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Falk Schwendicke - One of the best experts on this subject based on the ideXlab platform.
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Secondary Caries adjacent to bulk or incrementally filled composites placed after selective excavation in vitro
Materials, 2021Co-Authors: Haitham Askar, Gerd Gostemeyer, Sebastian Paris, Allam Alabdi, Uwe Blunck, Falk SchwendickeAbstract:Objectives: selective Caries excavation (SE) is recommended for deep carious lesions. Bulk fill composites (BF) may be considered to restore SE-cavities. We compared the susceptibility for Secondary Caries adjacent to BF versus incrementally filled composites (IF) in SE and non-selectively excavated teeth (NS) in vitro. Methods: in 72 extracted human premolars, artificial Caries lesions were induced on pulpo-axial walls of standardized cavities. The lesions were left (SE) or removed (NS), and teeth were restored using two BF, GrandioSO x-tra/Voco (BF-Gra) and SDR/Dentsply (BF-SDR), and an IF, GrandioSO/Voco (IF-Gra) (n = 12/group for SE and NS). After thermo-mechanical cycling (5–55 °C, 8 days), teeth were submitted to a continuous-culture Lactobacillus rhamnosus biofilm model with cyclic loading for 10 days. Mineral loss (ΔZ) of enamel surface lesions (ESL), dentin surface lesions (DSL), and dentin wall lesions (DWL) was analyzed using transversal microradiography. Results: ΔZ was the highest in DSL, followed by ESL, and it was significantly lower in DWL. There were no significant differences in ΔZ between groups in DSL, ESL, and DWL (p > 0.05). Regardless of lesion location, ΔZ did not differ between SE and NS (p > 0.05). Conclusions: BF and IF both showed low risks for DWL (i.e., true Secondary Caries) after SE in vitro, and surface lesion risk was also not significantly different between materials. SE did not increase Secondary Caries risk as compared with NS. Clinical Significance: the risk of Secondary Caries was low after selective excavation in this study, regardless of whether bulk or incrementally filled composites were used
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Secondary Caries risk of different adhesive strategies and restorative materials in permanent teeth systematic review and network meta analysis
Journal of Dentistry, 2021Co-Authors: Haitham Askar, Joachim Krois, Gerd Gostemeyer, Falk SchwendickeAbstract:Abstract Objectives Secondary Caries is a major long-term complication of dental restorations. Different adhesive strategies and restorative materials may affect Secondary Caries risk. We aimed to systematically review and synthesize the Secondary Caries risk of different adhesive strategies and restorative materials. Sources Medline via PubMed 01/2005-10/2019. Study selection Randomized controlled studies with minimum 2 years follow-up, comparing different adhesive strategies and/or restorative materials in permanent teeth were included. Our outcome was the occurrence of Secondary Caries. Bayesian pairwise and network-meta-analysis were conducted. Data We included 50 trials; 19 assessing Secondary Caries depending on different adhesive strategies, 31 on restorative materials. Studies were published between 2005 and 2017, largely of unclear risk of bias, and included a mean of 40 (range: 8–90) participants and 46 (range: 14–200) placed restorations. Mean follow-up was 43 (range: 24–180) months. Secondary Caries was a rare event; the majority of studies did not find any lesions. Network meta-analysis found great uncertainty. 3-step etch-and-rinse adhesives showed the lowest risk of Secondary Caries, 2-step etch-and-rinse the highest. For restorative materials, resin-modified glass ionomer showed the lowest risk of Secondary Caries. Most resin composites showed similar risks. Conclusion Data from randomized trials comparing different adhesive strategies or restorative materials are extremely scarce. The differences between materials were limited over the observational period of the included studies. The yielded rankings should be interpreted with caution. Clinical significance Despite often claimed to be a major complication of restorations, there is surprisingly little data on Secondary Caries from randomized trials. Longer-term studies may be needed to identify differences in Secondary Caries risk between materials.
