Aim: To investigate the electromyographic activity of masseter and temporalis muscles in full dentate participants after deprogramming with various muscle deprogramming devices (MDDs). Materials and Methods: The current study was a randomized crossover clinical trial. After the screening of 96 individuals, 30 participants were included based on the eligibility criteria. Surface electromyographic (SEMG) activity of masseter and temporalis muscles was analyzed in different clinical conditions: Condition A—at rest without muscle deprogramming, Condition B—after clenching without muscle deprogramming, Condition C—subsequent to 30 min of deprogramming by cotton rolls, Condition D—subsequent to 30 min of deprogramming by Leaf gauge, Condition E—subsequent to 30 min of deprogramming by Lucia jig, Condition F—subsequent to 24 h of deprogramming by Kois deprogrammer. The inter-group comparison was performed using the analysis of variance (ANOVA) test, and the pairwise comparison was done using Bonferroni post hoc test. Results: ANOVA showed a statistical significant difference in the electromyographic activity of masseter and temporalis muscles in tested individuals, subsequent to deprogramming with different MDDs. Between the tested MDDs, the lowest mean muscle activity was reported with the Kois deprogrammer and the highest with cotton rolls, when used for deprogramming. Conclusion: Muscle deprogramming with the Kois deprogrammer presented lowest muscle activity in both masseter and temporalis muscles involving both sides, thus confirming its effectiveness in achieving patient’s centric relation position.

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Aim: It has been proven that the linguistic differences between patients and health professionals make access to health care difficult in Latin American countries with a Quechua-speaking population. Therefore, this review focusses on the importance of learning the Quechua language as a useful tool for increasing health access. Materials and Methods: Electronic databases such as Scopus, Web of Science, and PubMed were searched from January 2010 until December 2020 using the Quechua terms for rural population, language barriers, health, and services. Results: This narrative review is based on the importance of learning the Quechua language to reduce the linguistic barrier in medical–dental care and was classified as: (1) Quechua and access to health, (2) the importance of learning Quechua in dental clinical practice, (3) teaching Quechua in universities, and finally, (4) a vocabulary in Quechua is proposed for its application in dental practice. Conclusion: Knowledge of the Quechua language is key to improving medical and dental care in Andean countries; therefore, training in this language should start from undergraduate studies.

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Aim: To determine the root and canal morphology of the mandibular first molars in a Moroccan subpopulation using cone-beam computed tomography (CBCT) images. Materials and Methods: This cross-sectional study assessed CBCT images using 2019 database from a private dental clinic in Casablanca (Morocco). Three hundred ninety-seven permanent mandibular first molars were evaluated in this study, according to Vertucci classification to determine root and canal morphology. The associations among the frequency of these variables were evaluated by the chi-square test (P < 0.05). Data were analyzed using the SPSS (Statistical Package for the Social Sciences) software. Results: Approximately 95.2% of examined molars had two roots, 4.5% had three roots, and 0.3% had single root. No significant differences were observed between the sexes. The results show no differences between the sexes. The root canal configuration was significantly different between mesial root of two-rooted and three-rooted mandibular first molars (P < 0.001). The most frequent type in the mesial roots is type IV with 59.3% and 77.8% for two-rooted molars and three-rooted molars, respectively. The most frequent type in the mesial roots is type I (54.2% for molars with two-separated roots and 77.7%–100% for molars with three roots). Conclusion: A higher prevalence of two separate roots with two canals in the mesial root and single canal in the distal root was observed in 95.2%. The root canal configuration was significantly different between mesial root of two-rooted and three-rooted mandibular first molars.

