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Background/purpose The restoration of endodontically treated teeth (ETT) with cervical defects has been a challenge for dentists. The purpose of this study was to evaluate the effect of restorative treatment on the fracture resistance of ETT with cervical defects. Materials and methods One hundred and twenty freshly extracted human intact straight-single-root maxillary premolars were randomly divided into 6 groups. Group 1 remained untreated. Cervical defects of 4 mm-depth and 3 mm-height were created in groups 2–6. Group 3–6: root canal treatment. Group 4: direct composite resin restoration. Group 5: 2-mm full-cusp-coverage composite resin restoration. Group 6: fiber-post-supported composite resin restoration. A static fracture test was used to determine the fracture resistance of teeth under axial (n = 10) and palatal (30°) (n = 10) loading. Fracture modes were categorized as restorable and unrestorable. Results Compared with intact teeth, the axial fracture resistance of teeth with cervical defects decreased by approximately 39%, and endodontic procedures resulted in 10% more reduction. When ETT with cervical defects were restored using direct composite resin filling, the axial fracture resistance recovered to 72% of that of intact teeth, but no significant change occurred under oblique loading. After full-cusp-coverage or fiber-post-supported restoration, fracture resistance showed complete recovery to the value of intact teeth (P > 0.05). Sixty percent of fractures were unrestorable for fiber-post-supported teeth, while in the full-cusp-coverage restoration group, 80–90% of fractures were restorable. Conclusion Full-cusp-coverage restoration or fiber-post-supported restoration could improve the fracture resistance of ETT with cervical defects, whereas unrestorable fractures easily occurred in fiber-post-supported restorations.

У статті наводиться аналіз якості життя за опитувальником QOLIE-31 у пацієнтів з епілепсією, яким на тлі регулярного прийому мінімальних терапевтичних доз антиконвульсантів проведено курс терапії з використанням ритмічної транскраніальної магнітної стимуляції (рТМС). Аналіз результатів проведеного дослідження з використанням рТМС і протиепілептичних препаратів показав, що подібна комбінація фармакологічних засобів і фізичних факторів дозволяє контролювати перебіг епілепсії та забезпечує досить високу протисудомну дію. Отримані результати дозволили обґрунтовано доповнити медикаментозне лікування епілепсії проведенням курсу рТМС, домогтися оптимального терапевтичного результату для кожного пацієнта з мінімальним ризиком побічних ефектів, а також поліпшити якість його життя.

Мета — дослідити вплив імплантації NeuroGelTM в асоціації зі стовбуровими клітинами кісткового мозку (СККМ) на динаміку спастичності в паретичній задній кінцівці щура після травми спинного мозку. Матеріали та методи. Тварини — білі безпородні щури-самці (5 міс., 250 г); групи: 1-ша — травма спинного мозку (n = 16); 2-га — травма спинного мозку + гомотопічна імплантація фрагмента NeuroGelTM (n = 20); 3-тя — травма спинного мозку + гомотопічна імплантація фрагмента NeuroGelTM, асоційованого зі СККМ миші (n = 16). Модель травми — лівобічний перетин половини спинного мозку на рівні Т11; термін спостереження — 28 тиж., оцінку показника функції (ПФ) та показника спастичності (ПС) задньої іпсилатеральної кінцівки (ЗІК) проводили за шкалами Basso — Beattie — Bresnahan та Ashworth відповідно. Результати. ПС ЗІК станом на 28-й тиждень експерименту в групі 1 становив 2,5 ± 0,4 бала за шкалою Ashworth, у групах 2 і 3 — 1,7 ± 0,2 бала та 1,7 ± 0,3 бала відповідно. Значущу різницю між значеннями ПС ЗІК у групах 1 і 2 виявляли на 7-му добу, на 5–7-му та 12–24-му тижнях, між групами 1 і 3 — на 7-му добу, на 7–8-му та 16-му тижнях; максимальну різницю ПС ЗІК між групами 2 і 3 — на 12-му тижні спостереження (р = 0,059). Динаміка ПС ЗІК у групах 2 і 3 однотипна, відрізняється відсутністю значущого приросту протягом 3-го тижня, наявністю значущого приросту протягом 3–4-го місяця. На відміну від групи 1 у групах 2 і 3 при від’ємній кореляції індивідуальних значень ПФ та ПС ЗІК у межах кожного з термінів спостереження визначали сильну додатну кореляцію значень обох показників, усереднених по групах, упродовж загального періоду спостереження. Висновок. Ксенотрансплантація СККМ у комплексі з NeuroGelTM не призводить до значущих змін рівня спастичності порівняно з ізольованою імплантацією NeuroGelTM, однак суттєво змінює динаміку цього ускладнення спінальної травми.

В основу роботи покладено результати діагностики, реабілітації та відновного лікування 220 хворих із посткоматозними тривалими розладами свідомості після тяжкої черепно-мозкової травми (ЧМТ). Основна увага приділяється актуальній і досі темі — групі синдромів тривалого пригнічення свідомості після тяжкої ЧМТ, а саме найскладнішому з них — вегетативному статусу (ВС), в якому хворі заходять на реабілітаційне лікування та проходять реабілітаційний маршрут. Розкриваються клініко-неврологічні особливості вегетативного статусу пацієнтів, які мали ключове значення на реабілітаційному маршруті, з одного боку, для з’ясування ефективності лікування, а з іншого — для прогнозування переходу на вищі стадії посткоматозної свідомості. В дослідженні акцентується на тому, що кореляційного зв’язку між змінами в неврологічному статусі, особливо у рефлекторній, руховій, чутливій сферах, та тривалістю перебування в даній стадії посткоматозного порушення свідомості, а тим більше виходом на вищі рівні відновленої свідомості не встановлено. Зазначається, що шкала/класифікація Т.А. Доброхотової найкраще описувала даний рівень посткоматозного розладу свідомості, оскільки на основі рушійної ознаки чітко відділяла дану стадію від коми та інших стадій посткоматозного відновлення свідомості. На основі отриманих даних робиться висновок про відсутність специфічної неврологічної вогнищевої симптоматики, а клініко-неврологічна картина характеризується виключно топіко-функціональними особливостями первинно уражених структур головного мозку на сегментарному та надсегментарному рівнях. Єдиними факторами, з якими виявлено стійкий прямолінійний кореляційних зв’язок прогнозу виходу з ВС на вищі рівні посткоматозної свідомості, були варіант клінічної форми тяжкої ЧМТ та глибина коми, що передувала ВС. Саме хворі з комою ІІІ, спричиненою ДАП в результаті ДТП, так і не вийшли з ВС в межах року після тяжкої ЧМТ. Майже кожний третій пацієнт відновився лише до стану мінімальної свідомості, в якій залишався надалі. Відмінна неврологічна картина, яка по осьовим ознакам виявлялася в динаміці відновлення свідомості, свідчила лише за початок нового етапу/стадії відновлення та викривала активні зони інтересу/цілі для можливого/необхідного лікувального (реабілітаційного) впливу з метою покращення загального стану пацієнта, якості його життя і через поки невідомі механізми (можливо, активізований чи доповнений саногенез) сприяння швидшому переходу до максимально вищого рівня свідомості.

