The Analysis of Facio-Dental Proportions to Determine the Width of Maxillary Anterior Teeth: A Clinical Study.

The present study aimed to analyze mid horizontal facial third proportions, those being the interpupillary, inner intercanthal, and bizygomatic distance modified with golden proportion, The Preston proportion, golden percentage and 70% recurring esthetic dental proportion were used for determining maxillary anterior teeth width. A total of 230 participants took part in this study. The front dental and facial photographs along dental stone cast which were converted to three-dimensional (3D) models were used for evaluation. The mid horizontal facial third proportions showed no significant relationship with maxillary anterior teeth width without modification with dental proportions. Whereas, with modification, no statistically significant difference was found between inner-intercanthal distance by golden percentage and width of central incisors. The bizygomatic distance was greater than intercanine distance. While the interpupillary distance by golden proportion was found to be consistent with intercanine distance in female participants. The modified anterior teeth width was significantly different from measured values, when determined by using the three mid facial proportions with Preston and 70% recurring esthetic dental (RED) proportion. Furthermore, the measured width of maxillary anterior teeth showed no difference when plaster dental casts widths were compared with 3D models. The interpupillary, inner-intercanthal, and bizygomatic distance should not be directly used to determine maxillary anterior teeth width. While maxillary anterior teeth width can be determined by modifying the inner inter-canthal distance with golden percentage and interpupillary distance with golden proportion. Moreover, the midfacial third proportions modified with Preston and 70% recurrent esthetic dental proportion were found to be unreliable for the determination of maxillary anterior teeth widths.

Effects of calcium hydroxide intracanal medicament on push-out bond strength of endodontic sealers: A systematic review and meta-analysis.

OBJECTIVE: To investigate the effect of calcium hydroxide intracanal medicament on the push-out bond strength of resin-based and calcium silicate-based endodontic sealers. METHODS: A comprehensive search of was conducted for all relevant in-vitro studies. All randomized controlled in-vitro studies that evaluated the effect of calcium hydroxide on the push-out bond strength of resin-based or calcium silicate-based endodontic sealers were assessed. The variables of interest were extracted, and the risk of the included studies was evaluated. The standardized mean difference was calculated and the significance level was set at p value <0.05. RESULTS: A total of 26 studies were eligible for analysis. There were 45 independent comparison groups and 1009 recruited teeth. The pooled data showed no significant difference in push-out bond strength between calcium hydroxide and control group in the resin-based group (SMD = 0.03; 95% CI = -0.55, 0.60; p = 0.93), and calcium silicate-based group (SMD = 0.02; 95% CI = -0.31, 0.35; p = 0.90). Most of the studies (21 out of 26) were at medium risk of bias and five studies showed a low risk of bias. CONCLUSION: The available evidence suggests that calcium hydroxide used as intracanal medication does not influence the push-out bond strength of the resin- and calcium silicate-based endodontic sealers. CLINICAL SIGNIFICANCE: The results of this meta-analysis suggest that calcium hydroxide used as intracanal medication does not influence the push-out bond strength of resin-based and calcium silicate-based endodontic sealers.

Modeling the Relationship Between Tooth Color and Skin Color in Equations to Predict Tooth Color.

Background Color selection for discolored teeth or for edentulous patients is a subjective process in dentistry. To the best of the authors' knowledge, there is no objective method for tooth color selection for edentulous patients. Several studies have investigated the relationship between tooth color and skin color and the ability to use skin color as a guide to select tooth color in dental rehabilitation cases. The objective of this study was to find and model the relationship between tooth color and skin color in equations to be able to predict tooth color by assessing skin color. Methodology This study was done on 150 participants with equal gender distribution. Digital photography with soft boxes and strobe lights were used to measure tooth and skin color. Digital photography was performed in a dark room with controlled and measured lighting sources and strength. A calibration board was used to create two calibration profiles in software. All photos were calibrated in Adobe Lightroom software. Then, color measurement was done using Adobe Photoshop software in the Commission International de I'Eclarirage (CIELab) system. Results There were positive significant relationships in color spaces L* and a* between tooth color and skin color, and an inverted significant relationship in color space b* between tooth and skin. Three equations with excellent reliability were formulated in this study to predict tooth color by assessing skin color. Conclusions The relationship between tooth color and skin color was modeled in three equations. For edentulous patients, this research might be useful in detecting the proper tooth color and transferring the CIELab color data to dental technicians for further processing. Computerized shade matching and prediction dental software may be designed using these equations.

A Randomized Controlled Trial Evaluating the Levels of the Biomarkers hs-CRP, IL-6, and IL-8 in Patients with Temporomandibular Disorder Treated with LLLT, Traditional Conservative Treatment, and a Combination of Both.

