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Sen Yavuz B, Kaya R, Kodaman Dokumacigil N, Ozgur EG, Bekiroglu N, Kargul B. Clinical performance of short fiber reinforced composite and glass hybrid on hypomineralized molars: A 36-month randomized split-mouth study. J Dent 2024; 144:104919. [PMID: 38431187 DOI: 10.1016/j.jdent.2024.104919] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES This study aimed to assess the clinical performance outcome at 36 months of molars with molar incisor hypomineralization and carious lesions, treated with two different restorative approaches following selective caries removal. METHODS The children aged 6 to 12 years (18 female, 13 male) included in the study had at least two carious permanent first molars diagnosed with molar incisor hypomineralization. Sixty-two molars were restored in a split-mouth design. In all subjects, selective caries removal was performed so that caries was completely removed from the cavosurface walls and only soft dentin was left above the pulp chamber. Short fiber reinforced composite (SFRC; EverX Flow™) covered by micro-hybrid composite (G-Aenial® posterior composite) and Glass Hybrid (GH; Equia Forte® HT) were used as restorative materials. The restorations were evaluated according to modified United States Public Health Service (USPHS) criteria at baseline, 6, 12, 18, 24, and 36 month follow-ups. RESULTS During the 36-month follow-up, eight GH and four SFRC restorations failed. The clinical success of both restorations decreased statistically over time (p < 0.001 for both). When variables such as restoration type, sex, age, tooth type, and time were included in the model, the risk of failure of the restorations of the left lower first molar was statistically significantly higher than that of the left upper first molar (p < 0.002). CONCLUSION Direct composite restorations with SFRC and GH restorations perform similar clinical success with selective caries removal in the management of permanent molars affected by molar incisor hypomineralization. CLINICAL SIGNIFICANCE SFRC or GH restorations with similar clinical success might be preferred for the management of MIH-affected molars.
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Affiliation(s)
- Betul Sen Yavuz
- Department of Pediatric Dentistry, Faculty of Dentistry, Marmara University, Basibuyuk yolu, 9/3, Maltepe, Istanbul 34854, Turkey.
| | | | - Nur Kodaman Dokumacigil
- Department of Pediatric Dentistry, Faculty of Dentistry, Marmara University, Basibuyuk yolu, 9/3, Maltepe, Istanbul 34854, Turkey
| | - Emrah Gokay Ozgur
- Department of Biostatistics, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nural Bekiroglu
- Department of Biostatistics, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Betul Kargul
- Department of Pediatric Dentistry, Faculty of Dentistry, Marmara University, Basibuyuk yolu, 9/3, Maltepe, Istanbul 34854, Turkey
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Weimann D, Fleck C, Razi H. Marginal integrity in minimally invasive molar resin composite restorations: Impact of polymerization shrinkage. J Mech Behav Biomed Mater 2024; 155:106554. [PMID: 38676971 DOI: 10.1016/j.jmbbm.2024.106554] [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: 01/29/2024] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES This study utilized non-linear finite element (FE) models to explore polymerization shrinkage and its impact on marginal integrity in molars following both selective caries removal (SCR) and conventional treatment. Specifically, we performed 2D in silico simulations to study residual stresses post-resin polymerization shrinkage and their influence on the marginal integrity of various restoration types. METHODS Initially, FE models were developed based on a cohesive zone framework to simulate crack propagation along the bonded interfaces between restoration and tooth structure in SCR-treated molars with class I and class II restorations. The modeled resin composite restorations first underwent polymerization shrinkage and were then subjected to various occlusal loading conditions. Stress magnitudes and distributions were identified to evaluate the margin integrity and predict the mechanism and location of interfacial failure. RESULTS AND DISCUSSION The FE models computed polymerization shrinkage stresses of less than 1 MPa, exerting a minor influence on the composite/tooth interface. Occlusal loading, however, significantly impacted the load-bearing capacity of the composite/tooth (c/t) interface, potentially jeopardizing the restoration integrity. Especially under bi-axial occlusal loading, interfacial debonding occurred in the vertical cavity walls of the class I restorations, increasing the risk of failure. Notably, SCR-treated teeth exhibited better margin integrity than restored teeth after complete caries removal (NCR). These findings provide valuable insights into the mechanical behavior of SCR-treated teeth under different loading conditions and highlight the importance of considering the load scenarios that may lead to failure at the c/t interface. By investigating the factors influencing crack initiation and delamination, this novel research contributes to the optimization of restorative treatments and aids in the design of more resilient dental restorations.
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Affiliation(s)
- Dominique Weimann
- Materials Science and Engineering, Technische Universität Berlin, Berlin, Germany
| | - Claudia Fleck
- Materials Science and Engineering, Technische Universität Berlin, Berlin, Germany.
| | - Hajar Razi
- ETH Zurich, Zurich, Switzerland; WoodTec Group, Cellulose & Wood Materials Laboratory, Empa, Dübendorf, Switzerland.
