Pub Date : 2024-09-18DOI: 10.1038/s41432-024-01066-8
Darshini Ramasubbu, Jonathan Lewney
Design
The Brushing RemInder 4 Good oral HealTh (BRIGHT) multi-centre randomized controlled trial was based in state-funded secondary schools in England, Wales and Scotland. It had two arms, aiming to assess the clinical and cost effectiveness of a 50 min education session and twice daily brush reminder text messages on toothbrushing and caries rates, compared to the normal education curriculum and no SMS. Outcomes were assessed at intervals over 2.5 years and were assessor-blinded.
Case selection
Pupils aged 11-13 were recruited from participating schools, and in each school randomised via year group to either the intervention or control group following baseline assessments by calibrated dental professionals. Exclusion criteria included not having a functioning mobile phone.
Data analysis
The primary outcome, D4–6 MFT (Decayed, Missing and Filled Teeth), was analysed using mixed-effect logistic regression and sensitivity analyses were conducted. A cost-utility analysis was also undertaken.
Results
In total 42 schools, containing 84 year groups were randomised, and 4680 pupils were in the final sample. 663 pupils withdrew from follow up. At 6 months, there was evidence that intervention group pupils were more likely to report brushing at least twice per day However, by 2.5 years this effect was no longer evident. 2383 participants had a valid dental assessment at both baseline and 2.5 years, with 514 children in the intervention and 529 children in the control group presenting with obvious decay experience in at least one permanent tooth after 2.5 years. The intervention was estimated to have a 7% chance of being cost-effective. Over the 2.5-year follow-up, there were no significant differences in QALYs and costs between groups.
Conclusions
The findings from the BRIGHT trial indicate no evidence of a statistically significant difference between the intervention and control groups for the prevalence of caries after 2.5-years. The behaviour change intervention did not translate into a reduction in caries rates.
{"title":"Can a behaviour change toothbrushing intervention prevent dental caries in 11–13-year-olds?","authors":"Darshini Ramasubbu, Jonathan Lewney","doi":"10.1038/s41432-024-01066-8","DOIUrl":"https://doi.org/10.1038/s41432-024-01066-8","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Design</h3><p>The Brushing RemInder 4 Good oral HealTh (BRIGHT) multi-centre randomized controlled trial was based in state-funded secondary schools in England, Wales and Scotland. It had two arms, aiming to assess the clinical and cost effectiveness of a 50 min education session and twice daily brush reminder text messages on toothbrushing and caries rates, compared to the normal education curriculum and no SMS. Outcomes were assessed at intervals over 2.5 years and were assessor-blinded.</p><h3 data-test=\"abstract-sub-heading\">Case selection</h3><p>Pupils aged 11-13 were recruited from participating schools, and in each school randomised via year group to either the intervention or control group following baseline assessments by calibrated dental professionals. Exclusion criteria included not having a functioning mobile phone.</p><h3 data-test=\"abstract-sub-heading\">Data analysis</h3><p>The primary outcome, D<sub>4–6</sub> MFT (Decayed, Missing and Filled Teeth), was analysed using mixed-effect logistic regression and sensitivity analyses were conducted. A cost-utility analysis was also undertaken.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>In total 42 schools, containing 84 year groups were randomised, and 4680 pupils were in the final sample. 663 pupils withdrew from follow up. At 6 months, there was evidence that intervention group pupils were more likely to report brushing at least twice per day However, by 2.5 years this effect was no longer evident. 2383 participants had a valid dental assessment at both baseline and 2.5 years, with 514 children in the intervention and 529 children in the control group presenting with obvious decay experience in at least one permanent tooth after 2.5 years. The intervention was estimated to have a 7% chance of being cost-effective. Over the 2.5-year follow-up, there were no significant differences in QALYs and costs between groups.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>The findings from the BRIGHT trial indicate no evidence of a statistically significant difference between the intervention and control groups for the prevalence of caries after 2.5-years. The behaviour change intervention did not translate into a reduction in caries rates.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"208 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1038/s41432-024-01062-y
Meenakshi Lall
