Recurrent Caries Research Articles

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia.

Objective The aim of this study was to evaluate the current clinical practice of general dentists in Saudi Arabia in restoring class II cavities using direct resin composites and to set evidence-based practice recommendations of concern. Methods An online survey formed of 20 questions and classified into four domains was developed. 500 dentists in 5 Saudi provinces were invited to join the survey anonymously and voluntarily using poster announcements and e-mail invitations. Descriptive statistics were used to analyze participants' responses. Results 343 responses were received. Dentists in Saudi Arabia vary in their clinical practices and techniques of insertion of resin composite in class II cavities. 67% of participants use cotton rolls for isolating the field while 32% use rubber dam isolation. 33% and 28% of respondents use circumferential matrix (Tofflemire) and AutoMatrix, respectively. Fracture, followed by recurrent caries and open proximal contacts, was the received main reason of failure of class II direct resin composite restorations. Conclusion Diversity of class II resin composite practices exists among dentists in Saudi Arabia. For ensuring optimum quality outcomes and high standards of restorative dentistry healthcare, several dentists in Saudi Arabia need to reconsider their clinical practice and modify their clinical procedures of direct class II resin composites. Several evidence-based practice guidelines are recommended to dentists in this article to improve their practice and enhance the clinical reliability and longevity of class II direct resin composite restorations.

Effects of thermal cycling on mechanical and antibacterial durability of bioactive low-shrinkage-stress nanocomposite

ObjectivesRecent studies developed low-shrinkage-stress composite with remineralizing and antibacterial properties to combat secondary caries and increase restoration longevity. However, their long-term durability in thermal cycling is unclear. The objectives of this study were to develop an antibacterial, remineralizing and low-shrinkage-stress composite, and to investigate its durability in thermal cycling for 20,000 cycles, equivalent to two years of clinical life. MethodsThe resin consisted of urethane dimethacrylate (UDMA) and triethylene glycol divinylbenzyl ether (TEG-DVBE). Composites were made with 5% dimethylaminohexadecyl methacrylate (DMAHDM) and 20% of nanoparticles of amorphous calcium phosphate (NACP). Composites were thermal cycled at 5°C and 55°C for 20,000 cycles. A human salivary biofilm model was used to evaluate antibiofilm activity before and after thermal cycling. ResultsAfter 20,000 cycles, the flexural strength of bioactive low-shrinkage-stress composite matched commercial control with no antibacterial activity (p > 0.05). Surface roughness was clinically acceptable at less than 0.2 μm. UV+NACP+DMAHDM composite reduced the total microorganisms, total streptococci, and mutans streptococci by 2-5 logs, compared to commercial composite. Biofilm lactic acid production was reduced by 11 folds. The antibacterial performance was maintained after thermal cycling, with no decrease after 20,000 cycles. ConclusionsBioactive low-shrinkage-stress composite possessed good mechanical properties that matched commercial composite both before and after thermal cycling. The new composite had potent antibacterial activity, which was maintained and did not decrease after thermal cycling. Clinical significanceThe new bioactive low-shrinkage-stress composite could reduce polymerization shrinkage stress and release calcium and phosphate ions, with good mechanical properties and strong antibacterial function that were durable after thermal cycling. These properties indicate great potential for inhibiting recurrent caries and increasing the restoration longevity.

Evaluation of Shear Bond Strength between Resin Composites and Conventional Glass Ionomer Cement in Class II Restorative Technique-An In Vitro Study.

