Faculty Bibliography

OBJECTIVES/OBJECTIVE:This report describes the training of dental examiners participating in two dental caries clinical trials and reports the inter- and intra-examiner reliability scores from the initial standardization sessions. METHODS:Study examiners were trained to use a modified International Caries Detection and Assessment System II system to detect the visual signs of non-cavitated and cavitated dental caries in adult subjects. Dental caries was classified as no caries (S), non-cavitated caries (D1), enamel caries (D2), and dentine caries (D3). Three standardization sessions involving 60 subjects and 3,604 tooth surface calls were used to calculate several measures of examiner reliability. RESULTS:The prevalence of dental caries observed in the standardization sessions ranged from 1.4 percent to 13.5 percent of the coronal tooth surfaces examined. Overall agreement between pairs of examiners ranged from 0.88 to 0.99. An intra-class coefficient threshold of 0.60 was surpassed for all but one examiner. Inter-examiner unweighted kappa values were low (0.23-0.35), but weighted kappas and the ratio of observed to maximum kappas were more encouraging (0.42-0.83). The highest kappa values occurred for the S/D1 versus D2/D3 two-level classification of dental caries, for which seven of the eight examiners achieved observed to maximum kappa values over 0.90. Intra-examiner reliability was notably higher than inter-examiner reliability for all measures and dental caries classifications employed. CONCLUSION/CONCLUSIONS:The methods and results for the initial examiner training and standardization sessions for two large clinical trials are reported. Recommendations for others planning examiner training and standardization sessions are offered.

PURPOSE/OBJECTIVE:This study determined the effect of saliva contamination and cleansing solutions on microtensile bond strengths of self-etch adhesives to dentin. MATERIALS AND METHODS/METHODS:Seventy-five human molars were ground flat to expose mid-coronal dentin and randomly assigned to five groups (N = 15): no contamination, saliva contamination without cleansing, saliva and cleansing with water, saliva and cleansing with 2% chlorhexidine, and saliva and cleansing with 5% sodium hypochlorite. One-third of the specimens in each group of 15 were bonded with Adper Prompt L-Pop (all-in-one self-etch adhesive; 3M ESPE, St. Paul, MN, USA), one-third with Adper Easy Bond (all-in-one self-etch adhesive; 3M ESPE), and one-third with Clearfil SE Bond (self-etch primer system; Kuraray America, New York, NY, USA). Specimens were restored with composite and processed for microtensile bond strength testing (5-6 rods/tooth). RESULTS:Mean bond strengths ranged from 17.3 MPa for Adper Prompt L-Pop after water cleansing to 69.3 MPa for Clearfil SE Bond after water cleansing. For all three adhesives, there was no statistically significant difference in bond strengths between the saliva contaminated group, the cleansing groups, and the no contamination groups. CONCLUSIONS:Neither saliva nor the cleansing solutions adversely affected bond strengths of the self-etch adhesive systems.

OBJECTIVE:To identify risk indicators that are associated with root caries incidence in published predictive risk models. METHODS:Abstracts (n = 472) identified from a MEDLINE, EMBASE, and Cochrane registry search were screened independently by two investigators to exclude articles not in English (n = 39), published prior to 1970 (none), or containing no information on either root caries incidence, risk indicators, or risk models (n = 209). A full-article duplicate review of the remaining articles (n = 224) selected those reporting predictive risk models based on original/primary longitudinal root caries incidence studies. The quality of the included articles was assessed based both on selected criteria of methodological standards for observational studies and on the statistical quality of the modeling strategy. Data from these included studies were extracted and compiled into evidence tables, with information about the cohort location, incidence period, sample size, age of the study participants, risk indicators included in the model, root caries incidence, modeling strategy, significant risk indicators/predictors, and parameter estimates and statistical findings. RESULTS:Thirteen articles were selected for data extraction. The overall quality of the included articles was poor to moderate. Root caries incidence ranged from 12% to 77% (mean ± SD = 45 ± 17%); follow-up time of the published studies was ≤ 10 years (range = 9; median = 3); sample size ranged from 23-723 (mean ± SD = 264 ± 203; median = 261); person-years ranged from 23 to 1540 (mean ± SD = 760 ± 556; median = 746). Variables most frequently tested and significantly associated with root caries incidence were (times tested; % significant; directionality): baseline root caries (12; 58%; positive); number of teeth (7; 71%; three times positive, twice negative), and plaque index (4; 100%; positive). Ninety-two other clinical and nonclinical variables were tested: 27 were tested three times or more and were significant between 9% and 100% of the times tested; and 65 were tested but never significant. CONCLUSIONS:The root caries incidence indicators/predictors most frequently reported were root caries prevalence at baseline, number of teeth, and plaque index. This finding can guide targeted root caries prevention. There was substantial variation among published models of root caries risk in terms of variable selection, sample size, cohort location, assessment methods, incidence periods, association directionality, and analytical techniques. Future studies should emphasize variables frequently tested and often significant, and validate existing models in independent databases.

