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Objectives: The aim of this study is to evaluate the effect of different surface treatments on the shear bond strength (SBS) of clear aligner attachments bonded to Bis-acryl provisional crowns. Methods: 120 cylindrical bisacrylic composite material (ProTemp type) specimens were prepared and divided into six groups (n = 20) based on surface treatment, control: (no treatment); super coarse grit diamond bur, carbide bur, alumina-blasting, non-thermal plasma treatment, and Er:YAG laser treatment. The features of treated surfaces were examined using scanning electron microscopy (SEM). A flowable composite resin (Transbond XT; 3M Unitek) was bonded to the specimens forming the attachment. Half of specimens were subjected to thermal cycling (5,000 cycles). SBS was measured before and after thermal cycling. Each specimen was loaded at the attachment/resin interface at a speed of 0.5 mm/min until failure. The nature of the failure was analyzed using the composite remnants index (CRI). Two-way ANOVA and Tukey HSD were used for data analysis α = 0.5. For CRI scores analysis, Kruskal-Wallis test and Dunn's multiple comparison were used as post-hoc test. Results: SEM analysis showed that all surface treatments altered surface properties and increase surface bonding area. The specimens treated with plasma, Er:YAG laser, and alumina-blasting had higher SBS values before and after thermal cycling. In comparison to control plasma, Er:YAG laser, and alumina-blasting showed a significant increase in SBS (P < 0.001) while carbide and diamond bur groups showed no significant differences (P > 0.05). Thermal cycling significantly decreased the SBS of control, carbide bur, diamond bur, and Er:YAG laser while no significant effect of alumina-blasting and plasma group. Er:YAG laser and plasma groups significantly exhibited more dominance for scores 2 and score 3 and the absence of score 0. Conclusion: Alumina-blasting, Er:YAG laser, or non-thermal plasma surface treatments increased the shear bond strength between clear aligner attachments and resin-based restorations.

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OBJECTIVE: Safe patient care can help reduce treatment costs, morbidity, and mortality. This study aimed to assess dentists' perceptions of patient safety culture and related factors in the Eastern region of Saudi Arabia. METHODS: This cross-sectional study used a sample of 271 dental professionals working in private and public dental hospitals and clinics in the Eastern region of Saudi Arabia. The Safety Attitude Questionnaire (SAQ), a validated tool consisting of 36 items on a 5-point Likert scale, was used to assess dentists' perceptions of patient safety culture. The score of SAQ ranges from 0 to 100 and a cut-off ≥ 75 is considered a positive attitude toward patient safety culture. RESULTS: There were 53.9% males and 46.1% females in the study with a mean age of 35.56 ± 6.87 years. Almost half of the participants (52%) attended a course on patient safety and 22.1% experienced medical error in the last month. The mean score of the SAQ of the sample was 65.14 ± 13.03 and the patient safety score was significantly related to the marital status (P = 0.041), attendance of patient safety course (P < 0.001), and experience of medical error (P = 0.008). The highest mean score (73.27 ± 20.11) was for the job satisfaction domain, followed by the safety climate domain (67.69 ± 16.68), and working conditions domain (66.51 ± 20.43). About one-quarter of the participants (22.5%) demonstrated positive attitudes toward patient safety culture. Multiple logistic regression analysis showed that dental professionals who attended a patient safety course were 4.64 times more likely to demonstrate positive attitudes toward patient safety than those who did not attend a course (P < 0.001). CONCLUSION: This study showed that patient safety culture was significantly related to the attendance of safety courses, marital status, and experiencing medical error. About one out of four dental professionals demonstrated a positive attitude towards patient safety culture which was significantly associated with the attendance of the safety course.

