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Antibacterial Efficacy Of Resin-Based Dental Composites Modified With Antibacterial Agents Against S. Mutans: A Systematic Review, Ahmad Setiawan Jarigau, Erwin Gunawan, Muhammad Akira Takashi Dharma, Fanny Dinda Nur Aulia, Lenni Indriani Hatta, Nurhayati Natsir

International Arab Journal of Dentistry

Introduction: Dental caries caused by Streptococcus mutans is a leading cause of dental restoration failure. Enhancing composite resins with antibacterial agents aims to inhibit bacterial growth and prolong restoration life.

Objectives: This review evaluates the anti-bacterial agents efficacy of these modified composites against S. mutans and explores their mechanisms and potential clinical benefits.

Methods: A comprehensive literature search was conducted across multiple databases following PRISMA guidelines, focusing on in vitro studies published between 2015 and 2025. Studies evaluating composites with antibacterial additives against S. mutans using standard microbiological assays were included. The quality of eligible studies was assessed using the …

Effect Of Home Bleaching With Carbamide Peroxide And Over-The-Counter Products On Stained Supra-Nano-Filled Composite: An In-Vitro Study., Lynn Harrouk, Pascale Habre, Samar Bou Jaoude, Carina Mehanna Zogheib

International Arab Journal of Dentistry

Objective: This study evaluated the impact of home and over-the-counter (OTC) bleaching products, compliant with SCCS regulations, on color changes in tea-stained supra-nano filled composite, using the CIEDE2000 formula.

Methods: One hundred Estelite® Sigma Quick discs were fabricated, thermocycled, and tea-stained for 12 days. Samples were divided into four groups: Opalescence 15% carbamide peroxide (CP) gel, White Dental Beauty 6% hydrogen peroxide (HP) strips, Pola Luminate 6% HP brush-on gel, and a control. Color was measured at baseline, post-staining, and post-bleaching using a VITA EasyShade spectrophotometer. ΔE₀₀ values were analyzed with Kruskal-Wallis and Dunn’s post-hoc tests (p < 0.05).

Results: All bleaching …

Comparison Of Three Intraoral Scanners For Digital Impressions Of Biologically Oriented Preparation: An In-Vivo Study, Lara Habli, Pascale Habre-Hallage, Hani Tohme, Dany Noujaim, Maryse Nassif, Camille Haddad

International Arab Journal of Dentistry

Introduction: The accuracy of intraoral scanners (IOSs) in capturing a Biologically Oriented Preparation Technique (BOPT) remains uncertain. The aim of this study was to evaluate the accuracy of digital impressions obtained with three intraoral scanners for recording BOPT preparations.

Methods: A maxillary central incisor was prepared following BOPT. After temporization, a conventional polyvinyl siloxane impression was scanned with a desktop scanner to obtain a reference model. Forty-two scans (n D 14 per scanner) were recorded with three IOSs—Trios 3, Sirios, and Helios 680—by a single operator under standardized conditions. Accuracy was assessed using Geomagic Control X by calculating 3D surface …

Evaluation Of Optimal Force For Intrusion Of A Periodontally Compromised Maxillary Anterior Dentition Treated With Fixed Orthodontics – A Finite Element Analysis, Tanzim Ahmed, Amrita Puri, Aatira Nair, Anshul Singla, Mathew Koshy Vaidyan, Shruti Sharma, Chhavi Singh

International Arab Journal of Dentistry

Introduction: Adult orthodontic treatment is increasingly sought due to aesthetic and functional concerns, often involving periodontally compromised patients with altered biomechanics. Reduced bone support shifts the center of resistance and necessitates lower, carefully controlled forces, while finite element modeling has become a key tool to analyze tissue response under such conditions.

Objectives: The study aimed to determine the optimal intrusive force for periodontally compromised maxillary anterior teeth using Finite Element Analysis (FEA).

