Understanding parental perspectives on young children's oral health (≤ 4 years) growing up in a disadvantaged neighbourhood of Amsterdam, the Netherlands: an exploratory study.

BACKGROUND: Families' understanding towards oral health problems among young children is poorly studied. More insight into parents' experiences, especially of those living in disadvantaged neighbourhoods, is needed to address persistent oral health inequalities. This qualitative study aims to explore parental perspectives on children's oral health (≤ 4 years) and the opportunities they see to improve children's oral health. METHODS: Forty-seven mothers and five fathers with different migration backgrounds from a disadvantaged neighbourhood in Amsterdam, the Netherlands, participated in our study. Semi-structured interviews (n = 27), participant observations (n = 7) and one focus group discussion were conducted. A thematic data analysis was used. RESULTS: Parents describe their daily life with young children as busy, hectic and unpredictable. Parents seem to be most concerned about parenting. Mothers, in particular, feel fully responsible for raising their children and managing daily complexities. While most parents value their children's oral health, they all experience challenges. Parents find it hard to limit daily candy intake and to handle unwilling children during tooth brushing. They feel limited support for these issues from their household, social network and professionals. CONCLUSION: Parental struggles in children's oral health are complex and interrelated as they occur across family, societal, community and professional levels. Given the complex daily reality of families with young children, establishing and maintaining healthy oral health habits seems not at the top of parents' minds. They ask for advice in the upbringing of their children backed up by social support, increased attention to children's oral health within the community and professional assistance. Collaborating with parents as knowledgeable partners might be the first step in acting upon the endeavour to address oral health inequality among young children.

Knowledge and management of molar-incisor hypomineralisation amongst dentists in The Netherlands.

BACKGROUND: Molar-incisor hypomineralisation (MIH) is a frequently encountered dental condition in the clinical setting, and correct diagnosis can influence management outcomes. AIM: To assess the knowledge of and attitudes towards the management of MIH amongst dentists in the Netherlands. DESIGN: The study was conducted as a cross-sectional web survey. The questionnaire used included questions regarding respondent characteristics, awareness, knowledge and management of MIH and was distributed through the Royal Dutch Association for Dentistry (KNMT) to a random sample of 900 dentists. Variables were analysed using descriptive statistics, and differences between distinct groups of dentists were tested using the chi-squared test. RESULTS: Respondents consisted of 76.6% general dental practitioners, 9.1% paediatric dentists and 14.3% differentiated (specialist) dentists, with a 25.6% overall response rate. The majority knew the term MIH and its clinical characteristics, and could distinguish MIH from other enamel defects. Regarding aetiological factors, 76.6% reported a genetic component. In an asymptomatic case, 47.3% reported non-invasive treatments. In a mild symptomatic case, treatments from non-invasive to invasive were reported (p < .05). In a severe symptomatic case, the majority reported invasive treatments. Two-thirds of respondents were interested in further clinical training about MIH. CONCLUSIONS: Most respondents knew the term MIH and its clinical characteristics and would like further clinical training about MIH.

2-year survival and cost analysis of occlusoproximal ART restorations using encapsulated glass ionomer cement in primary molars: a randomized controlled trial.

BACKGROUND: The survival of ART restorations can be influenced by the choice of the restorative material. The aim of this randomized non-inferiority controlled trial was to compare the 2-year survival rate and cost analysis of two encapsulated glass ionomer cements (GIC) as occlusoproximal restorative materials in primary molars. METHODS: Children from public schools in Tietê (Brazil), aged 4-8 years with occlusoproximal dentine carious lesions in primary molars were selected and randomly assigned to receive either Equia Forte (EF) or Riva Self Cure (RSC) as restorative materials. Treatment was carried out by two trained final-year dental students in schools following ART premises. Restorations were assessed by a trained and calibrated examiner after 2, 6, 12, 18, and 24 months. The primary outcome was restoration survival after 2 years, analyzed using Kaplan-Meier survival and Cox regression analysis (α = 5%). Professional and materials costs for each group were collected in Brazilian Reais (R$) and converted into US dollars (US$) and analyzed using Monte-Carlo simulation. RESULTS: A total of 152 children (76 per group) were included in the study, and 121 (79%) were evaluated after 2 years. The overall 2-year restoration survival rate was 39% (EF = 45%; RSC = 32%) with no difference between the groups. The baseline and 2-year total cost of restorations using RSC was lower when compared to EF (incremental cost: US$ 6.18). CONCLUSION: After two years of follow-up, Riva Self Cure shows comparable restoration survival rates to Equia Forte, being more cost-effective in the Brazilian perspective. TRIAL REGISTRATION: This randomized clinical trial was registered on ClinicalTrials.Gov - NCT02730000.

