Restorations in primary teeth: a systematic review on survival and reasons for failures

Effects of poly(amidoamine) as an extrafibrillar demineralization agent on dentin bonding durability of deciduous teeth

OBJECTIVES

To investigate the effects of the sixth generation of poly(amidoamine) (G6-PAMAM)-based extrafibrillar demineralization on bonding durability of deciduous dentin and explore the possible mechanisms.

METHODS

The cytotoxicity and inhibitory effects on recombinant human matrix metalloproteinases-9 (rhMMP-9) of G6-PAMAM were investigated. The chelation demineralization capacity of G6-PAMAM with molecular weight > 40 kDa was quantitatively analyzed. Atomic force microscopy-infrared spectroscopy (AFM-IR) was used to verify selective extrafibrillar demineralization of dentin conditioned by G6-PAMAM. After dentin surfaces were conditioned with G6-PAMAM or phosphoric acid (H3PO4), G6-PAMAM- and H3PO4-conditioned dentin were applied with adhesive restoration using both wet- and dry-bonding technique. Microtensile bond strength (μTBS) was evaluated after 24 h storage or 10,000 thermocycling. Nanoleakage expression at the bonding interface was observed using field emission scanning electron microscopy. Gelatinolytic activity within the hybrid layer was examined using in situ zymography.

RESULTS

In addition to being nontoxic, 20 µg/mL G6-PAMAM showed inhibitory effects on rhMMP-9 and calcium-chelating capability. AFM-IR confirmed that G6-PAMAM conditioning can achieve selective demineralization of dentin extrafibrillar minerals. Deciduous dentin treated with 20 µg/mL G6-PAMAM for 60 s produced μTBS equivalent to H3PO4-based etch-and-rinse technique. Those bond strengths were maintained after thermocycling, irrespective of wet-bonding or dry-bonding. G6-PAMAM conditioning produced less nanoleakage and suppressed endogenous gelatinolytic activity compare with H3PO4 etching.

CONCLUSION

The G6-PAMAM-based extrafibrillar demineralization strategy under dry-bonding technique could enhance bonding durability of deciduous dentin by retaining intrafibrillar minerals, decreasing interfacial nanoleakage, and preventing endogenous protease-initiated collagen degradation.

CLINICAL RELEVANCE

The G6-PAMAM-based extrafibrillar demineralization strategy has the potential to improve the stability of the resin-dentin bonding interface and prolong the longevity of resin restorations in deciduous teeth.

Association between lesion depth and placement technique with failures requiring extraction of preformed metal crowns in primary molars. A retrospective study

PURPOSE

The aim of the present study was to evaluate the factors associated with failure requiring extraction after placement of preformed metal crowns (PMCs) in primary molars. Radiographic caries depth at baseline (initial/moderate and severe) and placement technique (Conventional and Hall technique) and other patient-related variables were analysed.

METHODS

Clinical and radiographic records from children aged 2-10 years who had at least one primary molar treated with PMCs between 2011 and 2019 were evaluated. Chi-square test, Fisher exact tests and logistic regression analysis (α = 5%) were performed to verify the relationship between the primary outcome and categorical variables (caries depth, restorative teachnique, jaw, tooth type and gender).

RESULTS

A total of 244 teeth treated in 165 children were included in the analysis. A total of 18 failures were observed (7.4%), of which 17 were in deep caries lesions and in which 15 had the PMC placed according to the conventional technique. Both caries lesion depth and restorative technique were associated with treatment failure (p < 0.05).

CONCLUSION

Taking into account the limitations of this retrospective study, treatment failures requiring extraction occurred more often in deep caries lesions when treated with preformed metal crowns (PMCs) following the conventional technique when compared to the Hall Technique.

Influence of different cavity disinfectants on composite adhesion to dentin of primary teeth: An in vitro study

Restorative treatment is the most common approach to treating dental caries. However, after cavity preparation, some microorganisms may still persist in the substrate, suggesting the use of cavity disinfectants. Nevertheless, their effect on adhesion to composite resins is not yet fully understood, especially in primary teeth. The study aimed to assess the impact of five different cavity disinfectants on dentin adhesion in primary teeth. A total of 60 primary molars were uniformly flattened at their occlusal thirds and randomly allocated into six groups (n = 10 each): Control; Glutaraldehyde; Chlorhexidine; EDTA; Ethanol; Aloe vera. All disinfectants were actively applied, rinsed, and air-dried. The adhesion procedure was carried out according to the manufacturer's instructions, and the restoration was positioned using a mold. Shear bond strength was evaluated. Data were statistically analyzed (One-way ANOVA with Post-hoc Tukey test), with the level of significance set at 5 %. Glutaraldehyde (14.59 ± 3.89 MPa), Chlorhexidine (11.24 ± 2.25 MPa), and EDTA (11.04 ± 2.95 MPa) did not impair the shear bond strength when compared to the Control group (14.95 ± 2.75 MPa). Ethanol and Aloe vera application significantly lowered SBS. The results suggest that Glutaraldehyde, Chlorhexidine, and EDTA can be used as cavity disinfectants. Nevertheless, further in vitro and clinical research is required.

Clinical and radiographic comparison of primary molar pulpotomy using formocresol, portland cement, and NeoMTA plus: a randomized controlled clinical trial

The present study aimed to compare the clinical and radiographic success rates of Formocresol (FC), Portland Cement (PC), and NeoMTA Plus in primary molar pulpotomy. Ninety-six primary molars in ninety-six children aged 3‒9 years were randomly assigned to FC, PC, and NeoMTA Plus groups. Radiographic and clinical follow-up evaluations were performed at six and twelve months. After six and twelve months, clinical success rates were 100% in the three groups. The radiographic success rates in the 6-month follow-up were 96.7 and 96.7% in the FC and PC groups and 100% in the NeoMTA Plus group. At 12 months, radiographic success rate was 93.8, and 93.8% in the FC and PC groups and 96.9% in the NeoMTA Plus group. There were no significant differences between the three groups at all follow-up evaluations. NeoMTA Plus showed highest success rate, clinically and radiographically. PC and NeoMTA Plus can be considered as an alternative to FC.

Survival Analysis of Prefabricated Zirconia Crowns with and Without Pulpotomy in Primary Teeth: A Retrospective Cohort Study

BACKGROUND

Prefabricated Zirconia Crowns (PZCs) are increasingly preferred for restoring primary teeth due to their esthetic appeal and retention. However, their rigid, unmodifiable design requires precise tooth preparation, often leading to aggressive reduction and potential pulp exposure. Pulpotomy, a standard treatment for reversible pulpitis and mechanical pulp exposure, is sometimes employed before PZCs. While pulpotomy is not routinely performed, its use raises important considerations about the interplay between restorative procedures and pulp therapy in pediatric dentistry, particularly regarding the long-term restoration outcomes of PZCs.

PURPOSE

This study aimed to investigate the impact of pulpotomy on the success rate of PZCs.

METHODS

We examined 81 anterior upper primary teeth treated with PZCs in children aged 2-5 years over a two-year period. Cases were divided into groups with and without pulpotomy. Follow-ups occurred at 6-month intervals, assessing clinical and radiographic outcomes. Analyses were performed using SPSS 25.0 software. The statistical significance was p < 0.05.

RESULTS

A total of 81 anterior primary teeth were included. Chi-square analysis showed no association between pulp therapy and PZC success (χ2 = 0.051, p = 0.822). The Kaplan-Meier survival analysis revealed comparable survival curves and the log-rank test showed no statistically significant difference in survival time between pulpotomy-treated and untreated groups (χ2 = 0.051, p = 0.821).

CONCLUSIONS

Pulpotomy did not significantly affect the success rate of PZCs within 2 years.

Advantages and feasibility of prefabricated PEEK crowns for aesthetic restoration in primary teeth

Objectives The main purpose of this study is to evaluate the efficacy of polyetheretherketone (PEEK) as a material for prefabricated crown restorations in pediatric dentistry, particularly for restoring primary tooth structure defects. Materials and methods This study analyzed the effects of three surface treatment modalities on PEEK's surface morphology, wettability (as measured by contact angle), and shear bond strength. These treatments included alumina (Al2O3) sandblasting alone, and in conjunction with a 98% sulfuric acid pretreatment. Subsequently, an evaluation was conducted to assess the compressive and fatigue properties of self-fabricated PEEK preformed crowns, preformed metal crowns, and preformed zirconia crowns. Results Al2O3 sandblasting followed by sulfuric acid pretreatment significantly enhanced the bond strength of PEEK. PEEK crowns, when compared with stainless steel and zirconia crowns, showed similar compressive and fatigue strengths to zirconia crowns but lower than metal alternatives. Additionally, PEEK crowns required less extensive modification of dental abutments compared to zirconia crowns. Conclusions The study concludes that PEEK prefabricated crown, especially after alumina (Al2O3) sandblasting in conjunction with a 98% sulfuric acid pretreatment, exhibits improved bond strength and favorable material characteristics for use in pediatric dental restorations. Clinical relevance The findings highlight the potential of PEEK prefabricated crowns in pediatric dentistry as a viable option for the aesthetic restoration of primary teeth, offering benefits over traditional materials like stainless steel and zirconia in terms of preferable compressive and fatigue strengths and ideal reduction of dental abutments.

