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Amend S, Boutsiouki C, Winter J, Kloukos D, Frankenberger R, Krämer N. Clinical effectiveness of pit and fissure sealants in primary and permanent teeth of children and adolescents: an umbrella review. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00876-9. [PMID: 38488955 DOI: 10.1007/s40368-024-00876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/24/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE This umbrella review aimed to critically appraise the evidence published in systematic reviews (SRs) on the clinical effectiveness of sealants compared with each other/the non-use in primary/permanent teeth of children and adolescents with at least 12-month follow-up. METHODS A systematic literature search on 4 electronic databases was conducted up to January 18th, 2023. Following handsearching, two review authors independently screened retrieved articles, extracted data, and assessed the risk of bias (RoB) using the risk of bias in systematic reviews (ROBIS) tool. Based on a citation matrix, the overlap was interpreted by the corrected covered area (CCA). RESULTS Of 239 retrieved records, 7 SRs met the eligibility criteria with a moderate overlap among them (CCA = 7.4%). For primary molars, in 1120 1.5- to 8-year-old children, data on the clinical effectiveness of sealants were inconclusive. For permanent molars, 3 SRs found a significant caries risk reduction for sealants versus non-use (≤ 36-month follow-up). There was insufficient evidence to proof superiority of sealants over fluoride varnish for caries prevention (3 SRs), and to rank sealant materials according to the best clinical effectiveness in permanent molars. One study was rated at low and 6 at high RoB, which did not allow for a valid quantitative synthesis. CONCLUSION Considering the limitations of this umbrella review, sealants are more effective for caries prevention in children's permanent molars compared to no treatment. Future well-implemented RCTs are needed to draw reliable conclusions on the clinical effectiveness of sealants in primary and permanent teeth of children and adolescents.
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Affiliation(s)
- S Amend
- Department of Paediatric Dentistry, Medical Centre for Dentistry, University Medical Centre Giessen and Marburg (Campus Giessen), Justus-Liebig-University Giessen, Schlangenzahl 14, 35392, Giessen, Germany.
| | - C Boutsiouki
- Department of Paediatric Dentistry, Medical Centre for Dentistry, University Medical Centre Giessen and Marburg (Campus Giessen), Justus-Liebig-University Giessen, Schlangenzahl 14, 35392, Giessen, Germany
| | - J Winter
- Department of Operative Dentistry, Endodontics and Paediatric Dentistry, Medical Centre for Dentistry, University Medical Centre Giessen and Marburg (Campus Marburg), Philipps-University Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Freiburgstr. 7, 3008, Bern, Switzerland
| | - R Frankenberger
- Department of Operative Dentistry, Endodontics and Paediatric Dentistry, Medical Centre for Dentistry, University Medical Centre Giessen and Marburg (Campus Marburg), Philipps-University Marburg, Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - N Krämer
- Department of Paediatric Dentistry, Medical Centre for Dentistry, University Medical Centre Giessen and Marburg (Campus Giessen), Justus-Liebig-University Giessen, Schlangenzahl 14, 35392, Giessen, Germany
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Duggal M, Gizani S, Albadri S, Krämer N, Stratigaki E, Tong HJ, Seremidi K, Kloukos D, BaniHani A, Santamaría RM, Hu S, Maden M, Amend S, Boutsiouki C, Bekes K, Lygidakis N, Frankenberger R, Monteiro J, Anttonnen V, Leith R, Sobczak M, Rajasekharan S, Parekh S. Best clinical practice guidance for treating deep carious lesions in primary teeth: an EAPD policy document. Eur Arch Paediatr Dent 2022; 23:659-666. [PMID: 36219336 PMCID: PMC9637614 DOI: 10.1007/s40368-022-00718-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
Purpose The European Academy of Paediatric Dentistry (EAPD) has developed this best clinical practice guidance to help clinicians manage deep carious lesions in primary teeth. Methods Three expert groups conducted systematic reviews of the relevant literature. The topics were: (1) conventional techniques (2) Minimal Intervention Dentistry (MID) and (3) materials. Workshops were held during the corresponding EAPD interim seminar in Oslo in April 2021. Several clinical based recommendations and statements were agreed upon, and gaps in our knowledge were identified. Results There is strong evidence that indirect pulp capping and pulpotomy techniques, and 38% Silver Diamine Fluoride are shown to be effective for the management of caries in the primary dentition. Due to the strict criteria, it is not possible to give clear recommendations on which materials are most appropriate for restoring primary teeth with deep carious lesions. Atraumatic Restorative Technique (ART) is not suitable for multi-surface caries, and Pre-formed Metal Crowns (PMCs) using the Hall technique reduce patient discomfort. GIC and RMGIC seem to be more favourable given the lower annual failure rate compared to HVGIC and MRGIC. Glass carbomer cannot be recommended due to inferior marginal adaptation and fractures. Compomers, hybrid composite resins and bulk-fill composite resins demonstrated similar values for annual failure rates. Conclusion The management of deep carious lesions in primary teeth can be challenging and must consider the patient’s compliance, operator skills, materials and costs. There is a clear need to increase the use of MID techniques in managing carious primary teeth as a mainstream rather than a compromise option.
