Biodentine™ as a temporary filling in deep carious lesions in permanent teeth: a prospective observational 33-month follow-up study.

PURPOSE: The study aimed to evaluate temporary fillings using Biodentine™ in asymptomatic deep carious lesions after 12, 24, and 36 months in school children from the remote village of Kerung, Nepal. METHODS: From November 2018 to November 2019, 91 temporary fillings were placed using Biodentine™ (a hydraulic calcium silicate cement) in permanent molars with deep carious lesions of schoolchildren in the remote district of Kerung, Nepal. These restorations were performed after selective caries removal in a non-dental setting with hand instruments and cotton roll isolation, as electric motors and saliva ejection systems were unavailable. In total, 78 single-surface and 13 multi-surface fillings were placed. Clinical and radiographic follow-up periods encompassed 12, 21, and 33 months, respectively. RESULTS: After 12 months, all single-surface fillings (100%) survived, whilst all multi-surface fillings were partially or entirely lost. The survival rate of single-surface restorations after 21 and 33 months was 67.6% and 50%, respectively. Radiographically, no pathology was observed. CONCLUSION: This study showed that Biodentine could be used in deep carious lesions as a temporary filling in single-surface lesions for at least up to 1 year and in a substantial number of cases for up to 21 and 33 months.

In vivo correlation of near-infrared transillumination and visual inspection with bitewing radiography for the detection of interproximal caries in permanent and primary teeth.

PURPOSE: To evaluate near-infrared light transillumination (NILT) for interproximal caries detection in children by comparing the correlation between both NILT and visual inspection (ICDAS) with bitewing (BW) radiography and by investigating possible differences in caries detection with NILT between primary and permanent teeth. METHODS: From 35 patients, 121 and 63 interproximal surfaces in, respectively, primary and permanent teeth were included. NILT images were obtained using DIAGNOcam™ (KaVo) and scored by two calibrated raters. A consensus diagnosis was reached for BW radiography; whereas, the ICDAS scores were obtained by one calibrated rater. Weighted Kappa (wκ) was used to evaluate inter- and intra-rater reliability of NILT and to evaluate the correlation between NILT, ICDAS and BW radiography. RESULTS: The correlation between NILT and BW radiography was moderate to substantial for primary teeth [Rater 1: wκ = 0.61 (95% CI = 0.49-0.75), Rater 2: wκ = 0.55 (95% CI = 0.41-0.69)] and fair for permanent teeth [Rater 1: wκ = 0.34 (95% CI = 0.15-0.53), Rater 2: wκ = 0.33 (95% CI = 0.08-0.58)]. The correlation between ICDAS and BW radiography was moderate for primary teeth [wκ = 0.49 (95% CI = 0.35-0.63)] and substantial for permanent teeth [wκ = 0.62 (95% CI = 0.32-0.92)]. No significant differences were found between primary and permanent teeth. CONCLUSION: NILT cannot be recommended as a single diagnostic tool for interproximal caries detection in primary teeth. The number of false negatives for dentine caries, especially in first primary molars, was too high. For the use in permanent teeth, NILT could be more accurate than BW radiography.

Paediatric dental emergencies: a retrospective study and a proposal for definition and guidelines including pain management.

AIM: This was primarily to perform a retrospective analysis of 1000 emergency dental visits in order to characterize the nature of the dental emergency and the treatment provided and secondly to define a guideline for dental emergency treatment in children including pain management. MATERIALS AND METHODS: A retrospective review was conducted of 1000 patients (aged 0-16 years) who visited the dental emergency service of the paediatric dental clinic at the Ghent University Hospital, Belgium over a period of 3 years. Data regarding age, gender, reason for visit, year of visit, consequent appointments and treatment provided were collected. Statistical analysis was carried out using descriptive statistics (frequency distribution) and Chi-square test, with significance level set as P < 0.05. RESULTS: The number of patients visiting with a dental emergency increased annually. Approximately half (50.2%) of all paediatric dental emergency consultations were based on pain due to caries and its consequences. More than a quartile (26.7%) of emergency patients suffered from dental trauma of either primar or permanent teeth. The majority (96.7%) of the patients reported pain, 16.3% of the patients did not necessarily need immediate attention. CONCLUSION: Dental emergencies in a university hospital based setting were predominantly related to caries and trauma. A precise definition of dental emergencies is recommended in order to prevent abuse of paediatric emergency services.

