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Lei B, Xiong H, Chen K. Comparison of wear and marginal fitness of 3D-printed deciduous molar crowns: An in vitro study. Dent Mater J 2024; 43:227-234. [PMID: 38417862 DOI: 10.4012/dmj.2022-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This study aimed to evaluate the wear resistance of primary tooth enamel and 3 kinds of 3D printing materials and to compare the marginal fitness and internal suitability of prefabricated all-ceramic crowns, computer-aided design/manufacturing (CAD/CAM) all-ceramic crowns, and three 3D-printed deciduous molar crowns. Multifunctional friction wear testing machine was used to image the wear surface of the sample and calculate the maximum wear depth and volume loss value of each sample. The internal fit evaluation used the silicon replica method, The four points were measured using scanning electron microscopy (SEM). The obtained data were statistically analyzed using ANOVA and Tukey HSD-test with a fully randomized design (p<0.05). The results showed the wear resistance of E-Dent400 was better than that of PEEK and three different 3D printed materials have good wear resistance compared with the primary tooth enamel. The measured values at M1 and M4 of E-Dent400 were both the smallest.
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Affiliation(s)
- Bin Lei
- Department of pedodontics, Stomatological Hospital, Southern Medical University
- School of Stomatology, Jinan University
| | - Huacui Xiong
- Department of pedodontics, Stomatological Hospital, Southern Medical University
| | - Ke Chen
- Department of pedodontics, Stomatological Hospital, Southern Medical University
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2
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Pascareli-Carlos AM, Tedesco TK, Calvo AFB, Floriano I, Gimenez T, Gonçalves MDS, Calumby D, Imparato JCP. Survival rate of the Hall technique compared with resin composite restoration in multi-surface cavities in primary teeth: a 1-year randomized clinical trial. J Appl Oral Sci 2023; 31:e20230048. [PMID: 37820181 PMCID: PMC10561961 DOI: 10.1590/1678-7757-2023-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/11/2023] [Accepted: 08/14/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Hall technique (HT) has been indicated for teeth with dentinal caries lesion; however, extensive cavities, with more than two surfaces still seem challenging for restorative treatment in pediatric dentistry, resulting in a higher failure rate and an increased need for retreatment. OBJECTIVES To compare the survival rate of the Hall technique preformed metal crown (HT) with resin composite restoration (RC) for multi-surface cavitated caries lesions in primary molars. METHODOLOGY In this multicenter two-arm randomized clinical trial, children between 4 and 9 years of age with at least one primary molar with cavitated caries lesion involving more than two surfaces, including one buccal or palatal/lingual surface, were selected from 17 Brazilian cities. A total of 364 teeth were allocated into two groups: (1) teeth treated with selective caries removal and RC and (2) treated with the HT. The survival rate was assessed at 6 and 12 months after the interventions. Survival analysis was performed with the Kaplan‒Meier method. Cox regression was used to determine the influence of explanatory variables on the survival rate (α=5%). RESULTS After 12 months, 292 teeth were re-evaluated. A total of 358 teeth were re-evaluated at least once during the study and included in the survival analysis. The HT (87.8%) resulted in a higher survival rate than RC restoration (75.7%) (p=0.004). CONCLUSION HT has a higher survival rate than RC as a treatment for multi-surface cavitated caries lesions in primary teeth. ClinicalTrials.gov: NCT02782390.
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Affiliation(s)
| | - Tamara Kerber Tedesco
- Universidade Cruzeiro do Sul, Programa de Pós-graduação em Odontologia, São Paulo, Brasil
| | - Ana Flávia Bissoto Calvo
- Instituto São Leopoldo Mandic e Centro de Pesquisa, Programa de Pós-graduação em Odontologia, Campinas, Brasil
| | | | - Thais Gimenez
- Universidade Metropolitana de Santos, Santos, Brasil
| | - Monicque da Silva Gonçalves
- Instituto São Leopoldo Mandic e Centro de Pesquisa, Programa de Pós-graduação em Odontologia, Campinas, Brasil
| | - Daniela Calumby
- Instituto São Leopoldo Mandic e Centro de Pesquisa, Programa de Pós-graduação em Odontologia, Campinas, Brasil
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Boyd DH, Foster Page LA, Moffat SM, Thomson WM. Time to complain about pain: Children's self-reported procedural pain in a randomised control trial of Hall and conventional stainless steel crown techniques. Int J Paediatr Dent 2023; 33:382-393. [PMID: 36841968 DOI: 10.1111/ipd.13059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/21/2022] [Accepted: 02/18/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Children's pain in dentistry has undesirable short- and long-term consequences; therefore, less invasive treatments merit consideration. AIM To investigate procedural pain scores for two treatments for carious primary molars in New Zealand primary care. DESIGN This study was a split-mouth randomised control trial, with secondary outcome analysis. Children (4-8 years) with proximal carious lesions on matched primary molars had one tooth treated with the Hall technique (HT) and one treated with a conventional stainless steel crown (CT); treatment type and order of treatment were randomly allocated (allocation concealment). The Wong-Baker self-report pain scale measured pretreatment dental pain, procedural pain at each treatment and post-operative pain. RESULTS Data were analysed for 103 children: 49 children had the HT first and 54 children had the CT first. Procedural pain scores did not differ by treatment type, with 71.8% and 76.7% of children reporting low pain for the HT and the CT, respectively. Fewer children reported low procedural pain for the second treatment than the first (p = .047). Most children reported low procedural pain for both treatments (58.3%), although 41.7% experienced moderate-high procedural pain with at least one treatment. CONCLUSIONS The HT caused pain for as many children as the CT. There is an opportunity for better dental pain management in this setting.
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Affiliation(s)
- Dorothy H Boyd
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Lyndie A Foster Page
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Susan M Moffat
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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Dhar V, Pilcher L, Fontana M, González-Cabezas C, Keels MA, Mascarenhas AK, Nascimento M, Platt JA, Sabino GJ, Slayton R, Tinanoff N, Young DA, Zero DT, Pahlke S, Urquhart O, O'Brien KK, Carrasco-Labra A. Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association. J Am Dent Assoc 2023; 154:551-566.e51. [PMID: 37380250 DOI: 10.1016/j.adaj.2023.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/07/2023] [Accepted: 04/01/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute's program for Clinical and Translational Research conducted a systematic review and developed recommendations for the treatment of moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated primary and permanent teeth. TYPES OF STUDIES REVIEWED The authors searched for systematic reviews comparing carious tissue removal (CTR) approaches in Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Trip Medical Database. The authors also conducted a systematic search for randomized controlled trials comparing direct restorative materials in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of the evidence and formulate recommendations. RESULTS The panel formulated 16 recommendations and good practice statements: 4 on CTR approaches specific to lesion depth and 12 on direct restorative materials specific to tooth location and surfaces involved. The panel conditionally recommended for the use of conservative CTR approaches, especially for advanced lesions. Although the panel conditionally recommended for the use of all direct restorative materials, they prioritized some materials over the use of others for certain clinical scenarios. PRACTICAL IMPLICATIONS The evidence suggests that more conservative CTR approaches may decrease the risk of adverse effects. All included direct restorative materials may be effective in treating moderate and advanced caries lesions on vital, nonendodontically treated primary and permanent teeth.
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Philip N, Suneja B. The revolutionary evolution in carious lesion management. J Conserv Dent 2023; 26:249-257. [PMID: 37398856 PMCID: PMC10309123 DOI: 10.4103/jcd.jcd_54_23] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/23/2023] [Accepted: 04/19/2023] [Indexed: 07/04/2023] Open
Abstract
Contemporary paradigms of dental caries management focus on the biological approaches to treating the disease and its principal symptom, the carious lesion. This narrative review traces the evolution of carious lesion management from the operative and invasive approaches of G. V. Black's era to the current period of minimally invasive biological approaches. The paper explains the rationale for adopting biological approaches to dental caries management and lists the five core principles of this management approach. The paper also details the aims, features, and the most recent evidence base for the different biological carious lesion management approaches. Based on current practice guidelines, collated clinical pathways for lesion management are also presented in the paper to aid clinicians in their decision-making. It is hoped that the biological rationale and evidence summarized in this paper will bolster the shift to modern biological carious lesion management approaches among dental practitioners.
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Affiliation(s)
- Nebu Philip
- Paediatric Dentistry, College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
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Chua DR, Tan BL, Nazzal H, Srinivasan N, Duggal MS, Tong HJ. Outcomes of preformed metal crowns placed with the conventional and Hall techniques: A systematic review and meta-analysis. Int J Paediatr Dent 2023; 33:141-157. [PMID: 36151937 DOI: 10.1111/ipd.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/08/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Doris Ruyi Chua
- Paediatric Dentistry Unit, National Dental Centre Singapore, Singapore City, Singapore
| | - Bing Liang Tan
- Youth Preventive Dental Service, Health Promotion Board, Singapore City, Singapore
| | - Hani Nazzal
- Hamad Dental Center, Hamad Medical Corporation, Doha, Qatar.,College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | | | | | - Huei Jinn Tong
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
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Iovan A, Benchea M, Stoleriu S, Tărăboanță I, Cimpoeșu N, Nica I, Andrian S. Effects of Acidic Challenge on Demineralized Root Surface Treated with Silver Diamine Fluoride and Potassium Iodide. Diagnostics (Basel) 2023; 13:diagnostics13030530. [PMID: 36766635 PMCID: PMC9914569 DOI: 10.3390/diagnostics13030530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The aim of the study was to assess the protective effect of applying potassium iodide (KI) over silver diamine fluoride (SDF) on demineralized root dentin in the case of a sustained acidogenic attack. METHODS Forty caries-free third molars were used in the study. A diamond disc was used to separate the roots and the tooth crowns from the roots. Each root fragment was randomly distributed in one of the four study groups: C-samples were not demineralized; DD-demineralized samples; RS1-demineralized samples covered with SDF+KI (RS-Riva Star product, SDI limited, Bayswater, Australia); RS2-demineralized samples covered with SDF+KI and submersed to another acidic challenge for 3 days. SEM and EDX were used for the morphological and elemental analysis. Vickers hardness assessment was performed using a tribometer CETR UMT-2 (Bruker Corporation, Berlin, Germany). One-way ANOVA and post hoc Bonferroni tests were used for the statistical analysis with a significance level of p < 0.05. RESULTS Morphological and elemental changes were observed on the surface of the study samples. Significant differences were observed between the recorded hardness values of groups C and DD (p = 0.005), C and RS2 (p = 0.002), DD and RS1 (p = 0.011); RS1 and RS2 (p = 0.004). CONCLUSIONS The application of SDF and KI (Riva Star product) on root dentin caries resulted in the formation of a heterogeneous outer layer that sealed the dentin and increased the microhardness of the treated surface. In the conditions of the present study, this layer did not provide enough protection for root dentin exposed to continuous attacks.
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Affiliation(s)
- Alexandru Iovan
- Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iași, Romania
| | - Marcelin Benchea
- Faculty of Mechanical Engineering, “Gh. Asachi” Technical University, 67 Dimitrie Mangeron Str., 700050 Iași, Romania
- Correspondence: (M.B.); (S.S.)
| | - Simona Stoleriu
- Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iași, Romania
- Correspondence: (M.B.); (S.S.)
| | - Ionuț Tărăboanță
- Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iași, Romania
| | - Nicanor Cimpoeșu
- Faculty of Materials Science and Engineering, “Gh. Asachi” Technical University, 67 Dimitrie Mangeron Str., 700050 Iași, Romania
| | - Irina Nica
- Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iași, Romania
| | - Sorin Andrian
- Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iași, Romania
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Hall technique for primary teeth: A systematic review and meta-analysis. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:286-297. [PMID: 36185501 PMCID: PMC9520271 DOI: 10.1016/j.jdsr.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/07/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background There has been a debate about the use of Hall Technique (HT), whether it can be considered as a standard technique for the management of carious primary molars. Aim To summarise the evidence on HT for managing dentine caries in primary teeth. Design MEDLINE, Embase, CENTRAL and Epistemonikos databases were searched for clinical studies conducted from 2007 to 2021 evaluating HT in primary teeth. Two reviewers independently screened, data extracted and quality assessed the studies. Results Eleven publications from eight unique studies were included. Four were of low risk of bias overall and five studies were included in a meta-analysis. Overall, HT was 49 % (RR 1.49 [95 % CI: 1.15–1.93], I2 =89.5 %, p < 0.001) more likely to succeed. When compared to direct restorations, HT was 80 % more likely to succeed; while similar success was found when compared to conventional preformed metal crowns. HT was also over 6 times (RR 0.16 [95 %CI: 0.10–0.27], I2 =0 %, p < 0.001) less likely to fail. Most of the studies included proximal or multi-surface lesions. Conclusions HT is successful option for the management of caries in primary teeth, particularly for proximal or multi-surface dentine lesions. It is well-tolerated by children and acceptable to parent, with mild adverse effects reported.
