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European Archives of Paediatric... Oct 2022This umbrella review systematically appraised published systematic reviews on Minimal Intervention Dentistry interventions carried out to manage dentine carious primary...
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.
Topics: Humans; Dental Atraumatic Restorative Treatment; Dental Caries; Pit and Fissure Sealants; Systematic Reviews as Topic; Tooth, Deciduous; Meta-Analysis as Topic
PubMed: 34784027
DOI: 10.1007/s40368-021-00675-6 -
Dental Materials : Official Publication... Oct 2021The purpose of this systematic review and meta-analysis was to analyze the literature on the bond strength of self-etching (SE) adhesives containing 10-MDP or other... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The purpose of this systematic review and meta-analysis was to analyze the literature on the bond strength of self-etching (SE) adhesives containing 10-MDP or other acidic functional monomers, comparing the bonding performance of both compositions.
METHODS
This study is registered in PROSPERO (CRD42020175715) and it followed the PRISMA Statement. The literature search was performed in PubMed, Web of Science, SciELO, Scopus, LILACS, IBECS, and BBO from the starting coverage date through 30 June 2021. Study eligibility criteria consisted of in vitro studies that evaluated the bond strength (microtensile, microshear, tensile or shear testing) to sound dentin/enamel of a minimum of two distinct SE systems, with at least one material containing 10-MDP and one other being comprised of a distinct acidic composition. Statistical analyses were carried out with RevMan 5.3.5 and using random-effects models with the significance level at p < 0.05. Also, Bayesian network meta-analysis (NMA) was conducted using MetaInsight V3 tool.
RESULTS
From 740 relevant studies evaluated in full-text analysis, 210 were incorporated to the systematic review and 206 in meta-analysis. The majority of studies was classified as having medium risk of bias (56.7%), followed by low (35.2%) and high (8.1%) risk of bias. Data from a total of 64 adhesive systems were collected, which favored the 10-MDP-based group at both dentin (overall effect: 6.98; 95% CI: 5.61, 8.36; p < 0.00001) and enamel (overall effect: 2.79; 95% CI: 1.62, 3.96; p < 0.00001) substrates. Microtensile testing was more frequently used (73.4%) in the included studies. Adhesives based on 10-MDP showed greater bonding performance than adhesives comprised of monomers such as PENTA, 6-MHP, 4-META, 4-MET, pyrophosphate esters, mixed composition or monomers derived from sulfonic acid (p ≤ 0.01); whereas similar bond strength values were verified between 10-MDP-based materials and those containing PEM-F, acrylamide phosphates, 4-AET, MAC-10, or monomers derived from polyacrylic and phosphonic acids (p ≥ 0.05). Adhesives based on GPDM were the only ones that resulted in greater bonding potential than the 10-MDP-based group (p = 0.03). Dental bonds in dentin were favored with the application of 2-step 10-MDP-based adhesives; whereas in enamel the dental bonds were favored for both 2-steps versions of adhesives, regardless of the presence of 10-MDP. Indirect evidence from NMA revealed that 1-step 10-MDP-free and universal 10-MDP-free adhesives seemed to perform worst in dentin and enamel, respectively.
SIGNIFICANCE
Adhesives containing 10-MDP showed higher bonding performance than materials formulated with other acidic ingredients, although this result relied on the type of mechanical testing, type of the substrate, acidic composition of the adhesive, and the application category of the SE system. This review summarized the effects of the foregoing factors on the adhesion to dental substrates.
Topics: Bayes Theorem; Dental Bonding; Dental Cements; Dentin; Dentin-Bonding Agents; Materials Testing; Methacrylates; Resin Cements; Tensile Strength
PubMed: 34456050
DOI: 10.1016/j.dental.2021.08.014 -
Pediatric Dentistry Mar 2019The purpose of this study was to perform a systematic review to assess current evidence for association between various risk factors and the prevalence or incidence of... (Meta-Analysis)
Meta-Analysis
The purpose of this study was to perform a systematic review to assess current evidence for association between various risk factors and the prevalence or incidence of early childhood caries (ECC). Two reviewers searched various databases until January 2019. The Newcastle-Ottawa scale was used to perform risk of bias assessment. The included studies were categorized according to the World Bank classification. Data were summarized in a meta-analysis using fixed and random effects inverse-generic meta-analyses. A total of 7,034 records involving 89 studies that evaluated 1,352,097 individuals were included; 23 were high, 46 were moderate, and 20 were of low quality. A total of 123 risk factors were found. Meta-analysis revealed that the strongest risk factors found in the high-income countries were presence of dentinal caries (dmft greater than zero; odds ratio [OR] equals 4.21 [2.18 to 8.16]) and high levels of mutans streptococci (OR equals 3.83 [1.81 to 8.09]). In upper-middle-income countries, presence of enamel defects (OR equals 14.62 [6.10 to 35.03]) was found to be the strongest risk factor. The strongest risk factors associated with early childhood caries was the presence of enamel defects, presence of dentinal caries and high levels of mutans streptococci.
