This study compared the 2-year survival rates of Class II restorations placed in primary molars using either cotton rolls or rubber dam as isolation methods. 232 children received ART restorations that were evaluated at 6, 12, 18, and 24 months. The cumulative survival rates were similar between groups, with rates of 61.4% vs 64.1% at 6 months and 18% vs 32.1% at 24 months for the cotton roll and rubber dam groups, respectively. The log rank test found no statistically significant difference in survival rates between the isolation methods. Both provided comparable survival rates for Class II ART restorations in primary molars.
The document summarizes a clinical study that compared the performance of a two-step self-etching adhesive system (Clearfil Protect Bond) and a one-step self-etching adhesive system (Xeno III) over one year. 163 restorations were placed in noncarious cervical lesions in 35 patients using the two adhesive systems. The restorations were evaluated at baseline and 3, 6, 9, and 12 months using criteria such as color matching, marginal adaptation, retention, etc. At one year, the retention rate was 100% for the two-step system and 96% for the one-step system. Both systems showed excellent performance during the one-year clinical trial, though the two-step system
Preference of materials for posterior restorations: A cross-sectional study a...Premier Publishers
The aim of the study is to evaluate the preferences of materials for posterior restorations among Palestinian dentists and to assess whether postgraduate training or clinical experience had an influence on their material preferences. A cross-sectional study was carried out among 216 dentists in Palestine using an online survey, which consisted of closed questions asking about socio demographic variables, the level of specialization and time since graduation. It further probed into the preferences for posterior restorations through questions about the first choice of material, type of composite resin (if used), use of rubber dam and preferences for curing. It was observed that 66.2% of the dentists preferred using composite and 72.9% preferred nano-hybrid composite restorations over other types of composite material. However, the majority (88.4%) did not prefer using a rubber dam. There was no significant association between the time of clinical training or post-graduate training and their choices for the materials. The study reports that composite was the preferred material for posterior restoration among the Palestinian dentists, and nano-hybrid their preferred type of composite. However, these dentists seldom used rubber dam and their postgraduate training or time of training did not influence their choice of material
JOURNAL CLUB: Terminology of Dental Caries and Dental Caries Management: Cons...Urvashi Sodvadiya
Vita Machiulskienea, Guglielmo Campusb, c Joana Christina, Carvalhod Irene, Digee Kim, Rud Ekstrandf, Anahita Jablonski-Momenig, Marisa Maltzh, David J. ,Mantoni Stefania, Martignonj, k E. Angeles, Martinez-Mierl, Nigel B., Pittsj Andreas G., Schultem Christian, H. Spliethn, Livia Maria, Andaló Tenutao, Andrea Ferreira Zandonap, Bente Nyvade
CARIES RESEARCH; OCT 2019
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document outlines the phases of periodontal therapy, including:
1) Preliminary phase focusing on emergencies and extractions.
2) Nonsurgical phase involving plaque control, non-surgical treatments like scaling and root planing.
3) Surgical phase using various periodontal surgeries and other treatments like implants and endodontics.
4) Restorative phase for final restorations and prosthodontics.
5) Maintenance phase for long-term supportive periodontal therapy.
Surgical periodontal therapy aims to eliminate pathologic changes, create a stable periodontium, and promote regeneration through techniques like pocket reduction surgeries and correction of anatomic defects
This study evaluated microbial contamination of toothbrushes used by dental students and tested a decontamination protocol using chlorhexidine spray. Cultures from 32 used student toothbrushes found microbial growth on 91%, primarily Streptococcus (81.3%) and sometimes Staphylococcus and Enterobacteriaceae. In a randomized crossover study, 30 students used new toothbrushes with daily water spray or 0.12% chlorhexidine spray once or three times daily. Chlorhexidine sprayed three times daily after brushing significantly reduced bacterial levels compared to water. Thus, simple chlorhexidine spraying after brushing can lower toothbrush bacterial load.
The document summarizes a clinical study that compared the performance of a two-step self-etching adhesive system (Clearfil Protect Bond) and a one-step self-etching adhesive system (Xeno III) over one year. 163 restorations were placed in noncarious cervical lesions in 35 patients using the two adhesive systems. The restorations were evaluated at baseline and 3, 6, 9, and 12 months using criteria such as color matching, marginal adaptation, retention, etc. At one year, the retention rate was 100% for the two-step system and 96% for the one-step system. Both systems showed excellent performance during the one-year clinical trial, though the two-step system
Preference of materials for posterior restorations: A cross-sectional study a...Premier Publishers
The aim of the study is to evaluate the preferences of materials for posterior restorations among Palestinian dentists and to assess whether postgraduate training or clinical experience had an influence on their material preferences. A cross-sectional study was carried out among 216 dentists in Palestine using an online survey, which consisted of closed questions asking about socio demographic variables, the level of specialization and time since graduation. It further probed into the preferences for posterior restorations through questions about the first choice of material, type of composite resin (if used), use of rubber dam and preferences for curing. It was observed that 66.2% of the dentists preferred using composite and 72.9% preferred nano-hybrid composite restorations over other types of composite material. However, the majority (88.4%) did not prefer using a rubber dam. There was no significant association between the time of clinical training or post-graduate training and their choices for the materials. The study reports that composite was the preferred material for posterior restoration among the Palestinian dentists, and nano-hybrid their preferred type of composite. However, these dentists seldom used rubber dam and their postgraduate training or time of training did not influence their choice of material
JOURNAL CLUB: Terminology of Dental Caries and Dental Caries Management: Cons...Urvashi Sodvadiya
Vita Machiulskienea, Guglielmo Campusb, c Joana Christina, Carvalhod Irene, Digee Kim, Rud Ekstrandf, Anahita Jablonski-Momenig, Marisa Maltzh, David J. ,Mantoni Stefania, Martignonj, k E. Angeles, Martinez-Mierl, Nigel B., Pittsj Andreas G., Schultem Christian, H. Spliethn, Livia Maria, Andaló Tenutao, Andrea Ferreira Zandonap, Bente Nyvade
CARIES RESEARCH; OCT 2019
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document outlines the phases of periodontal therapy, including:
1) Preliminary phase focusing on emergencies and extractions.
2) Nonsurgical phase involving plaque control, non-surgical treatments like scaling and root planing.
3) Surgical phase using various periodontal surgeries and other treatments like implants and endodontics.
4) Restorative phase for final restorations and prosthodontics.
5) Maintenance phase for long-term supportive periodontal therapy.
Surgical periodontal therapy aims to eliminate pathologic changes, create a stable periodontium, and promote regeneration through techniques like pocket reduction surgeries and correction of anatomic defects
This study evaluated microbial contamination of toothbrushes used by dental students and tested a decontamination protocol using chlorhexidine spray. Cultures from 32 used student toothbrushes found microbial growth on 91%, primarily Streptococcus (81.3%) and sometimes Staphylococcus and Enterobacteriaceae. In a randomized crossover study, 30 students used new toothbrushes with daily water spray or 0.12% chlorhexidine spray once or three times daily. Chlorhexidine sprayed three times daily after brushing significantly reduced bacterial levels compared to water. Thus, simple chlorhexidine spraying after brushing can lower toothbrush bacterial load.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
The document describes a modified neutral zone technique for improving the stability of mandibular complete dentures. The technique involves making an acrylic resin base with posterior occlusal rims, applying a thermoplastic denture adhesive, and having patients wear it for 2 days to record the neutral zone. The base is then used to make an acrylic resin complete denture. Most patients reported improved denture stability and reduced pressure sores. However, the technique is complex and not recommended for routine use.
