The impact of sealer extrusion on endodontic outcome: A systematic review with meta-analysis.

The purpose of this systematic review was to qualify and quantify the evidence regarding the effect of extruded sealers on endodontic treatment outcomes. Two reviewers independently conducted a comprehensive literature search. The EMBASE, MEDLINE, Cochrane, PubMed databases, bibliographies, grey literature of all relevant articles and textbooks were searched. Six articles met the inclusion criteria with a moderate risk of bias and were analysed for qualitative and quantitative synthesis. There was moderate-certainty evidence that sealer extrusion can contribute to non-healing outcomes, 95% confidence interval, risk ratio 1.32 (1.12-1.54) and P < 0.05. This indicates that the current authors are somewhat confident the true effect is likely to be close to the estimate of the effect. Sealer extrusion had a 32% higher risk of contributing to a non-healing outcome than no extrusion. However, well-conducted research would need to be conducted to confirm this causality claim.

The clinical effects of laser preparation of tooth surfaces for fissure sealants placement: a systematic review and meta-analysis.

BACKGROUND: This systematic review aimed to assess the clinical effects of laser preparation compared to other types of chemical or mechanical preparation of tooth surfaces used in fissure sealant placement. METHODS: A systematic literature search was conducted up to January 2019, through Pubmed, Scopus, Medline/EMBASE via OVID and the Cochrane library. Only randomized clinical trials were included. RESULTS: Five studies were included in the systematic review and three were included in the meta-analysis. All the studies used acid-etching as a comparator to lasers. All the included studies were rated as having an overall high risk of bias introduced by performance bias. Three studies assessed the clinical effects of fissure sealants placed by acid or laser etching, one compared acid etching versus laser combined with acid etching and one investigated the influence of lasers on the objective and subjective parameters of stress during sealant application in children. The meta-analysis showed no significant difference between laser preparation and conventional acid-etching preparation at 3- (P = 0.08), 6- (P = 0.49), and 12-month (P = 0.87) follow-ups. One study reported that laser preparation as an adjunct to acid-etching enhanced the retention rate. No significant difference in the incidence of caries was reported. And no significant differences were found in heart rates, oxygen saturation or degree of the patient dental anxiety between acid-etching and laser preparation. CONCLUSION: The present limited evidence suggests that lasers could be an effective pretreatment method. The retention rate was similar to that of conventional acid etching. However, the included studies had an overall high risk of bias and more rigorously designed research is needed.

Wear profile of canal wall surfaces and bond strength of endodontic sealers after in situ acid challenge.

AIM: To evaluate the wear of root wall surfaces, the bond strength of sealers to dentine and the demineralization around root filling materials after canals were exposed to acid challenge in situ. METHODOLOGY: Eighty-seven roots of mandibular incisors were selected. Thirty-two were used in the laboratory bond strength study (n = 8), and 55 in the in situ study (n = 11). Root canals were prepared biomechanically and then filled with gutta-percha and AH Plus, MTA Fillapex, Sealapex or Endofill. For 14 days, 11 participants used intra-oral devices with five sterilized roots (four experimental and one control - only canal prepared). Drops of sucrose were dripped onto roots allowing the accumulation of biofilm on canal surfaces. Roots were removed, sectioned and analysed for the following: bond strength of filling material using a push-out test and also wear profile and dentine demineralization using confocal microscopy. Bond strength (MPa) was evaluated by two-way anova and Tukey test (α = 0.05), and wear profile was assessed by Kruskal-Wallis and t-tests (α = 0.05). RESULTS: AH Plus had the highest bond strength values. Intermediate results were found in roots with MTA Fillapex and Endofill, whilst Sealapex had inferior results (P < 0.05). No significant differences were found amongst root thirds (P > 0.05). For wear profile, samples were associated with degradation of the filling materials after exposure to the oral environment (P < 0.05). Roots had signs of demineralization around the filling material when Sealapex and Endofill were used. CONCLUSIONS: Sealers were not able to prevent degradation of the adhesive interface and dentine. AH Plus and MTA Fillapex had superior bond strength to dentine and less intense demineralization around the root filling.

Use of Pit-and-Fissure Sealants.

BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits-and-fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the U.S. market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of non-cavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. Conclusions and practical implications: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians re-orient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.

Comparison of Microleakage of Class V Cavities restored with the Embrace WetBond Class V Composite Resin and Conventional Opallis Composite Resin.

PURPOSE: This study was undertaken to compare the micro-leakage of class V cavities restored with the newly introduced Embrace WetBond class V (EWC) composite resin and conventional Opallis composite resin. MATERIALS AND METHODS: In this in vitro study, class V cavities were prepared on 30 extracted bovine incisors, with the gingival floor and the coronal margin of the cavities 1 mm apical and coronal to the cementoenamel junction (CEJ) respectively. The cavities measured 3 mm in length, 2 mm in width, and 1.5 mm in depth. The teeth were randomly divided into two groups. In group I, the cavities were restored with Opallis composite resin in association with ExciTE adhesive system (total-etch); in group II, the EWC composite resin was used for restorations. After 500 thermocycling procedures, the teeth were immersed in 0.5% fuchsin solution for 24 hours. Then, the samples were placed within a polyester model and sectioned in the buccolingual direction. The samples were evaluated under a stereomicroscope at ×30 for the penetration of dye. The enamel and dentin margins were evaluated separately. To test ordinal results, we used nonparametric statistical methods. To find out whether each independent composite groups I and II came from the same populations, we used Mann-Whitney U test and to compare two related samples' coronal margin and gingival margin, Wilcoxon signed-rank test was used. RESULTS: There was significantly more microleakage in group II at both the enamel and dentin margins (coronal margin: p = 0.04; gingival margin: p = 0.21). In both groups, microleakage at gingival margins was significantly higher than that at coronal margins (group I: p = 0.008; group II: p = 0.26). CONCLUSION: Despite the high speed and the short process of restoration with Embrace WetBond, it is not a reliable restorative material for class V cavities due to its inadequate marginal seal.

Use of pit-and-fissure sealants

BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits-and-fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the U.S. market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of non-cavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. Conclusions and practical implications: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians re-orient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents

Performance of pit and fissure sealants according to tooth characteristics: A systematic review and meta-analysis.

OBJECTIVE: Aim of this systematic review was to assess the clinical performance of sealants on various teeth in an evidence-based manner. SOURCES: Five databases were searched from inception to February 2017. DATA: Randomized clinical studies on humans. METHODS: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, Paule-Mandel random-effects meta-analyses of Relative Risks (RRs) and their 95% confidence intervals (CIs) were calculated. RESULTS: A total of 16 randomized clinical trials with 2778 patients (male/female 49.1%/50.9%) and an average age of 8.4 years were included. No significant difference in either caries incidence of sealed teeth or sealant retention could be found according to (i) mouth side (right versus left), (ii) jaw (upper versus lower), (iii) and tooth type (1st permanent molar versus 2nd permanent molar/1st permanent molar versus 2nd deciduous molar/1st deciduous molar versus 2nd deciduous molar), based on evidence of very low to low quality. On the other side, compared to 1st permanent molars, sealed premolars were significantly less likely to develop caries (3 trials; RR=0.12; 95% CI=0.03 to 0.44; P=0.001) and less likely to experience loss of the sealant (5 trials; RR=0.33; 95% CI=0.20 to 0.54; P=0.001), both based on low to moderate quality evidence. CONCLUSIONS: The performance of pit and fissure sealants does not seem to be negatively affected by mouth side, jaw, and tooth type, apart from the exception of a favorable retention on premolars. CLINICAL SIGNIFICANCE: Based on existing evidence, pit and fissure sealants can be effectively applied on any deciduous or permanent posterior teeth without adverse effects on their clinical performance.

Pit and fissure sealants for preventing dental decay in permanent teeth.

