Effect of Obturation Techniques on the Quality of Root Canal Fillings: A Systematic Review and Meta-analysis of in Vitro Studies.

Introduction: The current study aimed to compare the quality of root canal obturation performed with cold lateral condensation with other obturation techniques. Materials and Methods: Diverse Search was conducted using six electronic/academic databases following PICOS (i.e. population, intervention, control, outcomes, and study design) strategy: (P) Extracted mature permanent teeth; (I) Obturation techniques except for cold lateral condensation; (C) Cold lateral condensation tyechnique; (O) Quality of root canal obturation; and (S) In vitro studies assessing parameters using micro-computed tomography. The statistical method used for the meta-analyses was the "inverse variance DerSimonian-Laird test". The heterogeneity data was calculated using the T2, Cochran Q test, and I2 statistics. Results: Fifteen studies were included for the final analysis; one had a low risk of bias, eight a moderate risk, and six a high risk of bias. Ten studies were selected for meta-analyses; three studies comparing cold lateral condensation with carrier-based gutta-percha techniques [P=0.96; mean difference (MD)=-0.02; confidence interval (CI): (-0.77, 0.73); I2=21%]; three comparing cold lateral condensation with single-cone techniques [P=0.75; MD=-0.39; CI: (-2.77, 1.99); I2=92%]; two comparing cold lateral condensation and thermo-plasticized injectable techniques [P=0.37; MD=5.91; CI: (-7.13,18.94); I2=99%]; and five comparing cold lateral condensation with warm vertical condensation techniques [P<0.0001; MD=5.29; CI=(2.84, 7.74); I2=92%]. The overall effect reported significant results [P=0.0003; MD=2.69; CI=(1.23, 4.16); I2=96%]; favoring fewer voids and gaps for the other used obturation techniques. Conclusions: Cold lateral condensation and single-cone techniques presented no statistical differences. Nonetheless, Warm vertical condensation technique had better results compared to cold lateral condensation.

How different attributes are weighted in professionals' decision-making in Pediatric Dentistry-a protocol for guiding discrete choice experiment focused on shortening the evidence-based practice implementation for dental care.

BACKGROUND: Important evidence has been constantly produced and needs to be converted into practice. Professional consumption of such evidence may be a barrier to its implementation. Then, effective implementation of evidence-based interventions in clinical practice leans on the understanding of how professionals value attributes when choosing between options for dental care, permitting to guide this implementation process by maximizing strengthens and minimizing barriers related to that. METHODS: This is part of a broader project investigating the potential of incorporating scientific evidence into clinical practice and public policy recommendations and guidelines, identifying strengths and barriers in such an implementation process. The present research protocol comprises a Discrete Choice Experiment (DCE) from the Brazilian oral health professionals' perspective, aiming to assess how different factors are associated with professional decision-making in dental care, including the role of scientific evidence. Different choice sets will be developed, either focusing on understanding the role of scientific evidence in the professional decision-making process or on understanding specific attributes associated with different interventions recently tested in randomized clinical trials and available as newly produced scientific evidence to be used in clinical practice. DISCUSSION: Translating research into practice usually requires time and effort. Shortening this process may be useful for faster incorporation into clinical practice and beneficial to the population. Understanding the context and professionals' decision-making preferences is crucial to designing more effective implementation and/or educational initiatives. Ultimately, we expect to design an efficient implementation strategy that overcomes threats and potential opportunities identified during the DCEs, creating a customized structure for dental professionals. TRIAL REGISTRATION: https://osf.io/bhncv .

Effectiveness of non-operative approaches in active enamel carious lesions: a retrospective longitudinal study.

The aim of the study was to investigate the effectiveness of non-invasive and micro-invasive treatments in active enamel carious lesions in high-caries-risk children. Clinical records of children treated in a dental school setting were retrospectively screened for active enamel carious lesions treated non-invasively (topical fluoride applications, oral hygiene instruction, or dietary guidance) or micro-invasively (sealant). The control of active carious lesions was set as the main outcome established by the combination of inactivation and non-progression of the lesions based on Nyvad and ICDAS criteria, respectively. Individual and clinical factors associated with the outcome were analyzed by Poisson regression. The sample consisted of 105 high-caries-risk children with a mean age of 8.3 (± 2.4) years. From a total of 365 active enamel carious lesions, most lesions (84.1%) were active non-cavitated carious lesions (ICDAS scores 1 and 2) and only 15.9% presented localized enamel breakdown (ICDAS score 3). Of these, 72.6% were inactivated and 92.1% did not progress (mean time of 6.5 ± 4.1 months). The prevalence of controlled carious lesions was higher among children older than 6 years (PR:1.43; 95%CI:1.00-2.03; p = 0.04) and in those with better biofilm control (PR:0.99; 95%CI: 0.98-0.99; p = 0.03). Non-operative approaches are effective for controlling active enamel carious lesions. The majority of active enamel carious lesions became inactive and did not progress after treatment. Caries control was associated with older children and better biofilm control.

