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Molyneux LE, Banerjee A. Minimum intervention oral care: staging and grading dental carious lesions in clinical practice. Br Dent J 2024; 237:457-463. [PMID: 39333813 PMCID: PMC11436382 DOI: 10.1038/s41415-024-7843-4] [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: 04/03/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 09/30/2024]
Abstract
Developmental staging of carious lesions is pivotal for appropriate ethical clinical decision-making in contemporary caries management. Accurate assessment of lesion extent/severity (staging) and activity (grading) allows practitioners to provide the most appropriate preventive advice and suitable interventions, enabling the implementation of evidence-based, person-focused, prevention-based, team-delivered and susceptibility-related phased minimum intervention oral care. Minimally invasive dentistry remains an important operative interventive option for cavitated lesions, but intervening at the right stage ensures patients are not started on an irreversible, destructive restorative cycle unnecessarily. This article provides an update on recommended practical methods for staging the extent/severity and grading the activity of dental carious lesions, especially for those clinical teams delivering primary care and needing to navigate remuneration systems.
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Affiliation(s)
- Lorraine Emma Molyneux
- Senior Lecturer in Restorative Dentistry, University of Liverpool, School of Dentistry, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, Liverpool University Dental Hospital, Pembroke Place, Liverpool, L3 5PS, UK
| | - Avijit Banerjee
- Professor of Cariology and Operative Dentistry, Honorary Consultant/Clinical Lead, Restorative Dentistry, Research Centre of Oral Clinical Translational Sciences/Conservative and MI Dentistry, Faculty of Dentistry, Oral and Craniofacial Sciences, King´s College London, Guy´s Dental Hospital, Great Maze Pond, London, SE1 9RT, UK.
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Hatipoğlu Ö, Martins JFB, Karobari MI, Taha N, Aldhelai TA, Ayyad DM, Madfa AA, Martin-Biedma B, Fernandez R, Omarova BA, Yi LW, Alfirjani S, Lehmann A, Sugumaran S, Petridis X, Krmek SJ, Wahjuningrum DA, Iqbal A, Abidin IZ, Intriago MG, Elhamouly Y, Palma PJ, Hatipoğlu FP. Repair versus replacement of defective direct dental restorations: A multinational cross-sectional study with meta-analysis. J Dent 2024; 148:105096. [PMID: 38796090 DOI: 10.1016/j.jdent.2024.105096] [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: 01/08/2024] [Revised: 04/22/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVES When dental practitioners encounter a defective restoration, they are faced with a crucial decision whether to repair or replace it. This study aims to explore international preferences for repair procedures and the clinical steps taken during the repair process. METHOD An 11-question survey was distributed to dentists across 21 countries via different platforms. The survey comprised two sections: the first included five questions aimed at gathering demographic information, while the second consisted of six questions focusing on participants' practices related to the repair of composite or amalgam restorations A meta-analysis was employed to ascertain the pooled odds ratio of repairing versus replacement. The statistical analysis was carried out using the RevMan 5.3 program and forest plots were generated using the same program to visualize the results. RESULTS The survey was completed by 3680 dental practitioners. The results indicated a strong tendency to repair defective composite restorations (OR: 14.23; 95 % CI: 7.40, 27.35, p < 0.001). In terms of amalgam, there was a significant tendency to replace the restorations (OR: 0.19; 95 % CI: 0.12, 0.30, p < 0.001). When repairing restorations, the most common protocols were etching with orthophosphoric acid and creating an enamel bevel, regardless of the restorative material used. CONCLUSION The findings of this study indicate that there exists a knowledge gap among dental practitioners regarding restoration repair. It is imperative that dental practitioners receive proper education and training on restoration repair, to ensure the usage of adequate protocols and restoration survival. CLINICAL SIGNIFICANCE A significant portion of dental practitioners lack the necessary knowledge and education required for the repair of restorations. Therefore, it is imperative to establish guidelines aimed at enhancing the management of defective restorations, along with protocols for clinical interventions. This includes the incorporation of proper courses in undergraduate, graduate, and continuing education programs.
