Conservative Dentistry Research Articles

Use of Phentolamine Mesylate in Implant Surgery: Analysis of Adverse Effects and Haemodynamic Changes.

The clinical application of phentolamine mesylate (PM) as an anaesthetic reversal agent has been documented in the paediatric population and in conservative dentistry, but no studies have been conducted regarding dental implant surgery. A prospective randomised study was conducted on 60 patients eligible for mandibular implant treatment, randomly divided between a control group (CG) and an experimental group (EG), to whom PM was administered. Haemodynamic changes, adverse effects and patient satisfaction were assessed. No statistically significant differences in haemodynamic changes and postoperative pain were found between CG and EG (p < 0.05), except for systolic blood pressure (SBP), which increased slightly in EG, without posing a risk to patients. There were no differences in the occurrence of adverse effects between the two groups, except for greater difficulty in chewing and biting (p < 0.05) in CG and greater pain in the injection area (p = 0.043) in EG. Among EG patients, 83.3% reported that they would request PM again for future dental treatment. The use of PM offers an alternative to implant surgery, thereby increasing patients’ quality of life without increasing the risks.

Microleakage of Direct Restorations-Comparisonbetween Bulk-Fill and Traditional Composite Resins:Systematic Review and Meta-Analysis.

Since the bulk-fill composites were produced, there was a progressive diffusion of their use for direct conservative treatment in posterior teeth. Their chemical structure increases the depth of cure and decreases the polymerization contraction; in this manner, bulk-fill composites can be placed in 4 mm single layers and the treatment times are considerably reduced. However, aesthetic and mechanical properties and impact on microleakage of bulk-fill resins are still unclear.This systematic review and meta-analysis aimed to assess the risk of microleakage of direct posterior restorations made of bulk-fill versus conventional composite resins.Researches were performed on PubMed and Scopus databases. Eligible in vivo studies, published since 2006, were reviewed. Outcomes of marginal discoloration, marginal adaptation, and recurrent caries were considered to conduct the systematic review and meta-analysis. Secondary data were examined to implement additional analysis and assess the risk of bias.Eight randomized clinical trials were analyzed, involving 778 direct restorations. The summary of RCTs led to significant but inconsistent results; the marginal discoloration and recurrent caries were found to be improved respectively by 5.1 and 1.4%, whereas the marginal adaptation was reduced of 6.5%. Secondary analyses revealed that follow-up periods, the adhesive system used and the class of carious lesions evaluated are confounding factors, and they result in a risk of bias across studies.Bulk-fill composites are innovative materials for conservative dentistry and they can be used to reduce treatment steps and duration of operative times. There are insufficient data to explore the relationship between bulk-fill composites and microleakage and further investigations are needed.

Aesthetic management of fluorosis

With increasing awareness and aesthetic concerns, the number of people seeking professional dental help for improvement in the appearance of their dentitions and for smile makeovers are on rise. Dental fluorosis, tetracycline staining, localised and chronological hypoplasia, and both amelogenesis and dentinogenesis imperfecta can all produce a cosmetically unsatisfactory dentition. The aetiology of intrinsic discolouration of enamel may sometimes be deduced from the patient's history, and one factor long associated with the problem has been a high level of fluoride intake. Optimal use of topical fluorides leads to a decrease in the caries prevalence but may show an increase in the prevalence of fluorosis staining because of metabolic alterations in the ameloblasts, causing a defective matrix formation and improper calcification. A 28 yr female patient was screened at the Department of Conservative Dentistry and Endodontics at desh bhagat dental college, mandi gobindgarh, Punjab. She wanted us to remove and/or minimise the noticeable brown/yellow staining of his teeth. She requested the least invasive and most cost-effective treatment to change his smile. Various treatment modalities are present for the treatment of fluorosis stains. This report discusses the microabrasion technique in the patient having dental fluorosis.

Management of the Oral Health of Children During the COVID-19 Pandemic in Poland.

