2-year survival and cost analysis of occlusoproximal ART restorations using encapsulated glass ionomer cement in primary molars: a randomized controlled trial.

BACKGROUND: The survival of ART restorations can be influenced by the choice of the restorative material. The aim of this randomized non-inferiority controlled trial was to compare the 2-year survival rate and cost analysis of two encapsulated glass ionomer cements (GIC) as occlusoproximal restorative materials in primary molars. METHODS: Children from public schools in Tietê (Brazil), aged 4-8 years with occlusoproximal dentine carious lesions in primary molars were selected and randomly assigned to receive either Equia Forte (EF) or Riva Self Cure (RSC) as restorative materials. Treatment was carried out by two trained final-year dental students in schools following ART premises. Restorations were assessed by a trained and calibrated examiner after 2, 6, 12, 18, and 24 months. The primary outcome was restoration survival after 2 years, analyzed using Kaplan-Meier survival and Cox regression analysis (α = 5%). Professional and materials costs for each group were collected in Brazilian Reais (R$) and converted into US dollars (US$) and analyzed using Monte-Carlo simulation. RESULTS: A total of 152 children (76 per group) were included in the study, and 121 (79%) were evaluated after 2 years. The overall 2-year restoration survival rate was 39% (EF = 45%; RSC = 32%) with no difference between the groups. The baseline and 2-year total cost of restorations using RSC was lower when compared to EF (incremental cost: US$ 6.18). CONCLUSION: After two years of follow-up, Riva Self Cure shows comparable restoration survival rates to Equia Forte, being more cost-effective in the Brazilian perspective. TRIAL REGISTRATION: This randomized clinical trial was registered on ClinicalTrials.Gov - NCT02730000.

Assessment of CAD/CAM Fabrication Technologies for Post and Core Restorations-A Narrative Review.

The primary objective of this study is to conduct a comprehensive review of the existing literature that discusses research on post and core restorations, covering aspects such as their composition, manufacturing methods, and clinical effectiveness. The methodology employed in this review encompasses the implementation of a well-defined search strategy, the establishment of criteria for inclusion and exclusion, and the selection of relevant studies to summarize their findings. To gather relevant literature published between 1993 and 2023, the research team conducted separate searches on PubMed, Web of Science, and Embase databases. In total, 168 titles were initially retrieved from these electronic databases. By applying the predefined exclusion criteria, the researchers identified 73 articles that specifically address the conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) technologies employed in post and core restorations. These treatments are commonly employed to restore teeth that have received endodontic therapy and subsequently experienced loss of dental structure. The development of computerized technology for the creation of customized posts and cores has emerged as a straightforward and efficient alternative to traditional methods. The review synthesizes papers discussing the techniques and materials involved in CAD/CAM-based construction of post and cores. It explores strategies for restoring endodontically treated teeth, highlighting both direct and indirect approaches. Commonly mentioned materials include zirconia, composite resin, and hybrid ceramics. Despite the limited literature on CAD/CAM post and core procedures, the review emphasizes the necessity of further research to assess long-term outcomes and efficacy. Additionally, it suggests including implications for future research and clinical recommendations to enhance the depth and practical relevance of the review.

Cost-effectiveness of restorative treatments for permanent molars with severe molar incisor hypomineralization: perspectives for the Brazilian public health system.

