Background: Deep bites represent one of the most difficult cases in orthodontic treatment. In growing patients, strategies for deep bite correction include extrusion of posterior teeth and intrusion of incisors, which can be achieved using anterior bite plates. This case report presents the treatment of a deep bite in a growing patient using an anterior bite plate. Case Report: A 13-year-old female presented with a convex profile, short lower facial height, a Class II skeletal relationship, a deep bite (6 mm overbite), a 6 mm overjet, and severe crowding on both arches. The patient was treated with a removable anterior bite plate in conjunction with a fixed appliance. A normal overbite (2 mm) was achieved, severe crowding was corrected on both arches, the lower facial height was increased, the interincisal angle remained favorable, the mandibular incisors were well positioned in the basal bone, and the smile esthetics improved. Conclusion: The use of an anterior bite plate in combination with fixed appliances is effective in treating deep bites in a growing patient.

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Background: Tooth loss in individuals more commonly occurs with increasing age. In a dental practice, many patients present with torus palatinus, which is usually caused by problems and complications resulting from denture fabrication. Therefore, a nonsurgical approach in which horseshoe-shaped complete dentures are fabricated is considered to be a viable option to address torus palatinus. Case Report: A 59-year-old edentulous male came to the Prosthodontic Department, Faculty of Dentistry, Trisakti University, with a chief complaint of the instability of his maxillary complete dentures, and he requested new dentures. The patient had been wearing the dentures for approximately 5 years. Based on the intraoral examination, the patient had a large, single lobule torus palatinus that extended posteriorly through the junction between the hard palate and the soft palate (AH line). It was covered with thin mucosal tissue, and it did not interfere with his speech, his ability to chew, or other oral functions without the dentures. After the problems were thoroughly diagnosed and corrected, horseshoe-shaped complete dentures were chosen as the appropriate solution, and the dentures were fabricated. Conclusion: Torus palatinus tends to have very thin mucosa that causes discomfort and irritation during routine usage of acrylic dentures. Therefore, the horseshoe-shaped dentures facilitated good retention and stability, and they did not irritate the torus palatinus.

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Background: A chronic apical abscess is defined as an inflammatory response to pulp infection and necrosis. It is identified by a step-wise onset, almost no discomfort, and the discontinuous release of pus through a related sinus tract. Radiographically, there are regular indications of bone destruction, such as radiolucency. The source of the infection in the root canal should be eradicated by root canal treatment. The main purpose of endodontic treatment is the finished debridement of the pulp tissue from the canal combined with the shaping and sufficient obstruction of the root canal system. This case report was written to show the proper management of a tooth with a chronic apical abscess and to reveal self-bone regeneration after treatment. Case Report: A 27-year-old woman complained of a cavity on her left lower back tooth, and she wanted it to be filled. There was a history of a fistula that appeared frequently in the gums near the decayed tooth. The radiographic examination showed that the caries had reached the pulp, along with a periapical lesion and bone destruction. The canals were prepared using a file instrument and irrigation with 5.25% sodium hypochlorite, 17% ethylenediaminetetraacetic acid, and 2% chlorhexidine gluconate. Calcium hydroxide paste was used as an intracanal medicament, and the canals were obturated using a continuous wave compaction technique. At the 4-month follow-up, healing of the periapical lesion and bone regeneration was evident. Conclusion: Adequate root canal treatment can result in the healing of periapical lesions and bone regeneration in chronic apical abscesses.

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Dentistry is an honorable profession, but the relationship between the patient and the dentist has changed drastically in the last 20 years. Anxiety has risen in the community and dental profession due to patients' increased tendency to file legal cases against dentists. Thus, awareness of ethics and medicolegal matters is essential for every dental practitioner. This review was conducted to find exact literature related to dental negligence, dentist awareness of negligence, dental consent, and the Consumer Protection Act. An attempt has also been made to inform dentists that they must follow certain protocols to avert lawsuits due to illegal and/or negligent dental practice. In December 2019, the PubMed, Medline, and EBSCOhost databases were electronically searched for published literature, and 648 articles were screened. A manual search was also conducted to retrieve articles of interest. Titles and abstracts related to the topic of interest and available in English were screened and included in the study. Patient consent must be obtained in written before any treatment procedure. Dentists must be aware of dental negligence, as well as the laws governing it, and should be insured under professional indemnity insurance (“defense costs”). In the event of legal proceedings, this provides protection and financial support for case settlement and other expenses.

