Comparison of facilitators and barriers to providing oral hygiene measures in dependent older people and young children: A systematic review.

OBJECTIVE: The objective of the study was to systematically compare barriers/facilitators providing oral hygiene to young children and dependent older people and to generate ideas to improve the implementation of oral hygiene measures. BACKGROUND: Many older people, like children, rely on third-party assistance for teeth cleaning. Barriers/facilitators in providing oral care services have been described in recent works. The aim of our study was to compare these results for both groups and to increase knowledge on analogies/differences in barriers/intermediaries. METHODS: We performed a systematic review. Studies reporting on knowledge, attitudes and beliefs acting as barriers/facilitators for provision of teeth cleaning were included. Thematic analysis was used and identified themes translated to domains and constructs of the theoretical domains framework and aligned to the behaviour change wheel. Based on three published reviews in children or older people, our search (PubMed via Medline), Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science, Google Scholar, last search (21 January 2023) encompassed both populations dated from their last publication (28 February 2018). The review was registered (Prospero, CRD42021278944). For quality assessment, the Newcastle-Ottawa Scale (NOS) was used. RESULTS: Seventeen articles were identified (older people (n = 8), children (n = 9)). Deficits exist for both in terms of "knowledge/skills" among caregivers, with special difficulties in children with challenging behaviour and older people. "Capability" as one of the main elements of behavioural factors that are the basis for behaviour to take place (COM-B, Capability, Opportunity, Motivation-Behaviour) is most often mentioned for children and "opportunity" for older people. CONCLUSIONS: Most of the facilitators and barriers affecting oral care provision in children are also relevant in older people. Approaches for the development of strategies for better implementation of oral hygiene measures in older people are presented.

Older people's preferences and expectations of preventive oral care in the home.

OBJECTIVE: The aim of the study was to assess older people's preferences and expectations for preventive oral care in their own home. BACKGROUND: With increasing age, the use of dental services declines and oral health becomes secondary, yet good oral health contributes to quality of life and has a positive impact on general health. Thus, the healthcare system should offer a care structure in which oral health can be maintained into old age. To provide patient-centred care, patient preferences in additional preventive oral care need to be explored. MATERIALS AND METHODS: In this qualitative study, semi-structured interviews were conducted with community-dwelling individuals aged ≥65 years to understand their preferences and expectations for oral care in a home-based setting. Interviews were recorded, transcribed verbatim and analysed thematically. RESULTS: Fourteen dental patients were included. Three overarching themes were identified. The desire for independence was predominant when addressing their future capability to perform oral hygiene. When addressing possible future oral health support, self-determination and independence were important to them. Concerns about dependency in inpatient care facilities and the associated reduction in oral care were evident. Frequency, costs and the practice environment played a decisive role when thinking about additional preventive measures for their future. CONCLUSION: The results of this study provide important information about older people's preferences and expectations for preventive oral care in the home environment and relate to three core themes of (1) changes in oral hygiene skills and perceptions, (2) support and (3) organisational factors. These must be considered when planning and implementing preventive oral care.

Cost-effectiveness and efficacy of fluoride varnish for caries prevention in South African children: A cluster-randomized controlled community trial.

