Cost-effectiveness of composite resins and amalgam in the replacement of amalgam Class II restorations. Intravenous sedation in pediatric dentistry using midazolam, nalbuphine and droperidol. Comparison of oral chloral hydrate with intramuscular ketamine, meperidine, and promethazine for pediatric sedation--preliminary report. A Comparative Evaluation of Marginal Leakage of Different Restorative Materials in Deciduous Molars: An in vitro Study A clinical study of the "open sandwich" technique in pediatric dental practice. Caries Management Strategies for Primary Molars General dental practitioners' views on the use of stainless steel crowns to restore primary molars Recommendations for conducting controlled clinical studies of dental restorative materials The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months Clinical evaluation of a chemomechanical method for caries removal in children and adolescents The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic. Psychosocial benefits of insulin pump therapy in children with diabetes type 1 and their families: The pumpkin multicenter randomized controlled trial Reporting quality of randomised controlled trials published in prosthodontic and implantology journals. A CAMBRA Model For High Caries Risk Indian Children: A Pragmatic Comprehensive Tailored Intervention. Comparison of a high and a low intensity smoking cessation intervention in a dentistry setting in Sweden – a randomized trial Four-year clinical evaluation of posterior resin-based composite restorations placed using the total-etch technique. Pain related to different ways of minimal intervention in the treatment of small caries lesions. Bilayer technique and nano-filled coating increase success of approximal ART restorations: a randomized clinical trial. Improving the care of children with advanced cancer by using an electronic patient-reported feedback intervention: results from the PediQUEST randomized controlled trial. Two-year evaluation of Class II resin-modified glass ionomer cement/composite open sandwich and composite restorations The Clinical Outcomes of Immediate Versus Delayed Restoration Procedures on Immediate Implants: A Comparative Cohort Study for Single-Tooth Replacement. Sealants and dental caries: dentists' perspectives on evidence-based recommendations. Design and Validity of Randomized Controlled Dental Restorative Trials
OBJECTIVES The replacement of an old amalgam Class II restoration  is a common treatment and will remain so for decades . In addition to effectiveness , possible adverse health effects and esthetics , the costs of the treatment options will play a role in the choice of material . The aim of this study was to yield information on the relative cost-effectiveness of the use of composite resins and amalgam for the rerestoration of amalgam Class II restorations . METHODS As part of a larger r and omized clinical trial , treatment effectiveness and treatment costs were estimated in 73 composite and amalgam Class II posterior re-restorations .  The main treatment outcome was longevity . Secondary outcomes included need of repair and quality of the margin while in situ . Costs were analyzed from the perspective of dentistry , assuming a treatment strategy aim ed at offering ' value for money ' . From this perspective , differential costs were based on personnel costs as approximated by treatment time . RESULTS Replacing an amalgam Class II restoration with amalgam is associated with lower costs than replacing with a composite resin . A sensitivity analysis , considering type of composite , increasing proficiency with the material , and time needed for future removal of material , demonstrated that these differences are fairly robust . The material s performed equally well for the first 5 years after placement with respect to longevity . Differences in secondary outcomes were minor and not all in favor of the same material . CONCLUSIONS It is tentatively concluded that amalgams are more cost-effective than composites for replacing existing Class II amalgam restorations PURPOSE The purpose of this pilot investigation was to study the efficacy , physiologic responses , and safety of a multi-drug intravenous conscious sedation technique in an outpatient setting in children who demonstrated uncooperative behavior when comprehensive restorative dental treatment was attempted . METHODS Using a time-based sedation record , the physiologic responses of 153 healthy children , age range 23 months to 14.5 years , were measured after they had received midazolam ( Versed ) , nalbuphine ( Nubain ) , and droperidol ( Inapsine ) , each administered intravenously , and nitrous oxide and oxygen administered by nasal mask , while each child received comprehensive restorative or surgical dental care . Each patient was monitored according to the American Academy of Pediatrics Sedation Guidelines . Heart rate and rhythm , blood pressure , respiratory rate , hemoglobin oxygen saturation , end-tidal CO2 , level of sedation , and behavioral responses were recorded preoperatively , at 5 minute intervals during treatment and in recovery until discharge . Sedation was titrated to Level 2 or 3 during treatment as defined by the American Academy of Pediatric Dentistry Reference Manual . RESULTS For each child , the sedation level was judged to be either acceptable or optimal for the completion of all planned dental treatment . There were no sedation failures . Children under 20 kg required significantly higher dosages of each sedative medication than children more than 20 kg to achieve the same level of sedation ( P < 0.001 , ANOVA ) . There were no episodes of intraoperative vomiting , hypotension , cardiac arrhythmias , respiratory depression requiring respiratory support , or dysphoria during treatment , in the recovery period , or after discharge . CONCLUSION This multi-drug intravenous conscious sedation technique is a safe and effective method to control the behavior of uncooperative children who require comprehensive dental treatment Fifteen consecutive pediatric patients ranging from 3 to 5 years old were selected to receive one of three sedative/hypnotic techniques . Group 1 received oral chloral hydrate 50 mg/kg , and groups 2 and 3 received intramuscular ketamine 2 mg/kg and 3 mg/kg , respectively . In addition to ketamine , patients in groups 2 and 3 received transmucosal intramuscular injections of meperidine and promethazine into the masseter muscle . Sedation for the satisfactory completion of restorative dentistry was obtained for over 40 min on average in the chloral hydrate group , but completion of dental surgery longer than 40 min was achieved in groups 2 and 3 only by intravenous supplements of ketamine ABSTRACT Context : Microleakage around dental restorative material s is a major problem in clinical dentistry . Inspite of many new restorative material s available in the market very few actually bond to the tooth surface . Aims : The aims of this study were : ( 1 ) To evaluate and compare the marginal leakage of newer restorative material s viz colored compomer , ormocer , giomer and RMGIC in class I restoration of deciduous molars . ( 2 ) To compare the microleakage scores between the groups of : Colored compomer and ormocer , giomer and RMGIC , ormocer with giomer and RMGIC , giomer with RMGIC . Material s and methods : A total of 40 primary molars were r and omly divided into four groups of 10 each . Class I cavities were prepared and the cavities were restored with colored compomer ( Group A ) , Ormocer ( Group B ) , Giomer ( Group C ) and RMGIC ( Group D ) . The teeth were thermocycled and subjected to 0.5 % basic fuchsin dye penetration followed by sectioning . The cut sections were evaluated under a stereomicroscope and the data was subjected to statistical analysis . Statistical analysis used : Mann-Whitney U test and Student t-test . Results : No significant difference was observed when colored compomer was compared to ormocer , giomer and RMGIC . Ormocer showed significantly lower microleakage when compared to giomer . However , no significant difference was observed when ormocer was compared to RMGIC . No significant difference between giomer and RMGIC was found . Conclusion : Ormocer has proven to be an excellent restorative material as it showed least microleakage followed by colored compomer , giomer and RMGIC in increasing order . How to cite this article : Yadav G , Rehani U , Rana V. A Comparative Evaluation of Marginal Leakage of Different Restorative Material s in Deciduous Molars : An in vitro Study . Int J Clin Pediatr Dent 2012;5(2):101 - 107 PURPOSE This study evaluated the clinical efficacy of the " open s and wich " restoration for pediatric dental practice . METHODS Three pediatric dentists used a st and ardized preparation and restorative technique to place the restorations . The prepared tooth was etched with a phosphoric acid semigel and rinsed . A resin modified glass ionomer ( Fuji II LCor Photac-Fil ) was placed short of the margins and then light cured . The resin modified glass ionomer was covered with an occlusal layer of a microhybrid flowable composite ( Aeliteflo or Flow-it ) . The same preparation for the experimental restorations was used for the control conventional amalgam ( Tytin ) restorations . The restorations were evaluated at 6-month intervals and ranked with a modified United States Public Heath Survey ( USPHS ) scale as follows : Alfa : No discernible marginal opening or stain ; Beta : Slight opening of margin discernible with dental explorer , but without stain ; Charlie : Open margin and stain ; Delta : Recurrent caries or restoration failure . Restoration failures were categorized according to etiology , pulpal necrosis , bruxism , marginal leakage , isthmus fracture , or adhesive failure . RESULTS All recalled experimental restorations , except 8 , were rated as either Alpha or Beta . Six failed due to isthmus fracture and 2 due to pulpal necrosis . Fifteen restorations had delaminating of the flowable composite from the resin modified glass ionomer . The use of the " open s and wich " technique compared favorably with a similar study using adhesive amalgam restorations . CONCLUSIONS The " open s and wich " technique can be successfully used in a pediatric dental practice Minimal invasive approaches to managing caries , such as partial caries removal techniques , are showing increasing evidence of improved outcomes over the conventional complete caries removal . There is also increasing interest in techniques where no caries is removed . We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars :  conventional restorations ( CR ; complete caries removal and compomer restoration ) , Hall technique ( HT ; no caries removal , sealing in with stainless steel crowns ) , and nonrestorative