The document summarizes the key phases and techniques involved in nonsurgical periodontal therapy (NSPT). It discusses the goals of NSPT to eliminate pathogens and halt disease progression. Techniques include scaling and root planing to remove calculus, contaminated cementum, and bacterial toxins. Studies found that aggressive root planing is not needed and that clinical improvements result from scaling alone or with root planing. The effects of NSPT on subgingival microflora and selection of instrumentation techniques are also summarized.
This document contains abstracts from a conference on dental treatment and restorative dentistry. The abstracts describe various studies and case presentations on topics such as:
- Common complications with denture wear, including pain, poor retention, and poor oral hygiene. One study found the most common issues were pain from upper and lower dentures.
- Using a multidisciplinary approach including orthodontics, periodontics, and prosthodontics to restore a fractured tooth, allowing for esthetic restoration.
- Using an astringent gum massage to increase keratinization of denture-bearing mucosa and improve prosthesis fit. One study found the massage significantly increased keratinization over 4
This study evaluated the clinical outcomes and properties of periodontal ligament progenitor cells (PDLPs) for the treatment of periodontitis. Three patients with intrabony periodontal defects were treated by transplantation of autologous PDLPs cultured on a bone graft material. Clinical measurements over 32-72 months showed reduced probing depths and clinical attachment gains, indicating potential therapeutic benefits. In vitro analysis found that PDLPs showed characteristics similar to periodontal ligament stem cells (PDLSCs), including proliferation, mesenchymal surface marker expression, and multipotent differentiation, but lacked expression of the tendon marker scleraxis. This provides preliminary evidence that PDLP transplantation may be an effective and safe approach for periodontitis
This randomized controlled trial compared the efficacy of 2% lignocaine with epinephrine (Group A) to a mixture of 2% lignocaine with epinephrine and 4 mg dexamethasone (twin mix, Group B) for third molar surgery. The study found that the twin mix provided a faster onset of anesthesia, longer duration of soft tissue anesthesia, and less postoperative pain, swelling and trismus compared to lignocaine alone. Specifically, the twin mix group had onset of anesthesia in 51 seconds compared to 81 seconds, duration of anesthesia of 251 minutes compared to 142 minutes, and lower pain scores on the first, third and seventh postoperative days. The twin mix also resulted in less facial swelling and reduced mouth opening after
Non-surgical periodontal therapy involves procedures like manual debridement, machine-driven debridement, supra/subgingival irrigation, local drug delivery, lasers, systemic drugs and host modulation therapy to reduce probing depth and bleeding and improve clinical attachment levels. Surgical therapy involves flap procedures to access root surfaces and eliminate deep pockets. Systematic reviews found that both non-surgical and surgical periodontal therapy are effective in treating periodontitis, with no significant differences in clinical outcomes between the two approaches. The choice of treatment depends on the initial probing depth, with non-surgical therapy used for shallower pockets and surgery for deeper pockets above a critical threshold.
This document discusses laser induced biostimulation as a potential treatment for endo-perio lesions. It presents a case study of a patient with an endo-perio lesion on tooth #32 who was treated with both endodontic and periodontal procedures in the same appointment using a 980nm diode laser. The laser was used for canal disinfection, new attachment procedure and hemostasis. At the 1 month recall the patient was asymptomatic with healed sinus tract and reduced pocket depths. Follow-ups showed continued healing over 4 years. The conclusion is that laser treatment may be an effective way to simultaneously treat endo-perio lesions in a shorter time.
An Evaluation of Short Term Success and Survival Rate of Implants Placed in F...DrHeena tiwari
An Evaluation of Short Term Success and Survival Rate of Implants Placed in Fresh Extraction Socket Post Prosthetic Rehabilitation- A Prospective Study
The document discusses the principles and techniques of minimal invasive dentistry for diagnosing and treating dental caries, including identifying patients' caries risk factors, using remineralization methods to prevent or control non-cavitated caries, and employing restorative techniques that minimize removal of healthy tooth structure. It outlines the goals of preserving tooth structure, stopping disease progression, and restoring function with minimal intervention. The approach focuses on changing the disease process through dietary and lifestyle modifications rather than solely operative treatment.
Conservative Management of Mature Permanent Teeth with Carious Pulp ExposureDR.AJAY BABU GUTTI M.D.S
1) The study evaluated the correlation between clinical diagnoses of normal/reversible pulpitis (savable pulp) vs irreversible pulpitis (nonsavable pulp) and histologic diagnoses.
2) Results found the clinical diagnosis of normal/reversible pulpitis matched the histologic diagnosis in 84% of teeth, suggesting clinical diagnoses can reliably determine whether the pulp is savable or nonsavable.
3) However, clinical pulp testing alone is not definitive, and an urgent need remains for more accurate diagnostic tools to determine pulpal status.
This document discusses non-surgical therapy for periodontal disease. It covers the objectives of plaque control and scaling and root planing, which is the gold standard of non-surgical periodontal therapy. It also discusses outcomes of non-surgical therapy such as reductions in pocket depth and clinical attachment levels, as well as changes to microflora and radiographic bone levels. Limitations of non-surgical therapy are outlined, as well as factors that influence treatment effectiveness like disease severity and the skill of the clinician. The role of adjunctive treatments like systemic antibiotics and full mouth disinfection are also summarized.
Effectiveness of Low-Level Lasers subsequent to Third Molar Surgery: An Origi...DrHeena tiwari
This study assessed the effectiveness of low-level lasers in reducing postoperative pain, swelling, and trismus following third molar surgery. 32 patients who required bilateral lower wisdom tooth removal were treated, with one side receiving laser treatment and the other serving as the control. Pain was significantly lower on the laser treated side on days 6-7, though swelling and trismus did not significantly differ between sides. The results suggest low-level lasers may help reduce pain following third molar surgery when applied immediately after surgery.
JOURNAL CLUB PEDODONTICS - Evaluation of antibacterial efficacy of fungal der...Rachael Gupta
1) The study evaluated the antibacterial efficacy of silver nanoparticles (AgNPs) biosynthesized using the fungus Fusarium semitectum against Enterococcus faecalis, a common cause of persistent endodontic infections.
2) Agar well diffusion tests showed that the AgNPs had a significant antibacterial effect against E. faecalis comparable to 2% chlorhexidine. Higher concentrations of AgNPs resulted in larger inhibition zones.
3) Biosynthesized fungal AgNPs show promise as effective antimicrobial agents that could help eliminate persistent endodontic pathogens like E. faecalis.