Managing the oral health of children during the time of a health emergency linked to the current COVID-19 pandemic presents specific problems. A high number of non-specific effective infection control protocols are available in dental settings. It is of fundamental importance to implement specific protocols relating to those clinical situations that normally do not represent an emergency but which now fall into that category. The aim of this study was the comparison of data obtained from the Regional National Health Fund (NFZ) relating to the number and the type of procedures in the oral health management of children aged 0–18 years from the Wielkopolska region, with the months of March and April of 2019 being compared with those of the, respective, pandemic period of 2020. The results showed statistical differences in the number of performed procedures when comparing 2019 and 2020; especially in April (n = 53,077 in 2019 but only n = 2,287 in 2020), when lockdown restrictions reached their highest level and when only 30% of the dental clinics for children were open for patients in the Wielkopolska region of Poland. Regarding surgical cases, there were no differences in percentage frequency between April 2019 and 2020 in terms of extractions. However, an increase was observed in abscess incisions (3.5–17.8%) and surgical dressings (1.5–10.07%). There was a decrease in the total number of performed conservative dentistry procedures in April 2020, but temporary fillings in primary and permanent teeth showed a prominent increase: from 6.4% in 2019 to 19.3% in 2020; and 5.8–11.4%, respectively. Pulp treatment and mucosal lesions therapy fall into the dental emergency category during this COVID-19 pandemic. These cases have shown an increase from 3.2% in 2019 to 12.8% in 2020 for pulp treatment, and from 2.3 to 4.3% for the treatment of oral mucosal lesions. As suspected, after the lockdown was implemented, the number of pediatric dental cases were low. Moreover, the analysis revealed differences in the profile of clinical situations that represented the emergency cases and the pandemic treatment protocols. Future implications suggest that dental prophylactic procedures be included in pandemic protocols with even dental services being limited to a form of urgent treatment. New approaches and treatment models should be implemented in the control of the infectious spread of the disease in the management of the oral health of children in this pandemic period.

Impact of COVID-19 on Dental Care during a National Lockdown: A Retrospective Observational Study.

The coronavirus disease 19 (COVID-19) has challenged dental health professions. This study analyzes its impact on urgent dental care in the Department of Conservative Dentistry and Periodontology, University Hospital Munich and Bavaria, Germany. Patient numbers without and with positive/suspected COVID-19 infection, their reasons for attendance, and treatments were retrospectively recorded (February–July 2020) and linked to local COVID-19 infection numbers, control measures, and numbers/reasons for closures of private dental practices in Bavaria, Germany. Patient numbers decreased within the urgent care unit and the private dental practices followed by a complete recovery by the end of July. While non-emergency visits dropped to almost zero during the first lockdown, pain-related treatments were administered invariably also in patients with positive/suspected COVID-19 infections. Reasons for practice closures were lack of personal protective equipment (PPE), lack of employees, staff’s increased health risks, and infected staff, which accounted for 0.72% (3.6% closures in total). Pain-driven urgent dental care remains a constant necessity even in times of high infection risk, and measures established at the beginning of the pandemic seem to have provided a safe environment for patients as well as oral health care providers. PPE storage is important to ensure patients’ treatment under high-risk conditions, and its storage and provision by regulatory units might guarantee a stable and safe oral health care system in the future.

Spanish Curriculum in Cariology for undergraduate dental students: Proceedings and consensus.

