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Abstract This split-mouth blinded randomized controlled study compared the efficacy of a desensitizing agent with oxalate/resin polymer and a universal adhesive containing mesoporous bioactive glass (MBG) for dentin hypersensitivity (DH) relief, using Schiff sensitivity score (SSS) and visual analog scale (VAS). Split quadrants containing teeth with DH were treated with either MS Coat ONE or Hi-Bond Universal with MBG as the functional additive. Assessments at baseline, immediately post-application, and at 1- and 2-week follow-ups used standardized stimulus protocols (air, cold, and acid). The SSS difference was the primary outcome, while the VAS difference was the secondary outcome. A mixed linear effect model performed statistical analysis. Immediate DH reduction occurred in response to air stimuli, with a significant decrease in Group HB than in Group MS (p = 0.0178). Cold stimulus reduction exhibited a gradual cumulative effect, with consistently greater reductions in Group HB than in Group MS (p ≤ 0.0377). Both groups effectively managed acidic stimuli, with no significant differences (p > 0.05). The VAS scores decreased gradually over the follow-up period (p

(1) Background: This study aimed to enhance the biological properties of hydraulic calcium silicate cements (HCSCs) by incorporating organic and inorganic components, specifically elastin-like polypeptides (ELPs) and bioactive glass (BAG). We focused on the effects of these composites on the viability, migration, and osteogenic differentiation of human periodontal ligament fibroblasts (hPDLFs). (2) Methods: Proroot MTA was supplemented with 1–5 wt% 63S BAG and 10 wt% ELP. The experimental groups contained various combinations of HSCS with ELP and BAG. Cell viability was assessed using an MTT assay, cell migration was evaluated using wound healing and transwell assays, and osteogenic activity was determined through Alizarin Red S staining and a gene expression analysis of osteogenic markers (ALP, RUNX-2, OCN, and Col1A2). (3) Results: The combination of ELP and BAG significantly enhanced the viability of hPDLFs with an optimal BAG concentration of 1–4%. Cell migration assays demonstrated faster migration rates in groups with 2–4% BAG and ELP incorporation. Osteogenic activity was the highest with 2–3% BAG incorporation with ELP, as evidenced by intense Alizarin Red S staining and the upregulation of osteogenic differentiation markers. (4) Conclusions: The incorporation of ELP (organic) and BAG (inorganic) into HCSC significantly enhances the viability, migration, and osteogenic differentiation of hPDLFs. These findings suggest that composite HCSC might support healing in destructed bone lesions in endodontics.

Abstract The 4-week double-blind clinical trial to manage dentin hypersensitivity (DH) using different desensitizing toothpastes was conducted. 53 participants with DH were enrolled in this trial. The participants were randomized into 3 groups: Group N; no active ingredient-containing toothpaste (Pleasia fluoride-free), Group SC; a toothpaste containing strontium chloride (Sensodyne Original), and Group TP; a toothpaste containing tricalcium phosphate (Vussen S). They were instructed to brush their teeth manually for 3 min, 3 times per day for 4 weeks with the allocated toothpastes, and were assessed at baseline (0), 2, and 4 weeks, respectively. Schiff sensitivity score was recorded to 3 different stimuli (air-blast, cold, and acid) at each assessment. Overall DH was also assessed using a visual analog scale (VAS). The longer participants used the toothpastes, the greater reduction in DH in all groups to the three stimuli. Group TP demonstrated significant reduction of DH compared to group N for air-blast and cold stimuli. Group TP showed significantly lower VAS than group N and SC. Tricalcium phosphate containing toothpaste used in this trial was most useful to reduce DH. It can be one of the treatment options that alleviate DH.

