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The longevity of dental restorations: a systematic review
... The PMCs were cemented over carious primary molars, with a glass-ionomer (GI) luting cement, with no caries removal, tooth preparation, or local anesthesia. A retrospective analysis of Dr. Hall's practice records showed that the outcomes for this technique (the Hall Technique) were similar to those reported for more conventional restorations (Chadwick et al., 2002). ...
... This number approaches those reported in another Primary Care-based study where carious primary teeth were left unrestored (Levine et al., 2002). Restoration survival rates for the Hall Technique were comparable with those of conventional restorations placed by specialists, and in Secondary Care settings (Chadwick et al., 2002). ...
There is currently uncertainty regarding best practice for management of carious primary teeth in the UK Primary Care environment. The Hall Technique (HT) is a method for managing carious primary molars where decay is sealed under preformed metal crowns (PMCs) without local anaesthesia, tooth preparation or any caries removal. Objectives: To compare clinical/ radiographic failure rates for the HT with General Dental Practitioners' (GDPs) standard restorations (SRs) for carious primary molars. Methods: Split mouth, centrally randomised, controlled trial (132 children, aged 310) set in General Dental Practice (dentists n=17), Scotland, UK. Study teeth were significantly carious (42% of the initial caries lesions >1/2 way into dentine; 67% of the restorations were Class II). For teeth randomised to the intervention arm, a PMC (3M/ESPE) was cemented using the HT and all caries sealed-in. Control teeth were restored using the dentists' usual choice of caries removal/ SR. Clinical and radiographic follow-up data were collected annually. A Major failure was defined as: irreversible pulpitis; loss of vitality; abscess; or unrestorable tooth and Minor failure as: reversible pulpitis; restoration loss/ wear/ fracture, requiring intervention; or secondary caries. Results: Data at 60 months were analysed for 88 participants/ 176 teeth (66%) with minimum follow-up of 48 months. First Major failures: HT 3(3%); SR 12(14%) (P<0.05) and first Minor failures: HT 4(5%); SR 36(41%) (P<0.0001). Including repeat failures, these increased to Major failures: HT 3; SR 21; and Minor failures: HT 4; SR 73. Conclusion: Sealing-in caries using the HT statistically, and clinically, significantly outperformed the GDPs SRs. These results are comparable to, or better than, published data for conventional restorative techniques, including many Secondary Care studies (Chadwick, 2002 EBD 3(4):96-99), and strongly support the HT as a predictable, low maintenance, method for managing carious primary molars. Supported by CSO Scottish Government and 3M/ESPE. (300 words)
... The emphasis in current strategies is more to seal remaining caries off from the oral environment (Mertz-Fairhurst et al. 1998) rather than completely eliminate infected dentine, and success of such treatment is highly dependent on the effectiveness of the seal achieved at the interface between the tooth surface and restorative material, as well as on the overall quality of restoration placed. The longevity of bonded direct restorations involving glass ionomers and composites has been reported to last from as little as 3 y to well over 10 y (Chadwick et al. 2002;Brunthaler et al. 2003;Soncini et al. 2007). Operator experience and technique sensitivity have been identified as critical factors affecting success of restorative treatment, with the main reason for restoration failure being secondary caries (Bernardo et al. 2007;Demarco et al. 2012). ...
A novel silver nanoparticle (AgNP) formulation was developed as a targeted application for the disinfection of carious dentine. Silver nitrate (AgNO3) was chemically reduced using sodium borohydrate (NaBH4) in the presence of sodium dodecyl sulfate (SDS) to form micelle aggregate structures containing monodisperse 6.7- to 9.2-nm stabilized AgNPs. AgNPs were characterized by measurement of electrical conductivity and dynamic light scattering, scanning electron microscopy, transmission electron microscopy, and inductively coupled plasma mass spectrometry. Antimicrobial activity of AgNPs was tested against planktonic cultures of representative gram-positive and gram-negative oral bacteria using well diffusion assays on tryptic soy broth media and monoculture biofilms grown with brain heart infusion ± sucrose anaerobically at 37°C on microtiter plates. Biofilm mass was measured by crystal violet assay. Effects were compared to silver diamine fluoride and chlorhexidine (negative controls) and 70% isopropanol (positive control) exposed cultures. In the presence of AgNPs, triplicate testing against Streptococcus gordonii DL1, C219, G102, and ATCC10558 strains; Streptococcus mutans UA159; Streptococcus mitis I18; and Enterococcus faecalis JH22 for planktonic bacteria, the minimum inhibitory concentrations were as low as 7.6 µg mL–1 and the minimum bacteriocidal concentrations as low as 19.2 µg mL–1 silver concentration. Microplate readings detecting crystal violet light absorption at 590 nm showed statistically significant differences between AgNP-exposed biofilms and where no antimicrobial agents were used. The presence of sucrose did not influence the sensitivity of any of the bacteria. By preventing in vitro biofilm formation for several Streptococcus spp. and E. faecalis, this AgNP formulation demonstrates potential for clinical application inhibiting biofilms.
