Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: a report of the American Dental Association and the American Academy of Pediatric Dentistry

BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits and fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the US market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. CONCLUSIONS AND PRACTICAL IMPLICATIONS: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians reorient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.(AU)

Mutational analysis of AXIN2, MSX1, and PAX9 in two Mexican oligodontia families.

The genes for axin inhibition protein 2 (AXIN2), msh homeobox 1 (MSX1), and paired box gene 9 (PAX9) are involved in tooth root formation and tooth development. Mutations of the AXIN2, MSX1, and PAX9 genes are associated with non-syndromic oligodontia. In this study, we investigated phenotype and AXIN2, MSX1, and PAX9 gene variations in two Mexican families with non-syndromic oligodontia. Individuals from two families underwent clinical examinations, including an intra-oral examination and panoramic radiograph. Retrospective data were reviewed, and peripheral blood samples were collected. The exons and exon-intronic boundaries of the AXIN2, MSX1, and PAX9 genes were sequenced and analyzed. Protein and messenger RNA structures were predicted using bioinformative software programs. Clinical and oral examinations revealed isolated non-syndromic oligodontia in the two Mexican families. The average number of missing teeth was 12. The sequence analysis of exons and exon-intronic regions of AXIN2, MSX1, and PAX9 revealed 11 single-nucleotide polymorphisms (SNPs), including seven in AXIN2, two in MSX1, and three in PAX9. One novel SNP of MSX1, c.476T>G (Leu159Arg), was found in all of the studied patients in the families. MSX1 Leu159Arg and PAX9 Ala240Pro change protein and messenger RNA structures. Our findings suggested that a combined reduction of MSX1 and PAX9 gene dosages increased the risk for oligodontia in the Mexican families, as in vivo investigation has indicated that interaction between Msx1 and Pax9 is required for tooth development.

Phenotype characterization and sequence analysis of BMP2 and BMP4 variants in two Mexican families with oligodontia.

Both BMP2 and BMP4 are involved in tooth development. We examined phenotypes and BMP2 and BMP4 gene variations in two Mexican oligodontia families. Physical and oral examinations and panoramic radiographs were performed on affected and unaffected members in these two families. The affected members lacked six or more teeth. DNA sequencing was performed to detect BMP2 and BMP4 gene variations. Three single nucleotide polymorphisms (SNPs) in BMP2 and BMP4 genes were identified in the two families, including one synonymous and two missense SNPs: BMP2 c261A>G, pS87S, BMP2 c570A>T, pR190S, and BMP4 c455T>C, pV152A. Among the six affected patients, 67% carried "GG" or "AG" genotype in BMP2 c261A>G and four were "TT" or "AT" genotype in BMP2 c570A>T (pR190S). Polymorphism of BMP4 c455T>C resulted in amino acid changes of Val/Ala (pV152A). BMP2 c261A>G and BMP4 c455T>C affect mRNA stability. This was the first time that BMP2 and BMP4 SNPs were observed in Mexican oligodontia families.

O45-regulation of osteoblast differentiation and ECM remodeling by Bmp2/4 in vitro.

Both of bone morphogenetic proteins 2 and 4 (Bmp2 and Bmp4) are two closely related members of the transforming growth factor beta superfamily and play diverse roles in normal and pathological processes. However, detail understandings of mechanisms through which Bmp2 and Bmp4 exert their effects remain elusive due to their functional compensations each other. To study roles of Bmp2/Bmp4 in osteoblast differentiation and extracellular matrix (ECM) remodeling, calvarial osteoblasts from Bmp2/4 conditional mice with Cre recombinase recognition site (loxP) were isolated and transfected with simian virus 40 large T antigen to generate immortalized BMP2C/C4C/C (iBMP2 C/C/4C/C) osteoblast lines. The BMP2/4 genes in the iBMP2 C/C/4C/C cells were double knocked out by Ad-Cre recombinase infection. Differentiation and mineralization of iBMP2C/C/4C/C knock-out (iBmp2C/C/4C/C KO) cells were detected by alkaline phosphatase (ALP) and alizarin (ALZ) red S staining analyses. ECM remodeling was also observed in fluorescent microscope. Cell differentiation was dramatically decreased in the iBMP2C/C/4C/C KO cells compared to that of the iBMP2C/C/4C/C osteoblasts. Mineralization was also reduced in these KO cells by ALZ staining. Furthermore, Bmp2/4 double knock-out cells have major defects in remodeling the ECM as reflected by changes in collagen type I processing. Here we for the first time demonstrate the establishment of iBmp2C/C/4C/C KO osteoblasts. Cell differentiation and mineralization in the iBmp2C/C/4C/C KO cells were decreased. Furthermore, ECM processing in these KO cells was impaired. This indicates that BMP2/4 play important roles in osteoblast differentiation and ECM remodeling.

