Dental News September 2022 by Dental News

SEMI-SPLIT Bulk Placement Technique

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ARTICLES 8

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Semi-Split Bulk Placement Technique For Overcoming The Loss of Adaptation At The Pulpal Floor of Large Occlusal Bulk-Fill Resin Composite Restorations

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Semi-Split Bulk Placement Technique For Overcoming The Loss of Adaptation At The Pulpal Floor of Large Occlusal Bulk-Fill Resin Composite Restorations Khamis A Hassan*, BDS, MSD, Doctorate, FADI *1, Professor of Operative Dentistry & Senior Clinical Consultant, Global Dental Centre, Vancouver, Canada

Keywords

Salwa E Khier,

Abstract

BDS, MSD, MSc, PhD, FADM 2 Professor of Dental Biomaterials & Senior Research Consultant, Global Dental Centre, Vancouver, Canada

When composite resin hardens by light curing, it shrinks and undergoes deformation which occurs in one region more than other regions within the composite bulk. This behavior is mainly related to variations in bonding to enamel and dentin of surrounding cavity walls. Bonding to surrounding cavity walls creates restrained shrinkage which develops tensile stresses within the composite bulk. The developed tensile stresses act against the tensile strength of the composite resin, and may cause cracks in enamel or composite, as well as residual strain at the adhesive interface, forming marginal and internal gaps. Using the bulk filling technique, a bulk of 4mm increment of bulk-fill resin composite is placed in a deep Class I cavity. Within the composite bulk, shrinkage displacement occurs axially in the top region more than in the bottom region, resulting in debonding and gap formation at the pulpal floor. This gap is associated with persistent postoperative

*Corresponding author Dr. Khamis A Hassan, Professor of Operative Dentistry & Senior Clinical Consultant, Global Dental Centre, Vancouver, Canada. E-mail: globaldental@ shaw.ca

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Bulk placement, bulk-fill resin composite, debonding, diagonal gap, displacement, polymerization shrinkage, postoperative sensitivity, pulpal floor gap, semi-split bulk, stress reduction.

sensitivity and consequent pain. The semi-split bulk filling technique is a modification of the bulk filling technique used for placing bulk-fill resin composites in large occlusal cavities. It aims at diminishing the shrinkage stresses within the composite bulk and minimizing the incidence of pulpal floor gap formation and the consequent postoperative sensitivity and pain.

Introduction In the past decade, bulk-fill resin composites have been introduced in the dental market as a new concept for restoring posterior teeth. 1-3 They became popular among dentists who prefer simpler clinical procedures with reduced working time. 4,5 Bulk-fill resin composites were claimed by manufacturers to have a depth of cure of up to 4- 5mm. The increased depth of cure is achieved by using more efficient photoinitiators 6 , or by using fillers and monomers with similar refractive index. 7 Another group of bulk-fill resin composite was claimed by manufacturers to have a reduced shrinkage stress, as compared to that of the conventional composites placed incrementally. The stress reduction is achieved by additions in the organic matrix of low-shrink monomers, higher molecular weight monomers, or stress-relieving additives. 1 Quarter IV

Semi-Split Bulk Placement Technique For Overcoming The Loss of Adaptation At The Pulpal Floor of Large Occlusal Bulk-Fill Resin Composite Restorations

Polymerization shrinkage is an undesired property of dental composites which causes a discrepancy in dimensions when the restoration hardens. This affects the interface and results in residual strains at the adhesive interface, or marginal/internal gap formation. 5,6 The polymerization shrinkage stress is a complex phenomenon as it depends on several factors. Among which are the boundary conditions, the amount of material, and the polymerization reaction. They all play essential roles in stress development and/or transmission to tooth structures. 8,9 Within a large occlusal composite restoration placed as in bulk of 4mm increment using the bulk filling technique, a greater shrinkage strain or displacement takes place in the top composite region, where it undergoes more axial displacement than the bottom composite. 7,10 Additionally, the top composite displacement exerts an upward pull on the bottom composite region resulting in its debonding from the pulpal floor, and formation of pulpal floor gap beneath the composite restoration. 5,6,11 Several studies found that bulk-fill resin insertion technique resulted in higher rates of postoperative sensitivity compared to conventional resins. This sensitivity was attributed to the formation of pulpal floor gap in bulk-fill resin composite occlusal restorations. The dentinal fluid in the gap undergoes contraction or expansion with cold or hot stimuli, resulting in sudden movement of the fluid in dentinal tubules and causes pain. 1,12-14 The objective of this paper is to present the semisplit bulk filling technique, as a modification of the bulk filling technique which is used for placing bulk-fill resin composites in large occlusal cavities. This technique aims to reduce the shrinkage stresses generated due to the polymerization of bulk-fill resin composites, as well as to minimize the incidence of gap formation at pulpal floor, and consequent postoperative sensitivity and pain.

The presented technique In the semi-split bulk filling technique, a diagonal gap (1.5mm wide) is created vertically into the 4mm composite bulk inserted in a large occlusal bonded cavity. This gap extends for a depth of 2mm, prior to light polymerization, using a Tefloncoated plastic filling instrument in push stroke.

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This gap splits the top composite 2mm region into two equal segments. The segmented composite bulk is then light cured. The diagonal gap is then filled with the same bulk-fill resin composite and light cured.

Discussion The shrinkage stresses generated in bulk-fill resin composites exert tension on the bonding adhesive and surrounding tooth structure during the polymerization process. If this tension exceeds the adhesive bond, or the strength of either the composite or tooth, it can cause interfacial debonding, resulting in internal/marginal gaps. Comparing the incremental vs. the bulk filling techniques, the bulk filling technique was reported to produce more interfacial debonding. 15-17 In the bulk filling technique, the shrinkage stress occurs during light polymerization within a bulk of 4mm increment of bulk-fill resin composite inserted into a large occlusal cavity. (Fig. 1- A) The magnitude and direction of shrinkage stress varies between the top and bottom composite regions. 7,10 The polymerizing bulk-fill resin composites undergo shrinkage displacement in both axial and lateral dimensions, with less displacement occurring laterally than axially. The axial displacement in the top 2mm composite region occurs in downward direction, whereas it takes place in upward direction in the bottom 2mm composite region. 18,19 Additionally, the top composite displacement exerts an upward pull on the bottom composite region strong enough to result in its debonding from the pulpal floor, and formation of pulpal floor gap beneath the composite restoration. 2022 (Fig. 1-B) The strength of the upward pulling is augmented by bonding the composite in the top region to enamel and dentin of surrounding cavity walls, as compared to bonding to dentin only in the bottom region. Moreover, the upward pull is boosted by the position of the light tip closer to the occlusal outer area of the cavity, leading to its faster polymerization than that at the cavity floor, 22,23 and subsequently resulting in immobilization of the resin matrix in the top composite sooner than in the bottom composite. 24-26 It is noteworthy to mention that scattered areas of bonding and gaps could coexist within the same restoration. 27 It is well understood that bulk-fill resin composites Quarter IV

Semi-Split Bulk Placement Technique For Overcoming The Loss of Adaptation At The Pulpal Floor of Large Occlusal Bulk-Fill Resin Composite Restorations

were introduced in the dental market for their easy placement in cavity preparations as one piece using the bulk filling technique which saves much of the chairside time. However, this technique is reported to cause more axial than lateral shrinkage displacement in the top composite region and to generate more axial stresses which result in debonding at the pulpal floor and gap formation, leading to persistent postoperative sensitivity and pain. 1,5-7,10-14 As a solution, the semi-split bulk filling technique is presented for modifying the bulk filling technique by using an additional step which needs a little extra chairside time. This technique is based on creating a diagonal gap into a bulk of 4mm increment of bulk-fill resin composite, prior to light curing. This gap is 1.5mm wide and extends for a depth of 2mm in the top composite region splitting it into two equal segments. (Fig.2-A) The rationale for the presented technique is that the created diagonal gap would enable, through its adhesion-free surfaces, each composite segment to undergo more lateral than axial shrinkage displacement, in contrast to the more axial than lateral shrinkage displacement which occurs in composite bulk when using bulk fill technique. The outward displacement is expected to exert a lateral pull on each composite segment in opposite direction away from the gap center and towards the bonded cavity walls. The outward displacement of each segment in opposite direction is anticipated to greatly relieve the polymerization shrinkage stress and preserve the marginal and internal gap formation in cavity walls, resulting in volume reduction of each segment and diagonal gap widening. (Fig.2-B) Furthermore, the created diagonal gap is expected to disable the less occurring axial displacement from gaining strength through bonding to enamel and dentin in the top composite region and exerting upward pull on the bottom composite region, preventing/ minimizing its debonding away from the pulpal wall and forming a pulpal gap, in contrast to that which occurs in composite bulk when using bulk fill technique. (Fig.3-A) Following the light curing of the segmented composite bulk, the diagonal gap is filled with the same bulk-fill resin composite and light cured, (Fig. 3-B). Considering the small composite volume used for filling the diagonal gap, the generating shrinkage stress is judged to be unable to cause

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deleterious effects on tooth enamel, composite resin, and/or adhesive interfaces. There are variations in the number of diagonal gaps and depth between the presented technique and the original split-increment technique. In the presented technique, the gap extends halfway for a depth of 2mm into the 4mm thick composite bulk, whereas in the original split-increment technique 28, it extends into the full thickness of each of the 2mm increments. (Fig. 4) In the presented technique, the reason for not extending the gap into the full depth of 4mm thick increment is that the diagonal splitting created in the top composite minimizes its axial displacement and greatly decreases the likelihood of exerting an upward pull on the bottom composite. As for the number of diagonal gaps, only one diagonal gap is created into the single composite bulk in the presented technique, whereas two gaps are created in the original technique (Fig. 4). The creation of two diagonal gaps in the presented technique is considered unnecessary because of the generation of lower polymerization shrinkage stress in most bulkfill composites, according to manufacturers, as compared to that developed in the conventional resin composites used in the original technique. Several studies 15,29,30 reported that bulkfill resin composites resulted in higher rates of postoperative sensitivity as compared to conventional composite resins and was attributed to pulpal gap formation beneath the composite restoration. The pulpal gap formation is attributed to postoperative sensitivity which fills with dentinal fluid. This fluid undergoes contraction or expansion by cold or hot stimuli, resulting in its sudden movement in the dentinal tubules which makes postoperative sensitivity persistent and causes pain. 29 It has also been reported that bulk-fill flowable composites also resulted in gap formation over the internal walls of the restored cavities. 30 The restorative techniques, along with some other factors were reported to affect the shrinkage stress generation, debonding, and postoperative tooth sensitivity, as well as microleakage, and secondary caries. 1 The original split-increment technique, as compared to the oblique layering technique, significantly minimized microleakage in Class V silorane-based resin composite restorations. 31 Also, it had the least microleakage Quarter IV

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Semi-Split Bulk Placement Technique For Overcoming The Loss of Adaptation At The Pulpal Floor of Large Occlusal Bulk-Fill Resin Composite Restorations

Figure 1: The bulk filling technique for placing a single composite bulk. (a) A large occlusal bulk fill resin composite restoration. (b) A sectional view, illustrating more axial than lateral shrinkage displacement and more upward axial displacement along with gap formation at pulpal floor.

Figure 2: The semi-split bulk filling technique using a single composite bulk; (a) Prior to light curing, a 2 mm deep diagonal gap created in composite bulk; (b) Upon light curing, each composite segment undergoes lateral shrinkage displacement from the gap center outwards, resulting in volume reduction of each segment and diagonal gap widening.

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Semi-Split Bulk Placement Technique For Overcoming The Loss of Adaptation At The Pulpal Floor of Large Occlusal Bulk-Fill Resin Composite Restorations

Figure 3: The semi-split bulk filling technique; (a) A sectional view, illustrating more lateral than axial shrinkage displacement of the top composite, resulting in no gap formation at pulpal floor; (b) Diagonal gap filled with the same composite, and light cured.

Figure 4: The original split-increment technique using two increments of conventional composite resin; (a) Prior to light curing, two diagonal gaps are created in first composite increment, and light cured; (b) Diagonal gaps filled using the same composite resin, and light cured; (c and d) Diagonal gaps in the second increment created and filled, as in the first increment.

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Semi-Split Bulk Placement Technique For Overcoming The Loss of Adaptation At The Pulpal Floor of Large Occlusal Bulk-Fill Resin Composite Restorations

at occlusal and gingival margins in Class II composite restorations, followed by centripetal and oblique techniques. 32 Moreover, the original technique exhibited lower degrees of microleakage at the occlusal and gingival margins of Class V, as compared to the oblique and occlusogingival incremental techniques. 33 Furthermore, the split-increment technique and the group with fiber inserts in gingival increment technique showed significantly lower microleakage at gingival margins in Class II restored with a nanocomposite resin when compared to bulk insertion, oblique, centripetal, and flowable composite techniques. 34 Based on the results of the research studies conducted on the original split-increment technique, it is expected that the presented semi-split bulk filling technique would be able to minimize the shrinkage stress and decrease the incidence of pulpal gap formation beneath the large occlusal bulk-fill resin composite restorations. A research study is currently underway to investigate the effect the presented technique on reducing shrinkage stresses and pulpal gap formation in large occlusal bulk-fill resin composite restorations.

