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• Visual aids impact on patients' expectations and satisfaction with orthodontic result. • Patients filled expectations inquiries before and after viewing the predicted outcome. • Patient satisfaction with the proposed and final changes was evaluated. • Expectations level was clinically similar before and after watching the prediction. • The final outcome was met with slightly more satisfaction than the predicted result. Investigating the possible changes in patients' expectations of and satisfaction with the orthodontic treatment outcomes when they were given the three-dimensional digital prediction of their teeth alignment before the beginning of treatment. A prospective non-controlled single-group clinical trial was conducted on 28 (18 females, 10 males, mean age: 20.68 ± 1.91 years) patients with Class I malocclusion and moderate dental crowding who required a nonextraction orthodontic treatment. Patients were given the expectations questionnaire on their first visit (T0). Then, patients were shown a three-dimensional digital setup–created by Orthoanalyzer software (3Shape, Copenhagen, Denmark)–of the proposed treatment results before orthodontic treatment (T1) and received two questionnaires, the second expectations questionnaire and the satisfaction with the proposed changes questionnaire. Treatment was then initiated using the fixed appliances and completed. After debonding, a question about patients' satisfaction with the achieved changes was completed (T2). Patients' expectations level significantly increased after watching the predicted alignment of teeth compared with the initial levels in terms of chewing (x ¯ = 5.54 and x ¯ = 6.71), speech (x ‾ =5.93 and x ¯ = 6.93), and oral hygiene improvement (x ‾ = 7.93 and x ¯ =8.61 ± 1.06; at T0 and T1, respectively). The remaining items showed no significant differences between the two assessment times. Patients had a higher level of satisfaction at the end of treatment than after watching the proposed outcome. There were significant statistical differences in the items related to teeth appearance (x ¯ = 9.12 and x ¯ = 9.60 at T1 and T2, respectively), and teeth engagement (x ¯ = 8.92 and x ¯ = 9.40 at T1 and T2, respectively) Watching the predicted alignment outcome increased patients' expectations of chewing, speech, and oral hygiene improvement compared with the initially recorded levels. Patients were more satisfied with the final result than what was recorded after viewing the predicted plan. However, these results were not clinically significant. [ABSTRACT FROM AUTHOR]

The aim of direct pulp capping (DPC) is to promote pulp healing and mineralized tissue barrier formation by placing a dental biomaterial directly over the exposed pulp. Successful application of this approach avoids the need for further and more extensive treatment. In order to ensure a complete pulp healing with the placement of restorative materials, a mineralized tissue barrier must form to protect the pulp from microbial invasion. The formation of mineralized tissue barrier can only be induced when there is a significant reduction in pulp inflammation and infection. Consequently, promoting the healing of pulp inflammation may provide a favorable therapeutic opportunity to maintain the sustainability of DPC treatment. Mineralized tissue formation was observed as the favorable reaction of exposed pulp tissue against a variety of dental biomaterials utilized for DPC. This observation reveals an intrinsic capacity of pulp tissue for healing. Therefore, this review focuses on the DPC and its healing procedure as well as the materials used for DPC treatment and their mechanisms of action to promote pulpal healing. In addition, the factors that can affect the healing process of DPC, clinical considerations and future perspective has been described. [ABSTRACT FROM AUTHOR]

