One-year clinical evaluation of class II bulk-fill restorations in primary molars: a randomized clinical trial.

This double-blind, randomized clinical trial aimed to compare the clinical performance and clinical time to restore occluso-proximal cavities in primary molars withbulk-fillresin and conventional resin. A total of 140 class II restorations in primary molars of 65 participants (mean age of 6.7 + 1.5) were placed in two random groups:bulk-filland conventional resin. The restorations were evaluated using FDI criteria at the baseline, 6-month, and one year by a single calibrated examiner, and the clinical restorative time was measured with a digital timer. The success and survival of the restorations were evaluated with Kaplan-Meier graphs. The log-rank test compared the curves. Differences in restorative clinical time were compared using the Mann-Whitney U test. The level of significance was 5%. After one year, 115 restorations were evaluated. The success probability was 88.7% for Filtek Z350 XT and 85.9% for FiltekTM Bulk-fill, and for the survival probability, Filtek Z350 XT presented 90%, and FiltekTM Bulk-fill presented 93.7%. No significant difference was found between the success and survival curves (p=0.62), (p=0.51). The main reason for failure was marginal adaptation.Bulk-fillresin required 30% less time than the conventional resin (p<0.001).Bulk-fillresin presented similar clinical performance to the conventional resin and required less restorative clinical time. It is an option to restore class II lesions of primary molars.

One-year clinical evaluation of class II bulk-fill restorations in primary molars: a randomized clinical trial

Abstract This double-blind, randomized clinical trial aimed to compare the clinical performance and clinical time to restore occluso-proximal cavities in primary molars withbulk-fillresin and conventional resin. A total of 140 class II restorations in primary molars of 65 participants (mean age of 6.7 + 1.5) were placed in two random groups:bulk-filland conventional resin. The restorations were evaluated using FDI criteria at the baseline, 6-month, and one year by a single calibrated examiner, and the clinical restorative time was measured with a digital timer. The success and survival of the restorations were evaluated with Kaplan-Meier graphs. The log-rank test compared the curves. Differences in restorative clinical time were compared using the Mann-Whitney U test. The level of significance was 5%. After one year, 115 restorations were evaluated. The success probability was 88.7% for Filtek Z350 XT and 85.9% for FiltekTM Bulk-fill, and for the survival probability, Filtek Z350 XT presented 90%, and FiltekTM Bulk-fill presented 93.7%. No significant difference was found between the success and survival curves (p=0.62), (p=0.51). The main reason for failure was marginal adaptation.Bulk-fillresinrequired 30% less time than the conventional resin (p<0.001).Bulk-fillresin presented similar clinical performance to the conventional resin and required less restorative clinical time. It is an option to restore class II lesions of primary molars.

Resumo Este ensaio clínico randomizado, duplo-cego objetivou comparar a performance clínica e tempo clínico para restaurar cavidades ocluso-proximais em molares decíduos, restauradas com resina bulk-fill e resina convencional. Um total de 140 restaurações classe II em molares decíduos de 65 participantes (média de idade 6.7 + 1.5) foram realizadas dividas em dois grupos randomizados: resina bulk-fill e resina convencional. As restaurações foram avaliadas conforme o critério da FDI no baseline, após 6 meses e 1 ano, por um único examinador calibrado e o tempo clínico restaurador foi mensurado por um cronômetro digital. O sucesso e a sobrevida das restaurações foram avaliados através dos gráficos de Kaplan-Meier. O teste de log-rank comparou as curvas. A diferença no tempo clínico restaurador foi comparada usando o teste U de Mann-Whitney. O nível de significância foi de 5%. Após 1 ano, 115 restaurações foram avaliadas. A probabilidade de sucesso foi de 88,7% para Filtek Z350 XT e 85.9% para FiltekTM Bulk-fill e quanto a probabilidade de sobrevivência, Filtek Z350 XT apresentou 90% e FiltekTM Bulk-fill apresentou 93,7%. Não foi encontrada diferença significativa entre as curvas de sucesso e sobrevida (p=0,62), (p=0,51). A principal causa de falha foi a adaptação marginal. A resina bulk-fill exigiu 30% menos tempo do que a resina convencional (p<0,001). A resina bulk-fill apresentou desempenho clínico semelhante ao da resina convencional e necessitou menor tempo clínico restaurador. Dessa forma, é uma opção para restaurar lesões classe II em molares decíduos.

