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Miotti LL, Vissotto C, De Nardin L, de Andrades Manjabosco B, Tuchtenhagen S, Münchow EA, Emmanuelli B. Does the liner material influence pulpal vitality in deep carious cavities submitted to selective caries removal? A network meta-analysis review. Clin Oral Investig 2023; 27:7143-7156. [PMID: 37932637 DOI: 10.1007/s00784-023-05372-w] [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: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To evaluate whether the restorative material in direct contact with the dentin influences pulp vitality in primary and permanent teeth with deep carious lesions restored after selective caries removal (SCR). MATERIAL AND METHODS Systematic searches of databases MEDLINE via PubMed, Scopus and ISI Web of Science were performed for primary and permanent teeth. Inclusion criteria were applied for title and abstract reading of databases search results. After full texts review of included studies, those that did not meet exclusion criteria were excluded from meta-analysis. RESULTS For meta-analysis, 2 studies were included for permanent teeth and 6 for primary teeth. The failure events reported were meta-analyzed using two statistical methods: standard pairwise meta-analysis (SPMA) and network meta-analysis (NMA). The SPMA identified similar failure occurrence of restorations performed with calcium hydroxide (CH) and other liner materials (RR 0.84, 95% CI 0.41, 1.74; p = 0.64), no significant difference between the use of alternative liners or CH regardless deciduous or permanent teeth (RR 0.79, 95% CI 0.36, 1.71; p = 0.55) and similar risk of failing at different follow-ups for all liner materials tested (RR 0.77, 95% CI 0.35, 1.70; p = 0.52). Probabilistic analysis indicated GIC as liner material with the highest probability of clinical success (SUCRA = 72.76%), and CH ranked as the worst liner material (SUCRA = 21.81%). CONCLUSION Pulpal vitality was not affected by material used as liner after selective caries removal in deep carious cavities. CLINICAL RELEVANCE Current clinical evidence supports the weak recommendation to not use calcium hydroxide as liner after SCR.
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Affiliation(s)
- Leonardo Lamberti Miotti
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil.
| | - Cariane Vissotto
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Letícia De Nardin
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Bianca de Andrades Manjabosco
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil
| | - Simone Tuchtenhagen
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Eliseu Aldrighi Münchow
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil
| | - Bruno Emmanuelli
- Stomatology Department, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande Do Sul (RS), Brazil
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Clarkson JE, Ramsay CR, Ricketts D, Banerjee A, Deery C, Lamont T, Boyers D, Marshman Z, Goulao B, Banister K, Conway D, Dawett B, Baker S, Sherriff A, Young L, van der Pol M, MacLennan G, Floate R, Braid H, Fee P, Forrest M, Gouick J, Mitchell F, Gupta E, Dakri R, Kettle J, McGuff T, Dunn K. Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care. BMC Oral Health 2021; 21:336. [PMID: 34243733 PMCID: PMC8267238 DOI: 10.1186/s12903-021-01637-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/18/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth. METHOD This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes. DISCUSSION SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN. TRIAL REGISTRATION NUMBER ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search .
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Affiliation(s)
- Jan E Clarkson
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK.,NHS Education for Scotland, Edinburgh, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Ricketts
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Avijit Banerjee
- Faculty of Dentistry, Oral and Craniofacial Services, Kings College London, London, UK
| | - Chris Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Thomas Lamont
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK.