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Background: Fractured instruments, especially endodontic files, are a common problem in daily practice. A broken file causes a canal blockage that impedes the cleaning and shaping process. Therefore, an attempt to remove the broken file should be considered in most cases. Nowadays, with advances in technology, such as ultrasonic tips, fractured instruments can be easily retrievable. Case Report: This case report presented a 15-year-old female patient with a complaint of a large cavity in the left mandibular region who presented to the department of conservative dentistry and endodontics. The clinical diagnosis was pulp necrosis, and a root canal treatment was performed. During the shaping procedure, a file was broken in the mesiolingual canal. Conclusion: The broken file was removed using ultrasonic tips with a dental operating microscope. After the instrument was retrieved, the obturation was performed successfully.

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Background: Toothpaste is essential in the process of oral care. One of the components of toothpaste, Eugenia caryophyllus, might have an anti-inflammatory and antibacterial effect. Objectives: The objective of this study is to analyze the effectiveness of E. caryophyllus in the toothpaste against Streptococcus mutans, Lactobacillus, and total microbial load in the saliva of healthy subjects after toothbrushing using E. caryophyllus toothpaste. Methods: Saliva (n = 10, aged 18–25 years) were collected before and 2 weeks after toothbrushing using toothpaste-containing E. caryophyllus (Antiplaque, Triple-Ace, Indonesia). The total microbial load of saliva was determined by the measurement of colony-forming unit (CFU) number on brain–heart infusion agar, at 37°C, for 24 h, in anaerobic-condition. Real-time polymerase chain reaction technique was used to quantify the S. mutans and Lactobacillus deoxyribonucleic acid using SYBR green and 16S-rRNA gene-specific primers for S. mutans and Lactobacillus. Primers were 5'-ATTCCCGCCGTTGGACCATTCC-3' (fwd); 5'-CCGACAAAGACCATTCCATCTC-3' (rvs) and 5'-CTTGTACACACCGCCC GT CA-3' (fwd); 5'-CTCAAAACTAAACAAAGTTTC-3' (rvs) for S. mutans and Lactobacillus, respectively. Data were analyzed using t-pair test with P < 0.05 set as the level of significance. Results: The result showed that there was a significant reduction of total microbial load, S. mutans, and Lactobacillus number in the saliva after toothbrushing. The total microbial number in the saliva was significantly decreased before (5.84 ± 0.43 log CFU/mL) and 2 weeks after toothbrushing (5.27 ± 0.61 log CFU/mL) (P < 0.05). The number of S. mutans and Lactobacillus was also significantly decreased before (8.27 ± 0.11 and 2.34 ± 0.71 log CFU/mL) and after toothbrushing (8.18 ± 0.11 and 1.91 ± 0.25 log CFU/mL) (P < 0.05). Conclusion: E. caryophyllus toothpaste may reduce the number of total microbial, S. mutans, and Lactobacillus in the saliva of healthy subjects. Further studies are needed to explore this result.

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Background: The aim of endodontic treatment is to eliminate bacteria from the root canal. Bacterial removal from the root canal can be achieved with a mechanical approach using an instrument and a disinfecting irrigation agent. Enterococcus faecalis is the most prevalent bacteria found in root canals. Research studies have also been conducted to examine irrigation systems using herbal products such as drumstick tree leaf (Moringa oleifera) instead of NaOCl. Active compounds in M. oleifera, such as flavonoids, tannins, saponins, alkaloids, phenolics, and triterpenoids, possess antibacterial effects. Objectives: The aim of this study is to assess the antibacterial effect of drumstick tree extract (M. oleifera) in several concentrations (25%, 50%, 75%, and 100%) as an irrigation solution against E. faecalis through in the root canal ex vivo. Methods: This study used 24 mandibular premolars, divided into six category groups. Group 1 received 5.25% NaOCl as a positive control, Group 2 received 25% M. oleifera extract, Group 3 received 50% M. oleifera extract, Group 4 received 75% M. oleifera extract, Group 5 received 100% M. oleifera extract, and Group 6 received irrigation using phosphate-buffered saline as a negative control. Quantitative polymerase chain reaction methods used to analyze the E. faecalis number in the root canal after treatment with M. oleifera extract. Results: A one-way ANOVA showed significant differences (P = 0.05) between the three types of irrigation solutions against E. faecalis. Among the six study groups, the most prominent efficacy was found in Groups 1, 4, and 5. Conclusion: M. oleifera extract solution at concentrations of 75% and 100% is as effective as 5.25% NaOCl. This extract may be used as an alternative irrigation agent for root canal treatment. However, further studies are warranted to examine the toxicity effect.

