Aim and objective: This research aims to evaluate the comfort during digital intraoral scanning, to summarize patients’ opinions for the procedure of creation of digital models, and to investigate if this new procedure influences their motivation for orthodontic treatment. Materials and methods: In this investigation, 159 patients from different age groups are included. All of them had digital casts, taken by intraoral scanning and classic models, made by using machine mixed alginate material. The assessments were given by the patients by filling in a questionnaire with a number measurement of the processes on a scale from 1 to 10 or positive answer “Yes” or a negative answer “No”. Results: According to 81.14% of patients, the more informative method is digital and 18.86% still perceive that the classic gypsum models as a reliable carrier of data. Patients feel greater discomfort while working with an alginate impression, rated on a scale of 3.30, while the discomfort when intraoral scanning was made is rated 2.92. If the patients have the chance to choose only one of these procedures, they will prefer intraoral scanning in 73.58% of the cases. For 94.33% of the interviewed patients, the intraoral scanning was of great interest and only a few patient percepts it as clinical manipulation. Conclusion: The patients are cooperative to the establishment of digital technology in modern orthodontics and they are ready to assist in this process. The advantage of 3D files and virtual presentations are more demonstrative for the patients. The STL files give opportunities for greater accuracy, the possibility for analysis, long-term storage, and transfers in contemporary orthodontic practice. Clinical significance: All clinical manipulations and the final result of orthodontic treatment depend on the patient's cooperation and the patient's direct participation in the process. Therefore, it is really important, during the first visits in orthodontic practice, that the patient feels calm and in comfort. The use of innovative technologies in orthodontics is perceived by young patients as routine technologies because their daily routine is more digitalized. In older patients, who are used to pass routine dental manipulations, the new technologies are associated with more expensive and more incomprehensible treatment, which disturbs them. It is important to know their willingness toward the digitalization of the orthodontic tests and manipulations and to receive feedback.

Aim and objective: This study aimed to evaluate the sealing ability of EndoSequence root repair material (ERRM), mineral trioxide aggregate (MTA), and glass ionomer cement (GIC) in the repair of furcal perforation. Materials and methods: Thirty extracted mandibular molars were selected. After access cavity preparation of each molar, artificial perforation was made directly in the center of the pulp chamber floor. The teeth were randomly divided into three groups (N = 10) according to the used root repair material (RRM). The perforation sites were repaired with MTA (G1), ERRM (G2), and GIC (G3). The access opening of the teeth in all groups was filled with composite. Then, all teeth were immersed in 2% methylene blue for 24 hours and sectioned longitudinally to evaluate the maximum apical extent of dye leakage. Data were collected and analyzed statistically using ANOVA, Bonferroni, Kruskal–Wallis, and Mann–Whitney tests (p = 0.05). Results: The less mean value of dye penetration was observed with MTA followed by ERRM and GIC. There was a significant difference among RRMs in relation to dye penetration. Both MTA and ERRM were significantly better than GIC in sealing the perforation site. Conclusion: Mineral trioxide aggregate and ERRM showed a similar dye microleakage and had a better sealing ability when compared to GIC in this in vitro study. Clinical significance: This current study showed the sealing ability of MTA, ERRM, and GIC while using to seal the furcal perforation during root canal treatment.

Aim and objective: To evaluate fracture resistance, patient satisfaction, and survival rate of IPS Empress CAD vs zirconia-reinforced lithium silicate ceramic (ZLS) laminate veneers. Materials and methods: Fifty-four ceramic laminate veneers were fabricated for maxillary anterior teeth. The patients were divided into three groups according to the material group I (control group) fabricated from IPS Empress CAD laminate veneers, group II (intervention group I) fabricated from glazed CELTRA DUO laminate veneers, and group III (intervention group II) fabricated from VITA SUPRINITY laminate veneers. Standardized the same preparation with butt joint design and chamfer finish line located supra gingival were performed for all the teeth. The fabrication of the veneers was performed using CAD\\CAM (Ceramill motion) machine, with software (Exocad). The veneers surfaces were treated and silanated according to the manufacturer's instruction of each ceramic and enamel surfaces were etched where total etch adhesive protocol was obeyed using dual cured amine free adhesive resin cement. Fracture resistance, patient satisfaction, and survival rate for all groups were evaluated according to United States Public Health Services (USPHS) criteria. Results: Fracture resistance, patient satisfaction, and survival rate were evaluated according to the criteria of USPHS and we found there is no significant difference as all groups scaled zero score. Conclusion: IPS Empress CAD, glazed CELTRA DUO, and VITA SUPRINITY laminate veneers revealed high successful clinical performance in terms of fracture resistance, patient satisfaction, and retention. Clinical significance: Zirconia-reinforced lithium silicate ceramics are recommended to be used for laminate veneers.

