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Objective: This study aimed to assess the remineralization efficacy of casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP), silver diamine fluoride/potassium iodide (SDF/KI), and sodium fluoride with functionalized tricalcium phosphate (NaF/fTCP) on artificial early enamel lesion using laser fluorescence and micro‐CT analysis. Methodology: On extracted impacted third molars, artificial enamel lesions were prepared. Twenty‐eight specimens were randomly assigned to four groups (n = 7 per group): a control group (artificial saliva), CPP‐ACP (GC Tooth Mousse), SDF/KI (Riva Star), and NaF/fTCP (Clinpro White varnish). Following the manufacturer's instructions, the remineralization agents were applied to demineralized surfaces. Laser fluorescence and micro‐CT were used to evaluate the remineralization efficacy of the agents and analyzes were performed during four stages: before demineralization, after demineralization, 1st day of remineralization and 30th day of remineralization. Shapiro–Wilk test, repeated measures two‐way ANOVA, and Spearman correlation tests were used for statistical analysis. A significant level of p < 0.05 was established. Results: SDF/KI significantly reduced the lesion area and lesion volume on the demineralized enamel surface after 30 days of remineralization. In the T3 period, SDF/KI increased the mineral density statistically significantly compared to the T1 period. The laser fluorescence values for all three remineralizing agents exhibited a linear decrease. A significant correlation between the fluorescence values and the mineral density was found (p = 0.01). Conclusion: All three investigated agents were showed positive remineralization efficacy on artificial enamel lesion. However, SDF/KI, containing silver diamine fluoride and potassium iodide exhibited superior than other agents in promoting remineralization. Clinical Significance: Although all three remineralization agents showed positive remineralization efficacy on artificial enamel lesions, SDF had higher remineralization performance over the other two agents. SDF has potential to prevent progression of demineralization in treating children with high caries risk in the long‐term. [ABSTRACT FROM AUTHOR]

Energy‐dispersive Laue diffraction (EDLD) is a powerful method to obtain position‐resolved texture information in inhomogeneous biological samples without the need for sample rotation. This study employs EDLD texture scanning to investigate the impact of two salivary peptides, statherin (STN) and histatin‐1 (HTN) 21 N‐terminal peptides (STN21 and HTN21), on the crystallographic structure of dental enamel. These proteins are known to play crucial roles in dental caries progression. Three healthy incisors were randomly assigned to three groups: artificially demineralized, demineralized after HTN21 peptide pre‐treatment and demineralized after STN21 peptide pre‐treatment. To understand the micro‐scale structure of the enamel, each specimen was scanned from the enamel surface to a depth of 250 µm using microbeam EDLD. Via the use of a white beam and a pixelated detector, where each pixel functions as a spectrometer, pole figures were obtained in a single exposure at each measurement point. The results revealed distinct orientations of hydroxyapatite crystallites and notable texture variation in the peptide‐treated demineralized samples compared with the demineralized control. Specifically, the peptide‐treated demineralized samples exhibited up to three orientation populations, in contrast to the demineralized control which displayed only a single orientation population. The texture index of the demineralized control (2.00 ± 0.21) was found to be lower than that of either the STN21 (2.32 ± 0.20) or the HTN21 (2.90 ± 0.46) treated samples. Hence, texture scanning with EDLD gives new insights into dental enamel crystallite orientation and links the present understanding of enamel demineralization to the underlying crystalline texture. For the first time, the feasibility of EDLD texture measurements for quantitative texture evaluation in demineralized dental enamel samples is demonstrated. [ABSTRACT FROM AUTHOR]

Objectives: This study was aimed to clarify the incidence, severity, and clinical risk factors for white spot lesions (WSLs) in adolescent patients treated with clear aligners. Methods: Pre‐treatment and post‐treatment intraoral photographs of 203 adolescent patients undergoing clear aligner therapy were retrospectively evaluated to assess the occurrence and severity of WSLs. Information on patients' general oral condition and orthodontic treatment was collected from clinical medical documents, retrospective questionnaires, and ClinCheck® software. Independent risk factors and model performance were determined by multivariate logistic regression and receiver operating characteristic curve analysis. Results: Thirty‐five percent of adolescent patients developed WSLs during clear aligner treatment. Logistic regression analysis revealed that the presence of WSLs before treatment (OR 2.484, 95% CI 1.245‐4.957), frequency of drinking carbonated beverages (OR 1.508, 95% CI 1.045‐2.177), and number of anterior attachments (OR 2.192, 95% CI 1.502‐3.198) were risk factors for the occurrence of WSLs in adolescent patients treated with clear aligners (P <.05), whereas the number of times they brushed each day (OR 0.656, 95% CI 0.454‐0.947) and frequency of aligner cleaning after eating while wearing them (OR 0.611, 95% CI 0.433‐0.861) were protective factors against WSLs (P <.05). Conclusions: The incidence of WSLs was high in adolescent patients treated with clear aligners. Few brushings each day, pre‐treatment WSLs, a high frequency of drinking carbonated beverages, a low frequency of aligner cleaning after eating while wearing them, and a high number of anterior attachments are strongly associated with the development of WSLs in adolescent patients treated with clear aligners. [ABSTRACT FROM AUTHOR]

The article offers a perspective on principles and care pathways for caries management in children. Topics discussed include advances in the science of cariology, evidence-based care pathway for caries management, prevention and restorative strategies, caries risk/susceptibility assessment, shared decision-making in oral healthcare, and active surveillance as part of restorative dental care, advances in clinical caries management for children, improvements for oral health systems.

Background: No consensus exists on how molar incisor hypomineralisation (MIH) should be covered by the undergraduate dental curricula. Aim: To assess the current teaching and assessment of MIH in the UK. Design: A piloted questionnaire regarding the teaching and assessment of MIH was disseminated to paediatric, restorative and orthodontic teaching leads in each UK dental school (n = 16). Data were analysed using descriptive statistics, chi‐squared and Kruskal–Wallis tests. Results: Response rates from paediatric, restorative and orthodontic teams were 75% (n = 12), 44% (n = 7) and 54% (n = 8), respectively. Prevention of caries, preformed metal crowns, anterior resin composites and vital bleaching were taught significantly more by paediatric teams (p =.006). Quality of life and resin infiltration were absent from restorative teaching. Orthodontic teaching focussed on the timing of first permanent molar extractions. Paediatric teams were mainly responsible for assessment. Risk factors, differential diagnoses for MIH and defining clinical features were more likely to be assessed by paediatric teams than by others (p =.006). All specialities reported that students were prepared to manage MIH. Conclusion: Molar incisor hypomineralisation is primarily taught and assessed by paediatric teams. No evidence of multidisciplinary or transitional teaching/assessment existed between specialities. Developing robust guidance regarding MIH learning in the UK undergraduate curricula may help improve consistency. [ABSTRACT FROM AUTHOR]

Background: Molar incisor hypomineralisation (MIH) is a developmental enamel defect in the first permanent molars and frequently in the incisors. It poses a unique challenge to the dental practitioner because of its nature, clinical presentations and treatment strategies. Aim: This study assessed the perception of Libyan dentists in Benghazi regarding MIH and its management. Design: Paper‐based, self‐administered questionnaires were distributed to dentists in Benghazi, Libya. The questionnaires investigated the awareness of MIH, knowledge of MIH aetiology, clinical challenges of MIH treatment and choices of restorative management. Descriptive statistics, chi‐squared test and binary logistic regression analysis were performed at a significance level of ≤.05. Results: A total of 389 questionnaires were completed and analysed, giving an overall response rate of 76% (389/511). Most participants were female (85%, 332), with an average of 6.05 (SD = 6.24) years of experience. The majority of participants (67%) recognised MIH in their practice. Statistically significant differences in the awareness of MIH and its prevalence were observed according to the type of practice (p ≤.001) and experience of dentists (p ≤.001). Dentists working in public dental practice were less familiar with MIH and less likely to report it. Likewise, novice dentists were less aware of MIH than more experienced colleagues. The most reported aetiological factor in MIH was genetics by 60.2% of respondents, followed by environmental contamination (47.6%) and fluorides (42.9%). Most participants (92.3%) considered MIH a clinical problem. Aesthetics and diagnosis were the most reported challenging aspects (59.4% and 44.2%, respectively). The most commonly selected restorative options were high‐fluoride glass ionomer cement (43.2%) and preformed metal crowns (41.6%). Conclusion: The majority of participants reported awareness of the existence of MIH condition. Nevertheless, variations in estimating MIH prevalence and its proper treatment, as well as factors influencing its treatment and diagnosis, were recorded. It is recommended that the current dental curriculum is reviewed, and scientific evidence providing dental practitioners with updated information on the diagnosis and clinical management of MIH should be circulated. [ABSTRACT FROM AUTHOR]