caries treatment ( N RCT ; no caries removal , opening up the cavity , teaching brushing and fluoride application ) . In sum , 169 children ( 3 - 8 yr old ; mean , 5.56 ± 1.45 yr ) were enrolled in this secondary care – based , 3-arm , parallel-group , r and omized clinical trial . Treatments were carried out by specialist pediatric dentists or postgraduate trainees . One lesion per child received CR , HT , or N RCT . Outcome measures were clinical failure rates , grouped as minor failure ( restoration loss/need for replacement , reversible pulpitis , caries progression , etc . ) and major failure ( irreversible pulpitis , abscess , etc . ) . There were 148 children ( 87.6 % ) with a minimum follow-up of 11 mo ( mean , 12.23 ± 0.98 mo ) . Twenty teeth were recorded as having at least 1 minor failure : N RCT , n = 8 ( 5 % ) ; CR , n = 11 ( 7 % ) ; HT , n = 1 ( 1 % ) ( p = .002 , 95 % CI = 0.001 to 0.003 ) . Only the comparison between N RCT and CR showed no significant difference ( p = .79 , 95 % CI = 0.78 to 0.80 ) . Nine ( 6 % ) experienced at least 1 major failure : N RCT , n = 4 ( 2 % ) ; CR , n = 5 ( 3 % ) ; HT , n = 0 ( 0 % ) ( p = .002 , 95 % CI = 0.001 to 0.003 ) . Individual comparison of N RCT and CR showed no statistically significant difference in major failures ( p = .75 , 95 % CI = 0.73 to 0.76 ) . Success and failure rates were not significantly affected by pediatric dentists ’ level of experience ( p = .13 , 95 % CI = 0.12 to 0.14 ) . The HT was significantly more successful clinical ly than N RCT and CR after 1 yr , while pairwise analyses showed comparable results for treatment success between N RCT and CR ( Clinical Trials.gov NCT01797458 ) Aim To ascertain general dental practitioners ' views on the use of stainless steel ( pre-formed metal ) crowns to restore carious primary molars . Method Ninety-three general dental practitioners were selected at r and om from those practising in Lancashire , Cheshire and Greater Manchester in 2003 and interviewed separately about the clinical care they provide to the primary dentition . Before the interview participants recorded the care they would provide for a case scenario , describing a child with a carious lesion that the British Society of Paediatric Dentistry ( BSPD ) guidelines indicate should be treated with a stainless steel crown . Results In answering the case scenario only six ( 7 % ) of the dentists reported that they would fit a stainless steel crown .  Of the 93 dentists interviewed 71 % knew of the BSPD guidelines , but only 18 % had ever fitted a stainless steel crown  in general practice . Reasons given for not using stainless steel crowns were they are inappropriate for many children , time consuming to fit , difficult to manipulate , expensive , and ugly . Conclusion The BSPD guidelines on the use of stainless steel crowns do not reflect the views of the majority of general dental practitioners who consider these crowns unsuitable for most children and an impractical restorative technique in busy daily practice About 35 years ago , Ryge provided a practical approach to evaluation of clinical performance of restorative material s. This systematic approach was soon universally accepted . While that methodology has served us well , a large number of scientific method ologies and more detailed questions have arisen that require more rigor . Current restorative material s have vastly improved clinical performance and any changes over time are not easily detected by the limited sensitivity of the Ryge criteria in short term clinical investigations . However , the clinical evaluation of restorations not only involves the restorative material per se but also different operative techniques . For instance , a composite resin may show good longevity data when applied in conventional cavities but not in modified operative approaches . Insensitivity , combined with the continually evolving and non-st and ard investigator modifications of the categories , scales , and reporting methods , has created a body of literature that is extremely difficult to meaningfully interpret . In many cases , the insensitivity of the original Ryge methods is misinterpreted as good clinical performance . While there are many good features of the original system , it is now time to move to a more contemporary one . The current review approaches this challenge in two ways : ( 1 ) a proposal for a modern clinical testing protocol for controlled clinical trials , and ( 2 ) an in-depth discussion of relevant clinical evaluation parameters , providing 84 references that are primarily related to issues or problems for clinical research trials . Together , these two parts offer a st and ard for the clinical testing of restorative material s/ procedures and provide significant guidance for research teams in the design and conduct of contemporary clinical trials . Part 1 of the review considers the recruitment of subjects , restorations per subject , clinical events , validity versus bias , legal and regulatory aspects , rationale s for clinical trial design s , guidelines for design , r and omization , number of subjects , characteristics of participants , clinical assessment , st and ards and calibration , categories for assessment , criteria for evaluation , and supplemental documentation . Part 2 of the review considers categories of assessment for esthetic evaluation , functional assessment , biological responses to restorative material s , and statistical analysis of results . The overall review represents a considerable effort to include a range of clinical research interests over the past years . As part of the recognition of the importance of these suggestions , the review is being published simultaneously in identical form in both the “ Journal of Adhesive Dentistry ” and the “ Clinical Oral Investigations . ” Additionally an extended abstract will be published in the “ International Dental Journal ” giving a link to the web full version . This should help to introduce these considerations more quickly to the scientific community Background Scotl and has high levels of untreated dental caries in primary teeth . The Hall Technique is a simplified method of managing carious primary molars using preformed metal crowns ( PMCs ) cemented with no local anaesthesia , caries removal or tooth preparation . This study compared the acceptability of the  Hall Technique  for children , their carers , and dentists , and clinical outcomes for the technique , with conventional restorations . Methods General dental practice based , split mouth , r and omized controlled trial ( 132 children , aged 3–10 ) . General dental practitioners ( GDPs , n = 17 ) in Tayside , Scotl and ( dmft 2.7 ) placed conventional ( Control ) restorations in carious primary molars , and Hall Technique PMCs on the contralateral molar ( matched clinical ly and radiographically ) . Dentists ranked the degree of discomfort they felt the child experienced for each procedure ; then children , their carers and dentists stated which technique they preferred . The teeth were followed up clinical ly and radiographically . Results 128 conventional restorations were placed on 132 control teeth , and 128 PMCs on 132 intervention teeth . Using a 5 point scale , 118 Hall PMCs ( 89 % ) were rated as no apparent discomfort up to mild , not significant ; for Control restorations the figure was 103 ( 78 % ) . Significant , unacceptable discomfort was recorded for two Hall PMCs ( 1.5 % ) and six Control restorations ( 4.5 % ) . 77 % of children , 83 % of carers and 81 % of dentists who expressed a preference , preferred the Hall technique , and this was significant ( Chi square , p < 0.0001 ) . There were 124 children ( 94 % of the initial sample ) with a minimum follow-up of 23 months . The Hall PMCs outperformed the Control restorations  : a ) ' Major ' failures ( signs and symptoms of irreversible pulpal disease ) : 19 Control restorations ( 15 % ) ; three Hall PMCs ( 2 % ) ( P < 0.000);b ) ' Minor ' failures ( loss of restoration , caries progression ) : 57 Control restorations ( 46 % ) ; six Hall PMCs ( 5 % ) ( P < 0.000)c ) Pain : 13 Control restorations ( 11 % ) ; two Hall PMCs ( 2 % ) ( P = 0.003 ) . Conclusion The Hall Technique was preferred to conventional restorations by the majority of children , carers and GDPs . After two years , Hall PMCs showed more favourable outcomes for pulpal health and restoration longevity than conventional restorations . The Hall Technique appears to offer an effective treatment option for carious primary molar teeth . Trial registration numberCurrent Controlled Trials IS RCT N47267892 – A r and omized controlled trial in primary care of a novel method of using preformed metal crowns to manage decay in primary molar teeth : the Hall technique Objective . The purpose of this study was to make a clinical comparison of the chemomechanical method for caries removal and the conventional rotary instruments technique when used in children and adolescents . Material and Methods . The study comprised 120 patients aged 3–17 years r and omized into two groups : caries were removed chemomechanically in 60 patients and 60 patients received conventional treatment with rotary instruments . The outcome variables were : clinical ly complete caries removal , pain during caries removal , need for local anesthesia , treatment time , preferences of patients , and clinical success of the restorations during the 12-month evaluation period . Results . Complete caries removal was achieved in 92 % of chemomechanically treated teeth and in all teeth treated with rotary instruments ( p>0.05 ) . The chemomechanical method significantly reduced the need for local anesthesia ( p<0.001 ) . Eighty-five percent of patients treated with Carisolv and 47 % treated with rotary instruments were satisfied with the treatment ( p<0.05 ) . The mean time for chemomechanical caries removal was 11.2±3.3 min and 5.2±2.8 min for caries removal with rotary instruments ( p<0.001 ) . At the end of the 12-month evaluation period , there was no observed influence of the caries removal method on the survival of the restorations . Conclusions . The chemomechanical caries removal technique is an adequate alternative to the conventional rotary instruments method and is advantageous in pediatric dentistry OBJECTIVES The aims of this study are to assess the feasibility of the  Atraumatic Restorative Treatment ( ART ) approach in primary teeth and to compare the ART approach with traditional amalgam restorations in primary molars . METHODS This study was conducted in a paediatric dentistry clinic in Kuwait between April 1999 and December 2001 . The ART and amalgam restorations were placed r and omly on comparable pairs of primary molars , if available . In addition , the ART approach was used for