Two-year clinical and radiographic evaluation of ACTIVA BioACTIVE versus Compomer (Dyract® eXtra) in the restoration of class-2 cavities of primary molars: a non-inferior split-mouth randomised clinical trial.

OBJECTIVES: The trial aimed to compare the clinical performance and radiographic success of ACTIVA BioACTIVE versus Compomer in restoring class-II cavities of primary molars. MATERIALS AND METHODS: A non-inferior split-mouth design was considered. A pre-calculated sample size of 96 molars (48 per group) with class-2 cavities of twenty-one children whose ages ranged from 5 to 10 years were randomly included in the trial. Pre-operative Plaque Index (PI), DMFT/dmft scores and the time required to fill the cavity were recorded. Over 24 months, the teeth were clinically evaluated every six months and radiographically every 12 months by two calibrated and blinded evaluators using the United States public health service (USPHS)-Ryge criteria. The two-sided 95% confidence interval (CI) for the difference in success rate was considered to assess non-inferiority, and the margin was set at -18%. The linear mixed model and Firth's logistic regression model were used for data analysis (P < 0.05). RESULTS: After 24 months, 86 teeth (43 per group) were evaluated. The mean PI score was 1.1(± 0.9), while DMFT/dmft was 0.35 (± 0.74) and 6.55 (± 2.25) respectively. The clinical and radiographic success rate of Dyract vs. ACTIVA was 95.3% and 88.3% vs. 93% and 86%, respectively. The two-sided 95% CI for the difference in success rate (-2.3%) was - 3.2 to 1.3% and didn't reach the predetermined margin of -18% which had been anticipated as the non-inferiority margin. Clinically, ACTIVA had a significantly better colour match (P = 0.002) but worse marginal discolouration (P = 0.0143). There were no significant differences regarding other clinical or radiographic criteria (P > 0.05). ACTIVA took significantly less placement time than Dyract, with a mean difference of 2.37 (± 0.63) minutes (P < 0.001). CONCLUSION: The performance of ACTIVA was not inferior to Dyract and both materials had a comparable high clinical and radiographic performance in children with high-caries experience. ACTIVA had a significantly better colour match but more marginal discolouration. It took significantly less time to be placed in the oral cavity. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov on 4 May 2018 (#NCT03516838).

Effects of frequently consumed beverages by children on the surface roughness of compomers.

PURPOSE: To evaluate and compare changes on the surface roughness of conventional and colored compomers used in pediatric dentistry caused by beverages frequently consumed by children. METHODS: 176 conventional and colored compomer discs were prepared. The discs were divided into four equal subgroups and incubated in different beverages: distilled water, milk, fruit juice, and cola. The surface roughness of the samples was measured and recorded on Days 1, 7, 14, 21, and 28. The data obtained were statistically analyzed. RESULTS: In distilled water and milk, the surface roughness of the conventional compomer was higher than the colored compomer after Day 7 (P< 0.05). In fruit juice and cola, the surface roughness of conventional and colored compomers was similar at all timepoints (P< 0.05). There was a significant difference between discs incubated in distilled water and milk, on Days 21 and 28 (P< 0.05). The colored compomer showed the highest roughness in cola on Day 1, whereas the conventional compomer showed the highest roughness in milk on Day 21. CLINICAL SIGNIFICANCE: Cola caused the highest surface roughness on the surface of colored compomers, whereas milk caused the highest surface roughness on conventional compomers.

Residual Monomer Release after the Polymerization of Different-Colored Flowable Compomer.

BACKGROUND: Compomers are restorative materials commonly used in pediatric dentistry. It is important to investigate the monomer release of materials used especially in pediatric patients. The aim of this study was to evaluate the residual monomer released from different-colored flowable compomers at five polymerization times. MATERIALS AND METHODS: Three experimental groups were formed: Group 1: pink flowable compomer (Twinky Star, VOCO, Germany), Group 2: blue flowable compomer (Twinky Star, VOCO), Group 3: white flowable compomer, A2 color of Dyract XP (Dentslpy DeTrey, Konstanz, Germany). For each group, samples were prepared using standard cylindrical Teflon molds (n = 10), and the compomers were cured using a light-emitting diode (LED) source in accordance with the manufacturer's recommendations. During each time period, the number of residual monomers: bisphenol-A glycidyl methacrylate (bis-GMA), urethane dimethacrylate (UDMA), hydroxyethyl methacrylate (HEMA), and triethylene glycol dimethacrylate (TEGDMA) were determined with high-performance liquid chromatography (HPLC). All data were analyzed statistically. RESULTS: In all groups, the amount of residual monomers increased after 1-h release periods (P < 0.05). For 2 weeks, the total residual monomers released were determined at most in Group 3 and at least in Group 1. However, there was no significant difference between the groups in terms of released amounts of monomers (P > 0.05). CONCLUSIONS: According to the study, when the total amount of residual monomer released from all groups was compared, no difference was found and it was observed that none of them exceeded the toxic dose. Flowable colored compomers can be used as safely as white compomers in pediatric dentistry.

