Evaluation of the effect of high-intensity light-curing device on micro-leakage of pits and fissure sealants

Reducing treatment time is one of the most important trends in modern dentistry. This study aimed to compare the micro-leakage around the resin sealants when using both high and conventional intensity light-curing systems. The study sample consisted of 30 extracted human maxillary premolar teeth that were divided into two equal groups according to the light-curing system used: Group 1, High-Intensity Light-Curing System and Group 2, Conventional Light-Curing System. Light-curing by Woodpecker I-LED device with two intensities (high and conventional) has been used. All teeth were subjected to 500 cycles of thermocycling. Then, a methylene blue dye microleakage test was performed, and the teeth were sectioned longitudinally and studied under a stereo microscope. The mean of micro-leakage in the high-intensity group (1.33 ± 1.29) was less than in the conventional intensity group (1.63 ± 1.29) without any statistically significant differences (p = 0.320). The high-intensity light-curing system mode may be a good and acceptable alternative to conventional intensity light-curing system mode in polymerization of pits and fissure sealants.

Clinical performance of sealants under different humidity control conditions: a split-mouth 1-year randomized trial

PURPOSE

Sealants are an effective method of prevention and treatment for early caries lesions. This study analyzed the 1-year clinical performance of resin-based and ionomeric sealants applied to permanent teeth under different humidity conditions.

METHODS

The investigation was a triple-blind randomized clinical trial (RCT) with a four arms split-mouth design, divided according to the sealant protocol: (1) Resin-based sealant applied with rubber dam isolation, (2) Resin-based sealant applied with cotton rolls isolation, (3) Ionomeric sealant applied with rubber dam isolation and (4) Ionomeric sealant applied with cotton rolls isolation. Fifty-eight patients started the study (232 teeth), and 47 (188 teeth) remained until the 1-year recall. The modified USPHS criteria were used in the analyzes to investigate surface texture, retention and the presence of secondary caries lesions around the sealants; in the following periods: baseline, after 3, 6, 9, and 12 months by two calibrated examiners. Data were analyzed by the Mann-Whitney and Friedman tests.

RESULTS

There was no difference between the types of sealants (p > 0.05). The type of humidity control influenced the superficial texture (p = 0.0012) and the retention of sealants (p = 0.0023). The sealant displacement was greater under cotton rolls isolation. Only one active caries lesion in enamel was found in the 9th month.

CONCLUSION

It may be concluded that sealants effectively prevented caries, even when they were partially or totally lost, regardless of the material. The rubber dam isolation with a rubber dam promoted lower surface roughness and improved the retention rates. International Clinical Trials Registry Platform: #1111-1215-2832 (07/26/2018).

Empirical correlations for diffusivity and the partition coefficient for phthalates in PVC materials and modelling emissions of automotive sealants

Polyvinylchloride (PVC) based sealants commonly contain phthalate plasticizers that are emitted into the air over time. The low volatility classifies them as Semi-Volatile Organic Compounds (SVOCs). Empirical relationships are determined for estimation of the diffusion and solid/air partition coefficients for phthalates in PVC materials using data compiled from studies of phthalates in other PVC materials, such as vinyl flooring. The relationships are functions of vapor pressure of the compounds, which are determined from a Clausius-Clapeyron equation. A test chamber was constructed to continuously sample the air and measure the air concentration based on a Solid Phase MicroExtraction (SPME) method. The partition coefficient was tested with dioctyl terephthalate (DOTP) in a PVC-based sealant, in which the results fell within the reasonable error of the value predicted from the empirical relationship. The model is applied to outdoor and manufacturing scenarios to evaluate the effect of temperature and mass transfer coefficient.

Pit-and-fissure sealants on primary molars are a cost savings

BACKGROUND

In this study, the authors examine the cost-effectiveness of light-polymerized resin-based fluoride sealants on primary molars in high caries risk children younger than 6 years.

METHODS

The authors examined the cost-effectiveness of pit-and-fissure sealant (PFS) treatment on primary molars by comparing sealed and unsealed molars treated in the outpatient clinic or operating room. Using 1,884 primary molars followed over a 5-year period, the authors used a mixed-effects regression model to estimate the probability of caries development. They used restricted means to estimate years free of caries for carious molars. They used a decision tree to address uncertainty due to PFS treatment failure, predict the expected value associated with each strategy, and estimate the incremental cost-effectiveness ratio using a 3% discount rate to adjust future cost and outcomes to present value.