Summary The use of the presented semi-split bulk filling technique for restoring large occlusal bulk-fill resin composite restorations can minimize shrinkage stress and prevent or decrease the incidence of pulpal gap formation beneath the restoration. This would consequently result in less occurrence of persistent postoperative sensitivity and pain.

References 1. Al Sunbul H, Silikas N, Watts DC. (2016) Polymerization shrinkage kinetics and shrinkagestress in dental resin-composites. Dent Mater. 32(8): 998-1006. 2. Engelhardt F, Hahnel S, Preis V, et al. (2016) Comparison of flowable bulk-fill and flowable resin-based composites: an in vitro analysis. Clin Oral Invest. 20(8): 2123–2130. 3. Ilie N, Schoner C, Bucher K, et al. (2014) An in-vitro assessment of the shear bond strength of bulk-fill resin composites to permanent and deciduous teeth. J Dent.

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42(7): 850–855. 4. Tauböck TT, Jäger F, Attin T. (2019) Polymerization shrinkage and shrinkage force kinetics of highand low-viscosity dimethacrylate- and ormocer based bulk-fill resin composites. Odontology. 107(1): 103-110 5. Gonçalves F, Campos LM, RodriguesJúnior EC, et al. (2018) A comparative study of bulk- fill composites: degree of conversion, post-gel shrinkage and cytotoxicity. Braz Oral Res. 32: e17-e26. 6. Menees TS, Lin CP, Kojic DD, et al. (2015) Depth of cure of bulk fill composites with monowave and polywave curing lights. Am J Dent. 28(6): 357-361. 7. Boaro LCC, Lopes DP, de Souza ASC, et al. (2019) Clinical performance and chemicalphysical properties of bulk fill composites resin —a systematic review and metaanalysis. Dent Mater. 35(10): e249–e264. 8. Stansbury JW, Trujillo-Lemon M, Lu H, Ding X, et al. (2005) Conversion-dependent shrinkage stress and strain in dental resins and composites. Dent Mater. 21(1): 56–67. 9. Watts DC. (2005) Reaction kinetics and mechanics in photo-polymerised networks. Dent Mater. 21(1): 27–35 10. Kim HJ, Park SH. (2014) Measurement of the internal adaptation of resin composites using micro-CT and its correlation with polymerization shrinkage. Oper Dent. 39(2): e57– e70. 11. Souza-Junior EJ, de Souza-Regis MR, Alonso RC, et al. (2011) Effect of the curing method and composite volume on marginal and internal adaptation of composite restoratives. Oper Dent. 36: 231–238. 12. Manhart J., Chen H.-Y., Hickel R. (2010) Clinical evaluation of the posterior composite Quixfil in class I and II cavities: 4-year followup of a randomized controlled trial. J Adhes Dent. 12(3):237-243. 13. Correia A., Jurema A., Andrade M.R., et al. (2020) Clinical evaluation of noncarious cervical lesions of different extensions restored with bulk-fill or conventional resin composite: preliminary results of a randomized clinical Quarter IV

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Semi-Split Bulk Placement Technique For Overcoming The Loss of Adaptation At The Pulpal Floor of Large Occlusal Bulk-Fill Resin Composite Restorations

trial. Oper Dent. 45(1): E11–20. 14. Canali G.D., Ignácio S.A., Rached R.N., et al. (2019) One-year clinical evaluation of bulk- fill flowable vs. regular nanofilled composite in non-carious cervical lesions. Clin Oral Investig. 23(2):889–897. 15. Park J, Chang J, Ferracane J, et al. (2008) How should composite be layered to reduce shrinkage stress: Incremental or bulk filling? Dent Mater. 24(11):1501–1505. 16. AbbasG, Fleming G, Harrington E, et al. (2003) Cuspal movement and microleakage in premolar teeth restored with a packable composite cured in bulk or in increments. J Dent Res. 31(6): 437-444. 17. Li H, Li J, Yun X, Liu X, et al. (2011) Non-destructive examination of interfacial debonding using acoustic emission. Dent Mater. 27(10):964-971. 18. Novaes JB Jr, Talma E, Las Casas EB, et al. (2018) Can pulpal floor debonding be detected from occlusal surface displacement in composite restorations? Dent Mater. 34(1): 161- 169. 19. Sun J, Eidelman N, Lin-Gibson S. (2009) 3D mapping of polymerization shrinkage using X- ray micro-computed tomography to predict microleakage. Dent Mater. 25(3): 314-320. 20. Chiang YC, Rosch P, Dabanoglu A, et al. (2010) Polymerization composite shrinkage evaluation with 3D deformation analysis from microCT images. Dent Mater. 26(3): 223-c231. 21. Cho E, Sadr A, Inai N, et al. (2011) Evaluation of resin composite polymerization by three- dimensional micro-CT imaging and nanoindentation. Dent Mater. 27(11): 10701078. 22. Papadogiannis D, Kakaboura A, Palaghias G, et al (2009). Setting characteristics and cavity adaptation of low-shrinking resin composites. Dent Mater. 25(12): 1509-1516. 23. Sato T, Miyazaki M, Rikuta A, et al. (2004) Application of the laser speckle-correlation method for determining the shrinkage vector of a light-cured resin. Dent Mater J. 23(3): 284-290. 24. Shortall AC, Palin WM, Burtscher P. (2008) Refractive index mismatch and monomer 20

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reactivity influence composite curing depth. J Dent Res. 87(1): 84-88. 25. Van Ende A, Van de Casteele E, Depypere M, et al. (2015) 3D volumetric displacement and strain analysis of composite polymerization. Dent Mater. 31(4): 453-461. 26. Van Meerbeek B, Peumans M, Poitevin A, et al. (2010) Relationship between bondstrength tests and clinical outcomes. Dent Mater. 26(2): e100-e121. 27. Bortolotto T, Bahillo J, Olivier Richoz O, et al. (2015) Failure analysis of adhesive restorations with SEM and OCT: from marginal gaps to restoration loss. Clin Oral Invest. 19(8):1881-1890. 28. Hassan K, Khier S. (2005) Splitincrement horizontal layering: A simplified placement technique for direct posterior resin restorations. Gen Dent. 53(6): 406409. 29. Brännström M. (1984) Communication between the oral cavity and the dental pulp associated with restorative treatment. Oper Dent. 9(2): 57-68. 30. Furness A, Tadros MY, Looney SW, et al. (2014) Effect of bulk/incremental fill on internal gap formation of bulk-fill composites. J Dent. 42(4): 439-449. 31. Usha HL, Kumari A, Mehta D, et al. (2011) Comparing microleakage and layering methods of silorane-based resin composite in Class V cavities using confocal microscopy: An in vitro study. J Conserv Dent. 14(2): 164168. 32. Nadig RR, Bugalia A, Usha G, et al. (2011) Effect of four different placement techniques on marginal microleakage in class ii restorations: an in vitro study. World J Dent. 2(2): 111-116. 33. Khier S, Hassan K. (2011) Efficacy of composite restorative techniques in marginal sealing of extended class v cavities. International Scholarly Research Network. (ISRN) Dentistry. 2011:80197. 34. Bugalia A, Yujvender, Bramta N, et al. (2015) Effect of placement techniques, flowable composite, liner and fibre inserts on marginal microleakage of Class II composite restorations. J Evidence Based Med & Healthcare. 2(11): 4779-4787. Quarter IV

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3Moscow, Moscow, Russia; Russia; University of Hong Kong, 34 Hospital Road, vs@mail.ru(S.V.L.); (S.V.L.); Hong Kong vs@mail.ru SAR, China .ru (P.A.B.); ru (P.A.B.);

- Department of Restorative Dentistry and Prosthodontics, School of Dentistry, The University of evalence and risk of Center evalence risk of Texasand Health Science at Houston, TX, United States GERD) compared compared to to GERD)

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Abstract Objective To investigate the effectiveness of glass ionomer cement (GIC) restorations on preventing new caries in primary or permanent dentitions compared with other types of restorations. Data Randomized controlled clinical trials evaluating caries experience increment or caries incidence in patients with GIC restorations, including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations, were included. Sources A systematic search of publications in English was conducted in PubMed/ Medline, Web of Science, Cochrane, and Scopus databases. Study selection/results This review included 10 studies reporting caries preventive effect of GIC restorations and selected 5 studies for meta-analysis. Patients with GIC restorations showed lower caries incidence compared with other restorations in primary and permanent dentition [RR=0.67, 95% CI:0.55–0.82, p < 0.0001]. Patients with CGIC restorations showed lower caries incidence compared with amalgam restorations [RR=0.57, 95% CI:0.43–0.76, p = 0.0001] and RMGIC restorations [RR=0.70, 95% CI:0.56–

0.87, p = 0.002], but no statistical difference with composite resin restorations [RR=0.73, 95% CI:0.51– 1.04, p = 0.08] in primary dentition. Patients with RMGIC restorations showed no statistical differences of caries incidence compared with composite resin restorations in primary and permanent dentition [RR=0.83, 95% CI:0.56–1.22, p = 0.33]. Conclusions GIC restorations presented a better preventive effect on new caries than other restorations did in primary and permanent dentitions. CGIC restorations presented a better caries preventive effect on new caries than RMGIC and amalgam restorations in primary dentitions did. RMGIC restorations showed similar preventing effect on new caries with composite resin restorations in primary and permanent dentitions. Clinical significance This review affirmed the potential of GIC in preventing new caries development in the dentition. Keywords Glass ionomer cement, Resinmodified glass ionomer cement, Caries prevention, Fluoride, Systematic review

Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

1. Introduction Dental caries, or tooth decay, is one of the most common chronic diseases worldwide [1]. According to the World Health Organization’s (WHO) report, dental caries affects 60–90% of schoolchildren globally and almost all adults [2] . Dental caries can occur throughout life in both primary and permanent dentitions. It can damage the tooth crown and expose the root surfaces in a later lifetime [3]. Untreated caries can cause pain, develop into apical periodontitis, form abscesses and even infection [4]. A survey reported that pain and discomfort due to untreated dental caries were found in 18% of 5–6-year-olds and 64% in older adults [5]. Different types of direct restorative materials are used to restore teeth affected by dental caries. Glass ionomer cement (GIC), including conventional glass ionomer cement (CGIC) and resin-modified glass ionomer cement (RMGIC), are commonly used as dental restorative materials [6]. The Government Chemist Laboratory (London, UK) developed CGIC in 1969. They are used as restorative materials, liners and bases, fissure sealants and bonding agents [7]. CGIC has several advantages, including adhesion to tooth structures, biocompatibility, long-lasting fluoride release and simple clinical operation [6,8] . However, CGIC also has disadvantages, such as moisture sensitivity, low mechanical strength and compromised aesthetics [9]. To overcome the problems traditionally associated with the CGIC materials [10], Mitra introduced RMGIC as evolution of CGIC in 1989 [11]. RMGIC are used for numerous specific applications in clinical dentistry, notably as liners/bases, luting agents and restorative materials [12]. The RMGIC maintain the clinical advantages of the CGIC, such as the fluoride release and simplicity in clinical operation. They are more aesthetic than CGIC [13]. Based on laboratory data regarding sustained fluoride release, CGIC and RMGIC have been associated with caries prevention. An in vitro study showed that CGIC or RMGIC restorations increased the fluoride uptake in adjacent tooth structure [14]. Previous in vitro studies also showed that interproximal caries-like lesions adjacent to CGIC restorations presented a higher degree of remineralisation compared with those

2 24

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of resin-based restorations [15]. Because the fluoride can diffuse through the saliva in the oral cavity, CGIC or RMGIC restorations may promote the remineralisation in the other teeth in the dentition [16]. Therefore, CGIC and RMGIC may prevent new caries formation in the dentition. Although in vitro studies have demonstrated the potential effect of GIC restorations on caries prevention, clinical evidence of the effect of GIC restorations, including CGIC or RMGIC restorations, in preventing new caries formation is limited. A systematic quantitative evaluation of the available evidence on the preventive effect of GIC restorations, including CGIC or RMGIC, on new caries formation has never been undertaken. Therefore, this review aimed to evaluate the preventive effect of GIC restorations, including CGIC or RMGIC restorations, on new caries compared with other types of dental restorations. 2. Methods 2.1. Research questions and protocols This review answered the research question of, ‘What is the effectiveness of glass ionomer cement (GIC), including conventional glass ionomer cement (CGIC) restorations and resin-modified glass ionomer cement (RMGIC) restorations, on preventing new caries formation in permanent and primary dentitions compared with other types of dental restorations?’. This systematic review was written following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Statement [17] . This systematic review and meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO Registration ID: 302,578). 2.2. Search strategy A comprehensive literature search was conducted on May 15, 2022, to identify the available studies evaluating the prevention of caries lesions in GIC restorations, with no limits of publication year. The literature search was conducted in four databases, including PubMed/ Medline, Web of Science, Cochrane and Scopus. The search strategy was developed as follows. 1 “demineralization” OR “tooth demineralization” “teeth demineralization” OR “caries” “carious” Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

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The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

OR “tooth decay” OR “teeth decay” OR “dental caries” OR “caries susceptibility” 2 “glass ionomer cement” OR “glass ionomer” OR “GIC” “glass polyalkenoate cement” OR “glass-ionomer cement” OR “ART” OR “atraumatic restorative procedure”. 3 “#1″ AND “#2″ Two independent reviewers (KXG & OYY) conducted the study selection. Both authors independently screened titles, compared findings and included full texts after deduplication. The third author (CHC) was consulted when there was disagreement. Studies with consensus being reached through discussion were included.

