Cavities In Permanent Teeth Research Articles

The clinical performance of high-viscosity glass ionomer-based and bulk-fill resin-based restorations in permanent teeth with occlusal or proximal cavities: a systematic review and meta-analysis.

To summarize and analyze existing evidence regarding the clinical performance of high-viscosity glass-ionomer-based materials (HVGIs) and bulk-fill resin-based composites (BFs) in patients with occlusal or proximal cavities in permanent teeth. A literature search was conducted using PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Scopus, and Web of Science (WOS) (last update: April 19th, 2024). Randomized control trials (RCTs), retrospective and prospective comparative cohorts were included. Manual searching was performed for twelve relevant dental journals. The primary outcome was the retention of the restoration. The evaluation of included studies, data extraction, and study selection were completed by two independent reviewers. The Cochrane risk-of-bias tool (RoB 2) and the Newcastle-Ottawa scale were used to assess the quality of included studies. A quantitative meta-analysis was conducted, and the overall quality of the evidence was evaluated. Five RCTs and one retrospective study were included, of which one had a high risk of bias and the others had an unclear risk of bias. In meta-analyses, HVGIs were associated with a less favorable outcome on retention both at one (p = 0.013) and two-year follow-ups (p < 0.0001) compared with BFs. The quality of the evidence was very low. Very low certainty evidence suggested that BFs presented favorable clinical performance on retention and marginal adaptation in Class I and II restorations in permanent teeth comparing HVGIs. Nevertheless, HVGIs with a resin-based coating showed acceptable clinical behavior. For patients with a high caries risk, HVGIs serve as a direct restorative alternative for the posterior permanent teeth; however, they should be carefully considered as bulk-fill composite resin alternatives for long-term restoration. PROSPERO (CRD42024535999).

EVALUATION OF PERFORMANCE OF COMPOSITE FILLING MATERIALS IN RESTORATION OF PERMANENT TEETH IN CHILDREN

A paradigm shift in dental caries treatment in paediatric dentistry is viewed towards a wide using of composite resins. This prospective clinical trial are evaluated and compared during 18 months of clinical performance of a microhybrid composite with a nanoceramic resin composite placed in сlass I and II cavities in permanent teeth in children. &#x0D; Thirty one children aged between 7 and 15 years were investigated during this study. About 40 restorations were performed, 50% for each material: a nanoceramic resin composite “Ceram. X Sphere TEC one” and a microhybrid resin composite “Charisma”. The restorations have been estimated by investigators immediately after complete polishing a filling. Clinical evaluation was performed 18 months after replacement by two other investigators using modified USPHS criteria. In addition to hand instruments, a magnifier was used for investigation of the restoration margins. Eighteen fillings with “Ceram. X Sphere TEC one” and 17 fillings with “Charisma” were available. The USPHS parameters were analyzed with the Chi-square test in18 months. The level of significance was p&lt;0.05. Also Green-Vermillion index was used for oral hygiene estimation. &#x0D; There are no failed restorations and secondary caries during the studied period. There were no statistically significant differences among the materials used (p&gt;0.5) regarding the clinical performance. Green-Vermillion hygienic index was 1.48. Thirteen children (43.42%) showed satisfactory level of oral hygiene, 10 children (35.71%) demonstrated good level and 7 children (20.87%) – unsatisfactory level. &#x0D; According to the marginal discoloration and surface roughness criteria, there were no significant differences among the restorative materials (p&gt;0.5). Marginal discoloration was seen in children with unsatisfactory oral hygiene that corresponds to the data of recent study. Marginal adaptation rate was 94.95% for nanoceramic, and 82.35% for the microhybrid restorations. The marginal defects recorded had small detectable defects at the enamel margin of the restorations. According to the anatomic form criterion, there were no significant differences among the restorative materials (p&gt;0.5).&#x0D; Postoperative sensitivity of one nanoceramic and two microhybrid restorations was scored as Bravo at baseline examination, but it disappeared by the 18-months evaluation. For color match criterion, the slight differences were observed in microhybrid restoration in 18 months. This shade mismatch was clinically acceptable (Bravo), with no significant differences noted between the materials studied (p&gt;0.5).&#x0D; The nanoceramic and microhybrid composites have provided acceptable clinical performance over 18-months period. The research pertaining to bigger size of a studied sample and longer observation period is considered advisable to ensure the higher clinical success rate of nanoceramic than microhybrid composite in restoration of permanent teeth in children.

