Placement Of Fissure Sealants Research Articles

Vitamin D deficiency and chronological hypoplasia with hypomineralisation: a case report.

Patients being reported for vitamin D deficiency (VDD) are increasing, particularly among the children and adolescents. This study aims to manifest the clinical and dental evaluations of a child with VDD, referred to the dental office. A 10-year-old British Asian boy was referred to the paediatric specialist dentistry clinic by the general dentist for dental management. The medical history depicted that the patient was diagnosed with VDD, secondary hyperparathyroidism and delayed growth. Moreover, his mother had the VDD during pregnancy. The patient was breast fed and had rickets in infancy. He was prescribed vitamin D supplements at the age of 16 months. He had received multiple dental treatments under local anaesthesia but with limited cooperation. Clinical examination revealed that the patient had chronological enamel hypoplasia shown as bands at the occlusal third on specific teeth. Suboptimal hygiene with general plaque induced gingivitis, dental caries in permanent and primary teeth, and delayed the teeth eruption. Preventions included appropriate oral hygiene and dietary advice, fluoride varnish application and fissure sealant placement. The treatments included anterior direct composite restoration, posterior composite restoration, stainless steel crowns and extractions. Thorough medical history is essential to understand the underlying causes of dental defects. Early dental intervention can restore the patient appearance and function and prevent further dental damage.

Retention and Caries Development after Pit and Fissure Sealant Placement among 6-14 Years Old School Children from Pimpri Chinchwad Municipal Corporation - Cohort Study

Aim: To check for the retention of sealants and caries experience of the teeth after 9 months.
 Methods: An interventional study was planned for the children of Government school in Pimpri, Pune, aged 6-14 years, where a total of 290 occlusal surfaces of molar teeth were selected to place GIC pit and fissure sealant. The oral screening was done to rule out children with carious and unerupted or children who didn’t need any sealant placement. The remaining were selected for placement of pit and fissure sealant.
 Results: At the end of the 9th month, the total retention rate was 67.93%. There was also a slight increase in caries experience in 8 children with dislodged sealants but the extent was not severe.
 Discussion: The pit and fissure sealants procedure are one of the widely accepted preventive treatments since the 1970s. The effectiveness of pit and fissure is allied with how long the sealants stay over the tooth surfaces and the degree of their presence. The GIC sealants though having the advantage of fluoride release after placement also have the disadvantage of difficulty in handling limiting their adoption and use.
 Conclusion: At the follow-up visit in the 9th month it was seen that the retention rate of sealant was 67.93%. Sealants were dislodged from the pit and fissures but remnants of sealants were present on the tooth which could have provided protection to the tooth from caries due to the fluoride-releasing property of GIC.

Parental Knowledge, Attitude and Practices Toward Dental Sealants as Preventive Strategy for Dental Caries in Children: A Cross Sectional Study.

Aim. This study aimed to evaluate the knowledge, attitude, and practices of parents residing in Pakistan toward pits and fissure sealants in children. Materials and Methods. This descriptive, cross-sectional study was carried out between November 2022 to March 2023. An online questionnaire was distributed through various social media platforms. Independent t-test and Multiple Linear Regression analysis were performed. Results. A total of 570 participants were recruited. For protection against tooth decay, most of the participants 456(80%) believed that fissure sealants should be placed to protect teeth from decay. Placement of fissure sealants was considered to be a cost-effective measure by majority of the 480 (84.2%) respondents. Conclusion. Fissure sealants are one of the most effective preventive measures against tooth decay. The knowledge, attitude and practice of parents were some being aware of fissure sealants and some were not. It appeared to support the placement of fissure sealants for their children.

