Erbil Dental Journal (EDJ)

Correlation Between Facial Forms and Bolton Ratios in Class I and Class II Malocclusions

Brwa Chapook Abdullah — 2026-06-30

Background and Objective: Facial morphology and dental arch dimensions coordination are fundamental aspects of orthodontic diagnosis and treatment planning. Tooth-size discrepancies, as quantified by anterior and overall Bolton ratios, may vary with facial form and malocclusion classification. Aim: To evaluate the correlation between facial forms (as measured by facial index) with anterior and overall Bolton ratios in Class I and Class II malocclusion subjects in Erbil city, using three-dimensional facial and intraoral digital scans.

Methods: The cross-sectional study included 128 participants divided by sex (males: 64, females: 64), malocclusion class (Class I: 64, Class II: 64), and facial form based on facial index thresholds (24 euryprosopic, 27 mesoprosopic, 77 leptoprosopic). Facial scans provided measurements of facial height (nasion–gnathion) and bizygomatic width, which were used to calculate the facial index. Digital intraoral scans were used to calculate anterior and overall Bolton ratios. Normality was assessed with the Shapiro–Wilk test. Group differences were analyzed using the Kruskal–Wallis and Mann–Whitney U tests, and associations were evaluated using Spearman correlation.

Results: No correlation was found between facial index and either anterior or overall Bolton ratios (P>0.05). However, anterior Bolton ratios differed significantly among facial form types (P=0.009), with pairwise analysis showing higher values in mesoprosopic forms compared to euryprosopic forms. No significant differences were found between Class I and Class II groups.

Conclusions: These findings indicate that although facial index does not predict anterior or overall Bolton ratios across malocclusion classes, differences in anterior ratios among facial types may still occur. Clinically, this emphasizes that Bolton ratio assessment should always be performed individually, rather than inferred from facial form or malocclusion type, to ensure precise diagnosis and treatment planning.

Biomechanical Evaluation of a Novel Chambered Overlay Design in Endodontically Treated Mandibular Molars

Hozan S. Salhi — 2026-06-30

Background and objectives: Endodontically treated teeth (ETT) are structurally weakened because of extensive loss of internal dentin architecture. Although adhesive overlays have been introduced as a conservative restorative approach, limited evidence exists regarding the influence of internal design modifications on fracture resistance. This study evaluated the effect of a novel biomimetic overlay design, termed the Embedded Chamber Overlay (ECO), also known as Hozan’s Chambered Overlay, on the fracture resistance of lithium disilicate restorations in endodontically treated mandibular first molars.

Methods: Sixteen extracted human mandibular first molars underwent endodontic treatment and decoronation at the cementoenamel junction level. Specimens were randomly allocated into two groups (n = 8) according to overlay design: conventional lithium disilicate overlays or ECO lithium disilicate overlays. All restorations were fabricated and adhesively cemented using standardized protocols. Fracture resistance was evaluated under axial compressive loading using a universal testing machine. Failure modes were assessed under magnification. Data were analyzed using independent samples t-tests with statistical significance set at α = 0.05.

Results: The ECO lithium disilicate overlay group demonstrated significantly higher fracture resistance (3971 ± 20 N) than the conventional overlay group (2641 ± 20 N) (p < 0.001). Cohen’s d analysis revealed an extremely large effect size (d = 66.1). All specimens exhibited catastrophic Class IV fractures involving root-level structural separation.

Conclusion: Within the limitations of this in vitro study, ECO significantly enhanced the fracture resistance of lithium disilicate restorations in endodontically treated mandibular molars, suggesting improved biomechanical performance in structurally compromised posterior teeth.

Mouth Breathing in Schoolchildren in Ankawa District: Symptoms, Risk Factors, and Orthodontic Implications in a Cross-Sectional Study with Home-Based Test Validation

Dina Jawhar Butrus — 2026-06-30

Background and Objective: Mouth breathing is common in children and has been associated with a range of clinical concerns. Early recognition may help orthodontists and other healthcare professionals identify and manage this condition.

This study aimed to determine the prevalence of mouth breathing among school-aged children in the Ankawa district and to examine its associations with demographic factors, sleep-related symptoms, general well-being, and parent-reported school functioning.

Methods: A cross-sectional school-based study was conducted among 270 primary schoolchildren using multistage stratified cluster sampling. Data were collected using a parent-completed questionnaire and a home-based water retention screening test. Students were trained during school visits, and parents completed the questionnaire at home after providing written informed consent.