OBJECTIVES: To undertake a cost-effectiveness analysis of restorative treatments for a first permanent molar with severe molar incisor hypomineralization from the perspective of the Brazilian public system. MATERIALS AND METHODS: Two models were constructed: a one-year decision tree and a ten-year Markov model, each based on a hypothetical cohort of one thousand individuals through Monte Carlo simulation. Eight restorative strategies were evaluated: high viscosity glass ionomer cement (HVGIC); encapsulated GIC; etch and rinse adhesive + composite; self-etch adhesive + composite; preformed stainless steel crown; HVGIC + etch and rinse adhesive + composite; HVGIC + self-etch adhesive + composite, and encapsulated GIC + etch and rinse adhesive + composite. Effectiveness data were sourced from the literature. Micro-costing was applied using 2022 USD market averages with a 5% variation. Incremental cost-effectiveness ratio (ICER), net monetary benefit (%NMB), and the budgetary impact were obtained. RESULTS: Cost-effective treatments included HVGIC (%NMB = 0%/ 0%), encapsulated GIC (%NMB = 19.4%/ 19.7%), and encapsulated GIC + etch and rinse adhesive + composite (%NMB = 23.4%/ 24.5%) at 1 year and 10 years, respectively. The benefit gain of encapsulated GIC + etch and rinse adhesive + composite in relation to encapsulated GIC was small when compared to the cost increase at 1 year (gain of 3.28% and increase of USD 24.26) and 10 years (gain of 4% and increase of USD 15.54). CONCLUSION: Within the horizon and perspective analyzed, the most cost-effective treatment was encapsulated GIC restoration. CLINICAL RELEVANCE: This study can provide information for decision-making.

[Radiological assessment of long-term outcomes of restorative treatment in patients with shortened dental arches]. / Rentgenologicheskaya otsenka otdalennykh rezul'tatov ortopedicheskogo lecheniya patsientov s ukorochennym zubnym ryadom.

BACKGROUND: Restoring the integrity of the dentition with orthopedic structures should be carried out strictly according to indications, taking into account the condition of the supporting teeth and/or teeth limiting the defect. OBJECTIVE: To conduct a retrospective analysis of the results of orthopedic treatment of patients with shortened dentition according to clinical and radiological methods. MATERIALS AND METHODS: The material for the study was data from cone beam computed tomography (CBCT) of 126 patients with shortened dentition (most patients with the absence of a second molar, as well as the absence of the first and second molars), who sought a consultation about missing teeth in the orthopedic and surgical department of the Federal State Budgetary Institution National Medical Research Center TsNIISiCHLKh Ministry of Health of Russia. RESULTS: At the stages of treatment for patients in the study group, insufficient attention is paid to the restoration of terminal defects of the dentition in the upper and lower jaws, especially the restoration of second molars. This may be due to improper planning of dental treatment and insufficient motivation of the patient to carry out comprehensive dental rehabilitation. According to CT studies, the number of complications of orthopedic treatment in the area of supporting teeth and/or teeth limiting the included defect or terminal defect of the dentition in the masticatory region increases depending on the period of use of the orthopedic structure. CONCLUSIONS: The use of cantilever structures leads to functional overload of the supporting teeth. Neglecting the restoration of a full dentition and prosthetics of end defects of the dentition leads to dentoalveolar advancement of antagonists of missing teeth and the appearance of complications such as functional overload of supporting teeth and resorption of alveolar bone.

Comparing modified USPHS and FDI criteria for the assessment of glass ionomer restorations in primary molars utilising clinical and photographic evaluation.

PURPOSE: To compare the applicability of modified US Public Health Service (USPHS) and FDI criteria for evaluating glass ionomer cement (GIC) restorations in primary posterior teeth through digital image analysis. METHODS: This comparative analytic study was conducted at the Children's Dental Clinic RSKGM FKG UI, involving 40 GIC restorations on lower first primary molars in children aged 4-9 years. After cleaning, the restorations were assessed clinically using modified USPHS and FDI criteria before taking digital images, then the collected images were re-evaluated using both sets of criteria, and the clinical assessment results were compared to the digital image assessment results. RESULTS: Statistical analysis revealed significant differences between the clinical evaluation of GIC restorations in primary teeth and their corresponding digital photographs when using the modified USPHS criteria, and although the use of FDI criteria yielded different results, these differences were not statistically significant. CONCLUSION: The assessment of GIC restorations through digital images aligns more closely with clinical assessments using the FDI criteria compared to the modified USPHS criteria.

Comparative Assessment of Marginal Micro Leakage of Different Esthetic Restorative Materials Used on Primary Teeth: An In-vitro Study.