Aim and objective: The application of artificial intelligence (AI) in diagnosis support is the new approach in telemedicine which is meaningful in disadvantaged areas where are lacking health workers. However, the number of studies investigating the validity of AI in diagnosis support is still few. Periapical lesions, a common dental disease, are conventionally detected by dentists through radiography. This study aimed to assess the application of AI in support the diagnosis of periapical lesions. Materials and methods: One hundred and thirty bite-wing images were recruited to evaluate the sensitivity, specificity, and accuracy of diagnosis provided by DentaVN software. Diagnoses provided by dentists were defined as references. Results: The sensitivity, specificity, and accuracy of diagnoses of the software were 89.5, 97.9, and 95.6%, respectively. Conclusion: DentaVN can be used as a support tool in diagnosis periapical lesions. Clinical significance: To support the diagnosis of periapical diseases in disadvantaged areas where lack of dentists.

Aim and objective: This study aimed to compare the fracture resistance and fracture patterns of maxillary central incisors restored with different post systems. Materials and methods: Thirty-two human maxillary central incisors were randomly divided into four groups (n = 8). Posts were placed according to the assigned groups: (I) Stainless Steel ParaPost, (II) Fiber White ParaPost, (III) everStick post, and (IV) No post. The cementation was carried out with self-adhesive resin cement, and nonprecious metal crowns were used for the core build-up and restoration. The thermocycling process was conducted for 500 cycles between 5°C and 50°C with a 2-second dwell time and 30-second dipping time, and the samples were subjected to a compressive load at a crosshead speed of 1.0 mm/minute and at an angle of 135° using an Instron testing machine. A Kruskal–Wallis test and Fisher's exact test were used for the data analysis, with p < 0.05. Results: One of the samples was damaged during the testing, and thus, only 31 samples were used. The highest median load was recorded in group III (764.44 N), followed by group II (702.37 N) and group IV (657.44 N), while group I recorded the lowest median load (505.31 N). Favorable fracture patterns were recorded in groups II, III, and IV, while unfavorable fracture patterns were recorded in group I. The statistical analysis showed that there was no significant difference in the fracture resistance or fracture pattern between all the tested groups (p > 0.05). Clinical significance: This study helps in determining the prognosis of endodontically treated teeth restored with post and core. Conclusion: Given the limitations of this study, the metallic and nonmetallic post systems had no significant influence on the fracture resistance and fracture pattern of the maxillary anterior teeth.

Aim and objective: To identify the specificity and sensitivity of CYFRA21-1 in differentiating between oral malignancy and oral potentially malignant lesions (PML) and to be able to early diagnose malignant changes in oral lesions. Materials and methods: It was a prospective pilot study. Twenty-eight participants were collected in a convenience series and divided into three groups. Group I: 12 patients suffering from PML. Group II: eight patients with oral squamous cell carcinoma (OSCC). Group III: eight participants with no oral lesions. Serum and salivary CYFRA21-1 levels were measured using enzyme-linked immunosorbent assay and correlated with the histopathological examination to confirm the diagnosis. Results: The OSCC group showed the highest levels of both salivary and serum CYFRA21-1 followed by the group of PML than the control group. The differences in means were statistically significant. At a cutoff value of 0.4 ng/mL, salivary CYFRA21-1 showed 87.5% sensitivity and 100% specificity in differentiating PML from OSCC, with 95% accuracy. Serum CYFRA21-1, at a cutoff value of 1.03 ng/mL showed 100% sensitivity, specificity, and accuracy. Conclusion: Serum and salivary CYFRA21-1 could be considered promising biomarkers for the diagnosis of oral malignancy and could help detect early malignant changes in PML, especially oral lichen planus and leukoplakia.