Professionals' perspectives on how to address persistent oral health inequality among young children: an exploratory multi-stakeholder analysis in a disadvantaged neighbourhood of Amsterdam, the Netherlands.

BACKGROUND: Oral health promotion interventions have had limited success in reaching families in disadvantaged neighbourhoods resulting in persistent oral health inequality. This qualitative study provides insight into professionals' perspectives on children's poor oral health (≤ 4 years), their perceptions of the roles and responsibilities, and opportunities for child oral health promotion strategies. METHODS: Thirty-Eight professionals from different domains (community, social welfare, general health, dental care, public health, private sector) working in a disadvantaged neighbourhood in Amsterdam, the Netherlands, participated through 24 semi-structured (group) interviews. Transcripts and notes were analysed through thematic analysis. RESULTS: Professionals indicate that unhealthy diet, children's non-compliance, poor parental coping, parental low oral health literacy, parent's negative attitude, family's daily struggles, and insufficient emphasis on childhood caries prevention in dental practices, general healthcare and social welfare organisations, underlie poor oral health. They hold parents most responsible for improving young children's oral health, but recognise that families' vulnerable living circumstances and lack of social support are important barriers. Interestingly, non-dental professionals acknowledge their beneficial role in child oral health promotion, and dental professionals stress the need for more collaboration. CONCLUSION: A broad child-, parental-, and societal-centred educational communication strategy is perceived as promising. Professionals working within and outside the dental sector acknowledge that local and collective action is needed. This involves a better understanding of family's complex daily reality. Furthermore, intensifying child oral health knowledge in dental practices is essential in collaboration with families, general health and social welfare organisations.

Atraumatic Restorative Treatment-Sealed versus Nonsealed First Permanent Molars: A 3-Year Split-Mouth Clinical Trial.

To investigate the efficacy of atraumatic restorative treatment (ART) sealants vs. no sealant in preventing the development of dentine caries lesions in first permanent molars over a period of 3 years. A total of 187 schoolchildren (aged 6-8 years) from a low-income population presenting the 4 first permanent molars without clinically detectable dentine caries lesions were selected to be part of a split-mouth clinical trial. All 4 first permanent molars were investigated in this trial and the children's mouth was split vertically into left and right sides; therefore, 2 molars were randomly allocated to receive ART sealants, while the other 2 molars remained nonsealed. All children received toothbrushing instructions and dietary advice every 6 months for a period of 3 years. Clinical evaluations were performed after 3, 6, 12, 18, 24, and 36 months and both sealant retention and dental caries were scored. Kaplan-Meier survival analysis, log-rank test, and Cox regression with shared frailty analysis were performed. A cavitated dentine caries lesion was considered a failure. The cumulative survival rates of dentine cavity-free first permanent molars were 90% for ART-sealed molars and 90.8% for nonsealed molars, with no statistically significantly difference between sealed and nonsealed molars (p = 0.70). The retention of sealants was not associated with the development of cavitated dentine caries and children presenting a higher baseline caries experience had greater chances of developing dentine lesions. In conclusion, the application of ART sealants was not more efficacious than nonsealing in reducing the development of dentine cavitated lesions in first permanent molars.

The effect of pulp inflammation and premature extraction of primary molars on the successor permanent teeth. A retrospective study.

