Long-Term Follow-Up of Restorations of Equine Cheek Teeth Infundibula (2006–2017)

Background:Caries of the infundibula of equine cheek teeth can lead to significant dental disease including increased attritional wear, pulpar and apical disease, secondary sinusitis, and dental fracture. Restorations of cavities of equine cheek teeth infundibula have been performed since 1889. Recent advances in dental materials, instrumentation, and techniques have facilitated the use of dental restoration techniques by equine veterinary practitioners. No studies to date have demonstrated the safety or efficacy of restorations of equine cheek teeth infundibula.Objectives:To assess the long-term results of restorations of equine cheek teeth affected by infundibular caries, to report on the safety of the procedure, and to give guidelines for future restorative therapies.Study Design:Retrospective analysis of results of clinical and oroscopic examination of horses that underwent infundibular restoration procedures between 2006 and 2017.Methods:A total of 223 infundibula in 185 maxillary cheek teeth in 92 horses were restored using a variety of dental materials including glass ionomer cement, flowable and compactible resin composites. The time between restoration and re-examination was recorded along with findings of clinical signs in the interim, restorative material loss, and any further pathological changes of the teeth including caries progression, fracture, or apical disease. Follow-up examinations were performed over two study periods 2006–2012 and in 2017.Results:Over the full study period, 99% of treated horses available for follow-up examinations had no adverse clinical signs or developed any abnormalities of restored teeth observable on oroscopic examination. Of horses re-examined, 83% of restorations were shown to have minimal or no loss of the restoration material, with occlusal surface wear visibly comparable to other adjacent maxillary teeth. Statistical analysis showed success of the procedure was related to the restorative material used, the restoration technique, and the caries grade present at the time of restoration (grade 2 is more successful than grade 3).Main Limitations:There are no case controls in this study and therefore it is not clear if restoration of equine infundibula is a consistently beneficial procedure, or at which grade of caries progression restorations should be performed for optimum benefit. The procedures were not re-examined at consistent regular times creating some difficulties in standardizing results. Re-examinations of treated horses did not consistently include radiography or computed tomography and therefore some apical changes may have occurred in treated teeth without visual oroscopic or external clinical signs.Conclusion:Restoration of equine infundibula using materials developed for human dentistry including flowable resin composites is a safe and long-lasting procedure and appears to prevent the development of further pathological changes including apical infection and dental fracture.

Comparision of effectiveness of calcium hyroxide and MTA when used as an indirect pulp therapy (IPT) material- A clinical and radiological assessment

: The present study assessed and compared the success of an IPT procedure both clinically and radiographically when Dycal and MTA were used as an IPT material on primary molars.Children aged 4-9 years were screened and those who fulfilled the inclusion criteria were selected. Accordingly fiftychildren were divided into 2 groups with 25 patient in each group. Cavity preparation was done and the two test materials (Dycal and MTA) were placed at the base in their respective groups and restored with RMGIC. Post-operative radiograph was taken for baseline data. Patients were assessed at Subsequent at 1 and 6 months both clinically and radiographically. Both the test materials had formed a good biological seal, arrested further caries progression and did not cause any adverse pulpal reaction. However the amount of reparative dentin formed was highest in the Dycal group followed by MTA group. Both the experimental materials Dycal and MTA showed reparative dentin formation at the end of 1 and 6 months and also formed a good biological seal and maintained vitality of the pulp which indicates both are good IPT material.

CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol

Background Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this “Caries OUT” study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time. Methods In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children’s oral-health behaviour change, parents’ and dentists’ process acceptability, and costs exploration. A sample size of 258 3–5 and 6–8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments’ time. A trained examiner per centre will conduct examinations at baseline, at 5–5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child’s CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents’ and dentists’ process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate. Discussion The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time. Trial registration: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h. Protocol-version 2: 27/01/2021.

Biofilm formation by Streptococcus mutans and its inhibition by green tea extracts

Dental Caries is considered one of the most existing and worldwide common diseases related to the oral cavity affecting both children and adults. Streptococcus mutans is the main cariogenic microorganism involved in the dental caries progression. Natural products such as herbal plants were found to have less side effects and economic value than those of the chemically synthesized antibiofilm agents. This study aimed to isolate Streptococcus mutans from different oral samples taken from saliva and dental plaques specimens to determine their capability for biofilm formation and to evaluate the antibiofilm activity of aqueous and alcoholic green tea extracts. The results revealed that 35, 4 and 1% of recovered dental plaque isolates exhibited strong, moderate and weak biofilm formation capabilities versus 26, 12 and 2% for those recovered from saliva. Two green tea extracts (aqueous and alcoholic) were tested for their antibiofilm formation activity against some selected S. mutans isolates. The results showed that the minimum biofilm inhibitory concentrations (MBICs) of the alcoholic and aqueous green tea extracts were in the range of 3.1 to 12.5 mg/ml and 6.5 to 50 mg/ml, respectively. Accordingly, green tea extracts can be incorporated in various oral preparations for preventing dental caries.

How combining different caries lesions characteristics may be helpful in short-term caries progression prediction: model development on occlusal surfaces of primary teeth

Background Few studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status. Methods The occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions. Results 205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959–0.966) than those combining parameters (AIC:365–393, C:0.958–0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91). Conclusions Univariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.