Use of bulk fill resin composite and universal adhesive for restoring primary teeth after selective carious tissue removal to soft dentin: A randomized clinical trial.

PURPOSE: To investigate the survival of adhesive restorations after selective carious tissue removal to soft dentin in primary molars. METHODS: This two-arm randomized clinical trial included 62 subjects (5.9 years ± 1.7) and 144 primary molars presenting deep active dentin carious lesions. The sample was randomly assigned based on restorative material: universal adhesive (Scotchbond Universal) plus bulk fill resin composite (Filtek Bulk Fill Posterior Restorative) and resin-modified glass-ionomer cement (Vitremer). Two operators performed all restorative procedures. Restorations were evaluated at 6, 12, and 18 months using the FDI World Dental Federation criteria. Survival estimates for restorations' longevity were evaluated with Kaplan-Meier method. Multivariate Cox regression analysis with shared frailty was used to assess the factors associated with failures (P< 0.05). RESULTS: Restorative material did not influence the restorations' survival (HR 1.56 95% CI 0.78-3.13; P= 0.12). The survival rates at 18 months of follow-up were 62.9% and 76.8% (AFR: 26.6% and 16.1%) for resin-modified glass-ionomer cement and bulk fill resin composite restorations, respectively (long-rank P= 0.14). Boys had higher risk of failure in their restorations (HR: 2.64, 95% CI: 1.29-5.40). Restorations performed by a less experienced operator had 3.26 times more risk of failure (P= 0.001). CLINICAL SIGNIFICANCE: The effectiveness of resin-modified glass-ionomer cement (Vitremer) and bulk fill resin composite (Filtek Bulk Fill Posterior Restorative) restorations after selective removal of carious tissue to soft dentin in primary molars was similar at 18 months of follow-up.

Do undergraduate dental students perform well detecting and staging caries and assessing activity by visual examination? A systematic review and meta-analysis.

AIM: To assess the undergraduate students' performance in detecting and staging caries and assessing activity using visual inspection. DESIGN: Two independent reviewers searched the literature through PubMed/MEDLINE, Scopus, Lilacs databases, and OpenSINGLE. Meta-analyses summarized the results concerning reproducibility and accuracy at D1 (considering all lesions) and D3 (including only cavitated lesions or lesions into dentin) levels. For activity, we considered sound surfaces plus inactive caries lesions vs active lesions. Meta-regression assessed the effect of methodological variables on the outcomes. RESULTS: Fourteen studies were included. The mean reproducibility values were ≥0.52, except for interexaminer agreement when assessing caries activity (0.39; 95% CI 0.10-0.67). The intra-examiner reproducibility tended to be higher than the interexaminer reproducibility. Overall, undergraduate students' performance in staging caries lesions using visual examination was good (AUC>0.85 and DOR>25). The sensitivity values were moderate; however, these were associated with excellent specificity values. Despite few pooled studies, caries activity assessment revealed moderate overall performance, with lower pooled sensitivity than pooled specificity. Students' education level and background clinical experience had no influence on the accuracy and reproducibility of the visual inspection. CONCLUSION: Undergraduate students' performance in detecting and staging caries using visual inspection was good, although caries activity assessment still requires improvement.

Do adhesive systems influence the color match of resin composites?

BACKGROUND: This in vitro study evaluated the influence of adhesive systems on the color match of a resin composite with different translucencies. METHODS: Sixty disk-shaped specimens were made with A2 and opaque A2 (OA2) shades of nanohybrid resin composite Z250 XT. Specimens of each shade (n = 30) were randomly reassigned to 3 subgroups according to adhesive system: a 2-step etch-and-rinse adhesive (Adper Single Bond Plus), a 2-step self-etch system (Clearfil SE Bond) and a universal adhesive (Scotchbond Universal Adhesive). The bonding agents were applied to resin composite specimens following the manufacturers' recommendations. Additionally, 5 disk samples of each adhesive system were prepared. Colorimetric evaluation (CIE L*a*b* system) was performed immediately after polishing the sample and application of the adhesive systems. Color changes (ΔE and ΔE00) were calculated between 2 measurements. Color coordinates L*, a* and b* of the adhesive disks were also assessed. The data obtained were analyzed using ANOVA and Tukey's post hoc test (α = 0.05). RESULTS: The application of Scotchbond Universal Adhesive to the resin composite A2 shade resulted in the highest color change (p<0.01; ΔE = 3.1 ± 0.7 and ΔE00 = 1.8 ± 0.4). However, no significant difference was observed among adhesive systems when applied to the resin composite OA2 shade (p>0.05). Scotchbond Universal Adhesive revealed augmented yellowing and greening in comparison with other experimental groups. CONCLUSIONS: The universal adhesive tested resulted in higher visually perceptible color changes when using a more translucent resin composite shade, but this was clinically acceptable.

