Evaluation of toothpastes for treating root carious lesions - a laboratory-based pilot study.

BACKGROUND: Root caries is preventable and can be arrested at any stage of disease development. The aim of this study was to investigate the potential mineral exchange and fluorapatite formation within artificial root carious lesions (ARCLs) using different toothpastes containing 5,000 ppm F, 1,450 ppm F or bioactive glass (BG) with 540 ppm F. MATERIALS AND METHODS: The crowns of each extracted sound tooth were removed. The remaining roots were divided into four parts (n = 12). Each sample was randomly allocated into one of four groups: Group 1 (Deionised water); Group 2 (BG with 540 ppm F); Group 3 (1,450 ppm F) and Group 4 (5,000 ppm F). ARCLs were developed using demineralisation solution (pH 4.8). The samples were then pH-cycled in 13 days using demineralisation solution (6 h) and remineralisation solution (pH 7) (16 h). Standard tooth brushing was carried out twice a day with the assigned toothpaste. X-ray Microtomography (XMT) was performed for each sample at baseline, following ARCL formation and after 13-day pH-cycling. Scanning Electron Microscope (SEM) and 19F Magic angle spinning nuclear magnetic resonance (19F-MAS-NMR) were also performed. RESULTS: XMT results showed that the highest mineral content increase (mean ± SD) was Group 4 (0.09 ± 0.05), whilst the mineral content decreased in Group 1 (-0.08 ± 0.06) after 13-day pH-cycling, however there was evidence of mineral loss within the subsurface for Groups 1, 3 and 4 (p < 0.05). SEM scans showed that mineral contents within the surface of dentine tubules were high in comparison to the subsurface in all toothpaste groups. There was evidence of dentine tubules being either partially or completely occluded in toothpaste groups. 19F-MAS-NMR showed peaks between - 103 and - 104ppm corresponding to fluorapatite formation in Groups 3 and 4. CONCLUSION: Within the limitation of this laboratory-based study, all toothpastes were potentially effective to increase the mineral density of artificial root caries on the surface, however there was evidence of mineral loss within the subsurface for Groups 1, 3 and 4.

The antimicrobial effect of different vitamin D compounds on Streptococcus mutans and their impact on glycosyltransferase expression.

Background: Streptococcus mutans is a virulent microorganism associated with dental caries. This in vitro study aimed to investigate the antimicrobial effects of Cholecalciferol (D3) and Doxercalciferol (D2), against S. mutans and on glycosyltransferase gene expression. Methods: Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of D3 and D2 for S. mutans were determined according to the Clinical Laboratory Standards Institute guidelines. The effect of the compounds on environmental pH in 1% w/v and 5% w/v sucrose broth cultures after 24 hours were assessed colorimetrically. Additionally, their impact on glycosyltransferases gene expression (GtfB, GtfC, GtfD) in 5% w/v sucrose culture was evaluated using quantitative real-time PCR. Results: The MBCs of D3 and D2 were 83 µg/ml and 166 µg/ml respectively. Both compounds were effective in preventing the local pH drop <5.5 at ≥166 µg/ml in sucrose supplemented cultures. However, the compounds did not inhibit pH drop at MIC values. Notably, D2 upregulated GtfD expression significantly (p < 0.05) and downregulated GtfB and GtfC. Conclusion: Vitamin D2 and D3 inhibited S. mutans mediated pH drop in sucrose supplemented cultures and altered glycosyltransferase expression, suggesting potential therapeutic roles in dental caries prevention. Further research is needed to assess their full impact on S. mutans survival under environmental stresses.

Effect of topical applications containing surface pre-reacted glass-ionomer filler on dental hard tissues-A systematic review.

