Radiology of Dental Caries

A Nanoparticle, Fluorescence-Based Rinse for Caries Activity Assessment, an in Vitro Study

OBJECTIVES

This in vitro study aimed to compare the agreement of a starch-based nanoparticle fluorescence rinse (FR) (LumiCare™ Caries Detection Rinse, GreenMark Biomedical Inc.) in the assessment of caries activity of initial smooth surface carious lesions with the International Caries Classification and Management System (ICCMS) Lesion Activity Assessment.

METHODS

A convenience sample of permanent extracted human teeth (N = 57) were scored by visual assessment (VA) using the ICCMS activity criteria by 2 calibrated examiners. VA categories included: sound, inactive and active. For fluorescence assessment (FA), each tooth was fully immersed in FR for 30 seconds, rinsed with water for 10 seconds, compressed air dried and examined under an orange filter while illuminating with a curing light. Fluorescence was assessed as no fluorescence or fluorescence. Both VA and FA were repeated after at least 24 hours and Kappa was calculated for inter- and intra-examiner agreement.

RESULTS

Based on VA, 12 teeth (21%) were classified into the active category, while 45 teeth (79%) were classified into the sound (n = 20) or inactive (n = 25) categories. When combining the latter 2 categories, VA and FA's classifications were concordant in 100% of cases (all 12 teeth in VA's active category exhibited fluorescence, and all 45 teeth in VA's sound/inactive category did not exhibit fluorescence according to FA; Kappa = 1).

CONCLUSION

FA with FR demonstrated perfect agreement with VA using ICCMS when comparing active versus inactive and/or sound surfaces suggesting it has potential as an objective indicator of caries activity.

CLINICAL SIGNIFICANCE

A fluorescence rinse could improve clinical detection of smooth surface caries activity and could easily be integrated as part of the dental hygiene appointment.

Trends in incidence of untreated caries in permanent teeth in BRICS countries: an age-period-cohort analysis from 1992 to 2021 and projections for the next two decades

OBJECTIVE

This study aimed to delineate the temporal trends and project the future incidence of untreated caries in permanent teeth in the BRICS countries.

MATERIALS AND METHODS

Data were obtained from the 2021 Global Burden of Disease (GBD) study. A joinpoint model was used to examine the trends in disease burden. The age-period-cohort (APC) model was applied to analyze the trends across different age groups, periods, and birth cohorts. The Bayesian age-period-cohort (BAPC) model was used to make projections of incidence for the next two decades.

RESULT

A total of 1,068.31 million cases of untreated caries in permanent teeth were found in BRICS countries in 2021, accounting for 45.07% of the global number. The incidence in most of the BRICS countries showed an increasing trend between 1992 and 2021. APC analyses indicated a net drift below 0 in most of the BRICS countries. The peak incidence was observed in people aged 20-24 years for most of the BRICS countries. There was a downward trend in the period rate ratio (RR) in BRICS countries except China and Russia. Compared to younger birth cohorts, older birth cohorts exhibited higher risks in most of the BRICS countries. It is projected that from 2022 to 2041, the age-standardized incidence rate (ASIR) for both males and females in most of BRICS countries may decline.

CONCLUSIONS

In conclusion, the burden of untreated dental caries in permanent teeth remains significantly high in BRICS countries, with age, time period, and birth cohort significantly affecting the incidence. All BRICS countries need to improve public health policies to mitigate this public concern, especially for high-risk groups.

CLINICAL RELEVANCE

The ASIR of untreated caries in permanent teeth in most BRICS countries may decrease in the next twenty years by projections, but the burden of disease remains high in the BRICS countries. It is crucial for BRICS countries to enhance public health policies related to caries prevention and treatment for high-risk populations.

