The high risk of infection with coronavirus forced dental practices to decline/limit oral healthcare services to emergency and urgent conditions. Under this policy, the economic burden on dental professionals and their employees was immense. With the prolonged duration of coronavirus health crisis, it was clear that dentists and associated workers and companies cannot bear the cost of longer suspension of regular dental services. At this point, calls have been made for gradual return to regular dental clinical practice. However, dental health professionals around the world realized that oral care services should be tailored to fit the time of COVID-19 pandemic. An important question to be raised here is regarding planning the dental treatment during the time of coronavirus pandemic. Should a dentist plan the dental treatment in a different way to that at a normal time? This paper aims to propose a simple strategy to plan the restorative dental treatment at the time of coronavirus pandemic. The aim of this strategy is to expand the range of oral care services and minimize the risk of infection with this deadly virus. The role of the shortened dental concept and minimum use of aerosol- /droplet-generating procedures have been emphasized.

Aim: The 75th anniversary of community water fluoridation in the United States was celebrated in 2020. However, there are studies that stimulate polarized discussion over the use of fluoride in dentistry. The purpose of this study was to evaluate dental and dental hygiene students’ knowledge and perception of fluoride use in dentistry. Materials and methods: A survey was conducted to gauge participant's knowledge and perception of fluoride and their opinion on the need for developing viable alternatives to fluoride. An Institutional Review Board (IRB# 5190496) application was filed and approved. A hard copy survey was distributed to all student classes at Loma Linda University School of Dentistry (U.S.) between January 13, 2020, and February 5, 2020. Descriptive data were compiled and analyzed. Knowledge-based questions were compared using Kruskal–Wallis procedure to evaluate correct percentage among different classes. Perception questions were analyzed using a Likert scale and also a Chi-squared test. All tests were two-sided with α at 0.05. Results: Out of 482 students, 282 students responded (58.5%). The mean of correct responses for knowledge ranged from 49 to 69%. There was a statistically significant difference among the classes. Overall the perception of the use of fluoride in dentistry was positive, and it changed with exposure to lectures on fluoride over the years. Conclusion: There was a correlation between knowledge and the perception of the use of fluoride in dentistry, indicating the importance of adequate delivery of didactic teaching on knowledge of fluoride to dental and dental hygiene students. Clinical significance: The oral healthcare provider plays a pivotal role in communicating pertinent information on the benefits of fluoride in preventing dental caries to the general public, prompting adequate delivery of didactic teaching on this topic in dental education.

Aim: This study aims to test the feasibility and effectiveness of a novel pacifier-based saliva collection method on children and infants in comparison to an oral swab-based saliva collection method. Materials and methods: This study was performed during spring 2018 in a clinical non-sponsored setting at Queen Silvia Children's Hospital pediatric emergency ward. Saliva collection was performed by comparing oral swab (Salimetrics® SalivaBio's Children's Swab) with a pacifier-based saliva collection method (Salivac®). All participating children used both saliva collection systems. The amount of saliva collected in 2 minutes was measured. The amount of time needed for the healthcare professional was recorded. Parental preference was evaluated by a questionnaire. Results: No statistically significant difference was observed in collected saliva (174 µL for pacifier-based saliva collection and 158 µL for oral swab). The healthcare professional spent significantly less (p < 0.001) mean time with the pacifier-based saliva collection method than with the oral swab (31 vs 150 sec). A total of 48 out of the 52 caretakers preferred the pacifier-based saliva collection method compared to the oral swab. Conclusion: The novel pacifier-based saliva collection method proved to be a feasible, appreciated, and effective way of collecting saliva that simplifies the saliva collection method among children and infants. Clinical significance: The pacifier-based saliva collection method simplifies saliva testing. The closed vacutainer system minimizes the risk of saliva contamination and opens up for novel home testing strategies.

