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Felemban OM, Khan JA, Alamoudi NM, El-Ashiry EA, Bagher SM. Perception of Pain With Bitewing, DIAGNOcam, and Teeth Separation Amongst Children. Int Dent J 2024; 74:631-637. [PMID: 38216389 PMCID: PMC11123552 DOI: 10.1016/j.identj.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND This study evaluated the pain and discomfort associated with 3 diagnostic techniques for proximal carious lesions in children aged 5 to 8 years: bitewing (BW) radiographs, DIAGNOcam, and temporary teeth separation. METHODS The study included 60 healthy children between the ages of 5 and 8 years who had no prior history of dry mouth or mouth breathing, were definitely positive or positive based on Frankl Behavioral Rating Scale, had at least one pair of matched bilateral primary molars and/or permanent first molars in close contact with the adjacent tooth, and were free of restorations and frank cavitation. Each patient evaluated all 3 techniques. The pain and discomfort ratings were obtained by the Wong-Baker FACES Pain Rating Scale immediately after taking 2 standardised BW radiographs or undergoing use of DIAGNOcam and 2 days after temporary teeth separation with elastic separators by a single trained and experienced paediatric dentist. RESULTS The DIAGNOcam procedure resulted in much higher pain and discomfort (3.69 ± 3.10) than the other 2 diagnostic techniques. Within-participant pain and discomfort scored significantly higher with DIAGNOcam compared to BW radiographs (P < .001) and temporary teeth separation (P = .002). CONCLUSIONS The DIAGNOcam diagnostic technique caused much more pain and discomfort than BW radiographs and temporary teeth separation using orthodontic elastic separators. The report is part of a randomised clinical trial that was registered at www. CLINICALTRIALS gov under the identifier NCT03685058.
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Affiliation(s)
- Osama M Felemban
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jihan A Khan
- University Medical Services Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Najlaa M Alamoudi
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Eman A El-Ashiry
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; Pedodontic Department, Faculty of Dental Medicine for Girls, Al Azhar University, Cairo, Egypt
| | - Sara M Bagher
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
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Godenzi D, Bommer C, Heinzel-Gutenbrunner M, Horst Keeper J, Peters K. Remineralizing potential of the biomimetic P 11-4 self-assembling peptide on noncavitated caries lesions: A retrospective cohort study evaluating semistandardized before-and-after radiographs. J Am Dent Assoc 2023; 154:885-896.e9. [PMID: 37642611 DOI: 10.1016/j.adaj.2023.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Self-assembling peptide (SAP) P11-4 was introduced to treat initial caries lesions by means of guiding hydroxyapatite regeneration within the lesion. The objective of this study was to assess its effectiveness in a practical clinical setting. METHODS Caries lesions in permanent teeth treated with monomeric and polymeric SAP P11-4 from May 2015 through October 2020 were retrospectively analyzed at lesion and child levels by means of bite-wing radiography for changes in stage and cavitation and restoration. RESULTS Two hundred and nineteen children aged 10 through 19 years with a total of 405 proximal lesions in posterior teeth were followed from 0.4 through 5.5 years (median, 7 months; interquartile range, 6-19 months). Regression occurred in 37% of stage RA1 (radiolucency in the outer one-half of enamel) (95% CI, 31% to 44%), 38% of stage RA2 (radiolucency in the inner one-half of enamel plus or minus the enamel-dentin junction) (95% CI, 30% to 45%), and 40% of stage RA3 (radiolucency limited to the outer one-third of dentin) (95% CI, 16% to 68%) lesions. The proportion of lesions with no cavitation was 0.96 (95% CI, 0.94 to 0.98) after 1 year and 0.91 (95% CI, 0.88 to 0.95) after 2 years. CONCLUSIONS Real-world clinical data indicate that SAP P11-4 can lead to recovery and a healthier tooth stage. PRACTICAL IMPLICATIONS SAP P11-4 is a safe treatment for initial caries lesions in permanent teeth that remineralizes in the deepest zone of the lesion and can be introduced easily into routine dental practice.
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Cebula M, Göstemeyer G, Krois J, Pitchika V, Paris S, Schwendicke F, Effenberger S. Resin Infiltration of Non-Cavitated Proximal Caries Lesions in Primary and Permanent Teeth: A Systematic Review and Scenario Analysis of Randomized Controlled Trials. J Clin Med 2023; 12:jcm12020727. [PMID: 36675656 PMCID: PMC9864315 DOI: 10.3390/jcm12020727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
The present study aimed to meta-analyze and evaluate the certainty of evidence for resin infiltration of proximal carious lesions in primary and permanent teeth. While resin infiltration has been shown efficacious for caries management, the certainty of evidence remains unclear. The protocol was registered with PROSPERO (CRD42018080895), and PRISMA guidelines have been followed. The databases PubMed, Embase, and Cochrane CENTRAL were systematically screened, complemented by hand searches and cross-referencing. Eleven relevant articles were identified and included, i.e., randomized controlled trials (RCTs) comparing the progression of resin infiltrated proximal caries lesions (combined with non-invasive measures) in primary or permanent teeth with non-invasive measures. Random-effects meta-analyses and trial sequential analyses (TSA) were performed for per-protocol (PP), intention-to-treat (ITT), and best/worst case (BC/WC) scenarios. Six included trials assessed lesions in permanent teeth and five trails assessed lesions in primary teeth. The trials had a high or unclear risk of bias. Risk of caries progression was significantly reduced for infiltrated lesions in the PP, ITT, and BC scenarios in both permanent teeth and primary teeth, but not in the WC scenario. According to the TSA, firm evidence was reached for all of the scenarios except the WC. In conclusion, there is firm evidence for resin infiltration arresting proximal caries lesions in permanent and primary teeth.
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Affiliation(s)
- Marcus Cebula
- Clinical Research Department, DMG Dental Material Gesellschaft mbH, Elbgaustraße 248, 22547 Hamburg, Germany
| | - Gerd Göstemeyer
- Department of Restorative, Preventive and Pediatric Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Vinay Pitchika
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Sebastian Paris
- Department of Restorative, Preventive and Pediatric Dentistry, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Susanne Effenberger
- Clinical Research Department, DMG Dental Material Gesellschaft mbH, Elbgaustraße 248, 22547 Hamburg, Germany
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité—Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
- Correspondence:
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Treeratweerapong Y, Nakornchai S, Jirarattanasopha V. Effectiveness of applying proximal enamel caries with fluoride-releasing sealant and fluoride varnish on caries progression in permanent teeth: A 12-month split-mouth randomized clinical trial. Int J Paediatr Dent 2023; 33:30-39. [PMID: 35579583 DOI: 10.1111/ipd.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 05/07/2022] [Accepted: 05/15/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies report on managing initial proximal caries with sealants, and no reports focus on fluoride-releasing sealants. AIM To compare the effectiveness between applications of a fluoride-releasing sealant and fluoride varnish on proximal enamel caries to control caries progression in permanent teeth. DESIGN This was a split-mouth randomized controlled trial in forty-four 11- to 16-year-old children with radiographic caries in at least one contralateral pair of teeth with proximal enamel caries. The lesions were evaluated using DIAGNOdent and were also assessed visually after tooth separation. The lesions in each subject were randomly sealed with a fluoride-releasing sealant (Helioseal® F) or applied with fluoride varnish (Duraphat®). The fluoride varnish-treated lesion was reapplied at 3 and 6 months. Clinical examination, bitewing radiograph evaluation, and DIAGNOdent assessment were performed at 6 and 12 months. The caries progression outcome variables were regression, no change, and progression. The data were analyzed with the McNemar-Bowker test. RESULTS Radiographic examination and DIAGNOdent assessment demonstrated no significant differences in the percentages of regression, no change, or progression at the 12-month follow-up (p > .05). CONCLUSION Applications of a fluoride-releasing sealant and of fluoride varnish three times resulted in a nonsignificant difference in caries progression of initial proximal caries at the 12-month follow-up.
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Affiliation(s)
| | - Siriruk Nakornchai
- Department of Pediatric Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Resin Infiltration of Non-Cavitated Enamel Lesions in Paediatric Dentistry: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121893. [PMID: 36553336 PMCID: PMC9776437 DOI: 10.3390/children9121893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
The resin infiltration (RI) technique was introduced as one of the minimal intervention dentistry strategies in addressing dental caries among the paediatric population. This technique used the low-viscosity resin monomer to infiltrate the non-cavitated carious lesion and other developmental enamel porosities, thus allowing the conservation of the tooth structure. This narrative review aims to explore the value of RI in Paediatric Dentistry. Through our search of the literature, the development of the material, their clinical applications and shortcomings, as well as the innovation that has been carried out to improve the current RI, were discussed. There are number of high-level evidence supporting the use of RI in arresting non-cavitated proximal caries lesions in primary and permanent teeth, but its efficacy in managing anterior white spot lesions is still unclear. Limited penetration depth, not radiopaque and questionable long-term colour and material stability were among the limitation of the material. Various laboratory-based studies have been conducted to improve the current properties of RI. Nevertheless, RI has emerged as one of the important micro-invasive techniques in addressing non-cavitated and anterior white-spot enamel lesions in children and adolescents with great success.
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Esteves-Oliveira M, Passos VF, Russi TMAZC, Fernandes ARR, Terto CNN, Mendonça JS, Campus G, Wierichs RJ, Meyer-Lueckel H, Lima JPM. Randomized in situ evaluation of surface polishing protocols on the caries-protective effect of resin Infiltrant. Sci Rep 2022; 12:20648. [PMID: 36450787 PMCID: PMC9712577 DOI: 10.1038/s41598-022-25091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
The aim of this placebo-controlled randomized in situ study was to evaluate the effect of different surface polishing protocols on enamel roughness, bacterial adhesion and caries-protective effect of a resin infiltrant. Seventy-five bovine enamel samples having artificial caries lesions were treated with a resinous infiltrant and afterwards randomly dividided into five polishing protocols: aluminum oxide flexible disks (Al2O3-Disks), silicon carbide tips (SIC-Tips), silicon carbide brush (SIC-Brush), silicon carbide polyester strips (SIC-Strips) or no polishing [negative control (NC)]. Average surface roughness (Ra) was assessed by profilometry. Samples were mounted in palatal appliances under a mesh for biofilm accumulation. Fifteen volunteers wore the intraoral appliances (14-days) and cariogenic challenge was triggered by sucrose solutions. Biofilm formed was collected for microbiological analysis of caries-related bacteria (Streptococcus mutans, Lactobacillus acidophilus) and demineralization was assessed by cross-sectional microhardness. Mean Knoop hardness numbers (Kg/mm2) were plotted over lesion depth (µm) and area under the lesion curve was subtracted from sound enamel to determine demineralization (ΔS, Kg/mm2xµm). Data were analyzed by ANOVA and post-hoc comparisons (α = 0.05). NC resulted in significantly higher Ra means than Al2O3-Disks and SIC-Strips. Bacterial counts were not significantly different between the groups (p > 0.05). Regards ΔS means, however none of the groups were significantly different to NC (6983.3 kg/mm2xµm /CI 4246.1-9720.5, p > 0.05). Conclusions: Polishing protocols (Al2O3-Disks, SIC-Strips) significantly decreseased roughness of infiltrated-enamel, however none of the polishing protocols could signicantly decrease bacterial counts nor resulted in significant less demineralization.