Methods: A 3D finite element model of the maxillary anterior dentition was created and divided into healthy and compromised halves, the latter with one-third alveolar bone loss. A …

Impact Of Antihypertensive Medications On Implant Success: A Retrospective Cohort Study On Monomedicated Patients, Antony Chidiac, Stephanie Mrad, Charbel Kachouh, Richard M. Sadaka, Joseph Bassil

International Arab Journal of Dentistry

Objective: The aim of this study main is to analyze the influence of antihypertensive treatments on the failure and survival rates of dental implants.

Methods: Medical records of 586 patients who received a total of 1,814 dental implants between 2012 and 2022 met the inclusion criteria and were retrospectively reviewed. Patients were divided into two groups: a control group comprising 512 systemically healthy patients with 1581 implants, and a group of 74 patients taking only antihypertensive medications who received a total of 233 implants. Implant failure was assessed according to criteria defined by the International Congress of Oral Implantologists.

Results: …

Hypo-Responsiveness Of The Dental Pulp In Patients With Type 2 Diabetes And Hypertension: A Cross-Sectional Study, Kavitha M, Mallolu Anthony Sanjana Vijay, Niveditha B, Fathima A.I, Pavithra D, Vigneshwaran J

International Arab Journal of Dentistry

Introduction: Diabetes mellitus and hypertension, two of the most prevalent metabolic disorders worldwide, exert profound and progressive effects on multiple physiological systems. While their systemic complications are well documented, their subtle yet clinically significant impact on oral structures, particularly the dental pulp, remains underexplored.

Objectives: This study aims to assess the functional responsiveness of dental pulp nerves in individuals with type 2 diabetes mellitus and systemic hypertension, and to compare the findings with responses from healthy individuals, using an Electric pulp tester (EPT) as a diagnostic tool.

Methods: A total of 600 teeth from 75 adult patients (25 diabetic, 25 …

The Efficacy Of Mini-Screw Rapid Palatal Expansion (Marpe) In Late Adolescents And Young Adults: A Systematic Review, Afaf El Merouani Drissi, Hajar Ben Mohimd, Hicham Benyahia, Fatima Zaoui

International Arab Journal of Dentistry

Introduction: Mini-screw assisted rapid maxillary expansion (MARPE) emerged as a less invasive alternative treatment for transverse maxillary expansion, and designed to overcome the limitations of conventional rapid maxillary expansion for patients from post-pubertal growth spurt period onwards, often presenting with an interdigitated suture. The aim of this systematic review is to evaluate the efficacy of this treatment on skeletal, dento-alveolar and periodontal levels based on CBCT studies, by comparing it to the conventional rapid maxillary expansion (RPE).

Methods: a literature search of five databases (PubMed, Scopus, Web of Science, ScienceDirect and the Cochrane library) was conducted from 2010 until July …

Minimally Invasive Decompression And Long-Term Follow-Up Of An Orthokeratinized Odontogenic Cyst Of The Mandible: A 7-Year Case Report, Akram Belmehdi, Karima El Harti

International Arab Journal of Dentistry

Introduction: Orthokeratinized odontogenic cyst (OOC) is a rare developmental jaw lesion with indolent behavior and low recurrence potential.

Case presentation: A 33-year-old healthy male was referred after incidental discovery of a mandibular radiolucency. Cone-beam CT revealed a well-defined unilocular lesion in close relation to the inferior alveolar canal. Aspiration confirmed its cystic nature, and a conservative decompression was performed using a rubber drain to reduce lesion size and preserve adjacent structures. Histopathologic examination identified orthokeratinized epithelium consistent with OOC. After seven months of decompression, the lesion showed marked ossification, allowing safe enucleation and peripheral curettage. Radiographic follow-ups at 19 months …

Employing Artificial Intelligence For Non-Invasive Diagnosis Of Craniofacial Deformities: A Systematic Review Of Non-Ionizing Radiation Methods, Nurul Mutmainnah, Harun Achmad, Lusy Damayanti

International Arab Journal of Dentistry

Introduction: Craniofacial deformities, like craniosynostosis and plagiocephaly, require early diagnosis, but traditional methods like CT scans use harmful ionizing radiation. Artificial Intelligence (AI) offers a non-invasive, radiation-free alternative, using 2D and 3D imaging for accurate diagnosis, improving safety and accessibility, especially in remote areas.