other primary teeth that had no pulpal involvement and no perceived pain before treatment . The restorations were assessed by both the ART evaluation criteria and USPHS criteria in August-September 2000 and in August-December 2001 . The mean follow-up period for the restorations was 8.3 months in the first assessment ( 2000 ) and 22 months in the second assessment ( 2001 ) . The assessment was possible for 35 children ( mean age = 5.7 years ) , 18 of whom had comparable pairs ( n = 35 pairs ) of restorations in their primary molars . In addition , 48 other ART restorations  were assessed in 2000 and 42 in 2001 . RESULTS In a 2-year follow-up , 89.6 % of all ART restorations were considered successful . The failure rate of the comparable pairs of ART and amalgam restorations was 5.7 % . There was no significant difference in success rate between ART and amalgam techniques . CONCLUSIONS Based on a 2-year follow-up evaluation , the class I ART restorations seemed to have a high success rate , indicating the appropriateness of the ART approach in primary teeth OBJECTIVE Continuous subcutaneous insulin infusion ( CSII ) is on the rise among pediatric patients with type 1 diabetes mellitus . Metabolic effects alone can not explain this rising popularity . From the patient 's perspective , the main benefits of CSII may be found in subjective psychosocial health outcomes ( patient-reported outcomes [ PRO ] ) . SUBJECTS AND METHODS In a multicenter open r and omized controlled trial , children and adolescents aged 6 to16 years currently treated with multiple daily injections ( MDI )  were r and omized 1:1 , stratified by center , to either starting with CSII immediately after the baseline interview or to continuing MDI while waiting 6 months for transmission to CSII . The primary outcomes were patient-reported diabetes-specific health-related quality of life ( DHRQOL ) and diabetes burden of the main caregiver . Secondary outcomes were caregiver stress , fear of hypoglycemia , satisfaction with treatment , and HbA1c . RESULTS Two-hundred and eleven patients were r and omized between February 2011 and October 2014 , and 186 caregivers and 170 patients were analyzed using the intention-to-treat principle for primary outcomes . Children 8 to 11 years in the CSII group reported improved DHRQOL at follow-up compared to MDI ( median difference [ MD ] 9.5 , 95 % confidence interval [ CI ] 3.6 - 16.7 , P = 0.004 ) . There were no treatment differences in the adolescent age-group 12 to 16 years ( MD 2.7 ; 95 % CI -3.2 - 9.5 ; P = 0.353 ) . The main caregivers of the CSII group reported a significant decline of overall diabetes burden at follow-up compared to the MDI group ( MD 0 ; 95 % CI -1 - 0 ; P = 0.029 ) . Secondary PROs also were in favor of CSII . CONCLUSIONS CSII has substantial psychosocial benefits . PROs demonstrate these benefits . Registered as NCT01338922 at clinical trials.gov The purpose of this study was to examine the reporting quality of r and omised controlled trials ( RCTs ) published in prosthodontic and implantology journals . Thirty issues of nine journals in prosthodontics and implant dentistry were search ed for RCTs , covering the years 2005 - 2012 : The Journal of Prosthetic Dentistry , Journal of Oral Rehabilitation , The International Journal of Prosthodontics , The International Journal of Periodontics & Restorative Dentistry , Clinical Oral Implants Research , Clinical Implant Dentistry & Related Research , The International Journal of Oral & Maxillofacial Implants , Implant Dentistry and Journal of Dentistry . The reporting quality was assessed using a modified Consoli date d St and ards of Reporting Trials ( CONSORT ) statement checklist . Data were analysed using descriptive statistics followed by univariable and multivariable examination of statistical associations ( α = 0·05 ) . A total of 147 RCTs were identified with a mean CONSORT score of 69·4 ( s.d . = 9·7 ) . Significant differences were found among journals with the Journal of Oral Rehabilitation achieving the highest score ( 80·6 , s.d . = 5·5 ) followed by Clinical Oral Implants Research ( 73·7 , s.d . = 8·3 ) . Involvement of a statistician/ method ologist was significantly associated with increased CONSORT scores . Overall , the reporting quality of RCTs in major prosthodontic and implantology journals requires improvement . This is of paramount importance considering that optimal reporting of RCTs is an important prerequisite for clinical decision-making OBJECTIVE To evaluate a CAMBRA based therapeutic and preventive model for high caries risk children in a pediatric dentistry clinic set-up . STUDY DESIGN A total of 100 systemically healthy children aged 4 - 8 years with dmft/DMFT ≥ 5 and /or ≤ 20 % magnitude of cariogram sector ' chance to avoid new cavities ' were enrolled . The program comprised of following components i.e. caries risk assessment , customized preventive interventions ( Motivational interviewing and counseling , oral prophylaxis , fluoride varnish , fissure sealants ) and restorative procedures . The recall intervals were scheduled on the basis of caries risk i.e. every 1 month ( ≤ 40 % chance to avoid new cavities ) and 3 months ( ≥ 41 % chance to avoid new cavities ) . The primary outcome measure was ' new carious lesions ' at 12 months following achievement of ' termination levels ' i.e. ≥ 41 % magnitude of ' chance to avoid new cavities . ' The secondary outcome measures were changes in cariogram parameters at termination and duration needed to achieve termination levels . RESULTS The program showed 97 % success rate as 3/100 subjects developed new carious lesions at 12 months follow up . Highly significant ( p<0.001 ) favorable shift was achieved in cariogram parameters at termination . Termination levels were achieved in 2.71 ± 4.854 months . CONCLUSIONS The present CAMBRA based program with customized intervention and recall schedules showed favorable results Background Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases . Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting . The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting . Methods 300 smokers attending dental or general health care were r and omly assigned to two arms and referred to the local dental clinic for smoking cessation support . One arm received support with low intensity treatment ( LIT ) , whereas the other group was assigned to high intensity treatment ( HIT ) support . The main outcome measures included self-reported point prevalence and continuous abstinence ( ≥ 183 days ) at the 12-month follow-up . Results Follow-up question naires were returned from 86 % of the participants . People in the HIT-arm were twice as likely to report continuous abstinence compared with the LIT-arm ( 18 % vs. 9 % , p = 0.02 ) . There was a difference ( not significant ) between the arms in point prevalence abstinence in favour of the HIT- protocol ( 23 % vs. 16 % ) . However , point prevalence cessation rates in the LIT-arm reporting additional support were relatively high ( 23 % ) compared with available data assessing abstinence in smokers trying to quit without professional support . ConclusionS creening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden . The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option , but should be integrated with other forms of available support in the community . The more extensive and expensive HIT- protocol should be offered to those who are unable to quit with the LIT approach in combination with other support . Trial Registration Trial registration number : PURPOSE To report the 4-year clinical performance of  posterior resin-based composite restorations placed using the total-etch technique . MATERIAL S AND METHODS Over a period of 1 year , 726 restorations ( 248 molars , 478 premolars ; 260 Class I , 466 Class II ; 540 replacements , 186 primary decay ) were placed on conservative preparations , using the incremental placement technique in a clinical environment . Baseline data were collected , and the restorations were evaluated after 4 years . Z100 and Scotchbond Multi- Purpose ( SBMP ) ( 3 M Dental Products , St. Paul , Minnesota ) were used as the restorative system . The criteria evaluated were color match , marginal adaptation , anatomic form , cavosurface marginal discoloration , axial contour , interproximal contact , secondary caries , postoperative sensitivity , and tooth vitality . RESULTS At baseline , 24 % of the teeth restored presented postoperative sensitivity ; 86 % of the sensitive teeth were from the replacement group . At 4 years , all teeth were vital to cold test . Eighteen restorations ( 2.5 % ) presented clinical ly detectable marginal fracture . The shade was acceptable in all restorations . Cavosurface marginal discoloration was observed in 47 restorations ( 6.5 % bravo scores ) . Axial contour , interproximal contact , and marginal adaptation received 100 % alfa scores . No secondary caries was diagnosed in any of the teeth examined . None of the examined restorations required replacement . CLINICAL SIGNIFICANCE Under controlled clinical conditions , posterior resin-based composite restorations placed with the total-etch technique and restorative Z100/SBMP have the potential to present a high success rate at 4 years . None of the examined restorations required replacement , and there was no clinical ly detectable wear in any of the restorations . Simultaneous etching of enamel and dentin followed by the application of a resin adhesive can be considered an adequate modality of pulp protection in nonexposed tooth preparations Pain during invasive treatment of dental caries is a common phenomenon , if no local analgesia has been used before cavity preparation . Atraumatic restorative technique ( ART ) is a suggested procedure which is at least less traumatic for the patient . Although the ART approach has been received well by both children and adults who belong to population groups hardly ever exposed to regular oral health care , it has not yet been proven that this particular procedure really causes less pain , compared to more conventional techniques with rotating instruments . In the present study , pain was reported in connection with tooth restoration in 19.3 percent of the cases , when the ART technique was used , which is significantly less than with a conventional restorative technique ( 35.7 percent ) . Finally the results show a clear relationship in the pain reports between the first and the following treatments in both ART and the conventional technique groups BACKGROUND The high-viscosity consistency of glass ionomer cement ( GIC ) may lead to its incorrect adaptation into the cavity and therefore to restoration failure . AIM To compare two different insertion techniques for GIC in approximal atraumatic