The document discusses various aspects of media coverage of Hurricane Katrina in 2005. It provides criteria for good journalism, such as being honest, asking critical questions, and providing context. It also examines examples of coverage in the days and years after Katrina, some of which speculative or sensationalized the disaster. Interviews with FEMA and analyses published years later provided more balanced, responsible coverage that asked important questions.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
The document describes a modified neutral zone technique for improving the stability of mandibular complete dentures. The technique involves making an acrylic resin base with posterior occlusal rims, applying a thermoplastic denture adhesive, and having patients wear it for 2 days to record the neutral zone. The base is then used to make an acrylic resin complete denture. Most patients reported improved denture stability and reduced pressure sores. However, the technique is complex and not recommended for routine use.
The document summarizes the key phases and techniques involved in nonsurgical periodontal therapy (NSPT). It discusses the goals of NSPT to eliminate pathogens and halt disease progression. Techniques include scaling and root planing to remove calculus, contaminated cementum, and bacterial toxins. Studies found that aggressive root planing is not needed and that clinical improvements result from scaling alone or with root planing. The effects of NSPT on subgingival microflora and selection of instrumentation techniques are also summarized.
This document contains abstracts from a conference on dental treatment and restorative dentistry. The abstracts describe various studies and case presentations on topics such as:
- Common complications with denture wear, including pain, poor retention, and poor oral hygiene. One study found the most common issues were pain from upper and lower dentures.
- Using a multidisciplinary approach including orthodontics, periodontics, and prosthodontics to restore a fractured tooth, allowing for esthetic restoration.
- Using an astringent gum massage to increase keratinization of denture-bearing mucosa and improve prosthesis fit. One study found the massage significantly increased keratinization over 4
This study evaluated the clinical outcomes and properties of periodontal ligament progenitor cells (PDLPs) for the treatment of periodontitis. Three patients with intrabony periodontal defects were treated by transplantation of autologous PDLPs cultured on a bone graft material. Clinical measurements over 32-72 months showed reduced probing depths and clinical attachment gains, indicating potential therapeutic benefits. In vitro analysis found that PDLPs showed characteristics similar to periodontal ligament stem cells (PDLSCs), including proliferation, mesenchymal surface marker expression, and multipotent differentiation, but lacked expression of the tendon marker scleraxis. This provides preliminary evidence that PDLP transplantation may be an effective and safe approach for periodontitis
This randomized controlled trial compared the efficacy of 2% lignocaine with epinephrine (Group A) to a mixture of 2% lignocaine with epinephrine and 4 mg dexamethasone (twin mix, Group B) for third molar surgery. The study found that the twin mix provided a faster onset of anesthesia, longer duration of soft tissue anesthesia, and less postoperative pain, swelling and trismus compared to lignocaine alone. Specifically, the twin mix group had onset of anesthesia in 51 seconds compared to 81 seconds, duration of anesthesia of 251 minutes compared to 142 minutes, and lower pain scores on the first, third and seventh postoperative days. The twin mix also resulted in less facial swelling and reduced mouth opening after
Non-surgical periodontal therapy involves procedures like manual debridement, machine-driven debridement, supra/subgingival irrigation, local drug delivery, lasers, systemic drugs and host modulation therapy to reduce probing depth and bleeding and improve clinical attachment levels. Surgical therapy involves flap procedures to access root surfaces and eliminate deep pockets. Systematic reviews found that both non-surgical and surgical periodontal therapy are effective in treating periodontitis, with no significant differences in clinical outcomes between the two approaches. The choice of treatment depends on the initial probing depth, with non-surgical therapy used for shallower pockets and surgery for deeper pockets above a critical threshold.
This document discusses laser induced biostimulation as a potential treatment for endo-perio lesions. It presents a case study of a patient with an endo-perio lesion on tooth #32 who was treated with both endodontic and periodontal procedures in the same appointment using a 980nm diode laser. The laser was used for canal disinfection, new attachment procedure and hemostasis. At the 1 month recall the patient was asymptomatic with healed sinus tract and reduced pocket depths. Follow-ups showed continued healing over 4 years. The conclusion is that laser treatment may be an effective way to simultaneously treat endo-perio lesions in a shorter time.
An Evaluation of Short Term Success and Survival Rate of Implants Placed in F...DrHeena tiwari
An Evaluation of Short Term Success and Survival Rate of Implants Placed in Fresh Extraction Socket Post Prosthetic Rehabilitation- A Prospective Study
The document discusses the principles and techniques of minimal invasive dentistry for diagnosing and treating dental caries, including identifying patients' caries risk factors, using remineralization methods to prevent or control non-cavitated caries, and employing restorative techniques that minimize removal of healthy tooth structure. It outlines the goals of preserving tooth structure, stopping disease progression, and restoring function with minimal intervention. The approach focuses on changing the disease process through dietary and lifestyle modifications rather than solely operative treatment.
Conservative Management of Mature Permanent Teeth with Carious Pulp ExposureDR.AJAY BABU GUTTI M.D.S
1) The study evaluated the correlation between clinical diagnoses of normal/reversible pulpitis (savable pulp) vs irreversible pulpitis (nonsavable pulp) and histologic diagnoses.
2) Results found the clinical diagnosis of normal/reversible pulpitis matched the histologic diagnosis in 84% of teeth, suggesting clinical diagnoses can reliably determine whether the pulp is savable or nonsavable.
3) However, clinical pulp testing alone is not definitive, and an urgent need remains for more accurate diagnostic tools to determine pulpal status.
This document discusses non-surgical therapy for periodontal disease. It covers the objectives of plaque control and scaling and root planing, which is the gold standard of non-surgical periodontal therapy. It also discusses outcomes of non-surgical therapy such as reductions in pocket depth and clinical attachment levels, as well as changes to microflora and radiographic bone levels. Limitations of non-surgical therapy are outlined, as well as factors that influence treatment effectiveness like disease severity and the skill of the clinician. The role of adjunctive treatments like systemic antibiotics and full mouth disinfection are also summarized.
Effectiveness of Low-Level Lasers subsequent to Third Molar Surgery: An Origi...DrHeena tiwari
This study assessed the effectiveness of low-level lasers in reducing postoperative pain, swelling, and trismus following third molar surgery. 32 patients who required bilateral lower wisdom tooth removal were treated, with one side receiving laser treatment and the other serving as the control. Pain was significantly lower on the laser treated side on days 6-7, though swelling and trismus did not significantly differ between sides. The results suggest low-level lasers may help reduce pain following third molar surgery when applied immediately after surgery.
JOURNAL CLUB PEDODONTICS - Evaluation of antibacterial efficacy of fungal der...Rachael Gupta
1) The study evaluated the antibacterial efficacy of silver nanoparticles (AgNPs) biosynthesized using the fungus Fusarium semitectum against Enterococcus faecalis, a common cause of persistent endodontic infections.
2) Agar well diffusion tests showed that the AgNPs had a significant antibacterial effect against E. faecalis comparable to 2% chlorhexidine. Higher concentrations of AgNPs resulted in larger inhibition zones.
