Aim: This study aimed to evaluate the effect of pseudocolor filter in micro-computed tomography (CT) images for the detection of proximal and occlusal caries lesions in primary molars. Materials and methods: For this in vitro analysis, 26 extracted human primary teeth were scanned using a compact micro-CT device (Skyscan 1172, Bruker micro-CT, Kontich, Belgium) and the projection images were reconstructed into cross-sectional slices (NRecon v.1.6.9, Bruker micro-CT, Kontich, Belgium). The original and pseudocolor images were evaluated twice by three calibrated radiologists. The tooth surfaces were scored according to Mejàre et al. criteria. The agreement was assessed by the Kappa coefficient, and the Chi-square test was used to evaluate the association between radiolucent lesion depth in enamel and dentin. Results: There was a good intra-observer agreement for detecting proximal caries lesions with or without using pseudocolor filter (k > 0.60). The inter-examiner agreement had similar results, and the agreement rates were good or moderate for the proximal surfaces. There were no statistically significant differences between the original and pseudocolor images (p > 0.05). The pseudocolor filter showed high sensitivity and specificity when compared with the original image with the exception of the occlusal face in enamel. Conclusion: The pseudocolor filter appears to be a promising enhancement tool for micro-CT images used for the detection of caries lesions in primary molars; even if it was not significantly different from the original images. Clinical significance: The pseudocolor filter converts grey scale images into color images. It is present in micro-CT software and must increase the diagnostic capacity of detecting caries lesion in occlusal and proximal surfaces.

Aim: The study evaluated the marginal vertical misfit of feldspathic ceramic crowns fabricated by the computer-aided design (CAD)/computer-aided manufacturing (CAM) technology and compared the two methods of scanning techniques: direct digital impression and indirect digital impression. Materials and methods: The titanium specimens were divided into two groups: scanning with the direct digital impression (DDI) at the milled prosthetic abutment level and indirect digital impression (IDI) at the cast model and after milled feldspathic ceramics blocks. Vertical marginal misfit was analyzed. The t-test was used for the analysis of the comparison factor between the groups and the one-way analysis of variance (ANOVA) test, and post hoc Tukey test was used to compare the variance of crown analysis regions within the group. A significance level of 5% was considered for the analyses. Results: There was no significant difference in vertical marginal misfit between the groups of DDI and IDI (p = 0.345). In relation to each region measured within the studied groups, it was observed the similarity between the six regions analyzed in the DDI group (p > 0.05) and IDI group, a significant difference between two areas. Conclusion: The vertical marginal adaptation was similar between digital scanning methods. Based on the data evaluated, vertical marginal adaptation indices were within acceptable clinical standards. Clinical significance: The direct digital scanning in unit bodies was reliable, pointing that the coating of titanium dioxide in the titanium abutment did not negatively influence the vertical marginal adaptation of the feldspathic ceramic crowns.

Aim: This in vitro study was conducted to measure and compare the incidence of dentinal defects caused by (RECIPROC blue, ProTaper Gold, ProTaper NEXT and RECIPROC) nickel titanium (NiTi) rotary instruments. Materials and methods: Seventy-five palatal roots of freshly extracted human maxillary first molars were used in this study. The total samples were randomly divided into five groups. Each group contained 15 samples (N = 15): group I: single file RECIPROC system, group II: ProTaper Next system, group III: ProTaper GOLD system, group IV: single file RECIPROC blue system and Group V: control group (No preparation). Root canal instrumentation were carried out according to manufacturer's instructions for each instrumentation system to # 40 apical size. Each root sample was sectioned horizontally at 2 mm, 4.5 mm and 7 mm, respectively from the apex. All root sections were observed under a stereomicroscope at 25X magnification. Results: The roots prepared by Reciproc showed the highest incidence of dentinal defects followed by ProTaper NEXT, ProTaper Gold then RECIPROC blue group which showed the lowest incidence of dentinal defects. The data obtained were analyzed statistically using Fisher's exact test at or equal to 5% significance levels. Fisher's exact test revealed that RECIPROC groups had a significant difference when compared with RECIPROC blue (p. 0.01) and with ProTaper Gold (p. 0.05) groups. While, other comparisons between each pair of groups revealed a non-significant difference between groups (p > 0.05). Regarding dentinal defects at different levels (apical, middle, coronal), Fisher's exact test showed that there was a non-significant difference in the incidence of dentinal defects when comparing among different levels in the same group or when comparing among different groups at the same level (p > 0.05). Conclusion: all experimental groups showed dentinal defects while no dentinal defects were observed in the negative control group. Clinical significance: the potential of root fracture is reduced using more flexible Ni Ti rotary instruments.

