43,472 research outputs found

    The Evolution of Dental Composites: A Preventative Approach to Restoration Failure

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    This study investigates the problem of restoration failure using research data from primary and secondary sources. The failure of dental composites due to secondary caries is very common, so the creation of a restorative material that will serve as a multifactorial solution will be a significant advancement. An enhanced composite material with antibacterial properties and remineralization properties could be the solution to restoration failure. This composite contains dimethylaminododecyl methacrylate (DMADDM) which has antibacterial properties and the remineralizing effect of amorphous calcium phosphate (NACP). Studies have shown that the combination of NACP and DMADDM is a promising new technology that could increase the longevity of dental restorations and provides several potential benefits for both clinicians and patients. Along with its inhibitory properties, the new composite material is also aesthetically pleasing and could potentially be used in all areas and surfaces of the clinical dentition. Composite failure is a prevalent issue and having a longer lasting dental material would certainly be in the patient’s best interest. Our project intends to take a step forward by not only recognizing a problem (primary and secondary caries) and seeking a better solution (enhanced composite fillings), but to plan for the future by incorporating a preventive strategy where dental hygienists could inform and advocate for their patients

    Biomimetic Adhesive Thiol-Ene Films For Improved Adhesion

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    Current dental restoration materials fall short in adhesion and often pull away from the surface of the tooth upon curing. This project seeks to design polymers that can adhere to wet, heterogeneous surfaces as potential materials for dental restoration applications. The goal of this project is to mimic the structure and adhesive properties of natural adhesives containing 3,4-dihydroxyphenyl-L-alanine (DOPA). We will synthesize mono- and di-functional DOPA derivatives with catechol functionality and investigate their adhesion compared to their non-catechol-containing alternative through incorporation into a model thiol-ene photopolymerization. Functional group conversion, real time kinetics, and adhesion data will be used to analyze these materials. Successful completion of this study may provide improved understanding of the design parameters necessary to achieve wet adhesion to dental surfaces, and may provide a new route for the development of dental restoration composites that result in reduced delamination at the composite-tooth interface and ultimately lower failure rates

    Development of an innovative urease-aided self-healing dental composite

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    Dental restorative materials suffer from major drawbacks, namely fracture and shrinkage, which result in failure and require restoration and replacement. There are different methods to address these issues, such as increasing the filler load or changing the resin matrix of the composite. In the present work, we introduce a new viable process to heal the generated cracks with the aid of urease enzyme. In this system, urease breaks down the salivary urea which later binds with calcium to form calcium carbonate (CaCO₃). The formation of insoluble CaCO₃ fills any resultant fracture or shrinkage from the dental composure hardening step. The healing process and the formation of CaCO₃ within dental composites were successfully confirmed by optical microscope, scanning electron microscopy (SEM), and energy-dispersive X-ray (EDS) methods. This research demonstrates a new protocol to increase the service life of dental restoration composites in the near future

    Outcomes of Primary Endodontic Therapy in Medicaid Enrollees

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    The objective of this study was to determine factors affecting survival of teeth after nonsurgical root canal therapy (NSRCT) among enrollees of Wisconsin Medicaid during the years 2001-2009. Only permanent teeth with NSRCTs and that had permanent restorations within 60 days after treatment completion were included in the analysis. Patients with less than 60 days of insurance coverage after treatment completion were excluded. NSRCTs and untoward events (extraction) were identified based on Code on Dental Procedures and Nomenclature (CDT). Kaplan-Meier methods were used to plot the survival distribution for the overall cohort and subgroups by age, gender, race, tooth location, geographic area (urban vs. rural), and restoration type (crown vs. other). Univariate and multivariable Cox proportional hazards regression were used to model time from root canal restoration to extraction. The multiple regression model included all baseline covariates: age, gender, race, tooth location, geography, and restoration type. After applying the inclusion and exclusion criteria, 14,281 teeth among 11,788 patients were included in the final analysis. The overall 5-year survival rate was 88.67%. Survival rates were higher among younger individuals, males, anterior teeth, and when post-operative restoration was a crown as opposed to a filling. This study concludes that the success of primary endodontic therapy in a Medicaid population can be significantly improved by using post-operative crown restorations

