Objective To evaluate the 5-year clinical performance of a glass hybrid restorative system and a nano-hybrid resin composite in moderate to large two-surface class II cavities. Materials and methods This study was carried out by dental schools in Zagreb, Croatia; Izmir, Turkey; Belgrade, Serbia; and Milan, Italy. A total of 180 patients requiring two class-II two-surface restorations in the molars of the same jaw were recruited. The teeth were randomly restored with either a nano-hybrid resin composite (Tetric EvoCeram, Ivoclar Vivadent) or a glass-hybrid material (EQUIA Forte, GC). During the 5-year follow-up, two calibrated evaluators at each centre scored the restorations annually using the FDI-2 scoring system. The survival rates were calculated using the Kaplan–Meier method and compared using non-parametric matched pair tests ( p < 0.05). Results There were no statistically significant differences between the overall survival and success rates of the two types of restorations (p>0.05). The success rates (FDI-2 scores 1–3) for EQUIA Forte were 81.9% (average annual failure rate: 3.9%) and 90.7% for Tetric EvoCeram (average annual failure rate: 1.9%). The survival rates (FDI-2 scores 1–4) for EQUIA Forte and Tetric EvoCeram were 94.5% and 94.4%, respectively, with an average annual failure rate of 1.1%. Conclusions In terms of success and survival rates, both the glass-hybrid restorative system and the nano-hybrid resin composite have been shown to perform satisfactorily. Clinical relevance The results of this study indicate that EQUIA Forte can be one of the therapeutic options for moderate to large two-surface class II restorations of posterior teeth.

Understanding that dental carious lesions occur as a result of the action of micro-organisms in the dental plaque biofilm, where demineralisation on the tooth surface is the first sign of the disease, such incipient lesions can be treated using preventive, non-operative and minimally invasive operative dentistry. If the caries process is left unmanaged, the lesions progress towards cavitation, leading to more invasive treatments. This article discusses the principles of preventive, non-invasive and micro-invasive treatments of early carious lesions, outlining the clinical situations where these therapies can be applied.

OBJECTIVES:We assessed the long-term cost-effectiveness of glass hybrid (GH) versus composite (CO) for restoring permanent molars using a health economic modelling approach.METHODS:A multi-national (Croatia, Serbia, Italy, Turkey) split-mouth randomized trial comparing GH and CO in occlusal-proximal two-surfaced cavities in permanent molars (n=180/360 patients/molars) provided data on restoration failure and allocation probabilities (i.e. failure requiring re-restoration, repair or endodontic therapy). Using Markov modelling, we followed molars over the lifetime of an initially 12-years-old individual. Our health outcome was the time a tooth was retained. A mixed-payers' perspective within German healthcare was used to determine costs (in Euro 2018) using fee item catalogues. Monte-Carlo-microsimulations, univariate and probabilistic sensitivity analyses were conducted. Incremental cost-effectiveness ratios (ICER)s and cost-effectiveness-acceptability were quantified.RESULTS:In the base-case scenario, CO was more effective (tooth retention for a mean (SD) 54.4 (1.7) years) but also more costly (694 (54) Euro) than GH (53.9 (1.7) years; 614 (56 Euro). The ICER was 158 Euro/year, i.e. payers needed to be willing to invest 158 Euro per additional year of tooth retention when using CO. In a sensitivity analysis, this finding was confirmed or GH found more effective and less costly.CONCLUSION:CO was more costly and limitedly more effective than GH, and while there is uncertainty around our findings, GH is likely a cost-effectiveness option for restoring permanent molars.CLINICAL SIGNIFICANCE:When considering the long-term (life-time) cost-effectiveness, GH showed cost savings but CO was limitedly more effective. Overall, cost-effectiveness differences seems limited or in favour of GH.

