Predictors of survival of large non-occlusal non-incisal glass-ionomer restorations in older adults

PURPOSE

This study aimed to investigate the predictors of survival of non-occlusal non-incisal glass-ionomer restorations as a surrogate for root surface restorations among older adults.

METHODS

In a retrospective cohort analysis using the University of Iowa College of Dentistry electronic dental records, we included 721 patients aged 65+ who received 2+ surface non-occlusal non-incisal glass ionomer restorations placed from January 2005 - December 2011. Restorations were followed until September 2017 or until they were deemed to have failed.

RESULTS

At baseline, participants' mean age was 77.6 ± 8.2 years, and 45.8% were females. Most patients were self-pay (65.2%). Most restorations were placed by residents and dental students (82.7%) and included only two surfaces (95.6%). About half (49.1%) failed during follow-up, with a median survival time of 3.7 years. The time ratio for lower incisors compared to other teeth was 0.6 (p = .006), for three-and-four-surface restorations compared to two was 0.7 (p = .007), for faculty as providers compared to residents and students was 1.4 (p = .039), and for the Geriatric & Special Needs Clinic compared to others was 0.8 (p = .013). Time ratios less than one indicate association with shorter durations for restorations, and time ratios greater than one indicate association with longer durations for restorations.

CONCLUSION

Tooth type, number of restored surfaces, provider type, and clinic were all significant factors associated with survival of these restorations.

Effectiveness of fluorides in root caries prevention, Department of Veterans Affairs (2009-2018)

AIMS

The aim of this study was to examine the effectiveness of topical fluorides in prevention of root caries-related treatment in high caries risk Veterans.

METHODS

This retrospective analysis of longitudinal data examined the effectiveness of professionally applied or prescription (Rx) fluoride treatment, in VHA clinics from FY 2009-2018. Professional fluoride treatments included 5% Sodium Fluoride (NaF) varnish (22 600 ppm fluoride), 2% NaF gel/rinse (9050 ppm fluoride), and 1.23% APF gel (12 300 ppm fluoride). The Rx for daily home use was 1.1% NaF paste/gel (5000 ppm fluoride). Outcomes studied were new root caries restorations or extractions and percent of patients with treatment over 1 year. Logistic regressions were adjusted for age, gender, race, ethnicity, chronic medical or psychiatric conditions, number of medication classes, anticholinergic drugs, smoking, baseline root caries treatment, preventive care, and time between first-last restoration in the index year.

RESULTS

Root caries at baseline was associated with a high risk for new root caries. Veterans without root caries during the index year who received a fluoride gel/rinse intervention were 32-40% less likely to receive caries-related treatment for root caries during the follow-up period. Once Veterans had root caries, fluorides did not exhibit a positive effect.

CONCLUSION

In older adults with high caries risk, early fluoride prevention is key, before root caries requires treatment.

Dental innovations which will influence the oral health care of baby boomers

From the widespread use of smartphones and tablets to the multitude of applications available, older adults are showing an interest in utilizing technology to maintain their independence and to improve their quality of life. As technology continues to advance and be incorporated into many day-to-day activities, the baby boom generation will see these changes affecting the way they access and utilize dental services. Innovative toothbrushes and chemotherapeutics are continuing to be developed and utilized by many older adults. Within the dental office, older adults are seeing greater application of technology in every day dental procedures. These include the use of teledentistry, artificial intelligence (AI), innovative restorative materials, digitization of fixed and removable prosthodontics, cone beam computed tomography (CBCT) scans to guide dental implant placement and endodontic procedures. There is also new technology to aid in cancer detection and shielding during cancer treatment. Improved communication between the medical and dental fields has become increasingly necessary to facilitate effective patient care and a few innovative healthcare systems have begun to consolidate these services. Overall, the baby boom generation will continue to see dental innovations that will change the way they experience everyday life and dental services.

Perspective and practice of root caries management: a multicountry study - Part I

Background:

Every effort needs to be made to better understand the current state of practice and trends relating to root caries management which will be of benefit to dentists universally in the practice of dentistry.

Aim:

This article presents a multicountry questionnaire survey of the current state of practice in the management of root caries among dentists in nine different countries to get a wider range of opinions and perspectives.

Methodology:

A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among groups.

Results:

The results showed statistically significant differences among dentists in most questionnaire aspects. Bleeding is the greatest obstacle facing dentists when restoring root surface lesions. Reported survival rates reflect uncertainty about the material and/or approach of choice in the management of root surface caries.

Conclusion:

This questionnaire survey revealed the current status of management of root surface caries in clinical practice in various countries. Substantial attention is required to bridge the knowledge gap and address the current void of uncertainty as relates to root caries management by providing a common ground for communication between dentists from all around the globe. In all, this work found a degree of consensus at the international level on what appears to work well among the dental practices surveyed and identified several issues with existing approaches that need to be addressed in future studies.

