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Aim: The purpose of this study was to evaluate the effectiveness of different adhesive systems in amalgam restorations and their effects on microleakage. Methodology: In this study, 105 caries-free extracted human permanent molar teeth were used. Teeth were randomly assigned to five groups (n=21), and class I cavities were created on the surface of each tooth. The first was a control group to which no adhesive system was applied. Amalgam Liner (VOCO GmbH, Cuxhaven Germany) was applied to Group II, Clearfil SE-Bond (Kuraray Europe GmbH, Frankfurt Germany) was applied to Group III, Panavia F 2.0 (Kuraray Europe GmbH, Frankfurt Germany) was applied to Group IV, Amalgambond Plus (Parkell Inc.Edgewood, NY USA) was applied to Group V, and then amalgam (Tytin, Kerr, California USA) restorations were placed. After the polishing process, samples were subjected to thermocycling 1,000 times. Teeth were sectioned bucco-palatinally/lingually, and microleakage scores of the occlusal walls were evaluated under a stereomicroscope at 15X magnification by a standardized scale ranging from 0 to 4. One tooth was selected randomly from each group for SEM (Scanning Electron Microscope), and SEM LEO EVO 40 (LEO Ltd., Cambridge UK) photographs of amalgam-tooth hard tissue interfaces were also taken at different magnifications. The results of the microleakage tests were statistically analyzed by both the Kruskal-Wallis Test and the Mann Whitney U Test. Results: In terms of microleakage among groups, the differences that were determined were significant (p

Statement of problem Which restorative material is best suited for treating the posterior molar region is unclear. As dentists presumably choose the most appropriate restoration, German dentists were asked how their own molars were treated. Purpose The purpose of this survey study was to examine molar restorations and their durability in German dentists. Material and methods In the official journal of the Federal Dental Association, German dentists were asked to participate in an online survey that gathered demographic data and information on the type and durability of their molar restorations. To reduce selection bias, the data were weighted for region, sex, and age of the dentist. Results The data set consisted of 1719 molars from 288 dentists. Restorations included gold inlays (25%), composite resin (24.3%), amalgam (11.8%), ceramic inlays (5.4%), glass ionomer cement or compomer (0.8%), gold crowns (21.8%), ceramic crowns (6.6%), and metal-ceramic crowns (4.3%). Notable differences were identified based on the sex, age, and region of the dentist. Women selected increased esthetic options, as did young dentists. Restorations made of gold, amalgam, and base metal had the highest longevity, at more than 20 years Conclusions Among German dentists, restorations with metallic materials dominated in molars, with gold accounting for the largest share. In recent years, the proportion of tooth-colored restorations has increased, and in particular, young dentists use composite resin and ceramics.

BACKGROUND፡ The ability of mercury to deposit throughout the body and alter a wide range of molecular and cellular pathways results in a polymorphic and complex clinical phenotype with over 250 possible symptoms. However, some of them are recurrently cited as evoking chronic mercury poisoning. In this light, dentists users of dental amalgams are chronically exposed to mercury so that in-depth epidemiological investigations and adapted statistical methods are required to highlight adverse effects of this exposure.METHODS: In order to study the health impact of the occupational mercury exposure in a population of liberal dentists practicing in two Moroccan regions, a list of eighteen subjective symptoms commonly associated with micro-hydrargyrism was drawn up. Then, seven statisctical models adapted to count data were fitted. Finally, three methods were used to compare their relative performance in order to choose the most appropriate one.RESULTS: The adopted logical path, from the response variable selection till models’ comparison, led us to lean towards quasi- Poisson regression as the best way to predict the number of symptoms declared by dentists according to mercury exposure.CONCLUSIONS: Interpretation of the selected model allowed us to conclude that the reduction of dental amalgam use allows the reduction of subjective symptoms related to mercury exposure.

Objectives: To compare the frequency of apical periodontitis (AP) in non-endodontically treated teeth restored with full coverage crowns, amalgam and resin composite fillings, and to disclose the association of type and quality of coronal restoration with periapical disease. Material and methods: The cross-sectional study involved 597 subjects who attended the Dental Clinic of the Clinical Hospital Centre, Rijeka, Croatia for the first time. Data were collected by means of a clinical and radiological survey. The following data were recorded for all permanently restored non-endodontically treated teeth: the type, the quality of coronal restoration according to clinical and radiographic criteria for marginal integrity as well as the recurrent caries presence, periapical status and marginal bone loss. Chi-square tests were used to analyze the difference in periapical status regarding the type and the quality of restoration. The multivariate logistic regression analysis was used to assess the effect of explanatory tooth-specific variables on periapical status. Results: There was no significant difference in the proportion of AP with regards to the type and material of adequate quality coronal restorations (χ 2 =5.000, P=0.082). The regression analysis revealed significant positive associations with outcome variable (AP) for crowns (OR=3.39; P, Cilj: Svrha studije bila je usporediti učestalost apikalnog parodontitisa (AP) u endodontski neliječenim zubima koji su restaurirani potpunim krunicama te amalgamskim i smolastim kompozitnim ispunima. Također je istraživana povezanost vrste i kvalitete koronarne restauracije s prisutnošću periapikalne bolesti. Materijali i postupci: Presječno istraživanje obuhvatilo je 597 ispitanika koji su prvi put posjetili Kliniku za dentalnu medicinu Kliničkoga bolničkog centra Rijeka. Podatci su prikupljeni kliničkim i radiološkim pregledom. Za sve trajno restaurirane endodontski neliječene zube analizirani su vrsta, kvaliteta koronarne restauracije prema kliničkim i radiološkim kriterijima za rubnu cjelovitost restauracije i prisutnost rekurentnog karijesa, periapikalni status te gubitak marginalne kosti. Hi-kvadrat testovi primijenjeni su u analizi razlike periapikalnog statusa s obzirom na vrstu i kvalitetu restauracije. Multivarijantna logistička regresijska analiza obavljena je u procjeni utjecaja prediktorskih dentalnih varijabli na periapikalni status. Rezultati: Nije dokazana značajna razlika u proporciji AP-a s obzirom na vrstu i materijal koronarne restauracije odgovarajuće kvalitete (χ 2 = 5,000, P = 0,082 ). Regresijskom analizom otkrivena je značajna pozitivna povezanost s ishodišnom varijablom (AP) za krunice (OR = 3,39; P < 0,001), rekurentni karijes (OR = 4,67; P < 0,001) i pretkutnjake (OR = 1,73; P = 0,002). Zaključak: Ako su restauracije primjerene kvalitete, nema razlike u periapikalnom statusu endodontski neliječenih zuba s obzirom na vrstu i materijal korišten za koronarne restauracije.

This systematic review summarizes characteristics and treatment outcomes of dental amalgam-associated oral lichenoid lesions (OLLs) and oral lichen planus (OLP). Embase and MEDLINE were searched for original studies on OLLs or OLP associated with dental amalgam. Data extraction was completed from 44 studies representing 1855 patients. Removal of amalgam restorations led to complete resolution in 54.2% (n = 423/781), partial resolution in 34.8% (n = 272/781), and no resolution in 11.0% (n = 86/781) of the patients with OLLs, whereas complete resolution occurred in 37.1% (n = 72/194), partial resolution in 26.3% (n = 51/194), and no resolution in 36.6% (n = 71/194) of the patients with OLP. For patients with OLLs, 91.6% of the patients with positive patch tests and 82.9% with negative patch tests had improvement with removal of amalgam, whereas for patients with OLP, 89.2% of the patients with positive patch tests and 78.9% with negative patch tests had improvement with removal of amalgam. Our results suggest improvement occurs, regardless of patch testing status.

