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                                                                                                                                    Review Article

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The effects of oscillating-rotating electric toothbrushes on plaque and gingival health: A meta-analysis

 

Julie Grender, phd,  Ralf Adam, phd  &  Yuanshu Zou, phd

 

Abstract: Purpose: To compare the effects of oscillating-rotating (O-R), sonic (side-to-side), and manual toothbrushes on plaque and gingival health after multiple uses in studies up to 3 months. Methods: A meta-analysis was conducted on randomized clinical trials (RCTs) up to 3 months in duration to evaluate O-R electric toothbrush effectiveness regarding gingivitis reduction and plaque removal versus sonic and/or manual toothbrushes. To ensure access to subject-level data, this meta-analysis was limited to RCTs involving O-R toothbrushes from a single manufacturer conducted from 2007 to 2017 for which subject-level data were available and that satisfied criteria of duration, parallel design, examiner-graded, etc. For gingivitis studies, a one-step individual subject meta-analysis was used to assess direct and indirect treatment differences and to identify any subject-level covariates modifying treatment effects. In the two-step meta-analysis, individual participant data were first analyzed in each study independently using the last timepoint (up to 3 months), producing aggregate data for each study. Then forest plots were produced using these aggregate data with random-effects models. For plaque studies, the efficacy variables were standardized so direct comparisons could be generated using the 2-step meta-analysis. Network meta-analysis was performed to assess the indirect plaque comparisons. Results: 16 parallel group RCTs with 2,145 subjects were identified assessing gingivitis via number of bleeding sites. In five and 11 gingivitis studies assessing O-R brushes versus manual and sonic brushes, respectively, a change in the average number of bleeding sites of -8.9 (95% CI: -15.9, -1.9) and -3.1 (95% CI: -3.8, -2.4) was observed (P≤ 0.008). These reductions equate to a 50% and 28% bleeding benefit for O-R technology versus the respective controls. The sonic brush bleeding change versus manual was -5.9 (P= 0.062), a 34% bleeding benefit. Utilizing individual bleeding scores, subjects with localized or generalized gingivitis (≥ 10% bleeding sites) had 7.4 times better odds of transitioning to generally healthy (< 10% bleeding sites) after using an O-R brush versus manual. 20 parallel design RCTs with 2,551 subjects assessed plaque (TMQHI, RMNPI). In eight and 12 plaque RCTs assessing an O-R brush versus manual and sonic brushes, respectively, standardized changes in average plaque scores of –1.51 (95% CI: -2.17, -0.85) and -0.55 (95% CI: -0.82, -0.28) were observed (P< 0.001). These plaque reductions by O-R equate to a relative 20% and 4% greater benefit, respectively. The change for sonic versus manual was -0.93 (95% CI:
-1.48, -0.38); (P< 0.001) which equates to a 12% plaque benefit. (Am J Dent 2020;33:3-11).

 

 

 

 

 

Mail: Dr. Julie Grender, Procter & Gamble, 8700 Mason-Montgomery Road, Mason, OH 45040, USA. E-mail: grender.jm@pg.com

 

 

 

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                                                                                                                                          Review Article

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Systematic review of in vitro studies evaluating tooth bleaching efficacy

 

So Ran Kwon, dds, ms, phd, ms, Elisa Cortez, mils, ahip, Min Wang, dds, ms, Mohit Jagwani, bds, mph, Udochukwu Oyoyo, mph  &  Yiming Li, dds, msd, phd

 

Abstract: Purpose: To review and assess the literature on in vitro studies evaluating tooth bleaching efficacy considering the use of a negative control, type of tooth substrate, storage medium, color evaluation methods, and evaluation time points. Methods: The following databases were searched: PubMed (MEDLINE), Web of Science. Search used Medical Subject Headings (MeSH) in PubMed in addition to free text. The following limits were applied: English, articles published between January 1989 and October 2017. Additional free text key terms included: in vitro, tooth bleaching, placebo, negative control, overall CIELAB color change (ΔE*ab), change in shade guide units (ΔSGU), tooth color stabilization, evaluation time points, bovine teeth, and staining. Search was repeated in Web of Science but no additional articles were identified. A total of 11 studies were included for qualitative and quantitative analysis. Results: The meta-analysis of nine included studies that reported ΔE*ab values, revealed that the NC statistically exceeded the perceptibility threshold (PT) of 1.2 (P< 0.05). The estimate was 2.872 with lower and upper bounds of 1.955 and 3.790, respectively. (Am J Dent 2020;33:17-24).

