Preventive management of carious lesions: from non-invasive to micro-invasive operative interventions.

Understanding that dental carious lesions occur as a result of the action of micro-organisms in the dental plaque biofilm, where demineralisation on the tooth surface is the first sign of the disease, such incipient lesions can be treated using preventive, non-operative and minimally invasive operative dentistry. If the caries process is left unmanaged, the lesions progress towards cavitation, leading to more invasive treatments. This article discusses the principles of preventive, non-invasive and micro-invasive treatments of early carious lesions, outlining the clinical situations where these therapies can be applied.

Clinical performance of a glass-hybrid system in comparison with a resin composite in two-surface class II restorations: a 5-year randomised multi-centre study.

OBJECTIVE: To evaluate the 5-year clinical performance of a glass hybrid restorative system and a nano-hybrid resin composite in moderate to large two-surface class II cavities. MATERIALS AND METHODS: This study was carried out by dental schools in Zagreb, Croatia; Izmir, Turkey; Belgrade, Serbia; and Milan, Italy. A total of 180 patients requiring two class-II two-surface restorations in the molars of the same jaw were recruited. The teeth were randomly restored with either a nano-hybrid resin composite (Tetric EvoCeram, Ivoclar Vivadent) or a glass-hybrid material (EQUIA Forte, GC). During the 5-year follow-up, two calibrated evaluators at each centre scored the restorations annually using the FDI-2 scoring system. The survival rates were calculated using the Kaplan-Meier method and compared using non-parametric matched pair tests (p < 0.05). RESULTS: There were no statistically significant differences between the overall survival and success rates of the two types of restorations (p>0.05). The success rates (FDI-2 scores 1-3) for EQUIA Forte were 81.9% (average annual failure rate: 3.9%) and 90.7% for Tetric EvoCeram (average annual failure rate: 1.9%). The survival rates (FDI-2 scores 1-4) for EQUIA Forte and Tetric EvoCeram were 94.5% and 94.4%, respectively, with an average annual failure rate of 1.1%. CONCLUSIONS: In terms of success and survival rates, both the glass-hybrid restorative system and the nano-hybrid resin composite have been shown to perform satisfactorily. CLINICAL RELEVANCE: The results of this study indicate that EQUIA Forte can be one of the therapeutic options for moderate to large two-surface class II restorations of posterior teeth.

RoBDEMAT: A risk of bias tool and guideline to support reporting of pre-clinical dental materials research and assessment of systematic reviews.

OBJECTIVES: To develop a risk of bias tool for pre-clinical dental materials research studies that aims to support reporting of future investigations and improve assessment in systematic reviews. METHODS: A four-stage process following EQUATOR network recommendations was followed, which included project launch, literature review, Delphi process and the tool finalization. With the support of the European Federation of Conservative Dentistry (EFCD) and the Dental Materials Group of the International Association for Dental Research (DMG-IADR), a total of 26 expert stakeholders were included in the development and Delphi vote of the initial proposal. The proposal was built using data gathered from the literature review stage. During this stage, recent systematic reviews featuring dental materials research, and risk of bias tools found in the literature were comprehensively scanned for bias sources. The experts thus reached a consensus for the items, domains and judgement related to the tool, allowing a detailed guide for each item and corresponding signalling questions. RESULTS: The tool features nine items in total, spread between 4 domains, pertaining to the following types of bias: bias related to planning and allocation (D1), specimen preparation (D2), outcome assessment (D3) and data treatment and outcome reporting (D4). RoBDEMAT, as presented, features signalling questions and a guide that can be used for RoB judgement. Its use as a checklist is preferred over a final summary score. CONCLUSION: RoBDEMAT is the first risk of bias tool for pre-clinical dental materials research, supported and developed by a broad group of expert stakeholders in the field, validating its future use. CLINICAL SIGNIFICANCE: This new tool will contribute the study field by improving the scientific quality and rigour of dental materials research studies and their systematic reviews. Such studies are the foundation and support of future clinical research and evidence-based decisions.

Comparison of Different Restoration Techniques for Endodontically Treated Teeth.

The aim of the present study is to evaluate the physical properties of endodontically treated teeth restored with five different restorative techniques and materials. Hundred and forty extracted human molar teeth were used. In addition to five restoration groups, specimens with no restorations were used as the negative control, and intact molar teeth were used as the positive control. For flexural strength tests, material specimens were made from 5 different materials using a mould according to ISO 4049 standards. One-way ANOVA revealed that the fracture resistance was significantly affected by the restoration type. SFRC group showed the best fracture resistance values, while lowest values were seen in the GWF group. The test results of flexural strength showed values between 140 and 184 MPa and modulus of elasticity between 6.33 and 18.89 GPa (p < 0.05). Under the limits of this study, results showed that SFRC can be used to increase the fracture resistance of ETT.

