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Effectiveness of Piper longum Extract as Natural Irrigant on Antimicrobial Properties and Smear Layer Removal: A Scanning Electron Microscope Study

J Contemp Dent Pract. 2025 Nov 1;26(11):1073-1078. doi: 10.5005/jp-journals-10024-3875.

ABSTRACT

AIM: This study aims to evaluate the antimicrobial effectiveness and smear layer removal of Piper longum extract as a natural irrigant in root canal therapy compared to ethylenediaminetetraacetic acid (EDTA), a commonly used irrigant.

MATERIALS AND METHODS: A total of 0.5 gm of powdered P. longum fruit was extracted using distilled water and heat. Eighteen freshly extracted human maxillary central incisors were selected and decoronated to a length of 16 mm. Root canals were prepared and divided into two groups (n = 9 each): Group I was treated with 17% EDTA (control), and group II was treated with P. longum extract (test). Irrigants were activated using gutta-percha cones. Samples were sectioned for SEM evaluation at coronal, middle, and apical regions. SEM imaging was performed at ×200 (debris) and ×1,000 (smear layer). The antimicrobial analysis was done by incubating a fresh suspension of microorganisms, and the sterile wells bored were filled with varying concentrations of P. longum, and inhibition zones were measured using a vernier caliper for positive, negative, and experimental groups. Data were recorded and statistically analyzed using SPSS software.

RESULTS: Mean smear layer scores were 2.11 ± 0.60 EDTA and 1.66 ± 0.70 (P. longum). Mean debris scores were 2.22 ± 0.44 EDTA and 2.11 ± 0.33 (P. longum). Piper longum demonstrated enhanced smear layer removal and comparable debris clearance. Antimicrobial zones of inhibition for P. longum at 150 µL ranged from 12 mm (Streptococcus mutans) to 11 mm (Candida albicans), comparable to the positive control, ampicillin (bacteria) and fluconazole (fungi). The differences in inhibition zones between P. longum and the positive control were statistically significant (p < 0.05). No zones were observed for negative controls (distilled water).

CONCLUSION: Piper longum extract demonstrated substantial efficacy in removing the smear layer and reducing microbial load within the root canal system, comparable to conventional EDTA.

CLINICAL SIGNIFICANCE: There is a growing need for biocompatible and sustainable alternatives to synthetic irrigants, which may cause adverse effects such as tissue toxicity or dentin erosion. This study explores the potential of P. longum, a natural herbal extract with known antimicrobial and anti-inflammatory properties, as an adjunctive irrigant in root canal therapy. How to cite this article: Varshasree S, Sinduja P, Manjesh D, et al. Effectiveness of Piper longum Extract as Natural Irrigant on Antimicrobial Properties and Smear Layer Removal: A Scanning Electron Microscope Study. J Contemp Dent Pract 2025;26(11):1073-1078.

PMID:41368747 | DOI:10.5005/jp-journals-10024-3875

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Prevalence and Patterns of Iatrogenic Damage to Adjacent Teeth during Fixed Prosthodontic Preparation

J Contemp Dent Pract. 2025 Nov 1;26(11):1067-1072. doi: 10.5005/jp-journals-10024-3974.

ABSTRACT

AIM: This study aimed to evaluate the prevalence, patterns, and severity of iatrogenic damage to adjacent teeth during fixed prosthodontic tooth preparation.

METHODOLOGY: A total of 126 teeth were assessed following fixed prosthodontic preparation procedures. The adjacent tooth surfaces were examined clinically to determine the level (degree), location, and type of damage on both mesial and distal surfaces. Damage severity was graded as normal, mild, or severe; locations were recorded according to the specific third of the surface involved, and damage type was categorized as abrasion, nick, or both. A Chi-square test was performed to explore differences based on tooth position (maxillary vs mandibular) and operator experience (clinicians, interns, and students).

RESULTS: Normal surfaces were the most frequently recorded finding, accounting for 155 (61.5%) of all assessed surfaces. Mild damage was observed in 77 (30.5%) of cases, while severe damage was less common in 19 (7.5%). The middle third of the proximal surface was the most affected site among damaged teeth. Nicks were the predominant damage type 66 (26.2%), followed by abrasion 21 (8.3%). Maxillary teeth exhibited more severe damage, particularly on mesial surfaces, whereas mandibular teeth more often remain undamaged. A statistically significant difference was observed based on operator experience; students recorded a higher frequency of both mild and severe damage compared to interns and clinicians.

