Influence of thickness and restorative system on the mechanical behavior of CAD/CAM minimally invasive occlusal veneers - in vitro study.

AIM: The aim of this study was to evaluate the physical-mechanical behavior of the occlusal veneers when subjected to thermomechanical cycling. MATERIALS AND METHODS: Sixty specimens were divided into 04 groups (n=15 per group), according with the different restorative materials and thicknesses: material - lithium dissilicate LD (IPS e.max CAD, Ivoclar Vivadent) and nano- ceramic-resins NCR (ESPE Lava Ultimate, 3M); thickness - 0.6 and 1.2mm. The occlusal veneers were bonded over human flattened fresh extracted molars with dual-polymerizing luting agent (Variolink N, Ivoclar Vivadent and RelyX Ultimate 3M) using the respective adhesive system following the selective-etch technique (self-etch in dentin and total etch in enamel). The resin cement was light cured for 40 seconds each face, using a LED light cure equipment (BlueStar II, Microdont, 1100 mW/cm2). The response variables consisted of veneer survival rates (crack formation, catastrophic cracks and debonding) when subjected to thermal cycling from 5° to 55° C and simultaneous mechanical cycling performed at load intensities of 100, 200, 300, 400 and 450N for 20,000 cycles each. RESULT: Data were submitted to the Kruskall Wallis test and Pairwise Comparison, adopting a significance level of 5%. NCRs presented a lower incidence of failures (p<0.05) when compared to LD. According to thickness factor, 1.2mm thick occlusal veneers withstand higher cycling loads. CONCLUSION: NCR occlusal veneers with 1.2mm thickness presented superior physical-mechanical behavior than lithium disilicate and 0.6mm restorations.

3D printed implant surgical guides with internally routed irrigation for temperature reduction during osteotomy preparation: A pilot study.

OBJECTIVE: The purpose of this study was to test a novel through-the-guide means of irrigation in an in-vitro bovine bone model and to explore the method clinical applicability. MATERIALS AND METHODS: Surgical guides were designed to fit over five fresh bovine samples. Control osteotomy sites were compared to experimental sites irrigated through a 3D printed surgical guide with customized channels that direct the coolant toward the interface of the alveolar crest and drill. Temperature was measured during surgery with thermocouples located at 3 and 6 mm from the crestal height of the bone, and with an infrared thermal camera taking direct temperature readings from a window cut into axial wall at 9 mm from the crestal height of the ridge. RESULTS: Incorporation of routed irrigation significantly decreased heat generation, keeping temperature consistently below 47°C. A clinical case illustrates the method applicability using standard implant planning software, 3D printing technology, and regular implant armamentarium. CONCLUSIONS: The in-vitro analysis shows that this method mitigates temperature increase caused by static surgical guide irrigation blockade at the osteotomy site. This technique can be incorporated in the surgical guide design using commercially available software and 3D printing technology and has immediate applications in practice. CLINICAL SIGNIFICANCE: The in-vitro analysis shows that this method can significantly mitigate the temperature increase caused by static surgical guide irrigation blockade at the osteotomy site. This technique also has the advantage that it can be incorporated in the digital surgical guide design using commercially available software and 3D printing technology. The method has immediate applications in practice, and especially in the treatment of edentulism in esthetic zone where use of guided surgery for implant placement is crucial in obtaining consistent results.

Can postpolymerization for 3D-printed interim restorations be improved?