BACKGROUND: Dental sealants were introduced in the 1960s to help prevent dental caries, mainly in the pits and fissures of occlusal tooth surfaces. Sealants act to prevent bacteria growth that can lead to dental decay. Evidence suggests that fissure sealants are effective in preventing caries in children and adolescents compared to no sealants. Effectiveness may, however, be related to caries incidence level of the population. This is an update of a review published in 2004, 2008 and 2013. OBJECTIVES: To compare the effects of different types of fissure sealants in preventing caries in occlusal surfaces of permanent teeth in children and adolescents. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched: Cochrane Oral Health's Trials Register (to 3 August 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 7), MEDLINE Ovid (1946 to 3 August 2016), and Embase Ovid (1980 to 3 August 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 3 August 2016. No restrictions were placed on language or date of publication. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing sealants with no sealant or a different type of sealant material for preventing caries of occlusal surfaces of premolar or molar teeth in children and adolescents aged up to 20 years. Studies required at least 12 months follow-up. We excluded studies that compared compomers to resins/composites. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We presented outcomes for caries or no caries on occlusal surfaces of permanent molar teeth as odds ratio (OR) or risk ratio (RR). We used mean difference (MD) for mean caries increment. All measures were presented with 95% confidence intervals (CI). We conducted meta-analyses using a random-effects model for comparisons where there were more than three trials; otherwise we used the fixed-effect model. We used GRADE methods to assess evidence quality. MAIN RESULTS: We included 38 trials that involved a total of 7924 children; seven trials were new for this update (1693 participants). Fifteen trials evaluated the effects of resin-based sealant versus no sealant (3620 participants in 14 studies plus 575 tooth pairs in one study); three trials with evaluated glass ionomer sealant versus no sealant (905 participants); and 24 trials evaluated one type of sealant versus another (4146 participants). Children were aged from 5 to 16 years. Trials rarely reported background exposure to fluoride of trial participants or baseline caries prevalence. Resin-based sealant versus no sealant: second-, third- and fourth-generation resin-based sealants prevented caries in first permanent molars in children aged 5 to 10 years (at 24 months follow-up: OR 0.12, 95% CI 0.08 to 0.19, 7 trials (5 published in the 1970s; 2 in the 2010s), 1548 children randomised, 1322 children evaluated; moderate-quality evidence). If we were to assume that 16% of the control tooth surfaces were decayed during 24 months of follow-up (160 carious teeth per 1000), then applying a resin-based sealant would reduce the proportion of carious surfaces to 5.2% (95% CI 3.13% to 7.37%). Similarly, assuming that 40% of control tooth surfaces were decayed (400 carious teeth per 1000), then applying a resin-based sealant would reduce the proportion of carious surfaces to 6.25% (95% CI 3.84% to 9.63%). If 70% of control tooth surfaces were decayed, there would be 19% decayed surfaces in the sealant group (95% CI 12.3% to 27.2%). This caries-preventive effect was maintained at longer follow-up but evidence quality and quantity was reduced (e.g. at 48 to 54 months of follow-up: OR 0.21, 95% CI 0.16 to 0.28, 4 trials, 482 children evaluated; RR 0.24, 95% CI 0.12 to 0.45, 203 children evaluated). Although studies were generally well conducted, we assessed blinding of outcome assessment for caries at high risk of bias for all trials (blinding of outcome assessment is not possible in sealant studies because outcome assessors can see and identify sealant). Glass ionomer sealant versus no sealant: was evaluated by three studies. Results at 24 months were inconclusive (very low-quality evidence). One sealant versus another sealant: the relative effectiveness of different types of sealants is unknown (very low-quality evidence). We included 24 trials that directly compared two different sealant materials. Comparisons varied in terms of types of sealant assessed, outcome measures chosen and duration of follow-up. Adverse events: only four trials assessed adverse events. No adverse events were reported. AUTHORS' CONCLUSIONS: Resin-based sealants applied on occlusal surfaces of permanent molars are effective for preventing caries in children and adolescents. Our review found moderate-quality evidence that resin-based sealants reduced caries by between 11% and 51% compared to no sealant, when measured at 24 months. Similar benefit was seen at timepoints up to 48 months; after longer follow-up, the quantity and quality of evidence was reduced. There was insufficient evidence to judge the effectiveness of glass ionomer sealant or the relative effectiveness of different types of sealants. Information on adverse effects was limited but none occurred where this was reported. Further research with long follow-up is needed.

Spectrophotometric analysis of crown discoloration induced by two different sealers: An In vitro study.

