Levels of Inflammatory and Bone Metabolic Markers in the Gingival Crevicular Fluid of Individuals Undergoing Fixed Orthodontic Treatment in Comparison to Those Utilizing Invisalign.

Background and Objectives: Evaluation of the levels of cytokine and bone metabolic biomarkers (BMBs) in patients receiving fixed orthodontic therapy (FOT) and Invisalign. Materials and Methods: Sixty participants were enrolled after meeting the predefined inclusion criteria. Patients then underwent either FOT or Invisalign by allocating them randomly to each group (n = 30). The basic periodontal assessment was performed, including the plaque index (PI), gingival index (GI), and bleeding on probing (BoP), at baseline and again after 4 weeks. Gingival crevicular fluid (GCF) samples were taken from each individual at baseline and after 4 weeks. An enzyme-linked immunosorbent assay (ELISA) technique was used to determine the cytokine and BMB levels. An unpaired t-test compared the FOT and Invisalign group's means and SDs. Paired t-tests examined the difference between T0 baseline and T1. Results: Patients treated with either FOT or Invisalign presented no statistically significant difference in terms of periodontal parameters such as PI, GI, and BoP (p > 0.05). The levels of IL-6 were significantly higher in patients treated with FOT as compared to Invisalign at T1 (p < 0.05) The other tested cytokines, IL-10, 13, 17, and GM-CSF, were not significantly different in either the FOT or Invisalign group at baseline and 4 weeks follow-up (p > 0.05). Regarding BMBs, it was detected that NTx and OC levels in both of the investigated groups were not significantly different at baseline and after 4 weeks (p > 0.05). However, NTx levels rose significantly (p < 0.05) and OC levels fell from T0 to T1. Conclusions: FOT and Invisalign displayed comparable outcomes in terms of cytokine and BMB levels. However, only IL-6 and NTx were significantly different at week 4 from baseline.

Therapeutic Approach for Trigeminal Neuralgia: A Systematic Review.

This umbrella review aimed to determine the various drugs used to treat trigeminal neuralgia (TN) and to evaluate their efficacies as well as side effects by surveying previously published reviews. An online search was conducted using PubMed, CRD, EBSCO, Web of Science, Scopus, and the Cochrane Library with no limits on publication date or patients' gender, age, and ethnicity. Reviews and meta-analyses of randomized controlled trials pertaining to drug therapy for TN, and other relevant review articles added from their reference lists, were evaluated. Rapid reviews, reviews published in languages other than English, and reviews of laboratory studies, case reports, and series were excluded. A total of 588 articles were initially collected; 127 full-text articles were evaluated after removing the duplicates and screening the titles and abstracts, and 11 articles were finally included in this study. Except for carbamazepine, most of the drugs had been inadequately studied. Carbamazepine and oxcarbazepine continue to be the first choice for medication for classical TN. Lamotrigine and baclofen can be regarded as second-line drugs to treat patients not responding to first-line medication or for patients having intolerable side effects from carbamazepine. Drug combinations using carbamazepine, baclofen, gabapentin, ropivacaine, tizanidine, and pimozide can yield satisfactory results and improve the tolerance to the treatment. Intravenous lidocaine can be used to treat acute exaggerations and botulinum toxin-A can be used in refractory cases. Proparacaine, dextromethorphan, and tocainide were reported to be inappropriate for treating TN. Anticonvulsants are successful in managing trigeminal neuralgia; nevertheless, there have been few studies with high levels of proof, making it challenging to compare or even combine their results in a statistically useful way. New research on other drugs, combination therapies, and newer formulations, such as vixotrigine, is awaited. There is conclusive evidence for the efficacy of pharmacological drugs in the treatment of TN.

Different cavity disinfectant efficacy against S.mutans and shear bond strength of caries affected dentin bonded to resin restoration.