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Aim: Post-endodontic pain during root canal treatment (RCT) is inevitable. Previous meta-analysis reported a lesser post-endodontic pain in using continuous rotation instruments compared with using reciprocating instruments in a single-visit root canal therapy. No evidence has been elucidated to prove the same in multi-visit root canal therapy. The aim of this systematic review was to compare the intensity of post-instrumentation pain on using continuous and reciprocating motion engine-driven systems in multi-visit root endodontic treatment. Materials and Methods: An extensive literature search in PubMed, Cochrane Library, and Google Scholar was performed to identify investigations that evaluated the effect of continuous and reciprocating instrument systems on post-operative pain. The certainty of evidence was assessed using GRADEpro (GRADEpro GDT software, https://gradepro.org). We included two trials in this review, and their risk of bias was found to be low. A fixed-effects model was used to pool the mean post-operative pain as this was found by less heterogeneity. Results: Pooled results showed no difference in the mean post-instrumentation pain measured using a visual analog scale between continuous and reciprocating instrument systems with a mean difference of −0.13 (P = 0.48; I² = 26%). Also pooled relative risk showed no difference in the risk for post-endodontic pain between continuous and reciprocating instrument systems with a relative risk of 0.53 (P = 0.08; I² = 34%). Conclusion: The use of both continuous and reciprocating instruments had lower intensity of post-operative pain in patients who received multi-visit RCT with no significant difference between them. Further clinical trials with high quality are needed to understand the effect of continuous and reciprocal engine-driven instrumentation systems in multi-visit RCT.

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Aim: To evaluate the effectiveness of using dissolving xylitol chewable tablets versus xylitol chewing gum in geriatric bedridden patients in decreasing bacterial count in both saliva and interdental plaque as well as in increasing salivary pH. Materials and Methods: Overall, 98 patients were included in this randomized clinical trial and they were divided into two groups (n = 49). Group 1 (intervention group) received xylitol chewable tablets (Listerine Ready Tabs), and group 2 (Control group) received xylitol chewing gum (Trident Original). The primary outcome was salivary mutans streptococci count, and secondary outcomes were interdental plaque mutans streptococci count (both were assessed through plate culturing on MSBA media) and salivary pH (measured by a pH meter). All outcomes were assessed at baseline, after 5 min, and after 15 days. Friedmann test was used to show the effect of follow-up periods followed by a multiple comparison with Dunn Bonferroni correction. Mann-Whitney test was used to compare between tested groups for all examined variables. Result: Regarding MS count in both saliva and interdental plaque, there was a statistically significant difference between both groups at baseline and after 5 min; however, after 15 days, there was no statistically significant difference between both groups. Regarding salivary pH, there was no statistically significant difference at baseline and after 5 min between both groups; however, after 15 days, there was a statistically significant difference between both groups. Conclusion: Both xylitol dissolving chewable tablet and xylitol chewing gum have potent antibacterial effects and enhanced salivary pH in geriatric bedridden patients.

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Aim: To compare dentinal cracks incidences after root canal preparation using Hand K-files; Rotary files: Protaper NEXT (PTN), Hyflex Controlled Memory (CM); and Reciprocating files: Wave One and Wave One Gold files. Materials and Methods: Hundred extracted human mandibular first premolars with straight root canals were taken postextraction and were allocated randomly into five groups (n = 20 teeth per group). The canals were instrumented using Hand K-files, Protaper Next (PTN), Hyflex CM, Wave One, and Wave One Gold systems. Group 1-Control group comprised of canals prepared by Hand files. Further, the roots were sectioned at three levels: 3, 6, and 9 mm horizontally from the apex using a saw at a low-speed saw and under water cooling. These slices were examined under a stereomicroscope at 25× magnification and the presence of any dentinal cracks was noted. The frequency of cracks was presented in number and percentage. Intergroup comparison of crack frequency was performed using analysis of variance. Results: No cracks were observed in the control group. In all the other groups, dentinal cracks were observed. The rotary files PTN and Hyflex CM files produced significantly fewer dentinal cracks than the reciprocating Wave One and Wave One Gold files (P < 0.05). The reciprocating files significantly produced more cracks apically than the rotary files (P < 0.05). Analyses were performed on SPSS software (windows version 22.0). Conclusion: Instrumentation with file systems can cause crack formation in the dentinal wall of the root canal. Determination of which files to choose for root canal preparation is technique sensitive and each instrument type has own benefits. However, care should be taken while biomechanical preparation to avoid dentinal cracks formation.