Compomers for the restorative treatment of dental caries in primary teeth: An umbrella review.

OBJECTIVES: This umbrella review comprehensively appraised the evidence on the use of compomers in comparison to other dental filling materials for restorative treatment of decayed primary teeth. DATA: The literature search was conducted based on the question: "Is the use of compomers as a dental filling material more successful in the restorative treatment of decayed primary teeth than other dental filling materials?" No language restriction was applied and systematic reviews published up to May 2023 were included. The ROBIS tool was used to assess the methodological quality of the included systematic reviews. Data were extracted for narrative synthesis, considering the restoration failure/success outcomes. SEARCH: Online search was conducted in three databases (PubMed/Medline, Embase and Cochrane library). STUDY SELECTION: The electronic search yielded a total of 779 publications. Finally, 18 systematic reviews were included in this umbrella review. Four systematic reviews presented a low risk of bias, 11 presented an unclear risk of bias and three presented a high risk of bias. Most systematic reviews presenting low risk of bias reported no difference in the success rates of compomers compared to other dental filling materials used for restoration of decayed primary teeth. Studies that found a significant difference or that made clear recommendations towards the use of compomers were commonly rated with a high risk of bias. CONCLUSION: Compomers are similar to other dental filling materials for the placement of direct restorations in primary teeth. CLINICAL SIGNIFICANCE: The results of this umbrella review indicate a similar clinical performance of compomers compared to other materials containing a resin component for direct restoration in primary teeth. Therefore, the choice of restorative material will depend on multiple factors, such as clinician's skills/preferences, patients' wishes, costs, and cavity type/location.

The effects of gastric acid on pediatric restorative materials: SEM analysis.

In this study, we aimed to demonstrate changes in the surface roughness and microhardness of three different restorative materials routinely used in pediatric dentistry (composite, compomer and resin-modified glass ionomer cement (RMCIS)) in response to continuous daily exposure to gastric acid. Twelve samples of each of type of restorative material were prepared. Eleven of the specimens were included in the gastric acid cycle. The microhardness and surface roughness of ten samples were measured before and after the cycle. Another sample included in the cycle was compared with the sample not included in the cycle by scanning electron microscopy (SEM). There was a significant difference between the groups in terms of roughness scores following gastric acid cycle (p = 0.039). RMCIS material possessed the highest roughness value. A significant difference was identified in terms of microhardness levels before and after the gastric acid cycle (p = 0.001). The most significant change was observed in the compomer material. SEM analysis, performed after the gastric acid cycle, revealed that most cracks were identified in RMCIS material; this was followed by compomer and composite materials, respectively. Our analysis indicates that the restorative materials used frequently in pediatric dental procedures, show increased surface roughness and reduced microhardness when exposed to gastric acid.

Treatment success of carious primary molars with marginal breakdown: comparison of three treatment approaches in a real-world clinical setting (using decision tree analysis).

OBJECTIVES: Treatment of carious primary molars is always indicated, especially on young children; however, there are no clear guidelines that precisely explain the best treatment approach for Class II carious molars with marginal breakdown (International Caries Detection and Assessment System [ICDAS] 5). The objective of this prospective observational clinical study was to assess the efficacy of three restorative techniques in treating ICDAS 5 Class II lesions in primary molars: compomer fillings (CF), preformed metal crowns (PMC), and pulpotomy and conventional preformed metal crowns (PMC+P). The secondary goal was to evaluate the impact of some cofactors on the course of treatment. METHOD AND MATERIALS: Overall, 92 children (female, n = 50, 54.3%; male, n = 42, 45.7%) aged 2 to 9 years old (mean age = 5.9 ± 1.9 years) with 166 treated teeth were included. The average number of decayed, missing, or filled teeth (d3mft) of the whole sample was 8.0 ± 3.4. The distribution of the sample according to type of treatment was CF = 53 (31.9%), PMC = 64 (38.6%), and PMC+P = 49 (29.5%). Paired t test, nonparametric Friedman ANOVA test, and decision tree analysis were used as the basis for the statistics. RESULTS: After 12 months, data from 75.8% (72/95) treated patients, corresponding to 62.0% (103/166) of the treated teeth (CF = 42/53, 79.2%; PMC = 38/64, 59.4%; PMC+P = 23/49, 46.9%) were available for analysis. The mean patients age was 6.8 ± 1.8 years; 32 (47.1%) boys and 36 (52.9%) girls. The mean d3mft of the remaining sample was 7.8 ± 3.35. PMC and PMC+P arms showed the highest success rates (> 91%) as compared to the CF arm, which showed the lowest success rates (61.9%), with 9/42 teeth of the CF group (21.4%) presenting with minor failures, and 7/42 teeth (16.7%) with major failures (P < .0001). CONCLUSION: According to the decision tree analysis, PMC and PMC+P had a success rate of 99%, whereas CF had a success rate of only 69%. Some cofactors (treatment decision, Approximal Plaque Index, and tooth number) had a higher impact on the decision tree analysis than others (age, dmfs, and dmft values), especially when the treatment selection was CF. In future studies it is necessary to examine the impact of other cofactors on the outcomes of conventional fillings using a larger sample size.