Bioactive Compounds Enhance the Biocompatibility and the Physical Properties of a Glass Ionomer Cement

In order to characterize a novel restorative material, knowledge about the toxicological effect on human cells and the physical behavior of a glass ionomer cement (GIC) containing flavonoids was established. The flavonoids apigenin, naringenin, quercetin, and liquiritigenin were manually incorporated into a GIC. In the control group, no incorporation was performed. Two cell culture assays evaluated the toxicity of GICs: SRB and MTT. For both assays, the keratinocyte cell line (HaCaT) was exposed to GIC (n = 3/group) for 24 h. The physical properties of the GICs were evaluated by compressive strength (n = 10), surface roughness (n = 10), and hardness (n = 10) tests. Cell viability by SRB ranged from 103% to 97%. The control revealed a significant decrease in the metabolism of cells (61%) by MTT, while the GIC+apigenin slightly increased the succinic dehydrogenase activity (105%; p > 0.05), also confirmed microscopically. The compressive strength and roughness values were similar among groups, but the hardness increased after the incorporation of naringenin and quercetin into GIC (p < 0.05). The incorporation of flavonoids positively altered the biological and physical properties of the GICs.

Partial Amelogenesis Imperfecta: A Report of a Rare Case

Amelogenesis imperfecta is a collection of genetic disorders that impair the structure of dental enamel. The condition presents in a variety of ways, affecting enamel development, mineralization, and maturation. Amelogenesis imperfecta can follow various inheritance patterns, including autosomal dominant, autosomal recessive, sex-linked, and sporadic. This case report describes a 22-year-old female diagnosed with amelogenesis imperfecta. The patient's clinical presentation, diagnostic process, and comprehensive treatment approaches are discussed, emphasizing the importance of multidisciplinary care in improving functional and esthetic outcomes. Treatment is ongoing and aims to improve both functional and esthetic outcomes. This case report details the presentation, characteristic radiographic findings, and management discussion of a patient presented with a rare condition that is termed "partial amelogenesis imperfecta."

Adhesive restorations in primary dentition: A retrospective analysis of survival rate and associated factors

BACKGROUND

Several clinical and individual factors may play a role in the survival rate of dental restorations, such as characteristics related to the child's age and oral hygiene, and factors associated with the tooth, such as the type of material and number of surfaces to be restored.

AIM

To analyse the survival rate of adhesive restorations on primary teeth and factors associated with restoration survival.

DESIGN

The study included dental records of children aged 3-12 years having received adhesive restorations on primary teeth at a Brazilian dental school between 2009 and 2019. A Kaplan-Meier survival curve was used to plot survival rates using the log-rank test. A multivariate Cox regression model was run to identify individual and dental factors associated with restoration failure.

RESULTS

The sample comprised 269 restored teeth in 111 children. Survival curves were similar for all materials (p = .20) and types of isolation (p = .05). The annual failure rate was 3.60% for glass ionomer cement, 1.23% for resin-modified glass ionomer cement and 0.40% for composite resin. The following variables were associated with more failures: Class II restoration compared with Class I (HR = 1.96; 95%CI: 1.28-2.99, p < .001), proportion of decayed teeth (HR = 11.89; 95%CI: 2.80-50.57, p < .001) and child's age (HR = 1.17; 95%CI: 1.06-1.29, p < .001).

CONCLUSION

The different materials and types of isolation had similar survival rates. Children with more decayed teeth have an increased risk of restoration failure.

Knowledge, attitude, and practice of dental patients toward dental defects and dental fillings in Jinan, Shandong Province, China: a mediation analysis

BACKGROUND

Dental filling is a prevalent method for treating dental defects. This study aimed to investigate the knowledge, attitude, and practice (KAP) toward dental defects and dental fillings among dental patients in Jinan, Shandong Province, China.

METHODS

This cross-sectional study was conducted at the main campus and several branch campuses of Jinan Stomatological Hospital, and community locations within Jinan city between October 2023, and January 2024. Spearman correlation analysis and mediation analysis were used to assess the associations and interrelationships between KAP scores.

RESULTS

In this study, 2529 dental patients participated, with 69.1% being females. Of these, 1711 had no dental defects, 551 had defects and fillings, and 267 had defects without fillings. Their median knowledge, attitude, and practice (Questions 1-6) scores were 8.00 [5.00, 12.00] (possible range: 0-18), 27.00 [26.00, 29.00] (possible range: 10-50), and 19.00 [15.00, 24.00] (possible range: 9-45), respectively. Mediation analysis revealed that in patients without dental defects, knowledge had a direct effect on attitude (β = -0.983, 95% CI: -0.999, -0.966, P < 0.001). Additionally, attitude had a direct effect on practice (β = -0.797, 95% CI: -1.490, -0.103, P = 0.024), while knowledge had an indirect effect on practice through attitude (β = 0.783, 95% CI: 0.096, 1.470, P = 0.026). In patients with dental defects who had undergone dental fillings, significant direct effects were observed between knowledge and attitude (β = -0.736, 95% CI: -0.821, -0.650, P < 0.001), knowledge and practice (β = 0.396, 95% CI: 0.214, 0.577, P < 0.001), and attitude and practice (β = -0.499, 95% CI: -0.683, -0.315, P < 0.001). Moreover, knowledge had an indirect effect on practice (β = 0.367, 95 CI: 0.221, 0.513, P < 0.001). In patients with dental defects but without any fillings, direct effects were found between knowledge and attitude (β = -0.929, 95% CI: -1.028, -0.829, P < 0.001).

CONCLUSIONS

Dental patients had inadequate knowledge, attitude, and practices concerning dental defects and fillings. It is recommended that clinical interventions should focus on enhancing patient education and promoting positive engagement in dental care practices.

A Critical Review on the Factors Affecting the Bond Strength of Direct Restorative Material Alternatives to Amalgam

This article comprehensively reviews the performance of simplified direct restorative materials that have the potential to be an alternative to amalgam. Following an understanding of the material structures and clinical performances, this review provides an analysis of the bonding mechanisms and influential factors on the bond strength. These factors include substrate-related variations, involving primary vs. permanent dentin, sound- vs. caries-affected/demineralized dentin comparisons and surface-related factors and pretreatments. Special attention is given to the factors changing the substrate surface, such as different contaminants, remedy methods after contamination and different conditioning methods related to the materials. Variations in sample preparation and bond strength test parameters are also evaluated for the analysis of the outcomes. This review aims to provide an overview of the factors involved in the application procedure of direct restorations together with in vitro testing variations to guide the selection of suitable materials by understanding strengths and shortcomings.

Comparison of Fracture Strength of Milled and 3D-Printed Crown Materials According to Occlusal Thickness

This study aimed to measure the fracture strengths and hardness of final restorative milled and 3D-printed materials and evaluate the appropriate crown thickness for their clinical use for permanent prosthesis. One type of milled material (group M) and two types of 3D-printed materials (groups P1 and P2) were used. Their crown thickness was set to 0.5, 1.0, and 1.5 mm for each group, and the fracture strength was measured. Vickers hardness was measured and analyzed to confirm the hardness of each material. Scanning electron microscopy was taken to observe the surface changes of the 3D-printed materials under loads of 900 and 1500 N. With increased thickness, the fracture strength significantly increased for group M but significantly decreased for group P1. For group P2, the fracture strengths for the thicknesses of 0.5 mm and 1.5 mm significantly differed, but that for 1.0 mm did not differ from those for other thicknesses. The hardness of group M was significantly higher than that of groups P1 and P2. For all thicknesses, the fracture strength was higher than the average occlusal force for all materials; however, an appropriate crown thickness is required depending on the material and component.

Is use of flowable resin composite an option for occluso-proximal restorations in primary teeth? A fracture strength analysis

BACKGROUND

Use of flowable resin composites for ocluso-proximal restorations in primary molars could improve cervical adaptation, and reduce the failure risk.

AIM

To investigate the fracture strength of occluso-proximal restorations in primary teeth using different flowable resin composites (as an intermediate layer or entire cavity) and a conventional resin composite (incremental technique).

DESIGN

Two standardized occluso-proximal cavities were prepared on mesial and distal surfaces of 50 sound primary molars. The teeth were randomly assigned into five groups (n = 10): 2 mm Filtek Bulk Fill Flow + Z350 XT; 4 mm Filtek Bulk Fill Flow; 2 mm Z350 XT Flow + Z350 XT; 4 mm Z350 XT Flow; and Z350 XT inserted by incremental technique. All restored teeth were subjected to cariogenic challenge and then submitted to fracture strength test. The failure pattern of each specimen was categorized as reparable or irreparable/need for replacement based on the World Dental Federation (FDI) criteria. Fracture strength means were submitted to one-way ANOVA and Tukey's post hoc tests. Failure pattern was analyzed descriptively.

