Potential risk of dental fluorosis associated with different baby formulas and water brands marketed in Spain.

Despite efforts to promote breastfeeding, many babies aged <6 months receive only baby formula reconstituted with bottled water. The intake of high levels of fluoride during amelogenesis has been associated with hypomineralization of the tooth enamel, with aesthetic and mechanical repercussions. The objective of this study was to determine the potential risk of dental fluorosis associated with baby formulas marketed in Spain. We measured 26 baby formulas frequently consumed in Spain; 17 brands for babies aged <6 months, 5 for those aged >6 months, and 4 ready-to-use brands. They were prepared with 4 types of water: distilled water and three brands of bottled water with different levels of fluoride. The fluoride concentration (mg/L or ppm F) was measured with an ion-specific electrode coupled to an ion analyzer. Each sample was prepared according to the manufacturer's instructions and analyzed in triplicate. A descriptive analysis was carried out. The minimum fluoride level found was 0.04 mg/L and the maximum was 1.02 mg/L. Considering the daily intake of these formulas, none exceeded the clinically-acceptable daily dose limit risk for fluorosis (0.07 mg F/day/kg body weight) when mixed with bottled water with a low level of fluoride (0.1 mg/L). However, when the same brands of formula were reconstituted with bottled water with a higher fluoride content (0.99 mg/L), they all exceeded the daily dose limit for the risk of fluorosis. As the potential risk of dental fluorosis associated with the formulas tested depends exclusively on the fluoride concentration of the waters used for reconstitution, formula packaging should contain a warning.

A Surgical Approach to Root Coverage and Correction of Mucogingival Conditions and Deformities in Mandibular Incisors with Isolated Gingival Recession: Free Mucogingival Graft. A Pilot Prospective Cohort Study.

The aim of this study was to present a periodontal plastic surgery approach to treat gingival recessions (GRs) and correct mandibular incisor mucogingival conditions and deformities. Isolated deep GRs (≥ 3 mm) in the mandibular incisors (n = 24 teeth) were treated: 66.6% of sites were recession types 2 or 3, and 58.3% of teeth were malpositioned. Recessions were treated using free mucogingival grafts (FMGs) harvested from the buccal aspect of donor teeth with altered passive eruption or healthy periodontal support, with < 3 mm between the cementoenamel junction and the buccal alveolar crest. Clinical parameters (GR, clinical attachment level, interproximal papilla tip location, keratinized tissue, vestibule depth) and root coverage esthetic score were evaluated at 9 months. FMG significantly reduced GR (P < .001) and increased keratinized tissue (P < .001) without loss of vestibule depth (P > .05). Mean root coverage was 94.37% ± 10.60%, mean residual GR was 0.08 ± 0.65 mm, and the mean root coverage esthetic score was 8.9 ± 1.24. Recession types 2/3 showed significant interproximal clinical attachment gain (P < .05). The interproximal papilla was significantly augmented at sites with papilla loss (P < .001). No clinical attachment loss (P = .346) was detected at donor sites. These results suggest that FMG is a promising root coverage approach for recession types 1, 2, and 3, correcting mucogingival conditions and deformities and reconstructing the interproximal papilla.

Deep Sedation for Dental Care Management in Healthy and Special Health Care Needs Children: A Retrospective Study.

