Manejo de defectos tipo recesiones múltiples luego de la terapia de ortodoncia: un caso reportado basado en la evidencia científica / The management of multiple recession like defects after orthodontic therapy: report of a case based on scientific evidence

Por qué en este caso hay nueva in- formación? - Este caso demostró métodos basado en la evidencia para el manejo de severas recesiones gingivales luego de la terapia or- todóntica. - La modificación del grosor gin- gival lleva a resultados estables a largo plazo estéticos y funcio- nales. - Este caso demostró beneficios clínicos usando injertos tomados desde el mismo sitio donador en diferentes momentos de tiempo. Cuales son las claves de éxito para manejar este caso? - Sólidos conocimientos de la anatomía periodontal - Identificación de las caracterís- ticas de RC relacionadas con las causas de la terapia ortodóntica. - ITCSE su toma del paladar. - Uso de colgajos sin tensión. - Incremento del grosor gingival para promover resultados a largo plazo. Cuales son las limitaciones prima- rias del éxito en este caso? - Necesidad de tomas de paladar en ambos lados - Anatomía de las RG y la fina en- cía que puede limitar la extensión del colgajo - Experiencia clínica (AU)

Report of an experience: self-study to foster self-regulated learning for International DentalDegree Program (IDDP) students in Canada / Relato de experiência: estudo autônomo para encorajar o aprendizado autorregulado dos estudantes do Programa de Graduação Internacional de Odontologia (IDDP) no Canadá

This article aimed tobrieflyreport a self-study methodology experience performed in the International Dental Degree Program (IDDP) ina University in Canada. This approach fostered students` self-regulated learning.Due to Covid-19 pandemic theon-sitedentistry school classes were discontinued. Students from the IDDP were allowed to go to on-siteonly to perform pre-clinical activities (supervised by one faculty member at a time). As the 2020 class of the IDDP program was small (2 students), the director of the IDDP Program and faculty members considered that self-study would be an appropriate idea.We noticed that students were successful in self-regulating their learning. Some of the examples for that were: students used note-taking sheets, monitored their comprehension of class lecture material, asked questions etc.The experience with IDDP students showed that the self-study opportunity was a favorable learning environment for the teaching of pre-clinical disciplines (AU).

Este artigo objetivou descrever brevemente uma experiência com a metodologia de estudo autônomo realizada no Programa de Graduação Internacional de Odontologia (IDDP) em uma Universidade no Canadá. Esta abordagem encorajou o aprendizado autorregulado dos estudantes.Devido à pandemia COVID-19 as aulas "on-site" da faculdade de odontologia foram descontinuadas. Os estudantes do programa IDDP eram permitidos frequentar o prédio da faculdade somente para realizar as atividades pré-clínicas (e eram supervisionados por apenas um professor de cada vez). Como a turma de 2020 do programa IDDP era pequena (2 alunos), o diretor do programa e os professores consideraram que o estudo autônomo seria uma ideia apropriada. Percebeu-se que os estudantes tiveram sucesso em autorregular o aprendizado. Como por exemplo: usaram suas anotações, monitoraram a compreensão do material teórico disponibilizado, fizeram perguntas etc.A experiência com os estudantes do programa IDDP mostrouque a oportunidade de estudo autônomo se caracterizou como um ambiente favorável para os professores usarem nas disciplinas pré-clínicas (AU).

Injerto pediculado palatino en regeneración ósea guiada / Palatal pedicle graft in bone guided regeneration

La regeneración localizada de grandes defectos horizontales en los procesos alveolares, previa a la inserción de implantes dentales, sigue siendo un procedimiento quirúrgico desafiante en cirugía bucal. Entre los procedimientos quirúrgicos más utilizados para tal propósito se encuentran la corticotomía con expansión, injerto en bloque "onlay" y la regeneración ósea guiada (ROG), todos ellos con sus diferentes grados de predictibilidad. El uso de micromalla de titanio en combinación con injertos y sustitutos óseos es un método eficiente para la contención, estabilización y protección de estos injertos, permitiendo así una mejor regeneración de los tejidos. Esta técnica no queda exenta de posibles complicaciones asociadas como pueden ser la infección, necrosis del injerto o exposición de la malla de titanio. En el presente artículo se pretende mostrar la evidencia clínica de la efectividad del uso del colgajo pediculado de rotación palatina como método válido para evitar la exposición de la malla de titanio durante la regeneración ósea guiada

