Restorations In Permanent Teeth Research Articles

What are the emerging trends in dental composite materials in permanent teeth with occlusal cavities: self-adhesive vs traditional?

The research is a systematic review and meta-analysis of randomized controlled trials (RCTs). The study aimed to compare the clinical outcomes of self-adhesive flowable composite resins (SAFCs) versus conventional flowable composite resins (FCs) used in occlusal cavity restorations in permanent teeth. This research included a search for RCTs. Multiple databases were systematically searched for RCTs with a minimum 1-year follow-up comparing SAFCs to FCs. Outcomes evaluated were retention, secondary caries, marginal adaptation, marginal discoloration, and postoperative sensitivity based on modified USPHS criteria. Risk of bias was assessed using Cochrane RoB 2 tool. Random effects meta-analyses were conducted where applicable. Certainty of evidence was rated using GRADE approach. Five RCTs (four parallel and one split mouth) comprising 138 patients were included. During 1- and 2-year recalls, there were generally no significant differences in clinical performance between SAFCs and FCs. However, FCs applied using the etch-and-rinse technique demonstrated statistically better marginal adaptation at 2 years (3 studies, RR 3.21, 95% CI 1.50-6.83) and marginal discoloration (4 studies, RR 3.40, 95% CI 1.10-10.48). The overall quality of evidence ranged from low to moderate. SAFCs showed comparable short-term outcomes to FCs in treating occlusal cavities. Further high-quality RCTs with longer follow-up are warranted to confirm long-term performance of SAFCs. Use of separate enamel etching may improve marginal adaptation and discoloration with FCs.

Complicated caries of permanent teeth in children: status of the problem and modern solution ways

The issue of improving dental care protocols for children with multiple (decompensated) and complicated caries of permanent teeth, their full rehabilitation is particularly relevant, especially in periods of social cataclysms (the COVID-19 pandemic, martial law, etc.). The purpose of this study was an assessment of the dental caries experience, analysis of modern approaches to diagnosis, treatment, prevention and rehabilitation of complicated caries of permanent teeth among children in Kyiv. The material of the study was data from medical histories of 236 children aged 7-18 years. During the analysis of the obtained data, the dental caries experience, % of cases of toothache complaints and part of the need for replacement or correction of restorations after the treatment of complicated caries were calculated. The prevalence of caries of permanent teeth among 7-18-year-old children (n=236) in the period 2020-2023 was 42-95%, the dental caries experience – 1.73-6.4, the frequency of diagnosis of complicated caries – 4.8-37,1%, the prevalence of toothache – 31%, the part of the need for replacement of restorations after treatment of complicated caries – 62%. The obtained indicators confirm the absence of a downward trend compared to similar data for more than 15 years of observation. Diagnosis, treatment and full rehabilitation of complicated caries of permanent teeth in children is complex, multi-stage and requires the practical experience and patience of a dentist and the usage of the most modern materials and technologies. To date, there are no clear scientifically based protocols for the restoration of permanent teeth, in particular with incomplete root formation, after endodontic treatment. The usage of modern technologies of orthopedic dentistry and materials science (3D scanner, 3D printer, T-scan, polymers) will allow to significantly improve the quality of comprehensive treatment and rehabilitation of children with complications of caries of permanent teeth.

Caries-related hospital morbidity in the Brazilian Unified Health System from 2008 to 2022.

Dental caries is an important Public Health issue. However, the treatment of this disease in tertiary dental care requires further investigation. Therefore, the objective of this study was to evaluate caries-related hospital morbidity in the Brazilian Unified Health System (SUS) from 2008 to 2022. An ecological study was conducted with secondary data on caries-related Hospital Admission Authorizations (AIH) and in-hospital dental procedures (IDP). Data were collected nationwide and statistical analysis was performed with a significance level (p) of 5%. In the last 15 years, 3,474 caries-related AIH and 63,657 IDP were approved within SUS. There was a significant upward trend in the number of caries-related AIH (p = 0.018) and a stationary trend in the number of caries-related IDP (p = 0.841). Moreover, from 2008 to 2022, R$ 1,160,843.09 was allocated for caries-related AIH. Hospital mortality was 0.29% (10 deaths), and 75.1% were elective inpatient admissions. Among SUS users, adults constituted the majority (49%), with a higher frequency of males (59.8%) and whites (46.2%). The most frequent type of caries-related IDP was restoration of permanent teeth (55.3%). Nonetheless, during the COVID-19 pandemic years, significant reductions in caries-related AIH and IDP within the SUS were observed (all p <0.05). Thus, within the SUS, caries-related tertiary dental care has shown a specific pattern over the last 15 years, including an increase in hospitalizations and a high number of in-hospital dental procedures, especially before the COVID-19 pandemic onset.