OBJECTIVES: This cluster-randomized controlled community trial aimed to assess the efficacy and costs of fluoride varnish (FV) application for caries prevention in a high-risk population in South Africa. METHODS: 513 children aged 4-8 years from two schools in a township in South Africa were randomly allocated by class to the FV or Control (CO) groups. In addition to supervised toothbrushing with fluoridated toothpaste in both groups, FV was applied in 3-month intervals by trained local non-professional assistants. Intraoral examinations were conducted at baseline, 12, 21 and 24 months. Primary outcome was the increment of teeth with cavitated lesions (i.e. newly developed or progressed, formerly non-cavitated lesions), requiring restoration or extraction over the study period. Additionally, treatment and re-treatment costs were analyzed. RESULTS: 513 children (d1-4 mft 5.9 ± 4.3 (mean ± SD)) were randomly allocated to FV (n = 287) or CO (n = 226). 10.2% FV and CO teeth received or required a restoration; 3.9% FV and 4.1% CO teeth were extracted, without significant differences between groups. While FV generated high initial costs, follow-up costs were comparable in both groups, resulting in FV being significantly more expensive than CO (1667 ± 1055 ZAR vs. 950 ± 943 ZAR, p < .001). CONCLUSIONS: Regular FV application, in addition to daily supervised toothbrushing, had no significant caries-preventive effect and was not cost-effective in a primary school setting within a peri-urban, high-risk community in South Africa. Alternative interventions on community or public health level should be considered to reduce the caries burden in high-risk communities.

Retrospective investigation of organization and examination results of the state examination in restorative dentistry, endodontology and periodontology under simulated conditions in times of Covid-19 compared to standard conditions when treating patients.

Objective: Primary outcome of this retrospective study was the comparison of state examination results under simulated treatment conditions in times of Covid-19 versus patient treatment under non-pandemic conditions. Additionally, correlation analysis was performed between students' self- and examiners' assessment of the treatment results. Methods: Within 4 hours, 22 examinees each had to place a multi-surface adhesive anterior and posterior restoration, performed an endodontic treatment on a maxillary premolar and a periodontal debridement of one quadrant. All treatments were performed on a model fixed in a phantom head. Compliance with the prescribed hygiene and social distancing guidelines and self-assessment of the practical performance was part of the practical examination as well. One examiner per examination part evaluated anonymously the final results. The historical control was based on the exam results of a cohort from 2019. Mean values (standard deviation), non-parametric correlations (Spearman's Rho) and group comparisons (Mann-Whitney) were calculated for statistical analysis. Results: Examination results under simulated treatment conditions were significantly worse (p<0.05) than in the cohort that took their state exam in patients, with exception of the endodontic partial exam. The overall scores in restorative dentistry and periodontology of both groups, which include a structured theoretical examination, did not differ. The majority of the candidates rated their performance worse than the examiners, and there was no correlation between self- and third-party assessment. Conclusion: In the comparison of two years, a simulated practical examination without patients in restorative dentistry, endodontics and periodontology resulted in matchable results compared with an examination on patients. Equal conditions for the candidates resulting in better comparability and avoidance of ethical dilemmas of patient treatment under examination conditions could also be arguments towards a state examination under phantom conditions in the future.

Power bleaching enhances resin infiltration masking effect of dental fluorosis. A randomized clinical trial.

OBJECTIVES: Patients with moderate dental fluorosis often feel esthetically compromised. Aim of this RCT was to evaluate the objectively and self-assessed masking effect of resin infiltration alone or in combination with in-office bleaching on dental fluorosis in adults. METHODS: Twenty-seven patients (9 male, 18 female, 24.81 ± 3.7 yrs) with 410 fluorotic teeth (TF 1-4) were randomly assigned to a treatment (BLI) or control group (NBLI). Patients underwent in-office bleaching (25% H2O2) in the BLI or a placebo bleaching (ACP gel) in the NBLI group followed by resin infiltration after two weeks. Standardized digital photographs were obtained at baseline; after bleaching; before and after resin infiltration and after 1, 3, and 6 months. Color differences (ΔE) between sound and fluorotic areas were calculated and patient satisfaction was evaluated using a VAS (1-10). RESULTS: Statistical analysis revealed significant differences in the mean ΔE values 6 months after resin infiltration between the BLI (ΔE = 1.41) and the NBLI group (ΔE = 4.33) (p = 0.024). VAS values increased after resin infiltration (p < 0.05) in both groups. After 3 months patients in the BLI group had higher VAS values than in the NBLI group (p = 0.029). CONCLUSIONS: Findings of this study suggest that resin infiltration alone can effectively mask mild to moderate dental fluorosis in young adults. In-office bleaching with 25% H2O2 before resin infiltration provides significantly better masking effects. CLINICAL SIGNIFICANCE: Resin infiltration is a safe and efficient treatment option for masking fluorotic opacities. A priori in-office bleaching with 25% H2O2 enhances the masking effect. This controlled clinical trial is registered in the German Clinical Trials Register #DRKS00010465.