Evaluation of In situ Adaptability of two types of fissure sealants placed with or without enameloplasty

Context: Literature has no consensus over the utility of enameloplasty before fissure sealant placement. Aim: The objective of the study was to explore the effect of enameloplasty using a scanned electron microscope on the adaptability of resin-modified glass ionomer versus flowable resin-based sealants. Settings and Design: An in vitro, experimental study was done from July to November 2017 at the NED University and Dow University of Health Sciences, Karachi, Pakistan. Materials and Methods: An in vitro experimental study was done, for which twenty extracted human molars and premolars were selected. They were divided into two groups on the basis of sealant type (resin-modified glass ionomer versus flowable resin-based sealant). The groups were further subdivided on the basis whether these were subjected to enameloplasty or not. All specimens were thermocycled, sectioned, dried, and gold sputtered before inspection under a scanning electron microscope (×50). Statistical Analysis Used: The adaptability of the sealant material in the tooth fissures was assessed on an ordinal scale. SPSS version 23.0 was used for data analysis. Mann–Whitney U-test and ordinal regression were applied at 0.05 level of significance. Results: There were no statistically significant differences between adaptability scores achieved with resin-modified glass ionomer-based sealant and flowable resin-based sealant (P = 0.96). Moreover, enameloplasty resulted in inferior adaptability of the two sealant materials (P = 0.02). Conclusions: Enameloplasty has shown to exert a negative influence over adaptation of the sealant material into the tooth fissure irrespective of the sealant chemistry.

Comparison of Fissure Sealant Chair Time and Patients’ Preference Using Three Different Isolation Techniques

This randomized clinical trial aimed to evaluate the patient’s preference and chair time needed during pit and fissure sealant placement under three isolation techniques (Isolite system, rubber dam isolation, and cotton roll isolation). Participants, aged 6–15 years and requiring four sealants on the first or second permanent molars, attending the pediatric dental clinics at King Saud University in Saudi Arabia were enrolled according to the inclusion criteria. Each participant received sealants on three random first or second permanent molars using three isolation techniques. The time required for sealant placement was recorded for each technique. Following sealant placement, an interview-based questionnaire was administered to the participants to evaluate their preference regarding the isolation techniques. Forty-eight children (23 male and 25 female) with a mean age of 8.58 ± 1.93 years participated in this study. The mean chair times were 248.14, 255.89, and 243.29 s for the Isolite system, rubber dam isolation, and cotton roll isolation, respectively. Approximately 79% of participants considered cotton roll isolation to be the most comfortable, whereas approximately 71% were significantly less likely to use rubber dam isolation again. In conclusion, there were no significant differences in sealant placement time among the three isolation techniques. However, cotton roll isolation was the technique that was most preferred by the participants.

Assessment of Cytotoxic and Genotoxic Effect of Fissure Sealants in Buccal Epithelial Cells.

AimThe main purpose of this study was to assess the genotoxic and cytotoxic effect of fissure sealants on buccal epithelial cells.Material and methodsThe study was conducted on 45 patients (27 girls and 18 boys), seven to 16 years of age (age mean 12.09 ± 2.20). Buccal swabs were collected before (T0), seven (T1), 30 (T2) and 90 days (T3) consequently after fissure sealant placement (Helioseal F®, Equia Fil®, Constic®). Patients or legal guardians filled in the questionnaire regarding the demographic data (age, gender), dietary habits, health status, medication usage, and recent X-ray exposure. DNA damage was analyzed using the micronucleus test.ResultsStatistically significant difference in the number of buccal cells with condensed chromatin was found between T0 (time before fissure sealant placement) and T3 (90 days after fissure sealant placement) period for Helioseal F® (P = 0.025). For the other two analyzed materials, no difference was observed during the tested period. There was no difference between materials in the same sampling time.ConclusionApart from an increase in cells with condensed chromatin 90 days after the placement of Helioseal F®, no other nuclear abnormalities were observed for tested fissure sealants. Although these sealants have now largely been used, it is of high importance that their biocompatibility is checked continuously, especially in in vivo clinical studies.

Evaluation of the Effectiveness of Sodium Hypochlorite Gel Application in Removing Dental Plaque Before Pit and Fissure Sealant Placement: A Randomized Controlled Clinical Trial

Evaluation of the Effectiveness of Sodium Hypochlorite Gel Application in Removing Dental Plaque Before Pit and Fissure Sealant Placement: A Randomized Controlled Clinical Trial

Pit and fissure sealants penetration capacity and their correlation with fissure morphology.

