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In this clinical study, the 8-year clinical performances of a flowable resin composite was compared with that of a conventional resin composite.Ninety non-carious cervical lesions (NCCLs) in 19 participants were involved in this trial. NCCLs were restored with a flowable composite (Clearfil Flow FX: FX, Kuraray Noritake, Japan) or a conventional resin composite (Clearfil AP-X: AP) in conjunction with a one-step self-etch adhesive (Clearfil S3 Bond). Each participant had both types of resin composite restorations that were randomly allocated. The restorations were evaluated at baseline and annually up to 8 years using modified USPHS criteria. The data were statistically analyzed using the Fisher's exact test, Kaplan-Meier method, and a multivariate Cox-regression with frailty models (p 0.05).The 8-year participant recall rate was 95%. One hundred percent retention was recorded for AP, whereas four out of 46 restorations were lost for FX during the 8 years. The incidence of marginal staining increased over time regardless of the type of resin composite, showing 48% for AP and 57% for FX after 8 years. Wear of the resin composite occurred only for the flowable material and there was a significant difference between the types of resin composite (p = 0.024). Overall survival rates at 8 years for AP and FX were 98% and 82% respectively (p = 0.110).The flowable resin composite presented lower wear resistance and showed a lower survival rate compared with the conventional composite after eight years of clinical service.Flowable resin composites may show greater wear after long-term clinical service.UMIN000028745, Date of registration: August 19, 2017.

The purpose of this clinical trial was to evaluate and compare the performances of three different universal adhesives used with a highly filled flowable universal resin composite in the restoration of non-carious cervical lesions (NCCLs) over a 60-month period.Ninety-nine NCCLs were restored at 18 participants. NCCLs were divided into three different universal adhesive groups: Clearfil Universal Bond (CU) (n = 31), iBOND Universal (IU) (n = 33), and G-Premio Bond (GP) (n = 35). Prior to the adhesive procedures, selective enamel etching was performed with 37% phosphoric acid in all experimental groups. Adhesive systems were applied following the manufacturers' instructions, and the lesions were restored with a highly filled flowable resin composite (G-ænial Universal Flo). Restorations were finished and polished immediately after placement. All restorations were scored with regard to retention, marginal discoloration, marginal adaptation, sensitivity, surface texture, and color match using modified United States Public Health Service (USPHS) criteria after 1 week (baseline) and 6, 12, 18, 24, 36, and 60 months. Statistical analyses were performed using chi-square and McNemar's and Kaplan Meier tests. The level of significance was set at p 0.05.After 60 months, the recall rate was 72.2%. Survival rates of CU, IU, and GP restorations were 87%, 85.2%, and 96.5%, respectively. Five CU (25%), 8 IU (34.8%), and 12 GP (42.9%) restorations exhibit bravo scores for marginal adaptation. However, no differences were seen among them. CU showed lower bravo score than IU and GP for marginal discoloration (CU, 0%; IU, 26.1%; GP, 32.1%). Two CU, 7 IU, and 6 GP restorations showed bravo scores for surface texture, and 2 (9.1%) CU and 1 (3.3%) GP restorations were scored as bravo score for color match (p 0.05).The tested universal adhesives showed similar success rates during the 60-month follow-up. However, CU showed better clinical performance than IU and GP in terms of marginal adaptation and discoloration.ClinicalTrials.gov Identifier: NCT03415412 CLINICAL RELEVANCE: The long-term clinical performances of the three universal adhesives in the restoration of NCCLs using selective enamel etching mode were successful after 60 months.

The aim of this clinical trial was to evaluate and compare the performance of a universal adhesive with different adhesive strategies in the restoration of non-carious cervical lesions (NCCLs) over a 36-month period. One hundred sixty-five NCCLs in 35 patients (13 female, 22 male) with at least 3 lesions each were included in this study. Three groups were formed according to the adhesive strategy used (n = 55): selective-etch mode, etch-and-rinse mode, or self-etch mode of a universal adhesive, Single Bond Universal. The same nanofilled resin composite, Filtek Ultimate, was used for all restorations by a single operator. The restorations were evaluated by two calibrated examiners at baseline and at 6, 12, 18, 24, and 36 months in accordance with the modified USPHS criteria. The chi-square test was used for intergroup comparison and Cochran’s Q test for intragroup comparison (∝ = 5%). At 36 months, the recall rate was 98.1% and three restorations, one from each group, had failed because of retention loss (P > 0.05). The self-etch mode group showed 17 bravo scores for both marginal staining and marginal adaptation after 3 years, which was significantly different from the selective-etch and etch-and-rinse groups (P

This longitudinal study aimed to investigate morphologically and quantitatively the progression of non-carious cervical lesions (NCCLs) using a confocal laser scanning microscope (CLSM) and replica models. The samples examined comprised sets of replicas annually obtained from 83 lesions in 16 participants over 3 to 5 years. All lesions were visually categorized as wedge-shaped, saucer-shaped, or mixed-shaped lesions. CLSM images of the replicas were analyzed in terms of axial depth, occlusogingival width (height) in the buccolingual cross-section, and estimated volume using a custom code of the image analysis software to estimate the progression of the NCCLs over time. The morphological characteristics of the NCCLs were also objectively divided into three groups according to the depth to height ratio (D/H ratio). Fisher’s exact test and the Cochran-Armitage trend test were used for statistical analysis. Saucer-shaped lesions progressed mainly in height, whereas wedge-shaped lesions increased both in height and depth. Annual progression in depth and volume significantly increased as the D/H ratio increased. More than half of the NCCLs with a small D/H ratio progressed 50 μm or more in height, whereas none of them progressed more than 50 μm in depth. Annual progression in depth significantly increased as the lesion depth at baseline increased. Progression patterns significantly differed between NCCLs of different shapes. Most NCCLs progressed slowly in depth regardless of their shape. Moreover, NCCLs may progress through active and inactive stages.

