Defective Restoration Research Articles

A Questionnaire-Based Survey Assessment of Iraqi Dentists Using Repair Versus Replacement of Defective Composite Restoration

Tooth restoration one of the most common procedures in dental practice. The replacement of the entire restoration leads to loss of tooth structure and increase risk of pulp injury; replacement is also time consuming and costly. According to the minimally invasive approach when minimal defects, repair is the better choice than the total replacement of the restoration. This study aims to evaluate repair rating versus replacement treatment procedure for defective composite fillings among Iraqi dentists. Material and methodology: A questionnaire survey were designed and distributed to 184 post-graduate dentists in Iraq. The inquiry pertained general information; including their clinical experience in years, their preference in terms of direct composite restoration, repair or replacement of old restorations, whether they taught the indications for repair, and the selection type of composite for repair. Result of 200 questioner’s disrepute, 184 questionnaires were completed and collected. The data revealed that the respondents with 1-5, 6-15 and16-25 years of experience were 62 (33.7%), 75 (40.8%), and 47(25.5%) of total respondents, respectively. The total 174 dentists (94.6%) prefer using tooth-colored restorations and 10 (5.4%) dislike this approach. Result clearly indicate that most of the dentists choose replacement for any fractured or discolored restorations. The data showed that 59.2% of dentist are not familiar with repair, and 40.8% dentists are familiar. The result revealed that 82.1% the dentists were not trained on repair during their undergraduate study. Generally, they had no ideal standard to replace or repair depending on their clinical experience. Therefore, clear criteria and guidelines for replacing and repairing should be developed and followed in post-graduate courses.

Outcomes of Class II composite restorations placed by dental students: An observational study

Introduction: Main objectives of restoring the teeth is to remove the caries and replace the tooth structure to restore form and function. This radiographic study aimed to determine the defective Class II composite restorations in permanent teeth placed by the undergraduate dental students in a private dental school. Materials and Methods: A retrospective analysis of bitewing radiographs of Class II composite restorations placed by the clinical dental students of 2017–2018 year was assessed to determine the defective restorations. Bitewing radiographs were examined to record voids, open contact, residual caries, open margin, defective restoration, and acceptable composite Class II restorations. Results: A total of 1514 permanent teeth filled with composite Class II restorations were assessed using bitewing radiographs. Almost 935 teeth showed signs of failure of Class II restorations. Reasons for the failure of most of the Class II composite restoration were due overhang 197 (13.01%), followed by voids 184 (12.15%), open contact 167 (11%), poor contour 165 (10.88%), open margin 135 (8.91%), and residual caries 87 (5.75%). A significant difference between male and female students was observed with regard to voids (P = 0.026), overhang (P = 0.016), and open margins (P = 0.001) of the Class II composite restorations. Conclusion: Overhang was the most common, and residual caries was the least common defects observed in the bitewings. Male dental students placed higher defective composite Class II restorations compared to the female dental students.

Dynamic Changes in Ex Vivo T-Cell Function After Viral Clearance in Chronic HCV Infection

Direct-acting antiviral (DAA) agents can successfully treat chronic hepatitis C virus (HCV) infection. However, the ex vivo HCV-specific T-cell function following viral clearance remains unknown. We investigated functional alterations and phenotypic changes in ex vivo HCV-specific CD8+ T cells with a longitudinal analysis of 41 patients with chronic HCV infection who were undergoing DAA treatment. A patient subset exhibited a significantly increased T-cell response (mainly CD8+ T cells) at week 4 of treatment. However, this increased T-cell response diminished in later weeks. Relative to pretreatment levels, the ex vivo HCV-specific CD8+ T-cell frequency decreased at 12 weeks after the end of treatment, along with a decreased antigen-experienced CD8+ T-cell population. DAA treatment increased the proliferative capacity of HCV-specific CD8+ T cells, but this change was not correlated with ex vivo function. Patients experiencing viral breakthrough or relapse exhibited defective restoration of T-cell function. Our present results indicated that DAA-mediated viral clearance only transiently restored ex vivo T-cell function, suggesting a need to enhance T-cell function in DAA-treated patients.