Background and aimsPit and fissure sealant placement corresponds to an effective approach of the prevention of caries on occlusal surfaces. Fissure morphology and dental material characteristics are the key factors for sealant effectiveness. The aim of this in vitro study was to compare the penetration ability of two commercially available pit and fissure sealants.MethodsTwenty sound human premolars extracted for orthodontic purpose have been sealed according to manufacturer’s instructions as follows: Group I (n=10), light-cured unfilled resin-based sealant, Admira Seal® (Voco GmbH); Group II (n=10), resin modified glass ionomer sealant without varnish, GC Fuji Triage® (GC Corporation). The teeth have been sectioned buccal-lingually in the middle of the occlusal surface, and the sections were examined at 40× with an inverted microscope.ResultsPenetration of the sealants was found to be greater in U-type fissure pattern (91.69%) followed by V-type (75.42%), IK-type (71.24%) and then in I-type (63.98%). The depth of penetration of GC Fuji Triage® (82.85%) demonstrated to be superior to Admira Seal® (76.28%).ConclusionU fissure design was more common than other fissure patterns and showed significantly higher penetration for the two type of sealants evaluated. Resin modified glass ionomer sealant used in the present study perform comparably with the filled resin sealant.

Dental caries experience in children of a remote Australian Indigenous community following passive and active preventive interventions.

ObjectivesTo report on changes in dental caries experience in children of a remote Indigenous community following 6 years of passive preventive intervention (PPI) and 2 years of active preventive intervention (API).MethodsFive consecutive cross‐sectional surveys were conducted on 4‐ to 15‐year‐old school going children between 2004 and 2017 following phases of Community Water Fluoridation (CWF), post‐cessation of CWF and API. Following treatment of any cavities present, API included selective placement of fissure sealants (FS) and an annual application of povidone‐iodine (PI) and fluoride varnish (FV). The World Health Organization's (WHO) “Oral Health Surveys – Basic Methods (4th Edition)” methodology was used in the first two and the International Caries Detection and Assessment System (ICDAS‐II) in the latter three surveys. ICDAS‐II codes of 3‐6, representing advanced caries, were combined to allow comparison to the decayed component of the DMF caries index.ResultsAge‐weighted mean dmft decreased by 37.7% in the deciduous (DD) and DMFT by 35% in the permanent (PD) dentitions between the pre‐ and post‐CWF surveys, followed by increases of 25% and 7.7%, respectively, between the 1‐year and 4‐year post‐CWF surveys. After 2 years of API, mean dmft decreased by 14.3% and DMFT by 7.1%. Untreated dental caries however remained a concern in the DD and PD during both phases of PPI and of API. The decline in caries experience for both dentitions following 2 years of API exceeded that for the 6‐year period of PPI.ConclusionsThe annual reductions in caries experience of 7.2% (DD) and 8% (PD) during the phase of API exceeded annual decreases of 4.7% (DD) and 4.6% (PD) during the phase of PPI. Due to remoteness, cost and logistics in ensuring long‐term viability of API programmes, CWF remains necessary in this type of community.

Combined Effect of Enamel Deproteinization and Intermediate Bonding in the Retention of Pit and Fissure Sealants in Children: A Randomized Clinical Trial.

This manuscript shows if enamel deproteinization along with an intermediate layer of bonding enhances the retention of pit and fissure sealants.. Two hundred six mandibular first permanent molars were allocated to Group I (n=103) and Group II (n=103). Group I underwent deproteinization, acid etching, bonding agent application and pit & fissure sealant placement while Group II treated with acid etching followed by pit & fissure sealant application only. Clinical analysis of all the teeth in the two groups was performed at 1, 3, 6, 9 and 12 months respectively. Pearson's chi - square test was utilized to evaluate the success of both treatment procedures (p<0.05). At 12 months follow up the differences between the groups pertaining to Marginal integrity, Marginal discoloration and Anatomical form were statistically significant suggesting enhanced retention in Group I. Enamel deproteinization along with the use of intermediate bonding layer significantly enhances the retention of pit and fissure sealants in terms of enhanced marginal integrity, decreased marginal discoloration and preserving the anatomical form.