Assessment of oral health status of tribal students in Nashik district of Maharashtra state

Background: Oral health is a state of well being and is essential to an individual's general health and quality of life. “Tribal” are the indigenous native people living in isolation in natural and unpolluted surroundings with their traditional values, customs and beliefs. The tribal constitute a substantial indigenous minority of the population in India, comprising of 9.01% of the nation's total population. The data on the Oral health status of students residing in tribal Dindori Taluka of Nashik District of Maharashtra State is still unrevealed. Hence, the present study was undertaken with the objective to provide baseline data about oral health status of students from the school and colleges of tribal Talukas from Nashik District of Maharashtra State in India. Aim: To provide baseline data about oral health status of students from the school and colleges of tribal Talukas form Nasik District of Maharashtra State in India. Methodology: The survey was carried out mostly on Second and Fourth Saturday by visiting the schools and Colleges from March 2018 to August 2019. The data was collected by personal examination of each student by using oral diagnostic instruments such as mouth mirror and probe. After visual examination, record of systematic observation and oral hygiene status was noted in participant's observation note. Consent from the principal/headmaster of the concerned college/school was taken, and the survey was done with their prior permission. Results: Out of total 1530 participants, oral hygiene status of 1263 (82.54 %) students was found to be affected while only 267 (17.46%) were found to be healthy. Affected participants were characterised by symptoms of ulcers, sores or tender areas in the mouth, bleeding or swollen gums, pain or toothache, bad breathing, calculus, pain with chewing or biting cracked or broken teeth and loss of attachment. Affected participants were characterised by symptoms of ulcers, sores or tender areas in the mouth, bleeding or swollen gums, pain or toothache due to dental caries, bad breathing, calculus, stain, pain with chewing or biting, cracked or broken teeth, loss of attachment and dental caries and facets. Affected participants required dental treatment like restoration of cavities in deciduous and/or permanent teeth, root canal treatment of permanent teeth, pulpotomy or pulpectomy of deciduous teeth, scaling, extraction of non restorable teeth and extraction of over retained deciduous teeth. Conclusion: Tribal students of dindori taluka in nashik district of maharashtra state were characterized by the lack of awareness about oral health, periodontal disease, dental caries and lack of dental care, high treatment needs and limited access to oral health services. Hence it is recommended to focus on improving the oral health status and treatment needs of this tribal students.

Survival of occlusal ART restorations using high-viscosity glass-ionomer with and without chlorhexidine: A 2-year split-mouth quadruple-blind randomized controlled clinical trial

The study question was whether the use of high-viscosity glass-ionomer with chlorhexidine (HVGIC/CHX) for the Atraumatic Restorative Treatment (ART) prepared cavities could achieve a higher restoration survival percentage and be more effective for preventing dentine carious lesions adjacent to the restoration than the use of HVGIC without CHX. The study followed a split-mouth, quadruple-blind, randomized controlled clinical design and lasted 2 years. Patients with at least two small- to medium-sized occlusal cavities were included. The occlusal cavities were prepared according to the ART method and restored with HVGIC/CHX (test) and HVGIC (control). A replica of all restorations available and digital photographs were fabricated at baseline and after 0.5, 1, 1.5 and 2 years and evaluated by two examiners using the ART and Federation Dentaire International (FDI) restoration assessment criteria. Survival curves were constructed using the Kaplan-Meier method, and the log-rank test was used to test for significance between the survival percentages. A total of 100 subjects with an average age of 14.4 years participated. According to the ART restoration assessment criteria, the 2-year survival percentages of ART/HVGIC/CHX (96.8%) and ART/HVGIC (94.8%) did not differ significantly and no significant difference was found between the test (97.9%) and control (96.9%) groups according to the FDI restoration assessment criteria. Eight and five occlusal restorations failed according to the ART and FDI restoration criteria, respectively. No dentine carious lesions along the restoration margin were observed. The 2-year survival of ART restorations in both groups was high. The development of carious dentine lesions adjacent to the restoration was not observed in either treatment group. There is no evidence for modifying HVGIC by incorporating chlorhexidine in order to prevent dentine carious lesion development or to improve the survival of ART restorations in occlusal surfaces in permanent teeth. HVGIC without chlorhexidine can be used successfully to restore occlusal ‘ART-prepared’ cavities in permanent teeth.