Cariology is today a broad-based discipline and in the Spanish university teaching field, all this knowledge is not unified in a curriculum. Therefore, the aim was to develop a consensus text based on the European Core Curriculum, updated, and adapted to the characteristics of the Spanish university environment. A Spanish Cariology Curriculum Group (SCCG) was set up with members of the Spanish Society of Epidemiology and Oral Public Health (SESPO), Spanish Society of Conservative and Aesthetic Dentistry (SEOC) and Spanish Society of Paediatric Dentistry (SEOP) and university experts to adapt the European Core Curriculum in Cariology for undergraduate dental students (ECCC) for Spain. The work was carried out online during 2018 and 2019, and also face-to-face meetings took place to obtain a draft curriculum open for discussion that was presented to all the Spanish universities. The final modifications to the document were specified in a Consensus Conference of Spanish universities offering a Degree in Dentistry that took place in Madrid on 19November 2019. Thirty-eight university experts, under SCCG supervision, participated in the elaboration of the new framework document. A total of 16 universities, from 23 invited, reached a consensus as to the contents of the Spanish Curriculum in Cariology for undergraduate dental students. This new Curriculum emphasises learning outcomes, uses a consensus-based terminology pertaining to caries and other hard-tissue conditions, and introduces a new domain of competence in Domain III of ECCC. This new Cariology Curriculum is the result of a very broad-based consensus of university experts in Spain and lays the foundation for the implementation of an integrated teaching of Cariology in Spain in adherence to Alliance for a Caries Free Future (ACFF) objectives.

Follow-up of Endodontically Treated Teeth Without Crown Coverage in Vidarbha Region

Statement of Problem: Teeth are weakened after endodontic treatment and should, preferably, be crowned, especially posterior teeth. However, this is not always possible due to certain reasons. Information about the appropriate treatment modalities. This retrospective study was carried out to evaluate the survival of endodontically treated teeth (ETTs) without crown coverage on the basis of various parameters in the region of Vidarbha in Maharashtra, India. Purpose: The aims of this cohort study were to evaluate the survival rate for endodontically treated molars without crown coverage and to identify possible related factors. Materials and Methods: Relevant data from 300 subjects for 148 ETTs was recorded at the Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, Wardha, Maharashtra. Follow-up data were derived from a clinical examination and review of the dental record and radiographs. Subjects were not included in the study if teeth had provisional crowns, definitive restorations with cuspal coverage, or with dowel and core and/or crown restorations. The outcome evaluated was defined as a failure if there were negative findings in the condition of a tooth that required a restoration, tooth repair, or extraction. Tooth loss due to endodontic and periodontal reasons was excluded. The independent variables assessed were patient age, gender, location (maxilla or mandible), the existence of an opposing dentition and adjacent teeth, remaining tooth structure, and types of restorative material. One hundred and forty-eight teeth restored using glass-ionomer cement (GIC), SF, and composites were considered successful during the observation time of 3 years because no intervention was needed in these teeth were labeled as “survived.” The teeth restored with composite were 90. The teeth restored with GIC were 14. The teeth restored with silver amalgam were 44. Out of 148 teeth were considered successful during the observation time of 3 years because no intervention was needed in these teeth were labeled as “survived.” Follow-up was done at regular intervals after 5, 7, and 10 years, respectively. At the end of 10 years, the number of teeth survived was 26. The teeth restored with composite were 14. The teeth restored with GIC were 4. The teeth restored with silver amalgam were 8. Results: At the end of the observation time period (10 years), 13 teeth had to be extracted at the end of 6 years and 19 restorations were repaired or replaced at 5, 7, and 9 years. Conclusion: Within the limitations of this study, the amount of remaining tooth structure and types of restorative material have a significant association with the longevity of endodontically treated molars without crown coverage. ETTs evaluated after 10 years showed positive survival and success in long time period. Various parameters were significantly seen to influence the outcome and thereby survival of teeth in the arch when no crowns were placed on ETTs.