Do NSAIDs used prior to standard inferior alveolar nerve blocks improve the analgesia of mandibular molars with irreversible pulpitis? An umbrella review.

INTRODUCTION: The aim of the present umbrella review was to answer the following question: "Does the use of NSAIDs as premedication increase the efficacy of the standard inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?" MATERIAL AND METHODS: Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were searched in six electronic databases (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Grey Literature Reports), without the restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies. RESULTS: Twelve systematic reviews were included. Only one did not perform a meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high. In general, the main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with acetaminophen, and ketorolac) increased the success rate of the inferior alveolar nerve block. CONCLUSIONS: From the "very low" to "high"-quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenase pathways and block the synthesis of specific prostaglandins that complicate the mechanism of action of the anesthesia, improving its success rate. CLINICAL RELEVANCE: Non-steroidal anti-inflammatory drugs can increase the success rate of the anesthetic technique of inferior alveolar nerve block efficacy in situations of mandibular molars with symptomatic irreversible pulpitis.

Is there a better interceptive treatment for unerupted palatally displaced canines? A network meta-analysis.

This systematic review aimed to investigate if there is a better interceptive treatment for palatally displaced canines (PDC) in the mixed dentition stage. The PubMed/MEDLINE, CENTRAL, Scopus, and EMBASE databases were searched for randomized clinical trials related to the research topic. The gray literature and reference lists were also assessed. Network meta-analysis was conducted to analyze the effects of different approaches on PDC eruption. The surface under the cumulative ranking area was calculated to rank the treatments. The certainty of the evidence was evaluated using the GRADE approach. Of the 892 eligible studies, 18 were selected for full-text analysis and 9 for meta-analysis, involving 506 participants and 730 PDC, to compare 9 approaches. The proportion of erupted PDC was significantly higher for all interceptive treatments compared with control (no intervention). Furthermore, the proportion of erupted PDC was higher in patients subjected to rapid maxillary expansion (RME) than those who underwent double extraction of primary canine and primary molar (relative risk (RR) = 2.68 ICr95%: 1.12-9.35). A higher proportion of erupted PDC was found for RME (RR = 3.07 ICr95%: 1.31-10.67), RME plus use of transpalatal arch (TA) plus extraction of primary canine(s) (EC) (RR = 1.43 ICr95%: 1.09-1.95), EC plus use of cervical pull headgear (RR = 1.38 ICr95%: 1.11-1.79), and EC plus use of TA (RR = 1.36 ICr95%: 1.00-1.9) than for EC. RME was most likely to be considered as the best interceptive treatment. Overall, the certainty of the evidence was considered low due to imprecision and indirectness. In conclusion, no intervention in the mixed dentition stage is the worst choice for PDC.

Effectiveness of non-operative approaches in active enamel carious lesions: a retrospective longitudinal study

Abstract The aim of the study was to investigate the effectiveness of non-invasive and micro-invasive treatments in active enamel carious lesions in high-caries-risk children. Clinical records of children treated in a dental school setting were retrospectively screened for active enamel carious lesions treated non-invasively (topical fluoride applications, oral hygiene instruction, or dietary guidance) or micro-invasively (sealant). The control of active carious lesions was set as the main outcome established by the combination of inactivation and non-progression of the lesions based on Nyvad and ICDAS criteria, respectively. Individual and clinical factors associated with the outcome were analyzed by Poisson regression. The sample consisted of 105 high-caries-risk children with a mean age of 8.3 (± 2.4) years. From a total of 365 active enamel carious lesions, most lesions (84.1%) were active non-cavitated carious lesions (ICDAS scores 1 and 2) and only 15.9% presented localized enamel breakdown (ICDAS score 3). Of these, 72.6% were inactivated and 92.1% did not progress (mean time of 6.5 ± 4.1 months). The prevalence of controlled carious lesions was higher among children older than 6 years (PR:1.43; 95%CI:1.00-2.03; p = 0.04) and in those with better biofilm control (PR:0.99; 95%CI: 0.98-0.99; p = 0.03). Non-operative approaches are effective for controlling active enamel carious lesions. The majority of active enamel carious lesions became inactive and did not progress after treatment. Caries control was associated with older children and better biofilm control.