OBJECTIVES: The objective of this systematic review was to assess the efficacy of topical applications containing surface pre-reacted glass-ionomer filler on dental hard tissues. DATA SOURCES: A comprehensive literature search was conducted in PubMed, MEDLINE, Embase, Scopus, ClinicalTrials.gov, Lilacs and Cochrane Central Register of Controlled Trials (until 15.08.2022). Google and Open Grey were used to search for grey literature and handsearching was conducted. STUDY SELECTION: Clinical and in vitro studies conducted on human adult teeth were considered eligible without date and language restrictions. The electronic database generated 2,488 results. In total, 227 studies were found to be relevant from which 71 duplicates were removed. Title and abstract screening were then conducted, and a total of 33 studies met the inclusion criteria were assessed for full text screening. Two authors concluded that 11 studies satisfied the eligibility criteria. In vitro studies were evaluated using an accepted quality assessment tool for dental studies. Cochrane risk of bias tool was used for quality assessment of clinical randomised studies, whilst ROBINS-I tool was used for non-randomised studies. RESULTS: Nine in vitro and only two non-randomised clinical trials were reported to meet the eligibility criteria. Results were grouped and analysed separately according to the study design. Different modes of surface pre-reacted glass-ionomer filler delivery were reported in the included studies. Three studies tested the effect of surface pre-reacted glass-ionomer filler containing toothpastes, whilst three studies investigated the effect of polishing pastes with surface pre-reacted glass-ionomer filler, three studies used eluates as surface pre-reacted glass-ionomer filler delivery method and two studies reported the effect of the coatings. The effect of those vehicles was tested on enamel, dentine or oral biofilm. Each study was analysed individually, and heterogeneity was detected among in vitro and clinical studies. Half of the in vitro studies were medium risk, whilst three were low and two studies presented with high risk. In clinical trials, outcome, confounding, selection biases were reported. Meta-analysis was therefore unable to be carried out. CONCLUSION: Regardless of the mode of delivery and type of studies, all included studies demonstrated the efficacy of surface pre-reacted glass-ionomer filler containing topical applications to inhibit demineralisation of dental hard tissues at a dose dependant manner. Antimicrobial properties towards cariogenic species were also reported. CLINICAL SIGNIFICANCE: Surface pre-reacted glass-ionomer filler containing topical applications may serve as potential caries preventive and cariostatic tools. The systematic review registered in PROSPERO, International prospective register of systematic reviews, No. CRD42022347130.

The impact of sociodemographic determinants and diabetes type-2 on oral health outcomes: An analytical cross-sectional study.

OBJECTIVES: This study compared adults with type 2 diabetes (T2DM) and those without diabetes (ND) from East London in terms of sociodemographic characteristics, oral health behaviors, dietary practices, and alcohol and tobacco-related habits. MATERIALS AND METHODS: A total of 182 participants (n = 91 for each group) were recruited and requested to complete the validated questionnaire with 33 items. RESULTS: Results showed that the mean ± SD age was 61 ± 11.7 in the T2DM, while 51 ± 11.2 in the ND group. The mean ± SD age at T2DM diagnosis was 43 ± 10. There was a significant gender difference, with more males in the T2DM group (67.7%) and more females in the ND group (64.8%). Asian-British (38.4%) were significantly high in the T2DM group when compared to other ethnicities. 92.3% of T2DM participants were significantly more likely to use medications in comparison to the ND group (29.7%). The T2DM participants' personal statements on general health were fair (34%) and good (46.2%) when compared with the ND group (15.4% and 59.3%, respectively). The majority of T2DM and ND participants (98%) lacked dental insurance. In the T2DM group, 31.8% were receiving benefits, and 39.5% were retired, while 46% of the ND group were full-time employees. Tooth brushing twice a day was slightly less common in T2DM (68%) when compared to the ND group (78%). Nearly half of the participants in both groups failed to carry out interdental cleaning (T2DM = 52%; ND = 47%), and 38.5% of the T2DM group used mouthwash occasionally, while 30% of the ND group had it twice daily. There was a weak association between chewing paan and annual income in ND participants (r = .90, p = .49). There were significant differences in the presence of removable prostheses, juice, and sweetened juice consumptions between the two groups (p < .05). CONCLUSION: Within the confines of this study, being male, Asian British, retired due to disability, polypharmacy, and the presence of removable prostheses were all significant factors for T2DM.

The effect of different concentrations of fluoride in toothpastes with or without bioactive glass on artificial root caries.