    Outcomes of Primary Endodontic Therapy Provided by Endodontic Specialists Compared to Other Providers

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    Introduction: The objective of this study was to compare the outcomes of initial non-surgical root canal therapy (NSRCT) for different tooth types provided by both endodontists and other providers. Methods: Using an insurance company database, 487,476 initial NSRCT procedures were followed from the time of treatment to the presence of an untoward event indicated by Current Dental Terminology (CDT) codes for retreatment, apical surgery, or extraction. Population demographics were computed for provider type and tooth location. Kaplan-Meier survival estimates were calculated for 1, 5, and 10 years. Hazard ratios for provider type and tooth location were calculated using the Cox proportional hazards model. Analyses were performed using SAS 9.4 (Cary, NC). Results: The survival of all teeth collectively was 98% at 1 year, 92% at 5 years, and 86% at 10 years. Significant differences in survival based on provider type were noted for molars at 5 years, and for all tooth types at 10 years. The greatest difference discovered was a 5% higher survival rate at 10 years for molars treated by endodontists. This was further evidenced by a hazard ratio of 1.394 when comparing other provider’s success to endodontists within this ten-year molar group. Conclusions: These findings show that survival rates of endodontically teeth is high at ten years post treatment regardless of provider type. Molars treated by endodontists after 10 years have significantly higher survival rates than molars treated by non-endodontists

    Resistance to Fracture of Two All-Ceramic Crown Materials Following Endodontic Access

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    Statement of problem There is currently no protocol for managing endodontic access openings for all-ceramic crowns. A direct restorative material is generally used to repair the access opening, rendering a repaired crown as the definitive restoration. This endodontic procedure, however, may weaken the restoration or initiate microcracks that may propagate, resulting in premature failure of the restoration. Purpose The purpose of this in vitro study was to evaluate how an endodontic access opening prepared through an all-ceramic crown altered the structural integrity of the ceramic, and the effect of a repair of this access on the load to failure of an all-ceramic crown. Material and methods Twenty-four alumina (Procera) and 24 zirconia (Procera) crowns were fabricated and cemented (Rely X Luting Plus Cement) onto duplicate epoxy resin dies. Twelve crowns of each were accessed to simulate root canal treatment therapy. Surface defects of all accessed specimens were evaluated with an environmental scanning electron microscope. The specimens were repaired with a porcelain repair system (standard adhesive resin/composite resin protocol) and were loaded to failure in a universal testing machine. Observations made visually and microscopically noted veneer delamination from the core, core fracture, shear within the veneer porcelain, or a combination thereof. A Kruskal-Wallis test was used to determine if a significant difference (α=.05) in load to failure existed between the 4 groups, and a Mann-Whitney test with a Bonferroni correction (P Results All specimens exhibited edge chipping around the access openings. Some displayed larger chips within the veneering porcelain, and 4 zirconia crowns showed radial crack formation. There was a significant difference in load to failure among all groups with the exception of the alumina intact and repaired specimens (P=.695). The alumina crowns generally showed fracture of the coping with the veneering porcelain still bonded to the core, whereas the zirconia copings tended not to fracture but experienced veneering porcelain delamination. Conclusion Endodontic access through all-ceramic crowns resulted in a significant loss of strength in the zirconia specimens but not in the alumina specimens

    Selective Caries Removal in Permanent Teeth (SCRiPT) for the treatment of deep carious lesions:a randomised controlled clinical trial in primary care

