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Aim To update the existing European Academy of Paediatric Dentistry (EAPD) 2010 policy document on the ‘Best Clinical Practice guidance for clinicians dealing with children presenting with Molar-Incisor-Hypomineralisation (MIH).’ Methods Experts, assigned the EAPD, worked on two different topics: (A) Aetiological factors involved in MIH, and (B) Treatment options for the clinical management of MIH. The group prepared two detailed systematic reviews of the existing literature relevant to the topics and following a consensus process produced the updated EAPD policy document on the ‘Best Clinical Practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH).’ The GRADE system was used to assess the quality of evidence regarding aetiology and treatment which was judged as HIGH, MODERATE, LOW or VERY LOW, while the GRADE criteria were used to indicate the strength of recommendation regarding treatment options as STRONG or WEAK/CONDITIONAL. Results (A) Regarding aetiology, it is confirmed that MIH has a multifactorial aetiology with the duration, strength and timing of occurrence of the aetiological factors being responsible for the variable clinical characteristics of the defect. Perinatal hypoxia, prematurity and other hypoxia related perinatal problems, including caesarean section, appear to increase the risk of having MIH, while certain infant and childhood illnesses are also linked with MIH. In addition, genetic predisposition and the role of epigenetic influences are becoming clearer following twin studies and genome and single-nucleotide polymorphisms analyses in patients and families. Missing genetic information might be the final key to truly understand MIH aetiology. (B) Regarding treatment options, composite restorations, preformed metal crowns and laboratory indirect restorations provide high success rates for the posterior teeth in appropriate cases, while scheduled extractions provide an established alternative option in severe cases. There is great need for further clinical and laboratory studies evaluating new materials and non-invasive/micro-invasive techniques for anterior teeth, especially when aesthetic and oral health related quality of life (OHRQoL) issues are concerned. Conclusions MIH has been studied more extensively in the last decade. Its aetiology follows the multifactorial model, involving systemic medical and genetic factors. Further focused laboratory research and prospective clinical studies are needed to elucidate any additional factors and refine the model. Successful preventive and treatment options have been studied and established. The appropriate choice depends on the severity of the defects and the age of the patient. EAPD encourages the use of all available treatment options, whilst in severe cases, scheduled extractions should be considered.

To systematically review the aetiological factors associated with molar incisor hypomineralisation (MIH). To this day, the aetiology remains unknown. Determining risk factors would allow risk assessment and enhance early diagnosis of MIH in young patients. The aim was to assess, evaluate and summarise the relationship between MIH and reported aetiological hypotheses. Electronic database searches of MEDLINE, EMBASE, EBSCO, LILACS and Cochrane Library were conducted. Authors conformed to PRISMA guidelines. Studies were screened, data extracted, assessment of risk of bias and calibration was completed by two independent reviewers. Meta-analyses with heterogeneity calculations were performed. Of the potential 8949 studies, 64 studies were included in the qualitative analysis whilst 45 were included in the quantitative analysis. Prenatal factors: results are inconclusive as only unspecified maternal illnesses appear to be linked to MIH. Perinatal factors: prematurity (OR 1.45; 95% CI 1.24–1.70; p = 0.0002) and caesarean delivery (OR 1.45; 95% CI 1.09, 1.93; p

Purpose To systematically review the treatment modalities for molar-incisor hypomineralisation for children under the age of 18 years. The research question was, ‘What are the treatment options for teeth in children affected by molar incisor hypomineralisation?’ Methods An electronic search of the following electronic databases was completed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, Google Scholar and Open Grey identifying studies from 1980 to 2020. The PRISMA guidelines were followed. The studies were screened, data extracted and calibration was completed by two independent reviewers. Results Of 6220 potential articles, 34 studies were included. Twenty studies investigated management of molars with fissure sealants, glass ionomer cement, polyacid modified resin composite, composite resin, amalgam, preformed metal crowns, laboratory-manufactured crowns and extractions. In four articles management of incisors with microabrasion, resin-infiltration and a combination of approaches was reported. Eight studies looked at strategies to mineralise MIH-affected teeth and/or reduce hypersensitivity. Two studies investigated patient-centred outcomes following treatment. Due to the heterogeneity between the studies, meta-analysis was not performed. Conclusion The use of resin-based fissure sealants, preformed metal crowns, direct composite resin restorations and laboratory-made restorations can be recommended for MIH-affected molars. There is insufficient evidence to support specific approaches for the management of affected incisors. Products containing CPP-ACP may be beneficial for MIH-affected teeth.

