BDJ Open最新文献

Background

Managing dental caries in primary teeth with pulp involvement is a significant challenge. Clinical guidelines offer recommendations for effective management.

Aim

To identify and analyze policies, guidelines, and recommendations for treating primary teeth with pulp-involved carious lesions, highlighting existing research gaps and setting the foundation for future research.

Methods

A comprehensive search was conducted across databases (PubMed, Scopus, Embase, GIN, and LILACS) and grey literature sources (Trip and ProQuest) to identify guidelines, consensus, policy, and position statements on primary teeth pulp therapy and extraction thresholds. Two independent reviewers screened the abstracts and titles, followed by full-text screening.

Results

After removing duplication, of the 1098 records, 14 were selected for analysis. This review examined various treatments for deep caries lesions in primary teeth, including indirect/direct pulp capping, pulpotomy, pulpectomy, lesion sterilization/tissue restoration, and extraction. Time search was restricted to documents published from 30th January 2008 to 30th January 2024, offering insights into evolving clinical practices.

Conclusion

Treatment for carious lesions in primary teeth involving the pulp depends on clinical indications and may involve minimally invasive techniques. Recommended options are indirect pulp capping, pulpotomy, and pulpectomy, while direct capping and tooth removal are discouraged. Further research is needed to address gaps, improve guideline development, and enhance consistency of recommendations.

Objective

This study aims to assess the efficacy of bioceramic (BC) sealer when applied using the single cone technique (SCT), in comparison to AH Plus sealer applied with the cold lateral condensation technique (LCT), concerning their impact on the healing of large-sized periapical lesions in both untreated and retreatment cases.

Materials and methods

A randomized controlled trial was conducted on 41 patients who had 60 permanent teeth in the maxillary incisors that were accompanied by large-sized periapical lesions. The included teeth were radiographed with cone beam computed tomography (CBCT) images and divided equally into two groups according to the endodontic treatment statute (30 untreated previous cases and 30 retreated cases). Subsequently, teeth received uniform preparation, irrigation, and dressing procedures. Then each group was divided equally according to the used sealer (15 teeth obturated using AH plus sealer with LCT and 15 teeth obturated using BC sealer with SCT). All cases were followed up after 6 and 12 months with CBCT images. Subsequently, the change in periapical lesion diameter (PLD) was observed as an indicator to determine the treatment outcome score. One-way ANOVA and Mann–Whitney U test were used to analyze the PLD changing and scoring the treatment outcome during the follow-up periods. The significance level was set at α = 0.05.

Results

There were no statistically significant differences between untreated and retreatment cases neither using AH plus sealer with LCT nor BC sealer with SCT regarding changes in PLD in the follow-up periods. Moreover, there were no significant differences between groups regarding treatment outcome scores in the follow-up periods. All groups showed a high success rate.

Conclusions

Successful treatment was achieved for untreated or retreatment maxillary incisor cases accompanied by large-sized periapical lesions using either BC sealer with the SCT or AH Plus sealer with LCT with a similar high success rate up to 12 months follow-up period.

Background

This study aimed to evaluate the efficiency of diode LASER activated irrigation in the removal of GuttaFlow Bioseal root canal filling material during retreatment.

Materials and subjects

Root canals of forty-five single-rooted human mandibular premolar teeth were prepared with ProTaper Universal rotary system and obturated with lateral condensation obturation technique using Gutta Percha and Roeko GuttaFlow Bioseal root canal sealer. All specimens were retreated with ProTaper Universal Retreatment System files then divided to three different groups according to the technique of activation of irrigation. Samples were sectioned, and the residual filling remnants were captured using digital camera attached to microscope. Data was collected by three different interpreters, to eliminate the subjectivity of the process, using the ImageJ Software. The mean value of the data was obtained and evaluated statistically. The significance level was set at P ≤ 0.05.

Results

The remaining filling materials in the canals irrigated with ultrasonic activation (6.17 ± 1.42 at coronal level, 10.93 ± 1.91at middle level, and 14.58 ± 2.23 at apical level) were less than these irrigated with LASER activation (15.87 ± 3.78 at coronal level, 21.28 ± 4.44 at middle level, and 27.06 ± 2.68 at apical level). Maximum amount of remaining filling materials was present in the canals irrigated with passive side-vented syringe (23.07 ± 3.22 at coronal level, 38.09 ± 7.27 at middle level, and 34.24 ± 9.77 at apical level).

Conclusion

The activation of irrigation techniques used were incapable of complete removal of filling material at root canal walls.

Background: Pakistan faces a significant burden of oral diseases, which can be effectively reduced through preventive measures. Dentistry in Pakistan predominantly focuses on corrective dental procedures, increasing the treatment costs and widens disparities in oral healthcare access. To address this gap and meet the country's oral health needs, Aga Khan University initiated a Dental Hygiene program aimed to expand and diversify the oral health workforce and improving access to quality care in various healthcare settings. Due to limited awareness of this profession in the country, the program encounters significant challenges.

Aim: This article aims to present a SWOT analysis of the Dental Hygiene profession in Pakistan and propose evidence-based strategic changes to address these challenges and improve future outcomes.

