Deterioration of anterior resin composite restorations in moderate to severe tooth wear patients: 3-year results.

OBJECTIVES: Deterioration in anterior resin composite restorations placed in tooth wear patients was investigated after 36 months. MATERIALS AND METHODS: Data collected prospectively for 47 participants of the Radboud Tooth Wear Project were used (41 ± 8 years, 90% male, n = 270 restorations). Restorations were individually evaluated using intraoral photographs and 3D scans to rate modified FDI scores and to record the presence of degradation features. Four groups with distinct combinations of composites and techniques were assessed, and multivariable logistic regression models were used to analyze the data (p < 0.05). RESULTS: For all groups together, early degradation signs were present at 1 month: irregularities (41.5%) and ditching (7.4%) were observed at the surface and adhesive interfaces. The frequency of irregularities decreased in the 36-month evaluation (37%), but ditching (12.2%) and fractures (10.7%) were more common. The most frequent deterioration (based on photographs) was observed for staining (44%) and loss of luster (31%). In 3D scans, the most frequent were for wear (25%), marginal adaptation (24%), and the presence of irregularities (19%). Canines had 5.5 times more chances of deterioration by ditching than incisors (p < 0.001). The differences between composites and restorative techniques were minor. CONCLUSIONS: A continuous degradation process of restorations placed in tooth wear patients was observed in anterior teeth restored with different composites, with a progression of the deterioration over 36 months. CLINICAL RELEVANCE: When placing anterior resin composite restorations in tooth wear patients, it could be important to establish realistic expectations and the need for checkup appointments.

Dental caries in three-year-old preschool children in Lima, Peru assessed according to the CAST instrument.

The aim of this study was to determine the caries situation of three-year-old preschool children residing in low socioeconomic status districts in Lima, Peru. The study is a crosssectional analysis of the caries situation of suburban areas of Lima. A stratified sampling procedure by geographical distribution, considering healthcare centers with a motherand- child health clinic and surrounding preschools as factors, identified 45 randomly selected preschools, of which 17 accepted to participate. Children from 3-year-old classrooms were examined by two independent calibrated dentists using the Caries Assessment Spectrum and Treatment (CAST) instrument at their premises using artificial light, sterile examination mirrors and gauze for drying each tooth before evaluation. ANOVA and the Tamhane method were used to analyze the data. 308 children, mean age 3.4 years (min: 3 years; max: 3 years, 7 months), were examined. The sample prevalence of enamel and dentine carious lesions (CAST code 3-7) was 91.2% while the prevalence of dentine carious lesions (CAST code 4-7) was 58.8%. The mean number of teeth with cavities that had reached the pulp and those that had an abscess or fistula were 2.0% and 0.5% respectively. The majority of enamel and dentine carious lesions were observed in molars. The CAST severity score was 7.0. Mean examination time was 57 seconds. The burden of dental caries of the children at this young age was high.

El objetivo del presente estudio fue determinar la prevalencia de caries dental en niños en edad preescolar de 3 años residentes en áreas suburbanas de Lima, Perú. Se trata de un análisis transversal de la situación de caries de áreas periféricas de Lima. Un procedimiento de muestreo estratificado por distribución geográfica consideraba a los centros de salud materno-infantiles y centros educativos preescolares de la jurisdicción como factores, identificando 45 centros prescolares aleatoriamente, de los cuales 17 aceptaron la invitación para participar del presente estudio. Dos odontólogas independientes, calibradas examinaron a los niños de las aulas de 3 años utilizando el instrumento Caries Assessment Spectrum and Treatment (CAST) en las instalaciones de cada jardín de infancia, utilizando luz artificial, instrumental estéril y gasas para el secado de las superficies a evaluar. Los datos fueron analizados utilizando ANOVA y el método Tamhane. Se evaluaron 308 niños, quienes tenían una edad media de 3.4 años (min: 3 años; max: 3 años, 7 meses). La prevalencia de lesiones de caries de esmalte y dentina (código CAST 3-7) fue del 91,2%, mientras que la prevalencia de lesiones de caries en dentina (código CAST 4-7) fue de 58,8%. El número promedio de dientes afectados por caries dental con compromiso pulpar y que tenían un absceso o fístula fue de 2.0% y 0.5% respectivamente. La mayoría de las lesiones de caries en esmalte y dentina se observaron en los molares. La valoración de severidad CAST fue 7.0. El tiempo promedio de examinación fue de 57 segundos. La carga de la enfermedad caries dental a estas edades tan tempranas ya es alta en la infancia suburbana de Lima.