Aim and objective: This in vivo longitudinal study aimed to do a comparative analysis of the efficacy of carrier-based obturation (CBO) technique and lateral compaction (LC) technique in patients undergoing root canal therapy. Materials and methods: A total of 40 patients scheduled to undergo root canal therapy were enrolled based on inclusion and exclusion criteria. The patients were assessed using periapical digital radiographs. All the patients were broadly divided into two study groups based on the type of obturation technique used as follows: Group I—patients in which CBO technique with Thermafill carriers (30/0.04) (Dentsply Maillefer) with EndoSequence BC Sealer (Brassler, USA) was used and group II—patients in which LC technique with 30, 0.02 taper GP cone (Dentsply Maillefer) with EndoSequence BC Sealer (Brassler, USA) was used. All the root canal procedures were performed by two skilled and experienced endodontists. Clinical and radiographic evaluation of all the patients was done for assessing gutta-percha-filled area (GPFA) and the prognosis. Results: Clinical and radiographic success was seen in 90% of the patients of group I while it was seen in 95% of the patients of group II. Statistically, nonsignificant results were obtained in the comparison of the efficacy of both the obturation techniques. Conclusion: Within the limitations of this study, it can be opined that in patients undergoing root canal therapy, both the obturation techniques can be used with equal effectiveness. Clinical significance: The present study helps us in envisaging the preferable obturation technique out of lateral condensation technique and CBO technique when the influence of treatment variables is also instituted. This study enhances the scope of obturation techniques in the discipline of endodontics.

Aim and objective: The purpose of this study was to evaluate and compare the changes in the release of vascular endothelial growth factor (VEGF) from platelet-rich fibrin (PRF) as well as the changes observed in the fibrin architecture of PRF when layered with mineral trioxide aggregate (MTA), Biodentine, and Theracal. Materials and methods: Platelet-rich fibrin was obtained from eight volunteers to form PRF membrane (PRFm) and divided into four groups of control (PRF alone), PRF with MTA, PRF with Biodentine, and PRF with Theracal by layering the PRFm over with these materials. Four samples of each group were prepared. Release of VEGF was estimated using enzyme-linked immunosorbent assay (ELISA) at 1 hour and 5 hours. PRFm in contact with the materials was analyzed under a scanning electron microscope to observe the fibrin architecture. Results: A significantly higher amount of VEGF was released from the Theracal group as compared to control (PRF only), Biodentine, and MTA. The fibrin architecture of the Biodentine group was more similar to that of the control group at both 1 hour and 5 hours. Conclusion: Theracal could be a suitable material to be used along with PRF for endodontic use wherever indicated. Clinical significance: The results show an increased release of VEGF from PRFm when layered with Theracal. PRFm used in procedures like revascularization and pulpotomy may therefore be layered with these dental materials to enhance the regeneration and create a biocompatible seal.

Aim and objective: This study aimed to evaluate the impact of coronal sealing ability of three temporary restorative materials called Orafil LC, Cavit-G, and Coltosol to prevent microleakage. Materials and methods: Endodontic access cavities were prepared in 60 caries-free human extracted premolars. All 60 extracted teeth were divided into 3 experimental groups randomly and filled with Orafil LC, Cavit-G, and Coltosol into 4 mm deep cavities. The thermocycling process was performed and then all 60 teeth were immersed in 10% India ink at 37°C for 1 week. Teeth were sectioned buccolingually and a stereomicroscope was used to measure dye penetration. Data were analyzed using Fisher's exact test. Results: There were significant differences present between Orafil LC, Cavit-G, and Orafil LC–Coltosol groups. The highest and lowest leakage scores were present in Coltosol and Orafil LC experimental groups, respectively. Conclusion: Orafil LC showed better sealing ability compared to Cavit-G and Coltosol. The selection of temporary restorative material is very important for long-term endodontic treatment success. Clinical significance: The importance of temporary restorative materials should not be ignored by a dental practitioner. Orafil LC showed better sealing ability compared to other materials.

Aim and objective: This cross-sectional study aimed to evaluate the trends in the storage of orthodontic records among final-year orthodontic postgraduates in India. Materials and methods: A web-based survey form (Google Form, Google Inc., ABC Alphabet, California, USA) was created and sent to 325 final-year orthodontic postgraduate trainees in India through email and third-party messenger applications. The questionnaire consisted of queries regarding the current method of storage of orthodontic records, the problems being faced storing them, and the recommended method for storing them. The data acquired were subjected to descriptive statistical analysis. Results: The response rate was 80.6%. The majority of participants stored all their records and 80.5% of them had a history of loss of records. All the participants stored study models in plaster form and 95.8% of participants stored the photographs and radiographs in both hard and soft copy forms. Google Drive was used by 82.8% of participants as their backup and 86.6% of them stored their soft copies in an external hard disk. Conclusion: Study models in physical forms; photographs and radiographs in both hard and soft copy forms are currently being used and recommended by the majority of the participants. External hard disks have been used by many as a mode of backup of records compared with cloud services. Among participants using cloud services as their mode of backup, Google Drive is commonly being used. Duration of patient's record storage has to be a minimum of 10 years which is not being followed by most of the participants. Clinical significance: The current trends in various methods of storing orthodontic records help the clinician to know the best method suitable for them in archiving accurate records for longer periods.

