Challenges in conducting clinical research in primary care dentistry.

The integration of dentistry into primary health care is crucial for promoting patient well-being. However, clinical studies in dentistry face challenges, including issues with study design, transparency, and relevance to primary care. Clinical trials in dentistry often focus on specific issues with strict eligibility criteria, limiting the generalizability of findings. Randomized clinical trials (RCTs) face challenges in reflecting real-world conditions and using clinically relevant outcomes. The need for more pragmatic approaches and the inclusion of clinically relevant outcomes (CROs) is discussed, such as tooth loss or implant success. Solutions proposed include well-controlled observational studies, optimized data collection tools, and the integration of artificial intelligence (AI) for predictive modelling, computer-aided diagnostics and automated diagnosis. In this position paper advocates for more efficient trials with a focus on patient-centred outcomes, as well as the adoption of pragmatic study designs reflecting real-world conditions. Collaborative research networks, increased funding, enhanced data retrieval, and open science practices are also recommended. Technology, including intraoral scanners and AI, is highlighted for improving efficiency in dental research. AI is seen as a key tool for participant recruitment, predictive modelling, and outcome evaluation. However, ethical considerations and ongoing validation are emphasized to ensure the reliability and trustworthiness of AI-driven solutions in dental research. In conclusion, the efficient conduct of clinical research in primary care dentistry requires a comprehensive approach, including changes in study design, data collection, and analytical methods. The integration of AI is seen as pivotal in achieving these objectives in a meaningful and efficient way.

Airborne-particle Abrasion and Dentin Bonding: Systematic Review and Meta-analysis.

CLINICAL RELEVANCE: The literature reviewed suggests that airborne particle abrasion has no negative effects on the bond strength of resin-based materials to dentin and that a positive influence on dentin bond strength was only achieved in specific air-abrasion conditions. SUMMARY: In this systematic review the authors investigated how airborne-particle abrasion (APA) using aluminum oxide affects the bond strength of resin-based materials to dentin. The search was performed in three databases. In vitro studies (Type of study) comparing the bond strength of resin-based materials (Outcome) to air-abraded (Intervention) compared with non-air-abraded (Comparison) human dentin (Population) were included (the PICOT elements are given parenthetically). From 5437 unique articles, 65 were read in full, 33 were included in the qualitative synthesis, and 32 were included in the meta-analysis. Methodologic quality and risk of bias were assessed. Comparisons were performed between air-abraded and control dentin groups by adopting a random-effects model (α=0.05). Additional analyses were carried out for the different parameters used in APA: type of surface treatment in the control group, particle size, air pressure, and APA duration. The bond strength to air-abraded dentin was favored only when the control surface was treated with a hand excavator. For particle size, APA was favored when the particle size was >30 µm and the controls were no treatment or hand excavator or when the particle size was ≤30 µm and the control was bur. In addition, the results favored air-abraded groups only when the pressure was > 5 bar and bur was used in the control group. No significant differences were observed for duration of APA. No comparison on bond strength considering the presence of aging conditions was possible in the included studies due to the low number of studies that aged the specimens. In conclusion, APA had no negative effects on the bond strength of resin-based materials to dentin and was able to improve the dentin bond strength only when the particle size was > 30 µm and air pressure was > 5 bar. PROSPERO registration protocol: CRD42018096128.

Intraoral Repair of Direct and Indirect Restorations: Procedures and Guidelines.

The service life of defective direct or indirect restorations could be prolonged by repair or relayering actions where durable adhesion of resin-based composite materials is established for longevity of repairs. The advances in adhesive technologies have introduced several surface conditioning concepts to adhere resin composites onto different restorative materials. The purpose of this report is to summarize reasons for failure, survival of repaired reconstructions, elaborate upon types and mechanisms of available surface conditioning methods, and present operative dentists with practical guidelines for intraoral repair procedures.

Case Report: A Predictable Technique to Establish Occlusal Contact in Extensive Direct Composite Resin Restorations: The DSO-Technique.

This paper describes the application technique of direct shaping by occlusion (DSO) for large composite restorations including the entire occlusal surface. For this technique, matrix bands and wedges are inserted without interference with antagonists in the desired occlusion. The final increment of soft-composite resin is shaped by letting the patient occlude on the uncured composite. Due to the nature of the technique, special care has to be taken for moisture control and handling of contamination. The procedure, advantages, and limitations of the technique are discussed.