Which are the clinical consequences of Molar Incisor hypomineralization (MIH) in children and adolescents? Systematic review and meta-analysis.

OBJECTIVE: This systematic review was conducted to address the following research question: "What are the clinical consequences (outcome) of Molar Incisor Hypomineralization (MIH) (exposure) in children and adolescents (population/patient)?". MATERIAL AND METHODS: After defining the strategy, a search was performed in different databases (MEDLINE via Pubmed, Cochrane Library, BBO, LILACS, Scopus, Web of Science, Embase) and Grey literature in August 2023. Cross-sectional observational studies that identified clinical consequences of MIH (dental caries, post-eruptive structural loss, atypical restorations, hypersensitivity and tooth extraction) were included. The risk of bias was assessed following the Joanna Briggs Institute protocol for cross-sectional studies. Meta-analyses were conducted for each outcome, taking into account the number of patients and teeth. The effect measure considered was the prevalence; random-effects model was adopted. Heterogeneity was assessed using I2 statistics and prediction intervals (PI). RESULTS: A total of 903 studies were identified; 41 were selected for qualitative analysis and 38 for quantitative analysis. Twenty eight studies were classified as presenting uncertain risk of bias, 11 as low risk and 3 as high risk of bias. The prevalence levels, ranked from highest to lowest and considering the tooth and patient units, respectively, were: caries lesions (0.252 - 95% CI 0.158-0.375; 0.512 - 95% CI 0.385-0.639); hypersensitivity (0.286 - 95% CI 0.190-0.407; 0.417 - 95% CI 0.197-0.674), post-eruptive fracture (0.125 - 95% CI 0.099-0.158; 0.257 - 95% CI 0.145-0.412); atypical restorations (0.048 - 95% CI 0.030-0.077; 0.167 - 95% CI 0.096 - 0.274); tooth extraction (0.012 - 95% CI 0.007-0.019; 0.090 - 95% CI 0.019 - 0.331). All meta-analyses resulted in heterogeneity greater than 85%, with the exception of the outcome "tooth extraction" according to the tooth unit (I2 = 57.83). This heterogeneity may be attributed to factors such as differences in the location where the study was realized, the socioeconomic conditions of the studied population, the asymmetric nature of MIH, and patient age. CONCLUSION: The most common consequences of MIH are caries lesions, hypersensitivity, and post-eruptive breakdown. (PROSPERO:CRD42020201410).

Genetic polymorphisms associated with developmental defects of enamel: A systematic review.

BACKGROUND: Polymorphisms in genes related to enamel formation and mineralization may increase the risk of developmental defects of enamel (DDE). AIM: To evaluate the existing literature on genetic polymorphisms associated with DDE. DESIGN: This systematic review was registered in the PROSPERO (CRD42018115270). The literature search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and in the gray literature. Observational studies assessing the association between DDE and genetic polymorphism were included. The Newcastle-Ottawa Scale was used to assess the risk of bias. RESULTS: One thousand one hundred and forty-six articles were identified, and 28 met the inclusion criteria. Five studies presented a low risk of bias. Ninety-two genes related to enamel development, craniofacial patterning morphogenesis, immune response, and hormone transcription/reception were included. Molar-incisor hypomineralization (MIH) and/or hypomineralization of primary second molars (HPSM) were associated with 80 polymorphisms of genes responsible for enamel development, immune response, morphogenesis, and xenobiotic detoxication. A significant association was found between the different clinical manifestations of dental fluorosis (DF) with nine polymorphisms of genes responsible for enamel development, craniofacial development, hormonal transcription/reception, and oxidative stress. Hypoplasia was associated with polymorphisms located in intronic regions. CONCLUSION: MIH, HPSM, DF, and hypoplasia reported as having a complex etiology are significantly associated with genetic polymorphisms of several genes.

