Effect of Plant-Based Mouthwash (Morinda citrifolia and Ocimum sanctum) on TNF-α, IL-α, IL-ß, IL-2, and IL-6 in Gingival Crevicular Fluid and Plaque Scores of Patients Undergoing Fixed Orthodontic Treatment.

Background and Objectives: To investigate the antiplaque properties of two plant-based mouthwashes, Morinda citrifolia (MC) and Ocimum sanctum (OS), and their effect on TNF-α, IL-α, IL-ß, IL-2, and IL-6 in gingival crevicular fluid (GCF) of patients undergoing fixed orthodontic treatment. Materials and Methods: Seventy-five individuals were recruited according to defined inclusion and exclusion criteria. This study was structured into two distinct phases. Phase I was a combination of toothbrushing using toothpaste containing fluoride (Protocol A), while Phase II toothbrushing included fluoride toothpaste and use of a mouthwash (Protocol B). For Phase II, individuals participating in this study were allocated into different groups through a randomization process: Group 1-0.12% CHX, Group 2-5% MC, and Group 3-4% OS. Each individual's Phase I and Phase II scores were assessed. GCF was measured in three phases to determine the level of inflammatory biomarkers. The paired t-test evaluated the disparities between the pre- and post-plaque index. Categorical data were subjected to crosstab analysis to assess qualitative variables. The mean values of cytokine levels were presented. An unpaired t-test was employed to assess the levels of cytokines between individuals in Phase I and Phase II. Results: Toothbrushing, fluoride toothpaste, and the supplementary use of mouthwash (Phase II) resulted in mean plaque scores significantly lower than group A (p < 0.001). Cytokines TNF-α, IL-α, and IL-ß demonstrated a significant downward trend in herbal mouthwash users. Conclusions: In conjunction with fluoridated toothpaste and brushing, OS and MC can serve as a viable alternative to conventional synthetic mouthwash CHX. This combination demonstrates reducing mean plaque scores and diminishing the levels of cytokines TNF-α, IL-α, and IL-ß.

COVID-19 and cardiovascular system-a comprehensive review.

Coronavirus disease 2019 (COVID-19), a mystified cryptic virus has challenged the mankind that has brought life to a standstill. Catastrophic loss of life, perplexed healthcare system and the downfall of global economy are some of the outcomes of this pandemic. Humans are raging a war with an unknown enemy. Infections, irrespective of age and gender, and more so in comorbidities are escalating at an alarming rate. Cardiovascular diseases, are the leading cause of death globally with an estimate of 31% of deaths worldwide out of which nearly 85% are due to heart attacks and stroke. Theoretically and practically, researchers have observed that persons with pre-existing cardiovascular conditions are comparatively more vulnerable to the COVID-19 infection. Moreover, they have studied the data between less severe and more severe cases, survivors and non survivors, intensive care unit (ICU) patients and non ICU patients, to analyse the relationship and the influence of COVID-19 on cardiovascular health of an individual, further the risk of susceptibility to submit to the virus. This review aims to provide a comprehensive particular on the possible effects, either direct or indirect, of COVID-19 on the cardiovascular heath of an individual.

Evaluation of cephalometric lip morphology in a Saudi sub population: A cross sectional study.

This cross-sectional study was done to evaluate linear and angular measurement of lip morphology in Saudi adults and their comparison with the norms. After taking their history and physical examination, the patients were referred for a lateral Cephalograph using Dolphin Imaging Software. Linear and angular measurements related to lip morphology were recorded. Significant differences were found in the lower lip to E line, upper and lower lip protrusion, upper and lower lip to S line and upper and lower lip thickness, nasolabial angle, Z angle, with Saudi males having more prominent, thicker lips than the Saudi females. Comparison with the norms revealed that both lips are prominent among Saudi males, while in females there is an increased prominence of the lower lip. Value of the lower lip to H line is increased in both genders, males have prominent and thicker upper lips compared to the females and the lower lip in both genders is more prominent compared to the norms.

Efficacy of Yttrium (III) Fluoride Nanoparticles in Orthodontic Bonding.