AIM: The aim of the current investigation was to evaluate the marginal microleakage of various esthetic restorative materials applied to primary teeth. MATERIALS AND METHODS: A total of 75 noncarious primary molars that were removed for orthodontic intervention and teeth nearing exfoliation were chosen. One millimeter (mm) above the cementoenamel junction, on the buccal surface of the teeth, Class V cavities were prepared. William's graded periodontal probe was used to standardize cavity preparation on all teeth. 3 mm was the cavity's length, 2 mm in width, and 2 mm in depth. The teeth were then divided into three groups (25 samples in each group) according to the type of esthetic restorative material used. Group I: Resin-modified glass ionomer cement, Group II: Ormocer, Group III: Giomer. The samples underwent 500 cycles of thermocycling, with an immersion time of 60 seconds and a well time of 15 seconds, between 5 and 55°C. The samples were submerged in methylene blue dye for 24 hours at room temperature and dried. The samples were then divided into sections and examined with a stereomicroscope. Data was recorded and statistically analyzed. RESULTS: The least marginal microleakage was found in the ormocer group (1.22 ± 0.01) followed by resin-modified glass ionomer cement group (1.31 ± 0.07) and the giomer group (1.78 ± 0.03). There was a highly statistically significant difference found between resin-modified glass ionomer cement group and the ormocer group, resin-modified glass ionomer cement group and giomer group. And no significant difference was found between the ormocer group and the giomer group. CONCLUSION: The present study concluded that there was some amount of microleakage in primary teeth in all restorative materials examined in this in-vitro investigation. However, the marginal sealing ability of ormocer was found highest compared to resin-modified glass ionomer cement and Giomer materials. CLINICAL SIGNIFICANCE: The primary reason dental restorations fail, particularly in Class V cavities, is microleakage since the margins of these restorations are typically found in the dentin or cementum. Assessing microleakage is a crucial step in determining the marginal integrity of restorative materials. Developing methods and resources that reduce the adverse effects caused by the restorative marginal seal failing would benefit from this. How to cite this article: Al Ghwainem A, Alqarni AS. Comparative Assessment of Marginal Micro Leakage of Different Esthetic Restorative Materials Used on Primary Teeth: An In-vitro Study. J Contemp Dent Pract 2024;25(1):58-61.

Optical impressions assessment for overlay restorations with rubber dam: A clinical trial.

OBJECTIVE: The possibility of making impressions of teeth prepared with a rubber dam in place has been proposed; however, this requires trimming and rescanning the mesh, which has been described as a cause of accuracy loss. This study aims to clinically determine whether overlay restorations obtained from a scan with a rubber dam in place have equivalent marginal fit, contact points, and occlusal fit to the same type of restorations obtained from a scan without a rubber dam. MATERIAL AND METHODS: Thirty patients who underwent overlay restoration of a molar with at least one neighbouring tooth were selected. After tooth preparation, two scans were performed: one without a rubber dam and the other with a rubber dam. Restorations were randomly created from one scan or another. The marginal fit, interproximal contact points, and occlusal fit were evaluated clinically. Two meshes, with and without rubber dams, were also compared. RESULTS: No significant differences were observed in the clinical evaluation of the overlays made of the two meshes. The trueness of the mesh from the impression made with a rubber dam with respect to the mesh without a rubber dam was about 40 µm in the critical areas of the preparation (margins, intaglio, and interproximal contact points). CONCLUSIONS: The results of this study show that under the conditions performed and with the equipment used, there are no significant clinical differences between overlay restorations made from a scan with a rubber dam and those made from a scan without a rubber dam. CLINICAL SIGNIFICANCE: Scanning with a rubber dam in place may be a valid option for certain types of restorations under certain clinical conditions.

Assessment of internal porosities for different placement techniques of bulk-fill resin-based composites: a micro-computed tomography study.