Introduction: A European Union amalgam phase-down has recently been implemented. Publicly funded health care predominates in the United Kingdom with the system favoring amalgam use. The current use of amalgam and its alternatives has not been fully investigated in the United Kingdom. Objectives: The study aimed to identify direct posterior restorative techniques, material use, and reported postoperative complication incidence experienced by primary care clinicians and differences between clinician groups. Methods: A cross-sectional survey was distributed to primary care clinicians through British dentist and therapist associations (11,092 invitations). The questionnaire sought information on current provision of direct posterior restorations and perceived issues with the different materials. Descriptive statistical and hypothesis testing was performed. Results: Dentists’ response rate was 14% and therapists’ estimated minimum response rate was 6% (total N = 1,513). The most commonly used restorative material was amalgam in molar teeth and composite in premolars. When placing a direct posterior mesio-occluso-distal restoration, clinicians booked on average 45% more time and charged 45% more when placing composite compared to amalgam ( P < 0.0001). The reported incidences of food packing and sensitivity following the placement of direct restorations were much higher with composite than amalgam ( P < 0.0001). Widely recommended techniques, such as sectional metal matrix use for posterior composites, were associated with reduced food packing ( P < 0.0001) but increased time booked ( P = 0.002). Conclusion: Amalgam use is currently high in the publicly funded sector of UK primary care. Composite is the most used alternative, but it takes longer to place and is more costly. Composite also has a higher reported incidence of postoperative complications than amalgam, but time-consuming techniques, such as sectional matrix use, can mitigate against food packing, but their use is low. Therefore, major changes in health service structure and funding and posterior composite education are required in the United Kingdom and other countries where amalgam use is prevalent, as the amalgam phase-down continues. Knowledge Transfer Statement: This study presents data on the current provision of amalgam for posterior tooth restoration and its directly placed alternatives by primary care clinicians in the United Kingdom, where publicly funded health care with copayment provision predominates. The information is important to manage and plan the UK phase-down and proposed phase-out of amalgam and will be of interest to other, primarily developing countries where amalgam provision predominates in understanding some of the challenges faced.

Objective: The Minimata Convention on mercury includes amalgam phase-down and eventual phase-out from dentistry. To aid its subsequent evaluation it is important to have baseline data of amalgam use in a locality prior to implementing a phase-down. Methodology: Records of patients spanning 5 years from January 2011 to January 2016 were analysed to determine and the compare frequency of amalgam usage with other dental materials for carious teeth restorations in a Nigerian university teaching hospital. Classes of cavities restored and cadres of operators who employed the different materials were included. Institutional ethics committee approval was obtained prior to commencing the study. Results: 2,058 patients’ records were retrieved, 59% females and 41% males. Their ages ranged 19–80 years, mean 33.5 ± 12.7 years, young adults 20–39 years old were the majority (62.9%). Filling materials included 57.5% amalgam, 17.6% glass ionomer cement (GIC) and 24.9% resin composite. Class I restorations constituted 70.5% of amalgam restorations, while Class II restorations made up 29.4% and Class V restorations accounted for 0.1%. Undergraduate dental students placed most of the amalgam restorations (60.5%), and 78.9% of all their restorations were amalgam. Less experienced dentists used all materials equally; the more experienced dentists placed more composite resin and GIC (43.3%). Conclusion: Amalgam fillings constituted nearly 60% of the restorations of carious teeth. Training of dental students in placement of non-mercury alternatives to amalgam and Minimum Intervention Dentistry needs to be emphasized in dental schools. Phase-down of amalgam should be intensified in Nigeria with the ultimate aim of a phase-out in line with the Minamata Convention.

SUMMARY Background and Objectives: Information on the choice of material and performance of restorations placed in a dental practice annually is limited. The Minamata Convention on Mercury is likely to affect the use of amalgam worldwide. The objective of this research was to investigate the use of restorative materials at the University of Otago Faculty of Dentistry in New Zealand from 1998 to 2017. Methods: Data from the Faculty of Dentistry's database from the years of interest were compiled. These data included information on the characteristics of restorations, including information on the material used and number of surfaces involved for each restoration. The tooth in which each restoration was placed was categorized by arch, tooth type, and deciduous or permanent dentition. Results: Records identified 227,514 permanent restorations placed from January 1998 to December 2017, of which 91.7% were direct restorations. Among direct restorations, composite resin was the most commonly used material, followed by amalgam, glass ionomer, and compomer. The use of amalgam for direct restorations decreased from 52.3% of direct restorations in 1998 to 7.1% in 2017. A corresponding increase was observed in the use of tooth-colored direct restorations, particularly composites. Among indirect restorations, porcelain fused to metal, gold, and stainless steel (in pediatric applications) were the materials most frequently used. Conclusions: Despite having no official policy on reducing the use of dental amalgam, the Faculty of Dentistry is following the global trend in reducing its use, with composite resin now well established as the predominant restorative material used. If the current rate of decline persists unchecked, the Faculty of Dentistry could transition to being amalgam free by 2020, although it seems likely that the characteristics and principles of use of the material (and its removal) will be taught for some time to come. This knowledge is important to planning curriculum changes needed to prepare graduates for clinical practice.

Objectives: We investigated the first re-interventions of two- and three-surface direct restorations on posterior teeth, specifically noting the type and time of the first re-intervention. Materials and methods: In 2002, altogether 5542 posterior two- and three-surface composite and amalgam restorations were done for 3051 patients aged 25-30 years at Helsinki City Public Dental Service (PDS). Based on electronic patient records, we analysed all restorations (n = 2445) having re-intervention during a 13-year follow-up. We recorded the type of tooth, restoration size, and type of first re-intervention. The time to re-intervention was the interval between the date of the placement of restoration at the year 2002 and its first re-intervention. Results: Restorative treatment was the most common (77.9%) first re-intervention, followed by endodontics (11.5%), extractions (5.2%), and other (5.4%). Males, more frequently than females, had extraction or endodontics as first re-intervention. The average time to re-intervention was 5.7 years (SD 3.8; median 5.2). Both median and mean times were shortest for cases involving endodontics or extractions. Conclusions: For the majority of two- and three-surface posterior restorations, the first re-intervention is restorative (replacement or repair of restoration). The shortest time to re-intervention is for restorations that have endodontics or extraction as the first re-intervention.

OBJECTIVES: The objectives of this cross-sectional survey were to determine the prevalence of secondary caries (SC) in general population, to identify patient- and material-related factors which may affect the prevalence, and to describe some clinical characteristics of SC lesions. MATERIALS AND METHODS: A total of 4036 restorations in 450 patients, who visited the university dental clinic for a regular (half) yearly checkup, were examined clinically (and radiographically) for the presence of SC. Clinical characteristics of the detected SC lesions (size, activity, and location) and the planned treatment were recorded. In addition, patients' caries-risk status was assessed according to the modified "cariogram" model. RESULTS: In total, 146 restorations were diagnosed with SC, which gives an overall prevalence of 3.6%. Restorative material, restoration class, patient's caries risk, and smoking habits were shown to be important factors, as SC prevalence was significantly higher with composites, class II restorations, high-caries-risk patients, and smokers. Restorations' gingival margins were most frequently affected by SC. The largest number of restorations with SC (72%) was scheduled for the replacement. CONCLUSIONS: Prevalence of SC was higher with composite than with amalgam restorations, irrespective of the patient's caries-risk status. Gingival margins of class II, including MOD restorations, seem to be the place of less resistance to SC development. Management of SC seems to place a considerable burden on the health care workforce and expenditure. CLINICAL RELEVANCE: Secondary caries (SC) is considered to be the main cause of dental restoration failure and one of the biggest clinical challenges related to dental composites. Nevertheless, its prevalence in daily practice is still not clear, which impedes an accurate estimation of its impact on health care costs. ispartof: CLINICAL ORAL INVESTIGATIONS vol:24 issue:2 pages:683-691 ispartof: location:Germany status: published

Dental amalgam, causes perturbation in photon dose distribution of head and neck (H&N) radiotherapy. The aim of this study was to evaluate the effects of dental amalgam on dose distribution of H&N radiotherapy and accuracy of dose calculations algorithm of commercial treatment planning system (TPS). In this study, the measurements were performed using a constructed H&N anthropomorphic. The sample of healthy teeth and teeth filled by amalgam inserted in the desired segment of the phantom in turn. After scanning and organs segmentation of phantom, intensity-modulated radiation therapy (IMRT) plan including 7 fields in the absence (plan 1) and presence (plan 2) of dental amalgam were created separately. Phantom was irradiated using 6 MV linear accelerator (SIMENS-ARTISTE, 5918). Assessment of the effects of dental amalgam on dose distribution and the accuracy of dose calculation algorithm of TPS was done by measurement and comparing of organ's received dose using thermoluminescent dosimeter (TLDs), placed on a phantom and TPS calculations. The scattering and attenuation due to the presence of dental amalgam led to an increase in parotid glands received dose (up to 24.38%) and a decrease in mean dose (up to -6.25%) PTV70. Results of this study revealed that discrepancies between the collapsed cone convolution (CCC) algorithm calculations Prowess Panther TPS and TLD measurements were -19.77% to 27.49% in presence of amalgam and -1.09% to 5.03% in presence of healthy teeth in phantoms. Attenuation and scattering due to amalgam in IMRT of H&N cancer may lead to a significant dose perturbation which is not predictable by dose calculation of TPS.

