Influence of universal adhesives and silane coupling primer on bonding performance to CAD-CAM resin-based composites: A laboratory investigation.

OBJECTIVE: Obtaining strong resin bonds to computer-aided design and computer-aided manufacturing (CAD-CAM) resin-based composites with dispersed fillers (CCRBCs) poses a challenge. Therefore, this study aimed to assess the effect of three universal adhesives and a two-component silane coupling agent on the shear bond strength to three (CCRBCs). MATERIALS AND METHODS: Eight hundred and sixty-four specimens of Brilliant Crios, Lava Ultimate, and Tetric CAD were polished or grit blasted, bonded with Adhese Universal DC, One Coat 7 Universal (OC7), and Scotchbond Universal Plus Adhesive (SBU) with or without a silane primer. Shear bond strength was measured after 24 h and 10,000 thermocycles. Linear regressions were performed (α = 0.05). RESULTS: After thermocycling, bond strengths were similar for the universal adhesives on polished Brilliant Crios and Lava Ultimate (p ≥ 0.408). Grit blasted Tetric CAD showed no significant differences (p ≥ 0.096). The silane primer had minimal impact on grit blasted Tetric CAD (p ≥ 0.384). The silane primer increased the bond strength of OC7 to Brilliant Crios (p = 0.001) but decreased the adhesion of SBU to Brilliant Crios and Lava Ultimate (p ≤ 0.018). CONCLUSIONS: Bond strength of universal adhesives varied with CCRBC type. The two-component silane coupling agent showed mixed effects on adhesive performance. CLINICAL SIGNIFICANCE: Selecting universal adhesives from the same CCRBC product line does not always guarantee superior bond strength. The efficacy of silane coupling agents differs based on the bonding substrate.

Interdisciplinary Delphi study by PROSEC North America: Recommendations on single indirect restorations made from ceramic and nonmetallic biomaterials for posterior teeth.

OBJECTIVE: This article puts forward consensus recommendations from PROSEC North America regarding single indirect restorations made from ceramic and nonmetallic biomaterials in posterior teeth. OVERVIEW: The consensus process involved a multidisciplinary panel and three consensus workshops. A systematic literature review was conducted across five databases to gather evidence. The recommendations, informed by findings from systematic reviews and formulated based on a two-phase e-Delphi survey, emphasize a comprehensive treatment strategy that includes noninvasive measures alongside restorative interventions for managing dental caries and tooth wear. The recommendations advocate for selecting between direct and indirect restorations on a case-by-case basis, favoring inlays and onlays over crowns to align with minimally invasive dentistry principles. The recommendations highlight the critical role of selecting restorative biomaterials based on clinical performance, esthetic properties, and adherence to manufacturer guidelines. They emphasize the importance of precision in restorative procedures, including tooth preparation, impression taking, contamination control, and luting. Regular follow-up and maintenance tailored to individual patient needs are crucial for the longevity of ceramic and nonmetallic restorations. CONCLUSIONS: These PROSEC recommendations provide a framework for dental practitioners to deliver high-quality restorative care, advocating for personalized treatment planning and minimally invasive approaches to optimize oral health outcomes. CLINICAL SIGNIFICANCE: The PROSEC North America recommendations highlight the importance of minimally invasive techniques in posterior tooth restorations using ceramic and non-metallic biomaterials. These principles prioritize tooth structure conservation and personalized treatment planning, essential for enhancing clinical outcomes and long-term oral health.

Quality of CAD-CAM inlays placed on aged resin-based composite restorations used as deep margin elevation: a laboratory study.