Minimally invasive surgery for the treatment of macroscopic cervical cancer leads to worse oncologic outcomes than with open surgery. Preoperative conization may mitigate the risk of surgical approach. Our objective was to describe the oncologic outcomes in cases of cervical cancer initially treated with conization, and subsequently found to have no residual cervical cancer after hysterectomy performed via open and minimally invasive approaches. This was a retrospective cohort study of surgically treated cervical cancer at 11 Canadian institutions from 2007 to 2017. Cases initially treated with cervical conization and subsequent hysterectomy, with no residual disease on hysterectomy specimen were included. They were subdivided according to minimally invasive (laparoscopic/robotic (MIS) or laparoscopically assisted vaginal/vaginal hysterectomy (LVH)), or abdominal (AH). Recurrence free survival (RFS) and overall survival (OS) were estimated using Kaplan–Meier analysis. Chi-square and log-rank tests were used to compare between cohorts. Within the total cohort, 238/1696 (14%) had no residual disease on hysterectomy specimen (122 MIS, 103 AH, and 13 VLH). The majority of cases in the cohort were FIGO 2018 stage IB1 (43.7%) and underwent a radical hysterectomy (81.9%). There was no statistical difference between stage, histology, and radical vs simple hysterectomy between the abdominal and minimally invasive groups. There were no significant differences in RFS (5-year: MIS/LVH 97.7%, AH 95.8%, p = 0.23) or OS (5-year: MIS/VLH 98.9%, AH 97.4%, p = 0.10), although event-rates were low. There were only two recurrences. In this large study including only patients with no residual cervical cancer on hysterectomy specimen, no significant differences in survival were seen by surgical approach. This may be due to the small number of events or due to no actual difference between the groups. Further studies are warranted.

Abstract Background Recently, various kinds of heat-treated nickel-titanium (NiTi) glide path instruments have been manufactured. This study aimed to investigate design, phase transformation behavior, mechanical properties of TruNatomy Glider (#17/02), V Taper 2H (#14/03), and HyFlex EDM (#15/03) and compare torque/force generated during simulated glide path preparation with them. Methods The designs and phase-transformation behaviors of the instruments were examined via scanning electron microscopy (n = 3) and differential scanning calorimetry (n = 2). Their bending (n = 15), torsional (n = 15), and cyclic fatigue resistances (n = 15) were tested. The ultimate strength and distortion angle were obtained from torsional resistance test. The number of cycles to failure (NCF) was calculated from cyclic fatigue resistance test. The preparation of the glide path was simulated using a double-curved artificial canal (n = 15), and the maximum torque and screw-in forces were measured. Data except NCF was compared between brands with one-way ANOVA with Tukey’s honestly significant difference test. NCF was analyzed via Kruskal–Wallis and Mann–Whitney U tests. Results TruNatomy Glider had the greatest number of threads. TruNatomy Glider showed progressive taper, while V Taper 2H and HyFlex EDM had constant taper. The austenitic transformation-finish temperatures of all the instruments were above body temperature. V Taper 2H demonstrated significantly lower ultimate strength, higher distortion angle, and a higher number of cycles to failure compared with HyFlex EDM and TruNatomy Glider (p

The characteristics of 3-dimensional (3D) cultured periodontal ligament stem cells derived from permanent teeth (pPDLSCs) and supernumerary teeth (sPDLSCs) were compared and evaluated in this study. pPDLSCs and sPDLSCs were cultured in an ultra-low attachment 6-well plate, and the changes in morphology and size were observed under an optical microscope for 14 days. Cell counting kit-8 was used to quantitatively evaluate cell viability, and a live/dead assay was performed for the qualitative assessment. The degrees of osteogenic, chondrogenic, and adipogenic differentiation of pPDLSCs and sPDLSCs were also assessed. The pPDLSCs and sPDLSCs were initially spherical, and sPDLSCs were smaller than pPDLSCs. The viability of pPDLSCs decreased by 47.9% (day 3) and 10.4% (day 7), whereas that of sPDLSCs decreased by 34.3% (day 3) and 2.5% (day 7) compared to the percentage on Day 1. No significant difference in osteogenic differentiation was found (p = 0.94); however, significant differences in adipocyte and cartilage differentiation were observed (p = 0.003 and p = 0.013, respectively). Within the limitations of this study, sPDLSCs and pPDLSCs exhibited multilineage differentiation capacities, including osteogenic, chondrogenic, and adipogenic differentiation, in 3D culture. Overall, pPDLSCs should be further investigated as a source of stem cells for tissue engineering and regenerative medicine.