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How to intervene in the Caries process in adults: proximal and Secondary Caries? An EFCD-ORCA-DGZ expert Delphi consensus statement
Clinical Oral Investigations, 2020Co-Authors: Falk Schwendicke, Peter Bottenberg, Christian Splieth, Lorenzo Breschi, Guglielmo Campus, Sophie Doméjean, Kim Ekstrand, Rodrigo Giacaman, Rainer Haak, Matthias HannigAbstract:Objectives To provide consensus recommendations on how to intervene in the Caries process in adults, specifically proximal and Secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual's Caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and Secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/ inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiograph-ically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of Secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for Secondary lesions should be tailored according to the individual's Caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm Secondary Caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing Secondary Caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in the Caries process in adults. Clinical significance Dental clinicians have an increasing number of interventions available for the management of dental Caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.
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how to intervene in the Caries process in adults proximal and Secondary Caries an efcd orca dgz expert delphi consensus statement
Clinical Oral Investigations, 2020Co-Authors: Falk Schwendicke, Peter Bottenberg, Christian Splieth, Lorenzo Breschi, Guglielmo Campus, Sophie Doméjean, Kim Ekstrand, Rodrigo Giacaman, Rainer HaakAbstract:To provide consensus recommendations on how to intervene in the Caries process in adults, specifically proximal and Secondary carious lesions. Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Managing an individual’s Caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and Secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of Secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for Secondary lesions should be tailored according to the individual’s Caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm Secondary Caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing Secondary Caries, if possible. An individualized and lesion-specific approach is recommended for intervening in the Caries process in adults. Dental clinicians have an increasing number of interventions available for the management of dental Caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients’ expectations, clinicians’ expertise, and the individual clinical scenario all need to be considered during the decision-making process.
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Secondary Caries what is it and how it can be controlled detected and managed
Clinical Oral Investigations, 2020Co-Authors: Haitham Askar, Domenick T Zero, Joachim Krois, Gerd Gostemeyer, Peter Bottenberg, Avijit Banerjee, Falk SchwendickeAbstract:To assess how to control, detect, and treat Secondary Caries. This review serves to inform a joint ORCA/EFCD consensus process. Systematic and non-systematic reviews were performed or consulted and narratively synthesized. Secondary (or recurrent) Caries is defined as a lesion associated with restorations or sealants. While the restorative material itself has some influence on Secondary Caries, further factors like the presence and size of restoration gaps, patients’ Caries risk, and the placing dentist’s experience seem more relevant. Current detection methods for Secondary Caries are only sparsely validated and likely prone for the risk of over-detection. In many patients, it might be prudent to prioritize specific detection methods to avoid invasive overtreatment. Detected Secondary Caries can be managed either by repair of the defective part of the restoration or its complete replacement. There is sparse data towards the nature of Secondary Caries and how to control, detect, and treat it. Despite often claimed to be a major complication of restorations, there is surprisingly little data on Secondary Caries. Longer-term studies may be needed to identify differences in Secondary Caries risk between materials and to identify characteristic features of progressive lesions (i.e., those in need of treatment).
Rainer Haak - One of the best experts on this subject based on the ideXlab platform.
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How to intervene in the Caries process in adults: proximal and Secondary Caries? An EFCD-ORCA-DGZ expert Delphi consensus statement
Clinical Oral Investigations, 2020Co-Authors: Falk Schwendicke, Peter Bottenberg, Christian Splieth, Lorenzo Breschi, Guglielmo Campus, Sophie Doméjean, Kim Ekstrand, Rodrigo Giacaman, Rainer Haak, Matthias HannigAbstract:Objectives To provide consensus recommendations on how to intervene in the Caries process in adults, specifically proximal and Secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual's Caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and Secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/ inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiograph-ically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of Secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for Secondary lesions should be tailored according to the individual's Caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm Secondary Caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing Secondary Caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in the Caries process in adults. Clinical significance Dental clinicians have an increasing number of interventions available for the management of dental Caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.
