Objective To evaluate the marginal adaptation of thermoviscous bulk-fill, preheated, and conventional nanohybrid composite resins in class II cavities. Patients and methods Thirty extracted human sound molars were selected in this in vitro study. Simple class II cavities were prepared using carbide bur. The overall dimensions and depth of cavities were standardized as follows: 4 mm length occlusocervically, 4 mm width buccolingually, and 2 mm depth axially. The teeth were randomly divided into three groups (n = 10 each). Futurabond DC (one-step self-etch adhesive) was applied in all groups. Group 1: cavities were restored with VisCalor bulk composite, group 2: cavities were restored with Grandio composite, group 3: cavities were restored with preheated Grandio composite. The specimens of each group were thermocycled in a thermocycling apparatus by alternating immersion in a water bath at 5 and 55°C with a dwell time of 2 min for 600 thermal cycles. Impressions of the teeth were made and then poured with epoxy resin and replicas were examined under scanning electron microscopy to examine marginal gaps. All data were collected, tabulated, and statistically analyzed. Result The highest percentage of marginal gap length was recorded for group 2, recording 22.93%, while there was no significant difference between group 1 and group 3, recording 13.44 and 13.83%, respectively. One-way analysis of variance test was used to compare the tested groups at a level of significance (P < 0.05). Conclusion The marginal gaps decreased when VisCalor bulk and Grandio composite resins were applied after preheating so preheating composite resins considerably improves marginal adaptation.

Aims This study was designed to evaluate the amount of bone resorption related to implant in free end saddle in response to different occlusal designs. Patients and methods Twenty patients with unilateral free end saddle in the lower arch till the second premolar were selected and received delayed single dental implants replacing the first molar tooth. They were divided into two main groups according to the implant superstructure deign (n = 10). Group 1: implant-supported fixed dental prosthesis which follow the principals of implant protected occlusion, and with the occlusal contact area of the crown smaller than the occlusal contact area of adjacent tooth. Group 2: implant-supported fixed dental prosthesis which follow the principals of implant protected occlusion, and with the occlusal contact area of the crown larger than the occlusal contact area of adjacent tooth. Patients were evaluated for the amount of marginal bone level at the time of crown insertion, after 3 and 6 months of function. Results There was a statistically significant change by time in marginal bone loss in both groups especially during the first 3 months. However, there was no statistically significant difference between marginal bone loss regarding the two groups. Conclusion It was concluded that increasing the occlusal contact area of the implant superstructure has no effect on marginal bone loss.

Aim To clinically and radiographically evaluate single visit root canal treatment (RCT) and pulpotomy in management of mature teeth with irreversible pulpitis. Patients and methods Twenty-four patients diagnosed with irreversible pulpitis in their mature permanent mandibular molars, were selected and randomly divided into two equal groups according to the treatment protocol either single visit RCT or pulpotomy. For single visit RCT group, ProTaper NEXT rotary system was used for canal preparation and obturation was done using cold lateral condensation technique. While in pulpotomy group, after coronal pulp amputation and hemostasis, Biodentine was used as the pulpotomy agent. The clinical examination of tested groups was performed immediately after completing the procedure (baseline), 3, 6, 9, and 12 months posttreatment. While the radiographic examination using cone-beam computed tomography was carried out at baseline and 12 months postoperatively. Statistical analysis was performed by χ² test for clinical evaluation criteria and t test for radiographic data. Results Single visit RCT had clinical success rate of 91.67%, while pulpotomy group showed 83.33% success rate. Radiographically, both groups showed normal width of periodontal ligament membrane space and normal bone density after follow-up. There was no statistically significant difference between two groups (P > 0.05). Conclusions Single visit RCT and pulpotomy had high success rate in management of mature permanent teeth diagnosed with irreversible pulpitis. Pulpotomy can be considered as an alternative treatment option.