Abstract Background The addition of bioactive glass (BG), a highly bioactive material with remineralization potential, might improve the drawback of weakening property of mineral trioxide aggregates (MTA) when it encounters with body fluid. This study aims to evaluate the effect of BG addition on physical properties of MTA. Methods ProRoot (MTA), and MTA with various concentrations of BG (1, 2, 5 and 10% BG/MTA) were prepared. Simulated body fluid (SBF) was used to investigate the effect of the storage solution on dentin remineralization. Prepared specimens were examined as following; the push-out bond strength to dentin, compressive strength, setting time solubility and X-ray diffraction (XRD) analysis. Results The 2% BG/MTA showed higher push-out bond strengths than control group after 7 days of SBF storage. The 2% BG/MTA exhibited the highest compressive strength. Setting times were reduced in the 1 and 2% BG/MTA groups, and solubility of all experimental groups were clinically acceptable. In all groups, precipitates were observed in dentinal tubules via SEM. XRD showed the increased hydroxyapatite peaks in the 2, 5 and 10% BG/MTA groups. Conclusion It was verified that the BG-added MTA increased dentin push-out bond strength and compressive strength under SBF storage. The addition of BG did not negatively affect the MTA maturation reaction; it increased the amount of hydroxyapatite during SBF maturation.

Germanium (Ge) has potential as a dopant suitable for the hematite-based photoelectrochemical water splitting system. Here, the authors report the fabrication of Ge doped porous hematite and demonstrate an efficient tandem system of Ge doped porous hematite and the perovskite solar cell.

Abstract Although mineral trioxide aggregates (MTA) have been adopted as an endodontic sealer because of excellent sealing effect and bioactive property and been modified with improvement of its characteristics, the developed MTA sealers have not yet satisfied all the ideal requirements of endodontic sealers. The aim of this study was to assess the characteristics of elastin-like polypeptide (ELP)-incorporated MTA for use as an endodontic sealer and compare them with those of commercial MTA sealers. Two commercial MTA sealers and three experimental ELP-incorporated MTA sealers with 0.3, 0.4, and 0.5 liquid/powder (L/P) ratio for 10 wt% ELP liquid were evaluated. The push-out bond strength, flow rate, sealer penetrability and wash-out resistance were tested and the sealer-dentin interface was observed using a scanning electron microscope (SEM). Our study revealed the ELP-incorporated MTA sealer, especially in 0.4 L/P ratio, exhibited the higher push-out bond strength and flow rate (P

The aim of this study is to explore the policy considerations that should be taken into account regarding the practical introduction of affirmative action policies in the field of education. For this purpose, we analysed the 100 most relevant YouTube videos produced between 2015 and 2023 using network analysis, the aim being to utilize the material they provide on affirmative action so as to reflect this in future education policies. As a result, nine key policy considerations that should be considered when introducing affirmative action policies in the field of education were derived. [ABSTRACT FROM AUTHOR]

Abstract Control of blood clotting in root canal systems is one of the most critical and difficult concerns for regenerative endodontics therapy (RET). The purpose of this study was to investigate the effects of using gelatin- and fibrin-based hemostatic hydrogels as a scaffold on pulp regeneration in a minipig model. Cell viability of human dental pulp stem cells cultured three-dimensionally in gelatin-based and fibrin-based scaffolds was evaluated by MTT and live/dead assay. RET was performed on 24 immature premolars with an autologous blood clot (PC), gelatin-based and fibrin-based hemostatic matrices (GM and FM), or without the insertion of a scaffold (NC). The follow-up period was 12 weeks. Radiographic and histologic assessments for pulp regeneration were performed. Gelatin-based scaffolds exhibited significantly higher cell viability than fibrin-based scaffolds after 15 days (P

Abstract We report a wire-shaped three-dimensional (3D)-hybrid supercapacitor with high volumetric capacitance and high energy density due to an interconnected 3D-configuration of the electrode allowing for large number of electrochemical active sites, easy access of electrolyte ions, and facile charge transport for flexible wearable applications. The interconnected and compact electrode delivers a high volumetric capacitance (gravimetric capacitance) of 73 F cm−3 (2446 F g−1), excellent rate capability, and cycle stability. The 3D-nickel cobalt-layered double hydroxide onto 3D-nickel wire (NiCo LDH/3D-Ni)//the 3D-manganese oxide onto 3D-nickel wire (Mn3O4/3D-Ni) hybrid supercapacitor exhibits energy density of 153.3 Wh kg−1 and power density of 8810 W kg−1. The red light-emitting diode powered by the as-prepared hybrid supercapacitor can operate for 80 min after being charged for tens of seconds and exhibit excellent electrochemical stability under various deformation conditions. The results verify that such wire-shaped 3D-hybrid supercapacitors are promising alternatives for batteries with long charge–discharge times, for smart wearable and implantable devices.