STATEMENT OF PROBLEM: Postpolymerization methods influence the properties of 3-dimensionally (3D) printed materials. Nevertheless, it is a time-consuming step that could lead dentists to avoid the chairside use of 3D printing. Information assessing the impact of different postpolymerization workflows on flexural strength and color stability is sparse. PURPOSE: The purpose of this in vitro study was to analyze the impact of different postpolymerization methods on the flexural strength and color stability of 3D-printed resins used for interim restorations. MATERIAL AND METHODS: Three resin materials: CT (Cosmos Temp; Yller Biomaterials), DT (Denture Teeth; Formlabs), and CB (C&B MFH; NextDent) were submitted to 4 methods of postpolymerization: a Form Cure polymerization chamber (FC) (Form Cure; Formlabs), a broadband LED device (Valo Grand; Ultradent Products, Inc) operating at 1000 mW/cm2 for 2 different polymerization times (40 seconds/V40 or 120 seconds/V120), and a custom-made polymerization chamber with a 24 W UV LED Strip (CC). The specimens were assessed for flexural strength using an universal testing machine immediately after polymerization or after 10 000 thermal cycles, and the color stability was evaluated using a spectrophotometer at baseline, after 7 days in dark, dry storage at 37 °C and after 24 hours of artificial aging in water at 60 °C. The data were evaluated using 3-way ANOVA (flexural strength) and 3-way repeated measurements ANOVA (color stability), followed by the Tukey HSD test (α=.05). RESULTS: Flexural strength showed significant differences for resin, postpolymerization method, time, and for the interaction between all effects. CT showed the highest overall flexural strength, while DT showed the lowest. In general, V120 produced specimens with higher flexural strength. Thermocycling did not reduce flexural strength except for CB polymerized with FC and V120, and DT polymerized with V40. For color stability, significant differences were found for resin, postpolymerized method, time, and for the interaction between all effects. The highest ΔE values were observed for DT polymerized using V40 after artificial aging. The lowest values were observed for the same resin but polymerized using V120 after 7 days in dark, dry storage at 37 °C. CONCLUSIONS: Postpolymerization with the broadband LED device for 120 seconds can produce specimens with higher flexural strength values and higher color stability when compared with the other postpolymerization workflows tested in this study.

Aerosol and spatter mitigation in dentistry: Analysis of the effectiveness of 13 setups.

OBJECTIVES: The current study aims to investigate the aerosol and spatter mitigation quality of 13 dry-field isolation methods in a simulated setup that replicates real-life work scenarios encountered in dental practices. METHODS: A crown preparation on a manikin was performed on tooth number 30 and repeated five times for each setup to simulate a patient under care. Aerosol, environmental, and operator face shield spatter, and sound intensity was measured. Generalized linear mixed models were used, and posthoc pairwise comparisons were performed to compare least-squares means when appropriate using a Tukey adjustment. RESULTS: All tested setups showed some environmental spatter formation; however, these were able to control most (and in some cases all) spatter on the operator face shield. All methods resulted in excellent aerosol mitigation when a second line of high-volume evacuation (HVE) was added to the device setup. However, in most setups, total sound levels exceeded 85 dB, posing a concern for prolonged noise exposure. CONCLUSIONS: The Prototype device and four other tested setups with secondary HVE addition completely eliminated aerosol creation as tested. Spatter of the Face Shield was best eliminated using the Prototype device. CLINICAL SIGNIFICANCE: Within the limitations of this study, it can be concluded that the dental community has at its disposal equipment that can effectively mitigate aerosol and spatter.

Validation of a method of quantifying 3D leakage in dental restorations.

STATEMENT OF PROBLEM: A reliable and validated protocol for nondestructive analysis of the entire restorative interface that could be applicable in studies assessing the adaptation of direct and indirect restorations is lacking. PURPOSE: The purpose of this in vitro study was to validate a 3D protocol for microleakage assessment in class II mesio-occluso-distal (MOD) cavities restored with composite resin. MATERIAL AND METHODS: Sixteen human third molars received standardized class II MOD preparations with cervical margins located 1 mm apical to the cemento-enamel junction. The specimens were restored with Filtek Bulk Fill Posterior (FBP) or Filtek Bulk Fill Flowable (FBF) and submitted to 10 000 thermocycles (5 °C and 55 °C with a 30-second dwell time at each temperature and 5-second transfer time). The specimens were scanned with microcomputed tomography (µCT) before and after immersion in 50% ammoniacal silver nitrate solution for 12 hours. Scanned data were processed, and the 3D amount of infiltrated silver nitrate was analyzed through the entire adhesive interface. In addition, the linear distance of silver nitrate infiltration was assessed using 3 axial images obtained from each specimen proximal box (2D analysis). Data were tested for homogeneity by using the Shapiro-Wilk test and evaluated by using 1-way ANOVA, followed by the post hoc Tukey HSD test (α=.05). RESULTS: FBP showed significantly lower leakage than FBF for both 2D and 3D analyses. A low correlation was observed between the assessment methods. CONCLUSIONS: Three-dimensional analysis of microleakage using µCT is a predictable and more reliable method for nondestructive and comprehensive analysis of the entire specimen.

