Relationship of ankyloglossia and obstructive sleep apnea: systematic review and meta-analysis.

PURPOSE: Recent studies have highlighted the potential role of a short lingual frenulum as a risk factor for pediatric obstructive sleep apnea syndrome. A shortened frenulum may contribute to abnormal orofacial development, leading to increased upper airway resistance and susceptibility to upper airway collapsibility during sleep. Recognizing early indicators, such as a short lingual frenulum, is crucial for prompt intervention. This systematic review aims to evaluate the association between a short lingual frenulum and the risk of obstructive sleep apnea syndrome in children. METHODS: This systematic review adheres to PRISMA criteria for a quantitative analysis. A comprehensive search was conducted on five databases until January 2024 to identify relevant studies. The selected articles underwent rigorous analysis, considering study design, sample characteristics, lingual frenulum characterization, sleep assessment methods, and key findings. RESULTS: A total of 239 references were initially identified. Finally, six studies were included in the qualitative synthesis, with four studies eligible for the quantitative synthesis. The Newcastle-Ottawa scale was employed to assess study quality. Meta-analysis, supported by a moderate evidence profile according to the GRADE scale, revealed statistically significant differences, with odds ratios of 3.051 (confidence interval: 1.939 to 4.801) for a short frenulum and 12.304 (confidence interval: 6.141 to 24.653) for a high-arched palate. CONCLUSION: This systematic review and meta-analysis provide evidence supporting the association between ankyloglossia and obstructive sleep apnea in children. Nevertheless, it is crucial to consider additional factors such as tongue mobility and the presence of a high-arched palate in further evaluations.

Nonsurgical treatment of an adult with skeletal Class III malocclusion, posterior crossbite and mandibular asymmetry.

Class III malocclusion represents a very heterogeneous clinical condition that is characterized by the combination of a wide variety of skeletal and/or dental components. Given the wide diversity, diagnosis and treatment of such malocclusion has always been a challenge for clinicians. Despite the different treatment options available, the treatment approach in the adult patient must depend fundamentally on the patient's decision, guided by the orthodontist and the maxillofacial surgeon. This case report presents the treatment of a patient with Class III malocclusion, with posterior crossbite and anterior edge-to-edge bite with fixed appliances and skeletal anchorage, an interdisciplinary, nonsurgical approach for a skeletal malocclusion. Firstly, to improve the posterior transverse relationship a band-soldered compressed lingual arch was cemented to the mandibular first molars. Then, once a correct transverse relationship was achieved, two miniscrews were placed distal to the mandibular second molars to distalize the whole mandibular arch, and avoid excessive inclination of maxillary incisors to improve dentofacial esthetics. At the end of the treatment, all the objectives planned at the beginning had been achieved and remained stable after the retention period. Key words:Clase III, orthodontic treatment, distalizing, appliances, posterior crossbite.

Improving the Antibacterial Properties of Dental Bonding Materials Loaded with Silver Compounds.

Biofilm accumulation, the appearance of white spot lesions and the development of secondary caries are the main complications in orthodontic patients. A promising approach to fight this situation is the development of adhesive cements with improved antibacterial properties. The aim of the present study was to evaluate the possibility of improving the antibacterial properties of glass ionomer cements by incorporating different types of antimicrobial compounds without altering their physical and mechanical properties. Different concentrations of silver carbonate (SC) and an inorganic glass with encapsulated silver were added to the glass ionomer cement, as well as chitosan, to achieve synergistic antibacterial activity. Variations in the antibacterial capacity were evaluated using the agar diffusion test; the potential alteration of the physical and mechanical properties of the material was analyzed by the shear bond strength test. SEM characterization and colorimetric evaluation were also conducted. Samples of SC up to 1% and inorganic glass with encapsulated silver up to 5% showed significant improvement in their antibacterial ability without compromising shear strength. The highest antimicrobial activity was observed for Lactobacillus acidophilus, with inhibition zones of 3.8 and 3.1 mm for SC and inorganic glass, respectively. The characterization of the samples did not detect any major structural changes between the different samples. The only group that underwent a noticeable color change was the group with SC. The results show that the incorporation of silver carbonate and inorganic glass with encapsulated silver provided the glass ionomer cement with an antibacterial capacity without compromising the bond strength and without modifying the structure of the material.

