Effect of Dentin Contamination with Hemostatic Agents and Cleaning Techniques on Bonding with Self-Adhesive Resin Cement.

BACKGROUND Dentin contamination with hemostatic agents before bonding indirect restorations negatively affects the bond strength. However, the consensus on which materials could be used to clean contamination of hemostatic agents has not been explored. The aim of this study was to assess the effect of Katana Cleaner applied on the surface of dentin contaminated with hemostatic agents on the shear bond strength (SBS) of self-adhesive resin cement by comparing it with three other surface cleaners. MATERIAL AND METHODS Ninety dentin specimens were divided into a no contamination group (control) (n=10), 4 groups contaminated with 25% aluminum chloride (Viscostat Clear) (n=40), and 4 groups contaminated with 20% ferric sulfate (Viscostat) (n=40). Subsequently, 4 different cleaners were used for each contamination group (water rinse, phosphoric acid, chlorhexidine, and Katana Cleaner). Then, self-adhesive resin cement was directly bonded to the treated surfaces. All specimens were subjected to 5000 thermal cycles of artificial aging. The shear bond strength was measured using a universal testing machine. RESULTS Two-way analysis of variance showed that the contaminant type as the main factor was statistically non-significant (p=0.655), cleaner type as the main factor was highly significant (p<0.001), and interaction between the contaminant and cleaner was non-significant (p=0.51). The cleaner type was the main factor influencing the bond strength. Phosphoric acid and chlorhexidine showed better performance than Katana Cleaner. CONCLUSIONS Cleaning dentin surface contamination with phosphoric acid and chlorhexidine had better performance than with Katana Cleaner.

Noninvasive assessment of novel nanohybrid resin cement adaptation using cross-polarization optical coherence tomography.

OBJECTIVES: Zein-coated magnesium oxide nanoparticles (zMgO NPs) can potentially improve cement adaptation to the tooth-restoration interface, which would aid in minimizing marginal leakage and secondary caries. The aim of this study was to assess the effect of incorporating zMgO NPs on the adaptation of self-adhesive resin cement using cross-polarization optical coherence tomography (CP-OCT) and scanning electron microscopy (SEM). METHODS: Resin inlays were fabricated to be cemented in Class-I cavities of extracted human molars. All specimens were randomly divided into five groups (n = 10), and the resin inlays were cemented using self-adhesive resin cement with various concentrations of zMgO NPs (0% [control], 0.3%, 0.5%, 1%, 2%). Characterization was done by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and SEM. The specimens were examined for interfacial adaptation under CP-OCT. Floor and wall adaptation measurements were analyzed by software on 20 B-scans, and samples were sectioned for interfacial measurement by SEM. RESULTS: Results for CP-OCT and SEM showed a statistically significant increase of adaptation in the floor and wall of resin cement filled with zMgO NPs compared to the control. The samples enhanced with 0.3% and 0.5% showed a statistically significantly better adaptation in floor and wall in CP-OCT and SEM. However, there was no significant difference between the 1%, 2%, and control groups for CP-OCT and SEM analysis. SIGNIFICANCE: The incorporation of zMgO NPs in self-adhesive resin cement can enhance the cement's properties by significantly improving its wall and floor adaptation.

Anterior provisional fixed partial dentures: A finite element analysis.

PURPOSE: The aim of this study was to analyze the stress distribution of fiber-reinforced composite provisional fixed partial denture utilizing a finite element analysis model. MATERIAL AND METHODS: Three anterior teeth were collected: upper right central, left central, and right lateral incisors. A fiber-reinforced composite strip was applied to the palatal surfaces of the teeth. Micro-computed tomographic scans were acquired of the models in order to generate three-dimensional geometrical replicas. Finite element analysis was used to assess the stress distribution of fiber-reinforced composite provisional fixed partial denture using different pontic types under static applied forces that were 100, 30, and 0 N. RESULTS: The maximum stress values were found on the unprepared natural pontic. Stress values ranged from 92.2 to 909.8, 116.4 to 646.7, and 93.8 to 393.5 MPa for composite, naturally prepared, and natural unprepared pontic, respectively. CONCLUSIONS: Using unprepared natural tooth pontic in anterior provisional fixed partial denture to replace missing central incisors is considered superior to other types in terms of stress distribution.

Influence of inorganic nanoparticles on dental materials' mechanical properties. A narrative review.