Reliability of different techniques to assess marginal defects of Class II restorations in retrieved primary molars: a visual-tactile, SEM, dye penetration and polarized light microscopy study.

The aims of the present article were to assess the reliability of different techniques to assess marginal defects in Class II restorations in retrieved primary molars, and to determine the degree of agreement between the various assessment modalities. The material evaluated was comprised of 18 exfoliated primary molars that had been restored 20 to 22 months previously with a resin-modified glass ionomer (Vitremer--7 teeth), a hybridized composite resin (Z100 + Scotchbond Multipurpose--9 teeth), and amalgam (Dispersalloy--2 teeth). No significant differences could be observed between the groups. The majority of the restorations rated A at the buccal and lingual margins, but poor adaptation was disclosed at the cervical margin of the three types of restorations. SEM evaluation revealed that the highest percentage of defects was seen at the cervical margins with no statistically significant difference between the groups. No or minimal leakage was present at the occlusal margins and severe penetration of dye was seen at the cervical margins in all groups. Significantly less demineralization was seen adjacent to the Vitremer and Z100 restorations when compared to the Dispersalloy but no difference was found between the esthetic restorations. Except for the visual tactile examination, small marginal defects could be disclosed by the three assessment techniques (SEM, dye penetration, and polarized light microscopy). A good degree of agreement was observed between the three evaluation techniques.

Clinical performance of resin-modified glass ionomer cement restorations in primary teeth. A retrospective evaluation.

BACKGROUND: The authors retrospectively evaluated the clinical performance of one resin-modified glass ionomer cement as a restorative material in Class I, Class II, Class III and Class V restorations in primary teeth. METHODS: A total of 306 patients who had received a total of 864 resin-modified glass ionomer restorations, which had been in their mouths for a minimum of three years, were included in this evaluation. The authors assessed the clinical observations recorded in patients' records and used bitewing radiographs to assess Class II restorations. RESULTS: The authors found an overall restoration success rate of 93.0 percent, with Class I restorations having a 92.6 percent success rate, Class II restorations having a 93.3 percent success rate, Class III restorations having a 100 percent success rate, and Class V restorations having a 98.0 percent success rate. CONCLUSIONS: The resin-modified glass ionomer cement functioned well as a Class I, Class II, Class III and Class V restorative material in primary teeth. CLINICAL IMPLICATIONS: Resin-modified glass ionomer restorative cement is a durable and reliable material to use for Class I, Class II, Class III and Class V restorations in primary teeth. Therefore, dentists have a proven alternative to silver amalgam and resin-based composite for primary tooth restoration.

Demineralization around orthodontic brackets bonded with resin-modified glass ionomer cement and fluoride-releasing resin composite.

PURPOSE: Enamel demineralization adjacent to orthodontic brackets is one of the risks associated with orthodontic treatment. Glass ionomer cements have been shown to decrease enamel demineralization adjacent to brackets and bands but do not exhibit bond strengths comparable to resin composites. The purpose of this in vitro study was to compare a fluoride-releasing resin composite versus a resin-modified glass ionomer cement for inhibition of enamel demineralization surrounding orthodontic brackets. METHODS: Forty-five teeth were randomly assigned to 3 groups of 15 teeth. Fifteen were bonded with Concise (3M), a non-fluoride-releasing resin composite (control); 15 teeth were bonded with Light Bond (Reliance), a fluoride-releasing resin composite; and 15 teeth were bonded with Fuji Ortho LC (GC Corporation), a resin-modified glass ionomer cement. The teeth were placed in an artificial caries solution to create lesions. Following sectioning of the teeth in a buccolingual direction, polarized light microscopy was utilized to evaluate enamel demineralization adjacent to the orthodontic bracket. The area of the lesion was measured 100 microns from the orthodontic bracket and bonding agent. RESULTS: MANOVA (P < .0001) and Duncan's test (P < .05) indicated the resin-modified glass ionomer cement (Fuji Ortho LC) and the fluoride-releasing resin composite (Light Bond) had significantly less adjacent enamel demineralization than the non-fluoride-releasing resin composite control. However, there was no significant difference between the resin-modified glass ionomer cement and the fluoride-releasing resin composite. CONCLUSIONS: Based on the results of this in vitro study, it can be concluded that Fuji Ortho LC and Light Bond exhibit significant inhibition of adjacent demineralization compared to the non-fluoride-releasing control.

