Aim: The purpose of this in vitro study was to evaluate the color and microhardness of teeth subjected to different overthe- counter (OTC) whitening products in association or not with 10% carbamide peroxide (10% CP). Materials and methods: Enamel–dentin specimens (n = 210) were obtained from bovine incisors and stained. Half of the specimens were then subjected to daily cycles of staining (5 minutes), 10% CP bleaching (8 hours) in association with OTC products, and artificial saliva storage until complete 24 hours, for 2 weeks; the other half was subjected to daily cycles of staining, OTC treatment, and storage in artificial saliva for 12 weeks. The specimens were divided into 14 groups according to the OTC: CP-Water and Water (deionized water); CP-Listerine and Listerine (whitening mouth rinse); CP-Brushing and Brushing (mechanical brushing); CP-Colgate and Colgate (conventional toothpaste), CP-ColgateW and ColgateW, CP-OralBW and OralBW, and CP-CloseUpW and CloseUpW (whitening toothpaste). After staining and whitening, color and microhardness were measured. Data were submitted to analysis of variance (ANOVA) and the Tukey's test for multiple comparisons for color analysis and the paired t-test for microhardness analysis. Results: The CP and CloseUpW groups had the largest color change (ΔE₀₀). The teeth treated with Colgate increased significantly in microhardness after whitening. Conclusion: The association of 10% CP with OTC whitening agents did not increase the whitening effect or microhardness. The OTC agents containing hydrogen peroxide and abrasives had a similar effect to one another but were not as effective as the CP groups and the subgroup brushed only with blue covarine toothpaste. Clinical significance: The current study provides information about the mechanism of OTC whitening products. None of the whitening agents evaluated damaged the enamel when used according to the manufacturers’ instructions. The use of toothpaste containing hydrogen peroxide or abrasives cannot provide a whitening effect similar to at-home bleaching, and this does not improve with the association with 10% CP. However, toothpaste containing blue covarine has a satisfactory whitening effect immediately after brushing.

Aim: The aim of this study is to compare the effect of dental rehabilitation on oral health-related quality-of-life (OHRQoL) in children with special health care needs (CSHCN) and healthy children. Materials and methods: The prospective study's sample consisted of 213 parents of caries-affected children, who were aged 6 years or younger and were scheduled for dental rehabilitation under general anesthesia (DRGA). The parent–child dyads were recruited from three public hospitals in Jeddah between October 2014 and May 2016. They comprised healthy children (n = 133) and CSHCN (n = 80). Parents self-completed the early childhood oral health impact scale (ECOHIS) before and 1 month after DRGA. The parents also rated the overall oral health status of their children by answering a global question before and after DRGA. Results: At baseline, the CSHCN had significantly worse OHRQoL in most of the scale domains at 25.9 [standard deviation (SD) 11.3] and 19.9 (SD 10.3) respectively. The OHRQoL significantly improved in both groups postoperatively (p = 0.005, Wilcoxon rank-sum test). The effect size of the improvement in the CSHCN group (+1.8) was greater than that in the healthy group (+1.5) in all domains, except for the family impact and parental distress sections. Conclusion: The DRGA markedly improves OHRQoL in children aged 6 years or younger, and the improvement is even greater in CSHCN. Clinical significance: The substantial improvement in OHRQoL after DRGA highlights the importance of oral health care in young children, which should receive higher priority than it has been done to date.

Introduction: Salivary gland tumors are the most histologically heterogeneous group of tumors with the greatest diversity of morphologic features among their cells and tissues. The present study was aimed at assessing the validity of Ki-67, a cell proliferation marker, as a prognostic factor in benign and malignant salivary gland tumors and to study whether it is related to age, sex, anatomical site, and size of the lesion in salivary gland tumors. Materials and methods: A retrospective study consisted of benign salivary gland tumors (BSGTs) (n = 15), malignant salivary gland tumors (n = 18), and normal salivary gland parenchyma (n = 15). Results: There was a significant difference of Ki-67 labeling index (LI, %) in normal salivary gland parenchyma, BSGTs, and malignant salivary gland tumors. The Ki-67 LI (%) in normal salivary gland parenchyma is negligible (0.27 ± 0.31%), whereas malignant salivary gland tumors showed very high Ki-67 LI (%) of 18.79 ± 18.06% compared with BSGTs being 0.76 ± 2.02%. There was a significant correlation statistically of mean ± standard deviation (SD) of Ki-67 LI (%) with the age of the patients being the maximum (32.68 ± 15.87%) in the 50 to 59 years age group, whereas sex, site of the lesion, and size of the lesion in salivary gland tumors had no significant correlation. Conclusion: The Ki-67 is a useful marker for assessing proliferative potential of tumors. Clinical significance: The Ki-67 LI% can be used as a reliable adjuvant diagnostic tool to differentiate between the subtypes and grading of certain malignant tumors, such as mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (AdCC), and acinic cell carcinoma (AcCC), which are usually difficult to diagnose on histopathological criteria alone.

