Changes in complacency to adherence to COVID-19 preventive behavioral measures and mental health after COVID-19 vaccination among medical and dental healthcare professionals.

Medical and dental professionals should continue to adhere to preventive measures after COVID-19 vaccination due to their increased risk of exposure to the virus, particularly as new variants emerge that may heighten their risk perception and susceptibility. Therefore, this study aimed to explore the effects of COVID-19 vaccination on complacency to adherence to COVID-19 preventive behavioral measures and mental health among medical and dental professionals. In this cross-sectional study 410 medical and dental professionals were recruited from different medical and dental hospitals in Islamabad, Pakistan. The data was collected using a valid and reliable questionnaire comprising of three sections (socio-demographic, information of preventive behaviors performance against COVID-19 after vaccination, mental health status). A chi-square test and ordinal logistic regression were used for analysis. Post COVID-19 vaccination there was decrease in the frequency of use of hand washing, sanitizers (70.2%), and social distancing (60.5%), however greeting with a handshake (58.8%) and use of public transport (45.9%) seen upward trend among participants. Only face mask usage post-vaccination was statistically significant (p < .05) in association with age, marital status, and years of working Experience. The greatest decrease in the usage of masks after COVID-19 vaccination was seen in age group of 10-30 (41.7%) and working experience group of 0-5 years (39.7%). All the preventive behaviors are statistically significant (p < .05) associated with the mental status of the participants except online shopping and use of public transport. These results indicate the presence of vaccination-induced complacency in adherence to COVID-19 preventive behavioral measures among healthcare professionals.

Catch composition, catch per unit effort (CPUE) and species selectivity of fishing gears on multi-species Kaptai Lake in Bangladesh.

Kaptai Lake, the largest artificial reservoir in Southeast Asia, is home to a diverse fish fauna that supports thousands of livelihoods and is distinguished by multi-species and multi-gear fisheries. In Kaptai Lake, the gear-based catch composition, catch rate and distribution pattern are little known. From August 2020 to April 2021, a nine-month study was conducted in five upazilas using direct catch assessment surveys and fishing effort surveys from four fishing gears, namely seine nets, gill nets, lift nets, and push nets. A total of 49 morpho-species from 22 families were found, with three species from the Clupeidae accounting for 93.63 % of the catch in all gear combined. The total catch composition and CPUE were higher in seine nets (75.07 %, 13.86 ± 1.8 kg/gear/trip respectively) and lower in lift nets (4.97 %, 1.01 ± 0.21 kg/gear/trip) and showed significant differences among gears, except sampling sites whereas CPUE was higher in Naniarchar for seine nets (17.29 ± 8.89 kg/gear/trip) and lower in Langadu for lift nets (0.62 ± 0.25 kg/gear/trip). Seine nets captured more species, and the number of species increased significantly as CPUE increased. Our study assessed four gears that targeted different fish species with little overlap in leading species; seine nets and gill nets primarily targeted Clupeidae (96.53 % and 41.69 %, respectively), whereas lift nets and push nets primarily targeted Cyprinidae and Palaemonidae (38.93 % and 99.37 % respectively). The observed abundance and variety of fish species captured in gill nets suggest a significant overlap in the selectivity of this fishing method with that of lift nets. Due to the varying contributions of sites and gears, the nMDS ordination pattern reveals a weak spatial variation in catch composition. According to the SIMPER results, Bagridae, Gobiidae, and Ambassidae were the most significant contributors to site grouping patterns across all gears. Furthermore, the findings indicate that the catch composition does not follow the typical pattern of spatial variation. By implementing measures to eliminate or decrease the usage of small mesh nets, there is expected to be a corresponding decrease in the capture of small fish. Additionally, this action will help mitigate the issue of overlapping selectivity among the current fishing gears. Our findings provide baseline data on the potential efficacy of gear limitation and suggest a gear-based management strategy.

Role of artificial intelligence in behavior management of pediatric dental patients-a mini review.