Repair potentiality of CAD/CAM composite block and hybrid ceramic block by direct resin composite restoration with and without surface treatment

Objective: to evaluate microshear bond strength of CAD/CAM composite block and hybrid ceramic block repaired by direct resin composite restoration with and without surface treatment.Materials and Methods: Two different CAD/CAM restorative materials were tested in the present study: hybrid ceramic blocks (Vita Enamic) and resin composite blocks (Grandio). Six sections were prepared from each CAD/CAM blocks. The sections from each block type were randomly divided into three groups according to the surface treatment performed. Control group: the specimens were ground with a grinding machine. Etching gel Group: 37% phosphoric acid etching gel was applied occlusally on the surface of the section and CoJet Group. the surface of all groups were then silanized using Bis-Silane then bonding agent Futura bond DC was applied. A polyethylene micro tubes were prepared that were held in place with a tweezer on the uncured then light cured for 10 seconds Resin composite (Grandioso X-tra) was packed inside the microtubes and light cured. All specimens were prepared by the same operator at 22.0–22.5 ˚C (room temperature) and relative humidity of 50%. The specimens were further divided into two groups according to storage conditions. Half of the specimens were thermocycled in distilled water for 5000 cycles in a 5–55˚C water bath with a dwell time of 30 seconds and a transfer time of 5 seconds. The other specimens were stored in distilled water for 2 days. Microshear bond strength was performed and fractographic analysis to determine the failure mode. Statistical analysis was then performed using a commercially available software program (SPSS 19; SPSS, Chicago, IL, USA). As data were not normally distributed, significance of the difference between different groups within the same surface pretreatment was evaluated using Kruskall Wallis test. Mann Whitney U test was used for pairwise comparisons and to study the effect of surface pre-treatment. The interaction of restoration and type of pretreatment variables was evaluated using 3 ways ANOVA. The level of significance was set at P < 0.05.Results: Three ways ANOVA test revealed that each of the material type (composite/hybrid ceramic), the subgroup type group (control/etching/Cojet) and the thermocycling (Yes/No) variables resulted in a statistically significant difference (p=0.00, p=0.00, p=0.003 respectively). Interaction of the subgroup (control/etching/Cojet) variable with the thermocycling (Yes/No) variable and the material (composite/hybrid ceramic) variable showed a statistically significant difference (P=0.023, p=0.001 respectively). Moreover, interaction of thermocycling and material variable resulted in a significant difference (p=0.034). However, interaction of the 3 study variables (material, subgroup, thermocycling) was not statistically significant (p=0.165). The failure mode of the tested specimens analyzed using Scanning Electron Microscope at magnification 80X was commonly mixed type of failure (adhesive failure between resin composite restoration and CAD/CAM blocks with cohesive failure within resin composite restoration).Conclusions: Grandio composite blocks is very promising materials and their optimum long lasting repair potentiality that offers to the clinicians great chance to easily repair the defective restoration with safety. Surface treatment using Phosphoric acid or Cojet system greatly improve the bond strength between composite repair system and hybrid ceramic or composite blocks. The bond performance of repaired composite blocks was much more greater than than that of repaired hybrid ceramic. Thermocycling affect the bond durability of repaired hybrid ceramic blocks and composite blocks.Further investigations focusing on the effect of different surface treatments to yield results that lead to concrete clinical recommendations are needed to evaluate the long term durability of new CAD/CAM materials.

Very serious limitations in systematic review summarizing how minimally invasive techniques compare with defective restoration replacement render it not useful for making clinical decisions

de Carvalho Martins BM, da Silva EJNL, Tavares Pereira Ferreira DM, Rodrigues Reis K, da Silva Fidalgo TK. Longevity of defective direct restorations treated by minimally invasive techniques or complete replacement in permanent teeth: a systematic review [published online ahead of print September 3, 2018]. J Dent. https://doi.org/10.1016/j.jdent.2018.09.001.

