Penetration of Silver Diamine Fluoride in Deep Carious Lesions of Human Permanent Teeth: An In Vitro Study

Background. When silver diamine fluoride (SDF) is used in conjunction with conservative caries removal in deep carious lesions, the distribution depth of silver is critical for safety and effectiveness. Objective. The purpose of this study is to determine the effect of selected caries removal on silver penetration when 38% SDF is applied to deep carious lesions in permanent teeth. Methods. Extracted permanent teeth with caries extending to the inner third of the dentin were used (N = 18). The periphery of the carious lesion was completely removed to the dentinoenamel junction (DEJ). In group A (n = 9), no further removal of carious tissue was performed, leaving necrotic dentin inner to the DEJ, whereas in group B (n = 9) superficial necrotic dentin was completely removed until leathery, slightly moist, reasonably soft dentin remained. SDF was applied for 3 minutes in both groups. Microcomputer tomography (micro-CT) and field emission scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (FESEM-EDS) were used to measure mineral density and silver distribution. The silver penetration depth/lesion depth (PD/LD) ratio was calculated for each sample. The Mann–Whitney U test was used to compare differences between the two groups. Results. The micro-CT analysis showed that the PD/LD ratios of group B (1.07–2.29) were marginally greater than those of group A (1.00–1.31). However, a statistically significant difference was not observed ( p value = 0.5078). When stratified by remaining dentin thickness (RDT), the PD/LD ratios of group B were still greater than those of group A only when RDT was >500 µm. The FESEM-EDS analysis indicated that silver particles precipitated throughout the entire thickness of the carious lesions. Conclusion. Applying SDF on a deep carious lesion and leaving the necrotic dentin pulpally did not affect silver penetration. However, the extent to which silver penetrates the remaining dentin beneath the lesions is dependent on the amount and characteristics of that dentin.

Application of caries assessment spectrum and treatment instrument for staging and evaluating treatment needs of an adult population - A hospital based cross-sectional study

Background: Application of caries assessment spectrum and treatment (CAST) instrument for staging and evaluating treatment needs of an adult population suffering from dental carious lesionObjectives: Study was conducted with aim of applying CAST instrument for staging adult urban Indian population according to severity of carious lesion and treatment needs required.Methods: Cross-sectional descriptive study was conducted on 300 adult patients. After training session and calibration of examiner, all patients were examined for the caries experience and CAST codes were recorded on a structured proforma.Results: Of 300 adult patients, 18% (54) adults have healthy dentition denoted by codes 0,1, and 2. 12 % and 15.3% adults were in reversible premorbidity stage (code 3) and morbidity stage (codes 4 and 5) respectively. The largest number of adults 29.7% were seen in serious morbidity stage (codes 6 and 7) followed by 21.3% adults in mortality stage (code 8) requiring either root canal treatment or extraction and replacement of teeth as treatment needs.Conclusion: CAST instrument has been found useful in staging adult population suffering with dental carious lesion and evaluating their treatment needs. Moreover, CAST is easy to apply for staging the carious lesion due its hierarchical structure and reporting results in an understandable manner.Keywords: Adults; Caries Assessment Spectrum and Treatment; Dental Caries; Treatment needs.

Restorative treatment decisions for carious lesions: Do Russian dentists and dental students apply minimal intervention dentistry?

Background The concept of minimal intervention dentistry (MID) includes both delayed restorative treatment and conservative caries removal, and is now recognised as an evidence-based approach for dental caries management. In order to determine if dental professionals in Russia are incorporating this concept into their clinical practice, we investigated the restorative treatment decisions of Russian dentists and dental students, and the factors associated with these decisions. Methods We included 171 general dental practitioners and dental therapists (collectively referred to here as “dentists”) from North-West Russia, and 76 dental undergraduate students from the Northern State Medical University in Arkhangelsk (response rate of 11.5% and 67.9%, respectively). Participants completed a questionnaire, which collected background information (sex, region of work, place of dental school graduation, practice type, years of working experience, working in an urban or rural area, and specialisation in restorative dentistry) and information on restorative treatment decisions for proximal and occlusal carious lesions of permanent teeth. Treatment options in accordance with MID were defined as intervention at dentin level and minimally invasive cavity preparation. Multinomial logistic regression was used for statistical analysis. Results For the proximal carious lesion, 9.4% of participants said they would employ both MID treatment options; 60.7% said they would choose only one; and 29.9% said they would use neither option. For the occlusal carious lesion, the corresponding figures were 37.2%, 52.1%, and 10.7%. No differences in restorative treatment options were observed among general dental practitioners, dental therapists, and dental students. For the proximal carious lesion, dentists from regions outside Arkhangelsk had 4.15 (95% confidence interval [CI] 1.13–15.27) times higher odds of following one versus both MID treatment options. For the occlusal carious lesion, working experience above 15 years was associated with higher odds of using only one versus both MID treatment options (adjusted odds ratio = 3.04, 95% CI 1.33–6.91). Almost all respondents preferred tooth-coloured materials for restorations; more than 75% chose resin-based composite. Conclusions The majority of Russian dentists and dental students do not apply the MID concept when treating dental caries in permanent teeth. Clinical protocols on dental caries treatment and dental school curriculums should be updated to place an enhanced focus on evidence-based practice and preventive strategies. Further studies with larger samples of Russian dentists and dental students and alternative methods of recruitment are needed to validate our results.