Evaluation of failure rate of molar tubes with a modified bonding technique: a randomized clinical trial.

BACKGROUND: During orthodontic therapy, bond failure of molar tubes may delay treatment. With the high failure rate of molar tubes, alternative bonding techniques were tested to improve bond strength. OBJECTIVES: To compare the failure rates of molar tubes bonded with conventional and alternative bonding techniques by adding a layer of compomer adhesive at the molar/tube interface. TRIAL DESIGN: Single-centre, single-blinded, split-mouth, randomized clinical trial. METHODS: Patients aged 12 years or older, who required fixed appliance orthodontic treatment without extraction and with no occlusal interference were eligible to participate. They were allocated randomly using a simple non-stratified split-mouth design with a 1:1 allocation ratio. Blinding was only possible for the patients and data analysts. Molar tubes bonded with the modified bonding technique had an additional layer of compomer at the occlusal molar/tube interface. The patients were followed-up for nine months. Outcome measures included the survival time of molar tubes and the number of molar tubes debonded. The bond failure of molar tubes was analyzed using Kaplan-Meier and Cox regression analysis (P < 0.05). RESULTS: Thirty patients were recruited, randomized, and analyzed (mean age 20.33 years). The failure rate of molar tubes bonded with the modified bonding technique was 4.2 per cent and that of molar tubes bonded with the conventional bonding technique was 6.7 per cent. This difference was not statistically significant (P > 0.05). The dental arch and molar type were found to be as significant predictors for molar tube failure rate. No harm was detected during treatment. LIMITATIONS: The effect of compomer to reduce enamel demineralization was not tested. CONCLUSIONS AND IMPLICATIONS: The modified bonding technique did not significantly reduce the failure rate of molar tubes. The molar tubes bonded on the upper arch and second molars are more susceptible to debond. REGISTRATION: The trial was registered with ClinicalTrials.gov on 21 May 2022 (Registration number: NCT05391386). FUNDING: This research did not receive any funding.

12-Month flexural mechanical properties of conventional and self-adhesive flowable resin composite materials.

The aim of this study was to investigate the 12-month flexural mechanical properties of 23 flowable resin-based composites (FRBC) that included 5 self-adhesive FRBC materials. Specimens were evaluated following ISO 4049:2019 guidelines, but additionally stored in physiologic 0.2M phosphate buffered saline solution being tested at 24 h, 1 week, 1 month, and at 3-, 6-, 9-, and 12-months. While some deviation and degradation were noted at testing intervals, conventional FRBC materials overall demonstrated greater flexural strength than the self-adhesive and compomer materials. Three self-adhesive materials and the compomer were below recommended ISO 4049:2019 flexural strength values at 24 h with another after 6 months storage. Conventional FRBC materials, except at 1 month, overall demonstrated increased flexural modulus than the self-adhesive FRBC materials. Although results were material dependent, conventional FRBC materials demonstrated overall greater flexural mechanical properties as compared to the self-adhesive FRBC materials and the compomer evaluated.

Marginal Quality and Wear of Bulk-fill Materials for Class-II Restorations in Primary Molars.

PURPOSE: The aim of this in-vitro study was to evaluate the marginal integrity and wear of eight bulk-fill materials in comparison to a compomer in Class-II cavities in primary molars after thermomechanical loading (TML). MATERIALS AND METHODS: Prepared Class-II cavities in 72 extracted primary molars were filled with eight bulk-fill materials. A compomer served as the control group. After water storage (incubator, 28 days, 37°C), samples were subjected to TML (2500 thermal cycles 5°C/55°C; 100,000 load cycles, 50 N, 1.67 Hz). Before and after TML, replicas were made which were used for both SEM analysis of marginal integrity and 3-D wear analysis. Statistical analysis was performed using Kruskal-Wallis and Wilcoxon tests (p < 0.05). RESULTS: A significant reduction in perfect margins was observed for all groups, while marginal gap formation increased (Wilcoxon test, p < 0.02) for all groups but the compomer. Significant interindividual differences were observed between the tested materials regarding marginal integrity (Kruskal-Wallis test, p < 0.05). Wear analysis revealed no significant differences between groups (Kruskal-Wallis test, p > 0.05). CONCLUSION: Some of the bulk-fill materials investigated here achieved better results than the compomer and should be further evaluated clinically.

The assessment of internal adaptation and fracture resistance of glass ionomer and resin-based restorative materials applied after different caries removal techniques in primary teeth: an in-vitro study.