RESULTS

Over 5 years, the cost of care was $90 for unsealed molars and $75 for sealed molars. Unsealed molars remained caries free for 4.32 years compared with 4.85 years in sealed molars. The cost-effectiveness of PFS treatment was dominant, leading to a savings of $25 for each caries-free year gained and overall savings of $742 million for the United States dental health system over a 5-year period.

CONCLUSIONS

PFS treatment is associated with cost savings and a delay in caries development and should be considered in children with high caries risk.

PRACTICAL IMPLICATIONS

Policy makers should consider reimbursement of PFS treatment on primary molars in high caries risk children.

Exploring consensus for the optimal sealant use to prevent air leak following lung surgery: a modified Delphi survey from The European Society of Thoracic Surgeons

OBJECTIVES

The use of sealants is one of the methods available to reduce the occurrence of intraoperative air leaks. The objective of this modified Delphi survey among ESTS members is to understand the attitudes of clinicians to the optimal use of sealants in air leak management.

METHODS

To understand the attitudes of a wider sample of clinicians, a questionnaire was developed highlighting key issues through 37 statements. Respondents were invited to score their level of agreement with each. A modified Delphi methodology was used to review responses with a threshold of agreement for consensus of 75%.

RESULTS

A total of 258 responses were received (response rate 17%). Respondents agreed that prolonged air leaks are a common complication in thoracic surgery presenting a burden to the patient and increasing the costs of care. There is clear support for the use of sealants to reduce costs and improve the efficiency of healthcare provision and duration of chest tube use in selected high-risk patients with intraoperative air leak at the end of the lung surgery. Respondents also agreed that, due to often complex nature of thoracic surgery, sealants should be developed specifically for this application.

CONCLUSION

There is a clear role for sealants in the management of air leaks and certain surgical procedures demand their use (i.e. lung volume reduction surgery, decortication). This opinion-based consensus review helps to raise the debate about the burden of air leaks in thoracic surgery in order that this issue is recognized in practice and informs the optimal use of sealants in lung surgery.

The using of sealants in pancreatic surgery: A Systematic Review

Background

POPF derives from the pancreatic stump, which follows pancreatic resection and the pancreatoenteric anastomosis following pancreaticoduodenectomy. Since 1978 sealants have been used in pancreatic surgery to prevent pancreatic fistula after resection of the pancreatic head and tail or for the management of trauma and the treatment of low-output pancreatic fistula. Different types of fibrin sealants have been evaluated for their potential to reduce the occurrence of POPF.

Methods

A systematic search of the electronic literature was performed using PubMed, Cochrane Library, and Scopus databases to obtain access to all publications, especially clinical trials, randomised controlled trials, and systematic reviews concerning fibrin sealants pancreatic surgery. Searching for “fibrin sealants pancreas,” we found a total of 73 results on Pubmed, 61 on Scopus, and 14 on Cochrane Library (148 total results).

Results

Eighteen studies were found on literature, following the criteria already described, concerning the use of fibrin sealants in pancreatic surgery. All articles described were published in the period between 1989 and 2019.

Most of these were single centre studies. A total of 1032 patients were enrolled in this review. In the studies, sealants were used to reinforce pancreatic anastomoses and for the occlusion of the main pancreatic duct.

Conclusion

CR-POPF is a fearful complication of pancreatic surgery; among the possible solutions to reduce the risk of onset, sealants were used on the pancreatic stump; today the sealants should be considered such as an option to reduce the CR-POPF, but the routine use in clinical practice has to be validated.

•

Discuss the use of sealants in pancreatic surgery.

•

Compare the application of sealants on pancreatic stump and the effect on p-popf

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Describe the previous experiences reported in literature.

Effectiveness of Repair Techniques for Spinal Dural Tears: A Systematic Review

BACKGROUND

Incidental or intentional durotomy in spine surgery is associated with a risk of cerebrospinal fluid (CSF) leakage and reoperation. Several strategies have been introduced, but the incomplete closure is still relatively frequent and troublesome. In this study, we review current evidence on spinal dural repair strategies and evaluate their efficacy.

METHODS

PubMed, Web of Science, and Scopus were used to search primary studies about the repair of the spinal dura with different techniques. Of 265 articles found, 11 studies, which specified repair techniques and postoperative outcomes, were included for qualitative and quantitative analysis. The primary outcomes were CSF leakage and postoperative infection.

RESULTS

The outcomes of different dural repair techniques were available in 776 cases. Pooled analysis of 11 studies demonstrated that the most commonly used technique was a combination of primary closure, patch or graft, and sealant (22.7%, 176/776). A combination of primary closure and patch or graft resulted in the lowest rate of CSF leakage (5.5%, 7/128). In this study, sealants as an adjunct to primary closure (13.7%, 18/131) did not significantly reduce the rate of CSF leakage compared with primary closure alone (17.6%, 18/102). The rates of infection and postoperative neurologic deficit were similar regardless of the repair techniques.

