Tooth‐coloured restorative materials are being used increasingly more often in Class II preparations in permanent teeth. Using a practice‐based study design, we aimed to assess the survival time of Class II restorations and to identify factors relevant to their longevity. Class II restorations ( n = 4,030), consisting of resin composites (81.5%), compomers (12.7%), amalgams (4.6%), and glass‐ionomer cement restorations (1.2%), were placed in 1,873 patients with a median age of 15 yr. In total, 92.7% of restorations were placed due to primary caries and 5.8% were replacements. After an average follow‐up period of 4.6 yr, 61.6% of the restorations were successful, 11.2% had failed, and 27.2% were not available for evaluation (owing to patient drop‐out). The mean annual failure rate was 2.9% for resin‐composite restorations and 1.6% for amalgams. For resin‐composite restorations, secondary caries was the most common reason for replacement (73.9%), followed by loss (8.0%), fracture (5.3%), and marginal defects (2.4%). Multilevel Cox‐regression analyses identified young age of the patient, high previous caries experience, deep cavities, and saucer‐shaped preparation technique as predisposing to shorter longevity of resin‐composite restorations. One brand of resin composite had a shorter survival time than the others.
Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (-22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.
The purpose of this systematic review was to calculate the 5-yr survival rates of all-ceramic zirconia-based fixed dental prostheses (FDPs) and to analyze technical and biological complications. An electronic literature search of MEDLINE (PubMed) was conducted independently by three reviewers to identify clinical studies from 1999 to 2009 and was completed by a manual search. Keywords and inclusion and exclusion criteria were well-defined. The search revealed 399 titles and led to the final analysis of 18 full-text articles. Nine studies met the inclusion criteria. Extracted data were statistically calculated into 5-yr survival rates and 5-yr complication-free rates by using Poisson regression analysis. In total, 310, 3- to 4-unit FDPs and 20 FDPs with more than 4 units were included. The estimated 5-yr survival rate for all FDPs was 94.29% (95% CI: 58.98-99.32); 19 FDPs were lost as a result of catastrophic failures. The 5-yr complication-free rate regarding technical complications was 76.41% (95% CI: 42.42-91.60) with chipping being the most frequent complication. Regarding biological complications, the 5-yr complication-free rate was 91.72% (95% CI: 59.19-98.53). The survival rates of zirconia-based short-unit FDPs are promising. However, an important improvement of the veneering systems is required, and for FDPs with more units in function, further randomized, controlled clinical trials are necessary.
Guided bone regeneration ( GBR ) is commonly used in combination with the installment of titanium implants. The application of a membrane to exclude non‐osteogenic tissues from interfering with bone regeneration is a key principle of GBR . Membrane materials possess a number of properties which are amenable to modification. A large number of membranes have been introduced for experimental and clinical verification. This prompts the need for an update on membrane properties and the biological outcomes, as well as a critical assessment of the biological mechanisms governing bone regeneration in defects covered by membranes. The relevant literature for this narrative review was assessed after a MEDLINE /PubMed database search. Experimental data suggest that different modifications of the physicochemical and mechanical properties of membranes may promote bone regeneration. Nevertheless, the precise role of membrane porosities for the barrier function of GBR membranes still awaits elucidation. Novel experimental findings also suggest an active role of the membrane compartment per se in promoting the regenerative processes in the underlying defect during GBR , instead of being purely a passive barrier. The optimization of membrane materials by systematically addressing both the barrier and the bioactive properties is an important strategy in this field of research.
Implant therapy in the atrophic posterior maxilla becomes challenging in the presence of reduced maxillary bone height. Sinus augmentation can be performed for resolving this condition prior to implant placement. The aim of this article was therefore to evaluate implant survival rates in the grafted sinus taking into account the influence of the implant surface, graft material, and implant placement timing. A systematic review of the literature was performed. Articles retrieved from electronic databases were screened using specific inclusion criteria, and data extracted were divided according to: graft material (autogenous, non‐autogenous, composite graft), implant surface (machined or textured), and implant placement (simultaneous with grafting or delayed). Fifty‐nine articles were included. Survival rates for implants placed in grafts made of bone substitutes alone and grafts of composite material were slightly better than the survival rates for implants placed in 100% autogenous grafts. Over 90% of implants associated with non‐autogenous grafts had a textured surface. Textured surfaces achieved better outcomes compared with machined surfaces, and this was independent of the graft material. Simultaneous and delayed procedures had similar outcomes. It may be concluded that bone substitutes can be successfully used for sinus augmentation, reducing donor‐site morbidity. Long‐term studies are needed to confirm the performance of non‐autogenous grafts. The use of implants with a textured surface may improve the outcome in any graft type.