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Affiliation(s)
- Marcella Esteves-Oliveira
- grid.5734.50000 0001 0726 5157Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland ,grid.8664.c0000 0001 2165 8627Department of Restorative Dentistry and Endodontology, Justus Liebig University Gießen, Gießen, Germany
| | - Vanara F. Passos
- grid.8395.70000 0001 2160 0329Department of Restorative Dentistry, Federal University of Ceara, Fortaleza, Ceara Brazil
| | | | | | - Caroline N. N. Terto
- grid.8395.70000 0001 2160 0329Department of Restorative Dentistry, Federal University of Ceara, Fortaleza, Ceara Brazil
| | - Juliano S. Mendonça
- grid.8395.70000 0001 2160 0329Department of Restorative Dentistry, Federal University of Ceara, Fortaleza, Ceara Brazil
| | - Guglielmo Campus
- grid.5734.50000 0001 0726 5157Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Richard J. Wierichs
- grid.5734.50000 0001 0726 5157Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Hendrik Meyer-Lueckel
- grid.5734.50000 0001 0726 5157Department of Restorative, Preventive & Pediatric Dentistry, University of Bern, Bern, Switzerland
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Nedeljkovic I, Doulabi BZ, Abdelaziz M, Feilzer AJ, Exterkate RA, Szafert S, Gulia N, Krejci I, Kleverlaan CJ. Cytotoxicity and anti-biofilm properties of novel hybrid-glass-based caries infiltrant. Dent Mater 2022; 38:2052-2061. [DOI: 10.1016/j.dental.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022]
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Nedeljkovic I, Abdelaziz M, Feilzer AJ, Szafert S, Gulia N, Dawaa M, Krejci I, Kleverlaan CJ. Novel hybrid-glass-based material for infiltration of early caries lesions. Dent Mater 2022; 38:1015-1023. [DOI: 10.1016/j.dental.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 11/26/2022]
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9
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Schwendicke F, Walsh T, Lamont T, Al-Yaseen W, Bjørndal L, Clarkson JE, Fontana M, Gomez Rossi J, Göstemeyer G, Levey C, Müller A, Ricketts D, Robertson M, Santamaria RM, Innes NP. Interventions for treating cavitated or dentine carious lesions. Cochrane Database Syst Rev 2021; 7:CD013039. [PMID: 34280957 PMCID: PMC8406990 DOI: 10.1002/14651858.cd013039.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Traditionally, cavitated carious lesions and those extending into dentine have been treated by 'complete' removal of carious tissue, i.e. non-selective removal and conventional restoration (CR). Alternative strategies for managing cavitated or dentine carious lesions remove less or none of the carious tissue and include selective carious tissue removal (or selective excavation (SE)), stepwise carious tissue removal (SW), sealing carious lesions using sealant materials, sealing using preformed metal crowns (Hall Technique, HT), and non-restorative cavity control (NRCC). OBJECTIVES To determine the comparative effectiveness of interventions (CR, SE, SW, sealing of carious lesions using sealant materials or preformed metal crowns (HT), or NRCC) to treat carious lesions conventionally considered to require restorations (cavitated or micro-cavitated lesions, or occlusal lesions that are clinically non-cavitated but clinically/radiographically extend into dentine) in primary or permanent teeth with vital (sensitive) pulps. SEARCH METHODS An information specialist searched four bibliographic databases to 21 July 2020 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA: We included randomised clinical trials comparing different levels of carious tissue removal, as listed above, against each other, placebo, or no treatment. Participants had permanent or primary teeth (or both), and vital pulps (i.e. no irreversible pulpitis/pulp necrosis), and carious lesions conventionally considered to need a restoration (i.e. cavitated lesions, or non- or micro-cavitated lesions radiographically extending into dentine). The primary outcome was failure, a composite measure of pulp exposure, endodontic therapy, tooth extraction, and restorative complications (including resealing of sealed lesions). DATA COLLECTION AND ANALYSIS Pairs of review authors independently screened search results, extracted data, and assessed the risk of bias in the studies and the overall certainty of the evidence using GRADE criteria. We measured treatment effects through analysing dichotomous outcomes (presence/absence of complications) and expressing them as odds ratios (OR) with 95% confidence intervals (CI). For failure in the subgroup of deep lesions, we used network meta-analysis to assess and rank the relative effectiveness of different interventions. MAIN RESULTS We included 27 studies with 3350 participants and 4195 teeth/lesions, which were conducted in 11 countries and published between 1977 and 2020. Twenty-four studies used a parallel-group design and three were split-mouth. Two studies included adults only, 20 included children/adolescents only and five included both. Ten studies evaluated permanent teeth, 16 evaluated primary teeth and one evaluated both. Three studies treated non-cavitated lesions; 12 treated cavitated, deep lesions, and 12 treated cavitated but not deep lesions or lesions of varying depth. Seventeen studies compared conventional treatment (CR) with a less invasive treatment: SE (8), SW (4), two HT (2), sealing with sealant materials (4) and NRCC (1). Other comparisons were: SE versus HT (2); SE versus SW (4); SE versus sealing with sealant materials (2); sealant materials versus no sealing (2). Follow-up times varied from no follow-up (pulp exposure during treatment) to 120 months, the most common being 12 to 24 months. All studies were at overall high risk of bias. Effect of interventions Sealing using sealants versus other interventions for non-cavitated or cavitated but not deep lesions There was insufficient evidence of a difference between sealing with sealants and CR (OR 5.00, 95% CI 0.51 to 49.27; 1 study, 41 teeth, permanent teeth, cavitated), sealing versus SE (OR 3.11, 95% CI 0.11 to 85.52; 2 studies, 82 primary teeth, cavitated) or sealing versus no treatment (OR 0.05, 95% CI 0.00 to 2.71; 2 studies, 103 permanent teeth, non-cavitated), but we assessed all as very low-certainty evidence. HT, CR, SE, NRCC for cavitated, but not deep lesions in primary teeth The odds of failure may be higher for CR than HT (OR 8.35, 95% CI 3.73 to 18.68; 2 studies, 249 teeth; low-certainty evidence) and lower for HT than NRCC (OR 0.19, 95% CI 0.05 to 0.74; 1 study, 84 teeth, very low-certainty evidence). There was insufficient evidence of a difference between SE versus HT (OR 8.94, 95% CI 0.57 to 139.67; 2 studies, 586 teeth) or CR versus NRCC (OR 1.16, 95% CI 0.50 to 2.71; 1 study, 102 teeth), both very low-certainty evidence. CR, SE, SW for deep lesions The odds of failure were higher for CR than SW in permanent teeth (OR 2.06, 95% CI 1.34 to 3.17; 3 studies, 398 teeth; moderate-certainty evidence), but not primary teeth (OR 2.43, 95% CI 0.65 to 9.12; 1 study, 63 teeth; very low-certainty evidence). The odds of failure may be higher for CR than SE in permanent teeth (OR 11.32, 95% CI 1.97 to 65.02; 2 studies, 179 teeth) and primary teeth (OR 4.43, 95% CI 1.04 to 18.77; 4 studies, 265 teeth), both very low-certainty evidence. Notably, two studies compared CR versus SE in cavitated, but not deep lesions, with insufficient evidence of a difference in outcome (OR 0.62, 95% CI 0.21 to 1.88; 204 teeth; very low-certainty evidence). The odds of failure were higher for SW than SE in permanent teeth (OR 2.25, 95% CI 1.33 to 3.82; 3 studies, 371 teeth; moderate-certainty evidence), but not primary teeth (OR 2.05, 95% CI 0.49 to 8.62; 2 studies, 126 teeth; very low-certainty evidence). For deep lesions, a network meta-analysis showed the probability of failure to be greatest for CR compared with SE, SW and HT. AUTHORS' CONCLUSIONS Compared with CR, there were lower numbers of failures with HT and SE in the primary dentition, and with SE and SW in the permanent dentition. Most studies showed high risk of bias and limited precision of estimates due to small sample size and typically limited numbers of failures, resulting in assessments of low or very low certainty of evidence for most comparisons.
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Affiliation(s)
- Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Thomas Lamont
- School of Dentistry, University of Dundee, Dundee, UK
| | - Waraf Al-Yaseen
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Lars Bjørndal
- Cariology and Endodontics, Section of Clinical Oral Microbiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janet E Clarkson
- Division of Oral Health Sciences, School of Dentistry, University of Dundee, Dundee, UK
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Michigan, USA
| | - Jesus Gomez Rossi
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Colin Levey
- Division of Restorative Dentistry, School of Dentistry, University of Dundee, Dundee, UK
| | - Anne Müller
- Department of Oral Diagnostics, Digital Health and Health Research Services, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Ruth M Santamaria
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Nicola Pt Innes
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Wenzel A. Radiographic modalities for diagnosis of caries in a historical perspective: from film to machine-intelligence supported systems. Dentomaxillofac Radiol 2021; 50:20210010. [PMID: 33661697 PMCID: PMC8231685 DOI: 10.1259/dmfr.20210010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/03/2021] [Accepted: 02/16/2021] [Indexed: 01/17/2023] Open
Abstract
Radiographic imaging for the diagnosis of caries lesions has been a supplement to clinical examination for approximately a century. Various methods, and particularly X-ray receptors, have been developed over the years, and computer systems have focused on aiding the dentist in the detection of lesions and in estimating lesion depth. The present historical review has sampled accuracy ex vivo studies and clinical studies on radiographic caries diagnosis that have compared two or more receptors for capturing the image. The epochs of film radiography, xeroradiography, digital intraoral radiography, panoramic radiography and other extraoral methods, TACT analysis, cone-beam CT and artificial intelligence systems aiding in decision-making are reviewed. The author of this review (43 years in academia) has been involved in caries research and contributed to the literature in all the mentioned epochs.
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Affiliation(s)
- Ann Wenzel
- Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
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11
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Proximal caries infiltration - Pragmatic RCT with 4 years of follow-up. J Dent 2021; 111:103733. [PMID: 34174349 DOI: 10.1016/j.jdent.2021.103733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Efficacy of proximal caries infiltration to arrest lesion progression has been shown in university settings, but only once in a practice-based pragmatic design with a follow-up of 18 months. The aim of this randomized split-mouth placebo-controlled study was to follow-up this cohort for 3 years and those with high caries risk for 4 years. METHODS Originally, in 87 children and young adults pairs of 238 proximal caries lesions, radiographically extending into inner half of enamel (E2) or outer third of dentin (D1), were randomly allocated to two groups: infiltration (Icon; DMG) or mock (control) treatment by five dentists in four private practices. All subjects received risk-related instructions for diet, flossing and fluoridation. The primary outcome was radiographic lesion progression (pairwise comparison) evaluated by two evaluators independently being blinded to treatment allocation. RESULTS After 36 months [mean (SD): 1152 (166) days] 165 lesion pairs in 64 patients as well as after 48 months [mean (SD): 1496 (121) days] 71 lesion pairs in 20 high caries risk patients could be re-evaluated clinically as well as radiographically using individualized bitewing holders as at baseline. No adverse events could be observed. After 36 months, progression was recorded in 23/165 test (14%) and 64/165 control lesions (39%) [McNemar/Obuchowski test; p<0.001; relative risk reduction (CI95%): 64 (45-77%)]. After 48 months lesion progression was recorded in 13/71 test (18%) and 34/71 control lesions (48%) [p = 0.003; relative risk reduction (CI95%): 62 (34-78%)] of high caries risk patients. CONCLUSIONS It can be concluded that also in a practice-setting proximal caries infiltration is more efficacious in reducing lesion progression compared with individualized non-invasive measures alone over a period of four years.