Dimensions of Occlusoproximal Cavitated Carious Lesions as a Cut-Off Point for Restorative Decision in Primary Teeth

ABSTRACT Objective: To investigate whether the dimensions of cavitated dentin carious lesions on the occlusoproximal surfaces of primary teeth could predict the location of cement-enamel junction (CEJ). Material and Methods: Two hundred extracted primary molars were selected and digital images were obtained. The teeth were set in arch models for clinical measurement. The cervical-occlusal (CO) and buccal-lingual/palatal (BL/P) cavities' dimensions were obtained by digital (Image J) and clinical (periodontal millimeter probe) assessments. The cervical margin location was also determined. The thresholds (cut-off points) were determined by sensitivity, specificity and the areas under the receiver operating characteristics curves (Az) for the two methods. Pearson's correlation coefficient was used to investigate the correlation between clinical and digital measurements. Logistic regression analysis was performed to evaluate the association between the dimensions and cervical margin location. Results: There was a strong correlation between methods for all measurements (CO: r=0.90, VL/P: r=0.95). Cavities with BL/P distance higher than 4.5 mm and CO dimension higher than 3.5 mm had a lower chance of presenting the cervical limit above the CEJ, irrespective of the measurement method. Conclusion: CO and VL/P dimensions could be used to predict the CEJ location and, ultimately, as a clinical parameter for restorative decision-making.

Influence of the chemomechanical and mechanical carious tissue removal on the risk of restorative failure: a systematic review and meta-analysis.

OBJECTIVE: To summarize and evaluate critically the results of clinical trials comparing the risk of failure of restorations after chemomechanical and mechanical carious tissue removal. MATERIALS AND METHODS: The PubMed/MEDLINE, EMBASE, Scopus, LILACS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, and grey literature were searched to identify studies related to the research question and published up to January 2022. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and the certainty of evidence. Meta-analysis was performed using a random effects model to compare the effect of chemomechanical and mechanical excavation on the outcome (restorative failure), considering the type of carious tissue removal (selective and complete) as subgroups. RESULTS: From 443 potentially eligible studies, 58 clinical studies were selected for full-text analysis, and 6 were included in the review. There was no statistically significant difference in the risk for failure of restorations performed after chemomechanical and mechanical excavation (RR: 1.26, 95% CI 0.93; 1.72, p = 0.14) either for complete (p = 0.97) or selective (p = 0.11) carious tissue removal. The heterogeneity found was null. The risk of bias was high and the certainty of evidence was low. CONCLUSION: Based on the low certainty of evidence, the risk of failure of restorations performed after chemomechanical and mechanical carious tissue removal is similar. CLINICAL RELEVANCE: Chemomechanical carious tissue removal may be performed before restoration placement, without jeopardizing the short-term longevity. Further studies are required before definitive conclusions can be drawn.

Risk of failure of repaired versus replaced defective direct restorations in permanent teeth: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to systematically review the literature to compare the risk of failure of repaired and replaced defective direct resin composite and amalgam restorations performed in permanent teeth. MATERIALS AND METHODS: The PubMed/MEDLINE, Scopus, Lilacs, BBO, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL) databases, and gray literature were searched to identify longitudinal clinical studies related to the research question. No publication year or language restriction was considered. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and certainty of evidence. A meta-analysis was performed using a fixed effects model at a 5% significance level. RESULTS: From 1224 potentially eligible studies, thirteen were selected for full-text analysis, and three were included in the systematic review and meta-analysis. There was no difference in the risk of failure of repaired and replaced defective direct restorations (RR: 1.21, 95% CI: 0.51-2.83), either for resin composite (p = 0.97) or amalgam (p = 0.51) restorations. The risk of bias was high and the certainty of evidence was very low. CONCLUSION: Based on the very low certainty of evidence, the repair of direct restorations does not present a significant difference in the risk of failure when compared to replacements in permanent teeth. CLINICAL RELEVANCE: Restoration repair is a procedure that is included in the minimal intervention principle for improvement of tooth longevity in that the risk of failure of repaired partially defective restorations in permanent teeth seems similar to that of replacement. Further studies are required before definitive conclusions can be drawn.