Our study evaluated the adhesion strength and antibacterial effect of a conventional orthodontic composite resin blended with yttrium fluoride (YF3) nanoparticles. Yttrium fluoride nanoparticles (NP) were added to the conventional orthodontic composite resin (Transbond XT) at concentrations of 1%, 2%, and 3% (w/w), and the blended composite resins were labeled as NP1, NP2, and NP3, respectively. A total of 60 extracted human premolars was randomly allocated to four groups of 15 samples (n = 15). Orthodontic brackets were bonded using the conventional (control) and experimental composite resins (NP1, NP2, and NP3). The adhesion strengths of the composite resins were determined using a universal testing machine. The debonding sites were assessed and scored using the adhesive remnant index (ARI). The antibacterial effect of YF3 nanoparticles against Streptococcus mutans was assessed by the viable cell counting method. For the same, 40 composite disc specimens were prepared using the control and experimental composite resins (n = 10). The data was analyzed by one-way ANOVA and Tukey's post hoc analysis. In all the tests, the significance level was determined to be 0.05. The highest adhesion strength values were found in the control group (11.61±0.23) and the lowest values were found in the NP3 group (10.49±0.17). A significant difference was observed between the control and experimental groups, NP2 and NP3 (P < 0.05). NP1 group showed insignificant (P = 0.388) adhesion strength values compared with the control group. There was no significant difference between the ARI scores of the conventional and experimental groups (P > 0.05). The highest colony forming units (CFU) were found in the control group (75.85±1.15) and the lowest CFU were found in the NP1 group (2.24±1.14). A significant difference between the mean CFU of the conventional and experimental composite groups was observed (P < 0.05). Despite higher antibacterial activity in the NP1 group compared with NP2 (P = 0.146) and NP3 (P = 0.117), the difference was not significant. Similarly, no significant difference was observed between NP2 and NP3 groups (P = 0.97). Our results suggested that yttrium fluoride nanoparticles, blended with a conventional resin at 1% concentration, demonstrated significant antibacterial effect and did not compromise adhesion strength.

Does the antioxidant treatment affect the shear bond strength of orthodontic brackets: An in vitro study.

OBJECTIVE: To determine the shear bond strength of orthodontic brackets after anti-oxidant treatment on previously bleached teeth.. METHODS: The experimental in-vitro study was conducted in Saudi Arabiaat Qassim University, Al-Qassim, and King Saud University, Riyadh, from December 2016 to March 2017, and comprised extracted maxillary and mandibular premolars which were divided randomly into three groups. In Group A, which was the control group, the teeth were etched and bonded, while those in Group B were bleached, etched and bonded. Group C was subjected to bleaching, followed by treatment with anti-oxidant 10% sodium ascorbate solution, then etched and bonded. All three groups were then tested and analysed for bond strength using the Instron, Universal testing machine. SPSS 23 was used for data analysis.. RESULTS: There were 60 teeth with 20(33.3%) in each of the three groups. Group C had the maximum mean shear bond strength of 12.231}2.1Mpa, followed by Group A with 10.948+/-2.1Mpa and Group B with 7.621}1.8Mpa. CONCLUSIONS: Anti-oxidant treatment had a positive effect on the shear bond strength of orthodontic brackets after tooth bleaching. Keywords: Anti-oxidant. Bleaching, Brackets, Extracted premolars, Shear bond strength.

Anti-plaque Efficacy of Herbal Mouthwashes Compared to Synthetic Mouthwashes in Patients Undergoing Orthodontic Treatment: A Randomised Controlled Trial.

PURPOSE: The present study compared the antiplaque effects of two herbal mouthwashes containing Salvadora persica and Azadirachta indica, respectively, with two synthetic mouthwashes containing either chlorhexidine or cetylpyridinium. MATERIALS AND METHODS: In this triple-blind, randomised controlled trial, 100 patients undergoing orthodontic treatment underwent scaling and polishing at baseline to obtain a plaque score of zero. In the first phase, they were given oral hygiene instructions and were provided with a standard toothpaste to be used twice daily for a period of three weeks. In the second phase, following scaling and polishing, they were randomly allocated to 4 groups according to 4 different types of mouthwash (A: chlorhexidine; B = cetylpyridinium; C = extracts of Salvadora persica miswak; D: extract of Azadirachta indica miswak) along with previously taught toothbrushing protocol for three more weeks. Plaque accumulation was scored three times according to the Modified Bonded Bracket Plaque Index: at the start, after the toothbrush-toothpaste trial, and at the end of mouthwash trial. The paired t-test was used to compare the pre-plaque and post-plaque indices in all groups. Analysis of mean differences of post-plaque indices between and within groups was performed using the post-hoc Tukey test. Qualitative variables were compared by Crosstab. RESULTS: Eighty participants completed the study - 63 females and 17 males. There was a statistically significant decrease in mean plaque scores after using mouthwashes in all four groups at follow-up when compared to the baseline plaque score (p = 0.001). The greatest reduction of plaque score was found in group C (extract of Salvadora persica) when compared with group A, chlorhexidine (p = 0.016). CONCLUSION: Compared to other mouthwashes, Salvadora persica miswak-based mouthwash showed a maximum reduction in the plaque scores among orthodontic patients.

