The Effect of Chemical Degradation and Polishing on the Gloss of Composite Dental Materials.

This aim of this study was to investigate surface gloss changes of different composite dental materials after chemical degradation or polishing. Five different composites were used (Evetric, GrandioSO, Admira Fusion, Filtek Z550, Dynamic Plus). The gloss of the tested material was measured with a glossmeter before and after chemical degradation in different acidic beverages. Statistical analysis was performed using a t-test for dependent samples, ANOVA, and a post hoc test. For comparison between groups, a level of significance was set at 0.05. Initial gloss values ranged from 51 to 93 at baseline to 32 to 81 after chemical degradation. The highest values were obtained for Dynamic Plus (93.5 GU) and GrandioSO (77.8 GU), followed by Admira Fusion (82 GU) and Filtek Z550 (70.5 GU). Evetric showed the lowest initial gloss values. After acidic exposures, the gloss measurements revealed different patterns of surface degradation. The results showed that the gloss of the samples decreased with time regardless of the treatment. The interaction between chemical-erosive beverages and the composite could lead to a decrease in the surface gloss of the composite restoration. The nanohybrid composite showed less gloss changes under acidic conditions, suggesting that it is more suitable for anterior restorations.

Pediatricians' Knowledge of Emergency Management of Dental Injuries and Use of Mouthguards: A Cross-Sectional Survey.

AIM: Dental injuries are one of the most frequent oral health problems in children and adolescents. This study aimed to evaluate Croatian pediatricians' knowledge and practice regarding dental injuries management and the use of mouthguards as means of protection against traumatic injuries. MATERIALS AND METHODS: A questionnaire-based cross-sectional survey conducted among 186 pediatricians examined their demographic characteristics, knowledge and experience with dental injuries. Student t-test or one-way ANOVA, with Tukey's post-hoc were used to analyze obtained data (p ≤ 0.05). RESULTS: The overall mean score of knowledge on the management of dental injuries was 3.6 ± 1.53 points. Male pediatricians (p = 0.016), those who witnessed dental injuries (p = 0.003), and those who had more than ten years of pediatric practice (p = 0.027) showed better knowledge. The results of multiple linear regression analysis demonstrated impact between pediatricians' knowledge in the emergency treatment of traumatic dental injuries concerning the level of health care (practice settings) (ß = -0.254, p = 0.002) and the number of patients treated by a pediatrician per day (ß = -0.187, p = 0.030). CONCLUSION: Pediatricians have a low level of knowledge regarding the primary care of traumatic dental injuries. An additional course on dental injurie management should be recommended as part of the physician and pediatricians' educational training.

Comparison of Different Methods of Education in the Adoption of Oral Health Care Knowledge.

AIM: The scope of this study was to determine if there is a critical distinction in the usage of lectures, videos, and pamphlets as educational material utilized in the adoption of oral health care knowledge. MATERIALS AND METHODS: Three-hundred and thirty children from ages 11 to 13 from the city of Split, Croatia completed the questionnaire on oral health care knowledge. Consequently, they were educated by randomly using a method: lecture, pamphlet, or video. Finally, after education, their knowledge was tested again. RESULTS: Different statistical tests were used for comparison of different sets of data. The Wilcoxon signed-rank test showed a statistically significant difference (p ˂ 0.001) compared to the results before and after education. The Kruskal-Wallis test comparing knowledge outcomes after three different types of education: video, lecture, and pamphlet, showed a statistically significant difference in the final knowledge between groups (p ˂ 0.05). A pairwise comparison between different types of education showed a significant statistical difference between education conducted by pamphlet and video material (p = 0.003) and pamphlet and lecture (p = 0.006). No difference was observed between the level of knowledge acquired through video material education and lectures (p = 0.928). CONCLUSION: Videos and lectures as means of education showed equal effectiveness in the adoption of oral health care knowledge, while the pamphlet was a method that proved to be less effective.

Fusion of Unerupted Mesiodens with a Regular Maxillary Central Incisor: a Diagnostic and Therapeutic Challenge.

