Evaluation of microleakage of mineral trioxide aggregate and biodentine as apical barriers in simulated young permanent teeth.

BACKGROUND: Apexification is a procedure that promotes apical closure by forming mineralized tissue in the apex region of a nonvital young permanent tooth. Calcium silicate-based cement like Mineral trioxide aggregate (MTA) and Biodentine are commonly employed as apical barriers to facilitate this process. Microleakage, defined as the leakage along the junction between the canal wall and filling material, is a crucial aspect to assess in MTA and Biodentine applications as apical barriers, as it directly impacts the prevention of bacterial seepage and maintenance of structural integrity. The current study aims to assess the microleakage of MTA and Biodentine when used as apical barriers in simulated young permanent teeth. METHODS: From a total of 128 extracted teeth, 114 were selected for the study and randomly allocated into three groups: G1 (MTA), G2 (Biodentine), and G3 (Control), with 38 teeth per group. After excluding 5 teeth from each group due to issues such as canal calcification, breakage during sectioning, and procedural errors, 33 teeth were analyzed to ensure equal distribution. To simulate young permanent teeth, samples were instrumented using a person-reamer with a diameter of 1.7 mm. A 4 mm thick apical plug of MTA and Biodentine was placed in G1 and G2, respectively, while G3 was the control group. Apical microleakage in all experimental groups was assessed using a dye penetration method. Specimens were longitudinally sectioned and examined under a stereomicroscope with graded eyepiece. RESULTS: The Kruskal-Wallis test revealed variations in mean apical microleakage among the groups: G1 recorded 0.67, G2-0.16, and G3-1.62, with G2 showing the lowest value and G3 group exhibiting the highest. CONCLUSIONS: Biodentine was found to excel in its ability to create a secure seal and function effectively as an apical barrier in simulated young permanent teeth. These results underscore its potential as a highly efficient material for dental applications, particularly in scenarios requiring reliable sealing and barrier formation in the root canal system of developing permanent teeth.

Antimicrobial Efficacy of Glass Ionomer Cement in Incorporation with Biogenic Zingiber officinale Capped Silver-Nanobiotic, Chlorhexidine Diacetate and Lyophilized Miswak.

In the present study, Zingiber officinale is used for the synthesis of Zingiber officinale capped silver nanoparticles (ZOE-AgNPs) and compares the antimicrobial efficacy and compressive strength of conventional glass ionomer cement (GIC) combined with ZOE-AgNPs, lyophilized miswak, and chlorhexidine diacetate (CHX) against oral microbes. Five groups of the disc-shaped GIC specimens were prepared. Group A: lyophilized miswak and GIC combination, Group B: ZOE-AgNPs and GIC combinations, Group C: CHX and GIC combination, Group D: ZOE-AgNPs + CHX + GIC; Group E: Conventional GIC. Results confirmed the successful formation of ZOE-AgNPs that was monitored by UV-Vis sharp absorption spectra at 415 nm. The X-ray diffractometer (XRD) and transmission electron microscope (TEM) results revealed the formation of ZOE-AgNPs with a mean size 10.5-14.12 nm. The peaks of the Fourier transform infrared spectroscopy (FTIR) were appearing the involvement of ZOE components onto the surface of ZOE-AgNPs which played as bioreducing, and stabilizing agents. At a 24-h, one-week and three-week intervals, Group D showed the significantly highest mean inhibitory zones compared to Group A, Group B, and Group C. At microbe-level comparison, Streptococcus mutans and Staphylococcus aureus were inhibited significantly by all the specimens tested except group E when compared to Candida albicans. Group D specimens showed slightly higher (45.8 ± 5.4) mean compressive strength in comparison with other groups. The combination of GIC with ZOE-AgNPs and chlorhexidine together enhanced its antimicrobial efficacy and compressive strength compared to GIC with ZOE-AgNPs or lyophilized miswak or chlorhexidine combination alone. The present study revealed that The combination of GIC with active components of ZOE-AgNPs and chlorhexidine paves the way to lead its effective nano-dental materials applications.