Assessment of microleakage of class V restored by resin composite and resin-modified glass ionomer and pit and fissure resin-based sealants following Er:YAG laser conditioning and acid etching: in vitro study.

AimThe aim of this study was to make a comparison between microleakage of conventionally restored class V cavities using acid etchant and the ones conditioned by erbium-doped yttrium aluminum garnet (Er:YAG) laser, and also to assess and compare the effectiveness of enamel surface treatments of occlusal pits and fissures by acid etching and conditioned by Er:YAG laser-etch.Materials and methodsSeventy-two extracted third molars were used in this study. The samples were divided into two major groups: class V cavities and pit and fissure sealants. Each subgroup was divided into conventional acid etching, Er:YAG laser conditioning and conventional acid etching, and combination with Er:YAG laser conditioning (n=12). The teeth were placed in 2% methylene blue dye solution, were sectioned, and were evaluated according to the dye penetration criteria. Two samples per subgroup were chosen for scanning electron microscopic (SEM) analysis.ResultsThere was a significant difference between occlusal and cervical margin groups. Laser conventional composite cementum group showed more microleakage values compared to other groups. There was no significant difference between occlusal margin groups. However, there was a significant difference between cervical margin groups in terms of microleakage. In sealant groups, there was a significant difference between laser and conventional with/without laser treatment groups in terms of microleakage.ConclusionBased on the results reported in this study, it can be concluded that the application of the Er:YAG laser beneath the resin composite, the resin-modified glass ionomers (GIs), and the fissure sealant placement may be an alternative enamel and dentin etching method to acid etching.

Histochemical changes of occlusal surface enamel of permanent teeth, where dental caries is questionable vs sound enamel surfaces.

This in vitro study was to classify questionable for caries occlusal surfaces (QCOS) of permanent teeth according to ICDAS codes 1, 2, and 3 and to compare them in terms of enamel mineral composition with the areas of sound tissue of the same tooth. Partially impacted human molars (60) extracted for therapeutic reasons with QCOS were used in the study, photographed via a polarised light microscope and classified according to the ICDAS II (into codes 1, 2, or 3). The crowns were embedded in clear self-cured acrylic resin and longitudinally sectioned at the levels of the characterised lesions and studied by SEM/EDX, to assess enamel mineral composition of the QCOS. Univariate and multivariate random effect regressions were used for Ca (wt%), P (wt%), and Ca/P (wt%). The EDX analysis indicated changes in the Ca and P contents that were more prominent in ICDAS-II code 3 lesions compared to codes 1 and 2 lesions. In these lesions, Ca (wt%) and P (wt%) concentrations were significantly decreased (p=0.01) in comparison with sound areas. Ca and P (wt%) contents were significantly lower (p=0.02 and p = 0.01 respectively) for code 3 areas in comparison with codes 1 and 2 areas. Significantly higher (p=0.01) Ca (wt%) and P (wt%) contents were found on sound areas compared to the lesion areas. The enamel of occlusal surfaces of permanent teeth with ICDAS 1, 2, and 3 lesions was found to have different Ca/P compositions, necessitating further investigation on whether these altered surfaces might behave differently on etching preparation before fissure sealant placement, compared to sound surfaces.

Is there a place for Tooth Mousse in the prevention and treatment of early dental caries? A systematic review.

