Islamic Azad University Dental Branch Journal of Research in Dental and Maxillofacial Sciences 2588-4166 10 2 2025 6 1 Effect of 660 nm and 808 nm Low-Level Diode Laser Irradiation on Production of Vascular Endothelial Growth Factor by Human Gingival Fibroblasts: An in vitro Study 82 87 EN Mahta Fazlyab Department of Endodontics, TeMS.C., Islamic Azad University, Tehran, Iran Zohreh Sadat Hosseini Private Dentist, Tehran, Iran. Mehdi Vatanpour Department of Endodontics, TeMS.C., Islamic Azad University, Tehran, Iran Fatemeh Rezaei Department of Endodontics, TeMS.C., Islamic Azad University, Tehran, Iran Background and Aim: This study aimed to assess the effect of 660 nm and 808 nm low-level diode laser irradiation on the production of vascular endothelial growth factor (VEGF) by human gingival fibroblasts (HGFs).    Materials and Methods: In this in vitro experimental study, HGFs were cultured in McCoy’s 5A modified medium and assigned to three groups of control, 660 nm laser irradiation, and 808 nm laser irradiation. The concentration of VEGF was measured in the three groups at 1, 3, and 7 days after the intervention using ELISA. The three groups were compared in this respect using repeated measures ANOVA. Statistical significance was defined as P<0.05.    Results: The concentration of VEGF in 808 nm laser group was significantly higher than that in the control and 660 nm laser groups (P<0.05). Also, the concentration of VEGF in 660 nm laser group was significantly higher than that in the control group (P<0.05). The concentration of VEGF at 7 days was significantly higher than that at 1 and 3 days, and the value at 3 days was significantly higher than that at 1 day in all three groups (P<0.05). Conclusion: Within the limitations of this study, it appears that irradiation of 660 and 808 nm diode laser can increase the production of VEGF by HGFs.

Islamic Azad University Dental Branch Journal of Research in Dental and Maxillofacial Sciences 2588-4166 10 2 2025 6 1 In Vitro Cleaning Efficacy of Neolix and M3 Immatural Rotary Files in Comparison with Hand Files in Primary Molar Root Canals 88 95 EN Shabnam Maleki Student Research Committee, Babol University of Medical Sciences, Babol, Iran. Effat Khodadadi Dental Materials Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Elham Mahmoudi Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Seyedali Seyedmajidi Dental Materials Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Background and Aim: This study assessed the cleaning efficacy of Neolix and M3 Immatural rotary files compared with hand K-files in primary molar root canals.    Materials and Methods: This in vitro study evaluated 40 primary maxillary and mandibular molars. After access cavity preparation, Indian ink was injected into the root canals of primary molars. The teeth were then randomly divided into three experimental and one control group (n=30 canals per group). In group 1, the root canals were instrumented with #20 M3 Immatural file and then with #25/4% to the working length. In group 2, the root canals were instrumented with #25/6% Neoniti A1 file. In group 3, hand K-files were used for instrumentation of the mesial canals of mandibular molars and buccal canals of maxillary molars to #25, and palatal canals of maxillary molars and distal canals of mandibular molars to #30. Group 4 served as the control group and was only rinsed with saline with no instrumentation. After clearing, the teeth were inspected under a stereomicroscope. Data were analyzed by the Kruskal-Wallis and Mann-Whitney U tests.    Results: No significant difference was noted among the groups in cleaning of the coronal third of the root canals (P=0.174). In the middle and apical thirds, two rotary systems showed significantly superior cleaning compared with hand files (P=0.031 and P=0.007, respectively), but there was no significant difference between the two rotary files (P>0.05). Conclusion: Neolix and M3 Immatural files can serve as efficient alternatives to hand files for pulpectomy of primary molars.

