Effects of Thermocycling with Two Different Curing Techniques on Enamel Micro-Cracks Formation, Debonding, and Failure Modes of Ceramic Brackets: An In Vitro Study.

Despite the rise in popularity of ceramic braces for adults, the risk of enamel microcracks (EMCs) upon removal remains a significant drawback for both dental professionals and patients. Our study aimed to assess the effects of thermocycling, pre-curing, and co-curing techniques with different bonding agents on the enamel surface of teeth after the removal of ceramic brackets. We also examined the incidence, quantity, length, and direction of EMCs on tooth surfaces. Additionally, the adhesive remnant index (ARI) scores and orthodontic bracket bond failure modes were evaluated and compared. The study divided 40 extracted upper canine teeth into ten groups for further analysis. Two groups had intact enamel as the negative control, while the remaining groups had orthodontic ceramic brackets bonded using different bonding agents and curing techniques. Thermocycling was performed in five groups, and ARI was assessed after debonding. The study findings were statistically significant (p < 0.05) in demonstrating the impact of curing techniques on EMCs and debonding outcomes. Seventh-generation bonding agents resulted in complete adhesive removal (ARI = 0). The microcracks' incidence, number, and length showed insignificant results. Differences in ARI between thermocycler and non-thermocycler samples were insignificant. Both co-curing and pre-curing techniques yielded comparable ARI results. This study highlights the importance of using advanced bonding agents to minimize enamel damage during ceramic bracket debonding.

Incorporation of Plant Extracted Hydroxyapatite and Chitosan Nanoparticles on the Surface of Orthodontic Micro-Implants: An In-Vitro Antibacterial Study.

In our study, the structural and morphological applications of hydroxyapatite and chitosan nanoparticles and coated micro-implants were assessed for their ability to combat oral pathogenic bacteria. The hydroxyapatite, as well as chitosan nanoparticles, were synthesized from the Salvadora persica plant. The crystal morphology, phase composition, particle size, and surface functional groups of the nano-samples were analyzed via classical examinations and energy dispersive X-ray analysis. The prepared nanoparticles have been examined for antibacterial activity against four common oral bacterial strains. The antimicrobial effect was also assessed by the Live/Dead BacLight technique in combination with confocal scanning laser microscopy. Titanium micro-implants were coated with regular hydroxyapatite (HAP) and chitosan nanoparticles, and the surface was characterized by scanning electron microscopy. The analysis asserted elemental composition of the prepared nanoparticles and their textural features, metal crystallization, and functional bonds. The antibacterial activity of the nanoparticles was evaluated against oral pathogenic microorganisms by the disc diffusion method, minimum bacterial concentration (MBC), and minimum inhibitory concentration (MIC). Chitosan nanoparticles showed (MICs) of 8 µg mL-1 for (Streptococcus salivarius, Streptococcus mutans and Enterococcus faecalis), and 16 µg mL-1 for Streptococcus sanguinis. HAP nanoparticles showed (MICs) of 16 µg/mL for E. faecalis, and S. sanguis, 8 µg/mL for S. salivarius and finally 4 µg/mL for S. mutans. HAP nanoparticles showed enhanced antibacterial activity and more obvious damage in the bacterial cell membrane than that of synthesized chitosan nanoparticles. The prepared nanoparticles could successfully coat titanium microplates to enhance their efficiency.

Third molar impaction in the Jazan Region: Evaluation of the prevalence and clinical presentation.

OBJECTIVE: To provide information on the prevalence and clinical features of impacted third molar teeth in the South-Western region of Saudi Arabia. MATERIAL AND METHODS: In this cross-sectional study, 1200 panoramic radiographs (50% males and 50% females) were retrieved from the electronic clinical records of patients at the College of Dentistry, Jazan University from December 2014 to December 2016, and impacted third molars were evaluated. Data on clinical and radiographic presentation were analyzed. RESULTS: Overall, there were 291 (24.3%) patients with impacted third molars among 1200 radiographs. The distribution of impacted third molars according to the number of impacted teeth was as follows: one impaction in 121 (41.6%); two impactions in 90 (30.9%); three impactions in 42 (14.4%); and four impactions in 38 (13.1%) patients. There was a high prevalence of all impaction types among females (54.5%). Maxillary vertical angulation was most common (50%) followed by mandibular mesioangular angulation (48.3%). The depth of impaction in maxillary teeth was higher than in mandibular teeth. Pain was uncommon (4.5% of patients). DISCUSSION: Clinically, vertical impaction in the maxilla was present in 50% of patients because of limited posterior space, and mesioangular angulation in the mandible was present in 48% of patients because of inadequate space between the ramus and the second molar. These findings are similar to other reports. Vertical impaction of the maxillary wisdom tooth is mostly related to the discrepancy between the mesiodistal size of the tooth crown and the limited retromolar space. CONCLUSION: Noiseless presentation of an impacted third molar requires raising the population's awareness about the need for diagnosis and treatment of the problem to avoid any further complications. The study can be to guide surgical procedures. This study documented the prevalence, pattern, and clinical features of impacted third molars in South Western region of Saudi Arabia.