This ex vivo study aimed to compare the microtensile bond strength of fiber-reinforced and particulate filler composite to coronal and pulp chamber floor dentin using a self-etching adhesive system. Coronal dentin of 40 human molar teeth was exposed by cutting occlusal enamel with a low-speed saw. Teeth were then randomly divided into two groups (n = 20). The first group was left as is, while in the second group, pulp chamber floor dentin was exposed by trepanation. After placement of a self-etching adhesive system (G-aenial Bond, GC, Tokyo, Japan), groups were further divided into two sub-groups (n = 10) according to the type of composite: fiber-reinforced composite (EP, everX Posterior, GC, Tokyo, Japan) and particulate filler composite (GP, G-aenial Posterior, GC, Tokyo, Japan). Then, composite blocks were built up. Sticks (1.0 × 1.0 mm2) were obtained from each specimen by sectioning, then microtensile bond strength (μTBS) test was performed. Statistical analysis included one-way ANOVA test and Student's t-test (p < 0.05). μTBS values were 22.91 ± 14.66 and 24.44 ± 13.72 MPa on coronal dentin, 14.00 ± 5.83 and 12.10 ± 8.89 MPa on pulp chamber floor dentin for EP and GP, respectively. Coronal dentin yielded significantly higher μTBS than pulp chamber floor dentin (p < 0.05), independently from the tested composites.

Background: Rapid detection and isolation of SARS-CoV-2 infections is critical to mitigate the pandemic;however, testing access across the US has been uneven and data on barriers to testing are limited. Methods: We conducted serial cross-sectional assessments of experiences around SARS-CoV-2 PCR testing in Florida, Illinois, and Maryland. We sampled ∼1000/state using an online survey from Jul 15-31 and Sep 16-Oct 15, 2020, with additional waves planned at 6-8 week intervals. At the time of surveys, there were no systematic differences in testing availability (public, private and free testing options) across these states. Participants were recruited using on online panel;demographic targets were provided to match age, sex, race/ethnicity and income distributions of each state. Participants were ≥18 years, provided consent, and resided in the study state. The survey covered demographics, symptoms, and PCR testing in the prior 2 weeks. Results: Of 3,058 persons surveyed most recently (Sep 16-Oct 15), 316 (10%) reported wanting/needing a test in the prior two weeks. Median age of participants wanting/needing a test was 36 years and 46% were female;47% self-identified as White and 57% reported working outside home. Of 316 who wanted/needed a test in the prior 2 weeks, 53% were able to get tested, of whom, 94% received results, with no significant differences by state (Figure);this was not substantially different from the proportion able to get tested in July (51%). Among those wanting/needing a test, getting tested was significantly less common among men (aOR: 0.46) and those reporting black race (aOR: 0.53) and more common in those reporting recent travel (aOR: 3.35;all p<0.05). The primary reasons for testing were desire to know status (35%) and symptoms (28%). Among those tested, 53% had to wait ≥8 days to get a result from the time they wanted/needed a test. Of those tested, 71% reported quarantining while awaiting results. An additional 146 who wanted/needed a test did not get tested;the main reasons for not testing in this group were not knowing where to go (36%) and distance/waiting time (33%);an additional 21% reported fear of being tested. Conclusion: These data reflecting similar testing barriers across three US states underscore the importance of a unified national strategy with clear messaging on who, where, when, and how to get a test, as well as improved turn-aroundtimes. As demand rises borrowing strategies from HIV such as self-testing could help overcome logistical barriers.