Islamic Azad University Dental Branch Journal of Research in Dental and Maxillofacial Sciences 2588-4166 10 2 2025 6 1 Comparison of the London Atlas Method of Age Estimation with the Chronological Age in a South Kerala Population 96 102 EN Nripan T Department of Oral Pathology and Microbiology, Azeezia College of Dental Sciences and Research, Meeyannoor P.O, Kollam- 691537, Kerala, India. R Vina Vaswani Department of Forensic Medicine & Toxicology, Yenepoya, Deralakatte, 575018, Mangalore, Karnataka, India Leena K Pramod Department of Forensic Medicine & Toxicology, Yenepoya, Deralakatte, 575018, Mangalore, Karnataka, India Rathy Ravindran Department of Oral Pathology and Microbiology, Azeezia College of Dental Sciences and Research, Meeyannoor P.O, Kollam- 691537, Kerala, India. Saira Siraj E Department of Public Health Dentistry, Azeezia College of Dental Sciences and Research, Meeyannoor P.O, Kollam- 691537, Kerala, India. Deepa MS Department of Oral Medicine and Radiology, Azeezia College of Dental Sciences and Research, Meeyannoor P.O, Kollam- 691537, Kerala, India. Background and Aim: The London Atlas is a recently introduced method of age estimation using orthopantomographs (OPGs), which has not been tested in the Kerala population. Thus, the present study was carried out to assess and compare the chronological age of the participants with the estimated age using the London Atlas method. Materials and Methods: A retrospective cross-sectional study was conducted to evaluate the London Atlas method for age estimation using OPGs of 220 healthy individuals (60.5% females and 39.5% males) between 5 to 23.99 years collected from the archives. The chronological age of the participants was calculated using their date of birth. Data were analyzed by paired t-test and Pearson’s correlation coefficient (alpha=0.05). The intra-examiner reliability was analyzed using the Cohen’s kappa.  Results: A statistically significant difference existed between the chronological age and the age estimated using the London Atlas method (t-value=-8.301, P<0.05). A positive statistically significant correlation was found between the estimated age using the London Atlas method and the chronological age in all age groups (Pearson’s correlation coefficient of 0.989 in males and 0.985 in females, P<0.05). The goodness of fit evaluation of the London Atlas method for prediction of actual age indicated that the model can fit with R2 value of 0.975. Conclusion: The London Atlas method showed a strong positive correlation with actual chronological age while at the same time a statistically significant difference existed between the actual age and estimated age. There was no difference in age estimation between the two genders.

Islamic Azad University Dental Branch Journal of Research in Dental and Maxillofacial Sciences 2588-4166 10 2 2025 6 1 In Vitro Effect of Photodynamic Therapy with 660 nm Diode Laser and Methylene Blue Photosensitizer on Acyclovir-Resistant Herpes Simplex Virus Type 1 103 110 EN Nazanin Mohitmafi Department of Oral and Maxillofacial Medicine, TeMS.C., Islamic Azad University, Tehran, Iran. Masoud Parsania Department of Microbiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran. Arezoo Alaee Department of Oral Medicine, Dental Material Research Center, TeMS.C., Islamic Azad University, Tehran, Iran. Pooya Olyaee Department of Orthodontics, Urmia University of Medical Science, School of Dentistry, Urmia, Iran. Mohammad Vahedi Department of Oral and Maxillofacial Medicine, TeMS.C., Islamic Azad University, Tehran, Iran. Background and Aim: Herpes simplex virus type 1 (HSV-1) is one of the most common infections of the mouth and face. This study was conducted to assess the effect of photodynamic therapy (PDT) with 660 nm diode laser and methylene blue photosensitizer (PS) with different concentrations and radiation parameters on acyclovir-resistant HSV-1.    Materials and Methods: In this in vitro study, first the cytotoxicity of methylene blue for HeLa cells was assessed by the methyl thiazolyl tetrazolium (MTT) assay, and its highest non-toxic concentrations were found (0.001%, 0.002%, 0.005%, and 0.01%). Laser was used with 660 nm wavelength, 100 mW power, and 10, 20, and 30 J/cm2 energy densities for 50, 100, and 150 seconds. The samples were divided into 20 groups, including 12 PDT groups with laser and methylene blue, 3 groups subjected to laser irradiation alone, 4 groups exposed to methylene blue alone with different concentrations, and one negative control group. After laser irradiation, HSV-1 was titrated by the tissue culture infectious dose 50 (TCID50) method. Two-way ANOVA was used for data analysis (alpha=0.05).    Results: The effects of methylene blue concentration (0.001%, 0.002%, 0.005%, and 0.01%) (P=0.675) and laser energy density (10, 20, 30 J/cm2) (P=0.914), and their interaction effect (P=0.977) on the titer of acyclovir-resistant HSV-1 were not significant. Conclusion: PDT with 660 nm laser with different energy densities and different methylene blue concentrations had no significant effect on acyclovir-resistant HSV-1.  