Mild acids are known to activate dentin matrix metalloproteinase (MMPs). All self‐etching dental adhesives are acidic (pH 1.5–2.7) and may activate dentin MMPs. The purpose of this study was to compare the ability of several all‐in‐one adhesives to activate gelatinolytic and collagenolytic activities in powdered mineralized dentin. Powdered dentin made from human teeth was mixed with all‐in‐one adhesives (Clearfil Tri‐S Bond, G‐Bond, Adper Prompt L‐Pop) or a self‐etching primer (Clearfil SE Bond primer) for varying times and then the reaction was stopped by extracting the adhesives using acetone. Fresh untreated mineralized dentin powder had a gelatinolytic activity of 3.31 ± 0.39 relative fluorescent units (RFU) per mg dry weight (24 h) that increased, over storage time, to 87.5 RFU mg −1 (24 h) after 6–8 wk. When fresh powder was treated with acidic Tri‐S Bond, the gelatinolytic activity increased from 3.24 ± 0.70 RFU mg −1 to > 112.5 RFU mg −1 (24 h) after 20 min and then remained unchanged. Monomers with lower pH values produced less activity. There was a significant, direct correlation between gelatinolytic activity and pH, with Tri‐S giving the highest activity. Coating dentin powder with Tri‐S resin prevented fluorescent substrates from gaining access to the enzyme, even though it activated the enzyme. In conclusion, self‐etch adhesives may activate latent MMP and increase the activity to near‐maximum levels and contribute to the degradation of resin–dentin bonds over time.
The purpose of the present study was to estimate the point prevalence of dental fear and dental phobia relative to 10 other common fears and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV-TR subtypes of specific phobia. Data were also analysed to examine differences with regard to severity, presence of distressing recollections of fear-related events, gender, and prevalence across age. Data were obtained by means of a survey of 1,959 Dutch adults, 18-93 yr of age. Phobias were assessed based on DSM-IV-TR criteria, whereas severity of present fears was assessed using visual analogue scales. The prevalence of dental fear was 24.3%, which is lower than for fear of snakes (34.8%), heights (30.8%), and physical injuries (27.2%). Among phobias, dental phobia was the most common (3.7%), followed by height phobia (3.1%) and spider phobia (2.7%). Fear of dental treatment was associated with female gender, rated as more severe than any other fear, and was most strongly associated with intrusive re-experiencing (49.4%). The findings suggest that dental fear is a remarkably severe and stable condition with a long duration. The high prevalence of dental phobia in the Netherlands is intriguing and warrants investigation in other countries.
The need for cross-culturally adapted oral-health specific health outcome measures is increasingly recognized in Germany. Following accepted cultural adaptation technique guidelines, we report the development of the German version of the Oral Health Impact Pro le ( OHIP). The original 49 items were translated using a forward backward method. A de novo development of German items established content validity. A priori hypothesized associations between the OHIP summary score and self-reported oral health and five oral disorders were confirmed in a random sample of the general population (n = 163, age 20 60 yr). These associations were interpreted as support for construct validity. The instrument's responsiveness, as indicated by a mean OHIP summary score change from 45.0 to 28.3, was established in 67 consecutive patients treated for temporomandibular disorder pain ( age 19 85 yr; 72% women). Test-retest reliability was demonstrated by intraclass correlation coefficients of 0.63-0.92 for dimensions and summary scores ( convenience sample, n = 30, age 18 85 yr; 53% women). Internal consistency was high (Cronbach's alpha > 0.74). Sufficient discriminative and evaluative psychometric properties of the Oral Health Impact Pro le German version (OHIP-G) make the instrument suitable for assessment of oral health-related quality of life in cross-sectional as well as longitudinal studies.