Patient-related outcomes of conventional impression making versus intraoral scanning for prosthetic rehabilitation: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Intraoral scanning has been reported to be preferred by patients over conventional impression making. Nevertheless, information regarding patient-related outcomes for conventional impression making and digital scanning is sparse. PURPOSE: The purpose of this systematic review and meta-analysis was to analyze patient-related outcomes of intraoral scanning and conventional impression methods. The primary outcomes evaluated were patient preference and satisfaction, and the secondary outcomes discomfort, nausea, unpleasant taste, breathing difficulty, pain, and anxiety. MATERIAL AND METHODS: Electronic and manual searches were performed for clinical trials that evaluated patient-related outcomes for intraoral scanning and conventional impression making for prosthetic rehabilitation. The Cochrane Collaboration risk of bias tool and Newcastle-Ottawa scale were used to assess the quality of the studies. Random-effects models using mean difference were used for meta-analyses. Heterogeneity was assessed using the Cochran Q test and I2 statistics (α=.05). RESULTS: The search strategy identified 1626 articles, and 11 studies were included in the meta-analyses. Patients preferred intraoral scanning to conventional impression making. The mean difference for patient preference was 15.02 (95% confidence interval of 8.33 - 21.73; P<.001). Discomfort, absence of nausea, absence of unpleasant taste, and absence of breathing difficulty were also significantly different (P<.05). CONCLUSIONS: Intraoral scanning is a suitable alternative to conventional impression procedures, promoting less discomfort for patients sensitive to taste, nausea, and breathing difficulty than when conventional impression making techniques are used.

Tooth abnormalities associated with non-syndromic cleft lip and palate: systematic review and meta-analysis.

OBJECTIVE: To evaluate the association between orofacial clefts (OFC) and tooth abnormalities (TA). METHODS: We searched PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and BBO, and in the gray literature and selected observational studies that evaluated the association between TA and OFC. The risk of bias was analyzed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed comparing the presence and absence of OFC, cleft type-cleft palate (CP) and cleft lip with or without palate (CL/P)-and cleft laterality-unilateral and bilateral. The certainty of evidence was evaluated using the GRADE approach. RESULTS: A total of 99 studies were included in the qualitative analysis, and 37 were included in the meta-analysis. Only four studies were classified as low risk of bias. Significant associations were observed between the presence of OFC and tooth agenesis (OR = 19.46; 95%CI = 4.99-75.96), supernumerary teeth (OR = 4.04; 95%CI = 1.26-12.99), developmental defects of enamel (OR = 3.15; 95%CI = 1.28-7.80), microdontia (OR = 15.57; 95%CI = 1.06-228.51), and taurodontism (OR = 1.74; 95%CI = 1.74-2.86). Individuals with CP had a lower frequency of supernumerary teeth (OR = 0.22; 95%CI = 0.08-0.64), peg-shaped tooth (OR = 0.31; 95%CI = 0.12-0.80), and morphological TA (OR = 0.13; 95%CI = 0.04-0.45) than individuals with CL/P. No TA was significantly associated with cleft laterality (p > 0.05). The quality of the evidence was very low in all analyses. CONCLUSION: Individuals with OFC had a higher frequency of TA than those without OFC. Individuals with CP had a lower frequency of TA than individuals with CL/P. No TA was associated to cleft laterality. CLINICAL RELEVANCE: Help to identify the treatment needs of individuals affected by OFC, improving the services provided to this population.

Do tooth-supported zirconia restorations present more technical failures related to fracture or loss of retention? Systematic review and meta-analysis.