Aim: The World Health Organization (WHO) periodontal probe is recommended for epidemiologic surveys and periodontal screening, but its ability to identify subgingival dental calculus (DC) relative to a #11/12 explorer is not known. This study compared in vitro the ability of the WHO probe and a #11/12 explorer to detect subgingival DC. Materials and methods: Three typodont models with randomly distributed artificial DC on mandibular molar and premolar root surfaces were assessed with a WHO periodontal probe and a #11/12 explorer by two periodontists. The diagnostic performance of the two instruments for subgingival DC detection was compared using 2 × 2 contingency table analysis. Results: A #11/12 explorer provided better reproducibility, a higher level of sensitivity, higher positive predictive values, higher negative predictive values, and greater overall accuracy (diagnostic effectiveness) (76.9% vs. 68.5% for the first periodontist; 87.0% vs. 75.0% for the second periodontist) for detection of subgingival DC than the WHO probe. Conclusion: The in vitro diagnostic performance of a #11/12 explorer was superior to the WHO periodontal probe for identification of subgingival DC. Clinical significance: A #11/12 explorer, rather than the WHO probe, is recommended for identification of subgingival DC.

Aim: The aim of this retrospective study is to assess potential correlation between the width of the keratinized gingiva (KG), and the dimensions of the supracrestal gingival tissue (SGT) components. Materials and methods: On the sample of 259 teeth of 79 patients, the following measurements were collected: width of KG, sulcus depth (SD), SGT, and biological width (BW) dimensions; separate correlations between measured elements were computed for males and females, for anterior and posterior, and for maxillary and mandibular teeth separately. Results: Correlations between buccal KG and BW were present only for the upper anterior teeth and were nonsignificant in the female subsample, whereas the correlation between lingual KG and SGT were present only in females. Additionally, correlations between buccal KG and SD were present in upper anterior teeth only and were absent in the male subgroup. Conclusion: The width of the KG cannot routinely be used as an indicator for the dimensions of the SGT components. Clinical significance: While the width of the KG can hardly be a useful indicator in upper anterior teeth, probing depth and bone sounding prior to prosthetic rehabilitation remains an essential tool to ensure tissue preservation.

Aim: To assess schoolchildren's feelings and attitudes towards dentists and their potential impact on oral health. Materials and methods: 7902 schoolchildren (12 and 15 years old) attending public and private schools completed a questionnaire that assessed their feeling and attitude toward dentists. DMFT and CPI indices were used to assess dental caries and periodontal diseases respectively according to the World Health Organization method and criteria. Results: 79.7% of all schoolchildren who participated in this study had been to the dentist. 24.7% reported that they are afraid of dental visits, pain being the main reason for this disturbing feeling (88, 2%). Of the children, 81.4% preferred a female dentist; 82.3% preferred a dentist with a colored coat and 80.3% favored a renovated dental facility. 91.1% of the children are irritated by the noises in the dental clinic. The mean DMFT and CPI scores were significantly higher in patients with dental fear, and in patients who never had a dental visit. Conclusion: Meeting patient's perceptions and preferences regarding their dentist may help to reduce the potential dental anxiety and thus ensure the delivery of a high-quality dental treatment leading to better oral health status. Clinical relevance: Patient perception about dentists is affected by a series of factors related to the dentist, the patient, and the dental clinic. Patients who experience the worst perceptions of dental professional tend not to seek dental care, which leads to a bad oral health status, hence the importance of further studies in this area to improve such perceptions, and promote attitudinal changes toward positive health-seeking behavior.

Aim: To evaluate the precision of the orthodontic bracket slot dimensions of 0.022 inch and to compare them with those of the manufacturers’ specifications. Materials and methods: The slots of upper-right central incisor brackets (n = 5) from 11 commercial bracket systems of three different manufacturers (3M Unitek: Victory Mini Metal, Clarity, SmartClip, Clarity SL; ORMCO/SYBRON: Mini Diamond Twin, Damon Q, Damon Clear; Dentsply/GAC: Ovation, Mystique, In-Ovation R, In-Ovation C) were measured. The orthodontic brackets were scanned using micro-computed tomography (micro-CT), and the bracket slots were measured using micro-CT images. The slot was measured at four different surfaces (occlusal, gingival, base, and face) for both mesial and distal sites. Data were subjected to ANOVA and unpaired t-tests. A p-value of ≤0.05 was considered statistically significant. Results: All brackets had slot dimensions that were significantly larger (p < 0.05) than the stated 0.022 inch. 3M-victory were 11.99% larger (0.02509 inch) and the closest to the stated dimension and the ORM-Damon C were 24.07% larger (0.02948 inch) than the quoted slot size of 0.022 inch. Comparison between mesial and distal sides showed that 91% of the bracket slots were asymmetrical at their bases and 100% asymmetrical at their faces. All of the bracket system showed divergent walls from base to face with values ranging from 1.96 (3M-SmartClip) to 26.58% (ORM-Damon C). Conclusion: The actual measurements of 11 bracket systems from three different manufacturers were more substantial than the manufacturers’ specifications, and the walls of the slots diverged from the bracket bases in all of the tested bracket system. Clinical significance: Orthodontic bracket slots vary significantly from that of the manufacturers’ specification. The orthodontist should anticipate such shortcomings and be able to modify treatment mechanics through additional wire bending in three spatial planes.

