Relationship of the Degree of Nerve Exposure and Surgical Manipulation and Short-Term Neurosensory Disturbance Following Sagittal Split Ramus Osteotomy: A Prospective Study.

BACKGROUND: Neurosensory disturbance (NSD) is a common complication after sagittal split ramus osteotomy (SSRO) due to inferior alveolar nerve (IAN) injury. The impact of intraoperative nerve manipulation on NSD remains debated. PURPOSE: The purpose of this study was to evaluate the influence of IAN exposure and manipulation during SSRO on functional sensory recovery (FSR). STUDY DESIGN: This was a single-center, prospective cohort study of 40 patients undergoing SSRO at Mahidol University from December 2020 to December 2021. The inclusion criteria were patients aged 20-34, ASA Class I-II. The exclusion criteria were patients with systemic bone disease, history of head and neck or neurological pathology, previous SSRO, or incomplete data collection. PREDICTOR VARIABLE: Degree of intraoperative nerve manipulation was divided by the attending surgeon as follows; 1) Nerve fully encased in distal segment and not visible (NS); 2) Nerve encased in distal segment but partially visible (DS); and 3) Nerve partially encased in proximal segment and fully dissected free (PS). OUTCOME VARIABLES: The area of interest was divided into the lip and chin. The primary outcome was time to FSR. The secondary outcome was subjective patient report, using a visual analogue scale, compared to FSR. COVARIATES: The covariates were sex, age, skeletal diagnosis, degree of movement, and concomitant genioplasty/subapical procedure. ANALYSES: Kaplan-Meier survival analysis, Cox proportional hazards regression, and Mcnemar test were utilized. P-value < .05 was significant. RESULTS: In the lip, the median times to FSR were NS, 2 days; DS, 45 days; PS, 102 days. (Interquartile range: 77,127, 114, respectively) In the chin, the median times to FSR were NS, 23 days; DS, 92 days; PS, 87 days. (Interquartile range: 77, 161, 101, respectively.) Nerve manipulation significantly affected FSR in the lip and chin (P = .001, <0.001, respectively. Cox hazard ratios for DS and PS were lower compared to NS. Patients consistently reported more NSD compared to FSR as per Mcnemar test. CONCLUSION AND RELEVANCE: After SSRO, FSR in the lip is prolonged when the IAN is partially encased in the proximal segment and released. This raises the question of the efficacy of surgically releasing a partially encased IAN.

Agreement test of P value versus Bayes factor for sample means comparison: analysis of articles from the Angle Orthodontist journal.

BACKGROUND: Researchers are cautioned against misinterpreting the conventional P value, especially while implementing the popular t test. Therefore, this study evaluated the agreement between the P value and Bayes factor (BF01) results obtained from a comparison of sample means in published orthodontic articles. METHODS: Data pooling was undertaken using the modified PRISMA flow diagram. Per the inclusion criteria applied to The Angle Orthodontist journal for a two-year period (November 2016 to September 2018), all articles that utilised the t test for statistical analysis were selected. The agreement was evaluated between the P value and Bayes factor set at 0.05 and 1, respectively. The percentage of agreement and Kappa coefficient were calculated. Plotting of effect size against P value and BF01 was analysed. RESULTS: From 265 articles, 82 utilised the t test. Of these, only 37 articles met the inclusion criteria. The study identified 793 justifiable t tests (438 independent-sample and 355 dependent-sample t tests) for which the agreement percentage and Kappa coefficient were found to be 93.57% and 0.87, respectively. However, when anecdotal evidence (1/3 < BF01 < 3) was considered, almost half of the studies missed statistical significance. Furthermore, two-thirds of the significantly reported P values (0.01 < P < 0.05; 30 independent-sample and 20 dependent-sample t tests) showed only anecdotal evidence (1/3 < BF01 < 1). Moreover, BF01 indicated moderate evidence (BF01 > 3) for approximately one-third of the total studies, with nonsignificant P values (P > 0.05). Furthermore, accompanying the P values, the effect sizes, especially for studies with independent-sample t tests, were very high with a strong potential to show substantive significance. Although it is best to extend the statistical calculation of a doubted P value (just below 0.05), especially for orthodontic innovation, orthodontists may reach a balanced decision relying on cephalometric measurements. CONCLUSIONS: The Kappa coefficient indicated perfect agreement between the two methods. BF01 restricted this judgement to approximately half of them, with two-thirds of these studies showing nonsignificant P values. Simple extensions of statistical calculations, especially effect size and BF01, can be useful and should be considered when finalising statistical analyses, especially for orthodontic studies without cephalometric analysis.