Objectives To characterise the ion release, pH changes and apatite formation of a phosphate free bioactive glass. Methods A SiO2-CaO-CaF2-Na2O glass was synthesized by a melt route with a composition close to the reactive glass in the commercial Cention N® composite. The glass was characterized after immersion in three media: Artificial Saliva pH4 (AS4) Artificial Saliva pH7 (AS7) and in a high phosphate artificial saliva at pH6.5 (AS6.5). The pH and fluoride release were measured using a pH meter and an ion selective electrode. The concentration of Ca, P, Na and Si were measured by ICP-OES. The glass powders after immersion were characterized by FTIR, X-ray powder diffraction and 19F MAS-NMR. Results The glass increased the pH in all three media. Fluoride was detected in all three media but was much higher in AS 6.5. Calcium fluoride formed in AS4 with a small amount of fluorapatite at long immersion times. Fluorapatite and calcium fluoride formed in AS7, whilst in AS6.5 fluorapatite formed. The ion concentrations in solution after immersion reflected the glass composition and the immersion media with fluorapatite being favoured by higher pHs and phosphate contents in the media. Significance The results demonstrated the ability of the glass to increase the pH and to form fluorapatite in phosphate containing media. This may explain the low incidence of secondary caries found in the commercial composite. Unlike the commercial composite evidence was found for the precipitation of fluorite, which will act to reduce the release of fluoride for preventing secondary caries.

Objective: To determine whether there are differences in the facial soft tissue morphology between participants with mild (up to two) or severe (six or more) hypodontia. Design and Setting: A prospective hospital-based cohort study. Participants and Methods: Ninety-two participants, aged 11–16 years, with confirmed hypodontia were recruited. Participants were sub-grouped based on the severity (mild, two or less and severe, six or more) and distribution of the missing teeth and age. They underwent a three-dimensional (3D) optical surface scan of the facial soft tissues. Facial surface scans were compared quantitatively, applying landmark measurements and surface-based analysis. Results: In total, 92 participants, with an equal distribution between the mild (n=46) and severe (n=46) categories, were recruited. Patients with severe hypodontia displayed a reduced alar base, lower facial height, nasolabial angle ( P = 0.02) and transgonial width ( P < 0.001) compared to those with milder hypodontia. Furthermore, significant differences were observed between mild-male and severe-female groups regarding alar base, lower anterior face height and transgonial width and between mild-male and mild-female groups regarding nasolabial angle and transgonial width. Conclusion: Significant reductions were seen in the 3D soft tissue morphology of participants with severe hypodontia, in terms of the nasolabial angle, lower facial height, alar base and transgonial widths, emphasising the importance of using facial scanning as a relatively simple non-invasive method of assessment.

Objective The objective of this study was to establish the overall remineralizing potential of bioactive glasses which were specifically designed to be incorporated in dental varnishes. This study evaluates the in vitro ability of bioactive glasses (BAGs) to release ions including: fluoride, calcium, strontium and phosphate and to form apatite when immersed in Tris buffer solution, and also investigates the effect of increasing strontium substitution for calcium on remineralization potential. Materials and methods A melt-derived bioactive glass series was formulated (SiO2–Na2O–CaO–P2O5-CaF2) with progressive (0–100%) replacement of calcium (Ca) with strontium (Sr) and prepared. Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD) were utilised before and after immersion for specific time periods (0, 3, 6, 24, 72, 168 h) in 50 ml Tris buffer solution at 37 °C. A fluoride-ISE was used to measure the concentration of fluoride, whilst inductively coupled plasma–optical emission spectroscopy (ICP-OES) was used to measure the concentration of phosphorus, calcium and strontium in the solutions. Results The FTIR and XRD data indicated the amorphous nature of all unreacted bioactive glasses, except for the high Sr-substituted glasses, which crystallised to fluorapatite. Degradation of all the glass powders resulted in fluoride, phosphate and calcium/strontium ion release. All the glasses formed apatite on immersion. Ion release enhanced significantly in the three compositions with 50% SrO substituted for CaO, while calcium ion release was greater for low SrO substitutions. Conclusion Ion release data obtained for the new compositions of novel bioactive glasses to be incorporated into varnishes have promise in the prevent and/or treatment of white spot lesions through the release of fluoride, phosphate and calcium/strontium.

Objectives The objective was to investigate the mechanical properties, fluoride release and apatite formation of resin based dental composites based on a fluoride containing Bioactive Glass (BG) with and without a silylating agent. Methods A SiO2–P2O5–CaO–SrO–Na2O–CaF2 BG was synthesized by the melt quench route. This glass and a commercially available inert glass (IG) were incorporated into a light cured BisGMA-TEGMA resin. The composite resins were then evaluated in terms of their ability to form apatite by Fourier Transform Infrared spectroscopy (FTIR) and by scanning electron microscopy (SEM) following immersion in artificial saliva at pH 4 (AS4) and pH 7 (AS7). The experiments were performed with and without silylation of the BG. The compressive strength and flexural strength were determined after 1, 28 and 84 days of immersion in the AS4 and AS7 immersion media. Results The FTIR spectra of the BG composites exhibited split bands at approximately 560 and 600 cm−1 corresponding to a apatite formation in the surface or on the surface under all immersion conditions. SEM showed the presence of a reacted layer of glass particles in the composite surface and the presence of a surface layer of apatite in AS7. The compressive strength and flexural strength were significantly higher for the silylated BG composites. The strengths of both silylated and non silylated BG composites and IG composites decreased upon immersion. Significance BG composites exhibit reduced strengths upon immersion but still exhibit strengths comparable to existing composites after 84 days of immersion.

