Clinical performance of a glass-hybrid system in comparison with a resin composite in two-surface class II restorations: a 5-year randomised multi-centre study.

OBJECTIVE: To evaluate the 5-year clinical performance of a glass hybrid restorative system and a nano-hybrid resin composite in moderate to large two-surface class II cavities. MATERIALS AND METHODS: This study was carried out by dental schools in Zagreb, Croatia; Izmir, Turkey; Belgrade, Serbia; and Milan, Italy. A total of 180 patients requiring two class-II two-surface restorations in the molars of the same jaw were recruited. The teeth were randomly restored with either a nano-hybrid resin composite (Tetric EvoCeram, Ivoclar Vivadent) or a glass-hybrid material (EQUIA Forte, GC). During the 5-year follow-up, two calibrated evaluators at each centre scored the restorations annually using the FDI-2 scoring system. The survival rates were calculated using the Kaplan-Meier method and compared using non-parametric matched pair tests (p < 0.05). RESULTS: There were no statistically significant differences between the overall survival and success rates of the two types of restorations (p>0.05). The success rates (FDI-2 scores 1-3) for EQUIA Forte were 81.9% (average annual failure rate: 3.9%) and 90.7% for Tetric EvoCeram (average annual failure rate: 1.9%). The survival rates (FDI-2 scores 1-4) for EQUIA Forte and Tetric EvoCeram were 94.5% and 94.4%, respectively, with an average annual failure rate of 1.1%. CONCLUSIONS: In terms of success and survival rates, both the glass-hybrid restorative system and the nano-hybrid resin composite have been shown to perform satisfactorily. CLINICAL RELEVANCE: The results of this study indicate that EQUIA Forte can be one of the therapeutic options for moderate to large two-surface class II restorations of posterior teeth.

Multilevel calibration procedure for the oral health national multicenter survey in primary teeth.

BACKGROUND: Early childhood caries (ECC) requires systematically collected and standardized data. AIM: To describe a novel multilevel calibration procedure in primary dentition. DESIGN: Calibration method involved two calibration levels: the first (L1 ) involved an interexaminer agreement between three main investigators, the group leaders (GLs) in the following level; the second level (L2 ) involved three groups of 11 paediatric dentists and interexaminer agreement assessment according to the GLs in each group. The study sample consisted of 650 primary teeth surfaces in eight children (mean age 6.56 ± 2.22 years). Surface-by-surface percent agreement, tooth-by-tooth percent agreement, Cohen's kappa, and Fleiss kappa statistics were used to calculate interexaminer reliability. Statistical analysis was performed with SPSS 27.0. RESULTS: Surface-by-surface percent agreement regarding ICDASepi-merged revealed almost perfect agreement (>90.00%) on both L1 and L2 . Kappa values and ranges showed good agreement at both L1 (overall κ = .95) and L2 (overall κ = .98) and almost perfect consistency was detected between GLs at L1 (>91.30%) and substantial agreement at L2 (>85.00%). All examiners at L2 showed almost perfect positive agreement (sensitivity = 96.77%-100%) when detecting the presence of dental plaque. CONCLUSION: The calibration procedure appeared feasible prior to organizing multicenter epidemiological oral health survey in large population groups of preschool children, with higher number of examiners.

Efficacy of pastes containing CPP-ACP and CPP-ACFP in patients with Sjögren's syndrome.

OBJECTIVES: The purpose of this study was to evaluate efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) containing pastes among individuals with Sjögren's syndrome (SS). MATERIALS AND METHODS: Thirty patients were randomised into three groups: CPP-ACP, CPP-ACFP, and 0.05 % NaF to be used two times a day during a 28-day experimental period. Saliva was analysed for flow rate, pH, buffering capacity and mineral concentrations. Dental plaque was examined for pH. Following the formation of artificial carious lesion, participants wore enamel slabs for an in situ remineralisation study. Remineralisation potential was examined using scanning electron microscope (SEM) and energy dispersive spectroscopic (EDS) technique. SE microphotographs were subsequently analysed for area, diameter, perimeter, roundness and the number of enamel defects and percentage of tooth surface affected by defects. RESULTS: At the end of the experimental period, a slight increase of salivary pH could have been observed. No differences in mineral composition of saliva were noted. The use of CPP-ACP and CPP-ACFP contributed to a significant rise of plaque pH. Image analysis revealed excessive reduction of defects' dimensions in the three experimental groups, and a decrease of the number of enamel defects in the CPP-ACP and CPP-ACFP groups. The EDS analysis did not show differences in Ca/P, Ca/O and P/O ratios in any of the treatment groups. CONCLUSION: CPP-ACP and CPP-ACFP hold promise as remineralising agents for patients with SS. CLINICAL RELEVANCE: Pastes containing CPP-ACP/CPP-ACFP show enhanced remineralisation potential compared with NaF mouthrinse in patients with SS.