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Aim: To compare and validate the dimensional accuracy of two of the most popular 3D printing techniques: highly professional stereolithography (SLA) and low-cost fused deposition modeling (FDM), using 3D printed mandibular models based on low-dose multislice computed tomography (MSCT) scan data. Materials and Methods: In order to compare SLA and FDM, the mandibular model was scanned using an ultralow dose MSCT scanner. The scanner generated DICOM file which was converted to STL format. The digital 3D model was printed seven times with each of the printing techniques: SLA and FDM. Ten linear measurements of the printed models were compared with the reference model using a digital caliper. Differences between measurement were analyzed and compared for trueness and accuracy of both FDM and SLA printers. Results: The statistical analysis showed a statistically significant difference in the dimensional error of both techniques in comparison to the reference model, in which the mean relative difference is 0.30% and −0.97% and the mean absolute difference is 0.13 mm and −0.44 mm for SLA and FDM, respectively. Upon comparing the two utilized 3D printing techniques, the trueness of both SLA and FDM showed no statistical or clinically significant difference in the dimensional error, with the mean relative difference and the mean absolute difference of SLA being lower than those of FDM. Conclusion: These results suggest that both printers can be used safely in dental practice and that a low-cost FDM printer can provide an accuracy level comparable to the professional SLA printer.

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Aim: To compare the antimicrobial efficacy of an indigenously prepared gold nanoparticle (AuNP) oral rinse with chlorhexidine oral rinse on plaque samples of subjects undergoing orthodontic treatment. Materials and Methods: In the presented ex-vivo study, previously prepared AuNPs were subjected to microbroth dilution assay for determination of MIC. Dental plaque samples were collected from either first or second maxillary molar teeth from first and second quadrants in 20 subjects (18–30 years) undergoing orthodontic treatment in the outpatient department. An aliquot of 100 µL of saline mixed with plaque was diluted in 0.5 mL of each group (Group 1: control, Group 2: 0.6% AuNP mouthwash, and Group 3: 0.2% chlorhexidine mouthwash). An aliquot of 10 µL was collected from every group and inoculated in the Brain Heart Infusion agar. After incubating for 48 h, colony-forming units (cfu)/mL were counted and identification of colony morphologies was performed. Shapiro–Wilk’s test was done for normality testing and descriptive statistics to quantify the cfu, Kruskal–Wallis test for intergroup comparisons, and Dunn’s post hoc Tukey test for pairwise comparisons. Results: Mean and SD of cfu in group 1 was 521.36 ± 168.02, group 2 was 0.85 ± 0.74, and group 3 was 0.55 ± 0.45. Intergroup comparisons revealed statistically significant differences (P < 0.000). Pairwise comparison showed significant difference between the groups 1 and 2, groups 1 and 3 (P < 0.000), but not between groups 2 and 3 (P = 0.929). Conclusion: The indigenous AuNP herbal mouth rinse had a good antimicrobial effect against common oral microbes found in patients undergoing orthodontic treatment. The antibacterial effect of the new novel oral rinse when compared with commercially available chlorhexidine did not differ significantly.

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Aim: To estimate the cost of the provision of oral health services in the public health facilities in uMgungundlovu and eThekwini districts of KwaZulu-Natal during the financial year 2018/19. Materials and Methods: The study was a retrospective costing analysis using the provider’s perspective for estimating the cost for the period from April 1, 2018 to March 31, 2019. A mixed costing approach in which secondary data were obtained from the human resources system and the Basic Accounting System (BAS) package. Primary data that was collected at facility level included dental headcount, type of diagnosis, medication prescribed, and consumables utilized. The cost of supply for medicines were obtained for individual items commonly used by dental practitioners during consultation from the Pharmaceutical Supply Chain Management Unit. The costs are quoted in USD based on an average exchange of R13.25 per USD in 2018. Results: The total dental headcount across the 16 facilities was 206,309 for the 2018/19 financial year. The mean cost for dental outpatient curative care per patient per facility was $45.65 [95% confidence interval (CI): $32.88–$58.42]. The estimated total dental health expenditure across the Province based on an average unit cost per patient per facility equals to 0.86% (95% CI: 0.62%–1.10%) of the total provincial expenditure. Conclusion: The costs of dental outpatient curative care in the current study are higher than other studies and may be indicative of technical inefficiencies within the health system. We recommend that an audit of oral health services be conducted that could identify the technical inefficiencies and provide a platform for re-orientation of oral health service.