RESULTS

There was no statistically significant difference on fracture strength among groups (p = .48). A similar distribution of reparable (35%-40%) and irreparable (60%-65%) failures was observed among groups.

CONCLUSION

Based on a laboratorial setting, the use of different flowable resin composites (as an intermediate layer or entire cavity) may be an option to restore occluso-proximal cavities in primary molars.

Comparative analysis of shear bond strength of MTA and Theracal PT with different restorative materials

BACKGROUND

This study aimed to compare the in vitro shear bond strength (SBS) of mineral trioxide aggregate (MTA) and dual-cured, resin-modified calcium silicate material (Theracal PT) to composite resin, compomer, and bulk-fill composite, and to evaluate the bond failure mode under a stereomicroscope.

METHODS

Ninety acrylic specimens, each with a 4 mm diameter and 2 mm height central hole, were prepared. These specimens were randomly divided into two groups based on the capping materials: MTA and Theracal PT. Each group was further subdivided into three subgroups (n = 15) according to the restorative materials: composite resin, compomer, and bulk-fill composite. The specimens were then subjected to shear testing using a universal testing machine at a crosshead speed of 1 mm/min. Post-test, the fracture locations were examined using a stereomicroscope. Data were analyzed using a two-way analysis of variance (ANOVA) and the Tukey test.

RESULTS

The SBS values for the Theracal PT group were significantly higher than those for the MTA group (p < 0.001). Within the MTA groups, no significant differences were observed in SBS values across the different restorative materials. However, a significant difference was found between the mean SBS values of the Theracal PT + composite resin group and the Theracal PT + compomer group (p < 0.001).

CONCLUSIONS

Theracal PT shows promise in dentistry due to its superior bond strength. Given its bond values, Theracal PT appears capable of forming durable and long-lasting restorations by establishing reliable bonds with various restorative materials commonly used in dentistry.

Success rate of Hall Technique for restoring carious primary molars - systematic review and meta-analysis

OBJECTIVES

The overall pooled success rate of the Hall Technique (HT) in various types of studies has not been investigated. The present study aims to evaluate the success rate of HT to restore carious primary molars.

METHODS

A systematic search was carried out in the MEDLINE/PubMed, Excerpta Medica Database (EMBASE), Scopus, Web of Science, and LIVIVO electronic databases, as well as the ProQuest database for grey literature review. A search was carried out up to September 2023 for studies meeting the eligibility criteria: Randomised Clinical Trials (RCTs) and Non-Randomised Studies of Interventions (NRSIs); children with primary molars treated using HT; and reporting success for at least 1-month post-treatment. Single-arm meta-analysis assessed the pooled proportion (95% CI) of HT success rates. Risk of bias and certainty of evidence using the GRADE approach were assessed.

RESULTS

Searching identified 665 studies, with 25 (15 RCTs and 10 NRSIs) meeting the eligibility criteria. In meta-analyses of RCTs, the pooled proportion success rate was 98% (95% CI: 97-99%) at 12-month follow-up. For NRSIs, the pooled proportion success rate was 95% (95% CI: 91-100%) up to 89 months.

CONCLUSIONS

HT presents a high success rate, even though the primary studies had "low" to "high" risk of bias and demonstrated "moderate" to "low" certainty of evidence. One of the main reasons for downgrading was related to blinding, which was generally unfeasible due to visibly different restorative materials. The systematic review protocol was registered in PROSPERO (ID: CRD42021204415).

Optimizing restorative procedure and material selection for pulpotomized primary molars: Mechanical characterization by 3D finite element analysis

Purpose

This study aimed to assess the stress distribution in pulpotomized primary molars with different types of restorative materials using 3D-finite element analysis (FEA), and provide valuable insights into the selection and application of restorative materials, with the ultimate goal of reducing the risk of pulpotomy failure and protecting residual dental tissue.

Methods

Four 3D models of pulpotomized primary molars with different restorative materials according to the material and its elastic modulus were analysed: resin composite, stainless steel crowns (SSCs), prefabricated zirconia crowns and endocrowns. The food layer was also designed before vertical and bucco-lingual forces were applied to simulate physiological masticatory conditions. The results were obtained by colorimetric graphs of the von Mises stresses (VMS) in the restoration and tooth remnant. The maximum shear stress on the bonding interfaces and pressure stress on the Mineral trioxide aggregate (MTA)-pulp interfaces were recorded.

Results

The results of the 3D-FEA showed that all restorative materials generated stresses and strains on the tooth structure after pulpotomy. In the resin composite group, the marginal enamel exhibited the highest stress peaks. In the zirconia crown and SSC groups, there was a concentration of stress at the dentin-restoration margin. The shear stress concentrations were mainly at the adhesive margins, with lower levels around endocrowns compared to other groups. MTA in the resin composite group experienced more VMS than in the other group. The resin composite group also generated relatively higher pressure stress values at the MTA-pulp interface compared to the other groups.

Significance

In the model of primary teeth following pulpotomy, the three types of restorations covering the occlusal surface can effectively reduce the stress on pulp capping materials under occlusal loads, thereby potentially decreasing the risk of pulpotomy failure. In addition, the group of endocrowns demonstrated reduced stress at the bonding interface and in the stress concentration zone near the dentist-restoration edge, making them more effective at protecting residual dental tissue.

Alternative Direct Restorative Materials for Dental Amalgam: A Concise Review Based on an FDI Policy Statement

Dental restorative procedures remain a cornerstone of dental practice, and for many decades, dental amalgam was the most frequently employed material. However, its use is declining, mainly driven by its poor aesthetics and by the development of tooth-coloured adhesive materials. Furthermore, the Minamata Convention agreed on a phase-down on the use of dental amalgam. This concise review is based on a FDI Policy Statement which provides guidance on the selection of direct restorative materials as alternatives to amalgam. The Policy Statement was informed by current literature, identified mainly from PubMed and the internet. Ultimately, dental, oral, and patient factors should be considered when choosing the best material for each individual case. Dental factors include the dentition, tooth type, and cavity class and extension; oral aspects comprise caries risk profiles and related risk factors; and patient-related aspects include systemic risks/medical conditions such as allergies towards certain materials as well as compliance. Special protective measures (eg, a no-touch technique, blue light protection) are required when handling resin-based materials, and copious water spray is recommended when adjusting or removing restorative materials. Cost and reimbursement policies may need to be considered when amalgam alternatives are used, and the material recommendation requires the informed consent of the patient. There is no single material which can replace amalgam in all applications; different materials are needed for different situations. The policy statement recommends using a patient-centred rather than purely a material-centred approach. Further research is needed to improve overall material properties, the clinical performance, the impact on the environment, and cost-effectiveness of all alternative materials.

An In Vitro Evaluation of Mechanical Properties of a New Dual-cure, Universal, Bioactive Luting Cement

Aim and background

The aim of this study was to determine the properties of a new luting cement, BioCem®, by evaluating shear bond strength (SBS) and flexural strength (FS).

Materials and methods

A total of 60 extracted deciduous molars were included in this study. Samples were divided into two groups: Group I, Fuji I® (n = 30), and group II, BioCem® (n = 30). Each tooth was embedded in one acrylic block, such that the flattened enamel surface was exposed. Cylinders of 6 mm diameter and 8 mm height were prepared and evaluated for SBS using a universal testing machine. Ten rods of 25 × 2 × 2 mm of each material were prepared using a custom mold to evaluate the FS using a universal testing machine. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analyses. Intergroup analysis was performed using an independent sample t-test.

Results

Upon comparing the SBS values of the luting agents and prepared enamel surfaces, glass ionomer cement (GIC) displayed the highest value, while BioCem® displayed the lowest. Upon comparing the FS values of the luting agents and prepared enamel surfaces, BioCem® performed better than GIC.

Conclusion

BioCem® may be used as a luting agent for the cementation of stainless steel crowns (SSCs) on primary teeth.

Clinical significance

BioCem®, a recently developed luting cement, may be used for cementing SSCs to the surfaces of prepared deciduous teeth; it exhibits significantly higher FS but lower SBS than that of GIC.

How to cite this article

Shams SA, Nekkanti S, Shetty S. An In Vitro Evaluation of Mechanical Properties of a New Dual-cure, Universal, Bioactive Luting Cement. Int J Clin Pediatr Dent 2024;17(8):887-891.