Removing or Controlling? How Caries Management Impacts on the Lifetime of Teeth.

Historically, traditional carious lesion management focused on the importance of removal of all carious tissue, with little thought to the lesion origins. The surgical removal of any sign of a carious lesion was prioritised with little, or no, consideration to pulp vitality, loss of tooth structure, or caries disease management. This symptomatic approach concentrating on lesions rather than on the cause of the disease, focused on preventing secondary carious lesion development. Early detection and improved understanding of the caries process - that lesion progress can be arrested or slowed - has led to preventive measures and less destructive management as a focus. The choice of lesion management depends on: whether a primary or permanent tooth is involved; which tooth surface(s) is/are involved; whether the lesion is confined to enamel or extends into dentine; the lesion depth, and lesion cleansability. Use of preventive and minimally invasive operative strategies is complicated by the lack of predictable ways of recording lesions' status to allow early detection of failed strategies and early intervention. Because re-restoration usually makes the cavity larger and, consequently, the tooth weaker, the clinician should be certain about initiating the repeat restoration cycle, delaying the first restoration as much as possible. The 3 main principles that support preventing or slowing the repeat restoration cycle are: (1) avoid restoration placement until there is no other option; (2) place them for maximum longevity; (3) if re-restoration is necessary, repair or refurbishment is preferable to replacement of a defective restoration.

Attitudes of Greek dentists towards repair of conservative restorations. An online survey

Repair versus replacement of a defective direct restoration is one important step for conserving tooth structure. This study was designed to collect information on the attitudes of Greek dentists towards repairing direct restorations. An electronic questionnaire with 16 multiple-choice and rank-ordering questions was created online and its URL address was randomly emailed to 800 dentists in the area of Athens, Greece. The questionnaire remained open for 3months, and after two reminder emails the data collected were analysed statistically to identify differences between clinician's sex or years of practicing dentistry, using the chi-square and Kruskal-Wallis tests at α=0.05. Three-hundred and twenty dentists completed and submitted the questionnaire (response rate = 40%). A high proportion (86.8%) of the respondents reported that they routinely repair defective restorations, ranking the order of their frequency as 2.47 for amalgam and 2.41 for resin restorations. The reasons, with the highest ranks, for repairing amalgams were the restoration of bulk fractures (4.10) and restoration of marginal fractures (3.69). For repair of resin restorations, the reasons with the highest ranks were improving their colour (4.04) and removing marginal discoloration (3.99). Moreover, 94.1% of the respondents stated that they were enough, much and very much satisfied with the repair, 1year after it was performed. A high percentage of Greek dentists are repairing defective direct restorations. There are discrepancies in the indications, techniques and materials used for repairs, such as bulk fractures and marginal restorations. Further studies on the efficacy of repairs, the criteria and procedure protocols are needed. Further, additional clinical education should be offered at the undergraduate or continuing education levels.

Repair may increase survival of direct posterior restorations – A practice based study

ObjectivesTo investigate repairs of direct restorations by a group of Dutch general dental practitioners (GDPs) and its consequences on longevity of restorations. MethodsData set was based on dental records of patients attending 11 general dental practices (24 Dentists) in the Netherlands. Patients that received Class II Amalgam or Composite restorations were included in the study. The outcomes were considered in two levels: “Success” – When no intervention was necessary on the original restoration, it was considered clinically acceptable. “Survival” – Repaired restorations were considered clinically acceptable. Kaplan–Meier statistics and Multivariate Cox regression were used to assess restorations longevity and factors associated with failures (p<0.05). Results59,722 restorations placed in 21,988 patients were analyzed. There was a wide variation in the amount of repairs among GDPs when a restoration had failed (Level 1). Repairs of multi-surface restorations were more frequent (p<0.001). A total of 9253 restorations (Level 1) or 6897 restorations (Level 2) had failed in a 12-year observation time. “Success” and “Survival” of the restorations reached 65.92% (AFR=4.08%) and 74.61% (AFR=2.88%) at 10 years, respectively. Patient (age, removable denture) and tooth/treatment-related factors (molars, >2 restored surfaces, endodontic treatment, Amalgam) were identified as risk factors for failure (p<0.001). ConclusionOverall, the GDPs showed satisfactory rates of restoration longevity over 10 years. Repair can increase the survival of restorations although, substantial differences exist among practitioners in repair frequency and AFRs. Molars, multi-surface restorations, presence of an endodontic treatment and a removable denture were identified as risk factors for failure. Clinical significanceRepair, instead of total replacement of a defective restoration, is a Minimally Invasive procedure which can increase the survival of the original filling, reducing the risk for pulp complications and treatment costs.