The mesiodens is the most frequent type of supernumerary tooth which can appear in the maxillary midline area. The etiology of mesiodentes is not fully understood. This report shows a case of incomplete fusion of an unerupted mesiodens with a permanent maxillary central incisor, aligned in the dental arch. Intraoral and radiographic examinations indicated fusion of the crown and cervical part of the root of the supernumerary tooth with the permanent incisor. The clinical situation was further complicated by the presence of another supernumerary tooth located palatally. The treatment approach has included two phase surgical therapy to extract the supernumerary teeth. Early diagnosis and appropriate surgical treatment of mesiodentes are important to decrease the risk of clinical complications. Pre-operative 3D imaging is strongly advisable since it allows accurate data to be obtained, and reduces the extent of surgery and the possibility of procedural complications. In most cases, a multidisciplinary collaboration is necessary for precise diagnosis and predictable treatment outcome.

Assessment of Cytotoxic and Genotoxic Effect of Fissure Sealants in Buccal Epithelial Cells.

AIM: The main purpose of this study was to assess the genotoxic and cytotoxic effect of fissure sealants on buccal epithelial cells. MATERIAL AND METHODS: The study was conducted on 45 patients (27 girls and 18 boys), seven to 16 years of age (age mean 12.09 ± 2.20). Buccal swabs were collected before (T0), seven (T1), 30 (T2) and 90 days (T3) consequently after fissure sealant placement (Helioseal F®, Equia Fil®, Constic®). Patients or legal guardians filled in the questionnaire regarding the demographic data (age, gender), dietary habits, health status, medication usage, and recent X-ray exposure. DNA damage was analyzed using the micronucleus test. RESULTS: Statistically significant difference in the number of buccal cells with condensed chromatin was found between T0 (time before fissure sealant placement) and T3 (90 days after fissure sealant placement) period for Helioseal F® (P = 0.025). For the other two analyzed materials, no difference was observed during the tested period. There was no difference between materials in the same sampling time. CONCLUSION: Apart from an increase in cells with condensed chromatin 90 days after the placement of Helioseal F®, no other nuclear abnormalities were observed for tested fissure sealants. Although these sealants have now largely been used, it is of high importance that their biocompatibility is checked continuously, especially in in vivo clinical studies.

Molar Incisor Hypomineralization in Children with Intellectual Disabilities.

The aim of the study is to compare the frequency and the distribution of molar incisor hypomineralization (MIH) in children with intellectual disabilities. METHODS: Seventy-two children with intellectual disabilities and 72 healthy children were included in the study. They ranged in age from 5 to 18 years with the same distribution by age and sex. Standard clinical examination was performed, at a dental clinic or in the institution where the children lived, by using a dental mirror and a probe, according the European Academy of Paediatric Dentistry judgment criteria for MIH. RESULTS: Among the 72 children with intellectual disabilities, eight children (11.1%) presented MIH with 19 affected teeth. In the control group, one child (1.4%) presented MIH with two affected teeth. The difference was statistically significant (p = 0.033). There were no statistically significant differences between boys and girls. The molars, especially the first right molars were the most affected tooth. Brown defects were less common than white defects. CONCLUSION: Children with MIH should be identified because this condition is a common problem in children with intellectual disabilities.

Reliability and Validity of Scales for Assessing Child Dental Fear and Anxiety.

INTRODUCTION: Children with high dental anxiety display uncooperative behavior during dental procedures. Different self-assessment questionnaires are in use to estimate the prevalence of dental fear and anxiety (DFA) in children but they need to be tested for reliability and validity in different populations. OBJECTIVES: The aim of this study was to test the reliability and validity of two scales for the assessment of child dental fear and anxiety in a sample of Croatian children. MATERIAL AND METHODS: The sample comprised 202 pairs consisting of children and their mothers (97 boys and 105 girls) aged 5 - 12 years. Two scales were used to assess children's DFA: the Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) and the Modified Child Dental Anxiety Scale - face version (MCDAS-f). The Corah's Dental Anxiety Scale (CDAS) was used in the sample of children's mothers. The average scores of cooperative children and children with behavior management problem (BMP) were compared. RESULTS: Cooperative children displayed significantly lower CFSS-DS scores than children with BMP (M = 28. 46 vs. M = 39. 36; P < 0.001). The average MCDAS-f score was significantly higher in children with BMP than in cooperative children (M = 28. 07 vs. 20. 01; P < 0.001). The CFSS-DS showed high internal consistency (Cronbach's α = 0. 90), while internal consistency of MCDAS-f was good (α = 0. 73). The maternal CDAS showed good internal consistency (α = 0, 89). The correlations with other self-report measurements of DFS show good validity of all scales. The correlations between CFSS-DS and MCDAS-f were highly significant (r = 0.482; P < 0. 01) as well as the correlations of CFSS-DS and MCDAS-f with CDAS scores (r = 0.223; P < 0. 01 and r = 0.198; P < 0. 01, respectively. CONCLUSION: The obtained results suggest that both the CFSS-DS scale and the MCDAS-f scale are reliable and valid scales for measuring dental fear and anxiety in children in a sample of Croatian children. The MCDAS-f scale has shown slightly lower internal consistency but it is suitable for use in young children. In addition, the MCDAS-f scale is simple to administer.