Restoration-repair potential of resin-modified glass ionomer cement

This in vitro study aimed to evaluate the repair bond strength of resin-modified glass ionomer cement using either the same material or a universal adhesive in the etch-and-rinse and self-etch modes plus resin composite. Twenty-four resin-modified glass ionomer cement blocks were stored in distilled water for 14 d and thermocycled. Sandpaper ground specimens were randomly assigned to three experimental groups according to the repair protocol: resin-modified glass ionomer cement (Riva Light Cure, SDI) and universal adhesive (Scotchbond Universal Adhesive, 3M Oral Care) in etch-and-rinse or self-etch modes and nanohybrid resin composite (Z350 XT, 3M Oral Care). After 24 h of water storage, the blocks were sectioned, and bonded sticks were subjected to the microtensile bond strength (μTBS) test. One-way ANOVA and Tukey's test were used to analyze the data. The failure mode was descriptively analyzed. The highest μTBS values were obtained when the resin-modified glass ionomer cement was repaired using the same material (p < 0.01). In addition, the mode of application of the universal adhesive system did not influence the repair bond strength of the resin-modified glass ionomer cement. Adhesive/mixed failures prevailed in all groups. Repair of resin-modified glass ionomers with the same material appears to be the preferred option to improve bond strength.

Digital measurement of deciduous tooth dimensions in China: A cross-sectional survey

OBJECTIVE

Crown dimensions data of deciduous teeth hold anthropological, forensic, and archaeological value. However, such information remains scarce for the Chinese population. This multi-center study aimed to collect a large sample of deciduous crown data from Chinese children using three-dimensional measurement methods and to analyze their dimensions.

DESIGN

A total of 1592 children's deciduous dentition samples were included, and the sample size was distributed according to Northeast, North, East, Northwest, Southwest and South China. Digital dental models were reconstructed from plaster dental models. Independent sample t test, paired t test, principal component analysis (PCA), and factor analysis (FA) were used to analyze the tooth crown dimensions.

RESULT

18,318 deciduous teeth from 1592 children were included. Males exhibited slightly larger values than females. The range of sexual dimorphism percentages for each measurement was as follows: mesiodistal diameter (0.40-2.08), buccolingual diameter (0.13-2.24), and maxillogingival diameter (0.48-3.37). The FA results showed that the main trend of crown dimensions changes was the simultaneous increase or decrease in mesiodistal diameter, buccolingual diameter and maxillogingival diameter in three directions.

CONCLUSION

This is the first large-scale survey of deciduous tooth crown dimensions in China, which supplements the data of deciduous tooth measurement and provides a reference for clinical application.

Polymorphisms in ENAM, AMBN, and KLK4 predispose Egyptian adults to dental caries: A cross-sectional study

Objective

This study investigates the distributional discrepancies of four single-nucleotide polymorphic loci as correlatives and causatives of dental caries susceptibility among Egyptians.

Method

We conducted a cross-sectional study through the genotyping of enamelin (ENAM rs3796703), ameloblastin (AMBN rs4694075), tuftelin 1 (TUFT1 rs78802584), and kallikrein 4 (KLK4 rs2242670) in 132 adults (males = 74, females = 58) and 72 controls (males = 40, females = 32) referred from various Egyptian hospitals. For each participant, the number of decayed, missing, and filled teeth was charted, and the presence of biofilm/gingivitis/fluorosis was assessed. Bitewing radiographs were taken to detect interproximal caries. In addition, statistical analysis was conducted using Chi-square test, odds ratios, and corresponding P-values.

Results

The alleles and genotypes of ENAM rs3796703, AMBN rs4694075, and KLK4 rs2242670 correlated strongly with dental caries susceptibility. However, TUFT1 rs78802584 did not exhibit such associations.

Conclusion

These findings suggest the potential role of ENAM, AMBN, and KLK4 as determinants of dental caries susceptibility among Egyptian adults. The role of ENAM, AMBN, and KLK4 genetic variants is determinant in influencing susceptibility to dental caries in the Egyptian population, providing valuable insights into the genetic aspects of oral health. However, the lack of associations of caries susceptibility with TUFT1 rs78802584 contradicts its cariogenic role in many ethnicities.

Survival of pre-formed zirconia crowns in primary teeth: a prospective practice-based cohort study

BACKGROUND

This study aimed to investigate the (1) survival probabilities of prefabricated zirconia crowns (PZCs) placed on primary teeth and (2) identify demographic and tooth-related factors that might affect survival probability.

METHODS

This study prospectively followed children treated under general anaesthesia by a single practitioner between 2012 and 2020. Demographic variables including the age at treatment, gender and tooth-related variables including FDI tooth number, crown size used and any procedural complications at postoperative reviews were collected.

RESULTS

A total of 155 children involving 319 teeth with PZCs were followed up between 12 and 78 months postoperatively with a mean of 38 months. Of the 319 crowns followed, five failures were observed in three patients requiring extraction. Other procedural complications noted included fracture (n = 3), overhangs (n = 3), internal resorption (n = 5) and 24% of crowns showed signs of radiographic changes on postoperative radiographs when these were taken. Age at treatment, tooth type and need for pulp therapy were not statistically associated with clinical success (P > 0.1).

CONCLUSIONS

PZCs provide an aesthetic and durable solution in the management of children with early childhood caries. This study shows very good clinical success and survival extending up to 78 months for PZCs placed on primary teeth under general anaesthesia.

Two-year clinical and radiographic evaluation of ACTIVA BioACTIVE versus Compomer (Dyract® eXtra) in the restoration of class-2 cavities of primary molars: a non-inferior split-mouth randomised clinical trial

OBJECTIVES

The trial aimed to compare the clinical performance and radiographic success of ACTIVA BioACTIVE versus Compomer in restoring class-II cavities of primary molars.

MATERIALS AND METHODS

A non-inferior split-mouth design was considered. A pre-calculated sample size of 96 molars (48 per group) with class-2 cavities of twenty-one children whose ages ranged from 5 to 10 years were randomly included in the trial. Pre-operative Plaque Index (PI), DMFT/dmft scores and the time required to fill the cavity were recorded. Over 24 months, the teeth were clinically evaluated every six months and radiographically every 12 months by two calibrated and blinded evaluators using the United States public health service (USPHS)-Ryge criteria. The two-sided 95% confidence interval (CI) for the difference in success rate was considered to assess non-inferiority, and the margin was set at -18%. The linear mixed model and Firth's logistic regression model were used for data analysis (P < 0.05).

RESULTS

After 24 months, 86 teeth (43 per group) were evaluated. The mean PI score was 1.1(± 0.9), while DMFT/dmft was 0.35 (± 0.74) and 6.55 (± 2.25) respectively. The clinical and radiographic success rate of Dyract vs. ACTIVA was 95.3% and 88.3% vs. 93% and 86%, respectively. The two-sided 95% CI for the difference in success rate (-2.3%) was - 3.2 to 1.3% and didn't reach the predetermined margin of -18% which had been anticipated as the non-inferiority margin. Clinically, ACTIVA had a significantly better colour match (P = 0.002) but worse marginal discolouration (P = 0.0143). There were no significant differences regarding other clinical or radiographic criteria (P > 0.05). ACTIVA took significantly less placement time than Dyract, with a mean difference of 2.37 (± 0.63) minutes (P < 0.001).

CONCLUSION

The performance of ACTIVA was not inferior to Dyract and both materials had a comparable high clinical and radiographic performance in children with high-caries experience. ACTIVA had a significantly better colour match but more marginal discolouration. It took significantly less time to be placed in the oral cavity.

TRIAL REGISTRATION

The study was registered at ClinicalTrials.gov on 4 May 2018 (#NCT03516838).

Effects of design software program and manufacturing method on the marginal and internal adaptation of esthetic crowns for primary teeth: A microcomputed tomography evaluation

STATEMENT OF PROBLEM

The adaptation of digitally produced crowns is affected by the design software program and manufacturing method. The effect of artificial intelligence (AI) software program design on the adaptation of the crowns is unclear and comparative evaluations should be documented.

PURPOSE

The purpose of this study was to assess the marginal and internal gaps, the absolute marginal discrepancies, and the 3-dimensional (3D) discrepancy volumes of the resin-based milled and 3D printed crowns for primary teeth designed with computer-aided design (CAD) and AI software programs by using microcomputed tomography (µCT).

MATERIAL AND METHODS

A total of 40 resin-based esthetic crowns were produced for a prepared typodont tooth (right mandibular primary second molar) according to the design software program (CAD and AI) and manufacturing method (milling and 3D printing) (n=10). Four experimental groups were generated as CAD-milled, CAD-3D printed, AI-milled, and AI-3D printed. The marginal, axial, and occlusal gap values, the absolute marginal discrepancies, and the 3D discrepancy volumes of the specimens were measured by using µCT. The data were analyzed by using 2-way ANOVA and the Tukey HSD tests (α=.05).

RESULTS

The lowest value for the marginal gap (54 ±43 µm) was observed in the CAD-milled group and the marginal gap value of the AI-3D printed group was significantly lower than the AI-milled group (P<.05). The lowest value for the axial gap (63 ±7 µm) was observed in the AI-3D printed group, and the highest value (145 ±58 µm) was observed in the CAD-milled group; the result for the occlusal gap value was opposite. The highest absolute marginal discrepancy value was observed in the CAD-milled group. The 3D discrepancy volumes increased in the order of the CAD-3D printed, AI-milled, CAD-milled, and AI-3D printed groups.