Regeneration of Defective Epithelial Basement Membrane and Restoration of Corneal Transparency After Photorefractive Keratectomy.

To study regeneration of the normal ultrastructure of the epithelial basement membrane (EBM) in rabbit corneas that had -9.00 D photorefractive keratectomy (PRK) and developed late haze (fibrosis) with restoration of transparency over 1 to 4 months after surgery and in corneas that had incisional wounds. Twenty-four rabbits had one of their eyes included in one of the two procedure groups (-9.00 D PRK or nearly full-thickness incisional wounds), whereas the opposite eyes served as the unwounded control group. All corneas were evaluated with slit-lamp photographs, transmission electron microscopy, and immunohistochemistry for the myofibroblast marker alpha-smooth muscle actin and collagen type III. In the -9.00 D PRK group, corneas at 1 month after surgery had dense corneal haze and no evidence of regenerated EBM ultrastructure. However, by 2 months after surgery small areas of stromal clearing began to appear within the confluent opacity (lacunae), and these corresponded to small islands of normally regenerated EBM detected within a larger area of the excimer laser-ablated zone with no evidence of normal EBM. By 4 months after surgery, the EBM was fully regenerated and the corneal transparency was completely restored in the ablated zone. In the incisional wound group, the two dense, linear corneal opacities were observed at 1 month after surgery and progressively faded by 2 and 3 months after surgery. The EBM ultrastructure was fully regenerated at the site of the incisions, including around epithelial plugs that extended into the stroma, by 1 month after surgery in all eyes. In the rabbit model, spontaneous resolution of corneal fibrosis (haze) after high correction PRK is triggered by regeneration of EBM with normal ultrastructure in the excimer laser-ablated zone. Conversely, incisional wounds heal in rabbit corneas without the development of myofibroblasts because the EBM regenerates normally by 1 month after surgery. [J Refract Surg. 2017:33(5):337-346.].

Repair vs replacement of direct composite restorations: a survey of teaching and operative techniques in Oceania

ObjectivesTo evaluate the teaching and operative techniques for the repair and/or replacement of direct resin-based composite restorations (DCRs) in dental schools in Oceania. MethodsA 14-item questionnaire was mailed to the heads of operative dentistry in 16 dental schools in Oceania (Australia, New Zealand, Fiji and Papua New Guinea). The survey asked whether the repair of DCRs was taught within the curriculum; the rationale behind the teaching; how techniques were taught, indications for repair, operative techniques, materials used, patient acceptability, expected longevity and recall systems. ResultsAll 16 schools participated in the study. Thirteen (81%) reported the teaching of composite repairs as an alternative to replacement. Most schools taught the theoretical and practical aspects of repair at a clinical level only. All 13 schools (100%) agreed on tooth substance preservation being the main reason for teaching repair. The main indications for repair were marginal defects (100%), followed by secondary caries (69%). All 13 schools that performed repairs reported high patient acceptability, and considered it a definitive measure. Only three schools (23%) claimed to have a recall system in place following repair of DCRs. Most respondents either did not know or did not answer when asked about the longevity of DCRs. ConclusionsRepair of DCRs seems to be a viable alternative to replacement, which is actively taught within Oceania. Advantages include it being minimally invasive, preserving tooth structure, and time and money saving. However, standardised guidelines need to be developed and further clinical long-term studies need to be carried out. Clinical significanceThe decision between replacing or repairing a defective composite restoration tends to be based on what clinicians have been taught, tempered by experience and judgement. This study investigated the current status of teaching and operative techniques of repair of direct composite restorations in dental schools in Oceania.