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12
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Chen Y, Chen D, Lin H. Infiltration and sealing for managing non-cavitated proximal lesions: a systematic review and meta-analysis. BMC Oral Health 2021; 21:13. [PMID: 33413327 PMCID: PMC7791990 DOI: 10.1186/s12903-020-01364-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022] Open
Abstract
Background Infiltration and sealing are micro-invasive treatments for arresting proximal non-cavitated caries lesions; however, their efficacies under different conditions remain unknown. This systematic review and meta-analysis aimed to evaluate the caries-arresting effectiveness of infiltration and sealing and to further analyse their efficacies across different dentition types and caries risk levels. Methods Six electronic databases were searched for published literature, and references were manually searched. Split-mouth randomised controlled trials (RCTs) to compare the effectiveness between infiltration/sealing and non-invasive treatments in proximal lesions were included. The primary outcome was obtained from radiographical readings. Results In total, 1033 citations were identified, and 17 RCTs (22 articles) were included. Infiltration and sealing reduced the odds of lesion progression (infiltration vs. non-invasive: OR = 0.21, 95% CI 0.15–0.30; sealing vs. placebo: OR = 0.27, 95% CI 0.18–0.42). For both the primary and permanent dentitions, infiltration and sealing were more effective than non-invasive treatments (primary dentition: OR = 0.30, 95% CI 0.20–0.45; permanent dentition: OR = 0.20, 95% CI 0.14–0.28). The overall effects of infiltration and sealing were significantly different from the control effects based on different caries risk levels (OR = 0.20, 95% CI 0.14–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), there were significant differences between micro-invasive and non-invasive treatments (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.17, 95% CI 0.10–0.29; and high risk: OR = 0.14, 95% CI 0.07–0.28). Except for caries risk at moderate levels (moderate risk: OR = 0.32, 95% CI 0.01–8.27), infiltration was superior (low risk: OR = 0.24, 95% CI 0.08–0.72; low to moderate risk: OR = 0.38, 95% CI 0.18–0.81; moderate to high risk: OR = 0.20, 95% CI 0.10–0.39; and high risk: OR = 0.14, 95% CI 0.05–0.37). Conclusion Infiltration and sealing were more efficacious than non-invasive treatments for halting non-cavitated proximal lesions.
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Affiliation(s)
- Yuanyuan Chen
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Key Laboratory for Dental Disease Prevention and Control, Sun Yat-Sen University, Guangzhou, China
| | - Dongru Chen
- Department of Orthodontics, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Key Laboratory for Dental Disease Prevention and Control, Sun Yat-Sen University, Guangzhou, China
| | - Huancai Lin
- Hospital of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China. .,Department of Preventive Dentistry, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China. .,Guangdong Key Laboratory for Dental Disease Prevention and Control, Sun Yat-Sen University, Guangzhou, China.
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13
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Lindquist B, Emilson CG. Sealing Proximal Non- and Micro-Cavitated Carious Lesions Using a One-Session Separator Technique: A 2-Year Randomised Clinical Study. Caries Res 2020; 54:483-490. [PMID: 33147593 DOI: 10.1159/000509679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 06/12/2020] [Indexed: 11/19/2022] Open
Abstract
The presence of initial caries accounts for the majority of approximal carious lesions in many countries. The aim of this clustered, split-mouth, randomised, controlled clinical trial was to use a metal separator to widen the approximal space in a one-visit session before sealing and to evaluate patient acceptance, together with the efficacy of the proximal sealing in arresting incipient carious lesions after 2 years. A total of 48 patients with a mean age of 41.9 years were selected. They had at least one pair of proximal initial carious lesions, including the distal surface of the canines to the mesial surface of the third molars (bite-wing score D1-D3). The patient's caries risk at baseline was analyzed using a Cariogram. All surfaces were examined for mutans streptococci (ms) counts. The separator technique made it possible to diagnose whether or not a microcavity was present. After 2 years, 212 surfaces in 45 subjects were examined using the same as baseline standardized digital follow-up radiographs. Two analyses were performed, one sensitive, where a progression or a regression was assessed if one of the examiners made one of those diagnoses, and one conservative, where unchanged. For both analyses, the sealed test surfaces showed a significantly higher regression (67 and 29%) compared to the control group (13 and 2%) p < 0.0001. It did not appear that the baseline variables, such as the caries risk, surface diagnoses, or ms counts, influenced the caries outcome. In the test group, there was no difference in caries progression if there was a microcavity or not. The separation treatment was well accepted by the patients. The method of separation for diagnosis and sealing treatment in a single session appears to be a clinically applicable method for the control of proximal carious lesions.
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Affiliation(s)
- Birgitta Lindquist
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - Claes-Göran Emilson
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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Hayashi M, Momoi Y, Fujitani M, Fukushima M, Imazato S, Kitasako Y, Kubo S, Nakashima S, Nikaido T, Shimizu A, Sugai K, Takahashi R, Unemori M, Yamaki C. Evidence-based consensus for treating incipient enamel caries in adults by non-invasive methods: recommendations by GRADE guideline. JAPANESE DENTAL SCIENCE REVIEW 2020; 56:155-163. [PMID: 33294058 PMCID: PMC7701193 DOI: 10.1016/j.jdsr.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/22/2022] Open
Abstract
Remineralization treatment, which offers the advantage of being non-invasive, is increasingly being used as a minimal intervention treatment in managing incipient enamel caries. The aim of this review was to develop EBM guideline for optimized strategies for non-invasive treatment of incipient enamel caries. Japanese Society of Conservative Dentistry (JSCD) guideline committee formulated a Guideline for treating incipient enamel caries using the GRADE system, which is the global, mainstream standard for guideline development. The committee selected the most frequent clinical questions (CQs) in treating incipient enamel caries and identified clinically important outcomes in evaluating the efficacy of treatments. Using extensive electronic and manual searches, relevant randomized controlled trials and controlled clinical trials were identified. Based on evidence profiles produced by the committee, the panel discussed the effects, benefits and disadvantages of the selected treatments, as well as their cost effectiveness and feasibility, in order to achieve a consensus in treating incipient enamel caries non-invasively. A recommendation was made for each clinical question after voting by the panel members. Based on the evidence profile and panel discussions for each CQ, the experts strongly recommended application of topical fluoride to inhibit cavitation of incipient enamel caries, and to diminish white spot lesions.
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Affiliation(s)
- Mikako Hayashi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yasuko Momoi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Morioki Fujitani
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Masayoshi Fukushima
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Satoshi Imazato
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yuichi Kitasako
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shisei Kubo
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shoji Nakashima
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Toru Nikaido
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Akihiko Shimizu
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kenichi Sugai
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Rena Takahashi
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Masako Unemori
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Chinami Yamaki
- Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
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15
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Al-Sane M, Ricketts DN, Mendes FM, Altarakemah Y, Deery C, Innes N, Rollings S. Reproducibility of subtraction radiography in monitoring changes in approximal carious lesions in children: An in vivo study. Int J Paediatr Dent 2020; 30:587-596. [PMID: 32181942 DOI: 10.1111/ipd.12638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/10/2020] [Accepted: 03/03/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Laboratory studies have shown that digital subtraction radiography (DSR) can be a more effective tool, than conventional radiography, in monitoring changes in carious lesions. The clinical performance of the technique, however, has not been sufficiently researched. AIM To compare the reproducibility of DSR to that of bitewing radiographs, in monitoring changes in approximal caries in the mixed dentition. A secondary aim was to determine whether assessment outcomes differed as a function of the method used. DESIGN Six assessors evaluated 310 lesions first on bitewings, then with DSR. The overall reproducibility was evaluated via intra-class correlation coefficient (ICC). Intra- and inter-rater reproducibility were assessed using weighted Kappa. Paired t test was used to assess differences in the reproducibility across methods. RESULTS The overall reproducibility for DSR was (ICC = 0.47, 95% CI = 0.31-0.56). Intra- and inter-rater reproducibility were 0.65 and 0.44, respectively. The overall reproducibility for bitewings was ICC = 0.45, 95% CI = 0.42-0.57. Intra- and Inter-rater reproducibility were 0.71 and 0.46, respectively. Differences in the reproducibility across methods were not statistically significant. Significantly more lesions were scored as progressed using DSR. CONCLUSIONS The reproducibility of DSR in monitoring changes in approximal caries is comparable to that of bitewings. Additionally, DSR detected higher proportion of progression than bitewing assessments.
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Affiliation(s)
- Mona Al-Sane
- Faculty of Dentistry, Department of Developmental and Preventive Sciences, Kuwait University, Kuwait City, Kuwait
| | - David N Ricketts
- Section of Operative Dentistry, Fixed Prosthodontics and Endodontology, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
| | - Fausto M Mendes
- Department of Pediatric Dentistry, School of Dentistry, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Yacoub Altarakemah
- Faculty of Dentistry, Department of Restorative Sciences, Kuwait University, Kuwait City, Kuwait
| | - Christopher Deery
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Nicola Innes
- Department of Paediatric Dentistry, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
| | - Sam Rollings
- Aberdeen Dental Hospital and Institute of Dentistry, Department of Restorative Dentistry, Aberdeen, UK
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16
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Splieth CH, Kanzow P, Wiegand A, Schmoeckel J, Jablonski-Momeni A. How to intervene in the caries process: proximal caries in adolescents and adults-a systematic review and meta-analysis. Clin Oral Investig 2020; 24:1623-1636. [PMID: 32306093 DOI: 10.1007/s00784-020-03201-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/07/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults". MATERIAL AND METHODS Separating between the management of initial and cavitated proximal caries lesions, Medline via PubMed was searched regarding non-operative/non-invasive, minimally/micro-invasive and restorative treatment. First priority was systematic reviews or randomized controlled trials (RCTs), otherwise cohort studies. After extraction of data, the potential risk of bias was estimated depending on the study type, and the emerging evidence for conclusions was graded. RESULTS Regarding non-invasive/non-operative care (NOC), no systematic reviews or RCTs were found. In cohort studies (n = 12) with a low level of evidence, NOC like biofilm management and fluoride was associated with a low proportion and slow speed of progression of initial proximal lesions. Minimally/micro-invasive (MI) treatments such as proximal sealants or resin infiltration (four systematic reviews/meta-analyses) were effective compared with a non-invasive/placebo control at a moderate level of evidence. Data on restorative treatment came with low evidence (5 systematic reviews, 13 RCTs); with the limitation of no direct comparative studies, sample size-weighted mean annual failure rates of class II restorations varied between 1.2 (bulk-fill composite) and 3.8% (ceramic). Based on one RCT, class II composite restorations may show a higher risk of failure compared with amalgam. CONCLUSIONS Proximal caries lesions can be managed successfully with non-operative, micro-invasive and restorative treatment according to lesion stage and caries activity. CLINICAL RELEVANCE Proximal caries treatment options like non-operative, micro-invasive and restorative care should be considered individually.
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Affiliation(s)
- C H Splieth
- Clinic for Preventive and Paediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany.
| | - P Kanzow
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - A Wiegand
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - J Schmoeckel
- Clinic for Preventive and Paediatric Dentistry, University of Greifswald, Fleischmannstr. 42, 17475, Greifswald, Germany
| | - A Jablonski-Momeni
- Department of Orthodontics, Dental School, Philipps-University Marburg, Marburg, Germany
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17
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Paris S, Bitter K, Krois J, Meyer-Lueckel H. Seven-year-efficacy of proximal caries infiltration – Randomized clinical trial. J Dent 2020; 93:103277. [DOI: 10.1016/j.jdent.2020.103277] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
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18
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Arslan S, Kaplan MH. The Effect of Resin Infiltration on the Progression of Proximal Caries Lesions: A Randomized Clinical Trial. Med Princ Pract 2020; 29:238-243. [PMID: 31476757 PMCID: PMC7315193 DOI: 10.1159/000503053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/02/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this clinical trial was to assess the effect of resin infiltration on the progression of proximal caries lesions. SUBJECTS AND METHODS Forty-one patients, aged between 15 and 33 years, with 2 or more non-cavitated proximal caries lesions were included. In 41 of the adolescent and young adults, 45 pairs of proximal lesions with radiological extension into the inner and outer half of the enamel, or into the outer third of the dentin, were randomly allocated to the test groups (resin infiltration application + fluoridated toothpaste and flossing use) or to the control group (fluoridated toothpaste and flossing use). Standardized geometrically aligned digital bitewing radiographs were obtained using individual biting holders. The radiographic progression of the lesions was assessed after 1 year by digital-subtraction radiography. The McNemar test was used for statistical analysis. RESULTS In the test group 1/45 of the lesions (2.2%) and in the control group 9/45 of the lesions (20%) showed progression. The caries progression rate of the control group was significantly higher than that of the test group (p < 0.05). CONCLUSIONS Resin infiltration of proximal caries lesions is effective in reducing progression of the lesion.
