BMC Oral Health最新文献

Background: Pit and fissure sealants are widely used for caries prevention; however, their long-term success depends largely on retention. Giomer-based sealants containing surface pre-reacted glass ionomer fillers offer bioactive properties, yet concerns remain regarding their bonding durability when applied with mild self-etch primers. This randomized clinical trial evaluated the effect of bioactive glass air-abrasion pretreatment on the retention and caries preventive efficacy of a giomer-based sealant in young adults over 12 months.

Methods: This parallel-arm randomized clinical trial included 96 participants, each contributing one eligible sound permanent molar (n = 48 per group). Participants were randomly allocated to either bioactive glass air-abrasion pretreatment followed by application of a giomer-based sealant (intervention group) or application of the same sealant without pretreatment (comparator group). Sealant retention and secondary caries incidence were evaluated at baseline, 6 months, and 12 months using Simonsen's criteria, and modified United States Public Health Service (USPHS) criteria, respectively. The primary outcome was sealant retention at 12 months, whereas secondary caries incidence was assessed as a secondary outcome. Intergroup comparisons were analyzed using the Chi-square test. Intragroup comparisons were analyzed using Cochran's Q test followed by multiple comparisons. Relative risk with 95% confidence intervals was calculated. Statistical significance was set at p ≤ 0.05.

Results: At 6 months, complete sealant retention was observed in 91.7% of teeth in the intervention group and 75.0% in the comparator group, with no statistically significant difference between groups (p = 0.068). At 12 months, complete sealant retention was significantly higher in the intervention group (87.5%) than in the comparator group (33.3%) (p < 0.0001). Teeth in the intervention group exhibited an 81.25% lower risk of sealant retention failure compared with the comparator group (RR = 0.1875; 95% CI: 0.0864-0.4069; p < 0.0001). No differences in secondary caries incidence were detected between groups during the 12-month follow-up period (p = 1.0000).

Conclusions: Bioactive glass air-abrasion pretreatment significantly improved the retention of a giomer-based fissure sealant compared with sealant application without pretreatment. No differences in secondary caries incidence were detected between groups during the 12-month follow-up period. Incorporating mechanical surface conditioning prior to sealant placement may enhance sealant retention without compromising preventive efficacy.

Trial registration: https://clinicaltrials.gov/ , (NCT06003452), 15-08-2023.

Background: Periodontitis is commonly known as a chronic inflammatory disease which adversely affects pulpal and periodontal tissues, including odontoblasts. Bone marrow mesenchymal stem cell-derived exosomes (BM-MSC-Exo) and nanocurcumin (NCUR) possess anti-inflammatory and regenerative properties; however, their combined effects on odontoblasts remain insufficiently explored. The research target was to assess the histological, histochemical, and anti-inflammatory effects of BM-MSC-Exo and NCUR-loaded BM-MSC-Exo on odontoblasts of LPS-induced periodontitis in rats.

Methods: Twenty-eight male albino rats were assigned at random into four groups (n = 7 each): control, periodontitis, periodontitis treated with BM-MSC-Exo, and periodontitis treated with NCUR-loaded BM-MSC-Exo. Periodontitis was induced via intra-periodontal LPS injections. Histological evaluation was performed using hematoxylin and eosin staining, and collagen synthesis was analyzed using Masson's trichrome stain. Morphometric analysis of newly formed collagen and enzyme-linked immunosorbent assay (ELISA) of interleukin-10 (IL-10) levels were conducted.

Results: Untreated periodontitis caused marked odontoblastic degeneration, reduced predentin thickness, and decreased collagen formation. Treatment with BM-MSC-Exo significantly improved odontoblastic architecture, enhanced collagen deposition, and increased IL-10 expression. NCUR-loaded BM-MSC-Exo demonstrated superior regenerative and anti-inflammatory effects, characterized by improved odontoblastic organization, increasing the area of newly formed collagen, and significantly elevated IL-10 levels compared with all other groups (p < 0.001).

