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Kielbassa AM, Summer S, Frank W, Lynch E, Batzer JS. Equivalence study of the resin-dentine interface of internal tunnel restorations when using an enamel infiltrant resin with ethanol-wet dentine bonding. Sci Rep 2024; 14:12444. [PMID: 38816512 PMCID: PMC11139992 DOI: 10.1038/s41598-024-63289-0] [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: 02/18/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024] Open
Abstract
This preregistered ex vivo investigation examined the dentinal hybrid layer formation of a resinous infiltrant (Icon), with reference to both thickness (HLT) and homogeneity when combined with modified tunnel preparation (occlusal cavity only) and internal/external caries infiltration. The adhesives Syntac and Scotchbond MP were used as controls (Groups 1 and 3) or in combination with Icon (Groups 2 and 4). A split-tooth design using healthy third molars from 20 donors resulted in 20 prepared dentine cavities per experimental group. The cavity surfaces (n = 80) were etched (37% H3PO4), rinsed, and air-dried. Rewetting with ethanol was followed by application of the respective primers. After labeling with fluorescent dyes, either Syntac Adhesive/Heliobond or Scotchbond MP Adhesive was used alone or supplemented with Icon. HLT, as evaluated by scanning electron microscopy, did not significantly differ (P > 0.05), and confocal laser scanning microscopy revealed homogeneously mixed/polymerized resin-dentine interdiffusion zones in all groups. Icon can be successfully integrated into an ethanol-wet dentine bonding strategy, and will result in compact and homogeneous hybrid layers of comparable thickness considered equivalent to the non-Icon controls, thus allowing for preservation of the tooth's marginal ridge and interdental space in the case of internal/external infiltration of proximal caries.
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Affiliation(s)
- Andrej M Kielbassa
- Centre for Operative Dentistry, Periodontology, and Endodontology, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University (DPU), Steiner Landstraße 124, 3500, Krems an der Donau, Austria.
| | - Sabrina Summer
- Department for Biomedical Research, Centre of Experimental Medicine, University for Continuing Education Krems, Krems an der Donau, Austria
| | - Wilhelm Frank
- Centre for Health Sciences, Department of Medicine, Faculty of Medicine and Dentistry, Danube Private University (DPU), Krems an der Donau, Austria
| | - Edward Lynch
- Leicester School of Pharmacy, De Montfort University, Leicester, UK
| | - Julia-Susanne Batzer
- Centre for Operative Dentistry, Periodontology, and Endodontology, Department of Dentistry, Faculty of Medicine and Dentistry, Danube Private University (DPU), Steiner Landstraße 124, 3500, Krems an der Donau, Austria
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Godenzi D, Bommer C, Heinzel-Gutenbrunner M, Horst Keeper J, Peters K. Remineralizing potential of the biomimetic P 11-4 self-assembling peptide on noncavitated caries lesions: A retrospective cohort study evaluating semistandardized before-and-after radiographs. J Am Dent Assoc 2023; 154:885-896.e9. [PMID: 37642611 DOI: 10.1016/j.adaj.2023.07.009] [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: 04/11/2023] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Self-assembling peptide (SAP) P11-4 was introduced to treat initial caries lesions by means of guiding hydroxyapatite regeneration within the lesion. The objective of this study was to assess its effectiveness in a practical clinical setting. METHODS Caries lesions in permanent teeth treated with monomeric and polymeric SAP P11-4 from May 2015 through October 2020 were retrospectively analyzed at lesion and child levels by means of bite-wing radiography for changes in stage and cavitation and restoration. RESULTS Two hundred and nineteen children aged 10 through 19 years with a total of 405 proximal lesions in posterior teeth were followed from 0.4 through 5.5 years (median, 7 months; interquartile range, 6-19 months). Regression occurred in 37% of stage RA1 (radiolucency in the outer one-half of enamel) (95% CI, 31% to 44%), 38% of stage RA2 (radiolucency in the inner one-half of enamel plus or minus the enamel-dentin junction) (95% CI, 30% to 45%), and 40% of stage RA3 (radiolucency limited to the outer one-third of dentin) (95% CI, 16% to 68%) lesions. The proportion of lesions with no cavitation was 0.96 (95% CI, 0.94 to 0.98) after 1 year and 0.91 (95% CI, 0.88 to 0.95) after 2 years. CONCLUSIONS Real-world clinical data indicate that SAP P11-4 can lead to recovery and a healthier tooth stage. PRACTICAL IMPLICATIONS SAP P11-4 is a safe treatment for initial caries lesions in permanent teeth that remineralizes in the deepest zone of the lesion and can be introduced easily into routine dental practice.
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Nicholas LS, Yew Christopher QE, Fei Frank LK. Conservative esthetic management of brown enamel fluorosis using combination therapy: A clinical report. J Conserv Dent 2023; 26:349-354. [PMID: 37398859 PMCID: PMC10309132 DOI: 10.4103/jcd.jcd_632_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/22/2022] [Accepted: 03/25/2022] [Indexed: 12/12/2022] Open
Abstract
Dental fluorosis is caused by ingestion of excessive fluoride during tooth development resulting in hypomineralization of the enamel and can present as white or brown intrinsic lesions. This case report describes a combination of minimally invasive techniques: microabrasion, bleaching, and resin infiltration to address brown enamel fluorosis present on the maxillary anterior teeth of a young patient. Before resin infiltration, air microabrasion was targeted at subsurface lesions located on the maxillary central and lateral incisors, and chairside bleaching was done with 37% hydrogen peroxide (Opalescence). After which, hypoplastic lesions on the buccal surfaces were etched before being treated with two sessions of resin infiltration (ICON and DMG). Following treatment, satisfactory esthetic outcomes were achieved. Accurate diagnosis, depth of lesions, and understanding the effectiveness and limitations of each technique are essential to select the appropriate type of treatment to obtain the best esthetic outcome. In conclusion, the conservative management of varying severity of dental fluorosis may require the appropriate use of combination treatment modalities, such as microabrasion, bleaching and resin infiltration, when clinically indicated, to address the treatment needs and achieve a desired outcome.
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Affiliation(s)
| | - Quek Eng Yew Christopher
- Senior Lecturer, Department of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore
| | - Lee Kong Fei Frank
- Senior Lecturer, Department of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore
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Cebula M, Göstemeyer G, Krois J, Pitchika V, Paris S, Schwendicke F, Effenberger S. Resin Infiltration of Non-Cavitated Proximal Caries Lesions in Primary and Permanent Teeth: A Systematic Review and Scenario Analysis of Randomized Controlled Trials. J Clin Med 2023; 12:jcm12020727. [PMID: 36675656 PMCID: PMC9864315 DOI: 10.3390/jcm12020727] [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: 12/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
The present study aimed to meta-analyze and evaluate the certainty of evidence for resin infiltration of proximal carious lesions in primary and permanent teeth. While resin infiltration has been shown efficacious for caries management, the certainty of evidence remains unclear. The protocol was registered with PROSPERO (CRD42018080895), and PRISMA guidelines have been followed. The databases PubMed, Embase, and Cochrane CENTRAL were systematically screened, complemented by hand searches and cross-referencing. Eleven relevant articles were identified and included, i.e., randomized controlled trials (RCTs) comparing the progression of resin infiltrated proximal caries lesions (combined with non-invasive measures) in primary or permanent teeth with non-invasive measures. Random-effects meta-analyses and trial sequential analyses (TSA) were performed for per-protocol (PP), intention-to-treat (ITT), and best/worst case (BC/WC) scenarios. Six included trials assessed lesions in permanent teeth and five trails assessed lesions in primary teeth. The trials had a high or unclear risk of bias. Risk of caries progression was significantly reduced for infiltrated lesions in the PP, ITT, and BC scenarios in both permanent teeth and primary teeth, but not in the WC scenario. According to the TSA, firm evidence was reached for all of the scenarios except the WC. In conclusion, there is firm evidence for resin infiltration arresting proximal caries lesions in permanent and primary teeth.
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Affiliation(s)
- Marcus Cebula
- Clinical Research Department, DMG Dental Material Gesellschaft mbH, Elbgaustraße 248, 22547 Hamburg, Germany
| | - Gerd Göstemeyer
- Department of Restorative, Preventive and Pediatric Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Vinay Pitchika
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Sebastian Paris
- Department of Restorative, Preventive and Pediatric Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Susanne Effenberger
- Clinical Research Department, DMG Dental Material Gesellschaft mbH, Elbgaustraße 248, 22547 Hamburg, Germany
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
- Correspondence:
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Treeratweerapong Y, Nakornchai S, Jirarattanasopha V. Effectiveness of applying proximal enamel caries with fluoride-releasing sealant and fluoride varnish on caries progression in permanent teeth: A 12-month split-mouth randomized clinical trial. Int J Paediatr Dent 2023; 33:30-39. [PMID: 35579583 DOI: 10.1111/ipd.13011] [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: 09/04/2021] [Revised: 05/07/2022] [Accepted: 05/15/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies report on managing initial proximal caries with sealants, and no reports focus on fluoride-releasing sealants. AIM To compare the effectiveness between applications of a fluoride-releasing sealant and fluoride varnish on proximal enamel caries to control caries progression in permanent teeth. DESIGN This was a split-mouth randomized controlled trial in forty-four 11- to 16-year-old children with radiographic caries in at least one contralateral pair of teeth with proximal enamel caries. The lesions were evaluated using DIAGNOdent and were also assessed visually after tooth separation. The lesions in each subject were randomly sealed with a fluoride-releasing sealant (Helioseal® F) or applied with fluoride varnish (Duraphat®). The fluoride varnish-treated lesion was reapplied at 3 and 6 months. Clinical examination, bitewing radiograph evaluation, and DIAGNOdent assessment were performed at 6 and 12 months. The caries progression outcome variables were regression, no change, and progression. The data were analyzed with the McNemar-Bowker test. RESULTS Radiographic examination and DIAGNOdent assessment demonstrated no significant differences in the percentages of regression, no change, or progression at the 12-month follow-up (p > .05). CONCLUSION Applications of a fluoride-releasing sealant and of fluoride varnish three times resulted in a nonsignificant difference in caries progression of initial proximal caries at the 12-month follow-up.