Assessment of shade matching using visual and instrumental methods

Aims: This study aimed to compare the shade selection of natural teeth using visual method, digital photographic method, spectrophotometric method, and using an intraoral scanning device. Settings and Design: A study was conducted at the department of conservative dentistry and endodontics. Subjects and Methods: Right maxillary central incisors of ten subjects without caries, defects, or any restorations were selected for the study. Shade selection was done from the middle third of the labial surface of the tooth. In visual method the shade selection was carried out by an experienced clinician and in digital photographic method by a technician with gray cards as background and software analysis the other methods were spectrophotometric method and using an intraoral scanning device. Statistical Analysis Used: Statistical analysis was done using the nonparametric Kruskal–Wallis test. Post hoc was done using the Mann–Whitney U-test. Results: When the shades selected using the four methods were compared, with spectrophotometric methods, statistically significant differences were found for visual and digital photographic methods. Conclusions: Whenever possible, it is better to combine visual and instrumental methods so as to reduce the subjective errors that can happen while using the visual method alone. Among the instrumental methods, the less expensive digital photographic method can be opted for instead of the more sophisticated methods with chances of minimal errors.

C-Shaped Canal in Second Molar of Mandible among Cases of Cone Beam Computed Tomography in Tertiary Care Centres: A Descriptive Cross-sectional Study.

C-shaped canal configuration is mostly found in the mandibular second molar. The morphological characteristic of a C-shaped canal is the presence of a fin or web connecting the individual canal, making it difficult for cleaning, shaping, and obturation. The objective of this study was to find out the prevalence of C-shaped canal in mandibular second molar among cases of Cone Beam Computed Tomography in tertiary care centres. The descriptive cross-sectional study was conducted in the department of conservative dentistry and endodontics of tertiary care centres from 20th June 2020 to 20th December 2020 after receiving ethical approval from the Nepal Health Research Council on 19 June 2020. Cone-beam computed tomography images of 199 mandibular second molars with completely formed roots were used. Teeth with orthodontic braces, root resorption, root canal filling, and post were excluded from the study. The research was conducted taking a tooth as a unit. Convenience sampling was done. Statistical analysis was done by using Statistical Package for Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. The prevalence of C-shaped canal according to this study is 25 (12.6%) (7.99-17.21 at 95% Confidence Interval). The findings of the study conclude that C-shaped configuration is quite frequent in mandibular second molar among cases of Cone Beam Computed Tomography. A careful pre-operative radiographic evaluation may be helpful for diagnosing C-shaped configuration prior to root canal treatment.

Textbook of Conservative and Restorative Dentistry

Textbook of Conservative and Restorative Dentistry

The Trends of Endodontic and Prosthodontic Treatment by Postgraduate Students in University of Malaya

This study is aimed to provide an insight into the types of treatment carried out by postgraduate students in the past 10 years. A retrospective study was carried out between November 2019 and February 2020 by deriving data from postgraduate students’ clinical logbooks of three different cohorts of Master of Clinical Dentistry (Restorative Dentistry in Conservative Dentistry) in 2010, 2013 and 2016. This retrospective data was systematically extracted from the records and tabulated categorically using an Excel spreadsheet (Microsoft Office Excel 2019). A descriptive analysis was carried out to further evaluate the results. Overall, the types of treatment carried out in the field of endodontics and fixed prosthodontics has changed in the past 10 years. An increasing trend is seen in the placement of all ceramic crowns and primary root canal treatment procedures, while a decreasing pattern is evident for secondary root canal procedures and placement of dental bridges.

Bioactive Material in Pediatric Dentistry

A new generation of bioactive materials which has been developed during the last ten years has been used in every field of dentistry and medicine. These bioactive materials are able to release calcium, phosphate and other specific ions to help rebuild demineralized dentin and enamel. These materials are broadly used in the field of conservative dentistry for regeneration, repair and reconstruction. These materials are available in different form and composition that acts directly on vital tissue inducing its healing and repair. These materials directly function because of induction of various growth factors and different cells. New innovations are necessary to continue to help reinforce existing technologies and to introduce new paradigms for treating dental disease and restoring teeth seriously compromised by caries lesions via biomimetic and more biological operative approaches. Bioactive materials with nanoscale structure, including nanomedicine, nanodevices, nanomaterials, such as nanofibres and nanocomposites, can be designed and produced from natural biopolymers, synthetic polymers and inorganic substances. The nanocomposite-based scaffold allows for cell growth, yielding a unique composite system.

