Antibacterial Agents for Composite Resin Restorative Materials: Current Knowledge and Future Prospects.

Resin composites became the material of choice for direct restorations in anterior and posterior teeth. Despite the revolutionary improvement in the material, restoration failure is still a major drawback due to the material's inherent negative properties, including a lack of antibacterial effects. Therefore, many attempts have been made to incorporate antibacterial agents into resin composite materials to improve their antimicrobial properties and prevent secondary caries formation. Multiple laboratory studies have been conducted using different antibacterial agents, such as quaternary ammonium compounds, methacryloyloxydodecylpyridinium bromide, magnesium oxide nanoparticles, chlorhexidine, and chitosan. This review provides a glance at the current status of these materials and the research directions needed in the future.

Evaluation of Students' Proficiency in Removing Gutta-Percha Prior to Fiber Post Placement: A Retrospective Study.

INTRODUCTION: This retrospective study focuses on dental students' proficiency in removing gutta-percha during fiber post space preparation, which is important for maintaining apical seal integrity in endodontically treated teeth. Emphasizing the significance of preventing further reinfection. The primary objective of this study was to assess the proficiency of undergraduate dental students in the manipulation of gutta-percha during fiber post preparation, specifically focusing on the psychomotor skills involved. In addition, the study aims to determine the predictive value of these skills on the ultimate clinical outcomes of the procedure, with particular emphasis on variations attributable to tooth type. MATERIALS AND METHODS: The analysis encompassed 290 periapical radiographs obtained from endodontically treated teeth, all of which had undergone fiber post placement by undergraduate students at the College of Dentistry, Taibah University, Saudi Arabia. Postoperatively, the length of the remaining gutta-percha was measured by two experts in the field, and subsequent outcomes were classified into three categories: optimal, suboptimal, and inadequate, based on the extent of gutta-percha remaining. RESULTS: Students showed optimal removal rates ranging from 33.3% to 73.1%. Among the studied sample, upper anterior teeth were the highest included teeth (n=117, 40%). Remarkably, lower anterior teeth were more prone to suboptimal and inadequate gutta-percha remaining lengths (n=24, 33%). However, the chi-square test revealed no statistically significant difference in students' psychomotor skills while removing the gutta-percha and preparing the teeth to receive fiber posts across tooth types (p-value > 0.05). CONCLUSION: With the limitations of this study, more than half of the included cases show that undergraduate students of the College of Dentistry at Taibah University, Saudi Arabia, possess an optimum level of psychomotor skills in removing gutta-percha while preparing the teeth for receiving fiber posts. This study suggests enhancing the preclinical training of students by considering more training on different tooth types in relation to dental arches.

Exploring the Perception and Awareness of Dental Students and Interns in Managing and Treating Pregnant Patients.

Background Undergraduate dental students and interns express reluctance to deal with pregnant women in the dental office due to the fear of medical consequences on the fetus. This study aims to explore the knowledge, attitudes, and practices of dental students and interns regarding the dental considerations of pregnant women in three dental schools in Saudi Arabia. Methodology This cross-sectional study was performed between October and December 2023 and targeted the clinical academic years of dental students and interns at three dental schools in Saudi Arabia, namely, Taibah University, Umm Al-Qura University, and Qassim University. Using the convenience sampling method, 223 students were invited to respond to a questionnaire constructed from previously published studies and reviewed by experts in the field. It consisted of 15 questions divided into four sections. Descriptive analysis and chi-square test were conducted to assess the difference between the different sociodemographic groups and students' educational levels with the significance level set at p-values <0.05. Results Overall, 223 complete responses were received, with a response rate of 97%. Demographics included 99 (44.40%) males and 124 (55.60%) females, with a reasonable distribution across academic years. Knowledge assessment findings revealed that 114 (51%) participants acquired adequate knowledge. Regarding participants' attitudes, 112 (50%) found the curriculum-centered information sufficient. In addition, 173 (77.6%) participants chose lectures/books as their preferred source of information. Almost 138 (61.9%) participants did not feel confident in managing pregnant women. The chi-square test revealed that educational level significantly impacts the knowledge and practice of the participants, regardless of their gender (p < 0.05). Conclusions Both students and dental interns showed adequate-to-good levels of knowledge and attitude. Both need more exposure to clinical situations with pregnant women during their undergraduate dental training programs to boost their confidence level and enhance their readiness to practice dental procedures with such a group of patients after graduation.

