Frontiers in Dentistry (FID)  is the first Iranian dental journal in English. FID is an Open Access, Peer-Reviewed  journal published by Dental Research Center (DRC) of Tehran University of Medical Sciences which is a dynamic, rapidly growing research center.

The Journal aims to publish novel and high quality relevant information written by peers to researchers and readers involved in all fields of dentistry, oral health sciences and related interdisciplinaries, strives to keep pace with the rapid growth of publications, and move on to the edge of knowledge in this field.

Frontiers in Dentistry encourages submission from General dentists, dental specialists, clinicians, students and postgraduate students of dentistry, as well as researchers and academic members who do research in the field of dentistry and oral health sciences. The journal supports the following types of articles:

  • Original/Research Article
  • Systematic Review/Meta-Analysis
  • Reports including Technical Reports and Case Reports
  • Letter to the Editor

Announcements

Our Approach Towards COVID-19 Papers

2020-10-21
Considering the importance of disseminating the most recent knowledge on COVID-19 during this ongoing pandemic, Frontiers in Dentistry is providing free fast track of all manuscripts related to the disease. Decisions on such papers shall be provided within a maximum of three weeks. 
We invite authors in different fields of Dentistry to submit their COVID-19-related manuscripts to this journal accompanied by a brief statement in their Cover Letter, explaining the importance of the study and what it would add to the existing literature. 
We also request that all colleagues who feel they can provide a timely review (maximum 2 weeks) on such papers, contact the journal at: jd_drc@tums.ac.ir and declare their availability. For each review completed within this timeframe Frontiers in Dentistry is offering a 20% discount on the next paper accepted by the reviewer, up until January 1st, 2022. Please note that points are collectable and a review of 5 papers by the same reviewer would result in a free article published in the journal, if accepted through peer review.
Editor-in-Chief: 
Mohammad-Sadegh Ahmad-Akhoundi, DDS, MSc.   Read more about Our Approach Towards COVID-19 Papers

Current Issue

Vol 19 (Continuously Published Article-Based)

Review Article

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    Root proximity is defined as a situation where the distance between the roots of adjacent teeth on radiographs is ≤1.0 mm. This important situation should be detected by clinicians before definitive restorative treatments and they should be well aware of different approaches available for the management of this situation. The purpose of this study was to collect and review the available literature on this topic by searching the PubMed, Google Scholar, Scopus, Embase, and Cochrane Library in order to summarize the complications and treatment plans for root proximity in cases requiring restorative procedures.

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    Objectives: Incorporation of fillers might improve the physical properties of sealants. This systematic review and meta-analysis evaluated the retention and caries development rate of filled and unfilled fissure sealants.

    Materials and Methods: This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Scopus, Embase, Cochrane Database of Systematic Reviews, and ISI Web of Knowledge were searched until October 24, 2019. The risk of bias (ROB) was assessed for the included studies based on the Cochrane collaboration common scheme for bias, and the meta-analysis was performed through a random effects model.

    Results: The search resulted in 6,336 unrepeated relevant studies. After the title, abstract and full-text screening, 19 studies with 26 comparing groups were finally included in this systematic review and meta-analysis. According to the included studies, both retention rate and caries development in filled and unfilled resin-based sealants did not significantly differ within 2 years of follow-up.

    Conclusion: Since there was no significant difference in the retention rate and caries development between filled and unfilled sealants, it seems that the final decision should be made uniquely for each patient according to the type of fissure, patient’s age, habits, etc.

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    As the coronavirus disease-2019 pandemic outbreak continues to be a global public health concern, dentists should seek means to provide oral health care with minimal risk. To meet the recommendations of the Center for Disease Control, alternative non-aerosol generating techniques have been proposed to minimize the risk of disease transmission to patients and dental healthcare personnel. Among recent materials, silver diammine fluoride (SDF) has been shown to be effective in preventing and arresting caries. This along with an atraumatic restorative treatment with glass ionomer cements (GICs) makes it a potentially attractive adjunctive therapy for caries management in pediatric patients. In this technique, SDF is applied over carious tissue and the lesion is restored with auto-polymerizing GIC. This review article aims to provide a practical background and clinical guide for the application of silver-modified atraumatic restorative technique (SMART) as a safe way to provide dental services to children during the pandemic.

