Systematic Review of the Prevalence of Tooth Wear in Children and Adolescents

Restorative options for moderate and severe tooth wear: A systematic review

OBJECTIVES

This systematic review aimed to evaluate the failure of different types of restorative treatments for tooth wear.

STUDY DESIGN

A search was conducted in Medline, Cochrane, Web of Science, SCOPUS, and Embase (October 2023) with no limits for publication year or language. Randomized and non-randomized studies comparing restorative options to treat moderate to severe tooth wear were included. Two reviewers independently selected studies, extracted data and assessed the risk of bias. Failure data was obtained from each study and organised into either 'major failure,' with the need to replace the restoration, or 'minor failure,' where the restoration was repaired or refurbished. Studies that did not bring comparisons or sufficient data to calculate failures were excluded.

RESULTS

3977 articles were found; 43 studies were eligible for analysis. For RCT studies (n = 6), direct composite showed a mean annual failure rate (AFR) of 10.54 % for minor failures and 8.38 % for major failures. For non-RCT studies (n = 37), these were 3.97 % and 0.4 % respectively. For RCT studies, indirect composite showed a mean AFR of 12.84 % for minor failures and 10.41 % for major failures. For non-RCT studies, these were 2.9 % and 0.15 % respectively. For RCT studies, indirect ceramic showed a mean AFR of 0.09 % for minor failures and 0.13 % for major failures. For non-RCT studies, these were 0.83 % and 0.33 % respectively.

CONCLUSION

Indirect restorations demonstrated lower failure rates; however, they can be more invasive and require more operator time than alternatives. Direct methods showed greater failures but offer a minimally invasive modality. (CRD42022358586) CLINICAL SIGNIFICANCE: This study will provide clinicians with a more informed view of the success, survival and failure rates of materials when deciding how to restore tooth wear.

Tooth Wear Prevalence and Associated Risk Factors Among a Small Portuguese Community: A Retrospective Study

Background/Objectives: Early tooth wear (TW) assessment prevents challenging and costly dental treatments. Knowledge of data on the prevalence and risk factors is crucial for developing preventive guidelines. This retrospective cross-sectional study aims to study the prevalence of TW in a sample of patients seeking a Screening and Emergency appointment at Egas Moniz Dental Clinic (EMDC) and its associated risk factors. Methods: Descriptive and logistic regression analysis were applied to data from a sample of 2266 patients, collected between 2021 and 2023, to ascertain the presence of tooth wear, its different types and its correlation with potential risk factors. Results: The prevalence of dental wear was found to be 54.7%, with attrition (24.1%) being the most prevalent lesion and erosion (2.7%) the least prevalent. Concerning the risk predictors for tooth wear, age (OR = 1.01-1.05, p < 0.05), decreased DVO (OR = 2.16, p = 0.028), antacids (OR = 7.07, p = 0.003), mastication difficulties (OR = 1.87, p = 0.039), drugs (OR = 2.38, p = 0.032) and use of mouthwash (OR = 1.47, p = 0.008) were positively associated. Gender (OR = 0.7, p = 0.015) was negatively associated, with females showing a 30% less risk than males. Conclusions: It was concluded that TW is prevalent and increases with age, underscoring the necessity for timely and accurate diagnosis to minimize its progression. Additionally, it is crucial to conduct a thorough evaluation of the risk factors involved to implement effective preventive measures and treatment strategies.

The role of orthodontics in the management of tooth wear

Pathological tooth wear is a dental problem that affects all age groups and appears to be increasing in prevalence. A subset of these patients may benefit from a combination of orthodontic and restorative care which will be discussed in this article. Orthodontics can help to create the necessary vertical, anterior-posterior and mesio-distal space for restorative work, reducing the need for tooth reduction and lessening the biological costs of restorative care, helping to reposition the gingival margins where this impacts upon aesthetics, as well as correcting co-existing malocclusion.

Susceptibility of fluorotic enamel to dental erosion-abrasion

Dental hard tissue conditions can be of pre- or post-eruptive nature, such as enamel fluorosis and erosive tooth wear (ETW), respectively. Dental enamel fluorosis is caused by the chronic and excessive intake of fluoride during enamel development, leading to increased fluoride concentration and increased porosity. ETW has become a common clinical condition and often impairs dental function and aesthetics. This in vitro study tested the hypothesis that fluorotic enamel presents different susceptibility to dental erosion-abrasion. It consisted of a 3×3×2 factorial design, considering a) fluorosis severity: sound (TF0), mild (TF1-2), moderate (TF3-4); b) abrasive challenge: low, medium, and high; and c) erosive challenge: yes or no. A total of 144 human teeth were selected according to the three fluorosis severity levels (n=48), and subdivided into six groups (n = 8) generated by the association of the different erosive and abrasive challenges. Enamel blocks (4×4 mm) were prepared from each tooth and their natural enamel surfaces subjected to an erosion-abrasion cycling model. After cycling, the depth of the lesions in enamel was assessed by profilometry. ANOVA showed that the three-way and two-way interactions among the factors were not significant (p > 0.20). Enamel fluorosis level (p=0.638) and abrasion level (p = 0.390) had no significant effect on lesion depth. Acid exposure caused significantly more enamel surface loss than water (p < 0.001). Considering the limitations of this in vitro study, fluorosis did not affect the susceptibility of enamel to dental erosion-abrasion.

Intraoral scanner-based monitoring of tooth wear in young adults: 24-month results

OBJECTIVES

Tooth wear causes irreversible cumulated surface loss and already occurs at a young age. Therefore, the objective of this clinical prospective observational study was to monitor the occlusal surface of a mandibular first molar in young adults for a period of 24 months. Furthermore, potential aetiological factors obtained by a questionnaire were considered.

MATERIALS AND METHODS

The study teeth (FDI #36 or #46) of 81 participants (mean age 22.8 ± 2.2 years) were scanned with the intraoral scanner (IOS, Trios 3, 3Shape) at the second follow-up (T2) after an observation period of 24 months. Standard-tessellation-language datasets were superimposed with baseline (T0) and T2 scans in 3D analysis software (GOM Inspect). The maximum vertical substance loss was measured between T0 and T2 at 6/7 areas (4/5 cusps and 2 ridges) of each study tooth and data compared to the already published data of the first follow-up (T1) after 12-month observation period. The morphology of tooth wear was classified into three groups: cupping (C), facet (F) and combined cupping-facet (CF). The analysis of aetiological factors, such as acid impacts, was based on a questionnaire filled out by participants at time points T0, T1 and T2. Non-parametric tests were used for statistical analysis (p < 0.05).

RESULTS

The buccal load-bearing cusps (mesiobuccal: median 15 μm, 95%CI 11/18 μm; mesiolingual 8 μm, 0/11 μm) were most affected by tooth wear. Loss values increased significantly at T2 compared to T1 for all areas, although significantly less than in the first 12 months (T0-T1). Areas that already exhibited F at T0 mostly displayed them also at T2 and only rarely developed further into C or CF. The only association between aetiological factors and loss values could be detected for sex as males had significantly higher loss values than females.

CONCLUSIONS

Progression of tooth wear could be clearly shown with high interindividual variations in loss values among participants. This indicates the need for individual monitoring with IOS.

CLINICAL RELEVANCE

IOSs show the potential for patient-specific monitoring to detect the progression of tooth wear. Thus, data of 24 months fills the gap of tooth wear data for young adults in literature. Further studies over a longer observation period are highly recommended to gain more information about the dynamic of tooth wear and aetiological factors.