Background Data from countries that have implemented a complete phase out of dental amalgam following the Minamata agreement suggest increased costs and time related to the placement of alternatives with consumers absorbing the additional costs. This aim of this study was to investigate the impact of a complete phase out of dental amalgam on oral health inequalities in particular for countries dependent on state run oral health services. Methods A mixed methods component design quantitative and qualitative study in the United Kingdom. The quantitative study involved acquisition and analysis of datasets from NHS Scotland to compare trends in placement of dental amalgam and a survey of GDPs in Yorkshire, UK. The qualitative study involved analysis of the free text of the survey and a supplementary secondary analysis of semi-structured interviews and focus groups with GDPs (private and NHS), dental school teaching leads and NHS dental commissioners to understand the impact of amalgam phase down on oral health inequalities. Results Time-trends for amalgam placement showed that there was a significant (p Survey respondents suggest that direct impacts of a phase down were related to increased costs and time to place alternative restorations and reduced quality of care. This in turn would lead to increased tooth extractions, reduced access to care and privatisation of dental services with the greatest impact on deprived populations. Conclusion Amalgam is still a widely placed material in state run oral health services. The complete phase down of dental amalgam poses a threat to such services and threatens to widen oral health inequalities. Our data suggest that a complete phase out is not currently feasible unless appropriate measures are in place to ensure cheaper, long-lasting and easy to use alternatives are available and can be readily adopted by primary care oral health providers.

Objective Many patients have medically unexplained physical symptoms (MUPS); some of them attribute their health complaints to dental amalgam fillings. The aim of this study was to assess the validity and responsiveness of General Health Complaints index (GHC-index) for measuring the symptom load in MUPS patients compared to the widely used symptom outcome measure, Giessen Subjective Complaints List (GBB-24). Methods Three outcome measures – GHC-index, GBB-24, and Munich Amalgam Scale (MAS) – were administered at baseline and 12 months after removal of all dental amalgam restorations. The validity and responsiveness of these symptom measures were tested against external anchors: bodily distress syndrome (BDS), SF-36 vitality, and visual analogue scale (VAS). We tested both convergent and known group validities. We also examined the predictive validity and responsiveness to changes for each instrument. Results All the main outcome measures showed evidence of convergent and known group validities. The GHC-index, GBB-24 and MAS were all able to detect the anticipated differences in BDS and Energy. But the GBB-24 was more efficient in discriminating the BDS compared with the GHC-index (relative efficiency: RE = 0.69; 95% CI: 0.41–0.96) and MAS (RE = 0.59; 95% CI: 0.32–0.86). Each main outcome variable revealed good predictive validity for vitality (standardized coefficient: b ≈ 0.71 and R2 ≈ 0.50). Moderate to high sensitivity to change over time was demonstrated, with GHC-index performing better. Conclusion The GHC-index is a valid and responsive instrument for assessing symptom load in MUPS patients attributing their health complaints to amalgam fillings and undergoing amalgam removal.

Background Root canal therapy is a sequence of treatments involving root canal cleaning, shaping, decontamination and obturation. It is conventionally performed through a hole drilled into the crown of the affected tooth, namely orthograde root canal therapy. For teeth that cannot be treated with orthograde root canal therapy, or for which it has failed, retrograde root filling, which seals the root canal from the root apex, is a good alternative. Many materials, such as amalgam, zinc oxide eugenol and mineral trioxide aggregate (MTA), are generally used. Since none meets all the criteria an ideal material should possess, selecting the most efficacious material is of utmost importance. Objectives To determine the effects of different materials used for retrograde filling in children and adults for whom retrograde filling is necessary in order to save the tooth. Search methods Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 13 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 13 September 2016); MEDLINE Ovid (1946 to 13 September 2016); Embase Ovid (1980 to 13 September 2016); LILACS BIREME Virtual Health Library (1982 to 13 September 2016); and OpenSIGLE (1980 to 2005). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We also searched Chinese BioMedical Literature Database (in Chinese, 1978 to 20 September 2016); VIP (in Chinese, 1989 to 20 September 2016); China National Knowledge Infrastructure (in Chinese, 1994 to 20 September 2016); and Sciencepaper Online (in Chinese, to 20 September 2016). No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria We selected randomised controlled trials (RCTs) only that compared different retrograde filling materials, with reported success rate that was assessed by clinical or radiological methods for which the follow-up period was at least 12 months. Data collection and analysis Two review authors extracted data independently and in duplicate. Original trial authors were contacted for any missing information. Two review authors independently carried out risk of bias assessments for each eligible study following Cochrane methodological guidelines. Main results We included six studies (916 participants with 988 teeth) reported in English. All the studies had high risk of bias. The six studies examined five different comparisons, including MTA versus intermediate restorative material (IRM), MTA versus super ethoxybenzoic acid cement (Super-EBA), Super-EBA versus IRM, dentine-bonded resin composite versus glass ionomer cement and glass ionomer cement versus amalgam. There was therefore little pooling of data and very little evidence for each comparison. There is weak evidence of little or no difference between MTA and IRM at the first year of follow-up (risk ratio (RR) 1.09; 95% confidence interval (CI): 0.97 to 1.22; 222 teeth; quality of evidence: low). Insufficient evidence of a difference between MTA and IRM on success rate at the second year of follow-up (RR 1.06; 95% CI: 0.89 to 1.25; 86 teeth, 86 participants; quality of evidence: very low). All the other outcomes were based on a single study. There is insufficient evidence of any difference between MTA and Super-EBA at the one-year follow-up (RR 1.03; 95% CI: 0.96 to 1.10; 192 teeth, 192 participants; quality of evidence: very low), and only weak evidence indicating there might be a small increase in success rate at the one-year follow-up in favour of IRM compared to Super-EBA (RR 0.90; 95% CI: 0.80 to 1.01; 194 teeth; quality of evidence: very low). There was also insufficient and weak evidence to show that dentine-bonded resin composite might be a better choice for increasing retrograde filling success rate compared to glass ionomer cement at the one-year follow-up (RR 2.39; 95% CI: 1.60 to 3.59; 122 teeth, 122 participants; quality of evidence: very low). And there was insufficient evidence of a difference between glass ionomer cement and amalgam at both the one-year (RR 0.98; 95% CI: 0.86 to 1.12; 105 teeth; quality of evidence: very low) and five-year follow-ups (RR 1.00; 95% CI: 0.84 to 1.20; 82 teeth; quality of evidence: very low). None of these studies reported an adverse event. Authors' conclusions Based on the present limited evidence, there is insufficient evidence to draw any conclusion as to the benefits of any one material over another. We conclude that more high-quality RCTs are required.

Made available in DSpace on 2022-04-29T08:35:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Oral pigmented lesions can be physiological or pathological, exogenous or endogenous, as well as focal, multifocal, or diffuse. Among them, the oral melanotic macule (OMM) is a small, well-delimited brown-to-black macule, often affecting the lip and gingiva. Amalgam tattoo (AT) is a grey or black area of discoloration on the oral mucosa as a result of entry of dental amalgam into the soft tissues, commonly gingiva and alveolar ridge. Herein, we present a patient with gingival pigmentation with features of both OMM and AT in the same location. Department of Pediatric Dentistry Riberão Preto Dental School (FORP/USP) University of São Paulo, Riberão Preto Department of Diagnosis and Surgery Araraquara Dental School Universidade Estadual Paulista (UNESP) Oral Pathology Department of Stomatology Public Oral Health and Forensic Dentistry Ribeirão Preto Dental School (FORP/USP) University of São Paulo, Riberão Preto Department of Diagnosis and Surgery Araraquara Dental School Universidade Estadual Paulista (UNESP)

To evaluate the effects of different types of restorations on observer ability to detect proximal caries in CBCT images. Forty human premolars and molars with artificial proximal caries were placed proximal and distal to 5 molars having different restorations (amalgam, composite, resin-modified glass ionomer cement (RMGIC) fillings, zirconia, and lithium disilicate crowns) and a non-restored molar. CBCT scans were obtained using i-CAT® Next Generation. Images were rated twice by 2 observers. The exact depth of artificial caries was histologically established. Sensitivity, specificity, and area under the receiver operating characteristic curve (Az) values were calculated. Caries detection in teeth surfaces mesial and distal to amalgam showed compromised specificity and accuracy. Moreover, caries detection in teeth surfaces mesial to zirconia crown showed low sensitivity, specificity, and accuracy. Capability of CBCT in detection of proximal caries in teeth adjacent to composite, RMGIC, and lithium disilicate was comparable to those adjacent to non-restored molar. CBCT scans performed for tasks other than caries detection should be assessed for proximal caries in absence of any restorations as well as in presence of composite, RMGIC fillings, and lithium disilicate crowns. However, CBCT should not be used for proximal caries detection in teeth adjacent to amalgam and teeth surfaces mesial to zirconia crowns. It is important to investigate the influence of artifacts produced by various restorations on CBCT-based caries detection to optimize CBCT benefits, caries diagnosis and avoid unnecessary treatment of sound surfaces.