Localized regeneration of large horizontal defects in alveolar processes prior to the insertion of dental implants remains a challenging surgical procedure in oral surgery. Among the most widely used surgical procedures for this purpose are expansion corticotomy, onlay block graft and guided bone regeneration all of them with their different degrees of predictability. The use of titanium micromesh in combination with bone grafts and bone substitutes is an efficient method for the containtment, stabilization and protection of these grafts, thus allowing better tissue regeneration. This technique is not exempt from associated complications such as infection, graft necrosis or exposure of the titanium micromesh.This article aims to show the clinical evidence of the effectiveness of using the palatal rotated pedicle graft as an effective method to avoid exposing the micromesh during guide bone regeneration procedure

Cone beam computed tomography (CBCT) in periodontal diseases: a Systematic review based on the efficacy model.

BACKGROUND: Periodontal diseases are prevalent among adult populations. Its diagnosis depends mainly on clinical findings supported by radiographic examinations. In previous decades, cone beam computed tomography has been introduced to the dental field. The aim of this study was to address the diagnostic efficacy of cone-beam computed tomographic (CBCT) imaging in periodontics based on a systematic search and analysis of the literature using the hierarchical efficacy model. METHODS: A systematic search of electronic databases such as PubMed, Scopus, Web of Science, and Cochrane was conducted in February 2019 to identify studies addressing the efficacy of CBCT imaging in Periodontics. The identified studies were subjected to pre-identified inclusion criteria followed by an analysis using a hierarchical model of efficacy (model) designed for an appraisal of the literature on diagnostic imaging modality. Four examiners performed the eligibility and quality assessment of relevant studies and consensus was reached in cases where disagreement occurred. RESULTS: The search resulted in 64 studies. Of these, 34 publications were allocated to the relevant level of efficacy and quality assessments wherever applicable. The overall diagnostic accuracy of the included studies showed a low or moderate risk of bias and applicability concerns in the use of CBCT. In addition, CBCT is accurate in identifying periodontal defects when compared to other modalities. The studies on the level of patient outcomes agreed that CBCT is a reliable tool for the assessment of outcomes after the treatment of periodontal defects. CONCLUSION: CBCT was found to be beneficial and accurate in cases of infra-bony defects and furcation involvements.

Demineralization preventive practices among Nigerian orthodontists-An evidence-based approach?

BACKGROUND: The prevalence of white spot lesions/tooth demineralization during orthodontic fixed appliance therapy ranges widely from 2 to 96% of patients. The purpose of this study was to evaluate measures used by orthodontists practicing in Nigeria to manage demineralization during and after fixed orthodontic treatment and how it compares with the available evidence-based information. METHOD: Study group comprised of 60 practitioners (21 orthodontists and 39 orthodontic residents) in Nigeria. Self-administered questionnaires were used to obtain information on the measures they use to prevent the occurrence of demineralization at the onset and during orthodontic treatment, as well as the management of its occurrence at treatment completion. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 17.0. Descriptive statistics were used. Level of significance was set at P < 0.05. RESULTS: Responses obtained showed that 96.7% of orthodontic practitioners routinely advised their patients on tooth cleaning methods; the use of manual orthodontic toothbrush (78.3%) and dental floss (51.7%) being popularly recommended methods. However, 51.7% used a specific demineralization preventive protocol at the start of treatment. Oral hygiene instruction was observed to be the most commonly adopted protocol (51.7%), followed by fluoride rinses (41.7%) (considered relatively ineffective). Extraoral hygiene instruction was the most common treatment protocol used when tooth demineralization occurred during and after treatment (56.7% and 73.3% respectively). Approximately 92% of the orthodontists agreed on the need for the development of a basic protocol to prevent demineralization. CONCLUSION: The demineralization preventive measures used by Nigerian orthodontists and orthodontic residents are inconsistent and not based on evidence-based information. The development of standardized demineralization prevention protocol was therefore recommended.

¿Estamos preparados para ejercer una Endodoncia basada en la evidencia? / No disponible

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How do dental faculty members relate to Evidence-Based Dentistry?

