The effect of socio-economic status on children's dental health.

The aim of the present study was to record the oral health status of children from different socioeconomic backgrounds and correlate these findings with parent-associated factors. It comprised a cross-sectional study of healthy children, aged 6-12 years, attending either the Reception and Solidarity Center of the Municipality of Athens or the Postgraduate Paediatric Dentistry Department (NKUA) for dental care. Data regarding the demographics of both parents-guardians, as well as the children, and oral hygiene and dietary habits were collected through a structured questionnaire. This was followed by a thorough clinical examination evaluating oral hygiene status, gingival inflammation and caries experience. Analysis was based on the socioeconomic status (SES) of the parents which was according to the family income. Families with a monthly income of <1400 euros were considered as being of a low SES and families with incomes of >1400 euros as medium. Data were presented in frequency tables and significance of calculated differences was tested using chi-square and Fisher's exact tests. Multivariate regression analysis was used to detect possible risk factors for development of poor dental health. The sample consisted of 216 children (146 from a low and 70 from a medium SES) with a mean chronological age of 9.19 years. Parents from low SES were younger, of lower education, had lived abroad most of their lives and were unemployed or worked in the private sector. Children from low SES backgrounds reported infrequent dental visits, consumed more meals and had more sugary snacks. This was reflected in their worse dental health with significantly higher values for oral hygiene and caries indices. Despite the above differences, none of the parent-associated factors were significantly correlated to worse dental health. In conclusion, SES of parents is reflected in the oral health of children, although it is not a significant predictor of dental health.

Inter-examiner Reliability of Two Methods for Scoring Post-Orthodontic White Spot Lesions from Digital Photographs.

Objective: To compare the reliability of two scoring systems for detecting white spot lesions (WSLs) from clinical photographs captured during debonding of fixed orthodontic appliances. Methods: Digital images of 58 healthy adolescents (34 females and 24 males) were examined, depicting 384 buccal surfaces of maxillary incisors, canines, and first premolars. Three trained examiners (E1, E2 and E3) independently evaluated the fully anonymized photos in a randomized order using the Gorelick index (GI) and the modified International Caries Detection and Assessment System (ICDAS II). A 1-2-week interval separated the scorings. Spearman's rank correlation coefficient, Fisher's z-test, and the interclass correlation coefficient (ICC) were applied to compare the scoring methods and express examiner agreement. Results: The two scoring systems showed a moderate to strong positive relationship, but inter-examiner variations were significant (p<0.05). We found moderate to good reliability (ICC 0.60 to 0.84) with the ICDAS II system and good to excellent values with the GI (ICC 0.72 to 0.94), depending on the examiner. The agreement concerning the sound surfaces and the most severe WSLs was perfect, whereas the scoring of the milder lesion stages appeared more uncertain. Conclusion: A moderate to strong positive relationship was demonstrated between the two methods when scoring the presence and severity of WSLs from digital images. Significant inter-examiner variations affected reliability.

Two years outcome of an individualized oral health preventive program for preschool children with neurodevelopmental disorders.

AIMS: Limited data exist on the effectiveness of oral health preventive programs in children with Neurodevelopmental Disorders (NDD). The aim of this study was to evaluate the effectiveness of an individualized preventive oral health program for preschool children with NDD at a rehabilitation center, over a two years period. METHODS AND RESULTS: In this study, 102 preschool children with NDD were assessed for caries (dmft), oral hygiene status (Green & Vermillion Index) and presence of developmental dental defects. An individualized preventive program was applied based on caries risk and children were followed for two years. Effectiveness of the program was assessed for caries and dental plaque change and explanatory individual factors were used in multivariate models. After two years prospective, dmft increased significantly from 1.1 (SD = 2.7) to 2.04 (SD = 3.6), while GVPI was reduced significantly from 1.8 (SD = 0.9) to 1.4 (SD = 0.9). Children in the moderate and high-risk groups missed significantly more follow-ups compared to the low caries risk group (p < .001) while older maternal age (OR = 1.38, 95%CI = 1.057-1.808) and consumption of more than three sugary snacks/day (OR = 0.005, 95%CI = 0-0.0794) were significantly correlated with dental caries. CONCLUSION: The individualized preventive program for preschool children with NDD was effective in improving oral hygiene but not dental caries status.