Dental caries in three-year-old preschool children in Lima, Peru assessed according to the CAST instrument / Caries dental en niños prescolares de 3 años en Lima-Perú evaluados con el instrumento CAST

ABSTRACT The aim of this study was to determine the caries situation of three-year-old preschool children residing in low socioeconomic status districts in Lima, Peru. The study is a crosssectional analysis of the caries situation of suburban areas of Lima. A stratified sampling procedure by geographical distribution, considering healthcare centers with a motherand- child health clinic and surrounding preschools as factors, identified 45 randomly selected preschools, of which 17 accepted to participate. Children from 3-year-old classrooms were examined by two independent calibrated dentists using the Caries Assessment Spectrum and Treatment (CAST) instrument at their premises using artificial light, sterile examination mirrors and gauze for drying each tooth before evaluation. ANOVA and the Tamhane method were used to analyze the data. 308 children, mean age 3.4 years (min: 3 years; max: 3 years, 7 months), were examined. The sample prevalence of enamel and dentine carious lesions (CAST code 3-7) was 91.2% while the prevalence of dentine carious lesions (CAST code 4-7) was 58.8%. The mean number of teeth with cavities that had reached the pulp and those that had an abscess or fistula were 2.0% and 0.5% respectively. The majority of enamel and dentine carious lesions were observed in molars. The CAST severity score was 7.0. Mean examination time was 57 seconds. The burden of dental caries of the children at this young age was high.

RESUMEN El objetivo del presente estudio fue determinar la prevalencia de caries dental en niños en edad preescolar de 3 años residentes en áreas suburbanas de Lima, Perú. Se trata de un análisis transversal de la situación de caries de áreas periféricas de Lima. Un procedimiento de muestreo estratificado por distribución geográfica consideraba a los centros de salud materno-infantiles y centros educativos preescolares de la jurisdicción como factores, identificando 45 centros prescolares aleatoriamente, de los cuales 17 aceptaron la invitación para participar del presente estudio. Dos odontólogas independientes, calibradas examinaron a los niños de las aulas de 3 años utilizando el instrumento Caries Assessment Spectrum and Treatment (CAST) en las instalaciones de cada jardín de infancia, utilizando luz artificial, instrumental estéril y gasas para el secado de las superficies a evaluar. Los datos fueron analizados utilizando ANOVA y el método Tamhane. Se evaluaron 308 niños, quienes tenían una edad media de 3.4 años (min: 3 años; max: 3 años, 7 meses). La prevalencia de lesiones de caries de esmalte y dentina (código CAST 3-7) fue del 91,2%, mientras que la prevalencia de lesiones de caries en dentina (código CAST 4-7) fue de 58,8%. El número promedio de dientes afectados por caries dental con compromiso pulpar y que tenían un absceso o fístula fue de 2.0% y 0.5% respectivamente. La mayoría de las lesiones de caries en esmalte y dentina se observaron en los molares. La valoración de severidad CAST fue 7.0. El tiempo promedio de examinación fue de 57 segundos. La carga de la enfermedad caries dental a estas edades tan tempranas ya es alta en la infancia suburbana de Lima.

Children's Oral Health-related Quality of Life (OHRQoL) Three Years after Implementation of Treatment Protocols for Managing Cavitated Carious Dentine Lesions.

PURPOSE: To assess children's oral health-related quality of life (OHRQoL) three years after implementation of three treatment protocols for managing cavitated carious dentine lesions in primary molars by parent proxy report with the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) and to assess the level of agreement between the children's self-reporting and the parents' reporting of the children's OHRQoL. MATERIALS AND METHODS: Schoolchildren aged 6 to 7 were included in a clinical trial that compared three treatment protocols for managing cavitated carious dentine lesions: CRT (Conventional Treatment); ART (Atraumatic Restorative Treatment) and UCT (Ultraconservative Treatment). Before treatment (baseline), the OHRQoL of 273 children was assessed by B-ECOHIS using the parents'/caregivers' proxy report. Three years later, 147 parents/caregivers filled in the questionnaire while the children, ages 9 to 10, were interviewed. The t-test and one-way ANOVA were used for statistical analysis. RESULTS: No difference was observed between treatment protocols in regard to the children's OHRQoL (p = 0.41). A significant reduction in the parent distress domain was observed when baseline and parents'/caretakers' responses after three years (p = 0.01) were compared. The level of agreement between the parents'/caregivers' and children's scores was low. Children scored lower on the impact of oral health on their quality of life than their parents/caregivers did (p < 0.0001). CONCLUSION: The use of UCT, a largely non-restorative protocol, leads to a perception of OHRQoL by parents/caregivers that is similar to the ART and CRT protocols after three years. Parent distress decreased over time. Children and parents/caregivers disagreed about children's OHRQoL.