Accuracy of Two Visual Criteria for the Assessment of Caries around Restorations: A Delayed-Type Cross-Sectional Study

The aim of this study was to compare the performance of two visual criteria used for the detection of caries around restorations in permanent teeth. In this delayed-type cross-sectional study, the study sample was randomly allocated to one of two visual criteria for the assessment of restorations as follows: (a) International Dental Federation (FDI) criteria, considers marginal staining, marginal adaptation, and caries recurrence and (b) Caries Associated with Restorations or Sealants (CARS) criteria, defined by the International Caries Classification and Management System. A calibrated examiner assessed the restorations using two reference standards as follows: (i) for restorations requiring operative interventions (repair/replacement), the restoration was partially or totally removed and the presence or absence of carious tissue was assessed; and (ii) for restorations requiring nonoperative intervention, follow-up for a period of 1 year was recommended to allow identification of the presence of new lesions not detected at baseline. The sensitivity, specificity, area under receiver operating characteristic curve (Az), and accuracy of the criteria were assessed. The study included 305 restorations. The FDI marginal staining parameter had the lowest Az value (Az = 0.501), while similar sensitivity was observed between the CARS (62.0%), FDI presence of caries (65.0%), and FDI marginal adaptation (74.0%) parameters. CARS exhibited the highest specificity (88.3%) and accuracy (85.6%). The CARS criteria exhibited better specificity and accuracy in detecting caries around restorations, followed by the FDI criteria for caries recurrence and marginal adaptation. Considering marginal staining or combining multiple marginal features to assess secondary caries resulted in an increased risk of false-positive outcomes and overtreatment.

Survival analysis of fragment reattachments and direct composite restorations in permanent teeth after dental traumatic injuries.

In case of crown fractures after traumatic dental injuries, the affected teeth can be restored either with reattachment of the fractured fragment or with a direct composite restoration. So far, longevity data for reattachments and direct composite restorations with regard to different failure types (pulp necrosis and infection, restoration loss) are scarce. Therefore, the aim of this retrospective study was to evaluate the restorative and biological survival of reattached fragments and composite restorations after crown fractures in permanent teeth. Dental records of patients treated between 2000 and 2018 were retrospectively analysed regarding the restoration (reattachment or direct composite restorations) of teeth with crown fractures. Survival (no further intervention) and restorative and/or biological failure of all restored teeth were recorded. Statistical analysis was performed using Kaplan-Meier statistics, and the mean annual failure rates for two and 5 years were calculated. Furthermore, the effect of potential risk factors on survival was assessed. Log-rank tests and univariate Cox regression models (likelihood ratio tests) were used to assess the univariate effect of all variables of interest. Variables with a p-value ≤.10 were included in a multivariate Cox regression model with shared frailty (p< .05). Overall, 164 patients with 235 teeth (uncomplicated crown fracture: N=201, complicated crown fracture: N=34) were included (1.6± 2.5 years observation time). Of these, 59 teeth were restored with reattachment of the fragment and 176 with a composite restoration. Overall, composite restorations had a significantly higher survival rate than reattachments (p= .002). The cumulative survival after 2 years was 42.9% and 65.0% for teeth treated with a reattachment (mAFR=34.5%) and a composite restoration (mAFR=19.3%), respectively. When differentiating between failure types, restoration failure and pulp necrosis were significantly more frequently detected in reattached crown fractures compared to composite restorations (restorative failure: p= .001; biological failure: p=.036). In the multivariate Cox regression model, the variable jaw and luxation significantly influenced the survival when the tooth was restored with a composite restoration. The survival was not influenced by the fracture type. Restorative and biological failures were more frequently detected when the tooth was restored with a reattached fragment compared to a direct composite restoration. Both, restoration failure and pulp necrosis with infection should be considered as frequent complications after restoration of crown-fractured teeth which emphasizes the necessity of regular and short follow-up intervals throughout the first 2 years.

