Microleakage of Silver-Modified Atraumatic Restorative Technique (SMART) Restorations Using Silver Diammine Fluoride and High-Viscosity Glass Ionomer.

Purpose: The purpose of this study was to investigate the microleakage of atraumatic glass ionomer restorations with and without silver diammine fluoride (SDF) application. Restorations with SDF are termed silver-modified atraumatic restorations (SMART). Methods: Sixty carious extracted permanent teeth were randomly allocated to two SMART groups and two control groups (n equals 15 per group) for a total of four groups. After selective caries removal, test specimens were treated with 38 percent SDF and polyacrylic acid conditioner was applied and rinsed; teeth were restored with Fuji IX GP® glass ionomer (n equals 15) or with SMART Advantage™ glass ionomer (SAGI; n equals 15). For control groups, specimens were restored with their respective GI material after selective caries removal, both without SDF. Restored teeth were placed in Dulbecco's Phosphate-Buffered Saline solution at 37 degrees Celsius for 24 hours. Teeth were thermocycled between five and 55 degrees Celsius for 1,000 cycles, stained with two percent basic fuchsin, sectioned, and visually inspected for microleakage utilizing stereomicroscopy on a four-point scale. Data were statistically analyzed using Kruskal-Wallis one-way analysis of variance on ranks using Dunn's method (P<0.05). Results: Microleakage between the two SMART restoration groups was insignificant. SAGI alone demonstrated significantly more microleakage than all other groups. There was no statistical significance between the Fuji IX GP® control group and the two SMART restoration groups. Conclusions: This in vitro study indicated that silver diammine fluoride placed before glass ionomer restoration does not increase microleakage. Polyacrylic acid may be used after SDF placement without increasing microleakage.

A Structural Analysis of 3D Printed Pediatric Space Maintainers.

Purpose: To design, fabricate, and evaluate in vitro 3D printed space maintainers (SMs) and compare their retentive capabilities to tradi- tional stainless-steel (SS) space maintainers. Methods: E-Guard was selected as the printing material based on flexural strength and elastic modulus. SMs with a claw design were printed, cemented to testing blocks, and vertically loaded to determine failure strength and flexure (n equals 10). The intaglio surfaces of SM bands, printed with plain, crosshatched, or horizontal ridges, were cemented to extracted primary teeth. The force needed to dislodge the bands was compared to cemented traditional SS bands (n equals 14). Results: Flexural strength (mean±standard deviation [SD]) of E-Guide, E-Dent, and E-Guard materials was 65±12, 90±13, 134±25 MPa, respectively. Elastic modulus (mean±SD) was 1.54±0.40, 2.49±0.14, 2.65±0.89 GPa, respectively. When subjected to vertical loading, the mean failure load of 3D printed SMs (E-Guard) was 124 N and the mean deflection at fracture was 1.73 mm. Retention strengths (mean±SD) of 3D printed bands were 32±13, 43±13, 43±16 N for the plain printed, cross- hatched, and horizontal ridges designs, respectively. The retention strength of traditional SS bands was 126±27 N. Conclusions: E-Guard had superior mechanical properties among tested printing resins. Strength and deflection under the vertical load of claw-design 3D printed space maintainers may be adequate as a viable alternative to traditional SMs. Retention of 3D printed SMs was significantly lower than for traditional SS bands. Textured intaglio surfaces did not significantly improve the retention of 3D printed bands.

Benefits of virtual externships with a pediatric dentistry program for potential residents.

PURPOSE: To determine if a virtual externship (VE) is beneficial to potential applicants regarding their perceived knowledge of a pediatric dentistry residency program. Secondarily, this study identified general program characteristics that influence resident ranking decisions. METHODS: All applicants who applied to a pediatric dentistry residency program in the Southeast were invited to participate in a VE. Those who participated in the externship (n = 65) were asked to voluntarily complete Pre- and Post-VE surveys. Participants were asked 22 questions about their level of knowledge of both tangible and intangible aspects of the program such as stipend, patient volume, faculty-resident interaction, and resident comradery. Participants were also asked to rank 9 general characteristics that influence ranking decisions such as geography, cost to attend, and reputation of the program and were asked to rate their satisfaction with the VE. Post-VE data were compared to pre-VE data to determine level of knowledge gained via Wilcoxin matched pairs signed rank test (significance set at p < 0.05). RESULTS: When comparing Pre- and Post-VE ratings of level of knowledge about each category, all 22 categories assessed showed statistically significant mean differences indicating perceived knowledge gain with the most knowledge gained for "resident satisfaction in the program." Of the nine program characteristics, clinical experience was the most important factor to participants. Participants (100%) were satisfied with the VE experience and indicated the VE gave them the opportunity to get to know the program. CONCLUSIONS: A virtual externship is a satisfactory option for increasing applicant knowledge of the tangible and intangible aspects of a residency program.

