Journal of Baghdad College of Dentistry

Abstract: Background: This study aimed to evaluate the efficiency of Laser-Activated-Irrigation, XP-Endo Finisher, and Endo Activator irrigation protocols in removing the smear layer from root canal walls by evaluating the opening of the dentinal tubules in the coronal, middle, and apical thirds using scanning electron microscopy. Materials and Methods: Thirty single-rooted human anterior teeth were decoronated to a standardized length. The samples were prepared using the primary WavOne Gold rotary system and divided into 3 groups (n=10): Laser-Activated-Irrigation (LAI), XP Finisher and Endo Activator. In addi-tion to the control group, which was irrigated with a conventional syringe only. The teeth were split lon-gitudinally and examined under SEM at 1000x magnification. Images were taken at apical, middle, and coronal thirds. Data were analyzed using the Kruskal-Wallis test, with a significant p-value being less than 0.05. Results: Upon examining the removal of the smear layer in the root canal under 1000x magni-fication, there were no statistically significant differences in the coronal, middle, and apical third between the three studied groups. However, the study revealed significant differences compared to the control group. The LAI demonstrated a minimal smear layer and open dentinal tubules in the coronal and mid-dle thirds, however, a smear layer was still present in the apical third. The XP-Endo Finisher effectively produced a thin, homogeneous smear layer with fewer open dentinal tubules, particularly in the apical third. In contrast, the Endo Activator resulted in a uniform smear layer with minimal tubule exposure in the coronal third, but it covered over 50% of the apical third. No significant differences among root thirds were observed, and complete smear layer removal was not achieved in the apical third with any method. Conclusions: XP-Endo Finisher was the most effective method in removing the smear layer in the apical third. Endo Activator was found to be the best in the middle third. Finally, LAI was determined to be the most effective in removing the smear layer in the coronal third. In clinical practice, it is recommended to use different techniques for cleaning different parts of the canal. Conventional needles for irrigation are less effective. Using these advanced techniques can significantly improve root canal treatments.

Abstract: Background: New technologies have developed to allow newly created enamel caries to be remineralized. Silver nanoparticle (NP) products have a strong inhibitory and bactericidal effect. Silver ions may penetrate carious lesions, which may precipitate and cause enamel to harden. Objectives: This study evaluates and compares the effectiveness of the application of silver NPs with sodium fluoride solution on the microhardness of artifi-cially induced demineralization on the enamel surface in comparison with sodium fluoride alone. Materials and methods: Thirteen upper first premolars that were extracted for or-thodontic therapy were used. Each tooth was cleaned, inspected, polished, and painted with acid-resistant nail polish to create a circular window with a diameter of 2×2mm. Then it was soaked in a demineralizing solution for four days after that the teeth were divided in to three groups (A: untreated, B: treated with silver NPs and 5% sodium fluoride and C: treated with 5% sodium fluoride) groups were immersed for 4 minutes, and all stages were conducted under room temperature. A digital Vickers microhardness tester with a diamond indenter with 500 g of load applied for 30 s directed vertically to the enamel surface was used to measure microhardness. The Vickers microhardness test results show that the solution of sodium fluoride and silver NPs has higher microhardness ratings (mean surface micro-hardness [SMH] 286.837) than sodium fluoride alone (mean SMH 191.530) with significant P value = 0.00001. Conclusion: Using silver Silver nanoparticles with sodium fluoride is better than using sodium fluoride alone in increasing surface microhardness; thus, it is more promising in remineralizing enamel caries.

