Resin infiltration versus fluoride varnish for visual improvement of white spot lesions during multibracket treatment. A randomized-controlled clinical trial.

AIMS: This study aimed to evaluate the visual improvement of resin infiltration of white spot lesions (WSL) during orthodontic treatment with the multibracket appliance (MBA) compared to fluoride varnish. METHODS: Patients aged 12-17 years with at least one WSL with an International Caries Detection and Assessment System (ICDAS) score of 1-2 during an active MBA treatment were included and randomized to receive either resin infiltration (Icon) or fluoride application (Flairesse). Standardized digital images were obtained before, one-day, one-week, one-month, three-months and six-months after treatment using a DSLR camera and a matching polarization filter. A grey reference card was used for color standardization. A Matlab routine was used to measure the color difference between adjacent healthy enamel and treated WSL. The independent-samples t-test was used for intergroup and paired-samples t-test for intragroup comparison. RESULTS: Images of 116 teeth from 36 patients were analyzed. The ΔE for the "Icon" treated WSL was smaller (T1ICON = 5.0 ± 1.4) than in the fluoride group (T1Fluoride = 8.4 ± 3.2). Caries infiltration significantly improved the aesthetic appearance of WSL (p < 0.001), which remained satisfactory at six months (T5ICON = 5.2 ± 1.6). CONCLUSION: WSL infiltration management during orthodontic treatment was superior to topical fluoridation in not only arresting the enamel lesions but also significantly improving the aesthetic appearance of demineralized regions around the brackets. CLINICAL RELEVANCE: WSL treatment in orthodontic patients is usually initiated after debonding. Research has shown that the earlier WSL is treated, the better the aesthetic outcome. There is limited data on the efficacy of resin infiltration of WSL during orthodontic treatment.

Microhardness and elemental analysis of ion-releasing restoration/ dentin interface following enzymatic chemomechanical caries excavation.

BACKGROUND: This study was conducted to compare chemical, elemental and surface properties of sound and carious dentin after application of two restorative materials resin-modified glassionomer claimed to be bioactive and glass hybrid restorative material after enzymatic chemomechanical caries removal (CMCR) agent. METHODS: Forty carious and twenty non-carious human permanent molars were used. Molars were randomly distributed into three main groups: Group 1 (negative control) - sound molars, Group 2 (positive control) - molars were left without caries removal and Group 3 (Test Group) caries excavated with enzymatic based CMCR agent. After caries excavation and restoration application, all specimens were prepared Vickers microhardness test (VHN), for elemental analysis using Energy Dispersive Xray (EDX) mapping and finally chemical analysis using Micro-Raman microscopy. RESULTS: Vickers microhardness values of dentin with the claimed bioactive GIC specimens was statistically higher than with glass hybrid GIC specimens. EDX analysis at the junction estimated: Calcium and Phosphorus of the glass hybrid GIC showed insignificantly higher mean valued than that of the bioactive GIC. Silica and Aluminum mean values at the junction were significantly higher with bioactive GIC specimens than glass hybrid GIC specimen. Micro-raman spectroscopy revealed that bioactive GIC specimens showed higher frequencies of v 1 PO 4, which indicated high level of remineralization. CONCLUSIONS: It was concluded that ion-releasing bioactive resin-based restorative material had increased the microhardness and remineralization rate of carries affected and sound dentin. In addition, enzymatic caries excavation with papain-based CMCR agent has no adverse effect on dentin substrate.

Potential factors affecting the success rate of indirect pulp therapy in primary molars with deep caries: a retrospective study.