Introduction: Actinic cheilitis (AC) is a lesion potentially malignant that affects the lips after prolonged exposure to solar ultraviolet (UV) radiation. The present study aimed to assess and describe the proliferative cell activity, using silver-stained nucleolar organizer region (AgNOR) quantification proteins, and to investigate the potential associations between AgNORs and the clinical aspects of AC lesions. Materials and methods: Cases diagnosed with AC were selected and reviewed from Center of Histopathological Diagnosis of the Institute of Biological Sciences, Passo Fundo University, Brazil. Clinical data including clinical presentation of the patients affected with AC were collected. The AgNOR techniques were performed in all recovered cases. The different microscopic areas of interest were printed with magnification of ×1000, and in each case, 200 epithelial cell nuclei were randomly selected. The mean quantity in each nucleus for NORs was recorded. One-way analysis of variance was used for statistical analysis. Results: A total of 22 cases of AC were diagnosed. The patients were aged between 46 and 75 years (mean age: 55 years). Most of the patients affected were males presenting asymptomatic white plaque lesions in the lower lip. The mean value quantified for AgNORs was 2.4 ± 0.63, ranging between 1.49 and 3.82. No statistically significant difference was observed associating the quantity of AgNORs with the clinical aspects collected from the patients (p > 0.05). Conclusion: The present study reports the lack of association between the proliferative cell activity and the clinical aspects observed in patients affected by AC through the quantification of AgNORs. Clinical significance: Knowing the potential relation between the clinical aspects of AC and the proliferative cell activity quantified by AgNORs could play a significant role toward the early diagnosis of malignant lesions in the clinical practice.

Aim: The aim of the study was to evaluate the capacity to resist fracture in different core buildup materials with porcelain fused to metal (PFM) crown. Materials and methods: Totally, 45 mandibular single rooted first premolars were collected, which were sound along with similar shape and size. The teeth were sectioned at 15 mm above the root apex sparing the sound tooth structure. The teeth were endodontically treated with the crown-down technique using nickel–titanium (NiTi) instrumentation. The specimens were randomized into three groups as per the core materials used and were labeled accordingly. Group I consisted of dualcured composite resin, group II consisted of glass ionomer reinforced with resin, and group III consisted of Miracle mix. Universal loading machine is used for measuring the compressive load applied to fracture the tooth. Results: The mean value of compressive strength was maximum in the dual cured composite resin (598.42 ± 22.64) followed by glass ionomer reinforced with resin (478.88 ± 26.74) and Miracle mix (442.16 ± 30.10). The results showed a significant difference statistically within the core materials used with p < 0.05. The results from the Tukey's post hoc test of multiple comparisons between dual-cured composite resin vs glass ionomer reinforced with resin, dual-cured composite resin vs Miracle mix, and glass ionomer reinforced with resin vs Miracle mix showed a highly statistical difference with p < 0.05, which is significant. Conclusion: This in vitro study showed that the dual-cured composite resin had maximum resistance to fracture compared with other core buildup materials on teeth which were endodontically treated. Clinical significance: Restoration of a tooth which is structurally compromised is a tricky job for all the dentists. Restoring it with a proper core buildup material with adequate fracture resistance makes the tooth structure stable. The core material should be able to resist all types of occlusal forces and to distribute it equally within the tooth structure.