2.3. Eligibility criteria This review used participants, intervention, comparison, outcome and type of study (PICOT) to formulate questions in evidencebased practice. The inclusion criteria were developed based on PICOT strategy. The PICOT strategy for the inclusion criteria is summarized in Table 1.

Table 1. The PICOT (participants, intervention, comparison, outcome and type of study) strategy used for selection of publications in the review. The inclusion criteria of the studies were:

Participants

Studies with participants of all ages were included

Intervention

GIC restorations including CGIC or RMGIC restorations for caries treatment

Comparison

CGIC restorations compared with other types of dental restorations RMGIC restorations compared with other types of dental restorations

Outcome

Caries incidence Caries experience increment

Type of study

Randomized controlled clinical trial (RCT)

1 To be the randomized controlled clinical included. Caries experience increment refers trials. to DMFT/DMFS (decayed, missing, and filled teeth/surfaces in permanent teeth) increment 2 To investigate GIC for restorations or dmft/dmfs (decayed, missing, and filled application in patients. teeth/surfaces in primary teeth) increment. 3 To evaluate the caries incidence or caries experience increment. Caries incidence refers to the rate of new caries development in the adjacent teeth after the restoration. The development of secondary caries was not

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The exclusion criteria of the studies were: 1 To be the in vitro studies, animal studies, reviews, letters to the editor, case report/series and observational studies. Quarter IV

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The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

2 To investigate other types of restorations but did not include the GIC. 3 To investigate GIC for nonrestorative application in clinic (i.e., fissure and sealant, liners/bases or cement). 4 To output data that did not contain the caries incidence or caries experience increment. 2.4. Data extraction The reviewers collected the required information of the eligible studies. For each included study, the following data were systematically extracted from each paper: • Publication details: authors name, publication year and duration •Tooth characteristics: type of dentition and number of restorations for each material •Outcome information: assessment, outcome measure, and main findings All the data obtained from patients with GIC restorations were extracted to Group CGIC or RMGIC in this review, regardless of the original study design.

2.5. Assessment on the quality and risk of bias assessment of the studies The assessment of risk of bias to longitudinal trials assessment was performed according to bias assessment forms (Cochrane Handbook for Systematic Reviews of Interventions 5.4.1). The Cochrane ‘risk of bias’ instrument was used to assess the risk of bias. Three independent reviewers performed this evaluation. Disagreements between estimators were resolved through discussion until consensus was reached. The risk of bias was classified into three categories:

2.6. Data synthesis and analysis The participants’ caries experience increment in DMFT/DMFS and dmft/dmfs was based only on the first and last measurements. The DMFT/DMFS and dmft/dmfs increments were calculated by subtracting the results at baseline from the results at follow-up. Meta-analysis of the caries incidence after GIC restorations, including CGIC or RMGIC restorations, was carried out. The Review Manager 5.4.1 was used for conducting the meta-analysis. Heterogeneity was assessed via the I2 statistic on the level of α=0.10. If there was considerable or substantial heterogeneity (I2>50%), a random-effects mode was adopted; otherwise, a fixed-effects model was used. The results of the intervention effect were presented as risk ratio (RR) utilizing 95% confidence intervals (CI). All tests were 2-tailed, and p ≤ 0.05 was considered statistically significant.

3. Results 3.1. Search result and study selection A total of 5456 studies was retrieved from the four databases. After subtracting 2486 duplicated studies, 2970 potential studies were identified and screened for inclusion. After screening the titles and abstracts, 2616 studies were excluded. 354 studies were considered potentially relevant and were read for the full text. With the reviewers’ consensus, 10 studies that reported the new caries preventive effect of the GIC restorations were included for this review. Seven of the studies were on CGIC restorations while three were on RMGIC restorations. The details of search procedure are presented in a flowchart (Fig. 1).

(a) Low risk of bias: all domains were marked as ‘low risk’. (b) Moderate risk of bias: no domain was marked as ‘high risk’; one or more domains were coded as ‘unclear risk’. (c) High risk of bias: one or more domains were marked as ‘high risk’.

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Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

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The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

5,456 studies were retrieved in four databases • PubMed (Medline): 1,745 • Scopus: 1,599 • Cochrane: 994 • Web of Science: 1,118

2,486 duplicate studies were excluded 2,970 potential studies identified and screened for inclusion •

Step 1 - Titles and abstracts were reviewed

2,616 studies were excluded, including

studies not relevant (n=2,118) • reviews, case report or laboratory studies (n=273) • studies did not investigate GIC restorations (n=225)

354 studies were retrieved for full text evaluation •

Step 2 - Full-lenght articles were retrieved

344 studies were excluded, including

studies did not investigate caries preventinve effect (n=58) • studies on GIC sealants, liner, base or cement (n=62) • studies on preventive effect on secondary caries (n=224)

10 studies reported the new curies preventive effect of the GIC restorations

7 studies reported the new caries preventive effect of the CGIC restorations

3 studies reported the new caries preventive effect of the RMGIC restorations

3 studies were eligible for CGIC meta-analysis

2 studies were eligible for RMGIC meta-analysis

4 studies in GIC were eligible for meta-analysis Fig. 1. Flow diagram of the systematic review. GIC: glass ionomer cement (including CGIC and RMGIC); CGIC: conventional glass ionomer cement; RMGIC: resin-modified glass ionomer cement.

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The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

3.2. Study characteristics

restorations on 153 participants, aged from 4 to 15 years. The main characteristics of the studies included in the study are presented in Table 2.

3.2.1. Studies on CGIC restorations Seven included studies published between 1997 and 2020 investigated the preventive effect of the CGIC restorations on new caries. The included studies involved 2655 CGIC restorations, 2182 participants, aged from 2 to 74 years old. The average follow-up period of the included studies was 3.3 years. One study was performed in permanent dentition, published in 2003. The study involved 417 CGIC restorations in 81 participants [18] . Six studies were performed in primary dentition, published between 1997 and 2020. These studies involved 2238 CGIC restorations in 2101 participants, aged from 2 to 13 years [19], [20], [21],

Table 2. Characteristics of included randomized controlled clinical trials studies. CGIC: conventional glass ionomer cement; RMGIC: resin-modified glass ionomer cement. Main findings showed the results of the outcome measure for each study.

[22], [23], [24].

3.2.2. Studies on RMGIC restorations Three studies were included for the RMGIC restorations, published between 2000 and 2004 [25], [26], [27] . These studies investigated 328 RMGIC restorations in 271 participants, aged from 4 to 53 years. The average follow-up period of the included studies was 1.7 years. One study, published in 2000, had the outcome assessment in permanent dentition [27] . This study involved 114 RMGIC restorations and 106 composite resin restorations in 118 participants, aged from 4 to 53 years. Two studies, published in 2004, had the outcome assessment in primary dentition [25,26]. These studies investigated on 214 RMGIC restorations and 41 composite resin

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Dental News

Study

Duration

Dentition

Assessment

Moura et al. 2020 Arrow et al. 2016 Arrow et al. 2015 Bolgul et al. 2004 Zanata et al. 2003

1 year

Primary

Clinical

1 year

Primary

Clinical

1 year

Primary

Clinical

1 year

Primary

Clinical

2 years

Permanent

Clinical

2 years

Permanent

Radiographic

2 years

Primary

Radiographic

3 years

Primary

Radiographic

7 years

Primary

Radiographic

8 years

Primary

Clinical

Vilkinis et al. 2000 (Meta-analysis) Kotsanos et al. 2004 (Meta-analysis) Qvist et al. 1997 (Meta-analysis) Foley et al. 2004 (Meta-analysis) Qvist et al. 2004 (Meta-analysis)

Outcome measure Caries experience increment Caries experience increment Caries experience increment Caries experience increment Caries experience increment

Groups

Main findings

CGIC (n = 728)

CGIC: 0.8

Eligible for meta-analysis No

CGIC (n = 220)

CGIC: 0.8

CGIC (n = 254)

CGIC: 0.3

RMGIC (n = RMGIC: 0.2 173) CGIC: 2.2 CGIC (n = 417) Composite res- Composite resin: in (n = 127) 2.8 P > 0.05 Caries incidence RMGIC (n = RMGIC: 15.9% Composite resin: 114) Composite res10.0% in (n = 106) P > 0.05 Caries incidence RMGIC (n RMGIC: 24.3% = 41) Composite resin: Composite 17.1% P > 0.05 resin (n = 41) Caries incidence CGIC (n = 515) CGIC: 12.0% Amalgam (n Amalgam: 21.0% = 543) P < 0.01 Caries incidence

CGIC (n = 70) CGIC: 45.0% Composite Composite resin: resin (n = 41) 60.0% P > 0.05 Caries incidence CGIC (n = 451) CGIC: 21.0% RMGIC (n = RMGIC: 30.0% 543) P < 0.05

No No

Yes

Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

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The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

3.3. Risk of bias of the included studies

(Random sequence generation (selection bias (Allocation concealment (seleciton bias (Blinding of participants and personnel (performance bias (Blinding of outcome assessment (detection bias (Incomplete outcome data (attrition bias (Selective reporting (reporting bias Other bias 0% Low risk of bias

Other bias

Selective reporting (reporting bias)

Incomplete outcome data (attrition bias)

Blinding of outcome assessment (detection bias)

Blinding of participants and personnel (performance bias)

Allocation concealment (selection bias)

Random sequence generation (selection bias)

Among the 10 included RCTs, 7 studies had one or more ‘high’ ratings due to the method about the blinding of participants and outcome

assessment. The statement of the method of allocation concealment was not reported in 4 studies. Four studies had ‘unclear’ ratings due to lack of information. The risk of bias assessment ratings for each study are shown in Fig. 2, Fig. 3 .

Faley et al.(2004) Kotsanos et al.(2004) Moura et al.(2020) Arrow et al.(2015) Bolgul et al.(2004) Qvist et al.(2004) Arrow et al.(2016) Qvist et al.(1997) Vilkinis et al.(2000)

Unclear risk of bias

25%

50%

75%

100%

High risk of bias

Fig. 3. Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies. 3.4. Results of the included studies 3.4.1. CGIC restorations on permanent dentition Zanata et al. assessed the caries experience increment by analysing DMFS score in the dentition with CGIC restorations compared with that of zinc oxide-eugenol (ZOE) and composite resin restorations. The results showed that permanent dentitions with CGIC restorations showed a lower increase of the DMFS compared with dentitions with ZOE or composite resin restorations [18].

Zanata et al.(2003)

3.4.2. CGIC restorations on primary dentition Fig. 2. Risk of bias summary: review authors’ judgements about each risk of bias item for each included study.

Three studies assessed the caries incidence by bitewing radiographs in the primary dentition with CGIC restorations and compared with dentitions with amalgam [24], RMGIC [22] or composite resin restorations [23]. These studies showed that primary dentitions with CGIC restorations showed a lower caries incidence compared with amalgam, RMGIC and composite resin restorations. Three separate studies investigated the caries experience increment by analysing dmft/ dmfs score in the primary dentitions with CGIC restorations. No other types of restoration were included. These studies investigated the dmft/ dmfs increment after CGIC restorations with different clinical protocols, such as the atraumatic

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Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

restorative treatment (ART), standard care approach and minimum intervention dentistry (MID-ART) [19], [20], [21]. The results suggested the use of the CGIC by ART technical may be an effective option for managing caries in preschool-aged children. 3.4.3. RMGIC restorations on permanent dentition Vilkinis et al. investigated the caries incidence in the permanent dentitions with RMGIC restorations compared with composite resin restorations. Main findings showed that RMGIC and composite resin had a 15.9% and 10.0% caries incidence respectively. The results showed that no statistical significant differences between the RMGIC restorations and composite resin restorations were observed with respect to the caries incidence [27]. 3.4.4. RMGIC restorations on primary dentition Bolgul et al. investigated caries experience increment by dmft score in the primary dentition with RMGIC restorations and reported the dmft differences between different controlled levels of the insulin-dependant diabetes mellitus (IDDM) patients [26]. The results showed that the dmft Study or Subgroup 1.1.1 Amalgam Qvist et al. (1997) Subtotal (95% CI)

log(Risk Ratio)

3.5. Meta-analysis Five studies were included for the meta-analysis. Three studies were on CGIC restorations and two were on RMGIC restorations. We also pooled the data of CGIC and RMGIC restorations to analyse the caries preventive effect of GIC restorations. Four out of the five studies were included the meta-analysis on GIC restorations. One study was not included in the meta-analysis of GIC restorations, because this study compared the caries preventive effect of CGIC restorations with that of RMGIC restorations, not with other types of restorations [22]. The main results of the metaanalysis are presented in Fig. 4, Fig. 5, Fig. 6, Fig. 7, Fig. 8, Fig. 9.

