The surgery-first approach (SFA), which proceeds without presurgical orthodontic treatment, is assumed to shorten the treatment course because the direction of post-surgical orthodontic tooth movement conforms to the normal muscular forces. Moreover, the regional acceleratory phenomenon (RAP), evoked by surgery, helps in tooth alignment and compensation in a faster way. Although SFA has definite advantages, especially in class III individuals, there is a lack of data about its indications in patients with facial asymmetry. In this article, we reviewed recently published articles on the treatment of asymmetric patients using the SFA. Different aspects, including the three-dimensional assessment of stability in different planes, approaches for fabrication of a surgical splint, predictability of the results, skills needed for bimaxillary surgery, indications as the treatment of choice for condylar hyperplasia, and combination with distraction osteogenesis in candidates with severe asymmetries were found to be the main topics discussed for patients presenting with facial asymmetry

Background. Orthodontic tooth movement (OTM) occurs in the alveolar bone; therefore, any condition affecting bone quality can alter OTM. This study aimed to evaluate the effect of amitriptyline on OTM in rats. Methods. Forty-five male Wistar rats were randomly divided into three groups: (I) no injection, (II) injection with saline solution, and (III) injection of amitriptyline. Next, a 60-gr force was applied to the maxillary left first molar tooth of all the rats, using a nickel‒titanium closed-coil spring ligated between the maxillary incisors and the left first molar tooth. The rats were sacrificed after 21 days to measure OTM and perform histological analysis to determine the number, width, and depth of resorptive lacunae, osteoclast counts, and periodontal ligament (PDL) width. Results. The highest and the lowest OTM rates were found in the control and amitriptyline groups, respectively; however, there was no significant difference between the study groups in this regard. Histological analysis showed a significantly lower number of resorption lacunae in the amitriptyline group than the saline group. Conclusion. Although no significant difference was noted in OTM after amitriptyline administration, a reduction in the number of resorptive lacunae in rats injected with amitriptyline suggests that amitriptyline affects the bone tissue at the cellular level.

Introduction: Remineralizing agents may be used for the treatment of white spot lesions (WSLs) prior to bracket bonding. However, some concerns exist regarding their possible interference with the etching and bonding process, negatively affecting the bond strength. This study aimed to assess the effect of two remineralizing agents with/without CO2 laser irradiation on the mechanical properties and shear bond strength (SBS) of demineralized enamel to the orthodontic bracket. Methods: This study evaluated 60 premolar teeth in 6 groups (n=10) as follows: (I) sound enamel, (II) demineralized enamel, (III) Nupro remineralizing agent (N), (IV) Nupro and CO2 laser (N/L), (V) Teethmate remineralizing agent (T), and (VI) Teethmate and CO2 laser (T/L). The remineralizing agents were applied to the enamel surfaces after their immersion in a demineralizing solution for 5 days. In groups IV and VI, the CO2 laser with a 10.6 μm wavelength, 10 ms pulse duration, a 50 Hz repetition rate, 0.3 mm beam diameter and 0.7 W power was irradiated after applying the remineralizing agents. Brackets were bonded to the enamel surfaces and SBS was measured by a universal testing machine. For the assessment of enamel microhardness, 20 sections of molar teeth were divided into 4 groups (n=5; N, N/L, T, T/L) and their microhardness was measured before demineralization, after demineralization and after remineralization. X-ray diffraction (XRD) analysis, field-emission scanning electron microscopy (FESEM) and energy-dispersive spectrometry (EDS) were carried out to assess the formation of hydroxyapatite. The atomic percentages of the C, O, P, Ca, Na, Si, F and Ca/P ratio were determined by EDS analysis. Results: The SBS significantly decreased in group II (P<0.001). There was no significant difference among the groups I, III, IV, V and VI (P<0.05). This finding was similar to the microhardness results, which showed an increase in microhardness after remineralization (P<0.05), with no difference among the remineralizing agents. The Ca/P ratio was the highest in the Nupro group and the lowest in the demineralized group. Conclusion: Remineralizing agents can significantly improve the microhardness and structural properties of demineralized enamel to a level similar to that of sound enamel with no adverse effect on SBS to orthodontic brackets.