Indirect pulp therapy (IPT) is a common conservative treatment for deep dental caries. However, the potential risk factors for the prognosis of IPT have not been well studied. This study retrospectively investigated the success rate of IPT in treating primary molars with deep caries and the factors potentially affecting the two-year success rate. A total of 303 primary molars in 202 children (106 boys and 96 girls) were included in this study. These primary molars were identified as having deep caries by clinical and radiographic examinations and were treated with IPT. The factors potentially affecting the IPT success rate were analyzed after two years of follow-up. The results indicated that the two-year IPT success rate was 86% (262/303). The success rate of primary molars with and without stainless steel crowns was 96% (120/125) and 80% (142/178), respectively. Primary molars treated with stainless steel crowns showed a significantly lower risk of failure (hazard ratio (HR) = 0.18, 95% confidence interval (CI): (0.10, 0.34), p = 0.01). There were no significant differences in other factors, including gender (male vs. female), age (preschool vs. school age), cooperation level (Frankl 2 vs. 3 or 4 scales), arch type (maxillary vs. mandibular), tooth type (first vs. second primary molar), or pulp capping material (calcium hydroxide vs. glass ionomer cement). IPT is an effective, conservative treatment modality for primary molars with deep caries. Stainless steel crowns could significantly improve the IPT success rate.

Vitamin D deficiency and chronological hypoplasia with hypomineralisation: a case report.

Patients being reported for vitamin D deficiency (VDD) are increasing, particularly among the children and adolescents. This study aims to manifest the clinical and dental evaluations of a child with VDD, referred to the dental office. A 10-year-old British Asian boy was referred to the paediatric specialist dentistry clinic by the general dentist for dental management. The medical history depicted that the patient was diagnosed with VDD, secondary hyperparathyroidism and delayed growth. Moreover, his mother had the VDD during pregnancy. The patient was breast fed and had rickets in infancy. He was prescribed vitamin D supplements at the age of 16 months. He had received multiple dental treatments under local anaesthesia but with limited cooperation. Clinical examination revealed that the patient had chronological enamel hypoplasia shown as bands at the occlusal third on specific teeth. Suboptimal hygiene with general plaque induced gingivitis, dental caries in permanent and primary teeth, and delayed the teeth eruption. Preventions included appropriate oral hygiene and dietary advice, fluoride varnish application and fissure sealant placement. The treatments included anterior direct composite restoration, posterior composite restoration, stainless steel crowns and extractions. Thorough medical history is essential to understand the underlying causes of dental defects. Early dental intervention can restore the patient appearance and function and prevent further dental damage.

[The impact of laser radiation on the effectiveness of therapeutic treatment of dental patients]. / Vliyanie lazernogo izlucheniya na effektivnost' terapevticheskogo lecheniya stomatologicheskikh bol'nykh.

The paper presents an overview of modern scientific data on the study of the effect of laser radiation on biological tissues of the mouth in the therapeutic treatment of dental diseases. The use of lasers in the treatment of dental caries and its complications, non-carious lesions of hard dental tissues, as well as the use of lasers in the treatment of periodontal diseases and aesthetic restoration of teeth is considered.

Clinical influencing factors of vital pulp therapy on pulpitis permanent teeth with 2 calcium silicate-based materials: A randomized clinical trial.

BACKGROUND: Compared with traditional root canal therapy (RCT), vital pulp therapy (VPT) is a personalized and minimally invasive method for the treatment of pulpitis caused by dental caries. However, there are still no clear guidelines for VPT because high-quality randomized clinical trials are scarce. This prospective cohort study evaluated the clinical efficacy of VPT with the light-curable calcium silicate-based material TheraCal LC (TH) and bioceramic material iRoot BP Plus (BP) in reversible and irreversible pulpitis permanent teeth with carious exposures. METHODS: 115 teeth with reversible or irreversible pulpitis caused by deep care were randomly divided into 2 groups. TheraCal LC and iRoot BP Plus were used for the pulp capping. Direct pulp capping (DPC), partial pulpotomy (PP) and full pulpotomy (FP) were performed based on observation of the exposed pulp. Postoperative discomforts were enquired and recorded via follow-up phone calls. Clinical and radiographic evaluations were performed 3, 6, and 12 months postoperatively. RESULTS: The overall clinical success rate in the first year was 90.4% (47/52) in both groups. The TH group required less operating time, showed lower levels of pain, and had shorter pain duration post-operative (P < .001). According to the binary logistic regression model, preoperative pain duration was significantly correlated with the prognosis of VPT (P = .011). CONCLUSION: VPT with TheraCal LC and iRoot BP Plus in pulpitis permanent carious teeth both achieved good clinical outcomes, and TheraCal LC can be easily operated for clinical use. Preoperative pain duration of the affected tooth might have a significant correlation with the prognosis of VPT.