BACKGROUND: Very young children, and those with disabilities and extensive oral pathology, who cannot be treated in the dental chair, require deep sedation or general anesthesia for dental treatment. OBJECTIVE: The aim of this study is to describe and compare the oral health status in healthy and SHCN children and the treatments performed under deep sedation on an outpatient basis with a minimal intervention approach, and their impact on quality of life. METHODS: A retrospective study between 2006 and 2018 was made. A total of 230 medical records of healthy and SHCN children were included. The data extracted were age, sex, systemic health status, reason for sedation, oral health status before sedation, treatments administered during sedation, and follow-up. The quality of life after deep sedation of 85 children was studied through parental questionnaires. Descriptive and inferential analyses were made. RESULTS: Of the 230 children, 47.4% were healthy and 52.6% were SHCN. The median age was 7.10 ± 3.40 years (5.04 ± 2.42 in healthy children and 8.95 ± 3.09 in SHCN children). The main reason for sedation was poor handling in the dental chair (99.5%). The most frequent pathologies were caries (90.9%) and pulp pathology (67.8%). Healthy children had more teeth affected by decay and with pulp involvement. Patients aged < 6 years received more pulpectomies and pulpotomies. After treatment, parents stated that children were more rested and less irascible, ate better, increased in weight, and had improved dental aesthetics. CONCLUSIONS: Differences in treatments carried out did not depend on the general health status or the failure rate but on age, with more pulp treatments in healthy children who were younger, and more extractions near to the age of physiological turnover in children with SHCN who were older. Intervention under deep sedation with a minimally invasive treatments approach met the expectations of parents and guardians, as it improved the children's quality of life.

Periodontal granulation tissue preservation in surgical periodontal disease treatment: a pilot prospective cohort study.

PURPOSE: The aim of this study was to evaluate the clinical outcomes of periodontal granulation tissue preservation (PGTP) in access flap periodontal surgery. METHODS: Twenty patients (stage III-IV periodontitis) with 42 deep periodontal pockets that did not resolve after non-surgical treatment were consecutively recruited. Access flap periodontal surgery was modified using PGTP. The clinical periodontal parameters were evaluated at 9 months. The differences in the amount of granulation tissue width (GTw) preserved were evaluated and the influence of smoking was analyzed. RESULTS: GTw >1 mm was observed in 97.6% of interproximal defects, and the granulation tissue extended above the bone peak in 71.4% of defects. At 9 months, probing pocket depth reduction (4.33±1.43 mm) and clinical attachment gain (CAG; 4.10±1.75 mm) were statistically significant (P<0.001). The residual probing depth was 3.2±0.89 mm. When GTw extended above the interproximal bone peak (i.e., the interproximal supra-alveolar granulation tissue thickness [iSUPRA-GT] was greater than 0 mm), a significant CAG was recorded in the supra-alveolar component (1.67±1.32 mm, P<0.001). Interproximal gingival recession (iGR) was significant (P<0.05) only in smokers, with a reduction in the interdental papillary tissue height of 0.93±0.76 mm. In non-smokers, there was no increase in the iGR when the iSUPRA-GT was >0 mm. The clinical results in smokers were significantly worse. CONCLUSIONS: PGTP was used to modify access flap periodontal surgery by preserving affected tissues with the potential for recovery. The results show that preserving periodontal granulation tissue is an effective and conservative procedure in the surgical treatment of periodontal disease.

Spanish Paediatricians' Knowledge, Attitudes and Practices Regarding Oral Health of Children under 6 Years of Age: A Cross-Sectional Study.

BACKGROUND: Early Childhood Caries (ECC) is a prevalent chronic pathology, and it has a negative impact on the oral and general health of the child patient. AIM: To evaluate the knowledge, attitudes and practices of Spanish paediatricians regarding early childhood caries according to the professional's years of experience. MATERIAL AND METHODS: A cross-sectional questionnaire was conducted by Spanish paediatricians via WhatsApp and e-mails from January to April 2021. Data were analysed using Chi-squared test, Fisher's exact test and Cramer's V test. RESULTS: There were a total of 359 participants. Most respondents were women (81.3%) with up to 10 years of professional experience (31.2%) in primary health care and public health. In most cases, participants had an excellent knowledge of primary dentition (90.8%), but they ignored (56%) when the first visit to the dentist should occur. Regarding the aetiological factors of caries, oral hygiene and prevention, a lower rate of knowledge was observed. The majority of participants (80.8%) were not able to identify white spot lesions and enamel defects (76%). They considered that their knowledge in oral health was deficient, highlighting the need to increase their training. Less experienced paediatricians were found to have higher success rates. CONCLUSIONS: The level of knowledge and attitudes regarding early childhood caries of the evaluated paediatricians should be improved. Paediatricians had difficulties in identifying early caries lesions and enamel defects. Nevertheless, a higher level of knowledge and positive attitudes towards dental caries has been detected among paediatricians with fewer years of professional experience.