OBJECTIVE: To investigate the effect of different toothpastes either containing 5,000ppm-F, 1,450ppm-F or bioactive glass (BG) with 540ppm-F on artificial root carious lesions (ARCLs). METHOD: The crowns of 23 extracted sound teeth were removed leaving their roots only. Subsequently, each root was divided into four parts. A total of 15 sound root dentine (SRD) was left untreated as baseline. The ARCLs were developed for the remaining roots using demineralisation solution (pH-4.8). 15-ARCLs samples were then left untreated. The rest of samples were divided into four groups (n = 15 each) and treated with Group-1(BG with 540ppm-F); Group-2(5000ppm-F); Group-3(1450ppm-F) and Group-4(deionised water). 13-day pH-cycling included using demineralisation solution for 6 h, then placing samples into remineralisation solution (pH-7) for 16 h. Each sample was brushed with the assigned toothpaste twice a day during pH-cycling. Fluoride concentrations at each time point were measured using F-ISE, whilst calcium (Ca2+) and phosphorus (P) ion release was determined using ICP-OES, KHN, XRD, 19F-MAS-NMR analyses. RESULTS: KHN showed significant surface changes for each group (p<0.001). The uptake of Ca2+ occurred at days 1-2, phosphorus ion loss was high when compared to the uptake in all groups. XRD showed presence of sharp diffraction lines evidencing apatite formation for Groups 1-3. 19F-MAS-NMR confirmed fluorapatite presence in Groups 1-3. CONCLUSION: All toothpastes were promising in fluorapatite formation. BG with 540ppm-F toothpaste released more ions (Ca2+and P) and reharden the artificial root carious lesions when compared to other groups. However, 1450ppm-F toothpaste showed more fluoride-substituted apatite formation whilst 5000ppm-F toothpaste had more fluorapatite formation. CLINICAL SIGNIFICANCE: Toothpaste containing BG with 540ppm-F, 5000ppm-F and 1450ppm-F toothpastes are likely to have a significant impact in reversing and arresting root caries. However, randomised controlled double-blinded clinical trials are required to translate these results into clinical practice.

The Use of Toothpastes Containing Different Formulations of Fluoride and Bioglass on Bleached Enamel.

OBJECTIVES: To investigate the application of toothpaste either containing calcium sodium phospho-silicate bioglass (NovaMin) or calcium fluorosilicate bioglass (BioMinF) on the surface mineral composition and morphology of enamel after bleaching procedure. Methods: Thirty extracted noncarious human teeth were allocated into five groups (n = 6). Group 1: Bleaching using 40% hydrogen peroxide (HP) and fluoridated toothpaste containing bioactive glass (1450 ppm fluoride). Group 2: Bleaching using 40%HP and toothpaste containing calcium fluorosilicate bioglass (540 ppm fluoride). Group 3: Bleaching using 40%HP and fluoridated toothpaste (1450 ppm fluoride). Group 4: Bleaching alone using 40%HP. Group 5: Negative control with distilled water alone. The surface morphology was evaluated using Scanning Electron Microscope (SEM) and Scanning Probe Microscope (SPM). The concentration of elements as atomic percentages were determined by X-ray Photoelectron Spectroscopy (XPS) and Energy-Dispersive X-ray Spectroscopy (EDS). Results: This laboratory-based study reported that SPM and SEM detected minor changes on the surfaces of all toothpaste-treated enamel samples (Groups 1-3) after 45 days. Bioactive glass deposits were observed on enamel surfaces in Groups 1 and 2, whilst the bleaching-alone samples (Group 4) had rough enamel surfaces. XPS reported that toothpaste containing calcium fluorosilicate bioglass (Group 2) had a high atomic% of calcium and phosphate, whilst silicon values were high in the toothpaste containing bioactive glass and 1450 ppm fluoride (Group 1) after bleaching procedure when compared to other groups (p < 0.05). In addition, EDS detected the highest %F in Groups 1, 2 and 5. Conclusions: Within the limitations of this laboratory-based study, there was no significant decrease in the Ca%, P% values and surface properties of enamel after the bleaching procedure following the use of different formulations of toothpastes for a period of 45 days. However, the Ca% and P% values were significantly high for the toothpaste containing calcium fluorosilicate bioglass (BioMinF) on the bleached enamel. Clinical relevance: The bleaching process can provide optimum aesthetic outcomes, but the effect of peroxides on hard tissues is still in question. Toothpastes containing different formulations of fluoride and bioactive glass might have the potential to prevent mineral loss on bleached enamel. However, further laboratory-based studies and controlled double-blind randomised clinical trials are required to interpret the effects of toothpastes with different fluoride and bioactive glass formulations on enamel surfaces following bleaching procedures.

A systematic review on the effect of silver diamine fluoride for management of dental caries in permanent teeth.

