Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review

Comparative study of dentin remineralization with Nano-amorphous calcium phosphate-modified bioactive restoratives

Objective

Modern caries management emphasizes minimally invasive techniques to promote remineralization through a balanced pH and mineral ion availability. Bioactive restorative materials, including giomer (Beautiful II, SHOFU Dental GmbH, Japan), and ACTIVA BioACTIVE (Pulpdent Corp., Watertown, MA, USA), release fluoride, calcium, and phosphate to enhance dentin remineralization. Nano-amorphous calcium phosphate (NACP) is a highly reactive mineral with proven remineralization capabilities due to its high surface area and solubility. The synergistic effects of NACP and the bioactive materials remain underexplored. This study evaluates the remineralization potential of giomer and ACTIVA BioACTIVE with and without NACP integration using energy-dispersive X-ray spectroscopy (EDX) microanalysis and Knoop hardness number (KHN) assessments.

Materials and methods

Four restorative composite materials: Beautifil II, Beautifil II with NACP, ACTIVA BioACTIVE, and ACTIVA BioACTIVE with NACP, were evaluated on demineralized dentin cavities created in non-carious molars. The mineral content (Ca, P, F) was analyzed via EDX, and the microhardness was measured using KHN. Statistical analyses included analysis of variance (ANOVA) and post hoc Tukey tests.

Results

NACP significantly increased calcium and phosphate deposition, with ACTIVA BioACTIVE with NACP demonstrating the highest remineralization (Ca/P ratio: 2.16). Fluoride intensities were higher in the giomer-based materials, promoting fluorapatite formation. KHN analysis revealed that Beautifil II with NACP exhibited the highest hardness, whereas ACTIVA BioACTIVE with NACP showed reduced hardness despite enhanced mineral content.

Conclusion

The incorporation of NACP into giomer and ACTIVA BioACTIVE facilitated the accumulation of calcium and phosphate ions, leading to enhanced mineralization.

Preventing white spot lesions around orthodontic brackets: efficacy of pre-reacted glass-ionomer barrier coat versus silver diamine fluoride: an in vitro study

OBJECTIVES

to compare the effect of using a pre-reacted glass-ionomer (PRG) barrier coat versus silver diamine fluoride (SDF) varnish treatment before orthodontic bracket bonding to prevent white spot lesions (WSL). The effect of these materials on the shear bond strength of orthodontic brackets was evaluated through an in vitro study.

METHODS

One hundred-five premolars were used; forty-two specimens were designated for comparing SDF versus PRG-barrier coat using a scanning electron microscope (SEM) with elemental analysis and microhardness testing (n = 21/group). Tested materials were applied in a split-tooth design protocol (side A: control, side B: treated). Measurement was made at baseline and after bracket placement and exposure to the pH cycle. A polarized light microscope (PLM) was used for qualitative examination. Sixty-three specimens were intended for shear bond strength (SBS) testing after the pH cycle as follows: control group (no treatment), SDF group, and PRG-barrier coat group (n = 21/group). Statistical analysis was done using Paired T-test.

RESULTS

SEM for specimens treated by SDF or PRG revealed enamel remineralization with calcium deposits and small porosities between the crystallites. All groups had a significant difference regarding the Ca/P ratio and microhardness. Baseline hardness for both groups was significantly higher than the treated sides, which was significantly higher than the non-treated sides (P = 0.000*) and (P = 0.000*) in accordance with the Paired T-test. In comparing SDF with PRG-coat groups, the T-test showed non-significant differences in mean differences between treated and baseline hardness values (T = 0.32, P = 0.74). PLM for treated specimens by SDF or PRG depicted an evident remineralized surface enamel layer. SBS values did not differ significantly between groups.

CONCLUSIONS

As confirmed by SEM and PLM, applying either SDF varnish or PRG-barrier coat before bonding orthodontic brackets could effectively prevent the development of WSL and achieve surface enamel protection. In addition, the two applied varnishes showed slightly higher shear bond strength of orthodontic brackets compared to the control group, with the SDF slightly higher than PRG. Also, clinical translation is needed in future research to evaluate the study.

Improving Bonding Protocols: The Effect of Selective Dentin Etching with Two Different Universal Adhesives-An In Vitro Study

Universal adhesives can be applied in versatile bonding strategies, with selective dentin etching (SDE) emerging as a promising approach for enhancing dentin-adhesive interfaces. This study evaluated the immediate adhesive interface to dentin of two universal adhesives (OptibondTM Universal and Futurabond M+) with an SDE strategy. Sixty human molars were randomly assigned to six experimental groups (n = 10): control (self-etch strategy), SDE, and SDE3 (SDE with three adhesive layers). After dentin exposure and smear layer simulation, adhesives were applied, followed by composite resin restoration. Microtensile bond strength in 1 mm2 beams was performed in a universal testing machine (1 kN; 0.5 mm/min) after 24 h water storage. Failure modes were classified, and the adhesive interfaces were characterized by scanning electronic microscopy. SDE was higher for both adhesives compared to the control group, but was this change statistically significant in Futurabond M+ only (Mann-Whitney, p < 0.001). On the other hand, in OptibondTM Universal, only SDE3 significantly increased bond strength (Mann-Whitney, p < 0.001). Adhesive failures predominated across all groups. Microscopy images revealed longer and more numerous resin tags in SDE and SDE3 specimens. The SDE strategy enhanced immediate bond strength of these universal adhesives, with product-specific variations, suggesting that application strategies should be tailored to each universal adhesive's unique formulation to optimize dentin bonding effectiveness.

Antimicrobial, remineralization, and infiltration: advanced strategies for interrupting dental caries

Dental caries, driven by plaque biofilm, poses a major oral health challenge due to imbalance in mineralization and demineralization. The primary objective in caries management is to maintain biofilm homeostasis while facilitating the repair and regeneration of dental hard tissues, thus restoring both structural integrity and functionality of affected teeth. Though antimicrobial and remineralization approaches haven shown promise, their standalone utilization without concurrent bacterial control or rebalancing lacks an integrated strategy to effectively arrest caries progression. Furthermore, according to the principles of minimally invasive dentistry, treatment materials should exhibit high permeability to ensure optimal sealing of demineralized tooth surfaces. The concept of interrupting dental caries (IDC) has emerged as a holistic approach, drawing upon extensive research encompassing three pivotal techniques: antibacterial strategies, remineralization therapies, and infiltration mechanisms, all of which are indispensable components in combating the progression of dental caries. In this review, we provide a comprehensive overview of the mechanisms and applications of antibacterial, remineralization, and infiltration technologies within the context of caries management. Additionally, we summarize advanced materials that align with the IDC concept, aiming to offer valuable insights for designing next-generation materials adept at preventing or halting caries progression efficiently.