Temporomandibular disorders (TMDs) are a type of idiopathic orofacial pain. Inflammation, particularly elevated circulating levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8), has been linked to pain symptoms. The purpose of this study was to compare hs-CRP, IL-6, and IL-8 biomarkers and pain intensity with different treatment strategies (LLLT, standard conservative treatment, and combination) for TMD patients. METHODS: A total of 32 participants were randomly included in the study and divided into three groups (Group I, Group II, and Group III) referred from the Dental Clinic, School of Dental Science, HUSM. Patients received LLLT (Groups II and III) in five sessions for the duration of 10 days. Patients in Groups I and III received standard conservative TMD treatment (diet and stress counseling, jaw exercises, physical therapy, which was a hot towel application) by the principal investigator. All blood samples for biomarkers were performed before starting treatments and directly after finishing the treatment protocols, where all results were recorded. RESULTS: The result showed a significant difference in the mean IL-8 (p = 0.001) between the three intervention groups (LLLT, standard treatment, and combined treatment). IL-6 showed an increase in the mean of IL-6 levels from baseline to post-treatment with a better mean in the LLLT treatment group without any significant differences. Additionally, there were no significant mean differences found between the groups and in the group for the hs-CRP biomarker. CONCLUSIONS: A statistically non-significant difference was found in hs-CRP and IL-6 before and after LLLT, conservative, and combined treatment strategies of TMD. A statistically significant difference was observed in the mean levels of IL-8 between the LLLT intervention group and the combined treatment group. Although there was no statistically significant correlation between pain intensity and biomarkers, a statistically significant difference was found in pain intensity before and after LLLT, conservative, and combined treatment strategies. TMJ degeneration could be exacerbated by elevated IL-8 levels. Thus, this can be an important biomarker to mark or identify the painful condition of TMJ.

Minimum Intervention in Managing Two Cases of Tetracycline Staining of Different Severity.

Patient dissatisfaction with tooth discoloration as a result of tetracycline therapy is not uncommon. To address patients' aesthetic demands, conservative bleaching treatments were considered before more invasive, irreversible treatments such as dental veneers or crowns. Bleaching is a relatively non-invasive, safe, and cost-effective method of achieving a desirable result. However, due to many limiting variables, including the extended duration of active bleaching, tetracycline-stained teeth are one of the most challenging cases to obtain satisfactory bleaching outcomes. This clinical report presents two cases of management of tetracycline staining of the teeth with varying degrees of severity.

Effectiveness of the Laser Application in Temporomandibular Joint Disorder: A Systematic Review of 1172 Patients.

Objective: The aim of this systematic review was to evaluate the effectiveness of laser application in temporomandibular joint disorder. Methods: PubMed, SCOPUS, Science Direct, Web of Science, and Google Scholar electronic databases were searched systematically with restricting the languages to only English and year (January 2001 to March 2020), and studies were selected based on the inclusion criteria. Study quality and publication bias were assessed by using the Robvis, a software package of R statistical software. Results: This systematic review included 32 studies (1172 patients) based on the inclusion and exclusion criteria. Most of the studies reported significant reduction of pain by the use of the laser during TMD treatment. Two-thirds of the study (78.13%) found a better outcome comparing with conventional one. According to Robvis, 84.4% of the studies were high methodological studies with low risk of bias. Conclusion: TMD patients suffer with continuous pain for long time even after conventional treatment. Laser therapy shows a promising outcome of pain reduction for TMD patients. Therefore, laser therapy can be recommended for the TMD patients' better outcome. This trial is registered with PROSPERO (CRD42020177562).

Biomarkers for Temporomandibular Disorders: Current Status and Future Directions.

Numerous studies have been conducted in the previous years with an objective to determine the ideal biomarker or set of biomarkers in temporomandibular disorders (TMDs). It was recorded that tumour necrosis factor (TNF), interleukin 8 (IL-8), IL-6, and IL-1 were the most common biomarkers of TMDs. As of recently, although the research on TMDs biomarkers still aims to find more diagnostic agents, no recent study employs the biomarker as a targeting point of pharmacotherapy to suppress the inflammatory responses. This article represents an explicit review on the biomarkers of TMDs that have been discovered so far and provides possible future directions towards further research on these biomarkers. The potential implementation of the interactions of TNF with its receptor 2 (TNFR2) in the inflammatory process has been interpreted, and thus, this review presents a new hypothesis towards suppression of the inflammatory response using TNFR2-agonist. Subsequently, this hypothesis could be explored as a potential pain elimination approach in patients with TMDs.

Quality and Readability of Web-based Arabic Health Information on Denture Hygiene: An Infodemiology Study.