Web-Based Information on the Treatment of Dental Hypomineralization.

PURPOSE: To categorise and evaluate the quality and readability of the web-based information about the treatment of the variety of forms of dental hypomineralization. METHODS: An internet search using two different search terms regarding treating dental hypomineralization was conducted using the Google search engine. The first 100 websites from each search were analysed. Data recorded included DISCERN instrument scores, the Journal of the American Medical Association (JAMA) benchmarks, and the Health on the Net seal (HON). Flesch Reading Ease Scores (FRES), Flesch-Kincaid Grade Level (FKGL), the Simplified Measure of Gobbledygook Index (SMOG), and the Coleman-Liau index were calculated to assess readability. RESULTS: A search for "Treatment of hypomineralized teeth" on Google yielded 48,500 results. After excluding irrelevant websites, only 25 were evaluated based on affiliation with universities/medical centers, non-profit organizations, commercial entities, or government agencies. The majority of the content was medical facts presented as text and visuals such as images and videos. The study found that the scores for questions about the benefits and risks of treatment were low, while alternative treatments had high scores. Only one website met the HON code criteria, and a minority of websites achieved JAMA benchmarks. The readability ratings varied across different tests used in the study. CONCLUSION: Most websites had university or medical center affiliation but only partially related to the specialty. Two-thirds of websites used images. The online information was inaccurate, poor quality, and hard to read for the average person. Dental professionals should be aware of this information's quality and work to improve it.

Relationships between Dental Topography, Gross Wear, and Bang and Ramm/Liversidge and Molleson Age Estimates for a Sample of Human Premolar Teeth.

Objectives: Molar crown wear is often used in bioarchaeological research as a proxy for age at death. However, a small number of researchers have used premolars or compared the application of different methods of relative age estimation. Material and methods: Using a sample of 197 previously extracted maxillary first premolars from US dental patients, we considered three protocols for estimating age: the Bang and Ramm/Liversidge and Molleson (BRLM) age estimate method, occlusal topographic analysis, and the Smith system of macrowear scoring. A previous study utilizing the Bang and Ramm method yielded an age estimate range of 9.4 to 10.8 years for the sample. Results: Our analyses showed no associations between occlusal topography parameters (occlusal slope, relief, or faceting) and BRLM age estimates, but some concordance was found between Smith scoring and BRLM ages estimates and between Smith scoring and occlusal topography parameters. Conclusion: The results of the present study suggest that relationships between gross tooth wear, tooth shape, and dental age estimates are complex, and available methods should be considered together to gain a more comprehensive understanding of how teeth change their shape with wear throughout the lifecourse.

Clinical and Radiographical Outcomes of Restorative Treatment With Stainless Steel Crowns Performed by Undergraduate Dental Students in Medina, the Kingdom of Saudi Arabia.

Background and objective Stainless steel crown (SSC) placement has long been the preferred restorative treatment modality for treating multi-surface carious primary molars. This study aimed to assess the outcomes of SSC placement on primary molars performed by undergraduate dental students. Materials and methods A total of 112 children aged four to eight years were contacted for follow-ups 12 months after they underwent SSC restorations by fifth- or sixth-year female dental students in 2018-2020. Clinical and radiographic examinations were performed by trained dentists to evaluate for signs of failure. Descriptive statistics were applied for categorical variables and a Chi-squared test was used to assess the relationship between failure rate and demographic variables (i.e., age, gender, and type of tooth). Results The majority of the included children were aged seven years, with females (52.7%) slightly outnumbering males (47.3%). The failure rate clinically was 17.8%, involving one or more of the following signs: pain (16.1%), poor crown adaptation (16.1%), improper marginal seal (13.4%), fistula (6.3%), and mobility (4.5%). The rate of failure as per radiological examinations was 15%, involving one or more of the following signs: furcation involvement (9.8%), periapical radiolucency (3.6%), and pathological root resorption (1.8%). No significant association was found between failure rate and age, gender, or type of tooth. Conclusions The restorative treatment of primary molars with SSCs exhibited a high success rate when performed by less experienced undergraduate dental students from different academic levels. The failure rate did not appear to be associated with the child's age and gender or the type of tooth.