CAUSES OF ROOT CANAL TREATMENT FAILURE

The aim of this study was to determine different causes of endodontic treatment failure in patients who approached our Department of Conservative Dentistry and Endodontics for re- treatment.This study included one hundred fifty patients of both genders with different post endodontic treatment complaints.Clinical and radio- graphic examination was used to confirm treatment failure. The most common clinical symptoms were tenderness, tenderness and pain, or swelling (72%, 29.3% and 22.7% respectively). The common causes of endodontic treatment failure were poorly filled (40%), under filled (34.7%) and no root canal filling (17.3%).Root canal failure due to overfilling was 5.3%.Most of these failed cases were either treated by internees (House officers) in the teaching institutes (34.7%) or general dental practitioners (57.3%).

Evaluation Grids for Endodontics Preclinical Practical Activities

Preclinical practical activities (PPAs) are an important part of undergraduate dental education. They are a type of teaching based on practical learning. As a result, the Department of Conservative Dentistry of the Faculty of Dentistry of Casablanca provides endodontic activity sessions for third-year students; the objective is to develop the students’ manual dexterity and prepare them for clinical practice. During these sessions, students are required to perform the various stages of endodontic treatment from taking preoperative radiographs to root canal filling, including the creation of the access cavity and root canal preparation. At the end of the treatment, the act performed is evaluated in its entirety. This evaluation is very often considered to be the final activity of a teaching course, which makes it possible to assess the knowledge and practical aptitude of each student. This approach allows neither the teacher to objectively evaluate the acts performed nor the student to identify his/her difficulties. Concerned by the pitfalls of the methods of evaluation adopted during these activities, we thought about the development of criterion-referenced evaluation grids in order to remedy the subjectivity of the teacher’s assessment and to enable the student to improve his learning.

Use of the Er:YAG Laser in Conservative Dentistry: Evaluation of the Microbial Population in Carious Lesions.

The aim of this study is to investigate the Erbium:Yttrio-Aluminum-Granate (Er:YAG) laser photothermal and mechanical effects on cariogenic species concentration and on the microbial load composition of therapeutic cavities, in order to evaluate the possible micro-organisms reduction and make a comparison with manual and rotating conventional therapy (CT). A clinical trial was designed, including adults with active deep carious lesions on permanent teeth who were divided into two groups, i.e., control group and intervention group treated with CT and Er:YAG therapy, respectively. Before and after any conservative treatment, two oral samples were collected using a small sterile microbrush scrubbed within the base of the dentinal cavity tissue. The percentage of reduction and the colony-forming units (CFUs) count after Er:YAG and conventional treatments were compared for total microorganisms, including Candida spp., Streptococcus spp., and Lactobacillus spp. The microbial reduction varied from 90.2% to 100% and was significantly observed for total microorganisms and Streptococcus spp. (p < 0.05). The Er:YAG laser shows the potential for clinical applications, especially with paediatric and complicated patients, thanks to its minimally invasive properties and its effect on the reduction of microbial load.

Role of silver nanoparticles in Conservative Dentistry. A Review

Role of silver nanoparticles in Conservative Dentistry. A Review

Graphene – Scope in Conservative Dentistry and Endodontics

Graphene, a member of the carbon family, is the strongest, stiffest, and thinnest known material, with a thickness of 10 nm. It has emerged as engineered nanomaterials and nanomedicines in dentistry with promising results. Usually produced employing Hummers method, graphene possesses excellent physiomechanical properties, electrical conductivity, stability, biocompatibility, and biodegradability. Owing to their interactions with dental pulp stem cells, they have been functionalized with many scaffolds in regenerative dentistry, to upregulate the odontogenic and osteogenic genes. This emerging science of graphene-based materials has also been used for the debridement of root canals. Their unique property of antibiofilm and antiadhesiveness has been used to prevent dental caries and erosions. In addition, they have been incorporated into various biomaterials to enhance their original properties, like in glass ionomers, biodentine, and in bleaching agents like hydrogen peroxide. Depending on their concentration and time of exposure to the substrate, graphene and their derivatives can be effective antibacterial agents. This updated review provides useful information on the promising introduction of graphene in the field of conservative dentistry and endodontics.