Abstract: Background: A single gene mutation causes beta-thalassemia, an autosomal recessive disorder. It is hemolytic anemia that needs constant blood transfusions for life. In children and adolescents with thalassemia major, no clear concepts are found concerning the association between beta-thalassemia and growth retardation is a common side effect. Saliva contains a variety of biochemists, which may affect the severity of dental caries. Aim: This research aimed to evaluate the link between β -thalassemia major, dental caries and growth impairment in relation to some salivary constituents. Materials and Method: As part of an investigation at the Basra/Iraqi Thalassemia Center, 40 thalassemic children aged 10 to 12 were compared to 40 healthy controls in terms of dental caries (who were the same age and gender as the study group). Anthropometric measurements were used to assess their physical development. A sample of unstimulated whole saliva was taken from each child to determine salivary calcium, phosphorus, and alkaline phosphatase enzyme concentrations. Result: For both the primary and permanent dentition, dental caries experience (dmft/DMFT) was higher among β-thalassemic children, with a statistically significant dif-ference. A higher percentage of thalassemic youngsters were found to be underweight. Alt-hough salivary constituents like calcium, phosphorus, and alkaline phosphatase enzyme were higher in the control group than in the study group, there was no statistically signifi-cant difference between the two groups. Conclusion: Dental caries and growth impairment were associated with beta-thalassemia major.

Abstract: Background: Fractures of endodontic files are one of the serious concerns affecting root canal treatment prognosis. Recently, countless innovations have been presented to optimize their microstructure and flexibility, reflected in different commercial brands. However, their performance has not been evaluated in complex root canals. Aim: To evaluate and compare the resistance to cyclic fatigue of three rotary endodontic files utilizing artificial canals designed with different angles and radii of curvature. Materials and Methods: sixty rotary instruments of the following types were used. Group I: Edge endo X7; Group II: Luster dent pliancy total solution; and Group III: Race Evo FKG. Instruments in each group were constrained into two subgroups (n=20) to be examined in artificial canals having a single curvature or a double curvature. The cyclic fatigue resistance of each rotary file was tested, where the number of cycles to fracture (NCF) and the fractured segment length (FL) were recorded. Results: In both single and double curvature canals, the Edge endo X7 files (9162.50 ± 441.14 and 2210.00 ± 341.07, respectively) demonstrated significantly higher resistance to cyclic fatigue than did the Race Evo FK (3866.66 ± 410.99 and 1825.00 ± 230.17, respectively) and Luster dent pliancy total solution (7077.77 ± 1001.84 and 1257.77 ± 126.95, respectively). However, in the double canal tests, the Luster dent pliancy total solution had a greater mean NCF than the Race Evo FK. In relation to the FL, there was no statistically significant difference between any of the groups, and only the edge of the Endo X7 file was significantly different between single- and double-curvature canals (P = 0.058). Conclusion: The Edge Endo X7 rotary file demonstrated greater cyclic fatigue resistance than did the Race Evo FKG and Luster dent pliancy total solution.

Abstract: Background: Periodontal disease is highly prevalent among insulin-resistant and type 2 diabetes mellitus (T2DM) subjects. However, the pathogenesis and associated factors of periodontal disease among these subjects are not well known. Recently, it has been re-ported that oxidative stress-antioxidant (redox) imbalance may play an important role in the pathogenesis of periodontal disease. Objective: Determine the relation between three salivary redox biomarkers; total antioxidant capacity (TAC), total oxidative status (TOS), advanced glycation end products (AGEs), and periodontal disease parameters in insulin resistance (IR) and controlled T2DM (C-T2DM) subjects. Methods: An analytical observational study was conducted on 180 participants aged between 35 and 65 years; males and females were di-vided into three groups, each consisting of 60 individuals: IR group, C-T2DM, and healthy control group. Periodontal parameters were examined: dental plaque index (PLI), bleeding on probing percentage (BOP%), probing pocket depth (PPD), and clinical attachment level (CAL), according to these, three subgroups presenting (healthy periodontium, gingivitis, or periodontitis) were conducted. Un-stimulated saliva was collected, and Enzyme-linked immunosorbent assay (ELISA) was used to determine salivary AGEs, while colorimetric assays were used to determine salivary TAC and TOS. The data were analyzed using SPSS version 21. Results: A significant correlation between TOS and PLI and an inverse correlation between TAC and PLI in the periodontitis subgroup of the control subjects were found. In multiple regression analysis, salivary AGEs and CAL were inversely associated in the C-T2DM group. Conclusion: Salivary TOS and AGEs were the highest in the periodontitis subgroup of the IR and C-T2DM groups, while the salivary TAC was found the lease in the both IR and C-T2DM groups when compared to the control group. In addition, there were a relationship between salivary redox biomarkers and periodontal parameters. However, salivary AGEs were considered a significant independent predictor for CAL in C-T2DM.