Inorganic nanoparticles have been widely incorporated in conventional dental materials to help in improving their properties. The literature has shown that incorporating nanoparticles in dental materials in different specialties could have a positive effect on reinforcing the mechanical properties of those materials; however, there was no consensus on the effectiveness of using nanoparticles in enhancing the mechanical properties of dental materials, due to the variety of the properties of nanoparticles itself and their effect on the mechanical properties. This article attempted to analytically review all the studies that assessed the effect of different types of inorganic nanoparticles on the most commonly used dental materials in dental specialties such as polymethyl methacrylate, glass ionomer cement, resin composite, resin adhesive, orthodontic adhesive, and endodontic sealer. The results had shown that those inorganic nanoparticles demonstrated positive potential in improving those mechanical properties in most of the dental materials studied. That potential was attributed to the ultra-small sizes and unique physical and chemical qualities that those inorganic nanoparticles possess, together with the significant surface area to volume ratio. It was concluded from this comprehensive analysis that while a definitive recommendation cannot be provided due to the variety of nanoparticle types, shapes, and incorporated dental material, the consensus suggests using nanoparticles in low concentrations less than 1% by weight along with a silane coupling agent to minimize agglomeration issues and benefit from their properties.

Color behavior of composite resin enhanced with different shapes of new antimicrobial polymer coated nanoparticles.

BACKGROUND: Zein-coated magnesium oxide nanoparticles (zMgO NPs) demonstrate a potent antimicrobial effect, endorsing it as a compelling additive to dental materials formulations for oral health care advances. However, currently there is no data on the imprint of zMgO NPs on the color permanence of dental composites. The objective of this study is to evaluate the color stability of different types of composite enhanced with antimicrobial zein-coated magnesium oxide nanoparticles (zMgO NPs) of different shapes before and after thermocycling. METHODS: Two hundred composite samples were divided into four groups: Gp1: Tetric N-Flow with zMgO nanowires, Gp2: Tetric N-Flow with zMgO nanospheres, Gp3: Tetric N-Ceram with zMgO nanowires; Gp4: Tetric N-Ceram with zMgO nanospheres. Each group was subdivided into 5 subgroups (n = 10) with concentrations of zMgO NPs 0%, 0.3%, 0.5%, 1% and 2%. The characterization of the modified composite containing the zMgO was done via X-ray Diffraction, Field Emission Scanning Electron Microscopy (FESEM), and Fourier Transform Infrared Spectroscopy (FTIR). Colorimetric evaluation was performed through spectrophotometry with a white background. Samples underwent color assessment using a spectrophotometer, followed by thermocycling, and then another color assessment. RESULTS: FESEM analysis showed a uniform distribution of the zMgO nanoparticles in the composite and FTIR illustrated no change in the spectra. However, the XRD spectra exhibited an amorphous pattern in the composite enhanced with zMgO NPs. There was no compelling discrepancy in color variation ΔE among the different groups before and after thermocycling (p > 0.05). A statistically notable variation in ΔL was found amid the control and N-Flow and N-Ceram with 2% zMgO nanospheres before and after thermocycling respectively (p < 0.05). While after thermocycling, there was a statistically significant difference in Δa in N-Flow and N-Ceram wires amid the control and the different groups (p < 0.05). Additionally, after thermocycling there was a statistically significant difference in Δb in N-Flow and N-Ceram wires between the control and the different groups (p < 0.05). The Tukey test exhibited no variation among the groups with different zMgO concentrations (p > 0.05). CONCLUSION: Enhancing N-Flow and N-Ceram composite with antimicrobial zMgO nanowires and nanospheres did not alter the total color stability of the materials before and after thermocycling.

Cytotoxic effects of dose dependent inorganic magnesium oxide nanoparticles on the reproductive organs of rats.