To explore and evaluate the application of a surgical guide in the extraction of impacted mesiodentes.Patients with impacted mesiodentes approachable from the labial side of the maxilla were randomly divided into three groups. The surgical guide for group I was made using cone beam computed tomography (CBCT) and dental cast, whereas the surgical guide for group II was only made using CBCT data. Group I and group II were first evaluated to determine whether guide use could accurately locate the cementoenamel junction (CEJ) of the mesiodentes, and the impacted mesiodentes were extracted with the help of the surgical guide. Group III underwent an operation without a guide. For all patients, the preoperative design time, tooth searching time, operation time, complications, and costs were measured.The guides for group I and group II could locate the CEJ of the mesiodentes accurately, with good application effect during the operation. Group I and group II required additional preoperative design time compared with group III. However, the tooth searching time and operation time in groups I and II were significantly reduced compared with those in group III. Group I and group II showed no intraoperative complications, and two cases in group III showed imprecision during localization. The overall cost for group III was higher than that of group I or group II. But group I and group II required extra visits and costs.Despite some limitations, the surgical guide assisted with mesiodentes extraction and can improve the quality of the operation quality as well as reducing its economic burden, difficulty, and duration. Through proper design, we can create a high-quality surgical guide using only CBCT data.The surgical guide can be used as an important assistive tool in alveolar surgery.

The aim of this randomized, controlled prospective clinical trial was to evaluate and compare the performances of three different universal adhesives using a flowable universal composite resin in the restoration of non-carious cervical lesions (NCCLs) over an 18-month period. Eighteen participants recieved 99 restorations from a single operator. NCCLs were divided into three groups according to adhesive systems used: Clearfil Universal Bond (CU), iBOND Universal (IU), and G-Premio Bond (GP). No enamel bevel was placed and no mechanical retention was created for the NCCLs. Prior to adhesive procedures, selective etching was performed with 37% phosphoric acid. Adhesive systems were applied following manufacturers’ instructions and the lesions were restored with a flowable composite resin (G-aenial Universal Flo). Restorations were finished and polished immediately after placement and scored with regard to retention, marginal discoloration, marginal adaptation, sensitivity, surface texture, and color match using modified USPHS criteria after a week (baseline) and 6, 12, and 18 months. Descriptive statistics were performed using chi-square tests. The 18-month recall rate was 88.8% and retention rates for CU, IU, and GP were 100%, 96.8%, and 100%, respectively. No restorations exhibited post-operative sensitivity and secondary caries. After 18 months, CU, IU, and GP groups showed similar alpha rates for marginal adaptation (CU 93.1%, IU 90%, GP 81.8%) and marginal discoloration (CU 100%, IU 90%, GP 87.9%). A total of ten (CU 2, IU 3, GP 5) restorations exhibited bravo scores for surface texture and three (CU 2, GP 1) restorations showed bravo score for color match. No statistical differences were found among the tested adhesives for any criteria evaluated (p > 0.05). The three adhesive systems demonstrated similar performances during the 18-month follow-up in the restoration of NCCLs. Universal adhesives could be used successfully in the restoration of NCCLs.

This study investigated the effect of toothbrush stiffness and dentifrice slurry abrasivity on the development and progression of simulated non-carious cervical lesions (NCCLs). Human maxillary premolars were allocated to 12 groups generated by the association between toothbrushes, soft, medium, and hard stiffness, and simulated dentifrice slurries, lower, medium, and higher; deionized water (DI) served as negative control. Teeth were mounted on acrylic blocks, and their root surfaces partially covered with acrylic resin to simulate gingiva, leaving a 2-mm area apical to the cemento-enamel junction exposed to toothbrushing. Specimens were brushed with the test slurries for 35,000 and 65,000 double strokes. Impressions taken at baseline and after both brushing periods were scanned by a 3D optical profilometer. Dentin volume loss (mm3) was calculated by image subtraction. Data were analyzed using three-way ANOVA and Fisher’s PLSD tests. All toothbrushes caused higher volume loss when associated to higher abrasive slurry, compared to medium- and lower-abrasive slurries. Medium caused more volume loss than lower-abrasive slurry, which led to more volume loss than DI. Hard and medium toothbrushes were not different when used with medium- or higher-abrasive slurries. There were no differences among toothbrushes when used with DI and lower-abrasive slurry. Overall, 35,000 brushing strokes resulted in significantly less volume loss than 65,000. Toothbrush stiffness was an important factor on NCCL development, especially when brushing with medium- and higher-abrasive slurries. Medium and hard toothbrushes associated with medium- and high-abrasive toothpastes can yield more severe NCCLs.