Aim: The aim of this study was to in vitro evaluate the apical sealability of mineral trioxide aggregate (MTA) when used as an orthograde root filling material, and to evaluate whether smear layer removal has any influence on the apical seal of this material. Materials and methods: Forty single-rooted human mandibular premolars were selected in this in vitro study. The selected teeth were randomly divided into two equal groups (n = 20) based on the irrigation type. Group 1 was irrigated using distilled water to keep the smear layer intact, and group 2 was irrigated using NaOCl 5.25% and ethylenediaminetetraacetic acid (EDTA) 17% to remove the smear layer. All teeth were instrumented using a step-back technique and obturated using white MTA. Microleakage of 0.2% rhodamine B solution at the tooth-material interface was evaluated to assess the apical seal of MTA. The data were analyzed statistically using Mann–Whitney test U-test (p = 0.05). Results: When the smear layer was present, MTA revealed less leakage compared to the group of MTA without smear layer with statistically significant difference (p <0.05). Conclusion: The apical seal produced by MTA when smear layer is left intact was better than the apical seal of MTA when smear layer is removed. It can be stated that MTA is a promising root canal filling material with good sealing ability in the presence of a smear layer. Clinical significance: Using white MTA material for the obturation of root canals is a useful procedure. It could be done without complexity in irrigation during root canal treatment and cause no discoloration to the teeth.

Aim: This study sought to assess perception of facial esthetics by laypersons and dental professionals. Materials and methods: Three standard photographs were digitally manipulated involving three facial characteristics; facial symmetry, facial profile and facial vertical proportions. A sample of 465 [142 laypersons (LP), 97 dental assistants (DA), 152 general dental practitioners (GDP) and 74 dental specialists (DS)] evaluated the standard and the manipulated images on a visual analogue scale ranging from 1 (the less pleasant image) to 5 (the standard image). The responses were analyzed using Kruskal–Wallis and Mann-Whitney tests. A p value of <0.05 was considered significant. Results: The overall score was 61.29 ± 16.19% with no statistical difference by gender. GDP showed significantly higher perception score than LP, DA and DS did. Regarding the individual facial esthetic components, females showed significantly better perception for “facial profile”, while males showed significantly better perception for “facial symmetry” and “facial vertical proportions”. Facial symmetry and facial vertical proportions were perceived differently with the higher perception score for the GDP and the lowest perception scores were for LP. Conclusion: Remarkable variations do exist with regard to facial esthetic perception by LP, DA, GDP and DS, with GDP showed more favorable perception. Clinical significance: Perception of facial esthetics by laypersons and dental practitioners with a different level of dental education and clinical experience gives an indication about the difference between the patients’ desire and the practitioners’ perception of such esthetic demands.

Aim: The objective of the study is to evaluate the cervicalapical sealing of bulk-fill flow resins associated with a universal adhesive system, in endodontically treated teeth, considering two methods of evaluation. Materials and methods: The samples used in the bacterial leakage analysis were autoclaved, filled inside a laminar flow chamber, and divided into four experimental groups (n = 8) according to the restorative material: Filtek Bulk-fill flow; Surefil SDR flow; Tetric Evoflow and the positive control. The samples were inoculated with the Enterococcus faecalis (E. faecalis), every 7 days and the microleakage was evaluated on a daily basis for 60 days. Microleakage tested with dye (n = 5) was considered in 2-time intervals of evaluation (24 hours and 72 hours), and the results were obtained in scores from 0–5. Data were submitted to the statistical tests, at a level of significance of 0.05. Results: About 12.5% of the FBF specimens showed bacterial microleakage as from the thirteenth day, and SDR, from the 20th day. TEF presented the highest percentage of microleakage at 40 days, concluding the 60 days with 37.5% of viable specimens. The Log-rank test revealed that the survival curve of TEF was statistically significant in comparison with those of the other groups. In the test with dye TEF and SDR presented the highest and lowest rate of microleakage, respectively, with statistically significant differences in the time interval of 72h. Conclusion: The resins FBF, SDR, and TEF were incapable of promoting the hermetic sealing of fillings in the root canal system. Clinical significance: No bulk-fill flux studied was able to completely eliminate microleakage, despite the best performance with respect to the microleakage time presented by Filtek Bulk fill, followed by Surefil SDR flow.