POLYETHYLENE FIBER-REINFORCED STRESS-REDUCED COMPOSITE RESIN RESTORATION ON EXTENSIVE CARIOUS LESION: A CASE REPORT

The purpose of this article about the use of polyethylene fibers and resin composite to treat large carious tooth providing a high strength restoration within one appointment. Polyethylene fibers decrease the polymerisation shrinkage and increase the fracture resistance of the teeth. The polyethylene fibers, besides offering the proper strength to the mastication forces, as well reduce the risk of fractures, voids and micro-filtration.

Overtreatment in Restorative Dentistry: Decision Making by Last-Year Dental Students

To evaluate the tendency for overdiagnosis and overtreatment upon different clinical situations among last-year students from the degree in dentistry from Valencia University (Spain) during the 2018–2019 course. A questionnaire consisting of 10 case exemplifications examining the diagnosis, treatment, and clinician’s attitude towards different common clinical situations regarding restorative dentistry was designed. Fifty-two students were surveyed, from whom 42 completed the questionnaire (80.77%). Data were analyzed descriptively. A total of 58.8% of the students correctly identified an early carious lesion in the occlusal surface of a molar, while 63.2% would perform unnecessary complementary tests for its diagnosis. The treatment for carious lesions in different evolutive phases with a vital pulp was correct between 51.2 and 92.7% of the cases. The treatment for irreversible pulp pathology and the restoration of the tooth with root canal treatment were adequately selected in 56.1% and 78.3% of the cases, respectively. For the repair of a faulty restoration, an overtreatment was proposed by 87.8% of the students. A tendency to perform unnecessary complementary tests for caries diagnosis was observed. Treatment caries proposals were in accordance with available evidence in the majority of the cases. Students tended to overtreat defective restorations and would perform unnecessary treatments in medically compromised patients.

Nano-Hydroxyapatite Gel and Its Effects on Remineralization of Artificial Carious Lesions

Introduction. Nano-hydroxyapatite gel (NHG) has never been investigated for enamel remineralization. This study evaluated the effects of two concentrations of NHG on remineralization of an artificial carious lesion in comparison with nano-HA toothpaste (NHT) and fluoride varnish (FV). Materials and Methods. Carious lesions were prepared on 100 enamel samples and divided into 5 groups: FV, NHT, 20% NHG, and 30% NHG. One untreated (NT) group was left as control. The hardness of the surface was evaluated before, during, and after remineralization. Microhardness at various phases and the percent recovery of hardness (%HR) were determined and analyzed with ANOVA. Polarized-light micrographs (PLM) were evaluated for depth of the carious lesion. Results. Significantly different remineralization capability was indicated for tested agents ( p < 0.05 ). NHT was significantly capable of remineralization greater than NHG, FV, and NT ( p < 0.05 ). No noticeable difference in %HR between 20% NHG and 30% NHG ( p > 0.05 ) was found. Decreasing in the depth of caries lesion was notified by PLM as applying either NHT or NHG as greater than FV, with no reduction in the depth for NT. Conclusions. Nano-HA both in toothpaste and gel form was capable of remineralization better than fluoride varnish. Comparable remineralization of 20% versus 30% NHG was evidenced. NHG for both concentrations was recommended as a capable remineralizing agent for caries remineralization. Clinical Significance: This study indicated that an application of nano-HA gel is an attractive route to deliver the material and can be more effective and less toxic than conventional formulations and provide its effectiveness directly at the site of action, especially for a noncooperative young child and medicinally intimidated patients who may face with inconvenience in using toothbrush and toothpaste for hygiene control.