Clinical Success of Pulpotomies Using Intermediate Restorations and Preformed Metal Crowns in the Context of a Developing Country: A Retrospective Questionnaire-Based Investigation

Background: Dental caries is one of the most prevalent dental illnesses in children. Untreated severe caries can damage teeth, requiring pulpotomy to save them. Objective: To evaluate the clinical success rate of treatments involving pulpotomies + IRM (Intermediate Restorative Material, composed of reinforced zinc oxide-eugenol polymers) + preformed metal crowns (PMCs) in primary teeth of children treated at a public university in Mexico. Materials and Methods: A cross-sectional ambispective study was conducted on children aged 10 years or younger, treated at a public university in Mexico. A total of 1281 medical records from February 2018 to June 2023 were reviewed, yielding a sample of 199 children treated with pulpotomy + IRM + PMC. Information was collected via telephone interviews with parents/caregivers to inquire about any symptoms following the pulpotomy and metal crown treatments. Success was defined as the absence of pain, inflammation, or infection. Results: During the study period, the number of teeth treated with pulpotomy + IRM + PMC was 414, with follow-ups ranging from 6 to 69 months. Most participants were girls (54.3%), while 45.7% were boys. Out of the 167 pulpotomy + IRM + PMC treatments included in the study, the clinical success rate was 98.2%. Conclusions: The clinical success rate of primary teeth treated with pulpotomy + IRM + PMCs was high, close to 100%, based on evidence and symptom reports from parents/caregivers. It would be beneficial to implement its use in public health institutions in countries such as Mexico.

Physicochemical and biological properties of dental materials and formulations with silica nanoparticles: A narrative review

OBJECTIVE

Silica nanoparticles (SNPs) have been extensively studied and used in different dental applications to promote improved physicochemical properties, high substance loading efficiency, in addition to sustained delivery of substances for therapeutic or preventive purposes. Therefore, this study aimed to review the SNPs applications in nanomaterials and nanoformulations in dentistry, discussing their effect on physicochemical properties, biocompatibility and ability to nanocarry bioactive substances.

DATA RESOURCES

Literature searches were conducted on PubMed, Web of Science, and Scopus databases to identify studies examining the physicochemical and biological properties of dental materials and formulations containing SNPs. Data extraction was performed by one reviewer and verified by another STUDY SELECTION: A total of 50 were reviewed. In vitro studies reveal that SNPs improved the general properties of dental materials and formulations, such as microhardness, fracture toughness, flexural strength, elastic modulus and surface roughness, in addition to acting as efficient nanocarriers of substances, such as antimicrobial, osteogenic and remineralizing substances, and showed biocompatibility CONCLUSIONS: SNPs are biocompatible, improve properties of dental materials and serve as effective carriers for bioactive substances CLINICAL SIGNIFICANCE: Overall, SNPs are a promising drug delivery system that can improve dental materials biological and physicochemical and aesthetic properties, increasing their longevity and clinical performance. However, more studies are needed to elucidate SNPs short- and long-term effects in the oral cavity, mainly on in vivo and clinical studies, to prove their effectiveness and safety.

Tooth numbering with polygonal segmentation on periapical radiographs: an artificial intelligence study

OBJECTIVES

Accurately identification and tooth numbering on radiographs is essential for any clinicians. The aim of the present study was to validate the hypothesis that Yolov5, a type of artificial intelligence model, can be trained to detect and number teeth in periapical radiographs.

MATERIALS AND METHODS

Six thousand four hundred forty six anonymized periapical radiographs without motion-related artifacts were randomly selected from the database. All periapical radiographs in which all boundaries of any tooth could be distinguished were included in the study. The radiographic images used were randomly divided into three groups: 80% training, 10% validation, and 10% testing. The confusion matrix was used to examine model success.

RESULTS

During the test phase, 2578 labelings were performed on 644 periapical radiographs. The number of true positive was 2434 (94.4%), false positive was 115 (4.4%), and false negative was 29 (1.2%). The recall, precision, and F1 scores were 0.9882, 0.9548, and 0.9712, respectively. Moreover, the model yielded an area under curve (AUC) of 0.603 on the receiver operating characteristic curve (ROC).

CONCLUSIONS

This study showed us that YOLOv5 is nearly perfect for numbering teeth on periapical radiography. Although high success rates were achieved as a result of the study, it should not be forgotten that artificial intelligence currently only can be guides dentists for accurate and rapid diagnosis.

CLINICAL RELEVANCE

It is thought that dentists can accelerate the radiographic examination time and inexperienced dentists can reduce the error rate by using YOLOv5. Additionally, YOLOv5 can also be used in the education of dentistry students.