Correction to: Biodentine™ material characteristics and clinical applications: a 3 year literature review and update.

Owing to a misunderstanding on the part of the authors, the name of the last author, Prof. R. M. H. Verbeeck, was omitted from this article.

Biodentine™ material characteristics and clinical applications: a 3 year literature review and update.

INTRODUCTION: Biodentine™ has frequently been acknowledged in the literature as a promising material and serves as an important representative of tricalcium silicate based cements used in dentistry. AIM: To provide an update on the physical and biological properties of Biodentine™ and to compare these properties with those of other tricalcium silicate cements namely, different variants of mineral trioxide aggregate (MTA) such as ProRoot MTA, MTA Angelus, Micro Mega MTA (MM-MTA), Retro MTA, Ortho MTA, MTA Plus, GCMTA, MTA HP and calcium enriched mixture (CEM), Endosequence and Bioaggregate™. STUDY DESIGN: A comprehensive literature search for publications from November 20, 2013 to November 20, 2016 was performed by two independent reviewers on Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov. Electronic and hand search was carried out to identify randomised control trials (RCTs), case control studies, case series, case reports, as well as in vitro and animal studies published in the English language. CONCLUSIONS: The enhanced physical and biologic properties of Biodentine™ could be attributed to the presence of finer particle size, use of zirconium oxide as radiopacifier, purity of tricalcium silicate, absence of dicalcium silicate, and the addition of calcium chloride and hydrosoluble polymer. Furthermore, as Biodentine™ overcomes the major drawbacks of MTA it has great potential to revolutionise the different treatment modalities in paediatric dentistry and endodontics especially after traumatic injuries. Nevertheless, high quality long-term clinical studies are required to facilitate definitive conclusions.

Addition of bioactive glass to glass ionomer cements: Effect on the physico-chemical properties and biocompatibility.

OBJECTIVES: Glass ionomer cements (GICs) are a subject of research because of their inferior mechanical properties, despite their advantages such as fluoride release and direct bonding to bone and teeth. Recent research aims to improve the bioactivity of the GICs and thereby improve mechanical properties on the long term. In this study, two types of bioactive glasses (BAG) (45S5F and CF9) are combined with GICs to evaluate the physico-chemical properties and biocompatibility of the BAG-GIC combinations. The effect of the addition of Al3+ to the BAG composition and the use of smaller BAG particles on the BAG-GIC properties was also investigated. MATERIALS AND METHODS: Conventional aluminosilicate glass (ASG) and (modified) BAG were synthesized by the melt method. BAG-GIC were investigated on setting time, compressive strength and bioactivity. Surface changes were evaluated by Fourier transform infrared (FT-IR), scanning electron microscopy (SEM), EDS and PO43- -and Ca2+ uptake in SBF. Biocompatibility of selected BAG-GICs was determined by a direct toxicity assay. RESULTS: The addition of BAG improves the bioactivity of the GIC, which can be observed by the formation of an apatite (Ap) layer, especially in CF9-containing GICs. More BAG leads to more bioactivity but decreases strength. The addition of Al3+ to the BAG composition improves strength, but decreases bioactivity. BAGs with smaller particle sizes have no effect on bioactivity and decrease strength. The formation of an Ap layer seems beneficial to the biocompatibility of the BAG-GICs. SIGNIFICANCE: Bioactive GICs may have several advantages over conventional GICs, such as remineralization of demineralized tissue, adhesion and proliferation of bone- and dental cells, allowing integration in surrounding tissue. CF9 BAG-GIC combinations containing maximum 10mol% Al3+ are most promising, when added in ≤20wt% to a GIC.

Efficacy of three different pulpotomy agents in primary molars: a randomized control trial.