restorative treatment ( ART ) restorations and two different surface protection material s. DESIGN Approximal caries lesion in primary molars from 208 schoolchildren was r and omly assigned into four groups : G1 , conventional GIC insertion protected with petroleum jelly ( PJ ) ; G2 , bilayer technique protected with PJ ; G3 conventional GIC insertion protected with nano-filled particles coating for GIC ( NPC ) ; G4 , bilayer technique protected with NPC . Restorations were evaluated after 1 , 6 , 12 , 18 , 24 , and 36 months . Kaplan-Meier survival analysis and log-rank test were performed . Cox regression analysis ( α = 5 % ) was used to verify the influence of clinical factors . RESULTS Restoration survival was 52.8 % . Log-rank test indicated a better survival of the bilayer technique restorations , compared to conventional restorations ( P = 0.005 ) , whereas the coated conventional restorations presented higher survival than the uncoated ones ( P = 0.035 ) . Cox regression analysis showed no influence of any clinical tested variables . CONCLUSION The survival rate of the approximal ART restorations is positively influenced by the bilayer technique , and the application of nano-filled coating increases the longevity of the conventional approximal ART restorations PURPOSE This study aim ed to determine whether feeding back patient-reported outcomes ( PROs ) to providers and families of children with advanced cancer improves symptom distress and health-related quality of life ( HRQoL ) . PATIENTS AND METHODS This study was a parallel , multicentered pilot r and omized controlled trial . At most once per week , children age ≥ 2 years old with advanced cancer or their parent completed the  computer-based Pediatric Quality of Life and Evaluation of Symptoms Technology ( PediQUEST ) survey consisting of age- and respondent-adapted versions of the Memorial Symptom Assessment Scale ( MSAS ) , Pediatric Quality of Life Inventory 4.0 Generic Core Scales ( PedsQL4.0 ) , and an  overall Sickness question  . In the intervention group ( n = 51 ) , oncologists and families received printed reports summarizing PROs ; e-mails were sent to oncologists and subspecialists when predetermined scores were exceeded . No feedback was provided in the control  group ( n = 53 ) . Primary outcomes included linear trends of MSAS , PedsQL4.0 total and subscale scores , and Sickness scores during 20 weeks of follow-up , along with child , parent , and provider satisfaction with PediQUEST feedback . RESULTS Feedback did not significantly affect average MSAS , PedsQL4.0 , or Sickness score trends . Post hoc subgroup analyses among children age ≥ 8 years who survived 20 weeks showed that feedback improved PedsQL4.0 emotional ( + 8.1 ; 95 % CI , 1.8 to 14.4 ) and Sickness ( -8.2 ; 95 % CI , -14.2 to -2.2 ) scores . PediQUEST reports were valued by children , parents , and providers and contributed at least sometimes to physician initiation of a psychosocial consult ( 56 % ) . CONCLUSION Although routine feedback of PROs did not significantly affect the child 's symptoms or HRQoL , changes were in expected directions and improvements observed in emotional HRQoL through exploratory analyses were encouraging . Importantly , children , parents , and providers value PRO feedback Abstract Restorations made of a combination of resin modified glass ionomer cement ( RMGIC ) and composite resin ( CR ) – open s and wich fillings – have been recommended for use in proximal boxes of molar cavities . The aim of this study was to compare the clinical behaviour over time of RMGIC/CR s and wich restorations versus CR restorations in Class II molar cavities . During a period of 2 years , a total of 220 restorations were placed in 118 patients by one operator ( VV ) . A r and om block allocation was used to allocate cavities to one of the two restorative techniques . Bitewing radiographs and photographs were taken at baseline and at annual recall appointments . At present , a total of 210 restorations have been evaluated after 1 year and 141 restorations after 2 years . All restorations were evaluated using a modification of USPHS criteria . A total of three RMGIC/CR and two CR restorations ( 2.8 % ) were rated as failures caused by endodontic complications or major fractures . Twenty-eight teeth were reported to have postoperative sensitivity at the baseline evaluation 1 week following placement . Nine RMGIC/CR ( 8.5 % ) and four CR ( 4.9 % ) restorations with minor fractures were rated Charlie but were still acceptable . Bitewing radiographs revealed progression of carious lesions in proximal surfaces of originally intact or restored teeth adjacent to five ( 5.9 % ) RMGIC/CR restorations and eight ( 10.9 % ) CR restorations . No statistically significant differences between the two types of restoration were observed with respect to marginal adaptation , discoloration and caries progression . However , a higher number of large CR fillings exhibited postoperative sensitivity at baseline compared to moderate CR or extensive and moderate RMGIC/CR restorations BACKGROUND Immediate implant placement into fresh extraction sockets is generally considered a reliable procedure that offers several clinical advantages . PURPOSE The primary aim of this study was to evaluate and compare the overall clinical outcomes of immediate and delayed restoration procedures for  implants placed in fresh extraction