Judgment of the Quality of Restorative Care as Predictors of Restoration Retreatment: Findings from the National Dental PBRN.

Dental patients' ratings of their dentist's skills were not related to a restoration needing retreatment. Patients focus on other aspects of the dental visit when making this judgment.

Effect of Finishing Time on Microleakage at the Composite-Repair Interface.

Background:Repair is a conservative treatment of defective composite restoration. Sealing the repair interface is a critical factor to achieve successful repaired restorations.Objective:The aim of this study was to evaluatethe effect of three finishing times on the microleakage at the composite-repair interface.Method:Eighty composite specimens (Z250) were made and aged for eight weeks in water. They were randomly divided into four groups. In the control group, repairing was done with no surface treatment and using bonding agent. In groups 2 to 4, the specimens were repaired following roughening, etching and use of Adper Single Bond, and finished immediately, after 20 minutes and after 24 hours, respectively. After thermocycling, the microleakage at the repair interface was assessed using dye-penetration technique. The results were analyzed using Kruskal-Wallis and Mann-Whitney tests (α=0.05).Results:There was a significant difference among the four groups (P<0.001). The control group with the highest leakage showed a significant difference with the other groups (P<0.05). Immediate finishing showed a significantly higher leakage compared to 20-minute and 24-hour delayed finishing time (P<0.001). The two latter groups had no difference.Conclusion:Immediate finishing of the repaired restorations negatively affect the sealing at the repair interface, while 20-minute and 24-hour delayed finishing had no adverse effect on the interface sealing.

Insulin secretion impairment in Sirt6 knockout pancreatic β cells is mediated by suppression of the FoxO1-Pdx1-Glut2 pathway.

Sirtuin 6 (Sirt6), a chromatin associated class III deacetylase, controls whole-body energy homeostasis and has a critical role in glucose-stimulated insulin secretion (GSIS) in pancreatic β cells. However, its underlying molecular mechanism remains poorly understood. To gain further insights, we studied the pathway by which Sirt6 regulates GSIS utilizing mice lacking Sirt6 in their β cells (βS6KO). Further, we overexpressed wild type or deacetylase-inactive mutant Sirt6 in isolated islets as well as in MIN6 cells. We confirmed that βS6KO mice developed glucose intolerance with severely impaired GSIS. Gene expression analysis of knockout islets and overexpression studies demonstrated that Sirt6 deacetylates forkhead box protein O1 (FoxO1) to trigger its nuclear export and releases its transcriptional repression of key glucose sensing genes such as Pdx1 and Glut2. Ectopic overexpression of Sirt6 in knockout islets resulted in rescue of the defective insulin secretion and restoration of the expression of Pdx1 and Glut2. These results show that Sirt6 in pancreatic β cells deacetylates FoxO1 and subsequently increases the expression of Pdx1 and Glut2 to maintain the glucose-sensing ability of pancreatic β cells and systemic glucose tolerance.

Management of dentin hypersensitive

Dentin hypersensitivity is a common problem found in both male and female, mainly of older age. Discomfort or pain perceived in dentin hypersensitivity is caused by crown surface area that is not protected by enamel or dental root that is not protected by cementum. Characteristic of dentin hypersensitivity is acute, brief but sharp pain in dentin that is not covered by enamel. Pain can also be caused by edge leak on a defective restoration, fractured teeth, and disorder. Therefore, a thorough examination is required in order to apply the appropriate treatment. Various action and material can be used to treat this condition, however the principle idea is to organize intradental nervous activity or seal off dentinal tubule. On a case of dentin hypersensitivity due to cavity lesion either caused by caries or non caries, restoration has to be done. Condition without cavity can be treated with desenzitising agent such as sodium fluoride solution applied using particular device, fluoride toothpaste, calcium phosphate sillicate. The aim of this paper is to inform the etiology, mechanism of stimulation spread, and case management.