Building the rationale to critically appraise scientific evidence on the best approach for each patient requires incorporating the Evidence-Based Dentistry (EBD) model, preferably into undergraduate dental courses. This approach would favor the diffusion of EBD culture amongst dental professionals. Therefore, this study aimed to characterize the relationship of dental faculty members with the EBD model. The study was conducted in 2018 with all 23 dental faculty members (100% response rate) of a community university. They responded the Evidence-Based Practice Questionnaire (EBPQ) and a set of supporting questions involving sociodemographics, search for information, proficiency of foreign languages, and perceived need for knowledge on issues related to EBD. The data were analyzed by descriptive statistics. A total of 73.9% of faculty members claimed having been prepared to search for scientific evidence and 69.5% are aware of connected computer systems for research. Scientific journals, the internet, courses, and colleague opinions were the main sources of information. Reading and comprehension of foreign languages was limited to 30%. The practice and attitudes towards EBD by dental faculty members were positive, with the lowest mean value of 4.85. Knowledge and skills related to EBD had lower mean values, which coincided with a relatively high perceived need for knowledge on EBD. Dental faculty members present a positive attitude towards the EBD model, have been trained to search for scientific information and acknowledge the existence of institutional structure for applying and teaching EBD. On the other hand, knowledge and skills associated with EBD may require improvement (AU).

A construção do raciocínio para avaliar criticamente a evidência científica sobre a melhor abordagem para cada paciente requer a incorporação do modelo de Odontologia Baseada em Evidências (OBE), preferencialmente ainda no ensino de graduação. Essa abordagem favorece a difusão da cultura da OBE entre os profissionais de Odontologia. Assim, este estudo teve como objetivo caracterizar a relação de docentes de um curso de Odontologia com o modelo OBE. O estudo foi conduzido em 2018 com todos os 23 professores de uma universidade comunitária. Eles responderam o EvidenceBased Practice Questionnaire (EBPQ) e algumas perguntas complementares envolvendo fatores sociodemográficos, busca por informação, proficiência em idioma estrangeiro e necessidade percebida de conhecimento sobre aspectos relacionados à OBE. Os dados foram analisados descritivamente. Aproximadamente 74% dos professores afirmaram ter sido preparados para pesquisar por evidência científica e 69,5% reconheceram a existência de computador conectado para essa finalidade. Periódicos, internet, cursos e opinião de colegas foram as principais fontes de informação. Leitura e compreensão de idiomas estrangeiros foram limitadas a 30%. A prática e as atitudes voltadas à OBE pelos professores foram positivas, com um valor mínimo de 4,85. O conhecimento e as habilidades relacionadas à OBE tiveram valores mais baixos, que coincidiram com alta necessidade percebida de informação sobre OBE. Os professores apresentaram uma atitude positiva com relação ao modelo da OBE, foram treinados para buscar informação científica e reconhecem a estrutura institucional para fazê-lo e ensiná-lo. Por outro lado, o conhecimento e as habilidades relacionadas à OBE requerem melhorias (AU).

Evidence-based care pathways for management of early childhood caries.

The purpose of this article is to provide general dentists with simple care pathways for evidence-based early childhood caries chronic disease management (ECC-CDM). Early childhood caries, defined as the presence of dental caries in children younger than 6 years old, is a chronic disease that has been traditionally managed with conventional restorative care. There are limits to the long-term success of restorative care alone, and the care pathways in the ECC-CDM model include additional treatment modalities such as fluoride varnish, silver diamine fluoride, interim therapeutic restorations, and sealants. The ECC-CDM model also pairs customized, patient-specific strategies to these treatment options. These strategies include the use of active surveillance, counseling on prevention, recall strategies to prevent disease relapse, and the option to defer restorative care. General dentists can use the care pathways in the ECC-CDM model to manage caries progression in a way that best addresses the individual needs of children.

Identification and description of controlled clinical trials in Spanish language dental journals.

BACKGROUND: To identify controlled clinical trials (CCTs) published in Spanish and in Latin American dental journals, and provide access to this body of evidence in a single source. METHODS: Handsearching, following Cochrane Collaboration guidelines, of CCTs published in Spanish dental journals from Spain and Latin America. For each eligible trial, we collected the dental specialty, the interventions evaluated, whether and how randomisation was achieved, and the corresponding bibliographic reference. RESULTS: We handsearched 107 journals published in Spain and Latin America in Spanish. Over 17 051 articles, 244 (1.43%) were CCTs. These studies focused mainly on periodontics (70, 29.0%) and oral and maxillofacial surgery (66, 27.0%), assessing mostly pharmacological interventions (112, 46.0%). One hundred fifty-three studies (62.7%) used a random allocation of participants to study arms. CONCLUSIONS: A significant number of dental journals published in Spain and Latin America in Spanish language present original research relevant to inform clinical practice. These journals are not indexed in the major electronic databases. PRACTICAL IMPLICATIONS: References to the identified CCTs are now available in CENTRAL, the Cochrane Collaboration repository for these studies. We call for adherence to the CONSORT statement in dentistry to improve reporting of CCTs in journals published in Spanish language.