Aim: The aim of this in vitro study was to estimate the penetration depth and fracture resistance of three different sealers and to verify the relationship between the penetration depth and fracture resistance. Materials and methods: Sixty single-rooted teeth were selected and root canal preparation was done. After the instrumentation, the teeth were divided into three groups of 20 each. The groups were then obturated with gutta-percha (GP)-AH Plus sealer, Resilon-Real Seal, and propoint-bioceramic sealers, respectively. Ten teeth from each group were sectioned at three different regions (i.e., coronal, middle, and apical thirds of the root canal) and were viewed under a confocal microscope to determine the penetration depth of the sealer. The remaining samples were subjected to fracture resistance under a universal testing machine and the statistical analysis was done by using one-way ANOVA and post hoc Bonferroni tests. Results: Propoint-bioceramic group showed the highest fracture resistance values followed by GP-AH Plus sealer and Resilon-Real seal groups with no significant difference noticed between them. Depth of penetration was greater for GP-AH Plus sealer, propoint-bioceramic, with no significant difference followed by the Resilon-Real seal group. Conclusion: The newer obturating material propoint-bioceramic group showed a greater fracture resistance. No correlation could be established between the depth of sealer penetration and fracture resistance. Clinical significance: Fracture resistance of tooth obturated with propoint-bioceramic sealer combination is significantly greater than GP-AH Plus and Resilon-Real seal combination, thereby showing propoint-bioceramic as a promising obturating material.

Aim: To compare the efficacy of diclofenac sodium and mefenamic acid in relieving pain in mandibular impacted third molar surgery and to assess the level of the C-reactive protein (CRP) level. Materials and methods: This study was conducted on 90 patients of impacted mandibular third molars. All patients were administered with 2% lignocaine with 1:80,000 adrenaline, and surgical removal of impacted third molar was done following the standardized surgical procedure by a single oral surgeon. Patients were divided into two groups of 45 each. In group I, patients were prescribed 50 mg diclofenac sodium and in group II patients were prescribed 500 mg mefenamic acid for three times a day for 3 days. The CRP level was again evaluated after 3 days of analgesics. Pain was assessed using the visual analog scale (VAS). Results: The mean VAS was 2.58 in group I and 3.46 in group II, which was statistically considerable (p < 0.05). The mean CRP level postoperatively in group I was 15.7 and after 3 days was 27.2 in group I, whereas it was 25.1 postoperatively and 31.5 after 3 days in group II. Conclusion: Authors found that diclofenac sodium as useful as mefenamic acid. The CRP level was raised significantly following surgery, thus reflecting that it is an indicator of inflammation. Clinical significance: Diclofenac sodium can be used to relieve pain. The CRP level evaluation can be helpful to assess inflammation following surgery.

Aim: This study aimed to assess the occurrence of postoperative pain and associated factors in patients treated endodontically at a Postgraduate Center in Endodontics in Southern Brazil. Materials and methods: The evaluation was performed using the medical records of 658 patients. Pulp conditions, postoperative pain, pain intensity, edema, number of sessions (single or multiple), and medication administration in the postoperative period were analyzed. For data analysis, descriptive analyses and univariate and multiple regressions were performed. In the multiple analyses, odds ratios (OR) and their respective 95% confidence intervals were estimated, crude and adjusted for exposure variables in a binary logistic regression model (p-value < 0.05). Results: To perform the adjusted logistic regression, all variables associated with p-value <0.10: gender, edema, and pulp condition (bio- and necropulpectomy) entered the crude model. After the multivariate analysis, a statistically significant association was found between the outcome variable of the presence of postoperative pain and the independent variable of pulp condition, and the presence of pain was associated with patients who underwent endodontics on teeth with live pulp and edema with greater chances of postoperative pain. Conclusion: It was concluded that the pulp condition and edema affected postoperative pain. Clinical significance: The occurrence of postoperative pain was around 30% in both single and multiple sessions, and it was considered relevant for the dental clinic. Pulp condition affected postoperative pain, and the presence of pain was associated with patients who underwent endodontics on teeth with live pulp.