OBJECTIVES: The aim was to compare the porosity of different bulk-fill resin-based composites (RBCs) placement techniques to the conventional incremental technique using microcomputed tomography (µ-CT). MATERIAL AND METHODS: Occlusal cavities were prepared on extracted human molars, divided into five groups based on the placement technique (n = 10/group). Techniques examined were Monoblock-two-step (SureFil SDR flow + Ceram.X), Monoblock-two-step (Tetric EvoFlow Bulk-Fill + Tetric EvoCeram Bulk-Fill), Monoblock-one-step (Tetric EvoCeram Bulk-Fill), Monoblock with sonic activation (SonicFill2), and incremental technique (Filtek Z250). µ-CT scanning (SkyScan, Bruker, Belgium) assessed the number, volume of closed pores, and total porosity. Analysis of variance on ranks was used (Student-Newman-Keuls method and Mann-Whitney rank-sum test), to determine the significance of RBC viscosity and the sonication placement technique. The Spearman correlation method assessed the correlation between porosity characteristics (α = 0.05). RESULTS: The SonicFill2 presented a higher number of closed pores than the other groups (p < 0.05). The overall porosity within the restoration seemed greater in this order: Filtek Z250 > SonicFill2 > Tetric EvoFlow Bulk-Fill + Tetric EvoCeram Bulk-Fill > Tetric EvoCeram Bulk-Fill > SureFil SDR Flow + Ceram.X. Sonication was associated with increased number (p = 0.005) and volume (p = 0.036) of closed pores. A strong correlation was observed between the number and volume of closed pores (R2 = 0.549, p < 001). CONCLUSIONS: The monoblock technique with sonic activation showed significantly more internal porosity than the other placement techniques. Sonication during application contributed to the higher number and volume of closed pores than the passive bulk-fill application. CLINICAL RELEVANCE: Using bulk-fill materials enhances efficiency, yet void formation remains an issue, depending on viscosity and active/passive delivery of materials. Clinicians must familiarize themselves with effective placement techniques to reduce void formation and optimizing treatment outcomes.

Amalgam or composite in pediatric dentistry: Analysis of private insurance claims data.

BACKGROUND: Advancements in dental materials and changing parental preferences are modifying the frequency of use of restorative materials. This insurance claims analysis examined the trends in the use of amalgam and resin composite in the United States. METHODS: Commercial dental insurance claims were analyzed to compare 505,994 restorations, corresponding with procedure codes for 1-, 2-, and 3-surface amalgam or resin restorations. Paid claims collected nationwide from January 2010 through March 2020 were analyzed. Data for children aged 3 through 12 years were used, resulting in 219,632 unique patient identification numbers. Generalized estimating equation models applied to logistic regression were used. All tests were conducted using a 2-sided 5% significance level. RESULTS: In general, girls were less likely to receive amalgam than boys. A $20,000 increase in median household income was associated with a 16% decrease in the odds of amalgam being placed. Pediatric dentists (performing 15.1% of all restorations) were not as likely as general dentists (18.4%) to use amalgam. Having more surfaces in a restoration was associated with higher probability of amalgam placement. The percentage of amalgam restorations was higher for 2010 (26.9%) than for 2011 through 2020, and this pattern recurred in several of the years analyzed. Generally, patient age at time of amalgam restoration increased over time. CONCLUSION: The use of amalgam is trending down; the sharpest decline was noted in 2014. Pediatric dentists were less likely to use amalgam than general dentists. Girls and patients with higher socioeconomic status were less likely to have amalgam. PRACTICAL IMPLICATIONS: The findings of this study can inform and support clinical decisions and the formation of public policies.

Posterior dental restoration material choices in privately insured people in the United States, 2017 through 2019.