Mercury (Hg), cadmium (Cd), and lead (Pb) are of great concern for food safety and infants are especially sensitive to exposure to the maternal body burden. We quantified these elements in breast milk from Norwegian mothers and determined their association with dietary habits, maternal amalgam fillings, and smoking. Breast milk (n = 300) from the Norwegian Human Milk Study (HUMIS) was analyzed using triple quadrupole inductively coupled plasma mass spectrometry, after an acidic decomposition using microwave technique. We used multiple linear regression to examine predictors of Hg and Cd in breast milk, and logistic regression to test predictors of Pb above the quantification limit. The median breast milk concentrations (minimum - maximum) were 0.20 μg Hg/kg (0.058-0.89), 0.057 μg Cd/kg (0.017-1.2), and0.67 μg Pb/kg (0.2-7.5). Cadmium showed no significant relation with any exposure variable investigated. Lead was associated with intake of liver and kidneys from game. For Hg concentration in breast milk, number of amalgam fillings and high fish consumption were significant predictors (p 0.001). We detected a significant association (p 0.01) between Hg in breast milk and maternal consumption of Atlantic halibut, lean fish, mussels and scallops and lifetime consumption of crab. Seafood intake alone explained 10% of variance, while together with amalgam explained 46% of variance in Hg concentration in breast milk. Our findings emphasize the importance of following consumer advice with respect to fish and seafood and points to amalgam as an important source for Hg exposure.

Objective To investigate current teaching and operative techniques of posterior composite restorations in dental schools in Oceania (Australia, New Zealand, Fiji and Papua New Guinea). Methods A 24-item validated questionnaire including closed and open questions was mailed to the Heads of Department of Operative/Restorative Dentistry in 16 dental schools. Responses were compiled in Excel and analyzed. Results The response rate of this study was of 94% (n = 15). All respondent schools taught the use of posterior composites for occlusal and occluso-proximal cavities in premolars and molars. The mean percentage of preclinical teaching devoted to composites was greater than for amalgam (39% vs 29%). This proportion was anticipated to be 3:1 for posterior composite/amalgam in five years’ time. Most posterior restorations placed by students are composites (average 64%, ranging from 10 to 100%), with amalgam representing 19.5% of the restorations placed (ranging from 0%–50%). Slot-type cavities were the preparation techniques most commonly taught (80%) and most schools (67%) teach the mandatory use of rubber dam for moisture control. The most common contraindication to composite placement (67% of the schools) was a history of adverse reaction to composites. The phase down of teaching and use of amalgam in Oceania is expected to occur within 8–10 years. Conclusions Despite minimally invasive approaches becoming increasingly common worldwide, the use of amalgam is still taught in Oceania. Future studies should assess whether the clinical teaching of posterior composites is in keeping with material development and trends in mainstream dental practice.

The Minamata treaty (2013) enacted a globally binding agreement to phase down amalgam use, which may significantly affect dental care for underserved populations. To comply with the Minamata treaty, strategic approaches need to be implemented to reduce amalgam use while imposing minimal risk on the dental care of the underserved.To establish strategic approaches to reduce amalgam use, the aim of this study is to use a marketing research analysis to determine which patient-related factors influence pediatric dentists' choice of amalgam.A survey containing questions regarding amalgam use, perception about the environmental impact of amalgam waste, and hypothetical clinical scenarios of a child with dental caries with varying levels of caries risk and types of dental insurance was developed and pretested. Emails linked to an electronic survey were sent via Qualtrics to all active American Academy of Pediatric Dentistry members (Of 892 (17.6%) replies, 850 responses were eligible for analysis. Only 385 (45%) respondents indicated using amalgam, and their responses were analyzed in the conjoint model. Respondents' selection of amalgam varied between 8% and 28% across all the clinical scenarios, with most respondents choosing composite or stainless steel crowns. Conjoint analysis revealed that, while both caries risk and type of insurance affected respondents' decision about amalgam use, caries risk was the driving factor in decision-making for using amalgam.These results underscore the importance of prevention and management of risk factors to successfully phase down amalgam use.Our study applied the marketing research tool, choice-based conjoint analysis, to investigate the relative importance of different factors on dentists' decision-making regarding amalgam use. This study should be of great interest to policy makers when developing strategic approaches to comply with the 2013 United Nations Environment Programme (a.k.a. Minamata treaty) policy recommendations for phase-down of dental amalgam.

Background The link between restless legs syndrome (RLS) and the number of amalgam fillings in older people was investigated. Restless legs syndrome decreases the quality of life and impairs normal functioning. Mercury (in amalgam) may be toxic to nerve cells and may account for the incidence of RLS. Material and methods The relationship between RLS and the presence of amalgam in the teeth of 104 people aged 60-97 years old was determined. By using 4 questions, together with the diagnostic criteria from the internationally used questionnaire produced by the International Restless Legs Syndrome Study Group (IRLSSG), authors assessed the extent of the symptoms and occurrence of RLS. Careful medical history and medical examination were used for ascertaining each subject's type of restorative materials (i.e., amalgam or other metal) and the number of such fillings. Results Subjects who answered "yes" (indicating presence of RLS) to the 4 subsequent questions had a significantly higher number of amalgam dental fillings as compared to the subjects without RLS symptoms. Presence of other metal dental restorative materials and the number of amalgam dental fillings reported in the past had no significant influence on RLS symptomatology. Conclusions Authors conclude that while examining the correlates of the appearance of restless legs syndrome the use of amalgam in the dentition should be taken into account. Med Pr. 2019;70(1):9-16.

Context: Dental offices are known to be one of the largest users of inorganic mercury in the preparation of amalgam-a restorative material which, if not handled and disposed through scientific methods, can pose grave threats to the biosphere. Aims: The objective of this study was to assess and record the mercury management and disposal strategies of dental practitioners belonging to the two South Indian states, Kerala and Tamil Nadu. Subjects and Methods: A questionnaire regarding the usage and disposal of a filling material containing mercury (amalgam) was designed and distributed online. The 150 dental practitioners partaking in this study responded anonymously. Results: The results were statistically analyzed using chi-square test and the P value was evaluated. The usage of amalgam was correlated with the age of the practitioner and the nature of practice and it was found to be statistically significant. The number of fillings was correlated with the years of practice and locality of the clinic, which were found to be statistically significant. Conclusions: This study showed that mercury was widely preferred and utilized even today as a restorative material by dentists and dental specialists, despite the availability of other alternative strategies. Only a minor section of practitioners were found to be aware of the global changes in the guidelines pertaining to the handling and disposal of amalgam. We feel that Safe Mercury Amalgam Removal Technique, amalgam safety rules, and amalgam-free practice should be a part of the academic curriculum and continuing dental education.

This study examines the effects of household corrosive products on 105 restored (silver amalgam and porcelain-fused-to metal) and non-restored teeth. Five household products were utilized, including hydrochloric acid, sulfuric acid and detergent. Teeth were radiographed before and after exposure and were submerged for 120 or 264h. Documentation included weight, mesiodistal and buccolingual crown measurements, ordinal scores, and photography at specific hours of exposure. Results indicate that 81.9% of the teeth could be positively matched by radiographs. Hydrochloric acid had the most destructive effects mainly to non-restored and silver amalgam teeth followed by sulfuric acid. Porcelain samples were more resistant to the effects of acid and conferred protection to the underlying teeth. Acid type, acid concentration and the restoration type are statistically significant contributors to alterations and in radiographic matching. Household corrosive substances may affect the morphology of teeth, and in some cases completely destroy teeth, which could conceal identifications.

