Persistent gender disparity in leading dental publications across 4 decades: an observational study.

OBJECTIVES: This observational study assessed the differences in the gender of the first and last authors in the most-cited dental articles over the last 4 decades. STUDY DESIGN AND SETTING: Articles were obtained through an electronic search of the most-cited articles in dentistry by decade (total n = 400 articles). The 100 most-cited studies in each decade (1980-1989, 1990-1999, 2000-2009, and 2010-2019), with any study design, with results in dentistry were eligible. The gender of the first and last authors was determined using the Genderize database. Comparative evaluation of gender distribution in general and across the 4 decades was performed with the Chi-square test, and the contribution of variables on the citation rate of articles was performed using linear regression. RESULTS: There were statistical differences between the gender distributions, with a predominance of men in the first (83.8%) and the last (86.8%) positions (P < .001). Over the decades, there was a tendency for an increase in the proportion of women as the last author (P = .002; Chi-square trend Test), with an increase of women from 6% to 22% across the last 4 decades. However, no statistically significant differences were observed between the genders for the first author in the last 4 decades (P = .163; Chi-square trend Test). CONCLUSION: The findings indicate that men lead a large percentage of the most-cited articles in dentistry and that this trend has not shown substantial modifications over the last years. Nonetheless, for the position of last authorship, an increase in women's representativity was observed over the last decades.

Methodological quality of evidence-based clinical practice guidelines in cariology.

OBJECTIVE: The present study aimed to appraise the methodological quality of evidence-based Clinical Practice Guidelines (CPGs) in the cariology field. MATERIALS AND METHODS: A systematic search on electronic databases (MEDLINE/Pubmed, EMBASE, DARE and Epistemonikos), websites, and guideline organizations were undertaken. Evidence-based CPGs including at least one recommendation for clinical prevention and/or management of dental caries, developed for any clinical setting, were included. The quality of each guideline was evaluated using the AGREE II tool. Descriptive analysis was performed and the average overall score for each domain was calculated. RESULTS: Thirty-two guidelines were included. Most of the CPGs achieved higher scores for the domains of clarity of presentation (66.7%, 95% IC 37.3-52.2) and scope and purpose (59.6%, 95% IC 53.7-65.5) domains; and lower scores for editorial independence (46.1%, 95% IC 37.8-55.7) and applicability domain (44.7%, 95% IC 37-55.3). The reviewers assessed 12 CPGs (37.5%) as recommended for use, 15 (46.9%) recommended with modifications, and 5 (15.6%) as not recommended. CONCLUSION: The overall methodological quality of evidence-based CPGs in the cariology field is moderate, and there is a need for improvements in reporting related to most domains. The poorest reporting was found in the description of the domains' applicability of its recommendations and editorial independence. CLINICAL RELEVANCE: Clinical Practice Guidelines provide guidance to patients, healthcare professionals, and stakeholders. The quality of these documents is essential for establishing trust in their recommendations.

The impact of gender on citation rates: An observational study on the most cited dental articles.

OBJECTIVE: This cross-sectional study aims to determine whether the gender of the authors plays a role in the position of authorship within the 100 most cited articles in dentistry. METHODS: An electronic search was performed in October 2022 in the SCOPUS database, considering filters by 'subject area' [dentistry], 'document type' [article], and 'source type' [journal]. The search was performed without restriction on the study design, publication yearor language. Information regarding each article was then extracted. The gender of the first and last author was determined by associating their first names with the probability of the name being male or female, using the Genderize database. Comparative evaluation of gender distribution was performed with the Chi-Square test. RESULTS: Articles ranged from 5214 to 579 citations. Included studies were published between 1964 and 2019, with the majority being from journals with the highest impact factors in the field. There were statistical significance differences between the gender distribution of the first and last authors, with a predominance of man in both authorships positions (all p<0.00). Only 15% and 12.6% the most cited papers in dental research presented a woman as first and last authors, respectively. CONCLUSION: In conclusion, female authors are not as regarded as male authors in prestigious authorship positions in the most cited dental publications, and gender bias can still be considered prominent in the dental research community. CLINICAL RELEVANCE: The findings of the present study indicate that the gender imbalance in citation practices, reported in several areas, also occurs in the field of Dentistry. It is essential that more discussions be raised about gender disparities and about the female presence in the scientific community.