Percepção de uso e preparo químico mecânico realizado com diferentes instrumentos endodônticos por estudantes de graduação em Odontologia: uma revisão sistemática de estudos laboratoriais / Undergraduate dental students' use perception of different endodontic instruments for mechanical­chemical preparation: a systematic review of laboratory studies

O estudo revisou a literatura existente com o objetivo de comparar a percepção de uso, qualidade e tempo do preparo químico mecânico de canais radiculares realizado por estudantes de graduação em Odontologia com instrumentos de níquel-titânio (NiTi) e aço inoxidável. Para isso, as bases de dados eletrônicas PubMed, LILACS, Scopus, Embase,SciELOe CENTRALforam acessadas para verificar e selecionar estudos relacionados com a questão de pesquisa publicados até janeiro de 2021. Estudos laboratoriaisque compararam o uso de instrumentos de NiTi com aço inoxidável por alunos de graduação em Odontologia foram avaliados. Dois revisores independentemente selecionaram os estudos, coletaram os dados e analisaram o risco de viés.Dos 92 estudos potencialmente relevantes, 10 atenderam aos critérios de inclusão para análise de texto completo e, posteriormente, incluídos na revisão sistemática. O risco de viés foi considerado alto em todos os estudos. Instrumentos de NiTi apresentarammaior preferência e melhor percepção por estudantes de graduação em Odontologia, menor tempo e melhor qualidade do preparo químico mecânico, commenor ocorrência de acidentes como degraus, transporte e desvios de canal, apesar de estarem associados à maior ocorrência de fratura de instrumentos (AU).

This literature review aimed to compare undergraduate dental students' perceptions regarding the use of nickel­titanium (NiTi) and stainless steel instruments for the mechanical-chemical preparation of root canals, focusing on quality and time. PubMed, LILACS, Scopus, Embase, SciELO,and CENTRAL electronic databaseswere accessed to verify and select related studies published as of January 2021. Laboratory studies comparing the use of NiTi instruments with stainless steel instruments by undergraduate dental students were evaluated. Two reviewers independently selected the studies, collected the data, and analyzed the risk of bias. Out of the 92 potentially relevant studies, 10 met the inclusion criteria for a full-text analysis and were subsequently included in the systematic review. The risk of bias was considered high in all studies. Undergraduate dental students demonstrated a greater preference for and better perception of NiTi instruments. NiTi instruments also resulted in less time for and better qualityof the mechanical-chemical preparation. These were associated with a lower incidence of accidents, such as canal ledges, transportations, and deviations, as well as a higher incidence of instrument fractures (AU).

Factors Associated with Longitudinal Changes in the Caries Activity Profile of Children.

Purpose: To evaluate the factors associated with longitudinal changes in the caries activity profile of high caries risk children.
Methods: The sample consisted of clinical records of children who had undergone dental care in a public setting during a one-year period. Patients with active carious lesions (non-cavitated and/or cavitated) at the initial examination and who completed treatment were considered for the analysis. A caries-controlled profile was set as the main outcome based on arresting active carious lesions. Poisson regression was used to evaluate the association of patient- and treatment-related factors with the outcome ( P <0.05).
Results: The analysis included 130 caries-active children (7.8±2.4 [standard deviation - SD] years), with a mean missing and filled teeth index score of 8.3±4.4 SD. Patients with lower caries experience (prevalence ratio [PR]=0.93; 95 percent confidence interval [95% CI]=0.87 to 0.99) who received more appointments focused on oral health promotion based on dietary and oral hygiene instructions (PR=1.28; 95% CI= 1.03 to 1.58) had a greater rate of moving to caries-controlled status. The number of invasive treatments was not associated with a shift from caries-active to caries-controlled status (PR=0.98; 95% CI=0.87 to 1.11).
Conclusion: A preventive regimen focused on dental and diet guidance may play an important role in arresting active carious lesions in high caries risk children.

Influence of the FDI criteria in the restorations' evaluation and treatment decision in primary molars / Influência dos critérios da FDI na avaliação de restaurações e decisão de tratamento em molares decíduos

Objective: This study investigated the impact of FDI criteria for evaluating restorations on examiners' decision-making compared with their previous personal judgment in primary teeth. Secondly, the possible factors related to changes when using the criteria, including the examiners' experience were explored. Material and Methods: A cross-sectional study in a dental office setting was conducted selecting 27 resin composite restorations placed in primary molars in 11 children. Examinations of the restorations were performed by five undergraduate and five graduate dental students. First, the evaluations were performed based on personal judgment, and 2 weeks later, with FDI criteria. All examiners underwent training to use the FDI criteria after the first evaluation. The consensus of two benchmark examiners was considered to be the reference standard. Initially, a descriptive analysis was performed. Multiple Poisson regressions analyses were used to identify possible associated factors with outcomes - to be less or more invasive based on the FDI criteria than personal judgment. Results: The use of the FDI criteria changed the examiners' decisions in approximately 15% of the cases. Irrespective of examiners' experience, there was a trend of false results (compared to the reference examiners) when a change in the treatment decision was registered by using the FDI criteria. Examiners chose a less invasive option when assessing multi surface restorations with FDI criteria (PR=2.04, 95%CI=1.03-4.05; p=0.04). Examiners who spent more time for evaluation with FDI criteria were more invasive (PR=1.001, 95%CI=1.0001-1.002; p=0.03). Students were more invasive with the FDI criteria when examined children with higher dmf-t (PR=1.16, 95%CI=1.01-1.32; p=0.03). Conclusion: The use of the FDI criteria negatively influenced the restorations' evaluation and treatment decision in primary molars by undergraduate and graduate students.(AU)