OBJECTIVES: This systematic review was performed to determine the main cause of technical failure of tooth-supported zirconia crowns and fixed partial dentures (FPDs), categorizing them as fracture/chipping or loss of retention/decementation. MATERIALS AND METHODS: Electronic and manual searches were performed for randomized clinical trials, prospective clinical trials, and prospective cohort studies that reported the technical failure rates of zirconia restorations. The Cochrane Collaboration risk-of-bias tool and Newcastle-Ottawa scale were used to assess the quality of the studies. RESULTS: Fifty-two studies were included and most of them had unclear risk of bias. Considering all reported fractures/chipping, for veneered crowns with 1 to 3 years of follow-up, the relative risk (RR) of fracture in relation to loss or retention was 3.95 (95% CI 1.18-13.23; p = 0.03). For 4 to 6 years of follow-up, the RR was 5.44 (95% CI 1.41-20.92; p = 0.01). For veneered FPDs with 1 to 3 years of follow-up, the RR was 5.98 (95% CI 2.31-15.01; p = 0.0002). For 4 to 6 years of follow-up, the RR was 3.70 (95% CI 1.63-8.41; p = 0.002). For 7 years or more of follow-up, the RR was 3.45 (95% CI 1.84-6.46; p = 0.0001). When only framework fractures were considered, there were no significant differences for the RR in all follow-up periods (p > 0.05). CONCLUSIONS: Higher RR for fracture/chipping in relation to decementation for veneered zirconia crowns and FPDs at all follow-up times. For framework fractures, no difference was observed between the risk of failure of the restoration due to fracture or decementation. CLINICAL RELEVANCE: Zirconia crowns and FPDs showed relatively high success and survival rates. However, considering the technical failures, there is approximately four times higher chance of fracture/chipping than loss of retention for both single and multi-unit tooth-supported veneered zirconia restorations.

How is the quality of the available evidence on molar-incisor hypomineralization treatment? An overview of systematic reviews.

OBJECTIVE: This overview analyzed the quality of the systematic reviews (SRs) available on treatments for molar-incisor hypomineralization (MIH). MATERIAL AND METHODS: Six electronic databases were searched (PubMed/MEDLINE, Scopus, Web of Science, LILACS, Brazilian Bibliography of Dentistry and Cochrane Library) until March 2022. Two reviewers independently performed the selection, the quality assessment (Assessment of Multiple Systematic Reviews 2 - AMSTAR-2), and the risk of bias assessment of the SR (Risk of Bias in Systematic Reviews - ROBIS). RESULTS: Two hundred nine records were retrieved; after removing duplicates and applying the inclusion/exclusion criteria, 5 SRs remained. Three SRs were rated as showing critically low methodological quality and high risk of bias, and two were rated as moderate methodological quality and low risk of bias. The identified treatments that may be suitable for MIH were classified as (1) non-invasive - casein incorporated into toothpaste and sugar-free chewing gum, toothpaste containing arginine, 0.4% stannous fluoride gel; fluoride varnish; (2) micro-invasive - resin sealants for pits and fissures, microabrasion, dental whitening, resin infiltration; (3) invasive - ART restorations, indirect restorations (metal, composite, or ceramic); and (4) mixed intervention - stainless steel crowns. CONCLUSION: Despite the considerable number of published papers included in this set of systematic reviews, the evidence supporting the effectiveness of treatments for treating MIH is limited due to the methodological quality and risk of bias of the systematic reviews, as well as the quality of the primary studies (PROSPERO: CRD42020144831). CLINICAL RELEVANCE: Different treatments have been purposed for MIH treatment, but there is still not enough scientific evidence of good quality for the establishment of a definitive clinical protocol for the treatment of MIH.

Is the clinical performance of composite resin restorations in posterior teeth similar if restored with incremental or bulk-filling techniques? A systematic review and meta-analysis.

OBJECTIVES: A systematic review was performed to analyze the clinical performance of class I and II restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The primary outcome was retention/fracture rate, and the secondary outcomes evaluated were anatomical form, surface texture, color match, marginal adaption, marginal discoloration, caries, and postoperative sensitivity. METHODS: Electronic and manual searches were performed for randomized clinical trials comparing the clinical performance of composite resin restorations in posterior teeth placed with the incremental or the bulk-filling techniques. The Cochrane Collaboration risk of bias tool was used to assess the quality of the studies and the GRADE tool was used to access the quality of the evidence. RESULTS: Fourteen studies were included in this systematic review and most of them had unclear risk of bias. The risk difference (RD) for retention/fracture was 0.00 (95%CI = - 0.01, 0.01; p = 0.86) for 1-1.5 years of follow-up; 0.00 (95%CI = - 0.02, 0.02; p = 0.88) for 2-3 years of follow-up; 0.05 (95%CI = - 0.08, 0.18; p = 0.46) for 5 or more years of follow-up. The RD for postoperative sensitivity was 0.04 (95%CI = - 0.02, 0.10; p = 0.18) for up to 30 days; 0.00 (95%CI = - 0.01, 0.02; p = 0.63) for 1-1.5 years of follow-up; and 0.00 (95%CI = - 0.01, 0.02; p = 0.71) for 2-3 years of follow-up. For the other secondary outcomes, no significant differences were observed (p > 0.05) between the restorative techniques. The certainty of evidence was graded as moderate. CONCLUSIONS: The clinical performance of class I and II restorations in posterior teeth is similar when placed with the incremental and bulk-filling techniques. CLINICAL RELEVANCE: Based on the results of this study, posterior restorations placed with bulk-filling technique present satisfactory clinical performance, which is similar to direct restorations placed with the conventional incremental technique, considering various follow-up periods evaluated. TRIAL REGISTRATION:  CRD42018108450.

