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Aim: This systematic review explores the postoperative behavior outcomes of oral midazolam (OM) premedication in pediatric dental general anesthesia (DGA). Premedication drug assists in the reduction of negative psychological impact during the general anesthesia induction, thus influence the behavior, particularly in pediatric patients. OM is one of the common premedications given due to its efficacy and well accepted administration. Materials and Methods: This review was registered under the International Prospective Register of Systematic Reviews (PROSPERO). Studies published in the databases including PubMed Central, Cochrane, Web of Science, Google Scholar and others between January 1980 and December 2020 were analyzed using Preferred Reporting Items for Systematic Review and Meta‐analysis (PRISMA) guidelines. Risks of bias and evidence levels were determined on each selected study. Results: Seven out of 6944 studies, were scrutinized for final analysis, which involved a total of 392 children in experimental groups and 89 children in placebo groups. OM had shown both positive and negative behavior outcomes post DGA using different assessment tools, in comparison to other premedications. It also showed less side effect post consumption. Conclusions: OM premedication demonstrated very limited evidence for positive behavior outcomes in pediatric DGA. The 0.5 mg/kg body weight dosage of midazolam yields the most favorable behavior postoperatively. Based on this collective review, there is still limited evidence for positive behavior outcomes in OM premedication.

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Aim: In prosthodontics, adequate bone volume is required to place a dental implant. Augmentation treatment can increase bone volume if it is insufficient. The guided bone regeneration (GBR) approach can be applied for either horizontal or vertical alveolar ridge augmentation. The GBR approach requires material in the form of a membrane to prevent non-osteogenic cells from accessing the wound, thus preventing any disruption of the process of new bone creation. Typically, non-resorbable membranes like titanium mesh are used in the GBR procedure to augment bone vertical dimension volume. In order to improve healing and bone regeneration, titanium mesh can be coupled with several membranes, including collagen membranes, platelet-rich fibrin (PRF), and polytetrafluoroethylene (PTFE). This review sought to ascertain the effects of adding vertical bone to titanium mesh following GBR with a collagen membrane, PRF, and PTFE for dental implant treatment. Materials and Methods: In this review, the medical literature on membrane titanium mesh used for implant therapy with the GBR technique was gathered from journals and publications published in the PubMed and Google Scholar databases between 2015 and 2020. Experimental research, case reports, and randomized clinical trials (RCTs) were included. The keywords used were “titanium mesh membrane, titanium mesh guided bone regeneration, titanium mesh with collagen membranes, titanium mesh with PRF, and PTFE. Results: Thirteen publications were found and chosen which discuss the usage of titanium mesh in conjunction with collagen membranes, PRF, and PTFE as barrier membranes for GBR. Conclusion: The GBR technique, which combines titanium mesh with PTFE and collagen membranes, can improve alveolar bone vertical addition, and the combination of titanium mesh with PRF can help the healing process move faster.

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Aim: To compare the cutting efficiency, cyclic fatigue, corrosion resistance, and autoclave cycle effects of ProTaper Gold, TruNatomy, and WaveOne Gold file systems. Materials and Methods: Thirty mesiobuccal roots of extracted maxillary first molars were randomly divided into three groups (10 specimens each) for testing cutting efficiency: Groups A, B, and C: ProTaper Gold, TruNatomy-Prime, and WaveOne Gold-Primary, respectively. Root canal instrumentation was carried out in each root accordingly. Specimens’ weights were measured and micro-computed tomography was used to scan the samples before and after root canal preparation. For cyclic-fatigue, corrosion-resistance, and autoclave-cycle-effects testing, 30 files were allocated into three groups at random, Groups A, B, and C: ProTaper Gold-F2, TruNatomy-Prime, and WaveOne Gold-Primary (10 specimens each). For cyclic-fatigue testing, the instruments were firmly held in a stainless steel block with an artificial canal without pressure. The time (s) was calculated until fracture. For the corrosion-resistance test, SEM surface-topographical analysis was carried out in response to 5.25% NaOCl, 2% CHX, and 17% EDTA. For evaluation of autoclave cycle effects, SEM surface-topographical analysis was carried out for 1, 5, and 10 autoclave cycles. Data were analyzed statistically using one-way analysis of variance followed by multiple comparisons with Bonferroni’s test at P<0.05. Results: TruNatomy was the most resistant to cyclic fatigue and ProTaper Gold the least. WaveOne Gold removed significantly more dentin and had the least corrosion resistance and highest autoclave cycle effects. Conclusion: TruNatomy can be considered as a better file system compared with WaveOne Gold and has comparable efficiency with that of ProTaper Gold.