The success of dental restorations depends mainly on the ability to bond to other filling materials and tooth substances, in order to resist the multitude of forces acting on the bond within the oral cavity. Although the shortcomings of composite resins have been significantly reduced over the past three decades, microleakage due to shrinkage under masticatory loads is unavoidable. In order to overcome such problems, two materials laminated with matched properties can be used to achieve optimum results. The sandwich technique is an approach in which dentine is replaced by glass ionomer cement (GIC), and enamel is replaced by composite resin. In the past, numerous materials have been proposed with adequate properties to be used in this manner, but the results are conflicting in terms of bonding to the various forms of GIC, and the appearance of microcracks or gap formation during functional loading. This study aimed to evaluate the shear bond strength (SBS) and mode of failure between the following core materials: composite resins (CR) (Methacrylate Z350™, Ceram X™, and Spectrum™) with a base material of glass ionomer cement (GIC, Ketac Molar™). Eight samples were made with the help of polytetrafluoroethylene sheets (TEFLON, Wilmington, DE, USA). Each sheet consisted of holes which were 4 mm in diameter and 2 mm in thickness. The combination of materials was sandwiched. The samples were stored in distilled water and then placed in an incubator for 24 h in order to ensure complete polymerization. The samples were thermocycled for 500 cycles between 5–55 °C/ 30 s. Following thermocycling, SBS testing was performed using a universal testing machine. Additionally, scanning electron microscopy (SEM) was performed on representative samples for the bond failure analysis between GIC and the composite resins. The Ceram-X™ nanocomposite showed significantly higher bond strength than Methacrylate Z350™ or Spectrum™ (p = 0.002). The Methacrylate Z350™ and the Spectrum™ composite specimens demonstrated a similar SBS (p = 0.281). The SBS of the Ceram X™ to GIC was the highest compared to Methacrylate Z350™ and Spectrum™. Therefore Ceram X™ may produce a better bond with GIC, and may protect teeth against recurrent caries and failure of the restoration. Methacrylate Z350™ is comparable to Spectrum™ CR and can be used as an alternative. A combination of adhesive and mixed failure was observed in Methacrylate Z350™ CR and GIC, while adhesive failure was predominantly found in both Ceram X™ and Spectrum™ with GIC restorations.

Comparison of efficiency of different crowns in primary children an original research

Introduction: The restorations to anterior teeth in children is very significant. Hence in this study we compared efficiency of strip crowns versus primary anterior zirconium crowns in 3 to 6 year old children. Material and Methods: We selected 100 children of ages 3-6 years to receive the anterior crowns, attending the institution department of pedodontics. They were divided to 50 each of zirconia and strip crown groups. The various parameters were checked at 3,6 and 12 months. Values were compared keeping p<0.05 as significant. Results: Zirconia crowns showed significantly lower plaque accumulation, gingival bleeding restoration failure, at the 3- and 6-months no, but more wear to opposing teeth. With regards to recurrent caries no significant difference was found between the two crowns. Conclusion: Based on our data we conclude that overtime teeth covered with zirconia crowns show better gingival health and less bleeding, plaque accumulation as well as less loss of material. On the other hand, zirconia can cause more loss of opposing tooth structure.

Correction of the State of Enamel Mineral Metabolism in Persons with Decompensated Caries at Various Times after Oral Cavity Sanitation

The aim of the study was to determine the effectiveness of brushite exposure to correct the marginal permeability of composite restorations in persons with a decompensated form of carious process activity; this study also examined the penetrating ability of brushite in the micro-cracks of the enamel-composite border Methods and Results: The study included 120 patients (age 18-40 years) with a decompensated course of the carious process, who underwent complete oral cavity sanitation with the direct composite restoration of 300 teeth. The obtained results were analyzed and interpreted in vivo (the clinical effectiveness of the restoration was assessed according to the Ryge criteria immediately after treatment and 1, 12, and 36 months after treatment) and in vitro (scanning electron microscopy of the enamel-composite joint after applying the composite and after treatment with the studied means). According to the purpose and objectives of the study, two groups of patients were formed: Group 1 (control, n=58): the prevention of recurrent caries after sanitation was carried out using a standard personal hygiene product containing fluorine; Group 2 (experimental, n=62): the prevention of recurrent caries after sanitation was carried out using a natural two-component complex for strengthening and remineralization of enamel RemarsGel. During statistical processing of the obtained data, immediately after sanitation and one month after it, the differences in the indicators of the Ryge criteria in Groups 1 and 2 were statistically insignificant. Twelve months after the sanitation, the Ryge restoration quality indicators in Group 2 were higher than in Group 1 (P≤0.001). After 36 months, the statistical significance of the difference in the restoration quality indicators increased (P≤0.0001). These results were confirmed by the data of scanning electron microscopy. Based on the results obtained, stating the state of the quality of the enamel-composite joint, it can be concluded that brushite crystals are highly effective in preventing violations of the integrity of the enamel-composite joint, which has a direct and immediate impact on the quality of restoration. Conclusion: We consider it necessary to add to the list of main indications for the use of the RemarsGel system one more, a scientifically based indication of the targeted use of the system in the presence of a significant amount of adhesive, both direct and indirect restorations in the oral cavity, especially in the decompensated course of the carious process.