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BACKGROUND: Renin-angiotensin system and its ACE2/Ang(1-7)/Mas receptor axis regulates skeletal response to multiple physiological and pathological conditions. Recent research suggested a vital role of Ang(1-7) in regulating alveolar bone metabolism and remodeling. In this context, this study evaluated the effects of the Ang(1-7)/Mas receptor axis on orthodontic tooth movement (OTM) and the alveolar bone response to mechanical load. METHODS: A coil spring was placed between the right maxillary first molar and the anterior tooth of Wistar rats to apply bidirectional mechanical force. Ang(1-7) with or without a specific Mas receptor antagonist (A779) was infused using subcutaneous osmotic pumps (200 and 400 ng/kg/min: respectively). Animals were killed after 5 and 14 days from the OTM procedure after the clinical evaluation of tooth movement and mobility. Morphometric analysis of alveolar bone structure was conducted using micro-CT and the histological picture was evaluated after H&E staining. Moreover, collagen fiber distribution was assessed using Picro-Sirius red stain. In addition, bone samples were collected from the pressure and tension sites around the anterior tooth for gene expression analysis. RESULTS: Ang(1-7) infusion suppressed the tooth movement and mobility after 14 days of the orthodontic force application. Additionally, Ang(1-7) infusion preserved the morphometric and histological structure of the alveolar bone at pressure and tension sides. These effects were abolished by adding A779 infusion. Collagen fiber distribution was dysregulated mainly by the A779 Mas receptor blockage. Ang(1-7) affected the bone formation, remodeling- and vascularity-related genes in the pressure and tension sides, suggesting a prominent suppression of osteoclastogenesis. Ang(1-7) also improved osteoblasts-related genes on the tension side, whereas the osteoclasts-related genes were augmented by A779 on the pressure side. CONCLUSION: Collectively, the activation of Ang(1-7)/Mas receptor axis appears to hinder tooth movement and regulates alveolar bone remodeling in response to mechanical force.

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Objective: This study aimed to evaluate the impact of bevacizumab on orthodontic tooth movement (OTM) in Wistar rats. Materials and methods: The OTM model was constructed by placing an orthodontic coil spring between the maxillary first molar and anterior tooth. Bevacizumab (Avastin®; 10 mg/kg twice per week) was started one week before the OTM and continued for 3 weeks. After 1 and 2 weeks, OTM distance and anterior tooth mobility were measured. Thereafter, the maxilla was dissected for micro-CT microarchitectural analysis, followed by histological analysis, and tartrate-resistant acid phosphatase (TRAP) staining. Moreover, the distributions of collagen fibers type-I and -III (Col-I and Col-III) were evaluated using Picro-Sirius red staining. Results: Orthodontic force prompted bone resorption and formation on the pressure and tension sides, respectively. Bevacizumab therapy resulted in a 42% increase of OTM, particularly after 2 weeks. Furthermore, bevacizumab disturbed the morphometric structure at both pressure and tension sites. The histological evaluation indicated about 35-44% fewer osteoblasts in the bevacizumab group, especially at the tension side, whereas the proportion of TRAP-positive osteoclasts at the pressure side was 34-37% higher than the control. The mature Col-I was reduced at the tension site by 33%, whereas the Col-III/Col-I ratio was enhanced by 20-44% at pressure and tension sites, after 2 weeks, in the bevacizumab group. Conclusion: Anti-vascular bevacizumab therapy accentuates OTM in rat model, possibly through the enhancement of bone resorption, at the pressure side, and the reduction of bone formation, at the tension side as well as dysregulation of collagen fibers distribution.

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BACKGROUND: Body dysmorphic disorder (BDD) is a common disorder that consists of a distressing or impairing preoccupation with imagined or slight defects in appearance. In dentistry, those patients will have unrealistic expectations and usually will be unsatisfied with the outcomes of dental treatment. This study investigated the prevalence of BDD and its associated factors among dental patients. MATERIAL AND METHODS: In this cross-sectional survey-based study, a purposive sample was used to recruit adult patients seeking dental treatment in private and public facilities. Data was collected using the validated Arabic version of the Cosmetic Procedure Screening Questionnaire (COPS) for Body Dysmorphic Disorder, a validated nine-item self-administrated instrument that is scored from zero (least impaired) to five (most impaired). Chi-Square, Mann-Whitney U, and Fisher's Exact tests were used to compare the associations between the study variables and BDD. RESULTS: A total of 507 patients responded to the questionnaire. The prevalence of BDD was 34.1%. The average age of the participants was 35.2 years; the majority were males 290 (57%) and Saudis 436 (86%) with a college education 304 (60%). None of the demographics was associated with BDD but the type of treatment was significantly associated with BDD with teeth crowning and restorations. CONCLUSION: This study provides insights into the prevalence of BDD and its associated factors among dental patients in Eastern Saudi Arabia. The findings highlight the need for further research to better understand the factors contributing to the development of BDD and to guide prevention and intervention strategies in dental settings.