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Background: Mineral trioxide aggregate (MTA) is the most widely used material in endodontics, and recently, it has been used as an endodontic sealer. Bioceramic (BC) is a newly developed material based on calcium silicate, which is already used as a biocompatible root canal obturation material to overcome the weakness of MTA. However, there have been no studies comparing the materials used to seal the root canal. Objective: This study aimed to determine the apical leakage differences between BC and MTA sealers with BC-coated gutta-percha (GP) and conventional GP. Methods: In total, 40 mandibular premolars were cut coronally to 14 mm of working length. All samples were randomized and sorted into four groups: BC sealer with BC-coated GP, bioceramic sealer with conventional GP, MTA sealer with BC-coated GP, and MTA sealer with conventional GP. The samples were stored in an incubator, and nail varnish was applied to all root surfaces except for a 1 mm area from the apex. The samples were also soaked in methylene blue for 72 h before undergoing diaphanization. A stereomicroscope was used to measure the methylene blue penetration. All data were analyzed using analysis of variance. Results: There were significant differences in apical leakage between the BC and MTA sealers (P < 0.05). Conclusion: The BC sealer prevented apical leakage better than MTA. The BC-coated GP had better results than the conventional GP, but the differences were not significant, indicating that the choice of sealer is more important in preventing the apical leakage.

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Background: Recurrent aphthous stomatitis (RAS) is a common oral mucosa disease. Anxiety plays a role in the development of RAS, as it can lead to parafunctional oral habits such as bruxism (teeth grinding or jaw clenching) that may injure the mucosa, and this physical trauma can trigger ulceration in susceptible individuals with RAS. This case report describes the parafunctional oral habits caused by anxiety as the contributing factors of RAS. Case Report: A 17-year-old female came to the Dental Hospital, Faculty of Dentistry, Universitas Indonesia, with the complaints of ulcers at the lateral aspect of the tongue for 4 days since the tongue was bitten while she was sleeping. From the patient history, clinical evaluation, and investigation of the questionnaire, we detected a bruxism habit. We assumed that clenching was a contributing factor for the ulcers in this case. Intra-oral examination revealed two irregular ulcers of about 3 mm and 0.5 mm that were surrounded by erythematous halos and were yellow at the floors of the 46 and 36 teeth. The patient completed the Hospital Anxiety and Depression Scale and the Hamilton Rating Scale for Anxiety; the results of both were moderate anxiety. The management we suggested to the patient to control the anxiety was referral to a psychologist and an orthodontist; we gave chlorhexidine 0.2% to compress the lesions three times a day. Conclusion: Anxiety can produce a parafunctional oral habit that is a contributing factor of RAS. Coping with anxiety is needed to improve the clenching activity and RAS.

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Background: Lactobacillus reuteri and Lactobacillus casei have been proposed as probiotic bacteria that promote oral health. Objectives: The present study aimed to evaluate the in vitro effects of L. reuteri and L. casei on the biofilm formation of major oral pathogens, Streptococcus mutans and Porphyromonas gingivalis. Materials and Methods: L. casei strain Shirota and L. reuteri ATCC 55730 were isolated from the commercial products and cultured in de Man, Rogosa, and Sharpe broth. Polymerase chain reaction was used to confirm the identity of the species. S. mutans ATCC 25175 and P. gingivalis ATCC 33277 were cultured in brain–heart infusion broth and used for biofilm formation on 96-well microplate platform. The biofilms were treated with the probiotics and appropriate controls in a time-dependent experiment from 15 min to 24 h. The biofilm biomass was evaluated using crystal violet and safranin. Results: The statistical analysis showed a significant reduction in the S. mutans and P. gingivalis biofilms after treatment with the L. reuteri and L. casei probiotics at all incubation times (P < 0.05). Conclusion: The present study demonstrated the potential antibiofilm activity of L. casei strain Shirota and L. reuteri ATCC 55730 against S. mutans and P. gingivalis biofilms in vitro. The foregoing data have formed a basis for future clinical studies to evaluate the beneficial oral health effect of probiotic Lactobacilli strains.