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Aim: The conventional restorative materials amalgam and glass ionomer have multifarious drawbacks leading to introduction of newer materials with superior biomechanical attributes. The present study aimed to assess and compare the compressive strength of ceramic-reinforced glass ionomer cement, zirconia-reinforced glass ionomer cement, high strength glass ionomer posterior restorative material, alkasite restorative material, and amalgam when used as posterior restorative materials. Materials and Methods: Five restorative materials were evaluated: modified glass ionomer cements including ceramic-reinforced, zirconia-reinforced, and high strength glass ionomer; alkasite restorative material; and dental amalgam. Fifty cylindrical specimens were fabricated using test materials (n = 10 for each group). Class II cavities prepared on 50 intact permanent molars were restored with test materials. After thermocycling and 24 h of storing, the specimens in artificial saliva, compressive strength, and fracture resistance were tested. Data were analyzed statistically. One-way analysis of variance and post hoc Tukey test were used for intergroup comparison. Pearson’s correlation was used for correlating the maximum load by cylindrical and tooth specimens. Results: A significantly high compressive strength was displayed by specimens of group 4, followed by group 5, group 3, group 1, and least by group 2. The highest fracture resistance was displayed by teeth restored with the test materials in group 4, group 1, group 5, group 2, and least by group 3. Conclusion: Within the limitations of the present study, alkasite restorative material (Cention N) showed the highest compressive strength in cylindrical and highest fracture resistance in tooth specimens.

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Aim: The present study aimed to evaluate and compare the fracture resistance of four different core build-up materials on endodontically treated teeth. Materials and Methods: In this in vitro study, sample size estimation was done using G*power software (version 3.1.9.2), an effect size of 0.66 was obtained at 95% confidence interval. 48 Teeth samples were decoronated 2 mm above the Cementoenamel junction. Root canal treatment done, followed by preparation of post space and fiberglass posts of 10 mm length was cemented with resin cement into the root canal and 4 mm above the prepared tooth. All the samples were randomly divided into 4 groups of 12 samples for four different core build up materials. All teeth were restored with a Nickel chromium crown of standard dimensions and cemented with glass ionomer cement. Fracture resistance measured by applying the load at an angle of 135° to the long axis of the tooth at a crosshead speed of 0.05 mm/min until failure. Analysis was performed using KRUSKAL-WALLIS to compare mean values and standard deviation of fracture resistance, followed by post – hoc MANN WHITNEY test for assessing the significant difference of fracture resistance between the four groups. Results: Resistance to fracture was greater in Luxacore Z group followed by Vitremer, Denfil and Filtek. However, no statistically significant differences in the fracture resistance were observed among the groups. Conclusion: The results indicate that Luxacore Z core build-up material exhibits superior fracture resistance. Resin modified glass ionomer cement had fracture resistance comparable to Luxacore.

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Aim: The aim of this study was to assess the effect of using turmeric powder extract on changes of tooth color with extra-coronal and intra-coronal bleaching methods. Materials and Methods: Turmeric powder extract was weighted and mixed with two different hydrogen peroxide concentrations (3% and 6%) to be used as a bleaching agent. Thirty teeth were allocated into three groups (n = 10): Group A: bleaching agent (6%) was applied on the labial surface, Group B: bleaching agent (3%) was applied inside the pulp chamber, and Group C: extra- and intra-coronal bleaching techniques were used (6% and 3%, respectively). A standardized access cavity was opened in the palatal surface of each tooth in both Groups B and C. Color parameters were measured using a spectrophotometer. Results: A statistically significant difference in color difference values (∆E*) and enamel brightness (∆L*) was found between Group C and each of Groups A and B. There was no statistically significant difference in (∆E*) and (∆L*) between Group A and Group B. The highest mean value of (∆E*) and (∆L*) was found in Group C, whereas the least mean value was found in Group B. Conclusion: Bleaching the external and internal tooth structure with low concentrations of hydrogen peroxide solution mixed with turmeric extract has a promising effect in color enhancement.