Conclusions: BM-MSC-Exo exerts regenerative effects on odontoblasts in periodontitis, which are further enhanced by NCUR loading. NCUR-loaded BM-MSC-Exo declares an encouraging cell-free medicinal strategy for regeneration of periodontal and pulpal tissues.

Statement of problem: The selection of appropriate dental materials plays a crucial role in the success of prosthetic restorations. With the limitations of metallic alloys, including their aesthetic shortcomings, weight, corrosion potential, and cost, there is growing interest in high-performance polymer alternatives.

Purpose: The objective of the present study was to evaluate color stability, surface roughness and Hardness of BioHPP, Nanocarbon HPP and PEEK used for fabrication of prosthetic restorations (An In Vitro Study).

Material and methods: A total of 42 cylindrical samples (14 per group) were divided into three groups: Group 1: nanocarbon High-Performance Polymer, Group 2: BioHPP, Group 3: PEEK. They were fabricated using CAD/CAM technology and subjected to thermocyclic aging. Color stability was assessed spectrophotometrically after immersion in a staining medium over 28 days. Surface roughness was measured using a profilometer, while hardness was evaluated using the Vickers hardness test.

Results: Statistically significant differences were observed among all three materials in color stability, surface roughness, and hardness (p < 0.001). PEEK demonstrated the highest surface roughness, while nano-carbon reinforced polymersexhibited the lowest surface roughness and highest hardness values. In terms of color stability, all materials showed varying degrees of discoloration over time, but nano-carbon-HPP generally maintained better stability.

Conclusion: Nano-carbon-HPP demonstrated superior mechanical performance, combining low surface roughness with high hardness, making them a promising alternative to traditional materials for full-arch dental prostheses. These findings highlight the potential of nano-carbon materials to improve durability, patient comfort, and aesthetic outcomes in prosthodontic applications.

Clinical implication: The use of nano‑carbon reinforced polymers may improve the longevity, esthetics, and patient comfort of implant‑supported overdentures.

Background: This study aimed to evaluate the efficacy of Er: YAG laser treatment for glass-ceramic bonding to bleached enamel and to further investigate the potential mechanisms.

Methods: This in vitro study included 132 molars, with each molar used to prepare a single specimen. A total of 48 enamel slices, 48 enamel blocks, and 36 embedded whole-tooth specimens were prepared. The specimens were randomly allocated to four groups: the Control group, hydrogen peroxide (HP) group, HP combined with sodium ascorbate (HP-SA) group, and HP combined with Er: YAG laser (HP-Er: YAG) group. They were subsequently evaluated for enamel surface morphology, residual hydrogen peroxide (H₂O₂) concentration, resin degree of conversion (DC), resin penetration, shear bond strength (SBS), and failure mode.

Results: SEM showed that the HP-Er: YAG group exhibited rough and irregular enamel surfaces, while the HP and HP-SA groups showed no obvious morphological changes. Compared with the HP group (109.60 ± 10.38 µmol/L), H₂O₂ concentrations were significantly lower in the HP-SA (51.05 ± 20.06 µmol/L) and HP-Er: YAG (29.96 ± 13.01 µmol/L) groups (P < 0.0001). The HP-Er: YAG group showed a lower concentration than the HP-SA group (P < 0.05).The DC of the HP-Er: YAG group (51.10 ± 7.02%) was comparable to that of the Control (59.84 ± 5.36%) and HP-SA (41.82 ± 7.28%) groups (P > 0.05). The Control and HP-Er: YAG groups exhibited extensive resin penetration at the enamel-adhesive interface. SBS was significantly higher in the Control (21.92 ± 4.33 MPa) and HP-Er: YAG (22.62 ± 4.06 MPa) groups than in the HP (13.46 ± 3.62 MPa) and HP-SA (17.76 ± 2.56 MPa) groups (P < 0.01). For ARI scores, the Control and HP-Er: YAG groups did not differ significantly (P > 0.05), whereas all other pairwise comparisons were statistically significant (P < 0.05).

Conclusion: Reduced H₂O₂ levels, increased resin polymerization, and modification of the enamel surface may contribute to the improved bonding performance observed after Er: YAG laser treatment of bleached enamel. Compared with 10% SA treatment for 10 min, Er: YAG laser was more effective in restoring bond strength, suggesting its potential for immediate glass‑ceramic bonding to bleached enamel.