AIMS: The existing study aimed to assess the survival rate of S.mutans and shear bond strength (SBS) of resin adhesive restoration bonded to carious affected dentin (CAD) after using different cavity disinfectants (Chitosan, Fotoenticine®, and CO2 laser) in comparison to Chlorhexidine (CHX). MATERIALS AND METHODS: The study included human mandibular molars assessed on International Caries Detection and Assessment System (ICDAS) score 4 and 5. The cusp part of the clinical crown was cut off until the reduction reaches the central fossa while being continuously supplied with water coolant till the tooth cementoenamel junction (CEJ). The root sections were embedded in polymethyl methacrylate acrylic resin followed by culturing S.mutans biofilm on the CAD surface. Specimens were arbitrarily allocated into four groups(n = 10) based on the type of disinfection. Group 1 (2% CHX), Group 2 (Chitosan), Group 3 (Fotoenticine), and Group 4 (CO2 laser). S.mutans survival rate was assessed and CAD was restored with a composite restorative material. Thermoocycling of the samples was performed and a universal testing machine (UTM) and Stereomicroscope were used to identify bond integrity and type of fracture. ANOVA and Tukey multiple comparison tests were used to assess SBS. Data on the survival rate of S. mutans were compared between groups using the nonparametric Kruskal-Wallis test RESULTS: Outcomes revealed that Group 1 (CHX) displayed the highest survival rate (0.65 ± 0.10). However, lowest survival rate was demonstrated by Group 3 (Fotoenticine) treated specimens (0.25 ± 0.06). It was also discovered that CHX unveiled highest bond strength values (21.48 ± 1.39 MPa). Nevertheless, Group 2 (Chitosan) showed lowest SBS (11.01 ± 1.00 MPa). Intergroup comparison analysis presented that group 1, and group 4 (Co2 laser) (17.76 ± 0.41 MPa) displayed no significant difference in their bond integrity achieved. (p > 0.05). However, group 3 (Fotoenticine) (16.28 ± 0.51 MPa) and group 2 demonstrated comparable outcomes of SBS. (p > 0.05) CONCLUSION: The use of CHX and CO2 lasers as disinfectants on the CAD surface resulted in a positive impact on the SBS of resin composite, according to the study's findings. However, it is worth noting that Fotoenticine exhibited better antimicrobial efficacy against S. mutans.

A Critical Evaluation of the Undergraduate Endodontic Teaching in Dental Colleges of Saudi Arabia.

BACKGROUND: The purpose of the research was to evaluate the content and delivery of the undergraduate endodontic curriculum. METHODS: A needs assessment survey was distributed among the Deans of all the dental colleges in Saudi Arabia. RESULTS: The response rate was 72%. All the colleges include foundational and advanced topics in their curriculum. Didactic lectures, clinical cases, self-directed learning assignments and projects, and videos are the most common teaching methods, whereas virtual learning and reading list are the least popular methods. The average staff-to-student ratio for preclinical and clinical training is 1:6 and 1:7, respectively. Eighty-six percent of colleges utilize dedicated endodontic clinics supervised by specialized endodontists. Eighty percent of colleges use simple cases for canal preparation and obturation. Most colleges do not use magnification and ultrasonic instruments. Saline and sodium hypochlorite are preferred irrigation solutions, whereas calcium hydroxide is the preferred inter-visit medicament. Many use MTA as an advanced material, calcium hydroxide as an inter-visit medicament, and provisional restoration after RCT. CONCLUSION: The content and delivery of the endodontic undergraduate curriculum are primarily uniform. The use of specialist endodontists dedicated endodontic clinics, rotary instruments, and advanced materials have emerged as curricular strengths. However, diversification of teaching strategies, use of magnification instruments, and an increase in the minimum number of endodontically treated teeth are leading areas demanding curricular improvement.

Effect of two hemostatic agents containing Aluminium chloride and ferric sulfate on bond integrity of resin-modified glass ionomer cement.

OBJECTIVE: To evaluate the influence of hemostatic agents (Expasyl and Viscostat) on the bond values of RMGIC bonded to pretreated dentin surface with cavity conditioner (CC), self etch primer (SEP), and antimicrobial photodynamic therapy (aPDT) MATERIALS AND METHODS: One hundred and eighty human third molars were embedded in a self-cure acrylic resin-filled polyvinyl cylinder. The dentinal surface was prepared and all the samples were arbitrarily distributed into three different groups liable to the hemostatic agent used (n = 60). Samples in group 1: no hemostatic agent used, Group 2: Samples exposed to Expasyl, and group 3: Viscostat. After applying the hemostatic agent, all the samples were surface treated with different surface conditioners. Subgroup A1, B1, C1 were conditioned with aPDT, Subgroup A2, B2, and C2 surface were treated with SEP, and Subgroup A3, B3, and C3 were smeared with CC. RMGIC was placed and SBS was assessed using a universal testing machine and failure mode analysis was performed using and stereomicroscope at 40x magnification. Analysis of variance (ANOVA) and Tukey's post hoc test compared the means and standard deviations (SD) following SBS testing (p = 0.05). RESULTS: Highest SBS was exhibited by group A2 (22.36 ± 1.66 MPa Control - SEP) whereas group A1 (14.14 ± 1.32 aPDT + Control) demonstrated the lowest SBS. Subgroups B1 (17.23 ± 0.33- Expasyl + aPDT) and C1 (18.36 ± 0.25 MPa -Viscostat + aPDT) were found to be comparable (p > 0.05). Similarly, A3 (19.69 ± 1.01- Control + CC) and B3 (18.23 ± 0.33 MPa- Expasyl + CC) and C3 (18.36 ± 0.37 Viscostat + CC) demonstrated no significant difference in bond scores (p > 0.05). Most of the failures in aPDT were adhesive. However, SEP and CC groups demonstrated admixed and cohesive failure CONCLUSION: Dentin conditioned by aPDT after hemostatic agents improves bond values of RMGIC. Self etch Primer and Cavity conditioner using polyacrylic acid without hemostatic agent improves bond integrity of RMGIC.

