Deep Carious Lesions Management with Stepwise, Selective, or Non-Selective Removal in Permanent Dentition: A Systematic Review of Randomized Clinical Trials

Effects of Er,Cr:YSGG Laser Disinfection on the Bond Strength of Bioactive-Restorative Materials to Caries-Affected Dentin

Objective: This study aimed to evaluate the effects of different Er,Cr:YSGG laser disinfection protocols on the bonding performance of bioactive restorative materials to caries-affected dentin (CAD). Background: With the adoption of minimally invasive caries removal techniques, bonding to CAD has become increasingly important. Adhesion challenges caused by CAD can be overcome through the application of effective disinfection methods and the selection of compatible bioactive restorative materials. Methods: A total of 120 human third molars (240 specimens) were prepared, with dentin surfaces exposed under water cooling. After pH-cycling to simulate CAD, specimens were assigned to four disinfection groups: no disinfection (C), 2% chlorhexidine gluconate (CHX), Er,Cr:YSGG laser at 0.5 W (L1), and 1 W (L2). Four restorative materials (n = 12 per group)-G-ænial Achord (a resin composite used as the control group), Equia Forte HT, Beautifil-II Restorative, and Cention Forte-were applied according to manufacturers' instructions. Shear bond strength (SBS) testing was conducted on 192 specimens, while energy-dispersive spectroscopy (EDS) analyzed F, P, and Ca on 48 specimens, and scanning electron microscopy images were obtained from representative specimens. Results: CHX disinfection significantly improved SBS compared to the control group. Among restorative materials, G-ænial Achord showed the highest SBS, while Equia Forte HT demonstrated the lowest (p < 0.05). L1 disinfection combined with G-ænial Achord achieved the highest bond strength, whereas its combination with Equia Forte HT resulted in the lowest (p < 0.05). EDS revealed increased fluoride content on CAD surfaces treated with CHX. Conclusion: Er,Cr:YSGG laser disinfection at 0.5W improved bonding performance for resin composites. Selecting a disinfection protocol based on the restorative material is crucial for optimizing adhesion to CAD.

Effect of photobiomodulation and selective caries removal in deep cavities on postoperative sensitivity, pulp vitality and dentin neoformation: randomized clinical trial and tomographic evaluation

OBJECTIVES

This randomized clinical trial aimed to evaluate the effect of selective caries removal in deep cavities of posterior teeth associated or not by photobiomodulation (PBM) on postoperative sensitivity, pulp vitality, and dentin neoformation.

MATERIALS AND METHODS

Twenty seven permanent molars with deep Class I cavities were allocated into three groups (n = 9): selective caries removal (Control), selective caries removal followed by infrared (IR; 810 nm) or red (R; 660 nm) laser irradiation. After the cavities were restored with a two-step self-etch adhesive and composite layers, the participants scored their tooth sensitivity perception on a visual analogue scale, as well as after 1, 3, and 6 months. Two teeth per group were randomly selected for cone beam computed tomography (CBCT) scanning upon restoration and after 6 months to evaluate the thickness, mineralization density, and area of neoformed dentin. The sensitivity scores among groups were statistically analyzed by the Friedman test (p < 0.05) while dentin neoformation aspects were descriptively compared.

RESULTS

All teeth remained vital, and the sensitivity mean scores were not significantly different among groups (p < 0.05). Most of the CBCT sections revealed dentin neoformation in all groups. The mineralization density of affected dentin and the remaining dentin area increased in all groups, albeit higher values were found in IR and R groups.

CONCLUSION

Selective removal of infected dentin followed by mild self-etch adhesive application and composite restoration was effective in maintaining pulp vitality, attenuating postoperative sensitivity, and dentin neoformation after 6 months. PBM therapy improved the mineralization density and area of neoformed dentin.

CLINICAL RELEVANCE

Selective caries removal in deep cavities is a regenerative, effective, safe, and simplified treatment that can be combined with photobiomodulation therapy to optimize dentin neoformation.

Assessment of Endocyn on Dental Pulp Stem Cells (DPSCs): A Pilot Study of Endodontic Irrigant Effects

Many endodontic procedures within the pediatric population are performed with patients aged 12 years and older, using intracanal irrigants to complement mechanical debridement for the removal of debris and to disinfect the root canal system. The use of antimicrobial irrigants that limit damage to the dental pulp are the goals of endodontic biomaterials research. Using an existing biorepository of dental pulp stem cells (DPSCs), Endocyn was evaluated in varying concentrations in proliferation and viability assays, and compared with positive (sodium hypochlorite or bleach) and negative (phosphate-buffered saline) controls. The DPSC viability was reduced in the range of -8.3% to -15.8%, p = 0.22 to p = 0.042, while the growth inhibition varied between -29.7% and -63%, p = 0.041 to p = 0.022. However, the RNA analysis revealed that no significant changes in biomarker mRNA expression (Nestin, NANOG, Sox2, Oct4, CD73, CD90, and CD105) were observed. These data demonstrated that all of the concentrations of Endocyn inhibited the DPSC viability and growth, although only high concentrations were statistically significant. Moreover, the administration of Endocyn did not alter the DPSC biomarker expression, which are novel and important findings not previously observed or reported that may assist with the development of clinical decision protocols and methods for the treatment of vital pulp tissue.