Aim of the study was to compare the trimming and non‐trimming variants of the microtensile technique with the ‘micro’ push‐out test in the ability to measure accurately the bond strength of fiber posts luted inside root canals. In 15 endodontically treated teeth (Group A), fiber posts were cemented with Excite DSC in combination with Variolink II (Ivoclar‐Vivadent). In 15 roots RelyX Unicem (3M‐ESPE) was used for fiber post luting (Group B). Within each group, the bond strength of cemented fiber posts was assessed with the trimming and non‐trimming microtensile technique, as well as with the push‐out test. The great number of premature failures (16.9% in Group A, 27.5% in Group B) and the finding of high standard deviation values make questionable the reliability of the trimming microtensile technique. With the non‐trimming microtensile technique, only five sticks were obtained from a total of six roots. The remaining specimens failed prematurely during the cutting phase. With the push‐out test no premature failure occurred, the variability of the data distribution was acceptable, and regional differences in bond strength among root levels could be assessed. Relatively low values of bond strength were, in general, recorded for luted fiber posts. In conclusion, when measuring the bond strength of luted fiber posts, the push‐out test appears to be more dependable than the microtensile technique.
The main objective of this study was to assess whether dental caries status was related to nutritional status in preschool urban Brazilian children aged 12–59 months. Dental and anthropometric examinations were conducted on 1,018 12–59‐month‐old children during the National Day of Children Vaccination. Dental caries prevalence and severity were measured using the decayed, missing or filled surfaces (dmfs) index. The World Health Organization (WHO) Child Growth Standards Reference was used to evaluate nutritional status. Results on nutritional status were presented as Z‐scores. The data collected included socio‐economic conditions. Multilevel linear regression was applied to investigate the effect of nutritional, socio‐economic, and demographic factors on the status of children’s dental caries. Caries was present in 23.4% of children. The final hierarchical logistic model showed a significant association between nutritional status and caries experience. Children with low Z‐scores in some indexes had an increased risk of having caries. In addition, children whose mothers had < 8 yr of education and were from lower‐income families had an increased risk of high levels of dental caries. There was an association between nutritional and socio‐economic factors, and dental caries. In conclusion, underweight children and those with adverse socio‐economic conditions were more likely to have caries experience.
The aim of this systematic review was to compare the therapeutic and adverse effects of lingual and labial orthodontic fixed appliances from clinical trials on human patients in an evidence‐based manner. Randomized and prospective non‐randomized clinical trials comparing lingual and labial appliances were included. Risk of bias within and across studies was assessed using the Cochrane tool and the Grading of Recommendations Assessment, Development and Evaluation ( GRADE ) approach. Random‐effects meta‐analyses were conducted, followed by subgroup and sensitivity analyses. Six electronic databases were searched from inception to July 2015, without limitations. A total of 13 papers pertaining to 11 clinical trials were included with a total of 407 (34% male/66% female) patients. Compared with labial appliances, lingual appliances were associated with increased overall oral discomfort, increased speech impediment (measured using auditory analysis), worse speech performance assessed by laypersons, increased eating difficulty, and decreased intermolar width. On the other hand, lingual appliances were associated with increased intercanine width and significantly decreased anchorage loss of the maxillary first molar during space closure. Based on existing trials, there is insufficient evidence to make robust recommendations for lingual fixed orthodontic appliances regarding their therapeutic or adverse effects, as the quality of evidence was low.
This aim of this study was to compare universal adhesives and two‐step self‐etch adhesives in terms of dentin bond fatigue durability in self‐etch mode. Three universal adhesives – Clearfil Universal, G‐Premio Bond, and Scotchbond Universal Adhesive – and three‐two‐step self‐etch adhesives – Clearfil SE Bond, Clearfil SE Bond 2, and OptiBond XTR – were used. The initial shear bond strength and shear fatigue strength of resin composite bonded to adhesive on dentin in self‐etch mode were determined. Scanning electron microscopy observations of fracture surfaces after bond strength tests were also made. The initial shear bond strength of universal adhesives was material dependent, unlike that of two‐step self‐etch adhesives. The shear fatigue strength of Scotchbond Universal Adhesive was not significantly different from that of two‐step self‐etch adhesives, unlike the other universal adhesives. The shear fatigue strength of universal adhesives differed depending on the type of adhesive, unlike those of two‐step self‐etch adhesives. The results of this study encourage the continued use of two‐step self‐etch adhesive over some universal adhesives but suggest that changes to the composition of universal adhesives may lead to a dentin bond fatigue durability similar to that of two‐step self‐etch adhesives.