Objectives: We assessed the cost-effectiveness of two amalgam alternatives, glass hybrid (GH) and composite (CO) in a multi-country randomized controlled split-mouth trial. Materials: University clinics in Croatia, Serbia, Italy and Turkey participated. Pairs of GH (EQUIA Forte, GC) and a nano-hybrid CO (TetricEvoCeram, IvoclarVivadent) were randomly placed in occlusal-proximal two-surfaced cavities in permanent molars of adults (n = 180/360 patients/molars). We used 3-years interim data for this evaluation. FDI-2 criteria were applied and teeth requiring repair, re-restoration, endodontic treatment or extraction recorded. Our outcome was the time until any or major complications (requiring endodontic treatment or extraction) occurred. Costs were calculated in US Dollar (USD) 2018, with the local currencies being converted using Purchasing Power Parities. To estimate initial and re-treatment costs, a payers' perspective was taken and direct medical costs estimated from fee item catalogues. Incremental-cost-effectiveness ratios (ICER) were used to express the cost difference per gained or lost effectiveness. Results: Overall costs were lower for GH than CO in Croatia, Turkey and Serbia, while this difference was minimal in Italy. GH tended to survive longer than CO in Croatia and Italy, and shorter in Serbia and Turkey; overall survival time was not significantly different (p = 0.67/log-rank). The cost-effectiveness differences indicated CO to be more expensive at limited (ICER: 268.5 USD/month without any complications) or no benefit at all (-186.2 USD/month without major complications). Conclusions: GH was less costly than CO both initially and over 3 years. Efficacy differences were extremely limited. Clinical significance: Given their low initial costs and as efficacy between GH and CO did not differ significantly, GH had a high chance of being more cost-effective within this specific trial.

Aim: The aim of the study is to reveal the relationship between smoking status and nicotine addiction and tooth loss in patients.Materials and Methods: Approval was obtained from the OMU Clinical Research Ethics Committee for the study.A questionnaire including Fagerström nicotine dependence test and DMFT index was created to evaluate the patients' condition.Radiographic examination and clinical examination were performed.The analysis and evaluation of the data was done with SPSS 25.0, statistical significance level was accepted as p <0.05.Results: 124 patients who applied to OMU Faculty of Dentistry were included in the study.The average age was 38.42 ± 14.46 years (min:18-max:72).65 (52.4%) of the patients included in the study were nonsmokers, 55 (44.4%) were currently smoking and 4 (3.2%) had quit smoking.The mean number of missing teeth was 3.57 ± 3.9 (min:1max:19).The mean DMFT index was 9.58 ± 6.08 (min:1-max:28).Those who currently smoke and quit smoking were separated as the case and the control group.The mean number of missing teeth in the case group (X ̅= 4.14) was significantly higher than the control group (X ̅= 3.06).There was a significant positive correlation between the number of teeth lost and the number of cigarettes used per day (pack), duration of smoking (years) and the amount of smoking (pack years) of patients who smoked in a period of their life.As a result of linear regression analysis, the change in the number of missing teeth can be explained by 4 independent variables (age, amount of smoking (pack year) FNTD score, tooth brushing frequency) with a rate of 34.1%.Conclusion: In the study, a significant relationship was found between smoking and the number of missing teeth.Due to the increase in nicotine addiction, an increase in the number of missing teeth was found.

Objective: To provide a narrative review of the preprocedural mouth rinse protocols suggested for oral surgery in order to contrast the presence of SARS-CoV-2 in aerosol. Sources and Methods: Electronic searches were performed in medical databases PubMed, Medline, CINAHN and Scopus to identify relevant studies published up until the third week of April 2020. This research was supplemented by exploration through a web-based search engine as well as a manual search for international and national guidelines. Studies and protocols which suggested preoperative mouth rinsing as a recommended measure during the COVID-19 outbreak were included. Given the small number of studies, a narrative literature review was conducted. In total, 15 references (11 articles and 4 guidelines) were considered relevant and were critically analysed. Conclusion: The findings show a high heterogeneity in the protocols suggested. Further research is required to better understand the viral features and epidemiologic characteristics of this new virus and to test the efficacy of commonly used antiseptics against SARS-CoV-2 in future clinical trials. However, the use of chlorhexidine, hydrogen peroxide, PVP-I and cetylpyridinium chloride in contrasting the spread of Covid-19 is described as advisable and substantial in different publications.