Dental students and recent dental graduates' perceptions of preparedness in treating pediatric patients.

PURPOSE/OBJECTIVES: To survey potential applicants applying to advanced education in pediatric dental programs and evaluate their preparedness upon graduating from an accredited dental school. METHODS: Attendees of a virtual externship of a University program were recruited to participate in a web-based survey. The survey collected demographic data, current levels of confidence with various pediatric clinical procedures, predicted confidence with those procedures, and number of procedures completed. Chi-Square and analysis of variance statistics were performed on resulting data to determine statistical significance. RESULTS: Fifty-three participants completed the survey in its entirety (n = 53). Most respondents reported adequate didactic training, mean score of 3.6 (range 0-5) and a moderate to high impact of coronavirus disease 2019 on their overall training with a mean score of 4.9 (range 0-10). Current dental students reported that they are "not confident at all" (<2.0) for 15/24 (63%) of the procedures. Graduates reported "somewhat confident" (<3.0) for 13/24 (54%) of the categories. Both students and graduates report the lowest levels of confidence for managing dental trauma, invasive treatment of young patients (<4 years of age), and patients with special healthcare needs. Dental students self-reported the expectation to feel more confident throughout their matriculation; however, their clinical experience was still reported to be limited. Students did not report reaching the level of "confident" for 75% of the procedures. CONCLUSION: Dental students and recent dental graduates alike perceive themselves to be under prepared for practice and do not feel confident in performing pediatric dental procedures. This study can provide dental schools, program directors, recent graduates, and dental students with an understanding of areas where they are under prepared and could offer areas where curricula and clinical experiences could be updated or modified.

A Randomized Controlled Pilot Study Examining Effects of Animal Assisted Therapy in Children Undergoing Sealant Placement.

Purpose: The purpose of this study was to examine the effects of a companion canine on physiologic responses, discomfort level, and behavior in children undergoing sealant placement using a dental isolation system (Isodry®). Methods: Forty-seven healthy six- to 10-year-olds who needed sealants were randomly assigned to a control group (N =23) or experimental group (N =24) that utilized an emotional support canine in the child's lap. Preoperative baseline anxiety was obtained. Pulse, pulse oximetry, and behavior (measured by Frankl and Houpt scales) were recorded at various time points (beginning, at first sealant placement, switching the isolation system to the other side, second side sealant placement, and end) throughout the procedure. Participants reported a comfort level utilizing the FACES scale. Participants in the intervention group were asked, "Did you like having the dog in your lap?" The dentist rated the difficulty of and time required for the procedure. Results: Baseline anxiety was similar; no significant differences in physiologic measurements or FACES ratings were found between groups. The intervention group had significantly lower Houpt ratings for all three variables when the isolation system was repositioned (P=0.002, P=0.03, and P=0.05) and had higher Frankl scores at isolation repositioning and when completing sealants on the second side (P=0.02 and P=0.03, respectively). Both groups had similar ratings from the dentist. Conclusions: Animal-assisted therapy (AAT) should be studied more rigorously to substantiate its effectiveness in enhancing cooperative behavior in children for dental procedures. High levels of satisfaction were observed among pediatric users of AAT.

Color Stability of Prefabricated Pediatric Zirconia Crowns Following Sterilization.