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Aim: The aim of this study was to compare and evaluate the antibacterial efficacy of triphala mouthwash and its combination with 0.2% chlorhexidine against salivary Streptococcus mutans of orthodontic patients. Materials and Methods: A total of 54 patients under fixed orthodontic therapy were included in this randomized clinical trial and divided into three groups of 18 each. The groups were requested to use one of three mouthwashes two times a day for 10 days: chlorhexidine 0.2%, triphala 25%, and the combination of chlorhexidine and triphala (1:1). Saliva samples were collected at baseline (day 0) and after 10 days. Ultimately, the samples were diluted and cultured. After incubation, the formed colonies were counted and the CFU/mL was calculated. The results were analyzed statistically with one-way analysis of variance and t test. Results: All mouthwashes decreased the bacterial count from baseline to the end of 10 days (P < 0.05). Although triphala had the least antimicrobial effect, no significant difference was observed between the chlorhexidine and the combined mouthwash group (P = 0.251). Conclusion: It was concluded that the combination of chlorhexidine and triphala reduces the side effects of chlorhexidine while presenting an acceptable antibacterial efficacy.

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Aim: Silver diamine fluoride (SDF) followed by potassium iodide (KI) application helps minimize discoloration; however, such an application may interfere with the bond strength of the restorative material. The aim was to assess the microtensile bond strength (mTBS) of SDF with KI–treated carious primary dentin, which were restored immediately or on the seventh day with glass ionomer cement (GIC) and/or composite resin. Materials and Methods: Thirty-six carious primary molars were collected, and gross debris was removed. Prior to the placement of the restoration, SDF/KI was applied to all the specimens and divided randomly into group I: immediate placement of restoration, and group II: seventh-day placement of restoration (n = 18, per group). Group I was further divided into group Ia: GIC was placed immediately, and group Ib: composite resin was placed. Group II was divided into group IIa: GIC placed on the seventh day, and group IIb: composite placed on the seventh day (n = 9, per group). The specimens were then stored in artificial saliva at 37°C. After 7 days, the specimens were sliced for microtensile strength test using a slow-speed diamond saw (Isomet 1000). The failure mode was evaluated with stereomicroscope at 40× magnification. Results: The mTBS was compared using Kruskal–Wallis test. Group Ib (immediate composite) showed the highest bond strength (1.71 ± 0.80) though this difference was not statistically significant (P = 0.88). The failure modes were compared using chi-square test, which showed no statistically significant difference between the groups. Conclusion: The mTBS showed no difference with the time of placement between the materials.

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Aim: To evaluate the success of orthodontic treatment and the degree of change using the mobile application-based Index of Complexity, Outcome and Need (ICON) score calculation and also inquired the difference of ICON score in time calculation in the results of orthodontic treatment estimated using the mobile application-based method compared with the manual method. Materials and Methods: The present analytic observational study with a cross-sectional approach with a total sampling was performed using 31 pairs of study models in patients treated at the Orthodontic Department of Nala Husada Dental and Oral Hospital, Hang Tuah University, Surabaya, in 2020. The components calculated consisted of the treatment need, complexity assessment, treatment outcome, and the degree of change. The study model was estimated objectively alternating from employing the mobile application to the manual calculation; thus, the results of the calculation time were balanced. The data were analyzed by the independent t-test and Mann–Whitney test (P < 0.05). Results: The results revealed that the independent t-test significance values were P = 0.780 for care needs, P = 0.880 for the assessment of complexity, P = 0.745; P > 0.05 for the treatment outcome, and P = 0.903 for the degree of change. There was a significant difference between manual and mobile application calculation to examine ICON (P = 0.001). Conclusions: The calculation of ICON in the mobile application showed faster performance than the manual method that can be used to evaluate the orthodontics treatment need, complexity assessment, orthodontic treatment outcome, and the degree of change.

