Comparative microleakage outcomes of different techniques used for creating the occlusal anatomy in occlusal direct restorations using the dental operating microscope.

OBJECTIVES: Microleakage in direct dental restorations is a primary causal factor in the restoration's failure. The aim of this study was to evaluate whether the technique for occlusal layering of the composite resin (the use of brush adaptation, the use of magnification, cusp build-up, stamp technique) has any effect on microleakage of direct restorations in occlusal cavities. MATERIALS AND METHODS: One hundred extracted human molars were restored using five restoration techniques (Packable Bulk technique, Occlusal Stamp technique, Successive Cusp Build-up technique, Successive Cusp Build-up technique + Brush adaptation, Successive Cusp Build-up technique + brush adaptation + Dental Operative Microscope magnification). The teeth were subjected to thermal aging for 800 cycles at 5°C and 55°C, infiltrated with basic fuchsin dye for 24 h, and then sectioned buccolingually in the middle of the crown. Infiltration was measured in four areas of the tooth section by five different observers and then given a score from 1 to 3, proportional to infiltration depth. RESULTS: The lowest mean scores for infiltration (meaning less infiltration observed) were present in Group A (1.41 ± 0.878) and Group C (1.46 ± 0.679), while Group D showed the highest infiltration scores (1.75 ± 0.853). When comparing the groups for differences, no statistically significant difference in infiltration was found between any technique p < .586. CONCLUSION: The techniques examined for placing the occlusal layer of composite in direct restorations do not differ significantly in terms of marginal infiltration, although a slight improvement was found when using the bulk technique and the successive cusp build-up.

In Vitro Fracture Resistance of Adhesively Restored Molar Teeth with Different MOD Cavity Dimensions.

PURPOSE: Molar MOD (mesial-occlusal-distal) cavity preparation weakens relative cuspal stiffness by up to 63%, often resulting in cuspal fracture. This investigation inspects fracture resistance of MOD cavities restored using direct composite restoration. MATERIALS AND METHODS: 120 extracted, intact mandibular molars were selected. MOD cavities with different depth/wall thickness were prepared in 9 groups (n = 12): A: 3 mm/3.5 mm, B: 3 mm/2.5 mm, C: 3 mm/1.5 mm, D: 5 mm/3.5 mm, E: 5 mm/2.5 mm, F: 5 mm/1.5 mm, G: 7 mm/3.5 mm, H: 7 mm/2.5 mm, I: 7 mm/1.5 mm. Specimens with 7 mm deep cavities received root canal treatment. The teeth were restored with dental composite. Maximal fracture strength test was conducted. Intact natural teeth were used as control. For statistical analysis Kruskal-Wallis ANOVA with post-hoc pairwise comparisons was used (α = 0.05). RESULTS: Significant difference was indicated between the control and groups D, E, F, G, H, and I. No significant differences were found between the A, B, C groups and the control. Comparing the 5 and 7 mm cavity depth groups, there was no statistical difference between any of them. CONCLUSIONS: Within the limitations of this investigation, the following conclusions can be drawn regarding molar teeth with a MOD cavity: 3 mm or shallower cavities can be restored to the physiological fracture strength with direct composite restorations; 5 mm or deeper cavities cannot be restored to the physiological fracture strength with direct composite restorations. Cusp thickness does not significantly influence fracture strength in molar MOD cavities with a direct composite restoration.

Conservative treatment for deep carious lesions in primary and young permanent teeth.

The management of deeply carious lesion could be accomplished conservatively by two techniques: an indirect single-step and stepwise techniques. The former involves incomplete removal of carious dentin and then application of a well-sealed permanent restoration. While the latter involves incomplete removal of caries and then reentry after a period to remove the residual caries, after changing its environment. The aim of this article was to review the dental literature concerning the conservative methods available to treat deeply carious teeth. A literature search was done using electronic databases "PubMed," "Google Scholar," and "Cochrane Database" for articles in English. Several keywords were used: conservative treatment, deep caries, deeply carious lesion, indirect pulp capping (IPC), and stepwise excavation. This review mentions two operative methods for conservative treatment of deeply carious lesions, namely, IPC, including criteria for case selection and success and failure of the deeply carious lesion, and an account on various used materials. Both single-step and stepwise IPC techniques could be used for managing deeply carious lesions with maintaining pulp vitality; more longitudinal studies are needed to determine which technique is preferable to be used.