AIM: To compare the clinical and radiographic efficacy of Biodentine™ , ProRoot® White Mineral Trioxide Aggregate (WMTA) and Tempophore™ as pulpotomy medicaments in the treatment of carious primary molars. METHODOLOGY: A parallel-design, randomized controlled trial was developed. Patients above 3 years of age with carious primary teeth with vital pulps without spontaneous pain or history of swelling were included. Fifty-eight patients (82 teeth) with a mean age of 4.79 ± 1.23 years were included. The teeth were randomized, blinded and allocated to one of the three groups (Biodentine™ , ProRoot® WMTA or Tempophore™ ) for pulpotomy treatment. All teeth were followed up clinically and radiographically (after 6, 12 and 18 months) by two blinded calibrated investigators. A generalized estimating equation (GEE), Wald chi-square test and an intention-to-treat analysis (ITT) with 'last carried forward' approach were performed using Statistical Package for Social Sciences v 21.0 (IBM Corp., Armonk, NK, USA). RESULTS: Forty-six patients and 69 teeth were available for follow-up after 18 months. Clinical success (radiographic success in parenthesis) was 95.24% (94.4%), 100% (90.9%) and 95.65% (82.4%) in the Biodentine™ , ProRoot® WMTA and Tempophore™ groups, respectively, but the difference was not significant. Pulp canal obliteration was significantly different amongst the experimental groups as the Biodentine™ group exhibited significantly more pulp canal obliteration when compared to the ProRoot® WMTA group at 6 months (P = 0.008) and 18 months (P = 0.003). CONCLUSIONS: After 18-month follow-up, there was no significant difference between Biodentine™ in comparison with ProRoot® WMTA or Tempophore™ .

Bioactivity and biocompatibility of two fluoride containing bioactive glasses for dental applications.

OBJECTIVE: Bioactive glasses (BAG) form, in contrast to formerly used implant materials, a stable bond with tissues, especially bone, when implanted. Nowadays BAGs are often mixed with a cement/composite that hardens in situ to broaden its applications in dentistry or orthopedics. The bioactivity and biocompatibility of possible BAG candidates for BAG-cement/composite development were evaluated. METHODS: Two fluoride containing BAGs were tested: a Na+-containing (45S5F), based on the first commercial BAG, and a Na+-free BAG (CF9), with a higher Ca2+ and PO43- content. BAGs were tested on their bioactivity upon immersion in SBF for 7days by evaluating the surface changes by FT-IR, SEM, EDS and PO43- and Ca2+ uptake and/or release from SBF. Moreover, the biocompatibility of the BAGs was investigated with a direct contact cell viability study with HFF cells and a cell adhesion study with MG-63 cells. RESULTS: The Na+-free BAG, CF9, showed the highest potential to bioactivate cements because of its high Ca2+-release and apatite (Ap) formation, as evidenced by SEM pictures and corresponding EDX patterns. FT-IR confirmed the formation of an Ap layer. Moreover CF9 had a higher biocompatibility than 45S5F. SIGNIFICANCE: For the bioactivation of GICs/composites in order to enhance bonding and remineralization of surrounding tissues, fluoride containing BAG may have advantages over other BAGs as a more stable fluorapatite can be formed. CF9 may be an excellent candidate therefore.

Biodentine™ material characteristics and clinical applications: a review of the literature.

INTRODUCTION: Biodentine™ is a new version of calcium silicate-based inorganic cement. AIM: The aim of this review is to provide a detailed analysis of the physical and biological properties of Biodentine™ and to compare these properties with those of other tricalcium silicate cements viz. mineral trioxide aggregate (MTA) and Bioaggregate™ (Bioaggregate). STUDY DESIGN: A comprehensive systematic literature search for all publications to date was performed on 20th November 2013 by two independent reviewers in Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov using the search terms Biodentine, "tricalcium silicate", Ca3SiO5, "dentine substitute", "dentin substitute" and RD 94. In addition to the electronic search, hand searches and reference searches were performed to include articles published in journals that were not indexed in Medline. Randomised control trials (RCT), case control studies, case series, case reports, in vitro studies, animal studies and short communications in English language were considered for this review. CONCLUSIONS: Considering the superior physical and biologic properties, Biodentine™ could be an efficient alternative to MTA to be used in a variety of clinical applications. There appears to be a wide range of clinical applications where Biodentine™ could be used in the field of endodontics, dental traumatology, restorative dentistry and pediatric dentistry. Although it seems to be good clinical practice, currently there is little clinical evidence to support all potential indications.

