The aim of this meta-analysis, based on individual participant data from several studies, was to investigate the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a search resulting in 12 longitudinal studies of direct posterior resin composite restorations with at least 5 years' follow-up. Original datasets were still available, including placement/failure/censoring of restorations, restored surfaces, materials used, reasons for clinical failure, and caries-risk status. A database including all restorations was constructed, and a multivariate Cox regression method was used to analyze variables of interest [patient (age; gender; caries-risk status), jaw (upper; lower), number of restored surfaces, resin composite and adhesive materials, and use of glass-ionomer cement as base/liner (present or absent)]. The hazard ratios with respective 95% confidence intervals were determined, and annual failure rates were calculated for subgroups. Of all restorations, 2,816 (2,585 Class II and 231 Class I) were included in the analysis, of which 569 failed during the observation period. Main reasons for failure were caries and fracture. The regression analyses showed a significantly higher risk of failure for restorations in high-caries-risk individuals and those with a higher number of restored surfaces.

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The summarized scanning electron microscopic-supported micromorphologic data of a 10-year longitudinal clinical study of GIC/Hybrid composite posterior restorations is reported. The aim of this study was to compare the results to USPHS-compatible clinical criteria of the CPM index and to analyse the deterioration pattern and the success rate. Out of a total of 194 Class I and Class II fillings 46 restorations were at baseline, after 1, 3, 5, 7 and 10 years. The restorations were micromorphologically examined using gold-sputtered replicas and coded according to the M-criteria of the CPM index. The features for surface roughness, surface texture, marginal integrity, excess of material, marginal fracture, loss of material, marginal leakage and other filling imperfections were assessed. Eighteen fillings showed perfect margins, rapidly deteriorating after the first year of service. Despite poor micromorphologic marginal conditions all restorations retained optimal functional characteristics. Parallel longitudinal micromorphologic and clinical assessment of posterior GIC/Composite restorations revealed fine structure and deterioration patterns of the tooth-biomaterial interface. The layer-technique using GIC as dentine replacement and resin-based composite as enamel replacement results, according to previous biocompatibility testing, and clinical data, in optimal pulp protection and correct anatomic form over a 10-year period. The myth of the need for perfect marginal integrity requires further discussion.

The periodontal condition of 123 poodles was assessed using the parameters of depth of gum pocket, attachment level, bleeding on probing, and plaque and calculus accumulation. No dogs were free of periodontal disease. The number of deep pockets and dramatic loss of attachment ranged from 0.1 teeth in young dogs to 4.2 teeth in old animals. A sixfold increase in deep pocketing took place in dogs between the ages of six and seven, followed by a twofold increase in the number of teeth missing in dogs within the 10 to 11 year age group. First premolars, incisors and second molars were at highest risk. No correlation between dietary conditions and disease incidence could be detected. It is concluded that, by concentrating their diagnostic efforts on those age groups and types of teeth at highest risk, clinicians could improve the effectiveness of their treatment interventions.

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BackgroundIt was the aim of this study to investigate the effect of four different toothpastes with differing fluoride compounds on enamel remineralization.MethodsA 3 × 3 mm window on the enamel surface of 90 human premolars was demineralized in a hydroxyethylcellulose solution at pH 4.8. The teeth were divided into 6 groups and the lower half of the window was covered with varnish serving as control. The teeth were immersed in a toothpaste slurry containing: placebo tooth paste (group 1); remineralization solution (group 2); Elmex Anticaries (group 3); Elmex Sensitive (group 4); Blend-a-med Complete (group 5) and Colgate GRF (group 6). Ten teeth of each group were used for the determination of the F- content in the superficial enamel layer and acid solubility of enamel expressed in soluble phosphorus. Of 6 teeth of each group serial sections were cut and investigated with polarization light microscopy (PLM) and quantitative energy dispersive X-ray analysis (EDX).ResultsThe PLM results showed an increased remineralization of the lesion body in the Elmex Anticaries, Elmex Sensitive and Colgate GRF group but not in the Blend-a-med group. A statistically significant higher Ca content was found in the Elmex Anticaries group. The fluoride content in the superficial enamel layer was significantly increased in both Elmex groups and the Blend-a-med group. Phosphorus solubility was significantly decreased in both Elmex groups and the Blend-a-med group.ConclusionIt can be concluded that amine fluoride compounds in toothpastes result in a clearly marked remineralization of caries like enamel lesions followed by sodium fluoride and sodium monofluorophosphate formulations.

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Caries is the most common cause of pulp-periapical disease. When the pulp tissue involved in caries becomes irreversibly inflamed and progresses to necrosis, the treatment option is root canal therapy because the infected or non-infected necrotic pulp tissue in the root canal system is not accessible to the host's innate and adaptive immune defense mechanisms and antimicrobial agents. Therefore, the infected or non-infected necrotic pulp tissue must be removed from the canal space by pulpectomy. As our knowledge in pulp biology advances, the concept of treatment of pulpal and periapical disease also changes. Endodontists have been looking for biologically based treatment procedures, which could promote regeneration or repair of the dentin-pulp complex destroyed by infection or trauma for several decades. After a long, extensive search in in vitro laboratory and in vivo preclinical animal experiments, the dental stem cells capable of regenerating the dentin-pulp complex were discovered. Consequently, the biological concept of ‘regenerative endodontics’ emerged and has highlighted the paradigm shift in the treatment of immature permanent teeth with necrotic pulps in clinical endodontics. Regenerative endodontics is defined as biologically based procedures designed to physiologically replace damaged tooth structures, including dentin and root structures, as well as the pulp-dentin complex. According to the American Association of Endodontists’ Clinical Considerations for a Regenerative Procedure, the primary goal of the regenerative procedure is the elimination of clinical symptoms and the resolution of apical periodontitis. Thickening of canal walls and continued root maturation is the secondary goal. Therefore, the primary goal of regenerative endodontics and traditional non-surgical root canal therapy is the same. The difference between non-surgical root canal therapy and regenerative endodontic therapy is that the disinfected root canals in the former therapy are filled with biocompatible foreign materials and the root canals in the latter therapy are filled with the host's own vital tissue. The purpose of this article is to review the potential of using regenerative endodontic therapy for human immature and mature permanent teeth with necrotic pulps and/or apical periodontitis, teeth with persistent apical periodontitis after root canal therapy, traumatized teeth with external inflammatory root resorption, and avulsed teeth in terms of elimination of clinical symptoms and resolution of apical periodontitis.