A 24-month randomized clinical study of flowable bulk-fill resin composites in Class III restorations.

Background: The 24-month clinical performance of 3 commercially available flowable bulk-fill resin composites in Class III restorations was evaluated. Material and Methods: Forty-two patients, 27 females (64.3%) and 15 (35.7%) males, received at least 3 Class III restorations that never exceeded 4 mm depth and width. One hundred thirty-eight teeth, divided up into three groups (n=46), were randomly restored with Admira Fusion x-base (AFB), Estelite Bulk Fill Flow (EBF) and SDR flow+ (SDR) in one single increment. A 2-step self-etch adhesive system Clearfil SE Bond (C-SE) with selective enamel etching was used for all restorations. The restorations were clinically evaluated using a slightly modified USPHS criteria at the baseline and every 6 months for 24 months. Success rates of each material between the baseline and at 24 months were compared with the McNemar test. At each timepoint, the comparison of the clinical performance among materials in terms of the ratings of the considered criteria was analyzed by using the Friedman and Cochran's Q tests. Results: At the end of the 24-month follow-up, the overall clinical success rate was 100% for each tested material. However, significant differences among the composites were highlighted for several criteria involving the marginal adaptation, marginal discoloration, surface texture, surface staining and color match. Conclusions: The flowable bulk-fill resin composites tested showed an overall good effectiveness for Class III restorations after the 24 months, although significant rating differences among the materials emerged for some specific clinical criteria. Key words:Bulk-fill, Class III restoration, flowable composite, clinical study, self-etching adhesive.

Age estimation of Russian individuals by teeth using the London Atlas / Análise da estimativa de idade em indivíduos russos utilizando a metodologia London Atlas

Knowing an individual's age is necessary for several situations, both in the living and the deceased. The London Atlas uses dental development and eruption to estimate age. Testing the method in different populations is necessary to assess its performance. This study aimed to assess the performance of the London Atlas method in a Russian sample using panoramic radiographs. A sample of 703 panoramic radiographs of Russian individuals (n = 405 females, 57.61% and n = 298 males, 42.39%) with ages between 8 and 23 years were analyzed. The results showed overestimation in individuals from 8 to 14 years and underestimation from 15 to 23 years. The mean difference between estimated and chronological ages did not exceed 0.7 years among individuals with ages below 19 years. The difference increased to over three years in individuals from 20 to 23 years. Statistically significant differences were found between females and males between 17 and 18 years (p<0.05). The London Atlas is suitable for Russian children and adolescents aged between 8 and 19 years; however, it showed unsatisfactory results for application in individuals over 20 years (AU).

Conhecer a idade de um indivíduo, vivo ou morto, é essencial em diversas situações. O método London Atlas utiliza desenvolvimento e erupção dentais para estimar a idade. Testar o método em diferentes populações é importante para avaliar sua performance. Esse estudo objetivou analisar o desempenho do London Atlas em uma amostra de origem russa, utilizando radiografias panorâmicas. Uma amostra de 703 indivíduos russos (n = 405 mulheres, 57,61% e n = 298 homens, 42,39%), com idades entre 8 e 23 anos foram analisadas. Resultados obtidos mostram uma superestimação em indivíduos de 8 a 14 anos e subestimação nos grupos de 15 a 23 anos. A diferença média entre idades estimadas e reais não excederam o valor de 0,7 anos nos indivíduos com idade abaixo de 19 anos. Essa diferença aumentou em até três anos em indivíduos de 20 a 23 anos. Diferenças estatisticamente significantes foram encontradas entre homens e mulheres com 17 e 18 anos (p<0,05). O London Atlas é adequado para crianças e adolescentes de origem russa, com idades de 8 a 19 anos. No entanto, observou-se resultados insatisfatórios para sua aplicação em indivíduos acima de 20 anos (AU).

Minimization of Adverse Effects Associated with Dental Alloys.