CONCLUSIONS

The marginal and internal gap values of the resin-based crowns were affected by the design software program and manufacturing method; however, tested groups showed clinically acceptable gap values.

Low and high viscosity bulk-fill composite resins stress distribution in primary molar tooth inlay cavity

The aim of this study is to evaluate the stress distributions of low and high viscosity bulk-fill composite resins at class II MOD inlay cavity in primary molar tooth using Finite Element Analysis (FEA). Original DICOM data of a primary molar tooth from a research archive was used to create a 3D model. Two models were prepared as Model 1: the tooth model without restoration (control group) and Model 2: the tooth model with class II MOD inlay restoration. Two different bulk-fill composite resins were tested in study: Model 2 A (class II MOD inlay cavity model restored with low viscosity bulk-fill composite resin) and Model 2B (class II MOD inlay cavity model restored with high viscosity bulk-fill composite resin). Occlusal vertical loading of 232 N was applied to the teeth in occlusal contact areas. Maximum Von Mises stress values in the models for enamel, dentin, and restorative material were evaluated as MPa. More intense stress accumulation is observed in enamel than in dentin. In addition, more stress values were determined in Model 2B (206.15 MPa, 32.76 MPa, 128.95 MPa) than in Model 2 A (203.39 MPa, 29.77 MPa, 120.61 MPa) for enamel, dentin and restorative material, respectively.

Single crown vs. composite for glass fiber post-retained restorations: An 8-year randomized clinical trial

OBJECTIVES

This study aimed to compare the success and survival rates of metal-ceramic crowns and composite resin restorations applied in root filled teeth that received a glass fiber post.

METHODS

A prospective, randomized controlled trial, with equivalent parallel groups was designed. Eighty-two teeth were randomly allocated to the metal-ceramic or composite resin groups. Multivariate Cox regression analysis with shared frailty for patients and Kaplan-Meier curves were performed using success and survival rates (p<0.05).

RESULTS

Seventy-five post-retained restorations (34 metal-ceramic crowns and 41 composite restorations) in 62 patients were analyzed. The median follow-up was 8.1 years [IQR 4.0-9.9]. Twenty-seven failures were observed. Twenty-two failures (81.5 %) were observed in the composite resin group, of which six (27.3 %) were not repairable. Five failures (18.5 %) were observed in the metal-ceramic crown group, of which three (66.6 %) were non-repairable. The cumulative success rate at 8 years was 85.0 % for crowns (AFR=1.31 %) and 43.2 % for composite resins (AFR=6.58 %), while the survival rate was 93.8 % for crowns (AFR=0.52 %) and 97.6 % for composite resins (AFR=0.20 %). Considering the success rates, adjusted multivariate Cox regression showed that composite resin had a Hazard Ratio of 5.07 (95 %CI, 1.99-12.89) greater than the metal-ceramic crown. No significant difference in the failure risk was observed when the survival rates were considered (HR=0.38, 95 %CI (0.10 - 1.44), p = 0.156). Co-variables did not affect the success and survival rates (p>0.05).

CONCLUSIONS

Metal-ceramic crowns showed a higher success rate than composite restorations. The survival rates were similar, but composite restorations presented a higher need for repairs.

CLINICAL SIGNIFICANCE

Post-retained composite restorations may need more reinterventions during the lifecycle, although more preservation of sound tooth structure is expected with a large restoration of resin post-and-core. These aspects have to be discussed with the patient for decision-making planning.

Evaluating Glass Ionomer Cement Longevity in the Primary and Permanent Teeth-An Umbrella Review

The aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner's ability, each case analysis, and the patient's wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition.

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.

The use of rubber dam in the survival of RMGIC restorations in primary molars: a 30-month randomized controlled clinical trial

This study was a randomized controlled clinical trial with two parallel arms and the objective was to compare the survival of resin modified glass ionomer (RMGIC) restorations in primary teeth using rubber dam or cotton roll isolation after a 30-month follow-up period. Ninety-two children (mean age 6.8 ± 1.37) and 200 primary molars with occlusal or occluso-proximal cavitated dentin caries lesions were randomly assigned into two groups: cotton rolls and rubber dam. All lesions were restored using RMGIC (RIVA Light Cure) after selective caries removal. Restorative failure and lesion arrestment were evaluated by two independent, trained, and calibrated examiners through clinical and radiographic examinations. The Kaplan-Meier test was used to assess the survival of restorations and Cox regression was used to assess the association of risk factors with restorative failure. There was no significant difference in survival rates between groups (p = 0.17). Older age (HR = 2.81 [95%CI: 1.47-5.44]) and higher rate of gingival bleeding (HR = 0.47 [95%CI: 0.23-0.99]) were associated with restorative failure. No patient had painful symptoms, pulp outcomes, or radiographic changes compatible with lesion progression. The use of rubber dam isolation did not increase the survival rate of occlusal and occluso-proximal restorations using RMGIC in primary molars after 30 months of follow-up. Since the survival is not influenced by the type of isolation, the professional can safely choose the appropriate technique for each case, considering his experience and preferences, as well as those of the patient.

[The value of restoration marginal fit as risk factor for pathological root resorption in primary teeth]

The presented clinical case describes the need for repetitive dental treatment in a child with pathological root resorption in all the primary molars after pulpotomy and composite resin restoration. Pathological resorption is of inflammatory origin in the majority of cases and an important risk factor for it is marginal leakage of the restoration. According to literature, the optimal restorative choice considering marginal fit are stainless steel pediatric crowns. Root resorption in the patient was asymptomatic. It proves the necessity for radiological control after treatment and 3, 6, 12, 24 months after it.

General dentists' perceptions and clinical management of hypomineralised second primary molars (HSPM) in Ireland

PURPOSE

This questionnaire aimed to explore how general dentists in the Republic of Ireland perceive and manage hypomineralised second primary molars (HSPM).

METHODS

Following ethical approval, a validated structured questionnaire containing 19 questions was sent to Irish dentists using Survey Monkey. Questions on awareness, dentist's experience, barriers to care and clinical scenarios with different treatment options were included. Binary outcomes and independent variables were compared using logistic regression analysis (α = 5%).

RESULTS

Responses from 279 general dentists were analysed. The majority of dentists were aware of HSPM (72%) and most dentists felt confident in diagnosing HSPM (71%). Dentists who had practiced for ≥ 15 years were significantly more likely to document HSPM frequently compared to those with less experience (OR 0.29; p = 0.012). No significant association was found between confidence in HSPM diagnosis and other variables, such as age group, years of practice and workplace. Dentists not working in private practice reported to be less comfortable in the management of HSPM (OR 0.49; p = 0.030). The most cited barrier to management of HSPM was child's behaviour. A broad variation was observed in the clinical scenarios, in particular when treatment planning more severe HSPM.

CONCLUSIONS

In general, Irish dentists are aware of HSPM and are confident in diagnosis and management. Variation existed in treatment options reflecting the disparity that exists in clinical management.

A polyhexamethylene biguanide-assembly assisted strategy of dentin bonding greatly promotes bonding effects and caries treatment

Structural degeneration of a hybrid layer composed of a demineralized dentin matrix (DDM) and adhesive causes unsatisfactory functional outcomes in terms of bonding repair and caries treatment and is accompanied by high prevalence of secondary caries. Clinically, defects in the hybrid layer from insufficient adhesive infiltration, bacterial load from retained infected-dentin, and bacterial attack from the oral cavity are the main threats to degeneration. Currently, there is no strategy to simultaneously address adhesive penetration and bacterial infection. Herein, based on the core role of the strongly-polar hydrated DDM interface in dentin bonding, an interface-reconstructed bonding strategy assisted by electrostatic assembly of broad-spectrum germicidal polyhexamethylene biguanide (PHMB) is proposed that kills two birds with one stone. PHMB is absorbed onto the anionic 3D DDM forming a PHMB/DDM complex. The surface potential of the DDM increases by about 100 mV, the anion content decreases by 20%, and the interface water content decreases by nearly 40%. All of these changes contribute to the penetration of the adhesive, thereby improving the bonding strength and durability. After thermal cycling aging, the bonding strength of the PHMB group was 1.45-1.65 times that of the control group. In terms of antibacterial properties, PHMB treatment not only has a bacterial-killing ability due to the already formed biofilm but also significantly reduces the adhesion of bacteria, thereby delaying the occurrence of secondary caries. In summary, PHMB treatment reconstructed the DDM interface, resulting in a defect-low and inherent antibacterial hybrid layer that improves the bonding effect, treatment of caries and even prevention of secondary caries.