INTRODUCTION: Magnesium oxide nanoparticles (MgO NPs) have a variety of applications that have contributed to their elevated popularity, however, the safety and toxic effects on humans are also of concern with these increased applications. There is insufficient data regarding the effect of MgO NPs on reproductive organs, which are crucial aspects to the body's vital physiological functions. The present study was undertaken in male and female rats to assess the reproductive toxicological potential of two doses (low versus high) of MgO NPs on testicular and ovarian tissues. The toxicity was evaluated using histological, hormonal, and oxidative parameters. MATERIAL AND METHODS: In this work, magnesium oxide nanoparticles (MgO NPs) were synthesized by the sol-gel route and were characterized by X ray diffraction analysis (XRD) and Fourier transform infra-red spectroscopy (FTIR). Forty-eight adult Wister albino rats were used in this experiment which were divided into groups of male and female, and then further into control, low dose MgO NPs, and high dose MgO NPs. The low dose used was 131.5 mg/kg b.w. (1/10 LD50) while the high dose used was 263 mg/kg b.w. (1/5 LD50). All doses were given orally by gastric tube. After 4 weeks, blood samples were collected to investigate the level of sex hormones and both ovarian and testicular tissues were examined for variable oxidative parameters and histopathological changes by light microscopy. RESULTS: The obtained findings showed that high dose of MgO NPs produced considerable changes in sex hormones and stress parameters in both male and female rats in comparison to the low dose and control groups. Histomorphometric analysis demonstrated the presence of histopathological alterations in the testicular and ovarian tissues. CONCLUSION: The results of this study showed dose-dependent adverse effects of MgO NPs on the testis and ovary both functionally and histopathologically as compared to the control rats.

Evaluation of the time-dependent osteogenic activity of glycerol incorporated magnesium oxide nanoparticles in induced calvarial defects.

Introduction: Magnesium-based biomaterials have been explored for their potential as bone healing materials, as a result of their outstanding biodegradability and biocompatibility. These characteristics make magnesium oxide nanoparticles (MgO NPs) a promising material for treating bone disorders. The purpose of this investigation is to assess the osteogenic activity of newly-developed locally administered glycerol-incorporated MgO NPs (GIMgO NPs) in rabbits' calvarial defects. Materials and methods: Characterization of GIMgO was done by X-ray Diffraction (XRD) and Fourier Transform Infrared Spectroscopy (FTIR). Bilateral calvarial defects were created in eighteen New Zealand Rabbits, of which they were divided into 3 groups with time points corresponding to 2, 4, and 6 weeks postoperatively (n = 6). One defect was implanted with absorbable gel foam impregnated with GIMgO NPs while the other was implanted with gel foam soaked with glycerol (the control). The defects were assessed using histological, Micro-Computed Tomography (Micro-CT), and histometric evaluation. Results: The characterization of the GIMgO nanogel revealed the presence of MgO NPs and glycerol as well as the formation of the crystalline phase of the MgO NPs within the nanogel sample. The histological and micro-CT analysis showed time-dependent improvement of healing activity in the calvarial defects implanted with GIMgO NPs when compared to the control. Furthermore, the histometric analysis demonstrated a marked increase in the total area of new bone, connective tissue, new bone area and volume in the GIMgO NPs implanted site. Statistically, the amount of new bone formation was more significant at 6 weeks than at 2 and 4 weeks postoperatively in the calvarial defects implanted with GIMgO NPs as compared to the control. Conclusion: The locally applied GIMgO NPs demonstrated efficacy in promoting bone formation, with more significant effects observed over an extended period. These findings suggest its suitability for clinical use as a therapeutic alternative to enhance bone healing.

Effect of non-rigid connector on the stress distribution of tooth-implant supported fixed prostheses using different implant length and diameter: A comparative 3D finite element study.

PURPOSE: To investigate the significance of the connector type on stress dissemination within the tooth-implant-supported fixed dental prostheses in the mandibular posterior region with different combinations of implant diameter and length by means of finite element analysis (FEA). MATERIALS AND METHODS: Six models of different designs for tooth-implant fixed dental prosthesis (FDPs) were simulated and divided into two main groups. Implant lengths were 10, 11.5, and 13 mm while implant diameters were 3.7, 4.7, and 5.7 mm. The main difference between the groups was the connector type. Models were evaluated using 3D FEA (Solidworks Premium 2018 × 64 Edition). Group A tooth-implant FDPs (5.7 mm × 10 mm) had a mesial and distal rigid connector while group B tooth-implant FDPs (3.7 mm × 10 mm, 3.7 mm × 11.5 mm, 3.7 mm × 13 mm, 4.7 mm × 10 mm and 5.7 mm × 10 mm) had a mesial non-rigid connector in their design between the pontic and the tooth. Models were analyzed to determine the magnitude of von Misses Stresses at six specific zones (fixed dental prosthesis, bone around distal implant, bone around tooth, cementum, periodontal ligament, implant) under vertical occlusal loading of 100 N after meshing and assigning the material properties. RESULTS: Stress values around the supporting bone were significantly higher in Group B (tooth-implant FDP with non-rigid connection) when compared to Group A (tooth-implant FDP with rigid connection). Also, the stresses measured at the FDP level showed that the rigid connection group (5.7 mm × 10 mm) exhibited 26% lower stress values when compared to the non-rigid group (5.7 mm × 10 mm). CONCLUSIONS: Implant-tooth FDPs with rigid connector design using the combination of implant diameter and length (5.7 mm × 10 mm) demonstrated a better design modality thus predicting a higher success rate and more longevity than using the non-rigid connection option.

