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Schmidt J, Proesl S, Schulz-Kornas E, Haak R, Meyer-Lueckel H, Campus G, Esteves-Oliveira M. Systematic review and network meta-analysis of restorative therapy and adhesive strategies in root caries lesions. J Dent 2024; 142:104776. [PMID: 37977410 DOI: 10.1016/j.jdent.2023.104776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 09/29/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
AIM This systematic review and network meta-analysis (NMA) aimed to establish a clinically relevant hierarchy of the different adhesive and/or restorative approaches to restore cavitated root caries lesions through the synthesis of available evidence. MATERIALS AND METHODS A systematic search was conducted in Medline/Web of Science/Embase/ Cochrane Library/Scopus/grey literature. RCTs investigating ≥2 restorative strategies (restorative /adhesive materials) for root caries lesions in adult patients were included. Risk of bias within studies was assessed (Cochrane_RoB-2) and the primary outcome was survival rate of restorations at different follow-up times (6-/12-/24-months). Network meta-analyses were conducted using a random effects model stratified by follow-up times. I2-statistics assessed the ratio of true to total variance in the observed effects. All available combinations of adhesives (1-SE: one-step self-etch; 2-3ER: two-/three-step etch-and-rinse) and restorative materials (conventional composite (CC) as well as conventional and resin-modified glass ionomer cements (GIC, RMGIC)) were included. Risk of bias across studies and confidence in NMA (CINeMA) were assessed. RESULTS 547 studies were identified and nine were eligible for the NMA. In total, 1263 root caries lesions have been restored in 473 patients in the included clinical trials. Patients involved were either healthy (n = 6 trials), living in nursing homes (n = 1 trial) or received head-and-neck radiotherapy (n = 2 trials). There was statistically weak evidence to favour either of material/material combination regarding the survival rate. A tendency for higher survival rate (24-months) was observed for 2-3ER/CC (OR24mths 2.65; 95%CI=1.45/4.84) as well as RMGIC (OR24mths 2.05; 95%CI=1.17/3.61) compared to GIC. These findings were though not statistically significant and confidence of the NMA was low. CONCLUSION An evidence-based choice of restorative strategy for managing cavitated root caries lesions is currently impossible. There is a clear need for more standardised, well-designed RCTs evaluating the retention rate of root caries restoration approaches.
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Affiliation(s)
- J Schmidt
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - S Proesl
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - E Schulz-Kornas
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - R Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Leipzig, Germany
| | - H Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - G Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - M Esteves-Oliveira
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland; Department of Restorative Dentistry and Endodontology, Justus-Liebig-University Giessen, Giessen, Germany.
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Dhar V, Pilcher L, Fontana M, González-Cabezas C, Keels MA, Mascarenhas AK, Nascimento M, Platt JA, Sabino GJ, Slayton R, Tinanoff N, Young DA, Zero DT, Pahlke S, Urquhart O, O'Brien KK, Carrasco-Labra A. Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association. J Am Dent Assoc 2023; 154:551-566.e51. [PMID: 37380250 DOI: 10.1016/j.adaj.2023.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/07/2023] [Accepted: 04/01/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute's program for Clinical and Translational Research conducted a systematic review and developed recommendations for the treatment of moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated primary and permanent teeth. TYPES OF STUDIES REVIEWED The authors searched for systematic reviews comparing carious tissue removal (CTR) approaches in Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Trip Medical Database. The authors also conducted a systematic search for randomized controlled trials comparing direct restorative materials in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of the evidence and formulate recommendations. RESULTS The panel formulated 16 recommendations and good practice statements: 4 on CTR approaches specific to lesion depth and 12 on direct restorative materials specific to tooth location and surfaces involved. The panel conditionally recommended for the use of conservative CTR approaches, especially for advanced lesions. Although the panel conditionally recommended for the use of all direct restorative materials, they prioritized some materials over the use of others for certain clinical scenarios. PRACTICAL IMPLICATIONS The evidence suggests that more conservative CTR approaches may decrease the risk of adverse effects. All included direct restorative materials may be effective in treating moderate and advanced caries lesions on vital, nonendodontically treated primary and permanent teeth.