Effect of Erosive Agents on Surface Characteristics of Nano-Fluorapatite Ceramic: An In-Vitro Study.

Erosive beverages cause dissolution of natural teeth and intra-oral restorations, resulting in surface characteristic changes, particularly roughness and degradation. The purpose of this study was to evaluate the surface roughness and topography of a dental ceramic following immersion in locally available erosive solutions. A total of 160 disc specimens of a nano-fluorapatite type ceramic (12 mm diameter and 2 mm thickness) were fabricated and equally distributed into two groups (n = 80) and then evenly distributed among the following five testing groups (n = 16): lemon juice, citrate buffer solution, 4% acetic acid, soft cola drink, and distilled water which served as a control. The surface roughness (Ra) and topography were evaluated using a profilometer and scanning electron microscope at baseline, 24 h, 96 h, and 168 h respectively. Data were analyzed using ANOVA and Tukey's multiple comparisons (p ≤ 0.05). Surface changes were observed upon exposure to all acidic beverages except distilled water. Amongst all immersion media, 4% acetic acid produced the most severe surface roughness across all time periods (i.e., baseline, 24 h, 96 h, and 168 h). A statistically significant difference in the surface roughness values between all immersion media and across all four time intervals was observed. Erosive agents had a negative effect on the surface roughness and topography of the tested ceramic. The surface roughness increased with increased storage time intervals.

Antimicrobial activity of biosynthesized silver nanoparticles, amoxicillin, and glass-ionomer cement againstStreptococcus mutansandStaphylococcus aureus.

Background. The development of dental caries is associated with various microorganisms and secondary caries formation is the main cause of restorations failure. The advice for restorative dental materials that have antimicrobial properties has stimulated the introduction of materials containing different antibacterial agents.Objectives. The present study has been designed to synthesize silver nanoparticles (AgNPs) and incorporate AgNPs and amoxicillin into glass ionomer cement (GIC) to synergize its effect on oral microbes. The effect of the added antimicrobial agents on compressive strength (CS) of GIC was also evaluated.Material and methods. Biosynthesis of AgNPs was done usingCupressus macrocarpaextract and AgNPs were characterized. A total of 120 disc-shaped specimens were prepared and classified into 4 main groups where Group A includes conventional GIC, Groups B and C include GIC with AgNPs or amoxicillin, respectively, while Group D included GIC with both AgNPs and amoxicillin. Each group was tested for the antimicrobial activity against bothStreptococcus mutans(S. mutans) andStaphylococcus aureus(S. aureus). The distribution of biofilm was examined via a scanning electron microscope. The CS of the tested material was measured using a Material Test System.Results. The UV-visible spectrum showed a peak of 429 nm. Transmission electron microscopy, x-ray diffraction pattern and Fourier transform infrared analysis confirmed the formation of AgNPs with spherical to oblong polydispersed particles of diameter in the range of 13.5-25.8 nm. The maximum inhibitory zone was recorded for group D against both tested bacteria with a mean of 29 mm at first 24 h period to 15 mm at three weeks and showed antimicrobial rate 92.2% and 92.56%, against both strains, respectively. Additionally, group D disintegrated the structure ofS. aureusbiofilm and even kill bacteria in the biofilms. The addition of AgNPs and amoxicillin caused an insignificant effect on CS of GIC.Conclusion.TheAgNPs showed a synergistic effect in combination with amoxicillin and GIC dental restorative material against studied microorganisms. The agents can be safely added with minimal effect on the mechanical properties of the original cement.

Self-assembling peptide P11-4 in remineralization of enamel caries - a systematic review of in-vitro studies.