Association between being overweight and oral health in Serbian schoolchildren.

BACKGROUND: Childhood obesity, dental caries, and periodontal disease are major public health problems due to their adverse impact on the growth and development of children. AIM: To examine the association between nutritional status, oral health, and lifestyle habits among schoolchildren in Serbia. DESIGN: This cross-sectional study assessed 422 children and adolescents aged 6-18 years with the following dental indexes analyzed: DMF/dmf (decayed, missed, and filled teeth), plaque index (PI), and gingival index (GI). Depending on their nutritional status, the subjects were categorized, as being 'normal weight,' 'at risk of overweight,' and 'overweight.' Logistic regression was applied to study the association between the dental indexes and independent variables: gender, age, toothbrushing, nutritional status, and lifestyle factors. RESULTS: Being overweight positively correlated with GI, but negatively correlated with the DMF/dmf index among the participants. Multivariate analysis showed a strong association between the weight category and toothbrushing with GI and PI. Overweight children (6-11 years) were less likely to have caries, whereas in older children/adolescents (12-18 years), caries was associated with the intake of sugar-sweetened juices. CONCLUSIONS: Being overweight was found to be significantly associated with a higher probability of developing gingivitis and negatively associated with caries prevalence in Serbian children and adolescents.

Influence of casein phosphopeptide-amorphous calcium phosphate on the surface topography and composition of nickel-titanium archwires during orthodontic treatment with fixed appliances.

PURPOSE: To investigate the surface topography and nickel content of nickel-titanium (NiTi) archwires exposed to either routine oral hygiene or a prophylactic regimen with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) during orthodontic treatment. METHODS: This in vivo study involved 40 orthodontic patients with fixed appliances, who were randomly assigned to either a routine oral hygiene group or a CPP-ACP supplementary regimen group. Twenty new NiTi archwires served as controls. All archwires underwent scanning electron microscopy and energy-dispersive spectroscopy to evaluate their surface topography and elemental composition. The nickel content was quantified as a percentage of total weight and the Ni/Ti ratio, and statistical comparisons were made using pairwise tests. RESULTS: Wires exposed to fluoride toothpaste showed signs of pitting corrosion, deep grooves, and corrosion debris. In contrast, wires exposed to supplementary CPP-ACP exhibited smooth surface areas interspersed with microdefects and deposits. Statistically significant differences in nickel content were found between the new and retrieved archwires, as well as between wires exposed to routine oral hygiene and CPP-ACP (P < 0.001). The archwires exposed to CPP-ACP had the lowest nickel content (P < 0.001). CONCLUSION: The use of CPP-ACP holds promise for application as a safe anticariogenic agent with possible protective properties during orthodontic treatment.

Toothpaste ingestion-evaluating the problem and ensuring safety: systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate the ingestion of toothpaste and its sequelae. The study adhered to the PRISMA guidelines and was registered in the PROSPERO database. A comprehensive search strategy was conducted across multiple databases, resulting in the inclusion of 18 relevant publications. Eligible studies encompassed various designs and included both children and adults as the study population. Data extraction was carried out systematically, and relevant information on study characteristics, interventions, and outcomes were collected. The assessment of bias was performed using the Joanna Briggs Institute's Critical Appraisal Tools showing variations of bias among the included studies. The overall risk of systemic toxicity was found to be low, and no severe or life-threatening events were reported in the included studies. Furthermore, some toothpaste formulations containing higher concentrations of fluoride were associated with an increased risk of dental fluorosis. These findings have several implications for practice and policy. Healthcare providers and dental professionals should emphasize the importance of promoting safe toothpaste use, especially in vulnerable populations such as young children who are more prone to accidental ingestion. Public health campaigns and educational initiatives should aim to raise awareness about appropriate toothpaste usage and the potential risks. In addition, toothpaste manufacturers and regulatory bodies should consider revising guidelines and regulations to ensure the safety of oral care products, including the appropriate concentration of active ingredients. Future research should focus on investigating the long-term effects of toothpaste ingestion, exploring potential interactions between different active ingredients, and evaluating the efficacy of current preventive measures.