BACKGROUND: In the context of evolving dental materials and techniques and a national agenda to phasedown use of dental amalgam, estimates of dental amalgam placement are necessary for monitoring purposes. METHODS: Numbers of amalgam and composite posterior restorations from 2017 through 2019 were calculated using retrospective dental claims analysis of privately insured patients. Kruskal-Wallis and multilevel, multivariable negative binomial regression models were used to test for differences in rates of amalgam and composite restoration placement by age group, sex, urban or rural area, and percentage race and ethnicity area distribution. Statistical significance was set at 0.05, with Benjamini-Hochberg correction for false discovery rate. RESULTS: The rate of amalgam restorations declined over time from a mean of 6.29 per 100 patients in 2017 to 4.78 per 100 patients in 2019, whereas the composite restoration rate increased from 27.6 per 100 patients in 2017 to 28.8 per 100 in 2019. The mean number of amalgam restorations placed per person were lowest in females compared with males, in urban areas compared with rural areas, and in areas with more than 75% non-Hispanic White residents. CONCLUSIONS: Amalgam restoration placements in privately insured people in the United States declined from 2017 through 2019. Amalgam restoration placements may be unevenly distributed by location. PRACTICAL IMPLICATIONS: Achieving further declines of dental amalgam use may require changes to insurance coverage, incentives, and provider training as well as augmented disease prevention and health promotion efforts. These efforts should focus particularly on groups with high caries risk or higher rates of amalgam placement.

3D-2D microleakage assessment of preheated bulk-fill composite resin applied with different parameters: a micro-CT analysis.

This study evaluated microleakage from class II cavities filled with bulk-fill composite preheated to different temperatures, applied at different thicknesses, and with different polymerization modes. A total of 60 mesio-occlusal cavity were drilled into the extracted human third molars at 2 mm and 4 mm thickness. Preheated bulk-fill composite resin (Viscalor; VOCO, Germany) was applied to the cavities at 68 °C and 37 °C after the adhesive resin was applied, and cured using standard and high-power light-curing modes of a VALO light-curing unit. An incrementally applied microhybrid composite was used as the control. The teeth were subjected to 2000 cycles of heating to 55 °C and cooling to 5 °C with a 30-s hold time. Then, they were immersed in a 50% silver nitrate solution for 24 h and scanned with micro-computed tomography. Scanned data were processed using the CTAn software. Two (2D) and three (3D) dimensional analyses of leached silver nitrate were performed. The data's normality was assessed using the Shapiro-Wilk test before comparisons using a three-way analysis of variance. In both 2D and 3D analysis, bulk-fill composite resin preheated to 68 °C and applied at 2 mm thickness showed less microleakage. In the 3D analysis, restorations applied at 37 °C and 4 mm thickness in high-power mode showed significantly higher values (p < 0.001). Preheated bulk-fill composite resin can be applied at 68 °C and effectively cured at both 2 mm and 4 mm thickness.

Survival Analysis and Cost Effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and ART Occlusal Restorations in Primary Molars: a randomized controlled trial.

OBJECTIVE: To evaluate and compare the clinical performance and cost effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and Atraumatic Restorative Treatment (ART) restorations in primary molars over 12 months follow up period. MATERIALS AND METHODS: Sixty-seven children, aged 5-9 years old having at least one asymptomatic primary molar with active caries, were randomly assigned to either the test arm (SMART) or the control arm (ART). Clinical performance was assessed after 6 and 12-months using the modified United States Public Health Services criteria. The trial was registered at Clinical Trial.gov with a registration number (NCT03881020). Treatment time for each restoration was recorded, Kaplan-Meier survival analysis and the log-rank test were performed (p<0.05) and cost effectiveness was measured at the end of the study. RESULTS: Both techniques showed comparable clinical performance and the mean survival time was 11.8 and 11.6 months for SMART and ART restorations respectively with no detected significant differences (p=0.416). Mean treatment time for SMART restorations (7.8 min.), however, was significantly lower than ART (15 min.) (p < 0.001). SMART technique, also, showed statistically significant lower mean total cost per restoration (p <0.001). CONCLUSIONS: Though SMART and ART have comparable clinical performance and survival in single-surface occlusal restorations in primary molars, SMART is less time consuming and more cost effective. CLINICAL SIGNIFICANCE: Using SMART technique could change paradigms in caries management. Being a patient friendly and cost-effective approach, it could be adopted as a superior treatment option when dealing with young children, those with behavioral and medical challenges and for promoting access to oral care among the underprivileged.

Accuracy of Two Visual Criteria for the Assessment of Caries around Restorations: A Delayed-Type Cross-Sectional Study.