Objective: This review evaluates the use of AI in diagnosing craniofacial deformities without ionizing radiation, focusing on its strengths, limitations, and challenges in clinical implementation.

Methods: The literature was searched across five databases—PubMed, Google Scholar, ScienceDirect, Wiley, and Cochrane—over the last decade, following PRISMA guidelines. Inclusion criteria were AI-based, non-invasive imaging techniques for craniofacial deformities. The …

Influence Of Veneer Thickness On Double Bond Conversion Of Preheated Composite And Self-Adhesive Resin Cement Under Lithium Disilicate Restorations: An In-Vitro Study., Vanessa Kanaan, Marie Abboud, Alexandre Monnier, Dani Irani, Vana Mardirossian, Cynthia Kassis

International Arab Journal of Dentistry

Introduction: This study evaluated the influence of lithium disilicate restoration thickness on the degree of conversion (DC) of a self-adhesive dual-cured resin cement (Bifix SE®; VOCO GmbH, Cuxhaven, Germany) and a preheated composite resin (VisCalor Bulk®; VOCO GmbH, Cuxhaven, Germany).

Methods: Sixty IPS e.max CAD (LTB1) specimens (2 mm, 4 mm, 6 mm; n D 10 per group) were fabricated and divided into six groups. Groups 1–3 were luted with Bifix SE, and Groups 4–6 with preheated VisCalor Bulk. Specimens were conditioned with 5% hydro_uoric acid and silane, then cemented and light cured. Raman spectroscopy was used to determine DC. …

Progesterone And Cerclage Together For Short Cervix: Evaluating Potential Complementary Effects For Improved Preterm Birth Prevention, Vincenzo Berghella, Ilaria Paladino, Moti Gulersen, Lauren Sayres, Amanda Roman, Rupsa C. Boelig

Department of Obstetrics and Gynecology Faculty Papers

Management of patients with a short cervical length (CL) on transvaginal ultrasound (TVU) often involves therapy with vaginal progesterone and/or cervical cerclage. Although these interventions are frequently viewed as alternative strategies, they may also represent complementary approaches targeting different mechanisms involved in spontaneous preterm birth. As in other areas of medicine, therapies with different mechanisms are often used together rather than as mutually exclusive options. In line with current level 1 evidence from randomized controlled trials (RCTs) and meta-analyses of RCTs on either vaginal progesterone or cerclage, in singleton gestations with no prior spontaneous preterm birth (SPTB), vaginal progesterone is …

Predictive Analysis For Success And Complications In Dental Implant Therapy Using Artificial Intelligence Models, Vishnu Priya Veeraraghavan, Aysha Jebin A, Isha Dusane, Govind Baheti, Ankita Agarwal, Santosh R Patil

International Arab Journal of Dentistry

Introduction: Dental implant therapy is a predictable treatment for tooth replacement, but its success is influenced by multiple patient, surgical, and systemic factors. Traditional statistical models, such as logistic regression, are limited in capturing nonlinear relationships among these variables. Artificial intelligence (AI) can integrate diverse predictors to enhance clinical risk assessment and improve treatment outcomes.

Objective: To identify key predictors of dental implant success and develop AI-based models capable of accurately forecasting implant outcomes using clinical and surgical parameters.

Methods: This retrospective cohort study analyzed data from 172 patients (219 implants) placed between 2020 and 2021. Patient demographics, systemic health …

Specific Carbohydrate Diet Versus Mediterranean Diet In Adult Patients With Mild To Moderate Ulcerative Colitis: A Randomized Controlled-Feeding Trial, Albert Sheng-Yin Chen, Long Nguyen, Brianna Gray, Katherine Williams, Jenny Gurung, Lauren Canha, Jessica Mcgoldrick, Jane Hubbard, Hamed Khalili

Student Papers, Posters & Projects

Background and aims: This pilot randomized controlled-feeding trial compared the effect of Specific Carbohydrate Diet (SCD) and Mediterranean diet (MeD) in mild to moderate ulcerative colitis (UC).