Effects of Different Stain Removal Protocols on Bonding Orthodontic Brackets to Enamel.

AIM: To evaluate the effect of different stain removal protocols with or without topical fluoride application on the bond strength of orthodontic brackets to enamel. MATERIALS AND METHODS: Eighty extracted premolars were randomly assigned into four groups according to the stain removal protocol. The stain removal protocols were (1) using rubber cup with prophylaxis paste in (G1, n = 20), (2) air-abrasion with prophy-jet polishing system (G2, n = 20), (3) micro-abrasion with opalusture polishing paste (G3, n = 20), and (4) macro-abrasion with ultrafine diamond finishing tips (G4, n = 20). Ten teeth in each group (SG1, n = 10) had no topical fluoride treatment after stain removal protocol, while the rest (SG2, n = 10) were subjected to topical fluoride application. After bonding the orthodontic brackets, all specimens were thermocycled before testing their bracket-enamel bond strength. The debonded bracket and enamel surfaces of each specimen were also assessed to determine the adhesive remnant index (ARI) for each subgroup. RESULTS: Specimens in G2, G3, and G4 recorded lower shear bond strength as compared with G1 (p < 0.05). For all groups, specimens in SG2 demonstrated lower bond strength than their counterpart in SG1 (p < 0.05). No significant differences were detected between the ARIs of different subgroups (p > 0.05). CONCLUSION: Bonding orthodontic brackets is affected by the protocol of removing enamel stains. The use of the rubber cup with prophylaxis paste provided the highest bracket-enamel bond strength. Topical fluoride application usually complicates the bonding process of orthodontic brackets to cleaned enamel surfaces. CLINICAL SIGNIFICANCE: The results of the current study indicate higher bracket bond strength to enamel surfaces treated with different stain removal protocols than the clinically acceptable values (5.9-7.8 MPa). However, the more aggressive enamel pretreatment methods should not be considered unless the clinical situation necessitates such action. Postponing the topical fluoride application is advisable to follow the bracket bonding procedure. This action would prevent the negative effect of topical fluorides on bracket-enamel bond strength.

Evaluation of skeletal variations and establishment of Cephalometric Norms in Saudi Sub Population using Bjork Jarabak's analysis.

OBJECTIVE: To evaluate the skeletal variations amongst individuals and to compare the measurements with the standardized linear and angular values of Bjork Jarabak's analysis. METHODS: This study was conducted at POS Department, King Khalid University on 100 adult Saudi patients recruited through convenience sampling. It was conducted between April to September 2017, had inclusion criteria of patients between the age group 17 to 22 years showing normal occlusion. After history and examinations, lateral cephalographs were taken, scanned and traced using Dolphin Imaging Software and Cephalometric points were recognized. Linear and angular dimensions were calculated according to Bjork-Jarabak's method. RESULTS: Analysis and assessment of Saudi male and female values revealed considerable variation in the anterior and posterior cranial base lengths (p<0.05), anterior and posterior face height, ramus height, and mandibular length. Male measurements in contrast to Jarabak's values showed noteworthy variances in articular angle, anterior and posterior cranial base, ramus height, length of mandible, anterior face height and Jarabak's ratio. Female dimensions in relation to Jarabak's norms showed considerable variances in articular angle, anterior cranial base, posterior facial height with less significant values in Saudi females while compared with Jarabak's norms apart from mandibular body length which is more in Saudi females. CONCLUSION: Skeletal variations amongst Saudi males and females were significant and comparison with standardized linear and angular values of Bjork Jarabak's analysis was also significant.

Visible light-activated curcumin-doped zinc oxide nanoparticles integrated into orthodontic adhesive on Micro-tensile bond strength, degree of conversion, and antibacterial effectiveness against Staphylococcus Aureus. An investigation using scanning electron microscopy and energy-dispersive X-ray spectroscopy.