Cariogenic Diet Assessment and Analysis Tools in Children and Adolescents: A Systematic Review.

PURPOSE: To collect and evaluate the available evidence on existing tools used in research and clinical practice to assess and analyse the diet of children and adolescents for its cariogenicity. MATERIALS AND METHODS: Multiple databases were searched up to October 2022, with no date, publication, or language restrictions, followed by a manual search. Study screening, data extraction, and risk of bias assessment were performed in duplicate. Dietary assessment tools and dental clinical parameters tested were retrieved for qualitative assessment and synthesis. RESULTS: Of the 2896 papers identified, 9 cohort and 23 cross-sectional studies fulfilled the inclusion criteria. To assess dietary data, 13 studies used a 24-h recall, 11 used a food diary, and 7 used a food frequency questionnaire. For analysis, five studies reported using the Healthy Eating Index, ten used a score based on consumption of sugars, and the remaining analysed cariogenic diet based on the weight and frequency of sugars consumed, or the daily caloric intake from free sugars. Risk of bias assessment suggested that 65.7% of the studies were of moderate and 31.5% of high quality. CONCLUSION: Inconsistency exists regarding methods used for the assessment and analysis of dietary cariogenicity. Although every dietary assessment tool has different strengths and limitations, the 24-h recall was the most commonly used method for the assessment of dietary cariogenicity and the most consistent in detecting a positive relationship between sugary diet and carious lesions. A standardised method for cariogenic analysis of dietary data needs to be determined.

The role of calcium in the prevention of erosive tooth wear: a systematic review and meta-analysis.

OBJECTIVES: The loss of hard dental tissue due to recurrent acid challenges and mechanical stresses without bacterial involvement is known as erosive tooth wear (ETW). Many studies in the literature have concentrated on variables that may affect the ETW process and prevent its occurrence or reduce its advancement. However, to date, no previous systematic review has evaluated the role of calcium in preventing ETW. Therefore, the purpose of the present systematic review was to review and critically appraise the scientific evidence regarding the role of calcium formulations in the prevention of ETW. METHODS: The review protocol was registered in the PROSPERO international prospective register of systematic reviews (Ref: CRD42021229819). A literature search was conducted in electronic databases to identify in situ randomized controlled trials evaluating the prevention of ETW following the application of calcium formulations. The outcomes studied included mean enamel loss, surface microhardness, surface roughness, mean erosion/softening depth, mineral loss/precipitation and remineralization. Study characteristics and outcomes of included studies were summarized. Cochrane's risk-of-bias tool 2.0 was used to assess the quality of eligible studies, and meta-analysis using a random effects model was performed. RESULTS: The search retrieved 869 studies of which 21 were considered eligible. Regarding the results of the quality assessment for potential risk of bias in all included studies, overall, 5 studies were considered as being at low risk, another 12 at unclear risk and 4 at high risk of bias. The findings of the studies showed that the addition of calcium in juice drinks led to reduced enamel loss, with blackcurrant juice presenting 2.6 times statistically significant less enamel loss compared to orange juice (p = 0.0001, I2 = 89%). No statistically significant difference in mean surface microhardness of eroded enamel was recorded between chewing gum with or without casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (p = 0.31, I2 = 71%). Contradictory were the results regarding the effect of milk and CPP-ACP pastes on prevention of ETW. CONCLUSIONS: Calcium formulations play an important role in ETW prevention, mainly through their addition to acidic drinks.

Exposure and protection protocols of dentomaxillofacial imaging applied by paediatric dentists in Europe.