Progress in research on defective protein trafficking and functional restoration in HERG-associated long QT syndrome

The human ether-a-go-go related gene (HERG) encodes the α -subunit of the rapid component of the delayed rectifier K(+) channel, which is essential for the third repolarization of the action potential of human myocardial cells. Mutations of the HERG gene can cause type II hereditary long QT syndrome (LQT2), characterized by prolongation of the QT interval, abnormal T wave, torsade de pointes, syncope and sudden cardiac death. So far more than 300 HERG mutations have been identified, the majority of which can cause LQT2 due to HERG protein trafficking defect. It has been reported that certain drugs can induce acquired long QT syndrome through directly blocking the pore and/or affecting the HERG trafficking. The trafficking defects and K(+) currents can be restored with low temperature and certain drugs. However, the mechanisms underlying defective trafficking caused by HERG mutations and the inhibition/restoration of HERG trafficking by drugs are still unknown. This review summarizes the current understanding of the molecular mechanisms including HERG trafficking under physiological and pathological conditions, and the effects of drugs on the HERG trafficking, in order to provide theoretical evidence for the diagnosis and treatment of long QT syndrome.

Repair or replacement of restorations: A prospective cohort study by dentists in The National Dental Practice-Based Research Network

BackgroundA prospective cohort study that included dentists in The National Dental Practice-Based Research Network was conducted to quantify 12-month failures of restorations that were repaired or replaced at baseline. The study tested the hypothesis that no significant differences exist in failure percentages between repaired and replaced restorations after 12 months. It also tested the hypothesis that certain dentist, patient, and restoration characteristics are significantly associated with the incidence of restoration failure. MethodsDentists recorded data for 50 or more consecutive defective restorations. The restorations that were either repaired or replaced were recalled after 12 months and characterized for developing defects. ResultsDentists (N = 195) recorded data on 5,889 restorations; 378 restorations required additional treatment (74 repaired, 171 replaced, 84 teeth received endodontic treatment, and 49 were extracted). Multivariable logistic regression analysis indicated that additional treatment was more likely to occur if the original restoration had been repaired (7%) compared with replaced (5%) (odds ratio [OR], 1.6; P < .001; 95% confidence interval [CI], 1.2-2.1), if a molar was restored (7%) compared with premolars or anterior teeth (5% and 6%, respectively) (OR, 1.4; P = .010; 95% CI, 1.1-1.7), and if the primary reason was a fracture (8%) compared with other reasons (6%) (OR, 1.3; P = .033; 95% CI, 1.1-1.6). ConclusionsAn additional treatment was more likely to occur within the first year if the original restoration had been repaired (7%) compared with being replaced (5%). However, repaired restorations were less likely to need an aggressive treatment (replacement, endodontic treatment, or extraction) than replaced restorations. Practical ImplicationsOne year after repair or replacement of a defective restoration, the failure rate was low. However, repaired restorations were less likely to need an aggressive treatment than replaced restorations.

Factors influencing repair of dental restorations with resin composite.

The presentation of patients with dental restorations that exhibit minor defects is one of the commonest clinical situations in the practice of general dentistry. The repair of such restorations, rather than replacement, is increasingly considered to be a viable alternative to replacement of the defective restoration. This paper considers factors influencing the repair of direct restorations, including indications and details of relevant techniques, based on the best available knowledge and understanding of this important aspect of minimal intervention dentistry. Practitioners who do not consider repair before deciding to replace restorations that present with limited defects are encouraged to consider including repair in the treatment options in such situations. The effective repair of direct restorations can greatly influence the rate of descent down the “restorative death spiral”.