This study correlated the morphological characteristics with the bond strengths of various resin cements used for bonding fiber posts to root canal dentin. Fifty glass-fiber posts (FRC Postec Plus) were luted into the root canals of extracted human anterior teeth using five resin cements (n = 10): Panavia F 2.0, PermaFlo DC, Variolink II, RelyX Unicem, and Clearfil Core. Before insertion of the post, the adhesive systems were labeled with fluorescein and the resin cement was labeled with rhodamine isothiocyanate. The roots were sectioned into three slices (of 2 mm thickness), and each slice was analyzed using confocal laser scanning microscopy in dual fluorescence mode to determine hybrid layer thickness, the number of resin tags, and the number of broken tags. Bond strengths were measured using a micro push-out test. Bond strengths to root canal dentin, as well as the morphological characteristics, were significantly affected by the materials. However, these factors did not correlate. The self-adhesive resin cement, which showed the formation of a hybrid layer and resin tags only sporadically, had the highest bond strengths. These results indicate that chemical interactions between the adhesive cement and hydroxyapatite may be more crucial for root dentin bonding than the ability of the same material to hybridize dentin.
Dark‐colored fruit berries are a rich source of polyphenols that could provide innovative bioactive molecules as natural weapons against dental caries. High‐quality extracts of cranberry, blueberry, and strawberry, and a combination of the three berry extracts (Orophenol), were used to treat 24‐h‐old Streptococcus mutans biofilms. The grown biofilms were treated with the berry extracts at concentrations ranging from 62.5 to 500 μ g ml −1 . Treated biofilms were assessed for metabolic activity, acidogenicity, biovolumes, structural organization, and bacterial viability. The biofilms treated with the cranberry and Orophenol extracts exhibited the most significant reductions in metabolic activity, acid production, and bacterial/exopolysaccharide ( EPS ) biovolumes, while their structural architecture appeared less compact than the control‐treated biofilms. The blueberry extract produced significant reductions in metabolic activity and acidogenicity only at the highest concentration tested, without significantly affecting bacterial/ EPS biovolumes or biofilm architecture. Strawberry extracts had no significant effects on S. mutans biofilms. None of the berry extracts were bactericidal for S. mutans . The results indicate that cranberry extract was the most effective extract in disrupting S. mutans virulence properties without significantly affecting bacterial viability. This suggests a potential ecological role for cranberry phenols as non‐bactericidal agents capable of modulating pathogenicity of cariogenic biofilms.
Psychosocial factors may explain variance in health beyond conventional indicators, such as behaviours. This study aimed to examine changes in health associated with perceived stress, social support, and self‐efficacy, controlling for sociodemographic characteristics and health behaviour. A random sample of 45‐ to 54‐yr‐old subjects was surveyed in 2004–2005, with a follow‐up 2 yr later. The outcomes were self‐reported changes in oral and general health. Explanatory variables included stress, social support, and perceived health competence with covariates of income, gender, dentition status, toothbrushing, and smoking. Responses were collected from 986 persons (response = 44.4%). At the 2‐yr follow‐up, 25.6% reported worsening in oral health and 15.3% reported worsening in general health. Prevalence ratios ( PR ) from adjusted log‐binomial regression showed an association between worsening oral health and higher perceived health competence ( PR = 0.75, 95% CI: 0.57–0.99), and worsening general health was associated with perceived health competence ( PR = 0.82, 95% CI: 0.72–0.94) and stress ( PR = 1.17, 95% CI: 1.03–1.32). Worsening oral and general health were seen for male subjects ( PR = 1.33, 95% CI: 1.06–1.68 and PR = 1.14, 95% CI: 1.01–1.29) and low income ( PR = 1.40, 95% CI: 1.04–1.89 and PR = 1.20, 95% CI: 1.03–1.40). Health‐related self‐efficacy representing psychosocial resilience was associated with oral and general health, while stress was associated with general health. Psychosocial factors were independent predictors of change in health after controlling for sociodemographic characteristics and health behaviours.