The influence of behavioral science on various organizations has been experiencing remarkable growth worldwide. With the integration of recent technological advancements, behavioral science's impact has expanded into diverse fields such as finance and policy. The term "artificial intelligence" (AI) has become increasingly prevalent, but it is essential to provide clarity before proceeding. AI pertains to the theory and creation of systems capable of executing tasks that typically necessitate human intelligence. Integrating artificial intelligence (AI) in pediatric dentistry has emerged as a promising avenue to enhance patient care, improve diagnostic accuracy, streamline treatment planning, and augment patient engagement. AI-driven tools such as image analysis, natural language processing, and machine learning algorithms assist in early caries detection, orthodontic treatment planning, behavior management, and personalized oral hygiene education for pediatric patients. This paper presents an overview of AI's applications in pediatric dentistry, particularly behavior management, highlighting its potential to revolutionize traditional pediatric dental practices.

Unlocking the Potential: Investigating Dental Practitioners' Willingness to Embrace Artificial Intelligence in Dental Practice.

BACKGROUND: Artificial intelligence (AI) holds significant promise for transforming healthcare delivery, including dentistry. However, the successful integration of AI into dental practice necessitates an understanding of dental professionals' perspectives, attitudes, and readiness to adopt AI technology. This study aimed to explore dental professionals' perceptions, attitudes, and practices regarding AI adoption in dentistry. METHODS: This cross-sectional study was conducted among 256 dental professionals using an online questionnaire. Participants were assessed for familiarity with AI technology, perceived barriers to adoption, attitudes towards AI, current usage patterns, and factors influencing adoption decisions. Data are analysed using descriptive statistics, including frequencies, percentages, means, and standard deviations. Inferential statistics, such as chi-square tests and regression analysis, were employed to examine associations between variables and identify predictors of AI adoption in dentistry. RESULTS: The study surveyed 256 dental professionals from various regions across India, primarily aged 30 to 50 years (mean age: 42.6), with a nearly equal gender split (male: 48.4%, female: 51.6%) and high educational attainment (67.8% with master's or doctoral degrees). Private practices were predominant (56.3%). The diagnostic algorithms and treatment planning software were well known (77.3% and 70.3% familiarity, respectively). Technical concerns (average score: 3.82 ± 0.68) were the main barriers to AI adoption, followed by financial considerations (average score: 3.45 ± 0.72), ethical and legal issues (average score: 3.21 ± 0.65), and organizational factors (average score: 3.67 ± 0.71). Despite these concerns, most participants had positive attitudes towards AI (70.3% agreed). Current usage varied, with diagnostic support and administrative tasks being the most common (44.5% and 82.8% usage, respectively). Perceived utility (average score: 4.12 ± 0.75) and ease of use (average score: 3.98 ± 0.69) significantly influenced adoption, as identified by regression analysis (perceived utility: ß = 0.342, p < 0.001; ease of use: ß = 0.267, p = 0.005). CONCLUSION: This study provides valuable insights into AI adoption in dentistry, highlighting the multifaceted nature of barriers and facilitators that influence dental professionals' adoption decisions. Strategies to promote AI adoption should address practical considerations, ethical concerns, and educational needs to facilitate the integration of AI technology into dental practices.

Tumor Microenvironment Landscapes Supporting EGFR-mutant NSCLC Are Modulated at the Single-cell Interaction Level by Unesbulin Treatment.