The purpose of this study was to determine the efficacy of a dental nurse–delivered intervention—the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI)—in reducing the recurrence of dental caries in children who have a primary tooth extracted. It was based on a 2-arm multicenter randomized controlled trial with blinded outcome assessment. Participants were 5- to 7-y-old children ( n = 241) scheduled to have primary teeth extracted in 12 UK centers. Test intervention parents ( n = 119) received DR-BNI led by trained dental nurses. DR-BNI is a 30-min structured conversation informed by motivational interviewing with a forward focus to prevent future caries. Preventive goals are agreed, and a review appointment is made with child’s general dental practitioner, who is advised to treat the child as being at high caries risk. The control intervention ( n = 122) was a parent-nurse conversation about child’s future tooth eruption, with advice given to visit a general dental practitioner as usual. At baseline, the DR-BNI group’s mean dmft was 6.8, and the control group’s was 6.3. A median of 5 teeth were extracted, mainly under general anesthesia. Final dental assessments were conducted by a single examiner visiting 189 schools 2 y after intervention; 193 (80%) of 241 children were examined. In the control group, 62% developed new caries in teeth that were caries-free or unerupted at baseline, as compared with 44% in the test group, a significant reduction ( P = 0.021). The odds of new caries experience occurring were reduced by 51% in the DR-BNI group as compared with control. There was a 29% decrease in the relative risk of new caries experience in the DR-BNI group as compared with control. This single low-cost, low-intensity intervention was successful in significantly reducing the risk of recurrence of dental caries in children. This trial has implications for changing pediatric dental practice internationally. Training in and implementation of a motivational interviewing–informed brief intervention provides opportunities for dental nurses to facilitate behavior change improving the oral health of children at high caries risk (ISRCTN 24958829).

ImportanceFamilial hypercholesterolemia (FH) is an underdiagnosed and undertreated genetic disorder that leads to premature morbidity and mortality due to atherosclerotic cardiovascular disease. Familial hypercholesterolemia affects 1 in 200 to 250 people around the world of every race and ethnicity. The lack of general awareness of FH among the public and medical community has resulted in only 10% of the FH population being diagnosed and adequately treated. The World Health Organization recognized FH as a public health priority in 1998 during a consultation meeting in Geneva, Switzerland. The World Health Organization report highlighted 11 recommendations to address FH worldwide, from diagnosis and treatment to family screening and education. Research since the 1998 report has increased understanding and awareness of FH, particularly in specialty areas, such as cardiology and lipidology. However, in the past 20 years, there has been little progress in implementing the 11 recommendations to prevent premature atherosclerotic cardiovascular disease in an entire generation of families with FH. ObservationsIn 2018, the Familial Hypercholesterolemia Foundation and the World Heart Federation convened the international FH community to update the 11 recommendations. Two meetings were held: one at the 2018 FH Foundation Global Summit and the other during the 2018 World Congress of Cardiology and Cardiovascular Health. Each meeting served as a platform for the FH community to examine the original recommendations, assess the gaps, and provide commentary on the revised recommendations. The Global Call to Action on Familial Hypercholesterolemia thus represents individuals with FH, advocacy leaders, scientific experts, policy makers, and the original authors of the 1998 World Health Organization report. Attendees from 40 countries brought perspectives on FH from low-, middle-, and high-income regions. Tables listing country-specific government support for FH care, existing country-specific and international FH scientific statements and guidelines, country-specific and international FH registries, and known FH advocacy organizations around the world were created. Conclusions and RelevanceBy adopting the 9 updated public policy recommendations created for this document, covering awareness; advocacy; screening, testing, and diagnosis; treatment; family-based care; registries; research; and cost and value, individual countries have the opportunity to prevent atherosclerotic heart disease in their citizens carrying a gene associated with FH and, likely, all those with severe hypercholesterolemia as well. This guideline presents updated recommendations for management of familial hypercholesterolemia. (c) 2020 American Medical Association. All rights reserved.