CONCLUSIONS

Although the use of sealants has become prevalent, available sealants as an adjunct to primary closure did not reduce the rate of CSF leakage compared with primary closure. The combination of primary closure and patches or grafts could be effective in decreasing postoperative CSF leakage.

Sealing Proximal Non- and Micro-Cavitated Carious Lesions Using a One-Session Separator Technique: A 2-Year Randomised Clinical Study

The presence of initial caries accounts for the majority of approximal carious lesions in many countries. The aim of this clustered, split-mouth, randomised, controlled clinical trial was to use a metal separator to widen the approximal space in a one-visit session before sealing and to evaluate patient acceptance, together with the efficacy of the proximal sealing in arresting incipient carious lesions after 2 years. A total of 48 patients with a mean age of 41.9 years were selected. They had at least one pair of proximal initial carious lesions, including the distal surface of the canines to the mesial surface of the third molars (bite-wing score D1-D3). The patient's caries risk at baseline was analyzed using a Cariogram. All surfaces were examined for mutans streptococci (ms) counts. The separator technique made it possible to diagnose whether or not a microcavity was present. After 2 years, 212 surfaces in 45 subjects were examined using the same as baseline standardized digital follow-up radiographs. Two analyses were performed, one sensitive, where a progression or a regression was assessed if one of the examiners made one of those diagnoses, and one conservative, where unchanged. For both analyses, the sealed test surfaces showed a significantly higher regression (67 and 29%) compared to the control group (13 and 2%) p < 0.0001. It did not appear that the baseline variables, such as the caries risk, surface diagnoses, or ms counts, influenced the caries outcome. In the test group, there was no difference in caries progression if there was a microcavity or not. The separation treatment was well accepted by the patients. The method of separation for diagnosis and sealing treatment in a single session appears to be a clinically applicable method for the control of proximal carious lesions.

Protective factors for caries of a school-based oral health program in Bangkok, Thailand: a retrospective cohort study

OBJECTIVES

The aim of the study was to assess protective factors of a school-based oral health preventive program on caries in permanent teeth in students and to identify other risk and protective factors associated with caries in this group.

STUDY DESIGN

This is a retrospective cohort study.

METHODS

A total of 433 students were examined in the 1st grade and followed up until the 6th grade. Each student was annually assessed for caries as per the World Health Organization index. Binary simple and multiple logistic regressions were performed to assess risk or protective factors with a P-value ≤0.05.

RESULTS

In 1st graders, the caries prevalence in deciduous teeth was 87.2%, and the mean decayed, missing and filled teeth (dmft) index was 6.44 (±4.4); in 6th graders, the caries prevalence in permanent teeth was 51.7%, and the mean DMFT was 1.37 (±1.84). Protective factors for caries in permanent teeth were complete participation in the program, receiving fluoride varnish >4 times, and sealant applications on all first molars. Risk factors were female sex and caries prevalence in deciduous teeth. After multiple logistic regression, sealant application only remained significant, with an odds ratio (OR) of 0.19 (95% confidence interval [CI] = 0.06-0.63, P = 0.007), and for risk factor, caries prevalence in deciduous teeth only remained significant, with an OR of 5.44 (95% CI = 2.23-13.27, P < 0.001).

CONCLUSIONS

There is an association between deciduous dentition caries and permanent dentition caries. Early prevention in school settings by applying fluoride varnish and dental sealants onto molars is protective and feasible. The study suggests that regular fluoride varnish and sealant applications should be extended to similar low-income area schools.

Ameloplasty is counterproductive in reducing microleakage around Resin Modified Glass Ionomer and Resin based fissure sealants

Objective:

To compare the microleakage around resin modified glass ionomer cement (RMGIC) based sealants and flowable resin based sealants placed with or without ameloplasty in extracted human teeth.

Methods:

This in-vitro experimental study was conducted at the Operative Dentistry Department, Dow University of Health Sciences, Karachi, Pakistan from June 2017 to December 2018. Sixty extracted human molars and premolars were assigned to four groups (n=15) each, according to the type of fissure sealant (flowable resin based sealant or resin modified glass ionomer based sealant) used and either placed with or without ameloplasty. Specimens were thermocycled and then immersed in 1% methylene blue for 24 hours. Specimens were then sectioned and examined using stereo-microscope (50X) for microleakage that was scored on an ordinal scale. Mann-Whitney U test and Ordinal regression were applied. Level of significance kept at 0.05.