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OBJECTIVE: This study aimed to examine the correlation between the morphology of the maxilla and unilateral palatally impacted maxillary canine (PIMC) among the Saudi population in the Eastern Province of Saudi Arabia. MATERIALS AND METHODS: In this retrospective study, 36 patients' records [(17 PIMC, 8 male, 9 female, mean age 16.75 ± 2.12 years) (19 control; 9 male,10 female, mean age: 17.16 ± 2.12 years)] were included from a teaching dental hospital. On cone-beam computed tomographic images, measurements of maxillary arch length (MAL), palatal vault depth (PVD), intermolar width, sum of widths of 4 maxillary incisors, available arch space (AAS), palatal maxillary width (PMW) in the molar and premolar regions, nasal cavity width (NCW), maxillary arch shape (MAS) (arch length/intermolar width x 100), and palatal vault shape (PVS) (the PVD/intermolar width x100) were performed. Data were analyzed by SPSS-20.0. p-value less than or equal to 0.05 reflected statistical significance. RESULTS: This study's findings depicted that AAS (p = 0.012), PVD (p = 0.028), and PMW in the molar and premolar regions at the level of the alveolar crest (p = 0.002 and p = 0.034) and mid-root (p = 0.004 and p = 0.022) were significantly higher in the control compared to the PIMC group. PVS showed a significant difference between the PIMC and control groups (p = 0.037). However, regarding MAS, no significant difference was observed (p = 0.707). CONCLUSION: MAS was narrower in PIMC compared to the control group. The control group had a deeper palatal vault and greater AAS compared to the PIMC group. However, no significant difference was observed between groups regarding tooth size or NCW.

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OBJECTIVES: Many countries have enforced lockdowns on their populations due to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the effects of the lockdown on dental students. METHODS: A longitudinal, repeated cross-sectional study was conducted to evaluate psychological problems experienced by dental students during the COVID-19 lockdown in Saudi Arabia. The dental students were selected from different universities using 2-stage cluster sampling. The validated Arabic version of the 21-item depression, anxiety, and stress scale questionnaire was distributed at the beginning and end of the lockdown. Mann-Whitney U and Kruskal-Wallis tests were used as appropriate. Chi-square test was used to compare the proportions between the sociodemographic data, and logistic regression analysis was used to identify variables associated with the students' responses. RESULTS: A total of 1287 respondents participated in this study (695 first-survey respondents, 592 second-survey respondents). There were longitudinally significant differences in the students' mental health outcomes based on gender, university, class year, and survey time during the COVID-19 lockdown. The lockdown increased the likelihood of female, single, and junior students experiencing stress. The students who lived alone recorded a high chance of elevated levels of depression, anxiety, and stress, which showed a significant longitudinal reduction during the lockdown. Moreover, the lockdown increased the likelihood of mental health problems among the students staying in households of two persons or two-five persons. CONCLUSIONS: This study indicates the importance of considering the detrimental mental health consequences on dental students in the event of future pandemics.

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BACKGROUND: The number of patients seeking orthodontic treatment has been consistently increasing. During orthodontic treatment, it is recommended to place the provisional restoration and to delay the final restoration until completion of orthodontic treatment. Recurrent bracket debonding necessitates orthodontists to prepare the bonding area with special measures. OBJECTIVE: This study aimed to evaluate the effect of different grit sizes of diamond burs and sandblasting surface treatment on the shear bond strength of orthodontic brackets to provisional crowns. MATERIALS AND METHODS: A total of 75 discs were fabricated from a bisacrylic composite and divided into 5 groups (n = 15) according to surface treatment by black, blue, and green diamond burs and sandblasting in addition to a control group. Metal orthodontic brackets were bonded to discs in a standardized conventional manner. All specimens were subjected to thermocycling with 5000 cycles of alternating 5°C and 55°C waterbaths. The shear bond strength test was performed using a universal testing machine. A scanning electron microscope (SEM) was used to analyze the surface treatment effect and features of debonded surfaces. The amount of composite resin left on the specimen surfaces was analyzed and classified with the adhesive remnant index. One-way ANOVA was performed at α = 0.05. RESULTS: The shear bond strength of specimens treated with sandblasting was significantly higher than that of the control group under thermal aging conditions (p=0.022), as well as blue burs (p=0.001), while no significant differences were found between different grit diamond burs and the controls (p > 0.05). CONCLUSION: Under thermocycling conditions, sandblasting of provisional crowns increases the bond strength of orthodontic brackets.