Protective Buffering Capacity of Restorative Dental Materials In Vitro.

PURPOSE: To investigate the buffering capacity of restorative materials during a simulated carious and intrinsic erosive attack. MATERIALS AND METHODS: Cavities with a volume of 130 µl were milled (Cerec MC XL) out of blocks of Ceram X Mono (CM), Quixfil (QX), Filtek Supreme (FS), Apa Fill 3 (AF), an experimental dual-curing composite containing a bioactive glass (EX), Dyract eXtra (DY), Beautifil (BE), Equia Fil (EQ), Telio CAD (TL) (negative control), TheraCal (TC; positive control), and extracted teeth (ED). 80 µl of lactic acid (pH 4.5) and hydrochloric acid (pH 2.6) were each pipetted into the cavities of two samples of each material. Change of pH in the solutions was measured continuously for 12 min using a calibrated pH electrode. RESULTS: CM, AF, and FS (final pH 3.0-3.2) neutralized hydrochloric acid to a significantly lesser extent than did BE, EQ, DY and QX (final pH 5.0-5.6) (p < 0.05, ANOVA Scheffé). The lactic-acid buffering capacity of CM, BE, and AF was equivalent (final pH 6.3-7.4) to that of ED (7.5), but was surpassed by FS (pH 8.0). pH values for EX and TC (final pH 9.2-11.3) increased significantly (p < 0.05) in response to both acids. CONCLUSIONS: Conventional restorative materials do not buffer better than human teeth. However, the experimental composite demonstrates that buffering against carious and intrinsic erosive acid attacks is technically feasible.

High-fluoride toothpaste: a multicenter randomized controlled trial in adults.

OBJECTIVE: The aim of this single - blind, multicenter, parallel, randomized controlled trial was to evaluate the effectiveness of the application of a high-fluoride toothpaste on root caries in adults. METHODS: Adult patients (n = 130, ♂ = 74, ♀ = 56; mean age ± SD: 56.9 ± 12.9) from three participating centers, diagnosed with root caries, were randomly allocated into two groups: Test (n = 64, ♂ = 37, ♀ = 27; lesions = 144; mean age: 59.0 ± 12.1; intervention: high-fluoride toothpaste with 5000 ppm F), and Control (n = 66, ♂ = 37, ♀ = 29; lesions = 160; mean age: 54.8 ± 13.5; intervention: regular-fluoride toothpaste with 1350 ppm F) groups. Clinical examinations and surface hardness scoring of the carious lesions were performed for each subject at specified time intervals (T0 - at baseline before intervention, T1 - at 3 months and T2 - at 6 months after intervention). Mean surface hardness scores (HS) were calculated for each patient. Statistical analyses comprised of two-way analysis of variance and post hoc comparisons using the Bonferroni-Dunn correction. RESULTS: At T0 , there was no statistical difference between the two groups with regard to gender (P = 0.0682, unpaired t-test), or age (P = 0.9786, chi-squared test), and for the overall HS (Test group: HS = 3.4 ± 0.61; CONTROL GROUP: HS = 3.4 ± 0.66; P = 0.8757, unpaired t-test). The anova revealed significantly better HS for the test group than for the control groups (T1 : Test group: HS = 2.9 ± 0.67; CONTROL GROUP: HS = 3.1 ± 0.75; T2 : Test group: HS = 2.4 ± 0.81; CONTROL GROUP: HS = 2.8 ± 0.79; P < 0.0001). However, the interaction term time-point*group was not significant. CONCLUSIONS: The application of a high-fluoride containing dentifrice (5000 ppm F) in adults, twice daily, significantly improves the surface hardness of otherwise untreated root caries lesions when compared with the use of regular fluoride containing (1350 ppm F) toothpastes.

