Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 11 2 2024 10 13 70 78 Naghmeh Bahrami Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran; Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Bayat Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Jafar Ai Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran. Shiva Shirazian Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran, And Department Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Farnoosh Mohammadi Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Mona Mohajeri Tehrani Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mahbooh Khabaz Mafinejad Department of Medical Education, Health Professions Education Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2023 11 30 2023 11 30 Introduction: Scientists have developed solutions, for oral health by leveraging advancements in medicine. These solutions, known as “ reconstructive dentistry “ aim to address the limitations and short lifespan of restorative methods. Unlike restorative treatments, reconstructive dentistry focuses on not only restoring the structure of tissues but also their physiological functions. To achieve this, it requires an effort among dentists, biologists, stem cell researchers, material scientists, tissue engineers and other experts. Consequently, this study was carried out to create and evaluate a fellowship program called “Reconstructive Medicine in Dentistry.” The program aims to foster an approach towards reconstruction, in dentistry. Materials and Methods: This research involved three stages. Utilized a mixed method approach. In the first stage, we developed a design based on the Kern model, which involved conducting a review of relevant studies to extract and determine the goals and topics related to medical reconstruction, in dentistry. Expert panel meetings were held to finalize these goals and topics. For each target group, we identified the learners, learning environment and educational strategies. We also made arrangements for implementing the program. Established evaluation methods for both students and the program itself. Subsequently, we implemented the designed curriculum for two groups of students. Finally, we evaluated the program’s effectiveness through questionnaires and semi structured interviews, with students, professors and organizers. The collected data was analyzed using statistics. Results: In 2020 and 2021, two groups of students were meticulously selected from disciplines such as maxillofacial surgeons, oral medicine specialists, periodontists, endodontists, and more, after passing the entrance exam. The primary objective of this program is to educate graduates with the skills to restore missing tissues in the mouth, jaw and facial regions using cutting edge regenerative medicine techniques. The curriculum was developed in collaboration with experts from areas like tissue engineering, dental specialization (including maxillofacial surgeons) biomaterials and developmental biology. Both students and professors expressed satisfaction, with the program. Conclusion: A group of professors, from specialties came together to implement a fellowship program in reconstructive dentistry. The main goal of this program was to train specialists in tissue reconstruction for patients who have suffered jaw and facial injuries; by using advanced methods in medicine. Additionally, this initiative can also be a step towards strengthening the university’s movement towards third and fourth-generation universities. The findings from this study can provide insights, for those involved in planning and implementing interdisciplinary fellowship programs. Keywords: Dentistry; Regenerative medicine; Curriculum design; Interdisciplinary. https://jcr.tums.ac.ir/index.php/jcr/article/view/472 https://jcr.tums.ac.ir/index.php/jcr/article/download/472/409

Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 11 2 2024 10 13 79 86 EN Tahereh Padeganeh Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Nima Dehghani Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Mohadeseh Azarsina Private Practice, Tehran, Iran. Xaniar Mahmoudi Department of Oral and Maxillofacial Surgery, Tabriz University of Medical Sciences, Tabriz, Iran. 2024 05 25 2024 07 24 Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is an important uncommon complication. Due to its complexity, its prevention requires a multidisciplinary approach, involving physicians and dental clinicians.  Materials and Methods: This study aimed to assess the knowledge level of physicians prescribing bisphosphonates in Tehran, Iran, about dental considerations in such patients and the prevention and treatment of MRONJ in 2019. This descriptive, cross-sectional study evaluated 100 physicians (rheumatologists, endocrinologists, oncologists, and orthopedists) practicing in Tehran. A questionnaire comprising a demographic section and knowledge questions regarding dental considerations in patients taking bisphosphonates was administered among the physicians. The frequency of qualitative variables such as gender, type of specialty, and physicians’ responses to each question was calculated, and the knowledge scores were analyzed separately based on the physicians’ specialty types using one-way ANOVA followed by Tukey’s test for pairwise comparisons. The effect of different variables on knowledge scores was analyzed by simple regression. Results: The mean knowledge score of physicians was 5.19±1.78 (range 2-8). The mean knowledge score of oncologists was significantly higher than that of endocrinologists (5.88 versus 4.52, P=0.03). No other significant differences were noted. Work experience (P=0.04), age (P=0.02), orthopedics specialty (P=0.05), and oncology specialty (P=0.006) had significant effects on the knowledge score. Conclusion: Considering acquiring about 50% of the total score, physicians seem to have limited knowledge about dental considerations in patients taking bisphosphonates. Keywords: Knowledge; Tehran; Bisphosphonates; Bisphosphonate-associated osteonecrosis of the jaw. https://jcr.tums.ac.ir/index.php/jcr/article/view/502 https://jcr.tums.ac.ir/index.php/jcr/article/download/502/410

Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 11 2 2024 10 13 87 92 Abdolreza Mohamadnia Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Amir Jalal Abbasi Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Farnoush Mohammadi Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Seyedeh Zahra Fotook Kiaei Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pulmonary and Critical Care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mona Mohajeri Tehrani Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran. Somaieh Lookzadeh Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Fatemeh Yassari Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shadi Shafaghi Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Farnaz Ahmadi Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Naghmeh Bahrami Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2024 05 19 2024 07 24 Introduction: Mucormycosis, an infection, with a high death rate, requires understanding its symptoms, diagnosis methods and treatment options due, to its growing occurrence. The research employs a molecular method to evaluate the diagnosis of the mucormycosis. Materials and Methods: In this study, we obtained 30 samples from patients undergoing diagnosis and conducted DNA extraction. Additionally, DNA extraction was carried out on 30 tissue samples suspected of infection in paraffin blocks. Subsequently, PCR and Real-time PCR were performed using targeted primers, for mucormycosis followed by analysis of the results. Results: In the research findings among 30 liquid samples 8 tested positive, for mucor using the PCR method. 10 using the Real-time PCR method. Similarly, out of 30 tissue samples, 9 cases showed mucor presence with the PCR method and 11 cases, with the Realtime PCR method. Conclusion: In this study, real-time PCR and PCR techniques showed promising and faster results in detecting Mucor than the culture approach. The molecular methods provided results that could be of great use for scenarios. Keywords: Mucormycosis; Diagnosis; Real-time PCR. https://jcr.tums.ac.ir/index.php/jcr/article/view/501 https://jcr.tums.ac.ir/index.php/jcr/article/download/501/411

Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 11 2 2024 10 13 93 105 Kardo Abdalkarim Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Sulaymaniyah, Madam Mitterrand, Sulaymaniyah, Iraq. Kanar Hamaamin Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Sulaymaniyah, Madam Mitterrand, Sulaymaniyah, Iraq. Bayad Mahmood Faris Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Sulaymaniyah, Sulaymaniyah, Iraq. 2024 04 15 2024 07 24 Introduction: To evaluate undergraduate students’ clinical ability to extract teeth, we created a new, coordinated, and quantitative assessment form containing nine items that were required to measure the various skills, using the visual analog scale. Materials and Methods: A pilot study was performed with 30 students, each of whom was rated by three examiners. In addition, 118 students (59 fourth-year and 59 fifth-year) were reviewed halfway through the year and at their final examinations. The assessment form was then used to evaluate students’ abilities for tooth extraction throughout the academic year 2022–2023. Results: High inter-examiner reliability and a significant association of mean scores (p<0.001) between three examiners at the beginning and final of the block for both 4th and 5th students. Both groups showed considerable improvement in their mean scores between the beginning and final examinations. The result shows the association between socio-demographic characteristics of patients treated by fourth and fifth-stage students, (52.54% and 54.24%) of the participants were males in fourth and fifth-stage students respectively. At the same time (47.46% and 45.76%) of the participants were females in fourth and fifth stage students respectively. The age of majority of the participants was more than 30 years old, representing (76.27%), and only (10.17%) were between 25-30 years in fourth stage students, and (8.47%) were between 25-30 years in fifth stage students. Conclusion: The use of a newly developed assessment scale during tooth extraction offered an objective, standardized, and feasible method for the assessment of clinical skills of undergraduate students for both formative and summative purposes. Keywords: Dental extraction; Clinical performance; Undergraduate dental students. https://jcr.tums.ac.ir/index.php/jcr/article/view/500 https://jcr.tums.ac.ir/index.php/jcr/article/download/500/412

Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 11 2 2024 10 13 106 112 Aryan Hesam Arefi Department of Orthodontics, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran. Abolfazl Hosseinabadi Department of Orthodontics, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran. 2024 06 13 2024 07 24 Introduction: Orthodontic treatment interferes with oral hygiene and can discoloration. Therefore, given the importance of tooth discoloration for patients, the present study determined the effect of orthodontic treatment on tooth color changes. Materials and Methods: Thirty-six patients under orthodontic treatment were evaluated. Photographs were taken before and after orthodontic treatment to evaluate color changes of the teeth. The photos were evaluated by experts and laypeople. The researcher completed a questionnaire consisting of each patient’s demographic data and treatment information (the composite resin type, the bonding agent type, and the bracket and wire types). Then, the relationships between these variables and tooth discoloration were analyzed. McNermar test was used to compare tooth color distribution status before and after orthodontic treatment. Chi-squared or Fisher’s tests were used to compare the tooth discoloration distribution status in terms of each variable studied. Spearman’s correlation coefficient was used to determine the relationship between demographic variables and tooth discoloration. Statistical significance was set at P<0.05. Results: Tooth colors were different before and after treatment. There were no significant relationships between tooth discoloration and the variables of composite resin type, bonding agent, bracket type, and gender. However, the relationship between age and tooth discoloration was significant. Conclusion: Various factors affect tooth color changes after orthodontic treatment. Although the majority of the factors evaluated in the present study did not alone have a significant relationship with tooth discoloration, it can be claimed that tooth discoloration due to orthodontic treatment is a multifactorial finding with several confounding factors. Keywords: Discoloration; Orthodontic treatment; Tooth color. https://jcr.tums.ac.ir/index.php/jcr/article/view/507 https://jcr.tums.ac.ir/index.php/jcr/article/download/507/413

Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 11 2 2024 10 13 113 118 Sahar Chokami Rafiei Department of Periodontology, Faculty of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran. Mohamad Karami Mohammad Javad Kharrazifard Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran. Simin Mohebbi Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Caries Prevention, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2025 11 18 2025 11 18 Introduction: Early childhood caries (ECC) is a highly prevalent condition that significantly impacts children’s general health and quality of life, while also imposing substantial economic burdens on families and healthcare systems. Its treatment is often complex and costly, sometimes requiring sedation or general anesthesia in young children. This study aimed to determine the prevalence of ECC among children aged 12 to 71 months in Qom province in 2022.  Materials and Methods: This cross-sectional descriptive-analytical study included 172 children aged 12–71 months in Qom. Participants were recruited from 15 clusters, including kindergartens and health centers. Children were categorized as toddlers (12–47 months) and preschoolers (48–71 months). Data were collected through clinical oral examinations and structured, face-to-face questionnaires completed by parents or guardians. Caries diagnosis was based on WHO criteria, and plaque was assessed using the Silness & Loe index. Results: The mean dmft score was 1.46 (SE = 0.27). The overall prevalence of ECC was 26.7%, with 13.6% in toddlers and 48.6% in preschoolers. Visible dental plaque was observed in 49% of children (38.6% of toddlers, 65.9% of preschoolers). ECC prevalence and mean dmft scores were significantly higher in rural areas (p < 0.009). A significant association was found between lower fathers’ education and higher DMFT scores (p < 0.05). Children who consumed sugary snacks and drinks had significantly higher dmft scores (p = 0.02) and ECC prevalence (p = 0.02).   Conclusion: This study provides a comprehensive snapshot of ECC prevalence and its determinants among 1–5-year-old children in Qom, Iran. The relatively high burden of ECC and its strong association with socio-behavioral determinants such as residence in rural areas, low parental education and poor dietary habits underscore the need for integrated and equity-focused oral health programs.  Keywords: Early childhood caries (ECC); Dmft; Dietary habits; Tooth-brushing; Parental education. https://jcr.tums.ac.ir/index.php/jcr/article/view/583 https://jcr.tums.ac.ir/index.php/jcr/article/download/583/459

Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 12 3 2025 12 07 196 200 Sepideh Aarabi Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2025 10 04 2025 11 28 Foreign body aspiration following maxillofacial trauma is a significant diagnostic challenge. The difficulty is compounded when dental prostheses are involved, as radiolucent materials are not visible on standard radiographs, and clinical symptoms can be delayed. A young woman sustained a mandibular fracture in a motor vehicle collision and was discharged after initial evaluation. She returned to the emergency department one week later with progressive dyspnea. Subsequent investigation revealed a large, aspirated fragment of her denture. This case underscores the critical importance of maintaining a high index of suspicion for occult foreign body aspiration in patients with maxillofacial trauma. This potential complication must be considered even in younger individuals and in cases where the initial clinical presentation appears stable.  Keywords: Foreign body aspiration; Maxillofacial trauma; Mandibular fracture; Denture aspiration. https://jcr.tums.ac.ir/index.php/jcr/article/view/565 https://jcr.tums.ac.ir/index.php/jcr/article/download/565/460

Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 12 3 2025 12 07 201 205 Bahareh Fattahi Department of Oral and Maxillofacial Pathology, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran. Arash Esmaeili Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. Akram Fallah Department of Oral and Maxillofacial Radiology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. Saeedeh Khalesi Department of Oral and Maxillofacial Pathology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. 2025 07 11 2025 08 12 Primary neuroendocrine carcinomas (NECs) of the oral cavity represent exceptionally rare malignancies (< 30 reported cases globally), posing significant diagnostic challenges due to histological mimicry of other round cell tumors and nonspecific clinical presentation. This report details a novel case with atypical clinicopathological features and favorable therapeutic outcomes. A 38-year-old male presented with a 3-month history of a right hard palate ulceration. Clinical examination revealed an indurated endophytic lesion. Histopathology and immunohistochemistry confirmed poorly differentiated large cell NEC. Due to unresectable pterygopalatine fossa involvement, chemoradiation was administered. Given the extreme rarity of oral large cell neuroendocrine carcinoma (LCNEC), clinicians must consider this entity even in patients lacking traditional risk factors (e.g., smoking). Its aggressive growth pattern and metastatic propensity necessitate prompt specialist referral for early intervention.  Keywords: Oral pathology; Neuroendocrine carcinoma; Large cell carcinoma. https://jcr.tums.ac.ir/index.php/jcr/article/view/550 https://jcr.tums.ac.ir/index.php/jcr/article/download/550/461

Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 12 3 2025 12 07 206 213 Seyyed Amirreza Panjtanian Oral & Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Ali Mirzaei Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran. Siavash Moushekhian Dental Research Center and Department of Endodontics, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 10 19 2025 11 15 Separation of endodontic instruments can compromise canal disinfection and long-term prognosis. Microscope-guided ultrasonics combined with a loop device may improve retrieval in anatomically demanding canals. Three molars with fractured instruments in challenging canals (maxillary MB2, maxillary distobuccal, mandibular mesiolingual) were managed under a dental operating microscope. A staging platform was created with a modified #2 Gates-Glidden bur, followed by conservative ultrasonic troughing (ED87 tip) to create space around the fragment. The Kamand loop system was then used to engage and retrieve the fragment. Devices were used according to manufacturers’ instructions; any variant use is reported in the Case Presentation. All fragments were retrieved and canals were subsequently cleaned/shaped to 25–30/.04 with warm vertical obturation using AH Plus sealer. Patients were asymptomatic at 6–12 months with radiographic findings consistent with periapical healing. A combined approach, precise ultrasonic troughing to create safe space, followed by loop capture, enabled conservative and predictable retrieval of separated instruments across different canal anatomies, facilitating definitive disinfection and obturation.  Keywords: Dental equipment; Endodontics; Equipment failure; Root canal therapy; Ultrasonics. https://jcr.tums.ac.ir/index.php/jcr/article/view/569 https://jcr.tums.ac.ir/index.php/jcr/article/download/569/462

Tehran University of Medical Sciences Journal of Craniomaxillofacial Research 2345-5489 12 3 2025 12 07 214 217 EN Giti Shami School of Dentistry, Zanjan University of Medical Sciences, Zanja