The aim of this study was to investigate the association between orthodontic treatment need and oral health‐related quality of life ( OHRQ oL) among 12‐yr‐old children. The study also assessed whether self‐esteem modifies and/or moderates this relationship. Cross‐sectional data on 406 schoolchildren aged 12 yr were analyzed. Data on socio‐economic and demographic characteristics, dental pain, self‐esteem, and OHRQ oL were collected using validated questionnaires. Orthodontic treatment need was assessed, through dental examinations, using the dental aesthetic index ( DAI ). Multiple negative binomial regression and path analysis were used to estimate the association of orthodontic treatment need and self‐esteem with OHRQ oL. A modifying effect of self‐esteem on the relationship between DAI and OHRQ oL was observed. Self‐esteem did not mediate the abovementioned relationship. Children with lower scores of self‐esteem had worse OHRQ oL among those with lower orthodontic treatment need (a DAI score of < 31). However, self‐esteem did not influence the association between DAI and OHRQ oL in children with greater orthodontic treatment need (a DAI score of ≥ 31). Self‐esteem attenuated the impact of malocclusion on OHRQ oL in children with minor or definite malocclusion, but not among those with severe or very severe malocclusion. Self‐esteem appears to buffer the impact of malocclusion on OHRQ oL in children with minor orthodontic treatment need.
Occlusal support may influence muscular function during complex motor tasks. This study evaluated the duration and sequence of muscular activation of masticatory (temporal, masseter), postural head/neck (sternocleidomastoid, trapezius), postural trunk (rectus abdominis, paravertebrals), and low extremity strength (rectus femoris, gastrocnemius) muscles during simulation of activities of daily living ( ADL ) in edentulous women wearing complete dentures (n = 10) and in dentate women (n = 10). Electromyographic activity was recorded during tests of stand‐up/sit down in the Chair, sit up/lie down in the Bed and lift/lower Bags. Occlusal support (dentures) had a significant effect on duration of muscular activation in the Chair Test: the masseter muscle activated longer with dentures during the standing movement. The masseter and sternocleidomastoid muscles showed significant alteration in their order of activation in non‐denture‐wearing women. For the Bed Test, dentures had significant effect for the gastrocnemius during the sitting‐up phase and for the rectus abdominis during the lying‐down movement. For the Bag Test, head/neck muscles were activated in a different order as a function of occlusal support. Anticipation of activation of the paravertebral muscles, rectus abdominis, and gastrocnemius was observed in dentate women compared with denture wearers. These findings suggest that occlusal support influences electromyographic activity of some muscles during simulation of ADL .
In addition to improved oral health and function, many people are motivated to undergo orthognathic surgery to improve their facial aesthetics and overall psychological well‐being (daily affect and satisfaction with life). This article explains the phenomenon of hedonic adaptation, which challenges the notion that patients treated with orthognathic surgery can expect to experience improvements in psychological well‐being following surgery. We review evidence for hedonic adaptation across a variety of life circumstances and explain the psychological processes which account for the relative stability of people's well‐being over their life course despite significant positive (and negative) changes in their circumstances. We examine the conditions that assist and inhibit hedonic adaptation to positive life events, and argue that if patients are made aware of these processes, they are more likely to achieve sustained improvements in psychological well‐being following orthognathic surgery. Based on our narrative review of evidence for hedonic adaptation, we conclude that orthognathic surgery should not be expected to improve patients’ psychological well‐being in the long term and suggest that patients be advised to take intentional steps to preserve any improvements in their day‐to‐day affect and satisfaction with life that arise as a result of their surgery.
Polydopamine‐templated hydroxyapatite ( tHA ) is a type of nano‐biomaterial that can promote osteogenesis in bone tissue engineering. However, high concentrations of tHA stimulate production of reactive oxygen species ( ROS ), resulting in cell injury and apoptosis. Metformin has been demonstrated to activate the adenosine monophosphate‐activated protein kinase ( AMPK ) signaling pathway, which induces autophagy and decreases ROS production to prevent apoptosis. The present study was performed to investigate the potential application of tHA in combination with metformin in periodontal bone tissue engineering. Human periodontal ligament stem cells ( hPDLSC s) were exposed to tHA in the presence or absence of metformin, and cytocompatibility and osteogenesis were detected by related assays. Additionally, the autophagy signaling pathway was analyzed by western blotting. Polydopamine‐templated hydroxyapatite, in combination with metformin, substantially reduced ROS production and apoptosis, and enhanced proliferation and osteogenic differentiation of hPDLSC s. Enhanced levels of microtubule‐associated protein 1 light chain 3 II and Beclin‐1 were observed after exposure to tHA plus metformin. Expression of phosphorylated AMPK was increased and that of phosphorylated mammalian target of rapamycin ( mTOR ) was decreased after exposure to tHA plus metformin. Taken together, our results demonstrate that tHA , combined with metformin, increases the viability of hPDLSC s via the AMPK / mTOR signaling pathway by regulating autophagy and further improving the osteogenic effect.