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Item does not contain fulltext AIM: To investigate the prevalence of non-carious cervical lesions (NCCLs) and their association with individual and tooth-related factors in adults from the 1982 Pelotas Birth Cohort. MATERIALS AND METHODS: Participants were interviewed and clinically examined at the age of 31. NCCL was defined as loss of dental tissue without bacterial involvement in the cervical region. Independent variables were the socioeconomic, demographic, behavioural, and clinical characteristics. Associations were tested using a multilevel Poisson regression model. RESULTS: Five-hundred and thirty-nine participants were clinically examined, with a 26% prevalence of NCCLs, which were more prevalent in the maxilla (56.5%) and in premolars (72.9%). In the multilevel analysis, women presented lower prevalence than men [prevalence ratio (PR) 0.59 (0.48-0.73)]; those who reported smoking at both 22 and 30 years of age had more NCCLs than those who never smoked [PR 1.65 (1.31-2.07)]; and high-frequency brushers presented higher prevalence than low-frequency brushers [PR 1.26 (1.03-1.55)]. Gingival recession increased 10 times the prevalence of NCCLs [PR 10.03 (8.15-12.35)], while the presence of periodontal pockets (≥4 mm) reduced the prevalence of NCCLs [PR 0.43 (0.28-0.66)]. CONCLUSIONS: NCCLs were more prevalent in males, smokers, and those with higher frequency of toothbrushing. While the presence of periodontal pockets was associated with a lower prevalence of NCCLs, gingival recession was a strong clinical indicator for the presence of NCCLs.

Made available in DSpace on 2022-04-28T17:30:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-12-28 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Introduction: Gingival recession (GR) is a relevant clinical condition due to its high prevalence worldwide, which leads to aesthetic demands and dentin hypersensitivity. Collagen matrices have been associated with different designs of coronally advanced flaps (CAFs) to treat GR defects. However, the literature lacks long-term follow-up of this treatment option. The aim of this study is to present the long-term follow-up (up to 7 years) of two GR defects (associated or not with noncarious cervical lesion) treated with a CAF and a collagen matrix (CM). Case presentation Case 1 underwent a CAF associated with a CM to treat a single GR defect. After 7 years, Case 1 presented with 3 mm of recession reduction, which corresponds with the 85.7% of root coverage. Case 2 presented two GR defects associated with noncarious cervical lesions (NCCLs). The NCCLs were partially restored with resin composite and then underwent a modified CAF for multiple defects and a CM. After 5 years of follow-up, Case 2 presented with 1.5 and 2.5 mm of recession reduction, which corresponds with the average 83.3% defect coverage. Conclusion These two cases may show that CMs can provide long-term stable outcomes in the treatment of GR defects. Fed Univ Pernambuco UFPE, Dept Prosthesis & Surg Orofacial, Recife, PE, Brazil Sao Paulo State Univ, Inst Sci & Technol, Div Periodont, UNESP, Av Engn Francisco Jose Longo 777, BR-12245000 Sao Jose Dos Campos, SP, Brazil Private Educ Inst, Sao Paulo, Brazil Sao Paulo State Univ, Inst Sci & Technol, Div Periodont, UNESP, Av Engn Francisco Jose Longo 777, BR-12245000 Sao Jose Dos Campos, SP, Brazil CAPES: 001 CNPq: 304269/2019-0

Gingival recession accounts for apical migration of the gingival margin, resulting in exposure of the cementoenamel junction and root surface, with exposure of the root surface linked to deteriorated esthetic appearance and increased dentinal hypersensitivity. Various surgical techniques have been used to correct labial gingival recession defects. The present study evaluated and compared the results of semilunar coronally positioned flap (SCPF) alone and in conjunction with free gingival graft (FGG) for the treatment of Miller Class I and II gingival recession defects in maxillary anterior teeth. A total of 20 bilateral Miller Class I and II gingival recession sites were included and randomly allocated (n = 10 sites/group) to either the semilunar coronally positioned flap technique alone (SCPF group; control) or with FGG (SCPF+FGG group; test). Longitudinal alterations in probing depth (PD), recession width (RW), recession height (RH), width of keratinized tissue (WKT), and clinical attachment level (CAL) were measured and analyzed for both groups at 1-, 3-, 6-, and 12-month follow-ups. Both groups saw a significant decrease in RH, RW, and CAL and a significant increase in WKT. No statistically significant difference was observed in the final root coverage outcome between both groups in terms of RH, RW, and CAL, but a significant increase in WKT was seen with SCPF+FGG. Both techniques demonstrated optimal results without significant differences in the final root coverage outcomes except for WKT, which had a statistically significant increase in the SCPF+FGG group.

Impacted mandibular third molars (M3M) are associated with the occurrence of distal caries on the adjacent mandibular second molars (DCM2M). In this study, we aimed to develop and validate five machine learning (ML) models designed to predict the occurrence of DCM2Ms due to the proximity with M3Ms and determine the relative importance of predictive variables for DCM2Ms that are important for clinical decision making. A total of 2642 mandibular second molars adjacent to M3Ms were analyzed and DCM2Ms were identified in 322 cases (12.2%). The models were trained using logistic regression, random forest, support vector machine, artificial neural network, and extreme gradient boosting ML methods and were subsequently validated using testing datasets. The performance of the ML models was significantly superior to that of single predictors. The area under the receiver operating characteristic curve of the machine learning models ranged from 0.88 to 0.89. Six features (sex, age, contact point at the cementoenamel junction, angulation of M3Ms, Winter's classification, and Pell and Gregory classification) were identified as relevant predictors. These prediction models could be used to detect patients at a high risk of developing DCM2M and ultimately contribute to caries prevention and treatment decision-making for impacted M3Ms.

External cervical resorption (ECR) refers to a pathological state in which resorption tissues penetrate into the dentin at the cervical aspect of the root. Despite being latent in its initial phase, ECR could cause severe damage to mineralized dental tissue and even involve the pulp if not given timely diagnosis and treatment. Nevertheless, the etiology of ECR is still poorly understood, which adds to the difficulty in early diagnosis. ECR has received growing attention in recent years due to the increasing number of clinical cases. Several potential predisposing factors have been recognized in cross-sectional studies as well as case reports. In the meantime, studies on histopathology and pathogenesis have shed light on possible mechanisms of ECR. This review aims to summarize the latest findings in the pathogenesis and potential predisposing factors of ECR, so as to provide pragmatic reference for clinical practice.

The aim of this study was to investigate the impact of the incision type, with or without a coronally repositioning flap (CRF), on soft tissue healing and crestal bone remodeling after endodontic microsurgery (EMS).Clinical pictures and cone-beam computed tomography images from 47 patients (120 teeth) taken before surgery and at the follow-up appointment were included in this study. Clinical pictures were qualitatively evaluated by 2 endodontists for the gingival marginal level (GML) (recession, same position, or coronal root coverage), papillary height (same position/receded), and for presence/absence of scars for each tooth. Cone-beam computed tomography images were used to calculate the changes in the distance between the cementoenamel junction and the crestal bone level (CBL) between the preoperative and follow-up scans. Statistical analyses were performed to determine a correlation between patient-related factors (age, sex, tooth type, position, and presence/absence of a crown), incision techniques, and changes within the CBL.Gingival recession was more prevalent in mandibular teeth, molar teeth, and teeth that received intrasulcular or papilla-based incisions (P .05). Scar formation was affected by the flap design (P .05). CRF was the only technique resulting in coronal root coverage (P .05). There were no changes observed in the papillary height between the various flap designs. There was also no statistically significant difference in the crestal bone height between the preoperative and follow-up scan measurements (P .05).Soft tissue changes are evident after EMS and can be affected by the flap design selected, as well as the site being treated. Application of CRF can improve the position of GML after EMS. There are insignificant changes within the CBL at the facial aspect of the root after EMS.

The purpose of this in‐vivo study was to evaluate the clinical performance of restorations placed in non‐carious cervical lesions (NCCLs), using different cavity preparation designs, after 7.7 years. A total of 85 NCCLs with coronal margins in enamel and cervical margins in dentin were randomly assigned to the following treatment protocols: dentin surface cleaning, dentin surface roughening with round bur plus flowable composite, dentin surface roughening/cervical groove preparation with round bur, dentin surface roughening/cervical groove preparation with round bur plus flowable composite. After enamel beveling and selective enamel etching, the defects were restored with composite. The restorations were assessed by two independent, calibrated and blinded investigators, using modified USPHS criteria. At 7 years (7.7 (± 0.35)), a total of 64 restorations (75.3%) were available for follow‐up examination. The total retention rate, irrespective of the test groups, was 82.8%. Restorations placed without any preparation showed the highest loss rate (27.8%). Esthetic appearance, marginal adaptation, anatomic form and marginal discoloration did not differ significantly between the groups. Composites are long‐term stable materials for restoring NCCLs. Restorations placed without any dentin preparation (cavity cleaning only) showed the highest loss rate.

