Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group

Comparative evaluation of the clinical effectiveness of chemomechanical (Papacarie) and conventional mechanical caries removal methods in treatment of carious primary molars: a randomized controlled clinical study

BACKGROUND

Traditionally, treating dental caries involves using rotary instruments, which can create noise that may frighten and cause discomfort in children. Recent research into caries management has introduced minimal invasive techniques like the Papacarie, which is a chemomechanical caries removal agent.

OBJECTIVES

To determine and compare the average time taken for caries removal and pain perception during caries removal by Papacarie as a chemomechanical caries removal method with the use of mechanical method using rotary instrument on carious primary molars.

METHODOLOGY

This randomized controlled clinical study carried out at the dental clinic in Lagos university teaching hospital. A split-mouth design was used and it involved 50 primary molars in 25 healthy children aged 5-9 years, each child having at least two primary molar teeth with occlusal dentine caries. Each tooth was allocated to the intervention using simple balloting method and treated with either Papacarie or conventional method for caries removal. Outcome measured were caries removal time, pain during caries removal and preference. Pain assessment was blinded. The statistical package for social sciences (SPSS) version 25.0 IBM was used for data analysis. The significance level was set at p ≤ 0.05 for all statistical tests at 95% confidence interval.

RESULT

Twenty-five children (with 50 primary molars) met the inclusion criteria and were recruited for the study. The children were between ages 5-9 years. Twenty-five primary molars were treated using Papacarie caries removal method while 25 primary molars were treated using conventional rotary method. There was no statistically significant difference in the time of caries removal between the two groups. Pain perception was lower with the Papacarie method compared to the conventional method, which was statistically significant. More participants preferred the Papacarie method. Twenty-five children (with 50 primary molars) met the inclusion criteria and were recruited for the study. The children were between ages 5-9 years. Twenty-five primary molars were treated using Papacarie caries removal method while 25 primary molars were treated using conventional rotary method. There was no statistically significant difference in the time of caries removal between the two groups. Pain perception was lower with the Papacarie method compared to the conventional method, which was statistically significant. More participants preferred the Papacarie method.

CONCLUSION

The findings from this study indicates that the Papacarie demonstrated a comparable caries removal time, lesser pain perception and better acceptability compared to the conventional method of caries removal.

TRIAL REGISTRATION

Pan African Clinical Trial Registry (PACTR) Trial number PACTR202111738486539. Registered 18th November 2021.

Training received, knowledge, and use of Silver Diamine Fluoride among Italian dentists: a nationwide survey

OBJECTIVE

To investigate the education, knowledge and behaviour of Italian dentists regarding Silver Diamine Fluoride (SDF).

METHODS

A cross-sectional study was conducted from January to December 2022, through an online survey linked to an online continuing medical education (CME) course sent to Italian dentists. A priori power analysis estimated the necessary sample to be 1480 dentists with an anticipated frequency of 50% and a power of 99.99%. The questionnaire included 46 questions on participants ' demographic characteristics, training received, clinical knowledge of SDF, and attitudes and behaviours regarding its use. Descriptive statistics, bivariate, and mutlivariable regression analyses were performed to determine the association between the variables.

RESULTS

The response rate was 6.1% with 3876 respondents, evenly distributed geographically. Less than 10% of respondents had received training at undergraduate, postgraduate or masters level. A minority of dentists were familiar with the use of SDF for the treatment of dentine hypersensitivity (19.0%) and for the treatment of caries in children (22.2%) and adults (15.7%). The percentage of dentists who reported SDF use at least once was 20.6%. On mutlivariable analysis (χ2(11) = 995.9 p-value < 0.01), dentists who used SDF were positively associated with those who cared for patients with special needs, those who received good undergraduate or postgraduate training, and those who knew how to use SDF (p < 0.01). A second mutlivariable analysis (χ2(11) = 47.9 p-value < 0.01) revealed that younger respondents were associated with good training and knowledge of the use of SDF received during undergraduate studies, while older respondents were associated with good training received on managing hypersensitivity and caries in adults (p < 0.01).

CONCLUSIONS

Overall, Italian dentists ' education, knowledge, and use of SDF were relatively poor. The majority of the sample 's responses were not consistent with scientific evidence. The use of SDF among Italian dentists is still far from being a reality. In Italy, it is necessary to increase training on SDF, primarily through the university, to hopefully increase its use, especially in non-invasive caries treatment.

High-intensity focused ultrasound: an innovative approach for micro-manipulation of demineralized dentine

BACKGROUND

Treatment of deep carious lesions poses significant challenges in dentistry, as complete lesion removal risks compromising pulp vitality, while selective removal often reduces the longevity of restorations. Herein, we propose a minimally invasive approach using High-Intensity Focused Ultrasound (HIFU) for microscale removal of carious dentine. Concurrently, HIFU's antimicrobial effects against associated cariogenic biofilms and the corresponding thermal and biological impacts on surrounding tissues were investigated.

METHODS

A total of 238 sound human molars were utilized, with 203 samples of artificial carious-simulated dentine (ACSD) prepared for HIFU exposure. HIFU (250 kHz) was applied at 20 W for varying durations (60, 120, and 180 s). The acoustic waves were administered via a collimated cone coupled to the dentine surface using ultrasonic gel.

RESULTS

Advanced characterization techniques including scanning electron microscopy (n = 5/group), Raman spectroscopy, atomic force microscopy, and nano-indentation (n = 5/group), demonstrated HIFU's effectiveness in removing demineralized collagen-fibrils. This was reflected in the increased mineral content, nano-hardness, and reduced elastic-modulus of ACSD lesions. Micro-CT (n = 6/group) confirmed the increase in mineral density post-HIFU exposure. Confocal microscopy of Rhodamine-B stained ACSD (n = 5/group) quantified the depth of dentine microscale removal post-HIFU exposure in a time-dependent manner. HIFU's potent anti-biofilm effect (n = 9/group) against Streptococcus mutans biofilms was evidenced by microscopic characterizations and significant reductions in metabolic-activity and colony-forming units. Furthermore, HIFU promoted the proliferation of dental pulp stem cells (n = 3/group) while maintaining the associated temperature-rise within the physiological tolerance.

CONCLUSION

HIFU's potential as an innovative, minimally invasive, non-ionizing tool for dentine carious lesion micromanipulation was demonstrated through the interaction between focused acoustic waves and dentine, warranting further studies for future clinical translation in restorative and/or preventive dentistry.

Chronic Disease Management of Early Childhood Dental Caries: Practices of US Pediatric Dentists

Introduction

Early childhood caries (ECC), dental cavities in children younger than 6 years, is common, consequential, and inequitably concentrated among socially disadvantaged children. The World Health Organization and authoritative clinical and public health agencies promote 4 chronic disease management (CDM) approaches that are low-cost and can be delivered in home and community sites: pharmacologic, behavioral, monitoring, and minimally invasive dentistry (MID). The extent of adoption of these approaches among US pediatric dentists is unknown.

Methods

From November 2021 through July 2023, trained research staff members administered and videorecorded via Zoom a semistructured survey on ECC management to 1,639 clinically active pediatric dentists in the US, including 170 thought leaders (organizational and academic leaders). Data collected included treatment approaches, time allocated to counseling, and personal, practice, and patient population characteristics.

Results

The survey response rate was 27.7%. Among CDM approaches, 88.7% cited pharmacologic approaches, 43.4% behavioral, 41.1% monitoring, and 39.3% MID approaches. MID was significantly associated with thought leaders and with more recent graduates engaged as associates in larger practices or in safety-net settings serving high volumes of low-income children and children with a history of caries. We noted fewer significant associations between other CDM approaches and the characteristics of dentists, practices, and populations served. CDM was not associated with the race or ethnicity of dentists or patients, the numbers of ancillary personnel in practice, or dental management organizations. One-third (32.4%) of respondents reported scheduling 5 or fewer minutes for counseling on caries.

Conclusion

Except for pharmacologic treatments and despite professional guidelines, CDM approaches are underused. We posit that CDM approaches hold strong promise to enhance oral health equity as value-based care arrangements expand in dentistry.

Comparing Polymerization Shrinkage Measurement Methods for Universal Shade Flowable Resin-Based Composites

Universal shade flowable composites have been introduced to mimic tooth structure with reduced color mismatch and reduced chair time and cost. However, the polymerization shrinkage of resin material may lead to sensitivity and restoration failure. The purpose of this study was to compare the polymerization shrinkage of recently introduced universal shade flowable resin-based composites using both wet and dry density methods. Using two measurement methods, ISO 17304 (wet method) and a gas displacement pycnometry system (dry method), the density of the unpolymerized and the polymerized RBCs were measured, and the polymerization shrinkage was calculated from the density difference. Scanning electron microscopy was used to visualize filler particles. The polymerization shrinkage showed significant differences between many materials. In particular, Bulk Base HARD II Medium Flow showed significantly lower polymerization shrinkage than all the other materials. Shrinkages measured by different methods were significantly different in all cases. The wet method measured a smaller shrinkage than the dry method in most cases, but the shrinkage measured for Gracefil LoFlow was larger with the wet method. Shrinkage between universal shade flowable resin-based composites significantly varied based on both material and measurement method. The polymerization shrinkage of resin-based composites is an important factor in biomimetic clinical dentistry, and work must be conducted to measure it accurately and with more standardization.

Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment in arresting dentin caries lesions in preschoolers: a randomized clinical trial

OBJECTIVE

To compare the efficacy of silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) in arresting caries lesions. Variables such as treatment time, adverse effects/parental aesthetic perception, anxiety and patients' behavior were also evaluated.

MATERIALS AND METHODS

Children (3.53 ± 1.03 years) with dentin caries lesions on the occlusal surface of primary molars were randomized into test (SDF) and control (ART) groups. To determine the presence of caries, dmf-t and ICDAS indexes were used. Caries lesions were also classified according to activity (active or inactive). The time required to perform treatments was recorded and the children's anxiety was assessed by a Facial Image Scale. The adverse events/aesthetic perception were registered by the operator and caregivers. The Frankl Behavioral Scale assessed patients' behavior. The chi-square/Fisher's exact and Mann-Whitney tests were used for comparisons between the groups.

