Trends in dental service provision in Australia: 1983-1984 to 2009-2010.

OBJECTIVE: To investigate time trends in dental service provision. METHODS: A random sample of Australian dentists was surveyed by mailed questionnaires in 1983-1984, 1993-1994, 2003-2004, and 2009-2010 (response rates 67-76%). The service rate per visit was collected from a log of services. RESULTS: The rate of service provision per visit [rate ratio (RR)] increased from 1983-1984 to 2009-2010 for the service areas of diagnostic (RR=1.8; 1.6-1.9), preventive (RR=1.9; 1.6-2.1), endodontic (RR=2.1; 1.7-2.6), and crown and bridge (RR=2.9; 2.3-3.8), whereas prosthodontic services decreased (RR=0.7; 0.6-0.9). CONCLUSIONS: The profile of services provided by dentists changed over the study period to include less emphasis on replacement of teeth and more on diagnosis, prevention, and retention of natural dentitions.

Advances in light-curing units: four generations of LED lights and clinical implications for optimizing their use: Part 2. From present to future.

UNLABELLED: The first part of this series of two described the history of light curing in dentistry and developments in LED lights since their introduction over 20 years ago. Current second- and third-generation LED light units have progressively replaced their halogen lamp predecessors because of their inherent advantages. The background to this, together with the clinical issues relating to light curing and the possible solutions, are outlined in the second part of this article. Finally, the innovative features of what may be seen as the first of a new fourth-generation of LED lights are described and guidance is given for the practitioner on what factors to consider when seeking to purchase a new LED light activation unit. CLINICAL RELEVANCE: Adequate curing in depth is fundamental to clinical success with any light-activated restoration. To achieve this goal predictably, an appropriate light source needs to be combined with materials knowledge, requisite clinical skills and attention to detail throughout the entire restoration process. As dentists increasingly use light-cured direct composites to restore large posterior restorations they need to appreciate the issues central to effective and efficient light curing and to know what to look for when seeking to purchase a new light-curing unit.

What is different in operative dentistry?

There have been both large and small changes in operative dentistry in the last 30 years. Extension for prevention is no longer the mantra. The design features of amalgam preparations have moved into the smallest preparations possible to gain full access to the carious dentin. The default Class 2 amalgam or resin composite is a slot preparation with no preparation of the occlusal fissures. Class 1 fissure caries once implied the entire fissure system was to be cut out. Now only the known carious portions of the fissure are cut away, the tooth is restored, and the remaining fissures in that tooth are sealed. Resin composite preparations have no depth requirements and saucer shaped boxes are more favorable for lowering shrinkage strains on the bonded walls. Re-mineralization of proximal lesions that can be seen on a radiograph is now a proven successful service for many lesions that are at or just into the dentin by radiographic interpretation. The largest paradigm shift has been in the decision that in vital teeth with normal pulps soft dentin can be left over a vital asymptomatic pulp with every expectation that the direct restoration will be successful long term.

[Secular trends of caries prevalence among 6 and 12 year-old youths in the Netherlands]. / Trends in de prevalentie van cariës bij de 6- en 12-jarige jeugd in Nederland.

In order to gain insight into the development of caries prevalence and caries experience among Dutch youth, a meta-analysis was carried out on epidemiological caries data collected in 5 and 6 and 11 and 12 year-olds between 1980 and 2009. From the present analysis it appears that after the mid-1980's a halt occurred in the decline of caries experience in the primary dentition among 5 and 6 year-olds. At the same time, the percentage of children with a caries-free primary dentition who were covered by public health insurance or participated in institutions for youth dental care decreased. Among 11 to 12 year-olds there is no indication that the prevalence of caries in the permanent dentition has changed. Considering the high percentage of 12 year-olds with a caries-free permanent dentition, an additional improvement in oral health for this age-group will be difficult to achieve. The average restorative index of the primary dentition in 5-6 year-old children covered by public health insurance and children in The Hague appears not to have changed dramatically in the last 15 years.

[Cavity preparation and restorative therapy in articles, published by the Fogorvosi Szemle in the last hundred years]. / Az üregalakítás és a tömésterápia 100 éve a Fogorvosi Szemle publikációinak tükrében.

The aim of this review is to overview the development achieved in restorative therapy based on the publications in Fogorvosi Szemle during the past hundred years. The top quality of the restorative therapy was, and still has been the inlay, but nowadays the esthetic inlay -- fixed with adhesive material -- has priority over the gold inlay. The quality of amalgam fillings has been recently improved by using high-copper containing amalgam alloys. The development on the field of adhesive material and methods made it possible to give up the routine use of any conventional base material. The place of gingival wall of the cavity moved from subgingival position into supragingival position. The macro retention has been replaced by micro retention, and nowadays the cavity preparation prefers minimal-invasive techniques.