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Background: Acute exacerbation represents a painful condition whereby the tooth becomes highly sensitive to percussion and bite testing, and it can be aggravated by traumatic occlusion. In general, it results from earlier acute apical periodontitis. Bone destruction can be detected via a radiographic examination, and it can be seen as a radiolucent area at the periapex. Bone resorption is caused by osteoclast activation, which results from pulp inflammation. Nonsurgical endodontic treatment is typically performed to resolve the condition. This study aimed to provide an overview of both the treatment protocol and the role of 2% chlorhexidine gluconate as an endodontic irrigant. Case Report: A 38-year-old woman presented with a major complaint regarding tenderness in her lower second right premolar. The patient reported having experienced similar pain approximately 8 months previously. Clinically, the tooth had lost 50% of its coronal structure, which indicated a Class II cavity. Radiographically, bone resorption was detected in the periapical area of the tooth. An analgesic had been consumed for approximately 3 days. The cavity was cleaned and opened, and working length measurements were performed using an electronic apex locator and conventional radiography. Biomechanical preparation was done using ProTaper NEXTTM files, until size X3. Irrigation was performed using 5.25% sodium hypochlorite at each file change and continued with 17% ethylenediaminetetraacetic acid and 2% chlorhexidine for final irrigation. Sterile Aqua Dest was used for each irrigation change to avoid interaction between irrigants. Obturation was performed by means of warm vertical compaction with an epoxy resin-based sealer. An endocrown composite was recommended for permanent restoration. Four months of follow-up revealed bone regeneration and healing. Conclusion: Bone resorption is a common finding in a diseased tooth, and it stems from the persistent inflammatory process. Osteoclasts are responsible for both bone demineralization and activated pro-inflammatory cytokines. The correct endodontic treatment protocol plays an essential role in periapical bone healing.

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Background: Any changes in the clinical presentation of the oral mucosa in terms of the color, size, texture, and integrity should be carefully checked. Dentists are responsible for doing a comprehensive oral examination in order to find cancer lesions at the initial stage. The prognosis of an oral squamous cell carcinoma (OSCC) is still determined by the stage of the initial diagnosis. The aim of this report was to describe a posterior tongue OSCC case in a patient who underwent general anesthesia due to the gag reflex in order to obtain a thorough clinical assessment of the primary lesion and a representative biopsy sample. Case Report: A 50-year-old woman with a 4-month history of a sore tongue was referred to the Oral Medicine Clinic of the Cipto Mangunkusumo Hospital. The intraoral examination revealed an ulcer measuring 2 cm × 0.5 cm on the right ventral side of the tongue, facing the area near teeth 46 and 47. There was also a 0.5 cm × 0.5 cm × 0.3 cm white cauliflower-like nodule at the anterior portion of the ulcer. Despite the ulcerative appearance of the lesion, the posterior border of the lesion could not be defined due to its location and the patient's high gag reflex. This patient was referred to the Oral Surgery Department for a further analysis of the clinical lesion and a biopsy. The detailed clinical examination under general anesthesia revealed a much larger lesion measuring 7 cm × 4 cm × 0.3 cm. An incisional biopsy specimen was taken, and the histopathology confirmed the diagnosis of a poorly differentiated OSCC. Conclusion: A thorough clinical examination was needed to assess the oral mucosal lesion in the posterior area of the mouth in order to provide a proper definitive diagnosis.

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Background: Oral cancer is one of the sixth most common cancers in human, and oral squamous cell carcinoma (OSCC) is the most common type of oral cancer. The clinical appearance of OSCC may resemble other types of oral cancer such as rhabdomyosarcoma (RMS). The definitive diagnosis is crucial as the management and prognosis of both lesions are quite different. Case Report: A 42-year-old male presented with a unhealed painful ulcer of the posterior right lateral border of the tongue for about 4 months. Restricted mobility of the tongue and positive submandibular lymph nodes were detected. Wide excision with regional neck dissection was performed. Discussion: Pleomorphic RMS (PRMS) was identifed by immunohistochemistry of positive desmin and smooth muscle actin. The clinical presentation of the lesion is exactly similar to OSCC. PRMS is a rare type of high-grade sarcoma of the oral cavity. It usually occurs in the deep of lower extremities of adult on the six decade. Conclusion: Although the management of OSCC and RMS is almost alike, the ability of metastasis is salient compared to OSCC. Therefore, the definitive diagnosis should be careful due to its characteristic.