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Duggal M, Gizani S, Albadri S, Krämer N, Stratigaki E, Tong HJ, Seremidi K, Kloukos D, BaniHani A, Santamaría RM, Hu S, Maden M, Amend S, Boutsiouki C, Bekes K, Lygidakis N, Frankenberger R, Monteiro J, Anttonnen V, Leith R, Sobczak M, Rajasekharan S, Parekh S. Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document. Eur Arch Paediatr Dent 2022; 23:659-666. [PMID: 36219336 PMCID: PMC9637614 DOI: 10.1007/s40368-022-00718-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
Purpose The European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth. Methods Three expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified. Results There is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates. Conclusion The management of deep carious lesions in primary teeth can be challenging and must consider the patient’s compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.
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Affiliation(s)
- M Duggal
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - S Gizani
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian, University of Athens, Athens, Greece
| | - S Albadri
- School of Dentistry, Unit of Oral Health, University of Liverpool, Liverpool, UK
| | - N Krämer
- Department of Paediatric Dentistry, Justus-Liebig University Gießen, Giessen, Germany
| | - E Stratigaki
- Department of Pediatric Oral Health and Orthodontics, University Center of Dental Medicine, Basel, Switzerland
| | - H J Tong
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - K Seremidi
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian, University of Athens, Athens, Greece
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | - A BaniHani
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - R M Santamaría
- Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - S Hu
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - M Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - S Amend
- Department of Paediatric Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen) Medical Centre for Dentistry, Schlangenzahl 14, 35392, Giessen, Germany
| | - C Boutsiouki
- Department of Paediatric Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen) Medical Centre for Dentistry, Schlangenzahl 14, 35392, Giessen, Germany
| | - K Bekes
- Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria
| | - N Lygidakis
- Lygidakis Dental Clinic (Private Dental Practice), 2 Papadiamantopoulou str. & Vasilissis Sofias Ave, 11528, Athens, Greece
| | - R Frankenberger
- Medical Centre for Dentistry, Department of Operative Dentistry and Endodontics, Phillips-University Marburg, University Medical Centre Giessen and Marburg (Campus Marburg), Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - J Monteiro
- Department of Paediatric Dentistry, Sheffield Teaching Hospitals, Sheffield, UK
| | - V Anttonnen
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - R Leith
- Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - M Sobczak
- Specialized Dental Practice, Warsaw, Poland
| | - S Rajasekharan
- Department of Paediatric Dentistry, School of Oral Health Sciences, Ghent University, B-9000, Ghent, Belgium
| | - S Parekh
- Department of Paediatric Dentistry, UCL Eastman Dental Institute, London, UK.
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Clinical effectiveness of restorative materials for the restoration of carious lesions in pulp treated primary teeth: a systematic review. Eur Arch Paediatr Dent 2022; 23:761-776. [PMID: 36056991 PMCID: PMC9637617 DOI: 10.1007/s40368-022-00744-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/21/2022] [Indexed: 11/14/2022]
Abstract
Purpose To systematically review the clinical performance of restorative materials after pulp therapy of carious primary teeth. It is part 2 of a systematic review on the clinical effectiveness of restorative materials for the management of carious primary teeth supporting the European Academy of Paediatric Dentistry (EAPD) guideline development. Methods Four electronic databases were systematically searched up to December 28th, 2020. Randomised controlled clinical trials (RCTs) on restorative materials for the restoration of carious primary teeth after pulp therapy were included. Failure rate, annual failure rate (AFR) and reasons for failure were recorded. Studies were sorted by restorative materials. The Cochrane Risk of bias tool for randomised trials (RoB 2.0) was used for quality assessment. Results After identification of 1685 articles and screening of 41 papers from EAPD review group 1, 5 RCTs were included. Restored primary molars with pulpotomy presented the following AFRs: composite resin (CR) 0%, preformed metal crowns (PMCs) 2.4–2.5%, resin-modified glass-ionomer cement combined with CR 3.8%, compomer 8.9%, and amalgam 14.3%. Maxillary primary incisors receiving pulpectomy exhibited AFRs of 0–2.3% for composite strip crowns (CSCs) depending on the post chosen. Reasons for failure were secondary caries, poor marginal adaptation, loss of retention and fracture of restoration. All studies were classified as high risk of bias. Meta-analyses were not feasible given the clinical/methodological heterogeneity amongst studies. Conclusion Considering any limitations of this review, CR and PMCs can be recommended for primary molars after pulpotomy, and CSCs for primary incisors receiving pulpectomy. However, a need for further well-designed RCTs was observed. Supplementary Information The online version contains supplementary material available at 10.1007/s40368-022-00744-4.
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Amend S, Boutsiouki C, Bekes K, Kloukos D, Lygidakis NN, Frankenberger R, Krämer N. Clinical effectiveness of restorative materials for the restoration of carious primary teeth without pulp therapy: a systematic review. Eur Arch Paediatr Dent 2022; 23:727-759. [PMID: 35819627 PMCID: PMC9637592 DOI: 10.1007/s40368-022-00725-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/22/2022] [Indexed: 01/04/2023]
Abstract
Purpose To systematically search the available evidence and evaluate the clinical effectiveness of restorative materials for restoration of carious primary teeth. The findings aimed to support the European Academy of Paediatric Dentistry (EAPD) guidelines development. Methods Literature search was performed by searching 4 electronic databases for eligible randomised controlled clinical trials (RCTs) comparing restorative materials for the restoration of carious primary teeth up to December 28th, 2020. Quality assessment was performed with the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results Of 1685 identified articles 29 RCTs were finally deemed as eligible for inclusion. Annual failure rates were: Amalgam 1–28%; atraumatic restorative treatment 1.2–37.1%; glass-ionomer cement (GIC) 7.6–16.6%, metal-reinforced GIC 29.9%, resin-modified GIC 1.9–16.9%, high-viscosity GIC 2.9–25.6%; glass carbomer ≤ 46.2%; compomer 0–14.7%; composite resin (CR) 0–19.5%, bulk-fill CR 0–16.9%; zirconia crowns 3.3%, composite strip crowns 15%, and preformed metal crowns (Hall-Technique) 3.1%. Secondary caries, poor marginal adaptation, loss of retention, and fracture of restoration were reported as reasons for failure. Four studies were evaluated at unclear and 25 at high risk of bias. Clinical and methodological heterogeneity, and the diversity of tested materials across included studies did not allow for meta-analyses. Conclusions Within the limitations of this systematic review, namely, the heterogeneity and the overall high risk of bias among included studies, clear recommendations based on solid evidence for the best restorative approach in primary teeth cannot be drawn. There is a need for future thoroughly implemented RCTs evaluating restorations in primary teeth to close this knowledge gap. Supplementary Information The online version contains supplementary material available at 10.1007/s40368-022-00725-7.
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Affiliation(s)
- S Amend
- Department of Paediatric Dentistry, Medical Centre for Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen), Schlangenzahl 14, 35392, Giessen, Germany.
| | - C Boutsiouki
- Department of Paediatric Dentistry, Medical Centre for Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen), Schlangenzahl 14, 35392, Giessen, Germany
| | - K Bekes
- Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - N N Lygidakis
- Lygidakis Dental Clinic (Private Dental Practice), 2 Papadiamantopoulou str. & Vasilissis Sofias Ave, 11528, Athens, Greece
| | - R Frankenberger
- Department of Operative Dentistry, Endodontology, and Paediatric Dentistry, Medical Centre for Dentistry, Phillips-University Marburg, University Medical Centre Giessen and Marburg (Campus Marburg), Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - N Krämer
- Department of Paediatric Dentistry, Medical Centre for Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen), Schlangenzahl 14, 35392, Giessen, Germany
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Review on Preformed Crowns in Pediatric Dentistry—The Composition and Application. MATERIALS 2022; 15:ma15062081. [PMID: 35329535 PMCID: PMC8950869 DOI: 10.3390/ma15062081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
Abstract
The purpose of this review is to compare and contrast the various types of preformed crowns that can be used to restore the primary teeth in children. Historically, preformed crowns have been widely available for the past 50 years. The clinical performance of preformed crowns has evolved to meet higher functional, mechanical, and aesthetic demands. Preformed crowns are available in a range of prefabricated sizes and shapes. Preformed crowns can vary depending on their properties, compounds, methods of preparation, and biocompatibility.
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Shetty AA, Acharya A, R. M. Is Non-Restorative Cavity Treatment a Practical Choice in Primary Teeth? JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2022. [DOI: 10.1055/s-0042-1743530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractFor years, “extension for prevention” was considered as the standard protocol for the restoration of caries. With advances in the field of cariology regarding the biofilm and improvement in materials, this perspective is being challenged. This is being challenged by more biological and less-invasive approaches, where the emphasis is on biofilm alteration to arrest carious lesions. This minimally invasive intervention is based on the concept that biofilm overlying the carious lesion is a driving force for the carious process and not the bacteria present in the infected dentin. Hence, daily removal or disruption of this biofilm will slow down the carious process or bring it to halt.One such approach is non-restorative cavity treatment, where no caries is removed but lesions are made self-cleansable that allows it to be brushed by the parent or the child. This wholesome approach targets the disease at a causal level.This review of literature describes the various advantages and limitations of this technique and the practicability of its use in pediatric patients during the pandemic COVID-19.
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Affiliation(s)
- Amarshree A. Shetty
- Department of Paediatric and Preventive Dentistry, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore, Karnataka, India
| | - Aditi Acharya
- Department of Paediatric and Preventive Dentistry, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore, Karnataka, India
| | - Manju R.
- Department of Pediatric Dentistry, AB Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore, Karnataka, India
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Zirconia Crowns for Primary Teeth: A Systematic Review and Meta-Analyses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052838. [PMID: 35270531 PMCID: PMC8910015 DOI: 10.3390/ijerph19052838] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023]
Abstract
Objective: The aim of this systematic review was to summarize the literature regarding the clinical performance of zirconia crowns for primary teeth. Materials and Methods: Four electronic databases, Ovid, PubMed, Scopus, and Web of Science were searched. Clinical, observational, and laboratory studies were included. Studies that assessed the performance of zirconia crowns for primary teeth using outcomes such as gingival and periodontal health, parental satisfaction, color stability, crown retention, contour, fracture resistance, marginal integrity, surface roughness, and recurrent caries were included. Risk of bias was assessed using different assessment tools depending on the type of the assessed study. Results: Out of the 2400 retrieved records, 73 full-text records were assessed for eligibility. Thirty-six studies were included for qualitative analysis. The included studies reported that zirconia crowns for primary teeth were associated with better gingival and periodontal health, good retention, high fracture resistance, color stability, high parental acceptance, good marginal adaptation, smooth cosmetic surface, and no recurrent caries. Conclusion: Zirconia crowns are promising alternative to other restorative materials and crowns in the field of pediatric dentistry. They showed higher properties and performance in different clinical aspects and great parental satisfaction.
