Attitudes towards and strategies for repair of dental direct restorations: Minimally Invasive Treatment approach

Repair of defective dental restorations may often save the patient time, pain and money at the dentists. Repair seem to be good treatment as to the quality of restorations, and preservation of teeth on the long run. Good routines for treatment procedures will be of consequence for the result. DDS Frode Staxrud, lecturer at Dental Faculty, UiO, has in a thesis for the degree Dr. Philos., looked into attitudes among Norwegian dentists towards repair of old dental restorations. Two questionnaires have been carried out, where the amount of and reasons for restoration repair was assayed. The thesis also comprise three in vitro material studies carried out at NIOM (Nordic Institute of Dental Materials, Oslo). They aimed to assess the importance of different methods concerning the repair process. Five research projects, published in scientific journals, constitutes the base of the thesis. The questionnaires show that Norwegian dentists often want to perform minimal invasive repair. The answers ranged from doing as little as necessary, to restorations that are more comprehensive. The conclusion is that the dentists show respect to the patients’ needs and concerns. After the “amalgam ban”, 2008, we wanted to assay Norwegian dentists’ attitudes towards alternative materials. Already in 2009, the general view on composites was positive, although many at that time certainly missed their custom material. The research at NIOM investigated different material properties concerning restoration repair. First, we explored the role of bonding in repair of resin composite restorations. The conclusion is that bonding plays a very important role for the strength of repair interface. Secondly, silanizing agents before bonding, or as an additive, was tested. The conclusion to be drawn is that silanes create important contribution to repair strength. The third experiment tested the repair strength when repairing old amalgam restorations with composite- or glass-ionomer materials. The conclusion was that the latter does not adhere to amalgam at all, and that bonding agents creates moderate bond strength between composite and amalgam. The main conclusion is that repair of defective dental restorations is common among Norwegian dentists and the repair should be reliable when considering the above-mentioned factors

The Post-Amalgam Era: Norwegian Dentists’ Experiences with Composite Resins and Repair of Defective Amalgam Restorations

Amalgam was banned as a dental restorative material in Norway in 2008 due to environmental considerations. An electronic questionnaire was sent to all dentists in the member register of the Norwegian Dental Association (NTF) one year later, to evaluate dentists’ satisfaction with alternative restorative materials and to explore dentists’ treatment choices of fractured amalgam restorations. Replies were obtained from 61.3%. Composite was the preferred restorative material among 99.1% of the dentists. Secondary caries was the most commonly reported cause of failure (72.7%), followed by restoration fractures (25.1%). Longevity of Class II restorations was estimated to be ≥10 years by 45.8% of the dentists, but 71.2% expected even better longevity if the restoration was made with amalgam. Repair using composite was suggested by 24.9% of the dentists in an amalgam restoration with a fractured cusp. Repair was more often proposed among young dentists (p < 0.01), employees in the Public Dental Service (PDS) (p < 0.01) and dentists working in counties with low dentist density (p = 0.03). There was a tendency towards choosing minimally invasive treatment among dentists who also avoided operative treatment of early approximal lesions (p < 0.01). Norwegian dentists showed positive attitudes towards composite as a restorative material. Most dentists chose minimally- or medium invasive approaches when restoring fractured amalgam restorations

Repair bond strength of bulk-fill composites: influence of different primers and direction of debonding stress

AbstractBackground The purpose of this in vitro study was to evaluate the effect of different adhesion primers on the repair bond strength of bulk-fill resin composite and short-term hydrolytic stability of the repair interface before and after accelerated aging. In addition, direction of debonding stress was examined.Materials and methods Bulk-fill substrates were aged in water for 14 days at 37 °C. Smooth resin composite surfaces were prepared for the substrates with a superfine grinding paper (FEPA #500, #1200, #2000). Test specimens were produced by attaching bulk-fill composite to the substrate surfaces, using three different primer/bonding systems. Specimens were aged 24 h at 37 °C in water, or thermal cycled (5–55 °C/5,000 cycles). Subsequently, shear bond strength and micro-tensile bond strength were evaluated. In total there were 60 specimens for the shear bond strength and 60 specimens for the micro-tensile bond strength measurements (30 stored in water 24 h, 30 thermal cycled, n = 10 in each primer/bonding mode).Results The mean shear bond strength was 9.1–13.1 MPa after 24 h water storage and 6.9–10.7 MPa after thermal cycling. The mean micro-tensile bond strength was 28.7–45.8 MPa after 24 h water storage and 22.7–37.9 MPa after thermal cycling.Conclusion The Ceramic primer (silane containing) seems to perform better than the three-step etch and rinse adhesive or the Composite primer. Shear-type stress had an adverse effect on the repair bond strength of bulk-fill resin composites

Silver release from dentine treated with combinations of silver diamine fluoride, potassium iodide and etching

AbstractFor individuals with very high to extremely high caries activity and poor control of daily oral hygiene, a simple treatment for arresting their caries activity is necessary. Silver Diamine Fluoride (SDF) has become increasingly common for this purpose due to its efficacy and ease of application. To avoid or reduce tooth discoloration after SDF treatment potassium iodide (KI) may be applied. However, the release of silver from SDF-treated tooth surfaces may be of concern. Thus, the aim of the present study was to quantify the amount of silver leached in both a short- and long-term perspective. In this in vitro experiment we measured the cumulative release of silver from SDF-treated dentin surfaces with and without imminent application of KI, and with and without phosphoric acid etching as pre-treatment, after 24 h and weekly for four weeks. The release of silver was highest after 24 h for all treatment groups, with a significant drop after this point. When etching was not used, the use of KI did not affect the release of silver. However, when etching was used, there was a significantly lower silver release when KI was also used compared to when KI was not used. This effect was largest for the first two weeks, after which the difference was smaller as all groups released low amounts of silver