Objectives: This study was aimed to obtain an experimental bleaching agent by adding casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP) in order to eliminate the mineral loss on the tooth surface after bleaching and to evaluate the bleaching effectiveness. Materials and Methods: In this study, experimental bleaching agents containing 1%, 3% CPP‐ACP and without CPP‐ACP were obtained. Bleaching effectiveness (color change), the effect of bleaching agents on mineral content (energy dispersive x‐ray spectroscopy), surface morphology (scanning electron microscope), and surface hardness of enamel (Vicker's microhardness) before and after bleaching were evaluated. The obtained data were statistically analyzed. Results: When the bleaching levels of the groups were compared, no statistically significant difference was observed between the control and 1% CPP‐ACP groups (p > 0.05) while the addition of 3% CPP‐ACP decreased significantly the effectiveness of the bleaching agent (p < 0.05). When the effects of experimental bleaching agents on surface hardness were examined, while the enamel surface hardness decreased statistically significantly after application in the control group (p < 0.05), no statistically significant change was observed in surface hardness after the application of 1% CPP‐ACP containing bleaching agent (p > 0.05). However, a statistically significant increase was observed in surface hardness after the application of 3% CPP‐ACP containing bleaching agent (p < 0.05). When the Ca and P ratio of the groups were compared, no statistically significant difference was observed between the control and 1% CPP‐ACP groups (p > 0.05), while they increased significantly in 3% CPP‐ACP group (p < 0.05). Conclusions: The addition of 1% CPP‐ACP to the bleaching agent had positive effects on the mineral content and surface hardness of the enamel, and did not negatively affect the whitening effectiveness. Clinical Significance: Adding CPP‐ACP to the bleaching agent at appropriate concentrations can eliminate possible negative effects without compromising the effectiveness of the bleaching agent. [ABSTRACT FROM AUTHOR]

Objective: To analyze prenatal and perinatal stressors associated with molar incisor hypomineralization (MIH) in adolescents. Methods: Prospective cohort study collected prenatal (socioeconomic status, maternal age, number of prenatal visits, smoking, obesity during pregnancy, abortion history, gestational hypertension) and perinatal stressors (type of delivery, gestational age, birth weight, intensive care unit‐ICU at birth). The outcome was MIH at 18–19 years follow‐up (n = 590). MIH was defined according to the Ghanim criteria – Model I. We performed a sensitivity analysis, including opacities demarcated in index tooth, incisive or molars, Model II. Through structural equation modeling, we analyzed direct and mediating pathways between multiple stressors with outcomes. Results: MIH was observed in 15.25% (n = 90), and opacities demarcated in any index tooth were observed in 22.8% of adolescents (n = 135). In Model I, no stressor explained MIH significantly, although we watched high standardized coefficients (SC) for low birth weight (SC = 0.223, p = 0.147), lower gestational age (SC = 0.351; p = 0.254), and ICU admission (SC = 0.447, p = 0.254). In Model II, advanced maternal age (SC = 0.148; p < 0.05) and not undergoing prenatal care (SC = 0.384, p < 0.03) explained opacities demarcated in incisors or molars. Conclusion: Advanced maternal age and not undergoing prenatal care were associated with MIH lesion‐like in incisors or molars. [ABSTRACT FROM AUTHOR]

Background: Molar–incisor hypomineralization (MIH) is a developmental enamel defect characterized by opacities from white to brownish color. A suspected multifactorial etiology has been suggested, whereas psychological factors during pregnancy have only been limitedly analyzed. Aim: We assessed the association between stress, depression, and anxiety in pregnancy and the presence of MIH in children at a later age. Design: Using a cross‐sectional Web‐based questionnaire, we included 384 mothers who had children aged 6 and 12 years from Pasto, Colombia. Data were collected between October 2021 and March 2022. Sociodemographic variables; maternal and child factors related to prenatal, natal, or postnatal problems; and psychological factors such as stress and symptoms of anxiety and depression in pregnancy were inquired. Utilizing photographs depicting MIH lesions, mothers assessed their child's MIH status. A directed acyclic graph (DAG) analysis was performed to create causal assumptions, and logistic regression models were estimated to evaluate these assumptions. p‐value was set at p <.05. Results: The prevalence of MIH was 33.3%; 12.8% of the participants exhibited hypomineralization in both molars and incisors. DAG analysis and logistic regression models determined that MIH (present or not) was associated with symptoms of maternal depression (ORadj = 3.26, 95% CI: 1.92–5.52, p <.001), and MIH (both molars and incisors) was associated with symptoms of maternal anxiety (ORadj = 3.49, 95% CI: 1.80–6.76, p <.001). Conclusion: Psychological factors, among others, were significantly associated with the presence of MIH. [ABSTRACT FROM AUTHOR]

Background: Molar–incisor hypomineralisation (MIH) is a prevalent condition, and how it is managed varies greatly between professional groups. Aim: To explore, and compare, the UK and Australian general dental practitioners' management of MIH in children. Design: Face‐to‐face (remote) semistructured interviews were undertaken, using country‐specific topic guides. Participants were purposively sampled and recruited through national conferences and research networks (eviDent Foundation and Northern Dental Practice Based Research Network). Interviews (from each country) were audio‐recorded, transcribed verbatim and independently analysed using thematic analysis. Results: Two major themes arose from the UK interviews: (i) decision‐making complexities and understanding of treatment options and (ii) need for specialist input. The main Australian themes were (i) multidisciplinary approach to management supporting decision‐making complexities and (ii) economic implications for care. Several difficulties, such as financial implications, multidisciplinary care and clinical decision‐making, were identified as barriers to effectively managing MIH by GDPs in primary care. Conclusion: There are similarities and differences in the knowledge and management of MIH amongst UK and Australian nonspecialists. The different healthcare systems played a significant role in shaping how GDPs manage MIH with barriers relating to affordability, multidisciplinary care and clinical decision‐making. [ABSTRACT FROM AUTHOR]

Background: There is no consensus on which molar incisor hypomineralization (MIH) indices are more suitable for epidemiological surveys. Aim: To compare the operational aspects and diagnostic ability of the MIH index (simplified/MIH_s and extended/MIH_e) with the MIH‐Severity Scoring System (MIH‐SSS) in classifying and diagnosing MIH. Design: This cross‐sectional study assessed the indices in a homogeneous group of 680 6‐ to 10‐year‐old schoolchildren in Bauru, Brazil, who had at least one first permanent molar, ensuring consistent conditions. Followed by toothbrushing, the children seated on school chairs were examined by the two calibrated researchers under artificial lighting, using mouth mirror and WHO probe, and chronometer recording the duration of examinations. Results: The prevalence of MIH was 24.7%. The most common characteristic of MIH was demarcated opacity, with a prevalence of 81.7% and 85.45% according to the MIH_s and the MIH‐SSS, respectively. A positive association was observed among the MIH_s, the MIH_e, and the MIH‐SSS (chi‐squared test; p <.01). The MIH‐SSS demonstrated a shorter average application time than both versions of the MIH index (ANOVA/Tukey; p <.05). Additionally, fluorosis was found to be the most prevalent among other developmental defects of enamel, with a prevalence of 38.38%. Conclusion: All systems effectively diagnosed MIH and its characteristics. [ABSTRACT FROM AUTHOR]

Background: Molar hypomineralization (MH) is defined as a multifactorial condition, and thus, its presence may be defined by interactions between environmental and genetic factors. Aim: To evaluate the association between MH, genes involved in enamel development, and the use of medication during pregnancy in early childhood. Design: One hundred and eighteen children, 54 with and 64 without MH, were studied. The data collected included demographics, socioeconomic data, and the medical history of mothers and children. Genomic DNA was collected from saliva. Genetic polymorphisms in ameloblastin (AMBN; rs4694075), enamelin (ENAM; rs3796704, rs7664896), and kallikrein (KLK4; rs2235091) were evaluated. These genes were analyzed by real‐time polymerase chain reaction using TaqMan chemistry. The software PLINK was used to compare allele and genotype distributions of the groups and to assess the interaction between environmental variables and genotypes (p <.05). Results: The variant allele KLK4 rs2235091 was associated with MH in some children (odds ratio [OR]: 3.75; 95% confidence interval [CI] = 1.65–7.81; p =.001). Taking medications in the first 4 years of life was also associated with MH (OR: 2.94; 95% CI = 1.02–6.04; p =.041) and specifically in association with polymorphisms in ENAM, AMBN, and KLK4 (p <.05). The use of medications during pregnancy was not associated with MH (OR: 1.37; 95% CI = 0.593–3.18; p =.458). Conclusion: The results of this study suggest that taking medication in the postnatal period appears to contribute to the etiology of MH in some evaluated children. There may be a possible genetic influence of polymorphisms in the KLK4 gene with this condition. [ABSTRACT FROM AUTHOR]