Influence of the digital file format on radiographic diagnostic in dentistry: a scoping review

Given today's higher demand for online transmission of radiographic images, clinicians and regulatory agencies should be given the evidence they need to guide them in choosing the best image file format to be adopted. To this end, the present scoping review aims to explore, map, and evaluate the literature, with the object of reporting the influence of image file formats on dental diagnostic tasks by assessing intraoral radiographic images. This scoping review complies with PRISMA-ScR. It was customized to assess the risk of bias of the included studies, and was registered on the Open Science Framework platform. The data extraction protocol was developed based on the PCC acronym. An electronic search was conducted in six databases (Pubmed, Web of Science, Scopus, Embase, Lilacs, Cochrane) in December 2023. Original articles were screened, having observational, diagnostic accuracy, and consisting of in vivo or ex vivo laboratory studies investigating the influence of file formats on different diagnostic tasks in dentistry. Eighteen studies, published between the years 1996 and 2022, were included. The following data were extracted from the selected articles: article title, authors' citation, publication date, country, diagnostic task, image file formats tested, compression level, and main conclusion. The most widely investigated diagnostic task was caries lesions (n = 10), led by root resorptions (n = 3), root fractures (n = 2), periapical lesions (n = 2), and periodontal disease (n = 1). The most commonly used radiographic techniques were periapical (n = 12) and bitewing (n = 6). The most frequently investigated image file formats were JPEG (all studies) and TIFF (n = 10 studies). BMP, PNG, and JPEG2000 were also included in 7, 3 and 3 studies, respectively. No studies included the DICOM file format. In regard to the subjective assessment of the several dental diagnostic tasks, the studies mostly showed that the influence of the file formats was not significant (n = 10/55.5%). As for the quality assessment of the included papers, more than 70% of the studies featured a low risk of bias. Current evidence on image file formats and dental radiographic diagnosis is reliable. Any image file format can be used without impairing diagnostic accuracy.

VMT/ACP/Dextran composite nanosheets against dental caries through promoting mineralization of dentin tubules, pH buffering, and antibacterial

Dental caries is a worldwide public healthcare concern, and is closely related to the acidic environment that caused by bacterial decomposition of food. In this study, a two-step ion exchange liquid-phase stripping method was applied to strip out vermiculite (VMT) nanosheets, then amorphous calcium phosphate (ACP) and dextran were inserted between the VMT nanosheets interlayer to obtain a composite two-dimension nanosheets (VMT/ACP/Dextran). VMT/ACP/Dextran composite nanosheets exhibited excellent biocompatibility and could provide exogenous Ca2+and PO43- from ACP, provide SiO44-, Mg2+, Fe2+ and obtain buffering pH and antibacterial properties from VMT, as well as improve suspension stability and targeting Streptococcus mutans through glucan. The in vitro study showed that the composite materials could promote the mineralization and sealing of dentin tubules by releasing active ions, buffer pH 4.5 (a value close to the pH in the dental plaque environment) to pH 6.6-7.1 (values close to the pH in human saliva) through ion exchange, and exert antibacterial effects by targeting Streptococcus mutans and exerting oxidase like and peroxidase like activities to produce reactive oxygen species (ROS). The in vivo animal study showed that daily cleaning teeth using VMT/ACP/Dextran composite nanosheets could effectively reduce the incidence rate and severity of dental caries in rats. Taking together, the developed VMT/ACP/Dextran composite nanosheets, which integrated the excellent properties of VMT, ACP and dextran, can effectively prevent dental caries through a combination of factors such as buffering acids, antibacterial properties, and promoting calcification, and may be used as an active ingredient for daily oral hygiene or filling materials to prevent and treat dental caries.

Development of a correction coefficient for radiographic evaluation of the alveolar bone crest: a pilot study

OBJECTIVES

To analyze the differences in cusp height on radiographs, establishing proportional relationships between cusp and alveolar bone crest (ABC) measurements. The goal of this study was to develop a correction coefficient by considering this proportion.

MATERIALS AND METHODS

Twenty-one artificial teeth, molars and premolars, and bovine ribs were used. Interproximal radiographs were taken with the aid of a positioner. The vertical angles used were: 0°, + 5°, and + 10°, and processed using three spatial resolutions measured in line pairs per mm (lp/mm): 20, 25 and 40. The Perio filter was applied to each image, in addition to the original one. Combinations of angle, resolution, and filter were made. Eighteen images were analyzed by three specialists, resulting in 252 measurements for each evaluator, totaling 756 measurements.