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Aim: The introduction of a new drug for preventing dental caries, suitable for localized release in the mouth, has become a need of the hour. Silver nitrate has long been used in dentistry because of its sclerosing and dehydrating properties. This study aimed at evaluating the antimicrobial action of two concentrations of silver nitrate (0.05 N, 0.1 N) against Streptococcus mutans and Candida albicans and at comparing it with 2% chlorhexidine (CHX) and 0.9% saline. Materials and Methods: Standard strains of S. mutans and C. albicans were cultured on agar plates and disks impregnated with four test solutions, namely Group I: 2% CHX, Group II: 0.1 N silver nitrate, Group III: 0.05 N silver nitrate, and Group IV: 0.9% N Saline was incorporated into these. The plates were then incubated and inhibition zone was measured using calipers. The measured values were subjected to statistical analysis using one-way ANOVA and Tukey’s post hoc test for a pairwise comparison. Results: The analysis using one-way analysis of variance (ANOVA) showed a highly significant difference among different groups for both organisms. Further analysis using post hoc test in case of S. mutans showed not much significant difference between group II and group III, but a significant difference was exhibited when compared with group 1 and group IV. In the case of C. albicans, there was a highly significant difference among each group (II>III>1>IV). Conclusion: The 0.05 N and 0.1N silver nitrate showed significant antimicrobial action, with 0.1 N AgNO₃ being the most effective.

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Aim: Demineralized freeze-dried bone allografts (DFDBA) are osteoinductive and platelet-rich fibrin (PRF) plays an essential role in wound repair. It also provides a matrix for migration of tissue-forming cells. Both entities may accelerate the bone healing process and soft tissues. The present study was aimed to compare the clinical and radiographic outcomes obtained with the combination of PRF and DFDBA to those obtained with PRF alone in the treatment of periodontal intrabony defects 9 months after surgical intervention. Materials and Methods: A split-mouth study was conducted in 20 subjects (40 sites - intrabony defect bilaterally). The sites had been randomly divided into two groups (Site A and Site B) in which one quadrant (Site A) received DFDBA+PRF whereas the other quadrant (Site B) received PRF alone. Clinical parameters gingival index (GI), probing depth (PD), clinical attachment level (CAL), gingival marginal level (GML), and radiographic parameters—crestal bone resorption and bone fill was measured at baseline, 3 and 9 months. Results: Over a period of 9 months, a significant reduction was observed in GI 0.88 ± 0.06 (P < 0.001)along with a greater reduction in PD(4.30 ± 1.38 mm), greater gain in CAL (4.35 ± 1.53 mm) as well as a greater bone fill (2.40 ± 0.99 mm) present with Site A (DFDBA+PRF) as compared to Site B (PRF alone). However, slight gingival recession and crestal bone resorption were observed with both groups which were not clinically significant but were statistically significant. Conclusion: The combination of PRF and DFDBA both clinically and radiographically showed much better results as compared to PRF alone in the treatment of periodontal 3 wall intrabony defects over a period of 9 months after surgical intervention.

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Microstomia is a term used for reduced mouth opening; it can be associated with congenital or acquired conditions. Oral cavity is an entrance to the rest of the body, and a disability in this crucial area leads to impaired function, psychology, and esthetics. Microstomia is one such condition which not only hampers the patient’s physical well-being but also mental tranquility. The rehabilitation in such patients should offer them functional demand with esthetics and elevate their quality of life. It is a responsibility of a prosthodontist to meet such challenges as these patients face difficulty in inserting as well as removing the dentures and the problem aggravates with age as the manual dexterity reduces. This clinical report demonstrates a case of a completely edentulous female who underwent radiation therapy of the head. This article presents a simple yet effective approach for rehabilitation of a microstomia patient with the fabrication of collapsible denture using a silicone-based permanent soft denture liner.

