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Journal of the American Dental... May 2024Dental sealants are effective for the prevention of caries in children at elevated risk levels, and increasing the proportion of children and adolescents who have dental...
BACKGROUND
Dental sealants are effective for the prevention of caries in children at elevated risk levels, and increasing the proportion of children and adolescents who have dental sealants on 1 or more molars is a Healthy People 2030 objective. Electronic health record (EHR)-based clinical decision support systems (CDSSs) have the ability to improve patient care. A dental quality measure related to dental sealant placement for children at elevated risk of caries was targeted for improvement using a CDSS.
METHODS
A validated dental quality measure was adapted to assess a patient's need for dental sealant placement. A CDSS was implemented to advise care team members whether a child was at elevated risk of developing caries and had sealant-eligible first or second molars. Data on dental sealant placement at examination visits during a 5-year period were analyzed, including 32 months before CDSS implementation and 28 months after CDSS implementation.
RESULTS
From January 1, 2018, through December 31, 2022, the authors assessed 59,047 examination visits for children at elevated risk of developing caries and with sealant-eligible teeth. With the implementation of a CDSS and training to support the clinical care team members in September 2020, the appropriate placement of dental sealants at examination visits increased from 27% through 60% (P < .00001).
CONCLUSIONS
Integration of a CDSS into the EHR as part of a quality improvement program was effective in increasing the delivery of sealants in eligible first and second molars of children aged 5 through 15 years and considered at high risk of developing caries.
PRACTICAL IMPLICATIONS
An EHR-based CDSS can be implemented to improve standardization and provide timely and appropriate patient care in dental practices.
Topics: Humans; Pit and Fissure Sealants; Child; Dental Caries; Decision Support Systems, Clinical; Adolescent; Female; Male; Child, Preschool; Quality Improvement; Electronic Health Records
PubMed: 38583172
DOI: 10.1016/j.adaj.2024.02.009 -
Heliyon Apr 2024Sealing dental pits and fissures with resin-based sealants effectively prevents occlusal dental caries. The effectiveness of resin-based pit and fissure sealants relies...
BACKGROUND
Sealing dental pits and fissures with resin-based sealants effectively prevents occlusal dental caries. The effectiveness of resin-based pit and fissure sealants relies on maintaining a strong bond between the sealant and the enamel.
OBJECTIVE
This study compared the micro-tensile bond strength (μTBS) of a conventional resin-based sealant (Clinpro™) and a hydrophilic resin-based sealant (Embrace™ WetBond™) when applied to intact, aprismatic human enamel.
METHODS
Forty extracted permanent premolar and molar teeth were divided into two groups and paired by tightly approximating two buccal surfaces to create an artificial enamel groove (fissure). Fissure sealants (Clinpro™ and Embrace™ WetBond™) were applied to the artificial enamel 'grooves' in each group. The specimens were then cut into beams with a cross-sectional area of 1 mm and tested for the micro-tensile bond strength (μTBS). Fractured surfaces of samples were examined under a conventional microscope to identify the failure modes. Two specimens from each group were prepared and observed under a scanning electron microscope (SEM). Mann-Whitney U and Fischer-Freeman-Holton exact tests were used to test the statistical differences between the fissure sealants.
RESULTS
The μTBS mean ± SD for Clinpro™ was 16.43 ± 7.08, and 10.57 ± 6.64 for Embrace™ WetBond™. There was a statistically significant difference in μTBS between Embrace™ WetBond™ and Clinpro™ (p < 0.001). There was no association between fissure sealant and failure modes (p = 0.922).
CONCLUSION
Clinpro™ showed higher μTBS to enamel than Embrace™ WetBond™. Further studies are needed to conclude the clinical effectiveness of these sealants.
PubMed: 38571654
DOI: 10.1016/j.heliyon.2024.e28324 -
International Journal of Clinical... Jan 2024The role of sealants for pits and fissures has been emphasized in caries prevention. Considering the advantages of a surface sealer and the effects of its application...
