The impact of minimally invasive restorative techniques on perception of dental pain among pregnant women: a randomized controlled clinical trial

ART with or without the aid of chemo-mechanical agents: a systematic review

OBJECTIVES

To investigate whether the use of chemo-mechanical carious tissue removal (CMCTR) agents is effective for Atraumatic Restorative Treatment (ART).

MATERIALS AND METHODS

Searches were conducted in 6 databases for inclusion of clinical studies. Risk of bias was assessed (RoB 2 and ROBINS-I), a meta-analysis was performed with data from time of carious tissue removal (TCTR), and the certainty of evidence was estimated. ART + CMCTR was compared to ART for the treatment of caries lesions in primary teeth (pt) and permanent teeth (PT) of humans, considering acceptability, pain/discomfort, survival and success of restorations (SSR), Oral Health-Related Quality of life (OHRQol), satisfaction, TCTR, total treatment time (TTT), carious tissue removal efficacy and adverse effects.

RESULTS

Of 12 included studies, 4 showed low risk of bias, considering pain, TTT and TCTR outcomes. ART + CMCTR was similar or more accepted than ART for pt, causing similar or less pain/discomfort for both dentitions. There was no difference in SSR, OHRQol for PT, and adverse effects (pt), although greater satisfaction was reported after ART + CMCTR in case of PT. ART + CMCTR was better or as effective as ART in removing carious tissue (pt). TTT for pt was divergent between the groups, but without difference of TCTR for both, pt and PT (MD 0.11 [-1.56, 1.77] p = 0.90, I 2 =93%).

CONCLUSIONS

In general, ART + CMCTR is effective, providing greater satisfaction, with no difference in SSR, OHRQol and adverse effects compared to ART, which did not present advantages in relation to pain/discomfort and efficacy in removing carious tissue. The TTT was influenced by the CMCTR agent; however, there was no difference for TCTR in the overall quantitative synthesis with Papacárie DuoGel®.

CLINICAL RELEVANCE

The use of chemo-mechanical agents for carious tissue removal in the ART may benefit patients with reduced pain/discomfort.

Oral processing behavior and dental caries; an insight into a new relationship

INTRODUCTION

Previous evidence suggests an individual variation in the preferred oral processing behavior. Individuals can be classified as firm processing(FPL) or soft processing likers(SPL). FPL(crunchers and chewers) prefer using their teeth while SPL(smooshers and suckers) prefer using the tongue and the palate when processing different food items. Variation in the preferred oral processing behavior has been associated with differences in food texture preference and eating time. Time is one of the factors directly related to the development of dental caries(tooth decay). Oral retention and eating times are associated with greater caries experience. This study aims to explore if a relationship exists between the preferred oral processing behavior and the individual's caries experience.

MATERIALS AND METHODS

This was a cross-sectional, dental center-based study conducted at Jordan University of Science and Technology. Five hundred participants consented to fill out the preferred oral processing behavior(POPB) questionnaire. Anthropometric measurements (including weight, height, and waist circumference) were recorded. A single trained and calibrated dentist registered each participant's caries experience and plaque levels using the DMFS index and plaque index of Silness and Loe.

RESULTS

A total of 351(70.2%) and 149(29.8%) participants were typed as FPL and SPL, respectively. SPL demonstrated higher levels of dental caries experience compared to FPL. The mean DMFS score for SPL was 28.8(±25.43) while for FPL was 18.71(± 18.34). This difference remained significant after adjustment for confounders(P<0.001). SPL exhibited a significantly higher mean score for the "M" component(P <0.001) while no significant difference in the mean score of the "D"(P = 0.076) and "F"(P = 0.272) components was observed when compared to FPL.

CONCLUSION

The current findings provide new insight into a possible relationship between the preferred oral processing behavior and an individual's caries experience. A relationship in which the preferred oral processing behavior can potentially affect and/or be affected by the dental caries experience.

Fracture characteristics and translucency of multilayer monolithic zirconia crowns of various thicknesses

OBJECTIVES

Multilayer monolithic zirconia (M-Zr) crowns can be engineered to achieve gradational translucency and color intensity. However, this modification may compromise the mechanical strength, raising concerns regarding the ability of M-Zr crowns to withstand occlusal stresses. The effects of M-Zr crown thickness on translucency and ability to endure occlusal forces were investigated at different tooth positions (incisors, premolars, and molars). The objective was to determine the minimal thickness of M-Zr crowns used in tooth preparation to meet aesthetic and functional demands.