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Ahmed B, Wafaie RA, Hamama HH, Mahmoud SH. 3-year randomized clinical trial to evaluate the performance of posterior composite restorations lined with ion-releasing materials. Sci Rep 2024; 14:4942. [PMID: 38418863 PMCID: PMC10902344 DOI: 10.1038/s41598-024-55329-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
To evaluate the impact of using ion-releasing liners on the 3-year clinical performance of posterior resin composite restorations after selective caries excavation with polymer burs. 20 patients were enrolled in this trial. Each patient had two deep carious lesions, one on each side of the mouth. After selective caries removal using polymer bur (PolyBur P1, Komet, Brasseler GmbH Co. KG, Lemgo, Germany), cavities were lined with bioactive ionic resin composite (Activa Bioactive Base/Liner, Pulpdent, Watertown, MA, USA) or resin-modified glass ionomer liner (Riva Light Cure, SDI, Bayswater, Victoria, Australia). All cavities were then restored with nanofilled resin composite (Filtek Z350XT, 3M Oral Care, St. Paul, MN, USA). All the tested materials were placed according to the manufacturers' instructions. Clinical evaluation was accomplished using World Dental Federation (FDI) criteria at baseline and after 6 months, 1, 2, and 3 years. Data were analyzed using Mann-whitney U and Friedman tests (p < 0.05). The success rates were 100% for all resin composite restorations either lined with ion-releasing resin composite or resin-modified glass ionomer liner. Mann-whitney U test revealed that there were no statistically significant differences between both ion-releasing lining material groups for all criteria during the follow-up periods (p > 0.05). Resin composite restorations showed acceptable clinical performance over 3 years either lined with bioactive ionic or resin-modified glass ionomer liners after selective caries excavation preserving pulp vitality. After the 3-year follow-up period, Activa Bioactive and Riva Light Cure liners were clinically effective and they exhibited with the overlying composite restorations successful clinical performance.Trial registration number: NCT05470959. Date of registration: 22/7/2022. Retrospectively registered.
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Affiliation(s)
- Basma Ahmed
- Conservative Dentistry Department, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Gamasa, Egypt
| | - Ramy Ahmed Wafaie
- Conservative Dentistry Department, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Gamasa, Egypt
| | - Hamdi H Hamama
- Conservative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, 35516, Egypt.
- Faculty of Dentistry, New-Mansoura University, New-Mansoura, Egypt.
| | - Salah Hasab Mahmoud
- Conservative Dentistry Department, Faculty of Dentistry, Mansoura University, Mansoura, 35516, Egypt
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Miotti LL, Vissotto C, De Nardin L, de Andrades Manjabosco B, Tuchtenhagen S, Münchow EA, Emmanuelli B. Does the liner material influence pulpal vitality in deep carious cavities submitted to selective caries removal? A network meta-analysis review. Clin Oral Investig 2023; 27:7143-7156. [PMID: 37932637 DOI: 10.1007/s00784-023-05372-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To evaluate whether the restorative material in direct contact with the dentin influences pulp vitality in primary and permanent teeth with deep carious lesions restored after selective caries removal (SCR). MATERIAL AND METHODS Systematic searches of databases MEDLINE via PubMed, Scopus and ISI Web of Science were performed for primary and permanent teeth. Inclusion criteria were applied for title and abstract reading of databases search results. After full texts review of included studies, those that did not meet exclusion criteria were excluded from meta-analysis. RESULTS For meta-analysis, 2 studies were included for permanent teeth and 6 for primary teeth. The failure events reported were meta-analyzed using two statistical methods: standard pairwise meta-analysis (SPMA) and network meta-analysis (NMA). The SPMA identified similar failure occurrence of restorations performed with calcium hydroxide (CH) and other liner materials (RR 0.84, 95% CI 0.41, 1.74; p = 0.64), no significant difference between the use of alternative liners or CH regardless deciduous or permanent teeth (RR 0.79, 95% CI 0.36, 1.71; p = 0.55) and similar risk of failing at different follow-ups for all liner materials tested (RR 0.77, 95% CI 0.35, 1.70; p = 0.52). Probabilistic analysis indicated GIC as liner material with the highest probability of clinical success (SUCRA = 72.76%), and CH ranked as the worst liner material (SUCRA = 21.81%). CONCLUSION Pulpal vitality was not affected by material used as liner after selective caries removal in deep carious cavities. CLINICAL RELEVANCE Current clinical evidence supports the weak recommendation to not use calcium hydroxide as liner after SCR.
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Affiliation(s)
- Leonardo Lamberti Miotti
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil.
| | - Cariane Vissotto
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Letícia De Nardin
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Bianca de Andrades Manjabosco
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil
| | - Simone Tuchtenhagen
- Dentistry Department, Regional Integrated University of Alto Uruguai and Missões (URI), Erechim, Rio Grande Do Sul (RS), Brazil
| | - Eliseu Aldrighi Münchow
- Conservative Dentistry Department, Federal University of Rio Grande Do Sul (UFRGS), Ramiro Barcelos St., 2492, Porto Alegre, Rio Grande Do Sul (RS), 90035003, Brazil
| | - Bruno Emmanuelli
- Stomatology Department, Federal University of Santa Maria (UFSM), Santa Maria, Rio Grande Do Sul (RS), Brazil
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Ortega-Verdugo P, Warren JJ, Gaeth GJ, Carter K, Kateeb E, Kolker JL, Shane DM. 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. Caries Res 2023; 57:243-254. [PMID: 37699363 DOI: 10.1159/000533658] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/09/2023] [Indexed: 09/14/2023] Open
Abstract
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.
