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Daood U, Ilyas MS, Bashir S, Yousuf N, Rashid M, Kaur K, Bapat RA, Bijle MN, Pichika MR, Mak KK, Zhang S, Sheikh Z, Khan AS, Peters O, Matinlinna JP. Unravelling the Programmed Inflammation and Tissue Repair by a Multipotential Antimicrobial K21 Silane. Int Dent J 2024:S0020-6539(24)01502-8. [PMID: 39322516 DOI: 10.1016/j.identj.2024.09.012] [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: 07/14/2024] [Revised: 09/04/2024] [Accepted: 09/06/2024] [Indexed: 09/27/2024] Open
Abstract
AIMS AND OBJECTIVES To examine if a novel antimicrobial silane K21 can alter macrophage polarisation and affect fibroblast proliferation by deciphering the molecular pathways for programmed healing using a combined in vitro and in vivo (animal) burn model. MATERIALS AND METHODS An injectable silane-based antimicrobial aimed to modulate macrophage polarisation was manufactured. Experimental analysis included colorimetric cell migration assays on gingival fibroblasts, macrophage phagocytosis characterisation, immunofluorescence staining, triacylglycerol accumulation within macrophages by LCMS, cellular metabolic/proliferation assays, macrophage exposure quantification with morphology assessment using FE-SEM, Raman spectral analysis, RNA isolation for relative gene expression and animal study model to morphometrically and microscopically analyse partial thickness burn wound healing under QAS/K21. RESULTS M1 and M2 polarisation both appeared exaggerated under QAS/K21 treatment. The wounds treated with K21 had depicted accelerated healing as compared to control (P < .05) in dorsal skin of rabbits. Relative gene expression results demonstrate reduced cytokine and anti-inflammatory response under the influence of K21. While M1 expression, TG accumulation, and associated characterisations demonstrate the programmed inflammatory potential of K21. CONCLUSION the antimicrobial and reparative efficacy of K21 silane aids in programmed inflammation for enhanced tissue healing and repair.
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Affiliation(s)
- Umer Daood
- Restorative Dentistry Division, School of Dentistry, International Medical University Kuala Lumpur, Kuala Lumpur, Malaysia; School of Dentistry, The University of Queensland, Herston, Queensland, Australia.
| | | | - Sehar Bashir
- Histopathology, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Neelofar Yousuf
- Pharmacology, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Maryam Rashid
- Pharmacology, Akhtar Saeed Medical and Dental College, Lahore, Pakistan
| | - Kanwardeep Kaur
- Clinical Oral Health Sciences Division, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Ranjeet Ajit Bapat
- Restorative Dentistry Division, School of Dentistry, International Medical University Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Mohammed Nadeem Bijle
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | | | - Kit-Kay Mak
- School of Pharmacy, International Medical University Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Shiming Zhang
- Interdisciplinary Institute of Life Medicine, Hunan University, Changsha, Hunan Province, China
| | - Zeeshan Sheikh
- Biomaterials & Applied Oral Sciences (BAOS), Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Abdul Samad Khan
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University; Dammam, Saudi Arabia
| | - Ove Peters
- Department of Endodontics, Arthur A Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA; School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Jukka P Matinlinna
- Dental Materials Science, Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China; Biomaterials Science, Division of Dentistry, School of Medical Sciences, The University of Manchester, Manchester, UK
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Daood U, Ilyas MS, Ashraf M, Akbar M, Asif A, Khan AS, Sidhu P, Sheikh Z, Davamani F, Matinlinna J, Peters OA, Yiu C. A Novel Coated Suture Displays Antimicrobial Activity Without Compromising Structural Properties. J Oral Maxillofac Surg 2024; 82:1147-1162. [PMID: 38830601 DOI: 10.1016/j.joms.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 05/11/2024] [Accepted: 05/11/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Treated or coated sutures promise to prevent contamination of wounds. PURPOSE The purpose of the study was to coat surgical sutures with a new quaternary ammonium silane (QAS) antimicrobial compound at two different application temperatures and then to evaluate the resulting structural, physical, mechanical, and biological properties. STUDY DESIGN, SETTING, SAMPLE In vitro and in vivo studies were conducted using male albino Wistar rats approved by the Joint Ethical Committee of IMU and Postgraduate Medical Institute, Lahore. Only suture samples, coated uniformly with verified presence of the compound and of adequate length were used. Samples which were not coated uniformly and with inadequate length or damaged were excluded. PREDICTOR VARIABLE Predictor variables were sutures with and without QAS coatings and different temperatures. Sutures were coated with QAS at 0.5 and 1.0% wt/vol using the dip coating technique and sutures with and without QAS coating were tested