Repair bond strength of bulk-fill composites:influence of different primers and direction of debonding stress

Abstract Background: The purpose of this in vitro study was to evaluate the effect of different adhesion primers on the repair bond strength of bulk-fill resin composite and short-term hydrolytic stability of the repair interface before and after accelerated aging. In addition, direction of debonding stress was examined. Materials and methods: Bulk-fill substrates were aged in water for 14 days at 37 °C. Smooth resin composite surfaces were prepared for the substrates with a superfine grinding paper (FEPA #500, #1200, #2000). Test specimens were produced by attaching bulk-fill composite to the substrate surfaces, using three different primer/bonding systems. Specimens were aged 24 h at 37 °C in water, or thermal cycled (5–55 °C/5,000 cycles). Subsequently, shear bond strength and micro-tensile bond strength were evaluated. In total there were 60 specimens for the shear bond strength and 60 specimens for the micro-tensile bond strength measurements (30 stored in water 24 h, 30 thermal cycled, n = 10 in each primer/bonding mode). Results: The mean shear bond strength was 9.1–13.1 MPa after 24 h water storage and 6.9–10.7 MPa after thermal cycling. The mean micro-tensile bond strength was 28.7–45.8 MPa after 24 h water storage and 22.7–37.9 MPa after thermal cycling. Conclusion: The Ceramic primer (silane containing) seems to perform better than the three-step etch and rinse adhesive or the Composite primer. Shear-type stress had an adverse effect on the repair bond strength of bulk-fill resin composites

How French dentists manage defective restorations: Evidence from ReCOL the French dental practice-based research network––A survey study

Objectives: The objective of this study was to describe the knowledge, opinions and practices about the defective restoration (DR) management of French general dental practitioners (GDPs). Methods: A cross-sectional, online survey-based study was carried out amongst 378 GDPs - members of the dental practice-based research network in France (ReCOL). Bivariate comparisons were made using Fisher's exact test to assess the association of the respondent characteristics (age, gender…) with the decision to repair DRs, and responses to clinical cases. Results: The response rate was 82.9%. 50.4% of the respondents declared they at least sometimes consider DRs repair in their clinical practice instead of DRs total replacement. For the 89.8% who at least rarely repaired DRs, the main characteristic determining the therapeutic strategy was the defect size (71%, mainly inclined to repair small defects), followed by the defect type (marginal defect or crack for more than 60% of the respondents) and the material of initial restoration (composite for 63.5%). When shown clinical photographs illustrating DRs, most of respondents proposed a replacement with inlay/onlay or crown. Conclusions: This study indicates that a significant proportion of French GDPs do not make sufficient use of DR repair on a routine basis. A lack of knowledge of the concept seems to explain at least part of this situation. Collective and individual efforts from the profession are still needed to promote DR repair and therefore more often apply MinimalIntervention Dentistry. Clinical significance: This survey shows that MID is not yet sufficiently used in routine practice in France regarding DR management. Further efforts (continuing education toward MID, public funding revaluation for MID strategies…) are needed to help GDPs to implement MID into everyday practice

RoBDEMAT: A risk of bias tool and guideline to support reporting of pre-clinical dental materials research and assessment of systematic reviews

International audienceObjectives: To develop a risk of bias tool for pre-clinical dental materials research studies that aims to support reporting of future investigations and improve assessment in systematic reviews.Methods: A four-stage process following EQUATOR network recommendations was followed, which included project launch, literature review, Delphi process and the tool finalization. With the support of the European Federation of Conservative Dentistry (EFCD) and the Dental Materials Group of the International Association for Dental Research (DMG-IADR), a total of 26 expert stakeholders were included in the development and Delphi vote of the initial proposal. The proposal was built using data gathered from the literature review stage. During this stage, recent systematic reviews featuring dental materials research, and risk of bias tools found in the literature were comprehensively scanned for bias sources. The experts thus reached a consensus for the items, domains and judgement related to the tool, allowing a detailed guide for each item and corresponding signalling questions.Results: The tool features nine items in total, spread between 4 domains, pertaining to the following types of bias: bias related to planning and allocation (D1), specimen preparation (D2), outcome assessment (D3) and data treatment and outcome reporting (D4). RoBDEMAT, as presented, features signalling questions and a guide that can be used for RoB judgement. Its use as a checklist is preferred over a final summary score.Conclusion: RoBDEMAT is the first risk of bias tool for pre-clinical dental materials research, supported and developed by a broad group of expert stakeholders in the field, validating its future use.Clinical significance: This new tool will contribute the study field by improving the scientific quality and rigour of dental materials research studies and their systematic reviews. Such studies are the foundation and support of future clinical research and evidence-based decisions

RoBDEMAT: A risk of bias tool and guideline to support reporting of pre-clinical dental materials research and assessment of systematic reviews

10.1016/j.jdent.2022.104350Journal of Dentistry127104350-10435