CONTEXT: Endodontic materials have been assessed with regards to their potential for dental staining. AIMS: To evaluate the coronal discoloration effect of Apexit Plus and Resino Seal in mandibular premolars using spectrophotometer. SETTINGS AND DESIGN: The study design was original research. MATERIALS AND METHODS: Forty human single-rooted mandibular first premolar teeth were selected for the study. They were divided into four groups of ten specimens each. Group 1 - Apexit Plus sealer, Group 2 - Resino Seal sealer, Group 3 - positive control (Blood), and Group 4 - negative control (distilled water). Teeth were resected 3 mm below at cementoenamel junction. In all samples, access cavities were prepared, instrumented, and irrigated. Sealers were mixed and placed into the pulp chamber through cervical access and control groups were filled with blood and distilled water. Coronal orifices were sealed using self-cure glass ionomer cement. Samples were analyzed using spectrophotometer to determine the discoloration in each group at 10, 17, and 24 days interval. STATISTICAL ANALYSIS USED: Statistical analysis used Wilcoxon signed-rank test. RESULTS: All sealers used in the present study caused a progressive coronal discoloration over a time period of 17-24 days. There was statistically significant difference between resino seal sealer and apexit plus sealer , with resino seal showing greater coronal discoloration. CONCLUSION: Resino seal sealer has greater potential to cause discoloration of crown as compared to apexit plus sealer over a period of time.

Microleakage and shear bond strength of a new sealant containing prereacted glass ionomer particles.

A new fluoride-releasing sealant system is claimed to allow easier and faster placement while providing high bond strengths without the need for phosphoric acid etching. A study was designed to compare the microleakage and shear bond strength of a self-etching, Giomer-based sealant system with those of a traditional resin sealant. Group 1 received traditional sealant applied after use of a 35% phosphoric acid etchant; group 2 received Giomer sealant after use of a self-etching primer; and group 3 received Giomer sealant after the addition of an initial phosphoric acid etching step and placement of the primer. The sealants were placed in the occlusal pits and fissures of extracted human third molars, thermocycled, placed in dye, and sectioned. The extent of microleakage (dye penetration) was expressed as a percentage of the cross-sectional length of the sealed interface. The sealants were also bonded to the facial enamel of bovine incisors. Specimens were thermocycled and tested in shear mode in a universal testing machine. The new self-etching sealant demonstrated significantly greater microleakage (P < 0.017) and lower bond strength (P < 0.05) than both the traditional sealant system and the new system when placed with phosphoric acid etchant. Phosphoric acid etching significantly improved the shear bond strength and reduced the microleakage of the new sealant.

Evidence-based clinical practice guideline for the use of pit-and-fissure sealants

"BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits-and-fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the U.S. market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of non-cavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. Conclusions and practical implications: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians re-orient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents."

Effect of sealant agents on the color stability and surface roughness of nanohybrid composite resins.

STATEMENT OF PROBLEM: The effect of sealant agents on the surface roughness and color stability of nanohybrid composite resins is unknown. PURPOSE: The purpose of this in vitro study was to evaluate the effect of sealant agents on the surface roughness and color stability of 4 nanohybrid composite resin materials. MATERIAL AND METHODS: Forty disks (10×2 mm) were fabricated for each nanohybrid composite resin material (Z-550, Tetric EvoCeram, Clearfill Majesty, Ice) (N=160) and divided into 4 surface treatment groups: 1 conventional polishing (control) and 3 different sealant agent (Palaseal, Optiglaze, BisCover) coupling groups (n=10). The specimens were thermocycled, and surface roughness (Ra) values were obtained with a profilometer. Scanning electron microscope images were also recorded. CIELab color parameters of each specimen were measured with a spectrophotometer before and after 7 days of storage in a coffee solution. Color differences were calculated by the CIEDE 2000 (ΔE00) formula. The data were statistically analyzed by 2-way ANOVA and by the Tukey HSD test (α=.05). RESULTS: The surface treatment technique significantly affected the Ra values of the composite resins tested (P<.001). The interaction between the surface treatment technique and composite resin material was also significant for ΔE00 values (P<.05). Within the composite resin groups, significant decreases in Ra were observed only for the Palaseal agent coupled composite resin groups (except Ice) compared with the control groups (P<.05). Scanning electron microscope images revealed rougher surfaces with conventionally polished groups compared with test groups. Conventionally polished groups had the highest ΔE00 (3.09 to 3.49) values for each composite resin group, except for BisCover applied Clearfill Majesty (P<.05). Within the composite resin groups, significant differences were observed between the color change seen with BisCover and other sealants for Clearfill Majesty composite resin (P<.05). CONCLUSIONS: Using Palaseal agent on all tested composite resins except for Ice produced smoother surfaces. All surface sealant agents provided less discoloration of nanohybrid composite resins after coffee staining compared with conventional polishing except for BisCover applied Clearfill Majesty composite resin.