Methodological quality of network meta-analysis in dentistry: a meta-research.

This meta-research aimed to provide an overview of the methodological quality and risk of bias of network meta-analyses (NMA) in dentistry. Searches for NMA of randomized clinical trials with clinical outcomes in dentistry were performed in databases up to January 2022. Two reviewers independently screened titles/abstracts, selected full texts, and extracted the data. The adherence to PRISMA-NMA reporting guideline, the AMSTAR-2 methodological quality tool, and the ROBIS risk of bias tool were assessed in the studies. Correlation between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results was also investigated. Sixty-two NMA studies were included and presented varied methodological quality. According to AMSTAR-2, half of the NMA presented moderate quality (n = 32; 51.6%). The adherence to PRISMA-NMA also varied. Only 36 studies (58.1%) prospectively registered the protocol. Other issues lacking of reporting were data related were data related to the NMA geometry and the assessment of results consistency, and the evaluation of risk of bias across the studies. ROBIS assessment showed a high risk of bias mainly for domains 1 (study eligibility criteria) and 2 (identification and selection of studies). Correlation coefficients between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results showed moderate correlation (rho < 0.6). Overall, NMA studies in dentistry were of moderate quality and at high risk of bias in several domains, especially study selection. Future reviews should be better planned and conducted and have higher compliance with reporting and quality assessment tools.

Longevity of composite restorations is definitely not only about materials.

OBJECTIVES: This review study provides an overview of factors that influence the longevity of all types of direct resin composite restorations. METHODS: A systematic search was performed in PubMed, Scopus, and Web of Science databases for articles reporting data from primary longitudinal clinical studies on composite longevity published 2011-2021. Prospective or retrospective studies with restorations in permanent dentition, with follow-up periods of at least 5 years were included. RESULTS: In total, 33 articles were included with different study designs, practice settings, datasets, countries of origin, and sample sizes. Annual failure rates of restorations ranged from 0.08% to 6.3%. Survival rates varied between 23% and 97.7%, success rates varied between 43.4% and 98.7%. Secondary caries, fractures, and esthetic compromise were main reasons for failures. Risk factors for reduced restoration durability included patient-level factors (e.g., caries risk, parafunctional habits, number of check-ups per year, socioeconomic status), dentist factors (different operators, operator's experience), and tooth/restoration factors (endodontic treatment, type of tooth, number of restored surfaces). Patient gender and the composite used generally did not influence durability. SIGNIFICANCE: A number of risk factors are involved in the longevity of composite restorations. Differences between composites play a minor role in durability, assuming that materials and techniques are properly applied by dentists. Patient factors play a major role in longevity. The decision-making process implemented by dentists relative to the diagnosis of aging or failed restorations may also affect the longevity of restorations. Clinicians should treat patients comprehensively and promote a healthy lifestyle to ensure longevity.

Antiplaque and antigingivitis efficacy of new and worn manual toothbrushes: A systematic review and meta-analysis.

OBJECTIVE: To systematically review the literature about the antiplaque and antigingivitis efficacy of new and worn manual toothbrushes. METHODS: Five databases were searched to identify randomized controlled trials, involving adults, comparing the clinical efficacy of new and worn manual toothbrushes. Experimental groups need to have different usage time in changing their manual toothbrush. Two reviewers performed studies selection, data extraction and risk of bias assessment independently. Meta-analyses were performed comparing the toothbrushes after a single use (antiplaque efficacy) and after multiple uses (antiplaque and antigingivitis efficacy). RESULTS: Eight studies were included, totalling 344 individuals. In studies with a single-use design, no statistically difference was found between new and worn toothbrushes for antiplaque efficacy (SMD:-0.39; 95%CI:-0.80 to 0.03). Studies with a multiple-use design showed no statistically difference between groups for the antigingivitis efficacy (MD:-0.10; 95%CI:-0.24 to 0.03). However, higher antiplaque efficacy was demonstrated in new toothbrushes in the studies with a multiple-use design (SMD:-0.75; 95%CI:-1.37 to -0.14). The certainty of the evidence ranged from very low (antiplaque) to low (antigingivitis). CONCLUSION: New and worn toothbrushes presented similar antiplaque and antigingivitis efficacy. However, further randomized controlled trials, with a lower risk of bias, are needed to enhance the certainty of this evidence.