The Efficacy of Remineralizing Materials on Artificial Enamel Lesions: An In Vitro Study

Background and Objectives: Contemporary caries treatment seeks to preserve hard dental tissues as well as to promote lesion remineralization and biological tissue regeneration. While fluoride-based treatments remain the gold standard, their effectiveness has limitations, prompting interest in innovative remineralization technologies. Nano-hydroxyapatite (nano-HA) varnish and self-assembling peptide (SAP) P11-4 are promising biomimetic materials that promote enamel repair, yet long-term data on their efficacy are limited. The objectives of this study were to evaluate the effectiveness of nano-HA varnish and peptide P11-4 in restoring enamel surface hardness after artificial lesions in vitro and to compare them to a control group and fluoride varnish. Materials and Methods: Artificial enamel lesions were created on the buccal surfaces of 36 extracted human molars, which were randomly divided into four groups (n = 9): control, peptide P11-4, fluoride varnish, and nano-hydroxyapatite varnish. After applying the materials as per manufacturer instructions, specimens were stored in artificial saliva for 14 days. Enamel surface hardness was measured using the Vickers hardness test (HV) at baseline, after demineralization, and after remineralization. Statistical analysis was performed with "IBM SPSS 27.0" using non-parametric Kolmogorov-Smirnov, Kruskal-Wallis, Dunn's, and Wilcoxon tests. Results: The mean baseline enamel hardness value was 323.95 (SD 33.47) HV. After 14 days of demineralization, the mean surface hardness of artificial enamel lesions significantly plummeted to 172.17 (SD 35.96) HV (p = 0.000). After 14 days of remineralization, the mean value significantly increased to 213.21 (SD 50.58) HV (p = 0.001). The results of the study revealed statistically significant enamel remineralization of the peptide P11-4 group in regard to the demineralized enamel (p < 0.05). In contrast, there were no significant results in other treatment groups (p > 0.05). Remineralization of enamel was the highest in samples from the P11-4 group (54.1%), followed by the nano-HA group (35.4%), FV group (17.8%), and control group (11.2%). There was a significant difference (p < 0.05) in the remineralizing ability between the peptide P11-4 and all other treatment groups. Conclusions: Self-assembling peptide P11-4 effectively remineralized artificial enamel lesions and proved to be significantly more effective compared to fluoride varnish and nano-hydroxyapatite varnish, showcasing its superior performance as a remineralizing agent.

Chemomechanical Caries Removal with Enzymatic Technology: A Comparative In Vitro Study

Purpose

This study aims to compare the efficiency of caries removal between the chemomechanical caries removal agent Brix 3000 and the conventional method using a laser fluorescent device (DIAGNOdent Pen), caries detection dye, microbial culture, and real-time polymerase chain reaction (PCR) methods.

Materials and methods

The study involved 64 primary molars with dentinal caries between March and June 2022. Standardization was achieved based on International Caries Detection and Assessment System (ICDAS-II) criteria (score 6) and DIAGNOdent Pen measurements (30 and above). Caries were removed using the conventional method (32) and Brix 3000 (32). Following this, dentin samples were collected, and measurements were made with the DIAGNOdent Pen to evaluate the presence of residual caries in both groups. After the measurements, the presence of residual caries was evaluated in both groups using caries detection dye. The decrease in values obtained by microbial culture and real-time PCR methods of dentin samples taken before and after caries removal was evaluated.

Results

When DIAGNOdent Pen and caries detection dye were evaluated, the caries removal efficiency of the conventional method was found to be higher (p < 0.05). As a result of the microbial culture evaluation for Streptococcus mutans and total bacteria, the caries removal efficiencies of both methods were found to be similar (p > 0.05). The caries removal efficiency of Brix 3000 was found to be higher as a result of the evaluation with real-time PCR for S. mutans (p < 0.05).

Conclusion

It is thought that Brix 3000 is an effective agent for caries removal and may be an alternative agent to the conventional method, especially considering its advantages in children.

How to cite this article

Aydogdu AB, Olmez A, Akca G. Chemomechanical Caries Removal with Enzymatic Technology: A Comparative In Vitro Study. Int J Clin Pediatr Dent 2025;18(3):245-250.

Factors Influencing the Choice of Conservative and Surgical Procedures in Dental Patients from Poland: A Single-Center Retrospective Analysis

Background/Objectives: Oral health behaviors can be shaped by various factors, both global (such as the COVID-19 pandemic) and individual (e.g., gender, age). This retrospective study aims to assess the factors influencing the choice between conservative and surgical dental procedures among patients based on the example of the university specialized center in Poznan. Methods: We explored the patient dataset from the University Center of Dentistry and Specialized Medicine (Poznan, Poland), covering the period from 1 January 2017 to 31 December 2023. A total of 182,654 medical records were analyzed, focusing on procedures such as restorations, endodontic interventions, and extractions. Multivariate logistic regression and multidimensional correspondence analyses were employed to assess the impact of demographic factors (age and gender) and tooth-specific characteristics on clinical decisions. Results: Females, particularly younger, were more likely to choose restorative procedures, while males, especially those over 50, predominantly underwent surgical procedures. Endodontic treatments were most common in males aged 18-30, primarily for maxillary anterior teeth and premolars. Molar extractions, especially in the mandible, were the most frequent surgical procedure. Maxillary teeth, particularly canines and premolars, were more likely to be treated conservatively. Conclusions: Economic factors, limited treatment access, and variations in patient preference influenced the observed patterns. Despite a national trend toward increased conservative treatments, disparities persisted based on age, gender, and tooth type. These findings emphasize the need for targeted prevention strategies and equitable access to advanced dental care.

Treating White Spot Lesions and Non-Carious Cervical Lesions with Amelogenin Peptide-Based Hydrogel

Peptide-based biomimetic treatments have gained increased attention in the dental field due to their biocompatibility and minimally invasive qualities. These biomimetic approaches can replicate the native architecture of dental tissues, thus contributing to higher success rates and improved longevity of restorations. The aim of this study was first to examine the biocompatibility and stability of an amelogenin peptide-based chitosan hydrogel (P26-CS) against salivary enzymes. Second, we aimed to evaluate its efficacy in biomimetically repairing human dental lesions in situ. White spot lesions (WSLs) in enamel and non-carious cervical lesions (NCCLs) in dentin were artificially created. Chitosan (CS) improved peptide stability, while remineralization of enamel sections with P26-CS was not impeded by salivary enzymes. The peptide was not cytotoxic, irritating, or sensitizing. Fluorescently labeled P26-CS penetrated ~300 μm into the enamel of WSLs and ~100 μm into the dentin of NCCLs. After peptide treatment, quantitative light-induced fluorescence (QLF) and microcomputed tomography (μCT) indicated a gain in mineral density of WSLs. In NCCLs, scanning electron microscopy showed that the dentin was covered by a mineral layer of needle-shaped crystals. Our results show that the repair of artificial WSLs and NCCLs was achieved by P26 peptide-guided remineralization and demonstrate its potential to repair dental lesions.

Artificial intelligence-produced radiographic enhancements in dental clinical care: provider and patient perspectives

Introduction

Artificial intelligence (AI)-based software can be used with dental radiographs to facilitate dental providers' diagnoses and to educate patients about their oral health conditions. The goal of this study was to survey dental providers and patients about the use of AI-enhanced radiographs in the diagnostic and patient education processes.

Methods

Within their Community Collaborative Practice model, Apple Tree Dental in Minnesota implemented the use of an AI software platform that annotates carious lesions and periodontal measurements on dental radiographs. Before and after implementation of this software, providers (dentists, dental hygienists, dental therapists, and dental assistants) were surveyed about what benefits and challenges they anticipated and experienced in using the AI software. A small-scale study of patients who viewed AI-generated annotations on their own radiographs examined patient perspectives on the use of this software.