This hypothesis-testing study evaluated the relationship between mercury (Hg)-based dental amalgams and arthritis diagnoses among adults in the United States (US). A total of 86 305 425 weighted-persons with ⩾1 dental amalgam filling surface (DAFS) (exposed group) and 32 201 088 weighted-persons with ⩾1 other dental filling surface (ODFS) (no DAFS, unexposed group) were examined in the 2015 to 2016 National Health and Nutritional Examination Survey (NHANES). All persons were 20 to 80 years-old with known demographic characteristics and arthritis status. Survey logistic regression and survey frequency modeling in SAS were employed with and without adjustment of covariates. The arthritis rate was significantly increased in the exposed group compared to the unexposed group in the unadjusted (7.68-fold) and adjusted (4.89-fold) models. Arthritis (per 10 000 weighted-person-years) was 6.0-fold significantly increased in the exposed group (6.2) compared to the unexposed group (1.06). A significant bimodal dose-dependent relationship between DAFS and arthritis rate was observed. The arthritis rate increased with increasing DAFS (peak among persons with 4-7 DAFS) and, subsequently, decreased among those with >6 DAFS. A significant decrease in arthritis rate among persons with >13 DAFS as compared to those persons with 4 to 7 DAFS was observed. A significant association between DAFS and arthritis risk and a dose-dependent DAFS associated immune-stimulation/immune-suppression with arthritis risk were observed. An estimated additional $96 835 814 US dollars (USD) are spent on annual medical costs and $184 797 680 USD are lost in annual wages from reported new onset arthritis attributably associated with DAFS (annual total cost = $281 633 494 USD).

Objectives Estimate the proportion of amalgam restorations among the US population. Methods Data from ≥15 year old clinically examined dentate participants in three 2-year survey cycles (NHANES 2011-2016) were analyzed. The 2015-2016 data include restorative material type, allowing for the first time a US estimate of amalgam-restored teeth. Results The percent of the US population with at least one restoration (65.8 ± 1.4) was relatively constant in 2011-2016. Among those with restored teeth, the mean number of teeth with amalgam restorations increased with age from 4.71 among 15-24 year olds to 7.03 among those ≥75 years. Non-Hispanic Whites with restored teeth had the highest mean of teeth with amalgam restorations (5.94), while non-Hispanic Blacks had the lowest (5.08). Conclusion In 2015-2016, about half (51.5 percent) of restored teeth in the US population contained amalgam. Amalgam presence varied by age, tooth type, and race/ethnicity, but not by sex. These estimates can be used to assess future US caries prevention and dental amalgam reduction efforts.

Amalgam has been the gold standard for restorations in posterior teeth. Mercury, a major component of dental amalgam, is considered an environmental pollutant. The Minamata Convention on mercury recomends a reduction in the use of mercury-containing products. Since Pakistan is a signatory to the Convention, the same amalgam phase-out limitations are implemented in Pakistan.To identify and assess the use of amalgam and its waste management by dentists in Pakistan post-Minamata Convention guidelines.A cross-sectional study was conducted in Lahore among 520 general dental practitioners in 2019.The sample size for the study was calculated as 500; the questionnaire was distributed among 550 dentists. Dental amalgam was used by only 41.6% of the dentists in their practice; 55.0% perceived it to be a health risk. Most of the dentists (76.3%) were unaware of the proper disposal protocols for dental amalgam and 76.5% were unaware of any guidelines regarding amalgam use and disposal.Although there is a gap in knowledge among the dentists regarding amalgam disposal, dentists in Pakistan are reducing their use of dental amalgam in accordance with the guidelines of the Minamata Convention.التخلص التدريجي من الأمالجم، أحد الشواغل المتعلقة بالسلامة البيئية: دراسة مقطعية على مستوى الممارسين العامِّين لطب الأسنان في باكستان.سلمان خان، نعيمة خالد، عبيد بجوة، طه قمر، علي كاظمي، أمينة طارق.كان الأمالجم هو العلاج المعياري في عمليات الترميم في الأسنان الخلفية. كما يعد الزئبق، وهو عنصر رئيسي في أمالجم الأسنان، ملوثًا بيئيًا. وتنص اتفاقية ميناماتا بشأن الزئبق على الحدّ من استخدام المنتجات المحتوية على الزئبق. وبما أن باكستان من الدول الموقعة على هذه الاتفاقية، فإن القيود نفسها المفروضة على التخلص التدريجي من الأمالجم تُنفَّذ في باكستان.هدفت هذه الدراسة إلى تحديد استخدام الأمالجم وتقييمه وإدارة نفاياته بواسطة أطباء الأسنان في باكستان بعد وضع المبادئ التوجيهية لاتفاقية ميناماتا.أُجريت دراسة مقطعية في مدينة لاهور على 520 ممارسًا عامًّا لطب الأسنان في عام 2019.تم حساب حجم العينة الخاصة بالدراسة على أنه 500، كما تم توزيع الاستبيان على 550 طبيبًا للأسنان. وكان 41.6٪ فقط من أطباء الأسنان يستخدمون أمالجم الأسنان في ممارساتهم، بينما رأى 55.0٪ أنه يُشكِّل خطرًا على الصحة. ولم يكن معظم أطباء الأسنان (76.3٪) على علم بالبروتوكولات المناسبة للتخلص من أمالجم الأسنان، كما لم يكن 76.5٪ من أطباء الأسنان على علم بأي مبادئ توجيهية تتعلق باستخدام الأمالجم والتخلص منه.على الرغم من وجود فجوة معرفية لدى أطباء الأسنان عندما يتعلق الأمر بالتخلص من الأمالجم، فإن أطباء الأسنان في باكستان يقللون من استخدامهم لأمالجم الأسنان وفقًا للمبادئ التوجيهية لاتفاقية ميناماتا.Élimination progressive des amalgames dentaires, une préoccupation de sécurité environnementale : étude transversale parmi les dentistes généralistes au Pakistan.L'amalgame dentaire a été le matériau de référence pour les restaurations des dents postérieures. Le mercure, composant majeur des amalgames dentaires, est considéré comme un polluant environnemental. La Convention de Minamata sur le mercure impose de réduire l'utilisation des produits qui en contiennent. Le Pakistan étant signataire de ladite Convention, les mêmes limitations relatives à l'élimination progressive des amalgames dentaires lui sont appliquées.Identifier et évaluer l'utilisation de l'amalgame dentaire et la gestion des déchets qui en résultent par les dentistes au Pakistan suite aux directives de la Convention de Minamata.Une étude transversale a été menée à Lahore auprès de 520 dentistes généralistes en 2019.La taille de l'échantillon pour l'étude a été fixée à 500 ; le questionnaire a été distribué à 550 dentistes. Les amalgames dentaires n'étaient utilisés que par 41,6 % des dentistes dans leur pratique ; 55,0 % estiment qu'ils représentent un risque pour la santé. La plupart des dentistes (76,3 %) ne connaissaient pas les protocoles d'élimination des amalgames dentaires et 76,5 % ne connaissaient aucune directive concernant l'utilisation et l'élimination des amalgames.Bien que les connaissances des dentistes en matière d'élimination des amalgames soient insuffisantes, les dentistes pakistanais réduisent leur utilisation des amalgames dentaires conformément aux directives de la Convention de Minamata.

Background Evidence of health utility changes in patients who suffer from longstanding health complaints attributed to dental amalgam fillings are limited. The change in health utility outcomes enables calculating quality-adjusted life-year (QALY) and facilitates the comparison with other health conditions. The purpose of this study was to estimate the validity and responsiveness of the EQ-5D-5L and SF-6D utilities following removal of dental amalgam fillings in patients with health complaints attributed to their amalgam fillings, and examine the ability of these instruments to detect minimally important changes over time. Methods Patients with medically unexplained physical symptoms, which they attributed to dental amalgam restorations, were recruited to a prospective cohort study in Norway. Two health state utility instruments, EQ-5D-5L and SF-6D, as well as self-reported general health complaints (GHC-index) and visual analogue scale (EQ-VAS) were administered to all patients (n = 32) at baseline and at follow-up. The last two were used as criteria measures. Concurrent and predictive validities were examined using correlation coefficients. Responsiveness was assessed by the effect size (ES), standardized response mean (SRM), and relative efficiency. Minimally important change (MIC) was examined by distribution and anchor-based approaches. Results Concurrent validity of the EQ-5D-5L was similar to that of SF-6D utility. EQ-5D-5L was more responsive than SF-6D: the ES were 0.73 and 0.58 for EQ-5D-5L and SF-6D, respectively; SRM were 0.76 and 0.67, respectively. EQ-5D-5L was more efficient than SF-6D in detecting changes, but both were less efficient compared to criteria-based measures. The estimated MIC of EQ-5D-5L value set was 0.108 and 0.118 based on distribution and anchor-based approaches, respectively. The corresponding values for SF-6D were 0.048 and 0.064, respectively. Conclusions In patients with health complaints attributed to dental amalgam undergoing amalgam removal, both EQ-5D-5L and SF-6D showed reasonable concurrent and predictive validity and acceptable responsiveness. The EQ-5D-5L utility appears to be more responsive compared to SF-6D. Trial registration The research was registered at ClinicalTrials.gov., NCT01682278. Registered 10 September 2012, https://clinicaltrials.gov/ct2/show/NCT01682278.