The effect of undergraduate education in communication skills: a randomised controlled clinical trial.

PURPOSE: To determine whether students improve their communication skills as a result of supervised patient care and whether a newly implemented communication course could further improve these skills. METHOD: We conducted a randomised, controlled trial including all participants of the first clinical treatment course (n = 26) between October 2006 and February 2007. Randomisation was balanced by gender and basic communication skills. The test group practised dentist-patient communication skills in small groups with role-plays and videotaped real patient interviews, whereas the control group learned in problem-based workshops both on a weekly basis. Before and after the interventions (two group pre- and post-design) all students conducted two interviews with simulated patients. The encounters were rated using a 10-item checklist derived from the Calgary-Cambridge Observation Guide I. RESULTS: Repeated measures ANOVA (alpha = 0.05) showed a significant difference of the sum scores of the ratings between test and control group (P = 0.004). The participants educated in communication skills improved significantly (Delta = +14.9; P = 0.004), whereas in the control group no accretion of practical communication competence was observed (Delta = -3.9; P = 0.23). CONCLUSION: It could be demonstrated that solely interacting with patients during a clinical treatment course did not inevitably improve professional communication skills. In contrast, implementation of a course in communication skills improved the practical competence in dentist-patient interaction.

A triclosan-containing compomer reduces Lactobacillus spp. predominant in advanced carious lesions.

OBJECTIVES: To assess the antimicrobial effect of acid etching or a triclosan-containing compomer on the cultivable microflora of incompletely excavated dentinal carious lesions. METHODS: Thirty detinal lesions were opened with a diamond burr. Subsequent to removal of the softened biomass a sample of dentin was taken from the cavity floor with a round bur. Ten cavities each were treated with 36% phosphoric acid (PH) for 15s, covered with a triclosan-containing compomer (TC) or received no treatment as control (CO). All lesions were restored with a compomer composite. Sampling was performed directly after etching in the PH group and at re-entry after 6 weeks in all groups. Aliquots were plated on blood agar and selective media for Lactobacilli (Rogosa) and mutans Streptococci (MSB). Cultures were incubated anaerobically for 7 days at 37 degrees C prior to quantitative assessment and biotyping of the isolates. RESULTS: Application of phosphoric acid resulted in initial reduction of the totally cultivable microflora (p=0.006). Evaluation of the total number of cultivable microflora after 6 weeks revealed no differences between the groups (p>0.05). Lactobacilli counts were significantly lower in the TC group compared to the PH and CO groups (p<0.05). No difference was detected between the PH and CO groups after 6 weeks. SIGNIFICANCE: Phosphoric acid initially reduces the number of microorganisms in carious dentin but not in the longer term. The experimental triclosan composite suppresses Lactobacilli species over a period of 6 weeks.

Grey-scale reversed radiographic display in the detection of approximal caries.

OBJECTIVES: Purpose of this study was to determine the influence of grey-scale reversal of digital radiographic images on the detection of proximal caries. METHODS: Five observers assessed digital bitewing radiographs (Sidexis((R)), Sirona) of 320 unrestored surfaces of extracted posterior teeth embedded in 20 models, simulating pairing of maxillary and mandibular arches, using a six-category caries rating scale. Images were displayed in normal [N] and inverse [IN] mode at different image sizes (display ratio: 1:1, 1:2, 1:7) on a cathode-ray tube monitor (Nokia 446 XS) and a TFT display (Panasonic LC 50 S). Validation standard was defined as histological lesion depth. Validity was expressed as areas under receiver operating characteristic curves (AUC) calculated for two levels of histological caries penetration: presence of caries and presence of a dentine lesion. The factors 'inverse display', 'image size on-screen' 'display type' and 'disease cut-off' were analysed by repeated measures ANOVA. RESULTS: Inverse image display significantly influenced the diagnostic validity (P=0.014), but a reduced accuracy was only seen at the lowest image size (AUC (SE): [N] 0.64 (0.02); [IN] 0.62 (0.02)). At the validation threshold 'dentine caries' approximal caries detection deteriorated when using grey-scale reversal (AUC (SE): [N] 0.71 (0.02); [IN] 0.69 (0.02)). CONCLUSIONS: In conclusion, grey-scale reversal of digital radiographs did not optimise approximal caries detection and aggravated the detectability of dentinal lesions.