Purpose To compare the Atraumatic Restorative Treatment (ART) associated with Brix3000™ to ART considering treatment time, pain experienced, and acceptability to children. Methods This study was accepted in Research Ethics Committee in July 2019 (number 3469402). Healthy patients (n = 20) aged 3–9 years, with at least one primary molar with occlusal dentine caries without cusp involvement were randomly allocated to either the ART + Brix3000™ group or the ART-only group. The sample was characterised by sex, age, tooth location and caries experience. Time spent and pain experience scores were recorded at prophylaxis, caries removal and restoration. The pain experience (intense, moderate, or mild) was evaluated by the Face, Legs, Activity, Cry, Consolability-revised scale (FLACC-r). Acceptability was assessed by a five-point hedonic facial scale (dichotomised into ‘like’ and ‘indifferent/dislike’ bins) and by an open-question interview. Mann–Whitney, Chi-square, and Fisher’s exact tests were applied to discern differences in time, pain/sample characterisation and acceptability, respectively. Results The ART + Brix3000™ group required 8.6 ± 3.1 min to remove caries tissue, whereas the ART group required only 4.8 ± 2.0 min (p = 0.03). The total time spent with treatments was 13.1 ± 4.0 min for ART + Brix3000™, and 9.8 ± 2.7 min for ART (p = 0.03). There was no difference in pain experience and acceptability found among the groups (p > 0.05). Conclusion Although the ART + Brix3000™ technique demanded more treatment time than the ART alone, there were no differences in either pain experience or acceptability.

BACKGROUND There are potential barriers to using the atraumatic restorative treatment (ART) approach in conventional dental offices, as many professionals assume that it is only used for field conditions. This systematic review and meta-analysis evaluated the survival data of ART restorations in permanent and primary teeth when performed in and out of the conventional environment. METHODS Searches were performed on PubMed/MEDLINE, Scopus, Web of Science, and Open Grey databases up to April 2020. Studies that evaluated ART restorations were prospective and had survival rate data were included. The risk of bias was evaluated by Rob 2.0 and ROBINS-I tools. Meta-analyses were carried out considering as outcome the survival rate of primary and permanent teeth. Subgroups analysis was performed for setting and type of cavity (occlusal or multi-surface). RESULTS Thirty-four studies were included. For primary teeth, in general, the overall percentage of survival rate was not influenced by setting, ranging up to 71% in 12 months to 65% in 36 months. Similarly, for permanent teeth, the overall percentage of survival rate was not influenced by setting, ranging up to 96% in 12 months to 61% in 36 months. CONCLUSION ART is a feasible approach for field settings as well as conventional dental offices. PROSPERO CRD42020184680.

Tariq AlSwayyed,1,2 Raneem Bin Nafesah,2 Manal Alqutub,3 Ali Alfarhan,4 Arwa Almashhaf,5 Hessa Alshaikh,6 Nura Alhedeithi7 1College of dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 2Department of Dentistry, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 3Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 4King Khalid University, Abha, Saudi Arabia; 5Ministry of Health, Riyadh, Saudi Arabia; 6King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 7King Saud University, Riyadh, Saudi ArabiaCorrespondence: Raneem Bin NafesahKing Abdulaziz Medical City, Riyadh, Saudi ArabiaEmail ralnafisa@gmail.comAim: This study aims to describe the pattern of coronal restoration use among different dental specialties after root canal obturation in two governmental hospitals in Riyadh.Materials and Methods: Electronic dental records at King Abdul-Aziz Medical City and University Dental Hospital were reviewed. Teeth that underwent initial root canal treatment on a permanent tooth for obturation using gutta-percha between April 2019 and June 2019 were included. The collected data included the type of material used for coronal restoration after RCT, immediate post-space preparation, cotton pellet placement, the clinical title and specialty of the treating physician, and the center where treatment was performed. Excel was used for data collection. IBM SPSS was used for descriptive and interferential analyses.Results: A total of 763 patients were included in the study, in which the double seal technique was used in 56% of the patients, followed by Cavit, which was used in approximately 17% of the patients. Post space was prepared immediately after root canal treatment in 49 patients, and only 17 teeth received the final post, whereas post space was temporized for the rest of the prepared teeth and received the final post at the following visits. Significant relations were found between the type of material used and the clinical title of the treating physician and between the material of choice and the specialty of the dentist. The double seal was the technique of choice among endodontists and restorative dentists, whereas advanced general dentists frequently used Cavit. The least used materials were IRM, amalgam, and Ketac Silver.Conclusion: The double seal technique was found to be the most commonly used method to achieve a coronal seal, followed by Cavit. Other materials used after RCT, in sequential order based on the frequency of use, were GIC, temporary crowns, resin composite, RMGIC, prefabricated post with composite buildup, IRM, amalgam, and Ketac Silver.Keywords: coronal restoration, temporary fillings, endodontic treatment, restorative treatment, root canal treatment

Adhesive indirect restorations are a popular restorative treatment option. This article discusses the many factors that contribute to their successful adhesive cementation, including a review of how to surface treat and manage contaminants across the wide range of indirect materials available., Key points Critiques the current various adhesive strategies used by resin cements at the tooth tissue interface.Describes how to prepare the fitting surface of a wide range of restorative materials for adhesive cementation.Discusses how to mitigate against contaminants during the adhesive cementation process.

Background Managing a child's anxiety is most critical for the success of treatment in the pediatric dental setup. Present trend advocates the use of non-aversive behavior management techniques. Aim and objective To compare and evaluate the efficacy of aromatherapy using orange essential oil with that of music distraction in the management of anxious pediatric dental patients. Design One hundred and fifty children of the age 6-8 years were divided into three groups of 50 each and performed restorative treatment under aromatherapy, with music distraction, without aromatherapy, or music distraction, respectively. Venham's picture test and facial image scale (FIS), pulse rate, respiratory rate, and oxygen saturation were recorded before and after the procedure. Results Compared with controls, both the aromatherapy group and music distraction group showed significant posttreatment change in anxiety levels with respect to Venham's picture test and FIS, along with the reduction in pulse rate and respiratory rate. When compared between music distraction and aromatherapy, it did not yield statistical significance, though music distraction showed better results compared to aromatherapy. Conclusion Both music distraction and aromatherapy using orange essential oil are effective in anxiety management of which music distraction presents a comparatively better result. Either these non-invasive techniques alone or a combination of both may be employed in the dental setup of pediatric dentists for molding cooperative patients. How to cite this article James J, Retnakumari N, Vadakkepurayil K, e t a l. Effectiveness of Aromatherapy and Music Distraction in Managing Pediatric Dental Anxiety: A Comparative Study. Int J Clin Pediatr Dent 2021;14(2):249-253.