3) Biosynthesized fungal AgNPs show promise as effective antimicrobial agents that could help eliminate persistent endodontic pathogens like E. faecalis.
The document discusses various aspects of media coverage of Hurricane Katrina in 2005. It provides criteria for good journalism, such as being honest, asking critical questions, and providing context. It also examines examples of coverage in the days and years after Katrina, some of which speculative or sensationalized the disaster. Interviews with FEMA and analyses published years later provided more balanced, responsible coverage that asked important questions.
Kayla Fitzwater wrote about her dog Echo and why she is an awesome pet. Echo can perform tricks like sit, shake, fetch, and turn on lights. She enjoys playing with other dogs, eating socks, and laying on couches awkwardly. Echo also likes being as close to Kayla as possible, even if it means sitting on top of her. Kayla concludes that Echo is her best friend and she loves her.
Study: The Future of VR, AR and Self-Driving CarsLinkedIn
We asked LinkedIn members worldwide about their levels of interest in the latest wave of technology: whether they’re using wearables, and whether they intend to buy self-driving cars and VR headsets as they become available. We asked them too about their attitudes to technology and to the growing role of Artificial Intelligence (AI) in the devices that they use. The answers were fascinating – and in many cases, surprising.
This SlideShare explores the full results of this study, including detailed market-by-market breakdowns of intention levels for each technology – and how attitudes change with age, location and seniority level. If you’re marketing a tech brand – or planning to use VR and wearables to reach a professional audience – then these are insights you won’t want to miss.
LSTR is a new pulp therapy technique used in pediatric dentistry.
This presentation illustrated some studies which ensures the high success probability of the new technique
This study compared the Atraumatic Restorative Treatment (ART) technique and Hall Technique (HT) for restoring occlusoproximal lesions in primary molars in children. 30 children were randomly assigned to receive either ART or HT. The ART group showed no change in bite opening, while the HT group showed a statistically significant increase. The HT took a significantly longer time than ART. Both techniques were well accepted by children and parents based on reported satisfaction levels. The study concluded that HT was preferred for its minimal discomfort, though ART was a good aesthetic alternative with a shorter procedure time and no change in bite opening.
EFFICACY OF FIXED VERSUS REMOVAL RETAINER POST ORTHODONTIC TREATMENT: A COMP...DrHeena tiwari
This study compared the efficacy of fixed versus removable retainers for maintaining orthodontic treatment outcomes over 4 years. 48 participants from an original randomized controlled trial were evaluated. Those with fixed retainers had lower irregularity scores on average (0.85mm increase) compared to removable retainers (1.47mm increase). After adjusting for confounding factors, the difference in irregularity between groups was statistically significant, with removable retainers having 1.64mm more irregularity on average. No other significant differences were found between groups for other metrics like inter-canine width. Compliance with removable retainers decreased over time. Fixed retainers maintained their position better, though some required repair. In conclusion, fixed retainers appeared to
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Of partial defects of the dental rows of dynamic study of the state of the mu...SubmissionResearchpa
Despite the rapid development of dentistry and advances in the prevention of diseases of the maxillofacial region, implantology, and the treatment of dental diseases, the number of patients who need prosthetics with removable orthopedic structures of dentures remains high, and only increases with age, due to the increasing rate of aging. society of the planet (M.Yu. Ogorodnikov, 2007; V.I.Shemonaev, 2012; E.S. Kalivradzhiyan, 2013; E.A.Zholudev, 2014; CE. Bragin, 2014; L.D. Veisheim, 2014). Among the reasons for the high demand for orthopedic treatment with removable dentures, the leading position is still held by insufficient sanitation of the oral cavity, untimely access of patients to the dentist. In addition, an important role is played by the problem of imperfection of materials and technologies used for the manufacture of dentures, leading to a deterioration in the condition of the dentition by A.Kh. Zhumaev 2020. Of partial defects of the dental rows of dynamic study of the state of the mucosa of the oral cavity in the new conditions of functioning. International Journal on Integrated Education. 3, 12 (Dec. 2020), 61-63. DOI:https://doi.org/10.31149/ijie.v3i12.913 https://journals.researchparks.org/index.php/IJIE/article/view/913/861 https://journals.researchparks.org/index.php/IJIE/article/view/913
This case series examines a new surgical technique for regenerating interimplant papillae using subepithelial connective tissue grafts. 10 patients with missing papillae between implant restorations received the new procedure involving buccal and palatal incisions made away from the papilla to preserve blood supply, and tunneling performed with a specialized instrument. The papillae scores improved on average from 0.8 to 2.4 after 16 months, demonstrating regeneration of the papillae over 11-30 months. However, long-term studies are still needed to validate the technique and outcomes.
This randomized clinical trial compared the survival of composite resin restorations and metal-ceramic crowns on endodontically treated teeth over a follow-up period of 1 to 5 years. 57 restorations were placed in 47 patients, with 30 being composite resin and 27 being metal-ceramic crowns. One tooth was extracted in the composite group due to root fracture. There were 8 failures in the composite group and 1 failure in the crown group, mostly due to secondary caries or restoration fracture. Metal-ceramic crowns demonstrated better clinical performance and lower need for re-intervention, but both types of restorations showed good survival rates with no significant difference.
Evaluation effect of an in office zoom bleaching gel agent on theAmir Hamde
This study evaluated the effects of an in-office bleaching gel containing 25% hydrogen peroxide on the surface texture of three contemporary restorative materials (Beautifil II, IPS Empress Direct, and Ceram.x.mono). Scanning electron microscope images were taken of impressions of the restorations before bleaching, immediately after, and at follow-ups of 2 days, 3 months, 6 months, and 1 year. The results showed the bleaching effect was material- and time-dependent, with no major surface texture changes observed on the restorative materials.
This randomized controlled clinical trial compared the efficacy of MI varnish and Clinpro XT varnish in reducing dentinal hypersensitivity. The study found that MI varnish, a calcium phosphate-based varnish, was more effective at reducing sensitivity based on ice test and cold water test scores compared to Clinpro XT varnish, a resin modified glass ionomer-based varnish. Both varnishes showed a reduction in sensitivity but MI varnish produced approximately double the percentage change in sensitivity scores compared to Clinpro XT varnish. The study concluded that MI varnish was more effective at reducing dentinal hypersensitivity.
The Perio Tray is a prescription medical device used to deliver medications prescribed by a dentist directly into periodontal pockets. It is custom formed to seal around each pocket to direct and maintain medication in the pocket long enough to be therapeutically effective. Other trays do not provide the specialized seals and extensions to fit each individual pocket shape and depth. The document then discusses various experiments and studies on treating biofilms and dental caries with methods like hydrogen peroxide gel, fluoride treatments, and the CTx line of products that use multiple agents to neutralize pH, reduce bacteria, aid remineralization, and more to target dental caries.
Class II subdivision treatment. ( journal club presentation)Sneh Kalgotra
This document summarizes a study comparing the outcomes of symmetric vs asymmetric extraction protocols for treating Class II subdivision malocclusions. The study examined pre-treatment and post-treatment models of 51 patients, with 28 patients receiving symmetric 4-premolar extractions and 23 receiving asymmetric 3-premolar extractions. The asymmetric approach showed a tendency for better correction of dental midline deviation and posterior discrepancies. However, there were no statistically significant differences in final occlusion or changes between the two protocols.