A prospective, randomized, split-mouth clinical study by the two previously trained and calibrated pediatric dentists without blinding operators and patients due to different protocols in both treatment groups. An SDF + potassium iodide (KI) and SDF + KI + glass ionmer cement (GIC) on International Caries Detection and Assessment System (ICDAS) 1/2 molar was received by each patient on either side of mouth. The local Ethics Committee approved this study. Sample size calculation was not performed due to the lack of published studies on the longevity of SMART sealant on MIH-affected molars and the absence of research on the apparent difference between the effectiveness of SMART and SDF treatments in preventing further caries and sensitivity. These were children between the ages of 6 years to 13 years, who visited the Pediatric Dentistry Clinic at XX University School of Dentistry for routine exams and treatment between July 2019 to May 2020. They were in good health and had at least two fully erupted permanent first molars with MIH as per the European Academy of Pediatric Dentistry, ICDAS code 1/2. This study recorded 12 months of treatment outcomes on hypomineralised molars of 48 children with a follow-up of three years. Children were excluded with specific syndromes associated with enamel malformation, lack of cooperation, ongoing orthodontic treatment, and teeth with ICDAS 3/4/5/6 lesions, existing restorations, fluorosis, or pulpal symptoms. Mann-Whitney U Test was used to assess differences between independent groups (SDF and SMART) and the Friedman Test between dependent groups at different time points. Kaplan-Meier analysis to evaluate the cumulative survival of SMART sealants and survival of caries-free hypomineralised molars in both groups. Chi-Square test was used to compare the success percentages of the SDF and SMART groups. To assess the changes in success percentages at three different time intervals for the caries preventive effect of SDF and SMART, and to evaluate the retention percentages for the SMART group. McNemar’s test with a Bonferroni correction was used for significant differences. Cohen’s kappa test indicated that the inter-examiner reliability determining the presence of MIH was 0.87. The intra-examiner reliability for US Public Health Service (USPHS)-Modified criteria was 0.90. The statistical significance level was set at p < 0.05 for all statistical analyses. At 12, 24 and 36 months the caries preventive effect was 100%, 67.9%, and 65.4% for SDF + KI-treated teeth; and 100%, 97.6%, and 94.7% for SMART (SDF + KI + GIC) respectively. During the recall period, there was no substantial difference in hypersensitivity scores between the groups. There was no hypersensitivity in teeth at 18 months and beyond. Compared to the baseline Schiff Cold Air Sensitivity Scale (SCASS) score 26 molar with initial hypersensitivity to hypomineralisation had a massive reduction at evaluation periods. The mean survival
设计由两名经过培训和校准的儿童牙医进行前瞻性、随机、分口临床研究，由于两组治疗方案不同，操作者和患者均未设置盲区。每位患者口腔两侧分别接受国际龋病检测和评估系统（ICDAS）1/2臼齿的SDF+碘化钾（KI）和SDF+碘化钾+玻璃离子水泥（GIC）治疗。当地伦理委员会批准了这项研究。数据来源由于缺乏关于SMART封闭剂在受MIH影响的臼齿上的使用寿命的公开研究，也缺乏关于SMART和SDF治疗在预防进一步龋齿和敏感性方面的明显差异的研究，因此没有进行样本量计算。研究选择这些儿童年龄在6岁至13岁之间，于2019年7月至2020年5月期间到XX大学牙科学院儿童牙科门诊进行常规检查和治疗。他们健康状况良好，至少有两颗完全萌出的永久性第一磨牙，并有欧洲儿童牙科学院（European Academy of Pediatric Dentistry）ICDAS代码1/2的MIH。这项研究记录了 48 名儿童 12 个月的低矿化臼齿治疗结果，随访时间为三年。数据分析曼-惠特尼 U 检验用于评估独立组（SDF 和 SMART）之间的差异，弗里德曼检验用于评估不同时间点依赖组之间的差异。Kaplan-Meier分析评估两组中SMART封闭剂的累积存活率和无龋低矿化磨牙的存活率。采用Chi-Square检验比较SDF组和SMART组的成功率。评估SDF和SMART预防龋齿效果的成功率在三个不同时间间隔内的变化，并评估SMART组的保留率。采用McNemar检验并进行Bonferroni校正，以确定是否存在显著差异。Cohen's kappa 检验表明，确定是否存在 MIH 的检查者间可靠性为 0.87。美国公共卫生署（USPHS）修订标准的检查员内部可靠性为 0.90。所有统计分析的显著性水平均定为 p < 0.05。结果在 12、24 和 36 个月时，SDF + KI 处理过的牙齿的防龋效果分别为 100%、67.9% 和 65.4%；SMART（SDF + KI + GIC）的防龋效果分别为 100%、97.6% 和 94.7%。在回访期间，各组之间的超敏反应评分没有实质性差异。在 18 个月及以后，牙齿也没有出现过敏现象。与基线希夫冷空气敏感度量表（SCASS）评分相比，26 颗最初对矿化度过高过敏的臼齿在评估期间的评分大幅下降。考虑到研究的局限性，SMART（SDF + KI + GIC）封闭剂和每 6 个月使用一次 SDF + KI，都能为永久性 MIH 磨牙提供类似的、实质性的脱敏效果。如果将 SMART 用作无龋永久性 MIH 磨牙的封闭材料，1 年、2 年和 3 年后的临床保持率分别为 88.7%、73.1% 和 66.6%。SMART（SDF + KI + GIC）封闭剂对低矿化牙齿的龋病预防效果优于SDF + KI封闭剂，但由于SMART封闭剂的固位率会逐渐下降，因此有必要进行长期监测和复查。
{"title":"Is SDF better than the SMART (silver modified atraumatic restorative technique) in the management of molar incisor hypomineralisation molars with initial caries?","authors":"Meenakshi Lall","doi":"10.1038/s41432-024-01062-y","DOIUrl":"10.1038/s41432-024-01062-y","url":null,"abstract":"A prospective, randomized, split-mouth clinical study by the two previously trained and calibrated pediatric dentists without blinding operators and patients due to different protocols in both treatment groups. An SDF + potassium iodide (KI) and SDF + KI + glass ionmer cement (GIC) on International Caries Detection and Assessment System (ICDAS) 1/2 molar was received by each patient on either side of mouth. The local Ethics Committee approved this study. Sample size calculation was not performed due to the lack of published studies on the longevity of SMART sealant on MIH-affected molars and the absence of research on the apparent difference between the effectiveness of SMART and SDF treatments in preventing further caries and sensitivity. These were children between the ages of 6 years to 13 years, who visited the Pediatric Dentistry Clinic at XX University School of Dentistry for routine exams and treatment between July 2019 to May 2020. They were in good health and had at least two fully erupted permanent first molars with MIH as per the European Academy of Pediatric Dentistry, ICDAS code 1/2. This study recorded 12 months of treatment outcomes on hypomineralised molars of 48 children with a follow-up of three years. Children were excluded with specific syndromes associated with enamel malformation, lack of cooperation, ongoing orthodontic treatment, and teeth with ICDAS 3/4/5/6 lesions, existing restorations, fluorosis, or