Even with the evolution of chemotherapeutic procedures and agents, chemotherapy may cause certain side effects that impair the patients’ quality of life. The aim of this review is to isolate and describe the oral side effects arising only from chemotherapy and focus on the dentist’s contribution to their management. This paper comprises an extensive literature review of the main side effects affecting the oral health status of patients’ undergoing chemotherapy procedures. In addition, it describes the dentist’s contribution in the treatment of such patients before, throughout and after antineoplastic therapy. In conclusion, the oral cavity is a usual site of discomfort and pain caused by chemotherapy, making the dentist’s contribution to the patient’s relief imperative.

This paper reports a case of a recurrent periapical cyst treated with enucleation of the lesion, apicoectomy, and root end obturation on a lower left first molar. In the case of conventional root canal treatment failure, non-surgical retreatment is the preferred option in most of the cases. Several factors such as a complex root canal system or previous procedural accidents may impede the success of non-surgical retreatment. The authors have performed root-end resection and preparation under local anesthesia on a lower left first molar; The root canal filling is placed within the new cavity to close the path of communication between the infected root canal system and periradicular structures with an intermediate restorative material. The lesion was fully enucleated and sent for histopathology. The 29-year-old female patient was followed up at 2 weeks, 3 and 6 months presenting as a functional and symptomless tooth. Radiographic findings showed a clear and progressive refilling of the cavity with bone. All these factors highlight a positive prognosis for the tooth after periradicular surgery, which is now considered a valid treatment to keep the tooth as a functional unit in the oral cavity.

Aim: To evaluate a novel approach for reinforcing 2 types of provisional restoration materials [polymethylmethacrylate (PMMA) and bis-acryl resin] with different concentrations of silica gel powder (0%, 0.5%, 1%, 1.5%, 3%, 5%, 10% by weight).

Methods: A total of 60 rectangular fracture toughness specimens were prepared in this study according to the ISO 13586 Standard with dimensions of 2 mm × 5 mm × 25 mm. The specimens were divided into 2 groups according to the materials used PMMA or bis-acryl. Each subgroup was divided into 6 subgroups according to the different silica gel concentrations (0%, 0.5%, 1.5%, 3%, 5%, and 10% by weight) added where the 0% subgroup was used as a control group. Fracture toughness for the specimens was determined by loading the specimens in a universal testing machine.

Results: The results showed that addition of 0.5% by weight of the silica gel powder for PMMA recorded the highest mean value (2.69 ± 0.08 MPa•m^1/2) and this was statistically significant.

Conclusion: Within the limitation of this study it was concluded the addition of 0.5% by weight silica powder gel could increase the fracture toughness of PMMA.

Aim: The purpose of this in vitro study was to determine the optimum margin thickness which allows more conservative tooth preparation, thus giving space for the veneer material and to evaluate the effect of the processing technique on fracture resistance of IPS e.max^® copings.

Methods: Forty all lithium disilicate copings were divided into 2 equal groups according to the construction technique; twenty copings each (n = 20) per group. Each group was further subdivided into 2 equal subgroups according to the coping margin thickness; 0.5 mm and 0.7 mm (n = 10/subgroup). Two dies were prepared with 5 mm cervical diameter, 60° axial taper, and 5 mm occluso-cervical height with the non-anatomical occlusal table. Copings were constructed using heat pressing and CAD/CAM milling techniques, and were cemented on epoxy dies using RelyX™ Unicem resin cement. Samples underwent pre-loading in a cyclic manner equivalent to the average masticatory cycle. Afterward, samples were loaded until fracture using the same computer controlled material testing machine. Data were analyzed for each group using one-way analysis of variance (ANOVA) followed by a Tukey’s pairwise post-hoc test between the 2 coping thicknesses. P values which were 0.05 or less were considered statistically significant. Separate student t-tests was performed to detect the significance between the main groups. Finally, a two-way ANOVA was done to evaluate the effect of the processing technique, and the coping thickness on the fracture resistance.