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Affiliation(s)
- Ömer Hatipoğlu
- Department of Restorative Dentistry, Nigde Omer Halisdemir University, Turkey.
| | | | - Mohmed Isaqali Karobari
- Dental Research Unit, Center for Global Health Research, Saveetha Institute of Medical and Technical Sciences, Saveetha Medical College and Hospital, Chennai, Tamil Nadu 600077, India.
| | - Nessrin Taha
- Department of Conservative Dentistry Jordan, University of Science and Technology, Irbid, Jordan.
| | - Thiyezen Abdullah Aldhelai
- Department of Orthodontics and pediatric Dentistry, College of Dentistry, Qassim University, Buraydah, Saudi Arabia.
| | - Daoud M Ayyad
- Head of the Endodontics Department, Faculty of Dentistry, Al-Quds University, Palestine.
| | - Ahmed A Madfa
- Department of Restorative Dental Science, College of Dentistry, University of Ha'il, Ha'il, Saudi Arabia.
| | | | - Rafael Fernandez
- Endodontist, associate professor from endodontic department at CES University, Medellín.
| | - Bakhyt A Omarova
- S. D. Asfendiyarov Kazakh National Medical University, Dentistry School, Departement of Therapeutic Dentistry, Almaty, Kazakhstan.
| | - Lim Wen Yi
- Department of Restorative Dentistry, National Dental Centre Singapore.
| | - Suha Alfirjani
- Department of Conservative Dentistry and Endodontics, University of Benghazi, Libya.
| | - Anna Lehmann
- Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Poland.
| | - Surendar Sugumaran
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
| | - Xenos Petridis
- Department of Endodontics, Section of Dental Pathology and Therapeutics, School of Dentistry, National and Kapodistrian University of Athens, Greece.
| | - Silvana Jukić Krmek
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Gundulićeva 5, Zagreb 10000, Croatia.
| | | | - Azhar Iqbal
- Department of Restorative Dental sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia; Department of Operative Dentistry & Endodontics, Frontier Medical and Dental College, Abbottabad, Pakistan.
| | - Imran Zainal Abidin
- Department of Restorative Dentistry, International Islamic University Malaysia, Malaysia.
| | | | - Yasmine Elhamouly
- Department of Pediatric and Community Dentistry, Faculty of Dentistry, Pharos University in Alexandria, Egypt.
| | - Paulo Jorge Palma
- Centre for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, Coimbra 3000-075, Portugal; Institute of Endodontics, Faculty of Medicine, University of Coimbra, Coimbra 3000-075, Portugal.
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da Silva Tagliaferro EP, Riley JL, Gilbert GH, da Silva SRC, Rosell FL, Junior AV, Gordan VV. EVIDENCE-PRACTICE GAP IN TREATMENT DECISIONS ABOUT DEFECTIVE COMPOSITE AND AMALGAM RESTORATIONS AMONG BRAZILIAN DENTISTS. BRAZILIAN JOURNAL OF ORAL SCIENCES 2023; 22:e231640. [PMID: 38077621 PMCID: PMC10702847 DOI: 10.20396/bjos.v22i00.8671640] [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] [Indexed: 01/31/2024] Open
Abstract
Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). Aim: this study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap.
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Affiliation(s)
- Elaine Pereira da Silva Tagliaferro
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Joseph L Riley
- University of Florida College of Dentistry, Director, Pain Clinical Research Unit, UF CTSI, South Atlantic Region, Dental Practice-based Research Network, Clinical and Translational Research Building (CTRB), Room 2227, 2004 Mowry Road, Box 100404, Gainesville, FL 32610-0404, The United States of America
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, Room SDB 109, School of Dentistry, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0007, The United States of America
| | - Silvio Rocha Correa da Silva
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Fernanda Lopez Rosell
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Aylton Valsecki Junior
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Valeria Veiga Gordan
- University of Florida, College of Dentistry, Room D9-6 P.O. Box 100415, Gainesville, FL 32610-0415, The United States of America