Factors associated with the use of fashion braces of the Saudi Arabian Youth: application of the Health Belief Model.

BACKGROUND: In spite of the fact that fashion braces (FBs) have been in the spotlight in recent years among both orthodontists and the general public in several countries, there is still limited evidence regarding FBs. The aim was to identify health-related behaviors in using FBs by considering the Health Belief Model (HBM). METHODS: A cross-sectional study with a random sampling technique was conducted in Jazan, Saudi Arabia. The data was obtained from different middle and high schools students, and first-year students at Jazan University. The questionnaire collected data on demographic characteristics and 27 items to examine the constructs of the HBM. Chi Square test was carried out to establish the factors associated with using, the intention to use, and previous knowledge on the use of fashion braces. Logistic regression analysis was utilized to determine the factors associated with the use of fashion braces. RESULTS: 406 study participants completed the questionnaire with a response rate of 88.3%. Majority of respondents were males (52.2%) and > 19 years old (44.3%). Only 9.9% students had used the FBs. However, 25.7% of students had the intention to use them. The perceived susceptibility, perceived benefits and cues to action constructs scores were fair with the mean values of 15.38 (SD = 9.4), 28.17 (SD = 10.8) and 6.65 (SD = 2.50), respectively. However, the perceived barrier score was high with the mean values of 22.14 (SD = 7.50), and lower score of self-efficacy with mean of 8.73 (SD = 3.30). Gender, age, monthly income (family), and education level were significantly (p < 0.05) associated with the use of fashion braces among the study's participants. Based on the results of logistic regression analysis family income, perceived susceptibility, and risk severity constructs predict the use of fashion braces in the study's sample. CONCLUSIONS: The current study suggests that the family income, perceived susceptibility, and risk severity of students significantly influence the use of fashion braces. Hence, it is recommended that researchers should investigate effective educational strategies and programs for improving young people's knowledge about fashion braces and focus more on low family income students so that their using of fashion brace will be decreased.

Correlation of spheno-occipital synchondrosis fusion stages with a hand-wrist skeletal maturity index: A cone beam computed tomography study.

OBJECTIVES: To examine the correlation between spheno-occipital synchondrosis fusion stages and the hand-wrist skeletal maturity index. MATERIALS AND METHODS: Digital records of 164 individuals (77 males, 87 females) aged 10 to 18 years old were examined. Three-dimensional CBCT scans and hand-wrist two-dimensional radiographs were scored for the spheno-occipital synchondrosis fusion stages and hand-wrist skeletal maturity index, respectively. Statistical analyses were performed for associations using R software with a significance threshold of P< .01. RESULTS: A significant positive relationship was demonstrated between spheno-occipital synchondrosis fusion stages and hand-wrist skeletal maturity in both sexes. The Kendall's rank correlation τ between hand-wrist skeletal maturity index and spheno-occipital synchondrosis fusion percentage were high and positive in males and females (r = .74 and r = .71, respectively). CONCLUSIONS: The significant, positive relationship between the hand-wrist skeletal maturity index and spheno-occipital synchondrosis fusion stages support the idea of using spheno-occipital synchondrosis fusion as a biological indicator for craniofacial and mandibular growth spurt prediction.

Application of artificial intelligence and machine learning for prediction of oral cancer risk.