The Effectiveness of the Blended Learning in Conservative Dentistry with Endodontics on the Basis of the Survey among 4th-Year Students during the COVID-19 Pandemic.

The COVID-19 pandemic has undoubtedly affected education at all levels, including medical and dental education. Our study aimed to assess the effectiveness of the blended learning in conservative dentistry with endodontics. The students had theoretical classes in a remote form (using the e-learning portal and Teams communicator) and practical classes with the participation of patients in the appropriate sanitary regime. The author’s survey was conducted among fourth-year dental students. The online questionnaire consisted of 5 parts: self-evaluation, evaluation of theoretical e-learning classes, evaluation of practical clinical classes, evaluation of safety, and evaluation of performed blended learning. The majority of respondents declared that their learning effectiveness increased during the pandemic. Most surveyed students preferred remote learning in asynchronous form (e-learning portals) to synchronous form (virtual meetings in real-time). All respondents described the provided personal protective equipment as sufficient or even as excessive. Our students were very satisfied with the proposed blended-learning model and would like to continue it even after the pandemic has ended. Among the advantages, they particularly mentioned the increase in efficiency and the individualised pace of learning, while the disadvantage was the limitation of social contacts. The appropriate use of modern technology can effectively revolutionise dental education.

Evaluation of the Most Stressful Dental Treatment Procedures of Conservative Dentistry among Polish Dental Students.

Background: Dental schools are considered to be a very stressful environment; the stress levels of dental students are higher than those of the general population. The aim of this study was to assess the level of stress among dental students while performing specific dental procedures. Methods: A survey was conducted among 257 participants. We used an original questionnaire, which consisted of 14 questions assigned to three categories: I—Diagnosis, II—Caries Treatment, and III—Endodontic Treatment. Each participant marked their perceived level of stress during the performed dental treatment procedures. The scale included values of 0–6, where 0 indicates no stress, while 6 indicates high stress. Results: Third- () and fourth-year () women were characterized by a higher level of perceived stress during dental procedures related to caries treatment. Caries treatment procedures were the most stressful for 18.3% of third-year students, 4.3% of fourth-year students, and 3.2% of fifth-year students. Furthermore, 63.4% of third-year students, 47.3% of fourth-year students, and 17.2% of fifth-year students indicated that they felt a high level of stress when performing endodontic procedures. Conclusion: Third- and fourth-year female students are characterized by a higher level of stress during caries and endodontic treatment procedures. The most stressful treatments for participants were endodontic treatment procedures.

An Update of the Possible Applications of Magnetic Resonance Imaging (MRI) in Dentistry: A Literature Review.

This narrative review aims to evaluate the current evidence for the application of magnetic resonance imaging (MRI), a radiation-free diagnostic exam, in some fields of dentistry. Background: Radiographic imaging plays a significant role in current first and second level dental diagnostics and treatment planning. However, the main disadvantage is the high exposure to ionizing radiation for patients. Methods: A search for articles on dental MRI was performed using the PubMed electronic database, and 37 studies were included. Only some articles about endodontics, conservative dentistry, implantology, and oral and craniofacial surgery that best represented the aim of this study were selected. Results: All the included articles showed that MRI can obtain well-defined images, which can be applied in operative dentistry. Conclusions: This review highlights the potential of MRI for diagnosis in dental clinical practice, without the risk of biological damage from continuous ionizing radiation exposure.