Hyaluronic acid as adjunctive to non-surgical and surgical periodontal therapy: a systematic review and meta-analysis.

OBJECTIVES: To evaluate the potential added benefit of the topical application of hyaluronic acid (HA) on the clinical outcomes following non-surgical or surgical periodontal therapy. MATERIALS AND METHODS: A systematic search was performed in Medline, Embase, Cochrane, Web of Science, Scopus and Grey literature databases. The literature search was preformed according to PRISMA guidelines. The Cochrane risk of bias tool was used in order to assess the methodology of the included trials. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) between the treatment and controls were estimated using the random-effect model for amount of bleeding on probing (BOP), probing depth (PD) reduction and clinical attachment level (CAL) gain. In order to minimize the bias and to perform meta-analysis, only randomized clinical studies (RCTs) were selected. RESULTS: Thirteen RCTs were included: 11 on non-surgical periodontal treatment and two on surgical periodontal treatment. Overall analysis of PD reduction, CAL gain and BOP reduction in non-surgical therapy with adjunctive HA presented WMD of - 0.36 mm (95% CI - 0.54 to - 0.19 mm; p < 0.0001), 0.73 mm (95% CI 0.28 to 1.17 mm; p < 0.0001) and - 15% (95% CI - 22 to - 8%; p < 0.001) respectively, favouring the application of HA. The overall analysis on PD and CAL gain in surgical therapy with adjunctive HA presented WMD of - 0.89 mm (95% CI - 1.42 to - 0.36 mm; p < 0.0001) for PD reduction and 0.85 mm (95% CI 0.08 to 1.62 mm; p < 0.0001) for CAL gain after 6-24 months favouring the treatment with HA. However, comparison presented considerable heterogeneity between the non-surgical studies and a high risk of bias in general. CONCLUSIONS: Within their limits, the present data indicate that the topical application of HA may lead to additional clinical benefits when used as an adjunctive to non-surgical and surgical periodontal therapy. However, due to the high risk of bias and heterogeneity, there is a need for further well-designed RCTs to evaluate this material in various clinical scenarios. CLINICAL RELEVANCE: The adjunctive use of HA may improve the clinical outcomes when used in conjunction with non-surgical and surgical periodontal therapy.

A comparison of implant complications and failures between the maxilla and the mandible.

STATEMENT OF PROBLEM: Identifying factors that affect the clinical outcomes of implant therapy is important. PURPOSE: The purpose of this retrospective study was to determine whether implant location was a factor affecting the complication and failure rates of single-tooth implant-supported restorations in a predoctoral setting. MATERIAL AND METHODS: The charts of 431 patients treated with a surgically placed dental implant and restored with a single crown in the predoctoral clinic were analyzed. Data on implant location, type of complication (surgical or prosthetic), and type of failure were collected and analyzed according to implant location using the Fisher Exact Test and Mantel-Haenszel Exact Chi Square Test analysis (α=.05). RESULTS: The charts revealed 158 complications (68 surgical and 90 prosthetic) in 110 patients, and 3.9% of the implants failed. No statistically significant difference was found between the number of surgical complications or prosthetic complications in the maxilla and the mandible (P=.469). CONCLUSIONS: Jaw location (maxilla compared with mandible) of the implant had no statistically significant impact on the incidence of surgically or prosthetically related complications. No statistically significant difference was found in overall implant failures, surgical failures, and prosthetic failures between maxillary and mandibular implants.

Influence of resin-coating agents on the roughness and color of composite resins.