Riboflavin (Vitamin B2), Turmeric (Curcumin) Photosensitizers Mediated Photodynamic Therapy, and Er, Cr: YSGG on Microleakage of Class V Cavities Restored by Resin-Modified Glass-Ionomer Cement

Purpose: The present study aimed to assess the effect of RF and CP intervened PDT and Er, Cr: YSGG laser on microleakage in class V RMGIC restorations in permanent teeth. Materials and Methods: In-vitro eighty standardized class V cavities (4×4×2) were prepared in extracted permanent molars based on ICDAS II (International Caries Detection and Assessment System II) caries severity code 0. All samples were arbitrarily alienated into four groups: Group 1, PDT mediated riboflavin photosensitizer (RF) [concentration of 150 μg/mL]; Group 2, PDT with curcumin photosensitizer (CP) [concentration of 100 μg/mL]; Group 3, Er, Cr: YSGG laser application; Group 4, control group: rinsed and dried dentin. Cavities were restored with conventional RMGIC. The specimens were immersed in 0.5% Fuchsine solution for 24 hrs. and sectioned. Microleakage scores were assessed under a microscope. Intergroup and intragroup comparisons were made at enamel and cementum margin respectively. Data were analyzed by non-parametric Kruskal-Wallis test and Wilcoxon tests at the level of significance deemed p &lt; 0.05. Results: Riboflavin and curcuminmediated PDT would produce a superior reduction (95% viz 90%) of microleakage as compared to Er, Cr: YSGG laser (85%), and no control groups. Cu-PDT observed the highest amount of microleakage with the least amount of microleakage in the control group. Conclusion: Riboflavin and curcumin photosensitizers mediated PDT and Er, Cr: YSGG laser has the potential to be utilized in class V cavities before RMGIC restorations at enamel margins without adversely affecting the marginal integrity.

Repair of Dental Restorations: A 10-year Retrospective Analysis of Clinical Data.

This study collected and analyzed clinical data regarding the repair of dental restorations in patients treated in the clinics of a dental school over 10 years. Data related to repair procedures for permanent tooth restorations were extracted from the digital dental records system and filtered according to year (January 1, 2008, to December 31, 2017), age (<30, 30-60, >60), tooth group, and dental surfaces. Data were analyzed with descriptive statistics in terms of the absolute and relative frequency, and chi-square tests (95% confidence) were used to compare the frequency of repairs between years, age, tooth, and dental surfaces. A total of 48,915 dental records were accessed by searching for general restorative procedures, of which 1,408 were repairs of dental restorations on permanent teeth. The number of repairs per year increased over the period assessed, and there was a significant increase in the years 2016 and 2017. Individuals aged between 30 and 60 years received the largest number of repairs, with significantly more repairs than the other groups. Regarding the tooth group and surface, the canines and the incisal and lingual surfaces received the least number of repairs. The number of repairs increased over the study period. When comparing frequencies between groups, those belonging to the 30- to 60-years of age group received more repairs; the least repaired surfaces were the lingual and the incisal.

Automated detection of posterior restorations in permanent teeth using artificial intelligence on intraoral photographs

ObjectivesIntraoral photographs might be considered the machine-readable equivalent of a clinical-based visual examination and can potentially be used to detect and categorize dental restorations. The first objective of this study was to develop a deep learning-based convolutional neural network (CNN) for automated detection and categorization of posterior composite, cement, amalgam, gold and ceramic restorations on clinical photographs. Second, this study aimed to determine the diagnostic accuracy for the developed CNN (test method) compared to that of an expert evaluation (reference standard). MethodsThe whole image set of 1761 images (483 of unrestored teeth, 570 of composite restorations, 213 of cements, 278 of amalgam restorations, 125 of gold restorations and 92 of ceramic restorations) was divided into a training set (N = 1407, 401, 447, 66, 231, 93, and 169, respectively) and a test set (N = 354, 82, 123, 26, 47, 32, and 44). The expert diagnoses served as a reference standard for cyclic training and repeated evaluation of the CNN (ResNeXt-101–32 × 8d), which was trained by using image augmentation and transfer learning. Statistical analysis included the calculation of contingency tables, areas under the receiver operating characteristic curve and saliency maps. ResultsAfter training was complete, the CNN was able to categorize restorations correctly with the following diagnostic accuracy values: 94.9% for unrestored teeth, 92.9% for composites, 98.3% for cements, 99.2% for amalgam restorations, 99.4% for gold restorations and 97.8% for ceramic restorations. ConclusionsIt was possible to categorize different types of posterior restorations on intraoral photographs automatically with a good diagnostic accuracy. Clinical significanceDental diagnostics might be supported by artificial intelligence-based algorithms in the future. However, further improvements are needed to increase accuracy and practicability.

