Effect of Dietary Simulating Solvents on the CAD-CAM Provisional Restorative Materials' Microhardness and Color Stability Properties: An in vitro Study.

Purpose: This in vitro study investigated the effects of dietary solvents on the microhardness and color stability of CAD/CAM provisional restorations compared to conventional materials. Methods: Disc-shaped specimens (n=200) were fabricated from self-cured acrylic resin, two 3D-printing resins (FormLabs, NextDent), and a milled material (TelioCAD). Randomization assigned specimens (n=10/group) to immersion solutions: artificial saliva, citric acid, heptane, coffee, and tea. Microhardness and color stability were evaluated. One-way and three-way ANOVA with Tukey's post hoc test analyzed the data. Results: Dietary solvents significantly reduced the surface microhardness of all tested materials (p<0.05). Unpolished surfaces exhibited greater color changes compared to polished ones (p<0.05) across all materials. Coffee and tea induced the most substantial reductions in hardness and the most significant color alterations (p<0.05), whereas saliva and citric acid had minimal effects. Conclusion: Milled provisional restorations exhibited superior hardness and color stability. Dietary solvents significantly affected material properties over time, highlighting the importance of material selection for clinical applications.

Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia.

Background: Esthetic anterior composite restorations are very challenging. They constitute a main part of the clinical practice of restoring teeth with resin composites. Distinctive variations in composite material selection and technique of application in anterior teeth exist when compared to the practice of restoring posterior teeth with resin composites. In a continuation of a previous assessment of class II resin composite practice,  a cross-sectional survey study was performed to determine the awareness of general dental practitioners in Saudi Arabia about resin composite restorations in anterior teeth and to provide evidence-based recommendations to improve their practice. Methods: A total of 500 dental practitioners from different provinces in Saudi Arabia were invited to participate in an online questionnaire which comprised four domains and included a total of sixteen questions addressing aspects regarding the selection of resin composites, cavity configuration, etching protocol, light-curing technique, liner application, application of poly-chromatic composite, as well as finishing and polishing procedures. Chi square testing and descriptive statistics were used to analyze the attained data. Results: From 250 respondents, the greatest participation was from the Eastern and Middle provinces of Saudi Arabia. Female dentists participated less than males. There was no general agreement between participants regarding the resin composite material or the employed technique of application in restoring anterior tooth defects. Respondents indicated that discoloration and hypersensitivity were the most common reasons for patient's dissatisfaction with resin composites in anterior teeth. Conclusions: Dental practitioners are highly encouraged to improve their clinical practice of restoring anterior teeth using resin composites with the focus upon continuous education programs, online webinars, and workshops.

Analyses of Experimental Dental Adhesives Based on Zirconia/Silver Phosphate Nanoparticles.

This study aimed to evaluate the incorporation of zirconia/silver phosphate nanoparticles to develop experimental dental adhesives and to measure their physical and mechanical properties. The nanoparticles were synthesized by the sonication method, and the phase purity, morphological pattern, and antibacterial properties with Staphylococcus aureus and Pseudomonas aeruginosa were assessed. The silanized nanoparticles were incorporated (0, 0.15, 0.25, and 0.5 wt.%) into the photoactivated dimethacrylate resins. The degree of conversion (DC) was assessed, followed by the micro-hardness and flexural strength/modulus test. Long-term color stability was investigated. The bond strength with the dentin surface was conducted on days 1 and 30. The transmission electron microscopy and X-ray diffractogram confirmed the nano-structure and phase purity of the particles. The nanoparticles showed antibacterial activities against both strains and inhibited biofilm formation. The DC range of the experimental groups was 55-66%. The micro-hardness and flexural strength increased with the concentration of nanoparticles in the resin. The 0.5 wt.% group showed significantly high micro-hardness values, whereas a non-significant difference was observed between the experimental groups for flexural strength. The bond strength was higher on day 1 than on day 30, and a significant difference was observed between the two periods. At day 30, the 0.5 wt.% showed significantly higher values compared to other groups. Long-term color stability was observed for all the samples. The experimental adhesives showed promising results and potential to be used for clinical applications. However, further investigations such as antibacterial, penetration depth, and cytocompatibility are required.

Fragment Reattachment: A 4-Year Case Report of Uncomplicated Dental Fractures.