RESULTS

Of the 118 participants who received treatment (SDF, n = 59; ART, n = 59), after 12-month follow-up, 91.5% (43/47) of caries lesions in the SDF and 90.2% (46/51) in the ART group were arrested (p = 1.000). After 24 months, 72% (18/25) were arrested in the SDF group and 95.2% (20/21) in the ART. The treatment times were 6.08 ± 1.72 and 13.58 ± 4.83, for SDF and ART, respectively (p < 0.001). No statistically significant difference of adverse effects, aesthetic perception, anxiety, and patients' behavior were found between the groups.

CONCLUSIONS

SDF was similar to ART in arresting caries lesion but required less time for treatment. The anxiety, adverse effects/aesthetic perception and patients' behavior were also similar between the groups.   CLINICAL RELEVANCE: The use of SDF may be a faster and less invasive alternative for the treatment of caries lesions. Clinical trial registration number and date of registration: NCT03063307. September 2016.

Efficacy of chemo-mechanical caries removal: a 24-month randomized trial

Introduction

Chemo-mechanical caries removal (CMCR) offers an alternative to conventional drilling for carious dentin removal, but limited evidence exists on its long-term effects on treating caries in primary teeth. The primary aims of this study were to compare CMCR to drilling in terms of restoration status and the presence of secondary caries after 24 months.

Methods

A randomized, parallel-group, single-blinded, controlled trial was conducted in Thailand. Participants were children aged 7-8 years with occlusal caries in second primary molars, randomly assigned to CMCR with Papacarie® (n = 242) or drilling (n = 246). All cavities were restored using glass ionomer cement. Completeness of caries removal was evaluated clinically by two blinded dentists, and patients' discomfort was measured using a facial visual analogue scale. Restoration status and development of secondary caries were assessed every six months clinically and every 12 months radiographically over a 2-year period.

Results

Both groups achieved complete caries removal, but the CMCR took significantly longer than the drilling method (9 vs. 2.3 min, p < 0.001). Children in the CMCR group reported significantly lower discomfort during treatment (p < 0.001). At 24 months, ten (4.6%) restorations in the CMCR group failed, compared to three (1.2%) in the drilling group. Clinically, four restorations (CMCR = 2, control = 2) exhibited secondary caries at the margin, while nine restorations (CMCR = 8, control = 1) showed radiographic evidence of secondary caries beneath the restoration. However, neither clinical nor radiographic evaluations revealed statistically significant differences in treatment outcomes at the two-year mark.

Conclusion

CMCR demonstrated comparable efficacy to conventional drilling for complete caries removal and restoration success at 24 months in primary teeth. Despite a longer chair time, it resulted in less discomfort during treatment.

Clinical Trial Registration

https://clinicaltrials.gov/study/NCT01641861, identifier: NCT01641861.

A deep learning feature importance test framework for integrating informative high-dimensional biomarkers to improve disease outcome prediction

Many human diseases result from a complex interplay of behavioral, clinical, and molecular factors. Integrating low-dimensional behavioral and clinical features with high-dimensional molecular profiles can significantly improve disease outcome prediction and diagnosis. However, while some biomarkers are crucial, many lack informative value. To enhance prediction accuracy and understand disease mechanisms, it is essential to integrate relevant features and identify key biomarkers, separating meaningful data from noise and modeling complex associations. To address these challenges, we introduce the High-dimensional Feature Importance Test (HdFIT) framework for machine learning models. HdFIT includes a feature screening step for dimension reduction and leverages machine learning to model complex associations between biomarkers and disease outcomes. It robustly evaluates each feature's impact. Extensive Monte Carlo experiments and a real microbiome study demonstrate HdFIT's efficacy, especially when integrated with advanced models like deep neural networks. Our framework shows significant improvements in identifying crucial features and enhancing prediction accuracy, even in high-dimensional settings.

Targeted enamel remineralization with mineral-loaded starch particles

Background

Noninvasive caries treatments work topically, which may limit efficacy. The authors hypothesized that an alternative approach using mineral-loaded particles designed to target the subsurface of noncavitated caries lesions could be advantageous. This study shows in vitro proof-of-concept.

Methods

Mineral-loaded cationic starch (MLCS) particles were prepared, containing calcium, phosphate, and fluoride to provide fluoride-plus (FP) and fluoride-free (FF) alternatives. Particles were characterized for mineral loading and release. MLCS-FP and -FF treatments vs 1,000 ppm fluoride and deionized water controls were evaluated on natural smooth-surface caries lesions (n = 15 per group) after a 20-day protocol with immersion in artificial saliva with amylase and acid challenge. Treatment efficacy was assessed by microcomputed tomography, labeled fluorescence imaging, and blinded qualitative visual assessment.

Results

In aqueous suspension and absent amylase, particles showed sustained mineral ion release. The tomographic evaluation found significant (multivariable regression analysis, P < .05) restoration of lesion mineral density by MLCS-FP and MLCS-FF (42.9% and 38.6%, respectively) vs fluoride and negative controls (7.4% and -18%, respectively), particularly for the lesion subsurface (13.8% [13.0%], 15.9% [9.4%], -2.2% [7.3%], and -1.8% [4.0%] relative hydroxyapatite density for 0.25 through 0.45 μm lesion depth for FP, FF, fluoride, and deionized water, respectively). Visually reduced white opacity (Fisher exact test, P = .038, MLCS-FF vs fluoride) and labeled fluorescence (analysis of variance, P < .05 for MLCS-FF [75.4%], MLCS-FP [75.7%], fluoride [64.1%] vs negative control [-0.2%]) were observed.

Conclusions

These foundational studies show the potential of mineral-loaded starch particles to remineralize enamel as a new approach to treating early caries by subsurface targeted mineral delivery. The in vitro study results indicated that targeted particles improved treatment efficacy, with the data supporting the superiority of MLCS-FP and FF formulations over control conditions for subsurface remineralization and visual esthetic.

Dental Hygienists' Readiness to Perform Resin Infiltrations: A Qualitative Study From Finland

OBJECTIVES

Resin infiltration is a micro-invasive treatment method for non-cavitated enamel lesions that aims to arrest the progression of carious lesions and improve the aesthetic qualities of teeth. The aim of this study is to provide a description of dental hygienists' readiness to perform resin infiltration and their experiences of performing it.

METHODS

The study was conducted during the years 2020 and 2021 using qualitative research methods. The data was collected through semi-structured single interviews and analysed using inductive content analysis. The informants were dental hygienists (n = 10) from Finland. The criterion for participation was experience of performing resin infiltration. The average number of procedures performed was seven. Five out of 10 informants had received training in the technique prior to their first procedure.

RESULTS

Dental hygienists had varied experiences of resin infiltrations. The readiness required to perform resin infiltrations was seen to be equivalent to their basic professional skills. Assessing the treatability and extent of lesions caused uncertainty, though readiness was felt to improve with experience. Resin infiltration training and inclusion in the curriculum of a dental hygienist was perceived to be important. The treatment was felt to be well suited to the job description of dental hygienists.

CONCLUSIONS

The results indicate that dental hygienists in Finland have adequate readiness to perform resin infiltration. However, the results are based on 10 informants' experiences and therefore cannot be generalised. Including resin infiltration in a dental hygienist's training programme could enhance dental hygienists' readiness to perform resin infiltrations.

Evaluation of dental cements derived from mixtures of highly reactive ionomer glasses and bottle glass: Cement manipulation, mechanical, fluoride ion releasing, radiopaque and setting properties

OBJECTIVES

To evaluate the mechanical properties, fluoride release, radiopacity, and setting characteristics of dental cements derived from highly reactive ionomer glasses and bottle glass mixtures.

METHODS

Two highly reactive glass series, LG99 and LG117, were synthesized, milled, sieved, and characterized using XRD and laser particle size analysis. These glasses were mixed with predetermined ratios of ground bottle glass, poly(acrylic acid), and aqueous tartaric acid to form glass ionomer cements. The cements' working time (WT), setting time (ST), fluoride release, radiopacity, compressive strength (CS), and elastic modulus (EM) were evaluated. Mean differences in CS were analyzed using multivariate ANOVA with Tukey's post hoc test at p = 0.05.

RESULTS

The WT and ST for both groups ranged from 1.5 to 2.5 min. LG99 series cements showed significantly higher CS (∼65 MPa) and EM (∼2 GPa) than LG117 series (p < 0.05). Both series showed similar fluoride release profiles, peaking at 1.2 mmol/L at 28 days. Radiopacity for LG99 ranged from 0.97 to 1.34, while LG117 ranged from 0.60 to 0.95. Solid state 27Al magic-angle spinning-nuclear magnetic resonance (MAS NMR) confirmed the presence of Al(IV) and Al(VI), indicating setting completion by one day for both series. Bottle glass showed a chemical shift at 55.8 ppm, overlapping with LG99's Al(IV) signal. The 19F MAS NMR spectra revealed Al-F and F-Sr(n) species in all glasses, with LG117 forming CaF2 after one day in deionized water.

CONCLUSION

Mixtures of highly reactive ionomer glass and bottle glass produced cements with satisfactory properties for dental applications. Further research is needed to optimize their formulation and properties.

Comparison of three management approaches for dental caries in primary molars: A two-year randomized clinical trial

AIM

to compare two-year clinical success rates of caries management in children (Hall Technique HT, Nonrestorative caries treatment NRCT, Conventional restorations CR), and to evaluate pain perception, behaviour, technique acceptability by patients, parents and dentists.

METHODS

122, 3-8-year-olds were enrolled in 2-year parallel group randomised controlled trial (CR, n = 52, HT, n = 35, NRCT, n = 35). Caries was recorded using Nyvad criteria to measure clinical success/ failure rates. Child's pain perception (Visual Analogue Scale of Faces), child behaviour (Frankl scale), parents' and dentists' treatment opinions (5-point Likert scale) were assessed. Statistical analysis included Chi-square, non-parametric Kruskal-Wallis, Bonferroni-corrected Mann-Whitney U tests (p < 0.05), absolute risk reduction (ARR) and number needed to treat (NNT).