at 25 and 40 °C temperatures. MAIN OUTCOME VARIABLE(S) Outcome variables of structural and physico-mechanical properties of QAS-coated and non-coated sutures were measured using Fourier transform infrared spectroscopy (for structural changes), confocal laser and scanning electron (for diameter changes), and tensile strength/modulus (for mechanical testing). Biologic outcome variables were tested (bacterial viability); macrophage cultures from Wistar rats were tested (M1/M2 polarization detecting IL-6 and IL-10). Macrophage cells were analyzed with CD80+ (M1) and CD163+ (M2). Chemotaxis index was calculated as a ratio of quantitative fluorescence of cells. COVARIATES Not applicable. ANALYSES Ordinal data among groups were compared using the Wilcoxon Mann-Whitney U test along with the comparison of histological analysis using the Wilcoxon Sign-rank test (P < .05). RESULTS Fourier transform infrared spectroscopy peak at 1490 cm-1 confirmed the presence of QAS on suture's surfaces with a significant increase (P < .05) in diameter (0.99 ± 0.5-mm) and weight (0.77 ± 0.02-mg) observed for 1% QAS groups treated at 40 °C. Non-coated samples heated at 25 °C had significantly (P < .05) less diameters (0.22 ± 0.03-mm) and weights (0.26 ± 0.06-mg). Highest tensile strength/modulus was observed for 0.5% QAS-coated samples which also had significantly higher antibacterial characteristics than other sutures (P < .05). QAS-coated sutures significantly increased M1 and M2 markers. CONCLUSION AND RELEVANCE QAS coating conferred antibacterial action properties without compromising the physical and mechanical properties of the suture.
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Affiliation(s)
- Umer Daood
- Associate Professor, Head of Restorative Division, Division of Restorative Dentistry, School of Dentistry, International Medical University Kuala Lumpur, Kuala Lumpur, Malaysia.
| | - Muhammad Sharjeel Ilyas
- Assistant Professor, Department of Oral Biology, Post Graduate Medical Institute, Lahore, Pakistan; Associate Professor, Postgraduate Medical Institute, Lahore, Pakistan
| | - Mariam Ashraf
- Assistant Professor, Department of Oral Biology, Post Graduate Medical Institute, Lahore, Pakistan; Professor, Postgraduate Medical Institute, Lahore, Pakistan
| | - Munazza Akbar
- Assistant Professor, Department of Oral Biology, Post Graduate Medical Institute, Lahore, Pakistan; Professor, Postgraduate Medical Institute, Lahore, Pakistan
| | - Amina Asif
- Assistant Professor, Department of Oral Biology, Post Graduate Medical Institute, Lahore, Pakistan; Assistant Professor, Postgraduate Medical Institute, Lahore, Pakistan
| | - Abdul Samad Khan
- Professor, Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Preena Sidhu
- Senior Lecturer, Head of Restorative Division, Division of Restorative Dentistry, School of Dentistry, International Medical University Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Zeeshan Sheikh
- Assistant Professor, Department of Periodontology, Applied Oral Sciences & Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Fabian Davamani
- Associate Professor, Division of Human Biology, Faculty of Biomedical Science, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia; Professor, Applied Dental Sciences, Division of Human Biology, Dental Materials Science, Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, PR China
| | - Jukka Matinlinna
- Professor, Applied Dental Sciences, University of Manchester, School of Dentistry, Manchester, United Kingdom; Professor, Program Convenor, Department of Endodontics, Arthur A Dugoni School of Dentistry, University of the Pacific, San Francisco
| | - Ove A Peters
- Professor, Program Convenor, Department of Endodontics, The University of Queensland, Brisbane, Queensland, Australia
| | - Cynthia Yiu
- Professor, Head of Paediatric Dentistry, Pediatric Dentistry Division, Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, PR China
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Xiao S, Sun G, Huang S, Lin C, Li Y. Nanoarchitectonics-Based Materials as a Promising Strategy in the Treatment of Endodontic Infections. Pharmaceutics 2024; 16:759. [PMID: 38931881 PMCID: PMC11207628 DOI: 10.3390/pharmaceutics16060759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/19/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Endodontic infections arise from the interactive activities of microbial communities colonizing in the intricate root canal system. The present study aims to update the latest knowledge of nanomaterials, their antimicrobial mechanisms, and their applications in endodontics. A detailed literature review of the current knowledge of nanomaterials used in endodontic applications was performed using the PubMed database. Antimicrobial nanomaterials with a small size, large specific surface area, and high chemical activity are introduced to act as irrigants, photosensitizer delivery systems, and medicaments, or to modify sealers. The application of nanomaterials in the endodontic field could enhance antimicrobial efficiency, increase dentin tubule penetration, and improve treatment outcomes. This study supports the potential of nanomaterials as a promising strategy in treating endodontic infections.
