Inconsistent decision making in dental caries diagnosis and treatment: A case-based questionnaire survey.

Background and Aims: Delayed implementation of new knowledge into clinical practice poses patient safety risks. This study investigates agreement on use of the dental caries interventions, sealing, and stepwise excavation. Methods: A cross-sectional questionnaire survey, based on 11 constructed cases with descriptions of patient symptoms, radiographic, and clinical findings. Interrater agreement on dental caries- and pulp diagnoses and interventions were measured with Cohen's and Light's κ. The data collection period was September 28 to November 5, 2021. To explore variations in use and knowledge factors, we examined Danish dentists' attitudes toward continuing education. Results: Based on 243 responses, moderate interrater agreement for dental caries and pulp diagnoses and weak agreement on interventions were seen. The agreement with the gold standard for caries was moderate. No agreement was found for dental pulp diagnosis, and for interventions the agreement was weak. No pattern in agreement with the gold standard was seen in relation to case difficulty level. The majority reported knowing of and using stepwise excavation, in conflict with findings that less than half chose stepwise excavation in cases, where considered appropriate. One in four (25%) reported to be unfamiliar with sealing, and half (50%) use sealing regularly. Better access to continuing education and for universities to offer continuing education as alternatives to one-sided private market were requested. Conclusion: Some patients may receive too radical treatment despite available less invasive evidence-based effective treatments. Dentists acknowledge the importance of continuing education. Easier access and perhaps more incentives for seeking out high-quality continuing education from trustworthy sources are needed.

Second molar sealants among US adolescents and their association with select sociodemographic factors and first molar sealants: A cross-sectional study using National Health and Nutrition Examination Survey data.

BACKGROUND: Caries is an important public health concern. Dental sealants are effective in preventing caries; however, their uptake is suboptimal and little is known about second molar (2M) sealants. The authors examined the prevalence of 2M sealants among US adolescents and investigated the factors associated with their presence. METHODS: The authors conducted a cross-sectional analysis of 2011-2016 National Health and Nutrition Examination Survey data on adolescents aged 12 through 19 years with complete sealant data (n = 3,636). Race and ethnicity, income, and first molar (1M) sealant were primary variables of interest. The logistic regression models were used to estimate the factors associated with 2M sealants. All analyses used survey weights and accounted for complex survey design. RESULTS: Only 34.6% of adolescents (95% CI, 31.2% to 38.0%) had 2M sealants. Approximately 89.0% of adolescents (95% CI, 86.1% to 92.0%) with 2M sealants and 19.6% (95% CI, 17.1% to 22.2%) without 2M sealants had 1M sealants. In the adjusted models, race and ethnicity were strongly associated with 2M sealant presence, but the association did not hold when 1M sealant was included in the model. 1M sealants were the most significant factor explaining the presence of 2M sealants (odds ratio, 0.03; 95% CI, 0.02 to 0.04). CONCLUSIONS: Two of 3 adolescents lacked 2M sealants, with considerable disparities in their presence. To improve adolescent oral health, clinical and community programs should increase delivery of 2M sealants. PRACTICAL IMPLICATIONS: Study findings highlight the need to evaluate adolescent sealant delivery programs to improve the uptake of 2M sealants.

Adoption and Effect of Sealants for Occlusal Noncavitated Caries in a Large Dental Network in the USA.