Objetivo: Este estudo investigou o impacto dos critérios da FDI para avaliar restaurações na tomade de decisão feita pelos examinadores em comparação ao seu julgamento pessoal prévio em dentes decíduos. Secundariamente, foram explorados os possíveis fatores relacionados com mudanças causadas pelo uso dos critérios, incluindo a experiência dos examinadores. Material e Métodos: Um estudo transversal em ambiente de consultório odontológico foi conduzido selecionando 27 restaurações de resina composta realizado em molares decíduos em 11 crianças. As avaliações das restaurações foram realizadas por cinco estudantes de Graduação e cinco de Pós-graduação em Odontologia. As avaliações foram realizadas com base no julgamento pessoal e, duas semanas depois, com os critérios da FDI. Todos os examinadores foram treinados para utilizar os critérios da FDI após a primeira avaliação. O consenso de dois examinadores "padrão-ouro" foi considerado o padrão de referência. Inicialmente, uma análise descritiva foi realizada. Análises de regressão múltipla de Poisson foram utilizadas para identificar possíveis fatores associados com os desfechos ­ ser mais ou menos invasivo com o uso dos critérios da FDI em relação ao julgamento pessoal. Resultados: A utilização dos critérios do FDI alterou as decisões dos examinadores em aproximadamente 15% dos casos. Independente da experiência dos examinadores, houve uma tendência de resultados falsos (em comparação com os examinadores de referência) quando uma mudança na decisão de tratamento foi registrada usando os critérios da FDI. Os examinadores escolheram uma opção menos invasiva quando avaliaram restaurações envolvendo múltiplas superfícies com os critérios da FDI (RP = 2,04, IC 95% = 1,03-4,05; p = 0,04). Os examinadores que levaram mais tempo para avaliação das restaurações foram mais invasivos com o uso dos critérios da FDI (RP = 1,001, IC 95% = 1,0001-1,0002; p = 0,03). Os alunos foram mais invasivos com o uso dos critérios da FDI quando examinaram crianças com maior experiência de cárie (RP = 1,16, IC 95% = 1,01-1,32; p = 0,03). Conclusão: O uso dos critérios da FDI influenciou negativamente a avaliação das restaurações e decisão de tratamento em dentes decíduos realizada por estudantes de graduação e pós-graduação. (AU)

Is there a better interceptive treatment for unerupted palatally displaced canines? A network meta-analysis

Abstract This systematic review aimed to investigate if there is a better interceptive treatment for palatally displaced canines (PDC) in the mixed dentition stage. The PubMed/MEDLINE, CENTRAL, Scopus, and EMBASE databases were searched for randomized clinical trials related to the research topic. The gray literature and reference lists were also assessed. Network meta-analysis was conducted to analyze the effects of different approaches on PDC eruption. The surface under the cumulative ranking area was calculated to rank the treatments. The certainty of the evidence was evaluated using the GRADE approach. Of the 892 eligible studies, 18 were selected for full-text analysis and 9 for meta-analysis, involving 506 participants and 730 PDC, to compare 9 approaches. The proportion of erupted PDC was significantly higher for all interceptive treatments compared with control (no intervention). Furthermore, the proportion of erupted PDC was higher in patients subjected to rapid maxillary expansion (RME) than those who underwent double extraction of primary canine and primary molar (relative risk (RR) = 2.68 ICr95%: 1.12-9.35). A higher proportion of erupted PDC was found for RME (RR = 3.07 ICr95%: 1.31-10.67), RME plus use of transpalatal arch (TA) plus extraction of primary canine(s) (EC) (RR = 1.43 ICr95%: 1.09-1.95), EC plus use of cervical pull headgear (RR = 1.38 ICr95%: 1.11-1.79), and EC plus use of TA (RR = 1.36 ICr95%: 1.00-1.9) than for EC. RME was most likely to be considered as the best interceptive treatment. Overall, the certainty of the evidence was considered low due to imprecision and indirectness. In conclusion, no intervention in the mixed dentition stage is the worst choice for PDC.

