Systematic review and meta-analysis of diagnostic studies of proximal surface caries.

AIM: This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail. MATERIAL AND METHODS: PRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated. RESULTS: From 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81-0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited. CONCLUSION: The number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies. CLINICAL RELEVANCE: BWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution.

Systematic review and meta-analysis of diagnostic methods for occlusal surface caries.

AIM: This systematic review and meta-analysis aimed to assess the diagnostic performance of commonly used methods for occlusal caries diagnostics, such as visual examination (VE), bitewing radiography (BW) and laser fluorescence (LF), in relation to their ability to detect (dentin) caries under clinical and laboratory conditions. MATERIALS AND METHODS: A systematic search of the literature was performed to identify studies meeting the inclusion criteria using the PIRDS concept (N = 1090). A risk of bias (RoB) assessment tool was used for quality evaluation. Reports with low/moderate RoB, well-matching thresholds for index and reference tests and appropriate reporting were included in the meta-analysis (N = 37; 29 in vivo/8 in vitro). The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR) and areas under ROC curves (AUCs) were computed. RESULTS: SP ranged from 0.50 (fibre-optic transillumination/caries detection level) to 0.97 (conventional BW/dentine detection level) in vitro. AUCs were typically higher for BW or LF than for VE. The highest AUC of 0.89 was observed for VE at the 1/3 dentin caries detection level; SE (0.70) was registered to be higher than SP (0.47) for VE at the caries detection level in vivo. CONCLUSION: The number of included studies was found to be low. This underlines the need for high-quality caries diagnostic studies that further provide data in relation to multiple caries thresholds. CLINICAL RELEVANCE: VE, BW and LF provide acceptable measures for their diagnostic performance on occlusal surfaces, but the results should be interpreted with caution due to the limited data in many categories.

Treatment outcomes after uncomplicated and complicated crown fractures in permanent teeth.

OBJECTIVES: The objectives of this retrospective clinical study were to describe characteristics of crown fractures in permanent teeth and to investigate the survival of pulp vitality and restorations in uncomplicated and complicated crown fractures. MATERIALS AND METHODS: This retrospective study collected information from patients suffering from dental trauma who were treated between January 2004 and June 2017. The study population consisted of 434 patients (253 males/181 females; mean age 20.7 years) with 489 uncomplicated and 127 complicated crown fractures. The Kaplan-Meier survival curves and Cox proportional hazard regression analyses were performed to explore the data statistically. RESULTS: The mean observation time was 522 days. Uncomplicated crown fractures without luxation showed a higher success rate of 82.3% (345/419) than complicated crown fractures without luxation (72.3%, 73/101). An additional luxation in uncomplicated crown fractures resulted in significantly reduced success rates in terms of survival of the pulp and restoration. Direct restorations survived significantly better independent of the fracture mode than did adhesively reattached crown fragments. No superiority of mineral trioxide aggregate or calcium hydroxide as pulp capping agent in complicated crown fractures was documented. Approximately 85.5% of all complications occurred within 2 years after the accident. CONCLUSION: The treatment of crown fractures resulted mostly in successful outcomes and only a moderate number of complications were observed. CLINICAL RELEVANCE: Primary dental management of crown fractures should follow recently published clinical guidelines, and close monitoring over at least 2 years seems to be justified.

Evaluation of retentive strength of four luting cements with stainless steel crowns in primary molars: An in vitro study.

BACKGROUND: Stainless steel crown (SSC) is the most reliable restoration for primary teeth with extensive caries. Retention is of great importance for a successful restoration and is provided by various factors such as luting cements. The aim of this study was to evaluate the retentive strength of SSC cemented with four different luting cements. MATERIALS AND METHODS: In this in vitro study, A total of 55 extracted primary first molars were selected. Following crown selection and cementation (one with no cement and four groups cemented with resin, glass ionomer, zinc phosphate, and polycarboxylate), all the specimens were incubated and thermocycled in 5°C-55°C. Retentive properties of SSCs were tested with a mechanical test machine. First dislodgement of each specimen and full crown removal were recorded. One-way ANOVA test followed by least significant difference test and Kruskal-Wallis test was used for retentive strength comparison at the level of significance of P < 0.05. RESULTS: The results of the study showed that the specimens cemented with zinc phosphate exhibited higher retentive strength as compared to glass ionomer and polycarboxylate (P < 0.001 and P = 0.023, respectively). CONCLUSION: Zinc phosphate cement showed the most promising results; thus, it can be preferably used for cementation of the teeth with no grossly broken down crowns.

Evaluation of bond strength of orthodontic brackets without enamel etching.

BACKGROUND: To compare the shear bond strength of brackets with and without enamel etching. MATERIAL AND METHODS: In this study, 60 sound premolars were randomly divided into four different groups: 1- TXE group: Enamel etching+Transbond XT adhesive+ Transbond XT composite. 2- TXS group: Transbond plus self-etch adhesive+ Transbond XT composite. 3- PQ1E group: Enamel etching+ PQ1 adhesive+ Transbond XT composite. 4- PQ1 group: PQ1 adhesive+ Transbond XT composite. The shear bond strengths of brackets were evaluated using universal testing machine at cross head speed of 0.5 mm/min. The Adhesive Remnant Index (ARI) was also measured. One-way ANOVA, Tukey's post hoc, Kruskal-wallis and Mann-Witney U test were used for data analysis. RESULTS: There was a significant difference between etched and unetched groups respect to SBS and ARI (p<0.05), however; no significant difference was observed between unetched group and self-etch adhesive group (p>> 0.05). The shear bond strength of PQ1 group was the least but in acceptable range and its ARI was less than other groups. CONCLUSIONS: PQ1 adhesive can be used for bracket bonding without enamel etching with adequate bond strength and minimal ARI. KEY WORDS: Bracket, shear bond strength, filled-adhesive, self-etch adhesive.