OBJECTIVE: The present systematic review was conducted to investigate the effect of the self-assembling peptide (SAP) - P11-4 in the remineralization of enamel caries. MATERIAL AND METHODS: The systematic search for studies was conducted through CINAHL, EMBASE, MEDLINE, Scopus, PsychINFO, and various key journals. This review was conducted in adherence to PRISMA standards and was registered in PROSPERO with registration number CRD42019110156. The methodological quality of the studies was graded through Cochrane's tool of risk of bias in non-randomized studies - of interventions (ROBINS-I). RESULTS: In total, 91 studies were identified for screening, and 12 studies were eligible. Ten studies showed effective enamel remineralization with P11-4 compared to controls. One study showed a combination of P11-4 with fluoride varnish or Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CPP-ACPF) leads to significantly higher remineralization compared to P11-4 alone. Quality assessment of study showed 6 (50%) studies as medium risk of bias and 6 (50%) studies as low risk of bias. CONCLUSION: To conclude, the present study results showed SAP- P11-4 is effective in the remineralization of enamel caries.

Well-Orientation Strategy Biosynthesis of Cefuroxime-Silver Nanoantibiotic for Reinforced Biodentine™ and Its Dental Application against Streptococcus mutans.

Dental caries results from the bacterial pathogen Streptococcus mutans (S. mutans) and is the maximum critical reason for caries formation. Consequently, the present study aims to evaluate the antibacterial activity of a newly synthesized nanoantibiotic-Biodentine formulation. The silver nanoparticles (ROE-AgNPs) were biosynthesized from the usage of Rosmarinus officinalis L. extract (ROE) and conjugated with cefuroxime to form Cefuroxime-ROE-AgNPs. Using Biodentine™ (BIOD), five groups of dental materials were prepared, in which Group A included conventional BIOD, Group B included BIOD with ROE-AgNPs, Groups C and D included BIOD with Cefuroxime-ROE-AgNPs at concentrations of 0.5% and 1.5% cefuroxime, respectively, and Group E included BIOD with 1.5% cefuroxime. The synthesized ROE-AgNPs or Cefuroxime-ROE-AgNPs were characterized for conjugating efficiency, morphology, particle size, and in vitro release. Minimum inhibitory concentration (MIC) of the cefuroxime, ROE-AgNPs, and Cefuroxime-ROE-AgNPs were additionally evaluated against cefuroxime resistant S. mutans, which furthered antibacterial efficacy of the five groups of dental materials. The UV-Visible spectrum showed the ROE-AgNPs or Cefuroxime-ROE-AgNPs peaks and their formation displayed through transmission electron microscopy (TEM), X-ray diffraction (XRD) pattern, and Fourier transforms infrared (FTIR) analysis. The end result of Cefuroxime-ROE-AgNPs showed conjugating efficiency up to 79%. Cefuroxime-ROE-AgNPs displayed the highest antibacterial efficacy against S. mutans as compared to cefuroxime or ROE-AgNPs alone. Moreover, the MIC of ROE-AgNPs and Cefuroxime-ROE-AgNPs was detected against S. mutans to be 25 and 8.5 µg/mL, respectively. Consequently, Cefuroxime-ROE-AgNPs displayed that a decrease in the MIC reached to more than three-fold less than MIC of ROE-AgNPs on the tested strain. Moreover, Cefuroxime-ROE-AgNPs/BIOD was employed as a novel dental material that showed maximum antimicrobial activity. Groups C and D of novel materials showed inhibitory zones of 19 and 26 mm, respectively, against S. mutans and showed high antimicrobial rates of 85.78% and 91.17%, respectively. These data reinforce the utility of conjugating cefuroxime with ROE-AgNPs to retrieve its efficiency against resistant S. mutant. Moreover, the nanoantibiotic delivered an advantageous antibacterial effect to BIOD, and this may open the door for future conjugation therapy of dental materials against bacteria that cause dental caries.

Enamel matrix derivative (Emdogain) in treatment of replanted teeth - a systematic review.

