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Janosy AM, Moca AE, Juncar RI. Early Diagnosis and Treatment of Mandibular Second Premolar Impaction: A Case Report. Diagnostics (Basel) 2024; 14:1610. [PMID: 39125486 PMCID: PMC11311950 DOI: 10.3390/diagnostics14151610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/20/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
Odontogenesis, the process of tooth formation, is complex and susceptible to disruptions that can result in dental anomalies such as tooth impaction. The mandibular second premolar, though less commonly impacted than wisdom teeth, presents a unique challenge in pediatric dentistry due to its intricate etiology and the need for timely intervention. This case report aims to highlight the significance of early diagnosis and conservative management strategies in treating mandibular second premolar impaction. The case involves a pediatric patient with impacted mandibular second premolars. Initial treatment included the use of a lower removable appliance with an expansion screw to alleviate crowding, followed by a fixed space maintainer and a Haas rapid palatal expander. These interventions created the necessary space for the premolars to erupt. Self-ligating brackets were later applied, reducing friction and improving periodontal health. The patient underwent two CBCT examinations to monitor progress, which confirmed the successful eruption and alignment of the impacted premolars without the need for surgical exposure. This case underscores the effectiveness of early diagnosis and minimally invasive treatment in managing mandibular second premolar impaction. The tailored approach facilitated the natural eruption of the teeth, highlighting the importance of individualized treatment plans. Future research should focus on optimizing these conservative strategies to enhance patient outcomes in similar cases.
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Affiliation(s)
- Anna-Maria Janosy
- Private Dental Practice CMI Dr. Janosy Anna-Maria, 23 Corneliu Coposu Street, 410445 Oradea, Romania;
| | - Abel Emanuel Moca
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania;
| | - Raluca Iulia Juncar
- Department of Dentistry, Faculty of Medicine and Pharmacy, University of Oradea, 10 Piața 1 Decembrie Street, 410073 Oradea, Romania;
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Meistere D, Kronina L, Karkle A, Neimane L. Non-syndromic tooth agenesis in Latvian adolescent dental patients: a retrospective study with relevant literature review. Eur Arch Paediatr Dent 2024; 25:427-432. [PMID: 38842757 PMCID: PMC11233428 DOI: 10.1007/s40368-024-00901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/03/2024] [Indexed: 06/07/2024]
Abstract
AIM To investigate the prevalence of tooth agenesis and associated dental anomalies in Latvian adolescent dental patients and compare it to other European countries. DESIGN Cross-sectional study of 2692 11-to-14-year-old patients (39.9% males and 60.1% females) attending Riga Stradins University Institute of Stomatology with panoramic radiographs taken between August 2020 and September 2021. Patients with any genetic syndromes were excluded. Data on tooth agenesis (excluding third molars) and other dental anomalies were recorded. RESULTS The prevalence of tooth agenesis in Latvian adolescent dental patients was 9.3% with no statistically significant difference between genders (χ2 test, p = 0.472). The most commonly missing teeth were mandibular second premolars, followed by upper lateral incisors and upper second premolars. There was a statistically significant association with the presence of other dental anomalies in tooth agenesis patients (p < 0.001). CONCLUSIONS This study found that the prevalence of non-syndromic tooth agenesis in Latvian adolescent dental patients was 9.3% with no statistically significant differences between the genders. Patients with tooth agenesis have a statistically significant possibility of the presence of other dental anomalies (p < 0.001).
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Affiliation(s)
- D Meistere
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia.
| | - L Kronina
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia
- Riga Stradins University Institute of Stomatology, Riga, Latvia
| | - A Karkle
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia
- Riga Stradins University Institute of Stomatology, Riga, Latvia
| | - L Neimane
- Department of Conservative Dentistry and Oral Health, Riga Stradins University, Riga, Latvia
- Riga Stradins University Institute of Stomatology, Riga, Latvia
- Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia
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Kammoun R, Ghoul S, Chaabani I, Ben Salem K, Ben Alaya T. Dental and jawbone abnormalities linked to amelogenesis imperfecta: A retrospective and analytic study comparing panoramic radiographs. SPECIAL CARE IN DENTISTRY 2024; 44:878-885. [PMID: 37885117 DOI: 10.1111/scd.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/14/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Amelogenesis Imperfecta (AI) is a disorder of tooth development characterized by abnormal enamel formation. In order to detect other dental and jawbone abnormalities that could be associated with AI, a retrospective and analytic study was conducted comparing panoramic radiographs of AI and non-AI patients. MATERIAL AND METHODS Digital panoramic radiographs of 60 AI and 60 non-AI patients were examined. Abnormalities in dental number, size, shape, eruption, and in the shape of the dental arches were checked and blindly recorded by two experimented observers. Descriptive statistics using percentages and chi-square test with .05 level of significance value was used. RESULTS Prevalence of supernumerary teeth, dental agenesis, microdontia, taurodontism, radicular dilacerations, dental inclusions, temporary teeth persistence, and pulp calcifications was significantly higher in AI patients compared to control patients. Prevalence of periapical images, cysts, and hypercementosis was lower in AI patients compared to control patients, with no statistically significant difference. A significant prevalence of mandibular hypoplasia was also noted in AI patients. CONCLUSION In addition to enamel defect, panoramic radiography was useful in detecting other dental abnormalities and mandibular hypoplasia associated with AI and should therefore be systematically indicated for AI patients' care.