The Participation of Pediatric Dentists in Oral Health Promotion and Education in Serbia.

Objectives: To identify the involvement of Serbian paediatric dentists in oral health promotion and education, and to propose further actions for the improvement of these activities. Methods: This is an analysis of data collected by a cross-sectional, questionnaire-based survey of 445 dentists involved in the provision of dental health services to children at the primary healthcare level. We explored dentists' involvement in oral health education and promotion and the cooperation with other health professionals at the healthcare centre and the community level as well as their attitudes towards the importance of some factors influencing their work. Results: Dentists estimate their cooperation with different services with ratings higher than 3 on the scale of 1 to 5. They reported the highest satisfaction in cooperation with paediatric services for preschool and schoolchildren (4.0±1.0). At the community level, they reported excellent cooperation with kindergartens (4.4±0.8), while collaboration with Roma health mediators (3.14±1.34) and nongovernmental organizations (2.5±1.4) received lower ratings. According to the average rating (4.7±0.7), dentists perceive the motivation of patients and/or their guardians for keeping good oral health as the factor with the highest importance for the quality of interventions they provide. Conclusions: Dentists involved in the provision of dental healthcare for children and adolescents in primary healthcare centres in Serbia participate in different oral healthcare education and promotion activities in the community, and highlight the importance of strengthening cooperation with healthcare and other professionals and services aimed at vulnerable population groups, both within the health sector and nongovernmental organizations.

A Prospective Study of Mid-Trimester MCP-1 Levels as a Predictor of Preterm Delivery.

Background: The prevention of preterm delivery (PTD) represents one of the major topics in modern obstetrics. The aim was to design a prospective study and investigate if mid-trimester serum and amniotic fluid levels of MCP-1 could predict the occurence of spontaneous PTD. Methods: The study involved 198 women who underwent genetic amniocentesis and blood sampling in the middle of their trimester. After applying the criteria for inclusion in the study, there were 16 respondents in the study group, and 38 respondents in the control group. Level of MCP-1 in amniotic fluid and serum was measured with commercially available enzyme-linked immunosorbent assays (ELISA) and statistical analysis was conducted. Results: There was no statistically significant difference in serum or amniotic fluid MCP1 levels between PTD and the control groups. Conclusion: The results suggest that MCP-1 is probably not the most relevant marker for predicting PTD. This study provides new normative data for MCP-1 levels in amniotic fluid and maternal sera and is a valuable tool for future diagnostic and comparative studies.

Antimicrobial and Toxic Effects of Boswellia serrata Roxb. and Mentha piperita Linn. Essential Oils on Vaginal Inhabitants.

Commercial essential oils (EOs) of incense, Boswellia serrata Roxb, and mint, Mentha piperita L., were investigated against vaginal bacterial and Candida albicans isolates for antimicrobial potential and safety use. The antimicrobial activity of EOs was investigated through a double-dilution micro-plate assay. A brine shrimp assay was used for the determination of toxicity, while the determination of the chemical composition of EOs was carried out using GS-MS. Obtained minimal inhibitory (MIC) and minimal bactericidal concentration (MBC) point to the activity of mint essential oil (EO) against the multi-resistant P. aeruginosa isolate (MIC/MBC at 6.25 µL/mL), while MIC and MBC values for other isolates were reached at higher concentrations (25-50 µL/mL). According to the toxicity assay, the incense EO reached the LC50 value at 3.07 µL/mL, while mint EO showed higher toxicity at lower concentrations (0.5 µL/mL) and the LC50 could not be determined. The highest antimicrobial potential was obtained for incense against P. aeruginosa. Although the toxicity assay showed high toxicity of mint EO to the eggs of aquatic crustaceans Artemia salina, further testing of EO toxicity is proposed, for example on healthy cell-lines. According to the GC/MS spectrometry, the most represented components of mint EO were the oxygenated hydrocarbons L-menthone (20.86%) and menthol (31.86%), and they could be proposed for further antimicrobial and toxicity investigation.

Using role play to develop positive attitudes toward people with disabilities among dental students: An exploratory pilot study.