Aim: The aim of this study was to assess the fracture strength of posterior crowns made of Adoro and Gradia fiber-reinforced composites (FRCs). Materials and methods: In this in vitro, experimental study, extracted sound 37 maxillary first and second premolars were selected. A celluloid index was taken from teeth and the teeth received crown preparation. Impressions were made and poured. Composite crowns were fabricated of Adoro and Gradia composite resins. After curing, the teeth were immersed in distilled water for 24 hours and thermal cycled for 6,000 cycles between 5 and 55°C. Load was applied at a crosshead speed of 1 mm/minute and the fracture strength was measured. Specimens were inspected under a stereomicroscope to determine the mode of failure. Results: The fracture strength was 1,631.77 N for Gradia and 1,569.84 N for Adoro. The difference between the fracture strength of the two groups was not significant (p > 0.05). The mode of failure was cohesive in composite in 7 specimens and adhesive between composite and fiber in 12 specimens in the Gradia group. In the Adoro group, the mode of failure was cohesive within composite in 11 specimens and adhesive between composite and fiber in 7 specimens. Complete tear of fiber did not occur in any group. Conclusion: The fracture strength of Gradia and Adoro composites is not significantly different. Clinical significance: Cohesive fracture within the fiber did not occur in any case in our study and the mode of failure was adhesive at the fiber–composite interface or cohesive within the composite in most specimens.

Aim: To assess the prevalence of oral findings in diabetic and nondiabetic chronic renal failure (CRF) patients receiving hemodialysis (HD). Materials and methods: This study was conducted on 144 CRF patients undergoing HD therapy. They were further classified into diabetic and nondiabetic groups and also according to the duration of CRF. An oral examination was performed, searching for CRF-associated oral findings, along with due considerations to duration of CRF. Results: The oral manifestations were found to be higher in diabetic CRF patients (97.14%) relative to nondiabetic CRF patients (89.18%). The diabetic group exhibited a significantly higher number of patients with poor oral hygiene index (p = 000), uremic fetor (p = 0.005), unpleasant taste (p = 0.009), dry-fissured lips (p = 0.002), and pale mucosa (p = 0.019) than the nondiabetic group. The oral manifestations were significantly higher in CRF patients of more than 24 months’ duration. Conclusion: The CRF HD patients with diabetes mellitus exhibited a higher risk of oral uremic manifestations including uremic fetor, unpleasant taste, pale mucosa, and dry-fissured lips than nondiabetics. The oral health status of CRF HD patients becomes worse with the increase in the duration of CRF Clinical significance: Oral health status is often a neglected aspect in CRF patients. It should be given prime importance for CRF patients receiving HD to improve the quality of life.

Introduction: Modifying the durability of resin bonding systems resulted in introducing materials with cross-link property, such as chlorhexidine (CHX) that can promote the strength of resindentin bonding. The aim of this study was evaluation of the effect of CHX on shear bond strength (SBS) of self-etch (SE) and etchand- rinse (E&R) bonding systems to the primary teeth dentin. Materials and methods: In this in vitro study, 40 freshly extracted primary molars collected and were cut mesiodistally, and then the buccal and lingual surface enamel was grounded. The specimens were randomly divided into two groups: I: Single Bond adhesive and II: Clearfil SE Bond adhesive. Then, each group was divided into two subgroups: On the buccal surface of each sample (I1, II1), CHX was applied for 30 seconds and on the lingual surface of (I2, II2 groups), CHX was not applied. The SBS (MPa) of samples was assessed using the Zwick universal testing machine. Data were analyzed by paired t-test and independent t-test using Statistical Package for the Social Sciences (SPSS), version 16. Results: The mean SBS was significantly higher in the Single Bond group with CHX (66.45 ± 8.3) than without CHX (25.43 ± 12.94) in the nonaging group (p = 0.002). There was no significant difference in the mean SBS in the Clearfil SE Bond group with CHX and without CHX in the aging and nonaging groups. Conclusion: CHX had positive influence on immediate SBS of Single Bond adhesive to primary teeth dentin. In addition, no positive effect has been seen in the Clearfil SE Bond system. Clinical significance: Now more researches are needed about the recommendation of CHX in resin restorations of primary teeth.