Awareness of professional fluoride application and its caries prevention role among women in KSA.

Objectives: Considering the high caries prevalence among Saudi females, spreading knowledge on caries prevention modalities such as high-concentration professional fluoride (PF) applications could decrease their risk of dental caries. However, little is known about the current level of female awareness on the important caries prevention role of PF applications. Therefore, this study assessed the level of awareness of female adults in the KSA regarding PF application and its role in caries prevention. Methods: An electronic self-administered anonymous questionnaire was distributed among women in Almadinah Almunawwarah, KSA using social media groups. It consisted of four sections: demographic data, caries experience, knowledge regarding fluoride and caries prevention, and knowledge regarding PF application and caries prevention. For the statistical analyses, simple descriptive statistics as means and frequency distributions were calculated, whereas comparisons were performed using the chi-squared test. Results: A total of 405 females participated in the study. Participants were mostly married non-working Saudi women aged between 18 and 55 years. The education level of the majority of participants was at least a bachelor's degree. Most of the participants reported a high caries experience indicated by the presence of cavities (69.1%), fillings (87.2%), and missing teeth due to cavities (64.7%). Regarding PF questions, 34.8% knew the role of PF in caries prevention and 35.6% responded correctly to forms of PF. Only 14.5% reported receiving PF, whereas 57.3% did not know the frequency of PF application. A significant relationship was found between a lack of knowledge regarding the role of PF application and the presence of cavities (p = 0.003). Only 30.4% of participants reported receiving advice from their dentists regarding PF application. Conclusion: Most female adults in Almadinah Almunawwarah, KSA have limited knowledge of the importance of PF application in caries prevention, which could contribute to their caries experience.

Tooth Age Impact on Dental Erosion Susceptibility and Treatment Efficacy.

This laboratory study investigated the impact of tooth age on dental erosion susceptibility and preventive treatment efficacy. Extracted human premolars were selected and had their age estimated (∼10-100 years old) using established dental forensic methods. Enamel and root dentin slabs were prepared, embedded in acrylic blocks, flattened, and polished. The specimens were randomly assigned to one of three treatments (n = 93): Sn+F (800 ppm Sn as SnCl2 and 250 ppm F as NaF, pH 4.5), NaF (250 ppm F, pH 4.5), or deionized water (DIW). Each specimen was subjected for 10 days to a daily cycling protocol consisting of six 5-min erosive challenges (0.3% citric acid, pH 2.6), six 60-min remineralization periods (artificial saliva), and three 2-min treatments with the test solutions. Surface loss (SL) was measured after 3, 5, and 10 days, using optical profilometry. Effects of tooth age, antierosive treatment, and time on SL were evaluated using linear mixed effects regression analysis. SL increased with age for all substrate-treatment-time combinations (p < 0.0001). Sn+F and NaF solutions significantly reduced SL compared to DIW, regardless of substrate, time, or age (p < 0.0001), with best results shown for Sn+F. Efficacy of Sn+F increased with tooth age on enamel, but tooth age did not affect the efficacy of NaF on enamel. For dentin, increased efficacy was observed with age after 5 (for Sn+F) and 10 days (for Sn+F and NaF). In conclusion, increase of tooth age rendered enamel and root dentin more susceptible to dental erosion. NaF preventive efficacy improved with tooth age for dentin, in advanced erosion simulation. Sn+F reduced enamel SL due to erosion regardless of tooth age.

Susceptibility of Dental Enamel of Different Ages to Caries-Like Lesion Development.