Risk of failure of repaired versus replaced defective direct restorations in permanent teeth: a systematic review and meta-analysis.

This study aimed to systematically review the literature to compare the risk of failure of repaired and replaced defective direct resin composite and amalgam restorations performed in permanent teeth. The PubMed/MEDLINE, Scopus, Lilacs, BBO, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL) databases, and gray literature were searched to identify longitudinal clinical studies related to the research question. No publication year or language restriction was considered. Two authors independently selected the studies, extracted the data, and assessed the risk of bias andcertainty of evidence. A meta-analysis was performed using a fixed effects model at a 5% significance level. From 1224 potentially eligible studies, thirteen were selected for full-text analysis, and three were included in the systematic review and meta-analysis. There was no difference in the risk of failure of repaired and replaced defective direct restorations (RR: 1.21, 95% CI: 0.51-2.83), either for resin composite (p = 0.97) or amalgam (p = 0.51) restorations. The risk of bias was high and the certainty of evidence was very low. Based on the very low certainty of evidence, the repair of direct restorations does not present a significant difference in the risk of failure when compared to replacements in permanent teeth. Restoration repair is a procedure that is included in the minimal intervention principle for improvement of tooth longevity in that the risk of failure of repaired partially defective restorations in permanent teeth seems similar to that of replacement. Further studies are required before definitive conclusions can be drawn.

Эффективность применения композиционного материала при реставрации постоянных зубов у детей

The prevalence, intensity of dental caries and the need for treatment of permanent immature teeth remain high among the child population of the Republic of Belarus. The choice of restorative material and treatment regimen for caries of permanent teeth in children are relevant at the present. The aim of the study was to evaluate the clinical effectiveness of «Admira Fusion» composite material for the restoration of permanent teeth in children. Material and methods. 143 permanent teeth in 52 children and adolescents (average age 13.4 years) were treated using universal nanohybrid «Admira Fusion» composite. Restorations assessment was carried out in 12 and 24 months according to Ryge criteria. Results. In has found that caries experience of permanent teeth in children and adolescents participating in the study according to the DMFT index is 4.3±1.4, which corresponds to the moderate level of caries intensity. The level of oral hygiene according to the OHI-S index is 0.7±0.1, which is assessed as satisfactory hygiene. It has been analyzed that in children and adolescents 51.05 % caries affected teeth were the first permanent molars (73 teeth) and 27.27 % – the second permanent molars (39 teeth). In 11.89 % of clinical cases caries was detected in the first premolars (17 teeth) and in 9.79 % (14 teeth) – in the incisors of the upper jaw. The analysis of lesions localization on the surfaces of permanent teeth has indicated that in children and adolescents most often in 60.46 % treated teeth caries was detected on the occlusal surfaces (I class by Black). In 27.9 % of the restored teeth, combined lesions of the occlusal and proximal surfaces (Black, class II) were recorded: 11.53 % on the distal-occlusal surfaces and 16.27 % on the medial-occlusal surfaces. Isolated lesions of the medial (14.65 %) and vestibular (6.98 %) surfaces (Black, class V) were noted rarely. It has been found high effectiveness of the proposed treatment using universal nanohybrid material «Admira Fusion» for restoration in two years. 100 % retention of restorations were detected. There were no found complaints of toothache or loss of fillings in 100 % clinical cases. 100 % of the restorations were noted with good edge adaptation and anatomical shape. There were no signs of secondary caries in all clinical cases. Evaluation of the shade adaptation after 2 years has shown that 93.01±2.13 % composite restorations was impossible to recognize without a mirror, and 6.99±2.13 % (10) of the restorations had color deviations in contrast to the tooth tissues, but no more than a change in their shade or transparency which is within the normal color and transparency of the tooth. The color deviations were more often registered in the occlusal-proximal and the occlusal restoration (II Black class, 10.3±4.83 % and Black I class, 5.8±2.51 % accordingly). Color assessment of the filling’ edge after 2 years showed no change in the transition from the restoration to the tooth tissues during visual inspection with a mirror in 89.51±2.56 % of the nanohybrid restorations. Discoloration in the area of the filling-tooth junction not extending in depth was detected in 10.49±2.56 % (15) fillings. Most often, edge discoloration was observed in class II restorations by Black (11 teeth) and less often in class I restorations by Black (4 teeth). The evaluation of the surface quality of the fillings has shown, that 2 years after the treatment, 100 % of the restorations were with a shine and smooth surface, did not require correction or re-treatment, and also had no signs of irritation of the surrounding soft tissues. Conclusion. The use of «Admira Fusion» composite for the restoration of permanent teeth in children provides high clinical efficacy in 89–93 % of clinical cases. Thus, the «Admira Fusion» universal nanohybrid material is characterized by great working properties with good adaptation to the tooth hard tissues, retains its aesthetic characteristics in the oral cavity for 2 years. Convenience in work and technical ability to use any adhesive systems make it the material of choice in pediatric dentistry. Key words: children, caries, permanent teeth, restoration, composite, clinical efficacy.