Clinical Performance and Parental Satisfaction with Composite Strip Crown and Prefabricated Zirconia Crown for Primary Anterior Teeth: A Randomized Clinical Trial

To compare clinical performance and parental satisfaction with composite strip crown and prefabricated zirconia crown for primary anterior teeth. The study compares clinical evaluation and parental satisfaction of two different crowns for primary anterior teeth. A total of 102 teeth in each group selected between ages 3 and 6 years, who met the inclusion criteria, were randomly allocated into two groups for further evaluation. Group A for strip crowns (55 teeth) and group B for zirconia crowns (47 teeth). The crowns were evaluated clinically with various criteria like-color match, crown retention, gingival health, crown contour, opposing tooth wear, marginal integrity, and recurrent caries. The samples were also evaluated for parental satisfaction based on 5-point Likert scale and child liking was also recorded with Smiley face Likert scale at baseline, 3 and 9 months. Statistical analysis was done using Chi-square test (p <0.05). Zirconia crowns showed better color match, crown retention, crown contour, and gingival health. Strip crowns showed more discoloration and chipping of material over a period of time. None of the samples showed opposing tooth wear, open margins, and recurrent caries in strip and zirconia crown group. Parents and children both were highly satisfied with zirconia crowns. Clinically zirconia crowns showed higher success rate as compared to strip crowns and parental overall satisfaction was higher for zirconia crowns. Zirconia crowns exhibited a higher clinical performance and parental satisfaction; hence, if affordability is out weighted, zirconia crown stands better with esthetics of the child.

Clinical Accuracy of Two Different Criteria for the Detection of Caries Lesions around Restorations in Primary Teeth

This is a delayed-type cross-sectional prospective accuracy study nested in a randomized clinical trial. The aim was to investigate the diagnostic accuracy of two visual criteria for caries lesions detection around restorations in primary teeth: the International Dental Federation (FDI) criteria, considering adaptation, staining, and the presence of caries, and the Caries Associated with Restorations and Sealants (CARS) system. For this, one examiner made the diagnosis and subsequent treatment decision using visual assessment in 163 children (3–10 years old) with both FDI and CARS criteria. The order of criteria used was defined by randomization. The reference standard was composed of two approaches: (1) the presence of carious tissue after restoration removal and (2) the presence of caries lesions after 6 and 12 months of follow-up. Sensitivity, specificity, and accuracy parameters were calculated at the dentin threshold. Poisson multilevel regression analyses were performed to evaluate the association of the diagnostic methods and other explanatory variables with the outcomes. Of the 651 restorations included, 480 were evaluated by the reference standard methods and were analyzed. The CARS system presented higher accuracy (0.721) than those obtained with FDI recurrence of caries (0.702), FDI marginal adaptation (0.700), and FDI marginal staining criteria (0.681). The FDI marginal staining showed the study’s lowest sensitivity (0.280) and accuracy (0.681) values. The specificity values of FDI recurrence of caries and FDI marginal adaptation were lower than the CARS system. Restorations assessed after the follow-up period resulted in lower sensitivity but higher specificity than those replaced after initial evaluation. In conclusion, the CARS system is more accurate in detecting caries around restorations in primary teeth than the FDI system, in general. However, the FDI recurrence of caries and FDI marginal adaptation present similar performance to the CARS system when the dentin threshold is considered. On the other hand, marginal staining is not an accurate parameter to evaluate caries around restorations.

Development and Assessment of Bioactive Coatings for the Prevention of Recurrent Caries Around Resin Composite Restorations.

