Public Health Service Criteria Research Articles

3D-Printed Permanent Resin Crowns on Pre-Molar and Molar Teeth; Two-Year Results of a Prospective Clinical Study.

The aim of this prospective clinical study was to evaluate the 12 and 24-month clinical results of overlay and one-piece endodontic crown restorations applied with additively manufactured 3D printed permanent ceramic-filled resin (PCR) according to the Modified US Public Health Service (USPHS) criteria. A total of 33 indirect restorations (16 overlay, 17 endocrown) (4 premolar, 29 molar) produced using PCR (Formlabs) were applied to 30 patients by a single dentist. The restorations were evaluated according to the modified USPHS criteria at baseline (7 days), 12 and 24 months times by two independent evaluators. The study registration number is NCT05168852. In the comparisons of the dependent criteria scores, the Related Samples Cochran Q test was used, and in post-hoc paired comparisons, the Bonferroni test. The Fisher-Freeman-Halton test was applied in the comparisons of categorical variables according to the restoration type groups (α = 0.05). No statistically significant difference was determined between the evaluation criteria scores at baseline, 12 months, and 24 months for the marginal adaptation (P=0.05), retention (P=1), interproximal contact (P=0.368), color match (P=1), surface texture (P=1), and patient satisfaction (P=1). The only score criteria that showed a statistically significant difference between baseline and 24 months (P=0.001) among all other criteria was marginal discoloration. This criteria's score change was from 100% A score to 69.7% A score. In the 2-year follow-up of indirect single-tooth restorations produced with 3D-printed PCR, all restorations showed acceptable clinical performance. (≥99.5%A+B score at 2 years).

Marginal Degradation of Universal Adhesive Restorations in NCCLs: A Systematic Review and Meta-analysis

Purpose This systematic review aimed to answer the PICO question: do adhesive protocols used for non-carious cervical lesions (NCCLs) using a universal adhesive system influence marginal degradation, marginal staining, and retention of these restorations? The self-etching adhesive strategy and selective enamel etching were compared with the etch-and-rinse strategy as a control. Materials and Methods The study searched various databases, including PubMed, Web of Science, Cochrane Central Register of Controlled Trials, Scopus, Embase, and grey literature, to find randomized clinical trials (RCTs) comparing self-etching (SE) or selective enamel etching (SEE) to the etch and rinse (ER) strategy. The risk of methodological bias was assessed using the Cochrane RoB 2 tool. Data were dichotomized and analyzed using RevMan v 5.3, adopting the Mantel-Haenszel method. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results Twenty RCTs were included in the meta-analysis. Results showed that using universal adhesives with the SE strategy resulted in clinical signs of marginal degradation at 12 months, 24 months, and 36 months of follow-up, and marginal staining at 24 months. The adhesive strategy did not interfere with the retention of restorative material used for NCCLs over 36 months, as assessed based on both the United States Public Health Service (USPHS) and World Dental Federation (FDI) criteria. Conclusion With moderate certainty of evidence, after 24 months of follow-up, the SE strategy results in the detection of clinical signs of marginal degradation and staining. The adhesive strategy adopted did not influence the retention rate of the restorations over 36 months of follow-up.

A 3-year clinical evaluation of endocrown restorations with two different materials using the computer-aided design/ computer-aided manufacture system

ObjectiveTo compare the clinical efficacy of resin nanoceramic and zirconia-reinforced lithium silicate ceramic endocrowns in the treatment of endodontically treated teeth by assessing the clinical performance of restorations fabricated using a chairside computer-aided design/computer-aided manufacturing (CAD/CAM) system. Materials and methodsNinety endocrown restorations were fabricated on endodontically treated teeth using a CAD/CAM system. Fifty-two restorations were fabricated using Lava Ultimate blocks (LU, 3 M Espe, Seefeld, Germany) and 38 restorations were fabricated using Celtra Duo blocks (CD, Dentsply Sirona, York, PA, USA). The performance of the endocrown restorations was evaluated over a 3-year period using the modified United States Public Health Service (USPHS) criteria by two calibrated evaluators. The data were analyzed using Chi-square (x2) and Fisher exact tests (p < 0.05). ResultsThe restoration survival rates in the two groups were 82.7 % (LU) and 86.8 % (CD) (p = 0.6). Twelve restorations failed (8 LU, 4 CD) due to debonding (n = 4, 2 LU, 2 CD), ceramic fracture (n = 2, 1 LU, 1 CD), tooth fracture (n = 5, 4 LU, 1 CD), and secondary caries (n = 1, 1 LU) during the follow-up period. There was no statistically significant difference between the two materials according to the modified USPHS criteria (p > 0.05). ConclusionResin nanoceramic and zirconia-reinforced lithium silicate ceramic endocrown restorations fabricated using a chairside CAD/CAM system demonstrated acceptable clinical performance in the treatment of endodontically treated teeth. Clinical SignificanceResin nanoceramic and zirconia-reinforced lithium silicate ceramics are potential alternative materials for the chairside fabrication of endodontically treated teeth.

