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

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

Saliva Collection Methods Among Children and Adolescents: A Scoping Review.

OBJECTIVE: Saliva can be used for screening and diagnostic purposes. Although multiple saliva collection methods are available, their use in children can be limited due to lack of cooperation, developmental stage, and age. The aim of this scoping review was to comprehensively appraise the different methods of saliva collection among both children and adolescents by assessing the available scientific literature. METHODS: A literature search was performed using the databases PubMed, Embase, and Web of Science. Eligible studies on saliva collection methods among children and adolescents were included for this review. RESULTS: The literature search identified 249 eligible articles, of which 205 had a cross-sectional study design. Four distinct saliva collection methods have surfaced: the drooling method, the absorption method, the spitting method, and the suction method. Among infants or children under the age of 6 years, the suction and absorption methods were most preferred. The drooling and spitting methods were only applicable among children above the age of 3 years. When children were not willing to cooperate, the absorption method was most feasible. In adolescents and older children, no specific method was found to be preferred over another method. CONCLUSION: Overall, saliva collection is well tolerated by children and adolescents, with the absorption and suction methods being preferred with young and uncooperative children.

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

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

Is there an association between early childhood caries and iron deficiency anaemia?

Clinical question To determine the association between early childhood caries (ECC) and iron deficiency anaemia (IDA).Data sources A systematic search was carried out in seven databases by two independent reviewers. Also, manual searching and grey literature screening were carried out.Study selection Cross-sectional, case-control and cohort studies that evaluated the association between ECC and IDA were included. Only publications in the English language were considered for study eligibility.Data extraction and synthesis The characteristics of the included studies - age, sex, sample size, diagnostic methods used, index used for ECC, blood parameters, odds ration/risk ratio, confidence interval, p value, outcomes and assessment of any confounders - were extracted from the included papers. The quality assessment for case-control and cohort studies was performed according to the Newcastle-Ottawa assessment scale, while the modified Newcastle-Ottawa assessment scale was used for the cross-sectional studies.Results A total of 14 publications were included for qualitative review and seven of them were included in the meta-analysis. Children affected by ECC had an increased likelihood of IDA when compared to those not affected by ECC. However, the meta-analysis showed no statistical difference in blood parameters (haemoglobin, mean corpuscular volume and serum ferritin) in children with and without ECC.Conclusions There is an association between ECC and increased odds of IDA; however, there is a lack of scientific evidence to determine a cause and effect relation or direction of association between ECC and IDA.

General and paediatric dentists' knowledge, attitude and practises regarding the use of Silver Diammine Fluoride for the management of dental caries: a national survey in the Netherlands.

BACKGROUND: Silver Diammine Fluoride (SDF) is a topical medication used to arrest cavitated carious lesions non-invasively. The primary aim was to investigate, and analyse the relationships between; knowledge, attitudes and practises (including barriers and facilitators) for SDF use in the management of dental caries by general dental practitioners (GDPs) and paediatric dentists (PDs) in the Netherlands. A secondary aim was to explore any differences in these, between these groups. METHODS: A randomly selected sample of 600 Dutch GDPs (out of 9,502 respectively) and all 57 registered Dutch PDs were invited to participate in this cross-sectional survey, consisting of four sections: (1) participant characteristics, (2) knowledge (through responses to summative questions), (3) attitudes (through statement agreement using 5-point Likert scale), and (4) practises, use, barriers and facilitators (through multiple choice questions). RESULTS: The response rates were: GDPs 23% (n = 140) and PDs 47% (n = 27). Knowledge: out of 15 questions to test understanding of SDF, the mean number of correct answers were GDPs 6.7; standard deviation (SD) 2.6 and PDs 7.4, SD 2.2 with no significant difference. The mean overall attitude score showed positive attitudes towards SDF use for both groups. Compared to GDPs, PDs were more likely to use SDF (p < 0.001) and expected to increase their use (p = 0.037). The main barrier for users was parental acceptance (47%) and for non-users it was lack of knowledge (60%). The main facilitator for both users and non-users was gaining knowledge through courses and workshops, followed by written information leaflets about SDF for parents. CONCLUSION: Less than half of the knowledge questions about SDF were answered correctly. Despite low knowledge, attitude towards SDF use was positive. Practitioners believed that its use would be facilitated by professionals having more accessible information and training and by the availability of parent information leaflets. Furthermore, SDF is used more frequently by PDs than GDPs.

Stainless steel crown vs bulk fill composites for the restoration of primary molars post-pulpectomy: 1-year survival and acceptance results of a randomized clinical trial.