CONCLUSION: Iatrogenic damage to adjacent teeth during fixed prosthodontic preparation was commonly observed, with mild damage and nicks affecting the middle third of the proximal surface being the most frequent. Severe damage occurred more on the maxillary mesial surfaces.

CLINICAL SIGNIFICANCE: Iatrogenic damage was more pronounced on maxillary mesial surfaces and occurred predominantly in preparations performed by less experienced operators. How to cite this article: Alharbi MF, Agwan MAS, Alrethia RA. Prevalence and Patterns of Iatrogenic Damage to Adjacent Teeth during Fixed Prosthodontic Preparation. J Contemp Dent Pract 2025;26(11):1067-1072.

PMID:41368746 | DOI:10.5005/jp-journals-10024-3974

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Berberine Induces Ferroptosis and Impairs Migration via Glutathione Peroxidase4/Six-transmembrane Epithelial Antigen of Prostate3 Signaling Pathway in Oral Cancer Cells

J Contemp Dent Pract. 2025 Nov 1;26(11):1050-1059. doi: 10.5005/jp-journals-10024-3971.

ABSTRACT

AIM: This study aims to examine the pro-apoptotic and anti-migratory effects of Berberine in KB-1 oral cancer cells and its role in ferroptosis via glutathione peroxidase4/six-transmembrane epithelial antigen of prostate3 (GPX4/STEAP3) signaling pathway.

MATERIALS AND METHODS: KB-1 cells were treated with Berberine, and cell viability was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Morphological changes were analyzed via phase-contrast microscopy, while nuclear fragmentation was examined using acridine orange/ethidium bromide (AO/EtBr) staining. Molecular docking, gene expression analyses were performed to assess ferroptosis markers. Wound healing and migration assays evaluated Berberine’s effect on cell migration.

RESULTS: Berberine reduced cell viability (IC50: 22.2 μM) and induced morphological changes, including shrinkage and membrane blebbing. AO/EtBr staining confirmed nuclear fragmentation. Gene expression analysis showed ferroportin upregulation and GPX4, STEAP3, and transferrin receptor 1 (TFR1) downregulation, validated by western blotting. Molecular docking confirmed strong Berberine binding, particularly with GPX4 and STEAP3. Wound healing and migration assays showed significant migration suppression. All experimental data were statistically evaluated using the Student’s t-test and one-way ANOVA.

CONCLUSION: Berberine induces ferroptosis and inhibits KB-1 oral cancer cell proliferation and migration by modulating the ferroptosis signaling pathway, suggesting its potential as a novel therapeutic agent.

CLINICAL SIGNIFICANCE: By promoting iron-dependent cell death and suppressing migratory capacity, Berberine may overcome resistance to conventional therapies and reduce metastatic progression. Its natural origin and prior safety profile support drug repurposing opportunities, though challenges such as poor bioavailability and systemic toxicity must be addressed. These findings provide a foundation for biomarker-driven preclinical and early clinical evaluations. How to cite this article: Alassiri S. Berberine Induces Ferroptosis and Impairs Migration via Glutathione Peroxidase4/Six-transmembrane Epithelial Antigen of Prostate3 Signaling Pathway in Oral Cancer Cells. J Contemp Dent Pract 2025;26(11):1050-1059.

PMID:41368744 | DOI:10.5005/jp-journals-10024-3971

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Assessment of Fatigue Resistance in Heat-treated Nickel-titanium Rotary Instruments with Single Canal Curvatures: An In Vitro Evaluation

J Contemp Dent Pract. 2025 Nov 1;26(11):1047-1049. doi: 10.5005/jp-journals-10024-3892.

ABSTRACT

AIM AND BACKGROUND: In a controlled, simulated root canal environment, this study examined and contrasted the resistance to cyclic fatigue of three heat-treated nickel-titanium (NiTi) rotary file systems. The goal of this work was to find systems with greater fatigue endurance because cyclic fatigue is a primary mode of instrument failure in current endodontics.

MATERIALS AND METHODS: A total of 30 NiTi rotary instruments-10 from Hero Gold, NeoEndo Flex, and T-Pro-were put to the test. The dimensions of all instruments were the same: Size 25, taper 0.04, and length 21 mm. A specially designed device simulated a 60° canal curvature (8 mm from the tip) was used. Time to fracture (TTF) was recorded while the instruments were run at the torque and speed recommended by the manufacturer until they failed. A conventional procedure was used to calculate cycles to fracture (NCF). Measurements of fragment lengths were made, and one-way ANOVA and post hoc analysis were used to evaluate the significance of the findings.