Suppression of caries-related microorganisms in dentine lesions after short-term chlorhexidine or antibiotic treatment.

This study investigated the efficiency of a chlorhexidine varnish and an antibiotic paste in suppressing the cultivable microflora of deep dentine cavities in a stepwise excavation procedure. Subsequent to enamel preparation and removal of the central biomass, infected dentine was sampled from the cavity floor. Ten cavities each were either covered with the 1% chlorhexidine- and 1% thymol-containing varnish Cervitec (CE), the demeclocycline hydrocortisone-containing ointment Ledermix (LE) or received no treatment as control (CO). A compomer composite was used as intermediate restorative. Cavities were reassessed after 6 weeks and again dentine samples were microbiologically investigated for total viable counts, mutans streptococci and lactobacilli. After 6 weeks a significant reduction of the total viable counts was observed in the LE group (p = 0.011) compared to the control, whereas no differences were found in the CE group (p > 0.05). Mutans streptococci were rarely recovered at baseline and after 6 weeks. Compared to the CO group counts of lactobacilli were significantly reduced in the CE and LE groups (p < 0.05). Lactobacillus species were frequently recovered at baseline and after 6 weeks of observation. Lactobacillus rhamnosus was the predominant species in all samples investigated. Application of CE or LE resulted in reduced counts of lactobacilli after a period of 6 weeks. Although none of the materials completely eliminated the viable microorganisms, the use of LE was more effective than CE in reducing the total anaerobic microorganisms associated with carious dentine.

Lesion orientated caries treatment--a classification of carious dentin treatment procedures.

PURPOSE: To review experimental and marketed techniques for the treatment of infected dentin as a potential substitute for conventional rotary excavation. MATERIALS AND METHODS: A hand and systematic search of Medline (via DIMDI) was performed. Additionally, manufacturers' data about relevant clinical studies were checked. After classification of the identified techniques described, relevant studies are cited to allow an overview of the different treatment options. RESULTS: Excavation, disinfection and sealing techniques for the treatment of infected dentin can be differentiated. Besides several mechanical approaches, chemo-mechanical excavation, enzymatic digestion and photo ablation are discussed. Disinfection techniques can be undertaken with even less invasive approaches like gasiform ozone application, photodynamic therapy or local application of antibacterial materials. Additionally, or alternatively, the sealing of carious dentin is discussed using fluoride-releasing cements, dentin adhesives or antibacterial resin materials. CONCLUSION: Although some of the techniques are still experimental and much clinical research has to be done, many different approaches are so promising, or already established, that hopefully the days of radical excavation with rotary instruments are numbered.

Treatment of root caries lesions with chlorhexidine-containing varnishes and dentin sealants.

PURPOSE: To evaluate the effects of chlorhexidine-containing varnishes and dentin sealants on the progress of demineralization, cariogenic bacteria and clinical appearance of root caries lesions. METHODS: 68 lesions in 22 adult patients, with a mean age of 51.3 +/- 13.8 years were enrolled in this study. After the removal of soft, infected dentin, all lesions were randomly sealed with (1.) Cervitec, used as control (CE), (2.) EC 40 (EC), (3.) Prime and Bond NT (PB) or (4.) Seal & Protect (SP). Clinical appearance, laser fluorescence diagnosis (DIAGNOdent) and bacteriological status were recorded at intervals of 1 and 3 months. RESULTS: Regarding alteration of surface texture and color of the lesions, differences between the groups were not detected. Application of EC resulted in suppressed MS counts after 3 months (P < 0.05). Initial lower MS counts were observed in the CE group (P = 0.053). Laser fluorescence values increased in the chlorhexidine groups (CE = 27.9 +/- 17.5, EC = 28.3 +/- 26.0) but remained stable in the sealant groups (PB = 15.1 +/- 22.0, SP = 10.2 +/- 7.3), (P < 0.05).