pulpal symptoms. Mann-Whitney U Test was used to assess differences between independent groups (SDF and SMART) and the Friedman Test between dependent groups at different time points. Kaplan-Meier analysis to evaluate the cumulative survival of SMART sealants and survival of caries-free hypomineralised molars in both groups. Chi-Square test was used to compare the success percentages of the SDF and SMART groups. To assess the changes in success percentages at three different time intervals for the caries preventive effect of SDF and SMART, and to evaluate the retention percentages for the SMART group. McNemar’s test with a Bonferroni correction was used for significant differences. Cohen’s kappa test indicated that the inter-examiner reliability determining the presence of MIH was 0.87. The intra-examiner reliability for US Public Health Service (USPHS)-Modified criteria was 0.90. The statistical significance level was set at p < 0.05 for all statistical analyses. At 12, 24 and 36 months the caries preventive effect was 100%, 67.9%, and 65.4% for SDF + KI-treated teeth; and 100%, 97.6%, and 94.7% for SMART (SDF + KI + GIC) respectively. During the recall period, there was no substantial difference in hypersensitivity scores between the groups. There was no hypersensitivity in teeth at 18 months and beyond. Compared to the baseline Schiff Cold Air Sensitivity Scale (SCASS) score 26 molar with initial hypersensitivity to hypomineralisation had a massive reduction at evaluation periods. The mean survival","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"162-163"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142177669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.1038/s41432-024-01061-z
Túlio Silva Pereira, Juliana Freire-Maia, Luna Chagas Clementino, Paulo Antônio Martins-Júnior
Cohort study. Confirmatory Factor Analysis (CFA) and Structured Equation Modeling (SEM). Psychosocial status emerged as the main predictor of traumatic dental injuries (TDIs). Better psychosocial status had a direct protective effect on the incidence of TDIs. The impact of increased overjet and lower parental schooling on TDIs was mediated through psychosocial status. Children residing in areas with poorer contextual socio-economic indicators faced a higher risk of experiencing new TDIs due to psychosocial factors. Poor psychosocial status directly correlated to TDIs. Indirectly, psychosocial factors mediated the occurrence of TDIs through overjet, parental schooling and contextual residential area.
{"title":"The role of psychological status in the incidence of traumatic dental injuries in schoolchildren","authors":"Túlio Silva Pereira, Juliana Freire-Maia, Luna Chagas Clementino, Paulo Antônio Martins-Júnior","doi":"10.1038/s41432-024-01061-z","DOIUrl":"10.1038/s41432-024-01061-z","url":null,"abstract":"Cohort study. Confirmatory Factor Analysis (CFA) and Structured Equation Modeling (SEM). Psychosocial status emerged as the main predictor of traumatic dental injuries (TDIs). Better psychosocial status had a direct protective effect on the incidence of TDIs. The impact of increased overjet and lower parental schooling on TDIs was mediated through psychosocial status. Children residing in areas with poorer contextual socio-economic indicators faced a higher risk of experiencing new TDIs due to psychosocial factors. Poor psychosocial status directly correlated to TDIs. Indirectly, psychosocial factors mediated the occurrence of TDIs through overjet, parental schooling and contextual residential area.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"146-147"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.1038/s41432-024-01057-9
Joshua Kennedy, Greig Taylor
A systematic search was conducted across multiple databases (MEDLINE via PubMed, EMBASE, Scopus, LILACS, Web of Science, and EBSCO) up to January 2023. Any case-control, cohort, or cross-sectional study which assessed child temperament and early childhood caries (ECC) in children aged six years or younger were included. Literature reviews, studies with insufficient data, non-English publications, and those focusing on older children or adults were excluded. Data extraction was conducted independently by two authors, with a third author resolving any disagreements. Risk of bias was assessed using the Newcastle-Ottawa assessment scale (case-control and cohort studies) and the Appraisal tool for Cross-Sectional Studies (cross-sectional studies). The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Statistical analysis to evaluate heterogeneity included the chi-square test and the I-square index. A total 5072 studies resulted in the inclusion of 15 studies, encompassing data from 6,667 participants. Seven studies were of high quality and eight, moderate. Meta-analyses of seven studies revealed a significant association between certain temperament traits (e.g., higher levels of emotionality and lower levels of sociability) and ECC. In particular, difficult temperament was associated with ECC (OR 2.63 95%CI: 1.37–5.04) The study concluded that child temperament is a significant factor in the risk of developing ECC. Specifically, children with higher emotionality and lower sociability are at greater risk. Interventions targeting child temperament through child behaviour and parental management strategies may be effective in reducing ECC.
