Conventional Restorative Treatment Research Articles

Use of T-Scan III in analyzing occlusal changes in molar fixed denture placement

BackgroundThis study aims to analyze the longitudinal variation of occlusal force distribution prior to and after fixed restoration for molar full-crowns with T-SCAN III which provide reference for occlusal adjustment and long-term maintenance.MethodsWe enrolled a total of 20 patients who received conventional restorative treatment for molars. The occlusion examination was conducted in 3 stages (before placement, immediately after placement, and 3 months after placement) using T-SCAN III (Tekscan South Boston, MA, USA, 10.0) to examine and measure the occlusal contact areas of the full dentition.ResultsThe results indicated that the occlusal force distribution in the molar region of the patients changed before and after the fixed restoration, but the percentages of occlusal force in the dental arch of the molar did not differ significantly before and after the restoration (P > 0.05). Three months after the fixed restoration, the percentage of occlusal force in the restored dental arches of lateral teeth increased significantly (P < 0.05).ConclusionThe results of this study indicated that the occlusal forces of the patients changed with tooth movement and adaptation, which is mainly reflected in the increasing occlusal force. Quantitative occlusal force analysis using T-SCAN III occlusal analyzer can provide more objective and accurate data to effectively guide clinical occlusion adjustments.

Pulp neurovascular plexus response as a result of crown-root horizontal fracture and uncomplicated crown fracture in permanent dentition: a case report

Dental trauma often have severe and complex injuries to the dentoalveolar system. Objective: To report the treatment of crown-root horizontal fracture and uncomplicated crown fracture in permanent dentition. Case report: Child patient attended the dental trauma service 30 days after the fall. On clinical and imaging examination, an uncomplicated crown fracture in the right central incisor and crown-root fracture in the left central incisor was possible to identify (tooth 11 and tooth 21 respectively). The conventional restorative treatment (tooth 11) and repositioning (tooth 21) were performed. The endodontic treatment was performed at 6 months of follow-up (tooth 11). At the new imaging exam, cement neoformation was evidenced between the fragments of the crow-root fracture (tooth 21). After 24 months of follow-up, there was a decrease in periapical lesion (tooth 11), and maintenance of pulp vitality (tooth 21). Conclusion: There is a possibility of maintaining pulp vitality in crown-root fractures and highlights the importance of follow-up in non-complicated fractures.

Ozone Therapy for Early Childhood Caries (ECC) Treatment: An In Vivo Prospective Study

The present study aimed to evaluate the effectiveness of ozone therapy in (1) increasing the compactness of decayed dentin (main aim), (2) reducing dentin hypersensitivity, (3) decreasing the salivary bacterial count, and (4) improving the quality of life in ECC-affected children during a 3-month follow-up. A total of 20 subjects uncooperative with conventional restorative treatment were treated with a 60 s ozone application/week (OzoneDTA®) for 4 weeks. Patients were evaluated at T0 = baseline; T1 = after ozone cycle and T2, T3, T4 = 1, 2, 3-month follow-up, respectively. Dentin compactness was evaluated according to the Affected Dentine Scale (ADS) proposed by the authors; dentin hypersensitivity was recorded with the Wong–Baker Faces Pain Rating Scale (WBFPRS); salivary bacteria were measured with the Saliva Check Mutans Test and quality of life with the Early Childhood Oral Health Impact Scale (ECOHIS). ADS values and salivary bacteria count results were analyzed using non-parametric tests. Statistically significant differences were detected for both parameters between T0 and T1 (p &lt; 0.01). At T1, dentin hypersensitivity was resolved and quality of life improved. Ozone therapy is a simple and painless approach, which might be useful for controlling caries’ progression in uncooperative children until appropriate cooperation is achieved.