AIM: To acquire a thorough comprehension of the photoactivated Cur-doped ZnONPs at different concentrations 0%, 2.5%, and 5% on the physical qualities, antibacterial efficacy, degree of conversion, and µshear bond strength between orthodontic brackets and the enamel surface. MATERIAL AND METHODS: An extensive investigation was carried out utilizing a range of analytical methods, scanning electron microscopy (SEM) combined with energy-dispersive X-ray spectroscopy (EDX), Fourier-transform infrared (FTIR) spectroscopy, micro tensile bond strength (µTBS) testing, and evaluation of antibacterial effectiveness. Cur-doped ZnONPs at concentrations of 2.5% and 5% were blended with Transbond XT, a light-curable orthodontic adhesive. A control group without the addition of Cur-doped ZnONPs was also prepared. The tooth samples were categorized into three groups based on the weight percentage of NPs: Group 1 (control) with 0% Cur-doped ZnONPs, Group 2 with 2.5 wt% Cur-doped ZnONPs, and Group 3 with 5 wt% Cur-doped ZnONPs. The SEM technique was employed to analyze the morphological characteristics of Cur-doped ZnONPs and ZnONPs. The composition and elemental distribution of the modified Cur-doped ZnONPs were assessed using energy-dispersive X-ray spectroscopy. The effectiveness of NPs at various concentrations against S.Mutans was gauged through the pour plate method. DC of Cur-doped ZnONPs at a region of 1608 cm-1 to 1636 cm-1 for the cured area, whereas the uncured area spanned the same range of 1608 cm-1 to 1636 cm-1 was assessed. The Adhesive Remnant Index (ARI) approach was utilized to investigate the bond failure of orthodontic brackets, while a Universal Testing Machine (UTM) was utilized to test µTBS. The Kruskal-Wallis test was employed to investigate variations in S.mutans survival rates. To determine the µTBS values, analysis of variance (ANOVA) and the post hoc Tukey multiple comparisons test were used. RESULTS: The maximum µTBS was given and documented in group 3: 5 wt% Cur-doped ZnONPs (21.21 ± 1.53 MPa). The lowest µTBS was given in group 2: 2.5 wt% Cur-doped ZnONPs (19.58 ± 1.27 MPa). The highest efficacy against S.mutans was documented in group 3 in which 5 wt% Cur-doped ZnONPs (0.39 ± 0.15). The lowest efficacy was seen in group 1 in which no Cur-doped ZnONPs were used (6.47 ± 1.23). The ARI analysis indicated that the predominant failure was between scores 0 and 1 among all experimental groups. Control group 1 which was not modified showed the highest DC (73.11 ± 4.19). CONCLUSION: Orthodontic adhesive, containing 5% Cur-doped ZnONPs photoactivated with visible light exhibited a favorable impact on µTBS and indicated enhanced antibacterial efficacy against S.mutans. Nevertheless, it was observed that the addition of Cur-doped ZnONPs at different concentrations (2.5%,5%) resulted in a decrease in the monomer-to-polymer ratio compromising DC.

Role of six cytokines and bone metabolism biomarkers in gingival crevicular fluid in patients undergoing fixed orthodontic appliance treatment in comparison with aligners: a clinical study.

OBJECTIVES: The objective of this study was to assess bone biomarkers and cytokines in patients with conventional labial appliances (CLAs) and aligners. MATERIALS AND METHODS: Participants were recruited to undergo orthodontic treatment with CLAs and aligners according to predefined inclusion and exclusion criteria. Periodontal examination was accomplished at baseline and 4 weeks using the plaque index (PI), gingival index (GI), and bleeding on probing (BoP). Samples of gingival crevicular fluid (GCF) were collected at baseline (T0) before the start of treatment and at the 1-month follow-up (T1) to assess bone metabolic and inflammatory biomarkers. GCF from participants with CLAs and aligners was evaluated with enzyme-linked immunosorbent assay. Comparison between labial conventional orthodontic treatment and aligners were assessed using an unpaired t-test. The difference between T0 and T1 was measured using a paired t-test. RESULTS: BoP, PI, and GI demonstrated no significant difference between participants treated with aligners and subjects with CLAs at baseline and at 4 weeks (P > .05). Bone markers and other biomarkers (tumor necrosis factor α, interleukin [IL]-α, IL-2, IL-6, and IL-8) showed significant differences (P < .05). Also, a significant difference between CLAs and aligners was noted among all biomarkers (P < .05) except IL-ß. CONCLUSIONS: Aligners and CLAs increase the level of inflammatory and bone metabolic biomarkers after 1 month.

Impact of Clinical Pharmacist Running Anticoagulation Clinic in Saudi Arabia.