Islamic Azad University Dental Branch Journal of Research in Dental and Maxillofacial Sciences 2588-4166 10 2 2025 6 1 Development and Evaluation of a Convolutional Neural Network for Automated Detection of Lip Separation on Profile and Frontal Photographs 111 124 EN Yasamin Vazirizadeh Department of Orthodontics, Faculty of Dentistry, Shahed University, Tehran, Iran. Hoori Mirmohamadsadeghi Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohammad Behnaz Dentofacial Deformities Research Center, Research Institute for Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shahab Kavousinejad Dentofacial Deformities Research Center, Research Institute for Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Background and Aim: Lip incompetence is defined as a habitual gap of more than 3-4 mm between the lips at rest, which can contribute to oral health issues and malocclusions. This study aimed to propose a deep learning-based model for automatic detection of lip separation on orthodontic photographs.    Materials and Methods: This retrospective observational study employed a balanced dataset of 800 clinical images, comprising 400 cases of lip incompetence and 400 cases of lip competence. An auto-cropping technique based on averaged manual cropping coordinates was used to isolate the lip region. The cropped images were resized to 70×70 pixels and normalized before feeding into a novel attention-based residual connection convolutional neural network (ARN-CNN). The model incorporated both residual connections and attention modules to enhance feature learning and training stability. Data augmentation (e.g., rotation and scaling) was applied to improve generalizability. Training was conducted using 5-fold cross-validation, with an external test set to evaluate performance and reduce overfitting. Metrics such as accuracy, precision, recall, F1 score, receiver-operating characteristic curve-area under the curve (ROC-AUC), and a confusion matrix were used for performance evaluation.    Results: The ARN-CNN achieved 95% accuracy on the test set. For the competent class, precision was 0.97, recall was 0.94, and F1 score was 0.96. These values were 0.94, 0.96, and 0.95, respectively, for the incompetent class with an AUC of 0.98. Conclusion: The ARN-CNN model effectively identified lip incompetence, highlighting the potential of deep learning to support orthodontic diagnosis through image-based analysis.

Islamic Azad University Dental Branch Journal of Research in Dental and Maxillofacial Sciences 2588-4166 10 2 2025 6 1 Sedative Effect of Intravenous Propofol-Ketamine and Midazolam Ketamine Combinations for Dental Treatment of Uncooperative 2-6 Year-Old Children: A Clinical Trial 125 133 EN Ahmad Eghbali Zarch Department of Anesthesiology, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Narjes Amiri Tehranizadeh Private Pediatric Dentistry Practice, Tehran, Iran. Ghassem Ansari Department of Pediatric Dentistry, Dental Research Center, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Masoud Fallahinejad Ghajari Department of Pediatric Dentistry, Dental Research Center, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Background and Aim: Various medications are used for intravenous (IV) sedation in pediatric dentistry. This study evaluated the efficacy of IV midazolam/ketamine (MK) versus propofol/ketamine (PK) for dental sedation of uncooperative children.    Materials and Methods: This double-blind, randomized controlled clinical trial was carried out on 22 healthy, uncooperative children aged 2-6 years requiring two similar dental treatment sessions. Children were randomly assigned to two groups. Group A received PK in their first, and MK in their second visit. Group B received the same combinations in a reverse order. Oxygen saturation rate (SPO2) and heart rate (HR) were recorded at baseline, at the time of IV administration, local anesthetic injection, 15 and 30 minutes later, and at the time of discharge. Two independent calibrated pedodontists scored the sedation level using the Houpt scale during treatment. Data were analyzed by t-test, Wilcoxon, Mann-Whitney, and one-sample Kolmogorov-Smirnov tests.    Results: The mean age of the participants was 3.6 years with a mean weight of 15.68 kg. SPO2 was not significantly different between the two groups (P=0.609). However, the HR was significantly higher in the MK combination (P=0.001). No significant difference was detected between the two combinations for sleepiness (P=0.283), movement (P=0.180), crying (P=0.093), or overall behavior (P=0.364). The recovery time in the PK group was significantly shorter than that in the MK group (P=0.03). Conclusion: Both sedation regimens are effective for dental treatment of uncooperative children. PK combination provided a more acceptable hemodynamic stability and shorter recovery.