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Affiliation(s)
- M Duggal
- College of Dental Medicine, QU Health, Qatar University, Doha, Qatar
| | - S Gizani
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian, University of Athens, Athens, Greece
| | - S Albadri
- School of Dentistry, Unit of Oral Health, University of Liverpool, Liverpool, UK
| | - N Krämer
- Department of Paediatric Dentistry, Justus-Liebig University Gießen, Giessen, Germany
| | - E Stratigaki
- Department of Pediatric Oral Health and Orthodontics, University Center of Dental Medicine, Basel, Switzerland
| | - H J Tong
- Discipline of Orthodontics and Paediatric Dentistry, Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - K Seremidi
- Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian, University of Athens, Athens, Greece
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force and VA General Hospital, Athens, Greece
| | - A BaniHani
- Department of Paediatric Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - R M Santamaría
- Department of Preventive and Paediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - S Hu
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - M Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - S Amend
- Department of Paediatric Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen) Medical Centre for Dentistry, Schlangenzahl 14, 35392, Giessen, Germany
| | - C Boutsiouki
- Department of Paediatric Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen) Medical Centre for Dentistry, Schlangenzahl 14, 35392, Giessen, Germany
| | - K Bekes
- Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria
| | - N Lygidakis
- Lygidakis Dental Clinic (Private Dental Practice), 2 Papadiamantopoulou str. & Vasilissis Sofias Ave, 11528, Athens, Greece
| | - R Frankenberger
- Medical Centre for Dentistry, Department of Operative Dentistry and Endodontics, Phillips-University Marburg, University Medical Centre Giessen and Marburg (Campus Marburg), Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - J Monteiro
- Department of Paediatric Dentistry, Sheffield Teaching Hospitals, Sheffield, UK
| | - V Anttonnen
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - R Leith
- Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - M Sobczak
- Specialized Dental Practice, Warsaw, Poland
| | - S Rajasekharan
- Department of Paediatric Dentistry, School of Oral Health Sciences, Ghent University, B-9000, Ghent, Belgium
| | - S Parekh
- Department of Paediatric Dentistry, UCL Eastman Dental Institute, London, UK.
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Amend S, Boutsiouki C, Bekes K, Kloukos D, Lygidakis NN, Frankenberger R, Krämer N. Clinical effectiveness of restorative materials for the restoration of carious primary teeth without pulp therapy: a systematic review. Eur Arch Paediatr Dent 2022; 23:727-759. [PMID: 35819627 PMCID: PMC9637592 DOI: 10.1007/s40368-022-00725-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/22/2022] [Indexed: 01/04/2023]
Abstract
Purpose To systematically search the available evidence and evaluate the clinical effectiveness of restorative materials for restoration of carious primary teeth. The findings aimed to support the European Academy of Paediatric Dentistry (EAPD) guidelines development. Methods Literature search was performed by searching 4 electronic databases for eligible randomised controlled clinical trials (RCTs) comparing restorative materials for the restoration of carious primary teeth up to December 28th, 2020. Quality assessment was performed with the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results Of 1685 identified articles 29 RCTs were finally deemed as eligible for inclusion. Annual failure rates were: Amalgam 1–28%; atraumatic restorative treatment 1.2–37.1%; glass-ionomer cement (GIC) 7.6–16.6%, metal-reinforced GIC 29.9%, resin-modified GIC 1.9–16.9%, high-viscosity GIC 2.9–25.6%; glass carbomer ≤ 46.2%; compomer 0–14.7%; composite resin (CR) 0–19.5%, bulk-fill CR 0–16.9%; zirconia crowns 3.3%, composite strip crowns 15%, and preformed metal crowns (Hall-Technique) 3.1%. Secondary caries, poor marginal adaptation, loss of retention, and fracture of restoration were reported as reasons for failure. Four studies were evaluated at unclear and 25 at high risk of bias. Clinical and methodological heterogeneity, and the diversity of tested materials across included studies did not allow for meta-analyses. Conclusions Within the limitations of this systematic review, namely, the heterogeneity and the overall high risk of bias among included studies, clear recommendations based on solid evidence for the best restorative approach in primary teeth cannot be drawn. There is a need for future thoroughly implemented RCTs evaluating restorations in primary teeth to close this knowledge gap. Supplementary Information The online version contains supplementary material available at 10.1007/s40368-022-00725-7.
