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.

Misfit detection in implant-supported prostheses of different compositions by periapical radiography and cone beam computed tomography: An in vitro study.

STATEMENT OF PROBLEM: Misfits at the implant-abutment joint (IAJ) can cause the biological and mechanical failure of implant therapy. Standard parallel periapical radiography (PERI) is the method of choice for assessing the fitting of implant-supported prostheses. Although current guidelines do not support the use of cone beam computed tomography (CBCT) solely for misfit detection, CBCT scans can also register misfits as imaging findings. Whether the material used for prostheses manufacturing influences misfit appearance in PERI and CBCT images is unknown. PURPOSE: The purpose of this in vitro study was to assess the influence of the type of prosthesis material on misfit detection at the IAJ by using PERI and CBCT. MATERIAL AND METHODS: Thirty-two implants with an external hexagon connection were placed in dried human mandibles. Implant-supported crowns were manufactured with different materials and allocated to 3 experimental groups: metal-ceramic (MC), titanium abutment veneered with acrylic resin (TIT), and zirconia abutment veneered with glass-ceramic (ZIR). All crowns were installed both with and without a simulated 200-µm-thick gap at the IAJ (n=64) and were assessed by PERI and CBCT scans. Four dentists evaluated the images for the presence or absence of misfit. Statistical analysis included the Kappa test and areas under the receiver operating characteristics curve (Az values) comparisons (α=.05). RESULTS: Kappa values indicated almost perfect intraevaluator and interevaluator reproducibility for PERI and ranged from fair to almost perfect for CBCT. For PERI, Az values were not significantly different among the MC (0.995), TIT (0.997), and ZIR groups (1.000) (P>.05). Regarding CBCT, the Az values found for TIT (0.941) and MC (0.890) were significantly higher than for ZIR (0.762) (P<.05). Az values for PERI were significantly higher than for CBCT (P<.05). CONCLUSIONS: The type of prosthesis material did not influence misfit detection at the IAJ with PERI; however, ZIR had lower diagnostic accuracy than TIT and MC implant-supported crowns with CBCT.

Diagnostic accuracy of 4 intraoral radiographic techniques for misfit detection at the implant abutment joint.

STATEMENT OF PROBLEM: A misfit or gap at the implant-abutment joint (IAJ) requires detection as it may compromise the health of the peri-implant tissue. However, which radiographic technique provides the most orthogonal relationship between the central beam and the implant/image receptor is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the diagnostic accuracy of 4 intraoral radiographic techniques on misfit detection at the IAJ. MATERIAL AND METHODS: Twenty implants were placed in polyamide jaws, and customized dental implant abutments with a metal collar were installed. Different gaps were simulated by placing one or three 50-µm-thick polyester strips at the IAJ; the absence of the strip represented the control group (no gap). The 4 radiographic techniques were evaluated by using different film holders: a periapical with bisecting angle (PBA), a bitewing interproximal (BI), a periapical with standard paralleling (PSP), and a periapical with modified paralleling (PMP) holder (with a custom-made paralleling index). A total of 240 digital radiographs were evaluated by 4 clinicians experienced with dental implants. Differences were evaluated by using receiver operating characteristic (ROC) curves (Az) and Fisher tests (α=.05). Diagnostic values (sensitivity, specificity, accuracy, and positive and negative predictive values) were also obtained. The Kappa test was used to assess intra- and interevaluator reproducibility, which ranged from moderate to almost perfect. RESULTS: All diagnostic values, except specificity, were lower for the PBA technique for both the 50- and 150-µm gaps. Az values for the PBA technique were significantly lower than those obtained for the other 3 techniques (P<.05), which did not differ from each other. The 150-µm gaps were more easily detected than the 50-µm gaps only for PBA (P<.05). CONCLUSIONS: The BI, PSP, and PMP techniques detected misfits at the IAJ most accurately. The PBA technique is not recommended for this purpose.

The Importance of Integrated Healthcare in the Association Between Oral Health and Awareness of Periodontitis and Diabetes in Type 2 Diabetics.