Randomized clinical trial of class II restoration in permanent teeth comparing ART with composite resin after 12months.

This study evaluated the effectiveness of class II restorations, in permanent teeth, through the ART technique in comparison to composite resin. Participants (154), aged 8 to 19years, with good general health, with class II cavities in permanent teeth, and without pulp involvement and tooth pain were included in this parallel and randomized clinical trial. The Ethics Committee approval number was CAAE: 24012913.0.1001.5417. Seventy-seven restorations were made with each restorative material (Equia Fil-GC Corporation and Z350-3M). Evaluations occurred at 6 and 12months by the criteria of ART and the USPHS modified. Data were analyzed by Mann-Whitney, chi-square, Fisher's exact, chi-square tests with linear trend and logistic regression by enter method (p < 0.050). The Kaplan-Meier test evaluated the survival rates of the restorations. The log-rank test compared the survival curves. Regardless of the evaluation criteria used, the success rates of ART restorations were 98.7% (6months) and 95.8% (12months) and for composite resins were 100% (6months) and 98.7% (12months), with no statistical difference of restoration groups (p> 0.050). Survival rates for restorations, regardless of the evaluation criteria used, are the same as the success rates, with the exception of ART restorations at 12months of follow-up (94.8%). No differences in the success rates of class II restorations of ART compared to resin composite, in permanent teeth, were observed after 12months. HVGIC can safely be used to restore proximal cavities in permanent teeth up to 12months.

Clinical evaluation of carious cavity restorations using Vertise Flow – 2-year observations

Introduction. The introduction of self-adhesive materials in dentistry has significantly reduced the duration of filling carious cavities. This group includes a light-curing, semi-liquid composite material from Kerr, called Vertise Flow. Aim. The aim of the study was clinical evaluation of restorations made using Vertise Flow in class I cavities in permanent teeth. Material and methods. In children aged 8-17 years, 154 cavities were filled with Vertise Flow. After 2 years, 49 fillings were clinically evaluated according to the modified Ryge’s criteria. The anatomical shape, colour, smoothness, marginal integrity of restorations and the evidence of secondary caries were assessed. Parents or legal guardians of the children consented to the medical procedures. Results. All the evaluated restorations were found retained, with acceptable anatomical shape and smoothness. One restoration slightly changed the colour, and unacceptable marginal integrity was seen in 2 cases. Secondary caries involved 2 teeth. Conclusions. In this 2-year observation, Vertise Flow meets the requirements for materials used for filling minimally prepared class I carious cavities in permanent teeth of young patients.

Atraumatic Restorative Treatment: Restorative Component.

Atraumatic restorative treatment (ART) is a method of managing dental caries based on 2 pillars: sealants for preventing carious lesions in pits and fissures, and restorations for cavitated dentine carious lesions. ART uses only hand instruments for opening/enlarging the cavity and for removing carious tissue. The amount of carious tissue that should be removed depends mainly on the cavity depth. In cavities of shallow and medium depth, carious tissue is removed up to firm dentine. In deep/very deep cavities, in which there is no sign of pulp exposure, pulp inflammation and/or history of spontaneous pain, some soft dentine can be left in the pulpal floor/wall with the aim of avoiding pulp exposure. The ART restorative method is indicated for treating single-surface cavities in primary and permanent teeth, and in multiple-surface cavities in primary teeth. Insufficient information is available to conclude on its use for treating multiple-surface cavities in permanent teeth.

Atraumatic restorative treatment and minimal intervention dentistry.