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Background: Periodontitis has been referred to as the sixth complication of diabetes. A number of studies found a higher prevalence of periodontal disease among diabetes patients than among healthy controls. Objective: The objective of the study was to determine the periodontal status and periodontal treatment needs (TN) of diabetes mellitus Type 2 patients attending Talaga Bodas Community Health Center, Bandung City, Indonesia. Methods: This descriptive study included 30 subjects with diabetes mellitus Type 2. The periodontal tissue status and periodontal TN were determined using the Community Periodontal Index of TN. Data on periodontal status and TN are presented in percentages based on subject, sextant, and duration of diabetes mellitus. Results: Periodontitis (53.3%) was more common than gingivitis (43.3%) among diabetes mellitus Type 2 patients. Scaling and root planing were the treatments most commonly required in the diabetes mellitus patients (n = 21.70%) and sextants (n = 81.65.9%). A longer period of diabetes mellitus was associated with a tendency toward more severe periodontal disease and more complex periodontal TN. Conclusion: The prevalence of periodontitis was higher than gingivitis among patients with diabetes mellitus Type 2. The TN of diabetes mellitus Type 2 patients comprised mostly scaling and root planing.

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Background: Many odontogenic infection cases do not need antibiotic prescriptions. The excessive use of antibiotics can lead to microbial resistance. Objective: This study aims to acknowledge the rationale and varieties of antibiotic prescriptions in odontogenic infection treatment by dentists. Methods: Data were collected from 513 patients' medical records from the provincial public hospital and district public health center (PHC), Kupang City, from January to June 2016. The variables of this study were odontogenic infections treated with antibiotic therapy and the span of that antibiotic therapy. Results: Antibiotic use was not required in odontogenic infection cases: periapical abscess (27%), nonsurgery tooth extraction (20.7%), apical periodontitis (17.3%), and pulpitis (15%). Amoxicillin (76%) and clindamycin (12%) are widely used in odontogenic infection treatment. Based on the duration of therapy, it was found that the use of amoxicillin was 44% and clindamycin was 34%. Conclusion: Excessive antibiotic use is done by general dental practitioners in the treatment of odontogenic infection. Strict rules for antibiotic prescription are needed to prevent antibiotic resistance.

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Background: The management of immature central incisors with nonvital pulp is a challenge for dentists because the goals and criteria for successful root canal treatment are difficult to achieve. A necrotic immature root canal system accompanied by apical periodontitis cannot be disinfected by standard protocols with the aggressive use of endodontic files. This case report demonstrated the advantages of pulp revascularization as a treatment method for necrotic immature teeth based on clinical and radiographic outcomes. Case Report: The patient was an 11-year-old boy with a history of trauma to the upper left central incisor who was treated with a revascularization procedure. Clinical and radiographic evaluations showed nonvital pulp, asymptomatic apical periodontitis, and mucogingival swelling before treatment. At the 1-, 3-, and 6-month follow-up visits, the patient's teeth remained asymptomatic and well-functioning. There was a slight thickening of the tooth wall and loss of lesions, although total closure of the apical foramen was observable. Longer clinical and radiographic controls are needed to evaluate the success of this case.Conclusion: Revascularization is a procedure that promotes thickening of the dentinal wall and closure of the apical foramen, thereby preventing teeth from becoming weak. The minimum expectation of revascularization treatment is the absence of undesirable signs and symptoms, but the ultimate goal is full regeneration of the pulp complex and ideal root development.