Risk Ratio SE Weigh IV, Fixed, 95 % CI

-0.5561 0.1453

Heterogeneity: Not applicable Test for overall effect: Z= 3.83 (P= 0.0001) 1.1.2 Composite resin Foley et al. (2004) Kotsanos et al. (2004) Vilkinis et al. (2000) Subtotal (95% CI)

score decreased in all the IDDM patients’ primary dentition with RMGIC restorations. Kotsanos and Arizos evaluated the caries incidence by radiographs in the primary dentitions with RMGIC restorations compared with composite resin restorations. The results showed no statistically significant differences between the RMGIC and composite resin restorations with respect to the caries incidence [25].

-0.3198 0.1833 -0.1398 0.2114 -0.5428 0.5539

Risk Ratio IV, Fixed, 95 % CI

46.1% 0.57 [0.43, 0.76] 46.1% 0.57 [0.43, 0.76]

29.0% 21.8% 3.2% 53.9%

0.73 [0.51, 1,04] 0.87 [0.57, 1.32] 0.58 [0.20, 1.72] 0.77 [0.59, 1.00]

Heterogeneity: Chi2 - 0.69, df - 2 (P = 0.71): 12 - 0% Test for overall effect: Z = 1.94 (P = 0.05) Total (95% CI) 100.0% 0.67 [0.55, 0.82] Heterogeneity: Chi2 - 2.93, df - 3 (P = 0.40): 12 - 0% Test for overall effect: Z = 4.02 (P < 0.0001) Test for subgroup differences: Chi2 - 2.24, df - 1 (P = 0.13): 12 - 55.3%

0.01

0.1 1 10 Favours [GIC] Favours [Control]

100

Fig. 4. Meta-analysis of caries incidence in all dentitions with all GIC restorations vs amalgam or composite restorations. GIC: glass ionomer cement.

8 36

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Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

Risk Ratio log(Risk Ratio) Study or Subgroup SE Weigh IV, Fixed, 95 % CI 2.1.1 2 years Kotsanos et al. (2004) -0.1398 0.2114 40.4% 0.87 [0.57, 1.32] Vilkinis et al. (2000) -0.5428 0.5539 5.9% 0.58 [0.20, 1.72] Subtotal (95% CI) 46.3% 0.83 [0.56, 1.22] Heterogeneity Chi2 = 0.46, df = 1 (P = 0.50); I2 = 0% Test for overall effect: Z = 1.97 (P = 0.33)

2.1.2 7 years -0.3198 0.1833 Foley et al. (2004) Subtotal (95% CI) Heterogeneity: Not applicable Test for overall effect: Z = 1.74 (P = 0.08)

Risk Ratio IV, Fixed, 95 % CI

53.7% 0.73 [0.51, 1,04] 53.7% 0.73 [0.51, 1.04]

100.0% 0.77 [0.59, 1.00] Total (95% CI) Heterogeneity: Chi2 - 0.69, df = 2 (P = 0.71): I2 = 0% 0.01 Test for overall effect: Z = 1.94 (P = 0.05) Test for subgroup differences: Chi2 = 0.23, df = 1 (P = 0.63), I2 = 0%

0.1

100

Favours [GIC] Favours [Composite resin]

Fig. 5. Meta-analysis of caries incidence in all dentitions with GIC restorations vs composite resin restorations, with defined follow up period. GIC: glass ionomer cement.

Study or Subgroup

log(Risk Ratio)

Risk Ratio SE Weigh IV, Fixed, 95 % CI

3.1.1 Amalgam - primary dentition -0.5561 0.1453 Qvist et al. (1997) Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Z = 3.83 (P= 0.0001)

40.4% 0.57 [0.43, 0.76] 46.1% 0.57 [0.43, 0.76]

3.1.1 Amalgam - permanent dentition Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Not applicable 3.1.3 Composite resin - primary dentition -0.3198 0.1833 Foley et al. (2004) -0.5428 0.5539 Kotsanos et al. (2004) Subtotal (95% CI) Heterogeneity Chi2 = 0.41, df = 1 (P = 0.52); I2 = 0% Test for overall effect: Z = 1.75 (P = 0.08) 3.1.3 Composite resin - permanent dentition Vilkinis et al. (2000) -0.54288 0.5539 Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Z = 0.98 (P = 0.33)

Risk Ratio IV, Fixed, 95 % CI

Not estimable

29.0% 0.73 [0.51, 1.04] 21.8% 0.87 [0.57, 1.32] 50.7% 0.78 [0.60, 1.03]

3.2% 3.2%

0.58 [0.20, 1.72] 0.58 [0.20, 1.72]

100.0% 0.67 [0.55, 0.82] Total (95% CI) Heterogeneity: Chi2 = 2.93, df = 3 (P = 0.40): I2 = 0% Test for overall effect: Z = 4.02 (P < 0.0001) Test for subgroup differences: Chi2 = 2.51, df = 2 (P = 0.28), I2 = 20.4%

0.01

0.1

100

Favours [GIC] Favours [Composite resin]

Fig. 6. Meta-analysis of caries incidence in dentitions with GIC restorations. Not estimable: no studies were eligible for meta-analysis. CGIC: conventional glass ionomer cement; RMGIC: resinmodified glass ionomer cement; GIC: glass ionomer cement (including CGIC and RMGIC).

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Light-curing Glass Ionomer Filling Material • Excellent working time and the setting time is individually adjustable by light-curing • Immediately packable after placement in the cavity • No varnish required- ﬁll, polymerise and ﬁnish • No need to condition the dental hard tissue • Does not stick to the instrument and is easy to model • Suitable for large cavities Are you interested in our entire product range and detailed product information? Visit our website or contact us directly! PROMEDICA Dental Material GmbH

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The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

Study or Subgroup

Risk Ratio SE Weigh IV, Fixed, 95 % CI

log(Risk Ratio)

4.1.1 RMGIC -0.3542 0.1123 Qvist et al. (2004) Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Z = 3.15 (P= 0.002)

Risk Ratio IV, Fixed, 95 % CI

50.7% 0.70 [0.56, 0.87] 50.7% 0.70 [0.56, 0.87]

4.1.2 Amalgam Qvist et al. (1997) -0.5561 0.1453 Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Z = 3.83 (P= 0.0001)

30.3% 0.57 [0.43, 0.76] 30.3% 0.57 [0.43, 0.76]

4.1.3 Composite resin -0.3198 0.1833 Foley et al. (2004) Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Z = 1.74 (P= 0.08)

19.0% 0.73 [0.51, 1.04] 19.0% 0.73 [0.51, 1.04]

100.0% 0.66 [0.57, 0.78] Total (95% CI) Heterogeneity: Chi2 = 1.50, df = 2 (P = 0.47): I2 = 0% 0.01 Test for overall effect: Z = 5.11 (P < 0.00001) Test for subgroup differences: Chi2 = 1.50, df = 2 (P = 0.478), I2 = 0%

0.1

Favours [GIC] Favours [Composite resin]

100

Fig. 7. Meta-analysis of caries incidence in primary and permanent dentitions with CGIC restorations vs RMGIC, amalgam or composite resin restorations. CGIC: conventional glass ionomer cement; RMGIC: resin-modified glass ionomer cement. Study or Subgroup

log(Risk Ratio)

Risk Ratio SE Weigh IV, Fixed, 95 % CI

5.1.1 RMGIC - primary dentition Qvist et al. (2004) -0.3542 0.1123 Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Z = 3.15 (P= 0.002) 5.1.2 RMGIC - permanent dentition Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Not applicable 5.1.3 RMGIC - primary dentition Qvist et al. (1997) -0.5561 0.1453 Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Z = 3.83 (P= 0.0001) 5.1.4 RMGIC - permanent dentition Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Not applicable 5.1.5 Composite resin - primary dentition Foley et al. (2004) -0.3198 0.1833 Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Z = 1.74 (P= 0.08) 5.1.6 Composite resin - permanent dentition Subtotal (95% CI) Heterogeneity : Not applicable Test for overall effect: Not applicable

50.7% 0.70 [0.56, 0.87] 50.7% 0.70 [0.56, 0.87]

Not estimable

30.3% 0.57 [0.43, 0.76] 30.3% 0.57 [0.43, 0.76]

Not estimable

19.0% 0.73 [0.51, 1.04] 19.0% 0.73 [0.51, 1.04]

Not estimable

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Risk Ratio IV, Fixed, 95 % CI

0.1

Favours [GIC] Favours [Composite resin]

100

Fig. 8. Meta-analysis of caries incidence in primary or permanent dentitions with CGIC restorations vs RMGIC, amalgam or composite resin restorations. Not estimable: no studies were eligible for meta-analysis. CGIC: conventional glass ionomer cement; RMGIC: resinmodified glass ionomer cement. Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

Risk Ratio IV, Fixed, 95 % CI

Risk Ratio log(Risk Ratio) Study or Subgroup SE Weigh IV, Fixed, 95 % CI 6.1.1 Composite resin-primary dentition Kotsanos et al. (2004 -0.1398 0.2114 87.3% 0.87 [0.57, 1.32] Substotal (95% CI) 87.3% 0.87 [0.57, 0.32] Heterogeneity: Not applicable Test for overall effect: Z= 0.66 (P= 0.51)

6.1.2 Composite resin-primary dentition Vilkinis et al. (2000) -0.1398 0.2114 Substotal (95% CI) Heterogeneity: Not applicable Test for overall effect: Z= 0.98 (P= 0.33)

12.7% 0.58 [0.20, 1.72] 12.7% 0.58 [0.20, 1.72]

100.0% 0.87 [0.56, 1.22] Total (95% CI) Heterogeneity: Chi2 - 0.46, df = 1 (P = 0.50): 12 - 0% Test for overall effect: Z = 0.97 (P = 0.33) Test for subgroup differences: Chi2 - 0.46, df - 1 (P = 0.50): 12 - 0%

0.01

0.1 1 10 Favours [GIC] Favours [Control]

100

Fig. 9. Meta-analysis of caries incidence in primary or permanent dentitions with RMGIC restorations vs composite resin restorations. RMGIC: resin-modified glass ionomer cement. Meta-analysis showed that patients with GIC restorations showed a lower caries incidence compared with other restoration types [RR=0.67, 95% CI: 0.55–0.82, p<0.00001] (Fig. 4, Fig. 5, Fig. 6). The heterogeneity of this meta-analysis was 2.93 (I2=0%). Patients with CGIC restorations showed a lower caries incidence compared with other restoration types [RR=0.66, 95% CI: 0.57–0.78, p < 0.00001] (Figs. 7 and 8). The heterogeneity of this meta-analysis was 1.50 (I2=0%). Patients with RMGIC restorations showed no significant differences in the caries incidence compared with composite resin restorations [RR=0.83, 95% CII:0.56–1.22, p = 0.33] (Fig. 9). The heterogeneity of this metaanalysis was 0.46 (I2=0%). 3.5.1. Preventive effect of GIC on new caries in primary and permanent dentition The results of meta-analysis showed that patients with GIC restorations (either CGIC or RMGIC restorations) exhibited a lower caries incidence compared with amalgam restorations [RR=0.57, 95% CI:0.43–0.76, p = 0.0001]. Patients with GIC restorations exhibited a lower caries incidence compared with composite resin restorations [RR=0.77, 95% CI:0.59–1.00, p = 0.05] (Fig. 4). Data from the studies with different follow-up periods showed that patients with GIC restorations

exhibited no significant differences in the caries incidence compared with composite resin restorations in 2 years [RR=0.83, 95% CI:0.56–1.22, p = 0.33] and 7 years [RR=0.73, 95% CI:0.51–1.04, p = 0.08] (Fig. 5). Preventive effect of GIC on new caries in primary dentition The results of meta-analysis showed that primary dentition with GIC restorations exhibited a lower caries incidence compared with amalgam restorations [RR=0.57, 95% CI:0.43–0.76, p = 0.0001]. Patients with GIC restorations showed no significant differences in the caries incidence compared with composite resin restorations in primary dentition [RR=0.78, 95% CI:0.60–1.03, p = 0.08] (Fig. 6). Preventive effect of GIC on new caries in permanent dentition Patients with GIC restorations showed no significant differences in the caries incidence compared with composite resin restorations in permanent dentition [RR=0.58, 95% CI:0.20–1.72, p = 0.33] (Fig. 6). 3.5.2. Preventive effect of CGIC on new caries in primary and permanent dentition The results of meta-analysis showed that patients with CGIC restorations exhibited a lower caries

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

incidence compared with RMGIC restorations [RR=0.70, 95% CI:0.56–0.87, p = 0.002] and amalgam restorations [RR=0.57, 95% CI:0.43– 0.76, p = 0.0001], but no statistical difference with composite resin restorations [RR=0.73, 95% CI:0.51–1.04, p = 0.08] (Fig. 7). Preventive effect of CGIC on new caries in primary dentition The results of meta-analysis showed that primary dentition with CGIC restorations exhibited a lower caries incidence compared with amalgam restorations [RR=0.57, 95% CI:0.43–0.76, p = 0.0001] and RMGIC restorations [RR=0.70, 95% CI:0.56–0.87, p = 0.002]. Primary dentition with CGIC restorations exhibited a lower caries incidence compared with composite resin restorations, but the difference had no statistical significance [RR=0.73, 95% CI:0.51–1.04, p = 0.08] (Fig. 8). Preventive effect of CGIC on new caries in permanent dentition No study that investigated the preventive effect of CGIC on new caries in permanent dentition was eligible for meta-analysis. The results of the preventive effect of CGIC on new caries in permanent dentition are listed as ‘not estimable’ in Fig. 8. 3.5.3. Preventive effect of RMGIC on new caries in primary and permanent dentition Patients with RMGIC restorations showed no significant differences in the caries incidence compared with composite resin restorations [RR=0.83, 95% CI:0.56–1.22, p = 0.33] (Fig. 9). Preventive effect of RMGIC on new caries in primary dentition Primary dentition with RMGIC restorations showed no significant differences in the caries incidence compared with composite resin restorations [RR=0.87, 95% CI:0.57–1.32, p = 0.51] (Fig. 9). Preventive effect of RMGIC on new caries in permanent dentition Permanent dentition with RMGIC restorations showed no significant differences in the caries incidence compared with composite resin restorations [RR=0.58, 95% CI:0.20–1.72, p = 0.33] (Fig. 9).