Purpose: Since pediatric zirconia crowns (ZRCs) are prefabricated, they may be sterilized following try-in for re-use. Possible changes in color stability, gloss, and translucency were evaluated for four brands of prefabricated zirconia crowns following autoclave and cold sterilization. Methods: Sixteen maxillary right central incisor prefabricated ZRCs were obtained from NuSmile ®, Sprig, Cheng Crowns, and Kinder Krowns ® manufacturers and either autoclaved or cold sterilized. Gloss unit measurements were obtained with a small object Novo-Curve glossmeter. CIE-L*a*b* system values were measured with a CM-700d spectrophotometer under three different illuminants to calculate DE (quantitative representation of the perceived color). ΔE equals one was used for perceptibility threshold (PT) and ΔE equals 2.7 for acceptability threshold (AT). Results: All groups' baseline was ΔE less than one for all illuminants except Cheng Crowns to be autoclaved, indicating crowns are not identical in color from the manufacturer. For autoclaving, Cheng Crowns reached ΔE PT greater than one following the 10th sterilization cycle for all illuminants (D65 1.08±0.32 (standard deviation; P<0.001), A equals 1.07±0.32 (P<0.001), and F2 equals 1.25±0.38 (P<0.001). For cold sterilization, Sprig EZCrowns reached PT greater than one for all sterilization cycles, and Cheng Crowns reached ΔE PT greater than one for the sixth and 10th sterilization cycles. Gloss was not affected by either sterilization method. Spring EZcrowns had the highest mean translucency. Conclusions: Although each group may have a slight perceived difference, there was no clinically significant difference in color; all groups remained below the acceptability threshold of ΔE equals 2.7.

An In Vitro Comparison of Indirect Versus Direct Restorations of Incisal Edge Fractures.

Purpose: To compare fracture strength, failure mode, and chairside time of Class IV fractures restored with CEREC (Chairside Economic Restorations of Esthetic Ceramics) technology or direct composite. Methods: Forty-eight fractured anterior bovine teeth were randomly assigned to three experimental groups (indirect restoration) with margin designs including: A) butt joint, B) short chamfer (one mm), and C) long chamfer (two mm) and a control group (direct composite). Preparations were scanned; restorations were milled from zirconia-reinforced lithium-silicate blocks and cemented. Fracture load (N) and failure mode were analyzed. Techniques were timed from start of margin preparation through finishing. Results were analyzed using one-way analysis of variance or the Kruskal-Wallis test (significance level: P=0.05). Results: Fracture loads (mean±standard deviation) for groups A, B, and C and control group were 2,177±644 N, 2,183±507 N, 2,666±609 N, and 2,358±886 N, respectively (not significantly different; P=0.26). The direct composite was significantly different from all indirect groups (P<0.01) for failure mode. Chairside time was longer for direct restoration. Conclusions: Fracture strength is similar for directly and indirectly fabricated Class IV restorations, with margin design not affecting strength or failure mode. Practitioner's chairside time, but not total time, is reduced when using indirect methods.

Effectiveness of and Dental Student Satisfaction with Three Teaching Methods for Behavior Guidance Techniques in Pediatric Dentistry.

The aim of this study was to compare the effect of different types of instructional styles-traditional lecture with and without video examples and contemporary format that simulated a flipped classroom-on dental students' learning of behavior guidance techniques (BGTs) in pediatric dentistry. The study also sought to determine if students had an improved comfort level with BGTs with these instructional methods, if videos improved learning and comfort with BGTs, and if there were differences in outcomes by gender. All 96 second-year dental students at one U.S. dental school were recruited to participate in the study in 2017. Students were randomly divided into three groups: contemporary instruction (CI), traditional instruction with video (TIV), and traditional instruction with no video (TI). CI students watched a 20-minute mini-lecture and were divided into discussion groups led by calibrated faculty members. TIV students received 50 minutes of traditional lecture with video examples. TI students received a traditional lecture with no video examples. All groups completed a questionnaire prior to and on completion of the course. The questionnaire assessed students' learning and perceptions of the learning experience. All students participated in the course and the assessments, for a 100% response rate. The students' post-course scores improved for all teaching methods (TI>CI>TIV) with no significant differences among them. CI students rated comfort with BGTs and usefulness of videos higher than the other groups, but the difference was not statistically significant. Students rated their satisfaction with and usefulness of the course high for all groups (>3 on a four-point scale). Learning style and comfort treating children were not statistically significant by gender. Overall, the students reported high satisfaction with all the teaching methods. Although the differences were not statistically significant, discussion groups were ranked highest in satisfaction and usefulness.

Parents' Preferences and Perceptions of Their Children's Consumption of Sugar and Non-nutritive Sugar Substitutes.