Non-Carious Cervical Lesions are characterized by slow and progressive loss of hard tissue at the level of enamel-cement junction, without bacterial involvement. This work aimed to address a case report of restorative treatment in Class V cavities in multiple premolars using the direct-indirect technique with composite resin. A 42 year-old male patient presented for esthetic restorative treatment with the complaint of severe dentin hypersensitivity and wedged-shaped non-carious cervical lesions affecting the maxillary premolars. The restorative treatment chosen was a direct-indirect technique with composite performed into three sessions as follows: making the class V composite inlays, cementation, and final polishing. The direct-indirect technique as an alternative to the traditional direct technique has the benefits of a better contour of the restoration, since the finishing and polishing are made extraorally. Besides, the control of the polymerization stress and less discomfort to the patient are other advantages. In the case of direct-indirect class V restoration, the advantages far surpass those of the direct technique. Keywords: Hypersensitivity. Tooth Wear. Composites Resins ResumoAs Lesões Cervicais Não Cariosas se caracterizam pela perda lenta e progressiva de tecido duro próximo a junção cemento-esmalte, sem envolvimento bacteriano. Este trabalho tem o objetivo de relatar um caso clínico de tratamento restaurador em cavidades do tipo Classe V em pré-molares pela técnica direta-indireta com resina composta. Paciente do sexo masculino, 42 anos, queixava-se de forte sensibilidade e múltiplas Lesões Cervicais Não Cariosas na forma de cunha nos pré-molares superiores. O tratamento restaurador escolhido foi a técnica direta-indireta com resina composta realizado em três sessões distribuídas em confecção da peça em resina composta, cimentação e polimento final. A técnica direta-indireta surge como alternativa a técnica direta tradicional trazendo como benefícios um melhor contorno da restauração, uma vez que esta é acabada e polida fora da boca, além do controle do estresse de polimerização e menor desconforto ao paciente. A intervenção restauradora direta-indireta se mostra eficaz devido ao fato de conseguir contornar dificuldades encontradas em técnicas restauradoras diretas. Palavras-chave: Hipersensibilidade. Desgaste dos Dentes. Resinas Compostas

This review highlights the importance of atraumatic restorative treatment (ART) as a minimal intervention procedure for managing dental caries (pit and fissures caries) and restoring cavitated dentin carious lesions using restorative materials such as glass-ionomer cement. ART technique uses only hand instruments and requires no electricity. Its low cost and simplified protocol makes it more convenient and suitable for use in remote areas as well as underdeveloped nations with insufficient resources to provide the adequate restorative care. This technique can be used in all population groups including children, older people, and disabled. In the present scenario of the COVID-19 pandemic, the dental profession is facing a challenging task in managing restorative needs of the patients all over the world. ART technique is a safe and effective approach to manage the progression of carious lesions. As this technique involves no aerosol generation during the procedure, it should be well adopted in our routine practice by taking necessary precautions. The survival and retention rates of ART also appear to be fairly acceptable based on various studies.

Noncarious cervical lesions (NCCLs) are a common clinical finding often linked with dentin hypersensitivity (DH). Aim. The aim of the study was to evaluate the influence of diode laser for the treatment of DH on microleakage of subsequent NCCL restorations. Materials and Methods. Forty-eight extracted human premolars were collected. All teeth received standardized cervical preparation on both the buccal and palatal surfaces and were randomly divided into three groups ( n = 16 ) according to the restorative material used: nanohybrid composite resin (CR), resin-modified glass ionomer (RMGI), and conventional glass ionomer (GIC). The prepared cavities on the palatal surfaces were treated by diode laser using SIROlaser Blue (Sirona Dental Systems, Bensheim, Germany) prior to restoration, while preparations on the buccal surfaces were directly restored. After thermocycling, the teeth were immersed in methylene blue dye for microleakage evaluation under 40x magnification at both occlusal and cervical margins. The Kruskal-Wallis test followed by the Bonferroni tests was conducted to determine inter- and intragroup differences ( P < 0.05 ). Results. All restorative materials tested showed some degree of microleakage with no statistically significantly different scores with or without the use of laser desensitization prior to restorative treatment. Group CR showed the least microleakage, followed by group RMGI, while group GIC showed the highest. Cervical margins showed greater microleakage than the occlusal margins where the difference was statistically significant in the RMGI group without laser pretreatment ( P = 0.006 ) and in both groups CR ( P = 0.02 ) and RMGI ( P = 0.006 ) with the laser pretreatment. Conclusion. Application of diode laser for the treatment of DH prior to the restoration of teeth with NCCL did not affect the microleakage of all the restorative materials tested. All the materials showed some degree of microleakage, which was higher in gingival margins compared to occlusal margins. The resin composite shows the least microleakage among all the tested materials.

Purpose The aim of the present study is to assess the quality and reliability of web-based information about restorative treatment in pediatric patients on the internet using different scales. Materials and Methods Websites obtained by using keywords about restorative treatment in pediatric patients on Google and Yandex were included in the study. The study was conducted in English on a total of 440 websites. Websites were evaluated using the quality criteria for consumer health information (DISCERN toolkit), Journal of American Medical Association (JAMA) benchmarks, and Health on the Net Code of Conduct Certification (HONCode). Results The mean DISCERN points of the websites were moderate. Among the evaluated websites, the quality of the knowledge in 20% of the websites was low. The rate of websites with a score below 40 was 37.5%. None of them has reached an excellent score. No websites met all JAMA criteria. There was no HONCode Certificate on any website. Conclusion This study showed that the quality of the web-based information about restorative treatment in pediatric patients was generally inadequate and scientifically imperfect.

Background Stainless-steel crowns (SSCs) are recommended for restorative treatment of young teeth severely affected by caries, fractures or dental developmental disorders (DDDs). However, despite recommendations and clinical evidence, SSCs are not widely used by general dentists, who favour extraction and more conventional restorations. The present study aimed to investigate the views of and use of SSCs among Norwegian and Finnish dentists. Methods The present study was a cross-sectional survey among Norwegian and Finnish dentists. An electronic questionnaire was sent to Norwegian and Finnish dentists asking whether they used SSCs and on which indications. In addition, the questionnaire assessed reasons for non-use and dentists’ perceptions regarding advantages and challenges in the use of SSCs, as well as the need for additional training. Distributions of background characteristics, use of and views on SSCs were calculated, and statistical significance of the associations between respondents’ background and their answers were evaluated. Results Of the 574 Norwegian and 765 Finnish respondents, only 12.0% and 12.9% reported to use SSCs, respectively. The most frequently reported barrier reported by those who did not use SSCs was lack of practical training. The most frequent challenge reported by those using SSCs was difficulties in crown adjustment followed by aesthetic issues, and the most frequently reported advantage was that SSCs maintain the function and occlusion. The majority of respondents reported a need for more information and practical training in the use of SSCs, with hands-on course as their most frequently preferred education type. Conclusion Although the value of SSCs for restoring young molars is recognized by Norwegian and Finnish dentists, SSCs are rarely used by general dentists. The majority of the respondents reported lack of training and materials and was interested in receiving more information and education.

