Systematic review and meta-analysis on the effect of self-assembling peptide P11-4 on arrest, cavitation, and progression of initial caries lesions.

BACKGROUND: Simple noninvasive evidence-based interventions for caries are needed to overcome limitations in the restorative paradigm. The self-assembling peptide P11-4 is a noninvasive intervention that regenerates enamel in initial caries lesions. STUDIES REVIEWED: The authors conducted a systematic review and meta-analysis on the effectiveness of the P11-4 products Curodont Repair (Credentis; now manufactured by vVARDIS) (CR) and Curodont Repair Fluoride Plus (Credentis; now manufactured by vVARDIS) on initial caries lesions. Primary outcomes were lesion progression after 24 months, caries arrest, and cavitation. Secondary outcomes were changes in merged International Caries Detection and Assessment System score categories, quantitative light-induced fluorescence (QLF; Inspektor Research System), esthetic appearance, and lesion size. RESULTS: Six clinical trials met the inclusion criteria. Results of this review represent 2 primary and 2 secondary outcomes. When compared with parallel groups, use of CR likely results in a large increase in caries arrest (relative risk [RR], 1.82 [95% CI, 1.32 to 2.50]; 45% attributable risk [95% CI, 24% to 60%]; number needed to treat [NNT], 2.8) and likely decreases lesion size by a mean (SD) of 32% (28%). The evidence also suggests that use of CR results in a large reduction in cavitation (RR, 0.32 [95% CI, 0.10 to 1.06]; NNT, 6.9) and is uncertain about lowering merged International Caries Detection and Assessment System score (RR, 3.68 [95% CI, 0.42 to 32.3]; NNT, 19). No studies used Curodont Repair Fluoride Plus. No studies reported adverse esthetic changes. PRACTICAL IMPLICATIONS: CR likely has clinically important effects on caries arrest and decreased lesion size. Two trials had nonmasked assessors, and all trials had elevated risks of bias. The authors recommend conducting longer trials. CR is a promising treatment for initial caries lesions. The protocol for this systematic review was registered a priori with PROSPERO (304794).

Clinical Instructions for Using Silver Diamine Fluoride (SDF) in Dental Caries Management.

Manufacturer instructions for 38% silver diamine fluoride (SDF) are limited to current FDA clearance for tooth desensitization. There is a need for instructions to provide best-practice recommendations for off-label use of SDF for caries prevention and arrest. METHODS: The authors considered existing clinical approaches to the use of 38% SDF at pH 10 for the prevention and arrest of active dental caries, in light of the best current evidence. Application of SDF, with or without subsequent direct restoration, is included. The content was reviewed by stakeholders including but not limited to those listed on the consensus statement (Appendix A, below). RESULTS: 38% SDF for the prevention and arrest of active caries lesions, as well as compatibility with common direct restorative materials, such as glass-ionomer cement and resin composite, has a foundation in the scientific literature. A practical decision-flow diagram and accompanying best practices for treatment of caries lesions, based on clinical access and intention to restore, were developed based on available evidence and expert clinical observation when no evidence was available. CONCLUSIONS: Based on the best available evidence, a logical approach can be adopted regarding the practical use of 38% SDF for caries prevention and arrest. PRACTICAL IMPLICATIONS: SDF used as per these instructions for prevention on high-risk tooth surfaces and arrest of active caries lesions has a place in the practitioner's dental caries management armamentarium. When SDF is applied to active lesions, it can be used with or without subsequent restoration, depending on clinical context, expert judgment, and patient input.

The use of silver diamine fluoride (SDF) in dental practice.

Silver diamine fluoride (SDF) is a clear, odourless liquid indicated for desensitisation of non-carious tooth lesions and molar incisor hypomineralisation. It is also useful for arresting carious lesions in adults and children who are high caries-risk and/or have difficult-to-control, progressing carious lesions, those who are unable to tolerate invasive treatment, elderly populations, and those who are medically compromised or have additional care and support needs. SDF may be used to manage lesions that are too extensive to restore but not associated with pain and/or infection. This can be important particularly where extractions might be contra-indicated for medical or behavioural reasons. This paper summarises the global evidence for the effectiveness and safety of SDF, describes what it is, its mechanisms of action and presents recommendations on how to use it. There are details on indications/contra-indications and risks/benefits to be considered in the use of SDF also discussion of how to approach SDF's side effect of black staining of carious tooth tissue. We give an example of an information sheet (Appendix S1, see online supplementary information) that may be used when discussing SDF with patients, particularly for primary teeth in children, but adaptable for the permanent dentition and for adults.

Clinical outcomes for primary anterior teeth treated with preveneered stainless steel crowns.

PURPOSE: The purpose of this retrospective study was to explore clinical outcomes for NuSmile anterior preveneered stainless steel crowns. METHODS: A convenience sample of healthy children treated with anterior crowns was selected from a teaching clinic and private office. Crowns were placed by either a private practice dentist or pediatric dental resident. Clearly defined clinical outcomes were assessed by 3 calibrated examiners at recall, including: (1) presence; (2) chipping; (3) wear; (4) crazing; and (5) marginal location by clinical and radiographic examination. Factors affecting placement--such as operator experience and behavior--were also assessed. RESULTS: In 46 subjects (21 females, 25 males; mean age at placement=4 years, 2 months), 226 crowns with a mean post-placement time of 12.9 months were evaluated. Only 2 crowns matched natural teeth, with NuSmile crowns lighter in 83% of subjects. Most crowns (86%) were normal in size. Eighty-eight percent resisted fracture for 6 months. All but 3 crowns resisted color change for 6 months. Canine crowns were the least successful, but overall 91% of crowns retained good to excellent clinical appearance. CONCLUSIONS: NuSmile anterior preveneered crowns are a clinically successful restoration for primary incisors with early childhood caries.

Parental satisfaction with preveneered stainless steel crowns for primary anterior teeth.

PURPOSE: The purpose of this study was to evaluate parental satisfaction with preveneered stainless steel crowns placed on their child. METHODS: A questionnaire using a 5-point Likert-type scale was administered by a trained assistant to a convenience sample of 58 parents at recall of their child at least 6 months after placement of preveneered stainless steel crowns (PVSSCs; NuSmile). The questionnaire asked about: (1) durability; (2) color; (3) size; and (4) shape. Fifty-eight children ranged in age from 18 months to 12 years were approached for participation. Crowns were placed by pediatric dental residents or private practice pediatric dentists. RESULTS: Fifty-four of 58 parent questionnaires were usable. The average age of the children was 5 years, 2 months at recall. The children had crowns present an overage of 13 months at evaluation. Overall, parental acceptance of NuSmile PVSSCs was very high at 93% (N=50). Parents were most satisfied with the crown's: (1) size (N=52; 97%); (2) shape (N=51; 94%); (3) shade and retention (N=48; 89%); (4) metal visibility (N=40; 74%); and (5) durability (N=38; 70%). Forty-three parents (80%) stated that their children were satisfied with the crowns. CONCLUSIONS: Parent satisfaction with the NuSmile preveneered stainless steel crowns was very high.