Long-term performance of ceramic in/-onlays vs. cast gold partial crowns - a retrospective clinical study.

OBJECTIVES: To assess the long-term clinical performance of ceramic in-/onlays (CIOs) and cast gold partial crowns (CGPCs) in posterior teeth in terms of success, survival, complications (biological, technical) and quality. MATERIAL AND METHODS: In a retrospective study, a total of 325 patients were recorded after up to 24.8 years (mean 13.9 ± 3.8 years) having (pre-)molars restored with CIO (Empress I, Ivoclar Vivadent, n = 161) and CGPC (Degunorm, DeguDent, n = 164) by supervised undergraduate students. A total of 296 restorations were assessed clinically and radiologically in healthy and endodontically treated teeth using modified United States Public Health Service (USPHS) criteria. Cumulative success and survival rates of the restorations were calculated using Kaplan-Meier estimates. Biological and technical complications were recorded. Status of oral health comprising caries risk and localized periodontitis were assessed. RESULTS: The cumulative success rates of CIOs were 92.1% and of CGPCs 84.2% after mean service times of 14.5 years. The annual failure rates of total service times were 0.5% in teeth restored with CIO (n = 155) and 0.7% in teeth restored with CGPC (n = 163). The cumulative survival rates of CIOs were 93.9% after a mean service time of 15.2 years and decreased to 91.7% after 23.5 years. The cumulative survival rates of CGPCs were 92.6% after a mean service time of 14.9 years and 91.8% after 23.5 years. Complications in CIOs (n = 149) were ceramic fracture (6.7%), secondary caries (4.7%), endodontic complication (2.7%) and tooth fracture (1.3%) compared to CGPCs (n = 147) with endodontic complication (8.8%), secondary caries (4.8%) and decementation (2.0%). Endodontically treated teeth restored with CIO or CGPC revealed significantly less often success compared with corresponding vital teeth (p = .02). CIOs and CGPCs revealed clinically and radiographically good and excellent qualities with 71.8% (107/149) and 68% (100/147) without any significant differences regarding type of restoration. CONCLUSIONS: Both CIOs and CGPCs achieved high survival rates up to 24.8 years when performed by supervised undergraduate students. The longevity of the restorations may benefit from the intraoral repair of accessible defects and, in case of pulp infection or necrosis, an adequate endodontic management. CLINICAL RELEVANCE: CIOs and CGPCs made by supervised undergraduate students are proper restoration types in posterior teeth in the long-term. An adequate preparation design, meticulous care in the inserting technique and constant biofilm removal due to proper oral hygiene combined with professional maintenance care are substantial. The clinical long-term performance was mostly limited by ceramic fractures in CIOs and endodontic complications in CGPCs.

Comparison of three-dimensional printed resin crowns and preformed stainless steel crowns for primary molar restorations: a randomized controlled trial.

The importance of aesthetics in children has increased over time. Therefore, this multicenter randomized clinical trial aimed to analyze and compare three-dimensional (3D)-printed resin crowns (RCs) as a potential alternative to stainless-steel crowns (SSCs) for restoring primary molars with extensive carious lesions. According to the null hypothesis, no statistically significant difference was observed in restoration failure between RC and SSC groups. A total of 56 primary molars after pulp treatment at two dental hospitals were included. After pulp treatment, the teeth were randomly divided into two groups: SSCs (n = 28) and RCs (n = 28). At 1 week and 3, 6 and 12 months, the Quigley-Hein plaque index (QHI), gingival index (GI), occlusal wear, and survival rate were assessed by examination, radiography and alginate impressions. No significant difference in QHI was observed between the two groups. However, the GI at 12 months and occlusal wear in the RC group were significantly higher than those in the SSC group (p < 0.05). The survival rates were 100% in the SSC group and 82.1% in the RC group (p = 0.047). Cracks and discoloration were also observed in the RCs. Within the limitations of this study, 3D-printed RCs are aesthetically superior to SSCs and clinically easy to repair. However, if clinical effectiveness and safety are improved, RCs could potentially become a viable aesthetic alternative in the future.