Computer-aided design (CAD) of maxillofacial prostheses is a hardware-intensive process. The greater the mesh detail is, the more processing power is required from the computer. A reduction in mesh quality has been shown to reduce workload on computers, yet no reference value of reduction is present for intraoral prostheses that can be applied during the design. The purpose of this simulation study was to establish a reference percentage value that can be used to effectively reduce the size and polygons of the 3D mesh without drastically affecting the dimensions of the prosthesis itself. Fifteen different maxillary palatal defects were simulated on a dental cast and scanned to create 3D casts. Digital bulbs were fabricated from the casts. Conventional bulbs for the defects were fabricated, scanned, and compared with the digital bulb to serve as a control. The polygon parameters of digital bulbs were then reduced by different percentages (75%, 50%, 25%, 10%, 5%, and 1% of the original mesh) which created a total of 105 meshes across 7 mesh groups. The reduced mesh files were compared individually with the original design in an open-source point cloud comparison software program. The parameters of comparison used in this study were Hausdorff distance (HD), Dice similarity coefficient (DSC), and volume. The reduction in file size was directly proportional to the amount of mesh reduction. There were minute yet insignificant differences in volume (P >.05) across all mesh groups, with significant differences (P <.001) in HD. The differences were, however, only found with DB1. DSC showed a progressive dissimilarity until DB25 (0.17%), after which the increase was more prominent (0.46% to 4.02%). A reduction of up to 75% polygons (25% of the original mesh) was effectively carried out on simulated casts without substantially affecting the amount of similarity in volume and geometry. [ABSTRACT FROM AUTHOR]

The climate of tropical Southeast Asia includes high humidity and ultraviolet radiation that reduce the lifespan of silicone prostheses by inducing changes in their mechanical properties and color stability. Studies on the surface roughness (SR) and mechanical properties of different silicone elastomers (SEs) subjected to the natural tropical weather of Southeast Asia are lacking. The purpose of this in vitro study was to evaluate the SR, tensile strength (TS), and percentage elongation (% E) of different SEs subjected to outdoor weathering in the Malaysian climate. Type-II dumbbell-shaped specimens (N-120) (nonweathered=15, weathered=15) were made from 3 room-temperature vulcanized (A-2000, A-2006, and A-103) and 1 heat-temperature vulcanized (M-511) silicone (Factor II). For 6 months, weathered specimens were subjected to outdoor weathering inside a custom exposure rack. Simultaneously, the nonweathered specimens were kept in a dehumidifier. Subsequently, the SR was measured with a profilometer; TS and % E were measured by using a universal testing machine. Two-way ANOVA was used to compare the means of the tested properties of the nonweathered and weathered specimens, and pairwise comparison was carried out between the silicones (α=.05). After outdoor weathering, the SR, TS, and % E were adversely affected by weathering in the Malaysian environment. Among the silicone materials, A-2000 showed the least TS changes (2.51 MPa), while A-2006 demonstrated significant changes in percentage elongation after outdoor weathering (266.5%). M-511 exhibited the highest mean value (2.50 μm) for SR changes. In addition, A-103 SE showed statistically significant differences in most pairwise comparisons for all 3 dependent variables. Based on the evaluation of mechanical properties, A-103 can be suggested as a suitable silicone for maxillofacial prostheses fabricated for tropical climates. However, A-2000 can be a suitable alternative, although significant changes to surface roughness were detected after outdoor weathering. [ABSTRACT FROM AUTHOR]

Despite the ubiquitous use of N95 filtering facepiece respirators (N95 FFR), published literature on the topic remains scarce, especially in relation to dental professionals. This study assesses the impact of N95 FFRs on blood oxygen saturation and heart rate of dental health professionals while performing procedures requiring varying degrees of physical exertion in an aerosol-rich environment. A total of 51 participants, consisting of 43 men and eight women aged between 23 and 31 years were recruited into the study. All subjects were well-versed in wearing personal protective equipment (PPE). A clinical grade pulse oximeter was used with a clamp placed around the fingertip or the earlobe of the participant. The selection of N95 FFR was based on fit and leakage. All data were collected once from the same participants using a surgical mask as a control. Data were collected again from the same subjects after 1, 2, and 3 hours of use. There were significant differences in both oxygen saturation (SpO 2) and heart rate between the two groups after 1, 2, and 3 hours of wearing the respective masks. In healthy young individuals, wearing an N95 FFR for an extended period of time during clinical dental procedures reduced the SpO 2 level and increased the heart rate compared with a standard surgical mask. However, SpO 2 levels remained within a healthy range of more than 95%, and heart rate was within acceptable limits. [ABSTRACT FROM AUTHOR]