BackgroundIt is important for Dental Professionals to consider the evidence for the effectiveness of the preventive strategies used to maintain good oral health and reduce the risk of caries in their patients. Whilst many of the traditional preventive activities, including the recommendation and use of fluoride products and the placement of fissure sealants have a wealth of clinical evidence to support their use, some of the newer preventive agents have a more limited evidence base. In order to investigate the level of scientific support behind one such technology, a systematic literature review was carried out to assess the effectiveness of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) in the prevention and treatment of early dental caries.MethodsA broad search strategy using Medline via OvidSP and EMBASE was performed in order to capture all published studies to related Casein Phosphopeptide-Amorphous Calcium Phosphate. In addition to the above searches the terms “CPP ACP” and “casein phosphopeptide amorphous calcium phosphate” were searched using PREMEDLINE and the Cochrane Central Register of Controlled Trials. Inclusion criteria were clinical trials of participants of any age, comparing the use of Tooth Mousse® (MI Paste®) or Tooth Mousse Plus® (MI Paste Plus®) to a routine oral care regimen and reporting recognised clinical outcome measures for early caries lesions. Only research studies in English were selected.Results7576 articles were identified, but the majority were duplicates. Once these were removed 172 articles were inspected and the focus on ‘CPP-ACP formulations of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) resulted in 29 articles being selected, and of these 12 studies met the inclusion criteria and were considered acceptable for the systematic review.DiscussionThe overall findings of this review did not show any significant benefits of using Tooth Mousse® (MI Paste®) products over brushing with a fluoride toothpaste for the prevention of early dental caries. With regard to the regression of white spot lesions in orthodontic patients there is a tendency towards a benefit for the use of Tooth Mousse® (MI Paste®) but the quality of evidence is limited. There is a lack of evidence to support the use of Tooth Mousse Plus® (MI Paste Plus®) over Tooth Mousse® (MI Paste®) at this time.ConclusionThis review suggests that further well-designed randomized controlled trials are required prior to the widespread recommendation of Tooth Mousse® products for the prevention and treatment of early dental caries in the general population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-015-0095-6) contains supplementary material, which is available to authorized users.

Why, what and how: caries control for erupting molars.

This article aims to update the practitioner on the various techniques and interventions available to prevent or control caries during this high-risk period. The evidence to support provision of toothbrushing advice, placement of fissure sealants and fluoride varnish application is considered, along with more novel methods. An evidence-based protocol is suggested to help the practitioner determine when further intervention is required and what action to undertake. Clinical Relevance: This article aims to reinforce the need for rigorous caries prevention in an erupting permanent molar and provides an update on the evidence behind a range of clinical techniques used for this purpose.

Payment methods may influence behaviour of primary care dentists.

The Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, EconLit the NHS Economic Evaluation Database (EED) and the Health Economic Evaluations Database (HEED). Randomised controlled trials (RCTs), non-randomised controlled clinical trials (NRCTs), controlled before-after (CBA) studies and interrupted time series (ITS) studies were considered. Study selection was undertaken independently by three reviewers. Fee-for-service payments, fixed salary payments, capitation payments of combinations thereof included. Standard Cochrane methodological procedures were followed. Two cluster-RCTs, with data from 503 dental practices, representing 821 dentists and 4771 patients, met the selection criteria. The risk of bias for the two studies was considered to be high and the overall quality of evidence for the outcomes was low/very low for all outcomes, as assessed using the GRADE approach.One study conducted in the four most deprived areas of Scotland used a factorial design to investigate the impact of fee-for-service and an educational intervention on the placement of fissure sealants. The authors reported a statistically significant increase in clinical activity in the arm that was incentivised with a fee-for-service payment. Measures of health service utilisation or patient outcomes were not reported. The second study used a parallel group design undertaken over a three-year period to compare the impact of capitation payments with fee-for-service payments on primary care dentists' clinical activity. The study reported on measures of clinical activity, patient outcomes and healthcare costs. Teeth were restored at a later stage in the disease process in the capitation system and the clinicians tended to see their patients less frequently and tended to carry out fewer fillings and extractions, but also tended to give more preventive advice.There was insufficient information regarding the cost-effectiveness of the different remuneration methods. Financial incentives within remuneration systems may produce changes to clinical activity undertaken by primary care dentists. However, the number of included studies is limited and the quality of the evidence from the two included studies was low/very low for all outcomes. Further experimental research in this area is highly recommended given the potential impact of financial incentives on clinical activity, and particular attention should be paid to the impact this has on patient outcomes.