RESULTS: Hero Gold outperformed NeoEndo Flex and T-Pro regarding fatigue resistance, as evidenced by considerably higher TTF and NCF values (p < 0.05). There was no statistically significant difference in fragment lengths between groups, suggesting that instruments consistently failed in the same places.

CONCLUSION: Hero Gold rotary files displayed the best fatigue resistance, indicating enhanced performance and durability in root canal applications.

CLINICAL SIGNIFICANCE: Understanding the differences in fracture resistance aids clinicians in selecting the appropriate instrumentation system for curved canals. How to cite this article: Boreak N. Assessment of Fatigue Resistance in Heat-treated Nickel-titanium Rotary Instruments with Single Canal Curvatures: An In Vitro Evaluation. J Contemp Dent Pract 2025;26(11):1047-1049.

PMID:41368743 | DOI:10.5005/jp-journals-10024-3892

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Erbium Laser-assisted Access Flap Periodontal Surgery: Advancing Personalized Periodontal Care through Minimally Invasive Technologies

J Contemp Dent Pract. 2025 Nov 1;26(11):1025-1034. doi: 10.5005/jp-journals-10024-3965.

ABSTRACT

AIM: To evaluate the role of erbium lasers (Er:YAG and Er,Cr:YSGG) as adjuncts in access flap periodontal surgery and their potential contribution to personalized, minimally invasive periodontal care.

BACKGROUND: Periodontal surgery has progressively evolved toward minimally invasive techniques prioritizing tissue preservation, enhanced healing, and reduced morbidity. Erbium lasers represent a significant advancement by offering precise tissue ablation, improved decontamination, and favorable patient experiences compared to conventional approaches.

REVIEW RESULTS: Evidence shows that erbium lasers achieve clinical outcomes comparable to or better than traditional flap surgery. Benefits include reduced postoperative discomfort, minimized gingival recession (GR), and enhanced patient satisfaction. While gains in clinical attachment level are modest yet statistically significant in some studies, patient-reported outcomes (PROs) consistently favor erbium-assisted interventions.

CONCLUSION: Erbium lasers enhance access flap surgery by supporting precision, soft tissue preservation, and improved patient-centered outcomes. Current data suggest they are valuable adjuncts, though long-term trials are still needed to establish standardized protocols.

CLINICAL SIGNIFICANCE: Integration of erbium lasers into periodontal flap surgery supports personalized and minimally invasive care, aligning with modern principles of precision periodontics and improving both clinical and PROs. How to cite this article: Neophytou C, Neofytou AM, Davidopoulou S, et al. Erbium Laser-assisted Access Flap Periodontal Surgery: Advancing Personalized Periodontal Care through Minimally Invasive Technologies. J Contemp Dent Pract 2025;26(11):1025-1034.

PMID:41368740 | DOI:10.5005/jp-journals-10024-3965

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Health services and digital technologies used for mental health among a national cross-sectional sample of young people in Australia 2020-2022: Patterns and correlates within geographic regions

Aust N Z J Psychiatry. 2025 Dec 10:48674251389790. doi: 10.1177/00048674251389790. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the proportions and correlates of Australian young people who consulted with health professionals or used services via digital technologies for their mental health in 2020-2022.

METHODS: Data from 16- to 24-year-olds (N = 1620) in the 2020-2022 Australian National Survey of Mental Health and Wellbeing were analysed to estimate proportions, population counts and unadjusted odds ratios of past-year health professional consultations and use of services via digital technology for mental health within geographic regions. Logistic regression models explored socio-economic, psychosocial and clinically meaningful correlates of past-year consultation in the full sample, metro subgroup and regional, rural and remote subgroup.

RESULTS: In total, 24.2% of Australian young people consulted with a health professional for their mental health in the past year. Of those with a probable 12-month Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) mental health condition, 46.3% consulted a health professional. This proportion differed by sex (male: 34.2%, female: 55.6%) and symptom severity (mild: 20.0%, moderate: 47.8%, severe: 66.0%) but did not vary by geographic region. One-in-ten (9.9%) young people used other services via digital technologies for their mental health in the past year, doubling among those with a probable 12-month mental health condition (18.8%), and increasing with severity (mild or moderate: 14.2%, severe: 33.6%). Different factors were associated with service use in different regions.

CONCLUSION: Experiences of young people accessing mental health care in Australia differ by geographic region of residence, neighbourhood disadvantage, sex and disorder class. Australia’s mental health care system must facilitate diverse pathways to care that are responsive to young people’s needs and preferences.