OBJECTIVES: The objective of this review is to assess the available literature systematically related to the effect of silver diamine fluoride (SDF) for the management of occlusal and root carious lesions in permanent teeth regardless of age. MATERIALS AND METHODS: This systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Review and Meta-Analyses statement. A literature search was performed using PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, DOAJ, and Open Gray with no language restrictions up to December 2022. Three reviewers critically assessed the studies for eligibility. Any disputes between the reviewers were handled by a fourth independent reviewer. The quality assessment and data extraction of the studies were performed. RESULTS: A total of 2176 studies were screened. The titles and abstracts of the studies were then reviewed (n = 346), and 52 studies met the search criteria. Following the full-text review, 11 studies investigated the effect of SDF against other treatments such as chlorhexidine, sodium fluoride, ammonium bifluoride, tricalcium silicate paste, casein phosphopeptide amorphous calcium phosphate, glass ionomer cement (GIC) combined with fluoride varnish, resin-modified GIC, and atraumatic restorative treatment were assessed. CONCLUSIONS: Within the limitations of this review, the use of SDF is promising with high preventative fractions in permanent teeth of children and older populations when compared to other topical applications such as dental varnish containing sodium fluoride.

Systematic review on dental caries preventive and managing strategies among type 2 diabetic patients.

Purpose: The purpose of this systematic review was to evaluate current evidence to prevent and manage dental caries in patients with type 2 diabetes mellitus (T2DM). Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the Participants, Intervention, Comparison, Outcomes and Study Design (PICOS) strategy was used to formulate a structured search: systematic search of PubMed, Cochrane Library, MEDLINE via Ovid, EMBASE, Scopus, Web of Science, and Lilacs without any date limit and/or language restrictions. Two independent reviewers performed data extraction and risk of bias assessments in the included studies. Data homogeneity was assessed according to interventions for treating dental caries in T2DM. Statistical analyses were performed with JMP®. Results: Two studies out of 909 were included in the systematic review. Only quantitative studies involving topical applications for management of dental caries in patients with T2DM were included. One study assessed the effect of intensive oral hygiene care program including toothbrushing and interdental cleaning using interproximal brushes and/or dental floss and supragingival debridement by dental hygienist with educational brochures in T2DM, while another investigated the immunologically active salivary substitutes with using Oral Hygiene Instructions (OHI), mouthwash, and moisturizing gel for 6 months. Intensive oral hygiene care program or immunologically active salivary substitutes with using OHI, mouthwash, and moisturizing gel for 6 months were reported to reverse/arrest dental caries in patients with T2DM. Conclusion: The current randomized controlled clinical trials demonstrated that regular extensive oral health education using interdental cleaning aids, mouthwash, moistening gel, and saliva substitutes including lactoperoxidase, lysozyme, glucose oxidase, and lactoferrin could control oral inflammation and contribute to the management of dental caries in patients with T2DM. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020197507, identifier: CRD42020197507.

Comparison of different bioglass applications on root caries - A laboratory-based study.

The aim of this in-vitro study was to assess the effect of bioglass with different concentrations on root caries. Ninety freshly-extracted teeth with root caries were randomly assigned to a single-use prophylaxis paste containing 15 % bioglass for 30 s with 1,450 ppmF toothpaste (15 % bioglass, n = 30), 1,450 ppmF toothpaste with 5 % bioglass (5 % bioglass, n = 30), and toothpaste containing 1,450 ppmF (Control, n = 30). Each sample received a standard brushing procedure for 10 s twice a day using the toothpastes. Teeth were immersed in remineralising solution with pH of 7 at 37 °C for 720 h. Surface roughness (Ra) was measured at baseline and after the application of the products at 0.5, 1, 4, 12, 24, 48, 168, 336 and 720 h. Subsequently, three samples from each group were randomly selected to measure calcium ion release over 15 h immersion in deionised water. These samples were then analysed using the SEM for the qualitative assessment of lesion topography. Repeated measures ANOVA, Wilcoxon paired tests and percentage changes were carried out to assess Ra. Calcium ion release data was analysed using one-way ANOVA and Tukey post-hoc tests. After 720 h, 15 % bioglass had the highest decrease in Ra (Mean-difference = 1.502 µm, p = 0.001), then 5 % bioglass (Mean-difference = 0.723 µm, p = 0.09) whereas the control had the lowest Ra decrease (Mean-difference = 0.518 µm, p = 0.55). The differences in Ra between the groups were highly significant (p < 0.001). The cumulative calcium ion release was significantly high for the 5 % bioglass in comparison to the 15 % bioglass, whilst the control had the lowest release (p < 0.001). SEM analysis showed the presence of bioglass particles only on 15 % bioglass samples. The use of prophylaxis paste with 15 % bioglass and 1,450 ppmF toothpaste was promising to reverse/arrest root caries when compared to the toothpaste containing 1,450 ppmF with 5 % bioglass for a period of 30 days.

Do Tooth Loss and Dentures Cause Body Image Disturbance?