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4. Discussion This review’s results showed that patients with GIC restorations, had a lower caries incidence compared with other types of restorations, demonstrating that GIC restorations obtain a better caries preventive effect. Since the RMGIC restorations did not present a better preventive effects than other restorations, this result may be due to the effect of CGIC in the pool of the collected data. This result is consistent with previous studies that claimed that GIC restorations can be used as a tool in caries prevention28 . This may be due to the fluoride-releasing and recharging ability of GIC. Fluoride delivered by dentifrices or topical fluoride treatments can be taken up into GIC and released again [29]. In addition, fluoride can inhibit biofilm formation by S. mutans and other bacterial species. Caries treatment of GIC may offer enhanced protection for the surrounding tooth structure [30]. We found that GIC restorations were more effective in preventing new caries compared to amalgam restorations. Amalgam contains silver compounds, which have antimicrobial effects on the Streptococcus mutans and Actinomyces viscosus [31]. GIC obtains the cariostatic effect, which is partially due the antibacterial effect of GIC. Meanwhile, the fluoride release of GIC might contribute to the inhibition of bacterial acid production [32]. The hypothesis that the preventive effect of GIC restorations on new caries was related to the sustained fluoridereleasing property instead of the antibacterial property was supported with the result [33]. This review’s results suggested that GIC restorations might result in a lower caries incidence effect compared to composite resin with a statistical significance (p = 0.05), though CGIC (p = 0.08) and RMGIC (p = 0.33) had no significant differences in the reducing the caries incidence compared with composite resin restorations. The composite resin system has a hydrophobic medium, and the ion exchange from the fluoride component is reduced [34]. A previous study reported that GIC materials showed better cariostatic effects compared to composite resin [35], which is consistent with our results. Note that the CGIC meta-analysis only included one study. Further high-quality randomized control trials are needed to support the results. The study included in our review showed that CGIC restorations presented a better cariostatic effect of than RMGIC restorations did [22]. We analysed Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

the caries preventive effect of CGIC and RMGIC separately. The differences of the cariostatic effect between CGIC and RMGIC could be due to replacing part of the water in the GIC by the resin, which might affect the fluoride release kinetics of RMGIC [36]. In addition, the fluoride content of restorative resins is limited by the need for the restorative cements’ translucency. The enhanced translucency of the RMGIC had improved aesthetic effects but was accompanied by a reduction in fluoride content [37,38]. Meanwhile, the resin matrix might firmly encapsulate the fluoride ions in RMGIC. Consequently, the fluoride release rate of RMGIC into an aqueous environment might be smaller and slower compared to that of CGIC [39]. The lower fluoride release of RMGIC might attribute to the reduced preventive effect of RMGIC on new caries than CGIC. This study’s results showed that no statistically significant differences were observed with respect to the caries incidence between RMGIC and composite resin restorations in permanent dentition. Similarly, Yengopal et al. compared the preventive effect of RMGIC on recurrent caries to the composite resin and found no evidence to indicate that RMGIC had a superior cariostatic preventive effect in primary dentition [40]. The possible explanations might be that the high level of fluoride ions released initially from RMGIC might plateau within the first weeks of setting and that its composition behaves similarly to the composite resin thus leading to a lower fluoride release rate than CGIC [38,41]. Only 1 out of 7 studies investigating the preventive effect of CGIC on new caries were performed on permanent dentition. None of these studies were eligible for the meta-analysis, and thus were listed as not estimable in the results of metaanalysis (Fig. 8). The limited investigation on CGIC in permanent dentition might be due to its poor mechanical strength [42]. Further randomized control trials about CGIC on permanent dentition are needed. In the results of meta-analysis on the preventive effect of RMGIC on new caries, we only obtained the RR of RMGIC restorations compared to composite resin restorations (Fig. 9). The data from one study assessing the caries incidence in primary dentition with RMGIC vs CGIC restorations were pooled and presented in the meta-analysis of caries progression of CGIC [43] . One of the included studies assessing the caries incidence in primary dentition contained data of both CGIC and RMGIC restorations. The

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data from this study were pooled and presented in the meta-analysis of caries incidence in dentitions with CGIC restorations with RMGIC restorations as comparison [22]. Therefore, it was not appropriate to present the data again in the results of meta-analysis of caries incidence of dentition with RMGIC restoration. In this case, the caries incidence in dentitions with RMGIC restorations were not compared with CGIC again in Fig. 9. Other studies on RMGIC included for meta-analysis only compared the caries incidence between RMGIC and composite resin restorations. Therefore, this review only presented the results of the comparison between RMGIC and composite resin restorations regarding the caries preventive effect of RMGIC. The follow-up periods of the included studies ranged from 1 year to 8 years. The average followup period of the included studies with CGIC restorations was 3.3 years, while on the RMGIC restorations, it was 1.7 years. Seven studies had the follow-up period of less than 3 years. The included studies had relatively short follow-up periods, which could be another limitation of the study. The follow-up periods were relatively short. This may be because most of the GIC were used in the primary dentition, which have a limit on follow up time due to natural exfoliation. In addition, CGIC is brittle and easily to fracture. Previous studies showed a CGIC restoration fracture rate of 10% after two years, which prevented follow up6. Studies also reported that GIC restorations showed an overall 18% cumulative loss rate during the 6-year follow-up [44]. This may be the reason why the most included GIC studies had shorter follow-up years. The follow-up periods of the included studies in the meta-analysis varied. To minimize the effect of the follow-up period on the review’s results, we compared the new caries preventive effect of GIC with composite resin in 2 years and 7 years, respectively (Fig. 5). Regarding the meta-analysis of the new caries preventive effect of RMGIC compared with other restorations, we did not separate them into different follow-up groups because they had similar follow-up periods. We included three studies on CGIC and two studies on RMGIC reporting the caries incidence for the meta-analysis. The other included studies with the outcome measure of caries experience increment were not eligible for the meta-analysis and were included only in qualitative analysis. The reason was because three studies assessed the caries experience increment in the dentition Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

after CGIC restorations without a negative control group [19], [20], [21],[45]. Meanwhile, some included studies did not perform the blinding of participants or examiners due to the obvious visual differences of CGIC and other types of restoration [46]. The failure of blinding might cause detection/performance bias, which led to the ‘high’ ratings for risk of bias. The results of the included studies might have been affected [47]. Further high-quality randomized control trials are needed to verify the results. The number of the included studies were limited due to the insufficiency of previous publications on clinical studies, which was a limitation of this review. Since the included studies did not provide enough data (Fig. 6), comparing the caries preventive effect of GIC restorations on permanent dentition with primary dentition was not achievable in this review. Meanwhile, the number and size of restorations received by the patients, caries risk of the patients and the fluoridated factors might have influences on the caries incidence. Due to the limited data and information collection, these factors were not considered in the current review. The preventive effect of GIC restorations on secondary caries, i.e., caries developed beneath the restoration, was not the aim of the review. Previous studies on secondary caries were always evaluated by United States Public Health Service (USPHS) criteria [48]. The outcome measures of these study were very different from the studies on new caries. Therefore, it was not appropriate to pool the data and perform the meta-analysis. GIC is a favourable restorative material class with unique and advantageous properties, especially with a better preventive effect on new caries compared to other restorative materials. However, brittleness may limit their use in the load-bearing posterior regions. Several attempts to improve their mechanical strength and caries preventive effect might expand their clinical application. 5. Conclusion Based on the limited evidence, GIC restorations have a better preventive effect on new caries compared to other restoration types in primary and permanent dentition. CGIC present a better preventive effect on new caries compared to RMGIC and amalgam restorations, but no statistical differences with composite resin restorations in primary dentition. RMGIC restorations showed no statistical differences in

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preventive effect on new caries compared with composite resin restorations in both primary and permanent dentitions. References 1- R.H. Selwitz, A.I. Ismail, N.B. Pitts Dental caries Lancet, 369 (2007), pp. 51-59, 10.1016/S01406736(07)60031-2 2-P.E. Petersen, D. Bourgeois, H. Ogawa, S. Estupinan-Day, C. Ndiaye The global burden of oral diseases and risks to oral health Bull. World Health Organ., 83 (2005), pp. 661-669 3- R.A. Bagramian, F. Garcia-Godoy, A.R. Volpe The global increase in dental caries. A pending public health crisis Am. J. Dent., 22 (2009), pp. 3-8 View Record in ScopusGoogle Scholar 4- C.H. Chu, S.S.S. Wong, R.P.C. Suen, E.C.M. Lo Oral health and dental care in Hong Kong Surgeon, 11 (2013), pp. 153-157, 10.1016/j. s u r g e . 2 0 1 2 .1 2 . 0 1 0 5- L. Prasai Dixit, A. Shakya, M. Shrestha, A. Shrestha Dental caries prevalence, oral health knowledge and practice among indigenous Chepang school children of Nepal BMC. Oral. Health, 13 (2013), 10.1186/1472-6831-13-2020-20 6- U. Lohbauer Dental glass ionomer cements as permanent filling materials? – Properties, limitations future trends Mater, 3 (2009), pp. 76-96, 10.3390/ma3010076 -7 S.K. Sidhu, J.W. Nicholson A review of glass-ionomer cements for clinical dentistry J. Funct. Biomater., 7 (2016), pp. 16-31, 10.3390/ jfb7030016 8- S. Hoshika, S. Ting, Z. Ahmed, F. Chen, Y. Toida, N. Sakaguchi, B. Van Meerbeek, H. Sano, S.K. Sidhu Effect of conditioning and 1 year aging on the bond strength and interfacial morphology of glass-ionomer cement bonded to dentin Dent. Mater., 37 (2021), pp. 106-112, 10.1016/j. dental.2020.10.016 9- R. Nantanee, B. Santiwong, C. Trairatvorakul, H. Hamba, J. Tagami Silver diamine fluoride and glass ionomer differentially remineralize early caries lesions, in situ Clin. Oral Investig., 20 (2016), pp. 1151-1157, 10.1007/s00784-015-1603-4 10- J. Zhao, D. Xie A novel hyperbranched poly (acrylic acid) for improved resin-modified glass-ionomer Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

restoratives Dent. Mater., 27 (2011), pp. 478-486, 10.1016/j. dental.2011.02.005 11- A. Agha, S. Parker, M.P. Patel Development of experimental resin modified glass ionomer cements (RMGICs) with reduced water uptake and dimensional change Dent. Mater., 32 (2016), pp. 713-722, 10.1016/j. dental.2016.03.004 12- S.K. Sidhu Clinical evaluations of resin-modified glassionomer restorations Dent. Mater., 26 (2010), pp. 7-12, 10.1016/j. d e n t a l . 2 0 0 9.0 8 .0 1 5 13- J. Vaikuntam Resin-modified glass ionomer cements (RM GICs) implications for use in pediatric dentistry ASDC. J. Dent. Child., 64 (1997), pp. 131-134 14- C.F.C. Salas, C.A.B. Guglielmi, D.P. Raggio, F.M. Mendes Mineral loss on adjacent enamel glass ionomer cements restorations after cariogenic and erosive challenges Arch. Oral Biol., 56 (2011), pp. 1014-1019, 10.1016/j. archoralbio.2011.03.005 15- H.S. Lee, J.H. Berg, F. García-Godoy, K.T. Jang Long-term evaluation of the remineralization of interproximal caries-like lesions adjacent to glassionomer restorations: a micro-CT study Am. J. Dent., 21 (2008), pp. 129-132 16- L.S. Bueno, A.F.S. Borges, M.F.L. Navarro, J.W. Nicholson, R.G. Hill, S.K. Sidhu Determination of chemical species of fluoride during uptake mechanism of glass-ionomer cements with NMR spectroscopy Dent. Mater., 37 (2021), pp. 1176-1182, 10.1016/j. dental.2021.04.011 17- D. Moher, A. Liberati, J. Tetzlaff, D.G. Altman, P. Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement Br. Med. J., 339 (2009), pp. 25-35, 10.1016/bmj. b2535 18- R.L. Zanata, M.F. Navarro, S.H. Barbosa, J.R. Lauris, E.B. Franco Clinical evaluation of three restorative materials applied in a minimal intervention caries treatment approach J. Public. Health Dent., 63 (2003), pp. 221-226, 10.1111/j.1752-7325.2003.tb03503.x 19- M.S. Moura, G.P. Sousa, M. Brito, M.C.C. Silva, M.D.M. Lima, L. Moura, C.C.B. Lima Does low-cost GIC have the same survival rate as high-viscosity GIC in atraumatic restorative treatments? A RCT Braz. Oral. Res., 33 (2020), pp. 125-135, 1 0 .1 5 9 0 / 1 8 0 7 - 3 1 0 7 b o r - 2 0 1 9 .v o l 3 3 . 0 1 2 5