Aim: To evaluate the efficacy of irrigation of periodontal pockets by using ozonated water and 0.2% chlorhexidine (CHX) gluconate as adjuncts to scaling and root planing in the management of chronic periodontitis. Materials and methods: For the present study, 20 patients in the age group of 30–60 years, suffering from chronic periodontitis presenting with at least one site with an almost similar pocket depth of 4–6 mm in both the quadrants of maxillary arch was taken. Irrigation was done after 2 weeks of scaling and root planning on the same day with ozonated water and 0.2% chlorhexidine gluconate for two and half minutes. The clinical parameters like gingival index, probing pocket depth (PPD) and clinical attachment level (CAL) were recorded for both the groups at the baseline visit. They were subsequently recalled after 4 weeks and 3 months interval from the baseline visit. Data thus collected was compiled and put to statistical analysis. Results: The present study showed significant results in both the groups with regards to the improvement in the clinical parameters. When comparison was made between the two groups, ozonated water showed slightly better improvement than the chlorhexidine group. However, a statistically significant difference was seen only with Plaque score. Conclusion: Subgingival irrigation with ozonized water is beneficial than present conventional therapeutic modalities. Ozonated water restricts the formation of dental plaque and reduces the number of subgingival pathogens thereby treating periodontal diseases. Clinical significance: Ozone therapy is proving to be a new useful treatment modality which offers great benefits to the patients. The strong antimicrobial power of ozone, along with its ability to stimulate the circulatory system and modulate the immune response, makes it a remedial agent of choice in the treatment of various infectious oral diseases. The study was conducted to justify the routine use of ozone as a treatment modality in effective management of periodontal diseases.

Aim: To assess the knowledge about dental ergonomics and work-related musculoskeletal disorders (WRMSDs) among dental students of King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia, undergoing practical clinical training. Materials and methods: A self-designed questionnaire after pre-testing was distributed to 150 dental students of KSU undergoing clinical training, to collect data related to (a) basic knowledge about dental ergonomics; (b) any course/workshop about dental ergonomics attended; (c) basic knowledge about WRMSDs; (d) familiarity about preventive measures to decrease the risk of WRMSDs; and (e) knowledge about treatment options for WRMSDs. Results: One hundred forty-two students (95%) returned the completed questionnaires, of them 54 (38%) were males and 88 (62%) were females. The main findings of the study are that only 30% of the students knew about dental ergonomics; 93% of students have not attended any course/workshop about dental ergonomics; about half the students knew about WRMSDs; 62% of the students did not know about preventive measures to decrease the risk of WRMSDs, and 80% of students did not have knowledge about treatment options for WRMSDs. In general, female students had a better understanding of dental ergonomics and WRMSDs than male students. Conclusion: The basic knowledge of the dental ergonomics among dental students at King Saud University, Riyadh, Kingdom of Saudi Arabia is not adequate. Clinical significance: There is a need for introducing dedicated theoretical and practical courses covering all aspects of dental ergonomics in the undergraduate curriculum of dental education.

Aim: T-Wire and rotating motion of two-shape (2S), M-wire and rotating motion of ProTaper Gold (PG) are the recent innovations of Nickle Titanium (NiTi) rotary file system by means of thermal treatment. Therefore, a study was planned to assess the shaping ability of 2 Shape and ProTaper Gold using cone beam computed tomography (CBCT) Materials and methods: Thirty freshly extracted mandibular first molars were selected, and Pre-instrumentation CBCT imaging was performed to attain mesial and distal dentin wall measurements followed by chemo-mechanical preparation using the following NiTi files: 2S and ProTaper Gold. Post instrumentation CBCT imaging was performed for evaluation of the volume of removed dentin, apical transportation, and centering ratio. Statistical analysis was confirmed by a suitable analysis test with significance set at 0.05r. Results: In terms of the total volume of removed dentin, apical transportation, and centering ratio there was a significant difference noted between the tow-shape and ProTaper Gold. 2Shape performed better in all aspects compared to ProTaper Gold. Conclusion: Two-shape (2S) maintained better original canal anatomy and volume of removed dentin was also less during chemo-mechanical preparation when compared to ProTaper Gold. Clinical significance: Two-shape (2S) system when used clinically in patients may perform better and produce less canal transportation and canal preparation will be more centered as compared to the ProTaper Gold system.