BACKGROUND: Oral cancer requires early diagnosis and treatment to increase the chances of survival. This study aimed to develop an artificial neural network model that helps to predict the individuals' risk of developing oral cancer based on data on risk factors, systematic medical condition, and clinic-pathological features. METHODS: A popular data mining algorithm artificial neural network was used for developing the artificial intelligence-based prediction model. A total of 29 variables that were associated with the patients were used for developing the model. The dataset was randomly split into the training dataset 54 (75%) cases and testing dataset 19 (25%) cases. All records and observations were reviewed by Board-certified oral pathologist. RESULTS: A total of 73 patients met the eligibility criteria. Twenty-two (30.13%) were benign cases, and 51 (69.86%) were malignant cases. Thirty-seven were female, and 36 were male, with a mean age of 63.09 years. Our analysis displayed that the average sensitivity and specificity of ANN for oral cancer prediction based on the 10-fold cross-validation analysis was 85.71% (95% confidence interval [CI], 57.19-98.22) and 60.00% (95% CI, 14.66-94.73), respectively. The accuracy of ANN for oral cancer prediction was 78.95% (95% CI, 54.43-931.95). CONCLUSION: Our results suggest that this machine-learning technique has the potential to help in oral cancer screening and diagnosis based on the datasets. The results demonstrate that the artificial neural network could perform well in estimating the probability of malignancy and improve the positive predictive value that could help to predict the individuals' risk of developing OC based on knowledge of their risk factors, systemic medical conditions, and clinic-pathological data.

Assessment of Severity of Malocclusion and Orthodontic Treatment Need Using the Dental Esthetic Index and Angle's Classification: A Retrospective Study.

INTRODUCTION: Angle's classification is the most widely used instrument for evaluation of malocclusion. The dental esthetic index (DAI) is a reliable, valid, and universally accepted cross-cultural index adopted by the World Health Organization (WHO) that links objective, clinical, and subjective esthetic factors to produce a single score that reflects the severity and the treatment needs of the malocclusion. The present study aims to evaluate Angle's classification and DAI to assess the severity of malocclusion and treatment needs. MATERIALS AND METHODS: This retrospective cross-sectional study was done on pretreatment orthodontics records of 145 male patients and 153 female patients in the age-group 9-42 years with malocclusion who had received or were undergoing orthodontic treatment in the orthodontic department clinics of the College of Dentistry, Jazan University. Preorthodontic study casts, orthopantomography, and lateral cephalometric X-rays were analyzed. DAI scores were calculated, and treatment needs were assessed. Angle's classification of malocclusion was also noted. RESULTS: Among patients with normal or minor malocclusion (DAI score ≤25), a significantly higher percentage of patients were class I (58%) than any other class of malocclusion. Among patients determined to have handicapping malocclusion (DAI score ≥36), significantly higher percentage of patients were class II/1 (44%) than any other class of malocclusion. Class II/1 showed the highest percentage of definite (24%) (DAI score 26-30), severe (19%) (DAI score 31-35), and handicapping malocclusions (44%) (DAI score ≥36). A total of 26% of patients had skeletal class I. A total of 38% of patients had skeletal class II. A total of 36% of patients had skeletal class III. Approximately 13% of patients had maxillary canine impactions and 3% of patients had mandibular canine impactions. CONCLUSION: The study reported 35% of patients were having handicapping malocclusion (DAI ≥36) and 14% having severe malocclusion (DAI score 31-35). The malocclusion was characterized by a high frequency of anterior crowding. Thus, the complementary use of DAI and Angle's classification, with improvements, helps establish an all-inclusive criterion for screening and prioritizing of patients eligible for receiving subsidized, publicly funded orthodontic care and thus allows better use of limited available resources.

Advanced diagnostic aids for oral cancer.

Oral cancer, a universal malady, has become a stumbling block over the years due to its significant morbidity and mortality rates. The greater morbidity associated with this deadly disease is attributed to delay in its diagnosis / its presentation in advanced stage. Being multifactorial, Oral squamous cell carcinoma (OSCC) is the outcome of genetic and epigenetic instability. However, in many instances, oral cancer is preceded by precursor lesions named as oral potentially malignant disorders (OPMDs), the early detection of which makes it beneficial for patients with the possible increase in the productive longevity. Many diagnostic tools / aids have been explored with the aim of early detection of oral precancer and cancer. The basic chair-side procedures or relatively advanced aids come with a set of limitations along with subjectivity as one of the setbacks. The advent and exploitation of molecular techniques in the field of health diagnostics, is demanding the molecular typing of the OPMDs and also of oral cancer. The saga of various diagnostic aids for OSCC has witnessed the so-called latest trends such as lab-on-chip, microfluidics, nano diagnostics, liquid biopsy, omics technology and synthetic biology in early detection of oral precancer and cancer. Oral cancer being multifactorial in origin with the chief participation of altered genetics and epigenetics would demand high-end diagnostics for designing personalized therapy. Hence, the present paper highlights the role of various advanced diagnostic aids including 'omics' technology and synthetic biology in oral precancer and cancer.