Influence of past advanced behavior guidance experience on parental acceptance for autistic individuals in the dental setting.

BACKGROUND: Autism is a lifelong neurodevelopmental disorder that poses challenges during dental treatment. Advanced behavior guidance techniques (BGTs) have been used to provide dental care for autistic people who have specific characteristics and complex dental treatment. This study was conducted to evaluate parental acceptance and analyze parents' opinions of advanced BGTs during dental treatment in autistic people. METHODS: This cross-sectional study was conducted on 141 parents of autistic people from the Mahidol Dental Hospital and the Autism online community. Informed consent was obtained before enrolling participants in the study. All parents were asked to rate their acceptance after watching VDO clips: passive restraint by device (PRBD), oral sedation (OS), and general anesthesia (GA) to evaluate parental acceptance of advanced BGTs through an online questionnaire survey. The online questionnaire included a visual analog scale (VAS) and open-ended questions to collect their opinions on each advanced BGT. Participants were categorized into two subgroups as follows: 81 in the "Experience group" and 60 in the "No experience group" according to their autistic people' advanced BGT experience. Friedman's two-way analysis of variance and the Mann-Whitney U test were used for statistical analyses. Open-ended questions were analyzed using quantitative content analysis. RESULTS: PRBD was ranked the highest, followed by GA and OS. Parents in the "Experience group" rated significantly higher acceptance of their BGT experience than parents in the "No experience group" in all the three advanced BGTs. CONCLUSIONS: All advanced BGTs were particularly accepted in this study. Previous experience of advanced BGTs had an influence on parental acceptance. Parents commented on their opinions toward each advanced BGT with a variety of perspectives. TRIAL REGISTRATION: The protocol was approved by the ethical committee of the Faculty of Dentistry/Faculty of Pharmacy, Mahidol University (COA.No.MU-DT/PY-IRB 2021/022.1702) and was registered with Thai Clinical Trials Registry (TCTR20220521001).

Determining of canine position by multiple facial landmarks to achieve natural esthetics in complete denture treatment.

STATEMENT OF PROBLEM: Anterior tooth selection is an important step in complete denture treatment as it plays a pivotal role not only in esthetics but also in mastication and pronunciation. However, conventional methods for tooth selection are not well established and rely on facial measurements and proportions, which vary among different ethnicities. PURPOSE: The purpose of this clinical study was to investigate the relationship between interalar width and intercanine distance and to compare different clinical methods for determining the position of the canine tooth. MATERIAL AND METHODS: Two hundred Thai participants (100 men and 100 women) aged 18 to 25 years with 6 full maxillary anterior teeth were enrolled in this study. The interalar width and intercanine distance were measured with digital vernier calipers and compared by using the paired-samples t test. To determine the canine position, 2 reference lines-the alar line (A line) and the inner canthus of the eye to alar line (IA line)-were drawn through the canine on both sides. The horizontal distances from each reference line to the canine cusp tip and distal contact point were evaluated and then analyzed using the 1-sample t test. RESULTS: All measurements were significantly different between men and women (P<.01). Interalar width was greater than intercanine distance in both sexes. In men, the A line coincided with the canine distal contact point (P>.05). In contrast, the IA line was distal to the canine distal contact point by 3.5 ±3.6 mm on the left side and by 3.9 ±3.4 mm on the right side. In women, the A line was situated between the canine cusp tip and distal contact point. It was mesial to the distal contact point by 2.0 ±2.0 mm on the left side and by 1.8 ±2.0 mm on the right side. The IA line was distal to the canine distal contact point by 1.2 ±2.6 mm on the left side and by 1.6 ±2.7 mm on the right side. CONCLUSIONS: The interalar width is greater than the intercanine distance in both sexes. The A line is more clinically relevant than the IA line for predicting canine position. The A line can directly determine the distal contact point of the canine in edentulous male patients. However, in women, a distance of approximately 2 mm should be added distal to the A line to locate the distal contact point of the canine on both sides.