 

 

Mail: Dr. So Ran Kwon, Center for Dental Research, Loma Linda University School of Dentistry, 11175 Campus St. CSP A1010C, Loma Linda, CA 92350, USA.  E-mail: sorankwon@llu.edu

 

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The effects of charcoal dentifrices on Streptococcus mutans biofilm development and enamel demineralization

 

Beatriz H.D. Panariello, dds, ms, phd, Asma A. Azabi, bds, msd, Lamia S. Mokeem, bds, Fahad A. AlMady, bds, Frank Lippert, phd, Anderson T. Hara, dds, ms, phd &  Simone Duarte, dds, ms, phd

 

Abstract: Purpose: To evaluate the in vitro effects of commercially available charcoal dentifrices on Streptococcus mutansbiofilm development and their ability to prevent enamel demineralization. Methods: Streptococcus mutans biofilm was formed on polished bovine enamel specimens (n= 9 per treatment), and treated twice-daily for 120 seconds over the course of 5 days with: charcoal dentifrice containing fluoride (1,000 ppm F) (CF+), fluoride-free charcoal dentifrice (CF-), regular fluoride (1,100 ppm F) dentifrice (F+), or regular fluoride-free dentifrice (F-). Chlorhexidine (CHX, 0.12%) and deionized water (DIW) were used as positive and negative controls, respectively. Biofilms were analyzed for bacterial viability (colony-forming units, CFU). The pH of the medium was measured daily. Enamel specimens were analyzed using Vickers microhardness (HV) and transversal microradiography (TMR). Data were analyzed using one-way ANOVA followed by post-hoc tests (α= 0.05). Results: F+ showed higher pH values than CF+ and CF-, and CF- presented higher pH than CF+, showing that CF+ did not have inhibitory effects on the acidogenicity of cariogenic biofilms. CFU was significantly decreased when specimens were treated with CF+, CF- and F+, compared to specimens treated with DIW (P≤ 0.035) or F- (P≤ 0.001), respectively. However, the reduction observed was minimal (approximately 1 log). CF+ and CF- were less effective than F+ in preventing enamel demineralization as determined using HV (P= 0.041 and P= 0.003, respectively) and TMR (P≤ 0.001). Both charcoal dentifrices (CF+, CF-) did not show relevant inhibition of S. mutans biofilm growth. Additionally, neither product prevented enamel demineralization compared to a regular fluoride-containing dentifrice. (Am J Dent 2020;33:12-16).

 

 

 

 

 

 

Mail:  Dr. Simone Duarte, Indiana University School of Dentistry, Department of Cariology, Operative Dentistry and Dental Public Health, 1121 W Michigan St, DS 406, Indianapolis, IN 46202, USA.  E-mail:  siduarte@iu.edu

 

 

 

 

 

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                                                                                                                                         Research Article

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Effect of manual and electrical brushing on the enamel of sound primary teeth and teeth with induced white spot lesions

 

Ana Beatriz Chicalé-Ferreira, dds, msc, Regina Guenka Palma-Dibb, dds, msc, phd, Juliana Jendiroba Faraoni, dds, msc, phd, Patrícia Gatón-Hernández, dds, msc, phd,

Léa Assed Bezerra Silva, dds, msc, phd, Raquel Assed Bezerra Silva, dds, msc, phd, Alexandra Mussolino de Queiroz, dds, msc, phd, Marília Pacífico Lucisano, dds, msc, phd

&  Paulo Nelson-Filho, dds, msc, phd

 

Abstract: Purpose: To evaluate the effect of different electrical brushing systems on the surface roughness and wear profile of the enamel of sound primary teeth and teeth with induced white spot lesions. Methods: 45 specimens were obtained from sound primary incisors, and the buccal surface was divided into four parts: sound enamel; enamel with white spot lesions; sound enamel with brushing; and enamel with white spot lesions and brushing. Specimens were randomly divided into three groups (n=15), according to the different brushing systems: Group 1 - Electric rotating toothbrush (Kid’s Power Toothbrush - Oral B); Group 2 - Sonic electric toothbrush (Baby Sonic Toothbrush); and Group 3 - Manual toothbrush (Curaprox infantil) (control). The specimens were analyzed for surface roughness and wear profile. Data were analyzed by appropriate statistical tests, with a significance level of 5%. Results: Regarding the surface roughness, no significant difference was observed between the groups. However, with respect to the wear profile, Group 1 caused significantly higher wear in the sound tooth enamel and in the presence of white spot lesions, in comparison to the other brushing systems (2 and 3) (P< 0.05), which did not cause wear. Manual and electric brushing (rotational and sonic) did not increase surface roughness in primary tooth enamel. However, the electric rotational brushing caused significant wear of the sound and demineralized enamel surface of primary teeth. (Am J Dent 2020;33:25-28).