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20- P. Arrow Restorative outcomes of a minimally invasive restorative approach based on atraumatic restorative treatment to manage early childhood caries: a randomised controlled trial Caries. Res., 50 (2016), pp. 1-8, 10.1159/000442093 21- P. Arrow, E. Klobas Minimum intervention dentistry approach to managing early childhood caries: a randomized control trial Commun. Dent. Oral Epidemiol., 43 (2015), pp. 511520, 10.1111/cdoe.12176 22- V. Qvist, E. Manscher, P.T. Teglers Resin-modified and conventional glass ionomer restorations in primary teeth: 8-year results J. Dent., 32 (2004), pp. 285-294, 10.1016/j. jdent.2004.01.001 23- J. Foley, D. Evans, A. Blackwell Partial caries removal and cariostatic materials in carious primary molar teeth: a randomised controlled clinical trial Br. Dent. J., 197 (2004), pp. 697-701, 10.1038/ sj.bdj.4811865 24- V. Qvist, L. Laurberg, A. Poulsen, P.T. Teglers Longevity and cariostatic effects of everyday conventional glass-ionomer and amalgam restorations in primary teeth: three year results J. Dent. Res., 76 (1997), pp. 1387-1396, 1 0 . 1 1 7 7/ 0 0 2 2 0 3 4 5 9 7 0 7 6 0 0 7 0 9 0 1 25- N. Kotsanos, S. Arizos Evaluation of a resin modified glass ionomer serving both as indirect pulp therapy and as restorative material for primary molars Eur. Arch. Paediatr. Dent., 12 (2011), pp. 170-175, 10.1007/bf03262801 26- B.S. Bolgül, S. Celenk, B.E. Ayna, F. Atakul, E. Uysal Evaluation of caries risk factors and effects of a fluoride-releasing adhesive material in children with insulin-dependent diabetes mellitus (IDDM): initial first-year results Acta Odontol. Scand., 62 (2004), pp. 289-292, 10.1080/00016350410001766 27- V. Vilkinis, P. Hörsted-Bindslev, V. Baelum Two-year evaluation of class II resin-modified glass ionomer cement/composite open sandwich and composite restorations Clin. Oral Investig., 4 (2000), pp. 133-139, 10.1007/ s007840000075 28- S. Mickenautsch, V. Yengopal, S.C. Leal, L.B. Oliveira, A.C. Bezerra, M. Bönecker Absence of carious lesions at margins of glassionomer and amalgam restorations: a metaanalysis Eur. J. Paediatr. Dent., 10 (2009), pp. 41-46, 10.1186/1756-0500-4-58 29- C. Trairatvorakul, S. Itsaraviriyakul, W. Quarter IV

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

Wiboonchan Effect of glass-ionomer cement on the progression of proximal caries J. Dent. Res., 90 (2011), pp. 99-103, 1 0 . 1 1 7 7/ 0 0 2 2 0 3 4 5 1 0 3 8 1 2 6 5 30- G.M. Knight, J.M. McIntyre, G.G. Craig, P.S.Zilm Mulyani, N.J. Gully An in vitro investigation of marginal dentine caries abutting composite resin and glass ionomer cement restorations Aust. Dent. J., 52 (2007), pp. 187-192, 10.1111/j.18347819.2007.tb00487.x 31- I. Nedeljkovic, J. De Munck, V. Slomka, B. Van Meerbeek, W. Teughels, K.L. Van Landuyt Lack of buffering by composites promotes shift to more cariogenic bacteria J. Dent. Res., 95 (2016), pp. 875-881, 1 0 . 1 1 7 7/ 0 0 2 2 0 3 4 5 1 6 6 4 7 6 7 7 32- A.M. Bynum, K.J. Donly Enamel de/remineralization on teeth adjacent to fluoride releasing materials without dentifrice exposure ASDC J. Dent. Child., 66 (1999), pp. 89-92 33- A. Wiegand, W. Buchalla, T. Attin Review on fluoride-releasing restorative materialsfluoride release and uptake characteristics, antibacterial activity and influence on caries formation Dent. Mater., 23 (2007), pp. 343-362, 10.1016/j. dental.2006.01.022 34- P. Weidlich, L.A. Miranda, M. Maltz, S. Samuel Fluoride release and uptake from glass ionomer cements and composite resins Braz. Dent. J., 11 (2000), pp. 89-96 35- S. Schlafer, T. Bornmann, S. Paris, G. Göstemeyer The impact of glass ionomer cement and composite resin on microscale pH in cariogenic biofilms and demineralization of dental tissues Dent. Mater., 37 (2021), pp. 1576-1583, 10.1016/j. dental.2021.08.007 36- M. Lezaja Zebic, N. Jakovljevic, V. Miletic Fluoride release from conventional, resin-modified and hybrid glass ionomer cements Serb. Dent. J., 65 (2018), pp. 187-194, 10.2478/sdj2018-0018 37- P. Karantakis, M. Helvatjoglou-Antoniades, S. Theodoridou-Pahini, Y. Papadogiannis Fluoride release from three glass ionomers, a compomer, and a composite resin in water, artificial saliva, and lactic acid Oper. Dent., 25 (2000), pp. 20-25 38- G. Vermeersch, G. Leloup, J. Vreven Fluoride release from glass-ionomer cements, compomers and resin composites J. Oral. Rehabil., 28 (2001), pp. 26-32, 10.1046/j.13652842.2001.00635.x

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39- Y. Momoi, J. McCabe Fluoride release from light-activated glass ionomer restorative cements Dent. Mater., 9 (1993), pp. 151-154, 10.1016/01095641(93)90112-4 40- V. Yengopal, S. Mickenautsch Caries-preventive effect of resin-modified glassionomer cement (RM-GIC) versus composite resin: a quantitative systematic review Eur. Arch. Paediatr. Dent., 12 (2011), pp. 5-14, 10.1007/BF03262772 41- P. Hörsted-Bindslev Fluoride release from alternative restorative materials J. Dent., 22 (1994), pp. 17-20, 10.1016/03005712(94)90166-x 42- G.J. Mount An Atlas of Glass-Ionomer cements: a Clinician’s Guide CRC Press (2001), 10.3109/9780203215456 43- V. Qvist, L. Laurberg, A. Poulsen, P.T. Teglers Eight-year study on conventional glass ionomer and amalgam restorations in primary teeth Acta. Odontol. Scand., 62 (2004), pp. 37-45, 10.1080/00016350310008689 44- J.W. van Dijken Retention of a resin-modified glass ionomer adhesive in non-carious cervical lesions. A 6-year follow-up J. Dent., 33 (2005), pp. 541-547, 10.1016/j. jdent.2004.11.015 45- C.M. Da Silva, M.C. Figueiredo, L. Casagrande, T.L. Lenzi Survival and associated risk factors of atraumatic restorative treatment restorations in children with early childhood caries J. Dent. Child., 87 (2020), pp. 12-17 46- V. Qvist, L. Laurberg, A. Poulsen, P.T. Teglers Longevity and cariostatic effects of everyday conventional glass-ionomer and amalgam restorations in primary teeth: three-year results J. Dent. Res., 76 (1997), pp. 1387-1396, 1 0 . 1 1 7 7/ 0 0 2 2 0 3 4 5 9 7 0 7 6 0 0 7 0 9 0 1 47- P.J. Karanicolas, F. Farrokhyar, M. Bhandari Practical tips for surgical research: blinding: who, what, when, why, how? Can. J. Surg., 53 (2010), pp. 345-348 48- J.F. Cvar, G. Ryge Criteria for the clinical evaluation of dental restorative materials, US department of health, education, and welfare Public Health Serv. (1971)

Quarter IV

ExECUTIvE COMMITTEE OF THE LOS; DRS.; ELIE KHOURY, FADI DAHBOUL, RONALD YOUNES, RAMZI HADDAD, SAMER RIFAII, MARIA HAIDAR, BACHAR REDA, ALI FAHS, GIvING THE TROPHY TO THE PRESIDENT OF THE LDA.

THE LEBANESE ORTHODONTIC SOCIETY JULY 15 , 2022, GEFINOR ROTANA, BEIRUT On July 19, 2022, the President of the Lebanese Orthodontic Society, Dr. Ramzi Haddad, welcomed the delegates of the 19th Annual meeting at the Gefinor Rotana, on behalf of the LOS executive committee. He presented the lecturers; Dr. Naji Abou Chebel (maxillofacial Surgeon,) Prof. Mona Sayegh Ghossoub, Prof. Lina Medawar, Dr. Roy Sabri, and Prof Stephane Barthelemi from Montpellier, France. Since 1965, the year of the foundation of the LOS by late Prof. Rizkallah, the LOS members always participated in local, regional and international events as attendees as well as lecturers, and the LOS hosted international Key opinion leaders from around the world to exchange knowledge. Dr. Haddad highlighted that there are around 500 specialists in Lebanon, for 5,000.000 inhabitants, each registered orthodontist serving around 10.000 population. During the coffee breaks the delegates had the chance to browse the latest innovations the dental industry has to offer to the orthodontists. It was a nice occasion for colleagues to network after a long time of interruption. He ended by thanking the LOS committees officers and invited colleagues to check the website http://www.leborthosoc.org/ to keep updated.

DR. RAMZI HADDAD, PRESIDENT OF THE LEBANESE ORTHODONTIC SOCIETY 48

Dental News

Quarter IV

PROF. RONALD YOUNES, PRESIDENT OF THE LDA

LEFT TO RIGHT; DRS. ELIE KHOURY, FADI DAHBOUL, NAZEM HAFFAR (PRESIDENT OF THE LDA-TRIPOLI), RAMZI HADDAD, SAMER RIFAII OFFERING HIM THE TROPHY.

DRS.; ANTHONY MAKARI, MARIA SAADEH HADDAD, RAMZI HADDAD

PROF. MONA SAYEGH GHOSSOUB LECTURING ABOUT THE MANAGEMENT OF ExCESSIvE GINGIvAL DISPLAY

SAMER RIFAII, MONA GHOSSOUB, JOSEPH GHAFARI

DR. SAMER RIFAII AND DR. JOSEPH GHAFARI CHAIRING THE SESSIONS DURING THE LOS MEETING

PROF. STéPHANE BARTHéLEMI LECTURING

Dental News ABOUT THE TIMING OF EARLY ExPANSION

DR. ROY SABRI TALKING ABOUT EARLY TREATMENT Quarter IV OF ARCH LENGTH DEFICIENCY

DRS.; MARIA ELKHOURY ABBOUD, AMIN ZOGHBY, ABDULNABI BASSAM, TONY DIB

Success CD TheCompressed material for perfect temporary crowns and bridges air is indispensable in dental this also means potential exposure to residues of practices. For instance, it ensures a long-term

oil droplets, oil mist or oil/water emulsions.

High-quality temporary restorations within 5 minutes After a retention time of 30 to 60 seconds in the oral This potential contamination also involves cavity, the material takes on an elastic consistency, which several undesirable risks. The viscous lubricating facilitates removal without risking deformation. The of treatment and helps avoid infections. But oil can add to the low viscosity oil of dental material cures completely within a further 3 minutes and this presupposes that the compressed air itself turbines and, especially after partial oxidation and can then be polished. This procedure is timesaving and is completely hygienic. Simple filters alone are resin deposits when exposed to heat, the gaskets thus highly economical.