Aim and objective: The study aims to compare the alveolar bone thickness in the lower incisors area in skeletal class I average growing adults with two different growth patterns of class II adults using cone-beam computed tomography (CBCT) imaging technique. Materials and methods: The CBCT images of 20 class II and 10 class I average growth pattern patients were examined. Class II patients were subdivided into high- and low-angle groups of 10 patients each. The alveolar bone thickness of mandibular incisors in the buccal and lingual region was measured at the level of the alveolar crest and 3, 6, and 9 mm from the alveolar crest. Results: Buccal and lingual alveolar bone thickness in class II high- and low-angle patients was not significantly different at all levels except at 3 and 9 mm apical levels where lingual bone shows more thickness than buccal. Class II high-angle group showed thinner alveolar bone than low-angle and class I average groups, in most areas. Conclusion: Skeletal class II subjects with hyperdivergent growth patterns showed thinner mandibular alveolar bone in most areas compared with average/low-angle subjects. In class I average growing patients, the lingual alveolar bone is thicker in all sites. In class II high-angle patients, most sites exhibit thicker lingual bone thickness. In class II low-angle cases, all sites have a greater buccal bone thickness. Clinical significance: The anatomic limit set by the alveolar cortical bone should be considered during treatment planning during the sagittal correction, retraction of teeth, and miniscrew insertion. It is important to consider these boundaries as a limit to reposition teeth. Considering the anatomy of the alveolus is one of the keys to minimize unfavorable sequelae.

Aim: This study was conducted to assess and evaluate the knowledge, attitude, and practice among 9–13 years old day scholars and residential schoolchildren in South Bengaluru, Karnataka. Materials and methods: A total of 2,155 schoolchildren aged between 9 years and 13 years from 13 schools in South Bengaluru participated in the study out of which 1,039 were residential schools and 1,116 were day scholars. All children were given 36 close-ended questionnaires pertaining to knowledge attitude, diet, practice, and behavior regarding oral health and were requested to complete them within 15 to 20 minutes on the school premises only. Results: The results of our study showed about 89.2% of the participants had good knowledge about maintaining healthy and good teeth for their good health. Also, 75.7% of children knew that sugar is the cause of tooth decay, 94% of the study participants had good oral hygiene practice, but the awareness regarding other oral hygiene aids (flossing) was found to be 11%. Conclusion: Results of our study showed general awareness of oral health was quite good and children had a positive attitude toward oral hygiene practices but exhibited limited knowledge on the preventive dental practices. This suggests the need for implementation of the importance of the early preventive dental visit, through effective oral health promotion through school dental health programs. Clinical significance: Good oral hygiene keeps teeth free from dental plaque buildup, fights off cavities, and bad breath. A healthy diet that is low in sugary foods, regular dental visits, oral hygiene instructions provided by the dentist is an essential part of the maintenance of good oral hygiene. Based on the study, we recommend establishing oral health programs under school health that addresses oral health promotion and awareness of dental diseases.

Aim: As a reference for restorative materials that can be used in early childhood caries (ECC) cases. Background: The term ECC is used to describe any form of caries in infants and preschool children. Treatment of ECC should be adjusted depending on the clinical condition of pediatric patients, which is to restore teeth function by restoring cavity and also to give esthetic aspect. Application of correct restorative material could prevent secondary caries and extensive damage to the tooth layer while maintaining primary teeth until exfoliation. Giomer is a real hybrid restorative material from glass ionomer and resin composites with fluoride-releasing and fluoride-recharging properties, with the main composition based on prereacted glass ionomer (PRG) technology. Case description: A 5-year-old boy accompanied by his mother to Dental Hospital Universitas Padjadjaran with a cavity on the right and left front upper teeth, absence of throbbing pain. Intraoral clinical examination showed caries on teeth 51, 52, 61, 62, 63, 64, 84, and composite fillings and secondary caries on teeth 74. The restoration was performed on the anterior teeth using giomer technology surface prereacted glass (S-PRG) material with different techniques (bulk-fill using strip crown, bulk-fill without using strip crown and layering). Pulpotomy treatment was lads performed on teeth 64, 74, and 84, then restored using bulk-fill giomer material. The restoration was evaluated for 1 month using modified USPHS criteria and assessments. The results showed Alfa (A) criteria for all teeth restored using giomer material. Conclusion: Based on the characteristics of the giomer S-PRG technology, this material can be considered as an alternative for restoration in cases of ECC. Clinical significance: Giomer S-PRG technology releases ions that can play a role in tooth mineralization, antibacterial activity, improvement of acid resistance, and prevention of bacterial adhesion.