AIM: This study aimed to assess the quality and readability of the available health information on the net regarding denture hygiene. MATERIALS AND METHODS: Three search engines (Google, Yahoo!, and Bing) were searched. The first 20 consecutive websites from each engine were obtained and checked for eligibility. For the quality of the websites, the Health on the Net Foundation Code of Conduct (HONcode), the DISCERN tool, the Journal of the American Medical Association (JAMA) Benchmarks, and Google PageRank were used for the assessment of the included websites. For readability, an online web tool was used, including well-known analyzing indices [Flesch Kincaid grade level (FKGL), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease (FRE)]. The acceptable readability level was set to be ≥80.0 for the FRE and <7 for the FKGL and SMOG. The data were presented in frequencies and percentages. RESULTS: Out of the 60 screened websites, 14 websites were eligible for analysis. There was only one (7.1%) website that had the HONcode seal. The mean score of all websites based on the DISCERN tool was 29.6 ± 12.1, with no website achieved the high score (≥65). Only one (7.1%) website scored >5 based on Google PageRank. Regarding JAMA benchmarks, all websites achieved a mean score of 2.57 ± 1.1. The mean grade level based on the FKGL was 8.4 ± 6.3. All websites had a score of <7 according to the SMOG index. The mean score of the readability ease index was 90.5 ± 16.4. CONCLUSION: Most of the dental health information on denture hygiene available on the Arabic websites did not have the required level of quality, regardless of being readable and comprehensible by most of the general people. CLINICAL SIGNIFICANCE: Directing the patients to the appropriate websites related to their cases is the responsibility of the dentists.

Nonprescription Bleaching versus Home Bleaching with Professional Prescriptions: Which One is Safer? A Comprehensive Review of Color Changes and Their Side Effects on Human Enamel.

OBJECTIVES: This study evaluates the efficacy and safety of the professionally prescribed and nonprescription over-the-counter (OTC) bleaching agents. MATERIALS AND: METHODS: Extracted human upper central incisors were prepared and stained with red wine for 14 days before being subjected to four different bleaching agents: professionally prescribed opalescence PF 15%, VOCO Perfect Bleach 10%, nonprescription OTC Crest 3D Whitestrips, and Whitelight Teeth Whitening System. Colorimetric measurement was performed with Vita Easyshade Handheld Spectrophotometer, enamel surface microhardness measured using Vickers Hardness machine, and surface roughness was evaluated with profilometer, before and after bleaching. Scanning electron microscope (SEM) evaluation and atomic force microscopy were conducted postbleaching. STATISTICAL ANALYSIS: The data were analyzed with t-test, two-way ANOVA, one-way ANOVA, and Turkey's test at a significance level of 5%. RESULTS: All bleaching products have the same efficacy to whiten stained enamel. Opalescence PF 15% showed significant increase in the microhardness (92.69 ± 68.316). All groups demonstrated significant increase in surface roughness (p < 0.05). SEM evaluation showed that Opalescence PF 15% resulted in same microscopic appearance as unbleached enamel, while VOCO Perfect Bleach 10%, Whitelight Teeth Whitening System and Crest 3D Whitestrips demonstrated mild to moderate irregularities and accentuated irregularities, respectively. CONCLUSION: Professionally prescribed bleaching agent of Opalescence PF 15% is effective tin whitening the teeth, while the other bleaching products may be effective but also have deleterious effects on the enamel.

Shear bond strength of computer-aided design and computer-aided manufacturing feldspathic and nano resin ceramics blocks cemented with three different generations of resin cement.

AIM: To evaluate the shear bond strength between the dentin substrate and computer-aided design and computer-aided manufacturing feldspathic ceramic and nano resin ceramics blocks cemented with resin cement. MATERIALS AND METHODS: Sixty cuboidal blocks (5 mm × 5 mm × 5 mm) were fabricated in equal numbers from feldspathic ceramic CEREC(®) Blocs PC and nano resin ceramic Lava™ Ultimate, and randomly divided into six groups (n = 10). Each block was cemented to the dentin of 60 extracted human premolar using Variolink(®) II/Syntac Classic (multi-steps etch-and-rinse adhesive bonding), NX3 Nexus(®) (two-steps etch-and-rinse adhesive bonding) and RelyX™ U200 self-adhesive cement. All specimens were thermocycled, and shear bond strength testing was done using the universal testing machine at a crosshead speed of 1.0 mm/min. Data were analyzed using one-way ANOVA. RESULTS: Combination of CEREC(®) Blocs PC and Variolink(®) II showed the highest mean shear bond strength (8.71 Mpa), while the lowest of 2.06 Mpa were observed in Lava™ Ultimate and RelyX™ U200. There was no significant difference in the mean shear bond strength between different blocks. CONCLUSION: Variolink(®) II cement using multi-steps etch-and-rinse adhesive bonding provided a higher shear bond strength than the self-adhesive cement RelyX U200. The shear bond strength was not affected by the type of blocks used.