How to Intervene in the Caries Process: Early Childhood Caries - A Systematic Review.

For an Organisation for Caries Research/European Federation of Conservative Dentistry consensus, this systematic review is aimed to assess the question of how to manage the caries process in the case of early childhood caries (ECC). Medline via PubMed was searched systematically regarding management of ECC. First priority was existing systematic reviews or randomized clinical trials otherwise cohort studies dealing with management of ECC, primarily with carious anterior teeth. After data extraction, the potential risk of bias was estimated depending on the study types, and the level of evidence was evaluated. Regarding management of ECC, results are presented for silver diamine fluoride (SDF, n = 5), nonoperative caries management (NOCM, n = 10), and restorative approaches (RA, n = 8) separately, as different kinds of studies with different levels of evidence were found for the different aspects in the management of ECC. The 5 systematic reviews on SDF showed a high potential for arrest of ECC on a high level of evidence. In NOCM, a low level of evidence for a moderate effect of fluoride varnish in arresting or remineralizing, especially non-cavitated lesions, was assessed. For RA in carious anterior upper primary teeth, a low level of evidence was found for higher failure rates of glass ionomer cement and composite fillings than composite strip crowns even if placed under general anaesthesia and especially compared to other crowns (stainless steel and zirconia). In conclusions, ECC may be managed successfully with nonoperative (SDF, regular fluoride application) and moderately well with operative approaches, but the decision is affected by many other variables such as pulpal involvement, the child's cooperation, or a general anaesthesia setting.

Acceptance of Orthodontic Therapy according to the Aesthetic Component of the Index of Orthodontic Treatment Need among Schoolchildren - a Cross-Sectional Study.

OBJECTIVE: Orthodontic anomalies with impaired facial aesthetics and disturbed oral functions have a major effect on emotional and social development. It is necessary to determine the degree of acceptance of treatment. This study includes an evaluation of the Index of Orthodontic Treatment Need (IOTN) according to the Aesthetic Component (AC) of dental health in schoolchildren. METHODS: The research included 300 schoolchildren (150 girls, 150 boys) with an age range from 12 to 15 years. An evaluation of the need for orthodontic treatment according to the AC consisted of a ten-grade scale illustrated with a sequence of ten intraoral photographs showing different degrees of acceptability of dental appearance. Results were expressed as absolute and relative frequencies. The Chi-square test (in the absence of the expected frequencies of Fisher's Exact test) was used for testing the significance of differences. Cohen's kappa statistic measure was used for measuring the agreement between the children and dentists. RESULTS: There is a significant substantial agreement between children and dentists in assessing the need for orthodontic treatment. Differences in assessment of the degree of orthodontic anomalies by the doctor of dental medicine with respect to boys and girls, are negligible, and statistical analysis did not show any significant difference. Analysis of the need for orthodontic treatment with respect to the age of the children showed a significant difference. CONCLUSION: The need for orthodontic treatment is more pronounced in older children, and there is no difference between boys and girl.

An In-Vitro Analysis of Microleakage of Self-Adhesive Fissure Sealant vs. Conventional and GIC Fissure Sealants.