Results:

There was a statistically significant difference (p-value <0.001) between the two sealant types for the microleakage scores. Sealants placed with ameloplasty demonstrated significantly higher microleakage values (p-value <0.001).

Conclusion:

Microleakage was found to be more pronounced in RMGIC based sealants compared to the resin based sealants. Ameloplasty resulted in higher leakage around the sealants irrespective of the chemistry of material.

Evaluation of Marginal Microleakage and Depth of Penetration of Different Materials Used as Pit and Fissure Sealants: An In Vitro Study

Objective

Fissure sealants hold a great significance in the preclusion of inception of caries process. The present in vitro study assesses the marginal sealing ability and penetration depth of various dental products used as pit and fissure sealants.

Study design

Sixty freshly extracted human non-carious premolars were arbitrarily categorized into four groups of 15 samples. Prophylaxis of occlusal surfaces of sample teeth was done with pumice slurry and sealant was applied. Later, the teeth underwent thermocycling and immersion in 5% methylene blue for 24 hours. Sectioning of teeth samples was done buccolingually and they were analyzed under stereomicroscope.

Statistical analysis used

Nonparametric tests Kruskal–Wallis and Mann–Whitney were applied to carry out microleakage comparison. The percentage penetration depth was compared using the one-way analysis of variance (ANOVA) test. Tukey's post hoc test was applied for multiple analogies.

Results

Highest microleakage was seen in glass ionomer-based sealant followed by flowable composite and least for classical sealant. Flowable nanocomposite gave comparable results with that of the classical sealant. No statistical difference was found with respect to depth of penetration between different tested materials.

Conclusion

Flowable nanocomposite can be considered as a promising substitute for sealing fissures and thus can be endorsed to caries-susceptible pediatric patients.

How to cite this article

Butail A, Dua P, Mangla R, et al. Evaluation of Marginal Microleakage and Depth of Penetration of Different Materials Used as Pit and Fissure Sealants: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(1):38–42.

Assessment of Knowledge, Attitude, and Practice among Private Dental Practitioners toward Preventive Measures of Pediatric Patients in Durg-Bhilai City

INTRODUCTION

The old saying "prevention is better than cure" holds true when applied to preventive dental care. It is vitally important for the general health and well-being of the individual to take the necessary steps to prevent the occurrence of major dental problems. American Academy of Pediatric Dentistry (AAPD) emphasizes the importance of initiating professional oral health intervention in infancy and continuing through adolescence and beyond.

MATERIALS AND METHODS

Around 109 available private general dental practitioners of Durg-Bhilai city (within city limits) made up the (convenient) sampling frame of the study. These entire dentists were identified and contacted. But, out of 109 dentists, only 92 were surveyed. BDS graduates and MDS (other than pedodontists) were included in the study. Dentists who were not willing to participate were excluded from the study. The sample size was calculated based on the total number of dentists practicing in Durg-Bhilai city limits.

CONCLUSION

A statistically significant correlation was found in-between the knowledge and practice score (0.368), knowledge and attitude (0.269); attitude and practice (-0.257).

HOW TO CITE THIS ARTICLE

Tiwari J, Pattanshetti K, Doifode D, et al. Assessment of Knowledge, Attitude, and Practice among Private Dental Practitioners toward Preventive Measures of Pediatric Patients in Durg-Bhilai City. Int J Clin Pediatr Dent 2020;13(S-1):S78-S81.

Sealed primary molars are less likely to develop caries

BACKGROUND

The authors examined the association between light-polymerized resin-based fluoride-releasing sealants and the development of pit-and-fissure caries on primary molars.

METHODS

In this 3-year retrospective study, the authors reviewed the dental records of 297 children (1,352 teeth) younger than 6 years who were at high caries risk. Sealant placement or nonplacement on primary molars in the outpatient clinic and operating room setting was recorded, and random-effects logistic regression analysis accounting for the effect of data clustering was performed to measure caries incidence over time.

RESULTS

The odds of developing pit-and-fissure carious lesions on sealed primary molars were 0.055 times (95% confidence interval [CI], 0.011 to 0.285; P = .001) and 0.013 times (95% CI, 0.001 to 0.159; P = .001) the odds of that on nonsealed primary molars in the outpatient clinic and in the operating room, respectively. In molars that became carious, those sealed were associated with longer time to caries development in both the outpatient clinic (2.69 years, 95% CI, 2.08 to 3.29) and operating room (1.97 years, 95% CI, 1.45 to 2.48).

CONCLUSIONS

Sealed primary molars were less likely to develop pit-and-fissure caries when placed in both the clinic and operating room settings.