CBCT (cone beam computed tomography) analysis of condyle morphometry, to investigate the gender differences, symmetry and relationship with mandibular size. This is a retrospective study. 800 CBCT scan obtained for the measurement of condyle in anterior-posterior and medio-lateral aspect using OnDemand 3D software. Participants were Saudi nationals of age above 18 years. 395 Males and 405 Females with the mean age of 38.2 ± 10.5 years. Right and left anterior-posterior width and medio-lateral width of the condyle were measured. Condyles were not isolated on the CBCT for volume measurement. Mean right and anterior-posterior condyle width was 9.02 mm and 8.74 mm in males whereas in females it was 9.01 mm 8.69 mm respectively. For males mean medio-lateral width of the condyle in right and left side was 17.40 mm and 16.95 mm. For females, mean medio-lateral width of the condyle in right and left side was 17.14 mm and 16.93 mm. The prediction rate of gender was 57.2% for males and 53.3% for females. Statistically significant differences (p < 0.05) were found in the anterior–posterior and medio-lateral width of right and left condyles among males and females. Left anterior-posterior and medio-lateral width of average vs small mandible shows statistically significant difference (p < 0.05). Condyle morphometry is a weak predictor for gender. Irrespective of gender, right and left condyle are asymmetrical in relation to condyle morphometry of anterior-posterior and medio-lateral aspect. Left mandibular condyle morphometry is different in relation to the mandible size. [ABSTRACT FROM AUTHOR]

An artificial intelligence expert system called the Computational Formulation of Orthodontic referral Decisions (CFOD) was created in order to provide decision-making for orthodontic diagnosis and referral in the Emirates public oral healthcare system. Purpose: The study purposes were to validate and implement the CFOD system, and to quantify GP and pediatric dentist referral patterns to the orthodontist specialist before and after implementation of the CFOD system. Materials & Methods: The CFOD system was created using eight mandatory malocclusion variables and a technology and programming stack including PHP, Codelgniter, MySQL and WampServer. The CFOD system was implemented and clinical dentists were trained following validation by 15 experienced orthodontist experts. Pre- and post CFOD system orthodontic referral patterns were analyzed. Results: Seven of eight mandatory malocclusion variables (except crowding) were directly correlated (r = 1) with orthodontist expert evaluation which validated the CFOD system. A comparison of referral patterns of orthodontic patients before and after implementation and training of the CFOD system demonstrated a 10-fold increase for GP referrals and 2-fold for pediatric dentist referrals. Conclusions: An artificial intelligence expert system for orthodontic patient referral can improve the efficiency of a large public oral healthcare system such as found in the United Arab Emirates. [ABSTRACT FROM AUTHOR]

Introduction: This research aimed to investigate the effect of Nano-Bio Fusion Gingival Gel ([NBFG] NanoCureTech, Gangdong-gu, Seoul, Korea) as an aid along with oral hygiene advice and routine scaling in patients with malocclusion to control treatment-induced gingivitis and periodontitis in patients undergoing fixed orthodontic treatment.Methods: A split-mouth design, prospective analysis after application of NBFG in 32 subjects with fixed orthodontic treatment-induced gingivitis was conducted. Patients applied NBFG to their gingiva twice daily, after brushing, for 90 consecutive days. Outcomes measured included: the plaque index (PI), papillary bleeding gingival index (PBI), probing depth (PD), and clinical attachment loss using standard assessment. PI, PBI, PD, and clinical attachment loss were measured at baseline, on the seventh day of gel application, at the next visit at the orthodontic clinic (28th day), and after 90 days.Results: From baseline to the seventh day to the 90th day, the treatment group showed significant improvement in PI, PBI, and PD over time compared with the placebo group.Conclusions: NBFG showed positive clinical effects in patients undergoing fixed orthodontic treatment. Clinical outcomes were measured in a comparatively short period. [ABSTRACT FROM AUTHOR]