Background: Condylar guidance can be determined using the clinical and radiographic methods. The present study was conducted to determine condylar guidance using the protrusive interocclusal wax method, panoramic radiographs, and lateral cephalogram. Aims: The aim of the study was to compare the correlation between sagittal condylar guidance with protrusive interocclusal method, panoramic radiographs, and lateral cephalogram. Materials and methods: The present study was conducted on 82 dentulous subjects (males 41, females 41). In all subjects, interocclusal registration values and condylar guidance values were measured using panoramic radiographs and lateral cephalograms. Results: The mean ± SD protrusive interocclusal registration value on the left side was 34.01 ± 1.2 mm and 34.08 ± 1.4 mm on the right side. The panoramic radiographs showed 35.12 ± 1.6 mm on the left side and 35.16 ± 1.7 mm on the right side. The mean ± SD protrusive interocclusal registration values on the left side was 34.01 ± 1.2 mm on the left side and 34.08 ± 1.4 mm on the right side. Lateral cephalogram showed 34.35 ± 1.3 mm on the left side and 34.67 ± 1.6 mm on the right side. There was a significant difference between the methods (p < 0.05). Conclusion: Sagittal condylar guidance can be evaluated using protrusive interocclusal method. Along with it, other methods such as panoramic radiographs and lateral cephalogram may also be used for recording condylar guidance. Clinical significance: Lateral cephalogram and panoramic radiographs may be reliable in determining condylar guidance, which can be used in orthodontic treatment planning.

Aim: To investigate risk factors associated with halitosis in children using OralChroma™. Materials and methods: Sixty-seven children between the ages of 3 and 8 who attended a pre-general anesthesia assessment at the Dental University Hospital at King Saud University, Riyadh, Saudi Arabia, were enrolled in this study after satisfying the inclusion criteria. Demographic data, medical history, and oral hygiene practices were obtained by a standardized questionnaire completed by the parents of each child. Clinical dental examination was conducted to record the following: caries index (dmft/DMFT), simplified debris index (DI-S), modified gingival index (MGI), and Winkel tongue coating index (WTCI). Clinical halitosis was assessed using the OralChroma™ device that measures the concentration of volatile sulfur compounds (VSCs) including hydrogen sulfide (H₂S), methyl mercaptan (CH₃SH), and dimethyl sulfide (CH₃SCH₃). Statistics were completed using Spearman's correlation coefficient and Mann–Whitney U-test to assess the association with the VSC scores with continuous and binary variables, respectively. Then, multivariate linear regression analysis was performed to detect the degree of association. Results: High VSC measures were detected in 58 children (87%). The dmft/DMFT was significantly associated with H₂S level (β = 26.84, p = 0.034) and CH₃SH level (β = 19.96, p = 0.016) after controlling possible confounders. There was no significant association of DI-S, MGI, and WTCI with the VSC measures. Conclusion: The result suggested that dmft/DMFT score (children's caries experience) is associated significantly with high levels of H₂S and CH₃SH in the sample studied. Clinical significance: Caries experience in children is a significant risk factor for halitosis and should be considered during the management of halitosis.

Aim: The aim of this ex vivo randomized study is to evaluate the efficiency of gutta-percha cones that match a nickel–titanium instrumentation system and nonmatching greater taper cones, when used with continuous warm vertical condensation technique. Material and methods: Thirty-six straight canals were prepared using ProTaper Next files, and the apical third was obturated using either ProTaperNext cones (group A), ISO uniform greater taper cones (group B), or nonstandardized cones (group C). Cone adaptation time was quantified by the number of required modifications. Micro-computed tomography was used to measure voids and sealer percentage. Results: There was no significant difference between the groups regarding void volume (p = 0.666), percentage (p = 0.379), and the number of modifications (p = 0.757). Sealer percentage, however, was significantly lower in group B when compared to group A (p = 0.0194). Conclusion: In straight canals, matching gutta-percha cones were not associated with significantly better obturation or saving time to fit the cone. Clinical significance: Using gutta-percha cones that do not match a nickel–titanium instrumentation system to obturate the straight canals with continuous warm vertical condensation technique is as efficient as using matching cones in terms of obturation quality and ease of cone fit.