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Affiliation(s)
| | - Siriruk Nakornchai
- Department of Pediatric Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Mazzitelli C, Josic U, Maravic T, Mancuso E, Goracci C, Cadenaro M, Mazzoni A, Breschi L. An Insight into Enamel Resin Infiltrants with Experimental Compositions. Polymers (Basel) 2022; 14:polym14245553. [PMID: 36559920 PMCID: PMC9782164 DOI: 10.3390/polym14245553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Resin infiltration is a conservative treatment of initial enamel carious lesions. Only one infiltrant material is available on the market (Icon, DMG), and research is now investigating new chemical compositions so as to further exploit the benefits of the resin infiltration technique. A literature search of the articles testing the effects of different formulations on mechanical properties, resin penetration ability, remineralizing, and antibacterial activities was conducted. Of 238 articles, 29 resulted in being eligible for the literature review. The formulations investigated were all different and consisted in the inclusion of hydrophobic monomers (i.e., BisEMA, UDMA), solvents (ethanol, HEMA), alternative etchants (PAM) or molecules with antibacterial or bioactivity features (i.e., AgNP, YbF3, MTZ, chitosan, DMAMM, HAp, MC-IL, NACP, PUA, CHX) and microfilled resins. Information on the long-term performances of the tested experimental materials were scarce. The combination of TEGDMA with hydrophobic monomers and the inclusion of a solvent alternative to ethanol reinforced mechanical properties of the materials. Hybrid-glass materials demonstrated an enhanced remineralization capacity. Techniques such as tunnelization increased the penetration depth and preserved the recourse to less-conservative treatments. Combining the min-invasive infiltrant approach with remineralizing and bacteriostatic properties would be beneficial for therapeutic and economical aspects, according to the principles of minimally invasive dentistry.
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Affiliation(s)
- Claudia Mazzitelli
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Uros Josic
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Tatjana Maravic
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
- Correspondence:
| | - Edoardo Mancuso
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Cecilia Goracci
- Dipartimento di Biotecnologie Mediche, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100 Siena, Italy
| | - Milena Cadenaro
- Department of Medical Sciences, University of Trieste, Strada di Fiume 447, 34125 Trieste, Italy
- Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, Via dell’Istria 65/1, 34137 Trieste, Italy
| | - Annalisa Mazzoni
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
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Emilson CG, Basili C, Corvalan GC, Moran MPH, Quiroz MD, Torres C, Gomez SS. A 5-year clinical follow-up of the efficacy of proximal sealing in high caries risk children. J Dent 2022; 128:104382. [PMID: 36574596 DOI: 10.1016/j.jdent.2022.104382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate, after 5 years, the efficacy of proximal microinvasive sealing of permanent teeth on the risk for caries lesion development. METHODS Children aged 8 to 10 y at baseline, at high caries risk, were studied. In the preventive (P) group the children had caries lesions on the distal surface of primary second molars (05d) but sound mesial surfaces of the approximating permanent first molars (6m). In the therapeutic (T) group the children had initial caries lesions on 6m that abutted lesions on 05d. Each child in the two groups had one 05d/6m pair. Using a split-mouth design, one 6m surface in each pair was randomly assigned to receive sealing while the other pair served as an unsealed control. RESULTS Of the 61 children at baseline 42 could be blindly examined clinically and radiographically both at baseline and after 5 years. In the P group, 8 of 28 (28.6%) sealed and 15 of 28 (53.6 %) unsealed sound 6m surfaces had developed caries lesions (p = 0.04). In the T group, the progression of the carious lesions on 6m was observed in 4 of 14 sealed (28.6%) and 8 of 14 (57.1%) unsealed caries control surfaces (p = 0.29). Pooling the data from the two groups, the difference between sealed and non-sealed surfaces was significant (p = 0.013). CONCLUSION Both preventive and therapeutic sealant to 6m adjacent to a lesion on 05d has effectiveness in caries reduction in high caries risk children CLINICAL SIGNIFICANCE: The beneficial effect of sealing is observed for at least 5 years after a single sealant treatment.
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Affiliation(s)
- Claes-Göran Emilson
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Cristian Basili
- Department of Preventive Dentistry, Facultad de Odontología Universidad de Valparaíso, Valparaíso, Chile
| | - Gonzalo C Corvalan
- Department of Preventive Dentistry, Facultad de Odontología Universidad de Valparaíso, Valparaíso, Chile
| | - Maria Paz H Moran
- Department of Preventive Dentistry, Facultad de Odontología Universidad de Valparaíso, Valparaíso, Chile
| | - Mariela D Quiroz
- Department of Preventive Dentistry, Facultad de Odontología Universidad de Valparaíso, Valparaíso, Chile
| | - Carlos Torres
- Department of Preventive Dentistry, Facultad de Odontología Universidad de Valparaíso, Valparaíso, Chile
| | - Santiago S Gomez
- Department of Preventive Dentistry, Facultad de Odontología Universidad de Valparaíso, Valparaíso, Chile
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Paiva MF, Rizk M, Pessan JP, Kreutz M, Rohland B, Biehl R, Stadler A, Stellbrink J, Wiegand A. Material properties and bioactivity of a resin infiltrant functionalized with polyhedral oligomeric silsesquioxanes. Dent Mater 2022; 38:1900-1909. [DOI: 10.1016/j.dental.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/26/2022] [Accepted: 09/25/2022] [Indexed: 11/28/2022]
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Kotsanos N, Wong F. Restoration of Carious Hard Dental Tissues. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Al-Saeed EJ, AlMarhoon ZW, Al-Eid ZAA, AlAhmari TA, AlJamed SH, AlSarhan R, AlShehri A, Al-Debasi YT, Badaoud OM, AlHussain BS. Properties, Success, and Applications of Resin Infiltration for Minimal Invasive Restoration: A Scoping Review. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/nabhjpaqo7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Dhamija M, Tyagi R, Kalra N, Khatri A. Efficacy of Resin Infiltration and Fluoride Casein Phosphopeptide Amorphous Calcium Phosphate Varnish on Non-cavitated Active White Spot Lesions in Children: A Randomized Clinical Trial. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2022. [DOI: 10.1590/pboci.2022.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Rish Tyagi
- University College of Medical Sciences, India
| | | | - Amit Khatri
- University College of Medical Sciences, India
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12
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A retrospective clinical study on the resin infiltration of proximal caries lesions: the operator's effect. Eur Arch Paediatr Dent 2021; 22:879-885. [PMID: 34570361 PMCID: PMC8526425 DOI: 10.1007/s40368-021-00653-y] [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: 12/11/2020] [Accepted: 07/13/2021] [Indexed: 12/01/2022]
Abstract
Purpose This retrospective university-based study investigated the effect of operators’ training and previous experience on the success of resin infiltration (RI) in arresting proximal non-cavitated caries lesions in primary and permanent teeth. Methods Information was collected regarding RI of proximal non-cavitated caries lesions in primary and permanent teeth with a follow-up period up to 32 months. Factors investigated were: operators’ clinical experience and training, patient’s age, tooth, arch, mouth-side, surface treated, tooth separation, and baseline lesion depth. Kaplan–Meier survival and Cox regression analysis with shared frailty were used (α = 5%). Results A total of 130 proximal surfaces treated on 115 teeth of 43 children (11 ± 4.4 years) were evaluated. Survival of RI was 46% up to 32 months. Lesions treated by non-trained dentists were more likely-to-present progression than those performed by non-trained dental students under supervision (HR 2.41, 95% CI: 1.00–5.80); conversely, no difference was found between non-trained dental students under supervision and trained dentists (HR 0.52, 95% CI: 0.16–1.70). Additionally, dentin lesions were 59% more-likely-to-present progression than enamel lesions (HR 0.41, 95% CI: 0.17–0.99). Conclusion The operator’s experience and training could influence the success of RI on proximal non-cavitated caries lesions and it should be taken into consideration when choosing this treatment modality.
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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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14
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Wenzel A. Radiographic modalities for diagnosis of caries in a historical perspective: from film to machine-intelligence supported systems. Dentomaxillofac Radiol 2021; 50:20210010. [PMID: 33661697 PMCID: PMC8231685 DOI: 10.1259/dmfr.20210010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 01/17/2023] Open
Abstract
Radiographic imaging for the diagnosis of caries lesions has been a supplement to clinical examination for approximately a century. Various methods, and particularly X-ray receptors, have been developed over the years, and computer systems have focused on aiding the dentist in the detection of lesions and in estimating lesion depth. The present historical review has sampled accuracy ex vivo studies and clinical studies on radiographic caries diagnosis that have compared two or more receptors for capturing the image. The epochs of film radiography, xeroradiography, digital intraoral radiography, panoramic radiography and other extraoral methods, TACT analysis, cone-beam CT and artificial intelligence systems aiding in decision-making are reviewed. The author of this review (43 years in academia) has been involved in caries research and contributed to the literature in all the mentioned epochs.
