Sandra Guzmán-Armstrong

Surface coating and leakage of dentin-bonded resin composite restorations

OBJECTIVES To compare the marginal leakage of dentin-bonded resin composite restorations in tooth sections coated with nail varnish and similarly restored sections coated with cyanoacrylate cement. METHODS MO and DO cavities were prepared with the gingival floor below the CEJ in 11 non-carious extracted human molars. Each cavity was restored with a dentin adhesive and resin composite. Sectioning yielded four specimens per tooth (N=44). One specimen from each restoration was coated with varnish. The other specimen was coated with cyanoacrylate cement. The coatings were applied to all surfaces except that a 1mm window on either side of the interproximal gingival margin was left uncoated. Specimens were thermocycled and stained with silver nitrate. Silver penetration into the gingival margin of each section was measured with a measuring microscope. The predominant leakage path for each coating type was determined by scanning electron microscopy. RESULTS There was no significant difference between the leakage of the varnish-coated and cyanoacrylate-coated specimens. No marginal gaps were observed either by optical or by electron microscopy. However, the both optical and electron microscopy revealed leakage in nearly all specimens. This leakage was confined to either the dentin/hybrid layer interface or the adhesive resin/hybrid layer interface. CONCLUSIONS The results suggest that these coating materials are not confounding factors in laboratory investigations of marginal leakage along dentin-bonded interfaces of resin composite restorations. Although marginal gaps were undetectable even at high magnification, leakage was observed along the gingival margin of almost all of these Class II resin composite restorations.

Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions

BACKGROUND An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence-Based Dentistry conducted a systematic review and formulated evidence-based clinical recommendations for the arrest or reversal of noncavitated and cavitated dental caries using nonrestorative treatments in children and adults. TYPES OF STUDIES REVIEWED The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane database of systematic reviews to identify randomized controlled trials reporting on nonrestorative treatments for noncavitated and cavitated carious lesions. The authors used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions. RESULTS The expert panel formulated 11 clinical recommendations, each specific to lesion type, tooth surface, and dentition. Of the most effective interventions, the panel provided recommendations for the use of 38% silver diamine fluoride, sealants, 5% sodium fluoride varnish, 1.23% acidulated phosphate fluoride gel, and 5,000 parts per million fluoride (1.1% sodium fluoride) toothpaste or gel, among others. The panel also provided a recommendation against the use of 10% casein phosphopeptide-amorphous calcium phosphate. CONCLUSIONS AND PRACTICAL IMPLICATIONS Although the recommended interventions are often used for caries prevention, or in conjunction with restorative treatment options, these approaches have shown to be effective in arresting or reversing carious lesions. Clinicians are encouraged to prioritize use of these interventions based on effectiveness, safety, and feasibility.

Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis:

The goal of nonrestorative or non- and microinvasive caries treatment (fluoride- and nonfluoride-based interventions) is to manage the caries disease process at a lesion level and minimize the loss of sound tooth structure. The purpose of this systematic review and network meta-analysis was to summarize the available evidence on nonrestorative treatments for the outcomes of 1) arrest or reversal of noncavitated and cavitated carious lesions on primary and permanent teeth and 2) adverse events. We included parallel and split-mouth randomized controlled trials where patients were followed for any length of time. Studies were identified with MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews. Pairs of reviewers independently conducted the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data were synthesized with a random effects model and a frequentist approach. Forty-four trials (48 reports) were eligible, which included 7,378 participants and assessed the effect of 22 interventions in arresting or reversing noncavitated or cavitated carious lesions. Four network meta-analyses suggested that sealants + 5% sodium fluoride (NaF) varnish, resin infiltration + 5% NaF varnish, and 5,000-ppm F (1.1% NaF) toothpaste or gel were the most effective for arresting or reversing noncavitated occlusal, approximal, and noncavitated and cavitated root carious lesions on primary and/or permanent teeth, respectively (low- to moderate-certainty evidence). Study-level data indicated that 5% NaF varnish was the most effective for arresting or reversing noncavitated facial/lingual carious lesions (low certainty) and that 38% silver diamine fluoride solution applied biannually was the most effective for arresting advanced cavitated carious lesions on any coronal surface (moderate to high certainty). Preventing the onset of caries is the ultimate goal of a caries management plan. However, if the disease is present, there is a variety of effective interventions to treat carious lesions nonrestoratively.

Conservative treatment planning in veneer replacement.

This clinical report describes a conservative treatment in veneer replacement where diastemas, malalignment, and midline shift were the main modifying factors. When replacement veneers are indicated, the definitive results can only be accurately predicted after an esthetic reanalysis of the existing restorations.

Factors Associated with Reevaluation of the Stepwise Excavation Procedure: An 8-Year Retrospective Study.