WITHDRAWN: Impact of riboflavin and curcumin mediated photodynamic therapy and Er,Cr:YSGG on microleakage of class V resin glass ionomer restorations in permanent molar teeth

The present study aimed to evaluate the impact of PDT using curcumin and riboflavin as photosensitizers and Er,Cr:YSGG on microleakage in class V RMGIC restorations in permanent teeth. Eighty permanent molars were investigated and randomly divided into 4 groups: control group: resin-modified glass ionomer restoration with no treatment, R-PDT: PDT with riboflavin, Cu-PDT: PDT with curcumin (Cu) and, Er,Cr:YSGG: laser application. All the teeth in each group were restored with the help of RMGIC. The samples were dipped for 24 h in 0.5 % Fuchsine solution, and subsequently fixed in acrylic resin-based molds. Microleakage scores were estimated considering both cervical and occlusal boundaries. Intergroup comparisons were made at each margin, and intragroup comparisons made at the cervical and occlusal margins. The Shapiro Wilk test was used to check the normality of the values. Whereas, the analysis of data was conducted using SPSS version 25 via the Kruskal-Wallis and Wilcoxon tests. P < 0.05 was contemplated to be statistically important. A high frequency (95%) of the enamel walls were not penetrated when subjected to treatment with R-PDT, followed by Cu-PDT and Er,Cr:YSGG. The highest amount of microleakage was observed (55%) Cu-PDT at the site of the cavity near the cementum. The least amount of microleakage was observed in the control group. A statistically significant difference in microleakage was noted at the cervical wall (p=0.015), while no significant difference was seen at the occlusal wall (p=0.789) between the groups. A significant difference was noted at the cervical wall between the control and R-PDT group (p=0.021) and Cu-PDT group (p=0.005), respectively. A significant difference in microleakage was observed when occlusal was compared with cervical walls within each group (p<0.05). Photosensitizers using riboflavin and curcumin may reduce the microleakage within the enamel surface restored with RMGIC in class V lesions that may not interfere with bonding. However, extreme caution should be taken while considering riboflavin and curcumin for class V RMGIC restorations extending to cementum surface.

EVALUATION OF PERFORMANCE OF COMPOSITE FILLING MATERIALS IN RESTORATION OF PERMANENT TEETH IN CHILDREN

A paradigm shift in dental caries treatment in paediatric dentistry is viewed towards a wide using of composite resins. This prospective clinical trial are evaluated and compared during 18 months of clinical performance of a microhybrid composite with a nanoceramic resin composite placed in сlass I and II cavities in permanent teeth in children. &#x0D; Thirty one children aged between 7 and 15 years were investigated during this study. About 40 restorations were performed, 50% for each material: a nanoceramic resin composite “Ceram. X Sphere TEC one” and a microhybrid resin composite “Charisma”. The restorations have been estimated by investigators immediately after complete polishing a filling. Clinical evaluation was performed 18 months after replacement by two other investigators using modified USPHS criteria. In addition to hand instruments, a magnifier was used for investigation of the restoration margins. Eighteen fillings with “Ceram. X Sphere TEC one” and 17 fillings with “Charisma” were available. The USPHS parameters were analyzed with the Chi-square test in18 months. The level of significance was p&lt;0.05. Also Green-Vermillion index was used for oral hygiene estimation. &#x0D; There are no failed restorations and secondary caries during the studied period. There were no statistically significant differences among the materials used (p&gt;0.5) regarding the clinical performance. Green-Vermillion hygienic index was 1.48. Thirteen children (43.42%) showed satisfactory level of oral hygiene, 10 children (35.71%) demonstrated good level and 7 children (20.87%) – unsatisfactory level. &#x0D; According to the marginal discoloration and surface roughness criteria, there were no significant differences among the restorative materials (p&gt;0.5). Marginal discoloration was seen in children with unsatisfactory oral hygiene that corresponds to the data of recent study. Marginal adaptation rate was 94.95% for nanoceramic, and 82.35% for the microhybrid restorations. The marginal defects recorded had small detectable defects at the enamel margin of the restorations. According to the anatomic form criterion, there were no significant differences among the restorative materials (p&gt;0.5).&#x0D; Postoperative sensitivity of one nanoceramic and two microhybrid restorations was scored as Bravo at baseline examination, but it disappeared by the 18-months evaluation. For color match criterion, the slight differences were observed in microhybrid restoration in 18 months. This shade mismatch was clinically acceptable (Bravo), with no significant differences noted between the materials studied (p&gt;0.5).&#x0D; The nanoceramic and microhybrid composites have provided acceptable clinical performance over 18-months period. The research pertaining to bigger size of a studied sample and longer observation period is considered advisable to ensure the higher clinical success rate of nanoceramic than microhybrid composite in restoration of permanent teeth in children.