The document describes a clinical trial that assessed the effects of using a Connecticut intrusion arch (CIA) with or without a distal bend on maxillary incisor and molar positions. 44 patients were randomly divided into two groups: one treated with a CIA without a distal bend, and one treated with a CIA with a distal bend. Cephalometric analysis found that the group without a distal bend experienced labial flaring and proclination of maxillary incisors, while the group with a distal bend experienced palatal inclination and retroclination of maxillary incisors. No significant differences were found between the groups for maxillary molar positions. The presence or absence of a distal bend in the CIA affects incis
The document describes the Atraumatic Restorative Technique (ART), which is a minimally invasive dental procedure for managing tooth decay. ART involves removing decayed tooth material using hand instruments only, without anesthesia or drilling, and then restoring the cavity with adhesive materials like glass ionomer cement. The key principles of ART are preserving tooth structure, minimizing trauma, and using materials that bond chemically to tooth surfaces. ART has advantages like pain reduction, lower costs, and improved access for patients who cannot access traditional dental care. The document outlines the indications, contraindications, procedure steps, advantages, and limitations of the ART approach.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
Comprehensive Assessment of Attitude Towards Denture Hygiene Habits in Compl...Ajay Pacharne
Abstract---Background and Aim: With the advanced innovations in
the rehabilitation techniques, the usages of removable denture have
been reduced significantly. However; complete denture are one of the
most common and trendy avenue for restoring completely edentulous
situations. The ultimate aim of this study was to assess the denture
hygiene attitude in complete denture patients. Materials and Methods:
A total of 100 complete denture wearing patients were selected for this
assessment. The patients were selected in the age range of 45-70
years. The methodologies were explained to the patients prior to the
real execution of the study. All interested complete denture patients
were included in the study. We also performed a small demographic
recording of the patients that includes data on gender, age, length of
prosthesis utilize, cleaning strategies and materials, and so on.
Statistical Analysis and Results: Basic statistical analysis was
completed using SPSS statistical package for the Social Sciences
version 21 for Windows. Only 58% of the patients reported that they
use to clean their dentures every day once. Approximately 68% of the
patients agreed that they do not remember the verbal and written
instructions for denture hygiene at the time of delivery of complete
dentures by the dentists.
Assessment of Microbial Contamination of the Tooth Brush Head Used On Orthodo...inventionjournals
Introduction: Oral diseases can be greatly controlled by reducing the microbial load in the oral cavity and this can be achieved by maintaining proper oral hygiene.Tooth brushes are the most commonly used oral hygiene aid to promote oral health and prevent dental diseases. The insertion of fixed appliances alters the oral microbiological profile, thus increasing the risk for caries and gingivitis considerably. Aim: To assess the microbial growth of S.Mutans and Lactobacillus between and among the brushes. Setting and Study Design: A Hospital setting and Randomized Control study design Methods:A total of 56 (MB) patients aged 16-26 years received a toothbrush [Regular soft bristle design (group-A) and Orthodontic bristle design (group B)],A sterile gamma radiated pouch and checklist was distributed to each participant. After 2 weeks period the brushes were collected and placed in 5ml saline solution (0.05g Sodium Chloride). The suspension was incubated on selective agar plates and the amount of Streptococcus mutans and lactobacilli for each brush head was assessed. Results:The retention of S.Mutanswas found to be higher in group A, as compared to group B and was found to be statistically more significant between the two groups (P<0.001). The retention of Lactobacillus was also found to be higher in group A, as compared to group B and was found to be statistically significant between the groups (P= 0.001). However, there was no significant difference (P= 0.101) observedamong the microbial growth of S.Mutans and Lactobacillus in two bristle designs. Conclusions: Regular soft bristle design had a higher microbial load than those of subjects using orthodontic bristle design, a more frequent replacement of toothbrushes during t treatment may be advisable. Due to significant differences between the two bristle designs, the orthodontic toothbrush is recommended for patients undergoing orthodontic t appliances
Assessment of Microbial Contamination of the Tooth Brush Head Used On Orthodo...inventionjournals
Introduction: Oral diseases can be greatly controlled by reducing the microbial load in the oral cavity and this can be achieved by maintaining proper oral hygiene.Tooth brushes are the most commonly used oral hygiene aid to promote oral health and prevent dental diseases. The insertion of fixed appliances alters the oral microbiological profile, thus increasing the risk for caries and gingivitis considerably. Aim: To assess the microbial growth of S.Mutans and Lactobacillus between and among the brushes. Setting and Study Design: A Hospital setting and Randomized Control study design Methods:A total of 56 (MB) patients aged 16-26 years received a toothbrush [Regular soft bristle design (group-A) and Orthodontic bristle design (group B)],A sterile gamma radiated pouch and checklist was distributed to each participant. After 2 weeks period the brushes were collected and placed in 5ml saline solution (0.05g Sodium Chloride). The suspension was incubated on selective agar plates and the amount of Streptococcus mutans and lactobacilli for each brush head was assessed. Results:The retention of S.Mutanswas found to be higher in group A, as compared to group B and was found to be statistically more significant between the two groups (P<0.001). The retention of Lactobacillus was also found to be higher in group A, as compared to group B and was found to be statistically significant between the groups (P= 0.001). However, there was no significant difference (P= 0.101) observedamong the microbial growth of S.Mutans and Lactobacillus in two bristle designs. Conclusions: Regular soft bristle design had a higher microbial load than those of subjects using orthodontic bristle design, a more frequent replacement of toothbrushes during t treatment may be advisable. Due to significant differences between the two bristle designs, the orthodontic toothbrush is recommended for patients undergoing orthodontic t appliances
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7
Carvalho class ii art_ijpd_2010
1. Two years survival rate of Class II ART restorations in primary
molars using two ways to avoid saliva contamination
THIAGO SAADS CARVALHO1,2
, FA´ BIO CORREIA SAMPAIO1
, ALEXANDRE DINIZ1
, MARCELO
BO¨ NECKER2
& WILLEM EVERT VAN AMERONGEN3
1
Departamento de Clı´nica e Odontologia Social, Universidade Federal da Paraı´ba, 2
Departamento de Odontopediatria;
Faculdade de Odontologia da Universidade de Sa˜o Paulo, and 3
Department of Cariology, Endodontology, Pedodontology,
ACTA - Academisch Centrum Tandheelkunde Amsterdam
International Journal of Paediatric Dentistry 2010; 20: 419–
425
Aim. To compare the survival rates of Class II
Atraumatic Restorative Treatment (ART) restora-
tions placed in primary molars using cotton rolls
or rubber dam as isolation methods.
Methods. A total of 232 children, 6–7 years old,
both genders, were selected having one primary
molar with proximal dentine lesion. The children
were randomly assigned into two groups: control
group with Class II ART restoration made using
cotton rolls and experimental group using rubber
dam. The restorations were evaluated by eight cal-
ibrated evaluators (Kappa > 0.8) after 6, 12, 18
and 24 months.