Treatment planning for space maintenance in the primary and mixed dentition.

This manuscript provides the current standard passive space maintenance recommendations and identifies the appropriate space maintainer for premature loss of teeth in the primary dentition, early mixed dentition, and late mixed dentition.

Remineralizing effects of glass ionomer restorations on adjacent interproximal caries.

The purpose of this study was to examine the in vitro remineralization of incipient caries lesions on teeth adjacent interproximally to teeth with Class II glass ionomer cement restorations. Sixty-four extracted molars were selected and 1 x 5 mm artificial caries lesions were created at the interproximal contact point. One hundred micrometer sections were obtained at the caries sites, and polarized-light photomicrographs were obtained. The sections were covered with varnish, leaving only the external section site exposed, and were placed back into the original tooth. In another sixty-four molars, Class II cavities were prepared. Equal numbers of preparations were filled with Fuji IX GP, Vitremer, Ketac-Molar, or Z 250. These sixty-four teeth were mounted to have interproximal contact with the adjacent teeth containing the artificial caries lesions. Specimens were placed in closed environments of artificial saliva for one month. After thirty days, the same sections were photographed again under polarized light, and areas of the lesions were quantitated. Decrease in the size of caries lesions indicated the glass ionomers had significantly greater remineralization effects on adjacent caries than the nonfluoridated composite resin (ANOVA p < 0.05). There were no significant differences among the three glass ionomers tested.

In vitro dentin demineralization inhibition effects of an experimental fluoridated HEMA and water wetting agent.

The ability of fluoride-releasing resins to inhibit dentin demineralization remains controversial. The purpose of this study was to evaluate the caries inhibition of resin composite restorations with an experimental fluoridated hydroxyethyl methyl methacrylate (HEMA) and water wetting agent. Standardized Class V preparations were placed in 40 molars, the gingival margin placed below the cementoenamel junction. Two dentin primers (sodium fluoride, HEMA and water; HEMA and water) were placed in equal numbers of 20 preparations, then One-Step Dental Adhesive (Bisco) was applied as recommended by the manufacturer, followed by the placement of a resin composite restoration. Amalgam restorations with no primer/adhesive were placed in 10 preparations and 10 preparations were restored by placing One-Step Dental Adhesive, then resin composite. All teeth were subjected to an artificial caries challenge (pH 4.4) for 5 days. Results demonstrated the mean areas (microm2 +/- s.d.) of demineralization 100 microm from the restoration/dentin margin to be: amalgam 5,570 +/- 873; One-Step 7,038 +/- 2,099; HEMA and water 6,126 +/- 634; fluoridated HEMA and water 3,411 +/-593. ANOVA and Duncan's test (P < 0.05) demonstrated the fluoridated HEMA and water wetting agent to have significantly less adjacent dentin demineralization than the other three groups. Eighty percent of HEMA and water wetting agent, 80% of One-Step Dental Adhesive and 100% of amalgam restorations demonstrated wall lesions. One hundred percent of restorations with fluoridated HEMA and water wetting agent demonstrated inhibition zones in adjacent dentin.

The effect of locally delivered controlled-release doxycycline or scaling and root planing on periodontal maintenance patients over 9 months.

BACKGROUND: This research report evaluates clinical changes resulting from local delivery of doxycycline hyclate (DH) or traditional scaling and root planing (SRP) in a group of patients undergoing supportive periodontal therapy (SPT). METHODS: In all, 141 patients received either DH (67) or SRP (74) treatment in sites > or =5 mm on one-half of their dentition at baseline and month 4. RESULTS: Clinical results were determined at month 9. Baseline mean probing depth recordings were similar between the two groups (DH = 5.9 mm; SRP = 5.9 mm). Mean month 9 results showed similar clinical results for attachment level gain (DH 0.7 mm; SRP 0.8 mm) and probing depth reduction (DH 1.3 mm; SRP 1.1 mm). Percentage of sites showing > or =2 mm attachment level gain at month 9 was 24.7% in the DH group and 21.2% in the SRP group. Thirty-nine percent (39%) of DH sites and 38% of SRP sites showed > or =2 mm probing depth reduction. When treated sides of the dentition were compared to untreated sides, DH showed a difference in disease activity (> or =2 mm attachment loss) from 19.3% (untreated) to 7.2% (treated); and SRP from 14.3% (untreated) to 8.1% (treated). CONCLUSIONS: Results show that both DH without concomitant mechanical instrumentation and SRP were equally effective as SPT in this patient group over the 9-month study period.

