Aim: To evaluate and compare the surface morphology, wettability, roughness, and bacterial adhesion properties of polymethyl methacrylate (PMMA) materials fabricated by conventional methods and 3D printing for complete denture applications. Materials and methods: Two PMMA materials were investigated: Conventionally processed (ProBase Hot) and 3D-printed (3DP) (V-Print Dentbase). Surface morphology (n = 3) was analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). Surface roughness (n = 10) was measured using an optical profilometer. Wettability was assessed through contact angle measurements (n = 6) at 10, 30, and 60 seconds. Bacterial adhesion (n = 9) and biofilm formation (n = 3) were evaluated using Escherichia coli (E. coli) as a model organism, with quantitative bacterial counts and SEM analysis of bacterial morphology. Data were statistically analyzed. Results: Scanning electron microscopy analysis revealed nanoparticles on the surface of 3DP samples, while EDX detected silicon in these samples, absent in conventional PMMA. 3D-printed surfaces exhibited significantly lower roughness (1.05 ± 0.32 µm) compared to conventional surfaces (20.46 ± 6.71 µm) (p < 0.001). Contact angle measurements showed that 3DP surfaces were more hydrophilic (64–68°) than conventional surfaces (100°) (p < 0.05). Bacterial adhesion studies demonstrated more adherent bacteria on 3DP surfaces (92.5 ± 30.8) compared to the conventional surfaces (57.6 ± 12.5), but biofilm formation was observed only on conventional surfaces. Conclusion: 3D-printed PMMA exhibited distinct surface characteristics compared to conventionally processed PMMA, including the presence of silicon nanoparticles, lower surface roughness, and higher hydrophilicity. While 3DP surfaces showed higher initial bacterial adherence, in contrast, they appeared to inhibit biofilm formation, which highlights the complex nature of bacterial interactions with these materials. Clinical significance: Further clinical studies are needed to validate the results of this investigation and generate clinical translational data.

Aims: This study aims to identify the barriers associated with access to oral health services among individuals aged 18 or over in Danang city. Materials and methods: A cross-sectional descriptive study using a self-completed questionnaire with 29 questions built on the theoretical framework of Jean-Frederic Levesque and the modified dental anxiety scale (MDAS) was conducted on 386 people aged 18 years and older living in Danang city through face-to-face interviews. The study responses were closed after achieving the target sample size, with the sample collection period recorded as 3 months from October 2023 to January 2024. Data were analyzed using SPSS 20.0 software. Factors influencing the decision to use dental services among individuals who have either never used or have used oral care services more than 12 months ago were analyzed in univariate analysis and multivariate logistic regression analysis. Results: The proportion of participants who have either never utilized dental services or had last used them more than 12 months ago was 57.5%. Factors linked to the decision to seek dental care include personal dental hygiene practices, knowledge of oral health, accessibility to information, recommendations from peers, the process of scheduling appointments, examination duration, and income level, with odds ratio (OR) of 2.011–15.394 (p < 0.05). Conclusion: A large proportion of adults in Danang lack the habit of utilizing dental care services. The prevalent barriers include physical accessibility to dental facilities (such as locating, scheduling, and arranging appointments), affordability, and a deficiency in individual skills and knowledge regarding the importance of regular oral healthcare. Clinical significance: The analysis of factors such as knowledge of oral health and service accessibility provides crucial insights for developing strategies to enhance community engagement in oral care. The clinical translational value of this research lies in its potential to support the development of more effective educational programs and healthcare policies, thereby encouraging regular oral health practices and improving the oral health of the community.