Objectives: The aim of this review was to assess the effect of different adhesive systems and tooth preparation on the retention of tooth-colored restorative materials placed in non-carious cervical lesions (NCCLs). Methods: Randomized clinical trials with a minimum of 3 years of follow-up that evaluated the effectiveness of tooth-colored materials, adhesive systems, and preparation techniques for the restoration of NCCLs were selected. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (OVID), the Latin American and Caribbean Health Sciences Literature database (LILACS), and Medline (OVID) electronic databases were searched from 1990 to 2013. Results: Twenty-seven randomized clinical trials were included and reviewed. Meta-analysis was used to determine the relative risk of loss of tooth-colored NCCL restorations between different categories of adhesive systems. The effect of tooth preparation could not be similarly analyzed. Conclusion: The current best evidence indicates that a glass ionomer cement has a significantly lower risk of loss of a NCCL restoration compared to either a three-step etch-and-rinse or a two-step etch-and-rinse adhesive system; a three-step etch-and-rinse adhesive system has a significantly lower risk of loss of a NCCL restoration compared to a two-step etch-and-rinse adhesive system. No significant difference could be observed in the risk of loss of a tooth-colored NCCL restoration between a three-step etch-and-rinse adhesive system and either a two-step self-etch or a one-step self-etch adhesive system. © 2014 Springer-Verlag Berlin Heidelberg.

The clinical suitability of low-shrinkage resin composites for class V cavities has not been investigated in vivo. The purpose of this double-blind randomized clinical trial was to compare the clinical performances of low-shrinkage resin composite Filtek silorane and nanoceramic resin composite Ceram X mono in non-carious cervical lesions (NCCLs) over 36 months.Two calibrated operators restored 144 NCCLs in 24 patients by using Filtek silorane with silorane system adhesive (FS/SSA) and Ceram X mono with Clearfil SE (CXM/CSE) or XP bond (CXM/XPB). Then, two blinded, calibrated evaluators assessed the restorations at the baseline and 6, 12, 24, and 36 months thereafter by using the modified US Public Health Service criteria. Data were analyzed with the Freidman and Wilcoxon signed-rank tests at a significance level of 5 % (P 0.05).No restoration was associated with postoperative sensitivity or secondary caries. Further, no group showed significant changes until 12 months. The retention rates of the FS/SSA (97.5 %), CXM/CSE (97.5 %), and CXM/XPB (92.31 %) restorations did not differ significantly (P 0.05). Six (4 CXM/XPB, 1 FS/SSA, and 1 CXM/CSE) of the 121 restorations evaluated at 36 months were completely lost. However, no significant intergroup differences were observed in the other evaluation criteria.The 3-year clinical performances of the restorative materials in NCCLs were not significantly different.Filtek silorane is suitable for restoring NCCLs.

The term "non-carious cervical lesion" (NCCL) describes a dental hard tissue defect of unknown origin. Two very distinct variations are known: wedge-shaped and saucer-shaped lesions. Reasons for occurrence of two forms might include different contributing factors.Forty-two teeth, 19 wedge-shaped and 23 saucer-shaped lesions, were analysed by light and confocal laser scanning microscopy (CLSM) to investigate presence of calculus and organic matter, surface structure of the lesion, borders of the lesion, and potential fractures in the dental hard tissues.One hundred percent of the wedge-shaped teeth showed evidence of additional abrasion (incisal/occlusal surface) but only 70% of the saucer-shaped teeth. In most teeth, the edge was rounded. Tiny grooves parallel to the cemento-enamel junction (CEJ) were present in 11% of the wedge-shaped and in 39% of the saucer-shaped lesions. Seventy-nine percent wedge-shaped and 52% saucer-shaped lesions had some sort of apposition. Eighty-eight percent of all teeth had dead tracts, 62% of which were located directly next to the defect (in the lesion). In 48%, sclerotic dentin was present right next to the defect (in the lesion). Tertiary dentin was visible in 60%. Not a single fracture was detected.Different characteristics associated with each type of cervical lesion support the theory of different aetiology or at least of differing contributions from different factors that participate in the development of NCCLs.Only knowledge of the correct aetiology of NCCLs will allow the best treatment and prevention for such lesions.

Objectives Oral Health-Related Quality of Life (OHRQoL) can be considered as the scientific expression of that part of a person’s well-being that is affected by his/her oral health. The aim of this paper was to evaluate how to use the data available in the field of research to make a link between OHRQoL and dentin hypersensitivity (DHS) in the dental office. Materials and methods Research papers in the field of OHRQoL and DHS and reviews and research papers about OHRQoL were used for analysis in this short review, with a particular insight on the instruments used to evaluate OHRQoL. Results Various psychometric instruments have been used to measure OHRQoL that are more or less patient- or expert-centred. Some are generic, others are adapted to specific conditions/domains or populations. The impact of DHS or exposed cervical dentin (ECD) on OHRQoL has been assessed in very few studies. It is therefore of the upmost importance that the use of the OHRQoL as a quality control tool be established in robust clinical studies. Conclusions/clinical relevance Future studies evaluating the impact of the DHS/ECD on OHQoL or evaluating the efficacy of desensitising agents should respect some key points, including study design (randomization, placebo/control group, etc.), validated specific questionnaires and trained calibrated practitioners.