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Bayazıt EÖ, Başeren M, Meral E. Clinical comparison of different glass ionomer-based restoratives and a bulk-fill resin composite in Class I cavities: A 48-month randomized split-mouth controlled trial. J Dent 2023; 131:104473. [PMID: 36863696 DOI: 10.1016/j.jdent.2023.104473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/01/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023] Open
Abstract
OBJECTIVE The aim of this study is to compare the retention rates (primary outcome) of high-viscosity glass ionomer (GI), glass carbomer (GC), zirconia-reinforced GI (ZIR), and bulk-fill (BF) composite resin restorations. Secondary outcomes included anatomical form, marginal adaptation, marginal discoloration, color match, surface texture, post-operative sensitivity and secondary caries. METHODS Two calibrated operators placed 128 restorations in 30 patients with a mean age of 21 years. The restorations were evaluated by one examiner at baseline and at 6, 12, 18, 24, and 48 months using the modified US Public Health Service criteria. The data were statistically analyzed using Friedman test. Differences between restorations were analyzed using Kruskal-Wallis test. RESULTS After 48 months, 23 patients and 97 restorations (23 GI, 25 GC, 24 ZIR, and 25 BF) were evaluated. Patient recall rate was 77%. No significant difference was observed between the retention rates of the restorations (p > 0.05). GC showed significantly lower results than the other three fillings in terms of anatomical form (p < 0.05). There was no significant difference in the anatomical form and retention between GI, ZIR, and BF (p > 0.05). No significant change was observed in the postoperative sensitivity or secondary caries for any of the restorations (p > 0.05). CONCLUSIONS GC restorations showed statistically lower anatomical form values, indicating lower wear resistance than the other materials. However, no significant difference was observed in the retention rates (as primary outcome) as well as the other secondary outcomes of the four different restorative materials after 48 months. CLINICAL SIGNIFICANCE GI-based restorative materials and BF composite resin restorations in Class I cavities yielded satisfactory clinical performance after 48 months.
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Affiliation(s)
- Elif Öztürk Bayazıt
- Faculty of Dentistry, Department of Restorative Dentistry, Hacettepe University, Sıhhiye 06100, Ankara, Turkey.
| | - Meserret Başeren
- Faculty of Dentistry, Department of Restorative Dentistry, Hacettepe University, Sıhhiye 06100, Ankara, Turkey
| | - Ece Meral
- Faculty of Dentistry, Department of Restorative Dentistry, Hacettepe University, Sıhhiye 06100, Ankara, Turkey
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Pilcher L, Pahlke S, Urquhart O, O'Brien KK, Dhar V, Fontana M, González-Cabezas C, Keels MA, Mascarenhas AK, Nascimento MM, Platt JA, Sabino GJ, Slayton RL, Tinanoff N, Young DA, Zero DT, Tampi MP, Purnell D, Salazar J, Megremis S, Bienek D, Carrasco-Labra A. Direct materials for restoring caries lesions: Systematic review and meta-analysis-a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2023; 154:e1-e98. [PMID: 36610925 DOI: 10.1016/j.adaj.2022.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/26/2022] [Accepted: 09/28/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The goal of restoring caries lesions is to protect the pulp, prevent progression of the disease process, and restore the form and function of the tooth. The purpose of this systematic review was to determine the effect of different direct restorative materials for treating cavitated caries lesions on anterior and posterior primary and permanent teeth. TYPE OF STUDIES REVIEWED The authors included parallel and split-mouth randomized controlled trials comparing the effectiveness of direct restorative materials commercially available in the United States placed in vital, nonendodontically treated primary and permanent teeth. Pairs of reviewers independently conducted study selection, data extraction, and assessments of risk of bias and certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors conducted pair-wise meta-analyses to summarize the evidence and calculated measures of association and their 95% CIs. RESULTS Thirty-eight randomized controlled trials were eligible for analysis, which included data on Class I and Class II restorations on primary teeth and Class I, Class II, Class III, Class V, and root surface restorations on permanent teeth. Included studies assessed the effect of amalgam, resin composite, compomer, conventional glass ionomer cement, resin-modified glass isomer cement, and preformed metal crowns. Moderate to very low certainty evidence suggested varying levels of effectiveness across restorative materials. CONCLUSIONS AND PRACTICAL IMPLICATIONS Owing to a relatively low event rate across various outcomes indicating restoration failure, there was limited evidence to support important differences between direct restorative materials used in practice.