Aim: This study aimed to evaluate the efficacy of a biodegradable dressing containing tranexamic acid in preventing alveolar osteitis (AO) following mandibular third molar extraction and to investigate the impact of various risk factors on its occurrence, including smoking, the use of oral contraceptives, a history of pericoronitis, and the difficulty level of the procedure. Materials and methods: This double-blind, randomized, controlled clinical trial was conducted on 182 patients requiring mandibular third molar extraction. The patients were randomly assigned to two groups and standardized in terms of gender, age, level of difficulty of surgery, smoking status, and intake of oral contraceptives. After the surgical extraction of the third molars, the control group received a biodegradable dressing without any loaded medication. The experimental group received a biodegradable dressing loaded with tranexamic acid in the extraction socket. The patients were recalled after 3 and 7 days, and the presence/absence of blood clots, detritus, empty sockets, halitosis, and pain using a visual analog scale (VAS) was assessed. Data were analyzed using the Chi-squared test, independent t-test, exact logistic regression, and repeated measures ANOVA (α = 0.05). Results: The incidence of AO was not significantly different between the two groups (7.6% in the experimental group and 8.9% in the control group, p = 0.744). The odds of AO development in patients with level II or III difficulty were 9.169 times the odds of AO in patients with level I difficulty (p = 0.015). The experimental group had significantly lower pain than the control group (p < 0.001). The interaction effect of time and AO was significant on pain (p < 0.001). Conclusion: A biodegradable dressing loaded with tranexamic acid was ineffective in preventing AO after third molar extraction but significantly decreased postoperative pain. Clinical significance: There is a critical need to explore effective strategies for reducing postoperative complications such as pain and AO following mandibular third molar extractions. The findings of this study highlight the potential clinical application of biodegradable dressings containing tranexamic acid for pain management, offering a translational benefit in improving patient comfort and recovery experiences.

Aim: To assess the coronal and apical microleakage of mineral trioxide aggregate (MTA), Biodentine, and Bioceramic putty when used as coronal and apical seals in endodontically treated teeth. Materials and methods: The study was conducted on 90 mandibular premolar teeth. The groups were divided into two subgroups. One group assessed the coronal seal (n = 45), and the other group assessed the apical seal (n = 45). Coronal and apical 3 mm of the root filling was removed and replaced randomly with MTA, Biodentine, and Bioceramic putty in the three experimental subgroups (n = 15). All teeth were immersed in methylene blue and after incubation, the degree of dye penetration was assessed under a stereomicroscope of ×10 magnification. Statistical analysis was done using the Kruskal–Wallis test with a p-value set at 0.05. Results: The mean depth of dye penetration for coronal sealing in the MTA group was 2.91 ± 0.66, in the Biodentine group was 2.12 ± 0.50 and in the Bioceramic putty group was 1.51 ± 0.46. The mean depth of dye penetration for root-end sealing in the MTA group was 0.75 ± 0.55, in the Biodentine group was 1.94 ± 0.88 and in the Bioceramic putty group was 0.29 ± 0.20. Conclusion: Within the limitations of this study, it can be concluded that Bioceramic putty exhibited better sealing ability in both coronal and apical barriers of root canals. Clinical Significance: The sealing ability of a material vastly influences the treatment outcome of nonsurgical and surgical root therapy. The study evaluates the coronal and apical seal of three physical variants of Bioceramic material.

Aim: This study evaluates compressive stress in teeth restored with endocrown (ECW) and build-up (BUP) using finite element analysis (FEA). Understanding stress distribution in dental restorations is crucial for improving treatment outcomes and longevity. Materials and methods: A second lower molar was modeled using Solidworks® (Version 2017). The ECW was simulated with nanoceramic resin, while the BUP included a core and nanoceramic crown. Mechanical properties, including modulus of elasticity, Poisson's ratio, and tensile strength were assigned to materials. Axial and oblique loads of 900N were applied, and stress was analyzed using Solidworks®. Results: Results indicated that under axial loading, ECW experienced a maximum stress of 91.9 MPa, significantly higher than BUP's 49 MPa. Under oblique loading, ECW exhibited 132 MPa compared with 116 MPa in BUP. The highest stress concentration was in the cervical area, where ECW showed greater stresses in both the substrate and restored area. Build-up demonstrated better stress distribution and lower fracture risk. Conclusion: Endocrown restoration results in higher compressive stresses, especially in the cervical region, which may increase the risk of fracture. Conversely, the BUP technique, which preserves cervical dentin, offers improved stress distribution and reduced fracture risk, making it a more robust solution for endodontic rehabilitation. Clinical significance: This study underscores the importance of selecting appropriate restoration methods to minimize stress and enhance the longevity of dental treatments, ultimately leading to better patient outcomes.