RESULTS

After two years, with 116 participants, clinical success rates were: CR=60.8 % (n = 31), HT=93.8 % (n = 30), NRCT=42.5 % (n = 14) (p < 0.001). Major/minor failure rates differed: CR=17.6 % (n = 9) / 21.6 % (n = 11); HT=6.2 % (n = 2)/ 0 %, NRCT=33.3 % (n = 11)/ 24.2 % (n = 8), (p < 0.05). When comparing HT to CR, ARR = 0.33; NNT= 3 (95 % CI 0.02 -0.58); NRCT to CR, - no observed benefit from NRCT. More than 70 % of children demonstrated "positive/definitely positive" behaviour during treatment. Pain intensity was "very low/low" in 92.3 % of cases for CR, 88.6 % for HT, and 77.1 % for NRCT . NRCT was "very easy" to perform for 82.9 % of participants, compared to 42.3 % for CR and 17.1 % for HT (p < 0.05). CR were reported to take longer than NRCT and HT (p < 0.05).

CONCLUSION

Clinical success rates of HT were superior to CR and NRCT. All treatment techniques were well tolerated by children, CR was more time-consuming and HT - technically more difficult to perform.

CLINICAL SIGNIFICANCE

caries management in primary molars can be successfully performed using minimal intervention, particularly, sealing in caries lesions with Hall technique. NRCT can prevent caries progression when adequate access to mechanical plaque disruption and fluoride is provided. However, occasional fluoride application, and uncontrolled toothbrushing with fluoride toothpaste cannot replace restorative procedures.

Managing Early Childhood Caries: A Comparative Review of Preventive and Restorative Approaches

Early childhood caries (ECC), one of the most common health problems among children aged six years and below, is considered present when one or more surfaces of a tooth are decayed, missing, or filled. Not only does ECC cause pain for a long time, but it also has short- and long-term health consequences in children. In order to treat ECC, holistic management that includes preventive, restorative, and prosthetic intervention is necessary. This review, a key aspect of which is preventive strategy, stresses the need to lessen the rate of incidence of such conditions as ECC. In case preventive measures do not work, restorative care is considered. The paper discusses all of the available restoration options for paediatric patients. Furthermore, this review includes a detailed analysis of the different types of crowns used in the treatment of ECC, such as stainless-steel crowns (SSCs), resin-composite crowns, and zirconia crowns, and considers their advantages and disadvantages relevant to clinical practice. Overall, this article calls for a well-rounded approach to treating the child's dental cavity as an emerging progression of ECC. Through this interdisciplinary approach, dentists can significantly enhance oral health among children and help prevent the negative impact of caries on their quality of life.

A Review of the Work of Dr. Jo E Frencken: The Pioneer of Atraumatic Restorative Treatment for Dental Caries

Dr. Jo E Frencken is a stalwart in preventive dentistry and cariology. He has worked extensively in diagnosing, treating, and assessing outcomes related to dental caries. He developed the concept of a novel technique known as atraumatic restorative treatment (ART) in 1986 for caries management. ART for field settings, where only hand instruments are used for caries removal, is a benchmark discovery made in the field of dentistry. His idea of ART has been adopted by the World Health Organization and has been included as a part of the Basic Package for Oral Care (BPOC) and practiced globally. He has dedicated his research to dental public health, caries prevention, and treatment modalities in various settings for over 40 years.

The efficacy of Er,Cr:YSGG laser and contemporary universal adhesive systems on composite resin repair bond strength: an in vitro study

The aim of this study is to investigate the repair bond strength of composite resin following three different surface treatments (bur-grinding, silanization, and Er,Cr:YSGG laser irradiation) using various universal adhesives. A total of 160 resin composite specimens, produced in cylindrical form (6 × 2 mm) with a nanohybrid composite resin within metal molds, were subjected to 5000 cycles of aging in a thermocycler. The aged samples were categorized into four groups based on surface treatments: control, bur, silane, and Er,Cr:YSGG laser. Following surface treatments, the specimens underwent repair using the same resin composite and four different adhesive systems: Tokuyama Universal Bond (TUB), Prime Bond Universal (PBU), Gluma Bond Universal (GBU), and Clearfil SE Bond (CSB). Subsequently, the specimens were subjected to shear forces, and statistical analysis was performed using two-way ANOVA and Tukey tests (p < 0.05). The failure modes were examined using a stereomicroscope, and the surface topography of the roughened resin composite was assessed through scanning electron microscopy (SEM). Results indicated that silane + GBU exhibited the highest shear bond strength (SBS) (15.61 MPa) while control + TUB showed the lowest SBS (7.63 MPa). Silane demonstrated significantly higher SBS values (p ≤ 0.05), with no significant difference observed between bur and laser methods (p = 0.998). It is recommended to include an additional silanization step before applying universal adhesive, as it effectively enhances the bond strength of the repaired composite.

Comprehensive Evaluation of Long-Term Dentin Bond Strength, Water Sorption, Solubility, and Degree of Conversion of Self-Adhesive Resin Composites

PURPOSE

To evaluate the long-term microtensile bond strength (µTBS) to dentin, water sorption (WSP) and solubility (WSL), and degree of conversion (DC) of self-adhesive resin composites (SACs).

MATERIALS AND METHODS

The mid-coronal dentin of human molars was exposed, and teeth were randomly assigned to five groups according to the SACs (n = 10): 1. FIT SA F03 (FIT); 2. Experimental (EXP); 3. Fusio Liquid Dentin (FLD); 4. Vertise Flow (VER); 5. Constic (CON). The µTBS was evaluated after 24 hours (24 h) and 6 months (6 m) storage. A scanning electron microscope examined failure modes and resin-dentin interfaces. The WSP and WSL (n = 5) were evaluated following ISO 4049:2019 specifications, and DC (n = 3) was measured using Raman spectroscopy. The statistical analyses were performed accepting a significance level of p = 0.05.

RESULTS

FIT, EXP, and FLD produced significantly higher µTBS median values than VER and CON after 24 h and 6 m (p 0.05). After 6m, the µTBS median of FIT and EXP significantly decreased (p 0.05), while FLD, VER, and CON showed no significant difference (p > 0.05). FLD and CON exhibited lower WSP than FIT, EXP, and VER (p 0.05). FLD presented the lowest (p 0.05), and VER revealed the highest WSL (p 0.05). FIT and EXP showed the highest (p 0.05), and VER demonstrated the lowest DC (p 0.05).

CONCLUSIONS

Following the present study's design, SACs' bonding performance and physical properties remained restricted. Therefore, the application should be considered cautiously, and further clinical trials are necessary to evaluate their long-term performance.

A Bibliometric Analysis of the 100 Most-Cited Articles Concerning Atraumatic Restorative Treatment

INTRODUCTION

The present study aimed to identify the 100 most-cited articles concerning atraumatic restorative treatment (ART) through a bibliometric analysis.

METHODS

The search was conducted in the Web of Science database in December 2023. Scopus and Google Scholar were used to compare the number of citations. The following data were extracted from the articles: title, authors, number of citations, access type, institution, country, continent, year of publication, journal, keywords, study design, and theme. Collaborative networks were generated using the VOSviewer software. Google Trends was used to investigate the global popularity of "atraumatic restorative treatment" research.

RESULTS

The 100 selected articles, published between 1996 and 2019, were cited 5,092 times, ranging from 21 to 239 citations. CariesResearch (12%) and Community Dentistry and Oral Epidemiology (12%) published the highest number of articles. Clinical study (52%) was the most prevalent study design. The main theme addressed was restoration longevity (43%). Conventional high-viscosity glass ionomer was the most used restorative material (69%). The country with the highest number of articles was The Netherlands (33%) and Europe was the continent with most publications (38%). The Radboud University of Nijmegen had the highest number of articles (25%). Frencken was the most prominent author (38%). The most common keyword was "atraumatic restorative treatment" (n = 60). According to Google Trends, Tanzania was the country that searched the most about ART.

CONCLUSION

The 100 most-cited articles on ART were mainly composed of clinical studies focusing on the longevity of restorations and originated in Europe.

Ion release of the glass ionomer restoration with silver diamine fluoride dentin pretreatment

OBJECTIVE

To assess the fluoride and silver ion release of glass ionomer cement (GIC) restorations, including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations, with 38 % silver diamine fluoride (SDF) solution dentin pretreatment.

METHODS

Eighty dentin blocks were allocated into 4 groups and restored with SDF+CGIC, CGIC, SDF+RMGIC and RMGIC, respectively. Each block was stored in deionized water at 37 °C for 2 years. Fluoride and silver ion concentration in storage solution was measured using ion-selective electrode and inductively coupled plasma-optical emission spectrometry for up to 2 years. The cross-sectional surfaces of restored dentin blocks were assessed by X-Ray diffraction analysis (XRD), scanning electron microscope (SEM) with energy-dispersive X-ray spectroscopy (EDS) after 1 week and 2 years, respectively.

RESULTS

The mean ± standard deviation (SD) of accumulative fluoride releasing in SDF+CGIC, CGIC, SDF+RMGIC and RMGIC for 2 years were 0.13±0.005 mg, 0.09±0.006 mg, 0.15±0.008 mg and 0.05±0.003 mg, respectively (Groups SDF+RMGIC > SDF+CGIC > CGIC >RMGIC, p < 0.05). The mean ± SD of accumulative silver releasing in SDF+CGIC, CGIC, SDF+RMGIC and RMGIC for 2 years were 0.03±0.009 mg, 0.00±0.00 mg, 0.01±0.003 mg, and 0.00±0.00 mg, respectively (Groups SDF+CGIC > SDF+RMGIC > CGIC&RMGIC, p < 0.05). Groups SDF+CGIC and SDF+RMGIC showed sustainably higher fluoride and silver releasing compared to Groups CGIC and RMGIC (p < 0.05). XRD analysis indicated the fluorapatite and silver chloride were observed only in Groups SDF+CGIC and SDF+RMGIC, but not in Groups CGIC and RMGIC. SEM images of the cross-sectional view of the dentin blocks showed silver crystals within dentinal tubules 1 week and 2-year in Groups with SDF pretreatment.