数据来源：对多个数据库（MEDLINE via PubMed、EMBASE、Scopus、LILACS、Web of Science 和 EBSCO）进行了系统检索，检索期截至 2023 年 1 月：研究选择：纳入任何对六岁或六岁以下儿童的气质和儿童早期龋齿（ECC）进行评估的病例对照、队列或横断面研究。文献综述、数据不充分的研究、非英语出版物以及以年长儿童或成人为研究对象的研究均被排除在外：数据提取由两位作者独立完成，第三位作者负责解决任何分歧。使用纽卡斯尔-渥太华评估量表（病例对照和队列研究）和横断面研究评估工具（横断面研究）评估偏倚风险。证据质量采用建议、评估、发展和评价分级法（GRADE）进行评估。评估异质性的统计分析包括卡方检验和 I 方指数：结果：总共有 5072 项研究，最终纳入了 15 项研究，涵盖了 6667 名参与者的数据。其中 7 项研究质量较高，8 项研究质量中等。对七项研究进行的元分析表明，某些气质特征（如较高的情绪化水平和较低的交际能力）与幼儿注意力缺失有显著关联。特别是，困难气质与幼儿保育相关（OR 2.63 95%CI：1.37-5.04）：研究得出结论，儿童的脾气是影响幼儿保育的一个重要因素。具体而言，情绪化程度较高和社交能力较差的儿童风险更大。通过儿童行为和家长管理策略对儿童气质进行干预，可能会有效降低幼儿保育的风险。
{"title":"Child temperament and early childhood caries: is there a link?","authors":"Joshua Kennedy, Greig Taylor","doi":"10.1038/s41432-024-01057-9","DOIUrl":"10.1038/s41432-024-01057-9","url":null,"abstract":"A systematic search was conducted across multiple databases (MEDLINE via PubMed, EMBASE, Scopus, LILACS, Web of Science, and EBSCO) up to January 2023. Any case-control, cohort, or cross-sectional study which assessed child temperament and early childhood caries (ECC) in children aged six years or younger were included. Literature reviews, studies with insufficient data, non-English publications, and those focusing on older children or adults were excluded. Data extraction was conducted independently by two authors, with a third author resolving any disagreements. Risk of bias was assessed using the Newcastle-Ottawa assessment scale (case-control and cohort studies) and the Appraisal tool for Cross-Sectional Studies (cross-sectional studies). The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Statistical analysis to evaluate heterogeneity included the chi-square test and the I-square index. A total 5072 studies resulted in the inclusion of 15 studies, encompassing data from 6,667 participants. Seven studies were of high quality and eight, moderate. Meta-analyses of seven studies revealed a significant association between certain temperament traits (e.g., higher levels of emotionality and lower levels of sociability) and ECC. In particular, difficult temperament was associated with ECC (OR 2.63 95%CI: 1.37–5.04) The study concluded that child temperament is a significant factor in the risk of developing ECC. Specifically, children with higher emotionality and lower sociability are at greater risk. Interventions targeting child temperament through child behaviour and parental management strategies may be effective in reducing ECC.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"143-145"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01057-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: To evaluate the efficacy of autologous platelet concentrates (APC) on periodontal outcomes in nonsurgical therapy of periodontitis patients.
Method: Electronic search via Web of Science, MEDLINE via PubMed, Scopus, and Cochrane CENTRAL registry as well as manual search were done from June 2024 to July 2024 for relevant publication from inception until June 2024. The articles were assessed by 2 independent reviewers and deemed relevant when the interventional studies reported on periodontal outcomes after adjunctive APC were used in NSPT. The studies were excluded if it was not in English or unpublished. The risk of bias for each study was assessed using the Cochrane risk-of-bias tool (RoB 2). Fixed effect meta-analysis was conducted to measure the summary effect for change of periodontal pocket depth (PPD) and Clinical Attachment Level (CAL). The statistical heterogeneity between studies was also calculated using I2 test.
Result: A total of 607 records were found in the four electronic databases. Following the removal of duplicates and initial title screening, 16 full text articles from electronic search and 7 articles from manual search were assessed resulting in 13 studies included in the systematic review. The overall risk of bias showed most studies have moderate to high risk of bias. The fixed-effect meta-analysis showed summary effects favored the adjunctive use of APC in nonsurgical periodontal therapy but with high heterogeneity between the studies, particularly for CAL.
Conclusion: The evidence on APC as adjunct in NSPT is limited by the small number of studies, moderate to high risk of bias in most studies and significant heterogeneity in the results.
{"title":"The effectiveness of autologous platelet-rich concentrates as an adjunct during nonsurgical periodontal therapy: a systematic review and meta-analysis of randomized controlled trials.","authors":"Nazurah Nik Eezammuddeen, Nurina Nasuha Johari, Olevia Demius, Fouad Hussain Al-Bayaty","doi":"10.1038/s41432-024-01060-0","DOIUrl":"https://doi.org/10.1038/s41432-024-01060-0","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the efficacy of autologous platelet concentrates (APC) on periodontal outcomes in nonsurgical therapy of periodontitis patients.</p><p><strong>Method: </strong>Electronic search via Web of Science, MEDLINE via PubMed, Scopus, and Cochrane CENTRAL registry as well as manual search were done from June 2024 to July 2024 for relevant publication from inception until June 2024. The articles were assessed by 2 independent reviewers and deemed relevant when the interventional studies reported on periodontal outcomes after adjunctive APC were used in NSPT. The studies were excluded if it was not in English or unpublished. The risk of bias for each study was assessed using the Cochrane risk-of-bias tool (RoB 2). Fixed effect meta-analysis was conducted to measure the summary effect for change of periodontal pocket depth (PPD) and Clinical Attachment Level (CAL). The statistical heterogeneity between studies was also calculated using I<sup>2</sup> test.</p><p><strong>Result: </strong>A total of 607 records were found in the four electronic databases. Following the removal of duplicates and initial title screening, 16 full text articles from electronic search and 7 articles from manual search were assessed resulting in 13 studies included in the systematic review. The overall risk of bias showed most studies have moderate to high risk of bias. The fixed-effect meta-analysis showed summary effects favored the adjunctive use of APC in nonsurgical periodontal therapy but with high heterogeneity between the studies, particularly for CAL.</p><p><strong>Conclusion: </strong>The evidence on APC as adjunct in NSPT is limited by the small number of studies, moderate to high risk of bias in most studies and significant heterogeneity in the results.</p>","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1038/s41432-024-01059-7
Omer Waleed Majid