Metal alloys are one of the most popular materials used in current dental practice. In the oral cavity, metal structures are exposed to various mechanical and chemical factors. Consequently, metal ions are released into the oral fluid, which may negatively affect the surrounding tissues and even internal organs. Adverse effects associated with metallic oral appliances may have various local and systemic manifestations, such as mouth burning, potentially malignant oral lesions, and local or systemic hypersensitivity. However, clear diagnostic criteria and treatment guidelines for adverse effects associated with dental alloys have not been developed yet. The present comprehensive literature review aims (1) to summarize the current information related to possible side effects of metallic oral appliances; (2) to analyze the risk factors aggravating the negative effects of dental alloys; and (3) to develop recommendations for diagnosis, management, and prevention of pathological conditions associated with metallic oral appliances.

The Effect of Toothpastes Containing Hydroxyapatite, Fluoroapatite, and Zn-Mg-hydroxyapatite Nanocrystals on Dentin Hypersensitivity: A Randomized Clinical Trial.

Aims: The aim of this study was to compare the effect of toothpastes containing hydroxyapatite (nHAP), Zn-Mg-hydroxyapatite (nZnMgHAP), and fluorapatite (nFAP) nanocrystals on dentin hypersensitivity (DH) associated with noncarious cervical lesions. Materials and Methods: Thirty consenting volunteers aged 35-45 years with DH were enrolled in a double-blind, parallel study, randomly assigned to the nHAP group (n = 10), the nZnMgHAP group (n = 10), or the nFAP group (n = 10), and instructed to use the toothpaste twice daily for one month. The primary outcome was Schiff scores at baseline and after 2 and 4 weeks. Results: All patients fulfilled the study requirements, and no adverse effects were registered. A reduction in DH was registered in 90%, 100%, and 50% of patients using nHAP, nZnMgHAP, and nFAP-containing toothpastes with effect sizes 2.52 (confidence interval [CI] 95%: 0.82, 4.14), 3.30 (CI 95%: 1.33, 5.20), and 1.44 (CI 95%: 0.09, 2.72), respectively. At 4 weeks, Schiff index scores decreased significantly in all groups compared to baseline. Conclusions: nZnMgHAP may be considered a promising agent for DH management.

The Effect of Ultrasonic Scaling and Air-Powder Polishing on the Roughness of the Enamel, Three Different Nanocomposites, and Composite/Enamel and Composite/Cementum Interfaces.

We aimed to assess the effects of ultrasonic scaling and air-powder polishing on the roughness of enamel, three nanocomposites (Premise, Herculite Ultra, Harmonize), and composite/enamel and composite/cementum interfaces. Class V cavities were restored in 99 extracted third molars with one of the three nanocomposites and treated with ultrasonic scaler or air-powder polishing device (calcium carbonate or sodium bicarbonate powders). The roughness (Ra) of the investigated surfaces was measured with contact profilometer before and after treatment. The data were analyzed using repeated measures ANOVA. Specimens' Ra values before instrumentation were near the clinically acceptable 0.2 µm threshold. All techniques increased the roughness of the tested surfaces; however, the enamel was slightly affected. The mean Ra values after prophylaxis for composite, composite/cementum and composite/enamel surfaces were 0.32-0.55, 1.33-1.73, and 1.25-1.36, respectively. The extent of composite surface damage was material dependent. Premise surface was not altered by ultrasonic scaling significantly. Air-powder polishing with both powders produced a greater increase in surface roughness of composite resin and restorations margins than ultrasonic scaling. The Ra values after both types of air polishing for Herculite Ultra and Harmonize were approximately 1.5 and 2 times higher, respectively, than those after ultrasonic scaling (p < 0.05).

Marginal quality of a full-body bulk-fill composite placed with an universal adhesive system in etch-and-rinse and self-etch mode: An in vitrostudy.