Two fractured maxillary central incisors were restored via the crown fragment reattachment technique with adhesive systems and composite resin material. A long-term successful outcome was achieved after 4 years of follow-up. The patient presented with fractured maxillary central incisors, and a comprehensive intraoral and radiographic examination revealed that both teeth had extended crown fractures with no pulpal exposure (Class II, Ellis and Davey). The tooth fragments were thoroughly cleaned and inspected before being repositioned. Both fragments were in excellent condition with almost no pieces missing. Therefore, the proposed treatment was fragment reattachment. After verifying the repositioning and adaptation of the fractured fragments, a flowable composite was used to perform the reattachment procedure under rubber dam isolation. With modern dental adhesives, the reattachment of tooth fragments in good condition is considered a more conservative option for restoring tooth morphology, esthetics, and function. Although one tooth showed signs of irreversible pulpitis and required root canal treatment 2 weeks after the restoration, the clinical and radiographic evaluations at the 4-year follow-up visits confirmed the success of the restorative treatment. The restorations showed good functional and esthetic outcomes after 4 years of follow-up.

Inorganic Compounds as Remineralizing Fillers in Dental Restorative Materials: Narrative Review.

Secondary caries is one of the leading causes of resin-based dental restoration failure. It is initiated at the interface of an existing restoration and the restored tooth surface. It is mainly caused by an imbalance between two processes of mineral loss (demineralization) and mineral gain (remineralization). A plethora of evidence has explored incorporating several bioactive compounds into resin-based materials to prevent bacterial biofilm attachment and the onset of the disease. In this review, the most recent advances in the design of remineralizing compounds and their functionalization to different resin-based materials' formulations were overviewed. Inorganic compounds, such as nano-sized amorphous calcium phosphate (NACP), calcium fluoride (CaF2), bioactive glass (BAG), hydroxyapatite (HA), fluorapatite (FA), and boron nitride (BN), displayed promising results concerning remineralization, and direct and indirect impact on biofilm growth. The effects of these compounds varied based on these compounds' structure, the incorporated amount or percentage, and the intended clinical application. The remineralizing effects were presented as direct effects, such as an increase in the mineral content of the dental tissue, or indirect effects, such as an increase in the pH around the material. In some of the reported investigations, inorganic remineralizing compounds were combined with other bioactive agents, such as quaternary ammonium compounds (QACs), to maximize the remineralization outcomes and the antibacterial action against the cariogenic biofilms. The reviewed literature was mainly based on laboratory studies, highlighting the need to shift more toward testing the performance of these remineralizing compounds in clinical settings.

A bibliometric analysis of minimally invasive dentistry: A review of the literature from 1994 to 2021.

STATEMENT OF PROBLEM: Minimally invasive dentistry is a technique for the maximal preservation of healthy tooth structures and has been a focus of attention in dental research. However, a detailed bibliometric analysis focusing on research related to minimally invasive dentistry is lacking. PURPOSE: The purpose of this bibliometric analysis was to analyze leading countries and organizations and to identify the preferred journals, the most productive authors, and the most commonly used keywords in the field of minimally invasive dentistry. MATERIAL AND METHODS: The search was performed by using the Scopus database, and publications pertinent to the field of minimally invasive dentistry from 1994 to 2021 were identified. A bibliometric analysis with reference to citations and documents, authors, journals, and keywords was performed. A total of 391 articles published in Scopus indexed journals between 1994 and January 2021 were analyzed by using a software program. RESULTS: A continuing yet steady increase in research publications was identified, with a substantial increase in publications since 2013. The United States and Germany were the countries that published the most articles (98 and 46, respectively), articles that received 1877 and 806 citations, respectively. Cardiff University, UK, was the most productive organization that received 212 citations. The most highly cited articles were from the Q1 category. Blum from King's College London was the highest-cited author in this field. CONCLUSIONS: Considerable advancement has been made in minimally invasive dentistry, as demonstrated by the increase in the number of publications linked with collaboration among various authors, nations, and institutes. This citation analysis gives a perspective on the progress of research in the field of minimally invasive dentistry and allows identification of the most significant and pertinent research areas.

Bioactive Inorganic Materials for Dental Applications: A Narrative Review.

Over time, much attention has been given to the use of bioceramics for biomedical applications; however, the recent trend has been gaining traction to apply these materials for dental restorations. The bioceramics (mainly bioactive) are exceptionally biocompatible and possess excellent bioactive and biological properties due to their similar chemical composition to human hard tissues. However, concern has been noticed related to their mechanical properties. All dental materials based on bioactive materials must be biocompatible, long-lasting, mechanically strong enough to bear the masticatory and functional load, wear-resistant, easily manipulated, and implanted. This review article presents the basic structure, properties, and dental applications of different bioactive materials i.e., amorphous calcium phosphate, hydroxyapatite, tri-calcium phosphate, mono-calcium phosphate, calcium silicate, and bioactive glass. The advantageous properties and limitations of these materials are also discussed. In the end, future directions and proposals are given to improve the physical and mechanical properties of bioactive materials-based dental materials.