Clinical Relevance Non-carious cervical lesion restorations using a dual-cure universal adhesive in self-etch and etch-and-rinse mode showed satisfactory clinical performance after 18 months. SUMMARY Objectives: The objective of this multicenter, double-blind, split-mouth randomized clinical trial was to evaluate the clinical performance of a new dual-cure universal adhesive system (Futurabond U, Voco GmBH) when applied using different strategies over a period of 18 months. Methods and Materials: Fifty patients participated in this study. Two hundred non-carious cervical lesions were restored using the adhesive Futurabond U according to four adhesive strategies (n=50 per group): only self-etch (SEE), selective enamel etching + self-etch (SET), etch-and-rinse with dry dentin (ERDry), and etch-and-rinse with wet dentin (ERWet). After the adhesive application, cavities were restored using Admira Fusion composite resin. These restorations were evaluated according to FDI World Dental Federation criteria for the following characteristics: retention/fracture, marginal adaptation, marginal staining, postoperative sensitivity, and caries recurrence. Results: After 18 months, only four patients (12 months: one patient, n=4 restorations; and 18 months: three patients, n=12 restorations) were not evaluated. Fourteen restorations were lost after 18 months of clinical evaluation (four for SEE, three for SET, three for ERDry, and four for ERWet). The retention rates for 18 months (95% confidence interval) were 92% (81%–97%) for SEE, 94% (83%–97%) for SET, 94% (83%–97%) for ERDry, and 92% (81%–97%) for ERWet (p>0.05). Thirty-eight restorations were considered to have minor discrepancies in marginal adaptation at the 18-month recall (13 for SEE, 13 for SET, six for ERDry, and six for ERWet; p>0.05). Fourteen restorations were detected as a minor marginal discoloration at the 18-month recall (six for SEE, six for SET, one for ERDry, and one for ERWet; p>0.05). However, all were considered clinically acceptable. No restorations showed postoperative sensitivity or caries recurrence at the time. Conclusion: The clinical performance of the Futurabond U did not depend on the bonding strategy used, and it was considered reliable after 18 months of clinical evaluation, although more marginal discrepancy was observed in the self-etch group.

Objectives To compare the clinical performance of a universal adhesive in class V non-carious cervical lesions (NCCLs) using two surface treatment protocols (self-etch [SfE] vs selective-enamel-etch [SelE]). Material and methods Thirty-three adults, each with ≥2 NCCLs, received one resin composite restoration utilizing a SfE universal adhesive and another utilizing the adhesive and SelE with 37% phosphoric acid. Restorations were evaluated for sensitivity, retention, marginal discoloration, marginal adaptation, and clinical acceptability through 24 months using Cochran-Mantel-Haenszel tests for stratified, ordered categorical outcomes. Results Sixty-six restorations (35 SfE, 31 SelE; 27 volunteers) were evaluated at 24 months. There were no significant differences between SfE and SelE for sensitivity, retention, marginal adaptation, or clinical acceptability. One SfE restoration was lost. Marginal adaptation was significantly worse at 24 months than baseline for SelE (P = 0.01), but not for SfE. Marginal discoloration was significantly worse for SfE (P = 0.02), but not for SelE. Sensitivity improved from baseline to 24 months for both groups (SelE P = 0.004, SfE P = 0.002). Conclusions Twenty-four-month data indicated significantly reduced sensitivity for both groups, worse marginal discoloration for SfE, and worse marginal adaptation for SelE. No changes in retention or clinical acceptability were observed in either group. All retained restorations were clinically acceptable at 24 months. Clinical significance Both self-etch and selective enamel etch techniques with a universal adhesive produced clinically acceptable results in resin composite restorations for NCCLs over 2 years.

The aim of this present prospective study was to evaluate the outcomes of the multiple coronally advanced flap (MCAF) with a site-specific application of connective tissue graft (CTG) for the treatment of multiple gingival recession defects with or without the presence of noncarious cervical lesions (NCCLs). Analysis of periodontal conditions was performed in order to determine if the cementoenamel junction (CEJ) restorations could affect adequate plaque control as well as maintenance over time. A total of 93 gingival recessions were treated, 61% of which presented a NCCL restored with composite resin positioned 1 mm apical to the position of the anatomical CEJ. The surgical treatment involved MCAF+CTG for 54 sites and MCAF alone for 39 sites. At 12 months, complete root coverage (CRC) and periodontal parameters of restored and nonrestored teeth were assessed, and the differences between the two groups were not significant. It can be concluded that the proposed treatment modality does not produce a negative effect on periodontal condition and amount of CRC, thus resulting in a satisfactory esthetic result.

SUMMARY Purpose: The purpose was to perform a systematic review and meta-analysis based on the following research question: do tooth- and cavity-related aspects of noncarious cervical lesions (NCCLs) affect the retention of composite restorations? Methods: Randomized clinical trials (RCTs) that evaluated the retention rate of resin restorations in NCCLs were included for the identification and comparison of their characteristics. The search was conducted in PubMed and adapted for Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), Cochrane Library, and System for Information on Grey Literature in Europe (SIGLE) without restrictions until July 2018. Unpublished and ongoing trial registries were also searched. The Cochrane Collaboration tool was used for assessing risk of bias. The quality of the evidence was graded using the Grading of Recommendations: Assessment, Development and Evaluation. Using the random effects model, a meta-analysis was conducted for each aspect (arch distribution, tooth location, wear facets, dentin sclerosis, shape, size, depth, occluso-gingival distance, and margin location). Results: We retrieved 6738 articles. After removal of duplicates and nonrelevant articles, 24 RCTs remained. The anterior tooth location favored the retention rates of restoration of NCCLs (relative risk [RR], 1.08; 95% confidence interval [CI], 1.00-1.16). The presence of wear facets is a risk factor for the retention of restorations (RR, 0.91; 95% CI, 0.83-0.99). The evidence was moderate for arch distribution and low or very low for all other factors because of heterogeneity, imprecision, and inconsistency. Conclusion: The tooth location and the presence of wear facets can affect the retention of composite resins in NCCLs.

Clinical Relevance Using the deep margin elevation technique in preparations extending beyond the cemento-enamel junction appears to be beneficial in maintaining structural integrity of CAD/CAM-fabricated feldspathic ceramic inlays. SUMMARY Objective: To evaluate the effect of deep margin elevation on structural and marginal integrity of ceramic inlays. Methods and Materials: Forty extracted human third molars were collected and randomly separated into four groups (n=10/group). In group 1 (enamel margin group), the gingival margin was placed 1 mm supragingival to the cemento-enamel junction (CEJ). In group 2 (cementum margin group), the gingival margin was placed 2 mm below the CEJ. In group 3 (glass ionomer [GI] margin group), the gingival margin was placed 2 mm below the CEJ, and then the margin elevated with GI to the CEJ. In group 4 (resin-modified glass ionomer [RMGI] margin group), the gingival margin was placed 2 mm below the CEJ, and then the margin elevated with RMGI to the CEJ. Standardized ceramic class II inlays were fabricated with computer-aided design/computer-aided manufacturing and bonded to all teeth, and ceramic proximal box heights were measured. All teeth were subjected to 10,000 cycles of thermocycling (5°C/55°C) and then underwent 1,200,000 cycles of vertical chewing simulation at 50 N of force. Ceramic restorations and marginal integrity were assessed with a Hirox digital microscope. The Fisher exact test (two-tailed) with adjusted p-values (α=0.05) and logistic regression were used for statistical analysis. Results: The cementum margin group had a significantly higher ceramic fracture rate (90%) compared to other groups (10% in enamel margin and GI margin groups, p=0.007; 0% in RMGI group, p Conclusion: Deep marginal elevation resulted in decreased ceramic fracture when preparation margins were located below the CEJ. There was no difference found between margin elevation with GI or RMGI. Increased heights of ceramic proximal box may lead to an increased probability of ceramic fracture.

