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Purpose: Since pediatric zirconia crowns (ZRCs) are prefabricated, they may be sterilized following try-in for re-use. Possible changes in color stability, gloss, and translucency were evaluated for four brands of prefabricated zirconia crowns following autoclave and cold sterilization. Methods: Sixteen maxillary right central incisor prefabricated ZRCs were obtained from NuSmile®, Sprig, Cheng Crowns, and Kinder Krowns® manufacturers and either autoclaved or cold sterilized. Gloss unit measurements were obtained with a small object Novo-Curve glossmeter. CIE-L*a*b* system values were measured with a CM-700d spectrophotometer under three different illuminants to calculate DE (quantitative representation of the perceived color). ΔE equals one was used for perceptibility threshold (PT) and ΔE equals 2.7 for acceptability threshold (AT). Results: All groups' baseline was ΔE less than one for all illuminants except Cheng Crowns to be autoclaved, indicating crowns are not identical in color from the manufacturer. For autoclaving, Cheng Crowns reached ΔE PT greater than one following the 10th sterilization cycle for all illuminants (D65 1.08±0.32 (standard deviation; P<0.001), A equals 1.07±0.32 (P<0.001), and F2 equals 1.25±0.38 (P<0.001). For cold sterilization, Sprig EZCrowns reached PT greater than one for all sterilization cycles, and Cheng Crowns reached ΔE PT greater than one for the sixth and 10th sterilization cycles. Gloss was not affected by either sterilization method. Spring EZcrowns had the highest mean translucency. Conclusions: Although each group may have a slight perceived difference, there was no clinically significant difference in color; all groups remained below the acceptability threshold of ΔE equals 2.7. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the effects of a companion canine on physiologic responses, discomfort level, and behavior in children undergoing sealant placement using a dental isolation system (Isodry®). Methods: Forty-seven healthy six- to 10-year-olds who needed sealants were randomly assigned to a control group (n=23) or experimental group (n=24) that utilized an emotional support canine in the child's lap. Preoperative baseline anxiety was obtained. Pulse, pulse oximetry, and behavior (measured by Frankl and Houpt scales) were recorded at various time points (beginning, at first sealant placement, switching the isolation system to the other side, second side sealant placement, and end) throughout the procedure. Participants reported a comfort level utilizing the FACES scale. Participants in the intervention group were asked, "Did you like having the dog in your lap?" The dentist rated the difficulty of and time required for the procedure. Results: Baseline anxiety was similar; no significant differences in physiologic measurements or FACES ratings were found between groups. The intervention group had significantly lower Houpt ratings for all three variables when the isolation system was repositioned (P=0.002, P=0.03, and P=0.05) and had higher Frankl scores at isolation repositioning and when completing sealants on the second side (P=0.02 and P=0.03, respectively). Both groups had similar ratings from the dentist. Conclusions: Animal-assisted therapy (AAT) should be studied more rigorously to substantiate its effectiveness in enhancing cooperative behavior in children for dental procedures. High levels of satisfaction were observed among pediatric users of AAT. [ABSTRACT FROM AUTHOR]

Purpose: To compare fracture strength, failure mode, and chairside time of Class IV fractures restored with CEREC (Chairside Economic Restorations of Esthetic Ceramics) technology or direct composite. Methods: Forty-eight fractured anterior bovine teeth were randomly assigned to three experimental groups (indirect restoration) with margin designs including: A) butt joint, B) short chamfer (one mm), and C) long chamfer (two mm) and a control group (direct composite). Preparations were scanned; restorations were milled from zirconia-reinforced lithium-silicate blocks and cemented. Fracture load (N) and failure mode were analyzed. Techniques were timed from start of margin preparation through finishing. Results were analyzed using one-way analysis of variance or the Kruskal-Wallis test (significance level: P=0.05). Results: Fracture loads (mean±standard deviation) for groups A, B, and C and control group were 2,177±644 N, 2,183±507 N, 2,666±609 N, and 2,358±886 N, respectively (not significantly different; P=0.26). The direct composite was significantly different from all indirect groups (P<0.01) for failure mode. Chairside time was longer for direct restoration. Conclusions: Fracture strength is similar for directly and indirectly fabricated Class IV restorations, with margin design not affecting strength or failure mode. Practitioner's chairside time, but not total time, is reduced when using indirect methods. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the microleakage of atraumatic glass ionomer restorations with and without silver diammine fluoride (SDF) application. Restorations with SDF are termed silver-modified atraumatic restorations (SMART). Methods: Sixty carious extracted permanent teeth were randomly allocated to two SMART groups and two control groups (n equals 15 per group) for a total of four groups. After selective caries removal, test specimens were treated with 38 percent SDF and polyacrylic acid conditioner was applied and rinsed; teeth were restored with Fuji IX GP® glass ionomer (n equals 15) or with SMART Advantage™ glass ionomer (SAGI; n equals 15). For control groups, specimens were restored with their respective GI material after selective caries removal, both without SDF. Restored teeth were placed in Dulbecco's Phosphate-Buffered Saline solution at 37 degrees Celsius for 24 hours. Teeth were thermocycled between five and 55 degrees Celsius for 1,000 cycles, stained with two percent basic fuchsin, sectioned, and visually inspected for microleakage utilizing stereomicroscopy on a four-point scale. Data were statistically analyzed using Kruskal-Wallis one-way analysis of variance on ranks using Dunn's method (P<0.05). Results: Microleakage between the two SMART restoration groups was insignificant. SAGI alone demonstrated significantly more microleakage than all other groups. There was no statistical significance between the Fuji IX GP® control group and the two SMART restoration groups. Conclusions: This in vitro study indicated that silver diammine fluoride placed before glass ionomer restoration does not increase microleakage. Polyacrylic acid may be used after SDF placement without increasing microleakage. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate opinions and preferences of parents from various sociodemographics regarding sugar and both natural and artificial non-nutritive sugar substitutes (NNS). Methods: Oral interview surveys were conducted in dental practice settings. Parents were asked about demographics, their consumption of and feelings about sugar and NNS for themselves and their children, and their concerns regarding NNS. Parents were asked about natural and artificial labels and were asked to select snacks/beverages they would purchase for their children. Results: Parents (N equals 100) preferred sugar-sweetened drinks for their children (76 percent), and 78 percent expressed concern about the potential health effects of NNS, especially cancer. Parents felt sugar was safer than NNS and were more positive about natural NNS than artificial ones. More highly educated parents (P = 0.02) were more likely to avoid NNS for their children, and parents of the lowest income level were likely to express ambivalence regarding naturally labeled NNS. Conclusions: Parents are concerned about giving their children NNS and cite cancer as the primary reason. Parents from higher sociodemographic backgrounds are more likely to limit their children's consumption of NNS and have negative feelings about them. Most parents, especially those of higher sociodemographics, are more accepting of natural NNS. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine provider and practice characteristics influencing usage of behavior guidance techniques (BGTs). Methods: A 24-item survey was emailed to 4,117 active AAPD members to identify factors influencing pediatric dentists' use of BGTs. Results: A total of 1,081 surveys were returned, for a 26 percent response rate. The mean age of respondents was 44.7 years old, with recent graduates comprising the largest group (30.5 percent). Usage of voice control, nitrous oxide, sedation, and general anesthesia (GA) differed significantly, according to experience. Respondents with at least 30 years of experience reported changes in usage. Tell-show-do, nitrous oxide, oral sedation, and passive restraint were significantly more frequent among female respondents. Parental absence, oral sedation, and GA were significantly more frequent in respondents serving low income populations. Parental absence, pharmacologic techniques, and restraint were significantly different in frequencies among the different geographic regions. Conclusions: Usage of behavior guidance techniques has changed over the past three decades, with more recent graduates and experienced practitioners now emphasizing pharmacologic techniques. More assertive behavior guidance techniques are used more frequently by experienced providers and those in practices in the southwest or serving lower income populations. Pharmacologic techniques are used at a higher prevalence by recent graduates and providers who are female or serving lower income populations. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the clinical success of and parental satisfaction with anterior pediatric zirconia crowns.Methods: A retrospective analysis of maxillary anterior pediatric zirconia crowns was performed. Crowns were evaluated for retention, gingival health, color match, contour, marginal integrity, and opposing tooth wear. Parental satisfaction regarding the esthetics of the crowns and parental perception of the impact of treatment on the child's appearance and oral health were evaluated by questionnaire.Results: Fifty-seven crowns were evaluated in 18 children. Eight teeth were lost to exfoliation, three were extracted due to pathology, and two crowns debonded, leaving 44 available for examination. The average crown age at time of examination was 20.8 months. Sixteen crowns (36 percent) displayed gingival inflammation and color mismatch. No recurrent caries or opposing tooth wear was noted. Parents reported high satisfaction with the color, size, and shape of the crowns. The majority of parents reported that crowns improved the appearance and oral health of their child (78 percent and 83 percent, respectively). Eight-nine percent of parents reported that they would highly recommend these crowns.Conclusions: Zirconia crowns are clinically acceptable restorations in the primary maxillary anterior dentition. Parental satisfaction with zirconia crowns is high. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine the opinions of parents about oral sedation in pediatric dentistry.Methods: A 21-question questionnaire, administered to parents of children presenting for care in four pediatric dental practices, collected demographic information, media exposure to sedation, and parental knowledge/opinions regarding sedation procedures, such as NPO (nothing by mouth) guidelines, need for restraint, parental presence, and parental acceptance of treatment scenarios.Results: Among 256 questionnaires completed, 235 were usable. Fifty-eight percent of respondents reported using public insurance. Parents agreed/strongly agreed (75 percent) that protective stabilization should not be necessary during sedation, and 87 percent preferred to stay with their child during the appointment. No parents perceived sedation as unsafe. Seventy-three percent of parents were unaware of media coverage of sedation; 82 percent reported it was acceptable for their child to sleep through a sedation appointment, while only 18 percent found it acceptable for the child to be highly reactive.Conclusions: Parents prefer to remain with their child, believe that sedation is safe and restraint should not be necessary, and are more accepting of the child sleeping during treatment. Most parents are unaware of media coverage of dental sedation for children. [ABSTRACT FROM AUTHOR]

Purpose: To determine if aggressiveness of primary tooth preparation varied among different brands of zirconia and stainless steel (SSC) crowns.Methods: One hundred primary typodont teeth were divided into five groups (10 posterior and 10 anterior) and assigned to: Cheng Crowns (CC); EZ Pedo (EZP); Kinder Krowns (KKZ); NuSmile (NSZ); and SSC. Teeth were prepared, and assigned crowns were fitted. Teeth were weighed prior to and after preparation. Weight changes served as a surrogate measure of tooth reduction.Results: Analysis of variance showed a significant difference in tooth reduction among brand/type for both the anterior and posterior. Tukey's honest significant difference test (HSD), when applied to anterior data, revealed that SSCs required significantly less tooth removal compared to the composite of the four zirconia brands, which showed no significant difference among them. Tukey's HSD test, applied to posterior data, revealed that CC required significantly greater removal of crown structure, while EZP, KKZ, and NSZ were statistically equivalent, and SSCs required significantly less removal.Conclusions: Zirconia crowns required more tooth reduction than stainless steel crowns for primary anterior and posterior teeth. Tooth reduction for anterior zirconia crowns was equivalent among brands. For posterior teeth, reduction for three brands (EZ Pedo, Kinder Krowns, NuSmile) did not differ, while Cheng Crowns required more reduction. [ABSTRACT FROM AUTHOR]

Women's presence in pediatric dentistry has dramatically increased over the past several decodes. Women now comprise almost 50 percent of AAPD membership and almost 75 percent of new members. Purpose: The purpose of this investigation was to determine differences between male and female pediatric dentists relative to practice patterns and use of behavior guidance techniques (BGTs). Methods: A web-based survey was sent to 511 pediatric dentists who had been recruited by the AAPD to participate in a series of surveys related to pediatric dentistry. Results: Fifty-nine percent of dentists responded. Fifty-two percent of the respondents were male and 48 percent were female. Female respondents were significantly younger than male respondents. Males were more likely to own a practice and hold leadership positions in dentistry while females were more likely to work as faculty, staff dentists, or part-time in private practice. No significant differences were noted between the genders relative to the use of BGTs, though females tended to involve parents more and were more likely to report the use of protective stabilization in selected situations. Both genders reported that parenthood had an effect on their behavior guidance styles. [ABSTRACT FROM AUTHOR]