A randomized, controlled, single-blind clinical trial. To assess and compare patient-reported outcome measures (PROMs) between low-speed drilling without irrigation and high-speed drilling with irrigation for implant site preparation. The study adhered to the Declaration of Helsinki principles, obtained approval from the local Ethics Committee, was registered on ClinicalTrials.gov, and was written in accordance with CONSORT guidelines. Included were adult patients with single posterior edentulism who exhibited good oral hygiene, sufficient bone dimensions for implant placement, adequate keratinized mucosa, stable occlusion, and a healthy periodontium. Patients were randomly assigned to either the test group (low-speed drilling (150 rpm) without irrigation) or the control group (high-speed drilling (800 rpm) with irrigation). A single dental implant was placed for each patient, with all surgeries conducted by the same experienced operator according to a standardized protocol. Patient satisfaction during surgery, including drilling-time perception, vibration, pressure, noise, comfort, and drowning sensation, as well as postoperative pain and inflammation, were assessed using a 100-mm visual analog scale. Quality of life (QOL) was evaluated using a 5-graded Likert scale for mouth opening, chewing, speaking, sleeping, daily routine, and job. Follow up extended on daily basis for 7 days. The PROMs were collected and analyzed in a blinded manner by independent researchers and a statistician to prevent bias. The study included 66 patients (33 males and 33 females) with a mean age of 54.5 years. Patients in the test group reported a lower perception of drilling time, vibration, and noise but a higher perception of pressure compared to the control group; however, these differences were not statistically significant. Compared to the test group, patients in the control group experienced significantly greater drowning sensation and lesser comfort measures (p < 0.001). There was a moderate inverse correlation between drowning sensation and comfort (r = −0.57). The real drilling time was significantly longer in the test group compared to the control group (p < 0.001). The test group reported significantly lower pain levels during the first 12 h (p < 0.05), and significantly lower inflammation levels at the second day (p < 0.05) compared to the control group. No significant differences were observed between the groups at any time point for any of the QOL parameters (p > 0.05). For a single implant site preparation, low-speed drilling without irrigation seems to offer greater patient comfort compared to high-speed drilling with irrigation, mainly due to reduced drowning sensation. Patients reported less postoperative pain and inflammation with the low-speed technique. Confirming these findings will require more research.
{"title":"Slow drilling technique may enhance peri-operative patient-reported outcomes in dental implant surgery","authors":"Omer Waleed Majid","doi":"10.1038/s41432-024-01059-7","DOIUrl":"10.1038/s41432-024-01059-7","url":null,"abstract":"A randomized, controlled, single-blind clinical trial. To assess and compare patient-reported outcome measures (PROMs) between low-speed drilling without irrigation and high-speed drilling with irrigation for implant site preparation. The study adhered to the Declaration of Helsinki principles, obtained approval from the local Ethics Committee, was registered on ClinicalTrials.gov, and was written in accordance with CONSORT guidelines. Included were adult patients with single posterior edentulism who exhibited good oral hygiene, sufficient bone dimensions for implant placement, adequate keratinized mucosa, stable occlusion, and a healthy periodontium. Patients were randomly assigned to either the test group (low-speed drilling (150 rpm) without irrigation) or the control group (high-speed drilling (800 rpm) with irrigation). A single dental implant was placed for each patient, with all surgeries conducted by the same experienced operator according to a standardized protocol. Patient satisfaction during surgery, including drilling-time perception, vibration, pressure, noise, comfort, and drowning sensation, as well as postoperative pain and inflammation, were assessed using a 100-mm visual analog scale. Quality of life (QOL) was evaluated using a 5-graded Likert scale for mouth opening, chewing, speaking, sleeping, daily routine, and job. Follow up extended on daily basis for 7 days. The PROMs were collected and analyzed in a blinded manner by independent researchers and a statistician to prevent bias. The study included 66 patients (33 males and 33 females) with a mean age of 54.5 years. Patients in the test group reported a lower perception of drilling time, vibration, and noise but a higher perception of pressure compared to the control group; however, these differences were not statistically significant. Compared to the test group, patients in the control group experienced significantly greater drowning sensation and lesser comfort measures (p < 0.001). There was a moderate inverse correlation between drowning sensation and comfort (r = −0.57). The real drilling time was significantly longer in the test group compared to the control group (p < 0.001). The test group reported significantly lower pain levels during the first 12 h (p < 0.05), and significantly lower inflammation levels at the second day (p < 0.05) compared to the control group. No significant differences were observed between the groups at any time point for any of the QOL parameters (p > 0.05). For a single implant site preparation, low-speed drilling without irrigation seems to offer greater patient comfort compared to high-speed drilling with irrigation, mainly due to reduced drowning sensation. Patients reported less postoperative pain and inflammation with the low-speed technique. Confirming these findings will require more research.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"127-128"},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142079823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1038/s41432-024-01043-1
Natália Magno Von Helde, Mariana Leonel Martins, Mayara da Costa Motta, Tainá Fontes de Souza, Marcela Baraúna Magno, Lucianne Cople Maia, Andréa Fonseca-Gonçalves
To analyze, through a systematic review, the effectiveness of educational tools (ETs) in Oral Health Programs (OHPs) for pregnant women in improving their oral status and that of their babies. Searches were carried out in 5 electronic databases. Randomized (RCTs) and non-randomized clinical trials (CTs) were selected that included pregnant women exposed or not to ETs in OHPs, whose oral health status, in the pre- or postnatal period, or of their babies were verified. The types of ETs, outcomes, and results were extracted. Bias risk was assessed by ROBINS-I and RoB 2.0; and the certainty of the evidence (CE) by GRADE. A total of nine studies were included. Most used more than one ET (n = 8), with verbal guidance used in all (n = 9). Mothers showed a reduction in biofilm (n = 3), caries (n = 4) and periodontitis (n = 4). All studies with babies (n = 3) were successful in preventing caries. RCTs (n = 3) were classified as low risk of bias (n = 1), with concerns (n = 1) and high risk of bias (n = 1). CTs (n = 6) presented risk of bias as low (n = 2), serious (n = 1) and critical (n = 3). Studies about caries in babies showed high CE, and those who evaluated caries and periodontal parameters/biofilm in the mother had moderate and low CE, respectively. ETs as a strategy of OHPs for pregnant women can be effective in preventing caries in themselves and in their babies. However, despite the improvement of the mothers’ oral hygiene and gingival condition, the CE was low considering this parameter.