Results

Dental therapists reported using the software most often, with 57.2% using the software at least 50% of their clinical time; 79% of dental assistants reported using the software 25% of the time or less. While the majority of providers (n = 70 for Survey I; n = 53 for Survey II) said that AI enhancements would help facilitate patient education efforts, providers' confidence in the ability of the AI software to improve diagnosis of dental caries and periodontal disease and its ability to improve the efficiency of their work was mixed. Patients (n = 25) found reviewing the AI-produced visual aids used by their dental provider to be helpful in understanding their oral health, and a large proportion (92%) said they planned to follow through on recommended treatment.

Discussion

While provider and patient perceptions of the use of AI software in dental care were positive overall, attitudes among providers were mixed regarding its effectiveness in diagnosing dental disease and improving work efficiency. More research is needed to determine whether use of AI software in clinical dental practice produces changes in treatment recommendations by providers or in patient adherence to these recommendations.

Physio-Mechanic and Microscopic Analyses of Bioactive Glass-Based Resin Infiltrants

This study aimed to investigate the efficacy and durability of bioactive glass-based dental resin infiltrants. Resin infiltrants were formulated by combining photoinitiated dimethacrylate monomers with three variations of bioactive glass: 45S5 Bioglass (RIS), boron-substituted (RIB), fluoride-substituted (RIF), and pure resins (PR), whereby TOOTH group (TH) and ICON (CN) served as commercial control groups. Teeth samples were prepared, and experimental and control infiltrants were applied on demineralized human-extracted teeth. All the samples were subjected to immersion in artificial saliva and pH cycling for 30 days. The samples from another group underwent tooth brushing simulation for 9600 cycles. Following artificial saliva immersion, the samples' hardness values showed that RIB had the highest values (318.44 ± 3.83) while PR (212.52 ± 9.02) had the lowest values. After immersing into the pH cycling solution, the RIF showed the highest hardness (286.86 ± 5.11), while the lowest values for the CN (143.76 ± 3.50). After the tooth brushing simulation, the teeth samples with RIB showed maximum microhardness values (312.06 ± 16.30) and the weakest for the TH (189.60 ± 6.43). The commercial and experimental enamel resin infiltrants showed almost similar results overall, with RIB demonstrating better microhardness and comparable surface roughness. In contrast, RIF proved more resistant to pH cycling, exhibited higher microhardness, and performed better in surface roughness analysis. These findings suggest that resin infiltrant materials, especially RIF, have promising potential for effectively and esthetically managing white spot lesions.

In-vitro comparative thermo-chemical aging and penetration analyses of bioactive glass-based dental resin infiltrates

Background

Teeth with small to moderate cavities can be repaired with enamel resin infiltrants, a form of dental restorative material. In dental materials, it is standard practice to include several filler particles for experimental use in dental resin infiltrates. The resin's BG particles penetrate the lesion and release ions that combine with saliva to provide a mineral-rich environment that can strengthen enamel and heal. This study aimed to compare resin infiltrants based on three types of bioactive glass materials and investigate the penetration depth, microleakage, and the effect of thermal and chemical aging.

Methodology

A triethylene glycol dimethacrylate (TEGDMA) and urethane dimethacrylate (UDMA)-based experimental resin infiltrate was prepared. Initial mixing was done manually for 1 h at room temperature, followed by another mix for 30 min on a magnetic stirrer. This prepared resin, called "PURE RESIN" was then further incorporated with three different types of bioactive glasses, i.e., Bioglass (45S5), boron-substituted (B-BG), and fluoride-substituted (F-BG). Initial manual mixing for 1 h, followed by ultrasonic mixing for 3 min and then proceeded for the final mixing on a magnetic stirrer for 24 h in a dark room at ambient temperature. Human-extracted teeth were demineralized, and the experimental resins were infiltrated on the demineralized surface. The surface area, pore size, and volume of the demineralized surface were measured. The microleakage and penetration depth were analyzed with the stereomicroscope and micro-CT, respectively. The samples were challenged with the pH cycle for 14 days, followed by a scanning electron microscope (SEM). Thermocycling (5,000 cycles) and chemical aging (4 weeks) were conducted, followed by microhardness, surface roughness, and SEM analyses. Statistical analyses were conducted after each test.

Results

The F-BG group achieved the highest initial and day 14 penetration coefficients. There was a superior dye penetration with the microleakage analysis in the F-BG group. The 45S5 group had the highest average penetration depth via micro-CT analysis. After thermocycling and chemical aging, the micro-hardness was reduced (non-significantly) among all samples except the F-BG group in post-chemical aging analysis, whereas the surface roughness was significantly increased. SEM images showed the presence of micro-pits on the surfaces after the thermal and chemical aging.

Conclusion

The F-BG group achieved the highest initial and day 14 penetration coefficients. There was a superior dye penetration with the microleakage analysis in the F-BG group. The 45S5 group had the highest average penetration depth via micro-CT analysis. After thermocycling and chemical aging, the micro-hardness was reduced (non-significantly) among all samples except the F-BG group in post-chemical aging analysis, whereas the surface roughness was significantly increased. SEM images showed the presence of micro-pits on the surfaces after the thermal and chemical aging.

Clinical and radiographic evaluation of silver diamine fluoride versus mineral trioxide aggregate as indirect pulp capping agents in deeply carious first permanent molars a randomized clinical trial

AIM

Clinical and radiographic evaluation of SDF versus MTA as indirect pulp capping agents in deeply carious first permanent molars.

METHODOLOGY

This study was conducted on (30) first permanent molars indicated for indirect pulp capping (IPC) randomly allocated to either SDF or MTA groups (n = 15). The molars were finally restored with glass hybrid glass ionomer restoration. Clinical assessment was conducted at 3, 6, 9 and 12 months, while radiographic assessment was performed at 6 and 12 months using predetermined criteria. Data was statistically analyzed.

RESULTS

There was no statistically significant difference between both groups for all assessed clinical and radiographic parameters, including dentin bridge formation, at all follow-up periods. There was no evidence of clinical or radiographic failure in either group.

CONCLUSIONS

SDF showed a high success rate compared to MTA and can be considered a promising alternative IPC agent in permanent molars.

Microinvasive interventions in the management of proximal caries lesions in primary and permanent teeth- systematic review and meta-analysis

BACKGROUND

Dental caries is one of the most common non-communicable diseases in humans. Various interventions are available for the management, of which microinvasive techniques such as infiltration, sealants, glass ionomers, are novel and convenient. The purpose of this systematic review and meta-analysis was to compare microinvasive techniques with noninvasive or invasive treatment modalities in terms of effectiveness in halting interproximal caries lesion progression radiographically assessed.

METHODOLOGY

The review was registered on PROSPERO (CRD42024557636). Three electronic databases, PubMed, Google Scholar and Cochrane Oral Health Group Trial Register, were searched for the randomized controlled trials comparing any of the microinvasive techniques with either non- invasive or invasive treatments for non-cavitated proximal lesions both in primary and permanent teeth. The radiographic lesion progression was set as primary outcome. Rayyan and EndNote X9 were used for screening and full text review respectively. The risk of bias was assessed using Cochrane Risk of Bias tool. We performed analysis with the help of RevMan5.4 and calculated odds ratio and 95% confidence interval for evaluation of efficacy. The quality of evidence was assessed with the help of GRADEpro.