Evaluation of Papacarie®, Carie-Care™, BRIX3000™ and conventional hand instrumentation for caries removal in primary teeth: a randomized control study.

In the current odontological era, carious lesions are removed while tooth tissue is preserved. Most of these ideals are met by chemomechanical caries removal (CMCR) methods, which are easy and comfortable to use, differentiate and eliminate infected tissues, minimize pressure, vibration and heat, and are cost-effective. This study examines the efficacy of commercially available CMCR agents, namely Papacarie®, Carie-Care™ and BRIX3000™, and a conventional hand instrumentation method for caries removal in deciduous molars in terms of time consumption, ease of application, and pain perception. For this randomized clinical trial, 120 children aged 4 to 9 years were selected and randomly allocated to four groups of 30 patients each. Time consumption, ease of application, and pain perception were evaluated at three intervals: pre-, during- and post-caries removal, using Wong-Baker FACES (WBF) Pain Rating Scale and the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The results showed that among the compared materials and conventional hand instrumentation technique, Carie-Care™ was statistically found to be the least time-consuming with a p-value of 0.019, have the least pain perception with a p-value of 0.02, and was clinically the best with respect to manipulation and handling. While all three CMCR agents aid in the removal of carious tissue, Carie-Care™ was the most effective based on time consumption, pain perception and simplicity of administration.

Two-year clinical and radiographic evaluation of ACTIVA BioACTIVE versus Compomer (Dyract® eXtra) in the restoration of class-2 cavities of primary molars: a non-inferior split-mouth randomised clinical trial.

OBJECTIVES: The trial aimed to compare the clinical performance and radiographic success of ACTIVA BioACTIVE versus Compomer in restoring class-II cavities of primary molars. MATERIALS AND METHODS: A non-inferior split-mouth design was considered. A pre-calculated sample size of 96 molars (48 per group) with class-2 cavities of twenty-one children whose ages ranged from 5 to 10 years were randomly included in the trial. Pre-operative Plaque Index (PI), DMFT/dmft scores and the time required to fill the cavity were recorded. Over 24 months, the teeth were clinically evaluated every six months and radiographically every 12 months by two calibrated and blinded evaluators using the United States public health service (USPHS)-Ryge criteria. The two-sided 95% confidence interval (CI) for the difference in success rate was considered to assess non-inferiority, and the margin was set at -18%. The linear mixed model and Firth's logistic regression model were used for data analysis (P < 0.05). RESULTS: After 24 months, 86 teeth (43 per group) were evaluated. The mean PI score was 1.1(± 0.9), while DMFT/dmft was 0.35 (± 0.74) and 6.55 (± 2.25) respectively. The clinical and radiographic success rate of Dyract vs. ACTIVA was 95.3% and 88.3% vs. 93% and 86%, respectively. The two-sided 95% CI for the difference in success rate (-2.3%) was - 3.2 to 1.3% and didn't reach the predetermined margin of -18% which had been anticipated as the non-inferiority margin. Clinically, ACTIVA had a significantly better colour match (P = 0.002) but worse marginal discolouration (P = 0.0143). There were no significant differences regarding other clinical or radiographic criteria (P > 0.05). ACTIVA took significantly less placement time than Dyract, with a mean difference of 2.37 (± 0.63) minutes (P < 0.001). CONCLUSION: The performance of ACTIVA was not inferior to Dyract and both materials had a comparable high clinical and radiographic performance in children with high-caries experience. ACTIVA had a significantly better colour match but more marginal discolouration. It took significantly less time to be placed in the oral cavity. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov on 4 May 2018 (#NCT03516838).

A scoping review of guidelines on caries management for children and young people to inform UK undergraduate core curriculum development.