OBJECTIVES: Evaluate exposure and protection practices regarding dentomaxillofacial imaging among pediatric dentists in Europe and determine the effect of different clinician specific characteristics on their implementation. METHODS: A cross-sectional study involving an electronic questionnaire addressed to paediatric dentists, participating in a seminar on dental radiology organized by the European Academy of Paediatric Dentistry. Participants were asked to respond to questions regarding dentomaxillofacial imaging in terms of applied radiation dose, adoption of radiation protection techniques, and different patterns of radiographic studying and exchange between patients and colleagues. Data analysis was performed and distribution of responses was tested using chi-square and Fisher's exact tests. RESULTS: A total of 151 paediatric dentists, 119 females and 32 males, with a mean chronological age of 42.8 years (s.e. 11.3 years), successfully completed the questionnaire (response rate = 82%). Regardless of the type of radiograph, majority of respondents (68%), reported that they perform the radiographs themselves, while 21% reported that they refer the patients. Half of the respondents (51%), indicated requesting a small (localized) field of view (FOV) when referring for a cone beam computed tomography (CBCT) with only a small proportion (11%) reporting a large (maxillofacial) FOV. Thyroid collars and optimizing exposure settings were the most commonly reported patient protection measures used. Lastly, paediatric dentists have adopted the latest technological capacities for the study of dental images. CONCLUSIONS: Dentomaxillofacial imaging protection and exposure protocols used are common among paediatric dentists with none of their specific characteristics having a significant effect.

Mandibular Cortical Bone Evaluation in a Healthy Paediatric Population.

BACKGROUND: Changes in mandibular cortical bone have been documented in children with chronic diseases but not in healthy populations. AIM: We aimed to qualitatively and quantitatively evaluate the mandibular cortical bone of a healthy paediatric population using dental panoramic radiographs (DPTs). The secondary objective was to assess the effect of dental status on cortical bone. DESIGN: The DPTs of 660 individuals, aged 6-18 years, were evaluated by two blinded examiners. Bone was qualitatively categorized according to the Mandibular Cortical Index (MCI), and its width was calculated using the Mandibular Cortical Width Index (MCW). Differences between gender and age were tested using Fisher's exact and correlation with dental status with the chi-square test. RESULTS: A significant correlation was observed between bone morphology and gender, with girls having more frequent even and sharp endosteal margins than boys, who showed semilunar defects. The degree of erosion increased with age, as did bone thickness. A positive correlation between thickness and type of dentition was recorded, with normal bone predominating in children in the mixed dentition stage. Νο correlation was found between bone morphology or thickness and the factors associated with dental status. CONCLUSIONS: Bone quality and quantity vary significantly between different genders and age groups. Dental needs and treatment characteristics did not seem to affect the above parameters.

Fluorescence and Near-Infrared Light for Detection of Secondary Caries: A Systematic Review.

BACKGROUND: Early detection of secondary caries near dental restorations is essential to prevent further complications. This systematic review seeks to evaluate the sensitivity of fluorescence and near-infrared (NIR) imaging techniques for detecting secondary caries and to provide insight into their clinical utility. METHODS: A comprehensive search strategy was used to select studies from seven databases, emphasizing diagnostic accuracy studies of secondary caries detection using fluorescence and NIR imaging techniques. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) instrument assessed bias risk and practicality. Two evaluators performed data extraction, screening, and quality assessment independently. RESULTS: From 3110 initial recordings, nine studies were selected for full-text analysis. Wide variations in sensitivity (SE) and specificity (SP) values were reported across the studies. These studies exhibited variable SE and SP values, and the findings highlighted the importance of method selection based on clinical context. This systematic review underlines the potential for fluorescence and NIR imaging to detect secondary caries. However, results from different studies vary, indicating the need to consider additional variables such as restoration materials. CONCLUSIONS: Although these technologies exhibit potential for detecting caries, our research underscores the complex procedure of identifying secondary caries lesions. It is a continuous necessity for progress in dental diagnostics to promptly identify secondary caries lesions, particularly those in proximity to tooth-colored ones.

Vital Pulp Therapy of Young First Permanent Molars: A Retrospective Study on Radiographic Findings 24 Months Post-treatment.