Comparative Assessment of Compomers and Ormocers as Pit and Fissure Sealants in Permanent Molars among Children Aged 7-9 Years.

In recent years, the dental profession's focus has shifted from the therapeutic to the preventive aspect of dental caries. Pit and fissure sealants, optimal fluoridation, healthy dietary habits, and good oral hygiene have been recommended for caries prevention. Many sealant materials are available on the market. Compomers are hybrid dental materials that are modified composite resins with polyacids. The esthetic properties of traditional composite systems are combined with the fluoride-releasing and adhesive properties of glass ionomer cement (GIC). Organically modified ceramic (Ormocer) material has high abrasion resistance and better aesthetics, similar to natural teeth. To compare the sealing ability of compomer and ormocer as pit and fissure sealants in permanent mandibular first molars of 7-9-year-old children. A cross-sectional study with a split-mouth design was conducted on 88 children aged 7-9 years who attended the Department of Pediatric and Preventive Dentistry. Children were selected based on the inclusion and exclusion criteria. By tossing a coin, the placement of sealant material was selected for the right permanent first molar. Rubber dam isolation was done. The tooth surface was etched and washed. The respective sealants were applied. Sealants were cured with visible light, and occlusion was checked with articulating paper. Subsequently, the second sealant was placed in the next appointment, following the same clinical procedure in the opposite quadrant. Clinical evaluation was done at 3, 6, and 9 months for retention, marginal integrity, color match, wear, and presence of caries. The criteria were graded and rated as alpha, beta, and charlie based on modified Ryge United States Public Health Service (USPHS) criteria. All the data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) software 20.0. The retention rate of ormocer at the 9-month review interval was 88.3%. There was a statistically significant difference in retention rates between compomer and ormocer (p = 0.003). The marginal integrity and wear of ormocer at the 9-month review interval were 84.4% compared with compomer, which was statistically significant with p = 0.010 and p = 0.035, respectively. Children with the fewest caries belonged to the ormocer group (p = 0.010) compared to the compomer group. Children with ormocer as a pit and fissure sealant showed good retention, remarkable marginal integrity, absence of wear, and fewer dental caries compared to compomer sealants. Hence, ormocer-based sealants can be used in pediatric dental practice to protect children's oral hygiene and promote a healthy lifestyle. Saravanan SM, Srinivasan D, AR SE, et al. Comparative Assessment of Compomers and Ormocers as Pit and Fissure Sealants in Permanent Molars among Children Aged 7-9 Years. Int J Clin Pediatr Dent 2024;17(7):742-747.

The survival and clinical performance of anterior composite resin restorations and posterior indirect and cast restorations used to treat generalised tooth wear

Objective To evaluate the survival and clinical performance of restorative materials used in the rehabilitation of generalised severe tooth wear within a UK NHS postgraduate teaching hospital.Methods The clinical performance of 527 restorations on 20 patients with generalised severe tooth wear was reviewed after a mean period of five years. Anterior teeth were restored with direct composite resin and posterior teeth with indirect restorations. The study used the modified United States Public Health Service criteria for restoration assessment. Survival of the restorations was analysed using Kaplan-Meier survival curves, the log-rank test and the Cox proportional hazards regression analysis.Results The sample included 20 participants: 13 men and 7 women, with a median age of 51.8 years (range: 33-73 years). The median survival time for all restorations was 11.3 years when major failures were considered and 5.9 years for restorations when all types of failure were considered. A median survival time of 5.9 years for composite resin restorations and over seven years for cast restorations was found when considering all failures. Composite resin restorations commonly failed as a result of fracture, wear and marginal discolouration. Factors significantly influencing restoration survival were the material used, aetiology, incisal relationship and tooth location. The biological complications associated with this treatment regime were rare. Patient satisfaction remained generally high, with greatest dissatisfaction related to treatment time.Conclusions The use of anterior composite resin with posterior indirect restorations to treat generalised severe tooth wear is a viable treatment modality with very few major complications.