INTRODUCTION
The role of sealants for pits and fissures has been emphasized in caries prevention. Considering the advantages of a surface sealer and the effects of its application over restorative materials; the study is aimed at evaluating two pit and fissure sealants with a nanofilled resin coating.
MATERIALS AND METHODS
In this double-blinded study, a total of 60 caries-free extracted third molars were collected and divided into two groups of 30 each receiving either a resin-based sealant (Helioseal F) or a glass ionomer-based sealant (GC Fuji VII). Each sample was then applied with GCoat Plus surface sealer. 15 samples each containing GC Fuji VII and 15 containing Helioseal F were then subjected to wear. Another 15 samples of GC Fuji VII and 15 of Helioseal F were subjected to compressive load.
RESULTS
On assessing the wear strength, the weight loss in group I (resin sealant with surface sealer) was 1.73 ± 0.50 (μg) which was statistically significant ( = 0.023). There was no significant difference in comparing the wear depth between both groups. There was a high statistically significant difference when assessing the compressive strength, group II (glass ionomer sealant with surface sealer) had 3566.4 ± 757 (μm) when compared to group I (resin sealant with surface sealer) 1568.53 ± 680 ( ≤ 0.01).
CONCLUSION
Sealants are known for their poor retention and keeping that in mind we designed this study to evaluate the physical properties of sealants with a resin coating over them. Within the limitations of this study, the conclusions are glass ionomer sealant showed greater resistance to wear when compared to the resin-based sealant and the resin-based sealant showed higher compressive strength values than the glass ionomer sealant.
HOW TO CITE THIS ARTICLE
Gunasekaran R, Sharmin D, Baghkomeh PN, Comparative Evaluation of Wear Strength and Compressive Strength of Two Pit and Fissure Sealants with a Nanofilled Resin Coating: An Study. Int J Clin Pediatr Dent 2024;17(1):31-35.
PubMed: 38559869
DOI: 10.5005/jp-journals-10005-2726 -
Cureus Feb 2024Introduction In modern dentistry, the focus is more on preventing caries than on treating it, which helps preserve the tooth structure. Pit and fissure sealants (PFS)...
Introduction In modern dentistry, the focus is more on preventing caries than on treating it, which helps preserve the tooth structure. Pit and fissure sealants (PFS) are the most effective methods for providing a mechanical barrier and avoiding the accumulation of dental plaque in deep pits and fissures, thereby preventing occlusal caries. The present study was conducted to compare the efficiency of dentin bonding agents (DBA) with or without fissurotomy in reducing microleakage before PFS placement. Materials and methods A total of 48 freshly extracted premolars were randomly divided into four groups as follows: Group 1, the conventional technique of PFS (Clinpro, 3M ESPE sealant); Group 2, fissurotomy performed before PFS placement; Group 3, Scotchbond Universal Adhesive (3M ESPE DBA) applied before PFS placement; and Group 4, fissurotomy along with DBA was used before PFS placement. The teeth were subjected to thermocycling followed by dye penetration using a 1% solution of methylene blue for 24 hours. All teeth were then assessed for microleakage by a qualitative method using a stereomicroscope at 40X and depth of dye penetration by image analysis. The Kruskal-Wallis test followed by Dunn's test was used for intergroup comparisons of microleakage scores, and ANOVA followed by Tukey's test was used for intergroup comparisons of the depth of dye penetration. These analyses were conducted using statistical software (SPSS version 22, Chicago, IL, USA). Results Statistically significant differences were observed between the groups in terms of the microleakage scores and depth of dye penetration (p<0.05). The group 4 showed a minimum microleakage score (0.50±0.52), and maximum scores were observed in Group 1 (2.16±0.71). Group 2 showed insignificant differences with groups 3 and 4 for depth of dye penetration (p>0.05). Statistically significant differences were observed between groups 1 and 2, groups 1 and 4, and groups 3 and 4 for the microleakage score (p<0.05). Conclusion Fissurotomy with or without DBA significantly reduced microleakage before the PFS placement. Prior use of fourth-generation DBA significantly reduced microleakage compared with PFS placement without the use of DBA.