Is there sufficient evidence to support the long-term efficacy of mineral trioxide aggregate (MTA) for endodontic therapy in primary teeth?

Several papers have been published to illustrate the effectiveness of mineral trioxide aggregate (MTA) as a pulpotomy medicament. Most of these reports do not offer a critical assessment on the data quality. Therefore, this review evaluated whether the currently available evidence is of an appropriate quality to support the long-term effectiveness of MTA as a pulpotomy medicament in primary molars using a standardized assessment criterion. A comprehensive literature search of human clinical outcome studies, which employed MTA as a pulpotomy medicament in primary teeth, was conducted using the MEDLINE database. Two independent observers rated these articles using the standardized assessment criteria. Furthermore, based on the initial sample mentioned in the individual studies and the sample included for the final analysis, the drop-out rates were calculated. Twenty-two studies were included for quality assessment with an excellent interobserver agreement. None of the 22 studies obtained grade A, four studies attained grade B1, five were graded B2 and 13 received grade C. Based on the assessment criteria employed, there was no evidence that MTA was better than present materials and techniques as a pulpotomy medicament. Furthermore, given the low quality of data, it is highly desirable to establish standard requisites for conducting and reporting on pulp therapy studies in primary teeth so as to benefit both researchers and clinicians to produce high-quality studies that are comparable and to prevent the misuse of clinical material and resources.

Fracture resistance of bone samples filled with fibre-reinforced composite posts: an ex vivo model.

AIM: To evaluate the strengthening effect of two different types of fibre-reinforced composite (FRC) posts in an ex vivo experimental model. METHODOLOGY: Compact and hollow bone samples from bovine femurs were used as standardized samples. A total of 80 hollow samples were divided into two groups and filled either with a prefabricated FRC post or with individually adapted FRC posts. For each group, half of the samples were subjected to thermocycling (5-55 °C, 5000×). The remaining samples were kept for 24 h at 37 °C at 100% relative humidity. All samples were loaded diametrically until fracture. The null hypothesis tested was that the fracture resistance of standardized bone samples is not influenced by the type of FRC post, independently of the exposure to thermocycling. Results were evaluated by anova, and subsequent multiple comparisons were performed. RESULTS: The samples filled with the individually adapted FRC posts were more resistant to fracture than the prefabricated ones (P < 0.001), but this difference was not apparent in the thermocycled groups. Detachment of the posts upon fracture was highest after thermocycling for both groups, amounting to 55% and 95% for the individual adapted posts and the prefabricated posts, respectively. CONCLUSIONS: Initially, the samples filled with the individually adapted FRC posts were more resistant to fracture than those filled with the prefabricated ones. However, after ageing of the samples, both types of posts had similar strengthening effects.

Laser physics and a review of laser applications in dentistry for children.

AIM: The aim of this introduction to this special laser issue is to describe some basic laser physics and to delineate the potential of laser-assisted dentistry in children. REVIEW: A brief review of the available laser literature was performed within the scope of paediatric dentistry. Attention was paid to soft tissue surgery, caries prevention and diagnosis, cavity preparation, comfort of the patient, effect on bacteria, long term pulpal vitality, endodontics in primary teeth, dental traumatology and low level laser therapy. Although there is a lack of sufficient evidence taking into account the highest standards for evidence-based dentistry, it is clear that laser application in a number of different aetiologies for soft tissue surgery in children has proven to be successful. Lasers provide a refined diagnosis of caries combined with the appropriate preventive adhesive dentistry after cavity preparation. This will further lead to a new wave of micro-dentistry based on 'filling without drilling'. CONCLUSION: It has become clear from a review of the literature that specific laser applications in paediatric dentistry have gained increasing importance. It can be concluded that children should be considered as amongst the first patients for receiving laser-assisted dentistry.

Low level laser therapy in oral mucositis: a pilot study.