 

 

Mail: Dra. Marília Pacífico Lucisano, Department of Children Clinic, Faculty of Odontology of Ribeirão Preto, University of São Paulo, Avenida do Café s/n, Monte Alegre, 14040-904, Ribeirão Preto, SP, Brazil. E-mail: marilia.lucisano@forp.usp.br

 

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                                                                                                                                                    Research Article

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Association between obstructive sleep apnea and enamel cracks

 

Eduardo Anitua, md, phd,   Joaquín Durán-Cantolla, md, phd,  Gabriela Zamora Almeida, bsc, msc &  Mohammad Hamdan Alkhraisat, dds, msc, phd, eu phd

 

Abstract: Purpose: To assess the association between obstructive sleep apnea (OSA) and enamel cracks. Methods: 219 patients were included. Separate operators assessed the sleep component of the study and the visual evaluation of the enamel cracks. Anthropometric data were also obtained. Results: Patients with slightly marked (superficial) enamel cracks had a significantly lower apnea-hypoapnea index (AHI) than the patients with moderately-to-severely marked (deep) craze lines. The frequency of patients with moderately-to-severely marked craze lines increased with the severity of OSA. Spearman's correlation indicated the presence of a statistically significant association between the severity of enamel crack and the severity of OSA. Multiple regression analysis indicated that age, sex, body mass index and OSA significantly affected the enamel cracks. Compared to patients with slightly marked craze lines, those with moderate-to-severe craze lines are higher aged males, with a higher body mass index and increased severity of OSA. (Am J Dent 2020;33:29-32).

 

 

 

 

 

 

Mail: Dr. Eduardo Anitua, Eduardo Anitua Foundation, Jose Maria Cagigal 19, 01007 Vitoria, Spain. E-mail: eduardo@fundacioneduardoanitua.org

 

 

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                                                                                                                                         Research Article

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Treatment of surface contamination of lithium disilicate ceramic before adhesive luting

 

Stephanie Marfenko, med dent,  Mutlu Özcan, dds, dmd, phd,  Thomas Attin, drmeddent &  Tobias T. Tauböck, drmeddent

 

Abstract: Purpose: To evaluate the effect of different contamination media and cleaning regimens on the adhesion of resin cement to lithium disilicate ceramic. Methods: Specimens (IPS e.max CAD) (n=15 per group) were etched with 5% hydrofluoric acid gel. While half of the specimens were silanized after etching, the other half was left etched only. After contamination with either saliva or dental stone, they were further divided into four subgroups depending on the cleaning regimens: water rinsing only (WR), 80% ethanol (E), 37% phosphoric acid (PA), cleaning gel (CG). All specimens were re-silanized, coated with adhesive resin (Heliobond) and resin cement (Variolink II) was bonded. After thermocycling (5.000x, 5-55ºC), ceramic-cement interface was loaded under shear (1 mm/minute) and failure types were classified. Data (MPa) were analyzed using 3-way ANOVA, Dunnett-T3 tests and Weibull moduli were calculated. Results: Saliva contamination (4.7±2.2-15.4±2.7) resulted in significantly lower bond strength compared to dental stone (17.8±4.8-23.6±2.7). Silanization before contamination showed protective effect especially for saliva (20.1±4.5-24.7±3.9) compared to non-silanized groups (4.7±2.2-15.4±2.7). Weibull modulus was the lowest for saliva-contaminated groups after cleaning with WR (2.22, 5.01) or E (1.14, 5.77) without and with initial silanization, respectively. Adhesive failures (272 out of 285) were commonly observed in all groups. Saliva contamination decreased the adhesion of luting cement to lithium disilicate ceramic considerably more than dental stone contamination, but silanization prior to try-in prevented deterioration in adhesion. (Am J Dent 2020;33:33-38).

 

 

Mail: Prof. Dr. Mutlu Özcan, Center for Dental Medicine, Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, University of Zurich, Plattenstrasse 11, CH-8032, Zurich, Switzerland. E-mail: mutluozcan@hotmail.com

 

 

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                                                                                                                            Research Article

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Follow-up of flowable resin composites performed with a universal adhesive system in non-carious cervical lesions: A randomized, controlled 24-month clinical trial

 

Hande Kemaloğlu, dds, phd, Cigdem Atalayin Ozkaya, dds, phd, Zeynep Ergucu, dds, phd  &  Banu Onal, dds, phd

 