Topics: DMF Index; Dental Caries; Dental Enamel; Humans; Risk Factors; Streptococcus mutans
PubMed: 30992106
DOI: No ID Found -
Archives of Oral Biology Dec 2022This systematic review examines the effect of age on changes to coronal dentin properties. (Review)
Review
OBJECTIVE
This systematic review examines the effect of age on changes to coronal dentin properties.
DESIGN
Pubmed, Cinhal, Scopus, Web of Science and the Cochrane Database were searched for publications up to 31 December 2021. All studies were uploaded and reviewed using Covidence software. At different stages of the review, study selection and the extraction of data were completed by six independent reviewers based on the eligibility criteria. The quality of the articles was judged based on JBI Critical Appraisal Checklist for quasi-experimental studies.
RESULTS
Twelve studies satisfied the eligibility criteria and were included. Dentin characteristics and mechanical properties alter with age, and spatially within a tooth to depend on tubule orientation. Age-related mineral deposition within tubules, and collagen maturation in intertubular dentin compound the spatial effects on mechanical properties. Mechanical properties depend on collagen fiber orientation and apatite alignment relative to dentin tubules, characteristic differences in peritubular and intertubular dentin, and relative dentin tubule distribution within a tooth. The bulk of the research focussed on age-related apatite effects, although many reported limited understanding of changes to collagen, particularly in intertubular dentin.
CONCLUSION
Investigations into the effect of age, depth, site and location on dentin collagen are warranted to minimize tooth loss in older populations by providing targeted adhesive, restorative or preventative interventions.
Topics: Adult; Humans; Aged; Dentin; Tooth; Collagen; Apatites; Minerals
PubMed: 36182707
DOI: 10.1016/j.archoralbio.2022.105553 -
Operative Dentistry Nov 2021The following PICO (Patient/Population, Intervention, Comparison, and Outcomes) question was proposed: "Are retention rates of composite resin restorations in noncarious... (Meta-Analysis)
Meta-Analysis
PURPOSE
The following PICO (Patient/Population, Intervention, Comparison, and Outcomes) question was proposed: "Are retention rates of composite resin restorations in noncarious cervical lesions (NCCLs) when using adhesives considered "gold standard" (OptiBond FL and Clearfil SE Bond) higher than those obtained with other adhesives brands"?
METHODS
A search was performed in February 2019 (updated in November 2019) in the PubMed/MEDLINE, EMBASE, LILACS, BBO, Web of Science, Cochrane Library, Grey Literature, and IADR abstracts (1990-2018); unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials (RCTs) conducted in NCCLs that compared either OptiBond FL or Clearfil SE Bond adhesive with other commercially available adhesives were included. The risk of bias (RoB) was applied by using the Cochrane Collaboration tool. A meta-analysis was performed for retention rates at different follow-up times using a random effects model for both the adhesives. Heterogeneity was assessed with the Cochran Q test and I2 statistics. Grading of Recommendations: Assessment, Development and Evaluation (GRADE) assessed the quality of evidence.
RESULTS
After removal of duplicates and noneligible articles, 25 studies remained for qualitative synthesis, as one study was common to the two adhesives, of which 9 studies were used for the OptiBond FL meta-analysis and 14 for the Clearfil SE Bond meta-analysis. No significant differences were observed for retention rates in follow-up periods of 12-24 months (p=0.97), 36-48 months (p=0.72), or 108-156 months (p=0.73) for OptiBond FL; and for 12-24 months (p=0.10) and 36-48 months (p=0.17) for Clearfil SE Bond. A significant difference was only found for OptiBond FL at 60-96 months (p=0.02), but only three studies were included in this meta-analysis.
CONCLUSIONS
The evidence from available RCTs conducted in NCCLs that compared OptiBond FL or Clearfil SE Bond does not support the widespread concept that these adhesives are better than any other competitive brands available in the dental market.