Preventive endodontics by direct pulp capping with restorative dentin substitute-biodentine: A series of fifteen cases.

INTRODUCTION: Treatment of mechanical exposure of the pulp during caries excavation presents a clinical challenge. In this case series of 15 patients, with a follow-up period of over a year, the outcome of direct pulp capping with Biodentine (septodont) after mechanical pulp exposure was assessed. AIM OF STUDY: The aim of this study is to evaluate the outcome of direct pulp capping with Biodentine in deeply carious teeth when pulp was mechanically exposed during caries excavation and cavity preparation. Vital pulps exposed during caries excavation in molar teeth were treated with 3% sodium hypochlorite for 2 min. If adequate hemostasis was achieved, the pulp tissue was capped with Biodentine, which covered the entire pulpal floor. This was followed by the placement of a layer of resin-modified glass ionomer cement and a final layer of composite resin (Filtek Z350-3M) to complete the restoration. The patients were recalled periodically and evaluated for any evidence of pulpal/periapical pathology. RESULTS: In the follow-up period that ranged from 12 to 24 months, all teeth were asymptomatic. CONCLUSION: Biodentine appears to be a suitable material for direct pulp capping under clinical conditions. However, long-term follow-up studies and controlled trials involving a large sample size are warranted.

Microleakage of Different Adhesive Systems in Primary Molars Prepared by Er: YAG Laser or bur.

BACKGROUND AND AIM: This study aimed to examine the microleakage of class V cavities of primary molars prepared by either a conventional dental bur or Er:YAG laser and one of two different adhesive systems. METHODS: A total of 50 tooth samples from primary molars were used in this study. They were randomly assigned into five experimental groups of 10 samples each, according to the cavity preparation technique and the type of adhesive system applied to the cavities. Following cavity preparation, etching, bonding, and filling steps, samples were dyed using basic fuchsine and were sectioned longitudinally in buccolingual direction. Percentages of dye penetration at gingival and occlusal margins were calculated for each group. RESULTS: Overall, microleakage scores of gingival margins were significantly higher than those of occlusal margins (P < 0.001). The group that underwent laser preparation, laser etch, and self-etch bonding procedures had worse microleakage scores for gingival margins. However, all groups had similar occlusal scores (P > 0.05). CONCLUSION: Self-etch bonding systems and cavity preparation with Er:YAG laser may be an alternative to conventional restoration of primary molars with compomers. Further studies are warranted to fully elucidate the effect of laser-based etching techniques in cavities prepared by laser.

The Effects of Cavity Preparation and Composite Resin on Bond Strength and Stress Distribution Using the Microtensile Bond Test.

OBJECTIVES: To evaluate the effect of flowable bulk-fill or conventional composite resin on bond strength and stress distribution in flat or mesio-occlusal-distal (MOD) cavity preparations using the microtensile bond strength (µTBS) test. METHODS: Forty human molars were divided into two groups and received either standardized MOD or flat cavity preparations. Restorations were made using the conventional composite resin Z350 (Filtek Z350XT, 3M-ESPE, St Paul, MN, USA) or flowable bulk-fill (FBF) composite resin (Filtek Bulk Fill Flowable, 3M-ESPE). Postgel shrinkage was measured using the strain gauge technique (n=10). The Z350 buildup was made in two increments of 2.0 mm, and the FBF was made in a single increment of 4.0 mm. Six rectangular sticks were obtained for each tooth, and each section was used for µTBS testing at 1.0 mm/min. Polymerization shrinkage was modeled using postgel shrinkage data. The µTBS data were analyzed statistically using a two-way analysis of variance (ANOVA), and the postgel shrinkage data were analyzed using a one-way ANOVA with Tukey post hoc test. The failure modes were analyzed using a chi-square test (α=0.05). RESULTS: Our results show that both the type of cavity preparation and the composite resin used affect the bond strength and stress distribution. The Z350 composite resin had a higher postgel shrinkage than the FBF composite resin. The µTBS of the MOD preparation was influenced by the type of composite resin used. Irrespective of composite resin, flat cavity preparations resulted in higher µTBS than MOD preparations ( p<0.001). Specifically, in flat-prepared cavities, FBF composite resin had a similar µTBS relative to Z350 composite resin. However, in MOD-prepared cavities, those with FBF composite resin had higher µTBS values than those with Z350 composite resin. Adhesive failure was prevalent for all tested groups. The MOD preparation resulted in higher shrinkage stress than the flat preparation, irrespective of composite resin. For MOD-prepared cavities, FBF composite resin resulted in lower stress than Z350 composite resin. However, no differences were found for flat-prepared cavities. CONCLUSIONS: FBF composite resin had lower shrinkage stress than Z350 conventional composite resin. The µTBS of the MOD preparation was influenced by the composite resin type. Flat cavity preparations had no influence on stress and µTBS. However, for MOD preparation, composite resin with higher shrinkage stress resulted in lower µTBS values.

