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Oral Health Surveys: Basic Methods

OBJECTIVES
Resin-based dental materials are not inert in the oral environment, and may release components, initially due to incomplete polymerization, and later due to degradation. Since there are concerns regarding potential toxicity, more precise knowledge of the actual quantity of released eluates is necessary. However, due to a great variety in analytical methodology employed in different studies and in the presentation of the results, it is still unclear to which quantities of components a patient may be exposed. The objective of this meta-analytical study was to review the literature on the short- and long-term release of components from resin-based dental materials, and to determine how much (order of magnitude) of those components may leach out in the oral cavity.


METHODS
Out of an initial set of 71 studies, 22 were included. In spite of the large statistical incertitude due to the great variety in methodology and lack of complete information (detection limits were seldom mentioned), a meta-analytical mean for the evaluated eluates was calculated. To relate the amount of potentially released material components with the size of restorations, the mean size of standard composite restorations was estimated using a 3D graphical program.


RESULTS
While the release of monomers was analyzed in many studies, that of additives, such as initiators, inhibitors and stabilizers, was seldom investigated. Significantly more components were found to be released in organic than in water-based media. Resin-based dental materials might account for the total burden of orally ingested bisphenol A, but they may release even higher amounts of monomers, such as HEMA, TEGDMA, BisGMA and UDMA. Compared to these monomers, similar or even higher amounts of additives may elute, even though composites generally only contain very small amounts of additives. A positive correlation was found between the total quantity of released eluates and the volume of extraction solution.


SIGNIFICANCE
There is a clear need for more accurate and standardized analytical research to determine the long-term release from resin-based materials. Several guidelines for standardization are proposed.

How much do resin-based dental materials release? A meta-analytical approach (vol 27 pg 723, 2011)

In vivo Degradation of Resin-Dentin Bonds in Humans Over 1 to 3 Years

Background Dental caries (tooth decay) and periodontal diseases (gingivitis and periodontitis) affect the majority of people worldwide, and treatment costs place a significant burden on health services. Decay and gum disease can cause pain, eating and speaking difficulties, low self-esteem, and even tooth loss and the need for surgery. As dental plaque is the primary cause, self-administered daily mechanical disruption and removal of plaque is important for oral health. Toothbrushing can remove supragingival plaque on the facial and lingual/palatal surfaces, but special devices (such as floss, brushes, sticks, and irrigators) are often recommended to reach into the interdental area. Objectives To evaluate the effectiveness of interdental cleaning devices used at home, in addition to toothbrushing, compared with toothbrushing alone, for preventing and controlling periodontal diseases, caries, and plaque. A secondary objective was to compare different interdental cleaning devices with each other. Search methods Cochrane Oral Health's Information Specialist searched: Cochrane Oral Health's Trials Register (to 16 January 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2018, Issue 12), MEDLINE Ovid (1946 to 16 January 2019), Embase Ovid (1980 to 16 January 2019) and CINAHL EBSCO (1937 to 16 January 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication. Selection criteria Randomised controlled trials (RCTs) that compared toothbrushing and a home-use interdental cleaning device versus toothbrushing alone or with another device (minimum duration four weeks). Data collection and analysis At least two review authors independently screened searches, selected studies, extracted data, assessed studies' risk of bias, and assessed evidence certainty as high, moderate, low or very low, according to GRADE. We extracted indices measured on interproximal surfaces, where possible. We conducted random-effects meta-analyses, using mean differences (MDs) or standardised mean differences (SMDs). Main results We included 35 RCTs (3929 randomised adult participants). Studies were at high risk of performance bias as blinding of participants was not possible. Only two studies were otherwise at low risk of bias. Many participants had a low level of baseline gingival inflammation.Studies evaluated the following devices plus toothbrushing versus toothbrushing: floss (15 trials), interdental brushes (2 trials), wooden cleaning sticks (2 trials), rubber/elastomeric cleaning sticks (2 trials), oral irrigators (5 trials). Four devices were compared with floss: interdental brushes (9 trials), wooden cleaning sticks (3 trials), rubber/elastomeric cleaning sticks (9 trials) and oral irrigators (2 trials). Another comparison was rubber/elastomeric cleaning sticks versus interdental brushes (3 trials).No trials assessed interproximal caries, and most did not assess periodontitis. Gingivitis was measured by indices (most commonly, Loe-Silness, 0 to 3 scale) and by proportion of bleeding sites. Plaque was measured by indices, most often Quigley-Hein (0 to 5). Primary objective comparisons against toothbrushing aloneLow-certainty evidence suggested that flossing, in addition to toothbrushing, may reduce gingivitis (measured by gingival index (GI)) at one month (SMD -0.58, 95% confidence interval (CI) -1.12 to -0.04; 8 trials, 585 participants), three months or six months. The results for proportion of bleeding sites and plaque were inconsistent (very low-certainty evidence).Very low-certainty evidence suggested that using an interdental brush, plus toothbrushing, may reduce gingivitis (measured by GI) at one month (MD -0.53, 95% CI -0.83 to -0.23; 1 trial, 62 participants), though there was no clear difference in bleeding sites (MD -0.05, 95% CI -0.13 to 0.03; 1 trial, 31 participants). Low-certainty evidence suggested interdental brushes may reduce plaque more than toothbrushing alone (SMD -1.07, 95% CI -1.51 to -0.63; 2 trials, 93 participants).Very low-certainty evidence suggested that using wooden cleaning sticks, plus toothbrushing, may reduce bleeding sites at three months (MD -0.25, 95% CI -0.37 to -0.13; 1 trial, 24 participants), but not plaque (MD -0.03, 95% CI -0.13 to 0.07).Very low-certainty evidence suggested that using rubber/elastomeric interdental cleaning sticks, plus toothbrushing, may reduce plaque at one month (MD -0.22, 95% CI -0.41 to -0.03), but this was not found for gingivitis (GI MD -0.01, 95% CI -0.19 to 0.21; 1 trial, 12 participants; bleeding MD 0.07, 95% CI -0.15 to 0.01; 1 trial, 30 participants).Very-low certainty evidence suggested oral irrigators may reduce gingivitis measured by GI at one month (SMD -0.48, 95% CI -0.89 to -0.06; 4 trials, 380 participants), but not at three or six months. Low-certainty evidence suggested that oral irrigators did not reduce bleeding sites at one month (MD -0.00, 95% CI -0.07 to 0.06; 2 trials, 126 participants) or three months, or plaque at one month (SMD -0.16, 95% CI -0.41 to 0.10; 3 trials, 235 participants), three months or six months, more than toothbrushing alone. Secondary objective comparisons between devicesLow-certainty evidence suggested interdental brushes may reduce gingivitis more than floss at one and three months, but did not show a difference for periodontitis measured by probing pocket depth. Evidence for plaque was inconsistent.Low- to very low-certainty evidence suggested oral irrigation may reduce gingivitis at one month compared to flossing, but very low-certainty evidence did not suggest a difference between devices for plaque.Very low-certainty evidence for interdental brushes or flossing versus interdental cleaning sticks did not demonstrate superiority of either intervention.Adverse eventsStudies that measured adverse events found no severe events caused by devices, and no evidence of differences between study groups in minor effects such as gingival irritation. Authors' conclusions Using floss or interdental brushes in addition to toothbrushing may reduce gingivitis or plaque, or both, more than toothbrushing alone. Interdental brushes may be more effective than floss. Available evidence for tooth cleaning sticks and oral irrigators is limited and inconsistent. Outcomes were mostly measured in the short term and participants in most studies had a low level of baseline gingival inflammation. Overall, the evidence was low to very low-certainty, and the effect sizes observed may not be clinically important. Future trials should report participant periodontal status according to the new periodontal diseases classification, and last long enough to measure interproximal caries and periodontitis.