Abstract: Background: Dental biofilm-induced gingivitis is an inflammatory condition resulting from the interaction between dental plaque and the host's immune-inflammatory response at the site level. Objective: examine the anti-plaque and anti-inflammatory properties of GT/SP (Green Tea/Salvadora Persica Linn) mouthwash in individuals with dental biofilm-induced gingivitis. Moreover, a study was conducted to compare the effects of GT/SP with those of CHX (Chlorhexidine) and placebo mouthwashes, and to anticipate outcomes of plaque control together with proposing cut-off points for the predictors on the profile of the salivary biomarker IL-6. Material and Methods: The clinical trial was conducted using a randomized, double-blinded, and parallel design. A total of sixty patients diagnosed with generalized biofilm-induced gingivitis were randomly divided into three groups for the administration of mouthwashes: GT/SP, CHX, and placebo. The study lasted for one month, during which participants used 15 milliliters of GT/SP mouthwash formulation, CHX (0.12%), or a placebo, twice daily. Each individual had two assessments, one at the beginning and another after one month. Before and after each participant’s mouthwash usage, the Patient's plaque level and bleeding on probing were assessed. The quantification of the Salivary IL-6 in saliva was assayed using enzyme-linked immunoassay (ELISA). Results: A significant decrease in salivary interleukin-6 was observed in all three groups. However, there was no significant difference between the GT/SP and CHX groups in intergroup comparisons at second visits (P>0.05). In addition, all treatments significantly decreased the build-up of Plaque, with the mouthwash containing Green Tea (GT) and Salvadora Persica Linn (SP) having a more pronounced effect compared to the other two treatments. Conclusion: Mouthwash with GT/SP exhibited both anti-plaque and anti-inflammatory properties. The above findings suggest that GT/SP may have positive effects in treating dental biofilm-induced gingivitis, making GT/SP a suitable alternative to chlorhexidine.

Abstract: Background: To compare autologous platelet concentrates (platelet-rich plasma [PRP] and platelet-rich fibrin [PRF]) with conventional induced blood clot (BC) and other scaffold approaches in regenerative endodontic therapy (RET) for necrotic immature permanent teeth. Data: Randomized controlled trials (RCTs) reporting clinical outcomes and/or radiographic measures of continued root development (e.g., root length, dentinal wall thickness, apical closure, periapical healing) after RET. Sources: A systematic search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar was conducted for studies published from February 2015 to February 2025. Reference lists of included studies were hand-searched. The review followed PRISMA 2020 reporting guidance. Study selection: Eligible studies were human RCTs evaluating PRP and/or PRF as a scaffold for RET in necrotic immature permanent teeth, with a comparator scaffold (BC or another platelet-derived scaffold). Two reviewers independently screened and selected studies. Six RCTs met the inclusion criteria. Conclusions: Across six small-to-moderate sized RCTs, platelet concentrates achieved high clinical survival and infection control comparable to BC. Radiographic outcomes (root length and wall thickening, apical closure, and periapical healing) were inconsistently reported and variably favored PRP/PRF or showed no between-group differences. Substantial methodological and clinical heterogeneity (protocols, imaging modalities, outcome definitions, and follow-up) limited quantitative synthesis. Standardized RET protocols and a core outcome set, with validated radiographic measurements (including CBCT where feasible), are needed to determine whether platelet concentrates provide clinically meaningful advantages over BC.