To develop hydrophilic resin-based surface coatings containing bioactive agents (proanthocyanidins from Vitis vinifera and calcium silicate) and assess their protective role at the dentin and enamel margins of cervical restorations against demineralization under simulated conditions of high and low caries activity. Suboptimal resin composite restorations were placed on cervical cavity preparations on buccal and lingual surfaces of thirty-two molars after a contamination protocol. Groups were divided according to the resin-based coatings (n=8): resin without bioactive (C), resin containing 2% enriched Vitis Vinifera (VVE), and resin coat containing 10% calcium silicate (CaSi). The control group did not receive a resin (NC). To simulate a hydrolyticenzymatic degradation, specimens were subjected to 2-month storage followed by incubation in esterase at 37°C for 8 days. Afterwards, recurrent caries was induced using a pH-proteolytic model on half of the specimens to simulate high caries activity, and the other half remained in simulated body fluid (SBF). Measurements of cross-section microhardness (KHN) and infiltration with rhodamine-B assessed the micropermeability (MP), the extent of demineralization (ED), and the demineralization area (DA). Data were analyzed using analysis of variance (ANOVA) and post-hoc tests (α=0.05). VVE and CaSi presented higher cross-sectional KHN values for enamel and dentin (p<0.001). The bioactive coatings resulted in lower MP, ED, and DA compared to NC (p<0.005) in enamel and dentin. CaSi coating preserved the enamel from demineralization (p=0.160). The application of bioactive coatings represents a potential strategy to protect the enamel-dentin margins of resin restorations.

Novel rechargeable nanostructured calcium phosphate crown cement with long-term ion release and antibacterial activity to suppress saliva microcosm biofilms

ObjectiveResin cements with remineralizing and antibacterial properties are favorable for inhibition of caries. The objectives of this study were: (1) to investigate the capability of the novel dimethylaminohexadecyl-methacrylate (DMAHDM) and nano-sized amorphous calcium phosphate (NACP) containing cement to reduce saliva microcosm biofilm, and (2) to investigate the long-term ion release, recharge, and re-release of DMAHDM-NACP cement. MethodsPyromellitic glycerol dimethacrylate (PMGDM) and ethoxylated bisphenol-A-dimethacrylate (EBPADMA) were used to make PEHB monomer. Five cements were fabricated: (1) PEHB+0%NACP+0%DMAHDM (experimental control); (2) PEHB+25%NACP+0%DMAHDM, (3) PEHB+25%NACP+0%DMAHDM; (4) PEHB+25%NACP+3%DMAHDM; (5) PEHB+25%NACP+5%DMAHDM. RelyX luting cement was used as commercial control. Colony-forming units (CFU), lactic acid production, metabolic activities, and minimum inhibitory concentration (MIC) were performed. Long-term Calcium (Ca) and phosphate (P) ion release, recharge, and re-release were assessed. ResultsCompared to experimental and commercial controls, the NACP-DMAHDM cement significantly reduced CFU biofilm by 2–3 orders of magnitude, metabolic activities from 0.24±0.06 A540/cm2 to 0.03±0.01 A540/cm2, and lactic acid production from 27.7 ± 2.5 mmol/L to 5.4 ± 2.1 mmol/L (n = 6) (p<0.05). The DMAHDM showed an MIC value of 0.03 mg/L. However, when the DMAHDM was combined with PMGDM monomer, the MIC was greater than DMAHDM alone. The ion concentrations for the experimental groups significantly increased over time (1–84 days), indicating continuous ion release (n = 3) (p<0.05). Increasing the DMAHDM mass fraction from 0% to 5% and 3% to 5% significantly enhanced ion recharge and re-release at the third cycle (p<0.05). ConclusionsIncorporating DMAHDM and NACP into resin-based crown cement provides strong antibacterial action against saliva microcosm biofilm and presents a high level of Ca and P ion recharge abilities, exhibiting long-term Ca and P ion release and remineralization potential. Clinical SignificanceResin based cement containing NACP and DMAHDM were developed with remineralizing and potent antibacterial effects. This cement formulation showed ion release and remineralization potential and are promising formulations to inhibit the incidence of recurrent caries and could promote remineralization and be sustainable for the long term.

Effect of different polishing techniques on surface properties and bacterial adhesion on resin-ceramic CAD/CAM materials.