Results: Based on the water retention screening test, 48% of the sample screened positive for mouth breathing. Children who retained water in their mouths for more than 3 minutes were classified as nasal breathers. Only 15.9% were reported to habitually breathe through the mouth during the day, while 18.1% were reported to do so during sleep. No statistically significant differences were found by age or sex (p > 0.05). However, a significant difference was observed between public and private school students (p < 0.05). A significant association was also found between positive screening test results and parent-reported teacher concern about the child's attention (p < 0.001).

Conclusion: Mouth breathing was common in this sample of school-aged children. Early recognition and increased awareness may help support timely assessment and management of potential health, behavioral, and academic consequences.

Detection of Biofilm Formation by Candida Species in the Oral Cavities of Diabetic Patients Using the Oral Rinse Technique in Erbil City

Dyar Musadaq Sleman — 2026-06-30

Background and Objective: Biofilm formation is a type of virulence factor of Candida spp. that promotes growth and protects against antifungal activity, especially in the oral cavity of diabetic patients.

Aim: The objective of this study is to detect biofilm formation by Candida spp. to determine the relationship between colony-forming units (CFU/mL) and blood sugar levels, and to assess the impact of biofilm formation on antifungal activity.

Method: In this current study, which includes two groups: group 1, Diabetic mellitus (55 males and 45 females) (31 Type 1 and 69 Type 2), and group 2, non-diabetic individuals (23 males and 27 females) in Erbil city. Oral rinses were collected for identification using Chromagar Candida and the Vitek 2 ID system. For biofilm formation, Congo Red Agar, tube adherence tests, and the Microtiter plate method were used. Antifungal discs (Voriconazole 1mg), (Fluconazole 25mg), (Miconazole 30mg), (Ketoconazole 10mg), and (Nystatin 100mg). Statistical analysis was performed using GraphPad Prism version 9.0, including independent-samples t-tests and ANOVA, and categorical variables were presented as frequencies and percentages.

Result: Candida spp. were detected in 60% (60/100) of people with diabetes and in 24% (12/50) of non-diabetic individuals. The study identified 15 of 60 isolates (25%) as biofilm producers in diabetic patients. A significant relationship between blood sugar level and oral Candida (CFU/mL) (P =0.0001). Moreover, biofilm formation increases resistance to an antifungal agent (P = 0.0001).

Conclusion: Biofilm formation was associated with increased antifungal resistance. Higher blood glucose levels were associated with increased Candida colony counts.

In Vitro Color Stability Assessment of Two Clear Aligner Types

Heshou Himdad Jemal — 2026-06-30

Background and Objective: Clear aligners, widely used in orthodontic treatment, are subject to various environmental stresses that can affect their performance and esthetics. In addition, due to patient non-compliance, aligners frequently contact hot beverages such as coffee and cold beverages like cola. This study evaluates the effect of these beverages, along with artificial saliva, on the color stability of clear aligner materials.

Methods: Two types of clear aligners; Polyethylene Terephthalate Glycol (DURAN) and copolyester/ thermoplastic elastomer (CAPro), were stained using artificial saliva, cola and coffee for up to 14 days. Color stability was assessed by Vita Easyshade ADVANCE 4.0 utilizing the Commission International lightening L*a*b* color scheme.

Results: Both DURAN and CAPro aligners showed significant color changes versus baseline (p < 0.01). For DURAN, all ΔE1–ΔE1 comparisons were significant (p < 0.01) except for saliva; CAPro showed significance only in coffee (p < 0.01). Solution-based differences at both time points were highly significant for both materials (p < 0.001). Solution type had the strongest impact on color stability, followed by material and duration.

Conclusions: Color stability was significantly influenced by solution type, material, and exposure time, with the solution having the strongest effect, followed by material and time. DURAN exhibits greater resistance to staining compared to CAPro, with coffee producing the most significant discoloration, followed by cola. The degree of color change intensifies with prolonged exposure.

Effects of Low-Level Laser Therapy on Histological Changes of Lingual Papillae in Streptozotocin-Induced Diabetes Mellitus in Rats: An Experimental Study

Bayar Taher Saeed — 2026-06-30

Background and Objectives: Diabetes mellitus (DM) is associated with structural alterations in oral tissues, including the lingual papillae, where epithelial atrophy, fibrosis, and degeneration of taste buds may occur. Low-level laser therapy (LLLT) has been suggested as a non-invasive therapeutic approach that may enhance tissue repair and regeneration.

Aim: This study evaluated STZ-induced diabetic changes in rat lingual papillae and the therapeutic effect of low-level diode laser therapy.