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Cleary J, Al-Hadidi R, Scully A, Yahn W, Zaid Z, Boynton JR, Eckert GJ, Yanca E, Fontana M. A 12-Month Randomized Clinical Trial of 38% SDF vs. Restorative Treatment. JDR Clin Trans Res 2022; 7:135-144. [PMID: 35120408 DOI: 10.1177/23800844211072741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this 2-arm, parallel-group, 12-mo randomized clinical trial was to compare the effectiveness of semiannual application of 38% silver diamine fluoride (SDF) versus restorative treatment (RT) to manage cavitated caries lesions in primary teeth in a diverse population of children in Michigan. METHODS Children aged 2 to 10 y with at least 1 soft cavitated lesion (International Caries Detection and Assessment System 5 or 6) with no pain or signs/symptoms of irreversible pulpitis were recruited and randomly assigned to 2 intervention groups. One random lesion per child received 38% SDF (twice, at a 6-mo interval) or RT. All interventions and assessments were done by calibrated dentists. Primary outcome measures were clinical failure rates: minor (e.g., reversible pulpitis, active/soft lesion or progression, restoration loss or need for replacement/repair, secondary caries) and major (e.g., irreversible pulpitis, abscess, extraction). Parent, child, and provider acceptability was also assessed. RESULTS Ninety-eight children were enrolled and randomized, with a mean (SD) age of 4.8 y (1.8); 46% were female and their mean dmft + DMFT was 6.3 (3.9). Sixty-nine children were assessed at 12 mo (sample was within the planned 30% attrition rate). There were significantly more teeth with minor failures (SDF = 65%, RT = 23%, P ≤ 0.001) and major failures (SDF = 13%, RT = 3%, P ≤ 0.001) in the SDF group than the RT group; 74% of SDF-treated lesions were hard at 12 mo vs. 57% at 6 mo. Providers stated that SDF was easier, faster, and more preferable than RT (P ≤ 0.001). No significant differences were found in parental satisfaction and acceptability. At 12 mo, children in the RT arm felt significantly (P < 0.05) happier with their tooth appearance and stated that their visit to the dentist hurt less. CONCLUSION At 12 mo, SDF-treated lesions had significantly more minor and major failures than RT, suggesting that SDF-treated teeth need to be closely monitored in a population at high caries risk (ClinicalTrials.gov NCT02601833). KNOWLEDGE OF TRANSFER STATEMENT The results of this study can be used by clinicians when deciding whether to restore or apply silver diamine fluoride to cavitated lesions in primary teeth. Information on treatment outcomes and parent, child, and provider acceptability can help guide appropriate treatment decisions and need for monitoring.
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Affiliation(s)
- J Cleary
- Private practice, East Lansing, MI, USA
| | - R Al-Hadidi
- Private practice, Grosse Pointe and Novi, MI, USA
| | - A Scully
- Department of Pediatric Dentistry, School of Dentistry, Indiana University, Indianapolis, IN, USA
| | - W Yahn
- Private practice, Saginaw, MI, USA
| | - Z Zaid
- Private practice, Westminster, CO, USA
| | - J R Boynton
- Division of Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - G J Eckert
- Department of Biostatistics and Health Data Science, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - E Yanca
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - M Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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16
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BaniHani A, Santamaría RM, Hu S, Maden M, Albadri S. Minimal intervention dentistry for managing carious lesions into dentine in primary teeth: an umbrella review. Eur Arch Paediatr Dent 2021; 23:667-693. [PMID: 34784027 DOI: 10.1007/s40368-021-00675-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This umbrella review systematically appraised published systematic reviews on Minimal Intervention Dentistry interventions carried out to manage dentine carious primary teeth to determine how best to translate the available evidence into practice, and to provide recommendations for what requires further research. METHOD An experienced information specialist searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Epistemonikos, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, and the NIHR Journals Library. In addition, the PROSPERO database was searched to identify forthcoming systematic reviews. Searches were built around the following four concepts: primary teeth AND caries/carious lesion AND Minimal Intervention Dentistry AND systematic review/meta-analysis. Searches were restricted to English language, systematic reviews with/without meta-analyses published between January 2000 and August 2020. Two reviewers independently screened all titles and abstracts. Interventions included involved no dentine carious tissue removal (fissure sealants, resin infiltration, topical application of 38% Silver Diamine Fluoride, and Hall Technique), non-restorative caries control, and selective removal of carious tissue involving both stepwise excavation and atraumatic restorative treatment. Systematic reviews were selected, data extracted, and risk of bias assessed using ROBIS by two independent reviewers. Studies overlap was calculated using corrected covered area. RESULTS Eighteen systematic reviews were included in total; 8 assessed the caries arresting effects of 38% Silver Demine Fluoride (SDF), 1 on the Hall Technique (HT), 1 on selective removal of carious tissue, and eight investigated interventions using atraumatic restorative treatment (ART). Included systematic reviews were published between 2006 and 2020, covering a defined time frame of included randomised controlled trials ranging from 1969 to 2018. Systematic reviews assessed the sealing efficacy of fissure sealants and resin infiltration in carious primary teeth were excluded due to pooled data reporting on caries arrest in both enamel and outer third of dentine with the majority of these carious lesions being limited to enamel. Therefore, fissure sealants and resin infiltration are not recommended for the management of dentinal caries lesions in primary teeth. Topical application of 38% SDF showed a significant caries arrest effect in primary teeth (p < 0.05), and its success rate in arresting dental caries increased when it was applied twice (range between 53 and 91%) rather than once a year (range between 31 and 79%). Data on HT were limited and revealed that preformed metal crowns placed using the HT were likely to reduce discomfort at time of treatment, the risk of major failure (pulp treatment or extraction needed) and pain compared to conventional restorations. Selective removal of carious tissue particularly in deep carious lesions has significantly reduced the risk of pulp exposure (77% and 69% risk reduction with one-step selective caries removal and stepwise excavation, respectively). ART showed higher success rate when placed in single surface compared to multi-surface cavities (86% and 48.7-88%, respectively, over 3 years follow-up). CONCLUSION Minimal Intervention Dentistry techniques, namely 38% SDF, HT, selective removal of carious tissue, and ART for single surface cavity, appear to be effective in arresting the progress of dentinal caries in primary teeth when compared to no treatment, or conventional restorations. There is clear need to increase the emphasis on considering these techniques for managing carious primary teeth as a mainstream option rather than a compromise option in circumstances where the conventional approach is not possible due to cooperation or cost.
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Affiliation(s)
- A BaniHani
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - R M Santamaría
- Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - S Hu
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - M Maden
- Liverpool Reviews & Implementation Group, University of Liverpool, Liverpool, UK
| | - S Albadri
- School of Dentistry, University of Liverpool, Pembroke place, Liverpool, L3 5PS, UK.
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AlShaya MS, Sabbagh HJ, El-Housseiny AA. Diagnosis and Management Approaches for Non-cavitated Carious Dental Lesions- A Narrative Review. Open Dent J 2021. [DOI: 10.2174/1874210602115010337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Dental caries is one of the most prevalent diseases. Its detection and management should start with a comprehensive treatment plan, with the goals of the elimination of cariogenic bacteria, the reduction of plaque acidogenicity, the encouragement of tooth remineralization, and the repair of damaged teeth.
Objectives:
The aim of this paper was to review the literature regarding the latest updates on the diagnosis and management approaches of non-cavitated carious dental lesions.
Methods:
Studies regarding the diagnosis and management of non-cavitated carious dental lesions were included.
Results: The subclinical non-cavitated carious lesion might progress to an early enamel lesion, develop into an established dentin lesion, or sometimes end up with a lesion reaching the pulp. The detection and management of caries should be patient-centered, risk-based, and evidence-supported, and should consider the dentists’ expertise and the patients’ needs and preferences. The visual-tactile and radiographic detection of non-cavitated carious lesions are greatly helped by the advances of non-invasive detection tools such as DIAGNOdent, fiber-optic transillumination, quantitative light-induced fluorescence, and DIAGNOcam.
Conclusion:
Accordingly, non-cavitated carious lesions can be arrested by several non-invasive techniques, which are preferred over the invasive options. The clinicians can use sealants plus fluoride varnish on occlusal surfaces, fluoride varnish or resin infiltration on proximal surfaces, and resin infiltration,fluoride gel, or varnish alone on facial or lingual surfaces to manage non-cavitated carious lesions.
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Balasubramani K, Asokan S, Geetha Priya PR. Knowledge, Attitude, and Practice Behavior of Pediatric Dental Postgraduate Students on Non-restorative Cavity Control Technique: A Cross-sectional Study. Int J Clin Pediatr Dent 2021; 14:217-221. [PMID: 34413595 PMCID: PMC8343691 DOI: 10.5005/jp-journals-10005-1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In the last few decades, the non-restorative treatment approach had been labeled by different names. The term non-restorative cavity control (NRCC) was recently established in 2016. The study aimed to evaluate the knowledge, attitude, and practice behavior about this technique among pediatric dental postgraduate students in India. Materials and methods An 18-item questionnaire was prepared from the previously established literature. The sample size was calculated as 234 responses based on the pilot study. The questionnaires were sent to 1,200 participants through the registered email address and WhatsApp as a Google form link. The online responses were received for a period of 4 weeks from July to August of 2020. The data from the responses were collected and descriptive analysis was done using a Microsoft Excel sheet (Version 2016). Results A total of 380 responses were received and 35 duplicate responses were eliminated. Among the 345 respondents, 61 (17.7%) were males and 284 (82.3%) were females. The average age of the participants is 27.43 years. About 78.6% (n = 271), 17.1% (n = 59), and 4.3% (n = 15) of the participants were third-year, second-year, and first-year postgraduate students, respectively. The responses were received from 21 out of 24 states’ colleges which were conducting pediatric dental postgraduate course. About 271 (76.8%) participants knew this technique with a maximum positive attitude and fewer practice behavior. Conclusion The knowledge and attitude about NRCC were good among the pediatric dental postgraduate students but implementing that in practice was relatively less. How to cite this article Balasubramani K, Asokan S, Geetha Priya PR. Knowledge, Attitude, and Practice Behavior of Pediatric Dental Postgraduate Students on Non-restorative Cavity Control Technique: A Cross-sectional Study. Int J Clin Pediatr Dent 2021;14(2):217–221.
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Affiliation(s)
- Kesavaraj Balasubramani
- Department of Pediatric and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
| | - Sharath Asokan
- Department of Pediatric and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
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Schwendicke F, Walsh T, Lamont T, Al-Yaseen W, Bjørndal L, Clarkson JE, Fontana M, Gomez Rossi J, Göstemeyer G, Levey C, Müller A, Ricketts D, Robertson M, Santamaria RM, Innes NP. Interventions for treating cavitated or dentine carious lesions. Cochrane Database Syst Rev 2021; 7:CD013039. [PMID: 34280957 PMCID: PMC8406990 DOI: 10.1002/14651858.cd013039.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC). OBJECTIVES To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps. SEARCH METHODS An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions). DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta-analysis to assess and rank the relative effectiveness of different interventions. MAIN RESULTS We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty-four studies used a parallel-group design and three were split-mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non-cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth. Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing with sealant materials (2); sealant materials versus no sealing (2). Follow-up times varied from no follow-up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias. Effect of interventions Sealing using sealants versus other interventions for non-cavitated or cavitated but not deep lesions There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non-cavitated), but we assessed all as very low-certainty evidence. HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low-certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low-certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low-certainty evidence. CR, SE, SW for deep lesions The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate-certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low-certainty evidence). The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low-certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low-certainty evidence). The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate-certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low-certainty evidence). For deep lesions, a network meta-analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT. AUTHORS' CONCLUSIONS Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.