Results. A total of 48 (20.7%) children were con-
sidered dropout, after 24 months. The cumulative
survival rate after 6, 12, 18 and 24 months was
61.4%, 39.0%, 29.1% and 18.0%, respectively
for the control group, and 64.1%, 55.1%, 40.1%
and 32.1%, respectively for the rubber dam
group. The log rank test for censored data
showed no statistical significant difference
between the groups (P = 0.07). The univariate
Cox Regression showed no statistical significant
difference after adjusting for independent vari-
ables (P > 0.05).
Conclusion. Both groups had similar survival rates,
and after 2 years, the use of rubber dam does not
increase the success of Class II ART restorations
significantly.
Introduction
The Atraumatic Restorative Treatment (ART)
approach was originally promoted as a means
of oral health treatment for people living in
remote areas, where there is lack of electricity,
or in places where there are no oral health
units, such as public schools and community
centers1,2
. Due to the use of hand instruments
to carry out the restorations, ART may promote
a less traumatic technique towards patients
and possibly produce smaller cavities in com-
parison to conventional preparations made
with the conventional rotatory equipment3
.
Single surface Class I ART restorations in
primary teeth can have high success rates of
almost 80% after 30 months4
. Class II restora-
tions, on the other hand, have lower success
rates, varying in the range of 12–75% even
after 3 years5)8
. Several researches have been
carried out to find the reasons for these lower
success rates.
It has been stated that survival rates of
single surface ART restorations using high
viscosity glass ionomer cements (GIC) as res-
toration material were high, and similar to
those filled with amalgam9)11
. However, Class
II restoration failure could be due to the res-
toration material or even the technique itself.
Some studies have shown that restorations
made using the conventional rotary instru-
ments had greater success rates than those
carried out with the ART approach8, 12, 13
.
Operator inexperience5, 14, 15
and inadequate
caries removal16, 17
have been suggested to
contribute to Class II ART restoration failures.
Among other factors, moisture contaminating
Correspondence to:
Thiago Saads Carvalho
Departamento de Odontopediatria da FOUSP
Av. Prof Lineu Prestes, 2227,
Cidade Universita´ria
05508-000
Sa˜o Paulo - SP - Brazil
E-mail: thiagosaads@hotmail.com
Ó 2010 The Authors
International Journal of Paediatric Dentistry Ó 2010 BSPD, IAPD and Blackwell Publishing Ltd 419
DOI: 10.1111/j.1365-263X.2010.01060.x
2. the cavity before placing the restorative mate-
rial could also cause higher failure rates in
Class II ART restorations18
. Therefore, the aim
of this randomized clinical trial is to compare
to compare the survival rates of Class II ART
restorations placed in primary molars using
cotton rolls or rubber dam as isolation meth-
ods. The null hypothesis is that no difference
is to be found between these methods.
Material and methods
This study was approved by the Committee of
Ethics in Research from the Federal University
of Paraı´ba, under protocol number 134⁄04.
Sampling
Children were selected from two medium
sized cities, Joa˜o Pessoa and Campina Grande,
from the Northeast region of Brazil where
water is not fluoridated. The children were
selected from schools located in the central
areas of Joa˜o Pessoa and Campina Grande.
All schools in these areas were visited.
A total of 42 public schools were visited,
from which 2316 children, aged between 6
and 7 years old, both genders, were examined
for proximal caries lesions in primary molars,
after the signed consent was obtained.
The proximal lesions should have had access
to ART hand instruments, have a mesio-distal
maximum dimension of 1 mm and a buccal-
lingual maximum dimension of 2 mm length,
measured on the oclusal surface using a peri-
odontal probe. Cavitated carious lesions hav-
ing pulpal involvement, swelling, fistula or
pain were not included in the study, and these
patients were referred to the university’s pae-
diatric dental clinic. The proximal surface of
the adjacent tooth should be unimpaired,
without visible lesions.
Only one cavitated carious lesion per child
was selected. If more than one cavity was
suitable in a child, one cavity was selected at
random by drawing a piece of paper contain-
ing which molar should be included in the
study. The other lesions were treated, but not
within the framework of the present study.
Out of the 2316 children examined, only 232
children participated in the study.
When all children had been selected, they
were randomly assigned into one of two study
arms, consisting of a control group (n = 117)
of Class II ART restorations made using cotton
rolls and an experimental group (n = 115) in
which the restorations were made using rub-
ber dam. Each child was individually allocated
into a group by the use of generated random
numbers, and no restrictions were considered.
The group in charge of making the restorations
or those who assessed the restorations did not
have access to the randomization procedure.
All children were allocated into the respective
group before the restorations were made.
Restorations
Four final year dental students were thor-
oughly trained on the ART technique, espe-
cially on the glass ionomer manipulation.
These students carried out all manipulation of
the glass ionomers and restorations.
After supervised tooth brushing, the resto-
rations made out on the school grounds. The
child laid in supine position on a school table,
according to Frencken et al.2
, and hand
instruments were used throughout the treat-
ment, under natural light.
Soft dentine was removed using only hand
instruments, mainly spoon excavators, then
the saliva barrier was placed. For the control
group, new cotton rolls were placed on both
sides of the molar, and for the experimental
group, a rubber dam was used, fixed with a
clamp on the adjacent distal tooth, without
local anaesthesia.
Both groups had the same restoration proce-
dure2
. The cavity was washed with cotton pel-
lets dipped in water, and a matrix band was
applied with wooden wedges. The cavity was
conditioned with the liquid part of the GIC
diluted with a wet cotton wool pellet for 15 s. It
was then washed with three cotton pellets
dipped in water, and dried with three cotton pel-
lets. The glass ionomer FujiÔ IX (GC, Europe)
was then hand mixed and placed into the cavity,
and the press-finger technique was carried out
with petroleum jelly. Excess was removed
immediately using the hand instruments. After
5 min, the matrix was removed and the occlu-
sion was checked with carbon paper.
420 T. S. Carvalho et al.
Ó 2010 The Authors
International Journal of Paediatric Dentistry Ó 2010 BSPD, IAPD and Blackwell Publishing Ltd
3. After the restorations were made, no differ-
ence was visually observed between the res-
torations in the rubber dam group or those in
the control group. This assured a successful
blind evaluation system, so the examiners
were blinded to the exposure categories.
Evaluation
The restorations were clinically assessed in six
month intervals in a follow-up period of
2 years: at 6, 12, 18 and 24 months. A total of
eight examiners were calibrated using 30
extracted teeth with Class II glass ionomer res-
torations. Their inter-examiner reliability was
Kappa > 0.76 and their intra-examiner reliabil-
ity was Kappa > 0.81. These examiners were
blinded to the exposure categories. In other
words, at the time of examination of the resto-
ration, the examiners did not know to which
group the child belonged to. These examiners
used mouth mirrors and explorers, under nat-
ural light, to assess the restorations. The defects
were measured using periodontal probes.