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how to intervene in the Caries process in adults proximal and Secondary Caries an efcd orca dgz expert delphi consensus statement
Clinical Oral Investigations, 2020Co-Authors: Falk Schwendicke, Peter Bottenberg, Christian Splieth, Lorenzo Breschi, Guglielmo Campus, Sophie Doméjean, Kim Ekstrand, Rodrigo Giacaman, Rainer HaakAbstract:To provide consensus recommendations on how to intervene in the Caries process in adults, specifically proximal and Secondary carious lesions. Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Managing an individual’s Caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and Secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of Secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for Secondary lesions should be tailored according to the individual’s Caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm Secondary Caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing Secondary Caries, if possible. An individualized and lesion-specific approach is recommended for intervening in the Caries process in adults. Dental clinicians have an increasing number of interventions available for the management of dental Caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients’ expectations, clinicians’ expertise, and the individual clinical scenario all need to be considered during the decision-making process.
Guglielmo Campus - One of the best experts on this subject based on the ideXlab platform.
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How to intervene in the Caries process in adults: proximal and Secondary Caries? An EFCD-ORCA-DGZ expert Delphi consensus statement
Clinical Oral Investigations, 2020Co-Authors: Falk Schwendicke, Peter Bottenberg, Christian Splieth, Lorenzo Breschi, Guglielmo Campus, Sophie Doméjean, Kim Ekstrand, Rodrigo Giacaman, Rainer Haak, Matthias HannigAbstract:Objectives To provide consensus recommendations on how to intervene in the Caries process in adults, specifically proximal and Secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual's Caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and Secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/ inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiograph-ically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of Secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for Secondary lesions should be tailored according to the individual's Caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm Secondary Caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing Secondary Caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in the Caries process in adults. Clinical significance Dental clinicians have an increasing number of interventions available for the management of dental Caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.
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how to intervene in the Caries process in adults proximal and Secondary Caries an efcd orca dgz expert delphi consensus statement
Clinical Oral Investigations, 2020Co-Authors: Falk Schwendicke, Peter Bottenberg, Christian Splieth, Lorenzo Breschi, Guglielmo Campus, Sophie Doméjean, Kim Ekstrand, Rodrigo Giacaman, Rainer HaakAbstract:To provide consensus recommendations on how to intervene in the Caries process in adults, specifically proximal and Secondary carious lesions. Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Managing an individual’s Caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and Secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using non-invasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of Secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for Secondary lesions should be tailored according to the individual’s Caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visual-tactile assessment to confirm Secondary Caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing Secondary Caries, if possible. An individualized and lesion-specific approach is recommended for intervening in the Caries process in adults. Dental clinicians have an increasing number of interventions available for the management of dental Caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients’ expectations, clinicians’ expertise, and the individual clinical scenario all need to be considered during the decision-making process.
N. K. Kuper - One of the best experts on this subject based on the ideXlab platform.
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a threshold gap size for in situ Secondary Caries lesion development
Journal of Dentistry, 2019Co-Authors: N. K. Kuper, Ewald M. Bronkhorst, T.t. Maske, A.c.c. Hollanders, Maximiliano Sérgio Cenci, M C D N J M HuysmansAbstract:Abstract Objectives This study investigated the influence of very small gaps in Secondary Caries (SC) development and additionally linked the threshold gap size with the Caries activity level from volunteers. Methods For 21 days, 15 volunteers wore a modified occlusal splint loaded with dentin-composite samples restored with different interfaces: bonded (B = samples restored with complete adhesive procedure), no-bonded (NB = restored with composite resin without adhesive procedure), and 30, 60 and 90 μm (no adhesive procedure and with intentional gap). The splint was dipped in a 20% sucrose solution (10 min) 8 x per day. Samples were imaged with transversal wavelength independent microradiography (T-WIM) and lesion depth and mineral loss were calculated. Average wall lesion depth from each volunteer was determined and according to the values the volunteers were grouped as high, mid and low Caries activity levels. Results No wall lesion formation was observed in B and NB groups. In general, intentional gaps led to SC lesion depth progression independent of Caries activity level of volunteers. No substantial wall lesions were found for two volunteers. A trend for deeper lesion in larger gaps was observed for the high activity group. Conclusion Very small gaps around or wider than 30 μm develop SC independent of the Caries activity level of the patient and SC wall lesion progression seemed to be related to individual factors even in this standardized in situ model. Significance Independently of Caries activity level of the patient, the threshold gap size for Secondary Caries wall lesion seems to be 30 μm at most.