The Effect of Implant Length and Diameter on Stress Distribution of Tooth-Implant and Implant Supported Fixed Prostheses: An In Vitro Finite Element Analysis Study.

The aim of this study is to evaluate the effectiveness of the implant diameter and length on force dissemination of tooth-implant and implant retained fixed restorations. A finite analysis model was used via a 3D simulation of a unilateral mandibular Kennedy Class I arch. Through thresholding the resultant assembly, a region of interest was selected from the computed tomography (CT) scan. Details of the diameter (D) and length (L) of implant were introduced. Ds used were 3.7, 4.7, and 5.7, while Ls used were 10, 11.5, and 13. The constant was the use of rigid connectors in both designs (implant-implant and implant-tooth fixed partial dentures [FPDs]) and the mesial implant (D 3.7 and L 11.5). Stress in cancellous bone around mesial abutment, which is the second premolar in tooth-implant FPD and mesial implant in the implant-implant FPD, revealed that the stress was significantly lower in tooth-implant FPD when compared with implant-implant FPD (21.1 ± 0.00 vs 46.1 ± 0.00, P < .001). Stress distribution in the bone around any implant depends on several factors such as diameter, length, and tooth-implant vs implant-implant support. The implant diameter was more significant for improved stress distribution than implant length. A moderate increase in the length of the implant consequently reduced stress.

Noninvasive Adaptation Appraisal of Antimicrobial Nano-Filled Composite.

OBJECTIVE: The aim of this research was to assess the effect of incorporating zein-coated magnesium oxide (zMgO) nanofillers to resin-based composite on the internal adaptation of the restorations using cross-polarisation optical coherence tomography (CP-OCT). METHODS: Thirty noncarious human molar teeth were used. Class V cavities (3 × 5 mm) were prepared on the buccal and lingual surfaces of each tooth. Clearfil SE Bond 2 was applied to all the cavities and then the teeth were divided into 3 groups (n = 10) as follows: group 1-restored with N-Flow composite; group 2 and group 3-restored with N-Flow composite mixed with different zMgO nanoparticle concentrations (0.3% and 0.5% by weight, respectively) and then light cured using an LED curing device. Specimens were examined for interfacial adaptation examination under CP-OCT. Characterisation of the dental composite incorporating zMgO was done by Fourier-transform infrared spectroscopy (FTIR), x-ray diffraction (XRD), and field emission scanning electron microscopy (FESEM). Results were analysed with Kruskall-Wallis test followed by Mann-Whitney U test, at a significance level of P < .05. RESULTS: XRD spectra exhibited the sharp peaks of zMgO in the composite enhanced with zMgO nanoparticles. FESEM analysis showed a uniform distribution of the zMgO nanoparticles in the composite and FTIR illustrated no change in the spectra. The gap percentage along the cavity floor was significantly lower in groups 2 and 3 in comparison to group 1 (P < .05). Also there was a significant difference in gap percentages between groups 2 and 3 (P < .05), with group 3 showing the lowest gap percentage. CONCLUSIONS: The incorporation of 0.3% and 0.5% zMgO nanoparticles in flowable composite assists in improving the internal adaptation of the composite to the tooth surface.

Appraisal of empathy among dental interns and postgraduate students at King Abdulaziz University: A cross-sectional study.