INTRODUCTION: Comprehensive and interprofessional undergraduate teaching and training in special care dentistry (SCD) could influence future dentists' attitudes towards patients with disabilities. The aim of the study was to assess the influence of role play as part of SCD training on the attitudes of undergraduates towards patients with disabilities. METHOD: The students attending the SCD module during the autumn semester of 2019 comprised our target population. A quasi-experimental design was used to compare the attitudinal scores between three groups of students exposed to different modalities of SCD teaching: group 1 - didactic teaching (N = 92), group 2 - didactic teaching and clinical training in the dental treatment of children or elderly patients with disabilities (N = 142), group 3 - theoretical teaching and clinical training, accompanied by role play sessions featuring persons with disabilities (N = 20). The contact rate was 100%. The outcomes of the intervention were measured using the altruism scale, which forms part of the International Association for Disability and Oral Health (iADH) Toolbox for measuring attitudes and intended behaviors towards persons with disabilities. RESULTS: The analysis revealed the two-factor structure of the nine-item altruism scale. The first factor was described as the acceptance of oral health care as a universal human right, while the second was the perception of the contribution of marginalised groups, including people with disabilities, to the community. The students participating in the role play scored higher on both factors in comparison to those attending other modes of SCD training. CONCLUSION: The presented findings suggested role play as a powerful tool in fostering positive attitudes towards persons with disabilities in the education of dental students and highlighted the importance of multidisciplinary training.

Oral Health in 12- and 15-Year-Old Children in Serbia: A National Pathfinder Study.

The aim of the paper is to present the oral health profile of 12- and 15-year-old schoolchildren in Serbia. Basic Methods for Oral Health Surveys of the WHO were implemented to record: Decayed, Missing, and Filled Teeth/Surfaces Index (DMFT/DMFS), gingival bleeding, enamel fluorosis and other structural anomalies, dental erosion, dental trauma, and oral mucosal lesions. In addition, Silness and Löe plaque index and orthodontic status were assessed. A total of 36% of 12-year-olds and 22% of 15-year-olds in Serbia were caries-free. The mean DMFT was 2.32 ± 2.69 for 12-year-olds and 4.09 ± 3.81 for 15-year-olds. DMFT was made up largely by the decayed component. Gingival bleeding was present in 26% of examined 12-year-old and 18% of 15-year-old children. Dental plaque was observed in 63% of both 12- and 15-year-olds. Fluorosis, structural anomalies, dental erosion, dental trauma, and oral mucosal lesion were rarely detected. Low prevalence of malocclusions was found. Oral disease is still a common public health problem among schoolchildren in Serbia. A significant increase in the prevalence of caries disease between 12- and 15-year-old groups implies that preventive care for adolescents requires special attention. Corrective actions and reforms to the current school-based oral health prevention program are needed to further improve oral health in Serbian children.

The impact of fissure depth and enamel conditioning protocols on glass-ionomer and resin-based fissure sealant penetration.

PURPOSE: To evaluate the effect that fissure depth and enamel conditioning protocols have on penetration abilities of resin-based and glass-ionomer fissure sealants. MATERIALS AND METHODS: Fifty extracted human molars were randomized into 10 experimental groups. Conditioning was performed as follows: groups I and VI, no pretreatment; groups II and VII, 10% polyacrylic acid and 37% phosphoric acid, respectively; groups III and VIII, self-etching adhesive; groups IV and IX, Er:YAG laser; groups V and X, Er:YAG laser/10% polyacrylic acid and laser/37% phosphoric acid, respectively. In groups I to V, teeth were sealed with a glass-ionomer material, and in groups VI to X a resin-based sealant was used. The sealed teeth were sectioned and the penetration ability was evaluated using scanning electron microscopy (SEM). RESULTS: Pretreatment with a suitable acid resulted in superior penetration of glass-ionomer and resin-based sealant when compared with other conditioning protocols (p < 0.0001), except for the teeth treated with both Er:YAG laser and acid. Both conditioning protocol and fissure depth significantly affected the sealant penetration (p < 0.0001), but fissure depth had a greater impact on fissure penetration than did conditioning protocol. CONCLUSION: Resin-based and glass-ionomer sealing materials show similar potential for pit-and-fissure penetration. Penetration of a fissure sealant is largely influenced by the fissure depth. Regarding the conditioning protocol, a pretreatment with a suitable acid is essential to obtain an adequate penetration of a sealing material.

Meta-Analysis of In-Vitro Bonding of Glass-Ionomer Restorative Materials to Primary Teeth.