Sleep Bruxism in Children—What Can Be Learned from Anamnestic Information

Sleep bruxism (SB) is a masticatory muscle activity during sleep, and its clinical manifestation in young children is still unclear. The aim of the present study was to evaluate the role of anamnestic information in predicting possible SB in children aged 4–12 years. In a cross-sectional retrospective exploratory study, the dental files of 521 children were examined with regard to the following anamnestic information: gender, age, medical conditions associated with ear, nose, and throat (ENT), respiratory disorders, use of methylphenidate (Ritalin), oral habits, and bruxing during sleep. A child was defined as presenting possible SB when a positive report was received from parents regarding such behavior (SB positive, No. = 84). There were no age- and/or gender-wise differences between SB-positive children and children whose parents did not report SB behavior (SB negative). SB-positive children suffered more from ENT and respiratory disorders than children without SB. Additionally, the use of pacifiers/finger sucking, as well as snoring, were more common among SB-positive children as compared to their SB-negative counterparts (Chi-square). The variables which were found to significantly increase the odds of possible SB in children were mouth breathing, ENT problems, and use of a pacifier or finger sucking (forward stepwise logistic regression). Clinicians should look for clinical signs of possible SB in children whose anamnesis reveals one or more of these anamnestic signals.

Tooth wear prevalence in individuals with Down syndrome: a systematic review

OBJECTIVES

This systematic review investigated the prevalence of tooth wear between patients with and without Down syndrome.

METHODS

Six databases (Embase, LILACS, Livivo, PubMed, Scopus and Web of Science) and grey literature (Google Scholar, OpenGrey and ProQuest) were searched until March 7, 2022. Observational studies were included to assess the differences in tooth wear prevalence and/or severity in Down syndrome and non-syndromic controls. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations were followed. Three reviewers independently screened studies, extracted data, assessed the methodological quality (Joanna Briggs Institute) and graded the certainty of evidence through the Grading of Recommendations, Assessment, Development, Evaluation (GRADE) approach. Results were summarized through meta-analyses using a random-effects model. The protocol was registered at PROSPERO (CRD42021266997).

RESULTS

Of the 1382 records identified, six cross-sectional studies were included. Individuals with Down syndrome had a higher prevalence and were more likely to have tooth wear than individuals without Down syndrome (44% × 15%; OR = 4.43; 95% CI 3.17-6.18; p < 0.00001; I² = 8%). Also, the severity of tooth wear was higher in the Down syndrome group (n = 275) compared with the controls (n = 294). The certainty of evidence analysis was very low.

CONCLUSIONS

Based on very low certainty of the evidence, patients with Down syndrome had a higher prevalence and likelihood and severity of tooth wear when compared to those without Down syndrome.

CLINICAL RELEVANCE

Screening early tooth wear lesions should be carefully done in the Down syndrome population since its occurrence is remarkable compared to the general population.

Enhancing the Antimicrobial Effect of Ozone with Mentha piperita Essential Oil

This study aimed to obtain and analyse Mentha piperita essential oil (MpEO) for the prospect of being used as an enhancement agent for the antimicrobial potential of ozone against gram-positive and gram-negative bacteria and fungi. The research was done for different exposure times, and it gained time-dose relationships and time-effect correlations. Mentha piperita (Mp) essential oil (MpEO) was obtained via hydrodistillation and further analysed by using GC-MS. The broth microdilution assay was used to determine the strain inhibition/strain mass growth by using spectrophotometric optical density reading (OD). The bacterial/mycelium growth rates (BGR/MGR) and the bacterial/mycelium inhibition rates (BIR/MIR) after ozone treatment in the presence and absence of MpEO on the ATTC strains were calculated; the minimum inhibition concentration (MIC) and statistical interpretations of the time-dose relationship and specific t-test correlations were determined. The effect of ozone on the following tested strains at maximum efficiency was observed after 55 s of single ozone exposure, in order of effect strength: S. aureus > P. aeruginosa > E. coli > C. albicans > S. mutans. For ozone with the addition of 2% MpEO (MIC), maximum efficacy was recorded at 5 s for these strains, in order of effect strength: C. albicans > E. coli > P. aeruginosa > S. aureus > S. mutans. The results suggest a new development and affinity regarding the cell membrane of the different microorganisms tested. In conclusion, the use of ozone, combined with MpEO, is sustained as an alternative therapy in plaque biofilm and suggested as helpful in controlling oral disease-causing microorganisms in medicine.

Morphological and Elemental Evaluation of Investigative Mouthwashes to Repair Acid-Eroded Tooth Surface

Purpose

Erosive tooth wear (ETW) is characterized by subsurface demineralization and tooth substance loss with crater formation. Remineralization of subsurface demineralization has previously been demonstrated; however, repair of the eroded surface is still under investigation. This study investigated the effectiveness of mouthwashes containing hydrolyzed wheat protein (HWP) in repairing ETW through promotion of organized crystal growth.

Methods

Enamel Erosion was created on 210 enamel blocks by 10-minute demineralization in 1% Citric Acid (pH 3.5). Then, blocks were randomly assigned to seven groups (30/group); (A) 0.2% HWP, B) 1% HWP, (C) 2% HWP, (D) 1% HWP + 0.05% NaF, (E) Listerine™ mouthwash, (F) 0.02% NaF Crest™ Pro-health mouthwash and (G) artificial saliva (AS) only. Groups were subjected to daily pH-cycling consisting of one 5-minute erosive challenge with citric acid, three 1-minute mouthwash treatment periods, and then storage in AS for the rest of the time for 28 days. Treatment effects were assessed using SEM-EDX. Statistical analysis was by ANOVA and Tukey's multiple comparison.

Results

In groups exposed to HWP-containing mouthwashes, there was growth of fiber-like crystals that increased in packing density in a dose-dependent manner (0.2%, 1%, 2%) on the eroded enamel surfaces, with increased calcium and phosphate contents on the treated surfaces. The non-HWP-containing groups had the eroded surfaces covered by structureless deposit layer firmly attached to the surface.

Conclusion

Treating eroded enamel surface with HWP-containing mouthwash resulted in repair of the damaged tissue by formation of a protective layer of crystal deposits within and on the eroded enamel tissue.

Pressable lithium disilicate ceramic versus CAD/CAM resin composite restorations in patients with moderate to severe tooth wear: Clinical observations up to 13 years

OBJECTIVE

To report the long-term clinical survival and failure rates of single-tooth restorations made of pressable lithium disilicate ceramics (LS₂ ) and CAD/CAM resin composite (RC) by two separate clinical observations.

MATERIALS AND METHODS

Twenty-one patients (12 female, nine male) were treated with 436 minimally invasive single-tooth restorations made of 274 pressed LS₂ (n = 12; posterior: monolithic IPS e.max Press; anterior: IPS e.max Ceram veneered, Ivoclar) or 162 milled from RC (n = 9; monolithic exp. CAD/CAM resin composite, Ivoclar). The mean age of patients was 44.1 ± 9.3 years and the mean observation time was 86.2 ± 13.5 months (7.7 ± 1.1 years), with 8.5 ± 2.7 years for LS2 and 6.7 ± 0.5 years for RC. All restorations were observed for technical/biological failures using the modified criteria of the United States Public Health Service (USPHS). Collected data were analyzed using Kaplan-Meier survival analysis and log-rank test (α < 0.025).

RESULTS

The 274 LS₂ restorations showed a survival of 100% and a total failure rate of 5.5%. The 162 RC restorations showed a survival of 100% and a total failure rate of 25.3%. RC restorations exhibited more material fractures (p = 0.020) and higher discoloration rates (p < 0.001).

CONCLUSIONS

Pressed LS₂ single-tooth restorations showed lower long-term failure rates than restorations made of RC.

CLINICAL SIGNIFICANCE

Despite the limitations of the clinical observations, single-tooth restorations of both materials can be recommended for permanent use in patients with severe tooth wear.

Linear and areal surface roughness assessments for the study of tooth wear in human enamel

OBJECTIVES

To test 8 models of linear surface roughness assessment in characterizing surface profile description and to correlate these models with equivalent areal parameters over sound human enamel in vitro.