Apical approach to the treatment of peri-implantitis in the esthetic zone: nonincised papillae surgical approach (NIPSA). Case reports.

OBJECTIVE: Advanced peri-implantitis treatment is a clinical challenge. Reconstructive surgery is not suggested in defects with limited bony walls and/or in those with a suprabony defect. All studies of peri-implantitis reconstructive surgery have considered a marginal surgical approach. However, in the present case report, a new apical approach is presented for the reconstruction of an advanced peri-implantitis lesion. MATERIALS AND METHOD: First, a non-surgical phase combines prosthetic, mechanical, and chemical strategies. Second, a surgical phase combines the apical nonincised papillae surgical approach (NIPSA) with biomaterials and a connective tissue graft. CONCLUSION: Successful results have been obtained when using a NIPSA for the treatment of peri-implantitis, despite the unfavorable characteristics of the peri-implant defect.

Prevention and Treatment of Oral Complications in Hematologic Childhood Cancer Patients: An Update.

Cancers have a highly negative impact on the quality of life of paediatric patients and require an individualised oral treatment program for the phases of the disease. The aim of this study was to update existing research on oral care in children diagnosed with cancer. We carried out a literature search (in English, Spanish and Portuguese) in the Pubmed, Cochrane Library, EBSCO, WOS, SciELO, Lilacs, ProQuest, and SCOPUS databases and the websites of hospitals that treat childhood cancers. We found 114 articles and two hospital protocols. After review, we describe the interventions necessary to maintain oral health in children with cancer, divided into: phase I, before initiation of cancer treatment (review of medical record and oral history, planning of preventive strategies and dental treatments); phase II, from initiation of chemo-radiotherapy to 30-45 days post-therapy (maintenance of oral hygiene, reinforcement of parent/patient education in oral care, prevention and treatment of complications derived from cancer treatment); phase III, from 1 year to lifetime (periodic check-ups, maintenance, and reinforcement of oral hygiene, dental treatments, symptomatic care of the effects of long-term cancer treatment). The use of standardised protocols can avoid or minimise oral cancer complications and the side effects of cancer therapies.

Preliminary Results of a Minimally Invasive Microsurgical Approach to Sinus Floor Elevation and Bone Reconstruction Using a Palatal Septum Window.

The aim of this case report was to present the preliminary results of a novel microsurgical approach to sinus floor elevation and bone augmentation. This technique was used to treat four patients in whom an implant could not be placed in the maxillary first molar position because of insufficient bone height. The maxillary first molar was extracted, and a sinus access window was created in the palatal area of the bony interradicular septum. The sinus membrane with the palatal septum fragment was elevated, and the sinus space between and above the roots was filled with xenograft. Alveolar preservation was done with xenograft and a nonresorbable membrane. Bone augmentation was evaluated 6 months after preservation by computed tomography and histology; clinical, radiologic, and histologic bone reconstruction were seen, allowing placement of implants. The novel approach utilized in this study demonstrated positive preliminary results in bone reconstruction with reduced morbidity.

Papilla preservation periodontal surgery in periodontal reconstruction for deep combined intra-suprabony defects. Retrospective analysis of a registry-based cohort.