PURPOSE: With success rates comparable to that of root canal treatment, vital pulp therapy (VPT) has gained clinical interest and has been used in the management of young permanent teeth with inflamed pulps. The aim of the present study was to retrospectively evaluate the radiographic success of VPT in young first permanent molars 24 months post-treatment and correlate findings with tooth and treatment-related characteristics. MATERIALS AND METHODS: Dental records of all patients with first permanent molars which received VPT in the Department of Paediatric Dentistry (National and Kapodistrian University of Athens) were retrieved. Demographic characteristics and data regarding the treatment performed were recorded. Patients' radiographs were evaluated at 6, 12 and 24 months post-treatment by two qualified paediatric dentists blinded regarding the treatment performed. Radiographic success, reasons for failure and continuation of root development were evaluated. Differences were tested using the Χ2 and Student's t-test, and possible correlations were determined by calculating the odds ratio. RESULTS: Overall radiographic success rate at 24 months was 77%, ranging between 50% for direct pulp capping and 92% for full pulpotomy. Differences were not statistically significant. Continuation of root development was recorded in almost 1/3 of the teeth and completion in almost 1/5. No statistically significant association was recorded between the outcome and any tooth and treatment-related variables. CONCLUSION: VPT seems to be a reliable option in the long term for the treatment of deep carious lesions in young permanent molars.

Assessing quality and quantity of cortical bone in childhood cancer survivors using anthropometric indices.

OBJECTIVES: Evaluate mandibular cortical bone in childhood cancer survivors (CCS) and correlate findings with disease and treatment characteristics. METHODS: Dental panoramic radiographs of 60 CCS and of 120 age and gender-matched healthy individuals were assessed by two independent observers. Bone was categorized as normal, moderately or severely eroded and its width was calculated at four sites bilaterally. Significant differences were tested using Chi-square and Pearson correlation co-efficient. Possible risk factors were detected by multivariate regression analysis. RESULTS: Forty five percent of CCS had moderately eroded bone, while 67% of healthy individuals normal bone. Mean width was 3.9 mm in CCS (1.9 mm-6.4 mm) and 2.7 mm in healthy controls (1.4 mm-6 mm). None of the above differences were significant. Survivors diagnosed at a younger age had a five times greater probability of presenting mildly eroded bone. CONCLUSIONS: No direct effect of antineoplastic treatment on cortical bone could be demonstrated in the current study, underlying the need for more well-designed studies.

Awareness and practice of dentomaxillofacial imaging among paediatric dentists: a questionnaire survey of members of the European Academy of Paediatric Dentistry.

OBJECTIVES: Assess knowledge, attitudes and practices of paediatric dentists towards dentomaxillofacial imaging and correlate findings with practitioner and practice-specific characteristics. METHODS: An online questionnaire was sent to all paediatric dentists who attended a scientific seminar organized by the European Academy of Paediatric Dentistry (EAPD) regarding dental radiology. Data regarding available equipment, number, type and reason for performing radiographs, frequency and reasoning for retakes were collected. Data analysis was performed according to practitioner- and practice-specific characteristics and factors directly associated with the type and frequency of radiographs taken, and reason and frequency of repeats were determined. Significant differences were tested using Chi-square and Fisher's exact test. Statistical significance was set at p < 0.05. RESULTS: More than half of the participants (58%) reported having digital radiographic equipment and almost 1/4 (23%) conventional. A panoramic equipment was available in 39% working places and a CBCT scanner in 41%. Two thirds of the participants reported taking up to 10 intra-oral radiographs per week, mainly for trauma (75%) and caries diagnosis (47%). Extra-oral radiographs were prescribed to monitor development (75%) and for orthodontic evaluation, (63%) with a frequency of less than 5 weekly (45%). Participants reported that they repeat radiographs in a frequency of < 5 per week (70%) mainly due to patient's movement (55%). CONCLUSIONS: The majority of paediatric dentists within Europe use digital imaging equipment for both intra- and extra-oral radiographs. Nevertheless, great variation in practices exists and, therefore, continuous education in oral imaging is crucial to maintain high quality standards for the radiographic examination of patients.

Impact of the COVID-19 lockdown on the oral health status of paediatric dental patients in Greece.