Methods: 21 Wistar albino rats were used. 3 Rats served as healthy controls, while diabetes was induced in 18 rats by a single intraperitoneal injection of STZ at 50 mg/kg. After confirmation of hyperglycemia (blood glucose level >= 300 mg/dL), diabetic rats were divided into two equal subgroups: untreated diabetic rats and LLLT-treated diabetic rats. Untreated diabetic rats were examined histologically at 2, 3, and 4 weeks after diabetes induction. The treated subgroup received diode laser therapy three times weekly starting 4 weeks after diabetes induction and was evaluated at 6, 7, and 8 weeks. Body weight and blood glucose levels were monitored throughout the study. Tongue specimens were collected for histological and semi-quantitative evaluation.

Results: Untreated diabetic rats showed progressive histological deterioration, including epithelial atrophy, fibrosis, and reduced taste bud density. These changes became more pronounced with longer diabetes duration. In contrast, LLLT-treated rats demonstrated improved epithelial thickness, better preservation of taste buds, and reduced fibrosis.

Conclusion: STZ-induced DM caused progressive degenerative changes in the lingual papillae. LLLT promoted histological improvement and may support tissue repair in diabetic lingual tissues.

Prevalence, Characteristics and Self-Management of Aphthous-Type Oral Ulcers among Yemeni Dental Students: Multicenter Cross-Sectional Study

Omar Abdullah Rageh — 2026-06-30

Background and Objective: Aphthous-type oral ulcers, often discussed in relation to recurrent aphthous stomatitis, can impair eating, speaking, and quality of life. Dental students may be particularly susceptible due to academic stress and other risk factors, yet data from Yemen are limited. This study aimed to determine the prevalence, clinical characteristics, triggers, and self-management practices of aphthous-type oral ulcers among Yemeni dental students.

Methods: A multicenter cross-sectional survey was conducted among 278 dental students from seven universities in Yemen. The questionnaire recorded demographic variables, smoking status, family history of aphthous ulcers, self-reported ulcer experience, reported sites, pain, interference with eating/drinking/speaking, other associated symptoms, perceived triggers, and management measures. Data were summarized descriptively using frequencies and percentages. Results were deemed significant when p < 0.05.

Results: Of the 278 respondents, 186 (66.9%) reported a history of aphthous-type oral ulcers. Commonly reported sites were the labial mucosa (37.5%), buccal mucosa (18.8%), and gingiva (18.8%). Among respondents who completed the symptom items, 72% reported pain and 76% reported interference with eating, drinking, or speaking. Stress was the most frequently perceived trigger (66.7%), followed by certain foods (22.2%). Self-management was common; antiseptic mouth rinses were the most frequently selected measure (31.0%), whereas only 4.0% sought professional care.

Conclusion: The overall finding of the current study highlights the negative effect of aphthous ulcers on quality of life and academic performance. These findings underscore the need for preventive strategies such as stress management programs and dietary counseling in dental education settings.

Oral Microbial and Salivary Alterations Associated with Type 1 Diabetes Mellitus in Children: A Case-Control Study from Erbil City

Frishta Saber Mohammed — 2026-06-30

Background and objective: Type 1 diabetes mellitus (T1DM) affects the pH, flow rate, and content of saliva, which increases the risk of dental caries. In comparison to their matched healthy controls, this study aimed to assess the association between dental caries, salivary traits, and Streptococcus mutans levels in children with T1DM.

Materials and Methods: A case-control study was conducted with 20 children with T1DM and 20 age- and sex-matched healthy controls. Clinical dental examinations assessed the Ageless DMFT (A‑DMFT) index, and saliva samples were analyzed for secretion rate, pH, and S. mutans using quantitative real-time PCR.

Results: There were no significant differences in A‑DMFT scores or salivary secretion rates between the groups. However, the T1DM group had significantly lower salivary pH (7.00 vs. 7.20, p = 0.002) and higher S. mutans levels (2.73×10⁵ vs. 3.25×10⁴ CFU/mL, p = 0.012). A strong positive correlation between A‑DMFT and S. mutans was found (ρ = 0.724, p < 0.001). No significant correlation was observed between A‑DMFT and saliva secretion rate (ρ = 0.183, p = 0.257). In logistic regression analysis, lower salivary pH (p = 0.005) and higher S. mutans levels (p = 0.023) were independently associated with T1DM status.

Conclusion: Children with T1DM had higher levels of S. mutans and lower salivary pH than controls, indicating an increased risk for dental caries. The results imply that the elevated cariogenic potential shown in this group may be caused by variables other than salivary secretion rate.