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Affiliation(s)
- Paula Ortega-Verdugo
- Section of Public and Population Health, The University of California, Los Angeles, California, USA
| | - John J Warren
- Department of Preventive and Community Dentistry, College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
| | - Gary J Gaeth
- College of Business, University of Iowa, Iowa City, Iowa, USA
| | - Knute Carter
- Department of Biostatistics, University of Iowa, Iowa City, Iowa, USA
| | - Elham Kateeb
- Oral Health Research and Promotion Unit, Al-Quds University, Jerusalem, Palestine
| | - Justine L Kolker
- College of Dentistry and Dental Clinics, Operative Dentistry, University of Iowa, Iowa City, Iowa, USA
| | - Dan M Shane
- Department of Health Management and Policy, Iowa City, Iowa, USA
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Gözetici-Çil B, Erdem-Hepşenoğlu Y, Tekin A, Özcan M. Selective removal to soft dentine or selective removal to firm dentine for deep caries lesions ın permanent posterior teeth: a randomized controlled clinical trial up to 2 years. Clin Oral Investig 2022; 27:2125-2137. [PMID: 36460919 PMCID: PMC9734731 DOI: 10.1007/s00784-022-04815-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/27/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES The aim of this randomized clinical trial was to compare selective removal to soft dentin (SRSD) and selective removal to firm dentin (SRFD) in permanent teeth. The primary outcome of the study was to compare the success rates of the two caries removal techniques. The secondary outcome of the study was to investigate whether or not calcium silicate-based material (CS) had an effect on the success rate of the treatment. MATERIALS AND METHODS Between November 2018 and March 2020, patients with deep caries lesions were invited to participate in the study. Posterior teeth (N = 165) with primary caries lesion radiographically extending ¾ of dentin and positive response to cold test were randomly selected. A total of 134 participants meeting the inclusion criteria were randomized to SRSD and SRFD (control) groups. After the caries removal procedure, teeth with exposed pulps were assigned to the pulp exposure (PE) group, and the SRSD group was further divided into test 1 (with CS) and test 2 groups (without CS). Success was defined as a positive response to the cold test, a negative response to percussion, the absence of pain, an abscess, a fistula, and periapical alterations. Fisher-Freeman-Halton exact tests, Kaplan-Meier survival analysis, and the log-rank tests were performed for comparisons between groups. RESULTS No statistically significant difference was found between the success rates of test 1 (100%) and test 2 (93.5%) groups, whereas the proportion of success in control (82.4%) and PE (84%) groups were significantly lower when compared with test groups (p = 0.024; p < 0.05) at the end of 2-year follow-up. CONCLUSIONS SRSD had a higher success rate when compared to SRFD to treat deep carious lesions after 2 years of follow-up. The use of CS material after SRSD as a liner had no effect on the treatment outcome. CLINICAL RELEVANCE SRSD with good coronal sealing might be recommended without CS application for the treatment of deep caries lesions in permanent teeth. TRIAL REGISTRATION Clinical trial registration number NCT04052685 (08/09/2019).
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Affiliation(s)
- Burcu Gözetici-Çil
- grid.411781.a0000 0004 0471 9346Department of Restorative Dentistry, School of Dentistry, Istanbul Medipol University, Birlik Mah. Bahçeler Cad. No. 5, Esenler, Istanbul, Turkey
| | - Yelda Erdem-Hepşenoğlu
- grid.411781.a0000 0004 0471 9346Department of Endodontics, School of Dentistry, Istanbul Medipol University, Birlik Mah. Bahçeler Cad. No. 5, Esenler, Istanbul, Turkey
| | - Alperen Tekin
- grid.411781.a0000 0004 0471 9346Oral Diagnosis and Maxillofacial Radiology, School of Dentistry, Istanbul Medipol University, Birlik Mah. Bahçeler Cad. No. 5 Esenler, Istanbul, Turkey
| | - Mutlu Özcan
- grid.7400.30000 0004 1937 0650Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
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Jurasic MM, Gillespie S, Sorbara P, Clarkson J, Ramsay C, Nyongesa D, McEdward D, Gilbert GH, Vollmer WM. Deep caries removal strategies: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2022; 153:1078-1088.e7. [PMID: 36175201 PMCID: PMC10787323 DOI: 10.1016/j.adaj.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The International Caries Consensus Collaboration (ICCC) has published recommendations on carious tissue removal to treat cavitated carious lesions in a manner that preserves hard tissue and retains teeth long term. This study quantifies The National Dental Practice-Based Research Network dentists' use of selective caries removal. METHODS This cross-sectional questionnaire study assessed reported use of selective caries removal when treating deep caries in asymptomatic and symptomatic teeth in response to clinical case scenarios. Statistical methods included the proportion of respondents concordant with ICCC guidelines at various thresholds and logistic regression to model factors associated with concordance. RESULTS A total of 500 dentists responded. The study sample was 57% male, mean (SD) age was 50.9 (12.6) years, and 60% worked in private practice settings. Higher levels of concordance for choosing selective caries removal 50% or greater of the time were found for asymptomatic (62.4%; 95% CI, 57.6 to 67.2) than for symptomatic caries (49.3%; 95% CI, 44.4 to 54.2). These differences were significantly associated with type of practice setting. CONCLUSIONS The National Dental Practice-Based Research Network dentists reported using selective caries removal strategies when managing deep carious lesions more often than in previous US and Japanese practice-based research network studies and from results of a systematic review and meta-analysis. Nonetheless, substantive discordance with the ICCC guidelines was seen by the authors of this study. PRACTICAL IMPLICATIONS More dissemination and continuing education activities, as well as implementation studies, may further encourage use of selective caries removal to soft or firm dentin when indicated.
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Cushley S, Duncan HF, Lundy FT, Nagendrababu V, Clarke M, El Karim I. Outcomes reporting in systematic reviews on vital pulp treatment: A scoping review for the development of a core outcome set. Int Endod J 2022; 55:891-909. [PMID: 35704241 PMCID: PMC9545459 DOI: 10.1111/iej.13785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/18/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022]
Abstract
Background A large number of research reports on vital pulp treatment (VPT) has been published over the last two decades. However, heterogeneity in reporting outcomes of VPT is a significant challenge for evidence synthesis and clinical decision‐making. Objectives To identify outcomes assessed in VPT studies and to evaluate how and when outcomes are measured. A subsidiary aim was to assess evidence for selective reporting bias in the included studies. The results of this review will be used to inform the development of a core outcome set (COS) for endodontic treatments. Methods Multiple healthcare bibliographic databases, including PubMed/MEDLINE, Ovid EMBASE, Scopus, Cochrane Database of Systematic Reviews and Web of Science were searched for systematic reviews published between 1990 and 2020, reporting on VPT. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Outcomes' information was extracted and aligned with a healthcare taxonomy into five core areas: survival, clinical/physiological changes, life impact, resource use and adverse events. Results Thirty‐six systematic reviews were included, 10 reporting on indirect pulp capping or selective caries removal, nine on direct pulp capping, eight on pulpotomy and nine on combined VPTs. There was considerable variation in the outcomes reported in these reviews and their included studies. Clinician‐reported outcomes were used considerably more often than patient‐reported outcomes. A range of instruments and time points were used for measuring outcomes. Several of the reviews were assessed as having low risk of selective reporting bias, but many did not specifically report this domain, whilst others did not provide risk of bias assessment at all. Discussion Considerable variation in selection of outcomes and how and when they are measured and reported was evident, and this heterogeneity has implications for evidence synthesis and clinical decision‐making. Conclusions Whilst there is a lack of consistency, several potentially important outcomes for VPT, including pulp survival, incidence of post‐operative pain and need for further intervention, have been identified which could inform the development of a COS for endodontic treatment. Registration Core Outcome Measures in Effectiveness Trials (COMET) (No. 1879).
