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Background: Vitamin D has anti-inflammatory properties and the potential to increase the generation of antimicrobial peptides like cathelicidin and defensins that may have a good impact on oral health. Higher vitamin D consumption has also been linked to a reduced risk of periodontal disease progression. Hence, the primary objective of this study was to evaluate and compare the clinical and laboratory parameters of oral supplementation of vitamin D as an adjuvant to scaling and root planing and to assess the bone mineral density via qualitative ultrasound bone density scanner in chronic periodontitis patients. Methodology . This study included 40 patients with periodontitis categorized into 2 groups with twenty patients each, Group I comprising scaling and root planing (SRP) alone and Group II comprising SRP along with vitamin D supplementation. Plaque index, gingival index, probing pocket depth, and clinical attachment loss was measured as clinical parameters. Serum vitamin D levels were assessed before and after SRP at both baseline and 6 weeks., Results: The intergroup comparison of clinical parameters (PI, GI, PPD, and CAL) at 6 weeks for both the groups showed statistical significance. Intragroup comparison of clinical parameters from baseline to 6 weeks showed a statistically significant reduction in both groups. The mean bone mineral density level in both the control and test groups demonstrated a mean T score of -1.3 and -1.21, respectively. The mean vitamin D levels were 27.8460 and 28.1020 for the test and control groups, respectively, which was statistically insignificant ( p = 0.705) and those at six-week intervals improved to 31.3650 and 28.0240 which were statistically significant ( p ≤ 0.001)., Conclusion: It could be stated that a positive relationship exists between periodontitis and osteopenia which could aggravate periodontal destruction. All periodontitis cases should thus be evaluated for BMD and supplemented with vitamin D 3 in an appropriate dosage and time frame to treat both these diseases., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Shree Mohan Mishra et al.)

Telerehabilitation offers an alternative healthcare delivery remotely in a patient's environment at a lower cost, better accessibility, and equivalent quality to the standard approach. Several studies had examined the effectiveness of telerehabilitation inpatients with musculoskeletal disorders, and although there is evidence that it is at least equally effective as the standard care, the patient and rehabilitation professional satisfaction with the delivery method is not conclusive. A systematic review was conducted to study the patients' and rehabilitation professionals' satisfaction with telerehabilitation for musculoskeletal disorders. A search for relevant studies on 29 April 2021 was carried out in Medline/PubMed, Scopus, and Web of Science (WOS). The search terms included "telerehabilitation," AND "satisfaction" AND "musculoskeletal disorders," "telehealth," "telemedicine," "patient experience," and "pain". Fifteen eligible studies with 12,341 patients were included in this systematic review. A report was included if it (a) assessed the satisfaction of patients or professionals or both as one of the outcomes of a telerehabilitation intervention, (b) included adults 18 years and above with musculoskeletal disorders, and (c) is an intervention study using a quantitative approach. The quality of studies was assessed using the critical appraisal checklist tool developed by Joanna Briggs Institute (JBI). Most of the studies reported that patients were satisfied with both telerehabilitation and face-to-face intervention. However, few studies reported that patients were more satisfied with telerehabilitation compared to face-to-face of intervention. Patients in one study had preferred the incorporation of telerehabilitation and face-to-face sessions. Two of three studies had reported overall satisfaction with telerehabilitation by the professionals. Overall, there is evidence that patients and rehabilitation professional are satisfied with telerehabilitation compared to face-to-face consultation., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Junaid Amin et al.)

Objective: Teledentistry is considered to be a technological advancement in providing dental care to patients while effectively addressing the time management. Furthermore, the pandemic of COVID-19 has been here for quite long now, forcing the dental practitioners to ponder upon other methods of healthcare delivery apart from the traditional in-office direct clinical examination. The aim of this study was to explore the perceptions of dental professionals of Malaysia regarding teledentistry, which can act as a future pedestal for improvements in virtual dental practice and patient care., Materials and Methods: It was a descriptive, cross-sectional study involving an electronic survey of a sample of dental professionals of Malaysia. A prevalidated, 26-item, 5-point Likert-scale questionnaire was used in assessing the perceptions of dental professionals regarding teledentistry in four domains: existing concerns about teledentistry use, the potential of teledentistry in improving practice, usefulness of teledentistry for dental practice, and its usefulness for patients. Statistical analyses involved descriptive statistics which included frequency distributions., Results: An overall response rate of 31.0% was observed with 310 dental practitioners participating in the survey. More than 60% of respondents agreed that teledentistry would benefit the dental practice through enhancement of communication with peers, guidance, and new patients' referral. However, a substantial proportion of practitioners (70-80%) expressed uncertainty with accuracy of diagnosis, technical reliability, and privacy., Conclusion: Generally, the results of this study point towards the readiness of dental professionals of Malaysia to engage in teledentistry practice. However, further work needs to be done to assess the commercial feasibility of teledentistry, not only in Malaysia but also in other parts of the world. To start with, directed campaigns in reference to teledentistry are necessary to educate dentists and the public about the technology and its potential., Competing Interests: There is no conflict of interest to declare from any author., (Copyright © 2022 Romaisa A. Khokhar et al.)

Background: Work-related musculoskeletal disorders (WMSDs) have a negative impact on quality of life, and dentists are at risk of WMSDs due to the nature of work being static, repetitious, and for a long duration. The study was aimed at measuring the prevalence and distribution of work-related musculoskeletal disorders and determining the risk factors associated with affliction among Pakistani dentists., Methods: An online cross-sectional survey was conducted using a validated questionnaire consisting of four sections. The first section had questions related to sociodemographic information, the second section had questions that assessed the intensity and frequency of musculoskeletal pain (MSP), third section questions were concerned with the effect of MSP on the respondents' daily life, while the last section contained questions on whether they perceived their work in the dental clinic as a cause of their pain. Chi-square and one-way ANOVA tests were used for the analysis of the data in SPSS-23., Results: A total of 600 completely filled questionnaires were received with a response rate of 76.4%, and about 87% of the dental practitioners had some sort of MSD. The intensity and frequency of WMSDs were statistically significant ( p < 0.05) in association with all the sociodemographic characteristics. The lower back area was the most reported site of WMSD pain (51.3%) followed by the neck/upper back (21.3%) and shoulder (17.6%). The site of pain was statistically significant ( p < 0.05) in association with all the sociodemographic characteristics except gender ( p = 0.11). A majority of participants (95.4%) had sought medical treatment and taken sick leaves (70%) due to WMSDs pain during their life. Participants attributed a number of working years and working posture as the two main reasons behind WMSDs., Conclusion: Considering the high prevalence of WMSDs among dentists, preventive strategies that minimize the occurrence of WMSDs should be adopted by dental professionals. The impact of WMSDs can be reduced by maintaining good posture, taking breaks and rest in between work, doing regular exercise, and improving the work environment., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Usman Younis et al.)

Coronaviruses are a family of viruses that infect mammals and birds. Coronaviruses cause infections of the respiratory system in humans, which can be minor or fatal. A comparative transcriptomic analysis has been performed to establish essential profiles of the gene expression of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) linked to cystic fibrosis (CF). Transcriptomic studies have been carried out in relation to SARS-CoV-2 since a number of people have been diagnosed with CF. The recognition of differentially expressed genes demonstrated 8 concordant genes shared between the SARS-CoV-2 and CF. Extensive gene ontology analysis and the discovery of pathway enrichment demonstrated SARS-CoV-2 response to CF. The gene ontological terms and pathway enrichment mechanisms derived from this research may affect the production of successful drugs, especially for the people with the following disorder. Identification of TF-miRNA association network reveals the interconnection between TF genes and miRNAs, which may be effective to reveal the other influenced disease that occurs for SARS-CoV-2 to CF. The enrichment of pathways reveals SARS-CoV-2-associated CF mostly engaged with the type of innate immune system, Toll-like receptor signaling pathway, pantothenate and CoA biosynthesis, allograft rejection, graft-versus-host disease, intestinal immune network for IgA production, mineral absorption, autoimmune thyroid disease, legionellosis, viral myocarditis, inflammatory bowel disease (IBD), etc. The drug compound identification demonstrates that the drug targets of IMIQUIMOD and raloxifene are the most significant with the significant hub DEGs., Competing Interests: The authors declare they have no competing interests., (Copyright © 2022 Md. Tanvir Hasan et al.)