Bonding of Glass-Ionomer Cement and Adhesives to Silver Diamine Fluoride-treated Dentin: An Updated Systematic Review and Meta-Analysis.

PURPOSE: To evaluate through a systematic review and meta-analysis the bonding performance of adhesive materials to silver diamine fluoride (SDF)-treated dentin. MATERIALS AND METHODS: Studies located in PubMed, Web of Science, LILACS, and Scopus up to September 2020, which compared the bond strength of adhesives (AD) or glass-ionomer cement (GIC) to SDF-treated and untreated (control) dentin were included. Mean differences were estimated separately by material and dentin condition (sound or caries-affected), with a random-effects model, at a 5% significance level. RESULTS: Twenty-two studies, including 11 new studies not included in our previous systematic review, met the eligibility criteria, and 21 studies were considered in the meta-analyses. SDF dentin pretreatment did not influence the bonding of GIC (Z = 0.53; p = 0.60), independent of dentin condition. SDF treatment significantly impaired the bonding of AD (Z = 2.43; p = 0.01). A rinsing step after SDF eliminated this effect in sound dentin (Z = 1.82; p = 0.07) and increased the bond strength to caries-affected dentin (Z = 2.14; p = 0.03). CONCLUSION: SDF pretreatment does not influence the bond strength of GIC. A rinsing step after SDF application can improve the bond strength of AD to caries-affected dentin.

Teaching and use of silver diamine fluoride in Pediatric Dentistry: a questionnaire-based cross- sectional analysis of undergraduate Brazilian dental schools / Ensino e uso do diamino fluoreto de prata em Odontopediatria: análise transversal baseada em questionário com cursos de graduação em Odontologia brasileiros

This study investigated the teaching and use of silver diamine fluoride (SDF) in Pediatric Dentistry in undergraduate Brazilian dental schools through a questionnaire-based cross-sectional analysis. Two-hundred and thirty-five questionnaires were e-mailed to directors of Pediatric Dentistry of undergraduate Brazilian dental schools. The details of the teaching and use of SDF in clinical practice were asked. Obtained data were analyzed descriptively and using the chi-square test. A total of 149 complete questionnaires were returned (63.4%). Most of schools taught SDF in lectures (73.8%, p <0.001). The majority use SDF in clinical practice (64.4%, p <0.001), but its use is not frequent (11.4%, p<0.001). All dental schools reported that SDF is applied in primary teeth, and few reported its use for permanent teeth (36.4%, p = 0.01). SDF has been used mainly for cavitated caries in primary teeth of children aged 0 to 3 years (93.7%, p<0.001), with restricted use in posterior teeth (42.7%, p <0.001). Although SDF is teaching and used in clinical practice in Pediatric Dentistry in most Brazilian undergraduate schools, its use is not frequent. Furthermore, SDF is not considered an option for caries lesions in some dental schools (AU).

Este estudo investigou o ensino e a utilização do diamino fluoreto de prata (DFP) em Odontopediatria em cursos de graduação em Odontologia brasileiros por meio de uma análise transversal baseada em questionário. Duzentos e trinta e cinco questionários foram enviados por e- mail a professores responsáveis pela disciplina de Odontopediatria de cursos de Odontologia brasileiros. Os detalhes do ensino e uso de DFP na prática clínica foram solicitados. Os dados obtidos foram analisados descritivamente e por meio do teste do qui-quadrado. Um total de 149 questionários completos foram devolvidos (63,4%). A maioria das escolas ensina sobre o DFP em aulas teóricas (73,8%, p <0,001). A maioria usa o DFP na prática clínica (64,4%, p <0,001), mas seu uso é pouco frequente (11,4%, p <0,001). Todas as escolas de Odontologia relataram que o DFP é aplicado em dentes decíduos, e poucas relataram seu uso em dentes permanentes (36,4%, p = 0,01). O DFP tem sido usado principalmente em lesões de cárie cavitadas em dentes decíduos de crianças de 0 a 3 anos (93,7%, p <0,001), com uso restrito aos dentes posteriores (42,7%, p <0,001). Embora o DFP seja tópico de ensino e utilizado na prática clínica em Odontopediatria na maioria dos cursos de graduação brasileiros, seu uso é pouco frequente. Além disso, o DFP não é considerado uma opção para lesões de cárie em algumas escolas avaliadas (AU).