PURPOSE/OBJECTIVE:This study evaluated the effect of the use of different finishing instruments on the marginal integrity of resin composite restorations. MATERIALS AND METHODS/METHODS:Bovine incisors (N = 75) embedded in epoxy resin had the facial enamel ground and polished to 1200-grit. A standardized cavity (3 x 3 mm, 2 mm deep) was prepared on each specimen and restored with a 2-step total-etch adhesive (Single Bond, 3M ESPE, St. Paul, MN, USA) and a hybrid resin composite (Filtek Z250, 3M ESPE) in a single increment. The restorations were mechanically polished to 1200-grit. Specimens were randomized into different groups (N = 5) according to finishing technique: positive control (1200-grit paper), negative control (regular-grit diamond), fine cross-cut laminated burs, straight-cut laminated burs, spiral-cut laminated burs, and finishing diamonds. The straight-cut burs, spiral-cut burs, and finishing diamonds were tested individually as fine, extra-fine, and ultra-fine, as well as sequentially as a series. A high-speed, water-cooled handpiece under standardized pressure (0.5 N) and time (40 seconds) was used for all finishing procedures. Specimens were processed for scanning electron microscope, and margin gaps were systematically measured. Data were analyzed with one-way analysis of variance and Duncan test. RESULTS:The negative control specimens (course diamond) presented the largest gaps, whereas the positive control specimens (mechanically polished) generated the smallest gaps. No statistically significant difference was noted between the finishing diamonds and the positive control. The negative control exhibited significantly larger gaps when compared with the other finishing instruments. Intermediate results were observed for cross-cut, straight-cut, and spiral-cut laminated burs. Fine, extra-fine and ultra-fine finishing diamonds generated smaller gaps compared with laminated burs, but the differences were not always statistically significant. CONCLUSION/CONCLUSIONS:Fine, extra-fine and ultra-fine finishing diamonds used to finish composite restorations generated better marginal integrity when compared with carbides and regular-grit diamonds. CLINICAL SIGNIFICANCE When finishing composite restorations, finishing diamond burs result in better composite margins than carbide laminated burs.

This paper describes the resolution of an extensive complicated crown-root fracture of an endodontically treated maxillary central incisor. Initially, the fractured crown was splinted to the adjacent teeth with orthodontic wire and composite resin. Subsequently, the crown fragment was reattached by means of a fiber post using a hybrid composite resin. Early stage success was achieved with the observance of normality in function, esthetics, and health of the tooth and surrounding periodontal structures. An athletic mouthguard was fabricated to prevent further trauma. Advantages, disadvantages, and prognosis of the treatment presented are discussed.

OBJECTIVE:This study evaluated the correlation between laser fluorescence readings and the extent of incipient occlusal caries as measured by the volume of tooth preparation in vitro. MATERIALS AND METHODS/METHODS:One hundred and three permanent molars and premolars containing incipient occlusal pit-and-fissure caries and sound occlusal surfaces (1/4 of the sample, control) were selected. DIAGNOdent (KaVo Dental Corporation, Lake Zurich, IL, USA) readings were obtained according to manufacturer instructions. Caries was removed with 1/4 round burs in high speed. The volume of tooth preparation was measured using a surrogate measure based on the amount of composite needed to fill the preparations. Sensitivity and specificity using different cutoff values were calculated for lesions/preparations extending into dentin. The results were analyzed statistically. RESULTS:The Pearson correlation for preparation volume and DIAGNOdent reading measurements was low (r = 0.285). Sensitivity and specificity of DIAGNOdent for detection of dentinal lesions were 0.83 and 0.60, and 0.66 and 0.73 for the cutoff values of 20 and 30, respectively. CONCLUSIONS:Within the limitations of this study, laser fluorescence measured with DIAGNOdent does not correlate well with extent of carious tooth structure in incipient occlusal caries. CLINICAL SIGNIFICANCE/CONCLUSIONS:Clinicians should not rely only on DIAGNOdent readings to determine the extension of incipient occlusal caries.

As the number of dental-related randomized clinical trials (RCTs) increases, there is a need for literature to help investigators inexperienced in conducting RCTs design and implement studies. This commentary describes four "lessons learned" or considerations important in the planning and initial implementation of RCTs in dentistry that, to our knowledge, have not been discussed in the general dental literature describing trial techniques. These considerations are a) preparing or securing a thorough systematic review; b) developing a comprehensive set of study documents; c) designing and testing multiple recruitment strategies; and d) employing a run-in period prior to enrollment. Attention to these considerations in the planning phases of a dental RCT can help ensure that the trial is clinically relevant while also maximizing the likelihood that its implementation will be successful.