Aim: To investigate and compare the cell cytotoxicity, proliferation, cell attachment, and morphology of human fetal osteoblasts (hFOB) cells of coated samples (titanium nanocopper (Ti Cu), titanium nanohydroxyapatite (Ti HA) and titanium nanocopper ion doped hydroxyapatite (Ti Cu/HA) and uncoated samples (Ti) in order to assess the suitability of these surface modifications on Ti-6Al-7Nb for dental implant application., Materials and Methods: The cytotoxicity was studied by examining the hFOB cell response by MTT assessment. The cell morphology was evaluated by inverted microscopy and observed under scanning electronic microscopy (SEM)., Results: MTT assay results displayed that the Cu content on the surface of Ti-6Al-7Nb alloys did not produce any cytotoxic effect on cell viability. The cell viability rate in all samples ranges from 97% to 126%, indicating that hFOB cells grew at a high proliferation rate. However, no significant differences in cell viability were observed between Ti and Ti Cu and between Ti HA and Ti Cu/HA groups. Microscopic examination demonstrated no difference in the cell morphology of hFOB among all samples. In addition, SEM observation indicated favorable adhesion and spreading of the cells on the coated and uncoated samples., Conclusions: The surface modification of Ti-6Al-7Nb alloy with Cu, HA, and Cu/HA exhibits good cell biocompatibility, and the Cu has no influence on the cell proliferation and differentiation of hFOB., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Hanan Ali Hameed et al.)

Objective: This study was designed to determine the antioxidant activity of the extracts of beetroot by using beetroot energy drink and flavored milk (products). Material & Methods . This experimental trial was conducted at Jinnah University for Women, Pakistan, under the approval of local institutional review board number JUW/DFST/RCB010/2020. All the materials such as beetroot, carrot, cucumber, and lemon were obtained commercially from which two products were formulated: beetroot energy drink (sample1) and flavored milk (sample 2). These formulated products were evaluated for quality analysis (pH and brix), phytochemical screening using the Keller-Kiliani test, Salkowski's test, Alkaline reagent test, lead acetate test, ferric chloride test, protein test, quantitative test of phenol, antioxidant activity, sensory analysis, and shelf life study. The paired t -test was applied to detect significant differences between two samples., Results: The phytochemical analysis revealed that cardiac glycosides, phytosterol, flavonoids, and terpenoids were found in both energy booster drink (EBD) and flavored milk (FM) except phenolic compounds that were found only in EBD. The antioxidant capacity of beetroot juice was far greater than FM. The statistical sensorial analysis of FM and EBD reported a significant mean difference between most of the groups with p < 0.0001., Conclusion: This study concludes that energy drinks having beetroot indicated higher antioxidant capacity than flavored milk. The nutraceutical products (energy booster drink and flavored milk) containing beetroot are enriched with optimum quantities of proteins and fats and low carbohydrates at a stable pH with an adequate total energy content., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Seema Ashraf et al.)

Introduction: Triglycerides are lipids composed of fatty acids that provide energy to the cell. These compounds are delivered to the body's cells via lipoproteins found in the bloodstream. Increased blood triglyceride levels have been associated with high-fat or high-carbohydrate diets. Generally, increased triglyceride levels occur in conjunction with other symptoms that are difficult to notice and recognize., Objectives: The study's goal was to develop and predict the model that could be used to explain the relationship between triglycerides and waist circumference, high-density lipoprotein (HDL), and hypertension status by determining the relationship between triglycerides and waist circumference, HDL, and hypertension status. This model was developed using qualitative predictor variables and incorporated data bootstrapping multilayer perceptron neural networks and fuzzy linear regression. Materials and procedures . This was a public health study that combined retrospective data analysis with methodology development. The medical records of patients who attended outpatient clinics at Hospital Universiti Sains Malaysia (USM) were collected and analyzed. This was to provide a more extensive illustration of the methods developed. Screening and selection of patient data were necessary following the inclusion and exclusion criteria. The patient's medical record was used to obtain triglycerides, high-density lipoprotein (HDL), waist circumference, and hypertension status. Due to the critical nature of the variable, it was chosen to aid the clinical expert. The R-Studio software was used to develop the associated syntax for the hybrid model, which would define the association between the examined variables. The purpose of this study is to create a technique for the clinical trial design that utilizes bootstrapping, Qualitative Predictor Variables (QPV), Multiple Linear Regression (MLR), Artificial Neural Networks (ANNs), and Fuzzy Regression (FR). All analyses were performed using the newly introduced R syntax. The research developed a fuzzy linear model that increased modelling performance by incorporating clinically significant factors and validated variables via Multilayer Perceptron (MLP)., Conclusion: The proposed technique for modelling and prediction appeared to be the ideal combination of bootstrap, Multilayer Feed Forward (MLFF) neural network, and fuzzy linear regression. The created syntax is currently being evaluated and validated clinically. For modelling and prediction, the proposed technique looked to be the best, as it incorporated bootstrap, MLFF neural network, and fuzzy linear regression. The established syntax is now being utilized in the clinic to evaluate and validate the outcome. In terms of variable selection, modelling, and model validation, this strategy was superior to earlier approaches for fuzzy regression modelling., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Wan Muhamad Amir W Ahmad et al.)

Purpose: To determine the hardness and Young's moduli of both commercial and experimental vinyl poly siloxane (VPS)., Methods: The purpose of this study was to develop a medium-bodied experimental (Exp-I, II, III, IV, and V) VPS impression materials and to analyse their effects on hardness and Young's modulus and compare them with three commercial VPS materials (Aquasil, Elite, and Extrude) using Shore A hardness tester. Measurements were recorded after 1, 24, 72, and 168 hours of mixing. The results were analysed with one-way ANOVA and post hoc Tukey's test using the SPSS PASW statistical 22 software., Results: Commercial and experimental vinyl polysiloxane exhibited higher Shore A hardness values with time (i.e., 1 hour after mixing, 24 hours after mixing, 72 hours after mixing, and 1 week after mixing). All Comml and Exp VPS demonstrated a significant increase (ANOVA, p < 0.05) in hardness at increasing time points. Generally, all commercial VPS exhibited significantly higher values for Shore A hardness compared to all Exp formulations. For commercial products, Elt M presented significantly highest values at all-time points followed by Aq M then Extr M. Exp-I was significantly harder than all other Exp VPS at all-time points. Young's modulus values were directly related to Shore A hardness; materials with higher Shore A hardness values had higher Young's moduli., Conclusion: Continued polymerisation of elastomeric impression materials results in increased hardness over time. Hardness, Young's moduli, and rigidity of the set commercial and experimental VPS materials were within the required limits. Shore A hardness and Young's moduli were directly proportional to each other, and commercial and experimental materials had enough rigidity to contain the stone during pouring., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Shahab Ud Din et al.)

Objective: To analyze the width and height ratios of maxillary anterior teeth at different crown levels through photographs, 3D, and plaster dental model techniques in a subset of the Pakistani population. Material and Methods . This clinical study consisted of 230 participants. The maxillary impression, standardized photographs, and models were constructed for crown width and height analysis. The SPSS version 25 was used for statistical analysis. Descriptive statistics were carried out for mean, standard deviation, and percentage calculation of teeth width and height, gender, and age of participants. Paired t -test analysis was carried out to compare the dependent variables (teeth size, width, and height ratios) with independent variables (techniques applied, side disparity). A p value of ≤ 0.05 was considered statistically significant., Results: The mean width and height of maxillary anterior teeth obtained through photographs, 3D, and plater models were statistically different. The 3D dental model analysis showed reliable and accurate results. The mean width and height ratio of teeth were different on both sides of the arch. There was a significant difference ( p = 0.001) in crown width-height ratios at different crown levels., Conclusion: The width and height ratios in the studied population were different at various crown levels. The dimensions of teeth varied from the incisal to the cervical part of the crown. Hence, rather than relying on a single, fixed ratio of 78% to 80% suggested by researchers for anterior teeth, the clinician should adopt different crown width-height ratios to restore teeth with the optimum esthetic outcome., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Naseer Ahmed et al.)