INTRODUCTION: Dental sealants applied to occlusal pit-and-fissure surfaces have been shown to prevent caries and arrest occlusal noncavitated carious lesions (NCCLs). The American Dental Association (ADA) recommends that oral healthcare providers apply sealants on occlusal NCCLs. Though the evidence is clear that sealants are effective, few studies have examined the adoption of the ADA guideline by dentists and the duration of protection provided by sealants in a large real-world setting. METHODS: This study used observational electronic health record (EHR) data from a network of dental clinics to follow teeth over a 2 year time period from when they were diagnosed as having an occlusal NCCL until either they were treated with a restoration or the time period ended with no restoration. The objectives of the study were to determine: (1) the degree to which dentists adopted the guideline, (2) whether the duration of protection was different for teeth that received a sealant from teeth that did not receive a sealant, and (3) whether dentists' experience placing sealants was associated with the duration of protection. RESULTS: Overall, there were 7,299 teeth in the sample. Of those, dentists restored 591 teeth and applied sealants on 164. The sealant application rate for eligible teeth was 2.2%. Sealant application was associated with provider, with 1.9% of providers placing more than half of the sealants. By the end of the observation period, the proportion of teeth progressing to restorations was 8.2% for teeth that had not received a sealant and 3.0% for teeth that had received one (RR = 0.37; 95% CI: 0.16-0.88; p = 0.02). Multilevel survival analysis showed that teeth that had not received a sealant were restored sooner than teeth that had received a sealant (aHR = 0.11; 95% CI: 0.03-0.36; p < 0.01). Overall, teeth that received a sealant had an 89% reduced hazard of restoration within 2 years compared with teeth that did not receive sealants. CONCLUSION: This study found that by arresting decay, the presence of sealants led to fewer restorations and delayed restorations compared with teeth not receiving a sealant or restoration in the 2 years following diagnosis of occlusal NCCL in clinical settings.

Usefulness and Safety of Gelatin-Thrombin Matrix Sealants in Minimally Invasive Microscopic Discectomy.

Objective This study aimed to evaluate the usefulness and safety of gelatin-thrombin matrix sealants (GTMSs) in minimally invasive microscopic discectomy, a surgical procedure commonly used to treat lumbar disc herniation. Materials and Methods Out of 484 patients who underwent minimally invasive microscopic discectomy between April 2018 and December 2022, 35 patients with a history of surgery at the same level were excluded, resulting in a total of 449 patients included in the study. Among them, 316 patients were treated using GTMS, whereas 133 were treated using collagen-based absorbable local hemostatic agents. Patient characteristics, surgical duration, intraoperative blood loss, postoperative drainage volume, intraoperative dural injury, and incidence of postoperative epidural hematoma were analyzed and compared between the two groups. Results No significant differences in patient demographics were observed between the two groups, except for activated partial thromboplastin time and prothrombin time. Although there were no significant differences in the mean surgical time and intraoperative blood loss between the two groups, they tended to be shorter and less in the GTMS group (56.3 ± 20.2 vs. 58.2 ± 20.4 minutes [ p = 0.36] and 10.0 ± 15.4 vs. 11.8 ± 8.3 g [ p = 0.20]). The volume of postoperative drainage was significantly lower in the GTMS group than that in the comparison group (35.3 ± 21.8 vs. 49.5 ± 34.1 g [ p < 0.01]). There was a trend indicating a difference in the number of intraoperative dural injuries and the need for reoperation due to postoperative epidural hematoma (2 vs. 3 ± 20.4 minutes [ p = 0.21] and 1 vs. 2 [ p = 0.16]). Conclusion The use of a GTMS in minimally invasive microscopic discectomy appears to be beneficial in reducing postoperative drainage volume. It has also been shown that it may improve clinical outcomes such as intraoperative dural injury and postoperative epidural hematoma. Furthermore, further consideration of the medical economic impact is required.

Clinical Effectiveness of Air Abrasion When Compared to Conventional Acid-etching Technique in Enhancing the Retention of Pit and Fissure Sealants: A Systematic Review.

