Hanen Boukhris

Background: Bioceramic materials have emerged as a significant advancement in endodontics, offering excellent biocompatibility, sealing ability, and bioactivity. Their use has expanded in recent years, particularly for pulp capping, perforation repair, and regenerative procedures. Objectives: This study aimed to assess the knowledge of bioceramics among private practice dentists, evaluate the frequency of use of sealing and filling bioceramics, and examine the applied clinical protocols as well as potential shortcomings. Materials and methods: This cross-sectional study was conducted according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, based on an epidemiological Knowledge, Attitudes, and Practices (KAP) survey. It was carried out among Tunisian private practice dentists. Data were processed and analyzed using Excel 2007 and Statistical Package for the Social Sciences (SPSS) Statistics 21.0. The sample size was calculated using the standard formula for estimating a proportion in a cross-sectional study, and participants were randomly selected. Participation was voluntary, anonymous, and confidential. Results: A total of 200 dentists participated. Only 54.5% reported using sealing bioceramics, with 35.05% using them in all cases, 19.94% for periapical lesions, and 16.92% for root perforations. Approximately half of the dentists (53.01%) observed faster healing when using these sealers. Regarding filling bioceramics, 67.5% of participants used them, with a preference for MTA. These materials were indicated for various clinical situations, including repair of floor perforations, pulp capping, apexification of immature permanent teeth, and repair of root perforations. However, 45.61% of participants reported treatment failures when using these bioceramics, with failure to adhere to one of the endodontic treatment steps identified as the primary cause. Conclusion: This study concluded that younger dentists tend to use bioceramics more frequently, filling bioceramics are better known than sealing ones, and most participants are familiar with the clinical indications of these materials. It is essential to provide further guidance and recommendations on the clinical application of bioceramics to optimize treatment outcomes.

This article aims to assess and analyze the knowledge, attitudes, and practices of Tunisian dentists regarding flexible removable partial dentures (RPDs). A cross-sectional study was conducted over an 8-month period, from March 1 to October 30, 2023, among dentists throughout Tunisia. A structured questionnaire was distributed via email to evaluate knowledge of flexible RPDs, which was scored. Data were analyzed using SPSS version 20.0. Frequencies and percentages were calculated for qualitative variables, while means and standard deviations were determined for quantitative variables. Student's t-test was used for mean comparisons, and Pearson's chi-square or Fisher's exact test for categorical variables. A p-value of < 0.05 was considered statistically significant. A total of 98 dentists participated, with a majority being women (64.3%) and working in the private sector (87.8%). Most participants (76.53%) were unfamiliar with the trade names of flexible resins. Regarding clinical indications based on edentulism type and prosthetic treatment, 60% achieved a score of at least 75%. The overall knowledge score was 16 or lower for 65.3% of respondents. Additionally, 33.74% expressed the need for further training, while 36% frequently prescribed flexible RPDs, mainly for esthetic purposes. There was no significant correlation between knowledge level and clinical experience (p = 0.23), but the adoption rate of flexible RPDs significantly varied with experience (p = 0.045). Tunisian dentists' knowledge of flexible RPDs remains limited, necessitating improvement. Clinical practices should be updated in accordance with current recommendations, given the limited scientific evidence available.

Introduction : The misuse of antibiotics in dentistry contributes to antimicrobial resistance. Understanding dentists' knowledge, attitudes, and behaviors is crucial for promoting rational antibiotic use. Objective: This study aims to assess Tunisian dentists' knowledge levels on antibiotic prescription, as well as their attitudes, behaviors and current practices regarding antibiotic use. Material and Methods: A descriptive cross- sectional KAP study including 16 questions was delivered to Tunisian dentists based on an online questionnaire. The questionnaire is composed of 2 parts, a knowledge assessment based on the indication or not of antibiotics in specific clinical conditions then the respondents were categorized based on the scores they obtained. The second part based on non-clinical situations aims to assess their attitudes regarding the prescription of antibiotics. Results: A total of 258 dentists were included in the study. Most Tunisian dentists (84.5%) showed an average level of knowledge regarding the indications of antibiotic. There is no statistically significant relationship between knowledge levels and their years of experience. For non-clinical factors, the high rate of prescribing antibiotics is only when it is necessary to delay treatment (33.7%). Participants disagreed on prescribing antibiotics when requested by patients and when pressed for time with rates of 83.3% and 55.4% respectively. However, dentists have shown a lack of individual practices aimed at improving the prescription of antibiotics including participation in continuing training on prescription (15.5%). Conclusion: This study highlighted shortcomings in antibiotic prescribing in our dental practice. Targeted action plans for the latter could be a first step in the implementation of a policy on the proper use of antibiotics in dentistry.