Radiological Evaluation of Stainless Steel Crowns Placed on Permanent Teeth in Patients Treated under General Anaesthesia.

Evidence-based evaluations of dental treatment are needed to support the development of special care dentistry services. This retrospective study was designed to collect and analyse X-ray images of permanent teeth restored with stainless steel crowns (SSC) in patients treated under general anaesthesia. Between 2013 and 2019, 360 permanent molars were crowned with SSCs in 198 adult patients. One calibrated investigator used an original validated tool to evaluate four radiographic criteria for molars restored with SSCs: (i) marginal adaptation; (ii) interdental proximal contact; (iii) the presence of glass ionomer cement overflow; and (iv) the loss of alveolar bone. Overall, no defect or a minor defect was reported for the majority of SSCs for the criteria “Marginal adaptation” (62.5%, n = 320), “Proximal contact” (82.2%, n = 236) and “Cement overflow” (95.8%, n = 337). Alveolar bone resorption was reported in 8.3% of cases, n = 14, after a mean period of 8.9 ± 14.3 months. It was shown that the restoration of permanent teeth using SSCs placed under general anaesthesia presents a low risk of periodontal morbidity in the medium term when assessed radiographically.

Long-term treatment costs and cost-effectiveness of restoration repair versus replacement

ObjectivesWhen managing partially defective restorations, dentists can choose between repair and replacement. We aimed to assess the long-term treatment costs of repairs and replacements. MethodsPartially defective anterior and posterior composite restorations in permanent teeth had been repaired or replaced in a German university hospital and were retrospectively followed until censoring or one of the following events: (1) Extraction, (2) Major complications including placement of indirect restorations, endodontic treatments and extractions, or (3) Any complications including major complications and further direct restorations. Costs were estimated from a German mixed public-private-payer perspective. Cost-effectiveness differences were described using median-based incremental-cost-effectiveness ratios (ICERMEDIAN). Statistical analysis was performed using generalized linear mixed modeling (GLM), Chi2-test, and Wilcoxon rank-sum test (p < 0.05). ResultsA total of 616 repairs in 468 patients (follow-up: 4.9 ± 4.1 years) and 264 replacements in 218 patients (follow-up: 4.8 ± 4.3) were included. While replacements were associated with higher initial treatment costs, median annualized treatment costs did not significantly differ between repair (47.58 Euro [IQR: 24.41–107.04]) and replacement (50.64 Euro [IQR: 26.30–118.78]; p > 0.05), but were higher for molars (75.53 Euro [IQR: 24.41–92.18]) than incisors (45.03 Euro [IQR: 28.19–168.50]; p = 0.011). The difference in the % of extractions, major and any complications were minimal between both groups. The mean ICERMEDIAN of replacement vs. repair was -146.8 Euro/% when extractions were considered as outcomes. Regarding major and any complications, mean ICERMEDIAN amounted to 67.6 Euro/% and 23.9 Euro/%, respectively. SignificanceRepairs and replacements of partially defective restorations showed similar long-term costs and cost-effectiveness.

Clinical study on resin composite and glass ionomer materials in II class restorations in permanent teeth.