Influence of cervical margin relocation (CMR) on periodontal health: 12-month results of a controlled trial.

OBJECTIVES: The concept of Cervical Margin Relocation (CMR) consists on placing a base layer of direct resin composite to elevate supra-gingivally the proximal indirect bonded restorations. The aims of this clinical study were to evaluate 1. Bleeding on Probing (BoP) on posterior indirect restorations with one interproximal margin relocated cervically, and 2. possible correlation between depth of the interproximal margins and BoP. METHODS: CMR (Group 1) and shoulder preparations (Group 2) were performed in 35 posterior teeth and evaluated after 12 months (T12). Cavities' margins were placed below the Cemento-Enamel-Junction (CEJ). CMR was applied in one interproximal box-slot preparation using G-Premio Bond, for dentin hybridization, and universal flow resin composite (GC Co. Tokyo, Japan). Pressed lithium disilicate crowns (LS2) (LiSi Press, GC Co. Tokyo, Japan) were made and placed with proprietary luting material. At baseline and after 12 months, clinical surrogate parameters were assessed; and measurements were recorded for the restorative margin position in relation to margo gingivae by probing, and radiographically, the distance from the bone crest was calculated (in mm). Statistical analysis was performed. RESULTS: CMR was associated with statistically significant increased BoP scores compared to shoulder preparation at T12 (53.0% vs. 31.5% per site, respectively) (p=0.10). Gingival Index (GI) and Plaque Index (PI) were not statistically different between both groups. The linear distance between the bone crest and the restorative margin was 2mm in 13 out of 19 experimental sites of Group 1, and 6 out of 11 of Group 2. CONCLUSIONS: Higher incidence of BoP can be expected around teeth treated with the concept of CMR and in coincidence with deep margins placed at or closer than 2mm from the bone crest. CLINICAL SIGNIFICANCE: CMR is a clinically sensitive-technique, especially when performed on deep subgingival margins.

Fracture Strength of Endodontically Treated Teeth with Different Access Cavity Designs.

INTRODUCTION: The purpose of this study was to compare in vitro the fracture strength of root-filled and restored teeth with traditional endodontic cavity (TEC), conservative endodontic cavity (CEC), or ultraconservative "ninja" endodontic cavity (NEC) access. METHODS: Extracted human intact maxillary and mandibular premolars and molars were selected and assigned to control (intact teeth), TEC, CEC, or NEC groups (n = 10/group/type). Teeth in the TEC group were prepared following the principles of traditional endodontic cavities. Minimal CECs and NECs were plotted on cone-beam computed tomographic images. Then, teeth were endodontically treated and restored. The 160 specimens were then loaded to fracture in a mechanical material testing machine (LR30 K; Lloyd Instruments Ltd, Fareham, UK). The maximum load at fracture and fracture pattern (restorable or unrestorable) were recorded. Fracture loads were compared statistically, and the data were examined with analysis of variance and the Student-Newman-Keuls test for multiple comparisons. RESULTS: The mean load at fracture for TEC was significantly lower than the one for the CEC, NEC, and control groups for all types of teeth (P < .05), whereas no difference was observed among CEC, NEC, and intact teeth (P > .05). Unrestorable fractures were significantly more frequent in the TEC, CEC, and NEC groups than in the control group in each tooth type (P < .05). CONCLUSIONS: Teeth with TEC access showed lower fracture strength than the ones prepared with CEC or NEC. Ultraconservative "ninja" endodontic cavity access did not increase the fracture strength of teeth compared with the ones prepared with CEC. Intact teeth showed more restorable fractures than all the prepared ones.