Aim: To evaluate and correlate levels of serum calcium and 25-hydroxycholecalciferol (vitamin D) in subjects with periodontitis and in subjects with healthy periodontium before and following nonsurgical periodontal therapy (NSPT). Materials and methods: A total of 52 patients were enrolled in the study with 26 patients in each group. The control group included patients without periodontitis, whereas the study group included patients with periodontitis. On the first visit, ~ 3–5 mL of venous blood was collected from all the participants for the assessment of calcium and Vitamin D levels in the blood. The various parameters evaluated included probing depth, clinical attachment level (CAL), gingival index (Loe and Silness 1963). Plaque index (Silness and Loe 1964), and IOPA (site having greatest pocket depth). Participants of both the groups received NSPT which involved extensive scaling and root planing. On the second visit (after 3 months), the same clinical parameters except IOPA were recorded in all the participants. On the third visit (after 6 months from the first visit), the blood sample was again collected for the evaluation of serum calcium and Vitamin D, and all the parameters of baseline were recorded. Result: The result of the study showed that Vitamin D levels at baseline were less in test subjects (12.73 ± 2.25) as compared to controls (17.81 ± 4.03), which improved at 6 months for the test group (24.53 ± 1.98) but not the control group (17.8 ± 4.14) following NSPT. All the clinical parameters improved for both groups. There was no statistically significant difference in the calcium levels of both groups at baseline or 6 months. Conclusion: Vitamin D levels were found to be lower in periodontitis patients than healthy controls, vitamin D levels improved in the test subjects along with the clinical parameters following NSPT highlighting the beneficial role of Vitamin D in maintaining periodontal health. No changes were seen in calcium levels in either of the groups at any point in time. Clinical significance: Vitamin D can reduce the incidence and severity of periodontal disease by its various anti-inflammatory and immunomodulatory effects in addition to its traditional role in bone metabolism. Thus, maintaining adequate levels of systemic vitamin D could be critical to periodontal health. This study justifies this notion and further suggests the adjunctive role of vitamin D supplementation to improve therapeutic outcomes.

Aim: This study aimed to evaluate and compare the color matching of OMNICHROMA (OM), a universal shade composite, to the well-established 3M Filtek Z350 composites (FT). Materials and methods: An in vitro experimental study was conducted on 80 freshly extracted permanent teeth, with intact buccal surfaces. The teeth were randomly assigned to four groups: Group I OM and groups II, III, and IV (3M Filtek Z350 in shades A3, A3.5, and B2, respectively). Class V cavity preparations were created and restored using the respective composites. Color matching was assessed instrumentally using a spectrophotometer to calculate the color difference (ΔE) values and visually by three trained observers using a standardized visual scoring system. Results: Visual assessments showed no significant differences in color matching across the four groups. However, the ΔE color matching analysis revealed significant differences (p < 0.0001), with OM exhibiting higher ΔE values compared to FT shades A3.5 and B2. No significant difference was found between OM and shade A3. Conclusion: OMNICHROMA demonstrated excellent visual color matching, comparable to the various shades of FT composites. Despite the higher ΔE values observed instrumentally in comparison to shades A3.5 and B2, OM's ability to blend with different tooth shades visually was highly effective. Clinical significance: These results suggest that OM offers a versatile and reliable option for achieving satisfactory esthetic outcomes, reducing the need for multiple shade variations in restorative procedures.