Purpose: The purpose of our study was to perform a systematic review to assess and compare the effectiveness of the air abrasion technique with that of the conventional acid-etching technique performed before the placement of pit and fissure sealants. Materials and methods: A search of studies was conducted in May 2021 using PubMed, Cochrane Library, and Google Scholar databases. Clinical trials in the English language between 1997 and 2019 were included. The quality of the studies was analyzed using the Cochrane Collaboration tool. Results: The search retrieved 276 references, out of which seven studies were included for a qualitative analysis. In these seven studies, the risk of bias across the Cochrane tool's domains varied from low to high. All the included studies considered acid-etching as a comparator to air abrasion technique either used alone or as an adjunct to acid-etching technique. Conclusion: When coverage of sealants or their retentivity was compared at different time intervals, it was more in the acid-etching group than in the air abrasion group. Similarly, carious lesions were seen more in the air abrasion group than in the acid-etching group. The air abrasion technique followed by acid-etching brought superior retention properties of sealants than the acid-etching technique alone. How to cite this article: Bhadule SN, Kalaskar R, Kalaskar A, et al. Clinical Effectiveness of Air Abrasion When Compared to Conventional Acid-etching Technique in Enhancing the Retention of Pit and Fissure Sealants: A Systematic Review. Int J Clin Pediatr Dent 2024;17(3):377-384.

Comparison of the Effect of Different Bonding Agents on the Microleakage of Two Hydrophilic Pit and Fissure Sealants: An Ex Vivo Study.

Aim: To compare the impact of fifth- and seventh-generation bonding agents on the microleakage between Embrace WetBond sealants and Ionoseal. Materials and methods: Forty extracted human premolar teeth were used for the study and grouped according to different sealants and bonding agents-group I: Embrace WetBond sealant with fifth-generation bonding agent; group II: Embrace WetBond sealant with seventh-generation bonding agent; group III: Ionoseal with fifth-generation bonding agent; group IV: Ionoseal with seventh-generation bonding agent. For microleakage evaluation, all the teeth were subjected to invasive sealant placement using the respective sealant materials in combination with bonding agents as specified. The treated teeth were stored at 37°C for 24 hours and then thermocycled for 100 cycles at temperatures of 5°C and 55°C with a dwell time of 30 seconds. In order to assess microleakage, the samples were immersed in 0.2% methylene blue dye for 24 hours, then sectioned in buccolingual direction, and evaluated under stereomicroscope. Results: The mean microleakage scores in group III were highest at 0.90 ± 0.57, while the least was in group IV at 0.30 ± 0.68, indicating that Ionoseal with seventh-generation bonding agent was the most effective. However, when the mean microleakage scores of the four groups were compared using Kruskal-Wallis test, it indicated that the differences were not statistically significant. How to cite this article: V R, P P, A A, et al. Comparison of the Effect of Different Bonding Agents on the Microleakage of Two Hydrophilic Pit and Fissure Sealants: An Ex Vivo Study. Int J Clin Pediatr Dent 2024;17(3):270-273.

The influence factors on pit and fissure sealing behavior of 12-year-old children: a cross-sectional study in Zhejiang, China.

BACKGROUND: In the 21st century, dental caries remains a global burden, particularly severely affecting the growth and quality of life of 12-year-old children. Fortunately, pit and fissure sealing (PFS) procedures can effectively prevent molars from caries. Hence, this study focused on the relationship between PFS and oral epidemiological factors in 12-year-old children. METHODS: A cross-sectional survey was conducted in 12-year-old children from 11 cities in Zhejiang Province. Their dental conditions were collected through questionnaires, as well as basic information such as relevant family information, oral health knowledge and behavior. Then, logistic regression analysis was used to identify the influencing factors associated with PFS. RESULTS: A total of 1204 children were included, with 252 in the PFS group and 952 in the non-PFS group. There were significant differences between the two groups in terms of decayed, missing and filled teeth (DMFT) score, first permanent molar DMFT score, residential area, educational level of parents, tooth-brushing frequency, use of dental floss, oral examination in a medical institution, having taken courses on oral health care, as well as having knowledge that tooth brushing could effectively prevent gingival inflammation, PFS could protect teeth, and oral disease may affect general health. According to further logistic regression analysis, the independent factors influencing PFS included use of dental floss [odds ratios (OR) = 1.672, 95% confidence intervals (CI) = 1.235-2.263, P = 0.001], having taken courses on oral health care (OR = 0.713, 95% CI = 0.515-0.988, P = 0.042), having knowledge that tooth brushing is effective in preventing gingival inflammation (OR = 0.627, 95% CI = 0.389-0.987, P = 0.044) and having knowledge that PFS can protect teeth (OR = 0.589, 95% CI = 0.438-0.791, P < 0.001). CONCLUSION: PFS can reduce the mean DMFT score of 12-year-old children. Independent influencing factors of PFS consist of use of dental floss, having taken courses on oral health care, oral health behavior and knowledge level.