Performance of Bonded Lithium Disilicate Partial-coverage Crowns in the Restoration of Endodontically Treated Posterior Teeth: An Up to Seven-Year Retrospective Study.

To evaluate the clinical performance of adhesively bonded lithium disilicate glass-ceramic (LDG) partial-coverage crowns in restoring posterior endodontically treated teeth (ETT). A total of 121 morphologically compromised posterior ETT were restored with LDG partial-coverage crowns between October 2015 and January 2018. The restorations were fabricated in the laboratory or at the chairside. Two adhesive systems and resin cements were used to cement the restorations. Tooth and restoration survival rates were calculated. The restorations were evaluated clinically using the modified United States Public Health Service (USPHS) criteria for an observation period of 5-7 years. The Cox proportional hazards model was used to estimate relative failure risks such as tooth type, resin cements, gender, and sleep bruxism. The standard chi-squared test was used to compare the survival of different tooth types for significant differences (α=0.05). In addition, survival probability was calculated using the Kaplan-Meier algorithm. Among seven failed cases, one was a tooth fracture, and six were restoration fractures. According to the Kaplan-Meier analysis, the estimated survival rate of the teeth was 99% for seven years, while the estimated survival rate of the restorations was 94.8% for 5 years and 92.8% for 7 years. Tooth type and resin cements did not influence restoration survival rates (p>0.05), while sleep bruxism and male patients might increase the risk of failure (p<0.05). The indirect adhesively bonded LDG partial-coverage crowns of posterior ETT exhibited favorable clinical outcomes. Ceramic fracture was the most common failure pattern.

The 24 months clinical evaluation of class II bulk fill composite restorations

Background: Resin Composite materials are widely used in daily clinical dentistry because of their moderate cost compared with ceramics, easy placement, adequate esthetics, ability to bond with enamel and dentine, and physico-chemical properties. Bulkfill composite materials were introduced to reduce chairside time. These materials have properties such as optimal bond strength, decreased polymerization shrinkage, and reduced cuspal deflection. This in-vivo study compared the clinical performance of three different class II resin composite restorations. Methods: Seventy-one patients (41 females and 30 males) aged 20–43 years with at least three approximal caries were included in the present study. Two hundred twenty-three teeth with approximal caries were restored with two bulk-fill composites (Tetric-N Ceram Bulk fill [TEC], Filtek Bulk Fill [FB]) and a posterior resin composite (Gradia Direct Posterior [GDP]). Two experienced dentists clinically evaluated the restorations with a 5x magnification loupe using the modified United States Public Health Service (USPHS) criteria at baseline and at 24 months. Results: The chi-square test was performed for statistical analysis. The cumulative retention rate for all restorations at 24 months was 90.5%. Retention loss was observed for three TEC (6.1%), four FB (8.2), and seven GDP (14%) restorations. There was no statistically significant difference among the three resin composite restoration groups in color match, marginal adaptation, surface roughness, marginal discoloration, anatomical form, and secondary caries criteria (P&gt;0.05). Conclusion: Bulk-fill composite restorations in class II slot cavities have the same clinical results as traditional posterior composite restorations.

Clinical study of cervical caries treatment the effectiveness by assessing composite restorations condition