PURPOSE/OBJECTIVES: Empathetic communication of dentists with their patients is a primary characteristic of their health care. This study aims to evaluate dental students' empathy levels during the transitional period of internship and postgraduate studies of different specialties at one of the oldest dental schools in Saudi Arabia and explore how this empathy was affected by gender, age, and study duration. METHODS: In this study, the self-reported empathy level among the participants was assessed using the Jefferson scale of empathy-student version (JSE-HPS). This survey includes a 20-question Likert scale formulated to measure clinical empathy in health care professionals. The JSE-HPS was distributed to all registered dental interns and postgraduate students during the academic year 2019-20 in King Abdulaziz University Faculty of Dentistry (KAUFD), Jeddah, Saudi Arabia. RESULTS: Mean total score of empathy of the participants was (101.07 ± 14.8) with a response rate of 89%. A statistically significant higher empathy score appeared among dental postgraduate students in general (p = 0.04) and specifically among the females (p = 0.04) and those with postgraduate programs for more than four years, (p = 0.02). Dental postgraduate students scored significantly higher in the parameters of standing in patients' shoes (p = 0.02). CONCLUSION: Gender, academic level, and duration of postgraduates' studies influenced empathy more than the age of the dental graduates in KAUFD. Our recommendation is to integrate empathy into the dental curriculum emphasizing interactive communication skills and early patient contact.

Antimicrobial properties of dental cements modified with zein-coated magnesium oxide nanoparticles.

The aim of this study was to test the antimicrobial properties of dental cements modified with magnesium oxide (MgO) nanoparticles. Zein-modified MgO nanoparticles (zMgO) in concentrations (0.0, 0.3, 0.5, and 1.0%) were mixed with dental cements (Fuji II, Rely X Temp E, Ionoglass Cem, Es Temp NE, and System P link). Eight discs were fabricated from each zMgO-cement pair for a total of 32 specimens for each cement. Characterization of the dental cements incorporating zMgO was done by X-ray Diffraction (XRD) and Field Emission Scanning Electron Microscopy (FESEM). The antimicrobial properties of the mixtures were tested using direct contact and agar diffusion assays against Streptococcus mutans, Staphylococcus aureus, Enterococcus faecalis, and Candida albicans. Data was analyzed using two-way analysis of variance and LSD post hoc test at 0.05 significance level. XRD spectra showed sharp peaks of zMgO indicating its high crystalline nature, while the amorphous dental cements with zMgO had broad peaks. FESEM analysis showed a uniform distribution of the zMgO nanoparticles in the cement. There were significant inhibition zone values associated with all concentrations of zMgO-cement mixtures tested compared to controls (p < 0.001) with a dose-response recorded only with Fuji II. Optical density values were significantly lower in zMgO groups compared to controls for all microorganisms. The effect was most prominent with Rely X against C. albicans and S. aureus. Dental cements containing zMgO showed significant antimicrobial properties that were dependent on the specific initial cement substrate.

Assessment of the dose-dependent biochemical and cytotoxicity of zein-coated MgO nanowires in male and female albino rats.

Introduction: Recently, zein-coated MgO nanowires were synthesized, which could be promising as an effective antimicrobial compounds that can be combined in the preparation of a diversity of new dental formulations. However, there is a deficiency of information concerning their toxicological profile regarding the human health.Objective: This in vivo study aimed to explore the hepato- and nephrotoxicity of low versus high doses of zein-coated MgO nanowires in rats.Materials and Methods: A 21-day recurrent dose toxicity research was carried out. Wistar rats were divided into 2 main groups, males and females (n = 18). Each group was further subdivided into 3 subgroups: control, MgO-zein nanowires low dose, MgO-zein nanowires high dose. The low dose used was 100 mg/kg while the high dose used was 200 mg/kg.Results: The results showed that MgO-zein nanowires at both doses did not affect the electrolytes levels compared to the control levels. Also, they did not produce any significant alteration in liver function markers in both rats' genders. MgO-zein nanowires at both doses did not produce any effective alteration in serum creatinine in treated rats of both genders. Moreover, very minimal histological alterations were observed in both doses of MgO-zein nanowires in liver and kidney of both genders.Conclusion: Based on the observed safety of zein-coated MgO nanowires, it can be utilized as an effective antimicrobial compound that can be combined in the preparation of a diversity of new dental formulations.KEY MESSAGESMgO NPs are globally used in multiple fields including the therapeutic field.Zein has wide pharmaceutical applications especially coating the tablet over sugar.There are no cytotoxic studies that investigate MgO-zein nanowires safety until now.

In vitro Investigation of the Antimicrobial Activity of Mouth Washes Incorporating Zein-Coated Magnesium Oxide Nanoparticles.

