The minimally invasive management of early occlusal caries: a practical guide

Randomized clinical split-mouth study on a self-adhesive vs. a conventional bulk-fill composite in class II cavities: Results after five years

AIM

In this randomized prospective split-mouth study, the clinical survival and performance of a novel not yet commercially available self-adhesive dual-curing bulk-fill restorative material (SA, Solventum) and a conventional bulk-fill composite (Filtek One, Solventum; FO) were examined for restoration of class II cavities over a period of 60 months.

METHODS

30 patients underwent the placement of one SA and one FO restoration each. FO restorations were bonded using Scotchbond Universal (Solventum) in self-etch mode, while SA was applied without adhesive. This publication reports restoration survival as a primary outcome and quality parameters of restorations according to FDI criteria as a secondary outcome at baseline, 48 and 60 months. Restorations were evaluated by two independent examiners. Kaplan-Meier survival analysis and non-parametric statistical methods were employed (χ2-tests; α=0.05).The study was registered prior to commencement (German Register of Clinical Studies: DRKS00013564).

RESULTS

25 patients out of initially 30 were available at 60-mo recall. At 60-mo, FO exhibited a clinical survival rate of 97.1 % and SA of 98.9 % without significant difference (p > 0.05). All restorations available for clinical evaluation maintained clinically acceptable FDI scores throughout the follow-up period. FO significantly outperformed SA in terms of surface luster, color match and translucency at both evaluation time points, in terms of marginal staining at 60-mo and in terms of surface staining at 48-mo. Surface luster, surface staining and marginal adaptation deteriorated over time for both materials.

CONCLUSIONS

Both materials demonstrated similar clinical survival and performance over 60 months, which is to date the longest observation period for a clinical study including a self-adhesive bulk-fill restorative. SA displayed slightly inferior but clinically acceptable esthetic properties compared to FO. Both materials exhibited clinically acceptable outcomes over 60 months, warranting their recommendation for clinical use.

CLINICAL SIGNIFICANCE

The novel self-adhesive dual-curing bulk-fill restorative material exhibited clinically acceptable outcomes over 60 months, similarly to a conventional bulk-fill restorative used with a universal adhesive, with only minor cutbacks in esthetic properties. Thus, both materials can be considered suitable for clinical application.

Clinical Evaluation of Flowable Composite Materials in Permanent Molars Small Class I Restorations: 3-Year Double Blind Clinical Study

This study evaluated the 3-year clinical performance of four different flowable composite materials used in Small Class I restorations in permanent molars. This double-blinded, clinical study analyzed 229 Small Class I restorations/103 children at baseline, 12, 24, and 36 months with modified United States Public Health Services (USPHS) criteria. The tested flowable materials were Voco Grandio Flow + Voco Solobond M, Vivadent Tetric EvoFlow + Vivadent Excite, Dentsply X-Flow + Dentsply Prime&Bond NT, and 3M ESPE Filtek Supreme XT Flow + 3M ESPE Scotchbond Universal. The retention and marginal adaptation rates were highest for Grandio Flow and X Flow materials after 36 months, resulting in the highest score of clinical acceptability at 95.3% and 97.6%, respectively. The Tetric EvoFlow and Filtek Supreme XT Flow had the same retention rate after 36 months at 88.1%. Statistical significance was found in Grandio flow material in postoperative sensitivity criteria (p = 0.021). Tetric EvoFlow showed statistical differences in retention (p = 0.01), color match (p = 0.004), and marginal adaptation (p = 0.042). Filtek Supreme showed statistical differences in retention (p = 0.01) and marginal adaptation (p < 0.001). The flowable composite materials showed excellent clinical efficacy after 36 months of their clinical usage. There was no difference among the tested flowable composite materials quality in Small Class I restorations over time.

Fissure Depth and Caries Incidence in First Permanent Molars: A Five-Year Follow-Up Study in Schoolchildren

This study aimed to evaluate the association between the fissure depth (tooth morphology) of permanent molars and dental caries incidence with a five-year follow-up period. In total, 110 Mexican schoolchildren aged seven years were recruited at baseline, of which 88 children completed the follow-up assessments. The fissure depths of the first permanent lower molars were recorded, and dental caries [decayed, missing, and filled deciduous surfaces (dmfs) and decayed, missing, and filled permanent surfaces (DMFS)] was evaluated annually. A generalized estimating equation model was constructed for evaluating the association between dental caries and fissure depth. The initial and final DMFS scores were 0.02 (±0.2) and 1.55 (±2.49), respectively. The generalized estimating equation model showed that children with deep molar fissures were more likely to develop caries lesions, (Odds Ratio OR = 3.15, p = 0.028) compared to children with shallow fissures. Moreover, dental caries in primary teeth (OR = 1.07, p = 0.005) was associated with the development of carious lesions in the permanent dentition. Fissure depth was a useful predictor of dental caries, according to this five-year follow-up study. The detection of deep occlusal fissures in the lower first permanent molars could contribute to the identification of children at high risk of dental caries. Tooth morphology may be used to identify children at a higher caries risk, particularly in settings with limited resources.