OBJECTIVE: The main purpose of the present systematic review was to evaluate the efficacy of enamel matrix derivative Emdogain in healing of replanted teeth in humans. MATERIALS AND METHODS: This review conducted in adherence to PRISMA standards and was registered in PROSPERO with registration number CRD42017062736. We graded the methodological quality of the studies by means of Cochrane's tool of risk of bias in non-randomized studies - of interventions (ROBINS-I). RESULTS: In total, 65 studies were identified for screening, and five studies were eligible. The uneventful healing of replanted teeth was varied from 20% to 75%. Two controlled trials found Emdogain treatment significantly reduced resorption of replanted teeth and improved the healing of periodontal ligament compared with controls. Two studies showed high recurrent resorption in Emdogain treated teeth. CONCLUSIONS: To conclude, the number of publications that met all inclusion criteria were limited and did not allow for drawing evidence for Emdogain being effective in supporting healing of replanted teeth.

Efficacy of platelet concentrates in pulpotomy - a systematic review.

The main purpose of the present systematic review was to evaluate the efficacy of platelet concentrates in pulpotomy of human teeth. Our systematic search included Medline, Embase, CINAHL, PsycINFO, Scopus, key journals, and review articles; the date of the last search was July 30, 2017. We graded the methodological quality of the studies by Cochrane Risk of Bias tool. Four randomized controlled trails were included in the present systematic review. The number of study participants ranged from 28 to 50, with a mean of 45.5. The age of study participants ranged between 4 and 25 years. In three of the included studies, platelet-rich fibrin (autologous) was used and in one study lyophilized freeze-dried platelet (allogenic) was used as pulpotomy material. Calcium hydroxide and mineral trioxide aggregate were used in control groups. The quality assessment rated three studies as being of fair quality and one study as poor quality. Two of the included studies showed a 100% success of pulpotomy with platelet concentrates and two studies showed more than 80% of success, but the difference between control group and platelet concentrates group was not statistically significant. To conclude, the number of publications that met all inclusion criteria was found to be very limited and no significant difference was reported in the studies comparing platelet concentrates with other materials in pulpotomy. The present results point to the need for high-quality randomized controlled trials in further research.

Pendulum and modified pendulum appliances for maxillary molar distalization in Class II malocclusion - a systematic review.

OBJECTIVE: The main purpose of the present systematic review was to evaluate the quantitative effects of the pendulum appliance and modified pendulum appliances for maxillary molar distalization in Class II malocclusion. MATERIALS AND METHODS: Our systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus and key journals and review articles; the date of the last search was 30 January 2017. We graded the methodological quality of the studies by means of the Quality Assessment Tool for Quantitative Studies, developed for the Effective Public Health Practice Project (EPHPP). RESULTS: In total, 203 studies were identified for screening, and 25 studies were eligible. The quality assessment rated four (16%) of the study as being of strong quality and 21 (84%) of these studies as being of moderate quality. The pendulum appliances showed mean molar distalization of 2-6.4 mm, distal tipping of molars from 6.67° to 14.50° and anchorage loss with mean premolar and incisor mesial movement of 1.63-3.6 mm and 0.9-6.5 mm, respectively. The bone anchored pendulum appliances (BAPAs) showed mean molar distalization of 4.8-6.4 mm, distal tipping of molars from 9° to 11.3° and mean premolar distalization of 2.7-5.4 mm. CONCLUSIONS: Pendulum and modified pendulum appliances are effective in molar distalization. Pendulum appliance with K-loop modification, implant supported pendulum appliance and BAPA significantly reduced anchorage loss of the anterior teeth and distal tipping of the molar teeth.

Caries Incidence Among Obese Adolescents: A 3-year Prospective Study.