RESULTS

A total of 185 studies were recruited after initial search, of which 18 were recruited after screening. Finally, 13 studies were included, and all were split mouth randomized controlled trials comparing various microinvasive techniques with non-invasive techniques. Five of the included trials studied primary teeth in children ranging from 3 to 9 years and seven trials assessed permanent teeth in children and adults ranging from 11 to 45 years while one trial included children having lesions on both primary and permanent teeth. The risk of bias assessment showed that 2 of the included studies had unclear risk of bias whereas 11 were at low risk of bias. Tau2, I2, and Chi-Square tests (0.04, 10% and 7.50 respectively) showed minimum level of heterogeneity. The overall odds ratio (95% confidence interval) of 0.29 (95% CI 0.19-0.38) showed that microinvasive techniques were superior as compared to noninvasive techniques for the management of proximal lesions. The subgroup analysis was also performed for types of dentitions, various microinvasive interventions and levels of caries depth. All showed improved outcomes in case of microinvasive interventions as compared to noninvasive techniques. The publication bias was assessed using forest plot and there was no significant publication bias. The quality of evidence assessed by GRADEpro came out to be moderate.

CONCLUSION

This review concludes that microinvasive techniques are superior to noninvasive interventions for the treatment of non-cavitated proximal lesions in both primary and permanent dentition. However, cost effectiveness, feasibility, durability, and long-term effects of microinvasive techniques need to be explored further.

Advancements in Minimally Invasive Techniques in Pediatric Dentistry: A Review

Minimally invasive dentistry (MID) has revolutionized pediatric dental care by emphasizing the preservation of healthy tooth structures, reducing treatment-related trauma, and improving patient compliance. This narrative review explores advancements in MID techniques, including silver diamine fluoride (SDF), resin infiltration, atraumatic restorative treatment (ART), bioactive materials, laser-assisted therapies, and three-dimensional (3D) printing technologies. These approaches prioritize early diagnosis, prevention, and conservative management, aligning with patient-centered and sustainable practices. SDF demonstrates high efficacy in arresting caries progression but presents esthetic challenges due to discoloration. Resin infiltration provides esthetic and noninvasive treatment for white spot lesions, while ART offers cost-effective and child-friendly caries management in resource-limited settings. Bioactive materials support tissue regeneration, and laser technologies enable precise and painless procedures, although their adoption is limited by high costs and training requirements. Emerging tools, such as artificial intelligence and 3D printing, enhance diagnostic accuracy and treatment precision. Despite challenges related to cost, operator training, and infrastructure, MID techniques continue to evolve, offering promising solutions for pediatric dental care. Future research should focus on optimizing materials, improving accessibility, and integrating digital technologies to broaden the impact of minimally invasive approaches. This review highlights MID's transformative role in improving oral health outcomes and ensuring sustainable, patient-focused care for children.

Oral health status and dental treatment needs in children with autism spectrum disorder

OBJECTIVE

To evaluate oral health care practices, health status, and dental treatment needs in children with Autism Spectrum Disorder (ASD).

METHODS

This cross-sectional study included 96 children diagnosed with ASD per the DSM-V criteria and 96 typically developing healthy children. The WHO form assessed oral health status and dental treatment needs.

RESULTS

Over 50 % of ASD children had mild/moderate autism, 35.4 % had severe autism, and 13.5 % had autistic traits. ASD children experienced more toothbrushing difficulties compared to non-ASD children. Based on Nyvad's criteria and decayed/filled teeth (dft) index, non-ASD children had higher caries prevalence than ASD children, indicating less need for restorative treatments in the ASD group. However, ASD children had poorer plaque scores than non-ASD children. A significantly higher percentage of ASD children exhibited harmful oral behaviors, including mouth breathing, lip biting, bruxism, nail biting, object biting, and self-injury (p < 0.001). ASD children also showed increased traumatic dental injuries compared to non-ASD children.

CONCLUSION

Compared to non-ASD peers, children with ASD have lower dental caries prevalence and less need for restorations, yet poorer plaque control. They also demonstrate more frequent oral self-injuries. ASD status appears related to toothbrushing difficulties. These findings highlight the need for tailored oral health interventions for children with ASD.

Updates on Caries Risk Assessment-A Literature Review

This narrative review aims to provide an update on caries risk assessment (CRA) and the available CRA tools. CRA can be used to monitor the status of oral care, as well as for documentation and research purposes. Caries risk is determined by the interplay of risk and protective factors. Common risk factors include suboptimal oral hygiene practices, previous caries experience, low plaque acidity, frequent snacking, cariogenic diet, enamel defects, reduced salivary flow, polypharmacy, and radiotherapy experience. Caries risk can be reduced through some preventive measures, such as the use of fluoride, gum chewing, dental sealants. The CRA process can be categorized as single or multifactor tools. Single-factor CRA tools include diet analysis questionnaires, cariogenic bacteria testing and saliva testing kits, whereas multifactor CRA tools encompass Caries Management by Risk Assessment (CAMBRA), Cariogram, and PreViser. Some CRA tools may quantify risk and protective factors to compute caries risk. Additionally, they can generate visual and educational presentations that foster success in oral care. Clinicians consider CRA beneficial for developing personalized care plans. However, the literature fails to reflect this and reveals limited studies supporting its use as evidence-based practice for caries management.

Arresting Active Carious Lesions Using Minimal Intervention Dentistry among a Group of Preschool Children: A Randomized Controlled Clinical Trial

Objectives

This clinical trial investigated the effectiveness of three minimal intervention dentistry protocols in arresting dentin caries in primary molars of preschool children. Treatment time, anxiety in children, adverse events, and parents' esthetic perception were all assessed.

Materials and methods

One hundred thirty-five 3-5-year-old children with active dentin caries lesions on the occlusal surface of primary molars were randomly allocated to the control group receiving atraumatic restorative treatment (ART) and two test groups receiving 38% silver diamine fluoride (SDF) or ultraconservative treatment (UCT). The existence and activity of caries were assessed using the International Caries Detection and Assessment System II (ICDAS II) criteria. Children were followed up at 3, 6, and 12 months. The time required to perform the treatments was recorded, and a facial image scale (FIS) was applied to assess anxiety. Questions posed to caregivers were used to investigate adverse events and esthetic assessment.

Results

After a year, the overall success rates of UCT, SDF, and ART were 61.6, 87.2, and 84.6%, respectively, with a statistically significant difference (p < 0.05). The time required to treat with SDF was significantly lower than that needed for ART and UCT (p < 0.01). Anxiety levels were significantly lower in the SDF group (p = 0.003). There was no difference in the percentage of adverse events and parental esthetic perception (p = 0.604).

Conclusion

After 3 months, the arrest rates of ART, SDF, and UCT were similar. However, after 1 year, the arrest rate of UCT was significantly lower.