BACKGROUND: Limited evidence regarding the post-COVID-19 dental status of paediatric patients is available, with most studies assessing only children's oral health habits. AIM: To evaluate the effect of the COVID-19 lockdown on the oral health of paediatric dental patients in Greece. DESIGN: This was a retrospective cohort study that included a questionnaire on children's oral health behavior and a clinical examination assessing dental caries and dental treatment needs using the International Caries Detection and Assessment System criteria, dmft/DMFT, and Treatment Need Index. The Wilcoxon signed-rank test was used for a statistical comparison between questionnaire and clinical data before, during, and after the lockdown. RESULTS: A total of 102 children with a median age of 9 years were recruited from the current cohort of patients that had their last dental examination 6 months prior to the lockdown. Results from the questionnaire showed decreased brushing frequency with increased eating frequency and sugar consumption during the lockdown period (p < .001). Moreover, 16.5% had to visit the dentist for urgent care during the lockdown, 13.6% experienced dental pain, and 51.5% did not experience any dental emergencies. Clinical examination, after the lockdown, recorded significantly increased mean dmft/DMFT scores by 0.63 units in the primary dentition (p = .01) and 0.52 units in the permanent teeth (p = .002). Significantly higher treatment needs, with more carious lesions requiring extensive treatment after the lockdown, were recorded (p < .001). CONCLUSION: The COVID-19 lockdown negatively affected children's oral health behavior: caries prevalence increased and more complex dental treatments were required.

Comparison between orthodontic and surgical uprighting of mandibular molars: a systematic review.

OBJECTIVES: To evaluate and compare the efficiency of orthodontic treatment and surgical uprighting of first and second mandibular molars. MATERIALS AND METHODS: An electronic literature search in PubMed, Science Direct, Embase, Scopus, Web of Science, Cochrane Library, LILACS, and Google Scholar, as well as a hand search was conducted by two independent researchers to identify relevant articles up to January 2022. In addition, a manual search was done that included article reference lists, grey literature, and dissertations. The risk of bias of the included prospective and retrospective studies was assessed with the Risk Of Bias Tool In Non-randomized Studies of Interventions (ROBINS-I) assessment tool. RESULTS: A total of six nonrandomized clinical trials (non-RCT) evaluating the efficiency of mandibular molar orthodontic and/or surgical uprighting were included. The quality analysis showed certain defects of the Non-RCTs included and, according to the criteria used, the majority of the articles were judged to be of moderate quality. CONCLUSIONS: Based on the evidence, orthodontic and surgical uprighting appear to be effective treatment methods for mandibular molars. Surgical uprighting may be associated with more complications than orthodontic uprighting. However, the existing literature on the subject is limited, heterogeneous, and methodologically limited. Therefore, the outcomes should be interpreted carefully.

A cross-sectional survey on knowledge and attitudes of Greek dentists regarding molar incisor hypomineralisation diagnosis and treatment.

BACKGROUND: Molar Incisor Hypomineralisation (MIH) remains a challenge for clinicians underlining the gap in the literature regarding the condition. The study aimed to record knowledge and attitudes of Greek dentists regarding diagnosis and treatment of MIH and correlate findings with non-dental characteristics. METHODS: It is a cross-sectional study based on a questionnaire consisting of 37 multiple-choice questions. Data regarding diagnosis, aetiopathogenesis, and clinical management of MIH were collected from active members of three Greek Dental Associations. Chi-square and student's t-test were used to correlate responses with practitioners' characteristics and odds ratios calculated to evaluate differences on treatment of MIH-affected teeth (p < 0.05). RESULTS: From the 360 participants (response rate = 94%), 185 were general dental practitioners (GDPs) and 175 dental specialists (59 paediatric dentists (PDs), 38 orthodontists and 78 of other specialties).MIH was commonly encountered as a clinical problem, with GDPs reporting genetics and fluoride intake as common aetiological factors at significantly higher percentages as compared to PDs (p < 0.05). Permanent molars and incisors (44%) were the teeth most commonly affected, with yellow/brown demarcated opacities (68%) the most common clinical feature with PDs reporting them in a significantly higher percentage (p < 0.05). Dentists with specialisation, dentists that treat > 10 children per week and children with MIH-affected teeth had a 2-5.5 times greater probability to report difficulty achieving sufficient anaesthesia and hypersensitivity problems (p < 0.001). Agreement between GDPs' and dental specialists' views was found on less invasive treatment of anterior lesions. Non-PDs reported bulk-fill restorations and onlays as the ideal treatment of severely-affected posterior teeth, as compared to PDs that preferred preformed metal crowns (p < 0.05). Multivariate logistic regression analysis revealed that the age of the clinician, years of experience and number of children treated per week were the factors significantly associated with the decision for the treatment of only severely-affected posterior MIH teeth. CONCLUSIONS: Most participants had encountered MIH-affected teeth in their clinical practice and were able to recognize main aetiological factors and clinical findings related to the condition. Nevertheless, their knowledge regarding treatment is limited.