Purpose: The purpose of this study was to investigate opinions and preferences of parents from various sociodemographics regarding sugar and both natural and artificial non-nutritive sugar substitutes (NNS). Methods: Oral interview surveys were conducted in dental practice settings. Parents were asked about demographics, their consumption of and feelings about sugar and NNS for themselves and their children, and their concerns regarding NNS. Parents were asked about natural and artificial labels and were asked to select snacks/beverages they would purchase for their children. Results: Parents (N equals 100) preferred sugar-sweetened drinks for their children (76 percent), and 78 percent expressed concern about the potential health effects of NNS, especially cancer. Parents felt sugar was safer than NNS and were more positive about natural NNS than artificial ones. More highly educated parents (P = 0.02) were more likely to avoid NNS for their children, and parents of the lowest income level were likely to express ambivalence regarding naturally labeled NNS. Conclusions: Parents are concerned about giving their children NNS and cite cancer as the primary reason. Parents from higher sociodemographic backgrounds are more likely to limit their children's consumption of NNS and have negative feelings about them. Most parents, especially those of higher sociodemographics, are more accepting of natural NNS.

Behavior guidance: that was then but this is now.

Pediatric dentistry has evolved. Seasoned pediatric dentists believe that patients, parents, and behavior techniques have changed over their practice lifetimes. The purpose of this article is to provide dentists with a framework in which to adapt to the changes in society. Understanding cultural diversity, current societal values, technology and media influences, and contemporary parenting philosophies is essential to fostering communication with patients and their families. Building and honing behavior guidance skills are part of the process by which dentists help turn child patients into fearless adult patients with excellent oral health. This article reviews basic techniques and offers practical examples of implementing these in daily practice. The discussion also addresses changing parental and societal acceptance of various techniques and dentists' responsibility for informed consent regarding the risks and benefits of advanced behavior guidance techniques. Treating a patient from childhood to adulthood is the ultimate opportunity for the dentist to play a vital role in advancing the health and wellness of another human being.

Usage of Behavior Guidance Techniques Differs by Provider and Practice Characteristics.

PURPOSE: The purpose of this study was to determine provider and practice characteristics influencing usage of behavior guidance techniques (BGTs). METHODS: A 24-item survey was emailed to 4,117 active AAPD members to identify factors influencing pediatric dentists' use of BGTs. RESULTS: A total of 1,081 surveys were returned, for a 26 percent response rate. The mean age of respondents was 44.7 years old, with recent graduates comprising the largest group (30.5 percent). Usage of voice control, nitrous oxide, sedation, and general anesthesia (GA) differed significantly, according to experience. Respondents with at least 30 years of experience reported changes in usage. Tell-show-do, nitrous oxide, oral sedation, and passive restraint were significantly more frequent among female respondents. Parental absence, oral sedation, and GA were significantly more frequent in respondents serving low income populations. Parental absence, pharmacologic techniques, and restraint were significantly different in frequencies among the different geographic regions. CONCLUSIONS: Usage of behavior guidance techniques has changed over the past three decades, with more recent graduates and experienced practitioners now emphasizing pharmacologic techniques. More assertive behavior guidance techniques are used more frequently by experienced providers and those in practices in the southwest or serving lower income populations. Pharmacologic techniques are used at a higher prevalence by recent graduates and providers who are female or serving lower income populations.

Intrapulpal Temperature Rise During Light Activation of Restorative Composites in a Primary Molar.

PURPOSE: To investigate intrapulpal temperature rise in a primary molar during light activation of a composite restoration to determine if clinically significant pulpal temperatures (greater than 5.5 degrees Celsius) were reached. METHODS: Restorative composites (EsthetX HD, Filtek Supreme Ultra, Filtek Bulk Fill) were placed into a primary molar with occlusal preparation (1.5 mm depth; remaining pulpal floor thickness one mm). The pulp was extirpated through a root access to place a thermocouple against the pulpal roof. Temperature changes were recorded during composite restoration light polymerization with three curing lights (one quartz-tungsten-halogen, two LEDs). Sample size was 10. Samples received additional irradiation to assure complete polymerization, followed by a third irradiation for calculating the exothermic heat contribution (subtracting third irradiation temperatures from first irradiation temperatures). Cured restorations were removed after each test, and the tooth was reused. Results were analyzed with Kruskal-Wallis (α =0.05). RESULTS: Type of curing light and composite material affected the intrapulpal temperature rise, which was up to five degrees Celsius for one combination of LED-composite. CONCLUSIONS: Clinicians should be aware of the potential for clinically significant intrapulpal temperature rises when light-activating composite restorations in a primary molar with a moderately deep cavity.