{"title":"Are educational tools in oral health programs for pregnant women effective in improving the oral status of mothers and babies? A systematic review","authors":"Natália Magno Von Helde, Mariana Leonel Martins, Mayara da Costa Motta, Tainá Fontes de Souza, Marcela Baraúna Magno, Lucianne Cople Maia, Andréa Fonseca-Gonçalves","doi":"10.1038/s41432-024-01043-1","DOIUrl":"10.1038/s41432-024-01043-1","url":null,"abstract":"To analyze, through a systematic review, the effectiveness of educational tools (ETs) in Oral Health Programs (OHPs) for pregnant women in improving their oral status and that of their babies. Searches were carried out in 5 electronic databases. Randomized (RCTs) and non-randomized clinical trials (CTs) were selected that included pregnant women exposed or not to ETs in OHPs, whose oral health status, in the pre- or postnatal period, or of their babies were verified. The types of ETs, outcomes, and results were extracted. Bias risk was assessed by ROBINS-I and RoB 2.0; and the certainty of the evidence (CE) by GRADE. A total of nine studies were included. Most used more than one ET (n = 8), with verbal guidance used in all (n = 9). Mothers showed a reduction in biofilm (n = 3), caries (n = 4) and periodontitis (n = 4). All studies with babies (n = 3) were successful in preventing caries. RCTs (n = 3) were classified as low risk of bias (n = 1), with concerns (n = 1) and high risk of bias (n = 1). CTs (n = 6) presented risk of bias as low (n = 2), serious (n = 1) and critical (n = 3). Studies about caries in babies showed high CE, and those who evaluated caries and periodontal parameters/biofilm in the mother had moderate and low CE, respectively. ETs as a strategy of OHPs for pregnant women can be effective in preventing caries in themselves and in their babies. However, despite the improvement of the mothers’ oral hygiene and gingival condition, the CE was low considering this parameter.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"216-216"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The systematic review aimed to review the existing evidence, to identify and appraise the effectiveness of periodontal prevention and treatment modalities in individuals diagnosed with Down syndrome (DS) and to determine the estimates of the effects of implemented periodontal prevention and treatment strategies compared to chromosomally normal (CN) individuals. The systematic review was conducted and reported in conformity with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The study protocol was registered in the Open Science Framework. Electronic and manual searches, in accordance with PICO framework and delineated inclusion/exclusion criteria, were conducted in multiple databases. The initial search identified 11,704 studies. After removing duplicates, 9,048 remained. Title and abstract screening narrowed these to 281 for full-text review. Ultimately, 16 studies met the inclusion criteria, with 4 eligible for quantitative data synthesis. Results of the meta-analysis indicated that professional tooth cleaning in combination with oral hygiene reinforcement was less effective in the reduction of PPD in patients with DS compared to those without DS (Mean difference (MD): 0.23; 95% Confidence Interval (CI): 0.14 to 0.32; p < 0.001). These findings suggest that conventional periodontal treatment is less effective in managing periodontitis in patients with DS. Thus, tailored periodontal care strategies that address the specific needs of individuals with DS should be implemented to improve treatment outcomes for this population The presence of moderate to high risk of bias in the included studies underscores the need for rigorously designed research that minimizes bias through effective blinding, randomization, control of confounding factors, and inclusion of diverse treatment outcomes to further investigate these associations. Based on the best available evidence, professional tooth cleaning combined with oral hygiene instructions appears to be less effective in reducing pocket depths in individuals with DS compared to those without DS. https://doi.org/10.17605/OSF.IO/UXTCG
{"title":"Efficacy of periodontal treatment modalities in Down syndrome patients: a systematic review and meta-analysis","authors":"Zakaria Yehia, Angelika Silbereisen, Despina Koletsi, Mahla Arabzadehtousi, Georgios Tsilingaridis, Nagihan Bostanci","doi":"10.1038/s41432-024-01055-x","DOIUrl":"10.1038/s41432-024-01055-x","url":null,"abstract":"The systematic review aimed to review the existing evidence, to identify and appraise the effectiveness of periodontal prevention and treatment modalities in individuals diagnosed with Down syndrome (DS) and to determine the estimates of the effects of implemented periodontal prevention and treatment strategies compared to chromosomally normal (CN) individuals. The systematic review was conducted and reported in conformity with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The study protocol was registered in the Open Science Framework. Electronic and manual searches, in accordance with PICO framework and delineated inclusion/exclusion criteria, were conducted in multiple databases. The initial search identified 11,704 studies. After removing duplicates, 9,048 remained. Title and abstract screening narrowed these to 281 for full-text review. Ultimately, 16 studies met the inclusion criteria, with 4 eligible for quantitative data synthesis. Results of the meta-analysis indicated that professional tooth cleaning in combination with oral hygiene reinforcement was less effective in the reduction of PPD in patients with DS compared to those without DS (Mean difference (MD): 0.23; 95% Confidence Interval (CI): 0.14 to 0.32; p < 0.001). These findings suggest that conventional periodontal treatment is less effective in managing periodontitis in patients with DS. Thus, tailored periodontal care strategies that address the specific