Amelogenesis imperfecta (AI) is an inherited disease that expresses a disorder in the development of enamel structure. In its mildest form, it promotes tooth color change; and in more severe cases, it presents a loss of enamel structure initiated during the eruption phase. Different AI manifestations can coexist in the same patient or in the same tooth, both in the primary and permanent dentures. In addition, several subtypes are described, characterized according to the variety of phenotype and genotype. Successful treatment requires early diagnosis and therapeutic solutions involving different dental specialties. Although some professionals prefer to postpone permanent rehabilitation until the development of complete permanent dentures, the aesthetic and functional impact of this disease in childhood and adolescence requires that restorative treatment be started as soon as possible. The proposed therapies demonstrate numerous challenges such as extreme dentinal sensitivity, difficulties installing and maintaining the orthodontic appliance and the need for restorative and prosthetic intervention in malformed teeth. This work aims to demonstrate the interaction between Orthodontics, Restorative Dentistry and Prosthesis in the treatment of a patient with AI, reporting the success of treatment involving aesthetics, function and well-being and the long-term benefit of this interdisciplinary approach for patients with this disease. Keywords: Orthodontics. Amelogenesis Imperfecta. Mouth Rehabilitation. ResumoA amelogênese imperfeita (AI) é uma doença hereditária que expressa uma desordem no desenvolvimento da estrutura do esmalte. Na sua forma mais branda, promove alteração na cor dos dentes; e em casos mais severos, apresenta perda de estrutura do esmalte iniciada durante a fase de irrupção. Diferentes manifestações da AI podem coexistir no mesmo paciente ou no mesmo dente, tanto na dentadura decídua quanto na permanente. Além disso, são descritos diversos subtipos, caracterizados de acordo com a variedade do fenótipo e genótipo. O sucesso do tratamento requer diagnóstico precoce e soluções terapêuticas que envolvam diversas especialidades odontológicas. Embora alguns profissionais prefiram adiar a reabilitação definitiva até o desenvolvimento da dentadura permanente completa, o impacto estético e funcional desta doença na infância e adolescência exige que o tratamento restaurador seja iniciado o mais cedo possível. As terapias propostas demonstram inúmeros desafios como a sensibilidade dentinária extrema, as dificuldades para instalação e manutenção do aparelho ortodôntico e a necessidade de intervenção restauradora e protética em dentes com má formação. O presente trabalho tem como finalidade demonstrar a interação entre a Ortodontia, a Dentística Restauradora e a Prótese no tratamento de um paciente com AI, relatando o sucesso do tratamento envolvendo estética, função, bem estar e o benefício em longo prazo desta abordagem interdisciplinar para os portadores desta doença. Palavras-chave: Ortodontia. Amelogênese Imperfeita. Reabilitação Bucal.

Tooth wear is increasing in prevalence within the United Kingdom. Treatment of tooth surface loss can be daunting for both the clinician and patient. However, use of additive resin composite restorations is a minimally invasive treatment modality. This case illustrates the treatment of tooth surface loss in both the maxillary and mandibular arches with direct composites restorations using putty indices generated from a diagnostic wax-up recorded in centric relation. The tooth surface loss had resulted in reduced restorative space on the right hand side. The restorative treatment involved increasing the anterior vertical dimension, enabling the provision of a cobalt-chrome partial denture. This case shows the restoration of form, function and aesthetics using a reorganised occlusal approach.

The aim of the study was to improve the effectiveness of treatment in ischemic stroke patients using reflexotherapy in complex therapy.

Objectives This study aimed to assess the survival of direct composite restorations placed under general anesthesia in adult patients with intellectual and/or physical disabilities. Materials and methods Survival of composite restorations placed under general anesthesia in adult patients with intellectual and/or physical disabilities was retrospectively analyzed. Failure was defined as the need for replacement of at least one surface of the original restoration or extraction of the tooth. Individual-, tooth-, and restoration-related factors were obtained from dental records. Five-year mean annual failure rate (mAFR) and median survival time were calculated (Kaplan-Meier statistics). The effect of potential risk factors on failure was tested using univariate log-rank tests and multivariate Cox-regression analysis (α = 5%). Results A total of 728 restorations in 101 patients were included in the analysis. The survival after 5 years amounted to 67.7% (5-year mAFR: 7.5%) and median survival time to 7.9 years. Results of the multivariate Cox-regression analysis revealed physical disability (HR: 50.932, p = 0.001) and combined intellectual/physical disability (HR: 3.145, p = 0.016) compared with intellectual disability only, presence of a removable partial denture (HR: 3.013, p < 0.001), and restorations in incisors (HR: 2.281, p = 0.013) or molars (HR: 1.693, p = 0.017) compared with premolars to increase the risk for failure. Conclusion Composite restorations placed under general anesthesia in adult patients with intellectual and/or physical disabilities showed a reasonable longevity as 67.7% survived at least 5 years. Clinical relevance Survival of composite restorations depends on risk factors that need to be considered when planning restorative treatment in patients with intellectual and/or physical disabilities. NCT04407520

An urgent task in modern restorative therapeutic dentistry is to make a decision in each specific clinical case, which is justified not only from the esthetic and medical, but also from the economic, as well as the biomechanical and ergonomic points of view. According to many authors, the key to the successful restorative treatment of hard tissue defects of any genesis is to understand the etiological causes and conditions of their occurrence, as well as to assess the size of the defect and the level of material and technical base of modern dentistry.Long-term results of esthetic restoration of teeth using the direct method with various composite materials indicated the admission of multiple errors and complications, such as inconsistency in the color and transparency of the filling; violation of the marginal adherence; and the appearance of marginal staining along the border of the composite material with the tooth tissues, both during and in various terms after treatment.In contrast to the direct method of restoration, the ceramic inlay is made indirectly. This allows reducing polymerization shrinkage, which in turn improves marginal adherence and reduces the frequency of caries recurrence.

Objectives: Dental caries remains among the most prevalent chronic conditions in childhood and remains highly prevalent among schoolchildren in Indonesia. Globally, atraumatic restorative treatment (ART) has been used to good effect in the management of carious lesions among high-risk cohorts, particularly in challenging environments. However, in settings, where labor, time, facilities, and materials are particularly limited, strategic triaging of teeth suitable for ART restorations may be valuable to better direct public health expenditure. Therefore, this study aims to (i) describe the prevalence of dental caries among Indonesian schoolchildren and (ii) evaluate the proportion of lesions indicated for ART. Materials and Methods: A cross-sectional cohort study of elementary schoolchildren from West Java, Indonesia, was examined and categorized according to Hellman’s dental development stages (Groups 1–4 corresponding to the early mixed dentition through to complete permanent dentition). Descriptive statistics and proportional analysis were conducted with the following variables being evaluated: Teeth with early caries (EC), late/advanced caries (LC), recurrent caries (RC), and total caries experience (TC = EC+ART+LC+RC). In evaluating the suitability for ART, additional variables of ART indicated carious lesions (ART) and lower molars with lesions indicated for ART (LM) were assessed. Results: A total of 437 children ranging from 8 to 14 years of age were examined. Out of 8882 teeth examined, 996 had active carious lesions and only 57 had received satisfactory restorative treatment. Children in Hellman’s Group 1 stage of development had the highest prevalence of EC (62%) and ART indicated caries (32%). Meanwhile, older children in Group 4 experienced the highest portion of advanced caries (15%). The proportion of lower molars indicated for ART was 87%, 76%, 70%, and 67% in Groups 1–4, respectively. Conclusion: Indonesian schoolchildren face a high burden of untreated dental caries from a young age. The younger the developmental stage, the higher the prevalence of early and ART-indicated lesions with the majority being found in lower permanent molars. Although ART and preventive strategies show the highest potential in the early mixed dentition, they alone cannot completely meet the dental needs of populations such as this where the severity and disease burden are extremely high.

BACKGROUND Atraumatic restorative treatment (ART) may be appropriate for populations without accessibility and affordability. More data are required regarding the success rate of ART in anterior teeth. AIM To evaluate the clinical performance of restoring class III cavities in anterior teeth of permanent dentition using the ART approach. METHODS A longitudinal interventional field study was carried out at two rural primary health centers, Tumkur district, India. A total of 54 teeth in 39 patients were evaluated for the survival rate of class III restorations in permanent anterior teeth using the ART approach in children and adult populations. Evaluation of ART restoration was carried out using Frencken J criteria, the mean procedure time, patient acceptance and reported pain severity during the ART approach were evaluated using a visual analog scale. Calculation of the cost of ART was also performed. RESULTS The mean time taken to perform the ART procedure was 14.79 ± 5.8 min with the majority of patients reporting only mild pain. At 6 mo follow-up, 72.2% remained in a good state, but this reduced to 27% at 12 mo. The cumulative survival rate of the restorations was 94.4% at 6 mo and 80.9% at 12 mo follow-up. Estimation of the direct cost for a single class III restoration was 186.50 INR (2.64 USD). CONCLUSION ART may be a good comprehensive option for basic oral health care for underserved or inaccessible populations, and preventive care for patients.