Aim: Overhang is the extension of restorative material beyond the cavity preparation. It changes sulcus microflora into organisms conducive to chronic periodontitis. After overhang removal the gingival index and microflora return to a healthy state. This can also improve access for dental plaque removal. The aim of this study was to compare the efficacy of three different instruments in association with amalgam overhang removal. Materials and methods: One hundred thirty-five intact premolars were selected. The teeth were restored with amalgam such that restorations had 1 mm overhangs. Overhangs were removed employing three different instruments in three groups: sickle scaler, ultrasonic scaler, and diamond flame bur. A stereomicroscope was utilized to evaluate both the level of smoothness in the restored area, tooth damage and probable gaps. The data were analyzed using post hoc and Chi-square. Results: The minimum and maximum time of removal were respectively obtained by ultrasonic scaler and sickle scaler, which was statistically significant (p <0.0001). Also, smoothness of the restored area in the sickle scaler group was significantly less than the other methods (p <0.0001).The percentage of tooth damage in the diamond flame bur group was significantly greater than the others (p <0.0001). The data concerning gap size showed no significant difference. Conclusion: Ultrasonic scaler causes no significant damage to the tooth during an overhang removal procedure. In addition, it offers an acceptable level of surface smoothness in restorations and decreases the required time for overhang removal. Clinical significance: Ultrasonic scaler can be recommended as an effective instrument for amalgam overhang removal.

Aim: The aim of the present study was to compare and evaluate the flexural strength of heat-polymerized Lucitone 199 and SR Ivocap denture base resin materials which uses polymerization techniques of compression molding and injection molding respectively and effect of artificial saliva and distilled water on long-term. Materials and methods: Ninety specimens each from both the materials measuring 65 × 10 × 3 mm were prepared. After the polymerization, flexural strength was calculated after 24 hours (control group) without immersing in the liquid medium. The test group specimens immersed in saliva and distilled water at 370C was calculated for the flexural strength at 2 weeks, 1 month, 2 months and 4 months. The flexural strength was measured using a universal testing machine. One-way analysis of variance (ANOVA) method was used to analyze the data, pairwise comparisons were done using Bonferroni post hoc test with a probability of less than 0.05 were considered to be statistically significant. Results: The evaluation showed that, despite the duration of immersion and type of acrylic resin, high flexural strength was seen with specimens immersed in saliva than specimens under distilled water. The higher flexural strength was seen in SR Ivocap compared to that of Lucitone 199 with the p value less than 0.05 which showed significant statistically. Conclusion: From the results, we can conclude that the higher flexural strength was shown in specimens of SR Ivocap fabricated through injection molding technique compared to specimens of Lucitone 199 fabricated through compression molding technique after immersion in artificial saliva and distilled water for long term. Clinical significance: The homogeneous copolymer beads, the difference in the water sorption and powder to liquid ratios also affect the mechanical properties of the resins other than the type of resin used in the dentures base.

Aim: The aim of this survey was to assess the dentists’ knowledge, attitude and practice of endodontic treatment procedures and materials in Damascus city (capital of Syria), and the effect of endodontic specialty and years of experience on the survey findings. Materials and methods: Two hundred direct contacts (25 multiple-choice questions containing) questionnaires were distributed to randomly selected dentists practicing in Damascus city in 11 different areas, and a questionnaire contained questions regarding dentists’ knowledge, attitude, and practice of root canal treatment procedure. The collected data were entered into a personal computer and analyzed using the statistical package for the social sciences (SPSS), 25 edition. Results: One hundred eighty-eight questionnaires were collected with a 94% response rate. About 71.8% were general dental practitioners (GDPs), 25.5% were not practicing molar endodontics, and only 5.3% were referring difficult cases to endodontists. 32.4% and 21.8% of respondents were practicing vital and necrotic single visit root canal treatment, respectively. Only 6.9% were using rubber dam isolation, and more than half of the respondents used the standardized preparation technique. Non-setting calcium hydroxide was used 100% as an intra-canal medicament during necrotic root canal treatment sessions.96.3% of our respondents prefer delaying final restoration to next visit for symptoms disappearance. Conclusion: It was evident that more practicing experience does not improve treatment options selections of endodontic treatment. So the continuous educational programs are a very important way to change the old or wrong concepts in dental offices. Clinical significance: The sample covered a large number of dentists who are working in Damascus; the most developed place in Syria. It is also considered that for carrying out such kind of surveys as long as the dentists are familiar with this type of studies.