COVID-19 is a rapidly emerging infectious disease caused by the SARS-CoV-2 virus currently spreading throughout the world. To date, there are no specific drugs formulated for it, and researchers around the globe are racing against the clock to investigate potential drug candidates. The repurposing of existing drugs in the market represents an effective and economical strategy commonly utilized in such investigations. In this study, we used a multiple-sequence alignment approach for preliminary screening of commercially-available drugs on SARS-CoV sequences from the Kingdom of Saudi Arabia (KSA) isolates. The viral genomic sequences from KSA isolates were obtained from GISAID, an open access repository housing a wide variety of epidemic and pandemic virus data. A phylogenetic analysis of the present 164 sequences from the KSA provinces was carried out using the MEGA X software, which displayed high similarity (around 98%). The sequence was then analyzed using the VIGOR4 genome annotator to construct its genomic structure. Screening of existing drugs was carried out by mining data based on viral gene expressions from the ZINC database. A total of 73 hits were generated. The viral target orthologs were mapped to the SARS-CoV-2 KSA isolate sequence by multiple sequence alignment using CLUSTAL OMEGA, and a list of 29 orthologs with purchasable drug information was generated. The results showed that the SARS CoV replicase polyprotein 1a had the highest sequence similarity at 79.91%. Through ZINC data mining, tanshinones were found to have high binding affinities to this target. These compounds could be ideal candidates for SARS-CoV-2. Other matches ranged between 27 and 52%. The results of this study would serve as a significant endeavor towards drug discovery that would increase our chances of finding an effective treatment or prevention against COVID19. [ABSTRACT FROM AUTHOR]

To evaluate the rate of canine retraction, mesial movement of molar and pain perception in maxillary first premolar extraction patients with or without flapless cortical perforations (FCPs). Thirty adult patients with class II div I malocclusion were randomly allocated with the help of SPSS software to either perforation or conventional group for carrying out this randomized parallel group-controlled trial in 1:1 ratio. Maxillary first premolars were extracted and after canine retraction, distance between the tip of the canine and midpoint of incisal edge and the distance between the cervical midpoints on the height of contour of respective cinguli was measured. Also, mesial movement of molar and pain perception were assessed in both groups. Three bilateral cortical FCP of 1.5 mm diameter were made in the perforation group. Data were analyzed with the help of SPSS software with an intention-to-treat the FCP approach. Significant canine retraction in patients with FCP (mean retraction of 6.68 ± 0.60 [measured at crown tip level] and 5.97 ± 0.71 mm [measured at mid cervical level]) was revealed, while patients with conventional mechanics had mean retraction of 2.54 ± 0.49 and 2.33 ± 0.46 mm. Mesial movement of molar also showed significant difference (FCP = 0.48 ± 0.11 mm and Conventional = 0.65 ± 0.19 mm). Pain perception in control group was significantly lower in day 1 and 2. FCPs are an effective method of accelerating the rate of canine retractions by 2–3 fold of tooth movement, however, pain perception was high in day 1 and 2. [ABSTRACT FROM AUTHOR]

To inspect the human adult odontometrics by the assistance of 3D cone beam computerized tomography (CBCT) imaging in Saudi, Jordan and Egypt population. Data of this cross sectional study from 252 subject were analysed by 3D CBCT volumetric data in college of dentistry, Aljouf University, from December 2016 to May 2017. All measurements were done by 3D on demand software. The tooth size from 2nd molar to 2nd molar of maxillary and mandibular arch was measured. Independent t test and ANOVA were used to examine the differences between gender and among Arabic population (Saudi, Jordan and Egypt) on the all tooth size. Comparison between the right and left side odontometrics were significantly dissimilar in 9 out of 14 pairs (p < 0.05). The odontometrics of the 2nd molar to 2nd molar tooth of maxillary and mandibular arch between gender and among Saudi, Jordan and Egypt population were insignificant (p > 0.05). 3D CBCT imaging permits us to measure the tooth size effectively and accurately. Based on results, significant asymmetry was revealed in 9 out of 14 pairs in relation to side disparities. No significant differences in tooth size between gender and among races were found. CBCT can elevate the record keeping problem, human adult odontometrics for the analysis can be obtained directly from the digital image. [ABSTRACT FROM AUTHOR]