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chlorhexidine a matrix metalloproteinase inhibitor and the development of Secondary Caries wall lesions in a microcosm biofilm model
Caries Research, 2019Co-Authors: T.t. Maske, N. K. Kuper, Maximiliano Sérgio Cenci, M C D N J M HuysmansAbstract:This study investigated the role of a matrix metalloproteinase (MMP) inhibitor (CHX 2%) in the development of Secondary Caries wall lesions in different interface conditions with small (run 1) and wider gaps (run 2). Dentin discs were restored and pretreated with or without CHX 2%. In run 1, interfaces were made with gaps of 30, 60, or 90 µm. Interfaces with composite placed directly onto the dentin were either bonded (Adper Single Bond 2) or not bonded. In run 2, interfaces were made with gaps of 100 µm, with or without adhesive on the composite side (CLEARFIL SE Bond). Interfaces were either bonded or not bonded, as in run 1. Microcosm biofilms were grown on dentin-composite samples for 14 days. Caries lesion outcomes were analyzed by transversal wavelength-independent microradiography at 3 locations: the outer surface, and the interface wall at a distance of 200 and 500 µm from the gap entrance. Linear regression analyses showed that pretreatment with MMP inhibitor did not influence progression of the wall lesion at any location (p ≥ 0.218). Interfaces with intentional gaps showed positive and significant effect on the wall lesion progression at 200 µm from the gap entrance (p ≤ 0.005). A small trend of increase in wall lesion development was observed at the 200-µm location when bonding was present on the composite side. In conclusion, the dentin pretreatment with CHX 2% was not able to slow down the development of Secondary Caries wall lesions in small and wide gaps in this biofilm model.
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Secondary Caries development and the role of a matrix metalloproteinase inhibitor: A clinical in situ study
Journal of Dentistry, 2018Co-Authors: T.t. Maske, N. K. Kuper, Ewald M. Bronkhorst, A.c.c. Hollanders, Maximiliano Sérgio Cenci, Marie-charlotte D.n.j.m. HuysmansAbstract:Abstract Objectives This in situ study aimed to investigate whether the dentin treatment with MMPs inhibitor (CHX 2%) could influence the development of Secondary Caries wall lesions in different dentin-composite interfaces. Material and methods For 21 days, 15 volunteers wore a modified-occlusal splint loaded with dentin-composite samples treated or not with CHX and restored according 4 different interface conditions: Bonding (B = samples restored with complete adhesive procedure), no bonding (NB = restored with composite resin without adhesive procedure), 100 μm (no adhesive procedure and with intentional gap) and 100 μm + B (adhesive material on composite side and intentional gap). Eight times per day, the splint with samples was dipped in a 20% sucrose solution for 10 min. Before and after Caries development, samples were imaged with T-WIM and lesion depth (LD) and mineral loss (ML) were calculated. Results Linear mixed effect analysis showed that dentin treatment with CHX did not significantly affect the Caries lesion progression (LD and ML; p ≤ 0.797). Dentin wall lesions were observed in the 100 μm and 100 μm + B groups independently of MMP inhibitor treatment. Conclusion The treatment of dentin with MMP inhibitor was not able to slow down the Secondary Caries wall lesion development in this in situ study. Significance The dentin treatment with 2% CHX did not prevent Secondary Caries wall lesion initiation.