Background: Early childhood caries (ECC) is one of the most common chronic conditions affecting children worldwide, with more than 530 million children affected. In Qatar, ECC prevalence among preschool children aged 4-5 years is reported at 89%. ECC can lead to significant physical, psychosocial, and economic consequences but is largely preventable through early preventive measures such as professionally applied fluoride varnish (FV). In Qatar, lack of water fluoridation and challenges attending multiple healthcare appointments highlight the need to integrate oral health prevention into existing child health services. This study assessed the feasibility of providing FV for children aged 1-5 years at moderate to high risk of ECC during routine well-baby visits in Qatar.

Methods: This was a 3-month feasibility study evaluating the implementation of fluoride varnish application among 50 children at moderate or high caries risk. Feasibility was assessed across acceptability, implementation, practicality, and direct implementation costs using questionnaires, clinic logs, interviews, and cost analysis. The reporting followed the Template for Intervention Description and Replication (TIDieR).

Results: The mean time required for completion of the structured caries risk assessment and fluoride varnish application was 1.09 ± 0.33 and 1.37 ± 0.62 min, respectively. The direct cost was 15 QAR per application. Key barriers to implementation included limited instruments, insufficient staff, lack of space, and difficulty reaching children who rarely attend the health center.

Conclusion: Incorporating fluoride varnish treatment into standard immunization appointments for children under five in primary care in Qatar is achievable. Nonetheless, enhancements in appointment scheduling, staff training, provider notifications, and staffing are essential for successful deployment.

Background: Quantitative light-induced fluorescence (QLF) provides fluorescence-loss and red-fluorescence signals that may behave differently across devices, surfaces, and lesion thresholds. This study compared QrayCam Pro and QrayPen for occlusal and proximal caries in permanent posterior teeth.

Methods: In this single-centre, paired in vivo diagnostic-accuracy and reliability study, 120 consecutively recruited adults underwent QrayPen and QrayCam Pro imaging. Multiple surfaces could be contributed by one participant. Surface-specific regions of interest in QA2 software generated maximum fluorescence loss (|ΔFmax|) and maximum red fluorescence (ΔRmax). Occlusal surfaces were classified using ICDAS and proximal surfaces using bitewing-based International Caries Classification and Management System (ICCMS)-oriented categories. Agreement was evaluated on 194 occlusal and 397 proximal paired measurements. Diagnostic analyses included 181 occlusal surfaces with complete ICDAS scores and all 397 proximal surfaces. AUC confidence intervals and paired AUC contrasts were estimated by 10,000 participant-cluster bootstrap resamples; Holm adjustment was applied across four paired contrasts within each surface-threshold family.

Results: At ICDAS ≥ 1, QrayCam |ΔFmax| and QrayPen |ΔFmax| yielded AUCs of 0.909 (95% CI 0.862-0.950) and 0.872 (0.821-0.919), respectively; |ΔFmax| exceeded ΔRmax within both devices (Holm-adjusted P < 0.001), whereas the QrayCam-QrayPen |ΔFmax| difference did not remain significant after multiplicity correction (adjusted P = 0.061). At proximal ICCMS ≥ 1, AUCs ranged from 0.646 to 0.697 and no paired contrast was significant after adjustment. QrayPen |ΔFmax| exceeded QrayPen ΔRmax at ICCMS ≥ 2 (adjusted P = 0.022) and ≥ 3 (adjusted P = 0.005); at ICCMS ≥ 3, QrayCam ΔRmax exceeded QrayPen ΔRmax (adjusted P = 0.011). Excluding the verified QrayPen ΔRmax value of 1962 changed individual proximal AUCs by no more than 0.012.

Conclusions: Metric selection influenced diagnostic performance at selected thresholds, but it was not uniformly more important than device selection. |ΔFmax| was more consistent for early occlusal detection and selected proximal thresholds, while device differences were generally small or threshold-specific. QLF should be used as an adjunct to structured visual examination and bitewing radiography rather than as a replacement.

