In Vitro Comparison of Optical Properties Between Single-Shade and Conventional Composite Resin Restorations.

INTRODUCTION: The recently developed single-shade composite resin (using the concept of structural coloring) is a promising option to eliminate the process and subjectivity of shade selection. However, current evidence of its performance is still insufficient. This study aimed to evaluate the color matching, color stability, and refractive index (RI) of single-shade restorations compared with conventional composite resin. METHODS: This in vitro study was conducted on 48 extracted maxillary premolars. The teeth were sorted into three tooth shade groups (B2, A3, and A3.5). Each group included two subgroups based on the materials used: Omnichroma (OM; Tokuyama Dental, Tokyo, Japan) and Filtek Z350 (FT; 3M ESPE, St. Paul, MN, USA). Buccal and lingual Class V round cavities were prepared and restored according to the randomly assigned subgroups, with the test single-shade material (OM) on one surface and the matching conventional control material (FT) of the proper shade on the other surface of each tooth. Color matching was evaluated by visual assessment and a spectrophotometer. All specimens were distributed into four staining groups and immersed in various staining beverages (black coffee, Arabic coffee, Coca-Cola, and distilled water) for four weeks. Color changes were assessed using a spectrophotometer. Four groups of disc-shaped specimens (single-shade, B2, A3, and A3.5) were fabricated to evaluate the RI using a refractometer. Statistical analyses were performed to compare the materials. RESULTS: The mean value of the color difference (ΔE) of single-shade restorations was significantly higher than that of paired conventional restorations in all shade groups. The highest mean ΔE was in subgroup A3.5-OM (8.84 ± 2.39) and showed significantly less color matching than other OM subgroups (p=0.009). The visual assessment showed comparable and acceptable color matching in all subgroups except A3.5-OM (p=0.006). There was a significant color change after the staining test within and across staining groups, but the color change was comparable between the OM and FT subgroups. The RI of single-shade material was significantly higher than conventional material (p<0.05). CONCLUSION: The color matching of single-shade restorations was affected by tooth shade. Its color stability was influenced by various staining substances but was similar to conventional restorations.

Barriers in Rubber Dam Isolation Behaviour of Dental Students During Adhesive Restorative Treatments: A Cross-Sectional Study.

PURPOSE:  There are unfavorable opinions connected with rubber dam isolation amongst dental students during adhesive restorative treatments. The aim of this study was to investigate the various barriers to practicing rubber dam isolation during dental procedures and provide necessary insight towards implementation of rubber dam among undergraduate dental students in Jazan. MATERIALS AND METHODS:  A pre-validated questionnaire in English entitled Rubber Dam Isolation Survey (E-RDIS) based on the Capability Opportunity Motivation-Behaviour (COM-B) model of behavioral change wheel was responded by 226 university dental students. RESULTS:  The satisfaction of training was highest among sixth year students (Mean=3.57, p<0.001). Fourth year dental students scored higher in the capability (Mean=3.18) and were more highly motivated to use rubber dams (Mean=4.21). Third year students were more likely to use rubber dams in anterior teeth (Mean=3.52) whereas fourth year students use rubber dam in posterior teeth (Mean=3.74). Lack of motivation was found to be the significant barrier influencing rubber dam usage (odds ratio (OR)=12.1; 3.74, p<0.05). CONCLUSION:  The satisfaction with training differed among the students of different years. The rubber dam technique might be used more frequently if it were made clear to students that mastering it would be necessary for them to receive good grades.

The Use of Informed Consent in Endodontic Treatment in Saudi Arabia: A Cross-Sectional Study.

INTRODUCTION: Informed consent is a legal process intended to protect patients' rights and ensure ethical medical practice. The aim of this cross-sectional study was to assess dentists' practice of obtaining informed consent and adherence to the recommended guidelines, and to investigate the types of consent, barriers, the process, and the quality of the information included in preoperative informed consent for endodontic treatment in Saudi Arabia. METHODS: A validated self-administered online questionnaire was developed and distributed to dentists performing endodontic treatment in Saudi Arabia. Data were collected using a snowball sampling technique for three months (May to July). RESULTS: Of the 452 participants included in the study, 79.4% (n = 359) obtained informed consent, and 63.5% of them followed the recommended guidelines. Dentists with over 10 years of experience used informed consent regularly (p < .005). The main barrier to obtaining informed consent was the lack of a standardized format (28.5%). Furthermore, only 36.3% of the participants obtained written informed consent. Most participants (75.4%, n = 341) reported that they discuss and disclose information about the treatment to patients themselves. Less than 5% of participants include all listed criteria in their consent process. CONCLUSION: Although obtaining informed consent prior to endodontic treatment was a broadly adopted process among the participants, their practice appears to be inadequate. Issues such as the type and quality of informed consent need to be improved through educational and awareness programs and strict implementation by responsible authorities.