Adhesive restoration of molars affected by molar incisor hypomineralization: a randomized clinical trial.

OBJECTIVE: This randomized clinical trial evaluated the survival of direct restorations on first permanent molars (FPMs) with molar incisor hypomineralization (MIH) and its impact on self-reported dental pain and dental anxiety. MATERIAL AND METHOD: FPMs with MIH of 35 patients aged 7 to 16 years were included. The FPMs were randomized into the following two groups: total-etch (TE-37% phosphoric acid etching) and self-etch (SE-no prior etching). The FPMs were restored with universal adhesive and bulk-fill resin composites. The restoration survival was evaluated according to USPHS criteria modified by a blinded examiner. Dental anxiety (Venham picture test) and dental pain (Faces pain scale-revised) were evaluated before treatment and at 1, 6, and 12 months post-treatment. Survival rates were analyzed by the Kaplan-Meier method and the log-rank test. Nonparametric tests compared pain and anxiety in the follow-up periods. RESULTS: A total of 64 FPMs were restored (TE = 33; SE = 31). Survival rates were 96.9% (TE) and 96.7% (SE) after 1 month, 90.5% (TE) and 80.6% (SE) after 6 months, and 80.8% (TE) and 62.3% (SE) after 12 months (p > 0.05). Self-reported dental pain and anxiety level decreased after treatment in both groups (p < 0.05). Self-reported pain decreased after 1 month in SE, but it occurred at 6 months in TE. CONCLUSION: Both restorative protocols presented similar longevity, decreasing self-reported pain and anxiety levels. CLINICAL RELEVANCE: A universal adhesive could be appropriate for restoration of MIH-affected teeth, and the survival of restorations could be higher in the total-etch technique, reducing dental pain and anxiety.

Is catechol-O-methyltransferase gene associated with temporomandibular disorders? A systematic review and meta-analysis.

BACKGROUND: Temporomandibular disorder (TMD) is a condition, in which multiple factors act synergistically to determine the outcome of the disorder. AIM: A systematic review and meta-analysis was conducted to evaluate the association between genetic polymorphisms in catechol-O-methyltransferase (COMT) and TMD. DESIGN: Observational studies that investigated this association were included. The risk of bias and study quality were evaluated according to the Newcastle-Ottawa tool. The meta-analysis was performed for each polymorphism associated with TMD signs and symptoms. RESULTS: A total of 1903 articles were identified. Ten remained in the qualitative analysis: six were classified as low risk of bias and four with moderate risk of bias, and three were included in the meta-analysis. The polymorphism rs6269, in the genotypic model (0.65; CI = 0.44-0.97; P = .04) and in the allelic model (0.73; CI = 0.54-0.98; P = .04), was associated with myofascial pain. The rs9332377 was associated with myofascial pain in the genotypic model (2.69; CI = 1.51-4.76; P = .0007) and in the allelic model (1.46; CI = 1.01-2.13; P = .05) and with painful TMD in the genotypic model (2.08; CI = 1.27-3.40; P = .004) and in the allelic model (1.34 CI = 0.98-1.82; P = .06). CONCLUSION: The polymorphisms in COMT were significantly associated with TMD.