Purpose: To present evidence-based recommendations on nonpharmacological behavior guidance for the pediatric dental patient. Methods: The work group assessed eight systematic reviews for effectiveness of nonpharmacological behavior guidance techniques in children undergoing preventive care or a dental treatment visit. The key outcomes assessed included cooperative behavior, anxiety, and procedural pain. To formulate the recommendations, the work group used the GRADE framework to obtain consensus on domains such as priority of the problem, certainty of the evidence, balance between desirable and undesirable consequences, patients’ values and preferences, acceptability, and feasibility. Results: Overall, the use of basic nonpharmacological behavior guidance techniques resulted in trivial-to-small effect on improvement in behavior or reduction in anxiety. However, for children and adolescents undergoing preventive care, mobile applications and modeling showed large effects in reduction of anxiety. For those undergoing dental treatment, strategies such as modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal-assisted therapy, combined tell-show-do, audiovisual distraction, and cognitive behavior therapy showed large reduction in anxiety. For children and adolescents with special health care needs, audiovisual distraction and sensory-adapted dental environment showed large reduction of anxiety. Conclusions: All the formulated recommendations were conditional and were mostly based on very low certainty of evidence. Conditional recommendations imply that different choices or combinations of behavior guidance techniques may be most appropriate for different patients. Clinicians should use techniques consistent with the parent/patient values and preferences. These recommendations are based on the best available evidence to-date and are intended to aid clinical decision making. [ABSTRACT FROM AUTHOR]

Purpose: To design, fabricate, and evaluate in vitro 3D printed space maintainers (SMs) and compare their retentive capabilities to traditional stainless-steel (SS) space maintainers. Methods: E-Guard was selected as the printing material based on flexural strength and elastic modulus. SMs with a claw design were printed, cemented to testing blocks, and vertically loaded to determine failure strength and flexure (n equals 10). The intaglio surfaces of SM bands, printed with plain, crosshatched, or horizontal ridges, were cemented to extracted primary teeth. The force needed to dislodge the bands was compared to cemented traditional SS bands (n equals 14). Results: Flexural strength (mean±standard deviation [SD]) of E-Guide, E-Dent, and E-Guard materials was 65±12, 90±13, 134±25 MPa, respectively. Elastic modulus (mean±SD) was 1.54±0.40, 2.49±0.14, 2.65±0.89 GPa, respectively. When subjected to vertical loading, the mean failure load of 3D printed SMs (E-Guard) was 124 N and the mean deflection at fracture was 1.73 mm. Retention strengths (mean±SD) of 3D printed bands were 32±13, 43±13, 43±16 N for the plain printed, crosshatched, and horizontal ridges designs, respectively. The retention strength of traditional SS bands was 126±27 N. Conclusions: E-Guard had superior mechanical properties among tested printing resins. Strength and deflection under the vertical load of claw-design 3D printed space maintainers may be adequate as a viable alternative to traditional SMs. Retention of 3D printed SMs was significantly lower than for traditional SS bands. Textured intaglio surfaces did not significantly improve the retention of 3D printed bands. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate and compare microleakage of prefabricated posterior NuSmiie ® ZR and EZCrowns when cemented with BioCem and Ketac Cem dental cements. Methods: Forty extracted permanent teeth (n equals 10 per group) were fitted for either NuSmiie or EZCrowns prefabricated posterior zirconia crowns and cemented with BioCem or Ketac Cem, for a total of four groups. Crowned teeth were placed in Dulbecco's Phosphate Buffered Saline solution at 37 degrees Celsius for 24 hours. Teeth were thermocycled between five degrees Celsius and 55 degrees Celsius fo r 6,000 cycles, stained with two percent basic fuchsin, sectioned and visually inspected for microleakage utilizing stereomicroscopy on a four-point scale. Data were statistically analyzed using one-way analysis of variance, SNK (P<.05). Resuits: All samples in this study had microleakage. NuSmiie ® ZR crowns demonstrated significantly less microleakage when cemented with BioCem and compared to Ketac Cem (P=.002). NuSmiie ® ZR cemented with BioCem had significantly less microleakage compared to EZCrowns with Ketac Cem (P=.002). Conclusions: In this in vitro investigation, BioCem cement had significantly less microleakage in zirconia prefabricated crowns compared to Ketac Cem, and NuSmiie® ZR crowns cemented with BioCem resulted in significantly less microleakage than EZCrowns cemented with Ketac Cem. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of nonpharmacological behavior guidance interventions used for children and youth with special health care needs (CYSHCN) during preventive and dental treatment visits. Methods: Databases: Ovid MEDLINE, PsyclNFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a preventive visit (exam, fluoride application, radiographs, and prophylaxis) or a treatment visit (simple surgical treatment, sealants, restorative care with or with local anesthesia) with control or other interventions. The primary outcome measures for the studied interventions were reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included Randomized Controlled Trials (RCTs), performed data extraction, and assessed the risk of bias (ROB). Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done. Results: Eleven articles qualified for analysis from 219 screened articles. Included studies evaluate the effectiveness of in office strategies such as modeling, audio-visual distraction, sensory adapted dental environment, and picture exchange communication system. The certainty of evidence ranged from Very low to Low and the magnitude of effect varied from trivial to large change in the desired outcomes. Conclusions: Most basic non-pharmacological behavior guidance techniques showed some trivial to small reduction in self-reported anxiety and/ or improvement in behavior, with audiovisual distraction, Sensory Adopted Dental Environment, and Picture Exchange Communication System showing large reduction in anxiety based on some rating scales. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of nonpharmocological behavior guidance interventions used for children undergoing dental treatment visits. Methods: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmocological techniques rendered during a dental . treatment visit including sealants, restorative core, dental local anesthesia, and simple surgical procedures. The primary outcome measures were reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included RCTs, performed data extraction, and assessed the risk of bios (ROB). Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done. Results: Forty articles qualified for analysis from 219 screened articles. Included studies evaluated the effectiveness of pre-visit preparation and in office strategies rendered pre-/post- or during treatment such as positive imagery, direct observation/modeling, desensitization, tell-show-do and its modifications, voice control, positive reinforcement, memory restructuring, bio-feedback and breathing relaxation, animal assisted therapy, combined therapies, and cognitive behavior therapy. The certainty of evidence ranged from Very low to high and the magnitude of effect varied from trivial to large change in the desired outcomes. Conclusions: Most of the basic non-pharmacological behavior guidance techniques showed trivial to small reduction in self-reported anxiety and/or improvement in behavior, with modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal assisted therapy, combined tell-show-do and audiovisual distraction, and cognitive behavior therapy showing large effects in reduction of anxiety based on some scales. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of nonpharmacological behavior guidance interventions used for a child undergoing preventive dental visits. Methods: Databases: Ovid MEDLINE, PsyclNFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a preventive visit including examination, prophylaxis, fluoride application and radiographs. Workgroup (WG) identified moderate-to-high quality systematic reviews (SRs) published on hypnosis, audiovisual distraction, and parental presence/absence; and decided to exclude these interventions from current SR to avoid duplication. The primary outcome measures for the studied interventions included reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included RCTs, performed data extraction, and assessed the risk of bias. Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done. Results: Fifteen articles qualified for analysis from 219 screened articles. WG found studies evaluating effectiveness of pre-visit preparation and in-office strategies rendered pre- or during treatment such as positive imagery, communication, modeling, tell-show-do, magic tricks, mobile applications, positive reinforcement, and sensory adapted dental environment. The certainty of evidence ranged from Very low to Moderate and the magnitude of effect varied from trivial to a large change in the desired outcomes. Conclusions: Most basic nonpharmacological behavior guidance techniques showed trivial to small reduction in self-reported anxiety and/or improvement in behavior, with mobile application and modeling showing large effects in reduction of anxiety based on some rating scales. [ABSTRACT FROM AUTHOR]