Evaluation of dental pulp stem cells response to flowable nano-hybrid dental composites: A comparative analysis.

BACKGROUND: Flowable resin composites (FRC) are tooth-colored restorative materials that contain a lower filler particle content, and lower viscosity than their bulk counterparts, making them useful for specific clinical applications. Yet, their chemical makeup may impact the cellular population of the tooth pulp. This in-vitro study assessed the cytocompatibility and odontogenic differentiation capacity of dental pulp stem cells (DPSCs) in response to two recent FRC material extracts. METHODS: Extracts of the FRC Aura easyflow (AEF) and Polofil NHT Flow (PNF) were applied to DPSCs isolated from extracted human teeth. Cell viability of DPSCs was assessed using MTT assay on days 1, 3 and 7. Cell migration was assessed using the wound healing assay. DPSCs' capacity for osteo/odontogenic differentiation was assessed by measuring the degree of mineralization by Alizarin Red S staining, alkaline phosphatase enzyme (ALP) activity, and monitoring the expression of osteoprotegerin (OPG), RUNX Family Transcription Factor 2 (RUNX2), and the odontogenic marker dentin sialophosphoprotein (DSPP) by RT-PCR. Monomer release from the FRC was also assessed by High-performance liquid chromatography analysis (HPLC). RESULTS: DPSCs exposed to PNF extracts showed significantly higher cell viability, faster wound closure, and superior odontogenic differentiation. This was apparent through Alizarin Red staining of calcified nodules, elevated alkaline phosphatase activity, and increased expression of osteo/odontogenic markers. Moreover, HPLC analysis revealed a higher release of TEDGMA, UDMA, and BISGMA from AEF. CONCLUSIONS: PNF showed better cytocompatibility and enhancement of odontogenic differentiation than AEF.

The Use and Reprocessing of Endodontic Files in Saudi Arabia: A Cross-Sectional Study.

Objectives This study aimed to assess the awareness, implementation, and compliance with the infection control policy recommended by the Saudi Ministry of Health (MOH) for the use and reprocessing of endodontic files and to examine the association between compliance and gender, experience, clinical ranks, and workplace sector. Methods This was a cross-sectional study conducted using a validated self-administered electronic questionnaire created and distributed to dentists who perform endodontic treatment in Saudi Arabia. Data were collected between June and July 2023. Descriptive statistics were reported as counts and percentages. Comparisons among the demographic groups were done using the Kruskal-Wallis and Mann-Whitney tests. Results A total of 402 dentists completed the survey. The results showed that 76.1% (n=306) of respondents claimed that they were aware of the infection control policy recommended by the Saudi MOH for the use and reprocessing of endodontic files in dental clinics. Only 13.2% (n=53) of dentists used single-use endodontic files, and 36.6% (n=147) did not use an endodontic box in their dental clinics. The most commonly reported method of tracing the number of uses of endodontic files was to write the ID of the patient or the number of uses on the sterilization pouch as reported by 37.6% of participants (n=151). The average compliance score percentage was 63.5 ± 16.7. Most of the respondents showed moderate to high levels of compliance (51.7% (n=208) and 42.0% (n=169) of dentists, respectively). Dentists with less than 5 years of experience showed significantly less compliance than dentists with more than 10 years of experience (p = 0.005). Gender, clinical rank, and workplace sector were not significantly associated with the extent of adhering to the evaluated infection control policy. Conclusions Our findings indicate a relatively high level of compliance with the Saudi MOH policy of using and reprocessing endodontic files. However, critical measures such as the single-use of endodontic files, sterilizing new endodontic files, and using the sterilized endodontic box for each patient need improvement. Hence, this study recommends enhancing awareness through continuous education and training.

Fracture Load of Mesio-Occluso-Distal Composite Restorations Performed with Different Reinforcement Techniques: An In Vitro Study.