Restoration of primary teeth is among the main clinical applications of glass-ionomer cements (GIC). The aim of the study was to review and summarize existing evidence of in vitro bond strength of glass-ionomer (GI) restoratives to enamel and dentin of primary teeth. A literature search was performed in PubMed/Medline, Scopus, Web of Science, Cochrane, and Google Scholar databases to identify studies published until April 2021. The search strategy was: ("glass") and ("ionomer") and ("primary" or "deciduous") and ("bond" or "tensile" or "shear"). Two researchers independently retrieved articles that reported on the bond strength of GIC to primary dentin and/or enamel. The meta-analysis was performed to compare the bond strength values of conventional (C) GIC and resin-modified (RM) GIC to different substrates. From 831 potentially eligible articles, 30 were selected for the full-text examination, and 7 were included in the analysis. Studies were rated at high (3), medium (3), and low (1) risk of bias. RM-GIC showed higher bond strength to primary enamel and dentin compared to the C-GIC. Meta-analysis of in vitro studies, evaluating bonding properties of GI restoratives to primary teeth, suggests the superior performance of RM-GIC. However, there is a lack of studies that examine the properties of novel GI formulations.

Cost-effectiveness of glass hybrid versus composite in a multi-country randomized trial.

OBJECTIVES: We assessed the cost-effectiveness of two amalgam alternatives, glass hybrid (GH) and composite (CO) in a multi-country randomized controlled split-mouth trial. MATERIALS: University clinics in Croatia, Serbia, Italy and Turkey participated. Pairs of GH (EQUIA Forte, GC) and a nano-hybrid CO (TetricEvoCeram, IvoclarVivadent) were randomly placed in occlusal-proximal two-surfaced cavities in permanent molars of adults (n = 180/360 patients/molars). We used 3-years interim data for this evaluation. FDI-2 criteria were applied and teeth requiring repair, re-restoration, endodontic treatment or extraction recorded. Our outcome was the time until any or major complications (requiring endodontic treatment or extraction) occurred. Costs were calculated in US Dollar (USD) 2018, with the local currencies being converted using Purchasing Power Parities. To estimate initial and re-treatment costs, a payers' perspective was taken and direct medical costs estimated from fee item catalogues. Incremental-cost-effectiveness ratios (ICER) were used to express the cost difference per gained or lost effectiveness. RESULTS: Overall costs were lower for GH than CO in Croatia, Turkey and Serbia, while this difference was minimal in Italy. GH tended to survive longer than CO in Croatia and Italy, and shorter in Serbia and Turkey; overall survival time was not significantly different (p = 0.67/log-rank). The cost-effectiveness differences indicated CO to be more expensive at limited (ICER: 268.5 USD/month without any complications) or no benefit at all (-186.2 USD/month without major complications). CONCLUSIONS: GH was less costly than CO both initially and over 3 years. Efficacy differences were extremely limited. CLINICAL SIGNIFICANCE: Given their low initial costs and as efficacy between GH and CO did not differ significantly, GH had a high chance of being more cost-effective within this specific trial.

Pediatric Dentists' Service Provisions in South-East Europe during the First Wave of COVID-19 Epidemic: Lessons Learned about Preventive Measures and Personal Protective Equipment Use.

INTRODUCTION: Having in mind the importance of providing continuous pediatric dental services during the COVID-19 pandemic and the fact that children have similar viral loads to adults, the potential to spread the virus to others, and with variable clinical presentation of COVID-19 infection, this study aimed to analyze the impact of COVID-19 outbreak on pediatric dentistry service provision, risks, and preventive measures before and during dental treatment. METHOD: Structured and closed epidemiological cross-sectional survey involved seven Southeastern European countries. The questionnaire was developed using the modified Delphi method, pretested, and tested in North Italy during April 2020. The sample consisted of licensed dental professionals reached via national dental chambers and social media using the best strategies according to the national setting. RESULTS: A total of 3227 dentists participated in the survey, and we included 643 specialists in this study-among them, 164 were pediatric dentists. Most pediatric dentists worked in the public sector (61.0%) and provided emergency (64.6%) and routine dental treatment (18.3%) during the outbreak. One-third of pediatric dentists were COVID-19 tested, statistically significantly more than other specialties, and 3.0% tested COVID-19 positive. In addition, significantly more pediatric dentists (13.4%) reported the presence of at least one symptom related to COVID-19 compared to other specialists (6.1%). None of the pediatric dentists reported PPE shortage. However, 26.2% of all specialists stated that they lacked clear step by step professional guidance in a national language. Similarly, in both groups, around 10% of specialists attended education on coronavirus. CONCLUSIONS: Considering that most pediatric dentists provided dental treatment during lockdown in their countries in public health centers and that they will continue to work during pandemic, our results suggest that pediatric dentists might be at higher risk of COVID-19 infection. Further research should focus on finding better ways to promote and adapt preventive, protective measures and PPE in the pediatric dental setting to be behaviorally acceptable. Moreover, additional efforts should be invested in dental education regarding COVID-19 in the mother tongue.

