Operative dentistry最新文献

Objective: To conduct a systematic review and meta-analysis to compare the efficacy, risk, and intensity of tooth sensitivity of at-home and in-office bleaching. This is an update of a systematic review first published in 2016, adding new evidence.

Methods and materials: A comprehensive search was performed in seven databases, including MEDLINE, EMBASE, and Cochrane Library. Additionally, other sources were screened manually for any additional trials, and the reference lists and citation lists of included trials and relevant reviews were manually searched. WE included randomized clinical trials that compared the risk intensity of tooth sensitivity or bleaching efficacy of in-office and at-home treatments in adult patients. After data extraction and risk of bias assessment, mean differences or relative risks and the corresponding 95% confidence intervals were calculated and assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results: A total of 910 articles were identified via databases and registers. After title and abstract screening, 11 studies remained. In addition, another 11 records were identified through websites, organizations, and citation searches. Including the previous studies from the earlier systematic review, 26 studies remained for qualitative analyses and 23 for meta-analysis. In 2024, six studies were added, totaling 32 studies included for qualitative analysis. The intensity of tooth sensitivity was significantly lower for at-home bleaching (standardized mean difference [SMD] -0.78; 95% confidence interval [CI] -1.53 to -0.03; p=0.04). There was no significant difference in the risk of tooth sensitivity (relative risk [RR] 0.82; 95% CI 0.61 to 1.10; p=0.19) or bleaching efficacy in ΔSGU (SMD 0.04; 95% CI -0.17 to 0.25; p=0.68). The color change in ΔE was significantly higher for at-home bleaching (SMD 0.49; 95% CI 0.14 to 0.84; p=0.006).

Conclusion: Although there was a difference in the intensity of tooth sensitivity and color change in ΔE favoring at-home bleaching, the quality of the evidence was considered low. Neither the risk of tooth sensitivity nor the color change in shade guide units (ΔSGU) was influenced by the bleaching technique.

Objective: The use of resin composites (RC) for complex restorations, including those involving cusp coverage, has increased dramatically in recent years. However, reports in the literature regarding the performance of posterior multisurface RC and amalgam (AM) restorations show conflicting results. This systematic review and meta-analysis aims to assess the clinical performance of complex (involving two or more surfaces) direct posterior resin composite and amalgam restorations in permanent teeth.

Methods: Inclusion criteria were for prospective randomized controlled trials (RCTs) of multisurface direct RC and AM restorations of permanent posterior teeth with a follow-up period of three years or more. The trials needed to include a minimum of 20 restored teeth for each evaluated material. Retrospective studies, studies lacking survival rates or clearly reported reasons for failure, and those with unclear randomization methods were excluded. Five bibliographic databases (Medline-OVID, Embase, Cochrane Library, Web of Science, and LILACS [Latin American and Caribbean Health Sciences Literature Database]) and manual searches were screened. The Cochrane Risk of Bias Tool was used to assess the included studies. Random-effects meta-analyses were conducted using the Freeman-Tukey double arcsine transformation and the DerSimonian-Laird random-effects model to evaluate restorative failures and compare the survival of AM and RC restorations.

Results: From the 6303 identified studies, 198 underwent meticulous examination, and 15 RCTs met the inclusion criteria. Only two studies compared AM and RC restorations. Although the combined data from these studies showed a trend toward higher failure rates in multisurface RC restorations, the difference was not statistically significant (p=0.06). The most common reasons for the failure of RC restorations were secondary caries, restoration fracture, and tooth fracture. For AM, the most common reasons for failure were secondary caries and tooth fracture.

Conclusions: The quality of the evidence was low. The scarcity of studies comparing RC and AM in complex restorations has resulted in insufficient evidence to substantiate superior performance by either material.

Objectives: To compare conventional hydrogen peroxide (H2O2) whitening therapy (CT) applied for 45 minutes with a test therapy (TT) containing H2O2 whitening gel and catalyst bioproducts applied for 15 minutes.