PURPOSE: To determine the incidence of caries in a 3-year follow-up of obese adolescents. MATERIALS AND METHODS: Seven-hundred eighty five 13-year-old school children were selected randomly. Caries was recorded according to WHO criteria and body mass index was assessed in a medical evaluation. With appropriate sample weighting, relationships between caries and other variables were assessed using the chi-squared test, Kruskal-Wallis H-test, and multivariable logistic regression. RESULTS: At baseline, 185 (24.2%) adolescents presented with caries, having mean DMFT and DMFS scores of 0.9 ± 2.0 and 2.4 ± 3.6, respectively. The accumulated incidence of caries during the 3-year period of study was 16.5%, with mean DMFT and DMFS increments of 0.8 ± 0.2 and 1.1 ± 3.3, respectively. Obese and overweight adolescents had a 3.7 times (95% CI = 1.3-6.8) greater chance of developing caries after adjusting for socioeconomic status, gender, use of fluoridated dentifrice, and past caries experience. CONCLUSION: Obese and overweight adolescents were at a higher risk of developing new caries in a 3-year-follow-up.

Untreated Gross Dental Malocclusion in Adolescents: Psychological Impact and Effect on Academic Performance in School.

PURPOSE: To evaluate the psychological impact and effect on academic performance of untreated gross dental malocclusion in adolescents. MATERIALS AND METHODS: A total of 366 (181 girls and 185 boys) adolescents with gross dental malocclusion were selected for the study group. A modified oral aesthetic subjective impact scale questionnaire was applied in face-to-face interviews. Similar data were collected from parents, schoolteachers and one friend of each adolescent selected for the study. Academic performance was evaluated from school records and compared with a control group of 400 adolescents (200 girls and 200 boys) having normal occlusion and an aesthetically pleasing facial appearance. The Kruskal-Wallis H and chi-square tests were used to analyse the data. The correlation between the academic performance of adolescents and the psychological impact of malocclusion was assessed using the Spearman rank correlation. RESULTS: Significant numbers of adolescents (81.1%) were concerned about the appearance of their teeth, with significant gender variation (0.02). 88.5% of the adolescents received comments from others about their appearance. The results differed significantly by gender for 'avoiding smiling' (p = 0.02) and 'participation in social activities' (p = 0.02). The evaluation of academic performance showed that 42.1% of the adolescents with gross dental malocclusion performed below average; this also differed statistically significantly by gender (p = 0.04). CONCLUSION: Untreated gross dental malocclusion significantly affects the psychosocial well-being of adolescents, who may avoid participating in social activities and tend to underperform in school.

Incidence of dental trauma among obese adolescents--a 3-year-prospective study.

OBJECTIVES: The main objective of the present investigation was to estimate the incidence of traumatic dental injuries (TDI), in particular crown fractures in a 3-year follow-up of obese adolescents. MATERIALS AND METHODS: Seven hundred and eighty-five 13-year-old school children were selected randomly. The crown fracture was classified according to Andreasen's criteria by visual examination without radiographs. Body mass index of the study subjects was determined. Increased overjet was considered as a risk factor when it presented values higher than 3 mm, while lip coverage was classified as adequate or inadequate. With appropriate sample weighting, relationships between TDI and other variables were assessed using the chi-squared test, Kruskal-Wallis H-test and multivariable logistic regression. RESULTS: At baseline, 131 (17.15%) adolescents presented with TDI. The accumulated incidence of TDI during the 3-year period of study was 9.03%. Children with obesity and overweight were 2.78 times greater chance suffering TDI after adjusting for socioeconomic status, lip coverage, incisal overjet and previous history of trauma. Both at baseline and follow-up examination, most frequently affected tooth is right maxillary central incisor and most frequent type of TDI was enamel fracture (44.68%). CONCLUSION: Adolescents with obesity and overweight were a greater chance of TDI in a 3-year follow-up.

Maternal Periodontitis as a Possible Risk Factor for Preterm Birth and Low Birth Weight--A Prospective Study.