The Antifungal and Antibiofilm Activities of Caffeine against Candida albicans on Polymethyl Methacrylate Denture Base Material.

BACKGROUND: In this study, the effect of pure caffeine was established against Candida albicans (C. albicans) using different microbiological techniques. METHODS: Broth microdilution and colony forming units (CFUs) assays were used to detect the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC). The Live/Dead fluorescent dyes were implemented to determine the yeast viability. Polymethyl methacrylate acrylic resin (PMMA) discs were prepared to evaluate caffeine's effects against adherent C. albicans using microplate reader, CFUs, and scanning electron microscope (SEM). RESULTS: caffeine's MIC was detected around 30 mg/mL, while the MFC was considered at 60 mg/mL. In an agar-well diffusion test, the inhibition zones were wider in caffeine groups. The Live/Dead viability test verified caffeine's antifungal effects. The optical density of the adherent C. albicans on PMMA discs were lower at 620 nm or 410 nm in caffeine groups. CFU count was also reduced by caffeine treatments. SEM revealed the lower adherent C. albicans count in caffeine groups. The effect of caffeine was dose-dependent at which the 60 mg/mL dose demonstrated the most prominent effect. CONCLUSION: The study reinforced caffeine's antifungal and antibiofilm properties and suggested it as an additive, or even an alternative, disinfectant solution for fungal biofilms on denture surfaces.

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia.

Objective: The aim of this study was to evaluate the current clinical practice of general dentists in Saudi Arabia in restoring class II cavities using direct resin composites and to set evidence-based practice recommendations of concern. Methods: An online survey formed of 20 questions and classified into four domains was developed. 500 dentists in 5 Saudi provinces were invited to join the survey anonymously and voluntarily using poster announcements and e-mail invitations. Descriptive statistics were used to analyze participants' responses. Results: 343 responses were received. Dentists in Saudi Arabia vary in their clinical practices and techniques of insertion of resin composite in class II cavities. 67% of participants use cotton rolls for isolating the field while 32% use rubber dam isolation. 33% and 28% of respondents use circumferential matrix (Tofflemire) and AutoMatrix, respectively. Fracture, followed by recurrent caries and open proximal contacts, was the received main reason of failure of class II direct resin composite restorations. Conclusion: Diversity of class II resin composite practices exists among dentists in Saudi Arabia. For ensuring optimum quality outcomes and high standards of restorative dentistry healthcare, several dentists in Saudi Arabia need to reconsider their clinical practice and modify their clinical procedures of direct class II resin composites. Several evidence-based practice guidelines are recommended to dentists in this article to improve their practice and enhance the clinical reliability and longevity of class II direct resin composite restorations.

Oral manifestations associated with Novel Coronavirus Disease - 2019 (COVID-19): A questionnaire based hypothetical study.

Background: Since the Coronavirus disease 2019 (COVID-19) outbreak in 2019, the virus has evolved drastically, presenting with sets of mutations that influence its properties, including transmissibility and antigenicity. The oral mucosa is postulated as probable portal entry and several oral manifestations have been identified, which places dental professionals in a position to recognize probable COVID-19 patients depending on oral signs and symptoms in the initial phases of the disease itself. As co-existing with COVID-19 seems to be a new reality, greater understanding is required regarding early oral signs and symptoms which can be predictors for timely intervention and prevention of complications in COVID-19 patients. The objective of the study is to identify the distinguishing oral signs and symptoms among COVID-19 patients and to establish possible correlation between severity of COVID-19 infection and oral symptoms. Methods: This study recruited 179 ambulatory, non-hospitalized COVID-19 patients from the Kingdom of Saudi Arabia's Eastern Province's designated hotels for COVID-19 and home isolated patients from the same region using a convenience sample method. Data was collected by qualified and experienced investigators, including two physicians and three dentists, using a validated comprehensive questionnaire through telephonic interviews with the participants. The X 2 was used to assess the categorical variables, and odd's ratio was calculated to determine the strength of the association between general symptoms and oral manifestations. Results: Oral and nasopharyngeal lesions or conditions like loss of smell and taste, xerostomia, sore throat, and burning sensation were predictors of COVID-19-related systemic symptoms such as cough, fatigue, fever, and nasal congestion were identified to be statistically significant (p<0.05). Conclusions: The study reveals the occurrence of olfactory or taste dysfunction, dry mouth, sore throat, and burning sensation along with COVID-19 generic symptoms, should be considered as suggestive yet not conclusive indicators of COVID-19.

Novel calcium phosphate ion-rechargeable and antibacterial adhesive to inhibit dental caries.