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Affiliation(s)
- Rym Kammoun
- Laboratory of Histology and Embryology, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia
- ABCDF Laboratory for Biological Clinical and Dento-Facial Approach, University of Monastir, Monastir, Tunisia
- Department of Radiology, University Dental Clinic, Monastir, Tunisia
| | - Sonia Ghoul
- Laboratory of Histology and Embryology, Faculty of Dental Medicine of Monastir, University of Monastir, Monastir, Tunisia
- ABCDF Laboratory for Biological Clinical and Dento-Facial Approach, University of Monastir, Monastir, Tunisia
- International Faculty of Dental Medicine, BioMed Unit, College of Health Sciences, International University of Rabat, Rabat, Morocco
| | - Imen Chaabani
- Department of Radiology, University Dental Clinic, Monastir, Tunisia
- Unity of Bioactive Natural Substances and Biotechnology, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
| | - Kamel Ben Salem
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Touhami Ben Alaya
- Department of Radiology, University Dental Clinic, Monastir, Tunisia
- Unity of Bioactive Natural Substances and Biotechnology, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia
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Mohan R, Puranik CP, Kaci P, Moore T, Katechia B, Schulman GS, Tadinada A. Prescription of panoramic radiographs in children using age-based prevalence of dental anomalies and pathologies. Int J Paediatr Dent 2024; 34:125-134. [PMID: 37330621 DOI: 10.1111/ipd.13095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Panoramic radiographs (PRs) are used in the detection and diagnosis of developmental dental anomalies and pathologies (DDAPs) in children. AIM The primary objective of this observational cohort study was to evaluate the age-based prevalence of DDAP on PRs, whereas the secondary objective was to determine a threshold age for the detection of DDAP to provide supportive evidence for the prescription of PR in paediatric dental practice. DESIGN The study examined diagnostic PRs from 581 subjects aged 6 to 19 years. All PRs were reviewed by experienced, calibrated, masked examiners for the identification or presence of anomalies in size, shape, position, structure, and other developmental anomalies and pathologies (ODAP) of the face-neck region in a standardized condition. The data were statistically analyzed for interpretation. RESULTS Overall, 74% (n = 411) of the cohort had at least one anomaly (shape anomaly: 12%, number anomaly: 17%, positional anomaly: 28%, structural anomaly: 0%, and ODAP: 63%). The optimal Youden index cutoff for any anomaly was 9 years. Twelve and 15 years also showed predictive ability. CONCLUSION The results suggest that PRs should be prescribed at ages 9, 12, and 15 years for the diagnosis of DDAP.
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Affiliation(s)
- Ritu Mohan
- Division of Paediatric Dentistry, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Chaitanya P Puranik
- Children's Hospital Colorado and School of Dental Medicine, University of Colorado, Aurora, Colorado, USA
| | - Pickett Kaci
- Center for Research Outcomes in Children's Surgery (ROCS), Children's Hospital Colorado, Aurora, Colorado, USA
| | - Timothy Moore
- Statistical Consulting Services Center for Open Research Resources & Equipment, Nathan L. Whetten Graduate Center, University of Connecticut, Storrs, Connecticut, USA
| | - Bina Katechia
- Division of Paediatric Dentistry, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Gary S Schulman
- Division of Paediatric Dentistry, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Aditya Tadinada
- Department of Oral Maxillofacial Diagnostic Sciences, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA
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Li L, Yang X, Ju W, Li J, Yang X. Impact of primary molars with periapical disease on permanent successors: A retrospective radiographic study. Heliyon 2023; 9:e15854. [PMID: 37187910 PMCID: PMC10176069 DOI: 10.1016/j.heliyon.2023.e15854] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/06/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
Objective To clarify the effects on the development, position and morphology of the permanent successors of primary molars affected by apical periodontitis (AP). Method A total of 132 panoramic radiographs of children aged from 4 to 10 were screened out and a total of 159 mandibular second primary molars with chronic apical periodontitis(AP)(93 males and 66 females) were analyzed. The maturation values of permanent successors were interpreted and scored according to Nolla's method and compared with normal ones'. The proportion of abnormalities in the morphology and orientation of permanent successors were counted, and the differences between men and women was analyzed. The distribution of various abnormalities in different age groups was also analyzed. Result There were significant differences in development of permanent successors in this study compared with the normal ones' in all age groups, among which the differences were statistically significant in males aged in 4,5,7 groups and females aged in 4,6 (P < 0.05). The proportions of permanent successors involved with dental follicle broken, malposition and malformation were 78.94%, 42.1%, 8.42% and 82.50%, 38.75%, 15.00%, respectively, with no gender difference. And the highest proportion of these three were all found in 9 years old age group. Conclusion AP of primary teeth can lead to accelerated or delayed development of permanent successors to some extent, and may also lead to changes in their shape and direction.