STATEMENT OF PROBLEM: Resin-coating agents can be used to fill microstructural defects within composite resin restorations, which might result in a smoother surface. Nevertheless, data about the color stability and surface roughness of coated restorations are lacking. PURPOSE: The purpose of this in vitro study was to compare the surface roughness and color stability of restorations before and after application of different resin-coating agents. MATERIAL AND METHODS: Forty specimens of composite resin (Filtek Z250) (diameter×height, 6×2 mm) were divided into 5 groups according to the surface treatments (n=8 per group): control (CTR), Fortify (FT), Lasting touch (LT), BisCover (BIS), and Fill Glaze (FG). The specimens were evaluated for surface roughness by using a profilometer with 3 readings for each specimen (separated by 300 µm) before immersion in a staining solution (coffee) and after 5 days immersed in coffee and for color stability (▵E) by using a spectrophotometer before being immersed in coffee (initial reading) and after 6 hours, 12 hours, 1, 2, 3, 4, and 5 days. RESULTS: Two-way ANOVA with repeated measures and the Tukey test showed that the CTR group showed the highest roughness values, similar to those of the FT and LT groups. The BIS and FG groups showed lower roughness than the other groups but similar results when compared with each other. All groups, except LT, showed increased roughness values after immersion in coffee solution, and the BIS group showed the lowest variation over time. Color alterations were found for all groups, with the CTR group showing the lowest ▵E values when compared with the other groups except for the BIS group. No correlation was found between surface roughness and degree of color change (P=.401). CONCLUSIONS: The BisCover surface sealant showed the lowest surface roughness and the best color stability. Surface sealants can be used to fill microcracks and microgaps but should not be used as a substitute for polishing.

Effect of thermal cycling on fracture toughness of CAD/CAM materials.

PURPOSE: To compare the fracture toughness of four different CAD/CAM materials, (VM) Vitablocs Mark II, (IP) IPS e.max CAD, (LU) LAVA Ultimate, and (VE) Vita Enamic under long thermocycling conditions. METHODS: Each type of ceramic block was sectioned into beams (n=9) with dimensions of 14×3×2.5 mm (L × W × H). All four ceramics were submitted to different conditions: the desiccator or distilled water, each for 7 days. The third and fourth conditions involved the specimens being submitted to 60,000 and 120,000 thermocycles in water respectively. The dwelling time was 52 seconds at 5° and 55°C. A three-point bend test with a universal loading machine on notched samples was per-formed. Furthermore, a fractographic analyses was made by scanning electron microscopy (SEM) to determine if any of these conditions influenced the type of fracture. Data were analyzed by two-way ANOVA (α= 0.05). RESULTS: A significant difference in fracture toughness (P< 0.05) was found among the groups; IP (4.20±1.23) had the highest value followed by VE (2.02±0.39), which did not have a statistically significant difference from LU (1.96±0.42). The lower value and statistical difference for VM was 1.52±0.35. The ceramics performed better after they were hydrated, while the polymer-based materials had the fracture toughness means decreased after the thermocycles. CLINICAL SIGNIFICANCE: A significant difference in fracture toughness (P<0.05) was found among the groups; IP had the highest value followed by VE, which was not statistically significantly different from LU. The ceramics performed better after they were hydrated, while the polymer-based materials had fracture toughness means decreased after thermocycling.

Management of Ankylotic Root Resorption Following Dental Trauma: A Short Review and Proposal of a Treatment Protocol.

Ankylotic root resorption is a serious complication following traumatic dental injuries. The aetiology of root resorption includes acute injury to the cementum and periodontal ligament, and subsequent biological processes that propagate the harm. The aim of the present paper is to present a structured treatment protocol for teeth that have experienced trauma and are at risk of developing ankylotic root resorption, followed by a decoronation protocol for situations in which ankylotic root resorption developed. This protocol provides a structured road map from the primary dental trauma, through the initial development of ankylosis detected radiographically, to the clinical manifestation that results in significant infra-occlusion. The current protocol integrates the best available evidence from the literature and from published guidelines. Ample contradictory data, which mainly consists of case reports related to the treatment of ankylotic root resorption, is available in the current literature. No accepted protocol or uniform guidelines for treatment in these cases exist, and many clinicians prefer avoiding replantation of an avulsed tooth that seems to have an uncertain longterm prognosis, or performing decoronation when infra-occlusion developed. As a result, young patients lose the benefits associated with replantation and decoronation procedures. The option of re-implantation of the avulsed teeth should be considered irrespective of the negative long-term prognosis. Following ankylosis development, the goal of submerging the tooth root (decoronation) is to maintain the horizontal dimension of the alveolar ridge and also to gain vertical dimension, allowing implant placement in the future.

The Influence of Shockwave Therapy on Orthodontic Tooth Movement Induced in the Rat.