Fracture strength of the remaining dental structure after different cavity preparation designs.

The aim of this in vitro study was to evaluate the loss of tooth structure after cavity preparation for direct (retentive) and indirect (nonretentive) restorations and its relationship to the fracture strength of the prepared tooth. Sound human third molars (60 maxillary and 60 mandibular) were randomly assigned into 12 groups (n = 10) according to the type of cavity preparation and the respective buccolingual width. Class II mesio-occlusodistal cavity preparations, for both indirect inlay and direct resin restorations, were prepared with standardized dimensions of one-half, one-third, or one-quarter of the occlusal intercuspal distance. Fracture resistance was lower and weight loss was greater for all nonretentive preparations. Greater losses in weight and fracture resistance occurred when the buccolingual width for both types of cavities increased, except for the weight loss of the one-quarter and one-third indirect cavity preparations in the mandibular molars, and the fracture resistance of the one-half and one-third direct cavity preparations in maxillary molars. Higher tooth structure loss and lower fracture strength were recorded after preparation of the inlay cavities.

Effect of cavity depth on dentine sensitivity in man.

OBJECTIVE: To determine if dentine at the enamel-dentine junction (EDJ) in man is more sensitive to hydrostatic pressure stimuli then deeper dentine. DESIGN: Cavities (1mm diam.) were cut at the tips of the buccal and lingual cusps of 8 premolars in 3 subjects (ages: 22-25 years). Both cavities were initially deepened to expose the EDJ then one (the test cavity) was deepened in steps of 0.5mm to a maximum of 2.0 mm below the EDJ. The cavities were tested at each stage, before and after etching, with 5s, hydrostatic pressure stimuli between 400 mm above, and 400 mm below atmospheric. The intensity of any pain produced was recorded on a VAS scale and electrodes were placed in both cavities in an attempt to monitor any action potentials evoked in intradental nerves. RESULTS: In all the teeth, the intensity of the pain produced by a stimulus tended to increase as the cavity was deepened, as did the number of action potentials recorded (in 6 of the 8 teeth). The responses were greater from etched than unetched dentine, and negative pressures evoked greater responses than the corresponding positive pressures. CONCLUSION: There was no evidence that dentine close to the EDJ was more sensitive to hydrostatic pressure stimuli than deeper dentine. It may however be more sensitive to mechanical stimuli as it is more compliant.

Microleakage in different primary tooth restorations.

BACKGROUND: Microleakage may cause tooth sensitivity, secondary caries, discoloration and even failure of the restoration. In order to overcome these potential problems, materials that are able to bind to the tooth structure have been developed, such as composite resin and glass ionomer cement. The purpose of the study was to compare microleakage arising from amalgam (Am), composite resin (CR), glass ionomer (GI), Ketac-Silver (KS), and GI filling with banding (GI+B) when these materials are used for class II restoration of a primary molar. METHODS: Fifty primary molars were collected and class II cavities were prepared on each tooth. The teeth were randomly divided into five groups (Am, CR, GI, KS, and GI+B), each of which received a different material as part of the restoration. The restored teeth then underwent 100 cycles of thermocycling that consisted of 55°C for 30 seconds, 19°C for 20 seconds, and 5°C for 30 seconds. The teeth were then immersed in 0.5% basic fuchsin solution for 24 hours. Afterwards, the teeth were embedded and sectioned mesiodistally through the center of each restoration. Dye penetration associated with the occlusal and cervical margins of each restoration was then assessed. RESULTS: Cervical leakage was greater than occlusal leakage in the CR, GI and KS groups (p < 0.05). When leakage on occlusal margin was examined, however, the Am group showed greater leakage than the CR, GI, and GI+B groups (p < 0.05). When leakage on the cervical margin was examined, the Am group showed greater leakage than the GI and GI+B groups, while the KS group showed greater leakage than the GI+B group (p < 0.05). CONCLUSION: Restorations using GI and GI+B indicated that these materials performed better than the other materials in this study overall. However, none of the materials were entirely devoid of leakage.