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Affiliation(s)
- Siobhan Cushley
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland
| | - Henry F Duncan
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Lincoln Place, Dublin, Ireland
| | - Fionnuala T Lundy
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland
| | - Ikhlas El Karim
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Northern Ireland
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BaniHani A, Santamaría RM, Hu S, Maden M, Albadri S. Minimal intervention dentistry for managing carious lesions into dentine in primary teeth: an umbrella review. Eur Arch Paediatr Dent 2021; 23:667-693. [PMID: 34784027 DOI: 10.1007/s40368-021-00675-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 07/25/2021] [Accepted: 10/08/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This umbrella review systematically appraised published systematic reviews on Minimal Intervention Dentistry interventions carried out to manage dentine carious primary teeth to determine how best to translate the available evidence into practice, and to provide recommendations for what requires further research. METHOD An experienced information specialist searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Epistemonikos, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, and the NIHR Journals Library. In addition, the PROSPERO database was searched to identify forthcoming systematic reviews. Searches were built around the following four concepts: primary teeth AND caries/carious lesion AND Minimal Intervention Dentistry AND systematic review/meta-analysis. Searches were restricted to English language, systematic reviews with/without meta-analyses published between January 2000 and August 2020. Two reviewers independently screened all titles and abstracts. Interventions included involved no dentine carious tissue removal (fissure sealants, resin infiltration, topical application of 38% Silver Diamine Fluoride, and Hall Technique), non-restorative caries control, and selective removal of carious tissue involving both stepwise excavation and atraumatic restorative treatment. Systematic reviews were selected, data extracted, and risk of bias assessed using ROBIS by two independent reviewers. Studies overlap was calculated using corrected covered area. RESULTS Eighteen systematic reviews were included in total; 8 assessed the caries arresting effects of 38% Silver Demine Fluoride (SDF), 1 on the Hall Technique (HT), 1 on selective removal of carious tissue, and eight investigated interventions using atraumatic restorative treatment (ART). Included systematic reviews were published between 2006 and 2020, covering a defined time frame of included randomised controlled trials ranging from 1969 to 2018. Systematic reviews assessed the sealing efficacy of fissure sealants and resin infiltration in carious primary teeth were excluded due to pooled data reporting on caries arrest in both enamel and outer third of dentine with the majority of these carious lesions being limited to enamel. Therefore, fissure sealants and resin infiltration are not recommended for the management of dentinal caries lesions in primary teeth. Topical application of 38% SDF showed a significant caries arrest effect in primary teeth (p < 0.05), and its success rate in arresting dental caries increased when it was applied twice (range between 53 and 91%) rather than once a year (range between 31 and 79%). Data on HT were limited and revealed that preformed metal crowns placed using the HT were likely to reduce discomfort at time of treatment, the risk of major failure (pulp treatment or extraction needed) and pain compared to conventional restorations. Selective removal of carious tissue particularly in deep carious lesions has significantly reduced the risk of pulp exposure (77% and 69% risk reduction with one-step selective caries removal and stepwise excavation, respectively). ART showed higher success rate when placed in single surface compared to multi-surface cavities (86% and 48.7-88%, respectively, over 3 years follow-up). CONCLUSION Minimal Intervention Dentistry techniques, namely 38% SDF, HT, selective removal of carious tissue, and ART for single surface cavity, appear to be effective in arresting the progress of dentinal caries in primary teeth when compared to no treatment, or conventional restorations. There is clear need to increase the emphasis on considering these techniques for managing carious primary teeth as a mainstream option rather than a compromise option in circumstances where the conventional approach is not possible due to cooperation or cost.
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Affiliation(s)
- 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 & Implementation Group, University of Liverpool, Liverpool, UK
| | - S Albadri
- School of Dentistry, University of Liverpool, Pembroke place, Liverpool, L3 5PS, UK.
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Asal MA, Abdellatif AM, Hammouda HE. Clinical and Microbiological Assessment of Carisolv and Polymer Bur for Selective Caries Removal in Primary Molars. Int J Clin Pediatr Dent 2021; 14:357-363. [PMID: 34720507 PMCID: PMC8543989 DOI: 10.5005/jp-journals-10005-1956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim and objective To assess the efficacy of the new Carisolv system and Polymer bur (SmartbursII®) for selective caries removal in primary molars clinically and microbiologically, compared with the conventional mechanical method. Materials and methods Sixty children with class I active carious lesions were selected. The children were randomly allocated to three groups (n = 20) according to the caries removal method. Under rubber dam isolation, dentin samples were taken before and after caries removal for microbial culture. Time spent in each technique was recorded. The clinical efficacy of caries removal was verified using caries detector dye. Patient satisfaction toward the treatment was evaluated using a facial image scale. Results The median of caries detector dye scores was significantly lower in the conventional group compared to others (p value < 0.05). The mean time for caries removal was the longest with Carisolv (p value < 0.05). The median of facial image scale scores was significantly higher in the conventional group compared with others (p value < 0.05). The mean total viable bacterial count after caries removal was significantly higher in polymer bur group compared with others (p value < 0.05). While, there was no significant difference between Carisolv and conventional groups (p value > 0.05). Conclusion The clinical efficacy of caries removal was highest with the mechanical method. Carisolv took the longest time for caries removal. Patient satisfaction was higher with Carisolv and polymer bur than the mechanical method. The antimicrobial efficacy of Carisolv and the mechanical method was higher than the polymer bur. Clinical significance Carisolv is a viable alternative to the mechanical method in the management of dental caries, especially in children. Further studies are needed to assess the efficacy of caries removal by SmartbursII®. How to cite this article Asal MA, Abdellatif AM, Hammouda HE. Clinical and Microbiological Assessment of Carisolv and Polymer Bur for Selective Caries Removal in Primary Molars. Int J Clin Pediatr Dent 2021;14(3):357–363.