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Background: The proper method for cleaning dentures is important to prevent an increase in the surface roughness average (Ra). An average roughness value above 0.2 μm can increase bacterial colonization. Objective: The aim of this study was to investigate the effects of brushing and immersion in denture cleanser on the surface roughness of polymethyl methacrylate (PMMA) materials. Methods: Fifty PMMA samples (18 mm × 10 mm × 2 mm) were randomly divided into five groups (n = 10 each): immersion in distilled water (Group A), brushing without toothpaste (Group B), brushing with toothpaste (Group C), immersion in denture cleanser and brushing without toothpaste (Group D), and immersion in denture cleanser and brushing with toothpaste (Group E). The surface roughness was measured using a surface roughness tester before and after the treatment. The results were obtained by calculating the difference between the initial and final surface roughness values. The data were analyzed using Welch's one-way analysis of variance and the Games–Howell post hoc test. Results: The mean Ra values were 0.033 ± 0.024 μm for Group A, 0.057 ± 0.018 μm for Group B, 1.551 ± 1.234 μm for Group C, 0.102 ± 0.026 μm for Group D, and 1.695 ± 1.158 μm for Group E. There were statistically significant differences among the groups, with the exception of Groups A and B and Groups C and E. Conclusion: Brushing without toothpaste had the least effect on increasing the surface roughness, whereas brushing with toothpaste and immersion in denture cleanser greatly increased the surface roughness.

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Background: A Class V restoration with composite resin poses a number of challenges, which can result in microleakage. Methods for minimizing microleakage include the use of adhesive materials and adhesive systems. Adhesive systems include total etch, self-etch, and selective etch. Each adhesive system has various advantages and disadvantages. Therefore, in a Class V cavity with little enamel attachment, research is needed to compare microleakage in total etch, self-etch, and selective etch systems to determine the best adhesion system to achieve treatment success. Objective: The purpose of this study was to compare total etch, self-etch, and selective etch adhesive systems in Class V composite resin restorations. Method: Class V cavities on premolar teeth (n = 24) were prepared on buccal and lingual surfaces. The teeth were divided into three groups: total etch, self-etch, and selective etch. All the samples of 3 mm mesiodistal, 2 mm occlusal–gingival, and 2 mm deep were prepared using a high-speed round bur. After the preparation of the samples, all the teeth were restored using a flowable composite resin. All the restored samples were immersed in 2% methylene blue for 24 h. They were then sectioned in a buccolingual direction and observed under a stereomicroscope at ×10 magnification. The data were analyzed using the Kruskal–Wallis test and post hoc Mann–Whitney U-test (P < 0.05). Result: There were significant differences in microleakage among the groups. The total etch group had the least microleakage, followed by the selective etch and self-etch groups. Conclusion: The use of phosphoric acid (37%) in total etch and selective etch technique reduced microleakage in composite restorations.

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Background: The storage condition of a toothbrush can influence the growth of bacteria. Indonesia as a developing country has a low awareness of the importance of toothbrush hygiene. Thus, an efficient and economic toothbrush storage solution is needed. Objective: The aim of this study was to evaluate the effect of soaking toothbrushes in mouthwash solution on the total number of Streptococcus mutans and Fusobacterium on the toothbrush. Methods: Eighteen toothbrushes were provided to healthy individuals aged 19–23-years. For 1 month, each toothbrush was soaked in disinfectant solution (25 mL) for 20 min after brushing, with Group 1 using mouthwash and Group 2 using sterile tap water. The real-time polymerase chain reaction (PCR) method was used to evaluate the number of microorganisms on each toothbrush. The total number of DNA targets was identified using real-time PCR followed by SYBR Green reagents and 16S rRNA-gene specific primers for S. mutans and Fusobacterium. A paired sample t-test was used for statistical analysis, and the level of significance was set at P < 0.05. Results: There were significant differences in the total bacterial numbers of S. mutans and Fusobacterium on toothbrushes after soaking with mouthwash solution. The average scores (Log10-CFU/mL ± standard deviation) of the total bacteria (2.66 ± 0.39), S. mutans (1.21 ± 0.18), and Fusobacterium (10.35 ± 6.02) on toothbrushes in Group 1 were significantly decreased compared to the average scores of the total bacterial load (5.19 ± 0.41), S. mutans (2.71 ± 1.59), and Fusobacterium (18.96 ± 4.26) in Group 2. Statistical evaluation brought statistically significant difference of total bacteria numbers and S. mutans between Group 1 and Group 2 (P < 0.05). Conclusion: Soaking toothbrushes in mouthrinse solution reduce the total number of bacterial load, S. mutans, and Fusobacterium. Further studies are needed to explore the effects of mouthwash solution against other oral pathogens.