MATERIALS AND METHODS

Thirty enamel blocks were randomly selected. The roughness data (2D-Rp; Rv; Rz; Rc; Rt; Ra; Rq; Rsk; Rku/3D-Sp; Sv; Sz; Sa; Sq; Ssk; Sku) was obtained in duplicate in a non-contact 3D optical profilometer. The models were composed by 1 single vertical trace (model 1) until 8 traces (model 8 composed by three vertical traces, three horizontal traces, and two diagonal).

RESULTS

The addition of linear sampling traces to the enamel blocks did not result in Rp, Rv, Rz, Rc, Rt, Ra, Rq, Rsk, and Rku value changes (low power-from 5 to 72%). Significant Spearman's correlation coefficients were obtained in most correlation analysis (Rp ↔ Sp; Rv ↔ Sv; Rz ↔ Sz; Ra ↔ Sa; Rq ↔ Sq; and Rku ↔ Sku).

CONCLUSIONS

A single vertical trace in the middle of the sample was representative of the overall enamel surface roughness (Rp, Rv, Rz, Rc, Rt, Ra, Rq, Rsk, and Rku) models. The majority of the assessed models in the correlation evaluation presented significant and positive association.

CLINICAL RELEVANCE

The findings highlight the applicable model for roughness analysis over human enamel recommended for research and in situ trials assessments.

Influence of Tucupi on Enamel Surface Roughness, Microhardness, Ultramorphology and Mass Variation

Aim

The study evaluated the influence of tucupi on enamel surface roughness, microhardness, ultramorphology, and mass variation.

Materials and Methods

Ninety healthy bovine incisors were divided into three experimental groups, according to the acidic challenge adopted, being: G1- tucupi, G2- cola-based soft drink, G3-distilled water. The enamel properties (surface roughness, microhardness, ultramorphology and mass variation) of all specimens were evaluated at times T0 (before any intervention), T10 (10 days after the proposed treatments), T20 (20 days after the proposed treatments) and T30 (30 days after the proposed treatments). After confirming the normality of the data (Shapiro-Wilk test), a two-way ANOVA (α = 5%) was performed, followed by Sidak post-test, with results described as mean and standard deviation.

Results

The roughness means increased for all tested groups, with no statistical difference only in G3 for all evaluated times. Microhardness of all groups showed a significant decrease over the time, with the lowest average observed in G1 in T30. Considering enamel mass variation, the lowest average was in G2 at time T3, with no statistical difference only in G3 (distilled water) over the time. Regarding ultramorphology (scanning electron microscopy - SEM), only groups G1 and G2, that were exposed to acidic challenges, showed disorganization of the enamel surface layer.

Conclusion

It was possible to conclude that tucupi has low pH and high titratable total acidity, being able to gradually decrease enamel microhardness, increasing surface roughness and causing loss of dental enamel.

Dual protective effect of the association of plant extracts and fluoride against dentine erosion: In the presence and absence of salivary pellicle

OBJECTIVES

To verify the protective effect of plant extracts associated with fluoride against dental erosion of dentine, in the presence and absence of a salivary pellicle.

METHODS

Dentine specimens (n = 270) were randomly distributed into 9 experimental groups (n = 30/group): GT (green tea extract); BE (blueberry extract); GSE (grape seed extract); NaF (sodium fluoride); GT+NaF (green tea extract and NaF); BE+NaF (blueberry extract and NaF); GSE+NaF (grape seed extract and NaF); negative control (deionized water); and a positive control (commercialized mouthrinse containing stannous and fluoride). Each group was further divided into two subgroups (n = 15), according to the presence (P) or absence (NP) of salivary pellicle. The specimens were submitted to 10 cycles: 30 min incubation in human saliva (P) or only in humid chamber (NP), 2 min immersion in experimental solutions, 60 min of incubation in saliva (P) or not (NP), and 1 min erosive challenge. Dentine surface loss (dSL-10 and dSL-total), amount of degraded collagen (dColl) and total calcium release (CaR) were evaluated. Data were analyzed with Kruskal-Wallis, Dunn's and Mann-Whitney U tests (p>0.05).

RESULTS

Overall, the negative control presented the highest values of dSL, dColl and CaR, and the plant extracts showed different degrees of dentine protection. For the subgroup NP, GSE showed the best protection of the extracts, and the presence of fluoride generally further improved the protection for all extracts. For the subgroup P, only BE provided protection, while the presence of fluoride had no impact on dSL and dColl, but lowered CaR. The protection of the positive control was more evident on CaR than on dColl.

CONCLUSION

We can conclude that the plant extracts showed a protective effect against dentine erosion, regardless of the presence of salivary pellicle, and that the fluoride seems to improve their protection.

Three-Dimensional Finite Element Analysis of Worn Molars With Prosthetic Crowns and Onlays Made of Various Materials

Background/Purpose

Restoration of worn teeth represents a challenge for practitioners in terms of preserving dental tissues, achieving restoration requirements, and choosing the most appropriate material. This study aimed to evaluate the effect of both preparation and restoration type on stress distribution in modeled first mandibular molars when functional and parafunctional occlusal forces were applied.

Materials and methods

The study sample consisted of 40 three-dimensional computer models of restored lower first molars with full crowns (gold, nickel-chrome, lithium disilicate, BruxZir® zirconia, and porcelain fused to metal) and onlays (gold, nickel, chrome, lithium disilicate, and direct and indirect composites). Forces of different intensities and directions were applied, and then finite element analysis was carried out based on the von Mises equivalent stress theory to predict the failure that could occur in the restoring materials and luting cement or bonding agent.

Results

In functional forces groups, zirconia crowns showed the lowest value of the failure risk, while the highest value was in veneering porcelain with values close to the rest of the models. For onlays, gold onlays represented the best stress distribution with the lowest value of the failure risk, in contrast to the composite onlays that had the highest failure risk. In parafunctional forces groups, the preference remained for zirconia and gold crowns, as well as for metal onlays, with greater differences in the values of the failure risk.

Conclusion

Gold alloy exhibited better behavior in the stress distribution. All restorations showed similar behavior when applying functional forces; however, when applying parafunctional forces, both gold and zirconia crowns have shown the best results.

Risk prediction models for erosive wear in preschool-aged children: a prospective study

Background

Despite increasing prevalence, age-specific risk predictive models for erosive tooth wear in preschool-age children have not been developed. Identification of at-risk groups and the timely introduction of behavioural change or treatment will stop the progression of erosive wear in the permanent dentition. This study aimed to identify age-specific risk factors for erosive wear. Distinct risk prediction models for 3-year-old and 5-year-old children were developed.

Methods

A prospective cohort study included school-based clinical examinations and parent administered questionnaires for consented 3 and 5-year-old healthy children. Calibrated examiners measured the following health parameters under standardised conditions: erosion, using the Basic Erosive Wear Examination Index (BEWE), caries using the International Caries Detection and Assessment System (ICDAS), plaque and calculus according to the British Association for the Study of Community Dentistry (BASCD) scores, dental traumatic injuries and soft tissue lesions, salivary testing and BMI. Other health conditions were collected via a parent-administered questionnaire that explored oral- and general-health. Non parametric tests were utilised to explore the temporal relation of erosion with, demographic factors, oral hygiene habits, general health and dietary habits. Variables showing significance with a difference in BEWE cumulative score over time were utilised to develop two risk prediction models. The models were evaluated by Receiver Operating Characteristics analysis.

Results

Risk factors for the 3-year-old cohort (N = 336) included erosive wear (χ²(1, 92) = 12.829, p < 0.001), district (χ²(5, 92) = 17.032, p = 0.004) and family size (χ²(1, 92) = 4.547, p = 0.033). Risk factors for the 5-year-old cohort (N = 441) also included erosive wear (χ²(1, 144) = 4.768, p = 0.029), gender (χ²(1, 144) = 19.399, p < 0.001), consumption of iced tea (χ²(1, 144) = 8.872, p = 0.003) and dry mouth (χ²(1, 144) = 9.598, p = 0.002).