OBJECTIVES: To assess the impact of the age of resin-based composite (RBC) restorations used for deep margin elevation (DME) on the marginal quality and fracture resistance of inlays. MATERIALS AND METHODS: Permanent human molars with direct RBC restorations, involving the mesial, occlusal, and distal surface (MOD), were allocated to four groups (each n = 12). Half of the teeth underwent thermomechanical loading including 240,000 occlusal load cycles and 534 thermal cycles (TML, 5 °C/55 °C; 49 N, 1.7 Hz). With RBC left in one proximal box as DME, all teeth received MOD inlays, made from lithium disilicate (LDS) or a polymer-infiltrated ceramic network material (PICN). The restored teeth underwent TML including 1.2 million occlusal cyclic loadings and 2673 thermal cycles. The marginal quality was assessed at baseline and after both runs of TML. Load-to-fracture tests were performed. The statistical analysis comprised multiple linear regressions (α = 0.05). RESULTS: Simulated aging of RBC restorations had no significant effect on the marginal quality at the interface between the RBC and the tooth and the RBC and the inlay (p ≥ 0.247). Across time points, higher percentages of non-continuous margin were observed between the inlay and the tooth than between the tooth and the RBC (p ≤ 0.039). The age of the DME did not significantly affect the fracture resistance (p ≥ 0.052). CONCLUSIONS: Artificial aging of RBC restorations used for DME had no detrimental effect on the marginal quality and fracture resistance of LDS and PICN inlays. CLINICAL RELEVANCE: This laboratory study suggests that-in select cases-intact, direct RBC restorations not placed immediately before the delivery of an indirect restoration may be used for DME.

Deep margin elevation-Present status and future directions.

OBJECTIVE: Deep margin elevation (DME) is a treatment approach to relocate the cervical margin of teeth with subgingival defects to a supragingival position with a direct restoration to facilitate rubber dam isolation, impression taking, and bonding of indirect restorations. This article provides an overview of the current scientific evidence on DME and future directions for research. OVERVIEW: The review included 38 studies on DME, most conducted in vitro. These studies indicate that DME has no detrimental effect on the fracture resistance of restored teeth. Evidence on the impact of DME on marginal quality is conflicting, but most in vitro studies observed no negative effect. Clinical studies, most comprising small patient cohorts, demonstrated favorable restorative outcomes and suggest that DME restorations made with scrupulous care are compatible with periodontal health. Bleeding on probing may occur more frequently at sites with DME, though evidence on this is not unequivocal. CONCLUSIONS: Current evidence, based largely on laboratory studies and limited clinical data, supports DME as a viable approach to restore teeth with localized subgingival defects. However, further clinical studies with long-term follow-ups are required to provide corroborative evidence. CLINICAL SIGNIFICANCE: Current evidence suggests that DME is a viable approach to restore teeth with localized subgingival defects as a possible alternative to surgical crown lengthening. Proper working field isolation, meticulous care in the bonding and buildup procedure, and biofilm removal through patient-performed oral hygiene and professional maintenance care are crucial. As scant clinical trial-based evidence is available today, further research is needed to evaluate the long-term performance of DME restorations and their impact on periodontal health.

Implications of large language models such as ChatGPT for dental medicine.

OBJECTIVE: This article provides an overview of the implications of ChatGPT and other large language models (LLMs) for dental medicine. OVERVIEW: ChatGPT, a LLM trained on massive amounts of textual data, is adept at fulfilling various language-related tasks. Despite its impressive capabilities, ChatGPT has serious limitations, such as occasionally giving incorrect answers, producing nonsensical content, and presenting misinformation as fact. Dental practitioners, assistants, and hygienists are not likely to be significantly impacted by LLMs. However, LLMs could affect the work of administrative personnel and the provision of dental telemedicine. LLMs offer potential for clinical decision support, text summarization, efficient writing, and multilingual communication. As more people seek health information from LLMs, it is crucial to safeguard against inaccurate, outdated, and biased responses to health-related queries. LLMs pose challenges for patient data confidentiality and cybersecurity that must be tackled. In dental education, LLMs present fewer challenges than in other academic fields. LLMs can enhance academic writing fluency, but acceptable usage boundaries in science need to be established. CONCLUSIONS: While LLMs such as ChatGPT may have various useful applications in dental medicine, they come with risks of malicious use and serious limitations, including the potential for misinformation. CLINICAL SIGNIFICANCE: Along with the potential benefits of using LLMs as an additional tool in dental medicine, it is crucial to carefully consider the limitations and potential risks inherent in such artificial intelligence technologies.

Endodontic and restorative management of an adult with avulsion of multiple teeth: A case report with 5 years and 9 months of follow-up.