ARE PIT AND FISSURE SEALANTS EFFECTIVE IN PREVENTING AND ARRESTING OCCLUSAL CARIES IN PRIMARY AND PERMANENT TEETH? AN OVERVIEW OF SYSTEMATIC REVIEWS.

OBJECTIVES: To compile the evidence from systematic reviews (SRs) about the use of sealants for preventing and arresting pit and fissure occlusal caries in primary and permanent teeth. MATERIALS AND METHODS: A search was performed in six databases and gray literature up to May 2023. Systematic reviews (SRs) that included randomized trials (RCTs) and nonrandomized clinical trials (n-RCTs) aiming to answer the PICO-based focused question "are pit and fissure sealants (I) more effective than other interventions, control or no treatment (C) in preventing and arresting occlusal caries (O) in primary and permanent teeth (P)?", were included. The methodological quality was assessed using the AMSTAR-2. The overlap between reviews was calculated (corrected covered, CCA). RESULTS: Among the 25 included SRs, 18 underwent meta-analysis. Eighteen SRs considered sealing enamel caries lesions, one considered sealing dentine caries, and six considered both. Seventeen SRs were devoted to preventive sealing (RCT only, n = 12; RCT and n-RCT, n = 5), while eight were devoted to prevention and arrest of dental caries (RCT only, n = 5; RCT and n-RCT, n = 3). Nine SRs showed positive results for the primary dentition, and the most frequent periods of follow-up were at least 6 (n = 5) and 12 months (n = 4). According to our meta-analysis, a significant association between resin-based sealants (RBS) and dental caries prevention was detected at 6 months (n = 1) and over longer follow-up periods (n = 4), and the DMFT and dmft indices decreased (n = 2). RBS was better than fluoride varnish at preventing dentine caries (n = 1). A lower caries incidence rate was observed in the resin-modified glass ionomer group at 6 months (n = 1). Overall, the sealants were superior (n = 11), similar (n = 21), or inferior (n = 1) to the other treatments. The AMSTAR-2 scores for studies on preventive sealing were critically low (n = 8), low (n = 6), moderate (n = 1) and high (n = 2) for studies on preventive sealing and critically low (n = 5), low (n = 2) and high (n = 1) for studies on the prevention and arrest of caries lesions. The overlap was low (CCA = 3%). CONCLUSION: This overview suggests that pit and fissure sealants are not inferior to other interventions in preventing and arresting dental caries lesions in primary and permanent teeth.

Comparison of the clinical performance of self-adhering flowable composite and resin-based pit and fissure sealant: a randomized clinical trial in pediatric patients.

