Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis

Coronavirus disease (COVID-19): Characteristics in children and considerations for dentists providing their care

The emergence of the novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease (COVID-19) has led to a global pandemic and one of the most significant challenges to the healthcare profession. Dental practices are focal points for cross-infection, and care must be taken to minimise the risk of infection to, from, or between dental care professionals and patients. The COVID-19 epidemiological and clinical characteristics are still being collated but children's symptoms seem to be milder than those that adults experience. It is unknown whether certain groups, for example children with comorbidities, might be at a higher risk of more severe illness. Emerging data on disease spread in children, affected by COVID-19, have not been presented in detail. The purpose of this article was to report current data on the paediatric population affected with COVID-19 and highlight considerations for dentists providing care for children during this pandemic. All members of the dental team have a professional responsibility to keep themselves informed of current guidance and be vigilant in updating themselves as recommendations are changing so quickly.

Success rate of proximal tooth-coloured direct restorations in primary teeth at 24 months: a meta-analysis

The aim was to determine the survival of tooth-coloured restorative materials in proximal restorations of primary teeth at 24 months of follow-up and the influence of the following variables: use of coating, use of cavity conditioner, use of rubber dam isolation, the cavity form, the dentist's experience and the methodological characteristics of the studies. We conducted a search until May 2019, obtaining 16 articles from which 30 independent studies were extracted, which were considered as units of analysis. Four outcome measures were extracted from each study: retention, marginal integrity, anatomic form, and absence of recurrent caries. Separate meta-analyses were carried for each outcome and multiple meta-regression model was applied. The outcomes with the highest mean success rates were absence of recurrent caries and anatomic form. The type of material significantly influenced success rates. The best materials were resin-based material plus total-etching adhesion and resin-modified glass ionomer cement (RMGIC), and the worst high viscosity glass ionomer cement (HVGIC). Atraumatic restorative treatment (ART) had a lower success rate than the conventional cavity form. RMGIC had the best clinical performance and HVGIC the worst. The form of the cavity, blinding and the experience of the operator were the variables that influenced success rates. Proximal primary molar restorations should be performed with RMGIC as it combines good mechanical performance of the resins together with the prevention of secondary caries of glass ionomers.

Recommended procedures for the management of early childhood caries lesions - a scoping review by the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE)

BACKGROUND

Early childhood caries (ECC) affects millions of children up to 6 years old. Its treatment positively impacts the quality of life of children and their families. However, there is no consensus on how to treat ECC. Thus, we performed a scoping review to identify the recommended procedures for the management of ECC lesions.

METHODS

A search was performed in PubMed, Scopus, The Cochrane Library, The International Guideline Library and pediatric dentistry associations around the world were contacted by email for unpublished search documents. ECC guidelines/guidance/policies were considered eligible regardless of language and publication date.

RESULTS

From a total of 828 references, 52 full-text articles were assessed for eligibility and 22 included in the scoping review. We found different procedures recommendations for the management of ECC lesions. For incipient lesions, minimally invasive methods such as professional fluoride and cariostatic (silver diamine) applications, as well as surveillance were recommended. If restoration was required, the recommended materials were glass ionomer cement, composite resin, amalgam and stainless-steel crown. Interim restorations and Atraumatic Restorative Treatment (ART) were also recommended. Extractions have been suggested for teeth with lesions with pulpal involvement, depending on the child's behaviour and other clinical conditions.

CONCLUSIONS

Non-operative procedures, restorative and extraction were recommended for the management of ECC, depending on the extent of the lesions. There is no difference between different management guidelines/guidance/policies for ECC lesions.

Molar incisor hypomineralization and pre-eruptive intracoronal lesions in dentistry-diagnosis and treatment planning

The aim of this study is to report the diagnostic features, prevalence, mineral content, clinical significance and treatment options of molar incisor hypomineralization (MIH) and pre-eruptive intracoronal lesions (PEIR), in order to minimize miss-treatment of primary and permanent teeth in young children. MIH was defined as the occurrence of hypomineralization of one up to four permanent first molars from a systemic origin and frequently associated with affected incisors. PEIR are lesions that are located in the occlusal portion of the crown of unerupted permanent or primary teeth. The prevalence of MIH was reported between 2.5%-40% in the permanent first molars and 0%-21.8% in primary second molars. PEIR was observed in 2%-8% of children, mainly in mandibular second premolars and second and third permanent molars. A number of possible causes for MIH were mentioned, including environmental changes, diet and genetics in prenatal and postnatal periods, but all are questionable. In PEIR, the resorption of the intracoronal dentine begins only after crown development is complete and is caused by giant cells resembling osteoclast observed histologically on the dentine surface close to the pulp. The mineral content in MIH is reduced in comparison to normal enamel and dependent on the severity of the lesion. In PEIR the resorbed surface of enamel showed less mineral content. The hypomineralized enamel in MIH is not suitable for restorations with amalgam or composite materials, and the best material should be based on remineralization material like glass-ionomers. Similar, the resorbed dentin surface in PEIR should be covered by the biocompatible and re-mineralizing glass-ionomer cement.

Survival of occlusal ART restorations using high-viscosity glass-ionomer with and without chlorhexidine: A 2-year split-mouth quadruple-blind randomized controlled clinical trial

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Comparing the survival of HVGICs (with and without CHX) using ART criteria.

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Comparing the survival of HVGICs (with and without CHX) using FDI criteria.

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Compare the effect of the two restorations on caries development.

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No significant difference in the survival percentages between the two types of HVGICs.

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The addition of CHX to the HVGIC is not recommended.

The study question was whether the use of high-viscosity glass-ionomer with chlorhexidine (HVGIC/CHX) for the Atraumatic Restorative Treatment (ART) prepared cavities could achieve a higher restoration survival percentage and be more effective for preventing dentine carious lesions adjacent to the restoration than the use of HVGIC without CHX. The study followed a split-mouth, quadruple-blind, randomized controlled clinical design and lasted 2 years. Patients with at least two small- to medium-sized occlusal cavities were included. The occlusal cavities were prepared according to the ART method and restored with HVGIC/CHX (test) and HVGIC (control). A replica of all restorations available and digital photographs were fabricated at baseline and after 0.5, 1, 1.5 and 2 years and evaluated by two examiners using the ART and Federation Dentaire International (FDI) restoration assessment criteria. Survival curves were constructed using the Kaplan-Meier method, and the log-rank test was used to test for significance between the survival percentages. A total of 100 subjects with an average age of 14.4 years participated. According to the ART restoration assessment criteria, the 2-year survival percentages of ART/HVGIC/CHX (96.8%) and ART/HVGIC (94.8%) did not differ significantly and no significant difference was found between the test (97.9%) and control (96.9%) groups according to the FDI restoration assessment criteria. Eight and five occlusal restorations failed according to the ART and FDI restoration criteria, respectively. No dentine carious lesions along the restoration margin were observed. The 2-year survival of ART restorations in both groups was high. The development of carious dentine lesions adjacent to the restoration was not observed in either treatment group. There is no evidence for modifying HVGIC by incorporating chlorhexidine in order to prevent dentine carious lesion development or to improve the survival of ART restorations in occlusal surfaces in permanent teeth. HVGIC without chlorhexidine can be used successfully to restore occlusal ‘ART-prepared’ cavities in permanent teeth.