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Secondary Caries development in in situ gaps next to composite and amalgam
Caries Research, 2015Co-Authors: N. K. Kuper, Ewald M. Bronkhorst, N J M Opdam, Anelise Fernandes Montagner, Francoise Helene Van De Sande, Mariecharlotte D J N M HuysmansAbstract:This in situ study investigated the Secondary Caries development in dentin in gaps next to composite and amalgam. For 21 days, 14 volunteers wore a modified occlusal splint containing human dentin samples with an average gap of 215 µm (SD=55 µm) restored with three different materials: Filtek Supreme composite, Clearfil AP-X composite and Tytin amalgam. Eight times a day, the splint with samples was dipped in a 20% sucrose solution for 10 min. Before and after Caries development, specimens were imaged with transversal wavelength independent microradiography, and lesion depth (LD) and mineral loss (ML) were calculated. The LD and ML of the three restoration materials were compared within patients using paired t tests (α=5%). In total 38 composite samples (Filtek n=19 and AP-X n=19) and 19 amalgam samples could be used for data analysis. AP-X composite presented the highest mean values of LD and ML of the three restorative materials. Amalgam showed statistically significantly less ML (Δ=452 µm×vol%) than the combined composite materials (p=0.036). When comparing amalgam to the separate composite materials, only AP-X composite showed higher ML (Δ=515 µm×vol%) than amalgam (p=0.034). Analysis of LD showed the same trends, but these were not statistically significant. In conclusion, amalgam showed reduced Secondary Caries progression in dentin in gaps compared to composite materials tested in this in situ model.
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restoration materials and Secondary Caries using an in vitro biofilm model
Journal of Dental Research, 2015Co-Authors: N. K. Kuper, Ewald M. Bronkhorst, Maximiliano Sérgio Cenci, N J M Opdam, Francoise Helene Van De Sande, J J De Soet, Marie-charlotte D.n.j.m. HuysmansAbstract:This in vitro study investigated whether restoration materials and adhesives influence Secondary Caries formation in gaps using a short-term in vitro biofilm model. Sixty enamel-dentin blocks were restored with 6 different restoration materials with or without adhesives (n = 10 per group) with a gap: 1) Clearfil AP-X composite, 2) Clearfil AP-X composite + SE Bond, 3) Clearfil AP-X composite + ProtectBond, 4) Filtek Silorane composite, 5) Filtek Silorane composite + Silorane System adhesive, or 6) Tytin amalgam. Specimens were subjected to an intermittent 1% sucrose biofilm model for 20 days to create artificial Caries lesions. Lesion progression in the enamel-dentin next to the different materials was measured in lesion depth (LD) and mineral loss (ML) using transversal wavelength independent microradiography (T-WIM). A regression analysis was used to compare the LD and ML of the different restoration materials at 4 measurement locations: 1 location at the surface of the enamel, 1 location at the wall of the enamel, and 2 locations at the wall of the dentin. A statistically significant effect of AP-X composite with Protect Bond was found for LD and ML at the WallDentin1 location, leading to less advanced wall lesions. An additional finding was that gap size was also statistically significant at the 2 wall locations in dentin, leading to increasing lesion progression with wider gaps. In conclusion, adhesives can influence wall lesion development in gaps. Protect Bond showed significantly less Caries progression compared to bare restoration materials or other adhesives in this short-term in vitro biofilm model.
Roland Frankenberger - One of the best experts on this subject based on the ideXlab platform.