Hearing loss in elderly patients, commonly referred to as age-related hearing loss (ARHL), is an increasingly significant cause of morbidity. ARHL noted to be the second most common illness in the elderly population, and can often be detrimental to the quality of life of patients. Presently, restorative treatment for age-related hearing loss is limited, however, multifactorial rehabilitation and management strategies exist. A pivotal aspect of management in ARHL is the use of amplifying hearing aids and implantable devices. At this time, options for amplification include external and internal hearing aids, middle ear implants, bone-anchored devices, and cochlear implants. Despite the presence of numerous management options, many patients with hearing loss are not using amplifying devices. This chapter discusses the different management options for ARHL including important considerations and operative techniques, with cochlear implants being discussed in a separate chapter.

The eardrum is an elastic partition between the outer and middle ear that participates in the perception and conduction of sound waves and provides protection of the middle ear from external influences. The eardrum disintegration is called perforation. The main causes of tympanic perforations are injuries (after acoustic shock, altitude trauma, foreign body ingress, careless conduct of some medical manipulations) and inflammations occurring after purulent otitis media or, less often, acute catarrhal otitis. Clinically, tympanic perforation is manifested by hearing loss, ear congestion, tinnitus. In case of an injury, blood or liquorrhea (if the skull base is fractured) may be discharged from the ear. In the case of inflammatory perforation accompanied by purulent otitis, otorrhea may occur, and the pain syndrome severity is reduced. In about 70% of cases, the eardrum defect heals by itself; but in some cases, surgery is required with reconstructive repair (tympanoplasty).

Objective: The aim of the present study was to investigate the decision-making by Iraqi dentists concerning the use of restorations in the treatment of dental caries. Methods: A cross-sectional study based on a self-administered questionnaire was conducted among 159 dentists who worked in public health sector in Baghdad during summer of 2016. A questionnaire which obtained information on age, attitude, knowledge and barriers, in addition to two scenarios designed to investigate dentists' restorative treatment threshold, was used. Paper patient cases (PPCs) were indicated high-risk (HR) and low-risk (LR) patients were also provided. Dentists were asked to point out at when they will start restoration of the teeth according to each PPC. Results: After checking for completeness, 90 questionnaires remained for data analysis. For HR scenario: Dentists with medium and high barrier scores (74.2%), and those with low and medium preventive attitude (78.6%) showed the lower scores in restorative treatment threshold. In LR scenario, we found an interaction between age and other predictors. Dentists ≤40 years old made better preventive decisions. Conclusion: The present study showed that age and good preventive attitude play an important role in making the restorative decision by dentists. Continuing education programs must be provided for Iraqi dentists to improve their preventive treatment decisions.

The spinal cord injury (SCI) refers to different degrees of injuries in the structure or function of spinal cord caused by different factors. The prevalence rate of SCI in the population under 40 years reaches 80%. SCI causes certain injury to both physiology and psychology of patients. An important factor leading to SCI is the rupture of nerve fibers. Bone marrow mesenchymal stem cells (BMMSCs) have the functions of inducing and supporting hematopoietic stem cells in bone marrow. In this study, SCI mouse model was established to assess the effect of BM-MSCs on SCI. A total of 30 SCI mouse model were established and assigned into transplantation group (15 mice) and control group (15 mice) according to random number table method. The mice in transplantation group were treated with BM-MSCs transplantation at SCI site, while mice in control group were treated with normal saline at SCI site. The bone marrow pathological changes were measured by HE staining and neural cells were assessed by Pischingert's methylene blue staining along with measuring SRY level by immunohistochemistry. The motor abilities of mice in transplantation group at the 2nd, 4th, 6th and 8th weeks were significantly higher than mice in control group (P < 0 05). A few vacuoles appeared in mice in transplantation group. The number of cells in mouse spinal cord tissues in transplantation group was increased significantly over time, but a large number of vacuoles appeared in mouse spinal cord tissues in control group with necrosis of a vast amount of nerve fibers (P < 0 05). The number and volume of Nissl bodies in mice in transplantation group was increased significantly at 2 weeks after treatment and degeneration status of nerve cells in transplantation group was significantly better than control group (P < 0 05). The SRY genes were expressed in transplantation group for a long term but not in control group (P < 0 05). The number of adherent cells increased significantly in transplantation group at 48 hours after treatment. BMMSCs transplantation can effectively promotes the recovery of SCI mice, indicating that it is worthy of clinical promotion and application.

Objective To determine patient satisfaction with esthetics, phonetics, and function following implant-supported fixed restorative treatment in the esthetic zone by measuring the Oral Health Related Quality of Life (OHRQoL). Materials and methods This systematic review follows the "Preferred reporting items for systematic review and meta-analysis protocols" (PRISMA-P) 2015 statement. Studies were searched in the databases Ovid, PubMed, Web of Science, Scopus, and the Cochrane Library. The quality of the studies included in the review was scored using the GRADE system. The impact of the findings was analyzed by calculating effect size and standardization of results across different OHRQoL measurements was achieved by calculating the percentage equivalent. Results A total of 13 studies were selected to be included in his systematic review after application of the inclusion criteria. A total of six studies recorded pre- and post-treatment OHRQoL results, while the remaining seven studies provided only post-treatment results. Conclusions This review concluded that implant-supported fixed restorations in the esthetic zone have an overall positive impact on OHRQoL. However, patient satisfaction from this treatment reduced as the number of missing teeth replaced by implants was increased. Clinical significance When implant-supported fixed restorations are being planned in the esthetic zone, dentists need to consider the patient's perception and the subsequent impact of these restorations on the patient's quality of life. Clinicians can be assured that patient OHRQoL will increase; however, clinicians should also keep in mind the importance of the gingival frame. Furthermore, they should be aware of the challenges when planning cases with larger numbers of implants in the esthetic zone as this could lead to a lowering of a patient QoL.

The occurrence of external cervical root resorption (ECRR) is rare. Herein, we report a case of extensive ECRR in the coronal third of the distal root of a mandibular right molar with food impaction and periapical radiolucency. The distal root was perforated and damaged due to delayed treatment. The resorptive defect was debrided, and the defect was restored with conventionally setting restorative glass-ionomer cement. Postoperative follow-up revealed complete healing.