/pdf/home-use-of-interdental-cleaning-devices-in-addition-to-2bqv0vns0u.pdf

Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries

Increasing demand for simplified and user-friendly adhesive systems has led to the development of a new class of adhesives termed as Universal Adhesives (UAs). The term "Universal" reflects manufacturers' claims that these adhesives can be applied with any adhesion strategy and offer the versatility of use with a variety of direct and indirect restorative materials. The aim of this review was to synthesize the literature regarding the current status of UAs, their adhesion potential to various substrates and their performance in different restorative situations. In vitro studies, clinical trials and systematic reviews were identified utilizing controlled vocabulary and keyword searches in Medline and EMBASE databases. About 282 studies (272 in vitro studies; 11 clinical studies) were included. Available laboratory and clinical evidence does not support the claim that UAs can be used with any adhesive strategy. Although, they can chemically bond to various tooth and direct/indirect restorative substrates, the stability of this bond is material-dependent and subject to hydrolytic degradation. Hence, additional measures are still needed to ensure long-term durability. which undermines the versatility of UAs. The lack of long-term data regarding the clinical performance of UAs further complicates clinical decision-making. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2121-2131, 2019.

Universal dental adhesives: Current status, laboratory testing, and clinical performance

Objectives:
The objectives of the present study were to assess the prevalence rate of caries on individual permanent tooth surfaces, and to compare individual tooth surface caries rates among gender and age groups.

/pdf/prevalence-of-caries-on-individual-tooth-surfaces-and-its-r8afdqazyy.pdf

Prevalence of Caries on Individual Tooth Surfaces and its Distribution by Age and Gender in University Clinic Patients

http://www.orocentro.com.br/files/file-15254990.pdf

Effect of Different Final Irrigation Solutions on Dentinal Tubule Penetration Depth and Percentage of Root Canal Sealer

Statement of Problem

The application of modeling resin could affect the surface quality and color of resin composites.



Purpose

To evaluate the effects of modeling resin on the microhardness, roughness, and color of composite restorations, with and without thermocycling.