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    Background Dental caries is one of the most prevalent non-communicable disease globally and can have serious health sequelae impacting negatively on quality of life. In the UK most adults experience dental caries during their lifetime and the 2009 Adult Dental Health Survey reported that 85% of adults have at least one dental restoration. Conservative removal of tooth tissue for both primary and secondary caries reduces the risk of failure due to tooth-restoration, complex fracture as well as remaining tooth surfaces being less vulnerable to further caries. However, despite its prevalence there is no consensus on how much caries to remove prior to placing a restoration to achieve optimal outcomes. Evidence for selective compared to complete or near-complete caries removal suggests there may be benefits for selective removal in sustaining tooth vitality, therefore avoiding abscess formation and pain, so eliminating the need for more complex and costly treatment or eventual tooth loss. However, the evidence is of low scientific quality and mainly gleaned from studies in primary teeth. Method This is a pragmatic, multi-centre, two-arm patient randomised controlled clinical trial including an internal pilot set in primary dental care in Scotland and England. Dental health professionals will recruit 623 participants over 12-years of age with deep carious lesions in their permanent posterior teeth. Participants will have a single tooth randomised to either the selective caries removal or complete caries removal treatment arm. Baseline measures and outcome data (during the 3-year follow-up period) will be assessed through clinical examination, patient questionnaires and NHS databases. A mixed-method process evaluation will complement the clinical and economic outcome evaluation and examine implementation, mechanisms of impact and context. The primary outcome at three years is sustained tooth vitality. The primary economic outcome is net benefit modelled over a lifetime horizon. Clinical secondary outcomes include pulp exposure, progession of caries, restoration failure; as well as patient-centred and economic outcomes. Discussion SCRiPT will provide evidence for the most clinically effective and cost-beneficial approach to managing deep carious lesions in permanent posterior teeth in primary care. This will support general dental practitioners, patients and policy makers in decision making. Trial Registration Trial registry: ISRCTN. Trial registration number: ISRCTN76503940. Date of Registration: 30.10.2019

    Systematic Review Of The Published Literature On Success And Failure Rates Of Nonsurgical Endodontic Treatment

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    Purpose: The aim of this study was to conduct a systematic review of the literature on treatment results in non-surgical Endodontic therapy. This included researching and defining inclusion and exclusion criteria and applying these criteria to identified relevant publications. The overall goal was to analyze the available literature and synthesize these results in an effort to inform the profession on the success and failure rates in non-surgical root canal therapy. Materials and Methods: Inclusion and exclusion criteria were established in an effort to systemically review and formulate an evidence-based understanding of treatment results in non-surgical root canal therapy. A comprehensive literature search was conducted using using PubMed and the Cochrane database using the search terms root canal therapy, apical periodontitis, success, failure, and treatment outcome and was restricted to January 2009 through December 2011. Articles were reviewed and analyzed according to the inclusion/exclusion criteria. Results: A review of the abstracts for these 330 publications resulted in 51 publications articles to be examined more closely for relevance and inclusion. From this, no publication met all defined inclusion/exclusion criteria. Discussion: Defining a set of criteria for how success is defined in practice is vital to the field of Endodontics. It is important to define, establish and incorporate a standardized methodology in the way research is conducted on Endodontic treatment results. This is necessary for the application of research to the practice of evidence-based Endodontics

    The effectiveness of Atraumatic Restorative Treatment versus conventional restorative treatment for permanent molars and premolars A critical assessment of existing systematic reviews and report of a new systematic review

