Clinical Evaluation of Flowable Composite Materials in Permanent Molars Small Class I Restorations: 3-Year Double Blind Clinical Study.

This study evaluated the 3-year clinical performance of four different flowable composite materials used in Small Class I restorations in permanent molars. This double-blinded, clinical study analyzed 229 Small Class I restorations/103 children at baseline, 12, 24, and 36 months with modified United States Public Health Services (USPHS) criteria. The tested flowable materials were Voco Grandio Flow + Voco Solobond M, Vivadent Tetric EvoFlow + Vivadent Excite, Dentsply X-Flow + Dentsply Prime&Bond NT, and 3M ESPE Filtek Supreme XT Flow + 3M ESPE Scotchbond Universal. The retention and marginal adaptation rates were highest for Grandio Flow and X Flow materials after 36 months, resulting in the highest score of clinical acceptability at 95.3% and 97.6%, respectively. The Tetric EvoFlow and Filtek Supreme XT Flow had the same retention rate after 36 months at 88.1%. Statistical significance was found in Grandio flow material in postoperative sensitivity criteria (p = 0.021). Tetric EvoFlow showed statistical differences in retention (p = 0.01), color match (p = 0.004), and marginal adaptation (p = 0.042). Filtek Supreme showed statistical differences in retention (p = 0.01) and marginal adaptation (p < 0.001). The flowable composite materials showed excellent clinical efficacy after 36 months of their clinical usage. There was no difference among the tested flowable composite materials quality in Small Class I restorations over time.

Caries prevalence among schoolchildren in urban and rural Croatia.

OBJECTIVE: The aim of the study was to evaluate caries prevalence in a sample of schoolchildren aged 6 to 16 years from rural and urban areas in Croatia. METHODS: Using standardized World Health Organisation (WHO) criteria, the oral health status of 1,589 children (265 from rural and 1,324 from urban areas) was assessed by recording the following indices: DMFT (decayed, missing, filled permanent teeth), deft (decayed, extracted, filled primary teeth), DMFS (decayed, missing, filled surfaces - permanent teeth), defs (decayed, extracted, filled surfaces - primary teeth) and SiC (Significant Caries Index). Rural areas were Stitar and Babina Greda municipalities in Slavonia and urban areas were the cities of Zupanja (Slavonia), Zagreb and Dubrovnik. RESULTS: Half of the examined children (50.0%) had caries (D component in DMFT), with 46.0% of these being from urban and 70.2% from rural areas. The median DMFT among children was 2, 4 (rural) and 2 (urban) (p < 0.001). Among 12-year-olds, the median DMFT was 4 (rural) and 3 (urban), and mean DMFT was 3.4. The median DMFS for rural area was 5 and for urban area 3 (p < 0.001). The median deft was 1.00 for rural and 1.00 for urban, while the highest value was found among 6-year-olds at 9 in rural and 7 in urban areas. The median SiC was 4, 4 (urban) and 5 (rural). CONCLUSION: Schoolchildren from urban and rural areas in Croatia differ significantly in caries prevalence. They fall into the medium DMFT classification group according to the WHO, which indicates the need for a comprehensive oral health preservation programme.

Radiopacity of Composite Luting Cements Using a Digital Technique.

PURPOSE: The aim of this in vitro study was to evaluate the radiopacity of 20 common dental composite luting materials using a digital technique. MATERIALS AND METHODS: A 1-mm-thick specimen of each material with a human tooth slice and aluminium step wedge were tested using digital radiographs under four combinations of exposure and voltage. The radiopacity in pixels was determined using computer software. The equivalent thickness of aluminium for each material was then calculated based on the calibration curve. RESULTS: All tested materials except one had higher radiopacity than dentin (p > α; α  =  0.01), and 80% of the materials had radiopacity above enamel value (p > α; α  =  0.01). Moreover, 40% of tested materials had radiopacity of three times above the minimal International Organization for Standardization (ISO) values for composite luting cements. At all exposure values, the highest radiopacity was for Solocem and Multilink groups of materials, at three to six times above dentin radiopacity. Only Variolink Veneer showed radiopacity below dentin and enamel. CONCLUSIONS: Composite luting materials should have radiopacity above ISO values or greater than the dentin or enamel equivalent. The highest radiopacity values were for the Solocem and Multilink family composite luting cements. Clinicians should choose materials with high radiopacity values, and manufacturers should be aware of the radiopacity values when introducing materials on the market.

Caries prevalence in chronic alcoholics and the relationship to salivary flow rate and pH.