BackgroundHistorically, lack of evidence for effective management of decay in primary teeth has caused uncertainty, but there is emerging evidence to support alternative strategies to conventional fillings, which are minimally invasive and prevention orientated.ObjectivesThe objectives were (1) to assess the clinical effectiveness and cost-effectiveness of three strategies for managing caries in primary teeth and (2) to assess quality of life, dental anxiety, the acceptability and experiences of children, parents and dental professionals, and caries development and/or progression.DesignThis was a multicentre, three-arm parallel-group, participant-randomised controlled trial. Allocation concealment was achieved by use of a centralised web-based randomisation facility hosted by Newcastle Clinical Trials Unit.SettingThis trial was set in primary dental care in Scotland, England and Wales.ParticipantsParticipants were NHS patients aged 3–7 years who were at a high risk of tooth decay and had at least one primary molar tooth with decay into dentine, but no pain/sepsis.InterventionsThree interventions were employed: (1) conventional with best-practice prevention (local anaesthetic, carious tissue removal, filling placement), (2) biological with best-practice prevention (sealing-in decay, selective carious tissue removal and fissure sealants) and (3) best-practice prevention alone (dietary and toothbrushing advice, topical fluoride and fissure sealing of permanent teeth).Main outcome measuresThe clinical effectiveness outcomes were the proportion of children with at least one episode (incidence) and the number of episodes, for each child, of dental pain or dental sepsis or both over the follow-up period. The cost-effectiveness outcomes were the cost per incidence of, and cost per episode of, dental pain and/or dental sepsis avoided over the follow-up period.ResultsA total of 72 dental practices were recruited and 1144 participants were randomised (conventional arm,n = 386; biological arm,n = 381; prevention alone arm,n = 377). Of these, 1058 were included in an intention-to-treat analysis (conventional arm,n = 352; biological arm,n = 352; prevention alone arm,n = 354). The median follow-up time was 33.8 months (interquartile range 23.8–36.7 months). The proportion of children with at least one episode of pain or sepsis or both was 42% (conventional arm), 40% (biological arm) and 45% (prevention alone arm). There was no evidence of a difference in incidence or episodes of pain/sepsis between arms. When comparing the biological arm with the conventional arm, the risk difference was –0.02 (97.5% confidence interval –0.10 to 0.06), which indicates, on average, a 2% reduced risk of dental pain and/or dental sepsis in the biological arm compared with the conventional arm. Comparing the prevention alone arm with the conventional arm, the risk difference was 0.04 (97.5% confidence interval –0.04 to 0.12), which indicates, on average, a 4% increased risk of dental pain and/or dental sepsis in the prevention alone arm compared with the conventional arm. Compared with the conventional arm, there was no evidence of a difference in episodes of pain/sepsis among children in the biological arm (incident rate ratio 0.95, 97.5% confidence interval 0.75 to 1.21, which indicates that there were slightly fewer episodes, on average, in the biological arm than the conventional arm) or in the prevention alone arm (incident rate ratio 1.18, 97.5% confidence interval 0.94 to 1.48, which indicates that there were slightly more episodes in the prevention alone arm than the conventional arm). Over the willingness-to-pay values considered, the probability of the biological treatment approach being considered cost-effective was approximately no higher than 60% to avoid an incidence of dental pain and/or dental sepsis and no higher than 70% to avoid an episode of pain/sepsis.ConclusionsThere was no evidence of an overall difference between the three treatment approaches for experience of, or number of episodes of, dental pain or dental sepsis or both over the follow-up period.Future workRecommendations for future work include exploring barriers to the use of conventional techniques for carious lesion detection and diagnosis (e.g. radiographs) and developing and evaluating suitable techniques and strategies for use in young children in primary care.Trial registrationCurrent Controlled Trials ISRCTN77044005.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 24, No. 1. See the NIHR Journals Library website for further project information.

Objectives Dental materials that can form apatite offer the potential to not only prevent demineralisation but enhance remineralisation of the enamel. The objective of this study was to investigate the ability of a novel BAG-resin adhesive to form apatite in 3 immersion media. Methods A novel fluoride containing BAG-resin adhesive described previously, with 80% by weight filler load, was used to fabricate 90 disks. Each disk was immersed in 10 ml of either tris buffer (TB), or artificial saliva at pH = 7 (AS7) or pH = 4 (AS4). At ten time points (from 6 h to 6 months), three disks were taken from each of the solutions and investigated by ATR-FTIR, XRD and SEM. Results The BAG-resin formed apatite on the disk surface, which increased with time, especially in AS4 and AS7. The apatite crystals formed in AS7 were highly oreintated and the oreintation increased with time. Significance This novel BAG-resin adhesive differs from the currently used adhesives by promting apatite formation, particularly under acidic conditions. Thus, applied in the clinical situation to bond orthodontic brackets, it may discourage the frequent occurrence of white spot lesion formation around the brackets.

What can be done to prevent premature polymerisation?

Objectives This qualitative study explored how the foster family environment influenced children's oral health. It also aimed to better understand foster carers’ oral health knowledge, attitudes and experiences of managing foster children's oral health behaviours and oral health care. Methods An interpretative phenomenological analysis (IPA) study design was used to recruit a purposive sample of foster carers in Tower Hamlets, United Kingdom, from a range of backgrounds (maximum variation sampling). Participants were aged 21 years and older and provided full-time foster care for children for a minimum of 1 year. The foster carers took part in focus groups that were audio-recorded and transcribed verbatim. Data analysis followed a five-step IPA process, which included reading the transcripts, note taking, identifying emerging themes, connecting related themes and writing up the final themes. Iterative data gathering and analysis continued to reach thematic saturation. Results Three focus groups were conducted, involving a total of 12 foster carers. Eight of the 12 participants had fostered children for more than 10 years and they were currently fostering 22 children aged five to 18 years old. Four themes emerged from within the context of the supportive and nurturing foster family environment that described how foster carers’ responded to and managed the oral health of their foster children. Foster carers had adopted an oral health caregiving role, “in loco parentis” responding to the poor oral health of their vulnerable foster children. They were hypervigilant about establishing and monitoring children's oral health routines and taking their children to see a dentist; these were seen as an integral part of being good foster carers. They were knowledgeable about the causes of children's oral ill health, gained from their own dental experiences and from looking after their own children. Foster carers had experienced tensions while adopting this oral health caregiving role with dentists who had refused to see younger children. Foster carers had also experienced tensions with teenage foster children who questioned their parental authority and legitimate right to set rules about smoking and healthy eating. Conclusions This is the first study to explore foster carers’ oral health perspectives and the foster family environment within the oral health context. It highlights the unrecognized and important role that foster carers have in improving the oral health of vulnerable children. Further research is needed to explore the relationship between foster carers and dentists and to support the development of health and social care interventions to improve foster children's oral health.