Aim: To analyze the impact of two nanocoating materials, EQUIA Forte nanocoat and universal adhesive, on flexural strength, color changes, surface roughness, and microleakage of bulk-fill and resin-modified glass ionomer cements (RM-GICs). Materials and methods: A total of 45 specimens were prepared for each group, bulk-fill (EQUIA Forte Fil) and RM-GI (Fuji II LC) cements, according to manufacturer's instructions for flexural strength, color change, and surface roughness tests. Each group was equally subdivided into three subgroups according to coating materials used; either without a coat (negative control) or covered with EQUIA Forte coat or universal adhesive. For the flexural strength test, 15 bar-shaped specimens were prepared using a rectangular-split Teflon mold (25 × 2 × 2 mm), then the test was conducted using a universal testing machine. Thirty disk-shaped specimens were prepared for color change and surface roughness tests using cylindrical-split Teflon mold (10 mm diameter and 2 mm height). The color change was measured using a spectrophotometer after immersion in tea infusion for seven days at room temperature. Surface roughness was examined using a profilometer after exposure to 2400 brushing cycles. Moreover, a microleakage test was conducted in 30 teeth restored with the same restorative protocols and evaluated using a stereomicroscope. Finally, the data were statistically analyzed. Results: EQUIA Forte nanocoat subgroups exhibited the highest flexural strength in both tested GICs compared to other subgroups (91.07 ± 7.12 MPa for RM-GIC and 51.61 ± 4.42 MPa for bulk-fill GIC). For the color change, the lowest ΔE values for bulk-fill and RM-GICs were recorded in EQUIA Forte nanocoat subgroups (2.37 ± 0.25 and 2.97 ± 0.39, respectively) with no significant difference between both groups. The surface roughness of both GICs was significantly decreased in the coated subgroups either with EQUIA Forte coat or universal adhesive, with no significant difference between both coating agents. Also, microleakage was significantly decreased in the coated subgroups with no significant difference between the coating materials. Conclusion: Nanocoats, especially the EQUIA Forte nanocoat, positively impact the physicomechanical properties and adaptation of bulk-fill GICs and RM-GICs. Clinical significance: The application of nanocoats on GI restorations is highly recommended.

Aim: This study was done to assess the time to achieve the working distance based on the size of the glide path, operating kinetics, and the fracture resistance of different file systems. Materials and method: One hundred and eighty mandibular premolars were divided into two groups of 90 each. Group I was subjected to continuous 360° rotary motion and group II to adaptive motion. Twisted File (TF) and Endostar E3 file methods were practiced in groups. The time (seconds) to achieving desired working length was recorded. Failures were classified as torsional failure or flexural failure. Results: The time taken by glide path size 15 in group I was 5.90 ± 4.06 seconds and in group II was 6.12 ± 4.16 seconds. The time taken by glide path size 20 in group I was 5.86 ± 3.12 seconds and in group II was 4.22 ± 2.10 seconds, with 25 size the time taken in group I was 5.32 ± 2.48 seconds and in group II was 3.16 ± 3.14 seconds. The time taken by group I was less as compared to group II, and the difference was significant (p < 0.05). There was a significant difference in time taken with different number files in both groups (p < 0.05). The mean time taken reaching the working length for continuous rotation was less as compared to TF adaptive motion; however, the difference was nonsignificant (p > 0.05). Conclusion: We recorded higher instrument separation and deformation with the TF method and adaptive gesture. The TF system showed additional time to achieve the working distance as compared to the Endostar E3 system. Clinical significance: The TF system showed higher instrument separation and deformation, and it requires additional time to achieve the working distance compared to the Endostar E3 system. Hence, the Endostar E3 system is effective in achieving required clinical results.

Aim: This study aimed to compare the level of interleukin (IL)-10, IL-17, IL-27, IL-35, and IL-37 in the gingival crevicular fluid (GCF) and human plasma of subjects with periodontal disease. Materials and methods: In this cross-sectional study conducted over a 3-month period at a primary dental clinic in Malaysia, 45 participants were recruited via consecutive sampling and assigned into three groups, namely healthy periodontium group (n = 15), gingivitis group (n = 15), and periodontitis group (n = 15). Gingival crevicular fluid and plasma samples were collected from each participant. Enzyme-linked immunosorbent assay test was conducted to measure the concentration of IL-10, IL-17, IL-27, IL-35, and IL-37. Kruskal–Wallis H test was used to compare the interleukin levels between patient groups. Results: In GCF samples, IL-17 level was the highest in the periodontitis group (p <0.05), while IL-27 was the lowest (p <0.05). Meanwhile, plasma levels of IL-27 and IL-37 were significantly lower (p <0.05) in the periodontitis group, but plasma IL-35 levels were observed to rise with increasing disease severity. Conclusion: There are reduced local and systemic levels of IL-27 in periodontitis patients. Clinical significance: Periodontal diseases exert both local and systemic effects, resulting in the destruction of the tooth-supporting structures and contributing to the systemic inflammatory burden. Some of the cytokines that were investigated in the current study, IL-17, IL-27, IL-35, and IL-37, can be potential biomarkers that warrant further longitudinal clinical studies to determine their usefulness as prognostic/diagnostic markers.