Conclusions

Predictive risk factors for 3-year-old children are based on demographic factors and are distinct from those for 5-year-old children based on biological and behavioural factors. Erosive wear is a risk factor for further wear in both age cohorts.

Differences in susceptibility of deciduous and permanent teeth to erosion exist, albeit depending on protocol design and method of assessment

Controversial results showing that deciduous teeth are more susceptible to erosion than permanent teeth might be related to study designs. We investigated how different conditions (pH: 3.0, 4.0, 5.0; acid agitation: gentle or vigorous; acid exposure times: 1–5 min) affect the susceptibility of both teeth to erosion. Enamel specimens (90 deciduous, 90 permanent) were distributed into groups (n = 15 permanent, n = 15 deciduous) according to acid pH (pH 5, 4 or 3) and agitation (gentle or vigorous) during erosive challenge. Both milder (less incubation time, gentle agitation, and higher pH) and more severe (longer incubation times, vigorous shaking, and lower pH) conditions were used. Demineralization was measured by relative surface microhardness (rSMH) and calcium released to the acid. Demineralization increased gradually for both teeth with increasing incubation time, agitation (gentle or vigorous), and with decreasing acid pH. The differences between deciduous and permanent teeth depended on the protocol design and assessment method. Under milder conditions, demineralization was better detectable with rSMH. Under more severe conditions, differences were more perceptible with calcium analyses. Differences exist in the susceptibility to erosion between deciduous and permanent teeth, but they are only distinguishable when the appropriate assessment method is used for the specific erosive condition.

Prevalence and Associated Factors of Erosive Tooth Wear among Preschool Children-A Systematic Review and Meta-Analysis

The prevalence of dental erosion among preschool children and its associated factors range widely between studies. The aims of this review are to evaluate the literature and to determine the prevalence and associated factors of dental erosion among children below 7 years old. An electronic search was undertaken to identify observational studies evaluating the prevalence of dental erosion and its associated factors in children below 7 years old. Dual independent screening, data extraction, risk of bias assessment, meta-analysis, meta-regression, and evaluation of quality of evidence were performed. Twenty-two papers were included. The overall estimated prevalence of dental erosion in children was 39.64% (95% CI: 27.62, 51.65; I2 = 99.9%), with very low certainty of evidence. There was also low-quality evidence suggesting that the likelihood of (1) boys having dental erosion was significantly higher than girls (p < 0.001) and (2) children with digestive disorders having dental erosion was significantly higher than those without such digestive disorders (p = 0.002). Qualitative synthesis identified that more frequent intake of fruit juices and soft drinks correlated with erosive tooth wear. Dental erosion is prevalent among over one-third of preschool children. Digestive disorders and dietary factors are the main potential contributing factors.

Mechanical failure of posterior teeth due to caries and occlusal wear- A modelling study

OBJECTIVES

The purpose of the present work is to explore the effect of occlusal wear and different types and degrees of caries on the mechanical performance and structural integrity of posterior teeth.

METHODS

Three-dimensional (3D) computational models with different combinations of caries parameters (caries location, caries size and caries induced pulp shrinkage) and occlusal wear factors (enamel thickness, marginal ridge height and cuspal slope) were developed and analyzed using the extended finite element method (XFEM) to identify the stress distribution, crack initiation load and ultimate fracture load values. The effect of a non-drilling conservative treatment using resin infiltration on the recovery of mechanical properties of carious molar teeth was also investigated.

RESULTS

Presence of fissural caries, worn proximal marginal ridge and decreased enamel thickness due to occlusal wear, imparted a significant negative effect on the crack initiation load value of the lower molar models. Accordingly, models with intact and strong proximal marginal ridge, generally exhibited higher crack initiation loading, regardless of caries size and location. Presence of fissure caries drastically decreased (55%-70%) the crack initiation load compared to sound teeth. The depth of the fissural lesion and the presence of proximal caries did not have a major effect on crack initiation load values. However, increasing the caries size resulted in lower final fracture load values in most of the cases. Accordingly, the groups with combined and connected large fissural and proximal lesions experienced the largest drop in the fracture load values compared to sound tooth models. The worst condition consisted of two connected large proximal and fissural caries with no proximal marginal ridge, in which the fracture load dramatically decreased to only 25% of that for sound teeth with intact marginal ridge. On the other hand, decreased cuspal slope due to occlusal wear and shrinkage of the pulp due to caries appeared to have a protective role and a direct relation with the fracture resistance of the tooth. Following the application of resin infiltration on the carious models, the crack initiation load and the fracture load could recover up to 75% and 90% of the values for the corresponding sound tooth models, respectively.

SIGNIFICANCE

Presence of fissural caries, if not treated (either with remineralization, resin infiltration or restoration), can be a major risk factor in the initiation of tooth fracture. When combined with decreased enamel thickness and loss of proximal marginal ridge due to mechanical or chemical wear, the weakening effect of the caries will be amplified specially in teeth with steep cuspal slopes. The application of a conservative treatment with resin infiltration can be an effective approach in prevention of further mechanical failure of demineralized enamel. The findings of this study emphasize the importance of early interventions in the management of caries for the prevention of future cuspal or tooth fracture especially in subjects with higher risk factors for tooth fracture such as caries, wear and bruxism.

Cell-Free Biomimetic Mineralization Strategies to Regenerate the Enamel Microstructure

The distinct architecture of native enamel gives it its exquisite appearance and excellent intrinsic-extrinsic fracture toughening properties. However, damage to the enamel is irreversible. At present, the clinical treatment for enamel lesion is an invasive method; besides, its limitations, caused by the chemical and physical difference between restorative materials and dental hard tissue, makes the restorative effects far from ideal. With more investigations on the mechanism of amelogenesis, biomimetic mineralization techniques for enamel regeneration have been well developed, which hold great promise as a non-invasive strategy for enamel restoration. This review disclosed the chemical and physical mechanism of amelogenesis; meanwhile, it overviewed and summarized studies involving the regeneration of enamel microstructure in cell-free biomineralization approaches, which could bring new prospects for resolving the challenges in enamel regeneration.

Biodentine or Mineral Trioxide Aggregate as Direct Pulp Capping Material in Mature Permanent Teeth with Carious Exposure? A Systematic Review and Meta-analysis

OBJECTIVE

To evaluate the success rate of direct pulp capping (DPC) with Biodentine in mature permanent teeth with carious vital pulp exposure compared to that of DPC with mineral trioxide aggregate (MTA) by means of a systematic review and meta-analysis.

DATA SOURCES

The two authors searched independently the literature published through July 31, 2020, in five electronic databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science Core Collection, the Wiley Online Library, and the SCOPUS database).

STUDY SELECTION

The research protocol was previously registered in the PROSPERO database (CRD42020192511). Clinical studies that met the inclusion criteria were chosen and independently screened by the authors.

DATA EXTRACTION

A custom-designed spreadsheet was used to extract the data. The quality of each study was evaluated by means of the revised Cochrane risk of bias (ROB) tool or the ROB of nonrandomized studies of interventions tool.

DATA SYNTHESIS

Three randomized controlled trials and one retrospective study met the inclusion criteria. Only one study had a high risk of bias. The included studies reported data on a total of 95 participants with an age range of 8-51 years. No significant difference was observed in the overall treatment outcome when comparing Biodentine with MTA (Risk ratio=1.00, 95% confidence interval [0.93-1.07], p=1.00).

CONCLUSIONS

Biodentine had comparable clinical and radiographic success to that of MTA when used as a DPC agent in mature permanent teeth with carious vital pulp exposure. Additional high-quality studies are needed.

The association between erosive tooth wear and diet, hygiene habits and health awareness in adolescents aged 15 in Poland

Purpose

The aim of the study was to assess the prevalence of erosive tooth wear (ETW) and risk indicators in the population of adolescents aged 15 in Poland.