BACKGROUND: Suprabony defects are the most prevalent defects and there is very little evidence on their treatment. This study aims to assess the effectiveness of papilla preservation periodontal surgery in the periodontal reconstruction of combined deep intra-suprabony defects. MATERIAL AND METHODS: 20 patients with combined intrabony and supra-alveolar deep periodontal defects treated by papilla preservation periodontal surgery were analyzed. Defects were treated with enamel matrix derivate plus xenograft. Clinical recordings made before surgery and at 12 months. RESULTS: Papilla preservation periodontal surgery showed significant PPD reduction (4.4 ± 1.46 mm; p<0.001), clinical attachment gain (3.35 ± 1.6 mm; p<0.001), increased REC (1.05 ± 0.94; p<0.001), papilla apical displacement (0.85 ± 1.31 mm; p<0.005) and KT reduction (0.5 ± 0.76 mm; p<0.05). At one week, there was incomplete wound closure and necrosis in 40% and 30% of the treated sites, respectively. At one year, the intrabony component filling was 73.65 ± 27.6 % and the supra-alveolar attachment gain indicated an incomplete intrabony defect resolution (-0.15 ± 1.56 mm). CONCLUSIONS: Periodontal pocket was significantly reduced and the level of clinical attachment increased. However, there was significant recession of the gingival margin and the papilla and a trend to incomplete resolution of the intrabony component. Key words:Periodontitis, surgical flaps, reconstructive surgery, regeneration.

Laterally rotated flap for soft tissue augmentation around maxillary loaded osseointegrated dental implants: preliminary results of a pilot study.

A minimal width and thickness of keratinized and attached soft tissue is desirable to prevent peri-implant diseases. This report describes the preliminary results of a pilot study of a surgical approach for soft tissue augmentation around loaded dental implants in the partially or totally edentulous maxilla. Four patients presenting eight maxillary implants with a buccal peri-implant soft tissue deficiency received a laterally rotated flap. A buccal mesial and apical recipient area was created around each implant, and a pediculated keratinized graft was rotated 90° from the distopalatal and positioned and sutured on the peri-implant buccal aspect. All implants treated showed a gain in buccal clinical peri-implant attachment (1.37 ± 0.44 mm) and buccal soft tissue levels (2.06 ± 1.40 mm) and interproximal soft tissue levels (1 ± 0.75 mm). The technique provided quality soft tissue with a gain in soft tissue thickness (3.06 ± 0.68 mm) and keratinized wide tissue (4.69 ± 0.80 mm) with minimal morbidity (1575 ± 549.67 mg of ibuprofen) and maintenance of prosthetic loading. Peri-implant soft tissue stability was maintained for 13.5 ± 1.87 months. Laterally rotated flap can be applied and provide clinical benefits to compromised implants due to the presence of buccal peri-implant soft tissue deficiency. Further studies are required to confirm these preliminary results.

Non-Incised Papilla Surgical Approach and Leukocyte Platelet-Rich Fibrin in Periodontal Reconstruction of Deep Intrabony Defects: A Case Series.

We present the preliminary results of the treatment of teeth with a deep, non-contained periodontal residual defect, vestibular bone dehiscence, and soft tissue recession, by combining an apical non-incised papilla surgical approach (NIPSA) to the defect and leukocyte platelet-rich fibrin (L-PRF) in the vestibular aspect. Four patients (upper left first premolar, upper left central incisor, upper right central incisor and upper right lateral incisor) have been treated. At one year of follow up, all cases showed a considerable reduction in the periodontal pocket depth, a gain in clinical attachment and no bleeding on probing, as well as an improvement in the marginal soft tissue minimizing soft tissue contraction (recession and/or loss of papilla) and improving soft tissue architecture. NIPSA plus L-PRF seem to improve clinical outcomes in deep non-contained intrabony defects associated with soft tissue recession.

[Total and soluble fluoride concentration in children´s toothpastes in Spain.] / Concentración de fluoruro total y soluble en pastas dentales de uso infantil en España.