Keywords Exposedcervicaldentin .Dentinhypersensitivity .Oralhealth-relatedqualityoflifeGeneral discussionFirst, the question was addressed whether exposed cervicaldentin deserves attention irrespective if the individual suffersfrom dentin hypersensitivity. All presentations had, however,discussed dentin hypersensitivity implicitly suggesting thatsymptom-free exposed cervical dentin does not warrant spe-cial treatment although these areas are at risk for dentinhypersensitivity but also for cervical caries. These risks wererecognized by the forum, and in the final managementscheme, it is advised that exposed cervical dentin is furtherinvestigated for hypersensitivity and that in absence of dentinhypersensitivity the patient is advised on the possible futurepresentationofit[1].Theforum,however,recognizedtheriskof creating patients, which should not be encouraged.All presentations adhered to a similar definition of dentinhypersensitivity: Dentin hypersensitivity is characterized bydistinctive short sharp pain arising from exposed cervicaldentin in response to various external stimuli that are typi-cally thermal, evaporative, tactile, electrical, osmotic, orchemical and which cannot be ascribed to any other formof dental pathology defect or disease [2]. Several aspects ofthis definition were discussed. It was questioned why thedefinition mention hypersensitivity. There is no evidencethat there are any biological changes making the tooth moresensitive than other teeth neither that pulp pathology isinvolved [3]. The difference between sensitive and non-sensitive dentin relates primarily to the number and size ofpatent dentin tubules [3]. Perhaps it would be better to usethe term dentin sensitivity. Coronal exposed dentin may alsopresent (hyper)sensitivity. Probably, the mechanisms are thesame as for cervical dentin (hyper)sensitivity and differen-ces in the degree of sensitivity are related to the number andshape of the dentinal tubules [3].A third point of discussion in relation to the definition isthe cause of exposureof the dentin. The forum agreed ontherole of gingival recession and that the exposure should benon-caries related. The exposure could be caused by eitherabrasion, erosion, attrition, or abfraction, or clinically morerelevant a combination of these. Finally, it was remarkedthat not the dentin but pulp is sensitive. In spite of all thesecomments on the definition, the forum suggested for clarityreason to stay in line with the common use and to continueto use the term dentin hypersensitivity.EpidemiologyIt became clear that there is only limited epidemiologicaldata available on the prevalence and the natural course ofdentin hypersensitivity [4]. The reported prevalence datavaries enormously depending on the selected population. Itis clear that it is prevalent after periodontal treatment but thelarger part of dentin hypersensitivity after periodontal treat-ment will faint out in 2 to 3 weeks [5]. It was estimated that2 to 6 % of periodontitis patients develop continuous dentinhypersensitivity, but there are no studies substantiating thesefigures. The suggestion to conclude each scaling and rootplaning procedure routinely by a preventive (desensitizing)treatment, e.g., fluoride application or prescription of adesensitizing toothpaste was not endorsed by the forum.The peak prevalence of dentin hypersensitivity is inindividuals aged between 30 and 40 years [4]. A problem

The main indication of the adjunctive use of local antimicrobials lies around situations in which the outcome of non-surgical mechanical treatment results in a limited number of residual pockets. The purpose of this investigation was to evaluate the clinical and microbiological effects of the subgingival application of a xanthan-based 1.5% chlorhexidine (CHX) gel (Xan-CHX), adjunctive to scaling and root planing (SRP) in localized periodontitis.Periodontitis patients with four to ten residual (after conventional SRP) or relapsing (during supportive periodontal treatment) pockets were recruited and randomized to receive SRP plus the subgingival application of (Xan-CHX) or SRP plus a placebo gel. Supragingival plaque, bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level were evaluated with a computerized probe at baseline, and after 1, 3, and 6 months. Subgingival samples were also collected for the microbiological analysis. Statistical analysis used ANOVA and chi-square tests.Overall, the clinical results were better in the test group, with significant changes in BOP (between baseline and 3 months) and with a significant increase in the proportion of shallow pockets (1-3 mm) at 6 months. These results did not result in significant intergroup differences. The microbiological impact was limited in both treatment groups.The adjunctive use of Xan-CHX may improve, although to a limited extent, the clinical outcomes (BOP and PPD), in chronic periodontitis patients with "residual" or "relapsing" pockets, but no significant differences were detected between groups. No side effects, neither clinical nor microbiological, were detected after the use of the test product.Adjunctive use of slow-released chlorhexidine might be considered in the management of periodontal disease and gingival inflammation to reduce the need for periodontal surgery.

The aim of this study was to analyze the variations in canal and root cross-sectional area in three-rooted maxillary premolars between high-resolution computed tomography (μCT) and cone beam computed tomography (CBCT).Sixteen extracted maxillary premolars with three distinct roots and fully formed apices were scanned using μCT and CBCT. Photoshop CS software was used to measure root and canal cross-sectional areas at the most cervical and the most apical points of each root third in images obtained using the two tomographic computed (CT) techniques, and at 30 root sections equidistant from both root ends using μCT images. Canal and root areas were compared between each method using the Student t test for paired samples and 95 % confidence intervals.Images using μCT were sharper than those obtained using CBCT. There were statistically significant differences in mean area measurements of roots and canals between the μCT and CBCT techniques (P 0.05). Root and canal areas had similar variations in cross-sectional μCT images and became proportionally smaller in a cervical to apical direction as the cementodentinal junction was approached, from where the area then increased apically.Although variation was similar in the roots and canals under study, CBCT produced poorer image details than μCT.Although CBCT is a strong diagnosis tool, it still needs improvement to provide accuracy in details of the root canal system, especially in cases with anatomical variations, such as the three-rooted maxillary premolars.