Trial registration: Not applicable; this was an observational diagnostic-accuracy study and was not prospectively registered.

Background: This study aimed to investigate the antibacterial effects of a self-adhesive 10-MDP contained Primer (Stela primer) modified with nano-sized zinc oxide (ZnO) and hydroxyapatite (HA) particles. Furthermore, it evaluated the extent of marginal microleakage in Class II restorations and conducted elemental analysis of the tooth-primer interface using energy-dispersive X-ray spectroscopy (EDX).

Materials and methods: The sixty-three premolars enrolled in this study were subjected to class II cavity preparation and divided into three groups according to the primer used (modified Stela primer containing zinc oxide nanoparticles (ZnO-NPs), hydroxyapatite nanoparticles (HA-NPs), and Stela primer without modification). Stela self-adhesive resin composite was applied to all teeth. The teeth were subjected to a microleakage test (n = 21) for each group and elemental analysis of the tooth-primer interface using EDX (n = 3) for each group. All modified and non-modified primers were evaluated for their antibacterial activity against Streptococcus mutans (S. mutans).

Results: No statistically significant differences in marginal microleakage were observed between the modified and unmodified groups at either the occlusal or gingival margins (P = 0.34 gingivally; P = 0.15 occlusally). EDX analysis showed a notable increase in calcium and phosphorus deposition at the tooth-primer interface in both nanoparticle-modified groups, especially in the HA-NP group, indicating interfacial mineralization (P < 0.001). The unmodified primer showed no significant changes in mineral content. Adding ZnO-NPs and HA-NPs to the Stela primer greatly improved its antibacterial effect against Streptococcus mutans, with HA-NPs producing the largest inhibition zone.

Conclusions: Incorporating ZnO-NPs and HA-NPs into Stela primer enhances its biological potential; however, they did not significantly alter the sealing ability (microleakage) compared to the control. Both nanoparticle-modified primers exhibited potent and comparable bactericidal activity against Streptococcus mutans. At the same time, nano-hydroxyapatite demonstrated the most pronounced antibacterial effect and the most significant improvement in mineral deposition at the tooth-primer interface.

Background: This in vitro study evaluated the impact of different workflow and finish line design on the marginal adaptation of 3D printed resin matrix ceramic crowns.

Methods: Forty extracted mandibular molars were randomly allocated into two groups according to finish line design (n = 20); heavy chamfer 0.8 mm (H) and conservative chamfer 0.2 mm (C). Each main group was divided into 2 subgroups (n = 10) according to workflow; direct digital intraoral scanning workflow (D) and semi-digital workflow (S). Crowns were 3D printed from hybrid resin and cemented using adhesive resin cement. Marginal adaptation was evaluated for all groups using a stereomicroscope before cementation and after the combined cementation and artificial aging. Statistical analysis was performed with 3-way ANOVAs and post hoc Tukey test, (P < 0.05).

Results: Significant effects were found for finish line design, workflow, and the combined cementation and artificial aging (P < 0.05), with no significant interaction between finish line design and workflow (P = 0.552). Mean marginal gaps (µm) of test groups before cementation and after the combined cementation and aging protocol were: HD, (71.72 ± 4.82), (84.5 ± 2.75); CD, (82.16 ± 3.76), (97.32 ± 3.16); HS, (92.51 ± 3.64), (111.8 ± 3.37); and CS, (106.1 ± 3.57), (123.4 ± 2.58). All groups showed significant increases thereafter (P < 0.05). Heavy chamfer finish line and direct digital workflow each yielded significantly smaller marginal gap than conservative chamfer and semi-digital workflow at both time points (P < 0.05).

Conclusions: Within the limitations of this in vitro study, finish line design and workflow type each independently influenced the marginal adaptation of 3D-printed resin matrix ceramic crowns. A heavy chamfer and a direct digital workflow were each associated with smaller marginal gaps.

Background: This study aimed to compare the calcium hydroxide [Ca(OH)₂] removal efficiency of six irrigation‑activation techniques and conventional syringe irrigation (control) from simulated internal root‑resorptive cavities in vitro.