PURPOSE: To investigate the psychologic morbidities associated with tooth loss despite treatment with technically successful dentures. MATERIALS AND METHODS: This cross-sectional questionnaire-based study compared the psychologic disturbance and functional difficulties in two groups: individuals with tooth loss who wore optimal-quality removable dentures (test group), and individuals with tooth loss who did not wear dentures (control group). The questionnaire used was developed and validated previously. The short-form revised Eysenck personality questionnaire was also used to assess the relationship with personality traits. A total of 138 participants were recruited (denture group = 70; control group = 68). RESULTS: There was a significant difference in body image dissatisfaction between the groups (χ2 = 7.72, P value = .005). The denture group had 5.75-times higher probability than the control group of suffering from body image disturbance. Older patients were predicted to have 75% less probability of body image disturbance (OR = 0.25), and men were predicted to have up to 70% less disturbance (OR = 0.3). As for psychologic morbidities, participants in both groups presented with somatic symptoms related to depression or anxiety, which were nearly double that expected in the general population (15.7% and 7.8%, respectively). Furthermore, participants who complained about body image impairment were more likely to have higher scores on the neuroticism scale (OR = 3.64). CONCLUSION: Tooth loss and dentures could be associated with body image dissatisfaction and psychologic morbidity. Planning for patient-centered care is paramount prior to extracting any teeth and providing replacement options.

Clinical and Radiographic Outcome of Non-Surgical Endodontic Treatment Using Calcium Silicate-Based Versus Resin-Based Sealers-A Systematic Review and Meta-Analysis of Clinical Studies.

The aim of this paper is to systematically analyse the effect of calcium silicate-based sealers in comparison to resin-based sealers on clinical and radiographic outcomes of non-surgical endodontic treatment in permanent teeth. Methods: The study was conducted according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. The literature search was performed using PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, DOAJ and OpenGrey with no language restrictions. Two reviewers critically assessed the studies for eligibility. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was carried out to assess the evidence. Meta-analysis of the pooled data with subgroups was carried out using the RevMan software (p < 0.05). Results: Results from the included studies showed that there were no significant differences between the groups in the 24 h post-obturation pain levels (mean difference (MD), −0.19, 95% CI = −0.43−0.06, p = 0.14, I2 = 0%), but at 48 h (MD, −0.35, 95% CI = −0.64−0.05, p = 0.02, I2 = 0%), a significant difference was observed in favour of calcium silicate sealers. Furthermore, there were no significant differences between the two sealers due to risk of onset or intensity of postoperative pain, need for analgesic and extrusion of the sealer. The heterogeneity assessed using Q test between the included studies was 97% (I2). Conclusions: Within the limitations of this review, the paper shows that calcium silicate-based sealers exhibited optimal performance with similar results to resin-based sealers in terms of average level of post-obturation pain, risk of onset and pain intensity at 24 and 48 h. The observations from the included studies are informative in the clinical evaluation of calcium silicate-based sealers and provide evidence for the conduction of well-designed, controlled randomised clinical trials for a period of at least four years in the future.

Reversal of Root Caries with Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Varnish in Xerostomia.

Different formulas of topical fluoride have been used to manage root carious lesions. This clinical trial aimed to investigate the efficacy of a dental varnish containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride compared with fluoride alone in reversing/arresting root caries in xerostomic patients over 1 year. A total of 80 patients (age range 45-92 years) with primary root caries (n = 184 root carious lesions) and unstimulated salivary flow rate of <0.2 mL/min were randomly allocated to receive either dental varnish containing CPP-ACP and 5% fluoride (group 1: MI varnish; GC, Japan) (n = 41, 83 lesions), or dental varnish with 5% fluoride alone (group 2: NUPRO White; Dentsply, USA) (n = 39, 101 lesions). Clinical assessments with Severity Index (SI) for root caries, DIAGNOdent measurements, and varnish application were carried out at baseline, 3, 6, and 12 months. Standard oral hygiene instructions with 1,450 ppm fluoride toothpastes were provided for both groups. After 3 months, 63.9% (n = 46) of root caries in group 1 became hard (SI: 0) compared with 39.3% (n = 35) in group 2 (p < 0.01). After 6 and 12 months, the differences in SI were insignificant (group 1, n = 60, 83.3%) (group 2, n = 66, 74.2%) (p = 0.36), and (group 1, n = 60, 89.6%) (group 2, n = 67, 81.7%, n = 1 soft, 1.2%) (p = 0.29), respectively. In both groups, noncavitated leathery lesions were more likely to become hard when compared to the cavitated root caries. A significant decrease in plaque index, surface roughness, lesion dimension, and DIAGNOdent readings with a significant increase in lesion distance from the gingival margin was reported in both groups (p < 0.05). This study has provided evidence that fluoride dental varnish either with or without calcium and phosphate has the potential to arrest/reverse root caries, especially noncavitated lesions for patients with xerostomia.