Methods

Erosive tooth wear in 2639 participants was determined by calibrated examiners according to the BEWE scoring system, and the prevalence of risk factors was assessed on the basis of a survey.

Results

Erosive tooth wear was reported in 24.3% of participants. Initial loss of surface (BEWE 1) was the predominant finding, observed in 21.3% of participants. Hard tissue loss (BEWE 2 and 3) occurred very rarely, only in 3% of participants. Acidic diet, masculine gender and lower socio-economic status were associated with higher prevalence and severity of erosive lesions in the examined population.

Conclusion

Two modifiable factors—acidic diet and low health awareness—were found to be highly unsatisfactory in the adolescents aged 15 in Poland. Accordingly, to prevent the deterioration of the functionality and aesthetics of the teeth in young people, certain measures, such as routine clinical examination, education, dietary consulting and prophylaxis, should be implemented as early as possible, focusing predominantly on families with lower socio-economic status.

Tooth wear and socioeconomic status in childhood and adulthood: Findings from a systematic review and meta-analysis of observational studies

OBJECTIVES

To evaluate the association and level of evidence between socioeconomic status (SES) and tooth wear (TW) in children, adolescents, and adults.

DATA

Eligibility criteria comprised population-based observational studies assessing the association between SES and TW in permanent dentition of adolescents and adults. Interventional and descriptive studies or those without an internal comparison between exposed and nonexposed groups were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied where applicable. Risk of bias (RoB) was assessed using the Newcastle-Ottawa scale. Meta-analyses were conducted to estimate the pooled effect measures. Q-statistic, I²statistic, subgroup and sensitivity analyses assessed study heterogeneity.

SOURCES

PubMed/Medline, Embase, Scopus, Web of Science, LILACS, SciELO, Cochrane Library, and Google Scholar databases were searched for articles published in English between 1st January 1980 and 31st March 2021.

RESULTS

Sixty-five studies were included, involving 63,893 participants in over 30 countries. A positive association was found between TW and education (OR=1.25 [0.96; 1.62]), family income (OR=1.18 [0.91; 1.53]), and private school (OR= 1.24 [0.90; 1.72]) among adolescents. Higher educated adults had a lower risk for TW (OR=0.70 [0.52; 0.93]). Most included studies had a moderate RoB. Limitations relating to population representation and assessment methodologies were identified in the included studies.

CONCLUSIONS

SES was associated with TW with its direction depending on the individuals' age. The overall quality of evidence was moderate.

CLINICAL SIGNIFICANC

SES should be included as part of the routine screening and risk assessment for tooth wear.

Intraoral scanner-based monitoring of tooth wear in young adults: 12-month results

OBJECTIVES

To investigate tooth wear in young adults, intraoral scanning was used for digital monitoring of the mandibular first molar over 12 months. A possible influence of aetiological factors obtained by a questionnaire on tooth wear was investigated.

MATERIALS AND METHODS

A total of 109 participants (mean age at the start of the study: 21.0 ± 2.2 years) were included in this clinical study. At baseline (T0), an intraoral scan (Trios 3, 3Shape) of the study tooth (FDI # 36 or #46) was conducted. After a mean observation period of 373 ± 19 days, a second intraoral scan (T1, n = 94) of the same tooth as at T0 was performed and standard tessellation language datasets were superimposed with 3D analysis software (GOM Inspect). The occlusal surface of the study tooth was divided into 7 areas (5 cusps, 2 ridges) and maximum vertical substance loss was measured between T0 and T1 (n = 91). Three types of tooth wear were defined: cupping (C), facet (F) and combined cupping-facet (CF). Furthermore, a questionnaire on aetiological factors, such as dietary behaviour, was filled out at T0. Data were analysed with non-parametric tests (p < 0.05).

RESULTS

Only one study tooth exhibited no tooth wear at T0, whereas 3 teeth showed C, 47 teeth F and 40 teeth CF. A progression of vertical substance loss for all three types was shown. Most affected were the mesiobuccal cusps (43, 38/47 µm; median, 95%CI) followed by distobuccal (36, 33/39 µm), mesiolingual (35, 26/40 µm), distolingual (34, 27/36 µm) and distal (31, 25/34 µm). On mesial and distal ridges, only F was detected with the lowest vertical substance loss of all areas (mesial ridge: 0, 0/0 µm; distal ridge: 0, 0/0 µm). An association between aetiological factors and loss values could not be shown.

CONCLUSIONS

All study teeth showed clear signs of wear, and after only 1 year, further substance loss was detectable. This result is of significance for young adults.

CLINICAL RELEVANCE

Since data of young adults regarding tooth wear are scarce, the results give a first idea of the amount of vertical loss per year and its relation to aetiological factors such as dietary behaviour. Therefore, further studies over a longer observation period are highly recommended.

In vitro effect of toothpaste with low fluoride combined with sodium trimetaphosphate on dentine erosion

PURPOSE

This study sought to evaluate in vitro the effect of a dentifrice containing sodium trimetaphosphate (TMP) combined or not with low fluoride (500 ppm NaF) on dentine erosion of intrinsic origin.

METHODS

Human root dentine blocks were selected based on surface microhardness and randomly allocated into five groups (n = 12): negative control (0 ppm F; no TMP); F500 (500 ppm NaF); F1500 (1500 ppm NaF-positive control); TMP (1% TMP); and F + TMP (500 ppm NaF + 1% TMP). The blocks were submitted to erosion cycles (3 ×/day) for 3 days (0.01 M HCl, pH 1.5-30 s), treatment (1 min-1:3 p/p dentifrice/distilled water) and remineralization (artificial saliva/120 min). Dentine alterations were determined according to the percentage of microhardness loss (%HL), surface loss (SL) and surface analysis by scanning electron microscopy. The data were analyzed using one-way ANOVA (p < 0.05).

RESULTS

The values of SL and %HL in each group were, respectively: negative control (1.36 ± 0.36; 57.29 ± 14.14), F500 (1.46 ± 0.28; 65.66 ± 5.11), F1500 (1.52 ± 0.36; 61.66 ± 5.15), TMP (1.45 ± 0.45; 62.08 ± 3.83) and F + TMP (1.38 ± 0.42; 63.38 ± 6.47). There was no statistically significant difference in all the parameters (p = 0.873 and p = 0.152).

CONCLUSION

The dentifrices containing TMP combined or not with fluoride were not able to prevent dentine erosion.

Dental erosive wear in primary teeth among five-year-olds - Bergen, Norway

OBJECTIVE

To estimate the prevalence of dental erosive wear among five-year-olds in Bergen, Norway, and to investigate associations between background factors and the condition.

METHODS

A total of 387 children received a dental examination in five Public Dental Service clinics in Bergen, Norway. The parents responded to items about the children's dental hygiene and drinking habits, type of beverage container, diet, and other habits, and about their own age, educational level and country of origin. We explored background variables for possible associations with the outcome status as worst affected by erosive wear (19.4%, n = 75). Chi-squared statistics and logistic regression (Odds Ratios (OR): 95% Confidence Intervals (CI), served as statistical tools).

RESULTS

Approximately 80% showed erosive wear (by SEPRS and by adopted diagnostic instrument (78.5% vs 79.8%)). The condition affected maxillary anterior teeth in 13.9% (n = 54), and cuppings in molars in 79.3% (n = 307) of cases. Grinding teeth during the day and/or night (OR: 1.87, CI: 1.07-3.25) and male sex (OR: 1.76, CI: 1.05-2.96) significantly related to outcome status as worst affected by erosive wear, respectively.

CONCLUSION

Dental erosive wear was widespread. Grinding teeth and male sex associated with outcome status as worst affected by erosive wear.