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Affiliation(s)
- Suli Xiao
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Xiamen 361003, China;
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen 361003, China
| | - Guanwen Sun
- Department of Stomatology, Fujian Medical University Xiamen Humanity Hospital, Xiamen 361018, China;
| | - Shan Huang
- Department of Stomatology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen 361005, China;
| | - Chen Lin
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Xiamen 361003, China;
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen 361003, China
| | - Yijun Li
- Department of Endodontics, Stomatological Hospital of Xiamen Medical College, Xiamen 361003, China;
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen 361003, China
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Bapat RA, Libat R, Yuin OS, Parolia A, Ilyas MS, Khan AS, Kay MK, Pichika MR, Saxena K, Seow LL, Sidhu P, Daood U. Antimicrobial FiteBac® K21 promotes antimicrobial Potency and wound healing. Heliyon 2023; 9:e19282. [PMID: 37664740 PMCID: PMC10469996 DOI: 10.1016/j.heliyon.2023.e19282] [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: 10/03/2022] [Revised: 07/27/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives Successful root canal therapy is dependent on the efficacy of complete instrumentation and adequate use of chemical irrigant to eliminate the biofilm from dentin surface. The aim of the study was to examine antibiofilm and antimicrobial effectiveness of newly formulated Quaternary ammonium silane (QAS/also codenamed K21; against Fusobacterium nucleatum (F. nucleatum) and Enterococcus faecalis (E. faecalis) biofilm on radicular dentin with evaluation of the anti-inflammatory consequence in vivo. Methods Fourier Transform Infrared Spectroscopy (FTIR) was performed after complete hydrolysis of K21 solution. Human teeth were inoculated with biofilms for 7-days followed by treatment with various irrigants. The irrigant groups were Sodium hypochlorite [NaOCl (6%)], Chlorhexidine [CHX (2%)], K21 (0.5%), K21 (1%) and Saline. Scanning electron microscopy (SEM) was performed for biofilm and resin-dentin penetration. Transmission Electron Microscopy (TEM) of biofilms was done to evaluate application of K21. For in vivo evaluation, Albino wistar rats were injected subcutaneously and sections were stained with haematoxylin/eosin. Macrophage, M1/M2 expression were evaluated along with molecular simulation. Raman measurements were done on dried biofilms. Results FTIR K21 specimens demonstrated presence of ethanol/silanol groups. Raman band at 1359 cm-1 resemble to -CH2- wagging displaying 29Si atoms in Nuclear Magnetic Resonance (NMR). 0.5%K21 showed cells exhibiting folded membranes. SEM showed staggering amount of resin tags with 0.5% K21 group. TEM showed membrane disruption in K21-groups. K21 groups were initially irritant, which subsided completely afterwards showing increased CD68. K21 and MMP/collagen complex was thermodynamically favourable. Conclusion K21 root canal irrigant was able to penetrate bacterial wall and can serve as a potential irrigant for therapeutic benefits. Expression of M2 polarized subsets showed K21 can serve in resolving inflammation and potentiate tissue repair.
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Affiliation(s)
- Ranjeet Ajit Bapat
- Restorative Division, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Rikan Libat
- Restorative Division, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Ong Shu Yuin
- Restorative Division, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Abhishek Parolia
- Restorative Division, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | | | - Abdul Samad Khan
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University; Dammam, Saudi Arabia
| | - Mak Kit Kay
- Pharmaceutical Chemistry, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Mallikarjuna Rao Pichika
- Pharmaceutical Chemistry, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Kirti Saxena
- Clinical Oral Health Sciences Division, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Liang Lin Seow
- Restorative Division, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Preena Sidhu
- Restorative Division, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Umer Daood
- Restorative Division, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Imad R, Sheikh Z, Rao Pichika M, Kit-Kay M, Siddiqui RA, Nawaid Shah SN, Banavar S, Matinlinna J, Lin SL, Daood U. Cathepsin-K inhibition enhances anti-cancerous activity within oral squamous cell carcinoma cells: Uncloaking the potency of new K21 formulation. Exp Cell Res 2023:113687. [PMID: 37356748 DOI: 10.1016/j.yexcr.2023.113687] [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: 03/05/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The ability of cancer cells to be invasive and metastasize depend on several factors, of which the action of protease activity takes center stage in disease progression. PURPOSE/OBJECTIVE To analyze function of new K21 molecule in the invasive process of oral squamous cell carcinoma (OSCC) cell line. MATERIALS & METHODS The Fusobacterium (ATCC 23726) streaks were made, and pellets were resuspended in Cal27 (ATCC CRL-2095) OSCC cell line spheroid cell microplate. Cells were seeded and Lysotracker staining performed for CathepsinK red channel. Cell and morphology were evaluated using Transmission Electron microscopy. Thiobarbituric acid assay was performed. OSCC was analyzed for Mic60. Raman spectra were collected from the cancer cell line. L929 dermal fibroblast cells were used for Scratch Assay. ELISA muti arrays were used for cytokines and matrix molecules. Internalization ability of fibroblast cells were also analyzed. Structure of K21 as a surfactant molecule with best docked poses were presented. RESULTS Decrease in lysosomal staining was observed after 15 and 30 min of 0.1% treatment. Tumor clusters were associated with cell membrane destruction in K21 primed cells. There was functional silencing of Mic60 via K21, especially with 1% concentration with reduced cell migration and invasiveness. Raman intensity differences were seen at 700 cm-1, 1200 cm-1 and 1600 cm-1 regions. EVs were detected within presence of fibroblast cells amongst K21 groups. Wound area and wound closure showed the progress of wound healing. CONCLUSION Over expression of CatK can be reduced by a newly developed targeted K21 based drug delivery system leading to reduced migration and adhesion of oral squamous cell carcinoma cells. The K21 drug formulation can have great potential for cancer therapies due to targeting and cytotoxicity effects.