Background: The aim of this study was to evaluate the 3-dimensional (3D) internal adaptation (IA) and fracture resistance (FR) of compomer and glass ionomers applied after conventional caries removal to sound dentin (CCRSD) and selective caries removal to firm dentin (SCRFD) in in-vitro. Methods: Thirty extracted primary molars were randomly assigned to three main groups (n = 10) as glass hybrid restorative (GHR) (Equia Forte® HT), conventional glass ionomer (CGIR) (Voco Ionofil Molar) and compomer (Dyract XP). Each group was randomly divided into two subgroups according to caries removal technique as CCRSD (n = 5) and SCRFD (n = 5). The restoration procedures were completed after caries removal (CCRSD or SCRFD) in all samples. Then, specimens were subjected to IA and FR tests. Data were analyzed with Student's t, one-way ANOVA, and Kruskal Wallis-H tests. The correlation between IA and FR results was analyzed with a Pearson test. The statistical significance level was considered as 5%. Results: While CCRSD showed superior IA results than SCRFD for all restorative materials (p < 0.05), no statistical difference was found between CCRSD and SCRFD in FR assessment (p > 0.05). In CCRSD, compomer showed superior results for IA and FR than glass ionomers (p < 0.05). In SCRFD, it was found no significant difference between the restoratives for IA (p > 0.05). However, compomer showed superior FR results than glass ionomers (p < 0.05). There was moderate negative correlation between internal voids and FR without statistically significant difference (r = -0.333, p = 0.072). Conclusions: Despite the advantages of SCRFD, it was found to be less superior than CCRSD in IA assessment. Therefore, when SCRFD is preferred, a peripheral seal should be provided for ideal restorative treatment. On the other hand, compomer mostly showed superior results compared to others.

Comparison between a glass ionomer cement and a compomer concerning bonded acrylic expander retention and white spot formation : A randomized clinical trial.

BACKGROUND: The goal of the present study was to compare a compomer and a glass ionomer cement (GIC) used for full the cementation of acrylic splint-type maxillary expanders with respect to failure rate and white spot lesions (WSLs) in vivo. METHODS: A total of 120 patients with posterior crossbite and transverse maxillary deficiency were included to the study. The patients were randomly allocated to two groups: GIC group (n = 60) and compomer group (n = 60). The hyrax screw in both groups was activated two times a day for the first week then once a day until the desired amount of expansion was achieved. The rapid maxillary expansion (RME) appliance was left in the mouth for an extra month after the active expansion phase as a retention appliance. Then cementation failures were recorded. In addition, the patients were evaluated for white spot lesions (WSLs) before cementation and after removal of the appliance. RESULTS: A total of 12 (20%) and 2 (3.3%) RME devices failed in the GIC and the compomer group, respectively. This difference between groups was statistically significant (p = 0.044). There were also statistically significant differences between the GIC and compomer groups in terms of WSLs on the central (p = 0.06) and lateral (p = 0.011) incisors, and on the first molar (0.028). However, no differences were observed for the canines (p = 0.185), first (p = 0.457) and second premolars (p = 0.116). In total, there was a statistically significant difference between the GIC and compomer groups (p = 0.048), with more WSLs in the GIC group. CONCLUSIONS: Among the products used in the study, the compomer should be preferred over the GIC for cementation of acrylic splint-type rapid maxillary expanders in terms of failure rate and WSLs.

Effect of topical fluoride applications on residual monomer release from resin-based restorative materials.

BACKGROUND: The effects of topical fluoride applications on the release of monomer ingredients from resin-based dental materials by immersion in various extraction solutions are unclear. The aim of this study was to determine the effect of topical fluorides (APF and NaF) on the elution of residual monomers (Bis-GMA, TEGDMA, UDMA, and HEMA) from resin-based materials. METHODS: Ninety specimens were prepared, 30 bulk-fill composite resin, 30 nanohybrid universal composite resin, and 30 polyacid-modified composite resin (compomer). These were randomly divided into three groups based on fluoride application procedures. Each specimen was kept in 75% ethanol solution, and residual monomers released from materials were analyzed using high-performance liquid chromatography (HPLC) after 10 min, 1 h, 24 h, and 30 days. The groups were compared using the Mann Whitney U and Kruskal Wallis tests. Measurements were analyzed using the Friedman and Wilcoxon signed-rank tests. RESULTS: Fluoride applications generally had no considerable effect on the amount of residual monomer released from resin-based restorative materials. The amount of monomer release after topical APF application was similar to the release in the control group and was lower than the release in the NaF group. The release of monomers from the resin-based material used in the study did not approach toxic levels at the applied time intervals. The compomer released lower amounts of monomer than other resin-based materials. CONCLUSIONS: Fluoride applications do not increase monomer release from resin-based restorative materials. However, compomers should be employed by clinicians due to their lower monomer release compared to other resin restorative materials. The release of monomers from all the resin-based materials did not approach toxic levels at the applied time intervals.