Islamic Azad University Dental Branch Journal of Research in Dental and Maxillofacial Sciences 2588-4166 10 2 2025 6 1 Effects of Laser-Assisted and LED-Assisted Bleaching Techniques on Color Parameters 134 143 EN Farzaneh Sadeghi Mahounak Restorative Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran Nasim Chiniforush Laser Research Center of Dentistry, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran Eugenia Anagnostaki Anagnostaki Abolfazl Bazari Jamkhaneh Orthodontics Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran Zohreh Moradi Laser Research Center of Dentistry, Restorative Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran Background and Aim: This study assessed the effects of laser-assisted and light emitting diode (LED)-assisted bleaching on color parameters.    Materials and Methods: This in vitro study evaluated 40 sound central incisors and premolars immersed in tea solution for 6 days. They were then randomly divided into 4 groups: (I) Bleaching with White Smile containing 40% hydrogen peroxide gel + LED irradiation (Monitex; 4 blue lights with 420-490 nm wavelength and 1 red light with 620-630 nm wavelength), (II) Opalescence Boost containing 40% hydrogen peroxide gel without activation, (III) Opalescence Boost activated by LED, and (IV) Opalescence Boost activated by 980 nm diode laser with 2 W/cm2 power. The color parameters of the teeth were measured at baseline, after staining, immediately after bleaching, and 1 week after bleaching. Color change (∆E) was calculated and analyzed by one-way ANOVA and Tukey’s test (alpha=0.05).    Results: Discoloration was significantly resolved in all groups with significant ∆E values (P<0.05). All modalities had a comparable performance regarding the changes in value in the middle and coronal thirds, and caused tooth shade lightening. Opalescence Boost was superior to laser-assisted Opalescence Boost in the incisal third. The changes in a* and b* parameters were not significant and were within the range of lower chroma. Conclusion: The results showed that laser-assisted bleaching with Opalescence Boost had the poorest performance regarding changes in L* parameter. The performance of the conventional Opalescence Boost, LED-assisted Opalescence Boost, and LED-assisted White Smile was the same regarding ∆L, ∆a, and ∆b.

Islamic Azad University Dental Branch Journal of Research in Dental and Maxillofacial Sciences 2588-4166 10 2 2025 6 1 Flexural Strength and Microshear Bond Strength of Conventional and Flowable Composite Resins to Dentin 144 151 EN Sina Farahiparizi Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Kasra Tabari Department of Restorative Dentistry, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hasan Torabzadeh Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Narges Panahandeh Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Background and Aim: This study aimed to evaluate the flexural strength (FS) and microshear bond strength (µSBS) of conventional and flowable composite resins to dentin.    Materials and Methods: This in vitro study was conducted on composite specimens fabricated from Filtek Z250 and Clearfil AP-X Esthetics (CE) conventional, and Clearfil AP-X Esthetics Flow (CEF) and Clearfil AP-X Flow (CF) flowable composite resins in 4 groups (n=10). The specimens underwent a 3-point bending test for measurement of their FS. For assessment of µSBS, dentin discs with 2 mm thickness were obtained from the coronal third of the crowns of 20 extracted premolars. Composite resins were bonded to dentin discs in Tygon tubes (1 mm height, 0.7 mm internal diameter) using Tetric N-Bond 5th generation bonding agent, and a universal testing machine measured their µSBS. Data were analyzed by ANOVA and Tukey test (alpha=0.05).    Results: Z250 showed a significantly higher FS than CEF (P=0.002); no other significant difference was found in FS. The two conventional composites (P=0.847) and the two flowable composites (P=0.575) had no significant difference with each other in µSBS. However, the conventional composites had a significantly higher µSBS than the flowable composites (P<0.001). Conclusion: The FS of CEF was significantly lower than that of Z250, and comparable to that of other tested composite resins. All tested composites had a FS higher than 80 MPa recommended by ISO-4049 for restorations under occlusal forces. Both CEF and CF showed significantly lower µSBS than the tested conventional composite resins.