BACKGROUND: Marginal seal of a nanohybrid bulk-fill composite compared to a nanohybrid conventional composite, using a universal adhesive (UA) applied in etch-and-rinse (ER) and self-etch (SE) mode was investigated. MATERIAL AND METHODS: Thirty-six intact molars were selected and two standardized cavities in each tooth were prepared and allocated into four groups according to restorative material and etching strategy. All samples were placed in a 1% methylene blue solution for 24 h, then cut in the middle of the restorations obtaining two parts (n=144) and used for microscopic evaluation (50x) for dye penetration measurements. RESULTS: The data were analysed by ANOVA and Tukey post-hoc test (p<0.05). Marginal seal was influenced by adhesive strategy (p<0.05) but not from the composite used (p>0.05). CONCLUSIONS: Simplified restorations with nanohybrid bulk-fill composite showed comparable marginal leakage to incrementally placed nanohybrid composite. The UA used with a ER technique resulted in better marginal seal irrespective of the restorative material used. Key words:Bulk-fill composite, universal adhesive, self-etching, etch-and-rinse, marginal seal.

Radiographic assessment of third molar development in a Russian population to determine the age of majority.

OBJECTIVE: To test the applicability of "Gleiser and Hunt dental staging system modified by Kohler" (GHK) to assess third molar (3 M) development in a Russian population in order to determine the age of majority. DESIGN: The sample consisted of 918 panoramic radiographs from Russian females (n = 551) and males (n = 367) within the age interval between 8 and 23 years. On each radiograph, 3 M development was classified based on the GHK technique. Statistics tested the data for normality. Mean age and standard deviation were described for each 3 M position. Ordinal logistic regression tested the performance of the technique to classify individuals below or above the 18-year threshold. Receiver Operating Characteristic (ROC) curves were used. RESULTS: The mean ages and standard deviation (SD) for apex closure in females were 21,11 (SD = 1,47), 21,11 (SD = 1,43), 21,24 (SD = 1,39), and 21,29 (SD = 1,28) years for the teeth #18, 28, 38, and 48, respectively. Among males, the same teeth showed mean closure ages of 20,57 (SD = 1,69), 20,64 (SD = 1,76), 20,68 (SD = 1,68), and 20,81 (SD = 1,62) years, respectively. Area under the curve (AUC) reached 0.904 and 0.915 for classifying females and males below or above the 18-year threshold. CONCLUSION: The GHK technique was able to describe 3 M development in a Russian population. The statistic model was able to classify individuals below or above the 18-year threshold. However, the outcomes must be carefully interpreted, especially in borderline cases (17-19-year spectrum).

Xerostomia and hyposalivation in patients with obstructive sleep apnoea.

OBJECTIVE: (a) To report the xerostomia prevalence and severity in patients with obstructive sleep apnoea (OSA). (b) To assess the saliva pH in patients with OSA. DESIGN: Simultaneous cohort observational clinical study. SETTING: In Sleep Medicine Centre at Lomonosov Moscow State University from March to June 2019. PARTICIPANTS: The study was conducted on 30 patients with OSA aged from 35 to 65 years. MAIN OUTCOMES MEASURES: The diagnosis of sleep apnoea was made after standard polysomnography using the Domino programme. The severity of OSA was indicated using the Apnoea-Hypopnea Index. Xerostomia was evaluated using Fox's test. Hyposalivation was evaluated by measurement of salivary flow rate. Determination of the saliva pH was carried out with a pH metre. Statistical analysis was performed by one-way ANOVA and Tukey-Kramer multi-comparison test. RESULTS: Twenty-two out of 30 (73.3%) patients were diagnosed with "dry mouth". Hyposalivation was observed in 6 out of 30 (20%). Dry mouth on awakening was observed in 60.0%, 72.7% and 88.9% of patients with mild, moderate and severe OSA, respectively. The average salivary flow rate was 0.28 mL/min, 0.24 mL/min and 0.14 mL/min, respectively. The average pH value in patients with mild, moderate and severe apnoea was 6.40 ± 0.017, 6.15 ± 0.27 and 5.87 ± 0.24, respectively. CONCLUSIONS: In patient with mild and moderate OSA, the saliva amount and rate are similar (P > .05). With the increase of OSA severity, both these parameters change (P < .001). The acidity of the saliva was correlated with the level of OSA, and it statistically increased with the increment of the OSA severity (P < .05-P < .001).