Xanthones are secondary metabolites isolated from the peel of mangosteen showing medicinal potencies. Alpha-mangostin (α-MG) is the most plentiful xanthone, which has been reported to possess anti-inflammatory, anti-oxidant, and anti-bacterial activities. We aimed to investigate the anti-inflammatory effects of xanthones on LPS-treated hDPCs. Cell viability was determined using the WST-1 assay. The mRNA and protein expression profiles of inflammatory mediators were evaluated using quantitative real-time polymerase chain reaction (qPCR) and Western blot analysis. Anti-inflammatory effects were assessed using the Western blot analysis to examine underlying mechanisms. A one-way analysis of variance followed by Tukey’s post hoc test was used to determine statistically significant differences (p < 0.05). The study found no significant differences between the cytotoxic effects in the α-MG-treated groups and controls. The mRNA and protein expression levels of inflammatory markers in the α-MG treated groups decreased. α-MG significantly inhibited LPS-induced phosphorylation of proteins associated with the MAPK and NF-κB pathways. This study suggests that α-MG exerts anti-inflammatory effects by suppressing the MAPK and NF-κB signaling pathways in LPS-treated hDPCs.

Background/purpose: Matrix metalloproteinases (MMPs) play a crucial role in the pathogenesis of dental caries, collapse of adhesive interface, and chemical erosion of teeth. The objective of this study was to investigate the inhibitory effect of zinc on collagen degradation. Materials and methods: Human dentin was ground and demineralized by citric acid (pH 2.0). The demineralized ground dentin was incubated in six different media: artificial saliva (AS); 5 mg/ml doxycycline in AS; 3.33, 6.82, 13.63, and 27.26 mg/ml of zinc chloride (Zn) in AS. Each group was divided into two subgroups, and active MMP-2 was incorporated into one subgroup. Specimens were incubated for 24 h, 1 week, and 2 weeks. Collagen degradation product was assessed using ELISA. The results were analyzed using repeated measured ANOVA and Duncan's post hoc analysis (α = 0.05). Results: The amount of collagen degradation was the lowest in Doxy group. Zn groups showed a significant inhibitory effect in collagen degradation for all concentrations (P

Heart disease: A key enzyme for healthy contraction Enhancing activity of an enzyme that promotes healthy heart contraction could benefit patients at risk of serious heart conditions. Chronic high blood pressure can cause excessive thickening of heart muscle tissue, reducing the heart’s ability to contract correctly and leading to heart failure. A healthy heart fuels itself by oxidizing fatty acids to trigger production of the key energy transfer molecule ATP. Yin Hua Zhang and In-Gyu Kim at Seoul National University College of Medicine, Korea and co-workers have highlighted how S-nitrosylation, addition of nitric oxide, affects transglutaminase 2 (TG2), an enzyme that promotes ATP production. Experiments on rats and mice showed that fatty acids activate TG2, increasing ATP production and maintaining contractibility in healthy hearts. However, in pressure-overloaded hearts, TG2 activity is inhibited by S-nitrosylation, which stops heart muscle cells contracting properly.

Abstract Calcium phosphate cements (CPCs) are synthetic bioactive cements widely used as hard tissue substitutes. Critical limitations of use include their poor mechanical properties and poor anti-washout behaviour. To address those limitations, we combined CPC with genetically engineered elastin-like polypeptides (ELPs). We investigated the effect of the ELPs on the physical properties and biocompatibility of CPC by testing ELP/CPC composites with various liquid/powder ratios. Our results show that the addition of ELPs improved the mechanical properties of the CPC, including the microhardness, compressive strength, and washout resistance. The biocompatibility of ELP/CPC composites was also comparable to that of the CPC alone. However, supplementing CPC with ELPs functionalized with octaglutamate as a hydroxyapatite binding peptide increased the setting time of the cement. With further design and modification of our biomolecules and composites, our research will lead to products with diverse applications in biology and medicine.