Topics: Composite Resins; Dental Bonding; Dental Cements; Dental Restoration, Permanent; Dentin-Bonding Agents; Humans; Resin Cements
PubMed: 34919728
DOI: 10.2341/20-059-LIT -
PloS One 2016Pulpitis is mainly caused by an opportunistic infection of the pulp space with commensal oral microorganisms. Depending on the state of inflammation, different treatment... (Review)
Review
BACKGROUND AND OBJECTIVE
Pulpitis is mainly caused by an opportunistic infection of the pulp space with commensal oral microorganisms. Depending on the state of inflammation, different treatment regimes are currently advocated. Predictable vital pulp therapy depends on accurate determination of the pulpal status that will allow repair to occur. The role of several players of the host response in pulpitis is well documented: cytokines, proteases, inflammatory mediators, growth factors, antimicrobial peptides and others contribute to pulpal defense mechanisms; these factors may serve as biomarkers that indicate the status of the pulp. Therefore, the aim of this systematic review was to evaluate the presence of biomarkers in pulpitis.
METHODS
The electronic databases of MEDLINE, EMBASE, Scopus and other sources were searched for English and non-English articles published through February 2015. Two independent reviewers extracted information regarding study design, tissue or analyte used, outcome measures, results and conclusions for each article. The quality of the included studies was assessed using a modification of the Newcastle-Ottawa-Scale.
RESULTS AND CONCLUSIONS
From the initial 847 publications evaluated, a total of 57 articles were included in this review. In general, irreversible pulpitis was associated with different expression of various biomarkers compared to normal controls. These biomarkers were significantly expressed not only in pulp tissue, but also in gingival crevicular fluid that can be collected non-invasively, and in dentin fluid that can be analyzed without extirpating the entire pulpal tissue. Such data may then be used to accurately differentiate diseased from healthy pulp tissue. The interplay of pulpal biomarkers and their potential use for a more accurate and biologically based diagnostic tool in endodontics is envisaged.
Topics: Antimicrobial Cationic Peptides; Biomarkers; Cytokines; Databases, Factual; Dental Pulp; Enzymes; Humans; Inflammation; Leukocytes; Peptide Hydrolases
PubMed: 27898727
DOI: 10.1371/journal.pone.0167289 -
Operative Dentistry Jan 2021The literature reviewed suggests that airborne particle abrasion has no negative effects on the bond strength of resin-based materials to dentin and that a positive... (Meta-Analysis)
Meta-Analysis
CLINICAL RELEVANCE
The literature reviewed suggests that airborne particle abrasion has no negative effects on the bond strength of resin-based materials to dentin and that a positive influence on dentin bond strength was only achieved in specific air-abrasion conditions.
SUMMARY
In this systematic review the authors investigated how airborne-particle abrasion (APA) using aluminum oxide affects the bond strength of resin-based materials to dentin. The search was performed in three databases. In vitro studies (Type of study) comparing the bond strength of resin-based materials (Outcome) to air-abraded (Intervention) compared with non-air-abraded (Comparison) human dentin (Population) were included (the PICOT elements are given parenthetically). From 5437 unique articles, 65 were read in full, 33 were included in the qualitative synthesis, and 32 were included in the meta-analysis. Methodologic quality and risk of bias were assessed. Comparisons were performed between air-abraded and control dentin groups by adopting a random-effects model (α=0.05). Additional analyses were carried out for the different parameters used in APA: type of surface treatment in the control group, particle size, air pressure, and APA duration. The bond strength to air-abraded dentin was favored only when the control surface was treated with a hand excavator. For particle size, APA was favored when the particle size was >30 μm and the controls were no treatment or hand excavator or when the particle size was ≤30 μm and the control was bur. In addition, the results favored air-abraded groups only when the pressure was > 5 bar and bur was used in the control group. No significant differences were observed for duration of APA. No comparison on bond strength considering the presence of aging conditions was possible in the included studies due to the low number of studies that aged the specimens. In conclusion, APA had no negative effects on the bond strength of resin-based materials to dentin and was able to improve the dentin bond strength only when the particle size was > 30 μm and air pressure was > 5 bar. PROSPERO registration protocol: CRD42018096128.
Topics: Aged; Aluminum Oxide; Composite Resins; Dental Bonding; Dentin; Humans; Materials Testing; Resin Cements; Shear Strength; Surface Properties
PubMed: 32926155
DOI: 10.2341/19-216-L -
Journal of Clinical Medicine Jan 2022This systematic review and meta-analysis aimed at assessing the diagnostic accuracy of emerging technologies, such as laser fluorescence (LF), transillumination,... (Review)
Review
This systematic review and meta-analysis aimed at assessing the diagnostic accuracy of emerging technologies, such as laser fluorescence (LF), transillumination, light-emitting diode devices, optical coherence tomography (OCT), alternating current impedance spectroscopy, fluorescence cameras (FC), photo-thermal radiometry, and modulated luminescence technology. In vivo and in vitro results of such non-ionizing, non-invasive, and non-destructive methods' effectiveness in non-cavitated dentin caries detection are sometimes ambiguous. Following the PRISMA guidelines, 34 relevant research articles published between 2011-2021 were selected. The risk of bias was assessed with a tool tailored for caries diagnostic studies, and subsequent quantitative uni- and bi-variate meta-analysis was carried out in separate sub-groups according to the investigated surface (occlusal/proximal) and study setting (in vivo/in vitro). In spite of the high heterogeneity across the review groups, in vitro studies on LF and FC proved a good diagnostic ability for the occlusal surface, with area under the curve (AUC) of 0.803 (11 studies) and 0.845 (five studies), respectively. OCT studies reported an outstanding performance with an overall AUC = 0.945 (four studies). Promising technologies, such as OCT or FC VistaProof, still need well-designed and well-powered studies to accrue experimental and clinical data for conclusive medical evidence, especially for the proximal surface. Registration: INPLASY202210097.