This study investigated the impact of estimated age, anatomical location, and the presence of wear facets on the susceptibility of enamel to develop caries-like lesions. Extracted human premolars (n = 261) had their age estimated between 10 and 93 years old, using established forensic methods. Specimens of enamel (4 × 4 mm) were prepared from the middle of the buccal surfaces, preserving the outer surface layer. The central area of the block (4 × 1 mm) was protected with nail polish and used as an internal control. The specimens were demineralized for 8 days (with 0.1 M acetic acid, 1.28 mM Ca, 0.74 mM Pi, and 0.03 µg F/mL, pH 5.0), to simulate caries-like lesion development. They were then scanned individually using microtomography, and digital 2D images were used to calculate the outcomes of integrated mineral concentration loss (ΔZ in µm/g/cm3) and lesion depth (LD in µm) at 3 locations, i.e., the cervical, middle, and occlusal thirds. The presence of natural surface wear facets was considered in the analysis. Data were evaluated using a linear mixed-effects models (α = 0.05). ΔZ increased significantly as a function of estimated tooth age at all 3 locations, and this increase was greater after the age of 30 years (p < 0.001), when a higher ΔZ was found in the occlusal third than in the middle and cervical thirds (p < 0.001). LD increased only in the occlusal third before the age of 30 years (p = 0.039) and this increase was significantly greater after 30 years at all 3 locations (p < 0.01), with no differences among them (p > 0.15). The presence of wear facets significantly increased ΔZ and LD (p < 0.001 for both). Overall, we concluded that the susceptibility of enamel to developing caries-like lesions increased with estimated dental age. This effect was more pronounced after the estimated age of 30 years and in the presence of natural tooth wear facets.

Enamel crack association with tooth age and wear severity: An optical coherence tomography study.

PURPOSE: To investigate the association of dental enamel cracks with estimated tooth age and varying tooth wear severities. METHODS: 355 premolars were sorted from a pool of extracted human teeth, based on their estimated age range: 21-40, 41-60 years old, determined by a dental forensic method and on the presence/severity of lesions: none, mild, moderate and severe wear (Basic Erosive Wear Examination Index). The buccal and lingual surfaces of the teeth were inspected for cracks under an optical coherence tomography system. Images were evaluated according to the following scores: 0= no crack; 1= crack beginning and terminating within the enamel, not reaching the outer surface; 2= crack extending from outer enamel surface terminating within the enamel; 3= crack extending from within enamel terminating at or beyond the dentin-enamel junction (DEJ); 4= crack extending from outer enamel surface terminating at or beyond the DEJ. Data were analyzed by Spearman correlations and Mantel-Haenszel chi-square tests. RESULTS: Estimated tooth age and crack score were moderately correlated. Crack scores increased between each range of estimated tooth age (P< 0.050). Occlusal surfaces showing moderate or severe wear had higher buccal crack scores than occlusal surfaces having no wear (P< 0.020) and mild wear (P< 0.001). Buccal surfaces presenting severe wear had higher buccal crack scores than buccal surfaces with no wear, mild or moderate wear (P< 0.001). Premolars having severe wear had significantly higher crack scores than premolars showing no, mild or moderate wear lesions. CLINICAL SIGNIFICANCE: Knowing that older and more severely worn teeth are more prone to enamel cracks allows clinicians to better diagnose, monitor, and prevent further damage to teeth.

Trend-analysis of dental hard-tissue conditions as function of tooth age.