Clinical significance

Silver diamine fluoride takes significantly less chair time and has success rates comparable to ART. Ultraconservative treatment has a short-term successful application. It was confirmed that there were no variations in adverse events between SDF, ART, and UCT.

Clinical trial registration number

NCT05314660.

How to cite this article

Hamza BE, Attia NM, Abdellatif AM, et al. Arresting Active Carious Lesions Using Minimal Intervention Dentistry among a Group of Preschool Children: A Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2024;17(9):1018-1024.

A Comparative In Vitro Physicochemical Analysis of Resin Infiltrants Doped With Bioactive Glasses

Objective This study aimed to investigate the longevity and effectiveness of bioactive glass (BAG)-based dental resin infiltrants. Materials and methods The three types of BAG - 45S5 bioglass (RIS), boron-substituted (RIB), and fluoride-substituted (RIF) - were incorporated with photoinitiated dimethacrylate monomers to create experimental resin infiltrants. ICON® (CN; DMG-America, Ridgefield Park, NJ) and pure resin (PR) were used as control groups in this study. Disc-shaped samples were prepared for the experimental and control groups. The samples were challenged with the pH cycle and immersed in the artificial saliva for 30 days. On Day 0 and Day 30, the pH cycle and artificial saliva immersion, Vicker's microhardness, surface roughness, and surface morphology were investigated. Results The RIF group's disc samples showed the highest Vicker's microhardness values (78.20 ±0.06) on Day 30 of artificial saliva immersion, whereas the CN group's values were the lowest (55.99 ±0.24). Following the pH cycling, the RIF displayed the highest hardness (64.15 ±1.89) whereas the CN group's values were the lowest (33.47 ±1.28). Regarding surface roughness, on Day 30, the RIB resin group exhibited the highest (1.14 ±0.001 µm). In contrast, the CN resin showed the lowest (1.07 ±0.06 µm) values, while immersed in the artificial saliva solution. In the same duration of time, in the pH cycling solution, PR showed the least (0.85 ±0.89 µm), while RIF showed the highest roughness value (0.94 ±0.54 µm). Morphological analysis revealed that following the artificial saliva immersion, the RIB, CN, and PR exhibited smoother surfaces compared to the RIS and RIF groups. However, when immersed in the pH cycling solution, RIB and RIF showed more resistance against acid attack. Conclusions Our results revealed that the experimental resin groups performed much better than the commercial resin infiltrants following artificial saliva and pH cycling challenges.

Efficacy of F-ACP-Containing Dental Mousse in the Remineralization of White Spot Lesions after Fixed Orthodontic Therapy: A Randomized Clinical Trial

Fixed appliance (FA) therapy predisposes patients to white spot lesions (WSLs). The F-ACP complex (amorphous calcium phosphate nanoparticles enriched with carbonate and fluorine and coated with citrate) has been effective for in vitro enamel remineralization. The aim of this study was to evaluate the efficacy of the F-ACP complex in remineralizing WSLs after FA therapy. One hundred and six adolescents (aged 12-20 years) were randomized into study and control groups after FA therapy. Patients in the study group were advised to use dental mousse containing F-ACP applied within Essix retainers for six months. The presence of WSLs was recorded at baseline (T0), 3 months (T1), and 6 months (T2) according to the International Caries Detection and Assessment System (ICDAS). Visual Plaque Index (VPI) and Gingival Bleeding Index (GBI) were recorded. Among 106 study participants, 91 (52 and 39 in study and control groups, respectively) completed the study. The results showed that the ICDAS score was significantly lower (p < 0.001) in the study group than in the control group between T0 and T2. The application of mousse containing the F-ACP complex inside Essix retainers for six months is effective in remineralizing white spot lesions in patients after FA therapy without side effects.

Efficacy of pulpotomy in managing irreversible pulpitis in mature permanent teeth: A systematic review and meta-analysis

OBJECTIVES

This paper evaluated the success rates of pulpotomy, compared its efficacy with non-surgical root canal treatment (NSRCT), evaluated different pulpotomy techniques, and analyzed the effectiveness of contemporary bioactive materials in managing irreversible pulpitis in mature permanent teeth.

DATA SOURCES

A comprehensive literature search was conducted across multiple databases including PubMed, Web of Science, Scopus, and the Cochrane Library. Search was conducted from the inception of each database to the present, adhering to PRISMA 2020 guidelines.

STUDY SELECTION

Studies were selected through a multi-step screening process, focusing on adult populations, randomized controlled trials, and single-arm trials.

DATA

Fifteen randomized controlled trials and eight single-arm trials were included. For a follow-up period of more than 24 months, pooled clinical success rate of pulpotomy was 92.9 % (95 %CI;82.1-99.0 %), whereas pooled radiographic success rate was 78.5 % (95 %CI;66.7-88.4 %). Meta-analyses showed that there was no significant difference in success rates between pulpotomy and NSRCT, between full and partial pulpotomy techniques, or between Mineral Trioxide Aggregate pulpotomy and Calcium Enriched Mixture pulpotomy. The results indicated comparable efficacy across these variables.

CONCLUSIONS

The study highlights the potential of less invasive treatments. Pulpotomy may be a viable alternative to NSRCT for managing irreversible pulpitis in mature permanent teeth. Limitations such as the low quality of some single-arm trials and the high risk of bias in some randomized controlled trials highlight the need for further research to standardize methodologies and broaden literature inclusion for a more comprehensive understanding of the efficacy of pulpotomy, considering the high success rates reported. Clinical Significance This quantitative systematic review recognizes the potential of full or partial pulpotomy as a viable treatment alternative to root canal therapy for managing irreversible pulpitis in mature permanent teeth. Future studies should aim for standardized protocols to validate these findings and improve patient treatment outcomes.

The Assessment of Resin-Based Composite Sealants' Effectiveness in Arresting Non-Cavitated Dentin Carious Lesions (ICDAS 3)-A 12 Month Follow-Up Preliminary Study

Background and Objectives: The therapeutic management of carious lesions remains a significant focus for researchers, given their persistently high prevalence despite being largely preventable. This study aimed to compare the effectiveness of a composite resin-based sealant material in halting extended non-cavitated dentin carious lesions when used therapeutically versus preventively on caries-free teeth over a period of twelve months. Materials and Methods: out of the 236 children examined, 45 were excluded from the study due to non-compliance with the inclusion criteria. Thus, the study included 191 children aged 10-12 years, and 764 molars in total. Results: among these molars, 171 were caries-free (ICDAS II code 0), forming the Control group, while 180 molars were classified with an ICDAS II score of 3, forming the Study group. All molars were sealed and evaluated at 6- and 12-month follow-up intervals. Both intervals revealed statistically significant differences (p < 0.05) in sealant retention and carious lesion development between sound (ICDAS code 0) and decayed (ICDAS code 3) teeth. Conclusions: the findings did not support the effectiveness of sealants in halting non-cavitated dentin carious lesions classified as ICDAS II with code 3 compared to their preventive application in sound teeth classified as ICDAS II with code 0.