Aim: The present study aimed to assess the sealing ability of various repair materials in furcation perforations using dye penetration. Materials and methods: A total of 80 human first molars from mandible with unbroken enamel surfaces, which were extracted completely for periodontal reasons, were chosen. All extracted teeth were kept in a sterile solution up until further use. Endo-access bur was used to prepare endodontic access cavity, and a high-speed long shank round bur was used to create a planned perforation on the floor of pulp. All the specimens were randomly grouped (20 teeth in each group): Group I: control; group II: Pro-Root MTA; group III: resin-modified glass-ionomer cement (RM GIC); and group IV: Biodentin. After placement of repair materials in perforated furcation, the chamber of each tooth was accessed with 2% methylene blue dye. Later, a diamond disk was used to split the teeth buccolingually. A stereomicroscope (10×) was used to visualize the highest dye penetration. Results: The least penetration was seen in teeth repaired by Biodentin group (0.88 ± 0.02), next by Pro-Root MTA group (1.24 ± 0.13) and resin-modified glass ionomer cement group (3.62 ± 0.46). A statistically significant difference was seen among different perforation repair materials by analysis of variance. A statistically significant difference (p value < 0.05) was found between each group, excluding group II v/s group IV. Conclusion: This study concluded that reduced dye penetration in perforation repair along the furcations and improved sealing ability are shown by biodentine group in comparison to Pro-Root MTA and resin-modified glass-ionomer cement group. Clinical significance: Root perforations along the furcation that develop due to the endodontic procedures have a remarkable damaging effect on prognosis and frequently result in loss of secondary periodontal attachment, thus resulting in early loss of the involved tooth. Therefore, the selection of biocompatible repair material aids to enhance the treatment prognosis.

Aim: The aim of this study was to assess the insertion torque of the mini-implant used in orthodontic patients and to assess the correlation between the insertion torque, primary stability, and perception of pain in patients undergoing orthodontic therapy with mini-implant-augmented anchorage. Material and methods: Among the patients undergoing orthodontic therapy, 31 samples who required mini-implant for anchorage purpose were selected. A total of 59 mini-implants were placed in these patients. This included interradicular mini-implants and extra-alveolar mini-screws. Immediately after placement, the insertion torque in all these was measured using a digital torque meter and primary stability was assessed by identifying any mobility of the implant placed. Primary stability was noted at two time intervals immediate post-placement and 1 week after that. All the mini-implants that were considered in this study were immediately loaded. Patients were asked to record any pain experienced on the visual analog scale (VAS) score sheet at 24 hours and 1 week post-placement. Results: Among the mini-implants placed, those with 2 mm diameter needed higher placement torque, i.e., infrazygomatic crest mini-implants and buccal shelf mini-implants were placed with average placement torque of 10.08 and 10.25 N cm, respectively. Extra-alveolar screws caused more pain, especially higher in the mandible than the maxilla. Decrease in pain scores was noted from T₀ to T₁ in almost all the cases. Conclusion: Thicker mini-implant needed more insertion torque and highest insertion torque was recorded with extra-alveolar screws. No direct correlation could be obtained with the pain levels experienced by the patients and with the primary stability of the mini-implants. Clinical significance: Mini-implants placed with an insertion torque above the recommended range tend to fail and break more often. Patients placed with extra-alveolar bone screws reported more pain than that of the smaller-dimension mini-implant.