Too many people worldwide suffer from the consequences of untreated dentine carious lesions. This finding reflects the inability of the currently used traditional mode of treatments to manage such lesions. A change is needed. Dental training institutions should depart from the traditional 'drill and fill' treatments and embrace the holistic oral healthcare approach that is minimal intervention dentistry (MID) and includes within it minimally invasive operative skills. Dental caries is, after all, a preventable disease. The atraumatic restorative treatment (ART) concept is an example of MID. ART consists of a preventive (ART sealant) and a restorative (ART restoration) component. ART sealants using high-viscosity glass-ionomer (HVGIC) have a very high dentine carious lesion preventive effect. The survival rate of these sealants is not significantly different from that of sealants produced with resin. The survival rate of ART/HVGIC restorations matches those of amalgam and resin composite in single- and multiple-surface cavities in primary teeth and in single-surface cavities in permanent teeth. The principles of carious tissue removal within a cavity recommended by the International Caries Consensus Collaboration are in line with those of treating a cavity using ART. Owing to its good performance and the low levels of discomfort/pain and dental anxiety associated with it, ART and/or other evidence-based atraumatic care procedures should be the first treatment for a primary dentine carious lesion. Only if the use of ART is not indicated should other more invasive and less-atraumatic care procedures be used in both primary and permanent dentitions.

Evaluation of school-based prevention program in Turkey: Results of a 24-month study.

Objective:In this paper, cavity experiences of children with different levels of eruption and cavity activities that are enrolled at an elementary school with semi-rural characteristics in Kırıkkale Provincial center were monitored for 2 years after a variety of protective applications.Materials and Methods:Three hundred and twenty-two children at the age of 7–11 were included in this study. Children were grouped as follows according to their cavity experiences and applications done: Group 1 - control group (with or without cavities) – was given hygiene training only; Group 2 - with medium level cavity activity (2–4 cavities in average) – oral hygiene training + surface restoration applied; Group 3 - children with 2–4 cavities on average – oral hygiene training + professional flour gel applied; Group 4 - children with 2–4 cavities in average – oral hygiene training + flour gel applied with brush; Group 5 - children with extreme cavity activity (children with 5 or more cavities) – oral hygiene training + surface restoration + professional flour gel combination applied.Results:At the end of the 2nd year, 277 children were reached. The increase of number of cavities in permanent teeth was determined as 35%, 0%, 1%, 0%, and 7% in groups 1–5, respectively. The difference between groups was found to be significant (Chi-square analysis, Pearson Chi-square = 27.002, P < 0.01).Conclusion:These findings have showed that, in Kırıkkale Provincial center, some cavity-preventive measures such as surface restoration and gel applications, along with hygiene training, could provide optimum protection for school-age children.

Challenges to teaching posterior composites in the United Kingdom and Ireland

Recent surveys from general dental practice have found increased placement of direct composite resin restorations in occlusal (Class I) and occlusoproximal (Class II) cavities in permanent teeth by general dental practitioners. This has been matched, and possibly driven, at least in part, by the development of new composite resin materials and bonding technologies. Recent studies by the authors have found an increase in the teaching of Class I and Class II composite resin restorations in the UK, Ireland, the US, and Canada. The increased teaching in the UK and Ireland, however, was not as great as in North America, and several worrying trends were observed. The aim of this paper is to discuss these trends and related factors considered important to the necessary further development of the teaching of Class I and Class II direct composite resin restorations, let alone modern operative dentistry in general, in the UK and Ireland.

Clinical evaluation of multisurface ART restorations

The aim of this study was to evaluate the performance of two different glass-ionomer cements: a high-density (Ketac Molar - ESPE) and a resin-modified cement (Fuji VIII - GC) using the Atraumatic Restorative Treatment technique to restore multisurface cavities in permanent teeth. A total of 60 ART restorations (30 with each material) were placed in schoolchildren (9-16 years of age) by two operators. After a period of 6 months, two independent examiners evaluated 59 restorations according to the criteria used in previous ART studies. Data were submitted to McNemar and Fischer tests. The success rate of the treatment was 98.3%. One restoration (Ketac Molar) was replaced by another material and was recorded as failure. The success rates of the restorations were 100% and 96.6% for Fuji VIII and Ketac Molar, respectively. There was no statistically significant difference in the restorations success between baseline and 6 months (p>0.05). In the same way, no significant differences were found between materials, cavity types or operators (p>0.05). The ART approach was highly appropriate and effective in restorations involving two or more tooth surfaces, after 6 months. The results showed a promising performance of the ART technique with both materials.