Evaluation of the Use of Potassium Iodide Application on Stained Demineralized Dentin Under Resin Composite Following Silver Diamine Fluoride Application.

Purpose: The purpose of this study was to assess the effect of potassium iodide (KI) after applying silver diamine fluoride (SDF) on the staining of demineralized dentin covered or not by a composite resin layer. Methods: Dentin blocks from 30 bovine incisors were demineralized and randomly allocated in three groups (N equals 10): (1) control (no treatment); (2) treated with SDF; and (3) treated with SDF and KI. Half of the specimens of each group received a composite resin restoration immediately after treatment. A colorimetric evaluation, according to the CIE L*a*b* system, was performed at baseline and after seven, 14, 30, and 60 days. The ΔE data were analyzed using the generalized linear model (Δ equals 0.05). Results: The use of KI immediately after applying SDF decreased the dentin staining at all assessment times. SDF treatment only stained the dentin under composite resin after 60 days. The application of KI reduced the dentin under composite resin staining as ΔE values were similar to the control group even after 60 days. Conclusions: The use of potassium iodide minimizes the darkening of dentin and prevents the staining of the dentin under composite resin restorations in the long-term.

Etching time and bonding of adhesive systems to dentin of primary teeth: A systematic review and meta-analysis.

BACKGROUND: Due to the chemical and morphological differences between primary vs. permanent teeth, the time reduction of the acid etching or acidic primer can result in higher values of bond strength. AIM: To assess through a systematic review and meta-analysis the influence of the reducing etching (acid etching or acidic primer) time on the bond strength of adhesive systems to primary dentin. DESIGN: A systematic search was carried out in 3 databases: PubMed, Web of Science and Scopus. Studies that evaluated the effect of reducing the etching time on the bond strength of adhesive systems to primary dentin were included. Meta-analyses were performed using a random-effects model, with subgroups for etch-and-rinse and self-etching adhesives, with a significance level of P < .05. The risk of bias and heterogeneity between studies (Cochrane and I2 tests) were assessed. RESULTS: Eight studies were included in the systematic review and seven in the meta-analyses. The shortening etching time did not influence the immediate dentin bond strength for etch-and-rinse (Z = 0.07, P = .95) and self-etching adhesives (Z = 0.41, P = .69). After ageing, however, the shorting etching time improved the bond strength for etch-and-rinse adhesives (Z = 2.01, P = .04). All studies presented high bias risk. CONCLUSIONS: Reducing the acid-etching time to primary dentin improves the long-term bond strength to this substrate.

Step-stress vs. staircase fatigue tests to evaluate the effect of intaglio adjustment on the fatigue behavior of simplified lithium disilicate glass-ceramic restorations.