Methods: Seventeen adults were randomized to a 6-week SCD (n = 8) or MeD (n = 9) intervention. Primary outcome was change in partial Mayo Clinic score (pMCS).

Results: The study was discontinued early due to significant dropout (n = 9, 52.9%). There was no significant between-group differences observed for pMCS change (SCD, -0.8; MeD, -1.3; p = 0.499) or secondary outcomes. Exploratory metagenomic analysis revealed enrichment of Parasutterella excrementihominis …

Staff Education To Instruct Nurses On How To Use The Braden Scale To Increase Their Knowledge, Anna Shedrick

Walden Dissertations and Doctoral Studies

No abstract provided.

Enhancing Nursing Competency In The Ambulatory Surgery Center, Rachael Owokole

Walden Dissertations and Doctoral Studies

In this project, I addressed a persistent practice problem among agency nurses working in an ambulatory surgery center (ASC) in Southern California, who often enter the facility with varying familiarity with its policies and procedures. I designed this staff education, evidence-based practice (EBP), quality-improvement initiative to strengthen nursing knowledge and competency among agency nurses at the facility. The practice question was designed to assess on whether their knowledge and self-perceived competency improved after participating in the education program. I obtained evidence for the project from peer‑reviewed research, clinical guidelines, and national competency frameworks. I identified sources through systematic searches of …

Comparative Evaluation Of A-Prf+ Or Collagen Membrane On Hard And Soft Tissue Changes Following Immediate Implant Placement: A Randomized Clinical Trial, Raagul S, Rahul Chopra, Sumit Malhotra, Prashansa Sharma, Ankur Tyagi, Nancy Singh

International Arab Journal of Dentistry

Objectives: To evaluate and compare clinical and radiographic parameters viz. Gingival Index (GI), Plaque Index (PI), Width of Keratinized Tissue (WKT), Midbuccal & Midlingual/Midpalatal soft tissue thickness (STT), ISQ values and crestal bone levels (CBL) using CBCT at baseline and 6 months in Group I (Immediate implant placement & A-PRF+) and Group II (Immediate implant placement & Collagen Membrane).

Methods: A total of 20 sites indicated for extraction were selected and randomly divided into: GROUP I : 10 sites were treated with immediate implant placement and covered with an A-PRF+ membrane and GROUP II : 10 sites were treated with …

Gentle Beginnings: Innovative Use Of Melatonin And Triclofos Sodium For Uncooperative Children-An Invivo Study, Rohan Shrivastava, Sonal Gupta, Charu Aggarwal, Akil Prawin S.S

International Arab Journal of Dentistry

Objectives: To compare the pre- and post-use of oral melatonin and oral triclofos as oral sedative drugs on anxiety, sedation, and cognitive and psychomotor function to perform satisfactory dental treatment on uncooperative children.

Methods: A total number of 100 patients aged between 4 and 9 years who were scheduled for dental treatment were randomly divided into two groups, Group I and Group II, and administered melatonin and triclofos sodium, respectively, to determine changes in anxiety, cognitive, psychomotor, and sedation scores pre- and post-treatment. Data were analyzed using an unpaired/paired t-test, and P < 0.05 was contemplated as statistically significant.

Results: Post-treatment assessments revealed a significant reduction in …

The Effectiveness Of Anterior Torque Control By Clear Aligners In Extraction And Non-Extraction Cases : Systematic Review, Houda Ousli, Kawtar Chadli, Fatima Zaoui, Hicham Benyahia

International Arab Journal of Dentistry

Introduction: Clear aligner treatment has gained popularity in recent years. Accurate torque expression of the upper incisors is crucial for orthodontic treatment outcomes but remains challenging in invisible orthodontic treatment.