BACKGROUND: A key factor for the success and longevity of the endodontic treatment is sealing of the cavity after restorative treatment. AIM: The aim of this randomised clinical trial was to evaluate the 1-year survival of endodontic treatment in primary molars restored with stainless steel crowns (SSCs) and bulk fill composite resin (BF). As a secondary outcome, the acceptance of both children and parents was evaluated. DESIGN: Ninety-one 3- to 8-year-old children with at least one primary molar requiring endodontic treatment were selected. Participants were randomized to SSC or BF and evaluated after 1, 3, 6, and 12 months. An acceptance questionnaire was completed immediately after the treatment. The primary outcome was the endodontic treatment success, evaluated in the intention-to-treat (ITT) population using the Kaplan-Meier and non-inferiority Cox regression analyses, with a non-inferiority limit of 15%. Sensitivity analysis between the success rates after 1 year was performed using Miettinen-Nurminen's method. The Mann-Whitney test was used to compare the treatment acceptance (α = 5%). RESULTS: The survival rate after 1 year was BF = 75% and SSC = 88% (HR = 1.41; 90% CI 0.57-3.43). ITT analysis showed a success rate of BF = 86.7% and SSC = 82.6% (RR = 0.95; 0.78-1.16). The non-inferiority hypothesis between the survival of endodontic treatment could not be proved in both analyses (P > .05). The overall acceptance scores did not differ between the restorative groups (P > .05). CONCLUSION: This study failed to show non-inferiority of BF compared with the SSC. The materials were well accepted by both children and their parents.

Social capital and oral health in children and adolescents: A systematic review and meta-analysis.

OBJECTIVES: To systematically evaluate the association of individual and contextual social capital with oral health outcomes in children and adolescents. METHODS: Electronic searches were performed in PubMed/Medline, Embase, Web of Science and Scopus databases for articles published from 1966 up to June 2021. Two calibrated reviewers screened and critically appraised the identified papers. Observational studies that evaluated the relationship of individual or/and contextual social capital or their proxies with oral health outcomes in children and adolescents using validated methods were included. Quality assessment was conducted using the Newcastle-Ottawa Scale. Data were extracted for narrative synthesis and meta-analysis followed by a meta-regression model. Meta-analysis using random effects method was used to estimate pooled prevalence ratio (PR) and 95% confidence intervals (CI). RESULTS: Of the 3060 studies initially retrieved, 31 were included in the systematic review and 21 in the meta-analysis, totalling 81 241 individuals. The clinical outcomes included dental caries and gingival bleeding and subjective outcomes were oral health-related quality of life (OHRQoL) and self-rated oral health (SROH). Individuals with lower levels of individual social capital had a higher prevalence of poor clinical (PR 1.11; 95%CI 1.02-1.22) and subjective (PR 1.25; 95%CI 1.09-1.45) oral health conditions. The prevalence of worse clinical (PR 1.34; 95%CI 1.11-1.61) and subjective (PR 1.56; 95%CI 1.13-2.16) oral health outcomes were also associated with lower levels of contextual social capital. In general, the contextual level of social capital exerted more impact, and the subjective oral health outcomes were the more affected. CONCLUSIONS: Contextual and individual social capital were positively related to oral health outcomes, such as dental caries, gingival bleeding, SROH and OHRQoL in children and adolescents.

ART restorations for occluso-proximal cavities in primary molars: a two-year survival and cost analysis of an RCT comparing two GIC brands

Abstract There are many glass ionomer cements available on the Brazilian market for Atraumatic Restorative Treatment (ART), however, there is still a gap in the literature regarding their cost-effectiveness. Objectives To evaluate the influence of restorative materials (Ketac Molar, 3M ESPE; and Vitro Molar, Nova DFL) in the two-year survival rate and cost-effectiveness of occluso-proximal ART restorations in primary molars. Methodology A total of 117 children (aged four to eight years) with at least one occluso-proximal carious lesion in primary molars were selected and randomly divided in treatment groups (KM or VM) in this parallel randomized controlled trial. Treatments followed ART premises and were conducted in public schools by trained operators in Barueri, Brazil. A trained, calibrated, and blinded examiner performed the evaluations after two, six, 12, and 24 months (k=0.92). Kaplan-Meier survival analysis was used to estimate restoration survival and Cox regression was used to test the association with clinical factors (α=5%). For cost analysis, material and professional costs were considered. Monte Carlo analysis was used to generate a cost-effectiveness plane and bootstrapping was used to compare material costs over the years. Results The overall survival rate was 36.9% after two years (48.6% for KM and 25.4% for VM). Restorations with VM failed more than those with KM (HR=1.70; 95% CI=1.06-2.73; p=0.027). VM presented lower initial cost, but no difference was observed between groups considering the two-year incremental cost. Conclusion After a two-year evaluation, KM proved to be a better option than VM for occluso-proximal ART restorations in primary molars. ClinicalTrials.gov: NCT02267720

Glass Ionomer Sealants Can Prevent Dental Caries but Cannot Prevent Posteruptive Breakdown on Molars Affected by Molar Incisor Hypomineralization: One-Year Results of a Randomized Clinical Trial.