Background: Mineralization‐promoting peptide‐3 (MPP3) is a new biomimetic remineralization agent. Aim: To assess the remineralization efficiency of MPP3, either alone or in combination with fluoride gel. Design: The samples were divided into four groups: control, 1.23% fluoride gel, 10% MPP3 gel, and 1.23% fluoride gel + 10% MPP3. Following the application of remineralization agents (4 min), the samples remained in a pH‐cycling model (37°C, 4 weeks). Microhardness, microcomputed tomography (micro‐CT), polarized light microscopy (PLM), and field emission scanning electron microscopy (FE‐SEM) analysis were conducted. RM‐ANOVA, one‐way ANOVA, and intraclass correlation coefficient (ICC) were used for statistical analysis, and a significance level of p <.05 was employed. Results: Mineralization‐promoting peptide 3 and fluoride gel + MPP3 increased the microhardness of the enamel compared with initial values in each group (p <.05). Mineralization‐promoting peptide 3 successfully maintained the mineral density of enamel, although the cariogenic pH‐cycling and PLM results indicated that the lesion depth (μm) was significantly lower in the fluoride gel + MPP3 group (27.0336 ± 12.53650) than in the control group (37.3907 ± 12.76002, p <.05). Conclusion: The combined use of MPP3 with fluoride gel enhanced the caries‐protective and mineralization‐promoting effects of fluoride. Mineralization‐promoting peptide 3 may be a potential agent that can be employed to improve the physical properties of enamel. [ABSTRACT FROM AUTHOR]

Background: Difficulty in anesthetizing teeth that have been diagnosed with molar incisor hypomineralization (MIH) is a frequently reported clinical problem. The effects of low‐level laser application (photobiomodulation) on the efficacy of anesthesia during the dental treatment of patients with MIH have not yet been studied. Aim: To assess the effects of photobiomodulation therapy (PBMT) on the efficacy of anesthesia in maxillary permanent molar teeth with MIH. Design: This prospective, parallel‐arm control, randomized, triple‐blind clinical trial included children aged 7–12 years. Maxillary permanent first molar teeth with MIH that required pulpotomy treatment were included. Seventy participants were randomly divided into two groups: experimental (with PBMT) and control (placebo). In the experimental group, before the administration of local infiltration anesthesia, PBMT (diode laser: 940 nm; continuous mode; 0.5 W; 78 J/cm2) was applied to the oral mucosa for 60 s each. In the control group, the laser probe was channeled toward the mucosa but was not activated. Pain scores were evaluated during the access cavity preparation of the pulpotomy treatment (when using the dentin cutting handpiece and while entering into the pulp) using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Additional anesthesia requirements were assessed in both groups. The data obtained were analyzed for statistical significance (p <.05). The chi‐squared test was used to determine the effect of PBMT on categorical outcomes. Results: The no‐pain scores of the experimental group were higher than those of the control group (29% vs. 20%). Moderate‐to‐high pain was more frequent in the control group than in the experimental group (43% vs. 20%). While 31% of the experimental group required supplemental anesthesia, 49% of the control group required supplemental anesthesia during pulpotomy of the tooth with MIH. No statistical difference, however, was found between the two groups in terms of pain scores and the need for supplemental anesthesia (p =.235, p =.143). Conclusions: Anesthesia with and without PBMT caused no difference in pain during the treatment of maxillary molar teeth with MIH. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to evaluate the effect of remineralizing agents on demineralized enamel intended for use as fluoride substitutes or supplements for oral hygiene applications. Methodology: Enamel samples were obtained from 30 bovine teeth. The enamel blocks were stored in 20 mL of demineralization solution for 72 h. They were then brushed with the following toothpaste for the remineralization protocol: NaF, NaF/SnF2 combination, NovaMin, or nano‐hydroxyapatite. SEM/EDX examinations and microhardness measurements of the samples were performed to investigate the remineralization efficacy of the studied toothpaste. One‐way analysis of variance (ANOVA) with post hoc Tukey's HSD test was used to analyze the change in microhardness values in different remineralization protocols (p < 0.05). Results: Differences in the mean remineralization (%RP) and hardness recovery (%HR) were determined between the groups (p < 0.05). Groups 1 and 4 showed significant differences in %RP (p < 0.05). In the SEM/EDX examinations, the samples treated with n‐HAp showed an accumulation of crystal deposits on the enamel surface, although at a lower density than those treated with NaF and NaF/SnF2 combination. Conclusion: The remineralization strategy in toothpaste plays an important role in enamel remineralization. NovaMin‐containing toothpaste showed positive effects on the enamel surface with better Ca/P ratio. Toothpastes containing n‐HAp triggered less change in the increase of microhardness values compared to other toothpastes. The use of SnF2 in toothpaste in combination with NaF significantly increased the binding of fluoride to demineralized enamel compared to toothpaste containing NaF alone. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluated the remineralization potential of calcium sodium phosphosilicate and functionalized tri‐calcium phosphate (f‐TCP) dentifrices in deeper incipient carious lesions (ICLs). Materials and Methods: Artificial ICLs were created by placing premolars into demineralizing solutions. Teeth were randomly assigned into four groups: calcium sodium phosphosilicate (Group 1), f‐TCP (Group 2), 1450 ppm fluoride (Group 3), and distilled water (Group 4), which were subjected to 10‐day pH cycling. Mineral density (MD) was assessed using microcomputed tomography (Micro‐CT), while hardness (H) and elastic modulus (EM) were assessed using nanomechanical testing. Results: MD % gain was higher in Groups 1–3 than in Group 4. In addition, Groups 1 and 2 exhibited significantly higher MD % gain than Group 3. Also, Groups 1–3 showed significantly higher EM and H values than Group 4 in the outer enamel area; yet, Groups 1 and 2 displayed significantly higher EM and H values than Groups 3 and 4 in the inner enamel. Conclusions: The MD, EM, and H of ICLs significantly increased with the addition of calcium sodium phosphosilicate or f‐TCP to fluoridated dentifrices compared to standard fluoride dentifrices. The added active ingredients remineralized the deeper parts of the ICLs, while remineralization at the lesion surface was similar between tested dentifrices. [ABSTRACT FROM AUTHOR]

Introduction: Teaching caries lesion management with operative care requires tooth models with highly realistic anatomical detail and caries lesions that can be assessed using ICDAS. This study aimed to develop and evaluate a new 3D‐printed teeth model for ICDAS assessment and caries removal for pre‐clinical hands‐on education. Methods: Printable tooth with different layers for enamel, dentin and carious lesions was designed and tested by 31 dental students. They were asked to visually and radiologically assess the ICDAS severity of the simulated carious lesions, establish the therapeutic strategy according to CariesCare 4D, and perform a qualitative assessment of the models based on five‐point Likert scale items. Results: Concerning carious lesions, the texture was realistic, and the shade was adequate for 94% and 97% of the participants. Ninety per cent of the participants found the model adequate to perform an ICDAS visual assessment. Seventy‐four per cent of the students found the hardness adequate. Concerning the difference in shade and the noticeable hardness difference between enamel and dentin, participants have mixed agreement with a proportion of 61% and 55%, respectively. All the participants agreed these 3D‐printed models provide a good caries simulation, are suitable for hands‐on operative dentistry courses, and that learning outcomes better than the standard model. Conclusion: The present work shows that rapid prototyping paves the way for customized educational models capable of supporting operative but also preoperative skills. 3D printing opens up new opportunities by reducing the gap between pre‐clinical training and clinical reality in caries management, which can positively impact the quality of patient care. [ABSTRACT FROM AUTHOR]

Introduction: In orthodontics, white spot lesions are a persistent and widespread problem caused by the demineralization of buccal tooth surfaces around bonded brackets. The remaining adhesive around the brackets leads to surface roughness, which might contribute to demineralization. The present in vitro study aimed to compare a conventional and a modern adhesive system (APC Flash‐Free technology) for orthodontic brackets with regard to the adhesion of Streptococcus sobrinus, a leading caries pathogen. Methods: This in vitro study included 20 premolar teeth and compared 10 APC Flash‐Free adhesive‐coated ceramic brackets (FF)with 10 conventionally bonded (CB) ceramic clarity brackets. Specimens were incubated in an S. sobrinus suspension for 3 h. To evaluate the bacterial formation, samples were analysed with a scanning electron microscope (SEM). Imaging software was used to quantify and statistically compare percentage values of colonization (PVC) in both groups' adhesion and transition areas. Results: We found a significant difference in biofilm formation between the groups for the adhesive and transition areas. PVC in the adhesive area was approximately 10.3‐fold greater for the CB group compared with the FF group (median: 3.2 vs 0.31; P < 0.0001). For the transition area, median PVC was approximately 2.4‐fold greater for the CB group compared with the FF group (median: 53.17 vs 22.11; P < 0.01). Conclusions: There was a significantly lower level of S. sobrinus formation around the FF bracket system than there was surrounding the conventionally bonded group. This study suggests that the FF adhesive bracket system can help reduce the occurrence of bacterial growth around orthodontic brackets. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of resin infiltration treatment on enamel color stability and surface roughness after simulating daily exposure to coffee stains and regular toothbrushing with standard toothpaste. Materials and Methods: In this in vitro study, we utilized 47 caries‐free human enamel specimens, which were divided into two distinct groups. The teeth in the study group underwent artificial demineralization, Icon resin infiltration, and polishing, while the control group received only polishing. Following this, all teeth from both groups were regularly immersed in freshly brewed coffee for 15 min, twice daily, over a span of 30 days. After each staining session, the teeth underwent 10 heavy circular strokes using a soft toothbrush and standard toothpaste. Color changes were measured on Days 1 and 30 using a spectrophotometer. The L*, a*, b* color system defined by the International Commission on Illumination was used to assess the changes. Surface roughness was evaluated at baseline and after 30 days using a 3D surface Metrology Microscope. Results: After 30 days of immersion in coffee, both the study and control groups showed significant changes in color. However, differences were statistically significant between groups for "L" and "a" parameter but not for "b." The overall color change in the study group was higher than the control group. There were no significant differences in surface roughness within or between the groups before and after staining and brushing. Conclusions: Resin infiltration leads to a significant increase in staining compared to untreated enamel. These staining properties should be taken into account when making clinical decisions regarding the treatment of white spot lesions. [ABSTRACT FROM AUTHOR]