Objectives: This systematic review aims to evaluate the existing literature and critically assess the clinical effectiveness of aligners in controlling anterior torque or bucco-lingual root inclination, in both extraction and non-extraction cases.

Methods: A systematic search of Scopus, PubMed, Web of Science, Ebsco, and the Cochrane Library was conducted for peer-reviewed articles published between 2014 and March 2025. A total of 257 records were identified (Scopus: 32; Web of Science: …

Exploring Lifestyle Transitions And Perceptions Of Weight And Health Among College Students In Huntsville, Texas, Keyonna Nicole Thomas

Walden Dissertations and Doctoral Studies

College students aged 18–25 transitioning to independent living often experience changes in diet, physical activity, stress, and time management that increase health risks. These challenges may be amplified in semi-urban communities by limited access to healthy food, transportation barriers, and scheduling constraints. This qualitative phenomenological study explored how college students in Huntsville, Texas, perceived and interpreted these lifestyle changes and their influence on perceptions of health and weight. Guided by the social ecological model, the study included 12 participants who were 18–25 years old, enrolled in college, living independently in Huntsville, Texas, and able to describe their experiences with lifestyle …

Signal And Substance: Why Methodological Sophistication Fails To Guarantee Inference, Aamir Rashid, Rizwana Rasheed

Publications and Research

Despite increasing analytical sophistication, empirical research in organization studies continues to suffer from fragile inference, uneven theoretical accumulation, and contested credibility. This paper seeks to explain why these problems persist by shifting attention from authors’ methodological choices to the evaluative dynamics of peer review. Adopting a conceptual and theory-analytic approach, the paper theorizes peer review as an inferential gatekeeping system. Drawing on research design, theory evaluation, and philosophy-of-science literatures, this study develops an analytical framework to examine how evaluative routines shape what constitutes empirical rigor during the review process. The analysis identifies five recurring reviewer blind spots: inferential scope inflation, …

Influence Of Dietary Protein On Levodopa Effectiveness, Meghan Decker Rn

Nurse Residency

In adult patients with Parkinson's disease how does carbidopa-levodopa administration with protein vs without protein impact levodopa absorption and patient signs and symptoms?

Improving Patient And Staff Safety During Intrahospital Transport: Implementation Of A Nurse-Driven Checklist, Leah D. Kvintus Rn, Bsn

Nurse Residency

In hospitalized adult patients requiring intrahospital transport, how does the implementation of a standardized nurse-driven transport checklist and structured, facility-wide transport safety protocols compared to current practice without standardization affect patient and staff safety outcomes, including patient falls, safety incidents, and staff injuries or workflow disruption?

Why 4:1 Matters: Addressing Nurse Burnout, Alexandria Ranalletti Bsn Rn, Cecelia Greenleaf Bsn, Rn, Savannah Sheen Bsn, Rn

Nurse Residency

For nurses on medical-surgical floors, how does implementing a 4:1 nurse-to-patient staffing ratio compared to 5:1 or 6:1 staffing ratios impact nurse burnout?

Feasibility And Acceptability Of Automated Texts To Offer, Screen, And Enroll Patients In A Cancer Clinical Trial Financial Reimbursement Program: Mixed Methods Study, Ashley E Santaniello, Hena Patel, Sarah Milinski, Mohan Balachandran, Vivian Nguyen, E. Paul Wileyto, Robert H. Vonderheide, Dana Dornsife, Robert G. Johnson, Carmen E. Guerra

Student Papers, Posters & Projects

BACKGROUND: Out-of-pocket (OOP) costs pose a significant barrier to participating in cancer clinical trials (CCTs). Financial reimbursement programs (FRPs) that reduce the burden of OOP costs can support participation in CCTs if the information is readily available to participants at the time of enrollment. Prior studies have shown the importance and impact of FRPs, but despite improvements, significant barriers still remain.