To evaluate the preventive effect of glass ionomer cement (GIC) against dental caries and posteruptive breakdown (PEB) on molars affected by molar incisor hypomineralization (MIH). In this randomized clinical trial, 77 children aged 5-9 years with at least 1 MIH-affected molar and without PEB or dentin caries lesions (n = 228) were included and randomly allocated to one of the following groups: (1) MIH-affected molars that remained unsealed and (2) MIH-affected molars that received GIC sealants. Dental caries and PEB were clinically evaluated after 6 and 12 months. Associations between dental caries and PEB with independent variables were evaluated using logistic regression analysis (p < 0.05). The MIH-affected molars allocated to the GIC sealant group were less likely to develop dental caries compared to those allocated to the unsealed group (OR = 0.23; 95% CI 0.06-0.95). Conversely, application of a GIC sealant was not associated with prevention of PEB (p = 0.313). Furthermore, MIH-affected molars presenting yellow-brown opacities were almost 5 times more likely to develop dental caries (p = 0.013) and PEB (p = 0.001) compared to those presenting white-creamy opacities. We can conclude that GIC sealants can prevent dental caries on MIH-affected molars; however, the same protective effect was not observed for PEB.

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

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

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

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

Is it worth using low-cost glass ionomer cements for occlusal ART restorations in primary molars? 2-year survival and cost analysis of a Randomized clinical trial.

OBJECTIVE: To evaluate the 2-year survival rate and the cost-effectiveness of Atraumatic Restorative Treatment (ART) using three different glass ionomer cements (GICs) for restoring occlusal dentin caries lesions in primary molars. METHODS: One hundred and fifty (150) 4-8-year-old children were selected, randomly allocated and treated in school tables according to the restorative material: Fuji IX Gold Label (GC Corp), Vitro Molar (nova DFL) and Maxxion R (FGM), the latter two being low-cost brands. Materials and professionals' costs were considered to analyse baseline total cost, and from this the cumulative cost of each treatment was calculated. Restoration assessments were performed after 2, 6, 12 and 24 months by an independent calibrated examiner. Restoration survival was estimated using Kaplan-Meier survival analysis and Cox regression was used to test association with clinical factors. Bootstrap regression (1,000 replications) compared material´s cost over time and Monte-Carlo simulation was used to build cost-effectiveness scatter plots. RESULTS: The overall survival rate of occlusal ART restorations after 2 years was 53% (Fuji IX = 72.7%; Vitro Molar = 46.5%; Maxxion R = 39.6%). Restorations performed with Vitro Molar and Maxxion R were more likely to fail when compared to Fuji IX. At baseline, Fuji IX was the more expensive option (p < 0.001), however, considering the simulation of accumulated cost caused by failures until 2-year evaluation, no difference was found between the groups. CONCLUSIONS: After 2 years' follow up, restorations performed with Fuji IX proved to be superior in terms of survival, with a similar overall cost, when compared to low-cost glass ionomers cements (Vitro Molar and Maxxion R).

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

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

Surface Conditioning Prior to the Application of Glass-Ionomer Cement: A Systematic Review and Meta-analysis.

PURPOSE: To systematically review the literature to determine whether the laboratory and clinical performance of glass-ionomer cement (GIC) is influenced by surface conditioning with polyacrylic acid (PAA). MATERIALS AND METHODS: This systematic review was conducted according to PRISMA and registered in PROSPERO (CRD42016039305). A comprehensive literature search was conducted in seven electronic databases considering clinical and laboratory studies published up to July 2018, with no limit on year of publication. Two reviewers independently selected papers, extracted data, and assessed the risk of bias. Of 141 eligible studies, 23 were fully analyzed. A total of 15 studies (12 laboratory and three clinical trials) were included in the systematic review and three laboratory studies concerning the microtensile bond strength (µTBS) were included in the meta-analysis. RESULTS: The meta-analysis showed that pretreating the surface with PAA before using GIC significantly improved the µTBS (OR = 3.17; 95% CI: 0.51-5.83; p = 0.02). In the longitudinal clinical trials, no significant difference was observed between applying PAA or not into the cavities before using GIC. Risk of bias was considered high in all study designs. CONCLUSION: Surface preconditioning with PAA has a positive effect on the bond strength of GIC. However, this finding was not confirmed in longitudinal clinical trials.