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Affiliation(s)
- S Amend
- Department of Paediatric Dentistry, Medical Centre for Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen), Schlangenzahl 14, 35392, Giessen, Germany.
| | - C Boutsiouki
- Department of Paediatric Dentistry, Medical Centre for Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen), Schlangenzahl 14, 35392, Giessen, Germany
| | - K Bekes
- Department of Paediatric Dentistry, Medical University Vienna, University Clinic of Dentistry, Sensengasse 2a, 1090, Vienna, Austria
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - N N Lygidakis
- Lygidakis Dental Clinic (Private Dental Practice), 2 Papadiamantopoulou str. & Vasilissis Sofias Ave, 11528, Athens, Greece
| | - R Frankenberger
- Department of Operative Dentistry, Endodontology, and Paediatric Dentistry, Medical Centre for Dentistry, Phillips-University Marburg, University Medical Centre Giessen and Marburg (Campus Marburg), Georg-Voigt-Str. 3, 35039, Marburg, Germany
| | - N Krämer
- Department of Paediatric Dentistry, Medical Centre for Dentistry, Justus-Liebig-University Giessen, University Medical Centre Giessen and Marburg (Campus Giessen), Schlangenzahl 14, 35392, Giessen, Germany
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Kakali L, Giantikidis I, Sifakakis I, Kalimeri E, Karamani I, Mavrogonatou E, Kloukos D. Fluctuation of bone turnover markers' levels in samples of gingival crevicular fluid after orthodontic stimulus: a systematic review. Syst Rev 2022; 11:3. [PMID: 34983635 PMCID: PMC8725272 DOI: 10.1186/s13643-021-01860-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the present study was to provide an overview of gingival crevicular fluid (GCF) bone turnover markers (BTMs) concerning the physiology of orthodontic tooth movement (OTM) and assess their potential contributions to regulating bone remodeling, that could prove useful in designing future approaches to modulating orthodontic tooth movement. METHODS Multiple electronic databases (MEDLINE/PubMed, Ovid MEDLINE, Ovid Embase, LILACS, and Cochrane Library) were searched up to October 1st, 2020. Randomized controlled trials (RCTs), controlled clinical trials, observational studies of prospective and retrospective designs, and cross-sectional studies reporting on levels of BTMs in GCF were eligible for inclusion. The quality of the included RCTs was assessed per the revised Cochrane risk of bias tool for randomized trials (RoB 2.0), whereas the risk of bias of the included cohort studies was assessed using the Risk Of Bias In Non-randomized Studies of Interventions tool. RESULTS Five RCTs, 9 prospective cohort studies, and 1 cross-sectional study fulfilled the inclusion criteria. The risk of bias was deemed as high for the RCTs and 4 of the prospective studies and moderate for the rest of the studies. The following biomarkers for bone formation were assessed: bone alcaline phosphatase (BALP), alcaline phosphatase (ALP), and osteocalcin (OC). For bone resorption, the following BTMs were assessed: deoxypyridinoline (DPD) and pyridinoline (PYD), N-terminal telopeptide (NTX), osteopontin (OPN), and tartrate-resistant acid phosphatase (TRAP). The follow-up period ranged mainly from baseline to 45 days, although one study had an expanded follow-up period of up to 16 months. The results of the included studies comparing different BTMs were heterogeneous and qualitatively reported. CONCLUSIONS Current evidence continues to support the potential for BTMs to provide clinically useful information particularly for adjusting or standardizing the orthodontic stimulus. The present systematic review has retrieved studies of high, overall, risk of bias, and has unveiled a substantial clinical and methodological heterogeneity among included studies. Further data of the relationships between the clinical assays and the physiological or pre-analytical factors contributing to variability in BTMs' concentrations are required. SYSTEMATIC REVIEW REGISTRATION CRD42020212056 .
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Affiliation(s)
- L Kakali
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - I Giantikidis
- Department of Orthodontics and Dentofacial Orthopedics, 424 General Military Hospital, Thessaloniki, Greece
| | - I Sifakakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - E Kalimeri
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - I Karamani
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | - E Mavrogonatou
- Laboratory of Cell Proliferation and Ageing, Institute of Biosciences & Applications, National Centre for Scientific Research "Demokritos", Athens, Greece
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, 251 Hellenic Air Force & VA General Hospital, Athens, Greece. .,Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Bern, Switzerland.