Clinical Relevance The use of filled adhesive systems does not influence the clinical performance of the adhesive restoration in noncarious cervical lesions. SUMMARY Objective: The aim of this meta-analysis was to investigate the clinical performance of filled vs unfilled adhesive systems when applied in noncarious cervical lesions. Methods and Materials: A systematic search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE. Gray literature was also screened. Only randomized controlled clinical trials were included. The risk of bias of the studies was evaluated using the Cochrane Collaboration’s tool. A random-effects meta-analysis was conducted to compare the retention rate, marginal discoloration, and secondary caries of noncarious cervical lesions restored with filled adhesives vs unfilled adhesives. The quality of the body of evidence was assessed using the GRADE approach. Results: A total of 3662 studies were identified after removal of duplicates. Twenty-nine studies remained for qualitative analyses and 28 studies for the meta-analysis. Only one study was judged to have a low risk of bias, and the other 28 were considered to have unclear risk of bias. There was no statistically significant difference between filled adhesives compared with unfilled adhesives in relation to loss of retention, marginal discoloration, or secondary caries at any of the follow-up periods (12–18 months, 24–30 months, 3 years, and 5 years or longer). The quality of evidence was graded as moderate for most outcomes at the respective follow-ups, except when there was an explained heterogeneity, which occurred mainly for loss of retention at the 12-month to 3-year follow-up. The results did not depend on whether microfilled or nanofilled adhesives had been investigated. Conclusions: The addition of fillers into the composition of adhesive systems did not increase the clinical performance (retention rates, marginal discoloration, or secondary caries) of composite restorations placed in noncarious cervical lesions when compared with unfilled adhesives.

La prevalencia de las LCNC a nivel mundial entre la población adulta es del 46,7%, y con una tendencia al envejecimiento poblacional, esta ha ido aumento, siendo más asiduo en el grupo de más de 55 años. Un reto importante para la odontología ha sido lograr una unión adecuada entre la resina compuesta y la dentina, donde aún es visible una nebulosa en torno a la unión en dentina esclerótica. Se hace necesario contrastar cual protocolo o técnica adhesiva otorga una mejora en la interfaz adhesiva-dentinaria, para lograr una mayor adhesión de restauraciones de resina compuesta en LCNC sobre dentina esclerótica. Esta revisión sistemática buscó en la literatura estudios clínicos aleatorizados sobre protocolos adhesivos en restauraciones de resina compuesta en LCNC sobre dentina esclerótica, mediante una búsqueda en MEDLINE/PUBMED, ELSEVIER/SCOPUS y WEB OF SCIENCE, en la cual, se espera identificar los protocolos adhesivos que otorguen el mejor comportamiento clínico y mayor longevidad, estableciendo un tratamiento de superficie que mejore la retención de restauraciones resina compuesta en LCNC con dentina esclerótica. Se consideraron 11 artículos, los cuales cumplían con los criterios de elegibilidad establecidos en esta RSL. Podemos concluir que existen técnicas o protocolos que influyen positivamente en la adhesión, donde la aplicación vigorosa de los sistemas adhesivos y el pretratamiento de la dentina con EDTA al 15-17% por 1-2min aumentan las tasas retención de las restauraciones de resina compuesta en LCNC sobre dentina esclerótica.

Background The extent of gingival recession represents one of the most important measures determining outcome of periodontal plastic surgery. The accurate measurements are, thus, critical for optimal treatment planning and outcome evaluation. Present study aimed to introduce automated curvature-based digital gingival recession measurements, evaluate the agreement and reliability of manual measurements, and identify sources of manual variability. Methods Measurement of gingival recessions was performed manually by three examiners and automatically using curvature analysis on representative cross-sections (n = 60). Cemento-enamel junction (CEJ) and gingival margin (GM) measurement points selection was the only variable. Agreement and reliability of measurements were analysed using intra- and inter-examiner correlations and Bland–Altman plots. Measurement point selection variability was evaluated with manual point distance deviation from an automatic point. The effect of curvature on manual point selection was evaluated with scatter plots. Results Bland–Altman plots revealed a high variability of examiner’s recession measurements indicated by high 95% limits of agreement range of approximately 1 mm and several outliers beyond the limits of agreement. CEJ point selection was the main source of examiner’s variability due to smaller curvature values than GM, i.e., median values of − 0.98 mm− 1 and − 4.39 mm− 1, respectively, indicating straighter profile for CEJ point. Scatter plots revealed inverse relationship between curvature and examiner deviation for CEJ point, indicating a threshold curvature value around 1 mm− 1. Conclusions Automated curvature-based approach increases the precision of recession measurements by reproducible measurement point selection. Proposed approach allows evaluation of teeth with indistinguishable CEJ that could be not be included in the previous studies.

Made available in DSpace on 2022-05-01T08:44:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 The presence of a tooth-surface defect, such as a non-carious cervical lesion (NCCL), associated with sites of gingival recession (GR) defects creates a combined soft tissue/tooth defect (CD) that requires a different treatment plan. This study aimed to critically review the literature regarding the available treatment protocols for CDs and suggest a new decision-making process. NCCLs were classified as Class A-: the cementoenamel junction (CEJ) was visible and the root surface discrepancy was < 0.5 mm (no step); Class A+: CEJ was visible and the root surface discrepancy was > 0.5 mm (with a step); Class B-: unidentifiable CEJ without a step; Class B+: unidentifiable CEJ with a step. NCCLs affecting both root and crown surfaces (Class B) lead to CEJ destruction and consequently eliminate an important landmark used before and after root coverage procedures. The depth of the root surface discrepancy is vital owing to its possible impact on soft tissue adaptation after healing, which, in turn, may influence the treatment options, namely the use of graft and/or composites to compensate for the discrepancy. Clinically, a step with horizontal depth greater than 0.5 mm should be recognized as the minimum threshold value to define this condition. Extremely deep defects tend to assume a V-shaped topography. Therefore, extremely deep V-shaped defects were classified into subclasses A+V, a V-shaped defect, and B+V, a V-shaped defect with loss of CEJ, for management considerations. The treatment options, supported by the literature, and a decision-making process to deal with each condition are presented. Universidade Estadual Paulista — Unesp Institute of Science and Technology Department of Diagnosis and Surgery Universidade Estadual de Campinas — Unicamp Piracicaba Dental School Department of Prosthodontics and Periodontics Universidade de São Paulo — USP School of Dentistry Department of Stomatology Tuscany Academy of Dental Research — ATRO Universidade Estadual Paulista — Unesp Institute of Science and Technology Department of Diagnosis and Surgery

Human dentin consists of a primary layer produced during tooth formation in early childhood and a second layer which first forms upon tooth eruption and continues throughout life, termed secondary dentin (SD). The effect of attrition on SD formation was considered to be confined to the area subjacent to attrition facets. However, due to a lack of three-dimensional methodologies to demonstrate the structure of the SD, this association could not be determined. Therefore, in the current study, we aimed to explore the thickening pattern of the SD in relation to the amount of occlusal and interproximal attrition. A total of 30 premolars (50–60 years of age) with varying attrition rates were evaluated using micro-computerized tomography. The results revealed thickening of the SD below the cementoenamel junction (CEJ), mostly in the mesial and distal aspects of the root (p &lt, 0.05). The pattern of thickening under the tooth cervix, rather than in proximity to attrition facets, was consistent regardless of the attrition level. The amount of SD thickening mildly correlated with occlusal attrition (r = 0.577, p &lt, 0.05) and not with interproximal attrition. The thickening of the SD below the CEJ coincided with previous finite element models, suggesting that this area is mostly subjected to stress due to occlusal loadings. Therefore, we suggest that the SD formation might serve as a compensatory mechanism aimed to strengthen tooth structure against deflection caused by mechanical loading. Our study suggests that occlusal forces may play a significant role in SD formation.

Objective To analyze the prevalence of distal caries in mandibular second molars (M2Ms) and its correlation with the three-dimensional position of mandibular third molars (M3Ms) by cone beam computed tomography (CBCT) images. Materials and methods CBCT scans involving 421 M3Ms were assessed. The presence of distal caries of M2Ms, patient age and gender, impaction depths and mesial angulation of M3Ms, the cementoenamel junction (CEJ) distances and contact point localization, and the horizontal positions of M3Ms were assessed. Risk factors were identified by multivariate logistic regression analysis. Results The overall prevalence of distal caries in M2Ms was 31.6%. Mesial angulation (16°–75°) of M3Ms, contact point localization at or below the CEJ of M2Ms, and a buccal or lingual position of M3Ms relative to the molar line were identified as risk factors for the prevalence of distal caries in M2Ms (p p Conclusions Buccal or lingual position of M3Ms may represent a new risk factor for the distal caries in M2Ms. Mesial angulation (16°–75°) of M3Ms is a predictive parameter for both the presence and severity of distal caries in M2Ms. Clinical relevance As the presence of distal caries in M2Ms is significantly associated with the three-dimensional position of M3Ms, watchful monitoring or prophylactic removal of M3Ms should be deliberated when M3Ms are mesially angulated (16°–75°), buccally or lingually positioned, and with the contact point localization at or below the CEJ of M2Ms.