Aim: The aim of the present study was to compare the antibacterial activity of a self-etching primer containing antibacterial monomer methacryloyloxydodecylpyridinium bromide (MDPB) (Clearfil protect bond) with a conventional self-etching primer without MDPB (Clearfil SE bond) against Streptococcus mutans and the effect of incorporation of MDPB on the tensile bond strength of the experimental self-etching primer (Clearfil protect bond). Materials and methods: The antibacterial activity of the selfetching primers was assessed using agar disk diffusion method and the diameters of the zones of inhibition were measured and ranked. For tensile bond strength testing, 20 noncarious human molars were selected and randomly divided into two groups comprising 10 teeth in each group. Group I specimens were treated with Clearfil SE bond (without MDPB). Group II specimens were treated with Clearfil protect bond (with MDPB). Composite material was placed incrementally and cured for 40 seconds in all the specimens. Tensile bond strength was estimated using the Instron Universal testing machine at a crosshead speed of 1 mm/min. Results: The addition of MDPB into a self-etching primer exerts potential antibacterial effect against S. mutans. The tensile bond strength of MDPB containing self-etching primer was slightly lower than that of the conventional self-etching Clearfil protect bond primer, but the difference was not statistically significant. Conclusion: Thus, a self-etching primer containing MDPB will be a boon to adhesive dentistry as it has bactericidal property with adequate tensile bond strength. Clinical significance: The concept of prevention of extension in adhesive dentistry would result in micro/nanoleakage due to the presence of residual bacteria in the cavity. Self-etching primers with MDPB would improve the longevity of such restorations by providing adequate antibacterial activity without compromising the bond strength.

Aim: The present study was conducted with an aim to assess the antimicrobial activity of Ocimum sanctum (tulsi) extract on Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. Materials and methods: Tulsi extract with ethanol was prepared using cold extraction method in the present in vitro study. Various concentrations (2, 4, 6, and 8%) were then obtained by dilution with dimethylformamide. A 0.2% chlorhexidine served as the positive control, whereas the negative control was dimethylformamide. Zones of inhibition were measured, each for A. actinomycetemcomitans and P. gingivalis. For comparison within the group and between the study groups, one-way analysis of variance (ANOVA) and Tukey's post hoc tests were used. A statistical significance level of p < 0.05 was established. Results: The 8% concentration of the tulsi extract showed maximum zone of inhibition against A. actinomycetemcomitans and P. gingivalis (40.10 ± 0.90, 33.79 ± 1.82 mm), followed by the 6, 4, and 2% concentrations. The 0.2% chlorhexidine, which was the positive control, had 39.80 ± 1.24 and 32.28 ± 1.28 mm zones of inhibition; dimethylformamide showed 13.55 ± 1.92 and 10.21 ± 2.16 mm zones of inhibition against both the microorganisms. The ANOVA showed highly statistically significant (p < 0.0001) results between and within the groups. The antimicrobial activity of tulsi extract at 6 and 8% concentrations, and 0.2% chlorhexidine against A. actinomycetemcomitans showed statistically significant differences between the groups. The concentration of tulsi extract at 8 and 0.2% chlorhexidine on P. gingivalis showed statistically significant differences between the groups. Conclusion: It was concluded that 8% concentration of O. sanctum (tulsi) extract showed the maximum antimicrobial activity against A. actinomycetemcomitans and P. gingivalis. It is thus recommended that this may be useful as an adjunctive to mechanical therapy in the prevention and treatment of periodontal diseases. Clinical significance: O. sanctum (tulsi) is a herb that is abundantly available, easily accessible, economically feasible, and culturally acceptable. Therefore, it is very useful in the management of oral diseases and also for overcoming many barriers that exist for the utilization of dental services, such as affordability, accessibility, availability, and acceptability.