Evaluation Of CAD/CAM Milled Zirconia Crowns And 3D Printed Permanent Resin Crowns in the term of Adaptation

Dalan Jamal Kamal — 2026-06-30

Background and Objective: This study aimed to evaluate and compare the adaptability in term of internal fitting for both types of computer aided design and computer aided milling (CAD/CAM) milled zirconia crown and 3D printed permanent resin crown in both periods of before and after thermocycling aging to evaluate the clinical performance of both types of crowns.

Method: Forty crowns were manufactured: twenty from CAD/CAM zirconia milling group and twenty from 3D-printed permanent resin group. The internal fit test is done for the crowns both before and after thermocycle aging using silicone replica technique. Measurements were taken at marginal, axial, axio-occlusal, and centro-occlusal points under stereomicroscope of 20x magnification. Data analyzed on SPSS software using multiple comparison test.

Result: There were no differences that is statistically significant in most of the points measured for both types of CAD/CAM milled zirconia and 3D-printed permanent resin crown. Thermocycling aging did not result in statistically significant differences for the internal fit of both types of crowns.

Conclusion: Clinically acceptable internal fit values were shown by both 3D-printed permanent resin crowns and CAD/CAM milled zirconia crowns. In some cases of greater adaptation, 3D-printed crowns performed similarly to milled crowns. Thermocycling had no significant impact on internal fit, indicating the materials' and fabrication techniques' long-term clinical practicality.

The Effect of Coca-Cola on the Compressive Strength of Three Restorative Materials Used in Pediatric Dentistry: An In Vitro Comparative Evaluation

Znar Jihangeer Mohammed — 2026-06-30

Background and Objective: The consumption of acidic soft drinks has become common in young children, and their effects on teeth and restorative materials have become a concern for dentists. This in vitro study aimed to compare and analyze the compressive strength of three commonly used restorative materials in pediatric dentistry, Glass Ionomer Cement (GIC), Compomer, and Giomer, after immersion in Coca-Cola (as an acidic beverage) and distilled water (DW) (as a control).

Materials and Methods: Sixty cylindrical specimens were fabricated and divided into three main groups (n=20) for each material, and further randomly subdivided into two equal subgroups (n=10). Each subgroup was then immersed in either Coca-Cola or distilled water for seven days, with the liquids being changed every day. Compressive strength was tested using a Universal Testing Machine. The data were analyzed using two-way ANOVA and Tukey’s HSD post hoc test. The percentage of reduction of strength was also calculated for each material.

Results: All materials showed a statistically significant decrease in compressive strength after Coca-Cola exposure, p < 0.001. The mean compressive strengths of Giomer, Compomer, and GIC in distilled water were 276.85 MPa, 182.89 MPa and 103.7 MPa, respectively. The reduction in strength from distilled water to Coca-Cola for Compomer, Giomer, and GIC was 18.69%, 15.28%, and 11.97%, respectively.

Conclusion: Acidic exposure from beverages like Coca-Cola reduces the compressive strength of restorative materials, with Compomer being the most affected. GIC showed the highest resistance to acidic degradation, which may be attributed to the absence of a resin matrix.

Comparative Analysis of the Effects of Different Disinfection Methods on the Mechanical Properties of Valplast and Acrylic Resin Denture Base Materials

Ribaz Tahsin Hayas Kakai — 2026-06-30

Background and objective: Dental prostheses should be disinfected effectively without damaging the denture base.

Aim: This in vitro study evaluates the effect of three commonly used chemical disinfectants, 4% chlorhexidine, 2% glutaraldehyde, and 5.25% sodium hypochlorite, on the mechanical properties of two widely used denture base materials: Heat-cured acrylic resin and Valplast.

Methods: A total of 160 rectangular specimens were fabricated and equally divided into two main material groups (80 specimens of Heat-cured acrylic resin and 80 specimens of Valplast). Each group was further subdivided into four subgroups (n=20) according to the disinfectant applied, including a control group with distilled water. Disinfection protocols involved immersing each specimen in distilled water for 3 minutes, followed by a 10-minute exposure to the designated disinfectant, and concluding with a 3-minute washing in distilled water. Flexural strength and flexural modulus were assessed using a universal testing machine based on the three-point bending test according to ISO 178:2019 standards.

Results: Statistical analysis was conducted using one-way ANOVA, Dunnett’s post hoc, and an independent t-test at a significance level of P ≤ 0.05. The flexural strength test indicated that, for both main groups, the control group exhibited the highest mean values, while specimens immersed in 5.25% sodium hypochlorite recorded the lowest mean values and showed no significant differences between Heat-cured acrylic resin and Valplast materials under corresponding treatment conditions.