Background: Abfraction is a loss of tooth structure along the gingival margin and manifests with different clinical appearances. It has multifactorial etiology and may occur due to normal and abnormal tooth function and may also be accompanied by pathological wear, such as abrasion and erosion. The theory behind the abfraction is that the tooth flexure in the cervical area is caused due to occlusal compressive forces and tensile stresses. This results in the fractures in the hydroxyapatite (HA) crystals. It is also caused by the low packing density of the Hunter–Schreger band (HSB) at the cervical area. Unfortunately, there is a lack of evidence regarding the outcome of abfraction with or without intervention. The aim of this review is to collect clinical information from the literature and discuss the etiology, pathogenesis, clinical representation, and management. Also, search databases for clinical studies that describe the role of sclerotic dentine in non-carious cervical lesions (NCCLs) are becoming a clinical challenge. Methods: The literature was searched that described the etiology, pathogenesis, clinical representation, and management of the abfraction lesions. Also, a specific question regarding the formation of sclerotic dentin in the NCCL lesion was described and searched for evidence that challenges etching, bonding, and successfully restoring NCCLs. The databases PUBMED, SCOPUS, MEDLINE, WEB of SCIENCE, and EMBASE were searched using the key terms. The inclusion criteria were the randomized controlled clinical trial, cohort studies, and cross-sectional studies that aimed at determining the role of sclerotic dentine in NCCLs and its effect on etching, bonding. Results: One clinical study was retrieved according to the PRISMA flowchart and PICO format. The longer etching time, total-etch adhesive system, and EDTA pre-treatment of the sclerotic dentin of cervical wedge-shaped defects could improve the bonding strength in lesions like NCCL's. Conclusion: In conclusion, clinical challenges that occur due to NCCLs are better managed by a proper understanding of factors like etiopathogenesis, ultra-structure of enamel, and dentine and their effect on the bonding of restorations of the tooth.

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

Objectives This study investigated the effect of toothbrush bristle configuration and brushing load on the development of non-carious cervical lesions (NCCLs). Methods Human premolars were mounted on acrylic blocks and had their root surfaces partially covered with acrylic resin to simulate gingiva, leaving a 2-mm length area apical to the cemento-enamel junction exposed for brushing. The teeth were brushed under 1- or 3 N load with one of the following toothbrushes (n = 16): a) ordinary/flat-trimmed (Oral-B Indicator); b) rippled (Oral-B Contour); c) cross-angled/multileveled/rubber bristles (Oral-B Pro-Health All-in-One); d) cross-angled/multileveled/flex head (Oral-B Pro-Flex); e) feathered (Oral-B Compact Clean). Brushing was performed using toothpaste slurry (Crest Cavity Protection) for 55,000 double-strokes in back-and-forth motion, to simulate 10 years of brushing. Impressions were taken at baseline and after brushing and scanned by a 3D optical profilometer. The lesions formed were evaluated for volume loss, angle, and shape. Results The ordinary/flat-trimmed toothbrush caused significantly higher volume loss (3.81 mm3) in comparison to the other toothbrushes (2.56-2.92 mm3). The toothbrush having rubber bristles was associated with NCCLs showing the smallest angle and, along with the rippled toothbrush (53.1%), provoked higher proportion of wedge-shaped lesions (43.8%), whereas teeth brushed with the feathered toothbrush exhibited the lowest prevalence of wedge-shaped lesions (3.1%). The 1- and 3 N load applied during brushing affected neither volume loss nor lesion angle. Conclusions At the brushing loads tested, the development of NCCLs was dependent on toothbrush bristle configuration, with the ordinary/flat-trimmed version causing the highest abrasion and the feathered toothbrush the least proportion of wedge-shaped lesions. Clinical significance Toothbrush bristle arrangement plays a role in NCCL development, with the ordinary/flat-trimmed version being more abrasive and the feathered toothbrush causing less wedge-shaped lesions.

Objective: To assess the six-month clinical outcome of restorations of non-carious cervical lesions (NCCL) with two composite resins: Bulk-Fill and nanohybrid resin. Materials and methods: Fifty-one patients, with three NCCLs each, were randomly allocated into three restoration groups: Tetric-N-Ceram Bulk-Fill (TB); Filtek Bulk-Fill (FB); y Filtek Z350XT (Z350). Adhesive techniques and restorative procedures were performed according to the manufacturers’ instructions for the different materials. A 4mm increment was applied in TB and FB, and increments of ≤2mm depth were applied in Z350. Restorations were assessed by two calibrated examiners at baseline and at six months according to the FDI World Dental Federation guidelines (1: excellent, 2: acceptable, 3: sufficient, 4: unsatisfactory, 5: unacceptable) in Marginal Staining (MS), Fracture-Retention (FR), Marginal Adaptation (MA), Postoperative Sensitivity (S) and Caries (C). Wilcoxon test was used for the comparison between baseline and 6 months, and Kruskal-Wallis for the comparison of the three groups at six months (95% significance). Results: Forty-six patients with a total of 138 restorations attended a check-up at six months and were evaluated with excellent clinical outcome. In MS, 91.2% for Z350 and 97.8% for FB and TB; in FR, 97.8% for Z350 and 100% for FB and TB; in MA, 95.6% for Z350, 97.8% for FB and 100% for TN; in S, 95.6% for all three groups; and 100% for C. No statistically significant differences were found between the three groups nor in the comparison between the baseline and 6 months (p>0.05) Conclusion: No significant differences are observed between the three groups of resins in the parameters of MS, MA, S, FR and C regarding clinical outcome at six months.

The aim of this work was to compare the duration of treatment between orthodontic treatment combined with piezocorticision (OT-PC) and conventional orthodontic treatment (COT), as well as to evaluate the safety, inflammatory process, periodontal health, and soft tissue healing in the OT-PC group.Twelve patients were included in each group, and their treatment times were compared for preliminary bracket alignment (PBA) and for overall treatment. In the OT-PC group, the inflammatory process was evaluated by quantifying cytokines in the gingival crevicular fluid. A calibrated examiner measured the probing depth (PD), the distance between the gingival margin and the cementoenamel junction (GM-CEJ), and the clinical attachment level (CAL), before and after OT-PC. The presence of gingival scars was evaluated. Bone and root injuries were assessed with the use of cone-beam computed tomography.The treatment time was significantly reduced in the OT-PC group for PBA in both maxilla (45%; P = 0.001) and mandible (31%; P = 0.023), as well as for overall treatment (52%; P 0.0001). Although not statistically significant, several inflammatory mediators demonstrated peaks at 3-5 and 16 weeks. There were not significant changes in PD and GM-CEJ after OT-PC treatment, unlike CAL (0.09 ± 0.12 mm; P = 0.024); 47.5% of piezocorticisions caused gingival scars. Only one patient showed no scars. Four cortical bones did not heal completely, and 2 roots had piezoelectric injuries.OT-PC was effective at reducing the orthodontic treatment time.

Objective This study aimed to evaluate the effect of prolonging polymerization time on the 18 months clinical performance of a universal adhesive system used as etch-and-rinse (ER) and self-etch (SE). Methods 140 restorations were randomly placed in 35 subjects according to the following groups: ER10 (light-curing for 10 s); ER40 (light-curing for 40 s); SE10 (light-curing for 10 s) and; SE40 (light-curing for 40 s/1200 mW/cm2). A resin composite was placed incrementally. The restorations were evaluated at baseline and after 18 months by using the FDI criteria. The following outcomes were evaluated: marginal staining, marginal adaptation, spontaneous post-operative sensitivity and recurrence of caries. The differences among the groups were calculated using Friedman repeated measures analysis of variance rank (α = 0.05). Results After 18 months the retention/fracture rates were 88.9% (95%CI 74.1–95.6%) for ER10, 94.3% (95%CI 91.4–98.5%) for ER40, 77.2% (95%CI 60.1–87.9) for SE10 and 97.2% (95%CI 85.5–99.9%) for SE40. A significant difference was detected in the retention rate when SE10 was compared to the SE40 (p = 0.01). Also, ER40 showed a significant improvement of the marginal adaptation when compared to ER10 (p = 0.01). Significance This is the first study that demonstrates an improvement in the clinical performance of universal adhesive systems in non-carious cervical lesions when prolonged light-cured was applied.