Purpose: This study's purpose was to test the hypothesis that, after glass ionomer (Gl) sealant debonding, remaining Gl in the deepest parts of fissures and/or the inhibition of enamel demoralization after artificial caries challenge imparts the residual cariostatic property observed in clinical studies. Methods: Fuji IX Gl sealant was placed on one tooth from 14 matched pairs of noncarious extracted human permanent molars and premolars; the other tooth was the control. Sealed teeth underwent thermocycling (4,000 cycles), and the sealant was manually debonded. The amount of remaining sealant in the fissures was determined using a stereomicroscope. All teeth were placed in lactic acid gel (pH 5.0) at 37 degrees Celsius for three weeks to simulate caries formation. The extent of demineralizotion was determined using the serial micro-hardness method on the cross-sectioned specimens at 0.5 mm from the depth of the central fissure. Results: All teeth had Gl retained in the fissures at a microscopic level. Enamel deminerolization adjacent to the remaining Gl was not significantly different from the control (t test; P=.88). Conclusions: The residual cariostatic property of gloss ionomer sealant is most likely due to a physical barrier of remaining Gl in the fissures rather than a chemical effect on demineralization inhibition. [ABSTRACT FROM AUTHOR]

Purpose: Esthetic prefabricated pediatric crowns require more tooth reduction than stainless steel crowns due to their passive fit. The purpose of this study was to determine tooth reduction in primary molar preparations for various pediatric prefabricated crowns. Methods: Fifty primary maxillary and fifty mandibular typodont molars were scanned with an optical scanner. The teeth were mounted in a typodont, and 10 experienced pediatric clinicians prepared them for five types of pediatric prefabricated crowns: (1) stainless steel (SS); (2) zirconia EZCrowns™ (EZ); (3) NuSmile® ZR (NS); (4) Zirconia Kinder Krowns® (KD); and (5) an experimental composite crown (PS). The prepared teeth were rescanned, and the pre- and postpreparation scans were precisely aligned. Mean and maximum reduction depths were calculated for occlusal and mesiobuccal surfaces. Differences in reduction among crown types were compared using one-way analysis of variance followed by the Student-Newman-Keuls post hoc test (a equals 0.05). Results: Reduction depths were not significantly different among the esthetic crowns but were significantly higher than SS crowns. Maximum reduction exceeded two mm in some of the KD and NS crown preparations, with KD consistently showing the highest reduction. Conclusions: Preparations for esthetic prefabricated molar crowns were more extensive than SS crowns, especially at occlusal and mesiobuccal surfaces. Clinicians should carefully follow manufacturer preparation guidelines to avoid encroaching the mesiobucccal pulp horn. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether reduced curing performance due to compromised light tip placement can be mitigated by bulk-fill composite and/or high-intensity curing light. Methods: Plastic discs with 2.5-mm deep cavities were filled with a conventional (Mosaic™) or bulk-fill (Tetric® PowerFill) composite and cured with a BluePhase® PowerCure curing light at normal and high-power settings, with light tip placement at distance and/or 45 degree angle. Curing time and irradiance were three, five, or 10 seconds at 1,200, 2,000, or 3,000 mW/cm2 (10 samples). After 24 hours, Vickers hardness on top and bottom surfaces was measured and analyzed using analysis of variance and pairwise comparisons (α<0.05). Results: All top surfaces had higher hardness than bottom surfaces. Cure (bottom-to-top hardness ratio) was significantly affected by material, distance/angle, and curing regimen (P<0.001), and generally decreased when tip distance and angle increased. Bottom-to-top hardness ratios of bulk-fill composite (0.42 to 0.66) were significantly higher than those of conventional composite (0.20 to 0.31). High-power curing significantly increased bulk-fill's curing performance as it was specifically formulated for this curing light. Conclusions: Increased light tip distance and angle compromised composite curing. Bulk-fill composite cured better at the bottom of the restoration than conventional composite regardless of light tip distance/angle. High-power light curing improved curing performance only in bulk-fill composite. Nevertheless, due to low bottom-to-top ratios (0.20 to 0.66) across all samples, even under ideal light tip placement, both composites should be cured in increments of less than 2.5 mm.