Single nucleotide polymorphism rs4284505 in microRNA17 and risk of dental fluorosis.

OBJECTIVES: The aim of this study is to evaluate the association between the single nucleotide polymorphism (SNP) rs4284505 within the gene that codifies microRNA17 (miRNA17) and dental fluorosis (DF) in a group of children. METHODS: Children living in a city with fluoridation of public water supplies were included. DF was assessed in erupted permanent teeth by Dean's modified index. The miR-SNP rs4284505 was selected in miRNA17 and genotyping was carried out by real-time PCR. Genotype and allelic distributions between DF and control, and between DF phenotypes (mild, moderate and severe) and control were analysed. RESULTS: Among a total of 527 children enrolled for the study, 383 were DF free and 144 presented DF. In the dominant model analysis (AA + AG vs. GG) the miR-SNP rs4284505 was associated with moderate DF, with carriers of the GG genotype having an increased risk of more than two times for DF (p = 0.031; Odds Ratio = 2.26, Confidence Interval 95%= 1.04-4.73). Allelic distribution showed borderline statistical significance for moderate DF with the carriers of G allele having an increased risk for DF (p = .050; Odds Ratio = 1.75, Confidence Interval 95%= 1.00-3.12). CONCLUSION: The miR-SNP rs4284505 in miRNA17 was associated with an increased risk of DF.

Does computerized anaesthesia reduce pain during local anaesthesia in paediatric patients for dental treatment? A systematic review and meta-analysis.

This systematic review and meta-analysis analysed whether pain and disruptive behaviour can be decreased by the use of computerized local dental anaesthesia (CDLA) in children. The literature was screened to select randomized clinical trials that compared computerized and conventional anaesthesia. The primary outcome was pain perception during anaesthesia; the secondary, disruptive behaviour. The risk of bias of individual papers and the quality of the evidence were evaluated. After search, 8389 records were found and 20 studies remained for the qualitative and quantitative syntheses. High heterogeneity was detected for both outcomes. For the pain perception, the overall analysis showed a standard mean difference of -0.78 (-1.31, -0.25) favouring CDLA; however, when only studies at low risk of bias were analysed (subgroup analysis), there was no difference between the two techniques [-0.12(-0.46, 0.22)]. For disruptive behaviour, no differences were detected for continuous [-0.26 (-0.68, 0.16)] or dichotomous data [0.81 (0.62, 1.06)]. The quality of evidence was judged as low for pain perception and very low for disruptive behaviour. It is concluded that there is no difference in the pain perception and disruptive behaviour in children subjected to computerized or conventional dental local anaesthesia. Notwithstanding, the quality of the available evidence is low.

Are combined bleaching techniques better than their sole application? A systematic review and meta-analysis.

OBJECTIVES: A systematic review and meta-analysis were performed to answer this research question: "Does combined in-office (IO) and at-home (AH) bleaching produce improved color change and lower tooth sensitivity (TS) better than solely AH or IO bleaching in adults?" MATERIAL AND METHODS: Randomized controlled trials in adults that compared combined versus sole application bleaching were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color change in shade guide units (∆SGU) and with a spectrophotometer (∆E*), risk, and intensity of TS, using the random effects model. Heterogeneity was assessed with Cochran's Q test and I2 statistics. GRADE assessed the quality of the evidence. PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, IADR abstracts, unpublished, ongoing trial registries, dissertations, and theses were searched on August 28, 2017 (updated on January 29, 2019). RESULTS: Twelve studies remained. Two were considered to have low RoB. For combined vs. IO bleaching, no significant difference for ∆E*, ∆SGU, and risk of TS were observed; data were not available to analyze the intensity of TS. For combined vs. AH bleaching, no significant difference for ∆E*, ∆SGU, but lower TS to risk (RR 1.40, 95% 1.10 to 1.80) and intensity (MD 1.40, 95% CI 0.18 to 2.63) were detected for AH bleaching. Quality of evidence was graded as low or very low in all meta-analyses. CONCLUSION: Lower risk and intensity of TS was observed for the solely AH group without jeopardizing color change. However, more studies are still encouraged due to the low quality of evidence for most of the outcomes. CLINICAL RELEVANCE: If clinicians are to choose between combined or sole AH bleaching, the solely AH may be preferable; combined bleaching may potentiate the risk of TS without benefits in color change. For combined or sole IO bleaching, no important clinical difference in color change and risk of TS were detected; however, intensity of TS could not be compared due to lack of data. Further studies should be conducted due to the low/very low quality of the evidence.

