Journal of Dental Medicine

Background and Aims: Information collection about the malocclusion and oral health in blind children is essential to plan for their education in schools. Therefore, this study aimed to evaluate the status of malocclusion and oral health among blind children and teenagers in Mazandaran, Iran.
Materials and Methods: The population of this included 150 blind children and teenagers aged from 10 to 18 years who were referred to the public and private centers cities including Sari, Babol, Freydoonkenar, and Babolsar in Mazandaran, Iran in 2019. Information on maxillary occlusion status, oral hygiene index, and DMFT index was extracted through clinical examination. Data were analyzed using SPSS23 software by ANOVA and Chi-square tests in addition to the descriptive statistics.
Results: The mean DMFT was 10.25 (SD 4.67). Oral hygiene status was good in 16% of participants, moderate in 82%, and poor in 2%. There was no significant difference between girls and boys in terms of oral hygiene status (P=0.5). In all cases, 35.8% had class I malocclusion, 29.8% had class II malocclusion, and 14.6% had class III malocclusion. Class II malocclusion was more common in girls and class I in boys (P=0.01).
Conclusion: Dental caries and occlusal abnormalities were common among blind children and adolescents living in Mazandaran province. Addressing the oral and dental needs of the blind should be a priority for health policymakers in this province in Iran.

Background and Aims: This study aimed to collect reports and HIS in a web-based system due to the problems of paper recording of student activities in practical courses, as well as the lack of computers in the departments for observing graphs and treatment plans.
Materials and Methods: The initial graphic design of the website was done after the assessment of needs and the necessary planning for designing the website. The main template of the website was designed after consulting with the faculty and the designer company. A combination of HTML, CSS, JQuery, and Java script was used for static coding and what the user sees or interacts with. Then, the basic information entered the website and the content designer put the website in the designed layout. In the end, a sample hosting space was prepared and the website was fully provided to the professors and faculty officials to work with as an administrator and a user. They conveyed all their opinions and the corrections were made based on the feedback given.
Results: The use of the internet and software with a central database played a significant role in monitoring and evaluating the long-term information of the student and the evaluation of the entire department, universities, and patients in each region up to macro-national evaluations. This could give the expansion and advancement of science in addition to the central registration of documents and radiographs, as well as their ease to access.
Conclusion: The designed website was well received among the students and the attending staff. Introducing a web based logbook and HIS system can optimize the clinical teaching. These logbooks could help both students and staff saving time and resources, and to facilitate providing better personalized care for patients.

Background and Aims: The increase in life expectancy and decrease in birth rate enhances the elderly population in different societies and consequently, the demand from the health system for providing the treatment needs has been elevated. It has been proposed that dentists must improve their attitude, knowledge, and practice to meet these needs. The present study aimed to assess the knowledge, attitude, and practice of general dentists regarding geriatric oral health.
Materials and Methods: In this descriptive-analytic cross-sectional study, 150 general dentists participating in the annual congress of the Iranian Dental Association in 2018 were selected and completed a valid and reliable self-administered questionnaire including 5 parts about knowledge, attitude and practice regarding old age and oral health of elders. SPSS23 and multiple regression were used for data analysis.
Results: The mean age of dentists was 34.3 (SD: 9.1) and 92 (61.3%) of participants were women. The mean knowledge score about the old age was 16.67 (of maximum: 26, SD: 4.31) and the mean knowledge on the geriatric oral health was 11.01 (of maximum: 18, SD: 2.81). The mean general attitude about elderly was 19.1 (of maximum: 30, SD: 4.26), the mean attitude on geriatric oral health was 13.09 (of maximum: 20, SD: 2.65), and the mean practice about geriatric oral health was 6.5 (of maximum: 10, SD:2.96). Age was significantly associated with knowledge regarding the elderly (P<0.034); i.e. with increase in age lower scores in knowledge were gained.
Conclusion: General dentists participating in the congress of the Iranian Dental Association demonstrated a medium level of knowledge, attitude, and practice regarding the oral health of elders. Proper educational programs should be planned in dental schools to improve dental student's knowledge, attitude and practice about geriatric oral health.

Conclusion: The data of this study in proving the anti-biofilm and antibacterial effects of aloe vera extract showed that the expression of the target gene is reduced. It seems that this substance can be used as an alternative to oral hygiene chemicals.