Histopathological and risk factor analyses of oral potentially malignant disorders and oral cancer in a proactive screening in northeastern Thailand.

BACKGROUND: Lip and oral cavity cancer has been reported as the 10th most common cancer in Thailand. Recently, a screening program for oral potentially malignant disorders (OPMDs) and oral cancer was conducted in the northeastern Thailand which took into consideration a total of 371,911 people who resided in the provinces of Buriram, Chaiyaphum, Nakhon Ratchasima, and Surin. METHODS: A total of 330,914 subjects were consecutively screened for risk factors of oral cancer by village health volunteers (VHVs) using a questionnaire (S1). Then, 186,710 subjects with one or more risk factors for oral cancer were referred for oral screening by dental auxiliaries or dentists at sub-district level hospitals (S2) where 86,941 subjects were subsequently screened. Afterwards, 1576 subjects with suspicious oral lesions for OPMDs or oral cancer attended local hospitals for further investigation and treatment. Oral medicine specialists, oral surgeons, and local dentists at the district level hospitals performed biopsies and the samples were sent for histopathological analysis. The objectives of the study were to report the histopathology findings from the biopsies obtained from these subjects and the associated risk factors. RESULTS: Out of 427 subjects who received biopsies, complete diagnostic results were obtained from 409 patients (462 specimens). The 5 most common histopathological results from these specimens were mild epithelial dysplasia (27.3%), fibroepithelial hyperplasia (14.5%), oral lichen planus/oral lichenoid reactions (11.5%), moderate epithelial dysplasia (8%), and acanthosis with or without hyperkeratosis (5%). Oral squamous cell carcinoma was detected in 14 subjects and 11 other forms of oral cancer were revealed. Among the analyzed risk factors, habitual betel quid chewing was established as a statistically significant risk factor associated with OPMDs and oral cancer. CONCLUSION: The most frequently observed histopathological results of clinically suspected oral cancer and OPMDs included mild epithelial dysplasia, fibroepithelial hyperplasia, oral lichen planus/oral lichenoid reactions, moderate epithelial dysplasia, and acanthosis with or without hyperkeratosis. Betel quid chewing habit was found to be associated with OPMDs and oral cancer.

The efficacy of dental sealant used with bonding agent on occlusal caries (ICDAS 2-4): A 24-month randomized clinical trial.

BACKGROUND: Bonding before sealant application enhances retention on saliva-contaminated sound teeth; however, there are few studies of bonding's efficacy on sealant retention on occlusal caries. AIM: To evaluate a bonding agent's efficacy on sealant retention on occlusal caries and caries transition. DESIGN: One hundred twenty pairs of first permanent molars with occlusal caries (ICDAS 2-4) from 98 children aged 7.3-9.9 years were included. One molar was randomly selected to use bonding (Adper™ Single Bond 2, 3M ESPE) applied before sealant application (Helioseal® clear, Ivoclar Vivadent). Bonding was not used on the contralateral tooth. Retention was determined using Simonsen's criteria; caries transition was evaluated using ICDAS scores, DIAGNOdent values, and bitewings at baseline, 6, 12, and 24 months. Data were analyzed with McNemar's and Fisher's exact tests. RESULTS: Bonding agent use significantly increased sealant retention rates (P < .001). Bonded (B) sealants had a higher retention rate (83.3%) than non-bonded (NB) sealants (53.7%). The difference in the caries-transition rate was not significant between the groups (P > .05). Three teeth (1.4%; NB:B = 2:1) were restored due to radiographic dentin-caries progression. CONCLUSIONS: Using a bonding agent before applying sealant on permanent molar occlusal caries (ICDAS 2-4) significantly enhanced sealant retention. Caries progression was rarely detected at the 24-month follow-up.