Ozone Treatment for the Management of Caries in Primary Dentition: A Systematic Review of Clinical Studies

Dental caries in children is a frequent and debilitating condition, whose management is often challenging. The aim of this systematic review was to investigate the effectiveness of ozone applications for the treatment of caries in primary dentition. According to PRISMA guidelines, a systematic literature search was performed up to 6 January 2024. Clinical studies using ozone to treat caries of deciduous teeth were considered for inclusion. Out of the 215 records retrieved, seven studies were eventually included in the review, all of which used gaseous ozone. Four studies were judged at high risk of bias, two at low risk, and one of some concerns. The great heterogeneity of designs, outcomes, and protocols made it impossible to conduct a meta-analysis. Despite some limitations, the evidence yielded by the included studies suggests that ozone application, regardless of the protocol applied, is comparable to other interventions in terms of clinical outcomes and anti-bacterial activity, with no reported adverse effects and good patient acceptance. Therefore, ozone application may be a non-invasive approach to treat caries in primary dentition, especially in very young and poorly cooperative patients. Further standardized and rigorous studies are, however, needed to identify the best clinical protocols for this specific field.

Current trends in placing posterior composite restorations: Perspectives from Palestinian general dentists: A questionnair study

Aim

The success of composite restorations relies on material selection and practitioner-related factors that shape the overall outcome. This study explores the practices of Palestinian general dental practitioners in placing posterior composites, examining the impact of work sector, experience, and gender on their choices.

Materials and Methods

The study was conducted as an online cross-sectional questionnaire and involved 351 participants, with a response rate of 69.8%. The survey comprised 18 closed-ended questions covering demographics, material selection, and composite placement in special cases, techniques, and factors influencing the choices. Statistical analyses included descriptive statistics, chi-squared tests, and Fisher's exact tests.

Results

Composite was the predominant choice for small-size (83.7%) and large-size posterior cavities (60.4%). Practitioners commonly opted for composite restorations in cases involving occlusal parafunctional activity (60%), poor oral hygiene (78%), and subgingival cavities (72.2%). Only 19.6% and 5.3% reported occlusal and gingival beveling, respectively. Rubber dams for isolation stood at 30%, one-step self-etch adhesives at 44.9%, and the oblique layering technique at 51%. Light-emitting diode curing units were popular (97.55%), but monitoring output with a radiometer was infrequent (93.5%). Tofflemire metal matrix usage was 46.1%, whereas a sectional matrix system was employed by 29.8%. A 2 mm layer exposure to light curing for 20 s was reported by 62%, and 27.75% utilized additional light-curing postmatrix band removal.

Conclusion

The study highlights the need for Palestinian dental professionals to update their clinical approaches in placing composite restorations in posterior teeth. Gender, work sector, and experience influence practitioners' choices, emphasizing the importance of tailored continuing education programs for improving clinical practices.

The effect of preprocedural mouthrinses against COVID-19 before acid etching on the microleakage of a resin-based sealant in permanent molars: An in vitro experimental study

Aim

To determine whether rinsing with preprocedural mouthrinses against coronavirus disease before acid etching affects resin-based sealant microleakage.

Materials and Methods

A presented in vitro experimental study was performed on 15 extracted permanent third molars. Samples were randomly allocated into five groups: Group 1-distilled water (control); Group 2-1% hydrogen peroxide; Group 3-1.5% hydrogen peroxide; Group 4-0.5% povidone-iodine; and Group 5-1% povidone-iodine. After the teeth were immersed in the assigned mouth rinses for 60 s, they were sealed with Concise™ white sealant. Subsequently, the teeth were thermocycled for 500 cycles, immersed in 2% methylene blue solution for 24 h, and sectioned with two parallel cuts in the buccolingual direction. Sixty surfaces (12 surfaces in each group) were examined for microleakage under a 40× light microscope and scored as described by Zyskind et al. Welch's one-way analysis of variance test and the Games-Howell test were used to analyze the results at a significance level of P < 0.05 for all tests.

Results

The intergroup comparisons indicated that the 0.5% povidone-iodine group and the 1% povidone-iodine group had significantly higher microleakage compared with the control group. The 1% and 1.5% hydrogen peroxide groups demonstrated no significant difference in mean microleakage scores compared with the control group. There was no significant difference between the povidone groups and the hydrogen peroxide groups.

Conclusions

Preprocedural rinsing with 0.5% and 1% povidone-iodine before acid etching caused higher microleakage of resin-based sealant, while hydrogen peroxide rinsing gave comparable microleakage compared with the control group.

Effect of 38% silver diamine fluoride on fracture resistance of leucite reinforced feldspathic ceramic CAD/CAM class I inlay restorations

INTRODUCTION

Silver diamine fluoride (SDF) is a topical agent that has recently gained popularity for its ability to stop and prevent dental caries.

Bromelain: a review of its mechanisms, pharmacological effects and potential applications

The utilization of plant-derived supplements for disease prevention and treatment has long been recognized because of their remarkable potential. Ananas comosus, commonly known as pineapple, produces a group of enzymes called bromelain, which contains sulfhydryl moieties. Recent studies have shown that bromelain exhibits a wide range of activities, including anti-inflammatory, anti-diabetic, anti-cancer, and anti-rheumatic properties. These properties make bromelain a promising drug candidate for the treatment of various diseases. The anti-inflammatory activity of bromelain has been shown to be useful in treating inflammatory conditions such as osteoarthritis, rheumatoid arthritis, and asthma, whereas the anti-cancer activity of bromelain is via induction of apoptosis, inhibition of angiogenesis, and enhancement of the body's immune response. The anti-diabetic property of bromelain is owing to the improvement in glucose metabolism and reduction in insulin resistance. The therapeutic potential of bromelain has been investigated in numerous preclinical and clinical studies and a number of patents have been granted to date. Various formulations and delivery systems are being developed in order to improve the efficacy and safety of this molecule, including the microencapsulated form to treat oral inflammatory conditions and liposomal formulations to treat cancer. The development of novel drug delivery systems and formulations has further ameliorated the therapeutic potential of bromelain by improving its bioavailability and stability, while reducing the side effects. This review intends to discuss various properties and therapeutic applications of bromelain, along with its possible mechanism of action in treating various diseases. Recent patents and clinical trials concerning bromelain have also been covered.

Assessing the Acceptability of Less Invasive Caries Removal Techniques for treating Deep Carious Lesions: A Conjoint Survey among Dentists Practicing in a Midwestern American State

This study identified factors that influence dentists' decisions regarding less invasive caries removal techniques such as stepwise removal (SW) and selective removal (SE) using a marketing research technique, conjoint analysis. A survey was sent to 1,434 dentists practicing in Iowa. Dentists were randomly assigned to receive a questionnaire to rate the likelihood they would use either SW/SE in hypothetical clinical scenarios. The scenarios were carefully created by conjoint design and included three relevant attributes: depth of lesion, hardness of carious dentin, and patient age. Descriptive and conjoint analyses were performed to assess trade-offs between these attributes, using SPSS. The study revealed that depth of lesion was the most important factor in the dentists' decisions (49 importance value) when choosing a SW to treat a deep carious lesion, followed by hardness of carious dentin and patient age (21 importance value). For the SE group, depth of the lesion was also the predominant factor when selecting a treatment. The study also identified that a high proportion of dentists (24.9%) indicated they would never consider using SW or SE under any circumstances. Our survey showed that depth of lesion was the most important reason to select a less invasive caries removal method. The high proportion of dentists indicating they would never consider selective caries removal (SE) techniques suggests that these less invasive options are underutilized.