BACKGROUND: Untreated caries on primary molars often leads to pulp inflammation and extraction. AIM: To retrospectively investigate the effect of pulp inflammation and extraction of primary molars on their successors regarding alignment in the dental arch and developmental enamel defects (DED). DESIGN: The participants in this study were children at public schools in Petropolis (Brazil), who participated in a 3-year longitudinal clinical trial. Children (N = 44) were selected for the present study if they had at least one erupted premolar of which the predecessor primary molar presented pulp inflammation at baseline or during any of the 6-month follow-up assessments. All premolars were examined for DED and misalignment. Distinction was made between extraction performed before (E <8) or after the age of 8 years (E ≥8). Distinction was also made between pulp inflammation occurred before (P < 7) or after the age of 7 years (P ≥ 7). A logistic regression analysis was performed, and the odds ratio was calculated. RESULTS AND CONCLUSIONS: Misalignment occurred more frequently in E <8 as compared to E ≥8 (OR = 2.85; P = .03). There was no significant difference in DED between P < 7 and P ≥ 7. CONCLUSION: Misalignment of premolars occurs more frequently when the predecessor primary molars are extracted before the age of 8 years.

Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting.

BACKGROUND: Atraumatic Restorative Treatment (ART) and the Hall Technique (HT) are both minimally invasive, non-aerosol generating procedures (non-AGPs). They seem to have never been directly compared, nor has the HT been studied in a non-clinical setting. This study compared the HT and ART restorations placed in a school setting after 36 months. METHODS: Children (5-10 yo) who had a primary molar with a dentinal occluso-proximal, cavitated carious lesion were allocated to the ART (selective removal) or HT arms. PRIMARY OUTCOME: restoration survival over 36-months (using Kaplan-Meier survival analysis, log rank test, and Cox regression). SECONDARY OUTCOMES: (1) occlusal vertical dimension (OVD) (1, 2, 3, 4 weeks) and (2) child self-reported discomfort; (3) treatment acceptability (immediately following interventions); (4) Child Oral Health Related Quality of Life (OHRQoL), before treatment and after 6 months and (5) a post hoc analysis of time to tooth exfoliation (1, 6, 12, 18, 24, 30, 36 months). RESULTS: One-hundred and thirty-one children (ART = 65; HT = 66) were included (mean age = 8.1 ± 1.2). At 36 months, 112 (85.5%) children were followed-up. PRIMARY OUTCOME: restoration survival rates ART = 32.7% (SE = 0.08; 95% CI 0.17-0.47); HT = 93.4% (0.05; 0.72-0.99), p < 0.001; Secondary outcomes: (1) OVD returned to pre-treatment state within 4 weeks; (2) treatment discomfort was higher for the HT (p = 0.018); (3) over 70% of children and parents showed a high acceptability for treatments, with crown aesthetics being a concern for around 23% of parents; (4) Child OHRQoL improved after 6 months; and (5) teeth treated with the HT exfoliated earlier than those in the ART group (p = 0.007). CONCLUSIONS: Both ART and the HT were acceptable to child participants and their parents and all parents thought both restorations protected their child's tooth. However, the crown appearance concerned almost a quarter of parents in the HT arm. Children experienced less discomfort in the ART group. Although both treatments can be performed in a non-clinical setting and have the advantage of being non-aerosol generating procedures (non-AGPs), the HT had almost three times higher survival rates (93.4%) for restoring primary molar occluso-proximal cavities compared to ART (32.7%). TRIAL REGISTRATION: This trial was registered in ClinicalTrials.gov (NCT02569047), 5th October 2015. https://clinicaltrials.gov/ct2/show/study/NCT02569047?cond=Hall+Technique+Atraumatic+Rest orative+Treatment&draw=2&rank=2.

Glass carbomer and compomer for ART restorations: 3-year results of a randomized clinical trial.