Islamic Azad University Dental Branch Journal of Research in Dental and Maxillofacial Sciences 2588-4166 10 2 2025 6 1 Dentin Remineralizing Potential of a Bioactive Composite Resin Versus a Conventional Composite Resin: Mineral Index and Microhardness Analysis 152 158 EN Fariba Motevaselian Restorative Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran. Behnam Mohaghegh Dentist, Private practice, Tehran, Iran. Farzaneh Sadeghi Restorative Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran. Niyousha Rafeie Dental Research Center, Dentistry Research Institute, Dental School, Tehran University of Medical Science, Tehran, Iran. Mehdi Abbasi Restorative Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran. Ladan Ranjbar Omrani RRestorative Department, Dental School, Tehran University of Medical Sciences, Tehran, Iran. Background and Aim: This study aimed to compare the dentin demineralization inhibitory potential of a bioactive composite resin (ACTIVA-BioActive) with a conventional composite resin.    Materials and Methods: In this in vitro experimental study, 45 class V cavities were prepared on the root surface of extracted human third molars. The teeth were then immersed in a demineralizing solution (lactic acid, pH=4.5) at 37˚C for 3 days to induce the formation of secondary caries. The cavities were restored with Single bond 2 + Z250 (group A), ACTIVA BioActive (group B), and Single bond 2 + ACTIVA BioActive (group C). The dentin microhardness was measured close to the restoration margin (marginally exposed dentin), and at approximately 4 mm distance from the margin in a varnish-covered dentin area (protected dentin). Three measurements were made at each site at 50, 100, and 150 µm depths from the external dentin surface. Data were analyzed with one-way ANOVA and Tukey test (alpha=0.05).     Results: The highest Vickers hardness number (VHN) was observed in ACTIVA+ bonding agent (49.46±4.15), followed by Z250 (44.57±3.87), and ACTIVA (43.44±3.76) group. The mineral index was significantly higher in ACTIVA+ bonding agent (76.87±3.80) compared to other groups while no significant difference was observed between ACTIVA (70.85±4.06) and Z250 (71.98±3.09) in this regard (P<0.001). Conclusion: The results showed that flowable ACTIVA BioActive composite used with Single bond 2 resulted in a significantly smaller reduction in dentin microhardness and reduced secondary caries formation. ACTIVA BioActive with no adhesive had no advantage over Z250 composite.

Islamic Azad University Dental Branch Journal of Research in Dental and Maxillofacial Sciences 2588-4166 10 2 2025 6 1 Anatomical Correlation Between Mandibular Third Molar Position and Retromolar Nerve Variations: A CBCT Study 159 167 EN Mahdis Tahmasebi Dentist, Private Practice, Tehran. Sanaz Heidarkhan Tehrani Oral and Maxillofacial Radiology Department, TeMS.C, Islamic Azad University, Tehran, Iran. Fatemeh Mehmani Oral and Maxillofacial Radiology Department, TeMS.C, Islamic Azad University, Tehran, Iran. Hassan Mesgari Oral and Maxillofacial Surgery Department, TeMS.C, Islamic Azad University, Tehran, Iran. Amirreza Mehdizadeh Oral and Maxillofacial Radiology Department, TeMS.C, Islamic Azad University, Tehran, Iran. Background and Aim: Variations in the retromolar canal (RMC) and retromolar nerve can cause complications. This study aimed to evaluate the relationship between the anatomical position of mandibular third molars and variations of the retromolar nerve using cone-beam computed tomography (CBCT) imaging.    Materials and Methods: A descriptive analytical study was conducted on CBCT images of the mandible from 126 individuals (82 females, 44 males) over the age of 25 years. The impaction status of the mandibular third molars was classified using Pell and Gregory's classification, while angulation was determined according to Winter's classification. The presence of the retromolar nerve, its buccal or lingual position relative to the mandibular third molar, and the distance between the RMC and mandibular third molar were evaluated.    Results: The retromolar nerve was present in 53 cases (42.1%). It was positioned buccally in 36 cases (28.6%) and lingually in 17 cases (13.5%) relative to the mandibular third molar. The mean distance between the RMC and the cementoenamel junction (CEJ) of the mandibular third molar was 5.41 mm. A significant relationship was found between the third molar impaction status and presence and position of the retromolar nerve (P=0.002). Conclusion: The retromolar nerve was more frequently present in non-impacted mandibular third molars. In presence of semi-impacted third molars, the nerve was significantly more likely to be positioned buccally. These findings highlight the importance of preoperative CBCT imaging to identify anatomical variations, aiding in surgical planning and reducing the risk of neurological complications during mandibular third molar extractions.