Objectives The aim of this study was to assess the adjunctive regenerative effect of metformin (MF) gel in the treatment of stage II grade C periodontitis utilizing β-TCP bone graft in the control group, and β-TCP bone graft mixed with 1% MF gel in the test group on clinical, radiographic, and biochemical parameters. Patients and methods Thirty intrabony defects were selected in seven patients who met the inclusion criteria. Patients were randomly distributed in the two study groups and treated with β-TCP bone graft plus collagen membrane in the control group and β-TCP bone graft mixed with 1% MF gel plus collagen membrane in the test group. Clinically, evaluation was carried out by clinical parameters (bleeding on probing, pocket depth, and clinical attachment loss) at 3, 6, and 9 months posttreatment. Biochemically, gingival crevicular fluid concentration of receptor activator of nuclear factor-κB ligand (RANKL) and Osteoprotegerin (OPG) at baseline and 9 months posttreatment were evaluated and RANKL/OPG ratio was calculated. Radiographically, quantitative digital subtraction radiography was used to evaluate bone gain and bone mineral density at 9 months posttreatment follow up period. Results The intragroup comparison in the two studied groups demonstrated statistically significant improvement in all clinical parameters (bleeding on probing, pocket depth, and clinical attachment loss) after 3, 6, and 9 months when they were compared to their corresponding values at baseline, while, the intergroup comparison showed that there is no statistically significant difference regarding all clinical parameters at 3, 6, and 9 months posttreatment except pocket depth which differs statistically significant at 3 months posttreatment. The intragroup comparison of RANKL and OPG was statistically significant between baseline and 9 months posttreatment in the two groups but intergroup comparison revealed that there is no statistically significant difference. Regarding RANKL/OPG ratio, the intragroup analysis revealed that there was a statistically significant change in this ratio from baseline to 9 months posttreatment in the test and control group. Additionally, the intergroup analysis revealed that there was no statistically significant difference in RANKL/OPG ratio between the test and control group at baseline and at 9 month posttreatment. The intragroup quantitative digital subtraction radiography analysis demonstrated statistically significant bone gain and increase in bone mineral density in the two studied groups. Also, the intergroup comparison revealed that no statistically significant increase in bone level in the two groups although increase in bone density was statistically significant. Conclusion The present study demonstrated that guided tissue regeneration utilizing 1% MF gel combined with β-TCP bone graft showed better radiographic results, when compared with guided tissue regeneration utilizing β-TCP bone graft alone. The adjunctive regenerative action of MF is promising material for periodontal regeneration.

Introduction Tongue is a soft muscular tissue which is mainly made of mucosa, muscles, vascular and nerve supply. The mucosa of body is formed from the first pharyngeal arch and third pharyngeal arches; while the skeletal muscles develop from myoblast that migrate from occipital somite's. Aim Owing to its effect on the building structures all around and vital functions, this study was carried out to assess the tongue posture in vertical malrelations; in class I malocclusion. Materials and methods A cephalometric study was carried out on 153 adult patients (76 female, 75 male) from 17 to 22 years old) with skeletal class I. The sample was selected according to the mandibular plane angle (SN/GO-GN) and categorized according to vertical facial pattern into; high angle (SN/MP >37), low angle (SN/MP <27) and average angle (SN/MP 32 ± 5°); including 26 females and 25 males in each group. The tongue position was calculated along horizontal line passing through the incisal edge of the lower central incisor to the cervical distal third of the lower second molar and extending posteriorly. Taking the cervical area as a center, six angles will be drawn at 0°, 30°, 60°, 90°, 12°, and 150°. The contours of the dorsum of the tongue and the palate and six distances will be measured at 0°, 30°, 60°, 90°, 120°, and 150° between tongue and palate contour. Results Tongue positions were found to be higher in position in skeletal class I malocclusion in low and high mandibular plane (posterior part of the tongue); on the other, lower tongue position (anterior part) was found in increased mandibular plane angle without sex differences Conclusion Tongue position is affected by the position of the mandible in vertical plane; regarding the anterior or posterior part without sex differences.