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.

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.

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.

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.

Correlation of Buccal Micronucleus with Disease Activity Score Using Buccal Micronucleus Cytome Analysis (BMCA) in Systemic Lupus Erythematosus.

BACKGROUND: A disease activity score obtained by using systemic lupus erythematosus disease activity index (SLEDAI) has traditionally been a reliable method to assess the SLE status of patients. More recently, a buccal micronucleus cytome assay (BMCA) has been developed for use as a biomarker of DNA damage in patients with SLE. There has been a very limited number of studies pertaining to the oral lesions in Arab population suffering from SLE in Asir region. Hence, it became utmost important to study epidemiological data of oral mucosal lesions in SLE patients. Distribution of oral lesions in SLE patients could also be helpful in better management of oral complications. AIM: The aim of this study was to determine the existence of a correlation between SLEDAI score and the degree of micronuclei (MN) formation using BMCA. MATERIALS AND METHODS: After thorough oral examination of adult Saudi SLE patients of Asir hospital and that of healthy control subjects, the subjects underwent BMCA from normal unaffected bilateral buccal mucosae. RESULTS: Pearson's correlation test showed that MN count did not significantly correlate with either disease activity or duration of SLE. CONCLUSIONS: Controlled state SLE does not lead to a significant increase in MN formation. Thus, the occurrence of premalignant lesions in the oral cavity could be minimized using proper management protocols.

Prevalence of Distal Caries in Mandibular Second Molar Due to Impacted Third Molar.

INTRODUCTION: A tooth is said to be impacted if it does not reach the occlusal plane even after two-thirds root formation. The aetiology of impacted teeth is varied and multi-factorial. Significant problems associated with impacted teeth include trismus, infection, cervical caries of second molars. AIM: This study was aimed to assess the prevalence of distal caries in second molar teeth due to impacted third molars and to compare with similar studies conducted elsewhere. MATERIALS AND METHODS: Study included assessment of patients reporting between 2009 to 2014 for dental care at College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia. This is a retrospective cross-sectional study which included a total of 6000 Orthopantomograms (OPGs). The data collected was decoded and entered into excel spread sheet. Descriptive analysis of the data was done and results were displayed as frequency table and graphs. RESULTS: A total of 979 patients had impacted third molars (16.31%). A total of 39% patient's with impacted third molars had distal cervical caries in second molar. Mesioangular impaction was the most prominent type. This was closely followed by horizontal impaction causing distal caries in second molars. Age group between 21-28 years and male gender had the higher prevalence of distal caries in second molar teeth due to impacted third molars. CONCLUSION: A total of 39% of the patients with impacted mandibular third molars had distal cervical caries in second molars. Mesioangular type, male gender, age group 21-28 years were the prominent factors associated with distal caries in second molar teeth due to impacted third molars.

Oral and dental manifestations in Rubinstein-Taybi syndrome: report of a rare case.

Rubinstein-Taybi syndrome, or broad thumb-hallux syndrome, is a well-defined rare congenital disorder characterised by postnatal growth deficiency, craniofacial dysmorphism, broad thumbs and great toes, and mental retardation (intellectual disability). Occurrence may be either sporadic or through autosomal dominant inheritance. Reports of Rubinstein-Taybi syndrome are scarce in the literature. This case report describes the oral and dentofacial findings of Rubinstein-Taybi syndrome affecting a 13-year-old Indian female, including the uncommon presence of talon cusps and an unerupted supernumerary tooth.