Implants as a treatment alternative in children with multiple agnesia: Systematic review and meta-analysis.

Background: The bone growth factor was a conditioning circumstance that limited the use of implants in children and adolescents, which, in cases of anodontia or severe oligodontia, forced pediatric dentists to abandon their use, leaving children with removable prostheses, at an age and in a social context with increasingly functional and esthetic demands. Purpose. The objective is to assess which variables influence the survival of dental implants in pediatric patients with severe agenesis. Material and Methods: A search was carried out in the Pubmed, Scopus and Web of Science databases, which was completed with a manual search. Results: The following variables were extracted from the selected studies: author and year, number of patients or cases described, age, gender, number of implants, follow-up time, implanted area, percentage of success or failure, medical and dental history of the patients, type of treatment and study design. Conclusions: The use of implants as a treatment at an early age has been a controversial issue. Using the appropriate preventive measures, the clinician can offer the child or adolescent a better life quality, esthetics and functionality, until the growth completion period allows for more complex and extensive rehabilitative treatments. A success rate of 89.8% was established for these implants, with no association with follow-up time or type of implant used. The highest survival rates were reported in the anterior mandibular region. Key words:Pediatric dentistry, ectodermal dysplasia, anodontia, oligodontia and dental implant.

Scientific production of an oral implantology journal: a 5-year bibliometric study.

Oral implantology is a science in constant evolution, with a considerable number of articles being published every year in scientific journals. Publications can be analyzed through bibliometric analysis, thus observing the evolution and trends of the articles published in the journal. To evaluate, through bibliometric analysis, the scientific production of Clinical Implant Dentistry and Related Research (CIDRR) and its evolution and trends in the last 5 years (2016-2020).All articles published in CIDRR in the last 5 years were reviewed and classified according to the year of publication, volume, number, the number of authors, demographic data of the first and last author, the geographical scope of the article, the number of affiliations of the authors, research topic, type of study, and study design. The association between these variables and citation counts was also analyzed. 599 articles were analyzed. 77.4% were authored by 4-6 authors, obtaining 78.4% from 1 to 3 different affiliations. Male researchers predominated in both the first and last authorship. China showed the highest number of publications when comparing the origin of the authors' affiliations individually; however, most researchers (40.9%) were from the European Union (EU)-Western Europe area. The most studied topic was the implant/abutment design/treatment of the surface (19.1%). Clinical research articles accounted for 92.99% of the publications, of which cross-sectional observational studies prevailed (21.7%). The presence of articles from the United States of America-Canada and EU-Western Europe was positively correlated with the impact factor. This study revealed an increasing trend in Asian research production, particularly Chinese, whereas production of European origin showed a decrease. Clinical studies increased their relative weight to the detriment of translational ones. A growing tendency in the relative weights of female authors was appreciated. Journal citations were associated with certain study variables.

Is Revascularization the Treatment of Choice for Traumatized Necrotic Immature Teeth? A Systematic Review and Meta-Analysis.

Regenerative endodontic treatment (RET) has been considered a reliable procedure to treat immature necrotic teeth; however, the effect of dental trauma on the prognosis of RET is questionable. This systematic review aimed to evaluate the current level of evidence for revascularization techniques (the RET) in the management of traumatized necrotic immature permanent teeth with or without periapical radiolucent areas. Four electronic databases-PubMed, Web of Science, Scopus, and Embase-were searched until November 2022. Only randomized clinical trials, cohort studies, and case-control studies with a minimum of 10 cases and 12 months of follow-ups were included. The search identified 363 preliminary results. After discarding the duplicates and screening the titles, abstracts, and full texts, 13 articles were considered eligible. The results showed that RET techniques seemed to have high survival and success rates, 93.8% and 88.3%, respectively, in the treatment of traumatized necrotic immature permanent teeth. Root maturation with RET techniques seemed to be lower in traumatized teeth. Future studies are needed to evaluate root maturation in traumatized teeth using 3-dimensional radiographic evaluations. In addition, the lack of literature on the studies comparing RET and apexification (calcium hydroxide or an MTA) in the treatment of traumatized necrotic immature teeth highlights the necessity for high-level clinical studies comparing these treatment modalities.