Conclusion: These findings suggest that disinfection protocols do not impact the mechanical properties of denture base materials, and Valplast consistently exhibited lower values in both parameters compared to Heat-cured acrylic resin.

Evaluation of Antibacterial Properties and Solubility of Modified Metapex with Zinc Oxide Nanoparticles: An In Vitro Study

Zhakaw Abdulkhalq Faqi — 2026-06-30

Background and Objective: Pulpectomy plays a critical role in maintaining primary teeth until they naturally exfoliate, particularly in cases where the pulp is infected or necrotic. Metapex is a widely used root canal filling material for such treatments.

Methods: This study investigates the effect of incorporating zinc oxide nanoparticles (ZnO NPs) into Metapex on its antibacterial efficacy and solubility. Four groups were evaluated: a control group with Metapex alone and three experimental groups with Metapex modified with 1%, 3%, and 5% concentrations of ZnO NPs. The modified pastes were thoroughly homogenized. Antibacterial activity was tested against Enterococcus faecalis using the agar well diffusion method, and solubility was assessed by calculating weight change before and after immersion in distilled water.

Results: The results showed significant improvements in antibacterial activity with higher concentrations of ZnO NPs (p < 0.001). The 5% ZnO group produced the largest inhibition zone (11.42 ± 0.74 mm), and both 3% and 5% concentrations showed significantly greater antibacterial effects than the control. In terms of solubility, pure Metapex exhibited the highest rate (35.17 ± 0.59), while the addition of ZnO NPs resulted in a concentration-dependent decrease in solubility: 32.93 ± 2.11 for 1%, 27.77 ± 4.37 for 3%, and 24.03 ± 1.97 for 5% (p = 0.003).

Conclusion: The integration of ZnO NPs into Metapex enhances its antibacterial capabilities while improving its physical stability. A 5% concentration appears to offer the most effective balance, making it a promising enhancement for pulpectomy procedures.

Assessment of Caries Risk in Young Adults Using the Cariogram Model: A Cross-Sectional Study

Saraa Abdulrhman Alhamdani — 2026-06-30

Background and Objectives: Dental caries is considered one of the most prevalent global health issues, affecting over 3.1 billion people. The Cariogram, a Caries Risk Assessment (CRA) model, helps predict caries risk by evaluating multiple contributing factors. This study aimed to investigate caries risk in young adults in Erbil City, Iraq, using the Cariogram model, incorporating salivary factors and Streptococcus mutans levels.

Methods: This cross-sectional study involved 30 young adults aged 18–25 years (13 males, 17 females). Cariogram software was utilized to determine caries risk based on four main categories: diet, bacteria, susceptibility, and circumstances.

Results: The mean age was 23.38 ± 1.38 years for males and 22.82 ± 1.42 years for females. Caries experience was predominantly classified as better than normal (60%), and the most common fluoride regimen was fluoride toothpaste alone (46.7%). The majority of participants had normal salivary secretion (43.3%) and low buffering capacity (63.3%). Most participants were classified as having a low (33.3%) or medium (30%) risk for caries. Streptococcus mutans levels were highest in Classes 0 and 1 (33.3% each).

Conclusion: Factors such as Streptococcus mutans levels, diet, and individual susceptibility were strongly associated with caries risk.

The effect of Thermocycling on the Flexural and Impact strength of 3D printed dental resins by two different Technologies

Sara Kawa Ismael — 2026-06-30

Background and Objective: This research examines the effects of Thermocycling and various printing processes, including Digital Light Processing (DLP) and Stereolithography (SLA) 3D printing, on the mechanical characteristics of denture base resin.

Materials and Methods: Eighty denture base samples were prepared and equally distributed for two mechanical tests, 40 for the Flexural strength test and 40 for the Impact strength test. These were subsequently subdivided into two subsets based on the photopolymerization technology: DLP and SLA. Half of the samples in each group underwent 3,000 Thermocycles from 5 to 55°C. A universal testing machine and a Charpy's impact tester were used, respectively.

Results: The values of Flexural strength were 34.384, 31.591, 29.446, and 28.621 MPa; Impact strength 0.841, 0.552, 0.742, and 1.103 KJ/m² for DLP Before, DLP After, SLA Before, and SLA After Thermocycle, respectively. Before and after Thermocycling, DLP had greater Flexural strength than SLA. DLP had higher Impact strength before Thermocycling, but SLA had it after.