This study aimed to assess oral hygiene practices, dental conditions, and access to dental care among children with autism spectrum disorder (ASD) in Tunisia. This descriptive cross-sectional study included 48 children diagnosed with ASD. Data were obtained through a structured questionnaire completed by caregivers and a clinical oral examination. The questionnaire comprised 25 items divided into three domains: (1) Knowledge (awareness of oral hygiene importance, fluoride use, recognition of dental caries, and regular dental checkups); (2) Attitude (motivation for oral care, caregiver perception of dental visits, and beliefs about prevention); (3) Practices (tooth brushing frequency, technique, use of toothpaste, dental attendance, and dietary habits). The clinical examination assessed oral hygiene status, presence of untreated caries, gingival condition, and parafunctional oral habits. Descriptive statistics were used to analyze the data. Of the 48 children included in the study, 23% (n = 11) were classified at the severe end of the autism spectrum, while the remaining 77% (n = 37) presented with mild to moderate forms of ASD. Poor oral hygiene was observed in 46.6% (n = 14) of the children, untreated dental caries were present in 36.6% (n = 11), and 60% (n = 18) had never visited a dentist. Additionally, 33.3% (n = 10) of the children did not brush their teeth regularly. The presence of gingival inflammation and parafunctional habits was also noted but varied across severity levels of ASD. The study reveals considerable challenges regarding oral hygiene behaviors, dental health status, and access to dental care among children with ASD in Tunisia. These findings underscore the necessity for targeted oral health education programs and enhanced caregiver involvement to improve oral health outcomes in this population. A better understanding of the specific oral health needs of children with ASD is essential for tailoring dental care protocols. Focused caregiver training and adapted dental approaches are recommended to promote improved oral hygiene practices and overall oral health in children with ASD. How to cite this article: Ben Hadj Khalfa A, Boukhris H, Ayari G, et al. Oral Health Challenges and Hygiene Practices in Children with Autism Spectrum Disorder: A Cross-sectional Study from Tunisia. J Contemp Dent Pract 2025;26(6):581-586.

Long-term data evaluating both patient satisfaction and oral health-related quality of life (OHRQoL) in anterior maxillary implant rehabilitation are still limited, making this investigation highly relevant. This study aimed to evaluate patient satisfaction and OHRQoL 5 years after anterior maxillary implant placement. It specifically assessed long-term satisfaction with implant-supported restorations in the aesthetic zone, the impact on OHRQoL, and key clinical and prosthetic factors influencing perceived treatment success. A prospective study was conducted at the University Hospital of Farhat Hached, Sousse, Tunisia, from March to June 2024. Eligible patients who underwent anterior maxillary implant placement between 2018 and 2019 were included. Patients with fixed implant-supported restorations and good systemic health were eligible, while those with parafunctional habits or incomplete follow-up data were excluded. Satisfaction was assessed using a Visual Analog Scale (VAS), and OHRQoL was measured using the Oral Health Impact Profile (OHIP)-14 and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) questionnaires. A total of 50 patients participated. The sample size was determined based on an expected satisfaction rate of 80%, with a 95% confidence interval and a 10% margin of error, resulting in a required minimum of 47 participants. Data analysis was performed using SPSS version 20. Descriptive statistics summarized demographics, satisfaction scores, and OHRQoL outcomes. Inferential analyses included paired t-tests and Wilcoxon signed-rank tests to compare baseline and 5-year follow-up data. Spearman's correlation was used to examine relationships between implant-related factors and satisfaction or OHRQoL scores, while multivariate regression identified predictors of long-term satisfaction. A p-value of < 0.05 was considered statistically significant. Fifty patients (mean age: 36.5 ± 5.3 years) participated, with a 98.04% implant survival rate. At 5 years, 86.2% reported high satisfaction, with a mean VAS score of 92.8%. Phonetic outcomes received a 100% satisfaction rate, while chewing comfort and stability were also highly rated (94.0 and 93.7%, respectively). Esthetic satisfaction was reported by 85.0% of patients, and 67.5% had no difficulty maintaining hygiene. The OHIP-14 median score of 9.0 indicated minimal OHRQoL impairment. PIDAQ results showed that while most patients were satisfied with esthetics, some experienced psychosocial impacts. Five years after anterior maxillary implant placement, patients reported high satisfaction, especially regarding phonetics, chewing comfort, and esthetics. The minimal OHRQoL impact and low PIDAQ scores highlight the positive psychosocial effects of implant restorations. These results suggest that long-term evaluation of functional and psychological outcomes should be integrated into clinical decision-making and future prospective studies.

INTRODUCTION. C-shaped root canals represent a complex anatomical variation, primarily seen in mandibular molars. Their intricate morphology poses significant challenges for diagnosis, cleaning, shaping, and obturation in endodontic practice.AIM. To present a series of clinical cases illustrating the diagnosis and endodontic management of different types of C-shaped canals based on Fan’s classification.MATERIALS AND METHODS. Four clinical cases involving mandibular molars with C-shaped canal configurations were managed in accordance with CARE and PRICE guidelines. Each case included clinical and radiographic diagnosis, working length determination, cleaning and shaping with either the R2 Reciproc (VDW) or PlexV (Orodeka) system, irrigation with NaOCl and EDTA under ultrasonic activation, and obturation using thermocompaction or single-cone techniques with bioceramic sealers.RESULTS. All cases demonstrated successful identification and management of C-shaped canal systems (types C1 to C4). Clinical and radiological follow-up at 1 and 3 months showed favorable healing with resolution of symptoms and periapical pathology.CONCLUSIONS. Early and accurate diagnosis of C-shaped canals, supported by clinical and radiographic examination, is critical for successful endodontic outcomes. The use of magnification, appropriate canal preparation techniques, and bioceramic materials significantly enhances treatment success in such complex anatomical variations.