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Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Thomas Lamont
- School of Dentistry, University of Dundee, Dundee, UK
| | - Waraf Al-Yaseen
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Lars Bjørndal
- Cariology and Endodontics, Section of Clinical Oral Microbiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janet E Clarkson
- Division of Oral Health Sciences, School of Dentistry, University of Dundee, Dundee, UK
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Michigan, USA
| | - Jesus Gomez Rossi
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Colin Levey
- Division of Restorative Dentistry, School of Dentistry, University of Dundee, Dundee, UK
| | - Anne Müller
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Ruth M Santamaria
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Nicola Pt Innes
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Hamdy D, Giraki M, Abd Elaziz A, Badran A, Allam G, Ruettermann S. Laboratory evaluation of the potential masking of color changes produced by silver diamine fluoride in primary molars. BMC Oral Health 2021; 21:337. [PMID: 34243727 PMCID: PMC8268618 DOI: 10.1186/s12903-021-01697-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of Silver diamine fluoride (SDF) as a minimally invasive and nonaerosolizing management during COVID-19 pandemic has highly increased. SDF is a caries-arresting agent that causes staining of tooth structure. Managing this discoloration will increase its acceptance in treating primary teeth. The main aim of this study was to quantify the color change associated with the application of SDF on extracted carious primary molars, the potential masking of this color change by potassium iodide (KI), composite (CMP) and glass ionomer cement (GI) and the effect of aging on this color masking effect. METHODS An in-vitro study in which 52 carious primary molars were collected, prepared, and distributed randomly into four groups equally as follows: Group A: SDF 38%; Group B: SDF 38% + KI; Group C: SDF 38% + CMP; Group D: SDF 38% + GI. Color changes were recorded for each sample at baseline, and after application of the tested materials. Moreover, all samples had undergone Suntest aging followed by a third color reading. CIELAB values L*, a*, b*, ΔL, Δa, and Δb were measured, ΔE was calculated, and data were analyzed using multivariate analysis of variance (MANOVA) and post-Hoc Scheffé test (p < 0.05). RESULTS MANOVA revealed the significant influence of the factor 'material'. SDF caused an obvious color change compared to the color of carious dentin. Regarding ΔL, the color change of groups C and D was not significant directly after application of the tested materials. After aging, it was significant among all groups, including groups C and D. In Δa there was a difference between SDF and groups B and C after application of the tested materials, and aging produced the same results. The color shifts of Δb of all tested groups varied significantly from one another. After aging, there was no difference between group D and either group A or B. CONCLUSIONS Treatment with SDF caused obvious discoloration of carious dentin. Directly after SDF application, all tested materials could effectively mask the color change associated with the application of SDF. CMP was the only material whose color masking effect was not completely reversed by aging.
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Affiliation(s)
- Dina Hamdy
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Organization of African Unity Street, El Qobba Bridge, Al Waili, Cairo, 11865, Egypt
| | - Maria Giraki
- Department of Operative Dentistry, Dental School (Carolinum), Goethe-University Frankfurt, Theodor-Stern-Kai 7/29, 60596, Frankfurt am Main, Germany.
| | - Amr Abd Elaziz
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Organization of African Unity Street, El Qobba Bridge, Al Waili, Cairo, 11865, Egypt
| | - Amira Badran
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Organization of African Unity Street, El Qobba Bridge, Al Waili, Cairo, 11865, Egypt
| | - Gehan Allam
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Organization of African Unity Street, El Qobba Bridge, Al Waili, Cairo, 11865, Egypt
| | - Stefan Ruettermann
- Department of Operative Dentistry, Dental School (Carolinum), Goethe-University Frankfurt, Theodor-Stern-Kai 7/29, 60596, Frankfurt am Main, Germany
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21
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Abstract
Aim This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to compare the efficacy of different caries removal techniques: complete caries removal (CCR), selective caries removal (SCR) and stepwise caries removal (SWR) for deep carious lesions in vital primary teeth.Data sources The design of this review followed the PRISMA guidance ( http://www.prisma-statement.org/ ). Relevant studies were identified using electronic databases (PubMed [Medline], Cochrane Library, EMBASE) and finally reference lists were screened. The US National Institutes of Health Trials Register (NIHTR; http://clinicaltrials.gov ) and World Health Organisation International Clinical Trials Registry Platform (WHO ICTRP; http://apps.who.int/trialsearch ) were used to help assess publication bias, as it was not possible to test funnel plot asymmetry. Duplicates were located and eliminated using EndNote X7 programme.Study selection To be included, studies had to be published RCTs comparing SCR or SWR with CCR as caries removal strategies for deep carious lesions in vital primary teeth. The outcomes were pulp exposure, pulpo-periodontal complications (clinical and radiological failures) and/or restorative failures. RCTs applying these caries removal techniques were excluded if one of the other trial arms did not involve caries removal (that is, Hall Technique, therapeutic sealing of cavity lesions). Initially, 1,374 potentially eligible articles were identified, out of which 15 (English or French language only) were selected for full-text screening, which included ten relevant references corresponding to eight studies.Data extraction and synthesis Two authors independently extracted data using a piloted data extraction sheet, with a third reviewer resolving any disagreements. The authors performed conventional intention-to-treat and per-protocol meta-analyses, and calculated odds ratios (ORs) as effect estimates in the random-effects model, using Revman5.Results The eight included RCTs were conducted between 1977 and 2018. They include 669 patients and 824 teeth, with follow-up ranging from four weeks to 24 months. Collective results showed reduced risk of pulp exposure after SCR (OR: 0.10, 95% CI [0.04, 0.25]) or SWR (OR: 0.20, 95% CI [0.09, 0.44]), compared with CCR. There was a higher risk of composite restorative failure (OR: 2.61, 95% CI [1.05, 6.49]) using United States Public Health Service (USPHS) criteria, after SCR was compared with CCR only in intention-to-treat analysis. However, when comparing the risk of clinical or radiographic failure of pulpo-periodontal complications, no difference was found between SCR, CCR or SWR.Conclusion The conclusions of the paper are that there is a significant decrease in pulp exposure risk with SCR and SWR in comparison with CCR. However, there is a need for further studies with less risk of bias powered to report on the long-term outcomes of pulpo-periodontal health and restoration longevity.
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Kaptan A, Korkmaz E. Evaluation of success of stainless steel crowns placed using the hall technique in children with high caries risk: A randomized clinical trial. Niger J Clin Pract 2021; 24:425-434. [PMID: 33723119 DOI: 10.4103/njcp.njcp_112_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective This study aimed to compare the clinical efficacy and survival rates of the hall technique (HT), and conventional restoration (CR) for the management of occlusoproximal carious lesions in primary molars. Materials and Methods This clinical study observed 35 children (aged 4-8 years). Exclusion criteria included symptoms of pulpal or periradicular pathology or systemic conditions requiring special dental considerations. For each child, at least one tooth was treated with HT and one with CR. The primary outcome measures were minor and major clinical failure rates. Plaque and gingival scores of the teeth were also evaluated. Friedman test and Wilcoxon signed ranks test were used to compare the plaque and gingival index scores for each arm. Chi-square tests were used for comparisons of clinical outcomes, plaque-gingival index, and distribution of ICDAS categories among treatment arms (P < 0.05). Results Thirty-three of 35 (94.2%) participants returned for 1-year follow-up. HT showed statistically significantly higher treatment survival rate and fewer minor failures than CR (P = 0.040). The rate of major failures was minimal (2 of 84 teeth) and did not differ between treatments (P = 0.092). In both treatment groups, the gingival score and plaque score were significantly decreased at the 1-year follow-up (P < 0.05). Conclusion HT was a more successful method for managing caries in primary molars than CR, both for symptoms of pulpal disease and longevity of the restorations. HT is a simplified method of managing carious primary molars using SSCs cemented with no local anesthesia, caries removal, or tooth preparation.
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Affiliation(s)
- A Kaptan
- Department of Pediatric Dentistry, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Turkey
| | - E Korkmaz
- Department of Pediatric Dentistry, Faculty of Dentistry, Sivas Cumhuriyet University, Sivas, Turkey
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Gruythuysen RJM, van Loveren C, Burgersdijk RCW. NOCTP and NRCT Are Not Complete without Tailored Motivational Communication. Caries Res 2021; 55:162-163. [PMID: 33631750 DOI: 10.1159/000514022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Cor van Loveren
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Rob Cornelis Wilhelmus Burgersdijk
- Pediatric Dentistry, Department of Preventive and Restorative Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Binladen H, Al Halabi M, Kowash M, Al Salami A, Khamis AH, Hussein I. A 24-month retrospective study of preformed metal crowns: the Hall technique versus the conventional preparation method. Eur Arch Paediatr Dent 2021; 22:67-75. [PMID: 32342287 DOI: 10.1007/s40368-020-00528-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 04/15/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Conventional and Hall Technique (HT) Preformed Metal Crowns (PMCs) are used for treatment of carious primary molars. The aim was to evaluate the clinical and radiographic success of conventional and HT PMCs in a postgraduate dental setting. METHODS A retrospective study using patients' electronic case-notes and radiographic images of carious primary molars treated with either conventional or HT PMCs was conducted to assess clinical and radiographic success/failure. A Kaplan-Meier curve was used to assess PMC survival. RESULTS 187 PMCs (110 HT and 77 conventional) in 65 children (34 females and 31 males) at 6, 12, 18 and 24 months were assessed. At 24 months, the success rates of conventional and HT PMCs were 97.6% and 93.5%, respectively. Two HT (perforated/abscessed) and four conventional (abscessed) PMCs failures occurred. There was no significant difference in success/failure (p = 0.362) at 12 months, but the HT was more successful at 24 months (p = 0.002) with similar survival times for both methods. CONCLUSION HT and conventionally placed PMCs, when placed in a postgraduate paediatric dentistry setting, were clinically and radiographically very successful at 6, 12, 18 and 24 months post operatively with a slightly higher success of the HT at 24 months.
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Affiliation(s)
- H Binladen
- Department of Pediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - M Al Halabi
- Department of Pediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - M Kowash
- Department of Pediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - A Al Salami
- Department of Pediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - A H Khamis
- Department of Biostatistics Mohammed, Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - I Hussein
- Department of Pediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.
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Teng R, Meng Y, Zhao X, Liu J, Ding R, Cheng Y, Zhang Y, Zhang Y, Pei D, Li A. Combination of Polydopamine Coating and Plasma Pretreatment to Improve Bond Ability Between PEEK and Primary Teeth. Front Bioeng Biotechnol 2021; 8:630094. [PMID: 33585424 PMCID: PMC7880054 DOI: 10.3389/fbioe.2020.630094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022] Open
Abstract
Preformed crowns are preferred to reduce the failure risk of restoration of primary teeth, but some drawback of conventional material is still a main barrier for their clinical use. Polyether etherketone (PEEK), a tooth colored, high-performance thermoplastic polymer, has been recognized as a promising alternative to manufacture the restoration of primary teeth. However, the hydrophobic surface and low surface energy of PEEK make it hard to establish a strong and durable adhesion. In this study, we have evaluated a modification method of polydopamine (PDA) coating with plasma pretreatment for the PEEK films by physical and chemical characterization, bonding properties, and biocompatibility. The surface properties of PEEK were well-characterized by scanning electron microscope (SEM) and X-ray photoelectron spectroscopy (XPS). The adhesive strength of the PEEK films was greatly improved without significant reduction of the proliferation rate of human gingival fibroblast cells in MTT and Live/Dead assays. Therefore, PDA coating with plasma pretreatment may give a new solution for effective clinical application of PEEK in primary performed crowns.