AIM: The aim of this study was to investigate the dental status of alcoholics; to evaluate the relationship of unstimulated and stimulated saliva pH on their decayed/missing/filled teeth (DMFT); and to evaluate the relationship of unstimulated and stimulated salivary flow rate on their DMFT. METHOD: A cross-sectional study was conducted in patients treated for alcohol dependency (n = 70; mean age 41.7 years) and a control group of non-alcoholics (n = 70; mean age 39.1 years). Examinations for dental caries were conducted using the World Health Organization (WHO) criteria and questionnaires. The correlation between nominal variables was determined using chi2 test (alpha = 0.05). The correlation between interval variables was determined using Pearson's correlation coefficient. RESULT: The mean DMFT was similar in alcoholics (14.40) and the control group (13.44) (p > 0.05). There was a statistically significant correlation between alcoholism and unstimulated salivary flow rate (p < 0.05), but no relationship on DMFT was recorded. No statistically significant differences were found between alcoholics and controls in terms of stimulated salivary flow rate (p > 0.05) or stimulated salivary flow on DMFT (p > 0.05). There was a statistically significant correlation between alcoholism and the pH value of stimulated saliva (p < 0.01). There was no correlation between the amount of alcohol consumed and the number of carious lesions (p > 0.05). CONCLUSIONS: No major differences were found with respect to overall DMFT in alcoholics compared to the control group. Alcoholism and stimulated salivary flow rate showed no correlation. Unstimulated salivary flow rate as well as the pH values of both unstimulated and stimulated saliva, were lower in the alcoholic group.

The efficacy of gaseous ozone on some cariogenic bacteria.

The aim of this study is to analyze ozone impact on some cariogenic bacteria in ex vivo and in vitro conditions. The in vitro part of study inoculated dentine with strains of Streptococcus mutans ATCC 33402 and Lactobacillus paracasei ATCC 11974 bacteria. Samples of dentine before and after 40s ozone treatment were collected and anaerobically incubated. Samples of cariogenic dentine (N = 24) were collected from permanent molars within the ex vivo segment of the study, prior and after 40s ozone treatment and a number of colonies were counted after incubation. For the in vitro part of study, results have shown a statistically significant average value of reduction of Streptococcus mutans ATCC 33402 and Lactobacillus paracasei ATCC 11974 prior and after ozone treatment (p < 0.001). The ex vivo segment of the study has also demonstrated a statistically significant difference in the number of bacteria prior and after ozone implementation (p < 0.001). Gaseous ozone demonstrated a strong antimicrobial effect on cariogenic bacteria in both in vitro and ex vivo conditions and it can be used as an adjuvant in caries therapy.

Influence of different pulse durations of Er:YAG laser based on variable square pulse technology on microtensile bond strength of a self-etch adhesive to dentin.

OBJECTIVE: The aim of the study was to evaluate the microtensile bond strength of a composite resin to dentin modified with three different pulse durations of the Er:YAG laser based on variable square pulse technology and with one self-etch adhesive. MATERIALS AND METHODS: The entire occlusal enamel was removed to obtain flat dentin surface for 48 human molar teeth. The teeth were randomly divided into four experimental groups (n=12 per group), according to the pretreatment of dentin: (1) control group; (2) super short pulse (SSP) (50 µsec); (3) medium short pulse (MSP) (100 µsec); and (4) short pulse (SP) (300 µsec) with Er:YAG laser. The energy of the laser used was 80 mJ with average power of 0.8 W. The microtensile bond strength was tested with a universal testing machine. Two specimens from each experimental group were subjected to scanning electron microscopic (SEM) examination, to observe the irradiated surface. RESULTS: Dentin surface treated with SSP showed significantly lower microtensile bond strength values (24±9.8 MPa) in comparison with the control group and SP group (35.3±12.8 and 32.9±10.7 MPa, respectively), (p<0.05). The MSP and SP groups did not show any statistically significant difference in microtensile bond strength in comparsion with the control group (p>0.05). CONCLUSIONS: The use of SP and MSP of the Er:YAG laser with one step self-etch adhesive does not impair or improve the microtensile bond strength in dentin, whereas SSP may not be suitable for dentin surface treatment prior to bonding procedures.

Clinical effectiveness of diode laser therapy as an adjunct to non-surgical periodontal treatment: a randomized clinical study.