Aim: The aim of this study was to compare the remineralization potential of three different dentifrices using Raman spectroscopy and confocal laser scanning microscopy (CLSM). Materials and methods: Totally, 30 extracted intact impacted third molar teeth were selected and the crown of each tooth in a group was separated from the root and longitudinally sectioned into four parts with each section under a subgroup, of which one section was an untreated section, the second and the third sections were demineralized in a demineralizing solution, and the third section was remineralized after demineralization. The teeth in the three groups were demineralized for 4 days and then treated with 0.21% sodium fluoride dentifrice with tricalcium phosphate, casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), and NovaMin for 14 days, following which the teeth surfaces were studied using Raman spectroscopy and CLSM to assess the remineralization potential of the three dentifrices. The data were recorded and analyzed statistically. Results: Raman spectroscopic analysis revealed better remineralization with CPP-ACP, which was statistically significant from the groups treated with the NovaMin dentifrice and the fluoridecontaining dentifrice. Confocal laser scanning microscopic examination also revealed significant differences between the three groups with the NovaMin-containing dentifrice demonstrating a greater remineralization of the surface when compared with the CPP-ACP dentifrice. The teeth samples treated with fluoride-containing dentifrice demonstrated the least remineralization among the three groups. Conclusion: It can be concluded that the demineralized samples of teeth treated with CPP-ACP showed the highest concentration of phosphate ions when analyzed using Raman spectroscopy, and the microscopic examination using confocal laser revealed a better surface remineralization of the demineralized samples when treated with the NovaMin technology. Clinical significance: There is a great need to find ways to enhance the remineralization process and transfer such knowledge into clinical therapy to alter caries balance for the better, especially in individuals with a high cariogenic bacterial challenge.

Introduction: The success of dental implants depends primarily on the primary implant stability and the bone density so that predictable osseointegration can be achieved. To achieve the desired results, systematic preoperative planning for implant placement is required. The sole aim of the study was to assess the reliability of preoperative bone density of mandibular posterior region for implant placement using computerized tomography-derived bone densities in Hounsfield units (HU). Materials and methods: A total of 200 patients with 352 implant sites between 2014 and 2017 were assessed for the posterior mandibular area using cone-beam computed tomography (CBCT). Evaluation was done by two experienced observers independently. Results: The mean bone density of males was 690.5 ± 104.12 HU and in females, it was 580.20 ± 120.2 HU. Overall, 21% of sites were of low bone density, 39.5% were of intermediate density, and 39.4% were of high density. Receiver operating characteristic (ROC) analysis presented that the CBCT intensity values had a high predictive power for predicting both highdensity sites and intermediate-density sites. Conclusion: We can say from our results that, for predicting the bone densities in posterior mandible for determining implant sites, so as to achieve best osseointegration, CBCT values can be reliably used. Clinical significance: It has been proved that bone density and implant stability are dependent on each other and osseointegration is important for the success of treatment. With advancements in dentistry and introduction of CBCT, treatment planning and prediction of appropriate implant sites could be made easy and more predictable. Thus, we can say that CBCT can be considered an alternative diagnostic tool for the bone density evaluation during treatment planning for implant placement.

Aim: The aim of this study is (1) to inspect any difference in mandibular arch widths between males and females in class I and class II division 1 (class II-1) malocclusions using cone-beam computed tomography (CBCT), (2) to compare the mandibular dental and basal widths between the two groups, and (3) to investigate any possible correlation between dental and basal arch widths in both groups. Materials and methods: The CBCT images of 68 patients aged between 18 and 25 years consisted of 34 class I (17 males and 17 females) and 34 class II-1 (17 males and 17 females) who were recruited at the Department of Orthodontics, University of Damascus Dental School (Syria). Using on-demand threedimensional (3D) on axial views, facial axis points for dental measurements and basal bone center (BBC) points for basal measurements were identified on lower canines and first molars. Dental and basal intercanine width (ICW) and intermolar width (IMW) were measured. Results: Independent t-test showed a statistically significant difference between males and females in several variables in both groups and a statistically significant difference between class I and class II-1 groups in the basal ICW for both genders and in the dental ICW for females only (p < 0.05). In class I group, Pearson's correlation coefficients between dental and basal measurements showed a strong correlation in the IMW for both genders (r. 0.73; p < 0.01) and a moderate correlation in females' ICW (r = 0.67; p < 0.01). In the class II-1 group, a moderate correlation in females' IMW (r = 0.67; p < 0.01) was found. Conclusion: Females compared with males had narrower dimensions. Class I patients had larger ICW than class II-1 patients in all measurements and had narrower IMW than class II-1 in most measurements for both genders. There were moderate-to-strong correlations between dental and basal dimensions. BBC points might be landmarks that accurately represent the basal bone arch. Clinical significance: CBCT-based assessments of dental and basal arch dimensions provide a great opportunity to accurately evaluate these aspects, to enhance clinicians’ decisions regarding proper tooth movements, and to achieve good dentoalveolar intra-arch harmony.