Objective: This study assessed whether combining photobiomodulation therapy (PBMT) with casein phosphopeptide‐amorphous calcium phosphate fluoride (CPP‐ACPF) paste can effectively reduce post‐home whitening tooth sensitivity (TS) without compromising shade change. Methods: Fifty participants were selected and assigned to one of four groups: (1) PLACEBO group—received a placebo paste and PBMT simulation; (2) PBMT group—received a placebo paste + PBMT; (3) CPP‐ACPF group—received CPP‐ACPF paste and PBMT simulation; (4) CPP‐ACPF + PBMT group—received both CPP‐ACPF paste and PBMT. The participants used whitening trays containing 22% carbamide peroxide for 2 h a day for 21 days. TS was measured daily using a visual analog scale, while shade change was assessed using a spectrophotometer: before bleaching treatment (T0), after the first (T1), second (T2), and third (T3) weeks of treatment, and 30 days (T4) after completing the whitening treatment. Results: Intragroup analysis revealed that the PLACEBO group had the highest increase in sensitivity during the whitening treatment. The CPP‐ACPF and PBMT groups showed no significant difference tooth whitening (TW) between weeks regarding aesthetic change. The CPP‐ACPF and PBMT group exhibited a significant reduction in TS between the first and third and between the second and third weeks TW, but not between the first and second. Conversely, the PLACEBO group showed a higher sensitivity than the other groups (p <.05). The CPP‐ACPF and PBMT groups did not differ from each other. Furthermore, the CPP‐ACPF and PBMT group showed a greater decrease in sensitivity than the PLACEBO group at T1, T2, and T3 (p <.01), and was significantly differed from CPP‐ACPF and PBMT groups only at T2 and T3. All groups confirmed TW effectiveness. Student's and paired t‐test did not reveal any significant difference between groups (p >.05). Conclusion: Therefore, PBMT associated with CPP‐ACPF paste can reduce TS without compromising the efficacy of TW. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease (SCD) is the most important hemoglobinopathy in terms of frequency and social impact and can affect the stomatognathic system. Aim: To assess and compare the developmental defects of the enamel (DDE) in children and adolescents with and without SCD. Design: This was a cross‐sectional, analytical, and comparative study of 210 children and adolescents aged 5–18 years, who visited the Hematology and Hemotherapy Hospital of Pernambuco. Results: Developmental defects of the enamel were observed in 55.2% of the SCD patients and 35.2% of the non‐SCD patients (healthy group; p <.05). In the SCD group, DDE were more common in females than in males (69.1% vs. 40.0%; p <.05). The incidence of DDE in the permanent teeth was higher in the upper arch than in the lower arch (SCD group, 13.1% vs. 4.6%; healthy group, 8.9% vs. 3.6%; p <.05). Conclusion: Compared with the healthy group, the SCD patients were almost twice as likely to develop DDE, mostly affecting females and the permanent teeth. These findings suggest that individuals with SCD need early dental care to avoid future oral problems. [ABSTRACT FROM AUTHOR]

Objectives: Collagen fibrils from carious dentin matrix are prone to enzymatic degradation. This study investigates the feasibility and mechanism of nordihydroguaiaretic acid (NDGA), as a collagen crosslinker, to bio‐modify the demineralized dentin matrix. Methods: The physicochemical properties of the crosslinked dentin matrix were characterized by swelling ratio, ninhydrin assay, Fourier Transform Infrared spectroscopy, and atomic force microscopy. The collagenase degradation resistance was evaluated by measuring loss of dry mass, hydroproline release, loss of elasticity, and micro‐nano structure integrity. The cytotoxicity of NDGA‐crosslinked dentin collagen was evaluated by flow cytometry. Results: NDGA crosslinked dentin matrix without destroying the integrity of collagen. Mechanistically, NDGA formed bisquinone bond between two adjacent o‐quinone groups, resulting in NDGA polymeric matrix in which collagen fibrils were embedded. NDGA modification could significantly enhance the stiffness of dentin matrix at macro‐nano scale. The NDGA‐crosslinked dentin matrix exhibited remarkably low collagen degradation and sustained bulk elasticity after collagenase challenge, which were attributed to decreased water content, physical masking of collagenase bind sites on collagen, and improved stiffness of collagen fibrils. Notably, NDGA‐crosslinked dentin matrix exhibited excellent biocompatibility. Conclusion: NDGA, as a biocompatible collagen crosslinker, improves the mechanical properties and biodegradation resistance of demineralized dentin matrix. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this randomized clinical trial was to evaluate the desensitizing and remineralizing effect of a new zinc‐hydroxyapatite‐based paste in sites affected by molar–incisor hypomineralization (MIH), by assessing dental sensitivity, tooth wear, and periodontal indexes. Materials and Methods: Twenty‐five patients with presence of 1 enamel demineralization of permanent molars and incisors in two different quadrants were recruited. After professional dental hygiene, a domiciliary hydroxyapatite‐based paste was assigned and recommended to be applied on 2 MIH teeth in one random quadrant (test group), while the 2 contralateral MIH teeth did not undergo paste application (control group). The following primary outcomes were assessed: Plaque Control Record (PCR), Bleeding Index (BI), MIH Treatment Need Index (MIH‐TNI), and Schiff Air Index (SAI). Results: No significant inter‐ and intragroup differences were found for PI and BI, except for both intragroup T0–T1. For MIH‐TNI, significant intergroup differences were detectable in the test group after 9 months of treatment. For SAI values, no significant differences were found in the control group, while in the test group, significant lower values were found after 1 and 3 months since baseline, respectively. Conclusions and Clinical Relevance: Biomimetic zinc‐hydroxyapatite showed a desensitizing effect when used to treat MIH. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the cost‐effectiveness of retaining one or more compromised first permanent molars (cFPMs) affected by dental caries or enamel hypomineralization, compared to timely extraction, in children aged 8 years. Methods: A Markov model was developed to simulate the lifetime of a cFPM. Two management strategies were compared: extraction facilitating spontaneous space closure or maintenance of teeth with restorations. Ten health states were utilized to capture long‐term outcomes including various tooth restorations, prostheses or a retained gap at the cFPM site. Outcomes were expressed as Quality Adjusted Tooth‐Years (QATYs). The model was informed by survey data on patient preferences for treatment outcomes and UK data on costs. Discounted costs and QATYs were calculated over 62 years. Results: Regardless of the number of cFPMs, retaining cFPMs was more effective than early removal, generating an additional 2.3 QATYs per cFPM. Early removal of one or two cFPM under general anaesthetic (GA) was more expensive than retention and hence never cost‐effective. Retaining a cFPM was more expensive than early removal under local anaesthesia or where four cFPMs were extracted under GA. In these cases, retaining cFPMs was cost‐effective if a QATY was valued at £100 or £35, respectively. Results were robust to sensitivity analysis. Conclusion: Preserving a cFPM was more cost‐effective than the early loss of one, or two cFPMs under GA. Preservation of four cFPMs was cost‐effective if sufficient value was placed on a QATY. These findings can guide clinical practice on management of cFPMs alongside patient/payer values on maintaining teeth. [ABSTRACT FROM AUTHOR]

Objectives: White spot lesions (WSL) are prevalent in patients using orthodontic appliances. The presence of ion‐releasing compounds in the tooth‐appliance interface may limit enamel demineralization to control WSL incidence. Thus, this study aims to evaluate the mineral formation on SiNb‐containing experimental orthodontic resins and the influence of these fillers on the physicochemical and biological properties of developed materials. Materials and Methods: The SiNb particles were synthesized via the sol–gel route and characterized by their molecular structure and morphology. Photopolymerizable orthodontic resins were produced with a 75 wt% Bis‐GMA/25 wt% TEGDMA and 10 wt%, 20 wt%, or 30 wt% addition of SiNb. A control group was formulated without SiNb. These resins were tested for their degree of conversion, softening in solvent, cytotoxicity in fibroblasts, flexural strength, shear bond strength (SBS), and mineral deposition. Results: The addition of 10 wt% of SiNb did not impair the conversion of monomers, cytotoxicity, and flexural strength. All groups with SiNb addition presented similar softening in solvent. The presence of these particles did not affect the bond strength between metallic brackets and enamel, with SBS values ranging from 16.41 to 18.66 MPa. The mineral deposition was observed for all groups. Conclusion: The use of niobium silicate as filler particles in resins may be a strategy for the adhesion of orthodontic appliances. The 10 wt% SiNb concentration resulted in a material with suitable physicochemical and biological properties while maintaining the bond strength to tooth enamel and promoting mineral deposition. [ABSTRACT FROM AUTHOR]

