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Journal of International Society of... 2020The objective of this study was to assess knowledge, attitude, and practices among dental teaching institutions and private practitioners in Asian countries. (Review)
Review
A Systematic Review to Evaluate Knowledge, Attitude, and Practice Regarding Biomedical Waste Management among Dental Teaching Institutions and Private Practitioners in Asian Countries.
OBJECTIVE
The objective of this study was to assess knowledge, attitude, and practices among dental teaching institutions and private practitioners in Asian countries.
MATERIALS AND METHODS
Systematic review of observational studies on BMW management was conducted. We searched the following electronic bibliographic databases: PubMed/MEDLINE and Google Scholar. Manual search was carried out for similar topics in the National Medical Library, New Delhi. In addition, the bibliographies were manually searched. There was no disagreement between the two reviewers. This review was reported and conducted in step with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only studies written in English and published until November 2019 were included. This review was registered in International Prospective Register of Systematic Reviews (PROSPERO registration number is CRD42019124900).
RESULTS
In this review, of 678 articles, 24 articles met inclusion criteria. Available scientific studies showed that knowledge regarding BMW management guidelines varied from 33% to 100% among dentists. Most of the studies reported that knowledge and practice regarding segregation of BMW was limited. Most of the study subjects were aware of hazardous effects of amalgam and had amalgam separator. Studies done in Chennai and Karnataka, approximately one-third dentists were not following BMW guidelines for sharp management and most of them were disposing of sharps in general waste bins.
CONCLUSION
On the basis of the current evidence and data extracted from the various databases, it can be concluded that knowledge regarding BMW management guidelines among dentists is inadequate and practice regarding the same is poor. Regular training sessions and Continuing Dental Education (CDE) on BMW management guidelines and updates need to be organized for improvement of knowledge and practice regarding BMW among dentists.
PubMed: 33282760
DOI: 10.4103/jispcd.JISPCD_157_20 -
Dermatitis : Contact, Atopic,...This systematic review summarizes characteristics and treatment outcomes of dental amalgam-associated oral lichenoid lesions (OLLs) and oral lichen planus (OLP). Embase...
This systematic review summarizes characteristics and treatment outcomes of dental amalgam-associated oral lichenoid lesions (OLLs) and oral lichen planus (OLP). Embase and MEDLINE were searched for original studies on OLLs or OLP associated with dental amalgam. Data extraction was completed from 44 studies representing 1855 patients. Removal of amalgam restorations led to complete resolution in 54.2% (n = 423/781), partial resolution in 34.8% (n = 272/781), and no resolution in 11.0% (n = 86/781) of the patients with OLLs, whereas complete resolution occurred in 37.1% (n = 72/194), partial resolution in 26.3% (n = 51/194), and no resolution in 36.6% (n = 71/194) of the patients with OLP. For patients with OLLs, 91.6% of the patients with positive patch tests and 82.9% with negative patch tests had improvement with removal of amalgam, whereas for patients with OLP, 89.2% of the patients with positive patch tests and 78.9% with negative patch tests had improvement with removal of amalgam. Our results suggest improvement occurs, regardless of patch testing status.
Topics: Dental Amalgam; Dental Restoration, Permanent; Dermatitis, Allergic Contact; Humans; Lichen Planus, Oral; Mercury; Mouth Mucosa; Patch Tests; Treatment Outcome
PubMed: 33273245
DOI: 10.1097/DER.0000000000000703 -
International Journal of Dentistry 2020A systematic literature search was conducted in four electronic databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) including all available randomised... (Review)
Review
METHODS
A systematic literature search was conducted in four electronic databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) including all available randomised controlled trials published in the last 15 years comparing the use of dental amalgam with composite resins in humans with a follow-up period of at least one year. The primary outcome was the Hg concentration in biological fluids (urine, hair, blood, and saliva) with the aim of assessing their reliability as biomarkers of Hg exposure. The risk of bias was assessed through the Cochrane Collaboration tool and the overall quality of evidence through the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. The results of the meta-analysis were expressed using a random-effects model, and their power was assessed through the trial sequential analysis (TSA).
RESULTS
From the initial 2555 results, only 6 publications were included in the review: five were considered as having high risk of bias, whereas one as having moderate risk. Only two articles were eligible for quantitative analysis. The meta-analysis gathered data from 859 patients but was nevertheless not significant ( = 0.12). The TSA confirmed this evidence revealing that it was due to a lack of statistical power since the required information size (RIS) threshold is not reached.
CONCLUSIONS
The existing evidence revealed that there are not enough data to support the hypothesis that restorations with dental amalgam can cause nephrotoxicity when compared with composite resins restorations.