Non-carious cervical lesions (NCCLs) are characterized by a loss of hard dental tissue near the cement–enamel junction with multifactorial etiology. The aim of this study was to demonstrate that occlusal factors as attrition, malocclusion, and bruxism, and mental disorders as depression, stress, and anxiety are involved in the etiology of NCCLs. Salivary samples and clinical data of 340 individuals selected from 6,112 participants were obtained from the University of Pittsburgh School of Dental Medicine Dental Registry and DNA Repository project. The affected group was formed by individuals with NCCL (34 females, 34 males, mean age 55.34 years). In addition, the comparison group was formed by individuals without NCCL (136 females, 136 males, mean age 55.14 years). Eleven single-nucleotide polymorphisms (SNPs) previously associated with mental disorders were genotyped and tested for association with NCCLs. When all occlusal factors were combined there was found a significant association with NCCL (p = 0.000001/adjusted OR 4.38, 95% CI 2.50–7.69). Attrition (OR 3.56, 95% CI 2.00–6.32) and malocclusion (OR 5.09, 95% CI 1.65–15.68) as separate variables showed statistically significant associations with NCCL. There was a significant difference in stress history between the two groups (OR 2.17, 95% CI 1.08–4.39). No associations between NCCLs and the SNPs selected were found. However, when the occlusal factors were analyzed as covariates, associations were found between bruxism and seven of the selected SNPs. Our results suggest that occlusal factors might be associated with NCCLs.

The purpose of this multicenter clinical study was to compare the mid-term clinical effectiveness of direct resin composite restorations using one-step or two-step self-etch adhesives (1-SEAs or 2-SEAs). In total, 352 restorations of class I–V cavities and non-carious cervical lesions in vital teeth (1-SEAs; 52 cases, 2-SEAs; 300 cases) were placed at nine university hospitals and evaluated according to the modified USPHS criteria at baseline, and after 1, 2, and 3 years. The recall rates were 86.6% (1 year), 80.1% (2 years), and 62.2% (3 years). Two restorations failed due to fracture during the follow-up, and there was no significant difference in survival rates between 1-SEAs (97.6%) and 2-SEAs (99.4%). However, 2-SEAs exhibited significantly lower occurrences of discoloration, marginal discoloration, fracture, and plaque retention. Moreover, the subjects reported a significantly lower postoperative hypersensitivity and higher overall satisfaction at all evaluation periods if 2-SEAs were used.

Objective: To answer the following PICOS question: “Is the risk of retention loss, marginal discoloration, marginal adaptation and postoperative sensitivity (POS) equal for etch-and-rinse (EAR) compared to self-etch (SE) or selective-enamel etch (SEE) mode when restoring non carious cervical lesions (NCCLs) with universal adhesives?”. Methods: PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, LILACS, OpenGrey and Google Scholar™ were searched. Randomized controlled clinical trials in which resin composites and universal adhesives were used for restoration of NCCLs were considered. Cochrane Risk of Bias Tool was used to assess the risk of bias. Meta-analyses were performed using Revman; random-effects models were applied, and heterogeneity was tested using the I2 index. The significance level was set at p < 0.05. Certainty of evidence was assessed by GRADE tool. Results: After screening, 20 articles were included in qualitative, while 14 articles were used for quantitative synthesis. Twelve studies ranked as “low”, while 8 studies scored as “unclear” for risk of bias. At 12- and 18/24-months the risk for retention loss was higher for SE than for EAR groups (p = 0.005; RR = 0.22, 95% CI [0.08, 0.63],[moderate certainty of evidence and p = 0.0002; RR = 0.32, 95% CI [0.17, 0.58], moderate certainty of evidence, respectively). No significant differences were observed for marginal discoloration and adaptation (p > 0.05). The probability of POS occurrence was less in SE than in EAR groups (RR = 2.12, 95% CI [1.23, 3.64], moderate certainty of evidence). The certainty of evidence for other outcomes was scored as “low” or “moderate”, depending on the follow-up period. Significance: Using universal adhesives in EAR or SEE mode provides more predictable retention, while SE strategy reduces the risk of POS occurrence.

Background Understanding the anatomy of the facial alveolar bone (FAB), provides a prognostic tool for estimating the degree of dimensional ridge alterations after tooth extraction. This systematic review and meta-analysis aims to determine the FAB thickness and modifying factors of anterior maxillary teeth measured by CBCT scans. A secondary objective was to assess the facial distance from the cementoenamel junction (CEJ) to the bone crest. Methods An electronic search was made of Medline, Embase, Web of Science, Cochrane Library and Google Scholar up to December 2019. Studies that analyze and quantitatively compare FAB thickness at maxillary teeth by CBCT scans were included. The methodological quality of the included studies was appraised using the ROBINS-I tool and the overall meta-evidence certainty using the GRADE approach. A single means random-effects meta-analysis was performed to obtain the weighted mean for 95% confidence interval. A meta-regression of covariates and subgroup analysis was conducted. The nullity Qh test and I2 index for heterogeneity was estimated. Results 2560 potentially relevant articles were recorded from which 29 studies were selected for the qualitative analysis, including 17,321 teeth. Seventeen studies considered the facial bone crest, and 12 the CEJ as a reference point for their measurements. Mean FAB thickness was ≤ 1 mm in maxillary incisors and canines (0.75–1.05 mm) and 1–2 mm in premolars. Patients over 50 years of age, females and thin gingival phenotype was associated with thinner FAB at some apico-coronal locations of maxillary incisors and canines. The geographical setting was an effect modifier that could explain up to 87% of the heterogeneity in FAB thickness, being Asian populations that showed the lowest FAB thickness values. The CEJ-bone crest distance was 2–2.5 mm in all teeth analyzed. Population over 50 years of age exhibited greater CEJ-bone crest distances, and males also showed a trend for greater distance. Evidence certainty has shown moderate quality in most analysis subsets. Conclusions Facial alveolar bone at anterior maxillary teeth is thin, heterogeneous in width along its apico-coronal dimensions, and increases in thickness in maxillary premolars. The CEJ-bone crest distance presented homogeneous and similar values in all teeth analyzed.

Made available in DSpace on 2022-05-01T08:44:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: Evaluate the use of collagen matrix (CM) as adjunctive to coronally advanced flap (CAF versus CAF + CM) to treat gingival recession (GR) associated with non-carious cervical lesion–combined defects (CDs). Methods: Sixty-two patients presenting 62 CDs (RT1 GR and non-carious cervical lesion (NCCLs) were randomly allocated to either CAF group (n = 31): partial restoration of the NCCL and CAF; or to CAF + CM group (n = 31): partial restoration of the NCCL and CAF associated with CM. Clinical, esthetic, patient-centered outcomes, and restorative parameters were assessed. Results: After 12 months, CD coverage were 55.2% for CAF and 54.4% for CAF + CM (P = 0.8). Recession reduction were 1.9 ± 0.8 mm for CAF and 2.0 ± 0.7 mm for CAF + CM (P = 0.6). CAF+CM resulted in higher increase in keratinized tissue (KT) width (CAF: 0.3 ± 0.7 mm; CAF + CM: 0.9 ± 0.8 mm; P = 0.004) and KT thickness gain (CAF: 0.1 ± 0.3 mm; CAF + CM: 0.7 ± 0.2 mm; P = 0.001). Both treatments presented low postoperative pain and resulted in esthetics improvements. In addition, no restoration was lost, 27.4% showed a reduction of the superficial polishing, and 8% showed marginal staining, but still clinically acceptable. Conclusion: Partial resin composite restoration (with the apical limit up to 1 mm of the estimated CEJ) and CAF alone or combined with CM are suitable for treating CDs. The use of CM provided additional benefits in terms of KT width and thickness gain. (NCT03341598). UNESP Sao Paulo State University Division of Periodontology College of Dentistry Division of Operative Dentistry Department of General Dentistry University of Maryland School of Dentistry UNESP Sao Paulo State University Division of Operative Dentistry College of Dentistry College of Dentistry—Lexington University of Kentucky UNESP Sao Paulo State University Division of Periodontology College of Dentistry UNESP Sao Paulo State University Division of Operative Dentistry College of Dentistry

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

In human teeth, the cementoenamel junction (CEJ) can have different morphologies, known as Choquet cases or types: in type 1, the cementum overlaps the enamel; in type 2, the enamel overlaps the cementum; in type 3, the relationship between the cementum and enamel is edge-to-edge; and in type 4, there is a gap between the enamel and the cementum, with exposed dentin. Since little is known on the morphology of the CEJ in animals, the aim of this study was to characterize the structure of the CEJ of dog teeth by SEM. We studied 82 permanent teeth extracted from 4 dogs of similar size, aged from 7 months to 2 years. Teeth were grouped according to their size, sectioned and prepared for SEM. The teeth evaluated showed the 4 CEJ types. Type 3 was the most prevalent, being present, either alone or in combination, in 90.79% of the samples, followed by type 4 (present in 31.58% of the samples). Of the samples, 65.13% showed only one type, while 34.87% presented a combination of them. Types 3 and 4 were the only ones present alone (in 55.92% and 9.21% of the samples respectively), whereas the combinations between types 3 and 4 (20.40%) and types 1 and 3 (9.87%) were the most frequent. In all combinations, type 3 was predominant. The CEJ of the dogs evaluated showed a high degree of variability in the different types of teeth, within a same tooth, within the dentition of a single individual, and among individuals.