Conclusion: DLP demonstrated superior Flexural strength compared to SLA both before and after Thermocycling. Thermocycling had a material-dependent effect on Flexural strength, causing a statistically significant reduction in the DLP group (p < 0.001), while the reduction observed in the SLA group was not statistically significant. Regarding Impact strength, Thermocycling significantly decreased the values in the DLP, whereas it significantly increased the values in the SLA. These findings indicate that the effect of Thermocycling on mechanical properties varies depending on the printing technology and material characteristics.

Effect of Different Cement Thicknesses on Fracture Resistance of Monolithic Full Anatomic Zirconia Crowns: An In Vitro Study

Sally Wadeea — 2026-06-30

Background: Zirconia has become widely used in all-ceramic restorations because of its mechanical properties and improved esthetics compared with metal-based restorations. Concerns about Zirconia-based prostheses have historically been focused on the risk of chipping and veneering porcelain. Monolithic zirconia restorations eliminate the risk of veneering porcelain chipping commonly associated with layered restorations. In addition, the use of Computer-Aided Design (CAD)/ Computer-Aided Manufacturing (CAM) in the production of these crowns has improved restoration quality by providing a higher degree of material homogeneity.

Objective: To evaluate the effect of different digitally set cement thicknesses (30 µm, 60 µm, and 90 µm) on the fracture resistance of CAD/CAM monolithic zirconia crowns.

Methods: Thirty-six monolithic zirconia crowns were milled via CAD/CAM and divided into three groups based on cement thickness: 30 µm (Group A), 60 µm (Group B), and 90 µm (Group C). Specimens were loaded vertically in a universal testing machine at 1 mm/min with a 10 N preload until fracture, and forces were recorded in Newton.

Results: The mean fracture resistance values were 4305.3 N for Group A, 3696.5 N for Group B, and 4233.4 N for Group C. No statistically significant difference was found among the groups (p = 0.144).

Conclusion: Within the limitations of this in vitro study, cement thicknesses ranging from 30 µm to 90 µm did not significantly affect the fracture resistance of monolithic zirconia crowns.

Assessment of Oral Manifestation and Inflammatory Markers (IL-17) in End Stage Chronic Kidney Disease Patients: A Cross Sectional Study

Aya M. Redha — 2026-06-30

Background and Objectives: Chronic kidney disease (CKD) is a progressive condition characterized by irreversible deterioration of kidney function, resulting in systemic complications that may adversely affect oral health. Patients undergoing hemodialysis frequently present with various oral manifestations due to metabolic disturbances, medication use, and altered immune responses. Interleukin-17 (IL-17) is an inflammatory cytokine involved in host defense against Candida albicans and may play a role in the oral health status of CKD patients. This study aimed to evaluate oral manifestations and serum IL-17 levels in patients with end stage chronic kidney disease undergoing hemodialysis.

Methods: A cross-sectional study was conducted on 60 participants, including 30 patients with CKD undergoing hemodialysis for more than six months and 30 healthy controls matched for sex. Clinical examinations included assessment of oral dryness, salivary flow rate (sialometry), periodontal status, halitosis, coated tongue, pale oral mucosa, and lip fissures. Serum IL-17 levels were measured using laboratory analysis. Data were analyzed using independent samples t-test and Chi-square test, with statistical significance set at p < 0.05.

Results: Dry mouth, pale oral mucosa, and lip fissures were significantly more prevalent among CKD patients than controls (p < 0.05). Salivary flow rate was significantly reduced, while periodontal disease severity was significantly increased in the CKD group. Although serum IL 17 levels were higher in CKD patients than in healthy controls, the difference was not statistically significant (p = 0.182).

Conclusion: Patients with chronic kidney disease undergoing hemodialysis exhibit a higher prevalence of oral manifestations and periodontal disease compared with healthy individuals. Regular oral healthcare and preventive dental measures are essential for improving oral health outcomes in this population.

Assessment of Periodontal Health Status and Oral Hygiene Practice Among Students of College of Health and Medical Technologies in Mosul City

Hasan Hazim Hasan — 2026-06-30

Background and Objective: Periodontal disease is a major oral health concern caused primarily by dental plaque accumulation. Although dental technologists are not direct clinical care providers, their oral health knowledge may influence professional practice and patient awareness. This study aimed to assess periodontal health status, oral hygiene practices, and awareness among Prosthetic Dental Techniques students at Al-Noor University College, Mosul, Iraq.

Materials and Methods: A cross-sectional study was conducted on 120 students equally distributed across four academic stages. Data collection included a validated questionnaire assessing oral hygiene practices and periodontal awareness, in addition to clinical examination of Ramfjord teeth using William’s periodontal probe. Clinical parameters included plaque index (PI), gingival index (GI), sulcus depth, and bleeding on probing (BOP). Statistical analysis was performed using non-parametric tests.