Acceptability of fissure sealants from the child's perspective

To seek children's opinions about the acceptability of resin fissure sealant placement. Service evaluation using a child-centred questionnaire issued to a prospective sample of consecutive hospital patients.Method Questionnaires were issued to children, aged 3 to 16 years, immediately after resin fissure sealant placement in the Paediatric Dentistry Department in Sheffield. Participants used a three-point faces scale for positive, neutral and negative responses, arranged as a Likert scale with minimal text, to rate their treatment experiences and satisfaction with the dental visit. Two hundred questionnaires were returned. Overall, 96% (n = 191) recorded a positive or neutral response for the ease at which they coped with the procedure, with most children positive about having fissure sealants placed again (66%; n = 132). Further analysis demonstrated that children who had fissure sealants on a previous occasion found them easier than those having them for the first time (p <0.05, chi-squared test). Almost half of all participants where ambivalent about the taste and feeling (46%; n = 92 and 55%; n = 110 respectively). The vast majority of children were satisfied with the explanations provided by their operator. Most participants found having resin fissure sealants placed an overall acceptable procedure, with patient acceptance improving with increased treatment experience.

Summary of: acceptability of fissure sealants from the child's perspective.

Aim To seek children's opinions about the acceptability of resin fissure sealant placement. Study design Service evaluation using a child-centred questionnaire issued to a prospective sample of consecutive hospital patients. Method Questionnaires were issued to children, aged 3 to 16 years, immediately after resin fissure sealant placement in the Paediatric Dentistry Department in Sheffield. Participants used a three-point faces scale for positive, neutral and negative responses, arranged as a Likert scale with minimal text, to rate their treatment experiences and satisfaction with the dental visit. Results Two hundred questionnaires were returned. Overall, 96% (n = 191) recorded a positive or neutral response for the ease at which they coped with the procedure, with most children positive about having fissure sealants placed again (66%; n = 132). Further analysis demonstrated that children who had fissure sealants on a previous occasion found them easier than those having them for the first time (p <0.05, chi-squared test). Almost half of all participants where ambivalent about the taste and feeling (46%; n = 92 and 55%; n = 110 respectively). The vast majority of children were satisfied with the explanations provided by their operator. Conclusion Most participants found having resin fissure sealants placed an overall acceptable procedure, with patient acceptance improving with increased treatment experience.

The need of paediatric dentistry specialists in Pakistan.

In the last decade, a rapid increase has been observed in the number of dentists due to establishment of a number of dental colleges in Pakistan. Very few of these institutions have Paediatric Dentistry Department. Similarly, no postgraduate Paediatric Dentistry training program exists in the two major provinces of the country. The objectives of this study were to map the pattern of paediatric dentistry services provided by the clinicians in teaching institutions and private practices. A cross-sectional study was conducted at dental departments of academic institutions and selected dental practices in Karachi. There was a statistically significant difference in preferences, selection of dental materials and pattern of paediatric dentistry services provided by the teaching dentists compared to the private practitioners. Both the teaching and non-teaching dentists need to update themselves in the provision of Paediatric Dentistry services such as fluoride application and fissure sealant placement.

The effect of different methods of remuneration on the behaviour of primary care dentists