Results: Effect of the construction technique revealed significant (P < 0.05) influence on the fracture resistance mean values of the ceramic copings (CAD > Press). Effect of thickness showed significant (P < 0.05) influence on fracture resistance mean values as well (0.7 mm > 0.5 mm).

Conclusion: Within the limitations of this study, the following conclusions could be drawn: the CAD/CAM technique showed improved strength over the heat pressed technique, regardless of the margin thickness of the ceramic coping, 0.5 mm thickness coping, constructed using both pressing and milling techniques, has sufficient strength to withstand the average masticatory forces in the premolar region (222 to 445 N).

Aim: To introduce bifocal distraction osteogenesis (BDO) and subsequent endosseous dental implant placement as an overall method for reconstruction of complete maxillary and mandibular segmental defects.

Methods: Within the authors' whole series, 29 patients showing bony segmental defects within the maxillofacial skeleton underwent BDO. The authors focus on 3 patients who were further rehabilitated with endosseous dental implants into the distracted bone.

Results: The overall BDO success rate was 79%. The 3 reported cases underwent dental implant rehabilitation with 4, 6, and 5 endosseous dental implants, respectively. No relevant complications were observed, except for intraoral scarring in one patient, and pain at the end of the distraction phase in another patient. Adequate attached gingival tissue was obtained for maxillary and mandibular distracted bone in all the cases.

Conclusion: Three cases of segmental maxillo-mandibular defects that have been reconstructed by bifocal distraction osteogenesis and further rehabilitated with endosseous dental implants. Surgeons must keep in mind this technique as an alternative to bone microsurgical reconstruction in cases in which free flaps are contraindicated or extended surgical time has to be avoided.

Even with the evolution of chemotherapeutic procedures and agents, chemotherapy may cause certain side effects that impair the patients’ quality of life. The aim of this review is to isolate and describe the oral side effects arising only from chemotherapy and focus on the dentist’s contribution to their management. This paper comprises an extensive literature review of the main side effects affecting the oral health status of patients’ undergoing chemotherapy procedures. In addition, it describes the dentist’s contribution in the treatment of such patients before, throughout and after antineoplastic therapy. In conclusion, the oral cavity is a usual site of discomfort and pain caused by chemotherapy, making the dentist’s contribution to the patient’s relief imperative.

This paper reports a case of a recurrent periapical cyst treated with enucleation of the lesion, apicoectomy, and root end obturation on a lower left first molar. In the case of conventional root canal treatment failure, non-surgical retreatment is the preferred option in most of the cases. Several factors such as a complex root canal system or previous procedural accidents may impede the success of non-surgical retreatment. The authors have performed root-end resection and preparation under local anesthesia on a lower left first molar; The root canal filling is placed within the new cavity to close the path of communication between the infected root canal system and periradicular structures with an intermediate restorative material. The lesion was fully enucleated and sent for histopathology. The 29-year-old female patient was followed up at 2 weeks, 3 and 6 months presenting as a functional and symptomless tooth. Radiographic findings showed a clear and progressive refilling of the cavity with bone. All these factors highlight a positive prognosis for the tooth after periradicular surgery, which is now considered a valid treatment to keep the tooth as a functional unit in the oral cavity.

Trigeminal neuralgia (TN), also known as tic doloureaux, is a nerve disorder of the face and is considered to be one of the most painful human conditions. A 51-year-old male presented with severe intermittent pain on the left side of his face. Magnetic resonance image scan with contrast revealed a close association of the superior cerebella artery and the trigeminal nerve on the left side of the face. Oral medication is the first line of treatment for TN, because of its non-invasiveness, low cost and high effective rate. Surgical intervention for TN aims to relieve the pressure of the offending artery or vein that is compressing the trigeminal nerve or in other instances; surgery may stop the uncontrolled pain signals. An important criterion for clinical diagnosis is pain that cannot be attributed to another disorder and also the lack of evident neurologic disorder. TN is one of the most debilitating diseases an individual may suffer and an early astute diagnosis of TN will provide patients with relief from suffering, unnecessary dental and medical intervention. Appropriate and early diagnosis of TN is important to formulate an optimal management plan based on the patient’s age and general condition. The aim of this case report is to describe a case of Classical TN, and subsequent successful surgical management with microvascular decompression.