BackgroundGlass ionomer cements (GIC) used for restoration of missing dental structures have high biocompatibility and remineralization potential. However, low mechanical resistance excludes their use for long-term restorations of extensive lesions, particularly on approximal surfaces in permanent dentition. GIC with increased viscosity have much better physical properties, which involves better bonding and wear resistance, so they can be considered as an alternative to composite resin materials. The aim of this study was to perform a clinical and radiological assessment of restorations in permanent teeth, made with an increased viscosity GIC - Equia Fil (Ivoclar Vivadent) with Equia Coat (Ivoclar Vivadent) and composite material - Tetric EvoCeram (Ivoclar Vivadent) in young patients. Material and MethodsA total of 100 cavities on approximal surfaces were filled with the composite material or GIC in 49 patients aged from 12.08 to 19.58 years. During control examinations, the condition of each restoration was assessed with criteria acc. to Hickel et al. Bitewing radiographs had been taken before fillings were placed and after 12 and 24 months. ResultsAfter two years of observations, two GIC restorations were replaced due to loss of retention and staining. The other 96 restorations were given a satisfactory grade. The clinical efficacy of Equia Fil after 24 months was assessed at 95.83%, the Tetric EvoCeram at 100%. The difference was not statistically significant (P=0.145). When GIC was used, there was a higher risk of marginal adaptation deterioration and the occurrence of staining and erosion. Radiographic efficacy of the Equia Fil material for cavity restoration after 24 months was assessed at 93.75%, for the Tetric EvoCeram material at 100%. Differences were not significant statistically (P=0.073). ConclusionsTetric EvoCeram and Equia Fil used for the restoration of approximal lesions in premolars and permanent molars have similar efficacy in a 2-year period of observation. Key words:Dental restoration, permanent, composite resins, glass ionomer cements, clinical study.

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

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

In Vitro Wear Resistance of Self-Adhesive Restorative Materials.

To investigate simulated localized and generalized wear of self-adhesive restorative materials. Three commercially available restorative materials and one experimental material with self-adhesive properties were evaluated. The experimental material was tested in both light-cured and self-cured conditions. Activa (A), Fuji II LC (F), and Equia Forte (E) and the experimental material ASAR-MP4 (S) were investigated. Two kinds of wear were simulated in an Alabama wear machine. Localized wear was simulated with a stainless-steel ball bearing antagonist and generalized with a flat-ended stainless-steel cylinder antagonist. The wear challenge was carried out in an aqueous slurry of polymethyl methacrylate beads. Material volume loss was measured on polyvinyl siloxane replicates of each worn surface using a Proscan 2100 noncontact profilometer in conjunction with Proscan and AnSur 3D software. There were significant differences (p < 0.05) among the materials for both generalized and localized wear. The experimental material in both curing modes exhibited significantly less localized wear than F and A and significantly less generalized wear than F and E. Self-adhesive materials offer unique handling properties for direct placement of posterior restorations in permanent teeth. The experimental material ASAR-MP4 generated similar wear values to the other self-adhesive materials tested.

Stainless steel crowns as a restoration for permanent posterior teeth in people with special needs: A retrospective study

BackgroundLimited information exists regarding the use of stainless steel crowns (SSCs) in permanent teeth. The objective of this retrospective cohort study was to present the long-term clinical outcomes of the SSC compared with those of amalgam and composite resin restorations and the SSC radiographic outcomes in a special-needs population. MethodsThis study included 271 patients with at least 1 SSC restoration from the Mount Sinai Hospital Dentistry Clinic for Persons with Special Needs in Toronto, Ontario, Canada. A total of 2,621 posterior permanent tooth restorations were documented: 766 SSCs, 1,651 amalgam restorations, and 204 composite resin restorations. Clinical analysis included patient demographics, treatment parameters, and outcome assessments for each restoration recorded. Radiographic analysis of SSC restorations included 127 bite-wing radiographs and 118 periapical radiographs, measurement of interproximal bone loss, and assessment of periapical status using the Periapical Index Scale. ResultsThe 10-year survival rates for new SSC and amalgam restorations were 79.2% and 63.5%, respectively. The 91 SSC failures included 2 recementations, 33 replacements, and 56 extractions. Primary diagnoses at the time of failure included chronic periodontal disease (25) and loose or lost SSCs (24). Of the 528 failed conventional restorations that were replaced, 60% were replaced with SSCs. The mean alveolar bone loss from mesial and distal sites was 1.36 millimeters and 1.40 mm, respectively. Therefore, 93% of the sites recorded were less than 2 mm and classified as healthy. All pre-SCC and post-SSC periapical radiographs had healthy Periapical Index Scale scores (1 or 2) recorded over an average duration of 8.4 years (1-29.1 years). ConclusionsSSCs are a durable treatment option for the restoration of the posterior permanent dentition. Practical ImplicationsPosterior permanent teeth restored with stainless steel crowns can be expected to last for 10 years and represent a viable treatment choice for severely carious or fractured posterior permanent teeth.