Methods: Thirty patients and their hemiarches were randomly divided into two groups: CT: application of 35% H2O2 three times for 15 minutes; test therapy (TT): based on the prior application of a polycaprolactone scaffold and the addition of 10 mg of peroxidase to the 35% whitening gel (3 drops of thickener, 9 drops of peroxide and 10 mg of peroxidase) for an exposure time of 15 minutes.The two treatments were carried out in three whitening sessions, 7 days apart. The chromatic change (ΔE00) and the bleaching index (ΔWID) were analyzed by spectrophotometry. Spontaneous sensitivity was assessed through a questionnaire, and thermal sensitivity was provoked through thermal stimuli after the three sessions and 14 days later. Esthetic self-perception was also measured using the Orofacial Esthetics Scale before and after each session.

Results: After the first session, CT exceeded TT in ΔE00 and ΔWID, whereas they were equal at the other time points. Greater intensity and occurrence of spontaneous sensitivity occurred in the first and second sessions with CT. The CT group experienced thermal sensitivity at higher temperatures than the TT group at all times analyzed. Esthetic self-perception was higher (66.6%) in the TT group.

Conclusion: The test therapy can achieve the same whitening effect with less total exposure time and less tooth sensitivity than the conventional technique.

Objective: This study aimed to verify whether dental adhesives prevent noncarious cervical lesion (NCCL) development in an in vitro simulation model based on abrasive/erosive challenges.

Methods and materials: Extracted human premolars were randomly assigned to one of three treatments (n=16): 1. reference adhesive (Clearfil SE, Kuraray Co., Ltd., Chiyoda City, Tokyo, Japan); 2. experimental adhesive (10 wt% [percentage by weight] beta-tricalcium phosphate nanoparticles); 3. negative control (no treatment). After treatment, specimens were submitted to 11 episodes of 18 hours of acid exposure (1% citric acid solution-0.052 molar (M), pH ~2.5) interspersed by toothbrushing abrasion. Three-dimensional images of teeth were captured at baseline and after 5000, 10,000, 15,000, 35,000, and 55,000 toothbrushing strokes using an intraoral scanner. Tooth wear (mm3) was calculated after each toothbrushing period by scan superimposition. Lesion angle was measured, and shape classified. Data were analyzed using analysis of variance (ANOVA) and Fisher Protected Least Significant Difference (PLSD) tests (α=0.05).

Results: Tooth wear increased with toothbrushing strokes overall (p<0.001) and within each treatment (p<0.05) except between 10,000 and 15,000 strokes (p=0.24). Reference had less tooth wear than control overall (mean difference [95% CI]: 0.68 [0.20,1.15], p=0.008) and for all toothbrushing periods (p<0.05) except at 55,000 strokes (0.54 [-0.38,1.46], p=0.25). Reference had less tooth wear than experimental overall (0.54 [0.01,1.07], p=0.046) and for 35,000 strokes (0.80 [0.13,1.46], p=0.019). Experimental had less tooth wear than negative control at 5000 and 10,000 strokes (p<0.05). Treatments had no effect on lesion angle (p=0.52). At 55,000 strokes, reference had more flat-shaped lesions than experimental (p<0.001) and negative control (p<0.001), but experimental and negative control were not different from each other (p=1.00) having more striated lesions.

Conclusion: Adhesives showed some degree of protection against NCCL development at early stages; however, reference had longer-lasting protection than experimental.

Objectives: To assess the influence of patient age on tooth sensitivity, bleaching effectiveness, and the self-perception and psychosocial impact of dental esthetics following in-office tooth bleaching with 35% hydrogen peroxide.

Methods: This parallel study categorized 56 subjects by age into early adulthood (18-25 years) and middle-aged (40-65 years) groups. The bleaching agent was applied in a single 45-minute session, spanning two bleaching sessions at a 1-week interval. Bleaching effectiveness assessment used upper incisors and canines. A shade guide (VITA Bleachedguide 3D-MASTER) and a portable spectrophotometer evaluated color changes. A visual analog scale and verbal rating scale recorded tooth sensitivity during and up to 48 hours after the bleaching procedure. The Psychosocial Impact of Dental Aesthetics Questionnaire measured the self-perception and psychosocial impact of the bleaching protocol. Student t-test, Fisher exact test, Mann-Whitney, multivariate analysis of variance, chi-square, two-way repeated measures analysis of variance, and the Wilcoxon test (α=0.05) verified the data.