needs of individuals with DS should be implemented to improve treatment outcomes for this population The presence of moderate to high risk of bias in the included studies underscores the need for rigorously designed research that minimizes bias through effective blinding, randomization, control of confounding factors, and inclusion of diverse treatment outcomes to further investigate these associations. Based on the best available evidence, professional tooth cleaning combined with oral hygiene instructions appears to be less effective in reducing pocket depths in individuals with DS compared to those without DS. https://doi.org/10.17605/OSF.IO/UXTCG","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 4","pages":"213-214"},"PeriodicalIF":0.0,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41432-024-01055-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-25DOI: 10.1038/s41432-024-01053-z
Lucy Tiplady, Sadie Karia
A multi-centre randomised controlled trial was conducted with paediatric patients requiring crowns after pulp therapy. Participants were randomly divided into two groups: Stainless Steel Crown (SCC) (n = 28) and Resin Crown (RC) (n = 28). RCs were fabricated using a 3D printer with a standardised manufacturing process. The assessment was through periapical radiographs, photographs, quantitative light-induced fluorescence, impressions, and clinical assessment. Quigley-Hein plaque index (QHI), gingival index (GI), occlusal wear, and survival were evaluated. Participants were selected from two departments of paediatric dentistry at Yonsei University and Kyung Hee University of Dental College. Patients were between 4–7 years old. The tooth must require pulp therapy and crown, be in place for at least 2 years, and be in stable occlusion. Those with systemic illness, disability, poor cooperation, temporomandibular joint disorder, and bruxism were excluded. Analysis was performed at 1 week, 3 months, 6 months and 12 months. QHI and GI were compared between the two groups. Shapiro-Wilk test was used to analyse the normal distribution of occlusal wear. Comparison was completed using Mann-Whitney U and independent t-tests. Survival rates were assessed using Kaplan-Meier analysis and log-rank tests. Fifty-six teeth were included initially, with follow-up on 23 RCs and 25 SSCs due to failure or lack of attendance. RCs exhibited a statistically significant increase in wear, with mean root mean square (RMS) values of 0.064 (+/−0.02) at 3 months, 0.079 (+) at 6 months, and 0.125 (+/−0.05) at 12 months. Whereas SSCs demonstrated minimal wear, with mean RMS values ranging from 0.021 (+/−0.01) to 0.025 (+/−0.01). The QHI scores indicated no significant difference, except at 1 week where RC exhibited increased plaque. The GI scores for RCs were significantly higher at 12 months. The survival rate of RCs was significantly lower (82.1%) compared to SSCs (100%). While RCs offer improved aesthetics over SSCs, they exhibit lower wear resistance and higher plaque accumulation and gingival inflammation. The survival rate of RCs is significantly lower due to fractures. The clinical effectiveness of RCs has not yet been established.
{"title":"Who wears the crown? Comparing 3D-printed resin crowns to preformed stainless steel crowns for restoring primary molars","authors":"Lucy Tiplady, Sadie Karia","doi":"10.1038/s41432-024-01053-z","DOIUrl":"10.1038/s41432-024-01053-z","url":null,"abstract":"A multi-centre randomised controlled trial was conducted with paediatric patients requiring crowns after pulp therapy. Participants were randomly divided into two groups: Stainless Steel Crown (SCC) (n = 28) and Resin Crown (RC) (n = 28). RCs were fabricated using a 3D printer with a standardised manufacturing process. The assessment was through periapical radiographs, photographs, quantitative light-induced fluorescence, impressions, and clinical assessment. Quigley-Hein plaque index (QHI), gingival index (GI), occlusal wear, and survival were evaluated. Participants were selected from two departments of paediatric dentistry at Yonsei University and Kyung Hee University of Dental College. Patients were between 4–7 years old. The tooth must require pulp therapy and crown, be in place for at least 2 years, and be in stable occlusion. Those with systemic illness, disability, poor cooperation, temporomandibular joint disorder, and bruxism were excluded. Analysis was performed at 1 week, 3 months, 6 months and 12 months. QHI and GI were compared between the two groups. Shapiro-Wilk test was used to analyse the normal distribution of occlusal wear. Comparison was completed using Mann-Whitney U and independent t-tests. Survival rates were assessed using Kaplan-Meier analysis and log-rank tests. Fifty-six teeth were included initially, with follow-up on 23 RCs and 25 SSCs due to failure or lack of attendance. RCs exhibited a statistically significant increase in wear, with mean root mean square (RMS) values of 0.064 (+/−0.02) at 3 months, 0.079 (+) at 6 months, and 0.125 (+/−0.05) at 12 months. Whereas SSCs demonstrated minimal wear, with mean RMS values ranging from 0.021 (+/−0.01) to 0.025 (+/−0.01). The QHI scores indicated no significant difference, except at 1 week where RC exhibited increased plaque. The GI scores for RCs were significantly higher at 12 months. The survival rate of RCs was significantly lower (82.1%) compared to SSCs (100%). While RCs offer improved aesthetics over SSCs, they exhibit lower wear resistance and higher plaque accumulation and gingival inflammation. The survival rate of RCs is significantly lower due to fractures. The clinical effectiveness of RCs has not yet been established.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"152-153"},"PeriodicalIF":0.0,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-24DOI: 10.1038/s41432-024-01056-w
Soumya Narayani Thirumoorthy, Saumiya Gopal