OBJECTIVE: The use of fluoridated toothpastes is considered the most rational method in dental caries control, and it is recommended for all ages people, but for this they must be established at a minimum concentration of 1,000 ppm of total soluble fluoride, in pediatric patients. The objective of the study was to determine the concentration of total and soluble fluoride present in toothpastes marketed in Spain for pediatric use. METHODS: A descriptive and cross-sectional study was carried out throughout 2019, analyzing 11 toothpastes for pediatric use marketed in Murcia, Spain. The concentration of fluoride (ppm F=mg F/Kg) total (FT), soluble (FTS) and fluoride ion (F) and MFP (FPO32-) was analyzed using an ion-specific electrode coupled to an ion analyzer. A descriptive study was carried out to determinate mean and standard deviations for each variable analyzed. RESULTS: Among the analyzed toothpastes, 45% contained NaF (sodium fluoride), 45% MFP (sodium monofluorophosphate) and 10% both types of salts. The abrasive used was silica. 98% of the analyzed toothpastes showed total fluoride contents similar to those described by the manufacturer, only 3 toothpastes had fluoride concentrations lower than those described. The range obtained from FT oscillated between 398 -1,474.6 ppm F, and 100% of the toothpastes did not show differences between values of total fluoride and soluble fluoride. CONCLUSIONS: Most of the analyzed toothpastes contain a concentration of soluble fluoride between 1,000-1,500 ppm Fluoride, corresponding to the values described by the manufacturers However, there are still toothpastes with values lower than those recommended, minimum 1,000 ppm F, that do not allow effective anticaries activity from a public health point of view.

OBJETIVO: El uso de pastas dentales fluoradas es considerado el método más racional en el control de caries dental, y es recomendado para personas de todas las edades, pero para ello han de establecerse en una concentración mínima de 1.000 ppm de fluoruro total soluble, en pacientes pediátricos. El objetivo del estudio fué determinar la concentración de fluoruro total y soluble presente en pastas dentales comercializadas en España para uso pediátrico. METODOS: Se realizó un estudio descriptivo y transversal durante el año 2019, analizando 11 pastas dentales de uso pediátrico comercializadas en Murcia, España. Se analizó la concentración de fluoruro (ppm F=mg F/kg) total (FT), soluble (FTS) e ión de Flúor (F) y de MFP (FPO32-) mediante un electrodo ion-específico acoplado a un analizador de iones. Se llevó a cabo un estudio descriptivo determinando las medias y desviaciones estándar para cada variable. RESULTADOS: Entre las pastas dentales analizadas, el 45% contenían NaF (fluoruro sódico), 45% MFP (monofluorofosfato de sodio) y un 10 % ambos tipos de sales. El abrasivo de todas era sílice. El 98% de las pastas dentales analizadas mostraban contenidos de flúor total similares a los descritos por el fabricante, solamente 3 pastas presentaban concentraciones de flúor inferiores a las descritas por el fabricante. El rango obtenido de FT oscilaba entre 398-1.474,6 ppm F, y el 100% de las pastas dentales no mostraron diferencias entre valores de flúor total y flúor soluble. CONCLUSIONES: La mayoría de las pastas dentales analizadas contienen una concentración de flúor soluble entre 1.000-1.500 ppm F, correspondiéndose con los valores descritos por los fabricantes. Sin embargo, todavía existen pastas dentales con valores inferiores a los recomendados de mínimo de 1.000 ppm F que no permiten tener la actividad anticaries efectiva desde el punto de vista de salud pública.

Spanish Dentists' Awareness, Knowledge, and Practice Regarding COVID-19: A Multiple Regression Analysis.

INTRODUCTION: During the first months of the coronavirus disease 2019 (COVID-19) pandemic, Spain had the highest mortality rate and the second-highest infection rate in the world. OBJECTIVE: To analyze the occupational situation of dentists, hygienists, and dental auxiliary staff during the peak of the pandemic, after the state of alarm was declared in Spain, and when the state of alarm was declared. In addition, a possible relationship between the geographical distribution of infected people and the availability of individual protection systems was investigated. MATERIAL AND METHODS: A cross-sectional questionnaire was answered by 6470 dentists and dental staff via WhatsApp and social media. RESULTS: A total of 1 in 4 dental professionals ceased working completely. Of those that kept working, 25.28% of dentists and 19.61% of hygienist-auxiliary were equipped with filtering face piece (FFP) 2 masks (P < .05), and 61.8% complied with the official protection recommendations set by the General Council of Dentists of Spain. Nearly 59.4% of respondents had symptoms, but only 1.5% of dentists were tested, with 14% of dentists in isolation at the time of response. Overall, it is suggested that 10% of dental professionals may have been in direct contact with the coronavirus. CONCLUSIONS: Direct contact of Spanish dental health professionals with severe acute respiratory syndrome coronavirus disease 2 (SARS CoV-2) has been high during the most active phase of the pandemic. Dental professionals did not have personal protective equipment (PPE) necessary to care for patients, a situation that justified the reduction in scheduled dental care and only emergencies being treated. The Spanish geographical regions with the highest number of contagions had the least amount of individual protective resources (FFP2 and FFP3 masks).