PubMed: 38550456
DOI: 10.7759/cureus.54984 -
Academic Pediatrics Jul 2024To improve oral health disparities and outcomes among US children impacted by dental caries, there is a need to understand the cost-effectiveness of a targeted,...
OBJECTIVE
To improve oral health disparities and outcomes among US children impacted by dental caries, there is a need to understand the cost-effectiveness of a targeted, risk-based versus universal-based approach for caries prevention.
METHODS
Health and economic outcomes were simulated in a cohort of 50,000 US children aged 1-18 years, comparing current practice (CP) to risk-based-prevention (RBP) and prevention-for-all (PFA) strategies using health care sector and limited societal perspectives. Prevention included biannual oral health exams and fluoride varnish application, and one-time dental sealant placement. The primary outcome is the cost-effectiveness ratio (ICER), defined as the additional cost per quality-adjusted life year (QALY) gained when comparing each strategy to the next least costly one.
RESULTS
For RBP compared to CP, the ICER was US$83,000/QALY from the health care sector perspective; for PFA compared to RBP the ICER was US$154,000/QALY. Using a limited societal perspective that includes caregiver time spent attending dental or medical setting visits, RBP compared to CP yielded a ratio of $119,000/QALY and PFA compared to RBP was $235,000/QALY. Results were most sensitive to changes in the probability of pain from an episode of dental caries, costs for prevention and restoration, and the loss in health-related quality of life due to dental caries pain. Scenario analyses evaluating a reduced intensity of prevention services yielded lower ICERs.
CONCLUSION
Using a risk-based approach that identifies and targets children at increased risk for dental caries to guide the delivery of prevention services represents an economic value similar to other pediatric prevention programs.
Topics: Humans; Dental Caries; Cost-Benefit Analysis; Child; United States; Child, Preschool; Adolescent; Pit and Fissure Sealants; Quality-Adjusted Life Years; Infant; Fluorides, Topical; Male; Female; Cost-Effectiveness Analysis
PubMed: 38548263
DOI: 10.1016/j.acap.2024.02.006 -
Clinical Oral Investigations Mar 2024To compare the effectiveness of caries arrest by micro-operative treatment (sealing) to operative treatment (flowable resin composite restoration) through a 2-year... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To compare the effectiveness of caries arrest by micro-operative treatment (sealing) to operative treatment (flowable resin composite restoration) through a 2-year randomized controlled clinical trial.
MATERIALS AND METHODS
A prospective randomized controlled trial was conducted among 7-9-year-old children. At baseline, 630 subjects were screened and 92 children who had at least one carious lesion classified as ICDAS 3 on the pit and fissure of first permanent molar were included. Then they were randomly assigned to the sealant group (73 lesions) and the flowable resin composite group (76 lesions) to receive the corresponding intervention. Lesions status in each group was evaluated every 6 months up to 24 months. Clinical progression of dental caries and materials retention were the outcomes used for group comparisons at p-value < 0.05.
RESULTS
After 24 months, three lesions (4.1%) in the sealant group clinically progressed to dentin caries. No lesion in the flowable composite group was observed a progression. The results of Life-table survival analysis show that the cumulative caries arrest rate had no statistically significant difference between the two groups (p = 0.075). However, the cumulative retention rate was 57.5% in the sealant group and 92.1% in the flowable composite group, with significant differences (p < 0.001). The multilevel mixed model showed the sealant had higher risk of retention failure than the flowable composite (OR = 8.66, p < 0.001), while tooth position did not influence material retention (p = 0.083). In addition, the results of Fisher Exact test show that dentin lesions had more retention failure than enamel lesions in the sealant group (p = 0.026).