This multicenter 3-arm, parallel-group, patient-randomized controlled trial compared clinical effectiveness of 3 treatment strategies over 3 y for managing dental caries in primary teeth in UK primary dental care. Participants aged 3 to 7 y with at least 1 primary molar with dentinal carious lesion were randomized across 3 arms (1:1:1 via centrally administered system with variable-length random permuted blocks): C+P, conventional carious lesion management (complete carious tooth tissue removal and restoration placement) with prevention; B+P, biological management (sealing in carious tooth tissue restoratively) with prevention; and PA, prevention alone (diet, plaque removal, fluorides, and fissure sealants). Parents, children, and dentists were not blind to allocated arm. Co–primary outcomes were 1) the proportion of participants with at least 1 episode of dental pain and/or infection and 2) the number of episodes of dental pain and/or infection during follow-up (minimum, 23 mo). In sum, 1,144 participants were randomized (C+P, n = 386; B+P, n = 381; PA, n = 377) by 72 general dental practitioners, of whom 1,058 (C+P, n = 352; B+P, n = 352; PA, n = 354) attended at least 1 study visit and were included in the primary analysis. The median follow-up was 33.8 mo (interquartile range, 23.8 to 36.7). Proportions of participants with at least 1 episode of dental pain and/or infection were as follows: C+P, 42%; B+P, 40%; PA, 45%. There was no evidence of a difference in incidence of dental pain and/or infection when B+P (adjusted risk difference [97.5% CI]: −2% [−10% to 6%]) or PA (4% [−4% to 12%]) was compared with C+P. The mean (SD) number of episodes of dental pain and/or infection were as follows: C+P, 0.62 (0.95); B+P, 0.58 (0.87); and PA, 0.72 (0.98). Superiority could not be concluded for number of episodes between B+P (adjusted incident rate ratio (97.5% CI): 0.95 [0.75 to 1.21]) or PA (1.18 [0.94 to 1.48]) and C+P. In conclusion, there was no evidence of a difference among the 3 treatment approaches for incidence or number of episodes of dental pain and/or infection experienced by these participants with high caries risk and established disease (trial registration: ISRCTN77044005).

Importance Familial hypercholesterolemia (FH) is an underdiagnosed and undertreated genetic disorder that leads to premature morbidity and mortality due to atherosclerotic cardiovascular disease. Familial hypercholesterolemia affects 1 in 200 to 250 people around the world of every race and ethnicity. The lack of general awareness of FH among the public and medical community has resulted in only 10% of the FH population being diagnosed and adequately treated. The World Health Organization recognized FH as a public health priority in 1998 during a consultation meeting in Geneva, Switzerland. The World Health Organization report highlighted 11 recommendations to address FH worldwide, from diagnosis and treatment to family screening and education. Research since the 1998 report has increased understanding and awareness of FH, particularly in specialty areas, such as cardiology and lipidology. However, in the past 20 years, there has been little progress in implementing the 11 recommendations to prevent premature atherosclerotic cardiovascular disease in an entire generation of families with FH. Observations In 2018, the Familial Hypercholesterolemia Foundation and the World Heart Federation convened the international FH community to update the 11 recommendations. Two meetings were held: one at the 2018 FH Foundation Global Summit and the other during the 2018 World Congress of Cardiology and Cardiovascular Health. Each meeting served as a platform for the FH community to examine the original recommendations, assess the gaps, and provide commentary on the revised recommendations. The Global Call to Action on Familial Hypercholesterolemia thus represents individuals with FH, advocacy leaders, scientific experts, policy makers, and the original authors of the 1998 World Health Organization report. Attendees from 40 countries brought perspectives on FH from low-, middle-, and high-income regions. Tables listing country-specific government support for FH care, existing country-specific and international FH scientific statements and guidelines, country-specific and international FH registries, and known FH advocacy organizations around the world were created. Conclusions and Relevance By adopting the 9 updated public policy recommendations created for this document, covering awareness; advocacy; screening, testing, and diagnosis; treatment; family-based care; registries; research; and cost and value, individual countries have the opportunity to prevent atherosclerotic heart disease in their citizens carrying a gene associated with FH and, likely, all those with severe hypercholesterolemia as well.