Results: Female students demonstrated significantly higher oral hygiene practice scores (6.60 ± 2.10) and awareness scores (8.07 ± 1.91) compared with males (5.38 ± 1.88 and 6.79 ± 2.28, respectively; p = 0.002). Awareness scores increased significantly with academic progression (p < 0.001). PI, GI, Sulcus Depth, and BOP also showed significant differences across academic stages (p < 0.05). The dental curriculum (86.2%) was the primary reported source of oral health information.

Conclusions: Academic advancement was associated with improved periodontal awareness and clinical periodontal status among dental technology students. These findings highlight the importance of integrating periodontal education and preventive oral health practices into dental technology curricula.

The Impact of Social Media on Patients’ Selection of Orthodontic Treatment and Orthodontists in Erbil City

Muhamad Tayib Mahroof — 2026-06-30

Background and Objectives: Social media has become a major source of health information, particularly in orthodontics, where visual content such as photos and videos can strongly influence patient perceptions. This study aimed to assess the influence of social media on patients’ decisions to initiate orthodontic treatment and select orthodontists in Erbil City, Kurdistan Region, Iraq.

Methods: A descriptive cross-sectional study was conducted from February to May 2025 in dental clinics in Erbil. A pretested, structured questionnaire was administered through convenience sampling to 142 orthodontic patients aged ≥18 years. SPSS version 27 was then used to analyze the data with the use of descriptive statistics, chi-square tests, and binary logistic regression. Statistical significance was defined as p < 0.05.

Results: (54.2%) of the study participants reported that social media influenced their decision to start orthodontic treatment. The factor most associated with an increase of choice was visual content; (67.6%) stated that before-and-after images influenced their decision, and (57.0%) indicated that frequent posting by orthodontists influenced their decision. While (72.5%) used the internet for obtaining orthodontic information and (31.7%) followed orthodontic-related pages on social media, only (62.1%) believed that the information online is accurate. The platform with the highest usage (69.0%) was Instagram.

Conclusion: This study indicates that social media does influence orthodontic treatment decisions in Erbil City, and its high impact may be attributed to promoted visual information and provider activity on their pages. Yet the low level of trust in information found online emphasizes that a need exists for increasing the value and trustworthiness of online health information.

Intersection of Cancer and Sepsis: Molecular Characterization of Bacterial Pathogens and Antimicrobial Resistance in Hematological Patients from Erbil, Iraq

Sara Redar Yasseen — 2026-06-30

Background and Objective: Sepsis remains a leading cause of mortality in patients with hematological malignancies, particularly in settings with escalating antimicrobial resistance (AMR). This study characterized bloodstream pathogens, resistance phenotypes, and genetic determinants among septic hematological cancer patients in Erbil, Iraq.

Methods: A nine-month observational study (September 2024–March 2025) enrolled 80 patients (40 septic, 40 non-septic controls). Blood cultures were processed using the BacT/ALERT system. Antimicrobial susceptibility testing was performed using VITEK 2 Compact and Kirby–Bauer methods. Resistance genes were detected using the BioFire FilmArray BCID panel. Statistical analysis was conducted using SPSS v25 (p < 0.05).

Results: Septic patients were significantly older than controls (49.2 ± 21.5 vs. 32.8 ± 21.2 years; p = 0.0009). Gram-negative pathogens predominated (55%). Escherichia coli (22.5%) was the most frequent isolate, followed by Staphylococcus hominis (15%). Gram-positive isolates exhibited universal resistance to cefoxitin and penicillin (100%) and high resistance to oxacillin and erythromycin (88.9%), while linezolid retained 83.3% activity. Gram-negative isolates demonstrated marked resistance to cefotaxime (90.9%), ampicillin (81.8%), and imipenem (63.6%). The most prevalent resistance genes were blaCTX-M (22.7%) and NDM (9.1%) among Gram-negative isolates and mecA/mecC (11.1% each) among Gram-positive isolates.

Conclusion: The high prevalence of multidrug-resistant pathogens, including carbapenem-resistant strains, underscores the urgent need for molecular surveillance and region-specific antimicrobial stewardship in hematological oncology settings.

Evaluation of Physico-mechanical and Antimicrobial Properties of a Silicone-Based Soft Denture Liner Modified with Zinc Oxide Nanoparticles and Fluconazole: An In Vitro Study

Nakhshin Khalid Hamad — 2026-06-30

Purpose: This in vitro study evaluated the physico-mechanical and antimicrobial properties of a silicone-based soft denture liner modified with zinc oxide nanoparticles (ZnO-NPs).