Relationship between Periodontal Condition of the Pregnant Woman with Preterm Birth and Low Birth Weight.

The aim of this study was to determine the association between the mother's periodontal condition and perinatal complications, such as preterm birth (PTB) and/or low birth weight (LBW), in a cohort of women in Valencia, Spain. Other related factors, such as tobacco, were also analysed. A prospective cohort study was carried out in a sample of 102 women with a single foetus and ages ranging between 18 and 42 years. Sociodemographic and obstetric variables, caries status, percentage of bleeding, clinical attachment loss (CAL), and probing pocket depth (PPD) data have been collected and analysed. The mean age was 32.4 years, and the BMI was normal. The average weight of new-borns (NB) was 3034 g. A total of 9.8% of the women smoked during their pregnancy. Bleeding percentage was 16.43% (SD 14.81%) and PPDs > 3 mm 8.8 (SD 11.08). The mean of CAL > 0 mm was 1.14 (SD 2.83). The frequency of PTB and LBW was 26%. No statistically significant differences were found between probing depth > 3 mm or CAL > 1 mm, with PTB and/or LBW. Periodontal disease in the mother was not statistically significantly related to either PTB or LBW. Tobacco use during pregnancy showed a statistical significance linked to LBW, but not with PTB.

Comparison of the phenotypic characteristics between responders and non-responders to obstructive sleep apnea treatment using mandibular advancement devices in adult patients: Systematic review and meta-analysis.

Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup of patients. The aim of this systematic review is to identify predictors of the efficacy of oral appliance (OA) therapy for OSA in adult patients. This review focuses on performing the quantitative analysis by subgroups based on the response criteria used in the literature and based on the type of device. PubMed, EMBASE, Scopus, Web of Science and Cochrane databases was conducted to identify potentially relevant studies published until Dec 2021. The search identified 1343 preliminary references. A total of 99 studies met the eligibility criteria and were included in the review, and 60 in the meta-analysis. The quality of studies was assessed using the Newcastle-Ottawa scale and the Cochrane scale. Based on meta-analysis, and considering a low to moderate evidence profile according to the GRADE scale, responders are younger patients, with smaller neck circumference, lower body mass index. Responders have shorter maxillary length, lower anterior and posterior facial height, a shorter distance from the hyoid bone to the third cervical vertebra, a shorter airway length, a smaller minimum airway cross-sectional area and a higher minimum oxygen saturation during sleep. Responders needed a lower optimal continuous positive airway pressure than non-responders. The type of device has not affected the results of the meta-analysis. The criterion "AHI <10 and reduction AHI >50%" is the one that provides the "weight" of significance for several variables. This criterion should be taken into consideration for future studies to predict OSA treatment by OA.

Open science practices in general and internal medicine journals, an observational study.

BACKGROUND: As part of the Open Science movement, this study aims to analyze the current state of open access and open data policies concerning the availability of articles and raw data of the journals belonging to the category "Medicine, General & Internal" of the Science Citation Index Expanded. METHODS: Journal data sharing policies were evaluated through the following variables: possibility of manuscript storage in repositories; reuse policy; publication on a website; and statement regarding complementary material. Subsequently, an analysis of the supplementary material associated with each article was performed through the PubMed Central repository. The study reported was assessed following the STROBE guidelines for observational studies. RESULTS: This study shows that only one-third of the journals included in the category "Medicine, General & Internal" allow the depositing of their documents in repositories and its reuse, while approximately half of the journals agree to publish the document on a website as well as to deposit supplementary material along with the publication. However, the reality about this last variable is that only 9.5% of the articles analyzed contained supplementary material being the main journals involved, BMJ Open, JAMA Network Open, New England Journal of Medicine, Lancet and Plos Medicine. CONCLUSIONS: The analysis of the opening policies of the journals concerning data availability in medical research reveals the unequal positioning of publishers towards the sharing of open data, the ambiguity regarding government policies about the obligation to deposit data and the need for ethical and standardization requirements in the typology/format of the data deposited without forgetting the important role that the researcher plays. Further studies based on journals indexed in medical databases other than Science Citation Index Expanded are needed.