Aim: The purpose of the study was to evaluate the effect of artificial accelerated aging on surface roughness and color stability of three recently introduced CAD/CAM materials. The hypothesis was that artificial accelerated aging would have an effect on surface roughness and color stability of tested materials.

Methods: A total of 21 ceramic discs were fabricated in this study, including translucent zirconia (InCoris TZI) and resin nano ceramic (Lava Ultimate) ceramic blocks for CAD/CAM and a set of bi-layered discs made of a zirconia CAD/CAM substructure (inCoris ZI) with VM9 hand-layered feldspathic veneering. Initial surface roughness measurements using a stylus profilometer and color measurements using a spectroradiometer were carried out. All specimens were subjected to artificial aging by means of a weathering process in a Weather-O-meter for 300 h. Additional surface roughness and color measurements were again carried out after artificial aging of the specimens. The Wilcoxon Signed Rank Test was conducted to determine significant differences in surface roughness among the 3 groups (α = 0.05).

Results: Lava ultimate specimens showed a statistically significant difference in surface roughness before and after artificial accelerated aging (P = 0.028). There was no statistical significance in surface roughness of both the translucent zirconia TZ1 (P = 0.499) and the InCoris ZI with VM9 veneering (P = 0.398) specimens before and after aging. The amount of color change in the 3 ceramic groups was also not significant.

Conclusion: Artificial accelerated aging did not affect the color stability of any of the 3 ceramic groups, however, it caused a significant decrease in the surface roughness of the resin nano ceramic group.

For thousands of years, humans have been using herbal remedies to cure and prevent various illnesses. Out of many herbal products, neem has numerous properties which have promoted its use in both the medical and dental fields. Use of neem has been mentioned in alternative medical specialties, such as Ayurveda, Unani and Homeopathic medicine. Endodontic therapy aims to eliminate microorganisms from the root canal system. In endodontics, irrigating solutions play a significant role because of their antimicrobial activity. Their use becomes even more significant when handling infected endodontic cases where a plethora of microbes is invading the root canal system. However, one has to be extremely cautious while using irrigating chemicals in endodontics, owing to their toxic effects, in case they extrude into periradicular tissue. For this very reason, the use of herbal irrigating solutions such as neem is being advocated worldwide. This article highlights the origin, taxonomy, chemical composition, and medicinal properties of the neem tree and its potential use as an irrigating solution in the field of endodontics.

Aim: The aim of this study was to compare the shear bond strength (SBS) of various adhesive systems to a bioactive dentin substitute Biodentine^® with different time intervals.

Methods: Three hundred and fifty cylindrical acrylic blocks with a hole (4 mm diameter and 2 mm height) were prepared. The holes were filled with Biodentine^®, and the specimens were allocated into 5 main groups according to waiting times (group 1, 12 min; group 2, 24 h; group 3, 48 h; group 4, 72 h; and group 5, 96 h). All specimens were stored at 37 °C with 100% humidity during the waiting time. Then each group was divided into 7 subgroups of 10 units each: subgroup 1, Prime&Bond NT™; subgroup 2, Single Bond Universal (self-etch mode); subgroup 3, Single Bond Universal (etch and rinse mode); subgroup 4, All-Bond Universal™ (self-etch mode); subgroup 5, All-Bond Universal™ (etch and rinse mode); subgroup 6, G-aenial Universal Bond™ (self-etch mode); and subgroup 7, G-aenial Universal Bond™ (etch-and-rinse mode). After the application of adhesive systems, compomer Dyract XP Bond^® was applied over Biodentine^® SBSs were measured using a universal testing machine. After the SBS test, the fractured surfaces were examined under a stereomicroscope at 25× magnification, and the data were analyzed with Kruskal-Wallis and Mann-Whitney U (with Bonferroni correction) tests.