Simultaneous avulsion of four or more teeth is a rare event. This case report examines the dental care given to an adult who, during a bicycle accident, experienced the avulsion of a mandibular incisor as well as all of his maxillary incisors. In the immediate aftermath of the accident, four out of the five incisors were located, promptly collected, and stored in a tooth rescue box, all within a 20-min window. Replantation and splinting were performed on the day of the accident. Endodontic treatment involved sequential intracanal dressing with an antibiotic-corticosteroid paste followed by calcium hydroxide prior to root canal obturation. 3 months post-accident, signs of external replacement resorption (ERR) began to appear in all the replanted teeth. The gap created by the missing maxillary central incisor was managed with a three-unit fixed dental prosthesis, despite the onset of ERR in the incisors used as abutment teeth. Regular follow-ups showed a relatively slow ERR progression rate over a span of nearly 6 years. The patient expressed satisfaction with both the esthetic and functional outcomes. This case, marked by multiple avulsions, underscores the importance of immediate and appropriate intervention alongside the imperative for carefully considered long-term management strategies. Given the decelerated bone remodeling rate in adults, ERR generally progresses at a slower pace than in children. Accordingly, this case demonstrates the viability of retaining replanted teeth over the long term, even when these teeth have been subjected to nonphysiological storage for extended durations, a factor known to impede periodontal healing.

Head and dental injuries among farriers and hoof care practitioners: A nationwide survey in Switzerland.

BACKGROUND/AIM: There is a paucity of evidence on injuries sustained by farriers and hoof care practitioners, two professions exposed to unique occupational hazards. The aim of this study was to collect and examine data on occupational head/face and dental injuries among farriers and hoof care practitioners in a nationwide survey in Switzerland. MATERIALS AND METHODS: Data on occupational head/face and dental injuries were gathered in a questionnaire-based, voluntary survey, which was mailed to all farriers and hoof care practitioners in Switzerland. The statistical analysis comprised multiple regressions with a nested design (α = 0.05). RESULTS: The survey included 278 respondents (response rate of 78.1%). Head/face injuries were more frequently reported by farriers than hoof care practitioners (60.6% and 20.7%, respectively). Among full-time workers, farriers had a higher chance of an occupational head/face injury compared with hoof care practitioners (p = .007). The rate of dental injuries, mainly related to a horse kick, was 11.1% and 1.9% among farriers and hoof care practitioners, respectively. Negligence in wearing mandatory eye protection was reported by 37.5% of respondents. CONCLUSIONS: Farriery and hoof care management entail a significant risk of occupational head/face and dental injuries. Preventive safety measures-eye protection in particular-and knowledge in dental first aid should be promoted among farriers and hoof care practitioners to decrease the frequency and severity of work-related injuries.

General and dental injuries sustained at concerts: A questionnaire-based study.

BACKGROUND/AIM: Evidence on the risk of injury at concerts is scant. The aim of this study was to collect data on general and dental injuries incurred by concertgoers in Switzerland and to investigate whether the frequency of accidents was related to music genre, gender and consumption of alcohol. MATERIALS AND METHODS: A questionnaire-based, cross-sectional study comprising 451 concertgoers in Switzerland was conducted on the timeframe January 2019 to February 2021. The survey gathered data on general and dental injuries, alcohol consumption and drug use. The statistical analysis included Fisher's exact tests, chi-squared tests, rank sum tests and logistic regressions (α = .05). RESULTS: There were 28.8% of respondents who reported an injury incurred at a concert. Contusion was the most prevalent injury, accounting for 33.8% of all injuries. Legs were the most commonly injured body part (34.6%). Injuries to their mouth/lips/teeth were reported by 17.7% of respondents. Dental injuries, accounting for 4.6% of all reported injuries, comprised four tooth fractures, one lateral luxation and one avulsion. The risk of injury while attending punk rock concerts was 8.6 times higher than for pop concerts (p < .001). In comparison with pop concerts, metal and rock concerts had an increased risk of injury by factors of 5.1 and 2.3, respectively (p ≤ .029). Neither gender nor drug use had a significant effect on the injury risk (p ≥ .3). Heavy alcohol consumption (>5 standard glasses) increased the risk of injury by a factor of 2.3 (p = .028). CONCLUSIONS: This study suggests that concert attendees at rock, metal and punk concerts face an increased risk of injury, which is likely due to the frequency of aggressive dance styles such as moshing. Heavy alcohol consumption leads to a greater risk of injury at concerts.