Caries progression and need for reintervention on occlusal ICDAS 4 lesions after different treatments: a retrospective university-based study / Progressão de cárie e necessidade de reintervenção em lesões oclusais ICDAS 4 após diferentes tratamentos: um estudo retrospectivo de base universitária

Objective: To assess the caries progression and the need for reintervention on occlusal ICDAS 4 lesions after different treatments. Material and Methods: The sample consisted of records of children treated in a public setting who had at least an occlusal ICDAS 4 lesion in primary and/or permanent molars. The radiographic images of ICDAS 4 lesions at the first and last appointments were classified as absence of radiolucency, radiolucent image at the enamel­dentin junction, at the outer half or inner of the dentin. The need for retreatment after different treatments (non-invasive - topical fluoride applications, oral hygiene instructions and dietary guidance, micro-invasive - resin-based sealant, or invasive - restoration) was assessed by reviewing clinical and radiographic records. The need for retreatment was defined as any complication requiring mending (e.g., caries progression, total loss of sealant, or restoration failure). The Poisson regression model was used to investigate the association between individual and tooth-related variables and the outcome. Results: Among the 111 lesions in 81 patients, most (73.0%) lesions were in primary molars. Most lesions (52.3%) did not exhibit radiolucency, whereas 29.7% had radiolucency at the outer half of the dentin. The mean follow-up was 18.8 ± 6.5 months. After follow-up, 82.9% of the lesions did not require retreatment. The prevalence of ICDAS 4 lesions that did not need retreatment was higher among lesions with radiolucency at dentin (p=0.01). Conclusion: Most occlusal ICDAS 4 lesions did not require reintervention, especially those exhibiting radiolucency in the outer half of the dentin (AU)

Objetivo: Avaliar a progressão de cárie e a necessidade de reintervenção em lesões oclusais ICDAS 4 após diferentes tratamentos. Material e Métodos: A amostra consistiu de prontuários de crianças atendidas em ambiente público que apresentavam pelo menos uma lesão oclusal ICDAS 4 em molares decíduos e/ou permanentes. As imagens radiográficas de lesões ICDAS 4 na primeira e última consultas foram classificadas como ausência de radiolucidez, imagem radiolúcida na junção esmalte-dentina, em metade externa ou interna da dentina. A necessidade de retratamento após diferentes tratamentos (não invasivo ­ aplicações tópicas de flúor, orientações de higiene e dieta, micro-invasivo ­ selante resinoso ou invasivo ­ restauração) foi avaliada por meio da revisão dos registros clínicos e radiográficos. A necessidade de retratamento foi definida como qualquer complicação que requer intervenção (por exemplo, progressão da lesão, perda total do selante ou falha na restauração). O modelo de regressão de Poisson foi utilizado para investigar a associação entre as variáveis individuais e dentárias e o desfecho. Resultados: Entre as 111 lesões em 81 pacientes, a maioria (73,0%) das lesões eram em molares decíduos. A maioria das lesões (52,3%) não exibiu radiolucidez, enquanto que 29,7% apresentaram radiolucidez em metade externa de dentina. O tempo de acompanhamento médio foi de 18,8 ± 6,5 meses. Após o acompanhamento, 82,9% das lesões não necessitaram de retratamento. A prevalência de lesões ICDAS 4 que não necessitaram de retratamento foi maior entre as lesões com radiolucidez em dentina (p=0,01). Conclusão: A maioria das lesões oclusais ICDAS 4 não requerem reintervenção, especialmente aquelas que exibem radiolucidez em metade externa da dentina.(AU)

Reduction in erosive tooth wear using stannous fluoride-containing dentifrices: a meta-analysis.

Dentifrices containing different active agents may be helpful to allow rehardening and to increase the resistance of the eroded surface to further acids or mechanical impacts. This study aimed to compare the effects of conventional (sodium fluoride [NaF]) and stannous fluoride (SnF2)-containing dentifrices on reducing erosive tooth wear (ETW). The PubMed/MEDLINE, Scopus, LILACS, BBO, EMBASE, TRIP electronic databases, and grey literature were searched until January 2021 to retrieve relevant in vitro and in situ studies related to research question. There were no restrictions on publication year or language. Two authors independently selected the studies, extracted the data, and assessed the risk of bias. ETW data were pooled to calculate and compare both dentifrices (overall analysis) and in vitro and in situ studies separately (subgroup analysis). Statistical analyses were performed using RevMan5.3 with a random effects model. Of 820 potentially eligible studies, 101 were selected for full-text analysis, and 8 were included in the systematic review and meta-analysis. There was a significant difference between SnF2-containing dentifrices and NaF dentifrices only for in vitro studies (p=0.04), showing a higher effect of the SnF2-containing dentifrices against the erosion/abrasion (effect size: -6.80 95%CI: -13.42; -0.19). Most in vitro and in situ studies had high and low risk of bias, respectively. In vitro literature suggests that the ETW reduction is greater when using SnF2-containing dentifrices instead NaF-containing dentifrices. However, the evidence level is insufficient for definitive conclusions. Clinical trials are necessary for a better understanding of the effect of these compounds on ETW.