The aim of this study was to characterize the ion release, pH changes and apatite formation ability of two potentially bioactive composites Cention N (CN) and Activa (ACT). Ion release and apatite formation was investigated in three different immersion media: Tris buffer pH 7.3 (TB), Artificial Saliva pH 4 (AS4) and Artificial Saliva pH 7 (AS7) in order to mimic the conditions present in the mouth. Fluoride release was followed using an ion selective electrode, whilst all other ions were determined by inductively coupled plasma optical emission spectroscopy. Apatite formation was followed by FTIR and XRD. SEM was used to follow glass degradation and apatite formation on both polished cross-sections and surfaces of the composites. ACT released very few ions including fluoride upon immersion in TB and AS7, but released more ions including significant quantities of Al in AS4. This would suggest the glasses in ACT are acid degradable fluoro-alumino-silicate glasses similar to the glasses used in glass ionomer cements. There was no evidence of any apatite formation with ACT. CN released more ions in TB and AS7 than ACT and formed an apatite like phase in AS7. The calcium fluoro-silicate glass in CN was observed to degrade significantly in AS4. CN has bioactive properties that may explain the low incidence of secondary caries found clinically with this composite.

Objectives To study the dissolution and fluoroapatite (FAP) formation of a new bioactive glass (BAG)-resin adhesive in an acidic solution in reference to neutral solutions, using the magic angle spinning-nuclear magnetic resonance (MAS-NMR) and the scanning electron microscopy (SEM). Methods BAG composite disks (n = 90) were prepared from, novel fluoride-containing BAG-resin. Three sample groups (n = 30) of the disks were immersed in Tris buffer pH = 7.3 (TB), neutral artificial saliva pH = 7 (AS7) and acidic artificial saliva pH = 4 (AS4) at ten time points (from 6 h to 6 months). Half of the immersed disks at each time point were crushed into a powder and investigated by the solid state MAS-NMR. SEM studies were undertaken by embedding the other half of the immersed disk in a self-cure acrylic where the fracture surface was imaged. Results MAS-NMR results show that the BAG composite degraded significantly faster in AS4 compared to TB and AS7. At the end of the immersion period (6 months), around 80% of the glass particles in AS4 had reacted to form an apatite, evidenced by the sharp peak at 2.82 ppm in 31P signals compared to a broader peak in TB and AS7. It also shows evidence of fluorapatite (FAP) formation, indicated by 19F signal at −103 ppm, while signal around −108 ppm indicated the formation of calcium fluoride, from the excess Ca2+ and F− especially on longer immersion. SEM images confirm higher degradation rate of the BAG composite in AS4 and reveal the impact of time on the dissolution of more glass particles. The images also indicate apatite formation around the glass particles in TB and AS4, while it forms predominantly over the disk surface in AS7. Significance BAG composite demonstrate smart reactivity in response to pH change which has a potential clinical benefit against demineralization and promoting remineralisation to form more stable fluorapatites.

Estimating chronological age accurately in young adults is difficult and additional methods are required to increase the accuracy. This study explored a new semi-automated method to assess shape change of third cervical vertebra (C3) with age in the living; comparing this as a method to determine whether individuals could be categorised into being less than 18 years of age (18), or at least 18 years of age (≥18) with tooth formation of the second and third mandibular molars (M2 and M3). The sample was panoramic and lateral skull radiographs of 174 dental patients (78 males, 96 females aged 15-22 years). Twelve variables were compared in two age categories: younger than 18 and at least 18 years of age in males and females separately using a t-test. Tooth formation of M2 and M3 was assessed. Mean values of eight variables of C3 in males and one variable in females were significantly different between the two age categories (p 0.05). Results for males showed that the best age indicator for age ≥18 was the ratio between height and width of C3 and for females, the ratio between diagonals. Results for molars showed that M2 was mature in 69% of males and 83% of females, within the expected age range of 14-16 years. M3 was highly variable ranging from stages 6-14 for both; M3 was missing in 24% of males and 28% of females and mature in 14% of males and 15% of females. The conclusion was that shape change of C3 has potential as an additional method to group individuals18 and ≥ 18 years of age.

The viscoelastic properties of three commercially available resin-based composites (Filtek™ P60, Filtek™ Supreme, and Filtek™ Z250, 3M ESPE, Bracknell, UK) were measured to determine the effect of beverages on their storage moduli and damping ratios. Rectangular samples of the three hybrid composites were immersed in three beverages at 37 °C for 1, 7, 30, and 60 days. At each time interval, these samples were subjected to three-point bend tests in temperature mode using a Perkin Elmer DMA7 Dynamic Mechanical Analyzer (Perkin Elmer Corp., Waltham, MA, USA) to measure the storage modulus and damping ratio. The immersion time had significant influence on the viscoelastic property of composites and it was found that generally for all samples the storage modulus was reduced, whereas damping values increased with immersion time. The viscoelastic behavior of tested materials seems to be related to the pH environment, hydrophilicity and the chemical composition of composites.