Effect of repeated ultrasonic instrumentation on single-unit crowns: a laboratory study.

OBJECTIVES: This laboratory study aimed to assess the effects of ultrasonic instrumentation, simulating 10 years of supportive periodontal therapy (SPT), on single-unit crowns. MATERIALS AND METHODS: Standardized crowns were fabricated from porcelain-fused-to-metal (PFM) (n = 12), zirconia (ZrO2) (n = 12), lithium disilicate (LDS) (n = 12), feldspar ceramic (FSFC) (n = 6), and polymer-infiltrated ceramic network material (PICN) (n = 6). The crowns, luted on PICN abutments with resin-based luting material (RBLM), and if applicable glass ionomer cement (GILC), underwent thermal cycling and trimonthly ultrasonic instrumentation. After 1 and 10 years of simulated SPT, restoration quality assessments were performed, comprising profilometric surface roughness measurements, marginal integrity evaluations, and scores for luting material remnants and visible cracks. The statistical analysis included multiple logistic regressions with nested designs (α = 0.05). RESULTS: During simulated SPT, bulk fractures (n = 2) and a de-cementation failure (n = 1) of LDS and ZrO2 crowns were observed. No significant change in roughness was detected after 10 years (p = 0.078). Over time, marginal defects increased (p = 0.010), with PFM crowns showing the highest rate of chippings at sites with a narrow shoulder. Fewer marginal defects were detectable on crowns luted with RBLM compared with GILC (p = 0.005). Luting material remnants decreased during SPT (p < 0.001). Ultrasonic instrumentation caused cracks in most crown materials, in particular at sites with a narrow shoulder and in PFM crowns. CONCLUSIONS: Repeated ultrasonic instrumentation may damage single-unit crowns. PFM crowns with a narrow, all-ceramic margin are especially prone to defects. CLINICAL RELEVANCE: Frequent ultrasonic instrumentation of restoration margins of fixed dental prostheses, PFM crowns in particular, ought to be avoided.

Partial pulpotomy without age restriction: a retrospective assessment of permanent teeth with carious pulp exposure.

OBJECTIVES: This study aimed to retrospectively evaluate clinical and radiographic outcomes of partial pulpotomy performed in permanent teeth with carious pulp exposure. MATERIALS AND METHODS: Records of patients undergoing treatment at an undergraduate dental clinic between 2010 and 2019 were screened for partial pulpotomies in teeth with a presumptive diagnosis of normal pulp or reversible pulpitis. The follow-up had to be ≥ 1 year. Patient data were retrieved and analyzed using Mantel-Cox chi square tests and Kaplan-Meier statistics. The level of significance was set at α = 0.05. RESULTS: Partial pulpotomy was performed in 111 cases, of which 64 (58%) fulfilled the eligibility criteria. At the time of partial pulpotomy, the mean age was 37.3 (± 13.5) years (age range 18-85). The mean observation period was 3.1 (± 2.0) years. Two early failures (3.1%) and five late failures (7.7%) were recorded. The overall success rate of maintaining pulp vitality was 89.1%, with 98.4% tooth survival. The cumulative pulp survival rates of partial pulpotomy in patients aged < 30 years, between 30 and 40 years, and > 40 years were 100%, 75.5%, and 90.5%, respectively, with no significant difference between the age groups (p = 0.225). At follow-up, narrowing of the pulp canal space and tooth discoloration were observed in 10.9% and 3.1% of cases, respectively. CONCLUSIONS: Across age groups, partial pulpotomy achieved favorable short and medium-term outcomes in teeth with carious pulp exposure. CLINICAL RELEVANCE: Adequate case selection provided, partial pulpotomy is a viable operative approach to treat permanent teeth with deep carious lesions irrespective of patients' age.

STAndard Reporting of CAries Detection and Diagnostic Studies (STARCARDDS).