BACKGROUND: Self-adhering flowable composites are an innovative step in reducing the chair time of pit and fissure sealant treatment. This study aimed to compare the clinical performance of self-adhering flowable composite (SELF-ADH) and resin-based pit and fissure sealant (RBs). METHODS: This is a double-blinded, randomized, split-mouth clinical trial conducted on 80 fully erupted permanent mandibular first molars from 40 children aged 6 to 12 years. For each participant, two permanent molars were randomly treated with SELF-ADH or RB. All sealants were assessed at 3, 6, and 12-month follow-ups considering retention, marginal integrity, marginal discolouration, colour matching, surface texture, and caries recurrence. To analyse the data, logistic regression and Fisher's exact tests were used (significance level P < 0.05). RESULTS: At the 12-month follow-up, the number of fully retained sealants in the SELF-ADH group was significantly higher than that in the RB group (P < 0.001). Also, The success rate of marginal integrity in the SELF-ADH group was significantly greater than the the RB group (P = 0.031), while the rate of sealant marginal discolouration was higher in the RB group (P < 0.001). The incidence of recurrent caries in teeth with partial loss of sealant in both groups (P = 0.004, P < 0.001) increased significantly over time. CONCLUSION: The retention and marginal integrity of the self-adhering flowable composite were significantly greater than those of the resin-based sealant. Therefore, due to the small number of work steps, flowable self-adhering composites can be used as alternatives to resin-based pit and fissure sealants. TRIAL REGISTRATION: This study was approved by the Ethics Committee of Kerman University of Medical Sciences with the code IR.KMU.REC.1399.556 and Iraninan Registry of Clinical Trials (IRCT) code IRCT20180521039763N4, as well as full compliance with the Declaration of Helsinki.

In vivo comparative assessments on pleural adhesive effects of three commercially available sealants.

Objective: Surgical sealant, which is used for the reinforcement of suture lines, has been widely used in lung-resection surgeries with the aim of reducing postoperative morbidity; however, it may exacerbate surgical-site adhesion, creating the risks of restrictive thoracic movement and a difficult entrance for redo operation. We aimed to assess the pleural adhesive effects of 3 frequently used surgical sealants, (1) fibrin glue (fibrin), (2) a composite of polyethylene glycol and human serum albumin (PEG/HSA), and (3) bioabsorbable polyglycolic acid felt (PGA), in an in vivo setting. Methods: Eighty-one rats were randomly assigned to 3 experimental groups-fibrin, PEG/HSA, and PGA. After intrapleural application of the sealants, the extent and severity of adhesion and inflammation were quantitatively compared among the 3 groups at 2, 4, and 8 weeks. Results: The scores for both the extent and severity of adhesion were significantly greater in the PGA group than the other 2 groups throughout postoperative period (P < .001 for all). Although both scores in the PES/HSA and fibrin groups were 0 at 2 weeks, the fibrin group showed significantly greater scores than the PES/HSA group thereafter (P < .001 for all). Trends in inflammation scores were similar of those of adhesion scores, favoring the PES/HSA group followed by the fibrin group (P < .001 for all). Conclusions: Among 3 commonly used sealants, PEA/HSA showed least degree of adhesion/inflammation compared with fibrin and PGA, whereas PGA demonstrated greatest degrees of adhesion/inflammation throughout a postoperative course of 8 weeks in an in vivo model.

Comparative Evaluation of the Apical Sealability of AH Plus and RealSeal SE Using 5.25% Sodium Hypochlorite with 17% EDTA and 10% Citric Acid as Irrigants-An In Vitro Study.

Background: Apical microleakage is considered to be a common reason for the clinical failure of endodontic therapy. Three dimensional sealing of the root canal is one of the main goals of endodontic treatment and is essential for preventing reinfection of the canal and for preserving the health of the periapical tissues, Recently Epoxy resin sealers have been used because of their reduced solubility apical seal and micro-retention to root dentine. Aim and Objective: This in vitro study was done to evaluate and compare the apical sealability of AH Plus and RealSeal SE using 5.25% sodium hypochlorite with 17% EDTA and 10% citric acid as irrigants. Materials and methods: 44 single-rooted premolars were selected and the teeth are randomly divided into 4 groups (n=10) and 2 control groups (n=2). The extent of dye penetration, from the apical to the coronal part of the root canal, was assessed using a stereomicroscope at 10x magnification for all groups.One-way ANOVA and Kruskal-Wallis tests were performed to compare statistically significant differences among the groups, using SPSS software version 10.0. Results: Group IV (Citric acid + RealSeal SE) showed a statistically lower mean microleakage when compared to all other groups. Conclusion: From, the present study, it was concluded that, RealSeal SE sealer with 10% citric acid as irrigant (group IV) showed better apical sealability followed by RealSeal SE sealer with 17% EDTA as irrigant (group III), when compared to AH Plus groups which showed least sealability.