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Affiliation(s)
- Ann Wenzel
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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15
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Proximal caries infiltration - Pragmatic RCT with 4 years of follow-up. J Dent 2021; 111:103733. [PMID: 34174349 DOI: 10.1016/j.jdent.2021.103733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Efficacy of proximal caries infiltration to arrest lesion progression has been shown in university settings, but only once in a practice-based pragmatic design with a follow-up of 18 months. The aim of this randomized split-mouth placebo-controlled study was to follow-up this cohort for 3 years and those with high caries risk for 4 years. METHODS Originally, in 87 children and young adults pairs of 238 proximal caries lesions, radiographically extending into inner half of enamel (E2) or outer third of dentin (D1), were randomly allocated to two groups: infiltration (Icon; DMG) or mock (control) treatment by five dentists in four private practices. All subjects received risk-related instructions for diet, flossing and fluoridation. The primary outcome was radiographic lesion progression (pairwise comparison) evaluated by two evaluators independently being blinded to treatment allocation. RESULTS After 36 months [mean (SD): 1152 (166) days] 165 lesion pairs in 64 patients as well as after 48 months [mean (SD): 1496 (121) days] 71 lesion pairs in 20 high caries risk patients could be re-evaluated clinically as well as radiographically using individualized bitewing holders as at baseline. No adverse events could be observed. After 36 months, progression was recorded in 23/165 test (14%) and 64/165 control lesions (39%) [McNemar/Obuchowski test; p<0.001; relative risk reduction (CI95%): 64 (45-77%)]. After 48 months lesion progression was recorded in 13/71 test (18%) and 34/71 control lesions (48%) [p = 0.003; relative risk reduction (CI95%): 62 (34-78%)] of high caries risk patients. CONCLUSIONS It can be concluded that also in a practice-setting proximal caries infiltration is more efficacious in reducing lesion progression compared with individualized non-invasive measures alone over a period of four years.
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16
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Pozos-Guillén A, Molina G, Soviero V, Arthur RA, Chavarria-Bolaños D, Acevedo AM. Management of dental caries lesions in Latin American and Caribbean countries. Braz Oral Res 2021; 35:e055. [PMID: 34076079 DOI: 10.1590/1807-3107bor-2021.vol35.0055] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022] Open
Abstract
Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.
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Affiliation(s)
- Amaury Pozos-Guillén
- Universidad Autónoma de San Luis Potosí, Faculty of Dentistry, Basic Sciences Laboratory, San Luis Potosí, México
| | - Gustavo Molina
- Universidad Nacional de Córdoba, The Dental Faculty, Department of Dental Materials, Córdoba, Argentina
| | - Vera Soviero
- Universidade Estadual do Rio de Janeiro - UERJ, School of Dentistry, Department of Preventive and Community Dentistry, Rio de Janeiro, RJ, Brazil.,Centro Universitário Arthur Sá Earp Neto - Unifase, School of Dentistry, Petrópolis, RJ, Brazil
| | - Rodrigo Alex Arthur
- Universidade Federal do Rio Grande do Sul - UFRGS, Dental School, Department of Preventive and Community Dentistry, Porto Alegre, RS, Brazil
| | - Daniel Chavarria-Bolaños
- Universidad de Costa Rica, Faculty of Dentistry, Department of Diagnostic and Surgical Sciences, San José, Costa Rica
| | - Ana María Acevedo
- Universidad Central de Venezuela, Faculty of Dentistry, Institute of Dental Research "Raul Vincentelli", Caracas, Venezuela
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17
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Chen Y, Chen D, Lin H. Infiltration and sealing for managing non-cavitated proximal lesions: a systematic review and meta-analysis. BMC Oral Health 2021; 21:13. [PMID: 33413327 PMCID: PMC7791990 DOI: 10.1186/s12903-020-01364-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels. Methods Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings. Results In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs. non-invasive: OR = 0.21, 95% CI 0.15–0.30; sealing vs. placebo: OR = 0.27, 95% CI 0.18–0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI 0.20–0.45; permanent dentition: OR = 0.20, 95% CI 0.14–0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI 0.14–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.17, 95% CI 0.10–0.29; and high risk: OR = 0.14, 95% CI 0.07–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), infiltration was superior (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.20, 95% CI 0.10–0.39; and high risk: OR = 0.14, 95% CI 0.05–0.37). Conclusion Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.
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Affiliation(s)
- Yuanyuan Chen
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Key Laboratory for Dental Disease Prevention and Control, Sun Yat-Sen University, Guangzhou, China
| | - Dongru Chen
- Department of Orthodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Key Laboratory for Dental Disease Prevention and Control, Sun Yat-Sen University, Guangzhou, China
| | - Huancai Lin
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China. .,Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China. .,Guangdong Key Laboratory for Dental Disease Prevention and Control, Sun Yat-Sen University, Guangzhou, China.
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18
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Tiuraniemi S, Yli-Mannila J, Havela P, Käkilehto T, Vähänikkilä H, Laitala ML, Anttonen V. Success of resin infiltration treatment on interproximal tooth surfaces in young adults-A practice-based follow-up study. Clin Exp Dent Res 2020; 7:189-195. [PMID: 33242226 PMCID: PMC8019756 DOI: 10.1002/cre2.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives Arresting active initial caries lesions is part of the modern caries controlling system. Resin infiltration (RI) system has been found a promising method in arresting interproximal initial lesions. The aim was to investigate whether RI arrests progression of active caries lesions. Materials and methods Participants (n = 20) of the retrospective study were patients in the Dental Teaching Unit, City of Oulu, Finland, mean age 26 years (SD5.2). Indication for RI was radiographically diagnosed progressing (ICDAS 1–3) interproximal lesions (n = 54). RI treatments were performed in 2015–2017. Controls were initial lesions in the same bitewing radiographs without RI or other treatment (n = 24). For analyzes teeth were categorized as lower and upper premolars and molars. The change in lesions during the follow‐up period was recorded surface wise as follows: deterioration / improvement from ICDAS score 3/improvement from ICDAS score 2/improvement per se/at follow‐up, lesion was less diffuse/no change. The changes in each tooth surface were analyzed between RI intervention and control teeth by using Chi‐square test. Proportions of successful and failed surfaces were given. Results The mean length of follow‐up period was 17.4 m (SD7.2). Arresting of caries lesions (ICDAS scores 2 and 3) was distinctly better in RI group (63.0%) compared with the controls (29.1%). The situation progressed among 29.2% of the controls whereas the respective proportion among the intervention group was 14.8%. Progression of lesions was more distinct in all tooth groups in the control group. Outcome was successful despite the lesion depth. Conclusions Resin infiltration seems effective in arresting progression of initial caries lesions with monitoring period of 1.5 years.
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Affiliation(s)
- Susanna Tiuraniemi
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Jenny Yli-Mannila
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Päivi Havela
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Dental Teaching Unit, City of Oulu, Finland
| | | | - Hannu Vähänikkilä
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Marja-Liisa Laitala
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Vuokko Anttonen
- Department of Cariology, Endodontology and Paediatric Dentistry, Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,MRC, Oulu University Hospital and University of Oulu, Oulu, Finland
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19
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Lindquist B, Emilson CG. Sealing Proximal Non- and Micro-Cavitated Carious Lesions Using a One-Session Separator Technique: A 2-Year Randomised Clinical Study. Caries Res 2020; 54:483-490. [PMID: 33147593 DOI: 10.1159/000509679] [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: 08/25/2019] [Accepted: 06/12/2020] [Indexed: 11/19/2022] Open
Abstract
The presence of initial caries accounts for the majority of approximal carious lesions in many countries. The aim of this clustered, split-mouth, randomised, controlled clinical trial was to use a metal separator to widen the approximal space in a one-visit session before sealing and to evaluate patient acceptance, together with the efficacy of the proximal sealing in arresting incipient carious lesions after 2 years. A total of 48 patients with a mean age of 41.9 years were selected. They had at least one pair of proximal initial carious lesions, including the distal surface of the canines to the mesial surface of the third molars (bite-wing score D1-D3). The patient's caries risk at baseline was analyzed using a Cariogram. All surfaces were examined for mutans streptococci (ms) counts. The separator technique made it possible to diagnose whether or not a microcavity was present. After 2 years, 212 surfaces in 45 subjects were examined using the same as baseline standardized digital follow-up radiographs. Two analyses were performed, one sensitive, where a progression or a regression was assessed if one of the examiners made one of those diagnoses, and one conservative, where unchanged. For both analyses, the sealed test surfaces showed a significantly higher regression (67 and 29%) compared to the control group (13 and 2%) p < 0.0001. It did not appear that the baseline variables, such as the caries risk, surface diagnoses, or ms counts, influenced the caries outcome. In the test group, there was no difference in caries progression if there was a microcavity or not. The separation treatment was well accepted by the patients. The method of separation for diagnosis and sealing treatment in a single session appears to be a clinically applicable method for the control of proximal carious lesions.
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Affiliation(s)
- Birgitta Lindquist
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - Claes-Göran Emilson
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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Wang L, Freitas MCCDA, Prakki A, Mosquim V, González AHM, Rios D, Honório HM. Experimental self-etching resin infiltrants on the treatment of simulated carious white spot lesions. J Mech Behav Biomed Mater 2020; 113:104146. [PMID: 33125956 DOI: 10.1016/j.jmbbm.2020.104146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the penetration depth (μm) of experimental resin infiltrants containing different percentages of triethylene glycol dimethacrylate (TEGDMA) and phosphoric acid 2-hydroxyethyl methacrylate ester (PAM) in artificial carious white spot lesions (WSL). METHODS WSL were produced in 65 bovine flat enamel specimens by pH cycling protocol, which were treated with either Icon (control) or experimental acidic infiltrants based on different percentages of TEGDMA and PAM monomers (acidic), and their association or not with previous acid-etching with phosphoric acid. Ten readings using Confocal Laser Scanning Microscopy were conducted on each specimen and the penetration depth was calculated from the surface until the deepest point with the fluorescent dye Rhodamine B (0.02 mg/mL). The pH and the viscosity of the experimental infiltrants were also tested. Data were statistically analyzed with two-way ANOVA and Tukey tests (α < 0.05). RESULTS The material factor and the interaction material*acid-etching were statistically significant. The lowest penetration depth was observed for the samples treated with the commercial infiltrant after etching with 15% hydrochloric acid. When specimens were pre-treated with PA, highest penetration was seen for specimens treated with 100% TEGDMA, which differed from all other groups. The lowest penetration was seen for those treated with 50:50 TEGDMA:PAM infiltrants. When specimens were not previously etched, highest penetration was seen for Icon, which differed only from those treated with 25% TEGDMA 75% PAM, where the lowest values were seen. The values of viscosity increased and the pH decreased with the addition of PAM in the infiltrant formulations. CONCLUSION the association between TEGDMA and PAM seems to allow similar infiltration depth reached by Icon infiltrant without acid etching the enamel surface.