Background. Cervical caries is a fairly common teeth pathology and its treatment is carried out in complicated clinical conditions. Therefore, increasing the term of functioning of composite restorations is an urgent task. Aim. Identification of the effectiveness of a differential approach to dissection of hard dental tissues depending on the depth of enamel microcracks and implementation of professional hygiene in the treatment of cervical caries in the short- and long-term periods. Materials &amp; Methods. The study involved 50 people (average age [23.28±5.52] years) in whom cervical caries was treated in 72 teeth. All patients were divided into three equal groups based on the number of restorations according to the selected dissection technique and the chara­cteristics of professional hygiene. The dissection technique depended on the depth of the enamel microcracks in Main Group I (MG I), the dissection was carried out within the limits of clinically intact hard dental tissues in Control Group (CG) and Main Group II (MG II). The dental biofilm was removed from the vestibular surface of the teeth by the method of air-abrasive cleaning using the erythritol-based powder in MG I and MG II, the vestibular surface of the tooth was cleaned of dental deposits with a polishing paste without fluoride in CG. The quality of restorations was assessed based on the United States Public Health Service (USPHS) criteria on the day of restoration, 6 and 12 months later. The effectiveness of the prescribed treatment was identified by the dynamic indicators of the dental pulp electroexcitability and the electrical conductivity of the enamel. Results. There were no partial or completely destroyed restorations in all terms of the observation period. Composite restorations were preserved according to the criteria of "anatomical shape" and "color matching". One year later restoration defects were absent in 61 teeth (84.72%): in MG I – in 22 (91.67%), in CG – in 19 (79.17%), in MG II – in 20 (83.33%). Recurrent caries and symptoms of hypersensitivity were not identified in MG I. A slightly greater effectiveness of the treatment was noted in MG II group in comparison with CG (by 4.16%) that confirms the importance of removing the dental biofilm before restoration by the method of air-abrasive clea­ning using erythritol. Conclusions. The analysis of the state of restorations in the long-term period showed that the dissection technique and the features of professional hygiene affected their quality before restoration. The number of high-quality composite restorations was by 10.42% more on average in MG I than in the other groups. The obtained results make it possible to recommend the proposed method for using in practical dentistry. Keywords: electroodontology, electroodontometry, microcracks.

Clinical Survival of Reduced-Thickness Monolithic Lithium-Disilicate Crowns: A 3-Year Randomized Controlled Trial.

The aim of this randomized controlled trial was to see if the minimally invasive approach (reduced restoration thickness) would result in good clinical success of monolithic ceramic crowns compared to conventional layered all-ceramic crowns, and thus be an alternative to conventional tooth preparation. The ceramic that was investigated was IPS e.max lithium-disilicate ceramic produced using two different processing methods. A comparison was made between monolithic crowns with reduced thickness and standard layered crowns. Fifty-two patients, who had undergone endodontic treatment on either a premolar or molar, were randomly assigned into two groups. The teeth intended for layered crowns underwent to a 2 mm occlusal reduction with a 1 mm rounded shoulder, whereas the teeth intended for monolithic crowns underwent to a 1 mm reduction in the occlusal area with a 0.6 mm rounded shoulder. The clinical success was evaluated in eight categories using modified United States Public Health Service (USPHS) criteria. The observation period was 36 months, with control appointments every 6 months. There was no significant difference in clinical success between monolithic and conventional layered crowns after 3 years. One monolithic crown fractured while all other crowns were intact and the survival rate was 96%. All layered crowns were intact and the survival rate was 100%. The results of this study indicate that the minimally invasive approach can be a good alternative to conventional tooth preparation. IPS e.max lithium-disilicate ceramic demonstrated an exceptional three-year survival rate independently of the thickness of the material.

1-year Results of Molar Incisor Hypomineralization-affected Cases Treated with Silver Modified Atraumatic Restorative Treatment: A Retrospective Study.

Silver-modified atraumatic restorative treatment (SMART) can be an alternative method for molar incisor hypomineralization (MIH)-affected cases. The purpose of this study was to assess whether tooth location and cavity preparation affect the clinical success of MIH-affected permanent molars treated with the SMART technique. Modified United States Public Health Service criteria were utilized for the analyzes. The clinical records (3, 6, and 12 months) of 19 MIH-affected cases (6-12 years; no spontaneous pain and percussion/palpation sensitivity) treated with the SMART technique were assessed. The groups were allocated based on tooth location (mandibular-maxillary) and cavity preparation (class 1-2). The Fisher exact the Chi-squared test was utilized, and the p-value < 0.05 was accepted as statistically significant. Overall success rates were 94.7% at 3 and 6 months and 52.63% at 12 months. Clinical success did not differ statistically regarding location (p > 0.05). The class 1 cavity preparation group was found to be significantly more successful at the 12-month assessments (p = 0.033). The class of cavity preparation may affect the success of the treatment in long-term assessments. The SMART technique, especially in class 1 occlusal restorations, can be recommended as a short-term alternative to traditional treatment methods for MIH-affected cases. Bal C, Sozuoz MA, Sari MBD, et al. 1-year Results of Molar Incisor Hypomineralization-affected Cases Treated with Silver Modified Atraumatic Restorative Treatment: A Retrospective Study. Int J Clin Pediatr Dent 2024;17(6):683-689.