Methods: Forty disc-shaped specimens were fabricated from a silicone soft denture liner and divided into four groups according to ZnO-NP concentration (0%, 5%, 7%, and 10% w/w). Antimicrobial activity was assessed against Candida albicans (ATCC 10231) and Staphylococcus aureus (ATCC 25923) using disc diffusion and minimum inhibitory concentration assays. Shore A hardness and flexibility were evaluated according to ISO 10139-2 standards. Zinc ion release was measured after immersion in artificial saliva. Data were analyzed using one-way ANOVA (α = 0.05).

Results: Zinc oxide nanoparticle modification showed no antifungal activity against C. albicans. However, significant antibacterial activity against S. aureus was observed, with the 7% concentration demonstrating optimal inhibition. Physico-mechanical properties improved progressively with increasing ZnO-NP concentration. Zinc ion release was minimal at 5% and 7% concentrations and remained within acceptable limits.

Conclusions: Zinc oxide nano-particles at a 7% concentration enhanced antibacterial performance and mechanical properties of the soft denture liner while maintaining low ion release. These findings suggest that ZnO-NP modification may improve the functional performance of denture liners for prosthodontic applications.

Optimization of a Novel Toothpaste Formula Containing Calcined Kaolin, Perlite, Hydroxyapatite, and Calcium Carbonate for Enhanced Cleaning Efficiency, Enamel Polishing, and Abrasivity

Raman M. Asad — 2026-06-30

Background and Objectives: Effective toothpaste formulations must balance plaque and stain removal, enamel polishing, and controlled abrasivity to support long-term oral health. While conventional silica-based abrasives provide strong cleaning performance, they may contribute to excessive dentin wear over time.

Objective: This study aimed to develop and evaluate a novel dentifrice formulation containing calcined kaolin, perlite, hydroxyapatite, and calcium carbonate, designed to optimize cleaning efficacy, enamel polishing, and safe abrasivity.

Methods: An experimental toothpaste was developed in EU/US research laboratory and evaluated using standardized in vitro methods. Cleaning performance was assessed by the Pellicle Cleaning Ratio (PCR), while abrasivity was measured using Relative Dentin Abrasivity (RDA) and Relative Enamel Abrasivity (REA) according to ISO/ADA protocols. Enamel polishing potential was determined using Specular Reflectance Percentage (SRP). Statistical analyses were performed using two-tailed t-tests and one-way ANOVA, with significance set at P < 0.05.

Results: The experimental formulation achieved a PCR value of 145.6 ± 4.0, significantly exceeding the ISO/ADA reference standard (PCR = 100), indicating superior stain-removal efficacy. Enamel polishing performance demonstrated a substantial increase in surface gloss (ΔGloss = 83.2 ± 1.6). Despite its strong cleaning action, abrasivity remained within accepted safety limits, with RDA approximately 95 and REA approximately 57, suggesting effective cleaning and polishing without excessive dentin or enamel wear.

Conclusion: The calcined kaolin–perlite dentifrice demonstrated enhanced cleaning efficiency and enamel polishing while maintaining safe abrasivity levels. These findings support the use of complementary performance measures, including PCR and SRP, alongside RDA, for a more comprehensive evaluation of dentifrice effectiveness.

Mucormycosis of facial region: a fatal outcome of uncontrolled diabetes mellitus (Case Report)

Wirya Kamal Sadeq — 2026-06-30

Mucormycosis is a rare but severe fungal infection caused by fungi in the order Mucorales, typically affecting immunocompromised individuals. This opportunistic infection often presents in patients with uncontrolled diabetes, hematologic malignancies, or those on immunosuppressive therapy. The most common form of mucormycosis is rhino-orbital-cerebral, which can lead to facial gangrene, a life-threatening condition characterized by tissue necrosis due to impaired blood flow. The pathogenesis of mucormycosis involves the inhalation of fungal spores that invade blood vessels, leading to ischemia, thrombosis, and necrosis. Early diagnosis and prompt intervention, including antifungal treatment and surgical debridement, are crucial in improving survival rates. However, the high mortality associated with facial gangrene due to mucormycosis underscores the need for timely management and a multidisciplinary approach. This review explores the clinical features, diagnostic methods, therapeutic strategies, and outcomes of mucormycosis-associated facial gangrene, highlighting the importance of early recognition and aggressive treatment in preventing catastrophic consequences.