Effect of patients' attitude and perception of oral hygiene on white spot lesion development and plaque accumulation during orthodontic treatment : A survey of patients with fixed appliances.

PURPOSE: To explore the impact of oral hygiene practices, as well as beliefs and attitudes toward orthodontic treatment on white spot lesion (WSL) development and plaque accumulation in orthodontic patients. MATERIALS AND METHODS: A total of 106 individuals (61 female, 45 male) patients aged 10-49 years who were treated with fixed appliances treatment completed a 14-question survey regarding aspects of their oral hygiene (OH) and orthodontic visits. The number of teeth with WSL and the plaque indexes were recorded for each patient. Poisson regression and linear regression models were used to analyze the association of survey responses with the observed WSLs and plaque accumulation, respectively. RESULTS: Participants of both sexes reported similar beliefs about OH (66% agreed to the importance of OH statements), practiced proper OH (69% good practices), and reported a similar perception regarding the quality of their OH routine and of their orthodontic treatment. However, in total, none of the findings was significantly related to the development of WSLs or plaque accumulation. Significantly fewer WSLs were observed in male patients who perceived themselves as having good control over OH. Female participants reported significantly higher expectations regarding posttreatment smile improvement compared to males. Overall, responses by male participants were deemed to be more accurate than those by female participants when related to WSL development and plaque accumulation. CONCLUSION: Our survey hints at a possible relationship between WSL formation and patients' sense of control over OH routine in males. Future studies should further explore the effect of sex on the attitude toward and perception of OH in orthodontic patients. This survey highlights the multifactorial nature of WSL development in orthodontic patients and the complexity of predicting patient compliance.

Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting.

INTRODUCTION: The objective of this study was to determine the prevalence of white spot lesions (WSL) in orthodontic patients in an academic setting. Specific aims include using a novel combination to measure plaque accumulation (PA) and detect the association between WSL and PA and the associations between multiple independent variables. METHODS: Cross-sectional data were collected on 111 patients. To enhance standardization, a combination of plaque-disclosing agents and standardized intraoral photographs was used to analyze plaque index (PI) and WSL for all teeth except molars. Factors including time in fixed appliances (FA), number of teeth, location of the lesions, and demographic information were reported. A multiple linear regression model was used to detect associations between the PI and WSL and the independent variables (P <0.05). RESULTS: Approximately 79.3% of participants had at least one WSL, with a mean of 4 affected teeth per patient. A significant association was found between time in FA and the more severe PI reporting (P <0.001). There was no significant association between WSL and PI or the other variables. WSL was greater in the maxilla than in the mandible. PI was greater on the left than on the right side. Interexaminer reliability was assessed for PI and WSL (κ = 0.93 and 0.92). CONCLUSIONS: The prevalence of WSL for orthodontic patients treated at this institution was greater than previously reported in the literature. In addition, the severity of PI was associated with increased time in FAs. Combining the proposed method of reporting PA facilitates standardization, calibration, and documentation in an academic environment.

Flexural Performance of Direct Resin Composite Restorative Materials Past Expiration Date.

OBJECTIVE: This study' s purpose was to examine the flexural properties of five direct restorative resin composites stored up to 30 months after the expiration date. MATERIALS AND METHODS: Ambient-stored materials had pre-expiration date baseline flexure strength values as per ISO 4049 (n = 20). All materials were used per manufacturer guidelines, photopolymerized on both sides using a LED-based visible light curing unit, and stored in 0.2M phosphate buffered saline. At 24 hours, specimens were stressed to failure in three-point bend at a 0.5 mm/min cross head speed. Additional samples were made at 3, 6, 9, 12, 15, 18, 24, and 30 months past expiration date. Young's modulus (flexural) was ascertained using the linear slope of the stress-stain curve. STATISTICAL ANALYSIS: The mean data was found to contain a non-normal distribution and irregular variance which was compared using Kruskal-Wallis with Dunn's posthoc testing.Also, Pearson's correlation analysis was used to identify possible similar degradation behavior between products within both flexure strength and modulus determinations. A 95% level of confidence (α = 0.05) was used. RESULTS: Materials maintained similar to baseline flexure strength and modulus for up to 15 months past expiration date with two materials being similar at 30 months. However, clinicians were still advised to follow expiration dates, as resin composite degradation mechanisms are complex and vital constituents might degrade that are not overtly identified by clinical handling characteristics. No dental shelf life standards exist and manufacturers are requested to provide protocol information used in determining shelf life expiration.

Long-term survival and vitality outcomes of permanent teeth following deep caries treatment with step-wise and partial-caries-removal: A Systematic Review.