Aim In normal dental exams, dental anomalies are widespread. It may lead to occlusal, cosmetic, and functional problems. In this study, the prevalence and distribution of developmental dental abnormalities in a community of Egyptian children were studied. Patients and methods The average age of the sample was 7.5 years out of 2583 panoramic radiographs of kids between the ages of 6 and 12 that were analyzed, including 1110 boys and 1473 girls. The digital panoramic radiographs were examined by two experienced researchers in a standard manner and in good lighting for the following developmental anomalies: congenitally missing teeth, extra teeth, impaction, ectopic eruption, transposition, gemination, fusion, submerged, peg-shaped teeth, dilacerations, taurodontism, dens in dente (Dens Evaginatus), retained or early loss of primary teeth considering the chronological age of dental eruption, and any other anomalies. Results Two hundered sixty-six panoramic radiographs, or 10.3% of the study group, had at least one dental abnormality, while 2317, or 89.7%, had none. There was no significant difference between the sexes other than fusion, where the rate was higher in females than in males among the cases with dental anomalies. Of these cases, 57.14% were girls and 42.85% were boys. Supernumerary teeth were more common than congenitally lacking teeth (1.85 vs. 4.41%). Amelogenesis imperfect, transposition peg-shaped and halted teeth, impacted teeth (1.5%), taurodontism (1.16%), root dilacerations (1.04%), amelogenesis imperfect, fusion (0.23%), and no cases of accessory roots and dentinogenesis imperfecta were found in this study. Conclusion Dental anomalies were often found in this Egyptian study population. Various dental abnormalities were found. Congenital missing was the most frequent anomaly, followed by extra teeth, impacted teeth, taurodontism, root dilatation, fusion, amelogenesis imperfecta, transposition peg-shaped teeth, and arrested teeth, in that order. In this investigation, no instances of dentinogenesis imperfecta or accessory roots were found. Because of the high occurrence of developmental dental anomalies, it is imperative that their causes be better understood to provide better treatment, intervene earlier, and prevent future problems.

Aims This work aimed to compare the sound production and speech pattern in children with prematurely extracted anterior teeth after prosthetic rehabilitation with fixed functional space maintainer. Settings and design The study was conducted as a clinical trial. The clinical part was carried out at Pediatric Dentistry Department, Faculty of Dentistry, Tanta University and speech evaluation and assessment was done in Phoniatric Unit, ENT Department, Faculty of Medicine, Tanta University. Patients and methods Twenty-five children of both sexes aged from 3 to 6 years old were included in the study. The selected children were in need for extraction of maxillary primary incisors or had already got extracted and treated by anterior esthetic fixed appliance. Children attended for speech and language evaluation at before appliance delivery, immediately after appliance insertion, 7 days after appliance insertion, 14 days after appliance insertion and 1 month after appliance insertion. And they were evaluated by articulation test, speech intelligibility test, and spectrographic parameters. Statistical analysis used All test statistics were performed using the SPSS software statistical package and the significance was set at P value less than or equal to 0.05. Results There were statistically significant differences between follow up periods for/S/,/S/, and/Z/sounds but no statistically significant difference for/z/and/∫/sounds. The mean shimmer in dB, the mean absolute Jitter and the mean noise to harmonic ratio for the sounds were diminished after adaptation of the appliance. Also, high significant differences were found between 1 month after appliance insertion and all different follow up periods. No difference with immediately after appliance insertion. Conclusions Replacement of prematurely lost primary incisors with fixed prosthetic appliances will assist in the proper development and intelligibility of speech. Also, in accurate consonants sounds production as/s/,/s/,/z/,/∫/(alveolar fricatives), and/z/(dental fricatives).

Background The study aimed to assess the oral health practices of school teachers in Dharamshala city, Himachal Pradesh. Materials and methods The sampling used was probability stratified random sampling. The data was collected by interview recorded on a structured proforma adapted from previous study. Results All the teachers (100%) brushed their teeth with tooth brush and tooth paste. There were 535 (66.9%) teachers, brushing their teeth twice daily and 260 (32.5%) teachers brushing once daily. The frequencies of changing tooth brush within 3 months were higher in female (71.7%) as compared to males (60.6%) and the difference was statistically significant. This was higher among private school teachers (57.8%) than government school teachers (42.1%). Majority in the study reported that they did not use any form of smoked and smokeless tobacco in the present or past. Conclusion The study reported a moderate oral health practices in the teachers and the main reason for visit to the dentist was dental caries which clearly indicates the adequate awareness about early intervention of dental diseases. Further, efforts should be encouraged to educate teachers about modern preventive dentistry for translation of oral health promotion among school children. Continued dental education and teachers training programmes still remains the best way to impart scientific oral health knowledge to teachers to improve their oral health practices and reduce the burden of oral diseases.