The aim of this study is to evaluate the adhesion of Streptococcus mutans on the surface of CAD/CAM materials with various surface treatments. Vita Enamic, Lava Ultimate, and Cerasmart materials were used in this study. A total of 90 samples were prepared (n = 10). After various finishing and polishing procedures (non-polished, manual polished, and glazed), surface roughness (SR) measurements, surface free energy (SFE), and elemental and topographic analysis with FIB-SEM/EDX were used to evaluate the samples' surface properties. To improve bacterial adhesion, CAD/CAM materials were covered with sterile artificial saliva containing mucin for pellicle formation and incubated for 1h at 37°C. Bacteria were then inoculated into the pellicle-coated specimens, and incubation was performed at 37°C for 24h. Bacterial adhesion was determined as × 105CFU/mL and monitored using FIB-SEM analysis. The Kolmogorov-Smirnov test was used to statistically analyze the normality of the distribution; the groups were then compared using one-way ANOVA and Tukey's test. The SR of the control group was statistically higher in all materials (p < 0.05). There were no statistically significant differences in SR between all materials in the non-polished and manual polished groups (p > 0.05). The Vita Enamic control group exhibited the highest SFE value. The highest S. mutans adhesion was observed in non-polished (p < 0.05). Vita Enamic samples had higher CFU than other groups. Non-polished surfaces showed higher SR and bacterial adhesion. Polishing processes affected the surface properties and bacterial adhesion. Care must be taken in polishing restorations to minimize the risk of bacterial adhesion and recurrent caries. In this study, the materials used for dental treatments are in vitro evaluated. Due to that, this study is not registered to clinical trials.

Evaluation of antimicrobial property of self etch adhesive incorporated with green synthesized tio2 nanoparticles

Since its introduction about fifty years ago, adhesive technology has advanced rapidly. In this current era,nanoparticles has gained attention in restorative dentistry because of its advantages like improving bond strength and stability of restoration.As opposed to the chemical process, the green synthesis of titanium oxide nanoparticles has more advantages one of which is improved antimicrobial activity. Antibacterial dental adhesives can help to prevent recurrent or secondary caries. The aim of this invitro study was to evaluate the antimicrobial property of self etch adhesives incorporated with Tio2 nanoparticles. The extracts of Piper longum herb was used to make titanium dioxide nanoparticles (TiO2NPs) in a green way.Its aim is to create a tight bond between tooth dentin and restorative material.Failures in this process could result in microleakage, allowing bacteria, fluids, and ions to infiltrate.The antimicrobial property of self etch adhesives incorporated with Tio2 nanoparticles were tested against standard strain of S.mutans, lactobacillus and E.faecalis using the Zone of inhibition test. The diameter of inhibition zones were measured in millimeters.

An In Vitro Study to Compare the Release of Fluoride from Glass Ionomer Cement (Fuji IX) and Zirconomer.

Mercury toxicity from amalgam dental fillings and their potential for creating problems in the environment and for human health have prompted the development of new restorative materials. The leading alternatives among these are glass ionomer cements. According to current understanding, restorative materials that slowly release fluoride exert a local cariostatic effect. For this purpose, glass ionomer cements have desirable properties in that they help prevent recurrence of caries by releasing fluoride over a long period. Thus, they function in accord with the major cariostatic mechanism of fluoride, which is believed to be its action to promote remineralization and to influence the morphology of teeth by reducing enamel solubility and by suppressing oral cariogenic bacteria. Although the minimum local concentration of fluoride release required to inhibit demineralization has not been determined, it is reported that the cariostatic ability of fluoride releasing restorative materials is significant. Zirconomer defines a new class of restorative that promises the strength and durability of amalgam with the protective benefits of glass ionomer while completely eliminating the hazards of mercury. The inclusion of specially micronized zirconia fillers in the glass component of zirconomer reinforces the structural integrity of the restoration and imparts superior mechanical properties for the restoration of load-bearing permanent teeth. Combination of outstanding strength, durability, and sustained fluoride protection deems it ideal for multiple applications. The aim of the present study was to determine the fluoride release from glass ionomer cements and compare it with new material zirconomer.Materials and methodsSample preparationTablets of glass-ionomer cements and zirconomer were prepared. A dental floss was incorporated into the tablets during fabrication to allow suspension into the test medium. Each disk specimen was immersed in airtight polyethylene bottle containing 20 mL of deionized water and incubated at 37°C and stored for 24 hours.Determination of fluoride ion releaseFluoride ion measurement was performed after 6 hours, 24 hours, 48 hours, 7 days, and 14 days under normal atmospheric conditions by fluoride ion selective electrode connected to an ion selective electrode meter.Result and conclusionBoth the material tested in the study had the ability to release fluoride but higher fluoride release was observed by zirconomer as compared to GIC at all time intervals.Clinical significanceFrom a clinical point of view, both the restorative materials release fluoride at all time intervals; however, addition of zirconia particles in zirconomer increases its strength and provides superior mechanical properties. Therefore, due to the combination of both good structural integrity and fluoride releasing properties, zirconomer can be used for restoration of load bearing teeth.How to cite this articleKukreja R, Singla S, Bhadoria N, et al. An In Vitro Study to Compare the Release of Fluoride from Glass Ionomer Cement (Fuji IX) and Zirconomer. Int J Clin Pediatr Dent 2022;15(1):35-37.