CONCLUSION

The 38 % SDF dentin pretreatment sustainably increased the fluoride and silver release of GIC and RMGIC restorations for up to 2 years.

Frequent toothbrushing boosts resilience among children in poverty: results from a population-based longitudinal study

BACKGROUND

Poverty negatively impacts beneficial aspects of mental development, such as resilience. Toothbrushing, an oral health behavior, has the potential to protect children's resilience through its anti-inflammatory and self-management effects and may be more effective for children, especially children in poverty. This study investigated whether toothbrushing boosts resilience among children, especially children under poverty, and modifies the association between poverty and resilience using a longitudinal population sample of school children.

METHODS

Data from the Adachi Child Health Impact of Living Difficulty (A-CHILD Study) were analyzed. A baseline study was conducted in 2015 in which the children were in first grade and followed through fourth grade (N = 3459, response rate: 80%, follow-up rate: 82%). Poverty was assessed by material deprivation (life-related deprivation and child-related deprivation) and annual household income at baseline. Children's toothbrushing frequency was assessed at baseline and classified into less than twice a day or twice or more a day. Children's resilience was assessed at baseline and follow-up using the Children's Resilient Coping Scale (range 0-100).

RESULTS

Children who brushed their teeth twice or more a day in first grade had 3.50 points greater resilience scores in fourth grade than those who brushed their teeth less than twice a day in first grade. After adjusting for confounders, including resilience in first grade, among underpoverty children, those who brushed their teeth twice or more a day in first grade had higher resilience scores [2.66 (95% CI = 0.53, 4.79)] than those who brushed their teeth less than twice a day. Among nonpoverished children, toothbrushing frequency in first grade did not significantly correlate with resilience in fourth grade.

CONCLUSIONS

The beneficial effect of toothbrushing twice or more a day on resilience was more significant among children in poverty than among those without poverty in elementary school in Japan. Health policy focused on frequent toothbrushing may contribute to boosting resilience among children living in poverty.

Impact of COVID-19 on pediatric dental care in two epicenters: Italy and Brazil

The study aimed to compare the adherence of Brazilian and Italian pediatric dentists to the biosafety measures and operative protocols recommended by the health authorities during COVID-19 pandemic and to classify the participants according to their risk of infection. An online questionnaire with 34 questions about sociodemographic and occupational data, dental practice organization, biological risk management, and clinical operative protocols was sent to Brazilian and Italian pediatric dentists using a convenience sampling strategy. Chi-square test and multivariate analysis (two-step cluster) were performed (α = 5%). Of 641 respondents (377 Brazilians and 264 Italians), most were female (94% and 70%, respectively), aged 20-39 years (63%), with over 10 years of professional experience (58% and 49%, respectively). Based on adherence to recommended biosafety measures, participants were classified as "safer" (n = 219) or "less safe" (n = 422). Adherence to recommended protocols by the majority of participants resulted in low contagion rates (Brazilians = 5%; Italians = 12.5%). Participants with extensive professional experience in the dental setting exhibited a greater tendency to implement multiple adaptations (three or more) in their practice. Most participants (Brazilians = 92%; Italians = 80.7%) adopted the recommended minimal intervention dentistry approaches, with the use of fissure sealants and the use of non-rotary instruments for caries removal the most frequently techniques used among Brazilians (36%) and Italians (66%), respectively. Two different profiles of pediatric dentists were identified based on the biosafety protocols adopted during the pandemic. In addition, changes were implemented in the dental care provided to children, with focus on the minimal intervention dentistry.

Does the Self-Reported Behavioural Automaticity Index provide a valid measure of toothbrushing behaviour in adults?

BACKGROUND

Studies to promote regular toothbrushing usually rely on self-reports of toothbrushing frequency (SRF). However, toothbrushing frequency measures may be open to responder bias since twice-daily toothbrushing is a commonly accepted social norm. The validity of SRF measures is unclear, meaning that their use as outcomes in interventional work may be flawed. The study's aim was to compare two different self-reported toothbrushing measures: SRF and the Self-Reported Behavioural Automaticity Index (SRBAI); with measurement of observed toothbrushing frequency tracked over 6 weeks. A secondary aim was to explore the interaction effect of various moderators (age, ethnicity, socioeconomic status (SES), sex, self-efficacy, participant personality and routine preference) upon the correlation between SRBAI and observed toothbrushing frequency.

METHODS

One hundred and sixty-four adults were recruited via a number of different community groups and workplaces outside the dental setting. After consent, participants completed a questionnaire which collected demographic and participant characteristics measures (age, ethnicity, SES, sex, self-efficacy, participant personality and routine preference) and self-reported toothbrushing habits. Participants then attached a 'Brushlink' device to their toothbrush for 6 weeks to track their observed toothbrushing frequency.

RESULTS

Using the Pearson correlation coefficient, a moderately strong positive linear association (r = 0.65) between SRBAI and observed toothbrushing frequency was found. By comparison, the correlation between SRF and observed toothbrushing frequency was weak (r = 0.39). There was a weak positive association between self-reported behaviour frequency and SRBAI score (r = 0.35). Using multivariable linear regression, no statistically significant interactional effect was demonstrated for any moderator variable upon the correlation coefficient of SRBAI and observed toothbrushing frequency.

CONCLUSIONS

The SRBAI provided a stronger association with observed toothbrushing frequency than the SRF measure. A moderately strong relationship between SRBAI and observed toothbrushing frequency was found, compared to a weak positive relationship between self-reported behaviour frequency and SRBAI score. This suggests that the SRBAI score could be a suitable proxy to measure observed toothbrushing behaviour and preferable to SRF in interventional work.

Evaluation of dentin features in teeth after caries removal by three techniques (chemomechanical, mechanical with a smart bur, and air-abrasion): an in vitro study

Background

Different methods for removing dental carious lesions exist, including conventional rotary caries removal and new advanced technology like polymer-based burs, chemomechanical agents, air abrasion, and laser.

Objectives

This study shows the differences in features of dentin (smear layer, patency of dentinal tubules, surface irregularities, intertubular micro porosities, and exposed dentinal tubules) among different types of caries removal techniques.

Materials and Methods

An in vitro study was done on 60 primary molars with occlusal class I active caries. Teeth were divided into three groups according to a method of caries removal (G1: chemomechanical, G2: mechanical with a smart bur, and G3: air-abrasion). After complete caries excavation, the teeth were examined under a scanning electronic microscope (SEM) with the power of magnification 4,000x and 8,000x to show the morphological dentinal features with SEM microphotographs. Data obtained was analyzed using the SPSS program where Fisher exact, Kruskal-Wallis and multiple Wilcoxon sum rank tests were used. The level of significance is when the p-value is less than 0.05.

Results

Generally, SEM showed the highest ratio of score 1 of smear layer presence, surface irregularities, and microporosity in all groups in both magnifications. The patency of tubules showed the highest ratio of score 1 in G1, scores 2 in both G2 and G3 in magnification 4,000x, while 8,000x there was the highest ratio of its score 1 in G1 and G2 while the G3 has score 2 as the highest score. The exposed dentinal tubules showed the highest ratio in G1 in score 3, in G2 in score 2, and in G3 in score 1 in magnification 4,000x, while 8,000x there was the highest ratio of its score 2 in both G1 and G3 while the G3 has highest score 1. The study with magnification 4,000x showed a significant difference (S) among three groups in exposed dentinal tubules with a p-value (0.012), and there was S between chemomechanical and smart, chemomechanical and air-abrasions groups with a p-value (0.041, 0.001 subsequentially). Other dentin features showed non-significant differences (NS) among or between groups in both magnifications (4,000x, 8,000x).

Conclusions

All groups were effective in removing caries and can successfully treat young, scared or stressed patients. All methods of caries removal produce clinically parametric changes in the residual dentin.

Developing a novel glass ionomer cement with enhanced mechanical and chemical properties

OBJECTIVE

To develop a novel glass ionomer cement (NGIC) with enhanced mechanical and chemical properties and assess its biocompatibility, mechanical strength, and ion release.

METHODS

Nanosilver doped bioactive glass (NanoAg BAG) was synthesized by sol-gel method and characterized by scanning electron microscopy with energy-dispersive X-ray spectroscopy and transmission electron microscopy. The NanoAg BAG, together with poly(vinylphosphonic acid) (PVPA), alumino-fluorosilicate glass and poly-acrylic acid were used to synthesize NGIC. The optimal PVPA concentration for NGIC was determined by PVPA modified GIC's biocompatibility and mechanical properties and used to prepare NGIC specimens. NGIC specimens with NanoAg BAG at 0%, 1%, 2%, and 5% were allocated into Groups NGIC0, NGIC1, NGIC2, and NGIC5, respectively. The biocompatibility, surface morphology, elemental composition, surface topography, chemical properties, compressive strength, diametral tensile strength, and ion release of the NGIC were assessed. A conventional glass ionomer cement (GIC) was used as a control.

RESULTS

A granular BAG with nano silver particles attached on its surface were found, indicating the successful synthesis of NanoAg BAG. PVPA at 10% presented the best effect in enhancing the biocompatibility and mechanical properties of PVPA modified GIC and was used to prepare NGIC specimens. NGIC1 showed similar biocompatibility, surface morphology and topography to GIC. Chemical properties results showed that NGICs showed the same adsorption peaks to GIC. The compressive strength (mean±SD in MPa) was 168.1 ± 29.7, 205.5 ± 29.5, 221.8 ± 46.8, 216.6 ± 59.3 and 167.7 ± 36.4, and the diametral tensile strength (mean±SD in MPa) was 14.1 ± 1.7, 18.3 ± 4.9, 21.2 ± 2.2, 17.2 ± 3.8 and 13.3 ± 3.3 for GIC, NGIC0, NGIC1, NGIC2 and NGIC5 respectively. NIGC0, NGIC1 and NGIC2 showed higher compressive and diametral tensile strength than GIC (p < 0.01). NGIC2 and NGIC5 showed higher release of fluoride, calcium, phosphate and silver ion than GIC and NGIC0 (p < 0.05).