Factors related to treatment and outcomes of avulsed teeth.

BACKGROUND: The aim of this study was to examine factors associated with avulsion injury and to specify the association between these factors and the treatment, as well as the outcomes of avulsed permanent incisors in children. MATERIALS AND METHODS: The sample consisted of 51 children with 62 avulsed permanent incisors, whose injuries had been managed in the period 1998-2006. The study was prospective, recording the history of the accident, concomitant injuries, age, gender, apical maturity of the root, replantation rate, storage media, extra-alveolar duration, endodontic treatment, compliance and recall appointments response. Factors were analysed in relation to postoperative outcomes, classified as functional healing (FH), infection-related (inflammatory) resorption (IRR) and replacement resorption (RR). RESULTS: The average age of patients was 10.7 years (range 7-19). In 16/51 patients, tooth avulsion was caused by a road traffic accident. Avulsion was accompanied by concomitant injuries in all cases. Thirty of 62 avulsed teeth were not replanted and 32 incisors were replanted after dry storage. Time until replantation ranged between 15 min and 9 h (median 60 min). The observation period ranged from 1 to 6 years (median 2 years). FH was observed in 5/32, IRR in 20/32 and RR in 7/32 incisors. Ten teeth were extracted during 5-years of observation. Immature incisors exhibited significantly more complications compared with mature teeth (P = 0.04). Storage media and extra-alveolar duration did not significantly affect the survival of replanted teeth (P = 0.253, P = 0.350). Teeth in which endodontic treatment was in temporary phase exhibited significantly more complications in comparison with teeth with completed endodontic treatment (P = 0.0l6). CONCLUSION: The combination of delayed replantation and unphysiological storage is followed by low survival. Incisors with open apices exhibited lower survival compared with incisors with closed apices. Replanted incisors that required prolonged treatment with calcium hydroxide exhibited more complications compared with incisors with completed root canal treatment.

Clinical Performance of a Glass-Hybrid System Compared with a Resin Composite in the Posterior Region: Results of a 2-year Multicenter Study.

PURPOSE: To compare the clinical performance of a glass hybrid restorative system, EQUIA Forte, with that of a nanohybrid resin composite, Tetric EvoCeram, in two-surface class II cavities. MATERIALS AND METHODS: This multicenter, randomized controlled clinical study was conducted at four different dental schools. In total, 360 restorations were placed in patients in need of two class-II, two-surface restorations in the molar region of the same jaw. Each patient received one glass hybrid restoration (EQUIA Forte, GC) and one resin composite restoration (Tetric EvoCeram, Ivoclar Vivadent). Two independent evaluators performed a clinical evaluation of each site after 1 week (baseline), 1 year, and 2 years using the criteria of the FDI World Dental Federation (FDI-2). RESULTS: The estimated survival rates at the 2-year recall were 93.6% and 94.5% for EQUIA Forte and Tetric EvoCeram, respectively. There were no significant differences in the survival rates or in any of the evaluated esthetic, functional or biological properties between EQUIA Forte and Tetric EvoCeram restorations (p ˃ 0.05). CONCLUSION: Both the glass-hybrid restorative system and nanohybrid resin composite showed good clinical performance in moderate to large two-surface class II restorations in a 2-year follow-up.

Clinical evaluation of a chemomechanical method for caries removal in children and adolescents.