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Affiliation(s)
- Rui Teng
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Yuchen Meng
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Xiaodan Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Jie Liu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Rui Ding
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Yilong Cheng
- School of Chemistry, Xi'an Jiaotong University, Xi'an, China
| | - Yunhe Zhang
- Engineering Research Center of Super Engineering Plastics, Ministry of Education, College of Chemistry, Jilin University, Changchun, China
| | - Yanfeng Zhang
- School of Chemistry, Xi'an Jiaotong University, Xi'an, China
| | - Dandan Pei
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Ang Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.,Department of Periodontology, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
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Crisp J, Mihas P, Sanders AE, Divaris K, Wright JT. Influences on dentists' adoption of nonsurgical caries management techniques: A qualitative study. J Am Dent Assoc 2021; 152:463-470. [PMID: 33461729 DOI: 10.1016/j.adaj.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/27/2020] [Accepted: 10/04/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nonsurgical caries management techniques (NSCMT) offer a simple, conservative approach to treating caries. Despite evidence supporting and potential advantages of NSCMT, dentists can be reluctant to adopt these techniques. To better understand this phenomenon, the authors interviewed dentists who primarily treat children regarding their thoughts, attitudes, and adoption of 3 NSCMT. METHODS The 3 NSCMT were fluoride varnish, silver diamine fluoride, and Hall stainless steel crowns. The authors interviewed dentists in North Carolina whose practices were restricted mostly to children. A nonprobabilistic maximum-variation design was used in the sampling. Using a semistructured interview guide, the authors recorded the interviews digitally and analyzed them thematically. The authors stratified the analysis according to years of practice, geographic location, and type of practice. Reporting was based on emerging and recurring themes and insightful quotes. RESULTS Factors most likely to promote the adoption of NSCMT were related to clinical practice, family preference, patient safety, and provider philosophy. Barriers to adoption included previous practitioner negative experiences using the techniques, high-risk caries population, and perceived likelihood of negative outcomes. Characteristics of the practice environment, patient population, communication with families, and financial considerations were influential in the clinician's determination as to whether to use these techniques. CONCLUSIONS These findings provide valuable insight into practitioners' influences, motivations, and clinical decision making in the adoption and use of management and treatment approaches for carious lesions in the pediatric population. PRACTICE IMPLICATIONS The primary factors and barriers identified in this study are possible targets for education and quality improvement programs aimed at increasing NSCMT use.
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Cagetti MG, Angelino E. Could SARS-CoV-2 burst the use of Non-Invasive and Minimally Invasive treatments in paediatric dentistry? Int J Paediatr Dent 2021; 31:27-30. [PMID: 32748562 PMCID: PMC7436454 DOI: 10.1111/ipd.12679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/09/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Maria Grazia Cagetti
- Department of BiomedicalSurgical and Dental SciencesUniversity of MilanMilanItaly
| | - Eleonora Angelino
- Department of BiomedicalSurgical and Dental SciencesUniversity of MilanMilanItaly
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Hall technique: is it superior in success and savings to conventional restorations? Evid Based Dent 2020; 21:128-129. [PMID: 33339971 DOI: 10.1038/s41432-020-0134-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Design A cost-effectiveness analysis of caries management in primary molars using Hall technique (HT) versus conventional restoration (CR) from a pre-existing dataset from a randomised split-mouth trial, within primary care in Scotland, with a five-year follow-up.Case selection Computer-generated block randomisation was used to match asymptomatic primary molars of 3-10-year-old children recruited from primary care, to either HT or CR arms.Economic evaluation A cost-effectiveness analysis was undertaken. A five-year horizon was chosen. A societal perspective was adopted. Estimation of direct, indirect and opportunity costs were presented. Costs were discounted at 1.5%. Molar survival was chosen as the effectiveness measure.Data analysis Statistical significance of primary outcome (survival) was examined using the log-rank test. Bootstrapping produced a sampling distribution of mean cost and effectiveness with a 95% confidence interval around a mean value. An incremental cost-effectiveness ratio (ICER) was provided.Results HT molars had superior survival of 99% (95% CI: 98-100%) compared to CR at 92% (95% CI: 87-97%). Initials costs indicated HT to be more expensive than CR; however, direct costs, including retreatments, were cheaper for HT when using both NHS Scotland and NHS England cost data. Indirect/opportunity costs, including time and travel of parents, were significantly less for HT. Total cumulative costs were significantly lower in HT (32 GBP; 95% CI: 31-34) than CR (49 GBP; 34-69). HT dominated CR, being less costly and more effective with a mean ICER of 2.38 GBP spent additionally while losing 1% of molar survival with CR over HT.Conclusions HT molars are cost-effective, compared to CR, when managing asymptomatic carious primary molars after five years' follow-up.
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Araujo MP, Innes NP, Bonifácio CC, Hesse D, Olegário IC, Mendes FM, Raggio DP. Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting. BMC Oral Health 2020; 20:318. [PMID: 33176756 PMCID: PMC7656501 DOI: 10.1186/s12903-020-01298-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atraumatic Restorative Treatment (ART) and the Hall Technique (HT) are both minimally invasive, non-aerosol generating procedures (non-AGPs). They seem to have never been directly compared, nor has the HT been studied in a non-clinical setting. This study compared the HT and ART restorations placed in a school setting after 36 months. METHODS Children (5-10 yo) who had a primary molar with a dentinal occluso-proximal, cavitated carious lesion were allocated to the ART (selective removal) or HT arms. PRIMARY OUTCOME restoration survival over 36-months (using Kaplan-Meier survival analysis, log rank test, and Cox regression). SECONDARY OUTCOMES (1) occlusal vertical dimension (OVD) (1, 2, 3, 4 weeks) and (2) child self-reported discomfort; (3) treatment acceptability (immediately following interventions); (4) Child Oral Health Related Quality of Life (OHRQoL), before treatment and after 6 months and (5) a post hoc analysis of time to tooth exfoliation (1, 6, 12, 18, 24, 30, 36 months). RESULTS One-hundred and thirty-one children (ART = 65; HT = 66) were included (mean age = 8.1 ± 1.2). At 36 months, 112 (85.5%) children were followed-up. PRIMARY OUTCOME restoration survival rates ART = 32.7% (SE = 0.08; 95% CI 0.17-0.47); HT = 93.4% (0.05; 0.72-0.99), p < 0.001; Secondary outcomes: (1) OVD returned to pre-treatment state within 4 weeks; (2) treatment discomfort was higher for the HT (p = 0.018); (3) over 70% of children and parents showed a high acceptability for treatments, with crown aesthetics being a concern for around 23% of parents; (4) Child OHRQoL improved after 6 months; and (5) teeth treated with the HT exfoliated earlier than those in the ART group (p = 0.007). CONCLUSIONS Both ART and the HT were acceptable to child participants and their parents and all parents thought both restorations protected their child's tooth. However, the crown appearance concerned almost a quarter of parents in the HT arm. Children experienced less discomfort in the ART group. Although both treatments can be performed in a non-clinical setting and have the advantage of being non-aerosol generating procedures (non-AGPs), the HT had almost three times higher survival rates (93.4%) for restoring primary molar occluso-proximal cavities compared to ART (32.7%). TRIAL REGISTRATION This trial was registered in ClinicalTrials.gov (NCT02569047), 5th October 2015. https://clinicaltrials.gov/ct2/show/study/NCT02569047?cond=Hall+Technique+Atraumatic+Rest orative+Treatment&draw=2&rank=2.
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Affiliation(s)
- Mariana Pinheiro Araujo
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.,School of Dentistry, University of Dundee, Dundee, Scotland, UK
| | - Nicola Patricia Innes
- School of Dentistry, University of Dundee, Dundee, Scotland, UK. .,School of Dentistry, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK.
| | - Clarissa Calil Bonifácio
- Department of Paediatric Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Daniela Hesse
- Department of Paediatric Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Isabel Cristina Olegário
- Department of Public and Child Dental Health, Dublin Dental University Hospital, Trinity College, Dublin, Ireland, UK
| | - Fausto Medeiros Mendes
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Daniela Prócida Raggio
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Gok Baba M, Kirzioglu Z, Ceyhan D. One-year clinical evaluation of two high-viscosity glass-ionomer cements in class II restorations of primary molars. Aust Dent J 2020; 66:32-40. [PMID: 33084075 DOI: 10.1111/adj.12802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little information exists on the clinical performance of restorative materials on primary teeth of preschool children. This study aimed to evaluate clinical performance of compomer, glass-hybrid-added high-viscosity glass-ionomer cement and zinc-added high-viscosity glass-ionomer cement materials in class ΙΙ restorations of primary molars. METHODS The study included 251 teeth of 57 patients aged 4-7 years with proximal caries in primary molars. The teeth were divided into three groups, and each restorative material was randomly distributed. Dyract XP, Equia Forte and ChemFil Rock materials were placed after cavity preparation and clinically evaluated at 3, 6, 9 and 12 months using modified United States Public Health Service criteria. Statistical analyses were performed using chi-square and z tests. RESULTS At the end of 12 months, a total of three restorations in Dyract XP group, 22 in Equia Forte group and 11 in ChemFil Rock group failed in retention criteria. No statistically significant difference existed between retention, colour match and surface texture criteria of all groups at 3 and 6 months, but a statistically significant difference was found at 12 months (P < 0.05). CONCLUSION For class ΙΙ restorations of primary molars, the success of compomer material was superior to high-viscosity glass-ionomer materials.
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Affiliation(s)
| | - Zuhal Kirzioglu
- Department of Paediatric Dentistry, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
| | - Derya Ceyhan
- Department of Paediatric Dentistry, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
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Abstract
Objectives To define an expert Delphi consensus on when to intervene in the caries process and existing carious lesions.Methods Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference.Results Lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations may be placed for form, function, aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated lesions which are cleansable. Cavitated lesions which are not cleansable usually require minimally invasive management. In specific circumstances, mixed interventions may be applicable. Occlusally, cavitated lesions confined to enamel/non-cavitated lesions extending radiographically into deep dentine may be exceptions. Proximally, cavitation is hard to assess tactile-visually. Most lesions extending radiographically into the middle/inner third of dentine are assumed to be cavitated. Those restricted to the enamel are not cavitated. For lesions extending radiographically into the outer third of dentine, cavitation is unlikely. These lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.Conclusions Comprehensive diagnosis is the basis for systematic decision-making on when to intervene in the caries process and existing lesions.
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Eden E, Frencken J, Gao S, Horst JA, Innes N. Managing dental caries against the backdrop of COVID-19: approaches to reduce aerosol generation. Br Dent J 2020; 229:411-416. [PMID: 33037360 PMCID: PMC7546139 DOI: 10.1038/s41415-020-2153-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/10/2020] [Indexed: 11/08/2022]
Abstract
The COVID-19 pandemic resulted in severe limitation and closure of dental practices in many countries. Outside of the acute (peak) phases of the disease, dentistry has begun to be practised again. However, there is emerging evidence that SARS-CoV-2 can be transmitted via airborne routes, carrying implications for dental procedures that produce aerosol. At the time of writing, additional precautions are required when a procedure considered to generate aerosol is undertaken.This paper aims to present evidence-based treatments that remove or reduce the generation of aerosols during the management of carious lesions. It maps aerosol generating procedures (AGPs), where possible, to alternative non-AGPs or low AGPs. This risk reduction approach overcomes the less favourable outcomes associated with temporary solutions or extraction-only approaches. Even if this risk reduction approach for aerosol generation becomes unnecessary in the future, these procedures are not only suitable but desirable for use as part of general dental care post-COVID-19.