PURPOSE: This in vitro study was undertaken to investigate the antimicrobial effect of distinctive oral mouth washes after the addition of zein-coated (Magnesium oxide) MgO nanoparticles on exemplary of some oral microorganisms. MATERIALS AND METHODS: Three hundred and twelve samples were used in this study. A set of five concentrations of MgO nanoparticles with zein and without zein-coating were incorporated into three oral mouth washes: Listerine zero, Listerine total control and Oral B in the mass percentages of 0.3%, 0.5%, 1%, 2%, 5% and 10%, in addition to controls with no MgO nanoparticles. The antimicrobial effect of three mouth washes with variable concentrations of MgO was tested against the following organisms: Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis and Candida albicans using the disc diffusion test (DDT) and direct contact test (DCT). Data were analyzed using one-way ANOVA statistical test. RESULTS: The tested mouthwashes with zein-coated MgO nanoparticles showed significant differences of antimicrobial activity on S. mutans, S. aureus, E. faecalis, and C. albicans in the disc diffusion test. While in the DCT, all tested mouthwashes with MgO nanoparticles with and without zein coating showed antimicrobial activity on all tested microorganisms. CONCLUSION: Zein-coated MgO nanoparticles may be considered as a potential antimicrobial agent when added to oral mouthwashes. Future analysis, including in vivo studies, is required in order to incorporate zein/MgO nanoparticles into oral mouthwashes that may improve its antibacterial property.

Impact of dental implant diameter on the efficiency of fatigue: A systematic review analysis.

OBJECTIVE: To explain the success and failure of dental implant diameter on the efficiency of fatigue. METHODS: The systematic review was conducted using PubMed and Cochrane databases for Original Articles published in the English language from 1999 to 2019. Outcomes were evaluated to determine perceptions regarding the role of dental implant diameter in influencing the implant's fatigue performance. Data was analysed using SPSS 22. RESULTS: Of the 263 abstracts retrieved, 53(20%) were reviewed. Of them, 14(26.4%) were included; 9(64.3%) systematic reviews, and 5(35.7%) studies. The implant diameter could be categorised into wide diameter (5-6mm), regular diameter (3.75-4mm), and small/narrow diameter (3-3.4mm). The narrow diameter implants are indicated through thin alveolar ridges and mesiodistal spaces (<7mm). The implants with narrow diameter would offer greater risk of fatigue failure for clinical situations with significant functional loading (p<0.05). No significant differences were found either in success or failure of dental implant diameter on fatigue efficiency at 1-year and 3-year follow-ups (p>0.05). CONCLUSIONS: The technical complication of dental implant included abutment screw loosening or fracture, abutment and superstructure fracture, and implant body fracture. The review mainly focussed on the impact of dental implant diameter on the efficiency of fatigue and reviewed a significant impact of dental implant diameter on the fatigue efficiency.

Knowledge and attitude toward replacing missing teeth with dental implants among the Saudi population.

OBJECTIVES: To assess the knowledge level and attitude of the Saudi population about the use of a dental implant as a treatment option for replacing the missing teeth. MATERIALS AND METHODS: This cross-sectional study adopted a quantitative approach and used an online questionnaire to collect data. Nine hundred and five participants were recruited as per the inclusion criteria (above 18 years of age, know how to read and write, and technology literate). The collected data were analyzed statistically using IBM Statistical Package for Social Sciences (SPSS) software. RESULTS: A low level of knowledge about teeth replacement methods (56%) was recorded among the participant, while 44.4% of them had heard about implant, bridges, and dentures. The oral hygiene of the participants was considered good (59.3%). The main source of information, reported by the participants, was the dentist (53.4%). The knowledge about dental implants was found to be significantly the highest (P = 0.02) among the highly educated participant who had completed postgraduate studies. CONCLUSION: There is a need for introducing comprehensive orientation programs, conducted by dentists, to communicate knowledge about dental implants. The social campaigns and official information programs should be instigated for improving the knowledge of the patients. Structured programs should be also introduced at an academic level, for enhancing the knowledge related to replacing missing teeth and dental implants.

A Systematic Review of Screw versus Cement-Retained Fixed Implant Supported Reconstructions.