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Ferrando Cascales Á, Sauro S, Hirata R, Astudillo-Rubio D, Ferrando Cascales R, Agustín-Panadero R, Delgado-Gaete A. Total Rehabilitation Using Adhesive Dental Restorations in Patients with Severe Tooth Wear: A 5-Year Retrospective Case Series Study. J Clin Med 2023; 12:5222. [PMID: 37629264 PMCID: PMC10455517 DOI: 10.3390/jcm12165222] [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: 05/14/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION Currently, there is little clinical evidence to support the medium- and long-term survival and clinical performance of ultraconservative approaches using adhesive restorations in full-mouth restorations. The aim of this case series study was to evaluate the medium-term clinical performance of anterior and posterior adhesive restorations applied with direct and indirect techniques using resin composites and glass-ceramic-based materials. MATERIALS AND METHODS The inclusion criteria were an esthetic problem as the main reason for consultation and severe generalized wear of grade 2 to 4 according to the Tooth Wear Evaluation System (TWES 2.0). In addition, at each follow-up appointment, patients were required to submit a clinical-parameter-monitoring record according to the modified United States Public Health Service (USPHS) criteria. RESULTS Eight patients with severe tooth wear were treated through full rehabilitation in a private dental clinic in Spain by a single operator (AFC). A total of 212 restorations were performed, which were distributed as follows: 66 occlusal veneers, 26 palatal veneers and 120 vestibular veneers. No signs of marginal microleakage or postoperative sensitivity were observed in any occlusal, vestibular and/or palatal restoration after the follow-up period. The estimated survival rate of the 212 restorations was 90.1% over 60 months of observation, with a survival time of 57.6 months. Only 21 restorations had complications, which were mostly resolved with a direct composite resin. The dichotomous variables of the restoration type (posterior veneer, anterior veneer) and the type of restored tooth (anterior, posterior) were the risk predictors with statistically significant influences (p < 0.005) on the survival of the restorations. CONCLUSION According to the results of this study, there is a significantly higher risk of restorative complications in posterior teeth compared to anterior teeth. Also, it can be concluded that the indication of adhesive anterior and posterior restorations is justified in the total oral rehabilitation of patients with severe multifactorial tooth wear, as they are associated with a low risk of failure.
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Affiliation(s)
- Álvaro Ferrando Cascales
- Department of Biomaterials Engineering, Faculty of Medicine, UCAM, Universidad Católica de Murcia, Campus Los Jerónimos, 135 Guadalupe, 30107 Murcia, Spain; (Á.F.C.); (R.F.C.)
| | - Salvatore Sauro
- Dental Biomaterials and Minimally Invasive Dentistry, Department of Dentistry, University CEU Cardenal Herrera, C/Santiago Ramón y Cajal, s/n, Alfara del Patriarca, 46115 Valencia, Spain;
- Department of Therapeutic Dentistry, I. M. Sechenov First Moscow State Medical University, 119146 Moscow, Russia
| | - Ronaldo Hirata
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY 10010, USA;
| | - Daniela Astudillo-Rubio
- Division of Prosthodontics, School of Dentistry, Universidad Católica de Cuenca, Cuenca 010107, Ecuador; (D.A.-R.); (A.D.-G.)
| | - Raúl Ferrando Cascales
- Department of Biomaterials Engineering, Faculty of Medicine, UCAM, Universidad Católica de Murcia, Campus Los Jerónimos, 135 Guadalupe, 30107 Murcia, Spain; (Á.F.C.); (R.F.C.)
| | - Rubén Agustín-Panadero
- Prosthodontic and Occlusion Unit, Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de València, 46010 Valencia, Spain
| | - Andrés Delgado-Gaete
- Division of Prosthodontics, School of Dentistry, Universidad Católica de Cuenca, Cuenca 010107, Ecuador; (D.A.-R.); (A.D.-G.)
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Calvert G, Cocozza PG, Elsayed Ahmed K. Clinical factors to consider in definitive treatment planning for patients with tooth wear. Br Dent J 2023; 234:375-384. [PMID: 36964358 DOI: 10.1038/s41415-023-5618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 03/26/2023]
Abstract
Diagnosis, disease control and prevention are the precursors to successful definitive restorative treatment of pathological tooth wear. This case series illustrates how proposed key clinical features can influence treatment complexity and provide the clinician with a logical sequence of treatment options for definitive management of tooth wear.