Materiais restauradores em odontopediatria: preferência de pais e crianças e análise bibliométrica-altimétrica / Restorative materials in pediatric dentistry: children's and adults' preference and bibliometric-altmetric analysis

Atualmente, diversos materiais restauradores encontram-se disponíveis para aplicabilidade em Odontopediatria. Os avanços dos materiais restauradores conduzem à necessidade de novos estudos nessa temática. O presente estudo apresenta duas propostas de investigação: 1) Estudo transversal com objetivo de avaliar a preferência de pais/responsáveis e crianças quanto ao emprego do compômero colorido (Twinky Star®, Voco, Alemanha); 2) Estudo bibliométrico altimétrico com objetivo de analisar 50 artigos mais citados referente aos materiais restauradores utilizados em Odontopediatria e o alcance dessa informação científica nas mídias on-line. O estudo transversal envolveu 260 pares de pais/responsáveis e crianças de 5 a 11 anos de idade de dois serviços de saúde da região metropolitana de Belo Horizonte-MG. Exame quanto à cárie dentária foi realizado por examinadora calibrada para o critério da Organização Mundial da Saúde. Um manequim odontológico contendo restaurações com compômeros coloridos e materiais convencionais (resina composta, ionômero de vidro e amálgama) foi apresentado aos participantes do estudo e realizou-se inquérito sobre a preferência dos materiais dentários. O Questionário de Estilo e Dimensões dos Pais (PSDQ) e o Eysenck Personality Questionnaire Junior (EPQ-J) foram aplicados, este último apenas para pais/responsáveis de crianças de 5 e 6 anos de idade. Análises descritivas, bivariadas e regressão multivariada de Poisson foram realizadas. A maioria dos pais/responsáveis (74,2%) preferiu materiais convencionais. A idade da criança (p=0,006), a renda familiar (p= 0,001) e o nível de escolaridade (p< 0,001) associaram se a essa escolha. A análise multivariada demonstrou que crianças menores de 7 anos apresentaram 1,20 vezes maior probabilidade de escolher compômeros coloridos do que seus pares mais velhos (p< 0,001), assim como pais/responsáveis com menos de 11 anos de escolaridade e cujos filhos eram menores de 7 anos apresentaram 2,17 e 1,74 maior probabilidade para escolher compômeros coloridos, respectivamente. Concluiu-se que responsáveis com maior escolaridade apresentaram maior resistência às restaurações coloridas e crianças menores de 7 anos aceitaram melhor este material. O estudo bibliométrico-altimétrico adotou estratégia de busca em três bases (Web of Science, Scopus e Google Scholar), independente da data de publicação. Após seleção dos artigos por um grupo de cinco pesquisadores, em março de 2023, foram incluídos estudos que avaliassem qualquer material restaurador empregado em dentes decíduos e analisados dados referentes ao título, número de citações, país/continente, autoria, periódico, instituição, desenho do estudo, tipo de material restaurador, e escore altimétrico. Os artigos, publicados entre 1991 a 2002, apresentaram variação de citações de 19 a 113. Os autores com maior número de citações foram Qvist V e Teglers PT. O estudo experimental foi o principal delineamento de estudo observado e o cimento de ionomero de vidro foi o material mais reportado. A Europa foi o continente, e o Brasil, o país com maior número de citações. O escore altimétrico esteve presente em 23 artigos, com ênfase para dois artigos (43/6º e 73/7º). Concluiu-se que o cimento de ionômero de vidro foi o material mais estudado. Ficou evidente o distanciamento entre a posição dos trabalhos nas análises bibliométrica e altimétrica, apontando necessidade de disseminação da informação além dos círculos acadêmicos.

Currently, an arsenal of restorative materials is available for applicability in pediatric dentistry. The advances in restorative materials conducted to need for further studies in this thematic. The present study presents two investigation proposals: 1) Cross-sectional study aiming to evaluate the preference of parents and children regarding the use of colored compomer (Twinky Star®, Voco, Germany); 2) Bibliometric-altmetric study aiming to analyze the 50-most cited papers regarding to restorative materials used in pediatric dentistry and the dissemination of scientific information in online media. The cross-sectional study included 260 pairs of caregivers/children aged 5 to 11, in two public health services, in the metropolitan region of Belo Horizonte-MG. Examination for dental caries was performed by an examiner calibrated to the criteria of the World Health Organization. A dental mannequin containing colored compomers restorations and conventional materials (composite resin, glass ionomer cement and dental amalgam) was presented to the population and a survey was conducted about the preference of dental materials. Parents' Style and Dimensions Questionnaire (PSDQ) and Eysenck Personality Questionnaire Junior (EPQ-J) were applied, the last one only for parents/caregivers of children aged 5 to 6. Descriptive, bivariate and Poisson regression analyzes were performed. Most adults (74.2%) preferred conventional materials. Family income (p= 0.001) and education level (p< 0.001) were associated with its choice. Age up to 7 (p< 0.001) associated with children's choice for colored restorations (72.3%). Children younger than 7 had 1.20 higher probability to choose colored compomers than their older pairs, while adults with children younger than 7 and less than 11 years of schooling had 1.74 and 2.17 higher probability to choose colored compomers, respectively. It was concluded that caregivers with higher educational level showed greater resistance to use of colored restorations and children younger than 7 had better acceptance of colored material. The bibliometrics-altmetrics study adopted a search strategy in three databases (Web of Science, Scopus and Google Scholar), independent of the year of publication. After selection of papers by a panel of five researchers, in March 2023, any restorative material used in deciduous teeth was included and data about the title, number of citations, country/continent, authorship, journal, design of the study, type of restorative material, university and altmetrics score were analyzed. The papers, published between 1991 and 2002, ranged from 19 to 113 citations. The authors with the highest number of citations were Qvist V and Teglers PT. The experimental study was the main study design observed. Analyzing the continent and country with the highest number of citations, Europe highlighted and Brazil was predominant. The altmetric score was present in 23 papers, emphasizing two articles (43/6th and 73/7th). It was concluded that glass ionomer cement was the most studied material. A gap between the position of the papers correlating the bibliometrics and altmetrics analyzes was evident, demonstrating the need to disseminate the information beyond academic circles.