Despite the effectiveness of warfarin in extended anticoagulation, its narrow therapeutic index requires frequent dose adjustments and careful patient monitoring. Thus, we aimed to evaluate the outcomes of clinical pharmacists' intervention in warfarin therapy management in terms of International Normalized Ratio (INR) control, reduction of bleeding, and hospitalization in a tertiary care hospital. An observational retrospective cohort study was conducted on 96 patients taking warfarin therapy in a clinical pharmacist-led anticoagulation clinic. We observed that 39.6% of patients required dose adjustments at their first and second visits. However, dose adjustments during the third, fourth, and fifth weeks were required at 31.1%, 20.8%, and 4.2%, respectively, to achieve INR levels. We also observed that 36.46% of the patients attained the target INR at baseline, which was increased over the first week to the fifth week to 57.29%, 61.46%, 61.46%, 68.75%, and 85.42%, respectively. No one reported the ADR between the third and fifth weeks. Based on our findings, the study strongly suggests that pharmacists' interventions can improve the health-related quality of life of patients undergoing warfarin therapy. Thus, competent pharmacy personnel must be a priority in both usual patient care and critical care among primary care networks.

Ultrastructural and physicochemical characterization of pH receptive chlorhexidine-loaded poly-L-glycolic acid-modified orthodontic adhesive.

This study aims to evaluate the feasibility of chlorhexidine (CHX)-loaded poly-L-glycolic acid (PLGA) nanoparticles as a modifier of a commercial orthodontic adhesive via the assessment of physicochemical, biological, and mechanical properties at tooth-bracket interface. CHX-loaded PLGA nanoparticles were synthesized using double emulsion-solvent evaporation method and characterized using transmission electron microscopy and Raman analysis. CHX-loaded PLGA nanoparticles in Transbond XT orthodontic adhesive were prepared using two different concentrations of the CHX (25 and 50%) and characterized for degree of conversion (DC), antimicrobial, and cytotoxicity testing. Bonded specimens were tested for shear bond strength (SBS) and adhesive remnant index (ARI) at tooth-bracket interface. The synthesized PLGA nanoparticles averaged between 60 and 80 nm in size. After loading CHX inside PLGA nanoparticles, the morphology of the PLGA nanoparticles was considerably changed. Orthodontic bracket bonded with 25% CHX-loaded PLGA-modified adhesive demonstrated DC scores similar to control group. Both 25 and 50% CHX-loaded PLGA-modified adhesive specimens showed higher antibacterial activity against S. mutans compared to control group. The least mean SBS values were exhibited by 50% CHX-loaded PLGA-modified adhesive samples, while a statistically significant difference was observed in the mean ARI values among all study groups at all-time points (p = .018). This study indicates that the addition of CHX-loaded PLGA nanoparticles in Transbond XT achieved stable bonds with enhanced antimicrobial and mechanical properties.

Psychometric Properties and Validation of the Arabic Maslach Burnout Inventory-Student Survey in Saudi Dental Students.

Background: Few studies have studied burnout among dental students worldwide, and no such study is available from Saudi Arabia. In addition, an Arabic version of the Maslach Burnout Inventory-Student Survey (MBI-SS) has not yet been validated for use among students. Objectives: This study aimed to translate and validate an Arabic version of the MBI-SS questionnaire and to examine the psychometric properties of burnout among dental college students at a university in Saudi Arabia. Materials and Methods: This cross-sectional questionnaire study included all dental students at King Khalid University, Saudi Arabia, and was conducted between December 2019 and January 2020. After the MBI-SS questionnaire was translated, its face validity was determined and the test-retest reliability was assessed. Confirmatory factor analysis and reliability analysis were performed following the full-scale study to validate the Arabic MBI-SS. Results: A total of 433 dental students responded in the full-scale study (mean age: 21.9 ± 1.6 years). Emotional exhaustion was present in 32.3% (95% confidence interval: 28%-36.9%), cynicism in 33.7% (29.3%-38.4%), and poor academic efficacy in 34.2% (29.8%-38.9%) of the dental students. Emotional exhaustion and cynicism were significantly associated with academic level, a history of medication due to academic stress, and thoughts of quitting the course (for all, P < 0.05). The reliability of MBI-SS was found to be adequate for all three subscales: Emotional exhaustion, Cronbach's α = 0.827; cynicism, α = 0.855; academic efficacy, α = 0.704. Conclusions: All three subscales of burnout were highly prevalent in the study cohort. The Arabic version of the MBI-SS inventory was shown to be a valid and reliable tool for assessing the psychometric properties of burnout among dental students, and its use may aid in identifying burnout in the early stages.