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Affiliation(s)
- Gareth Calvert
- Glasgow Dental Hospital and School, Department of Restorative Dentistry, Glasgow, G2 3JZ, UK
| | - Paul Guerino Cocozza
- Glasgow Dental Hospital and School, Department of Restorative Dentistry, Glasgow, G2 3JZ, UK.
| | - Khaled Elsayed Ahmed
- School of Medicine and Dentistry, Griffith University, Queensland, 4215, Australia
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Al-Taee L, Banerjee A, Deb S. In-Vitro Adhesive and Interfacial Analysis of A Phosphorylated Resin Polyalkenoate Cement Bonded To Dental Hard Tissues. J Dent 2022; 118:104050. [DOI: 10.1016/j.jdent.2022.104050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022] Open
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LEAL SC, DAME-TEIXEIRA N, BARBOSA CDB, KOMINAMI PAA, RAPOSO F, NAKAGAWA EMT, BANERJEE A. Minimum intervention oral care: defining the future of caries management. Braz Oral Res 2022; 36:e135. [DOI: 10.1590/1807-3107bor-2022.vol36.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
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Application Modes Affect Two Universal Adhesive Systems' Nanoleakage Expression and Shear Bond Strength. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7375779. [PMID: 34631886 PMCID: PMC8497110 DOI: 10.1155/2021/7375779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022]
Abstract
Objectives The aim of this study was to evaluate the shear bond strength and the nanoleakage expression of CLEARFIL Universal Bond Quick and Tetric N-Bond adhesive systems bonded to dentin. Materials and Methods 100 freshly extracted human premolar teeth were utilized. The teeth were sectioned to expose dentin. All dentin specimens were assigned into 4 experimental groups; 2 groups had Universal Bond Quick (Universalself group) and Tetric N-Bond (Tetricself group) applied in the self-etch mode, while 2 groups had Universal Bond Quick (Universaltotal group) and Tetric N-Bond (Tetrictotal group) applied in the total-etch mode. n = 15 for shear bond strength and n = 10 for nanoleakage experiment. One-way ANOVA and Kruskal-Wallis test were utilized to analyze the shear bond strength test and the nanoleakage expression, respectively. Results The highest significant bond strength value was recorded by the Tetricself specimens (p < 0.05) when compared to the remaining three groups. There were no statistically significant differences between the shear bond strength values recorded in the Tetrictotal, Universalself, and Universaltotal groups (p < 0.05). Both bonding systems applied in the self-etch mode (Universalself, Tetricself) had no silver nitrate deposits in the hybrid layer and the hybrid layer-adhesive interface (p < 0.001); however, both bonding systems applied in the total-etch mode (Universaltotal, Tetrictotal) had silver nitrate deposits in the hybrid layer, the hybrid layer-adhesive interface, and the bonding layer (p < 0.001). Conclusion Applying the Universal Bond Quick and Tetric N-Bond in the self-etch mode exhibited better results in terms of nanoleakage expression. Universal Bond Quick showed the stability of the shear bond strength to dentin when applied using the total-etch or self-etch modes. Tetric N-Bond showed significant deterioration in bond strength when applied in the total-etch mode and exhibited the highest bond strength when applied in the self-etch mode.
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Guarnieri FDF, Briso ALF, Ramos FDSES, Esteves LMB, Omoto ÉM, Sundfeld RH, Fagundes TC. Use of auxiliary devices during retreatment of direct resin composite veneers. PLoS One 2021; 16:e0252171. [PMID: 34133430 PMCID: PMC8208554 DOI: 10.1371/journal.pone.0252171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/11/2021] [Indexed: 12/03/2022] Open
Abstract
The removal of direct composite veneers, when the retreatment is necessary, represents a challenge to the clinician, since the healthy dental structure must be preserved. Thus, the aim of this study was to compare the accuracy provided by different auxiliary devices during retreatment of direct composite veneers. Seventy-five bovine teeth were prepared for direct composite veneers, scanned (T1), and restored. Specimens were divided into 5 groups for retreatment: conventional high-speed handpiece without auxiliary device (WD); high-speed handpiece with a white LED (WL); high-speed handpiece with an UV light (UL); electric motor and multiplier 1/5 handpiece (EM); and conventional high-speed handpiece using magnifying loupe (ML). After retreatments, other scanning was performed (T2). Changes on dental wear or composite residues areas, as well as, the average between wear and presence of residues were measured. Data were submitted to Kruskal-Wallis and Dunn’s post-test (p≤ 0.05). There were greater areas of wear for ML, being statistically superior to WD and EM groups. The ML presented smaller residues areas, being statistically lower than the WD and EM groups. Regarding the average between wear and the presence of resin residues, additional wear occurred after re-preparation, regardless of the group. Magnifying loupe promoted greater areas of wear and smaller areas of resin residues than conventional high-speed handpiece and electric motor. Both techniques using light accessories did not differ from other ones.