Methods

Sixty disc-shaped specimens for each resin composite were prepared in three groups: Group 1: A resin composite disc was cured against a polyester matrix and finished/polished; Group 2: A composite instrument was wetted with Bisco Modeling Resin (Bisco, Schaumburg, IL, USA) to smooth the composite surface, which was cured against a polyester matrix and finished/polished; Group 3: A composite instrument was wetted with modeling resin to smooth the composite surface, which was cured against a polyester matrix. Microhardness, roughness, and color were measured 24 hours after curing and after 10,000 thermocycles.



Results

Modeling resin significantly influenced the microhardness of GrandioSO (Voco, Cuxhaven, Germany) and Gradia Direct Posterior (GC America, Alsip, IL, USA), and the surface roughness of GrandioSO, Filtek Silorane (3M ESPE, St Paul, MN, USA), and Aelite All Purpose Body (Bisco) (p   0.05). Tested composites showed clinically perceptible color changes after thermocycling. In Group 1, Filtek Ultimate (3M ESPE) showed the lowest color change (p < 0.05), and in Group 2, Filtek Silorane showed the highest significant color changes (p < 0.05).



Conclusions

Modeling resin did not affect the microhardness, surface roughness, and color of Aelite LS Posterior (Bisco), Filtek Ultimate (3M ESPE), and Clearfil Majesty Esthetic (Kuraray Medical Inc, Tokyo, Japan) specimens. Also, thermocycling process only affected microhardness of tested resin composites.



Clinical Significance

The effect of modeling resin on surface microhardness, roughness, and color stability of composite materials depends on the type of resin composite. In clinical practice, the adverse effects of modeling resin might be alleviated by a proper finishing and polishing procedure.

The effect of a modeling resin and thermocycling on the surface hardness, roughness, and color of different resin composites.

Objectives: The aim of this study was to evaluate the effect of three different drinks on the color parameters of four different restorative materials. Materials and Methods: Three different composites (Filtek Ultimate Universal Restorative, Filtek Ultimate Flowable, and Filtek Silorane, 3M ESPE) and a polyacid-modified composite resin material (Dyract XP, Dentsply DeTrey GmbH) were evaluated. Eighty-four discshaped specimens of 8 mm in diameter and 2 mm in thickness were prepared (n = 21 each). Color coordinates (L*a*b*, ΔL*, Δa*, Δb* and ΔE*) were measured using a VITA Easyshade Compact (VITA Zahnfabrik) after 24 hr of storage (baseline) and after 30 day of storage in three different beverages of black tea, Coca cola, or water (control) (n = 7). In each beverage, the specimens were stored three times a day, one hr each, for 30 day. The color changes (ΔE) were calculated and were analyzed by KruskalWallis and Dunn multiple comparison test. Results: The color difference (ΔE*) of the resin materials ranged between 1.31 and 15.28 after 30 day of immersion in the staining solutions. Dyract XP in Coca cola (15.28 ± 2.61) and black tea (12.22 ± 2.73) showed the highest mean ΔE* value after 30 day, followed by Filtek Ultimate Universal Restorative (5.99 ± 1.25) and Filtek Ultimate Flowable (4.71 ± 1.40) in black tea (p < 0.05). Conclusions: The compomers displayed unacceptable color changes at the end of 30 day in all beverages. Among resin composites, the silorane based composite exhibited relatively good color stability than the others. Filtek Ultimate Universal Restorative and Filtek Flowable showed similar color changes in all beverages.

/pdf/the-effect-of-different-drinks-on-the-color-stability-of-wlu9oc1qps.pdf

The effect of different drinks on the color stability of different restorative materials after one month.

The objectives of this study were to evaluate the mechanical and physical properties of resin composites. The materials evaluated were the Clearfil Majesty Posterior, Filtek Z550 and G-aenial Posterior composites. A total of 189 specimens were fabricated for microhardness, roughness, gloss and color tests. The specimens were divided into three finishing and polishing systems: Enhance, OneGloss and Sof-Lex Spiral. Microhardness, roughness, gloss and color were measured after 24 h and after 10,000 thermocycles. Two samples from each group were evaluated using SEM and AFM. G-aenial Posterior exhibited the lowest microhardness values. The mean roughness ranged from 0.37 to 0.61 µm. The smoothest surfaces were obtained with Sof-Lex Spiral for each material. G-aenial Posterior with Enhance was determined to be the glossiest surfaces. All of the materials exhibited similar ΔE values ranging between 1.69 and 2.75. Sof-Lex Spiral discs could be used successfully to polish composites.

https://www.jstage.jst.go.jp/article/dmj/35/2/35_2015-260/_pdf

Evaluation of the surface hardness, roughness, gloss and color of composites after different finishing/polishing treatments and thermocycling using a multitechnique approach.

Safa Tuncer

Papers

Prevalence of Caries on Individual Tooth Surfaces and its Distribution by Age and Gender in University Clinic Patients

Effect of Different Final Irrigation Solutions on Dentinal Tubule Penetration Depth and Percentage of Root Canal Sealer

The effect of a modeling resin and thermocycling on the surface hardness, roughness, and color of different resin composites.

The effect of different drinks on the color stability of different restorative materials after one month.

Evaluation of the surface hardness, roughness, gloss and color of composites after different finishing/polishing treatments and thermocycling using a multitechnique approach.