In vitro analysis of material micro-leakage in pit and fissure sealants.

A preferable choice of material offers superior resistance against micro-leakage for clinical applications in preventing dental caries in pits and fissures is of interest. A total of 45 extracted human premolars were cleaned, stored in a saline solution, and randomly divided into three groups, each intended for treatment with one of the sealants: Fuzi VII, ClinPro, and Embrace Wetbond. The application of the sealants followed the manufacturers' instructions strictly. The teeth were subjected to thermal cycling to simulate oral conditions. Marginal micro-leakage was then assessed by dye penetration method using a 0.5% methylene blue dye. Teeth were sectioned, and dye penetration was measured under a stereomicroscope. The results showed that all the tested materials exhibited some degree of micro-leakage. Within the limitations of this In vitro study, it was concluded that Embrace Wetbond exhibited superior performance in terms of minimizing marginal micro-leakage among the tested pit and fissure sealants.

Cellulose fibres enhance the function of hemostatic composite medical sealants.

Tissue adhesives and sealants offer promising alternatives to traditional wound closure methods, but the existing trade-off between biocompatibility and strength is still a challenge. The current study explores the potential of a gelatin-alginate-based hydrogel, cross-linked with a carbodiimide, and loaded with two functional fillers, the hemostatic agent kaolin and cellulose fibres, to improve the hydrogel's mechanical strength and hemostatic properties for use as a sealant. The effect of the formulation parameters on the mechanical and physical properties was studied, as well as the biocompatibility and microstructure. The incorporation of the two functional fillers resulted in a dual micro-composite structure, with uniform dispersion of both fillers within the hydrogel, and excellent adhesion between the fillers and the hydrogel matrix. This enabled to strongly increase the sealing ability and the tensile strength and modulus of the hydrogel. The fibres' contribution to the enhanced mechanical properties is more dominant than that of kaolin. A combined synergistic effect of both fillers resulted in enhanced sealing ability (247%), tensile strength (400%), and Young's modulus (437%), compared to the unloaded hydrogel formulation. While the incorporation of kaolin almost did not affect the physical properties of the hydrogel, the incorporation of the fibres strongly increased the viscosity and decreased the gelation time and swelling degree. The cytotoxicity tests indicated that all studied formulations exhibited high cell viability. Hence, the studied new dual micro-composite hydrogels may be suitable for medical sealing applications, especially when it is needed to get a high sealing effect within a short time. The desired hemostatic effect is obtained due to kaolin incorporation without affecting the physical properties of the sealant. Understanding the effects of the formulation parameters on the hydrogel's properties enables the fitting of optimal formulations for various medical sealing applications.

Inflammatory response induction as a result of BioGlue adhesive application in cardiac surgery - a review of the literature.

BioGlue is one of the best-known substances used as a tissue adhesive during surgical procedures, especially in cardiac surgery. Inappropriate use of BioGlue can result in inflammation in both the heart and adjacent tissues after its intraoperative application. Inflammation caused by BioGlue in cardiac surgery is a topic that has been discussed by numerous authors in scientific studies, meta-analyses and evaluations of this tissue adhesive. However, there is a lack of collected knowledge on this subject in a single concise article. The purpose of this paper is to review the current medical knowledge on the use of BioGlue in cardiac surgery versus the induction of an inflammatory response. Our paper discusses the details of this problem according to the most recent scientific reports.

The Assessment of Resin-Based Composite Sealants' Effectiveness in Arresting Non-Cavitated Dentin Carious Lesions (ICDAS 3)-A 12 Month Follow-Up Preliminary Study.