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BACKGROUND: This study aimed to assess the knowledge of dental professionals in Saudi Arabia regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19). METHODS: A questionnaire was developed to assess various dental professionals from both governmental and private sectors through online and social media outlets. RESULTS: A total of 1,033 questionnaires were collected (273 dental students, 193 dental auxiliary personnel, 544 dentists). In all, 63.4% of the respondents worked in hospitals. Of all the respondents, 44.9%, 33.4%, and 21.7% worked in governmental clinics, academia, and the private sector, respectively. Overall knowledge of the incubation period and route of transmission of SARS-CoV-2 was consistent across all dental professions. Knowledge of hand-soap cleaning time was significantly different among dental professionals (p < 0.001). Dental professionals displayed significant disagreement on the survival of SARS-CoV-2 outside the host (p < 0.001). Furthermore, 75.1% of the respondents were reluctant to treat a suspected COVID-19 patient, and 92% of the participants believed that the mode of transmission was droplet inhalation. Fever, coughing, and shortness of breath were identified as the most common symptoms of COVID-19. Most standard methods of prevention in the dental office were selected by at least 50% of the participants. CONCLUSIONS: Dental professionals seem to be consistent regarding their knowledge of the incubation period of SARS-CoV-2. However, knowledge of viral survivability and recommended hand-soap washing time was significantly variable among the professionals. A high degree of apprehension toward suspected COVID-19 patients existed among all dental professionals. Pandemic-awareness campaigns are essential among healthcare providers.

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Computer-based technologies play a central role in the dentistry field, as they present many methods for diagnosing and detecting various diseases, such as periodontitis. The current study aimed to develop and evaluate the state-of-the-art object detection and recognition techniques and deep learning algorithms for the automatic detection of periodontal disease in orthodontic patients using intraoral images. In this study, a total of 134 intraoral images were divided into a training dataset (n = 107 [80%]) and a test dataset (n = 27 [20%]). Two Faster Region-based Convolutional Neural Network (R-CNN) models using ResNet-50 Convolutional Neural Network (CNN) were developed. The first model detects the teeth to locate the region of interest (ROI), while the second model detects gingival inflammation. The detection accuracy, precision, recall, and mean average precision (mAP) were calculated to verify the significance of the proposed model. The teeth detection model achieved an accuracy, precision, recall, and mAP of 100 %, 100%, 51.85%, and 100%, respectively. The inflammation detection model achieved an accuracy, precision, recall, and mAP of 77.12%, 88.02%, 41.75%, and 68.19%, respectively. This study proved the viability of deep learning models for the detection and diagnosis of gingivitis in intraoral images. Hence, this highlights its potential usability in the field of dentistry and aiding in reducing the severity of periodontal disease globally through preemptive non-invasive diagnosis.

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AIM: To evaluate the prevalence of impacted teeth in Saudi patients and compare between male and female subjects. METHOD: This cross-sectional study comprised of Saudi patients who attended dental clinics in major hospitals in the Eastern Province of Saudi Arabia. Patients' dental records and panoramic radiographs were reviewed retrospectively. Impacted teeth excluding third molars and spaces occupied by primary, permanent, and transmigrated teeth were recorded from panoramic radiographs. The Pearson chi-squared test was performed to determine gender differences regarding impacted teeth and spaces occupied by other teeth. RESULTS: The study included radiographs of 539 patients with a mean age of 23.3 ± 10.8 years. Seventy-one patients (13.2%) had at least one impacted tooth. The total number of impacted teeth was 115 in the sample, out of which 91 (79.1%) were in the upper arch and 24 (20.8%) in the lower arch. Fifty-eight maxillary canines (50.4%) were impacted making them the most commonly impacted teeth, followed by 21 upper second premolars (18.2%) and 14 lower second premolars (12.2%). More females (70.7%) than males (29.3%) had impacted teeth (P=0.82). Of 61 spaces occupied, 35 (57.4%) were occupied by permanent teeth, 24 (39.3%) by primary teeth, and 2 (3.3%) by transmigrated teeth. Greater proportions of spaces were occupied in female than male participants (P > 0.05). CONCLUSION: There was a high prevalence of impacted teeth in Saudi patients. The canines were the most commonly impacted teeth followed by the second premolars. Females demonstrated a higher occurrence of impacted teeth than males. Early detection of impacted teeth can help prevent malocclusion and maintain a healthy dentition.