Abstract: Purpose: This randomized, controlled study evaluated the 2-year clinical performance of two flowable resin composites performed with a universal adhesive in two etching modes for restoring non-carious cervical lesions (NCCLs). Methods: One hundred NCCLs were restored with two flowable composites (Charisma Opal Flow and G-aenial Universal Flo) and a universal adhesive (Single Bond Universal) with two etching modes (self-etch and etch&rinse) in a random order. The restorations were evaluated for retention, marginal adaptation, anatomic form, marginal discoloration, surface texture and secondary caries (modified USPHS criteria) at baseline, and after 6, 12 and 24 months. Results: The clinical success for retention, surface texture and secondary caries parameters was scored as 100% for each group after 6, 12 and 24 months. The first acceptable changes (Bravo score) in marginal adaptation, anatomical form and marginal discoloration started to show up after 12 months for all test groups, except for etch&rinse+Charisma Opal Flow. Self-etch+Charisma Opal Flow and self-etch+G-aenial Universal Flo showed progressive marginal discoloration that remained in the clinical acceptability level after 2 years. After 24 months, each resin composite restored with either the etch&rinse mode or the self-etch mode of the universal adhesive showed similar clinical performance. Marginal discoloration was higher in the restorations performed with the self-etch system. Selective-etching can be favorable. (Am J Dent 2020;33:39-42).

 

 

Mail: Dr. Hande Kemaloğlu, Department of Restorative Dentistry, School of Dentistry, Ege University, 35100 Bornova, Izmir, Turkey. E-mail: handedalgar@gmail.com

 

 

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                                                                                                                                             Research Article

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Effect of different acid etchants on the remineralization process of white-spot lesions: An in vitro study.

 

Mohammad Tarek Ajaj, dds, mclindent, Susan Al-Khateeb, dds, phd  &  Ola B. Al-Batayneh, bds, mdsc

 

Abstract: Purpose: To investigate the effect of acid etchants with different low concentrations on remineralization of white spot lesion (WSL). Methods: WSL were prepared on buccal surfaces of 100 intact premolars using the methyl cellulose gel/lactic acid method. The samples were then placed in a remineralizing solution in addition to fluoride application twice daily for 5 minutes. The changes were quantified weekly using the Quantitative Light-induced Fluorescence (QLF) system. When changes in fluorescence radiance approached zero, each sample was etched with one of the following acids; 5% phosphoric acid, 10% phosphoric acid, 5% polyacrylic acid or 10% polyacrylic acid for 15 seconds, washed, dried, and placed again in the remineralizing solution. Two samples were randomly selected from each group for transverse microradiography (TMR) and scanning electron microscopy (SEM) analysis. Results: The 10% polyacrylic acid group showed the most significant improvement in fluorescence gain over the second phase of remineralization. It also showed partial loss of surface minerals without affecting enamel thickness as the phosphoric acid did. Additionally, 10% polyacrylic acid created the largest number of pores and smallest in size when compared to phosphoric acid, thus enhancing remineralization more efficiently than phosphoric acid without compromising the enamel outermost layer. (Am J Dent 2020;33:43-47).

 

 

 

 

 

 

Mail: Dr. Susan Al-Khateeb, Department of Preventive Dentistry, Division of Orthodontics, Faculty of Dentistry, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan. E-mail: susank@just.edu.jo

 

 

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Feasibility of establishing tele-dental approach to non-traumatic dental emergencies in medical settings

 

Adham Abdelrahim, bds, msc, Neel Shimpi, bds, mm, phd, Harshad Hegde, be, ms, Katelyn C. Kleutsch, Po-Huang Chyou, phd, Gaurav Jain, dds  &  Amit Acharya, bds, ms, phd

 

Abstract: Purpose: Non-traumatic dental condition visits (NTDCs) represent about 1.4% to 2% of all Emergency Department (ED) visits and are limited to palliative care only, while associated with high cost of care. Feasibility of establishing a tele-dental approach to manage NTDCs in ED and Urgent care (UC) settings was undertaken to explore the possibility of utilizing remote tele-dental consults. Methods: Participants with NTDCs in ED/UCs were examined extra and intra-orally: (1) directly by ED provider, (2) remotely by tele-dental examiner (trained dentist) using intra-oral camera and high-definition pan-tilt-zoom (PTZ) camera, (3) directly by treating dentist post ED/UC visit (if applicable) and, (4) secondary assessment by tele-dental reviewer. Comparisons were drawn between differential diagnoses and recommended managements provided by ED/UC providers, tele-dental examiner, treating dentist, and tele-dental reviewer. Results: 13 patients participated in the study. The overall inter-rater agreement between the tele-dental examiner and tele-dental reviewer was high while it was low between tele-dentists and the ED providers. The preliminary testing of tele-dental intervention in the ED/UC setting demonstrated potential feasibility in addressing the NTDC landing in ED/UC. Larger interventional studies in multi-site setting are needed to validate this approach and especially evaluate impact on cost, ED/UC workflow and patient outcomes. (Am J Dent 2020;33:48-52).

 

 

 

 

Mail: Dr. Amit Acharya, Marshfield Clinic Research Institute, Center for Oral and Systemic Health, 1000 North Oak Avenue, Marshfield, WI 54449. USA.  E-mail:acharya.amit@marshfieldresearch.org