Results: Early adulthood subjects demonstrated a significant increase (17%) in the risk of tooth sensitivity (p=0.038), and the highest pain levels occurred 1 hour after the bleaching session (p<0.01). Nonetheless, early adulthood subjects showed improved bleaching effects 30 days after the procedure when compared to the middle-aged subjects, even though the overall perception of the psychosocial impact of dental esthetics was more evident in middle-aged subjects.

Conclusions: Patient age influenced in-office bleaching outcomes. Both age groups reported esthetic satisfaction, but early adulthood subjects (18-25 years) experienced a more substantial whitening effect, greater dentin sensitivity, and higher psychological impact. Conversely, middle-aged subjects (40-65 years) had a better overall perception of the psychosocial impact of dental esthetics.

Background: Dental liners are used on caries-free dentin to attenuate postoperative sensitivity and caries-affected dentin to promote remineralization and for antibacterial effects. The shear bond strength of liners to caries-affected and caries-free dentin is a significant clinical property in the restoration of teeth with large caries lesions. Objective: The aim of this in vitro study was to compare the shear bond strengths (SBS) of different liners to caries-free and caries-affected dentin.

Methods and materials: SBS specimens were prepared according to ISO 29022:2013(E) (n=10/ group). Caries-free dentin specimens were ground to superficial dentin. For caries-affected dentin, grinding to proximity of carious dentin was performed, remaining caries-infected dentin was removed with a polymer bur, and sanding to 320 grit was conducted to achieve a flat surface. 150-micron thick tape was centered over caries-free or caries-affected dentin, and five different liners (new RMGI-based calcium silicate liner [RMGI/ CS], Biodentine, Lime-Lite Enhanced, TheraCal LC, Vitrebond Plus) were applied to dentin and leveled with the tape. Specimens were treated with adhesive, cured, and bonded with resin composite using the Ultradent fixture. Specimens were stored in 37°C water for 24 ± 2 hours and debonded at 1 mm/min. SBS was analyzed by two-way analysis of variance (ANOVA) and the Tukey post hoc test.

Results: There was a significant difference in SBS among materials for both caries-affected and caries-free dentin (p<0.01). Tukey post hoc analysis grouped materials into significantly different groups for caries-free dentin (Lime-Lite Enhanced, Biodentine < TheraCal LC < Vitrebond Plus, RMGI/CS) and caries-affected dentin (Lime-Lite Enhanced, Biodentine, TheraCal LC < Vitrebond Plus, RMGI/CS). There was no difference in SBS to caries-free and caries-affected dentin for Lime-Lite Enhanced (p=0.359), Biodentine (p=0.522), Vitrebond Plus (p=0.406), or RMGI/CS (p=0.165). SBS was significantly greater to caries-free dentin with TheraCal LC (p<0.01).

Conclusions: RMGI/CS and Vitrebond Plus produced higher SBS to caries-free and caries-affected dentin than the three other materials. There was a higher bond to caries-free dentin than caries-affected dentin for TheraCal LC, but not for any of the other liners tested. Clinicians should balance biologic advantages of liner materials with a decrease in bond strength.

Objective: In this case report, we describe the use of a universal shade resin composite to restore a discolored tooth before nonvital tooth bleaching. The intent of this procedure is to maintain an acceptable color match, eliminating the need for subsequent replacement of the restoration after bleaching.

Methods: A substantial defective Class IV resin composite was removed from a discolored, endodontically treated tooth #8. The existing gutta percha was sealed with glass ionomer, and 35% Thanawat Ruaydee, DDS MSc, Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Nahon Pathom, Thailand hydrogen peroxide gel was applied in the access chamber. The access cavity was temporarily sealed with a flowable resin composite and the entire tooth was restored with a group-shade universal resin composite. After a two-week bleaching period, the bleaching gel and temporary filling in the access cavity were replaced with the same universal shade resin composite, without necessitating the complete replacement of the entire restoration.