Methods: A SWOT analysis was conducted to identify the internal strengths, weaknesses, external opportunities, and threats related to the Dental Hygiene profession, gathering both quantitative and qualitative data through a survey of relevant stakeholders (Consultants, Dental hygiene graduates, dental auxiliaries, fresh dental graduates, and prospective students) using Research Electronic Data Capture (REDCap).

Results: A total of 267 respondents participated in the survey, providing insights into the current state of the Dental Hygiene profession.

Conclusion: The analysis reveals that the Dental Hygiene profession in Pakistan requires robust advocacy, increased collaboration with dentists, opportunities for higher education, and the establishment of proper legislative frameworks to prevent professional transgression beyond the scope of practice.

Objective: This study aimed to evaluate and compare the efficacies of Papacarie Duo gel, Brix 3000, Selecti-Solve gel, 2.4% sodium hypochlorite gel, and conventional rotary-mechanical method in caries removal and to evaluate the patient comfort.

Methods: It was a single-blinded, randomized, parallel-group, active-controlled trial with five arms. It was conducted at the Department of Restorative Dentistry and Endodontics, Damascus University. Seventy-five specimens were randomly allocated into five groups: chemomechanical caries removal (CMCR) using Selecti-Solve gel (G1), BRIX3000 (G2), Papacarie DUO gel (G3), or 2.4% sodium hypochlorite gel (G4), and caries excavation using conventional rotary-mechanical method (G5) (control group). The trial considered healthy patients aged 18-40. Permanent molars with class I carious lesions extending to the middle third of dentin with no pulpal and/or periodontal pathology were included. The efficacy of caries removal was considered the primary outcome measure, and the secondary outcome measures were treatment time, volumetric measurement of the cavity, and pain assessment.

Results: The majority (73.30%) of cases from BRIX3000 and conventional rotary-mechanical method groups showed complete caries removal (p = 0.982). The mean time of caries removal was the highest (17.45 ± 4.42) in the 2.4% sodium hypochlorite gel group (p < 0.05), and the lowest (6.33 ± 1.69) was in the conventional rotary-mechanical method group (p < 0.05). The mean cavity volume was the highest (18.97 ± 9.76) in the Papacarie DUO gel group, and the lowest (14.87 ± 4.76) was in the 2.4% sodium hypochlorite gel group (p = 0.506). The conventional rotary-mechanical group exhibited the highest mean score (5.40 ± 1.72) of pain (p < 0.05). However, the mean score (2.67 ± 1.11) of pain reported reduced in the BRIX3000 group.

Conclusions: CMCR agents could be a potential substitute for conventional rotary instrumentation methods, taking into account the long working time.

Aim: Assessment of interfacial gaps and mechanical impact of the materials layering between Cention Forte and Equia Forte restorations with two forms of Calcium Silicate Cements (CSCs) at the interfacial surface at two-time intervals.

Methodology: Six groups of 72 primary molars were categorized by restorative material type and CSCs: Cention Forte(C), Cention Forte without primer (Cx), and Equia Forte (EQ). All were applied over MTA Angelus powder (M) or Bio-C Repair putty (P). Restorative materials were applied immediately (subgroup A) or delayed (Subgroup B). SEM was used to detect interface gaps. EDX measured element migration from the interface at specific distances. Vickers Microhardness Tester assessed microhardness.

Results: Regarding SEM, there were no gaps between CSCs interfaces of both types (Powder and Putty) with all restorations at two-time intervals. Microhardness, there was a statistically nonsignificant difference between subgroups A & B in all groups except at 200 µm in the Cention groups (subgroup A) was significantly lower than (subgroup B) (P = 0.002, 0.03) respectively. At 400 µm in the MTA Angelus powder Group Cx, subgroup A was significantly higher than subgroup B (P = 0.003*). While Bio-C Repair putty in Group EQ (subgroup A) was significantly higher than (Subgroup B) (P < 0.0001*).

Conclusions: The delayed application of Cention Forte over two types of CSCs is useful in getting the maximum HV and, in turn, the long survival rate of the filling. Immediate application of Cention Forte without primer is better over both types of CSCs. The delayed application of Equia Forte over MTA angelus powder is more considerable.

Purpose: The aim of this study was to systematically review the literature to address the effect of strontium modified titanium implants on the osseointegration in the presence of osteoporotic conditions through animal models.

Materials and methods: The databases (PubMed, Scopus, Web of Science, and EBSCO) were searched electronically, and manual searches were performed till December 2022 to identify preclinical studies on the osseointegration of strontium coated titanium implants in animals with induced osteoporotic conditions. The primary outcomes were the bone-implant contact percentage (BIC%), bone area (BA) from the histomorphometric analysis, and the osseointegration parameters from biomechanical tests; the secondary outcomes were the osseointegration parameters from the micro computed tomography.