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Affiliation(s)
- Soley Arslan
- Department of Restorative Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkey,
| | - Melek Hilal Kaplan
- Department of Restorative Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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19
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Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Tampi MP, Pilcher L, Banfield L, Carrasco-Labra A. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. J Am Dent Assoc 2019; 149:837-849.e19. [PMID: 30261951 DOI: 10.1016/j.adaj.2018.07.002] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults. TYPES OF STUDIES REVIEWED The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions. RESULTS The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide-amorphous calcium phosphate. CONCLUSIONS AND PRACTICAL IMPLICATIONS Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility.
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20
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A clinical guideline for caries infiltration of proximal enamel lesions with resins. Br Dent J 2019; 225:299-304. [PMID: 30141501 DOI: 10.1038/sj.bdj.2018.647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/08/2022]
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21
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Machiulskiene V, Campus G, Carvalho JC, Dige I, Ekstrand KR, Jablonski-Momeni A, Maltz M, Manton DJ, Martignon S, Martinez-Mier EA, Pitts NB, Schulte AG, Splieth CH, Tenuta LMA, Ferreira Zandona A, Nyvad B. Terminology of Dental Caries and Dental Caries Management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR. Caries Res 2019; 54:7-14. [PMID: 31590168 DOI: 10.1159/000503309] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022] Open
Abstract
A 2-day workshop of ORCA and the IADR Cariology Research Group was organized to discuss and reach consensus on definitions of the most commonly used terms in cariology. The aims were to identify and to select the most commonly used terms of dental caries and dental caries management and to define them based on current concepts. Terms related to definition, diagnosis, risk assessment, and monitoring of dental caries were included. The Delphi process was used to establish terms to be considered using the nominal group method favored by consensus. Of 222 terms originally suggested by six cariologists from different countries, a total of 59 terms were reviewed after removing duplicates and unnecessary words. Sixteen experts in cariology took part in the process of reaching consensus about the definitions of the selected caries terms. Decisions were made following thorough "round table" discussions of each term and confirmed by secret electronic voting. Full agreement (100%) was reached on 17 terms, while the definitions of 6 terms were below the agreed 80% threshold of consensus. The suggested terminology is recommended for use in research, in public health, as well as in clinical practice.
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Affiliation(s)
- Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania,
| | - Guglielmo Campus
- Klinik für Zahnerhaltung, Präventiv- und Kinderzahnmedizin Zahnmedizinische Kliniken (ZMK), University of Bern, Bern, Switzerland.,Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | | | - Irene Dige
- Section of Dental Pathology, Operative Dentistry and Endodontics, Department of Dentistry and Oral Health, University of Aarhus, Aarhus, Denmark
| | - Kim Rud Ekstrand
- Section of Cariology and Endodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Marisa Maltz
- Department of Preventive and Social Dentistry, Faculty of Odontology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - David J Manton
- Growth and Development Section, Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | - Stefania Martignon
- Dental Innovation and Translation Hub, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom.,UNICA - Caries Research Unit, Research Vice-rectory, Universidad El Bosque, Bogotá, Colombia
| | - E Angeles Martinez-Mier
- Department of Cariology, Operative Dentistry and Dental Public Health, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Nigel B Pitts
- Dental Innovation and Translation Hub, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, United Kingdom
| | - Andreas G Schulte
- Department of Special Care Dentistry, Dental School, Witten/Herdecke University, Witten, Germany
| | - Christian H Splieth
- Section of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Livia Maria Andaló Tenuta
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrea Ferreira Zandona
- Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Bente Nyvad
- Section of Dental Pathology, Operative Dentistry and Endodontics, Department of Dentistry and Oral Health, University of Aarhus, Aarhus, Denmark
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22
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Ricketts D, Lamont T, Innes NPT, Kidd E, Clarkson JE. WITHDRAWN: Operative caries management in adults and children. Cochrane Database Syst Rev 2019; 7:CD003808. [PMID: 31339555 PMCID: PMC6653982 DOI: 10.1002/14651858.cd003808.pub4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The management of dental caries has traditionally involved removal of all soft demineralised dentine before a filling is placed. However, the benefits of complete caries removal have been questioned because of concerns about the possible adverse effects of removing all soft dentine from the tooth. Three groups of studies have also challenged the doctrine of complete caries removal by sealing caries into teeth using three different techniques. The first technique removes caries in stages over two visits some months apart, allowing the dental pulp time to lay down reparative dentine (the stepwise excavation technique). The second removes part of the dentinal caries and seals the residual caries into the tooth permanently (partial caries removal) and the third technique removes no dentinal caries prior to sealing or restoring (no dentinal caries removal). This is an update of a Cochrane review first published in 2006. OBJECTIVES To assess the effects of stepwise, partial or no dentinal caries removal compared with complete caries removal for the management of dentinal caries in previously unrestored primary and permanent teeth. SEARCH METHODS The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 12 December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 11), MEDLINE via OVID (1946 to 12 December 2012) and EMBASE via OVID (1980 to 12 December 2012). There were no restrictions regarding language or date of publication. SELECTION CRITERIA Parallel group and split-mouth randomised and quasi-randomised controlled trials comparing stepwise, partial or no dentinal caries removal with complete caries removal, in unrestored primary and permanent teeth were included. DATA COLLECTION AND ANALYSIS Three review authors extracted data independently and in triplicate and assessed risk of bias. Trial authors were contacted where possible for information. We used standard methodological procedures exacted by The Cochrane Collaboration. MAIN RESULTS In this updated review, four new trials were included bringing the total to eight trials with 934 participants and 1372 teeth. There were three comparisons: stepwise caries removal compared to complete one stage caries removal (four trials); partial caries removal compared to complete caries removal (three trials) and no dentinal caries removal compared to complete caries removal (two trials). (One three-arm trial compared complete caries removal to both stepwise and partial caries removal.) Four studies investigated primary teeth, three permanent teeth and one included both. All of the trials were assessed at high risk of bias, although the new trials showed evidence of attempts to minimise bias.Stepwise caries removal resulted in a 56% reduction in incidence of pulp exposure (risk ratio (RR) 0.44, 95% confidence interval (CI) 0.33 to 0.60, P < 0.00001, I2 = 0%) compared to complete caries removal based on moderate quality evidence, with no heterogeneity. In these four studies, the mean incidence of pulp exposure was 34.7% in the complete caries removal group and 15.4% in the stepwise groups. There was also moderate quality evidence of no difference in the outcome of signs and symptoms of pulp disease (RR 0.78, 95% CI 0.39 to 1.58, P = 0.50, I2 = 0%).Partial caries removal reduced incidence of pulp exposure by 77% compared to complete caries removal (RR 0.23, 95% CI 0.08 to 0.69, P = 0.009, I2 = 0%), also based on moderate quality evidence with no evidence of heterogeneity. In these two studies the mean incidence of pulp exposure was 21.9% in the complete caries removal groups and 5% in the partial caries removal groups. There was insufficient evidence to determine whether or not there was a difference in signs and symptoms of pulp disease (RR 0.27, 95% CI 0.05 to 1.60, P = 0.15, I2 = 0%, low quality evidence), or restoration failure (one study showing no difference and another study showing no failures in either group, very low quality evidence).No dentinal caries removal was compared to complete caries removal in two very different studies. There was some moderate evidence of no difference between these techniques for the outcome of signs and symptoms of pulp disease and reduced risk of restoration failure favouring no dentinal caries removal, from one study, and no instances of pulp disease or restoration failure in either group from a second quasi-randomised study. Meta-analysis of these two studies was not performed due to substantial clinical differences between the studies. AUTHORS' CONCLUSIONS Stepwise and partial excavation reduced the incidence of pulp exposure in symptomless, vital, carious primary as well as permanent teeth. Therefore these techniques show clinical advantage over complete caries removal in the management of dentinal caries. There was no evidence of a difference in signs or symptoms of pulpal disease between stepwise excavation, and complete caries removal, and insufficient evidence to determine whether or not there was a difference in signs and symptoms of pulp disease between partial caries removal and complete caries removal. When partial caries removal was carried out there was also insufficient evidence to determine whether or not there is a difference in risk of restoration failure. The no dentinal caries removal studies investigating permanent teeth had a similar result with no difference in restoration failure. The other no dentinal caries removal study, which investigated primary teeth, showed a statistically significant difference in restoration failure favouring the intervention.Due to the short term follow-up in most of the included studies and the high risk of bias, further high quality, long term clinical trials are still required to assess the most effective intervention. However, it should be noted that in studies of this nature, complete elimination of risk of bias may not necessarily be possible. Future research should also investigate patient centred outcomes.
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Affiliation(s)
- David Ricketts
- Dundee Dental School, University of DundeePark PlaceDundeeTaysideUKDD1 4HN
| | - Thomas Lamont
- University of Dundee, Dental School & HospitalPark PlaceDundeeTaysideUKDD1 4HN
| | - Nicola PT Innes
- Dundee Dental School, University of DundeePark PlaceDundeeTaysideUKDD1 4HN
| | - Edwina Kidd
- King's College London Dental InstituteDepartment of Conservative DentistryLondonUKSE1 9RT
| | - Janet E Clarkson
- Dundee Dental School, University of DundeeDivision of Oral Health SciencesPark PlaceDundeeScotlandUKDD1 4HR
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Martignon S, Cortes A, Gómez SI, Castiblanco GA, Baquero X, Franco-Triviño AM, Palacio-Benavides JC, Gamboa LF, Villena RS. How Long does it Take to Examine Young Children with the Caries ICDAS System and how do they Respond? Braz Dent J 2019; 29:374-380. [PMID: 30462764 DOI: 10.1590/0103-6440201801949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/02/2018] [Indexed: 01/13/2023] Open
Abstract
A caries-epidemiological study using the ICDASepi-merged system was conducted in Colombian young children. This study aimed at associating the time needed for the clinical examination of caries and caries risk in 1 to 5-year-old children according to age and caries risk, and to assess behavior and child pain self-perception during examination according to age. After IRB approval and given parents/caregivers' informed consent, seven trained examiners assessed 1 to 5-year olds in kindergartens under local field conditions. ICDASepi-merged caries experience (depiMEmf) was assessed as follows: Initial-depi (ICDAS 1/2 without air-drying); Moderate-dM (ICDAS 3,4); Extensive-dE (ICDAS 5,6) lesions; due-to-caries fillings-f and missing-m surfaces/teeth. Caries risk was assessed with Cariogram®. Child's behavior (Frankl-Behavior-Rating-Scale) and self-perceived pain (Visual-Analogue-Scale-of-Faces) during examination were evaluated. Clinical examination time was recorded with a stopwatch. A total of 592 children participated (1-yr.: n=31; 2-yrs.: n=96; 3-yrs.: n=155; 4-yrs.: n=209, 5-yrs.: n=101). The depiMEmfs prevalence was of 79.9% and the mean 8.4±10.4. Most were high-caries-risk children (68.9%). The majority (58.9%) showed ≥ positive-behavior and ≤ light-pain self-perception (88.4%). Mean clinical examination time was around 3.5 minutes (216.9±133.9 seconds). For 5-yr. olds it corresponded to 4 minutes (240.4±145.0 seconds) vs. 2 minutes (122.8±80.1 seconds) for 1-yr. olds (Kruskal-Wallis; p=0.00). For high- and low-caries risk children it was around 4.3 minutes (255.7±118.5 seconds) and 3.3 minutes (201.3±129.4 seconds), respectively (ANOVA; p=0.01). This study demonstrates using the ICDAS system in young children is feasible, taking less than 4 minutes for the clinical examination without children behavior/pain self-perception issues.