Aim: To compare the fracture resistance of anterior teeth restored with either glass fiber post (GFP) and conventional lithium disilicate (LDS) crowns or endocrowns made of LDS or hybrid ceramics. Materials and methods: A total of 21 central incisors with 2-mm ferrule and 1-mm shoulder finish line were applied in this investigation. The teeth were divided into three main groups (n = 7) according to the type of restoration used: PC glass fiber post (GFP) and e-max crown, EE (LDS endocrown), and VE (Vita-Enamic endocrown). Mechanical cyclic loading was conducted in a chewing simulator to simulate 6 months of clinical use. Fracture resistance and failure mode were assessed; further examination of fractured specimens was done with scanning electron microscopy. Results: Post-hoc Tukey's test was performed to investigate the pairwise differences in fracture resistance among the three groups, and the results were p = 0.0452 between PC and VE groups, which is significant statistically. In contrast, p = 0.0615 between PC and EE groups, which is not significantly different. Chi-square test was made to analyze the results of mode of failure among the three groups, and there was a significant difference; p-value = 0.0289. Conclusion: The LDS endocrowns show fracture resistance similar to that of GFP-supported full coverage LDS crowns, with advantage of more restorable mode of fractures. Vita-Enamic endocrowns, despite having fracture resistance lower than other groups, showed fracture resistance higher than the physiologic load, with restorable fractures more than both LDS endocrowns and GFP LDS crowns. Clinical significance: For dental practitioners, endocrowns in damaged anterior endodontically treated teeth provide similar fracture resistance to GFP and full crowns, with the advantage of more restorable fractures if occurred.

Aim and objective: To measure and contrast primary stability metrics, such as insertion torque values and implant stability quotient (IQS) at the time of implant placement, and secondary stability metrics, such as ISQ three months post-implant insertion, between implants inserted in osteotomy sites prepared with conventional drills and osseodensification drills (OD) in the femoral condyles of female New Zealand white rabbits, which are characterized by low-density D4 type bone. Materials and methods: Eight female New Zealand white strain rabbits, each 14 weeks old and weighing approximately 2.5 ± 0.3 kg, were utilized for this study. Using aseptic techniques and local anesthesia, a 3.1 × 8 mm implant was inserted into the rabbit's left femoral condyle using conventional drills (group I) from the Zimmer surgical kit. Similarly, using Densah drills (group II), a 3.1 mm × 8 mm implant was inserted into the rabbit's right femoral condyle. Primary implant stability was evaluated using insertional torque and ISQ values during insertion of implants using a torque wrench and radiofrequency analyzer, respectively. Secondary implant stability was evaluated by measuring ISQ values three months after implant placement. Results: Group I had a mean insertional torque of 31.13 ± 1.727 Ncm, while group II had 33.00 ± 1.309 Ncm. ISQ during insertion was 63.63 ± 5.927 in group I and 63.62 ± 7.615 in group II. After three months, ISQ was 67.25 ± 6.45 in group II and 75 ± 6.85 in group II. Significant differences were found in insertional torque (p = 0.028), ISQ after three months (p = 0.0353), and ISQ changes over time (p = 0.001), but not in ISQ at the time of implant placement. Conclusion: The investigation demonstrated that implants placed using the OD exhibited superior initial stability and subsequent stability progression compared to those placed using conventional drilling techniques in a rabbit model. Clinical significance: Primary and secondary implant stability are critical factors for successful implant treatment in clinical practice. Osseodensification demonstrates a higher insertional torque and implant stability quotient by enhancing bone density and volume surrounding implants. This enhanced stability can lead to improved osseointegration and reduced healing times, ultimately benefiting patients with compromised bone quality.

Aims: To determine the salivary level of glucose-6-phosphate dehydrogenase (G6PD) in subjects with normal appearing gingiva and periodontitis, and to compare the salivary levels of G6PD in all the study groups. Materials and methods: Unstimulated saliva (4 mL) was collected from 30 subjects; 15 periodontitis subjects and 15 control subjects. Later, saliva samples were subjected to RNA extraction via TRIzol method. The RNA was converted to complementary DNA, and quantitative real time polymerase chain reaction was set-up. Results: The expression of salivary G6PD in periodontitis subjects showed a significant increase when compared with control subjects, with a p-value of 0.001 (p > 0.05). Conclusion: In conclusion, the overall results show promise in future aspects of G6PD as a potential diagnostic as well as a prognostic marker. However, large-scale, multi-institutional, and large sample sized studies should be conducted to further find out the importance of G6PD in the diagnosis of periodontitis and its prognostic value. Clinical significance: The increase of G6PD levels in periodontitis subjects shows the increased oxidative stress, and this can be used for developing new noninvasive diagnostic procedures, developing novel treatment modalities, and also in assessing prognosis of treated cases of periodontitis.