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Affiliation(s)
- Mohamed A Asal
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Abeer M Abdellatif
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Hossam E Hammouda
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Mansoura University, Mansoura, Dakahlia, Egypt
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11
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Clarkson JE, Ramsay CR, Ricketts D, Banerjee A, Deery C, Lamont T, Boyers D, Marshman Z, Goulao B, Banister K, Conway D, Dawett B, Baker S, Sherriff A, Young L, van der Pol M, MacLennan G, Floate R, Braid H, Fee P, Forrest M, Gouick J, Mitchell F, Gupta E, Dakri R, Kettle J, McGuff T, Dunn K. Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions: a randomised controlled clinical trial in primary care. BMC Oral Health 2021; 21:336. [PMID: 34243733 PMCID: PMC8267238 DOI: 10.1186/s12903-021-01637-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/18/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth. METHOD This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes. DISCUSSION SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN. TRIAL REGISTRATION NUMBER ISRCTN76503940. Date of Registration: 30.10.2019. URL of trial registry record: https://www.isrctn.com/ISRCTN76503940?q=ISRCTN76503940%20&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search .
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Affiliation(s)
- Jan E Clarkson
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK.,NHS Education for Scotland, Edinburgh, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Ricketts
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Avijit Banerjee
- Faculty of Dentistry, Oral and Craniofacial Services, Kings College London, London, UK
| | - Chris Deery
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Thomas Lamont
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK.
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Banister
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Conway
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Bhupinder Dawett
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK.,Hafren House Dental Practice, Alfreton, Derbyshire, UK
| | - Sarah Baker
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Andrea Sherriff
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | | | | | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ruth Floate
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Hazel Braid
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Patrick Fee
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Mark Forrest
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jill Gouick
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Fiona Mitchell
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Ekta Gupta
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Riz Dakri
- Faculty of Dentistry, Oral and Craniofacial Services, Kings College London, London, UK
| | - Jennifer Kettle
- School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Tina McGuff
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
| | - Katharine Dunn
- Dental Health Services Research Unit, Dundee Dental School, The University of Dundee, 9th Floor, Park Place, Dundee, DD1 4HN, UK
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Weimann D, Morgenthal A, Schwendicke F, Fleck C, Razi H. Substantial regional differences in the biomechanical behavior of molar treated with selective caries tissue removal technique: a finite element study. Dent Mater 2021; 37:e162-75. [PMID: 33358015 DOI: 10.1016/j.dental.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/07/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Selective caries removal (SCR) is recommended over non-selective removal for managing deep carious lesions to avoid pulp exposure and maintain pulp vitality. During SCR, residual carious dentin is left behind and sealed beneath the restoration. The biomechanical effects of such residual lesions on the restored tooth remain unclear and were assessed using finite element modeling (FEM). METHODS Based on μ-CT images of a healthy permanent human third molar, we developed five finite element models. Generic class I and II cavity restorations were modeled where residual lesions of variable sizes were either left or fully removed on occlusal and proximal surfaces. The cavities were restored with adhesive composite. All 3D-FE models were compared with a model of a healthy, non-treated molar. A vertical load of 100 N was applied onto the occlusal surface. RESULTS Regardless of the lesion size, in molars with occlusal lesions higher mean stresses were predicted along the filling-lesion interface than in all other models. The smallest occlusal lesion (Ø1 = 1 mm) resulted in the highest maximum stresses at the filling-lesion interface with large stress concentrations at the filling walls indicating failure risk. In conclusion, lesion site and extent are influencing parameters affecting the filling-lesion interactions and thus the biomechanical behavior of the tooth after SCR. SIGNIFICANCE Retaining carious lesions around the pulpal floor affects the deformation and stress states in tooth-filling complexes. The higher stresses observed in molars with occlusal lesions may affect restoration stability and longevity. Suprisingly, more extended occlusal lesions may provide a more favorable tooth performance than less extended ones. In contrast, in molars with proximal lesions the residual lesion had only limited effect on the tooth's biomechanical condition.