Effect of orthodontic treatment on periodontal clinical attachment: a systematic review and meta-analysis.

Background: Insertion of orthodontic fixed appliances has been known to induce a mostly transient qualitative and quantitative alteration of the intraoral microbiota. However, the extent to which treatment with fixed appliances might have a lasting adverse effect on the periodontal attachment of the teeth has not yet been investigated in an evidence-based manner. Objectives: Aim of this systematic review was to assess the effect of comprehensive treatment with fixed orthodontic appliances on clinical attachment levels of adolescent and adult periodontally healthy patients. Search methods: Seven databases were searched from inception to February 2017. Selection criteria: Prospective non-randomized longitudinal clinical studies. Data collection and analysis: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, Paule-Mandel random-effects meta-analyses of the clinical attachment loss and its 95 per cent confidence intervals (CIs) were calculated. Results: A total of 9 trials were identified that included 335 treated patients (at least 34 per cent male / 66 per cent female) with an average age of 22.6 years. The average pooled clinical attachment loss was 0.11 mm (9 studies; 335 patients; 95 per cent CI = 0.12 mm gain to 0.34 mm loss; P = 0.338) with high heterogeneity. Furthermore, one study hinted that a small amount of clinical attachment might be gained by intrusion of upper incisors. Additional analyses indicated that the results were robust to addition of untreated patient groups, while patient age and timing of outcome measurement might play an important role. Conclusions: According to existing evidence from longitudinal clinical studies orthodontic treatment with fixed appliances has little to no clinically relevant effect on periodontal clinical attachment levels. Registration: PROSPERO (CRD42017057042). Funding: None.

Speech and orthodontic appliances: a systematic literature review.

Background: Various types of orthodontic appliances can lead to speech difficulties. However, speech difficulties caused by orthodontic appliances have not been sufficiently investigated by an evidence-based method. Objectives: The aim of this study is to outline the scientific evidence and mechanism of the speech difficulties caused by orthodontic appliances. Search methods and selection criteria: Randomized-controlled clinical trials (RCT), controlled clinical trials, and cohort studies focusing on the effect of orthodontic appliances on speech were included. A systematic search was conducted by an electronic search in PubMed, EMBASE, and the Cochrane Library databases, complemented by a manual search. Data collection and analysis: The types of orthodontic appliances, the affected sounds, and duration period of the speech disturbances were extracted. The ROBINS-I tool was applied to evaluate the quality of non-randomized studies, and the bias of RCT was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions. No meta-analyses could be performed due to the heterogeneity in the study designs and treatment modalities. Results: Among 448 screened articles, 13 studies were included (n = 297 patients). Different types of orthodontic appliances such as fixed appliances, orthodontic retainers and palatal expanders could influence the clarity of speech. The /i/, /a/, and /e/ vowels as well as /s/, /z/, /l/, /t/, /d/, /r/, and /ʃ/ consonants could be distorted by appliances. Although most speech impairments could return to normal within weeks, speech distortion of the /s/ sound might last for more than 3 months. The low evidence level grading and heterogeneity were the two main limitations in this systematic review. Conclusions: Lingual fixed appliances, palatal expanders, and Hawley retainers have an evident influence on speech production. The /i/, /s/, /t/, and /d/ sounds are the primarily affected ones. The results of this systematic review should be interpreted with caution and more high-quality RCTs with larger sample sizes and longer follow-up periods are needed. Registration: The protocol for this systematic review (CRD42017056573) was registered in the International Prospective Register of Systematic Reviews (PROSPERO).

Evidence-based practice and the evidence pyramid: A 21st century orthodontic odyssey.