CONCLUSION

A biocompatible NGIC with enhanced mechanical properties were developed. It presented enhanced fluoride, calcium, phosphate and silver ion release compared to conventional GIC.

Investigation on the Biaxial Flexural Strength of Universal Shade Resin-Based Composites

The biaxial flexural strength of universal shade and conventional dental resin-based composites before and after alkaline degradation was investigated. Disk samples were prepared from these resin-based composites, and some of the specimens were immersed in 0.1 M NaOH solution to create deteriorated samples. The biaxial flexural strength of the samples before and after the alkaline degradation test was measured and statistically tested. The fracture surfaces after the biaxial flexural test were observed using a scanning electron microscope. The results showed that the biaxial flexural strength of the paste-type universal shade resin-based composite before alkaline degradation was significantly (19%) higher than that of the conventional type, but no difference was observed between the materials after alkaline degradation. On the other hand, the biaxial flexural strength of the flowable universal shade resin-based composites was significantly (around 35%) lower than that of the conventional composite, with or without degradation. Although, for paste-type materials, the biaxial flexural strength of universal shade resin-based composites was higher than that of conventional resin-based composites before alkaline degradation, after degradation the two materials showed similar values. For flowable materials, the biaxial flexural strength of universal shade resin-based composites was lower than that of conventional resin-based composites regardless of the presence or absence of degradation processes. These results suggest that some caution should be used when deciding whether to use flowable universal shade resin-based composite to fill a cavity.

Salivary and urinary assessment of fluoride and silver ion concentrations after silver diamine fluoride application in children: a prospective cohort study

PURPOSE

The purpose of the study was to determine the fluoride (F) and silver (Ag) ions levels in the saliva and urine of healthy children after silver diamine fluoride (SDF) application on dental carious lesions.

METHODS

Sixty children (4-6 years with ≥ 3 caries lesions) were recruited from the outpatient department of Pediatric Dentistry. From each child, 3 ml unstimulated saliva samples were collected at baseline, one hour, and 24 h after SDF application. Similarly, 3 ml urine samples were collected prior to and after 24 h of SDF application. F and Ag ion concentrations were determined by fluoride ion-selective electrode (ISE) and inductively coupled plasma mass spectrometry (ICPMS), respectively.

RESULTS

The mean ± standard deviation (SD) baseline, 1-h, and 24-h salivary F concentrations (ppm) were 0.07 ± 0.07, 0.93 ± 0.48, and 0.19 ± 0.19, respectively, while the mean baseline and 24-h urinary F concentrations (ppm) were 0.33 ± 0.20 ppm and 0.43 ± 0.25 ppm, respectively. The mean baseline, 1-h, and 24-h salivary Ag concentrations (ppb) were 4.22 ± 3.15, 4198 ± 350, and 56.93 ± 37, respectively. The mean baseline and 24-h urinary Ag concentrations (ppb) were 2.80 ± 2.93 ppb and 4.72 ± 4.0 ppb, respectively. There were statistically elevated F and Ag ion concentrations at 1 h and 24 h after SDF application as compared to the baseline.

CONCLUSION

Salivary and urinary F and Ag ions concentrations elevated significantly at 24 h following SDF applications in children. A significant high recovery of these ions in urine indicates minimal systemic absorption, thus intermittent topical application of 38% SDF has a minimal risk of toxicity.

Nanoflower hydroxyapatite's effect on the properties of resin‐based dental composite

To investigate the reinforcing effect of nanoflower‐like hydroxyapatite (NFHA) in resin‐based dental composites, we synthesized a novel NFHA using microwave irradiation (MW), hydrothermal treatment (HT), and sonochemical synthesis (SS). Silanized NFHA was then used as the reinforcing filler in dental resin composites. We characterized the structure and morphology of various HA nanostructures using x‐ray diffraction, scanning electron microscope, and TEM. The mechanical performance of dental resin composites reinforced with silanized NFHA was measured using a universal testing machine. Spherical HA, synthesized through chemical precipitation (CP), served as the control group. One‐way analysis of variance was employed for the statistical analysis of the acquired data. The results demonstrate that the nanoflower morphology significantly was improved mechanical and physical properties. After conducting trials, the NFHA synthesized using MW and HT showed a substantial enhancement in mechanical and physical properties compared to the other structures. Therefore, it can be concluded that NFHA can serve as a novel reinforcing HA filler, providing regenerative properties to resin composites with sufficient mechanical strength.

Evaluation of resin infiltration for inhibiting initial caries progression: An in vitro study using Micro-Computed Tomographic analysis

Objective

To evaluate the changes in lesion depth and mineral density of resin infiltration-treated white spot lesions against a simulated oral environment using thermal and acidic challenges in vitro.

Materials and methods

Two enamel slabs were prepared from each buccal surface of permanent human premolars, for a total of 56 slabs. Artificial white spot lesions were induced. One specimen was treated with resin infiltration, while the other was used as an untreated control. A micro-CT was used to assess the lesion depth and mineral density of each specimen. Subsequently, all specimens were subjected to 10,000 cycles of thermocycling and pH cycling for 10 days before being re-evaluated using the micro-CT. Lesion depth and mineral density were examined and compared between before and after aging procedures within each group by the paired sample t-test. The independent samples t-test was utilized to compare lesion depth progression and percentage change of mineral density between groups.

Results

After aging, there was both a significant lesion depth progression and a mineral loss in the control and resin infiltration groups. Mean lesion depth progression was 132.88 ± 4.18 µm for the control group and 52.31 ± 4.16 µm for resin infiltration group. Percentage mineral density loss as a percentage for the control and resin infiltration groups were 16.1 ± 0.64 % and 8.83 ± 0.30 %, respectively. The resin infiltration group demonstrated a significantly lower mean lesion depth progression and percentage changes in mineral loss compared to the control group.

Conclusions

The lesion depth and mineral density changes in the resin infiltrated-treated group were lower than untreated white spot lesions after aging procedures using thermal and acidic challenges.

Clinical significance

Resin infiltration is a promising approach to inhibit the progression of white spot lesions related to the initial stage of dental caries.

Silver Diamine Fluoride in Pediatric Dentistry: Effectiveness in Preventing and Arresting Dental Caries-A Systematic Review

BACKGROUND

Tooth decay is considered a global scourge by the World Health Organization (WHO) starting at an early age. In recent years, silver diamine fluoride (SDF) has regained interest, particularly in pediatric dentistry, used to prevent the development of carious lesions or arrest their progression.

OBJECTIVE

The aim of this study was to assess, through a systematic review of the literature, the effectiveness of SDF, used in pedodontics, in temporary teeth, in preventing or arresting dental caries.

MATERIAL AND METHODS

An electronic search was conducted on PubMed, Web of Science and Scopus. The effect of SDF on both temporary and permanent teeth has been considered.

RESULTS

The inclusion criteria identified 16 randomized controlled trials involving patients aged 18 months to 13 years and followed over a period of 12-30 months.

CONCLUSIONS

SDF is a practical, accessible and effective non-invasive way to prevent and arrest caries in temporary and permanent teeth. Its application requires regular monitoring. The resulting black spot is diminished by immediate application of potassium iodide but this may affect its effectiveness.

Characterisation of experimental flowable composites containing fluoride-doped calcium phosphates as promising remineralising materials

OBJECTIVE

Remineralising composites with antibacterial properties may seal the cavity and prevent secondary caries. This study aimed at developing experimental flowable composites containing different concentrations of fluoride-doped calcium phosphate fillers and evaluating their remineralising and antibacterial properties.

METHODS

Experimental resin-based composites containing different concentrations (0-20 %) of fluoride-doped calcium phosphate fillers (VS10/VS20) were formulated. The release of calcium (Ca), phosphate (PO) and fluoride (F) ions was assessed for 30 days. Remineralisation properties were evaluated through ATR-FTIR and SEM/EDX after storage in simulated body fluid (SBF). The metabolic activity and viability of Streptococcus gordonii was also evaluated through ATP, CFU and live/dead confocal microscopy. The evaluation of specific monomer elution from the experimental composites was conducted using high-performance liquid chromatography (HPLC).

RESULTS

The composites containing VS10 showed the highest release of Ca, those containing VS20 released more F over time (p < 0.05), while there was no significant difference in terms of PO ions release between the groups (p > 0.05). A quick 7-day mineral precipitation was observed in the tested composites containing VS10 or VS20 at 10 %; these materials also showed the greatest antibacterial activity (p < 0.05). Moreover, the tested composites containing VS10 presented the lowest elution of monomers (p < 0.05).

CONCLUSIONS

Innovative composites were developed with low monomers elution, evident antibacterial activity against S. gordonii and important remineralisation properties due to specific ions release.

CLINICAL SIGNIFICANCE

Novel composites containing fluoride-doped calcium phosphates may be promising to modulate bacteria growth, promote remineralisation and reduce the risk of cytotoxicity related to monomers' elution.

An animal study on the effectiveness of platelet-rich plasma as a direct pulp capping agent

Direct pulp capping (DPC) is a conservative approach for preserving tooth vitality without requiring more invasive procedures by enhancing pulp healing and mineralized tissue barrier formation. We investigated the effectiveness of Platelet Rich Plasma (PRP) vs. Mineral Trioxide Aggregate (MTA) as a DPC agent. Forty-two teeth from three mongrel dogs were divided into two equal groups. After three months, the animals were sacrificed to evaluate teeth radiographically using cone-beam computerized tomography, histopathologically, and real-time PCR for dentin sialophosphoprotein (DSPP), matrix extracellular phosphoglycoprotein (MEPE), and nestin (NES) mRNA expression. Radiographically, hard tissue formation was evident in both groups without significant differences (p = 0.440). Histopathologic findings confirmed the dentin bridge formation in both groups; however, such mineralized tissues were homogenous without cellular inclusions in the PRP group, while was osteodentin type in the MTA group. There was no significant difference in dentin bridge thickness between the PRP-capped and MTA-capped teeth (p = 0.732). The PRP group had significantly higher DSPP, MEPE, and NES mRNA gene expression than the MTA group (p < 0.05). In conclusion, PRP enables mineralized tissue formation following DPC similar to MTA, and could generate better cellular dentinogenic responses and restore dentin with homogenous architecture than MTA, making PRP a promising alternative DPC agent.