AIM: The goal of this pilot study was to investigate the capacity of pain relief and wound healing of low level laser therapy (LLLT) in chemotherapy-induced oral mucositis (OM) in a paediatric oncology population group. STUDY DESIGN AND METHODS: 16 children (mean age 9.4 years) from the Gent University Hospital - Department Paediatric Oncology/haematology, suffering from chemotherapy-induced OM were selected. During clinical investigations, the OM grade was assessed using the WHO classification. All children were treated using a GaAlAs diode laser with 830 nm wavelength and a potency of 150 mW. The energy released was adapted according to the severity of the OM lesions. The same protocol was repeated every 48 hrs until healing of each lesion occurred. Subjective pain was monitored before and immediately after treatment by an appropriate pain scale and functional impairment was recorded. At each visit, related blood cell counts were recorded. RESULTS: After 12 mths, records were evaluated and information about treatment sequence, treatment sessions and frequencies related to the pain sensation and comfort were registered. Immediately after beaming the OM, pain relief was noticed. Depending on the severity of OM, on average, 2.5 treatments per lesion in a period of 1 week were sufficient to heal a mucositis lesion. CONCLUSIONS: LLLT, one of the most recent and promising treatment therapies, has been shown to reduce the severity and duration of mucositis and to relieve pain significantly. In the present study similar effects were obtained with the GaAlAs 830nm diode laser. It became clear that using the latter diode device, new guidelines could be developed as a function of the WHO-OM grades i.e. the lower the grade, the less energy needed. Immediate pain relief and improved wound healing resolved functional impairment that was obtained in all cases.

Review: behaviour management techniques in paediatric dentistry.

BACKGROUND: Behaviour management is widely agreed to be a key factor in providing dental care for children. Indeed, if a child's behaviour in the dental surgery/office cannot be managed then it is difficult if not impossible to carry out any dental care that is needed. It is imperative that any approach to behavioural management for the dental child patient must be rooted in empathy and a concern for the well being of each child. REVIEW: Based on various presentations given at Congresses of the European Academy of Paediatric Dentistry (EAPD), documents reviewing behaviour management prepared by the Clinical Affairs Committee of the EAPD, and written submissions to the Executive Board of the EAPD, a review of the various approaches to the behaviour management of the child dental patient was completed. All aspects of non-pharmacological behavioural management techniques described in the literature over the past 80 years were reviewed. FINDINGS: There is a very wide diversity of techniques used but not all are universally accepted by specialist paediatric and general dentists. Wide cultural and philosophical differences are apparent among European paediatric dentists that seem difficult to bridge when forming agreed guidelines. Accordingly, this review highlights those behaviour techniques that are universally accepted such as tell, show, do (TSD) or positive reinforcement, but nevertheless describes the most commonly mentioned techniques for which there are descriptions in the literature. CONCLUSION: A wide variety of behavioural management techniques are available to paediatric dentists which must be used as appropriate for the benefit of each child patient, and which, importantly, must take into account all cultural, philosophical and legal requirements in the country of dental practice of every dentist concerned with dental care of children.

Dental agenesis: genetic and clinical perspectives.

Dental agenesis is the most common developmental anomaly in humans and is frequently associated with several other oral abnormalities. Whereas the incidence of missing teeth may vary considerably depending on dentition, gender, and demographic or geographic profiles, distinct patterns of agenesis have been detected in the permanent dentition. These frequently involve the last teeth of a class to develop (I2, P2, M3) suggesting a possible link with evolutionary trends. Hypodontia can either occur as an isolated condition (non-syndromic hypodontia) involving one (80% of cases), a few (less than 10%) or many teeth (less than 1%), or can be associated with a systemic condition or syndrome (syndromic hypodontia), essentially reflecting the genetically and phenotypically heterogeneity of the condition. Based on our present knowledge of genes and transcription factors that are involved in tooth development, it is assumed that different phenotypic forms are caused by different genes involving different interacting molecular pathways, providing an explanation not only for the wide variety in agenesis patterns but also for associations of dental agenesis with other oral anomalies. At present, the list of genes involved in human non-syndromic hypodontia includes not only those encoding a signaling molecule (TGFA) and transcription factors (MSX1 and PAX9) that play critical roles during early craniofacial development, but also genes coding for a protein involved in canonical Wnt signaling (AXIN2), and a transmembrane receptor of fibroblast growth factors (FGFR1). Our objective was to review the current literature on the molecular mechanisms that are responsible for selective dental agenesis in humans and to present a detailed overview of syndromes with hypodontia and their causative genes. These new perspectives and future challenges in the field of identification of possible candidate genes involved in dental agenesis are discussed.