Organized evidence-based practice is said to have started in the medical field in the late 20th century. Its principles and usage eventually spread to other health sciences, including orthodontics. Although the conceptual foundations and basic tenets of evidence-based orthodontics are based on the classical approach of testing medical interventions, differences unravel as we encounter the ground realities in orthodontics, which are unique due to the length, complexity, and diversity involved in orthodontic treatment and research. How has this led to the evolution of evidence-based orthodontics and changes in its applications? Is it being translated to better clinical answers, treatment strategies, patient satisfaction, and information for orthodontists? What more needs to be done, considering the rapidly changing orthodontic scenario? This article aims to explore these questions to evaluate how evidence-based orthodontics has played itself out so far, so that it can continue to grow strong and stand up to the challenges of 21st century orthodontics.

www crownorfill com, un sitio que proporciona acceso instantáneo a la información basada en evidencia sobre restauraciones dentales posteriores: [Carta al Editor] / www.crownorfill. com Is the online tool that provides instant accessto evidence-based literature on dental restorations:[Letter to the Editor]

Crown-or-Fill© es una aplicación en un sitio web que resume la literaturabasada en la evidencia sobre los resultados del tratamiento para restauraciones en dientes posteriores en función de condiciones preexistentes. Los datos presentados se recogieron en dos revisionessistemáticas publicadas.

Crown-or-Fill© It is an application on a website that summarizes evidence based literature on treatment outcomes for restorations on posterior teeth as a function of pre-existing conditions. The data presented was collected in two published systematic reviews.

Molar incisor hypomineralisation.

Data sourcesThe Medline and Embase databases and hand searches in the journals International Journal of Paediatric Dentistry and European Archives of Paediatric Dentistry.Study selectionEnglish language cohort and case-control studies.Data extraction and synthesisStudy selection was carried out independently by two reviewers with data abstraction being conducted by a single reviewer and checked by a second reviewer. Risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale (NOS). Adjusted (aOR) and unadjusted odds ratios (uOR), P-values and 95% confidence intervals (CI) were obtained from the studies. Meta-analysis was not conducted.ResultsTwenty-eight studies were included; 25 reported on MIH, three on hypomineralised second primary molars (HSPM). Nineteen of the studies were of cohort design (six prospective,13 retrospective) and nine were case controls. There was little evidence of an association between the most frequently investigated prenatal factors (smoking, maternal illness, maternal medication, maternal stress) and MIH. Similarly there was little evidence of an association between MIH and perinatal factors such as prematurity, low birth weight, caesarean delivery and birth complications. Early childhood illness, up to three or four years of age, was widely investigated, with six studies reporting a crude association. Associations between antibiotics, anti-asthma medication and breastfeeding were also evaluated. Only three studies looked at HSPM; one study suggested that maternal antibiotic use during pregnancy is unlikely to be associated with HSPM but maternal alcohol intake may be. Another study reported possible associations with a large number of factors, with perinatal factors and neonatal illness being most common, followed by prenatal factors.ConclusionsPrenatal and perinatal factors are infrequently associated with MIH. However, despite a lack of prospective studies, early childhood illness (in particular fever) appears to be associated with MIH. Further prospective studies that adjust for confounding based on biological principles, as well as genetic and epigenetic studies, are needed because the aetiology is likely to be multifactorial.

Unclear if non-surgical adjuncts accelerate orthodontic treatment.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, LILACS, the metaRegister of Controlled Trials, the US National Institutes of Health Trials Register and the WHO International Clinical Trials Registry Platform.Study selectionRandomised controlled trials of orthodontic treatment using fixed appliances along with non-surgical adjunctive interventions to accelerate tooth movement.Data extraction and synthesisTwo reviewers independently selected studies, abstracted data and assessed risk of bias. Meta-analysis was not possible.ResultsTwo studies involving a total of 111 patients were included, both were at high risk of bias. The studies compared the use of Tooth Masseuse and OrthoAccel with conventional treatment mechanics. Using OrthoAccel with 30 Hz at 0.25 N for 20 minutes daily produced a higher rate of maxillary canine distalisation in comparison to the control group (MD 0.37 mm/month; 95% CI -0.07 to 0.81; P = 0.05). Whilst this difference suggested 50% faster tooth movement using the vibrational appliance, the absolute differences were marginal and deemed clinically unimportant. Similar levels of non-serious adverse effects were reported in the intervention and control groups with a risk ratio of 0.96 (95% CI 0.32 to 2.85). Overall, the quality of the evidence was very low and therefore we cannot rely on the findings.ConclusionsThere is very little clinical research concerning the effectiveness of non-surgical interventions to accelerate orthodontic treatment. The available evidence is of very low quality and so it is not possible to determine if there is a positive effect of non-surgical adjunctive interventions to accelerate tooth movement. Although there have been claims that there may be a positive effect of light vibrational forces, results of the current studies do not reach either statistical or clinical significance. Further well-designed and rigorous RCTs with longer follow-up periods are required to determine whether non-surgical interventions may result in a clinically important reduction in the duration of orthodontic treatment, without any adverse effects.