The purpose of this double-blind, randomised trial was to compare the clinical performance of a hybrid composite (Clearfil AP-X, Kuraray, Tokyo) and a nanocomposite (Filtek Z350, 3M ESPE, St. Paul, MN) over a period of 2 years in non-carious class V lesions using a modified US Public Health Service (USPHS) system.Forty-six patients with at least one pair of equivalent non-carious cervical lesions under occlusion and a mean age of 44.1 years (range 27-66 years; median 45 years) were enrolled in this study. A total of 116 restorations (58 with each material) were placed according to manufacturer's instructions by two calibrated operators. The restorations were evaluated at baseline and at 6, 12 and 24 months after placement using the USPHS criteria for retention, colour match, marginal discolouration, marginal adaptation, anatomic form, surface texture and secondary caries. Statistical analysis was conducted using the Cochran and the McNemar tests at a significance level of 5% (P 0.05).No surface texture changes or secondary caries were detected in association with any restorations. The retention rates for Clearfil AP-X (100%) and for Filtek Z350 (91.38%) did not differ significantly (P 0.05). Two Z350 restorations were completely lost after 2 years. No significant differences were observed in the colour match, marginal discolouration, marginal adaptation or anatomic form.There were no significant differences in the clinical performances between the materials.Both restorative materials exhibited acceptable clinical performance in class V non-carious lesions 2 years post-restoration.

It was previously reported the clinical results of placing subgingival resin-modified glass ionomer restoration for treatment of gingival recession associated with non-carious cervical lesions. The aim of this study was to evaluate the influence of this treatment on the subgingival biofilm and gingival crevicular fluid (GCF) inflammatory markers.Thirty-four patients presenting the combined defect were selected. The defects were treated with either connective tissue graft plus modified glass ionomer restoration (CTG+R) or with connective tissue graft only (CTG). Evaluation included bleeding on probing and probing depth, 5 different bacteria targets in the subgingival plaque assessed at baseline, 45, and 180 days post treatments, and 9 inflammatory mediators were also assessed in the GCF.The levels of each target bacterium were similar during the entire period of evaluation (p 0.05), both within and between groups. The highest levels among the studied species were observed for the bacterium associated with periodontal health. Additionally, the levels of all cyto/chemokines analyzed were not statistically different between groups (p 0.05).Within the limits of the present study, it can be concluded that the presence of subgingival restoration may not interfere with the subgingival microflora and with GCF inflammatory markers analyzed.This approach usually leads to the placement of a subgingival restoration. There is a lack of information about the microbiological and immunological effects of this procedure. The results suggest that this combined approach may be considered as a treatment option for the lesion included in this study.

The aim of this study was to evaluate the effect of post system and length on the fracture resistance of endodontically treated human anterior teeth. Seventy-five extracted human incisors were endodontically treated, out of which 60 were decoronated 2 mm above the cementoenamel junction and divided into two experimental groups based on the type of post system to be used: glass fiber post (GFP) and Ribbond fiber post groups (RFP). Endodontically treated human anterior teeth in which no post was placed served as control group. Each group was divided into two subgroups according to the length of post space: 5 and 10 mm and all the samples were restored with metal crowns. The fracture resistance was measured by applying loads at an angle of 130° to the long axis of teeth in an Instron universal testing machine. The results revealed that GFP group at 10-mm post space length showed the significantly highest fracture resistance (740.2133 N) among all groups and subgroups. Decrease in post length resulted in the decrease in fracture resistance in GFP group (425.1867 N), whereas in group RFP 5-mm subgroup (299.6200 N) showed significantly higher fracture resistance than 10-mm subgroup (216.9300 N) but lesser than the control (437.8733 N) in both the subgroups. Glass fiber posts efficiently increase the fracture resistance of an endodontically treated tooth but the determination of optimal post length is also essential. The present investigation highlights the significance of using glass fiber posts in the restoration of endodontically treated teeth. Endodontically treated teeth restored with glass fiber posts showed increased fracture strength and favorable mode of fracture, and are therefore highly recommended to achieve better clinical outcomes.

This study was carried out to assess whether the spatial resolution has an impact on the detection accuracy of proximal caries in flat panel CBCT (cone beam computerized tomography) images and if the detection accuracy can be improved by flat panel CBCT images scanned with high spatial resolution when compared to digital intraoral images. The CBCT test images of 45 non-restored human permanent teeth were respectively scanned with the ProMax 3D and the DCT Pro scanners at different resolutions. Digital images were obtained with a phosphor plate imaging system Digora Optime. Eight observers evaluated all the test images for carious lesion within the 90 proximal surfaces. With the histological examination serving as the reference standard, observer performances were evaluated by receiver operating characteristic (ROC) curves. The areas under the ROC curves were analyzed with two-way analysis of variance. No significant differences were found among the CBCT images and between CBCT and digital images when only proximal enamel caries was detected (p = 0.989). With respect to the detection of proximal dentinal caries, significant difference was found between CBCT and digital images (p < 0.001) but not among CBCT images. The spatial resolution did not have an impact on the detection accuracy of proximal caries in flat panel CBCT images. The flat panel CBCT images scanned with high spatial resolution did not improve the detection accuracy of proximal enamel caries compared to digital intraoral images. CBCT images scanned with high spatial resolutions could not be used for proximal caries detection.