Assessing the Antimicrobial Properties of Copper-Iodide Doped Adhesives in an In vitro Caries Model: A Pilot Study.

Context:Recurrent caries are the leading cause of composite resin failure.Aims:The purpose of this pilot study was to test the efficacy of a novel copper iodide (CuI) containing dental adhesive in an in vitro caries model.Subjects and Methods:Streptococcus mutans and Lactobacillus acidophilus were grown individually on the complex medium for 48 h at 37°C. The pH of the mixed medium was 7.0 initially and tested every 24 h. 40 extracted teeth were prepared with standardized cavity preparations and coated with control or experimental CuI adhesives and imaged using a micro-computed tomography (microCT). Four study groups were evaluated: (1) control (2) 0.5 μg/ml CuI (3) 1.0 μg/ml CuI, 4) 5.0 μg/ml CuI. After incubation, the teeth were re-imaged using the microCT. Utilizing AnalyzePro software the three-dimensional data sets were overlaid and demineralization was measured and statistics were run.Statistics:Stratified ANOVA models were run to determine if there were differences between the control and experimental adhesive groups. Similarly, pH and bacterial concentrations were evaluated to ensure the viability of polymicrobial specimen.Results and Conclusions:Significant differences were found between the control group and the 1.0 and 5.0 CuI adhesive groups. No differences in pH were noted between the groups. Overlaid changes in demineralization were recorded as volume loss. CuI adhesives with 5 mg/ml or higher have the potential to limit tooth demineralization after bacterial penetration of a dental restoration in an in vitro caries model. Further testing is needed.

Antimicrobial Effects of Propolis Incorporated Dental Composite Resin

Aim/Objective: The aim of this in-vitro study is to assess the antibacterial activity of a propolis-modified experimental dental composite resin in terms of reducing and preventing recurrent caries, usually caused by Streptococcus mutans. Materials and methods: Control group specimens were made using the 70/30 (filler/resin) method without the use of EPE. Group 1 specimens were made by mixing 12% EPE with 30% resin in experimental dental composite resin. The experimental dental composite was created by adding 16%EPE and 20% EPE to Group 2 and Group 3, respectively. Antibacterial testing was carried out in the inhibition zone using the minimum inhibition concentration (MIC) and minimum bactericidal concentration (MBC). Surface roughness was assessed using scanning electron microscopy. Results: The results were evaluated using one-way ANOVA and Tukey's high significant difference test (HSD). The EPE displayed antibacterial action against S.mutans, according to the findings. The inhibitory zone of 20% EPE integrated dental composite resin was 2.2mm to 2.5mm. Inhibition zones ranging from 1.2mm to 1.8mm were found in 12% and 16% of the samples, respectively. The results of the minimum inhibitory concentration showed that 20% had stronger antibacterial activity than 12 and 16 %. Scanning electron microscopy research revealed that 20% of EPE samples had decreased surface roughness. Conclusion: The experimental dental composite showed antibacterial activity against S.mutans. Antibacterial activity is increased by increasing the proportion of EPE in the experimental composite. Due to its dark color appearance it is recommended for usage as a lining material under restorative materials. Keywords: Streptococcus mutans, Secondary Caries, Antibacterial activity, Propolis, Ethanolic extract of Propolis, Dental Composite Resin

Effect of Dentin Moisture in Posterior Restorations Performed with Universal Adhesive: A Randomized Clinical Trial.