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Affiliation(s)
- Linda Wang
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru-SP, Brazil.
| | - Maria Cristina Carvalho de Almendra Freitas
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru-SP, Brazil; DeVry FACID, DeVry Education Group, Teresina-PI, Brazil
| | - Anuradha Prakki
- Faculty of Dentistry, University of Toronto, Restorative Department, Toronto-ON, Canada
| | - Victor Mosquim
- Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru-SP, Brazil
| | | | - Daniela Rios
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru-SP, Brazil
| | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru-SP, Brazil
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21
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Al-Sane M, Ricketts DN, Mendes FM, Altarakemah Y, Deery C, Innes N, Rollings S. Reproducibility of subtraction radiography in monitoring changes in approximal carious lesions in children: An in vivo study. Int J Paediatr Dent 2020; 30:587-596. [PMID: 32181942 DOI: 10.1111/ipd.12638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/10/2020] [Accepted: 03/03/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Laboratory studies have shown that digital subtraction radiography (DSR) can be a more effective tool, than conventional radiography, in monitoring changes in carious lesions. The clinical performance of the technique, however, has not been sufficiently researched. AIM To compare the reproducibility of DSR to that of bitewing radiographs, in monitoring changes in approximal caries in the mixed dentition. A secondary aim was to determine whether assessment outcomes differed as a function of the method used. DESIGN Six assessors evaluated 310 lesions first on bitewings, then with DSR. The overall reproducibility was evaluated via intra-class correlation coefficient (ICC). Intra- and inter-rater reproducibility were assessed using weighted Kappa. Paired t test was used to assess differences in the reproducibility across methods. RESULTS The overall reproducibility for DSR was (ICC = 0.47, 95% CI = 0.31-0.56). Intra- and inter-rater reproducibility were 0.65 and 0.44, respectively. The overall reproducibility for bitewings was ICC = 0.45, 95% CI = 0.42-0.57. Intra- and Inter-rater reproducibility were 0.71 and 0.46, respectively. Differences in the reproducibility across methods were not statistically significant. Significantly more lesions were scored as progressed using DSR. CONCLUSIONS The reproducibility of DSR in monitoring changes in approximal caries is comparable to that of bitewings. Additionally, DSR detected higher proportion of progression than bitewing assessments.
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Affiliation(s)
- Mona Al-Sane
- Faculty of Dentistry, Department of Developmental and Preventive Sciences, Kuwait University, Kuwait City, Kuwait
| | - David N Ricketts
- Section of Operative Dentistry, Fixed Prosthodontics and Endodontology, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
| | - Fausto M Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Yacoub Altarakemah
- Faculty of Dentistry, Department of Restorative Sciences, Kuwait University, Kuwait City, Kuwait
| | - Christopher Deery
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Nicola Innes
- Department of Paediatric Dentistry, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
| | - Sam Rollings
- Aberdeen Dental Hospital and Institute of Dentistry, Department of Restorative Dentistry, Aberdeen, UK
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22
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Ricucci D, Siqueira JF. Bacteriologic status of non-cavitated proximal enamel caries lesions. A histologic and histobacteriologic study. J Dent 2020; 100:103422. [PMID: 32615236 DOI: 10.1016/j.jdent.2020.103422] [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] [Received: 03/27/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This histologic and histobacteriologic study evaluated non-cavitated interproximal white spot lesions in human teeth for the 1) presence and morphology of bacterial aggregations at the enamel-dentinal junction (EDJ), and 2) reactions in the subjacent pulp tissue. METHODS The material comprised 16 third molars diagnosed with early interproximal caries lesions obtained consecutively in a single clinical practice. Four third molars with clinically intact proximal surfaces served as controls. Caries activity was categorized as active or arrested. Teeth were prepared for histologic and histobacteriologic analyses. RESULTS Control teeth exhibited normal tissue conditions with no bacteria. Macroscopic discoloration of the superficial dentin occurred in 14/16 teeth with early caries lesions. Bacterial aggregations resembling biofilms were observed in 10/16 teeth (six with active and four with arrested lesions). Bacterial cells were observed superficially in some of the underlying dentinal tubules, while in a few cases a deeper penetration was evident. Pathologic changes of varying degrees were observed in the pulps of all 16 teeth, regardless of the caries activity (active or arrested). Pulp reactions varied from disruption of the odontoblast layer, with loss of odontoblasts, to formation of tertiary dentin. CONCLUSIONS Bacterial biofilms associated with white-spot caries lesions may traverse the enamel and reach the underlying dentin in both active and arrested lesions. In all teeth with early lesions, the pulps showed changes in response to the very superficial biofilm challenge. CLINICAL SIGNIFICANCE In non-cavitated, active or arrested, enamel caries lesions, bacteria traverse the enamel and may establish structured biofilms at the enamel-dentinal junction, causing early pulp changes. These new findings may stimulate clinicians to rethink the rationale for treatment methods that are based on the assumption that bacteria are absent in white-spot lesions.
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Affiliation(s)
| | - José F Siqueira
- Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil; Department of Endodontics, Faculty of Dentistry, Grande Rio University (UNIGRANRIO), Rio de Janeiro, RJ, Brazil
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23
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Splieth CH, Kanzow P, Wiegand A, Schmoeckel J, Jablonski-Momeni A. How to intervene in the caries process: proximal caries in adolescents and adults-a systematic review and meta-analysis. Clin Oral Investig 2020; 24:1623-1636. [PMID: 32306093 DOI: 10.1007/s00784-020-03201-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/07/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults". MATERIAL AND METHODS Separating between the management of initial and cavitated proximal caries lesions, Medline via PubMed was searched regarding non-operative/non-invasive, minimally/micro-invasive and restorative treatment. First priority was systematic reviews or randomized controlled trials (RCTs), otherwise cohort studies. After extraction of data, the potential risk of bias was estimated depending on the study type, and the emerging evidence for conclusions was graded. RESULTS Regarding non-invasive/non-operative care (NOC), no systematic reviews or RCTs were found. In cohort studies (n = 12) with a low level of evidence, NOC like biofilm management and fluoride was associated with a low proportion and slow speed of progression of initial proximal lesions. Minimally/micro-invasive (MI) treatments such as proximal sealants or resin infiltration (four systematic reviews/meta-analyses) were effective compared with a non-invasive/placebo control at a moderate level of evidence. Data on restorative treatment came with low evidence (5 systematic reviews, 13 RCTs); with the limitation of no direct comparative studies, sample size-weighted mean annual failure rates of class II restorations varied between 1.2 (bulk-fill composite) and 3.8% (ceramic). Based on one RCT, class II composite restorations may show a higher risk of failure compared with amalgam. CONCLUSIONS Proximal caries lesions can be managed successfully with non-operative, micro-invasive and restorative treatment according to lesion stage and caries activity. CLINICAL RELEVANCE Proximal caries treatment options like non-operative, micro-invasive and restorative care should be considered individually.
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Affiliation(s)
- C H Splieth
- Clinic for Preventive and Paediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
| | - P Kanzow
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - A Wiegand
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - J Schmoeckel
- Clinic for Preventive and Paediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - A Jablonski-Momeni
- Department of Orthodontics, Dental School, Philipps-University Marburg, Marburg, Germany
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24
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Paris S, Bitter K, Krois J, Meyer-Lueckel H. Seven-year-efficacy of proximal caries infiltration – Randomized clinical trial. J Dent 2020; 93:103277. [DOI: 10.1016/j.jdent.2020.103277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
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25
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Pihlstrom BL. Selections from the current literature. J Am Dent Assoc 2020. [DOI: 10.1016/j.adaj.2019.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dhillon SN, Deshpande AN, Macwan C, Patel KS, Shah YS, Jain AA. Comparative Evaluation of Microhardness and Enamel Solubility of Treated Surface Enamel with Resin Infiltrant, Fluoride Varnish, and Casein Phosphopeptide-amorphous Calcium Phosphate: An In Vitro Study. Int J Clin Pediatr Dent 2020; 13:S14-S25. [PMID: 34434009 PMCID: PMC8359880 DOI: 10.5005/jp-journals-10005-1833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective The aim and objective of this study was to do a comparative evaluation of microhardness and enamel solubility (ES) of the treated surface enamel with resin infiltrant, fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). Materials and methods An in vitro study was conducted on freshly extracted 85 sound permanent teeth of which 5 teeth were subjected to check for microhardness by the Vickers microhardness tester and the remaining teeth were exposed to demineralizing solution to create initial enamel lesions. These 80 teeth were assigned to four groups: group I—negative control (n = 20), group II—resin infiltrant (n = 20), group III—fluoride varnish (n = 20), and group IV—CPP-ACP (n = 20), and microhardness was checked after application. These teeth were exposed to caries attack three times a day for three consecutive days. The ES of these four groups was checked by calcium ion loss in the artificial cariogenic solution and whole saliva by an atomic absorption spectrophotometer. Results It was found that none of the experimental groups reached the microhardness values of sound intact teeth. At 3rd day, the values of microhardness were: group II = group III > group IV > group I. Maximum ES was found for group I (control) followed with group IV. Conclusion All agents used in study remineralized initial carious lesion. Fluoride varnish has the highest microhardness and showed least ES compared to other remineralizing agents. Clinical significance Fluoride varnish can be regarded as the choice of material to be used for the treatment of incipient carious lesions because of the low application frequency (once every 3–6 months), requires minimal patient compliance as it is a noninvasive procedure and less time consuming. How to cite this article Dhillon SN, Deshpande AN, Macwan C, et al. Comparative Evaluation of Microhardness and Enamel Solubility of Treated Surface Enamel with Resin Infiltrant, Fluoride Varnish, and Casein Phosphopeptide-amorphous Calcium Phosphate: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(S-1):S14–S25.