Objective Dental materials that release calcium, phosphate and fluoride ions could prevent demineralisation and/or enhance remineralisation of enamel. The objective was to develop a novel bioactive glass (BAG) resin and investigate pH changes and ion release in 3 immersion media. Methods Quench melt derived BAG (35.25% SiO 2 , 6% Na 2 O, 43% CaO, 5.75% P 2 O 5 , and 10% CaF 2 ) was incorporated into a resin (42.25% BisEMA, 55% TEGDMA, 0.25% DMAEM, 0.5% camphorquinone and 2% 4-Meta), with a filler load of 80% by weight. Ninety composite disks for each BAG loading of 80%, 60%, 50%, 40%, 20%, and 0% were made and each disk was immersed in 10 ml of either tris buffer (TB), or artificial saliva at pH = 7 (AS7) or pH = 4 (AS4), n = 30 for each solution. Three disks of each loading were taken from each of the solutions, at ten time points (6 h–6 months), for measurement of pH, fluoride, calcium and phosphate. Results The BAG adhesive raised the pH in all the solutions, release Ca, PO 4 and F ions especially in AS4. The rise in pH and the release of Ca and F are directly related to the BAG loading and the time of immersion. The pH and the ion releases were maintained and continued over 6 months. Significance Unlike glass ionomer resins, favourable ions F, Ca and PO 4 releases were maintained over a long time period especially in acidic condition for this novel BAG-resin composite. This indicates the resin has the potential to prevent formation and progression of early caries lesions.

Despite the high success rates of preformed metal crowns (PMCs) in children no randomized clinical trials compare methods of placement and none describe its use in Africa. Our aim was to compare survival and cost-effectiveness of PMCs placed by conventional techniques (CT) and biological Hall techniques (HT) using a prospective randomized control trial in a general dental practice from Khartoum. One hundred and nine and 103 PMCs were placed in randomly selected children (5-8years) with 1-2 carious primary molars using HT and CT respectively and followed for 2 years. Socioeconomic status, periodontal health, occlusion, anxiety, and procedure time were compared using student t-test. Kaplan-Meier survival rates and incremental cost effectiveness ratio (ICER) were compared between CT and HT. CT and HT groups were similar for age, gender, socio-economic status. Survival rates were high (over 90%) for both study arms and not statistically different (p>0.05). Anxiety scores were significantly higher in CT arm after 12 months compared to HT (p0.05) but occlusions were raised in nearly all subjects in the HT arm (p

The aim was to develop an obturating material which has the tendency to release fluoride and minimize interfaces with tooth. Nano-fluorapatite (nFA) powder was synthesized by sol-gel. The composite based on polyurethane (PU) was obtained by chemically binding the nFA (10, 15, 20%wt/wt) to the diisocyanate component by utilizing in-situ polymerization. The procedure involved stepwise addition of monomeric units of PU, and optimizing the reagent concentrations to synthesize composite. The structural, phase and morphological analysis of nFA was evaluated. The structural, fluoride release and in-vitro adhesion analysis with tooth structure of PU/nFA was conducted. For fluoride release analysis the samples were stored in artificial saliva and deionized water for periodical time intervals. Bond strength of composites was analyzed by push-out test. Chemical linkage was achieved between PU and nFA without intermediate coupling agent. The insignificant difference of fluoride release pattern was observed in artificial saliva and (p≥0.05) deionized water. The PU/nFA composite provided sustained release of fluoride over a long period of time. The composite showed more adhesion toward tooth structure with the increase in concentration of nFA. Bond strength of composite was in accordance with root canal filling material, hence, the material with anti-cariogenic properties can be used as an obturating material.

NOTICE: this is the author’s version of a work that was accepted for publication in Ceramics International. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in CERAMICS INTERNATIONAL, [VOL 39, ISSUE 4, (2013)] DOI 10.1016/j.ceramint.2012.11.017

Structure and biocompatibility are key parameters that determine the usefulness of dental materials for clinical use. Novel polyurethane (PU) nanocomposite material was prepared by chemically binding nanohydroxyapatite (nHA) to the diisocyanate component of the PU backbone by solvent- polymerization. nHA was incorporated into PU by the stepwise addition of monomeric units of the PU. The PU/nHA composite was analyzed by 13C Nuclear magnetic resonance (structural) and X-ray diffraction (phase analysis). The tensile strength and elastic modulus was evaluated for mechanical properties. These analyses revealed linkage between the hard- and soft-segments are urethane linkage and showed high mechanical properties with increase in content of nHA. To assess biocompatibility osteoblast cells were seeded on to the material and allowed to adhere and proliferate. Osteoblast-like cell growth and proliferation was assessed by MTS assay. It was found that cells adhered and proliferated on these novel substrates. To test bacterial adhesion discs of composite with and without nHA were incubated with standardized suspensions of oral bacterium Streptococcus sanguinis strain NCTC 7863. PU composites with nHA exhibited biocompatibility with respect to mammalian cell growth and showed significantly reduced bacterial adhesion as compared to PU alone. Copyright © 2012 Wiley Periodicals, Inc.