OBJECTIVE: To evaluate the survival of atraumatic restorative treatment (ART) restorations using high viscosity glass ionomer cement (GIC), compomer (COM), and glass carbomer (CAR) for occlusal and occlusoproximal cavitated dentin caries lesions in primary molars. METHODS: A total of 568 4-7-year-old children (287 occlusoproximal and 281 occlusal cavities) were selected in Barueri, Brazil. The patients were randomly allocated in three groups: GIC, COM, and CAR. All treatments were performed on school setting following ART premises. Evaluations were performed after 2, 6, 12, 18, 24, and 36 months. Restoration survival was evaluated using Kaplan-Meier survival analysis and log-rank test, while Cox regression analysis was used for testing association with clinical factors (α = 5%). RESULTS: The overall survival rate after 3 years of occlusal ART restorations was 73% (GIC = 83%; COM = 78%; CAR = 62%) and 49% for occlusoproximal ART restorations (GIC = 56%; COM = 56%; CAR = 36%). CAR restorations were less successful than GIC and COM for both occlusal and occlusoproximal restorations (p < 0.05). No difference was found between GIC and COM (p > 0.05). CONCLUSIONS: GIC and compomer are clinically more successful than CAR for occlusal and occlusoproximal restorations in primary molars. CLINICAL SIGNIFICANCE: Both compomer and high viscosity glass ionomer cement are suitable materials for ART in primary molars. However, glass carbomer cement should not be used for ART (#NCT02217098).

Caries lesion prevention and arrestment in approximal surfaces in contact with glass ionomer cement restorations - A systematic review and meta-analysis.

BACKGROUND: Studies have suggested that in the presence of approximal cavities, the approximal surface in contact with this one shows a higher risk in the development of caries lesions. AIM: To evaluate the ability of dental materials to prevent and to arrest caries lesion in approximal surfaces in contact with occlusoproximal restorations. DESIGN: Two independent reviewers performed a literature search in PubMed through November 2014. The inclusion criteria were: (1) subject related to the scope of this systematic review, (2) study with follow-up, (3) not performed in specific groups, (4) to have a comparison group. After selection by title and abstract, potentially eligible articles were read in full. Meta-analysis was carried out considering the outcome as caries lesion progression or arrestment. RESULTS: The search strategy identified 772 potentially relevant studies, and 10 of them were included in the review (six laboratory studies and four longitudinal trials). For the longitudinal clinical trials, no difference was verified among the materials (OR = 0.680,95%CI:0.233-1.983). When a meta-analysis was performed for laboratory studies, GIC was significantly associated with better ability to arrest caries lesions (OR = 0.153,95%CI:0.060-0.391). CONCLUSIONS: In laboratory studies, GIC shows better ability to arrest caries lesion in approximal adjacent surfaces, but this ability was not confirmed in longitudinal clinical trials.

Bilayer technique and nano-filled coating increase success of approximal ART restorations: a randomized clinical trial.

BACKGROUND: The high-viscosity consistency of glass ionomer cement (GIC) may lead to its incorrect adaptation into the cavity and therefore to restoration failure. AIM: To compare two different insertion techniques for GIC in approximal atraumatic restorative treatment (ART) restorations and two different surface protection materials. DESIGN: Approximal caries lesion in primary molars from 208 schoolchildren was randomly assigned into four groups: G1, conventional GIC insertion protected with petroleum jelly (PJ); G2, bilayer technique protected with PJ; G3 conventional GIC insertion protected with nano-filled particles coating for GIC (NPC); G4, bilayer technique protected with NPC. Restorations were evaluated after 1, 6, 12, 18, 24, and 36 months. Kaplan-Meier survival analysis and log-rank test were performed. Cox regression analysis (α = 5%) was used to verify the influence of clinical factors. RESULTS: Restoration survival was 52.8%. Log-rank test indicated a better survival of the bilayer technique restorations, compared to conventional restorations (P = 0.005), whereas the coated conventional restorations presented higher survival than the uncoated ones (P = 0.035). Cox regression analysis showed no influence of any clinical tested variables. CONCLUSION: The survival rate of the approximal ART restorations is positively influenced by the bilayer technique, and the application of nano-filled coating increases the longevity of the conventional approximal ART restorations.

Sealing versus partial caries removal in primary molars: a randomized clinical trial.