Apps for oral hygiene in children 4 to 7 years: Fun and effectiveness

Background

Nowadays apps in preschool age are largely used in learning improvement. The aim of this work was to test effectiveness of apps in improving oral hygiene in children patients aged from 4 to 7 years and evaluating correlation between parents educational attainment and children oral hygiene.

Material and Methods

100 patients aged from 4 to 7 years were randomly assigned by an external office in the study group (SG: 32 females, 18 males) and in the control group (CG: 28 females and 22 males). Plaque index (PI) and carious lesions localisation were detected. At baseline all patients and one of the parents were instructed at chair-side about the proper oral hygiene techniques. SG patients were also given app as an aid in oral hygiene practice. Follow-up was 12 months. Measurements were made every three months at chair-side visits. Information about children compliance in oral hygiene and educational level of parents were obtained by questionnaires at t0 and after 12 months.

Results

SG patients showed stronger oral hygiene and PI lower than those in CG. Questionnaire showed higher compliance of SG patients and parents educational level seemed to affect children oral hygiene.

Conclusions

Apps in children allowed achieving encouraging results with improvement of oral hygiene and health. Key words:Apps, oral hygiene compliance, children oral hygiene, motivation, educational attainment.

Effect of Methods of Biosilicate Microparticle Application on Dentin Adhesion

Restorative procedures associated with bioglasses have shown to be a strategy to satisfy the contemporary concept of minimally invasive dentistry. Thus, the aim of this study was to evaluate bond strength to dentin treated by two different methods of biosilicate microparticle application. Dentin surfaces from 30 sound human molars were exposed and randomly assigned into three groups (n = 10) according to the surface treatment: (1) blasting with biosilicate microparticles (distance = 1 cm/pressure = 5 bar/time = 1 min); (2) 10% biosilicate microparticles paste; and (3) control (no treatment). After, dentin surfaces were restored with self-etch adhesive (Adper Easy Bond) and nanofilled composite (Filtek Z350). Specimens were sectioned perpendicularly to the adhesive interface to obtain sticks (cross-section area = 1 mm²), which were submitted to microtensile test (0.5 mm/min; 50 kgf). Data were analyzed by ANOVA and Tukey's test (α = 5%). Dentin/adhesive interfaces were morphologically analyzed by scanning electron microscopy (SEM). Data analysis showed that biosilicate-treated groups reached similar results (p > 0.05) and both of them demonstrated higher values (p < 0.05) than control group. SEM micrographs revealed hybridization with clear resin tags and no separation between resin-dentin adhesive interfaces. Within the limitations of this study, surface treatment with biosilicate positively influenced the adhesion to dentin and does not alter the morphology of the adhesive interface.

Minimally invasive direct restorations: a practical guide

The primary objectives of minimum intervention dentistry (MID) are to prevent or arrest active disease using non-operative management techniques. However, patients commonly present with cavitated caries lesions or failed restorations that are in need of operative intervention. Although much of clinical practice is devoted to preventing and managing the effects of caries and subsequent failure of the tooth-restoration complex, the clinical survival of restorations is often poor and becomes significantly worse as they increase in size and complexity. Minimally invasive (MI) restorative techniques present a range of well-documented advantages over more tissue-destructive traditional restorations by minimising unnecessary tooth tissue loss, insult to the dentine-pulp complex and reducing the risk of iatrogenic damage to adjacent hard and soft tissues. They also maximise the strength of the residual tooth structure by use of optimal adhesive restorative materials designed to restore function and aesthetics with durable, long-lasting restorations that are easy for the patient to maintain. In contemporary oral healthcare practice, if patients are to give valid consent for operative interventions, minimally invasive options must be offered, and may be expected to be the first choice of fully informed patients. This paper describes concepts of MID and provides an update of the latest materials, equipment and clinical techniques that are available for the minimally invasive restoration of anterior and posterior teeth with direct restorations.

Minimum Intervention (MI) Oral Healthcare Delivery Implementation - Overcoming the Hurdles

The United Nations Minamata Convention aims to protect human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds. In those 55 countries signed up to it to date (the convention came into force in those countries on 16 August 2017), dental caries management has been thrust indirectly into the limelight once again via the resulting phase down and ultimately, phase out of dental amalgam as a restorative material.20 It is interesting how the dental profession has become fixated on the notion of a post-amalgam world, with significant efforts concentrating on trying to develop the perfect amalgam substitute restorative material to be used to 'treat’ caries.

However, on more detailed examination of the treaty, it is abundantly clear that the United Nations and the WHO, at a global level, appreciates the significant concerns over the lack of an appropriate strategy of preventing this most prevalent of non-communicable diseases known to humankind in the modern world.1–4 Ml oral healthcare is very much now on this global agenda, with developing links between dental caries, general social health determinants and other health and social sectors, and will therefore help drive oral health change with implementation strategies at the population and individual level while also developing sustainable workforce development models globally. Even though minimally invasive surgical skills, procedures and materials need to be developed and taught, the principle consideration should be given as to how “all stakeholders can incite preventive behaviour change in all stakeholders.” This is the biggest challenge in delivering better oral health to current and future generations. The quest continues…