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Affiliation(s)
- Steffi N Dhillon
- Department of Pediatric and Preventive Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Anshula N Deshpande
- Department of Pediatric and Preventive Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Chirag Macwan
- Department of Pediatric and Preventive Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Kinjal S Patel
- Department of Pediatric and Preventive Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Yash S Shah
- Department of Pediatric and Preventive Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Aishwarya A Jain
- Department of Pediatric and Preventive Dentistry, KM Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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Arslan S, Kaplan MH. The Effect of Resin Infiltration on the Progression of Proximal Caries Lesions: A Randomized Clinical Trial. Med Princ Pract 2020; 29:238-243. [PMID: 31476757 PMCID: PMC7315193 DOI: 10.1159/000503053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this clinical trial was to assess the effect of resin infiltration on the progression of proximal caries lesions. SUBJECTS AND METHODS Forty-one patients, aged between 15 and 33 years, with 2 or more non-cavitated proximal caries lesions were included. In 41 of the adolescent and young adults, 45 pairs of proximal lesions with radiological extension into the inner and outer half of the enamel, or into the outer third of the dentin, were randomly allocated to the test groups (resin infiltration application + fluoridated toothpaste and flossing use) or to the control group (fluoridated toothpaste and flossing use). Standardized geometrically aligned digital bitewing radiographs were obtained using individual biting holders. The radiographic progression of the lesions was assessed after 1 year by digital-subtraction radiography. The McNemar test was used for statistical analysis. RESULTS In the test group 1/45 of the lesions (2.2%) and in the control group 9/45 of the lesions (20%) showed progression. The caries progression rate of the control group was significantly higher than that of the test group (p < 0.05). CONCLUSIONS Resin infiltration of proximal caries lesions is effective in reducing progression of the lesion.
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Affiliation(s)
- Soley Arslan
- Department of Restorative Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkey,
| | - Melek Hilal Kaplan
- Department of Restorative Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Ferreira JD, Flor-Ribeiro MD, Marchi GM, Pazinatto FB. The Use of Resinous Infiltrants for the Management of Incipient Carious Lesions: a Literature Review. JOURNAL OF HEALTH SCIENCES 2019. [DOI: 10.17921/2447-8938.2019v21n4p358-64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
AbstractThe objective of this work was to analyze scientific evidence from a literature review pertaining to the effectiveness of resinous infiltrants for minimally invasive treatment of incipient carious lesions. Studies published between 2002 and 2019 were queried from the following databases: Capes, PubMed, Medline, BBO, Lilacs and SciELO. The search keywords included "Dental Caries", "Tooth Remineralization", "Dental Leakage". Most of the studies found resin-infiltrating treatment to be a viable option for the minimally invasive treatment of incipient carious lesions; this treatment was able to fulfill the primary expected effects: inhibition of carious progression and the lesions esthetic improvement. However, some issues need to be clarified to improve the safety of this treatment because it can be recommended in clinical practice. In conclusion, the use of resinous infiltrants has been reported as promising for the treatment of incipient carious lesions. However, there is a need for long-term studies to confirm the effectiveness of this treatment to determine its applicability for clinical use. Keywords: Dental Caries. Dental Leakage. Tooth Remineralization. ResumoO objetivo desse trabalho foi analisar evidências científicas, por meio de uma revisão de literatura, sobre a eficácia do uso de infiltrantes resinosos para o tratamento minimamente invasivo de lesões cariosas incipientes. A seleção do material literário utilizado foi realizada por pesquisa sobre o tema nas bases de dados: portal de periódicos Capes, PubMed, Medline, BBO, Lilacs e SciELO, abrangendo prioritariamente, o período de 2002 a 2019. Para busca nas bases de dados foram utilizadas palavras-chave como “Cárie Dentária”, “Remineralização Dentária”, “Infiltração Dentária”, assim como suas correspondentes na língua inglesa. A maioria dos estudos encontrados aponta o tratamento infiltrante resinoso como uma opção viável para o tratamento minimamente invasivo de lesões cariosas incipientes sendo capaz de cumprir os principais efeitos esperados: inibição da progressão cariosa e melhoria estética das lesões. Entretanto, alguns impasses necessitam ser esclarecidos para que o tratamento seja recomendado com mais segurança na prática clínica. Conclui-se que o uso de infiltrantes resinosos tem sido relatado como promissor para o tratamento de lesões cariosas incipientes, contudo há necessidade de novas pesquisas e estudos a longo prazo para confirmar sua eficácia em todos aspectos desejáveis para seu uso clínico. Palavras-chave: Cárie Dentária. Infiltração Dentária. Remineralização Dentária.
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Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Tampi MP, Pilcher L, Banfield L, Carrasco-Labra A. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. J Am Dent Assoc 2019; 149:837-849.e19. [PMID: 30261951 DOI: 10.1016/j.adaj.2018.07.002] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults. TYPES OF STUDIES REVIEWED The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions. RESULTS The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide-amorphous calcium phosphate. CONCLUSIONS AND PRACTICAL IMPLICATIONS Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility.
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A clinical guideline for caries infiltration of proximal enamel lesions with resins. Br Dent J 2019; 225:299-304. [PMID: 30141501 DOI: 10.1038/sj.bdj.2018.647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/08/2022]
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Garg SA, Chavda SM. Color Masking White Fluorotic Spots by Resin Infiltration and Its Quantitation by Computerized Photographic Analysis: A 12-month Follow-up Study. Oper Dent 2019; 45:1-9. [PMID: 31567053 DOI: 10.2341/17-260-t] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To manage three cases of mild to moderate fluorosis by resin infiltration technique and to quantify the tooth color changes by measuring CIE L*a*b* values of digital photographs and calculating ΔE00 based on the CIEDE2000 formula using Adobe Photoshop software. METHODS AND MATERIALS Three cases of mild to moderate fluorosis were treated with a combination of bleaching and a resin infiltration technique. CIE L*a*b* values of 18 fluorosed spots were measured from digital photographs of these cases at four different stages-preoperative, postbleaching, postinfiltration and at 12-month follow-up-using Adobe Photoshop software, and ΔE00 was calculated based on the CIEDE2000 formula. The ΔE00 values of all 18 points obtained at different stages were submitted to statistical analysis (α=0.05). RESULTS In all the cases reported, clinically as well as by the photographic color analysis, it was found that the technique masked the lesions, improving the patients' esthetics, which was maintained even at 12-month recall. Statistically significant difference in ΔE00 values was present between comparison of all stages (p<0.001) except between postinfiltration and the 12-month follow-up stage (p=0.642). CONCLUSION A resin infiltration technique helped in the satisfactory management of white spot lesions of fluorosis, which were stable even at 12-month follow up. Quantitation of the changes was achieved using Adobe Photoshop software.
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Peters M, Hopkins A, Zhu L, Yu Q. Efficacy of Proximal Resin Infiltration on Caries Inhibition: Results from a 3-Year Randomized Controlled Clinical Trial. J Dent Res 2019; 98:1497-1502. [DOI: 10.1177/0022034519876853] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study reports 3-y outcomes of a split-mouth randomized clinical trial. Resin infiltration’s capacity to arrest caries lesion progression in noncavitated proximal lesions is affirmed. Forty-two consented young adults, blinded to tooth surface allocation, were treated with resin infiltration on 1 randomly selected surface and concurrently experienced a mock infiltration procedure on another. Both treatments were provided as an adjunct to the currently accepted standard-of-care regimen (periodic prophylaxis and serial fluoride varnish applications) appropriate for the management of high caries risk. Challenging periods of low oral hygiene compliance were expected. The primary outcome measure was 3-y radiographic lesion progression. Blinded investigators evaluated each study surface for lesion progression with a series of images obtained at intervals over the 3-y course of study. Proportions of progressing lesions were compared with McNemar’s test. Twenty-nine noncavitated lesion pairs in permanent posterior teeth demonstrating caries penetrating into inner enamel or outer dentin were included in the analyses. No adverse events were reported. Radiographic progression was recorded in 4 of 29 infiltrated lesions (14%) and 14 of 29 control lesions (48%, P < .003). Adjunct resin infiltration demonstrated a high 3-y efficacy of 71% (relative risk reduction). The prevented fraction was 86% for infiltration versus 52% for controls. Resin infiltration was 100% successful in arresting caries progression in inner enamel lesions (E2) and 64% in outer dentin lesions (D1). Supplementary microinvasive resin infiltration is significantly more efficacious in reducing proximal lesion progression than management by standard noninvasive therapy alone. Long-term results may shed light on whether this represents the arrest or delay of the caries disease process (ClinicalTrials.gov NCT01584024).
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Affiliation(s)
- M.C. Peters
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - A.R. Hopkins
- Operative and Comprehensive Dentistry, USADC West Point, NY, USA
| | - L. Zhu
- Biostatistics Program, Louisiana State University, New Orleans, LA, USA
| | - Q. Yu
- Biostatistics Program, Louisiana State University, New Orleans, LA, USA
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Jorge RC, Ammari MM, Soviero VM, Souza IPR. Randomized controlled clinical trial of resin infiltration in primary molars: 2 years follow-up. J Dent 2019; 90:103184. [PMID: 31465818 DOI: 10.1016/j.jdent.2019.103184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/08/2019] [Accepted: 08/24/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this split-mouth, randomized, controlled clinical trial was to evaluate the efficacy of resin infiltration in controlling the progression of non-cavitated proximal lesions in primary molars after two-years follow-up. METHODS Fifty healthy children presenting at least two primary molars with proximal lesion detected radiographically (in the inner half of enamel or the outer third of dentin) were included in the study. The proximal lesions were randomly allocated into resin infltration + flossing (test group) or flossing (control group). All patients received oral hygiene instructions for daily brushing with fluoride toothpaste (1100 ppmF) and flossing. The proportion of caries progression was compared using the McNemar test. The main outcome after 2-years, caries progression in the radiography was assessed by pair-wise reading by an independent examiner who was blind regarding the treatment. RESULTS The sample comprised 28 (56%) girls and 22 (44%) boys with a defs of 7,3 (SD = 6,5), mainly of moderate (46%) to high (48%) caries risk. Results after one year were published previously. After 2-years, 29 (58%) patients were assessed. Caries progression was observed in 24.1% (7/29) of the test lesions, compared with 55.2% (16/29) of the control lesions (p = 0.012). The therapeutic effect was 31.1% and the relative risk reduction (RRR) was 56.3%. Eigth lesions from the control group and two lesions from the test group progressed to the inner third of dentin and were restored. CONCLUSIONS In conclusion, resin infiltration was more efficacious in controlling proximal caries lesions in primary molars than non-invasive approach alone. CLINICAL SIGNIFICANCE The results indicate that resin infiltration was an efficacious method in controlling proximal caries lesions in primary molars after 2 years, even in patients with high caries risk, reaffirming the results of 1-year follow-up.