PRACTICAL IMPLICATIONS

Dental sealants on primary molars should be considered for children at high caries risk.

Households' age, country of birth, and marital status, stronger predictor variables than education in the prevalence of dental sealants, restorations, and caries among US children 5-19 years of age, NHANES 2005-2010

Background

The aim of this study is to use data representative of the U.S. population to determine if households (HHs) age, birth country, and marital status, are strong predictors as HHs education for dental sealants, restorations, and caries in children 5 to 19 years of age.

Methods

A cross sectional analysis was performed with oral health data from three waves of the National Health and Nutrition Examination Survey (NHANES 2005 to 2010). The sample size consisted of children 5 to 19 years of age (n = 9151) and households > 18 years of age (n = 31,034). Dependent variables included the number of children with dental sealants, restorations, and caries. HHs independent variables consisted of gender, age, race, country of birth, HHs education level, marital status, and HHs spouse education. Multivariate regression analysis models were adjusted for HHs citizenship, health insurance, family size, and children age categories.

Results

The prevalence of children 5–19 years of age with dental sealants, restorations, and caries was 31.3, 43, and 15.8% respectively. The odds of children having sealants were higher among HHs with a college education or above OR 2.05 [1.54.-2.73] vs. HHs with a < 9th grade, in HHs ages 39–49 (OR 1.78 [1.41–2.24) vs. 18–29 years of age, and in HHs spouses with a college education and above OR 1.71 [1.14–2.56] vs. HHs with a < 9th grade. The odds of having at least one restored tooth were higher in children from HHs born in Mexico 1.74 [1.44–2.10] vs. US born. The highest odds for caries were among children from HHs that were never married 1.91 [1.47–2.48] vs. married HHs. In HHs with a college education the odds for caries in children were 0.31 (0.22–0.43) for college and above, and 0.78 (0.60–1.01) for some college.

Conclusions

The odds of children having dental sealants were higher in HHs with a college education, however, HHs ages 30–49 provided higher odds for sealants than spouses with college education. HHs birth place increased the odds of children with restorations more than HHs education. Children from HHs that never married had higher odds of experiencing dental caries. Recognizing the impact of these HHs characteristics could augment efforts in the prevention of adverse oral health outcomes in U.S. children.

Households’ age, country of birth, and marital status, stronger predictor variables than education in the prevalence of dental sealants, restorations, and caries among US children 5–19 years of age, NHANES 2005–2010.

Microcavitated (ICDAS 3) carious lesion arrest with resin or glass ionomer sealants in first permanent molars: A randomized controlled trial

OBJECTIVES

Although there is some consensus that carious lesions in early stages (non-cavitated) could be treated using sealants, neither the type of materials nor their use in lesions with localized enamel breakdown (microcavitated) has been reported To compare the efficacy of resin or glass ionomer (GI) sealants in arresting microcavitated carious lesions (ICDAS 3) in first permanent molars.

MATERIALS AND METHODS

A double-blinded randomized controlled clinical trial was conducted in 41 healthy 6 to 11-year-old children. At the baseline examination, each subject had at least one carious lesion classified as ICDAS 3 on the first permanent molar. One hundred fifty-one lesions were randomized into: Group 1: resin sealants (76 lesions) and Group 2: GI sealant (75 lesions). Carious lesion progression was assessed clinically and radiographically. Progression and retention failure were the outcomes used for group comparisons at p-value<0.05.

RESULTS

After a two-year follow-up, only one lesion progressed to ICDAS 5, without statistically significant differences between the groups (χ²(1) = 0.90, p = 0.53). Radiographically, 100 lesions (98%) were arrested and 2 (2%) showed radiographic progression, without differences between groups (χ²(1) = 0.93, p = 0.93). At 2 years, complete retention was observed in 77% of the resin-based and in 83% of the GI sealants, without statistical differences between type of sealant (χ²(1) = 0.71, p = 0.48). The multilevel mixed model demonstrated that location and type of sealant did not affect retention rates (χ²(1) = 24,98, p < 0.001).

CONCLUSION

Sealing ICDAS 3 carious lesions in permanent molars appears to be effective in arresting lesions after a two-year follow-up. Clinicaltrials.gov: RCTICDAS3/2015.

CLINICAL SIGNIFICANCE

Minimally invasive approaches for carious lesion management have been promoted. Using sealants for the treatment of microcavitated lesions (ICDAS 3) appears predictable in the routine practice, without predilection for resin or glass ionomer materials. In addition to preserving tooth structure, this strategy reduces chair-time, dental fear and costs, and increases coverage to dental care.