Atraumatic restorative treatment as a minimum invasive approach in pediatric dentistry - A literature review

Introduction: Atraumatic restorative treatment (ART) is a minimally invasive approach of dental caries lesions that is indicated in primary and permanent dentition. Objectives: To investigate based on a review of the scientific literature, the use of ART as a minimally invasive treatment approach in Pediatric Dentistry. Methodology: A literature review was conducted to verify the evidence regarding Atraumatic restorative treatment as a minimally invasive treatment in pediatric dental patients. Searches were performed in the following electronic health databases: Pubmed, Scientific Electronic Library Online (SciELO), and Latin American and Caribbean Literature on Health Sciences (LILACS), using the following search terms: minimally invasive treatment and Atraumatic restorative treatment and dental caries. The inclusion criteria for the studies were epidemiological (cross-sectional, case-control, cohort, clinical trials) or qualitative studies that evaluated the use of ART in children's dental care; papers published in English, Portuguese or Spanish; and the publication date of the studies was limited to the last five years (2017 to 2022). Data were presented through a description of the included studies after a complete reading. Results: Twenty-three studies were identified and after the inclusion criteria were applied, eight studies were included in the full analysis. From the data analysis, it was observed that ART is a great alternative for the caries control and treatment of the lesions, contributing to the reduction of the patient's anxiety levels in relation to conventional restorative dental treatment, as it minimizes the fear of children regarding dental caries treatment. ART is a viable alternative to conventional treatments that are associated with local anesthetics, drills, and composite resin. In addition, the materials used in ART showed good results when compared to conventional restorative techniques in relation to the survival of the restoration. Conclusion: The use of the ART technique is an effective option for minimally invasive treatment for children, mainly young children, and especially nowadays due to the minimization of aerosols production for dental treatments due to virus transmission during pandemic period. In addition, ART is a comfortable and easy technique for both patient and dental health professional.

Atraumatic restorative treatment

Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments only, without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers). The ART approach so far has mainly used high-viscosity glass-ionomer as the sealant and restorative material.

Examining Parental Treatment Decisions Within a Contemporary Pediatric Dentistry Private Practice.

PurposeThe primary objective of this study was to compare relationships between child, parent, and clinical factors with patient-level treatment decisions for early childhood caries. A secondary objective was to describe children that received silver diamine fluoride (SDF) as interim versus long-term treatment.Patients and MethodsParents of 2–6-year-old children seeking care at a multi-center pediatric dentistry private practice were enrolled in this cross-sectional study. Demographic data and dental anxiety data according to the Modified Corah’s Dental Anxiety Scale were collected via questionnaire. A dental visit behavior rating and decayed, missing, and filled tooth (dmft) index were recorded from the child’s dental record. The primary outcome was treatment decision categorized into three groups: (1) treatment with SDF (n=25), (2) conventional restorative treatment under local anesthesia (n=32), and (3) restorative treatment under general anesthesia (n=33). Analyses included descriptive statistics, bivariate analysis, and ordered logistic regression.ResultsChild age, parent education level, family income, dental insurance status, dental visit behavior rating, and dmft were significantly different across treatment groups in bivariate comparisons. However, when included in multivariable, ordered logistic regression, child dental anxiety was the only significant covariate associated with treatment decisions (Odds Ratio=5.01, 95% confidence interval: 1.51 to 16.63). In secondary analysis, two distinct subgroups were identified within the SDF group: one as long-term treatment (n=9) and one as interim treatment prior to general anesthesia (n=16). The long-term group was younger (mean=3.2 versus 3.7), had lower dmft (mean=4 versus 11.1), and had lower frequency of very high dental anxiety (0% versus 15%).ConclusionThe present study identified child dental anxiety as the primary factor associated with treatment decisions at this private practice. The characterization of two subgroups of children treated with SDF has meaningful implications for studies evaluating the economic and public health impacts of SDF.

Possibilidades restaurativas usando cerâmica de zircônia para coroas unitárias.