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Affiliation(s)
- R C Jorge
- Department of Preventive and Community Dentistry, School of Dentistry, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brazil; Dental School, Faculty of Arthur Sá Earp Neto, Petrópolis, RJ, Brazil
| | - M M Ammari
- Department of Specific Training, School of Dentistry, Universidade Federal Fluminense - UFF, Nova Friburgo, RJ, Brazil; Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - V M Soviero
- Department of Preventive and Community Dentistry, School of Dentistry, Universidade do Estado do Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brazil; Dental School, Faculty of Arthur Sá Earp Neto, Petrópolis, RJ, Brazil.
| | - I P R Souza
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
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Elrashid AH, Alshaiji BS, Saleh SA, Zada KA, Baseer MA. Efficacy of Resin Infiltrate in Noncavitated Proximal Carious Lesions: A Systematic Review and Meta-Analysis. J Int Soc Prev Community Dent 2019; 9:211-218. [PMID: 31198691 PMCID: PMC6559044 DOI: 10.4103/jispcd.jispcd_26_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/14/2019] [Indexed: 01/18/2023] Open
Abstract
Objectives: Resin infiltration is a minimally invasive technique for treating noncavitated proximal caries. It slows/stops the carious lesion progression rate by creating a diffusion barrier inside the porous enamel lesion body. The aim was to evaluate the efficacy of resin infiltration on noncavitated proximal carious lesions in primary and permanent teeth. Materials and Methods: The records were obtained using electronic and other sources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to ensure transparent reporting. Eligible studies were randomized controlled trials evaluating the efficacy of resin infiltration for noncavitated proximal carious lesions by comparing it with control/placebo. Each included study was assessed concerning the “risk of bias” using the Cochrane Collaboration's “risk-of-bias” assessment tool. High risk-of-bias studies were excluded from the meta-analyses due to selective reporting matters. The statistics were performed by RevMan software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) utilizing the random effect model. The GRADE approach was implemented for assessing the quality of evidence. Results: From 106 studies identified, 17 were assessed for eligibility. After “risk-of-bias” assessment, two meta-analyses were conducted to eliminate the limitation of the significant heterogeneity between trials inspecting primary teeth (n = 2) and permanent teeth (n = 3). I2 = 0% indicates the absence of statistical heterogeneity. The risk of carious lesions’ progression with resin infiltration was significantly lower in primary (risk ratio [RR]; 95% confidence interval [CI]: 0.48; 0.30–0.75, P = 0.001) and in permanent teeth (RR; 95% CI: 0.19; 0.11–0.33, P < 0.00001) compared to that of control/placebo. The GRADE approach revealed high quality of evidence. Conclusion: The available evidence conveys high confidence that proximal resin infiltration has superior efficacy in slowing/arresting the carious lesions’ progression rate in comparison to conventional management modalities.
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Affiliation(s)
- Afra Hassan Elrashid
- Department of Restorative Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
| | - Basmah Sulaiman Alshaiji
- Department of Dental Internship, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
| | - Sara Abdulwahab Saleh
- Department of Dental Internship, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
| | - Khadijah Ahmed Zada
- Department of Dental Internship, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad Abdul Baseer
- Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
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Pandis N, Chung B, Scherer RW, Elbourne D, Altman DG. CONSORT 2010 statement: extension checklist for reporting within person randomised trials. Br J Dermatol 2019; 180:534-552. [PMID: 30609010 DOI: 10.1111/bjd.17239] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2017] [Indexed: 12/20/2022]
Abstract
Evidence shows that the quality of reporting of randomised controlled trials (RCTs) is not optimal. The lack of transparent reporting impedes readers from judging the reliability and validity of trial findings and researchers from extracting information for systematic reviews and results in research waste. The Consolidated Standards of Reporting Trials (CONSORT) statement was developed to improve the reporting of RCTs. Within person trials are used for conditions that can affect two or more body sites, and are a useful and efficient tool because the comparisons between interventions are within people. Such trials are most commonly conducted in ophthalmology, dentistry, and dermatology. The reporting of within person trials has, however, been variable and incomplete, hindering their use in clinical decision making and by future researchers. This document presents the CONSORT extension to within person trials. It aims to facilitate the reporting of these trials. It extends 16 items of the CONSORT 2010 checklist and introduces a modified flowchart and baseline table to enhance transparency. Examples of good reporting and evidence based rationale for CONSORT within person checklist items are provided.
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Affiliation(s)
- N Pandis
- University of Bern, Medical Faculty, School of Dental Medicine, Department of Orthodontics and Dentofacial Orthopedics, Bern, Switzerland
| | - B Chung
- Division of Plastic Surgery, University of British Columbia, Victoria, BC, Canada
| | - R W Scherer
- Johns Hopkins Bloomberg School of Public Health, Epidemiology Mailroom E6138, Baltimore, MD, USA
| | - D Elbourne
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, UK
| | - D G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK, OX3 7LD
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Manoharan V, Arun Kumar S, Arumugam SB, Anand V, Krishnamoorthy S, Methippara JJ. Is Resin Infiltration a Microinvasive Approach to White Lesions of Calcified Tooth Structures?: A Systemic Review. Int J Clin Pediatr Dent 2019; 12:53-58. [PMID: 31496574 PMCID: PMC6710943 DOI: 10.5005/jp-journals-10005-1579] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The treatment of white lesions should aim at arresting the lesion progression of carious lesions and improving the esthetics by diminishing the opacity of the developmental disturbances of a tooth. The objective of this review was to present the scientific basis, the principles of resin infiltration and to discuss its inherent clinical applications. Data sources Data were identified by PubMed searches. Papers published in English between 2010 and 2015 were selected and most up-to-date or relevant references were chosen. Conclusion The resin infiltration technique, while promising, needed more clinical evidence for conclusive findings. However, based on available laboratory and clinical studies, it seems convincing that resin infiltration of enamel lesions should aim at arresting the progression of white spot lesions. Combining this microinvasive approach with a substantial caries remineralization program may provide therapeutic benefits and significantly reduce both long term restorative needs and costs, thus complementing the concept of minimum intervention dentistry. How to cite this article Manoharan V, Kumar AS, et al. Is Resin Infiltration a Micro invasive Approach to White Lesions of Calcified Tooth Structures?: A Systemic Review. Int J Clin Pediatr Dent 2019;12(1):53-58.
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Affiliation(s)
- Vidya Manoharan
- Department of Pedodontics and Preventive Dentistry, Royal Dental College, Palakkad, Kerala, India
| | - S Arun Kumar
- Department of Public Health Dentistry, Educare Institute of Dental Sciences, Malappuram, Kerala, India
| | - Selva B Arumugam
- Department of Paediatric and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - Vijay Anand
- Department of Pedodontics and Preventive Dentistry, Tagore Dental College, Chennai, Tamil Nadu, India
| | - Santham Krishnamoorthy
- Department of Pedodontics and Preventive Dentistry, Sathyabama Dental College, Chennai, Tamil Nadu, India
| | - John J Methippara
- Department of Pedodontics and Preventive Dentistry, Annoor Dental College, Muvattupuzha, Kerala, India
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Urquhart O, Tampi MP, Pilcher L, Slayton RL, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Brignardello-Petersen R, Banfield L, Parikh A, Joshi G, Carrasco-Labra A. Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. J Dent Res 2018; 98:14-26. [PMID: 30290130 PMCID: PMC6304695 DOI: 10.1177/0022034518800014] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The goal of nonrestorative or non- and microinvasive caries treatment (fluoride-
and nonfluoride-based interventions) is to manage the caries disease process at
a lesion level and minimize the loss of sound tooth structure. The purpose of
this systematic review and network meta-analysis was to summarize the available
evidence on nonrestorative treatments for the outcomes of 1) arrest or reversal
of noncavitated and cavitated carious lesions on primary and permanent teeth and
2) adverse events. We included parallel and split-mouth randomized controlled
trials where patients were followed for any length of time. Studies were
identified with MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane
Database of Systematic Reviews. Pairs of reviewers independently conducted the
selection of studies, data extraction, risk-of-bias assessments, and assessment
of the certainty in the evidence with the Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) approach. Data were synthesized with a
random effects model and a frequentist approach. Forty-four trials (48 reports)
were eligible, which included 7,378 participants and assessed the effect of 22
interventions in arresting or reversing noncavitated or cavitated carious
lesions. Four network meta-analyses suggested that sealants + 5% sodium fluoride
(NaF) varnish, resin infiltration + 5% NaF varnish, and 5,000-ppm F (1.1% NaF)
toothpaste or gel were the most effective for arresting or reversing
noncavitated occlusal, approximal, and noncavitated and cavitated root carious
lesions on primary and/or permanent teeth, respectively (low- to
moderate-certainty evidence). Study-level data indicated that 5% NaF varnish was
the most effective for arresting or reversing noncavitated facial/lingual
carious lesions (low certainty) and that 38% silver diamine fluoride solution
applied biannually was the most effective for arresting advanced cavitated
carious lesions on any coronal surface (moderate to high certainty). Preventing
the onset of caries is the ultimate goal of a caries management plan. However,
if the disease is present, there is a variety of effective interventions to
treat carious lesions nonrestoratively.