Preoperative analgesia for children and adolescents to reduce pain associated with dental treatment.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, LILACS, ISI Web of Science, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform.Study selectionRandomised controlled clinical trials of analgesics given before dental treatment versus placebo or no analgesics in children and adolescents up to 17 years of age. Children and adolescents having dental treatment under sedation (including nitrous oxide/oxygen) or general anaesthesia were excluded.Data extraction and synthesisTwo reviewers independently selected studies, abstracted data and assessed risk of bias. Standard Cochrane methodological approaches were used.ResultsFive trials involving 190 patients were included. None of the studies were at low risk of bias. Three trials involved dental treatment and two involved orthodontic treatment. Three of the included trials compared paracetamol with placebo. Meta-analysis of the two trials showed no evidence of a benefit in taking paracetamol preoperatively; (RR) for postoperative pain of 0.81 (95%CI; 0.53 to 1.22). Four trials compared ibuprofen with placebo. Pooled data from two studies showed a statistically significant mean difference in severity of postoperative pain of -13.44 (95%CI; -23.01 to -3.88) on a visual analogue scale (0 to 100), which indicated a probable benefit. Both trials were at high risk of bias and the quality of the evidence is low.ConclusionsFrom the available evidence, we cannot determine whether or not preoperative analgesics are of benefit in paediatric dentistry for procedures under local anaesthetic. There is probably a benefit in using preoperative analgesics prior to orthodontic separator placement. The quality of the evidence is low. Further randomised clinical trials should be completed with appropriate sample sizes and well defined outcome measures.

Reliability of CBCT diagnosing root fractures remains uncertain.

Data sourcesPubMed, Web of Science, Science Direct, Cochrane library, Embase, SCOPUS, CNKI and Wanfang databases were searched until April 2014 followed by hand searching of relevant references.Study selectionUsing no language restrictions two authors independently assessed for inclusion of in vivo and in vitro studies involving at least ten teeth on the use of CBCT for diagnosing complete root fractures on non-endodontically treated teeth.Data extraction and synthesisTwo authors independently assessed for inclusion and performed quality assessment using QUADAS-2 (quality assessment of studies of diagnostic accuracy-2). A random effects model was used to calculate pooled sensitivity, specificity and likelihood ratio (positive and negative). In addition, the correlation between voxel size and diagnostic accuracy was calculated.ResultsTwelve studies were included in the review. Seven used i-CAT with 372 teeth and four used 3D Accuitomo with 237 teeth (one study used both). For i-CAT pooled sensitivity was 0.83 (0.78 to 0.86), while specificity was 0.91(0.87 to 0.93). For 3D Accuitomo sensitivity was 0.95 (0.90 to 0.96) and the specificity 0.96 (0.92 to 0.99) Correlation between voxel size and diagnostic accuracy was analysed among five subgroups for i-CAT and two subgroups on the 3D Accuitomo group. No statistically significant difference was observed based on voxel size.ConclusionsAccording to the authors CBCT provides clinically relevant accuracy and reliability to detect root fractures in untreated teeth independently of the voxel size.

To cord or not to cord? That is still a question.