Evaluation of residual monomer release after polymerization of different restorative materials used in pediatric dentistry.

BACKGROUND: The choice of the restorative resin material to be used in pediatric dentistry is of a great importance due to the cytotoxic effects caused by residual monomers. In this study, it was aimed to investigate the amount of residual monomer released over time from different resin-based restorative materials, which are widely used in pediatric dentistry, by using high performance liquid chromatography with photodiode array detector (HPLC-PDA). METHODS: The compomers in all colors (Twinky Star and Glasiositte A2), two composites with different hybrid properties (Arabesk-GrandioSO), and RMGIC (Ionolux) samples with 2 × 5 mm diameters were prepared. The samples were polymerized with an LED light unit (CELALUX 2, VOCO, Cuxhaven, Germany) and then finishing-polishing procedures were applied. A total of 156 samples were obtained, 13 samples in each of the 12 groups. The amount of residual monomer (BIS-GMA; HEMA, TEGDMA, UDMA) (µg/mL) released into the 75% ethanol solution was determined at different times, (1st hour, 1st, 7th, 14th, and 21st day) by using HPLC-PDA. RESULTS: The residual monomer release continued on day 21 and BIS-GMA was the most released monomer in all groups. HEMA release showed a maximum increase in all the materials at day 7. The highest amount of residual monomer was detected in the gold-colored compomer. HEMA and BIS-GMA release from RMGIC was less than others in all time frames. CONCLUSIONS: The color and composition of resin-based restorative materials affect the amount of residual monomer. Pediatric dentists should prefer gold-colored compomers less than others as a restorative material, especially in deep cavities. More studies are needed about the subject.

Clinical efficacy of resin-based direct posterior restorations and glass-ionomer restorations - An updated meta-analysis of clinical outcome parameters.

OBJECTIVE: The present review is an update of a systematic review that has been published in 2012. Meanwhile, many new clinical trials on resin composites had been published. New materials such as bulk fill resin composites and new glass-ionomer (GIC) based materials had been introduced. The focus of this review was to evaluate the longevity in relation to the material class and adhesive class, while adjusting for a possible study bias effect. MATERIAL AND METHODS: The database PUBMED/SCOPUS were searched for clinical trials on posterior resin composites. The inclusion criteria were: (1) studies published between 2000 and 2019, (2) prospective clinical trial with at least 2 years of observation; (2) minimal number of restorations at last recall = 20; (3) report on drop-out rate; (4) report of operative technique and used materials; (5) utilisation of Ryge, modified Ryge or FDI evaluation criteria. The bias of each study was assessed by two independent reviewers using Cochrane Collaboration's tool for assessing risk of bias in randomised trials. For the statistical analysis, linear mixed models fitted on the individual data recorded along time have been used with random effects to account for study, patients and experiment effects. P-values smaller than 0.05 were considered significant. RESULTS: Of the 423 clinical trials, 62 studies (including 110 experiments) met the inclusion criteria. Material class was divided according to the composite filler in microhybrid (39 experiments/2807 restorations), nanohybrid (24 experiments/1254 restorations), and hybrid (22 experiments/1255 restorations). So-called bulk fill materials were treated as a separate category (9 experiments/506 restorations) as were the GIC (11 experiments/2121 restorations) and the compomer materials (5 experiments/238 restorations). Only one study (1.6%) had low risk of bias, 42 (67.7%) were assessed to have unclear risk of bias and 19 (30.6%) had a high risk of bias. In 52.3% of the studies Class II and Class I restorations had been placed. After 10 years, the survival rate for resin composite restorations dropped to about 85-90% with no significant difference between hybrid, microhybrid and nao-hybrid resin materials. The main reasons for restoration replacement were bulk fractures and wear, which accounted for a about 70% of replacements. Caries at the restorative margins accounted for about 20% of the replacements, and retention loss, inacceptable colour match or marginal integrity, endodontic treatment or cusp fracture for about 10% of the replacements of the resin composite restorations. For compomer and GIC restorations the mean overall survival rate was about 80% after 6 years. For GIC, the main reasons for failure were substantial loss of anatomical contour along with loss of proximal contacts and retention loss. Mainly fractures reduced the longevity of compomers restorations. Also, there was no statistically significant difference between hybrid, micro-hybrid, nano-hybrid and bulk fill resin composites with regard to colour match, surface texture, material fractures, and anatomical form. CONCLUSIONS: Posterior resin composite restorations that were placed with the enamel etch technique showed the best overall performance; the longevity was not significantly influenced by the filler type or viscosity of resin composite material. With regard to colour match, surface texture and anatomical form, nanohybrid resins were not significantly superior to hybrid or microhybrid resin composites. Compomer and GIC restorations demonstrated considerable shortcomings and had a significant shorter longevity.