Do anterior and posterior teeth treated with post-and-core restorations have similar failure rates? A systematic review and meta-analysis.

STATEMENT OF PROBLEM: The association between tooth type, location in the dental arch, and selection of a post-and-core system for endodontically treated teeth is unclear. Information on the influence of these parameters on the failure rate of teeth treated with post-and-core restorations is needed. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the available evidence on the failure rates of anterior and posterior teeth treated with post-and-core restorations. MATERIAL AND METHODS: A search was performed in PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library, and Gray literature for randomized clinical trials comparing the failure rates of anterior and posterior teeth treated with post-and-core restorations. The risk of bias tool from the Cochrane Collaboration was used for quality assessment of the studies. RESULTS: The search strategy identified 2526 articles, and 6 studies were included in the meta-analysis. No difference in the failure rate of post-and-core restorations placed in anterior and posterior teeth was found in most studies. The risk ratio for anterior versus posterior teeth was 1.06 (95% confidence interval [CI], 0.69-1.64; P=.79). The risk ratio for incisors versus canines was 3.08 (95% CI, 0.56-17.04; P=.20) and that for premolars versus molars was 0.45 (95% CI, 0.12-1.74; P=.25). The risk ratio for prefabricated glass fiber posts on anterior versus posterior teeth was 1.13 (95% CI, 0.61-2.09; P=.70) and that for metal posts was 1.10 (95% CI, 0.64-1.91; P=.72). CONCLUSIONS: The failure rates in anterior and posterior teeth treated with post-and-core restorations were similar at short- to medium-term follow-up. More well-designed clinical trials comparing the survival and failure rates of anterior and posterior teeth treated with post-and-core restorations with longer follow-up times are needed.

Dopamine receptor D2 and ankyrin repeat domain containing one in temporomandibular disorder of adolescents.

BACKGROUND: Temporomandibular disorder (TMD) is a multifactorial condition that combines environmental and genetic factors and its prevalence increases during adolescence. AIM: To investigate the association between TMD and genetic polymorphisms in the DRD2 and ANKK1 in a population of Brazilian adolescents. DESIGN: The TMD group included adolescents diagnosed with any of the following TMD subgroups according to the RDC/TMD criteria: myofascial pain, arthralgia and disc displacement and painful TMD. Genomic DNA for molecular analysis was extracted from buccal cells, and genetic polymorphism rs6275 in DRD2 and rs1800497 in ANKK1 were genotyped by real-time polymerase chain reactions using the TaqMan assay. Data were analysed using the Epi Info 3.5.7 and Stata software, with significance level of 0.05. RESULTS: Two hundred fifty-one individuals were included in this study, 148 subjects presented TMD. For disc displacement, the genetic polymorphisms rs6275 was associated in a recessive model (P = 0.04), whereas the rs6276 and rs1800497 presented only a borderline association in a recessive and dominant models, respectively (P = 0.07 and P = 0.06). CONCLUSION: The genetic polymorphism rs6275 in DRD2 was associated with disc displacement in Brazilian adolescents.

Are Glass-Ionomer Cement Restorations in Cervical Lesions More Long-Lasting than Resin-based Composite Resins? A Systematic Review and Meta-Analysis.