Diagnostic Validity in Occlusal Caries Detection of ICDAS II, DIAGNOdent, Radiography and a Combination of the Three Methods: An In Vitro Study.

In this study, we compare the efficacy and diagnostic concordance of the ICDAS, the radiographic criterion and the instrument known as the DIAGNOdent fluorescence laser pen on occlusal caries lesions using a histological section as the gold standard. Of 100 teeth that did not present cavitated occlusal lesions or occlusal fillings, 80 were chosen through a randomization program and examined by two previously trained and calibrated researchers. Subsequently, the teeth were sectioned with a diamond disk and observed under an optical microscope. The results were studied for caries with a limit established in enamel and caries with extension to dentin. The intra-examiner (0.821-0.933) and inter-examiner (0.817-0.924) reproducibility obtained for both ICDAS and DIAGNOdent for the diagnosis of borderline enamel caries was high. Similarly, intra-examiner (0.686-1.000) and inter-examiner (0.809-0.944) reproducibility for diagnosis of caries with dentin extension was also high for both methods. The sensitivity obtained was 0.76 (ICDAS), 0.87 (DIAGNOdent) and 0.58 (Rx), whereas the specificity obtained was 0.66 (ICDAS), 0.4 (DIAGNOdent) and 0.77 (Rx) for lesions limited to enamel. For lesions with extension to dentin, the sensitivity obtained was 0.73 (ICDAS), 0.82 (DIAGNOdent) and 0.09 (Rx), and the specificity obtained was 0.79 (ICDAS), 0.52 (DIAGNOdent) and 0.97 (Rx). Sensitivity increases in both cases by combining diagnostic methods. In conclusion, ICDAS and DIAGNOdent are better diagnostic methods than Rx for the detection of occlusal caries, and the combination of these methods helps to obtain a better diagnosis.

Skin temperature measurement in individuals with spinal cord injury during and after exercise: Systematic review.

BACKGROUND: Athletes with spinal cord injury (SCI) have difficulties in maintaining thermal homeostasis during exercise due to their lower sweat capacity and skin vasodilation. Skin temperature (Tsk) assessment, as opposed to core temperature, has become more widely accepted due to its non-invasive nature. The aims of this systematic review was to collate research studies that measured Tsk of individuals with SCI during or after exercise, study their Tsk response, taking into account the method employed, the environmental and exercise conditions, and to identify the different cooling strategies and their effect during exercise. METHODS: Pubmed, Web of Science and Scopus databases were searched to identify the articles published since year 2000. Two reviewers working independently extracted data and assessed the quality of the articles included. If they disagreed, a third reviewer was consulted. ROBINS-I scale was used to assess the quality of the articles, and the review has been conducted in agreement with PRISMA guidelines. RESULTS: Twenty studies were included in this review. 84% of them presented moderate, serious or critical risk of bias. The entire of the studies assessed Tsk during exercise, but only seven studies measured it during rest or after exercise. Eighteen studies used contact thermometry to assess Tsk and the two remaining studies employed non-contact techniques. Seven studies were conducted in warm conditions (>31.5°C) and the remaining studies in moderate conditions (10°C to 26.6°C). According to cooling strategies, ice vests and water spray are effective in reducing Tsk and decreasing the risk of heat stroke. CONCLUSIONS: The 90% of the studies applied contact thermometry and due to their effect in the data assessed, it is necessary more research into the SCI population using infrared thermography due to its differences in characteristics, methodology, and applications. The methodological differences among studies make difficult to perform a meta-analysis.

Unplanned molar intrusion after Invisalign treatment.