... Dental caries (tooth decay) is one of the commonest diseases which afflicts mankind, and has been estimated to affect up to 80% of people in high-income countries (Chadwick 2001). The prevalence and severity of caries is strongly associated with social deprivation, and as such is a concern of particular relevance to children (WHO 2005). ...
... 16 Comparing AFRs, recent studies state that the durability of new posterior RC restorations is the same as that reported in reviews from earlier studies around the turn of the century. 6,10,45 However, it is difficult to compare earlier studies of posterior RCs with recent ones due to the fact that the former comprised much larger numbers of Class I restorations than the latter, as shown in a current review. 25 The value of inclusion of Class I restorations in posterior RC trials should therefore be questioned. ...
Purpose:
To evaluate the 3-year clinical durability of the flowable bulk-fill resin composite SDR in Class I and Class II restorations.
Materials and methods:
Thirty-eight pairs of Class I and 62 pairs of Class II restorations were placed in 44 male and 42 female patients (mean age 52.4 years). Each patient received at least two extended Class I or Class II restorations that were as similar as possible. In all cavities, a one-step self-etching adhesive (XenoV+) was applied. One of the cavities of each pair was randomly assigned to receive the flowable bulk-fill resin composite SDR in increments up to 4 mm as needed to fill the cavity 2 mm short of the occlusal cavosurface. The occlusal part was completed with an ormocer-based nanohybrid resin composite (Ceram X mono+). In the other cavity, only the resin composite CeramX mono+ was placed in 2 mm increments. The restorations were evaluated using slightly modified USPHS criteria at baseline and then annually for 3 years. Caries risk and bruxing habits of the participants were estimated.
Results:
No post-operative sensitivity was reported. At the 3-year follow-up, 196 restorations - 74 Class I and 122 Class II - were evaluated. Seven restorations failed (3.6%), 4 SDR-CeramX mono+ and 3 CeramX mono+ only restorations, all of which were Class II. The main reason for failure was tooth fracture, followed by resin composite fracture. The annual failure rate (AFR) for all restorations (Class I and II) was 1.2% for the bulkfilled restorations and 1.0% for the resin composite-only restorations (p > 0.05). For the Class II restorations, the AFR was 2.2% and 1.6%, respectively.
Conclusion:
The 4-mm bulk-fill technique showed good clinical effectiveness during the 3-year follow-up.
... 16 Comparing AFRs, recent studies state that the durability of new posterior RC restorations is the same as that reported in reviews from earlier studies around the turn of the century. 6,10,45 However, it is difficult to compare earlier studies of posterior RCs with recent ones due to the fact that the former comprised much larger numbers of Class I restorations than the latter, as shown in a current review. 25 The value of inclusion of Class I restorations in posterior RC trials should therefore be questioned. ...
Objective
The objective of this randomized controlled prospective clinical trial was to evaluate the efficacy of a flowable resin composite (SDR) bulk fill technique in posterior restorations and to compare it intraindividually with a conventional 2 mm resin composite curing technique in a 3-year follow up.
Materials and methods
Thirty-eight pairs Class II and 15 pairs Class I restorations were placed in 38 patients with a mean age of 55.3 years (range 32–87). Each patient received at random at least two, as similar as possible, Class II or Class I restorations of two restorative techniques. In all cavities a single step self-etch adhesive (Xeno V) was applied. In one of the cavities of each pair, a flowable resin composite (SDR) was placed, in bulk increments up to 4 mm as needed to fill the cavity 2 mm short of the occlusal cavosurface. The occlusal part was completed with a nano-hybrid resin composite (Ceram X mono) layer. In the second cavity, the hybrid resin composite was placed in 2 mm increments. The restorations were evaluated using slightly modified USPHS criteria at baseline and then yearly during 3 years. Caries risk and parafunctional habits of the participants were estimated.