Effect of ultrasonic scaling with adjunctive photodynamic therapy on the treatment of gingival inflammation among diabetic patients undergoing fixed orthodontic treatment.

BACKGROUND: The aim of the present clinical trial was to evaluate the effect of methylene blue-mediated antimicrobial photodynamic therapy (aPDT) on the gingival and immunological parameters in diabetic adolescent patients undergoing fixed orthodontic treatment. METHODS: The selected 40 participants were randomized equally into two groups; Group I (ultrasonic scaling + oral hygiene instructions) and Group II (ultrasonic scaling/oral hygiene instructions + aPDT). Serum HbA1c levels was assessed for all the participants at chairside. Plaque index (Pi), and bleeding on probing (BOP) were analyzed. Moreover, the assessment of crevicular fluid matrix metalloproteinase 8 (MMP-8) and macrophage inflammatory protein 1 alpha (MIP-1α) was performed using enzyme-linked immunosorbent assay technique. All measurements were recorded at baseline, 6 weeks, and 12 weeks follow-up periods, respectively. Intergroup comparisons for p-value were computed using Mann-Whitney test and Wilcoxon singed ranks test to compute p-value for intra-group comparisons. Stepwise logistic regression analysis was used to identify explanatory variables for reduction in plaque scores and bleeding on probing, after controlling for the effects of other covariates. Odds ratios and 95% confidence intervals were used to assess the direction and strength for associations. Significance level was set at 5% for all analyses. RESULTS: All 40 individuals completed the clinical trial. There was a statistically significant reduction in Pi and BOP in both Group I and Group II from baseline to 12 weeks of follow up (P<0.05). However, there was slight reduction in the plaque scores in Group-II as compared to Group-I at 12 weeks visit (P<0.05). There was also a statistically significant difference for BOP when Group-I was compared with Group-II on 12 weeks follow up assessment (P<0.05). HbA1c assessment indicated no statistically significant difference either within or between groups at any time point (P>0.05). Both MMP-8 and MIP-1α reported a significant decrease for both Groups I and II at 6 weeks and 12 weeks follow-up periods in comparison to baseline (P<0.05). Inter-group comparison indicated a statistically significant difference noted at both 6 weeks follow up that was maintained at 12 weeks follow up (P<0.05). The logistic regression analysis revealed that even after controlling the mean BMI as a predictor, the change of biomarker levels along with the improvement in plaque scores and bleeding on probing was not significant (p> 0.05). CONCLUSION: aPDT significantly improved bleeding on probing and proinflammatory biomarkers among diabetic adolescent patients undergoing fixed orthodontic therapy.

Detection of Dental Caries' and Dermatoglyphics' Association with Relative Enamel Thickness Using CBCT Images in Saudi Subpopulation: A Novel Approach.

BACKGROUND: Dental caries is the localized destruction of dental hard tissues (enamel and dentine). Decayed, Missing, and Filled Teeth (DMFT) index is the most commonly used dental caries index. Thickness of the outermost part of the tooth called the enamel is determined by the rate of deposition of enamel proteins. Relative enamel thickness (RET) gives a measure of enamel thickness with respect to dentine. Dental caries is influenced by a genetically determined factor called dermatoglyphics (DG). As the genes responsible for RET and DG lie on the same chromosome and develop during the same time of intrauterine life, it is biologically plausible to correlate RET and DG. AIMS: This study consists of two primary aims: (1) to assess RET using cone beam computed tomography images and correlate it with caries and (2) to correlate RET with DG. MATERIALS AND METHODS: 148 dental subjects were assessed for DMFT caries score and were categorized as Group 1 with DMFT = 0 and Group 2 with DMFT ≥ 1. Following this, their DG pattern was recorded digitally. The CBCT images of these subjects were assessed for RET, and the data were analyzed statistically. RESULTS: Mean RET in our sample population is 18.45 (SD 3.79) while mean DMFT is 5.34 (SD 5.13). Mean RET in Group 1 subjects was 19.82 (SD 4.05) while that in the Group 2 was 17.68 (SD 3.43). RET and DMFT showed a statistically significant negative correlation (p = 0.007). The "Single Loop" DG characteristic showed a statistically significant difference between males and females (p = 0.031). The "Simple Arch" type of DG was positively correlated with RET. CONCLUSION: This is the first in vivo study to assess RET using CBCT images and correlate with DMFT and DG. RET is inversely related to DMFT while directly proportional to the "Simple arch" DG pattern. Males and females differed in their "Single Loop" DG characteristic.