PubMed: 35160127
DOI: 10.3390/jcm11030674 -
Caries Research 2019To investigate whether silver diamine fluoride (SDF) is effective in preventing new caries lesions in primary teeth when compared to placebo or active treatments. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To investigate whether silver diamine fluoride (SDF) is effective in preventing new caries lesions in primary teeth when compared to placebo or active treatments.
METHODS
Systematic review (CRD42016036963) of controlled clinical trials. Searches were performed in 9 electronic databases, 5 registers of ongoing trials, and reference lists of identified review articles. Two researchers carried out data extraction and quality appraisal independently. The primary outcome was the difference in caries increment (decayed, missing, and filled surfaces or teeth - dmfs or dmft) between SDF and control groups. These differences were pooled as weighted mean differences (WMD) and prevented fractions (PF).
RESULTS
Searches yielded 2,366 unique records; 6 reports of 4 trials that randomized 1,118 and analyzed 915 participants were included. Two trials compared SDF to no treatment, 1 compared SDF to placebo and sodium fluoride varnish (FV), and 1 compared SDF to high-viscosity glass ionomer cement (GIC). All studies had at least 1 domain with unclear or high risk of bias. After 24 months of follow-up, in comparison to placebo, no treatment, and FV, SDF applications significantly reduced the development of new dentin caries lesions (placebo or no treatment: WMD = -1.15, PF = 77.5%; FV: WMD = -0.43, PF = 54.0%). GIC was more effective than SDF after 12 months of follow-up but the difference between them was not statistically significant (WMD, dmft: 0.34, PF: -6.09%).
CONCLUSION
When applied to caries lesions in primary teeth, SDF compared to no treatment, placebo or FV appears to effectively prevent dental caries in the entire dentition. However, trials specifically designed to assess this outcome are needed.
Topics: Cariostatic Agents; Child; Child, Preschool; Controlled Clinical Trials as Topic; Dental Caries; Fluorides, Topical; Follow-Up Studies; Glass Ionomer Cements; Humans; Inflammation; Quaternary Ammonium Compounds; Silver Compounds; Sodium Fluoride; Taste Disorders; Tooth Discoloration; Tooth, Deciduous
PubMed: 29874642
DOI: 10.1159/000488686 -
International Journal of Dentistry 2021Resin-dentin bond strength decreases over time. This reduction is related to the loss of hybrid layer integrity. Collagenolytic enzymes, especially matrix... (Review)
Review
OBJECTIVES
Resin-dentin bond strength decreases over time. This reduction is related to the loss of hybrid layer integrity. Collagenolytic enzymes, especially matrix metalloproteinases (MMPs), are responsible for the degradation of the collagen matrix of the hybrid layer. Various MMP inhibitors with the ability to prevent enzymatic degradation have been identified. This study aimed to systematically review the literature for studies which evaluated the effect of MMP inhibitors on the immediate and aged dentin bond strengths. Screening and analysis were carried out by two reviewers. Two databases were searched, and from a total of 740 articles, 43 were accepted for full review. 21 articles with 0.2%-2% chlorhexidine (CHX) treatments were included for meta-analysis. A risk of bias assessment was performed on all studies chosen for meta-analysis. A variety of MMP inhibitors have been studied, CHX being the most widely used.
CONCLUSIONS
A clear trend for a lower loss of dentin bond strength was observed with different MMP inhibitors. In meta-analysis, no significant difference was seen between the CHX and control in the immediate bond strengths. Bond strengths in the CHX group were significantly higher than the control group after aging ( < 0.001). The percentage of fractures occurring at the adhesive interface increased after aging. Five out of 21 studies included in the meta-analysis had high and the rest medium risk of bias. More long-term studies with lower risks of bias should be carried out to increase the reliability of results. The use of MMP inhibition with chlorhexidine can be recommended to increase the longevity of resin-dentin bond strength.
PubMed: 34135969
DOI: 10.1155/2021/9949699