Results
After three years, 76 Class II and 28 Class I restorations could be observed. One molar resin composite-only tooth showed post-operative sensitivity during 3 weeks for temperature changes and occlusal forces. Two failed Class II molar restorations in the resin composite-only group were observed during the first year, one cusp fracture and one resin composite fracture. An annual failure rate of 1.3% was found for the resin composite only restorations and of 0% in the bulk-filled restorations (n.s.). Ten participants were estimated as having high caries risk and eleven showed active bruxing habits.
Significance
The 4 mm bulk-fill technique with the flowable resin composite SDR showed highly clinical effectiveness, which was comparable during the 3-year follow-up with the 2 mm resin composite layering technique.
The history of aesthetic composites is reviewed, including monomers, curing, fillers, etc. Recently introduced restoratives include flowable, packable and bioactive materials. After a background in biocompatibility, initiatives currently in development for future clinical products to substantially improve resin composite oral durability and extend clinical service lifetime are described as are initiatives to use tissue engineering concepts and bioactive fillers to stimulate biological repair and inhibit caries.
Background
Dental caries (tooth decay) is one of the commonest diseases which afflicts mankind, and has been estimated to affect up to 80% of people in high-income countries. Caries adversely affects and progressively destroys the tissues of the tooth, including the dental pulp (nerve), leaving teeth unsightly, weakened and with impaired function. The treatment of lesions of dental caries, which are progressing through dentine and have caused the formation of a cavity, involves the provision of dental restorations (fillings). This review updates the previous version published in 2009.
Objectives
To assess the effects of adhesive bonding on the in-service performance and longevity of dental amalgam restorations.
Search methods
We searched the Cochrane Oral Health Group Trials Register (to 21 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 12), MEDLINE via Ovid (1946 to 21 January 2016) and EMBASE via Ovid (1980 to 21 January 2016). We also searched the US National Institutes of Health Trials Registry (http://clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (www.who.int/ictrp/search/en) (both to 21 January 2016) for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
Selection criteria
Randomised controlled trials comparing adhesively bonded versus traditional non-bonded amalgam restorations in conventional preparations utilising deliberate retention, in adults with permanent molar and premolar teeth suitable for Class I and II amalgam restorations only.
Data collection and analysis
Two review authors independently screened papers, extracted trial details and assessed the risk of bias in the included study.
Main results
One trial with 31 patients who received 113 restorations was included. At two years, 50 out of 53 restorations in the non-bonded group survived, and 55 of 60 bonded restorations survived with five unaccounted for at follow-up. Post-insertion sensitivity was not significantly different (P > 0.05) at baseline or two-year follow-up. No fractures of tooth tissue were reported and there was no significant difference between the groups or matched pairs of restorations in their marginal adaptation (P > 0.05).
Authors' conclusions
There is no evidence to either claim or refute a difference in survival between bonded and non-bonded amalgam restorations. This review only found one under-reported trial. This trial did not find any significant difference in the in-service performance of moderately sized adhesively bonded amalgam restorations, in terms of their survival rate and marginal integrity, in comparison to non-bonded amalgam restorations over a two-year period. In view of the lack of evidence on the additional benefit of adhesively bonding amalgam in comparison with non-bonded amalgam, it is important that clinicians are mindful of the additional costs that may be incurred.
Objective. To assess oral and nutritional condition in nursing home residents and their relationships looking for the potential role of a dental hygienist in the nursing home at least as consultant. Methods. Seventy residents (50 F, 20 M) of a nursing home in Nomi (Prov. Trento) were randomly selected and assessed for malnutrition with Mini Nutritional Assessment; they were divided into three groups as far as their oral conditions were concerned: residents with own teeth (Group A), resident edentules without dentures (Group B), edentules with dentures (Group C). Results. 27.1% were malnourished, 55.7% at nutritional risk and 17.1% well nourished. Group A (natural teeth) consisted of 25 people, Group B (edentules without dentures) of 14, Group C (edentules with dentures) of 21. In group A teeth were 6.04 ± 6.17, of whom just 0.7 ± 3.4 normal with a % of plaque and tartar respectively 72.7 ± 16.7 and 74.3 ± 15.7%. In group B DFMT was obvioulsy 28 ± 0. In group C there was no partial denture, but in 12% there was a superior denture, in 80% there was a complete denture, just in 6% an inferior denture. In 70% of residents denture was not fit and often used just at meals. People wearing dentures showed % of plaque and tartar respectively 71.6 ± 17.4 and 63.3 ± 17.2%. Conclusions. Oral and nutritional conditions in nursing homes residents are not reassuring; even though it is out of doubt that teeth not proper make feeding much difficult, it was not possibile to show a relationship between bad dentition and malnutrition. The importance of a registred dental hygienist is stressed within a nursing home together with its unvaluable role in monitoring oral condition starting from admission in the setting with at least an annual planned revaluation.