Bond assessment of enamel conditioned with Er, Cr: YSGG laser and methylene blue photosensitizer activated by photodynamic therapy to orthodontic metallic brackets.

AIM: To assess bond integrity and failure mode after enamel pretreated with conventional and contemporary conditioning methods were bonded to metallic brackets (MB). MATERIAL AND METHODS: Forty maxillary central incisors were selected and disinfected. All specimens were mounted up to the cement-o-enamel junction and divided into four experimental groups randomly based on the enamel conditioning technique. Photodynamic therapy (PDT) was used to condition enamel in group 1, Total-etch and rinse (TER) was used to treat samples in group 2, Specimens in group 3 were conditioned with ECL, and samples in group 4 surface pretreated with SEP. Bonding of MB was performed on the surfaces of all the specimens with a Transbond XT. Specimens from all investigated groups were positioned on a universal testing machine maintaining buccal surfaces similar to the direction of the force. After bracket debonding bond failure was assessed using ARI. The bond integrity of all four groups was compared using analysis of variance (ANOVA). Post hoc Tukey test was used for pairwise comparison among different groups. RESULTS: Group 2, TER+MB (15.38±0.14 MPa) displayed the highest bond value whereas the lowest values of SBS were exhibited by group 1, PDT+MB (10.11±0.17 MPa). The inter-group comparison revealed that specimens of group 2 and group 3, ECL+MB (14.61±0.55 MPa) demonstrated comparable bond strength (p>0.05). CONCLUSION: Enamel conditioned with TER and ECL demonstrated comparable SBS. However, bond integrity after PDT and SEP (self-etch primer) surface treatment of enamel bonded with MB significantly lowered bond values.

Impact of riboflavin mediated photodynamic disinfection around fixed orthodontic system infected with oral bacteria.

PURPOSE: The aim of this laboratory study was to investigate the amount of bacterial destruction through riboflavin mediated photodynamic therapy (PDT) around fixed orthodontic devices by using the two strains of bacteria Streptococcus mutans and Streptococcus sanguinis. MATERIALS AND METHODS: A total of 80 metallic brackets were divided into four groups consisting of 20 brackets each. Group-I: riboflavin + LED irradiation; Group-II: riboflavin alone; Group-III: immersion in 0.2 % chlorhexidine gluconate solution and Group-IV: not submitted to any treatment. All metallic brackets were immersed in the standard bacterial solutions and incubated at 48 h. All samples were subjected to MTT assay for microbial cell viability testing after treatment. After 24 h of incubation, biofilms adhered on the mesh of metallic brackets after treatment were assessed by confocal laser microscopy. The total CFU/mL was estimated, and the results were log-transformed (log10) and analyzed using one-way analysis of variance and Tukey-Kramer test. P-value was set to <0.05 that indicated statistical significance. RESULTS: The samples from group-IV showed the highest amount of relative biofilm viability compared to any other group while group-I (PDT) showed the least viability of the two bacterial strains studied (p < 0.05). Group-I showed no significant difference when compared with group-III (chlorhexidine) (p > 0.05). The biofilms on the samples from group-II and group-IV were largely viable indicating thick green staining across the mesh of the brackets. Among the group-III samples, there were predominantly dead cells as compared to the live cell staining. A considerable amount of red staining was observed with noticeable less green staining in group-I samples. CONCLUSION: This laboratory investigation revealed that riboflavin mediated PDT significantly reduced the amounts of S. mutans and S. sanguinis around the orthodontic brackets.

Three-dimensional geometric morphometric analysis of tooth shape in hypodontia: II size variation.

The study aimed to evaluate differences in tooth size between patients with hypodontia and those with normal complement of permanent teeth using three-dimensional geometric morphometric analysis. The number of anatomical landmarks was recorded on the clinical crown of the permanent teeth on three-dimensional scanned study models of hypodontia and in control subjects. The study sample comprised 120 patients with hypodontia (mild, moderate, severe) and 40 controls matched for age and sex. Tooth size differences were tested statistically using multivariate statistics. Size variation was for the most part found to be significant, especially when the control subjects were compared with the hypodontia groups. The explained variance among group membership was generally larger in the anterior and premolar region than in the molar region Sexual dimorphism was found less in the anterior region than in the posterior region; therefore, the sexes were pooled more often for teeth in the anterior region. Quantitative measurement of tooth size in patients with hypodontia may enhance the multidisciplinary management of these patients.