The performance of SoproLIFE for early detection of coronal caries using the International Caries Classification and Management System - A preliminary laboratory-based study.

The aim of this laboratory-based study is to evaluate performance of the Light-Induced Fluorescence Evaluator (SoproLIFE) for early detection of coronal caries and to validate the findings using the International Caries Classification and Management System (ICCMS). A total of 56 freshly extracted teeth with coronal carious lesions were included. 74 regions of interest were identified. Visual assessments with International Caries Detection and Assessment Systems (ICDAS), radiographic information and SoproLIFE images were used to classify each region of interest according to the ICCMS as a reference standard. SoproLIFE specificity and sensitivity were calculated at the sound-enamel and dentine lesion levels. Inter and intra reproducibility of ICDAS were analysed and showed a moderate agreement (0.52) and (0.58) respectively. At the sound-initial caries level, the sensitivity and specificity for the SoproLIFE were 90.0%, 95.8% respectively, whilst for the dentine caries level, sensitivity was 100% with specificity of 53.8%. A low proportion of teeth with dental caries were classified as caries-free using the SoproLIFE (false negative=10%). As a conclusion, the performance of SoproLIFE was promising in distinguishing between early enamel carious lesions and sound surfaces. This detection tool could be suggested to be used with ICCMS to assist in the clinical decision-making process.

Physico-Chemical Properties of Calcium-Silicate vs. Resin Based Sealers-A Systematic Review and Meta-Analysis of Laboratory-Based Studies.

INTRODUCTION: The aim of this systematic review is to analyse the effect of physico-chemical properties of calcium silicate-based sealers in comparison to epoxy resin sealers in permanent teeth using a single-cone obturation technique. METHODS: The study was conducted according to the guidelines of Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Literature search was performed using the PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, DOAJ, Open Gray with no language restrictions until October 2020. Two reviewers assessed the studies for eligibility. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was carried out to assess the evidence. Meta-analysis of the pooled data with subgroups was performed using the RevMan software (p < 0.05). RESULTS: Results from the 28 included studies showed that the mean difference in adaptation to root canal walls (marginal adaptation, interfacial gaps and void volume) for both sealers were non-significant. However, void volume values showed a significant mean difference (p < 0.00001) favouring the calcium silicate-based sealers. The pooled meta-analysis reported statistically significant differences for apical microleakage (p = 0.0007) whilst there were non-significant mean differences for fracture resistance (p = 0.09) and push-out bond strength (p = 0.63). The heterogeneity among the included studies was 97% (I2). CONCLUSIONS: Within the limitations of this review, calcium silicate-based sealers demonstrated a similar or superior performance in comparison to resin-based sealers in terms of the physico-chemical properties.

Mineral exchange within restorative materials following incomplete carious lesion removal using 3D non-destructive XMT subtraction methodology.

OBJECTIVES: The objective of this study was to quantify the changes in mineral and selected element concentrations within residual carious dentine and restorative materials following incomplete carious lesion removal (ICLR) using different cavity liners, with non-destructive subtraction 3D-X-ray Microtomography (XMT, QMUL, London, UK). MATERIALS AND METHODS: A total of 126 extracted teeth with deep dental caries were assessed using International Caries Risk and Assessment (ICDAS). Eight teeth were subsequently selected after radiographic evaluation. Each lesion was removed, leaving a thin layer of leathery dentine at the deepest part of cavity. Different cavity lining materials were placed; Mineral Trioxide Aggregate (MTA), calcium hydroxide, (Ca(OH)2), resin-based material (RBM). For each, the restorative material was an encapsulated glass ionomer (GIC) and the control group had a GIC restoration alone. Each tooth was immediately placed in Simulated Body Fluid (SBF). All samples were then imaged using XMT at baseline, and three weeks after treament. The XMT images were then subtracted to show the mineral concentration changes three weeks after treatment. RESULTS: There were significant increases in mineral concentrations within the residual demineralised dentine in individual teeth treated with Ca(OH)2, MTA, RBM, and GIC following immersion in SBF for three weeks. GIC group without any liners showed the greatest increase in mineral concentration, followed by MTA and Ca(OH)2. CONCLUSION: Mineral changes in demineralised dentine and within restorative materials are quantifiable using non-destructive 3D-XMT subtraction methodology. This laboratory study suggested that calcium, phosphate and strontium ion-exchange occurs with GIC, MTA and Ca(OH)2 in deep dentinal lesions following ICLR. CLINICAL RELEVANCE: In clinical practice, incomplete carious lesion removal could be performed to avoid the dental pulp exposure. 3D non-destructive XMT subtraction methodology in a laboratory setting is advantageous to provide evidence for different restorative materials on deep carious lesions prior to clinical investigations.