Caries assessment spectrum treatment: the severity score.

OBJECTIVES: To appraise the feasibility of the caries assessment spectrum and treatment (CAST) severity score according to the formula (F) recommended in the CAST manual. METHODS: Data from an epidemiological survey of 680 schoolchildren (mean age ± standard deviation: 7.45 ± 0.91 years), living in a low-income area in Brasília, were used. The CAST instrument was used for assessing enamel carious lesions (CAST code = 3), dentine carious lesions (CAST codes = 4-7) and tooth loss from caries (CAST code = 8). RESULTS: The prevalence of carious lesions including enamel and dentine in both deciduous and permanent dentitions was 49.41% and 69.12%, respectively. Calculating the CAST severity score per child using F was unsatisfactory because of the undiscriminating weight given for each CAST code. Modification of weights according to the accepted levels of disease severity for individual CAST codes resulted in a new formula (F1), in which the weight given to cavitated dentine lesions was quadrupled in relation to that given to enamel carious lesions; this was different from F, in which the weight given to such lesions was twofold. F1 was able to categorise satisfactorily the study children into one of three levels of dental caries severity: mild (34.1%); moderate (29.5%); or severe (36.4%). CONCLUSION: According to the outcomes of the present appraisal, it was concluded that the numerical score provided by the CAST severity scores allows an overview of the severity of caries disease and the classification of individuals into mild, moderate or severe levels of dental caries when the new formula (F1) is used.

Survival of Restored Endodontically Treated Teeth in Relation to Periodontal Status.

The aim of the present study was to investigate the success and survival of restored endodontically treated teeth (ETT) in a general practice environment related to periodontal parameters. Data from 360 restored ETT treated between 2000 and 2011 were collected. Dates of interventions like restorations, repairs, replacements and extractions were recorded. Additionally, general information about patients and dentitions as well as periodontal status was recorded. Success was analyzed using Kaplan-Meier statistics and a multivariate Cox regression analysis was performed to assess variables influencing success and survival. After a mean observation time of 4.34 years (range 0.6 - 11.6 years), 19 teeth were extracted and 27 restorations needed repair or replacement. According to the Cox regression, increasing maximum pocket depth of the tooth resulted in a higher risk for failure (p=0.012). In conclusion, periodontal pocket depth was found to be a significant factor in the survival of restored ETT.

Survival of Restored Endodontically Treated Teeth in Relation to Periodontal Status

Abstract The aim of the present study was to investigate the success and survival of restored endodontically treated teeth (ETT) in a general practice environment related to periodontal parameters. Data from 360 restored ETT treated between 2000 and 2011 were collected. Dates of interventions like restorations, repairs, replacements and extractions were recorded. Additionally, general information about patients and dentitions as well as periodontal status was recorded. Success was analyzed using Kaplan-Meier statistics and a multivariate Cox regression analysis was performed to assess variables influencing success and survival. After a mean observation time of 4.34 years (range 0.6 - 11.6 years), 19 teeth were extracted and 27 restorations needed repair or replacement. According to the Cox regression, increasing maximum pocket depth of the tooth resulted in a higher risk for failure (p=0.012). In conclusion, periodontal pocket depth was found to be a significant factor in the survival of restored ETT.