METHODS

M-Zr samples (Vita A1) with four thicknesses (0.5, 1.0, 1.5, and 2.0 mm) were prepared and subjected to translucency testing using a digital colorimeter by 3-third and 9-square division methods. Crown-shaped M-Zr samples with three thicknesses (1.0, 1.5, and 2.0 mm) and three tooth positions (incisor, premolar, and molar) were digitally designed, and 2.0 mm metal abutments were fabricated. The samples were bonded to the abutments; their fracture characteristics were evaluated using a universal testing machine, and their fracture surfaces examined using an optical microscope. Statistical analyses included the Shapiro-Wilk test, Pearson correlation, and one-way and two-way ANOVA with a post hoc Tukey HSD test (α = 0.05).

RESULTS

Color analysis results revealed a significant negative correlation between thickness and translucency (r < -0.96, P < 0.01), with the highest values in the incisal region. Cross-sectional profiles confirmed the uniform thickness and morphology of the digitally designed M-Zr crowns. The results of fracture strength analysis showed position-dependent variability, a strong positive correlation with thickness (r > 0.96, P < 0.01), and fracture strengths consistently exceeding 1200 N across all tooth positions. Fracture patterns indicated that thinner crowns at the incisors and molars were more prone to cracking, whereas those at the premolars demonstrated significantly higher strength (4872.51 N, P < 0.05), only with crack or even no fracture occurring at 2.0 mm.

CONCLUSIONS

Thickness significantly influenced both the translucency and fracture strength of M-Zr, with the tooth position playing an additional role, albeit to a lesser extent. Although thinner crowns exhibited lower strength at each tooth position, even at a thickness of 1.0 mm, fracture strength exceeding 1200 N was maintained, surpassing the typical occlusal forces. Thus, it can be asserted that M-Zr crowns with a minimum thickness of 1.0 mm can meet both aesthetic and functional requirements.

Minimal Intervention Dentistry: Biocompatibility and Mechanism of Action of Products for Chemical-Mechanical Removal of Carious Tissue

Conventional method for removal of carious tissue using low speed drills usually induce noise and vibration, in addition to thermal and pressure effects that can be harmful to the pulp tissue and cause fear in children. Therefore, several alternative methods are being developed to try to minimize the unpleasant perception of the patient during caries removal. Chemical-mechanical removal of carious tissue goal is to selectively remove the carious lesion, which reduces the amount of bacteria inside the cavity without removing the tissue susceptible to remineralization. This method is also able to minimize the tactile perception by the patient during the manipulation of the lesion compared to the conventional method, and, therefore, it has been widely accepted among phobic patients, children and special needs patients. Due to the close relationship between dentin and pulp tissue, all injuries imposed on this dentin may have repercussions on the underlying pulp connective tissue. The morphological aspects of remaining dentin favor the diffusion of chemical components of dental materials, which can be toxic to the pulp tissue or even negatively interfere in the reparative process. Thus, considering the proximity between the applied material and the underlying pulp tissue, especially in deep cavities, there is a need to assess the biological behavior of dental materials against pulp cells, since aggressions to the pulp tissue can be caused not only by metabolites from microorganisms involved in dental caries but also by components that are released from these products. This subject was explored in this narrative literature review.

Comparison of two minimally invasive restorative techniques in improving the oral health-related quality of life of pregnant women: a six months randomized controlled trial

BACKGROUND

Women tend to delay dental treatment due to misconceptions regarding the safety of dental procedures during pregnancy which may negatively affect their quality of life. Minimally invasive restorative techniques offer alternatives for caries treatment and can improve their oral health-related quality of life (OHRQoL) during this stage.

METHODS

A randomized controlled clinical trial was conducted in 2019 and included 162 pregnant women visiting public family health centers in Alexandria, Egypt, with mild to moderate dental pain due to caries. Participants were randomly assigned into Papacarie-Duo group (n = 82) and ART group (n = 80). The outcome variable was percent change in OHRQoL (oral health impact profile, OHIP-14) after 6 months. T test/Mann Whitney U test were used to compare groups and a multivariable linear regression analysis was conducted to evaluate the factors affecting the outcome variable.

RESULTS

A significant reduction (P < 0.002) was noted in OHIP-14 between baseline and 6 months indicating improvement in OHRQoL in the Papacarie-Duo and ART groups (16.26% and 18.91%, P = 0.120 in bivariate analysis). Multiple linear regression revealed significantly greater reduction in OHIP-14 scores in the Papacarie-Duo than the ART group (regression coefficient = 4.03, 95% confidence interval: 0.652, 7.409, P = 0.020).

CONCLUSION

Minimally invasive restorative techniques, such as ART and chemo-mechanical caries removal using Papacarie- Duo can improve the OHRQoL of pregnant women suffering from mild to moderate pain due to dental caries. Significantly more improvement was noted in the Papacarie-Duo group after adjusting all other variables. Trial registration ID NCT04619264 ( https://clinicaltrials.gov/ ); November 6 2020, retrospective registration. ( https://clinicaltrials.gov/ct2/show/NCT04619264?term=NCT04619264&draw=2&rank=1 ).