Three-dimensionally (3D) cultured dental pulp stem cells (DPSCs) reportedly exhibit superior multi-lineage differentiation capacities and have a higher expression in regeneration-related gene categories compared to conventionally cultured DPSCs. This study aimed to evaluate the effects of various mineral trioxide aggregates (MTAs) on DPSCs cultured in 3D, assessing their cell viability and tissue mineralization properties. We examined the morphology, cell viability, alkaline phosphate (ALP) activity and qualitative alizarin red S staining assay of the DPSCs that reacted with various MTAs, which included ProRoot (PRM), Biodentine (BIO), and Well-Root PT (WRP), in two different culture plates, an ultra-low attachment plate (ULA) and a conventional monolayer plate (2D). As a control, MTA-free and IRM samples were prepared. None of the MTA groups affected the microsphere-forming characteristics of DPSCs that had been cultured in ULA. The DPSCs that were cultured in ULA showed high cell viability in all MTA groups compared to IRM. The mineralization potential was favorable in all MTA groups, with a significantly higher ALP activity among the DPSCs that were cultured in ULA. Among MTAs, the PRM group showed substantially higher ALP activity than the other MTA groups. In conclusion, our results indicate that 3D-cultured DPSCs with various MTAs showed comparable viability and mineralization capacity similar to those cultured without reacting with MTA cement.

The aim of this study is to derive the important factors that influence levels of happiness in Korea, and to identify which factors are particularly important among these influencing factors. To achieve this goal, topic modelling analysis, machine learning analysis and neural network analysis methods were utilized. The Netminer 4.5 program was used for topic modelling analysis and machine learning analysis, and SPSS MODELER 18 was used to perform neural network analysis. Two types of analysis data were used in this study. The first consisted of 1 000 papers relating to happiness published in academic journals managed by the Springer publishing company, which were used to derive happiness-influencing factors. The second consisted of a survey conducted in 2020 by the Community Well-being Center of the Graduate School of Public Administration at Seoul National University in Korea. A total of 16 655 people responded to this survey. The analysis results of the study are as follows. Important variables that affect the level of happiness of Korean residents are: family life, social status, income, health, and perceptions of inequality. Analysis using neural network analysis of the most important factors influencing happiness showed that satisfaction with family life had the most important influence. This suggests that policies that can improve the quality of family life, such as family-friendly work environments, childcare support, and domestic violence prevention and response programmes, will become important in the future. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the characteristics of periodontal ligament stem cells derived from supernumerary teeth (sPDLSCs), cultured using a three-dimensional (3D) method and a conventional two-dimensional (2D) method. Methods: The morphology, viability, and osteogenic differentiation of the cells were analyzed. In addition, gene expression was analyzed by RNA sequencing, to characterize the functional differences. Results: The diameter of the 3D-cultured sPDLSCs decreased over time, but the spheroid shape was maintained for 7 days. The osteogenic differentiation was similar in the 2D and 3D. The gene expression related to the extracellular matrix (7.3%), angiogenesis (5.6%), cell proliferation (4.6%), inflammatory response (3.7%), and cell migration (3.5%) differed (p < 0.05). Conclusions: Within the limitations of this study, sPDLSCs varied in formation and function, depending on the culture method. In future, it is necessary to study tissue engineering using the advantages of 3D culture and the fewer ethical problems of supernumerary teeth.

This study compared the characteristics of periodontal ligament stem cells (PDLSCs) cultured using 3-dimensional (3D) versus conventional 2-dimensional (2D) methods. PDLSCs were cultured in either a 3D culture with a non-adhesive culture plate (Stemfit 3D®) or a conventional 2D culture using a 6-well plate. Morphology, viability, proliferation ability, and osteogenic differentiation were analyzed to characterize the differences induced in identical PDLSCs by 3D and 2D culture environments. In addition, gene expression was analyzed using RNA sequencing to further characterize the functional differences. The diameter and the viability of the 3D-cultured PDLSCs decreased over time, but the shape of the spheroid was maintained for 20 days. Although osteogenic differentiation occurred in both the 2D- and 3D-cultured PDLSCs, compared to the control group it was 20.8 and 1.6 higher in the 3D- and 2D-cultured cells, respectively. RNA sequencing revealed that PDLSCs cultured using 2D and 3D methods have different gene expression profiles. The viability of the 3D-cultured cells was decreased, but they showed superior osteogenic differentiation compared to 2D-cultured cells. Within the limitations of this study, the results demonstrate that the structure and function of PDLSCs are influenced by the cell culture method.