Effectiveness of a toothpaste and a serum containing calcium silicate on protecting the enamel after interproximal reduction against demineralization.

To evaluate the effectiveness of a calcium silicate/phosphate fluoridated tooth paste and a serum compared with a toothpaste containing hydroxyapatite on protecting the enamel after interproximal reduction against demineralization. 3 sets of eleven incisors were created. The teeth underwent interproximal enamel reduction (IER) of 0.5 mm. Each set was allocated to one of three groups: (1) Brushing without toothpaste (control group); (2) Vitis toothpaste + Remin Pro; (3) Regenerate toothpaste + Regenerate Serum. The agents were applied three times a day and specimens subjected to demineralization cycles for 30 days. The weight percentages of calcium (Ca) and phosphorous (P) were quantified by X-ray microfluorescence spectroscopy. Surface microhardness measurements and electron scanning microscopy (SEM) observations were made. Ca data and the Ca/P ratio were significantly higher in Group 3 than the other groups (p < 0.017), while P was significantly lower in Group 3 (p < 0.017). No significant differences were found between Groups 1 and 2 (p > 0.017). Group 3 showed significantly higher microhardness values (p < 0.05) than Group 1. No significant differences were found for other comparisons between groups (p < 0.05). SEM images showed less demineralization in Group 3. The application of a calcium silicate/phosphate fluoridated tooth paste (Regenerate advance) and a dual serum (Regenerate advance enamel serum) protect the enamel with interproximal reduction against demineralization. Therefore, this treatment could be used to prevent the dissolution of hydroxyapatite after IER.

Treatment of Stage 2 Medication-Induced Osteonecrosis of the Jaw: A Case Series.

Medication-induced jaw osteonecrosis (MRONJ) is a rare and serious disease with a negative impact on patients' quality of life, whose exact cause remains unclear and which may have a multifactorial origin. Although there are different therapeutic protocols, there is still no consensus. This case series evaluated three patients diagnosed with staged 2 MRONJ treated at the University of Murcia dental clinic according to the protocols described by the Spanish Society of Oral and Maxillofacial Surgery and the American Association of Oral and Maxillofacial Surgeons. Within 12 months of the application of therapeutic protocols, the lesions were completely healed in all cases. Radiography showed slow but progressive healing with normal bone structure. Conservative treatment with antibiotics, chlorhexidine rinses and minimally invasive surgical intervention with necrotic bone resection is effective in treating stage 2 of MRONJ. In cases of refractory osteonecrosis, the application of platelet and leukocyte-rich fibrin (PRF-L) in the surgical approach improves the outcome in soft tissue healing and bone regeneration but further research is needed to confirm its effectiveness.

Porosidad del agregado trióxido mineral. Una revisión sistemática / Mineral trioxide aggregate porosity. A systematic review