This study investigated the prevalence and associations of molar–incisor hypomineralisation (MIH) in 8–9 year‐old children in Oslo. A total of 3013 children in one age cohort participated in the study during their regular dental examination at the Public Dental Service. Hypomineralised enamel defects were recorded according to the European Academy of Paediatric Dentistry criteria for MIH. Information on health and medications used during pregnancy and in the child's first 3 years of life was obtained from a questionnaire administered to parents. The overall prevalence of MIH was 28.2%, with no gender difference. A higher prevalence of MIH was found in children who had been ill or had used medication in early life and in those whose mother had been ill during pregnancy. No association was found between MIH and prematurity or maternal use of medication during pregnancy. The multivariable analyses showed that children with MIH were more likely to have suffered from illness in early life (OR = 1.41, 95% CI: 1.17–1.70), used antibiotics during the first year of life (OR = 1.68, 95% CI: 1.19–2.35), experienced tooth pain (OR = 1.33, 95% CI: 1.03–1.72), and experienced pain while toothbrushing (OR = 2.17, 95% CI: 1.46–3.23) than children without MIH. The prevalence of MIH was high in the children participating in this study. [ABSTRACT FROM AUTHOR]

Objective: To assess whether the prevalence of dental caries is associated with the presence of molar‐incisor hypomineralisation (MIH) in first permanent molars (FPMs). Methods: A cross‐sectional study was conducted with a sample of 5368 FPMs from 1342 children aged 8–10 years from Florianopolis, Brazil. Dental caries was evaluated with the Decayed, Missing and Filled Teeth (DMFT) index and MIH was assessed according to the European Academy of Paediatric Dentistry (EAPD) criteria. The sociodemographic data were obtained with a questionnaire sent to caregivers. A hierarchical repeated measures Poisson regression, considering dependency among observations, was performed, since the unit of analysis was the tooth. Results: The presence of MIH was associated with a 6.15 times higher prevalence of dental caries in FPMs (PR: 6.15; 95%CI: 4.18–9.04). A monthly family income ≤2 minimum wages and the caries experience in the primary teeth were also significantly associated with greater prevalence rates of dental caries in FPMs. Conclusion: The presence of MIH showed a significant association with the prevalence of dental caries in FPMs. Thus, dentists should be alert to cases of MIH. Once the condition is detected, preventive measures should be taken to prevent enamel breakdown and the development of dental caries lesions. [ABSTRACT FROM AUTHOR]

Background: This study compared natural root caries lesions with artificial root caries lesions prepared with one of the two demineralising solutions. Methods: Twelve natural root caries lesions on upper incisors and 24 artificial root lesions were prepared on sound root surfaces using 50 mM acetic acid, 1.5 mM CaCl2, 0.9 mM KH2PO4 at pH 5.0 or 80 mL/L Noverite K‐702 polyacrylate solution, 500 mg/L hydroxyapatite, 0.1 mol/L lactic acid at pH 4.8 (n = 12/group) for 96 hours. Lesions were scanned using micro‐CT. Inciso‐gingival oriented images were analysed and mineral density calculated at 7.5 μm increments from the surface to 225‐μm deep. Sectioned lesions were analysed by Knoop microhardness up to 250 μm from the lesion surface. Data were analysed by the Dunn's test with Bonferroni correction. Results: Natural and artificial lesion mean mineral densities were not statistically different (P > 0.05). Mineral density from the surface to 75 μm was greater in natural lesions and from 150 to 225 μm was greater in artificial lesions (P < 0.05). Microhardness values were statistically higher in artificial lesions (P < 0.05); no difference was found among artificial lesions produced by the two solutions (P > 0.05). Mineral density and microhardness of natural and artificial root caries are different from each other. A greater mineralized surface layer existed on natural lesions. [ABSTRACT FROM AUTHOR]

Background: Molar–incisor hypomineralisation (MIH) and hypomineralised second primary molars (HSPM) involve qualitative structural developmental anomalies of tooth enamel, affecting the first permanent molars (FPM) and the second primary molars, respectively. This developmental anomaly of systemic origin has important consequences for oral health. Aim: To determine the prevalence of MIH and HSPM in south‐western France and explore the distribution of hypomineralised lesions on permanent and primary molars. Design: Amongst 856 children (aged 7–9 years) in schools randomly selected by the Academy of Bordeaux (Ministry of Education), the FPM, permanent incisors and the second primary molars were examined by two examiners trained and calibrated for the diagnostic criteria for MIH and HSPM of the European Academy of Paediatric Dentistry. Results: Molar–incisor hypomineralisation was present in 160 children (18.7%) and HSPM in 81 children (9.5%); 4.9% had both HSPM and MIH (42 of 856). Hypomineralised lesions were present in 1–4 FPM in affected individuals (mean = 2.4) and were distributed in an asymmetrical manner with widely varying severity at the tooth and individual level. A child with HSPM was more likely to have MIH than a child without HSPM (95% CI OR = 6.0 [3.7–9.7]; p <.0001). Conclusion: Molar–incisor hypomineralisation and HSPM have three main asymmetrical characteristics: tooth location, severity of hypomineralisation and number of teeth affected. [ABSTRACT FROM AUTHOR]

Background: Some oral conditions can have psychosocial consequences that affect children's daily life and well‐being. Aim: To create a structural model for the determination of dental caries, molar–incisor hypomineralization (MIH), and the impact of these conditions and socioeconomic status on schoolchildren's oral health‐related quality of life (OHRQoL). Design: A representative cross‐sectional study was conducted in Lavras, Brazil, with 1181 female and male schoolchildren 8–9 years of age. OHRQoL was measured using the Brazilian version of the CPQ8‐10. Clinical examinations were performed by a calibrated dentist for the diagnosis of dental caries (WHO) and MIH (EAPD). Parents/caregivers answered questionnaires addressing the child's medical history and socioeconomic status. Data were analyzed using structural equation modeling. Results: The model revealed that greater MIH severity (β =.874; p <.001) and worse socioeconomic status (β = −.060; p =.001) were associated with a greater number of teeth with caries experience. The higher the number of teeth with caries experience (β =.160; p =.007) and worse socioeconomic status (β = −.164; p <.001), the greater the negative impact on OHRQoL. Conclusion: The model created showed that dental caries and socioeconomic status had a direct negative impact on the OHRQoL of schoolchildren and MIH had an indirect impact mediated by the occurrence of caries experience. [ABSTRACT FROM AUTHOR]

The study's main objective is to limit bacterial biofilm formation on fixed orthodontic appliances. Bacterial biofilm formation on such devices (e.g., brackets) causes enamel demineralization, referred to as white spot lesions (WSL). WSL is significant health, social and economic problem. We provide a nanotechnology‐based solution utilizing a nanocomposite of gold nanoparticles embedded in a polyoxoborate matrix (BOA: B—boron, O—oxygen, A—gold, Latin aurum). The nanocomposite is fully inorganic, and the coating protocol is straightforward, effective, and ecologically friendly (low waste and water‐based). Prepared coatings are mechanically stable against brushing with a toothbrush (up to 100 min of brushing). Bacteria adhesion and antibacterial properties are tested against Streptococcus mutans—common bacteria in the oral cavity. BOA reduces the adhesion of bacteria by around 78%, that is, from around 7.99 × 105 ± 1.33 × 105 CFU per bracket to 1.69 × 105 ± 3.07 × 104 CFU per bracket of S. mutans detached from unmodified and modified brackets, respectively. Modified fixed orthodontic brackets remain safe for eukaryotic cells and meet ISO 10993‐5:2009 requirements for medical devices. The gathered data show that BOA deposited on orthodontic appliances provides a viable preventive measure against bacteria colonization, which presents frequent and significant complications of orthodontic treatment. [ABSTRACT FROM AUTHOR]

To investigate whether flash‐free adhesive ceramic brackets (FFA) have a better clinical performance than conventional adhesive ceramic brackets (CVA) in patients undergoing multi‐bracket orthodontic treatment. PubMed, CENTRAL, Web of Science, Scopus, Embase, CNKI and Grey‐literature were searched without restrictions up to January 2022. Both randomized controlled trials (RCTs) and controlled clinical trials (CCTs) were included. Risk of bias assessment was performed using the RoB 2.0 and ROBINS‐I cochrane risk of bias tools. Eight articles, for seven studies, were included in this systematic review, and four split‐mouth trials (SMT) were included in the meta‐analysis. A random‐effects meta‐analysis found a statistically significant faster bonding time with FFA (mean difference [MD] = −93.85 seconds/quadrant, P =.002, 2 SMT), and no statistically significant difference regarding bracket failure rate at 6 months (risk ratio [RR] = 1.05; P =.93, 3 SMT), adhesive removal time (MD = −18.26 seconds/quadrant, P =.50, 2 SMT), and amount of remnant adhesive (MD = −0.13/bracket, P =.72, 2 SMT) between FFA and CVA. No difference (P >.05, 3 SMT) was found in enamel demineralization and periodontal measurements. CVA showed a statistically significant higher debonding pain score (P =.004, 1 SMT). Both flash‐free and conventional adhesive ceramic brackets had a similar clinical performance, except for the faster bonding with FFA. Further, well‐designed clinical trials are still required. [ABSTRACT FROM AUTHOR]