Lung cancer is the leading cause of cancer deaths. Lethal pulmonary adenocarcinomas (ADC) present with frequent mutations in the EGFR. Genetically engineered murine models of lung cancer expedited comprehension of the molecular mechanisms driving tumorigenesis and drug response. Here, we systematically analyzed the evolution of tumor heterogeneity in the context of dynamic interactions occurring with the intermingled tumor microenvironment (TME) by high-resolution transcriptomics. Our effort identified vulnerable tumor-specific epithelial cells, as well as their cross-talk with niche components (endothelial cells, fibroblasts, and tumor-infiltrating immune cells), whose symbiotic interface shapes tumor aggressiveness and is almost completely abolished by treatment with Unesbulin, a tubulin binding agent that reduces B cell-specific Moloney murine leukemia virus integration site 1 (BMI-1) activity. Simultaneous magnetic resonance imaging (MRI) analysis demonstrated decreased tumor growth, setting the stage for future investigations into the potential of novel therapeutic strategies for EGFR-mutant ADCs. SIGNIFICANCE: Targeting the TME is an attractive strategy for treatment of solid tumors. Here we revealed how EGFR-mutant landscapes are affected at the single-cell resolution level during Unesbulin treatment. This novel drug, by targeting cancer cells and their interactions with crucial TME components, could be envisioned for future therapeutic advancements.

Advances in Non-Small Cell Lung Cancer (NSCLC) Treatment-A Paradigm Shift in Oncology.

Non-Small Cell Lung Cancer (NSCLC) management remains a formidable challenge in the field of oncology, representing a significant global health burden [...].

How various stakeholder pressure influences mega-project sustainable performance through corporate social responsibility and green competitive advantage.

Although numerous research studies have revealed that mega-projects are closely linked to globalization and civilization, few researchers have performed logical assessments of mega-projects using stakeholder theory. As stakeholders demand greater sustainability in the construction industry, sustainable development (SD) has become a priority. However, corporate social responsibility (CSR) and green competitive advantage (GCA) have often been overlooked. This study aims to fill this knowledge gap by creating a comprehensive model to predict mega-project sustainable performance (MSP). Data was collected from 289 respondents in Pakistan's construction industry, and hypotheses were tested using partial least squares structural equation modeling and fuzzy set qualitative comparative analysis. The results indicate that both secondary and primary stakeholders' pressure positively impacts CSR and MSP. Moreover, CSR significantly affects GCA and MSP, with CSR and GCA partially mediating these relationships. Thus, the proposed model could offer innovative insights for decision-makers and engineering managers, recommend adopting social and green practices to enhance MSP with the support of concerned stakeholders' pressure, and help achieve SD objectives.

Recent advances in chromosome capture techniques unraveling 3D genome architecture in germ cells, health, and disease.

In eukaryotes, the genome does not emerge in a specific shape but rather as a hierarchial bundle within the nucleus. This multifaceted genome organization consists of multiresolution cellular structures, such as chromosome territories, compartments, and topologically associating domains, which are frequently defined by architecture, design proteins including CTCF and cohesin, and chromatin loops. This review briefly discusses the advances in understanding the basic rules of control, chromatin folding, and functional areas in early embryogenesis. With the use of chromosome capture techniques, the latest advancements in technologies for visualizing chromatin interactions come close to revealing 3D genome formation frameworks with incredible detail throughout all genomic levels, including at single-cell resolution. The possibility of detecting variations in chromatin architecture might open up new opportunities for disease diagnosis and prevention, infertility treatments, therapeutic approaches, desired exploration, and many other application scenarios.

Remineralization of Dentinal Lesions Using Biomimetic Agents: A Systematic Review and Meta-Analysis.