Long-term performance of ceramic in/-onlays vs. cast gold partial crowns – a retrospective clinical study

ObjectivesTo assess the long-term clinical performance of ceramic in-/onlays (CIOs) and cast gold partial crowns (CGPCs) in posterior teeth in terms of success, survival, complications (biological, technical) and quality.Material and methodsIn a retrospective study, a total of 325 patients were recorded after up to 24.8 years (mean 13.9 ± 3.8 years) having (pre-)molars restored with CIO (Empress I, Ivoclar Vivadent, n = 161) and CGPC (Degunorm, DeguDent, n = 164) by supervised undergraduate students. A total of 296 restorations were assessed clinically and radiologically in healthy and endodontically treated teeth using modified United States Public Health Service (USPHS) criteria. Cumulative success and survival rates of the restorations were calculated using Kaplan–Meier estimates. Biological and technical complications were recorded. Status of oral health comprising caries risk and localized periodontitis were assessed.ResultsThe cumulative success rates of CIOs were 92.1% and of CGPCs 84.2% after mean service times of 14.5 years. The annual failure rates of total service times were 0.5% in teeth restored with CIO (n = 155) and 0.7% in teeth restored with CGPC (n = 163). The cumulative survival rates of CIOs were 93.9% after a mean service time of 15.2 years and decreased to 91.7% after 23.5 years. The cumulative survival rates of CGPCs were 92.6% after a mean service time of 14.9 years and 91.8% after 23.5 years. Complications in CIOs (n = 149) were ceramic fracture (6.7%), secondary caries (4.7%), endodontic complication (2.7%) and tooth fracture (1.3%) compared to CGPCs (n = 147) with endodontic complication (8.8%), secondary caries (4.8%) and decementation (2.0%). Endodontically treated teeth restored with CIO or CGPC revealed significantly less often success compared with corresponding vital teeth (p = .02). CIOs and CGPCs revealed clinically and radiographically good and excellent qualities with 71.8% (107/149) and 68% (100/147) without any significant differences regarding type of restoration.ConclusionsBoth CIOs and CGPCs achieved high survival rates up to 24.8 years when performed by supervised undergraduate students. The longevity of the restorations may benefit from the intraoral repair of accessible defects and, in case of pulp infection or necrosis, an adequate endodontic management.Clinical relevanceCIOs and CGPCs made by supervised undergraduate students are proper restoration types in posterior teeth in the long-term. An adequate preparation design, meticulous care in the inserting technique and constant biofilm removal due to proper oral hygiene combined with professional maintenance care are substantial. The clinical long-term performance was mostly limited by ceramic fractures in CIOs and endodontic complications in CGPCs.

Evaluation of pre-heated composite resins with soft-start polymerization and conventional composite restorations in class-I carious lesions – A randomized clinical trial

BackgroundBy increasing fluidity and conversion, pre-heated composites enhance adaptability and strength, while soft-start polymerization decreases internal stresses. AimOver a period of a year, this split-mouth design, randomized controlled clinical trial (RCT) compared pre-heated composites with soft-start polymerization to conventional composites in class-I lesions, with the goal of improving restoration outcomes. Methodsand Findings: Immediately following ethical approval and registration with CTRI, 37 patients with in-formed permission who met specified inclusion and exclusion criteria for class-I lesions were chosen for enrollment. Using a 1:1 ratio, teeth were randomly assigned to Group-A (pre-heated composite with soft-start polymerization) or Group-B (traditional composite restoration). At three-time intervals, the evaluation was blinded and calibrated using Modified United States Public Health Service (USPHS) criteria: baseline, six-month, and one-year marks. Statistical analysis was performed using SPSS 21.0 and the Mann-Whitney U test for inter-group comparisons and the Friedman test for intra-group comparisons. InterpretationPre-heated composites with soft-start polymerization performed better in terms of marginal adaptation with a statistically significant difference (p = 0.019) and in terms of color match they performed better clinically (p = 0.062) at 12 months. Other variables like marginal discolouration, sec-ondary caries, anatomic form, post-operative sensitivity, surface texture and retention showed no statistically significant difference (p < 0.05). Pre-heated composites with soft-start mode performed marginally better than nanofilled composites. However, both techniques can be used to successfully restore simple class-I carious lesions.