Restorations were assessed according to the
following criteria: (i) successful treatment: when
it was still present and correct or having only
a slight wear or defect at the margin less than
0.5 mm in depth; (ii) treatment failures: when
the restorations were either completely lost,
or were fractured with defects 0.5 mm in
depth or greater, had secondary caries or
inflammation of the pulp; or (iii) lost to follow-
up: when the children who were not found at
the time of assessment, or when the teeth
were lost to exfoliation or extraction. Also,
the children who were not found at the time
of assessment, or those who lost their teeth
due to exfoliation or extraction, had their res-
torations censored for statistical analyses.
In case of need to repair, the restorations
were re-done by the examiners, and were
marked as failed. These failed restorations
were excluded from further assessments. The
more complex cases were referred to the uni-
versity’s pediatric dental clinic.
Statistical analysis
The results were analyzed using SPSS (v. 13.0).
Survival analysis was carried out to determine
the survival rates and possible influences
towards failure.
A Pearson’s chi-square test was done in
order to find out if there were differences
between both groups in the number of chil-
dren lost to follow-up or whose teeth shed.
Initially, bivariate survival analysis, using
the Kaplan–Meier survival method and the
log rank test, was carried out for the differ-
ence in the survival rates between the two
groups. Then, univariate analyses using Cox
regression were carried out testing the effect
of independent covariates on the survival rate
of both groups. The covarites tested were age,
gender, upper or lower jaw, first or second
molar and operators. The covariates would
have been included in a multivariate model
by a forward stepwise procedure with
P < 0.20 as the cut-off point. As most P-val-
ues were above the cut-off point, the multi-
variate model was not realized. The
confidence level for all analyses was previ-
ously established at 95%.
Results
Two hundred and thirty-two children partici-
pated in the study, 128 (55.2%) boys. The
participant’s mean age was 6.3 years. From
the 232 restorations, 39.7% was in the upper
jaw and 60.4% in the lower jaw, 81.9% were
first molars and 18.1% second molars.
From the 232 children, 117 (50.4%) were
randomly allocated in the control group and
115 (49.6%) in the rubber dam group. All
these children received the restoration,
according to the technique described before-
hand. Throughout the study, a total of 48
(20.7%) children were considered as lost to
follow-up. Others eventually lost their teeth
due to exfoliation or extraction. Due to such
reasons, a total of 77 restorations (33.2%)
were censored (lost to follow-up), where 34
(14.7%) were from the control group and 43
(18.5%) from the rubber dam group
(v2
= 1.82; df = 1; P = 0.18).
The life table (Table 1) shows the number
of restorations considered as success and
failure during the 2 years of the study. The
failures in the control were found to be from
fractures greater than 0.5 mm or complete
Survival rate of Class II restorations in primary molars 421
Ó 2010 The Authors
International Journal of Paediatric Dentistry Ó 2010 BSPD, IAPD and Blackwell Publishing Ltd
4. loss of the restoration (88.3%), due to sec-
ondary caries (6.7%) or inflammation of the
pulp (5.0%); whereas in the rubber dam
group, the failures were 83.8% due to frac-
ture or loss of the restoration, 6.7% due to
secondary caries and 9.5% due to inflamma-
tion of the pulp. No difference was found
between both groups (v2
= 0.963; df = 2;
P = 0.62).
From the 232 Class II restorations, the over-
all cumulative survival rate was 34.4%. ART
restorations made using the rubber dam had
a median survival time of 20 months, and
those in the control group had a median sur-
vival time of 15 months. Although the con-
trol group seems to have a shorter time to
failure, the log rank and Kaplan–Meier analy-
sis shows that these survival times are similar
(P > 0.05) (Table 1).
Table 2 shows the univariate analysis done
with each independent variable using the
Cox Regression test. No influence of age, gen-
der, tooth (first or second molar), jaw (upper
or lower) or operator was found. Due to the
high P-values in this analysis, the authors did
not proceed to a multivariate analysis.
Discussion
Saliva contamination was thought to be one
of the causes for the low success rate of Class
II ART restorations. However, the use of rub-
ber dam to avoid saliva contamination during
the ART procedure does not significantly
improve the survival rate of Class II restora-
tions in primary teeth. This discussion section
will be divided into subheadings for easier
comprehension.
Sample size
No statistical difference was found between
both methods of saliva control in this study,
so we accepted the null hypothesis. However,
no calculation of sample size was carried out
prior to this study, and the sample size we
have here may be small. If so, there is a pos-
sibility that we are making type II error from
our results. On the other hand, a total of
2316 children were examined, and only 232
(10.0%) of them fit the inclusion criteria.
This suggests that we practically included all
possible subjects in our study, and a larger
sample size would not have been possible
within the scope of this study.
Censored data
The great number of restorations lost to fol-
low-up in this study was mostly due to chil-
dren transferred to other schools or other
cities, which implies that the student’s school
Table 1. Survival table of Class II ART restorations in
respect to the moments of evaluation, during 2 years.
Group
Interval
(months) Nstart Nfailure Ncensored
Failure
rate (%)
Cumulative
survival
rate ±
SE (%)
Control 0–6 117 43 11 38.6 61.4 ± 4.6
6–12 63 21 11 36.5 39.0 ± 4.9
12–18 31 7 7 25.5 29.1 ± 4.9
18–24 17 4 5 38.1 18.0 ± 5.3*
Rubber
dam
0–6 115 39 13 35.9 64.1 ± 4.6
6–12 63 8 12 14.0 55.1 ± 4.9
12–18 43 11 5 27.2 40.1 ± 5.3
18–24 27 3 13 20.0 32.1 ± 5.9*
Nstart = number of restorations at start of evaluation period;
Nfailure = number of restorations failed at end of the evaluation
period; SE = standard error.
Table 2. Univariate analyses of the association of covariates
on the survival rate of restorations from both study groups.
Variables
Group, n (%)
Exp(B) (95% CI) P*Control Rubber dam
Age
6 years 77 (33.2) 70 (30.2)
7 years 40 (17.2) 45 (19.4) 0.87 (0.61–1.24) 0.23
Gender
Male 58 (25.0) 70 (30.2)
Female 59 (25.4) 45 (19.4) 0.81 (0.58–1.15) 0.15
Molar
First molar 92 (39.7) 98 (42.2)
Second molar 25 (10.8) 17 (7.3) 0.84 (0.54–1.31) 0.23
Jaw
Lower 70 (30.2) 70 (30.2)
Upper 47 (20.3) 45 (19.4) 0.91 (0.65–1.29) 0.27
Operator
1 30 (12.9) 29 (12.5)
2 29 (12.5) 29 (12.5) 0.69 (0.43–1.09)
3 29 (12.5) 29 (12.5) 0.83 (0.53–1.32)
4 29 (12.5) 28 (12.1) 0.64 (0.39–1.03) 0.23
*Overall significance calculated from chi-squared test.
Exp(B) = hazard ratio; 95% CI = 95% confidence interval.