Resumo O objetivo do presente estudo foi investigar a taxa de sucesso e de sobrevivência de dentes restaurados e tratados endodonticamente (DTE) em uma clínica privada e relacionar com índices periodontais. Dados de 360 restaurações realizadas em DTE realizadas entre 2000 e 2011 foram coletados. As datas das intervenções, como restaurações, reparos, substituições e extrações foram registradas. Ainda, informações gerais relacionadas aos pacientes, aos dentes envolvidos e ao estado periodontal foram também coletadas. A taxa de sucesso foi analisada utilizando o método estatístico Kaplan-Meier e uma análise multivariada do tipo regressão de Cox foi realizada para avaliar variáveis que influenciaram na taxa de sucesso e de sobrevivência. Depois de um período de observação médio de 4,34 anos (0,6-11,6 anos), 19 dentes foram extraídos e 27 restaurações precisaram de reparo ou substituição. De acordo com a regressão de Cox, o aumento na profundidade de bolsa periodontal do dente resulta em um maior risco de falha (p=0,012). Em conclusão, a profundidade de bolsa periodontal foi considerada como um fator significativo na sobrevivência de dentes restaurados e tratados endodonticamente.

Effectiveness of an oral health program for mothers and their infants.

BACKGROUND: The baby oral health program (bOHP) provides pregnant women and their future babies with oral care. AIM: To assess the bOHP effectiveness by comparing caries prevalence in infants enrolled and not enrolled in the oral health program (OHP). DESIGN: Mothers who had been invited to participate in the bOHP from 2006 to 2009 were contacted. Two groups were formed: 87 pairs of mothers and infants who effectively participated in the OHP (G1) and 107 pairs who did not (G2). Mothers and infants were given a dental examination. Socio-economic status (SES) and education level (EL) questionnaires were completed. t-tests and multivariate logistic regression were used in analyzing data. RESULTS: Statistically significant differences were observed in the mean age of mothers (G1 = 33.8 years; G2 = 35.6 years; P = 0.015) and mean decayed, missed and filled surface (DMFS) score (G1 = 24.71; G2 = 32.58; P < 0.001), not in SES (P = 0.758) and EL (P = 0.109). Mean age and mean dmfs scores of G1 and G2 children were 4.2 and 4.4 years (P = 0.068), and 0.25 and 4.12 (P < 0.001), respectively. The odds ratio (OR) for children in G2 to develop dentine lesions, as opposed to those in G1, was 48.56. CONCLUSION: The bOHP was effective in preventing caries in infants enrolled in the program.

Assessing caries status according to the CAST instrument and WHO criterion in epidemiological studies.

BACKGROUND: The Caries Assessment Spectrum and Treatment (CAST) is a new epidemiological instrument for detection and treatment of dental caries. Worldwide, the WHO criterion constitutes the epidemiological tool most commonly used for caries detection. The objective of the present study is to determine the levels of similarity and difference between the CAST instrument and WHO criterion on the basis of caries prevalence, dmf/DMF counts, examination time and reporting of results. METHODS: An epidemiological survey was carried out in Brazil among 6-11-year-old schoolchildren. Time of examinations was recorded. dmft, dmfs, DMFT and DMFS counts and dental caries prevalence were obtained according to the WHO criterion and the CAST instrument, as well the correlation coefficient between the two instruments. RESULTS: Four hundred nineteen children were examined. dmft and dmfs counts were 1.92 and 5.31 (CAST), 1.99 and 5.34 (WHO) with correlation coefficients (r) of 0.95 and 0.93, respectively. DMFT and DMFS counts were 0.20 and 0.33 (CAST), 0.19 and 0.30 (WHO), with r = 0.78 and r = 0.72, respectively. Kappa coefficient values for intra-examiner consistency were CAST = 0.91-0.92; WHO = 0.95-0.96 and those for inter-examiner consistency were CAST = 0.90-0.96; WHO = 0.94-1.00. Mean time spent on applying CAST and WHO were 66.3 and 64.7 sec, respectively p = 0.26. The prevalence of dental caries using CAST (codes 2, 5-8) and the WHO criterion for the primary dentition were 63.0% and 65.9%, respectively, and for the permanent dentition they were 12.7% and 12.8%, respectively. CONCLUSIONS: The CAST instrument provided similar prevalence of dental caries values and dmf/DMF counts as the WHO criterion in this age group. Time spent on examining children was identical for both caries assessment methods. Presentation of results from use of the CAST instrument, in comparison to WHO criterion, allowed a more detailed reporting of stages of dental caries, which will be useful for oral health planners.

The caries assessment spectrum and treatment (CAST) instrument: its reproducibility in clinical studies.