Dois casos clínicos são apresentados para explorar as diferenças técnicas e discutir as vantagens e desvantagens do uso de zircônia folheada ou monolítica para confeccionar coroas únicas posteriores. O primeiro caso descreve as etapas clínicas na fabricação de uma coroa monolítica em um segundo pré-molar inferior esquerdo usando zircônia de alta translucidez. Mostra a utilização de um preparo dentário conservador baseado nas propriedades mecânicas superiores que este material apresenta, bem como nas características ópticas finais alcançadas pelo sombreamento e coloração. No segundo caso, foi realizado um tratamento restaurador convencional em bicamada com estrutura de zircônia seguida de estratificação com cerâmica de feldspato no primeiro molar inferior esquerdo. A literatura recente indica que cada uma dessas alternativas restauradoras apresenta vantagens e desvantagens específicas. Fatores como desempenho mecânico, fratura, características estéticas, sucesso clínico, taxas de complicações, desempenho de adesão e desgaste do antagonista são discutidos comparando os dois conjuntos restauradores. Os dados destacam que as coroas monolíticas evitam um grande problema relatado nas restaurações de duas camadas: o lascamento da cerâmica de recobrimento. As coroas monolíticas também permitem preparações dentárias minimamente invasivas, aumentando assim a preservação do remanescente dentário. No entanto, faltam dados que sustentem a similaridade do desempenho estético entre as montagens monolítica e bicamada, sendo a previsibilidade de uso restrita para a região posterior, pois casos que demandam alto apelo estético continuam a utilizar fundamentalmente as restaurações bicamada. Não foram encontradas falhas, e a satisfação do paciente foi relatada em ambas as técnicas após o acompanhamento de 12 meses.

How does atraumatic restorative treatment (ART) with high-viscosity glass ionomer cement (H-GIC) compare with conventional restorative treatment for children with dental caries in their primary teeth?

How does atraumatic restorative treatment (ART) with high-viscosity glass ionomer cement (H-GIC) compare with conventional restorative treatment for children with dental caries in their primary teeth?

Impact of Brix 3000 and conventional restorative treatment on pain reaction during caries removal among group of children in Baghdad city

Background: Pain and the usage of local anesthetic agents are still real problem in pediatric dentistry, for these reasons, the use of minimal invasive dentistry (MID) in regard to the patient comfort is important especially for children, anxious and uncooperative patients. Chemomechanical caries removal (CMCR) methods involve the selective removal of the carious dentine hence it avoided the painful removal of the sound dentine and the anxiety resulted due to the vibration of the hand piece which is also decreased thus it appears to be more acceptable and comfortable to the patient. Aims of this study: This study was conducted among group of children to assess and compare the anxiety rating scale (during and after treatment) between the use of a recent chemomechanical caries removal method (by using Brix 3000) and the use of rotary instruments (using the ceramic bur). Materials and methods: Thirty pediatric patients aged between 8-12years, with bilateral occlusal carious permanent molars (extending into dentin) were selected for this study. Carious lesions were removed using Brix 3000 (CMCR) on one side and rotary instruments on the contra lateral side. Both cavities were restored with light cured composite filling. Anxiety scores were determined using Frankle rating scale (1962) during and after the period of caries removal. Results: The anxiety rating scale during the period of treatment showed the percentage of the negative behavior in the CMCR method was less than the percentage of the ceramic bur reverse the positive and definitely positive, which means that the new CMCR agent (Brix 3000) was more comfortable than the conventional rotary instrument (ceramic bur), that reduced the need for local anesthesia and the use of the drill. While after the treatment there is no big difference in the acceptance of the patients in two groups. Conclusion: Brix 3000 gel as a CMCR is an effective alternative method for caries removal, which appears to be more comfortable for the patients and more conservative

Atraumatic vs conventional restorative treatment for root caries lesions in older patients: Meta- and trial sequential analysis.