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Banister
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Bhupinder Dawett
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.,Hafren House Dental Practice, Alfreton, Derbyshire, UK
| | - Sarah Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Andrea Sherriff
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | | | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ruth Floate
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Hazel Braid
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Patrick Fee
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jill Gouick
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Fiona Mitchell
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Ekta Gupta
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Riz Dakri
- Faculty of Dentistry, Oral and Craniofacial Services, Kings College London, London, UK
| | - Jennifer Kettle
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Tina McGuff
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Katharine Dunn
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
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Gasqui MA, Pérard M, Decup F, Monsarrat P, Turpin YL, Villat C, Gueyffier F, Maucort-Boulch D, Roche L, Grosgogeat B. Place of a new radiological index in predicting pulp exposure before intervention for deep carious lesions. Oral Radiol 2021; 38:89-98. [PMID: 33954908 DOI: 10.1007/s11282-021-00530-w] [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: 12/10/2020] [Accepted: 04/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND During interventions for deep caries lesions without severe symptoms, preserving pulpal vitality is important to ensure treatment success, improve organ prognosis, and decrease cost-effectiveness. Current pre-operative radiographs allow visual estimation but not accurate measurement of lesion depth. PURPOSE Investigate the ability of ratio 'remaining/total dentin thickness' (RDT/TDT, as determined on pre-operative radiographs) to predict pulp exposure during excavation. METHODS This retrospective study (January 2018-June 2020) analyzed data on 360 patients. Four independent raters examined standard pre-operative radiographs and their contrasted versions. Lines put at the dentino-enamel junction, the floor of the carious lesion, and the pulp chamber wall allowed deriving RDT/TDT. Inter-rater agreements and concordance were assessed. A logistic regression accounting for measurement errors provided odds ratios that estimated the ability of the RDT/TDT to predict pulp exposure. RESULTS The median RDT/TDT ratio ranges were 16.8-26.5% on standard and 16.2-24.6% on contrasted radiographs. Inter-rater agreements on RDT/TDT were rather poor and inter-rater reliability was low and similar in standard and contrasted radiographs: the concordance correlation coefficients (95% CIs) were estimated at 0.46 (0.40; 0.51) and 0.46 (0.40; 0.52), respectively. The risk of pulp exposure increased by 2.5 times [odds ratio (95% CI) 2.57 (2.06; 3.20)] per 10-point decrease of the ratio on standard radiographs vs. 4.15 (3.15; 5.46) on contrasted radiographs. CONCLUSION RDT/TDT ratio is potentially helpful in predicting pulp exposure. However, the measurement errors on RDT and TDT being non-negligible and the interrater agreements poor, there is still place for advances through development of an automated process that will improve reliability and reproducibility of pulp exposure risk assessment. CLINICAL TRIAL Trial registration number. ClinicalTrials.gov NCT04607395, October 29, 2020.
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Affiliation(s)
- Marie-Agnès Gasqui
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Pérard
- Faculté d'Odontologie, Université de Rennes 1, Rennes, France
- Institut des Sciences Chimiques de Rennes, UMR CNRS 6226, Rennes, France
- Pôle d'Odontologie, CHU Rennes, Rennes, France
| | - Franck Decup
- Faculté d'Odontologie, Université Paris Descartes, Montrouge, France
- Pathologie Imagerie et Biothérapies orofaciales, EA2496, Université Paris Descartes, 92120, Montrouge, France
- Service d'Odontologie, Assistance Publique des Hôpitaux de Paris, Hôpital Charles-Foix, Ivry, France
| | - Paul Monsarrat
- Faculté d'Odontologie, Université Paul Sabatier, Toulouse, France
- STROMALab, Université de Toulouse, CNRS ERL 5311, EFS, INP-ENVT, Inserm, UPS, Toulouse, France
- Centre Hospitalo-Universitaire, Toulouse, France
| | - Yann-Loïg Turpin
- Faculté d'Odontologie, Université de Rennes 1, Rennes, France
- Pôle d'Odontologie, CHU Rennes, Rennes, France
| | - Cyril Villat
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - François Gueyffier
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Hôpital cardiologique, Hospices Civils de Lyon, Lyon, France
| | - Delphine Maucort-Boulch
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Laurent Roche
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
- Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Brigitte Grosgogeat
- Faculté d'Odontologie, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
- Laboratoire des Multimatériaux et Interfaces, UMR CNRS 5615, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.
- Service d'Odontologie, Hospices Civils de Lyon, Lyon, France.