Developing a questionnaire to measure psychological disturbance associated with tooth loss.

OBJECTIVES: To develop and validate a self-reporting measure to assess the psychological disturbance in adult patients with tooth loss and dentures Methods: Ethical approval obtained from the Health Research Authority NHS England (Ref:17/NI/0098). 128 participants (100 patients - 28 clinicians) were recruited to participate in the development and validation of the questionnaire. Inclusion criteria included adults (age ≥18) with tooth loss/dentures. Exclusion criteria included patients with a history of psychotic mental illness or patients who had treatment with dental implants. The development processes included: Phase 1. Development of questionnaire: describing the aims/target population of the questionnaire, generating a pool of items, defining the constructs to be measured, adapting psychological morbidity screening tools, Items reduction and producing a preliminary questionnaire. Phase 2. Validation of questionnaire: content validation, face validation, establishing construct validity, pilot testing and establishing reliability. RESULTS: Face and content validation indicated that the questionnaire was an appropriate tool to measure the impact of tooth loss and related psychological morbidities. Reliability analysis (Test re-test reliability/internal consistency) indicated the questionnaire has satisfactory reliability (correlation >0.7). Testing the theoretical hypothesis structure of the impact of tooth loss has also enhanced the construct validity of the questionnaire (domains correlated mildly (r>5 & <3) to strongly (r>5). Pilot testing confirmed the scale adequacy and wording clarity (>90 % of respondents). Results indicated that the developed questionnaire has adequate psychometric properties. CONCLUSION: A disease-specific measure that assesses the psychological impact of tooth loss and the effectiveness of interventions (i.e. dentures) has been developed and validated. CLINICAL SIGNIFICANT: A patient outcome measure was developed which could be used to assess the psychological impact of tooth loss and compare the effectiveness of various interventions like dentures and implants.

Assessment of Psychological Disturbance in Patients with Tooth Loss: A Systematic Review of Assessment Tools.

PURPOSE: To systematically review the available evidence on screening tools to detect the psychological disturbance in patients with tooth loss and technically successful removable dentures (partial and complete). MATERIALS AND METHODS: The study protocol was registered with the National Institute of Health Research Database (I.D. CRD42017082125). The PICOS tool (patients, intervention, control, outcomes measure, and study design) was used to formulate an effective search strategy. Participants were adults (≥ 18), who were edentulous or had significant tooth loss (< 9 remaining teeth). The intervention included undergoing replacement with technically successful dentures (partial or complete). A control group of adults were either edentulous or had significant tooth loss and without dentures. Outcomes included assessing psychological disturbance due to treatment with dentures or due to no treatment using a validated tool. A structured search strategy was used to complete a standard systematic search of the electronic database without any date limit and/or language restriction. Only quantitative studies using a validated measuring tool to screen for psychological distress in adults with significant tooth loss were included. Two authors independently assessed the risk of bias in the included studies. Data homogeneity was assessed in regards to the screening tools to measure psychological disturbance following the management of tooth loss with dentures. The significant level was set at 0.05, using IBM SPSS Statistics 24.0 (SPSS Inc., New York, NY). The psychometric properties and the validation processes of the screening tools were assessed. RESULTS: From the original 3510 studies identified, only eight studies were found to meet the inclusion criteria. All eight studies used the same questionnaire to screen for the emotional distress of tooth loss. In addition, one study also used the Patient Health Questionnaire-9 (PHQ-9) to screen for the association of depression with tooth loss. Six studies suggested that a significant number of patients have difficulties in accepting tooth loss, were less confident, and had emotional distress related to tooth loss. However, two studies reported no significant link. All studies found a marked impact on functional activities and social interaction. However, four studies had a potentially biased selection process, and the questionnaire used was assessed to be at high-risk of measurement bias, as the development and validation process was not clear. There was also a lack of well-defined control groups in all studies. CONCLUSION: Tooth loss could cause psychological disturbance in some patients. To date, there is a lack of available tools that are suitable to screen and measure psychological disturbance in patients with tooth loss. Additional research is required to develop tools to identify and measure such impact and to recommend suitable interventions when needed.