BACKGROUND: The European Academy of Paediatric Dentistry (EAPD) has long recognised the necessity of promoting further research and knowledge regarding the dental defect described as molar-incisor-hypomineralisation (MIH). Following the establishment by EAPD of the defect diagnostic criteria in 2003, the publication of various papers and a whole issue assigned to the defect in the European Archives of Paediatric Dentistry (2008), an Interim Seminar and Workshop on MIH was organized in Helsinki in 2009. RESULT: The outcome of this event is the present consensus paper on the prevalence, diagnosis, aetiology and treatment for children and adolescents presenting with MIH. A clear diagnostic proposal and a treatment decision-making guide are presented together with suggestions on aetiology and guidance forfuture research. CONCLUSION: MIH is an important clinical problem that often concerns both the general dental and specialist paediatric dentists; the present ‘best clinical practice guidance’ aims to further help clinicians dealing with the condition.

The biostability of the polymer is one of the critical parameter to use them for biomaterial application. Polyurethane being one of the most compliant polymer but there are concerns regarding its resistance to degradation, particularly from hydrolysis and oxidation. The aim of this study is to synthesise a novel bioactive composite by creating a covalent linkage between polyurethane and nano-apatites and to analyse the in-vitro hydrolytic degradation of a series of newly synthesised polyurethane (PU) and polyurethane/nano-hydroxyapatite (PU/n-HA) composites. Nanoapatite powder was produced through sol–gel technique. A novel polyurethane composite material was prepared by chemically bonding the n-HA to the diisocyanate component in the polyurethane backbone by utilising solvent polymerisation. The concentration of nano-apatite was 5, 10, 15 and 20% wt/wt in polyurethane. Hydrolytic degradation of the PU and PU/n-HA composites were carried out both in deionised water and in phosphate buffer solution (PBS) having (pH 7.4) at 37 � C for a predetermined time interval of 90 days. The PU and PU/n-HA composites were physically and chemically characterised by using contact angle measurement, weight loss, Fourier Transform Infrared spectroscopy couples with Photoacoustic Sampling Cell (FTIR-PAS), Raman Spectroscopy, X-ray Diffraction (XRD) and Scanning electron microscopy (SEM). These characterisations showed that with the addition of n-HA the composite exhibits hydrophobic behaviour and degradation rate reduces due to covalent linkage between n-HA and PU. Hence it has been concluded that the degradation rate of the newly developed PU/n-HA composites can be controlled, which helps in tailor making the biomaterial for specific applications.

The visco-elastic behavior of a pre-impregnated reinforced glass fiber composite (everStick) was compared with a resin-based particulate composite (Filtek P60) by using dynamic mechanical analysis (DMA) to determine their storage modulus (E') and damping ratio (tandelta).These materials were subjected to three-point bend tests using a PerkinElmer DMA7. In temperature mode, the temperature was increased from 26 to 140 degrees C at 1 Hz. In frequency mode, the range was 1-10 Hz at a constant temperature of 37 degrees C.In both temperature and frequency modes, E' for everStick was significantly higher and tandelta was significantly lower than those for Filtek P60, indicating that the stiffness of the pre-impregnated glass fiber composite was higher and its damping property was lower than those for resin-based particulate composite.The glass fiber restorative composite appears to absorb less energy in repeated stress and is less likely to retain external energy as residual stress.

Aim: This was to assess the mineral composition and 3-D structure of enamel and bone in the teeth and skulls of diabetic rodents. Methods: Three-dimensional images of the skull were reconstructed using x-ray microtomography (XMT) computer-generated false colour to highlight different levels of mineralization in bone and enamel. Results: These showed that diabetic rodents exhibited more wear in their teeth. Deformities were observed in the alveolar process of the mandible and maxilla. Regions of extensive hypomineralization were found in the calvarial bone of skulls. The maximum mineral concentrations and the time constants for diabetic rodents were similar to the controls. The diabetic mice appeared to have random regions of hypomineralization and one diabetic rat had areas of hypoplasia in the mandibular incisors. Conclusions: Diabetes may have a profound detrimental influence on the function of ameloblasts in laying down enamel.

Dentists use a number of criteria in order to assess when a cavity is caries free, amongst which hardness is probably the most widely used. However, the judgement is subjective. X-ray microtomography (XMT) is a non-destructive microscopic technique that allows in vitro specimens to be scanned, manipulated and then rescanned. In this study, a high-definition XMT scanner was used to determine the mineral distribution of carious dentine in 10 deciduous molars, and the extent of dentine removed by an experienced clinician was investigated. For each tooth, after an initial XMT scan, caries was removed using a steel bur in a slow hand-piece. The tooth was then repositioned and rescanned. Mineral concentrations were calculated from the linear attenuation coefficients assuming the mineral phase to be hydroxyapatite and the organic phase to be collagen. The volume of dentine tissues removed was calculated by subtracting data of the second scan from the first. The results showed that the mean modal mineral concentration for the 10 teeth was 1.42 g · cm–3 for sound dentine. Because of uncertainty about collagen concentration in carious dentine, the mean modal mineral concentration for the carious dentine had a range of 0.37–0.5 g · cm–3. It was found that the subjective criteria used by the operator could lead to inconsistency of cavity preparation. The cavities could be overprepared by 8.5–44.3% in volume. However, the overpreparation was not uniform throughout the cavity: residual demineralised dentine could still be detected in the postoperative scan in isolated regions.