Results: Biodentine^® exhibits lower shear bond strength values in the 12 min groups. No significant differences were observed between self-etch or etch-and-rinse bonding modes.

Conclusion: A 24-h waiting period after the mixing of Biodentine^® could be useful to obtain higher SBS measurements. Also, similar SBS values were observed for the universal adhesives regardless of application mode.

Aim: The purpose of the study was to evaluate the effect of artificial accelerated aging on surface roughness and color stability of three recently introduced CAD/CAM materials. The hypothesis was that artificial accelerated aging would have an effect on surface roughness and color stability of tested materials.

Methods: A total of 21 ceramic discs were fabricated in this study, including translucent zirconia (InCoris TZI) and resin nano ceramic (Lava Ultimate) ceramic blocks for CAD/CAM and a set of bi-layered discs made of a zirconia CAD/CAM substructure (inCoris ZI) with VM9 hand-layered feldspathic veneering. Initial surface roughness measurements using a stylus profilometer and color measurements using a spectroradiometer were carried out. All specimens were subjected to artificial aging by means of a weathering process in a Weather-O-meter for 300 h. Additional surface roughness and color measurements were again carried out after artificial aging of the specimens. The Wilcoxon Signed Rank Test was conducted to determine significant differences in surface roughness among the 3 groups (α = 0.05).

Results: Lava ultimate specimens showed a statistically significant difference in surface roughness before and after artificial accelerated aging (P = 0.028). There was no statistical significance in surface roughness of both the translucent zirconia TZ1 (P = 0.499) and the InCoris ZI with VM9 veneering (P = 0.398) specimens before and after aging. The amount of color change in the 3 ceramic groups was also not significant.

Conclusion: Artificial accelerated aging did not affect the color stability of any of the 3 ceramic groups, however, it caused a significant decrease in the surface roughness of the resin nano ceramic group.

Aim: The aim of this study was to compare the shear bond strength (SBS) of various adhesive systems to a bioactive dentin substitute Biodentine^® with different time intervals.

Methods: Three hundred and fifty cylindrical acrylic blocks with a hole (4 mm diameter and 2 mm height) were prepared. The holes were filled with Biodentine^®, and the specimens were allocated into 5 main groups according to waiting times (group 1, 12 min; group 2, 24 h; group 3, 48 h; group 4, 72 h; and group 5, 96 h). All specimens were stored at 37 °C with 100% humidity during the waiting time. Then each group was divided into 7 subgroups of 10 units each: subgroup 1, Prime&Bond NT™; subgroup 2, Single Bond Universal (self-etch mode); subgroup 3, Single Bond Universal (etch and rinse mode); subgroup 4, All-Bond Universal™ (self-etch mode); subgroup 5, All-Bond Universal™ (etch and rinse mode); subgroup 6, G-aenial Universal Bond™ (self-etch mode); and subgroup 7, G-aenial Universal Bond™ (etch-and-rinse mode). After the application of adhesive systems, compomer Dyract XP Bond^® was applied over Biodentine^® SBSs were measured using a universal testing machine. After the SBS test, the fractured surfaces were examined under a stereomicroscope at 25× magnification, and the data were analyzed with Kruskal-Wallis and Mann-Whitney U (with Bonferroni correction) tests.

Results: Biodentine^® exhibits lower shear bond strength values in the 12 min groups. No significant differences were observed between self-etch or etch-and-rinse bonding modes.

Conclusion: A 24-h waiting period after the mixing of Biodentine^® could be useful to obtain higher SBS measurements. Also, similar SBS values were observed for the universal adhesives regardless of application mode.