A new caries assessment instrument, the Caries Assessment Spectrum and Treatment (CAST), was developed. It covers carious lesion progression from no lesion, sealants and restorations to lesions in enamel and dentine, advanced stages in pulpal and tooth-surrounding tissues, and tooth loss owing to dental caries, in nine codes. The objective of this study was to determine the reproducibility of the CAST instrument in primary and permanent dentitions, using three age groups. Two epidemiological surveys were conducted in Brazil, covering three age groups: 2-6-year-old and 6-9-year-old children and 19-30-year-old adults. Four trained and calibrated examiners performed the examinations. Reproducibility was calculated for intra- and inter-examiner at surface and tooth levels and expressed as unweighted kappa-coefficient value (κ) and percentage of agreement (Po) for CAST codes (0-7) and for the categories healthy (0-2) versus diseased (3-7), and non-cavitated (0-3) versus cavitated (4-7) teeth. Using CAST codes (0-7) for the 2-6-year-old age group in primary dentitions, inter-examiner consistency was κ = 0.74 and Po was 98.3%. In the 6-9-year-old age group in primary dentitions, inter-examiner consistency ranged from κ = 0.68 to κ = 0.86 and Po was ≥ 93.7%. In the 19-30-year-old age group inter-examiner consistency was κ = 0.87 and Po was 94.1%. The reproducibility of the CAST instrument for use in the primary dentition of 2-6-year olds and of 6-9-year olds was 'substantial' to 'almost perfect'. The reproducibility for its use in the permanent dentition of 19-30-year olds was 'almost perfect'. The CAST instrument can reliably be applied in epidemiological studies covering these ages.

Effect of different protocols for treating cavities in primary molars on the quality of life of children in Brazil--1 year follow-up.

The aim of this study was to test the hypothesis that the conventional restorative treatment (CRT) and the atraumatic restorative treatment (ART) protocols, in comparison with the ultra-conservative treatment (UCT) protocol, would increase the quality of life of children over a period of 1 year. Cavitated primary molars of 302 children 6-7 years of age were treated according to the CRT, ART and UCT protocols at the school compound. Children's parents completed the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS) at baseline and one year later. Paired t-test, Chi-square test and ANOVA were applied in analysing the data. Questionnaires from 277 and 160 children were collected at baseline and after 1 year, respectively. A statistically significant difference in B-ECOHIS scores over the 1-year period was found for domains 'child symptoms' (P = 0.03) and 'child psychology' (P = 0.02). Treatment protocols did not statistically significantly influence the changes in B-ECOHIS scores over the 1-year period (P = 0.78). It can be concluded that the UCT protocol was as good as the two restorative protocols. All treatment protocols were effective in reducing children's experience of pain, their sleeping problems and their irritability and/or frustration levels over the 1-year period.

22-Year clinical evaluation of the performance of two posterior composites with different filler characteristics.

OBJECTIVES: This retrospective longitudinal study investigated the longevity of posterior restorations placed in a single general practice using 2 different composites in filler characteristics and material properties: P-50 APC (3M ESPE) with 70vol.% inorganic filler loading (midfilled) and Herculite XR (Kerr) with 55vol.% filler loading (minifilled). METHODS: Patient records were used for collecting data. Patients with at least 2 posterior composite restorations placed between 1986 and 1990, and still in the practice for regular check-up visits, were selected. 61 patients (20 male, 41 female, age 31.2-65.1) presenting 362 restorations (121 Class I, 241 Class II) placed using a closed sandwich technique were evaluated by 2 operators using the FDI criteria. Data were analyzed with Fisher's exact test, Kaplan-Meier statistics, and Cox regression analysis (p<0.05). RESULTS: 110 failures were detected. Similar survival rates for both composites were observed considering the full period of observation; better performance for the midfilled was detected considering the last 12 years. There was higher probability of failure in molars and for multi-surface restorations. SIGNIFICANCE: Both evaluated composites showed good clinical performance over 22 years with 1.5% (midfilled) and 2.2% (minifilled) annual failure rate. Superior longevity for the higher filler loaded composite (midfilled) was observed in the second part of the observation period with constant annual failure rate between 10 years and 20 years, whereas the minifilled material showed an increase in annual failure rate between 10 years and 20 years, suggesting that physical properties of the composite may have some impact on restoration longevity.