Marginal and internal adaptation of extended class I restorations lined with flowable composites.

OBJECTIVES: Cavity lining with flowable composites has been proposed to reduce interfacial stress due to its strain-absorbing capacity. The purpose of this in vitro study was to evaluate marginal and internal adaptation of large Class I restorations filled in bulk after cavity lining with flowable composites. METHODS: Forty standardised large Class I cavities with enamel margins not supported by dentin, were randomly assigned to four groups and either restored in bulk after lining with flowable composites or in two oblique layers of high-viscosity composites. Two adhesives and flowable resins were used: Tetric Ceram, Tetric Flow, Excite (Vivadent, Schaan, Liechtenstein) vs. Prodigy Condensable, Revolution, Optibond Solo (Kerr Co., Orange, CA, USA). Immediately after restorative procedure marginal quality and the internal restoration interface of two bucco-oral sections were quantitatively assessed by SEM using replica technique. RESULTS: Marginal gaps were almost not seen in all test groups (<0.001%), whereas marginal enamel fractures frequently occurred (>23%). No differences in marginal adaptation were detected for both application techniques if the same adhesive was used (ANOVA, Tukey, p<0.05). Lining with Revolution resulted in a significantly higher percentage of marginal continuity (MC) and less enamel fractures (EF) compared to Tetric Flow (MC: 73 vs. 45%; EF: 23 vs. 50%). Gaps at the inner interface were rarely observed (<0.05%). CONCLUSIONS: Large Class I restorations without dentin supported cavity margins showed a high amount of marginal enamel fractures directly after placement. Lining with Revolution proved to have the highest potential to initially maintain the marginal integrity.

Detection of marginal defects of composite restorations with conventional and digital radiographs.

The purpose of this study was to determine the validity of detecting approximal imperfections of composite fillings using three intraoral radiographic systems in vitro. Class II composite resin restorations (108) with three radiopacities (264, 306, 443% Al 99.5) of which 27 had marginal openings or overhangs, respectively, were conventionally (Ektaspeed plus) and digitally (Dexis, Digora) radiographed. Images were assessed by 10 observers for the presence of marginal gaps and overhangs, as well as for their need of restorative treatment according to a five-point confidence rating scale. The validity of the observations were expressed as areas under receiver operating characteristic (ROC) curves (Aroc). Repeated measures analysis of variance revealed significant effects of 'radiographic system' and 'diagnostic purpose'. Marginal overhangs (Aroc = 0.90) were significantly easier to diagnose than openings (Aroc = 0.63). Marginal gaps were better detected on conventional and Dexis radiographs than on Digora images. the range of sensitivities and specificities of the treatment decision was 0.53-0.56 and 0.87-0.88, respectively. It was concluded that the validity of detecting marginal defects of composite resin restorations based on radiographs was only slightly affected by the radiographic system being used. The diagnosis of marginal gaps frequently resulted in false-positive and false-negative decisions.

Intra- and interexaminer variability and validity of laser fluorescence and electrical resistance readings on root surface lesions.