Influence of fluoride-releasing materials in the inhibition of enamel and dentin demineralization around restorations / Influência de materiais liberadores de flúor na inibição da desmineralização do esmalte e da dentina ao redor de restaurações

Objective: The aim was to evaluate the influence of fluoride-releasing restorative materials in enamel and dentin microhardness. Material and Methods: 40 blocks (5x5x3 mm) from cervical third of human molars received a cavity preparation between the enamel and dentin, and the restorations were subjected to in vitro caries model. Specimens were randomly restored with (n=10): conventional glass ionomer cement (Ketac Cem, 3M ESPE); polyacid-modified composite resin (Ionoseal, VOCO); resin-modified glass ionomer cement (Ionofast, Biodinâmica); or microhybrid composite resin (Filtek Z250, 3M ESPE). The specimens were sectioned longitudinally and enamel and dentin Knoop microhardness were determined at different distances from the restorative material (100, 200 and 300 µm) and depth of surface (20, 40 and 60 µm). The data were submitted to three-way repeated measures ANOVA and Tukey ́s test ( α =0.05). Results: For enamel, the double interactions between material x distance and material x depth were statistically significant. In all depths and distances, the highest values of enamel microhardness were observed for Ketac Cem. In dentin, the materials differed statistically from each other, and Ionoseal obtained higher microhardness values than those found in Ionofast. Conclusion: Conventional glass ionomer cement is more effective in preventing enamel demineralization around restoration followed by the polyacid-modified composite resin. In dentin, the polyacid-modified composite resin obtained better performance than resin-modified glass ionomer cement. (AU)

Objetivo: O objetivo foi avaliar a influência de materiais restauradores liberadores de flúor na microdureza do esmalte e da dentina. Material e Métodos: 40 blocos (5x5x3 mm) do terço cervical de molares humanos receberam preparo cavitário entre esmalte e dentina, e após a restauração foram submetidas a um modelo in vitro de cárie. As amostras foram restauradas aleatoriamente com (n=10): cimento de ionômero de vidro convencional (Ketac Cem, 3M ESPE); resina composta modificada por poliácidos (Ionoseal, VOCO); cimento de ionômero de vidro modificado por resina (Ionofast, Biodinâmica); ou resina composta microhíbrida (Filtek Z250, 3M ESPE). As amostras foram seccionadas longitudinalmente e a microdureza Knoop de esmalte e dentina foi determinada em diferentes distâncias do material restaurador (100, 200 e 300 µm) e profundidade de superfície (20, 40 e 60 µm). Os dados foram submetidos à ANOVA para medidas repetidas de três fatores e teste de Tukey (α =0,05). Resultados: Para o esmalte, as duplas interações entre material x distância e material x profundidade foram estatisticamente significativas. Em todas as profundidades e distâncias, os maiores valores de microdureza do esmalte foram observados para o Ketac Cem. Na dentina, Ionoseal obteve valores de microdureza superiores aos encontrados no Ionofast. Conclusão:O cimento de ionômero de vidro convencional é mais eficaz na prevenção da desmineralização do esmalte ao redor da restauração, seguido pela resina composta modificada por poliácidos. Na dentina, a resina composta modificada por poliácidos obteve melhor desempenho que o cimento de ionômero de vidro modificado por resina. (AU)

Tooth-coloured materials for class II restorations in primary molars: systematic review and meta-analysis.

PURPOSE: The aim of this systematic review was to compare the success rate of five tooth-coloured materials, namely Glass Ionomer (GI), Resin-Modified Glass Ionomer (RMGI), Composite Resin (CR), Polyacid-Modified Composite Resin or Compomer (CO) and High-Viscosity Glass Ionomer (HVGI) in primary molar Class II restorations. METHODS: Five databases were searched from inception to April 23, 2020 for randomized clinical trials comparing the failure rate of these materials. After duplicate study removal, data extraction and risk of bias assessment with the Cochrane tool, data synthesis was conducted, comparing all five tooth-coloured materials in pairs and computing the overall success rate for each one, respectively. RESULTS: A total of 5615 articles were obtained by electronic and hand literature search. After the application of the eligibility criteria, ten RCTs were included in this systematic review and six RCTs for meta-analysis. Their risk of bias was assessed to be high to moderate. Due to the small number of RCTs comparing the five restorative materials in pairs investigated in the same study, only three MAs were available for heterogeneity assessment. These were: (1) between CO-RMGI (RR 1.04 [0.59, 1.84]; p = 0.88; I2 = 1%), (2) CR-CO (RR 1.12 [0.41, 3.02]; p = 0.83; I2 = 57%), and (3) between CR-RMGI (RR 1.10 [0.74, 1.63]; p = 0.65; I2 = 0%). No statistically significant differences were found between the two materials in all three comparisons. CONCLUSION: CR, RMGI and CO presented no statistical differences. In comparison to other tooth-coloured materials, studies on GI were too few to allow recommendations about its use. More studies on HGVI are needed for evidence-based recommendations to be made. The evidence extracted from this meta-analysis was not strong enough (moderate), due to the small number of RCTs and the risk of bias ranging from high to moderate. More, well-designed RCTs comparing tooth-coloured materials for primary molar Class II restorations are necessary.