PubMed: 32849873
DOI: 10.1155/2020/8857238 -
Journal of the American Dental... Aug 2020The best treatment option for large caries in permanent posterior teeth is still a matter of uncertainty in dental literature. The authors conducted a network... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The best treatment option for large caries in permanent posterior teeth is still a matter of uncertainty in dental literature. The authors conducted a network meta-analysis to address the challenges related to rehabilitation of these teeth.
TYPES OF STUDIES REVIEWED
The authors selected prospective and retrospective studies that compared at least 2 different treatment alternatives for permanent teeth with a minimum of 5 years of follow-up. The authors searched databases from MEDLINE, Scopus, Cochrane Library, and Web of Science in October 2019 without language or year of publication restrictions.
RESULTS
From 11,263 studies identified, 43 studies fulfilled the eligibility criteria and were included in the final review. Only 13 studies were randomized controlled trials and were classified as low risk of bias. Gold (annual failure rate of 0.29%) and metal ceramic (annual failure rate of 0.52%) crowns performed better for indirect restorations and direct resin composite performed better for direct restorations (annual failure rate of 2.19%). The most substantial comparisons were between feldspathic and glass ceramics, followed by direct resin composite and amalgam; there were no statistically significant differences between these interventions. Results of the pairwise meta-analysis showed mainly glass ionomer as significantly more prone to failure than amalgam and direct composite resin.
CONCLUSIONS AND PRACTICAL IMPLICATIONS
Reference standard direct and indirect materials except for glass ionomer can be used for restorations of large posterior caries.
Topics: Composite Resins; Dental Caries; Dental Materials; Dental Restoration Failure; Dental Restoration, Permanent; Humans; Prospective Studies; Retrospective Studies
PubMed: 32718491
DOI: 10.1016/j.adaj.2020.05.006 -
Clinical Oral Investigations May 2020For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults". (Meta-Analysis)
Meta-Analysis
OBJECTIVES
For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults".
MATERIAL AND METHODS
Separating between the management of initial and cavitated proximal caries lesions, Medline via PubMed was searched regarding non-operative/non-invasive, minimally/micro-invasive and restorative treatment. First priority was systematic reviews or randomized controlled trials (RCTs), otherwise cohort studies. After extraction of data, the potential risk of bias was estimated depending on the study type, and the emerging evidence for conclusions was graded.
RESULTS
Regarding non-invasive/non-operative care (NOC), no systematic reviews or RCTs were found. In cohort studies (n = 12) with a low level of evidence, NOC like biofilm management and fluoride was associated with a low proportion and slow speed of progression of initial proximal lesions. Minimally/micro-invasive (MI) treatments such as proximal sealants or resin infiltration (four systematic reviews/meta-analyses) were effective compared with a non-invasive/placebo control at a moderate level of evidence. Data on restorative treatment came with low evidence (5 systematic reviews, 13 RCTs); with the limitation of no direct comparative studies, sample size-weighted mean annual failure rates of class II restorations varied between 1.2 (bulk-fill composite) and 3.8% (ceramic). Based on one RCT, class II composite restorations may show a higher risk of failure compared with amalgam.
CONCLUSIONS
Proximal caries lesions can be managed successfully with non-operative, micro-invasive and restorative treatment according to lesion stage and caries activity.
CLINICAL RELEVANCE
Proximal caries treatment options like non-operative, micro-invasive and restorative care should be considered individually.
Topics: Adolescent; Adult; Humans; Biofilms; Consensus; Dental Caries; Dental Materials; Dental Restoration, Permanent; Fluorides; Randomized Controlled Trials as Topic
PubMed: 32306093
DOI: 10.1007/s00784-020-03201-y -
Journal of Dentistry Jul 2019While repairs are increasingly recommended to manage partially defective restorations, performing the repair (including bonding to different substrates) can be...
OBJECTIVES
While repairs are increasingly recommended to manage partially defective restorations, performing the repair (including bonding to different substrates) can be challenging, and dentists should adhere to established repair protocols. We aimed to systematically assess the consistency and quality of repair protocols.
DATA
808 records were initially identified and 71 repair protocols based on 84 sources included. The number of published sources over time increased exponentially (p < 0.001). Recommended treatment steps varied widely. Some treatment steps were only recommended by a minority of protocols, while others were consistently recommended (e.g. surface roughening, hydrofluoric acid etching of silicate ceramics, application of an adhesive/bonding agent). The overall quality of included sources was moderate (mean ± SD 3.7 ± 0.9 out of 7 points).
SOURCES
Electronic databases (Medline via PubMed, Embase) were searched, hand searches using Google and Google Scholar conducted, and the reference lists of included full texts screened and cross-referenced.