Success CD is PROMEDICA’s composite-based, selfadhesive bond when dry blowing in restorative curing paste-paste system for quick and easy chairside therapy and prosthetics. More importantly it can production of temporary crowns, bridges, inlays and reduce pathogen contamination at the place onlays.

not enough. The following article explains the important factors in dental air.

in turbine heads can stick. This leads to total failure of the turbine. Any oil film in the patient’s Excellent physical properties and great aesthetic results mouth will prevent the adhesion of composites. As far as the material’s physical properties are concerned, Compressed air is required in many applications which can result in the failure of the restorative Success CD convinces with its excellent flexural and in dentistry. It drives a whole range of appliances therapy. overall strength as well as its capacity to withstand high and components – from turbines in handpieces functional loads. and pressure moulding machines for the pressure The industrial solution moulding technique up to the control of precision Air is used as a propellent medium in industrial The product’s minimal polymerisation shrinkage results milling cutters in the laboratory. Not least, dental compressors. It must achieve certain volume flows in precisely fitting temporary restorations. Success air is used for drying the treatment site directly and pressures yet does not necessarily satisfy CD’s high colour stability and brilliant, enamel-like gloss in the mouth of the patient. But in all these areas special hygienic requirements. Mainly the task ensure long-term aesthetic results. Moreover, its natural of application various factors have to be taken fluorescence and the choice of available shades promote into account and are connected with risks which perfect aesthetic results. should not be underestimated. Water as a risk factor website: www.promedica.de Compressed air with an excessive water content reduces the adhesive strength of dental adhesive. There is also a risk of corrosion of the driven instruments. In addition, moist air – especially if it is warm too – creates the ideal environment for bacteria, viruses and fungi: Alarm stage red! The dentist must always expect the presence of open wounds in the patient’s mouth. is only in transportation, assembly, control, etc. Stricter conditions are imposed by the foodstuffs TheraBase is a dual-cured, calcium and fluoride releasing, It is radiopaque allowing for effective identification on If the finest particles are also added to this, or pharmaceuticals industries – and, naturally, the self-adhesive base/liner. TheraBase contains MDP, radiographs. Its dual-cure ability ensures the material will together with water and oil they can form an most restrictive regulations must be observed chemically bonds to tooth structure, and utilizes THERA cure even in deep restorations where light cannot reach! emery paste that acts like sand in a gearbox. where air is used as the working medium for technology. It impairs the functioning of all bearings in the treatment in immediate contact with hard and turbine, disrupts the air circulation in turbine soft tissues directly on the patient. website: www.bisco.com heads and destroys the bearings and shaft. The cooling required for rapidly rotating components The dental solution is diminished, causing the wear of many Dental compressors typically have an components. Even the patient can become aware integrated air drying process. Modern membrane of this in the form of unpleasant musty odours. drying systems work the most efficiently. Firstly they bring the compressed air to room temperature in a cooler. Next the air flows through Oil as a risk factor thin membrane fibres that further dehumidifies it. Simple appliances in the industry use tried- Dry purging air on the other side of the membrane and-tested oil lubrication. It reduces the wear fibres absorbs more moisture. This means that of piston, bearings and shafts and supports the three times more water is separated than in work with low-pulsation, constant air output. But conventional systems. Furthermore, compressors

TheraBase

Dental News

Quarter IV

with conventional drying systems can only utilise around 50 percent of their capacity as the drying medium must be regenerated at regular intervals. This is not necessary in the membranedrying unit – the compressor can run non-stop 24 hours a day. A membrane-drying unit provides dependable, high-quality dental air at all times In the case of conventional air drying, the compressed air is cooled first, e.g. via a cooling coil. The moisture that condenses out is «flung to the edge», as it were, in a cyclone chamber by specifically targeted turbulence and pulled downwards into a separation tank by the force of gravity. Residual moisture is typically eliminated by an adsorption agent. This is regenerated in the shut-off phase of the compressor. Currently, there is not a single compressed air system working on the basis of oil-lubricated pistons that can guarantee 100 % oil-free air. The dental solution can, therefore, only be an oil-free compressor. In such «self-lubricating» systems, the pistons move in finely machined cylinder bores. The piston rings are made from a special compound that is distinguished by outstanding sliding properties. And where there is no oil, it cannot affect the function of a dental turbine or the adhesive strength of an adhesive. More safety – less maintenance Oil-free, dry and hygienic – apart from minimised infection risk and greater treatment efficiency, this also leads to lower maintenance. The annual filter change that the dental team easily carries out itself in seconds is normally all that is required. Apart from that, compressors from leading manufacturers (e.g. Dürr Dental, Bietigheim-Bissingen, Germany) are completely maintenance-free. This also saves the practice expensive technician hours and bothersome down times. The team need not be concerned about such a compressor after installation. State of the art Compressors from Dürr Dental are equipped with membrane technology as standard. Existing systems can be retrofitted with a membranedrying unit if necessary. Models that precisely match the respective requirements are available for any size of practice – from «Tornado» for

one treatment room, through the «Duo» and «Trio», right up to the «Quattro» for four to five therapists. In the case of models with the «Tandem» name affix, the performance can be simply doubled with an additional unit for extending the practice. The «Quattro Tandem» model, that produces its enormous output from two units with a total of eight cylinders, is particularly suitable for larger dental practices and dental laboratories. For clinics, Dürr Dental offers equipment with compressed air stations for 30 to 50 treatment places and beyond that if necessary. Such systems are running, for instance, at the universities of Prague, Toulouse, Santiago de Chile, Madrid and Valencia – to name but a few. Conclusion Not only do compressed air supply systems simplify the treatment of the patient, they also play an important role in practice hygiene. Systems with membrane drying units run extremely reliably for prolonged periods entirely free of maintenance and offer maximum security. It saves the practice unnecessary work and costs due to premature wear and ensures the success of the treatment through durable fillings. Also with regard to the increased mobility of people, growing tourism and continually emerging new illnesses, high-quality and robust compressed air systems for minimising infections are a solid investment for every dental practice to ensure therapeutic and hygienic security for many years to come.

Success CD The material for perfect temporary crowns and bridges

LED light is better, right?

Correlated Colour Temperature (CCT)

High-quality temporary restorations within 5 minutes CCT defines the colour appearance of a white After a retention time of 30 to 60 seconds in the oral LED and is defined in degrees Kelvin or ‘K’. The cavity, the material takes on an elastic consistency, which aim for a dental treatment light is 5,000K which facilitates removal without risking deformation. The products . You wouldn’t dream of buying a car emits a neutral, white light. Anything less than material cures completely within a further 3 minutes and today without ABS (or equivalent feature), you 5,000K could be a compromise and provide a can then be polished. This procedure is timesaving and will probably expect Bluetooth connectivity for slightly warm yellow looking light. Higher than thus highly economical.

Success CD is PROMEDICA’s composite-based, selfAs technology moves forward, we start to curing paste-paste system for quick and easy chairside see certain features of equipment as standard, production of temporary crowns, bridges, inlays and and we start to demand these features from onlays.

your phone and a satellite navigation system. We do the same with dental equipment and generally we chose these features to benefit our patient experience, enhance our capabilities or improve our working conditions. One such feature to become standard over recent years has been an LED treatment light, but does an LED treatment light necessarily improve our working conditions? There are undoubted benefits in moving towards LED technology in our practice: less heat, no need to change halogen bulbs and a more modern appearance are undeniable benefits we can attribute to most LED light offerings in the market. But when you are considering a new treatment light, are you also considering the quality of the light generated? In my experience this can often be overlooked. You may assume that as LED lights are a more modern technology, that the quality of light generated will be better than your ageing halogen light. You may be shocked to learn that this may not necessarily be the case. Dental manufacturers had decades to develop and enhance the light quality of their halogen treatment lights, in some cases, the light quality TheraBase is a dual-cured, calcium and fluoride releasing, from halogen lights was actually excellent, even if self-adhesive base/liner. TheraBase contains MDP, hot to work under, more expensive to run and the chemically bonds to tooth structure, and utilizes THERA bulbs need replacing from time to time. So what technology. should you look for in a dental treatment light? The four top areas I would recommend exploring are: Brightness You want to create a bright working light in the oral cavity to enhance the vision of the whole dental team. This light should be brighter than your ambient lighting but beware that too large of a contrast can cause its own issues such as eye fatigue. You want to ensure that the lighting levels are safe for you to look into day in day out. Illumination of around 25-30,000 LUX will provide brilliant illumination in the oral cavity at a safe level.

TheraBase

Dental News

5,000K and the light may appear a cool blue colour. Excellent physical properties and great aesthetic results Colour Rendering Index As far as the material’s physical properties are concerned, Colour Rendering Index (CRI) provides a Success CD convinces with its excellent flexural and measure of how well light reproduces the colour overall strength as well as its capacity to withstand high of an object it is illuminating in comparison to an functional loads. ideal or natural light source. On a scale of 0 – 100CRI with 100 being perfect natural light you The product’s minimal polymerisation shrinkage results need a high CRI score combined with a CCT at in precisely fitting temporary restorations. Success 5,000K to allow accurate colour matching and CD’s high colour stability and brilliant, enamel-like gloss soft tissue examination. ensure long-term aesthetic results. Moreover, its natural Composite Curing fluorescence and the choice of available shades promote How often have you had to work without a perfect aesthetic results. treatment light just when you are completing your most technical restorations to avoid composites curing early? Light cure composites are cured website: www.promedica.de using the blue spectrum of light. ‘Cure Safe’ in many cases is simply a dimmer light. This means that you are still curing your composite (allbeit a little slower) and working with a compromised light. For a true ‘cure safe’ mode look for a light which filters out the blue spectrum of light and allows you to work with a bright illuminance without curing your composite. The author has a passion for dental ergonomics and is certified by The Back School in the USA. It is radiopaque allowing for effective identification on Nick offers free dental ergonomics work shops radiographs. Its dual-cure ability ensures the material will both in person and online. cure even in deep restorations where light cannot reach! Nick Olive CEAS Territory Manager Middle East & Egypt website: www.bisco.com A-dec nick.olive@a-dec.com +971 (0)585931983

Quarter IV

‫‪THE PRESIDENT OF THE REPUBLIC MICHEL AOUN,‬‬ ‫‪RECEIvING THE PRESIDENTS OF THE INTERNATIONAL DENTAL DELEGATIONS.‬‬

‫‪THE LEBANESE DENTAL ASSOCIATION CONGRESS‬‬ ‫‪OCTOBER 13-15, 2022, SEASIDE PAVILLON, BEIRUT, LEBANON‬‬ ‫راعي األحتفال‪ ،‬فخامة رئيس الجمهورية اللبنانية العماد ميشال عون‬ ‫ممثالً بمعالي وزير الشوون االجتماعية الدكتور إكتور حجار‬ ‫معالي الوزراء‪ ،‬سعادة النواب ‘ ممثلي قادة األجهزة العسكرية‬ ‫واألمنية‬ ‫النقباء العرب‬ ‫النقباء والنقباء السابقين‪ ،‬العمداء والعمداء السابقين‬ ‫المحاضرين الكرام‬ ‫الزميالت والزمالء‬ ‫ايها الحفل الكريم‬ ‫نجتمع اليوم بمناسبة إنعقاد المؤتمرالعلمي الثالثون لنقابة أطباء‬ ‫األسنان في بيروت‪ .‬وإن ش َكل هذا اإلنعقاد حدثا ً هاما ً ليس بسبب‬ ‫اإلنقطاع لمدة عامين وألسباب نعلمها جميعاً‪ ،‬أو ألهميته لما يمثله من‬ ‫رفع شأن المهنة العلمي‪ ،‬إنما كونه يشكل مؤشراً على حيوية في العمل‬ ‫النقابي نشهد عليها جميعا ً وتعكس أجوا ًء واعدة في مسارنا النقابي‪،‬‬ ‫وإصرا ٌر على المضي قدما ً في هذا المسار متخطين كل الصعوبات‪.‬‬ ‫منذ اليوم األول لوصولنا حرصنا على إعتماد سياسة اليد الممدودة‬ ‫للجميع‪ ،‬كما إتباع طرق الحوار إليصال النقابة إلى بر األمان‪ .‬فالنقابة‬ ‫ملك للجميع وننتظر من الجميع أقصى التعاون واإليجابية لتعزيز‬ ‫العمل النقابي الجدي بعيداً عن المزايدات والصراعات وزواريب‬ ‫السياسة الضيقة التي أرهقت النقابة ولم تنتج سوى التعطيل والشلل‬ ‫وتعريض مصالح األطباء وأمنهم الصحي والتقاعدي كما النقابي‬ ‫للخطر‪.‬‬ ‫أردناها نقابة قوية‪ ،‬تتسع للكل و منفتحة على الجميع‪ .‬بحيث يشعر كل‬ ‫طبيب بانتمائه لها وفخره بها‪.‬‬ ‫‪Quarter IV‬‬