RESULTS

The overall variability of the measurements can be explained mainly by the variation in tooth anatomy. The 0° 25 lp/mm Perio filter method was the closest one to the actual clinical scenario for both cusps and ABC. The correction factor managed to explain 71.45% of the errors.

CONCLUSIONS

The variation in vertical angulation interferes with cusp and ABC measurements, and the angulation at 0º and spatial resolution of 25 lp/mm showed better results. The use of correction coefficients allowed approaching actual measurement values.

CLINICAL RELEVANCE

More accurate ABC height measurements are essential even in radiographic exams that do not meet the standard of excellence because the need to repeat radiographic exams is then eliminated.

Inhibition mechanism of theaflavins on matrix metalloproteinase-2: inhibition kinetics, multispectral analysis, molecular docking and molecular dynamics simulation

Dental caries is a chronic and destructive disease and matrix metalloproteinase-2 (MMP-2) plays a major role in caries. The inhibitory mechanisms of theaflavins [theaflavin (TF1), theaflavin-3-gallate (TF2A), theaflavin-3'-gallate (TF2B), and theaflavin-3,3'-digallate (TF3)] on MMP-2 were investigated using techniques such as enzyme inhibition kinetics, multi-spectral methods, molecular docking, and molecular dynamics simulations. The results showed that TF1, TF2A, TF2B, and TF3 all competitively and reversibly inhibited MMP-2 activity. Fluorescence spectra and molecular docking indicated that four theaflavins spontaneously bind to MMP-2 through noncovalent interactions, driven by hydrogen bonds and hydrophobic interactions, constituting a static quenching mechanism and resulting in an altered tryptophan residue environment around MMP-2. Molecular dynamic simulations demonstrated that four theaflavins can form stable, compact complexes with MMP-2. In addition, the order of theaflavins' ability to inhibit MMP-2 was found to be TF1 > TF2B > TF2A > TF3. Interestingly, the order of binding capacity between MMP-2 and TF1, TF2A, TF2B, and TF3 was consistent with the order of inhibitory capacity, and was opposite to the order of steric hindrance of theaflavins. This may be due to the narrow space of the active pocket of MMP-2, and the smaller the steric hindrance of theaflavins, the easier it is to enter the active pocket and bind to MMP-2. This study provided novel insights into theaflavins as functional components in the exploration of natural MMP-2 inhibitors.

Artificial intelligence for radiographic imaging detection of caries lesions: a systematic review

BACKGROUND

The aim of this systematic review is to evaluate the diagnostic performance of Artificial Intelligence (AI) models designed for the detection of caries lesion (CL).

MATERIALS AND METHODS

An electronic literature search was conducted on PubMed, Web of Science, SCOPUS, LILACS and Embase databases for retrospective, prospective and cross-sectional studies published until January 2023, using the following keywords: artificial intelligence (AI), machine learning (ML), deep learning (DL), artificial neural networks (ANN), convolutional neural networks (CNN), deep convolutional neural networks (DCNN), radiology, detection, diagnosis and dental caries (DC). The quality assessment was performed using the guidelines of QUADAS-2.

RESULTS

Twenty articles that met the selection criteria were evaluated. Five studies were performed on periapical radiographs, nine on bitewings, and six on orthopantomography. The number of imaging examinations included ranged from 15 to 2900. Four studies investigated ANN models, fifteen CNN models, and two DCNN models. Twelve were retrospective studies, six cross-sectional and two prospective. The following diagnostic performance was achieved in detecting CL: sensitivity from 0.44 to 0.86, specificity from 0.85 to 0.98, precision from 0.50 to 0.94, PPV (Positive Predictive Value) 0.86, NPV (Negative Predictive Value) 0.95, accuracy from 0.73 to 0.98, area under the curve (AUC) from 0.84 to 0.98, intersection over union of 0.3-0.4 and 0.78, Dice coefficient 0.66 and 0.88, F1-score from 0.64 to 0.92. According to the QUADAS-2 evaluation, most studies exhibited a low risk of bias.

CONCLUSION

AI-based models have demonstrated good diagnostic performance, potentially being an important aid in CL detection. Some limitations of these studies are related to the size and heterogeneity of the datasets. Future studies need to rely on comparable, large, and clinically meaningful datasets.

PROTOCOL

PROSPERO identifier: CRD42023470708.