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Affiliation(s)
- O Urquhart
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - M P Tampi
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - L Pilcher
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - R L Slayton
- 2 Department of Pediatric Dentistry, School of Dentistry, University of Washington, Seattle, WA, USA
| | - M W B Araujo
- 3 Science Institute, American Dental Association, Chicago, IL, USA
| | - M Fontana
- 4 Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - S Guzmán-Armstrong
- 5 Advance Education Program in Operative Dentistry, University of Iowa, Iowa City, IA, USA
| | - M M Nascimento
- 6 Division of Operative Dentistry, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - B B Nový
- 7 DentaQuest Institute and DentaQuest Oral Health Center, Westborough, MA, USA
| | - N Tinanoff
- 8 Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Maryland, College Park, MD, USA
| | - R J Weyant
- 9 Department of Dental Public Health and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M S Wolff
- 10 University of Pennsylvania, Philadelphia, PA, USA
| | - D A Young
- 11 Department of Diagnostic Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific, Stockton, CA, USA
| | - D T Zero
- 12 Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry Indiana University, Indianapolis, IN, USA
| | - R Brignardello-Petersen
- 13 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - L Banfield
- 14 Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - A Parikh
- 15 College of Dental Medicine, Midwestern University, Downers Grove, IL, USA
| | - G Joshi
- 16 GC America, Alsip, IL, USA
| | - A Carrasco-Labra
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA.,17 Evidence-Based Dentistry Unit and Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Santiago, Chile
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Yazkan B, Ermis RB. Effect of resin infiltration and microabrasion on the microhardness, surface roughness and morphology of incipient carious lesions. Acta Odontol Scand 2018; 76:473-481. [PMID: 29447057 DOI: 10.1080/00016357.2018.1437217] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The effects of resin infiltration and microabrasion on incipient carious lesions by surface microhardness, roughness and morphological assessments, and resistance to further acid attack of treated lesions were evaluated. MATERIAL AND METHODS Eighty artificially-induced incipient lesions were randomly divided into five groups (n = 16): resin infiltration with an adhesive resin (Excite F, Ivoclar Vivadent, Schaan, Liechtenstein), resin infiltration with a resin infiltrant (Icon, DMG, Hamburg, Germany), microabrasion without polishing (Opalustre, Ultradent, South Jordan, UT, USA), microabrasion with polishing (Opalustre, Ultradent, Diamond Excel, FGM, Joinville, SC, Brazil), and distilled water (control group). All specimens were exposed to demineralization for another 10 d. Microhardness, roughness and morphological assessments were done at baseline, following initial demineralization, treatment and further demineralization. Data were analysed by the Kruskal-Wallis, Friedman's and Bonferroni tests (p < .05). RESULTS Enamel lesions treated with resin infiltrant and microabrasion demonstrated similar hardness values, with a nonsignificant difference compared with sound enamel. Resin infiltration demonstrated lower roughness values than those of microabrasion, and the values did not reach the values of sound enamel. Further demineralization for 10 d did not affect the hardness but increased the roughness of infiltrated and microabraded enamel surfaces. Polishing did not influence the roughness of microabraded enamel surfaces. After resin infiltration, porosities on enamel were sealed completely. The surface structure was similar to that of the enamel conditioning pattern for microabraded enamel lesions. CONCLUSIONS Within the limitations of this study, the icon infiltration and microabrasion technique appeared to be effective for improving microhardness. Icon appeared to provide reduced roughness, although not equal to sound enamel. Further research is needed to elucidate their clinical relevance.
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Affiliation(s)
- Basak Yazkan
- Department of Restorative Dentistry, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
| | - R. Banu Ermis
- Department of Restorative Dentistry, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
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Cartagena A, Bakhshandeh A, Ekstrand KR. Approximal sealings on lesions in neighbouring teeth requiring operative treatment: an in vitro study. Acta Odontol Scand 2018; 76:459-465. [PMID: 29415607 DOI: 10.1080/00016357.2018.1436191] [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: 10/18/2022]
Abstract
OBJECTIVES With this in vitro study we aimed to assess the possibility of precise application of sealant on accessible artificial white spot lesions (WSL) on approximal surfaces next to a tooth surface under operative treatment. A secondary aim was to evaluate whether the use of magnifying glasses improved the application precision. MATERIAL AND METHODS Fifty-six extracted premolars were selected, approximal WSL lesions were created with 15% HCl gel and standardized photographs were taken. The premolars were mounted in plaster-models in contact with a neighbouring molar with Class II/I-II restoration (Sample 1) or approximal, cavitated dentin lesion (Sample 2). The restorations or the lesion were removed, and Clinpro Sealant was placed over the WSL. Magnifying glasses were used when sealing half the study material. The sealed premolar was removed from the plaster-model and photographed. Adobe Photoshop was used to measure the size of WSL and sealed area. The degree of match between the areas was determined in Photoshop. RESULTS Interclass agreement for WSL, sealed, and matched areas were found as excellent (κ = 0.98-0.99). The sealant covered 48-100% of the WSL-area (median = 93%) in Sample 1 and 68-100% of the WSL-area (median = 95%) in Sample 2. No statistical differences were observed concerning uncovered proportions of the WSL-area between groups with and without using magnifying glasses (p values ≥ .19). However, overextended sealed areas were more pronounced when magnification was used (p = .01). The precision did not differ between the samples (p = .31). CONCLUSIONS It was possible to seal accessible approximal lesions with high precision. Use of magnifying glasses did not improve the precision.
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Affiliation(s)
- Alvaro Cartagena
- Unit of Pulpal Biology and Endodontics, Finis Terrae University, Santiago, Chile
- Department of Odontology, Section of Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark
| | - Azam Bakhshandeh
- Department of Odontology, Section of Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark
| | - Kim Rud Ekstrand
- Department of Odontology, Section of Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark
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Chatzimarkou S, Koletsi D, Kavvadia K. The effect of resin infiltration on proximal caries lesions in primary and permanent teeth. A systematic review and meta-analysis of clinical trials. J Dent 2018; 77:8-17. [DOI: 10.1016/j.jdent.2018.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022] Open
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Liang Y, Deng Z, Dai X, Tian J, Zhao W. Micro-invasive interventions for managing non-cavitated proximal caries of different depths: a systematic review and meta-analysis. Clin Oral Investig 2018; 22:2675-2684. [PMID: 30238416 DOI: 10.1007/s00784-018-2605-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to further evaluate the caries-arresting effectiveness of micro-invasive interventions for non-cavitated proximal caries and analyze their efficacy for caries lesions of different depths. MATERIALS AND METHODS Randomized clinical trials (RCTs) of micro-invasive interventions for non-cavitated proximal caries were included in this study. We searched the Cochrane Library, PubMed, Embase, and Web of Science on May 25, 2017, without restrictions. After duplicate study selection, data extraction, and risk of bias assessment, a meta-analysis of the odds ratios (OR) with 95% confidence intervals (95% CIs) and a publication bias analysis were conducted using Stata 12.0. RESULTS After 2195 citations were screened, 8 citations of seven studies with follow-up periods from 12 to 36 months were included. The subgroup analysis showed that resin infiltration and resin sealant, but not glass ionomer cement (GIC), could reduce the caries progression rate (resin infiltration: OR = 0.15, 95% CI 0.09 to 0.24; resin sealant: OR = 0.33, 95% CI 0.19 to 0.58; GIC: OR = 0.13, 95% CI 0.01 to 2.65). Further analysis of their efficacies for caries lesions of different depths indicated that resin infiltration could arrest progression of enamel caries and caries around the enamel-dentin junction (EDJ) (enamel: OR = 0.05, 95% CI 0.01 to 0.35; EDJ: OR = 0.07, 95% CI 0.01 to 0.70). However, when the outer third of the dentin was involved, resin infiltration yielded significantly different results compared with the control group (OR = 0.42, 95% CI 0.16 to 1.10). Resin sealant seemed to be ineffective regardless of the caries depth (enamel: OR = 0.62, 95% CI 0.13 to 3.00; EDJ: OR = 0.44, 95% CI 0.09 to 2.15; dentin: OR = 0.43, 95% CI 0.07 to 2.63). CONCLUSIONS Resin infiltration is effective in arresting the progression of non-cavitated proximal caries involved in EDJ, while the therapeutic effects of resin sealant for different caries depths still needs to be further confirmed. CLINICAL RELEVANCE Based on existing evidence, dentists should carefully select appropriate micro-invasive interventions according to the different depths of non-cavitated proximal caries.
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Affiliation(s)
- Yuee Liang
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zilong Deng
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xingzhu Dai
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Wanghong Zhao
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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Peters MC, Hopkins AR, Yu Q. Resin infiltration: An effective adjunct strategy for managing high caries risk-A within-person randomized controlled clinical trial. J Dent 2018; 79:24-30. [PMID: 30227152 DOI: 10.1016/j.jdent.2018.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/07/2018] [Accepted: 09/13/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Micro-invasive resin-infiltration has shown to inhibit lesion progression of proximal non-cavitated carious lesions, suggesting an alternative to early operative treatment. This split-mouth, randomized placebo-controlled clinical trial evaluated the effects of proximal lesion infiltration supplementary to standard-of-care management in high caries risk (HCR)-patients. METHODS Forty-two HCR-subjects with two similar interproximal posterior lesions received professional HCR-regimen including repeated F-varnish applications. Two affected E2/D1-surfaces were randomized and concurrently treated by resin-infiltration or mock-infiltration (control). Individually standardized digital radiographs provided visual determination of lesion-size distribution at baseline and 2-year follow-up. Data were analyzed by logistic regression and McNemar's test. RESULTS Thirty-two lesion pairs (76%) were evaluated after 2 years. Categorical lesion depths were not different between groups (P > .5). Comparative pairwise assessment (image sets BL-2 yr) showed significantly more progression in control (7) versus infiltration (1) lesions (P = .035). Cumulative prevented fraction after two years was 97% for infiltrated lesions versus 74% for control lesions. CONCLUSIONS Two-year follow-up showed resin infiltration to be a highly efficacious (RRR: 86-89%) therapy. Long-term follow-up is needed to strengthen the evidence for efficacy of resin-infiltration as an adjunct to standard-of-care HCR-regimen including F-varnish. CLINICAL SIGNIFICANCE Showing 24% more stabilized lesions, the resin-infiltrated group performed significantly better than their controls, confirming successful early lesion management. Adjunct resin-infiltration provided an effective micro-invasive approach to inhibit short-term lesion progression.