Commercially Available Ion-Releasing Dental Materials and Cavitated Carious Lesions: Clinical Treatment Options.

The contemporary approach for operative caries management emphasizes personalized interventions for each patient, dependent upon the individual's caries susceptibility/risk, the stage of the carious lesion and its activity. The clinician's challenge is to optimize the extent of cavity preparation and the choice of dental restorative biomaterials, appreciating the benefits offered by ion-releasing restorative materials. There is a growing application of bioactive/bio-interactive materials in minimally invasive operative dentistry, as they may help with tissue recovery by ion release. In case of moderate or extensive occlusal cavitation, the clinical criteria include the individual caries susceptibility and carious lesion activity. In high caries risk cases, ion-releasing biomaterials (IRB) can be used, as well as for active carious lesions. In proximal lesions, the clinical criteria include the individual caries susceptibility, the lesion activity and presence of cavities with little or no enamel at the gingival margin. This article aims to discuss the restorative ion-releasing options, according to different clinical situations, and the caries susceptibility to manage cavitated carious lesions in permanent adult teeth.

Long-term cost-effectiveness of glass hybrid versus composite in permanent molars.

OBJECTIVES: We assessed the long-term cost-effectiveness of glass hybrid (GH) versus composite (CO) for restoring permanent molars using a health economic modelling approach. METHODS: A multi-national (Croatia, Serbia, Italy, Turkey) split-mouth randomized trial comparing GH and CO in occlusal-proximal two-surfaced cavities in permanent molars (n=180/360 patients/molars) provided data on restoration failure and allocation probabilities (i.e. failure requiring re-restoration, repair or endodontic therapy). Using Markov modelling, we followed molars over the lifetime of an initially 12-years-old individual. Our health outcome was the time a tooth was retained. A mixed-payers' perspective within German healthcare was used to determine costs (in Euro 2018) using fee item catalogues. Monte-Carlo-microsimulations, univariate and probabilistic sensitivity analyses were conducted. Incremental cost-effectiveness ratios (ICER)s and cost-effectiveness-acceptability were quantified. RESULTS: In the base-case scenario, CO was more effective (tooth retention for a mean (SD) 54.4 (1.7) years) but also more costly (694 (54) Euro) than GH (53.9 (1.7) years; 614 (56 Euro). The ICER was 158 Euro/year, i.e. payers needed to be willing to invest 158 Euro per additional year of tooth retention when using CO. In a sensitivity analysis, this finding was confirmed or GH found more effective and less costly. CONCLUSION: CO was more costly and limitedly more effective than GH, and while there is uncertainty around our findings, GH is likely a cost-effectiveness option for restoring permanent molars. CLINICAL SIGNIFICANCE: When considering the long-term (life-time) cost-effectiveness, GH showed cost savings but CO was limitedly more effective. Overall, cost-effectiveness differences seems limited or in favour of GH.

Cost-effectiveness of glass hybrid versus composite in a multi-country randomized trial.

OBJECTIVES: We assessed the cost-effectiveness of two amalgam alternatives, glass hybrid (GH) and composite (CO) in a multi-country randomized controlled split-mouth trial. MATERIALS: University clinics in Croatia, Serbia, Italy and Turkey participated. Pairs of GH (EQUIA Forte, GC) and a nano-hybrid CO (TetricEvoCeram, IvoclarVivadent) were randomly placed in occlusal-proximal two-surfaced cavities in permanent molars of adults (n = 180/360 patients/molars). We used 3-years interim data for this evaluation. FDI-2 criteria were applied and teeth requiring repair, re-restoration, endodontic treatment or extraction recorded. Our outcome was the time until any or major complications (requiring endodontic treatment or extraction) occurred. Costs were calculated in US Dollar (USD) 2018, with the local currencies being converted using Purchasing Power Parities. To estimate initial and re-treatment costs, a payers' perspective was taken and direct medical costs estimated from fee item catalogues. Incremental-cost-effectiveness ratios (ICER) were used to express the cost difference per gained or lost effectiveness. RESULTS: Overall costs were lower for GH than CO in Croatia, Turkey and Serbia, while this difference was minimal in Italy. GH tended to survive longer than CO in Croatia and Italy, and shorter in Serbia and Turkey; overall survival time was not significantly different (p = 0.67/log-rank). The cost-effectiveness differences indicated CO to be more expensive at limited (ICER: 268.5 USD/month without any complications) or no benefit at all (-186.2 USD/month without major complications). CONCLUSIONS: GH was less costly than CO both initially and over 3 years. Efficacy differences were extremely limited. CLINICAL SIGNIFICANCE: Given their low initial costs and as efficacy between GH and CO did not differ significantly, GH had a high chance of being more cost-effective within this specific trial.