Management of sports-related crown fractures.

Uncomplicated tooth crown fractures are the most common sports-related mouth injury and can have an excellent outcome if treated appropriately. Many times, however, crown fractures occur at the same time as concussion, luxation, displacement, or even avulsion injuries. This article discusses the treatment for and management of tooth crown fractures from sports-related injuries.

Vitremer restorative cement for children: three clinicians' observations in three pediatric dental practices.

BACKGROUND: The authors retrospectively evaluated the clinical performance of a resin-modified glass ionomer cement as a Class I, Class II, Class III, and Class V restorative material in primary teeth. METHODS: Three hundred and six patients that had received 864 resin-modified glass ionomer restorations, which had been in the mouth for a minimum of three years, were included in this evaluation. RESULTS: The results demonstrated an overall 93.4 percent restoration success rate, Class I restorations presenting a 92.6 percent success. Class II restorations presenting a 93.4 percent success, Class III restorations presenting a 100 percent success and Class V restorations presenting a 98 percent success, respectively. CONCLUSIONS: The resin-modified glass ionomer cement functioned well as a Class I, Class II, Class III, and Class V restorative material in the primary dentition. CLINICAL IMPLICATIONS: Resin-modified glass ionomer cement restorative material functions well for Class I, Class II, Class III, and Class V restorations in primary teeth.

Assessment of the effect of selected snack foods on the remineralization/demineralization of enamel and dentin.

This study utilized volunteer subjects to examine caries-like lesions for remineralization and demineralization patterns in dentin and enamel when nine different snack foods were eaten between meals. Caries progression was observed in enamel and dentin when apple juice, a cola beverage, and sweetened (strawberry) yogurt were consumed as snacks. Remineralization of enamel was observed when cheddar cheese, skim milk, 2% milk, whole milk, chocolate milk, and orange juice were used as between meal snacks. Dairy products, with the exception of the sweetened yogurt, generally reduced the amount of demineralization produced in dentin. This study helps establish a scientific basis for appropriate between-meal snacks for patients who are concerned about their dietary habits as a part of their overall preventive oral health plan.

Clinical performance and caries inhibition of resin-modified glass ionomer cement and amalgam restorations.

BACKGROUND: The authors clinically examined two restorative materials to evaluate their effectiveness in Class II restorations in primary molars and their ability to inhibit recurrent caries. METHODS: Forty subjects, each in need of two Class II restorations in primary molars, took part in this study. Each patient received one Class II restoration of resin-modified glass ionomer cement and one of amalgam. The authors evaluated the restorations at six-month, one-year, two-year and three-year recall appointments. On exfoliation, teeth with experimental restorations were retrieved and microscopically examined for inhibition of demineralization at restoration margins. RESULTS: The results of the clinical evaluation demonstrated no significant differences between the resin-modified glass ionomer cement restorations and the amalgam restorations (P < .05). Polarized light microscopic examination of the returned teeth that were restored as a part of this study indicated that the resin-modified glass ionomer cement had significantly less enamel demineralization at restoration margins than did amalgam (P < .0001). CONCLUSIONS: The resin-modified glass ionomer cement functioned clinically as well as amalgam for Class II restorations in primary molars. However, the resin-modified glass ionomer exhibited significantly less enamel demineralization at restoration margins than did amalgam. CLINICAL IMPLICATIONS: Resin-modified glass ionomer cement restorative material functions well for Class II restorations in primary molars and exhibits less recurrent caries at restoration margins than does amalgam.

Effects of smoking on local delivery of controlled-release doxycycline as compared to scaling and root planing.