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Affiliation(s)
- Ece Eden
- Ege University, School of Dentistry, Department of Paediatric Dentistry, Bornova, Izmir, 35100, Turkey.
| | - Jo Frencken
- Radboud University, Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Centre, Nijmegen, 6525 GA, The Netherlands
| | - Sherry Gao
- Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Hong Kong
| | - Jeremy A Horst
- Director of Clinical Innovation, DentaQuest, Boston, MA 02129 USA; University of Washington, Department of Oral Health Sciences, Seattle, 98195, USA
| | - Nicola Innes
- Professor and Honorary Consultant, Paediatric Dentistry, School of Dentistry, College of Biomedical & Life Sciences, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK
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Santamaría RM, Abudrya MH, Gül G, Mourad MS, Gomez GF, Zandona AGF. How to Intervene in the Caries Process: Dentin Caries in Primary Teeth. Caries Res 2020; 54:306-323. [PMID: 32854105 DOI: 10.1159/000508899] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/03/2020] [Indexed: 11/19/2022] Open
Abstract
For an ORCA/EFCD consensus, this review systematically assessed available evidence regarding interventions performed and materials used to manage dentin carious lesions in primary teeth. A search for systematic reviews (SRs) and randomized clinical trials (RCTs) with a follow-up of at least 12 months after intervention was performed in PubMed, LILACS, BBO, and the Cochrane Library. The risk of bias tool from the Cochrane Collaboration and the PRISMA Statement were used for assessment of the included studies. From 101 screened articles, 2 SRs and 5 RCTs, which assessed the effectiveness of interventions in terms of pulp vitality and success of restoration, and 10 SRs and 1 RCT assessing the success of restorative materials were included. For treatments involving no carious tissue removal, the Hall technique showed lower treatment failure for approximal carious lesions compared to complete caries removal (CCR) and filling. For the treatment of deep carious lesions, techniques involving selective caries removal (SCR) showed a reduction in the incidence of pulp exposure. However, the benefit of SCR over CCR in terms of pulp symptoms or restoration success/failure was not confirmed. Regarding restorative materials, preformed metal crowns (PMCs) used to restore multisurface lesions showed the highest success rates compared to other restorative materials (amalgam, composite resin, glass ionomer cement, and compomer), and in the long term (12-48 months) these were also less likely to fail. There is limited evidence supporting the use of PMCs to restore carious lesions with single cavities. Among nonrestorative options, silver diammine fluoride was significantly more effective in arresting caries than other treatments for treating active carious lesions of different depths. Considerable heterogeneity and bias risk were observed in the included studies. Although heterogeneity observed among the studies was substantial, the trends were similar. In conclusion, less invasive caries approaches involving selective or no caries removal seem advantageous in comparison to CCR for patients presenting with vital, symptomless, carious dentin lesions in primary teeth. There is evidence in favor of PMCs for restoring multisurface carious lesions in primary molars.
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Affiliation(s)
- Ruth M Santamaría
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany,
| | - Mohamed Hassan Abudrya
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Gülsün Gül
- Department of Comprehensive Care, Tufts University, Boston, Massachusetts, USA
| | - Mhd Said Mourad
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Grace Felix Gomez
- Department of Community Dentistry, Case Western Reserve University, Cleveland, Ohio, USA
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Boyd DH, Thomson WM, Leon de la Barra S, Fuge KN, van den Heever R, Butler BM, Leov F, Foster Page LA. A Primary Care Randomized Controlled Trial of Hall and Conventional Restorative Techniques. JDR Clin Trans Res 2020; 6:205-212. [PMID: 32559403 DOI: 10.1177/2380084420933154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate treatment outcomes of different restorative techniques undertaken by dental therapists for primary molar carious lesions in a sample of children in New Zealand primary care. METHODS This was a randomized controlled trial with children aged 3 to 8 y in New Zealand's Whanganui region. Children meeting inclusion criteria were randomly allocated to treatment with either the Hall technique (HT), in which a stainless-steel crown (SSC) is placed without any carious tissue removal or tooth preparation, or a non-Hall conventional restorative approach (NHT), including tooth preparation with selective carious tissue removal; this included SSC, amalgam, composite, or glass ionomer cement (GIC) restorations. Restorative outcomes after 12 and 24 mo were categorized as success, minor failure, or major failure. RESULTS Of the 295 eligible children, 149 and 146 were allocated to the HT and NHT groups, respectively, with a total of 570 carious primary molars treated by 13 dental therapists. The participant follow-up rates at 12 and 24 mo were 95% and 91%. SSCs were the most commonly used restoration in the NHT group (60%), followed by GIC (28%). SSCs were the most successful restorations regardless of whether they were placed with the HT or NHT, with success rates of 89% and 92% at 12 mo and 85% and 86% at 24 mo. In the NHT group, the treatment material was a predictor of minor failure at 12 and 24 mo, with significantly more failures with GICs. CONCLUSIONS SSCs placed by dental therapists are a highly successful restoration for the primary dentition, regardless of whether they are placed with the HT or conventionally. The high failure rate of glass ionomer restorations means that they cannot be recommended for widespread use in New Zealand primary care (Australian New Zealand Clinical Trials Registry, ACTRN12614000844640). KNOWLEDGE TRANSFER STATEMENT The findings of this study can be used by policy makers and clinicians when deciding on which materials and which approach to use to maximize success and to minimize retreatment rates when providing restorative treatment for carious primary molars in children's primary oral health care. Results also suggest that undertaking research in the primary care setting may enhance translation of new knowledge and techniques into clinicians' hands.
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Affiliation(s)
- D H Boyd
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - W M Thomson
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - S Leon de la Barra
- Consulting biostatistician, Waitaki Community Gardens, Oamaru, New Zealand
| | - K N Fuge
- Wellington Regional Dental Service, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | | | - B M Butler
- Dental Department, MidCentral District Health Board, Palmerston North, New Zealand
| | - F Leov
- Waikato District Health Board, Hamilton, New Zealand
| | - L A Foster Page
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
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Assessment of paediatric dental guidelines and caries management alternatives in the post COVID-19 period. A critical review and clinical recommendations. Eur Arch Paediatr Dent 2020; 21:543-556. [PMID: 32557183 PMCID: PMC7298449 DOI: 10.1007/s40368-020-00547-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/07/2020] [Indexed: 01/24/2023]
Abstract
Purpose The first aim of this paper is to provide dental professionals caring for children and adolescents during and after the COVID-19 pandemic with a reference to international dental guidelines. The second aim is to suggest minimally invasive treatment alternatives for caries management, minimising the risk of viral cross-infection and offering a safer clinical environment. Methods An evidence-based pertinent literature search of different electronic databases was performed in addition to leading global dental authorities, royal colleges, and programmes. Results All guidelines released in response to COVID-19 centred around minimising Aerosol Generating Procedures (AGP) impacting the provision of regular dental treatment of paediatric patients. There was an emphasis on triaging and only treating emergency and urgent cases. Special attention was given to medically compromised children in the guidelines. Detailed guidelines for the dental environment and equipment were given. This paper also summarised the relevant evidence-based guidelines for the use of non-invasive and minimally invasive caries management techniques. Conclusion Specific recommendations for dental management of paediatric patients during and in the post-COVID-19 era are suggested. Minimisation of AGP procedures, and case-based selection of biological, non-invasive or minimally invasive methods are recommended.
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Subjective versus objective, polymer bur-based selective carious tissue removal: 1-year interim analysis of a randomized clinical trial. Sci Rep 2020; 10:9130. [PMID: 32499552 PMCID: PMC7272648 DOI: 10.1038/s41598-020-66074-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/08/2020] [Indexed: 11/08/2022] Open
Abstract
We aimed to compare subjective (S) vs. objective (O) selective carious tissue removal using hand-excavation versus a self-limiting polymer bur, respectively. A community-based single-blind cluster-randomized controlled superiority trial was performed. This is a 1-year-interim analysis. 115 children (age 7-8 years) with ≥1 vital primary molar with a deep dentin lesion (>1/2 dentin depth) were included (60 S/55 O). The cluster was the child, with eligible molars being treated identically (91 S/86 O). Cavities were prepared and carious tissue on pulpo-proximal walls selectively removed using hand instruments (S), or a self-limiting polymer bur (Polybur P1, Komet). Cavities were restored using glass-hybrid material (Equia Forte, GC). Treatment times and children's satisfaction were recorded. Generalized-linear models (GLM) and multi-level Cox-regression analysis were applied. Initial treatment times were not significantly different between protocols (mean; 95%CI S: 433; 404-462 sec; O: 412; 382-441 sec; p = 0.378/GLM). There was no significant difference in patients' satisfaction (p = 0.164). No pulpal exposures occurred. 113 children were re-examined. Failures occurred in 22/84 O-molars (26.2%) and 26/90 S-molars (28.9%). Pulpal complications occurred in 5(6%) O and 2(2.2%) S molars, respectively. Risk of failure was not significantly associated with the removal protocol, age, sex, dental arch or tooth type (p > 0.05/Cox), but was nearly 5-times higher in multi-surface than single-surface restorations (HR: 4.60; 95% CI: 1.70-12.4). Within the limitations of this interim analysis, there was no significant difference in treatment time, satisfaction and risk of failure between O and S.
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Bhatia HP, Khari PM, Sood S, Sharma N, Singh A. Evaluation of Clinical Effectiveness and Patient Acceptance of Hall Technique for Managing Carious Primary Molars: An In Vivo Study. Int J Clin Pediatr Dent 2020; 12:548-552. [PMID: 32440073 PMCID: PMC7229388 DOI: 10.5005/jp-journals-10005-1699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Hall technique (HT) is a biological approach where decay is sealed under preformed metal crowns without any caries removal, tooth preparation or local anesthesia. Dental caries is one of the most common prevailing chronic condition that affect both adults and children. Since children are anxious and apprehensive to dental treatment, their uncooperative behavior might cause hindrance in the treatment, which often leads to manage them in general anesthesia. To better address the dental care needs in pediatric patients, dental surgeons require some alternatives for management of caries and restorative treatment in children. The Hall technique is one such conservative treatment approach developed by Dr Norna Hall in 1980s. Aim The purpose of this study was to assess the clinical effectiveness and patient acceptance of Hall technique for managing carious primary molars. Materials and methods 84 children in the age group 6–10 years with class I and class II carious lesions limited to dentin were selected for the study. Occlusal vertical dimension (OVD) was measured preoperatively, postoperatively and after 6 months. Discomfort level was assessed by facial pain rating scale and by questionnaires filled on the day of placement of SS crown, 1 week after placement and 6 months after placement. Results The Hall technique was found to be successful, as there was no failure clinically as well as radiographically within 6 months of placement of SS crown. The increased OVD postoperatively returned to its normal values within 6 months, the mean change in the OVD was found to be statistically significant (p = 0.02). Conclusion The Hall technique proved to be clinically effective and acceptable by maximum number of children. How to cite this article Bhatia HP, Khari PM, Sood S, et al. Evaluation of Clinical Effectiveness and Patient Acceptance of Hall Technique for Managing Carious Primary Molars: An In Vivo Study. Int J Clin Pediatr Dent 2019;12(6):548–552.
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Affiliation(s)
- Hind P Bhatia
- Department of Pedodontics and Preventive Dentistry, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Puneet M Khari
- Department of Pedodontics and Preventive Dentistry, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Shveta Sood
- Department of Pedodontics and Preventive Dentistry, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Naresh Sharma
- Department of Pedodontics and Preventive Dentistry, Manav Rachna Dental College, Faridabad, Haryana, India
| | - Akshara Singh
- Department of Pedodontics and Preventive Dentistry, Manav Rachna Dental College, Faridabad, Haryana, India
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Abu Serdaneh S, AlHalabi M, Kowash M, Macefield V, Khamis AH, Salami A, Hussein I. Hall technique crowns and children's masseter muscle activity: A surface electromyography pilot study. Int J Paediatr Dent 2020; 30:303-313. [PMID: 31894621 DOI: 10.1111/ipd.12611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/10/2019] [Accepted: 12/29/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Hall technique crowns (HTCs) alter the occlusion temporarily, potentially affecting jaw muscles, particularly the masseter - the primary jaw-closing muscle. AIM To assess masseter muscle activity (MMA) in children treated with a unilateral HTC. DESIGN In 12 children treated with a single HTC, bilateral MMA was recorded with surface electromyography (sEMG) for ten cycles of Rest Position (RP) and Maximum Voluntary Clenching (MVC) over 20 seconds immediately pre-HTC cementation (Pbase ), immediately post-HTC cementation (Pimmed ), at 2 weeks post-HTC cementation (P2w ) and at 6 weeks post-HTC cementation (P6w ). t test, ANOVA and post hoc statistics were used (P < .05). RESULTS As expected, MMA was low at rest and increased during maximal jaw clenching (P < .0001). MMA (mean ± SD) increased significantly (P < .001) between RP and MVC at: Pbase [from 1.60 μV·s (±0.96) to 5.40(±2.30)]; Pimmed [1.57(±1.15) to 3.75(±1.87)]; P2w [1.39(±0.54) to 5.54(±1.45)] and finally P6w [1.46(±0.56) to 6.45(±2.56)]. Rest MMA at Pbase , Pimmed , P2w and P6w remained unchanged (P = .18) whereas Pbase clench MMA reduced by a third at Pimmed (P < .001), returned to and exceeded baseline levels at P2w (P = .822) and P6w (P < .001), respectively. CONCLUSIONS This pilot study showed that Hall technique crowns may affect masseter muscle activity in children. Clench MMA was reduced immediately post-treatment but returned to and later exceeded baseline levels at 2 and 6 weeks, respectively. Rest MMA remained unchanged.