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

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

Clinical wear of approximal glass ionomer restorations protected with a nanofilled self-adhesive light-cured protective coating.

OBJECTIVE: High viscous glass ionomer cement (GIC) has gained popularity as a restorative material; however, high wear is pointed as one of the major drawbacks of this material. Protective surface coatings were developed to protect GIC from water contamination with the additional advantage of occluding any surface cracks or porosities commonly found in this material, possibly resulting in an increased wear resistance of the restorations. The objective of this study was to investigate the clinical wear of GIC approximal restorations in primary molars protected either with a nanofilled self-adhesive light-cured protective coating (NPC) or with petroleum jelly. MATERIAL AND METHODS: Approximal caries lesions in primary molars from 32 schoolchildren previously enrolled in another clinical trial were included in this investigation. GIC restorations were performed according to the Atraumatic Restorative Treatment approach and protected with either petroleum jelly or a NPC. Impressions of the restored hemiarch were done after 1 day and 6, 12, 24 and 36 months. The impressions were scanned in a 3-D appliance and the obtained images were superimposed using an appropriate computer software. Two-way ANOVA for repeated measures and Tukey's post-hoc test were used to analyze the wear of restorations (α=5%). RESULTS: A significant difference was found between the two groups, with a wear protection offered by the application of a NPC. Conclusion: These results suggest that the application of a NPC has a protective effect on the clinical wear of approximal GIC restorations in primary teeth.

Clinical wear of approximal glass ionomer restorations protected with a nanofilled self-adhesive light-cured protective coating

Abstract High viscous glass ionomer cement (GIC) has gained popularity as a restorative material; however, high wear is pointed as one of the major drawbacks of this material. Protective surface coatings were developed to protect GIC from water contamination with the additional advantage of occluding any surface cracks or porosities commonly found in this material, possibly resulting in an increased wear resistance of the restorations. Objective: The objective of this study was to investigate the clinical wear of GIC approximal restorations in primary molars protected either with a nanofilled self-adhesive light-cured protective coating (NPC) or with petroleum jelly. Material and Methods: Approximal caries lesions in primary molars from 32 schoolchildren previously enrolled in another clinical trial were included in this investigation. GIC restorations were performed according to the Atraumatic Restorative Treatment approach and protected with either petroleum jelly or a NPC. Impressions of the restored hemiarch were done after 1 day and 6, 12, 24 and 36 months. The impressions were scanned in a 3-D appliance and the obtained images were superimposed using an appropriate computer software. Two-way ANOVA for repeated measures and Tukey's post-hoc test were used to analyze the wear of restorations (α=5%). Results: A significant difference was found between the two groups, with a wear protection offered by the application of a NPC. Conclusion: These results suggest that the application of a NPC has a protective effect on the clinical wear of approximal GIC restorations in primary teeth.

ART is an alternative for restoring occlusoproximal cavities in primary teeth - evidence from an updated systematic review and meta-analysis.

BACKGROUND: A previous systematic review showed that atraumatic restorative treatment (ART) can be an option to restore the occlusoproximal cavities in primary teeth; however, few studies fulfilled the criteria of inclusion to generate a high level of evidence. AIM: To update the existing systematic review and address questions regarding survival rate of ART restorations compared to the conventional approach in occlusoproximal cavities in primary molars. DESIGN: The search was extended beyond the original search through the PubMed/MEDLINE database up to February 2016. Furthermore, Web of Science and EMBASE were searched. The inclusion criteria were subjects related to the scope of the systematic review. After selection by title and abstract, potentially eligible articles were read in full and included in accordance with exclusion criteria. Meta-analysis was carried out with the outcome being the survival rate of restorations. RESULTS: The search strategy identified 560 potentially relevant studies, in addition to 127 from the original systematic review. A total of four articles were included in the qualitative and quantitative analyses. Meta-analysis showed no statistically significant difference between ART and conventional approaches in survival rate of occlusoproximal cavities (OR = 0.887, 95% CI: 0.574-1.371). CONCLUSION: ART restorations have similar survival rate compared to conventional treatment and can be considered an option to restore occlusoproximal cavities in primary molars.