BACKGROUND: The aim of this randomized clinical study is to evaluate the effect of a 980-nm diode laser as an adjunct to scaling and root planing (SRP) treatment. METHODS: Thirty-five patients with chronic periodontitis were selected for the split-mouth clinical study. SRP was performed using a sonic device and hand instruments. Quadrants were equally divided between the right and left sides. Teeth were treated with SRP in two control quadrants (control groups [CG]), and the diode laser was used adjunctively with SRP in contralateral quadrants (laser groups [LG]). Diode laser therapy was applied to periodontal pockets on days 1, 3, and 7 after SRP. Baseline data, including approximal plaque index (API), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL), were recorded before the treatment and 6 and 18 weeks after treatment. Changes in PD and CAL were analyzed separately for initially moderate (4 to 6 mm) and deep (7 to 10 mm) pockets. RESULTS: The results were similar for both groups in terms of API, BOP, PD in deep pockets, and CAL. The laser group showed only significant PD gain in moderate pockets during the baseline to 18-week (P <0.05) and 6- to 18- week (P <0.05) periods, whereas no difference was found between LG and CG in the remaining clinical parameters (P >0.05). CONCLUSION: The present study indicates that, compared to SRP alone, multiple adjunctive applications of a 980-nm diode laser with SRP showed PD improvements only in moderate periodontal pockets (4 to 6 mm).

Radiopacity of composite dental materials using a digital X-ray system.

The aim of this study was to evaluate the radiopacity of 32 current dental composite materials with digital technique. Digital radiographs with CCD sensor along with an aluminum step wedge, 1-mm-thick tooth slice and 1mm thick composite specimen were taken in five different combinations of exposition/voltage. The radiopacity in pixels was determined using Digora 2.6. software. The equivalent in thickness of aluminum for each material was then calculated from the calibration curve. 74.9% of all tested materials in all exposure combinations had radiopacity between 2 mm and 4 mm aluminum equivalent. The radiopacity of composites ranged from 0.61 mm Al (Gradia Direct Anterior) to 4.78 mm Al (Te-Econom). The average radiopacity for enamel and dentine was 2.05 and 1.11 mm Al. The use of digital technique for radiopacity is an easy, reliable, fast and precise way to analyze different dental materials. Most of the tested composite materials fulfill the requested criteria for radiopacity with a few exceptions.

Caries prevalence among schoolchildren in Zagreb, Croatia.

AIM: To investigate the prevalence of dental caries and treatment needs in schoolchildren aged 7-14 years from Zagreb. METHODS: Dental examinations based on the World Health Organization criteria were performed on 1168 children in the period 2009-2010. The teeth were clinically examined with standard dental instruments using visual-tactile method under standard dental light. We recorded the clinical indexes of decayed, missed, and filled teeth (DMFT and dmft; upper-case letters refer to permanent and lower-case letters to primary teeth) and decayed, missed, and filled surfaces (DMFS), as well as the significant caries index (SiC). RESULTS: The median DMFT and DMFS of all children were 3 and 4, respectively. The median DMFT and DMFS of 12-year-old children were 4 and 5, respectively. The highest median DMFT score of 7 was found among 14-year-old children. There was a significant difference between age groups (7-10 years and 11-14 years) in DMFT and DMFS. Among 8-year-old children, the median dmft index was the highest (5.5) and SiC index was 7.4. As far as the location of caries on the surface of the first permanent molar is concerned, caries occurred mostly in the central occlusal surface (27.6%). CONCLUSION: Our results showed a high caries prevalence among schoolchildren in Zagreb, indicating a need for an extensive program of primary oral health care.

Erosive lesions in patients with alcoholism.

BACKGROUND: The authors conducted a study to determine the occurrence of erosive tooth lesions in patients with alcoholism and to establish the influence of salivary flow rates and pH levels on their appearance. METHODS: The authors conducted a cross-sectional study in 140 participants (70 with clinically diagnosed alcoholism who were undergoing therapy for their addiction were in the test group and 70 who did not consume alcohol were in the control group). The authors determined the participants' salivary statuses by measuring the flow rates and pH levels of both unstimulated and stimulated saliva. RESULTS: The authors found more erosive lesions in the test group (P < .01). They detected a higher number of erosive lesions in participants in the test group who had a pH range of 5 to 6 compared with a pH range of 6 to 7 (P = .01). They found a significant correlation between alcoholism and unstimulated salivary flow rate (P < .05). CONCLUSIONS: The salivary flow rate was similar in control and test groups. The prevalence of erosion in the test group was higher than that in the control group, which may be related to the decrease in salivary pH of both stimulated and unstimulated saliva in this group. The results of the study showed no connection between erosion prevalence and pH levels and stimulated salivary flow rates. CLINICAL IMPLICATIONS: Patients with alcoholism may be at risk of developing erosive lesions on their teeth owing to the low pH level of their oral environment and decreased saliva levels.