Development of 4-META/MMA-TBB resin with added benzalkonium chloride or cetylpyridinium chloride as antimicrobial restorative materials for root caries

To develop antimicrobial restorative materials for root caries, we assessed a 4-META/MMA-TBB resin (Bondfill SB Plus, Sun Medical) containing benzalkonium chloride (BAC) or cetylpyridinium chloride (CPC) at 1.25, 2.5, and 5.0 wt%. The same resin without antibacterial agent was used as control. The degree of conversion was measured by attenuated total reflectance-Fourier transform infrared spectroscopy. The 3-point flexural strength test was conducted according to ISO 4049. The antimicrobial effect against three oral bacteria (Streptococcus mutans, S. sobrinus, and Actinomyces naeslundii) was assessed using agar diffusion tests. The shear bond strength to root dentin was assessed after 24 h of storage in water with or without 10,000 thermal cycles. The shear bond strength data were statistically compared using a linear mixed-effects model (α = 0.05). The specimen with 5.0 wt% BAC showed a significantly higher degree of conversion than the control, but it also had significantly lower flexural strength and lower shear bond strength after thermal cycling than the other specimens. When BAC or CPC was added at ≥ 2.5 wt%, the resins inhibited the growth of the three investigated microbes. In conclusion, both BAC and CPC showed significant antimicrobial effects when added at 5.0 wt% to the 4-META/MMA-TBB resin. Up to 2.5 wt%, neither antimicrobial agent affected the degree of conversion, flexural strength, or shear bond strength of the resin.

The effect of dentin age on the microshear bond strength and microleakage of glass-ionomer cements

OBJECTIVE

To compare the microshear bond strength (µSBS) and microleakage of glass-ionomer cements when bonded to aged and young dentin.

BACKGROUND

Glass-ionomer cement (GIC) is frequently used to restore root caries in elders. Many studies of GIC have been conducted using young dentin; however, few studies have assessed adhesion and microleakage of GICs to aged dentin.

MATERIALS AND METHODS

Seventy-eight non-carious human molars (patient age 16-30 = 39; patient age ≥ 65 = 39) were tested with three GICs (Fuji II LC, Equia Forte Fil and Fuji BULK). For µSBS, teeth were horizontally sectioned, embedded in resin and three tubes attached to the sectioned surface. Materials were mixed and injected into the tubes, allowed to set and the tubes removed leaving the GIC cylinders. Specimens were stored in deionised water for 24 hours and tested in a universal testing machine. For microleakage, a buccocervical cavity was prepared, restored with GIC and stored in deionised water. The specimens were polished, coated with varnish, placed in 0.5% basic fuchsin for 24 hours, sectioned at the midpoint and evaluated for microleakage under a stereomicroscope and scanning electron microscope.

RESULTS

For µSBS, Fuji II LC showed the highest bond strength among three products. There was no significant difference between age groups. (P = .93) For microleakage, Fuji II LC had more dye penetration (P < .01) and there was significant difference between age groups.

CONCLUSION

After bonding of GICs, aged dentin showed no difference in µSBS but less microleakage when compared to young dentin.

Basic properties of novel S-PRG filler-containing cement

This study was aimed to evaluate the effect of a novel surface pre-reacted glass-ionomer (S-PRG) filler-containing cement for root caries. We prepared the cements using five different S-PRG filler amounts (0, 10, 20, 30, and 40 wt%). Compressive strength, ion release, acid buffering capacity, and microstructure of the as-prepared cements were evaluated. The compressive strength was statistically significant; it was highest for 0 wt% S-PRG cement. Ion release in 0 wt% S-PRG was highest for F^- and Al, whereas in 40 wt% S-PRG it was highest for B. For 20, 30, and 40 wt% S-PRG cements, Na and Sr release was higher compared to the other ions. The acid buffering capacity was significantly higher in the 40 wt% S-PRG cement than in the others. In the microstructural analysis, no difference of surface structure was observed among each of the S-PRG filler contents (0-40 wt% S-PRG).

Atraumatic vs conventional restorative treatment for root caries lesions in older patients: Meta- and trial sequential analysis

OBJECTIVES

We aimed to appraise the comparative clinical efficacy of atraumatic restorative treatment (ART) versus conventional restorative treatment (CT) using a meta-analysis, and assessed the robustness of evidence by trial sequential analysis (TSA).

BACKGROUND

Due to its simplified clinical approach, ART may be advantageous over CT for restoration of root caries lesions in institutionalised older patients.

METHODS

Three electronic databases (PubMed, Embase and Cochrane CENTRAL) were screened, and hand searches and cross-referencing performed to identify randomised controlled trials reporting on survival of ART vs CT for restoration of root caries in older patients. Trial selection, data extraction and risk of bias assessment were performed by two independent reviewers. ART and CT were compared using fixed- or random-effects pairwise meta-analysis for per-protocol (PP), intention-to-treat (ITT) and best-case scenarios. TSA was used to control for risk of random errors.

