Effect of Resin Coating on Surface Roughness and Microhardness of High Viscous Glass Ionomer Cements

High viscous glass ionomer cement (HVGIC) was recently developed for atraumatic restorative treatment (ART). However, its moisture sensitivity remains a limitation thus protective coating application is recommended. This study investigated the effect of resin coating on the surface roughness and microhardness of two HVGICs (Riva Self Cure HVGIC [RV] and Equia® Forte Fil [EQ]) conditioned in food-simulating liquids (FSLs). Fifty standard disc-shaped samples were fabricated using customised stainless-steel mould (10 × 2 mm). Coating was applied on top surface of all samples and subsequently divided into five groups: air (control), distilled water, 0.02 N citric acid, heptane and 50% ethanol-water solution. The samples were conditioned in FSLs at 37°C for seven days. Subsequently, the surface roughness and microhardness of samples were measured using optical profilometry and microhardness tester, respectively. SEM analysis was done for qualitative observation of surface morphological changes. Data were analysed using one-way ANOVA, two-way ANOVA and posthoc Tukey’s test (α = 0.05). Interestingly, the results revealed that surface roughness was significantly influenced by FSLs immersion, presence of coating and the materials itself (p < 0.001). The lowest surface roughness was found on control coated samples: RV (50.98±4.25) nm and EQ (62.77±3.92) nm, while the highest values seen on uncoated surfaces in citric acid: RV (505.26±31.10) nm and EQ (350.33±15.36) nm. RV samples had the lowest microhardness of 54.97±2.48 Vickers hardness number (VHN) post-immersion in citric acid. In conclusion, with the exception of RV conditioned in heptane and ethanol, the uncoated HVGICs generally had higher surface roughness than the coated HVGICs. HVGICs conditioned in citric acid showed the most significant increase in surface roughness and reduction in microhardness.

Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review

In recent years, due to a better understanding of the caries pathology and advances in dental materials, the utilization of non-invasive and minimally invasive techniques that delay/obviate the need for traditional restorations has started gaining momentum. This literature review focuses on some of these approaches, including fluoride varnish, silver diamine fluoride, resin sealants, resin infiltration, chemomechanical caries removal and atraumatic restorative treatment, in the context of their chemistries, indications for use, clinical efficacy, factors determining efficacy and limitations. Additionally, we discuss strategies currently being explored to enhance the antimicrobial properties of these treatment modalities to expand the scope of their application.

Minimal intervention dentistry for managing carious lesions into dentine in primary teeth: an umbrella review

Purpose This umbrella review systematically appraised published systematic reviews on Minimal Intervention Dentistry interventions carried out to manage dentine carious primary teeth to determine how best to translate the available evidence into practice, and to provide recommendations for what requires further research. Method An experienced information specialist searched MEDLINE, Embase, Cochrane Database of Systematic Reviews, Epistemonikos, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, and the NIHR Journals Library. In addition, the PROSPERO database was searched to identify forthcoming systematic reviews. Searches were built around the following four concepts: primary teeth AND caries/carious lesion AND Minimal Intervention Dentistry AND systematic review/meta-analysis. Searches were restricted to English language, systematic reviews with/without meta-analyses published between January 2000 and August 2020. Two reviewers independently screened all titles and abstracts. Interventions included involved no dentine carious tissue removal (fissure sealants, resin infiltration, topical application of 38% Silver Diamine Fluoride, and Hall Technique), non-restorative caries control, and selective removal of carious tissue involving both stepwise excavation and atraumatic restorative treatment. Systematic reviews were selected, data extracted, and risk of bias assessed using ROBIS by two independent reviewers. Studies overlap was calculated using corrected covered area. Results Eighteen systematic reviews were included in total; 8 assessed the caries arresting effects of 38% Silver Demine Fluoride (SDF), 1 on the Hall Technique (HT), 1 on selective removal of carious tissue, and eight investigated interventions using atraumatic restorative treatment (ART). Included systematic reviews were published between 2006 and 2020, covering a defined time frame of included randomised controlled trials ranging from 1969 to 2018. Systematic reviews assessed the sealing efficacy of fissure sealants and resin infiltration in carious primary teeth were excluded due to pooled data reporting on caries arrest in both enamel and outer third of dentine with the majority of these carious lesions being limited to enamel. Therefore, fissure sealants and resin infiltration are not recommended for the management of dentinal caries lesions in primary teeth. Topical application of 38% SDF showed a significant caries arrest effect in primary teeth (p < 0.05), and its success rate in arresting dental caries increased when it was applied twice (range between 53 and 91%) rather than once a year (range between 31 and 79%). Data on HT were limited and revealed that preformed metal crowns placed using the HT were likely to reduce discomfort at time of treatment, the risk of major failure (pulp treatment or extraction needed) and pain compared to conventional restorations. Selective removal of carious tissue particularly in deep carious lesions has significantly reduced the risk of pulp exposure (77% and 69% risk reduction with one-step selective caries removal and stepwise excavation, respectively). ART showed higher success rate when placed in single surface compared to multi-surface cavities (86% and 48.7–88%, respectively, over 3 years follow-up). Conclusion Minimal Intervention Dentistry techniques, namely 38% SDF, HT, selective removal of carious tissue, and ART for single surface cavity, appear to be effective in arresting the progress of dentinal caries in primary teeth when compared to no treatment, or conventional restorations. There is clear need to increase the emphasis on considering these techniques for managing carious primary teeth as a mainstream option rather than a compromise option in circumstances where the conventional approach is not possible due to cooperation or cost.