Aim: This study aimed to evaluate the dental students’ performance in ICDAS (International Caries Detection and Assessment System) coding with different levels of clinical experience. Materials and methods: Dental students (n = 122) in their clinical years, year 3 (n = 37), year 4 (n = 44), and year 5 (n = 41) received training (two-hour introductory lecture on ICDAS, followed by a 90 min e-learning video, and practice sessions using extracted teeth and photographs) from a calibrated expert. After training, the students examined a prevalidated set of extracted teeth and assigned scores in two sessions. The intra- and inter-examiner agreement between students was analyzed using weighted kappa statistics and a focus group discussion was conducted for qualitative feedback. Results: The range of kappa values for intra-examiner agreement among the year 3, 4, and 5 students for ICDAS caries code (0.611–0.879, 0.633–0.848, and 0.645–1.000) and restoration code (0.615–0.942, 0.612–0.923, 0.653–1.000), respectively. The range of kappa values for inter-examiner agreement for year 3, 4, and 5 students with a trained expert for ICDAS caries code (0.526–0.713, 0.467–0.810, and 0.525–0.842) and restoration code (0.531–0.816, 0.682–0.842, and 0.645–0.928), respectively. Conclusion: The ICDAS system is a promising tool for caries detection and its implementation in the curriculum was perceived by dental students as an effective method. In general, there was moderate to substantial agreement for ICDAS caries and restoration code between students of different academic year groups and with a trained ICDAS expert. Clinical significance: ICDAS is a simple, logical, and evidence-based system for the detection and classification of caries. Introducing ICDAS to dental students enables them to detect caries in a reliable and reproducible manner irrespective of their past clinical experience and also significantly improves their caries detection skills.

Aim: The present review aimed to summarize and evaluate the available literature regarding the survival rate and outcomes of dental implants in patients with Papillon-Lefèvre syndrome (PLS). Materials and methods: An extensive search of the literature was conducted on PubMed, Scopus and Web of Science databases for all data published from January 1996 till April 2020 using a combination of the following keywords: ‘Papillon Lefévre Syndrome’, ‘prosthodontic rehabilitation’ and ‘dental implant’ according to the PRISMA guidelines for the focused research question constructed using the PICO criteria. Clinical trials and observational studies on implant placement in PLS patients reported in English language were included in the study. Results: A total of 10 studies (nine case reports and one case series) comprising 124 dental implants placed in 13 PLS patients were included. The follow-up period ranged from 4 months to 9 years. With regard to implant loading, 9 studies reported delayed loading, while one study did not provide any information regarding the nature of implant loading. The design of prosthodontic superstructure was either a removable or fixed prosthesis. Out of the 124 inserted implants, 20 (16%) were reported as failed. The overall survival rate was 84%. Conclusion: The limited available evidence suggests that the survival rate of dental implants in patients with PLS is lower than that among healthy individuals. Nevertheless, no strict contraindication for implant-supported prosthesis seems to be justified in this group of patients. Further longitudinal studies with adequate follow-up periods are highly warranted. Clinical significance: The prognosis of implant treatment for PLS patients has not yet been established. Dental practitioners should follow a careful approach in planning the dental implant treatment for this cohort of patients.

Aim: This clinical technique report aimed to describe a composite resin repair technique performed in an implant-supported prosthesis. Background: Veneering ceramic fracture or chipping is one of the most frequent clinical failures in dentistry. Therefore, the use of less time- and cost-consuming ceramic repair techniques is helpful in clinical practice. Technique: Briefly, to treat the ceramic surface, the glaze was removed at the margins of the fracture area, then, air-abrasion and acid-etching were performed. To promote chemical adhesion, a silane coupling agent and adhesive system were applied over the ceramic surface, and the composite resin was applied by incremental technique. Finally, the polish was performed. Conclusion: In conclusion, the applied composite resin repair of feldspathic porcelain chipping in implant-supported prosthesis was a simple, easy, affordable, and minimally invasive treatment. Clinical significance: The causes of veneer materials failures in metal-ceramic crowns are considered a challenge for the dentist and a problem that displeases patients. Repairs are indicated to prevent cracks from spreading and to prevent the accumulation of biofilm on the damaged surface. Therefore, different repair protocols have been proposed to enhance the esthetic, functionality, and longevity of the implant-supported prosthesis. Additionally, the success of the clinical cases depends on the capability to identify ceramic failures and the ability to indicate/perform the correct repair protocol. Since the described repair technique of the fractured screw-retained implant-supported prosthesis was a simple, easy, affordable, and minimally invasive treatment, with excellent esthetic and masticatory results, it represents an interesting clinical option.