Awareness of possible complications associated with direct composite restorations: A multinational survey among dentists from 13 countries with meta-analysis.

OBJECTIVES: Resin-based composites (RBCs) evolved into favoured materials for teeth restorations, marking a significant change in dental practice. Despite many advantages, RBCs exhibit various limitations in their physical and chemical properties. Therefore, we assessed the dentists' awareness of possible complications after direct composite restorations and their opinions about this material. METHODS: The online questionnaire was created in English in May 2023. A 16-item survey was dedicated to general dentists and specialists. The first section included four questions related to demographic characteristics. The second section comprised twelve questions and focused on awareness of potential side effects of composite restorations, the most crucial advantages and disadvantages of composite resins, and the frequency of experienced clinical complications after the application of composite materials. RESULTS: A total of 1830 dentists from 13 countries took part in the survey. Dentists most often declared awareness of low adhesion to the dentine (77.5 %) and, most rarely, solubility in oral fluids (42.6 %). Aesthetics was identified as the main advantage of composite fillings (79 %), followed by the possibility of repair (59 %) and adhesion to enamel (57 %). Polymerisation shrinkage was a major disadvantage for most countries (70 % overall). Analysing the declared potential clinical complications for all countries, statistically significant findings were obtained for marginal discolouration (OR=2.982, 95 % CI: 1.321-6.730, p-value=0.009) and borderline significance for secondary caries (OR=1.814, 95 % CI: 0.964-3.415, p-value=0.065). CONCLUSIONS: Dentists value aesthetics and repairability but are aware of shrinkage and experience discolouration. The issue of toxicity and solubility seems to be the least known to dentists. CLINICAL SIGNIFICANCE: Dentists should use RBCs with critical caution due to possible side effects. Despite the undoubted aesthetics of direct composite restorations, it is necessary to remember potential clinical complications such as marginal discolouration or secondary caries.

Attitude and practice of regenerative endodontic procedures among endodontists and paediatric dentists: A multinational survey from 13 countries.

BACKGROUND: Regenerative endodontics (RET) refers to biologically based procedures that aim to restore damaged tooth structures and reinstate the pulp-dentine complex to its normal physiological state. AIM: The purpose of this study was to examine the attitudes and practices of endodontists and paediatric dentists regarding RET. DESIGN: A survey was conducted among endodontists and paediatric dentists from 13 countries. A number of factors were evaluated, including frequency of RET application, followed guidelines, disinfection techniques, intracanal medication type, scaffold type, preferred coronal seal material, and follow-up period. RESULTS: Among the 1394 respondents, 853 (61.2%) and 541 (38.8%) were endodontists and paediatric dentists, respectively. Almost half (43%) of participants have not performed RET yet. The American Association of Endodontics guideline (47.3%) was selected as the primary source for the clinical protocol. The most frequently selected irrigant solution was 1.5%-3% NaOCl at the first (26.1%) and second (13.6%) sessions. A blood clot (68.7%) and MTA (61.9%) were the most frequently selected scaffold type and coronal barrier. Most participants preferred a 6-month follow-up period. CONCLUSION: According to this survey, deviations exist from current RET guidelines regarding all aspects evaluated. Standardizing clinical protocols and adhering to available guidelines would help to ensure more predictable outcomes.

Factors Affecting the Decision-making of Direct Pulp Capping Procedures among Dental Practitioners: A Multinational Survey from 16 Countries with Meta-analysis.

INTRODUCTION: Direct pulp capping (DPC) procedures require the placement of a bioactive material over an exposure site without selective pulp tissue removal. This web-based multicentered survey had 3 purposes: (1) to investigate the factors that affect clinicians' decisions in DPC cases, (2) to determine which method of caries removal is preferred, and (3) to evaluate the preferred capping material for DPC. METHODS: The questionnaire comprised 3 sections. The first part comprised questions regarding demographic features. The second part comprised questions on how treatment plans change according to factors such as nature, location, number and size of the pulp exposure, and patients' age. The third part composed of questions on the common materials and techniques used in DPC. To estimate the effect size, the risk ratio (RR) and 95% confidence interval (CI) were calculated using a meta-analysis software. RESULTS: A tendency toward more invasive treatment was observed for the clinical scenario with carious-exposed pulp (RR = 2.86, 95% CI: 2.46, 2.32; P < .001) as opposed to the clinical scenario with 2 pulp exposures (RR = 1.38, 95% CI: 1.24, 1.53; P < .001). Complete caries removal was significantly preferred to selective caries removal (RR = 4.59, 95% CI: 3.70, 5.69; P < .001). Among the capping materials, calcium silicate-based materials were preferred over calcium hydroxide-based materials (RR = 0.58, 95% CI: 0.44, 0.76; P < .05). CONCLUSIONS: While carious-exposed pulp is the most important factor in clinical decisions regarding DPC, the number of exposures has the least impact. Overall, complete caries removal was preferred over selective caries removal. In addition, the use of calcium silicate-based materials appears to have replaced calcium hydroxide-based materials.