Materials and methods: Seventy single-rooted human teeth were standardized to a length of 18 mm, prepared, and split longitudinally. A standardized hemispherical resorptive cavity was created in each root half; the halves were then reassembled and filled with premixed Ca(OH)₂. Specimens were incubated for 7 days and randomly allocated (n = 10) to seven groups: (1) conventional syringe irrigation (control), (2) manual dynamic agitation (MDA), (3) XP‑Endo Finisher, (4) sonic EDDY, (5) sonic EQ‑S, (6) ultrasonic Irrisafe, or (7) ultrasonic Ultra X. In each irrigation protocol, two 30 s activations with 10 mL 2.5% NaOCl were used followed by one 30 s activation with 5 mL 17% EDTA. Residual Ca(OH)₂ percentages (%) within the simulated resorptive cavity (primary outcome) and the entire root canal system, including the coronal, middle, and apical thirds (secondary outcomes) was quantified stereo-microscopically using ImageJ software. Data were analyzed using Kruskal-Wallis and Friedman tests with Dunn-Bonferroni post hoc comparisons (α = 0.05).

Results: Significant differences were observed among the tested groups (P ≤ 0.001). Within the simulated resorptive cavities, EDDY group demonstrated the significantly lowest percentage values of residual Ca(OH)₂ [median: 1.48%, IQR (0.65-1.59)] (P < 0.05) followed by XP-endo Finisher [median: 23.31%, IQR (16.61-24.83)] and Irrisafe [median: 36.34%, IQR (14.31-49.05)] groups. EDDY, XP-Endo Finisher and Irrisafe groups showed the significantly lowest overall (total) percentage values (P < 0.05), with no significant differences among them. Most irrigation protocols tested showed significant lower percentage values in the coronal third compared with the apical third, while no significant difference was detected between root thirds within the EDDY and Ultra X groups (P = 0.199, P = 0.182). None of the tested techniques achieved complete removal of Ca(OH)₂.

Conclusions: Activated irrigation significantly enhances Ca(OH)₂ retrieval from internal resorptive defects; however, complete removal is not achieved with any of the tested techniques. EDDY demonstrates superior efficacy in removing Ca(OH)₂ specifically from simulated internal root resorption cavities. Across the entire root canal system, EDDY, XP-Endo Finisher, and Irrisafe demonstrate the highest overall efficacy for Ca(OH)₂ removal.

Objectives: This study evaluated the stain susceptibility and color recovery of Giomer and highly filled injectable composite compared with a nano-filled packable composite, using one-step and multi-step polishing systems.

Methods: Ninety composite specimens were prepared from Filtek Z350, Beautifil Flow Plus, and G-ænial Injectable and divided into three polishing subgroups (n = 10): Mylar strip, OneGloss, and Enamel Plus Shiny. After baseline color measurement (T₀), the specimens were immersed in coffee at 37 °C for 30 days. Color changes were measured using a Vita EasyshadeV spectrophotometer after brushing using a soft toothbrush (ΔE_brushing; T₁-T₀) and after repolishing using AL₂0₃ paste (ΔE_repolishing; T₂-T₀). Data were analyzed using a linear mixed model with Yeo-Johnson transformation and Holm's correction (α = 0.05).

Results: A significant interaction was observed among material type, polishing system, and color change (p = 0.020). G-ænial Injectable showed the lowest stain susceptibility (ΔE_brushing = 2.84; ΔE_repolishing = 1.88). Multi-step polishing significantly improved stain resistance for all tested materials. Repolishing significantly reduced discoloration in all groups (p < 0.001) by increasing L* values and reducing shifts in a* and b* coordinates. Among all materials, only the multi-step-polished G-ænial Injectable achieved color change values that approached the acceptability threshold (ΔE₀₀ ≤ 1.8).

Conclusion: Highly filled injectable composites and multi-step polishing improved stain resistance and color recovery of resin composites, whereas S-PRG fillers and matrix-set surfaces increased stain susceptibility.

Clinical relevance: Multi-step polishing enhances esthetics, while repolishing improves restoration longevity.