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Background: Tooth extraction is the most frequently conducted dental care procedure. In Indonesia, there is an extremely high utilization of dental and oral health services for tooth extraction, reaching 79.6%. Pain is a side effect of extraction. Pain due to extraction wounds can be treated with analgesic drugs, but alternative drugs with minimal or no side effects are still being researched. An herbal active beluntas leaf substance can reduce pain from extraction wounds. The beluntas plant not only aids in healing wounds but also exhibits anti-inflammatory and antipyretic effects. Objectives: In this study, the aims were to determine the 50% inhibitory concentration (IC₅₀value) and examine the viability effect of an ethanol extract of beluntas leaves on fibroblast cell cultures in vitro. Methods: Laboratory experiments were carried out. Beluntas leaves were obtained; their leaf extracts were prepared using ethanol as the solvent; phytochemical tests were performed. Triplicate measurements for the viability of 3T3 BALB/c fibroblast cells were carried out using the Methylthiazol sulfophenyl (MTS Assay) method. The extract concentrations were 500, 250, 125, 62.50, 31.25, 15.63, and 7.81 μg/mL. Results: Data analysis was carried out by one-way analysis of variance statistical test. Analysis results revealed that extract concentrations of 500, 31.25, 15.63, and 7.81 μg/mL exhibit a significant difference in the effect of cytotoxicity (P < 0.05) on fibroblast cells, and the IC₅₀value is 265.388 μg/mL. Conclusion: A significant difference in the cytotoxicity effect between the concentrations of the ethanol extract of beluntas (P. indica) leaves on the fibroblast cell cultures in vitro was observed. The beluntas leaf extract at an IC₅₀value of 7.81 μg/mL did not affect cell viability; hence, it is considered safe.

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Background: The development of adhesive systems has made the removal of carious lesion a minimally invasive procedure. Composite resin is the material of choice today, but the filler composition of the resin varies. Packable composite resin has good mechanical properties, but its high viscosity makes it hard to manipulate. Several methods, such as preheating, are used to decrease this viscosity. A syringe of composite resin might be preheated several times, but the effect of repeated preheating is unknown. Objectives: The purpose of this research was to analyze the effect of repeated preheating on the mechanical properties of a composite resin with different fillers. Method: Microhybrid, nanohybrid, and nanofill composite resins were preheated (ten times, twenty times, and control), molded into cylinder molds 6 mm in diameter and 3 mm in height, flattened with a celluloid strip, and polymerized with an light-emitting diode light-curing unit for 40 s. A total of 180 specimens were tested. The specimens were divided into two groups: Group 1 was immediately tested using a universal testing machine. Group 2 was soaked in 37°C artificial saliva for 24 h before testing. Each specimen was tested using the universal testing machine with the pressure side with a 1 mm/s crosshead speed. Result: Nanohybrid composite resin had the most stable diametral tensile strength after repeated preheating, whereas nanofill composite had the weakest strength. The increase and decrease in the diametral tensile strength in each group were not statistically significant. Conclusion: Repeated preheating does not significantly affect the diametral tensile strength of composite resin.

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Background: Endodontic irrigation with 5.25% sodium hypochlorite (NaOCl) solution using single side-vented and double side-vented needles is commonly used. Surfactant is added to reduce high surface tension of the NaOCl solution. Apical vapor lock, or air entrapment inside closed-end root canal system, lowers the efficacy of irrigants. Thus, the irrigants are hindered in penetrating the root canal system and can lead to risk of reinfection. Objective: The objective is to analyze the difference of 5.25% NaOCl solution with and without surfactant using two types of irrigation needle in the formation of apical vapor lock. Methods: Forty lower premolars were prepared and randomly divided into four groups (n = 10 per group) then irrigated with 5.25% NaOCl solution with and without surfactant using a single side-vented or double side-vented needle. Contrast medium was added so that the measurement of the apical vapor lock could be performed using a digital radiograph. Analysis was done with two-way analysis of variance and the Tukey method. Results: 5.25% NaOCl solution with a single side-vented needle showed a significant difference from 5.25% NaOCl solution with a double side-vented needle. 5.25% NaOCl solution with a surfactant using a single side-vented needle showed a significant difference from 5.25% NaOCl solution using a double side-vented needle, likewise NaOCl 5.25% using double side-vented needle group from NaOCl 5.25% with surfactant using single side-vented needle group. Conclusion: Minimal formation of an apical vapor lock resulted from the use of 5.25% NaOCl solution with a surfactant using a single side-vented needle.