Comparing case-based and lecture-based learning strategies for orthodontic case diagnosis: A randomized controlled trial.

BACKGROUND: Case-based learning (CBL), in contrast to traditional lecture-based learning (LBL), is an andragogical method carrying an earnest teaching approach that uses demonstration of clinical cases as an active learning tool. OBJECTIVE: To compare the effectiveness of knowledge delivery and student satisfaction between CBL and LBL strategies to diagnose orthodontic cases. METHODS: A single-blinded randomized controlled trial was performed. The sample of dental undergraduate students was randomly divided into 2 groups. Average GPA among the groups was compared to establish the baseline measure. Visual slides of 6 orthodontic diagnostic cases were presented to the students after implementing the teaching strategies, and a rubrics-based assessment method was adopted to assess the effectiveness in diagnosis. A questionnaire was distributed to compare the level of satisfaction between the groups exposed to CBL and LBL. A t-test was performed to assess the difference in effectiveness, while Cochran-Armitage trend analysis was performed to analyze the difference in the level of satisfaction between LBL and CBL experiences. RESULTS: We detected no significant (P = 0.11) relation of gender with effective orthodontic diagnosis. The orthodontic diagnostic ability of students for the 6 cases was significantly different (P < 0.05) in the CBL and LBL groups. The satisfaction score obtained for the CBL group was higher than for the LBL group (P < 0.05). CONCLUSION: The current study provides evidence that CBL is an effective and acceptable teaching strategy in comparison to traditional LBL among undergraduate dental students embarking on an orthodontic diagnostic course.

Association between Maxillary Sinus Dimensions and Midface Width: 2-D and 3-D Volumetric Cone-beam Computed Tomography Cross-sectional Study.

AIM: Evaluating the association of maxillary sinus dimensions and the maxillary arch dimensions may help to understand the interrelationship between the maxillary sinus and the anatomical facial features. The study aimed to investigate the correlation of the 2-D and 3-D maxillary sinus dimensions with the linear measurement of the maxillary arch width (MAW) in adult individuals. MATERIALS AND METHODS: A cross-sectional observational study was conducted using 54 cone-beam computed tomography scans obtained from patients starting their treatment in dental clinics of dental college, Jazan University. Maximal vertical diameter (maximal height) of the maxillary sinus (MSH), maximal horizontal diameter (maximal width) of the maxillary sinus (MSW), maximal anteroposterior diameter (maximal length) of the maxillary sinus (MSL), MAW, and maxillary sinus volume (MSV) were measured and recorded using 3-D Slicer software. The Spearman's rank correlation coefficient (rho-ρ) was used to analyze the strength and type of the relationship between variables. RESULTS: In both males and females, moderate to strong correlation (ρ range between 0.65 and 0.80) was observed between MSV for all linear measurements of the maxillary sinuses on both sides. The maxillary sinus length showed the weakest correlation with MAW in both genders Conclusion: The relationship of MAW with MSV on both sides shows a stronger correlation than its relationship with all 2-D linear measurements of maxillary sinuses. CLINICAL SIGNIFICANCE: The clinician should take into consideration the structure and function of the maxillary sinus when treating the midfacial structures for trauma or congenital malformations.

Cytokine levels in gingival crevicular fluid during orthodontic treatment with aligners compared to conventional labial fixed appliances: a 3-week clinical study.