PURPOSE: To compare the the loss of retention and color match of glass-ionomer cements (GIC) and resin-based composites (RC) in noncarious cervical lesions. Other secondary outcomes (surface texture, marginal adaptation, marginal discoloration, and secondary caries) were evaluated in a systematic review and meta-analysis. MATERIALS AND METHODS: A comprehensive search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, and Cochrane. We included only randomized clinical trials. The quality of the evidence for each outcome was assessed using the GRADE tool. RESULTS: A total of 1530 articles were identified, but only 19 reports remained for analysis, all of which were judged to possess "unclear" risk of bias. GIC showed higher retention rates in all follow-ups (1 to 3 years, p < 0.0001; at 5 years, p < 0.00001). No difference was observed for marginal discoloration, marginal adaptation and secondary caries in all follow-ups (p > 0.05). RC showed better color match than GIC only at 2 years (p = 0.03). Higher roughness was observed in GIC in all follow-ups (at 1 year p = 0.0003; at 3 years p = 0.0004). Quality of evidence was graded as moderate or low due to unclear risk of bias and imprecision in some outcomes. CONCLUSION: The loss of retention of RMGIC/GIC was inferior to that of RC, but a higher roughness was observed in the RMGIC/GIC when compared to RC in all follow-ups of the clinical studies evaluated. In addition, the color match was better with RC only in the 2-year follow-up when compared to GIC. The quality of evidence was judged as moderate to low in these two outcomes.

Does smoking habit increase the micronuclei frequency in the oral mucosa of adults compared to non-smokers? A systematic review and meta-analysis.

OBJECTIVES: A systematic review of clinical studies to evaluate the frequency of micronuclei in the oral mucosa of smokers and non-smokers in adult patients was performed. MATERIALS AND METHODS: A comprehensive search was carried out on MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO, and Cochrane Library and SIGLE without restrictions. Dissertations and thesis were searched using the ProQuest Dissertations and Periodicos Capes Thesis Databases. We included only cross-sectional clinical trials that compared the frequency of micronuclei in the oral mucosa of smokers and non-smokers in adult patients. DATA: After the removal of duplicates, 1338 articles were identified. After title and abstract screening, 35 studies remained. Eighteen studies were further excluded, whereas 17 studies remained for qualitative analysis and 16 for the meta-analysis of the primary and secondary outcomes. A significant difference in the frequency of micronuclei in smokers when compared to non-smokers was observed in the present study. CONCLUSIONS: Despite the high variation in the methodology of the assessed studies, this study showed a higher frequency of micronuclei in exfoliated cells of smokers compared to non-smokers. CLINICAL SIGNIFICANCE: The use of tobacco is associated with cytotoxic and genotoxic effects because a higher frequency of micronuclei in exfoliated cells of smokers was observed.

Efficacy of a new light-cured anesthetic gel for clamp placement before rubber dam isolation in children: A triple-blinded randomized controlled clinical trial.

PURPOSE: To evaluate the efficacy of a new light-cured anesthetic gel for pain control associated with the clamp placement for rubber dam isolation in children. METHODS: 82 children in need of sealant placement on the first permanent mandibular molars were selected to take part in this randomized, split-mouth, triple-blinded study. Before rubber dam placement, the light-cured anesthetic gel (test) or a placebo gel (control) was applied on the gingival margins of the molars. The hemi-arches were isolated with cotton rolls and the gels were applied; the anesthetic gel was light-cured. After 30 seconds, clamp #26 was positioned on tooth 36 or 46. If there was pain, the clamp was removed and rescue anesthesia was applied. The absolute risk and intensity of pain were registered using three scales: facial expression (Wong-Baker), observational (FLACC) and numerical (NRS). Data were analyzed by McNemar's test and Wilcoxon Signed Rank (α= 5%). RESULTS: Differences were detected for the risk of pain between groups (P= 0.0002) and for the different intensity of pain scales used (P< 0.001) with positive results for the anesthetic gel. CLINICAL SIGNIFICANCE: The new developed light-cured topical anesthetic is an alternative to infiltrative anesthesia for pain control during clamp adaptation for rubber dam isolation. Its use helps to overcome the fear of needles, which can trigger pain, anxiety and discomfort for the majority of the patients, hampering the behavior management in children.

Silver Diamine Fluoride Has Efficacy in Controlling Caries Progression in Primary Teeth: A Systematic Review and Meta-Analysis.