In vitro performance of QLF system and conventional methods for detection of occlusal caries around tooth-colored restorations in primary molars.

BACKGROUND: Secondary caries is the main reason for restoration replacement, and therefore, an accurate detection of this type of condition is fundamental. AIM: To compare in vitro the performance of different conventional and quantitative light-induced fluorescence-based (QLF) methods in detecting occlusal caries around resin composite restorations in primary molars. DESIGN: Two examiners evaluated independently 42 sites adjacent to tooth-colored restorations using visual inspection (ICDAS-CARS), radiographic examination, and QLF. Histological examination was used as reference standard method. Area under the ROC curve (Az), sensitivity, specificity, and accuracy of the methods were calculated at enamel (D1) and dentin caries (D3) lesions thresholds. Intra- and interexaminer reproducibility were calculated using intraclass correlation coefficient (ICC) and kappa statistics. RESULTS: There was no difference among the methods considering Az at D1 threshold. Visual inspection, radiograph, and QLF (scores) methods presented similar sensitivities and significantly higher than those obtained with the QLF (∆F%). At D3 threshold, there were no differences among the methods regarding sensitivities, specificities, and accuracy, except for the examiner 2 with the QLF (∆F%) who achieved a very low sensitivity value. CONCLUSION: Conventional methods are similar to QLF methods for detecting caries around tooth-colored restorations in primary teeth.

Tubule density and diameter in coronal dentin from primary and permanent human teeth.

This study compared dentinal tubule density and diameter of human primary and permanent teeth at different depths of the coronal dentin. Crowns of eight primary second molars and eight permanent third molars were serially sectioned into three disks of ~0.5 mm thickness (superficial, middle, and deep layers), perpendicular to the long axis. Tubule density and diameter were evaluated in 2,000× and 3,000× magnifications by scanning electron microscopy. Data obtained were subjected to two-way repeated measures ANOVA and Tukey's post hoc test (α = 0.05). Tubule density was greater in primary teeth compared with permanent ones, regardless of depth (primary: 124,329 ± 43,594 mm2; permanent: 45,972 ± 21,098 mm2). In general, the tubule density increased as the dentin depth increased, except to the superficial and middle layers from permanent teeth. Tubule diameter was larger in the dentin layer close to the pulp chamber (superficial: 2.4 ± 0.07 µm; middle: 3.70 ± 0.06 µm; deep: 4.28 ± 0.04 µm). No difference was observed between primary (3.48 ± 0.81 µm) and permanent teeth (3.47 ± 0.73 µm). The tubule diameter increases as the dentin depth increases for primary and permanent teeth; however, the tubule density is higher in primary teeth.

Is Atraumatic restorative treatment an option for restoring occlusoproximal caries lesions in primary teeth? A systematic review and meta-analysis.

BACKGROUND: Atraumatic restorative treatment (ART) has demonstrated good longevity when used for single-surface restorations, but lower success rates are reported for occlusoproximal surfaces. AIM: This systematic review and meta-analysis aimed to verify the pooled success rate of occlusoproximal ART restorations in primary teeth considering the outcomes: longevity, pulp damage, or caries lesion progression. DESIGN: Literature searching was carried out on the studies reporting clinical trials indexed in PubMed and in English language, comprising the outcomes. A meta-analysis was undertaken considering the results from reviewed studies. RESULTS: An initial search resulted in 126 articles, and three of them were finally selected. The main reasons for excluding articles were the absence of control group, as amalgam, composite resin, or compomer restorations to be compared with ART (hand excavation + high-viscous GIC). The pooled estimate (odds ratio; 95% confidence interval) for ART approach success was 1.04 (0.65-1.66). CONCLUSION: Atraumatic restorative treatment restorations performed with high-viscous GIC present similar survival/success rates to conventional approach using composite resin or amalgam for occlusoproximal restorations in primary teeth and can be suggested as a good option for occlusoproximal cavities in primary molars. In addition, further randomized controlled clinical investigations concerning occlusoproximal restorations in primary teeth are still necessary.