The objective of this article was to systematically provide an up-to-date review on the different methods of remineralizing human dentine using different biomimetic agents. The authors performed a systematic search within PubMed, Scopus, and Web of Science in addition to the grey literature in Google Scholar® using MeSH terms. The PICO question was P: human teeth dentinal sections; I: application of biomimetic remineralizing agents; C: other non-biomimetic approaches; O: extent of remineralization and physical properties of remineralized dentine. The initially identified studies were screened for titles and abstracts. Non-English articles, reviews, animal studies, studies involving the resin-dentine interface, and other irrelevant articles were then excluded. The other remaining full-text articles were retrieved. Bibliographies of the remaining articles were searched for relevant studies that could be included. A total of 4741 articles were found, and finally, 39 full-text articles were incorporated in the current systematic review. From these, twenty-six research studies used non-collagenous protein (NCP) analogs to biomineralize dentine, six studies used bioactive materials derived from natural sources, six studies used zinc hydroxyapatite, and one study used amelogenin peptide to induce hydroxyapatite formation on the surface of demineralized dentine. Additive effects of triclosan and epigenin were assessed when combined with commonly available NCPs. Overall, a moderate risk of bias was observed and, hence, the findings of the included studies could be acceptable. A meta-analysis of some similar studies was performed to assess the depth of remineralization and elastic modulus. Despite having high heterogeneity (I2 > 90), all the studies showed a significant improvement in biomimetic remineralization efficacy as compared to the control. All the included studies carried out a functional remineralization assessment and found a 90-98% efficacy in the extent of remineralization while the elastic modulus reached 88.78 ± 8.35 GPa, which is close to natural dentine. It is pertinent to note the limitations of these studies that have been carried out in vitro under controlled settings, which lack the effects of a natural oral environment. To conclude, the authors suggest that the biomimetic remineralization of dentine using NCP analogs, bioactive materials, and natural products carries significant potential in treating dentinal lesions; however, more long-term studies are needed to assess their clinical applications in vivo.

Efficacy of Platelet-Rich Plasma Therapy in Oral Lichen Planus: A Systematic Review.

Background and Objectives: Oral lichen planus (OLP) is an autoimmune, mucocutaneous, oral potentially malignant disorder (OPMD), which characteristically manifests with chronic, recalcitrant lesions, with frequent flare-ups and remissions. The precise etiopathogenesis of OLP is still debatable, although it is believed to be a T-cell-mediated disorder of an unidentified antigen. Despite the availability of various treatments, no cure for OLP exists due to its recalcitrant nature and idiopathic etiology. Platelet-rich plasma (PRP) has antioxidant, anti-inflammatory, and immunomodulatory properties, in addition to its regulatory action on keratinocyte differentiation and proliferation. These salient properties substantiate the possible role of PRP in the treatment of OLP. Our systematic review focuses on assessing the therapeutic potential of PRP as a treatment modality in OLP. Materials and Methods: We conducted a detailed literature search for studies assessing PRP as a therapeutic regimen in OLP, using the Google Scholar and PubMed/MEDLINE search engines. The search was limited to studies published from January 2000 to January 2023 and included a combination of Medical Subject Heading (MeSH) terms. ROBVIS analysis was carried out for the assessment of publication bias. Descriptive statistics were performed using Microsoft Excel. Results: This systematic review included five articles that met the inclusion criteria. Most of the included studies demonstrated that PRP treatment considerably ameliorated both objective and subjective symptoms in OLP subjects, with comparable efficacy to the standard corticosteroid treatment. Further, PRP therapy offers the added benefit of minimal adverse effects and recurrences. Conclusion: This systematic review suggests that PRP has significant therapeutic potential for treating OLP. However, further research with larger sample sizes is imperative to corroborate these findings.

Targeting Inflammation in Non-Small Cell Lung Cancer through Drug Repurposing.

Lung cancer is the most common cause of cancer-related deaths. Lung cancers can be classified as small-cell (SCLC) or non-small cell (NSCLC). About 84% of all lung cancers are NSCLC and about 16% are SCLC. For the past few years, there have been a lot of new advances in the management of NSCLC in terms of screening, diagnosis and treatment. Unfortunately, most of the NSCLCs are resistant to current treatments and eventually progress to advanced stages. In this perspective, we discuss some of the drugs that can be repurposed to specifically target the inflammatory pathway of NSCLC utilizing its well-defined inflammatory tumor microenvironment. Continuous inflammatory conditions are responsible to induce DNA damage and enhance cell division rate in lung tissues. There are existing anti-inflammatory drugs which were found suitable for repurposing in non-small cell lung carcinoma (NSCLC) treatment and drug modification for delivery via inhalation. Repurposing anti-inflammatory drugs and their delivery through the airway is a promising strategy to treat NSCLC. In this review, suitable drug candidates that can be repurposed to treat inflammation-mediated NSCLC will be comprehensively discussed together with their administration via inhalation from physico-chemical and nanocarrier perspectives.