Conclusion: The data of this study in proving the anti-biofilm and antibacterial effects of aloe vera extract showed that the expression of the target gene is reduced. It seems that this substance can be used as an alternative to oral hygiene chemicals.

Background and Aims: Survival of periodontal ligament (PDL) cells after avulsion is an important factor in treatment prognosis. Grapefruit Seed Extract (GSE) can be a proper environment for preserving periodontal ligament cells. The objective of this study was to analyze the effect of different concentrations of GSE on the proliferation of fibroblast PDL cells.
Materials and Methods: In this study, the undifferentiated PDL fibroblasts were obtained from two human premolars teeth and cultured in Dulbecco’s modified Eagle’s medium (DMEM). The cultured cells were exposed to different concentrations of GSE. The positive and negative control groups were cultured in fetal bovine serum (FBS) 10% and in a medium without FBS 10%, respectively. The plates were incubated for 1, 6, 12, 24, and 48 hrs. The PDL cell viability was assessed by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Statistical analysis of data was accomplished using repeated measure ANOVA with Post HOC Tukey, P<0.05 was considered statistically significant.
Results: We found out that among different concentrations of GSE, 1:128 had the most impact on undifferentiated PDL fibroblasts. Although, the cell vitality was higher in the twelfth hour, 1:128 GSE and in the forty-eighth hour, 1:1024 GSE than the positive control group but they were not statistically significant (P>0.05). Furthermore, all the samples were similar to the positive control group in three of the five timeperiods (P>0.05).
Conclusion: GSE was more effective in fewer concentration and longer periods and it had no toxic effect on PDL cells. Therefore, GSE can be considred as a promoting medium in PDL regeneration of avulsed permanent teeth in the future.

Background and Aims: Due to the review of general dental courses, it was necessary to assess the students' satisfaction with this curriculum. The aim of this study was the assessment level of students’satisfaction with the new educational curriculum of the Ministry of Health at the department of restorative dentistry of Tehran university of medical sciences in 2019-2020.
Materials and Methods: In this descriptive cross-sectional trial,72 sixth year dental students of Tehran University who passed the restorative dentistry courses based on the new curriculum were studied. A questionnaire was developed and for validity content assessment, it was presented to 5 professors and then revised. For reliability approval of the questionnaire, test-retest approach was used. The questionnaire was given to the 30 students of the main pilot group in one session and two-week later and agreement percentage and Kappa index were calculated.  After conducting the "test" process and re-testing, the "questions" were statistically analyzed using STATA software.
Results: The most level of satisfaction regarding to practicality of subjects was found for fundamental of restorative dentistry including principles of amalgam class I cavity preparations and restorations on the dentic (81.94% and 76.39% acceptable respectively) and the principles of amalgam classII cavity restorations on the dentic (72.22%). The least satisfaction levels were obsereved in the first and second theoretical restorative courses including tooth-colored restorations (47.22%), onlays and inlays (47.22%) and tooth-colored classII cavity preparations and restorations (48.61%). The amount (P-value or error of the first type) was reported in all questions>0.001.
Conclusion: Despite the limitation of this study, final-year dental students’ satisfaction of theoretical restorative dentistry courses was medium, while it was high for the fundamental and practical restorative courses of 2017 educational curriculum.

Background and Aims: According to the importance of primary stability on dental implant success and osseointegration, we intend to check and compare the stability and crestal bone loss rate between osteotomy technique and conventional implant insertion techniques.
Materials and Methods: In this study, 26 implants in anterior segment of maxilla in 13 patients were evaluated. The implants were TBR system (Toulouse, France) with 3.5 diameter and 10.5-12 mm length. The implant stability level was recorded immediately after surgery and 3 months later with Ostell mentor. The periapical radiography was taken immediately after surgery, 3 and 6 months to assess crestal bone resorption. Paired t-test and Wilcoxon signed Rank test used for data analysis.
Results: There were no statistically differences between the two treatments techniques in terms of stability (P>0.05). The mean crestal resorption was higher for the osteotomy technique 3 months after implant insertion (P<0.001) but there were no significant differences after 6 months (P=0.678).
Conclusion: Within the limitations of the current study, it can be concluded that the osteotomy it can be considered as a treatment technique in insufficient bone width.