Summary. Despite the rapid development of medical technologies, the problem of restoration the functions of the spinal cord remains unsolved. Objective: to improve the quality of life of patients with the consequences of traumatic damage to the spinal cord. Materials and Methods. The study is based on an analysis of the treatment results of 95 patients with the consequences of traumatic damage to the cervical segments of the spinal cord. Depending on the severity of the spinal cord injury, the patients were distributed as follows: group ASIA A – 43 patients, group B – 37 patients, and group C – 15 patients. Reconstructive surgery was performed on patients from 6 months to 2 years after the injury. Among the methods of rehabilitation treatment, chronic epidural electrical stimulation of the spinal cord (as the first stage of rehabilitation treatment) was used in all patients, neurotization of the anterior interosseous nerve (anterior interosseous nerve AIN) by the branch of the muscular cutaneous nerve – in 38 patients, transposition of the tendon of the deltoid muscle to the tendon of the triceps of the shoulder – in 8 patients. Results. The ASIA impairment scale, SCIM (Spinal cord independence measure scale) and MRC (Medical Research Council scale) were used to evaluate treatment outcomes. The results were evaluated 18 months after reconstructive surgery. In the ASIA A group, the quality of life improved in 74.4% of patients, due to an improvement of the upper extremity function. In the ASIA B group, an improvement in the quality of life was noted in 83.7% of patients, both due to improved self-care and mobility, and due to improved control of the function of the pelvic organs. In the ASIA C group, improved quality of life was mainly due to improved mobility. Conclusions. Complex restorative treatment of patients with incomplete cervical spinal cord injury allowed to improve the quality of life due to correction of segmentary and conductive violations of the spinal cord. In patients with complete spinal cord injury, only segmentary violations are suitable for correction.

Currently, the treatment of lumbosacral radiculopathy (LSR) is an urgent problem due to the frequent chronic pain syndrome, the lack of a unified methodological approach to the recommendations, taking into account the pathological characteristics of the compressed root. The purpose of the work is the development of the concept of a comprehensive etiopathogenetic treatment of acute lumbosacral radiculopathy. 100 patients, divided into two groups were examined (the main – 45 people, the control – 55 people). Each group was divided into subgroups depending on the treatment received (basic and complex). Basic therapy included treatment according to European and American recommendations. Complex treatment consisted of a combination of basic therapy and vibrotraction postisometric muscle relaxation (PIMR) with biomechanical stimulation of the paravertebral muscles. Treatment control was based on the analysis of the neurological and neuroorthopaedic status, severity of a pain syndrome using a 5-point verbal scale, PainDETECT questionnaire, the muscle syndrome index, as well as quantative sensory testing. The stages of the study were chosen taking into account the pathological stages of the disease: 1-7 days and 30 days. When analyzing the results of ELISA to IgG for urogenital infections in 46.7% of patients of the main group and 47.3% of the control, urogenital chronic infections were detected, while in the main group mycoplasmic and ureaplasmic infections were more common, and in the control group patients mostly had chlamydial infection. When antibacterial drugs were included in the treatment, the most pronounced regression of the pain syndrome was determined. Thus, it was found that the use of vibrotractional postisometric relaxation with biomechanical stimulation of the paravertebral muscles in combination with the use of NSAIDs is aimed at quickly removing the muscular-tonic and compression symtoms during 10-14 days (p

Objectives: To assess restorative treatment decisions on approximal caries by dental practitioners in College of Dentistry at Ajman University regarding treatment threshold, restorative techniques and restorative materials, and to evaluate the characteristics of dentists relative to their treatment decisions. Materials and Methods: Questionnaires were completed by a population of 180 dentists working in the university’s clinics. The questionnaire assessed responses to the treatment threshold for a hypothetical approximal carious lesion, the most preferred types of cavity preparation and restorative materials. Results: Out of the 180 participants, 57.9% were females, and 42.2% were males. Eighty-three percent were 35 years old or less, 12.2% were between 36 and 50 years, and 4.4% were 50 years or older. Most participants were UAE graduates (84.4%). Majority of the participants would delay surgical intervention of the approximal carious lesion until it reaches the dentine-enamel junction (41%), and 27% would wait further until it reaches into the outer dentine, while only 21% would intervene when the lesion is limited to enamel. The majority of the participants preferred simple box preparation (72.8%), and most of them chose composite as the restorative material (85%). Conclusion: There is some variation among restorative treatment decisions of approximal caries by Ajman University’s dentists, but the majority tend to delay restorative intervention until caries reaches dentine, they prefer minimally invasive restorative techniques, and prefer composite as a restorative material.

Objectives: This study compared the longevity of high strength posterior glass ionomer and metal-reinforced glass ionomer using ART in rural settings within an 18-month observation period. Study Design: A nonblinded parallel design randomized controlled trial was conducted among children who attended dental outreach programs in a rural area of Southern India. Atraumatic Restorative Treatment (ART) was performed in 92 permanent posterior teeth with either high strength posterior glass ionomer or metal-reinforced glass ionomer restorations. The allocation ratio was 1:1. Restorations were evaluated at 1, 6, 12 and 18 months after placement. Results: The success rate of metal-reinforced glass ionomer restorations was 100%, 95.4%, 90.4% and 87.2% as compared to high strength posterior glass ionomer whose success rates were 100%, 93%, 85% and 61.8% at the four follow ups respectively. There was a statistically significant difference between the success rate of the two materials at the end of 18 months with the metal-reinforced glass ionomer restorations having a higher success rate (p=0.015). Conclusions : Although the clinical performance of both materials were largely similar, the metal-reinforced glass ionomer restorations had a higher success rate than the conventional GIC at the end of 18 months of follow-up.

Objectives: This study aimed to assess oral health status and self-perceived oral health in hemodialysis (HD) patients. Materials and Methods: Thedecayed, missing and filled teeth (DMFT) index and the community periodontal (CPI) index were used to assess oral health status and self-perceived oral health in 128 HD patients.Salivary flow (SF) and pH were also measured. Results: Mean age was 56.2±17.1 years and mean DMFT was 23±9.14. There were 41 (32%) edentulous participants and 81 (94.3%) non-edentulous participants presented periodontal alterations. SF was normal (≥1.0ml/min) in five (3.9%) participants before HD and in 17 (13.3%) participants after HD. SF was very low (≤ 0.3ml/min) in 60 (46.9%) participants before HD and in 26 (20.3%) participants after HD. The difference in SF before (0.39±0.28ml/min) and after (0.60±0.34ml/min) HD was significant (p

For some patients, pre-prosthetic orthodontic intervention is necessary to optimize both esthetic and functional aspects of dental treatment. This review will focus on the following topics: orthodontics treatment with multiple missing teeth, correction of anterior deep vertical overlap, anterior worn dentition, up-righting of tilted teeth, and orthodontic crown lengthening. This review will aid restorative dentists in identifying which patients could benefit from orthodontic intervention, and in understanding how orthodontic treatment can be utilized to improve patient prognosis in restorative treatment. Keywords: Orthodontics, Interdisciplinary, Crown-lengthening, Worn-teeth, Tilted-molar

Statement of problem Patients with cleft lip and palate generally present with lateral incisor agenesis, which may be treated with an implant-supported prosthesis. However, whether implants can stabilize the dental arches in patients with cleft lip and palate is unclear. Purpose The purpose of this retrospective clinical study was to analyze the stability of the maxillary dental arch after orthodontic treatment and oral rehabilitation in the cleft area with an implant-supported prosthesis or a fixed partial denture. Material and methods Fifty-five participants, 20 with unilateral cleft lip and palate rehabilitated with implants (CLPI), 15 with unilateral cleft lip and palate rehabilitated with fixed partial dentures (CLPFP), and 20 in the noncleft group (NCLP) and their gypsum casts (N=110) were digitized and evaluated through 3D stereophotogrammetry. Measurements were made on casts obtained immediately after the orthodontic treatment (T1); for the cleft lip and palate group, casts were made 1 year after implant-supported restoration placement (T2), and for the noncleft group, 1 year after the conclusion of the orthodontic treatment (T2). The dimensions of the dental arches were measured digitally. Formula Δ=T2-T1 evaluated the stability of dental arches for intercanine distances, intermolar distances, arch length, palate surface, and volume (3D). Stability (Δ) was compared through 1-way ANOVA in all groups (α=.05). Results A statistically significant difference was found in the stability of the CLPI and CLPFP groups for intercanine measurement (P=.002). For the intermolar measurement, a statistically significant difference was detected between the CLPFP and NCLP groups (P=.002). From the 3D measurements, the stability was similar in all groups. Conclusions In patients with clefts, a fixed partial denture may provide better stability of the orthodontic outcomes than an implant-supported prosthesis. However, greater instability occurred at the molar area.