Purpose: To synthesize the literature regarding noncarious cervical lesions (NCCLs) and propose clinical guidelines when lesion restoration is indicated. Material and methods: A PubMed search was performed related to NCCL morphology, progression, prevalence, etiology, pathophysiology, and restoration. Results: NCCLs form as either rounded (saucerlike) depressions with smooth, featureless surfaces that progress mainly in height or as V‐shaped indentations that increase in both height and depth. Prevalence ranges from less than 10% to over 90% and increases with age. Common locations are the facial surfaces of maxillary premolars. They have a multifactorial etiology due to personal habits such as excessive horizontal toothbrushing and consumption of acidic foods and drinks. Occlusal factors have been identified as contributing to the prevalence of NCCLs in some studies, whereas other studies indicate there is no relationship. The concept of abfraction has been proposed whereby mechanical stress from occlusal loading plays a role in the development and progression of NCCLs with publications supporting the concept and others indicating it lacks the required clinical documentation. Regardless of the development mechanism, demineralization occurs and they are one of the most common demineralization diseases in the body. Treatment should be managed conservatively through preventive intervention with restorative treatment delayed until it becomes necessary due to factors such as lesion progression, impact on patient's quality of life, sensitivity, poor esthetics, and food collection may necessitate restoration. Composite resins are commonly used to restore NCCLs although other materials such as glass ionomer and resin‐modified glass ionomer are also used. Sclerotic dentin does not etch like normal dentin and therefore it has been recommended to texture the dentin surface with a fine rotary diamond instrument to improve restoration retention. Some clinicians use mechanical retention to increase retention. Beveling of enamel is used to increase the bonding area and retention as well as enhance the esthetic result by gradually creating a color change between the restoration and tooth. Both multistep and single‐step adhesives have been used. Dentin etching should be increased to 30 seconds due to the sclerotic dentin with the adhesive agent applied using a light scrubbing motion for 20 seconds but without excessive force that induces substantial bending of a disposable applicator. Both flowable and sculptable composite resins have been successfully used with some clinicians applying and polymerizing a layer of flowable composite resin and then adding an external layer of sculptable composite resin to provide enhanced resistance to wear. When caries is present, silver diamine fluoride has been used to arrest the caries rather than restore the lesion. Conclusions: Noncarious cervical lesions (NCCLs) form as smooth saucerlike depressions or as V‐shaped notches. Prevalence values as high as 90% and as low as 10% have been reported due to habits such as excessive toothbrushing and an acidic diet. Occlusal factors have been proposed as contributing to their presence but it remains controversial. Publications have both supported and challenged the concept of abfraction. They are one of the most common demineralization diseases in the body. Conservative treatment through prevention is recommended with restorative treatment delayed as long as possible. When treatment is needed, composite resins are commonly used with proposed restorative guidelines including texturing the sclerotic dentin, beveling the enamel, potential use of mechanical retention, 30 seconds of acid etching, and use of either multistep or single‐step adhesives in conjunction with a light scrubbing motion for 20 seconds without excessive force placed on disposable applicators. [ABSTRACT FROM AUTHOR]

Objective and Background: Resorption of alveolar bone after tooth extraction is a common problem often requiring bone grafting. The success of the grafting procedures is dependent on multiple factors including the presence of growth factors. This is the first in vivo study to investigate the role of the pleiotrophin family of cytokines in alveolar bone regeneration. This research investigated the role of the pleiotrophin–midkine (PTN–MDK) axis during osteogenesis, with and without a grafting material, after tooth extraction in a sheep model. Methods: Thirty Romney-cross ewes were anesthetized, and all premolar teeth on the right side were extracted. The sockets were randomized to controls sites with no treatment and test sites with Bio-Oss® graft material and Bio-Gide® membrane. Samples were harvested after sacrificing animals 4, 8, and 16 weeks post-grafting (n = 10 per time-point). Tissue for qRT²-PCR gene analysis was recovered from the socket next to the first molar using a trephine (Ø = 2 mm). Each socket was fixed, decalcified, paraffin-embedded, and sectioned. Immunohistochemistry was conducted to localize both PTN and MDK along with their receptors, protein tyrosine phosphatase receptor type Z1 (PTPRZ1), ALK receptor tyrosine kinase (ALK), and notch receptor 2 (NOTCH2). Results: Within the healing sockets, high expression of genes for PTN, MDK, NOTCH2, and ALK was found at all time-points and in both grafted and non-grafted sites, while PTPRZ1 was only expressed at low levels. The relative gene expression of the PTN family of cytokines was not statistically different at the three time-points between test and control groups (p > .05). Immunohistochemistry found PTN and MDK in association with new bone, NOTCH2 in the connective tissue, and PTPRZ1 and ALK in association with cuboidal osteoblasts involved in bone formation. Conclusions: The PTN–MDK axis was highly expressed in both non-grafted and grafted sockets during osteogenesis in a sheep model of alveolar bone regeneration with no evidence that grafting significantly affected expression. The activation of NOTCH2 and PTPRZ1 receptors may be important during bone regeneration in vivo. The discovery of the PTN–MDK axis as important during alveolar bone regeneration is novel and opens up new avenues of research into these stably expressed highly active cytokines. Growth factor supplementation with PTN and/or MDK during healing may be an approach for enhanced regeneration or to initiate healing where delayed. [ABSTRACT FROM AUTHOR]

Nutritional restriction during developmental periods impairs organ physiology. Female rats were subjected to protein restriction during pregnancy and lactation to analyze dental and maxillary development. Four exposure groups were considered: normal‐protein diet during pregnancy and lactation (NP, 17% casein), low‐protein diet during lactation (LP‐L, 6% casein), low‐protein diet during pregnancy and lactation (LP), and low‐protein diet during pregnancy (LP‐G). Maxillae from 15‐day‐old male pups were collected. All protein‐restricted groups presented increased dentin thickness and reduced alveolar bone area. When protein restriction was applied during both gestation and lactation (LP), harmful effects were observed in the form of loss of protective OPG (osteoprotegerin) in tooth epithelium‐mesenchyme, due to higher RANKL expression, delay in odontoblast maturation, less dental pulp vascularity, reduction in amount of alveolar bone, and less matrix mineralization. In the LP‐L group, effects of protein restriction seemed less harmful, and despite less alveolar bone, the enhancement in BMP‐7, VEGF, and RANKL seems a compensatory signal to maintain maxillary osteogenesis. In LP‐G animals, Dspp expression was higher, suggesting a delay in odontoblast maturation or expression recuperation. In conclusion, maternal protein restriction affects dental and maxillary development. A low‐protein diet only in gestation allows for normal development. A low‐protein diet during gestation‐lactation results in impaired odontogenesis that may increase susceptibility of dental anomalies. [ABSTRACT FROM AUTHOR]

Dental caries (tooth‐decay) is caused by biofilms harboring polymicrobial communities on teeth that leads to the onset of localized areas of enamel demineralization. Streptococcus mutans has been clinically associated with severe caries in childhood. Although commensal bacteria can combat S. mutans using self‐generated antimicrobials such as hydrogen peroxide (H2O2), constant sugar‐rich diet consumption disrupts microbial homeostasis shifting toward cariogenic community. Recently, Streptococcus oralis subsp. tigurinus strain J22, an oral isolate, was identified as a uniquely potent H2O2 producer. Here, we assess whether a high H2O2‐producing commensal streptococcus can modulate the spatial organization and virulence of S. mutans within biofilms. Using an experimental biofilm model, we find that the presence of S. oralis J22 can effectively inhibit the clustering, accumulation, and spatial organization of S. mutans on ex vivo human tooth surface, resulting in significant reduction of enamel demineralization. Notably, the generation of H2O2 via pyruvate oxidase (SpxB) from S. oralis J22 is not repressed by sugars (a common repressor in other mitis group streptococci), resulting in enhanced inhibition of S. mutans growth (vs. Streptococcus gordonii). We further investigate its impact on biofilm virulence using an in vivo rodent caries model under sugar‐rich diet. Coinfection of S. mutans with S. oralis results in reduced caries development compared to either species infected alone, whereas coinfection with S. gordonii has negligible effects, suggesting that the presence of an efficient, high H2O2‐producer can disrupt S. mutans virulence. This work demonstrates that oral isolates with unusual high H2O2 production may be capable of modulating biofilm cariogenicity in vivo. The findings also highlight the importance of bacterial antagonistic interactions within polymicrobial communities in health and in disease‐causing state. [ABSTRACT FROM AUTHOR]