Multiple supernumerary teeth without any associated systemic condition or syndrome: a case report.

UNLABELLED: A 49-year-old Black African male, originally of Nigerian origin, was referred by his dentist regarding a bad taste in the mouth. He was seen in a general restorative clinic at Barts and the London NHS Trust. Clinical examination did not reveal any relevant abnormalities. A panoramic tomography, however, showed the presence of multiple supernumerary teeth, which were located in the maxillary right and left premolar and molar regions, and the mandibular left premolar region. The family's history was non-contributory. The patient was unaware of the supernumerary teeth and, as far as he knew, there were no other members of his family with a similar problem. CLINICAL RELEVANCE: A decision regarding the appropriate management of supernumerary teeth should be considered carefully since surgical removal of the teeth may cause damage to adjacent structures, including bone. In this respect, it is interesting and rare to find multiple supernumerary teeth in individuals with no other associated diseases or syndromes elucidated by clinical and historical enquiry.

Effects of ozone and ND:YAG laser pretreatment on bond strength of self-etch adhesives to coronal and root dentin.

OBJECTIVES: The aim of this study was to evaluate the effects of two different disinfection treatments--ozone and Nd:YAG laser application--on shear-bond strength (SBS) of self-etch adhesives to coronal and root dentin. MATERIALS AND METHODS: Sixty extracted human canines were ground flat, exposing the coronal and root dentin surfaces, and randomly divided into three groups. The surfaces were untreated (Control) or treated with ozone (HealOzone, KaVo) or Nd:YAG laser (Fidelis III, Fotona). Coronal and root dentins of 10 teeth of each group were treated with a two-step self-etch adhesive (Clearfil SE Bond, Kuraray Medical; SE), whereas the remaining 10 teeth were treated with a one-step self-etch adhesive (Clearfil Tri-S Bond, Kuraray Medical; S3). A resin composite (Clearfil Majesty Esthetics, Kuraray Medical) was then placed, and SBS was tested with a universal testing machine. Failure modes were determined under a stereomicroscope. The mean SBS values of each group were calculated, and data were subjected to statistical analysis (p = 0.05). RESULTS: For the coronal dentin, Control/SE showed significantly higher values than Control/S3, Ozone/S3, and Nd:YAG/S3. Although Ozone/SE showed significantly higher values than Nd:YAG/S3 (p < 0.05), the differences within the other groups were not significant for the root dentin (p > 0.05). Comparison of two dentin substrates in each group did not show any significant difference except for Control/SE, in which coronal dentin showed higher SBS. The failure modes of all groups were mainly adhesive. CONCLUSION: Pretreatments with Ozone or Nd:YAG laser did not impair the SBS of both of the self-etch adhesives used to coronal and root dentin.

Clinical reversal of root caries using ozone: 6-month results.

PURPOSE: To assess the safety and efficacy of ozone either with or without a root sealant, for the management of leathery root caries. METHODS: 79 subjects with 220 root caries lesions were recruited into four study groups in this randomized, controlled trial. At baseline and after 1, 3, and 6 months, the ECM III and DIAGNOdent were employed. Subsequently, the root caries lesions were clinically assessed for color, hardness, cavitation, dimensions, distance from the gingival margin, and severity index. Modified USPHS criteria were also performed after 1, 3, and 6 months. These groups were as follows: Group 1: Ozone application was performed for a period of 10 seconds on caries lesions; Group 2: There was neither ozone nor root sealant application on root caries; Group 3: Ozone treatment and a root sealant were applied to root caries lesions; and Group 4: Only root sealant was applied to root caries. RESULTS: At the 6-month recall, 78 subjects were examined. There were no observed adverse events. 38.1% of lesions became hard in the ozone only group, while none of the lesions became hard in the control group (P< 0.001). Noncavitated lesions were more likely to reverse than cavitated lesions. 38.4% of noncavitated lesions became hard, while only 5.7% of cavitated lesions became hard in the ozone only group. Modified USPHS criteria revealed that there were 66.6% intact sealants in the ozone and sealant group and 45.5% intact sealants in the sealant only group (P< 0.05). After 1, 3, and 6 months, the ECM and DIAGNOdent readings showed improvements in the ozone only group when compared to the control group (P< 0.001). The ozone and sealant group also had greater improvements in the ECM and DIAGNOdent values when compared to the sealant only group (P< 0.05).