Objective: To test the hypothesis that the levels of IL-1ß and TNF-α increased more and IL-1α, IL-2, IL-6, IL-8 increased less, after 3 weeks of treatment with conventional labial fixed appliance and with aligners. Material and methods: Forty patients who were treated either with labial brackets (n = 20) or aligners (n = 20). Gingival crevicular fluid (GCF) samples were collected at baseline and after 21 days. Cytokine levels were evaluated by enzyme-linked immune sorbent assay (ELISA). Plaque index (PI), gingival index (GI), and bleeding on probing (POB) were also examined. Results: The levels of IL-1α, IL-1ß, IL-2, IL-6, IL-8 and TNF-α in the GCF were significantly increased in both groups. The levels of IL-2, IL-6, IL-8 increased more in patients treated with aligners compared to those treated by labial fixed appliances. There was a statistically significant difference in change of the mean cytokine levels of IL-1α, IL-2, IL-6, IL-8 and TNF-α compared to labial fixed appliances and aligners. Conclusions: The levels of the six studied cytokines in GCF (IL-1α, IL-1ß, IL-2, IL-6, IL-8 and TNF-α) increased after 3 weeks both after treatment with conventional labial fixed appliance and with aligners. IL-1ß and TNF-α showed a prominent increase compared to the other cytokines in the GCF of teeth by both the labial fixed appliance and aligners. However, there were only minor differences in the changes of the cytokine levels from baseline to 3 weeks between the two groups. There were no differences between the groups regarding PI, GI or POB.

Exploring Drug-Related Problems in Diabetic Patients during Ramadan Fasting in Saudi Arabia: A Mixed-Methods Study.

This study aimed to identify any drug-related problems (DRPs) in diabetic patients during Ramadan fasting in Saudi Arabia. The study used a mixed-methods approach consisting of two phases and was conducted in Makkah, Saudi Arabia from December 2017 to March 2018. The first phase of the study involved qualitative semi-structured individual interviews with diabetic patients. A 13-item questionnaire was used in the second phase to further identify DRPs in the wider population. The data was mainly presented as frequencies and percentages. Inferential statistics was performed using Statistical Package for Social Sciences (SPSS) version 21 to compare relevant variables/questions using the chi-square test. Twenty patients (10 male, 10 female) attended face-to-face interviews during the first phase of the study while 95 (40 male, 55 female) completed the questionnaire in the second phase of the study. Two possible risk factors for DRPs were identified from the qualitative data: patient-related factors, including changes in their medicine intake during fasting, and healthcare professionals-related factors, including lack of advice from healthcare professionals regarding fasting. The quantitative results indicated that 52 (54%) of the 95 participants who observed fasting reported to have changed the way they were taking their medicines. Furthermore, 41% of the participants experienced general healthcare problems such as hypoglycemia, hyperglycemia, fatigue, excessive sweating, and gastrointestinal disturbances. Healthcare professionals need to educate patients who are at risk of DRPs by providing structured education and counseling.

Correction: Timing and rate of spheno-occipital synchondrosis closure and its relationship to puberty.

[This corrects the article DOI: 10.1371/journal.pone.0183305.].

Timing and rate of spheno-occipital synchondrosis closure and its relationship to puberty.

OBJECTIVES: This study examines the relationship between spheno-occipital synchondrosis (SOS) closure and puberty onset in a modern American population. It also investigates the timing and the rate of SOS closure in males and females. MATERIALS AND METHODS: The sample includes cross-sectional and longitudinal 3D Cone Beam Computed Tomography (CBCT) scans of 741 individuals (361 males and 380 females) aged 6-20 years. Each CBCT scan is visualized in the mid-sagittal plane, and the spheno-occipital synchondrosis (SOS) is scored as completely open, partially fused, mostly fused, and completely fused. The Menarche commencement is used as an indicator of puberty onset in females. RESULTS: Mean ages of open, partially-fused, mostly-fused, and completely fused SOS were 11.07, 12.95, 14.44, and 16.41 years in males, and 9.75, 11.67, 13.25, and 15.25 in females, respectively. The results show there is a significant association between the SOS closure stage and the commencement of menarche (Fisher's Exact Test p < 0.001). It was found that females had a higher SOS closure rate (38.60%) per year than males at the age of 10 years. The closure rate in males appears slower than females at age 10, but it lasts a longer time, ranging between 22 and 26% per year from age 11 to 14 years. CONCLUSION: There is a significant relationship between puberty onset and SOS closure, suggesting its closure is at least partially affected by systemic, hormonal changes in the growing adolescent. Also, SOS closure occurs at a faster rate and at an earlier age in females compared to males.