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Aim: Four- to six-year-old children were examined to evaluate dental caries incidence in relation to knowledge, attitude, and practice (KAP) toward oral health and dietary practices among their parents, and improvements achieved through targeted oral health educational interventions. Materials and Methods: This was a longitudinal study over 1 year, with interventions at baseline and 6 months followed by evaluation at 1 year on children of two schools located at Bengaluru. The calculation of sample size was based on percentage of knowledge according to a pilot study = 66.87%, precision (%) = 5, desired confidence level (%) = 95, and sample size (n) = 340 samples were included. A 25-item KAP questionnaire on diet and dental caries was administered to parents along with an audio-visual intervention at baseline and oral health education booklet at 6 months. The children were examined at baseline and divided into two groups: Group A (caries free) and Group B (caries active). They were examined again at 1 year to evaluate impact of interventions on KAP of their parents, data recorded on modified World Health Organization (WHO) form, statistical analysis was done. Results: Group A showed higher mean scores for KAP with P value of (P < 0.001) being statistically significant. Z-test for proportions to evaluate deterioration in attitudes and practices among parents showed difference in proportion of samples with worsening in Groups A and B not statistically significant (P > 0.05, respectively). Conclusion: Diet is an important determinant in incidence of caries in the community, KAP toward dietary practices of caregivers of children impacts caries incidence.

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Aim: The relationship between children and parents significantly influences several aspects of child growth, including the oral health status. The research was carried out to analyze the oral health status and sociofamiliar characteristics among 12-year-old schoolchildren. Materials and Methods: The design of this study was descriptive, observational, and cross-sectional, with a quantitative approach; as well as the type of research was correlational. The population of this study involved 34,107 elementary school students, of which 380 12-year-old students were chosen through a random probabilistic sampling and a statistical formula. This research was conducted in Riobamba City, Chimborazo Province, Ecuador. Observational and surveys were used as techniques to collect data; their instruments included the Dental Clinical History and the Health Behavior in School-aged Children 2014—Spain questionnaire. The Kruskal–Wallis test for independent samples, the Spearman rho test, and Pearson’s correlation were applied for the statistical analysis. Results: The results showed a statistically significant relationship between toothbrushing frequency and the number of Decayed, Missing due to caries, and Filled Teeth in the permanent teeth (DMFT) index (P = 0.023), as well as the mother’s profession and their children’s DMFT index (P = 0.044), and the father’s educational level with their children’s toothbrushing frequency (P = 0.035). Conclusions: It was concluded that brushing teeth more than once a day is not enough to maintain optimal oral health status; other important indicators must complement this procedure. The parents’ educational level directly affected their children’s oral health status.

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Aim: The aim of this study was to compare the incidence of inferior alveolar sensory deficits, its association with various intraoperative nerve encounter status and the possible outcome of neurosensory deficits (NSDs) of the bilateral sagittal split osteotomy (BSSO) advancement, and setback procedures. Materials and Methods: This was an observational study among the oral and maxillofacial surgeons of south India who had expertise in the field of orthognathic surgery. A self-administered questionnaire (SAQ) with closed-ended answers was prepared using Google Forms (Google Inc.), pretested, and was sent to the prospective participants selected by convenience sampling through various social media outlets. A total of 1600 participants were included, and the sample size was estimated by the formula = 4pq/d2 and assessed 800 cases each of BSSO setback and advancement surgeries. Since the study focused on the NSD of the inferior alveolar nerve (IAN) post-BSSO, the advancement procedures, setback procedures, and various nerve encounter statuses were considered the variables. All the study procedures were performed as per the ethical guidelines laid down by the Declaration of Helsinki (October 2013) after approval by the Institutions Human Ethics Committee (IHEC), Rajah Muthiah Medical College, Annamalai University. Results: Chi-squared test was used to assess the qualitative variables. The incidence of NSDs was 17.7% in the setback cases and with respect to advancement, the NSD was 15.1%, P < 0.08 indicating no statistically significant difference. When comparing the independent nerve encounter status and NSDs between the groups, the cases where the nerve got transected post osteotomy, necessitating repair as well as those needing dissection due to its presence in the proximal fragment presented with a higher incidence of NSDs which was clinically and statistically significant, P < 0.001. Conclusion: No significant difference was observed in the NSD after mandibular sagittal split advancement and setback procedures. The status of the IAN intraoperatively can influence the incidence of postoperative prolonged IAN NSDs.