Efficacy of antimicrobial photodynamic therapy against halitosis in adolescent patients undergoing orthodontic treatment.

PURPOSE: The aim of the present randomized controlled clinical trial was to evaluate the efficacy of photodynamic therapy (PDT) on halitosis in adolescent patients undergoing fixed orthodontic treatment. MATERIALS AND METHODS: Forty-five adolescents with halitosis undergoing orthodontic treatment were equally randomized into three groups: Group - I: provision of treatment through PDT on dorsum of tongue; Group - II: provision of treatment with the help of tongue scrappers (TS); Group - III: provision of treatment with the help of TS and adjunctive PDT. Presence of halitosis confirmed on the basis of gas chromatography and estimation of oral malodour with a cysteine challenge and H2S values recorded ≥112 parts per billion (ppb). A portable device Oral Chroma™ was used for performing breath analysis. A total of 5 bacterial species including P. gingivalis, F. nucleatum, P. intermedia, T. forsythia and T. denticola were studied as the proportion of sites defined as having ≥1.0 × 105 bacterial cells. RESULTS: The mean age of the participants in Group-I, II and III were 15.4 years, 13.8 years, and 14.2 years, respectively. The median values for Group-I, II and III at initial breath analysis were 874 ppb, 613 ppb and 1089 ppb, respectively. After treatment with the respective therapeutic modalities, a statistically significant difference was seen among groups after 2-weeks (p < 0.0001) (Table 3). After applying Kruskal-Wallis test, group-III showed the highest amount of reduction in H2S concentration (100 %) at final 2-weeks breath analysis compared to group-I and group-II (p = 0.0001). Descriptive statistics for all bacteria showed that group-III (TS + PDT) statistically significantly reduced the proportional distribution of all bacteria at 2-week follow-up (p < 0.0001) compared to group-I or group-II. CONCLUSION: PDT along with tongue scrapping showed effective immediate reduction of H2S concentration and reduction of oral pathogens in adolescent patients undergoing fixed orthodontic treatment with short-term follow up. Long-term evaluation and complete eradication of halitosis needs to be explored in further clinical trials. In addition, the cost of PDT and its potential side effects should not be disregarded.

Clinical periodontal, bacterial, and immunological outcomes of antimicrobial photodynamic therapy in orthodontic treatment-induced gingival enlargement.

AIM: The aim of the present clinical trial is to evaluate the clinical, bacterial, and immunological outcomes of photodynamic therapy (PDT) in adolescent patients with orthodontic treatment-induced gingival enlargement (OTGE). MATERIALS AND METHODS: A total of 26 adolescent patients, 16 girls and 10 boys, of mean age 16.8 years, undergoing fixed orthodontic treatment for at least 6 months (mean duration in months, 8.3 ± 1.9) and presenting with GE were included in the clinical trial. All patients undergoing fixed orthodontic treatment with clinical diagnosis of OTGE were divided into two groups: Patients receiving full-mouth periodontal debridement (FMPD) 'Group-FMPD' and 'Group-PDT' included participants receiving methylene blue-assisted PDT in the selected area along with FMPD. Clinical periodontal assessments included the evaluation of plaque scores (PS), bleeding on probing (BOP), probing depth (PD) and hyperplastic index (HI). The total bacterial counts of Porphyromonas gingivalis (P. gingivalis), Treponema denticola (T. denticola), and Tannerella forsythia (T. forsythia) were estimated and expressed as log CFU/mL of each bacteria. Cytokines including interleukin (IL)-1ß and IL-6 were analyzed using enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: The mean percentage of PS and BOP statistically significantly reduced with both FMPD and PDT from baseline to 4 weeks (p < 0.05). Although mean PD significantly reduced in both the groups at all time points, there was significantly higher reduction with PDT as compared to FMPD at 2 weeks post treatment (p < 0.05). Inter-group comparison showed PDT demonstrated significantly higher HI at 2- and 4-weeks post treatment (p < 0.05). The mean log CFU/mL of P. gingivalis and T. forsythia showed statistically significantly higher reduction with PDT than FMPD (p < 0.05) at both 2-and 4-weeks follow-up. T. denticola reported significantly reduced levels at 2 weeks follow-up period only with PDT (p < 0.05). No statistically significant difference appeared when both treatment modalities were compared with one another (p > 0.05). Four weeks after periodontal treatment, IL-6 significantly reduced with PDT compared to FMPD (p < 0.05). CONCLUSION: PDT assisted in reducing bacterial counts and improving hyperplastic index in OTGE.