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Background: Home bleaching with carbamide peroxide is commonly used due to its high success rate and minimum side effects. Although home bleaching is safe, it causes structural changes in surface enamel, thereby facilitating Streptococcus mutans attachment on the enamel surface. Objectives: This study aimed to determine the effect of carbamide peroxide concentration on surface enamel structural changes and S. mutans attachment. Methods: Healthy, caries-free, and calculus-free upper first premolars were divided into 10%, 15%, and 35% carbamide peroxide concentration groups, with five samples in each group. Structural changes in the surface enamel of the teeth before and after the bleaching procedure were assessed subjectively based on observations using a stereomicroscope at × 40. The samples were inoculated in S. mutans culture and incubated for 24 h (37°C) in anaerobic conditions. The samples were then washed with phosphate-buffered saline, and bacterial attachment was released by vortexing for 1 min. Bacterial attachment was assessed using a turbidimetry test and total plate count test. Result: Structural changes in enamel were observed in the samples exposed to carbamide peroxide 35%. The results of an analysis of variance test revealed a significant difference (P < 0.05) in the bacterial attachment test. The samples exposed to carbamide peroxide 35% exhibited the highest amount of bacterial attachment (3 × 10^[6] CFU/mL, optical density: 0.06). Conclusion: The concentration of carbamide peroxide plays a role in structural changes in enamel and S. mutans attachment.

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Background: Maldistribution of health workers, including dentists, is a global issue faced by not only poor and developing countries but also developed countries due to the mobility of health workers, who prefer working in urban areas. The World Health Organization (2012) released global policy recommendations that cover education, regulation, incentives, and personal and professional support to overcome this issue. However, they have not been able to completely solve the issue, as is shown by a description of Indonesia's Health Profile (2018), which highlights that 43.53% of public health center lack of dentists. The number of studies concerning the real condition experienced by dentists working in rural and remote areas of Indonesia is still limited. Objectives: To analyze job satisfaction and factors affecting dentists' retention in rural and remote areas of Indonesia. Methods: This study used questionnaire to collect data which was designed based on seven major themes and inserted in Google Form. The link was distributed to dentists who work in rural and remote areas of Indonesia. The sample was selected based on random sampling techniques. Result: The study showed that 45.90% of respondents were not satisfied working in rural and remote areas. Most of the respondents claimed that working conditions, incentives, career and professional development, living conditions, and personal characteristics influenced their interest in working permanently in remote and rural areas. However, political and cultural factors did not give a high impact. Conclusion: The description of job satisfaction and factors affecting dentists' retention in rural and remote areas of Indonesia is expected to have a positive impact on formulating policy regarding dentists' maldistribution.

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Background: Porcelain veneer restoration is the primary choice for indirect restoration, especially for anterior teeth, given its high esthetic properties and lower failure rate than resin composites. Glass-based ceramics such as IPS e.max Press and Vintage LD Press are a choice for veneer due to its superior physical properties. Resin cement is used to attach the veneer restoration to the teeth. The polymerization of resin cement used in veneer restoration affects the stability, mechanical properties, and resistance of the restoration. The composition and thickness of the porcelain material affect the light-curing unit to cured resin cement. Objectives: The aim of this study was to evaluate the influence of porcelain thickness, light intensity, and exposure time in the hardness of resin cement. Methods: Porcelain samples measuring 5 mm in diameter with three types of thicknesses of IPS e.max Press and Vintage LD Press were used in the study. Resin cement in a metal mold was placed under a porcelain sample before curing with a light-emitting diode (LED) intensity of 1300 or 1700 mW/cm². The hardness test was then carried out on the bottom of the resin cement. Result: The highest hardness value was obtained from a Vintage LD Press with a thickness of 0.7 mm (cured at 1300 mW/cm² for 20 s). A four-way ANOVA test showed significant differences for brands, thicknesses, and times of exposure (P < 0.05) as well as insignificant difference for LED intensity. Conclusion: The study indicates that polymerization of resin cement with lower thickness presented higher hardness values. Irradiation time affected hardness, while LED intensity did not.

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