Influence of Cavity Size on the Survival of Single Surface Atraumatic Restorative Treatment Using Glass Ionomer Cement with or without Chlorhexidine Diacetate—A Randomized Trial

The purpose of the present study was to assess the influence of cavity size on the survival of conventional and CHX modified GIC in single surface primary molars receiving Atraumatic Restorative Treatment (ART). A randomized controlled trial with a split-mouth design was conducted on 90 children with symmetrical bilateral single surface carious lesions on primary molars. The teeth were randomly allotted to the conventional GIC group (group 1, n = 90) and CHX modified GIC group (group 2, n = 90). Both groups received atraumatic restorative treatment under rubber dam isolation. The cavity size was measured in terms of depth, mesiodistal, and buccolingual dimensions. The survival of ART restorations was measured after 6, 12, 18, and 24 months. The difference in proportion was tested using the Kruskal–Wallis H test, and survival curve estimation was carried out using the Kaplan–Meier method. The overall survival of all ART restorations was 83.3% at 24 months for the total sample. The survival of conventional GIC at 24 months was 83.9%, and for CHX-modified GIC was 82.7% (p > 0.05). The collective overall success of 65.1% was seen in the cavity volume category of 10–29.9 mm3. CHX modified GIC showed high survival percentage (60%) with depth >3 mm. To conclude, no significant difference was observed in the overall survival percentage of conventional and CHX modified GIC. Survival percentage was highest for cavities with a volume of 10–19.9 mm3.

Restaurações atraumáticas : usos e limitações

The Atraumatic Restorative Treatment are internationally known through their initials (A.R.T.) were recommended by the World Health Organization for dental caries treatment in places with no dental offices. Since then, other possibilities of use are appearing. This article presents a review of its uses and limitations in and out of the dental clinic.

Tratamiento restaurador atraumático: Eficacia clínica de ionómeros de vidrio en cavidades clase I

La Técnica de Restauración Atraumática (TRA) es un procedimiento preventivo–restauradormínimamente invasivo, como alternativa de tratamiento para poblaciones vulnerables conpoco o nulo acceso a servicios de salud, que consiste en la remoción del tejido dentario cariado utilizando sólo instrumentos manuales y un material adhesivo de restauración: el ionómerode vidrio de alta viscosidad debido a sus propiedades físicas y químicas, como la adhesión ala estructura dental, la biocompatibilidad, la reacción de fraguado químico y el desarrollo yla liberación de fluoruro, que le confieren características preventivas. Objetivo: Revisar laevidencia sobre la eficacia clínica, mediante el desempeño clínico y la supervivencia de losionómeros en el tratamiento restaurador atraumático en dentición decidua. Métodos: Se realizó la búsqueda de información: estudios in vitro, ensayos clínicos aleatorizados y revisionessistemáticas con antigüedad máxima de 10 años, en las bases de datos Medline, Scielo y Scopus, con las estrategias de búsqueda (“Dental Atraumatic Restorative Treatment/therapeuticuse”[Mesh] OR “Dental Atraumatic Restorative Treatment/trends”[MesH] OR ART OR PRAT) y((“Dental Atraumatic Restorative Treatment”[Mesh]) AND (“Glass Ionomer Cements”[Mesh])OR “Ketac-Molar Quick” [Supplementary Concept]). Conclusiones: Existe evidencia científicasuficiente para determinar el éxito de las restauraciones TRA en lesiones de una superficieen dentición decidua, incluso en comparación con los materiales restauradores de los tratamientos convencionales. El desempeño clínico y la supervivencia es alta cuando se utilizan ionómeros de alta viscosidad. Aún no hay consenso acerca de las ventajas del uso de ionómerosde menor costo, encapsulados, reforzados con metal y/o con propiedades mejoradas.

An Efficacy Study between High Viscosity Glass Ionomers and Resin Sealants in Fissure Caries Prevention: A 2-Year Split Mouth Randomized Controlled Trial

Objectives This clinical trial compared the efficacy of atraumatic restorative treatment (ART) sealants against resin-based sealants in terms of their retention and fissure caries preventive benefits over a period of 24 months among a section of school children in the Southern Indian state of Telangana. Materials and Methods A split mouth clinical trial employed 198 children, who received these sealants on their lower permanent first molars. Retention was assessed 6 monthly and caries annually Statistical Analysis Chi-square tests were utilized to analyze the retention rate and the incidence of dental caries between the two groups. Kaplan–Meier survival analysis plotted the cumulative survival percentage of partially, and fully retained sealants and the survival of dentin carious free pits and fissures among both the groups. A linear binary logistical regression analysis calculated the odds ratio. Results A statistical significant difference was observed in the retention rate between these sealants at every follow-up stage. The cumulative survival percentage of ART and resin sealants was calculated to be 30.9 and 37.5% by the end of 2 years. The Kaplan–Meier analysis showed no significant difference with regard to the survival of dentin carious free pits and fissures. The odds ratio for this trial was 0.747 (95% confidence interval: 0.493–1.13) Conclusion Resin sealants fared better than ART sealants in the field of retention. However, no significant differences were observed with regard to fissure caries prevention by the end of the study period.