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inhibition of Secondary Caries in vitro by addition of chlorhexidine to adhesive components
Dental Materials, 2019Co-Authors: C Boutsiouki, Roland Frankenberger, Susanne Lucker, Norbert KramerAbstract:Abstract Objective To investigate Secondary Caries inhibition after dentine pre-treatment with 2% CHX, experimental addition of CHX in primer and adhesive of a 3-step adhesive system, and industrial addition od CHX in a 2-step adhesive system. Materials and method Sixty Class-V cavities were restored according to the adhesive protocol (n = 12): 1) control group, Scotchbond Multi-Purpose, 3M (CTRL), 2) 2% CHX dentine pre-treatment (DENT), 3) 0.1% CHX in primer (PRIM), 4) 0.1% CHX in bonding agent (BOND), 5) Peak Universal Bond including 0.2% CHX (PEAK). Specimens were thermocycled (10,000 cycles) and inserted into a Streptococcus mutans biofilm artificial mouth (Caries model). The 10-day biological loading protocol consisted of consecutive phases of demineralisation (1 h) and remineralisation (5 h). Evaluation under a fluorescence microscope (demineralisation) and an SEM (marginal gap) followed, at restoration margins, and at 0.3 mm and 0.5 mm distance from the margins, in enamel and in dentine. Total demineralization was calculated as the sum of demineralisation and substance loss due to demineralisation. Results PRIM (p = 0.007, mod. LSD), BOND (p = 0.012, mod. LSD) and PEAK (p = 0.008, mod. LSD) exhibited significantly higher total demineralisation values in enamel margins than CTRL. No significant differences were noted for total demineralisation in dentine. Regarding marginal gaps, DENT exhibited significantly lower enamel gap values compared to all other groups (p = 0.001). Conclusions 2% CHX as dentine pre-treatment, 0.1% or 0.2% CHX added in adhesives did not provide any antibacterial effect regarding Secondary Caries in dentine. On the other hand, 2% CHX dentine pre-treatment managed to limit marginal gap formation in enamel compared to the other adhesive protocols in the study.
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Secondary Caries formation with a two species biofilm artificial mouth
Dental Materials, 2018Co-Authors: Stefanie Amend, Eugen Domann, Susanne Lucker, Roland Frankenberger, Norbert KramerAbstract:Abstract Objectives The present study aimed to establish Lactobacillus casei in a completely automated Streptococcus mutans-based artificial mouth model and to investigate Secondary Caries inhibiting properties of glass ionomer cements / resin composite groups in vitro. Methods Sixty extracted, Caries-free human third molars were used for preparation of standardized class-V-cavities. Specimens were restored with a resin-modified (Photac Fil; PF) as well as a conventional glass ionomer cement (Ketac Molar; KM) and one resin composite bonded with and without conduction of etch-and-rinse technique (PrimeB C+ERT, C). Following an incubation in distilled water for 28 d at 37 °C, specimens were exposed to 10,000 thermocycles (+5 °C/+55 °C). A completely automated S. mutans-based (DSM No.: 20523) artificial mouth model was extended by establishment of L. casei (DSM No.: 20021). During microbiological loading, demineralization (4 h/d) was caused by acid production resulting from bacterial glycolysis and artificial saliva was used for remineralization (20 h/d). For quantitative margin analysis under am SEM, epoxy replicas were produced from impressions taken after thermocycling and after microbiological loading. Specimens were cut in half perpendicularly to restoration surfaces and demineralization depths at restoration margins and in 500 μm distance from margins were evaluated by means of a fluorescence microscope (FITC filter). Results After microbiological loading, overall demineralization depths in enamel at restoration margin (EM) and in 500 μm distance (ED) as well as in cementum/dentin at restoration margin (DM) and in 500 μm distance (DD) were measured as follows (μm ± SD): PF: EM 42 ± 15, ED 60 ± 17, DM 83 ± 18; DD 127 ± 16; KM: EM 46 ± 22, ED 62 ± 17, DM 104 ± 21, DD 143 ± 28; C+ERT: EM 67 ± 19, ED 61 ± 17, DM 165 ± 31, DD 176 ± 35; C: EM 65 ± 23, ED 64 ± 17, DM 161 ± 27, DD 166 ± 33. For the glass ionomer cements, the overall demineralization depths at restoration margins were significantly lower than in 500 μm distance from margins (T-test, p Significance The refined experimental setup was suitable for production of artificial Secondary Caries-like lesions. Glass ionomer cements as fluoride-releasing materials may show an inhibition of Secondary Caries formation to a certain extent.