Aim: The aim of the current study was to assess the impact of weight loss on the gingival crevicular fluids (GCF) levels of adiponectin and TNF-á in obese patients with periodontal disease. Materials and methods: Sixty obese subjects were recruited into the study and were divided into three groups of 20 each. Group 1.periodontally healthy obese patients, group 2.obese patients with gingivitis, group 3.obese patients with periodontitis. The GCF levels of adiponectin and tumor necrosis factor ƒ¿ (TNF-ƒ¿) were evaluated using ELISA, and the same was correlated with the probing pocket depth (PPD) and clinical attachment loss (CAL) at baseline and after attainment of ≥10% weight reduction. Results: Reductions in body weight resulted in elevated adiponectin and reduced TNF-á levels in the GCF. Adiponectin levels showed significant positive correlations and TNF-á negative correlation with improved periodontal parameters. Conclusion: Weight reduction has an impact on obesity-related inflammatory changes on periodontal disease. Clinical significance: Obesity can be a potential risk factor for periodontitis, weight reduction measures can considerably reduce the inflammatory burden on the periodontium.

Aim: Complex anatomy of roots requires endodontic rotary instruments that respect and follow that anatomy. The purpose of this study was to compare the shaping ability of three engine-driven nickel-titanium instruments in severely curved simulated canals. Materials and methods: Forty-eight severely curved simulated canals in resin blocks were prepared to an apical size of 25 using the following systems (n = 16 per group): ProTaper Universal (PTU), ProTaper NEXT (PTN), and WaveOne Primary (WO) (all Dentsply Maillefer, Ballaigues, Switzerland). Composite images were made from the superimposition of pre- and post-instrumentation images. The amount of resin removed by each system was measured by using a digital template and image analysis software. Shaping ability of each system was compared using different parameters: total resin removal, centering ability, canal transportation in the apical, middle and coronal third of canal. Preparation times were also recorded. The data were statistically analyzed by using analysis of variance, paired t-test, and Tukey's post hoc test. Results: Canals prepared with PTN were better centered in the apical part than those prepared with WO and PTU (p < 0.05). WO removed significantly more resin at the outer aspect of the maximum point of curvature. WO and PTU caused similar canal transportations at 7 points out of 11 measuring points. At measuring points 3, 4, and 5 WO caused more canal straightening than PTU. Instrumentation with PTU required more time than with the two other instruments (p <0.05). No preparation error or instrument separation occurred. Conclusion: In the apical part of the canals PTN obtained the best results with regard to canal transportation. Clinical Significance: All of the rotary instruments were safe in preparing severely curved canals and PTN showed better preparation of apical part of the canal.

Aim: To determine and compare salivary fluoride retention after the use of different fluoride-containing chewing sticks and a non-herbal fluoridated toothpaste. Materials and methods: This double-blind cross-over experimental study was undertaken among twenty randomly selected senior secondary students in Ibadan, Nigeria. Saliva samples were collected to establish baseline fluoride concentration before the use of chewing sticks and non-herbal fluoridated toothpaste. Four commonly used chewing sticks and one non-herbal fluoridated toothpaste were each used at two days interval, and saliva samples were collected at 0, 10, 30, 45 and 60 minutes after each use. These samples were stored and transported in Gio' Style coolers to the laboratory, where they were analyzed for fluoride concentration using a spectrophotometer at a wavelength of 620 nm. Data were analyzed using descriptive and inferential statistics at p < 0.05. Result: At baseline mean (± SD) salivary fluoride concentration of participants was 25.95 (± 4.58) ppm. The mean (± SD) salivary fluoride concentration at 0 minutes was 228.0 (± 032.80) ppm, 427.65 (± 122.85) ppm, 413.45 (± 78.08) ppm, 329.05 (± 83.12) ppm and 323.80 (± 66.41) ppm corresponding to Alchornea laxiflora, Zanthoxylum zanthoxyloides, Anogeissus leocarpus, Masularia acuminate and non-herbal toothpaste respectively. At 60 minutes Zanthoxylum zanthoxyloides had the highest mean (± SD) fluoride concentration of 44.75 (± 13.32) ppm. The differences in mean (± SD) salivary fluoride concentrations amongst these tooth cleaning aids at 60 minutes were statistically significant (p < 0.001). Conclusion: Zanthoxylum zanthoxyloides had the highest mean (± SD) salivary fluoride retention followed by the nonherbal fluoridated toothpaste. Clinical significance: The use of chewing sticks can be a cost-effective and efficient means of caries prevention if used properly at regular interval.