Basic behavioral management techniques in pediatric dentistry: A systematic review and meta-analysis.

OBJECTIVE: To systematically retrieve and assess studies regarding the effectiveness of basic behavioral management techniques (BMTs) in pediatric patients. DATA SOURCES: Electronic and hand searches were conducted to locate Randomized Controlled Trials (RCTs) reporting on objective and subjective evaluation of anxiety and behavior of children up to 12 years of age. Data extraction and risk of bias evaluation, using the Cochrane risk of bias tool (RoB 2.0 Tool), were performed independently and in duplicate for all included studies. Mean differences and standard deviations were used to summarize the data from each study and meta-analyses were conducted with studies of limited heterogeneity. STUDY SELECTION: A total of 708 papers were identified and screened, 122 retrieved for full text appraisal and 62 finally included. Results suggested that all basic BMTs have acceptable effectiveness on pediatric patients' anxiety, fear and behavior during dental treatment. Meta-analysis showed a statistically significant difference in favor of distraction for subjective anxiety using Facial scale (Mean diff.: 2.78; 95% CI: -3.08, -0.53; p = 0.005) and Modified Child Dental Anxiety Scale (Mean diff.: 12.76; 95% CI: -6.09, -4.47; p = 0.001) and a non-significant difference for heart rate (Mean diff.: 1.70; 95% CI: -6.54, 0.46; p = 0.09). Music significantly reduced heart rate when compared to a control comparator, underlining the superiority of the BMT (Mean diff.: 2.71; 95% CI: -3.70, -0.59; p = 0.007). CONCLUSIONS: Limited evidence about efficacy of one technique over another raises important issues on the topic for future research regarding the management of the child patient in the dental setting of the 21st century. CLINICAL SIGNIFICANCE: Behavioral management comprises a challenge for clinicians, who need to be familiar with a range of techniques to meet patients' needs at individual level and be flexible in their implementation. Appropriate technique should incorporate patients' personality and parents' active involvement, within the contents of the changes in modern societies.

Evaluation of Lateral Incisor Resorption Caused by Impacted Maxillary Canines Based on CBCT: A Systematic Review and Meta-Analysis.

BACKGROUND: Root resorption (RR) of the adjacent teeth due to upper canine impaction requires an appropriate modification of the orthodontic treatment plan and the mechanotherapy used. AIM: The aim of this review was to assess scientific evidence published during the last decade, concerning the prevalence of lateral incisor RR caused by impacted maxillary canines, based only on cone-beam computed tomography (CBCT). The location of RR on this tooth, as well as the prevalence of RR on the other adjacent teeth, were additionally evaluated. METHODS: This review followed the criteria specified by the PRISMA statement. Four databases were searched for articles published between January 2008 and June 2021. Predefined and piloted data collection forms were used to record the necessary information. RESULTS: A total of 5098 records were initially screened. Only seven articles were finally eligible for further analysis. A total number of 540 participants (176 males and 364 females) was derived from the included studies. RR of maxillary lateral incisors was common (50%). RR of mild severity was more common (62%), more frequently located in the middle (52%) and apical (42%) thirds of the root. CONCLUSIONS: Further research with more homogeneous groups is required.