Shockwave therapy is used in medicine due to its ability to stimulate healing processes. The application of orthodontic force evokes an inflammatory reaction resulting in tooth movement. Shockwave therapy might have an effect on both inflammatory and periodonal ligament cytokine profiles. Our aim was to evaluate the fluctuations of different inflammatory cytokines after orthodontic force induction with and without shockwave therapy. An orthodontic appliance was applied between the rats' molars and incisors. In conjunction with the commencement of orthodontic force, the rats were treated with a single episode of 1000 shock waves and the gingival crevicular fluid was collected for 3 days. The expression and concentration of different cytokines was evaluated by a commercial 4-multiplex fluorescent bead-based immunoassay. The level of all cytokines displayed a similar trend in both shockwave-treated and untreated groups; the concentration peaked on the first day and declined thereafter. In all cases, however, the cytokine levels were smaller in the shockwave-treated than in untreated animals; a significant difference was found for sRANKL and borderline difference for IL-6 on Day 1. We conclude that shockwave therapy during the induction of orthodontic tooth movement influences the expression of inflammatory cytokines.

Lip buccal mucosa traumatic overgrowth due to sucking habit - a 10-year follow-up of a non-surgical approach: a combination of behavioural and myofunctional therapy.

OBJECTIVE: Traumatic lesion of the lip buccal mucosa may develop due to a repetitive lip sucking habit, secondary to a dental space which opened in the dental in adult patients. The non surgical treatment approach is based on increasing of patient's awareness to the sucking habit along with the creation of a change in the oral and dental surrounding tissues. The following case included a failure to identify a traumatic habit of lower lip sucking, resulting in a buccal mucosa overgrowth. Combined conservative periodontal and orthodontic approach will be presented to address this clinical issue without any need for surgical intervention. MATERIAL AND METHODS: 56 year old female patient presented with a complaint of unaesthetic appearance of the intraoral right buccal mucosa of the lower lip at rest position due to an intensive repetitive sucking habit of the right lower lip segment. We initiated a non surgical treatment approach including increasing the patient's awareness to the sucking habit, controlling the periodontal disease and orthodontic treatment to align and level the dental arch and to close the residual space. RESULT: The soft tissue overgrowth on the lip buccal mucosa almost completely subsided spontaneously as a result of conservative dental and behavioral management without the need for any oral surgery intervention. A 10 years follow-up revealed no repetitive oral mucosa overgrowth, no spaces reopening and no sucking habit redevelopment. CONCLUSION: Implementation of a morphological correction will assist the patient in breaking the habit and creating an environment that may effectively prevent the reoccurrence of the habit.

A critical appraisal of the systematic review process: systematic reviews of zirconia single crowns.

STATEMENT OF PROBLEM: Systematic reviews analyze the data of published research in an effort to assemble the scientific evidence to help clinicians apply evidence-based information in decision making. The quality of systematic reviews varies greatly. PURPOSE: The purpose of this study was to critically appraise the current systematic review process by evaluating systematic reviews that pertain to zirconia-based single crowns. MATERIALS AND METHODS: The following PICO (patients, intervention, comparison, outcome) question was formulated: "In adults, how does the long-term prognosis of zirconia-based single crowns compare with conventional single crowns on natural teeth?" An electronic search was performed in PubMed and the Cochran Library for articles published in English between 1950 and October 2012. Additional manual searches were completed. To be included in the analysis, the study must have been a systematic review, published in an English-speaking peer-reviewed journal, and evaluated zirconia crowns on teeth. Two examiners qualitatively evaluated the publications with an Assessment of Multiple Systematic Reviews checklist and the Oxford Systematic Review Appraisal form. RESULTS: Three systematic reviews were identified that met the search criteria. Two studies met 5 of the 11 Assessment of Multiple Systematic Reviews criteria, whereas the third met only 1 criterion. The same 2 studies met 3 of the 5 Oxford Systematic Review Appraisal criteria and the third met only 2 criteria. CONCLUSION: Because of the variation in methodologies, systematic reviews should be interpreted cautiously. The Assessment of Multiple Systematic Reviews Checklist and the Oxford Systematic Review Appraisal Sheet are practical tools for appraising and determining the quality of systematic reviews.

A critical appraisal of evidence-based dentistry: the best available evidence.