The decision to repair or replace a defective restoration is affected by who placed the original restoration: Findings from the National Dental PBRN

ObjectivesTo evaluate how restoration characteristics are associated with the decision to repair or replace an existing restoration. The following hypotheses were studied: dentists who placed the original restoration are more likely to repair instead of replace restorations (H1) that are in molar teeth; (H2) that are in the upper arch; (H3) that have amalgam restorative material; (H4) if a fracture is not the primary reason for the defect; and (H5) when the restoration comprises more than one surface. MethodsThis cross-sectional study used a consecutive patient/restoration recruitment design. 194 dentists members of a dental practice-based research network recorded data on restorations in permanent teeth that needed repair or replacement. ResultsFor 6623 of the 8770 defective restorations in 6643 patients, the treatment was provided by the dentist who had not placed the original restoration (75%). The 2-way interaction revealed that dentists who had placed the original restoration often chose to repair when the defective restoration was in a molar, relative to premolar or anterior teeth (OR=2.2, p<.001); and chose to replace when the restoration had amalgam (OR=0.5, p<.001), and when it was a fracture compared to another reason (OR=0.8, p=001). ConclusionMost dentists are not conservative when they revisit a restoration that they originally placed regardless of type of failure, number of surfaces or material used. However, dentists who had placed the original restoration were significantly more likely to repair it when the defective restoration was in a molar tooth. Clinical significanceMost dentists who placed the original restoration were prone to replace it, however if the defective restoration was located in a molar tooth they would consider repairing it.

Characterization of circulating endothelial microparticles and endothelial progenitor cells in primary Sjögren's syndrome: new markers of chronic endothelial damage?

Chronic autoimmune diseases are associated with increased risk of cardiovascular death. Endothelial dysfunction represents the first stage of subclinical atherosclerosis and multiple factors contribute to endothelial injury. Among these, an altered balance between endothelial microparticle (EMP) release and endothelial progenitor cell (EPC) generation promotes endothelial dysfunction. The role of EMPs and EPCs in promoting endothelial damage in primary SS (pSS) has never been investigated. Our aim was to evaluate the role of EMPs and EPCs as markers of endothelial damage in pSS and their correlation with disease clinical and immunological features. Circulating EMPs (CD31(+)/CD42(-)), true EPCs (CD34(+)/KDR(+)/CD133(+)) and mature EPCs (CD34(+)/KDR(+)/CD133(-)) were quantified by FACS analysis in 34 pSS patients and 18 age- and sex-matched controls. Correlation between EMP and EPC levels and parameters of disease activity and damage, clinical features and markers of immunological dysfunction was performed. Patients displayed higher EMP numbers with respect to healthy controls [HCs; mean 450 n/μl (S.D. 155) vs 231 (110), P < 0.0001]. EPC and mature EPC levels were higher in patients compared with HCs [mean 226 n/ml (S.D. 181) vs 69 (53), P < 0.001 and 166 (161) vs 36 (32), P < 0.0001, respectively). EMP levels directly correlated with disease duration from symptoms and diagnosis (ρ = 0.5, P < 0.01). Early EPCs inversely correlated with disease duration from symptoms (ρ = -0.5, P < 0.01) and diagnosis (ρ = -0.4, P < 0.05). This is the first demonstration of chronic endothelial fragmentation characterizing pSS. The reparative potentiality of the endothelial layer appears to be preserved in the earliest stages of disease. During the course of the disease, progressive exhaustion of the precursor endothelial pool may be hypothesized, leading to defective vascular layer restoration and endothelial dysfunction.

Defective amalgam restorations--repair or replace?

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, BIOSIS via Web of Knowledge, Web of Science and Opengrey databases were searched. In addition researchers and experts in the field were contacted to trace unpublished or ongoing studies. No restrictions were placed on the language or date of publication. Randomised controlled trials (including split-mouth studies), involving replacement and repair of amalgam restorations in adults with a defective molar restoration in permanent molar or premolar teeth were to be considered. Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. The search strategy retrieved 201 potentially eligible studies after de-duplication. After examination of the titles and abstracts, full texts of the relevant studies were retrieved but none of these met the inclusion criteria of the review. There are no published randomised controlled trials relevant to this review question. There is therefore a need for methodologically sound randomised controlled trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (www.consort-statement.org/). Further research also needs to explore qualitatively the views of patients on repairing versus replacement and investigate themes around pain, distress and anxiety, time and costs.