Apical Leakage Evaluation of Two Different Coated Carrier Systems for Root Canal Obturation Using a Dye Penetration Evaluation Method.

AIM: The carrier-based obturation is a reliable technique for sealing the endodontic space. The GuttaCore with a pink internal core of cross-linked gutta-percha, named GuttaCore Pink, has been recently introduced into the market. The aim of this in vitro study was to compare the quality of the apical seal of two-carrier-based system, Soft Core and the GuttaCore Pink, through the measurement of apical dye leakage. MATERIALS AND METHODS: Eighty-six extracted human teeth with single canals were used. Samples were shaped using ProTaper Universal rotary files up to a #30 apical size and randomly divided into four groups. Group SC (n = 40) was obturated with #30 Soft Core Obturators; Group GCP (n = 40) was obturated with #30 GuttaCore Pink obturators; Group CT+ (n = 3) and CT- (n = 3) left nonobturated used as positive and negative controls, respectively. The samples underwent a process of passive/active dye penetration and after a clearing procedure. The extent of the dye was measured under stereomicroscope. RESULTS: The Mann-Whitney U test showed a statistically significant difference (p <0.05) between Soft Core and GuttaCore Pink in terms of apical dye leakage, both considering the mean and the maximum infiltration value with a greater infiltration rate for Soft Core. CONCLUSION: In vitro GuttaCore Pink showed less apical dye leakage than Soft Core. CLINICAL SIGNIFICANCE: The apical leakage of carrier-based obturation materials, observed in both GuttaCore Pink and Soft Core, may be considered material-dependent.

Qualitative and Quantitative Assessment of Remineralizing Effect of Prophylactic Toothpaste Promoting Brushite Formation: A Randomized Clinical Trial.

BACKGROUND: Currently various studies are conducted to improve the effect of existing and developing new remineralizing agents. One of the trends in remineralizing therapy is the development of toothpaste allowing brushite crystals formation in the demineralized lesions of hard tooth tissues. AIM: The aim of this study was to assess the effect of toothpaste, forming a brushite, on the functional acid resistance of enamel and the speed of its remineralization. MATERIALS AND METHODS: This was a randomized controlled double-blind clinical study. Sixty consent patients aged 20-25 years were enrolled in the three groups: test group (n = 20), positive control group (n = 20), and negative control group (n = 20), which used brushite-forming toothpaste, toothpaste with hydroxyapatite (HAP), and toothpaste without remineralizing agents, respectively. The hygiene indices, the rate of enamel remineralization, the dynamics of acid resistance of enamel, and the level of enamel sensitivity were determined at baseline, after 2 and 4 weeks to assess the effectiveness of toothpastes. Friedman rank sum test (for related variables) and the Kruskal-Wallis rank sum test (for independent variables) with Nemenyi post hoc test were used for statistical comparisons. RESULTS: The study test and positive control groups showed significantly greater acid resistance of enamel (P > 0.05) and rate of its remineralization at the study endpoints as compared with negative control group.In the test and positive control groups, Schiff index values significantly decreased after 4 weeks, whereas in the negative control group no significant differences were observed at the study time points. The oral hygiene level improved significantly after 2 and 4 weeks in all groups. CONCLUSION: The 30-day use of paste that promotes brushite formation and paste with hydroxyapatite resulted in faster enamel remineralization and higher enamel resistance. Brushite-containing toothpaste may be used as an alternative to HAP containing for remineralizing and desensitizing treatment.

The Effect of Finishing and Polishing Sequences on The Surface Roughness of Three Different Nanocomposites and Composite/Enamel and Composite/Cementum Interfaces.