This double-blind, randomized clinical trial evaluated the influence of dentin moisture on postoperative sensitivity (POS), as well as, on clinical performance in posterior bulk-fill composite restorations, using a universal adhesive, until 12 months after clinical service. In accordance with a split-mouth design, 45 patients received posterior restorations, restored with a bulk-fill resin composite (Filtek Bulk Fill, 3M Oral Care) and a universal adhesive used in etch-and-rinse mode (SBU; Single Bond Universal Adhesive), which were applied on dry or moist dentin, with a cavity depth of at least 3 mm. Three operators placed 90 Class I/Class II restorations. Patients were evaluated for spontaneous and stimulated POS in the baseline, and after 48 hours, 7 days, and at 6 and 12 months. In addition, secondary parameters (marginal discoloration, marginal adaptation, fracture, and recurrent caries) were evaluated by World Dental Federation (FDI) criteria after 7 days and at 6 and 12 months. Statistical analyzes were performed using the Chi-square, Fisher exact, Friedman, Kruskall-Wallis, and Mann-Whitney tests (α=0.05). No significant spontaneous and stimulated POS was observed when SBU was applied in dry and moist dentin (p>0.05). A significant and higher risk of spontaneous POS (20.0%; 95%CI 10.9-33.82 for dry dentin and 22.22%; 95%CI 12.54-36.27 for moist dentin) occurred up to 48 hours after restoration placement for the dry and moist dentin groups (p<0.02). However, the POS intensity was mild up to 48 hours with no significant difference between dry and moist dentin groups (p>0.79). When secondary parameters were evaluated, no significant differences between the groups were observed. Dentin moisture did not influence POS in posterior bulk-fill composite restorations when associated with a universal adhesive applied in etch-and-rinse mode.

Zirconia Crowns for Primary Teeth: A Systematic Review and Meta-Analyses.

Objective: The aim of this systematic review was to summarize the literature regarding the clinical performance of zirconia crowns for primary teeth. Materials and Methods: Four electronic databases, Ovid, PubMed, Scopus, and Web of Science were searched. Clinical, observational, and laboratory studies were included. Studies that assessed the performance of zirconia crowns for primary teeth using outcomes such as gingival and periodontal health, parental satisfaction, color stability, crown retention, contour, fracture resistance, marginal integrity, surface roughness, and recurrent caries were included. Risk of bias was assessed using different assessment tools depending on the type of the assessed study. Results: Out of the 2400 retrieved records, 73 full-text records were assessed for eligibility. Thirty-six studies were included for qualitative analysis. The included studies reported that zirconia crowns for primary teeth were associated with better gingival and periodontal health, good retention, high fracture resistance, color stability, high parental acceptance, good marginal adaptation, smooth cosmetic surface, and no recurrent caries. Conclusion: Zirconia crowns are promising alternative to other restorative materials and crowns in the field of pediatric dentistry. They showed higher properties and performance in different clinical aspects and great parental satisfaction.

Clinical outcomes of dental treatment under general anesthesia and its effects on the caries activity and body growth of children: a 2-year retrospective study.

To analyze clinical outcomes of dental treatment under general anesthesia (DGA) and its effects on children's caries activity status and body growth within 2years after the treatment. The case data and 2-year follow-up records of children who underwent DGA from February 2017 to February 2018 were collected and analyzed. The general characteristics of the sample, the success rates of treatment procedures, the caries recurrence rate, the caries activity test scores, and the BMI of all the children were described. The caries activity levels between children with and without caries recurrence at 24months after DGA were compared before and after DGA to explore the relationship between caries activity level and caries recurrence. The correlation between BMI level and caries recurrence was explored using Cox regression analysis. A total of 94 children consisting of 46 boys and 48 girls were included in this study. The average dmft score before DGA was 13.90. Within 2years after the treatment, composite fillings and strip crowns of the anterior teeth achieved similar success rates, around 90%; SSCs showed a similar success rate to composite fillings of posterior teeth (P = 1.000); the clinical success rate of pulpectomy was 90.43%. All the children showed no caries relapse at 1month after DGA. The number of children with caries relapse at 6-, 12-, and 24-month post-treatment was 24 (25.53%), 35 (37.23%), and 53 (56.38%), respectively. The caries activity scores at each follow-up were significantly lower than those before the treatment (P < 0.0001). Children with caries relapse within 2years after DGA showed no significantly different caries activity scores than children without caries relapse before and after the treatment. The proportion of children with normal BMI at 12months after DGA was significantly higher than that before DGA (P = 0.007), and the difference was still very significant at 24months after DGA (P < 0.0001). Statistical results showed a correlation between BMI level before DGA and caries recurrence (P < 0.001). Dental treatment under general anesthesia achieves acceptable clinical outcomes in this study. Children's caries activity scores decrease significantly. Low or high BMI levels before DGA drift towards normal after the treatment. Acceptable outcomes are achieved within 2years after dental treatment under general anesthesia. However, children with abnormal BMI before the treatment tend to have caries relapse.