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Affiliation(s)
- Ling Li
- Department of Stomatology, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, China
| | - Xueming Yang
- Department of Stomatology, Zhenjiang First People's Hospital, Zhenjiang, 212000, China
| | - Wei Ju
- Department of Stomatology, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, China
| | - Jun Li
- Department of Stomatology, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, China
| | - Xihu Yang
- Department of Stomatology, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, China
- Corresponding author.
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Kolokitha OE, Balli D, Zarkadi AE, Gizani S. Association between maxillary canine impaction and other dental anomalies: radiological study of a mixed dentition children's cohort from an orthodontic clinic. Eur Arch Paediatr Dent 2023:10.1007/s40368-023-00798-y. [PMID: 37046044 DOI: 10.1007/s40368-023-00798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE To investigate the significance of association between maxillary impacted canines and various dental anomalies. METHODS Files of 874 orthodontic patients were evaluated for the presence of maxillary impacted canines. From this sample, a group of 97 patients (39 males and 58 females) with at least 1 impacted maxillary canine consisted the study group. This group was compared to a control group of 97 patients (42 males and 55 females) that was created by random selection from the initial sample without maxillary canine impaction. The impaction diagnosis was made from the panoramic radiographs. Chi-square test was used to perform the analysis for significant associations. Stepwise discriminant analysis, binary logistic regression and classification tree were used to identify best combinations. RESULTS Statistically significant difference was found for peg-shaped maxillary lateral incisors and infraoccluded deciduous molars. The presence of peg-shaped upper lateral incisors arises the probability of impacted canine to 83.3%, a distal displaced unerupted second premolar to 63.16% and the impaction of any other teeth to 80% as showed by the classification tree. CONCLUSIONS The presence of peg-shaped maxillary lateral incisors and infraocclusion of deciduous molars can be considered major valuable early risk indicators for maxillary canine impaction, because they manifest before the maxillary canine eruption. Special consideration should be given on distal displaced unerupted second premolar and the impaction of any other teeth. Patients with these dental anomalies are candidates for future interceptive treatment for canine eruption.
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Affiliation(s)
- O-E Kolokitha
- Department of Orthodontics, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - D Balli
- Department of Pediatric Dentistry, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A-E Zarkadi
- Department of Pediatric Dentistry, Faculty of Dentistry, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Gizani
- Head of Paediatric Dentistry, Department of Dentistry, Kapodistrian University of Athens (NKUA), Athens, Greece
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Vinjolli F, Zeqaj M, Dragusha E, Malara A, Danesi C, Laganà G. Dental anomalies in an Albanian orthodontic sample: a retrospective study. BMC Oral Health 2023; 23:47. [PMID: 36709286 PMCID: PMC9883948 DOI: 10.1186/s12903-023-02711-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/03/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To evaluate the prevalence and the distribution of dental anomalies in an Albanian orthodontic sample. METHODS For this retrospective study, a sample of panoramic radiographs (PR) of n. 779 (456 F and 323 M, mean age of 15.1 ± 5.5 years) Albanian subjects with no genetic syndromes or craniofacial malformations (e.g., cleft lip/palate), history of extraction, trauma or previous orthodontic treatment drawn from the archives of the University Dental Clinic Our Lady of Good Counsel, was examined. The inclusion criteria were: subjects from 8 to 30 years of age, good quality of PRs in order to allow the assessment of crown and root development. For different dental anomalies, both the prevalence and the association were evaluated by using Chi-square test (p < 0.05). RESULTS 24.4% of the sample had at least one dental anomaly and 4.6% had more than one. The following dental anomalies were most prevalent: hypodontia (9.8%), dental impaction (7.6%), and ectopic eruption (5.3%). No statistically significant correlation was found between males and females (p > 0.05). CONCLUSIONS The most common anomalies in this group are found to be those of number and position, and only radiological investigations can reveal either of these anomalies. Early diagnosis of dental anomalies can contribute to prevent their complications and to establish the most suitable therapy to achieve a functional occlusion.