This 13-year randomized clinical trial compared the clinical effectiveness of two three-step etch-and-rinse adhesives in combination with a hybrid, stiffer composite versus a micro-filled, more flexible composite. The influence of composite stiffness on the clinical performance of one of the adhesives was assessed as well. One hundred and forty-two non-carious cervical lesions were restored with composites with contrasting stiffness. Seventy-one patients randomly received two cervical restorations placed following two out of three adhesive procedures: (1) the three-step etch-and-rinse adhesive Permaquick applied with the stiff micro-hybrid composite Amelogen Hybrid (PMQ-H, Ultradent), (2) Permaquick applied with the more flexible micro-filled Amelogen Microfill (PMQ-M, Ultradent), or (3) the “gold-standard” three-step etch-and-rinse adhesive Optibond FL applied with the micro-hybrid composite Prodigy (OFL-P, Kerr). The restorations were evaluated after 6 months, 1, 2, 3, 5, 7, and 13 years of clinical service regarding their retention, marginal integrity and discoloration, caries occurrence, preservation of tooth vitality, and post-operative sensitivity. Retention loss, severe marginal defects, and/or discoloration that needed intervention (repair or replacement) and the occurrence of caries were considered as clinical failures. The recall rate at 13 years was 77%. Bond degradation after 13 years was mainly characterized by a further increase in the presence of small but clinically acceptable marginal defects and superficial marginal discoloration. Twelve percent of the OFL-P restorations were clinically unacceptable. In the PMQ group, 22% of the PMQ-M restorations and 26% of the PMQ-H restorations needed repair or replacement. Regarding the clinical failure rate, Optibond FL scored significantly better than Permaquick (McNemar; p = 0.015). No statistically significant differences were found between the micro-filled and the hybrid composite for each of the parameters evaluated (McNemar, p > 0.05). After 13 years of clinical functioning, the clinical effectiveness of the three adhesive/composite combinations remained highly acceptable.

The aim of this study was to evaluate the performance of shade-determining devices. For the daily practitioner, it is essential to know whether modern computer-aided shade selection is reliable in everyday life. So the question of how the clinical usability of these machines could be rated has to be clarified. In the following, three actual devices available in the market were compared using a human observer's perception. The SpectroShade device (MHT Optic Research AG, 8155 Niederhasli, Switzerland), the ShadeVision device (X-Rite Co., Grandville, USA) and the Digital Shade Guide DSG4 (A. Rieth, 73614 Schorndorf, Germany) were assessed with respect to their agreement with the color perception of three examiners looking at 57 test persons (six teeth each for a total of 342). Shades were reported in Vita Classical shades. It could be demonstrated that every single human examiner showed a significantly higher agreement value (human group on average 40.2%) when compared with the remaining five methods than each computer-aided tooth shade determination device. The devices reached on average only a value of 28.6%, whereas the X-Rite ShadeVision showed a significant better result (33.2%) than the MHT SpectroShade and Rieth DSG4 (27.0 and 25.7%). Identical shade results given by all three methods of a group (group of three devices and three humans) were found to be rather low for the computer-aided devices (9.9%) compared with humans (36.7%). All six methods together agreed in 3.3% of the cases. It becomes evident that the methods-especially the computer-aided shade determination-are rather divided about the respective tooth color. Deficiencies of the instrumental as well as the visual detection become obvious. The best agreement level was performed by the human examiners. The best agreement of the evaluated devices was obtained-generally as well as among the human testers-by the X-Rite ShadeVision system, followed at a statistically significant distance by the MHT SpectroShade and the Rieth DSG4. The agreement among the examiner group was 52.9%, significantly better than that of each device compared to this group (31.3% on average). Color detection and its realization are very complex. As shown, in many cases, computer-aided color shade determination of natural teeth seems to not reflect human perception.

The aim of this study was to delineate factors influencing the severity of bone loss in randomly selected orthopantomograms of adult patients seeking treatment by the dental service of the German Armed Forces. A total of 240 panoramic exposures was available for analysis, 60 in each of the age groups

The aim of this study was to evaluate in vivo the interfacial adaptation of class II resin composite restorations with and without a flowable liner. In 24 premolars scheduled to be extracted after 1 month, 48 box-shaped, enamel-bordered class II cavities were prepared and restored with a flowable liner (FRC, Tetric Flow/Tetric Ceram/Syntac Single-Component) or without (TRC), cured with three different curing modes: soft start and 500- or 700-mW/cm2 continuous irradiation. Interfacial adaptation was evaluated by quantitative scanning electron microscopic analysis using replica method. Gap-free adaptation in the cervical enamel (CE) was observed for FRC and TRC in 96.2 and 90.2%, for the dentin (D) in 63.6 and 64.9%, and for occlusal enamel (OE) in 99.7 and 99.5%, respectively. The difference between the two restorations was not statistically significant (ns). Significant better adaptation was observed for OE than CE and D (p

The aim of this study was to evaluate the efficiency of oxalic acid (BisBlock) on restorations of non-carious cervical lesions.One operator placed 90 restorations randomly divided into two groups in 20 patients under cotton rolls isolation: Control Group-two-step etch-and-rinse adhesive technique; and Experimental Group-two-step etch-and-rinse adhesive technique with oxalic acid pretreatment after acid-etched dentin. The restorative adhesive system used was XP Bond/Durafill. The restorations were directly assessed by two independent examiners, using the modified United States Public Health Service (USPHS) criteria at the baseline and 4 years. Data were statistically analyzed using the Fisher and McNemar tests (p0.05).Fifteen patients (75%) were available for recall after 4 years. The McNemar test detected significant differences within the Experimental Group between the baseline and 4-year evaluations for retention (p0.05). For the Control Group, there was no significant difference (p0.05) between the periods. The Fisher test showed no statistically significant difference between the groups for all other criteria (p0.05).After 4 years of service, the use of oxalic acid did not influence the clinical performance of restorations when it was used under composite resin restorations.