OBJECTIVE: This retrospective in-vitro study investigated tooth age effect on dental hard-tissue conditions. METHODS: Unidentified extracted premolars (n = 1500) were collected and their individual age was estimated (10-100 (±10) years old (yo)) using established dental forensic methods Dental caries, fluorosis and tooth wear (TW) were assessed using the International Caries Detection and Assessment System (ICDAS; 0-5 for crown and 0-2 for root), Thylstrup-Fejerskov (TFI; 0-9) and Basic Erosive Wear Examination (BEWE; 0-3) indices, respectively. Staining and color were assessed using the modified-Lobene (MLI) (0-3) and VITA shade (B1-C4) indices, respectively. Relationships between indices and age were tested using regression models. RESULTS: Starting at age ∼10yo, presence of caries increased from 35% to 90% at ∼50yo (coronal), and from 0% to 35% at ∼80yo (root). Caries severity increased from ICDAS 0.5 to 2 at ∼40yo and from ICDAS 0 to 0.5 at ∼60yo for coronal and root caries, respectively. Presence of TW increased from 25% (occlusal) and 15% (smooth-surfaces) to 100% at ∼80yo. TW severity increased from BEWE 0.5 to 2 at ∼50yo (occlusal) and ∼0.3 to 1.5 at ∼50yo (smooth-surfaces). Percentage and severity of fluorosis decreased from 70% to 10% at ∼80yo, and from TFI 1 to 0 at ∼90yo, respectively. Percentage of extrinsic staining increased from 0% to 85% at ∼80yo and its severity increased from MLI 0 to 2 at ∼70yo. Color changed from A3 to B3 at ∼50yo (crown), and from C2 to A4 at ∼85yo (root). CONCLUSIONS: Aging is proportionally related to the severity of caries, TW, staining, and inversely to dental fluorosis. Teeth become darker with age.

FTIR characterization and release of bovine serum albumin from bioactive glasses.

BACKGROUND: Bioactive glass has attracted substantial interest in orthopedics, but it has been less explored as a drug carrier. This study investigated the bovine serum albumin (BSA) release from bioactive 13-93B0 and 13-93B3 glasses. METHODS: Glass disks (13-93B0 and 13-93B3; n = 5) were loaded with 4 mg of BSA and coated under different chitosan-coating conditions. The amount of BSA released in phosphate-buffered saline (PBS) was evaluated, and a degradation study was performed to find out the weight loss and pH of PBS. Secondary structures of BSA on 13-93B0 were characterized by Fourier transform infrared (FTIR) spectroscopy. RESULTS: One hundred percent protein release occurred by 24 hours for all 13-93B3 groups. However, chitosan coating delayed 100% release up to 72 hours in 13-93B0 groups. The 13-93B3 glass showed higher degradation rates than 13-93B0 regardless of chitosan-coating status. Multilayer and sandwich chitosan coatings further delayed BSA release from 13-93B0. FTIR analysis revealed that α-helical structure was the highest among all groups and significantly higher in the 2% sandwich chitosan coating group (32.0% ± 2.1%), compared with uncoated and 4% chitosan groups. CONCLUSIONS: Chitosan coating can delay the burst release of BSA from 13-93B0 glass and be a potential coating on bioactive glass for drug delivery purposes.

Enamel Thickness Determination by Optical Coherence Tomography: In vitro Validation.

Optical coherence tomography (OCT) has been introduced in dentistry as a nondestructive diagnostic imaging tool that does not utilize ionizing radiation. This study investigated the agreement between polarization-sensitive OCT (PS-OCT), microcomputed tomography (µ-CT), and histology for enamel thickness measurements. Human enamel samples were prepared and evaluated with µ-CT and PS-OCT and then sectioned and observed via digital transversal light microscopy. For all methods, a standard transversal section (b-scan) in each sample was selected, and the enamel thickness was measured at three predetermined positions using ImageJ analysis software. The results revealed significant high agreement between all tested methods, indicating the potential of PS-OCT as a clinical tool to effectively measure enamel thickness.

Inhibitory effect of gels loaded with a low concentration of antibiotics against biofilm formation by Enterococcus faecalis and Porphyromonas gingivalis.