BACKGROUND: The microleakage of a self-adhesive composite, a glass ionomer fissure sealant and a conventional resin-based fissure sealant were compared. MATERIALS AND METHODS: Fifty intact human molars with well-delineated pits and fissures were used and divided into 5 groups (n = 10). Group 1 specimens were etched (37% phosphoric acid) and sealed with conventional resin-based sealant (Helioseal F, Ivoclar Vivadent). Both Group 2 and 3 specimens were sealed with self-adhesive composite (Constic, DMG), but in Group 3, specimens were also etched (37% phosphoric acid). In Groups 4 and 5, specimens were sealed with a GIC sealant (Equia Fill, GC Company), but Group 5 was also exposed to thermo-light curing (TLC) with a LED polymerization unit (60 s). Subsequently, specimens were thermocycled (1800 cycles, dwelling time of 10 s), immersed in 50% silver nitrate solution (45 min), placed in a photo-developing solution (Kodak) under a lamp (120 W, 6 h), and cut into 3⁻4 slices. Marginal leakage (dye penetration depth) was evaluated under a light microscope and the worst score of each specimen was recorded (0⁻3). RESULTS: Constic showed the lowest microleakage (Constic: 80% scored 0 or 1), followed by Helioseal (30% scored 0 or 1) (p = 0.037). Microleakage in groups sealed with Constic (with and without etching) were not different (p = 0.473). The quality of seal deteriorated after etching when Constic was used. However, TLC improved the seal when GIC sealant was used (p = 0.016) and also in comparison to Helioseal (p = 0.004). The TLC GIC sealant (Equia Fill, 90% scored 0 or 1) performed well, similar to self-adhesive composite (Constic, 80% scored 0 or 1) (p = 0.206). CONCLUSION: The present findings suggest that the self-adhesive sealant and the GIC sealant that were exposed to TLC had comparable sealing ability and superior sealing characteristics compared to the conventional resin-based sealant. A long-term clinical trial is needed to assess the intra-oral performance.

In vivo assessment of genotoxicity in buccal cells of children undergoing tooth restoration.

OBJECTIVES: Whereas dental materials came in direct or close contact with oral tissue, it is a great concern about the biocompatibility of those materials. This study was performed to evaluate possible DNA damage to buccal cells exposed to dental materials. METHODS: This prospective, longitudinal clinical study was conducted over a three months period. Class II restorations were placed in 60 young patients with no previous filling using one of three tested dental materials (two glass ionomers; Ketac Molar and Ionofil Molar and one compomer material; Twinky Star). DNA damage was analysed by micronucleus assays, in buccal exfoliated epithelial cells. RESULTS: In patients treated with Ketac Molar, a significant frequency of micronuclei (p = 0.027) and binucleated cells in samples taken 30 days following restoration (p = 0.029) was confirmed. In patients treated with Twinky Star, a statistically significant increase in the number of binucleated cells in samples taken after 7 and 30 days following restoration (p = 0.001 and p < 0.001, respectively) was observed. In all samples collected 90 days after treatment, there was no statistical difference in the number of any cell changes. CONCLUSION: In this study long-term biocompatibility of tested materials was confirmed. Glass ionomers and compomers are widely used materials in paediatric dentistry, and this study has proved their safety for usage in children.

The role of parental anxiety, depression, and psychological stress level on the development of early-childhood caries in children.

BACKGROUND: It is important to understand how the psychological status of parents affects oral health in children. AIM: This study aimed to assess the level of depression, anxiety, and stress of parents whose children have early-childhood caries. DESIGN: The study included 235 children and their parents who visited the Dental clinic at the School of Medicine of the University of Split between October 2016 and July 2017. The dental status of each child was recorded, while parents filled out the Depression Anxiety Stress Scale questionnaire and the questionnaire related to the demographic characteristics, questions related to child's habits of the tooth brushing, eating sweets. RESULTS: Multiple regression analysis showed that the incidence of active caries in the children was statistically significantly related not only to the level of parent depression (ß = -0.289; P = 0.040) but also the level of anxiety (ß = 0.186; P = 0.038) and stress (ß = -0.120; P = 0.036). The dmft index in the examined children was negatively significant associated with the parental level of depression (ß = -0.305; P = 0.032). CONCLUSION: Considering the results of our research it is essential to emphasize the need for better health education of parents.