Monolithic Zirconia Single Crowns Supported by Narrow- or Standard-Diameter Titanium-Zirconia Implants in Posterior Sites: 1-Year Results of a Randomized Controlled Trial.

To compare the prosthetic outcomes of screw-retained monolithic zirconia (Zr) single crowns supported by either narrow-diameter (3.3 mm) or standard-diameter (4.1 mm) tissue-level titanium-zirconia (TiZr) implants in posterior sites. A total of 18 participants, each with a missing molar or premolar tooth requiring an implantsupported single crown, were randomly assigned to either the test or control group. All participants received screwretained monolithic Zr single crowns supported by single tissue-level TiZr implants. Test group participants received narrow-diameter implants (3.3 mm), whereas control group participants received standard-diameter implants (4.1 mm). A modified version of the United States Public Health Service (USPHS) criteria was used to assess the prosthetic outcome across 12 parameters after 1 year of function. Data were analyzed descriptively, and statistical analysis was performed using a statistical software (SPSS, Version 28.0; IBM) with the level of significance set at P < .05. Of the 18 single crowns delivered, 16 were available for review at the 1-year follow-up, including 7 in the test group and 9 in the control group. Patient characteristics and crown site distribution were similar, with no significant differences observed between the two groups (chi-square test; P < .05). There were no crown failures, meaning a crown survival rate of 100% was achieved after 1 year. The prosthetic outcome based on USPHS criteria was comparable between the two groups with no significant differences observed (chi-square test; P < .05). There were 19 prosthetic events in total (10 in the test group and 9 in the control group), with no significant differences between the groups (chi-square test; P < .05). Loss of proximal contact was the dominant event, with a total of eight events (three in the test group and five in the control group). Patient satisfaction after 1 year was high in both treatment groups, with no significant differences detected. Screw-retained monolithic Zr single crowns supported by either narrow- or standard-diameter tissue-level TiZr implants in posterior sites have comparable prosthetic outcomes after 1 year. Long-term results from well-designed trials are still needed to validate the findings of the present study.

Clinical outcomes of self-glazed zirconia veneers produced by 3D gel deposition: a retrospective study

BackgroundSelf-glazed zirconia (SZ) restorations are made by a novel additive three-dimensional gel deposition approach, which are suitable for a straightforward completely digital workflow. SZ has recently been used as minimally invasive veneer, but its clinical outcomes have not been clarified yet. This study aimed to evaluate the preliminary clinical outcomes of SZ veneers compared with the widely used lithium disilicate glass–ceramic veneers made by either pressing (PG) or milling (MG) process.MethodsFifty-six patients treated with SZ, PG, and MG veneers by 2 specialists between June 2018 and October 2022 were identified. Patients were recalled for follow-up at least 1 year after restoration. Clinical outcomes were assessed by 2 independent evaluators according to the modified United States Public Health Service (USPHS) criteria. Overall patient satisfaction was assessed using visual analogue scale (VAS), and analyzed by one-way ANOVA. Chi-square test was applied to compare the difference in the success and survival rates among the 3 groups.ResultsA total of 51 patients restored with 45 SZ, 40 PG, and 41 MG veneers completed the study, with a patient dropout rate of 8.9%. Mean and standard deviation of follow-up period was 35.0 ± 14.7 months. All restorations performed well at baseline, except for 2 SZ veneers with mismatched color (rated Bravo). During follow-up, marginal discrepancy (rated Bravo) was found in 4 MG veneers and 1 PG veneer, and partially fractured (rated Charlie) was found in another 2 PG veneers. The survival rate of SZ, PG, and MG veneers was 100%, 95%, and 100%, with a success rate of 95.56%, 92.50%, and 90.24%, respectively, none of which were significantly different (p = 0.099 and 0.628, respectively). The mean VAS score of SZ, PG, and MG was 95.00 ± 1.57, 93.93 ± 2.40, and 94.89 ± 2.00 respectively, without significant difference (p > 0.05).ConclusionSZ veneers exhibited comparable preliminary clinical outcomes to PG and MG veneers, which could be considered as a feasible option for minimally invasive restorative treatment.