OBJECTIVE: The purpose of this study was to make a clinical comparison of the chemomechanical method for caries removal and the conventional rotary instruments technique when used in children and adolescents. MATERIAL AND METHODS: The study comprised 120 patients aged 3-17 years randomized into two groups: caries were removed chemomechanically in 60 patients and 60 patients received conventional treatment with rotary instruments. The outcome variables were: clinically complete caries removal, pain during caries removal, need for local anesthesia, treatment time, preferences of patients, and clinical success of the restorations during the 12-month evaluation period. RESULTS: Complete caries removal was achieved in 92% of chemomechanically treated teeth and in all teeth treated with rotary instruments (p>0.05). The chemomechanical method significantly reduced the need for local anesthesia (p<0.001). Eighty-five percent of patients treated with Carisolv and 47% treated with rotary instruments were satisfied with the treatment (p<0.05). The mean time for chemomechanical caries removal was 11.2 ± 3.3 min and 5.2 ± 2.8 min for caries removal with rotary instruments (p<0.001). At the end of the 12-month evaluation period, there was no observed influence of the caries removal method on the survival of the restorations. CONCLUSIONS: The chemomechanical caries removal technique is an adequate alternative to the conventional rotary instruments method and is advantageous in pediatric dentistry.

A retrospective study of intrusive injuries in primary dentition.

OBJECTIVE: The aim was to evaluate epidemiological aspects of intrusive injuries in primary teeth, extent and severity of injuries, provided treatment, and complications to the primary and permanent dentition. METHODS: This was a retrospective study based on the clinical and radiographic data of 102 intruded teeth in 70 patients. Follow-up period varied from 6 months to 6 years, with the mean time of 2.7 +/- 1.5 years. Data were collected through dental files and dental trauma forms. The following parameters were analyzed at control examinations: rate of spontaneous re-eruption, presence of complications, time elapsed between the injury and complication, and possible sequels on permanent successors. RESULTS: Mean age of the patients was 2.5 +/- 1.3 years. Fifty-six children were injured because of the fall while walking or running. Most of children had one intruded tooth. Maxillary central incisors were the most frequently injured teeth. Seventy injured teeth were <2 mm intruded. Mean time elapsed from the injury until the professional help was 45.0 +/- 67.3 h. Within 2 months after trauma, 48 intruded teeth re-erupted spontaneously. Crown discoloration occurred in 10 intruded teeth, pulp necrosis was diagnosed in nine cases and pathologic root resorption was found in five injured teeth. CONCLUSIONS: The most common mechanism of injury was fall. Spontaneous re-eruption occurred in the majority of intruded primary teeth. In comparison with moderate or severe intrusions, mildly intruded teeth took less time to re-erupt. Mildly intruded teeth exhibited less complications in comparison with moderately and severely intruded teeth.

How Much Country Economy Influences ECC Profile in Serbian Children-A Macro-Level Factor Analysis.

Introduction: Serbia has universal health coverage (UHC) for pediatric dental care and similar country distribution for dentists and physicians per 1,000 inhabitants. However, a high prevalence of early childhood caries (ECC) with wide variation across the country was observed in previous studies. This paper aimed to analyze the association between economic and healthcare country macro-level factors with ECC prevalence and treatment. Method: The outcome variables were ECC prevalence and frequency of untreated ECC in 36- to 71-month-olds. Cross-sectional pathfinder survey on a nationally representative sample of children was conducted in order to obtain data. Independent variables included the following: gross domestic product (GDP), social and health care budget beneficiaries' expenditures, local self-government budget, unemployment rate, population density and density of physicians and dentists. Guided by the WHO's Basic Methods for Oral Health Surveys stratified cluster sample, 17 sites were randomly chosen to obtain adequate distribution of data regarding urban, peri-urban and rural areas in each analyzed statistical territorial unit. The variables were analyzed using the independent t-test or Mann-Whitney U test. A probability value of <0.05 was considered significant. Results: The final sample included 864 children aged 36 to 71 months. Observed prevalence of ECC was 41.1%. Although no statistically significant difference was found, children with ECC compared to healthy children were living in parts of the country with averages of ≈122€ lower GDP per capita, ≈4€ lower social and health care expenditures per capita, 9 inhabitants per km2 lower population density, almost 7€ per capita lower local self-government budget and a 0.6% higher unemployment rate. Furthermore, although without a statistically significant difference, untreated ECC was associated with ≈302€ lower GDP per capita, ≈12€ lower social and health care expenditures per capita, 34 inhabitants per km2 lower population density, almost 20€ per capita lower local self-government budget and a 1.7% higher unemployment rate. Conclusions: This study, performed in a nationally representative sample of preschool children, revealed the association of economic macro-level factors with ECC prevalence and its (non-) treatment. Further research on a larger sample is necessary to confirm the results. These findings suggest that most of the public-health efforts regarding prevention and early treatment of ECC should be directed at regions with lower economic performance.