Results: A favorable outcome was noted during a one-year follow-up period, with the bleached tooth maintaining a harmonious color and the resin composite restoration exhibiting a stable and satisfactory condition.

Conclusion: The clinical use of a universal shade resin composite before bleaching exhibited significant promise in facilitating an effective color match in a discolored tooth after bleaching. This method may substantially diminish the need for restoration replacement due to challenges associated with color discrepancies.

Objectives: To depict restorative treatment recommendations of US dentists for posterior proximal enamel caries lesions detected with bitewing radiographs in permanent teeth.

Methods: The Fact Box format was utilized to depict the probabilities of restorative treatment recommendations made by US dentists for posterior proximal enamel caries lesions detected with bitewing radiographs in permanent teeth. Four case scenarios were considered, including patients at low caries risk versus those at high caries risk for two proportions (10% versus 38%) of proximal enamel caries lesions with external surface cavitation.

Results: The Fact Box showed that the decision to restore posterior proximal enamel caries lesion was more likely to be an incorrect decision (61-91%) in the four case scenarios considered. Meanwhile, the decision to not provide restorative treatment for posterior proximal enamel caries lesion was less likely to be erroneous (9-37%) in the four case scenarios considered.

Conclusion: Using the Fact Box to depict restorative decision-making for posterior proximal enamel caries lesions in permanent teeth may improve communication of decisional probabilities and reduce restorative overtreatment.

Objective: To evaluate the bond strength of self-adhesive (no need for bonding procedures) and conventional (with total-etch or self-etch primers) cementation strategies and the qualitative variables that interfere with the adhesion of fiberglass posts through a systematic review and meta-analysis of in vitro studies.

Methods: This systematic review and meta-analysis was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and registered under the International Prospective Register of Systematic Reviews (PROSPERO). The research question was "What resin cement provides better bond strength between the fiberglass posts and the root dentin: conventional or self-adhesive?" The PubMed/MEDLINE, Web of Science, Scopus, and Cochrane databases were searched by two independent researchers.

Results: There were statistically significant differences between self-adhesive and conventional resin cements (p<0.00001), favoring conventional cements.

Conclusion: Conventional cements presented the best results regarding the bond strength of the fiberglass post cementation. However, variations in methodology and the risk of bias in analyzed studies may have decreased the reliability of the present study. More studies on this subject using a leveled methodology are recommended.

Purpose: To evaluate the in vivo and in vitro performance of an intraoral camera (IC), visual examination using the Thylstrup and Fejerskov Index (TFI), and quantitative light-induced fluorescence (QLF) to detect and quantify enamel fluorosis (EF).

Methods and materials: Calibrated examiners performed IC-qualitative (ICQual), TFI, IC-quantitative (ICQuant), and QLF (Area, Fluorescence loss [ΔF], and ΔQ: Area×ΔF) on 150 extracted teeth in vitro and 150 children in vivo. Polarized light microscopy (PLM) was the gold standard for the in vitro phase. Cross tabulation, agreement, correlation, comparison of means from quantitative measures, sensitivity, and specificity were calculated for TFI, QLF, ICQual, and ICQuant. For the in vivo phase, TFI scores were cross tabulated with ICQuant and ICQual, and Kendall's Tau was used to measure correlation.

Results: Agreements of TFI and ICQual with PLM were 53.77% and 47.17%, respectively. Correlation coefficients for QLF (area, ΔF, ΔQ) and ICQuant with PLM scores were 0.47, 0.56, 0.51, 0.46, respectively. Sensitivity/specificity for TFI, ICQual, ICQuant, and ΔQ were 0.86/0.58, 0.86/0.62, 0.86/0.58, and 1.00/0.13, respectively. For the in vivo phase, correlations of ICQual and ICQuant with TFI were 0.55 and 0.52, respectively. Quantitative measurements of ICQuant by TFI scores showed consistent separation in means, while those for QLF were neither as clear nor as consistent.

Conclusion: All methods were able to detect and quantify enamel fluorosis. However, there were consistent and significant differences among them.