Comparing modified USPHS and FDI criteria for the assessment of glass ionomer restorations in primary molars utilising clinical and photographic evaluation.

To compare the applicability of modified US Public Health Service (USPHS) and FDI criteria for evaluating glass ionomer cement (GIC) restorations in primary posterior teeth through digital image analysis. This comparative analytic study was conducted at the Children's Dental Clinic RSKGM FKG UI, involving 40 GIC restorations on lower first primary molars in children aged 4-9years. After cleaning, the restorations were assessed clinically using modified USPHS and FDI criteria before taking digital images, then the collected images were re-evaluated using both sets of criteria, and the clinical assessment results were compared to the digital image assessment results. Statistical analysis revealed significant differences between the clinical evaluation of GIC restorations in primary teeth and their corresponding digital photographs when using the modified USPHS criteria, and although the use of FDI criteria yielded different results, these differences were not statistically significant. The assessment of GIC restorations through digital images aligns more closely with clinical assessments using the FDI criteria compared to the modified USPHS criteria.

Clinical performance and wear resistance of milled resin composite material versus direct nanohybrid bulk-fill resin composite in the restoration of endodontically treated posterior teeth over 1 year: Randomized clinical trial.

The restorative complexities associated with endodontically treated teeth surpass those encountered with vital ones. The field of adhesive dentistry experienced a significant advancement that led to a shift in treatment approach toward bonded restorations. The aim of the study was to assess the clinical performance of using indirect Milled composite or direct bulk-fill resin composite restorations for endo-treated teeth, as well as to measure the amount of wear on the occlusal tables of both restorations using a digital scanner. Participants were divided into two groups, where R1 represents the endodontically treated teeth restored with Milled composite, R2 represents the endodontically treated teeth restored with direct bulk-fill composite where 13 patients in each group were treated with a total number of 26 restorations in all patients. Where each restoration was assessed immediately at baseline (T0), 6 months (T6), and 12 months (T12) using the modified United States Public Health Service criteria. Moreover, wear was measured immediately at (T0) and (T12) intraorally and extraorally using intraoral scanners and three-dimensional surface-based superimposition software. Chi-squared test, Mann-Whitney U-test, Friedman's test, Nemenyi post hoc test, Shapiro-Wilk test, paired t-tests, intraclass correlation coefficient. At all intervals, the majority of the cases in both groups had an alpha score. Some cases exhibited bravo scores in both groups at T6 and T12 regarding the color match, marginal adaptation, marginal discoloration, and marginal integrity without statistically significant difference (P > 0.05). Direct nanohybrid bulk-fill resin composite showed a greater amount of wear without a statistically significant difference (P > 0.05). Extraoral measurement was significantly higher than intraoral measurement (P < 0.001). There was no significant reliability/agreement between both methods. Both milled composite and direct bulk-fill resin composite restorations in endodontically treated teeth demonstrated appropriate clinical performance and minimal wear over an 1-year follow-up period.

Clinical evaluation of “Snowplow” technique versus Bulk-fill technique in restoration of class II cavities: A randomized clinical trial

Abstract Aim: This study assessed the clinical performance of the “Snowplow” technique compared with the Bulk-fill technique in restoration of proximal cavities for 1 year using modified United States Public Health Service (USPHS) criteria. Materials and Methods: The study was a 12-month, double-blinded, two parallel arms, randomized clinical trial with a 1:1 allocation ratio. A total of 32 patients with proximal caries were separated into two groups (n = 16): group 1: “Snowplow” technique using co-cured X-tra base flowable Bulk-fill composite/X-tra Fil Bulk-fill composite, whereas group 2: Bulk-fill technique using X-tra Fil Bulk-fill composite. Modified USPHS criteria were employed to assess the restorations at baseline, after 3, 6, 9, and 12 months. The MedCalc software, version 19 for Windows was used to statistically analyze the collected data. Intergroup comparisons were carried out using the chi-squared test with a statistical significance level set at P ≤ 0.05 after Bonferroni correction. Results: The results suggested that there was no statistically significant difference found between “Snowplow” and Bulk-fill techniques at different time intervals in terms of marginal integrity, marginal discoloration, anatomic contour, surface texture, gross fracture, and secondary caries, where P = 0.150550. Conclusion: This study concluded that the clinical performance of the “Snowplow” technique and Bulk-fill technique was similar and clinically acceptable following a full year of clinical use. Bulk-fill and “Snowplow” techniques are highly recommended restorative techniques in proximal cavities.

Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study

ObjectivesThis study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal. MethodsThe children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups. ResultsDuring the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002). ConclusionDirect composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization. Clinical significanceSFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.

Optical behavior and marginal discoloration of a single shade resin composite with a chameleon effect: a randomized controlled clinical trial

Objective/aimEvaluating the optical behavior and marginal discoloration of a Single-shade universal resin composite over 12 months. To achieve this, a split-mouth with a double-blinded randomized strategy was employed.Materials and methodsTwenty adult patients, each presenting with at least two caries lesions in their posterior teeth, were selected and randomly subdivided into two identical groups: Group I received Single-shade universal resin composite (Omnichroma), and Group II received multi-shade nanohybrid resin composite (Tetric®N-Ceram). Color measurements and marginal discoloration were assessed visually by three blinded operators at baseline followed after 1,3,6,9, and 12‑month periods utilizing the Modified United States Public Health Services (USPHS) criteria. Statistical analysis was adopted utilizing the Wilcoxon test with a 0.05 significance level.ResultsThe two groups revealed non-statistically significant differences up to 6 months regarding color match and color stability. After 9 and 12 months, the multi-shade group demonstrated a statistically significant higher prevalence of color match (Alpha) scores than the single-shade universal group. Regarding marginal discoloration, all restorations in the two groups had no discoloration (Alpha scores).Discussion/conclusionSince the percentage of Alpha and Bravo scores was considered clinical success, both the single-shade universal and the multi-shade nanohybrid resin composites demonstrated satisfactory optical performance and marginal discoloration as posterior restorations after a 12-month follow-up period.

Organ Nonutilization Following Revision to the Public Health Service Donor Risk Criteria for HIV, HCV, or HBV Transmission.

Organs from Public Health Service criteria (PHSC) donors, previously referred to as PHS infectious-risk donors, have historically been recovered but not used, traditionally referred to as "discard," at higher rates despite negligible risk to recipients. On March 1, 2021, the definition of PHSC donors narrowed to include only the subset of donors deemed to have meaningfully elevated risk in the current era of improved infectious disease testing. Using Scientific Registry of Transplant Recipients data from May 1, 2019, to December 31, 2022, we compared rates of PHSC classification and nonutilization of PHSC organs before versus after the March 1, 2021, policy change among recovered decedents using the χ 2 tests. We performed an adjusted interrupted time series analysis to examine kidney and liver recovery/nonuse (traditionally termed "discard") and kidney, liver, lung, and heart nonutilization (nonrecovery or recovery/nonuse) prepolicy versus postpolicy. PHSC classification dropped sharply from 24.5% prepolicy to 15.4% postpolicy ( P < 0.001). Before the policy change, PHSC kidney recovery/nonuse, liver nonuse, lung nonuse, and heart nonuse were comparable to non-PHSC estimates (adjusted odds ratio: kidney = 0.98 1.06 1.14 , P = 0.14; liver = 0.85 0.92 1.01 , P = 0.07; lung = 0.91 0.99 1.08 , P = 0.83; heart = 0.89 0.97 1.05 , P = 0.47); following the policy change, PHSC kidney recovery/nonuse, liver nonuse, lung nonuse, and heart nonuse were lower than non-PHSC estimates (adjusted odds ratio: kidney = 0.77 0.84 0.91 , P < 0.001; liver = 0.77 0.84 0.92 , P < 0.001; lung = 0.74 0.81 0.90 , P < 0.001; heart = 0.61 0.67 0.73 , P < 0.001). Even though PHSC donors under the new definition are a narrower and theoretically riskier subpopulation than under the previous classification, PHSC status appears to be associated with a reduced risk of kidney and liver recovery/nonuse and nonutilization of all organs. Although historically PHSC organs have been underused, our findings demonstrate a notable shift toward increased PHSC organ utilization.