BACKGROUND: Current evidence in cariology teaching is not consistently reflected in paediatric dentistry in the United Kingdom (UK). Many dental schools are not consistently teaching biological approaches to caries management, with outdated or complex methods being taught outwith the purview of general dental practitioners. This scoping review aimed to map current guidelines on the management of caries in children and young people. This is part of a work package to inform the consensus and development of a UK-wide caries management curriculum for paediatric dentistry. METHODS: A search of electronic databases for peer reviewed literature was performed using Cochrane Library, MEDLINE via PubMed, TRIP Medical Database and Web of Science. Hand searching was undertaken for grey literature (citations of sources of evidence, websites of global organisations and Google Web Search™ (Google LLC, California, USA). Results from databases were screened independently, concurrently by two reviewers. Full texts were obtained, and reviewers met to discuss any disagreement for both database and hand searching. RESULTS: This review identified 16 guidelines suitable for inclusion. After quality appraisal, eight were selected for synthesis and interpretation. Key themes included the shift towards selective caries removal and avoidance of complete caries removal unless in specific circumstances in anterior teeth. For "early lesions" in primary and permanent teeth with and without cavitation, several guidelines recommend biological management including site specific prevention and fissure sealants. CONCLUSIONS: This review mapping current cariology guidelines for children and young people found gaps in the literature including classification of early carious lesions and management of early cavitated lesions. Areas identified for further exploration include integration of biological caries management into treatment planning, selective caries removal and whether pulpotomy is specialist-level treatment, requiring referral. These results will inform consensus recommendations in the UK, using Delphi methods.

Comparative evaluation and patient satisfaction with an electrical impedance-based device versus digital radiography in the estimation of remaining dentin thickness in carious posterior permanent teeth: (Diagnostic accuracy study).

BACKGROUND: Accurate assessment of remaining dentin thickness (RDT) is paramount for restorative decisions and treatment planning of vital teeth to avoid any pulpal injury. This diagnostic accuracy study compared the validity and patient satisfaction of an electrical impedance based device Prepometer™ (Hager & Werken, Duisburg, Germany) versus intraoral digital radiography for the estimation of remaining dentin thickness in carious posterior permanent teeth. METHODS: Seventy patients aged 12-25 years with carious occlusal or proximal permanent vital posterior teeth were recruited. Tooth preparation was performed to receive an adhesive restoration. Pre- and post-excavation RDT were measured radiographically by two calibrated raters using the paralleling periapical technique. Prepometer™ measurements were performed by the operator. Patients rated their satisfaction level with each tool on a 4-point Likert scale and 100 mm visual analog scale (VAS). Inter and intragroup comparisons were analyzed using signed rank test, while agreement between devices and observations was tested using weight kappa (WK) coefficient. RESULTS: the intergroup comparisons showed that, before and after excavation, there was a significant difference between measurements made by both techniques (p < 0.001). After excavation, there was a weak agreement between measurements (WK = 0.2, p < 0.001), whereas before excavation, the agreement was not statistically significant (p = 0.407). Patients were significantly more satisfied with Prepometer™ based on scales and VAS (p < 0.001). CONCLUSION: Prepometer™ could be a viable clinical tool for determining RDT with high patient satisfaction, while radiographs tended to overestimate RDT in relation to the Prepometer™.

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.

A quantitative and qualitative investigation into the management of carious primary molars by foundation dentists in primary care in the South East of England.

Introduction Dental caries is the most common reason for hospital admission of children aged 5-9 in the UK. Better management of caries in primary molars would reduce the number of children requiring treatment in hospitals; however, little research has been done into why primary care clinicians do not use an evidence-based approach to caries management for deciduous molars.Aims The aim of this paper is to identify the rationale behind caries management techniques used in primary care, as well as the choice of materials and long-term success of restorations placed.Materials and methods Use of a retrospective audit and a focus group with primary care clinicians to provide an insight into the management of carious primary molars and the barriers to achieving gold standard care.Results Glass ionomer cements (GICs) were the restoration of choice in primary care. Lack of time, equipment availability and clinician inexperience were cited as to why Hall crowns were not commonly placed.Conclusions The barriers to gold standard management of carious primary molars in practice are wide-ranging but tend to focus on the limitations of NHS care under the units of dental activity system. Lack of time and cost of materials encouraged clinicians to adopt a 'quick fix' approach in GIC.