The effect of different liners on the bond strength of a compomer to primary teeth dentine: in vitro study.

OBJECTIVE: This in vitro investigation should identify the effect of protective liners on dentine bond strength of a polyacid modified resin composite to dentine of primary teeth. METHODS: Forty-two extracted caries-free primary molars were randomly assigned to seven groups (n = 6) and flattened. Six test groups were centrally covered with different protective liners/base materials: Kerr Life (KL), IRM zinc oxide eugenol cement (IRM), Ketac Bond (KB), Vitrebond (VB), Dycal (DY), and mineral trioxide aggregate (MTA). Specimens were bonded with Prime&Bond NT (PB) and restored with Dyract eXtra. The control group (C) did not receive liner pretreatment. After 24-h storage in Aqua dest. (37 °C), specimens were cut and regional microtensile bond strengths of the uncovered areas were tested. Fractography was conducted under a light microscope and further interface/surface analyses were performed under a SEM. Statistical appraisal was carried out using oneway ANOVA (mod. LSD test; p < 0.05). RESULTS: Independent of the distance to the applied liner, all groups exhibited inferior µ-TBS to dentine of primary teeth compared to the control group (p < 0.05). The results were as follows in MPa(SD) x:significance level/percentage of adhesive fractures: PB: 34 (10)A/72%; KL: 23 (25)B/64%; KB: 15 (12)C/76%; DY 15 (13)C/55%; IRM: 14 (10)C/68%; VB: 12 (10)C/61%; MTA 12 (10)C/69%. CONCLUSIONS: Protective liners significantly reduced µ-TBS to dentine of primary teeth.

The cytotoxic and oxidative effects of restorative materials in cultured human gingival fibroblasts.

The aim of this study was to evaluate the cytotoxic and oxidative effects of the most commonly used dental restorative materials on human gingival fibroblast cells (HGFCs). HGFCs were obtained from healthy individuals. The tested restorative materials were a microhybrid resin based composite, a compomer resin, a glass ionomer cement, and an amalgam alloy. One hundred eight cylindirical samples, 10 mm in diameter and 2 mm in height, were prepared according to ISO 10993-12:2002 specifications (n = 9 in the tested subgroups). Freshly prepared and aged samples in artificial saliva at 37 °C (7 and 21 d) were placed into well plates and incubated. Wells without dental materials were constituted as the control group. After 72 h incubation period, cytotoxicity was determined using the neutral red (NR) assay. Oxidative alterations were assessed using total antioxidant capacity (TAC) and total oxidant status (TOS) assay kits. Data were analyzed using the ANOVA and LSD post hoc tests. All tested materials led to significant decreases in the cell viability rates (33-73%) compared to the control group. Glass ionomer and resin composite were found to be more cytotoxic than amalgam alloy and compomer. The highest TAC level was observed in glass ionomer after seven-day aging and these changes prevented an increase in TOS levels. Increases in TAC levels after seven-day aging in all groups exhibited significant differences with freshly prepared samples (p < 0.05). In all material groups, TOS levels of freshly prepared samples differed statistically and significantly from samples aged for 7 and 21 d (p < 0.05). The data obtained suggested that all the tested materials exhibited cytotoxic and pro-oxidant features. Freshly prepared samples caused higher TOS levels. However, oxidant status induced by materials decreased over time.

Evaluation of Residual Monomer Release After Polymerization of Colored Compomer Materials

ABSTRACT Objective: To evaluate the amount of residual monomers released after polymerization by the compomers in different colors and viscosities over time. Material and Methods: The compomer samples of different colors and viscosities (flowable compomers; blue-pink and packable compomers; A2-blue-pink-gold) were prepared in molds with an inner diameter of 5 mm and a height of 2 mm. In polymerization of samples, a LED unit was used. The amount of monomers released from the samples kept in 75% ethanol/water solution was measured by a high-performance liquid chromatography (HPLC) instrument in the 10th minute, in the 1st hour, and in the 1st, 7th, and 14th days. For statistical analyses, the paired sample t-test, independent sample t-test, and one-way ANOVA with Tukey's post hoc test were used. Results: The amount of residual monomers released from all materials increased over time. At the end of the 14th day, the most released monomer from all compomer samples was BisGMA. The total amounts of released monomers from the packable compomers were Gold>A2>blue>pink. The amount of residual monomers released from flowable compomers was higher in blue than in pink. Conclusion: The color and the viscosity are the factors affecting the residual monomer release in compomers.