Two-Year Survival of Ceramic Endocrowns and Partial Coverage Ceramic Restorations with Fiber Post: A 2-Year Double-Blind Randomized Clinical Trial.

PURPOSE: This double-blind randomized clinical trial (RCT) aimed to evaluate the 2-year survival rates of endocrowns and partial coverage ceramic restorations (PCCR) with fiber posts. MATERIAL AND METHODS: Forty (40) participants fulfilled the elegibility criteria, and they were randomly allocated in 2 groups: Endocrown or PCCR+post. The survival rates were assessed based on USPHS modified and radiographic examinations. A Chi-square test was used to assess the distribution of characteristics between groups. Kaplan-Meier and Log-rank tests were used to estimate the survival rate. To evaluate the association between survival of the restorations and the explanatory variables, the Multivariate Cox regression model was used. Only variables presenting p⟨0.20 were maintained in final model (α= 0.05). RESULTS: The highest 2-year survival rates were recorded for the Endocrown group (100%), whereas the PCCR+post group exhibited the lowest performance (66.7%). Most of the restoration failures was due to lack of marginal adaption, fracture, and recurrent caries. Cox Regression unadjusted analysis showed that only type of restoration presented a significant effect (p⟨0.20). Thus, adjusted analysis was not performed. CONCLUSIONS: Endocrowns appear to be a promising conservative restorative option and to be feasible and reliable approach restoring endodontically.

Giomer composite compared to glass ionomer in occlusoproximal ART restorations of primary molars: 24-month RCT.

BACKGROUND: Occlusoproximal restorations of primary molars usually fail, so it is necessary to investigate new materials that may overcome this challenge. Thus, this trial aimed to evaluate the longevity of occlusoproximal ART restorations in primary molars using a glass ionomer cement - GIC (Equia Forte® - GC Corp) and a Giomer resin composite - GCR (Beautifil Bulk Restorative® - Shofu Inc) after 24 months. METHODS: One hundred and eighty-two (182) children aged from 4 to 8 years were selected and randomly assigned to GIC or GCR. A paediatric dentist treated them in the school setting in Cerquilho, Brazil, and the restorations were assessed after 3, 6, 12, 18 and 24 months. The primary outcome was the restoration survival, evaluated using the Kaplan-Meier and superiority Cox regression analyses. Intention to treat (ITT) was performed as a sensitivity analysis using superiority test P value and confidence interval (CI = 95%). Independent variables included gender, age, molar, jaw, cavity volume and caries experience. RESULTS: The restoration survival after 24 months was GIC = 58.1% and GCR = 49.1% (HR = 1.24; CI = 0.97-1.59). ITT analysis showed a success of GIC = 61.1% and GCR = 52.2% (RR = 1.17; CI = 0.91-1.52). The superiority hypothesis was not proved in both analyses (P > 0.05). CONCLUSION: GCR does not have superior longevity than GIC in occlusoproximal ART restorations of primary molars.

Screening of hydrogel-based scaffolds for dental pulp regeneration-A systematic review.

OBJECTIVE: The aim of this systematic review was to evaluate the most appropriate hydrogel scaffold type (natural, synthetic or hybrid) to be applied with stem cells for dental pulp regeneration. The findings should help clinicians make an informed choice about the appropriate scaffold to be applied for this approach. DESIGN: Three electronic databases were searched (Medline, Web of Science and Scopus). The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). RESULTS: From 4990 potentially relevant studies initially identified, 18 papers fulfilled the eligibility criteria and were considered for this review. Natural scaffolds were applied in most studies. Collagen was the most studied scaffold. In 5 of 10 studies, only growth factors were added to the constructs. Even without growth factors, these scaffolds containing stem cells were able to support the formation of dentin. The synthetic scaffolds were the least studied. Only 4 studies were selected, and in 3 of them, the same scaffold (Puramatrix) was evaluated. Puramatrix by itself was unable to form dental pulp when dental pulp stem cells were not present. Synthetic and hybrid hydrogels were unable to attract stem cells from the host. The presence of growth factors in these constructs seems to be of relevance since dental pulp tissue formation was achieved only when the hybrid scaffold was applied with growth factors. CONCLUSION: All types of hydrogel-based scaffolds, when containing mesenchymal stem cells, are able to form connective tissue with different degrees of similarity to dental pulp. However, current data is too heterogeneous to compare and identify the advantages of any specific scaffold.

Comparison of validation methods for the diagnosis of occlusal caries in primary molars.

AIM: To evaluate the reproducibility of 7 validation methods used for caries diagnosis in primary teeth. METHODS: Seventy-two occlusal sites were selected on 40 primary molars. The sites were evaluated independently by 3 experienced examiners using validation methods that involved direct assessment, i.e. by using a (1) magnifying glass (8×) and (2) stereomicroscope (35×), or indirect assessment i.e. by using (3) photographs, (4) slide projections of photographs, (5) stereomicroscope (35×) photographs, (6) stereomicroscope (35×) slide projections, and (7) projections of polarised light microscope slides. Cohen's kappa coefficients were calculated and subjected to the Kruskal-Wallis test at a significance level of 5%. RESULTS: The mean inter-examiner kappa values for the validation methods were 0.31-0.51. There were statistically significant differences (p<0.05) between methods 1 and 3, 1 and 4, 2 and 4, 4 and 5, 4 and 6, and 4 and 7. Moderate agreement was observed for all methods except methods 1 and 4, for which the agreement was fair. CONCLUSIONS: The inter-examiner agreement for all validation methods for caries diagnosis was moderate, except for the method based on indirect assessment by slide projection, which showed low agreement.

Erosive effects of beverages in the presence or absence of caries simulation by acidogenic challenge on human primary enamel: an in vitro study.

AIM: To evaluate in vitro the erosive effects of beverages in the presence or absence of caries simulation (acidogenic challenge) on the microhardness of primary enamel. METHODS: Forty human primary teeth were submitted to the erosive effects: 3 × 20-min-long daily immersion in fresh orange juice (orange group), strawberry yogurt drink (yog group), or cola soft drink (cola group) separately or in combination with acidogenic challenge (pH cycling for 10 days). Specimens were also submitted to acidogenic challenge alone, and in the negative control group specimens were not submitted to any treatment. Mineral loss was evaluated by cross-sectional microhardness determination. The data (Knoop hardness numbers, KHN) were subjected to 2-way analysis of variance and Tukey's post hoc test (α = 0.05%). RESULTS: All the test beverages significantly reduced the sample cross-sectional enamel hardness (KHN ± SD, 235.93 ± 18.15, 257.23 ± 21.79, and 253.23 ± 13.86 in the orange, yog, and cola groups, respectively) compared to samples in the negative control group (290.27 ± 3.92). In vitro acidogenic challenge exacerbated the mineral loss induced by all beverages (166.02 ± 4.28, 190.43 ± 17.55, and 198.39 ± 21.39 in the orange, yog, and cola groups combined to acidogenic challenge, respectively) compared to acidogenic challenge alone. CONCLUSIONS: All beverages exhibited erosive effects on primary enamel. Simulated caries challenge considerably exacerbated the enamel softening of primary teeth.