Relevance. Unsatisfactory effectiveness of treatment of chronic periimplantitis, which makes 40-60%, is associated with a persistence of a bacterial film on the implant surface, as well as with inconsistency of stages of anti-inflammatory, restorative and supportive treatment. Purpose. To discuss an improved approach to restorative treatment of chronic periimplantitis using modified reconstructive technique. Materials and methods. The technique was substantiated using axiomatic method of theoretical analysis. The modified reconstructive technique is based on application of split-thickness submucosal-periosteal flap with blood supply base, which has sufficient reparative-regenerativepotentialand stability in conditions of inflammatory macro-and microenvironment. We have carried out treatment of chronic periimplantitis in two patients using the modified reconstructive technique at the recovery stage. Results. Preliminary assessment of the obtained results of use the modified reconstructive technique showed normal postoperative course and favorable outcome: low surgical stress response under conditions of primary chronic inflammation in the area of the implanted structure; low level of biological response of the submucosal-periosteal autograft with blood supply base as opposed to free grafts and osteoplastic materials; good condition of sutures in the early and medium postoperative period. Conclusion . Application of the modified reconstructive technique can enhance the success of rehabilitation treatment inpatients in chronic periimplantitis.

Introduction Long bone refractures can be a common injury among pediatric population. Approaches to rehabilitation of children with refractures are similar to those used for primary injuries. However, refracture healing and bone repair involve specific pathways that should be considered in rehabilitative approaches to restorative treatment. Objective To identify morphological specific features of simulated reparative processes in long bone refractures of growing animals (rats) at different stages of observation. Material and methods Two series of experiments were carried out on 36 laboratory animals (rats) to explore histological picture at the healing site of primary and repeat fractures at different stages of reparative process. Transverse fracture of the tibial shaft was simulated and fixed with external fixation device in the first series (n = 18). Tibial shaft was refractured and fixed again with external fixation device after 21 days of primary injury in the second series (n = 18). Results Delayed osteogenesis and greater period of organotypical regenerate restructuring were observed in animals with long bone refractures. Mechanism of slower osteogenesis was found to be associated with disturbed blood supply affecting cell differentiation at the refracture site. Conclusion Delayed bone repair and longer period of organotypical regenerate restructuring were specifically detected in growing animals with long bone refractures.

Restoration of an unaesthetic smile can be accomplished by various treatment approaches, indirect and direct. However, use of direct treatment modalities such as laminate veneers ensures minimal loss of tooth tissue, along with, pleasing final result which increases the acceptability of the treatment by the patient. Ceramics have been proved superior to composites for laminates, owing to increased strength, abrasion resistance and color stability. In this case report, anterior maxillary discolored dentition is restored by using ceramic laminate veneers. Keywords: Laminate veneers, Ceramic veneers, Minimal tooth preparation, Direct esthetic restorative treatment.

An ideal aesthetic standard consists of facial and smile harmony. Discolored teeth generally cause an imbalance in facial aesthetics, leading to low self-esteem and disturbance in social relationships. Causes of teeth discoloration are classified as intrinsic or extrinsic. Bleaching is considered a safe and effective treatment for discolored nonvital teeth and can be associated with restorative treatment to properly correct the dental color and maximize the aesthetic results. This paper aims to present two case reports of single discolored nonvital anterior teeth and the protocol used to reestablish the dental harmony of these patients by bleaching and direct composite resin restoration. To exert minimally invasive dentistry is very important to preserve tooth structure and reduce the risk of fracture. Internal bleaching, although may not be sufficient to reestablish the aesthetic in some cases, it is important to minimize dental preparation to perform an indirect or direct restoration. Dentists must take into account the patients expectations, dominate the restorative technique and know the dental materials to properly be able to restore function and aesthetics and consequently improve life quality and social relationships. RESUMO Um padrão estético ideal consiste na harmonia facial e do sorriso. Dentes descoloridos geralmente causam um desequilíbrio na estética facial, levando a baixa auto-estima e interferência nas relações sociais. As causas da descoloração dos dentes são classificadas como intrínsecas ou extrínsecas. O clareamento é considerado um tratamento seguro e eficaz para os dentes não vitais escurecidos e pode ser associado ao tratamento restaurador para corrigir adequadamente a cor dental e maximizar os resultados estéticos. O objetivo deste trabalho é apresentar dois relatos de casos de dentes anteriores não vitais escurecidos e o protocolo utilizado para restabelecer a harmonia dentária desses pacientes por meio de clareamento e restauração direta em resina composta. Para exercer uma Odontologia minimamente invasiva é muito importante preservar a estrutura dentária e reduzir o risco de fratura. O clareamento interno, embora possa não ser suficiente para restabelecer a estética em alguns casos, é importante para minimizar o preparo dental para realizar uma restauração indireta ou direta. Os dentistas devem levar em consideração as expectativas dos pacientes, dominar a técnica restauradora e conhecer os materiais dentários para poder restaurar adequadamente a função e a estética e, consequentemente, melhorar a qualidade de vida e as relações sociais.

The article discusses topical issues of treatment and rehabilitation strategies in patients with ischemic heart disease (IHD). The results of our own research on assessing the effectiveness of complex rehabilitation of patients with myocardial changes with the study of indicators of lipid metabolism, platelet aggregation, functional state of patients with coronary artery disease, after stenting of the coronary arteries have been stated in the article.

This case report presents the use of prefabricated composite veneers for restorative treatment of amelogenesis imperfecta (AI). This technique bridges the gap between a conventional direct technique and a conventional indirect technique and introduces an alternative semidirect restorative technique for AI patients. The aim of this case report is to describe restoration of a young girl with severe AI using prefabricated composite veneers and to discuss the benefits and limitations of this technique compared to the alternative restorative techniques.

Aim: To investigate restorative decisions made by dentists and to examine what demographic characteristics are associated with the decisions for managing approximal and occlusal lesions. Methods: A questionnaire was randomly sent to 900 Palestinian dentists. It noted the demographic details of the dentists and the years of experience. The questionnaire evaluated the respondents for their treatment decisions regarding approximal and occlusal carious lesions. The data was analyzed using the IBM SPSS statistics for windows. The associations between gender and years of experience of the respondents and their restorative decisions were assessed. Results: The response rate was 58.2%. For occlusal carious lesions, 93.9% of the respondents would postpone operative treatment until the lesion was in dentine (grade 3 to 5). For approximal lesions, intervention was deemed appropriate by 92.6% of the respondents when there was radiographic evidence of a carious lesion reaching the DEJ or deeper. Around 53% preferred to prepare approximal lesions according to the traditional principles of cavity preparation. For both approximal and occlusal lesions, the participants opted for resin composites. Statistically, there was a significant association between the restorative decisions with the years since graduation and gender. Conclusion: The study showed variations between the treatment decisions of Palestinian dentists. The subjects chose conservative treatment plans but still adhered to traditional learned practices especially when cavity preparation for approximal lesions was concerned. The years since graduation and gender played a significant role in the choice of treatment opted for. Resin composites seemed to be a popular choice for treatment.