Evidence-based Clinical Practice Guideline for the Use of Pit-and-Fissure Sealants.

BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits-and-fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the U.S. market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of non-cavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. Conclusions and practical implications: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians re-orient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.

In-vivo durability of a fluoride-releasing sealant (OpalSeal) for protection against white-spot lesion formation in orthodontic patients.

BACKGROUND: Sealant application during fixed appliances orthodontic treatment for enamel protection is common, however, reliable data on its durability in vivo are rare. OBJECTIVE: This study aims at assessing the durability of a sealant (OpalSeal, Ultradent) for protection against white-spot lesion formation in orthodontic patients over 26 weeks in vivo, taking into account the provision or absence of an adequate oral hygiene. We tested the null hypothesis of (1) no significant abatement of the sealant after 26 weeks in fixed orthodontic treatment compared to baseline, and (2) no significant influence of the factor of brushing and oral hygiene (as screened by approximal plaque index, API) on the abatement of the sealant. METHODS: Integrity and abatement of OpalSeal applicated directly following bracketing was assessed in thirty-six consecutive patients (n(teeth) = 796) undergoing orthodontic treatment with fixed appliances (male/female 12/24; mean age/SD 14.4/1.33 Y). Assessment of the fluorescing sealant preservation was by a black-light lamp, using a classification that was concepted in analogy to the ARI index: (3, sealant completely preserved; 2= > 50% preserved; 1 = <50%; 0 = no sealant observable) immediately following application (Baseline, T0), after 2 (T1), 8 (T2), 14 (T3), 20 (T4) and 26 weeks (T5). API was assessed at T0 and T1. Statistical analysis was by non-parametric repeated measures ANOVA (α = 5%, power >80%). RESULTS: At baseline, 43.4% of teeth had a positive API. Oral hygiene deteriorated after bracketing (T1, 53%) significantly. Null hypothesis (1) was rejected, while (2) was accepted: Mean values of both the well brushed and non-brushed anterior teeth undercut the score "1" at T3 (week 14). Despite a slightly better preservation of the sealer before and after T3 in not-sufficiently brushed (API-positive) teeth, this finding was statistically not significant. CONCLUSION: One single application of OpalSeal is unlikely to last throughout the entire fixed appliance treatment stage. On average, re-application of the sealant can be expected to be necessary after 3.5 months (week 14) in treatment.

New proposal of silver diamine fluoride use in arresting approximal caries: study protocol for a randomized controlled trial.

BACKGROUND: Approximal surfaces are a challenge to caries lesions control. Silver diamine fluoride (SDF) is a simple,low-cost and promisor intervention for arresting caries lesions, but it has never been tested on approximal surfaces. Our aim is to evaluate the efficacy and cost-efficacy of SDF in arresting initial lesions compared to resin infiltration and exclusively flossing (control group). Our second aim is to assess discomfort and satisfaction regarding interventions. METHODS/DESIGN: This is a randomized clinical trial, double-blinded, placebo-controlled study. Children/adolescents presenting at least one approximal initial caries lesion in primary molars/permanent premolars and molars will be included. Surfaces with advanced dentine lesions identified by radiography and participants who refuse to participate or present negative behaviors will be excluded. A minimum sample size of 504 surfaces will be required for each subgroup. Individuals will be randomly allocated in three groups of interventions: SDF, resin infiltration, and control group. Depending on the allocation, the patients will receive the active treatment and respective placebo therapies. All patients will be oriented to daily flossing the included surfaces. Our primary outcome will be caries progression by clinical and radiographic examinations. Appointments will be timed and costs of materials will be considered to calculate cost-efficacy. Patient discomfort will be assessed after interventions. Parent and patient satisfaction with the treatment will be collected after treatment and in the last follow-up visit. Individuals will be assessed at 1 and 3 months after treatment to evaluate dental biofilm and at 6, 12, and 24 months to assess caries progression by visual examination and/or radiography. Multilevel analyses will be used to verify if the type of treatment influenced on the tested outcomes. Costs will be compared and analyses of cost-efficacy will be performed. Poisson analysis will test the association between intervention and reported discomfort and satisfaction. DISCUSSION: Our hypothesis is that SDF is the most cost-efficacious option from all tested interventions. If our hypothesis is confirmed, the use of SDF in private and public contexts could represent an easier and effective option in the treatment of enamel approximal caries in children/adolescents. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01477385), Initial release: 11/16/2011: last update: 06/02/2014.