| INTRODUC TI ONWith regard to advancements in adhesive systems and bonding procedures, successful resin composite restorations show high retention, low post-restorative sensitivity, low degree of microleakage, and increased fracture resistance of the restored tooth and restoration. Despite the reliable adhesion to enamel, the resin-dentin bond is more difficult and less predictable. Different dentin bonding systems have been introduced and their usage can have a vital role on the quality and durability of the resin-dentin bond. 1 In addition, many materials have been advocated for dentin pretreatment due to their antibacterial or desensitizing effects. One of the other factors influencing resin-dentin bond strength and its durability is the degradation of exposed collagen fibers by the matrix metalloproteinase (MMP) in the saliva or those secreted from bacteria. 2 The presence of MMP inhibitors in chlorhexidine has been Abstract Aim: The aim of the present study was to investigate the effect of different dentin pretreatments on the interfacial fracture toughness of a self-adhesive flowable composite to dentin compared with that of a conventional flowable composite.Methods: Caries-free human molars were sectioned to expose the underlying dentin and were randomly divided into seven groups (N = 12) of dentin pretreatments bonded to a self-adhesive flowable composite (Vetise Flow, VF) or a conventional flowable composite (Clearfil Magesty Flow, CM). For VF; Control group (group C-VF), there was no pretreatment, self-etching primer (SP), oxalate dentin desensitizer (OX), and chlorhexidine gluconate (CH) were used. For CM; SP (group SP-CM), OX followed by SP (OX-CM), and CH followed by SP (CH-CM) were used. The interfacial fracture toughness was measured using a universal testing machine. Data were analyzed by Kruskal-Wallis test and analysis of variance.Results: For VF, the fracture toughness of SP-VF was significantly higher than that of other groups. For CM, a significantly higher fracture toughness for SP-CM than that of OX-CM was found. For all dentin pretreatments, the fracture toughness values were significantly higher for CM compared with the VF. Conclusions:The self-adhesive flowable composite had reduced bonding efficacy to dentin compared with that of the conventional flowable composite, regardless of the type of dentin pretreatment. K E Y W O R D Schlorhexidine, dentin desensitizer, flowable composite, fracture toughness, self-adhesive

Background: It is important to adhere to infection control measures in dental procedures due to direct contact with blood and saliva. During the Coronavirus disease 2019 pandemic, regular surveillance is imperative to ensure adherence to the standards. This study aimed to assess the level of adherence to infection control guidelines in specialized dental clinics in different working shifts. Materials and Methods: This study was assessed the level of adherence of 45 selected dental departments to three main guidelines released by (I) the Center for Disease Control (CDC), (II) Ministry of Health (MOH), and (III) armed forces organization (AFO) in three different working shift. The CDC checklist had eight domains. Thus, the items of each domain were individually scored, and considering the weighting coefficient of each item, the total score was calculated. The same procedure was carried out for the two remaining guidelines. Possible effect of working shifts and different specialties on infection control practice was also calculated. Results: The mean rate of adherence was 70.7% to the CDC, 93.8% to the MOH and 84.4% to the AFO guidelines indicating that adherence to the CDC guidelines was lower than the other two domestic guidelines. Individual assessment of each item revealed that hand hygiene (39%) and safe handling and disposal of sharp instruments (46%) acquired the lowest, and sterilization (79%) and safe injection (97%) acquired the highest score according to the CDC checklist. There was no relationship between working shifts and dental specialties regarding the adherence to infection control standards. Conclusion: Dental clinics had different performances regarding infection control guidelines. Further emphasis should be placed on hand hygiene and disposal of sharp instruments.