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Amend S, Boutsiouki C, Bekes K, Kloukos D, Lygidakis NN, Frankenberger R, Krämer N. Clinical effectiveness of restorative materials for the restoration of carious primary teeth without pulp therapy: a systematic review. Eur Arch Paediatr Dent 2022; 23:727-759. [PMID: 35819627 PMCID: PMC9637592 DOI: 10.1007/s40368-022-00725-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/22/2022] [Indexed: 01/04/2023]
Abstract
Purpose To systematically search the available evidence and evaluate the clinical effectiveness of restorative materials for restoration of carious primary teeth. The findings aimed to support the European Academy of Paediatric Dentistry (EAPD) guidelines development. Methods Literature search was performed by searching 4 electronic databases for eligible randomised controlled clinical trials (RCTs) comparing restorative materials for the restoration of carious primary teeth up to December 28th, 2020. Quality assessment was performed with the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results Of 1685 identified articles 29 RCTs were finally deemed as eligible for inclusion. Annual failure rates were: Amalgam 1–28%; atraumatic restorative treatment 1.2–37.1%; glass-ionomer cement (GIC) 7.6–16.6%, metal-reinforced GIC 29.9%, resin-modified GIC 1.9–16.9%, high-viscosity GIC 2.9–25.6%; glass carbomer ≤ 46.2%; compomer 0–14.7%; composite resin (CR) 0–19.5%, bulk-fill CR 0–16.9%; zirconia crowns 3.3%, composite strip crowns 15%, and preformed metal crowns (Hall-Technique) 3.1%. Secondary caries, poor marginal adaptation, loss of retention, and fracture of restoration were reported as reasons for failure. Four studies were evaluated at unclear and 25 at high risk of bias. Clinical and methodological heterogeneity, and the diversity of tested materials across included studies did not allow for meta-analyses. Conclusions Within the limitations of this systematic review, namely, the heterogeneity and the overall high risk of bias among included studies, clear recommendations based on solid evidence for the best restorative approach in primary teeth cannot be drawn. There is a need for future thoroughly implemented RCTs evaluating restorations in primary teeth to close this knowledge gap. Supplementary Information The online version contains supplementary material available at 10.1007/s40368-022-00725-7.
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Affiliation(s)
- S Amend
- Department of Paediatric Dentistry, Medical Centre for Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen), Schlangenzahl 14, 35392, Giessen, Germany.
| | - C Boutsiouki
- Department of Paediatric Dentistry, Medical Centre for Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen), Schlangenzahl 14, 35392, Giessen, Germany
| | - K Bekes
- Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - N N Lygidakis
- Lygidakis Dental Clinic (Private Dental Practice), 2 Papadiamantopoulou str. & Vasilissis Sofias Ave, 11528, Athens, Greece
| | - R Frankenberger
- Department of Operative Dentistry, Endodontology, and Paediatric Dentistry, Medical Centre for Dentistry, Phillips-University Marburg, University Medical Centre Giessen and Marburg (Campus Marburg), Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - N Krämer
- Department of Paediatric Dentistry, Medical Centre for Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen), Schlangenzahl 14, 35392, Giessen, Germany
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da Cunha CMBDL, Wambier LM, Matos TDP, Malaquias P, Reis A, Loguercio AD, Wambier DS, Chibinski ACR. New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial. Int J Clin Pediatr Dent 2022; 15:38-46. [PMID: 35528486 PMCID: PMC9016904 DOI: 10.5005/jp-journals-10005-2173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The clinical performance of new restorative materials must be evaluated before recommending its use in primary teeth. Aim This randomized clinical trial evaluated the survival rates of restorations in single and occluso-proximal cavities of primary teeth performed with a new dual-cure resin-based material in comparison with a resin-modified glass ionomer cement after 12 months of follow-up. Materials and methods A total of 107 restorations were placed in 27 children by one experienced pediatric dentist. Two materials were tested: Vitremer and a dual-cure resin-based material with (CentionN+Adh) and without (Cention N-Adh) adhesive system application. Two calibrated and blinded examiners evaluated the restorations at 3, 6, and 12-month. The longevity of the restorations was analyzed using Kaplan-Meier survival curves and Log-rank test (α = 5%). Results The overall survival rates after 12-month were 81.9% for Vitremer, 70.4% for Cention N+Adh, and 66.7% for Cention N-Adh, which had the poorer performance (HR = 0.54; 95% CI= 0.31-0.95; p = 0.031). When considering the type of the cavities, the difference was significant only for occluso-proximal cavities when Cention N-Adh was used (HR = 0.46; CI = 0.26-0.81; p = 0.008). Conclusion All evaluated materials are suitable for restoring occlusal cavities after selective caries removal. However, Cention N needs to be used with adhesive in occluso-proximal cavities. Clinical significance Cention-N can be used for deciduous teeth restorations, with similar longevity rates as resin modified glass ionomer cements. Trial registration number RBR-9nqszr How to cite this article da Cunha CM, Wambier LM, Paris Matos TD, et al. New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial. Int J Clin Pediatr Dent 2022;15(1):38-46.