We aimed to appraise the comparative clinical efficacy of atraumatic restorative treatment (ART) versus conventional restorative treatment (CT) using a meta-analysis, and assessed the robustness of evidence by trial sequential analysis (TSA). Due to its simplified clinical approach, ART may be advantageous over CT for restoration of root caries lesions in institutionalised older patients. Three electronic databases (PubMed, Embase and Cochrane CENTRAL) were screened, and hand searches and cross-referencing performed to identify randomised controlled trials reporting on survival of ART vs CT for restoration of root caries in older patients. Trial selection, data extraction and risk of bias assessment were performed by two independent reviewers. ART and CT were compared using fixed- or random-effects pairwise meta-analysis for per-protocol (PP), intention-to-treat (ITT) and best-case scenarios. TSA was used to control for risk of random errors. A total of 235 studies were identified, and three trials involving 130 patients (463 restorations) were included. Risk of bias was high or moderate in all but one trial. ART was associated with a significantly increased risk of failure (OR [95% CI] 2.06 [1.06/4.00]) in PP- but not in ITT analysis (1.36 [0.92/2.02]). Analyses for best-case scenarios found great uncertainty introduced by attrition. No firm evidence was reached according to TSA. For restoration of root caries, there is insufficient data to clearly rule out whether differences between ART and CT exist. Limited available data indicate there might be an increased risk of failure for ART.

Comparison of Silver Modified and Conventional Atraumatic Restorative Treatment Modalities

Comparison of Silver Modified and Conventional Atraumatic Restorative Treatment Modalities

Scientific evidence for the management of dentin caries lesions in pediatric dentistry: A systematic review and network meta-analysis.

BackgroundA systematic quantitative evaluation of the available evidence of the treatment for caries lesions in primary teeth that considers how different caries progressions lead to the need for distinct interventions might provide additional useful information for clinical evidence-based decision making. The aim of this systematic review and network meta-analysis was to verify the effect of the treatments on caries lesion arrestment (CLA) or the success rate (SR) of dentin caries lesion treatments in the primary teeth.MethodsA search was conducted using the MEDLINE/PubMed, Web of Science and Scopus databases through December 2017. The primary search terms used in combination were primary teeth, caries lesion and restoration. The grey literature was also screened, as were the reference lists of eligible studies. A search of prospective studies with at least 12 months of follow up that compared different techniques was performed. The exclusion criteria were the absence of a comparison group; no evaluation of different restorative techniques; the evaluation of other outcomes unrelated to this review; and the recruitment of specific patient. The risk of bias was evaluated by the tools: the Cochrane Handbook for Systematic Reviews of Interventions and ROBINS-I. A network meta-analyses and meta-analyses were conducted considering CLA or SR as outcomes according to the surface involved and the depth of progression.ResultsOf the 1671 potentially eligible studies, 15 were included. For occlusal surfaces, only two studies presented data regarding the outer half of the dentin, with conventional restorative treatment (CRT) using composite resin showing superior results; five studies presented data regarding the depth of caries lesions, and CRT with compomer resulted in the best results. Seven studies considered occlusoproximal surfaces, and the Hall technique showed the best SR among the evaluated treatments. Finally, two annual applications of silver diamine fluoride showed the best nonrestorative approach to arrest caries lesions on occlusal and smooth surfaces.Discussion/ConclusionsThe treatments for dentin caries lesions in primary teeth depend on the depth of progression and the surface involved. However, few of the included studies provided evidence to strongly recommend the best treatment option.OtherFunding: FAPESP; Systematic review registration number—PROSPERO CRD42016037784.

Interproximal grinding (disking) of caries in primary molars, attitudes and the extent utilized in a Swedish County

Objective: To assess the occurrence of interproximal grinding as a caries therapy in primary molars, to what degree grinding replaced conventional restorative caries therapy, to what extent anaesthesia was used while grinding and to assess open comments about attitudes about grinding.Materials and methods: A questionnaire was sent to 108 public dental service clinics with questions concerning the use of grinding as a therapy and alternative to restorative treatment, the use of anaesthesia prior to conventional caries therapy and grinding, respectively. In addition, a content analysis of open comments about grinding was performed.Results: Grinding had been performed in 96% of the clinics. Two-thirds of the dentists used grinding as an alternative to conventional restorative treatment at some point. Most dentists used anaesthesia prior to restorative therapy. Prior to grinding, the frequency of anaesthesia was lower (median 5.0) than for conventional restorative therapy (median 8.7) (p < .001). The open comment analysis revealed complex reasons for the use of grinding.Conclusions: Grinding has been widely practiced in parts of Sweden, is presently a technique employed by a multitude of dentists, and that anaesthesia is used less frequently prior to grinding, in comparison to conventional restorative therapy. Dentist considered grinding as a treatment option in specific situations.