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Affiliation(s)
- Stefania Martignon
- UNICA - Caries Research Unit, Research Vice-rectory, El Bosque University, Bogotá, Colombia.,Dental Innovation and Translation Centre, King's College Dental Institute, London, UK
| | - Andrea Cortes
- UNICA - Caries Research Unit, Research Vice-rectory, El Bosque University, Bogotá, Colombia
| | - Soledad Isabel Gómez
- CIO - Centro de Investigaciones Odontológicas, Javeriana University, Bogotá, Colombia
| | | | - Ximena Baquero
- Dental Faculty, Javeriana University, Bogotá, Colombia.,Paediatric Dentistry Specialization Program, Dental Faculty, El Bosque University, Bogotá, Colombia
| | | | | | - Luis Fernando Gamboa
- UNICA - Caries Research Unit, Research Vice-rectory, El Bosque University, Bogotá, Colombia
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24
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Urquhart O, Tampi MP, Pilcher L, Slayton RL, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Brignardello-Petersen R, Banfield L, Parikh A, Joshi G, Carrasco-Labra A. Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. J Dent Res 2018; 98:14-26. [PMID: 30290130 PMCID: PMC6304695 DOI: 10.1177/0022034518800014] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The goal of nonrestorative or non- and microinvasive caries treatment (fluoride-
and nonfluoride-based interventions) is to manage the caries disease process at
a lesion level and minimize the loss of sound tooth structure. The purpose of
this systematic review and network meta-analysis was to summarize the available
evidence on nonrestorative treatments for the outcomes of 1) arrest or reversal
of noncavitated and cavitated carious lesions on primary and permanent teeth and
2) adverse events. We included parallel and split-mouth randomized controlled
trials where patients were followed for any length of time. Studies were
identified with MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane
Database of Systematic Reviews. Pairs of reviewers independently conducted the
selection of studies, data extraction, risk-of-bias assessments, and assessment
of the certainty in the evidence with the Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) approach. Data were synthesized with a
random effects model and a frequentist approach. Forty-four trials (48 reports)
were eligible, which included 7,378 participants and assessed the effect of 22
interventions in arresting or reversing noncavitated or cavitated carious
lesions. Four network meta-analyses suggested that sealants + 5% sodium fluoride
(NaF) varnish, resin infiltration + 5% NaF varnish, and 5,000-ppm F (1.1% NaF)
toothpaste or gel were the most effective for arresting or reversing
noncavitated occlusal, approximal, and noncavitated and cavitated root carious
lesions on primary and/or permanent teeth, respectively (low- to
moderate-certainty evidence). Study-level data indicated that 5% NaF varnish was
the most effective for arresting or reversing noncavitated facial/lingual
carious lesions (low certainty) and that 38% silver diamine fluoride solution
applied biannually was the most effective for arresting advanced cavitated
carious lesions on any coronal surface (moderate to high certainty). Preventing
the onset of caries is the ultimate goal of a caries management plan. However,
if the disease is present, there is a variety of effective interventions to
treat carious lesions nonrestoratively.
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Affiliation(s)
- O Urquhart
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - M P Tampi
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - L Pilcher
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - R L Slayton
- 2 Department of Pediatric Dentistry, School of Dentistry, University of Washington, Seattle, WA, USA
| | - M W B Araujo
- 3 Science Institute, American Dental Association, Chicago, IL, USA
| | - M Fontana
- 4 Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - S Guzmán-Armstrong
- 5 Advance Education Program in Operative Dentistry, University of Iowa, Iowa City, IA, USA
| | - M M Nascimento
- 6 Division of Operative Dentistry, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - B B Nový
- 7 DentaQuest Institute and DentaQuest Oral Health Center, Westborough, MA, USA
| | - N Tinanoff
- 8 Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Maryland, College Park, MD, USA
| | - R J Weyant
- 9 Department of Dental Public Health and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M S Wolff
- 10 University of Pennsylvania, Philadelphia, PA, USA
| | - D A Young
- 11 Department of Diagnostic Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific, Stockton, CA, USA
| | - D T Zero
- 12 Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry Indiana University, Indianapolis, IN, USA
| | - R Brignardello-Petersen
- 13 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - L Banfield
- 14 Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - A Parikh
- 15 College of Dental Medicine, Midwestern University, Downers Grove, IL, USA
| | - G Joshi
- 16 GC America, Alsip, IL, USA
| | - A Carrasco-Labra
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA.,17 Evidence-Based Dentistry Unit and Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Santiago, Chile
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25
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Arslan S, Lipski L, Dubbs K, Elmali F, Ozer F. Effects of different resin sealing therapies on nanoleakage within artificial non-cavitated enamel lesions. Dent Mater J 2018; 37:981-987. [PMID: 30298854 DOI: 10.4012/dmj.2017-027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was to evaluate nanoleakage within the different lesion-sealing therapies applied to artificial non-cavitated enamel lesions. Thirty-two human anterior teeth were used. Artificial subsurface enamel lesions were produced on the labial surfaces of teeth. The specimens were then randomly divided into three groups (n=10): Group I- Clinpro Sealant application; Group II- ExciTE F adhesive resin application; and Group III- ICON resin infiltrant application. Each group was further divided into two subgroups: control and thermocycler. Nanoleakage was calculated by the digital image analysis software. In the control and thermocycled groups, there was no statistically significant difference between the Groups I, II, and III (p>0.05). The only significant leakage scores were obtained between the Group III control and thermocycler groups (p=0.027). ICON infiltrant can be used as an alternative to dental adhesives and fissure sealants in the sealing of initial non-cavitated enamel lesions. But the resin may become more affected by the water sorption than other resin materials over time. More studies are needed to evaluate long-term durability of resin infiltrants.
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Affiliation(s)
- Soley Arslan
- Department of Restorative Dentistry, Faculty of Dentistry, Erciyes University
| | - Linda Lipski
- Department of Materials Science and Engineering, Faculty of Engineering, University of Pennsylvania
| | - Keegan Dubbs
- Department of Materials Science and Engineering, Faculty of Engineering, University of Pennsylvania
| | - Ferhan Elmali
- Department of Biostatistics, Faculty of Medicine, Erciyes University
| | - Fusun Ozer
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania
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26
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Cartagena A, Bakhshandeh A, Ekstrand KR. Approximal sealings on lesions in neighbouring teeth requiring operative treatment: an in vitro study. Acta Odontol Scand 2018; 76:459-465. [PMID: 29415607 DOI: 10.1080/00016357.2018.1436191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES With this in vitro study we aimed to assess the possibility of precise application of sealant on accessible artificial white spot lesions (WSL) on approximal surfaces next to a tooth surface under operative treatment. A secondary aim was to evaluate whether the use of magnifying glasses improved the application precision. MATERIAL AND METHODS Fifty-six extracted premolars were selected, approximal WSL lesions were created with 15% HCl gel and standardized photographs were taken. The premolars were mounted in plaster-models in contact with a neighbouring molar with Class II/I-II restoration (Sample 1) or approximal, cavitated dentin lesion (Sample 2). The restorations or the lesion were removed, and Clinpro Sealant was placed over the WSL. Magnifying glasses were used when sealing half the study material. The sealed premolar was removed from the plaster-model and photographed. Adobe Photoshop was used to measure the size of WSL and sealed area. The degree of match between the areas was determined in Photoshop. RESULTS Interclass agreement for WSL, sealed, and matched areas were found as excellent (κ = 0.98-0.99). The sealant covered 48-100% of the WSL-area (median = 93%) in Sample 1 and 68-100% of the WSL-area (median = 95%) in Sample 2. No statistical differences were observed concerning uncovered proportions of the WSL-area between groups with and without using magnifying glasses (p values ≥ .19). However, overextended sealed areas were more pronounced when magnification was used (p = .01). The precision did not differ between the samples (p = .31). CONCLUSIONS It was possible to seal accessible approximal lesions with high precision. Use of magnifying glasses did not improve the precision.
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Affiliation(s)
- Alvaro Cartagena
- Unit of Pulpal Biology and Endodontics, Finis Terrae University, Santiago, Chile
- Department of Odontology, Section of Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark
| | - Azam Bakhshandeh
- Department of Odontology, Section of Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark
| | - Kim Rud Ekstrand
- Department of Odontology, Section of Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark
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27
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Chatzimarkou S, Koletsi D, Kavvadia K. The effect of resin infiltration on proximal caries lesions in primary and permanent teeth. A systematic review and meta-analysis of clinical trials. J Dent 2018; 77:8-17. [DOI: 10.1016/j.jdent.2018.08.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022] Open
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28
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Liang Y, Deng Z, Dai X, Tian J, Zhao W. Micro-invasive interventions for managing non-cavitated proximal caries of different depths: a systematic review and meta-analysis. Clin Oral Investig 2018; 22:2675-2684. [PMID: 30238416 DOI: 10.1007/s00784-018-2605-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to further evaluate the caries-arresting effectiveness of micro-invasive interventions for non-cavitated proximal caries and analyze their efficacy for caries lesions of different depths. MATERIALS AND METHODS Randomized clinical trials (RCTs) of micro-invasive interventions for non-cavitated proximal caries were included in this study. We searched the Cochrane Library, PubMed, Embase, and Web of Science on May 25, 2017, without restrictions. After duplicate study selection, data extraction, and risk of bias assessment, a meta-analysis of the odds ratios (OR) with 95% confidence intervals (95% CIs) and a publication bias analysis were conducted using Stata 12.0. RESULTS After 2195 citations were screened, 8 citations of seven studies with follow-up periods from 12 to 36 months were included. The subgroup analysis showed that resin infiltration and resin sealant, but not glass ionomer cement (GIC), could reduce the caries progression rate (resin infiltration: OR = 0.15, 95% CI 0.09 to 0.24; resin sealant: OR = 0.33, 95% CI 0.19 to 0.58; GIC: OR = 0.13, 95% CI 0.01 to 2.65). Further analysis of their efficacies for caries lesions of different depths indicated that resin infiltration could arrest progression of enamel caries and caries around the enamel-dentin junction (EDJ) (enamel: OR = 0.05, 95% CI 0.01 to 0.35; EDJ: OR = 0.07, 95% CI 0.01 to 0.70). However, when the outer third of the dentin was involved, resin infiltration yielded significantly different results compared with the control group (OR = 0.42, 95% CI 0.16 to 1.10). Resin sealant seemed to be ineffective regardless of the caries depth (enamel: OR = 0.62, 95% CI 0.13 to 3.00; EDJ: OR = 0.44, 95% CI 0.09 to 2.15; dentin: OR = 0.43, 95% CI 0.07 to 2.63). CONCLUSIONS Resin infiltration is effective in arresting the progression of non-cavitated proximal caries involved in EDJ, while the therapeutic effects of resin sealant for different caries depths still needs to be further confirmed. CLINICAL RELEVANCE Based on existing evidence, dentists should carefully select appropriate micro-invasive interventions according to the different depths of non-cavitated proximal caries.
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Affiliation(s)
- Yuee Liang
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zilong Deng
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xingzhu Dai
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Wanghong Zhao
- Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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29
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Peters MC, Hopkins AR, Yu Q. Resin infiltration: An effective adjunct strategy for managing high caries risk-A within-person randomized controlled clinical trial. J Dent 2018; 79:24-30. [PMID: 30227152 DOI: 10.1016/j.jdent.2018.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/07/2018] [Accepted: 09/13/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Micro-invasive resin-infiltration has shown to inhibit lesion progression of proximal non-cavitated carious lesions, suggesting an alternative to early operative treatment. This split-mouth, randomized placebo-controlled clinical trial evaluated the effects of proximal lesion infiltration supplementary to standard-of-care management in high caries risk (HCR)-patients. METHODS Forty-two HCR-subjects with two similar interproximal posterior lesions received professional HCR-regimen including repeated F-varnish applications. Two affected E2/D1-surfaces were randomized and concurrently treated by resin-infiltration or mock-infiltration (control). Individually standardized digital radiographs provided visual determination of lesion-size distribution at baseline and 2-year follow-up. Data were analyzed by logistic regression and McNemar's test. RESULTS Thirty-two lesion pairs (76%) were evaluated after 2 years. Categorical lesion depths were not different between groups (P > .5). Comparative pairwise assessment (image sets BL-2 yr) showed significantly more progression in control (7) versus infiltration (1) lesions (P = .035). Cumulative prevented fraction after two years was 97% for infiltrated lesions versus 74% for control lesions. CONCLUSIONS Two-year follow-up showed resin infiltration to be a highly efficacious (RRR: 86-89%) therapy. Long-term follow-up is needed to strengthen the evidence for efficacy of resin-infiltration as an adjunct to standard-of-care HCR-regimen including F-varnish. CLINICAL SIGNIFICANCE Showing 24% more stabilized lesions, the resin-infiltrated group performed significantly better than their controls, confirming successful early lesion management. Adjunct resin-infiltration provided an effective micro-invasive approach to inhibit short-term lesion progression.