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.

Analyzing working time and efficient caries removal using a novel bioactive caries detecting dye and air polisher prophy for caries excavation: randomised clinical trial.

OBJECTIVES: This study aims to analyze the working time consumed during caries excavation and pain perception while using a novel Bioactive caries-detecting dye solution (BCD), an Air Polisher Prophy and a combination. MATERIALS AND METHODS: Four groups (in each group, n = 20 permanent teeth) were selected from 60 people between 17 and 40 years of age. The study included teeth with occlusal dentinal caries in the molars with cavity entrance sizes of less than 2 mm (clinically and radiographically). Randomization software was used to assign patients to various groups. Group A: Conventional Rotary Drilling, Group B: BCD + Mechanical Excavation (Spoon Excavator), Group C: Air Polisher Prophy, and Group D: BCD + Air Polisher Prophy 0.5 mL BCD was applied with a micro brush to the carious tooth surface for 40 s in groups B and D. After that, radiographs were performed to see if the radiopaque extension was visible. For mechanical caries extraction, a spoon excavator was used for group B, and an air polisher prophy was employed for group D. For mechanical caries extraction, a spoon excavator was utilized for group B. An air polisher prophy was employed for group D. Multiple applications of the BCD were used in the event of residual caries. Working time and pain experienced during caries excavation were registered using the Verbal Pain Scale (VPS) (score 0-4), and caries removal was clinically graded using the modified Scale (score 0-5). RESULTS: The time taken was Group A, Group D, Group B, and Group C, according to statistical analysis using ANOVA and the Post Hoc Test (275.02, 403.8, 461.98, 615.41 s, respectively). Group A had the highest mean VPS (1.85), whereas Group B had the most minor pain (0.6), followed by Group D (1.2) and Group C (0.6). (1.45). Group C (2.35), followed by groups D (1.75), B (1.30), and A (1.30), had ineffective caries eradication (0.90). (p < 0.05). CONCLUSIONS: compared to group C, groups B and D took less time and had less/no pain while excavating caries. Compared to traditional mechanized caries removal methods, the chemo-chemical BCD can diagnose and aid in successful caries removal with minimal pain. CLINICAL RELEVANCE: The outcomes of the present study demonstrated that the chemo-chemical bioactive caries detecting dye solution has the potential to identify and help in effective caries removal before mechanized caries removal methods.

Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study.

OBJECTIVES: This study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal. METHODS: The children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups. RESULTS: During the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002). CONCLUSION: Direct composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization. CLINICAL SIGNIFICANCE: SFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.

The clinical performance of dental resin composite repeatedly preheated: A randomized controlled clinical trial.

OBJECTIVES: To assess the clinical performance of class II restorations performed by repeatedly preheated resin composite "RC" at 68 °C up to ten times. METHODS: 105 patients were selected and randomized into three groups, each comprising 35 patients. Each patient was provided with a single class II Bulk-fill resin composite "BF-RC" posterior restoration based on the number of preheating cycles; group I (H0): The BF-RC was packed non-heated, group II (H1): BF-RC preheated once, and group III(H10): BF-RC preheated ten cycles. These restorations were evaluated at 1, 3,6, and 12 months, using the modified United States Public Health Service "USPHS". Statistical analysis was performed using Kruskal-Wallis test, Mann Whitney U test, and Friedmann test, where p = 0.05. RESULTS: All the 105 restorations did not suffer from any clinical situation that recommended replacement regarding retention, fracture, secondary caries, or anatomical form. Although all performed restorations did have Alpha and Bravo scores with good clinical performance, the non-preheated RC restorations"" suffered from relatively inferior clinical performance through the follow-up period regarding marginal adaptation, marginal discoloration, and color matching when compared to preheated groups. One and ten times of preheating conducted better clinical performance. CONCLUSIONS: After 12-months follow-up, although no restoration needed replacement or repair in the 3 tested groups, restorations with single and ten times of preheating aided in better clinical performance of RC restorations compared to the non-preheated restorations. Preheating of RC for 10 times could be used safely with good clinical performance of restorations. CLINICAL SIGNIFICANCE: By continually preheating RC syringe up to ten times, the dentist will not only benefit from the enhanced clinical performance and easiness of application but also will use preheated RC syringes without hesitation, relying on the absence of drawbacks related to multiple preheating cycles.