Aim: The aim of the current study is to investigate the antioxidant and apoptotic potential of Ajwa date flesh (ADF) and Ajwa date pit (ADP) extract on human squamous cell carcinoma cell line (HSC-2)., Method: ADF and ADP were extracted with a solvent extraction method using hexane, acetone, and ethanol, which were then subjected to antioxidant assay by 2,2-diphenyl-1-picrylhydrazyl (DPPH). HSC-2 cells were then treated with different concentrations of ADF and ADP extract for 24, 48, and 72 hours. MTT assay was performed to assess the antiproliferative effect, and Annexin V-FITC was used for the detection of cellular apoptosis., Results: Acetone extracts of ADF and ADP had the highest radical scavenging and antioxidant activities followed by the ethanolic extracts, whereas ADP appeared to have significantly higher antioxidant effects than ADF. MTT assay demonstrated that acetone extracts of ADF and ADP were significantly cytotoxic against HSC-2 cells in a dose- and time-dependent manner. The half inhibitory concentration (IC50) of ADF was found to be 8.69 mg/ml at 24 h, and the maximum cell growth inhibition was observed at 50 mg/ml. The IC50 for the ADP was found to be 0.97 mg/ml at 24 h, and the maximum cell growth inhibition was observed at 5 mg/ml. Statistical analysis of the flow cytometry assay showed that the treatment with ADF and ADP extracts had a significant apoptotic effect which occurred in a dose-dependent manner. HSC-2 cells were seen in the late apoptotic stage with higher doses of ADF and ADP extract. ADP extract demonstrated higher apoptotic activity than ADF extract. In addition, combined treatment of ADF and ADP was also performed on HSC-2 cells which demonstrated higher apoptotic activity when compared to the single extract., Conclusion: Ajwa date fruit has a promising cytotoxic effect by inhibiting the growth and proliferation of OSCC cells and inducing cell death by apoptosis., Competing Interests: There are no conflicts of interest between the authors., (Copyright © 2022 Khushboo Shahbaz et al.)

Objective: To test the inter- and intraexaminer reliability of a recently developed instrument for measuring the maximum bite force (MBF). Material and Methods . Sixty patients who were clinically confirmed as having Oral Submucous Fibrosis (OSMF) and 60 healthy controls were included in this study. For each subject, age, gender, weight, height, and body mass index (BMI) were recorded. The maximum bite force was recorded in alternate order with a bite force sensor (D1) and an occlusal force meter (D2). Bite force was measured in the first molar region. Pearson's correlation coefficient and kappa statistic were applied to assess the reliability between D1 and D2 in the assessment of maximum bite force. The independent t -test was performed to find the statistical significance between the two study groups. The paired t -test was applied to find out the difference between the right and left disease in groups of two devices separately. The one-way analysis of covariance (ANOVA) was performed to find the significant difference between grades of OSMF., Results: The results of the kappa values were 0.8531 ± 0.0724 and 0.7336 ± 0.0737 for interdevice reliability in OSMF patients in right and left sides. Similar findings were obtained in right and left sides of healthy individuals (0.7549 ± 0.0816 and 0.9440 ± 0.0806) and in the total sample (0.8132 ± 0.0544 and 0.8303 ± 0.0538). Pearson's correlation coefficient between two devices revealed a high and significant positive correlation between D1 and D2 separately and in the whole sample., Conclusion: The observations of the present study suggest that the bite force sensor can be used as a reliable device for measuring bite force., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Santosh R. Patil et al.)

Background: The COVID-19 pandemic has made dentists very assiduous about cross-infection during dental treatment, thereby delaying dental radiographs for treatment. However, patients needing dental emergency treatment in the ongoing pandemic require relevant intra/extraoral dental radiography for adequate diagnosis and treatment planning., Methods: This article is aimed at adding to the hot debate: Is delay for intraoral radiographs justified or a possible proxy? As a narrative review, it provides an insight into the reasons for delaying intra-oral dental radiographs during in the pandemic and options of the nontraditional radiographic techniques available until the pandemic subsides. Discussion and Conclusion . Cross-contamination concerns through respiratory droplets grow while using intraoral film holders that stimulate gag reflex, coughing, saliva secretion, and if proper disinfection protocols are not applied. Since the patients' acquiring emergency dental treatment cannot be neglected, the return-to-work guidelines by the health regulatory bodies urge to prioritize extraoral radiographic imaging techniques to curb the infection, offering the best diagnostic efficacy. The dental professionals can consider cone-beam computed tomography (CBCT) scans and sectional dental panoramic radiographs (SDPRs), followed by a risk assessment for COVID-19, a safer modality in reducing cross-contamination and assuring an innocuous environment for both patient and coworkers., Competing Interests: The authors declare no conflict of interest for this article., (Copyright © 2022 Harneet Kaur et al.)

Esophageal carcinoma (EsC) is a member of the cancer group that occurs in the esophagus; globally, it is known as one of the fatal malignancies. In this study, we used gene expression analysis to identify molecular biomarkers to propose therapeutic targets for the development of novel drugs. We consider EsC associated four different microarray datasets from the gene expression omnibus database. Statistical analysis is performed using R language and identified a total of 1083 differentially expressed genes (DEGs) in which 380 are overexpressed and 703 are underexpressed. The functional study is performed with the identified DEGs to screen significant Gene Ontology (GO) terms and associated pathways using the Database for Annotation, Visualization, and Integrated Discovery repository (DAVID). The analysis revealed that the overexpressed DEGs are principally connected with the protein export, axon guidance pathway, and the downexpressed DEGs are principally connected with the L13a-mediated translational silencing of ceruloplasmin expression, formation of a pool of free 40S subunits pathway. The STRING database used to collect protein-protein interaction (PPI) network information and visualize it with the Cytoscape software. We found 10 hub genes from the PPI network considering three methods in which the interleukin 6 (IL6) gene is the top in all methods. From the PPI, we found that identified clusters are associated with the complex I biogenesis, ubiquitination and proteasome degradation, signaling by interleukins, and Notch-HLH transcription pathway. The identified biomarkers and pathways may play an important role in the future for developing drugs for the EsC., Competing Interests: All the authors have read the manuscript and approved this for submission as well as no competing interests., (Copyright © 2022 Md. Rakibul Islam et al.)

Failure of brackets is a common problem in orthodontics. This affects the treatment time, cost, and compliance of the patient. This study was conducted to estimate the bracket failure rate and the related factors for the long term. Methodology. This ambidirectional cohort study included 150 nonsyndromic orthodontic patients undergoing fixed appliance therapy for the last two years. The same patients were followed for 7 months. Different variables related to bracket failure were evaluated. The available data were analyzed descriptively, and the Kaplan-Meier estimate was used to measure the bracket survival rate from the date of bonding to failure. Results . A total of 180 bracket bond failures in the 150 included patients (52.2% males and 47.8% females) with a median age of 17 years (range 10-25 years). 69% of brackets failures were reported within the first 6 months after bonding. About 58.3% of bracket failure was noticed in adolescent patients before the age of 18 years. The majority of the cohort (81.1%) has good oral hygiene. The failure rate in patients with normal overbite was 41.1%, in decreased overbite cases was 15%, while in deep bite cases the failure rate was 43.9% with a statistically significant difference. Adults show less bracket failure (41.7%) than adolescent patients (58.3%). More bracket failure was noted in the lower arch (55%) than the upper arch (45%), and there were more bond failures posteriorly (61%) than on the anterior teeth (39%). Majority (41.1%) of the bracket failed on round NiTi wires. Conclusion . The bracket failure rate was 6.4%, with most bracket failure occurring in the first 6 months after bonding with individual difference. There was more incidence of bond failure in an increased overbite, adolescents, lower arch, posterior teeth, and lighter alignment wires., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2022 Haris Khan et al.)