PURPOSE: To explore the association of maternal periodontitis with preterm delivery and low birth weight in the state of Karnataka, India. MATERIALS AND METHODS: A prospective study was conducted among 340 pregnant women between 18 and 28 years of age. Subjects filled out a questionnaire and underwent a periodontal examination during the second trimester of pregnancy. The questionnaire included details regarding socioeconomic status, passive exposure to cigarette smoking, medical and reproductive history. Periodontal examination was performed according to the community periodontal index and clinical attachment loss. Logistic regression analyses were used to assess the association of periodontitis with pregnancy outcomes. RESULTS: Of 340 subjects enrolled in the study, 33 (9.71%) were either excluded or not available for follow-up. Of the remaining 307 subjects, 126 (41.04%) had periodontitis. Among subjects with periodontitis, 15.87% had a preterm birth (PTB) and 34.25% had low birth weight (LBW) infants. In the periodontally healthy group, the rates of PTB and LBW deliveries were 9.39% and 18.78%, respectively. Logistic regression analysis showed a strong association between periodontitis and poor pregnancy outcomes after adjusting for all variables with OR 4.54 (95% CI=1.98-5.46) for PTB, and 5.32 (95% CI=2.01-6.79) for LBW. CONCLUSION: The results suggest that periodontitis is an independent risk factor for poor pregnancy outcome.

Acceptance of COVID-19 Vaccines in India: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis sought to evaluate the acceptability levels for COVID vaccine(s) in various states in India. Published articles in PubMed/Scopus/Cochrane/DOAJ/the Web of Science that focused on assessing COVID-19 vaccine hesitation/vaccine acceptance using a survey/questionnaire were included. After extensive research, 524 records were found, and after screening on the basis of eligibility criteria, only 23 papers were added to this review. Increased vaccine assumption percentage (>70%) among the population was found in two surveys nationwide (92.8%) and in Delhi (79.5%). For pooled estimates of COVID-19 vaccine acceptance and heterogeneity, twenty-three studies (23) consisting of 39,567 individuals reported for acceptance of COVID 19 vaccine in India.. Out of these, 26,028 individuals accepted the COVID-19 vaccine, giving a pooled estimate of 62.6% (95% CI: 55.6-69.4) with considerable heterogeneity (χ2 = 3397.3, p < 0.0001; I2 = 99.40%). The results of this study give a brief insight into the percentage acceptance and hesitancy among the Indian population regarding COVID-19 vaccine immunisation. Future research and vaccine education initiatives can be steered by the findings of this work as a starting point.

Gingival Biotype and Its Relation with Malocclusion.

Objective: To systematically review the relationship between gingival biotype (GT) and malocclusion. Methods: The review followed PRISMA standards of quality for systematic reviews and meta-analyses reporting with PROSPERO registration number CRD42020126543. The systematic database search included MEDLINE, Scopus, Embase, PsychINFO, CINAHL, and other key journals; the article search was performed until February 2020. Cochrane's risk of bias in non-randomized studies-of interventions (ROBINS-I) was used to grade the methodological quality of the included studies. Results: The systematic search identified 105 studies, six studies satisfied the inclusion criteria for eligibility. The study participants ranged from 26 to 200 (total n=812), with a mean of 135. Study participants were aged between 14 and 32 years. Five studies were graded as the moderate risk of bias and one study as low risk of bias. Two studies showed thin GT among individuals with severe crowding compared to mild crowding. Three studies showed a thin GT with a narrow zone of the keratinized gingival width compared to a thick GT. No relationship was found between GT and Angle's classification of malocclusion. Conclusion: No relationship was observed between Angle's classification of malocclusion and GT. Thin GT was prevalent among individuals with pro-inclination of incisors. Keratinized gingival width was narrow among individuals with thin GT.

Prevalence of Carbapenemase and Extended-Spectrum ß-Lactamase Producing Enterobacteriaceae: A Cross-Sectional Study.