Molar-incisor hypomineralization and dental caries: A hierarchical approach in a populational-based study

Abstract The last couple of decades has seen an increasing interest in molar-incisor hypomineralization (MIH) studies. Hypomineralized defects can have several consequences such as hypersensitivity, increased dental plaque accumulation, and consequently higher caries risk. This cross-sectional study aimed to investigate the prevalence of MIH and its association with dental caries in schoolchildren from a city in southern Brazil. A random cluster sample of schoolchildren was selected. Clinical examinations were carried out to collect information on MIH (following the European Academy of Pediatric Dentistry criteria), dental caries (using the DMF-T index) and gingivitis. Socioeconomic, demographic and behavior variables were collected using a standardized questionnaire answered by the children's parents/caregivers. Prevalence ratios (PR) were estimated using Poisson regression analysis with robust variance through a hierarchical approach (p<0.05). A total of 513 schoolchildren were included in the study. MIH and caries prevalence was 19.7% and 31.6%, respectively. The mean age was 11.6 (+1.9) years. Dental caries was more prevalent in children with MIH (PR 1.39; 95% CI 1.05 - 1.85). Older children and children whose families were enrolled in conditional cash transference programs (PR 1.97 95% CI 1.47 - 2.64), and children who did not have their mother or father as the head of the family (PR 1.56 95% CI 1.06 - 2.30) presented a higher prevalence of dental caries. Our findings suggest that children with MIH are more likely to have dental caries.

Resumo Nas últimas duas décadas, observou-se um interesse crescente nos estudos de hipomineralização molar-incisivo (HMI). Os defeitos hipomineralizados podem ter várias consequências, como hipersensibilidade, aumento do acúmulo de placa dentária e, consequentemente, maior risco de cárie. Este estudo transversal teve como objetivo investigar a prevalência de HMI e sua associação com cárie dentária em escolares de um município do sul do Brasil. Uma amostra aleatória de alunos por conglomerado foi selecionada. Os exames clínicos foram realizados para coletar informações sobre HMI (seguindo os critérios da European Academy of Pediatric Dentistry), cárie dentária (usando o índice DMF-T) e gengivite. Variáveis socioeconômicas, demográficas e comportamentais foram coletadas por meio de um questionário padronizado respondido pelos pais / responsáveis pelas crianças. Razões de prevalência (RP) foram estimadas por meio de análise de regressão de Poisson com variância robusta por meio de abordagem hierárquica (p <0,05). Um total de 513 escolares foram incluídos no estudo. A prevalência de MIH e cárie foi de 19,7% e 31,6%, respectivamente. A média de idade foi de 11,6 (± 1,9) anos. A cárie dentária foi mais prevalente em crianças com HMI (RP 1,39; IC 95% 1,05 - 1,85). Crianças mais velhas e crianças cujas famílias estavam matriculadas em programas de transferência condicional de renda (RP 1,97 IC95% 1,47 - 2,64), e crianças que não tinham a mãe ou o pai como chefe da família (RP 1,56 IC95% 1,06 - 2,30) apresentaram maior prevalência de cárie dentária. Nossos resultados sugerem que crianças com HMI são mais propensas a ter cárie dentária.

Use of flowable resin composite as an intermediate layer in class II restorations: a systematic review and meta-analysis.

OBJECTIVE: To investigate the influence of an intermediate layer of a flowable resin composite in class II resin composite restorations. MATERIALS AND METHODS: The authors searched MEDLINE via PubMed, Scopus, LILACS, Embase, and Web of Science electronic databases, and the ClinicalTrials.gov website to identify laboratory and clinical studies that evaluated class II cavities with resin composite restorations with or without an intermediate layer of flowable resin composite. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and the quality of the evidence. Meta-analyses were performed using RevMan5.3 with fixed-effects model comparing bond strength (MPa), fracture strength (Newton), and clinical (number of failures) outcomes between restorative techniques (with or without flowable resin composite as an intermediate layer). RESULTS: From 1707 potentially eligible studies, 140 in vitro studies and 14 clinical studies were selected for full-text analysis, and 11 were included in the systematic review, being 7 in vitro and 4 clinical studies. There was no statistically significant difference between the restorative techniques considering the outcomes evaluated. The heterogeneity found was null. The risk of bias was classified as medium for in vitro studies and unclear in most clinical studies. The quality of the evidence of the clinical studies was low. CONCLUSION: The use of flowable resin composite as an intermediate layer does not improve the effectiveness of the class II restorations based on laboratory and clinical outcomes. CLINICAL RELEVANCE: Flowable resin composite as an intermediate layer may be used for class II restorations; however, this technique does not improve the effectiveness of the class II restorations.