422 T. S. Carvalho et al.
Ó 2010 The Authors
International Journal of Paediatric Dentistry Ó 2010 BSPD, IAPD and Blackwell Publishing Ltd
5. files and personal data are transferred to
another sector of the public service and no
record of the former student is kept at the ori-
ginal school. This caused the researchers to lose
contact or track of the children. Although the
number of children lost to follow-up is rather
high, it is in accordance with other studies per-
formed under similar conditions19
. After hav-
ing censored the data, no association was
found between the number of restorations
censored and the method used for saliva con-
trol (P > 0.05). Also, for the statistical analyses,
the log rank test took the censored data into
account20
. Moreover, the restorations that
were not assessed due to exfoliation could
have either survived or failed, but if the resto-
ration stayed in the tooth until exfoliation, it
could be considered as successful. Therefore,
exfoliation of teeth may be regarded as a limi-
tation for this type of study.
Variables affecting the success rate
Saliva contamination and moisture control. Success
rates found with Class II ART restorations
filled with GIC vary according to different
GICs, dentists and study period. To our
knowledge, no extended clinical trial was
carried out comparing the influence of saliva
contamination on the success rates of Class
II ART restorations. Only one report was
found which evaluated 59 restorations for
6 months and concluded that the rubber
dam did not improve ART success rate18
.
Similarly, our study showed that ART resto-
rations using rubber dam had a slightly
higher success rate than the control group,
but this difference was not statistically signif-
icant (Table 1). Therefore, one may suggest
that possible saliva contamination is not the
main cause for Class II ART restoration fail-
ures. The cause of such fractures may be
due to other factors.
Restorative materials. One could argue that the
GIC used in the present study could the cause
for the low survival rate found. However, in
two different studies carried out in China,
using Ketac MolarÔ glass ionomer (3M ESPE,
Seefeld, Germany), the success rates of Class
II restorations were 54% and 57%, after
2 years and 2.5 years, respectively4, 21
. When
Ketac MolarÔ (3M ESPE) was compared to
FujiÔ IX (GC), no significant difference was
found between both cements after 3 years10
.
When FujiÔ IX GP (GC) was used as restora-
tion material of proximal slot restorations in
primary molars, success rates above 90%
were found after 3 years22, 23
. The success
rate found in this study, after an evaluation
period of 2 years, for Class II restorations
using FujiÔ IX (GC) was 34.4%. This value is
in accordance with other studies, which
showed success rates as low as 30% after a
one year follow-up period5
.
When comparing the GIC used to resin
composite, it has been shown that when GIC
is used in Class II restorations it has a slightly
lower success rate than resin-based composite
restoration after 2 years24
. However, such a
difference was not statistically significant, and
proximal slot restorations filled with GIC have
demonstrated a high success rate of 94% after
3 years23
. So, one may suggest that the use
of Fuji IX in this study may not have been
the cause for the low survival rate of the
restorations.
Dentists who carry out the restorations. Some
studies have demonstrated that success rates of
ART restorations can be operator-dependent.
In other words, when experienced dentists
make the restorations, it leads to greater
success rates1, 14, 15
. This could be because
dentists have some influence on the child’s
behaviour independently of the method used
for the restoration25
. Also, the amount of
infected dentine removed from the cavity, as
well as the manipulation of the materials
could influence the restoration’s success rate.
When the ART technique is carried out, there
is a reduction, but not total removal, of micro-
organisms found in the carious lesion, such
differences in the practitioners’ cavity prepara-
tion may lead to failure of the restoration16, 17,
26, 27
. On the other hand, the use of a bur also
may not remove all microorganisms from the
lesion28
. Moreover, other defects caused by
dentists differenced, such as cervical gaps and
residual caries in the cavity, have also been
demonstrated to significantly influence the
survival rate of Class II restorations5
. In the
Survival rate of Class II restorations in primary molars 423
Ó 2010 The Authors
International Journal of Paediatric Dentistry Ó 2010 BSPD, IAPD and Blackwell Publishing Ltd
6. present study, four dental students made
the ART restorations, but differences in success
rates between them were not observed. There-
fore, the main cause for the low success rates
found in this study may not be operator-
dependent, as the regression study showed no
association between operators and the success
rates of the control and rubber dam groups
(Table 2). Nevertheless, it is difficult to com-
pare the skills among different dentists and dif-
ferent study. Despite the fact that the dental
students in the present study were considered
similar, they could differ in skills to those who
participated in other studies, thus possibly
explaining the lower survival rate found.
Discomfort. One other cause for the restoration
failure could be the discomfort felt by the
child during the ART procedure. Nonetheless,
no difference has been found in the discom-
fort felt by children whose restorations were
made with or without local anesthesia (LA)
during an ART restoration. The use of LA did
not affect the survival rate of Class II ART
restorations7
. Therefore, children undergoing
dental treatment with the ART approach are
not more prone to discomfort or pain leading
to crying and consequential hypersalivation.
In consequence, this possibly did not affect
the failure rate of the ART restorations.
The ART technique itself. The ART technique
itself could be a cause of Class II restoration
failure. Some studies have suggested that res-
torations made with the conventional method
with the rotary motor have better survival rates
than those made using the ART approach12, 13,
29
. However, ART restorations produce smal-
ler cavities, and smaller cavity size produce
higher survival rate for restorations30
. Still,
the restorations in this study were made in
the school grounds, as suggested by the ART
approach guidelines2
, where there is no den-
tal office and no possibility of using the drill.
Conclusion
The low success rate observed for restorations
made using the rubber dam indicates that it is
not worth the effort of using this procedure
to enhance the success rate of Class II restora-
tions. Furthermore, it is worth mentioning
that placing a rubber dam may compromise
the ‘atraumatic’ aspect of ART, and possibly
lead to greater discomfort in children. On the
other hand, further investigations with the
ART approach, especially in Class II cavities,
are necessary in order to arrive at different
strategies that may increase the success rate
of such restorations in oral health programs.
What this paper adds
d This paper states that rubber dam used as saliva barrier
during ART restorations does not improve the survival
rate of Class II restorations;
d Also, these findings suggest that the ART approach
may be carried out using cotton wool rolls, as sug-
gested originally;
d Possible saliva contamination from using cotton rolls
in ART restorations may not be responsible for the
high number of Class II ART restoration failure.
Why this paper is important to paediatric dentists
d It is quite relevant to paediatric dentists, above all,
those who carry out the ART approach. They may
continue to make ART restorations in proximal cavi-
ties in primary molars using cotton rolls, as this will
not affect the survival rate of the restoration.
Acknowledgements
The authors would like to thank CAPES for
funding part of this research. Also, we would
like to demonstrate the appreciation towards
the schools’ staff in Joa˜o Pessoa and Campina
Grande, and Dona Rita, Kim, Mu¨ riel, Noortje
de Kort, Anne, Hiske, Mirte, Aaron, Rene´,
Isabel, Hileke, Noortje Linnekamp, Chrysanta,
Figen and Augusta, and all who made this
study possible. The authors also wish to thank
the participants of the Seminars in Pediatric
Dentistry (FOUSP) for their ongoing scientific
contribution.
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