Enterobacteriaceae have been classified as severely drug resistant bacteria by the World Health Organization due to their extensive production and dissemination of carbapenemases (CPs) and extended-spectrum ß-lactamases (ESBL). The current study was conducted with the aim to determine the prevalence of CP- and ESBL-producing Enterobacteriaceae, as well as their antibiotic susceptibility profiles. For this, a hospital-based study was conducted which included 384 participants with bacterial infections. The collection and processing of specimens was conducted per standard microbiological protocol. The samples were inoculated on agar media plates to obtain the bacterial growths, and if they were positive for any bacterial growth, the antibiotic susceptibility testing was performed using disk diffusion method to check their antibiotic susceptibility patterns. The double disc diffusion as well as carbapenem inhibition techniques were used to examine the CP enzymes. Multiplex real-time PCR technique was performed to identify three distinct genetic types of CPs that have been identified in the Enterobacteriaceae (KPC, NDM, and OXA-48). A majority of participants (58.3%) in the current study were living in urban areas. A total of 227 (59.1%) patients were hospitalized. Furthermore, 26.04% of the patients were determined to be suffering from infections with Enterobacteriaceae. Escherichia coli was the most prevalent (9.1%) isolate overall, followed by Klebsiella pneumoniae (8.07%), Acinetobacter baumannii (2.6%), Pseudomonas aeruginosa (3.1%), Enterobacter cloacae (1.3%), Proteus spp. (1.3%), and Morganella spp. (0.5%). The studied patients were suffering from urinary tract infections (48.6%), blood stream infections (32.2%), wounds infection (11.9%), and respiratory infections (7.03%), confirmed with bacterial cultures. The resistance against carbapenems was seen in 31.4% of E. coli isolates, 25.8% in K. pneumoniae, 50% in P. aeruginosa, 25% in A. baumannii, and 20% in E. cloacae isolates. Such high rates of CP- and ESBL-producing Enterobacteriaceae are alarming, suggesting high spread in the study area. It is advised to implement better infection prevention and control strategies and conduct further nationwide screening of the carriers of these pathogens. This might help in reducing the burden of highly resistant bugs.

Teething disturbances; prevalence of objective manifestations in children under age 4 months to 36 months.

OBJECTIVE: The aim of this study was to present data as responded by parents on teething manifestation during eruption of primary teeth and the occurrence of objective manifestations in children ages 4 months to 36 months. SETTINGS AND DESIGN: Hospital based face-to-face questionnaire study. STUDY DESIGN: One thousand and one hundred children ages four to 36 months who had at least one erupting tooth were included in the study. Parents were asked to complete a short questionnaire and children were then checked by one of the authors. STATISTICAL ANALYSIS USED: Chi-square analysis was performed to analyze information obtained. Level of significance was set at P<.05. RESULTS: There were 660 girls (60%) and 440 boys (40%) in the study. The most frequent clinical manifestations were: Fever (16%), drooling (12%), diarrhea (8%), fever-drooling (15%), fever-diarrhea(8%) and drooling-diarrhea (6%). In the study sample, boys demonstrated a higher prevalence of diarrhea than girls (P<.05). No statistical significance regarding other clinical manifestations and gender were observed. Teething manifestations were most prevalent during the eruption of primary incisors. Occurrence of clinical manifestations in 4-12 months and 13-24 months age was statistically significant when compared with 25-36 months age (P<0.05). CONCLUSIONS: An association has been shown between general objective manifestations like fever (the most prevalent), drooling and diarrhea, and the eruption of primary teeth. Most manifestations appeared during the eruption of the primary incisors.

Effect of surface treatment on the mechanical stability of orthodontic miniscrews.