‫الزمالء األعزاء‬ ‫إن التكوين المركب للمجالس النقابية كما الصناديق يجعلها تحمل هشاشة‬ ‫معينة ما لم يواكبها إرادة صادقة من مراكز التأثير وتضامنا ً عميقا ً بين‬ ‫أعضاءها مع تغليب للمصلحة النقابية‪.‬‬ ‫أعود إلى المؤتمر‪ ،‬هذا الحدث العالمي الذي يعني لي الكثير شخصيا ً‬ ‫والذي تحملت مسؤوليته العلمية في مرحلة سابقة ويعيد األشعاع أليام‬ ‫بيروت العلمية في نسختها الثالثين‪ ،‬كما لهذه المدينة الجميلة التي إعتادت‬ ‫طويال ٌ تنظيم ورعاية المؤتمرات‪ ،‬وكانت أبوابها مفتوحة دوما ً لألشقاء‬ ‫واألصدقاء‪.‬‬ ‫لقد خضنا منذ وصولنا في إتحاد نقابات المهن الحرة معركة إسترداد‬ ‫حقوقنا المسلوبة ونحن مستمرون بها في مسارات قانونية وتحركات‬ ‫مواكبة مبنية على تحديد المسؤوليات في حجز أموال النقابات تعسفا ً‬ ‫وأحييهم على الجهد الكبير الذي نقوم به معا‪.‬‬ ‫وختاما ً أشكر كل من ساهم في إنجاح المؤتمر‪ ،‬كما المحاضرين‬ ‫والشركات العارضة‪ .‬وأخص بالذكر رؤساء وأعضاء اللجان العلمية‬ ‫والتنظيمية وأعضاء مجلس النقابة والموظفين لتفانيهم في التحضير لهذا‬ ‫الحدث الكبير‪ .‬أتمنى للمشاركين كل الفائدة من البرنامج العلمي الغني‬ ‫وحسن التنظيم وللضيوف الكرام إقامة طيبة‪.‬‬ ‫وكما نشهد اليوم على هذه اإلنطالقة الواعدة للمؤتمر‪ ،‬كلنا أيمان أن هذا‬ ‫الوطن سينتفض كما الفينيق وينهض من رماده‪ .‬عشتم وعاش لبنان‪.‬‬ ‫بروفسور رونالد يونس‪،‬‬ ‫نقيب أطباء األسنان في لبنان‪ -‬بيروت‬

‫‪Dental News‬‬

‫‪56‬‬

DR. GEORGES AOUN, PRESIDENT OF THE SCIENTIFIC COMMITTEE IN THE OPENING CEREMONY

DR. ANTOINE CHOUFANI, MASTER OF THE CEREMONY

DR. AZEM QADDOUMI, PRESIDENT OF JORDANIAN DENTAL ASSOCIATION, WITH HIS COLLEAGUES AT THE OPENING CEREMONY

THE PRESIDENT OF THE LEBANESE DENTAL ASSOCIATION, PROF. RONALD YOUNES AND DR. MARIA ABBOUD, OFFERING THE TROPHY TO THE MINISTER HECTOR HAJJAR, REPRESENTING THE PRESIDENT OF THE REPUBLIC.

DR. HOUSSAM JASSAR, GENERAL SECRETARY OF THE LDA

PROF. TAREK ABBAS, DR. AZEM QADDOUMI, DR. TONY DIB

HANINE PERFORMING WITH A vIOLIN SHOW DURING THE OPENING CEREMONY

DRS: ZAHRA AYOUB, TONY DIB, FADI DAHBOUL, RAMZI HADDAD, MO AMUZIAN, MONA GHOSSOUB, JOSIANE DIB

DRS: MARLENE KHOURY, NAHIDA ASSAF, DEAN NADA MCHAYLEH, JOSIANE DIB, TONY DIB

L TO R: DRS; SAMER RIFAI, TONY DIB, CAMILLE HADDAD, MOHAMED DARWISH, MAGID AMIN, TAREK ABBAS, RONALD YOUNES, COLETTE BOUEIZ, AZEM QADDOUMI, AHMAD RIZK, ABOUBAKR ELIWA, AMIN ZOGHBI

DRS.: JULIEN LAUPIE, AHMAD RIZK, TONY DIB, MARWAN DAAS, PATRICK ROUASS

DRS.:. TONY DIB, NAJIB KHALAF, ROLA KHALAF, RONALD YOUNES, JOSIANE DIB, ANTOINE CHOUFANI

DRS.: HAMADI GTAT, ARBIA TAMIM , TONY DIB

Dental News

TONY DIB, SAMER RIFAI, DIETMAR GOLDMANN, ISSAM GHAZAL, ZIAD MJAES, ROULA ABIAD, JOSIANE DIB

Quarter IV

Dental News

Quarter IV

BIDM YEARS OF BIDM

Press Release

Dentsply Sirona equips Qatar’s first dental school with cutting-edge training tools to prepare the next generation of dental professionals

Press

Krystel Wi Corporate Sirona Str 5071 Wals T: +43 66 krystel.win @dentsply

Charlotte, December 14, 2021. Universities and large clinics around the world have entrusted Dentsply Sirona’s International Special Clinic Solutions (ISCS) division and its comprehensive approach to achieve their specific goals. When Qatar University’s College of Dental Medicine in Doha, envisioned their brand-new preclinical laboratory, they worked with Dentsply Sirona’s team to comprehensively equip it with state-of-theart technology to prepare students for dentistry’s digital future. 64

Dental News

32 Sim Intego workstations plus two additional instructor units now

Christina M Edelman G Schönebe 10963 Ber T +49 30 dentsplysi www.edelm

Marion Pa Vice Presi Corporate Sirona Str 5071 Wals Quarter IV T +43 (0) offer F +43 (0)

15 CEREC AI have been installed to make CAD/CAM training a permanent feature from the start.

Dentsply Sirona equips Qatar’s first dental school with cutting-edge training tools to prepare the next generation of dental professionals Press Contact Krystel Winiker Villalobos Corporate Communications Manager Sirona Straße 1 5071 wals bei Salzburg, Austria T: +43 664 60097 612 krystel.winikervillalobos@ dentsplysirona.com

s Contact

iniker Villalobos Marion Par-Weixlberger e Communications Manager raße 1Vice President Public Relations & Corporate s bei Salzburg, Austria Cimmunications 64 60097 612 Sirona Straße 1 nikervillalobos ysirona.com 5071 Wals bei Salzburg,

Austira

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ar-Weixlberger ident Public Relations & e Communications raße 1 s bei Salzburg, Austria ) 662 2450-588 56 Dental News ) 662 2450-540

Qatar University, the country’s primary institution for higher education, is partnering with Dentsply Sirona to equip the university’s brand-new preclinical lab at the newly founded College of Dental Medicine. Dentsply Sirona is providing state-of-the-art simulator workstations, instruments, as well as the latest CEREC and inLxab software systems to prepare students for the digital future of dentistry. Universities and large clinics around the world have entrusted Dentsply Sirona’s International Special Clinic Solutions (ISCS) division and its comprehensive approach to achieve their specific goals. When Qatar University’s College of Dental Medicine in Doha, envisioned their brand-new preclinical laboratory, they worked with Dentsply Sirona’s team to comprehensively equip it with state-of-the- art technology to prepare students for dentistry’s digital future. 32 Sim Intego workstations plus

two additional instructor units now offer the best possible learning environment following the latest technological advancements. Additionally, 15 CEREC AI units and the inLab system will be used to support future dentists in their training for highly specialized procedures. “The new College of Dental Medicine at Qatar University sees it as part of its core mission to incorporate digital technologies and the latest advancements into its teaching. Thanks to Dentsply Sirona’s innovative products and team of experts we were able to create a future-proof training environment,” said Dr. Hanin Daas, Director of Dental Laboratories at Qatar University. Preparing for the future of dentistry on cutting-edge equipment All products installed at the University of Qatar have been designed and produced in Germany using particularly robust and durable materials that are ideal for a Quarter III

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university setting. The state-of-the-art Sim Intego workstations in the preclinic allow students to train in practice-like conditions. Sim Intego includes key components of treatment centers such as the dentist element so that students already familiarize themselves with the actual treatment process in their preclinical semesters. Furthermore, the university also opted for the lightweight T1 line instruments series. These easyto-handle instruments help ensure the College of Dental Medicine is able to deliver the best training of correct instrumentation techniques to deliver optimal results. The International Special Clinic Solutions team selected the ideal product mix for Qatar University to fulfill their plan to make the most modern learning tools available to their students. During the preclinical training, CEREC and inLab systems will prepare the students for using CAD/ CAM technology in dentistry. Additionally, staff will be supported by a multimedia teaching system designed to enhance communication and to give students the best view of demonstrations at the master workstation. With a one touch button, it is possible to share real-time, highquality images from any device on any screen in the classroom. Dentsply Sirona is proud to have been selected by Qatar University to help turn their vision of educating world-class dental professionals and the nation’s first graduates of dental medicine into a reality. In consultations for the preclinic area, the International Special Clinic Solutions team discussed the university’s ideas and goals thoroughly and addressed each individual requirement in detail. The engineering team in Germany then developed a custom-made concept that delivers the required portfolio from start to finish. The College of Dental Medicine’s preclinical lab educates students in the basics of clinical dentistry before they practice on actual patients. The new lab provides a technologically advanced environment to train students in digital dentistry thus ensuring that the next generation of dental practitioners are well prepared to meet the demands of the future.

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The state-of-the-art multimedia collaboration system links all workstations. It gives students a great view on individual monitors and facilitates image and video transmission of intraoral scanners,microscopes, and cameras.

The newly founded College of Dental Medicine at Qatar University selected Dentsply Sirona to equip its preclinic area.

About Dentsply Sirona Dentsply Sirona is the world’s largest manufacturer of professional dental products and technologies, with over a century of innovation and service to the dental industry and patients worldwide. Dentsply Sirona develops, manufactures, and markets a comprehensive solution offering including dental and oral health products as well as other consumable medical devices under a strong portfolio of world class brands.Dentsply Sirona’s products provide innovative, high-quality and effective solutions to advance patient care and deliver better and safer dental care. Dentsply Sirona’s headquarter is located in Charlotte, North Carolina. The company’s shares are listed in the United States on NASDAQ under the symbol XRAY. Visit www.dentsplysirona.com for more information about Dentsply Sirona and its products. Quarter IV

THE 11TH AIO/ITALIAN DENTAL ASSOCIATION INTERNATIONAL CONGRESS IN SARDINIA: A SUCCESS STORY DEDICATED TO THE WOMEN IN DENTISTRY JUNE 9-11, 2022 CAGLIARI - SARDINIA - ITALY

View More Pictures On facebook.com/dentalnews1

PHOTO FROM THE OPENING CEREMONY Five hundred attendees representing the dental team: dentists, dental students, dental hygienists, dental assistants, dental technicians and office personnel. Almost 200 foreign visitors from all over the world. Seventy speakers. Fifty guests. One hundred operators representing dental companies. These are the final numbers of the 11th AIO/Italian Dental Association International Congress that took place in Chia, a seaside resort town on the spectacular island of Sardegna, last weekend. Organized by AIO branch of Cagliari/Oristano, the Congress touched on an exciting and evolving topic: equality between men and women in dentistry. Today the number of women practicing dentists is steadily increasing. Just two years ago women made up 40% of graduates from dental school. Now, in many countries, women make up from 50% to 70% of the total number of dental students. Dentistry is well on the way to becoming a female dominated profession!

DR. ANA PAZ FROM LISBON, PORTUGAL

The AIO International Congress, “Focus on the Gender Shift in Dentistry: A New Perspective or a Future Challenge?” remained true to its theme, exploring this trend on an even playing field equally divided between male and female lectures in their respective specialties. A panel of top leaders in dentistry gathered to discuss this gender shift during the Inaugural Ceremony that was opened by the President of the FDI World Dental Federation, Imane Ben Yahya with contributions from the founder of the Washington Institute of Dentistry Claudia Cotca and the Canadian endodontist and chairman of the ceremony, Ken Serota.

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DR. JOSETTE CAMILLERI AND DR. AUDREY CAMILLERI Quarter IV III Quarter

DRS: KATALIN NAGY, HELENA CHERHAvA, IOANA DATCU AND HENRIETTE LERNER

DR. SALvATORE SCOLAvINO AND DR. GAETANO PAOLONE

DRS: PREETINDER SINGH, KEN SEROTA, KIANOR SHAH

DRS: WALID ALTAYEB, GIOvANNI OLIvI, NASIM CHINIFRUSH, ALEKSANDRA KRISAY DUMIC Dental News

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ids-cologne.de

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COLOGNE 14. – 18.03.2023 40th International Dental Show 14. March 2023: Trade Dealer Day

SHAPING THE DENTAL FUTURE

Koelnmesse GmbH Messeplatz 1 50679 Köln · Germany Tel. +49 180 677 3577 ids@visitor.koelnmesse.de

Explore your new projects in Virtual Reality! International Special Clinic Solutions is Dentsply Sirona’s project team. As the global leader in dental education, with over 60 years of experience and more than 1,000 successful projects, we are the right partner for bringing your education to the next level. The realistic visualization of a project makes the construction process more coordinated and precise. Dentsply Sirona thus has a design team specialized in both precise twodimensional floor plans and 3D simulation. In the interactive 3D floor plan, we can guide you through all the rooms and levels of your new clinic or university complex, both from a first-person perspective and as a bird’s-eye view. Find more details here: www.dentsplysirona.com/clinics For further information please contact: salzburgaut-clinicsolutions@dentsplysirona.com dentsplysirona.com

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