Purpose: The purpose of this study was to investigate the microleakage of atraumatic glass ionomer restorations with and without silver diammine fluoride (SDF) application. Restorations with SDF are termed silver-modified atraumatic restorations (SMART). Methods: Sixty carious extracted permanent teeth were randomly allocated to two SMART groups and two control groups (n equals 15 per group) for a total of four groups. After selective caries removal, test specimens were treated with 38 percent SDF and polyacrylic acid conditioner was applied and rinsed; teeth were restored with Fuji IX GP® glass ionomer (n equals 15) or with SMART Advantage™ glass ionomer (SAGI; n equals 15). For control groups, specimens were restored with their respective GI material after selective caries removal, both without SDF. Restored teeth were placed in Dulbecco's Phosphate-Buffered Saline solution at 37 degrees Celsius for 24 hours. Teeth were thermocycled between five and 55 degrees Celsius for 1,000 cycles, stained with two percent basic fuchsin, sectioned, and visually inspected for microleakage utilizing stereomicroscopy on a four-point scale. Data were statistically analyzed using Kruskal-Wallis one-way analysis of variance on ranks using Dunn's method (P<0.05). Results: Microleakage between the two SMART restoration groups was insignificant. SAGI alone demonstrated significantly more microleakage than all other groups. There was no statistical significance between the Fuji IX GP® control group and the two SMART restoration groups. Conclusions: This in vitro study indicated that silver diammine fluoride placed before glass ionomer restoration does not increase microleakage. Polyacrylic acid may be used after SDF placement without increasing microleakage.

Purpose: To investigate intrapulpal temperature rise in a primary molar during light activation of a composite restoration to determine if clinically significant pulpal temperatures (greater than 5.5 degrees Celsius) were reached., Methods: Restorative composites (EsthetX HD, Filtek Supreme Ultra, Filtek Bulk Fill) were placed into a primary molar with occlusal preparation (1.5 mm depth; remaining pulpal floor thickness one mm). The pulp was extirpated through a root access to place a thermocouple against the pulpal roof. Temperature changes were recorded during composite restoration light polymerization with three curing lights (one quartz-tungsten-halogen, two LEDs). Sample size was 10. Samples received additional irradiation to assure complete polymerization, followed by a third irradiation for calculating the exothermic heat contribution (subtracting third irradiation temperatures from first irradiation temperatures). Cured restorations were removed after each test, and the tooth was reused. Results were analyzed with Kruskal-Wallis (α =0.05)., Results: Type of curing light and composite material affected the intrapulpal temperature rise, which was up to five degrees Celsius for one combination of LED-composite., Conclusions: Clinicians should be aware of the potential for clinically significant intrapulpal temperature rises when light-activating composite restorations in a primary molar with a moderately deep cavity.

As a key component of the craniofacial team in caring for children with craniofacial anomalies, pediatric dentists play a vital role in the treatment and prevention of dental disease. The purpose of this paper was to review the current literature on the oral health status of individuals with craniofacial anomalies, concentrating on children with cleft lip and/or palate (CLP). CLP children are at high risk for developing caries and periodontal disease, have poor oral hygiene, and often have unmet dental needs. Recommendations for pediatric dentists caring for children with craniofacial anomalies include providing parent education, dietary counseling, oral hygiene instructions for the parent and child and implementing other preventive measures.