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Affiliation(s)
| | - Letícia Maíra Wambier
- Department of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | | | - Pamela Malaquias
- Department of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Alessandra Reis
- Department of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | | | | | - Ana Cláudia Rodrigues Chibinski
- Department of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
- Ana Cláudia Rodrigues Chibinski, Department of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil, Phone: +55 42 999171983, e-mail:
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Wambier LM, Gonçalves ADR, Wambier DS, Reis A, Chibinski ACR. Adherence to the CONSORT statement of randomized clinical trials on ART restorations in children: current status and reporting characteristics. Braz Oral Res 2022; 36:e017. [DOI: 10.1590/1807-3107bor-2022.vol36.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/03/2021] [Indexed: 11/22/2022] Open
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Garbim JR, Laux CM, Tedesco TK, Braga MM, Raggio DP. Atraumatic restorative treatment restorations performed in different settings: systematic review and meta-analysis. Aust Dent J 2021; 66:430-443. [PMID: 34407233 DOI: 10.1111/adj.12871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/04/2021] [Accepted: 08/15/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND There are potential barriers to using the atraumatic restorative treatment (ART) approach in conventional dental offices, as many professionals assume that it is only used for field conditions. This systematic review and meta-analysis evaluated the survival data of ART restorations in permanent and primary teeth when performed in and out of the conventional environment. METHODS Searches were performed on PubMed/MEDLINE, Scopus, Web of Science, and Open Grey databases up to April 2020. Studies that evaluated ART restorations were prospective and had survival rate data were included. The risk of bias was evaluated by Rob 2.0 and ROBINS-I tools. Meta-analyses were carried out considering as outcome the survival rate of primary and permanent teeth. Subgroups analysis was performed for setting and type of cavity (occlusal or multi-surface). RESULTS Thirty-four studies were included. For primary teeth, in general, the overall percentage of survival rate was not influenced by setting, ranging up to 71% in 12 months to 65% in 36 months. Similarly, for permanent teeth, the overall percentage of survival rate was not influenced by setting, ranging up to 96% in 12 months to 61% in 36 months. CONCLUSION ART is a feasible approach for field settings as well as conventional dental offices. PROSPERO CRD42020184680.
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Affiliation(s)
- Jonathan Rafael Garbim
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Caroline Mariano Laux
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | - Daniela Prócida Raggio
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Jiang M, Fan Y, Li KY, Lo ECM, Chu CH, Wong MCM. Factors affecting success rate of atraumatic restorative treatment (ART) restorations in children: A systematic review and meta-analysis. J Dent 2020; 104:103526. [PMID: 33188846 DOI: 10.1016/j.jdent.2020.103526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Aim of this systematic review was to summarize the factors that affect the success rate of atraumatic restorative treatment (ART) restorations in children. DATA/SOURCES Two independent reviewers conducted a literature search in the databases PubMed, Medline and Web of Science until October 2019 with no initial time limit. Articles reporting on clinical outcomes of ART restorations placed in children were included. STUDY SELECTION A total of 67 articles were included in this review reporting on clinical outcomes of ART restorations placed in children in 47 studies. The overall estimated success rate and 95 % confidence interval (CI) of ART restorations were 0.71 (0.65-0.77) and 0.67 (0.56-0.78) at the 12-month and the 24-month follow-up, respectively. Operator was one of the significant factors associated with the success rate of ART restorations. ART restorations placed by dental students/therapists had a significantly lower success rate compared with those placed by dentists. Besides, type of restoration (single-surface vs. multiple-surface restoration) was also associated with the success rate of ART restorations. Other factors including dentition, restorative material, clinical setting, and moisture control method had no significant influence on the success rate of ART restorations in children. CONCLUSION It is concluded that ART approach can be used to manage cavitated caries lesions in children. Operator and type of restoration are significant factors influencing the success rate of ART restorations. CLINICAL SIGNIFICANCE This study provides valuable information on the factors that affect success rate of ART restorations in children, which helps clinicians to make informed decisions on provision of ART restorations in children.
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Affiliation(s)
- Meng Jiang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Yanpin Fan
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Kar Yan Li
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | | | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - May Chun Mei Wong
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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Contemporary restorative ion-releasing materials: current status, interfacial properties and operative approaches. Br Dent J 2020; 229:450-458. [PMID: 33037365 DOI: 10.1038/s41415-020-2169-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/06/2020] [Indexed: 02/08/2023]
Abstract
Minimally invasive (MI) concepts in restorative dentistry in the year 2020 request from the practitioner not only a scientifically supported rationale for carious tissue removal/excavation and defect-oriented, biological cavity preparation, but also a deep understanding of how to ensure a biomechanically stable and durable restoration in different clinical situations by applying different restorative options. Bio-interactive materials play an increasingly relevant role, as they not only replace diseased or lost tissue, but also optimise tissue mineral recovery (among other properties) when used in restorative and preventive dentistry. Indeed, this is of certain interest in MI restorative dentistry, especially in those cases where gap formation jeopardises the integrity of the margins along resin composite restorations, causing penetration of bacteria and eventually promoting the formation of secondary caries. Recently, the interest in whether ion-releasing materials may reduce such biofilm penetration into margin gaps and reduce such a risk for development and propagation of secondary caries is growing significantly among clinicians and scientists. The aim of this article was to explore mechanisms involved in the process that allow mineral deposition at the interface between such materials and dentine, and to describe how conventional 'bioactive' restorative materials currently available on the market may benefit treatments in MI dentistry.
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