Background and Aims: The aim of this study was development and validation of a questionnaire measuring the pseudo-scientific unsupported of Iranians’ belief regarding oral health.
Materials and Methods: A list of 169 pseudo-scientific and invalid Iranian beliefs about oral health that was collected in the previous phase of the study were sent to a purposive sample of 13 professors at Mashhad dental school which resulted in extracting 34 beliefs being considered more common among Iranians. A list of 21 pseudo-scientific beliefs was obtained for preparing the questionnaire after receiving the sample opinions of 21 professors of Mashhad dental school about the invalidity and pseudoscientific propositions and their written revision. Finally, the questionnaire was completed by 44 participants to analyze the ease and clarity and to calculate Cronbach's alpha and Kuder Richardson measure as a homogeneity reliability index. It was completed in a group of 15 participants with a time interval of one month for test-retest analysis and consistency reliability evaluation.
Results: A questionnaire consisting of 21 beliefs was developed using four-point, three-point, or two-point Likert scales. The standardized Cronbach's alpha score and Kuder Richardson's measure score were 0.641 and 0.514, respectively, which indicated the moderate to good reliability of the homogeneity. The Interclass Correlation Coefficient (ICC) was calculated as 0.863, representing very good reliability of consistency of the questionnaire. Furthermore, the kappa coefficient of each of the 21 statements had a significant difference with zero (P<0.05) ranging between 0.605 and 1.
Conclusion: The result of the present study is a questionnaire measuring the level of Iranians’ belief in unsupported and invalid statements about oral health. Using this questionnaire would be helpful for dentists and oral health professionals to promote knowledge of Iranians about oral health.

Background and Aims: Activity-based costing enumerate every input consumed in treatment. The Covid-19 pandemic changed the dental treatment protocols and the ordinary circumstances of patients. The aim of this study was to calculate and compare the costs of three common dental services in Iran from the viewpoint of the providers and recipients of the services before the Covid-19 pandemic (2019) and during the pandemic (2021).
Materials and Methods: Direct medical and non-medical costs were considered from the service provider's perspective. Direct medical costs, indirect costs, direct non-medical costs, and intangible costs were considered from the recipient's perspective. To calculate the equivalent costs, the base year was considered 2021, and the costs of 2019 were calculated with a discount rate of 16%.
Results: From the service provider's perspective before the pandemic, the cost of dental amalgam restoration was 2,851,235 Rials, root canal treatment was 6,351,580 Rials, and tooth extraction was 1,887,295 Rials. The cost of these services in 2021 was 5,562,150 Rials, 8,070,591 Rials, and 4,865,563 Rials, respectively. From the recipient's perspective, before the pandemic, the cost of tooth restoration was 715,466 Rials, root canal treatment was 2,883,001 Rials, and tooth extraction was 3,267,359 Rials. The cost of the mentioned services in the year 2021 was 1,212,528 Rials, 3,971,640, and 3,680,880 Rials, respectively.
Conclusion: The Covid-19 pandemic has had an effect on increasing the cost of dental services from both the service provider and recipient perspective, but economic volatility has a vital role in increasing the estimated costs in the country. Probably, a part of the increase in costs was due to the role of brokers in providing dental materials and equipment.

Background and Aims: The evaluation of the results of health transformation plan in dentistry, which started in March 2016 with the aim of improving oral and dental health, is extremely important in order to improve planning for future actions. Therefore, the purpose of the present study was to evaluate the effect of the health transformation plan on common oral health indices in Guilan province in Iran.
Materials and Methods: This cross-sectional analytical study was performed using the Health Deputy of Guilan University of Medical Sciences data and results of the general population and housing census of the 2010 and 2015. Data analysis was done using Ordinary Least Squares regression method, considering dependent variables including DMFT, dmft and periodontal disease indices (CPI) and independent variables including gender, education, urban or rural residence, percentage of 13-year-old population, illiteracy rate, fertility rate and being or not in the transformation plan, to investigate the difference between the two groups before and after the implementation of the transformation plan in terms of variables and to examine the relationship between independent and dependent variables. Finally, data were analyzed by STATA SE software version 15.
Results: The health transformation plan did not have a significant relationship with the change of DMFT and CPI 2 to CPI 6 indices, but had succeeded in reducing dmft and CPI1 (P<0.05), which reduction in CPI1 index was not desirable.
Conclusion: It seems that despite the extensive activities of the health transformation plan in dentistry in the field of prevention and treatment, there is still a need for more changes, especially in terms of culture and education. Also, there is need to provide more facilities for access to services by all sections of the society, especially the weak sections for healthcare.