Prefabricated Zirconia Crowns and Preformed Metal Crowns in the Treatment of Severely Childhood Caries and Anterior Crossbite in a Child with Autistic Spectrum Disorder

Crowns have been recommended to treat decayed teeth and rebuild teeth function. The dental management of children with autism is a tremendous challenge for pediatric dentists due to the impaired behaviors and communication disorders. In this context, a 5-year-old boy with autism was treated to solve carious lesions under the assistance of general anesthesia. The posterior occlusal function was restored, and the crossbite existing in the primary anterior teeth was approached merely by NuSmile® zirconia crowns (ZCs) rather than orthodontic intervention. We conducted an 18-month period. Throughout the long-term follow-up, the boy's masticatory efficiency was remarkably improved and the anterior teeth had transferred into the correct position with adequate overbite to maintain the new relationship, thus ameliorating the appearance of tissue on the labial surface and enhancing his quality of life and oral health.

Detection, Diagnosis, and Monitoring of Early Caries: The Future of Individualized Dental Care

Dental caries remains a significant global health issue. It was highlighted by the World Health Organization's 2022 reports that despite the efforts and scientific advancements in caries detection and management, the situation has only marginally improved over the past three decades. The persistence of this problem may be linked to outdated concepts developed almost a century ago but are still guiding dentists' approach to caries management today. There is a need to reconsider professional strategies for preventing and managing the disease. Contemporary dentistry could benefit from embracing new concepts and technologies for caries detection and management. Dentists should explore, among others, alternative methods for caries detection such as optical-based caries detection. These tools have been established for over a decade and they align with current disease understanding and international recommendations, emphasizing early detection and minimally invasive management. This narrative review presents the current state of knowledge and recent trends in caries detection, diagnosis, monitoring, and management, offering insights into future perspectives for clinical applications and research topics.

Improving accuracy of early dental carious lesions detection using deep learning-based automated method

OBJECTIVE

To investigate the effectiveness of a convolutional neural network (CNN) in detecting healthy teeth and early carious lesions on occlusal surfaces and to assess the applicability of this deep learning algorithm as an auxiliary aid.

MATERIALS AND METHODS

A total of 2,481 posterior teeth (2,459 permanent and 22 deciduous teeth) with varying stages of carious lesions were classified according to the International Caries Detection and Assessment System (ICDAS). After clinical evaluation, ICDAS 0 and 2 occlusal surfaces were photographed with a professional digital camera. VGG-19 was chosen as the CNN and the findings were compared with those of a reference examiner to evaluate its detection efficiency. To verify the effectiveness of the CNN as an auxiliary detection aid, three examiners (an undergraduate student (US), a newly graduated dental surgeon (ND), and a specialist in pediatric dentistry (SP) assessed the acquired images (Phase I). In Phase II, the examiners reassessed the same images using the CNN-generated algorithms.

RESULTS

The training dataset consisted of 8,749 images, whereas the test dataset included 140 images. VGG-19 achieved an accuracy of 0.879, positive agreement of 0.827, precision of 0.949, negative agreement 0.800, and an F1-score of 0.887. In Phase I, the accuracy rates for examiners US, ND, and SP were 0.543, 0.771, and 0.807, respectively. In Phase II, the accuracy rates improved to 0.679, 0.886, and 0.857 for the respective examiners. The number of correct answers was significantly higher in Phase II than in Phase I for all examiners (McNemar test;P<0.05).

CONCLUSIONS

VGG-19 demonstrated satisfactory performance in the detection of early carious lesions, as well as an auxiliary detection aid.

CLINICAL RELEVANCE

Automated detection using deep learning algorithms is an important aid in detecting early caries lesions and improves the accuracy of the disease detection, enabling quicker and more reliable clinical decision-making.

Tooth ultrastructure changes induced by a nonsense mutation in the FAM83H gene: insights into the diversity of amelogenesis imperfecta

OBJECTIVES

The current research on single-nucleotide polymorphism (SNP) mutation sites at different positions of the FAM83H gene and their phenotypic changes leading to amelogenesis imperfecta (AI) is inconsistent. We identified a previously reported heterozygous nonsense mutation c.1192C>T (p.Q398*) in the FAM83H gene and conducted a comprehensive analysis of the dental ultrastructure and chemical composition changes induced by this mutation. Additionally, we predicted the protein feature affected by this mutation site. The aim was to further deepen our understanding of the diversity of AI caused by different mutation sites in the FAM83H gene.

