Morphology and root canal configuration of maxillary canines: a systematic review and meta-analysis.

BACKGROUND: This study assessed the internal morphology of maxillary canines (MxC) through a systematic review of existing literature. METHODS: Research articles up to June 2024 were retrieved from five electronic databases (MEDLINE via PubMed, Embase, Scopus, LILACS, and Cochrane). Predefined search terms and keywords were used, and potential studies were identified by cross-referencing and bibliographies of the selected articles reviewed. RESULTS: Two hundred studies were identified, 73 duplicates were removed, 127 records were screened, and 113 were removed after consultation of title and abstract. After full-text consultation and hand searching, finally 22 studies were included. Using the method for describing the root canal configuration (RCC) of Briseño Marroquín et al. (2015) and Vertucci (Ve) (1984), the most frequently reported RCC of MxC were 1-1-1/1 (Ve I, 75.4-100%), 2-2-1/1 (Ve II, 0.1-20%), 1-2-1/1 (Ve III, 0.1-11.6%), 2-2-2/2 (Ve IV, 0.1-0.4%), 1-1-2/2 (Ve V, 0.1-2.4%), 2-1-2/2 (Ve VI, 0.5-1.2%), and 1-2-1/2 (Ve VII, 0.1-0.2%). The meta-analysis of six studies (Europe/Asia) showed that a significantly higher number of RCC of 2-2-1/1 (Ve II) (OR [95%CI] = 1.34 [0.53, 3.41]), 1-2-1/1 (Ve III) (OR [95%CI] = 2.07 [1.01, 4.26]), and 1-1-2/2 (Ve V) (OR [95%CI] = 2.93 [1.07, 8.07]), were observed in males, and 2-2-2/2 (Ve IV) (OR [95%CI] = 0.08 [0.00, 4.00]) in females. No sex differences in the RCC of 1-1-1/1 (Ve I) and 1-2-1/2 (Ve VII) were observed. CONCLUSIONS: Cone beam computed tomography is the most frequently used method for research on the RCC of MxC. Despite the high prevalence of type 1-1-1/1 (Ve I) RCC in MxC, clinicians should remain vigilant for more complex and sex-differentiated patterns in up to 25% of cases to prevent endodontic treatment complications or failures.

Longevity of posterior direct versus indirect composite restorations: A systematic review and meta-analysis.

OBJECTIVES: The goal of this systemic review and meta-analysis was to compare the longevity of direct and indirect composite restorations in posterior teeth. DATA: Randomized controlled trials (RCT) investigating direct and indirect composite restorations in permanent posterior teeth. SOURCES: Three electronic databases (PubMed, CENTRAL (Cochrane) and Embase) were screened. No language or time restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Risk of bias and level of evidence was graded using Risk of Bias 2.0 tool and Grade Profiler 3.6. RESULTS: A total of 3056 articles were found by electronic databases. Finally, five RCTs were selected. Overall, 627 restorations of which 323 were direct and 304 indirect composite restorations have been placed in 279 patients (age: 28-81 years). The highest annual failure rates (AFR) were found for indirect restorations ranging from 0 % to 15.5 %. Lower AFR were found for direct restorations ranging from 0 % to 5.4 %. The most frequent failures were found to be chipping and fracture of the restoration followed by caries. Meta-analysis revealed that the failure rate for direct restorations was significantly lower than for indirect restorations (Risk Ratio (RR) [95 %CI] = 0.61 [0.47; 0.79]; very low level of evidence). Furthermore, all studies showed a high risk of bias. CONCLUSION: Direct and indirect composite restorations can be recommended for large class II cavities including cusp coverage in posterior teeth for single tooth restoration. Meta-analysis revealed significantly lower relative risk to fail for direct composite restorations than for indirect restorations but results are with high risk of basis.

Decision making and management of root caries: A practice-based survey.