Objective: Since composites still face a critical problem called polymerization shrinkage and bulk‐fill composites have reported acceptable results for this issue, this study aims to assess the polymerization shrinkage of a new bulk‐fill flowable composite (G‐aenial bulk injectable [GBI]) and compare it to other bulk‐fill and conventional composites. Materials and Methods: In this in vitro study, 25 composite discs were fabricated using three bulk‐fill and two conventional composites. They were bonded to a microscopic slide and were covered by a coverslip. This assembly was transferred to a linear variable differential transformer and composite samples were cured from underneath the slides. Dimensional changes formed in composite samples were recorded. Data were analyzed using analysis of variance followed by post hoc Tukey's and Dunnett's tests. Results: The groups were significantly different regarding polymerization shrinkage. G‐aenial bulk injectable and G‐aenial universal flo showed significantly higher polymerization shrinkage than other composites at 30, 60, and 1800 s after light irradiation, while X‐tra fil and Filtek Z250 showed the lowest polymerization shrinkage at the aforementioned time points. Conclusion: According to the results, the new composite had polymerization shrinkage similar to the conventional one. Bulk‐fill composites reported similar or lower shrinkage to conventional composites. Clinical significance: Polymerization shrinkage can lead to treatment failure by causing secondary caries, enamel cracks, posttreatment pain, and pulpitis. Since the type of material has a role in the amount of this shrinkage, using composites with lower polymerization shrinkage causes restorations with increased longevity. [ABSTRACT FROM AUTHOR]

Background: The main purpose of this experimental study was to determine the in vitro effects of two calcium phosphate‐containing agents (Remin Pro® and GC Tooth mousse™) on the enamel resistance of permanent molars to demineralization. Methods: Fifty extracted human third molars were randomly divided into four groups; that is the control group and three case groups treated with Remin Pro®, GC Tooth mousse™, and sodium fluoride gel. The three case groups were treated with 0.25 ml of the paste associated with each experimental group for 5 min, kept in fluoride‐free artificial saliva, and incubated at 37°C for 28 days. After the treatment regimen, 10 samples of each case group were subjected to demineralization using an acetic acid‐containing solution, and remineralization using a remineralizing solution. The morphology of enamel was observed via scanning electron microscopy and their enamel calcium/phosphorus (Ca/P) ratios were measured before/after the demineralization cycle with energy‐dispersive X‐ray analysis. Data were statistically analyzed using one‐way analysis of variance and post hoc Tukey tests. Results: The enamel Ca/P ratios in the case study groups were significantly higher than that of the control group before/after the demineralization regimen (p <.0001). However, the ratios were not significantly different between the case study groups after the treatment regimen and demineralization cycle (p >.05). Conclusion: The outcomes of the current study indicated that all three agents seemed to increase the enamel resistance of permanent molar teeth to demineralization. [ABSTRACT FROM AUTHOR]

Objectives: To compare the effectiveness of the casein phosphopeptide‐stabilized amorphous calcium phosphate (CPP‐ACP) in the in situ remineralization of enamel exposed with two different degrees of preformed enamel lesions. Methods: One hundred and sixty 3 × 3 × 2 mm human enamel slabs were demineralized and divided into two subgroups according to the baseline surface hardness (SH = B1≤150 and B2 >150). During each of four 10‐day experimental periods, 10 participants wore intra‐oral removable acrylic palatal expanders with four human enamel slabs with preformed lesions (B1 and B2): CO1 and CO2—Control: silica dentifrice without fluoride; MP1 and MP2: MI Paste; MPP1 and MPP2: MI Paste Plus; and FD1 and FD2: Fluoride dentifrice. The Knoop hardness test (50/15s Micromet 2001, Buehler) was performed after demineralization (B1 and B2) and after treatment (T1 and T2). Results: SH was higher in all treatment groups, when compared with the controls, except for CO2 (Mann‐Whitney Wilcoxon Test; p < 0.05). The %SH was similar between MPP2 and FD2 and between MPP2 and MP2; however, FD2 and MPP2 products were more effective in microhardness recovery. In B1, all treatment groups were similar. Conclusion: MPP and FD are more effective in preventing demineralization in enamel subsurface lesions. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effect of direct pulp capping on the expression of erythropoietin (Epo) and Epo‐receptor (Epor) genes in relation to the expression of inflammatory and osteogenic genes in rat pulp. Dental pulps of the first maxillary molars of Wistar Albino rats were exposed and capped with either calcium hydroxide or mineral trioxide aggregate, or were left untreated. After 4 wk, animals were euthanized, and maxillae were prepared for histological and real‐time polymerase chain reaction analysis. Histological scores of pulp inflammation and mineralization, and relative expressions of Epo, Epor, inflammatory cytokines, and pulp osteogenic genes were evaluated. The capped pulps showed higher expressions of Epo, while the untreated pulps had the highest expression of Epor. Both calcium hydroxide and mineral trioxide aggregate downregulated the expression of tumor necrosis factor alpha compared to untreated controls, and upregulated transforming growth factor beta compared to healthy controls. Alkaline phosphatase expression was significantly higher in experimental groups. Relative expression of Epo negatively correlated with pulp inflammation, and positively correlated with pulp mineralization. Pulp exposure promoted expression of Epor and pro‐inflammatory cytokines, while pulp capping promoted expression of Epo, alkaline phosphatase, and downregulated Epor and pro‐inflammatory cytokines. [ABSTRACT FROM AUTHOR]

The remineralization process of dental caries is dependent on the Ca and PO4−3 ions that are lost during demineralization back to the tooth tissue. The aim of this study was to determine the PO4−3 changes of enamel surfaces by using Raman analysis, as a result of applying three different remineralization agents containing Ca‐PO4−3 in in vitro conditions. Enamel specimens obtained from 80 human third molar teeth were randomly divided into four groups (n = 20) each according to surface treatment: no treatment (control), casein phosphopeptide‐amorphous calcium phosphate, tricalcium phosphate, and amorphous calcium phosphate. The effects of remineralization agents were evaluated according to PO4−3 changes by using Raman analysis. Statistical analyses were performed by using one‐way analysis of variance (ANOVA) and Tamhane's T2 tests. There was a statistically significant difference between the study group surfaces subjected to the pH cycling process and remineralization and the control group surfaces only subjected to pH cycling (p < 0.05). However, the intragroup evaluation showed no statistically significant difference between the mean PO4−3 changes of intact and remineralized surfaces (p > 0.05). Remineralizing agents have positive effects on the phosphate concentration of initial enamel caries at the level of intact tooth tissue. [ABSTRACT FROM AUTHOR]

Background: There are diverse opinions among dentists about managing compromised first permanent molars (cFPMs) in children and a perceived lack of guidance to help them evaluate prognosis. Aim: To evaluate the current management of cFPM in children referred to a UK hospital centre and to report the severity of the affected teeth. Design: A service evaluation was undertaken, based on case records of medically fit children (6‐11 years) referred to for the management of cFPMs. The presence of hypomineralisation, post‐eruptive breakdown and the proposed care plans were recorded. Radiographic signs of severity were scored using the ICDAS index (intra/inter‐rater kappa 0.96/0.82). Results: From 349 records screened over a 4‐month period, 249 met the selection criteria. Almost 81% were planned to have extraction of at least one cFPM, whereas 19.3% were managed without extraction. More than half of the extraction cases (n = 105) had radiographic radiolucencies not exceeding the middle third of dentine in the worst‐affected FPM. At the time of extraction, the mean age of the patients was 9.8 years (±0.9). GA was used in 196 (97.5%) cases, and 40.8% had not received previous treatment in any of their cFPMs. Conclusion: Potentially restorable cFPMs in children is, most of the time, in a cohort of UK patients referred for tier 3 services, being managed by timed extractions under general anasethesia. [ABSTRACT FROM AUTHOR]

This systematic review aimed to determine the effects of the interproximal enamel reduction (IPR) techniques used in orthodontics. Six databases were searched: PubMed, Scopus, Web of Science, Dentistry & Oral Sciences Source, ScienceDirect and Clinical Trials. Grey literature was sourced from Google Scholar. The risk of bias was assessed by Risk of Bias 2, Newcastle‐Ottawa Scale and Robins‐I depending on the design of the evaluated study. Additionally, the quality of the included studies was determined using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. This systematic review included randomized clinical trials, non‐randomized clinical trials and observational studies with a control group that reported the effects of IPR for orthodontic purposes on the teeth and periodontium. Case reports, and in vitro and in vivo studies were excluded. Eight clinical studies match the eligibility criteria. As a result, no demineralization of the enamel, no increase in caries incidence, no periodontal changes or dental sensitivity was found after IPR. Also, considering the duration of orthodontic treatment, IPR resulted in a quicker technique than dental extractions. At the risk‐of‐bias assessment, all observational studies showed low risk, the non‐randomized clinical trial had a critical bias, and all randomized clinical trials exhibited some concerns. The overall quality of the studies was found to be between low and very low. After the analysis of the data from included studies, it was concluded that the IPR procedures could be useful to treat dental crowding in orthodontic clinical practice without negative effects. However, more randomized controlled clinical trials with a longer follow‐up time and high‐quality studies are required to generate robust statements. [ABSTRACT FROM AUTHOR]

