Khalij-Libya Journal of Dental and Medical Research

Knowledge and Use of Silver Diamine Fluoride by Dentists in Libya: A Cross-Sectional Study

Najat Abushoufa — 2026-07-05

Silver diamine fluoride (SDF) is a minimally invasive cariostatic solution recommended by leading pediatric dentistry organizations; however, its uptake in dental practice differs across countries. To date, no nationally representative study has examined Libyan dentists’ knowledge, attitudes, and practices regarding SDF. This study was conducted to assess awareness, knowledge, attitudes, clinical use, and perceived barriers towards SDF among Libyan dentists. A cross-sectional study was conducted from July 2025 to May 2026 among 527 Libyan dentists across multiple governorates using a validated electronic questionnaire. Data was analyzed using SPSS V 27. Descriptive statistics summarized responses; chi-square tests examined associations between demographic variables and history of SDF use. A composite overall Knowledge Score (OKS) was constructed from ten binary items. Overall, 81.8% of respondents were aware of SDF, predominantly through colleagues (28.8%) and online resources (28.1%). Only 34.3% had used SDF clinically. The mean OKS was 5.31 ± 2.69 / 10 (moderate level); 35.5% correctly identified the recommended 38% concentration, while 52.4% did not know it. Attitudes were broadly favourable for coronal caries arrest (non-cavitated: 71.9%; enamel-cavitated: 70.3%), but declined for deeper lesions. The primary barriers were tooth discoloration (56.6%), patient satisfaction concerns (53.6%), and parental acceptance (52.2%). University type was the only significant demographic predictor of SDF use: private-university graduates were significantly more likely to have used SDF than governmental-university graduates (54.3% vs. 30.9%; χ² = 15.674, p < 0.001). SDF users demonstrated significantly higher OKS compared to non-users (mean 6.45 ± 2.04 vs. 4.72 ± 2.80; p < 0.001). Two-thirds (66.2%) anticipated increasing future SDF use. Libyan dentists demonstrate moderate awareness but suboptimal pharmacological knowledge and clinical adoption of SDF. Deficits are uniform across all demographic subgroups, indicating a systemic educational gap that requires coordinated curriculum reform and targeted continuing professional development. The use of SDF among Libyan dentists is still limited and has not yet become established in routine clinical practice. In Libya, it is necessary to increase training on SDF, primarily through the university, to promote its wider use and increase its use, especially as a non-invasive caries treatment.

Key Words: Schwartz-Jampel syndrome, Botulinum toxin A, Myotonia, Mentalis muscle overactivity, Case report.

A Prospective Evaluation of Laparoscopic Inguinal Hernia Repair Outcomes at Tobruk Medical Center, Libya

Fathi Asnini — 2026-07-05

Inguinal hernias are among the most common surgical pathologies worldwide, with laparoscopic Transabdominal Preperitoneal (TAPP) repair emerging as a preferred minimally invasive technique. However, continuous evaluation of short-term outcomes and identification of modifiable risk factors for postoperative complications remain essential for optimizing patient care. This study aimed to evaluate the clinical outcomes and identify independent predictors of complications following laparoscopic TAPP inguinal hernia repair. This prospective observational study was conducted at the Department of General Surgery, Tobruk Medical Center, Libya, over two years from 2023 to 2024. A total of 60 patients diagnosed with primary inguinal hernias and medically fit for general anesthesia underwent TAPP repair. Patients with irreducible/obstructed hernias, previous lower abdominal surgeries, recurrent hernias, severe cardiopulmonary comorbidities, or those lost to follow-up were excluded. All participants were monitored postoperatively for complications, pain scores (using the Numeric Rating Scale), and hernia recurrence over a one-year follow-up period. Multivariate logistic regression analysis was performed to identify independent predictors of overall complications. The mean patient age was 44.9 ± 12.5 years, and the mean BMI was 24.8 ± 1.36 kg/m². The mean operative time was 73.2 ± 8.3 minutes. Patients demonstrated rapid recovery, with a mean hospital stay of 31.5 ± 5.1 hours and a mean return to work of 7.5 ± 1.9 days. Postoperative pain scores decreased progressively from 4.9 on day 1 to 2.7 by the first week. Only 20% of patients required ongoing analgesics. Seroma occurred in 15% of patients at day 7, resolving spontaneously to 5% by the first month. Foreign body sensation was reported in 20% of patients. No recurrences, wound infections, hematomas, or chronic pain syndromes were recorded. Multivariate analysis identified chronic cough (OR: 2.66; p = 0.001), constipation (OR: 1.50; p = 0.01), heavy lifting (OR: 2.17; p = 0.001), diabetes mellitus (OR: 1.02; p = 0.02), and smoking (OR: 1.92; p = 0.001) as independent predictors of overall postoperative complications. Laparoscopic TAPP inguinal hernia repair is a safe, feasible, and effective procedure that offers rapid recovery, low morbidity, and excellent short-term outcomes with no recurrence at one year. Modifiable risk factors, particularly smoking, chronic cough, constipation, heavy lifting, and diabetes mellitus, should be systematically addressed preoperatively to minimize complication rates and optimize surgical success.