Reasons for Crown Failures in Primary Teeth: Protocol for a Systematic Review and Meta-Analysis

BACKGROUND

There is a tendency nowadays to restore large defects in primary dentition with pediatric crowns instead of conventional restorations. Thus, understanding the factors contributing to the survival or failure of dental crowns in pediatric dentistry is essential for optimizing treatment outcomes.

OBJECTIVE

The primary objective of this protocol is to outline the methodological approach for analyzing data from observational studies and randomized controlled trials to investigate reasons for the failure of dental crowns in primary teeth and to compute their survival and failure rates.

METHODS

A comprehensive literature review will be performed in electronic databases, including PubMed (MEDLINE), Cochrane, Embase, and Web of Science. As per predefined inclusion criteria, we will include observational studies (prospective clinical studies) and randomized clinical trials that have an English abstract and involve children aged 1-10 years undergoing crown restorations. Two independent reviewers will independently screen all retrieved records and full-text articles and extract data. The study's methodological quality will be appraised using suitable tools. Assessments of publication bias will be performed using funnel plots. The findings will be described qualitatively for the systematic review. If possible, a meta-analysis will be performed to estimate failure rates by dividing the number of failures by the total exposure time. A Poisson regression model, assuming constant event rates, will be used to compute 3-year and 5-year survival proportions. The Pearson goodness-of-fit statistics will be used to assess the heterogeneity of the model. A P value <.05 will be considered significant. All analyses will be performed using R Statistical software (version 4.1.2; R Core Team).

RESULTS

This systematic review and synthesis aim to assess the survival and failure rates of dental crowns in pediatric dentistry. By following this rigorous methodology, we seek to provide valuable insights into the factors contributing to the success or failure of these restorations. The results of our full review will have implications for pediatric dentists, researchers, and policy makers, helping to improve dental care for children.

CONCLUSIONS

This systematic review protocol helps in establishing a thorough approach for reviewing failures in pediatric crowns. By following this methodology, standardization and transparency of the process as well as accountability for the stated methods and outcomes will be ensured. The findings of this review and analysis will provide useful data on the survival of crowns to pediatric dentists and researchers.

TRIAL REGISTRATION

PROSPERO CRD42023442266; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=442266.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/51505.

Compomers for the restorative treatment of dental caries in primary teeth: An umbrella review

OBJECTIVES

This umbrella review comprehensively appraised the evidence on the use of compomers in comparison to other dental filling materials for restorative treatment of decayed primary teeth.

DATA

The literature search was conducted based on the question: "Is the use of compomers as a dental filling material more successful in the restorative treatment of decayed primary teeth than other dental filling materials?" No language restriction was applied and systematic reviews published up to May 2023 were included. The ROBIS tool was used to assess the methodological quality of the included systematic reviews. Data were extracted for narrative synthesis, considering the restoration failure/success outcomes.

SEARCH

Online search was conducted in three databases (PubMed/Medline, Embase and Cochrane library).

STUDY SELECTION

The electronic search yielded a total of 779 publications. Finally, 18 systematic reviews were included in this umbrella review. Four systematic reviews presented a low risk of bias, 11 presented an unclear risk of bias and three presented a high risk of bias. Most systematic reviews presenting low risk of bias reported no difference in the success rates of compomers compared to other dental filling materials used for restoration of decayed primary teeth. Studies that found a significant difference or that made clear recommendations towards the use of compomers were commonly rated with a high risk of bias.

CONCLUSION

Compomers are similar to other dental filling materials for the placement of direct restorations in primary teeth.

CLINICAL SIGNIFICANCE

The results of this umbrella review indicate a similar clinical performance of compomers compared to other materials containing a resin component for direct restoration in primary teeth. Therefore, the choice of restorative material will depend on multiple factors, such as clinician's skills/preferences, patients' wishes, costs, and cavity type/location.

Does the Modality of Dental Treatment Affect the Treatment Prognosis and the Necessity of Re-Treatments?

BACKGROUND

The utilization of evidence-based approaches is crucial to achieving long-term positive outcomes for treatment performed chairside or under general anesthesia. The study aimed to evaluate if treatment modality (at the chairside or under general anesthesia) affects prognosis and the need for re-treatment.

METHODS

Oral-hygiene, gingival, and plaque indexes were recorded during the control appointment. The success of all treatments was evaluated according to the scoring of particular evaluation criteria.

RESULTS

A total of 1066 dental procedures were performed on 92 children. Plaque index scores were higher for patients treated under general anesthesia. The success rate of restorative procedures was 82.5% under general anesthesia and 80.6% at the chairside. There was no statistically significant difference between the mean number of restorative treatments and the need for re-treatment between general anesthesia or chairside (p = 0.649, p = 0.311). The mean number of unsuccessful endodontic treatments performed under general anesthesia was higher than performed chairside. Only two out of thirty stainless-steel crowns were decemented, all performed under general anesthesia.

CONCLUSIONS

The high volume of restoration failure due to secondary caries has highlighted the need for alternative approaches to caries management, especially given the risks associated with repeat general anesthetic.

The effect of varying monocalcium phosphate and polylysine levels on dental composite properties

OBJECTIVES

The aim was to quantify effects of polylysine (PLS, 2 or 5 wt%) and monocalcium phosphate (MCP, 4 or 8 wt%) on properties of dental composites.

METHODS

Light-activated, lower surface polymerisation kinetics versus sample depth (1-4 mm) of 4 formulations were quantified using ATR-FTIR. Water sorption and solubility (at 1 week) were assessed following ISO/4049. PLS release (over 1 month) and biaxial flexural strength (over 6 months) of fully-cured, water-immersed, 1 mm thick discs were determined. Surface mineral precipitation, following immersion in simulated body fluid (SBF), was assessed by SEM. Z250 was used as a conventional composite comparator.

RESULTS

With 40s light exposure, increasing depth (from 1 to 4 mm) led to enhanced delay before polymerisation (from 3 to 17s) and decreased final conversion (72-66%) irrespective of PLS and MCP level. Increasing PLS and MCP raised solubility (4-13 μg/mm3). Water sorption (between 32 and 55 μg/mm3) and final PLS release (8-13% of disc content) were raised primarily by increasing PLS. Higher PLS also reduced strength. Strength reached minimum values (69-94 MPa) at 3 months. Surface mineral deposition was enhanced by increased MCP. For Z250, polymerisation delays (3-6s) and final conversions (55-54%) at 1-4 mm depth, solubility (0 μg/mm3), water sorption (16 μg/mm3) and strength (180 MPa) were all significantly different.

CONCLUSION

Delay time increased whilst final conversion decreased with thicker samples. Higher PLS enhances its percentage release, but lower level is required to keep water sorption, solubility and mechanical properties within ISO 4049 recommendations. Doubling MCP raises solubility and enhances minerals reprecipitation with minimal mechanical property compromise.

Engineered Biomaterials Trigger Remineralization and Antimicrobial Effects for Dental Caries Restoration

Dental caries is the most prevalent chronic disease globally, significantly impacting individuals' quality of life. A key reason behind the failure of implanted restorations is their biological inactivity, meaning they are unable to form crosslinks with the surrounding tooth structures, thus making patients susceptible to implant loss and recurrent tooth decay. For the treatment of caries, antibacterial medicine and remineralization are effective means of treating the recurrence of caries. Owing to the rapid progression in the biomaterials field, several biomaterials have been reported to display antimicrobial properties and aid in dentin remineralization. Bioactive materials hold considerable potential in diminishing biofilm accumulation, inhibiting the process of demineralization, enabling dentin remineralization, and combating bacteria related to caries. Bioactive materials, such as fluoride, amorphous calcium phosphate, bioactive glass, collagen, and resin-based materials, have demonstrated their effectiveness in promoting dentin remineralization and exerting antibacterial effects on dental caries. However, the concentration of fluoride needs to be strictly controlled. Although amorphous calcium phosphate can provide the necessary calcium and phosphorus ions for remineralization, it falls short in delivering the mechanical strength required for oral mastication. Resin-based materials also offer different advantages due to the complexity of their design. In this review, we delve into the application of advanced bioactive materials for enhancing dentin remineralization and antibacterial properties. We eagerly anticipate future developments in bioactive materials for the treatment of dental caries.

Novel Bioactive Nanocomposites Containing Calcium Fluoride and Calcium Phosphate with Antibacterial and Low-Shrinkage-Stress Capabilities to Inhibit Dental Caries

OBJECTIVES

Composites are commonly used for tooth restorations, but recurrent caries often lead to restoration failures due to polymerization shrinkage-stress-induced marginal leakage. The aims of this research were to: (1) develop novel low-shrinkage-stress (L.S.S.) nanocomposites containing dimethylaminododecyl methacrylate (DMADDM) with nanoparticles of calcium fluoride (nCaF2) or amorphous calcium phosphate (NACP) for remineralization; (2) investigate antibacterial and cytocompatibility properties.