Influence of Toothpaste pH on Its Capacity to Prevent Enamel Demineralization.

AIM: This study evaluated in vitro the remineralization capacity of commercial toothpastes with different fluoride (F) concentrations and their effectiveness when they are acidified. MATERIALS AND METHODS: One hundred and twelve caries-free teeth were used to prepare enamel specimens, and the specimens were divided into 16 groups (n = 7). Baseline surface Vickers microhardness was measured for all the specimens and all the tested groups were subjected to the pH-cycling regime involved five demineralization challenges each day for 10 days, and surface Vickers microhardness was then measured. Once daily, specimens were exposed for 30 min after last demineralization challenge of the day to the slurry of each toothpaste containing 1450 ppm F, 1000 ppm F, 450 ppm F, and 0 ppm F. The slurry was in original pH or acidulated on 6.5, 6.0, or 5.5 pH. The difference among tested group was assessed by analysis of variance and Newman-Keuls test (P < 0.05). RESULTS: The highest increase in microhardness was detected after treatment with toothpaste containing 1450 ppm fluoride (percentage of increase in microhardness was 6.20%), and the biggest loss was detected after treatment with toothpaste containing no fluoride (percentage of decrease was 6.82%), but there was no significant difference between tested groups. CONCLUSIONS: The highest increase in microhardness was detected after treatment with toothpaste containing more fluorides (1450 ppm F) regardless of the acidity.

Surface Roughness of Glass Ionomer Cements after Application of Different Polishing Techniques.

Glass Ionomer Cements (GIC) have been widely used in clinical practice since they have a wide range of positive characteristics: chemical bonding to the tooth surface, fluoride release, a heat-expansion coefficient similar to the tooth, do not require an absolutely dry working area, less volumetric contraction, good color stability. Physical properties can be improved by using external energy such as ultrasound and radiant heat (thermo-curing), which also accelerates chemical curing. Objectives: The aim of this study was to determine the most effective polishing technique and to compare the surface roughness of two Glass Ionomer Cements after treatment with heat (thermo-curing), and without heat treatment during the setting process. Materials and methods: Two polishing systems (Tungsten carbide burs and Sof-Lex discs) were used on two types of GIC (Equia Fil and Ketac Molar Universal). Bluephase 16i LED (Vivadent, Schaan Liechtenstein) light was used for the specimens treated with heat (thermo-curing). Samples without heat treatment are left for 10 minutes to chemically cure. Surface profilometar was used for measuring the mean surface roughness value (Ra). Results: Group with Mylar strip (control group) of each material showed the lowest (Ra) value. The Equia Fil material samples treated with heat (thermo-curing) achieved lower surface roughness values (Ra), and showed lower surface roughness values (Ra) after polishing with a Sof-Lex discs (p<0.05). The results for Ketac Molar Universal samples showed no statistically significant difference (p>0.05) between polishing with Sof-Lex discs and Tungsten carbide burs. Conclusion: Based on the obtained results, it can be concluded that the smoothest surface roughness is achieved by the Mylar strip. Some types of Glass Ionomer Cements can obtain better surface polishing with heat treatment (thermo-curing).

The prevalence of orthodontic treatment needs of school children in northern Herzegovina.

OBJECTIVE: The study was conducted to evaluate the Index of Orthodontic Treatment Need based on the Dental Health Component (DHC). MATERIALS AND METHODS: 300 students aged 12-15 years were included in this study. The examinations were performed in two elementary schools in the municipality of Prozor-Rama, using standard dental instruments. Children were ranked into five grades according to the DHC. RESULTS: Only 12% of children were found not to have a need for orthodontic treatment. Of the others, 45.33% had a great, and 10% a very great need for orthodontic treatment. The rest of the children were found to have a need for minor or moderate orthodontic treatment. Slightly more girls than boys had a great or a very great need for treatment, although the difference by gender was not statistically significant. Analysis of the level of need by age of children showed no significant difference; children with a great need of orthodontic treatment prevailed in all age groups. About 85% of children with a great and a very great need for orthodontic treatment would agree to orthodontic treatment, while the rate of non-acceptance was about 5%. CONCLUSION: The high rate of need for orthodontic treatment in the examined students is explained by the lack of programs for this type of health care, the insufficient number of qualified orthodontic specialists, and the very low percentage of allocations from the state budget for oral health.