CONCLUSION
Although sealing microcavitated carious lesions of the first permanent molar achieved lower retention rate than resin composite restoration, both sealing and restoration effectively arrested caries progression for two years.
CLINICAL RELEVANCE
To preserving dental structure and delaying or eliminating the need for operative procedures, microcavitated carious lesion can be arrested by sealing.
TRIAL REGISTRATION
Registered at http://www.chictr.org.cn ; Feb 15th, 2020; No. ChiCTR2000029862.
Topics: Child; Humans; Dental Caries; Pit and Fissure Sealants; Dental Caries Susceptibility; Prospective Studies; Molar
PubMed: 38499947
DOI: 10.1007/s00784-024-05567-9 -
BMC Public Health Mar 2024Dental caries are a common non-communicable disease among children. As a public health measure at the prefectural level, school-based fluoride mouth-rinse (S-FMR)...
BACKGROUND
Dental caries are a common non-communicable disease among children. As a public health measure at the prefectural level, school-based fluoride mouth-rinse (S-FMR) program, medical/dental expense subsidy policies, and other factors may reduce the incidence of dental caries and tooth loss. Prefectures focusing on promoting oral health policies may promote both, but the interaction effect of implementing both subsidy policies and S-FMR at the prefectural level on caries prevention has not yet been examined.
METHODS
We conducted an ecological study using two-wave panel data, prefecture-level aggregated data in Japan for 2016 and 2018. Coefficient and 95% confidence intervals (CI) were calculated for the dependent variables for oral health using mixed-effects linear regression analysis adjusted for possible confounders. Two dependent variables were used; the standardized claim ratio (SCR) of deciduous tooth extraction and 12-year-olds' decayed, missing, or filled permanent teeth (DMFT). Four independent variables were S-FMR, the SCR of dental sealants, prefectural income per person, and subsidy policy in three models: co-payment until children enter elementary school (n = 23), no co-payment until children enter elementary school (n = 7), and co-payment continuing beyond elementary school (n = 17). The effects of six interaction terms, each representing a unique pairing from the four independent variables, were individually calculated.
RESULTS
S-FMR was negatively associated with the SCR of deciduous tooth extractions and DMFT (coefficient = -0.11, 95% CI -0.20; -0.01 and coefficient = -0.003, 95% CI -0.005; -0.001, respectively). No co-payment until children enter elementary school was positively associated with the SCR of deciduous tooth extraction compared to co-payment until children enter elementary school(coefficient = 11.42, 95% CI 3.29; 19.55). SCR of dental sealants was positively associated with the SCR of deciduous tooth extractions (coefficient = 0.12, 95% CI 0.06; 0.19) but negatively associated with DMFT (coefficient = -0.001, 95% CI -0.003; -0.0001). Per capita prefectural income was positively associated with the SCR of deciduous tooth extractions(coefficient = 0.01, 95% CI 0.001; 0.02). No interaction was found between S-FMR and the subsidy policy at both outcomes.
CONCLUSION
High S-FMR utilization and no co-payment until children enter elementary school were associated with fewer deciduous tooth extractions. Also, S-FMR and dental sealant were associated with decreased DMFT.
Topics: Child; Humans; Fluorides; Oral Health; Japan; Mouthwashes; Pit and Fissure Sealants; Dental Caries; Mouth; DMF Index
PubMed: 38475804
DOI: 10.1186/s12889-024-18156-y -
Anatomy & Cell Biology Mar 2024Transverse basilar cleft (TBC) is an extremely rare variation of the clivus or the basilar part of the occipital bone. In this report, a unilateral transverse basilar...