We explored longitudinally the inhibitory effect of gels loaded with 1 mg/mL modified triple antibiotic paste (MTAP) or double antibiotic paste (DAP) against biofilm formation by Enterococcus faecalis and Porphyromonas gingivalis. Methylcellulose-based antibiotic gels of MTAP (ciprofloxacin, metronidazole and clindamycin) and DAP (ciprofloxacin and metronidazole) were prepared at a concentration of 1 mg/mL. Individually cultured E. faecalis and P. gingivalis bacterial suspensions were treated with MTAP, DAP, or placebo (vehicle only) gels at different dilutions and allowed to grow in 96-well microtiter plates. Untreated bacterial suspensions served as a negative control. Crystal violet assays were used to evaluate biofilm formation after 48 h. The ability of the gels to inhibit biofilm formation was determined immediately, and at 1 month and 3 months after the gels had been prepared. Data were analyzed using a mixed-model ANOVA. The MTAP and DAP gels significantly reduced biofilm formation by both bacterial species at all time points, regardless of the tested dilution. No-significant differences in biofilm-inhibitory effects between MTAP and DAP gels were observed at the majority of the tested dilutions through various time points. Gels loaded with 1 mg/mL MTAP and DAP demonstrated a significant antibiofilm effect against E.faecalis and P. gingivalis.

Efficacy of stannous, fluoride and their their combination in dentin erosion prevention in vitro.

The aim of this study was to compare the protective effects of solutions containing stannous (Sn), fluoride (F) and their combination in the prevention of dentin erosion. Forty bovine root dentin specimens (4'4'2 mm(3)) were prepared and randomly assigned to 4 groups (n = 10): SnCl2 (800 ppm/6.7 mM Sn), NaF (250 ppm/13 mM F), NaF/SnCl2 (800 ppm/6.7 mM Sn; 250 ppm/13 mM F), and deionized water (DIW) as a negative control. An acquired pellicle was formed on dentin samples by incubation in clarified, pooled, stimulated human saliva for 24 hours. The specimens were subjected to 5 daily cycles, each consisting of 5 of min demineralization (0.3%/15.6 mM citric acid, pH 2.6, 6'/day) and 60 min of re-mineralization in clarified human saliva. Thirty minutes after the 1st, 3rd and 5th demineralization episodes of each day, the specimens were treated with one of the test solutions for 2 min. Surface loss was measured via optical profilometry. Mixed-model ANOVA followed by Tukey's test were used for the statistical analysis. Sn, F, and their combination significantly reduced the dentin surface loss by 23%, 36%, and 60% compared with DIW, respectively. All groups were significantly different (p < 0.05). The combination of Sn and F significantly reduced the amount of dentin surface loss compared with all other groups. The F group also significantly reduced surface loss compared with Sn and DIW, followed by the Sn group, which showed significantly greater protection compared with the DIW control. The daily use of a combined fluoride and stannous solution is promising for preventing dentin erosion.

Efficacy of stannous, fluoride and their their combination in dentin erosion prevention in vitro

The aim of this study was to compare the protective effects of solutions containing stannous (Sn), fluoride (F) and their combination in the prevention of dentin erosion. Forty bovine root dentin specimens (4’4’2 mm3) were prepared and randomly assigned to 4 groups (n = 10): SnCl2(800 ppm/6.7 mM Sn), NaF (250 ppm/13 mM F), NaF/SnCl2 (800 ppm/6.7 mM Sn; 250 ppm/13 mM F), and deionized water (DIW) as a negative control. An acquired pellicle was formed on dentin samples by incubation in clarified, pooled, stimulated human saliva for 24 hours. The specimens were subjected to 5 daily cycles, each consisting of 5 of min demineralization (0.3%/15.6 mM citric acid, pH 2.6, 6’/day) and 60 min of re-mineralization in clarified human saliva. Thirty minutes after the 1st, 3rd and 5th demineralization episodes of each day, the specimens were treated with one of the test solutions for 2 min. Surface loss was measured via optical profilometry. Mixed-model ANOVA followed by Tukey’s test were used for the statistical analysis. Sn, F, and their combination significantly reduced the dentin surface loss by 23%, 36%, and 60% compared with DIW, respectively. All groups were significantly different (p < 0.05). The combination of Sn and F significantly reduced the amount of dentin surface loss compared with all other groups. The F group also significantly reduced surface loss compared with Sn and DIW, followed by the Sn group, which showed significantly greater protection compared with the DIW control. The daily use of a combined fluoride and stannous solution is promising for preventing dentin erosion.