STUDY SELECTION
(Non-)systematic reviews, working instructions, and textbooks with protocols on direct composite repair restorations for partially defective (1) composite, (2) amalgam, (3) porcelain-fused-to-metal (PFMs) with exposed metal base, (4) ceramic/PFMs without exposed metal base, and (5) full metal restorations were included. Data synthesis was performed by tabulation of recommended treatment steps and descriptive statistics. The quality of included sources was assessed based on a checklist for guideline appraisal (MiChe).
CONCLUSIONS
The main treatment steps were consistently reported across repair protocols.
CLINICAL SIGNIFICANCE
Dentists may want to adopt widely recommended treatment steps when performing repairs of different restoration materials in their daily practice.
Topics: Ceramics; Composite Resins; Dental Materials; Dental Porcelain; Dental Restoration Failure; Dental Restoration, Permanent
PubMed: 31108118
DOI: 10.1016/j.jdent.2019.05.021 -
Cadernos de Saude Publica Feb 2019Mercury is a metal found in the environment from natural and anthropogenic sources. It is highly toxic to ecosystems and living beings. Most human exposures come from...
Mercury is a metal found in the environment from natural and anthropogenic sources. It is highly toxic to ecosystems and living beings. Most human exposures come from ingestion of contaminated seafood, outgassing from dental amalgam or occupational exposure (e.g. gold mining), among other cases. Large populations are exposed to mercury, making it a very important issue from the public health perspective. Adverse health effects are commonly seen in the nervous system, but every organ is a potential target, such as the bone marrow. The main goal of this study was to assess the available evidence on human exposure to mercury and its hematological effects. A search strategy was constructed, including key terms (MeSH, text word and equivalents) for querying 2 repositories of master dissertation and PhD thesis (Fiocruz/ARCA and University of São Paulo) and 4 different electronic databases: BVS/LILACS, MEDLINE/PubMed, Scopus and TOXLINE/NIH, for articles published from 1950 to February 2018. There was no language restriction and a tool (EPHPP) was used to assess the quality of included studies. According to pre-established criteria, 80 studies were retrieved, all of them observational (48 case reports, 24 cross-sectional, 6 case series and 2 cohorts), comprising 9,284 people. Despite the fact that most exposed ones (6,012) had normal blood cell count and mercury hematological effects did not seem very usual (1,914 cases: 14 severe and 29 deaths), three studies reported association (β) for anemia, lymphopenia, neutrophilia and basophilia. We concluded that the gathered information pointed to mercury hematotoxic effects, some of them may be serious and even fatal.
Topics: Brazil; Cell Count; Environmental Exposure; Environmental Monitoring; Hematologic Diseases; Hematologic Tests; Humans; Mercury; Mercury Compounds; Mercury Poisoning; Occupational Exposure
PubMed: 30758455
DOI: 10.1590/0102-311X00091618 -
The Journal of Contemporary Dental... Aug 2018This article aims to systematically review the evidence reporting on physical properties of bonded amalgam, its clinical performance, and implications.
AIM
This article aims to systematically review the evidence reporting on physical properties of bonded amalgam, its clinical performance, and implications.
MATERIALS AND METHODS
An electronic search in "Medline" (search term: Amalgam and Dentin bonding) from 1987 to 2013 yielded 465 publications out of which 170 articles were selected for the analysis. Data were extracted relating to the bond strength of amalgam to dentin, microleakage, postoperative sensitivity, and longevity of bonded amalgam restorations.
RESULTS
A total of 129 in vitro studies out of 170 articles showed high bond strengths with filled adhesive resins and light-cured adhesives, in particular Amalgambond plus and Optibond adhe-sives. Thickness of bonding agent, type of alloy, and thermo-cycling showed inconclusive outcomes between bonded and nonbonded amalgam restorations. Majority of studies reported reduced microleakage when dentin bonding agents and resin-modified glass ionomer cements (RM-GICs) were used with amalgam. However, water stored, thermocycled, and spherical amalgam alloys resulted in higher microleakage. While bonded amalgam facilitated the retention of large restorations, reduction in postoperative sensitivity was not consistently observed between bonded and nonbonded amalgam restorations.
CONCLUSION
While bonded amalgam restorations reduce the need for mechanical retention conserving tooth structure and reducing the adverse effects of microleakage, there is lack of consistent evidence across all outcome domains to advocate the benefit of bonding of all amalgam restorations. Despite this, it can be considered the material of choice for large restorations and bonding enhances retention in vitro which can be considered beneficial clinically.