Objectives In this study, we characterized human dental pulp cells (HDPCs) obtained by different culture methods to establish the most suitable methodology for dental tissue engineering and regenerative endodontic applications. Materials and Methods HDPCs were isolated by the outgrowth method (HDPCs-OG), the enzymatic digestion method (collagenase/dispase/trypsin, HDPCs-ED), or the combination of both methods (HDPCs-Combined). The expression of mesenchymal stem cell markers (CD105, CD90, and CD73) was investigated. In vitro differentiation capacities of HDPCs into adipogenic, osteogenic, and chondrogenic lineages were compared. Differentiation markers were analyzed by quantitative reverse-transcription polymerase chain reaction (RT-PCR) and western blotting. Results Our data indicated that whole HDPCs-ED, HPDCs-OG, and HDPCs-Combined could be differentiated into adipogenic, chrondrogenic, and osteogenic cell types. However, we found that the methods for isolating and culturing HDPCs influence the differentiation capacities of cells. HDPCs-OG and HDPCs-ED were preferably differentiated into adipogenic and osteogenic cells, respectively. Differentiation markers shown by RT-PCR and western blotting analysis were mostly upregulated in the treated groups compared with the control groups. Conclusions Our findings confirmed that cell populations formed by two different culture methods and the combined culture method exhibited different properties. The results of this study could provide an insight into regenerative endodontic treatment using HDPCs.

Root canal treatment of mandibular incisor is difficult because of the narrow pulp space and apical curvature. The aim of this study was to measure the anatomical indicators of the mandibular incisors in Koreans using micro-computed tomography (MCT) with novel software (Kappa 2). The MCT-scanned data from 27 mandibular incisors were reconstructed and analyzed. For each canal, 3-dimensional (3D) surface models were re-sliced at 0.1 mm intervals perpendicular to the central axis of the root canal. Root canal width, dentine thickness, and direction and degree of root canal curvatures were measured automatically on each slice. Measurements were analyzed statistically with Bhapkar test, Friedman test, and Wilcoxon signed rank test. Labial and lingual dentine thicknesses were significantly larger than mesial and distal thicknesses (p < 0.001). The thinnest dentine was mainly located on the mesio-lingual side of the canals in the apical third. The mean narrowest and widest canal width in the apical sixth were 0.22 mm and 0.40 mm, respectively. The canal curvature abruptly increased in the apical 0.5-mm portion. MCT with novel software provided useful anatomical information for root canal instrumentation.

This case report presents surgical endodontic management outcomes of maxillary incisors that were infected via the lateral canals. Two cases are presented in which endodontically-treated maxillary central incisors had sustained lateral canal infections. A surgical endodontic treatment was performed on both teeth. Flap elevation revealed vertical bone destruction along the root surface and infected lateral canals, and microscopy revealed that the lateral canals were the origin of the lesions. After the infected lateral canals were surgically managed, both teeth were asymptomatic and labial fistulas were resolved. There were no clinical or radiographic signs of surgical endodontic management failure at follow-up visits. This case report highlights the clinical significance and surgical endodontic management of infected lateral canal of maxillary incisor. It is important to be aware of root canal anatomy variability in maxillary incisors. Maxillary central incisors infected via the lateral canal can be successfully managed by surgical endodontic treatment.

n dentistry, the term 'fusion' is used to describe a developmental disorder of dental hard tissues. In the permanent dentition, fusion of a normal tooth and a supernumerary tooth usually involves the incisors or canines. However, a few cases of fusion involving premolars have also been reported to date. We present a rare case in which fusion of the maxillary left second premolar and a supernumerary tooth in a 13-year-old girl was diagnosed using cone beam computed tomography (CBCT, Alphard-3030, Asahi Roentgen Ind. Co., Ltd.). The tooth was bicuspidized after routine nonsurgical root canal treatment, and the separated teeth underwent appropriate restoration procedures. The second premolar and supernumerary tooth remained asymptomatic without any signs of inflammation after a follow-up period of 9 years. Identification of anatomical anomalies is important for treatment in cases involving fusion with supernumerary tooth, and therefore the microscopic examinations and CBCT are essential for the diagnosis. Fused teeth can be effectively managed by the comprehensive treatment which includes both endodontic and periodontal procedures.