RESULTS

A total of 235 studies were identified, and three trials involving 130 patients (463 restorations) were included. Risk of bias was high or moderate in all but one trial. ART was associated with a significantly increased risk of failure (OR [95% CI] 2.06 [1.06/4.00]) in PP- but not in ITT analysis (1.36 [0.92/2.02]). Analyses for best-case scenarios found great uncertainty introduced by attrition. No firm evidence was reached according to TSA.

CONCLUSIONS

For restoration of root caries, there is insufficient data to clearly rule out whether differences between ART and CT exist. Limited available data indicate there might be an increased risk of failure for ART.

Periodontal complications with age

The present literature review on periodontal complications in aging focuses on the diagnosis, etiology and development of periodontal complications as a complete entity. In addition, the review also focuses on some of the common systemic diseases that either may further add to periodontal complications or, as result of anti-inflammatory treatment, limit the expression of periodontal disease. There is no evidence to suggest that clinical methods to provide periodontal therapies have been developed especially for older individuals. There is evidence that aging can be associated with periodontally healthy conditions through life and with a high level of tooth retention and function. Periodontal complications that are difficult to manage are usually associated with concurrent medical diseases and complications, or with socio-economic factors that limit the ability to provide dental care for the aging population. Currently, some systemic medical conditions are managed with anti-inflammatory medications with positive effects, while slowing the progression and expression of chronic periodontitis. The lack of data from clinical studies on how to manage periodontal complications in aging is obvious.

One-year water-ageing of calcium phosphate composite containing nano-silver and quaternary ammonium to inhibit biofilms

Dental composites are commonly used restorative materials; however, secondary caries due to biofilm acids remains a major problem. The objectives of this study were (1) to develop a composite containing quaternary ammonium dimethacrylate (QADM), nanoparticles of silver (NAg), and nanoparticles of amorphous calcium phosphate (NACP), and (2) to conduct the first investigation of the mechanical properties, biofilm response and acid production vs water-ageing time from 1 day to 12 months. A 4 × 5 design was utilized, with four composites (NACP-QADM composite, NACP-NAg composite, NACP-QADM-NAg composite, and a commercial control composite), and five water-ageing time periods (1 day, and 3, 6, 9, and 12 months). After each water-ageing period, the mechanical properties of the resins were measured in a three-point flexure, and antibacterial properties were tested via a dental plaque biofilm model using human saliva as an inoculum. After 12 months of water-ageing, NACP-QADM-NAg had a flexural strength and elastic modulus matching those of the commercial control (P>0.1). Incorporation of QADM or NAg into the NACP composite greatly reduced biofilm viability, metabolic activity and acid production. A composite containing both QADM and NAg possessed a stronger antibacterial capability than one with QADM or NAg alone (P<0.05). The anti-biofilm activity was maintained after 12 months of water-ageing and showed no significant decrease with increasing time (P>0.1). In conclusion, the NACP-QADM-NAg composite decreased biofilm viability and lactic acid production, while matching the load-bearing capability of a commercial composite. There was no decrease in its antibacterial properties after 1 year of water-ageing. The durable antibacterial and mechanical properties indicate that NACP-QADM-NAg composites may be useful in dental restorations to combat caries.

Elemental analysis of caries-affected root dentin and artificially demineralized dentin

OBJECTIVES

This study aimed to analyze the mineral composition of naturally- and artificially-produced caries-affected root dentin and to determine the elemental incorporation of resin-modified glass ionomer (RMGI) into the demineralized dentin.

MATERIALS AND METHODS

Box-formed cavities were prepared on buccal and lingual root surfaces of sound human premolars (n = 15). One cavity was exposed to a microbial caries model using a strain of Streptococcus mutans. The other cavity was subjected to a chemical model under pH cycling. Premolars and molars with root surface caries were used as a natural caries model (n = 15). Outer caries lesion was removed using a carbide bur and a hand excavator under a dyeing technique and restored with RMGI (FujiII LC, GC Corp.). The weight percentages of calcium (Ca), phosphate (P), and strontium (Sr) and the widths of demineralized dentin were determined by electron probe microanalysis and compared among the groups using ANOVA and Tukey test (p < 0.05).

RESULTS

There was a pattern of demineralization in all models, as visualized with scanning electron microscopy. Artificial models induced greater losses of Ca and P and larger widths of demineralized dentin than did a natural caries model (p < 0.05). Sr was diffused into the demineralized dentin layer from RMGI.

CONCLUSIONS

Both microbial and chemical caries models produced similar patterns of mineral composition on the caries-affected dentin. However, the artificial lesions had a relatively larger extent of demineralization than did the natural lesions. RMGI was incorporated into the superficial layer of the caries-affected dentin.