METHODS

Nanocomposites were made by mixing triethylene glycol divinylbenzyl ether with urethane dimethacrylate containing 3% DMADDM, 20% nCaF2, and 20% NACP. Flexural strength, elastic modulus, antibacterial properties against Streptococcus mutans biofilms, and cytotoxicity against human gingival fibroblasts and dental pulp stem cells were tested.

RESULTS

Nanocomposites with DMADDM and nCaF2 or NACP had flexural strengths matching commercial composite control without bioactivity. The new nanocomposite provided potent antibacterial properties, reducing biofilm CFU by 6 logs, and reducing lactic acid synthesis and metabolic function of biofilms by 90%, compared to controls (p < 0.05). The new nanocomposites produced excellent cell viability matching commercial control (p > 0.05).

CONCLUSIONS

Bioactive L.S.S. antibacterial nanocomposites with nCaF2 and NACP had excellent bioactivity without compromising mechanical and cytocompatible properties. The new nanocomposites are promising for a wide range of dental restorations by improving marginal integrity by reducing shrinkage stress, defending tooth structures, and minimizing cariogenic biofilms.

Working length determination in primary teeth pulpectomy: A systematic review and meta-analysis

The present meta-analysis aimed to describe the methods to determine the working length in primary teeth pulpectomy, also evaluating and comparing their reliability. A systematic review was performed following the PRISMA Statement. The electronic search was conducted on PubMed, Scopus, Cochrane Library and Web of Science. After the screening protocol, a number of 14 studies were included in the qualitative analysis, while seven were included in the quantitative one. The mean working length determined by the electronic apex locator was 11.8 mm (9.0-15.55), while 12.42 mm (11.0-13.52) and 12.3 mm (9.73-15.93) were the mean working length observed with the conventional radiography and the digital radiography, respectively. No statistically significant difference was detected in quantitative analysis between the investigated methods. The present meta-analysis showed that electronic apex locator, conventional radiography and digital radiography are similar in determining working length in primary teeth.

Lesion sterilization and tissue repair with chloramphenicol, tetracyline, zinc oxide/eugenol paste versus conventional pulpectomy: A 36-month randomized controlled trial

BACKGROUND

Endodontic treatment of primary molars represents one of the challenges in pediatric dentistry. There is a lack of consensus in the literature about the endodontic techniques and filling paste for primary teeth with pulp necrosis.

AIM

To compare the effectiveness of the LSTR technique (lesion sterilization and tissue repair) with CTZ paste (chloramphenicol, tetracycline, zinc oxide and eugenol) and pulpectomy with ZOE paste (zinc oxide and eugenol) in the treatment of primary molars with pulp necrosis.

DESIGN

Eighty-eight primary molars with pulp necrosis from 70 children between the ages of 3 and 8 years were included. The teeth were randomized to the LSTR with CTZ paste group or pulpectomy with ZOE paste group. Clinical and radiographic evaluations were performed at 18, 24, 30 and 36 months.

RESULTS

At 36 months, clinical success was 86.4% in LSTR with CTZ paste and 90.9% in pulpectomy with ZOE paste (p = .45). Radiographic success was 43.2% in both groups (p = 1.00). The overall success was 40.9% in LSTR with CTZ paste and 43.2% in pulpectomy with ZOE paste (p = 1.00).

CONCLUSION

After 36 months of evaluation, the effectiveness of the LSTR technique with CTZ paste and pulpectomy with ZOE paste was similar for the treatment of primary molars with pulp necrosis.

Evaluation of Antibacterial Activity of a Bioactive Restorative Material Versus a Glass-Ionomer Cement on Streptococcus Mutans: In-Vitro Study

BACKGROUND

Dental caries management consists of both preventive and restorative approaches. Pediatric dentists can rely on many techniques and materials to restore decayed teeth, but a high failure rate is still observed, mainly due to secondary caries. New restorative bioactive materials combine the mechanical and aesthetic characteristics of resinous materials with the capability to remineralize and the antimicrobial properties of glass ionomers, thus counteracting the occurrence of secondary caries. The aim of this study was to assess the antimicrobial activity against Streptococcus mutans of a bioactive restorative material (ACTIVA™ BioActive-Restorative™-Pulpdent©) and a glass ionomer cement with silver particles added (Ketac™ Silver-3M©), using agar diffusion assay.

METHODS

Each material was formed into disks of 4 mm in diameter, and four discs of each material were placed on nine agar plates. The analysis was repeated seven times.

RESULTS

Both materials showed statistically significant growth inhibition properties against S. mutans (p < 0.05). The difference in the effectiveness of the two materials was not statistically significant.

CONCLUSION

Both ACTIVA™ and Ketac™ Silver can be recommended since both are similarly effective against S. mutans. However ACTIVA™, given its bioactivity and better aesthetics and mechanical properties compared to GICs, may provide better clinical performance.

Long-Term Antibacterial Efficacy of Cetylpyridinium Chloride-Montmorillonite Containing PMMA Resin Cement

Despite being able to adhesively restore teeth, adhesives and cement do not possess any anticariogenic protection potential, by which caries recurrence may still occur and reduce the clinical lifetime of adhesive restorations. Several antibacterial agents have been incorporated into dental adhesives and cement to render them anticariogenic. Due to an additional therapeutic effect, such materials are classified as 'dental combination products' with more strict market regulations. We incorporated cetylpyridinium chloride (CPC), often used for oral hygiene applications, into montmorillonite (CPC-Mont), the latter to serve as a carrier for controlled CPC release. CPC-Mont incorporated into tissue conditioner has been approved by the Pharmaceuticals and Medical Devices Agency (PmontMDA) in Japan. To produce a clinically effective dental cement with the antibacterial potential to prevent secondary caries, we incorporated CPC-Mont into PMMA resin cement. We measured the flexural strength, shear bond strength onto dentin, CPC release, and the biofilm-inhibition potential of the experimental CPC-Mont-containing PMMA cement. An 8 and 10 wt% CPC-Mont concentration revealed the antibacterial potential without reducing the mechanical properties of the PMMA cement.

Fracture Load of Mesio-Occluso-Distal Composite Restorations Performed with Different Reinforcement Techniques: An In Vitro Study

BACKGROUND

Mesio-occluso-distal (MOD) cavity preparations are often fragile due to the amount of tooth and carious structure removed. MOD cavities can often fracture if left unsupported.

AIM

The study investigated the maximum fracture load of mesi-occluso-distal cavities restored using direct composite resin restorations with various reinforcement techniques.

METHOD

Seventy-two freshly extracted, intact human posterior teeth were disinfected, checked, and prepared according to predetermined standards for mesio-occluso-distal cavity design (MOD). The teeth were assigned randomly into six groups. The first group was the control group restored conventionally with a nanohybrid composite resin (Group I). The other five groups were restored with a nanohybrid composite resin reinforced with different techniques: the ACTIVA BioACTIVE-Restorative and -Liner as a dentin substitute and layered with a nanohybrid composite (Group II); the everX Posterior composite resin layered with a nanohybrid composite (Group III); polyethylene fibers called "Ribbond" placed on both axial walls and the floor of the cavity, and layered with a nanohybrid composite (Group IV); polyethylene fibers placed on both axial walls and the floor of the cavity, and layered with the ACTIVA BioACTIVE-Restorative and -Liner as a dentin substitute and nanohybrid composite (Group V); and polyethylene fibers placed on both axial walls and the floor of the cavity and layered with the everX posterior composite resin and nanohybrid composite (Group VI). All teeth were subjected to thermocycling to simulate the oral environment. The maximum load was measured using a universal testing machine.

RESULTS

The highest maximum load was exhibited by Group III with the everX posterior composite resin, followed by Group IV, Group VI, Group I, Group II, and Group V. A statistically significant difference was demonstrated between groups (p = 0.0023). When adjusting for multiple comparisons, there were statistical differences specific to comparisons between Group III versus I, Group III versus II, Group IV versus II, and Group V versus III.

CONCLUSIONS

Within the limitations of the current study, it can be concluded that a higher maximum load resistance can be achieved (statistically significant) when reinforcing nanohybrid composite resin MOD restorations with everX Posterior.

Outcomes of preformed metal crowns placed with the conventional and Hall techniques: A systematic review and meta-analysis

BACKGROUND

Preformed metal crowns (PMCs) have been used to restore carious primary molars and have a high success and survival rate. There are two methods currently employed for PMC placement - the conventional technique (CT) and Hall technique (HT).

AIM

This systematic review aims to compare the outcomes of PMCs placed using the CT and HT.

DESIGN

This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A literature search of five databases was performed up to 23 August 2022. Clinical studies comparing carious primary molars restored with PMCs using either technique with a minimum 12-month follow-up were included. Risk of bias (RoB) assessment was performed using the National Institutes of Health Quality Assessment tool.

RESULTS

Five articles met the inclusion criteria, and four were included for meta-analysis. The 12- and 24-month success and survival rates were above 85% for both groups, with no significant differences shown at 12 and 24 months. The HT requires a shorter treatment duration, is more cost-effective and has a high level of acceptability among parents when compared to the CT. Four articles were rated fair, and one article was rated good in the RoB assessment.