OBJECTIVES: To provide collective quantitative evidence about the effect of surface treatments on the mechanical stability of orthodontic miniscrews (MSs). MATERIALS AND METHODS: The study was registered in PROSPERO (No. CRD42020209652). The research question was defined according to the PICO (population, intervention, control, and outcomes) format. Various research databases were searched for animal and human studies on effects of surface treatment on the mechanical stability of MSs. Both prospective and retrospective in vivo clinical studies published in English were included. The risk of bias was assessed using SYRCLE's risk of bias tool for animal studies. The meta-analysis was conducted using RevMan 5.4. RESULTS: A total of 109 articles were identified; 14 were included in the systematic review, and seven studies with sandblasting, acid etching (SLA) methods of surface treatment were included for meta-analysis. The number of study participants ranged from 6 to 24 (total n = 185), with a mean of 13.2. A total of 949 MSs were used with a mean of 67.8. The overall success rate for surface-treated MSs ranged from 47.9% to 100%. Forest plot of removal torque values showed significantly higher values for SLA surface-treated MSs compared with controls with a standard mean difference of 2.61 (95% confidence interval = 1.49-3.72, I2 = 85%). Forest plot of insertion torque showed a standard mean difference of -6.19 (95% confidence interval = -13.63-1.25, I2 = 98%, P = .10). CONCLUSIONS: Surface treatment of MSs improved primary and secondary stability with good osseointegration at the bone-implant surface. However, significant heterogeneity across the studies included in the meta-analysis made it difficult to draw conclusions.

Combined effect of CO2 concentration and low-cost urea repletion/starvation in Chlorella vulgaris for ameliorating growth metrics, total and non-polar lipid accumulation and fatty acid composition.

Different CO2 concentration such as 0.03, 5, 10 and 15% and low-cost urea repletion/starvation in Chlorella vulgaris on growth, total and non-polar lipid content and fatty acid composition was studied. Chlorella vulgaris grown at 0.03% CO2 apparently revealed inferior biomass yield 0.55 g/L on 14th day compared to CO2 supplemented cells. In the case of CO2 supply, 15% CO2 has unveiled higher biomass yield at about 1.83 g/L on day 12 whereas biomass yield for 5 and 10% CO2 supplemented cells was 1.61 and 1.73 g/L, respectively on 12th day of cultivation. The biomass productivity (g) per liter per day was 32 mg in control condition whereas it was 125, 134 and 144 mg/L/d in 5, 10 and 15% CO2 supplied cells, respectively. Lipid content of the strain grown at control, 5, 10 and 15% CO2 was 21.2, 22.1, 23.4 and 24.6%, respectively and however, without CO2 addition in low-cost urea repleted and urea depleted medium grown cells revealed 21.2 and 24.2%, respectively. Interestingly, strain grown at 15% CO2 supply in urea deplete medium yielded 28.7% lipid and contribution of non-polar lipids in total lipids is 69.7%. Further, the fatty acid composition of the strain grown in 15% CO2 supply in urea depleted medium showed C16:0, C16:1, C18:1 and C18:3 in the level of 30.12, 9.98, 23.43, and 11.97%, respectively compared to control and urea amended condition.

Bio-based algal (Chlorella vulgaris) refinery on de-oiled algae biomass cake: A study on biopolymer and biodiesel production.

In this study, a novel bio-refinery concept was designed for efficient utilization of de-oiled algae cake as bio-resource for biopolymer (Polyhydroxyalkanoates (PHB)) production and thereby making the biorefinery process more economical and sustainable by completely utilizing the algal biomass without the production of waste algal residues. Algal oil was extracted from Chlorella vulgaris biomass via Bligh and Dyer method for biodiesel production through parabolic solar trough collector. Maximum lipid yield was 27.5 wt% at a temperature of 45 °C with de-oiled cake (DC) yield of 0.37 g. Maximum algal oil conversion efficiency was 89% and 94% for 0.3 wt% of clam shell waste and commercial calcium oxide catalyst at 90 min. After a reaction time of 120 h, the glucose, soluble sugars, xylose, and arabinose in the DC was reduced by 53%, 21%, 63%, and 69% respectively. The maximum PHB yield was 0.41 g PHB/g DC. This study provides additional support for the algal refineries on sustainability and circular usage of algae biomass for production of multiple products.