Volumetric analysis after caries excavation with caries detecting dyes and chemomechanical caries removal agents using 3D scanner-a randomised clinical trial

AIM

This research aimed to use an extra-oral 3D scanner for conducting volumetric analysis after caries excavation using caries-detecting dyes and chemomechanical caries removal agents in individuals with occlusal and proximal carious lesions.

METHODS

Patients with occlusal (A1, A2, A3) and proximal carious lesions (B1, B2, B3) were treated with the conventional rotary technique, caries detecting dyes (CDD) and chemomechanical caries removal (CMCR) method on 90 teeth (n = 45 for each). Group A1, B1: Excavation was performed using diamond points. Group A2, B2: CDD (Sable Seek™ caries indicator, Ultradent) was applied and left for 10 s, and then the cavity was rinsed and dried. For caries removal, diamond points or excavators were used. Group A3 and B3: BRIX3000 papain gel was applied with a micro-brush for 20 s and was activated for 2 min, and then the carious tissue was removed with a sharp spoon excavator. Post-excavation cavity volume analysis was performed using a 3D scanner. The time required and the verbal pain score (VPS) for pain were scored during excavation. Post-restoration evaluation was performed at 1, 3, and 6 months FDI (Federation Dentaire Internationale) criteria.

RESULTS

Comparison of age, time and volume with study groups were made using Independent Sample' t' test and one-way analysis of variance (ANOVA) for two and more than two groups, respectively. Using Cohen's Kappa Statistics, evaluators 1 and 2 agreed on caries removal status aesthetic, functional and biological properties at different follow-ups. The chi-square test revealed that the rotary groups [A1(2.5 ± 0.4 min) B1(4.0 ± 0.4 min)] had significantly less (p = 0.000) mean procedural time than CDD [A2(4.5 ± 0.4 min) B2(5.7 ± 0.4 min)] and CMCR [A3(5.4 ± 0.7 min) B3(6.2 ± 0.6 min)] groups. The CMCR group showed better patient acceptance and less pain during caries excavation than the rotary and CDD groups. CMCR group showed significantly less mean caries excavated volume(p = 0.000). Evaluation of restoration after 1-, 3-, and 6-month intervals was acceptable for all the groups.

CONCLUSION

Brix3000 helps effectively remove denatured teeth with less pain or sensitivity. The time required for caries removal was lowest in the rotary method and highest in the brix3000 group, while the volume of caries removed was the lowest for brix3000 and highest for the rotary group.

Application of omics technologies in cariology research: A critical review with bibliometric analysis

OBJECTIVES

To review the application of omics technologies in the field of cariology research and provide critical insights into the emerging opportunities and challenges.

DATA & SOURCES

Publications on the application of omics technologies in cariology research up to December 2022 were sourced from online databases, including PubMed, Web of Science and Scopus. Two independent reviewers assessed the relevance of the publications to the objective of this review.

STUDY SELECTION

Studies that employed omics technologies to investigate dental caries were selected from the initial pool of identified publications. A total of 922 publications with one or more omics technologies adopted were included for comprehensive bibliographic analysis. (Meta)genomics (676/922, 73 %) is the predominant omics technology applied for cariology research in the included studies. Other applied omics technologies are metabolomics (108/922, 12 %), proteomics (105/922, 11 %), and transcriptomics (76/922, 8 %).

CONCLUSION

This study identified an emerging trend in the application of multiple omics technologies in cariology research. Omics technologies possess significant potential in developing strategies for the detection, staging evaluation, risk assessment, prevention, and management of dental caries. Despite the numerous challenges that lie ahead, the integration of multi-omics data obtained from individual biological samples, in conjunction with artificial intelligence technology, may offer potential avenues for further exploration in caries research.

CLINICAL SIGNIFICANCE

This review presented a comprehensive overview of the application of omics technologies in cariology research and discussed the advantages and challenges of using these methods to detect, assess, predict, prevent, and treat dental caries. It contributes to steering research for improved understanding of dental caries and advancing clinical translation of cariology research outcomes.

Brazilian dentist's knowledge of minimum intervention dentistry for caries management: application of a developed knowledge scale (MIDDeC-KS) and evaluation of its psychometric properties

AIM

To assess the knowledge of Brazilian dentists about Minimum Intervention (MI) using a Minimum Intervention Dentistry to Dental Caries-Knowledge Scale (MIDDeC-KS) and evaluate its psychometric properties.

MATERIALS AND METHODS

An online scale was developed to evaluate dentists' knowledge about MI. The higher the score, the greater the knowledge and vice versa. A preliminary study was carried out with 143 dentists to validate the MIDDeC-KS. For psychometric properties analysis, convergent and discriminant validity, test-retest reliability, and internal consistency of the instrument were assessed. After validation, MIDDeC-KS was applied to a representative sample of Brazilian dentists. T test for independent samples, Chi-square, and/or ANOVA one-way tests were applied.

RESULTS

The MIDDeC-KS convergent (Spearman's = 0.48) and discriminant (P = 0.001) validity and reliability (ICC = 0.85, α = 0.72 and ω = 0.74) were proved. The participants (n = 637) obtained an overall mean score of 7.4 ± 2.5. The sample was mainly composed of females (P < 0.01), who graduated over 10 years prior (P = 0.02), from public colleges (P < 0.01), and most were pediatric dentists (38.2%). The highest and lowest scores were reached by pediatric dentists (9.2 ± 1.6) and bucomaxillofacial professionals (3.1 ± 2.1), respectively. Brazilian dentists demonstrated more knowledge about diet, biofilm, and topical fluoride control (84.3%), while the Hall technique (31.9%), resin infiltrant (47.6%), and chemical mechanical caries removal (48.4%) were the least known MI techniques.

CONCLUSION

Brazilian dentists demonstrated more knowledge about preventive measures and less about more recent protocols, such as the Hall technique, resin infiltrant, and chemical mechanical caries tissue removal. Sufficient psychometric evidence of the MIDDeC-KS was found.

CLINICAL RELEVANCE

Identify dentist's knowledge about MI.

Clinical Effectiveness of High-viscosity Glass Ionomer Cement and Composite Resin as a Restorative Material in Primary Teeth: A Systematic Review of Clinical Trials

Aim

This systematic review was designed to compare the clinical effectiveness of high-viscosity glass ionomer cement (HVGIC) restorations to direct composite resin (CR) restorations in single- or multisurface cavities in primary teeth.

Background

Restorative procedures are typically used to treat caries in primary teeth. Due to their improved preservation of the natural tooth structure and their adhesion to the remaining tooth structure, CR and GIC have drawn attention as the preferred restorative materials. In the literature, over the past 20 years, the term HVGIC has developed. Compared to C-GICs, HVGICs appear to have a higher survival rate. However, isolated studies provide contradictory findings regarding the durability of restorations in primary teeth.

Materials and methods

Major electronic databases were thoroughly searched to find publications from the years 2000 to 2021. Studies included were randomized and nonrandomized clinical trials on children aged 3-13 years, in which restoration of primary teeth using HVGIC and CR was performed.

Results

This systematic review includes four studies [three randomized controlled trials (RCTs) and one nonrandomized controlled trial]. No statistically significant difference between these materials was seen in any of the included studies.

Conclusion

This systematic review of findings supports the assertion that both HVGIC and CR restorations deliver satisfactory outcomes in terms of clinical efficacy and overall survivability. It was found that, for both materials, class I restorations had statistically higher survival rates than class II restorations. Long-term studies are essential to evaluate the clinical efficacy of both restorations.

Clinical significance

This systematic review outlines the application of HVGIC and CR as restorative materials for pediatric dentists to use in their everyday dental practices.

How to cite this article

Krishnakumar K, Kalaskar R, Kalaskar A, et al. Clinical Effectiveness of High-viscosity Glass Ionomer Cement and Composite Resin as a Restorative Material in Primary Teeth: A Systematic Review of Clinical Trials. Int J Clin Pediatr Dent 2024;17(2):221-228.

In Vitro Evaluation of Mechanical Properties of Cention N and Its Comparison with Resin Modified Glass Ionomer Cement (RMGIC) Restorative Material as Used in Primary Teeth

Methods

22 specimens prepared with Cention and RMGIC were embedded in primary teeth mounted in acrylic for analysing shear bond strength. Shear bond strength was analysed using a universal testing machine. The modes of failure in samples were observed under a stereomicroscope and scanning electron microscope. 22 customised samples of Cention N and RMGIC were prepared and categorised as group A and group B, respectively. The flexural and compressive strengths of these samples were evaluated using a universal testing machine.

Results

The shear bond strength of RMGIC was higher than that of Cention N, whereas the compressive and flexural strengths of Cention N were significantly higher than those of RMGIC. The modes of failure were predominantly adhesive followed by mixed failures.

Conclusion

The results of this study suggest that Cention N demonstrated superior mechanical properties compared with RMGIC and can therefore be recommended for restorations in primary posterior teeth. Cention N being a smart, esthetic, self-cured, or dual-cured material with better mechanical properties offers a wide range of applicability in primary teeth.

Integration of an evidence-based caries management approach in dental education: The perspectives of dental instructors

PURPOSE/OBJECTIVES

Evidence-based caries management (EBCM) has developed into an internationally recognized tool for integration of comprehensive non-surgical caries treatment in dental education. However, uptake of the EBCM approach remains uneven across Canadian dental schools. Our project sought to understand how dental instructors perceive the challenges and solutions to the integration of the EBCM approach in undergraduate clinical education.