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Effects of sub-lethal dose of antimicrobial photodynamic therapy on major virulence traits of Streptococcus mutans. Photodiagnosis Photodyn Ther 2020; 32:102044. [DOI: 10.1016/j.pdpdt.2020.102044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/23/2020] [Accepted: 09/21/2020] [Indexed: 02/08/2023]
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de Assis C, Lemos C, Gomes J, Vasconcelos B, Moraes S, Braz R, Pellizzer EP. Clinical Efficiency of Self-etching One-Step and Two-Step Adhesives in NCCL: A Systematic Review and Meta-analysis. Oper Dent 2020; 45:598-607. [PMID: 32503033 DOI: 10.2341/19-185-l] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE One-step self-etch adhesive systems provide a clinical time gain, decreasing the number of clinical steps. When a clinician is able to follow a simpler process of adhesion there is less chance of adhesive failure. SUMMARY Objective: A systematic review and meta-analyses were performed to evaluate whether one-step self-etching (1SSE) adhesive systems are as effective as two-step self-etching (2SSE) adhesives in noncarious cervical lesion (NCCL) restorations.Methods: This systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and recorded in the PROSPERO (CRD42018096747). Electronic systematic searches were conducted in the following databases: PubMed/MEDLINE, Scopus, and Cochrane Library for published articles. Only randomized clinical trials that compared 1SSE with 2SSE adhesives systems were selected. The outcomes were retention, postoperative sensitivity, secondary caries, color match, marginal discoloration, marginal adaptation, and anatomical form.Results: The searches resulted in 476 studies. After applying the eligibility criteria, five randomized controlled trials were selected in which 822 restorations in NCCLs were distributed in 237 patients. The results showed no statistical difference between 1SSE and 2SSE in relation to retention (p=0.23; relative risk [RR]=1.55; 95% confidence interval [CI]=0.76, 3.19), postoperative sensitivity ( p=0.50; RR=3.00; 95% CI=0.13, 70.64), Secondary caries (p=0.63; RR=0.68; 95% CI=0.14, 3.31), color match (p=0.41; RR=0.64; 95% CI=0.23, 1.83), marginal discoloration (p=0.93; RR=1.02; 95% CI=0.65, 1.61), and anatomical form (p=0.56; RR=1.38; 95% CI=0.46, 4.13). However there was statistical difference in relation to marginal adaptation ( p=0.01; RR=1.95; 95% CI=1.14, 3.34).Conclusion: This systematic review with meta-analysis revealed that both 1SSE and 2SSE adhesive systems have comparable clinical effectiveness in a follow-up period of 12 to 24 months, except in relation to marginal adaptation.
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Alnahwi TH, Alhamad M, Majeed A, Nazir MA. Management preferences of deep caries in permanent teeth among dentists in Saudi Arabia. Eur J Dent 2018; 12:300-304. [PMID: 29988208 PMCID: PMC6004804 DOI: 10.4103/ejd.ejd_397_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective: To report the management preferences of deep caries in permanent teeth among dentists. Materials and Methods: This observational cross-sectional study included a convenience sample of 177 dentists selected from private and public dental clinics in different cities of the Eastern Province of Saudi Arabia. Four clinical scenarios about the absence or presence of pain/symptoms and the risk of pulp exposure in deep caries were presented to the dentists in a pilot-tested questionnaire. Results: Most dentists (82.5%) preferred complete caries excavation when there was no risk of pulp exposure and no pain/symptom was associated with deep caries in permanent teeth. The stepwise technique was the procedure of choice reported by 57.8% of dentists when there was no pain but a risk of exposure was present. In case of no exposure risk but the presence of nonspontaneous pain (pain on thermal testing), complete caries removal was chosen by 55.9% of the respondents. Root canal treatment and stepwise caries removal were preferred by 42.4% and 38.4%, respectively, when there was a risk of exposure and nonspontaneous pain. The risk of exposure (81.4%), the progression of caries (73.4%), and treatment failure (58.8%) were the most common concerns with different caries removal techniques. The hardness was the most commonly used criterion (85.3%) followed by the color of caries (50.3%) during caries excavation. Conclusions: The majority of dentists preferred to completely remove caries in case of no risk of pulp exposure. The dentists should update their knowledge and adopt latest concepts about minimally invasive caries removal approaches.
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Affiliation(s)
| | - Mostafa Alhamad
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdul Majeed
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Ashraf Nazir
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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The use of FDI criteria in clinical trials on direct dental restorations: A scoping review. J Dent 2018; 68:1-9. [DOI: 10.1016/j.jdent.2017.10.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/14/2017] [Accepted: 10/18/2017] [Indexed: 12/17/2022] Open
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