CLINICAL SIGNIFICANCE
The use of adhesives to bond amalgam to the tooth structure offers potential advantages, as it helps in conservative cavity preparation without compromising the retention to tooth, making it a material of choice in large posterior restorations.
Topics: Databases, Bibliographic; Dental Amalgam; Dental Bonding; Dental Leakage; Dental Restoration, Permanent; Dentin; Dentin Sensitivity; Humans; In Vitro Techniques; Shear Strength
PubMed: 30150506
DOI: No ID Found -
The Journal of Adhesive Dentistry 2018The primary objective of this systematic review was to compare treatment outcomes of direct and indirect permanent restorations in endodontically treated teeth, and... (Meta-Analysis)
Meta-Analysis
PURPOSE
The primary objective of this systematic review was to compare treatment outcomes of direct and indirect permanent restorations in endodontically treated teeth, and provide clinical suggestions for restoring teeth after endodontic treatment.
MATERIALS AND METHODS
Electronic databases (Medline, EMBASE, CENTRAL) and gray literature were screened for articles in English that reported on prospective and retrospective clinical studies of direct or indirect restorations after endodontic treatment with an observation period of at least 3 years. Primary outcomes were determined to be short-term (≤ 5 years) and medium-term (> 5 and ≤ 10 years) survival. Secondary outcomes included restorative and endodontic success of restored teeth. The quality of included studies and risk of bias were assessed using Cochrane Collaboration's tool for RCTs (randomized controlled trials), the Newcastle-Ottawa Scale for cohort studies, and the Agency for Healthcare Research and Quality (AHRQ) methodology checklist for cross-sectional studies. The GRADE system was used for assessing collective strength of the overall body of evidence.
RESULTS
Of 2547 screened articles, only 9 (2 RCTs, 3 retrospective cohort studies, 3 cross-sectional studies) met the inclusion criteria, and 8 studies were used in the meta-analysis. In general, indirect restorations (mostly full crowns) showed higher 5-year survival (OR 0.28, 95% CI 0.19-0.43, p < 0.00001) and 10-year survival (OR 0.20, 95% CI 0.12-0.31, p < 0.00001) than direct restorations. However, there was no statistical difference in short-term (≤ 5-years) restorative success (OR 0.32, 95% CI 0.05-2.12, p = 0.24) and endodontic success (OR 0.88, 95% CI 0.72-1.08, p = 0.22).
CONCLUSIONS
Based on current evidence, there is a weak recommendation for indirect restorations to restore endodontically treated teeth, especially for teeth with extensive coronal damage. Indirect restorations using mostly crowns have higher short-term (5-year) and medium-term (10-year) survival than do direct restorations using composite or amalgam (GRADE quality of evidence: low to moderate), but no difference in short-term (≤ 5 years) restorative success (low quality) and endodontic success (very low quality). There is a need for high-quality clinical trials, especially well-designed RCTs.
Topics: Composite Resins; Cross-Sectional Studies; Dental Restoration, Permanent; Endodontics; Humans; Prospective Studies; Retrospective Studies; Tooth, Nonvital
PubMed: 29984369
DOI: 10.3290/j.jad.a40762 -
Journal of Conservative Dentistry : JCD 2018Composite resin, serves as esthetic alternative to amalgam and cast restorations. Posterior teeth can be restored using direct or indirect composite restorations. The... (Review)
Review
BACKGROUND
Composite resin, serves as esthetic alternative to amalgam and cast restorations. Posterior teeth can be restored using direct or indirect composite restorations. The selection between direct and indirect technique is a clinically challenging decision-making process. Most important influencing factor is the amount of remaining tooth substance.
AIM
The aim of this systematic review was to compare the clinical performance of direct versus indirect composite restorations in posterior teeth.
MATERIALS AND METHODS
The databases searched included PubMed CENTRAL (until July 2015), Medline, and Cochrane Database of Systematic Reviews. The bibliographies of clinical studies and reviews identified in the electronic search were analyzed to identify studies which were published outside the electronically searched journals. The primary outcome measure was evaluation of the survival of direct and indirect composite restorations in posterior teeth.
RESULTS
This review included thirteen studies in which clinical performance of various types of direct and indirect composite restorations in posterior teeth were compared. Out of the thirteen studies which were included seven studies had a high risk of bias and five studies had a moderate risk of bias. One study having a low risk of bias, concluded that there was no significant difference between direct and indirect technique. However, the available evidence revealed inconclusive results.
CONCLUSION
Further research should focus on randomized controlled trials with long term follow-up to give concrete evidence on the clinical performce of direct and indirect composite restorations.
PubMed: 29628639
DOI: 10.4103/JCD.JCD_213_16