BACKGROUND: The resin-based pit and fissure sealant is considered a successful tool in caries prevention, however there is a growing evidence of its use in controlling already established caries in posterior teeth. The aim of this clinical trial is to verify the efficacy of pit and fissure sealants in arresting dentinal caries lesions compared to partial excavation and restorative treatment in primary molar teeth. METHODS: Thirty six patients with occlusal cavitated primary molar reaching outer half of dentin were selected. The patients were randomly allocated into two groups: sealant application (experimental group - n = 17) and restoration with composite resin (control group - n = 19). Clinical and radiograph evaluation were performed after 6, 12 and 18 months. The chi-square test was used to verify the distribution of characteristics variables of the sample among the groups. The survival rate of treatments was evaluated using Kaplan-Meier survival and log-rank test. Fisher's Exact and logistic regression tests were calculated in each evaluation period (α = 5%). RESULTS: The control group showed significantly better clinical survival after 18 months (p = 0.0025). In both groups, no caries progression was registered on the radiographic evaluations. CONCLUSIONS: Sealing had similar efficacy in the arrestment of caries progression of cavitated occlusal lesions compared to partial excavation of the lesions, even though the frequency of re-treatments was significantly higher in sealed lesions. TRIAL REGISTRATION: Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-9kkv53.

Effect of erosive conditions on different sealant materials used in paediatric dentistry.

To evaluate the effect of acidic challenge on erosion depth and topographic characteristics of different materials used as occlusal sealants. Two hundred specimens of five sealant materials (Fuji IX, Ketac Molar, Fuji II, Equia and Clinpro) and forty bovine teeth enamel samples (control) were prepared and exposed to acidic challenge. The specimens were immersed in four different solutions (orange juice, coke drink, citric acid or distilled water) under mildly shaken conditions for 3 days. The erosion depth profiles were measured using a profilometer and Scanning Electron Microscope (SEM). Two-way ANOVA with Tukey post-hoc test was performed to evaluate the interactions. Sealant material and acidic challenge had significant effects on erosion depth. Among the materials, Fuji II presented the highest mean of erosion depth after immersion in orange juice, coke drink, and citric acid. All materials groups presented higher erosion depth values after immersion in the citric acid solution, except Clinpro. Bovine enamel presented higher erosion depth values compared to all materials when submitted to erosive challenge. Sealant materials submitted to the acidic challenge presented different degrees of erosion and topographic modification; however, they are less susceptible to erosion than bovine teeth enamel.

Survival rate of approximal-ART restorations using a two-layer technique for glass ionomer insertion.

OBJECTIVE: Good survival rates (SR) have been reported for occlusal-atraumatic restorative treatment (ART) restorations but not for approximal-ART restorations. The high-viscosity consistency of the glass ionomer cement (GIC) may lead to its incorrect adaptation into the cavity and thus to failure of the restoration. Because the use of a flowable GIC layer seemed to improve its adaptation in approximal restorations in vitro, we evaluated whether the use of an intermediate flowable GIC layer would improve the SR of approximal-ART restorations. METHODS: A total of 208 children (6-7 years old) with at least one occluso-proximal carious lesion in a primary molar were selected and randomly allocated to two groups: G1, conventional technique, one-layer GIC (powder/liquid ratio 1:1); and G2, two-layer technique, consisting of a first layer of GIC with a flowable consistency (powder/liquid ratio 1:2) and a second layer of a regular consistency. Restorations were made by final-year students and evaluated after 1, 6, 12 and 18 months. Restoration survival was evaluated using Kaplan-Meier survival and logrank test. Poisson regression analyses (α = 5) were used to verify the influence of factors such as insertion technique, restoration surface and operators. RESULTS: The overall SR of the restorations after 18 months was 68 %. There was no difference in SR between the techniques, neither did the other factors influence the SR. CONCLUSIONS: Over 18 months, the use of an intermediate flowable GIC layer in approximal-ART restorations does not improve the restoration survival. CLINICAL RELEVANCE: This study suggests that the two-layer technique is not the answer for increasing approximal-ART restoration longevity.