STATEMENT OF PROBLEM: The principle of evidence-based dentistry requires that relevant scientific literature be integrated into the dentist's practice and the patient's treatment needs and wishes. This approach involves critically appraising the scientific literature for the best available evidence in order to make clinical decisions. PURPOSE: The purpose of the study was to critically appraise the process by which a practitioner attempts to make an evidenced-based clinical decision. This process is illustrated by evaluating the clinical literature pertaining to zirconia-based single crowns. MATERIAL AND METHODS: An electronic search was performed in PubMed and the Cochrane Library by using Boolean operators for articles published in English between January 1950 and October 2012 to address the PICO (patients, intervention, comparison, outcome) question, "In adults, how does the long term prognosis of zirconia-based single crowns compare to conventional single crowns on natural teeth?" Comparisons were made across the publications to determine the quality of relevant information. RESULTS: Three systematic reviews included 4 clinical trials. Two randomized clinical trials and 1 retrospective study met the search criteria but were not identified in the systematic reviews. The definitions of the outcomes and the presentation of the data varied among studies. CONCLUSIONS: The lack of standardization of reporting data, the nonstandardized definitions of outcomes, and the impact of the length of the research study were identified as problems that need to be addressed to improve the quality of systematic reviews and other clinical trials.

Anti-nociceptive effect of IL-12p40 in a rat model of neuropathic pain.

IL-12p70 is a proinflammatory cytokine secreted by dendritic cells, monocytes and macrophages. It plays a crucial role in cell-mediated immunity by inducing proliferation of T cell and natural killer cells, and enhancing their cytotoxic activity. In adaptive immune response, it acts on naive T cells to differentiate into Th1-type cells. It is composed of two subunits, p35 and p40. The latter can be secreted in the form of monodimer or heterodimer, which is also referred as IL-12p80. Recently IL-12p70 has been proven to locally provoke nociceptive effect in naïve rats. This study investigated pain response following systemic administration of IL-12p70 and IL-12p40 homodimer in chronic neuropathic pain model, induced by chronic constriction injury. The doses tested were IL-12p40 homodimer or IL12p70 at 15, 150 and 1500ng/kg, respectively. Pain was assessed at 1, 4, 7 and 24h after injection, in the form of tactile allodynia and mechanical hyperalgesia. The side effect of sensory motor disability was measured by rotarod performance. By all behavioral measures, IL-12p70 of any dosage, at any time point, had no significant effect on tactile allodynia and mechanical hyperalgesia. A high dose of IL-12p40 homodimer induced significant analgesic effect by the measure of hind paw tactile allodynia from 1h to 4h after injection. Medium and low doses of IL-12p40 homodimer exerted their analgesic effect 4h post injection. Mechanical hyperalgesia, following high and medium doses of IL-12p40 administration, was significantly reduced at 4h after application. Also, no significant sensory motor dysfunction was detected for all dosage for both homodimers. These findings suggest that systemic application of IL-12p40 homodimer induces time-dependent analgesia to mechanical stimulation in rats exposed to neuropathic pain.

Comparative physical and mechanical properties of a 3D printed temporary crown and bridge restorative material.

Background: The objective was to compare physic-mechanical properties of different materials used for temporary restorations. Material and Methods: Protemp 4/bisacrylic resin, Jet/acrylic resin, and Nexdent C&B/3D-printed resin samples (10mm diameter x 2mm thickness) were analyzed for surface roughness and color stability tests (baseline, after 5 thousand brushing cycles; and after artificial aging in water at 60oC for 24 hours) and Knoop microhardness. All data were checked for normality using Shapiro-Wilk test. Surface roughness and color stability were analyzed using two-way repeated measurements ANOVA, microhardness data was subjected to one-way ANOVA. All tests were followed by Tukey test and were performed with α=0.05. Results: For roughness, material (p=.002), time points (p=.002) and interaction between both (p<.001) were significant. All groups presented similar roughness for measurements of baseline and after brushing. After artificial aging, 3D printed resin showed decreased roughness when compared with other resins, and with its baseline reading. Acrylic resin showed an increase in surface roughness (when compared with measurement after brushing cycles). Considering color stability, only the material (p=.039) and the time (p<0.001) were significant. All groups showed similar color variation before and after artificial aging. There was an increase in color alteration after artificial aging for all groups. Considering microhardness test (p<.001), the 3D printed resin showed the highest values and acrylic resin the lowest. Bysacylic resin was similar to both 3D printed and acrylic resins. Conclusions: The tested 3D printed resins present similar or better properties than other tested temporary materials while being integrated with the digital workflow. Key words:Disinfection methods, hydroxyl radical, environment, surfaces, dentistry.