Although the stepwise excavation procedure (SWP) has been shown to be an effective caries treatment technique, studies reporting its application outside of controlled clinical trials are limited. We performed a retrospective study from patient record data to assess the proportion of patients who had an SWP reevaluated within 18 months at The University of Iowa College of Dentistry (UICOD) between 2004 and 2012, and evaluated the association between different variables and this outcome. A total of 1,985 SWPs were performed in 1,326 patients, with 518 patients having had reevaluation within 18 months. Bivariate analysis and logistic regression modeling revealed strong associations between explanatory variables such as provider type, tooth type, patient age, number of recalls and the calendar year in which the SWP was done and reevaluation status. There was also evidence of association with dental insurance status. Other characteristics such as gender, distance traveled to the UICOD, number of surfaces treated and tooth arch did not show any significant association. In general, patients were more likely to have reevaluation when seen by faculty members or residents, the procedure was performed in molars/pre-molars, they were older, they had more recalls and were seen earlier in the study period. These results suggest that decisions to use SWP should consider patient demographics and treatment characteristics such as provider level, tooth type, patient age and number of recalls. The impact of treatment year may reflect program heterogeneity or temporal changes in external societal factors.

Retrospective analysis of factors associated with the success of stepwise excavation procedure in deep carious lesions

BACKGROUND Recent scientific evidence regarding the stepwise excavation procedure (SWP) has not addressed the consideration of patient factors when selecting SWP as treatment for deep carious lesions (DCLs). This study assessed patient factors predicting a successful SWP defined as a tooth restored with SWP and did not result in root canal treatment or a dental extraction. METHODS SWPs completed in 626 patients without symptomatic irreversible pulpitis at the University of Iowa College of Dentistry from January 2004 through December 2012 were evaluated. Patient demographic and tooth-specific characteristics were assessed in their relationship with the main outcome. RESULTS SWPs had a 75% success rate when evaluated within 36 months of the initial treatment. Findings showed that patients who had successful SWP treatment of DCLs were somewhat younger than patients whose SWP treatment was not successful (mean age, 37.4 years and 40.5 years, respectively; odds ratio, 0.981; 95% confidence interval, 0.967 to 0.994; P = .0058). Patients who returned to their second appointment within 5 to 9 months were more likely to have a successful SWP treatment than those returning sooner than 5 months (odds ratio, 0.338; 95% confidence interval, 0.210 to 0.545; p < .0001). CONCLUSION Treatment of deep carious lesions with SWP is effective for pulp preservation and patient age may influence the outcome. PRACTICAL IMPLICATIONS Although a somewhat younger mean patient age was associated with successful treatment of DCLs, SWP can be successful regardless of patient age and clinicians should consider SWP in treating DCLs.

Acknowledgement to Reviewers 2015

Kasper Aanaes Shawn Aaron Janice Abbott Frank Accurso Moira Aitken Michael Anstead Robert Aris Deborah Baines Jennifer Bartlett Tara Barto Ivan Bastian Jeffrey Beekman Scott Bell William Bennett Ariel Benson Paul Beringer Ariel Berlinski Jocelyn Bescond Julie Biller Diana Bilton Scott Blackman Hannah Blau Cristina Bombieri Richard Boucher Frederic Bouillaud Stephen Bourke Cynthia Brady Michelle Brotherwood Emanuela Bruscia Mandy Bryon Lucy Burr Chris Burtin Andre Cantin Rafael Canton Giussepe Castaldo Carlo Castellani Daniel Chambers Christine Chan Denmark Canada United Kingdom United States United States United States United States United Kingdom United States United States Australia Netherlands Australia United States Israel United States United States France United States United Kingdom United States Israel Italy United States France United Kingdom United States Canada United States United Kingdom Australia Belgium Canada Spain Italy Italy Australia United States Anne Chang Marc Chanson W Winn Chatham Jocelyn Choo Sanjay Chotirmall Oana Ciofu Natalia Cirilli John Clancy Lane Clarke Rubin Cohen Gary Connett Janet Crane Patrick Daigneault Jeannette Dankert-Roelse Elliott Dasenbrook Kausik Datta Peter Davies Gwyneth Davies Frans De Baets RC De Lisle Agnes Delaunay-Moisan Elisabeth Dellon Rajendar Deora Nico Derichs Gill Diamond Antonio DiGiandomenico G. Dimitriou Anh-Tuan Dinh-Xuan John Dodge Scott Donaldson Alistair Duff Helen Egan Olaf Eickmeier Joseph Elborn Marielle Engelen Tom Evans Pascale Fanen Albert Faro Australia Switzerland United states Australia Singapore Denmark Italy United States United States United States United Kingdom United States Canada Netherlands United States United States Australia United Kingdom Belgium United States France United States United States Germany United States United States Greece France United Kingdom United States United Kingdom United Kingdom Germany United Kingdom United States United Kingdom France United States