OBJECTIVE: This study was designed to explore the feasibility and acceptability of automated texts designed to offer, screen, and enroll CCT participants in an FRP for OOP travel and lodging-related clinical trial costs.

METHODS: This study used a mixed …

Spontaneous Intracranial Hypotension With Negative Brain Mri Findings: A Systematic Review Of Diagnostic Strategies And Clinical Outcomes, Marina Romozzi, Giuseppe Garignano, Valid Rastegar, Francesco Onorati, Catello Vollono, Federico Tosto, Masahito Katsuki, Yasuhiko Matsumori, Francesco Signorelli

Student Papers, Posters & Projects

BACKGROUND: Spontaneous intracranial hypotension (SIH) is a debilitating syndrome typically characterized by orthostatic headache and classic brain MRI findings. However, brain MRI abnormalities are indirect manifestations of cerebrospinal fluid (CSF) volume depletion rather than direct evidence of the leak, and some patients may present with unrevealing or absent typical brain MRI findings, posing a considerable diagnostic challenge.

METHODS: A comprehensive search of PubMed/Medline, Web of Science, and Scopus was conducted to perform a systematic review, according to PRISMA guidelines, analyzing the available evidence on MRI-negative SIH (patients without typical SIH findings on their initial brain MRI), including its clinical features, …

Transjugular Intrahepatic Portosystemic Shunt (Tips) Outcomes For Variceal Hemorrhage During And After Covid-19: Racial, Payer, And Income Disparities - A National Retrospective Cohort Study With Stratified Sensitivity Analyses, Nakul Ganju, Shubham Gupta, Sahak Hovsepian, Samay Shah, Shaunak Ganju, Farshad Aduli

Student Papers, Posters & Projects

BACKGROUND AND AIMS: Transjugular intrahepatic portosystemic shunt (TIPS) reduces mortality in esophageal variceal hemorrhage. Whether the COVID-19 pandemic worsened existing disparities in outcomes among patients undergoing TIPS remains unclear. We aimed to characterize racial, payer-based, and income-based disparities in post-TIPS outcomes before and after the COVID-19 pandemic.

METHODS: Using the 2016-2022 National Inpatient Sample, we conducted a retrospective cohort analysis of 31,860 weighted hospitalizations of adults with cirrhosis and esophageal variceal hemorrhage who underwent TIPS. Admissions were stratified as pre-COVID (2016-2019) and post-COVID (2020-2022). Primary outcomes were in-hospital mortality, length of stay, and total hospital charges. Multivariable regression models with …

Iron-Containing Cookware For The Reduction Of Iron Deficiency Anemia Among Children And Females Of Reproductive Age In Low- And Middle-Income Countries: A Systematic Review, Julia Dorf, Alana Schreibman, Sherry Morgan, Alexa Dietrich, Divine Oludi, Elizabeth Lowenthal, H. Okatch

College of Population Health Faculty Papers

Background: Worldwide, anemia impacts 40% of children aged 6 to 59 months and 30% of reproductive-aged women; about half of these cases are due to iron deficiency (IDA). Iron ingots are inexpensive, lightweight, and easy-to-use IDA treatments. This systematic review assessed the effect of iron ingots on IDA and described variability in iron ingot use. Methods: We included studies that evaluated the effectiveness of iron ingots for dietary iron supplementation and described ingot use conditions. Our search yielded 106 articles, 10 of which met inclusion criteria. Multiple authors independently performed data extraction and quality assessment. Results: Four articles were laboratory-based, …

Healthcare Provider's Perceptions Of Family Values When Making End-Of-Life Care Decisions For Their Children: Developing And Implementing A Survey Tool., Nithya Sivakumar, Stephanie Kukora, Cherie Ginwalla, Satyan Lakshminrusimha, Jennifer Rosenthal

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Healthcare providers help families navigate end-of-life care decisions in the neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU); however, limited studies exist regarding what values providers perceive families utilize when in these situations.