Clinical Evaluation and Parental Satisfaction with Pediatric Zirconia Anterior Crowns.

PURPOSE: The purpose of this study was to evaluate the clinical success of and parental satisfaction with anterior pediatric zirconia crowns. METHODS: A retrospective analysis of maxillary anterior pediatric zirconia crowns was performed. Crowns were evaluated for retention, gingival health, color match, contour, marginal integrity, and opposing tooth wear. Parental satisfaction regarding the esthetics of the crowns and parental perception of the impact of treatment on the child's appearance and oral health were evaluated by questionnaire. RESULTS: Fifty-seven crowns were evaluated in 18 children. Eight teeth were lost to exfoliation, three were extracted due to pathology, and two crowns debonded, leaving 44 available for examination. The average crown age at time of examination was 20.8 months. Sixteen crowns (36 percent) displayed gingival inflammation and color mismatch. No recurrent caries or opposing tooth wear was noted. Parents reported high satisfaction with the color, size, and shape of the crowns. The majority of parents reported that crowns improved the appearance and oral health of their child (78 percent and 83 percent, respectively). Eight-nine percent of parents reported that they would highly recommend these crowns. CONCLUSIONS: Zirconia crowns are clinically acceptable restorations in the primary maxillary anterior dentition. Parental satisfaction with zirconia crowns is high.

Comparison of Amount of Primary Tooth Reduction Required for Anterior and Posterior Zirconia and Stainless Steel Crowns.

PURPOSE: To determine if aggressiveness of primary tooth preparation varied among different brands of zirconia and stainless steel (SSC) crowns. METHODS: One hundred primary typodont teeth were divided into five groups (10 posterior and 10 anterior) and assigned to: Cheng Crowns (CC); EZ Pedo (EZP); Kinder Krowns (KKZ); NuSmile (NSZ); and SSC. Teeth were prepared, and assigned crowns were fitted. Teeth were weighed prior to and after preparation. Weight changes served as a surrogate measure of tooth reduction. RESULTS: Analysis of variance showed a significant difference in tooth reduction among brand/type for both the anterior and posterior. Tukey's honest significant difference test (HSD), when applied to anterior data, revealed that SSCs required significantly less tooth removal compared to the composite of the four zirconia brands, which showed no significant difference among them. Tukey's HSD test, applied to posterior data, revealed that CC required significantly greater removal of crown structure, while EZP, KKZ, and NSZ were statistically equivalent, and SSCs required significantly less removal. CONCLUSIONS: Zirconia crowns required more tooth reduction than stainless steel crowns for primary anterior and posterior teeth. Tooth reduction for anterior zirconia crowns was equivalent among brands. For posterior teeth, reduction for three brands (EZ Pedo, Kinder Krowns, NuSmile) did not differ, while Cheng Crowns required more reduction.

Can Increasing the Manufacturer's Recommended Shortest Curing Time of High-intensity Light-emitting Diodes Adequately Cure Sealants?

PURPOSE: To investigate sealant depth of cure after increasing the curing times of high-intensity light-emitting diode units (LEDs). METHODS: Three sealants (opaque-unfilled, opaque-filled, and clear-filled) were light cured in a covered-slot mold with: (a) three LEDs (VALO, SmartLite, Fusion) for six to 15 seconds; and (b) a quartz-tungsten halogen (QTH) light for 40 seconds as a control (N=10). Twenty-four hours after light curing, microhardness was measured at the sealant surface and through the depth at 0.5 mm increments. Results were analyzed via analysis of variance followed by the Student-Newman-Keuls test (significance level 0.05). RESULTS: The opaque-filled and clear-filled sealants cured with VALO for six or nine seconds had hardness values that were statistically equivalent to or better than the QTH to a depth of 1.5 mm. Using Fusion for 10 seconds (exposure limit) did not adequately cure the three sealants beyond one mm. SmartLite at 15 seconds (maximum exposure period without overheating) did not adequately cure the sealants beyond 0.5 mm. CONCLUSIONS: Among the tested high-intensity LEDs, only VALO at double or triple the manufacturers' shortest curing time (six or nine seconds) provided adequate curing of opaque-filled and clear-filled sealants at 1.5 mm depth compared to the 40-second QTH light.