Association of sensory sensitivities and toothbrushing cooperation in autism spectrum disorder.

BACKGROUND: Sensory over-responsivity (SOR) is common in autistic spectrum disorder (ASD), and it leads to a more intense response to sensory stimuli. AIM: To compare toothbrushing cooperation at home and in a dental office between SOR and sensory not over-responsivity (SNOR) children with ASD. DESIGN: This cross-sectional observational study was conducted with 51 children with ASD aged 4-17 years. Caregivers assessed each subject's sensory response by completing a back-translation questionnaire listing eight sensitivities. Subjects who had three or more of the sensitivities were considered SOR subjects. Toothbrushing cooperation in the dental office was recorded on videos. Statistical analysis used the Spearman correlation coefficient, chi-square test, Fisher's exact test, and Mann-Whitney U test. RESULTS: SNOR subjects (n = 10) had significantly higher scores in toothbrushing cooperation at home and in the dental office than did SOR subjects (n = 41) (P < .05). Oral sensitivity was significantly associated with toothbrushing cooperation at home, whereas oral, light, sound, and touch (face) sensitivities were significantly correlated with toothbrushing cooperation in the dental office (P < .05). CONCLUSIONS: SOR subjects showed less toothbrushing cooperation than SNOR subjects both at home and in the dental office.

Efficacy of antiseptics for rubber dam sterilization prior to endodontic treatment.

PURPOSE: This study investigated the efficacy of various antiseptics for disinfection of rubber dams used during endodontic treatment, the duration of disinfection effectiveness, and the disinfection protocol employed by dental schools in Thailand. METHODS: The efficacy of 10% povidone-iodine, 1.5% tincture iodine and 70% ethyl alcohol in eliminating Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans) on the rubber dam was investigated. Time duration of disinfection was evaluated at 0, 30, 60, and 120 min. The two-step disinfection method adopted at Thai dental school was examined. Independent t-test or Kruskal-Wallis followed by a Dunnett's test was used for statistical analysis. RESULTS: Among the three antiseptics, 10% povidone and 1.5% tincture iodine eradicated the microorganisms completely, whereas 70% ethyl alcohol did not achieve a statistically significant decrease. The duration of sterilization effectiveness was 120 min for 10% povidone-iodine, but bacteria were eliminated only at 0 min by 1.5% tincture iodine. The results also indicated that the two-step protocol scarcely eliminated the microorganisms. CONCLUSION: The best antiseptic for rubber dam disinfection is 10% povidone-iodine, which remains effective for 120 min. The two-step protocol typically practiced in Thai dental schools needs to be updated. The use of 10% povidone-iodine alone is adequate for complete eradication of E. faecalis and C. albicans.

Establishing Clinically Acceptable PES/WES Threshold for Single- Tooth Implant Restoration.