Abstract Background Recently quantitative evaluation of gingival zenith position was evaluated in different facial forms suggesting clinicians may need to evaluate patients facial form and then decide to distalise the Gingival Zenith position in relation to Vertical Bisected Midline (VBM). The aim of the study was to quantitatively evaluate the gingival zenith width in convex, concave and straight facial profiles for Saudi, Indian and Bangladeshi nationals. Materials/methods 114 subjects of each Saudi, Indian & Bangladeshi nationality were grouped into convex, concave and straight profile based on angle of convexity. Gingival zenith position (GZP) on #11 and #21 was evaluated on the scanned dental plaster model using CBCT. Inter and Intra group comparison was done using one-way ANOVA test. Results Mean GZP values ranged from 0.84 mm to 1.10 mm, 0.75 mm to 1.02 mm and 0.87 mm to 1.14 mm for Saudi, Indian and Bangladeshi subjects respectively. Statistically significant (p < 0.05) difference was observed in convex, concave and straight profile subjects of these nationalities. Conclusion GZP variation does exist in different facial profiles of Saudi, Indian & Bangladeshi nationalities with respect to central incisors. Clinical significance These findings help clinician to consider facial profile as important entity in designing the smile following restorative and prosthetic procedures such as crown lengthening, teeth selection, implant esthetics and laminates. [ABSTRACT FROM AUTHOR]

Background The analysis of skeletal relationships of jaws in the sagittal plane is of utmost importance in orthodontic diagnosis for which numerous lateral cephalometric analyses have emerged. None of the analyses is without flaws. Current study compares ANB, Wits appraisal, Beta angle, Yen angle and W angle for their validity and reliability in diagnosis of skeletal classes. Methods Pretreatment cephalograph of 209 orthodontic patients comprised of 92 males and 117 females were selected from orthodontic archives. Radiographs were traced for ANB, Wits appraisal, Beta angle, W angle and Yen angle measurements. Patients were divided into three skeletal classes i.e. class I, II and III based on measurements and incisor classification and profile recorded from their files. ANOVA was applied to check the validity of performed analyses and Cramer’s correlation was performed to find out the correlation between analyses and skeletal classes. Results All performed analyses showed statistically significant difference in the values for all three skeletal classes p < .05. All measured analyses were found equally reliable in diagnosis of skeletal discrepancies. Conclusion All five-skeletal cephalometric sagittal analyses are reliable and can be used in orthodontic diagnosis as alternative to each other. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the effect of low-level laser irradiation applied at 3-week intervals on orthodontic tooth movement and pain associated with orthodontic tooth movement using self-ligating brackets.Methods: Twenty-two patients (11 male, 11 female; mean age, 19.8 ± 3.1 years) with Angle Class II Division 1 malocclusion were recruited for this split-mouth clinical trial; they required extraction of maxillary first premolars bilaterally. After leveling and alignment with self-ligating brackets (SmartClip SL3; 3M Unitek, St Paul, Minn), a 150-g force was applied to retract the canines bilaterally using 6-mm nickel-titanium closed-coil springs on 0.019 x 0.025-in stainless steel archwires. A gallium-aluminum-arsenic diode laser (iLas; Biolase, Irvine, Calif) with a wavelength of 940 nm in a continuous mode (energy density, 7.5 J/cm2/point; diameter of optical fiber tip, 0.04 cm2) was applied at 5 points buccally and palatally around the canine roots on the experimental side; the other side was designated as the placebo. Laser irradiation was applied at baseline and then repeated after 3 weeks for 2 more consecutive follow-up visits. Questionnaires based on the numeric rating scale were given to the patients to record their pain intensity for 1 week. Impressions were made at each visit before the application of irradiation at baseline and the 3 visits. Models were scanned with a CAD/CAM scanner (Planmeca, Helsinki, Finland).Results: Canine retraction was significantly greater (1.60 ± 0.38 mm) on the experimental side compared with the placebo side (0.79 ± 0.35 mm) (P <0.05). Pain was significantly less on the experimental side only on the first day after application of LLLI and at the second visit (1.4 ± 0.82 and 1.4 ± 0.64) compared with the placebo sides (2.2 ± 0.41 and 2.4 ± 1.53).Conclusions: Low-level laser irradiation applied at 3-week intervals can accelerate orthodontic tooth movement and reduce the pain associated with it. [ABSTRACT FROM AUTHOR]