Efficacy of ClinproTMXT Varnish surrounding brackets on the enamel surface of white spot lesion

Orthodontics patients usual develop demineralization and present cavity caries lesions after six months. Minimally invasive procedures have been the goal in modern dental practice. The aim of this study was to evaluate the effect of ClinproTMXT Varnish, on the enamel surface roughness and severity of white spot lesions. Twenty premolars were submitted to bond brackets and experimental induction of demineralization and randomly divided into 2 groups: GI - fluoride varnish (Colgate Duraphat®); GII - Ionomeric Sealant (ClinproTMXT Varnish). The treatment was applied around the brackets. The surface roughness of specimens was analyzed, before treatment and 12 weeks after treatment by laser confocal microscopy, and the severity of the white spot lesion was by laser fluorescence device. The data were analyzed by non-parametric Wilcoxon and Mann-Whitney Test, at 5% significance, roughness percentage reduction was performed. The severity of demineralization decreased in both, GI (p = 0.005) and GII (p = 0.019). Enamel superficial roughness levels decreased in GI and GII. As well as the roughness percentage, being more expressive in the ClinproTMXT Varnish group (85,09%). Colgate Duraphat® or Clinpro™ XT Varnish reduced the severity of the demineralization and decreased the superficial roughness on the enamel. The Clinpro™ XT Varnish was superior to superficial roughness on enamel.

Repeated Etching Cycles of Resin Infiltration up to Nine Cycles on Demineralized Enamel: Surface Roughness and Esthetic Outcomes-In Vitro Study

Resin infiltration (RI) is used to mask enamel opacities. There are three recommended etching cycles. However, anecdotal evidence suggests that favorable esthetics outcomes can be obtained by increasing the etching cycles. This study aimed to evaluate the effects of repeated etching cycles during RI application on esthetic changes and surface roughness of demineralized enamel at multiple treatment stages. Artificial demineralization was prepared on the buccal surface of ninety sound extracted premolars. The teeth were divided into nine groups (n = 10); with each consecutive group having one additional etching cycle up to nine etching cycles. Resin infiltrant was performed twice, first for 3 min (Resin 1) and again for 1 min (Resin 2). Surface roughness and esthetic changes were assessed using a profilometer (Ambios XP-200) and Minolta spectrophotometer, respectively, at baseline (sound enamel), etching, resin 1, resin 2, 7 days, and 28 days post resin applications. Data were analyzed with two-way ANOVA (p < 0.05). There was a significant interaction between the different stages and various groups of etching cycles on surface roughness, F(48, 126) = 3.48, p < 0.001. There was a significant interaction between the different stages and various groups of etching cycles on color changes, F(4, 126) = 1.177, p = 0.045. The surface roughness of demineralized enamel infiltrated with RI was less than that of sound enamel (baseline). There is a significant difference in color changes between resin 1 and resin 2 (p < 0.05). After five etching cycles, RI improved the esthetic of the color of teeth similar to the baseline. Surface roughness and color changes remained constant for 28 days. RI can be considered an effective and predictable treatment option for the restoration of early enamel lesions owing to its better surface characteristics and reliable masking effects. The color stability and surface roughness stay unaltered for up to 28 days.

Number of Teeth and Denture Use Are Associated with Frailty among Chinese Older Adults: A Cohort Study Based on the CLHLS from 2008 to 2018

OBJECTIVES

The aim of this study was to determine the association between oral health and the development of frailty over a 10-year period in older Chinese adults.

DESIGN

This was a cohort study.

SETTING AND PARTICIPANTS

The data in this study were derived from the 2008, 2011, 2014 and 2018 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). The final analysis included 1155 older adults who had complete data for the Frailty Index (FI) and the other factors(oral health, sociodemographics, etc) that were analyzed in the study.

MEASUREMENTS

Frailty was assessed by the FI, which consists of 40 deficits(self-health assessments, diseases, physical functions,etc). Multivariable logistic regression was carried out to calculate the odds ratios (ORs) of the independent variables,which were obtained from investigator surveys and self-reports, in association with the development of frailty.

RESULTS

The prevalence of frailty at baseline was 22.94%, and the 10-year incidence of frailty was 24.16% (215/890). Age, number of natural teeth, use of dentures, toothache and sex were independent risk factors for frailty at baseline. After full adjustment, multivariate logistic regression analysis indicated that compared with having ≥21 teeth, edentulism (ORs 3.575; 95% CI 2.095,6.101) and partial tooth loss (ORs 2.448; 95% CI 1.592,3.766) were associated with progression to frailty. Compared with those with ≥21 teeth, those with <21 teeth and without dentures (ORs 2.617; 95% CI 1.713,3.999) were more likely to progress to frailty.

CONCLUSION

The loss of natural teeth is associated with the progression of frailty in older Chinese adults and denture using can help lower the odds of being frailty. Further research on maintain natural teeth and the appropriate use of dentures may help to establish effective frailty prevention strategies for the older adults.

Is It Mum or the Dad? Parental Factors That Influence the Use and Acceptance of Fluoride Varnish among Parents in Eastern Saudi Arabia

Objective

To investigate parental factors that influence knowledge, use, and acceptance of fluoride varnish (FLV) application.

Methods

This cross-sectional study was conducted during December 2021. A multistage sampling technique was used to recruit parents with children aged 3 to 6 years and residing in Eastern Saudi Arabia, excluding those working in the dental field. The questionnaire consisted of four parts: demographics, knowledge, previous experience, and acceptance of FLV and was pilot-tested and distributed online using social media.

Results

A total of 623 parents responded to the survey. Only 36.9% of parents had good FLV knowledge with dentists being the main source of information. Gender, educational level, family income, being in the medical field, and source of knowledge were factors that significantly (P < 0.05) influenced parental knowledge. Only 24.6% of the parents applied fluoride varnish to their children before, of whom only 29% were satisfied with the experience. Parent's FLV knowledge, view of dental visits, satisfaction with previous experience, perception of children's oral health, and willingness to reapply FLV were factors that significantly (P < 0.05) influenced FLV use. Working in the medical field, perception of dental visits, and the source of knowledge were factors that significantly (P < 0.05) influenced the parent's acceptance to apply FLV. While lack of knowledge about fluoride benefits (15%) was the main reason for parental refusal to apply FLV.

Conclusions

The current study highlights the lack of knowledge and application of FLV among parents. There were more factors influencing mothers' acceptance of FLV application compared to fathers. Age, educational level, working in the medical field, perception, and patterns of dental visits were some of the identified factors. Dentists played a major role in parental knowledge and FLV acceptance. In a country with high caries prevalence, preventive programs such as FLV education and application are crucial.