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Affiliation(s)
- Mathilde C Peters
- School of Dentistry, University of Michigan, Ann Arbor, MI, USA & Clinical Professor, School of Dentistry, Louisiana State University Health Science Center, New Orleans, LA, USA.
| | - Aubrey R Hopkins
- Operative and Comprehensive Dentistry, USADC West Point, NY & Comprehensive Dentistry, DC, USA
| | - Qingzhao Yu
- Biostatistics Program, Louisiana State University, New Orleans, LA, USA
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30
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Efficacy of resin infiltration of proximal caries in primary molars: 1-year follow-up of a split-mouth randomized controlled clinical trial. Clin Oral Investig 2017; 22:1355-1362. [PMID: 28990122 DOI: 10.1007/s00784-017-2227-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The main purpose of this split month, randomized, controlled clinical trial was evaluate the efficacy of caries infiltration in controlling the progression of non-cavitated proximal lesions in primary molars. Anxiety and time required for the caries infiltration was also evaluated. MATERIALS AND METHODS Fifty healthy children, 5 to 9 years, presenting two primary molars with proximal caries lesions (1/2 of the enamel or outer 1/3 of dentin), were included. Lesions were randomly allocated to the test group (fluoridated toothpaste + flossing + infiltration) or to the control group (fluoridated toothpaste + flossing). Caries risk was based on the Cariogram model. The main outcome after 1-year radiographic follow up was assessed by an independent blinded examiner A facial image scale (FIS) was applied to assess dental anxiety and time required to perform the infiltration was recorded. RESULTS Of the sample, 92.9% corresponded to high or medium caries risk. In 42 patients (1-year follow up), caries progression was observed in 11.9% (5/42) of the test lesions compared with 33.3% (14/42) of the control lesions (p < 0.05). Five control and three test lesions progressed to the middle 1/3 of dentin and were restored. No side effects were observed. Anxiety was both low before and after the treatment, and mean time required for the infiltration was 11.29 min (± 1.16 min). CONCLUSIONS Caries infiltration of proximal caries lesions in primary molars is significantly more efficacious than standard therapy alone (fluoride toothpaste + flossing). CLINICAL RELEVANCE Caries infiltration is an applicable and well-accepted method be used in children, representing a promising micro-invasive approach.
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31
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Schlee M, Schad T, Koch JH, Cattin PC, Rathe F. Clinical performance of self‐assembling peptide P
11
‐4 in the treatment of initial proximal carious lesions: A practice‐based case series. ACTA ACUST UNITED AC 2017; 9. [DOI: 10.1111/jicd.12286] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 06/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Markus Schlee
- 32 Schöne Zähne Forchheim Germany
- Department of Maxillofacial SurgeryGoethe University Frankfurt Germany
| | - Till Schad
- 32 Schöne Zähne Forchheim Germany
- Department of Maxillofacial SurgeryGoethe University Frankfurt Germany
| | - Jan H. Koch
- Dental Text and Consultancy Services Freising Germany
| | | | - Florian Rathe
- 32 Schöne Zähne Forchheim Germany
- Department of Maxillofacial SurgeryGoethe University Frankfurt Germany
- Department of Prosthodontics and BiomaterialsDanube Private University Krems Austria
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32
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Arthur RA, Zenkner JE, d’Ornellas Pereira Júnior JC, Correia RT, Alves LS, Maltz M. Proximal carious lesions infiltration—a 3-year follow-up study of a randomized controlled clinical trial. Clin Oral Investig 2017; 22:469-474. [DOI: 10.1007/s00784-017-2135-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/22/2017] [Indexed: 12/01/2022]
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33
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Martignon S, Zarta OL. The Use of Adhesive Systems Under Fissure Sealants Improves Their Retention, With Etch-and-Rinse Performing Better Than Self-Etching Adhesive Systems. J Evid Based Dent Pract 2017; 17:56-58. [DOI: 10.1016/j.jebdp.2017.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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34
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Influence of bioactive particles on the chemical-mechanical properties of experimental enamel resin infiltrants. Clin Oral Investig 2016; 21:2143-2151. [DOI: 10.1007/s00784-016-2005-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/01/2016] [Indexed: 10/20/2022]
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Abstract
SUMMARY
The decrease in caries prevalence in many industrialized countries and the improved knowledge about the etiology and pathogenesis of caries have shifted the focus of caries therapy over the past decades toward less invasive approaches. Studies on caries progression indicate that it is generally quite slow in most patients today which should lead to a reconsideration of the practice of early invasive intervention. Today noninvasive (eg, fluorides) and microinvasive (occlusal sealing, proximal infiltration) therapeutic options that address etiological factors are gaining importance. The goal of these therapies is to heal or at least to slow down the progress of the disease. Noninvasive treatments are mainly related to controlling pathogenic factors (ie, sugar consumption) and enhancing protective factors (mainly oral hygiene and fluorides). Microinvasive treatments do not rely on the compliance of the patient as much, since these treatments include a resinous material that is applied to serve as a diffusion barrier for acids formed by cariogenic bacteria in the overlying plaque. To establish a minimum intervention treatment strategy for caries, the disease must be diagnosed at an early stage. In addition to assessing caries lesions in single teeth, individual risk factors need to be identified so that the underlying causes related to patients' behavioral patterns that led to the disease can be addressed as well. The patient should be informed about the scientific evidence related to the treatment choices in a participative atmosphere. Decision trees may help to make the range of findings comprehensible and the therapeutic shared decision-making process understandable to the patients.
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Affiliation(s)
- H Meyer-Lueckel
- Hendrik Meyer-Lueckel, professor, RWTH Aachen University, Department of Operative Dentistry, Periodontology and Preventive Dentistry, Aachen, Germany
| | - S Paris
- Sebastian Paris, professor, Charité – Universitätsmedizin Berlin, Department of Operative and Preventive Dentistry, Berlin, Germany
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Dorri M, Dunne SM, Walsh T, Schwendicke F. Micro-invasive interventions for managing proximal dental decay in primary and permanent teeth. Cochrane Database Syst Rev 2015; 2015:CD010431. [PMID: 26545080 PMCID: PMC8504982 DOI: 10.1002/14651858.cd010431.pub2] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Proximal dental lesions, limited to dentine, are traditionally treated by invasive (drill and fill) means. Non-invasive alternatives (e.g. fluoride varnish, flossing) might avoid substance loss but their effectiveness depends on patients' adherence. Recently, micro-invasive approaches for treating proximal caries lesions have been tried. These interventions install a barrier either on top (sealing) or within (infiltrating) the lesion. Different methods and materials are currently available for micro-invasive treatments, such as sealing via resin sealants, (polyurethane) patches/tapes, glass ionomer cements (GIC) or resin infiltration. OBJECTIVES To evaluate the effects of micro-invasive treatments for managing proximal caries lesions in primary and permanent dentition in children and adults. SEARCH METHODS We searched the following databases to 31 December 2014: the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, EMBASE via OVID, LILACs via BIREME Virtual Health Library, Web of Science Conference Proceedings, ZETOC Conference Proceedings, Proquest Dissertations and Theses, ClinicalTrials.gov, OpenGrey and the World Health Organization (WHO) International Clinical Trials Registry Platform. We searched the metaRegister of Controlled Trials to 1 October 2014. There were no language or date restrictions in the searches of the electronic databases. SELECTION CRITERIA We included randomised controlled trials of at least six months' duration that compared micro-invasive treatments for managing non-cavitated proximal dental decay in primary teeth, permanent teeth or both, versus non-invasive measures, invasive means, no intervention or placebo. We also included studies that compared different types of micro-invasive treatments. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results, extracted data and assessed the risk of bias. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. We conducted meta-analyses with the random-effects model, using the Becker-Balagtas method to calculate the odds ratio (OR) for lesion progression. We assessed the quality of the evidence using GRADE methods. MAIN RESULTS We included eight trials, which randomised 365 participants. The trials all used a split-mouth design, some with more than one pair of lesions treated within the same participant. Studies took place in university or dental public health clinics in Brazil, Colombia, Denmark, Germany, Thailand, Greenland and Chile. Six studies evaluated the effects of micro-invasive treatments in the permanent dentition and two studies on the primary dentition, with caries risk ranging from low to high. Investigators measured caries risk in different studies either by caries experience alone or by using the Cariogram programme, which combines eight contributing factors, including caries experience, diet, saliva and other factors related to caries. The follow-up period in the trials ranged from one to three years. All studies used lesion progression as the primary outcome, evaluating it by different methods of reading radiographs. Four studies received industry support to carry out the research, with one of them being carried out by inventors of the intervention.We judged seven studies to be at high overall risk of bias, primarily due to lack of blinding of participants and personnel. We evaluated intervention effects for all micro-invasive therapies and analysed subgroups according to the different treatment methods reported in the included studies.Our meta-analysis, which pooled the most sensitive set of data (in terms of measurement method) from studies presenting data in a format suitable for meta-analysis, showed that micro-invasive treatment significantly reduced the odds of lesion progression compared with non-invasive treatment (e.g fluoride varnish) or oral hygiene advice (e.g to floss) (OR 0.24, 95% CI 0.14 to 0.41; 602 lesions; seven studies; I(2) = 32%). There was no evidence of subgroup differences (P = 0.36).The four studies that measured adverse events reported no adverse events after micro-invasive treatment. Most studies did not report on any further outcomes.We assessed the quality of evidence for micro-invasive treatments as moderate. It remains unclear which micro-invasive treatment is more advantageous, or if certain clinical conditions or patient characteristics are better suited for micro-invasive treatments than others. AUTHORS' CONCLUSIONS The available evidence shows that micro-invasive treatment of proximal caries lesions arrests non-cavitated enamel and initial dentinal lesions (limited to outer third of dentine, based on radiograph) and is significantly more effective than non-invasive professional treatment (e.g. fluoride varnish) or advice (e.g. to floss). We can be moderately confident that further research is unlikely to substantially change the estimate of effect. Due to the small number of studies, it does remain unclear which micro-invasive technique offers the greatest benefit, or whether the effects of micro-invasive treatment confer greater or lesser benefit according to different clinical or patient considerations.