Aim: To compare plaque removal and wear between charcoal infused bristle toothbrushes (T1) and nylon bristle toothbrushes (T2) in a randomized clinical crossover study. Materials and methods: A cross-over study was conducted in 2 phases of 6 weeks duration each with an intervening 2-week washout. Twenty-five participants meeting inclusion criteria were randomly allocated into groups A (13) and B (12). In phase 1: group A was assigned T1 and group B was assigned T2. Toothbrushing was advised twice daily for 2 minutes by modified bass technique after meals. At baseline, 3 weeks and 6 weeks the wear index (WI), plaque index (PI) and gingival index (GI) were recorded. Following washout in phase 2 group A was assigned T2 and group B was assigned T1 and the same study protocol was followed. Results: Intra-group comparison between baseline, 3 and 6 weeks by the paired t-test resulted in significant reduction in PI, GI and increase in WI (p <0.05) for T1 and T2. Inter-group comparison using the unpaired t-test resulted in WI for T1 being significantly higher (p <0.05) at 3 weeks and lower at 6 weeks (p <0.05) compared to T2. PI for T1 was significantly higher at 3 weeks (p <0.05) and lower at 6 weeks (p <0.05) compared to T2. No significant difference in GI scores between T1 and T2 at 3 and 6 weeks was observed (p > 0.05). Conclusion: Charcoal infused bristles demonstrated less wear and more plaque removal compared to nylon bristles. Clinical significance: Charcoal infused bristles demonstrate less wear compared to nylon bristles.

Aim: To investigate the bactericidal effect of gallium aluminium arsenide (GaAlAs) laser on photosensitized predominant periodontopathogenic anaerobic organisms. Materials and methods: The present prospective study was carried out among 50 patients of chronic periodontitis with pockets. 5 mm depth. For sample analysis of P. intermedia and P. gingivalis, a subgingival plaque was collected from periodontal pockets using sterile curettes under aseptic conditions. The sample was then immediately transported to microbiology laboratory using Transport media, Thioglycollate broth with Vitamin K and Hemin. After incubation period again the number of the viable bacterial count was carried out using a magnifying glass and expressed as CFU/mL, to determine the bactericidal effect of GaAlAs laser. A predetermined number of colonies (for P. intermedia 500 colonies were taken initially; for P. gingivalis 400 colonies were taken initially) were taken equally as control group and case group. The data was statistically analyzed using the SPSS statistical software version 16. Mann. Whitney Test was used for statistical analysis with p value less than 0.05 considered statically significant. Results: Study group shows a reduction in colony count of P. intermedia after being exposed to GaAlAs diode laser for 1 minute from 369–229, 134 and 41 which was statistically significant with p value <0.0001. Study group shows a decrease in colony count of P. gingivalis after being exposed to GaAlAs diode laser for 1 minute from 286.52–197, 94 and 39 which was statistically significant with p value <0.0001. Conclusion: The result of our study implies that for all tested bacterial strains, the effect of GaAlAs laser for 1 minute resulted in a significant reduction in the viable counts of photosensitized predominant periodontopathogenic anaerobic organisms. Photodynamic therapy (PDT) kills the bacteria and also leads to the detoxification of endotoxins. Further, it can thus be safely concluded that this technique is an alternative method adjunct to mechanical therapy. Clinical significance: The application of an alternative method to eradicate bacteria from periodontal pockets is desirable. One such approach is photodynamic therapy (PDT), i.e., laser therapy. Owing to the emergence of antibiotic resistance, PDT has to turn out to be a feasible alternative antibacterial therapy for biofilm-related diseases.