Management of Mild to Moderate Dental Fluorosis Using Enamel Microabrasion and Bleaching Techniques

Hanen Madhoni — 2026-07-06

Dental fluorosis is a developmental enamel defect that may result in esthetic concerns, particularly in mild and moderate cases. Conservative treatment modalities, including enamel microabrasion and bleaching, have gained increasing attention because of their ability to improve appearance while preserving tooth structure. The purpose of this narrative review was to evaluate the current evidence regarding the effectiveness of enamel microabrasion and bleaching in the management of mild to moderate dental fluorosis and to discuss their clinical applications, limitations, and future research needs. Previous studies have demonstrated that enamel microabrasion is an effective minimally invasive approach for superficial fluorosis stains, especially in mild cases. However, its effectiveness decreases with increasing lesion depth and severity. Comparative clinical studies indicate that bleaching procedures and combination protocols involving enamel microabrasion followed by bleaching generally provide superior esthetic outcomes and greater patient satisfaction than enamel microabrasion alone. Combination therapy appears to benefit from the complementary mechanisms of both procedures, resulting in improved color uniformity and more predictable outcomes. Despite encouraging clinical results, the available evidence remains limited by small sample sizes, methodological heterogeneity, short follow-up periods, and inconsistent outcome assessment methods. In addition, long-term randomized clinical trials and standardized treatment protocols are still lacking. Overall, minimally invasive conservative approaches represent effective options for the management of mild to moderate dental fluorosis. Treatment selection should be individualized according to lesion severity and patient expectations. Further high-quality studies are needed to establish evidence-based guidelines and optimize long-term treatment outcomes.

Panoramic Radiographic Analysis of Distal Caries Prevalence in Mandibular Second Molars Associated with Adjacent Third Molar Position: A Retrospective Study in Benghazi, Libya

Samia Alawjali — 2026-07-08

The present study aimed to investigate, using panoramic radiographs, the association between mandibular third molars and the occurrence of distal caries in adjacent second molars. This retrospective cross-sectional study was conducted at Elaml Dental Centre, Benghazi, Libya, using digital panoramic radiographs (orthopantomograms, OPGs) obtained between January 2022 and November 2023. A total of 557 radiographs from Libyan adults aged over 21 years were examined to evaluate the eruption status and angulation of impacted mandibular third molars, as well as the presence of distal caries in adjacent mandibular second molars. Impaction patterns were classified according to Winters’ and Pell & Gregory's systems. Statistical analysis was performed using the Chi-square test. Results showed that 339 second molars (34.8%) exhibited caries on the distal surface. The majority of second molars affected by distal carious lesions were linked to Level A third molar status, comprising 194 affected mandibular second molars (57.2%), followed by Level B, which accounted for 133 cases (39.2%). Mesially inclined third molars were most commonly associated with distal caries in the second molars (n=144, 42.5%), followed by vertically oriented third molars (n=94, 27.7%). The study concluded that mandibular third molars are associated with an increased risk of distal caries in second molars, especially when they are classified as level A or mesioangular-tilted third molars. It is advisable to conduct regular radiographic examinations for early detection. Additionally, if impacted third molars are in contact with the oral cavity, their removal may be necessary as a preventive measure.

Clinical Outcome of Free Gingival Grafting for Managing Localized Recession Type 1 (RTI): A Case Report

Anas Al-misurati — 2026-07-12

Localized gingival recession in the mandibular anterior region presents a clinical challenge, particularly in the presence of a shallow vestibule, high frenum attachment, and inadequate keratinized tissue. Achieving long-term soft tissue stability in such cases requires careful selection of the surgical approach. A 38-year-old female patient presented with a localized recession type I (RTI) affecting the mandibular left central incisor, associated with a thin gingival phenotype, high labial frenum attachment, and limited keratinized tissue. A free gingival graft (FGG) was selected to augment the keratinized tissue and deepen the vestibule rather than focusing solely on root coverage. Clinical evaluation demonstrated an increase in the width of keratinized tissue from 1 mm at baseline to 4 mm postoperatively. Gingival recession depth was reduced from 3 mm to 0.4 mm. These outcomes remained stable at one- and three-year follow-up examinations, with satisfactory graft integration and tissue maturation. Within the limitations of this case report, free gingival grafting proved to be a predictable and stable treatment option for managing localized RTI recession in the mandibular anterior region when the primary treatment goal is keratinized tissue augmentation and vestibular deepening

Treatment of External Root Resorption by Intentional Replantation Using Calcium Silicate-Based Cements

Sokaena Alswegi — 2026-07-15

Intentional replantation is a clinical technique that involves the extraction of the tooth and reinserting it into the socket after endodontic manipulation and restoring the defect of root resorption with a suitable biocompatible material. The procedure is typically performed as a last resort when other treatment options, such as root canal therapy or apical surgery, are not feasible or have failed. The aim and objective of this search were to show the success rate of intentional replantation as a treatment for teeth with root resorption. Using the PubMed, ResearchGate, and Google Scholar electronic databases. The keywords were as follows: intentional replantation, root resorption, and Biodentine. The results showed that intentional replantation is a reliable and predictable procedure; when indicated, with a very high success rate if it is done correctly, promptly, and the periodontal ligament integrity is preserved as much as possible. When standard protocols of intentional replantation are followed, clinical and radiological success is expected. From this point of view, intentional replantation should be considered as a viable therapeutic option and not as a procedure of last resort