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Affiliation(s)
- Mojtaba Dorri
- Bristol Oral and Dental SchoolDepartment of Restorative DentistryLower Maudlin StreetBristolUKBS1 2LY
| | - Stephen M Dunne
- Kings College London Dental InstitutePrimary Dental CareDenmark Hill CampusCaldecot RoadLondonUKSE5 9RW
| | - Tanya Walsh
- School of Dentistry, The University of ManchesterJR Moore BuildingOxford RoadManchesterUKM13 9PL
| | - Falk Schwendicke
- Charité ‐ Universitätsmedizin BerlinDepartment of Operative and Preventive DentistryCampus Benjamin FranklinAßmannshauser Str 4‐6BerlinGermany14197
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Wright MN, Ziegler A. Multiple censored data in dentistry: A new statistical model for analyzing lesion size in randomized controlled trials. Biom J 2015; 57:384-94. [DOI: 10.1002/bimj.201400118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/17/2014] [Accepted: 01/12/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Marvin N. Wright
- Institut für Medizinische Biometrie und Statistik; Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein; Campus Lübeck, Ratzeburger Allee 160 23562 Lübeck Germany
| | - Andreas Ziegler
- Institut für Medizinische Biometrie und Statistik; Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein; Campus Lübeck, Ratzeburger Allee 160 23562 Lübeck Germany
- Zentrum für Klinische Studien; Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein; Campus Lübeck Lübeck Germany
- School of Mathematics; Statistics and Computer Science, University of KwaZulu-Natal; Pietermaritzburg South Africa
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Ismail AI, Tellez M, Pitts NB, Ekstrand KR, Ricketts D, Longbottom C, Eggertsson H, Deery C, Fisher J, Young DA, Featherstone JDB, Evans W, Zeller GG, Zero D, Martignon S, Fontana M, Zandona A. Caries management pathways preserve dental tissues and promote oral health. Community Dent Oral Epidemiol 2015; 41:e12-40. [PMID: 24916676 DOI: 10.1111/cdoe.12024] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In May 2012, cariologists, dentists, representatives of dental organizations, manufacturers, and third party payers from several countries, met in Philadelphia, Pennsylvania, to define a common mission; goals and strategic approaches for caries management in the 21th century. The workshop started with an address by Mr. Stanley Bergman, CEO of Henry Schein Inc. which focused on the imperative for change in academia, clinical practice, and public health. For decades, new scientific evidence on caries and how it should be managed have been discussed among experts in the field. However, there has been some limited change, except in some Scandinavian countries, in the models of caries management and reimbursement which have been heavily skewed toward 'drilling and filling'. There is no overall agreement on a caries' case definition or on when to surgically intervene. The participants in the workshop defined a new mission for all caries management approaches, both conventional and new. The mission of each system should be to preserve the tooth structure, and restore only when necessary. This mission marks a pivotal line for judging when to surgically intervene and when to arrest or remineralize early noncavitated lesions. Even when restorative care is necessary, the removal of hard tissues should be lesion-focused and aim to preserve, as much as possible, sound tooth structure. Continuing management of the etiological factors of caries and the use of science-based preventive regimens also will be required to prevent recurrence and re-restoration. These changes have been debated for over a decade. The Caries Management Pathways includes all systems and philosophies, conventional and new, of caries management that can be used or modified to achieve the new mission. The choice of which system to use to achieve the mission of caries management is left to the users and should be based on the science supporting each approach or philosophy, experience, utility, and ease of use. This document also presents a new 'Caries Management Cycle' that should be followed regardless of which approach is adopted for caries prevention, detection, diagnosis, and treatment. To aid success in the adoption of the new mission, a new reimbursement system that third party payers may utilize is proposed (for use by countries other than Scandinavian countries or other countries where such systems already exist). The new reimbursement/incentive model focuses on the mission of preservation of tooth structure and outcomes of caries management. Also described, is a research agenda to revitalize research on the most important and prevalent world-wide human disease. The alliance of major dental organizations and experts that started in Philadelphia will hopefully propel over the next months and years, a change in how caries is managed by dentists all over the world. A new mission has been defined and it is time for all oral health professionals to focus on the promotion of oral health and preservation of sound teeth rather than counting the number of surgical restorative procedures provided.
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Affiliation(s)
- Amid I Ismail
- Korenberg School of Dentistry, Temple University, Philadelphia, PA, USA
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Doméjean S, Ducamp R, Léger S, Holmgren C. Resin infiltration of non-cavitated caries lesions: a systematic review. Med Princ Pract 2015; 24:216-21. [PMID: 25661012 PMCID: PMC5588225 DOI: 10.1159/000371709] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/21/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The aim of this systematic review was to evaluate the in vivo scientific evidence of the ability of resin infiltration (RI) to arrest non-cavitated caries lesions. MATERIALS AND METHODS The PubMed database was searched for randomized controlled trials that evaluated the in vivo effect of RI versus placebo or other preventive treatment on the progression of caries lesions. The keywords used were 'resin infiltration, dental caries', 'resin infiltration, carious lesions', 'resin infiltration, caries lesions', 'caries infiltration' and 'Icon DMG' with the 'clinical trial' filter activated. Among the 14 articles originally identified with these keywords, only 4 (related to 3 different in vivo studies) were included for this review. RESULTS All 4 articles reported on proximal caries lesions. One study had been conducted on 48 high-caries-risk children while the other 3 (n = 22, 22 and 39, respectively) concerned moderate- and low-caries-risk adolescents and adults. The quality of the studies was assessed to be high with respect to randomization, split-mouth design and blinding. All the included studies showed significant differences in caries progression between test and control/placebo groups, indicating that RI may inhibit the carious process. CONCLUSION This systematic review revealed that RI appeared to be an effective method to arrest the progression of non-cavitated caries lesions. Additional, long-term studies are required.
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Affiliation(s)
- Sophie Doméjean
- Centre de Recherche en Odontologie Clinique EA 4847, Montrouge, France
- Service d'Odontologie, CHU Clermont-Ferrand, Montrouge, France
- UFR d'Odontologie, Université de Clermont 1, Clermont-Ferrand, Montrouge, France
- *Prof. Sophie Doméjean, UFR d'Odontologie, Université de Clermont 1, 2 rue de Braga, FR-63100 Clermont-Ferrand (France), E-Mail
| | - Raphaël Ducamp
- Centre de Recherche en Odontologie Clinique EA 4847, Montrouge, France
- Service d'Odontologie, CHU Clermont-Ferrand, Montrouge, France
- UFR d'Odontologie, Université de Clermont 1, Clermont-Ferrand, Montrouge, France
| | - Stéphanie Léger
- Département de Mathématiques, University Blaise Pascal, Aubière, France
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Tridimensional surface roughness analysis after resin infiltration of (deproteinized) natural subsurface carious lesions. Clin Oral Investig 2014; 19:1473-83. [PMID: 25483122 DOI: 10.1007/s00784-014-1372-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate ex vivo the effects of resin infiltration on the areal surface roughness of natural non-cavitated proximal subsurface lesions with or without previous deproteinization and to determine differences between E2 and D1 lesions or between premolars and molars. MATERIALS AND METHODS Forty premolars and 40 molars with proximal carious lesions and macroscopically intact surfaces (International Caries Detection and Assessment System (ICDAS) II; code 2) were radiologically assessed and randomly allocated to four groups (with 20 E2 and 20 D1 lesions, respectively). In each group, 10 lesions were deproteinized (NaOCl; 1%) before etching (HCl; 15%) and resin infiltration (Icon). Areal surface roughness (Sa) at the most demineralized lesion part (DIAGNOdent) was evaluated topometrically before and after deproteinization, after etching, and after infiltration using focus variation 3D scanning microscopy. RESULTS Pretreatment with NaOCl (n = 40) had no significant effects on Sa (p = 0.208), but resulted in significantly differing Sa values between premolars and molars after etching (p = 0.011). Regarding the effects between etching and baseline, significantly differing Sa values (p = 0.0498) were found for premolars and molars (n = 40/40); Sa after resin infiltration (compared to etching) differed significantly between premolars and molars (p = 0.009). No treatment regimen lead to differences among the radiological grades (E2 vs. D1; p > 0.106). CONCLUSIONS Resin infiltration showed only minor effects on Sa values of etched subsurface lesions (p < 0.170) and did neither equal nor improve baseline surface roughness (p > 0.401) of the different tooth types. CLINICAL RELEVANCE Deproteinization should be recommended before etching and infiltration, even if surface roughness of infiltrated advanced (pre-)molar lesions will not be improved.
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Gelani R, Zandona AF, Lippert F, Kamocka MM, Eckert G. In Vitro Progression of Artificial White Spot Lesions Sealed With an Infiltrant Resin. Oper Dent 2014; 39:481-8. [DOI: 10.2341/13-202-l] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
This study assessed the ability of an infiltrant resin (Icon, DMG Chemisch-Pharmazeutische Fabrik GmbH, Hamburg, Germany) to prevent artificial lesion progression in vitro when used to impregnate white spot lesions and also assessed the effect of saliva contamination on resin infiltration. Enamel specimens (n=252) were prepared and covered with nail varnish, leaving a window of sound enamel. After demineralization (pH 5.0; four weeks), specimens were divided into six groups (n=42 per group): group 1, 2% fluoride gel (positive control); group 2, resin infiltrant; group 3, resin infiltrant + fluoride gel; group 4, no treatment (negative control); group 5, resin infiltrant application after saliva contamination; and group 6, resin infiltrant + fluoride gel after saliva contamination. Specimens from each group were cut perpendicular to the surface, and one-half of each specimen was exposed to a demineralizing solution for another four weeks. The other half was set aside as a record of initial lesion depth and was used later in the determination of lesion progression. Lesion progression and infiltrant penetration were measured using confocal laser scanning microscopy (CLSM) and transverse microradiography (TMR). For lesion depth, based on CLSM, groups 2 and 3 showed the least changes when submitted to demineralization challenge, followed by group 1, then groups 5 and 6, and finally group 4. There were no significant differences between groups 2 and 3 or groups 5 and 6 in their ability to inhibit further lesion progression (p<0.05). Based on TMR, groups 2 and 3 also showed the fewest changes when submitted to demineralization challenge, followed by group 5, then groups 1 and 6, and finally group 4. In terms of mineral loss as measured by TMR, all groups that contained fluoride (groups 1, 3, and 6) show less percentage change in mineral loss than the groups that did not contain fluoride (groups 2, 4, and 5). It can be concluded that infiltrant penetration into early enamel lesions inhibited further demineralization in vitro, especially in the presence of fluoride. Saliva contamination decreased the ability of the infiltrant to prevent further demineralization, but the presence of fluoride seemed to counteract this effect.
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Affiliation(s)
- R Gelani
- Rakhi Gelani, BDS, MSD Preventive Dentistry student, Indiana University School of Dentistry, Indianapolis IN, USA
| | - AF Zandona
- Andrea Ferreira Zandona, DDS, MSD, PhD, associate professor/director, MSD Preventive Dentistry, Department of Preventive and Community Dentistry, Indiana University School of Dentistry, Indianapolis IN, USA
| | - F Lippert
- Frank Lippert, MSc, PhD, assistant research professor/director, OHRI Remineralization Research Program, Department of Preventive and Community Dentistry, Indiana University School of Dentistry, Indianapolis IN, USA
| | - MM Kamocka
- Malgorzata Maria Kamocka, PhD, assistant research professor of medicine, Department of Medicine/Division of Nephrology, Research Institute, Indiana University School of Medicine, Indianapolis IN, USA
| | - G Eckert
- George Eckert, biostatistician supervisor, Department of Biostatistics, Indiana University School of Medicine, Indianapolis IN, USA
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Ammari MM, Soviero VM, da Silva Fidalgo TK, Lenzi M, Ferreira DMTP, Mattos CT, de Souza IPR, Maia LC. Is non-cavitated proximal lesion sealing an effective method for caries control in primary and permanent teeth? A systematic review and meta-analysis. J Dent 2014; 42:1217-27. [PMID: 25066832 DOI: 10.1016/j.jdent.2014.07.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to perform a systematic review and meta-analysis on the effectiveness of sealing non-cavitated proximal caries lesions in primary and permanent teeth. DATA Only controlled clinical trials and randomized controlled clinical trials that evaluated the effectiveness of sealing on non-cavitated proximal caries with a minimum follow-up of 12 months were included in the study. The primary outcome should be arrestment/progression of proximal caries evaluated by bitewing radiographs. A risk of bias evaluation based on the Cochrane Collaboration common scheme for bias was carried out for each study. The meta-analysis was performed on the studies considered low risk of bias and with pair-wise visual reading results through RevMan software. SOURCES A comprehensive search was performed in the Systematic Electronic Databases: Pubmed, Cochrane Library, Scopus, IBI Web of Science, Lilacs, SIGLE, and on website Clinical trials.gov, through until June 2013. STUDY SELECTION From 967 studies identified, 10 articles and 3 studies with partial results were assessed for eligibility. However three articles were excluded and our final sample included 10 studies. According to the risk of bias evaluation, six studies were considered "high" risk of bias, and four "low" risk of bias. The forest plot of the meta-analysis showed low heterogeneity (I(2)=29%) and a favourable outcome for the Infiltrant. The chance of caries progression when this technique was used was significantly lower (p=0.002) compared with Placebo. CONCLUSION Our results suggest that the technique of sealing non-cavitated proximal caries seems to be effective in controlling proximal caries in the short and medium term. Further long-term randomized clinical trials are still necessary to increase this evidence. CLINICAL SIGNIFICANCE Contemporary dentistry is focused in minimally invasive approaches that prevent the destruction of sound dental tissues next to carious lesions. This paper searches for evidence of the efficacy of sealing/infiltrating non-cavitated proximal caries in arresting caries progression both in permanent and primary teeth.