DNA barcodes are regarded as hereditary succession codes that serve as a recognition marker to address several queries relating to the identification, classification, community ecology, and evolution of certain functional traits in organisms. The mitochondrial cytochrome c oxidase 1 ( CO1 ) gene as a DNA barcode is highly efficient for discriminating vertebrate and invertebrate animal species. Similarly, different specific markers are used for other organisms, including ribulose bisphosphate carboxylase ( rbcL ), maturase kinase ( matK ), transfer RNA-H and photosystem II D1-ApbsArabidopsis thaliana ( trnH - psbA ), and internal transcribed spacer (ITS) for plant species; 16S ribosomal RNA (16S rRNA), elongation factor Tu gene ( Tuf gene), and chaperonin for bacterial strains; and nuclear ITS for fungal strains. Nevertheless, the taxon coverage of reference sequences is far from complete for genus or species-level identification. Applying the next-generation sequencing approach to the parallel acquisition of DNA barcode sequences could greatly expand the potential for library preparation or accurate identification in biodiversity research. Overall, this review articulates on the DNA barcoding technology as applied to different organisms, its universality, applicability, and innovative approach to handling DNA-based species identification., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2022 Sarfraz Ahmed et al.)

Background: Medulloblastoma (MB) is the most occurring brain cancer that mostly happens in childhood age. This cancer starts in the cerebellum part of the brain. This study is designed to screen novel and significant biomarkers, which may perform as potential prognostic biomarkers and therapeutic targets in MB., Methods: A total of 103 MB-related samples from three gene expression profiles of GSE22139, GSE37418, and GSE86574 were downloaded from the Gene Expression Omnibus (GEO). Applying the limma package, all three datasets were analyzed, and 1065 mutual DEGs were identified including 408 overexpressed and 657 underexpressed with the minimum cut-off criteria of ∣log fold change | >1 and P < 0.05. The Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and WikiPathways enrichment analyses were executed to discover the internal functions of the mutual DEGs. The outcomes of enrichment analysis showed that the common DEGs were significantly connected with MB progression and development. The Search Tool for Retrieval of Interacting Genes (STRING) database was used to construct the interaction network, and the network was displayed using the Cytoscape tool and applying connectivity and stress value methods of cytoHubba plugin 35 hub genes were identified from the whole network., Results: Four key clusters were identified using the PEWCC 1.0 method. Additionally, the survival analysis of hub genes was brought out based on clinical information of 612 MB patients. This bioinformatics analysis may help to define the pathogenesis and originate new treatments for MB., Competing Interests: All the authors have read the manuscript and approved this for submission; also, there are no competing interests., (Copyright © 2022 Md. Rakibul Islam et al.)

Background: The risk of acquiring COVID-19 during a pandemic is a major concern among health care workers. Dental professionals being in close proximity to the patients had been exposed more than other health care workers. Hence, all the standard operating procedures (SOPs) are strictly advised to be followed., Methods: A detailed relevant literature search was conducted in international databases such as PubMed, Web of Science, and Science Direct, from January 2020 to November 2020. All the studies that provided recommendations regarding endodontic procedures during the COVID-19 pandemic were included, and those that were not in the English language, case reports, book chapters, and short communications were excluded in this review. In the end, only 6 articles were selected for the systematic review considering that complete information regarding the provision of dental care in the time of COVID-19 with diagnostic accuracy (STARD) was provided., Results: Endodontic treatments were restricted to only emergency dental procedures, and all other patients have advised medications and catered through teledentistry. Endodontic emergencies were advised to be carried out with minimal aerosol production procedures., Conclusion: Provision of endodontic care during COVID-19 restricted to only emergency dental procedures by strictly following standard operating procedures. A protocol for COVID-19 prevention was followed by all the dentists and the dental staff in the dental clinics., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2021 Farooq Ahmad Chaudhary et al.)

Background: Cancer is primarily caused by smoking, alcohol, betel quit, a series of genetic alterations, and epigenetic abnormalities in signaling pathways, which result in a variety of phenotypes that favor the development of OSCC. Oral squamous cell carcinoma (OSCC) is the most common type of oral cancer, accounting for 80-90% of all oral malignant neoplasms. Oral cancer is relatively common, and it is frequently curable when detected and treated early enough. The tumor-node-metastasis (TNM) staging system is used to determine patient prognosis; however, geographical inaccuracies frequently occur, affecting management., Objective: To determine the additional relationship between factors discovered by searching for sociodemographic and metastasis factors, as well as treatment outcomes, which could help improve the prediction of the survival rate in cancer patients. Material and Methods . A total of 56 patients were recruited from the ambulatory clinic at the Hospital Universiti Sains Malaysia (USM). In this retrospective study, advanced computational statistical modeling techniques were used to evaluate data descriptions of several variables such as treatment, age, and distant metastasis. The R-Studio software and syntax were used to implement and test the hazard ratio. The statistics for each sample were calculated using a combination model that included methods such as bootstrap and multiple linear regression (MLR)., Results: The statistical strategy showed R demonstrates that regression modeling outperforms an R-squared. It demonstrated that when data is partitioned into a training and testing dataset, the hybrid model technique performs better at predicting the outcome. The variable validation was determined using the well-established bootstrap-integrated MLR technique. In this case, three variables are considered: age, treatment, and distant metastases. It is important to note that three things affect the hazard ratio: age ( β 1 : -0.006423; p < 2 e - 16), treatment ( β 2 : -0.355389; p < 2 e - 16), and distant metastasis ( β 3 : -0.355389; p < 2 e - 16). There is a 0.003469102 MSE for the linear model in this scenario., Conclusion: In this study, a hybrid approach combining bootstrapping and multiple linear regression will be developed and extensively tested. The R syntax for this methodology was designed to ensure that the researcher completely understood the illustration. In this case, a hybrid model demonstrates how this critical conclusion enables us to better understand the utility and relative contribution of the hybrid method to the outcome. The statistical technique used in this study, R, demonstrates that regression modeling outperforms R-squared values of 0.9014 and 0.00882 for the predicted mean squared error, respectively. The conclusion of the study establishes the superiority of the hybrid model technique used in the study., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Wan Muhamad Amir W Ahmad et al.)

Background: Potential antibacterial substances, such as titanium dioxide (TiO 2 ), are being extensively studied throughout the research world. A modified hydrothermal nanotitania extraction was shown to inhibit Staphylococcus aureus growth in the laboratory. However, the toxicity effect of the extract on rats is unknown. In this study, we observed the effects of a modified hydrothermal nanotitania extraction on the skin and behavior of Sprague-Dawley rats., Methods: Sprague-Dawley ( Rattus norvegicus ) rats were used as the experimental animals. The skin around the dorsum of the tested animals was shaved and pasted with 0.1 mg and 0.5 mg of the nanotitania extraction. The color and condition of the pasted area and the behavior of the animals were observed., Results: 0.1 mg nanotitania extraction application on the dorsum of the rat produced no skin color changes at day 1, day 3, day 5, or day 7 postapplication. There were no changes in their behavior up to day 7 with no skin rashes or skin scratches seen or fur changes. However, 0.5 mg of nanotitania extraction resulted in redness and less fur regrowth at day 7., Conclusions: A 0.1 mg modified nanotitania extraction was observed to have no effect on the skin of Sprague-Dawley rats., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Ahmad Mukifza Harun et al.)