Acceptability of fissure sealants from the child's perspective.

AIM: To seek children's opinions about the acceptability of resin fissure sealant placement. STUDY DESIGN: Service evaluation using a child-centred questionnaire issued to a prospective sample of consecutive hospital patients.Method Questionnaires were issued to children, aged 3 to 16 years, immediately after resin fissure sealant placement in the Paediatric Dentistry Department in Sheffield. Participants used a three-point faces scale for positive, neutral and negative responses, arranged as a Likert scale with minimal text, to rate their treatment experiences and satisfaction with the dental visit. RESULTS: Two hundred questionnaires were returned. Overall, 96% (n = 191) recorded a positive or neutral response for the ease at which they coped with the procedure, with most children positive about having fissure sealants placed again (66%; n = 132). Further analysis demonstrated that children who had fissure sealants on a previous occasion found them easier than those having them for the first time (p <0.05, chi-squared test). Almost half of all participants where ambivalent about the taste and feeling (46%; n = 92 and 55%; n = 110 respectively). The vast majority of children were satisfied with the explanations provided by their operator. CONCLUSION: Most participants found having resin fissure sealants placed an overall acceptable procedure, with patient acceptance improving with increased treatment experience.

Biological evaluation of enamel sealants in an organotypic model of the human gingiva.

OBJECTIVES: Various sealant materials have been suggested to decrease decalcification during orthodontic treatment. However, only a few in vitro studies on the cytotoxicity of resinous pit and fissure sealants have been published, and to the best of our knowledge no similar studies are available for the enamel sealants used in orthodontics. Therefore, we aimed to characterize the possible adverse effects of enamel sealants, especially on the gingival epithelium. METHODS: Organotypic cultures of the human gingival mucosa were used to assess the possible impact of six enamel sealants. Differentiation and apoptosis were determined by immunofluorescent staining. The pro-inflammatory cytokines IL-1ß and IL-6 were quantified by ELISA. Cytotoxicity was measured using MTS assays in monolayer cultures of human gingival fibroblasts. Leaching of monomers from enamel sealants was quantified using HPLC. RESULTS: The differentiation of the organotypic gingival mucosa remained unaffected. All under-cured and several standard-cured sealants (Light Bond™ Sealant, Light Bond™ Filled Sealant, and L.E.D. Pro Seal®) significantly induced apoptosis in the organotypic model. Light Bond™ Sealant, Light Bond™ Filled Sealant, and L.E.D. Pro Seal® caused a significant induction of pro-inflammatory cytokines. Reducing curing time had an influence on cytotoxicity in monolayer cultures of primary human oral cells. All resin-based sealants leached monomers. SIGNIFICANCE: Enamel sealants might exert adverse effects on the gingival epithelium. Due to the vicinity of the enamel sealant to the gingival epithelium, and the large surface area of applied sealants, these materials should be carefully applied and sufficiently cured.

Dental composite materials and renal function in children.