OBJECTIVES: This study aimed to develop an antibacterial and calcium (Ca) and phosphate (P) rechargeable adhesive and investigate the effects of dimethylaminododecyl methacrylate (DMAHDM) and nanoparticles of amorphous calcium phosphate (NACP) on dentin bonding, biofilm response, and repeated Ca and P ion recharge and re-release capability for the first time. MATERIALS AND METHODS: Pyromellitic glycerol dimethacrylate (PMGDM), ethoxylated bisphenol A dimethacrylate (EBPADMA), 2-hydroxyethyl methacrylate (HEMA), and bisphenol A glycidyl dimethacrylate (BisGMA) formed the adhesive (PEHB). Three groups were tested: (1) Scotchbond (SBMP, 3 M) control, (2) PEHB + 30% NACP, and (3) PEHB + 30% NACP + 5% DMAHDM. Specimens were tested for dentin shear bond strength, and Ca and P ion release, recharge, and re-release. Biofilm lactic acid production and colony-forming units (CFU) on resins were analyzed. RESULTS: The four groups had similar dentin shear bond strengths (p > 0.1). Adhesive with DMAHDM showed significant decrease in metabolic activity, lactic acid production, and biofilm CFU (p < 0.05). The adhesives containing NACP released high levels of Ca and P ions initially and after being recharged. CONCLUSION: This study developed the first Ca and P ion-rechargeable and antibacterial adhesive, achieving strong antibacterial activity and Ca and P ion recharge and re-release for long-term remineralization. CLINICAL RELEVANCE: Considering the restoration-tooth bonded interface being the weak link and recurrent caries at the margins being the primary reason for restoration failures, this novel calcium phosphate-rechargeable and antibacterial adhesive is promising for a wide range of tooth-restoration applications to inhibit caries.

Dental Fear and Patient Preference for Emergency Dental Treatment Among Adults in COVID-19 Quarantine Centers in Dammam, Saudi Arabia.

PURPOSE: Dental fear is associated with the avoidance of dental visits and negative oral health outcomes. It is important to assess distribution of dental fear and preference for emergency dental treatment among adult population during COVID-19. Therefore, the purpose of this study was to evaluate dental fear and emergency dental treatment among adults in COVID-19 quarantine centers in Greater Dammam, Saudi Arabia. MATERIALS AND METHODS: Male and female adults (N=606) in quarantine centers for COVID-19 participated in this cross-sectional study (June-July 2020). Dental Fear Survey was used to collect data on dental fear. The participants also provided their responses about emergency dental treatment/dental attendance patterns in addition to demographic information. RESULTS: The mean DFS score of the sample was 39.08 ± 19.47, and 23.1% of the participants were a little fearful and 22.6% were highly fearful. About 36.8% reported that they would prefer to visit a dental office in case of dental emergency mostly for dental pain and fractured tooth during the COVID-19 pandemic. Only 10.4% of the participants reported visiting a dentist in less than 3 months, 35.8% in less than 6 months, 52.5% between 6 and 12 months and more, and 1.3% never visited the dentist. DFS scores significantly differed among participants who visited the dentist in less than 3 months (31.86 ± 14.57), less than 6 months (37.70 ± 18.57), between 6 and 12 months and more (40.78 ± 20.23), and never visited the dentist (65.75 ± 14.74) (P < 0.001). The timing of last dental visit (P < 0.001), female gender (P 0.039), and dental pain (P < 0.001) were the significant predictors of dental fear. CONCLUSION: Dental fear was common among adults with a predilection for the female gender. Increased dental fear was significantly related to dental pain and reduced dental attendance. Only one-third of adults were willing to perform emergency dental visits.

Optical coherence tomography's current clinical medical and dental applications: a review.

Optical coherence tomography (OCT) is a non-invasive investigative technique that is used to obtain high-resolution three-dimensional (3D) images of biological structures. This method is useful in diagnosing diseases of specific organs like the eye, where a direct biopsy cannot be conducted. Since its inception, significant advancements have been made in its technology. Apart from its initial application in ophthalmology for retinal imaging, substantial technological innovations in OCT brought by the research community have enabled its utilization beyond its original scope and allowed its application in many new clinical areas. This review presents a summary of the clinical applications of OCT in the field of medicine (ophthalmology, cardiology, otology, and dermatology) and dentistry (tissue imaging, detection of caries, analysis of dental polymer composite restorations, imaging of root canals, and diagnosis of oral cancer). In addition, potential advantages and disadvantages of OCT are also discussed.

Knowledge of dentists, dental auxiliaries, and students regarding the COVID-19 pandemic in Saudi Arabia: a cross-sectional survey.