Non-invasive and micro-invasive treatments to arrest active occlusal carious lesions in erupting permanent molars: A randomized clinical trial.

This study aimed to evaluate the efficacy of non-invasive and micro-invasive treatments on the arrest of occlusal enamel carious lesions in erupting permanent molars. This two-arm randomized clinical trial included 27 subjects, aged 5-11 years, with 64 erupting permanent molars presenting active occlusal enamel carious lesions (as assessed by the International Caries Detection and Assessment System [ICDAS]; scores 1-3). The sample was randomly assigned into two treatment groups: 1) resin-modified glass ionomer cement sealant (Clinpro XT Varnish; 3M ESPE) and 2) 4-week topical fluoride varnish application (Duraphat; Colgate). All children and parents received oral hygiene and dietary instructions. Teeth were evaluated at baseline and 3, 6, 9, and 12 months regarding the eruption stage, biofilm accumulation, as well as severity and activity of the carious lesions. The Kaplan-Meier method was used to evaluate the survival estimates for inactivation of the carious lesions for both treatment groups. Multivariate Cox regression models with shared frailty were performed to identify factors associated with the outcome (p < 0.05). After 12 months, 22% and 3% of the lesions treated with topical fluoride varnish and sealant, respectively remained active. The adjusted model demonstrated that younger children had a higher probability of active enamel carious lesions arresting (hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.22-0.78; p=0.01). However, the probability of active enamel carious lesions arresting after sealant application was 8.85 times higher compared with fluoride varnish applications (p=0.01). Sealing is a more effective approach than fluoride varnish for arresting occlusal enamel carious lesions in erupting permanent molars.

Bonding Performance of Universal and Contemporary Adhesives in Primary Teeth: A Systematic Review and Network Meta-Analysis of In Vitro Studies.

Purpose: To systematically review the literature to compare the bond strength of universal adhesives with etch-and-rinse and self-etch systems to primary teeth. Methods: The search was carried out in PubMed® /MEDLINE, Scopus® , LILACS, Embase® , and Web of Science™ databases with no restrictions. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Direct comparisons among universal adhesive in etch-and-rinse (UER) and self-etch (USE) modes and etch-and-rinse (ER) and self-etch (SE) systems were performed considering different substrates (sound enamel and dentin, and carious dentin) through meta-analyses of random effects. A mixed treatment comparisons meta-analysis was also performed comparing the bond strength of all adhesive approaches on sound dentin. Results: From 3,276 potentially eligible studies, 18 were selected for full-text analysis, and eight were included in the systematic review. All studies included in the meta-analyses evaluated a mild universal adhesive (Scotchbond™ Universal). In direct comparisons, there was no difference between USE and SE to sound enamel (mean difference [MD] equals 5.22; 95 percent confidence interval [95% CI] equals -9.09 to 19.52). In carious dentin, the results favored only ER over USE (MD equals -3.88; 95% CI equals -7.40 to -0.37). In sound dentin, the bond strength values of UER were higher than ER (MD equals 5.50; 95% CI equals 4.03 to 6.96). The rank probability showed that the best treatment on sound dentin was UER. Conclusion: Pooled in vitro data suggest that a mild universal adhesive system can substitute the etch-and-rinse and self-etch systems for restoring primary teeth.

Self-etch Approach of Universal Adhesives as an Alternative to Minimize Bond Degradation on Sound Dentin vs Caries-affected Dentin over Time.

PURPOSE: To investigate the influence of the etching strategy of universal adhesives on bond degradation to sound and artificially-induced caries-affected dentin. MATERIALS AND METHODS: The universal adhesives (Scotchbond Universal Adhesive; All-Bond Universal; Prime&Bond Elect) and adhesives used as controls (Adper Single Bond 2 and Clearfil SE Bond) were applied to sound and artificially-induced caries-affected bovine dentin. Microtensile bond strength was evaluated immediately (24 h) and after one year of water storage (1 year). Representative specimens were also prepared to assess nanoleakage. Bond strength data (MPa) were analyzed using three-way ANOVA and post-hoc Tukey's test (α = 0.05), considering each substrate separately. RESULTS: Bonding degradation was observed for all universal adhesives on caries-affected dentin, irrespective of the etching strategy. On sound dentin, bonding degradation was observed when adhesives were used on the etch-and-rinse strategy. CONCLUSION: The universal adhesives were not capable of maintaining bond stability over time on caries-affected dentin. The self-etch strategy seems better able to maintain the durability of adhesive interfaces created on sound dentin.