Transverse basilar cleft (TBC) is an extremely rare variation of the clivus or the basilar part of the occipital bone. In this report, a unilateral transverse basilar fissure was found at the clivus in a head computed tomography of an 18-year-old female patient diagnosed with hemifacial microsomia (HFM). Image analysis of this patient showed shortening of the ramus of the right mandible along with medial displacement of the right temporomandibular joint and hypoplastic right maxilla. In addition, observation of the clivus showed a cleft between the basioticum and basioccipital bones at the level of the pharyngeal tubercle on the right side. This cleft was identified as TBC. Clival variations, TBC included, attributed to HFM have never been reported. This report draws attention to the complex relationship between abnormal development of clivus and HFM syndrome, and sheds light on a possible genetic and molecular association between these two conditions.
PubMed: 38449077
DOI: 10.5115/acb.23.289 -
Journal of Oral Biology and... 2024Periapical surgery has been suggested as a treatment option for teeth with periapical lesions when those lesions continue despite receiving root canal therapy. Since...
BACKGROUND
Periapical surgery has been suggested as a treatment option for teeth with periapical lesions when those lesions continue despite receiving root canal therapy. Since sealing the apical region is the operation's primary goal, the choice of the root-end filling material affects how the surgery turns out. The retrofilling materials Zinc Oxide Eugenol (ZOE) and Mineral trioxide aggregate (MTA) are both known to have antibacterial characteristics. The purpose of this study is to determine how MTA affects as a Modulator of Periapical Tissue Healing through histological examination in Rat Molar.
METHODS
A dental fissure bur measuring 0.7 mm is used to remove the buccal root apex from the buccal alveolar bone's surface, creating the cavity. One of the following is placed within each cavity: Group 1: MTA, Group 2: ZOE. For each material series, six samples were used. We classified the healing outcomes for each MTA and ZOE retrograde filling material into three groups based on histological analysis: the amount of newly generated bone, the number of fibroblasts, and the infiltration of neutrophils into the surgical site.
RESULTS
On the 6th day of examination, fibroblasts were seen in the area around the wound. A significant inflammatory response, including neutrophil infiltration, was seen around the ZOE after retrograde filling. On the 16th day, the new alveolar bone structure showed a slight increase. After filling the MTA on the 6th day of examination, the immediate inflammatory response was insignificant. Neutrophils were observed to enter the region surrounding the retrofilled MTA, and a small number of osteoclasts were observed to be resorbing bone. Around the wound site, fibroblasts can also be detected. On the 16th day, unlike ZOE, a lot of new bone grows close to this material.
CONCLUSION
MTA has the ability to modulate periapical healing in rat molar.
PubMed: 38445049
DOI: 10.1016/j.jobcr.2024.02.006 -
Scientific Reports Mar 2024Human enamel is composed mainly of apatite. This mineral of sorption properties is susceptible to chemical changes, which in turn affect its resistance to dissolution....
Human enamel is composed mainly of apatite. This mineral of sorption properties is susceptible to chemical changes, which in turn affect its resistance to dissolution. This study aimed to investigate whether metal leakage from orthodontic appliances chemically alters the enamel surface during an in vitro simulated orthodontic treatment. Totally 107 human enamel samples were subjected to the simulation involving metal appliances and cyclic pH fluctuations over a period of 12 months in four complimentary experiments. The average concentrations and distribution of Fe, Cr, Ni, Ti and Cu within the enamel before and after the experiments were examined using ICP‒MS and LA‒ICP‒MS techniques. The samples exposed to the interaction with metal appliances exhibited a significant increase in average Fe, Cr and Ni (Kruskal-Wallis, p < 0.002) content in comparison to the control group. The outer layer, narrow fissures and points of contact with the metal components showed increased concentrations of Fe, Ti, Ni and Cr after simulated treatment, conversely to the enamel sealed with an adhesive system. It has been concluded that metal leakage from orthodontic appliances chemically alters enamel surface and microlesions during experimental in vitro simulated treatment.
Topics: Humans; Orthodontic Appliances; Dental Care; Apatites; Computer Simulation; Metals
PubMed: 38443566
DOI: 10.1038/s41598-024-56111-4