Background and Objectives: The therapeutic management of carious lesions remains a significant focus for researchers, given their persistently high prevalence despite being largely preventable. This study aimed to compare the effectiveness of a composite resin-based sealant material in halting extended non-cavitated dentin carious lesions when used therapeutically versus preventively on caries-free teeth over a period of twelve months. Materials and Methods: out of the 236 children examined, 45 were excluded from the study due to non-compliance with the inclusion criteria. Thus, the study included 191 children aged 10-12 years, and 764 molars in total. Results: among these molars, 171 were caries-free (ICDAS II code 0), forming the Control group, while 180 molars were classified with an ICDAS II score of 3, forming the Study group. All molars were sealed and evaluated at 6- and 12-month follow-up intervals. Both intervals revealed statistically significant differences (p < 0.05) in sealant retention and carious lesion development between sound (ICDAS code 0) and decayed (ICDAS code 3) teeth. Conclusions: the findings did not support the effectiveness of sealants in halting non-cavitated dentin carious lesions classified as ICDAS II with code 3 compared to their preventive application in sound teeth classified as ICDAS II with code 0.

Detection of pit and fissure sealant microleakage using quantitative light-induced fluorescence technology: an in vitro study.

This in vitro study aimed to evaluate the feasibility of quantitative light-induced fluorescence (QLF) technology for detecting the presence and severity of microleakage of pit and fissure sealants. The areas of interest (AOIs) were 160 pits and fissures of 40 extracted permanent teeth. Fluorescent images were acquired using a QLF device, and the maximum fluorescence loss ΔFmax of each AOI was analyzed. After staining and cross-sectioning of the teeth, histological dye penetration was scored on a scale of 0 to 3. The relationship between ΔFmax and microleakage depth was analyzed, and the areas under the curve (AUCs) were calculated. The │ΔFmax│ increased as microleakage depth increased. The ΔFmax values of microleakage areas showed a strong significant correlation with the histological scores of dye penetration (r = - 0.72, P = 0.001). AUC analysis showed a high diagnostic accuracy for microleakage depth (AUC = 0.83-0.91). The highest AUC of 0.91 was found when differentiating the outer half microleakage of the sealant (histological score 0 vs. 1-3). QLF technology is effective in assessing the presence and severity of microleakage, suggesting its potential for noninvasive detection and monitoring of sealant microleakage in clinical settings.

Efficacy and safety of fibrin sealant application in patients undergoing thyroidectomy: a systematic review and meta-analysis.

Various studies have focused on the application of fibrin sealants (FS) in thyroid surgery. Utilizing a meta-analysis, this systematic review analyzed the findings of recent randomized controlled trials on the safety and efficacy of FS in patients who underwent thyroidectomy. The Cochrane Library, Web of Science, Embase, PubMed, and Medline databases were searched for relevant studies, without any language restrictions. Seven randomized controlled trials were included in the originally identified 69 studies. Overall, 652 patients received FS during thyroid surgery; their outcomes were compared with those of conventionally treated patients. The primary outcomes were total volume of wound drainage, length of hospitalization, and operative time. Significant differences were observed in the total volume of wound drainage (mean deviation (MD): -29.75, 95% confidence interval (CI): -55.39 to -4.11, P = 0.02), length of hospitalization (MD: -0.84, 95% CI: -1.02 to -0.66, P < 0.00001), and surgery duration (MD: -7.60, 95% CI: -14.75 to -0.45, P = 0.04). Secondary outcomes were seroma and hypoparathyroidism development. The risk of hypoparathyroidism did not differ between the FS and conventional groups (I = 0%, relative risk = 1.31, P = 0.38). Analysis of "seroma formation that required invasive treatment" indicated that FS showed some benefit (I2 = 8%, relative risk 0.44, P = 0.15). Heterogeneity among the different trials limited their conclusions. The meta-analysis showed that although FS use did not significantly reduce seroma or hypoparathyroidism incidence in patients after thyroidectomy, it significantly reduced the total drainage volume, length of hospitalization, and duration of surgery.