The impact of oral hygiene, the intensity and increase of caries on the condition of Equia Fil glass ionomer and Tetric EvoCeram composite proximal restorations in permanent teeth

Introduction. Glass-ionomer cements and composite materials are widely used for direct restoration of carious lesions, also in young permanent teeth. However, knowledge on the effects of cariogenic factors on the quality of restorations performed using these materials, especially those covering proximal surfaces, which are more often exposed to bacterial plaque, is insufficient. Aim. The aim of the study was to assess the impact of oral hygiene and increased intensity of caries on proximal composite and glass ionomer restorations in young permanent teeth after 2 years of usage. Material and methods. Equia Fil glass-ionomer and Tetric EvoCeram composite restorations were performed in patients aged between 12 and 20 years with proximal carious lesions in premolars and molars. The clinical condition of restorations was assessed and indices such as OHI-S and D1-2DMFT (along with their increased values) were calculated at baseline, as well as during follow-up visits at 6, 12, 18 and 24 months. Correlations between clinical assessment of restorations and indices for oral hygiene and caries intensity, their increase and increased number of teeth with carious spots were evaluated. The study was approved by the Bioethics Committee of the Medical University of Warsaw (No. KB/157/2013). Results. A total of 100 proximal restorations were performed in 49 patients. After 24 months, 98 restorations (50 Equia Fil and 48 Tetric EvoCeram) were evaluated. Mean baseline OHI-S and D1-2DMFT were 1.37 and 12.04, respectively, for Equia Fil restorations, and 1.27 and 10.38 for Tetric restorations, with the following values reported during follow-up: 1.80 and 15.4; 1.63 and 12.38. Statistically significant relationships were found between OHI-S and values describing the state of materials. These values increased with increasing OHI-S and D1-2DMFT. Conclusions. Both Tetric Evo Ceram and Equia Fil restorations are susceptible to cariogenic factors.

Dental cavity liners for Class I and Class II resin-based composite restorations.

Resin-based composite (RBC) is currently accepted as a viable material for the restoration of caries for posterior permanent teeth requiring surgical treatment. Despite the fact that the thermal conductivity of the RBC restorative material closely approximates that of natural tooth structure, postoperative hypersensitivity is sometimes still an issue. Dental cavity liners have historically been used to protect the pulp from the toxic effects of some dental restorative materials and to prevent the pain of thermal conductivity by placing an insulating layer between restorative material and the remaining tooth structure. This is an update of the Cochrane Review first published in 2016. The objective of this review was to assess the effects of using dental cavity liners in the placement of Class I and Class II resin-based composite posterior restorations in permanent teeth in children and adults. Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 12 November 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 10) in the Cochrane Library (searched 12 November 2018), MEDLINE Ovid (1946 to 12 November 2018), Embase Ovid (1980 to 12 November 2018) and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 12 November 2018). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. We included randomized controlled trials assessing the effects of the use of liners under Class I and Class II posterior resin-based composite restorations in permanent teeth (in both adults and children). We included both parallel and split-mouth designs. We utilized standard methodological procedures prescribed by Cochrane for data collection and analysis. Two review authors screened the search results and assessed the eligibility of studies for inclusion against the review inclusion criteria. We conducted risk of bias assessments and data extraction independently and in duplicate. Where information was unclear we contacted study authors for clarification. Eight studies, recruiting over 700 participants, compared the use of dental cavity liners to no liners for Class I and Class II resin-based composite restorations.Seven studies evaluated postoperative hypersensitivity measured by various methods. All studies were at unclear or high risk of bias. There was inconsistent evidence regarding postoperative hypersensitivity (either measured using cold response or patient-reported), with a benefit shown at some, but not all, time points (low-quality evidence).Four trials measured restoration longevity. Two of the studies were judged to be at high risk and two at unclear risk of bias. No difference in restoration failure rates were shown at 1 year follow-up, with no failures reported in either group for three of the four studies; the fourth study had a risk ratio (RR) 1.00 (95% confidence interval (CI) 0.07 to 15.00) (low-quality evidence). Three studies evaluated restoration longevity at 2 years follow-up and, again, no failures were shown in either group.No adverse events were reported in any of the included studies. There is inconsistent, low-quality evidence regarding the difference in postoperative hypersensitivity subsequent to placing a dental cavity liner under Class I and Class II posterior resin-based composite restorations in permanent posterior teeth in adults or children 15 years or older. Furthermore, no evidence was found to demonstrate a difference in the longevity of restorations placed with or without dental cavity liners.