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OBJECTIVES: The present trial's aim was to compare the remineralization potential of self-assembling peptide P11-4 combined with fluoride to that of fluoride varnish. MATERIALS AND METHODS: Twenty-eight participants with 58 incipient carious lesions were enrolled in the present trial. Participants were randomly divided into two groups with 14 participants and 29 incipient lesions in each group. Patients were assigned either to self-assembling peptide combined with fluoride (Curodont Repair Fluoride Plus™) or sodium fluoride varnish (NaF, Bifluorid 10) groups. Both agents were applied according to the manufacturer's instructions on non-cavitated incipient carious lesions. Lesions were assessed by two calibrated and blinded assessors at baseline, and after one-, three- and six-months using a laser fluorescence device (DIAGNOdent). RESULTS: Although laser fluorescence scores significantly improved in both groups over time (p < 0.05), no notable differences were evident between both groups at one-month (p > 0.05). Yet, at three- and six-months statistically lower laser fluorescence readings were evident in the self-assembling peptide combined with fluoride group in comparison to the fluoride alone group (p < 0.05). There was 60% less risk for caries progression for Curodont Repair Fluoride Plus™ when compared to NaF varnish after six months. Self-assembling peptide combined with fluoride was able to change 65.5% of non-cavitated carious lesions from DIAGNOdent score 3 (11-20) to score 1 (0-4). Fluoride varnish was able to change 13.8% of the lesions from score 3 to score 1 after six months. CONCLUSIONS: The self-assembling peptide combined with fluoride varnish showed higher remineralization potential than fluoride varnish alone for incipient carious lesions over a six-months follow up. CLINICAL RELEVANCE: The combination of self-assembling peptide P11-4 and fluoride could offer a new tool in managing incipient carious lesions.

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Background: Modern toothbrushes origin can be traced to plant-derived chewing sticks, which were documented to be used Babylonians as early as 3500 BC. Chewing sticks are routinely used for cleaning teeth in Asia, Africa, South America, and the Middle East. The aim of the current study was to evaluate the antibacterial effect of miswak herbal toothpaste compared to fluoride toothpaste using a normal toothbrush, against Streptococcus mutans in high caries risk patients. Material and Methods: A total of 32 participants were recruited to the current clinical trial using convenience sampling randomly either to miswak or fluoride toothpastes groups (n=16). The bacterial count represented as colony-forming units per milliliter (CFU/ml) was assessed at baseline and after 1 week, 1 month and 3 months. Moreover, the ion release for silicone, calcium, phosphorus, and fluoride from both toothpastes was analyzed in addition to the pH of both toothpastes and their supernatants. Intergroup comparison was performed using independent t test, while intragroup comparison was performed using repeated measures ANOVA followed by tukey post-hoc test and paired t test when appropriate. Results: There was no statistically significant difference between both toothpastes for the S. mutans count within each follow up period, however the bacterial count significantly decreased over time in both groups. Signal Fluoride toothpaste exhibited statistically significant higher ion release when compared to the Dabur Miswak toothpaste. There was no statistically significant difference between either toothpastes regarding pH (P = 0.5368), while comparison between supernatants of toothpastes have shown statistically significant difference (P = 0.0194), with a higher pH in miswak toothpaste. Conclusions: Miswak herbal toothpaste possesses a potent antibacterial effect, yet its remineralization potential is questionable due to its inferior ion release that will affect the ion substantivity in saliva, which is an important factor in remineralization. Key words:High caries risk, Miswak, Fluoride, Antibacterial, Streptococcus mutans.

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BACKGROUND: Resin composite restorations are highly esthetic restorations, which should have and maintain high surface polish. However, esthetic restorations are subjected to different beverages at variable temperatures, which may affect their surface roughness. This study aimed to evaluate the surface roughness of single-shade (Omnichroma) and multi-shade (Filtek Z350XT) composite materials, following aging by immersion and thermocycling in different beverages, simulating one year of clinical service. METHODS: Thirty specimens of each material were prepared and divided into 6 subgroups (n = 5). In each material, the grouping of the specimens was as follows: the first subgroup was the as-prepared specimens stored dry without immersion or thermocycling. The second, third, and fourth subgroups were immersed in saliva, tea, and red wine, respectively, for 12 days at 37 °C. The fifth and sixth subgroups were thermocycled for 10,000 cycles, in tea (the fifth between 37 and 57 °C) and in red wine (the sixth between 37 °C and12°C). The resultant surface roughness was measured by two different methods, stylus profilometer and atomic force microscopy (AFM). Intergroup comparison was performed using independent t test, while intragroup comparison was performed using one-way analysis of variance (ANOVA) followed by Tukey's post-hoc test. RESULTS: Intergroup comparison between both composites showed no statistically significant differences in all groups using the stylus profilometer roughness measurements (P>0.05), while the AFM measurements showed significant difference (P ≤ 0.05) within all storage media except the as-prepared control (P = 0.0645), where nanofilled Filtek Z350 XT showed lower nano-roughness. Intragroup comparison data were variable, depending on the material, aging conditions, and roughness assessment tool. However, the resultant average surface roughness (Ra) values in all groups did not exceed the threshold value of Ra 0.2 µm. CONCLUSIONS: Both resin composites attained and retained a clinically acceptable surface finish after immersion and thermocycling in different beverages.