Assessment of manual restorative treatment (MRT) with amalgam in high‐caries Filipino children: results after 2 years

The atraumatic restorative treatment (ART), using only hand instruments and glass-ionomer cement as adhesive material is recommended for restorative dental treatment in disadvantaged communities lacking electricity and sophisticated dental equipment. Research is required on more durable restorative materials appropriate for populations with high-caries experience. The aim of the study was to evaluate, under field conditions, the applicability and effectiveness of an encapsulated amalgam as restorative material in ART prepared cavities in permanent teeth of children with high-caries rates. As the definition of ART restricts the manual treatment to adhesive materials the approach used is called the manual restorative treatment (MRT). Two dentists and two trained healthcare workers, using hand instruments and an encapsulated amalgam that was mixed with a manually driven triturator, placed a total of 934 restorations in the permanent dentition in 466 children. Due to irregular school attendance of Filipino children only 611 restorations could be evaluated by one independent dentist. The average age at reassessment of restorations was 27 +/- 4.5 months. 93.3% of the restorations were acceptable. The failure rate of occlusal surface restorations was 5.6% compared with 13.6% of buccal surface fillings. The survival rate of large occlusal restorations was 95.1% compared with 93.7% for small restorations. The survival of MRT restorations was not influenced by the experience and professional level of the operator. Amalgam is a suitable MRT material, especially for extensive occlusal lesions in high-caries populations. Studies of longer duration are needed to confirm this finding.

Removal of Caries Using only Hand Instruments: A Comparison of Mechanical and Chemo–Mechanical Methods

The aim of this study was to evaluate the efficacy, comfort and efficiency of removing dentin caries using only hand instruments. The Carisolv™ system for caries removal consisting of a solvent gel and a set of specially designed hand instruments (chemo–mechanical) was compared to the use of conventional spoon excavators (mechanical). This was a clinical randomised controlled trial where the two techniques were compared in the same individual. The outcome variables were: complete caries removal; pain during caries removal; anaesthesia requested by the patient during caries removal; time taken to remove caries. Sixty–six individuals, each with a pair of similar cavities in permanent teeth were selected. After caries removal, a ‘blinded’ evaluator assessed the clinical status of the cavity, with the use of a probe. The times for caries removal of the chemo–mechanical and mechanical methods were respectively: 9.2±3.8 and 8.6±3.8 min (p>0.05). There were 4 cavities arguably presenting signs of caries after cavity preparation in the 66 cavities treated with the mechanical method and 7 in the 66 chemo–mechanical cavities (p>0,05). Some pain/discomfort was reported by 21 (32%) participants when the chemo–mechanical method was used, compared with 43 (65%) when the mechanical method was used (p<0.05). During the chemo–mechanical and the mechanical treatment, 2 (3%) and 5 (8%) patients, respectively, requested local anaesthesia (p>0.05). The chemo–mechanical method appeared to be more comfortable for most patients.

Five-year study of Class II restorations in permanent teeth using amalgam, glass polyalkenoate (ionomer) cermet and resin-based composite materials

The aim of this study was to compare the clinical performance of an amalgam, a glass polyalkenoate (ionomer) cermet material and a resin-based composite material used in small Class II cavities in permanent teeth. All restorations were inserted under rubber dam. They were examined yearly for 3 years. One clinician continued the study up to 5 years. The clinical examination focused on two criteria: clinically acceptable and failure. In addition, impressions were taken of the prepared cavities immediately before restoration and at each clinical examination using an elastomeric material. The study comprised 274 Class II restorations (88 amalgams, 95 cermets and 91 resin composites) placed in 142 adolescent patients. One hundred and sixty-seven restorations were in molar and 107 in premolar teeth. Patient dropout after 5 years resulted in the loss of 161 restorations, evenly distributed for restorative material and type of tooth involved. Four amalgam restorations, 22 glass ionomer cermet and nine resin composite restorations failed. The glass ionomer cermet and amalgam restorations failed primarily due to bulk fractures, while the resin composite restorations failed due to secondary caries and bulk fractures.