Methodological quality of network meta-analysis in dentistry: a meta-research

Abstract This meta-research aimed to provide an overview of the methodological quality and risk of bias of network meta-analyses (NMA) in dentistry. Searches for NMA of randomized clinical trials with clinical outcomes in dentistry were performed in databases up to January 2022. Two reviewers independently screened titles/abstracts, selected full texts, and extracted the data. The adherence to PRISMA-NMA reporting guideline, the AMSTAR-2 methodological quality tool, and the ROBIS risk of bias tool were assessed in the studies. Correlation between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results was also investigated. Sixty-two NMA studies were included and presented varied methodological quality. According to AMSTAR-2, half of the NMA presented moderate quality (n = 32; 51.6%). The adherence to PRISMA-NMA also varied. Only 36 studies (58.1%) prospectively registered the protocol. Other issues lacking of reporting were data related were data related to the NMA geometry and the assessment of results consistency, and the evaluation of risk of bias across the studies. ROBIS assessment showed a high risk of bias mainly for domains 1 (study eligibility criteria) and 2 (identification and selection of studies). Correlation coefficients between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results showed moderate correlation (rho < 0.6). Overall, NMA studies in dentistry were of moderate quality and at high risk of bias in several domains, especially study selection. Future reviews should be better planned and conducted and have higher compliance with reporting and quality assessment tools.

Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCT.

The aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate.

Adherence to preprints' publication in Dentistry by Brazilian researchers

Aim: The publication in preprint format is an interesting open science practice that allows fast outreach to the society of new scientific findings. However, no previous study has investigated how much this practice has been adopted by dental scientists. Therefore, the objective of this study was to evaluate the adherence to the preprint publication format by a sample of Brazilian researchers. Methods: Searches were carried out, in September 2021, on the MedArxiv, OSF, and SciELO preprints platforms, looking for publications in preprint format by all Brazilian researchers of graduate programs in dentistry (n=211) who were productivity fellows in 2021 (PQ). Searches were performed by typing the authors' full names and the possible variations, as indicated by each author's curriculum, openly available on the Lattes website platform. The data were analyzed through the Friedman test, with the Durbin-Conover post-hoc (α=0.05) in order to compare the three platforms. Spearman's correlation test (α=0.05) was performed to assess the possible correlations between the number of preprints and age, career stage, and the researcher's scholarship level variables. Results: From the 211 researchers searched, 22 (10.4%) published 1 (one) preprint on at least one platform. A total of 39 published preprints were found at MedArxiv (n=19, 48.7%), SciELO preprints (n=18, 46.2%), and OSF platforms (n=2, 5.1%). There was no difference between the adherence to MedArxiv and SciELO preprints (p = 0.731). However, the OSF platform presented the lowest adherence, statistically differing from MedArxiv (p=0.008) and SciELO preprints platforms (p=0.003). In addition, no correlation was found between the publication of preprints and the researcher's age (p=0.128), career stage (p=0.248), or the researcher's scholarship level (p=0.661). Conclusion: It was possible to observe a low adherence to the preprints publications by Brazilian researchers' productivity fellows of graduate programs in dentistry.

Adesão ao formato preprint por docentesde odontologia das universidades públicas do Rio Grande do Sul / Adherence to the preprint format by dentistry professors from public universities in Rio Grande do Sul