PMID:41368729 | DOI:10.1177/00048674251389790

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Internal fit and fracture resistance of different CAD-CAM surveyed ceramic crowns: In vitro comparative analysis

J Prosthodont. 2025 Dec 10. doi: 10.1111/jopr.70066. Online ahead of print.

ABSTRACT

PURPOSE: The success of removable partial dentures (RPDs) depends on well-designed abutments or surveyed crowns. Advances in computer-aided design and computer-aided manufacturing (CAD-CAM) technology have made all-ceramic materials viable alternatives to traditional ceramo-metal surveyed crowns, but their performance, particularly regarding internal fit and fracture resistance, requires further studies, especially with different rest seat preparations simulated on the abutment dies. This study evaluated the internal fit and fracture resistance of CAD-CAM ceramic crowns with wide and narrow rest seat designs to assess their potential as surveyed crowns for RPDs.

MATERIALS AND METHODS: Sixty mandibular premolar abutment dies were modified to simulate narrow and wide occlusal relief designs and were divided into six groups based on the design (wide/narrow) and material type: force-absorbed hybrid ceramics (HC), zirconium lithium silicate (ZLS), and lithium disilicate glass-ceramic (LDC). CAD-CAM ceramic crowns were fabricated, milled, and analyzed for internal fit using Geomagic Control X software. Fracture resistance in newton (N) was tested using a universal testing machine. Scanning electron microscopy (SEM) was employed to examine fracture morphology. Statistical analyses included two-way analysis of variance (ANOVA) and post hoc Tukey’s test (α = 0.05).

RESULTS: The LDC group had the highest fracture resistance, while ZLS and HC showed no significant difference [F(2) = 10.523, p < 0.001]. Internal fit did not significantly differ between materials [F(2) = 0.381, p = 0.686], though LDC had a slightly larger internal gap. Rest seat design significantly affected both fracture resistance and internal fit [F(1) = 68.581, p < 0.001; F(1) = 11.185, p = 0.002], with wide designs showing higher fracture resistance and narrow designs having larger internal gaps. SEM revealed crack propagation originating from rest seat bases, with longer crack lines observed in wide rest designs.

CONCLUSION: Rest seat design significantly influences the fracture resistance and internal fit of CAD-CAM ceramic crowns. Wide rest seat designs provide superior fracture resistance compared to narrow designs, while narrow seats exhibit larger internal gaps, potentially compromising restoration longevity.

PMID:41368727 | DOI:10.1111/jopr.70066

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Cost-efficiency of digital versus conventional workflow for removable complete dentures: A systematic review and meta-analysis

J Prosthodont. 2025 Dec 10. doi: 10.1111/jopr.70074. Online ahead of print.

ABSTRACT

PURPOSE: To compare the cost-efficiency of digitally designed and manufactured removable complete dentures (RCDs) with conventionally fabricated RCDs through a systematic review and meta-analysis.

METHODS: A comprehensive electronic and manual search was performed in PubMed, Embase, Web of Science, and Scopus up to February 10, 2025. Eligible studies included clinical trials and cohort studies comparing cost-related outcomes of digital and conventional RCD workflows. Primary outcomes were laboratory, clinical, and total costs; secondary outcomes included the number of treatment sessions. Meta-analyses were conducted using random-effects models. Risk of bias was evaluated using standardized tools.

RESULTS: Four retrospective studies and one prospective study, including 184 patients, met the inclusion criteria. No statistically significant differences were observed between digital and conventional workflows in laboratory costs (mean difference [MD]: -239.77 (2025 USD); p = 0.1063), clinical costs (MD: 74.39 (2025 USD); p = 0.4514), total costs (MD: -357.76 (2025 USD); p = 0.2577), or treatment sessions (MD: -1.47; p = 0.3514). Operator experience significantly influenced clinical costs (p < 0.0001) and the number of sessions (p = 0.0001).

CONCLUSION: Within the limitations of the available evidence, digital and conventional workflows for RCD fabrication demonstrated comparable cost-efficiency. Although digital workflows may reduce the number of sessions when performed by experienced clinicians, the current evidence is insufficient to establish a clear cost-efficiency advantage.

PMID:41368723 | DOI:10.1111/jopr.70074

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Evaluation of Skin Biopsy Techniques for the Diagnosis of Systemic Amyloidosis

J Dermatol. 2025 Dec 10. doi: 10.1111/1346-8138.70099. Online ahead of print.