PURPOSE: Dental implant is an effective and standardized treatment procedure in the healthcare setting. This study presents a comparison of dental implant reconstruction using screw and cement. It explicitly reviews the studies concerning cement and screws dental implants to determine the efficiency of the two. PATIENTS AND METHODS: A systematic review was conducted by comprehensively searching electronic literature. The keywords, such as "Screw versus Cement Retained Fixed Implant Supported Reconstructions," "Screw Retained Fixed Implant." "Cement Implant" and "Dental Implant" were used for article searching. Twelve studies were included based on the determined inclusion and exclusion criteria. RESULTS: No significant difference was found between the screw-retained and cemented retained implant supported reconstructions. Dental implants are associated with complications leading to implant failure based on the type of restoration that is being used; cement-retained restoration and screw-retained restoration. The treatment selection must be based on the significance criteria and the tooth condition. CONCLUSION: Screw-retained implant-supported reconstructions were found to pose less biological and technological complications. Retention of the tooth is more stable and functional when implantation is selected based on the efficiency of a treatment procedure.

A Cross-Sectional Study of Empathy Among Dental Students at King Abdulaziz University.

Empathy is the fundamental substructure of moral behavior. Skillful clinicians may not necessarily be successful dentists if they do not have sufficient empathy. The aim of this study was to assess the level of empathy among dental students at King Abdulaziz University with an emphasis on the effect of gender and study level. A cross-sectional study was carried out among third- to sixth-year dental students of King Abdulaziz University in Jeddah, Saudi Arabia. A validated, self-administered Jefferson Scale of Empathy-Health Care Provider Student Version was distributed in academic year 2016-17 to all 380 students in the third to sixth years. A total of 300 students responded, for a response rate of 78.9%. The results showed that the students' mean empathy score was 84.84±11.28 on a range from 20 to 140. The fifth- and sixth-year students had higher scores than the third- and fourth-year students although the differences were not statistically significant. The mean empathy score of women students was significantly higher (p<0.001) than that of men students, and the women demonstrated significantly better perspective-taking (p<0.001) than the men. This study found that the students were empathetic and had a sense of moral obligation although their mean empathy score was not as high as expected. Integrating empathic, ethical, and professional elements into the dental curriculum is needed.

Effect of self-etch adhesives on the internal adaptation of composite restoration: a CP-OCT Study.

Despite improvements in dental adhesive materials, internal adaptation remains a challenge in bonded restorations. The aim of this study was to compare microgaps and internal floor adaptation between two different self-etch adhesives in class-V cavities using cross-polarization optical coherence tomography (CP-OCT). In this in vitro study, standardized round class-V cavities were prepared in 20 non-carious human upper central incisor teeth. They were randomly divided into two groups, TN and SE, with each group receiving a different dental adhesive. In TN group, the adhesive used was all-in-one Tetric N-Bond Self-Etch (TN; Ivoclar/Vivadent, Liechtenstein), while SE group was bonded with two-step self-etch Clearfil SE Bond 2 adhesive (SE; Kuraray Noritake Dental Inc, Japan). The prepared cavities were restored with flowable composite and then stored in distilled water for 24 h. Next, they were immersed in silver nitrate, followed by immersion in a photo-developing solution. Optical comparison was carried out by CP-OCT to assess microgaps and composite adaptation at the cavity floor. A Mann-Whitney test was applied to the data, which showed a statistically significant difference in composite adaptation among the two groups (p < 0.001) with the SE group showing superior adaptation. CP-OCT is a reliable tool for non-invasive imaging that gives an insight into composite performance. Better adaptation was found with the two-step self-adhesive for the composite used in this study.

Clinical Concerns Regarding Dentition and Connections to Osseointegrated Implants: A Systematic Review of Implant Restoration Trends and Treatment of Partial Edentulism.

Issues associated with missing teeth can be found in almost all age groups. For edentulous patients, osseointegration is a highly efficient treatment. However, certain biochemical challenges are presented when osseointegrated implants are taken into consideration due to the periodontal ligament. Therefore, the current study focuses on clinical concerns that can occur with the use of dental implants and examines different trends of implant restoration and treatment of partial edentulous patients. Data were collected from ten research articles and analyzed by means of a qualitative secondary approach. The findings of the current study indicate that restoration and preservation of natural teeth are significant in the development of dental practices. Moreover, the determinant of endodontic treatment is considered to be a key factor in the retention and reconstruction of tooth functioning that is influenced by necrosis of dental pulp. We conclude that the osseointegration method is significant and highly effective for treating edentulous patients.