AIM: The aim of this paper is to present recommendations from an international workshop which evaluated the methodology and reporting of caries diagnostic studies. As a unique feature, this type of studies is focused on caries lesion detection and assessment, and many of them are carried out in vitro, because of the possibility of histological validation of the whole caries spectrum. This feature is not well covered in the existing reporting STARD guideline within the EQUATOR Network. PARTICIPANTS AND METHODS: An international working group of 13 cariology researchers was formed. The STARD checklist was reviewed and modified for caries detection and diagnosis purposes, in a three-step process of evaluation, consensual modification, and delivery during three 2-day workshops over 18 months. Special attention was paid to reporting requirements of caries studies that solely focus on reliability. RESULTS: The STARD checklist was modified in 14/30 items, with an emphasis on issues of sample selection (tooth selection in in vitro studies), blinding, and detailed reporting of results. CONCLUSION: Following STARCARDDS (STAndard Reporting of CAries Detection and Diagnostic Studies) is expected to result in complete reporting of study design and methodology in future caries diagnosis and detection experiments both in vivo and in vitro, thus allowing for better comparability of studies and higher quality of systematic reviews. CLINICAL RELEVANCE: Standardization of caries diagnostic studies leads to a better comparability among future studies, both in vivo and in vitro.

Do magnification loupes affect the precision of cavity preparations made by undergraduates? A randomized crossover study.

BACKGROUND: Evidence on the effect of magnification devices on procedure quality in restorative dentistry is scant. This study therefore aimed to assess, under simulated clinical conditions, if magnification loupes affect the quality of preparations carried out by undergraduate dental students. METHODS: 59 undergraduate dental students underwent two visual acuity tests, based on which they were divided into a "low visual acuity group" (visus < 1) and a "good visual acuity group" (visus ≥ 1). In a randomized crossover experiment, participants performed a two-dimensional S and a three-dimensional O figure preparation with a dental handpiece on standardized acrylic blocs designed for preclinical restorative training. Each participant carried out the preparation tasks twice, once with magnification loupes (2.5×) and once without. Two blinded investigators independently evaluated parameters of preparation precision. Data were analyzed using Spearman rank correlation coefficients, intra-class correlation coefficients, and Wilcoxon rank-sum tests (α = 0.05). RESULTS: Participants from the "low visual acuity group" did not show a statistically significant improvement in accuracy when they used magnification loupes for the S figure preparation (p ≥ 0.0625). Participants from the "high visual acuity group" obtained a higher level of accuracy (p ≤ 0.0012) when they used magnification loupes for the S figure preparation. The use of magnification loupes had no statistically significant effect on the accuracy parameters of the O figure cavity preparations (p ≥ 0.1865). Participants with high visual acuity achieved only a marginally better accuracy than participants with a visus < 1. CONCLUSIONS: This study suggests that loupes with 2.5× magnification increase the accuracy of two-dimensional preparations while they have no significant effect, favorable or otherwise, on the accuracy of complex, three-dimensional cavity preparations of untrained dental students.

Apical pressures generated by several canal irrigation methods: A laboratory study in a maxillary central incisor with an open apex.

AIM: A laboratory study to determine the apical pressure generated by seven canal irrigation methods in an anterior tooth with an open apex. METHODOLOGY: Canal irrigation was performed on a 3D-printed central maxillary incisor with an open apex (maximum diameter of 2.1 mm). Ultrasonically activated irrigation (UAI), sonic activation (EDDY), negative pressure irrigation (EndoVac), the self-adjusting file (SAF) and the XP-endo Finisher were employed at tooth length (TL), TL-1 mm, TL-2 mm and TL-3 mm. UAI was tested at three intensity levels additionally. Hydrodynamic irrigation with RinsEndo was performed in the pulp chamber, at the canal orifice, the coronal third, the middle of the canal and at TL. Er:YAG laser activation, at four frequency settings, was performed in the pulp chamber and at the orifice of the canal. The pressure of the fluid towards the canal terminus generated by activation was directly transferred to a pressure sensor with a range of 0 to 120 mmHg and a response time of ≤0.5 ms. The critical threshold for apical extrusion of the irrigant was set at 5.73 mmHg (lower limit of the central venous pressure: 5.88 ± 0.15 mmHg). Each experiment was repeated ten times. The tests were followed by descriptive analyses (maximum, mean, standard deviation, 95% confidence interval). RESULTS: EndoVac, the SAF, the XP-endo Finisher, and UAI never exceeded the critical threshold at any insertion depth or intensity level. Er:YAG laser activation exceeded the critical threshold exclusively at frequency settings that varied from the manufacturer's recommendation. EDDY at TL and RinsEndo at any insertion depth exceeded the critical threshold in 100% of the measurements. EDDY at TL-1,-2, and-3 mm crossed the critical threshold in 30%, 10%, and 20% of the measurements, respectively. CONCLUSIONS: In a simulated maxillary central incisor with an open apex, irrigation with EndoVac, Er:YAG laser activation, UAI, the SAF, and the XP-endo Finisher generated apical pressures below the critical threshold of 5.73 mmHg. By contrast, using EDDY and RinsEndo for irrigation produced higher apical pressures that exceeded the critical threshold.