BACKGROUND: This study aimed to assess the knowledge of dental professionals in Saudi Arabia regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19). METHODS: A questionnaire was developed to assess various dental professionals from both governmental and private sectors through online and social media outlets. RESULTS: A total of 1,033 questionnaires were collected (273 dental students, 193 dental auxiliary personnel, 544 dentists). In all, 63.4% of the respondents worked in hospitals. Of all the respondents, 44.9%, 33.4%, and 21.7% worked in governmental clinics, academia, and the private sector, respectively. Overall knowledge of the incubation period and route of transmission of SARS-CoV-2 was consistent across all dental professions. Knowledge of hand-soap cleaning time was significantly different among dental professionals (p < 0.001). Dental professionals displayed significant disagreement on the survival of SARS-CoV-2 outside the host (p < 0.001). Furthermore, 75.1% of the respondents were reluctant to treat a suspected COVID-19 patient, and 92% of the participants believed that the mode of transmission was droplet inhalation. Fever, coughing, and shortness of breath were identified as the most common symptoms of COVID-19. Most standard methods of prevention in the dental office were selected by at least 50% of the participants. CONCLUSIONS: Dental professionals seem to be consistent regarding their knowledge of the incubation period of SARS-CoV-2. However, knowledge of viral survivability and recommended hand-soap washing time was significantly variable among the professionals. A high degree of apprehension toward suspected COVID-19 patients existed among all dental professionals. Pandemic-awareness campaigns are essential among healthcare providers.

Incidental Diagnosis on Orthopantomography of Langerhans Cell Histiocytosis with Multifocal Jaw Involvement: A Case Report of Single-System Disease.

BACKGROUND Langerhans cell histiocytosis (LCH) is a relatively rare neoplasm with a strong inflammatory component. It has diverse clinical manifestations, which range from a single lesion or multiple bony lesions to severe multisystem involvement. Approximately 10% to 20% of cases of LCH occur in the jaw, with the posterior mandible being the site most frequently involved. CASE REPORT We report on the case of a 42-year-old man who presented with bilateral osteolytic lesions in the posterior mandible that were incidentally discovered during routine radiographic screening. Histological examination of the specimen confirmed the diagnosis of LCH. CONCLUSIONS This case illustrates the importance of orthopantomography (OPG) as a screening tool in new patients to perform an overall evaluation of the teeth and surrounding structures, such as the bone, temporomandibular joint, and sinuses. Moreover, OPG can be used to screen for the presence of asymptomatic lesions that are often diagnosed incidentally on radiographs.

Effect of resin cement, aging process, and root level on the bond strength of fiber-posts: An in vitro study.

PURPOSE: To compare the push-out bond strength (POBS) of two resin cement systems (total-etch versus self-etch) for cementing FRC (fiber-reinforced composite) posts in three different thermocycling aging periods (40,000; 20,000; and none) using thermocycling and three root levels (apical, middle, and coronal). METHODS: 60 bicuspid single rooted natural teeth were endodontically treated and post spaces were prepared to receive a fiber-post (RelyX FiberPost) cemented with either total-etch (RelyX Ultimate) or self-etch (RelyX Unicem) cement. Teeth were randomly allocated into six groups (n= 10): G1: Control (Ultimate without thermocycling); G2: Ultimate (20,000 cycles); G3: Ultimate (40,000 cycles); G4: Unicem without thermocycling; G5: Unicem (20,000 cycles); and G6: Unicem (40,000 cycles). POBS was determined by using a push-out test on a universal testing machine. Additionally, failure mode of each specimen was observed under a stereomicroscope at x40 magnification and scanning electron microscope (SEM) examination of selected samples. A nested general linear model was created for statistical significance P< 0.05. Post-hoc tests were carried out using pair-wise comparisons with a Bonferroni adjustment. RESULTS: No significant differences were found on the bond strengths between the resin cements (P= 0.856). Regarding aging effect, bond strengths of the 40,000 cycle groups (G3/G6) were significantly lower than 20,000 cycle groups (G2/G5). In addition, the POBS of the specimens collected from the coronal third of the roots were significantly lower than specimens from the apical third regardless of the type of cement used. Regarding types of failures, adhesive failure (post/cement) was significantly higher in total-etch groups (G1-G3) than the self-etch groups (G4-G6). Adhesive failure (dentin/cement) was significantly higher in self-etch groups than the total-etch groups. CLINICAL SIGNIFICANCE: Within the limitations of this study, the bond strength to root canal dentin of self-etch and total-etch cements demonstrated reliable results and was not affected by the type of resin cement. Simplification of technique is an evident advantage of these materials in clinical practice.