The objective of this randomized controlled trial was to evaluate the clinical performance of a 2-hydroxyethyl methacrylate (HEMA)-free one-step adhesive. Two hundred sixty-seven cervical lesions in 52 patients were restored with the composite Gradia Direct (GC), bonded with either the one-step self-etch adhesive G-Bond (GC) or the three-step etch-and-rinse adhesive Optibond FL (Kerr) in a random order. The restorations were evaluated for retention, marginal integrity, marginal discoloration, and caries occurrence after 5 years. Specific statistics were used to account for the clustered data (multiple restorations per patient). The clinical success rate for G-Bond (87.4 %) was not significantly different from that of Optibond FL (90.9 %). Both adhesives showed progressive marginal deterioration, but G-Bond exhibited more small enamel defects and marginal discoloration, and unlike previous recalls, several restorations failed because of deep microleakage. Large sclerotic lesions were a significant risk factor for retention loss with G-Bond. Irrespective of the adhesive, almost all restorations with retention loss were located in the lower jaw. After 5 years of clinical service, restorations bonded with the HEMA-free one-step adhesive did not need repair or replacement more often than those with the three-step etch-and-rinse adhesive, and both adhesives had a high retention rate (>90 %). There were indications that G-Bond did not (self-)etch enough in some clinical situations, as G-Bond exhibited more incisal defects and marginal discolorations, and sclerotic lesions were at higher risk of retention loss. The clinical performance of the HEMA-free one-step adhesive was clinically acceptable after 5 years.

The aim of this study was to compare the clinical performance over 1 year of a microhybrid composite resin for class V restorations both lined and not lined with a flowable composite resin. Nineteen patients having at least two pairs of cervical noncarious lesions under occlusion were enrolled in this study. A total of 38 restorations were placed, half for each group (Single-Bond + Filtek-Flow + Filtek Z250, and Single-Bond + Filtek Z250). Two calibrated operators placed all restorations according to the manufacturers' instructions. Two other independent examiners evaluated the restorations at baseline and after a 12-month period according to the USPHS criteria and modified criteria for color match. The classic alpha score was divided into A1 for "not detectable" and A2 for "slightly discernible" filling. Statistical analysis was conducted using Fisher's exact test and McNemar's test (P=0.05). One restoration was lost after 12 months for each group (retention rate 95% for each group). After 12 months, 18 restorations showed a trend towards dark yellowing (color match A2). The use of Filtek Flow as a liner under Filtek Z250 restorations did not improve the clinical performance of class V restorations after 6 and 12 months of evaluation.

The aim of this study was to evaluate the clinical performance of S(3) Bond (Kuraray Corp., Japan) and G-Bond (GC Corp., Japan) all-in-one bonding agents, over 3 years in non-carious cervical lesions (NCCLs). Ethics Committee approval was obtained, and 60 restorations were placed in 11 patients aged 45-84 years (mean 60.5 years), using either Clearfil ST resin composite (Kuraray) and S(3) Bond or Gradia resin composite (GC) and G-Bond alternately, without phosphoric acid etch on the uncut enamel margins. Patients were recalled at 6 months, 1 year, 2 years and 3 years, and photographs were taken for assessment of colour match and marginal discoloration. One patient was not available at 3 years, resulting in 54 restorations being available for evaluation. One restoration of S(3)/Clearfil ST was lost at 2 years, giving retention rates of 97% for S(3) and 100% for G-Bond. At 3 years, six restorations for S(3)/Clearfil ST showed slight marginal discoloration and one restoration pronounced marginal staining. For G-Bond/Gradia at 3 years, 11 restorations exhibited slight marginal staining and one restoration pronounced marginal staining. Most restorations were bonded to sclerotic dentin. Statistical analysis of marginal staining showed no significant difference between the two restoration groups. The degree of marginal staining was almost identical for both materials and tended to be in larger restorations. Both S(3) and G-Bond all-in-one bonding systems appear to be good adhesives for the restoration of NCCL for the length of the current study. Restoration of NCCLs with the newer all-in-one adhesives appears to be a viable alternative technique to more complicated adhesive materials.

The objective of this study was to determine, using digital panoramic radiographs, whether the bone level at the alveolar crest is related to the mandibular bone density and/or to vitamin D receptor (VDR) gene polymorphisms. We analyzed 319 digital panoramic radiographs from the same number of patients. Alveolar bone level was expressed as percentage of root length. The mandibular cortical width index was calculated as a measure of mandibular bone density, and, in 72 randomly selected cases, the haplotype of the VDR gene (BsmL) was determined by polymerase chain reaction. Alveolar bone level was not related to the mandibular cortical width index (p = 0.568) or VDR gene expression (p = 0.575). Bone loss was greater in smokers than in non-smokers (p = 0.036), and the mandibular cortical width index was higher in males (p = 0.04), the older age group (p = 0.032), and in those with more teeth (p = 0.01). Multivariate analysis confirmed the association between these variables and alveolar bone loss. Alveolar bone loss showed no significant relationship with the mandibular bone density evaluated on digital panoramic radiographs or with VDR genotype (BsmL) in Caucasian females and males aged under 47 years.