PURPOSE: Determining the esthetic success of single-tooth implant restorations (STIR) requires an objective tool such as one devised by Belser et al., 2009 - pink esthetic scores and white esthetic scores (PES/WES). This study aimed to utilized PES/WES to establish threshold scores based on (1) detectability and (2) acceptability of a STIR by lay person perception, (3) to study the difference in the ability of laypeople and dentists in detecting the presence of STIR, and (4) to study the pink and white deficiencies in relation to the detectability of the presence of STIR. MATERIALS AND METHODS: A total of 38 calibrated photographs of STIR in the anterior region were scored with PES/WES by 3 prosthodontists. Next, 100 laypeople and 60 dentists were instructed to identify the STIR among the anterior teeth and provide reasoning behind the identification (based on pink and white esthetic criteria). The acceptance of the STIR was recorded. Receiver Operating Characteristics (ROC) analysis was utilized to determine the threshold scores. RESULTS: At the PES/WES score of 17, 71% of laypeople could not correctly identify the STIR, and at the PES/WES score of 12, 80% of laypeople accepted the implant. Out of 3,800 occasions, laypeople correctly identified the STIR 1,770 (46.58%) of those occasions. Among the correctly identified STIR, 751 (42.43%) of those occasions were identified with pink deficiencies and 1019 (57.57%) of those occasions were with white deficiencies. Out of 2,280 occasions, dentists correctly identified STIR 1869 (81.98%) of those occasions. CONCLUSIONS: The PES/WES score of 12 indicates the clinically acceptable threshold, while the score of 17 indicates the detectable threshold for an exceptional esthetic outcome. Laypeople tend to accept the implant despite its detectability. For both laypeople and dentists, root convexity/soft tissue color and texture are the most focused criteria of PES/WES, followed by overall white deficiencies that remain influential. Compared to laypeople, dentists tend to have a higher ability to detect STIR.

Qualitative Histological Evaluation of Various Decalcifying Agents on Human Dental Tissue.

OBJECTIVE: Dental hard tissue is among the hardest tissue of humans because it contains high amounts of inorganic substances. This leads to difficulty in preparing histological sections for histopathological examination. Acid and chelating agents are generally used to decalcify teeth. We aimed to compare the histological quality of teeth decalcified with various calcifying agents including 5% nitric acid, 50% formic acid with 20% sodium citrate (Anna Morse solution), 10% formic acid, commercial solution, and 14.4% neutral EDTA. MATERIALS AND METHODS: Freshly extracted premolar teeth were fixed and submitted for decalcification using different agents. Histological examination was qualitatively evaluated for tissue integrity and staining quality. RESULTS: Dentin integrity of teeth decalcified with all decalcifying agents did not show any statistical differences except that with the formic acid, whereas cementum integrity decalcified with neutral EDTA showed a superior score compared with other agents. Tissue integrity and staining quality of dental pulp cells were the best decalcified with neutral EDTA or Anna Morse solution. CONCLUSION: Our findings demonstrated that EDTA and Anna Morse solution gave a similar efficiency in the preservation of tissue integrity while Anna Morse solution may be recommended as a decalcification agent in routine use due to the more satisfying decalcification time than EDTA.

Two-dimensional facial measurements for anterior tooth selection in complete denture treatment.

Purpose: Anterior tooth selection is one of the most challenging parts in determining tooth dimensions and critical to the aesthetic aspect of the complete denture treatment. However, the methods for anterior tooth size selection using facial measurements are still controversial. This study aimed to investigate the relationship between dental measurements and facial measurements, and to establish the anterior tooth size prediction equation using facial dimensions in the Thai population for the complete denture treatment. Materials & methods: One hundred and twenty-five Thai participants (53 men and 72 women) aged 18-35 years old with Angle class I occlusion, did not currently undergo orthodontic treatment, had normal alignment on the maxillary anterior teeth, no attrition, abrasion, proximal restoration or prosthesis were investigated. One frontal facial photograph and one dental photograph of each participant were made using an image analyzing program (ImageJ version 1.53b) to measure the six horizontal facial distances, five vertical facial distances and three dental distances as 2D facial and dental measurements. Pearson correlation and multiple linear regression analysis were performed. Results: The difference of facial and dental measurements between men and women were statistically significant (P < .001). Interpupillary width, interlateral canthal width, intercommissural width and bizygomatic width were correlated to dental measurements in both sexes. Intermedial canthal width and lip thickness were correlated to dental measurements in women. Face length and lateral canthus to lower border of face were correlated to dental measurements in men. Prediction equations of each dental measurement were established using only horizontal facial dimension and using both horizontal and vertical facial dimensions. Conclusions: Facial and dental dimensions are sex-dependent. Facial measurements can be applied in a regression equation to predict dental measurements. Adding vertical dimensions of facial measurements to the prediction equations of anterior tooth size selection results in a higher R squared to 0.444. This finding can be used as a tool for anterior tooth size selection in the complete denture treatment.