Effects of Leea indica leaf extracts and its phytoconstituents on natural killer cell-mediated cytotoxicity in human ovarian cancer.

BACKGROUND: The rich biodiversity of medicinal plants and their importance as sources of novel therapeutics and lead compounds warrant further research. Despite advances in debulking surgery and chemotherapy, the risks of recurrence of ovarian cancer and resistance to therapy are significant and the clinical outcomes of ovarian cancer remain poor or even incurable. OBJECTIVE: This study aims to investigate the effects of leaf extracts from a medicinal plant Leea indica and its selected phytoconstituents on human ovarian cancer cells and in combination with oxaliplatin and natural killer (NK) cells. METHODS: Fresh, healthy leaves of L. indica were harvested and extracted in 70% methanol by maceration. The crude extract was partitioned with n-hexane, dichloromethane and ethyl acetate. Selected extracts and compounds were analyzed for their effects on cell viability of human ovarian cancer cells, NK cell cytotoxicity, and stress ligands expression for NK cell receptors. They were also evaluated for their effects on TNF-α and IL-1ß production by enzyme-linked immunosorbent assay in lipopolysaccharide-stimulated human U937 macrophages. RESULTS: Leaf extracts of L. indica increased the susceptibility of human ovarian tumor cells to NK cell-mediated cytotoxicity. Treatment of cancer cells with methyl gallate but not gallic acid upregulated the expression of stress ligands. Tumor cells pretreated with combination of methyl gallate and low concentration of oxaliplatin displayed increased levels of stress ligands expression and concomitantly enhanced susceptibility to NK cell-mediated cytolysis. Further, NK cells completely abrogated the growth of methyl gallate-pretreated ovarian cancer cells. The leaf extracts suppressed TNF-α and IL-1ß production in human U937 macrophages. Methyl gallate was more potent than gallic acid in down-regulating these cytokine levels. CONCLUSIONS: We demonstrated for the first time that leaf extracts of L. indica and its phytoconstituent methyl gallate enhanced the susceptibility of ovarian tumor cells to NK cell cytolysis. These results suggest that the combined effect of methyl gallate, oxaliplatin and NK cells in ovarian cancer cells warrants further investigation, for example for refractory ovarian cancer. Our work is a step towards better scientific understanding of the traditional anticancer use of L. indica.

Rearing performance of black soldier fly (Hermetia illucens) on municipal biowaste in the outdoor ambient weather conditions of Pakistan and Indonesia.

The availability and continuous supply of black soldier fly larvae (BSFL) is crucial for efficient operation of a BSF biowaste recycling facility. Its rearing performance was for the first time investigated in Pakistan under outdoor ambient weather conditions. Comparison of the findings with the BSF rearing performance of Indonesia's facility highlights the life stages needing special attention. In Pakistan, mean BSF emergence, hatching and survival rate of 58.8% (SD 15.2), 44.5% (SD 21.8) and 91.4% (SD 1.68) were achieved respectively. A positive significant correlation was found between the number of emerged flies and prepupae (R = 0.75) and the number of eggs produced and hatched (R = 0.92). On average, BSF took 49.5 days (SD 3.20) to complete one life cycle (LC) under ambient temperature and relative humidity (RH) between (22-35 °C) and (24.7-89.3%) respectively. The mean duration of eclosion, pre-oviposition, egg hatching, larval feeding and pupation was 15.6 days (SD 1.6), 3.5 days (SD 0.5), 3 days (SD 0.6), 22 days (SD 2.5), 3.8 days (SD 1.2) respectively. In Pakistan, the LC duration was longer with a smaller number of eggs/fly, lower BSF emergence and hatching rates as compared to Indonesia. BSF tolerated the semiarid weather conditions of Pakistan, successfully developed into all instars and completed all LCs under observation. It is suggested to provide controlled environmental conditions at the nursery stage to improve BSFL rearing performance for sustainable biowaste management.