CODA standard 2-24 h-"replacement of teeth" dilemma: Unintended consequences and proposed solutions.

BACKGROUND: The Commission on Dental Accreditation (CODA) was established in 1975 with the goal of serving the public and the dental profession by developing and implementing standards that guide and maintain the quality of dental educational programs. These standards are defined broadly around competencies reflective of an evidence-based definition of general dentistry and that should be met by the new graduates to function as an entry level provider. Consequently, CODA "expects each school to develop specific competency definitions and assessment methods in the context of the broad scope of general dental practice". CODA Standard 2-24 h was implemented a decade ago to address concerns that dental schools are not sufficiently proactive in incorporating implant-related curricula and clinical competencies. When the standard was implemented, most patients already preferred dental implants over FPDs. This market trend, together with the prescriptive format of the standard, had the unintended consequence of creating pressure on programs that struggled to find enough patients who will chose FPDs as a treatment option. DISCUSSION: As a short term solution, we suggest a tooth replacement competency construct that has the potential to alleviate this burden. This solution incorporates principles of ethical decision making, patient-centered care, and evidence-based dentistry, without compromising educational aspects and competency development. For the longer term, we suggested to revise and rephrase the standard so that it will be clinically-centered rather than focused on technical tools that may evolve, change, or disappear as a result of technological progress and other market trends. This, in turn, will be conducive to fulfill the intent of Standard 2-24 to allow the schools to identify "competencies that will be included in the curriculum based on the school's goals, resources, accepted general practitioner responsibilities and other influencing factors."

A longitudinal study of the survival of interproximal root caries lesions restored with glass ionomer cement via a minimally invasive approach.

The prevalence of gingival recessions and the number of root surfaces exposed to the oral environment both increase with age. In turn, these increases place the older population at increased risk for caries; it is estimated that 23.7% of those over the age of 65 have root caries.1 Glass ionomer (GI) seems particularly suitable for restoring root lesions, as it has good esthetic and anti-cariogenic properties, allows for chemical bonding to teeth, and has gained wide acceptance. This article describes a minimally invasive approach for restoring interproximal root caries lesions with GI; in this study, 66 such lesions were restored and followed for up to 80 months. The results show that the radiographic quality score was the single most important predictor for restoration survival. High-quality restorations survived an average of 74 months (SE = 2.7), with a cumulative survival rate of 77.4% at 80 months. Age, gender, and periodontal status were unrelated to restoration survival.

The relationship between periodontal and kidney disease: a critical review.

Periodontal disease has been associated with various systemic diseases including kidney disease. However, a causal relationship is yet to be established. One possible association is that periodontitis may cause an increased inflammatory response in kidney disease patients which in turn destroys endothelial vasculature. This may contribute to development of risk factors of kidney disease such as diabetic neuropathy and cardiovascular events leading the progression and mortality in kidney disease patients. The role of periodontal inflammation driving kidney disease is still under investigation. This review article highlights the role of periodontal inflammation in the development and progression of kidney disease. It is crucial that dental practitioners and nephrologists understand the association between periodontal and kidney disease. Early periodontal screening and educating patients about the importance of good oral hygiene may play an important role in prevention of progression of kidney disease.

Guiding the practitioner through the caries management by risk assessment (CAMBRA) protocol.

In the past, the approach for treating caries was mainly symptomatic and involved removal of caries, teeth restoration, oral hygiene instructions, and fluoride applications in cases that presented with significant disease. As the bacterial component of the disease was revealed, questions emerged concerning the significance of each strain present and intervention in the process of caries development. This article reviews the evidence that supports the implementation of the current caries risk assessment and management protocol (CAMBRA). It details the current risk factors, techniques and devices for assessing them and, interventions that should be considered in order to address the risk. The paper defines specific guidelines for managing risks related to caries. Intervention should be customized according to the risk determined for each specific patient.