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Affiliation(s)
- Franceska Vinjolli
- grid.444978.20000 0004 5928 2057Department of Surgical Science, Catholic University Our Lady of Good Counsel, Tirana, 1001 Albania
| | | | - Edi Dragusha
- grid.444978.20000 0004 5928 2057Department of Economics and Business Sciences, Catholic University Our Lady of Good Counsel, Tirana, 1001 Albania
| | - Arianna Malara
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Carlotta Danesi
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppina Laganà
- grid.6530.00000 0001 2300 0941Department of Systems Medicine, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy ,UniCamillus - Saint Camillus International University of Health Sciences, Rome, Italy
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Aboujaoude S, Rizk C, Sokhn S, Moukarzel C, Aoun G. Dental Anomalies in a Sample of Lebanese Children: a Retrospective Study. Mater Sociomed 2023; 35:319-324. [PMID: 38380282 PMCID: PMC10875945 DOI: 10.5455/msm.2023.35.319-324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023] Open
Abstract
Background Dental anomalies (DAs) represent a significant chapter in pediatric dentistry with a lot of practical relevance. Both primary and permanent dentitions may be affected. Objective The main objective of our study was to evaluate, using digital panoramic radiographs, the prevalence, distribution, and patterns of DAs in a sample of Lebanese children aged between 8 and 15 years old. Methods 112 digital panoramic radiographs of patients aged between 8 and 15 years (60 males and 52 females) from the year 2017 till 2022 attending the department of Pediatric Dentistry and Dental Public Health at the Faculty of Dental Medicine at the Lebanese University were assessed for DAs of number (hypodontia, oligodontia, hyperdontia), of size (microdontia, macrodontia), of shape (fusion, gemination, dilaceration, taurodontism), of position (transposition, ectopia, impaction), and of structure (dentin dysplasia, amelogenesis imperfecta, dentinogenesis imperfecta). The data were analyzed statistically using Chi-square and Fisher's exact tests. Results Out of 112 patient radiographs, 84 showed at least one DA, which suggests a very high prevalence (75%). Among them, 36.9% exhibited multiple types of anomalies. These 84 patients showed a total of 274 DAs, distributed equally among males and females. Conclusion Dentists should be alerted to the presence of DAs. Their high prevalence requires careful clinical and radiological examinations for early detection. Regular monitoring is mandatory and could guide preventive approaches to minimize associated dental complications.
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Affiliation(s)
- Samia Aboujaoude
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Charline Rizk
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Sayde Sokhn
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Carla Moukarzel
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Georges Aoun
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
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Bakhurji EA, Aldossary F, Aljarbo J, AlMuhammadi F, Alghamdi M, Nazir MA. Prevalence and Distribution of Nonsyndromic Dental Anomalies in Children in Eastern Saudi Arabia: A Radiographic Study. ScientificWorldJournal 2021; 2021:9914670. [PMID: 34658677 PMCID: PMC8514940 DOI: 10.1155/2021/9914670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/20/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To report the prevalence and distribution of nonsyndromic dental anomalies in children in eastern Saudi Arabia. METHODS This retrospective records review study involved radiographic examination of 6-18 years old pediatric patients who attended the Dental Hospital of the College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Four calibrated examiners recorded nonsyndromic dental anomalies from patients' digital orthopantomograms (OPG). The anomalies recorded were related to tooth number, shape, and location. Descriptive statistics, chi-square test, and Fisher exact tests were used to report prevalence and differences by gender, nationality, and medical history at the 5% significance level. RESULTS Of 2226 reviewed patients' records, 1897 met the inclusion criteria and were included in the study. The study sample had equal distribution of males (52.6%) and females (47.4%) and comprised 81.2% Saudi children with a mean age of 8.8 ± 1.84 years. Most study subjects (97.8%) were in mixed dentition and 88.7% were healthy. The prevalence of dental anomalies was as follows: teeth rotations (24.5%), ectopically erupted teeth (6%), congenitally missing permanent teeth (5.4%), peg lateral (1.1%), supernumerary (0.5%), gemination (0.3%), and fusion (0.1%). No statistically significant differences were found in the distribution of dental anomalies by patients' gender, medical history, and nationality (p value ≥0.05). CONCLUSION This study showed that teeth rotations were the most common dental anomalies followed by ectopic eruptions and congenitally missing teeth. The study findings may guide dental practitioners to better diagnose and manage children with dental anomalies in eastern Saudi Arabia.
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Affiliation(s)
- Eman A. Bakhurji
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatima Aldossary
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jood Aljarbo
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah AlMuhammadi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Maysaa Alghamdi
- College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Ashraf Nazir
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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