INTRODUCTION: The objectives of this study were to analyze and quantify molar intrusion after the use of clear aligners and to analyze the relationship with other variables such as age, duration of treatment, and a series of cephalometric osseous and dental measurements at the start of treatment. METHODS: A retrospective descriptive-analytical study was designed with a sample of 58 patients aged 18-60 years who had undergone treatment with Invisalign. The cephalometric measurements were carried out after lateral x-rays were taken of the cranium; these were compared at the start (T0) and conclusion of treatment. Parametric and nonparametric tests were used to compare means, whereas Pearson correlations and multivariate lineal regression analyses were used to establish the variables associated with molar intrusion. RESULTS: Approximately 74.2% of the patients presented some degree of molar intrusion after treatment. Furthermore, 32.8% of patients presented intrusion only at the mandibular molar, whereas 25.9% experienced intrusion at both molars, maxillary and mandibular, simultaneously. However, 15.5% presented intrusion only at the maxillary molar. The average magnitude of intrusion here was 0.98 ± 0.54 mm, whereas the mandibular molar was 0.84 ± 0.29 mm. Statistically significant reductions exist for the distance L6_MP and U6_SN between T0 and at conclusion of treatment. Maxillary molar intrusion correlates negatively with mandibular molar intrusion (r = -0.270). The number of days of treatment did not correlate with either maxillary or mandibular molar intrusion. CONCLUSIONS: Clear aligners give rise to molar intrusion in 74.2% of patients. The cephalometric variables L6_MP T0, mandibular plane angle T0, and facial axis T0 were negatively and significantly associated with maxillary molar intrusion, whereas age and facial axis T0 were negatively associated with mandibular molar intrusion allowing smaller magnitudes of intrusion to be predicted when these variables present high values at T0.

Effectiveness of removable appliances with temperature sensors in orthodontic patients: a systematic review and meta-analysis.

BACKGROUND/OBJECTIVE: Patient compliance during orthodontic treatment is one of the factors that most affects success in the final result. The use of removable appliances is frequent at an early age and the monitoring of its use is essential to assess the collaboration of the patient. The aim of this study was to establish the effectiveness of microsensors included in removable appliances during orthodontic treatment or in the retention phase to enable a reliable and individualized follow-up of the patient. SEARCH METHODS: The article search was carried out in various electronic databases and journals without any language restrictions. SELECTION CRITERIA: Studies using microsensors into removable appliances were selected with the key selection criterion of a minimum follow-up of 4 weeks. DATA COLLECTION AND ANALYSIS: The quality of the studies included was evaluated using the Cochrane scale for the randomized controlled trials and the Newcastle Ottawa Scale for control-case, cohort, and transversal studies. The mean of the differences with a 95% confidence interval was expressed for the continuous data. RESULTS: Twenty-nine full-text articles were analysed and included in the qualitative synthesis. In general, the mean daily wear time of removable appliances measured objectively was less than the time that the professional had predetermined. CONCLUSIONS: The use of microsensors as an objective measurement method enhances communication and boosts confidence in the orthodontist-patient relationship. More random clinical studies with temperature sensors are needed to establish to what extent they influence the orthodontic outcome. REGISTRATION: PROSPERO (CRD42019120525).

Need for Orthodontic Treatment in Pupils Aged between 12 and 15 in the Valencian Region (Spain).

The World Health Organization recommends carrying out periodic epidemiological studies in order to provide a basis for the evaluation of the state of health of the population at any given time; in doing so, action strategies can be established for the treatment of different pathologies. The objective of this study is to evaluate the need for orthodontic treatment in adolescents at school aged between 12 and 15 in the Spanish autonomous region known as Comunidad Valenciana (hereafter: Valencian Region). A cross-sectional study was carried out on a sample of 539 12-year-old schoolchildren and 460 15-year-olds, respectively, selected by cluster sampling and representative of the school-aged population of the Valencian Region, using the IOTN-DHC, IOTN-AC, and DAI indices. The need for specific orthodontic treatment according to the IOTN-DHC was 12.6% at 12 years and 7% at 15. For the IOTN-AC and DAI indices, the treatment needs were 4.3% and 0.9% at 12 years and 30.1% and 20.9% at the age of 15. These results were similar to those obtained in the previous study carried out on the same target population. There was no significant association between the need for treatment and gender or social class. We conclude that the need for orthodontic treatment presents values similar to those obtained in 2010.