Microcomputed Tomography Evaluation of Dentine Mineral Concentration in Primary Molars Managed by Three Treatment Protocols

The objectives of the study were to quantify the dentine mineral concentration (DMC) in teeth restored conventionally, according to the atraumatic restorative treatment (ART) and ultraconservative (UCT) protocols (open cavities and small ART restorations), and the DMC underneath the open cavities of teeth managed by UCT versus nontreated, open cavities. We studied 50 teeth with restorations/open cavities, 39 restored teeth (9 by conventional restorative treatment [CRT], 17 by ART, and 13 by UCT) and 16 teeth with open cavities. Each restoration/open cavity was scanned using microcomputed tomography, with 3 hydroxyapatite disks with respective densities of 1.24, 1.33, and 1.57 g/cm³ as a reference. Images were reconstructed and the greyscale images were converted into DMC values. For each restoration/open cavity, 15 measurements of dentine immediately underneath and from the corresponding area in sound dentine were taken. DMC was expressed as a percentage of the DMC of sound dentine. ANOVA and the Student t test were used for statistical analysis. The mean DMC underneath restorations of the ART protocol group (98.93%) was statistically significantly higher than that of the UCT protocol group (91.98%), but not of the CRT protocol group (91.33%). On multiple surfaces, mean DMC in the axial area (94.32%) was statistically significantly higher than in the gingival area (92.80%). The mean DMC of open cavities managed by UCT protocol (89.05%) was statistically significantly higher than in nontreated open cavities (83.90%). In conclusion, a dentine-hypermineralized area underneath ART restorations was observed. Managing open cavities with a toothbrush and fluoride toothpaste (the UCT protocol) resulted in higher mineralized dentine underneath the cavity than in nontreated open cavities.

Pain and anxiety in children receiving atraumatic and conventional restorative dental treatment - a randomized clinical study

Pain and anxiety in children receiving atraumatic and conventional restorative dental treatment - a randomized clinical study

Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries.

Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries.

The Hall Technique and conventional restorative treatment in New Zealand children's primary oral health care - clinical outcomes at two years.

New Zealand children's oral health care is mostly provided in primary care oral health clinics. Little is known about treatment outcomes. To investigate different treatment outcomes of primary molar carious lesions in a sample of children in primary care. Quasi-experimental study of 180 5- to 8-year-old children. Each child had one carious primary molar treated by a dental therapist with a plastic restorative material (PRM) or a pre-formed stainless steel crown placed with the Hall Technique (HT). After 2years, restorative outcomes were categorised as success, minor failure, or major failure. Data were analysed using Chi-square tests. A total of 147 (82%) children were followed up; mean follow-up period 25months (range: 21-35months). Failure was observed significantly more in the PRM group (32%) than the HT group (6%). When baseline carious lesions were radiographically deep with marginal ridge breakdown (MRB), there was a higher proportionof major failures than when they were shallow without MRB (33% and 1%, respectively;P<0.001). Among the deep lesions, those treated with the HT showed better success than PRM. There was a much higher success rate in the children treated with HT than PRM. Deep carious lesions responded better to HT than PRM.

Long-term Effect of Supervised Toothbrushing on Levels of Plaque and Gingival Bleeding Among Schoolchildren.