Patients' preferences for selective versus complete excavation: A mixed-methods study.

OBJECTIVES: Despite increasing evidence supporting selective caries tissue removal, the technique is not adopted by most dentists, one possible reason being that patients might reject it. We aimed to assess patients' preferences for selective versus complete excavation, and to identify predictors of this preference. METHODS: A sequential mixed-methods approach was taken. First, semi-structured focus group discussions on two convenience samples were performed. Verbatim transcripts were evaluated using content-analysis to inform quantitative study design. The subsequent survey employed convenience, snow-ball and deviant-case sampling, yielding 150 respondents. The relevance of treatment attributes (risks of nerve damage, root-canal treatment, recurrent caries, restorative complications, treatment costs, aesthetic consequences) on patients' treatment preferences was measured using case-vignettes. Dental experience and anxiety as well as patients' personality and socio-demographic details were recorded. Association of predictor variables (age, gender, education, partnership status, personality items, dental experience, anxiety) with treatment preference was assessed using regression analysis. RESULTS: Focus group participants perceived complete excavation as reliable, but feared endodontic treatment. The vast majority of survey respondents (82.7%) preferred complete over selective excavation. The preference for selective excavation was significantly increased in patients with an emotionally stable personality (p<0.001), university entrance degree (p<0.001), none or little dental anxiety (p=0.044), few dentist changes in the past (p=0.025), and who accepted that sealed lesions could progress (p<0.002). CONCLUSION: Treatment attributes, socio-demographic characteristics, personality and dental experiences shape patients' preference towards caries excavation. CLINICAL SIGNIFICANCE: Clinical decision-making regarding carious tissue removal might be affected by dentists on both an informative and an empathic level.

The Influence of Liners on the Pulp Inflammation.

INTRODUCTION: The study included application of liners and dental composites in to cavities of six experimental animals-rabbits (Oryctolagus cuniculus). OBJECTIVE The aim of the study was to investigate rabbit dental pulp response to different liners. Methods Cavity preparation for class V were made on the maxillary central incisors and one lower incisor, while the second lower incisor served as a control tooth. These teeth were restored with the use of one of the following liners--Calcimol LC, ANA Liner and Fuji II LC Improved, and Ceram-X mono dental composite. After an observation period of five days animals were sacrificed and prepared for histological analysis.The existence and degree of the pulp inflammation was determined by using a light microscope. RESULTS: Results showed that the used liners do not cause distortion of the structure and continuity of the odontoblastic layer. Inflammation was not registered in the control group, while in each group of tested materials one tooth with mild signs of hyperemia was registered. Results showed that all three tested liners demonstrated favorable effects on the pulp of the tooth and did not lead to inflammatory reactions. CONCLUSION: Histological analysis of the dental pulp of experimental animals suggests that the liners used in this study do not compromise the integrity of the odontoblastic layer, if it is applied over a thin layer of dentin. In each group of tested materials one tooth with mild signs of hyperemia and vasodilation was registered.

Achieving Dental Analgesia with the Erbium Chromium Yttrium Scandium Gallium Garnet Laser (2780 nm): A Protocol for Painless Conservative Treatment.

OBJECTIVE: The aim of this research is to evaluate those techniques and optimal parameters of Erbium Chromium Yttrium Scandium Gallium Garnet (Er,Cr:YSGG) laser use in delivering predictable painless (or with very limited discomfort) restorative cavity preparation without the aid of injected local anesthesia. MATERIAL AND METHODS: This study was conducted on 30 patients (26 adults and 4 youth 9-16 years old; average age, 37) treated in a private practice. For each patient, a single cavity was prepared using the Er,Cr:YSGG laser (2780 nm). An Electric Pulp Tester (EPT) was used to monitor the changes in pulp sensibility threshold. The patient experience was tested before and after the treatment using a modified Visual Analogue Scale (VAS) and Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) to evaluate pain and anxiety. RESULTS: Pain analysis indicated that 80% of patients (24 out of 30) felt no pain and no discomfort, or only a very slight sensation. None of the 30 patients requested anesthesia. EPT was found to be unreliable in evaluating pulpal pain threshold levels. A tendency was noted wherein greater discomfort was felt by anxious patients. On average, the older the patient, the less discomfort was felt. The factors that have a greater tendency to promote discomfort were: posterior teeth, greater caries depth, greater use of higher power levels and ablation time. CONCLUSIONS: Using the Er,Cr:YSGG laser, it was possible to avoid local anesthesia during cavity preparation with a bur. The treatment was effective in a high number of cases (80%), leading to reduction in the anxiety frequently associated with dental care.