Oral Implants: The Paradigm Shift in Restorative Dentistry.

The discovery of the phenomenon "osseointegration," or functional ankylosis, has led to the development of oral implants with high clinical performance. Consequently, the placement of titanium implants has changed the paradigms of restorative dentistry. Implants are used to prevent placing reconstructions anchored on natural teeth when these are vital and intact. Furthermore, implants are suitable to improve subjective chewing function and to replace missing and strategically important abutments. The osseointegration process is characterized by a predictable sequence of healing events that encompass the formation of woven bone, parallel fibers, and lamellar bone and result in fully functional bone that will remodel throughout life. While the osseointegration facilitates the use of implants as prosthetic abutments, it has to be kept in mind that the peri-implant soft tissue may be subject to biological complications. This, in turn, may result in an infectious process that will jeopardize the osseointegration. Consequently, the monitoring of the peri-implant tissues is an important aspect, and early intervention in situations with peri-implant mucositis is mandatory for the prevention of peri-implantitis. Hence, it is evident that oral implants need lifelong maintenance care if their longevity is to be assured.

Clinical studies in restorative dentistry: New directions and new demands.

Clinical research of restorative materials is confounded by problems of study designs, length of trials, type of information collected, and costs for trials, despite increasing numbers and considerable development of trials during the past 50 years. This opinion paper aims to discuss advantages and disadvantages of different study designs and outcomes for evaluating survival of dental restorations and to make recommendations for future study designs. Advantages and disadvantages of randomized trials, prospective and retrospective longitudinal studies, practice-based, pragmatic and cohort studies are addressed and discussed. The recommendations of the paper are that clinical trials should have rational control groups, include confounders such as patient risk factors in the data and analysis and should use outcome parameters relevant for profession and patients.

Direct Posterior Restorations: A 13-Year Survey of Teaching Trends and Use of Materials.

OBJECTIVE:: The study aimed to evaluate teaching trends and use of materials in direct posterior restorations during a 13-year period in an Israeli dental school. METHODS:: Data registered in computerized files, relating to posterior restorations performed in the student clinic during the past 13 years (2004-2016), were collected. The restorative materials used (ie, amalgam vs composite), the type of tooth, and the number of surfaces restored were analyzed. RESULTS:: Data analysis included 26,925 restorations performed during 13 years. The number of one-surface composite restorations increased from 54.7% (n=330) to 81.9% (n=873). Two-surface restorations increased from 33.3% (n=254) to 64.3% (n=721). The percentage of amalgam restorations in three-surface restorations decreased from 72.08% to 51.34% (n=173). Analysis of tooth type showed that in 2016, the number of composite restorations performed in premolars reached 80.87% (n=723) and in molars 63.50% (n=1035). The percentage of composite restorations in the mandible and the maxilla was virtually equal. CONCLUSIONS:: A clear trend in favor of composite resin restorations is evident in the 13-year survey and suggests a move toward an amalgam-free era.

Clinical studies in restorative dentistry: Design, conduct, analysis.

OBJECTIVE: Clinical studies should be one main aspect underlying dentists' decision-making towards dental materials. Study design, conduct, analysis and reporting impact on the usefulness of studies. We discuss problems with current studies and highlight areas where improvement might be possible. METHODS: Based on systematically and non-systematically collected data, we demonstrate where and why current studies in clinical dentistry deliver less-than-optimal results. Lending from general medicine, we suggest ways forward for clinical dental material science. RESULTS: Randomized controlled (efficacy) trials remain a major pillar in dental material science, as they reduce selection bias and, if well-designed and conducted, have high internal validity. Given their costs and limited external validity, alternatives like practice-based or pragmatic controlled trials or observational studies can complement the evidence-base. Prior to conduct, researchers should focus on study comparators and setting (answering questions with relevance to clinical dentistry), and pay attention to statistical power, considering the study aim (superiority or non-inferiority trial), the expected event rate, and attrition. Study outcomes should be chosen on the basis of a core outcome set or, if not available, involving patients and other stakeholders. Studies should be registered a priori, and reporting should adhere to standards. Possible clustering should be accounted for during statistical analysis. SIGNIFICANCE: Many clinical studies in dental material science are underpowered, and of limited validity and usefulness for daily decision-making. Dental researchers should mirror existing efforts in other medical fields in making clinical studies more valid and applicable, thus contributing to better dental care.

Trends in the placement of posterior composites in dental schools.