Objective: Mercury (Hg)-based amalgam is a dental restorative material in common use. This hypothesis-testing study evaluated the relationship between dental amalgam exposure and the risk of reported asthma diagnoses in American adults. Methods: A total of 97,861,577 weighted-persons with one or more dental amalgam surfaces (exposed group) and 31,716,558 weighted-persons with one or more other dental surfaces (no dental amalgams, unexposed group) were examined in the 2015–2016 National Health and Nutrition Examination Survey. All persons were 20–80 years old and with known reported asthma status (only newly diagnosed asthma cases were examined). Survey logistic regression and survey frequency modeling in SAS were employed to evaluate the relative incidence rate of reported asthma diagnoses among those in the exposed group compared to the unexposed group. Covariates of gender, race, socioeconomic status, educational status, country of birth, and tobacco exposure were considered. Results: Survey logistic modeling revealed a significantly increased incidence rate of reported asthma in the exposed group as compared to the unexposed group in unadjusted (4.46-fold) and adjusted (4.84-fold) models. A dose–response relationship was observed for the risk of reported asthma per dental amalgam filling surface in unadjusted (1.073) and adjusted (1.076) models. Survey frequency modeling revealed that the frequency of reported asthma (per 10,000 weighted-person years) was 3.66-fold significantly increased in the exposed group (2.06) as compared to the unexposed group (0.56). Conclusion: Increased dental amalgam exposure was associated with an increased risk of reported asthma diagnoses in American adults, but future studies should further evaluate this relationship.

Amalgam tattoos are a serious cosmetic problem for patients. A 35-year-old woman came to a private periodontal practice complaining of black pigmentation (amalgam tattoo) above temporary crowns on the lateral and central maxillary incisors and asked that the cosmetic problem be solved before the new permanent crowns were cemented into place. A full-thickness coronoapical incision was made to raise a thick flap; another incision parallel to the surface of the alveolar mucosa made it possible to remove the pigmented connective tissue, which was sent for histologic examination. Due to the fact that the pigmentation extended into the gingival epithelium, the gingiva of the lateral and central incisors was completely removed, with a horizontal incision in the alveolar mucosa from the ends of the distal releasing incisions. Therefore, partially denuded alveolar bone was used as the recipient site for a free gingival graft (FGG). The histologic analysis revealed the presence of amalgam fragments of different sizes in both connective tissue and epithelium. At 6 months, 3 years, and 24 years postoperatively, the periodontal tissues appeared healthy, and the treated area was pink, without pigmentation or scarring, and was perfectly integrated with the adjacent tissues. The patient was very pleased with her appearance. A one-stage procedure, namely an FGG, should be considered an effective treatment of amalgam tattoo providing positive morphologic and cosmetic outcomes over a 24-year follow-up period.

Aims: Bisphenol A (BPA)-based dental composites have commonly been used to fill dental cavities or seal pits and fissures on teeth. However, epidemiological evidence with regard to the BPA exposure from dental composites among children has rarely been reported. This study investigated whether there is a relationship between the BPA concentration in urine and the presence of composite restorations and sealants among South Korean children. Methods: Oral examinations and urine sample analyses were conducted on a total of 495 children aged 8–9 years. We classified the participants into four groups by the number of resin composites and sealant surfaces (0, 1–5, 6–10 and 11+). Results: BPA concentrations in urine were higher in children with 11 or more surfaces restored with sealants and resin composites than in those with zero restored surfaces, although no difference was seen in the group with 1–10 surfaces. After adjusting for gender and age, the urinary BPA concentration in children with 11 or more resin composite surfaces was 2.67 lg ⁄ g creatinine, which was higher than the concentration found in those with no filling surfaces ( P< 0.01). Conclusions: Having many dental composite filling surfaces on teeth may increase the urinary BPA concentration in children.

Background: The use of amalgam in Dentistry has decreased since the 1980s. This study aimed to (i) assess the time trend in the usage of amalgam and composite in posterior teeth at Griffith University Dental Clinic from 2010 to 2019; (ii) to test whether this trend varied according to the dental health provider. Methods: We analyzed clinic records from 2010 to 2019. Prais-Winsten analyses were performed, and the average annual percentages change (AAPC) for amalgam and composite was estimated. Results: There were 397,013 procedures, including 80,995 direct posterior restorations. Amalgam use decreased from 12.9% in 2010 to 0.5% in 2019 among students, while composite use has increased from 87.1% to 99.5% of posterior restorations. The annual increase of composite was 1.4% per year for students, while amalgam decreased by 30.2% per year on average. A similar trend was noted among the dentists. Conclusions: A significant decrease in the use of amalgam was observed over time for both students and professionals. This trend raises questions about curriculum reviews, focusing on the repair, maintenance, and safe removal of amalgam while reinforcing the learning on Minimally Invasive Dentistry and composite restorations based on the patient's caries risk.

Objectives Owing to its cost-effectiveness and operative convenience, dental amalgam remains in use as a restorative material for tooth caries in children in many countries. The aim of this study was to evaluate the relationship between dental amalgam exposure and urinary mercury (U-Hg) concentrations in children. Methods In this longitudinal study, 463, 367 and 348 children, 8–11 years of age, were evaluated at baseline, and at the first and second follow-up visits, respectively. The interval between each survey was 6 months. For the oral examination and urine sample, the amalgam-filled tooth surface (TS), and U-Hg and creatinine concentrations of participants were determined, and the cumulative amalgam-filled TS and cumulative creatinine-adjusted U-Hg were calculated. To assess potential covariates, socio-demographic factors, oral health behaviour and dietary factors were surveyed by questionnaire. Data were analysed by the t-test, correlation analysis and mixed-model analysis. The statistical analyses were performed using SPSS 18.0. Results Children with more than one amalgam-filled TS exhibited significantly higher creatinine-adjusted U-Hg concentrations than those without, in all three survey periods (P

Introduction A retrospective cross-sectional study of early patient-reported failures of restorations was initiated to understand the reasons and factors associated with early failure. Early patient-reported failures are defined as restorations requiring replacement within three months of placement. Aim To investigate if restorative material placed or any other tooth/restoration/patient factors may be associated with early patient-reported failures. Methods In total, 360 restorations were replaced from January 2016 to December 2017. Multivariable analyses (logistic regression model) were used to identify any patient/tooth/restoration factors that were associated with early patient-reported failures. Results Dislodgement, fracture and pain/sensitivity were the three main failure modes. There was significant association between restorative material type and dislodgement and restoration fracture. The odds of dislodgement for composite resin (CR) were 4.3 times higher compared to amalgam. The odds of dislodgement for glass-ionomer cement (GIC) and resin-modified GIC were 3.7 times higher compared to amalgam. The odds of fracture for CR were ten times lower compared to amalgam. The odds of pain for teeth with a history of restoration failure for a particular tooth were five times lower compared to no history of restoration failure for a particular tooth. Conclusions Restorative material type affected patient-reported failures.

Background and Purpose. Following the new directives of the European Union, which foresee the amalgam ban, the debate on its hypothetical toxicity has started again. So, the aim of this systematic review is to definitively evaluate the eventual effects of the exposure to Hg in adults and children with and without dental amalgam fillings measuring the Hg concentration in various biological fluids.Methods. A systematic literature search was conducted in four electronic databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) including all available randomised controlled trials published in the last 15 years comparing the use of dental amalgam with composite resins in humans with a follow-up period of at least one year. The primary outcome was the Hg concentration in biological fluids (urine, hair, blood, and saliva) with the aim of assessing their reliability as biomarkers of Hg exposure. The risk of bias was assessed through the Cochrane Collaboration tool and the overall quality of evidence through the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. The results of the meta-analysis were expressed using a random-effects model, and their power was assessed through the trial sequential analysis (TSA).Results. From the initial 2555 results, only 6 publications were included in the review: five were considered as having high risk of bias, whereas one as having moderate risk. Only two articles were eligible for quantitative analysis. The meta-analysis gathered data from 859 patients but was nevertheless not significant (p = 0.12). The TSA confirmed this evidence revealing that it was due to a lack of statistical power since the required information size (RIS) threshold is not reached.Conclusions. The existing evidence revealed that there are not enough data to support the hypothesis that restorations with dental amalgam can cause nephrotoxicity when compared with composite resins restorations.