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Affiliation(s)
- Salsabeel Abu Serdaneh
- Department of Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Manal AlHalabi
- Department of Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Mawlood Kowash
- Department of Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Vaughan Macefield
- Department of Physiology, Baker Heart and Diabetes Institute, University of Melbourne, Melbourne, Vic., Australia
| | - Ammar H Khamis
- Department of Biostatistics, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Anas Salami
- Department of Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Iyad Hussein
- Department of Paediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Freeman R, Maguire A, Ryan V, Wilson N, Innes NP, Clarkson JE, McColl E, Marshman Z, Robertson M, Abouhajar A, Chadwick B, Deery C, Wong F, Douglas GV. The FiCTION trial: Child oral health‐related quality of life and dental anxiety across three treatment strategies for managing caries in young children. Community Dent Oral Epidemiol 2020; 48:328-337. [DOI: 10.1111/cdoe.12537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ruth Freeman
- Dental Health Services Research Unit University of Dundee Dundee UK
| | - Anne Maguire
- School of Dental Sciences Newcastle University Newcastle upon Tyne UK
| | - Vicky Ryan
- Institute of Health & Society Newcastle University Newcastle upon Tyne UK
| | - Nina Wilson
- Institute of Health & Society Newcastle University Newcastle upon Tyne UK
| | | | - Jan E. Clarkson
- Dental Health Services Research Unit University of Dundee Dundee UK
| | - Elaine McColl
- Institute of Health & Society Newcastle University Newcastle upon Tyne UK
| | - Zoe Marshman
- School of Clinical Dentistry University of Sheffield Sheffield UK
| | | | - Alaa Abouhajar
- Newcastle Clinical Trials Unit Newcastle University Newcastle upon Tyne UK
| | - Barbara Chadwick
- School of Dentistry College of Biomedical & Life Sciences Cardiff University Cardiff UK
| | | | - Ferranti Wong
- Institute of Dentistry Queen Mary University of London London UK
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Arrow P, Forrest H. Atraumatic restorative treatments reduce the need for dental general anaesthesia: a non-inferiority randomized, controlled trial. Aust Dent J 2020; 65:158-167. [PMID: 32040875 DOI: 10.1111/adj.12749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND A dental general anaesthesia (DGA) is commonly undertaken for the management of dental caries in young children. A randomized-controlled trial was undertaken to test the feasibility of using the Atraumatic Restorative Treatment and Hall Technique approaches (ART/HT) to manage the dental treatment of children recommended for a DGA. METHODS Consenting children, recommended a DGA for caries management, at the Oral Health Centre of Western Australia were randomized. Test group children were treated using the ART/HT approach and the control group under a DGA. Children were examined after 12 months by two blinded, calibrated examiners. Analysis was on an intention to treat basis; between and within group comparisons were undertaken using appropriate paired and unpaired tests. Logistic regression was used to test restorative success, controlling for clustering of teeth. RESULTS Sixty-five children participated, (Test = 32; Control = 33). At study termination, 28 children (88%) in the ART/HT group and 20 children (61%) in the DGA group had been provided with care, P < 0.01. Crown restorations were protective of restorative failure in a multivariate logistic model (OR 0.05, P < 0.01). CONCLUSION Use of the ART/HT approach enabled timely dental treatment of young children recommended for a DGA, and should be among the treatment options considered.
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Affiliation(s)
- P Arrow
- Dental Health Services, Perth, Western Australia
| | - H Forrest
- Dental Health Services, Perth, Western Australia
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Gomide RT, Frencken JE, Faber J, Kuijpers-Jagtman AM, Leal SC. Cavity treatment in primary molars and malocclusion: quasi-randomised clinical trial. PeerJ 2020; 8:e8439. [PMID: 32071805 PMCID: PMC7008815 DOI: 10.7717/peerj.8439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background An innovative caries treatment protocol for primary teeth, termed Ultra-Conservative Treatment (UCT), restores small cavities through the Atraumatic Restorative Treatment (ART) protocol and cleans medium to large open cavities with toothbrush and fluoride toothpaste. However, UCT-treated primary molars were found to exfoliate earlier than amalgam (CRT) and ART-restored cavities, which may lead to unacceptable loss of space for normal eruption of permanent successors. The null-hypothesis tested was that there is no difference between the three treatment protocols and the intra-arch distances, and index of orthodontic treatment need (IOTN) after 4 years. Methods Dental casts were taken at baseline (T0) and four (T4) years. The space of the premolars (D + E space), arch perimeter, anterior and total arch depth were measured using a morphometric computer programme. The presence and level of malocclusion were assessed according to the IOTN index. Dependent variables were all intra-arch distances and the IOTN while the independent variable was treatment protocol (CRT, ART and UCT). Data were analysed using linear and logistic regression. Results The sample consisted of 867 pairs of casts of 272 initial 6–7-year-olds. No difference was observed between the UCT protocol and the two restorative protocols for the intra-arch variables in both maxilla and mandible over the 4 year period. There was no difference between the UCT and the CRT and ART protocols regarding the occurrence of orthodontic treatment need (malocclusion). In conclusion, the UCT treatment protocol does not differ significantly from the traditional amalgam (CRT) and ART restorative protocols with respect to intra-arch distances and malocclusion. The earlier exfoliation of UCT-treated primary molars does not lead to a worsening of the eruption pattern of permanent successors.
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Affiliation(s)
- Rafael T Gomide
- Division of Pediatric Dentistry, Dental School, Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Jo E Frencken
- Radboud Institute for Health Sciences, Department of Dentistry-Oral Function and Prosthetic Dentistry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jorge Faber
- Unaffiliated, Brasília, Distrito Federal, Brasil
| | - Anne Marie Kuijpers-Jagtman
- Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia.,Department of Orthodontics, University Medical Center Groningen, Groningen, Netherlands.,Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Soraya C Leal
- Department of Dentistry, Faculty of Health Sciences, Universidade de Brasília, Brasília, Brazil
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Abstract
Background The Hall technique (HT) is popular with UK paediatric dentists (PDs). Global PDs perception/use of HT is unknown.Aim To investigate global PDs opinions/use of HT.Materials and methods A cross-sectional questionnaire of 26 questions was sent to specialist PDs across the globe.Results Responses of 709 PDs from six continents were obtained. The majority (n = 654, 92.32%) had heard about HT but only 50.6% (n = 358) used it, with wide country variations. Respectively, 37.5%, 31.5% and 31% were neutral, against or supportive of HT when they initially heard about it. Only 17% of HT users said it was always the treatment of choice for non-pulpal asymptomatic carious primary molars (NPACPMs), 62% would take a pre-operative radiograph, 65% would consider using high speed drills before HT, 63% would never consider HT under general anaesthesia, 56% would use HT under N2O sedation. Finally, in a clinical scenario of a NPACPM in a cooperative 6-year-old, 75% of PDs would choose conventional restorative methods over the HT.Conclusion The HT is recognised, but not used, by an outright majority of PDs across the globe. Identifiable barriers such as lack of training, perception as substandard dentistry and perceived lack of evidence reduced its use.
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Maguire A, Clarkson JE, Douglas GV, Ryan V, Homer T, Marshman Z, McColl E, Wilson N, Vale L, Robertson M, Abouhajar A, Holmes RD, Freeman R, Chadwick B, Deery C, Wong F, Innes NP. Best-practice prevention alone or with conventional or biological caries management for 3- to 7-year-olds: the FiCTION three-arm RCT. Health Technol Assess 2020; 24:1-174. [PMID: 31928611 PMCID: PMC6983909 DOI: 10.3310/hta24010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Historically, lack of evidence for effective management of decay in primary teeth has caused uncertainty, but there is emerging evidence to support alternative strategies to conventional fillings, which are minimally invasive and prevention orientated. OBJECTIVES The objectives were (1) to assess the clinical effectiveness and cost-effectiveness of three strategies for managing caries in primary teeth and (2) to assess quality of life, dental anxiety, the acceptability and experiences of children, parents and dental professionals, and caries development and/or progression. DESIGN This was a multicentre, three-arm parallel-group, participant-randomised controlled trial. Allocation concealment was achieved by use of a centralised web-based randomisation facility hosted by Newcastle Clinical Trials Unit. SETTING This trial was set in primary dental care in Scotland, England and Wales. PARTICIPANTS Participants were NHS patients aged 3-7 years who were at a high risk of tooth decay and had at least one primary molar tooth with decay into dentine, but no pain/sepsis. INTERVENTIONS Three interventions were employed: (1) conventional with best-practice prevention (local anaesthetic, carious tissue removal, filling placement), (2) biological with best-practice prevention (sealing-in decay, selective carious tissue removal and fissure sealants) and (3) best-practice prevention alone (dietary and toothbrushing advice, topical fluoride and fissure sealing of permanent teeth). MAIN OUTCOME MEASURES The clinical effectiveness outcomes were the proportion of children with at least one episode (incidence) and the number of episodes, for each child, of dental pain or dental sepsis or both over the follow-up period. The cost-effectiveness outcomes were the cost per incidence of, and cost per episode of, dental pain and/or dental sepsis avoided over the follow-up period. RESULTS A total of 72 dental practices were recruited and 1144 participants were randomised (conventional arm, n = 386; biological arm, n = 381; prevention alone arm, n = 377). Of these, 1058 were included in an intention-to-treat analysis (conventional arm, n = 352; biological arm, n = 352; prevention alone arm, n = 354). The median follow-up time was 33.8 months (interquartile range 23.8-36.7 months). The proportion of children with at least one episode of pain or sepsis or both was 42% (conventional arm), 40% (biological arm) and 45% (prevention alone arm). There was no evidence of a difference in incidence or episodes of pain/sepsis between arms. When comparing the biological arm with the conventional arm, the risk difference was -0.02 (97.5% confidence interval -0.10 to 0.06), which indicates, on average, a 2% reduced risk of dental pain and/or dental sepsis in the biological arm compared with the conventional arm. Comparing the prevention alone arm with the conventional arm, the risk difference was 0.04 (97.5% confidence interval -0.04 to 0.12), which indicates, on average, a 4% increased risk of dental pain and/or dental sepsis in the prevention alone arm compared with the conventional arm. Compared with the conventional arm, there was no evidence of a difference in episodes of pain/sepsis among children in the biological arm (incident rate ratio 0.95, 97.5% confidence interval 0.75 to 1.21, which indicates that there were slightly fewer episodes, on average, in the biological arm than the conventional arm) or in the prevention alone arm (incident rate ratio 1.18, 97.5% confidence interval 0.94 to 1.48, which indicates that there were slightly more episodes in the prevention alone arm than the conventional arm). Over the willingness-to-pay values considered, the probability of the biological treatment approach being considered cost-effective was approximately no higher than 60% to avoid an incidence of dental pain and/or dental sepsis and no higher than 70% to avoid an episode of pain/sepsis. CONCLUSIONS There was no evidence of an overall difference between the three treatment approaches for experience of, or number of episodes of, dental pain or dental sepsis or both over the follow-up period. FUTURE WORK Recommendations for future work include exploring barriers to the use of conventional techniques for carious lesion detection and diagnosis (e.g. radiographs) and developing and evaluating suitable techniques and strategies for use in young children in primary care. TRIAL REGISTRATION Current Controlled Trials ISRCTN77044005. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anne Maguire
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jan E Clarkson
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | | | - Vicky Ryan
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Elaine McColl
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Robertson
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Alaa Abouhajar
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Richard D Holmes
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Barbara Chadwick
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Christopher Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Ferranti Wong
- Institute of Dentistry, Queen Mary University of London, London, UK
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Fröhlich TT, Rocha RDO, Botton G. Does previous application of silver diammine fluoride influence the bond strength of glass ionomer cement and adhesive systems to dentin? Systematic review and meta-analysis. Int J Paediatr Dent 2020; 30:85-95. [PMID: 31419356 DOI: 10.1111/ipd.12571] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/24/2019] [Accepted: 08/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Silver diammine fluoride (SDF) applied before a restoration may prevent recurrent caries; therefore, its effect on the bonding of restorative materials is contradictory. AIM To assess through a systematic review and meta-analysis the influence of SDF on the bonding performance of adhesive materials to dentine. DESIGN A systematic search was carried out in PubMed, Web of Science, LILACS, and Scopus. Studies comparing bond strength of adhesive systems or glass ionomer cement to SDF-treated and -untreated (control) dentine were included. Global analysis comparing the bond strength data was performed, separately for adhesive systems and glass ionomer cement, using RevMan5.1, with a random-effect model, at a 5% significance level. RESULTS Eleven studies were included in the review and ten in the meta-analyses. Overall pooled effect for glass ionomer cement has shown no significant difference between the groups (Z = 0.47; P = .64). SDF treatment significantly impairs the bonding of adhesive systems to dentine (Z = 2.11; P = .03); this effect can be eliminated by the rinsing step (Z = 0.85; P = .40). CONCLUSIONS The previous application of SDF does not influence the dentine bond strength of glass ionomer cement, but compromises the bonding of adhesive systems.