This paper examines the effects of smoking on the treatment outcomes of two nonsurgical therapies: (1) scaling and root planing alone (SRP) or (2) controlled-release of subgingivally delivered doxycycline hyclate in a polylactic acid based polymer gel. Subjects from 2 9-month multicenter studies were classified as nonsmokers (never smoked: 100 subjects), former smokers (137 subjects), and current smokers (> or = 10 cigarettes/day: 121 subjects). Clinical parameters were analyzed for treated sites with baseline probing depths > or = 5 mm and for a subset of treated sites with baseline probing depths of > or = 7 mm. Clinical parameters (plaque levels, clinical attachment levels, pocket depths, and bleeding on probing) were analyzed at baseline, 4, 6, and 9 months. In the doxycycline treated group in general, there were neither marked significant differences in clinical attachment gain nor differences in probing depth reduction among the 3 smoking groups. On the other hand, in the scaling and root planing treated group in general, there were significant differences in clinical attachment gain and pocket depth reduction, with non-smokers responding better than former smokers and current smokers at 6 and 9 months. These differences in clinical response between scaling and root planing alone versus controlled-release of locally-delivered doxycycline hyclate among these 3 smoking groups are discussed in relation to treatment implications for smokers.

Demineralization inhibition at glass-ionomer cement and amalgam restoration margins in conjunction with additional fluoride regimens.

The purpose of this study was to evaluate demineralization inhibition at restoration gingival margins. The study compared the effectiveness of a fluoride-releasing restorative material and topical fluoride regimens utilized individually and in conjunction with fluoridated materials. Glass-ionomer restorations demonstrated significantly less dentin demineralization than amalgam restorations at restoration margins when the restorations were exposed to no external fluoride, when the restorations were brushed with a fluoridated dentifrice twice per day, and when the restorations were exposed to a fluoride rinse (p, 0.05). There was no significant difference in dentin demineralization adjacent to glass-ionomer and amalgam restorations when both a fluoride rinse and a fluoridated dentifrice were used on a daily basis over 30 days, in vitro.

Enamel de/remineralization on teeth adjacent to fluoride releasing materials without dentifrice exposure.

Interproximal caries presents a continual clinical concern. The purpose of this study was to evaluate the ability of fluoride-releasing materials to remineralize incipient caries lesions on adjacent teeth, at the interproximal site with and without exposure to a fluoridated dentifrice. Thirty extracted teeth had Class II preparations placed, then equal numbers were restored with amalgam (Tytin (3-Kerr), glass ionomer (Ketac Fil-ESPE) or composite (Heliomolar-Ivoclar). Thirty additional teeth had 1 x 5 mm artificial caries lesions formed at the interproximal contact point. One hundred mu thick sections were obtained at the caries sites and polarized photomicrographs were taken. The sections had varnish placed, leaving only the external section site exposed, and were situated back into the original tooth. These teeth were then mounted with the artificial lesion having an interproximal contact with the adjacent tooth restoration. Specimens were placed in closed environments of artificial saliva for two weeks; the saliva was changed every forty-eight hours. All teeth were cycled through an artificial caries system for thirty minutes, three times per day. Half the specimens in each group were brushed with Crest (Procter and Gamble) for two minutes, twice per day. The same sections were again photographed under polarized light and areas of the lesions were digitized quantitatively. Results demonstrated the mean (+/- S.D.) percent change in lesion size (water imbibition) for each material nonexposed and exposed to fluoridated dentifrice to be: Amalgam -64.1 +/- 22.0, -1.0 +/- 8.5; Glass Ionomer 2.2 +/- 10.6, 14.0 +/- 7.2; Composite -28.1 +/- 11.7, 18.2 +/- 6.7. Negative numbers represent demineralization and positive numbers represent remineralization. Duncan's analysis indicated the nonbrushed fluoride-releasing glass ionomer and composite resin to have significantly greater demineralization inhibition compared to the nonbrushed amalgam group and remineralization enhancement effects on adjacent interproximal lesions (p < 0.05) compared to the brushed amalgam group.

Effect of a fluoride varnish on demineralization adjacent to orthodontic brackets.

Home fluoride regimens have long been used to reduce the amount of demineralization adjacent to orthodontic appliances. In the absence of patient compliance, another method of applying the fluoride must be used. The purpose of this study was to evaluate, in vitro, the ability of a fluoride varnish, Duraflor, to directly inhibit demineralization of enamel surrounding orthodontic brackets. Brackets were bonded to 36 extracted human canines and premolars with a traditional composite resin and randomly assigned to three equal groups of twelve. Group 1 served as the control with no topical application after bonding. Group 2 was treated with a single application of a nonfluoridated placebo varnish. Group 3 was treated with a single application of Duraflor. All groups were cycled in an artificial caries challenge for 1 hour two times daily for 37 days and were brushed with a medium bristled toothbrush to simulate mechanical wear of the varnish. Demineralization of enamel was evaluated in longitudinal buccolingual tooth sections using polarized light microscopy. Both average depth and area of demineralization were measured with a sonic digitizer. ANOVA (P