Spectrophotometric insights: calcium hydroxide influences tooth discolorations induced by short-term application of antibiotic/corticosteroid pastes.

OBJECTIVES: This in vitro study aimed to assess the influence of a calcium hydroxide dressing regarding the relative color change (ΔE) of enamel-dentin specimens previously exposed to antibiotic/corticosteroid pastes. MATERIALS AND METHODS: Eighty bovine enamel-dentin specimens with a cylindrical central cavity were randomly allocated to four groups: NEG (empty), POS (blood), LED (Ledermix), and ODO (Odontopaste) (n = 20 each). The materials were applied and sealed with self-adhesive resin luting material. After 3 weeks, the materials were removed and a calcium hydroxide (Ca(OH)2) dressing was placed in all cavities. After a further 3-week storage period, the cavities were restored with resin-based composite. Spectrophotometric color measurements were taken over 6 months, and ΔE values were calculated. A Tukey's multiple comparison test was performed to assess significant differences within the treatment groups (p < 0.05). RESULTS: Tooth discolorations were present after 3 weeks in LED (ΔE 29.14 ± 6.55) and POS (ΔE 18.05 ± 7.03); NEG and ODO remained color stable (ΔE 3.2 ± 1.36 and ΔE 2.3 ± 1.16). The 3-week Ca(OH)2 dressing decreased discolorations of POS (ΔE 15.93 ± 6.63; p = 0.37), whereas LED showed a further significant increase (ΔE 39.55; p < 0.0001). Between the end of the Ca(OH)2 dressing and the final restoration no significant color changes were observed in any group (p > 0.9). CONCLUSIONS: Discolorations induced by LED progressed during the Ca(OH)2 dressing despite careful removal of all residues. CLINICAL RELEVANCE: Calcium hydroxide might negatively affect the discoloring potential of Ledermix. This highlights the need for direct intracanal application methods of Ledermix ensuring a material-free access cavity or alternative antibiotic/corticosteroid pastes such as Odontopaste should be used.

Impact of the COVID-19 pandemic on urgent dental care delivery in a Swiss university center for dental medicine.

OBJECTIVES: This study aimed to assess whether the emergency service of a major Swiss dental institution faced different demands (patient volume, treatment needs, dental care characteristics) during a lockdown, issued to mitigate the COVID-19 pandemic, compared with the weeks before and after. MATERIALS AND METHODS: Data of patients receiving urgent care at a university center for dental medicine (Basel, Switzerland) during the 6-week lockdown, pre-lockdown, and post-lockdown periods were retrospectively evaluated. Statistical analysis involved tests for equal proportions and logistic regression models. The level of significance was set at α=0.05. RESULTS: The study comprised 3109 dental emergency visits in the period from February 2 to June 5, 2020. Daily caseloads increased during lockdown. Abscesses, orthodontic emergencies, and surgical follow-ups were more common during lockdown, whereas the number of dento-alveolar injuries declined (≤0.048). Urgent dental care provision involved intraoral radiographs more frequently in the pre-lockdown period compared with the following weeks (p<0.001). Among all treatments, aerosol-generating procedures dropped from 56.1% (pre-lockdown) to 21.3% during lockdown (p<0.001), while teledentistry follow-ups became more frequent (p<0.001). Patients with comorbidities sought urgent dental care less frequently during the post-lockdown period (p=0.004). CONCLUSIONS: The lockdown significantly impacted the dental emergency service in terms of patients' diagnoses, treatment needs, and the characteristics of the urgent care that was delivered. CLINICAL RELEVANCE: Access to essential dental care must be monitored and safeguarded throughout the COVID-19 pandemic and beyond as deferred care entails risks for serious sequelae and persons with comorbidities may change their dental care-seeking behavior.