Clinical evaluation of indirect composite restorations at baseline and 36 months after placement.

This study determined the differences in clinical performance between materials for indirect composite restorations based on Ormocer (Admira) and nano-hybrid resin composite (Grandio), both at baseline and 36 months after placement. Modified USPHS criteria were used to analyze the degree of quality. Marginal integrity was assessed 36 months after placement, whereupon, the restorations fabricated from Grandio achieved an Alpha 1 score of 70.7% and an Alpha 2 score of 29.3%. The Wilcoxon test revealed a statistically significant difference in the evaluation of marginal integrity (p = 0.003), anatomic form of the marginal step (p = 0.025) and discoloration of the margins (p = 0.014) at baseline and after 36 months. For Admira, the Wilcoxon test showed statistically significant differences in the evaluation of surface texture (p = 0.025), anatomic form of the complete surface (p = 0.034), anatomic form of the marginal step (p = 0.008), marginal integrity (p = 0.002) and discoloration of the margins (p = 0.008) at baseline and after 36 months. According to the number of restorations awarded the Alpha 1 score (excellent), the overall success rates for marginal integrity were 70.7% for Grandio and 71.8% for Admira; both were evaluated 36 months after placement. The results have shown that the indirect restorations were acceptable after 36 months, which indicates a 100% success rate. Over 36 months, no statistically significant differences were noted between the two materials. Indirect resin composite restorations represent a good therapy choice for severely damaged teeth.

The influence of Healozone on microleakage and fissure penetration of different sealing materials.

The preventive effect of sealing materials depends on ability to penetrate into the fissures, and microleakage absence, resulting with better clinical success. The aim of present study was to investigate the influence of ozone on microleakage and penetration of nanoparticle fissure sealing resin and flowable composite, and quantitative and qualitative analysis of microleakage. Forty extracted non carious third molars were randomly divided in 4 groups. Group A: KaVo Healozone and Grandio Seal; Group B: Kavo Healozone and X-Flow; Group C: Grandio Seal; Group D: X-Flow. The teeth were thermocycled, immersed in 5% methylene dye for 24 hours, and sectioned with precision saw. The total of 149 slices were analysed with stereomicroscope for microleakage and sealant penetration. According to qualitative scores, there is a significant difference between groups C and D, group C showing better results. According to quantitative scores, there are no statistical differences between the groups. The treatment of the enamel with KaVo HealOzone after etching does not affect either microleakage or penetration proportion of flowable composite or sealing resin. There is no statistically significant difference in a degree of penetration between different groups of sealing materials. Groups of materials with flowable composite in combination with an adhesive system show a good degree of penetration into the fissure and low microleakage meaning that they can be used as a fissure sealing materials.

[Combined surgical-orthodontic therapy for compound odontoma]. / Kombinacija kirurske i ortodontske terapije rastavljeno slozenog odontoma (compound odontoma).

Odontogenic tumor is a rare condition in dental medicine that mostly proceeds unrecognized until the occurrence of clinical symptoms such as delayed eruption, or is incidentally detected on routine x-ray examination. The exact cause is not known, however, previous dental trauma and infection have been postulated as the potential factors in the development of odontogenic tumor. The earliest possible operative extirpation of the tumorous growth is recommended to eliminate permanent tooth impaction and to enable normal growth of the teeth. In some cases, corticotomy, including complete removal of the bony coat of the tooth, may be needed to additionally facilitate and precipitate its eruption. Orthodontic therapy is also of great importance in correct alignment of the teeth 'n the dental arch as well as in the management of other anomalies that may be associated with odontogenic tumor. A patient with compound odontoma is presented, along with the course of combined surgical-orthodontic therapy. The patient reported previous intrusion trauma that had occurred at the age of 4 years, which may have been the potential factor in the development of odontoma. In this case, there was a massive odontogenic tumor which had compromised the growth of permanent teeth, and the growth impulse was almost at the end since the patient was 11 years old and the apexes of the upper incisors were partially closed. The first operation included complete removal of the tumorous mass that had interrupted spontaneous eruption of the upper permanent incisors. It did not result in immediate spontaneous tooth eruption, so an additional operation was needed. The objective of the second operative procedure was complete removal of the covering bone over the unerupted upper permanent incisors in order to eliminate the physical barrier to tooth growth and eruption. The objective of fixed orthodontic therapy was full eruption of the partially erupted upper incisors. After 16 months, the upper incisors were regularly located in the dental arch. In this case, orthodontic therapy had another objective, i.e. to ensure rotation of the first upper premolar, to provide space for the upper permanent canine eruption and to establish regular intercuspidation after upper second premolar hypodontia. In colclusion, combined operative and orthodontic therapy can be recommended irrespective of the stage of the impacted tooth development because any treatment to precipitate tooth eruption has favorable effects. Impacted teeth should always be provided all treatment options for faster eruption, as demonstrated in our case where a good clinical result was achieved within 2.5 years. The role of regular clinical and x-ray controls for assessment of the impacted tooth eruption should also be emphasized.