Evidence-Based Dentistry Caries Risk Assessment and Disease Management

The objective of this article was to provide a summary of evidence-based recommendations for the assessment of caries risk and management of dental caries. The goal is to help clinicians manage the caries disease process using personalized interventions supported by the best available evidence, taking into account the clinician's expertise and the patient's needs and preferences, to maintain health and preserve tooth structure.

Silver diamine fluoride versus therapeutic sealants for the arrest and prevention of dental caries in low-income minority children: study protocol for a cluster randomized controlled trial

BACKGROUND

Dental caries is the most prominent childhood disease in the world. In the United States, more than 50% of children have experienced caries. Untreated caries can have negative impacts on quality of life, academic performance, and school attendance. To reduce oral health disparities, multiple organizations recommend school-based caries prevention.

METHODS/DESIGN

A longitudinal, cluster randomized, non-inferiority trial will be conducted in low-income children from primarily Hispanic/Latino backgrounds currently enrolled in public elementary schools in New York City, New York, United States, from 2018 to 2023. The primary objective is to compare the non-inferiority of silver diamine fluoride and fluoride varnish versus glass ionomer therapeutic sealants and fluoride varnish in the arrest and prevention of dental caries. Secondary objectives are to evaluate differences in effectiveness when care is provided by nurses versus dental hygienists and assess the impact of prevention on oral health-related quality of life and educational outcomes. Caries arrest will be evaluated after 2 years, and caries prevention and secondary outcomes will be assessed at the completion of the study. Data analysis will follow intent-to-treat, and statistical analyses will be conducted using a two-sided significance level of 0.05.

DISCUSSION

The comparative effectiveness of alternative caries prevention delivery models is considered to be one of the highest research priorities in the United States. Many treatments are currently available to prevent and arrest dental caries. The simplicity and affordability of silver diamine fluoride may be a viable alternative for the prevention of dental caries in high-risk children.

TRIAL REGISTRATION

U.S. National Library of Medicine, www.clinicaltrials.gov , ID: NCT03442309 . Registered on 22 February 2018.

A systematic review on the use of topical hemostats in trauma and emergency surgery

BACKGROUND

A wide variety of hemostats are available as adjunctive measures to improve hemostasis during surgical procedures if residual bleeding persists despite correct application of conventional methods for hemorrhage control. Some are considered active agents, since they contain fibrinogen and thrombin and actively participate at the end of the coagulation cascade to form a fibrin clot, whereas others to be effective require an intact coagulation system. The aim of this study is to provide an evidence-based approach to correctly select the available agents to help physicians to use the most appropriate hemostat according to the clinical setting, surgical problem and patient's coagulation status.

METHODS

The literature from 2000 to 2016 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] protocol. Sixty-six articles were reviewed by a panel of experts to assign grade of recommendation (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development and Evaluation] system, and a national meeting was held.

RESULTS

Fibrin adhesives, in liquid form (fibrin glues) or with stiff collagen fleece (fibrin patch) are effective in the presence of spontaneous or drug-induced coagulation disorders. Mechanical hemostats should be preferred in patients who have an intact coagulation system. Sealants are effective, irrespective of patient's coagulation status, to improve control of residual oozing. Hemostatic dressings represent a valuable option in case of external hemorrhage at junctional sites or when tourniquets are impractical or ineffective.

CONCLUSIONS

Local hemostatic agents are dissimilar products with different indications. A knowledge of the properties of each single agent should be in the armamentarium of acute care surgeons in order to select the appropriate product in different clinical conditions.

Sealing or infiltrating proximal carious lesions

OBJECTIVES

Micro-invasive treatment (sealing, infiltration) seems more efficacious to arrest early (non-cavitated) proximal carious lesions than non-invasive treatment (NI). Uncertainty remains as to the efficacy of sealing versus infiltration and the robustness of the evidence. We aimed to review and synthesize this evidence using pairwise and network meta-analysis (NMA) and to perform trial sequential analysis (TSA).

SOURCES

Searching three electronic databases (Medline, Embase, Cochrane Central) was complemented by hand searches and cross-referencing.

STUDY SELECTION

Randomized controlled trials comparing micro-invasive strategies against each other, NI or placebo for managing proximal carious lesions were included. The primary outcome was radiographically assessed lesion progression. Pairwise and Bayesian network meta-analyses as well as TSA were used for synthesis.