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Affiliation(s)
- Michelle Mikhael Ammari
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Specific Training, School of Dentistry, Universidade Federal Fluminense, Nova Friburgo, Brazil
| | - Vera Mendes Soviero
- Department of Preventive and Community Dentistry, School of Dentistry, Universidade do Estado do Rio de Janeiro, Brazil
| | - Tatiana Kelly da Silva Fidalgo
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michele Lenzi
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Cláudia Trindade Mattos
- Department of Dental Clinics, School of Dentistry, Universidade Federal Fluminense, Niterói, Brazil
| | - Ivete Pomarico Ribeiro de Souza
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Abstract
Zusammenfassung
Hintergrund
Karies hat bis heute eine hohe Prävalenz, auch in westlichen Ländern mit präventiven zahnmedizinischen Angeboten. Bei mechanischer Therapie werden die behandelten Zähne geschwächt. Dies führt über die Jahre oder Jahrzehnte häufig zum Verlust mit erheblichen Folgekosten. In den letzten Jahren eingeführte remineralisierende Substanzen sollen die etablierten remineralisationsfördernden Fluoride ergänzen. Daneben stehen die nicht oder minimal-invasiven Konzepte approximale Versiegelung und Kunststoffinfiltration zur Verfügung.
Methode
In diesem Beitrag wird mit der biomimetischen Mineralisation eine neue Methode vorstellt, die auf sich selbst organisierenden Peptiden (SAP) beruht. Die SAP werden in wässriger Lösung auf die gereinigte und geätzte Schmelzoberfläche aufgetragen und dringen in den Läsionskörper ein. Dort bauen sie eine organische Matrix auf, die sekundär mit Kalzium- und Phosphationen aus dem Speichel mineralisiert wird.
Ergebnis
Die Zwischenauswertung einer klinischen Studie bei Approximalläsionen zeigt, dass mit der neuen Methode drei von vier Läsionen stabilisiert oder remineralisiert werden konnten. Damit könnte es erstmals gelingen, demineralisierten Schmelz bis zum angrenzenden Dentin naturanalog wieder herzustellen.
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Shimada Y, Nakagawa H, Sadr A, Wada I, Nakajima M, Nikaido T, Otsuki M, Tagami J, Sumi Y. Noninvasive cross-sectional imaging of proximal caries using swept-source optical coherence tomography (SS-OCT) in vivo. JOURNAL OF BIOPHOTONICS 2014; 7:506-13. [PMID: 23450799 DOI: 10.1002/jbio.201200210] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 05/25/2023]
Abstract
The aim of this study was to determine the diagnostic accuracy of swept-source optical coherent tomography (SS-OCT) in detecting and estimating the depth of proximal caries in posterior teeth in vivo. SS-OCT images and bitewing radiographs were obtained from 86 proximal surfaces of 53 patients. Six examiners scored the locations according to a caries lesion depth scale (0-4) using SS-OCT and the radiographs. The results were compared with clinical observations obtained after the treatment. SS-OCT could detect the presence of proximal caries in tomograms that were synthesized based on the backscatter signal obtained from the proximal carious lesion through occlusal enamel. SS-OCT showed significantly higher sensitivity and larger area under the receiver operating characteristic curve than radiographs for the detection of cavitated enamel lesions and dentin caries (Student's t -test, p < 0.05). SS-OCT appears to be a more reliable and accurate method than bitewing radiographs for the detection and estimation of the depth of proximal lesions in the clinical environment.
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Affiliation(s)
- Yasushi Shimada
- Cariology and Operative Dentistry, Department of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
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Yazıcıoğlu O, Ulukapı H. The investigation of non-invasive techniques for treating early approximal carious lesions: an in vivo study. Int Dent J 2014; 64:1-11. [DOI: 10.1111/idj.12056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Schwendicke F, Meyer-Lueckel H, Stolpe M, Dörfer CE, Paris S. Costs and effectiveness of treatment alternatives for proximal caries lesions. PLoS One 2014; 9:e86992. [PMID: 24475208 PMCID: PMC3903601 DOI: 10.1371/journal.pone.0086992] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/17/2013] [Indexed: 11/18/2022] Open
Abstract
Objectives Invasive therapy of proximal caries lesions initiates a cascade of re-treatment cycles with increasing loss of dental hard tissue. Non- and micro-invasive treatment aim at delaying this cascade and may thus reduce both the health and economic burden of such lesions. This study compared the costs and effectiveness of alternative treatments of proximal caries lesions. Methods A Markov-process model was used to simulate the events following the treatment of a proximal posterior lesion (E2/D1) in a 20-year-old patient in Germany. We compared three interventions (non-invasive; micro-invasive using resin infiltration; invasive using composite restoration). We calculated the risk of complications of initial and possible follow-up treatments and modelled time-dependent non-linear transition probabilities. Costs were calculated based on item-fee catalogues in Germany. Monte-Carlo-microsimulations were performed to compare cost-effectiveness of non- versus micro-invasive treatment and to analyse lifetime costs of all three treatments. Results Micro-invasive treatment was both more costly and more effective than non-invasive therapy, with ceiling-value-thresholds for willingness-to-pay between 16.73 € for E2 and 1.57 € for D1 lesions. Invasive treatment was the most costly strategy. Calculated costs and effectiveness were sensitive to lesion stage, patient’s age, discounting rate and assumed initial treatment costs. Conclusions Non- and micro-invasive treatments have lower long-term costs than invasive therapy of proximal lesions. Micro-invasive therapy had the highest cost-effectiveness for treating D1 lesions in young patients. Decision makers with a willingness-to-pay over 16.73 € and 1.57 € for E2 and D1 lesions, respectively, will find micro-invasive treatment more cost-effective than non-invasive therapy.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Hendrik Meyer-Lueckel
- Department of Operative Dentistry, Periodontology and Preventive Dentistry, RWTH Aachen University, Aachen, Germany
| | | | - Christof Edmund Dörfer
- Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-University, Kiel, Germany
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Araújo GSA, Sfalcin RA, Araújo TGF, Alonso RCB, Puppin-Rontani RM. Evaluation of polymerization characteristics and penetration into enamel caries lesions of experimental infiltrants. J Dent 2013; 41:1014-9. [PMID: 24004967 DOI: 10.1016/j.jdent.2013.08.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 08/20/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To evaluate the properties of experimental infiltrant blends by comparing them with the commercial infiltrant Icon(®) and penetration homogeneity into enamel caries lesions. METHODS Groups were set up as follows: G1 (TEGDMA 100%); G2 (TEGDMA 80%, Ethanol 20%); G3 (TEGDMA 80%, HEMA 20%); G4 (TEGDMA 75%, BisEMA 25%); G5 (TEGDMA 60%, BisEMA 20%, Ethanol 20%); G6 (TEGDMA 60%, BisEMA 20%, HEMA 20%); G7 (TEGDMA 75%, UDMA 25%); G8 (TEGDMA 60%, UDMA 20%, Ethanol 20%); G9 (TEGDMA 60%, UDMA 20%, HEMA 20%) and Icon(®). Ten specimens were comprised by each group for the following tests (n=10): degree of conversion (DC), elastic modulus (EM), Knoop hardness (KH), and softening ratio (SR). Infiltrant penetration was evaluated using confocal microscopy (CLSM). Data were subjected to two-way ANOVA and a Tukey's test (5%). Data comparing experimental materials and Icon(®) were analysed using ANOVA and Dunnett's test (5%). RESULTS The highest DC values were found in G1, G7, G8, and G9. The lowest DC values were found in G2, G4, G5, and G6. EM and KHN were significantly lower in HEMA and with ethanol addition for all blends, except for G9. There was no significant difference among the groups regarding SR, and it was not possible to take KHN readings of G2, G5, and G8 after storage. There was no significant difference among groups for infiltrant penetration into enamel lesions. CONCLUSIONS The addition of hydrophobic monomers and solvents into TEGDMA blends affected DC, EM, and KHN. UDMA added to TEGDMA resulted in an increase in DC, EM, and KHN. Overall, solvents added to monomer blends resulted in decreased properties. The addition of hydrophobic monomers and solvents into TEGDMA blends does not improve the penetration depth of the infiltrants.
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Gomez SS, Emilson CG, Corvalan GC, Quiroz MD, Moran MPH. Efficacy of sealing the mesial surfaces of first permanent molars with respect to the status of the distal surfaces of the second primary molars in children at high caries-risk. Eur Arch Paediatr Dent 2013; 15:65-73. [PMID: 23835900 DOI: 10.1007/s40368-013-0066-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 06/27/2013] [Indexed: 10/26/2022]
Abstract
AIM This study aimed at evaluating the efficacy of sealants at preventing caries development or arresting the progression of non-cavitated mesial carious lesions in first permanent molars (6m) with respect to the status of the distal surfaces of the second primary molars (05d). METHOD The study population comprised 121, 8- to 10-year-old schoolchildren in a high-caries community in Valparaiso, Chile. They were examined clinically and radiographically and screened for caries-related risk factors using the risk-assessment software program Cariogram. The children were divided into three groups: Group A, with no caries lesions on adjacent surfaces of 05d-6m, served as a control group. Group B, with caries on 05d, received a preventive sealant on the caries-free 6m after temporary separation, and Group C, with carious 05d, received a therapeutic sealant on a 6m with initial lesions. Standardised follow-up radiographs were taken in 110 children after 12-14 months. RESULTS In group A, with no treatment, the mean percentage of sound surfaces that developed caries lesions was 3.8%. In group B, the mean percentage of sound 6m surfaces that developed caries lesions was 4.9% for sealed and 22.0% for unsealed surfaces (p < 0.05). In group C, the progression of therapeutically sealed carious lesions on 6m was 3.0% compared with 41.2% for unsealed carious control surfaces (p < 0.05). CONCLUSIONS These results suggest that sealing sound surfaces and non-cavitated caries in the proximal mesial surfaces of permanent molar teeth effectively prevents or reduces the progression of caries adjacent to lesions on the distal surfaces of the second primary molars.
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Affiliation(s)
- S S Gomez
- Department of Preventive Dentistry, Facultad de Odontología, Universidad de Valparaíso, Subida Carvallo 211, Playa Ancha, Valparaiso, Chile,
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Ekstrand K, Martignon S, Bakhshandeh A, Ricketts DNJ. The non-operative resin treatment of proximal caries lesions. ACTA ACUST UNITED AC 2013; 39:614-6, 618-20, 622. [PMID: 23479850 DOI: 10.12968/denu.2012.39.9.614] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
UNLABELLED Epidemiological data show that the prevalence of caries on proximal surfaces in need of operative treatment is very high around the world, both in the primary and the permanent dentition. This article presents two new treatment methods: proximal sealing and proximal infiltration. The indications are progressing proximal caries lesions, radiographically with a depth around the enamel-dentine junction. A small number of studies regarding the effect of sealing and infiltration on proximal caries versus the use of fluoride varnish, placebo treatment and flossing instructions have been carried out. About half of the studies disclose a not significant difference between test and control treatment. In the other half, the therapeutic effect is significant and corresponds to about 30% reduction in lesion progression. However, longitudinal studies of longer duration are lacking. CLINICAL RELEVANCE Proximal sealing and proximal infiltration may have a place in the treatment of non-cavitated proximal lesions. Proximal caries is a problem in both primary and permanent dentitions. Proximal sealants or lesion infiltration are possible treatments.
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Affiliation(s)
- Kim Ekstrand
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Dorri M, Dunne SM, Sabbah W, Kiani B. Proximal sealing for managing dental decay in primary and permanent teeth. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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