Background:
Dental caries (tooth decay) is a common disease that is preventable by reducing the dietary intake of free sugars and using topical sodium fluoride products. An antibacterial agent known as chlorhexidine may also help prevent caries. A number of over-the-counter and professionally administered chlorhexidine-based preparations are available in a variety of formulations and in a range of strengths. Although previous reviews have concluded that some formulations of chlorhexidine may be effective in inhibiting the progression of established caries in children, there is currently a lack of evidence to either claim or refute a benefit for its use in preventing dental caries.
Objectives:
To assess the effects of chlorhexidine-containing oral products (toothpastes, mouthrinses, varnishes, gels, gums and sprays) on the prevention of dental caries in children and adolescents.
Search methods:
We searched the Cochrane Oral Health Group Trials Register (25 February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 12), MEDLINE via OVID (1946 to 25 February 2015), EMBASE via OVID (1980 to 25 February 2015) and CINAHL via EBSCO (1937 to 25 February 2015). We handsearched several journals placed no language restrictions on our search. After duplicate citations were removed, the electronic searches retrieved 1075 references to studies.
Selection criteria:
We included parallel-group, randomised controlled trials (RCTs) that compared the caries preventive effects of chlorhexidine gels, toothpastes, varnishes, mouthrinses, chewing gums or sprays with each other, placebo or no intervention in children and adolescents. We excluded trials with combined interventions of chlorhexidine and fluoride or comparisons between chlorhexidine and fluoride interventions.
Data collection and analysis:
Two review authors independently extracted trial data and assessed risk of bias. We resolved disagreements by consensus. We contacted trial authors for clarification or additional study details when necessary. The number of included studies that were suitable for meta-analysis was limited due to the clinical diversity of the included studies with respect to age, composition of intervention, and variation in outcome measures and follow-up. Where we were unable to conduct meta-analysis, we elected to present a narrative synthesis of the results.
Main results:
We included eight RCTs that evaluated the effects of chlorhexidine varnishes (1%, 10% or 40% concentration) and chlorhexidine gel (0.12%) on the primary or permanent teeth, or both, of children from birth to 15 years of age at the start of the study. The studies randomised a total of 2876 participants, of whom 2276 (79%) were evaluated. We assessed six studies as being at high risk of bias overall and two studies as being at unclear risk of bias overall. Follow-up assessment ranged from 6 to 36 months.Six trials compared chlorhexidine varnish with placebo or no treatment. It was possible to pool the data from two trials in the permanent dentition (one study using 10% chlorhexidine and the other, 40%). This led to an increase in the DMFS increment in the varnish group of 0.53 (95% confidence interval (CI) -0.47 to 1.53; two trials, 690 participants; very low quality evidence). Only one trial (10% concentration chlorhexidine varnish) provided usable data for elevated mutans streptococci levels > 4 with RR 0.93 (95% CI 0.80 to 1.07, 496 participants; very low quality evidence). One trial measured adverse effects (for example, ulcers or tooth staining) and reported that there were none; another trial reported that no side effects of the treatment were noted. No trials reported on pain, quality of life, patient satisfaction or costs.Two trials compared chlorhexidine gel (0.12% concentration) with no treatment in the primary dentition. The presence of new caries gave rise to a 95% confidence interval that was compatible with either an increase or a decrease in caries incidence (RR 1.00, 95% CI 0.36 to 2.77; 487 participants; very low quality evidence). Similarly, data for the effects of chlorhexidine gel on the prevalence of mutans streptococci were inconclusive (RR 1.26, 95% CI 0.95 to 1.66; two trials, 490 participants; very low quality evidence). Both trials measured adverse effects and did not observe any. Neither of these trials reported on the other secondary outcomes such as measures of pain, quality of life, patient satisfaction or direct and indirect costs of interventions.
Authors' conclusions:
We found little evidence from the eight trials on varnishes and gels included in this review to either support or refute the assertion that chlorhexidine is more effective than placebo or no treatment in the prevention of caries or the reduction of mutans streptococci levels in children and adolescents. There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. Further high quality research is required, in particular evaluating the effects on both the primary and permanent dentition and using other chlorhexidine-containing oral products.
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