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OBJECTIVE: To assess the prevalence of temporomandibular disorder (TMD) and its association with text anxiety among undergraduate medical, dental, and pharmacy students in Dammam, Saudi Arabia. Material and Methods. This cross-sectional study included health professions students who responded to Fonseca's questionnaire and Test Anxiety Inventory by Spielberger to evaluate TMD and test anxiety, respectively. TMD score was compared in different categories of students, and bivariate and multiple logistic regression analyses evaluated the influence of test anxiety on TMD. RESULTS: The study included 884 participants (44.8% males and 55.2% females) with a mean age of 21.46 ± 1.36 years. Regarding items of Fonseca's questionnaire, most students reported being tense/nervous (65.7%) and had headaches (57.5%). About 45.8% of the participants reported no TMD, and remaining had mild (40.4%), moderate (11.3%), and severe (2.5%) TMD. The mean TMD score was significantly higher in students with high test anxiety (25.6 ± 18.32) than those with low test anxiety (20.25 ± 16.97) (P < 0.001). Mean test anxiety scores significantly differed among TMD categories (P < 0.001) with the lowest score in the no TMD group and the highest in the moderate TMD group. Female gender (adjusted odds ratio 1.4, P 0.039) and high test anxiety (adjusted odds ratio 1.92, P < 0.001) were significantly associated with increased odds of having TMD. CONCLUSIONS: The study revealed a high prevalence of TMD among students. There was a significant association between test anxiety and TMD. The data obtained may guide preventive policies and program on test anxiety and TMD.

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BACKGROUND: Despite drawbacks, cold-cured acrylic resin is still the most common material used in denture repair. Zirconia nanoparticles were among the reinforcements added to increase the strength of the resin. The effect on Candida due to the addition of zirconia nanoparticles to the resin has not been investigated. PURPOSE: The aim of this study was to evaluate the effect of zirconia nanoparticles added to cold-cured acrylic resin on Candida albicans adhesion. MATERIALS AND METHODS: A total of 120 acrylic resin specimens with dimensions measuring 22×10×2.5 mm3 were prepared and divided into two equal groups. One group (repair) comprised heat-polymerized specimens that were sectioned at the center and prepared to create a 2 mm repair area that was repaired with cold-cured resin reinforced with 0% wt, 2.5% wt, 5% wt, and 7.5% wt zirconia nanoparticles. The second group contained intact cold-cured acrylic resin specimens reinforced with 0% wt, 2.5% wt, 5% wt, and 7.5% wt zirconia nanoparticles. Specimens were incubated at 37°C in artificial saliva containing C. albicans, and the effect of zirconia nanoparticles on C. albicans was assessed using two methods: 1) a slide count method and 2) a direct culture test. Variations in the number of living Candida were observed in relation to the different concentrations of zirconia nanoparticles. Analysis of variance (ANOVA) and post hoc Tukey's tests were performed for data analysis. If the P-value was ≤0.05, then the difference was considered as statistically significant. RESULTS: It was found that C. albicans adhesion to repaired specimens was significantly decreased by the addition of zirconia nanoparticles (P<0.00001) in comparison with the control group. Intact cold-cured groups and groups repaired with cold-cured resin reinforced with 7.5% wt zirconia nanoparticles showed the lowest Candida count. Tukey's test showed a significant difference between the repaired group and the intact cold-cured group, while the later demonstrated a lower Candida count. CONCLUSION: The addition of zirconia nanoparticles to cold-cured acrylic resin is an effective method for reducing Candida adhesion to repaired polymethyl methacrylate (PMMA) denture bases and cold-cured removable prosthesis. CLINICAL SIGNIFICANCE: Based on the results of the current study, zirconia nanoparticles have an antifungal effect, which could be incorporated in the repair material for repairing denture bases and in PMMA removable prostheses as a possible approach for denture stomatitis prevention.

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