Data sourcesA broad computerised search with similar key terms was performed in different databases that included: Ovid Medline, Thomson's ISI Web of Science, PubMed, Science Direct, EMBASE and the Cochrane Library. Grey literature, dissertations, abstracts and theses were searched too. Reference lists of the selected articles were hand-searched.Study selectionThe inclusion criteria included in vivo randomised clinical trials and quasi-randomised clinical trials using gingival retraction techniques with and without cord. Studies were included if they examined the primary outcome from the review: efficiency of haemostasis control, the amount of gingival displacement and the influence of the techniques on gingival/periodontal health. Secondary outcomes accepted for the review included subjective factors reported by the patient such as pain, sensitivity, unpleasant taste and discomfort and operator's experience with both techniques. Non-English papers, clinical reports, animals studies or in vitro studies were excluded.Data extraction and synthesisTwo authors independently searched and screened the articles. Disagreements were resolved by discussion. A third reviewer participated in the eligibility of the studies. The risk of bias was assessed using the Cochrane Collaboration tool. Due to the heterogeneity of measurement variables across the studies and the differences among the studies, a meta-analysis was not performed. A narrative assessment was performed for the outcomes: moisture/bleeding control, gingival displacement, gingival/periodontal health and the subjective outcomes.ResultsFrom the initial search that retrieved 1,342 articles, 19 potential relevant full-text articles were considered for the review. Seven studies were selected for the systematic review. Four randomised clinical trials were included. Sample size ranged from eight to 252 participants per study. Five studies were conducted on patients requiring any indirect fixed restorations on prepared teeth. Two studies were done on unprepared teeth. In all studies, participants were in good health, had a healthy gingival condition and a sound periodontal status.ConclusionsBoth techniques are reliable in achieving gingival retraction. The review supports the observation that gingival retraction paste can more effectively help to achieve a dry field and at the same time be less injurious to soft tissues, however its ability to displace gingival tissues, compared to retraction cord, was compromising. Rather than considering the cost of material or the individual preference of the operator, choosing the right technique to maximise clinical efficiency should be based on scientific evidence. It seems that impregnated gingival cords are more effective on thick gingival tissue whereas paste is more effective when minimal retraction is required for haemostasis control, preservation of the gingiva and less tissue displacement.

School-based dental sealant programmes may be effective in caries prevention.

DesignSplit-mouth randomised controlled clinical trial.InterventionSchool-based dental sealant (SBDS) programme. The study population that was selected from 67-year-old pupils of 16 elementary schools in areas of low socioeconomic status within Nice, France. Children with first permanent molar pairs sufficiently erupted for sealing with no caries (ICDAS [International Caries Detection and Assessment System] 0) or initial enamel lesions (ICDAS 1-2) were included. Children were randomised to either the intervention group (light polymerised resin-based sealant with fluoride) or the control group (no treatment).Outcome measureThe primary outcome measure was caries with sealant retention as a secondary outcome.ResultsFour hundred and fifty-seven pairs of permanent first molars belonging to 276 school children were randomised. At three years 378 pairs in 228 children were available for analysis. The overall retention rate was 32.3%. Sealed molars had 67% less risk of new carious lesions, adjusted hazard ratio = 0.33(95%CI; 0.24-0.46).ConclusionsSBDS programmes can be effective in preventing the development of carious lesions in school children, particularly those who come from low socioeconomic backgrounds and may, as a result, be unable to receive adequate oral healthcare in other settings outside the school. ICR should determine the selection of at-risk sub-groups for which the intervention could be considered.

Regular supervised fluoride mouthrinse use by children and adolescents associated with caries reduction.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, LILACS, BBO, Proquest Dissertations and Theses, Web of Science Conference Proceedings, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform.Study selectionRandomised or quasi-randomised controlled trials where blind outcome assessment was stated or indicated, comparing fluoride mouthrinse with placebo or no treatment in children up to 16 years of age with a duration of at least 12 months.Data extraction and synthesisA least two reviewers independently selected studies, abstracted data and assessed risk of bias.ResultsThirty-seven trials involving 15,813 children and adolescents were included. Supervised rinsing in schools was tested in all trials. Twenty-eight studies were at high risk of bias, nine at unclear risk. Thirty-five trials (15,305 participants) contributed data on permanent tooth surface for meta-analysis and found a prevented fraction for D(M)FS = 27%(95%CI 23% to 30%; I2 = 42%) (moderate quality evidence). Meta-regression showed no significant association between estimates of D(M)FS with baseline caries severity, background exposure to fluorides, rinsing frequency or fluoride concentration. The pooled estimate of prevented fraction from 13 studies for D(M)FT = 23% (95%CI, 18% to 29%; I2 = 54%).There was limited information on possible adverse effects or acceptability of the treatment regimen in the included trials.ConclusionsThis review found that supervised regular use of fluoride mouthrinse by children and adolescents is associated with a large reduction in caries increment in permanent teeth. We are moderately certain of the size of the effect. Most of the evidence evaluated use of fluoride mouthrinse supervised in a school setting, but the findings may be applicable to children in other settings with supervised or unsupervised rinsing, although the size of the caries-preventive effect is less clear. Any future research on fluoride mouthrinses should focus on head-to-head comparisons between different fluoride rinse features or fluoride rinses against other preventive strategies, and should evaluate adverse effects and acceptability.