Introduction: Oral health is considered as one of the essential components of the overall health of every individual. Maintaining oral health is a gradual process that requires commitment. Children who require special care such as hearing impairment experience difficulty in maintaining oral health primarily due to communication difficulties. This study is aimed at using different interventions to evaluate the improvement of oral hygiene in hearing impaired children., Materials and Methods: Fifty-nine children were recruited in this study that were allocated randomly into each group with twenty children as follows: group 1: pictorial, group 2: video, and group 3: control. Mean plaque and gingival scores were noted before and after the use of different interventions. Oral hygiene was categorized as "excellent," "good," and "fair." Gingival health was categorized as "healthy," "mild gingivitis," and "moderate gingivitis.", Results: Thirty-four children (57.6%) were from 12-13 years of age bracket, and 25 (42.4%) belonged to 14-16 years of age. Regarding gender, there were 37 (62.7%) males and 22 (37.3%) females. About comparison of mean gingival and plaque scores before and after interventions in each group, a significant difference was found in group 1 ( p < 0.001) and group 2 ( p < 0.001), as compared to group 3 where the difference in scores was not significant ( p > 0.05)., Conclusion: Maintaining oral health requires the compliance of individuals to perform different methods of preventive dentistry, such as tooth brushing and use of dental floss. The use of different oral hygiene educational interventions such as pictorial and video methods have been proven and useful for hearing impaired children in improving oral health., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Maria Moin et al.)

Objective: The present study was aimed at assessing the impact of teledentistry, its application, and trends in uplifting dental practice and clinical care around the world. Material and Methods . The present observational study comprised of an electronic survey distributed among dental professionals around the globe. The validated survey form consisted of a total 26 questions with 5-point Likert scale response. The questionnaire used was divided into four domains: usefulness of teledentistry for patients, its usefulness in dental practice, its capacity to improve the existing practice, and the concerns attached to its use. The statistical analysis was performed using SPSS-25. ANOVA test was used to assess the effect of independent variables on dependent variables. A p value of ≤0.05 was taken as statistically significant., Results: A total of 506 dental professionals participated in the study with the response rate of 89.39%. More than half of the participants (50-75%) endorsed that teledentistry is a useful tool for improving clinical practice as well as patient care. Two-thirds of the participants (69.96%) considered that teledentistry would reduce cost for the dental practices. On the other hand, about 50-70% of dental professionals expressed their concerns regarding the security of the data and consent of patients. The most preferred communication tool for teledentistry was reported to be videoconference followed by phone. The majority of participants recommended the use of teledentistry in the specialty of oral medicine, operative dentistry, and periodontics. There was a significant difference between the age, experience of dentists, and their qualifications with domains of teledentistry., Conclusions: The overall impact of dental professionals towards teledentistry was positive with adequate willingness to incorporate this modality in their clinical practice. However, the perceived concerns pertaining to teledentistry are significant impediments towards its integration within the oral health system. An in-depth study of its business model and cost-benefit needs of time, especially in the context of developing countries, in order to avail the optimum benefits of teledentistry., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Afsheen Maqsood et al.)

Students have unique preferences when it comes to knowledge acquisition, information processing, retention in memory, and recall. This study is aimed at examining the preferred learning styles of medical and dental undergraduate students of Pakistan. It is also aimed at investigating the influence of gender, preclinical or clinical academic year, and academic record on the preferred learning style. A descriptive cross-sectional study was conducted in Pakistan. The learning styles of undergraduate students were identified using visual, aural, read/write, and kinesthetic (VARK) questionnaire. Students were also asked about their satisfaction towards teaching style of their teachers in institute. Descriptive statistics were done to characterize the learning styles of the students. The Fisher test and chi-square test were used to compare the learning preferences between genders and public/private sector students and among preclinical/clinical years. A p value of less than 0.05 was considered significant. A total of 1473 students participated in the study. Among the students, 39.37% preferred unimodal learning style whereas 60.62% preferred multimodal style. Kinesthetic (K) and visual (V) were the most preferred unimodal styles. The preferred learning styles of female students are aural (A), visual (V), and kinesthetic (K), whereas male students preferred visual (V) and kinesthetic more (K). Students with lower academic record chose unimodal styles in comparison to high achievers that chose multimodal styles. Students of clinical year preferred multimodal and quadmodal styles in comparison to preclinical year students. An alarming 78% of students were dissatisfied with their teacher's instructional style. Majority of students prefer multimodal learning styles over unimodal style. Gender, public/private sector, and academic record have influence on the preference of learning styles. Majority of the students are dissatisfied with their teacher's instructional style and rely on social media platforms for understanding. Academics need to adapt their teaching methods according to student preferences in order to get better graduates., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Ayesha Fahim et al.)

Dental caries is a multifactorial disease mainly caused by cariogenic bacteria commonly found in the oral cavity. Dental caries may cause demineralization of the tooth, cavitation, hypersensitivity, pulp inflammation, and even tooth loss if left untreated. Saliva secreted in the oral cavity can serve as a tool for identification of biomarkers for early detection of diseases. In the present study, differential expression of salivary proteins from 33 dental caries patients was compared with 10 control subjects. The unstimulated saliva was analyzed by 12% SDS-PAGE and two-dimensional gel electrophoresis. Gelatin and casein zymography was performed to check for protease activity. Also, salivary IgAs from both groups were compared by sandwich ELISA technique. Dental caries patient's saliva showed decreased caseinolytic and increased gelatinolytic activity probably due to metalloproteases and cathepsins. Mean salivary levels of sIgA were also significantly higher ( p < 0.018) in dental caries saliva samples. The 2D electrophoresis profile of both the groups showed regions on gel with visually detectable alterations in protein expression. The present study is among the few initial studies in the locality for identification of protein differences in saliva from dental caries patients and has demonstrated a good potential to identify alterations. However, a large population-based analysis is required to validate these findings to be translated as a tool for indicative applications., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2021 Zaid Majeed Khan et al.)

The current scenario of the COVID-19 pandemic has forced dentists to seek different options for delivering healthcare services other than the in-person direct examination in clinical practice. Teledentistry is one of the options for remote patient care and monitoring. Objective . The present survey was conducted to assess the knowledge and perception of the dentists in Pakistan regarding teledentistry as an emergent supportive tool. Materials and Methods . A self-administered, close-ended, and prevalidated survey questionnaire was used, comprising 21 questions, and distributed electronically via e-mail, WhatsApp, and Facebook Messenger to evaluate the knowledge and perception of dentists regarding teledentistry. The data collected was compiled in a systematic manner and analyzed in terms of frequency (yes/no). Results . Out of a total of 350 dentists, 325 responded to the questionnaire, and it was seen that 62.5% of them did not have knowledge about teledentistry prior to COVID-19. 65.8% of dentists considered the practice of teledentistry in nonpandemic situations in the future. Conclusion . In the present study, it was observed that most of the dental professionals had inadequate knowledge about teledentistry before COVID-19, but the awareness and perception regarding teledentistry were currently satisfactory among the dental professionals in Pakistan. This emerging trend gives a positive hope for the implementation of teledentistry in the healthcare setup of Pakistan in the near future, as it will prove to be beneficial for safe dental practice during times of pandemic and even after., Competing Interests: There is no conflict of interest from any author., (Copyright © 2021 Rootab Subhan et al.)

Objective: Analyzing and comparing the fit and accuracy of removable partial denture (RPDs) frameworks fabricated with CAD/CAM and rapid prototyping methods with conventional techniques., Materials and Methods: The present systematic review was carried out according to PRISMA guidelines. The search was carried out on PubMed/MEDLINE, Cochrane collaboration, Science direct, and Scopus scientific engines using selected MeSH keywords. The articles fulfilling the predefined selection criteria based on the fit and accuracy of removable partial denture (RPD) frameworks constructed from digital workflow (CAD/CAM; rapid prototyping) and conventional techniques were included., Results: Nine full-text articles comprising 6 in vitro and 3 in vivo studies were included in this review. The digital RPDs were fabricated in all articles by CAD/CAM selective laser sintering and selective laser melting techniques. The articles that have used CAD/CAM and rapid prototyping technique demonstrated better fit and accuracy as compared to the RPDs fabricated through conventional techniques. The least gaps between the framework and cast (41.677 ± 15.546  μ m) were found in RPDs constructed through digital CAD/CAM systems., Conclusion: A better accuracy was achieved using CAD/CAM and rapid prototyping techniques. The RPD frameworks fabricated by CAD/CAM and rapid prototyping techniques had clinically acceptable fit, superior precision, and better accuracy than conventionally fabricated RPD frameworks., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Naseer Ahmed et al.)