Epidemiology of Erosive Tooth Wear, Dental Fluorosis and Molar Incisor Hypomineralization in the American Continent

Non-carious dental lesions such as developmental defects of enamel (DDE) and erosive tooth wear (ETW) are the subject of intensive research. This paper aims to give perspectives on both DDE, including dental fluorosis and molar incisor hypomineralization (MIH), and ETW, presenting epidemiological data from the Americas and associated diagnostic aspects. Besides, it is important to present evidence to guide the clinical assessment process, supporting the clinicians' management decisions towards better oral health of their patients. The overall increase in the worldwide prevalence of non-carious lesions discussed in this this paper may reflect the need of perceptual changes. Although the number of publications related to these conditions has been increasing in the last years, there is still a need for clinical diagnostic and management awareness to include these conditions in routine dental practice. Besides, it is important to provide recommendations for standardized clinical assessment criteria, improving the process and helping clinicians' adherence. In this sense, this paper discusses the most commonly implemented indices for each condition. Thus, despite the wide range of diagnostic indices, BEWE is proposed to be the index recommended for ETW assessment, Dean or Thylstrup &amp; Fejerskov indices for fluorosis and preferably the EAPD criteria (or modified DDE index) for MIH. Overall, non-carious lesions are a growing concern, and it is important to implement preventive measures that control their severity and progression, and accurate diagnosis by the dental clinician.

Contemporary diagnosis and management of dental erosion

OBJECTIVE

This article is aimed at providing an overview of the topic of erosive tooth wear (ETW), highlighting the clinical signs, diagnosis, and management of dental erosion.

OVERVIEW

With the increased prevalence of ETW, it is important that oral health professionals are able to recognize the early signs. Early clinical signs of dental erosion are characterized by loss of enamel texture, a silky glossy appearance, and sometimes a dulling of the surface gloss, referred to as the "whipped clay effect, cupping, and restorations 'standing proud'." The progression of ETW should be monitored by means of diagnostic models or clinical photographs. ETW can be as a result of acid attack of extrinsic or intrinsic origin.

CONCLUSION

There is an increase of ETW that is being recognized by the profession. The first step in diagnosing and management is to recognize as early as possible that the process is occurring. At that point a determination of whether the primary etiology is either intrinsic or extrinsic should be made. If these findings are confirmed, appropriate prevention, and management strategies can be adopted followed by appropriate restorative therapy.

CLINICAL SIGNIFICANCE

The prevalence of ETW continues to increase. It is therefore important that oral health care providers have a better understanding of the etiology, pathophysiology, and management of this condition. This review aims to provide the guidelines for diagnosis and management of dental erosion.

Tooth Wear: Best Evidence Consensus Statement

PURPOSE

The purpose of this Best Evidence Consensus Statement was to evaluate the impact of wear on teeth.

MATERIALS AND METHODS

A search updated last on the 07th October 2020 using the terms tooth wear, dental erosion, dental abrasion or dental attrition yielded 11,694 results. Limiting the search to clinical trials, cross-sectional investigations, randomized controlled trials, reviews, systematic reviews and meta-analysis yielded 1,769 results. Mechanistic in vitro studies were also added to the list of abstracts supplying additional information of the impact of wear on teeth. All abstracts were reviewed by two authors. Those relating to the focus question formed the evidence base which was used to formulate the response.

RESULTS

From the search results, 212 articles were related to the research question and 60 were included in this paper. Although tooth wear prevalence is over 30% of the population in early adulthood and increases as individual's age, the impact on the dentition is poorly investigated in longitudinal clinical studies. Wear on teeth can result in alterations in shape and potentially dentine hypersensitivity depending on the etiology. However, the process is slow and pulpal death is rare. The impact that tooth wear has on the patient depends on patient characteristics to a greater extent than the severity of wear.

CONCLUSIONS

Tooth wear is a common condition and part of the ageing process. Erosive tooth wear is a term which acknowledges that acids are normally linked to progression, but mechanical actions of attrition and abrasion will cause visible damage. The changes to the shape of teeth on the macro and micro levels are used to investigate the progression, prevention, etiology, and management. The biological impact of wear on teeth is relatively innocuous and management is often a patient driven process. This article is protected by copyright. All rights reserved.

Salivary profile of children with erosive tooth wear: a transversal study

The aim of the present transversal study was to evaluate the clinical and biochemical salivary parameters of children with and without erosive tooth wear (ETW). The study population was children aged 4 to 9 years. A trained and calibrated examiner (kappa value for intraexaminer reliability = 0.89) classified the children into ETW (n = 24) and control groups (n = 24), and applied the O'Brien index. The salivary flow rate was initially evaluated by stimulated sialometry (paraffin chewing). Afterwards, the collected saliva was submitted to biochemical analyses of pH, uric acid, total buffering capacity, ferric-reducing antioxidant power, reduced glutathione, calcium, and phosphorus. Among the ETW children, 20 (83%) had dental lesions restricted to enamel, and 4 (17%) presented lesions affecting both enamel and dentin. A statistically significant difference between the groups was obtained only for the pH values (t-test; p = 0.004), with averages of 7.31 and 7.56 for the control and the ETW groups, respectively. Considering the parameters evaluated in general, it is suggested that the salivary profile of children with ETW does not differ considerably from that of children without ETW. However, the pH mean value seems to be slightly higher in ETW children, but is still within the normal physiological range.

Efficacy of silver diamine fluoride and sodium fluoride in inhibiting enamel erosion: an ex vivo study with primary teeth

PURPOSE

To assess the efficacy of silver diamine fluoride (SDF) and sodium fluoride (NaF) in inhibiting enamel erosion in primary teeth.

METHODS

80 primary canine teeth were immersed for 24 h in 2% NaF, 10% SDF, or distilled water. Afterward, some of them underwent a 10-min acid challenge using either 1% or 10% citric acid while others did not. Specimens selected for negative controls were immersed in distilled water but not exposed to the acids, whereas those selected for positive controls were not only immersed in distilled water, but also exposed to the acids. Following, 3-mL samples were collected for calcium and phosphorus analysis by an atomic emission spectrometer.

RESULTS

1% acid caused higher phosphorus loss in the positive control group than in the others (no differences between them). Regarding 10% acid, the SDF group showed lower phosphorus loss compared to the positive control and NaF groups. From calcium loss analysis, SDF and NaF groups presented no significant difference when compared to the positive control groups after both acidic challenges.

CONCLUSION

Considering phosphorus loss values, 10% SDF seems to be effective in inhibiting enamel erosion after 1% and 10% citric acid challenges, whereas 2% NaF only after 1% citric acid challenge. Regarding calcium loss values, both fluoride agents seem to have no impact on inhibiting enamel erosion after 1% and 10% citric acid challenges.

Effect of different citrus sweets on the development of enamel erosion in vitro

The increased consumption of citrus sweets can contribute to the development of erosive tooth wear (ETW).

Functionalized Graphene Oxide Shields Tooth Dentin from Decalcification

This in vitro study assessed the efficacy of functionalized graphene oxide (f-GO) nanocomposites on the decalcification of dentin, because dental caries of the root surface is becoming one of the new problems in aged society. Hydroxyapatite plates (HAP) and dentin slices were coated with f-GO nanocomposites by comparing them to silver diamine fluoride as a positive control, then treated with decalcification solutions such as ethylenediaminetetraacetic acid and citrate at 37°C for 24 h. Scanning electron microscopy (SEM) revealed significant protection of the surface morphology of HAP and dentin. On the other hand, a cariogenic Streptococcus mutans growth was inhibited by f-GO nanocomposites. In addition, cytotoxicity of them to epithelial cells was much less than that of povidone-iodine, which is commonly used for oral disinfectant. We synthesized 5 different f-GO nanocomposites such as GO–silver (Ag), GO-Ag–calcium fluoride (CaF2), GO-CaF2, GO-zinc, and GO–tricalcium phosphate (Ca3(PO4)2). They were standardized by evaluating under SEM, transmission electron microscopy (TEM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), thermogravimetry analysis (TGA), and Raman spectra after being synthesized in an aseptic technique. The abilities of GO-Ag, GO-Ag-CaF2, and GO-CaF2 nanocomposites were most preventive for decalcification. In addition, GO-Ag and GO-Ag-CaF2 almost completely inhibited S. mutans growth. However, they did not exhibit cytotoxicity to epithelial cells except at the highest concentration (0.1 w/v%) of GO-Ag and GO-Ag-CaF2. Furthermore, these f-GO nanocomposites exhibited less or no discoloration of dentin, although commonly used silver diamine fluoride causes discoloration of dentin to black. Thus, these f-GO nanocomposites are useful to protect dental caries on the tooth root that becomes a social problem in aged society.