The purpose of this clinical research was to evaluate peri-implant marginal changes around immediate implants placed either with the application of SCTG or XCM or without soft tissue grafting. A total of 48 patients requiring a single implant-supported restoration in the anterior jaw were selected for inclusion. Three surgical procedures were performed, as follows: type 1 implant with subepithelial connective tissue graft (SCTG), type 1 implant with xenogenic collagen matrix (XCM), and type 1 implant without soft tissue augmentation (NG) (control group). The marginal change of peri-implant soft tissue, facial soft tissue thickness (FSTT), peri-implant health status, esthetics, and patient satisfaction were assessed at one year after surgery. All of the placed implants showed a survival rate of 100%. No significant differences in FSTT were recorded between the SCTG group and the XCM group after treatment ( P > 0.05 ), while the NG group presented a significant difference ( P < 0.05 ). Patients in the NG group lost significantly more in the buccal marginal level than did patients in the SCTG group and those in the XCM group ( P < 0.05 ). The favourable success rate recorded in all groups confirmed immediate tooth replacement as a choice of treatment for a missing anterior single tooth. The NG group presented significant changes of FSTT and buccal marginal level, while XCM constituted a viable alternative to SCTG.

External cervical resorption (ECR) is a relatively uncommon yet aggressive form of dental hard tissue destruction. It is initiated at the cervical aspect of the root surface and extends apicocoronally and circumferentially inside the dentin. Despite the large number of case reports and clinical studies that have investigated ECR, its etiology remains unclear. Recent advancements in clinical assessment measures, such as the use of cone-beam computed tomographic imaging, have provided additional insights into the nature of this lesion. This has facilitated the continued development and improvement of treatment methods for this condition. In this article, we provide an overview of the latest research pertaining to the etiology, histopathology, predisposing factors, diagnosis, classification, and treatment of ECR. Furthermore, we provide a summary of the different classification schemes for ECR and highlight the relevant therapeutic principles.

Objective This study evaluated the effect of resin composite restorations of non-carious cervical lesions (NCCLs) on the occurrence/progression of gingival recession (GR), considering different tooth isolation techniques. Methods A randomized controlled split-mouth and blinded trial was carried out. Patients (n = 38) with at least two NCCLs were included. Before the cervical restoration placement, the NCCLs (181 teeth) were randomly allocated into two treatment groups according to the tooth isolation techniques: cotton roll or rubber dam. Experienced, trained, blinded, and calibrated examiners performed periodontal evaluations at baseline and 5-year follow-up, using a periodontal probe. Restorations were assessed with the FDI criteria. Thirty-two patients (154 teeth) were evaluated at 5 years. The occurrence/progression of GR between baseline and follow-up was considered the primary outcome. The relative risk (RR) and 95 % confidence interval (95 %CI) were calculated by Poisson regression (α Results After 5 year, 31 teeth (13.6 %) presented occurrence/progression of GR. In the multivariate analyses, the occurrence/progression of GR was associated with the use of rubber dam isolation (RR; 95 %CI: 2.65; 1.01–7.00) and a lack of marginal adaptation of the restoration (RR; 95 %CI: 10.98; 2.31–52.30). Toothbrush stiffness, use of abrasive dentifrice, tooth type, and the presence of biofilm or gingivitis did not present a statistically significant higher risk for occurrence/progression of GR. Conclusion The use of rubber dam isolation associated with retraction clamp and the lack of a proper marginal adaptation of the composite restorations are risk indicators for the occurrence/progression of GR in individuals who received a restoration for an NCCL. Clinical significance Isolation with a rubber dam and dental clamps may promote GR in sites with restored NCCLs. Moreover, clinical examinations for lack of marginal adaptations of the restorations may be included in a clinical setting.

Introduction The objective of this case-control study was to investigate the association between denosumab use and the risk of developing external cervical resorption (ECR). Methods Thirty-three patients ≥45 years old who were diagnosed with ECR were selected. Controls were matched to the cases based on sex and age (±5 years) in a 1:1 ratio. Confounders were classified into systemic factors, including a history of systemic sclerosis, hepatitis B, denosumab use, and bisphosphonate use, or local factors, including a history of traumatic occlusion, periodontal procedures (scaling and root planing and periodontal surgeries), and tooth extraction (excluding third molar extraction). Additionally, the number of remaining teeth in each subject was recorded using panoramic radiographs. The baseline characteristics of the 2 groups, including age, sex, and the number of remaining teeth, were compared using the chi-square and Mann-Whitney U tests. Binary logistic regression was used to determine the possible association between denosumab use and the risk of developing ECR (α Results No significant differences in baseline characteristics were observed between the case and control groups (P > .05). After adjusting for systemic and local cofounders, denosumab use was significantly associated with the occurrence of ECR (odds ratio = 7.317; 95% confidence interval, 1.410–37.966; P Conclusions Based on the binary logistic regression model, denosumab use could significantly predict the risk of developing ECR.

Background The purpose of this cross-sectional study was to evaluate radiologically, the relation between the distance from the cementoenamel junction (CEJ) to the facial bone crest (FBC), and the facial alveolar bone (FAB) width at maxillary anterior teeth. A further aim was to assess if the CEJ-FBC distance had an impact in the prevalence to find a FAB thickness greater than one mm. Material and Methods CBCT images were retrospectively obtained from the database of the Oral Surgery Unit of the University of Valencia. The teeth were divided in 3 groups according to the CEJ-FBC distance: Shorter (≤3mm), Middle (>3 ≤4.5 mm) and Larger (>4.5 mm). FAB thickness was measured by two different examiners at 1, 2 and 3 mm apical to the FBC. Normality of means were evaluated by Kolmogorov-Smirnov test and an ANOVA-type linear model was performed. Results 82 patients were included in the study, with 156 central incisors, 149 lateral incisors and 152 canines analyzed. A significant greater FAB thickness in Shorter (≤3mm CEJ-FBC) than Middle and Larger group was observed in all distances measured apical to the FBC. There was a significant inverse relation between the distance CEJ-FBC and FAB thickness at all distances measured. The prevalence of a FAB thickness equal or greater than one mm was 35.9% of all teeth analyzed from Shorter, 17.4% of Middle and 8.9% of Larger group at 1 mm apical to the FBC. Conclusions When the distance from the CEJ to the FBC is augmented, thinner FAB thickness has to be expected in all teeth of the anterior maxilla. The prevalence to find a FAB thicker than one mm decreases as the distance from the FBC to the CEJ increases. Key words:Facial bone, alveolar bone, cone-beam computed tomography, CEJ, maxillary teeth.

Clinical Relevance According to the clinical and scientific evidence presented in this systematic review and meta-analysis, dental adhesives containing either organic solvent (acetone or alcohol) can be used to achieve similar clinical performance and longevity of composite restorations. SUMMARY Objectives: This systematic review and meta-analysis compared the clinical performance and survival rates of composite restorations placed in noncarious cervical lesions (NCCLs) using dental adhesives containing acetone or alcohol-based solvents. Methods and Materials: PubMed, Scopus, Web of Science, Virtual Health Library (VHL) LILACS, Cochrane Library, OpenGrey, Clinical Trials, and Rebec were searched. MeSH terms, supplementary concepts, synonyms, and free keywords were used in the search strategy. All references were crosschecked by two independent investigators following the PICOS strategy (population, NCCLs; intervention, acetone-based bonding agent; comparison, alcohol-based bonding agent; outcome, clinical evaluation parameters and survival rates; study design, randomized controlled clinical trials). Cochrane Collaboration’s tool was used to assess risk of bias, and two distinct meta-analyses were performed using the RevMan software. The prevalence of success and the total number of restorations for each group (acetone- or alcohol-based) were used to calculate the risk difference at a confidence interval of 95%. Random-effects models were applied, and heterogeneity was assessed using the I2 index in the pooled and subgrouped meta-analyses. The certainty of evidence was evaluated through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: A total of 7876 studies were retrieved, from which 27 studies were selected for the systematic review. Ten studies were classified as “low risk of bias” and included in the meta-analyses. Overall heterogeneity was not significant (I2 = 0.00%). The clinical performance of restorations placed with bonding agents based on both solvents for each of the available parameters presented no statistical significance for any of the meta-analyses (p>0.05). Conclusion: Scientific evidence suggests composite restorations placed with acetone or alcohol-based dental adhesives present similar clinical performance and survival rates in NCCLs.