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13
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Schmidt J, Krohn S, Kallies R, Schneider H, Zeller K, Ziebolz D, Berg T, Haak R. Antibacterial effect of a brominated self-etch adhesive on carious dentin - An in vivo study. J Dent 2020; 105:103555. [PMID: 33346060 DOI: 10.1016/j.jdent.2020.103555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/19/2020] [Revised: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This in vivo study compared the antibacterial effect of a self-etch adhesive with and without the brominated monomer 12-methacryloyloxydodecyl-pyridinium bromide (MDPB) on carious dentin after selective caries removal. METHODS 10 patients showing deep primary carious lesions at two posterior teeth without pulpal symptoms were included. At visit I, carious tissue was selectively removed and carious dentin was sampled with a sterile roundbur (Komet No. 18). One cavity was restored with composite (SDR, Ceram X; DENTSPLY DeTrey) using an MDPB-containing self-etch adhesive (Clearfil Protect Bond, Kuraray Noritake; PB). The other restoration served as a control (Clearfil SE Bond II, Kuraray Noritake; SE). At visit II after 8 weeks, carious dentin was sampled again. Bacterial growth in carious dentin was differentiated using microbial cultivation. Bacterial DNA from intact cells and cell-free DNA were quantified using 16S rRNA gene-based real-time PCR and the microbial community composition was analyzed by amplicon deep-sequencing. Wilcoxon test was applied for statistical analysis. RESULTS Both treatments showed a decrease of intact bacterial cells in carious dentin at visit II compared to visit I (PB: visit I: 1.1*106, visit II: 1.7*105 (p = 0.03); SE: visit I: 1.1*107, visit II = 2.4*105 (p = 0.002)). No statistically significant reduction of cell-free bacterial DNA was detected (PB: visit I: 6.1*105, visit II: 1.6*105 (p = 0.08); SE: visit I: 5.3*105, visit II: 2.9*105 (p = 0.10)). The decrease of intact cell-derived (p = 0.371) and cell-free DNA (p = 0.455) did not differ significantly between PB and SE. Lactobacillus was most abundant within the microbial community at both visits. Alpha-diversity was not affected by treatment and samples showed high intra- and interindividual diversity. CONCLUSION AND CLINICAL SIGNIFICANCE Both self-etch adhesives have an antibacterial effect due to a decrease of bacterial DNA after selective caries removal. However, the results do not reveal any additional antibacterial effect by MDPB. The study is registered with the German Clinical Trials Register (DRKS00011532).
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Affiliation(s)
- Jana Schmidt
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103 Leipzig, Germany.
| | - Sandra Krohn
- Medical Department II Gastroenterology, Hepatology, Infectious Diseases, Pneumology, Section Hepatology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - René Kallies
- Department of Environmental Microbiology, Helmholtz Centre for Environmental Research - UFZ, Permoserstr. 15, 04318 Leipzig, Germany
| | - Hartmut Schneider
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103 Leipzig, Germany
| | - Katharina Zeller
- Medical Department II Gastroenterology, Hepatology, Infectious Diseases, Pneumology, Section Hepatology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103 Leipzig, Germany
| | - Thomas Berg
- Medical Department II Gastroenterology, Hepatology, Infectious Diseases, Pneumology, Section Hepatology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103 Leipzig, Germany
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Pereira JT, Knorst JK, Ardenghi TM, Piva F, Imparato JCP, Olegário IC, Hermoza RAM, Armas-Vega ADC, de Araujo FB. Pulp Vitality and Longevity of Adhesive Restorations Are Not Affected by Selective Carious Removal: A Multicenter Clinical Trial. Caries Res 2020; 55:55-62. [PMID: 33326969 DOI: 10.1159/000510698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/25/2019] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
The aim of this multicenter randomized clinical trial was to evaluate the pulp vitality and survival rate of adhesive restorations performed on posterior deciduous teeth after non-selective (NSCR) or selective (SCR) carious tissue removal over 33 months. One hundred and seven children (average age 4-8 years, SD 1.4) with at least two active moderate cavitated lesions in dentin were included. Teeth were randomized and submitted to NSCR or SCR before composite resin restoration. Restorations were clinically and radiographically assessed at baseline, 6, 12, 18, 24, and 33 months by a blinded, trained, and calibrated operator in each center. The characteristics of the restorations were recorded according to FDI criteria and were considered as restorative failures when scores 4 or 5 were presented. Pulp vitality was measured by clinical and radiographic examinations, and those teeth that presented any signs or symptoms of irreversible pulpitis or pulp necrosis were considered as failure. Data were analyzed by a Cox regression model with shared frailty, considering two outcomes: pulp and restorative. A total of 278 restorations (137 after NSCR and 141 after SCR) were performed at baseline in four different centers and there was no loss in the follow-up period. Survival rate was 97.1 and 87.1% for pulp and for restorative outcome, respectively. The overall annual failure rate was 7%. There were no differences in the failure risk according to the treatment group, center, and all the clinical and demographic variables, regardless of outcome. Composite restorations of active moderate deep carious lesions performed on posterior primary teeth show satisfactory survival for restorative and pulp outcome after a 33-month follow-up, regardless of the technique executed for carious tissue removal.
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Affiliation(s)
| | - Jessica Klöckner Knorst
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Thiago Machado Ardenghi
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Brazil
| | - Fabiane Piva
- School of Dentistry, Lutheran University of Brasil, Canoas, Brazil
| | | | - Isabel Cristina Olegário
- Department of Paediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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15
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Santamaría RM, Abudrya MH, Gül G, Mourad MS, Gomez GF, Zandona AGF. How to Intervene in the Caries Process: Dentin Caries in Primary Teeth. Caries Res 2020; 54:306-323. [PMID: 32854105 DOI: 10.1159/000508899] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 09/16/2019] [Accepted: 05/03/2020] [Indexed: 11/19/2022] Open
Abstract
For an ORCA/EFCD consensus, this review systematically assessed available evidence regarding interventions performed and materials used to manage dentin carious lesions in primary teeth. A search for systematic reviews (SRs) and randomized clinical trials (RCTs) with a follow-up of at least 12 months after intervention was performed in PubMed, LILACS, BBO, and the Cochrane Library. The risk of bias tool from the Cochrane Collaboration and the PRISMA Statement were used for assessment of the included studies. From 101 screened articles, 2 SRs and 5 RCTs, which assessed the effectiveness of interventions in terms of pulp vitality and success of restoration, and 10 SRs and 1 RCT assessing the success of restorative materials were included. For treatments involving no carious tissue removal, the Hall technique showed lower treatment failure for approximal carious lesions compared to complete caries removal (CCR) and filling. For the treatment of deep carious lesions, techniques involving selective caries removal (SCR) showed a reduction in the incidence of pulp exposure. However, the benefit of SCR over CCR in terms of pulp symptoms or restoration success/failure was not confirmed. Regarding restorative materials, preformed metal crowns (PMCs) used to restore multisurface lesions showed the highest success rates compared to other restorative materials (amalgam, composite resin, glass ionomer cement, and compomer), and in the long term (12-48 months) these were also less likely to fail. There is limited evidence supporting the use of PMCs to restore carious lesions with single cavities. Among nonrestorative options, silver diammine fluoride was significantly more effective in arresting caries than other treatments for treating active carious lesions of different depths. Considerable heterogeneity and bias risk were observed in the included studies. Although heterogeneity observed among the studies was substantial, the trends were similar. In conclusion, less invasive caries approaches involving selective or no caries removal seem advantageous in comparison to CCR for patients presenting with vital, symptomless, carious dentin lesions in primary teeth. There is evidence in favor of PMCs for restoring multisurface carious lesions in primary molars.