OBJECTIVE: To evaluate providers' perceptions of values that families considered when making end-of-life care decisions for their child.

DESIGN: Develop a novel survey tool to understand providers' perceptions of values families considered when making end-of-life care decisions for their children and distribute the survey tool to providers in a single quaternary care children's hospital within a university hospital.

METHODS: The novel survey tool …

Decoding The Allosteric Grammar Of Protein Kinases: A Dual-Stream Framework Integrating Protein Language Models And Energy Landscape Frustration Analysis, Will Gatlin, Max Ludwick, Lucas Turano, Brandon Foley, Kamila Riedlova, Vít Škrhák, Marian Novotný, David Hoksza, Gennady M. Verkhivker

Mathematics, Physics, and Computer Science Faculty Articles and Research

The spatial and energetic encoding of allosteric regulatory sites remains a major challenge in structural biology, frequently representing a “blind spot” for sequence-based artificial intelligence (AI) models. We present a protein language model (PLM)-guided approach complemented by the energy landscape frustration analysis as a dual-stream framework to investigate the relationship between AI prediction of binding sites and biophysical organization of regulatory pockets across the human kinome. By probing a fine-tuned residue-level PLM classifier across 453 kinase structures, a clear performance gap is discovered between highly predictable orthosteric pockets (Types I, I.5, and II) and poorly resolved distal allosteric sites (Type …

Preoperative Considerations For Cervical Cerclage (Part 1), Ilaria Paladino, Moti Gulersen, Amanda Roman, Rupsa C. Boelig, Vincenzo Berghella

Department of Obstetrics and Gynecology Faculty Papers

Transvaginal cervical cerclage remains a central strategy for preventing spontaneous preterm birth in appropriately selected pregnancies. Although decades of research have clarified which patients benefit most from cerclage, substantial heterogeneity persists in pre-, intra-, and postoperative management. This article, the first in a series on cerclage technique, synthesizes the evidence guiding preoperative decision-making. Cerclage is classified by indication as history-indicated cerclage, ultrasound-indicated cerclage and physical examination-indicated cerclage. History-indicated cerclage is recommended for patients with ≥3 prior early spontaneous preterm births or second-trimester losses < 28 weeks, prior ultrasound-indicated cerclage with delivery at< 32 weeks, or prior physical examination-indicated cerclage; twin gestation alone is not considered an indication. Ultrasound-indicated cerclage should be considered in singletons without prior spontaneous preterm birth with transvaginal ultrasound cervical length ≤20 mm and is recommended in singletons with prior spontaneous preterm birth when cervical length is ≤25 mm before 24 weeks' gestation; in twins, it may be considered when cervical length ≤15 mm before 24 weeks' gestation. Physical examination-indicated cerclage is recommended in singleton or twin gestations with asymptomatic cervical dilation ≥1 cm before 24 weeks' gestation. Timing varies by indication: history-indicated cerclage is typically placed at 12 to 14 weeks' gestation and is not urgent, whereas ultrasound-indicated cerclage and physical examination-indicated cerclage are usually performed between 16 and 23 6/7 weeks' gestation in response to cervical changes, ideally within 72 hours and 24 hours of diagnosis of short transvaginal ultrasound cervical length or dilated cervix, respectively. Preoperative evaluation should include a detailed anatomic ultrasound examination and appropriate genetic screening. Routine urogenital cultures are not indicated in the absence of symptoms. Amniocentesis is not recommended for history-indicated cerclage or ultrasound-indicated cerclage but should be considered before physical examination-indicated cerclage to evaluate for intra-amniotic infection. Adjunctive management remains variable. Progesterone is recommended for a short cervical lenght < =25mm before 24 weeks. Outpatient cerclage appears safe, with no clear benefit to routine inpatient management. Perioperative indomethacin and antibiotics are likely unnecessary for history-indicated cerclage but may be considered in ultrasound-indicated cerclage and are suggested for physical examination-indicated cerclage.