Results: Nineteen articles were included for the quantitative analysis on basis of the inclusion criteria. The results revealed that Sr-modified implants showed a significant 19.05% increase in BIC, and 15.01% increase in BA. The results of biomechanical tests indicated a significant effect in favor of Sr-coated implants. Furthermore, Results of the secondary outcomes supported the significant advantages of Sr-coated implants over the un-coated implants. The overall, systematic analysis of implants osteointegration parameters proved a significant increase in favor of Sr-coated titanium implants (P < 0.01).

Conclusion: The present results provide evidence that strontium-coated titanium implants enhanced the osseointegration in animal models under osteoporotic condition as this surface modification techniques have improved the mechanical and biological properties of the titanium implants.

Objectives: This study compared the whitening effect, microhardness, and enamel surface alterations of over-the-counter (OTC) tooth bleaching products with those of a dentist-prescribed at-home bleaching agent.

Materials and methods: The products available on a popular online marketplace were comprehensively searched and then rated using a specific formula. The effects of the lowest-rated OTC agent (LRA) and the highest-rated OTC agent (HRA) were compared with those of a dentist-prescribed bleaching agent (DPA) on the enamel of extracted human teeth. The bleaching efficacy, post-bleaching microhardness changes, and morphological alterations were assessed by spectrophotometric analysis, Vickers hardness testing, and scanning electron microscopy (SEM) respectively. Statistical analyses included one-way ANOVA and post hoc tests, maintaining a significance level of P < 0.05.

Results: The search of the online marketplace revealed 15 products. The LRA (Teeth Whitening Serum Gel, GEN, China) and the HRA (Bright White-Lovely Smile Premium Teeth Whitening strips, Ray of Smile, USA) were identified on the basis of their ranking. DPA resulted in significantly better tooth whitening than did LRA. The enamel microhardness was lower in the LRA treatment group (14.2%) than in the control and HRA treatment groups (8.84% and 7.26%, respectively). LRA also caused severe topographical alterations to the enamel.

Conclusion: Compared with the poorly rated product, the dentist-prescribed tooth bleaching product resulted in greater colour improvement, less microhardness reduction, and surface changes. The highest-rated product was comparable with the dentist-prescribed agent in this study.

Objective: To assess the micro-shear bond strength of light-cured adhesive resin cement compared to flowable composite to hybrid CAD/CAM ceramics.

Materials and methods: Rectangular discs were obtained from polymer-infiltrated (Vita Enamic; VE) and nano-hybrid resin-matrix (Voco Grandio; GR) ceramic blocks and randomly divided according to the luting agent; light-cured resin cement (Calibra Veneer; C) and flowable composite (Neo Spectra ST flow; F), resulting in four subgroups; VE-C, VE-F, GR-C and GR-F. Substrates received micro-cylinders of the tested luting agents (n = 16). After water storage, specimens were tested for micro-shear bond strength (µSBS) using a universal testing machine at 0.5 mm/min cross-head speed until failure and failure modes were determined. After testing for normality, quantitative data were expressed as mean and standard deviation, whereas, qualitative data were expressed as percentages. Quantitative data were statistically analysed using Student t test at a level of significance (P ≤ 0.05).

Results: Group GR-F showed the highest µSBS, followed by VE-C, VE-F and GR-C respectively, although statistically insignificant. All groups showed mixed and adhesive failure modes, where VE-F and GR-C showed the highest mixed failures followed by GR-C and VE-C respectively.

Conclusions: After short-term aging, flowable composite and light-cured resin cement showed high comparable bond strength when cementing VE and GR.

Background: The treatment strategy for patients with severe tooth wear associated with Class II Division 2 malocclusion remains a major challenge for dental practitioners.

Objectives: To systematically review and summarize the literature on treatment strategies, restoration procedures and clinical outcomes for Class II Division 2 malocclusion patients with severe tooth wear.

Methods: A literature review was conducted using Pubmed, Embase, the Cochrane Library, and Web of Science to identify eligible articles. Publications until October 16th, 2023 were searched independently and cross-checked by two researchers.

Results: Of 1513 articles screened, 10 reports detailed treatment processes, including six males and four females aged 34-68 years old. Four articles recorded pre-treatment freeway space (FWS) values ranging from 5 to 9 mm. All ten cases had significant occlusal vertical dimension (OVD) loss and the increase in OVD after treatment ranged from 1 to 7 mm. Pre-prosthetic orthodontic treatment was performed in two cases, in one of which only the maxillary region was orthodontically treated. The most common restorations provided were full coverage restorations. In most cases, temporary restorations were applied before the permanent restorations for eight weeks to six months. Four different sequences of final restoration were proposed. Follow-up ranged from four months to six years and included seven patients, one of them showed symptoms of temporomandibular disorder (TMD).

Conclusions: A multidisciplinary team (MDT) approach to treatment is recommended. Consideration of pre-prosthetic orthodontic treatment is essential. Commonly used cephalometric measurements for anterior teeth include the interincisal angle and collum angle. The increases in OVD ranging from 1 to 7 mm can be effectively accommodated. Temporary restorations are recommended to accommodate the OVD, and the transition periods of 8 weeks to 6 months help the patients adapted well. Four different sequences for final rehabilitation have demonstrated positive clinical outcomes. Full crown restorations have emerged as the preferred choice for the ultimate restoration of these patients.