Non-surgical periodontal therapy (NSPT) underpins all other restorative treatment which takes place in the mouth. Therefore a thorough understanding of the process of delivery of effective NSPT and long-term maintenance of periodontal health is essential for every dental practitioner. This article covers the steps involved and discusses the benefits and challenges which may be encountered. CPD/Clinical Relevance: This article highlights the benefits and challenges of non-surgical management of periodontal disease and the key role that the patient plays in achieving and maintaining periodontal health.

SUMMARYDetection and management of posterior approximal caries lesions are still problematic. Inspection of approximal surfaces is challenging, and bitewing radiographs are used when direct vision is not possible. Unfortunately, there is no definite radiographic appearance to identify lesion cavitation with absolute certainty. Many lesions detected radiographically within the outer half of dentin are not cavitated, often resulting in unnecessary restorative treatment. Our study compared radiographic depth of approximal caries lesions with presence of cavitation in adults using visual inspection following temporary tooth separation (TTS). We conducted this observational descriptive cross-sectional study at two dental schools in two cities in Chile. Clinicians were unaware of radiographic depths of lesions and examined 147 participants (57.3% female and 42.7% male) following TTS. Using the common classification system that consists of E0 (no lesion), E1 (lesion within the outer half of enamel), E2 (lesion within the inner half of enamel), D1 (lesion within the outer third of dentin), D2 (lesion within the middle third of dentin), and D3 (lesion within the inner third of dentin), a trained dentist evaluated all the processed films. Cavitation was detected in only three sites (0.22%) within the E0 category, seven sites (3.41%) in E1, five sites (14.8%) in E2, four sites (14.8%) in D1, six sites (50%) in D2, and eight sites (61.5%) in D3. Considering that restorative treatment should be indicated strictly for cavitated lesions, our findings support indication for restorative treatment for D3 lesions and the rationale for TTS for D1-D2 caries lesions to allow direct visual inspection to determine whether there is surface cavitation.

Parents/carers’ and dentists’ evaluations are important when assessing young children’s pain. However, there is little evidence on agreement regarding children’s pain according to proxy reports. The aims of this cross-sectional study were to investigate the agreement among paediatric dentists and parents/carers about children’s pain during treatment and the association between the reporting of pain and child behaviour. Participants were 81 parents/carers of uncooperative children undergoing restorative treatment, and five paediatric dentists. Pain during dental treatment was assessed after dental procedures using the Visual Analogue Scale (0–4 mm: no pain; 5–44 mm: mild pain; 45–74 mm: moderate pain; 75–100 mm: severe pain). Child behaviour was assessed by calibrated researchers using the Ohio State University Behavioural Scale. The agreement between respondents about a child’s pain was evaluated using the weighted kappa test. The association between the pain report and child behaviour was verified using the Kruskal–Wallis and Mann–Whitney tests. Parents/carers (36, 44.4%) and paediatric dentists (40, 49.4%) reported that children felt mild pain in all sessions. The parents/carers reported that the children experienced higher pain intensities compared to paediatric dentists. The agreement between respondents was slight (weighted Kappa

Objectives The purpose of this article was to review the fluoride release and uptake ability of some restorative materials which are used for minimally invasive procedures. Methods The literature search on published researches and review articles were carried out by using PubMed, Trip and Cochrane library databases. The search terms used were fluoride, restorative materials, atraumatic restorative treatment or ART, glass ionomer or GIC, resin modified glass ionomer cement or RMGIC. The articles included were between 2000 and 2015. Conclusion Fluoride release varies with m factors including the type of restorative materials used and also the media in which it is stored. Fluoride uptake is dependent on the type of the cement and the availability of fluoride including fluoride releasing capacity in the material.

As restorative treatment needs of patients become more challenging, how can funding appropriately support the quality of care?

Purpose To evaluate the challenges of the direct filling technique, the use of dental chairside CAD/CAM milling, the use of 3D printing, and the attitudes toward 3D printing-based applications for restorative treatments among Finnish dentists. Materials and methods An electronic questionnaire was sent to 3,777 Finnish dentists. Background information, challenges linked to the direct filling technique, use of dental chairside CAD/CAM milling, use of 3D printing, and attitudes toward 3D printing-based applications in restorative dentistry were asked in the questionnaire with multiple-choice questions. The number of replies was 760, and the response rate was 20.1%. Results Poor survival rates and moisture sensitivity were the main reported challenges associated with the direct filling technique. Use of chairside CAD/CAM milling was reported by 271 (35.7%) respondents. Use of 3D printing technique was reported by 54 (7.1%) respondents. Most respondents answered that they would consider using 3D printing for manufacturing tooth fillings in the future. Conclusion If dental chairside CAD/CAM technology can provide a solution for manufacturing long-lasting indirect restorations with good esthetic properties and an effective cost-benefit ratio, the wider use of chairside CAD/CAM systems might be indicated, especially in the public sector. New 3D printing-based applications used for restorative treatments are attracting interest among Finnish dentists, but also indicate a need for further development of 3D printing techniques for cost-effective restorative treatment.

Aim of the work. To evaluate the course of acute coronary syndrome in patients depending on the applied method of treatment and the formation of the components of the internal picture of health in the process of treatment and rehabilitation. Material and methods. The object of the study was 141 patients with ACS with ST elevation. The patients were divided into groups depending on the performed treatment: 63 patients who received conservative treatment tactics and 78 patients who had PCI. The course of ACS was analyzed, depending on the treatment tactics, on clinical-anamnestic and objective data, using psychometric techniques. Results. Estimation of the formation of components of the internal picture of health was performed on the basis of the ACS course analysis. There were low levels for all components, the lowest was the level according to the behavioral and value-motivational components. In patients with PCI, these levels were somewhat higher according to some indices. The importance of the application of evaluation and correction of the IPH components in patients after ACS was determined. Conclusions. In order to increase the effectiveness of restorative treatment of patients after ACS, it is necessary to evaluate the formation of components of IPH with optimization by participating in the “Program of clinical-psychological rehabilitation of patients by optimization of IPH”, which would allow us to influence the positive changes in the course of the disease.

Background. Myofascial pain syndromes are the most frequent companions of acute and chronic lumbar pain, and the problem of eliminating pain syndrome should be considered in terms of developing an effective program for diagnosis, treatment, physical rehabilitation and its accessibility for all categories of the population. Аim. To evaluate the effectiveness of complex application of osteopathy and shock wave therapy in the rehabilitation treatment of patients with MPS. Materials and methods. 120 patients with myofascial pain syndrome (MPS), mean age 49.65±0.89 years, mean disease duration 2.29±0.18 years were examined. Results. With the combination of standard therapy, osteopathic treatments and extracorporeal shock wave therapy (ESWT), the severity of pain on the scale of visual analogue scale (VAS) after 12 months of observation decreased by an average of 77.1%, in the group of standard therapy in combination with ostepathic treatment, 62.2%, in group of standard therapy and ESWT by 52.8% and in the group of standard therapy by 30.9%. According to the 12-month prospective follow-up, the maximum positive effect on the severity of MPS and emotional disorders was noted in the combination of standard therapy, osteopathic treatments and ESWT. Conclusion. The combination of these methods of treatment can be considered as a method of choice in complex programs of rehabilitation treatment of patients with MPS.