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Affiliation(s)
- Ruth M Santamaría
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany,
| | - Mohamed Hassan Abudrya
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Gülsün Gül
- Department of Comprehensive Care, Tufts University, Boston, Massachusetts, USA
| | - Mhd Said Mourad
- Department of Preventive and Pediatric Dentistry, University of Greifswald, Greifswald, Germany
| | - Grace Felix Gomez
- Department of Community Dentistry, Case Western Reserve University, Cleveland, Ohio, USA
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16
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Jardim JJ, Mestrinho HD, Koppe B, de Paula LM, Alves LS, Yamaguti PM, Almeida JCF, Maltz M. Restorations after selective caries removal: 5-Year randomized trial. J Dent 2020; 99:103416. [PMID: 32585263 DOI: 10.1016/j.jdent.2020.103416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To compare the survival of restorations placed in deep caries lesions after selective caries removal to soft dentin (SCRSD) over a 5-year period. A secondary aim was to investigate whether the material (amalgam or resin composite) affected the survival of restorations. METHODS This study used data derived from a multicenter randomized controlled clinical trial (Clinical trials registration NCT00887952). Inclusion criteria were: patients with permanent molars presenting occlusal or proximal deep caries lesions (≥1/2 of the dentin thickness on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions. The teeth were randomized into SCRSD and restoration in a single visit or stepwise excavation (SW). Each of these groups was divided according to the filling material: amalgam (AM) or resin composite (RC). Survival analyses were performed to estimate therapy success rates over 5 years (adjusted Weibull regression model). RESULTS 172 restorations were evaluated, 95 from SCRSD group and 77 from SW group, being 61 AMG and 111 RC. The 5-year survival analysis showed similar success rates for SW (76 %) and SCRSD (79 %) as well as for AM and RC (p > 0.05). CONCLUSION This study showed that, after a 5-year follow-up period, the presence of decayed tissue beneath restorations in deep caries lesions did not seem to affect restoration survival. Amalgam and resin composite restorations had similar survival rates, irrespective of the caries removal technique used - SCRSD or SW. CLINICAL SIGNIFICANCE Selective caries removal to soft dentin can be used in the management of deep caries to avoid pulp exposure and preserve tooth structure without affecting restoration longevity.
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17
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Liberman J, Franzon R, Guimarães LF, Casagrande L, Haas AN, Araujo FB. Survival of composite restorations after selective or total caries removal in primary teeth and predictors of failures: A 36-months randomized controlled trial. J Dent 2019; 93:103268. [PMID: 31881241 DOI: 10.1016/j.jdent.2019.103268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/07/2019] [Revised: 11/20/2019] [Accepted: 12/21/2019] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess the survival of composite restorations after selective (SCR) or total caries removal (TCR) and determine predictors of failures after 36 months. METHODS 120 teeth with deep occlusal or occlusal-proximal carious lesions were randomly divided into control (TCR; n = 54; 69% Class II) and test (SCR; n = 66; 63% Class II) groups. Clinical evaluation was applied using the USPHS criteria, and the presence of Charlie or Delta scores at the marginal integrity were considered as a failure. RESULTS The overall survival rate of restorations was 68% after 36 months, 81% for TCR and 57% for SCR (p = 0.004). The multivariable Cox Regression model demonstrated that restorations performed after SCR had 3.44 times greater probability of failure compared to TCR (p = 0.006). The other two predictors for failure of restorations were teeth with Class II cavities (hazard ratio = 3.3) and children with gingival bleeding over 20% (hazard ratio = 2.5). CONCLUSIONS Performing composite restorations after SCR in primary teeth had success rate significantly lower than restorations performed after TCR. Complex cavities and worst patient´s oral hygiene were found to be predictors of failure of restorations. CLINICAL SIGNIFICANCE Although SCR has been demonstrating high rates of pulp preservation, clinicians should consider that composite restorations fail in a higher frequency compared to TCR in primary teeth and, in some circumstances, may be preferable in terms of restoration longevity.
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Affiliation(s)
- J Liberman
- Department of Pediatric Dentistry, School of Dentistry, Universidad de la Republica, Montevideo, Uruguay
| | - R Franzon
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - L F Guimarães
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - L Casagrande
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - A N Haas
- Periodontology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - F B Araujo
- Department of Pediatric Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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18
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Schmidt J, Buenger L, Krohn S, Kallies R, Zeller K, Schneider H, Ziebolz D, Berg T, Haak R. Effect of a bioactive cement on the microbial community in carious dentin after selective caries removal - An in-vivo study. J Dent 2019; 92:103264. [PMID: 31843419 DOI: 10.1016/j.jdent.2019.103264] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/10/2019] [Revised: 12/07/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Selective caries removal in deep lesions means that soft carious affected dentin is left in the center of the cavity. Thus, using a tricalcium silicate cement Biodentine™ (Septodont, Paris) to seal the remaining soft dentin could have an antibacterial effect. This in-vivo study aimed to do quantitative and qualitative analyses on the bacterial composition within carious dentin before and after selective caries removal when applying Biodentine. METHODS Eleven patients with deep primary carious lesions at two posterior teeth without pulpal symptoms were included. Carious dentin was selectively removed and sampled with a sterile round bur (Komet No. 18) at baseline visit and eight weeks later. On the first visit, one lesion per patient, the remaining carious dentin was covered with Biodentine before adhesive restoration. Caries samples were investigated by microbial cultivation, molecular analysis and amplicon deep-sequencing of 16S rRNA genes. Bacterial DNA from intact cells was differentiated from cell-free DNA by DNase degradation prior to DNA isolation. RESULTS Reduction of cell-derived as well as cell-free bacterial DNA eight weeks after selective caries removal was significantly higher when Biodentine was applied. Lactobacillus was most abundant within the microbial community of deep carious dentin lesions at the first visit. After intervention with Biodentine application, Lactobacillus was diminished to a high degree. In general, the diversity in samples, as well as bacterial composition differed interindividually as well as intraindividually. CONCLUSION AND CLINICAL SIGNIFICANCE Despite the heterogenous and diversity of microbial composition in patients, Biodentine can have beneficial antibacterial effects when applied to residual carious dentin, offering an alternative and safe treatment option. The study is officially registered with German Clinical Trials Register (DRKS00011067).