Objetivo: Avaliar a aderência à publicação de preprints pelos professores dos cursos de pós-graduação em Odontologia, das três Universidades Federais do Estado do Rio Grande do Sul (UFRGS, UFPel e UFSM) (n = 97). Materiais e métodos: Quatro revisores realizaram a busca de publicações em formato preprint, em maio de 2021, nas plataformas MedArxive SciELO Preprints, por cada professor incluído. Os mesmos revisores extraíram os dados que foram checados por um quinto revisor. Para a avaliação e comparação das dife-rentes universidades foi utilizado o teste exato de Fisher, com posterior análise dos resíduos com α corrigido. Para a comparação entre as plataformas foi realizado o teste do Qui-quadrado de Pearson (α = 0,05). Resultados: Os resul-tados mostraram que 16,5% (n=16) do total de professores incluídos já haviam publicado pelo menos 1 preprint em alguma das duas plataformas, sendo que a UFPel diferiu estatisticamente das outras universidades, apresentando o maior número de aderência seguido pela UFRGS e UFSM (p=0,038). Não houve diferença estatística quanto a com-paração das plataformas pesquisadas (p=0,306). Discussão: Os achados demonstram que este formato, mesmo que de forma incipiente, já é uma realidade na área de Odontologia. Conclusão: Os achados deste estudo indicam uma baixa taxa de aderência ao formato de publicação preprint pelos professores dos programas de pós-graduação em Odontologia das universidades públicas do Rio Grande do Sul.

Aim: To evaluate the adherence to the publication of preprints by professors of postgraduate programs in Dentistry, from the three Federal Universities of the Rio Grande do Sul (UFRGS, UFPel and UFSM) (n = 97). Mate-rials and methods: Four reviewers performed a search for publications in the preprint format, in May 2021, on the MedArxiv and SciELO Preprints platforms, for each included professor. The same reviewers extracted the data which were checked by a fifth reviewer. Fisher's exact test was used for the evaluation and comparison of the different universities. For comparison between platfor-ms, Pearson's Chi-square test was applied with α = 0.05. Results: The results showed that 16.5% (n=16) of the total number of professors included had already published at least 1 preprint on either of the platforms, with UFPel differing statistically from the other universities, with the highest membership followed by UFRGS and UFSM (p = 0.038). There was no statistical difference between the platforms concerning the number of published pre-prints (p=0,306). Discussion: The findings demonstrate that this format, even incipiently, is already a reality in the Dentistry field. Conclusion: The findings of this study indicate a low rate of adherence to the preprint publication model by professors of the postgraduate programs in Dentistry in the public universities in of the Rio Grande do Sul state in Brazil.

Antiplaque and antigingivitis efficacy of medicated and non-medicated sugar-free chewing gum as adjuncts to toothbrushing: systematic review and network meta-analysis.

OBJECTIVE: This network meta-analysis (NMA) assessed the antiplaque and anti-inflammatory efficacy of different sugar-free chewing gums (SFCG) as adjuncts to toothbrushing. MATERIAL AND METHODS: PubMed, Scopus, EMBASE, Web of Science, and CENTRAL databases were searched up to February 2021 to identify randomized controlled trials, involving adults, comparing antiplaque and anti-inflammatory effects of SFCG, with different active ingredients, as adjunctive to mechanical control of biofilm, with a minimum of 7-day of follow-up. Plaque and gingival indexes were assessed. The risk of bias assessment was performed with the RoB 2.0 tool. NMA, and pairwise meta-analyses were performed for both dental plaque and gingival indexes. RESULTS: Twelve studies were included, comprising 850 (antiplaque) and 1459 (gingival inflammation) subjects randomized into 9 interventions: (1) chlorhexidine; (2) chlorhexidine + xylitol (CHX+Xyl); (3) green tea + xylitol (GT+Xyl); (4) magnolia; (5) Lactobacillus reuteri; (6) vitamin C + xylitol; (7) vitamin + carbamide; (8) eucalyptus; and (9) negative control, sorbitol, gum base only, or no chewing gum. No statistically significant differences were detected among SFCG, with different active ingredients, for both antiplaque and anti-inflammatory efficacy (p > 0.05). However, SFCG with GT+XyL outperformed negative control gums regarding antiplaque efficacy (SMD, - 2.93; 95% CrI, - 0.45 to - 5.38). The SUCRA results showed that SFCG containing GT+Xyl was ranked first, for both antiplaque and anti-inflammatory outcomes. CONCLUSION: SFCG containing GT+Xyl showed better antiplaque effect over negative controls. However, cautious interpretation is required due to the low number of direct comparisons arms. These shortcomings underscore the need for RCTs with mostly head-to-head comparison that provide more conclusive evidence. CLINICAL RELEVANCE: There is no robust evidence for the clinical indications of sugar-free chewing gums as adjunct to toothbrushing for the control of biofilm or the treatment of gingivitis.

Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCT

Abstract: The aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate.

Effects of cervical restorations on the periodontal tissues: 5-year follow-up results of a randomized clinical trial.

OBJECTIVE: This study evaluated the effect of resin composite restorations of non-carious cervical lesions (NCCLs) on the occurrence/progression of gingival recession (GR), considering different tooth isolation techniques. METHODS: A randomized controlled split-mouth and blinded trial was carried out. Patients (n = 38) with at least two NCCLs were included. Before the cervical restoration placement, the NCCLs (181 teeth) were randomly allocated into two treatment groups according to the tooth isolation techniques: cotton roll or rubber dam. Experienced, trained, blinded, and calibrated examiners performed periodontal evaluations at baseline and 5-year follow-up, using a periodontal probe. Restorations were assessed with the FDI criteria. Thirty-two patients (154 teeth) were evaluated at 5 years. The occurrence/progression of GR between baseline and follow-up was considered the primary outcome. The relative risk (RR) and 95 % confidence interval (95 %CI) were calculated by Poisson regression (α < 0.05). RESULTS: After 5 year, 31 teeth (13.6 %) presented occurrence/progression of GR. In the multivariate analyses, the occurrence/progression of GR was associated with the use of rubber dam isolation (RR; 95 %CI: 2.65; 1.01-7.00) and a lack of marginal adaptation of the restoration (RR; 95 %CI: 10.98; 2.31-52.30). Toothbrush stiffness, use of abrasive dentifrice, tooth type, and the presence of biofilm or gingivitis did not present a statistically significant higher risk for occurrence/progression of GR. CONCLUSION: The use of rubber dam isolation associated with retraction clamp and the lack of a proper marginal adaptation of the composite restorations are risk indicators for the occurrence/progression of GR in individuals who received a restoration for an NCCL. CLINICAL SIGNIFICANCE: Isolation with a rubber dam and dental clamps may promote GR in sites with restored NCCLs. Moreover, clinical examinations for lack of marginal adaptations of the restorations may be included in a clinical setting.

Glass fiber post treatment - does it influence resin cement bond strength? / Pinos de fibra de vidro pós tratamento - influencia a resistência de união do cimento resinoso?

Abstract Introduction Glass-fiber posts are used in order to improve the retention of restorations in endodontically treated teeth. Objective To evaluate the bond strength of glass-fiber posts submitted to different surface treatments and cemented to the root canal dentin with self-adhesive resin cement. Material and method Thirty roots of human canines were prepared and divided according to two factors: surface treatments (silane, 35% hydrogen peroxide, or sodium bicarbonate) and root thirds (cervical and middle thirds). The glass-fiber posts were cemented with self-adhesive resin cement (RelyX U200). After 24 h, the specimens were prepared for microtensile bond strength test (hourglass format), fracture pattern and micromorphological assessment by scanning electronic microscopy, in order to measure the cement line. Result The data (MPa and µm) were submitted to two-way ANOVA and Tukey's test (α = 5%). The surface treatments influenced the bond strength of the posts cemented with self-adhesive resin cement (p<0.00). The mean bond strength (standard deviations) differed according to the region of root dentin (p<0.00): the cervical region (Control: 19.16MPa (3.71); Silane: 25.65MPa (4.04); Hydrogen peroxide: 24.43MPa (3.16); Sodium bicarbonate: 37.42MPa (8.27)) showed higher bond strength values than the middle third of the root (Control: 14.66MPa (4.65); Silane: 12.52MPa (5.03); Hydrogen peroxide: 10.64MPa (3.33); Sodium bicarbonate: 10.87MPa (2.49)). Conclusion Treatment of the glass-fiber post surface with chemical and physical agents increased the bond strength of the cement-post-dentin interface in the cervical third and the treatment with Sodium bicarbonate showed better results in bond strength.