METHODS

Using a qualitative descriptive design, we recruited a purposeful sample of clinical instructors supervising undergraduate dental students in caries-related dental care. Semi-structured, online interviews focused on the main characteristics of EBCM. Interviews were analyzed using the awareness, desire, knowledge, ability, and reinforcement (ADKAR) change management model to understand challenges with EBCM implementation in undergraduate education. The analysis process started with verbatim transcription; then, transcripts were coded deductively based on the interview guide and the ADKAR model domains, and inductively to generate emergent codes. Finally, thematic analysis was used to develop themes and subthemes.

RESULTS

We interviewed 11 dental instructors with a wide range of clinical experience. Our results show that participants had sufficient awareness regarding the need for the EBCM approach and portrayed a strong desire to participate in bringing curricular changes. Knowledge and ability of participants depended on their training, experience, and involvement in continuing education courses. A lack of standardized caries management practices, less chairside time, and poor remuneration for instructors were major barriers in EBCM clinical implementation. Potential solutions suggested included providing continuing education courses, credits for students for non-surgical caries management, and remunerating instructors for implementation.

CONCLUSIONS

In conclusion, most participants were aware of the need for a substantive change toward EBCM and demonstrated the desire to participate and improve its implementation. Our analysis showed that to facilitate full integration of the EBCM approach into the undergraduate dental clinics, organizational focus needs to be placed on the individual's knowledge and ability, with tailored efforts toward reinforcement.

Detection, Diagnosis, and Monitoring of Early Caries: The Future of Individualized Dental Care

Dental caries remains a significant global health issue. It was highlighted by the World Health Organization's 2022 reports that despite the efforts and scientific advancements in caries detection and management, the situation has only marginally improved over the past three decades. The persistence of this problem may be linked to outdated concepts developed almost a century ago but are still guiding dentists' approach to caries management today. There is a need to reconsider professional strategies for preventing and managing the disease. Contemporary dentistry could benefit from embracing new concepts and technologies for caries detection and management. Dentists should explore, among others, alternative methods for caries detection such as optical-based caries detection. These tools have been established for over a decade and they align with current disease understanding and international recommendations, emphasizing early detection and minimally invasive management. This narrative review presents the current state of knowledge and recent trends in caries detection, diagnosis, monitoring, and management, offering insights into future perspectives for clinical applications and research topics.

Adolescent Toothbrushing and Its Association with Sociodemographic Factors-Time Trends from 1994 to 2018 in Twenty Countries

Regular toothbrushing is the primary self-care method to prevent the most common dental diseases and is considered an important public health indicator. This retrospective observational study aimed to examine cross-national time trends in adolescent toothbrushing behaviour and its association with sociodemographic factors between 1994 and 2018. We studied data from 20 countries that conducted seven surveys of the Health Behaviour in School-aged Children (HBSC) study. Adolescents aged 11, 13 and 15 years responded to questions on their toothbrushing frequency, family affluence and structure. Altogether, reports of 691,559 students were analysed using descriptive statistics and binominal logistic regression. The findings showed an overall positive trend in the prevalence of more-than-once-a-day toothbrushing frequency during the entire study period mainly due to a noticeable increase from 1994 to 2010 (except Denmark and Sweden); this trend continued significantly thereafter in 12 of 20 countries. Across all countries, girls and adolescents from more affluent families were more likely to brush their teeth regularly. These relationships remained unchanged throughout the study period, whereas the age-related difference in toothbrushing prevalence decreased noticeably, and the negative relationship between toothbrushing and living in a non-intact family became evident. While the prevalence of regular toothbrushing among adolescents has increased in recent decades, it is still far behind the recommended level of twice-daily brushing for everyone across all countries. The promotion of toothbrushing needs to start at an early age, with a special focus on boys and adolescents from low-affluence and non-intact families.

Risk Indicators for Noncavitated and Cavitated Carious Lesions in Preschool Children

OBJECTIVE

The aim of this study was to evaluate the risk indicators associated with noncavitated and cavitated lesions in preschool children.

METHODS

The cross-sectional study included 3- to 4-year-old healthy children (N = 741) recruited in a randomised controlled clinical trial. After obtaining written informed consent, parents completed a questionnaire about their child's sociodemographic background and oral health-related behaviours and parents' oral health-related knowledge and attitude. Caries and plaque were evaluated using International Caries Detection and Assessment System-II and Visible Plaque Index (VPI), respectively. Children were grouped according to their oral health status as being caries-free (CF), having only noncavitated lesions (NC), or having cavitated lesions (CL). The least absolute shrinkage and selection operator (LASSO) sparse multinomial regression was used to study the variables using 1 standard error above the minimum criterion set at P < .05.

RESULTS

The prevalence of children with NC and CL was 29.1% and 49.4%, respectively, with a prevalence of early childhood caries being 78.5%. The proportion of children who brushed twice or more than twice a day was highest in CF (71.7%), followed by NC (58.3%), and was least in CL (57.7%). A higher percentage of CL children (56.2%) had twice or more than twice the frequency of between-meal snacking than CF (41.7%) and NC (41.1%) (P < .001) children. The variables included with non-zero coefficients in the model were mean parental oral health knowledge, attitude score, and children's mean VPI score, and all were significant for CL; however, in NC, only VPI score was found to be significant.

CONCLUSIONS

Poor oral hygiene is the risk indicator associated with the presence of NC in preschool children, whilst poor oral hygiene and poor parental oral health knowledge and attitude are associated with the presence of cavitated lesions.

Integrating patient-centered caries management in dental education-A practical approach

Caries management is undergoing an evolution in dental education. This is part of a larger change in thinking focused on the person/patient as well as procedures to bring health to people. This perspective attempts to tell the story of the dental education culture regarding caries management from perspectives of evidence-based care; caries as a disease of a person, not only a tooth; and the management of high-risk and low-risk individuals. Culturally and organizationally, the integration of basic, procedural, behavioral, and demographic perspectives for dental caries has happened at different rates for some decades. The involvement of students, teaching faculty, course directors, and administration is essential in this process.

The efficacy of combined arginine and probiotics as an add-on to 1450 ppm fluoride toothpaste to prevent and control dental caries in children - A randomized controlled trial

OBJECTIVES

To determine how daily consumption of a lozenge combining arginine and two probiotic strains affects the Relative Risk Reduction (RRR) in children regarding dental caries transitions and lesion activity at tooth surface level during 10-12 months.

METHODS

A total of 21,888 tooth surfaces in 288 children were examined. The intervention group (n = 141) received a lozenge containing 2% arginine, Lacticaseibacillus rhamnosus, LGG® (DSM33156), and Lactobacillus paracasei subsp. paracasei, L. CASEI 431® (DSM33451). The placebo group (n = 147) received a placebo lozenge. Both groups received 1,450 ppm F- toothpaste. Primary canines, molars, and first permanent molars were examined clinically (ICDAS0-6) and radiographically (R0-6) at baseline and follow-up. Sealed, filled, and missing surfaces were also included. Caries activity was computed as a sum of each caries lesion's location, color, texture, cavitation, and gingival bleeding. RRRs were computed with cluster effect on surface level. ICH-GCP was followed, including external monitoring.

RESULTS

A total of 19,950 surfaces were analyzed after excluding 1,938 tooth surfaces. No statistically significant differences were found between the groups. The RRRs showed less caries progression (13.6%, p = 0.20), more regression (0.3%, p = 0.44), and fewer active caries lesions (15.3%, p = 0.15) in the intervention group.

CONCLUSION

Daily consumption of a lozenge combining arginine and probiotics for 10-12 months given to 5-9-years-old children characterized being with low caries risk demonstrated a marked, though not statistically significant RRR for caries progression, regression, and number of active lesions in the intervention group compared to the placebo-group.

CLINICALTRIALS

gov (NCT03928587).

CLINICAL SIGNIFICANCE

Since all the RRRs were in favor of the intervention group and the PF of combined arginine and probiotics is high (81.6%) compared to fluoride toothpaste (24.9%) and arginine-fluoride toothpaste alone (19.6%) the combined pre-and probiotics approach may be a future additional tool regarding caries prevention and control.

Identification method for dental alloy type using a cosine similarity program: A preliminary investigation

Although dental evidence is frequently used for the identification of unidentified persons, information about the many types of alloys used in prosthetics is not utilized. If the type of alloy can be identified from a small amount of material, the scope of the search could be narrowed. In this experiment, a method was investigated for identifying the alloy type using 3 kinds of cutting points (a white point and 2 types of silicone points). Wavelength-dispersive X-ray spectroscopy (WDS) was used for elemental analysis. The elements were translated into multidimensional vectors, and the cosine similarity was calculated to compare vectors of the WDS results and vectors of the official data of alloys. According to the results, cosine similarity showed a concordance of more than 0.8. The developed program is expected to be useful as a method for identifying alloy types using only a small amount of grinding dust.

The Classification and Selection of Adhesive Agents; an Overview for the General Dentist

Adhesive agents are essential to most restorative procedures used in everyday practice. Depending on the clinical situation, the dentist will choose among a rapidly evolving variety of adhesive agents (bonding agents). Due to the availability of many adhesive agents, appropriate selection can take time and effort. Typically, a practitioner relies more on marketing and experience than in-depth material knowledge. The classification of adhesive agents may need to be clarified and easier to remember due to its lack of relevance to clinical procedures. This paper reviews the published literature retrieved from PubMed, Google Scholar, and Scopus by using specific keywords "adhesive agents", "classification", "dentin", "enamel", "universal", "self-etch", "etch-and-rinse", and "bonding". The titles and abstracts were screened, and the relevant literature was retrieved. The list of references from each identified article was examined to find other potentially relevant articles. Adhesive agents can be classified as etch-and-rinse, self-etch, or "multi-mode" according to their approach to interacting with the smear layer, and each approach can be further classified according to the number of clinical steps required during application. This article reviews the classification of current adhesive agents and discusses the properties that make a specific adhesive agent the optimal choice for a particular clinical indication. The review will assist the general dentist in understanding the various types of available adhesive agents and how they function. Overall, the review will facilitate decision-making and allow the selection of appropriate materials.