Nonsurgical treatment of an adult with skeletal Class III malocclusion, anterior crossbite, and an impacted canine.

Class III malocclusion presents some complexity in terms of diagnosis and treatment and affects not only the jaws but the whole craniofacial complex. Besides, functional forward displacement of the mandible may be diagnosed in a patient presenting Class III malocclusion, as the 2 entities are not incompatible or mutually exclusive. This case report describes the multidisciplinary, nonsurgical, orthodontic treatment of an adult patient with a skeletal Class III malocclusion, anterior crossbite, and a palatally impacted canine, treated with fixed appliances and skeletal anchorage. To upright the mandibular molars, distalize the whole mandibular arch, and avoid excessive inclination of maxillary incisors to improve dentofacial esthetics, miniscrews were placed in the retromolar area. The treatment results were very satisfactory and remained stable after a reasonable retention period.

Arch expansion with the Invisalign system: Efficacy and predictability.

BACKGROUND: In adult patients, treatment of skeletal crossbite requires combined treatment by fixed or removable appliances and orthognathic surgery. In cases of dentoalveolar crossbite, expansion can be achieved with fixed multibrackets and removable transparent aligners. Various researchers have already assessed the Invisalign system's predictability for arch expansion. However, most of this research was conducted using older appliances, making it necessary to assess the characteristics of the updated system SmartTrack. MATERIAL AND METHODS: A sample of 114 patients with transverse malocclusion were treated with SmartTrack. The predictability of the system's software (Clincheck) was assessed by comparing planned measurements (width of canines, premolars and molars rotations and inclinations) with the real measurements achieved at the end of the first treatment phase. Measurements were imported to Clincheck software to create three data sets; T1: initial measurements at start of treatment; T2: Clincheck predicted measurements at end of first treatment phase; T3: measurements taken at start of the second treatment phase. RESULTS: Widths underwent significant advances as a result of treatment. For all widths, virtual planning obtained prognoses of greater expansion than actually achieved: a mean of 0.63 mm more expansion at the canine level (p<0.001), 0.77 mm at first premolar (p<0.001), 0.81 at second premolar (p<0.001), 0.69 mm at first molar (p<0.001), and 0.25 mm at second molar (p = 0.183). All the treatment plan's estimations, with the exception of the second molar, were significantly higher than the actual outcomes. CONCLUSIONS: Aligners are an effective tool for producing arch expansion, being more effective in premolar area and less effective in canine and second molar area. Predictability was reasonable for expansion movement. Overcorrection should be considered at the virtual planning stage in order to obtain the expected outcomes.

Systematic review of chewing simulators: Reality and reproducibility of in vitro studies.

BACKGROUND: The aim of this systematic review was to analyze the types of human chewing simulator described in scientific literature. MATERIAL AND METHODS: An electronic search was conducted in the databases PubMed, Embase and Scopus. The search strategy included 10 search terms: "in vitro"; "dental materials"; "shear strength"; "fatigue fracture"; "bite force"; "prosthetic materials"; "chewing simulator"; "chewing machine"; "simulated mastication"; and "dental wear simulator." Two researchers worked independently to assess the titles and abstracts of the articles. The quality of the in vitro trials selected was evaluated by means of the Consolidated Standards of Reporting Trials scale. RESULTS: The electronic search identified 80 articles related to the topic of interest. After reading the full texts, ten works were selected. The articles focused mainly on the design of chewing simulators. Most of them were considered of moderate quality. Regarding the characteristics that an ideal chewing simulator should encompass, the devices described in articles varied greatly in terms of movement, periodontal ligament simulation, force sensors, and the materials tested. CONCLUSIONS: No chewing simulator offers all the characteristics necessary to reproduce human masticatory movements and forces under the humidity and pH conditions of the oral cavity. A simulator that encompasses all these characteristics would make it possible to standardize trials involving simulated mastication. Key words:In vitro, dental materials, dental wear simulator.