Effect of Liners on Pulpal Outcome After Partial Caries Removal in Permanent Teeth: A Systematic Review and Meta-Analysis

Partial caries removal reduces the risk of pulp exposure while preserving the tooth structure that is otherwise unnecessarily lost during the cavity preparation. Liners are applied on the dentinal floors to induce the formation of tertiary dentin that effectively blocks the stimuli from reaching the pulp. The present systematic review was conducted to evaluate the effect of liners on pulp vitality after partial caries removal in permanent teeth. This systematic review followed the resources of evidence-based medicine such as the Cochrane Handbook and was conducted as per PRISMA guidelines. The PICOS strategy was designed and included patients with deep carious lesions in permanent teeth with and without application of liner after partial caries removal, with pulp vitality assessment at one year. After applying the inclusion and exclusion criteria, four articles were selected after an initial list of 750 articles. The results of meta-analysis indicated that there was no statistically significant difference between intervention and control groups (OR=1.440; 95% CL= 0.812 to 2.552; P=0.212). According to the Risk of Bias 2 tool, all four studies were classified as "low risk." Certainty of evidence was moderate as per GRADE (Grading of Recommendations, Assessment, Development, and Evaluations). Partial caries removal with and without a liner had similar outcomes on pulp vitality at one year follow up. Role of a liner remains controversial in partial caries removal therapy. On the basis of this systematic review and meta-analysis, it may be inferred that treatment success, as defined by continued pulp vitality, is independent of liner application.

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

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of select 2023 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertize in their subject areas that include (in order of appearance here): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine, oral and maxillofacial surgery, and oral radiology; and dental caries and cariology. The authors have focused their efforts on presenting information likely to influence the daily dental treatment decisions of the reader with an emphasis on current innovations, new materials and processes, emerging technology, and future trends in dentistry. With the overwhelming volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to inform and update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope readers find this work helpful in providing evidence-based care to patients seeking healthier and happier lives.

Selective Caries Removal: A Case Report with 21-Year Follow-Up

Dental caries remains the most prevalent chronic disease globally, and its management should adhere to the principles of minimal intervention dentistry. This study reports a series of successful cases involving the selective removal of carious tissue in permanent molars, with follow-up periods of up to 21 years. Six permanent molars with severe and deep carious lesions were treated with selective caries removal and restored with high-viscosity glass ionomer cement. Clinical examination revealed that the teeth were free from pain and sensitivity. Follow-up assessments were conducted at 7 and 21 years posttreatment. Treatment success was defined by the absence of clinical and radiographic signs, symptoms of pulp alterations, and lesion arrest. Successful minimally invasive approaches were observed with selective removal of carious tissue and maintenance of pulp vitality for up to 21 years.

Evaluating Glass Ionomer Cement Longevity in the Primary and Permanent Teeth-An Umbrella Review

The aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner's ability, each case analysis, and the patient's wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition.

A Comprehensive Evaluation of Zirconia-Reinforced Glass Ionomer Cement's Effectiveness in Dental Caries: A Systematic Review and Network Meta-Analysis

Dental cements are in a constant state of evolution, adapting to better align with the intricacies of tooth structure and the dynamic movements within the oral cavity. This study aims to evaluate the efficacy of zirconia-reinforced glass ionomer cement-an innovative variant of modified glass ionomer cements-in terms of its ability to withstand compressive forces and prevent microleakage during dental caries reconstruction. An extensive search was conducted across various databases, encompassing PubMed-MEDLINE, Scopus, Embase, Google Scholar, prominent journals, unpublished studies, conference proceedings, and cross-referenced sources. The selected studies underwent meticulous scrutiny according to predetermined criteria, followed by the assessment of quality and the determination of evidence levels. In total, 16 studies were incorporated into this systematic review and network meta-analysis (NMA). The findings suggest that both compomer and giomer cements exhibit greater compressive strength and reduced microleakage values than zirconia-reinforced glass ionomer cement. In contrast, resin-modified glass ionomer cement (RMGIC) and high-viscosity glass ionomer cement (GIC) demonstrate less favorable performance in these regards when compared with zirconia-reinforced glass ionomer cement.