Advances in materials and concepts in fixed prosthodontics: a selection of possible treatment modalities

The introduction of adhesive techniques in combination with translucent restorative materials has greatly influenced treatment concepts in fixed prosthodontics. Modern production technologies offer access to new polymer materials that provide innovative pre-treatment options for complex prosthetic rehabilitations. Additionally, computer-aided design and manufacturing (CAD/CAM) provides access to new ceramic types and thus extends the range of indications for metal-free restorative options. With these developments, important changes of treatment concepts in fixed prosthodontics have occurred which affect the professional life of dental practitioners with a focus on prosthetic dentistry. This article gives an overview of the advances in selected fields of fixed prosthodontics and provides support in material selection for different kinds of indications, from single-tooth restorations to fixed dental prostheses.

Socio-economic characteristics, acid drinking patterns and gastric alterations associated with erosive tooth wear in children: a cross-sectional study

AIMS

Assessing the influence of socio-economic characteristics, acid drinking patterns and gastric alterations considering erosive tooth experience in children.

METHODS

Cross-sectional study to assess 08-10-year-old children enrolled in the primary education in public schools in Florianopolis, Brazil (n = 1085). Caregivers have answered questionnaires comprising independent variables (head of the household education frequency consumption of sports drinks, acid juice/soda, chewing gum, recurrent vomiting, gastric disorders and vomiting after overeating). Four trained dental surgeons have examined the children for the erosive tooth wear-dependent variable (O'Sullivan index), as well as collected dental caries (DMFT) and dental crowding (DAI index) information. A two-stage cluster-sampling plan was conducted. Unadjusted and adjusted logistic regression models were applied (Odds ratio, OR; 95% Confidence interval, CI and 5% significance level).

RESULTS

The prevalence of erosive tooth wear was 15.67%. Erosive tooth wear was positively associated with high consumption of sports drinks (OR 3.42; 95% CI: 1.18-9.23). Children whose caregivers' educational level was equal or less than four years of study were less likely to have erosive tooth wear (OR 0.39; 95% CI: 0.17-0.88).

CONCLUSION

High consumption of sports drinks is positively associated with erosive tooth wear. Children whose caregivers' educational level is low are less likely to present erosive tooth wear.

A 2-year clinical evaluation of direct and semi-direct resin composite restorations in non-carious cervical lesions: a randomized clinical study

OBJECTIVES

The purpose of this study was to evaluate the 2-year success of resin composite restorations in non-carious cervical lesions (NCCLs) using the direct or semi-direct techniques.

MATERIALS AND METHODS

Thirty volunteers presenting with at least two NCCLs were included. Each participant received one restoration using the direct technique and the other using the semi-direct technique, totaling 60 restorations. Time for completing the treatment was computed. Assessments at baseline, 7 days, and 6, 12, and 24 months were performed using the modified United States Public Health Service criteria. Descriptive analysis was reported as a percentage of successful treatments. For inferential analysis, the Student t test was used to evaluate the differences between extension, depth, and time. The chi-square/Fisher tests were used to compare treatment success after each period (α = 0.05). The results were evaluated by using the Kaplan-Meier survival analysis.

RESULTS

Differences were detected regarding mean ± standard deviation time, in which direct and semi-direct procedures were accomplished in 21.8 (± 14.5) and 35.3 (± 19.9) min, respectively. Of the 60 restorations placed, 7 failed in the direct group while 8 failed in the semi-direct group up to 2 years. No differences were detected between restorative protocols. The cumulative survival was 88.5% and 88.4% for the direct technique and semi-direct techniques after 24 months, respectively.

CONCLUSION

The tested restorative protocols present similar results for NCCLs within the studied periods.

CLINICAL RELEVANCE

The semi-direct technique exhibited clinical performance similar to direct technique for NCCL, demonstrating an alternative for restorations of these lesions.

Clinical performance of occlusal onlays made of lithium disilicate ceramic in patients with severe tooth wear up to 11 years

OBJECTIVES

Evaluation of survival and complication rate of monolithic occlusal onlays made of lithium disilicate ceramic used in patients with severe tooth wear up to 11years of clinical service.

METHODS

In a prospective non-randomized clinical study 7 patients (4 male, 3 female; median age: 44.3±6.56years old) were restored full mouth with a total of 103 adhesively bonded occlusal onlays made of lithium disilicate ceramic (IPS e.max Press, Ivoclar Vivadent, Schaan, Liechtenstein). All restorations were examined during annual recall visits using periodontal parameters according to the modified United States Public Health Service (USPHS) criteria: (a) marginal discoloration, (b) secondary caries, (c) marginal integrity, (d) surface texture, (e) restoration fracture, and (f) occlusal wear, rating with Alpha, Bravo and Charlie over an observation period up to 11years (68-139 months; median: 94.9±26.1 months). Data was statistically analyzed using the Kaplan-Meier estimation.

RESULTS

Monolithic lithium disilicate occlusal onlays presented a 100% survival rate. Four restorations within one patient (3.9%) presented marginal discoloration, one after 60 and three after 108 months (all rated Bravo). One restoration (1%) showed a marginal crack formation (technical complication) after 120 months, rated Bravo. No biological complication, debonding or secondary caries could be found and tested periodontal parameters showed excellent results.

SIGNIFICANCE

Based on the analyzed data up to 11years, monolithic occlusal onlays made of lithium disilicate ceramic can be considered as a reliable treatment option for full-mouth rehabilitations in patients with severe tooth wear.

The use of fluoride for the prevention of dental erosion and erosive tooth wear in children and adolescents

BACKGROUND

Erosive tooth wear (ETW) has gained increasing clinical relevance. It is estimated that worldwide 30-50% of deciduous and 20-45% of permanent teeth are affected. One of the most important nutritional factors causing ETW is the overconsumption of soft drinks, but also patient-related factors like reflux or eating disorders can lead to erosive lesions. Whether acids lead to erosive demineralisation depends on their degree of saturation with respect to tooth mineral at their actual pH.

REVIEW

Fluoride compounds like sodium or amine fluoride seem to be of limited efficacy against erosion, the main reason for this is the missing biofilm in the erosive process as well as the lower pH of the acids compared to bacterial acids. This means that to achieve some kind of preventive effect it would be necessary to use products with higher fluoride concentration, which is not an appropriate option for small children, and/or to increase the frequency of application. In addition, the fluoride compound plays a role as promising effects were found when fluoride is combined with titanium or stannous ions. TiF₄ can cause acid-resistant surface coatings and when Sn²⁺/F^- formulations are applied, Sn is not only found on the surface but is also incorporated into enamel and dentine. Both effects make the tooth surface more resistant against acid demineralisation. Different fluoride-containing vehicles have been tested to prevent erosion/ETW, such as toothpastes, rinses, gels and varnishes. Toothpastes offer some degree of protection, especially Sn²⁺-containing formulations, but effects of the active ingredients are sometimes counteracted by the presence of abrasives.

CONCLUSION

Detecting associated factors and influencing them is the main instrument in arresting erosive tooth wear. Additionally, patients at risk for dental erosion should always use an additional fluoride source preferably containing Sn²⁺.