Aim: Aim of this study was to assess the efficiency of different treatment modalities for oral submucous fibrosis. Materials and methods: Sixty patients were included in the study, which was diagnosed as stage II oral submucous fibrosis (OSMF) based on habitual history and clinical findings. Three groups were made after randomization, i.e., group 1: capsule lycopene group, group 2: capsule lycopene and injection dexamethasone, group 3: injection dexamethasone and hyaluronidase group. Symptom severity was done by visual analog scale (VAS) scoring system viz burning sensation/pain in the patients; patient satisfaction was assessed. Vernier calipers were used to measure patients’ maximum mouth opening at day 1, 1st month, 2nd month, 3rd month. Results: Male and female had the mean age of 28.20 ± 4.26 and 39.34 ± 2.12 in group 1, in group 2 was 27.88 ± 7.12 and 40.92 ± 7.16, in group 3 was 28.90 ± 8.69 and 40.10 ± 6.22, respectively. There was no statistically significant difference between treatment modalities based on satisfaction. On 2nd month, maximum patients with no pain were more in group 3 followed by group 2, and this was statistically significant. At a 3rd month, the maximum reduction in pain was in group 3 followed by group 2 and group 1. Mouth opening was improved in the group 3 followed by groups 2 and 1, respectively. On 3rd month statistically significant difference was observed between the study groups. Conclusion: The present study concludes that the treatment with dexamethasone + hyaluronidase group showed better results in improvement in mouth opening in OSMF patients than lycopene, lycopene and dexamethasone groups. Improvement in mouth opening, reduced burning sensation in OSMF patients was also shown by lycopene. Hence lycopene can be considered as a good alternative for treatment for OSMF when dexamethasone is contraindicated due to different reasons. Clinical significance: Any oral cavity part can be affected by OSMF including the pharynx. It is a potentially malignant disorder. So early recognition and initiation of the effective regimen for the treatment in both early and advanced cases of OSMF are necessary.

Aim: The purpose of this review is to address the smear layer removing the ability of root different canal irrigants including ethylenediaminetetraacetic acid (EDTA), a mixture of tetracycline, acid and detergent (MTAD), tetraclean, citric acid, Q-Mix, maleic acid, and smear clear. Background: Smear layer is a layer which is produced during instrumentation. It contains both organic and inorganic materials. It may also contain bacteria and their byproduct considering the root canal situation. This layer may prevent the penetration of the healing material introduced to the canal to the interior of the dentinal tubules. In addition, it can affect the adaptation of sealing materials to the root canal walls. Review results: The smear layer removal ability of MTAD is superior and faster than EDTA. Tetraclean is similarly composed of an acid, an antibiotic, and a detergent. The presence of doxycycline is believed to help the smear layer removal ability of these irrigants. Antibiotics such as tetracycline had similar smear layer removal ability as even citric acid. EDTA is an amino acid with a chelating ability that sequestrates metal ions. Some believed EDTA smear layer removing ability is better than MTAD, tetraclean, Smear Clear, and 20% citric acid which is controversial in case of comparison between MTAD and EDTA. Phosphoric acid is efficient enough to be comparable to EDTA in removing the smear layer. Maleic acid is an organic compound with acid etching smear layer removal. Its ability seems to be similar or even better than EDTA. Citric acid as another organic acid is believed to be used as smear removing agent. HEBP is another chelating agent that can be used in combination with NaOCl; however, HEBP is a weak decalcifying agent compared to EDTA and hence cannot be applied as a mere final rinse. QMiX is a combination of CHX, EDTA, and detergent and should be used at final rinse. It is believed that QMiX is as efficient as EDTA. Smear clear is a 17% EDTA solution including an anionic and cationic (cetrimide) surfactant. The ability of QMiX is similar to EDTA. Conclusion: There are different canal irrigation solutions with various smear layer removal ability that some should be used as a mere final rinse and some should not. Clinical significance: The usage of canal irrigation solutions depends on the clinical situation and preference of the dentists. This study provides a good guide for clinician of the field.