sockets by means of a flapless technique and resorbable membrane stabilizing a xenograft . Total costs and operating times were also compared . MATERIAL S AND METHODS In this prospect i ve cohort study , changes of marginal bone level , facial soft tissue ( ΔFST ) , and width of keratinized gingiva ( ΔWKG ) , in addition to the papilla index , underwent a pairwise comparison ; correlations with pristine buccal bone thickness were also investigated . RESULTS Although similar results were recorded for the two procedures , with a bone loss of -1.0 ± 0.5 mm and -0.9 ± 0.7 mm , respectively , for immediate and delayed restoration  , negative remodeling in the delayed restoration procedure was seen to occur from 4 to 12 months after implant placement . No significant differences were recorded between the two procedures in terms of ΔFST and ΔWKG . A loss of the papillary soft tissues before restoration , followed by a reestablishment after restoration , seemed to be verified for the delayed group , for which the papilla index went from the minimum of 0 at 4 months to a value of 2 at 24 months . Moreover , the immediate restoration procedure seemed to be more promising in terms of healing times and costs . CONCLUSION Immediate restoration of implants installed in fresh extraction sockets was at least as effective and safe as delayed restoration BACKGROUND The authors conducted a study to survey the perspectives of dentists regarding the 2010 American Dental Association ( ADA ) recommendation to seal non-cavitated carious lesions ( NCCLs ) in children and young adults . METHODS The authors mailed a question naire to a r and omly selected sample of 2,400 general dentists ( GDs ) and pediatric dentists ( PDs ) in the United States . The sample was chosen by the ADA 's Survey Center . The question naire included two photographs of NCCLs ( permanent first molar and premolar ) in a 12-year-old child . Respondents were provided with radiographic findings and asked to choose from several management options . RESULTS In the absence of radiographic evidence of caries , 37.4 percent and 42.3 percent of GDs and PDs , respectively , indicated that they would seal the NCCL in the molar . For the premolar , a significantly lower percentage of GDs than of PDs indicated that they would seal the NCCL . With radiographic evidence of caries in dentin , less than 4 percent of all dentists surveyed indicated that they would seal the NCCLs , and more than 90 percent indicated that they would remove the caries and place restorations . Less than 40 percent of dentists indicated that they sealed NCCLs in their practice . CONCLUSIONS The U.S. dentists surveyed have not adopted evidence -based clinical recommendations regarding the sealing of NCCLs . Practice Implication s. New educational and dissemination programs should be developed regarding these evidence -based caries management approaches Background : The evidence stemming from trials on restorative material s is shaped not only by trial findings , but also trial design and validity . We aim ed to evaluate both aspects in r and omized controlled dental restorative trials published from 2005–2015 . Methods : Using systematic review methodology , we retrieved trials comparing  restorative or adhesive dental material s. Two authors independently assessed design , risk of bias , registration status , and findings of trials . Descriptive and regression analyses were performed . Results : 114 studies on 15,321 restorations placed mainly in permanent teeth of 5232 patients were included . Per trial , the median number of patients was 37 ( 25th/75th percentiles : 30/51 ) . Follow-up was 24 ( 20/48 ) months . Seventeen percent of trials reported on sample size calculations , 2 % had been registered . Most trials ( 90 % ) used US Public Health Service ( USPHS ) criteria , and had a high risk of bias . More recent trials were more likely to have been registered , to have reported on sample size calculations , to be of low risk of bias , and to use other than USPHS- criteria . Twenty-three percent of trials yielded significant differences between groups . The likelihood of such differences was significantly increased in older studies , studies with potential reporting bias , published in journals with high impact factor ( > 2 ) , longer follow-up periods , and not using USPHS- criteria . Conclusions : The majority of dental restorative trials published from 2005–2015 had limited validity . Risk of bias decreased in more recent trials . Future trials should aim for high validity , be registered , and use defined and appropriate sample sizes , follow-up periods , and outcome measures
Regarding pain , there was a trend for treatments without rotary instruments and local anesthesia to be less frequently reported as painful .
No statistical difference was found intragroup nor among treatments for OHRQoL. CONCLUSIONS Anxiety and pain are directly related with more invasive restorative treatments .
On the other h and , quality of life is not improved regardless of the restorative technique used .
BACKGROUND Despite the increasing number of studies evaluating patient reported outcome measures ( PROs ) , there is no clearness regarding which restorative treatment offers major benefits based on the pediatric patient perspective .
AIM To compare different restorative techniques in pediatric dentistry regarding patient-reported outcomes .