Multiple sclerosis (MS) is an inflammatory neurological disease characterized by autoimmune-mediated demyelination of the central nervous system. Genetic and environmental factors may contribute to the development of MS. This has not been confirmed yet. Dental amalgam has long been controversial in MS due to its mercury content but the toxicological implications of mercury-containing amalgam fillings (AMF) for MS remain to be elucidated. We conducted a case&ndash, control study to investigate the association between AMF and the risk of MS from the Taiwanese National Health Insurance Research Database (NHIRD). Case (n = 612) and control (n = 612) groups were matched by sex, age, urbanization level, monthly income, and Charlson comorbidity index by propensity score matched with a 1:1 ratio from 2000 to 2013. Differences between cases and controls was not statistically significant (OR: 0.82, 95% CI = 0.65&ndash, 1.05). In subjects stratified by gender, MS was also not associated with AMF for women (OR: 0.743, 95% CI = 0.552&ndash, 1.000) and men (OR: 1.006, 95% CI = 0.670&ndash, 1.509), respectively. In summary, this Taiwanese nationwide population-based case&ndash, control study did not find an association between MS and AMF.

Background Amalgam is one of the most reliable dental restorative materials. Health and environmental concerns associated with the mercury content of amalgam have necessitated an amalgam phase-down in clinical practice. Objectives This study investigated the level of awareness and preparedness for the planned amalgam phase-down recommended by the Minamata Convention amongst Nigerian dental students and dentists. Methods This cross-sectional national survey was performed across all geopolitical zones of Nigeria. Data regarding awareness, practice and level of preparedness for amalgam phase-down were obtained using a questionnaire that was distributed amongst clinical dental students and dentists of different cadres, who routinely place dental restorations, in public and private practice. The questionnaires were administered online or were hand delivered. Data were analysed using the chi-square test and Spearman's rank correlation coefficient. A p value ≤ 0.05 was considered statistically significant. Results Notably, 845 dental students and dentists participated in the survey. Mean age (±standard deviation) of participants was 30.15 ± 7.67 years, 33.8% were students, and 66.2% were dentists (most dentists [77.1%] were employed at public hospitals). A significant percentage of respondents had poor knowledge of the Minamata Convention (87.7%) and lacked training in the use of alternatives to amalgam (72.0%). Amalgam continues to be commonly used by 39.1% and 31.3% of dental students and dentists, respectively. Only 4.7% of the respondents admitted to following good amalgam phase-down practices. Awareness (P = 0.013) and amalgam phase-down practices (P = 0.011) were significantly higher amongst dentists than amongst dental students. Conclusion We observed low levels of awareness regarding the Minamata Convention, amalgam phase-down, mercury hygiene practices and training in alternatives to amalgam use amongst Nigerian dental professionals and students.

Background - The Norwegian Ministry of Health and Care Services initiated a project including experimental treatment for patients with health complaints attributed to amalgam restorations. Objective - The aim was to evaluate changes of general health complaints in patients who participated in the project and had all amalgam restorations removed. Methods - The project was designed as a prospective cohort study and organised by the Dental Biomaterials Adverse Reaction Unit in Bergen, Norway. The dental treatment was provided by the patient's local dentist. The main target group consisted of patients with medically unexplained physical symptoms, attributed to dental amalgam restorations (Amalgam cohort). The primary comparison group consisted of patients with medically unexplained physical symptoms without attribution to dental amalgam restorations (MUPS cohort). Primary outcome was self‐reported general health complaints (GHC index) at follow‐up 12‐months after completed amalgam removal. Results - In the Amalgam cohort, a significant reduction of GHC index from 43.3 (SD 17.8) at baseline to 30.5 (SD 14.4) at follow‐up (mean reduction 12.8, SD 15.9; n = 32; P < .001) was observed. The change scores for GHC index indicated that the reduction of complaints was significantly higher (P = .004) in the Amalgam cohort compared with the MUPS cohort (mean reduction 1.2, SD 12.3, n = 28). After adjustment for age, gender, education and baseline GHC index, the mean adjusted difference was −8.0 (95% confidence interval from −15.4 to −0.5; P = .036). Conclusion - In a group of patients with medically unexplained physical symptoms, which they attributed to dental amalgam restorations, removal of amalgam restorations was followed by a significant reduction of health complaints.

Essential tremor (ET) is a common neurological disorder and the most common movement disorder. Low-level occupational exposure to mercury vapor is known to be a crucial factor that increases the risk of tremor. Dental amalgam is one of the main sources of mercury in those who possess amalgam restorations. However, the relationship between ET and amalgam filling (AMF) is not quite clear. The purpose of this study was to investigate the association between AMF and the risk of ET using a population-based administrative databank. The data for this study were sourced from the Taiwanese National Health Insurance Research Database (NHIRD). A retrospective case-control study was conducted using this databank from 2000 to 2013. Case and control groups were matched by sex, age, urbanization level, monthly income, and Charlson comorbidity index using the propensity score method with a 1:1 ratio. In this study, 3008 cases and 3008 controls were included. The results from this nationwide population-based case-control study did not indicate any association between ET and AMF in Taiwan. Although the results were not significantly statistical, the findings may be worthy to be valued.

Objectives: This in vitro study aimed to investigate leakage of mercury from amalgam restorations after cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) examinations. Study Design: In total, 238 amalgam disks were prepared and placed in saline solution. The samples were allocated randomly to 7 groups, with 34 samples in each group. CBCT imaging was performed for 4 groups with different imaging parameters (narrow/wide field of view [FOV]; standard/high-resolution). MRI procedures were performed with 3.0-T and 1.5-T magnetic field strengths. No imaging was performed for the samples in the control group. The amalgam samples were removed from the tubes 24 hours after imaging and submitted for plasma mass spectrometry analysis. Kruskal-Wallis and Dunn's tests were performed to compare data. A P value less than .05 was accepted as statistically significant. Results: The highest mean mercury value was found in the 3.0-T MRI group, whereas the lowest mean value was found in the narrow FOV, standard-resolution CBCT group. There were no significant differences between the control group and the experimental groups (P ≥ .338) or between the experimental groups (P > .05). Conclusions: CBCT and MRI procedures similar to those used in patient care caused no significantly different mercury release compared with nonexposed samples. © 2020 Elsevier Inc.

Urinary mercury (Hg) levels are suitable to assess long-term exposure to both elemental and inorganic Hg. In this study, the urinary Hg levels of 250 children (aged 6&ndash, 11 years) from three areas with different anthropogenic impacts in the Rieti province, central Italy, were assessed. The Hg concentrations were in the range of 0.04&ndash, 2.18 &micro, g L&minus, 1 with a geometric mean equal to 0.18 &micro, 1 [95% confidence interval (CI), 0.17&ndash, 0.20 &micro, 1] or 0.21 &micro, g g&minus, 1 creatinine (95% CI, 0.19&ndash, 0.23 &micro, 1 creatinine), and a reference value calculated as 95th percentile of 0.53 &micro, 1 (95% CI, 0.44&ndash, 0.73 &micro, 1) or 0.55 &micro, 1 creatinine (95% CI, 0.50&ndash, 0.83 &micro, 1 creatinine). In all cases, urinary Hg data were below the HBM-I values (7 &micro, 1 or 5 &micro, 1 creatinine) established for urine, while the 95th percentile was above the German Human Biomonitoring Commission&rsquo, s RV95 (0.4 &micro, 1) set for children without amalgam fillings. A significant correlation (p &lt, 0.05) was found between creatinine-corrected results and residence area, with higher urinary Hg levels in children living in the industrial area. Multiple linear regression analysis showed that creatinine was the main predictor of urinary Hg.

SUMMARY Objective: Cracks in amalgam-filled teeth may be related to amalgam expansion. This study measured cuspal flexure and used finite element analysis to assess associated stress levels in amalgam-filled teeth. Methods and Materials: External surfaces of 18 extracted molars were scanned in three dimensions. Nine molars were restored with mesio-occluso-distal amalgam fillings; the other teeth were left intact as controls. All teeth were stored in saline and scanned after two, four, and eight weeks. Cuspal flexure and restoration expansion were determined by calculating the difference between scanned surfaces. Stresses in a flexed tooth were calculated using finite element analysis. Results: Cusps of amalgam-filled teeth flexed outward approximately 3 μm, and restoration surfaces expanded 4 to 8 μm during storage. Cuspal flexure was significantly higher in the amalgam group (multivariate tests, p0.05). Expansion caused stress concentrations at the cavity line angles. These stress concentrations increased stresses due to mastication 44% to 178%. Conclusions: Amalgam expansion pushed cavity walls outward, which created stress concentrations at the cavity line angles. Expansion stresses can raise stresses in amalgam-filled teeth and contribute to incidentally observed cracks.