A systematic review was performed to evaluate the efficacy of silver diamine fluoride (SDF) in controlling caries progression in children when compared with active treatments or placebos. A search for randomized clinical trials that evaluate the effectiveness of SDF for caries control in children compared to active treatments or placebos with follow-ups longer than 6 months was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and grey literature. The risk of bias tool from the Cochrane Collaboration was used for quality assessment of the studies. The quality of the evidence was evaluated using the GRADE approach. Meta-analysis was performed on studies considered at low risk of bias. A total of 5,980 articles were identified. Eleven remained in the qualitative synthesis. Five studies were at "low," 2 at "unclear," and 4 studies at "high" risk of bias in the key domains. The studies from which the information could be extracted were included for meta-analysis. The arrestment of caries at 12 months promoted by SDF was 66% higher (95% CI 41-91%; p < 0.00001) than by other active material, but it was 154% higher (95% CI 67-85%; p < 0.00001) than by placebos. Overall, the caries arrestment was 89% higher (95% CI 49-138%; p < 0.00001) than using active materials/placebo. No heterogeneity was detected. The evidence was graded as high quality. The use of SDF is 89% more effective in controlling/arresting caries than other treatments or placebos. The quality of the evidence was graded as high.

Intra-pocket anaesthesia and pain during probing, scaling and root planing: a systematic review and meta-analysis.

AIM: A systematic review/meta-analysis was performed to evaluate pain during probing, scaling and root planing using intra-pocket anaesthesia versus placebo in adult patients. METHODS: A search was performed in PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library and Grey literature. IADR abstracts, unpublished trials registries, dissertations and theses were also searched for randomized clinical trials comparing the clinical effectiveness of intra-pocket anaesthesia and placebo. Risk/intensity of pain was the primary outcome. The risk of bias tool from the Cochrane Collaboration was used for quality assessment. Meta-analysis was performed on studies considered at low risk of bias. RESULTS: A total of 1740 articles were identified. Eleven remained in the qualitative synthesis, and nine studies were considered at "low" risk of bias for meta-analysis. Standardized Hedge's g mean difference for pain intensity using visual analogue scale and Heft-Parker pain scales was -0.576 (95% confidence interval [CI] -0.94 to -0.22; p = 0.002) and for verbal rating scale pain scale it was -1.814 (95% CI -3.38 to -0.245; p = 0.023). The odds ratio for the risk of pain was 0.025 (95% CI 0.003 to 0.25; p = 0.002) and the odds ratio for the need for rescue anaesthesia it was 0.358 (95% CI 0.174 to 0.736; p = 0.005). CONCLUSIONS: The anaesthetic gel decreases the risk and intensity of pain during probing/SRP.

Effects of prolonged light exposure times on water sorption, solubility and cross-linking density of simplified etch-and-rinse adhesives.

PURPOSE: This study evaluated the effects of light exposure times on water sorption, solubility, and polymer cross-linking density of simplified etch-and-rinse adhesives. MATERIALS AND METHODS: Four commercial adhesives (XP Bond, Adper Single Bond 2, Tetric N-Bond, and Ambar) were selected, and resin disks 5 mm in diameter and 1.0 mm thick were prepared and light cured for 20, 40, or 80 s using an LED light-curing unit at 1200 mW/cm2. Water sorption and solubility were evaluated over a 28-day period. For polymer cross-linking density, additional specimens were prepared and their Knoop hardness measured before and after immersion in 100% ethanol. The data from each test were evaluated using a two-way ANOVA and Tukey's test (α = 0.05). RESULTS: The XP Bond adhesive showed higher water sorption (similar to Adper Single Bond 2) and solubility (p < 0.05) than did the other materials. Prolonged exposure times did not reduce the water sorption but did reduce the solubility of all tested materials (p < 0.05). For Ambar, the increase in the exposure time resulted in a significantly lower percent reduction in hardness. CONCLUSION: Water sorption, solubility, and cross-linking density of the materials selected in this study seem to be mainly influenced by the adhesive composition. Prolonged light exposure times reduced the solubility of the materials.