DATA

Thirteen split-mouth studies (486 participants, mean age 15 years) were included. Mean follow-up was 25 months (min/max 12/36 months). Firm evidence on the superior efficacy of sealing/infiltration over NI (OR; 95% CI: 0.25; 0.18-0.32) was reached. Firm evidence was also reached on the superior efficacy of sealing (OR; 95% CI: 0.29; 0.18-0.46, 7 studies) and infiltration (OR; 95% CI: 0.22; 0.15-0.33, 7 studies) over NI. One study compared infiltration versus sealing and found no significant difference (0.70; 0.34-1.47). Based on Bayesian NMA, infiltration was ranked first in 80% of the simulations (sealing 20%, NI 0%). The surface-under-the-cumulative-ranking (SUCRA) values were 0.90 for infiltration, 0.60 for sealing and 0.00 for NI. We did not detect significant inconsistency (p = 0.89, node-split).

CONCLUSIONS

Sealing or infiltration are likely to be more efficacious for arresting early (non-cavitated) proximal lesions than NI.

CLINICAL SIGNIFICANCE

Practitioners should strive to perform micro-invasive treatment instead of NI for early proximal lesions. The decision between sealing or infiltration should be guided by practical concerns beyond efficacy.

Microleakage of Sealants after Phosphoric Acid, Er: YAG Laser and Air Abrasion Enamel Conditioning: Systematic Review and Meta-Analysis

PURPOSE

The aim of this systematic review and meta-analysis is to answer the focused question: Does the application of phosphoric acid, Er:YAG laser and air abrasion enamel conditioning methods previous to the oclusal sealant application in human permanent molars influence the microleakage?

STUDY DESIGN

A literature research was carried out in the Pubmed Medline, Web of Science, Scopus and Cochrane databases using with the MeSH terms and keyword search strategy. A supplemental hand search of the references of retrieved articles was also performed. Inclusion criteria comprised ex vivo studies (extracted teeth) with permanent human teeth that used chemical (phosphoric acid) or mechanical (Er:YAG laser and air abrasion) conditioning methods previous the sealant application. The studies should evaluate microleakage as an outcome. Meta-analysis pooled plot were obtained comparing the microleakage after pre-treatment with phosphoric acid, Er:YAG and air abrasion enamel conditioning for sealant application using RevMan software.

RESULTS

The search resulted in 164 articles, 55 records were excluded because they were duplicated. The analysis of titles and abstracts resulted in the exclusion of 105 studies. Four studies were included in the systematic review and the meta-analysis. According to the risk of bias evaluation, the four studies were considered low risk of bias. The meta-analysis showed that phosphoric acid had lower microleakage than Er:YAG laser (p < 0.001) and air abrasion (p < 0.001), with heterogeinity of I² = 0% and I² = 71%, respectively. It was not found statistical difference when compared phosphoric acid and phosphoric acid combined with Er:YAG laser and air abrasion (p > 0.05).

CONCLUSION

The evidence supports that the pretreatment with phosphoric acid leads lower microleakage in oclusal sealants than Er:YAG laser and air abrasion.

Knowledge, Attitude and Practice among Dental Practitioners Pertaining to Preventive Measures in Paediatric Patients

INTRODUCTION

Prevention at primary level is of great value in Paediatric Dentistry. Since use of preventive measures can prevent future complications, dental professionals share an important responsibility toward early screening, prompt referral and treatment and this knowledge must transfer into the practice of dentistry.

AIM

To evaluate Knowledge, Attitude and Practice (KAP) among dental practitioners in Bhopal city (central part of India) pertaining to sealants, topical fluorides usage and orthodontic consideration in paediatric patients.

MATERIALS AND METHODS

A descriptive cross-sectional survey was conducted using a 20-item self-administered, closed ended, structured questionnaire. A total of 200 available private dental practitioners of Bhopal city made up the sampling frame of study.

RESULTS

Out of 200 practicing dentists, 147 participated with response rate of 73.5% in which 69.4% were males and 30.6% were females. A total of 83% dentists were less than 35 years of age, while 17% were equal to or more than 35 years of age. Qualification distribution revealed 67.3% dental graduate and 32.6% dental specialist. A highly significant difference in knowledge in relation to age was observed. The mean±SD were found for Knowledge as 8.46±1.82, Attitude as 2.65±0.780, and Practice as 1.66±1.57. Statistically significant correlations were found between attitude and practice (r=0.58, p<0.001).

CONCLUSION

Dentists in Bhopal city have vast knowledge towards preventive dentistry. The attitude is highly commendable but underutilized in practice, which needs to be improved.

Effects of enamel sealing on shear bond strength and the adhesive remnant index : Study of three fluoride-releasing adhesives in combination with metal and ceramic brackets

OBJECTIVES

Selected combinations of materials were used to create tooth-adhesive-bracket complexes to evaluate shear bond strength (SBS) and the adhesive remnant index (ARI) with regard to enamel sealing.