BACKGROUND: Mesio-occluso-distal (MOD) cavity preparations are often fragile due to the amount of tooth and carious structure removed. MOD cavities can often fracture if left unsupported. AIM: The study investigated the maximum fracture load of mesi-occluso-distal cavities restored using direct composite resin restorations with various reinforcement techniques. METHOD: Seventy-two freshly extracted, intact human posterior teeth were disinfected, checked, and prepared according to predetermined standards for mesio-occluso-distal cavity design (MOD). The teeth were assigned randomly into six groups. The first group was the control group restored conventionally with a nanohybrid composite resin (Group I). The other five groups were restored with a nanohybrid composite resin reinforced with different techniques: the ACTIVA BioACTIVE-Restorative and -Liner as a dentin substitute and layered with a nanohybrid composite (Group II); the everX Posterior composite resin layered with a nanohybrid composite (Group III); polyethylene fibers called "Ribbond" placed on both axial walls and the floor of the cavity, and layered with a nanohybrid composite (Group IV); polyethylene fibers placed on both axial walls and the floor of the cavity, and layered with the ACTIVA BioACTIVE-Restorative and -Liner as a dentin substitute and nanohybrid composite (Group V); and polyethylene fibers placed on both axial walls and the floor of the cavity and layered with the everX posterior composite resin and nanohybrid composite (Group VI). All teeth were subjected to thermocycling to simulate the oral environment. The maximum load was measured using a universal testing machine. RESULTS: The highest maximum load was exhibited by Group III with the everX posterior composite resin, followed by Group IV, Group VI, Group I, Group II, and Group V. A statistically significant difference was demonstrated between groups (p = 0.0023). When adjusting for multiple comparisons, there were statistical differences specific to comparisons between Group III versus I, Group III versus II, Group IV versus II, and Group V versus III. CONCLUSIONS: Within the limitations of the current study, it can be concluded that a higher maximum load resistance can be achieved (statistically significant) when reinforcing nanohybrid composite resin MOD restorations with everX Posterior.

Evaluation of the level of integration of the dental curriculum in Umm Al-Qura University.

Objectives: To identify the models and levels of integration of the undergraduate dental curriculum in Umm Al-Qura University in KSA. This comprehensive evaluation and analysis of the current dental curriculum will facilitate better planning for curriculum reform, thus improving the quality of dental education. Methods: All courses were evaluated by three reviewers who independently checked the most recent course specifications forms (2021) to extract data relating to course descriptions and contents. A model of integration was identified for each course (using a modified Harden's integration ladder). Courses and their relative weighting (by credit hours) were mapped to the level of integration by years, departments, course classification, and educational methods. The overall pattern of curriculum integration was then determined. Results: All courses exhibited some level of integration to varying degrees throughout years and across departments. The most frequently used model is the nested model of integration. The overall pattern of curriculum integration is low to moderate. Highly integrated courses are only taught during the second and final years and are managed by the Departments of Basic Oral Sciences and Restorative Dentistry. Clinical courses represent 44.3% of the curriculum although only 26.6% of clinical courses have a high level of integration. Problem-based learning/case-based learning (PBL/CBL) and clinical training strategies are mostly applied in moderately to highly integrated courses, although PBL/CBL is the least used educational method throughout the curriculum. Conclusion: All courses exhibited some level of integration with an overall low to moderate pattern. More collaborative planning and working between departments are recommended to increase the level of integration of courses throughout different academic years. In addition, modern educational strategies such as PBL/CBL and blended learning should be implemented more in our dental curriculum.

Evaluation of Fracture Strength of Fiber-Reinforced Direct Composite Resin Restorations: An In Vitro Study.

This in vitro study aimed to compare the fracture strength of direct non-reinforced class II composite resin restorations and polyethylene fiber-reinforced restorations, and also to investigate the influence of the locations of polyethylene fibers within the cavity on the fracture strength. Sixty freshly extracted human teeth were disinfected and prepared (class II cavity design). The teeth were assigned randomly into four groups (n = 13). Group I (control) was restored with nano-hybrid composite resin. The other three experimental groups were restored with the same composite resin material reinforced by polyethylene fibers (Ribbond) at different locations. Fibers were placed either on the axial wall (Group II), on the gingival floor (Group III), or on the axial wall and pulpal/gingival floor (Group IV) of the proximal cavity. All the teeth were subjected to thermocycling to simulate the oral environment. The fracture strength was measured using a universal testing machine. Group IV had the highest mean fracture strength at maximum load (148.74 MPa), followed by Group II (140.73 MPa), Group III (136.34 MPa), and Group I (130.08 MPa), with a statistically significant difference from the control group (p = 0.008) but not between groups II and III.

Recent trends in dental research in Saudi Arabia: Mapping review (2010-2020).