Background and Aims: Endocrown is a type of monoblock restoration using the pulp chamber and remaining coronal tooth structure for retention. Advancements in adhesive techniques have breathed fresh spirit into endocrown. Nowadays, there are two approaches for endocrown: conventional approach and  biomimetic approach. This study aimed to review data on the steps and clinical and philosophical points of using these approaches to help dentists’ selection and performance.
Materials and Methods: The review was conducted by reviewing the articles available in PubMed, Scopus, and Google Scholar databases from 1995 to 2022. The keywords used were; Crown, Endodontically-treated teeth, Light-curing of dental adhesive, Onlay, and Post-Core.  
Results: After removing duplicates, titles/abstracts were reviewed. Animal studies, studies without available full text or non-English language studies were excluded from the study. Then, the full texts of the remaining 59 articles were evaluated and 49 articles were eligible for the present study. The articles included clinical trials, in vitro, systematic reviews, and case reports.
Conclusion: Endocrown is a successful alternative to crown, especially in molar teeth. Regardless of the conventional or biomimetic approach, this treatment has a more favorable fracture pattern while preserving the remaining tooth tissue as much as possible.

Background and Aims: The white color of teeth is one of the most essential factors in smile esthetics. Therefore, various whitening agents such as bleaching mouthwashes have been produced in response to the people’s high demand for having whiter teeth. The present study evaluated the efficacy of three whitening mouthwash products on tooth enamel whiteness.
Materials and Methods: In the present in vitro study, 32 bovine incisors were assigned to four groups in terms of the mouthwash used (n=8): control (C); Xenon Smart White (ZSW), containing pyrophosphate and triphosphate; Signal White Now (SWN), containing Blue Covarine; and Pasta Del Capitano whitening mouthrinse (PCW), containing Plasdone. Colorimetry was carried out using a spectrophotometer at the baseline and 2, 4, 8, and 12 weeks after treatment with mouthwashes. Data were analyzed using CIELab parameters with ANOVA, RM two-way ANOVA, and post hoc Tukey tests (α=0.05).
Results: The results showed that the whiteness created by the SWN mouthwash was clinically visible (ΔE>3.3). However, the functions of all the mouthwashes were statistically similar with no significant differences from the control group (P>0.05).
Conclusion: Although, Blue Covarine-containing mouthwash was somewhat effective in whitening of tooth enamel, none of the mouthwashes had significant efficacy compared to distilled water.

Background and Aims: Ensuring the long-term stability of orthodontic treatments and preventing tooth relapse remains a significant challenge in orthodontics, often addressed through the extended use of retainers. Given the pivotal role of retainers' physical and mechanical properties in this regard, this study aimed to investigate the tensile strength, flexural strength, and deflection of three distinct types of fixed orthodontic retainers.
Materials and Methods: In this laboratory study, each group comprised 12 samples of twisted, flat, and coaxial retainer wires, each measuring 8 mm in length. These samples were affixed onto the polyethylene blocks using cyanoacrylate adhesive and subsequently subjected to compressive loads using a universal testing machine. The maximum bending strength and deflection rate were recorded from stress-strain diagrams. To evaluate the tensile strength, the identical samples underwent tensile loading. Statistical analysis was performed utilizing SPSS software, employing analysis of variance tests to compare data between groups.
Results: Significant differences were observed in the bending strength (P=0.004), deflection (P<0.001), and tensile strength (P<0.001) among the investigated retainer wires. The flat retainer wire exhibited the highest bending strength, averaging 822.876±136.07 MPa, while the coaxial retainer wire showed the lowest, with an average of 673.65±73.35 MPa. Regarding deflection, the flat retainer wire displayed the highest average at 4.04±0.6 mm, surpassing the other two types of retainers. However, the tensile strength of the twisted retainer wires, averaging 699.7±83.46 MPa, exceeded that of both the flat and coaxial retainer wires.
Conclusion: The flat retainer wires demonstrated the highest bending and deflection strength, while the twisted retainer wires exhibited the highest tensile strength. Overall, the bending strength, deflection, and tensile strength of the 3-strand twisted and flat retainer wires outperformed those of the 5-strand coaxial retainer wires, increased flexural and tensile strengths imply a higher resistance of the wires to the forces induced by harder and more viscous foodstuffs.