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Aim: To evaluate oral salivary microbes and associate them with chemoradiotherapy-induced oral mucositis in HNC patients. Materials and Method: This was a prospective cohort study on 21 head and neck cancer patients using simple random sampling; those undergoing chemoradiotherapy were evaluated for oral mucositis based on WHO criteria. Controls were healthy volunteers n = 8. Salivary samples were collected at the following 3 time points in patients undergoing chemoradiotherapy: day 1 (before chemoradiotherapy), day 7, and day 30 and from controls. Progression of oral mucositis according to grades on days 1, 7, and 30 was analyzed using Friedman tests. Clinical and microbiological profiles, the variations in the microbiota with increase in grades of OM as the day progresses were analyzed. Data were analyzed using SPSS. Association of grading of oral mucositis according to progress in days with different microbial colonization were analyzed using chi-squared test. Level of significance was set at P < 0.05. Results: Predominance of Streptococci species followed by Candida and other Gram-negative bacteria were observed on day 1 before chemoradiotherapy. Gradual increase in the Candida and Gram-negative species was observed after chemoradiotherapy progressing to gradual rise from Day 7 toward day 30 and is associated with moderate to severe OM (Grade >2). There was a statistically significant difference in grading of oral mucositis between Day 1 and Day 30 (P < 0.01), Day 7 and Day 30 (P < 0.01). The overall microbial profile was as follows: Candida albicans (71.4%, n = 15), Candida tropicalis (57.14%, n = 12), Enterococcus faecalis (42.85%, n = 9), Klebsiella pneumoniae (61.09%, n = 13), Pseudomonas aeruginosa (76.19%, n = 16), Streptococcus pneumoniae (19.04%, n = 4), and Viridans streptococci (14.28%, n = 3) were observed on day 30.The results were statistically significant with a P value 0.048, P < 0.05. Conclusion: There was a change in oral microbiota in head and neck cancer patients during chemoradiotherapy over a time period. Salivary microbes were associated with the severity of OM thus reflecting the disease status. Novel drugs with antimicrobial properties with fewer side effects are recommended that prevent and treat OM in head and neck cancer patients.

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Aim: Root fractures depict a challenge to dentists, especially when they are oriented vertically. They can be responsible for an important percentage of extractions of endodontically treated teeth. The objective of this research was to compare the accuracy of vertical root fractures (VRF) diagnosis in teeth treated endodontically and with posts in root canals, using images acquired by three different cone-beam computed tomography (CBCT) scanners and different acquisition protocols, a varying field of view (FOV), voxel size, kilovoltage (KVp), and milliamperes (mA). Materials and Methods: This study evaluated the diagnostic capacity of three different brands of CBCT devices. Overall, 240 images of single root teeth were included and they were divided into two groups: the test group in which teeth were artificially fractured, and the control group, without fractures. The CBCT images were assessed, reaching a consensus between three examiners. Descriptive statistics and a binary logistic regression test were performed. Sensibility, specificity, and accuracy values also were obtained. Statistical significance was set at P < 0.05. Results: Two studied scanners contributed 77.8% of diagnostic errors, and 61.1% of the errors were in the presence of metal in the root canal. There were no significant differences between the standard (STD) and high-definition (HD) protocols. Conclusion: The equipment brand and the condition of the tooth are important factors in the VRF assessment using CBCT.

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Aim: To assess the expression of Myb in the saliva and salivary gland tissues of patients suffering from salivary gland tumors to find out its ability to differentiate between salivary gland carcinomas and benign tumors. Materials and Methods: This was a prospective study comprising 70 patients with salivary gland tumors classified into two equal groups: 35 patients had benign tumors and 35 patients had malignant salivary gland carcinomas. Expression of Myb level in the saliva and salivary gland tissues of the patients was measured by enzyme-linked immunosorbent assay (ELISA) and detected by immunohistochemical (IHC) analysis. For parametric data, Student’s t test was used, and for nonparametric data Mann–Whitney U test was used. However, qualitative data were presented as frequencies and percentages. Chi-square test or Fisher’s exact test, when applicable, was used for the comparisons. ROC (receiver-operating characteristic) curve was constructed to determine the cutoff values of Myb for differentiation between the groups. Results: There was a statistically significant difference (P = 0.029) of Myb level in saliva and tissue in the malignant group in comparison to the benign group. Myb ELISA test in salivary gland tissues at a cutoff value of 355 mg/g could discriminate between benign and malignant salivary gland tumors with an 88.9% sensitivity, 86.7% specificity, and accuracy amounting to 91.8%. At a cutoff value of 78.9 mg/mL, Myb ELISA test in saliva could discriminate between benign and malignant salivary gland tumors with an 85.6% sensitivity, 79.7% specificity, and accuracy amounting to 83.4%. In tissues, Myb detection by IHC is significantly more diagnostic than by ELISA. Conclusion: Myb expression by ELISA was markedly observed in salivary gland tumors especially malignant carcinoma. Therefore, it can be used as a simple primary marker for the detection of salivary gland tumors in saliva or tissue biopsy. Myb expression evaluation by ELISA can differentiate between malignant and benign salivary gland tumors. The level of Myb detected in saliva can furnish an early diagnosis of salivary gland cancer as well as a noninvasive aid to monitor recurrence of malignant salivary gland lesions.

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