Evaluation of operational and financial viability models of combined landfill site for intermediate cities in Pakistan.

This study aims to evaluate municipal landfill sites' operational and financial viability, waste amount and characterization, primary and secondary collection systems, revenue generation from MSW, vehicle routing, and age of landfill sites located in Akhtarabad, Sahiwal Division. Three operational and financial models were developed to calculate cost/ton value based on obtained data. The obtained results indicate that the cost/ton values for models are the following: 20.01 USD for Model-1, 8.96 USD Model-2, and Model-3 is about 10.23 USD. The waste characterization represented waste consisting of compostable (57%), recyclable (10%), Refuse Derived Fuel (RDF) (12%), earth fill (20%), and disposable material (1%). Revenue/ton of municipal solid waste was about 19.47 USD, and according to cost-benefit analysis, the cost of Model-1 was higher than the benefit. In contrast, the costs of Model-2 and Model-3 were found to be lower than the revenue/ton. However, the waste collection efficiency of Model-1 was greater than both remaining models. The study concluded that utilizing all generated waste, only 21% of waste is dumped at the landfill site. It will reduce the area required for landfill sites from 431437 to 90602 m2 for the next 10 years and increase the age of landfill sites by over 20 years. It is recommended that the reuse of municipal solid waste and implementation of the no waste to landfill model would surely save money, land, and fuel, and it will also increase the age of landfill sites.

Current Trends in Root Canal Irrigation.

Chemical and mechanical root canal debridement are the primary methods used in endodontic therapy to remove all dead tissue, bacteria, and microbial byproducts from the canal. Sodium hypochlorite, a powerful organic tissue dissolver with a broad spectrum of antibacterial properties, is an excellent choice for disinfecting surfaces. Chelating agents, on the other hand, may be used to remove the inorganic components found on the smear layer. This irrigation method is capable of removing the smear layer; however, it is less effective in the apical third. While using irrigant activation devices, irrigating solutions need to be in direct contact with the whole root canal wall surfaces, especially in the apical portions of tiny root canals. The role of irrigants is extremely important because they help not only to clean the canal but also to allow the seepage of the medicaments into the canal system. Thus, the canal needs to be healthy before the obturation procedure. Nowadays, many irrigants have been studied and hence compilation of the various available sources and their effect has to be studied both in vivo and in vitro. The correlation between the irrigants and the canal cleanliness is of utmost importance, as the success of endodontic root canal treatment depends on its proper activation and characteristics. Hence, this review incorporates the current use of various irrigating solutions and their advantages and disadvantages. In the future, endodontists may employ the novel irrigants and irrigant activation devices that were discovered in this study.

Effects of Weight-Bearing on Tibiofemoral, Patellofemoral, and Patellar Tendon Kinematics in Older Adults.

Quantification of natural knee kinematics is essential for the assessment of joint function in the diagnosis of pathologies. Combined measurements of tibiofemoral and patellofemoral joint kinematics are necessary because knee pathologies, such as progression of osteoarthritis and patellar instability, are a frequent concern in both articulations. Combined measurement of tibiofemoral and patellofemoral kinematics also enables calculation of important quantities, specifically patellar tendon angle, which partly determines the loading vector at the tibiofemoral joint and patellar tendon moment arm. The goals of this research were to measure the differences in tibiofemoral and patellofemoral kinematics, patellar tendon angle (PTA), and patellar tendon moment arm (PTMA) that occur during non-weight-bearing and weight-bearing activities in older adults. METHODS: High-speed stereo radiography was used to measure the kinematics of the tibiofemoral and patellofemoral joints in subjects as they performed seated, non-weight-bearing knee extension and two weight-bearing activities: lunge and chair rise. PTA and PTMA were extracted from the subject's patellofemoral and tibiofemoral kinematics. Kinematics and the root mean square difference (RMSD) between non-weight-bearing and weight-bearing activities were compared across subjects and activities. RESULTS: Internal rotation increased with weight-bearing (mean RMSD from knee extension was 4.2 ± 2.4° for lunge and 3.6 ± 1.8° for chair rise), and anterior translation was also greater (mean RMSD from knee extension was 2.2 ± 1.2 mm for lunge and 2.3 ± 1.4 mm for chair rise). Patellar tilt and medial-lateral translation changed from non-weight-bearing to weight-bearing. Changes of the patellar tendon from non-weight-bearing to weight-bearing were significant only for PTMA. CONCLUSIONS: While weight-bearing elicited changes in knee kinematics, in most degrees of freedoms, these differences were exceeded by intersubject differences. These results provide comparative kinematics for the evaluation of knee pathology and treatment in older adults.