Epoxy resin-based root canal sealers: An integrative literature review.

The correct obturation of the root canal system achieved by means of a core and a cement is essential for the success of endodontic treatment. There are several root canal cements (RCCs) on the market; however, because of their excellent characteristics, epoxy resin-based sealers (ERBSs) have been widely used. The main aim of this review was to analyze and integrate the available information on different ERBSs. An electronic search was performed in the PubMed and Scopus databases, using "epoxy resin" AND "root canal treatment", and "epoxy resin" AND "endodontics" as search terms. In general, ERBSs have good flow properties, film thickness, solubility, dimensional stability, sealing capacity, and radiopacity. They are also able to adhere to dentin while exhibiting low toxicity and some antibacterial effects. However, their main disadvantage is the lack of bioactivity and biomineralization capability. A large number of ERBSs are available on the market, and AH Plus keeps being the gold standard RCC. Yet, information on many of them is limited or non-existent, which could be due to the fact that some of them are relatively new. The latter emphasizes the need for relevant research on the physicochemical and biological properties of some ERBSs, with the aim of supporting their clinical use with sufficient evidence via prospective and long-term studies.

Improvements in appropriate placement of dental sealants after implementation of a clinical decision support system.

BACKGROUND: Dental sealants are effective for the prevention of caries in children at elevated risk levels, and increasing the proportion of children and adolescents who have dental sealants on 1 or more molars is a Healthy People 2030 objective. Electronic health record (EHR)-based clinical decision support systems (CDSSs) have the ability to improve patient care. A dental quality measure related to dental sealant placement for children at elevated risk of caries was targeted for improvement using a CDSS. METHODS: A validated dental quality measure was adapted to assess a patient's need for dental sealant placement. A CDSS was implemented to advise care team members whether a child was at elevated risk of developing caries and had sealant-eligible first or second molars. Data on dental sealant placement at examination visits during a 5-year period were analyzed, including 32 months before CDSS implementation and 28 months after CDSS implementation. RESULTS: From January 1, 2018, through December 31, 2022, the authors assessed 59,047 examination visits for children at elevated risk of developing caries and with sealant-eligible teeth. With the implementation of a CDSS and training to support the clinical care team members in September 2020, the appropriate placement of dental sealants at examination visits increased from 27% through 60% (P < .00001). CONCLUSIONS: Integration of a CDSS into the EHR as part of a quality improvement program was effective in increasing the delivery of sealants in eligible first and second molars of children aged 5 through 15 years and considered at high risk of developing caries. PRACTICAL IMPLICATIONS: An EHR-based CDSS can be implemented to improve standardization and provide timely and appropriate patient care in dental practices.

Clinical Evaluation of the Retention of Four Different Pit and Fissure Sealants on the First Permanent Molars - An Original Research.

Objective: In this study, the retention rates of four different pit and fissure sealant materials on the first permanent molars were clinically assessed and compared. Materials and Methods: A total of 120 kids aged 7 to 10 participated in a randomized controlled experiment. On their first permanent teeth, the subjects each got one of the four sealant materials (A, B, C, or D). Over the course of 24 months, the retention rates were evaluated every 6 months. The Chi-square test and Kaplan-Meier survival analysis were used for statistical analysis. Results: At 6, 12, 18, and 24 months, the following retention rates were observed overall: A (85%, 78%, 65%, 52%), B (90%, 82%, 70%, 60%), C (78%, 70%, 55%, 42%), and D (95%, 88%, 75%, 62%). At each time point, the sealant materials showed significant variations in retention rates (P 0.05). While sealants A and C showed lower retention rates, sealant D showed the best retention rates, followed by sealant B. Conclusion: This study shows that different materials have different retention rates for pit and fissure sealants on first permanent molars. Higher retention rates for sealants D and B suggest that they may be superior than sealants A and C. These results highlight how crucial it is to choose the right sealant materials to guarantee long-term retention and effectiveness in avoiding dental cavities.