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Affiliation(s)
| | | | - Graziela Botton
- Department of Stomatology, Federal University of Santa Maria, Santa Maria, Brazil
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Alsaleh MM, Sabbarini JM, Al-Batayneh OB, Khader YS. Changes in Behavior Management and Treatment Modalities in Pediatric Dentistry during COVID-19 Pandemic. Int J Clin Pediatr Dent 2020; 13:S125-S131. [PMID: 34434029 PMCID: PMC8359884 DOI: 10.5005/jp-journals-10005-1885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective This study aims to assess the knowledge and confidence of dentists related to behavior management with extra personal protective equipment (PPE), non-aerosol-generating dental procedures in the course of the coronavirus disease-2019 (COVID-19) pandemic. Materials and methods A cross-sectional online survey was conducted among a sample of dentists who worked in Jordan and India in June 2020 during the COVID-19 pandemic. Results This study included a total of 177 dentists in Jordan and India that were practicing during the early months of the pandemic. Most dentists were seeing <6 patients per day. The most common emergency treatments during the pandemic by Jordanian dentists were abscesses (51.8%) and cellulitis (44.6%) vs (44.6%) abscesses and (35.5%) pulpitis in India. There was a high adoption of all elements of the PPE protocol. Most participants never or rarely used N2O sedation to manage their patients in Jordan and India (80.4 and 71.1%), respectively. Participants in Jordan and India that considered treatment non-aerosol-generating procedures (non-AGP) were (82.1 vs 97.5%, p = 0.000), respectively. Conclusion Most of the surveyed dentists believe the extra PPE acts as a barrier to patient communication and child behavior management and would consider modifying the PPE to be more child-friendly. Most dentists consider non-AGP procedures and silver diamine fluoride (SDF) to be practical ways to practice safer dentistry, yet more training and information is needed for dentists treating children to provide a more confident safe environment for both dentists and their patients. How to cite this article Alsaleh MM, Sabbarini JM, Al-Batayneh OB, et al. Changes in Behavior Management and Treatment Modalities in Pediatric Dentistry during COVID-19 Pandemic. Int J Clin Pediatr Dent 2020;13(S-1):S125–S131.
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Affiliation(s)
- Majd M Alsaleh
- Department of Developmental Sciences, Marquette University School of Dentistry, Milwaukee, Wisconsin, USA
| | | | - Ola B Al-Batayneh
- Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S Khader
- Department of Public Health and Epidemiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Machiulskiene V, Campus G, Carvalho JC, Dige I, Ekstrand KR, Jablonski-Momeni A, Maltz M, Manton DJ, Martignon S, Martinez-Mier EA, Pitts NB, Schulte AG, Splieth CH, Tenuta LMA, Ferreira Zandona A, Nyvad B. Terminology of Dental Caries and Dental Caries Management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR. Caries Res 2019; 54:7-14. [PMID: 31590168 DOI: 10.1159/000503309] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022] Open
Abstract
A 2-day workshop of ORCA and the IADR Cariology Research Group was organized to discuss and reach consensus on definitions of the most commonly used terms in cariology. The aims were to identify and to select the most commonly used terms of dental caries and dental caries management and to define them based on current concepts. Terms related to definition, diagnosis, risk assessment, and monitoring of dental caries were included. The Delphi process was used to establish terms to be considered using the nominal group method favored by consensus. Of 222 terms originally suggested by six cariologists from different countries, a total of 59 terms were reviewed after removing duplicates and unnecessary words. Sixteen experts in cariology took part in the process of reaching consensus about the definitions of the selected caries terms. Decisions were made following thorough "round table" discussions of each term and confirmed by secret electronic voting. Full agreement (100%) was reached on 17 terms, while the definitions of 6 terms were below the agreed 80% threshold of consensus. The suggested terminology is recommended for use in research, in public health, as well as in clinical practice.
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Affiliation(s)
- Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania,
| | - Guglielmo Campus
- Klinik für Zahnerhaltung, Präventiv- und Kinderzahnmedizin Zahnmedizinische Kliniken (ZMK), University of Bern, Bern, Switzerland.,Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | | | - Irene Dige
- Section of Dental Pathology, Operative Dentistry and Endodontics, Department of Dentistry and Oral Health, University of Aarhus, Aarhus, Denmark
| | - Kim Rud Ekstrand
- Section of Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Marisa Maltz
- Department of Preventive and Social Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - David J Manton
- Growth and Development Section, Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - Stefania Martignon
- Dental Innovation and Translation Hub, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom.,UNICA - Caries Research Unit, Research Vice-rectory, Universidad El Bosque, Bogotá, Colombia
| | - E Angeles Martinez-Mier
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Nigel B Pitts
- Dental Innovation and Translation Hub, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
| | - Andreas G Schulte
- Department of Special Care Dentistry, Dental School, Witten/Herdecke University, Witten, Germany
| | - Christian H Splieth
- Section of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Livia Maria Andaló Tenuta
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrea Ferreira Zandona
- Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Bente Nyvad
- Section of Dental Pathology, Operative Dentistry and Endodontics, Department of Dentistry and Oral Health, University of Aarhus, Aarhus, Denmark
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Abstract
The objective of this article is to review evidence-based strategies available for the nonrestorative management of caries lesions, both cavitated and noncavitated. The goal is to help clinicians make appropriate decisions regarding nonrestorative management of caries lesions. In addition, in the decision-making process, clinicians must consider thresholds for restorative and nonrestorative care and strategies for nonrestorative management that are supported by best available evidence. It is important that this information be considered taking into account a provider's clinical expertise and a patient's treatment needs and preferences, in order to maintain health and preserve tooth structure.
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Affiliation(s)
- Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, 1011 North University, Room 2393, Ann Arbor, MI 48109, USA.
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Schwendicke F, Splieth C, Breschi L, Banerjee A, Fontana M, Paris S, Burrow MF, Crombie F, Page LF, Gatón-Hernández P, Giacaman R, Gugnani N, Hickel R, Jordan RA, Leal S, Lo E, Tassery H, Thomson WM, Manton DJ. When to intervene in the caries process? An expert Delphi consensus statement. Clin Oral Investig 2019; 23:3691-3703. [PMID: 31444695 DOI: 10.1007/s00784-019-03058-w] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/08/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions. METHODS Non-systematic literature synthesis, expert Delphi consensus process and expert panel conference. RESULTS Carious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds. CONCLUSIONS Comprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions. CLINICAL RELEVANCE Carious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
| | - Christian Splieth
- Preventive & Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna-Alma Mater Studiorum, Bologna, Italy
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's Health Partners, King's College London, London, UK
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Michael F Burrow
- Faculty of Dentistry, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Felicity Crombie
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | - Lyndie Foster Page
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Patricia Gatón-Hernández
- Department of Dentistry, University of Barcelona, Barcelona, Spain
- Faculdade de Odontologia de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rodrigo Giacaman
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile
| | - Neeraj Gugnani
- Department of Pediatric and Preventive Dentistry, DAV (C) Dental College, Yamunanagar, Haryana, India
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | | | - Soraya Leal
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasilia, Brazil
| | - Edward Lo
- Faculty of Dentistry, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Hervé Tassery
- Faculty of Dentistry, AMU University, Marseille, France
| | - William Murray Thomson
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - David J Manton
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
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Abstract
This article reviews dental caries management in children. The goal is to help clinicians recognize common patterns of dental caries in primary dentition and make appropriate decisions regarding management of carious lesions in children, taking into account the best available evidence, clinician expertise and experience, and a child's treatment needs, age, medical history, and ability to tolerate treatment as well as caregiver preferences. It also is important to protect the developing psyche of the child, stabilize or restore the dentition to health and natural esthetics when possible, and maintain space for the eruption of the future permanent dentition.
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Affiliation(s)
- Martha Ann Keels
- Department of Pediatric Dentistry, University of North Carolina School of Dentistry, 2711 North Duke Street, Durham, NC 27704, USA; Department of Pediatrics, Duke University, Durham, NC, USA.
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A randomized clinical trial comparing Hall vs conventional technique in placing preformed metal crowns from Sudan. PLoS One 2019; 14:e0217740. [PMID: 31158253 PMCID: PMC6546341 DOI: 10.1371/journal.pone.0217740] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 05/13/2019] [Indexed: 11/26/2022] Open
Abstract
Despite the high success rates of preformed metal crowns (PMCs) in children no randomized clinical trials compare methods of placement and none describe its use in Africa. Our aim was to compare survival and cost-effectiveness of PMCs placed by conventional techniques (CT) and biological Hall techniques (HT) using a prospective randomized control trial in a general dental practice from Khartoum. One hundred and nine and 103 PMCs were placed in randomly selected children (5-8years) with 1–2 carious primary molars using HT and CT respectively and followed for 2 years. Socioeconomic status, periodontal health, occlusion, anxiety, and procedure time were compared using student t-test. Kaplan–Meier survival rates and incremental cost effectiveness ratio (ICER) were compared between CT and HT. CT and HT groups were similar for age, gender, socio-economic status. Survival rates were high (over 90%) for both study arms and not statistically different (p>0.05). Anxiety scores were significantly higher in CT arm after 12 months compared to HT (p<0.001). Clinically, gingival and plaque indices were similar between groups (p>0.05) but occlusions were raised in nearly all subjects in the HT arm (p<0.05). Periodontal health improved, and occlusions adjusted over time in both arms. There were 3 (2.7%) and 6 (5.8%) minor failures, 7 (6.4%) and 6 (5.8%) major failures in HT and CT arms respectively. Mean procedure time was lower in HT (9.1 min) than CT (33.9 min); p<0.001. Mean PMC cost was US$2.45 and US$7.81 for HT and CT respectively. The ICER was US$136.56 more for each PMC placed by CT per life year. We show that PMCs have high survival outcomes in disadvantaged populations similar to results from developed countries. As HT can be carried out by less experienced dental operators and therapists, this biological approach provides a promising cost-effective option to manage caries in developing countries with limited resources. Trial registration: The trial is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT03640013
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