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    This integrative review aims to provide a consolidated evidence-based appraisal of the most up-to-date guidelines and recommendations of international public and professional health regulatory bodies in relation to preparedness framework for restructuring safe delivery of dental services amid and beyond the coronavirus disease-2019 (COVID-19) pandemic. Most recent updated guidelines for dental professionals from major international health regulatory bodies were reviewed. PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, WHO COVID-19 and LILACS databases, along with relevant preprints were searched, and citations were checked up to January 23, 2021. The search was performed by one author. Shortlisted articles were read and brought to consensus to be included in the study by at least two co-authors. In case of any disagreement between the judgements, an independent co-author’s decision was taken as final. Of 849 records searched, 61 articles were included in the study. Following content analysis of the global guidelines and the collected prevailing evidence, the common themes and recommendations of different guidance documents were collated and summarized into seven domains. Most guidelines have a consensus regarding implementation of rigorous administrative, engineering and environmental infection control strategies. However, variations do exist with regard to the use of respirators in non-aerosol-generating procedure (non-AGP) settings, employment of airborne precautions during non-AGPs, use of supplemental air-handling systems, and preoperative use of mouthwashes. This evidence-based analysis can serve as a useful reopening resource tool and facilitate effective restructuring for delivery of optimal, equitable and safe dental practices globally, during and while emerging from the pandemic.

Original Article

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    Objectives: The basis of truth-telling is respecting the autonomy of patients and developing an ability to make informed decisions with valid consent. The purpose of this study was to ethically analyze the conflicts about truth-telling in dentistry.

    Materials and Methods: This case analysis focused on the issues of truth-telling in medicine and dentistry. The challenges encountered by dentists with respect to ethical issues related to truth-telling were discussed and analyzed by the research team.

    Results:  The literature review showed that the issue of truth-telling in dentistry has been addressed from three aspects: Truth-telling about other dentists’ medical errors, truth-telling about dangerous, refractory, or incurable diseases, and truth-telling to children or incompetent individuals for decision-making.

    Conclusion: When the duty of the dentist in truth-telling is conflicted with some other moral obligations, the conflict between the prima facie duties arises. The principle-based ethical theories provide a suitable conceptual framework for moral judgement in such conflicts. In cases of conflicts related to truth-telling, a balance should be maintained between principles and rules such as fidelity, respect for autonomy, maintaining trust in dentist-patient relation, and best interest of patients. The decision in truth-telling should be made individually for each patient based on the specific contextual conditions.

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    Objectives: The aim of this study was to evaluate the effects of rinsing water temperature and preheated composites on microleakage of class V restorations with two different bonding agents.

    Materials and Methods: Eighty class V cavities were prepared in the buccal and lingual surfaces of 40 molars. Single Bond and Prime and Bond NT bonding agents were used. The teeth were divided into four groups of 10. G1: After acid etching, cavities were rinsed with 23˚C water and filled with 23˚C composite resin. G2: Rinsing water and composite resin had 55˚C temperature. G3: Rinsing water had 55˚C and composite resin had 23˚C temperature. G4: Rinsing water had 23˚C and composite resin had 55˚C temperature. The specimens were immersed in 0.5% basic fuchsine dye. Microleakage scores were analysed with the Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests.

    Results: There were significant differences in microleakage of specimens prepared with Single Bond and Prime and Bond NT only in group 1 (P<0.05). There were no significant differences between the microleakage of groups rinsed with different water temperatures (P>0.05). There were significant differences between the unheated and preheated composite groups (P<0.05).

    Conclusion: Preheating of composite is a valuable method to increase its adaptability and decrease microleakage of composite restorations.

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    Objectives: For decades, the white coat has been the uniform of medical professionals. Recently, medical professionals show interest to use alternatives. We aimed to evaluate the perspectives and preferences of children and their parents regarding dentists’ attire and gender.

    Materials and Methods: This cross-sectional study was performed on 4-to 6-year-olds and their parents referred to dental clinics of Tehran School of Dentistry in 2018. Parents completed a questionnaire on demographics and dental fear, and both parents and children were asked about their preferences regarding the gender of dentist and the color of the dentist’s attire. Statistical analysis was performed by the logistic regression model.

    Results: Totally, 148 children (mean age of 5.42±0.71 years, 48% girls) and their parents participated in the study. Most of the participants (81.2% of the children and 68.0% of the parents) preferred colored coats compared with white coat. More than half of the parents preferred a female dentist for their children (56.5%) while most children preferred a male dentist (54.8%). Boys preferred a male dentist as well (P=0.01). The children were reluctant to go for a dental visit and preferred to be visited by a dentist of the same gender as themselves (P=0.041).

    Conclusion: Wearing colored coats by dentists and giving a chance to choose the gender of dentist in polyclinics may increase the children’s cooperation in pediatric settings.