Cette contribution propose une breve reflexion theorique sur le patrimoine en tant que « lieu » d'une activation potentielle d'acteurs, ressources, projets, pratiques et savoirs lies a un…

PURPOSE:To compare the clinical performance of a glass hybrid restorative system, EQUIA Forte, with that of a nanohybrid resin composite, Tetric EvoCeram, in two-surface class II cavities.MATERIALS AND METHODS:This multicenter, randomized controlled clinical study was conducted at four different dental schools. In total, 360 restorations were placed in patients in need of two class-II, two-surface restorations in the molar region of the same jaw. Each patient received one glass hybrid restoration (EQUIA Forte, GC) and one resin composite restoration (Tetric EvoCeram, Ivoclar Vivadent). Two independent evaluators performed a clinical evaluation of each site after 1 week (baseline), 1 year, and 2 years using the criteria of the FDI World Dental Federation (FDI-2).RESULTS:The estimated survival rates at the 2-year recall were 93.6% and 94.5% for EQUIA Forte and Tetric EvoCeram, respectively. There were no significant differences in the survival rates or in any of the evaluated esthetic, functional or biological properties between EQUIA Forte and Tetric EvoCeram restorations (p ˃ 0.05).CONCLUSION:Both the glass-hybrid restorative system and nanohybrid resin composite showed good clinical performance in moderate to large two-surface class II restorations in a 2-year follow-up.

Objective. The restorative treatment of a decayed, non-vital upper premolar often requires an interdisciplinary approach. Esthetics and the entity of the masticatory loads are usually affecting the choice of procedures and materials. A conservative treatment in a case with esthetic needs and functional requirements is investigated in this case report. Materials and methods. A case of a 45- yearold woman with a severely decayed upper premolar is presented. The tooth has been previously treated in an emergency department with a provisional endodontic medication, but a further treatment has been then performed. The tooth was painful at the moment of the visit and the carious lesion appeared to invade the subgingival level. A surgical-conservative approach has been selected involving crown lengthening, endodontic treatment and a prosthetic crown with a monolithic Lithium- Silicate. Results. The rehabilitative process required 3 months, including maturation times after surgery and the placement of the provisional crown. The patient claimed to be both esthetically and functionally satisfied with the restoration. Conclusion. A conservative treatment of a severely involved tooth requires a critical evaluation of the remaining structures and a precise selection of the restorative materials. A monolithic crown could represent an ideal solution for restoring an upper premolar requiring esthetics and solid function, but the choice of a high translucent, easily polishable and possibly even chair-side prosthetic material might be an appreciable added value for clinicians.

Objective: To compare the shear bond strength (SBS) values of orthodontic brackets luted using a resin-modified glass ionomer cement (RMGIC) on enamel surfaces etched using either an Er:YAG laser in two different working modes, or a conventional etching protocol, including phosphoric acid. Materials and methods: Sixty healthy human premolars were randomly allocated to three experimental groups (n=20) and etched with: Group 1: Er:YAG laser in super-short pulse (SSP) mode (100 mJ, 20 Hz, 2 W); Group 2: Er:YAG laser in quantum square pulse mode (120 mJ, 10 Hz, 1.2 W) using a digitally controlled handpiece ("X-Runner"); Group 3 (control): 5.25% sodium hypochlorite pretreatment, then 37% phosphoric acid for 15 sec. Stainless steel brackets were bonded using light-curing RMGIC for orthodontic bonding. After term cycling (1800 cycles), SBS testing was performed using a universal testing machine. After debonding, both enamel and bracket surfaces were examined to determine the amount of RMGIC still present on the surfaces. Results: Group 3 surfaces gave the lowest mean SBS (10.6104 +/- 2.66196 MPa), whereas Group 1 provided the highest 1 (13.1795 +/- 3.37904 MPa), which was significantly different from the control (Group 3, p=0.0226). Group 2 provided intermediate values (11.8486 +/- 0.59832 MPa) nonsignificantly different from the control or from SSP (p=0.4215 and p=0.3082, respectively). Conclusions: Er:YAG laser treatment in SSP mode of enamel surfaces for orthodontic bonding provided higher SBS and a shear behavior of the luting material similar to the conventional acid-etching procedures, making it a viable alternative to acid etching.