Effect of per Capita Income on the Relationship between Periodontal Disease during Pregnancy and the Risk of Preterm Birth and Low Birth Weight Newborn. Systematic Review and Meta-Analysis.

This work analyzed the available evidence in the scientific literature about the risk of preterm birth and/or giving birth to low birth weight newborns in pregnant women with periodontal disease. A systematic search was carried out in three databases for observational cohort studies that related periodontal disease in pregnant women with the risk of preterm delivery and/or low birth weight, and that gave their results in relative risk (RR) values. Eleven articles were found, meeting the inclusion criteria. Statistically significant values were obtained regarding the risk of preterm birth in pregnant women with periodontitis (RR = 1.67 (1.17-2.38), 95% confidence interval (CI)), and low birth weight (RR = 2.53 (1.61-3.98) 95% CI). When a meta-regression was carried out to relate these results to the income level of each country, statistically significant results were also obtained; on the one hand, for preterm birth, a RR = 1.8 (1.43-2.27) 95% CI was obtained and, on the other hand, for low birth weight, RR = 2.9 (1.98-4.26) 95% CI. A statistically significant association of periodontitis, and the two childbirth complications studied was found, when studying the association between these results and the country's per capita income level. However, more studies and clinical trials are needed in this regard to confirm the conclusions obtained.

Clinical Behavior of Ceramic, Hybrid and Composite Onlays. A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis was performed to analyze the survival of onlay restorations in the posterior region, their clinical behavior according to the material used (ceramic reinforced with lithium disilicate, conventional feldspathic ceramic or reinforced with leucite; hybrid materials and composite), possible complications, and the factors influencing restoration success. The systematic review was based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, without publication date or language restrictions. An electronic search was made in the PubMed, Scopus, Embase, and Cochrane databases. After discarding duplicate publications and studies that failed to meet the inclusion criteria, the articles were selected based on the population, intervention, comparison, outcome (PICO) question. The following variables were considered in the qualitative and quantitative analyses: restoration survival rate (determined by several clinical parameters), the influence of the material used upon the clinical behavior of the restorations, and the complications recorded over follow-up. A total of 29 articles were selected for the qualitative analysis and 27 for the quantitative analysis. The estimated restoration survival rate was 94.2%. The predictors of survival were the duration of follow-up (beta = -0.001; p = 0.001) and the onlay material used (beta = -0.064; p = 0.028). Composite onlays were associated with a lower survival rate over time. Onlays are a good, conservative, and predictable option for restoring dental defects in the posterior region, with a survival rate of over 90%. The survival rate decreases over time and with the use of composite as onlay material.

Caries Prevalence Evolution and Risk Factors among Schoolchildren and Adolescents from Valencia (Spain): Trends 1998-2018.

The aim of this study was to determine the caries status and risk factors in the schoolchildren of Spain's Valencia region in 2018 and to compare them to the 20-year evolution of caries indicators in the region. A cross-sectional survey was conducted with 1722 children and adolescents aged between 6 and 15 using cluster sampling. Caries status, using International Caries Detection and Assessment System II (ICDAS II) criteria, and sociodemographic variables were recorded. To ensure the comparison with previous studies using WHO caries criteria, the cut-off point was established at ICDAS II code 4. Caries prevalence was found to be 37.4% and the decayed and filled teeth index (dft) was 1.23 at 6 years for deciduous dentition (DD). In permanent dentition (PD) at 12 years, caries prevalence was 30.1% with a 0.66 decayed, missing and filled teeth index (DMFT), and at 15 years, prevalence was 44.6% and DMFT was 1.21. Socioeconomic status poses a major risk factor for caries prevalence in deciduous dentition; it is 1.8 times higher in the lowest socioeconomic group. Deciduous dentition status has worsened in the most recent eight-year period, whereas in permanent dentition the 12- and 15-year values are similar to those of the 2010 survey. Evolution analysis suggests that community dental care programs be enhanced, involving preventive activities staring at the first year and targeting disadvantaged groups.