Objectives The purpose of the current study was to assess the treatment outcome of non-syndromic patients having complete unilateral cleft lip and palate (CUCLP) by using GOSLON index and to determine any association of pre and/or postnatal factors with the treatment outcome. Materials and methods One hundred and one sets of dental models of patients having CUCLP were assessed in this retrospective study. Five examiners that were blinded to case-specific information scored the dental models at two instances with an interval of two weeks to ensure memory bias elimination (5 × 101 × 2 = 1010 observations). Calibration courses were conducted prior to scoring and each examiner was provided with scoring sheets, pictures of GOSLON reference models and flowcharts explaining the scoring method. Results According to GOSLON index, a mean (SD) GOSLON score of 3.04 (1.25) was determined. Based on treatment outcome groups, 62 patients had favorable (grade 1, 2, and 3) and 39 cases had unfavorable (grade 4 and 5) treatment outcome. Chi-square tests revealed a significant association of gender ( P = 0.002), cheiloplasty ( P = 0.001) and palatoplasty ( P < 0.001) with the treatment outcome. These associations were further explored by entering five independent variables in the logistic regression models. Conclusions The current study found an intermediate treatment outcome of CUCLP cases using GOSLON index. Final logistic model showed that gender, cheiloplasty, and palatoplasty had significantly higher odds of influencing outcomes. Identification of these factors provides us an evidence of traditional and outdated surgical methods and encourages clinicians to adopt current techniques to improve treatment outcomes. This implementation will facilitate comparison between the traditional and current techniques of primary surgical repair. [ABSTRACT FROM AUTHOR]

Objectives This study is to evaluate the dental arch relationship and palatal morphology of unilateral cleft lip and palate patients by using EUROCRAN index, and to assess the factors that affect them using multivariate statistical analysis. Method A total of one hundred and seven patients from age five to twelve years old with non-syndromic unilateral cleft lip and palate were included in the study. These patients have received cheiloplasty and one stage palatoplasty surgery but yet to receive alveolar bone grafting procedure. Five assessors trained in the use of the EUROCRAN index underwent calibration exercise and ranked the dental arch relationships and palatal morphology of the patients' study models. For intra-rater agreement, the examiners scored the models twice, with two weeks interval in between sessions. Variable factors of the patients were collected and they included gender, site, type and, family history of unilateral cleft lip and palate; absence of lateral incisor on cleft side, cheiloplasty and palatoplasty technique used. Associations between various factors and dental arch relationships were assessed using logistic regression analysis. Result Dental arch relationship among unilateral cleft lip and palate in local population had relatively worse scoring than other parts of the world. Crude logistics regression analysis did not demonstrate any significant associations among the various socio-demographic factors, cheiloplasty and palatoplasty techniques used with the dental arch relationship outcome. Conclusions This study has limitations that might have affected the results, example: having multiple operators performing the surgeries and the inability to access the influence of underlying genetic predisposed cranio-facial variability. These may have substantial influence on the treatment outcome. The factors that can affect unilateral cleft lip and palate treatment outcome is multifactorial in nature and remained controversial in general. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to see the effect of a single dose of low-level laser therapy on spontaneous and chewing pain after the placement of elastomeric separators.Methods: Eighty-eight patients were randomly selected for this single-blind study. Elastomeric separators were placed mesial and distal to the permanent first molars in all quadrants. Both arches were divided into experimental and control sides. The experimental sides were treated with low-level laser therapy on 3 points on the buccal mucosa for 20 seconds each, with a 940-nm gallium-aluminum-arsenic diode laser on continuous mode and power set at 200 mW. The other side received placebo laser therapy without turning on the laser. A numeric rating scale was used to assess the intensity of spontaneous and chewing pain for the next 7 days. The independent sample t test and repeated-measures analysis of variance with the post hoc Tukey test was used to analyze the results.Results: Significant differences were found in spontaneous and chewing pain among both groups (P <0.05).Conclusions: A single dose of low-level laser therapy can be an efficient modality to reduce the postoperative pain associated with the placement of elastomeric separators. [ABSTRACT FROM AUTHOR]