    Keywords: 

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    Objectives: The purpose of this study was to evaluate the effect of saliva contamination on shear bond strength (SBS) of orthodontic brackets bonded by a self-adhering composite compared with a conventional adhesive.

    Materials and Methods: This in vitro, experimental study investigated 40 human premolars. The teeth were randomly divided into four groups based on the adhesive type and bonding condition: (I) Vertise Flow composite without saliva contamination (VF), (II) Vertise Flow composite with saliva contamination (VF/S), (III) Transbond XT composite without saliva contamination (TXT), and (IV) Transbond XT composite with saliva contamination (TXT/S). After the preparation step, brackets were bonded to the buccal surface of the teeth, and samples were mounted in acrylic blocks, incubated at 37°C for 24 hours, and underwent thermocycling between 5- 55°C. Next, the SBS was measured by a universal testing machine. Data were analyzed by ANOVA and Tukey’s test.  P<0.05 was considered statistically significant.

    Results: ANOVA showed a significant difference in SBS among the groups (P<0.001). The highest SBS was achieved in the TXT group (26.63±9.09 MPa), followed by TXT/S (13.69±4.23 MPa), VF/S (3.68±1.49 MPa), and VF (3.04±1.73 MPa).

    Conclusion: Saliva contamination did not have a significant effect on SBS of brackets bonded with Vertise Flow. However, it did not provide acceptable bond strength for orthodontic bracket bonding in the clinical setting.

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    Objectives: This study aimed to assess the color change (∆E00) of 7 brands of denture teeth (conventional acrylic and composite teeth) following immersion in staining solutions.

    Materials and Methods: Maxillary central incisor denture teeth made of 4 conventional acrylic resins (Vitapan, SR Vivodent PE, Beta Star and Crystal) and 3 composite resins (Finex, Emeral and Phonares II) were randomly divided into four groups (n=5). Denture teeth of different brands were immersed in tea, coffee, cola, and turmeric solutions. The solutions were incubated at 37°C. The baseline color of the teeth was measured using an intraoral spectrophotometer. The color of the teeth was measured after 24 h (∆E12), 1 week (∆E13), 2 weeks (∆E14), and 1 month (∆E15). ∆E00 was calculated and analyzed using one-way ANOVA. Pairwise comparisons were performed by the Tukey’s post-hoc test (P<0.05).

    Results: The color stability of all teeth was significantly affected by the solutions (P<0.001). The type of tooth and coloring solution had significant interactions at all times (P<0.05). Turmeric caused the maximum color change in all teeth after 1 month. Repeated measures ANOVA showed that ∆E00 of all teeth was significantly affected by the duration of immersion in the solutions (P<0.001).

    Conclusion: within the limitations of this study, 1-month immersion of denture teeth in coffee, tea and cola solution altered the ∆E values; however, they were within the acceptable range, except for Beta Star. Turmeric solution caused unacceptable color change in all denture teeth even after 24 h of immersion.

     

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    Objectives: Use of miniscrews has become very common in orthodontic treatment of patients. Following tissue manipulation during miniscrew placement, bacteremia may occur, which is important in patients susceptible to infective endocarditis. This study aimed to investigate the possibility of bacteremia following orthodontic miniscrew placement.

    Materials and Methods: The present quasi-experimental study was conducted on 30 orthodontic patients, including 11 males (36.7%) and 19 females (63.3%) with a mean age of 23.67±4.87 years, who required miniscrew placement in their treatment plan. Two blood samples were taken from the patients for aerobic and anaerobic cultures right before and 30-60 seconds after miniscrew placement. To investigate the presence of bacteremia, the blood samples were incubated in an automated blood culture machine for five days. The standard biological methods were used for the positive sample(s) to identify the type of bacteria. Data analysis was performed using the McNemar test.

    Results: The blood samples of 29 patients were negative for the bacteria before and after miniscrew placement. Blood sample of one patient was positive for aerobic and anaerobic bacteria after miniscrew placement. However, bacteremia was negative in the initial (preplacement) blood samples for both aerobes and anaerobes.

    Conclusion: Miniscrew placement in orthodontic patients was not associated with bacteremia.

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    Objectives: The aim of this study was to assess the microtensile bond strength of three universal adhesives to dentin and enamel.