Fixed Prosthetic Restorations and Periodontal Health: A Narrative Review.

Periodontal health plays an important role in the longevity of prosthodontic restorations. The issues of comparative assessment of prosthetic constructions are complicated and not fully understood. The aim of this article is to review and present the current knowledge regarding the various technical, clinical, and molecular aspects of different prosthetic biomaterials and highlight the interactions between periodontal health and prosthetic restorations. Articles on periodontal health and fixed dental prostheses were searched using the keywords “zirconium”, “CAD/CAM”, “dental ceramics”, “metal–ceramics”, “margin fit”, “crown”, “fixed dental prostheses”, “periodontium”, and “margin gap” in PubMed/Medline, Scopus, Google Scholar, and Science Direct. Further search criteria included being published in English, and between January 1981 and September 2021. Then, relevant articles were selected, included, and critically analyzed in this review. The margin of discrepancy results in the enhanced accumulation of dental biofilm, microleakage, hypersensitivity, margin discoloration, increased gingival crevicular fluid flow (GCF), recurrent caries, pulp infection and, lastly, periodontal lesion and bone loss, which can lead to the failure of prosthetic treatment. Before starting prosthetic treatment, the condition of the periodontal tissues should be assessed for their oral hygiene status, and gingival and periodontal conditions. Zirconium-based restorations made from computer-aided design and computer-aided manufacturing (CAD/CAM) technology provide better results, in terms of marginal fit, inflammation reduction, maintenance, and the restoration of periodontal health and oral hygiene, compared to constructions made by conventional methods, and from other alloys. Compared to subgingival margins, supragingival margins offer better oral hygiene, which can be maintained and does not lead to secondary caries or periodontal disease.

Dental resin composites: A review on materials to product realizations

Dental resin composites have revolutionized dental care and enabled minimally invasive dentistry to preserve healthy tooth structure and provide natural-appearing esthetic results; these materials are now good alternatives to metal and amalgam restorations. Nevertheless, dental composites are being further developed to enhance their long-term clinical performance and longevity. With a complete understanding of the various material characteristics and design strategies of dental composite systems, frontiers of dental restoration research can aim towards creating novel materials that can produce very similar properties, functionalities, and internal structures as hard dental tissues. In this review article, the authors present an overview of the synthesis of the advanced dental composite systems with the recent research and development fields over the last 5 years. This review also explores how to control and optimize the required properties of the composites, ideally to increase the longevity/durability of restorations preventing recurrent caries. Research studies and commercial products are introduced to forecast the demands and trends of resin-based dental composites, in order to assist clinicians and researchers in optimal selection of materials to fulfill mechanical, physical, biological, and functional requirements.

Prevention of Recurrent Childhood Caries with Probiotic Supplements: A Randomized Controlled Trial with a 12-Month Follow-Up

The aim of this study was to evaluate the effect of drops containing probiotic bacteria on the recurrence of dental caries in preschool children. The study employed a randomized, placebo-controlled, double-blinded design with two parallel arms. 38 preschool children were enrolled after comprehensive restorative treatment under general anesthesia or conscious sedation (baseline), and they were followed up after 6 and 12 months. Parents of children in the test group were instructed to give 5 daily drops containing two strains of Limosilactobacillus reuteri (DSM 17938 and ATCC PTA 5289) at bedtime. The placebo drops were identically composed but lacked bacteria. The duration of the intervention was 12 months. The primary endpoint was recurrence of new caries lesions on subject level (yes/no), and secondary endpoints were presence of dental plaque and gingivitis. We found high rate of recurrent moderate and extensive lesions after 12 months (67%) but there were no significant differences between the groups. We observed no beneficial effects on dental plaque or gingival inflammation. The findings were however uncertain and inconclusive due to lack of power, a consequence of the COVID-19 pandemic. ClinTrials.gov Identifier: (NCT04929340), June 18, 2021; retrospectively registered.