Three-Dimensional Printing Technology in Orthodontics for Dental Models: A Systematic Review.

BACKGROUND: Three-dimensional printing technology is an additive manufacturing technology that is used to reconstruct 3D objects. In the last decade, it has been rapidly involved in dentistry and in orthodontics. This article aims to review the literature and present the accuracy of different 3D printer types and any factors that could affect the 3D printing of dental models in the orthodontic field. METHODS: The search strategy of this systematic review included keywords in combination with MeSH terms in Medline, Scopus, and Cochrane Library until June 2022 and only in English. RESULTS: Eleven articles were selected for our study. All the articles were in vitro prospective studies, and they presented a low risk of bias. The results suggested that the accuracy of a printed dental cast can be affected by the different types of 3D technologies, the dental cast's base design, and the printing materials. The accuracy appears to not be affected by the layer height and the position of the model on the building template. CONCLUSIONS: According to this systematic review, all different types of 3D technology can produce clinically accepted results for orthodontic purposes. There is a need for more studies to clarify the accuracy and added value of 3D printing technology in orthodontics.

Three-Dimensional-Printed Customized Orthodontic and Pedodontic Appliances: A Critical Review of a New Era for Treatment.

Three-dimensional (3D) designing and manufacturing technology is a direct derivative of digital technology. Three-dimensional volume and surface acquisition, CAD software, and 3D manufacturing are major changes included in daily practice in many orthodontic and pedodontic offices. Customized appliances can be designed using dental CAD software or general-purpose CAD software in the office or a laboratory. Materials that can be used are resins, alloys, or zirconia. METHODS: The search strategy of this critical review included keywords in combination with MeSH terms in Medline, Scopus, and Cochrane Library up to June 2022 in the English language without any limit to the publication period. RESULTS: According to our search, 12 articles were selected for our study. All the articles were in vitro prospective studies. CONCLUSIONS: The results suggested that almost all the known appliances can be designed and printed in a tailor-made fashion in contrast to the traditional one-size-fits-all approach. Customized appliances should be manufactured according to the patient's needs, and this is justified by the certainty that this approach will be beneficial for the patient's treatment. There is a need for more research on all direct 3D-printed appliances.

Deep dentine caries management of immature permanent posterior teeth with vital pulp: A systematic review and meta-analysis.

OBJECTIVES: Preservation of pulpal vitality in immature permanent teeth with deep carious lesions is essential to enable further root development and apical closure. This systematic review aimed to evaluate the evidence regarding the efficacy, presented clinical and radiographic success, and bacteriological outcomes of techniques and materials used for deep caries management in vital immature permanent teeth. DATA: Randomised controlled trials evaluating Vital Pulp Therapy (VPT) for deep caries in immature permanent posterior teeth without history of irreversible pulpitis, and a follow up period of ≥12 months were included. Study characteristics and outcomes of all included studies were summarized. Cochrane's Risk-of-bias tool 2.0 was used to assess the quality of eligible studies. Meta-analyses using a random effects model was performed. SOURCES: Electronic databases PubMed, Medline, Embase, LILACS, CENTRAL and Cochrane Library were searched, followed by a manual search. STUDY SELECTION: Twelve papers were included into the review. Overall success rates were 98%, 93.5%, 93.6% for direct pulp cap (DPC), indirect pulp cap (IPC) and pulpotomy (PP) respectively. Regardless of VPT technique, there were no significant differences between clinical and radiographic success rates. Completion of root development was achieved in more than 83% of the cases in all VPT techniques. CONCLUSIONS: All treatment modalities for PP were equally efficient with high overall success rates. Biodentine showed high success rates regardless of technique. No significant differences were found in the clinical and radiographic success rates between various follow-up intervals. There are no clear conclusions regarding superiority of either VPT technique on apical closure. CLINICAL SIGNIFICANCE: This manuscript systematically evaluates the evidence and summarises all available data on each vital pulp therapy technique and materials used in treatment of deep caries in immature permanent teeth with vital pulps. The limitations in the current scientific literature and recommendations for future research are also highlighted.