Guided bone and tissue regeneration is a common technique used in the treatment of areas around teeth and dental implants. In this framework, barrier membranes are employed to create a suitable environment that promotes new bone growth while preventing the invasion of foreign cellular components into this specific setting. Attributes such as biocompatibility with living tissues, structural integrity, longevity, and user-friendliness constitute the principal criteria for selecting appropriate membranes for this particular application. Given the extensive diversity of membrane types concerning their sources, texture, architecture, and inherent properties, determining the most suitable variant depends on the clinical condition presented by the patient and the specific treatment modality, thereby emphasizing its considerable importance. In recent years, fibrous membranes have garnered particular attention due to their distinctive characteristics. These membranes, made of natural or synthetic fibers, typically exhibit high porosity, which facilitates the ingress of vascular structures and osteogenic cells. Owing to their porosity and flexibility, fibrous membranes are considered exceptionally suitable for the regeneration of maxillofacial and dental tissues, thereby contributing to increase bone volume, guide its growth, and at the same time prevent soft tissue encroachment into the restoration area, which ultimately has a favorable effect on treatment outcomes. On the other hand, due to the complexity and extent of oral infections, new nanotechnological approaches have been proposed in recent years to reconstruct infected sites in dentistry. These strategies, by targeting specific sites and having non-toxic properties, can help deliver antimicrobial molecules, regenerate tissue, and maintain oral health. In this context, nanofibrous membranes serve as multifunctional structures, both in the controlled release of antimicrobial agents and as scaffolds for the formation of nascent tissue. Overall, fibrous membranes, by mimicking the physiological conditions of the organism, create an ideal environment for the growth and healing of bone tissues, leading to improved effectiveness in dental procedures. This article is devoted in detail to a comprehensive review of polymeric and composite fibrous membranes with drug release potential.

Background and aims: Dental anxiety is one of the most common barriers to utilizing oral health services. It can lead to delayed dental visits, treatment avoidance, and worsening of oral health problems. This study aimed to assess the level of dental anxiety among patients visiting general dental clinics in Babol, Iran.
Materials and Methods: This descriptive-analytical cross-sectional study was conducted in 2020 on 400 patients over the age of 18 who attended private general dental practices in Babol and were selected through convenience sampling. Data were collected using the Persian version of the standard Dental Anxiety Inventory (DAI), consisting of 36 items rated on a five-point Likert scale (score range:
36-180), the validity and reliability of which have been confirmed in previous studies. Data were analyzed using independent samples t-test and analysis of variance (ANOVA) in SPSS, with a significance level set at 0.05.
Results: The mean age of participants was 31.61  ± 9.03 years, and 61.8% were female. The mean dental anxiety score was 129.52 ± 31.04 out of 180, indicating a relatively high level of anxiety among the participants. Dental anxiety was significantly higher in female (P=0.002) and single participants (P=0.007), while no significant differences were observed based on the age, occupation, education level, or number of previous dental visits (P>0.05).
Conclusion: The findings indicated a high level of dental anxiety among patients attending general dental clinics in Babol. It is recommended that educational, psychological, and communication-based interventions be implemented in dental settings to help the reduction of anxiety and improvement of patient care.

Background and Aims: Dental caries is one of the most prevalent chronic oral diseases worldwide. Timely and accurate diagnosis of dental caries plays a crucial role in preventing lesion progression and reducing complications. This study aimed to systematically review the studies on dental caries detection using machine learning algorithms applied to periapical radiographs.
Materials and Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar databases up to the end of 2024. Inclusion criteria comprised studies using machine learning algorithms for detecting dental caries in periapical or intraoral radiographs. The quality of studies was assessed using the QUADAS-2 tool.
Results: From 825 initial articles, 13 studies met the inclusion criteria. All studies used Convolutional Neural Networks (CNNs) with various architectures including ResNet, VGG, Inception, DenseNet, and YOLO. ResNet-based models and their hybrid variants showed the best performance with diagnostic accuracy ranging from 82% to 98%. Comparison with human experts in 6 studies revealed that deep learning algorithms demonstrated similar or superior performance.
Conclusion: From the results, deep learning especially convolutional neural networks, had significant potential for improving dental caries detection in periapical radiographs. However, challenges such as limited high-quality training data and generalizability issues need further investigation.