Factores de riesgo de la atrición dental severa: un estudio de casos y controles

Objetivo: identificar los factores de riesgo de la atrición dental severa en pacientes que acudieron a instituciones de atención odontológica, públicas y privadas, de la ciudad de Cuenca, Ecuador. Materiales y métodos: fueron analizados 237 pacientes adultos, 79 casos con atrición dental grados 2, 3 y 4, según el índice de Smith y Knight, y 158 controles con atrición grados 0 y 1. Se realizó un examen clínico y fotográfico para determinar la relación entre la atrición dental y factores como edad, sexo, procedencia, número de dientes residuales, pH salival y bruxismo. Resultados: los pacientes mayores de 25 años (OR= 2,47 IC= 1,41 – 4,35 X2= 10,21 p= 0,001), con menos de 20 dientes en boca (OR= 4,95 IC= 1,47 – 16,62 X2= 7,97 p= 0,004) y con bruxismo (OR= 2,64 IC= 1,45 – 4,81 X2= 10,49 p= 0,001) tienen más probabilidades de presentar atrición dental severa. Luego de una regresión logística binaria se confirmó dicha relación: pacientes mayores de 25 años (OR= 2,03 IC= 1,08 – 3,818) con menos de 20 dientes en boca (OR= 3,90 IC= 1,07 – 14,19) y con bruxismo (OR= 3,22 IC= 1,70 – 6,10); sin embargo, se observó una capacidad predictora muy baja de la variables ajustadas según el R–cuadrado de Cox y Snell (0,123) y el R–cuadrado de Nagelkerke (0,172). Conclusiones: edad avanzada, menor cantidad de dientes en boca y bruxismo aumentaron la posibilidad de presentar atrición dental severa en los pacientes analizados. Mientras que el sexo masculino, la procedencia rural y el pH salival crítico (menor a 6) no se comportaron como factores de riesgo

Do fluoride toothpastes have similar preventive effect in permanent and primary teeth against erosive tooth wear?

BACKGROUND

Little is known about fluoride toothpastes effect on primary teeth submitted to erosive tooth wear.

OBJECTIVES

To evaluate the preventive effect of different toothpastes on surface loss (SL) after severe erosion/abrasion model and to compare this effect between permanent (PT) and primary teeth (pt).

DESIGN

Enamel samples were randomly divided according toothpastes groups (n = 17). G1: placebo; G2: NaF; G3: AmF-NaF-SnCl2 anti-erosion; G4: SnF2 ; and G5: NaF anti-erosion for children. Samples were incubated in artificial saliva (1 hour), submitted to erosive challenge (3 minutes; 1% citric acid; pH3.6; at 25°C) and to toothbrush abrasion (2 minutes slurry immersion; 50 strokes; 200 g) during 30 cycles. Surface loss (μm; mean ± SD) was quantified by contactless profilometry. The effects of the two covariables "tooth" and "toothpaste" were analysed by non-parametric ANOVA, variables with significant effects were tested by Wilcoxon tests.

RESULTS

pt showed significantly higher surface loss than PT in all groups (P < 0.001). The mean values of SL of each group were: G1 PT 18.18(±3.98), pt 25.65(±9.21); G2 PT 14.76(±2.82), pt 18.11(±3.92); G3 PT 12.62(±5.29), pt 15.61(±6.70); G4 PT 17.12(±2.24), pt 23.41(±7.9); G5 PT 13.24(±1.29), pt 18.28(±8.96).

CONCLUSIONS

In permanent teeth, G3 showed the best preventive effect. In primary teeth, G1, G3, and G5 showed similar effect.

Tooth wear and gingival recession in 210 orthodontically treated patients: a retrospective cohort study

Aim

To assess the association between tooth wear (TW) and gingival recession (GR).

Materials and Methods

Two hundred and ten orthodontically treated participants (100 males) were evaluated. GR and TW were rated independently by four raters on plaster models at four time points: before treatment (T1), mean age 13.8 years (SD = 3.7); after treatment (T2), mean age 16.7 years (SD = 3.9); 3 years after treatment (T3), mean age 19.7 years (SD = 4.2); and 7 years after treatment (T4), mean age 23.9 years (SD = 4.8). Univariable and mulitvariable random effects logistic regression analyses were performed with scores for GR as dependent variables and with TW, age, gender, dental segments (maxillary and mandibular anterior and posterior segments), time points, and Angle classification as independent variables. Method reliability was assessed with kappa statistics.

Results

Mandibular incisors, mandibular and maxillary first premolars and maxillary first molars were most vulnerable to GR. The prevalence of GR increased during the observation period. At T1 20.5% participants had one or more recession sites, at T4 85.7 % of the participants had at least one GR. There was evidence of association between moderate/severe TW and GR-for a tooth with moderate/severe wear, the odds of recession were 23% higher compared to a tooth with no/mild wear (odds ratio 1.23; 95% CI: 1.08-1.40; P = 0.002). Age, dental segment, and time were also significant recession predictors, whereas gender was not.

Conclusions

There is evidence that moderate/severe TW is associated with the presence of gingival recession. Clinical significance of this can be limited.

Bond Stability of a Universal Adhesive System to Eroded/Abraded Dentin After Deproteinization

OBJECTIVE

Erosive/abrasive challenges can potentially compromise bonding to dentin. Aiming to improve the quality and stability of bonding to this substrate, this study investigated the combined effect of erosion and toothbrush abrasion on the microtensile bond strength (μTBS) stability to dentin using a universal adhesive system in total and self-etching modes, associated or not associated with deproteinization.

METHODS

Bovine dentin specimens were divided into five groups according to the organic matrix condition (n=20): control (C); erosion (E); erosion + abrasion (EA); erosion + sodium hypochlorite (EH); erosion + abrasion + sodium hypochlorite (EAH). The groups were further divided (n=10) according to the mode of application (total or self-etching) of a universal adhesive. After the bonding procedure, composite blocks were built up, and the samples were cut to obtain sticks for μTBS testing. For each specimen, one-half of the sticks was immediately tested, and the other one-half was tested after artificial aging (5000 thermocycles, 5°C and 55°C).

RESULTS

Three-way analysis of variance (α=5%) showed a significant difference for the triple interaction ( p=0.0007). Higher μTBS means were obtained for the EH and EAH groups compared with the E and EA groups. The control group showed immediate μTBS values similar to that of the E and EA groups for both bond strategies.

CONCLUSIONS

Erosion and erosion/abrasion did not significantly influence the immediate μTBS to dentin. Artificial aging reduced μTBS values for the groups C, E, and EA using the total-etching mode. Deproteinization maintained the bond stability to artificially aged eroded and eroded/abraded dentin.

Wear measurement of dental tissues and materials in clinical studies: A systematic review

OBJECTIVES

This study aims to systematically review the different methods used for wear measurement of dental tissues and materials in clinical studies, their relevance and reliability in terms of accuracy and precision, and the performance of the different steps of the workflow taken independently.

METHODS

An exhaustive search of clinical studies related to wear of dental tissues and materials reporting a quantitative measurement method was conducted. MedLine, Embase, Scopus, Cochrane Library and Web of Science databases were used. Prospective studies, pilot studies and case series (>10 patients), as long as they contained a description of wear measurement methodology. Only studies published after 1995 were considered.

RESULTS

After duplicates' removal, 495 studies were identified, and 41 remained for quantitative analysis. Thirty-four described wear-measurement protocols, using digital profilometry and superimposition, whereas 7 used alternative protocols. A specific form was designed to analyze the risk of bias. The methods were described in terms of material analyzed; study design; device used for surface acquisition; matching software details and settings; type of analysis (vertical height-loss measurement vs volume loss measurement); type of area investigated (entire occlusal area or selective areas); and results.

SINIFICANCE

There is a need of standardization of clinical wear measurement. Current methods exhibit accuracy, which is not sufficient to monitor wear of restorative materials and tooth tissues. Their performance could be improved, notably limiting the use of replicas, using standardized calibration procedures and positive controls, optimizing the settings of scanners and matching softwares, and taking into account unusable data.