Marginal adaptation of two-step self-etch versus universal adhesives for Class V restorations: Effect of Er:YAG laser vs. bur prepared cavities.

PURPOSE: To compare the in vitro effect of laser and bur preparation on marginal adaptation of Class V cavities restored with a 2-step self-etch and distinct universal one-component universal adhesives used in self-etching mode. METHODS: 96 Class V cavities were prepared with conventional burs or with an Er:YAG laser. Four universal self-etch (Unibond Extra Low Shrinkage, All Bond Universal, SKB-100 and Prime&Bond active) and a 2-step self-etch adhesive (Clearfil SE Bond) that served as control were used to restore the cavities with direct composite. The percentages of continuous margins were evaluated by quantitative SEM analysis before and after a fatigue test consisting of 240,000 occlusal loads and 600 warm/cold thermal cycles. RESULTS: The marginal adaptation of bur prepared restorations was statistically superior to laser-prepared ones. Class V cavities restored with Clearfil SE Bond and the one-component self-etching universal adhesives All Bond Universal and Prime&Bond active presented the highest and statistically similar percentages of continuous margins before and after loading under both bur and laser cavity preparation. The lowest percentages of continuous margins were observed in the groups restored with the low shrinking adhesive (Unibond ELS), with medians of 49 and 21 for bur and laser prepared cavities after loading. CLINICAL SIGNIFICANCE: Class V cavities presented smoother and higher percentages of continuous margins when prepared by bur rather than by laser. The 2-step self-etch adhesive Clearfil SE Bond and 1-step self-etch universal adhesives All Bond Universal and Prime&Bond active showed a comparable marginal performance.

Development of short forms for screening children's dental caries and urgent treatment needs using item response theory and machine learning methods.

OBJECTIVES: Surveys can assist in screening oral diseases in populations to enhance the early detection of disease and intervention strategies for children in need. This paper aims to develop short forms of child-report and proxy-report survey screening instruments for active dental caries and urgent treatment needs in school-age children. METHODS: This cross-sectional study recruited 497 distinct dyads of children aged 8-17 and their parents between 2015 to 2019 from 14 dental clinics and private practices in Los Angeles County. We evaluated responses to 88 child-reported and 64 proxy-reported oral health questions to select and calibrate short forms using Item Response Theory. Seven classical Machine Learning algorithms were employed to predict children's active caries and urgent treatment needs using the short forms together with family demographic variables. The candidate algorithms include CatBoost, Logistic Regression, K-Nearest Neighbors (KNN), Naïve Bayes, Neural Network, Random Forest, and Support Vector Machine. Predictive performance was assessed using repeated 5-fold nested cross-validations. RESULTS: We developed and calibrated four ten-item short forms. Naïve Bayes outperformed other algorithms with the highest median of cross-validated area under the ROC curve. The means of best testing sensitivities and specificities using both child-reported and proxy-reported responses were 0.84 and 0.30 for active caries, and 0.81 and 0.31 for urgent treatment needs respectively. Models incorporating both response types showed a slightly higher predictive accuracy than those relying on either child-reported or proxy-reported responses. CONCLUSIONS: The combination of Item Response Theory and Machine Learning algorithms yielded potentially useful screening instruments for both active caries and urgent treatment needs of children. The survey screening approach is relatively cost-effective and convenient when dealing with oral health assessment in large populations. Future studies are needed to further leverage the customize and refine the instruments based on the estimated item characteristics for specific subgroups of the populations to enhance predictive accuracy.