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

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

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

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

Sonic irrigant activation for root canal disinfection: power modes matter!

BACKGROUND: Sonic irrigant activation has gained widespread popularity among general dentists and endodontists alike in recent years. This in vitro study aimed to evaluate the impact of three power modes of a sonic activation device (EDDY) on its antimicrobial effectiveness in infected root canals. METHODS: The root canals of straight, human roots (n = 120) were prepared to size 40/.06. In a short-term infection experiment, the root canals were inoculated with different microbial species for three days. The following irrigation protocols, using 4 ml of normal saline as irrigant, were performed: negative control, manual rinsing, sonic irrigant activation at power modes "low", "medium" and "high". In a second, long-term experiment, testing the same irrigation protocols, inoculation lasted 21 days and sodium hypochlorite was used as irrigant. Sequential infection control samples were assessed using culture assays. The statistical analysis included one-way analysis of variance of log10-scaled counts of colony-forming units (CFU) with post-hoc comparisons using Bonferroni corrections and Chi2 tests (α = 0.05). RESULTS: In the short-term experiment, the sonic irrigation protocols decreased the number of CFUs by 1.88 log10 units compared with the negative control (p < 0.001). The power modes "medium" and "high" achieved the most effective reduction of the microbial load. In the long-term experiment, microbial regrowth occurred after 7 days unless the device was used at its highest power setting. CONCLUSIONS: The power modes of the sonic irrigation device have a significant impact on the effectiveness for endodontic disinfection. The sonic irrigation device should always be used at the highest power setting in order to maximize its antimicrobial effectiveness.

Evaluation of a Fluorescence-aided Identification Technique (FIT) for removal of composite bonded trauma splints.

BACKGROUND/AIM: Accurate removal of composite bonded titanium trauma splints (TTS) can be challenging. The aim of this study was to evaluate a Fluorescence-aided Identification Technique (FIT) compared with a conventional light source (CT) for removal of trauma splints regarding loss of tooth substance, residual composite, and time taken. MATERIALS AND METHODS: Twenty maxillary models with six bovine teeth (13 - 23) were fabricated. An optical three-dimensional impression was taken and a TTS was applied from 12 to 22 with two bonding sites on every tooth under standardized conditions using an etch-and-rinse adhesive and resin composite. Two operators removed 10 splints each (5x FIT and 5x CT). For FIT, a 405 nm light-emitting headlamp was used. Time was recorded. A post-operative scan was superimposed on the pre-operative scan using OraCheck software. A qualitative and quantitative analysis of tooth defects and composite remnants was performed by two operators and statistically analyzed. RESULTS: Compared with the CT, FIT led to significantly fewer and smaller enamel defects (mean volume: -0.04 mm3 vs -0.33 mm3 ) (P < 0.001), significantly less composite remained (mean volume: 0.02 mm3 vs 0.28 mm3 ) (P < 0.001), and the removal procedure with FIT was significantly quicker (mean: 162 seconds vs 268 seconds) (P < 0.001), CONCLUSIONS: FIT facilitated the removal of composite used to bond trauma splints leading to less time-consuming as well as less invasive treatment. It left fewer composite residues on enamel surfaces.

"Karius and Baktus": A Critical Appraisal of Enger's Seminal Storybook.

Karius and Baktus, first published in 1949, is one of the most influential storybooks with dental caries as main theme and it remains in wide use for domestic health education. This study aimed at assessing oral health related contents of the historic storybook in the light of the current body of cariologic evidence. Two investigators independently identified phrases in the storybook with cariologically relevant content. Dental health related contents were systematically evaluated with respect to the current body of cariologic evidence. Karius and Baktus highlights important etiopathogenetic and preventive aspects such as sugars consumption and tooth brushing with toothpaste. Its behavior management techniques and narrative health didactics concerning dental care for children are, however, outmoded. The cariologic core statements in Karius and Baktus have remained valid whereas certain narrative features may have some drawbacks when employing the historic storybook for educational purposes for young children.