (P<0.001) and incisal (P<0.001) thirds. The ∆E was significant at 1 week compared to before bleaching (P=0.002 for the cervical, P<0.001 for the middle, and P<0.001 for the incisal third, respectively), immediately after bleaching compared with after staining (all Ps<0.001), and also at 1 week compared with after staining (all Ps<0.001).

Conclusion: Within the study limitations, all power bleaching protocols caused color change of the teeth. The efficacy of Boost (conventional bleaching), Boost plus LED, and White Smile was better than Snow L regarding color change of teeth.

Rhabdomyosarcoma is a rare soft tissue malignant neoplasm with striated muscle differentiation often found in the head and neck region. In our case a 33-year-old man presented with a bulging mass near his right mandibular second molar tooth, identified as a unilocular destructive lesion on an X-ray. An incisional biopsy confirmed rhabdomyosarcoma, leading to a hemi-mandibulectomy. Histopathologic findings showed spindle and rhabdoid cells with positive immunoreactivity to Desmin, myogenin and myoD1. In conclusion, it is crucial to differentiate rhabdomyosarcoma from other more common intraosseous malignancies, and using Desmin staining as part of the initial immunohistochemical panel can aid in the diagnosis process.

Objectives: Myofascial pain dysfunction syndrome (MPDS) is a musculoskeletal disorder with a multifactorial etiology. Some investigations suggest psychological disorders as a major risk factor for MPDS. This study is the first case series to report patients with obsessive-compulsive disorder (OCD) and MPDS comorbidity.

Case presentation: Sixteen patients suffering from both MPDS and OCD with the chief complaint of pain or limitation in jaw opening were evaluated. The patients were between 18 to 55 years, the majority were females, the masseter muscle was the most commonly involved muscle (40%), and some of the patients had a history or sign of bruxism.

Conclusion: OCD symptoms should be considered in MPDS patients. Bruxism due to psychological disorders can be the cause of MPDS. The findings of this case series study should be verified in clinical studies to assess the relationship between MPDS, OCD, and parafunctional habits.