PURPOSE: Purpose: To assess the association of various factors including education level and oral health with type 2 diabetics' awareness of periodontitis and periodontitis/diabetes relationship, and to evaluate the importance of integrated healthcare in this association. Materials and Methods: 288 type 2 diabetics were evaluated through a validated structured questionnaire about oral hygiene habits, access and attendance to dental treatment, the presence of periodontitis and previously received information of periodontitis and periodontitis/diabetes relationship. Descriptive data were explored and both simple and multiple logistic regressions were performed. Results: The average age of participants was 62.24 (±10.93) years, 81.6% were previously treated for periodontitis and approximately 70% have never received information on periodontitis and its relationship with diabetes. A higher chance of participants having previously received information regarding periodontitis was associated with more than 8 years of schooling, daily flossing habit, presence of periodontitis and prior treatment for periodontitis (p < 0.005). Regarding previously received information about periodontitis/diabetes relationship, statistically significant associations were observed for more than 12 years of schooling and diabetes diagnosed more than 8 years ago (p < 0.05). Conclusion: The vast majority of participants were previously treated for periodontitis without receiving proper oral health education, which means that access to costly dental treatment is provided while patient education is neglected. It was shown the influence of habits and living conditions on the previously received information about diseases, and therefore, particular attention to the population characteristics is important to make the information accessible to everyone.

Association between periodontitis and type 2 diabetes mellitus: study in a population attended by the Brazilian Health System / Associação entre periodontite e diabetes mellitus tipo 2: estudo em uma população atendida pelo Sistema Único de Saúde Brasileiro

Introduction: Periodontitis control helps to prevent and control diabetes mellitus and understanding of this relationship can lead to changes in health policy. Objective: The purpose of this study was to investigate the association between periodontitis, knowledge, and glycemic control. Material and method: This is a cross-sectional analytical epidemiological survey with 216 Type 2 diabetic patients, non-smokers, who had current blood screenings with glycated hemoglobin (HbA1c). Result: Overall, 93.51% of the patients reported brushing their teeth at least twice a day, 62.5% visited the dentist last year, 81.58% have already undergone treatment for periodontal disease, 43.52% reported having periodontitis and 59.72% had controlled diabetes. No significant (p=0.603) association between HbA1c control and the presence of periodontitis was found. Among the patients with periodontitis, no association between HbA1c control and information on the periodontal disease was found (p=0.996), and know/believe in its relationship with diabetes (p=0.659; p=0.973). Conclusion: No relationship between periodontitis and diabetes was found in the sample, as well as in patients with periodontitis, those with knowledge on periodontal disease and knowledge/belief in its relationship with diabetes, which could be justified by the care by a multi-professional health team.

Introdução: O controle da doença periodontal auxilia na prevenção e no controle do diabetes mellitus. A compreensão dessa relação pode desencadear mudanças nas políticas públicas de saúde. Objetivo: O objetivo deste estudo foi investigar a associação entre a doença periodontal, o controle glicêmico e o conhecimento dessa relação. Material e método: Trata-se de um inquérito epidemiológico analítico transversal com 216 pacientes com diabetes mellitus tipo 2, não fumantes, que realizaram exames de sangue atuais com hemoglobina glicada (HbA1c). Resultado: No geral, 93,51% dos pacientes relataram escovar os dentes pelo menos duas vezes ao dia, 62,5% visitaram o dentista no último ano, 81,58% já fizeram tratamento para doença periodontal, 43,52% relataram ter periodontite e 59,72% tinham diabetes controlado. Não foi encontrada associação significativa (p=0,603) entre o controle da HbA1c e a presença de periodontite. Entre os pacientes com periodontite, não foi encontrada associação entre o controle da HbA1c e informações sobre a doença periodontal (p=0,996), e conhecer/acreditar na sua relação com o diabetes (p=0,659; p=0,973). Conclusão: Não foi encontrada relação entre a doença periodontal e diabetes na amostra, o que poderia ser justificado pelo atendimento por uma equipe multiprofissional de saúde no Sistema Único de Saúde Brasileiro.