The aim of this study was to compare the performance of two visual criteria used for the detection of caries around restorations in permanent teeth. In this delayed-type cross-sectional study, the study sample was randomly allocated to one of two visual criteria for the assessment of restorations as follows: (a) International Dental Federation (FDI) criteria, considers marginal staining, marginal adaptation, and caries recurrence and (b) Caries Associated with Restorations or Sealants (CARS) criteria, defined by the International Caries Classification and Management System. A calibrated examiner assessed the restorations using two reference standards as follows: (i) for restorations requiring operative interventions (repair/replacement), the restoration was partially or totally removed and the presence or absence of carious tissue was assessed; and (ii) for restorations requiring nonoperative intervention, follow-up for a period of 1 year was recommended to allow identification of the presence of new lesions not detected at baseline. The sensitivity, specificity, area under receiver operating characteristic curve (Az), and accuracy of the criteria were assessed. The study included 305 restorations. The FDI marginal staining parameter had the lowest Az value (Az = 0.501), while similar sensitivity was observed between the CARS (62.0%), FDI presence of caries (65.0%), and FDI marginal adaptation (74.0%) parameters. CARS exhibited the highest specificity (88.3%) and accuracy (85.6%). The CARS criteria exhibited better specificity and accuracy in detecting caries around restorations, followed by the FDI criteria for caries recurrence and marginal adaptation. Considering marginal staining or combining multiple marginal features to assess secondary caries resulted in an increased risk of false-positive outcomes and overtreatment.

A comparative life cycle assessment of dental restorative materials.

OBJECTIVES: Different types of direct-placement dental materials are used for the restoration of structure, function and aesthetics of teeth. The aim of this research investigation is to determine, through a comparative cradle-to-gate life cycle assessment, the environmental impacts of three direct-placement dental restorative materials (DRMs) and their associated packaging. METHODS: Three direct-placement dental materials; dental amalgam, resin-based composite (RBC) and glass polyalkenoate cements (GIC) are assessed using primary data from a manufacturer (SDI Limited, Australia). The functional unit consisted of 'one dental restoration' of each restorative system under investigation: 1.14 g of dental amalgam; 0.25 g of RBC (plus the adhesive = 0.10 g); and 0.54 g of GIC. The system boundary per restoration included the raw materials and their associated packaging materials for each DRM together with the processing steps for both the materials and packaging. The environmental impacts were assessed using an Egalitarian approach under the ReCiPe method using Umberto software and the Ecoinvent database. Nine different impact categories were used to compare the environmental performance of these materials. RESULTS: Dental amalgam had the highest impact across most of the categories, but RBC had the highest Global Warming Potential. The highest sources of the environmental impacts for each restorative material were: Amalgam, derived from material use; RBC, derived from energy use in processing material and packaging material; GIC, derived from material and energy use for packaging. SIGNIFICANCE: Less intensive energy sources or more sustainable packaging materials can potentially reduce the impacts associated with RBC and GIC thus making them suitable alternatives to dental amalgam.

Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis.

OBJECTIVE: To evaluate the cost-effectiveness of retaining one or more compromised first permanent molars (cFPMs) affected by dental caries or enamel hypomineralization, compared to timely extraction, in children aged 8 years. METHODS: A Markov model was developed to simulate the lifetime of a cFPM. Two management strategies were compared: extraction facilitating spontaneous space closure or maintenance of teeth with restorations. Ten health states were utilized to capture long-term outcomes including various tooth restorations, prostheses or a retained gap at the cFPM site. Outcomes were expressed as Quality Adjusted Tooth-Years (QATYs). The model was informed by survey data on patient preferences for treatment outcomes and UK data on costs. Discounted costs and QATYs were calculated over 62 years. RESULTS: Regardless of the number of cFPMs, retaining cFPMs was more effective than early removal, generating an additional 2.3 QATYs per cFPM. Early removal of one or two cFPM under general anaesthetic (GA) was more expensive than retention and hence never cost-effective. Retaining a cFPM was more expensive than early removal under local anaesthesia or where four cFPMs were extracted under GA. In these cases, retaining cFPMs was cost-effective if a QATY was valued at £100 or £35, respectively. Results were robust to sensitivity analysis. CONCLUSION: Preserving a cFPM was more cost-effective than the early loss of one, or two cFPMs under GA. Preservation of four cFPMs was cost-effective if sufficient value was placed on a QATY. These findings can guide clinical practice on management of cFPMs alongside patient/payer values on maintaining teeth.

Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials.

AIMS: The purpose of this systematic review was to evaluate the cost-effectiveness and acceptance of children and their parents of the Hall technique (HT) for dental rehabilitation in pediatric dentistry. BACKGROUND: The approach of the HT is that of minimally invasive treatment of the dental element and is used exclusively on primary molars. Various studies in the literature point to HT as a restorative option well accepted by children and parents and quite predictable, with low retreatment rates and good cost-effectiveness for the management of primary molars with carious lesions. However, no systematic review in the literature has approached randomized clinical trials on these topics to produce a high level of evidence and help establish clinical HT protocols. REVIEW RESULTS: Eight articles were selected for the systematic review. The HT was more cost-effective than procedures using other restorative materials. Regarding acceptance, in terms of esthetics, high percentages of satisfaction were reported for parents and children, with a divergence between studies in the comparison of esthetic preference with atraumatic restorative treatment. However, when considering crown cementation pain, comfort, anxiety, preference, and satisfaction, the HT was generally better evaluated when compared to other restorative materials. CONCLUSION: The HT is an excellent restorative option when considering cost-effectiveness and acceptance and is recommended for use in daily clinical practice. CLINICAL SIGNIFICANCE: Results indicate that HT is superior to other restorative materials regarding its acceptance by children and parents in terms of pain, comfort, anxiety, and crown preference and satisfaction. There were also high percentages of satisfaction with esthetics. Hall technique may initially appear expensive for dentists, but its effectiveness over time and the lesser need for consultations and reinventions ensure better cost-benefit than other restorative materials. How to cite this article: Valentim FB, Moreira KMS, Carneiro VC, et al. Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials. J Contemp Dent Pract 2023;24(12):1016-1025.

Considerations for restorative dentistry secondary care referrals - part 3: assessment of case complexity.

Assessing the complexity of a case is a challenging exercise, with many tooth-specific as well as patient-specific considerations required. This decision is not made in isolation but goes hand in hand with the assessment of restorability, as well as strategic importance, both of which have been covered by the previous papers in this series. A number of guidelines regarding this matter have been devised in order to aid clinicians in determining the complexity of their patients and thus the most appropriate setting for their treatment. This paper aims to discuss the various complexity criteria available and their application, thus aiding clinicians in managing some of the more challenging cases.

Evaluation of micro-CT in the assessment of microleakage under bulk fill composite restorations.

PURPOSE: To evaluate microleakage measurements using micro-CT in comparison to dye tracers in Class 2 bulk-fill composite restorations with two adhesive techniques. METHODS: 60 sound molars were prepared with Class 2 cavities having cervical margins in enamel (mesial) and in dentin (distal) and restored with Filtek Bulk Fill, using either a self-etch or total-etch technique. All teeth were thermo-cycled between 5°C and 55°C for 800 cycles and randomly exposed to three tracer dyes: 2% methylene blue, 0.5% basic fuchsin or 50% silver nitrate solutions. Teeth were sectioned mesial-distal and depth of tracer penetration was measured as a ratio of dye penetration from the cavosurface divided by total depth of the cervical floor. The silver nitrate subgroup was micro-CT scanned prior to sectioning, evaluated in 3D serial sections, and calculated volumetrically. RESULTS: Analysis of ratios for dye tracer penetration showed significantly lower values for methylene blue (0.120). Micro-CT values calculated in 3D as volume (mm³) were significantly greater in enamel for self-etch (0.060) compared to total-etch (0.020). Micro-CT volumetric analysis showed better discrimination with significantly greater leakage in enamel margins using the self-etch adhesive. CLINICAL SIGNIFICANCE: Based on this in vitro study of microleakage, micro-CT volumetric evaluation in serial digital sections improves discrimination and represents a more reliable estimate of true microleakage. In vitro study of microleakage is most useful in comparing adhesive products, but clinical application of the data is questionable.