The effect of GIC-brand on the survival rate of proximal-ART restorations.

BACKGROUND: Laboratory studies show diverse behaviour of different brands of glass-ionomer cements (GIC). AIM: This study investigated the clinical performance [survival rate (SR)] of three GIC brands applied to proximal atraumatic restorative treatment (ART) restorations. Additionally, the SR of the tooth was evaluated. DESIGN: Proximal cavities of 262 primary molars were restored. The patients had been randomly allocated to two operators and three GIC brands: Fuji IX, Hi-Dense, and Maxxion R. Restorations were evaluated after 1, 6, 12, 18, 24, 30, and 36 months. Failed restorations were, if possible, repaired or replaced. Linear regression analyses were used to evaluate the effect of GIC brand, operator, and surface of restoration. Kaplan-Meier survival analysis and log-rank test were performed for both restoration survival and tooth survival (α = 5%). RESULTS: After 3 years, 82.4% of the restorations were evaluated. The SR of the restorations was 24.4%, and there was no difference among GIC brands (log-rank test, P = 0.6). In the first 18 months, a significant operator effect and significantly higher failures in distal surfaces were found. The SR of the tooth was 81.7%. CONCLUSIONS: The SR of proximal ART restorations was relatively low when compared with the SR of the tooth. There are no differences in the performance among the GIC brands used in the study.

A preliminary clinical trial using flowable glass-ionomer cement as a liner in proximal-ART restorations: the operator effect.

OBJECTIVES: This in vivo study was carried out to assess the influence of the operator experience on the survival rate of proximal-ART restorations using a two-layer technique to insert the glass-ionomer cement (GIC). STUDY DESIGN: Forty five proximal cavities in primary molars were restored in a school setting according to the ART technique. The cavities were restored by two operators with Ketac Molar Easymix, and received a flowable layer of GIC prior to a second GIC layer with a regular consistency. The operators had different clinical experiences with ART (no experience or two years of experience), but both completed a one-week training to perform the restorations and the GIC mixing in this study. RESULTS: After a 12-month follow-up, 74% of the restorations survived; the main reason for failure was bulk fracture or total loss of the restoration.There was no operator influence (long-rank test p=0.2) CONCLUSION: The results encourage future well designed controlled clinical trials using the two-layer technique for insertion of GIC in proximal-ART restorations, after training the operators.

Compomers for the restorative treatment of dental caries in primary teeth: An umbrella review.

OBJECTIVES: This umbrella review comprehensively appraised the evidence on the use of compomers in comparison to other dental filling materials for restorative treatment of decayed primary teeth. DATA: The literature search was conducted based on the question: "Is the use of compomers as a dental filling material more successful in the restorative treatment of decayed primary teeth than other dental filling materials?" No language restriction was applied and systematic reviews published up to May 2023 were included. The ROBIS tool was used to assess the methodological quality of the included systematic reviews. Data were extracted for narrative synthesis, considering the restoration failure/success outcomes. SEARCH: Online search was conducted in three databases (PubMed/Medline, Embase and Cochrane library). STUDY SELECTION: The electronic search yielded a total of 779 publications. Finally, 18 systematic reviews were included in this umbrella review. Four systematic reviews presented a low risk of bias, 11 presented an unclear risk of bias and three presented a high risk of bias. Most systematic reviews presenting low risk of bias reported no difference in the success rates of compomers compared to other dental filling materials used for restoration of decayed primary teeth. Studies that found a significant difference or that made clear recommendations towards the use of compomers were commonly rated with a high risk of bias. CONCLUSION: Compomers are similar to other dental filling materials for the placement of direct restorations in primary teeth. CLINICAL SIGNIFICANCE: The results of this umbrella review indicate a similar clinical performance of compomers compared to other materials containing a resin component for direct restoration in primary teeth. Therefore, the choice of restorative material will depend on multiple factors, such as clinician's skills/preferences, patients' wishes, costs, and cavity type/location.

An International Investigation of Molar Incisor Hypomineralisation (iMIH) and Its Association with Dental Anomalies: Development of a Protocol.