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    Available for download at: http://mahara.qmul.ac.uk/view/view.php?id=16447Available for download at: http://mahara.qmul.ac.uk/view/view.php?id=16447Available for download at: http://mahara.qmul.ac.uk/view/view.php?id=16447Available for download at: http://mahara.qmul.ac.uk/view/view.php?id=16447Available for download at: http://mahara.qmul.ac.uk/view/view.php?id=16447Available for download at: http://mahara.qmul.ac.uk/view/view.php?id=16447Available for download at: http://mahara.qmul.ac.uk/view/view.php?id=16447Background: Atraumatic Restorative Treatment (ART) is the removal of caries using hand instruments and restoration of the resulting cavity using an adhesive restorative material. It was designed to restore teeth in communities without access to conventional dental clinics in poorer countries but has come to be used by dentists in the developed world too, as an alternative to conventional restorative treatment. Objectives: 1) to assess the scope and the methodological and reporting quality of existing systematic reviews of the effectiveness of ART compared to conventional restorative treatment; 2) to evaluate the effectiveness of ART compared to conventional treatment in permanent teeth with class I and II cavities. Methods: Searches: 1) for the assessment of existing systematic reviews: Electronic searches were conducted of OVID Medline, OVID Embase, The Cochrane Database of Systematic Reviews (CDSR), the Centre for Reviews and Dissemination (CRD) databases (DARE, NHSEED and HTA), Google Scholar, and the CNKI and CAOD Chinese databases; 2) for the systematic reviews of ART in permanent teeth: the above searches were supplemented by searches of the Cochrane Central Register of Controlled Trials (CENTRAL), LILAC, BBO, IMEAR (WHO Index Medicus for South East Region), WPRIM (WHO Western Pacific Region Index Medicus) and IndMed, Current Controlled Trials, Clinical Trials, OpenSIGLE, IADR conference abstracts and NLM Gateway. Hand searches were conducted of six dental journals known to have reported ART studies. References from retrieved systematic reviews, trials and other related papers were searched for additional reports. Authors were contacted. There were no language restrictions. Selection criteria: 1) for the assessment of existing systematic reviews: systematic reviews that compared ART to conventional treatment for the restoration of dental cavities; 2) for the systematic reviews of ART in permanent teeth: randomised controlled trials that compared ART using any adhesive material to conventional treatment using amalgam or any adhesive material Data collection: 1) for the assessment of existing systematic reviews: Reviews were selected and data was extracted by a single reviewer using a custom made data extraction sheet. Scope was assessed in terms of materials used, teeth and cavity type. Methodological quality was assessed using AMSTAR. Reporting quality was assessed using the PRISMA guidelines; 2) for the systematic reviews of ART in permanent teeth: reports of trials were screened and selected independently by two reviewers and data would have been extracted on a custom made data extraction sheet had there been eligible trials. Results: 1) for the assessment of existing systematic reviews: three systematic reviews were identified. Two of these were restricted to comparing ART with glass-ionomer to conventional treatment with amalgam; two allowed for inclusion of all cavity types in both deciduous and permanent teeth. None was of high methodological quality and reporting quality was good in one of the reviews only; 2) for the systematic reviews of ART in permanent teeth: no eligible trials were identified. Author’s conclusions: 1) existing systematic reviews do not have sufficient scope to allow for the inclusion of potentially eligible trials that would assess ARTs effectiveness and they have been of high to medium risk of bias; 2) it is disappointing that there are no properly conducted randomised controlled trials comparing ART to conventional treatment in class I and II cavities in the permanent dentition

    Implant Treatment in the Predoctoral Clinic: A Retrospective Database Study of 1091 Patients

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    Purpose: This retrospective study was conducted at the Marquette University School of Dentistry to (1) characterize the implant patient population in a predoctoral clinic, (2) describe the implants inserted, and (3) provide information on implant failures. Materials and Methods: The study cohort included 1091 patients who received 1918 dental implants between 2004 and 2012, and had their implants restored by a crown or a fixed dental prosthesis. Data were collected from patient records, entered in a database, and summarized in tables and figures. Contingency tables were prepared and analyzed by a chi-squared test. The cumulative survival probability of implants was described using a Kaplan-Meier survival curve. Univariate and multivariate frailty Cox regression models for clustered observations were computed to identify factors associated with implant failure. Results: Mean patient age (±1 SD) at implantation was 59.7 ± 15.3 years; 53.9% of patients were females, 73.5% were Caucasians. Noble Biocare was the most frequently used implant brand (65.0%). Most implants had a regular-size diameter (59.3%). More implants were inserted in posterior (79.0%) than in anterior jaw regions. Mandibular posterior was the most frequently restored site (43%); 87.8% of implants were restored using single implant crowns. The overall implant-based cumulative survival rate was 96.4%. The patient-based implant survival rate was 94.6%. Implant failure risk was greater among patients than within patients (p \u3c 0.05). Age (\u3e65 years; hazard ratio [HR] = 3.2, p = 0.02), implant staging (two-stage; HR = 4.0, p \u3c 0.001), and implant diameter (wide; HR = 0.4, p = 0.04) were statistically associated with implant failure. Conclusions: Treatment with dental implants in a supervised predoctoral clinic environment resulted in survival rates similar to published results obtained in private practice or research clinics. Older age and implant staging increased failure risk, while the selection of a wide implant diameter was associated with a lower failure risk
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