Assessment of Physical/Mechanical Performance of Dental Resin Sealants Containing Sr-Bioactive Glass Nanoparticles and Calcium Phosphate

The aim of this study was to assess the chemical/mechanical properties of ion-releasing dental sealants containing strontium-bioactive glass nanoparticles (Sr-BGNPs) and monocalcium phosphate monohydrate (MCPM). Two experimental sealants, TS1 (10 wt% Sr-BGNPs and 2 wt% MCPM) and TS2 (5 wt% Sr-BGNPs and 4 wt% MCPM), were prepared. Commercial controls were ClinproXT (CP) and BeautiSealant (BT). The monomer conversion (DC) was tested using ATR−FTIR (n = 5). The biaxial flexural strength (BFS) and modulus (BFM) were determined (n = 5) following 24 h and 7 days of immersion in water. The Vickers surface microhardness (SH) after 1 day in acetic acid (conc) versus water was tested (n = 5). The bulk and surface calcium phosphate precipitation in simulated body fluid was examined under SEM-EDX. The ion release at 4 weeks was analyzed using ICP-MS (n = 5). The DC after 40 s of light exposure of TS1 (43%) and TS2 (46%) was significantly lower than that of CP (58%) and BT (61%) (p < 0.05). The average BFS of TS1 (103 MPa), TS2 (123 MPa), and BT (94 MPa) were lower than that of CP (173 MPa). The average BFM and SH of TS1 (2.2 GPa, 19 VHN) and TS2 (2.0 GPa, 16 VHN) were higher than that of CP (1.6 GPa, 11 VHN) and BT (1.3 GPa, 12 VHN). TS1 showed higher Ca, P, and Sr release than TS2. Bulk calcium phosphate precipitation was detected on TS1 and TS2 suggesting some ion exchange. In conclusion, the DC of experimental sealants was lower than that of commercial materials, but their mechanical properties were within the acceptable ranges. The released ions may support remineralizing actions.

Efficacy of diode laser application versus silver diamine fluoride (SDF) as a modification of Hall technique in primary teeth

Background

The Hall technique is a new technique aimed at depriving bacteria of any substrate, thereby limiting the progression of caries. Silver diamine fluoride (SDF) and diode laser are documented to have an antibacterial effect on carious enamel and dentin by eradicating bacteria such as Streptococcus mutans.

Aim

The current study aimed to increase the success rate of the Hall technique in carious primary molars by eradicating bacteria present in carious lesions using SDF or diode laser in combination with the Hall technique.

Materials and methods

A total of 159 children aged 4-8 years were randomly divided into three equal groups: Group I, application of the Hall technique; Group II, SDF with Hall technique; Group III, diode laser with Hall technique. Children were recalled at regular intervals over a year. Results: At the end of the follow-up period, Group III showed the highest clinical success rate (94.3 %), followed by Group II (96.2 %), while Group I showed the lowest clinical and radiographic success rates (88.7 % and 86.8 %, respectively); however, these differences were statistically non-significant.

Conclusion

Treatment of carious lesions using SDF or Diode Laser increased the success rate of the Hall technique in primary teeth.

Development of a Hybrid Biomimetic Enamel-Biocomposite Interface and a Study of Its Molecular Features Using Synchrotron Submicron ATR-FTIR Microspectroscopy and Multivariate Analysis Techniques

Using a biomimetic strategy and bioinspired materials, our work proposed a new technological approach to create a hybrid transitional layer between enamel and dental biocomposite. For this purpose, an amino acid booster conditioner based on a set of polar amino acids (lysine, arginine, hyaluronic acid), calcium alkali, and a modified adhesive based on BisGMA and nanocrystalline carbonate-substituted hydroxyapatite are used during dental enamel restoration. The molecular properties of the hybrid interface formed using the proposed strategy were understood using methods of multivariate statistical analysis of spectral information collected using the technique of synchrotron infrared microspectroscopy. The results obtained indicate the possibility of forming a bonding that mimics the properties of natural tissue with controlled molecular properties in the hybrid layer. The diffusion of the amino acid booster conditioner component, the calcium alkali, and the modified adhesive with nanocrystalline carbonate-substituted hydroxyapatite in the hybrid interface region creates a structure that should stabilize the reconstituted crystalline enamel layer. The developed technology can form the basis for an individualized, personalized approach to dental enamel restorations.

[The dentobiome and the minimum intervention in dentistry]

All of us who observe the chilling figures of children with dental caries on a daily basis and more recently the more frequent presence of enamel alterations and among them incisor molar hypomineralization, we begin to think what really happens with that tissue considered the strongest. of the human body; however, it bows down to an acid attack resulting from bacterial metabolism. And the question arises: Could it be that the tooth is already born with a predisposition to develop certain microorganisms? This comprehensive review of the literature, summarizing the authors' perspectives; aims to explore the knowledge about the biome and apply it to the dental organ and make available the definition of dentobiome, as an appropriate term for dental flora. Starting from this knowledge, apply it to better understand today the execution of the philosophy of minimal intervention and the development of materials that must be biocompatible with the dental structure but must also prevent dysbiosis and establish homeostasis in the tooth.

Assessment of Sodium Diamine Fluoride (SDF) with Light Curing Technique: A Pilot Study of Antimicrobial Effects

Silver diamine fluoride (SDF) has been useful in clinical dentistry for the purpose of caries arrest and prevention. Although methods for the application of SDF are well-known among dental professionals, such as microbrush applications, few studies have explored the effect of light curing, which accelerates precipitation onto dentin, and whether this has any effect on the antimicrobial properties of SDF. To assess this technique, single (Streptococcus gordonii) and polymicrobial (mixed salivary) colonies were grown and plated using SDF applied to hydroxyapatite discs with and without treatment with curing light. Kirby-Bauer Zone of Inhibition assay results revealed no significant differences in the areas between the two treatment groups (SDF: 1.27 mm, SDF plus curing light: 1.25 mm), p = 0.887 in the single culture (S. gordonii) experiments. In addition, no significant differences were found between the two treatment groups (SDF: 1.26 mm, SDF plus curing light: 1.24 mm), p = 0.771 in the polymicrobial culture experiments. Although there may be specific properties associated with SDF induced following light curing, these differences do not appear to be associated with the antimicrobial properties affecting gram-positive or polymicrobial films.

Review of Professionally Applied Fluorides for Preventing Dental Caries in Children and Adolescents

This review aims to evaluate the effectiveness of professional topical fluoride application on the prevention of dental caries in primary and permanent dentition. A web search was conducted for English papers published from 2000 to 2020, using various digital resources (Pubmed, Google Scholar, Cochrane Library, and ResearchGate). The keywords were “professionally applied fluoride”, “fluoride gel”, “fluoride varnish”, “fluoride foam”, “fluoride mouthrinses”, and “non-cavitated caries lesions”. Inclusion criteria: (a) participants: children and adolescents, treated in a dental care setting; (b) intervention: professionally applied fluorides (gel, varnish, foam, mouthrinse); (c) comparator: no professional treatment or other preventive treatments; (d) outcomes: clinical effectiveness (e.g., caries reduction, tooth remineralization); (e) study design: randomized controlled trials, systematic reviews, meta-analyses; (f) publication period: 1 January 2000–31 December 2021. Clinical studies about home-use fluoride products, discussion papers, in-vitro studies, case reports, non-English articles, and studies with unclear methodology were excluded. Topical fluoride applications are indicated for patients with active smooth surface caries and for patients in high caries risk groups. Both APF gel and fluoride varnish are effective and can be recommended for caries prevention in primary and permanent teeth. For children under the age of 6, only 2.26% fluoride varnish is recommended.