To noninvasively determine the relationship between the thickness of the buccal bone and attached gingiva of the maxillary premolars.128 maxillary premolars in 32 patients were assessed for measurement of buccal bone thickness and corresponding attached gingival thickness at 3 mm apical to cemento-enamel junction. Buccal bone thickness was measured on cone-beam computed tomography scans and attached gingival thickness by ultrasound unit. Pearson's correlation coefficient was calculated to assess the correlation between buccal bone and attached gingival thickness at each tooth type.The mean buccal bone thickness at the maxillary premolars was 1.07 mm. The 1st premolars had a buccal bone thickness 1 mm at 68% of all sites, and the 2nd premolars had a buccal bone thickness of 1.0-2.0 mm at 32% of all sites. The 1st premolars had a gingival thickness 1.2 mm at 55% of all sites, and the 2nd premolars had a gingival thickness of 1.1-1.3 mm at 45% of all sites. The correlation between buccal bone and attached gingival thickness was moderately positive (r = 0.406; P .001).The relationship between buccal bone thickness and gingival thickness is independent of each other in the maxillary right first premolar, whereas a moderate correlation with a dependent relation exists in the maxillary right second premolar, maxillary left first premolar, and maxillary left second premolar.Soft tissue and hard tissue associated with volumetric changes in maxillary premolar region can be unfavorable for both aesthetic and implant placement. In fact this study highlighted the relationship between the thickness of attached gingiva and corresponding buccal bone in maxillary premolar region so to enable for proper planning of implant therapy following extraction.

Purpose To examine cone beam computed tomography (CBCT) anatomical findings, such as the concavity of the ridge and angulation of the tooth and alveolar ridge, either facial or palatal, in order to assess the potential clinical risks of performing flapless implant surgery. Materials and methods CBCT images that met the inclusion criteria were examined. All images in maxillary anterior areas (canine to canine), facial bone thickness at 3 and 5 mm from the cementoenamel junction (CEJ), angulation of the tooth and alveolar ridge (Angle T: the angulation between the long axis of the tooth and the palatal plane; Angle D: the angulation between the long axis of the tooth and the midline of the ridge), the deepest point of facial concavity, the distance from the deepest point of facial concavity to the apex of the tooth and alveolar bone crest, nasopalatine canal, dehiscence, and fenestrations were measured and statistically analyzed. Results In total, 21 patients (12 women and 9 men) with a mean age of 55.9 years who met the inclusion criteria were included in the analysis. Data from 21 patients, 6 image sections per patient (total of 126 CBCT images) were analyzed. The mean value of facial bone thickness was 0.99 mm and 0.60 mm at 3 and 5 mm from CEJ, respectively. The distance from the deepest point of facial concavity to the apex of the tooth and alveolar bone crest was 2.79 and 11.29 mm, respectively. In canine areas, the mean values of facial bone thickness were larger at 3 mm but thinner at 5 mm. Also, canines were found to have a larger Angle D and a higher incidence of fenestration and dehiscence. Conclusion Based on the findings, fenestration and a larger Angle D were associated with thinner facial bone thickness at 5 mm, and the tooth types also had an impact. Hence, for immediate implant surgery without flap elevation, besides anatomical structures, both angulation of the tooth and the alveolar ridge also need to be assessed.

SUMMARY The purpose of this study was to analyze the influence of dentin surface treatments on the retention rate of resin composite restorations in non-carious cervical lesions (NCCLs). Seven randomized clinical trials were included in this review. Data regarding retention rate, type of surface treatment, and the main characteristics of studies were analyzed. Two reviewers performed a literature search up to December 2016 in eight databases: PubMed (Medline), Lilacs, Ibecs, Web of Science, BBO, Scopus, Scielo and The Cochrane Library. Only clinical trials evaluating dentin surface treatments in resin composite restoration in NCCLs were included. Noncontrolled clinical trials, reviews, editorial letters, case reports, case series and studies published in a language other than English, Portuguese, or Spanish were not included. The included studies evaluated different surface treatments, such as using an adhesive system with a frictional technique, drying the dentin, and removing sclerotic dentin by using a bur and applying EDTA before primer use. The analysis considering the mechanical removal of dentin surface with a bur and the application of an adhesive system in a frictional mode showed these treatments improved retention rates of the resin composite restorations in NCCLs (p

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

PURPOSE Peri-implant bone thickness is an important local factor that could influence esthetic outcomes in immediate implant therapy. The aim of this study was to assess the thickness of the buccal bone overlying the anterior maxillary teeth in Kenyans. MATERIALS AND METHODS A total of 184 cone beam computed tomography (CBCT) scans that met the inclusion criteria were retrospectively studied. Buccal bone thickness of all maxillary anterior teeth was assessed, resulting in a total of 1,104 teeth. Measurements were taken on sagittal views at a point 4 mm below the cementoenamel junction (M1) and at the mid-root level (M2). The data were analyzed using SPSS software (version 20, IBM), and statistical significance was set at P ≤ .05. RESULTS Mean buccal bone thickness of the teeth studied was 0.55 ± 0.38 mm at M1 and 0.60 ± 0.30 mm at M2. Missing buccal bone wall was observed in 31.61% (349 teeth) of all teeth at M1 and in 21.38% (236 teeth) of all teeth at M2. The majority of the teeth had a thin buccal bone wall (< 1 mm) at M1 (56.34%) and at M2 (68.48%), whereas a thick buccal bone (≥ 1 mm) was only observed in 12.05% of teeth at M1 and in 10.14% of teeth at M2. Thin buccal bone was mainly found in central incisors, while thick buccal bone wall was found mainly in canines. The thickness of buccal bone at M1 decreased with an increase in age. CONCLUSION Contour augmentation would be necessary in most of these cases, as the buccal bone was typically thin. The thickness at the cervical portion was inversely correlated with age. One in every four of the cases would not be ideal for flapless immediate implant placement due to a missing buccal bone wall. Preoperative CBCT analysis of the buccal wall is recommended for appropriate treatment planning.

Effective management of external cervical resorption (ECR) depends on accurate assessment of the true nature and accessibility of ECR; this has been discussed in part 1 of this 2 part article. This aim of this article was firstly, to review the literature in relation to the management of ECR and secondly, based on the available evidence, describe different strategies for the management of ECR. In cases where ECR is supracrestal, superficial and with limited circumferential spread, a surgical repair without root canal treatment is the preferred approach. With more extensive ECR lesions, vital pulp therapy or root canal treatment may also be indicated. Internal repair is indicated where there is limited resorptive damage to the external aspect of the tooth and/or where an external (surgical) approach is not possible due to the inaccessible nature of subcrestal ECR. In these cases, root canal treatment will also need to be carried out. Intentional reimplantation is indicated in cases where a surgical or internal approach is not practical. An atraumatic extraction technique and short extraoral period followed by 2-week splinting are important prognostic factors. Periodic reviews may be indicated in cases where active management is not pragmatic. Finally, extraction of the affected tooth may be the only option in untreatable cases where there are aesthetic, functional and/or symptomatic issues.

External cervical resorption (ECR) is the loss of dental hard tissue as a result of odontoclastic action. It is a dynamic process that involves periodontal, dental and in later stages pulpal tissues. Over the last two decades, ECR has attracted increased interest; this is in part due to novel micro-CT and histopathological techniques for its assessment and also improved radiographic detection using CBCT. This literature review will cover the aetiology, potential predisposing factors, histopathology and diagnosis of ECR. Part 2 will cover the management of ECR.