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Bourouni S, Dritsas K, Kloukos D, Wierichs RJ. Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a systematic review and meta-analysis. Clin Oral Investig 2021; 25:4711-4719. [PMID: 34106348 PMCID: PMC8342329 DOI: 10.1007/s00784-021-03931-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The present review systematically analyzed clinical studies investigating the efficacy of resin infiltration on post-orthodontic or non-post-orthodontic, white spot lesions (WSL), or fluorosis. MATERIALS Five electronic databases (Central, PubMed, Ovid MEDLINE, Ovid EMBASE, LILACS) were screened. Article selection and data abstraction were done in duplicate. No language or time restrictions were applied. Outcomes were visual-tactile or DIAGNOdent measurements. RESULTS Eleven studies with 1834 teeth being affected in 413 patients were included. Nine studies were randomized control trials, one a prospective cohort study, and one had an unclear study design. Meta-analysis could be performed for "resin infiltration vs. untreated control," "resin infiltration vs. fluoride varnish," and "resin infiltration without bleaching vs. resin infiltration with bleaching." WSL being treated with resin infiltration showed a significantly higher optical improvement than WSL without any treatment (standard mean difference (SMD) [95% CI] = 1.24 [0.59, 1.88], moderate level of evidence [visual-tactile assessment]) and with fluoride varnish application (mean difference (MD) [95% CI] = 4.76 [0.74, 8.78], moderate level of evidence [DIAGNOdent reading]). In patients with fluorosis, bleaching prior to resin infiltration showed no difference in the masking effect compared to infiltration alone (MD [95% CI] = - 0.30 [- 0.98, 0.39], moderate level of evidence). CONCLUSION Resin infiltration has a significantly higher masking effect than natural remineralization or regular application of fluoride varnishes. However, although the evidence was graded as moderate, this conclusion is based on only very few well-conducted RCTs. CLINICAL RELEVANCE Resin infiltration seems to be a viable option to esthetically mask enamel white spot lesions and fluorosis.
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Affiliation(s)
- S Bourouni
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - K Dritsas
- Department of Orthodontics and Dentofacial Orthopedics, zmk bern, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, zmk bern, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - R J Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
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Kloukos D, Koukos G, Doulis I, Sculean A, Stavropoulos A, Katsaros C. Gingival thickness assessment at the mandibular incisors with four methods: A cross-sectional study. J Periodontol 2018; 89:1300-1309. [DOI: 10.1002/jper.18-0125] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/29/2018] [Accepted: 05/23/2018] [Indexed: 11/08/2022]
Affiliation(s)
- D. Kloukos
- Department of Orthodontics and Dentofacial Orthopedics; School of Dental Medicine; University of Bern; Switzerland
- 251 Hellenic Air Force and VA General Hospital; Athens Greece
| | - G. Koukos
- 251 Hellenic Air Force and VA General Hospital; Athens Greece
| | - I. Doulis
- Department of Orthodontics; Faculty of Dentistry; School of Health Sciences; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - A. Sculean
- Department of Periodontology; School of Dental Medicine; University of Bern
| | - A. Stavropoulos
- Department of Periodontology; Faculty of Odontology; Malmö University; Malmö Sweden
| | - C. Katsaros
- Department of Orthodontics and Dentofacial Orthopedics; School of Dental Medicine; University of Bern; Switzerland
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Kloukos D, Papageorgiou SN, Doulis I, Petridis H, Pandis N. Reporting quality of randomised controlled trials published in prosthodontic and implantology journals. J Oral Rehabil 2015; 42:914-25. [DOI: 10.1111/joor.12325] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2015] [Indexed: 11/29/2022]
Affiliation(s)
- D. Kloukos
- Department of Orthodontics and Dentofacial Orthopedics; Faculty of Medicine; University of Bern; Bern Switzerland
| | - S. N. Papageorgiou
- Department of Orthodontics; School of Dentistry; University of Bonn; Bonn Germany
- Department of Oral Technology; School of Dentistry; University of Bonn; Bonn Germany
- Clinical Research Unit 208; University of Bonn; Bonn Germany
| | - I. Doulis
- Department of Orthodontics and Dentofacial Orthopedics; 251 Hellenic Air Force V.A. General Hospital; Athens Greece
| | - H. Petridis
- Department of Restorative Dentistry; UCL Eastman Dental Institute; London UK
| | - N. Pandis
- Department of Orthodontics and Dentofacial Orthopedics; Faculty of Medicine; University of Bern; Bern Switzerland
- Private Practice; Corfu Greece
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Kloukos D, Züger J, Grossen J. Anwendungsmöglichkeiten von paramedian gesetzten Gaumenimplantaten in der kieferorthopädischen Behandlung. Inf Orthod Kieferorthop 2013. [DOI: 10.1055/s-0033-1334926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- D. Kloukos
- Klinik für Kieferorthopädie, Universität Bern, Schweiz
| | - J. Züger
- Klinik für Kieferorthopädie, Universität Bern, Schweiz
| | - J. Grossen
- Klinik für Kieferorthopädie, Universität Bern, Schweiz
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