Clinical Performance of a Glass-Hybrid System Compared with a Resin Composite in the Posterior Region: Results of a 2-year Multicenter Study.

PURPOSE: To compare the clinical performance of a glass hybrid restorative system, EQUIA Forte, with that of a nanohybrid resin composite, Tetric EvoCeram, in two-surface class II cavities. MATERIALS AND METHODS: This multicenter, randomized controlled clinical study was conducted at four different dental schools. In total, 360 restorations were placed in patients in need of two class-II, two-surface restorations in the molar region of the same jaw. Each patient received one glass hybrid restoration (EQUIA Forte, GC) and one resin composite restoration (Tetric EvoCeram, Ivoclar Vivadent). Two independent evaluators performed a clinical evaluation of each site after 1 week (baseline), 1 year, and 2 years using the criteria of the FDI World Dental Federation (FDI-2). RESULTS: The estimated survival rates at the 2-year recall were 93.6% and 94.5% for EQUIA Forte and Tetric EvoCeram, respectively. There were no significant differences in the survival rates or in any of the evaluated esthetic, functional or biological properties between EQUIA Forte and Tetric EvoCeram restorations (p ˃ 0.05). CONCLUSION: Both the glass-hybrid restorative system and nanohybrid resin composite showed good clinical performance in moderate to large two-surface class II restorations in a 2-year follow-up.

Effect of re-use of a disposable micro-polisher on the surface of a microhybrid resin composite.

PURPOSE: To evaluate the surface roughness of Esthet-X resin-based composite with the multi-use of a one-step disposable diamond micro polisher PoGo with profilometer and scanning electron microscope (SEM). METHODS: 35 discs were obtained by condensing Esthet-X in an 8x2 mm plexiglass mold covered with a Mylar strip. The specimens were polymerized 40 seconds on both sides. Five Mylar strips' surfaces were used as a control. Six groups of five discs were formed by reusing the same PoGo disc 1, 2, 3, 4, 5 and 6 times. The surfaces of the 30 discs were ground wet with a 1200 grit silicon carbide paper and then polished 30 seconds with PoGo. The surface roughness was measured with Surtronic 4. One representative sample of each group was selected to visualize the surfaces morphology by SEM. The results were statistically evaluated by one-way ANOVA (P< 0.01). RESULTS: There were no statistical differences with the Mylar-created surfaces and one, two and three times' use of PoGo. Furthermore, reusing PoGo one to four times was not found to affect the surface roughness (P> 0.01). There were no differences with four and five re-uses of PoGo while using the same disc six times exhibited more roughness than single use and Mylar strip (P< 0.01). The SEM and the profilometer revealed similar results.

Clinical evaluation of different posterior resin composite materials: a 7-year report.

OBJECTIVES: The aim of this study was to investigate the clinical performance of 120 posterior composite restorations placed in 38 patients after a period of 7 years. METHOD AND MATERIALS: Eighty-eight Class I and 32 Class II restorations were made (93 molars and 27 premolars) using three different resin composite materials: Z100, Clearfil Ray-Posterior, and Prisma TPH. The restorations were evaluated using Ryge's criteria for color match, marginal discoloration, marginal adaptation, secondary caries, surface texture, and anatomic form at baseline, 1,2, 5, and 7 years. Photographs and radiographs were taken at each recall period. RESULTS: At 7-year recalls, 70 restorations were available for examination. Four restorations had failed due to secondary caries. Saliva sampling was performed to determine the level of mutans streptococci and lactobacilli for the four failed restorations at the last recall. No statistically significant differences were found among the materials in regard to color match, anatomic form, and secondary caries. Clearfil Ray-Posterior had statistically significantly rougher surface texture than the surrounding enamel compared to the other resin composites. Z100 showed more cavosurface margin discoloration after 5 years than the other two resin composites. All materials had slight marginal adaptation problems at the 7-year recall. There was no apparent relationship between the levels of mutans streptococci and lactobacilli in saliva and the failed restorations. CONCLUSION: The three posterior composites tested had acceptable clinical performance after 7 years.