This study evaluated the influence of cervical preflaring on the incidence of root dentin defects after root canal preparation.Extracted human maxillary central incisors were selected and allocated to 1 control group and 12 experimental groups (n = 15). Teeth in the control group were left unprepared, whereas the others were prepared using 2 reciprocating single-file systems (Reciproc and WaveOne [WO]), 3 full-sequence rotary systems (ProTaper Universal, ProTaper Next [PTN], and ProFile), and K-files driven by an oscillatory system, with and without cervical preflaring. Roots were then horizontally sectioned at 4, 8, and 12 mm from the apex, stained with 1% methylene blue, and viewed through a stereomicroscope at ×25 magnification. Slices were inspected and the absence/presence of defects (fractures, partial cracks, and craze lines) recorded. Data were analyzed using Kolmogorov-Smirnov and Levene tests followed by the Tukey post hoc test at a significance level of P .05.No root dentin defects were observed in the control group. WO was associated with a significantly higher number of defects than K-files, ProFile, and PTN (P .05), but was not significantly different from Reciproc or ProTaper Universal (P .05). Cervical preflaring significantly reduced the incidence of fractures and other defects in the WO and PTN groups (P .05).All instruments caused root dentin defects, regardless of the enlargement or not of the cervical portion. Cervical preflaring was associated with a lower incidence of defects, mainly in root canals prepared with WO and PTN.

Objective This double-blind randomized clinical trial evaluates the influence of dentin roughening (RO) on the clinical behavior of a new universal multi-mode adhesive (Tetric N-Bond Universal; Ivoclar-Vivadent) applied as self-etch and as etch-and-rinse in non-carious cervical lesions (NCCLs). Methods A total of 192 restorations were randomly placed in 48 patients according to the following groups: ER – Etch-and-rinse (no preparation); SE – self-etch (no preparation); ER + RO and; SE + RO. The resin composite Empress Direct (Ivoclar-Vivadent) was placed incrementally. The restorations were evaluated after one week (baseline), 6 and 18 months, using the FDI and USPHS criteria. Statistical analyses were performed using appropriate tests (α = 0.05). Results Fifteen restorations were lost at 18 months (3 for SE, 2 for ER, 5 for SE + RO and 5 for ER + RO) (p > 0.05 between groups). Post-operative sensitivity wasn’t observed in any of the recall periods. Eighty-four restorations were considered to have minor discrepancies in marginal adaptation at the 18-month recall using the FDI criteria (24 for SE, 18 for ER, 22 for SE + RO and 20 for ER + RO; p > 0.05 between groups). Nineteen restorations were considered to have minor discrepancies in marginal discoloration at the 18-month recall (10 for SE, 03 for ER, 05 for SE + RO and 01 for ER + RO; p > 0.05 between groups). Conclusion The dentin roughening before application of Tetric N-Bond Universal as self-etch and etch-and-rinse didn’t affect the clinical behavior of composite restorations placed in NCCLs.

SUMMARY Noncarious cervical lesions (NCCLs) are steadily increasing. Unfortunately, NCCL restorations represent one of the less durable types of restorations due to problems, including isolation and crevicular moisture control, especially in cases where the cervical margin is covered by soft tissue. This article presents a technique that allows us, through the use of a common metallic matrix, to isolate and make accessible class V cavities with intrasulcular cervical margins. The advantages and disadvantages of the technique are presented.

Background Several lesions of diverse origin may be detected in the oral cavity of young children, affecting the oral mucosa, jaws, or teeth. Their clinicopathologic features may show considerable overlap. We present an interesting case of a “ringlike hard mass” of initially unknown nature around the cervical area of a primary tooth in a young child, and we discuss the diagnostic challenges. Case Summary A 2-year-old girl presented for evaluation of a painless lesion surrounding a primary tooth, first noticed before she was 5 months of age. Her medical history was unremarkable without any history of trauma. The clinical examination revealed a yellowish cylindrical mass, hard in consistency, completely surrounding the cervical area of the left first primary lower incisor. It was nonremovable, strongly adhered to the root surface. With a provisional clinical diagnosis of a tooth abnormality (eg, hypercementosis), a periapical radiograph revealed acylindrical radiopacity of mild intensity enveloping the tooth cervix, extending approximately 2 mm apically. Based on an expert oral and maxillofacial radiologist's consultation, a diagnosis of a foreign body around the tooth was favored, although no relevant anamnesis was given. A watch-and-wait policy was adopted, and the patient was observed regularly in follow-up for the next 4 years with mild but progressive gingival recession, revealing a larger part of the ringlike structure. Radiographically, the “lesion” did not show any changes; however, a progressive but overall limited resorption of the alveolar bone in the cervical area was observed. At age 6 years, the tooth was extracted, and, on gross examination, a cylindrical structure was detached with difficulty from the tooth, confirming its nature as a foreign body, most likely an accidentally misplaced rubber ringlike toy part. Subsequent follow-up confirmed uneventful eruption of the permanent central incisor. Conclusions Accidental impregnation of a foreign body in the oral soft tissues is an unusual but not rare event in children. However, the occurrence of a foreign body completely surrounding the cervix of a tooth, eventually becoming inseparable possibly due to calcification, is probably very rare. Although harmless, the peculiar clinical and radiographic appearance may cause diagnostic dilemmas.

Objectives: To explore fatigue limits of ceramic endocrowns for premolars. Methods: Forty-eight devitalized premolars were cut at the CEJ. They were restored with standardized CAD–CAM lithium disilicate reinforced ceramic restorations (IPS e.max CAD, Ivoclar-Vivadent) and divided into four Groups (n = 12): overlays (Group A, no endo-core, negative control), endocrowns with an endo-core of 2 mm (Group B), 4 mm (Group C) and crowns with post and core (Group D, positive control). All specimens were first submitted to thermo-mechanical cyclic loading (TCML)(1.7 Hz, 49 N, 600000 cycles, 1500 thermo-cycles). Margins were analysed before and after the loading. Survived specimens were then submitted to cyclic isometric stepwise loading (5 Hz, 200N to 1200N) until completion of 105000 cycles or failure. In case of fracture, fragments were analysed using SEM and failure mode was determined. Results of stepwise loading were statistically analysed by Kaplan–Meier life survival analysis and log rank test (p = 0.05). Results: All the specimens survived the TCML test except four specimens of Group A (early restorations’ debonding). No difference in percentages of closed margins was found between endocrowns (Groups B, C) and crowns (Group D). After the stepwise test, differences in survival within the groups were not statistically significant. Most of restorations experienced non-reparable fracture. Conclusions: Endocrowns with both 2-mm and 4-mm long endo-cores displayed outcomes after fatigue equivalent to classical crowns. Results of this study discourage the use of flat overlays with only adhesive retention. Clinical significance: When restoring extremely destroyed devitalized premolars, adhesive strategies should be coupled to a macro-mechanical retention in the root.

Our goal was to automatically identify the cementoenamel junction (CEJ) location in ultrasound images using deep convolution neural networks (CNNs).Three CNNs were evaluated using 1400 images and data augmentation. The training and validation were performed by an experienced nonclinical rater with 1000 and 200 images, respectively. Four clinical raters with different levels of experience with ultrasound tested the networks using the other 200 images. In addition to the comparison of the best approach with each rater, we also employed the simultaneous truth and performance level estimation (STAPLE) algorithm to estimate a ground truth based on all labelings by four clinical raters. The final CEJ location estimate was obtained by taking the first moment of the posterior probability computed using the STAPLE algorithm. The study also computed the machine learning-measured CEJ-alveolar bone crest distance.Quantitative evaluations of the 200 images showed that the comparison of the best approach with the STAPLE-estimate yielded a mean difference (MD) of 0.26 mm, which is close to the comparison with the most experienced nonclinical rater (MD=0.25 mm) but far better than the comparison with clinical raters (MD=0.27-0.33 mm). The machine learning-measured CEJ-alveolar bone crest distances correlated strongly (R = 0.933, p0.001) with the manual clinical labeling and the measurements were in good agreement with the 95% Bland-Altman's lines of agreement between -0.68 and 0.57 mm.The study demonstrated the feasible use of machine learning methodology to localize CEJ in ultrasound images with clinically acceptable accuracy and reliability. Likelihood-weighted ground truth by combining multiple labels by the clinical experts compared favorably with the predictions by the best deep CNN approach.Identification of CEJ and its distance from the alveolar bone crest play an important role in the evaluation of periodontal status. Machine learning algorithms can learn from complex features in ultrasound images and have potential to provide a reliable and accurate identification in subsecond. This will greatly assist dental practitioners to provide better point-of-care to patients and enhance the throughput of dental care.