Background and Aim: Restoration of endodontically treated teeth is one of the most important and challenging topics in restorative dentistry. Longevity of such restorations is an essential factor in treatment planning. Amalgam build-up is a conservative method for restoration of endodontically treated teeth. Therefore, this study aimed to assess the longevity of this type of restoration in endodontically treated molar teeth. Materials and Methods: In this retrospective study, 110 endodontically treated molar teeth of 98 patients that had received amalgam build-up restorations with at least one cusp coverage with 3-10 years of longevity were evaluated. The restorations included mesio-occluso-distal (MOD;40%), disto-occlusal (DO;23%), mesio-occlusal (MO;17%) and complex amalgam restorations (20%). Binary logistic regression and Kaplan-Meier tests were used for statistical analysis. Results: Of all restorations, cracks were observed in 22.7% of restorative materials and 10.9% of teeth. Secondary caries was found in 29% of the teeth. Based on binary lo-gistic regression, MOD restorations had significantly higher rate of marginal fracture and recurrent caries (P

BACKGROUND: Pressure changes can influence dental restorations especially among divers. The aim of the current study was to evaluate the fracture resistance and microleakage of mesio-occluso-distal (MOD) amalgam and composite restorations undergoing pressure changes via diving and aviation simulation. METHODS: For the fracture resistance test, 60 sound maxillary premolar teeth were randomly allocated to two groups. Each group was then divided into three subgroups (n = 10) for simulating scuba-diving (pressure cycle to 203 kPa, 2 bar), flight (50.6 kPa, 0.5 bar), and control (atmospheric pressure). The teeth underwent pressure cycles for one month and then the fracture resistance test was conducted on them using the Instron testing machine. Microleakage scores were afterwards recorded by using a 2% methylene blue dye for 24 hours. RESULTS: Composite restorations showed significantly higher fracture resistance values compared to the amalgam group (P < 0.05). The control group had significantly higher fracture resistance values compared to the dive group, whereas there was no significant difference between the control group and the flight group (P = 0.083). No significant difference in the level of microleakage was observed between restoration materials or pressure cycles (P > 0.05). CONCLUSIONS: Composite restorations showed promising fracture resistance compared to the amalgam group. Diving pressure cycles demonstrated adverse effects on the fracture resistance values of the two restorative materials.

Background Densitometry plays an important role in the diagnosis and treatment planning. Due to diversity in density, equal amounts of different materials absorb various amounts of X-rays and yield different radiographic views. Objectives The aim of this study was to evaluate the gray scales of 5 commercially available restorative materials, including amalgam, composite resin, flowable composite resin, glass-ionomer, and Dycal. Material and methods Samples of the 5 test materials from various manufacturers were prepared, each 5-millimeter-thick. There were 7 glass-ionomer samples and 10 of each of the other materials, making a total of 47 samples in the study. The test materials were scanned using a Kodak cone-beam computed tomography (CBCT) unit. Subsequently, the gray scales were determined and evaluated by a radiologist using OnDemand3DTM Dental software and analyzed with SPSS v. 22 software. Results Amalgam had a higher gray scale than the other groups of restorative materials. In some cases, it was the same as that of composite resin; however, it was significantly different from gray scales of flowable composite resin, glass-ionomer and Dycal. It was concluded that composite resin and amalgam were high in gray scale, while flowable composite resin, glass-ionomer and Dycal exhibited low gray scales. Conclusions Amalgam and composite resin had high gray scales, and glass-ionomer and Dycal exhibited the lowest gray scale values. The findings show that CBCT can be helpful in differentiating amalgam and composite resin from other materials.

Yilmaz, Selmi/0000-0001-9546-6548; Yilmaz, Selmi/0000-0001-9546-6548; Adisen, Mehmet Zahit/0000-0002-5493-8390 WOS: 000442165000025 PubMed: 29944087 Purpose: To evaluate ex vivo mercury release from dental amalgam after 7.0-T and 1.5-T MRI. Materials and Methods: The authors evaluated 60 caries-free molar or premolar teeth that had been extracted for clinical indications. Two-sided cavities were opened in each tooth and amalgam fillings applied. After 9 days, two groups of 20 randomly selected teeth were placed in 20 mL of artificial saliva immediately followed by 20 minutes of MRI exposure at 1.5 or 7.0 T. A control group of teeth was placed in artificial saliva without undergoing MRI exposure. The teeth were removed from the artificial saliva 24 hours later, and the saliva was analyzed for mercury content by using inductively coupled plasma mass spectrometry. One-way analysis of variance was used to compare the mean mercury values among the three independent groups, and the Tukey test was used for multiple comparisons of the mean values. Results: The mean mercury content of the artificial saliva was 673 mu g/L +/- 179 in the 7.0-T MRI group, 172 mu g/L +/- 60 in the 1.5-T MRI group, and 141 mu g/L +/- 152 in the control group. The mercury content in the 7.0-T group was greater than that in both the 1.5-T group (P

Introduction: The aim of this report is to present a clinical case of oral lichenoid lesions associated with amalgam restorations with the presence of desquamative gingivitis for a nine months follow up period. Case Report: The histopathologic characteristics and direct immunofluorescence were compatible with Oral Lichenoid Lesion (LLO). Diagnosis was based on a synthesis of all available information, including medical history, clinical examination, histopathology and the results of specific tests, such as the patch test, which confirmed allergy to thimerosal, an organic compound of mercury. Discussion: The replacement of amalgam restorations has brought improvements to the instrument, as evidenced by the disappearance of desquamative gingivitis, aspect erythematosus and erosive lesions. The fading does not complete the same, however, indicates the need to continue has been under continuous observation, the patient, having in view the possibility of the existence of an underlying lichen planus.

In this study, we assessed intracorporal mercury concentrations in subjects living on partially mercury-contaminated soils in a defined area in Switzerland. We assessed 64 mothers and 107 children who resided in a defined area for at least 3 months. Mercury in biological samples (urine and hair) was measured, a detailed questionnaire was administered for each individual, and individual mercury soil values were obtained. Human biomonitoring results were compared with health-related and reference values. Mothers and children in our study had geometric means (GMs) of 0.22 µg Hg/g creatinine in urine (95th percentile (P95) = 0.85 µg Hg/g) and 0.16 µg Hg/g (P95 = 0.56 µg Hg/g), respectively. In hair, mothers and children had GMs of 0.21 µg Hg/g (P95 = 0.94 µg/g) and 0.18 µg/g (P95 = 0.60 µg/g), respectively. We found no evidence for an association between mercury values in soil and those in human specimens nor for a health threat in residential mothers and children.

Based on toxicological, clinical, and epidemiological knowledge, the present paper reviews the status regarding possible deleterious health effects from occupational exposure to metallic mercury (Hg) in dental practice. Symptoms from the central nervous system are among the health problems that most often are attributed to Hg exposure in dentists and dental nurses working with amalgam. Uncharacteristic symptoms of chronic low-level Hg vapor exposure including weakness, fatigue, and anorexia have been observed in numerous studies of dental personnel. It is crucial to protect both human health and the environment against negative effects of Hg. In line with this, the use of dental amalgam in industrial countries is about to be phased out. In Norway and Sweden, the use of the filling material is banned.

Aim To assess whether the timing of pulp disease after tooth restoration was associated with type of restorative dental material used, extent of the restoration or tooth type. Methodology A comprehensive search and analysis of data using the Titanium Oral Health Management software program at The Oral Health Centre of Western Australia were performed to correlate procedural codes for teeth that had restorations placed and subsequently developed pulp disease requiring endodontic treatment or extraction from 1st January 2009 to 31st December 2013. Manual analysis of paper and/or electronic patient record cards was also performed. Data collected included restoration type, restored tooth surfaces, tooth type and the dates of restoration and subsequent endodontic intervention or extraction. Results Of 330 teeth that met the inclusion criteria, 84 (26%) had composite resin restorations, 80 (24%) had amalgams, 119 (36%) had glass-ionomer cement (GICs), and 47 (14%) had crowns. The average time between restoration and further intervention was 330 days with a range from 3 to 1775 days (approximately 5 years). Teeth restored with crowns or five-surface restorations were significantly more likely to require earlier intervention than other restorations. Premolar and anterior teeth were also more likely to require earlier intervention. Conclusions Teeth that developed pulp disease requiring further intervention that were restored with crowns and five-surface GIC developed the disease sooner than teeth that were restored with amalgam or composite. In teeth with five-surface restorations that developed pulp disease requiring further intervention, premolar and anterior teeth developed the pulp disease sooner than molars.