Aim: Preservation of ridge dimensions is the important aspect after tooth extraction for prosthetic and implant rehabilitation. Titanium-platelet rich fibrin (T-PRF) is an autologous biomaterial, and when used with bone graft it could enhance the bone regeneration. Hence, the aim of this study was to evaluate the combined effect of T-PRF with nanocrystalline hydroxyapatite (Nano-HA) and T-PRF with demineralized bone matrix (DMBM). Materials and methods: Twenty systemically healthy patients were included in the study and were randomly assigned into two groups. Ten patients were treated with atraumatic extraction followed by ridge preservation using Nano-HA bone graft and T-PRF. In another group of ten patients, ridge preservation was done using a xenograft-DMBM. Preoperative cone beam computed tomography (CBCT) and postoperative CBCT after 3 months were evaluated for bone fill. The clinical parameters of ridge width (RW) and ridge height were measured clinically, with the help of UNC 15 probe, after 3 months. Results: The treatment modality resulted in significant bone fill in CBCT and adequate RW clinically in both the groups. The mean bone density in the Nano-HA + T-PRF group was recorded as 776.72 ± 223.94, and 854.72 ± 183.57 was observed in the DMBM + T-PRF group, after 14−16 weeks. Conclusion: The study's findings indicate that ridge preservation performed at the time of extraction is a reliable and predictable approach for minimizing alveolar bone resorption. Additionally, the combination of T-PRF with bone grafts yields effective results in a relatively short timeframe. Clinical significance: This technique involves combining osteoconductive material from Nano-HA and DMBM and the growth factor-rich matrix of T PRF for quicker healing and better esthetic and functional results. It reduces morbidity in patients, does not require an autogenous graft, is biocompatible, and is economical; therefore, both clinical practice and regenerative research in the field of dentistry are advanced. Hence, it is one of the important evidences through this original study.

Aim: Aim of this case report is to present an unfamiliar case of mandibular first molar with a C-shaped root having four canals. Background: Root canal system (RCS) is generally very complex, and it is always important for every practitioner who perform root canal treatment to have a knowledge of unusual variations in the root anatomy and root canal configuration, such as the C-shaped configuration. The frequency of C-shaped root canals is more common in mandibular second molars but very rare in mandibular first molars. Case description: A 28-year-old male patient presented with a history of spontaneous pain, intermittent in nature, in the right mandibular first molar region, for about 2 months. On clinical inspection, a large, carious lesion was noted distally in the mandibular first molar and was nonresponsive to percussion. A preoperative orthopantomograph (OPG) confirmed the involvement of pulp with widening of PDL space, and hence was diagnosed as symptomatic irreversible pulpitis with asymptomatic apical periodontitis. A nonsurgical endodontic treatment was planned. During access cavity preparation, four distinct orifices were located in the pulp chamber, which was not uncommon and hence, proceeded with obturation by the cold lateral compaction method and access cavity restoration with resin composite. Though the initial preoperative OPG or clinical examination of the access cavity did not reveal any significant morphological variation, on contrary, master-cone check radiograph had a different view from the common variation of the mandibular molar. Hence, postoperative cone beam computed tomography was conducted to verify the same, which revealed a C-shaped root with four canals, a rare morphological and unfamiliar variation of the mandibular first molar. Conclusion: An awareness and understanding of this unusual root and its root canal morphology can contribute to the successful outcome of root canal treatment. Clinical significance: Knowledge of root morphology and the configuration of the pulpal space play an important role in ensuring thorough debridement and the outcome of root canal treatment.