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Affiliation(s)
| | - André Luiz Fraga Briso
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Fernanda de Souza e Silva Ramos
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Lara Maria Bueno Esteves
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Érika Mayumi Omoto
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Renato Herman Sundfeld
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Ticiane Cestari Fagundes
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), Araçatuba, SP, Brazil
- * E-mail:
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Affiliation(s)
- Avijit Banerjee
- Guest Editor BDJ Minimum Intervention Themed Issue and Professor of Cariology & Operative Dentistry; Hon. Consultant, Restorative Dentistry; Head of Department, Conservative & MI Dentistry; Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, London, SE1 9RT, UK
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Wang J, Ling Z, Zheng Z, Zheng C, Gai Y, Zeng Y, Zhu X, Chen L, Wu B, Yan W. Clinical efficacy of ceramic versus resin-based composite endocrowns in Chinese adults: study protocol for a randomized controlled trial. Trials 2020; 21:559. [PMID: 32571397 PMCID: PMC7310236 DOI: 10.1186/s13063-020-04506-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 06/12/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Endocrown restoration is widely used to restore endodontically treated teeth. However, the clinical effects of different computer-aided design/computer-aided manufacturing (CAD/CAM) materials for endocrown restoration are not clear. The primary objective of this trial is to compare the clinical efficacy of resin-based bloc and ceramic endocrowns for restoring endodontically treated teeth. METHODS The proposed resin-based bloc and ceramic endocrown assessment trial is a parallel group-designed randomized controlled trial. We will recruit 156 adults between 18 and 75 years old with a minimum of one such molar. The inclusion criteria were good oral hygiene habits, root apex of molar without evident damage, receipt of standard endodontic treatment, need for endocrown restoration, and only one endocrown restoration performed per patient. Patients participating in another study or those with systemic diseases, disabilities, or known allergies to used materials will be excluded. All patients will be randomized and restored with resin-based bloc and ceramic endocrown according to a random number table. Clinical evaluations will be performed at baseline and after treatment at 6, 12, and 24 months, in accordance with the modified Federation Dentaire Internationale (FDI) criteria, by two independent evaluators. The primary outcome is marginal adaptation; secondary outcomes include wear, tooth integrity, fracture of material and retention, marginal staining, and patient view. All data will be analyzed by an independent statistician. Signed rank-sum tests will be used for intragroup comparisons. Wilcoxon rank-sum tests will be used for intergroup comparisons. Hierarchical logistic regression will be used to adjust the baseline and other important indicators. DISCUSSION This study will investigate endocrowns of two CAD/CAM materials for endodontically treated molars. The results may help clinicians choose the better CAD/CAM material option and explain to patients the advantages and disadvantages of these two materials with evidence-based support. For patients, the results may lead to improvement in long-term restoration. TRIAL REGISTRATION ClinicalTrials.gov NCT04033380. Registered on 24 July 2019.