    Materials and Methods: Sixty extracted human third molar teeth were chosen and divided into six groups regarding the adhesive (G-Premio Bond, Clearfil S3 Bond or Single Bond) and tooth surface. All the applied bonding agents were universal adhesives. The teeth were polished and the adhesives were applied; then the teeth were restored with composite resin. The samples were mounted in acrylic resin and sectioned. The specimens were subjected to a universal testing machine and the microtensile bond strength was measured. The failure mode of each specimen was determined under a stereomicroscope. Data were analyzed using two-way ANOVA (α=0.05).

    Results: The microtensile bond strength of G-Premio Bond to enamel and dentin was 11.79±8.27 and 17.55±9.47 MPa, respectively which was not significantly different from the values in Single Bond group (15.59±10.66 and 17.19±10.09 MPa to enamel and dentin, respectively; P>0.05). However, the values for Clearfil S3 Bond were 7.11±4.23 and 7.88±8.83 MPa to enamel and dentin, respectively, which were significantly lower than the values for G-Premio Bond (P<0.05). Scanning electron microscopic (SEM) images showed that the adhesive failure was dominant in both enamel and dentin groups and in all adhesive systems.

    Conclusion: G-Premio Bond and Single Bond provided higher microtensile bond strength compared with Clearfil S3 Bond. Universal adhesives with their acceptable performance can be applied in self-etch mode on both enamel and dentin.

     

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    Objectives: The aim of the present study was to develop and evaluate the psychometric properties of an instrument in Persian to assess the mothers’ knowledge, and perception about oral health of school children.

    Materials and Methods: A sequential exploratory mixed method design consisting of qualitative and quantitative phases was performed. We developed the questionnaire by inductive-deductive method, through a synthesis of literature review and a qualitative study with semi-structured interviews and focus group discussions. Face and content validity of the items were assessed by consulting a panel of 11 experts. In the quantitative phase, an exploratory factor analysis was performed using data from a cross-sectional study with a sample of 303 mothers. Reliability analysis with test-retest approach and Cronbach’s alpha coefficient and intra-class correlation coefficient (ICC) was done.

    Results: Pre-final version of the scale consisted of 120 items extracted from the qualitative study and literature review. After content and face validity, 92 items were chosen with the greatest agreement between experts, with a content validity index (CVI) >0.8 and content validity ratio (CVR) of 0.59. The final questionnaire covered 62 items. The overall Cronbach’s alpha was 0.94 and it ranged from 0.87 to 0.97 for the subscales. The ICC ranged from 0.91 to 0.98 (Cronbach's alpha ≥0.70).

    Conclusion: The present study introduced a valid and reliable questionnaire for assessment of the mothers’ perception regarding school children’s oral health. It can be used as a standardized measure for public health surveillance and evaluation of oral health promotion programs.

    Keywords: 

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    Objectives: We aimed to investigate oral health, oral hygiene, and associated factors in children with visual impairment aged 7-11 years.

    Materials and Methods: This cross-sectional study was conducted on 47 children with visual impairment aged 7-11 years who were selected from all three schools available for visually impaired children in Tehran in December 2018. Questions regarding age, gender, status of visual impairment, level of education of the parents, self-reported dental and gingival health, oral health, and dietary habits were asked face-to-face using the World Health Organization oral health questionnaire for children. The decayed, missing, and filled teeth index for both primary (dmft) and permanent (DMFT) dentitions was determined by clinical examination. Simplified Oral Hygiene Index (OHI-S), and bleeding on probing (BOP) were also assessed. Linear and logistic regression tests were used for statistical analysis.

    Results: Over 70% of the children were satisfied with their dental and gingival health. Daily brushing was reported by 70.2%. Over half of the children reported daily consumption of fruits and jam/honey. The mean dmft and DMFT scores were 2.85±3.21 and 0.81±1.15, respectively. The mean OHI-S was 2.09±0.58. Also, 57.4% and 34% of the children had unrestored caries in their primary and permanent teeth, respectively. BOP was seen in 78.7% of the children. A significant correlation was observed between toothache in the past 12 months and dmft score (P<0.003). Daily tooth brushing was inversely correlated with OHI-S index (P=0.02).

    Conclusion: The results highlight an urgent need for implementation of oral health programs for visually impaired children.

Case Report

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    Actinomycosis is caused by Actinomyces species and is relatively rare in humans. Because of the special collateral blood flow, osteomyelitis is less common in the maxilla than the mandible. Although there are few case reports for jaw osteomyelitis, actinomycotic osteomyelitis associated with phenytoin therapy has not been reported before. The data show that antiepileptic drugs induce suppression of the immune system. This report presents a rare case of a 58-year-old man on phenytoin with actinomycotic osteomyelitis, and reviews the relevant literature.

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