ABSTRACT

Systemic amyloidosis is a multisystem disorder that requires histological confirmation of amyloid deposition in at least one organ for a definitive diagnosis. While biopsies of organs such as the myocardium provide high diagnostic accuracy, they are highly invasive and technically demanding. Thus, skin biopsies are frequently performed as a less invasive alternative. However, when skin biopsies fail to detect amyloid depositions, more invasive procedures-such as gastrointestinal or myocardial biopsies-are often required. Despite the clinical importance of improving diagnostic yield, few studies have systematically evaluated optimal skin biopsy techniques. Then, we conducted a retrospective observational study of 100 patients who underwent skin biopsies for suspected systemic amyloidosis at Kobe University Hospital between April 2014 and November 2024. In this study, two skin biopsy methods were analyzed: Punch biopsies from multiple random sites (1-5 sites) using Dermapunch (“punch (multiple-punch) biopsy”), and spindle-shaped biopsy of long axis approximately 10 mm or more (“incision (spindle-shaped) biopsy”). As a result, among 69 cases diagnosed as systemic amyloidosis based on amyloid detection in any organ, including the skin, 13 of 28 punch biopsies (46.4%) were positive, and 21 of 41 incision biopsies (51.2%) were positive. The difference in sensitivity was not statistically significant (p = 0.81), but incision biopsies showed a numerically higher sensitivity. Furthermore, fatty tissue was the most common amyloid deposition site, with a mean depth of 5.1 mm. In two cases, depositions were found at a depth of approximately 12 mm. In this study, no significant difference was observed in the diagnostic yield between the two biopsy methods. However, because amyloid depositions may occur deep within subcutaneous fat and incision biopsy enables deliberate and consistent sampling of this layer, it potentially improves diagnostic accuracy. We, therefore, recommend incision biopsy as the preferred method for diagnosing systemic amyloidosis.

PMID:41368718 | DOI:10.1111/1346-8138.70099

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Using the Health Belief Model to Examine Parental Knowledge and Health Beliefs About Human Papilloma Virus (HPV) and iHPV Vaccine in Kuwait: Cross-Sectional Survey Study

JMIR Public Health Surveill. 2025 Dec 9;11:e75818. doi: 10.2196/75818.

ABSTRACT

BACKGROUND: Cervical cancer (CC) is a major public health issue, accounting for approximately 350,000 deaths, around 7.5% of all female cancer deaths worldwide, in 2018. Human papillomavirus (HPV) is the most common virus infecting the reproductive system. Despite the high number of diagnosed cases of CC globally, prevention is possible. Vaccination against HPV is considered to be a primary prevention strategy, while cervical screening can also play a secondary prevention role.

OBJECTIVE: This study aimed to examine the knowledge and health beliefs of parents in Kuwait towards HPV and HPV vaccination in order to prepare for the development of a national policy on CC.

METHODS: A cross-sectional survey was conducted among a representative multistage sample of 538 parents and guardians of eligible children aged 12-17 years in Kuwait, yielding a response rate of 89%. The survey was structured using the health belief model. Analysis showed statistically significant links between knowledge, health beliefs, concepts, and vaccination intention.

RESULTS: Knowledge of HPV and HPV vaccination was low in our study population: 55.6% (n=297), 24.9% (n=133), and 19.5% (n=104) for poor, fair, and good knowledge, respectively. Parents of daughters scored lower on perceived susceptibility to HPV and were more likely to have a higher perception of barriers to HPV vaccination, even though fathers were more likely to believe their daughters were at risk. HPV vaccination has the stigma of promiscuity attached, even though half of the parents are willing to accept HPV vaccination if that recommendation comes from Uhealth officials or relatives. A greater proportion of parents with female children had a low perception of the severity of HPV infection compared to those with male children (n=154, 58.6% vs n=134, 49.4%; P=.043). Around 52% (n=278) of parents perceived a high benefit of HPV vaccination. Parents with a female child had a lower perception of HPV vaccine benefits compared to parents with a male child. The findings demonstrated that parents with higher levels of education were better informed about the use of HPV vaccines in controlling the illness. Parents with female children were 1.34 times more likely to act on the recommendation for HPV vaccination compared to parents with male children after a recommendation from an official source, such as doctors or healthcare professionals.

CONCLUSIONS: Recommendations for a Kuwaiti vaccination policy for HPV must take into consideration different knowledge levels of parents for groups with different educational levels, as well as the stigma of promiscuity and other barriers, and various health beliefs regarding susceptibility for daughters and sons, respectively.

PMID:41368717 | DOI:10.2196/75818