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Affiliation(s)
- Jilei Wang
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Road, Guangzhou, 510515 China
| | - Zhiting Ling
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Road, Guangzhou, 510515 China
| | - Ziting Zheng
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Road, Guangzhou, 510515 China
| | - Chunqing Zheng
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Road, Guangzhou, 510515 China
| | - Yawen Gai
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Road, Guangzhou, 510515 China
| | - Yuting Zeng
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Road, Guangzhou, 510515 China
| | - Xiaoxia Zhu
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Road, Guangzhou, 510515 China
| | - Liya Chen
- The Statistics Room of Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Buling Wu
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Road, Guangzhou, 510515 China
| | - Wenjuan Yan
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Road, Guangzhou, 510515 China
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Kanzow P, Büttcher AF, Wiegand A, Schwendicke F. Quality of Information Regarding Repair Restorations on Dentist Websites: Systematic Search and Analysis. J Med Internet Res 2020; 22:e17250. [PMID: 32062595 PMCID: PMC7191344 DOI: 10.2196/17250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/31/2020] [Accepted: 02/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background Repairing instead of replacing partially defective dental restorations represents a minimally invasive treatment concept, and repairs are associated with advantages over complete restoration replacement. To participate in the shared decision-making process when facing partially defective restorations, patients need to be aware of the indications, limitations, and advantages or disadvantages of repairs. Patients are increasingly using the internet to gain health information like this online. Objective We aimed to assess the quality of German-speaking dentist websites on repairs of partially defective restorations. Methods Three electronic search engines were used to identify German-speaking websites of dental practices mentioning repairs. Regarding information on repairs, websites were assessed for (1) technical and functional aspects, (2) comprehensiveness of information, and (3) generic quality and risk of bias. Domains 1 and 3 were scored using validated tools (LIDA and DISCERN). Comprehensiveness was assessed using a criterion checklist related to evidence, advantages and disadvantages, restorations and defects suitable for repairs, and information regarding technical implementation. Generalized linear modeling was used to assess the impact of practice-specific parameters (practice location, practice setting, dental society membership, and year of examination or license to practice dentistry) on the quality of information. An overall quality score was calculated by averaging the quality scores of all three domains and used as primary outcome parameter. Quality scores of all three domains were also assessed individually and used as secondary outcomes. Results Fifty websites were included. The median score of quality of information was 23.2% (interquartile range [IQR] 21.7%-26.2%). Technical and functional aspects (55.2% [IQR 51.7%-58.6%]) showed significantly higher quality than comprehensiveness of information (8.3% [IQR 8.3%-16.7%]) and generic quality and risk of bias (3.6% [IQR 0.0%-7.1%]; P<.001/Wilcoxon). Quality scores were not related to practice-specific parameters (P>.05/generalized linear modeling). Conclusions The quality of German-speaking dentist websites on repairs was limited. Despite sufficient technical and functional quality, the provided information was neither comprehensive nor trustworthy. There is great need to improve the quality of information to fully and reliably inform patients, thereby allowing shared decision making.
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Affiliation(s)
- Philipp Kanzow
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - Amelie Friederike Büttcher
- Division of Medical Education Research and Curriculum Development, University Medical Center Göttingen, Göttingen, Germany
| | - Annette Wiegand
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Dettwiler C, Eggmann F, Matthisson L, Meller C, Weiger R, Connert T. Fluorescence-aided Composite Removal in Directly Restored Permanent Posterior Teeth. Oper Dent 2019; 45:62-70. [PMID: 31373886 DOI: 10.2341/19-032-l] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The aim of this study was to quantitatively compare conventional composite removal and composite removal supported by the fluorescence-aided identification technique (FIT) regarding the completeness, selectivity, and duration of the procedure in directly restored permanent posterior teeth. METHODS AND MATERIALS Two operators removed standardized direct class II composite restorations (n=32 per operator) in human tooth models under simulated clinical conditions. According to a randomized allocation scheme, removal was performed with either the conventional technique (contra-angle handpiece) or supported by FIT. The duration of each removal procedure was recorded. The completeness and selectivity were volumetrically assessed through superimposition of three-dimensional surface scans. Statistical significance was tested by examining the overlap of 95% confidence intervals (CI). Multiple comparison was performed with Tukey tests for each variable. RESULTS Compared with the conventional technique, composite removal with FIT was faster (329 seconds [95% confidence interval (CI): 268-390 seconds] vs 179 seconds [95% CI: 150-208 seconds]), generated less tooth substance loss (4.53 mm3 [95% CI: 3.77-5.30 mm3] vs 2.77 mm3 [95% CI: 2.11-3.43 mm3]), and left behind less composite residue (1.58 mm3 [95% CI: 1.23-1.94 mm3] vs 0.53 mm3 [95% CI: 0.39-0.67 mm3]). CONCLUSION Within the limitations of this in vitro study, FIT facilitated the selective and expeditious removal of tooth-colored composites in directly restored posterior teeth.