Binary Response Analysis Using Logistic Regression in Dentistry.

Multivariate analysis with binary response is extensively utilized in dental research due to variations in dichotomous outcomes. One of the analyses for binary response variable is binary logistic regression, which explores the associated factors and predicts the response probability of the binary variable. This article aims to explain the statistical concepts of binary logistic regression analysis applicable to the field of dental research, including model fitting, goodness of fit test, and model validation. Moreover, interpretation of the model and logistic regression are also discussed with relevant examples. Practical guidance is also provided for dentists and dental researchers to enhance their basic understanding of binary logistic regression analysis.

A Retrospective Clinical Study on Factors Influencing the Failure of NCCL Restorations.

Objectives: This retrospective study evaluated the factors influencing the clinical failure of noncarious cervical lesion (NCCL) restorations. Methods: Patients were routinely treated by undergraduate or postgraduate students and randomly received a clinical recall evaluation. A retrospective study was performed with two experienced calibrated examiners to evaluate NCCL restorations, including the critical parameters of retention, caries, marginal discoloration, and marginal integrity. The factors related to the restoration included gender, age, arch site, tooth position, the presence of occlusal wear facets, caries risk, operator, adhesive strategy, and composite. The clinical failure comparison between the parameters and factors was performed using the binary logistic regression analysis. Results: A total of 460 cervical restorations from 96 patients were evaluated. The adhesive strategy and the presence of occlusal wear facets were the most important factors influencing the parameter failure. Therefore, the highest failure was marginal integrity, in which the gingival marginal integrity failure was 50.7%, and the occlusal marginal integrity failure was 42.4%. Conclusions: The main factors influencing clinical failure for partial loss, marginal discoloration, and marginal integrity were the adhesive strategy and the presence of occlusal wear facets. Therefore, marginal integrity was the most frequent failure parameter.

Effects of dentin surface preparations on bonding of self-etching adhesives under simulated pulpal pressure.

Objectives: This study evaluated the effects of different smear layer preparations on the dentin permeability and microtensile bond strength (µTBS) of 2 self-etching adhesives (Clearfil SE Bond [CSE] and Clearfil Tri-S Bond Universal [CTS]) under dynamic pulpal pressure. Materials and Methods: Human third molars were cut into crown segments. The dentin surfaces were prepared using 4 armamentaria: 600-grit SiC paper, coarse diamond burs, superfine diamond burs, and carbide burs. The pulp chamber of each crown segment was connected to a dynamic intra-pulpal pressure simulation apparatus, and the permeability test was done under a pressure of 15 cmH2O. The relative permeability (%P) was evaluated on the smear layer-covered and bonded dentin surfaces. The teeth were bonded to either of the adhesives under pulpal pressure simulation, and cut into sticks after 24 hours water storage for the µTBS test. The resin-dentin interface and nanoleakage observations were performed using a scanning electron microscope. Statistical comparisons were done using analysis of variance and post hoc tests. Results: Only the method of surface preparation had a significant effect on permeability (p < 0.05). The smear layers created by the carbide and superfine diamond burs yielded the lowest permeability. CSE demonstrated a higher µTBS, with these values in the superfine diamond and carbide bur groups being the highest. Microscopic evaluation of the resin-dentin interface revealed nanoleakage in the coarse diamond bur and SiC paper groups for both adhesives. Conclusions: Superfine diamond and carbide burs can be recommended for dentin preparation with the use of 2-step CSE.

The Trend of Analytical Approaches in Dental Research.