The current study1 is a randomized controlled trial with two arm, multicenter and parallel group design. Study subjects were 38 orthodontic patients younger than 17 years who were being treated with metal braces. Patients with at least one white spot lesion (WSL) graded 1 to 2 according to the International Caries Detection and Assessment System (ICDAS) on the labial surface of permanent maxillary and mandibular canines and incisors were included for the trial. Teeth with carious lesions and restorations, anomalies of the enamel, and primary teeth were excluded. Patients were allocated by computer generated random sequence into resin infiltration and fluoride varnish intervention groups. Study subjects were blinded until the allocation, outcome assessors and statisticians remained blinded through the study, however the operators could not be blinded. Resin infiltration treatment involved removal of orthodontic wires and auxiliaries followed by cleaning the teeth with fluoride free prophylactic paste and completing the resin infiltration according to manufacturer’s instructions. In the fluoride varnish group, a thin layer of the material was applied after isolating the teeth, and patients were asked not to eat or drink for 1 hour. This was continued twice a month for 6 months. Digital images of the teeth were obtained before, and 1 day (T1), 1 week (T2), 1 month (T3), 3 months (T4) and 6 months (T5) after treatment, using a DSLR camera and a matching polarization filter. The images were processed for calibration and color stability. Regions of interest representing WSL (white spot lesion) and SAE (sound adjacent enamel) were isolated in the images for comparison at different stages the images were captured. Statistical analysis was performed using SPSS version 28. Independent-samples t-test was utilized for comparison between the two groups, and paired-samples t-test for comparison within the groups. A statistical significance level of α = 0.05 was set. At T1, significant color difference was observed between white spot lesion and adjacent sound enamel in the resin infiltration group and it remained stable after 6 months. Whereas in the fluoride varnish group, there were no statistical differences from baseline to 6 months. A statistical difference of 3.27 CIELAB units (p < 0.001) was reported between the infiltration group and the fluoride group at T5. No significant changes were noted in SAE with respect to changes in lightness. Resin infiltration was found to be better at masking the demineralization produced by WSL and also enhanced the esthetic appearance of demineralized areas around the brackets. Resin infiltration did not produce any clinically visible effects in non-affected enamel. These changes remained stable for a period of 6 months.
{"title":"Management of white spot enamel lesions with resin infiltration: potentials and future research directions","authors":"Soumya Narayani Thirumoorthy, Saumiya Gopal","doi":"10.1038/s41432-024-01056-w","DOIUrl":"10.1038/s41432-024-01056-w","url":null,"abstract":"The current study1 is a randomized controlled trial with two arm, multicenter and parallel group design. Study subjects were 38 orthodontic patients younger than 17 years who were being treated with metal braces. Patients with at least one white spot lesion (WSL) graded 1 to 2 according to the International Caries Detection and Assessment System (ICDAS) on the labial surface of permanent maxillary and mandibular canines and incisors were included for the trial. Teeth with carious lesions and restorations, anomalies of the enamel, and primary teeth were excluded. Patients were allocated by computer generated random sequence into resin infiltration and fluoride varnish intervention groups. Study subjects were blinded until the allocation, outcome assessors and statisticians remained blinded through the study, however the operators could not be blinded. Resin infiltration treatment involved removal of orthodontic wires and auxiliaries followed by cleaning the teeth with fluoride free prophylactic paste and completing the resin infiltration according to manufacturer’s instructions. In the fluoride varnish group, a thin layer of the material was applied after isolating the teeth, and patients were asked not to eat or drink for 1 hour. This was continued twice a month for 6 months. Digital images of the teeth were obtained before, and 1 day (T1), 1 week (T2), 1 month (T3), 3 months (T4) and 6 months (T5) after treatment, using a DSLR camera and a matching polarization filter. The images were processed for calibration and color stability. Regions of interest representing WSL (white spot lesion) and SAE (sound adjacent enamel) were isolated in the images for comparison at different stages the images were captured. Statistical analysis was performed using SPSS version 28. Independent-samples t-test was utilized for comparison between the two groups, and paired-samples t-test for comparison within the groups. A statistical significance level of α = 0.05 was set. At T1, significant color difference was observed between white spot lesion and adjacent sound enamel in the resin infiltration group and it remained stable after 6 months. Whereas in the fluoride varnish group, there were no statistical differences from baseline to 6 months. A statistical difference of 3.27 CIELAB units (p < 0.001) was reported between the infiltration group and the fluoride group at T5. No significant changes were noted in SAE with respect to changes in lightness. Resin infiltration was found to be better at masking the demineralization produced by WSL and also enhanced the esthetic appearance of demineralized areas around the brackets. Resin infiltration did not produce any clinically visible effects in non-affected enamel. These changes remained stable for a period of 6 months.","PeriodicalId":12234,"journal":{"name":"Evidence-based dentistry","volume":"25 3","pages":"160-161"},"PeriodicalIF":0.0,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号