The purpose of this study was to investigate the effect of final surface treatment and dental composite type on the roughness of the composite surface, composite/enamel interface, and composite/cementum interface, as well as on the polishing time. Class V cavities prepared in extracted teeth (n = 126) were restored using one of the three nanohybrid composites with different filler sizes. The specimens were randomly assigned to three different finishing and polishing sequences. The roughness (Ra) of the investigated surfaces was measured using the contact profilometer. The time required to achieve visible gloss was documented. The data were analyzed using ANOVA with Tukey's post hoc test (p < 0.05). There was no significant influence of the composite type on the restoration surface roughness (p = 0.088), while the polishing method had a significant impact (p < 0.001). The Ra of the composites ranged between 0.08 µm and 0.29 µm, with the lowest values (0.09 µm ± 0.05 µm) found in the aluminum oxide disc group (p < 0.001). The time to achieve a visible composite gloss was influenced by the polishing method, composite type, and interactions between these factors (p < 0.001). The interface roughness was significantly greater than that of the composite surface (p < 0.001), and depended on the composite type and polishing system employed.

Qualitative and Quantitative Evaluation of the Efficiency of the Application of Foams with False Xerostomia.

AIMS: Xerostomia syndrome is a significant medical and social problem. It is manifested by objective and subjective symptoms of a "dry mouth" and a decrease in sialometry. The aim of the study was to determine the dental status of students of different nationalities, to identify xerostomia induced on a background of stress, and to assess the effectiveness of the use of moisturizing foams in alleviating xerostomia. MATERIALS AND METHODS: A prospective cohort study survey (Fox test) of 100 students of the dental faculty was conducted to detect false xerostomia. The study involved 60 people with false xerostomia, divided into four groups of 15 each according to the nationality. The level of oral hygiene was determined using the Simplified Oral Hygiene and Silness-Loe indices and the rate of salivation was assessed with sialometry method by Pozharitskaya. Oral hygiene instructions were given to the participants. They were to apply moisturizing foams with lactoferrin, lactoperoxidase, and aloe vera, two-three times during the day for 3 weeks. A set of statistical programs was used (Microsoft Excel [2007] and the Statistical Package for the Social Sciences [SPSS], version 23) to perform Kolmogorov-Smirnov, Shapiro-Wilk, Kruskal-Wallis, and Wilcoxon tests. RESULTS: A statistically significant improvement in oral hygiene was observed in all study participants. A significant increase was detected in the rate of salivation in students from Russia (P = 0.005), Transcaucasian countries (P = 0.006), and Arab countries (P = 0.005). CONCLUSION: It has been established that the use of moisturizing foam has a positive effect on the rate of salivation and improves the level of oral hygiene, thereby improving the quality of life for patients.

Antibacterial and Remineralizing Fillers in Experimental Orthodontic Adhesives.

Orthodontic adhesives with antimicrobial and remineralizing properties may be an alternative to control white spot lesions around brackets. The aim of this study is to develop an experimental orthodontic adhesive containing boron nitride nanotubes (BNNT) and alkyl trimethyl ammonium bromide (ATAB). Methacrylate (BisGMA and TEGDMA) monomers were used to formulate the adhesives. Four experimental groups were produced with the addition of 0.1 wt.% BNNT (GBNNT); 0.1 wt.% ATAB (GATAB); and 0.2 wt.% BNNT with ATAB (GBNNT/ATAB); in the control group, no fillers were added (GCtrl). The degree of conversion, cytotoxicity, softening in solvent, contact angle and free surface energy, antibacterial activity, shear bond strength, and mineral deposition were evaluated. Adhesives achieved degree of conversion higher than 50% and cell viability higher than 90%. GBNNT and GATAB adhesives exhibited reduced softening in solvent. Mean free surface energy was decreased in the GBNNT adhesive. Significant reduction in bacterial growth was observed in the GBNNT/ATAB. No statistical difference was found for shear bond strength. Mineral deposition was found in GBNNT, GATAB, and GBNNT/ATAB groups after 14 and 28 days. The addition of 0.2% BNNT/ATAB to an experimental orthodontic adhesive inhibited bacterial growth and induced mineral deposition without affecting the properties of the material.