The formation of white spot lesions (WSLs) around orthodontic brackets as a result of biofilm accumulation is a common complication of fixed orthodontic therapy. A systematic review and meta-analysis were conducted to assess the antibacterial efficacy and bond strength of silver nanoparticles (AgNPs) incorporated orthodontic bracket adhesive to prevent WSLs. An electronic search of English literature was performed using Dissertations and Theses Global, Web of Science, LILACS, Cochrane, Scopus, and MEDLINE/PubMed using predetermined inclusion criteria. Specific terms were utilized in searching from the inception of the respective database up to April 2021. After the search strategy was applied by a reviewer, the data was extracted and results were analyzed. The focused question was: "whether AgNPs containing orthodontic bracket adhesives are superior to non-modified orthodontic bracket adhesives in terms of antibacterial activity and shear bond strength for the prevention of WSLs around brackets." Ten articles were included and a meta-analysis was performed. The bacterial growth inhibition was assessed in 7/10 included studies. Out of them, 2 studies showed no bacterial growth inhibition zone adjacent to orthodontic bracket adhesives supplementing AgNPs, while 5 articles exhibited a significant microbial growth inhibition zone diameter against varying bacteria. Streptococcus mutans was the main bacteria considered by the included studies (n = 10). In the included studies, the mean SBS scores of control group adhesives ranged between 5.48 ± 1.98 MPa and 24.53 ± 4.1 MPa, while the mean SBS scores of experimental group adhesives ranged between 5.22 ± 1.16 MPa and 17.63 ± 3.2 MPa. Low risk of bias of the included articles was observed in the meta-analysis. Although, studies have confirmed that the incorporation of AgNPs into orthodontic adhesive enhances its antibacterial activity, however, a degree of heterogeneity was observed throughout the studies due to the deficit in the in vitro models standardized protocols. [ABSTRACT FROM AUTHOR]

White-eyed blowout fracture was first termed by Jordan et al. in individuals sustaining a blow to the periocular area and presenting with ocular symptoms, although with minimal soft tissue signs of trauma. It is often found in pure orbital floor blowout fractures among paediatric patients, and it could manifest as a linear or hinge-like trapdoor deformity. Unlike the more common open orbital blowout fractures with distinct diagnostic clinical signs, white-eyed blowout fractures are rarer and their diagnoses can be easily missed, subsequently costing an optimal time window for surgical intervention. This is critical as better outcomes are found with earlier release of entrapments. This report describes a case of a white-eyed blowout fracture in a 10-year-old child faced with its diagnostic challenges. The current literature review discusses the types of fracture pattern, signs and symptoms, mechanism of action, as well as timing of surgery. In view of the common complication of persistent diplopia, clinical pitfalls in achieving this diagnosis are emphasized to prevent any delay of treatment. Current literature evidences are weighted towards urgent surgical intervention, as positive outcomes are found to correlate with earlier release of entrapments. [ABSTRACT FROM AUTHOR]