The objective of this study was to study the incidence of type of impaction of mandibular third molars based on the classifications of Pell and Gregory and Winter, which included angulation of the tooth and level of the occlusal surface of the third molar with respect to the second molar, respectively, in a sample of Saudi population in central region. In this retrospective study, orthopantomograms (OPGs) of 17760 patients were examined, who were reported by the Dental University Hospital (DUH) at King Saud University, Riyadh, Saudi Arabia, between the years 2016 and 2020. Out of 17760 radiographs, 2187 (12.31%) patients presented with at least one impacted third molar. Out of which, 1337 (7.52%) patients had bilateral impaction and 850 (4.78%) patients had unilateral impaction ( p < 0.001). No gender predominance was noted in the impaction status ( p > 0.05). In bilateral impaction, 671 were male (50.2%) and 666 were female (49.8%). Among unilateral impaction, 394 (46.4%) were male and 456 (53.6%) were female. Mesioangular angulation was the most common pattern of impaction (65%) followed by vertical angulation in both bilateral and unilateral impactions. Level A impaction was found to be highest in both bilateral and unilateral impactions which are 48.02% and 54.0%, respectively ( p < 0.05). Our study highlights mesioangular impaction and level "A" as the most frequently encountered angulation and level of impaction in impacted teeth. This study result provides us useful data regarding the radiographic status of mandibular third molars in the population of Saudi Arabia., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Mahmud Uz Zaman et al.)

The present study was aimed at reviewing the studies that used finite element analysis (FEA) to estimate the biomechanical stress arising in removable partial dentures (RPDs) and how to optimize it. A literature survey was conducted for the English full-text articles, which used only FEA to estimate the stress developed in RPDs from Jan 2000 to May 2021. In RPDs, the retaining and supporting structures are subjected to dynamic loads during insertion and removal of the prosthesis as well as during function. The majority of stresses in free-end saddle (FES) RPDs are concentrated in the shoulder of the clasp, the horizontal curvature of the gingival approaching clasp, and the part of the major connector next to terminal abutments. Clasps fabricated from flexible materials were beneficial to eliminate the stress in the abutment, while rigid materials were preferred for major connectors to eliminate the displacement of the prosthesis. In implant-assisted RPD, the implant receive the majority of the load, thereby reducing the stress on the abutment and reducing the displacement of the prosthesis. The amount of stress in the implant decreases with zero or minimal angulation, using long and wide implants, and when the implants are placed in the first molar area., Competing Interests: There are no conflicts of interest., (Copyright © 2021 Mohammed A. Mousa et al.)

Aim: This systematic review is aimed at investigating the biomechanical stress that develops in the maxillofacial prostheses (MFP) and supporting structures and methods to optimize it. Design and Methods . A literature survey was conducted for full-text English articles which used FEA to examine the stress developed in conventional and implant-assisted MFPs from January 2010 to December 2020., Results: 87 articles were screened to get an update on the desired information. 74 were excluded based on a complete screening, and finally, 13 articles were recruited for complete reviewing. Discussion . The MFP is subjected to stress, which is reflected in the form of compressive and tensile strengths. The stress is mainly concentrated the resection line and around the apices of roots of teeth next to the defect. Diversity of designs and techniques were introduced to optimize the stress distribution, such as modification of the clasp design, using materials with different mechanical properties for dentures base and retainer, use of dental (DI) and/or zygomatic implants (ZI), and free flap reconstruction before prosthetic rehabilitation., Conclusion: Using ZI in the defective side of the dentulous maxillary defect and defective and nondefective side of the edentulous maxillary defect was found more advantageous, in terms of compression and tensile stress and retention, when compared with DI and free flap reconstruction., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Mohammed A. Mousa et al.)

Introduction: In most disasters, teeth are the only means of positive identification of an otherwise unrecognizable body, as there has been tremendous increase in the use of dental restorations that have different resistance to prolonged high temperature which is an important aid in identifying burned victims. Application of SEM/EDS in forensics was found useful in areas where there is a need for good imaging with high magnification combined with elemental analysis. The objective of this study was to analyze incineration effects on teeth and restorative materials using SEM/EDS. Materials and Method . 128 extracted teeth were collected, 96 were restored with silver amalgam, composite, and GIC of 32 each, and crown preparation was done in 32 teeth for which metal ceramic crowns were prepared. These teeth were subjected to 4 different temperatures (500°C, 700°C, 900°C, and 1100°C) for 20 minutes, and they were analyzed macroscopically and by using SEM for the changes subsequent to their exposure to such high temperatures., Results: All the restorations which were very difficult to identify by naked eye were identified with the help of SEM/EDS., Conclusion: Elemental analysis of the specific restorative material proves to be an essential tool for the forensic odontologist., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 V. Yashoda et al.)

Objective: The objective of this systematic review was to investigate the quality and outcome of studies into artificial intelligence techniques, analysis, and effect in dentistry., Materials and Methods: Using the MeSH keywords: artificial intelligence (AI), dentistry, AI in dentistry, neural networks and dentistry, machine learning, AI dental imaging, and AI treatment recommendations and dentistry. Two investigators performed an electronic search in 5 databases: PubMed/MEDLINE (National Library of Medicine), Scopus (Elsevier), ScienceDirect databases (Elsevier), Web of Science (Clarivate Analytics), and the Cochrane Collaboration (Wiley). The English language articles reporting on AI in different dental specialties were screened for eligibility. Thirty-two full-text articles were selected and systematically analyzed according to a predefined inclusion criterion. These articles were analyzed as per a specific research question, and the relevant data based on article general characteristics, study and control groups, assessment methods, outcomes, and quality assessment were extracted., Results: The initial search identified 175 articles related to AI in dentistry based on the title and abstracts. The full text of 38 articles was assessed for eligibility to exclude studies not fulfilling the inclusion criteria. Six articles not related to AI in dentistry were excluded. Thirty-two articles were included in the systematic review. It was revealed that AI provides accurate patient management, dental diagnosis, prediction, and decision making. Artificial intelligence appeared as a reliable modality to enhance future implications in the various fields of dentistry, i.e., diagnostic dentistry, patient management, head and neck cancer, restorative dentistry, prosthetic dental sciences, orthodontics, radiology, and periodontics., Conclusion: The included studies describe that AI is a reliable tool to make dental care smooth, better, time-saving, and economical for practitioners. AI benefits them in fulfilling patient demand and expectations. The dentists can use AI to ensure quality treatment, better oral health care outcome, and achieve precision. AI can help to predict failures in clinical scenarios and depict reliable solutions. However, AI is increasing the scope of state-of-the-art models in dentistry but is still under development. Further studies are required to assess the clinical performance of AI techniques in dentistry., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Naseer Ahmed et al.)