A 2-year randomized, controlled prospective study evaluated the clinical effectiveness of a one-step self-etch adhesive and a “gold-standard” three-step etch-and-rinse adhesive in non-carious Class-V lesions. The null hypothesis tested was that the one-step self-etch adhesive does perform clinically equally well as the three-step etch-and-rinse adhesive. A total of 161 lesions in 26 patients were restored with Clearfil AP-X (Kuraray). The restorations were bonded either with the “all-in-one” adhesive Clearfil S3 Bond (Kuraray) or with the three-step etch-and-rinse adhesive Optibond FL (Kerr). The restorations were evaluated at baseline and after 6 months, 1 and 2 years, regarding their retention, marginal adapation, marginal discoloration, caries occurrence, preservation of tooth vitality and post-operative sensivity. Retention loss, severe marginal defects and/or discoloration that needed intervention (repair or replacement) and the occurrence of caries were considered as clinical failures. The recall rate at 2 years was 93.8%. Only one Clearfil S3 Bond restoration was lost at the 2-year recall. All other restorations were clinically acceptable. The number of restorations with defect-free margins decreased severely during the 2-year study period (to 6.7% and 25.3% for Clearfil S3 Bond and Optibond FL, respectively). The Clearfil S3 Bond restorations presented significantly more small marginal defects at the enamel side than the Optibond FL restorations (Clearfil S3 Bond: 93.3%; Optibond FL: 73.3%; p = 0.000). Superficial marginal discoloration increased in both groups (to 53.3% and 36% for Clearfil S3 Bond and Optibond FL, respectively) and was also more pronounced in the Clearfil S3 Bond group (p = 0.007). After 2 years, the simplified one-step self-etch adhesive Clearfil S3 Bond and the three-step etch-and-rinse adhesive Optibond FL were clinically equally successful, even though both adhesives were characterized by progressive degradation in marginal integrity. Clearfil S3 Bond exhibited more small enamel marginal defects and superficial marginal discolorations.

The objective of this study was to evaluate bone density changes around the teeth during orthodontic treatment by using cone beam computed tomography (CBCT). CBCT was used to measure the bone densities around six teeth (both maxilla central incisors, lateral incisors, and canines) before and after 7 months of orthodontic treatment in eight patients. In addition, each root was divided into three portions (cervical, intermediate, and apical) to determine whether the bone density change varied with tooth level. The mean reduction in bone density around the measured teeth was 24% after orthodontic treatment. The bone density reduction around teeth was largest for the upper-right and upper-left central incisor (29% and 26%, respectively) and ranged from 20% to 23% for the other four teeth. The mean bone density reduction did not differ significantly between the cervical, portion, and apical portions of the teeth (26%, 22%, and 24%, respectively). CBCT is useful for evaluating bone density changes around teeth during orthodontic treatment. The bone density around the teeth reduced significantly after the application of orthodontic forces for 7 months.

The aim of this clinical trial was to evaluate the effects of application mode on the clinical performance of a two-step etch-and-rinse adhesive in class V cavities over 24 months. Forty patients with at least three similar-sized non-carious cervical lesions participated in this study. A total of 120 restorations with Prime & Bond NT were placed, 40 in each group. The adhesive was applied with no rubbing action, with slight rubbing action, or with vigorous rubbing action. The restorations were placed incrementally using the composite resin Esthet-X. The restorations were evaluated at baseline and after 6, 12, and 24 months following the modified United States Public Health Service criteria. Statistical analysis was conducted using Friedman repeated measures analysis of variance by rank and using the Wilcoxon signed-rank test for significance at each pair (α = 0.05). The 24-month retention rates of Prime & Bond NT were 82.5% for the no rubbing group, 82.5% for the slight rubbing group, and 92.5% for vigorous rubbing group. No significant difference in the retention rates in each recall period was detected among groups (p > 0.05); however, the retention rates in the 24-month recall was statistically lower than the baseline only for no rubbing or slight rubbing groups. The use of a vigorous application mode can be a clinical approach to improve the retention of restorations placed in non-carious cervical lesions.

The aim of the study was to evaluate the clinical performance of two different one-step self-etching adhesives (Hybrid Bond/Sun Medical, Xeno III/Dentsply) in adhesive cervical resin composite restorations. In accordance with a split-mouth study design, 50 patients (57.3 ± 13.5) received at least one pair of restorations. In each of two comparable cervical cavities, either the adhesive systems Hybrid Bond or Xeno III was used with the resin composite Filtek Supreme (3M ESPE). After 6, 12 and 24 months, the restorations were scored according to the Ryge and California Dental Association criteria. After 2 years, the resulting scores (percent) of the Ryge evaluation for the groups Hybrid Bond/ Filtek Supreme and Xeno III/ Filtek Supreme were marginal integrity, Alpha (92/78), Bravo (8/2), Charlie (0/0) and Delta (0/10); anatomic form, Alpha (92/82), Bravo (8/8) and Charlie (0/10); secondary caries, Alpha (100/100) and Bravo (0/0); marginal discoloration, Alpha (80/84), Bravo (20/12), Charlie (0/0) and not available (0/4); color match, Oscar (39/47), Alpha (51/45), Bravo (10/4), Charlie (0/0) and not available (0/4); surface, Romeo (78/69), Sierra (22/22), Tango (0/0) and Victor (0/10); tooth vitality, Alpha (98/94), Bravo (2/6); and integrity of tooth, alpha 1 (96/96) and alpha 2 (4/4). After 2 years, all Hybrid Bond restorations were retained and showed clinically acceptable results, while five Xeno III restorations were lost in part or in toto. For marginal integrity, anatomic form and surface, significant differences (p