OBJECTIVES: With increasing life expectancy and improved preventive measures, teeth are retained longer, leading to a rise in prevalence of root caries lesions (RCL). However, little is known about how dentists manage this condition. The present survey aimed to evaluate the knowledge of Swiss dentists on decision making and management of RCL. METHOD: The survey evaluated dentists' knowledge, clinical routines, and demographics concerning RCL. Dentists were contacted via email and local newsletters, and 383 dentists from 25 (out of 26) cantons responded. Mann-Whitney U test, χ2 test, intraclass correlation coefficients, Spearman correlation and Chi Square were used. RESULTS: The dentists had a mean(SD) working experience of 22.5(12) years. Most dentists correctly classified an inactive (67%) and an active (81%)RCL. Although the inactive lesion did not call for restorative treatments, 61% of the dentist declared they would restore it. From the active lesion,83% would restore it. The invasive treatments leaned toward complete caries excavation with composite resin as preferred restorative material. There were significant correlations between material choice and expected success rates. Among the non-invasive options, oral hygiene instructions and (highly-)fluoridated toothpaste were favored. Most dentists declared having a recall system for such patients, with biannual follow-ups preferred. The dentists' place of education significantly influenced restorative decisions (p < 0.001), while participants' age (≥60years) impacted activity status (p = 0.048) and restorative decisions (p = 0.02). CONCLUSION: Material preferences for non-invasive or invasive management varied greatly and there were minimal differences in the management of inactive or an active RCL. Moreover, diagnosing active lesions appeared easier than diagnosing inactive ones. CLINICAL SIGNIFICANCE: Despite diverse material preferences for (non-)invasive treatments, a strong positive correlation existed between the chosen restorative material and its expected 2-year success rate. Moreover, diagnosing active lesions appeared easier than diagnosing inactive ones. The outcome emphasis the need to align guideline recommendations with their application in private dental practices.

Effects of Hydroxyapatite-Containing Toothpastes on Some Caries-Related Variables: A Randomised Clinical Trial.

OBJECTIVES: This randomised clinical trial was designed and carried out with the aim to evaluate the capacity of fluoride-substituted hydroxyapatite (HAF) toothpaste to modulate oral microflora composition and biofilm acidogenicity in schoolchildren. METHODS: In all, 610 children (4 to 5 and 6 to 7 years) were enrolled. Four toothpastes were randomly administered during 24 months: 2 contained fluoride-substituted hydroxyapatite (HAF1000 and HAF1450; 1000 and 1450 ppmF) and magnesium-, strontium-, and carbonate-substituted hydroxyapatite in a chitosan matrix, and 2 were monofluorophosphate fluoridated toothpastes (F1000 and F1450; 1000 and 1450 ppmF). Caries lesions were assessed by International Caries Detection and Assessment System scores, supragingival plaque was sampled from the approximal sites between primary molars using sterile Gracey curettes for microbiological analysis, and plaque pH curves after sucrose challenge were assessed at baseline and reevaluated after 1 year and after 2 years. The minimum and maximum pH decrease was calculated for caries-free patients and participants with a caries lesion(s) at baseline and at the end of the experimental period (24 months). Differences amongst measurements were analysed with 1-way analysis of variance. RESULTS: During the trial, the minimum pH value increased statistically significantly in all groups; in HAF1000 and HAF1450, the increase was greatest. At the end of trial, in the 2 HAF groups all primary cariogenic bacteria were statistically significantly lower with respect to F groups (P = .03 for Streptococcus mutans and sobrinus, for Lactobacillus casei, and for Lactobacillus fermentum). CONCLUSIONS: The trial provides robust but still inconclusive evidence on the efficacy of HAF toothpastes compared to traditional fluoridated toothpastes to reduce caries risk factors and to prevent caries lesions.

Diagnosing and recording root caries: A survey among Swiss dentists.

OBJECTIVES: Despite the increase in the root caries prevalence, little is still known about how dentists manage this condition. The present study aimed to evaluate the knowledge of dentists on diagnosing and recording root caries lesions (RCL). METHODS: The survey consisted of three domains: (1) dentists' knowledge on diagnosing, recording and managing RCL; (2) information about their current general clinical routines; and (3) their demographics. The four Swiss Universities distributed the survey via e-mail lists for alumni or professionals participating in continuing education. The data was quality checked. Construct validity, internal reliability and intraclass correlation (ICC) were assessed. RESULTS: The survey was answered by 383 dentists from 25(out of 26) cantons [mean(SD) working experience: 22.5(12) years]. The majority replied that they see less than 5 patients with RCL per week, whereas 41 have at least 5 per week, and 40 % (157 dentists) do not distinguish RCL from coronal caries in their patients' medical records. When diagnosing active RCL, tactile sensation was the most predominant criterion (n = 380), whereas color (n = 224) and visual appearance (n = 129) of the lesion were less often selected. The most often chosen risk factors for RCL were poor oral hygiene and presence of biofilm.The responses were significantly influenced by the participants' place of education, their age and working area. CONCLUSION: The present survey highlights the huge diversity in diagnosing, recording and assessing risk factors of RCL. The benefits of an appropriate diagnosis, recording and management of risk factors of RCL should be highlighted in under- and postgraduate dental education. CLINICAL SIGNIFICANCE: A great diversity in diagnosing, recording and assessing risk factors of RCL was observed, which migh strongly impact how dentists manage RCL. The study emphasizes the necessity for intensive efforts to bridge the gap between guideline recommendations and their implementation in private dental practices.