OBJECTIVE: To examine whether greater exposure to resin-based composite materials, which may intra-orally release bisphenol A (BPA), is associated with worse renal function outcomes in children. DESIGN: Prospective multi-centre study. SETTING: Community health dental clinics in Boston and Maine from 1997-2005.Subjects and methods Five hundred and thirty-four New England Children's Amalgam Trial participants aged six to ten years were randomised to treatment with amalgam or resin-based composite restorations over five years of follow-up. INTERVENTIONS: Restorations were placed according to treatment arm, and sealants placed per standard of care. Cumulative composite exposure was calculated using surface-years (each treated surface weighted by number years present). MAIN OUTCOME MEASURES: Urinary excretion of albumin, gamma-glutamyl transpeptidase (gamma-GT), and N-acetyl-ß-D-glucosaminidase (NAG) were available for 417 children. RESULTS: Analysis of covariance showed no association between exposure to dental composites, polyacid-modified compomer, or flowable composite dental sealants and preventative resin restorations with levels of renal function. There was no association between composite materials and thresholds indicating renal damage in logistic regression models. CONCLUSIONS: This study found no harmful associations between dental composite materials and renal function in children. Therefore, concerns about renal function need not be a consideration in the choice of dental restoration material or placement of preventative dental sealants.

The effect of different enamel surface treatments on microleakage of fissure sealants.

OBJECTIVE: The aim of this study was to evaluate the effects of different techniques of surface treatment on the microleakage of fissure sealants in permanent molar teeth in vitro. MATERIALS AND METHODS: 96 extracted impacted human third molars were randomly divided into 8 surface treatment groups (n=12/group) as 1. Er: YAG laser ; (Fidelis II, Fotona, Ljubljana, Slovenia) (125 mj, 20Hz) ; 2. Er: YAG laser + 37% H3PO4 (15s) ; 3. ER: AG laser + 37% H3PO4+Prime&Bond NT ; 4. Er: YAG laser + G Bond ; 5. Er: YAG laser + Prime&Bond NT ; 6. 37% H3PO4 ; 7. 37% H3PO4 + Prime&Bond NT ; 8. G Bond. Sealant material (Clinpro, 3M ESPE, Seefeld, Germany), was applied into the fissures and light-cured for 20s with LED (Bluephase C5, Ivoclar-Vivadent, Schaan, Liechtenstein). Specimens were subjected to thermocycling (1000×, 5-55°C, dwell time: 15s) and immersed in 0.5% basic fuchsin solution for 24h at 37°C. The samples were sectioned and scored on a 3 point rating scale using a light microscope with a magnification of ×20. One-way analysis of variance was used to analyze data. Multiple comparisons were analyzed using Bonferroni test (p=0.05). RESULTS: Er:YAG laser showed the highest microleakage scores whereas Er YAG laser + 37% H3PO4 showed the lowest. Although 37% H3PO4 group showed higher scores than Er:YAG laser + 37% H3PO4, the difference was not statistically significant. CONCLUSION: Etching fissures with phosphoric acid is sufficient prior to fissure sealant application.

Biology and cytotoxicity of dental materials: an in vitro study.

OBJECTIVE: The purpose of the experiment was to determine the degree of biocompatibility of a sealer (RO, laboratory made product) dental material in terms of cytotoxicity and animal tests. MATERIALS AND METHODS: In the present study, the biological compatibility of eight experimental composite materials was examined by in vitro methods. The bio-composites used for the cytotoxicity test were placed into direct contact with normal human fibroblasts in a cell-culture dish. After fibroblast bioassay was performed, a duplicate sample of biomaterial was placed in each well, and then the fibroblasts were incubated for 48 hours at 37°C and 5% carbon dioxide. Local reactions after the implantation of the material regarding preclinical evaluation have been carried out within the Biobase Laboratory of the "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. The biocompatibility was studied using the tolerance test by the subcutaneous and intramuscular implantation of the cured specimens. RESULTS: The sealant C3 scored the highest value to the cell viability. The results of the present study showed that different dental materials had different effects on cells. The resin monomer TEGDMA, present in the sealer's composition, increased the amount of intracellular reactive oxygen species. Resin-based composites are cytotoxic before polymerization and immediately thereafter, whereas already set specimens cause almost no reaction. The test of tolerance showed that the composite materials do not contain any toxic, irritant substances or destructive ones for the living cells or tissues. CONCLUSIONS: The tests with experimental composite materials revealed that they are not cytotoxic for the living cells, in all versions of the materials used. All the samples of composite materials have maintained their integrity during the experiment, allowing the testing together with the embedded cells, which proved good viability, so they are suitable for dentistry use.