Aim: The aim of this study was to determine the impact of oral health and socioeconomic variables on the quality of life in a sample of low-income Brazilians. Materials and methods: The sample consisted of 400 adults assisted by the Rescuing Smiles Social Program (Pernambuco University) in June 2014 in the town of Arcoverde, Pernambuco. Two 18+ physically and mentally healthy people were chosen to participate in the study per household. The data obtained were analyzed using Kruskal–Wallis and Mann–Whitney tests. Results: About 75% of participants were female, averaging 42.65 years; 59% had elementary schooling and 27% were illiterate; 63% of them needed dental restorative treatment, 59.5% periodontal, and 43.3% surgical procedures; and 68.2% of the respondents showed partial tooth loss, 22.8% were totally edentulous, and 9% had full dentition. Oral health impact profile (OHIP)-14 average score was 14.91, considered low. The highest averages were observed in low-income individuals (16.25). Individuals with total or partial tooth loss had an average 14.26 and 15.79, respectively, thus showing a statistically significant difference as compared with total dentate (9.86). Conclusion: Although low-income individuals with tooth loss showed the highest OHIP-14 averages, it could be concluded that oral condition did not affect the quality of life of most individuals in the population studied. Clinical significance: Thus, oral health did not have a significant impact on respondent health awareness. This study showed the need to better inform the public of the relevance of oral health to quality of life.

Aim: Retention is one of the stages of orthodontic treatment, which is an attempt to retain teeth in their corrected positions after active treatment with the use of fixed orthodontic appliances. The aim of the present study was to compare the stability of the results of orthodontic treatment and the gingival health between Hawley retainer (HR) and vacuum-formed retainer (VFR) with two different thicknesses. Materials and methods: In this randomized clinical trial, 66 patients undergoing comprehensive orthodontic treatment in a private office were evaluated after completion of treatment. The subjects were randomly assigned to three groups. At the end of orthodontic treatment, the subjects in all the groups received a fixed bonded retainer in the mandible; in the maxilla, group I received an HR, group II received a VFR with a thickness of 1.5 mm, and group III received a VFR with a thickness of 1 mm. The American Board of Orthodontics objective grading system (ABO-OGS) index was used at the end of treatment (before the delivery of the retainers) and 6 months after the use of retainers to evaluate the stability of the results of orthodontic treatment. Gingival index (GI) was used at the two above-mentioned intervals to evaluate gingival health. The ABO-OGS measurements were carried out on dental casts by a clinician who was blinded to the types of retainers the patients wore. Data were analyzed with Statistical Package for the Social Sciences (SPSS) version 20, using proper statistical analyses. Results: Six months after the delivery of retainers, ABO-OGS and GI scores with the 1.5 mm VFR were higher than those in the two other groups, with no significant differences between the three groups. There were no significant differences between the ABO-OGS scores before the delivery of retainers and 6 months after the use of retainers in any of the study groups. In the HR and 1.5 mm VFR groups, there were significant differences in GI scores between the period before the delivery of the retainers and 6 months after their delivery; however, in the 1 mm VFR group, no significant differences were observed in GI scores between the two time intervals. Conclusion: Hawley retainer and 1 mm thick and 1.5 mm thick VFRs were equally effective in preserving and stabilizing the results of orthodontic treatment during the 6-month interval after the completion of orthodontic treatment. In addition, there were no significant differences between the three retainers in relation to gingival health. Clinical significance: The VFR might be a good alternative for HR due to its better esthetic appearance and greater popularity with orthodontic patients.