BACKGROUND: Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations. METHODS: Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7-16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics. CONCLUSION: This large-scale study has the potential to improve understanding about MIH with benefits for patient management.

Coating glass-ionomer cements with a nanofilled resin.

OBJECTIVES: The objective of this study was to investigate the effect of a nanofilled resin coat on the flexural strength (FS) and the early wear (after 50,000 and 200,000 cycles) of the glass-ionomer cements Fuji IX GP Extra (FIXE) and Ketac Molar Aplicap (KM). MATERIALS AND METHODS: Specimens were prepared and half of them were coated with G-Coat plus. The uncoated specimens were used as controls. Flexural strength (n = 10) was evaluated after 24 h using a 3-point bending test on a universal testing machine (ISO 9917-2). Wear (n = 20) was evaluated after 50,000 and 200,000 cycles using the ACTA wear machine. One-way, two-way ANOVA and Tukey post-hoc tests were used to analyze differences in FS and wear. RESULTS: For FIXE the coat significantly increased the FS and the wear along the two time spans. KM did not show a significant difference in FS with the coat. Improvements in wear were observed only after 50,000 cycles. CONCLUSION: Based on these laboratory results, it is concluded that G-coat Plus is indicated in association with GP IX Extra with the aim to improve the mechanical properties of the former. However, this study is limited to a short-term observation.

Micro-mechanical bond strength tests for the assessment of the adhesion of GIC to dentine.

BACKGROUND: The aim of this study is to critically evaluate the bond strength (BS) of Glass-Ionomer Cements (GIC) to dentine with microtensile (µTBS) and microshear (µSBS) BS tests by assessing their rankings and failure patterns. METHODS: Samples were made on flat dentine surfaces and submitted to µTBS and µSBS. The materials used were: high viscosity GIC (Ketac™ Molar Aplicap-KM), resin-modified GIC (Fuji II-FII), nano-filled resin-modified GIC (Ketac™ N100-N100) and an etch-and-rinse adhesive system with a composite resin (Adper™ Single Bond 2 and Z100™-Z100). All tests were performed with a Universal Testing Machine (24 h water storage, crosshead speed of 1 mm/min). Debonded surfaces were examined with a stereomicroscope (×40) to identify the failure mode. The data was analyzed with two-way ANOVA (p < 0.05) and LSD test. RESULTS: Means were statistically different regarding the tests and materials, indicating that values for BS obtained for each material depend on the test performed. Failure analysis revealed that failures produced by µTBS were mainly cohesive for KM and FII. µSBS failures were mainly adhesive or mixed for all materials. For the µTBS, the rank was Z100 > FII > KM = N100, whereas for the µSBS it was Z100 = FII = KM > N100. CONCLUSION: It may be concluded that distinct micro-mechanical tests present different failure patterns and rankings depending on the material to be considered.

Two-Year Split-Mouth Randomized Controlled Clinical Trial on the Progression of Proximal Carious Lesions on Primary Molars After Resin Infiltration.

Purpose: The purpose of this split-mouth, randomized, controlled clinical trial was to assess the progression of early proximal carious lesions on primary molars after resin infiltration. Methods: Twenty-eight children presenting two primary molars with proximal carious lesions detected radiographically (on the outer half of the enamel up to the outer one-third of dentin) were included. Baseline assessments consisted of standard digital bitewing radiographs, Visual Plaque Index (VPI), Gingival Bleeding Index (GBI), and visual examination of caries. Proximal lesions were randomly allocated into two groups: (1) resin infiltration (test) and (2) no infiltration (control). Reassessments were performed after two years. Lesion progression was considered when the radiographic score increased. Results: A significant difference in lesion progression was observed between test (54.1 percent) and control (79.2 percent) groups after two years (McNemar's test, P=0.03). Logistic regression for matched pairs showed that the test group had an 82 percent lower risk of caries progression (odds ratio equals 0.18, 95%CI 0.29 to 0.31). Conclusions: Infiltrating proximal lesions decreases radiographic caries progression in primary molars after a two-year follow-up period.