Resumo Introdução Pinos de fibra de vidro são utilizados para melhorar a retenção das restaurações em dentes tratados endodonticamente. Objetivo Avaliar a resistência de união de pinos de fibra de vidro submetidos a diferentes tratamentos superficiais e cimentados à dentina radicular com cimento resinoso autoadesivo. Material e método trinta raízes de caninos humanos foram preparadas e divididas de acordo com dois fatores: tratamentos de superfície (silano, peróxido de hidrogênio a 35% ou bicarbonato de sódio) e o terço radicular (cervical e médio). Os pinos de fibra de vidro foram cimentados com cimento resinoso autoadesivo (RelyX U200) e foram divididos de acordo com duas regiões: cervical e terço médio. Após 24 horas, foram preparados para microtração (formato de ampulheta), padrão de fratura e avaliação micromorfológica por microscopia eletrônica de varredura, para medir a linha de cimento. Resultado Os dados (MPa e µm) foram submetidos à ANOVA two-way e teste de Tukey (α = 5%). Os tratamentos de superfície influenciaram a resistência de união dos pinos. A média da resistência de união (desvio padrão) diferiu de acordo com a região da dentina radicular (p <0,00): a região cervical (Controle: 19,16Mpa (3.71); Silano: 25,65MPa (4.04); Peróxido de hidrogênio: 24,43MPa (3.16); Bicarbonato de sódio: 37,42MPa (8.27)) apresentou valores de resistência a raiz (Controle: 14,66MPa (4.65); Silano: 12,52MPa (5.03); peróxido de hidrogênio: 10,64MPa (3.33); bicarbonato de sódio: 10,87MPa (2.49)). Conclusão O tratamento com agentes químicos e físicos aumentou a resistência de união da interface cimento-pino-dentina no terço cervical e o tratamento com bicarbonato de sódio apresentou melhores resultados na resistência de união.

Survival, Reasons for Failure and Clinical Characteristics of Anterior/Posterior Composites: 8-Year Findings.

This retrospective study aimed to compare the annual failure rate (AFR), reasons for failure and factors influencing survival of posterior and anterior composite restorations placed by undergraduate students. Composite restorations placed by undergraduate students were evaluated. The restorations should be in occlusion, with at least one adjacent tooth; and patients should have been present for check-up, with at least 1 annual recall. The investigation was performed in two separate analysis: 1) dental electronic records of 100 patients (n=333 restorations) were selected to assess factors influencing survival; 2) clinical evaluation of 30 patients by examining restorations (n=123) to assess clinical characteristics and failure type distribution. Data were subjected to Kaplan-Meier method, Log-rank test, Cox regression and Fisher's Exact test (p<0.05). After 8-year period, the AFR was 2.62%. There was difference between anterior and posterior restorations (p=0.005), with anterior showing a higher AFR. The patient caries-risk (p<0.001) and the number of surfaces restored (p=0.010) affected restoration survival. The superficial brightness (p=0.029), fracture (p=0.025) and retention (p=0.011) were clinical criteria with differences between anterior and posterior restorations. Income (p<0.001), caries activity (p<0.001), caries risk (p<0.001) and oclusal risk (p<0.001) also influenced on the restorations survival. After 8-year, the AFR of restorations placed by undergraduate students was acceptable and affected by patient risk factors and the position of the tooth in the arch: anterior restorations failed more than posterior.

Survival, reasons for failure and clinical characteristics of anterior/posterior composites: 8-year findings

Abstract This retrospective study aimed to compare the annual failure rate (AFR), reasons for failure and factors influencing survival of posterior and anterior composite restorations placed by undergraduate students. Composite restorations placed by undergraduate students were evaluated. The restorations should be in occlusion, with at least one adjacent tooth; and patients should have been present for check-up, with at least 1 annual recall. The investigation was performed in two separate analysis: 1) dental electronic records of 100 patients (n=333 restorations) were selected to assess factors influencing survival; 2) clinical evaluation of 30 patients by examining restorations (n=123) to assess clinical characteristics and failure type distribution. Data were subjected to Kaplan-Meier method, Log-rank test, Cox regression and Fisher's Exact test (p<0.05). After 8-year period, the AFR was 2.62%. There was difference between anterior and posterior restorations (p=0.005), with anterior showing a higher AFR. The patient caries-risk (p<0.001) and the number of surfaces restored (p=0.010) affected restoration survival. The superficial brightness (p=0.029), fracture (p=0.025) and retention (p=0.011) were clinical criteria with differences between anterior and posterior restorations. Income (p<0.001), caries activity (p<0.001), caries risk (p<0.001) and oclusal risk (p<0.001) also influenced on the restorations survival. After 8-year, the AFR of restorations placed by undergraduate students was acceptable and affected by patient risk factors and the position of the tooth in the arch: anterior restorations failed more than posterior.