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Affiliation(s)
- Jana Schmidt
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103 Leipzig, Germany.
| | - Laura Buenger
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103 Leipzig, Germany
| | - Sandra Krohn
- Department of Gastroenterology, Section of Hepatology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - René Kallies
- Department of Environmental Microbiology, Helmholtz Centre for Environmental Research - UFZ, Permoserstr. 15, 04318 Leipzig, Germany
| | - Katharina Zeller
- Department of Gastroenterology, Section of Hepatology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Hartmut Schneider
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103 Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, Liebigstr. 12, 04103 Leipzig, Germany
| | - Thomas Berg
- Department of Gastroenterology, Section of Hepatology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Rainer Haak
- Department of Gastroenterology, Section of Hepatology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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Abstract
Traditionally, before placing a restoration, excavation of tissues affected by caries was recommended. The goal was to have all walls of the cavity on sound, hard dentin, even when at risk of pulpal exposure. Current understanding of the caries process indicates that preserving tooth structure can lead to better long-term outcomes. Selective caries excavation refers to preserving tooth structure by delineating excavation in the pulpal and axial wall according to lesion severity and depth as well as pulpal health while keeping all cavity margins on sound tooth structure. Compounding evidence indicates that when a good marginal seal is present, the lesion will arrest.
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Affiliation(s)
- Andrea G Ferreira Zandona
- Department of Comprehensive Care, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA.
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20
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Silva PFD, Oliveira LRS, Braga SSL, Signori C, Armstrong SR, Soares CJ, Cenci MS, Faria-E-Silva AL. Effect of selective carious tissue removal on biomechanical behavior of class II bulk-fill dental composite restorations. Dent Mater 2018; 34:1289-1298. [PMID: 29793795 DOI: 10.1016/j.dental.2018.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/21/2018] [Revised: 04/25/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study aimed to develop a method to induce carious lesions in the pulpal floor dentin of a class II cavity preparation, and to determine the effects of this carious lesion on the biomechanical behavior of the dental composite restoration. METHODS The pulpal floor dentin of class I cavities in sound third molars were demineralised with acetic acid for 35days followed by a 7-day exposure to pooled human saliva biofilm and demineralization was verified by micro-CT. Subsequently, the proximal walls were removed forming a class II cavity and the caries lesion was left intact or was completely removed prior to restoration with a bulk-fill dental composite (n=10). Cuspal deflection was assessed by strain-gauge and micro-CT imaging. The presence of enamel cracks was assessed by transillumination before and after restoration, and again after 1,200,000 cycles of mechanical fatigue in a chewing simulator. Finally, resistance to fracture by axial compressive loading and failure mode was determined. Data were analyzed by 2-way repeated measures ANOVA, Fisher's exact test, and t-test (α=0.05). RESULTS The presence of carious lesions had no significant effect upon cuspal deflection, formation of enamel cracks, and fracture strength of the dental composite restorations. The restorative procedure increased the number of enamel cracks, which was not affected by mechanical cycling. SIGNIFICANCE Maintaining carious lesions does not affect the biomechanical behavior of class II restorations performed with bulk-fill dental composite.
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Affiliation(s)
- Paula Fernanda Damasceno Silva
- Graduate program in Dentistry, Federal University of Sergipe, Rua Claudio Batista s/n, Sanatorio, Aracaju, SE, 49060-100, Brazil.
| | - Lais Rani Sales Oliveira
- Graduate program in Dentistry, Dental School, Federal University of Uberlândia,Av. Pará 1720, Bloco 4LA, Campus Umuarama, Uberlândia, MG, 38400-902, Brazil.
| | - Stella Sueli Lourenço Braga
- Graduate program in Dentistry, Dental School, Federal University of Uberlândia,Av. Pará 1720, Bloco 4LA, Campus Umuarama, Uberlândia, MG, 38400-902, Brazil.
| | - Cácia Signori
- Graduate program in Dentistry, Dental School, Federal University of Pelotas, Rua Gonçalves Chaves 457, sala 505, Pelotas, RS, 96015-560, Brazil.
| | - Steve R Armstrong
- Department of Operative Dentistry, College of Dentistry and Dental Clinics, University of Iowa,S-244A Dental Science Building, Iowa City, IA, 52242, USA.
| | - Carlos José Soares
- Department of Restorative Dentistry, Dental School, Federal University of Uberlândia, Av. Pará 1720, Bloco 4LA, Campus Umuarama, Uberlândia, MG, 38400-902, Brazil.
| | - Maximiliano Sérgio Cenci
- Department of Operative Dentistry, College of Dentistry and Dental Clinics, University of Iowa,S-244A Dental Science Building, Iowa City, IA, 52242, USA.
| | - André Luis Faria-E-Silva
- Department of Dentistry, Federal University of Sergipe, Rua Claudio Batista s/n, Sanatorio, Aracaju, SE, 49060-100, Brazil.
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