Trigeminal neuralgia (TN), also known as tic doloureaux, is a nerve disorder of the face and is considered to be one of the most painful human conditions. A 51-year-old male presented with severe intermittent pain on the left side of his face. Magnetic resonance image scan with contrast revealed a close association of the superior cerebella artery and the trigeminal nerve on the left side of the face. Oral medication is the first line of treatment for TN, because of its non-invasiveness, low cost and high effective rate. Surgical intervention for TN aims to relieve the pressure of the offending artery or vein that is compressing the trigeminal nerve or in other instances; surgery may stop the uncontrolled pain signals. An important criterion for clinical diagnosis is pain that cannot be attributed to another disorder and also the lack of evident neurologic disorder. TN is one of the most debilitating diseases an individual may suffer and an early astute diagnosis of TN will provide patients with relief from suffering, unnecessary dental and medical intervention. Appropriate and early diagnosis of TN is important to formulate an optimal management plan based on the patient’s age and general condition. The aim of this case report is to describe a case of Classical TN, and subsequent successful surgical management with microvascular decompression.

Papillon-Lefévre syndrome (PLS) is a very rare autosomal recessive trait characterized by palmoplantar hyperkeratosis and severe generalized early-onset periodontitis leading to premature loss of both primary and permanent dentitions. The etiopathogenesis of the disorder is multifactorial with genetic, immunological, and microbial factors playing a major role. Other significant factors involved are environmental and reduced host defense mechanism. Consanguinity is a contributing factor because of its relevance to clinical genetics. The genetic defect underlying etiology of PLS is mutations of the gene 11q14-q21 encoding for cathepsin C, an enzyme involved in a variety of inflammatory and immune processes. Virulent pathogens and their toxins in the subgingival plaque play a major factor in the initiation and progression of PLS periodontitis. Dysfunction of leukocytes is secondary causative factor. Variable clinical expression, late onset of symptoms, and frequent gene mutations reflect the complexity of the syndrome. Today, over 300 cases been reported in dental and medical literature with more cases discovered among Arabs, Indians, and Africans. About 20%-25% of patients with PLS have increased susceptibility to infections besides overwhelming destructive periodontitis. Management of the disorder directed toward halting periodontal destruction by eliminating the reservoir of causative organisms; using conventional periodontal treatment, oral hygiene instructions, antiseptic mouth rinses; and systemic antibiotic. Skin lesions usually treated with topical application of emollients, keratolytic agents, steroids, and oral retinoid. Any attempt to achieve and preserve healthy oral conditions will improve quality of life in patients with this intriguing syndrome.

Aim: In the management of patients with discolored teeth, would home bleaching alone or in combination with in-office bleaching give better tooth color stability than in-office bleaching? This study aimed to test the effect of different bleaching techniques on color change, stability, and hypersensitivity.

Methods: A total of 21 patients were collected and randomly divided into 3 equal groups (n = 7), the first group in-office treatment with 25% hydrogen peroxide, the second group at-home bleaching with 9.5% bleaching treatment), and the third group in-office and at-home as a combined treatment. Testing for color stability was completed; at baseline, 1 day after, 1 week after, 1 month after, and 6 months after treatment using the VITA Easyshade^® spectrophotometer. Testing for hypersensitivity was completed; immediately after treatment, 24 h after, 48 h after, and 1 week after treatment using a visual analog scale.

Results: The current study found that there was no significant difference between mean values and standard deviation of the three bleaching techniques regarding color change (∆E) and stability in follow-up periods; hypersensitivity faded for all tested groups on a follow-up period of seven days.

Conclusion: The different tested bleaching techniques showed similar clinical efficiencies in a follow-up period of 6 months. Also, the different tested techniques showed equal color stability. The different tested techniques presented a similar degree of hypersensitivity which faded in the 7 days follow-up.

Aim: The aim of this study was to estimate the salivary cortisol levels in patients with oral lichen planus (OLP) and recurrent aphthous stomatitis (RAS) and to correlate it with their psychological profile using the Hospital Anxiety and Depression (HAD) scale.

Methods: The study population comprised of 60 patients - 20 with OLP, 20 with RAS and 20 healthy controls. Salivary cortisol levels were assessed using the chemiluminescent immuno assay technique. Anxiety and depression levels were evaluated using the HAD scale.