The influence of social indices on oral health and oral health behaviour in a group of Flemish socially deprived adolescents.

AIM: To investigate the impact of social indices on oral health and oral health behaviour in socially deprived adolescents and young adults in Flanders. METHOD: The study design was cross-sectional and included 68 subjects aged 12 to 26, who called for help by "Habbekrats", a non-profit organisation rendering assistance to adolescents and young adults living on the fringes of our society. The clinical oral examination was performed using criteria based on the diagnostic criteria for caries prevalence surveys published by BASCD. Information on parental occupational level, educational level, living condition and oral health behaviour was gained using questionnaires completed by the participants themselves and their social workers. RESULTS: The mean age was 16.2 years. Within the sample 92% and 90.8% respectively had a father or mother belonging to a low social level. For 68% of the sample the educational level was low. Concerning oral health behaviour 67% reported nutritional habits conducive to poor oral health whereas 64% reported good oral hygiene habits. The mean DMFS was 11.42 (SD = 14.33) and the mean care-index equalled 0.60 (SD = 0.39). Statistical analysis by means of a logistic regression model revealed that only the 'living condition' had a statistically significant influence on oral health behaviour (p < or = 0.05) and care-index (p < or = 0.05). There was no significant correlation between the parents occupation and subjects' educational level and the oral health behaviour and oral health status of the study group. CONCLUSION: From this analysis it is clear that 'living condition' had a significant influence on the oral health behaviour and care indices of the studied population of socially deprived adolescents.

Cranial suture biology and dental development: genetic and clinical perspectives.

Premature fusion of the calvarial bones at the sutures, or craniosynostosis (CS), is a relatively common birth defect (1:2000-3000) frequently associated with limb deformity. Patients with CS may present oral defects, such as cleft soft palate, hypodontia, hyperdontia, and delayed tooth eruption, but also unusual associations of major dental anomalies such as taurodontism, microdontia, multiple dens invaginatus, and dentin dysplasia. The list of genes that are involved in CS includes those coding for the different fibroblast growth factor receptors and a ligand of ephrin receptors, but also genes encoding transcription factors, such as MSX2 and TWIST. Most of these genes are equally involved in odontogenesis, providing a pausible explanation for clinical associations of CS with dental agenesis or tooth malformations. On the basis of the present knowledge on genes and transcription factors that are involved in craniofacial morphogenesis, and from dental clinics of CS syndromes, the molecular mechanisms that control suture formation and suture closure are expected to play key roles in patterning events and development of teeth. The purpose of this article is to review and merge the recent advances in the field of suture research at the genetic and cellular levels with those of tooth development, and to apply them to the dental clinics of CS syndromes. These new perspectives and future challenges in the field of both dental clinics and molecular genetics, more in particular the identification of possible candidate genes involved in both CS and dental defects, are discussed.

Review: finishing and polishing procedures of (resin-modified) glass ionomers and compomers in paediatric dentistry.

BACKGROUND: A smooth surface has a beneficial effect on the aesthetic quality and longevity of a dental restoration, as well as on its biocompatibility with oral tissues. In this review studies on glass-ionomer cements (GIC), resin-modified glass-ionomer cements (RM-GIC), and compomers or polyacid-modified resin composites (PAM-C) were assessed as these are currently used in paediatric dentistry. METHOD: Medline databases (USA National Library of Medicine) was searched using WinSpirs and Pubmed. This search used a keyword filter including dental materials, polishing procedures, and instrumentation including influencing factors. FINDINGS: Although the literature shows different commercially available tools it seems that the ideal polishing instrumentation in paediatric dentistry for GIC and compomers is not yet on the market. Furthermore, the constant development of dental materials and polishing products impose a need for continuous scientific research.