Clinical comparison of flowable composite to other fissure sealing materials--a 12 months study.

The subject of the study was the clinical analysis of six different sealing materials over a 12-months period. It was necessary to prove the clinical success of sealing with flowable composite with the use of adhesive system and preventing effect of sealants on caries developement. Our study included children aged from 6 to 15, and we sealed 326 teeth with materials from the group of flowable composites in combination with adhesive system (Admira Bond+Admira Flow, Excite+Tetric Flow) and other sealing resins (Teethmate F1, Admira Seal, Helioseal Clear Chroma, Fissurit FX). Over a 12-months period, the total retention was 83.3% (Tetric Flow), 81.5% (Admira Seal), 81.5% (Fissurit FX), 76.4% (Teethmate F1), 75.9% (Helioseal Clear Chroma) and 74.6% (Admira Flow). Only 5 molars (1.5%) developed clinical caries, so fissure sealing has showed to be an excelent prevention of occlusal caries. Flowable composites used with adhesive system are equal to other sealing materials. Sealing materials show great and durable preventive effect against caries development in the fissure system. Since there are many different sealing materials, adhesives, flowable composites on the market and many different pretreatments of the enamel, future studies are necessary and should have an aim to investigate the best technique and material for fissure sealing.

[Clinical evaluation of three different materials for fissure sealing after 12 months]. / Klinicka evaluacija triju razlicitih materijala za pecacenje fisura nakon 12 mjeseci uporabe.

AIM: Fissure sealing is a preventive and therapeutic procedure by which the occlusal surface of the fissure system of the teeth is closed with sealing materials for prevention and therapy of initial caries. The fissures of the teeth treated with sealing materials become physiologically clean spots, with no possibility for the developement of caries lesion. The aim of the study was to clinically compare three different fissure sealing materials after one year of use. METHODS: The study included 73 subjects, 29 (39.7%) male, and 44 (60.3%) female, aged 7-21 years. Sealing was carried out on 150 healthy permenant molars with three different sealing materials divided into three groups: Teethmate F1 (Kuraray) in 48 teeth, Helioseal Clear Chroma (Vivadent) in 52 teeth, and Tetric Flow (Vivadent) in 50 teeth. In each subject, at least two different sealing materials were used. On analysis of the degree of retention and occurrence of secondary caries lesion, modified criteria described by Kilpatrick et al. (1996) were used: 0=no loss, 1=loss of 1/3 of the seal, 2=loss of 2/3 of the seal, 3=complete loss of the seal (more than 2/3 of the material). The criteria for evaluation of the occurrence of secondary caries were: 0=no caries, 1=caries. RESULTS: After 12 months, complete retention of the Teethmate F1 material was 77.1%, of Helioseal Clear Chroma 76.9%, and of Tetric Flow 84%. There is no statistically significant difference in retention among the sealing materials after 12 months. Tetric Flow showed a better appearance of retention, although not statistically significant (p=0.287). Out of 150 sealed teeth, at 12 months caries was found in only 3 teeth: 2 in the group sealed with Teethmate F1 and one in the group sealed with Helioseal Clear Chroma. In the group sealed with Tetric Flow, no caries was recorded at 12 months. CONCLUSION: Comparison of the degree of retention showed flowable composite as a sealing material to yield better results than the classic sealing materials, although the difference was not statistically demonstrated. The low incidence of caries in the fissure system between sealed teeth indicated a good preventive action of the sealing materials. Because of the great supply of flowable composites on the market, differing in the content and consistency, and a great number of various enamel-dentin adhesive systems, there is a need of additional long-term research to determine their clinical justifiability.