Results: The Kruskal Wallis mean ranks of salivary cortisol level in the OLP and RAS groups were 33.45 and 33.48 respectively and were higher than the mean rank of the control group with 24.58. But this difference was not statistically significant (P = 0.178). The mean ranks of anxiety score in the OLP and RAS groups were 36.48 and 39.50. The mean ranks of depression scores were 41.88 and 35.25 in the OLP and RAS groups respectively. The control group had a statistically significant lower mean ranks for anxiety and depression (P < 0.001). Anxiety and depression scores showed strong positive correlation in both patient groups.

Conclusion: The results suggest that anxiety and depression play a role in the pathogenesis of OLP and RAS. The role of salivary cortisol as a biomarker of stress remains to be validated. Patients suffering from psychosomatic diseases such as OLP and RAS need a comprehensive and holistic treatment approach to manage effectively the psychosocial factors involved in the disease process.

Since the turn of the century a paradigm shift has challenged the centuries old tradition of non-surgical treatment for condylar fractures. The advent of functionally stable osteosynthesis introduced into condylar traumatology in the 1980ies step by step widened out the indications for surgical treatment, paralleled also by improvement in computerized tomography diagnostics and more recently by continuous refinement of indication-specific osteosynthesis materials, with three-dimensional-plates for the condylar base and neck and resorbable materials for the condylar head being the latest developments. Over the last decades, a series of new approaches was introduced, too, to cope with the specific demands for open reduction and rigid internal fixation (ORIF) in the different fracture locations, which according to the recent consensus based Arbeitsgemeinschaft für Osteosynthese comprehensive injury automatic classifier (AOCOIAC) classification are now defined as fractures of the condylar base, condylar neck and condylar head. By now even fractures of the condylar head, treated surgically by Rasse already in 1992, have moved into the focus of surgical interest and ORIF by now is far from being “experimental”, as dubbed only a decade ago. According to recent consensus (International Bone Research Association, 2012) and based on improved evidence, ORIF may now be considered as the golden standard for both displaced or dislocated condylar base and neck fractures in adults. Endoscopic approaches should be considered for base fractures with lateral displacement. Meanwhile, there is a growing tendency to perform ORIF in condylar head fractures and severely displaced or dislocated fractures in younger children with mixed dentition.

Alfred Stille said, “Medicine, like all knowledge has a past as well as a present and a future…in that past is the soil out of which improvement must grow.” This original paper will review how past successes and failures have led to the development of improved temporomandibular joint replacement devices. Future considerations and challenges will be presented.

Temporomandibular joint (TMJ) internal derangement (ID) is the most prevalent indication for surgery among TMJ pathology. Generally considered the literature lacks studies with the highest evidence -which is mainly supported by systematic reviews and randomized controlled trials- regarding the usefulness of surgery in the management of TMJ ID. The objective of the present manuscript is to report the actual knowledge in terms of surgical treatment of TMJ ID considering scientific evidence criteria. A non-systematic review in the literature in relation to the degree of the existing scientific evidence regarding the uselfuness of surgery for the treatment of ID of the TMJ is performed. A bibliography search on MEDLINE, EMBASE and the Cochrane library databases for studies published from March 2000 to March 2019 was conducted. The author only included studies published in the English language and those dealing with “surgical treatment of temporomandibular internal derangement”; The following technical bibliographic exclusion criteria were applied: (1) case reports; (2) technical report; (3) animal or in vitro studies; (4) review articles; (5) uncontrolled clinical studies; and (6) publications in which the same data were published by the same group of researchers. The abstracts of yielded results were reviewed and the full text of those with apparent relevance was obtained. Several results must be highlighted from the evaluation of the literature with the highest degree of evidence: (1) high-degree evidence is insufficient in relation to the effect of surgery; (2) surgery is useful in patients refractory to conservative treatment; (3) there are not differences among surgical techniques; (4) arthroscopy and arthrocentesis are effective in the treatment of chronic closed lock of the TMJ. Surgical treatment of the TMJ based on evidence is present in a moderate degree, as studies with the highest evidence are scarce. Specially for patients with TMJ ID, surgical treatment must be highly supported by the results of large series by experienced surgeons and recommendations from societies of experts in TMJ surgery.