The aim of this paper is to review trends in the teaching of posterior composites in the United States, Canada, Ireland, and the United Kingdom over the last fifteen years. The authors compared the results of surveys of the teaching of posterior composites performed in 1989, 1997, and 2004-05. Historical and contemporary international trends were investigated. The amount of clinical and didactic teaching of posterior composites has increased over the past fifteen years. From a time over fifteen years ago, when very few dental students placed posterior composites in dental school, approximately one-third of posterior plastic restorations placed by U.S., Irish, and UK dental students are now composite, with the corresponding finding for Canadian dental schools being approximately 50 percent. Some variations were noted between dental schools in terms of the teaching of contraindications to placement as well as lining and basing techniques. There was some inappropriate teaching of techniques, in particular, in relation to the use of transparent matrix bands and light transmitting wedges. There was also evidence of limited student exposure to newer forms of technology, notably LED curing light units. There have been clear increases in the teaching of posterior composites in the United States, Canada, the United Kingdom, and Ireland in recent years; however, the proportion of posterior composite restorations placed by dental students relative to dental amalgams does not yet match the typical situation in contemporary clinical practice. Dental schools have a responsibility to ensure that their curricula are evidence-based to best prepare their students to meet the needs and expectations of their future patients.

Caries prevalence and distribution in individuals aged 3-20 years in Jönköping, Sweden: trends over 40 years.

AIM: To present and analyse changes in caries prevalence and caries distribution in child population sample groups in the city of Jönköping, Sweden, based on investigations performed in 1973, 1978, 1983, 1993, 2003, and 2013. METHODS: At each investigation, the study population included about 500 randomly sampled individuals, divided into age groups of 3, 5, 10, 15, and 20 years. The oral health status of all individuals was clinically and radiographically examined by trained paediatric dentists. RESULTS: 35% of the 3-year-olds were caries-free in 1973, compared to 79% 40 years later. Decayed and filled primary (dfs) and permanent (DFS) tooth surfaces were reduced by 67-90% between 1973 and 2013. Adolescents aged 10 and 15 years exhibited the most pronounced reduction in DFS on the occlusal surfaces. By 2013, more than 90% of the proximal caries lesions in 15-year-olds were initial lesions. About 85% of 15-year-olds had a DFS of ≤ 5, whilst 1% exhibited a DFS of ≥ 26. The corresponding figures for 1973 were 0 and 45% respectively. The DFS score for the 20-year-olds was 35.1 in 1973 and 5.8 in 2013. Caries-free 20-year-olds were not seen until 1993 and reached 19% in 2013. CONCLUSIONS: Despite the dramatic decline in the prevalence of caries, caries still remains a health problem in a limited group of children, particularly those of pre-school ages. Repeated epidemiological studies are recommended to follow changes in oral health over time in order to evaluate existing preventive measures.

Adhesión a dentina parte I: características del sustrato y sistemas adhesivos / Dentin bonding part I: substrate characteristics and bonding systems

La Odontología Restauradora contemporánea no puede concebirse sin la adhesión de los materiales restauradores a las estructuras dentarias. En mu-chos procedimientos restauradores, no sólo el esmal-te sino también la dentina se encuentra involucrada, por lo tanto, la adhesión a esta última juega un rol cla-ve en el éxito clínico. No obstante, todavía supone un gran desafío lograr una adhesión estable y predeci-ble en el tiempo. El propósito del presente artículo es analizar las características principales de la dentina como sustrato adhesivo y describir los sistemas ad-hesivos actuales y sus mecanismos de acción (AU)

Contemporary Restorative Dentistry cannot be conceived without the adhesion of restorative materials to dental structures. In many restorative procedures not only the enamel, but also the dentin is involved, therefore dentin bonding plays a key role in their success. However, it is still a great challenge to achieve stable and predictable dentin bonding over time. The aim of this article is to analyze the main characteristics of dentin as an adhesive substrate and to describe current adhesive systems and their bonding mechanisms (AU)

Bonding efficiency and durability: current possibilities.

Bonding plays a major role in dentistry nowadays. Dental adhesives are used in association with composites to solve many restorative issues. However, the wide variety of bonding agents currently available makes it difficult for clinicians to choose the best alternative in terms of material and technique, especially when different clinical situations are considered. Moreover, although bonding agents allow for a more conservative restorative approach, achieving a durable adhesive interface remains a matter of concern, and this mainly due to degradation of the bonding complex in the challenging oral environment. This review aims to present strategies that are being used or those still in development which may help to prevent degradation. It is fundamental that professionals are aware of these strategies to counteract degradation as much as possible. None of them are efficient to completely solve this problem, but they certainly represent reasonable alternatives to increase the lifetime of adhesive restorations.