Resumo Este estudo retrospectivo comparou a taxa de falha anual (TFA), razões para falha e fatores influenciadores da sobrevida de restaurações posteriores e anteriores de resina composta realizadas por estudantes de graduação. As restaurações deveriam estar em oclusão, com pelo menos um dente adjacente, e os pacientes deveriam ter comparecido a pelo menos 1 consulta anual de retorno. A investigação foi realizada em 2 analises separadas: 1) dados odontológicos de prontuário eletrônico de pacientes (n=333 restaurações) foram selecionados para avaliar os fatores influenciadores na sobrevida; 2) avaliação de 30 pacientes por exame clinico das restaurações (n=123) para verificar as características clinicas e a distribuição do tipo de falha. Os dados foram submetidos a Kaplan-Meier método, Log-rank teste, regressão de Cox e Teste Exato de Fisher (p<0,05). Após o período de 8 anos, a TFA foi 2,62%. Houve diferença entre restaurações anteriores e posteriores (p=0,005), sendo que anteriores mostraram maior TFA. Os fatores de risco à carie (p<0,001) e o número de superfícies restauradas (p=0,010) influenciaram a sobrevida de restaurações. Brilho superficial (p=0,029), fratura (p=0,025) e retenção (p=0,011) foram critérios clínicos com diferenças entre restaurações anteriores e posteriores. Renda (p<0,001), atividade de cárie (p<0,001), risco à cárie (p<0,001) e risco oclusal (p<0,001) também influenciaram a sobrevida. Após 8 anos, a TFA das restaurações realizadas por estudantes de graduação foram clinicamente aceitáveis e afetadas pelos fatores de risco associados ao pacientes e a posição do dente na arcada; restaurações anteriores falham mais do que posteriores.

Scientific evidence for the management of dentin caries lesions in pediatric dentistry: A systematic review and network meta-analysis.

BACKGROUND: A systematic quantitative evaluation of the available evidence of the treatment for caries lesions in primary teeth that considers how different caries progressions lead to the need for distinct interventions might provide additional useful information for clinical evidence-based decision making. The aim of this systematic review and network meta-analysis was to verify the effect of the treatments on caries lesion arrestment (CLA) or the success rate (SR) of dentin caries lesion treatments in the primary teeth. METHODS: A search was conducted using the MEDLINE/PubMed, Web of Science and Scopus databases through December 2017. The primary search terms used in combination were primary teeth, caries lesion and restoration. The grey literature was also screened, as were the reference lists of eligible studies. A search of prospective studies with at least 12 months of follow up that compared different techniques was performed. The exclusion criteria were the absence of a comparison group; no evaluation of different restorative techniques; the evaluation of other outcomes unrelated to this review; and the recruitment of specific patient. The risk of bias was evaluated by the tools: the Cochrane Handbook for Systematic Reviews of Interventions and ROBINS-I. A network meta-analyses and meta-analyses were conducted considering CLA or SR as outcomes according to the surface involved and the depth of progression. RESULTS: Of the 1671 potentially eligible studies, 15 were included. For occlusal surfaces, only two studies presented data regarding the outer half of the dentin, with conventional restorative treatment (CRT) using composite resin showing superior results; five studies presented data regarding the depth of caries lesions, and CRT with compomer resulted in the best results. Seven studies considered occlusoproximal surfaces, and the Hall technique showed the best SR among the evaluated treatments. Finally, two annual applications of silver diamine fluoride showed the best nonrestorative approach to arrest caries lesions on occlusal and smooth surfaces. DISCUSSION/CONCLUSIONS: The treatments for dentin caries lesions in primary teeth depend on the depth of progression and the surface involved. However, few of the included studies provided evidence to strongly recommend the best treatment option. OTHER: Funding: FAPESP; Systematic review registration number-PROSPERO CRD42016037784.

Is Adhesive Bond Strength Similar in Primary and Permanent Teeth? A Systematic Review and Meta-analysis.