Commercially Available Ion-Releasing Dental Materials and Cavitated Carious Lesions: Clinical Treatment Options

The contemporary approach for operative caries management emphasizes personalized interventions for each patient, dependent upon the individual’s caries susceptibility/risk, the stage of the carious lesion and its activity. The clinician’s challenge is to optimize the extent of cavity preparation and the choice of dental restorative biomaterials, appreciating the benefits offered by ion-releasing restorative materials. There is a growing application of bioactive/bio-interactive materials in minimally invasive operative dentistry, as they may help with tissue recovery by ion release. In case of moderate or extensive occlusal cavitation, the clinical criteria include the individual caries susceptibility and carious lesion activity. In high caries risk cases, ion-releasing biomaterials (IRB) can be used, as well as for active carious lesions. In proximal lesions, the clinical criteria include the individual caries susceptibility, the lesion activity and presence of cavities with little or no enamel at the gingival margin. This article aims to discuss the restorative ion-releasing options, according to different clinical situations, and the caries susceptibility to manage cavitated carious lesions in permanent adult teeth.

Application of Er,Cr:YSGG laser versus photopolymerization after silver diamine fluoride in primary teeth

Examine the effect of dental curing light and laser treatments applied after Silver Diamine Fluoride (SDF) on dentin hardness in carious primary molars. This in-vitro study consisted of 30 extracted primary molars with caries extending into dentin without pulpal involvement. The collected teeth were randomly divided into three groups: group 1: received SDF then Sub-ablative low-energy of Er,Cr:YSGG laser, group 2: received SDF followed by application of curing light for 40 s, group 3: had SDF treatment only. In all groups, 38% Ag (NH3)2F SDF was used. Vickers hardness test was performed on sound dentin below carious lesion. Kruskal–Wallis Test was used to determine the mean difference in dentin hardness of the groups at 5% Significance level using SPSS software. Surface hardness of sound dentin below the carious lesion was statistically significantly higher in the laser + SDF group (891.24 ± 37.33 kgf/mm2) versus the two other groups (Light cure + SDF = 266.65 ± 90.81 kgf/mm2 and SDF only = 117.91 ± 19.19 kgf/mm2) with p-value ≤ 0.001. Although Photopolymerization of SDF increases the surface hardness of sound dentin below the carious lesion, applying laser after SDF has the highest surface hardness due to the laser’s sub-ablation of dentin.

Clinical Analysis of the Diagnostic Accuracy and Time of Execution of a Transillumination Caries Detection Method Compared to Bitewing Radiographs

Purposes: this clinical study evaluated the accuracy and execution time of a digital imaging fiber-optic transillumination (DIFOTI) technique for the detection of approximal caries in posterior teeth compared to intra-oral examination associated with bitewing radiographs. Methods: one hundred patients were selected and submitted to clinical inspection and bitewing radiographs. The outcomes of this process were converted into scores, according to the International Caries Detection and Assessment System (ICDAS): 0—sound tooth; 1, 2, and 3—carious lesion confined within enamel; 4, 5, and 6—dentin carious lesion. Subsequently, an independent investigator acquired digital images of the same teeth using a DIFOTI device (DIAGNOcam, Kavo Dental), which were also converted into ICDAS scores. The time required for executing diagnostic procedures was measured. The clinical sensitivity and specificity of DIFOTI were analyzed by receiver operating characteristic (ROC) curves. The time necessary to perform the diagnostic methods was evaluated by Mann–Whitney U (alfa = 0.05). Results: the overall test accuracy for the DIFOTI-based device ranged from 0.717 to 0.815 (area under the ROC curve) with p < 0.0001 for all ICDAS scores. Bitewing radiographs took almost twice the time required by DIFOTI (p < 0.001). Conclusions: the DIFOTI-based device DIAGNOcam provided accurate detection of approximal caries in posterior teeth, even at early stages. The technique employed for transillumination caries diagnosis by the same device took less time than conventional bitewing radiographs. Clinical Relevance: transillumination devices, such as DIAGNOcam, can be accurately used for caries diagnosis in approximal surfaces of posterior teeth, demanding less clinical time and without radiation-related risks.