The purpose of this study was to investigate the validity and reproducibility of laser fluorescence and electrical resistance readings on root carious lesions. One hundred and three freshly extracted human teeth with various forms of natural root caries were investigated by 6 operators using the laser fluorescence device DIAGNOdent (DD) and the Electronic Caries Monitor (ECM III). As a reference, a caries-free root area of each tooth was also examined. Specimens were classified as to colour, surface texture and cavitation depth. Teeth were sectioned through the centre of the lesion and prepared for polarising light microscopy. Histological depth of the lesions was defined as the distance between the surface and zone of translucency. Depths ranged from 0.1 to 3.1 mm. Statistical analysis of the interexaminer reproducibility revealed a significant correlation (Kendall's W) for DD measurements of 0.85 and 0.76 for ECM readings. Moderate correlation between the histological depth and DD (r(s) = 0.45) or ECM scores (r(s) = -0.48) could be demonstrated. Electrical resistance readings revealed a positive correlation (r(s) = 0.43) with the thickness of the remaining dentine, whereas this was negative for laser fluorescence readings (r(s) = -0.43). However, scatter plots suggested that most lesions had very low resistance. This investigation suggests that laser fluorescence and electrical conductance measurements can be obtained reproducibly by different operators and correlate moderately with histological lesion depth and remaining thickness of the dentine bridge.

The validity of proximal caries detection using magnifying visual aids.

The purpose of this study was to determine the validity of proximal caries detection supported by a prism loupe and a surgical microscope used by examiners having different professional experience. One hundred and sixty extracted premolars and molars with varying degrees of proximal caries or sound surfaces were embedded in 10 pairs of models with proximal tooth contacts and a simulated gingiva mask. The proximal surfaces were visually evaluated by 14 observers (7 students, 7 dentists) according to a 5-point caries rating scale using a head-worn prism loupe (x4.5), a surgical microscope (x 14) and without any magnifying device (control). The validity of observations was expressed as ROC curves calculated for two gold standard thresholds: (a) the presence of caries and (b) macroscopic cavitation. Repeated measures analysis of variance was used to determine the effects of 'observer group' and 'diagnostic modality'. An influence of the observer group could not be demonstrated (p > 0.72), whereas significant differences were revealed between the diagnostic modalities (p < 0.002). ROC areas of caries detection with magnifying aids were smaller compared to the control group. It was concluded that the use of a prism loupe or a surgical microscope does not improve the validity of proximal caries detection if the operators, irrespective of being dental students or clinical instructors, are inexperienced in its utilisation. In general only moderate validity was achieved with visual inspection of proximal sites.

Primary preparation of class II cavities with oscillating systems.

PURPOSE: To assess the effectiveness and side effects of three sonoabrasive systems and conventional rotary cavity preparation. MATERIALS AND METHODS: Standardized artificial carious lesions were placed in 48 human premolars at mesial and distal surfaces. Three dentists prepared eight cavities each using (1) diamond burs, (2) Sonicflex 2000 L/N (HS), (3) an experimental air scaler (HS.EXP), and (4) the Piezon Cavity System (PCS). A small hemispherical preparation tip (Sonicsys micro) was utilized with the airscalers in Groups 2 and 3. Loss of substance was determined by weighing. Residual caries and damage to the adjacent tooth were assessed by two calibrated investigators. Each cavity was digitally photographed prior to planimetrical measuring of its circumferential dimension. Quality of the cavities' margins was examined by SEM. RESULTS: Rotary preparation required less time (4 minutes 53 seconds) than oscillating preparation with HS (6 minutes 45 seconds) or PCS (7 minutes 45 seconds), (Scheffé, P< 0.05). Preparation with HS.EXP (5 minutes 52 seconds) was not different from rotary and HS. 64% of all cavities were completely excavated, 28% showed distinct and 8% marked residual caries. However, chi2-tests did not reveal differences in caries removal between the systems. Oscillating preparation with HS as well as the experimental air scaler in combination with the hemisphere resulted in less trauma to adjacent tooth surfaces than rotary preparation and the PCS system, (chi2-tests P< 0.05). HS.EXP caused less loss of substance (Scheffé, P< 0.05). Regarding circumferential extension of the cavities, there were no differences between the groups.