Background: This paper reports the corrosion behavior of uncoated commercially pure titanium and Ti-6Al-4V samples and these coated with hydroxyapatite, partial stabilized zirconia (PSZ), and the mixture of partial stabilized zirconia and hydroxyl-apatite by measuring passivation current density and see if there are any differences between them using electrochemical polarization tests in 37°C Hank's solution., Materials and Methods: The electrophoretic deposition method (EPD) was elected to keep the coating materials which are HA, PSZ, and the mixture of 50% HA and 50% PSZ on Cp Ti and Ti-6Al-4V alloy samples. The electrochemical corrosion test was achieved by exposing the coated and uncoated samples to Hank's solution which prepared in the laboratory and measuring the polarization potential, passivation current density, and the open circuit potential for all samples., Results: The results indicated that the passivation current density for all Cp Ti and Ti-6Al-4V alloy groups that coated with HA, PSZ, and with mixture of 50/50 HA and PSZ was less than uncoated groups. There are no significant differences between all Cp Ti groups when compared with all Ti-6Al-4 V alloy groups. The open circuit potential (OCP) for both Cp Ti and Ti -6Al -4V samples was in the following sequence PSZ > HA > mixture of HA and PSZ > uncoated., Conclusions: Coating significantly decreased the passivation current density of Cp Ti and Ti-6Al-4V alloy., Competing Interests: The author(s) declare(s) that they have no conflicts of interest., (Copyright © 2021 Hanan Ali Hameed et al.)

Introduction: The determination of skeletal maturity stages is very important in orthodontic treatment planning, especially skeletal discrepancies in growing individuals. A hand-wrist radiograph is considered the most accurate approach for skeletal maturity detection. Dental calcification stages have been suggested as an alternative diagnostic method to decrease radiation exposure. The recent study is aimed at detecting the efficacy of dental calcification stages in assessing skeletal maturity during the prepubertal and pubertal growth periods., Methods: Patients' records were collected from the Aleppo Orthodontic Center. Dental maturity stages were assessed from a panoramic radiograph using the Demirjian method, while skeletal maturity stages were determined using the Björk method. Four permanent left mandibular teeth were included (canine, 1st premolar, 2nd premolar, and 2nd molar) for the study., Results: From 517 records, 295 records (145 males and 150 females) were included. The Spearman rank-order correlation coefficients between skeletal maturation and dental maturation were strong and statistically significant (ranging from 0.789 to 0.835). The highest correlation was between skeletal stages and the second molar ( r = 0.829 and 0.88 in males and females, respectively). Receiver operating characteristic (ROC ) curve suggested a high validity of the sum of dental stages for the four teeth in identifying MP3= stage (sensitivity was 70%, specificity was 92.77%, and ROC area was 0.81) but not for MP3cap (sensitivity was 50.85%, specificity was 81.36%, and ROC area was 0.66)., Conclusions: The correlation between the skeletal maturity stages and the dental calcification stages was high. The orthodontist can use the dental stages as a definite diagnostic tool for prepubertal growth period., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Ayah Jourieh et al.)

Introduction: Dental anxiety is a common occurrence in patients undergoing dental treatments, especially in children. The success in paedriatric dental treatments and patient comfort depends on controlling the level of patient's anxiety in clinical settings. This study is aimed at evaluating the efficacy of different techniques applied for the reduction of dental anxiety in paediatric patients. Material and Methods . One hundred and sixty participants were divided into 4 groups; each group having 40 patients as follows: group I: mobile application "little lovely dentist," group II: YouTube® "dental video songs," group III "tell-show-do," and group IV "control." Dental prophylaxis treatments were provided to all the participants. Initial anxiety levels were noted during the patient's education phase by measuring heart rate with pulse oximeter and distress level with facial image scale, at the same time in each group, respectively. The postoperative anxiety was noted later with the same methods, after the application of anxiety reduction techniques. The data obtained were entered in the statistical package for the social sciences software, version 25. One-way ANOVA and paired t -test for matched groups were used to compare mean values of the 4 groups, in this study to determine their effectiveness. A p value of ≤0.05 was considered as statistically significant., Results: The mean age of patients in group 1 was 6.8 ± 2.1 years, group 2: 8.15 ± 2.27 years, group 3: 7.5 ± 2.3 years, and group 4: 7.27 ± 1.68 years. The intragroup comparisons of heart rate and facial image scores have shown a significant difference in before and after dental treatment procedures. Marked reduction in heart rate and facial image scale scores were found in patients belonging to group 1 (mobile applications) and group 2 (dental video songs). An increase in heart rate and facial image scale scores was seen in group 3 (tell-show-do) and the control group., Conclusion: The paediatric dental anxiety is a common finding in dental clinics. Behavior modification techniques like smartphone applications, "little lovely dentist," and "dental songs" can alleviate dental anxiety experienced by paediatric patients. The "tell-show-do" technique although most commonly used did not prove to be beneficial in the reduction of the anxiety levels., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Hira Abbasi et al.)

Objective: To investigate the correlation of periodontal parameters and bite force in different stages of periodontitis after phase I periodontal therapy., Methods: Periodontal clinical parameters such as mobility, attachment loss, gingival recession, and percentage of bone remaining were recorded at the mandibular first molar region after phase I therapy in subjects categorized according to the stage of periodontitis. Corresponding bite force was recorded at the first mandibular molar region using a bite force device after phase I therapy. ANOVA test was used to assess the significant difference among different groups. Pearson correlation coefficient was used to assess the correlation between measured variables., Results: The ANOVA test represents that there is no statistical significant difference between the bite force in stage I, stage II, and stage III type of periodontitis. A strong positive correlation was found ( r = 0.537) between bite force and percentage of remaining alveolar bone support whereas negative correlation was observed in measured parameters such as mobility ( r = -0.0181), attachment loss ( r = -0.608), and gingival recession ( r = -0.435)., Conclusion: Among all periodontal clinical parameters, the percentage of remaining alveolar bone is the strong predictor of bite force and mobility; attachment loss and gingival recession cannot predict the bite force in the first molar region. Bite force is variable in different stages of periodontitis., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Hussain Nayef Hussain Alsharif et al.)

Objective: To compare the orthodontic bracket debonding force and assess the bracket failure pattern clinically between different teeth by a validated prototype debonding device. Materials and Method . Thirteen (13) patients at the end of comprehensive fixed orthodontic treatment, awaiting for bracket removal, were selected from the list. A total of 260 brackets from the central incisor to the second premolar in both jaws were debonded by a single clinician using a validated prototype debonding device equipped with a force sensitive resistor (FSR). Mean bracket debonding forces were specified to ten (10) groups of teeth. Following debonding, Intraoral microphotographs of the teeth were taken by the same clinician to assess the bracket failure pattern using a 4-point scale of adhesive remnant index (ARI). Statistical analysis included one-way ANOVA with post hoc Tukey HSD and independent sample t -test to compare in vivo bracket debonding force, Cohen's kappa ( κ ), and a nonparametric Kruskal-Wallis test for the reliability and the assessment of ARI scoring., Results: A significant difference ( p < 0.001) of mean debonding force was found between different types of teeth in vivo. Clinically, ARI scores were not significantly different ( p = 0.921) between different groups, but overall higher scores were predominant., Conclusion: Bracket debonding force should be measured on the same tooth from the same arch as the significant difference of mean debonding force exists between similar teeth of the upper and lower arches. The insignificant bracket failure pattern with higher ARI scores confirms less enamel damage irrespective of tooth types., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Tamzid Ahmed et al.)

The objective of this paper was to evaluate the existence of golden percentage in natural maxillary anterior teeth with the aid of 3D digital dental models and 2D photographs. And to propose regional values of golden percentage for restoration of maxillary anterior teeth. For this purpose, one hundred and ninety dentate subjects with sound maxillary anterior teeth were selected. Standardized frontal images were captured with DSLR, and the apparent width of maxillary anterior teeth was measured utilizing a software on a personal laptop computer. Once the dimensions were recorded, the calculations were made according to the golden percentage theory (GPT). The data were analyzed by independent and paired T -test. The level of significance was set at p < 0.05. The golden percentage values were not found in this study. The values obtained were 16%, 15%, 20%, 20%, 15%, and 16% moving from the right canine to the left canine teeth. There was no significant gender difference in the golden percentage values. Thus, golden percentage should not be used solely for the correction of anterior teeth or for determining dental attractiveness. Emphasis should be given to a range of dental proportion on regional basis., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Naseer Ahmed et al.)