Background: Children with molar‐incisor hypomineralisation (MIH) frequently seek aesthetic treatment for incisor opacities. Surprisingly, few studies have evaluated the clinical success of such interventions. Aim: To quantify the effectiveness of minimally invasive treatments in reducing enamel opacity visibility in children with MIH. Design: This in vitro study used digital clinical images of 23 children aged 8–16 years with MIH who underwent microabrasion and/or resin infiltration for the management of incisor opacities. Standard images were taken pre‐treatment and 6 months post‐treatment. Image software (Image‐Pro Plus®V7) was employed to convert 24‐bit RGB images to 16‐bit greyscale and 145× magnification. Measurement repeatability was assessed using intra‐class correlation coefficients (ICCs). Post‐treatment changes in visible opacity area (mm2) and brightness (greyscale value) were tested using the Wilcoxon signed‐rank test for related samples. Results: The mean total opacity surface area significantly reduced from 14.3 mm2 (SD = 7.5) to 9.4 mm2 (SD = 9.0) post‐treatment. The proportion of tooth surface affected by the opacity also significantly reduced from 22.5% (SD = 10.5) to 14.7% (SD = 12.7). The mean maximum opacity brightness significantly reduced from 53 066 greyscale value (SD = 4740) to 49 040 (SD = 3796). ICC was good/excellent (0.75–1.0). Conclusion: Minimally invasive treatment is effective in reducing the size and brightness of discrete incisor opacities. Future research should compare objective findings with patient‐reported outcomes. [ABSTRACT FROM AUTHOR]

Background: Demineralization during multi‐bracketed fixed orthodontic treatment is a well‐known problem. Aim: To systematically evaluate the evidence for the prevention of enamel demineralization during multi‐bracketed fixed orthodontic treatment. Design: Systematic reviews (with or without meta‐analysis) that have appraised the primary studies on the prevention of demineralization during multi‐bracketed fixed orthodontic treatment were searched systematically and included as per pre‐defined eligibility criteria. The risk of bias of the included reviews was assessed by two authors using the ROBIS tool and AMSTAR‐2 tool. Results: Twenty‐nine reviews conducted on 128 exclusive primary studies were included for the present overview; 23 of these reviews were assessed to be of a high risk of overall bias, 5 were of low risk, and 1 review was of unclear risk of bias. Conclusions: Predominantly, the published reviews have focused on fluorides, whereas some reviews have also studied the role of casein phosphopeptide‐amorphous calcium phosphate (CPP‐ACP), reminder therapy, lasers, and sealants. Professional fluorides, sealants, reminder therapy, and lasers might be valuable interventions to prevent demineralization during orthodontic treatment based on the conclusions of reviews with high quality; however, further studies are required to elucidate the role of CPP‐ACP, chlorhexidine varnish, and powered toothbrushes. [ABSTRACT FROM AUTHOR]

Aim: To develop, apply, and evaluate a virtual learning object (VLO) for teaching undergraduate dental students and paediatric dentists to diagnose and manage molar incisor hypomineralization (MIH). Design: This controlled educational intervention included 170 undergraduate dental students and 50 paediatric dentists. The student intervention group (VLOG) was trained by the VLO, the control group of students (CG) received a synchronous virtual class, and the group of paediatric dentists (PDG) was trained by the VLO. Pre‐test and post‐test data were analyzed with a mixed one‐way and Tukey's post hoc ANOVA test (α = 0.05). The answers to the questionnaire were analyzed with the one‐way ANOVA test and Tukey's post hoc test (α = 0.05). Results: The values obtained in the pre‐test were significantly lower than those obtained in the post‐test for all groups. The specialists showed a higher level of knowledge before and after the MIH training compared with the students (p <.001). Similarly, statistical differences were found in the level of knowledge, which increased after MIH training (p <.001). There were no differences between the CG and VLOG. Conclusions: The level of knowledge increased in all groups after training regardless of the method used. VLOG works similar to traditional teaching approaches. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the prevalence of HSPM worldwide on a child and a tooth level and investigate the influence of diagnostic criteria on the prevalence of HSPM. Design: A comprehensive literature search was performed through MEDLINE/PubMed, Scopus, and Web of Science databases. The grey literature was also screened as were the reference lists of included studies. An adaptation of the Newcastle‐Ottawa Scale was used to evaluate the quality of the studies. A meta‐analysis was performed to determine the pooled prevalence of HSPM. Results: The search strategy identified 1,988 articles, 487 were retrieved for full‐text evaluation, and 37 studies were included in the meta‐analysis (32 for child and 23 for tooth level prevalence), providing data from 26,805 individuals and 81,107 molars. The prevalence of HSPM was 6.8% (95% CI 4.98%‐8.86%) on a child level and 4.08% on a tooth level (95% CI = 2.80%‐5.59%). The diagnostic criteria used did not seem to influence the prevalence results (P >.05). The majority of the papers (75%) showed a low‐to‐moderate risk of bias. Conclusion: There was a broad variation in the prevalence reported that may be attributed to differences in the study population. The present meta‐analysis showed a HSPM prevalence worldwide of 6.8% on a child level and 4.1% on a tooth level. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the antimicrobial effects of a peptide containing novel oral spray GERM CLEAN on dual‐species biofilm formed by Streptococcus mutans and Candida albicans and to investigate whether GERM CLEAN inhibits the demineralization procedure of bovine enamel in vitro. Methods: The antimicrobial effects of GERM CLEAN on dual‐species biofilm were analyzed by initial adherence rate calculation, water‐insoluble exopolysaccharides quantification, total biomass quantification, and colony‐forming units (CFUs) counting. Scanning electron microscopy and confocal laser scanning microscopy were applied to evaluate the impacts of GERM CLEAN on the biofilm structure. Further, the effects of GERM CLEAN on acidogenicity of dual‐species were appraised via glycolytic pH drop analysis and hydroxyapatite dissolution measurement. The percentage of Surface Microhardness Reduction (%SMHR) evaluation, Atomic Force Micrograph (AFM) examination, and Transverse Microradiography (TMR) analysis after pH cycling were used to determine whether GERM CLEAN inhibited the demineralization of bovine enamel. Results: GERM CLEAN decreased the adherence rate, water‐insoluble EPS production, biofilm formation, and acidogenicity of the dual‐species. Moreover, GERM CLEAN significantly inhibited the demineralization status of bovine enamels. Conclusion: This peptide containing novel oral spray GERM CLEAN has antimicrobial potential toward the dual‐species. GERM CLEAN can also impede the demineralization procedure of enamel. [ABSTRACT FROM AUTHOR]

Background: Hypomineralised second primary molar (HSPM) is a developmental enamel defect associated with dental caries. Aim: To evaluate the impact of HSPM on oral health–related quality of life (OHRQoL) in preschoolers through hierarchical analysis. Design: This population‐based cross‐sectional study assessed 834 5‐year‐old preschoolers, in Teresina, Piauí, Brazil, using sociodemographic questionnaires and Early Childhood Oral Health Impact Scale (ECOHIS). Dental examination was performed by two calibrated examiners (κ ≥ 0.80) for the diagnosis of HSPM (EAPD), dental caries (dmft and pufa indices), and malocclusion (Foster and Hamilton criteria). Analysis of the determinants of OHRQoL was stratified at three levels (P <.05). Results: Severe HSPM was associated with OHRQoL in bivariate analysis (P <.05). In adjusted final multivariate analysis (model 1), the presence of dental caries with or without clinical consequences was associated with worse OHRQoL (P <.05). In model 2, after the removal of dental caries, preschoolers with severe HSPM had greater probability of having a negative impact on OHRQoL in the child impact section (RR = 2.14; 95% CI = 1.26‐3.65), family impact section (RR = 1.99; 95% CI = 1.16‐3.42), and total score (RR = 2.09; 95% CI = 1.25‐3.49) of the ECOHIS. Conclusion: Severe HSPM had a negative impact on the OHRQoL of preschoolers and their families, but the presence of dental caries neutralised this impact. [ABSTRACT FROM AUTHOR]

Background: Currently, there is no consensus on the superiority of any material for the restorative treatment of molars affected by molar‐incisor hypomineralization (MIH). Aim: To evaluate the survival of restorations with stainless‐steel crown (SSC) or composite resin (CR) in first permanent molars affected by MIH for 24 months. Design: In this retrospective cohort study, 61 CR and 54 SSC restorations placed on molars affected by MIH of patients, aged between 7 and 10, that were treated and overseen at a university dental clinic in the period of 2017‐2020 were evaluated. The primary outcome was the failure‐free survival time. Parametric survival models were used for data censored by interval, and the comparison between SSC and CR was performed using the hazard ratio function with a 95% confidence interval. Results: The survival of SSC and CR restorations after 24 months was 94.4% and 49.2%, respectively. This difference was influenced by the presence of previous restoration (aHR = 3.4; 95% CI: 1.2‐9.4) and cusp involvement (aHR = 4.0; 95% CI: 1.5‐11.2). Conclusion: In molars with MIH and the need for restorative treatment, SSC had a significantly higher survival rate than CR over 24 months. [ABSTRACT FROM AUTHOR]