OBJETIVO: Los materiales que se emplean para procedimientos dentales en los que el material contacta directamente con el tejido pulpar y tejidos periodontales han de cumplir una serie de propiedades, entre ellas la biocompatibilidad. A su vez, han de ser materiales que eviten el paso de fluidos y microorganismos con el fin de preservar las condiciones óptimas de los tejidos. El objetivo de esta revisión sistemática fue evaluar la porosidad de los diferentes cementos de agregado trióxido mineral (MTA). MÉTODO: Dos investigadores realizaron búsquedas avanzadas en: PubMed Central, PubMed, Web of Science, Scopus, Cochrane Li-brary, Science Direc y Science Database (Proquest) siguiendo los criterios PRISMA. Los criterios de inclusión contemplaban los es-tudios in vitro, publicados en inglés desde enero de 1993 hasta abril de 2019, que analizaran y midieran la porosidad del MTA. Se excluyeron los estudios in vivo, piloto, editoriales, cartas, revisiones sistemáticas, reseñas literarias, resúmenes de conferencias y trabajos de fin de grado. RESULTADOS: Un total de 853 artículos resultó de la búsqueda inicial, de los que solo 19 pasaron los criterios de inclusión, exclusión y el análisis del riesgo de sesgo. En ellos, se analizan distintas técnicas de condensación del MTA, radiopacificadores, sustratos, etc., en busca de materiales que presenten menor porosidad. CONCLUSIONES: La elevada heterogeneidad de los estudios sobre porosidad y el hecho de que éstos no estén estandarizados, pue-de condicionar la validez externa o generalización de los resultados entre los distintos investigadores para un mismo material y procedimiento. En los estudios que realizan una comparación entre varios materiales, concluyen que tanto MTA ProRoot® y Bio-dentineTM obtuvieron mejores resultados en cuanto a porosidad. Número de solicitud (PROSPERO): 124340

OBJECTIVE: Materials used for dental procedures in which the material directly contacts the pulp and periodontal tissues must have a series of characteristics, such as biocompatibility. Equally, they must be materials that prevent the passage of fluids and microorganisms aiming at keeping the optimal conditions of the tissues intact. The objective of this systematic review was to evaluate the porosity of the different cements of mineral trioxide aggregate (MTA). METHOD: Two researchers conducted advanced searches in: PubMed Central, PubMed, Web of Science, Scopus, Cochrane Library, ScienceDirect and ScienceDatabase (Proquest) following the PRISMA criteria. Inclusion criteria took into account in vitro studies, published in English from January 1993 to April 2019, to analyse and measure the porosity of the MTA. In vivo and pilot studies were excluded, as well as editorials, letters, systematic reviews, literary reviews, conference abstracts and dissertations. RESULTS: A total of 853 articles resulted from the initial search, of which only 19 met the criteria for inclusion, exclusion and analysis of the risk of bias. In them, different condensation techniques of the MTA, radiopacifiers, substrates, etc., are analysed in quest of materials with less porosity. CONCLUSIONS: The high heterogeneity of the studies on porosity and the fact that they are not standardised, can condition the external validity or generalisation of the results among the different researchers for the same material and procedure. In the studies that make a comparison between several materials, they conclude that both MTA ProRoot® and BiodentineTM obtained better outcomes in terms of porosity as compared with other marketed brands. Application number (PROSPERO): 124340

Success rate of proximal tooth-coloured direct restorations in primary teeth at 24 months: a meta-analysis.

The aim was to determine the survival of tooth-coloured restorative materials in proximal restorations of primary teeth at 24 months of follow-up and the influence of the following variables: use of coating, use of cavity conditioner, use of rubber dam isolation, the cavity form, the dentist's experience and the methodological characteristics of the studies. We conducted a search until May 2019, obtaining 16 articles from which 30 independent studies were extracted, which were considered as units of analysis. Four outcome measures were extracted from each study: retention, marginal integrity, anatomic form, and absence of recurrent caries. Separate meta-analyses were carried for each outcome and multiple meta-regression model was applied. The outcomes with the highest mean success rates were absence of recurrent caries and anatomic form. The type of material significantly influenced success rates. The best materials were resin-based material plus total-etching adhesion and resin-modified glass ionomer cement (RMGIC), and the worst high viscosity glass ionomer cement (HVGIC). Atraumatic restorative treatment (ART) had a lower success rate than the conventional cavity form. RMGIC had the best clinical performance and HVGIC the worst. The form of the cavity, blinding and the experience of the operator were the variables that influenced success rates. Proximal primary molar restorations should be performed with RMGIC as it combines good mechanical performance of the resins together with the prevention of secondary caries of glass ionomers.