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Kanzow P, Wiegand A, Schwendicke F, Göstemeyer G. Same, same, but different? A systematic review of protocols for restoration repair. J Dent 2019; 86:1-16. [PMID: 31108118 DOI: 10.1016/j.jdent.2019.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES While repairs are increasingly recommended to manage partially defective restorations, performing the repair (including bonding to different substrates) can be challenging, and dentists should adhere to established repair protocols. We aimed to systematically assess the consistency and quality of repair protocols. DATA 808 records were initially identified and 71 repair protocols based on 84 sources included. The number of published sources over time increased exponentially (p < 0.001). Recommended treatment steps varied widely. Some treatment steps were only recommended by a minority of protocols, while others were consistently recommended (e.g. surface roughening, hydrofluoric acid etching of silicate ceramics, application of an adhesive/bonding agent). The overall quality of included sources was moderate (mean ± SD 3.7 ± 0.9 out of 7 points). SOURCES Electronic databases (Medline via PubMed, Embase) were searched, hand searches using Google and Google Scholar conducted, and the reference lists of included full texts screened and cross-referenced. STUDY SELECTION (Non-)systematic reviews, working instructions, and textbooks with protocols on direct composite repair restorations for partially defective (1) composite, (2) amalgam, (3) porcelain-fused-to-metal (PFMs) with exposed metal base, (4) ceramic/PFMs without exposed metal base, and (5) full metal restorations were included. Data synthesis was performed by tabulation of recommended treatment steps and descriptive statistics. The quality of included sources was assessed based on a checklist for guideline appraisal (MiChe). CONCLUSIONS The main treatment steps were consistently reported across repair protocols. CLINICAL SIGNIFICANCE Dentists may want to adopt widely recommended treatment steps when performing repairs of different restoration materials in their daily practice.
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Affiliation(s)
- Philipp Kanzow
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany.
| | - Annette Wiegand
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
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Omran TA, Garoushi S, Lassila LV, Vallittu PK. Effect of interface surface design on the fracture behavior of bilayered composites. Eur J Oral Sci 2019; 127:276-284. [PMID: 31002749 PMCID: PMC6617810 DOI: 10.1111/eos.12617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study aimed to evaluate the effect of different interface designs on the load‐bearing capacity of bilayered composite structures (BLS). Cylindrical specimens of BLS were prepared from base composite of 3.5 mm thickness and surface composite of 1.5 mm thickness (n = 80). Two different base composites – flowable bulk‐fill (FBF) [smart dentin replacement (SDR)] and short fiber‐reinforced (FRC) (everX Posterior) – were evaluated, and conventional composite (G‐ænial Posterior) was used as the surface layer. Four different interface designs were used: (i) pyramidal; (ii) mesh; (iii) linear grooves; and (iv) flat surface (control). Three‐dimensional printed molds were fabricated to standardize the interface design between the surface and the base composites. The specimens were then statically loaded with a steel ball until fracture using a universal testing machine. Fracture types were classified into catastrophic, complete, and partial bulk. anova revealed that both the material and the interface design had a statistically significant effect on the load‐bearing capacity. Flowable bulk‐fill showed lower mean load‐bearing capacity than FRC in all the interface designs tested, except for the flat surface design. Fracture analysis showed that FRC demonstrated up to 100% partial bulk fractures with the pyramid interface design, but no incidence of catastrophic bulk fracture. By contrast, FBF demonstrated up to 84.6% and 40% catastrophic bulk fractures with the flat interface design but no incidence of partial bulk fracture. Consequently, the interface designs studied enhanced the fracture behavior of BLS.
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Affiliation(s)
- Tarek A Omran
- Finnish Doctoral Program in Oral Sciences (FINDOS), Turku, Finland.,Department of Biomaterials Science, Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland.,Turku Clinical Biomaterials Centre (TCBC), Turku, Finland
| | - Sufyan Garoushi
- Department of Biomaterials Science, Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland.,Turku Clinical Biomaterials Centre (TCBC), Turku, Finland
| | - Lippo V Lassila
- Department of Biomaterials Science, Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland.,Turku Clinical Biomaterials Centre (TCBC), Turku, Finland
| | - Pekka K Vallittu
- Department of Biomaterials Science, Institute of Dentistry, Faculty of Medicine, University of Turku, Turku, Finland.,Turku Clinical Biomaterials Centre (TCBC), Turku, Finland.,City of Turku Welfare Division, Oral Health Care, Turku, Finland
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Fidalgo TKDS, Americano G, Medina D, Athayde G, Letieri ADS, Maia LC. Adhesiveness of bulk-fill composite resin in permanent molars submitted to Streptococcus mutans biofilm. Braz Oral Res 2019; 33:e111. [DOI: 10.1590/1807-3107bor-2019.vol33.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/24/2019] [Indexed: 11/21/2022] Open
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