Objectives: To map Saudi-affiliated dental research productivity by institution, managing sector, geographical region, collaboration pattern, study design, dental specialty, time course, publication source, authorship, and funding during 2010-2020. Methodology: A systematic search strategy was followed to retrieve data from the Web of Science and MEDLINE/PubMed databases. The study included only articles published in English between 2010 and 2020 by authors affiliated with Saudi dental institutions. Data screening and extraction from full-text articles were performed independently by the two authors. The kappa coefficient was >0.8. Descriptive statistics were calculated, including frequency and percentage. The chi-square test was used to compare categorical variables. Statistical significance was set at a p-value of 0.05. Results: A total of 1,899 articles were included. The greatest research activity was in the Riyadh region (47%). The most productive corresponding institution was King Saud University (29%). National collaborations between sectors represented 24% of publications, and multiple collaborations accounted for 33%. Endodontics showed the highest levels of collaboration between sectors (33%). The most frequent study designs were cross-sectional (51%) and laboratory experimental (19%), while case-control, cohort, and qualitative studies were among the least common. The most productive years were 2018 and 2019, and the average annual growth rate of research productivity was 21%. Implant dentistry showed the fastest growth rate. Total publications and local collaborations increased remarkably during the second half of the decade. Restorative dentistry was the most funded specialty (18%). There were statistically significant associations between study design, dental specialty, and funding (p < 0.05). Conclusion: This bibliometric analysis provides insight into the trends of Saudi-affiliated dental research. Based on our findings, more effective local collaboration between authors, institutions, and sectors; better funding planning for high-quality research; and more research conducted in less well-investigated dental specialties are recommended.

Level of Evidence of Dental Research in Saudi Arabia (2000-2020).

OBJECTIVES: The level of evidence (LOE) of Saudi dental research from 2000 to 2020 was evaluated, and factors associated with the LOE were determined. METHODS: This study was a systematic review. PubMed, Web of Science, and Medline databases were utilized to retrieve available dental articles published in English between January 2000 and May 2020. The inclusion criteria consisted of clinical studies conducted in Saudi Arabia with at least one Saudi dental affiliation. The retrieved eligible articles were evaluated independently by two reviewers using a modified Oxford LOE scale. The LOE of the studies was compared between the last two decades. RESULTS: Of the 7237 articles identified, 1557 articles met the inclusion criteria. Approximately 78% of the published articles reported Level IV evidence. A higher trend toward Level I, II, and III publications has occurred in recent years (i.e., 2010-2020). However, no statistically significant difference existed in LOE proportions between the two decades. The presence of international collaboration and high journals' impact factor was significantly associated with a higher LOE. CONCLUSION: Most published dental research studies were low LOE studies (i.e., Level IV). National and international collaboration is highly encouraged as this is a factor, according to our findings, that would be a positive addition toward publishing dental research of a higher LOE in Saudi Arabia.

Effect of grinding and polishing on roughness and strength of zirconia.

STATEMENT OF PROBLEM: The clinical applications of high-translucency monolithic zirconia restorations have increased. Chairside and laboratory adjustments of these restorations are inevitable, which may lead to increased roughness and reduced strength. The influence of grinding and polishing on high-translucency zirconia has not been investigated. PURPOSE: The purpose of this in vitro study was to compare the roughness averages (Ra) of ground and polished zirconia and investigate whether roughness influenced strength after aging. MATERIAL AND METHODS: High-translucency zirconia disks were milled, sintered, and glazed according to the manufacturer's recommendations. Specimens were randomized to 4 equal groups. Group G received only grinding; groups GPB and GPK received grinding and polishing with different polishing systems; and group C was the (unground) control group. All specimens were subjected to hydrothermal aging in an autoclave at 134°C at 200 kPa for 3 hours. Roughness average was measured using a 3-dimensional (3D) optical interferometer at baseline (Ra1), after grinding and polishing (Ra2), and after aging (Ra3). A biaxial flexural strength test was performed at a rate of 0.5 mm/min. Statistical analyses were performed using commercial software (α=.05). RESULTS: Group G showed a significantly higher mean value of Ra3 (1.96 ±0.32 µm) than polished and glazed groups (P<.001), which showed no statistically significant difference among them (GPB, 1.12 ±0.31 µm; GPK, 0.88 ±0.31 µm; C: 0.87 ±0.25 µm) (P>.05). Compared with baseline, the roughness of groups G and GPB increased significantly after surface treatments and after aging, whereas aging did not significantly influence the roughness of groups GPK or C. Group G showed the lowest mean value of biaxial flexural strength (879.01 ±157.99 MPa), and the highest value was achieved by group C (962.40 ±113.84 MPa); no statistically significant differences were found among groups (P>.05). Additionally, no significant correlation was detected between the Ra and flexural strength of zirconia. CONCLUSIONS: Grinding increased the roughness of zirconia restorations, whereas proper polishing resulted in smoothness comparable with glazed surfaces. The results provide no evidence that grinding and polishing affect the flexural strength of zirconia after aging.