Noninvasive Quantitative Evaluation of the Dentin Layer during Dental Procedures Using Optical Coherence Tomography.

A routine cavity preparation of a tooth may lead to opening the pulp chamber. The present study evaluates quantitatively, in real time, for the first time to the best of our knowledge, the drilled cavities during dental procedures. An established noninvasive imaging technique, Optical Coherence Tomography (OCT), is used. The main scope is to prevent accidental openings of the dental pulp chamber. Six teeth with dental cavities have been used in this ex vivo study. The real time assessment of the distances between the bottom of the drilled cavities and the top of the pulp chamber was performed using an own assembled OCT system. The evaluation of the remaining dentin thickness (RDT) allowed for the positioning of the drilling tools in the cavities in relation to the pulp horns. Estimations of the safe and of the critical RDT were made; for the latter, the opening of the pulp chamber becomes unavoidable. Also, by following the fractures that can occur when the extent of the decay is too large, the dentist can decide upon the right therapy to follow, endodontic or conventional filling. The study demonstrates the usefulness of OCT imaging in guiding such evaluations during dental procedures.

The iontophoresis of lignocaine with epinephrine into carious dentine for pain control during cavity preparation in human molars.

OBJECTIVE: To determine the effectiveness of the iontophoretic delivery of lignocaine with epinephrine through carious dentine for pain control during cavity preparation. DESIGN: The experiments were carried out on 56 carious molars that required class I restorations in 42 subjects (aged 15-20 years). The overhanging enamel and soft caries were removed then the sensitivity of the exposed dentine was tested with drilling, probing and air blast stimuli. The subject indicated the intensity of any pain produced by marking a visual analogue scale (VAS). The cavity was then filled with 20% w/v lidocaine with 0.1% w/v epinephrine and a 200 µA iontophoretic current applied for 2 min after which the sensitivity of the dentine was re-tested. If the dentine was not anaesthetized, the treatment and testing were repeated up to 6 times. RESULTS: The total duration (min) of iontophoresis required to anaesthetize the dentine was: 2 in 7 teeth, 4 in 17 teeth, 6 in 14 teeth, 8 in 4 teeth, and 10 in 7 teeth. The remaining 7 teeth were not anaesthetized even after 14 min of iontophoresis. CONCLUSIONS: The iontophoretic delivery of lignocaine with epinephrine anaesthetized dentine for cavity preparation in 49 of 56 (87.5%) of carious molars.

Evaluation and prevention of enamel surface damage during dental restorative procedures.

BACKGROUND: This study examined the effect of operator experience, dominance, tooth position and access, on frequency and extent of iatrogenic damage to approximal tooth surfaces during conventional Class II cavity preparations. The effectiveness of protective devices in minimizing damage was also explored. METHODS: 10 students and 10 experienced dentists each prepared 24 Class II cavity preparations in typodont teeth without protection; 10 utilizing stainless steel matrix bands and 10 utilizing protective wedges. The frequency and extent of damage were analysed with respect to the above variables. Subsequently, 20 natural and 20 typodont teeth were utilized to establish the relationship in depth of damage caused by a high-speed diamond bur on typodont versus natural teeth. RESULTS: Dentists caused iatrogenic damage on 74% of approximal surfaces without protection, which fell to 50% and 46% respectively when matrix bands and wedges were used as guards. The corresponding rates of damage for students were 94%, 80% and 44%. There was no difference in depth of damage caused on the two types of teeth when bur was in contact with teeth for a very short time. CONCLUSIONS: Greater operator experience and the use of guards reduces iatrogenic damage to proximal surfaces during preparation with high-speed rotary instruments.

Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review.

Composite resin is used extensively for restoration of teeth with vital pulps. Although cell culture studies have disclosed harmful effects on pulpal cells, any untoward clinical effects, manifest as adverse pulpal responses, have yet to be determined. This study comprises a systematic review, designed to address the question of whether the risk of endodontic complications is greater with composite resin restorations than with other restorative materials, such as amalgam. The study methodology involved (i) formulation of the research question, (ii) construction and conduct of an extensive literature search with (iii) interpretation and assessment of the retrieved literature. A search of the medical database PubMed was complemented with a search of the Controlled Trials Register (CENTRAL). The initial search yielded 1043 publications, the abstracts of which were read independently by the authors. After additional searches, 10 studies were included in the review. In all the included studies, the level of evidence was assessed as low. No conclusions could therefore be drawn. The included studies reported few, if any, endodontic complications. Little or no differences emerged between teeth restored with composite resins and those restored with amalgam. To determine whether composite resin restorations of teeth with vital pulps are associated with an increased risk for development of endodontic complications such as apical periodontitis, further evidence is needed, from well-constructed studies with a large number of participants.

Cytotoxicity and pro-inflammatory action of chemo-mechanical caries-removal agents against oral cells.

BACKGROUND: Chemo-mechanical caries removal eliminates the outermost portion of the infected layer, leaving behind healthy dentine surfaces, with scarce dental tissue damage; however, the safety of caries solvents has not been established. The aim of the present study was to investigate the possible cytotoxicity of two popular chemo-mechanical caries removal agents. MATERIALS AND METHODS: The cytotoxicity of Carisolv, Papacarie Duo and control vehicle solution (0.155-20% v/v) against human oral squamous cell carcinoma cells (HCS-2, HSC-3, HSC-4, Ca9-22) human gingival fibroblast (HGF), pulp (HPC) and periodontal ligament fibroblast (HPLF) was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide method. Prostaglandin E2 (PGE2) was quantified by enzyme-linked immunosorbent assay. Changes in fine cell structure were assessed by transmission electron microscopy. RESULTS: Carisolv exhibited neither cytotoxicity nor hormetic growth stimulation. Papacarie Duo significantly reduced the viable cell number within 30 min. HSC-4 exhibited the highest sensitivity, followed by HSC-2>HSC-3>HPLF>Ca9-22>HPC>HGF cells. Interleukin-1ß (3 ng/ml) stimulated HGF, but not HPC cells to produce PGE2 in the culture medium. Papacarie Duo stimulated HGF cells to produce PGE2 in synergistic fashion with interleukin-1ß. CONCLUSION: Carisolv had acceptable biocompatibility with both normal and cancerous oral cells. On the other hand, Papacarie Duo had a rapid but slight cytotoxicity and pro-inflammatory action against oral cells, suggesting the importance of careful application of this agent.

Determining treatibility of primary teeth with pulpal exposure.

OBJECTIVES: To determine rates of pulpal exposure during caries removal with an excavator or a bur, to assess success rates of vital pulp therapies in both cases, to analyze pulpal bleeding as an indicator of primary teeth treatability. STUDY DESIGN: Of the 352 primary mandibular molars with deep carious lesions, 141 with pulp exposed during the removal of caries were grouped according to type of instrument causing pulpal exposure and existence of bleeding at the exposure site. Teeth suitable for direct pulp capping or formocresol pulpotomy were treated and followed up for two years. RESULTS: The difference between the rates of pulpal exposure with an excavator (52.5%) or a bur (47.5%) was insignificant. The treatment success rate of teeth with pulp exposed by an excavator (15.8%) was significantly lower than teeth with pulp exposed by a bur (48.8%), regardless of whether bleeding existed at the exposure site or not; however when bleeding existed, this difference was insignificant (15.8% and 40.6%, respectively). CONCLUSIONS: Pulpal exposure possibility during caries removal caused by an excavator and a bur was similar the treatment success rate was lower when the exposure was caused by an excavator the existence of pulpal bleeding resulted in mistakes in diagnoses.