Objectives: The aim of this retrospective study was to determine the position of the impacted maxillary canine (IMC) and then to inspect the frequency, location, and extent of the consequent root resorption (RR) of the adjacent teeth by using CBCT., Materials and Methods: Forty-one patients aged 12-68 who have 56 IMC detected on CBCT images were retrospectively examined in 3D. The canine position was determined by assessing the side of impaction, buccopalatal location, the distance of the canine cusp tip to the midline and to the occlusal plane, and canine angulation to the midline. RR of adjacent teeth was analyzed by investigating the nearest location of ectopic canine to adjacent teeth in horizontal and vertical dimensions in addition to measuring the degree of RR., Results: Twenty-seven (48.2%) impacted canines were on the right side, and 29 (51.8%) were on the left. Most of these teeth 31 (55.4%) were located palatally, while buccal impaction was seen in only 13 (23.2%) canines and 12 (21.4%) were located centrally. The mean distance of the ectopic canine cusp tip to the occlusal plane was significantly higher in males (14.4 mm) than in females (10.7 mm). RR was seen in 9 central incisors (31.03%) and 21 lateral incisors (41.17%) as well as one case in the first and second premolar. This RR was slight for all the adjacent central incisors and premolars., Conclusions: IMC is more frequent in females, palatally and apically. When left untreated, it may cause RR of some of the adjacent teeth with various degrees, however, with no gender preference., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Israa Hussein Ali et al.)

Objective: This study was focused on comparing and analyzing the soft tissue changes induced by Reverse Twin-Block (RTB) and Reverse Pull Face Mask (RPFM) in early and late mixed dentition Malay children having Class III malocclusion., Methods: This cross-sectional study includes a total sample of 95 Malay children of both early (8-9 years) and late (10-11 years) mixed dentition stages. The comparison was between 49 samples treated by RTB and 46 samples treated by RPFM. Both pre- and posttreatment changes were assessed with Holdaway's analysis using the CASSOS software. In each cephalogram, 71 anatomic landmarks were traced. Descriptive and multiple regression analyses were performed for statistical evaluation., Results: Statistically significant changes were noticed in soft tissue facial angle, subnasale to H-line, skeletal profile convexity, upper lip strain, H-line angle, lower lip to H-line, and inferior sulcus to H-line measurements. Gender disparity was noticed in upper lip strain. Other significant changes were influenced by the type of appliance. However, the mean differences were minute to notice clinically. Age difference did not have any effect on the treatment changes., Conclusions: RPFM revealed treatment outcome with more protruded upper lip than RTB., Competing Interests: No conflict of interest to declare., (Copyright © 2021 Nashid Fareen et al.)

The possibility of platelet-rich plasma (PRP) on the improvement of bone and adjacent tissue recovery has previously been validated. However, there is insufficient data supporting the use of platelet-rich plasma to improve the healing of bone and adjacent tissues around an implant in the oral cavity. The purpose of this randomized controlled trial was to observe the effect of platelet-rich plasma (PRP) concentrate on marginal bone loss and bone density around immediate implant placement using Cone Beam Computerized Tomography (CBCT). This clinical study was conducted over a period of six months on 12 subjects, who were equally categorized into two groups. Group I was the control, whereas the subjects in Group II received PRP therapy at the surgical site. All subjects were given a standard treatment with a single implant system (DIO UFII hybrid sandblasted acid-etched implants). Inserted implants were analyzed through CBCT, and records were registered at baseline, at the 12 th week before functional loading and the 26 th week after functional loading. The bone loss was calculated at the proximal (mesial and distal) side of the implant and bone density at baseline, 12 th week, and 26 th week after implant placement. SPSS version 23.0 was used for statistical analysis of data. The changes in bone levels were measured and compared between the two groups using the Mann-Whitney U test, with no significant difference. Bone density was analyzed by an independent sample t -test, p value ≤ 0.05 was considered statistically significant. Again, no significant difference in bone density was observed between both groups at all three instances. Therefore, it can be concluded that local injection of PRP after immediate implant placement did not show any decrease in marginal bone loss or improvement in bone density. This trial is registered with NCT04650763., Competing Interests: All researchers have no conflict of interest related to this study., (Copyright © 2021 Aleshba S. Khan et al.)

Objective: To investigate the role of implant surface debridement alone and in conjunction with systemic antibiotics on the clinical and microbiological variables of periimplantitis., Materials and Methods: Data of forty-six patients with at least one dental implant having bleeding-on-probing (BoP), probing pocket depth (PPD) of more than 5 mm, and radiographic bone loss of more than 3 mm were retrieved from clinical records. Data was recorded for dental implant with the deepest PPD, BoP, and bone loss from each patient. "Group-A" received implant surface debridement alone, while "group-B" additionally received systemic antibiotics. Clinical and microbiological data of patients were compared before and after the treatment., Results: At the implant level, a significant reduction of PPD, mucosal recession (MR), and BoP was achieved for all patients. Group B achieved significant improvement in MR and BoP compared to group A at implant level. PPD, MR, and plaque scores showed improvement at implant site level. At 3 months recall visit, 44% of group A and 52% of group B implants required surgical treatment. The presence and proportions of studied bacteria of both groups did not differ significantly at the recall visit when compared to the initial visit. However, P. intermedia and P. micros showed a significant reduction in group A at the recall visit., Conclusions: Implant surface debridement improved the clinical parameters of periimplantitis. In addition, adjunctive use of systemic antibiotics increased mucosal recession and improved bleeding on probing in periimplantitis., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Muhammad Irshad et al.)

This study aims to evaluate the effects of vital tooth bleaching with carbamide peroxide home bleaching and in-office bleaching on the color stability and 3D surface profile of dental restorative filling materials. Thirty discs (n = 30) measure 6 mm in diameter and 2 mm thick for each of three restorative materials. These are nanofilled composite Filtek Z350 XT, the submicron composite Estelite Σ Quick, and nanofilled glass ionomer Ketac N100 nanoionomer and were fabricated in shade A2. Each group was further divided into three subgroups (n = 10): subgroup A (Opalescence PF), subgroup B (Opalescence Boost in-office bleaching), and subgroup C (distilled water) serving as control. Samples were bleached according to the manufacturer's instructions for a period of two weeks. The Commission Internationale de L'Eclairage (CIE L(*), a(*), b(*)) system was chosen for image processing, while 3D surface profile was tested with atomic force microscopy (AFM). Statistical analyses were performed with the Mann-Whitney tests and Krusal-Wallis with a P value of ≤ 0.05. The three restorative materials showed significant color changes (ΔE); P ≤ 0.05. In diminishing order, the mean color changes recorded were Estelite Σ (3.82 ± 1.6) > Ketac Nano (2.97 ± 1.2) > Filtek Z350 XT (2.25 ± 1.0). However, none of the tested materials showed statistically significant changes in surface roughness; P > 0.05.

Objective: To evaluate various noninvasive and minimally invasive procedures for the enhancement of orthodontic tooth movement in animals., Materials and Methods: Literature was searched using NCBI (PubMed, PubMed Central, and PubMed Health), MedPilot (Medline, Catalogue ZB MED, Catalogue Medicine Health, and Excerpta Medica Database (EMBASE)), and Google Scholar from January 2009 till 31 December 2014. We included original articles related to noninvasive and minimally invasive procedures to enhance orthodontic tooth movement in animals. Extraction of data and quality assessments were carried out by two observers independently., Results: The total number of hits was 9195 out of which just 11 fulfilled the inclusion criteria. Nine articles were good and 5 articles were moderate in quality. Low level laser therapy (LLLT) was among the most common noninvasive techniques whereas flapless corticision using various instruments was among the commonest minimally invasive procedures to enhance velocity of tooth movement., Conclusions: LLLT, low intensity pulsed ultrasound (LIPUS), mechanical vibration, and flapless corticision are emerging noninvasive and minimally invasive techniques which need further researches to establish protocols to use them clinically with conviction.