Background The plant Salvadora persica (miswak) has a long history of use in oral hygiene. Associations between the use of Salvadora persica and decreased oral bacteria numbers and plaque scores have been reported. This systematic review and meta-analysis assessed the ability of Salvadora persica mouthrinses to reduce plaque/cariogenic bacteria, in comparison to that of chlorhexidine and/or placebo rinses. Methods A comprehensive literature search for clinical trials reporting the use of Salvadora persica rinses as an antibacterial and/or antiplaque agent in comparison with chlorhexidine and/or placebo rinses was conducted, with no restriction to language. MEDLINE-PubMed, Cochrane Central Register of Controlled Trials, Wiley Online Library, ScienceDirect, and Google Scholar databases were searched to include all articles published up to December 2018. Based on inclusion/exclusion criteria, data were extracted from the identified reports by two independent reviewers. The primary and secondary outcomes measured from the eligible studies were mean plaque scores and mean cariogenic bacterial counts, respectively. Risk of bias of these studies was assessed. A statistical test of homogeneity was used to determine if the results of the separate studies could be combined. Based on the chi-square test, an inconsistency coefficient was computed (I 2 statistic). Sensitivity analyses using subgroups and homogeneity evaluation were conducted. Results A total of 1135 potentially eligible articles were identified, of which 19 were eventually included in the qualitative analysis whereas 18 were included in the quantitative meta-analysis. The meta-analysis showed that Salvadora persica rinses exhibited strong antiplaque effects ( P < 0.00001, MD: 0.46, and 95% CI: 0.29 to 0.63). In addition, it had statistically significant anti-streptococcal ( P < 0.0001, MD: -1.42, and 95% CI: -2.08 to − 0.76) and anti-lactobacilli effects ( P < 0.00001, MD: -1.12, and 95% CI: -1.45 to − 0.79) when compared to placebo. However, its effects were inferior compared to those by chlorhexidine rinse ( P = 0.04, MD: 0.19, and 95% CI: 0.01 to 0.37). Subgroup analyses yielded results similar to those prior to subgrouping. Conclusion The use of Salvadora persica extract was associated with a significant reduction in the plaque score and cariogenic bacterial count. Although, this reduction was lower than that achieved with the gold standard chlorhexidine mouthwash, Salvadora persica -containing rinse could be considered as a suitable oral hygiene alternative for use in individuals of all ages, socioeconomic backgrounds, and health con...

Despite improvements in dental adhesive materials, internal adaptation remains a challenge in bonded restorations. The aim of this study was to compare microgaps and internal floor adaptation between two different self-etch adhesives in class-V cavities using cross-polarization optical coherence tomography (CP-OCT). In this in vitro study, standardized round class-V cavities were prepared in 20 non-carious human upper central incisor teeth. They were randomly divided into two groups, TN and SE, with each group receiving a different dental adhesive. In TN group, the adhesive used was all-in-one Tetric N-Bond Self-Etch (TN; Ivoclar/Vivadent, Liechtenstein), while SE group was bonded with two-step self-etch Clearfil SE Bond 2 adhesive (SE; Kuraray Noritake Dental Inc, Japan). The prepared cavities were restored with flowable composite and then stored in distilled water for 24 h. Next, they were immersed in silver nitrate, followed by immersion in a photo-developing solution. Optical comparison was carried out by CP-OCT to assess microgaps and composite adaptation at the cavity floor. A Mann-Whitney test was applied to the data, which showed a statistically significant difference in composite adaptation among the two groups (p < 0.001) with the SE group showing superior adaptation. CP-OCT is a reliable tool for non-invasive imaging that gives an insight into composite performance. Better adaptation was found with the two-step self-adhesive for the composite used in this study.

Purpose: The aim was to compare the porosity of different bulk-fill resin-based composites (RBCs) placement techniques to the conventional incremental technique using microcomputed tomography (μ-CT). Methods: Occlusal cavities were prepared on extracted human molars that were allocated into five placement technique groups (n=10): Monoblock-two-step technique: SureFil SDR flow+Ceram.X; Monoblock with sonic activation technique: SonicFill2; Monoblock-one-step technique: Tetric EvoCeram Bulk-Fill; Monoblock-two-step technique: Tetric EvoFlow Bulk-Fill+Tetric EvoCeram Bulk-Fill, and incremental technique: Filtek Z250. The number, volume of closed pores, and the total porosity was evaluated (μ-CT). Data were analyzed with analysis of variance on ranks (Student-Newman-Keuls method and Mann-Whitney rank-sum test) to verify the RBC viscosity and the socination placement technique significance. Porosity characteristics correlation was performed (Spearman correlation) (α= 0.05). Results: The SonicFill2 group presented a higher number of closed pores than the other groups (p<0.05). The volume and total porosity characteristics were similar among all groups (p>0.05). The overall porosity within the restoration bulk seemed greater in the following order: Filtek Z250>SonicFill2>Tetric EvoFlow Bulk-Fill+Tetric EvoCeram Bulk-Fill>Tetric EvoCeram Bulk-Fill>SureFil SDR Flow+Ceram.X. Sonication tended to increase the number (p=0.005) and volume (p=0.036) of closed pores. Increased viscosity of the materials tended to increase the closed pores volume (p=0.036). There was a strong correlation between the number and volume of closed pores (R2=0.549, p<001). Conclusions: The different placement techniques resulted in significantly less internal porosity than the monoblock with sonic activation technique (SonicFill2). Sonication during application contributed to the higher number and volume of closed pores than the passive bulk-fill RBCs application.