To test the hypothesis that, in high caries-risk children, supervised toothbrushing (STB) reduces visible plaque levels and gingival bleeding to a greater extent than does unsupervised toothbrushing (USTB) in comparable children and in low caries-risk USTB children over 4 years. High caries-risk schoolchildren, ages 6 to 7, were allocated to three oral healthcare protocols using a cluster-randomised design: 1. Ultra-Conservative Treatment (UCT): small cavities in primary molars were restored using ART, while medium and large cavities were left open and cleaned under daily supervised toothbrushing together with the remaining dentition (UCT/STB); 2. Conventional Restorative Treatment (CRT): primary molars were restored with amalgam, while high caries-risk first permanent molars received resin sealants (CRT/USTB); 3. Atraumatic Restorative Treatment (ART): primary molars were restored using ART, while high caries-risk first permanent molars received ART sealants (ART/USTB). Low caries-risk children (dmft ≤ 1) formed the no-treatment/USTB group. 273 children were examined at baseline (T0) and after 4 years (T1) according to the VPI and GBI indices. Data were analysed using linear and logistic regression. Mean VPI and mean GBI scores were statistically significantly lower at T1 than at T0. Reduction in mean VPI scores in UCT/STB children was statistically significantly higher than for CRT+ART/USTB children over 4 years (p = 0.03), but no difference was observed between UCT/STB and no-treatment/USTB children (p = 0.361). No statistically significant difference in the reduction of mean GBI scores was observed between UCT/STB and CRT+ART/USTB (p = 0.62) and no-treatment/USTB children (p = 0.74). In high caries-risk children, the protocol based on supervised toothbrushing presented greater reduction in visible plaque levels than did protocols based on restorations and sealants over 4 years.

Selamento de lesão de cárie em metade externa de dentina em molar decíduo – relato de caso clínico com proservação de 12 meses

Introdução: A paralisação de lesões de cárie em metade externa de dentina é feita por meio de tratamentos conservadores. Objetivos: Relatar um caso clínico de um dente decíduo com lesão de cárie oclusal com pequena abertura e envolvimento dentinário radiograficamente restrito à metade externa de dentina; lesão controlada pela aplicação de um selante resinoso. Métodos: O selamento da superfície foi feito com o selante Fluoroshield aplicado com auxílio de uma sonda exploradora após condicionamento ácido da superfície. Resultados: As reavaliações foram feitas clínica e radiograficamente por 12 meses, sendo analisada a integridade do material e a estabilização da lesão de cárie. Após um ano, a integridade do selante e a não evolução radiográfica da lesão favoreceram um bom prognóstico ao caso. Conclusão: O selamento, desde que controlado periodicamente, atua de modo positivo na paralisação das lesões, podendo ser considerado como uma alternativa conservadora ao tratamento restaurador convencional.

Acceptability, feasibility and perceived satisfaction of the use of the Atraumatic Restorative Treatment approach for people with disability.

Unmet caries treatment need is prevalent among people with disability, partly due to difficulties cooperating with conventional dental treatment. This study compared Atraumatic Restorative Treatment (ART) with conventional restorative treatment (CRT) in the clinic and under general anaesthesia (GA), in terms of feasibility, acceptability and respondent satisfaction in patients referred for special care dentistry. Patients referred for dental restorative care were treated using either ART or CRT approach. Acceptance, feasibility and level of satisfaction with the treatment provided were assessed. ANOVA with Bonferroni correction and Chi-square tests investigated differences in age, gender and Visual Analogue Scale satisfaction scores. A total of 66 patients (mean 13.6 ± 7.8 years) were included and 43 respondents chose ART. ART was feasible for 47 patients, with optimal placement of restorations for 79% of all patients receiving ART. CRT in the clinic was chosen by 15 respondents and was feasible for 5 (33%). Local anaesthesia was required for 4 of the 47 patients receiving ART and for 3 of the 5 patients receiving CRT in the clinic. Neither ART nor CRT could be performed in the clinic for 14 patients who were treated under GA (21%). Respondent satisfaction was higher for those receiving ART than CRT (in the clinic and under GA). It was concluded that ART is a satisfactory, feasible, acceptable and effective approach to restorative dental treatment in patients with disability who have difficulty coping with conventional treatment. More research is now required to confirm these results in a larger study population.