Thermo-cured glass ionomer cements in restorative dentistry.

Numerous positive properties of glass ionomer cements including biocompatibility, bioactivity, releasing of fluoride and good adhesion to hard dental tissue even under wet conditions and easy of handling are reasons for their wide use in paediatric and restorative dentistry. Their biggest drawbacks are the weaker mechanical properties. An important step forward in improving GIC's features is thermo-curing with the dental polymerization unit during setting of the material. Due to their slow setting characteristics the GIC is vulnerable to early exposure to moisture. After thermo curing, cements retain all the benefits of GIC with developed better mechanical properties, improved marginal adaptation, increased microhardness and shear bond strength. Adding external energy through thermocuring or ultrasound during the setting of conventional GIC is crucial to achieve faster and better initial mechanical properties. Further clinical studies are needed to confirm these findings.

Effect of different thermo-light polymerization on flexural strength of two glass ionomer cements and a glass carbomer cement.

STATEMENT OF PROBLEM: Whether polymerization lights can be used for heating glass ionomer cements (GICs) or glass carbomer (GCP) to improve their mechanical properties is not well established. PURPOSE: The purpose of this in vitro study was to assess the effect of thermo-light polymerization on the flexural strength (FS) of 2 GICs (Fuji IX GP Fast, Ketac Molar) and a GCP. MATERIAL AND METHODS: Specimens (n=10) were prepared in stainless steel molds (2×2×25 mm), compressed, exposed to 3 polymerization lights (500, 1000, 1200 mW/cm2) for 2 cycles of 40 seconds on each side, and stored in petroleum jelly (37°C, 24 hours). RESULTS: Significant FS differences were detected among groups after different thermo-light polymerization regimens (F=50.926, df=11, P<.001). GCP showed the highest mean FS (∼5 times, P<.001) after thermo-light polymerization with power outputs of 1000 (127.1 ±25.8 MPa) and 1200 mW/cm2 (117.4 ±18.5 MPa), with no significance difference between them (P=.98), compared with 500 mW/cm2 (24.1 ±1.7 MPa). For Ketac Molar, compared with autopolymerization setting (15.5 ±3.1 MPa), a significant increase in mean FS (∼2.5 times) was only observed in specimens treated with 1200 mW/cm2 polymerization light (P=.03). For Fuji IX GP Fast, only the light with 1000 mW/cm2 output significantly increased the FS (98.9 ±23.4 MPa, P<.001) compared with the autopolymerization setting (34.9 ±6.4 MPa). CONCLUSIONS: Thermo-light polymerization accelerated the development of FS in the tested GICs, potentially protecting against saliva contamination during the first 3 to 4 minutes after mixing GIC. Thermo-light polymerization of the glass carbomer with power outputs of 1000 and 1200 mW/cm2 also substantially increased FS. The clinical advantages of the findings should be validated by in vivo studies.

Influence of Thermo-Light Curing with Dental Light-Curing Units on the Microhardness of Glass-Ionomer Cements.

The purpose of this study was to verify for various glass-ionomer cement (GIC) products whether the application of thermo-light curing on the initial curing material produces an increase in microhardness, and to determine whether this hardness varies depending on the depths of the GIC samples. The efficacy of various polymerization units on this additional hardening was also examined. The GIC samples were thermo-light cured for 60 seconds with three polymerization units. The Vickers microhardness was measured at three different depths: 2 mm, 3 mm, and 4 mm. Analysis of variance and Newman-Keuls test showed statistically significant differences among tested samples for all three GIC groups (P < .001). The results of linear regression analysis showed a statistically significant relationship between the hardness of the material and the temperature for samples with depths of 2 mm (R = 0.78; P = .0028) and 3 mm (R = 0.59; P = .045). The findings of this study indicate that thermo-light curing of GIC with different polymerization units for 60 seconds during setting reaction increases the microhardness of the GICs at all depths tested and may increase resistance to mastication forces, which can be validated in future clinical studies.