OBJECTIVES: The aims of this article are to examine statistical approaches employed in international dental articles published in 2018 and 2019, as well as to examine relationships among analytical approaches, journal rankings, and types of research. MATERIALS AND METHODS: International dental journals published in 2018 and 2019 were selected from the four quartiles (Q1-Q4) of journal rankings using a stratified random sampling. All original articles in a randomly sampled issue of each selected journal were reviewed to explore employed statistical approaches and to examine relationships among analytical approaches, journal rankings, and types of research. RESULTS: One hundred and twenty-eight English-written international journals listed according to SCImago Journal Rank were selected, consisting 969 original articles. Significant differences in the use of statistics were found among the four quartiles and between types of research. The articles in Q1 tended to use more advanced analysis but lower descriptive analytics than other quartiles. The narrative approach was highly used in laboratory-based articles (18.66%), whereas clinical research was likely to use more descriptive (92.32%) and advanced analyses (26.30%). The data also found no remarkable differences in the patterns of the three most common statistical use among the four quartiles. CONCLUSION: This research revealed statistical use in international dental journals, which will enable educators to consider statistical content to be included in dental curricula, either for undergraduate or for postgraduate programs.

Bonding Performance of Self-etching Adhesives to Bur-cut Dentin with Active Application Mode.

PURPOSE: This study evaluated whether active application of self-etching adhesives would influence their microtensile bond strength (µTBS) to dentin cut with burs of different grit sizes. MATERIALS AND METHODS: Eighty-four human premolars were divided into 12 groups according to 1) two dentin surface preparations with either superfine- or regular-grit diamond burs; 2) three adhesives - Clearfil SE Bond 2 (SE2), Scotchbond Universal (SBU, 3M Oral Care) and G-Premio Bond (GPB, GC); and 3) two application modes of each adhesive (active or passive). Six bonded teeth per group were sectioned into sticks for µTBS testing. Statistical analyses were performed using 3-way ANOVA followed by Duncan's test (p < 0.05). Additional teeth were prepared to observe the interaction between the dentin smear layer obtained from each bur with adhesives under different application modes using transmission electron microscopy (TEM). RESULTS: Active application significantly increased the dentin bond strength of SE2, irrespective of the kind of bur used (p < 0.05). The highest bond strength of SBU was observed when bonded to superfine-grit diamond bur-cut dentin with the active application. There was, however, no influence of the tested factors on GPB group (p > 0.05). TEM observation showed that active application promoted dentin smear layer dissolution in all adhesive groups. CONCLUSIONS: Bond strengths of self-etching adhesives to dentin are influenced by bur-cut smear layers and mainly by application mode of adhesive materials. Active application improves µTBS of self-etching adhesives by enhancing smear layer modification and resin penetration into bur-cut dentin.

The Effectiveness of Visual Pedagogy for Toothbrushing in Children with Autism Spectrum Disorder.

OBJECTIVES: The aim of this study was to evaluate toothbrushing effectiveness in children with mild and moderate levels of severity of autism spectrum disorder (ASD) after using visual pedagogy. MATERIALS AND METHODS: This quasi-experimental study was carried out with 30 children with ASD aged 5-17 years; 21 had mild ASD and 9 had moderate ASD. Informed consent and the subject's demographic information were obtained from caregivers. All subjects were then asked to show their toothbrushing practices, which were recorded by video. The toothbrushing ability, toothbrushing cooperation, and plaque index were evaluated before the study and at 2 weeks, 4 weeks, 3 months, and 6 months after visual pedagogy had been used. Results were analyzed by the Friedman test, Pearson's chi-square test, Fisher's exact test, and Mann‒Whitney U test. RESULTS: Toothbrushing ability was significantly improved at all periods of follow-up. Toothbrushing cooperation and the dental plaque index were significantly better than before the study at 4 weeks, 3 months, and 6 months of follow-up. The toothbrushing ability of subjects with mild ASD was significantly better than that of subjects with moderate ASD at 4 weeks and 6 months of follow-up. The toothbrushing cooperation of the mild group was significantly better than that of the moderate group at 2 weeks, 4 weeks, and 3 months. There was no statistically significant reduction in the plaque index between the two groups. CONCLUSION: Visual pedagogy is useful for improving toothbrushing effectiveness in children with mild or moderate severity ASD. However, children with moderate severity ASD take longer to improve.