Methods of remuneration have been linked with the professional behaviour of primary care physicians. In dentistry, this can be exacerbated as clinicians operate their practices as businesses and take the full financial risk of the provision of services. The main methods for remunerating primary care dentists include fee-for-service, fixed salary and capitation payments. The aim of this review was to determine the impact that these remuneration mechanisms have upon primary care dentists' behaviour. To evaluate the effects of different methods of remuneration on the level and mix of activities provided by primary care dentists and the impact this has on patient outcomes. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 7, 2013); MEDLINE (Ovid) (1947 to 11 June 2013); EMBASE (Ovid) (1947 to 11 June 2013); EconLit (1969 to 11 June 2013); the NHS Economic Evaluation Database (EED) (11 June 2013); and the Health Economic Evaluations Database (HEED) (11 June 2013). We conducted cited reference searches for the included studies in ISI Web of Knowledge; searched grey literature sources; handsearched selected journals; and contacted authors of relevant studies. Primary care dentists were defined as clinicians that deliver routine or mainstream dental care in a primary care environment. We included randomised controlled trials (RCTs), non-randomised controlled clinical trials (NRCTs), controlled before-after (CBA) studies and interrupted time series (ITS) studies. The methods of remuneration that we considered were: fee-for-service, fixed salary and capitation payments.Primary outcome measures were: measures of clinical activity; volume of clinical activity undertaken; time taken and clinical session length, or both; clinician type utilised; measures of health service utilisation; access and attendance as a proportion of the population; re-attendance rates; recall frequency; levels of oral health inequalities; non-attendance rates; healthcare costs; measures of patient outcomes; disease reduction; health maintenance; and patient satisfaction. We also considered measures of practice profitability/income and any reported unintended effects of the included methods of remuneration. Three of the review authors (PRB, JP, AMG) independently reviewed titles and abstracts and resolved disagreements by discussion. The same three review authors undertook data extraction and assessed the quality of the evidence from all the studies that met the selection criteria, according to Cochrane Collaboration procedures. Two cluster-RCTs, with data from 503 dental practices, representing 821 dentists and 4771 patients, met the selection criteria. We judged the risk of bias to be high for both studies and the overall quality of the evidence was low/very low for all outcomes, as assessed using the GRADE approach.One study used a factorial design to investigate the impact of fee-for-service and an educational intervention on the placement of fissure sealants in permanent molar teeth. The authors reported a statistically significant increase in clinical activity in the arm that was incentivised with a fee-for-service payment. However, the study was conducted in the four most deprived areas of Scotland, so the applicability of the findings to other settings may be limited. The study did not report data on measures of health service utilisation or measures of patient outcomes.The second study used a parallel group design undertaken over a three-year period to compare the impact of capitation payments with fee-for-service payments on primary care dentists' clinical activity. The study reported on measures of clinical activity (mean percentage of children receiving active preventive advice, health service utilisation (mean number of visits), patient outcomes (mean number of filled teeth, mean percentage of children having one or more teeth extracted and the mean number of decayed teeth) and healthcare costs (mean expenditure). Teeth were restored at a later stage in the disease process in the capitation system and the clinicians tended to see their patients less frequently and tended to carry out fewer fillings and extractions, but also tended to give more preventive advice.There was insufficient information regarding the cost-effectiveness of the different remuneration methods. Financial incentives within remuneration systems may produce changes to clinical activity undertaken by primary care dentists. However, the number of included studies is limited and the quality of the evidence from the two included studies was low/very low for all outcomes. Further experimental research in this area is highly recommended given the potential impact of financial incentives on clinical activity, and particular attention should be paid to the impact this has on patient outcomes.

Concurrent Occurrence of Developmental Anomalies-Dens Evaginatus and Dens Invaginatus in Maxillary Lateral Incisor: Report of Two Cases

Developmental anomalies affecting tooth morphology are common in the literature. Dens evaginatus (DE) occurring in anterior tooth, termed ‘talon cusp’ is a relatively rare developmental anomaly. It presents as an additional cusp that project predominantly from the lingual surface of primary or permanent anterior teeth. Dens invaginatus (DI) is a developmental anomaly resulting from infolding of the tooth crown or root before calcification has occurred. Concurrent occurrence of DE and DI within the same tooth is rare. The present article reports two cases with concurrent occurrence of DE and DI in permanent maxillary lateral incisor. In case 1 the DE and DI are associated with nonvital tooth and in case 2 the DE and DI are associated with a vital tooth. The management aspects are discussed. Key messages: The present article demonstrates successful management of two cases with concurrent occurrence of developmental anomalies dens evaginatus and dens invaginatus. Case 1 with necrotic pulp required endodontic therapy, while the vital tooth in case 2 was treated by prophylactic placement of fissure sealant. Early detection of such anomalies may allow early intervention and better prognosis.