Knowledge and attitudes toward evidence-based cariology and restorative dentistry among Egyptian dental practitioners: a cross-sectional survey

BACKGROUND

This is the first study to assess Egyptian dental practitioners' knowledge about conservative caries management approaches and investigate whether this knowledge transfers into clinical practice and the barriers to translating research into evidence-based practice.

METHODS

A sample of dental practitioners was surveyed using an online questionnaire. Convenience and snowball sampling were used to collect data from February to June 2022. We included graduated dentists from Egyptian universities who practiced in Egypt. Data were analyzed with descriptive statistics, and the associations between variables were checked using Kruskal Wallis and Chi-Square tests.

RESULTS

This study included 396 participants from throughout Egypt. There were significant correlations between specialty and participants' knowledge and behaviors toward evidence-based caries management (p = 0.002) and between specialization and tools used to detect carious lesions (p < 0.001). Most participants (59.1%) used G.V Black's classification, and (80.8%) removed caries based on the feature of dentin hardness and color, whereas (67%) removed caries until hard dentine remained. The participants' primary hurdle to staying up-to-date was their belief that the newly gained information would not be clinically applicable due to a lack of equipment or working in low-economic areas. Patient-related barriers were the major obstacles for participants in implementing evidence-based practice.

CONCLUSION

Egyptian dentists did not fully embrace minimal invasive approaches for caries management, and practitioners' experiences continue to shape decision-making. It emphasizes the imperative to practically educate dentists using effective knowledge translation dissemination to promote evidence adoption in daily practice and advocate value-based dental care to address the economic crisis's impact on Egypt's healthcare.

Effectiveness of MI Varnish™ and PreviDent® Varnish in Noncavitated Interproximal Lesions: A Randomized Clinical Trial

Aim

Evaluating the remineralization efficacy of noncavitated proximal incipient lesions with Colgate® PreviDent® and MI™ varnishes in comparison to the industry standard (1.23%) acidulated phosphate fluoride (APF) gel.

Study design

Parallel randomized controlled, multicenter, single-blinded trial.

Materials and methods

By flipping a coin, 18 patients with 91 lesions were divided into three groups. The Colgate® PreviDent (n = 33), MI varnish (n = 30), and control (APF gel) groups (n = 28) were identified as the three arms. We conducted an initial assessment and therapy as well as follow-ups at 3 and 6 months to evaluate the course of the caries lesion.

Results and statistics

Caries progression was significantly reduced on treated surfaces across both groups. Nine surfaces in the Colgate® PreviDent® group with white spots and dryness did not change, one surface turned into a white patch without dryness, and another surface changed to a sound surface; only two surfaces were discontinued from treatment (restored) due to a misdiagnosis by the operator (n = 2). Nine of the surfaces in the MI™ group maintained their white patches with dryness, whereas one developed a new white patch that was not dry. Only MI varnish™-treated teeth exhibited dramatic radiographic improvement. Caries on the outside enamel were either unchanged or restored to healthy levels. Caries on the inner surface of the enamel also did not change.

Conclusion

Remineralizing noncavitated early-stage lesions may be done with both MI™ and Colgate® PreviDent® varnishes. Despite this, radiographic results did not vary significantly across the three groups. In situations of rather advanced incipient caries seen on radiographs, the MI varnish™ might be recommended.

How to cite this article

Helal N, Azzahrani GS, Azzouz LZ. Effectiveness of MI VarnishTM and PreviDent® Varnish in Noncavitated Interproximal Lesions: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(5):751-757.

Beyond Tradition: Non-surgical Endodontics and Vital Pulp Therapy as a Dynamic Combination

Symptomatic irreversible pulpitis and apical periodontitis in mature permanent teeth present challenges in their management. Traditional treatment approaches, such as root canal therapy or tooth extraction, may compromise tooth structure and oral function. This review article explores the combination of non-surgical endodontic treatment and vital pulp therapy as an alternative approach for these conditions. The purpose is to examine this combined approach's effectiveness, benefits, challenges, and limitations. The objectives include reviewing the literature, evaluating clinical outcomes, discussing potential benefits, and providing recommendations for clinical practice. The combination approach aims to preserve tooth structure, promote healing, and reduce postoperative complications. The article discusses the rationale for combining the two techniques, presents evidence supporting their efficacy, and outlines the techniques and protocols involved. Clinical outcomes, case studies, potential challenges, and comparative analysis with traditional approaches are also explored. Future directions and research recommendations highlight areas for further investigation, innovations, and the development of clinical guidelines. In conclusion, the combination of non-surgical endodontic treatment and vital pulp therapy offers a valuable strategy for managing mature permanent mandibular molars with symptomatic irreversible pulpitis and apical periodontitis. Further research and advancements are needed to refine the treatment protocol and expand the evidence base, and clinicians should stay updated to provide optimal care and improve patient outcomes.

Epidemiological Study of Oral Health among Children and Adolescent Schoolchildren in Melilla (Spain)

Dental epidemiological studies are essential for analysing and evaluating the population's health state and dental treatments provided, as well as for planning future oral health programme activities and interventions based on their findings. In order to determine the health condition of children and adolescents in connection to the prevalence of caries, caries indices (decayed and filled teeth (dft) for primary teeth and decayed, missing and filled teeth (DMFT) in permanent teeth) and periodontal indices (community periodontal index (CPI)), oral exams of children and adolescents aged 6, 12 and 15 from selected schools were conducted. To assess the achievement of the oral health objectives set for Spain in 2020, these data were compared with those acquired at the national level. At 6 years of age, 278 children were examined, the prevalence of caries was 55.6%, the dft index was 2.77 (±3.44), the DMFT was 0.19 (±0.16), the restorative index (RI) was 4.62%, and the significant caries (SiC) index was 8.40 (±2.07). At 12 years of age, 208 students were examined, the prevalence of caries found was 65.86%, the DMFT index was 1.85 (±2.22), the RI was 36.63%, the SiC index was 5.43 (±2.07), and children without the presence of periodontal pathology was 59.13%. At 15 years of age, 165 students were examined, the prevalence of caries was 70.06%, the DMFT was 3.08 (±3.39), the RI was 42.42%, the SiC index was 8.10 (±2.55), and adolescents without periodontal disease was 47.90%. Conclusions: Melilla-born children and adolescents had higher caries indicators and indices than the corresponding national averages for Spain. Teenagers under the age of 15 have a particularly high frequency of dental caries. The investigation of the children's origin is where there is the most disparity. Children of Berber descent have much higher values than children of European heritage.

Survival Rate of Atraumatic Restorative Treatment Restorations in Primary Posterior Teeth in Children with High Risk of Caries in the Republic of Kosovo-1-Year Follow-up

OBJECTIVE

 Atraumatic restorative treatment (ART) may be beneficial for disadvantaged populations with no or limited access to dental services. This study aimed to evaluate the survival rate of single-surface ART restorations in primary posterior teeth in children with high caries risk.

MATERIALS AND METHODS

 This study was conducted in six rural areas of the Republic of Kosovo, and 100 children aged 3 to 8 years participated in the study. Information was obtained from each parent/guardian regarding their children, such as sociodemographic characteristics, general health, dental history, dietary habits, oral hygiene, and fluoride exposure. The reduced Cariogram was used to estimate the risk of caries in the participants based on the seven factors specified in the program, and all the provided information were collected and entered in a computer program of the Cariogram. A pediatric dentist, accompanied by two assistants, performed 100 ART restorations in school settings using high-viscosity glass-ionomer cement (Fuji IX) following the nine steps of the ART procedure. The restorations were evaluated at 3, 6, 9, and 12 months using the ART restoration criteria.

STATISTICAL ANALYSIS

 Percentages, mean value, standard deviation, mean interquartile range, and difference test between arithmetic mean values were used to analyze the research results.

RESULTS

 Review of the average of reduced Cariogram showed that the majority of children, 72%, were at high risk of developing caries, with only 28% having a good chance of avoiding caries in the future. A total of 77% of the children in the study had never visited dentists before due to poor economic conditions and the lack of dentists in the area. The success rates of ART restorations performed in single-surface cavities in primary teeth were very encouraging, with more than 97% success rates after a 1-year follow-up period.

CONCLUSION

 Our results demonstrate that ART is efficient, affordable, and practical for the treatment of single-surface cavities in primary posterior teeth. Owing to its low price and atraumatic nature, ART can potentially help disadvantaged children in Kosovo access dental care.

Insertion methods and gap/void formation in atraumatic restorative technique: A micro-CT analysis

Wetting the dentin is critical to atraumatic restorative treatment. The conventional insertion can be challenging when using high-viscosity glass-ionomer cement. This study evaluated the formation of gaps and voids after three insertion methods using micro-CT. Teeth underwent removal of occlusal and proximal caries through the atraumatic restorative treatment technique. Then, they were fixed in an artificial dental arch to simulate the clinical condition and were restored using three insertion methods: conventional, Centrix injection, and double-filling. Previous dentin conditioning procedures, steel matrix and wooden wedge application, and post-insertion procedures (digital compression and surface protection) were the same. The material was inserted using a manual instrument in the conventional technique and was inserted with a syringe in the Centrix injection group. In the double-filling technique, the tooth received a first layer of a flowable ionomer (through modifying the powder/liquid ratio), and a second layer (with standard ratio) was applied before the final set of the first one. A micro-CT unit scanned each tooth before and after restoration. Each cavity was defined as the volume of interest, and the volumes of gaps and voids were calculated. Data were analyzed using one-way ANOVA and Tukey posthoc test (p < .05). Double-filling had improved filling volume with lower values for gap volume, followed by Centrix injection. The conventional technique had the highest gap volume. No statistically significant difference was observed for void volume. Double-filling demonstrated fewer gaps, followed by Centrix injection, which is critical to obtain better adhesive, remineralizing, and antibacterial activities.

Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association

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.