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Affiliation(s)
- Mathilde C Peters
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA & Clinical Professor, School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA, USA.
| | - Aubrey R Hopkins
- Operative and Comprehensive Dentistry, USADC West Point, NY & Comprehensive Dentistry, DC, USA
| | - Qingzhao Yu
- Biostatistics Program, Louisiana State University, New Orleans, LA, USA
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Yoo HK, Kim SH, Kim SI, Shin YS, Shin SJ, Park JW. Seven-year Follow-up of Resin Infiltration Treatment on Noncavitated Proximal Caries. Oper Dent 2018; 44:8-12. [PMID: 30106331 DOI: 10.2341/17-323-l] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The purpose of this case report is to present success and failure outcomes of seven-year follow-up of resin infiltration treatment (RIT) used for the proximal caries of maxillary premolars. Although resin infiltration can be a good option for micro-invasive treatment, long-term follow-up data are not sufficient, and the outcome of this technique can be affected by factors such as technique sensitivity of procedure, patient's caries risk, and depth of caries progression. Therefore, careful case selection, application, and follow-up are needed.
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Efficacy of resin infiltration of proximal caries in primary molars: 1-year follow-up of a split-mouth randomized controlled clinical trial. Clin Oral Investig 2017; 22:1355-1362. [PMID: 28990122 DOI: 10.1007/s00784-017-2227-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The main purpose of this split month, randomized, controlled clinical trial was evaluate the efficacy of caries infiltration in controlling the progression of non-cavitated proximal lesions in primary molars. Anxiety and time required for the caries infiltration was also evaluated. MATERIALS AND METHODS Fifty healthy children, 5 to 9 years, presenting two primary molars with proximal caries lesions (1/2 of the enamel or outer 1/3 of dentin), were included. Lesions were randomly allocated to the test group (fluoridated toothpaste + flossing + infiltration) or to the control group (fluoridated toothpaste + flossing). Caries risk was based on the Cariogram model. The main outcome after 1-year radiographic follow up was assessed by an independent blinded examiner A facial image scale (FIS) was applied to assess dental anxiety and time required to perform the infiltration was recorded. RESULTS Of the sample, 92.9% corresponded to high or medium caries risk. In 42 patients (1-year follow up), caries progression was observed in 11.9% (5/42) of the test lesions compared with 33.3% (14/42) of the control lesions (p < 0.05). Five control and three test lesions progressed to the middle 1/3 of dentin and were restored. No side effects were observed. Anxiety was both low before and after the treatment, and mean time required for the infiltration was 11.29 min (± 1.16 min). CONCLUSIONS Caries infiltration of proximal caries lesions in primary molars is significantly more efficacious than standard therapy alone (fluoride toothpaste + flossing). CLINICAL RELEVANCE Caries infiltration is an applicable and well-accepted method be used in children, representing a promising micro-invasive approach.
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Pandis N, Chung B, Scherer RW, Elbourne D, Altman DG. CONSORT 2010 statement: extension checklist for reporting within person randomised trials. BMJ 2017; 357:j2835. [PMID: 28667088 PMCID: PMC5492474 DOI: 10.1136/bmj.j2835] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Nikolaos Pandis
- University of Bern, Medical Faculty, School of Dental Medicine, Department of Orthodontics and Dentofacial Orthopedics, Bern, Switzerland
| | - Bryan Chung
- Division of Plastic Surgery, University of British Columbia, Victoria, BC, Canada
| | - Roberta W Scherer
- Johns Hopkins Bloomberg School of Public Health, Epidemiology Mailroom E6138 Baltimore, MD, USA
| | - Diana Elbourne
- London School of Hygiene and Tropical Medicine, Department of Medical Statistics, London, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK OX3 7LD
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Basili CP, Emilson CG, Corvalan GC, Moran MP, Torres C, Quiroz MD, Gomez SS. Preventive and Therapeutic Proximal Sealing: A 3.5-Year Randomized Controlled Clinical Trial Follow-Up. Caries Res 2017; 51:387-393. [PMID: 28618424 DOI: 10.1159/000470851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/07/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this split-mouth, randomized controlled clinical trial was to evaluate the efficacy of proximal sealing for avoiding the development of new caries lesions or arresting incipient caries lesions on the mesial surface of first permanent molars (6m) abutting lesions on the distal surface of second primary molars (05d) in children at high caries risk. METHODS A total of 61 children 8-10 years old were selected based on the caries status of the proximal sites of 05d and 6m. Children with caries on 05d and caries-free 6m were placed in the preventive sealing group and children with caries on both 05d and 6m in the therapeutic group. The children in each group had one 6m surface pair and in each pair one 6m surface was randomly allocated to receive a preventive or therapeutic sealing. Using a split-mouth design, the other 6m surface in the pair served as control. RESULTS After 3.5 years, standardized follow-up radiographs were obtained for the 45 children who remained. In the preventive sealing group, 4 out of 30 (13.3%) sealed and 16 out of 30 (53.3%) unsealed sound 6m surfaces had developed new caries lesions (p = 0.004, McNemar test). In the therapeutic sealing group, the progression of the carious lesions on 6m was observed in 3 out of 15 sealed (20.0%) and 8 out of 15 (53.3%) unsealed caries control surfaces (p = 0.06). CONCLUSIONS Preventive sealing on sound 6m surfaces abutting 05d lesions in children at high caries risk efficaciously prevents the development of caries lesions. Therapeutically sealing active non-cavitated caries lesions reduces the progression.
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Affiliation(s)
- Cristian P Basili
- Department of Preventive Dentistry, Facultad de Odontología, Valparaiso University, Valparaíso, Chile
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Arthur RA, Zenkner JE, d’Ornellas Pereira Júnior JC, Correia RT, Alves LS, Maltz M. Proximal carious lesions infiltration—a 3-year follow-up study of a randomized controlled clinical trial. Clin Oral Investig 2017; 22:469-474. [DOI: 10.1007/s00784-017-2135-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/22/2017] [Indexed: 12/01/2022]
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Foster Page LA, Beckett D, Ahmadi R, Schwass DR, Leon de la Barra S, Moffat SM, Meldrum A, Thomson WM. Resin Infiltration of Caries in Primary Molars in a Community Setting: 24-Month Randomized Controlled Trial Findings. JDR Clin Trans Res 2017; 2:287-294. [PMID: 30938631 DOI: 10.1177/2380084417699400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study aimed to assess whether resin infiltration of primary molar proximal lesions is more effective than noninvasive measures in radiographically controlling carious lesion progression into the dentin. A split-mouth randomized controlled trial included 90 children, each with 2 proximal lesions confined to the inner half of the enamel or ≤0.5 mm into the dentin. For each child, lesions were randomly allocated to test (infiltration: DMG Icon preproduct and fluoride varnish) or control (fluoride varnish) status. The primary outcome measure was 24-mo radiographic lesion progression. Placement of a restoration during the study period was counted as lesion progression. Proportions of teeth with progressed lesions were compared using the McNemar test. Children also reported on the treatment's acceptability to them. Children (46% female) ranged in age from 6 to 9 y. Their mean number of decayed, missing, and filled teeth (d3mft) was 2.8 (SD 2.6). At baseline, 58% and 42% of children were at moderate and low risk, respectively. Test and control lesions presented with similar radiographic lesions at baseline. At the 24-mo follow-up, 6 children had moved and 30 teeth had exfoliated. In the test and control groups, 15 of 66 lesions (22.7%) and 30 of 69 lesions (43.5%) had progressed, respectively (P < 0.05). The 2-y therapeutic effect (based on pairwise radiographic readings) of infiltration over fluoride varnish was 20.8% (95% confidence interval, 10.6%-30.2%). Nearly all children (96.7%) had enjoyed their visit to the clinic, and more than two-thirds (72.2%) were not worried about returning for treatment. Infiltration is more efficacious than fluoride varnish for controlling carious lesion progression in proximal lesions in primary molars, and most children find the treatment acceptable (Australian New Zealand Clinical Trials Registry ANZCTR.org.au ACTRN12611000827932). Knowledge Transfer Statement: These study findings can help clinicians decide which caries management approach they wish to use to prevent progression of proximal lesions in primary molars. With consideration of cost and patient preference, this information could lead to more appropriate therapeutic decisions.
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Affiliation(s)
- L A Foster Page
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - D Beckett
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - R Ahmadi
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - D R Schwass
- 2 Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - S Leon de la Barra
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - S M Moffat
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - A Meldrum
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - W M Thomson
- 1 Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
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ZHOU Y, MATIN K, SHIMADA Y, SUMI Y, TAGAMI J. Evaluation of resin infiltration on demineralized root surface: An in vitro study. Dent Mater J 2017; 36:195-204. [PMID: 28111390 DOI: 10.4012/dmj.2016-229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yuan ZHOU
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Khairul MATIN
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
- Endowed Department of International Oral Health Science (affiliated with Department of Translational Research), School of Dental Medicine, Tsurumi University
| | - Yasushi SHIMADA
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Yasunori SUMI
- Division of Oral and Dental Surgery, Department of Advanced Medicine, National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology
| | - Junji TAGAMI
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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50
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Influence of bioactive particles on the chemical-mechanical properties of experimental enamel resin infiltrants. Clin Oral Investig 2016; 21:2143-2151. [DOI: 10.1007/s00784-016-2005-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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