CONCLUSION

Greater consideration may be given towards using the HT as part of standard treatment procedures in managing carious primary molars. Future studies should standardise reporting of outcomes to facilitate a more homogeneous pool of data for future meta-analysis.

Patients' preferences in dental care: A discrete-choice experiment and an analysis of willingness-to-pay

INTRODUCTION

Dental diseases are a major problem worldwide. Costs are a burden on healthcare systems and patients. Missed treatments can have health and financial consequences. Compared to other health services, dental treatments are only covered in parts by statutory health insurance (SHI). Using the example of dental crowns for a cost-intensive treatment, our study aims to investigate whether (1) certain treatment attributes determine patients' treatment choice, and (2) out-of-pocket payments represent a barrier to access dental care.

METHODS

We conducted a discrete-choice-experiment by mailing questionnaires to 10,752 people in Germany. In presented scenarios the participants could choose between treatment options (A, B, or none) composed of treatment attribute levels (e.g., color of teeth) for posterior (PT) and anterior teeth (AT). Considering interaction effects, we used a D-efficient fractional factorial design. Choice analysis was performed using different models. Furthermore, we analyzed willingness-to-pay (WTP), preference of choosing no and SHI standard care treatment, and influence of socioeconomic characteristics on individual WTP.

RESULTS

Out of n = 762 returned questionnaires (response rate of r = 7.1), n = 380 were included in the analysis. Most of the participants are in age group "50 to 59 years" (n = 103, 27.1%) and female (n = 249, 65.5%). The participants' benefit allocations varied across treatment attributes. Aesthetics and durability of dental crowns play most important roles in decision-making. WTP regarding natural color teeth is higher than standard SHI out-of-pocket payment. Estimations for AT dominate. For both tooth areas, "no treatment" was a frequent choice (PT: 25.7%, AT: 37.2%). Especially for AT, treatment beyond SHI standard care was often chosen (49.8%, PT: 31.3%). Age, gender, and incentive measures (bonus booklet) influenced WTP per participant.

CONCLUSION

This study provides important insights into patient preferences for dental crown treatment in Germany. For our participants, aesthetic for AT and PT as well as out-of-pocket payments for PT play an important role in decision-making. Overall, they are willing to pay more than the current out-of-pockt payments for what they consider to be better crown treatments. Findings may be valuable for policy makers in developing measures that better match patient preferences.

Effect of shape of titanium dioxide nanofillers on the properties of dental composites

The main objective of the present study was to evaluate the effect of the morphology of titanium dioxide nanofillers on the flexural strength and shear bond strength of the dental composite. Spherical and rhombic-shaped nano titanium dioxide fillers were synthesized via solvothermal method and were characterized. Subsequently, these fillers were incorporated into a flowable composite (Filtek^™ Z350 XT Flowable Restorative) at 0.5 wt.% and 1.5 wt.% and the prepared specimens were stored in water for 24 h. The specimens were then evaluated for flexural strength using a universal testing machine. Similarly, the shear bond strength of modified composites to the tooth was evaluated and bond failures were analyzed using stereomicroscope magnification. Incorporation of nanofillers significantly enhanced the flexural strength of flowable composite (p = 0.009) with a significant increase at 0.5wt.% of spherical (p = 0.015) and rhomboidal-shaped fillers (p = 0.010). However, no statistically significant difference in flexural strength was observed among the different shapes of nanofillers. The results of our study did not show a significant effect on the shear bond strength of the composites. Thus the reinforcing ability of titanium dioxide nanofillers on dental composite was confirmed in this study, although the effect of using nanofillers with different morphology was not significant.

Genes and single nucleotide polymorphisms in the pathway of saliva and dental caries: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to investigate the influence of single nucleotide polymorphisms (SNPs), related to genes in salivary composition and flow, on dental caries experience. Sixteen studies were included in the systematic review and ten in the meta-analysis. Forty-four SNPS, covering four genes (CA6, AQP2, AQP5, and MUC5B) were identified. Most of the SNPs were not associated with caries in meta-analysis. Homozygous TT genotype of the SNP CA6 rs17032907(C/T) was associated with caries [OR = 3.23(1.39-7.49)]. The pool effect of the SNPs assessed in AQP5 was associated with a reduction in the likelihood of caries [OR = 0.75(0.59-0.95)]. Considering all SNPs of salivary composition and flow, the effect allele was associated with a 75% increase in the likelihood of caries [OR = 1.75(1.06-2.89)] in the homozygous genotype. The present findings showed that the genes in salivary composition and flow can play an important role in dental caries experience.

Reciprocating instrumentation for endodontic treatment of primary molars: 24-month randomized clinical trial

BACKGROUND

Although reciprocating instrumentation has been extensively studied for permanent teeth, stronger evidence for its use in primary teeth is lacking.

AIM

The aim of this randomized clinical trial was to compare the efficacy of endodontic treatment in primary molars using reciprocating (RECIP) and manual (MAN) instrumentation techniques after 24 months.

DESIGN

Primary molars with indication of endodontic treatment were randomly divided into two groups: MAN and RECIP. Treatments were performed, and root canals were filled with calcium hydroxide and iodoform paste. Teeth were later restored with bulk-fill composite resin and re-evaluated after 6, 12, 18, and 24 months. The primary outcome was the success of the endodontic treatment evaluated by Cox regression analysis adjusted by cluster and success rate after 24 months in the intention-to-treat (ITT) population. Instrumentation time, discomfort, postoperative pain, and quality of root canal filling were also evaluated as secondary endpoints.

RESULTS

A total of 151 primary win 107 children were included, and 137 were followed up for 24 months. Success rate of teeth allocated to the MAN group was 57.3% and 55.3% for RECIP (p = .792); MAN instrumentation, however, was more time-consuming (p = .005).

CONCLUSION

The efficacy of endodontic treatment in primary molars using reciprocating and manual instrumentation is similar after 24 months.

Disinfection of caries-affected dentin using potassium titanyl phosphate laser, Rose bengal and Ozonated water on shear bond strength of deciduous teeth

AIM

To assess the efficacy of disinfection of caries-effected dentin (CAD) using KTP laser and different decontamination methods using ozonated water (OW), Rose Bengal photosensitizer (RBP), chlorhexidine (CHX), and Er, YAG laser on the shear bond strength (SBS) of adhesive resin bonded to deciduous teeth.

MATERIAL AND METHODS

A total of 50 extracted and radiographically verified carious primary molars were collected and scrutinized according to ICDAS criteria. Specimens were allocated randomly into five groups (n = 10) as per the type of CAD disinfectants. KTP laser, OW, RBP, CHX (control), and Er, YAG laser. After cavity sanitization, a resin adhesive (prime and bond NT) was smeared on the dentinal exterior followed by incremental composite filling. SBS evaluation was performed by employing specimens in the universal testing machine. The debonded surface was assessed under 40x magnification in a stereomicroscope to ascertain fracture mode. Statistical analysis was done by using the ANOVA and the Post Hoc Tukey multiple comparison tests (p < 0.05).

RESULTS

The highest SBS was exhibited by group 2 i.e., when OW was employed for CAD disinfection (10.25 ± 0.24 MPa). Whereas, the lowest SBS bond value was unveiled by samples in group 3 when RBP was applied for dentin surface sanitization (7.85 ± 0.59 MPa).CAD disinfection with KTP laser (8.25 ± 0.41 MPa), CHX (8.19 ± 0.73 MPa), and RBP displayed comparable bond values (p > 0.05).

CONCLUSION

Ozonated water and Er, YAG laser could be employed as cavity disinfectants in primary teeth as they demonstrated better shear bond strength without jeopardizing the adhesive binding capacity of restorative resins bonded to caries-affected dentin.

A retrospective cohort study of pediatric hospitalization due to dentoalveolar infection before and after a change in national health insurance

This retrospective cohort study aimed to examine trends in pediatric (0-18 years old) hospitalizations due to dentoalveolar infection, before and after the inclusion of pediatric dental care in Israel's National Health Insurance Law. Data were collected from the medical records of one oral and maxillofacial surgery department. Data were compared between patients hospitalized during 2002-2010 (group A, n = 531) and 2011-2019 (group B, n = 381). The mean age of the cohort was 8 years. A dentoalveolar abscess was the main cause of hospitalizations in both groups. Group B exhibited a higher rate of previous dental treatment in general (p = 0.001), and of previous dental treatment for the tooth responsible for the infection (p = 0.03). The prevalent treatment during hospitalization combined intravenous antibiotics and extraction, with or without drainage (58.1%) for group A; and intravenous antibiotics and drainage (49.4%) for group B (p < 0.01). Dental care provided by the Israel's National Health Insurance should focus not only on operative treatment but also on oral health promotion and caries prevention, to reduce hospitalizations due to dentoalveolar infections.