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Affiliation(s)
- Rehan Imad
- Department of Molecular Medicine, Faculty of Health Sciences, Ziauddin University, Pakistan
| | - Zeeshan Sheikh
- Applied Oral Sciences & Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, 5981 University Ave, Halifax, Nova Scotia, B3H 1W2, Canada
| | - Mallikarjuna Rao Pichika
- Pharmaceutical Chemistry, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Mak Kit-Kay
- Pharmaceutical Chemistry, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Rehan Ahmed Siddiqui
- Department of Molecular Medicine, Faculty of Health Sciences, Ziauddin University, Pakistan
| | - Syed Nudrat Nawaid Shah
- Department of Anatomy, Ziauddin Medical College, Ziauddin University, Clifton, Karachi, Pakistan
| | - Spoorthi Banavar
- Division of Clinical Oral Health Sciences, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Bukit Jalil, Kuala Lumpur, Malaysia
| | - Jukka Matinlinna
- Dental Materials Science, Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, PR China; University of Manchester, School of Dentistry, Manchester, United Kingdom
| | - Seow Liang Lin
- Restorative Dentistry Division, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Umer Daood
- Restorative Dentistry Division, School of Dentistry, International Medical University Kuala Lumpur, 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Bukit Jalil, Wilayah Persekutuan Kuala Lumpur, Malaysia.
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Bapat RA, Parolia A, Chaubal T, Yang HJ, Kesharwani P, Phaik KS, Lin SL, Daood U. Recent Update on Applications of Quaternary Ammonium Silane as an Antibacterial Biomaterial: A Novel Drug Delivery Approach in Dentistry. Front Microbiol 2022; 13:927282. [PMID: 36212832 PMCID: PMC9539660 DOI: 10.3389/fmicb.2022.927282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Quaternary ammonium silane [(QAS), codename – k21] is a novel biomaterial developed by sol-gel process having broad spectrum antimicrobial activities with low cytotoxicity. It has been used in various concentrations with maximum antimicrobial efficacy and biocompatibility. The antimicrobial mechanism is displayed via contact killing, causing conformational changes within the bacterial cell membrane, inhibiting Sortase-A enzyme, and causing cell disturbances due to osmotic changes. The compound can attach to S1' pockets on matrix metalloproteinases (MMPs), leading to massive MMP enzyme inhibition, making it one of the most potent protease inhibitors. Quaternary ammonium silane has been synthesized and used in dentistry to eliminate the biofilm from dental tissues. QAS has been tested for its antibacterial activity as a cavity disinfectant, endodontic irrigant, restorative and root canal medication, and a nanocarrier for drug delivery approaches. The review is first of its kind that aims to discuss applications of QAS as a novel antibacterial biomaterial for dental applications along with discussions on its cytotoxic effects and future prospects in dentistry.
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Affiliation(s)
- Ranjeet Ajit Bapat
- Restorative Dentistry Division, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Abhishek Parolia
- Restorative Dentistry Division, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Tanay Chaubal
- Restorative Dentistry Division, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Ho Jan Yang
- Restorative Dentistry Division, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Prashant Kesharwani
- School of Pharmaceutical Education and Research, Jamia Hamdard (Hamdard University), New Delhi, India
| | - Khoo Suan Phaik
- Division of Clinical Oral Health, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Seow Liang Lin
- Restorative Dentistry Division, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Umer Daood
- Restorative Dentistry Division, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
- *Correspondence: Umer Daood
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