Aim: This study was conducted to clinically evaluate the effect of low-level laser therapy (LLLT) as a method of reducing pain reported by patients after placement of their first orthodontic archwires. Materials and methods: A sample of 10 patients with an age group of 12 to 26 years with moderate-to-severe anterior crowding was selected. Each patient was assigned to an experimental group (left quadrant with laser therapy) and a control group (right quadrant with no laser therapy). Low-level laser therapy was given immediately after the placement of initial archwire. All patients were instructed to fill up a survey form at home over the next 7 days. Results: The results revealed that the average onset of pain in the experimental group (16.10 hours) was significantly reduced when compared with the control group (3.10 hours). The most painful day was similar for both the groups. The pain ceased much sooner in the experimental group than in the control group. The intensity of pain was lesser in the experimental group when compared with the control group. Conclusion: Low-level laser therapy was an effective and noninvasive method for controlling pain in orthodontic patients after receiving their first archwires. The duration and intensity of pain reduced with the application of LLLT. Clinical significance: Pain reduction during orthodontic procedures.

Aim: Smokeless tobacco (ST) use is a significant health risk and cause of disease. Most studies conducted in the Kingdom of Saudi Arabia (KSA) focused on cigarette smoking. Therefore, the objective was to study the epidemiologic pattern and types of oral ST usage in northern and western Saudi Arabia. Materials and methods: A total of 428 volunteers living in three cities (Hail, Mecca, and Tabuk) were investigated. All of the study subjects were currently ST users of one type or more, including toombak, shammah, pan masala (PM), Afdhal, Nashooq, and others. Results: Most of the study population were found to use toombak representing 127/428 (29.7%), followed by shammah, PM, Afdhal, Nashooq, Adani, Qat, Majun, and others, representing 67/428 (15.7%), 66/428 (15.4%), 44/428 (10.3%), 36/428 (8.4%), 32/428 (7.5%), 23/428 (5.4%), 22/428 (5.1%), 21/428 (4.9%), and 13/428 (3%) respectively. Conclusion: This survey showed a high prevalence of existing ST usage among foreign workers and Saudis, which can establish a prospective public health problem. Clinical significance: Smokeless tobacco cessation is a crucial element of tobacco control policy since it is the most important determinant of many diseases, including oral cancer.

Background: Patients present with malocclusions in the form of bilateral open bite with functional and esthetic challenges. These are particularly so whereby these are acquired through growth anomalies that create a change in the occlusal status whereby a patient has to adapt to the challenge of the occlusal change. While surgical intervention is a considered option to correct such changes, not all patients are willing to endure the consequences of this intervention and as such this report presents a conservative minimally invasive approach. Aim: This clinical report demonstrates a nonsurgical approach in the management of a patient with bilateral metabolically active condylar hyperplasia. Case report: The patient presented with a bilateral open bite with occlusal contacts only present on her second molars. The severity of the open bite was reported to be recently progressing and getting worse. This condition had impaired her chewing function and quality of life over an 8-year period. Bone scintigraphy was performed and metabolically active bilateral condylar hyperplasia was diagnosed. The patient refused surgical intervention and instead a conservative overlay denture was prescribed, which successfully restored her function and esthetics. Conclusion: Removable overlay dentures can be a relatively simple and effective treatment option for patients presenting with newly acquired bilateral open bites to give a functional and esthetic outcome. Clinical significance: This clinical report shows the conservative management of bilateral condylar hyperplasia with a simple removable overlay appliance. The occlusion has stabilized and the patient functions well.

Aim and background: This case report describes a 74-year-old female patient whose teeth were rehabilitated using telescopic crowns (TCs) on abutments and fixed dental prostheses (FDPs) in the maxillary arch with the aid of computer-assisted design and computer-assisted manufacturing (CAD/CAM) technology. The mandibular arch was restored using casted removable dental prostheses (RDPs) and surveyed crowns. Case report: The treatment sequences were followed as recommended in the dental literature. First, existing defective restorations were eliminated, caries was removed, and excellent mouth preparation was performed. Subsequently, root canal treatments and post and core placements were conducted. The casts were mounted, and a new vertical dimension was established. Maxillary telescopic FDP and mandibular prostheses were fabricated. Finally, a regular and proper follow-up and maintenance program was implemented. Conclusion: The patient was satisfied with the esthetics and function of the telescopic FDP in the presence of the established occlusion. Clinical significance: The secondary coping of the telescopic FDP is cemented with temporary cement, which can be changed easily whenever it is loose. Furthermore, it is completely opposed to RDP in the mandibular posterior masticatory area. The prognoses will be good improvement; the patient was medically fit, motivated, and followed continual oral hygiene protocol.