Effectiveness of conventional treatment using bulk-fill composite resin versus Atraumatic Restorative Treatments in primary and permanent dentition: a pragmatic randomized clinical trial.

BACKGROUND: Clinical studies are being conducted in less strict conditions in order to establish an adequate scientific basis for decision making. The aim of this pragmatic randomized clinical trial is to evaluate the effectiveness of single and multiple-surfaces restorations performed following the Atraumatic Restorative Treatment (ART) premises compared with Conventional Treatment (CT) using bulk fill composite restorations in primary and permanent teeth. METHODS/DESIGN: A total of 1,214 5-to-13 year-old children with at least one single or multiple-surface dentin caries lesion in primary or permanent molars will be selected in public schools of Barueri-SP, Brazil. The participants will be randomly assigned into 2 groups: CT (caries removal with bur and restoration performed with Scotchbond™ Universal Adhesive system associated with Filtek Bulk Fill - 3 M/ESPE) and ART (Caries removal with hand instruments and restoration with high viscosity glass ionomer cement Ketac Molar Easy Mix - 3 M/ESPE). Ten untrained dentists will perform the treatment in in dental offices located at public schools. The restorations will be evaluated after 6, 12 and 24 months by an independent trained and calibrated examiner. The restoration and tooth survival, the cost-effectiveness analysis between the two groups and the operators' preferences regarding the techniques will be also evaluated. Kaplan-Meier survival analysis and log-rank test will be applied for the restoration and tooth survival. All the average event rates in the two groups will be modelled and compared with a Cox proportional hazard shared frailty model since there is an operator-cluster effect. The significance level for all analyses will be 5 %. DISCUSSION: Our hypothesis is that despite similar expected effectiveness between ART using high viscosity GIC and conventional treatment using bulk fill composite resin when treating single or multiple-surface in posterior primary and permanent teeth, ART will present superior cost-effectiveness. The results of this trial will support decision-making by clinicians and policy makers. TRIAL REGISTRATION: NCT02568917 . Registered on May 10th 2015.

Atraumatic Restorative Treatment compared to the Hall Technique for occluso-proximal cavities in primary molars: study protocol for a randomized controlled trial.

BACKGROUND: In many parts of the world, school-age children have high dental treatment needs; however, there is often low, or no, dental care provision. Although Atraumatic Restorative Treatment (ART) was developed to address this, its survival rate in occluso-proximal lesions is low. An alternative, the Hall Technique (HT) has shown better relative outcomes for occluso-proximal lesions, but has not been directly compared to ART or tested in field settings. This trial will compare ART and the HT for the most clinically- and cost-effective strategy for managing occluso-proximal lesions in primary molars, in a school setting, using low-technology and child-friendly dental techniques. METHODS/DESIGN: This two-arm, parallel group, patient-randomized controlled, superiority trial will have treatment provided in schools. Schoolchildren (n = 124, age 6-8) with at least one occluso-proximal carious primary molar lesion will have random allocation to treatment with ART or HT. Baseline measures and outcome data will be assessed through participant report, clinical examination and parent report/questionnaires. The primary outcome is survival rate, a composite measure of absence of Minor Failures (a defect in the restoration/crown, but not interfering with tooth health) and Major Failures (signs or symptoms of irreversible pulp damage, such as dental fistula/abscess, tooth fracture or failures that cannot be repaired). Secondary outcomes are: (1) child-reported discomfort, (2) childrens' and (3) parents' concerns around dental appearance and (4) acceptability of treatments, (5) occlusal-vertical dimensions (OVD) changes, (6) plaque index, (7) gingival health, (8) decayed, missing, filled teeth in permanent teeth (DMFT)/decayed, missing, filled teeth in primary teeth (dmft), (9) oral health-related-quality of life, reported by children and parents/caregivers, (10) the incremental cost-effectiveness, and (11) operator effect. A trained and calibrated examiner will evaluate the treated teeth after 1 week, then 1, 6, 12, 24 and 36 months post treatment. Kaplan-Meier and Cox regression tests will be used to investigate the primary outcome. The Mann-Whitney or t test, Friedman test, paired t test or Wilcoxon test and Ordinal Logistic Regression Analysis will be used to analyze the secondary outcomes. DISCUSSION: The results of this trial will support decision-making by clinicians and policy-makers for managing occluso-proximal lesions in settings with constrained resources and limited dental access. TRIAL REGISTRATION: www.clinicaltrials.gov, NCT02569047 , registered 5 October 2015.