The aim of the study was to compare the outcomes for the fatigue mechanical behavior of bonded simplified lithium disilicate restorations, with and without an internal adjustment by grinding with diamond bur in running two fatigue tests: Staircase and Step-stress testing approaches. Ceramic discs (IPS e.max CAD) were prepared (Ø = 10 mm; thickness = 1.0 mm), submitted to an in-lab simulation of CAD/CAM milling (#60 SiC paper) and allocated into 2 groups according to the internal adjustment by grinding of the cementation surface: no adjustment (CTRL); or grinding with a coarse diamond bur (GR). Adhesive cementation (Multilink N) was performed onto epoxy resin discs (Ø = 10 mm; thickness = 2 mm) after ceramic/epoxy surface treatments. The cemented assemblies of each group were randomly assigned into 2 subgroups considering two fatigue tests (n = 15): Staircase - SC (250,000 cycles; 20 Hz), or Step-stress - SS (10,000 cycles per step; 20 Hz). Roughness, topographic and fractographic analyses were additionally performed. Statistical analyses were carried out using the Dixon and Mood method for Staircase data, and Kaplan-Meier and Mantel-Cox (log-rank) tests for Step-stress data. Ceramic restorations having its intaglio surface ground (GR group: SC test = 306.67 N; SS test = 646.67 N) presented lower fatigue failure load (FFL) values than the CTRL group (SC test = 879.28 N; SS test = 1090.00 N), regardless of the fatigue testing approach. The percentage of mean FFL decrease comparing the CTRL to GR group was higher for SC (65.1%) than the SS (40.7%) approach. However, a different total number of cycles was applied for each method. Both fatigue tests were able to detect the negative effect of internal adjustments of lithium disilicate glass-ceramic simplified restorations on their mechanical behavior. Therefore, both methods can be applied for similar evaluations (fatigue testing for ceramic restorations).

Does previous application of silver diammine fluoride influence the bond strength of glass ionomer cement and adhesive systems to dentin? Systematic review and meta-analysis.

BACKGROUND: Silver diammine fluoride (SDF) applied before a restoration may prevent recurrent caries; therefore, its effect on the bonding of restorative materials is contradictory. AIM: To assess through a systematic review and meta-analysis the influence of SDF on the bonding performance of adhesive materials to dentine. DESIGN: A systematic search was carried out in PubMed, Web of Science, LILACS, and Scopus. Studies comparing bond strength of adhesive systems or glass ionomer cement to SDF-treated and -untreated (control) dentine were included. Global analysis comparing the bond strength data was performed, separately for adhesive systems and glass ionomer cement, using RevMan5.1, with a random-effect model, at a 5% significance level. RESULTS: Eleven studies were included in the review and ten in the meta-analyses. Overall pooled effect for glass ionomer cement has shown no significant difference between the groups (Z = 0.47; P = .64). SDF treatment significantly impairs the bonding of adhesive systems to dentine (Z = 2.11; P = .03); this effect can be eliminated by the rinsing step (Z = 0.85; P = .40). CONCLUSIONS: The previous application of SDF does not influence the dentine bond strength of glass ionomer cement, but compromises the bonding of adhesive systems.

The Thickness of the Adhesive Layer Increases the Misdiagnosing of the Radiolucent Zones and Restoration Replacement Indication.

OBJECTIVE: To evaluate the influence of the thickness of the adhesive layer and demineralized dentin on the decision to replace composite restoration. MATERIALS AND METHODS: Eighty human third molars with occlusal preparations (Class I) were randomly assigned to eight groups (n = 10): adhesive system (Clearfil SE Bond [CSE] or Scotchbond Universal Adhesive [SBU]); the number of adhesive layers (one or two); and substrate (sound or demineralized dentin). A blinded examiner evaluated radiographs of each restored tooth. Obtained scores for the presence or absence of radiolucent zone under restoration were submitted to a relative risk (RR) calculus and Z-test, and the scores for the decision to replace restorations were submitted to Fisher's exact test (p < 0.05). RESULTS: The relative risk of identifying a radiolucent zone under restoration in sound and demineralized dentin were, respectively, 2 and 1.85 times higher when two layers of adhesive were applied. Demineralized dentin did not increase the probability of identifying a radiolucent zone. A higher relative (1.6, p = 0.01) was observed when two layers of SBU were applied. The number of layers did not influence the relative risk for CSE (RR = 1.3, p = 0.13). CONCLUSION: Thicker layers of SBU increase the relative risk of identifying a radiolucent layer under restoration and the decision to replace a/composite restoration, irrespective of the substrate. The presence of demineralized dentin did not increase the probability of identifying a radiolucent zone when compared to sound dentin. CLINICAL SIGNIFICANCE: The results of this in vitro study suggest that thicker layers of a particular adhesive under resin composite restorations can negatively influence the decision to replace them. (J Esthet Restor Dent 29:193-200, 2017).