OBJECTIVES: A systematic review was performed to compare the long-term survival of deep dentine caries-affected permanent teeth treated with partial-caries-removal (PCR) versus similar teeth treated with stepwise-caries-removal techniques (SWT). DATA: Clinical studies investigating long-term PCR and SWT outcomes in unrestored permanent teeth with deep dentine caries were evaluated. Failures were defined as loss of pulp vitality or restorative failures following treatment. SOURCES: PubMed, Web of Science, Dentistry and Oral Sciences Source, and Central databases were systematically searched. STUDY SELECTION: From 136 potentially relevant articles, 9 publications utilizing data from 5 studies (2 RCTs, and 3 observational case-series) reporting outcomes for 426 permanent teeth over two to ten years were analyzed. Regarding restorative failures, >88% success at two years for both techniques was reported. For loss of pulp vitality, observational studies reported >96% vitality at two years for each technique, while one RCT reported significantly higher vitality (p<0.05) at three years for PCR (96%) compared to SWT (83%). Risk of bias was high in all studies. CONCLUSION: Successful vitality and restorative outcomes for both PCR and SWT have been demonstrated at two years and beyond in permanent teeth with deep dentine caries. Partial-caries-removal may result in fewer pulpal complications over a three year period than SWT, although claims of a therapeutic advantage are based on very few, limited-quality studies. CLINICAL SIGNIFICANCE: Partial-caries-removal and SWT are deep caries management techniques that reduce pulp exposure risk. Permanent teeth with deep dentine caries treated with either technique have a high likelihood for survival beyond two years.

Characterization of genipin-modified dentin collagen.

Application of biomodification techniques to dentin can improve its biochemical and biomechanical properties. Several collagen cross-linking agents have been reported to strengthen the mechanical properties of dentin. However, the characteristics of collagen that has undergone agent-induced biomodification are not well understood. The objective of this study was to analyze the effects of a natural cross-linking agent, genipin (GE), on dentin discoloration, collagen stability, and changes in amino acid composition and lysyl oxidase mediated natural collagen cross-links. Dentin collagen obtained from extracted bovine teeth was treated with three different concentrations of GE (0.01%, 0.1%, and 0.5%) for several treatment times (0-24 h). Changes in biochemical properties of NaB(3)H4-reduced collagen were characterized by amino acid and cross-link analyses. The treatment of dentin collagen with GE resulted in a concentration- and time-dependent pigmentation and stability against bacterial collagenase. The lysyl oxidase-mediated trivalent mature cross-link, pyridinoline, showed no difference among all groups while the major divalent immature cross-link, dehydro-dihydroxylysinonorleucine/its ketoamine in collagen treated with 0.5% GE for 24 h, significantly decreased compared to control (P < 0.05). The newly formed GE-induced cross-links most likely involve lysine and hydroxylysine residues of collagen in a concentration-dependent manner. Some of these cross-links appear to be reducible and stabilized with NaB(3)H4.

Two-year bond strengths of "all-in-one" adhesives to dentine.

OBJECTIVES: To test the long-term in vitro bonding performance of "all-in-one" self-etch adhesives to dentine. METHODS: Adper Prompt (3M ESPE), Bond Force (Tokuyama), Brush & Bond (Parkell), iBond Self Etch (Heraeus Kulzer), OptiBond All-In-One (Kerr), and Xeno IV (Dentsply Caulk) were tested. The two-step self-etch adhesive Clearfil SE Bond (Kuraray) served as the control. Extracted human teeth were assigned to groups after creation of smear layer on occlusal dentine. Adhesives were applied according to manufacturers' instructions, and resin composite (Filtek Z250, 3M ESPE) build-ups were placed. The bonded specimens were sectioned into beams after 24h of storage in water. Microtensile bond strengths (µTBS) was determined at baseline, and following one and two years of water storage using an EZ-Test device (Shimadzu). Representative specimens were examined under field emission scanning electron microscope. Fracture mode was recorded. The data were analyzed using linear mixed effects and least square means analyses. The significance level was set at 0.01 for the pairwise comparisons and at 0.05 for the overall model effects. RESULTS: The mean µTBS decreased significantly over time for Adper Prompt, iBond Self Etch, and OptiBond All-In-One. After two years of water ageing, Bond Force, Brush & Bond, OptiBond All-In-One, and Xeno IV had mean µTBS values not statistically different from Clearfil SE Bond. CONCLUSIONS: After two years of water ageing, Clearfil SE Bond outperformed two of six all-in-one adhesives. That indicates that the composition of the adhesives rather than their application approach is accountable for their performance. CLINICAL SIGNIFICANCE: Despite the data available suggesting that most all-in-one adhesives are severely affected by hydrolytic degradation, results of the present in vitro study suggest that some may perform as well as the clinically proven Clearfil SE Bond in the longer term.