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glass ionomer cement inhibits Secondary Caries in an in vitro biofilm model
Clinical Oral Investigations, 2018Co-Authors: Norbert Kramer, Susanne Lucker, Eugen Domann, Miriam Schmidt, Roland FrankenbergerAbstract:The objective of this study was to investigate the effect of different glass ionomer cements on Secondary Caries inhibition in a fully automated in vitro biofilm model. One hundred and twenty-four extracted third molars received class V cavities and were filled with one conventional (Ketac Molar/KM), and two resin-modified glass ionomer cements (Photac Fil/PF, Ketac N100/KN, 3M Espe). A bonded resin composite (Single Bond Plus/Filtek Supreme XTE) served as control. After 14 days water storage at 37 °C, specimens were thermocycled (10,000 × 5/55 °C). Over a period of 10 days, specimens were subjected to cariogenic challenge for 3/4/6 h/day. Demineralization was caused by Streptococcus mutans (DSM 20523) alternatingly being rinsed over specimens using artificial saliva. After biological loading, teeth were cut longitudinally and demineralization depths were evaluated at the margins and at a distance of 0.5 mm from the margins using fluorescence microscopy. Marginal quality was investigated under a SEM at ×200 magnification. Four-hour demineralization depths were for enamel margins (EM), enamel (E), dentin margin (DM), and dentin (D) (μm ± SD): KM: EM 12 ± 8, E 33 ± 7, DM 56 ± 11, D 79 ± 6; PF: EM 19 ± 13, E 34 ± 13, DM 53 ± 10, D 77 ± 12; and KN: EM 26 ± 5, E 38 ± 6, DM 57 ± 11, D 71 ± 7. For all glass ionomer cements (GICs), demineralization depth at the margins was less compared to 0.5 mm distance, with demineralization depth having been correlated to duration of cariogenic challenge (ANOVA [mod. LSD, p < 0.05]). Compared to the bonded resin composite, all GICs exhibited Caries inhibition at restoration margins in enamel and dentin. Fluoride-releasing GIC materials exhibit a Secondary Caries inhibiting effect in vitro. Glass ionomer cements have a higher Secondary Caries inhibiting effect than resin composites.
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effect of microparticulate silver addition in dental adhesives on Secondary Caries in vitro
Clinical Oral Investigations, 2015Co-Authors: Norbert Kramer, Mandy Mohwald, Susanne Lucker, Eugen Domann, Jose Zorzin, Martin Rosentritt, Roland FrankenbergerAbstract:The aim of the present study was evaluate the effect of microparticulate silver additions in adhesives on Secondary Caries formation using an artificial mouth model. One hundred eight intact human third molars received standardized Class-V resin composite restorations (Filtek Supreme XTE bonded with Syntac, Scotchbond 1 XT, Futurabond M). Adhesives were charged with different amounts of microparticulate silver (0 %/0.1 %/0.5 %). After storage for 4 weeks at 37 °C, teeth were subjected to 10,000 thermocycles (+5 °C and +55 °C), and impressions were taken. Streptococcus mutans 10449 was used in a nutrition medium for Secondary Caries simulation in a fully automated artificial mouth. After completion of thermocycling and biological load cycling, impressions were taken and replicas were investigated under a light microscope for gap widths at enamel and dentin margins. Evaluation of fluorescence was carried out using a special FITC filter. The demineralization depths at the cavity margin were evaluated using Xpert for Windows working at a pixel distance of 5 μm. After thermocycling, no difference in gap widths and demineralization depths was found (p > 0.05). After incubation, gap widths and demineralization depths were significantly reduced with higher amounts of silver loading in most of the adhesives (p < 0.05). The 0.5 % silver addition resulted in a slight decrease of Secondary Caries at resin–dentin margins (p < 0.05). Addition of microparticulate silver in commercially available dental adhesives has the potential of reducing Secondary Caries. The chosen setup was able to produce Secondary Caries with a distinct in vivo appearance. Microparticulate silver additions in dental adhesives may have an impact on inhibition of Secondary Caries.