METHODS

Four adhesive systems also appropriate for use as enamel sealants were combined with four bracket types, resulting in 16 adhesive-bracket combinations, each of which was tested on 15 permanent bovine incisors. Sealant-adhesives included two recently introduced fluoride-releasing systems (Riva bond LC^® and go!^®), one established primer (Opal^® Seal™), and one commonly used adhesive as control (Transbond™ XT). Brackets included two metal (discovery^® by Dentaurum and Sprint^®) and two ceramic (discovery^® pearl and GLAM^®) systems. After embedding the bovine teeth, bonding the brackets to their surface, and storing the resultant samples as per DIN 13990-2 with modifications, an SBS test was performed by applying the shear force directly at the bracket base in an incisocervical direction. Then the ARI scores were determined.

RESULTS

Discovery^® + Transbond™ XT yielded the highest (47.2 MPa) and GLAM^® + go!^® the lowest (17.0 MPa) mean SBS values. Significant differences (p < 0.0001) were found between metal and ceramic brackets of the same manufacturers (Dentaurum and Forestadent). Our ratings of the failure modes upon debonding predominantly yielded ARI 0 or 1. The high SBS values and low ARI scores observed with discovery^® + Transbond XT™ were reflected in a high rate of enamel fracture, which occurred on 11 of the 15 tooth specimens in this group.

CONCLUSIONS

All sealant-bracket combinations were found to yield levels of SBS adequate for clinical application. SBS values and ARI scores varied significantly depending on which sealant-brackets were used.

Do light cured ART conventional high-viscosity glass-ionomer sealants perform better than resin-composite sealants: a 4-year randomized clinical trial

OBJECTIVE

The hypotheses tested were: the cumulative survival rates of dentin caries lesion-free pits and fissures of ART conventional high-viscosity glass-ionomer sealants with light-curing (high-intensity LED) and glass-carbomer sealants are higher than those of conventional ART sealants and resin-composite sealants after 4 years.

METHODS

The randomized controlled clinical trial covered 405 children (mean age 8-years). Three dentists placed sealants in pits and fissures of high caries-risk children. Evaluation by two independent evaluators was conducted after 0.5, 1, 2, 3 and 4 years. The Kaplan-Meier survival method, ANOVA and t-test were used in data analyses.

RESULTS

1304 first permanent molars were sealed. 12.3% of children and 15.4% of sealants dropped out. 46 re-exposed pits and fissures, 39 (occlusal) 7 (free smooth surfaces), in 42 children developed a dentin carious lesion. The cumulative survival of dentin caries lesion-free occlusal pits and fissures in ART plus LED group (98%) was statistically significantly higher than in the resin-composite group (96.4%) and in the glass-carbomer group (94.5%). The cumulative survival of dentin caries lesion-free occlusal pits and fissures in the glass-carbomer group was statistically significantly lower than that in the conventional ART group (97.3%). For the free smooth surfaces, there was no statistically significantly difference among the four sealant groups.

SIGNIFICANCE

Light-cured ART conventional high-viscosity glass-ionomer sealants prevented the occurrence of dentin cavities best.

A Comparative Evaluation of the Effect of Bonding Agent on the Tensile Bond Strength of Two Pit and Fissure Sealants Using Invasive and Non-invasive Techniques: An in-vitro Study

BACKGROUND

Newer technologies and the development of pit and fissure sealants have shifted the treatment philosophy from 'drill and fill' to that of 'seal and heal'.

AIMS

The purpose of this in-vitro study was to evaluate the effects of bonding agents on the tensile bond strengths of two pit and fissure sealants by using invasive and non-invasive techniques.

STUDY DESIGN AND METHODS

One hundred and twenty bicuspids were collected and teeth were divided into two groups: Group-I (Clinpro) and Group-II (Conseal f) with 60 teeth in each group. For evaluating tensile bond strengths, occlusal surfaces of all the teeth were flattened by reducing buccal and lingual cusps without disturbing fissures. Standardised polyvinyl tube was bonded to occlusal surfaces with respective materials. Sealants were applied, with or without bonding agents, in increments and they were light cured. Tensile bond strengths were determined by using Universal Testing Machine.

STATISTICAL ANALYSIS

Data were then statistically analysed by using Student t-test for comparison.

RESULTS

A statistically significant difference was found in tensile bond strength in invasive with bonding agent group than in non-invasive with bonding agent group.

CONCLUSION

This study revealed that invasive techniques increase the tensile bond strengths of sealants as compared to non- invasive techniques and that the use of a bonding agent as an intermediate layer between the tooth and fissure sealant is beneficial for increasing the bond strength.