Introduction Conventional treatments for caries removal in children are often associated with pain and fear, so chemomechanical caries removal agents as Brix 3000 have been developed as one of minimally invasive technique which consists of applying a proteolytic substance that only softens the infected dentin tissue and preserves healthy tooth tissue providing more comfortable, and conservative treatment. Objectives The aim of this study was to evaluate the clinical efficacy of papain compared to the conventional bur preparation in caries removal in primary teeth. Patients and methods A randomized controlled clinical trial with sample consisted of 30 healthy children aged from 4 to 7 years old. On 60 bilaterally cavitated primary molars, a split mouth approach was used, where caries excavation was carried out with Brix 3000 on one side and traditional burs on the other. The variables evaluated were pain response, the average treatment time needed and Streptococcus mutans and Lactobacillus counts before and after caries removal. Results Regarding pain response, there was a statistically significant difference between the two techniques, however Brix 3000's caries removal time was significantly longer than the bur's. S. mutans and Lactobacillus counts were reduced using each of the methods, and a statistically significant difference was found; however, the reduction was slightly greater using the chemomechanical method than the conventional method, but this difference was not statistically significant. Conclusions Brix 3000 is an efficient alternative for caries removal in primary teeth with no pain and great microbiological efficacy, however it requires longer time.

Aims Evaluation of smear layer changes following ultrasonic endoactivator irrigation system during root canal treatment of primary teeth under Electron Microscope. Settings and design The study was conducted as a clinical trial. The laboratory part was carried out at Pediatric Dentistry Department, Faculty of Dentistry, Tanta University, scanning electron microscopic analysis was conducted at electron microscope unit, Faculty of Science, Alexandria University. Patients and methods A total of 40 intact, extracted primary canines (due to serial extraction) were collected and randomly divided into four equal groups' including 10 teeth for each. Group I: irrigation of root canal with sodium hypochlorite by a plastic syringe with end-vented needle. Group II: irrigation of root canal by a plastic syringe with side-vented needle. Group III: the same of group I in conjunction with ultrasonic endoactivator. Group IV: the same of group II in conjunction with ultrasonic endoactivator. Then preparation of specimens was done for scanning electron microscope. Results It was noticed that groups III and IV that used ultrasonic endoactivator had lower scores of smear layer amount than the other groups. Conclusions Ultrasonic endoactivator system in conjunction with conventional irrigation could improve disinfection of the root canals of primary teeth.

Pediatric dentists frequently encounter challenges in management of first permanent molars with molar incisor hypomineralization (MIH). They are found to have posteruptive breakdowns, active growth phase, inconclusive occlusal contacts, and wide pulp chambers with prominent pulp horns. The previous led to poor compliance, defective anesthesia, and restoration adhesion problems. Objectives Evaluate clinically indirect lithium disilicate glass–ceramic overlay versus indirect composite resin overlay using complete digital workflow in treatment of permanent molars with MIH in children. Patients and methods This split mouth randomized clinical trial compared full digital workflow lithium disilicate glass–ceramic overlay in comparison with the same workflow indirect computer aided design-computer aided manufacturing resin overlay in treatment of MIH molars in 12 children aged between 8 and 13 years with total of 24 first permanent molars into two groups. These MIH vital molars fell in the array of index 2 and 4 upon which the entire carious and hypomineralized enamel was removed with uniform reduction with final shoulder margin on sound enamel to receive the overlays. Results Both groups were assessed according to United States Public Health Services criteria of evaluation on 3 months interval for 9 months where the lithium disilicate glass ceramic overlay group showed 100% cumulative survival rate with consistent retention and anatomic form results as well as complete absence of pain and hypersensitivity at 9 months. No significant difference between both groups except for the anatomic form in which significant difference was found in favor of the lithium disilicate glass–ceramic group. Conclusion Overlays serve as esthetic, conservative and long-term treatment option with digital dentistry incorporation in every aspect of dentistry nowadays to provide accurate and quick delivery of the restorations with both groups behaved in a clinically acceptable performance.

Aim Color stability is crucial to the esthetic success of restorative materials. The research carried out on the development of restorative materials, especially the preheating process to resins draws attention due to some advantages. The purpose of the research was to examine the effect of preheated polyacid-modified composite resins of children's beverages on color stability in vitro. Materials and methods The discs were prepared from A2-colored polyacid-modified composite resin material preheated at four different temperatures (4, 23, 39, and 55°C). The discs were kept in distilled water, cola, cherry juice, and chocolate milk. The data obtained by calculating the color changes were statistically evaluated using a two-way robust analysis of variance. Results No significant color change was observed in the chocolate milk group compared to the distilled water group at all preheating temperatures on the working period. In the cola group, a similar color change was observed for up to 60 days at pretemperature values of 39 and 55°C, and up to 30 days at temperatures of 4 and 23°C. Conclusion It should be considered that the preheating process may be beneficial for the longevity of the color stability of restorations, and that different beverage groups may have different effects.