PURPOSE: To systematically review the literature on laboratory studies to determine whether the bond strength of adhesives to primary teeth is similar to that to permanent teeth. MATERIALS AND METHODS: This systematic review was conducted according to PRISMA and registered in PROSPERO (CRD42014015160). A comprehensive literature search was conducted considering in vitro studies published up to June 2015 in the PubMed/MEDLINE database, with no limit on year of publication. Two reviewers independently selected papers, extracted data and assessed the risk of bias. From 422 eligible studies, 42 were fully analyzed. Thirty-seven studies were ultimately included in the systematic review and meta-analysis. A global comparison was performed with a random-effects model at a significance level of p < 0.05, expressed by the difference of means between the groups. The mean bond strengths and standard deviations were tabulated and statistical analyses were conducted in RevMan 5.1 (The Cochrane Collaboration). RESULTS: There was a significant difference between groups, with permanent teeth presenting higher bond strength than primary teeth (p = 0.0005). When the enamel and dentin substrates were considered separately, dentin presented the same trend (p = 0.002), while for enamel there was no significant difference between the dentitions (p = 0.11). The majority of the studies had a high bias risk. CONCLUSION: Adhesives have higher bond strengths when applied to permanent than to primary teeth. This difference was also valid when the comparison was made between permanent and primary dentin.

Effectiveness of pre-treatment with chlorhexidine in restoration retention: A 36-month follow-up randomized clinical trial.

OBJECTIVES: This study evaluated the effect of the pre-treatment with 2% chlorhexidine digluconate (CHX) as coadjutant in restoration retention of noncarious cervical lesions (NCCL), after 36 months of follow-up. METHODS: A randomized controlled split-mouth and triple-blind (operators, patients and evaluator) trial was carried out. Patients (n=42) with at least two non-carious cervical lesions were included. The teeth with NCCL were randomly assigned to two treatment groups: application of 2% CHX (experimental group) or a placebo solution (control group) for 60s after acid etching and before the adhesive application. A trained and calibrated examiner evaluated the restorations at baseline (1 week) and at each recall (6, 12, 24 and 36 months) using the FDI criteria. A total of 225 restorations were evaluated after 36-month follow-up. Data were subjected to survival analysis using the Kaplan-Meier method, and the log-rank test was used to evaluate the existence of differences between the survival curves (α=0.05). RESULTS: The restorations survival rate after 36 months of follow-up was 76.1%. There was no difference in the retention and failure rates between the experimental and the control group (p=0.968). There was an increased failure trend when restorations were located subgingival compared to those at the gingival level or supragingival. CONCLUSION: The pre-treatment with 2% chlorhexidine digluconate did not promote further restoration retention of noncarious cervical lesions. CLINICAL SIGNIFICANCE: The cavity pre-treatment with chlorhexidine for inhibition of hybrid layer degradation does not add any beneficial effect to the clinical performance of restorations.

Effect of 180-Day Water Storage on Bonding Effectiveness of Self-Adhesive Systems to Occlusal and Proximal Dentin.

PURPOSE: This study aimed to evaluate the microshear bond strength (µSBS) values of adhesive systems to occlusal and proximal dentin submitted to water storage aging. MATERIALS AND METHODS: Occlusal and proximal dentin surfaces were obtained from 90 molars, polished with 600-grit SiC and divided according to the type of adhesive system: one total-etch and two self-etch. Starch tubing was used to perform 1 mm2 cylindrical composite resin restorations. The specimens were aged in distilled water during different storage times: 24 hours, 3 months, and 6 months (n = 10). The specimens were submitted to µSBS test. The µSBS values in MPa were subject to three-way ANOVA and post hoc Tukey test (p < 0.05). RESULTS: There was no statistical difference in the µSBS values among the storage times (p = 0.72); however, the dentin region (p < 0.01) and the adhesive system (p < 0.01) significantly affected the µSBS. The proximal surface (14.7 ± 3.3 MPa) presented higher µSBS values than the occlusal dentin (10.9 ± 4.1 MPa). The all-in-one adhesive system (GB) achieved the highest µSBS mean (17.0 ± 1.7 MPa). CONCLUSION: Both material and dentin surface factors affected the composite-dentin bond strength; however, the water storage did not influence bonding effectiveness over time.