Aim and objective: This case report aims to highlight the use of ultra-low-frequency (ULF) transcutaneous electric nerve stimulation (TENS) as a treatment alternative for the rehabilitation of a completely edentulous patient with altered neuromuscular coordination. Background: Transcutaneous electric nerve stimulation has been successfully used in the management of orofacial pain-related problems in patients. Due to its ability to produce coordinated muscular activity, it can also be used as an effective modality in removable prosthodontics for the rehabilitation of patients with altered neuromuscular coordination. Case description: This case report describes the use of ULF-TENS in prosthodontic management of a 64-year-old female patient with difficulty in chewing for the last 4 years due to loss of all her teeth. Examination revealed that the patient had altered neuromuscular coordination and was unable to guide the mandible into a repeated centric relation position. ULF-TENS has been applied at an amplitude of 0–20 mA with a frequency below 4 Hz for 30 minutes in a continuous mode. This led to coordinated rhythmic muscular contraction with relief of pain and muscle relaxation, thus producing functionally molded borders and helped in guiding the mandible to a repeatable physiologically stable neuromuscular-based maxillomandibular relation. The patient was followed up at 1 week, 1 month, and 6 months interval and was comfortable and satisfied with the prosthesis. Conclusion: Ultra-low-frequency TENS can be a practical treatment modality for the recording of peripheral borders and centric jaw relation for the fabrication of a complete denture prosthesis that is in harmony with the gnathological system. Clinical significance: Ultra-low-frequency TENS can be an alternative treatment modality for the fabrication of complete denture prosthesis with enhanced success in patients with altered neuromuscular coordination.

Aim and objective: To critically evaluate the displacement of orthodontic mini-implants (MIs) under orthodontic force loading. Materials and methods: This trial has been registered to PROSPERO and the registration number is CRD42020150084. An electronic search was done and two independent authors (SS and AKS) screened the initial titles and abstracts to find all the eligible studies in PubMed, Cochrane library, Google Scholar Beta, LILACS from 1950 until June 26, 2020, using the terms orthodontic treatment, temporary anchorage devices, loading behavior, reactive force, stability, primary displacement, migration, dislodgement, loss of anchorage drift, primary stability, loosening, drift characteristics, movement, deflections, biomechanical effect, and randomized controlled trial. The assessment of articles was done using selection criteria. According to the PICOS (population, intervention, comparison, outcome, study design) criteria, the inclusion criteria were worked out. This review took into consideration only randomized and non-randomized trials, and prospective clinical studies were included. We used standard methodological procedures for selecting studies, collecting data. The risk of bias was evaluated and findings were synthesized. Results: Of the 28 initial records identified, a total of 12 studies were included in this review. One study had a poor risk of bias and the remaining 11 studies had moderate to good overall risk. Of the parameters evaluated for displacement, mobility, root approximation of the MIs, the results showed that there was a displacement of MIs but clinically not often relevant to cause failure or complication in treatment. Conclusion: From this review, it can be concluded that there is a displacement of the MI under orthodontic force loading. The primary displacement of the MIs did not appear to be clinically relevant to failure and mobility. Clinical significance: There is a primary displacement that occurs during the loading of MIs and even in some cases secondary displacement. The position and direction of insertion of the MIs should be planned to keep in mind the migration in such a way that it does not interfere with the orthodontic tooth movement and vital structures.

Aim: This study aimed to assess the potential of the hybrid heat treatment (HHT) technique for shaping severely curved canals. Background: This innovative HHT technique combines the use of both Ni-Ti austenitic and martensitic Ni-Ti files, with a simplified sequence, to properly utilize the different files’ properties. Case description: The operative technique started with canal scouting and determination of working length using a size 10 SS K-file. Then, a specific sequence was applied using the F1 20.06v Ni-Ti austenitic file (EdgeTaper) for the preparation of the coronal and middle parts of the canal. This step was followed by S2 20.04 and F1 20.06v martensitic Ni-Ti files (EdgeTaper Platinum) to enlarge the canal until the apex reached. No intracanal breakage of any instruments or deformation of flutes was recorded. Conclusion: The present study describes a new HHT technique aiming at simplifying procedures and taking most of the different characteristics of the different heat treatment; the clinical cases seem to show its potentialities in terms of safety, speediness, effectiveness, and preservation of original anatomy. Clinical significance: The cases show the advantages of the newly proposed technique over a traditional approach to properly shape complex anatomies with only a few Ni-Ti rotary instruments number.