Selected and simplified FDI criteria for assessment of restorations.

OBJECTIVES: Assess the quality of dental restorations with simplified FDI criteria and examine its relationships with other general characteristics of restored teeth. METHODS: The study involved 76 dentists from private and hospital practices. Assessments of successes and failures of previous restorations used a simplified rating with FDI criteria 3 to 8, 11, 12, and 14. The results were examined versus tooth location, number of restored surfaces, type of restoration, and filling material. RESULTS: The dentists examined 4,612 dental restorations, of which 4,185 direct fillings mainly with resin composite materials (2,555). Of all restorations, 2,048 (44.4%) were considered as failures, of which 1,489 had one or two criteria for 'clinically unsatisfactory/poor restoration'. As simplified, the esthetic criterion 'color match' was the most frequent criterion for failure (912 cases). The rate of restoration failures was found associated with the number of surfaces restored and the use of glass-ionomer cement. Results are not comparable with others obtained with original FDI criteria. CONCLUSIONS: Assessing dental restorations with the original FDI criteria leads generally to much more failure statements than practitioners' decisions to reintervene. Though requiring some adjustment (e.g., regarding 'color match'), the simplified assessment proved convenient and amenable to standardization. CLINICAL SIGNIFICANCE: Regardless of the type of practice, selecting, understanding, and optimal interpreting of FDI criteria for failure is essential to help practitioners faced with daily dilemmas of replacement vs. repair of failed dental restorations. Standardization of simplified criteria is desirable to help comparing research data.

Clinical and OCT assessment of application modes of a universal adhesive in a 12-month RCT.

OBJECTIVES: To evaluate a universal adhesive clinically using FDI criteria and by optical coherence tomography (OCT). METHODS: In 50 patients, three or four non-carious cervical lesions (NCCL) were restored with composite (Venus® Diamond Flow, Kulzer) using iBond® Universal (iBU, Kulzer) applied in self-etch (iBU-SE, n = 50), selective-enamel-etch (iBU-SEE, n = 29) or etch-and-rinse mode (iBU-ER, n = 50) and the reference OptiBond™ FL (OFL, Kerr, n = 50). Restorations were imaged by SD-OCT. The weighted mean length of interfacial adhesive defects (AD, %) was quantified per restoration immediately after placement (t0), simultaneously with clinical assessment (FDI criteria) after 14 days (t1), 6 (t2) and 12 months (t3). Data were statistically analyzed (McNemar-/Wilcoxon-/Mann-Whitney-U test (α = 0.05), Kaplan-Meier survival curves). RESULTS: After 12 months, cumulative failure rates were lower with iBU-SE (0.0%; p = 0.016), iBU-SEE (0.0%; p = 0.125), and iBU-ER (2.1%; p = 0.070; loss t3) compared to OFL (16.7%; losses t2, t3). Generally, marginal adaptation decreased (pi < 0.001) and marginal staining increased (pi ≤ 0.031), without significant group differences (pi > 0.064). AD increased in all groups (pi < 0.001). At enamel, AD appeared more extended with iBU-SE vs. iBU-SEE (t2-t3; pi ≤ 0.005), iBU-ER (t1-t3; pi ≤ 0.051) and OFL (t0-t3; pi ≤ 0.018). At dentin/cement iBU generally caused fewer defects than OFL (t1-t3; pi ≤ 0.010) and with SE vs. ER (t2-t3; pi = 0.010). CONCLUSIONS: In NCCLs, iBU generally provides a more durable bond than OFL. Recommended mode is SEE. Clinic and OCT provided comparable results. OCT has higher statistical power, shows group differences earlier and specifically for the different hard tooth tissues. CLINICAL SIGNIFICANCE: The universal adhesive iBU was superior against the reference OFL in NCCLs. It can be recommended with SEE. Evaluation of interfacial adhesive defects by OCT seems to allow early prediction of adhesives' clinical performance.