METHODS

Whole-exome sequencing (WES) and Sanger sequencing were used to confirm the mutation sites. Physical features of the patient's teeth were investigated using various methods including cone beam computer tomography (CBCT), scanning electron microscopy (SEM), contact profilometry (roughness measurement), and a nanomechanical tester (nanoindentation measurement). The protein features of wild-type and mutant FAM83H were predicted using bioinformatics methods.

RESULTS

One previously discovered FAM83H heterozygous nonsense mutation c.1192C>T (p.Q398*) was detected in the patient. SEM revealed inconsistent dentinal tubules, and EDS showed that calcium and phosphorus were lower in the patient's dentin but higher in the enamel compared to the control tooth. Roughness measurements showed that AI patients' teeth had rougher occlusal surfaces than those of the control tooth. Nanoindentation measurements showed that the enamel and dentin hardness values of the AI patients' teeth were both significantly reduced compared to those of the control tooth. Compared to the wild-type FAM83H protein, the mutant FAM83H protein shows alterations in stability, hydrophobicity, secondary structure, and tertiary structure. These changes could underlie functional differences and AI phenotype variations caused by this mutation site.

CONCLUSIONS

This study expands the understanding of the effects of FAM83H mutations on tooth structure.

CLINICAL RELEVANCE

Our study enhances our understanding of the genetic basis of AI and may contribute to improved diagnostics and personalized treatment strategies for patients with FAM83H-related AI.

Use of Digital Diagnostic Aids for Initial Caries Detection: A Review

The advance in digital diagnostic technologies has significantly facilitated the detection of dental caries. Despite the increase in clinically available digital diagnostic aids for dental caries, there is yet to be a comprehensive summary of all available technology. This review aims to provide an overview of digital diagnostic aids for the clinical detection of dental caries, particularly those at an initial stage. Currently available digital diagnostic aids for caries detection can be classified into four categories according to the initial source of energy, including radiation-based aids, light-based aids, ultrasound-based aids, and electric-based aids. Radiation-based aids use ionizing radiation, normally X-ray, to produce images of dental structures. Radiation-based aids encompass digital bitewing radiography and cone beam computed tomography. Light-based aids employ light or laser to induce signals for the detection of the changes in the carious dental hard tissue. Common light-based aids include digital transillumination and light/laser-induced fluorescence. Ultrasound-based aids detect the signal of ultrasound waves to assess the acoustic impedance of the carious teeth. The ultrasound caries detector is an available ultrasound-based aid. Electric-based aids assess the changes in the electric current conductance or impedance of the teeth with caries. Available electric-based aids include electrical conductance measurement and alternating current impedance spectroscopy. Except for these clinically available digital diagnostic aids, many digital diagnostic aids for caries detection are still under development with promising results in laboratory settings.

Contemporary Endodontic Approaches for Children

Endodontic therapy is necessary when caries extend further into the tissues of the tooth and reach the pulp, producing irreparable inflammation or necrosis [...].

Insight into the Relationship between Oral Microbiota and the Inflammatory Bowel Disease

Inflammatory bowel disease has been a growing concern of lots of people globally, including both adults and children. As a chronic inflammatory disease of the intestine, even though the etiology of inflammatory bowel disease is still unclear, the available evidence from clinic observations has suggested a close association with microorganisms. The oral microbiota possesses the characteristics of a large number and abundant species, second only to the intestinal microbiota in the human body; as a result, it successfully attracts the attention of researchers. The highly diverse commensal oral microbiota is not only a normal part of the oral cavity but also has a pronounced impact on the pathophysiology of general health. Numerous studies have shown the potential associations between the oral microbiota and inflammatory bowel disease. Inflammatory bowel disease can affect the composition of the oral microbiota and lead to a range of oral pathologies. In turn, there are a variety of oral microorganisms involved in the development and progression of inflammatory bowel disease, including Streptococcus spp., Fusobacterium nucleatum, Porphyromonas gingivalis, Campylobacter concisus, Klebsiella pneumoniae, Saccharibacteria (TM7), and Candida albicans. Based on the above analysis, the purpose of this review is to summarize this relationship of mutual influence and give further insight into the detection of flora as a target for the diagnosis and treatment of inflammatory bowel disease to open up a novel approach in future clinical practice.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.