Effectiveness of Self-Assembling Peptide (P11-4) in Dental Hard Tissue Conditions: A Comprehensive Review.

The limitations on the use of fluoride therapy in dental caries prevention has necessitated the development of newer preventive agents. This review focusses on the recent and significant studies on P11-4 peptide with an emphasis on different applications in dental hard tissue conditions. The self-assembling peptide P11-4 diffuses into the subsurface lesion assembles into aggregates throughout the lesion, supporting the nucleation of de novo hydroxyapatite nanocrystals, resulting in increased mineral density. P11-4 treated teeth shows more remarkable changes in the lesion area between the first and second weeks. The biomimetic remineralisation facilitated in conjunction with fluoride application is an effective and non-invasive treatment for early carious lesions. Despite, some studies have reported that the P11-4 group had the least amount of remineralised enamel microhardness and a significantly lower mean calcium/phosphate weight percentage ratio than the others. In addition, when compared to a low-viscosity resin, self-assembling peptides could neither inhibit nor mask the lesions significantly. Moreover, when it is combined with other agents, better results can be achieved, allowing more effective biomimetic remineralisation. Other applications discussed include treatment of dental erosion, tooth whitening and dentinal caries. However, the evidence on its true clinical potential in varied dental diseases still remains under-explored, which calls for future cohort studies on its in vivo efficacy.

In Vivo Efficacy of Diode Laser as a Monotherapy in Root Canal Disinfection: A Systematic Review and Meta-Analysis.

Objective: The aim of this study was to conduct a systematic review and meta-analysis of the available scientific evidence to validate the use of diode laser treatment as monotherapy for disinfection of root canals during endodontic treatment. Background data: Root canal disinfection is an integral step in successful endodontic therapy. Evidence suggests better clinical outcomes when diode laser treatment is opted as compared with conventional, root canal disinfection/irrigation protocols. However, there is currently no standard protocol for the use of diode lasers in disinfection of root canals. Methods: Four electronic databases, namely PubMed, Scopus, Web of Science, and Embase, were systematically searched up to December 2020 to identify studies addressing the therapeutic efficacy of dental diode lasers in endodontic root canal disinfection as monotherapy. Two examiners assessed the eligibility and quality of relevant studies, and interobserver agreement was reached for each included study. The effect of laser treatment in reduction of bacterial growth (both aerobic and anaerobic) was studied and an appropriate forest plot was prepared. A meta-analysis of similar studies was performed by calculating the pooled weighted mean difference and 95% confidence interval using a random-effects model. Results: Six and nine articles were included in the quantitative and qualitative analyses, respectively. Although moderate to high risk of bias was detected, high heterogeneity was found among the studies. Statistically significant reduction of microorganisms was observed when diode laser treatment was used for root canal disinfection; however, a small number of reported randomized clinical trials in humans with small sample sizes and high heterogeneity provide insufficient support toward its efficacy. Conclusions: There was no concluding evidence grade for recommendation of laser monotherapy for infected root canals. This does not necessarily invalidate the effect of laser therapy, but instead underscores the need for future high-quality studies.