OBJECTIVESThe average age of world populations has been growing almost continuously for several decades. Medical therapies, positive socio-economic conditions and the adoption of quality lifestyles are certainly the main factors contributing to this increase.MATERIALS AND METHODSFrom the dental point of view, oral health has also seen a marked improvement over the past years, with a notable reduction in epidemiological indices for diseases such as dental caries and periodontitis. From a statistical point of view, however, this means that over the next few years, dental practices will be dealing with an increasing number of elderly patients, who will also present a higher number of their own teeth in respect to present times.RESULTSIf a tooth lingers more in the oral cavity of the patient, it will meet all the diseases related to its prolonged use, especially abrasions, erosions, fractures, root dental caries. However, the tissues of a tooth of an elderly subject has very peculiar histomorphological characteristics, and its mechanical behavior is very different from that of a young tooth, which is more elastic and repairable.CONCLUSIONSIt is necessary that the professional knows all typical pathologies of the dental elements of an elderly subject, the limits to therapeutic treatments, the possible interferences of the commonly used pharmacological therapies and the behavior over time of the treatments performed, compared to the younger patients, if he wants to avoid early failure of the therapies.

OBJECTIVESNumerous active ingredients have been developed over the last few years and are described as being able to interact with the demineralized surfaces of the hard dental tissues so far as to be reconstructed, regenerated and repaired. Beyond the commercial communication of individual products, returning damaged enamel and damaged dentine minerals is certainly possible, although the biological mechanisms that govern the processes of dental remineralization must be known beforehand, and therefore what active principles can be more effective than others.MATERIALS AND METHODSThe active agents currently available on the market have been analyzed, considering the mechanisms of action, the advantages and the role within dental remineralization.RESULTSAmong the various active ingredients, those with higher biomimetic activity seem to promise the best results for effective remineralization of tooth tissues. The increasing of the presence and bioavailability of ions such as calcium and phosphate seems to be linked to a better remineralizing action by these more bioactive principles. The development of knowledge and the advent of nanotechnology has certainly helped the formulation of bioavailable mineral particulates, mainly based on calcium, phosphates and fluoride.CONCLUSIONSBeyond the active ingredient used, only the biological processes that normally occur within the oral cavity can bring any product to the ideal environment to function. It is therefore essential to understand when a remineralizing treatment should be used, to fully understand the biological mechanisms that regulate the balance between acid demineralization and remineralization, to understand the biochemical mechanisms for which an active ingredient contained in a product the practitioner is about to use should work, identify risk factors that could reduce the effectiveness of the treatment and remove, if possible, possible barriers to the operation of the therapy.

OBJECTIVESDental vitality is an important prognostic factor for the survival of a dental element. The loss of vitality, especially if in early stages of age, often precludes the possibility of a lifetime permanence of the dental element, although even sophisticated conservative treatments can be performed.MATERIALS AND METHODSThere are numerous approaches that have been described in the literature to preserve pulpal vitality. Maintaining the dental vitality allows to keep a more elastic and hydrated tooth, a normal root development (if dental caries has developed in early stages of age), the possibility of performing conservative therapies instead of more invasive prosthetic therapies, and a type of periodic remaking that normally requires less sacrifice than healthy tissues.RESULTSIt has been many years since it was essential to endodontically treat a tooth when the removal of tooth decay exposed of the dental pulp: now, the availability of bio-compatible and bioactive materials able to protect the exposed areas of pulp induces a new proliferation of a dentinal seal the injured part. Moreover, the possibility of using bioactive restorative materials such as some bioglasses or glassionomer cements allows to interact with the demineralized dentin or even the frankly softened one, allowing the operator to avoid a massive tissue removal and limiting the risk of pulp exposure.CONCLUSIONSThe clinician is required to know the biological mechanisms that regulate the pulp healing processes and the use of some bioactive materials that can be used in direct contact with the cells of the pulp, with the relative results that can be obtained in terms of preservation of vitality.