Does local delivery of bisphosphonates influence the osseointegration of titanium implants? A systematic review.

The aim of this study was to systematically review the influence of the local delivery of bisphosphonates on the osseointegration of titanium implants in humans. A search of health sciences databases was performed (The Cochrane Library, Embase, PubMed MEDLINE, ISI Web of Knowledge, Scopus, and SIGLE OpenGrey), including articles published until October 2016. A total of 679 articles were identified. Following the removal of duplicates, 278 were screened by title and abstract. The complete texts of seven studies were read, and of these, three met the inclusion criteria. Each article included in the analysis was submitted to a quality and level of evidence evaluation, and relevant data were extracted and tabulated. Despite methodological differences, all articles presented positive results for osseointegration when a local bisphosphonate was used: the authors reported greater implant stability, better implant survival rates, and reduced peri-implant bone loss when compared with the control groups. On the basis of the results of this systematic review, it is concluded that the local use of a bisphosphonate appears to favour the osseointegration of titanium implants in humans. Nonetheless, a higher level of standardization and the control of methodological bias is required in future research so that stronger evidence might be produced.

Repairing ditched amalgam restorations is less time and tooth structure-consuming than replacement.

AIM: To evaluate the dental structure loss associated with procedures of replacement or maintenance for ditched amalgam restorations in primary molars and the time required to perform each treatment. METHODS: Ditched amalgam restorations (n = 40) were submitted to four different strategies: polishing group-polishing and finishing of restorations; amalgam group-replacement of ditched amalgam restorations with new amalgam restorations; resin group-replacement of amalgam restorations with resin composite restorations; flowable resin group-filling the ditch with a flowable resin composite. The teeth were analysed with a stereomicroscope and the areas pre- and post-treatment were determined by image analysis software to evaluate structural loss. The time required to perform each treatment was recorded in seconds. STATISTICS: Student's t test was used to compare areas pre- and post-treatments. ANOVA and Student-Newman-Keuls tests (p < 0.05) were used to compare differences among groups and the time to perform each procedure. RESULTS: Dental structure loss was observed in resin and amalgam groups. Replacing the restorations with amalgam took more time, while polishing and applying flowable resin composite consumed less than half of the time compared with amalgam and resin groups. CONCLUSION: Maintenance of ditched amalgam restorations by polishing and sealing preserves dental structure and involves less time compared with that for replacement of restorations.

Paediatric dentistry education of atraumatic restorative treatment (ART) in Brazilian dental schools.

AIM: To evaluate the degree of knowledge, use and teaching of atraumatic restorative treatment (ART) of paediatric dentistry lecturers in dental schools throughout Brazil. METHODS: A structured questionnaire was applied, containing questions regarding the use of ART, socio-demographic characteristics and academic degree background. Descriptive analysis and Poisson's regression were conducted in order to verify the association between exploratory variables and ART teaching (α=5%). RESULTS: Of the 721 questionnaires sent to dental schools, approximately 40% were returned (n=285). Some 98.2% of the participants teach ART. STATISTICS: Concerning dental lecturers who teach ART, in multiple regression model, considering ART indication (emergency versus restorative treatment) the lecturers residents of the Mid-West (PR=1.66; CI:1.13-2.45) and Northeast region (PR=1.33; CI:1.02-1.72) and lecturers who use ART regularly (PR=3.73; CI:2.11-5.59) teach ART as restorative treatment. When the question was about reason for using ART (conservative technique versus other techniques failures/fast treatment), lecturers with a longer period of TG (time elapsed since graduation) (PR=1.30; CI:1.08- 1.56) and also lecturers who use ART regularly (PR=2.87; CI:1.95-4.22), teach it as being a conservative technique. Regarding the patients' age covered by ART (versus without limitation), women (PR=1.26; CI:1.06-1.50) and lecturers who use ART regularly (PR=1.28; CI:1.06-1.54), teach that there is no age restriction. CONCLUSIONS: ART has been widely taught in Brazilian dental schools, is regularly used in lecturer's clinical practices and has positively influenced the appropriate teaching of this technique.

Nanoleakage related to bond strength in RM-GIC and adhesive restorations.

AIM: This was to investigate the nanoleakage of Resin Modified Glass Ionomer Cement (RMGIC) and composite resin (CR) restorations in sound and caries-affected primary dentine, submitted to load cycling and cariogenic challenge in vitro. METHOD: Occlusal cavities were prepared in 60 sound exfoliated primary second molars and 30 specimens were subjected to chemical induction of artificial caries lesions and the others were restored without caries induction. All prepared teeth were divided into 2 groups according to restorative materials. From each dentine condition 5 restored teeth and restorative material were subjected to microtensile bond strength and nanoleakage tests immediately or after load-cycling or submitted to the pH-cycling procedure before testing. RESULTS: The adhesive presented bigger areas of silver leakage at the interfaces on caries-affected dentine (2.46±0.47)mm2 than sound dentine (0.90±0.19)mm2. RMGIC nanoleakage was not influenced by the sound (1.75±0.11)mm2 or caries-affected (2.08±0.39) condition of the substrate. A significant moderate inverse correlation was revealed between the bond strength and silver leakage area at the interface, (r= -0.55, p<0.001). CONCLUSIONS: Nanoleakage is greater in caries-affected primary teeth dentine than sound dentine in adhesive restorations although at the interfaces of RMGIC does not differ. As nanoleakage increases, bond strength decreases significantly.

Efficiency of different polyacrylic acid concentrations on the smear layer, after ART technique, by Scanning Electron Microscopy (SEM).

AIM: To assess the efficiency of different polyacrylic acid concentrations on the removal of the smear layer after caries removal with hand and rotary instruments in affected dentine of primary teeth. STUDY DESIGN: In vitro study. METHODS: Six exfoliated primary molars with carious lesions were divided into two groups for caries removal: (1) hand instrument or (2) low speed bur. Each tooth was cut into four pieces. One piece assigned as control surface and the other three surfaces were actively treated with either 40% Fuji IXGP Liquid (GC America), or 40% Fuji IXGP Liquid diluted with water, and 25% Ketac Molar(TM) Conditioner (3M-ESPE). Surfaces were prepared for scanning electron microscopy (SEM). All images were submitted to an analysis by an experienced SEM professional, regarding presence or absence of smear layer and dentinal demineralization pattern. Chi-squared test was carried out (5% significance). RESULTS: There was no difference concerning the presence of a smear layer in relation to the method of caries removal, and 40% Fuji IXGP diluted with water causes a higher demineralization when compared with the control group of teeth (p=0.01). CONCLUSION: Treatments with polyacrylic acid are indicated prior to glass ionomer cement application in primary teeth.