Second primary molar hypomineralisation and drugs used during pregnancy and infancy. A systematic review.

OBJECTIVES: Hypomineralised second primary molars (HSPM) are due to idiopathic hypomineralisation that affects from 1- to 4-s primary molars, and its aetiology remains unclear. Our objective was to systematically review studies in which the investigators had studied the association between HSPM and drug use during pregnancy and the first year of life. MATERIALS AND METHODS: A systematic search for publications until July 2018 was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. No restrictions were placed on year of publication. The PECO Question was as follows: P, children exposed to drugs during pregnancy and the first year of life; E, drugs to which mothers, during pregnancy and their offspring were exposed; C, control groups from studies with the same characteristics not exposed to drugs during pregnancy and the first year of life; and O, relationship between drug exposure during pregnancy and the first year of life and HSPM. Two reviewers extracted the data and assessed the risk of bias using the Newcastle-Ottawa Scale criteria. RESULTS: We initially identified 986 articles, or which seven were selected for review: two case-control studies, one cross-sectional studies and four cohort studies. Four studies reported data on drug consumption during pregnancy and four investigated drug use during the first year of life and the occurrence of enamel defects in primary dentition. CONCLUSIONS: There is no clear evidence that the use of drugs during pregnancy and during the first year of life is associated with HSPM. Further well-designed prospective studies are needed. CLINICAL RELEVANCE: Determining the etiological factors related to the development of HSPM would help to establish preventive protocols in patients at potential risk. As HSPM is predictive of molar incisor hypomineralisation (MIH), the application of preventive protocols would avoid complications in both the primary and permanent dentition.

Connective Tissue Grafts with Nonincised Papillae Surgical Approach for Periodontal Reconstruction in Noncontained Defects.

This case report presents the preliminary results of combining a modification of the nonincised papillae surgical approach (NIPSA), attempting to improve outcomes in the treatment of teeth with advanced periodontal support loss. The modification added a connective tissue graft (CTG) in the buccal aspect of these unfavorable cases caused by deep buccal bone dehiscence, soft tissue deficiencies, or tooth malposition (especially when positioned outside the bony contour). Deep, intrabony, noncontained defects affecting the maxillary incisors were treated in four patients. At the 1-year follow-up, all cases showed an improvement in the marginal soft tissue with considerable reductions in periodontal pocket depth and gains in clinical attachment. NIPSA plus CTG seem to improve clinical outcomes in deep, noncontained intrabony defects.

Supra-alveolar attachment gain in the treatment of combined intra-suprabony periodontal defects by non-incised papillae surgical approach.

AIM: To assess the effectiveness of non-incised papillae surgical approach (NIPSA) in periodontal reconstructive surgery of combined intra-suprabony defects. MATERIALS AND METHODS: Patients with deep periodontal defects treated with NIPSA (n = 20) were analysed. Defects were treated with enamel matrix derivative plus xenograft. Clinical outcomes were assessed before surgery and at 12 months. Wound closure was assessed one week post-surgery. Supra-alveolar attachment gain (SUPRA-AG) was recorded at 12 months post-surgery. RESULTS: Non-incised papillae surgical approach showed significant improvements in clinical attachment gain (5.9 ± 2.38 mm; p < 0.001), recession reduction (0.25 ± 0.44; p < 0.05) and tip of the papillae coronal displacement (0.4 ± 0.5; p < 0.05). It also showed complete wound closure of the apical mucosal incision in the 85% of the cases, with no interproximal tissue necrosis. SUPRA-AG (1.9 ± 1.74) showed a positive tendency, associated with complete intrabony defect resolution. CONCLUSIONS: Non-incised papillae surgical approach promoted primary intention healing, wound stability and space provision for optimal periodontal reconstruction, preserving supra-alveolar soft tissue integrity.