Background: Mock-ups play a crucial role in aesthetic dentistry by allowing patients to preview potential treatment outcomes. Traditional chairside techniques and computer-aided design/ computer-aided manufacturing (CAD/CAM) milling are two common fabrication methods. However, limited clinical...

The aim of this study was to assess biomedical waste management practices in dental clinics and explore the sustainability of strategies employed to minimize environmental impact while ensuring public health safety. A cross-sectional descriptive study was conducted among dental professionals in Tunisia from March 3, 2023, to March 10, 2024. A total of 50 clinics participated in the study. Data were collected using a survey questionnaire consisting of 30 questions, which were divided into three sections: Knowledge (10 questions), attitudes (10 questions), and practices (10 questions). The survey was conducted in person and was complemented by an observation checklist during waste audits in selected dental clinics. The data were recorded and statistically analyzed using the statistical software SPSS, version 20.0. The study involved 120 dental professionals across 50 clinics. The results revealed that 68% of the participants demonstrated basic awareness of waste segregation, but only 42% followed consistent waste management protocols. The study identified challenges in sustainable practices, including limited training (only 30% of the participants had received formal waste management training) and insufficient infrastructure (44% of clinics lacked proper segregation bins). Environmental concerns were raised regarding incineration practices, with 50% of clinics continuing to use this method despite its environmental impact. This study provides an overview of biomedical waste management practices in dental clinics, revealing variations in awareness, implementation, and available resources. These findings are crucial for policymakers and educators working to promote sustainable biomedical waste management in dental settings. By addressing knowledge gaps and implementing eco-friendly practices, the dental sector can reduce its environmental footprint while maintaining high public health standards. How to cite this article: Boukhris H, Zidani H, Khalifa ABH, et al. Environmental Impact of Dental Waste: A Survey-based Analysis of Waste Segregation and Recycling Practices in Dental Clinics. J Contemp Dent Pract 2025;26(3):250-256.

Background Polyetheretherketone (PEEK) is widely used in the biomedical field due to its outstanding biological and mechanical properties. Originally employed as a temporary abutment in implantology, recent research has expanded its indications for more definitive applications, such as frameworks and dental post and core. However, PEEK’s inert nature and low surface energy pose challenges for adhesion, necessitating surface modifications. Various physical and chemical modification techniques, including acid etching (e.g., 98% sulfuric acid), sandblasting with alumina oxide (Al₂O₃), plasma treatment, laser irradiation, silanization, and air abrasion with silica-coated particles, have been proposed to enhance PEEK’s bonding performance. Despite numerous clinical investigations, standardized protocols for surface treatment remain lacking. This systematic review aims to assess the impact of surface treatments on the bonding performance of PEEK posts. Methods A detailed search of the literature will be conducted across several databases including PubMed, Scopus and clinical trial registries. Additional databases such as Cochrane Central, EMBASE, Web of Science and EBSCO will also be included. The search strategy will target controlled randomized studies and non-randomized clinical trials evaluating the impact of surface treatments on PEEK post adhesion strength. The Newcastle-Ottawa Scale (NOS) will be used to assess bias in non-randomized studies, while the Cochrane Risk of Bias (ROB II) tool will be employed for evaluating randomized controlled trials. Data extraction will focus on study design, treatment methods, outcomes and results. This systematic review protocol will adhere to the guidelines for systematic reviews outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Discussion The discussion will explore the implications of findings on clinical practice, highlighting the importance of enhancing PEEK’s bioactivity and surface energy to improve bonding efficacy in dental procedures. Moreover, it will suggest areas for future research to advance dental materials science, aiming to optimize the utilization of PEEK in dental applications Systematic review registration PROSPERO: CRD42024529783 (Registered on 08/04/2024).

The tongue, as a multifunctional organ, exhibits a variety of physiological characteristics and pathological alterations. Identifying and understanding these variations is crucial for ensuring an accurate diagnosis and appropriate management. This article explores the main common physiological variations, such as geographic tongue, fissured tongue, etc., as well as pathological conditions, including elementary lesions such as vesicles, bullae, erosions, ulcers, plaques, along with surface changes (atrophy), color changes (coatings, pigmentation), or even shape alterations (infiltrations). It discusses current diagnostic tools and therapeutic approaches while emphasizing the importance of regular monitoring to prevent complications and maintain optimal oral health.