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Aim: To evaluate the influence of different dentin moisture conditions on the wetting action of different classes of endodontic sealers, that is, Bioceramic based sealer – Smart Paste Bio, Resin based sealer - AH Plus and Zinc oxide eugenol based sealer – Tubliseal. Materials and Methods: The present research is an in vitro comparative study in which the samples were selected by random sample method. A total of 54 dentin samples were prepared by longitudinally sectioning 27 freshly extracted single rooted mandibular first premolars. 54 samples were then allocated into three groups of 18 each based on the sealer used. Irrigation of the dentin samples were done with 5.25% sodium hypochlorite followed by 17% EDTA and a final rinse with distilled water.18 samples in each sealer group were further divided into separate subgroups of six each on the wide variety of dentin moisture conditions subjected to dry, moist and wet conditions. 0.1ml of sealer was deposited on flat dentin surface and contact angles were measured. Statistical evaluation was done using Analysis of variance and Post-hoc Tukey test at 95% confidence interval and P value <0.05 was considered statistical significant. Results: One way ANOVA was done to analyse the statistical significant difference between the wetting ability of three different sealers under different moisture condition the P Value was <0.001 which was considered statistically significant. Post hoc Tukeys test was done to analyze the contact angle between the two groups in dry, moist and wet condition with P value =0.001 which is <0.05 hence there is a statistical significant difference among all the subgroups. Conclusion: Within the limitation of this in vitro study it can be concluded that the wetting behavior of Resin based sealer - AH Plus was significantly better than Bioceramic sealer - Smart Paste Bio and Zinc oxide eugenol sealer - Tubliseal during dry and moist dentin conditions.

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Aim: The aim of this study was to compare serum and gingival crevicular fluid (GCF) levels of fibroblast growth factor 23 (FGF23) in healthy patients with periodontitis versus gingivitis in end-stage renal disease (ESRD) patients undergoing hemodialysis and periodontitis in patients with ESRD undergoing hemodialysis. Materials and Methods: The study design was a cross-sectional analytical study that included a total of 45 patients with periodontal disease that were divided into three groups with 15 in each group. Group I (n = 15) was systemically healthy having periodontitis, group II (n = 15) had ESRD and gingivitis, and group III (n = 15) had ESRD and periodontitis. The clinical parameters for gingivitis and periodontitis, level of FGF in serum, and GCF were all evaluated in the three groups and the results were compared. Results: FGF23 levels in GCF and serum were statistically significantly higher in group III: ESRD with periodontitis (534 ± 92.7) and (448.2 ± 274.5), respectively, followed by group II: ESRD with gingivitis (150 ± 33.4) and (242.1 ± 31.1), respectively, while were significantly lower in group I: healthy patients with periodontitis (53.7 ± 8.1) and (52.9 ± 6.3), respectively, with a significant difference between the three groups with P < 0.001. Conclusion: Periodontitis patients on hemodialysis showed higher clinical scores (plaque index, bleeding on probing %, pocket depth, and clinical attachment loss) as compared with their counterparts with free medical conditions. The adverse effect of both periodontal and renal disease on clinical presentation and inflammatory markers were strongly evident by the high serum and GCF FGF23 levels with ESRD having the strongest impact.

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Pulp exposures are the common problems encountered during the management of deep carious lesions in children and adolescents. The clinical skill plays an important role to achieve cooperation, reduced chair side time, and total patient care. This article describes a novel endodontic simulation trainer for dental pulpotomy and pulp capping. The simulator described in the article provides advantages such as life size design, easy to use, and cheaper to fabricate with good functional fidelity. This invention has the advantage that the pellet is replaceable, and so the procedure can be done multiple times simply by replacing it with a new pellet.

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