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Aim: The present investigation aimed at assessing the diagnostic accuracy of DIAGNOdent compared to the International Caries Detection and Assessment System-II (ICDAS-II) in the detection of facial, smooth surface noncavitated carious lesions. Settings and Design: Sixty patients were enrolled in the current study according to the eligibility criteria. There were 161 teeth with noncavitated, white spot carious lesions and 32 sound teeth. Materials and Methods: Before examination, teeth were cleaned and polished and all patients were assessed under standardized operating conditions: preset dental unit position, operating light, and prolonged air drying (approximately 5 s). All teeth were assessed by two calibrated examiners individually without any contact using ICDAS-II and DIAGNOdent. Statistical Analysis: The diagnostic accuracy of DIAGNOdent device was determined, including sensitivity, specificity, overall accuracy, positive and negative predictive values, and receiver operating characteristic curve analysis. Chi-square test was conducted to compare the distribution of ICDAS-II and DIAGNOdent scores. Inter-observer agreement between assessors was evaluated using Cohen's kappa test. Results: In the current study, DIAGNOdent had an overall accuracy of 84.45% with sensitivity and specificity of 87.58% and 96.87%, respectively, and +PV and -PV of 97.7% and 83.9%, respectively, when score 0 represented sound tooth surface, while scores 1 and 2 were considered clinically noncavitated carious lesions. Moreover, when only ICDAS score 1 was considered representing first visual change in enamel, DIAGNOdent had an accuracy of 74.15% with sensitivity and specificity of 83.53% and 90.62%, respectively, and +PV and -PV of 93% and 78.6%, respectively. In the present study, when only ICDAS score 2 was considered representing distinct visual change in enamel, DIAGNOdent had an accuracy of 100% with sensitivity and specificity of 100% and 100%, respectively, and +PV and -PV of 100% and 100%, respectively. Conclusions: The overall performance of DIAGNOdent was equivalent to the visual inspection using ICDAS-II. DIAGNOdent might be considered a useful adjunctive device for detection and monitoring development of noncavitated carious lesions on facial smooth surfaces.

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Background: Early caries detection became mandatory in modern dentistry. However, the traditional methods in caries detection had many limitations. Hence,a novel approach based on Near Infrared technology was introduced to overcome such limitations. Material and Methods: Proximal surfaces of 102 posterior teeth from 36 adult participants who fulfilled the eligibility criteria were assessed by two examiners using three diagnostic methods. Teeth were examined visually according to the criteria of the International Caries Detection and Assessment System (ICDAS-II) then examined by bitewing digital radiograph (BW) and near infrared light transillumination (NIRT) camera (Vista Proxi iX HD smart). Inter and intra observer agreements were assessed using Kappa test.Dignostic accuracy parameters and Area Under the ROC curve (AUROC) with 95% confidence interval (95% CI) were evaluated for the different caries assessment methods. Results: The results of inter-observer agreement showed an excellent agreement in the different groups. There was a statistically significant difference in the score distribution between ICDASII and VistaCam modalities (P-value <0.05). While there was no statistically significant difference in the score distribution between bitewing radiography and VistaCam modalities (P-value >0.05). ROC curve analysis revealed that VistaCam when compared with ICDASII had sensitivity (99.0%), specificity (50.0 %), diagnostic accuracy (98.0%) and Area under the ROC curve (AUC) was 0.745 with 95% Confidence Interval (0.649 - 0.826).When VistaCam compared with bitewing radiography, it showed sensitivity (100.0%); specificity (40.0%), diagnostic accuracy (97.1%) and AUC (0.700) with 95% confidence interval (0.601 - 0.787). Conclusions: NIRT based diagnostic modality is a promising method for detection of hidden proximal lesions overcoming the hazards of radiograph. Key words:Bitewing radiography , ICDAS II , Near-infrared transillumination, proximal caries, VistaCam® iX Proxi.

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Objective: The present clinical trial was conducted to evaluate the clinical performance of the biomimetic, bilayered structure utilizing a fiber reinforced bulk fill resin composite with a nanohybrid capping layer, compared to incremental packing of nanohybrid resin composite, in deep proximal cavities in permanent molars. Material and methods: A total of 36 deep proximal cavities in vital molars were restored either with a bilayered structure of fiber reinforced composite resin as a dentine substitute and a capping layer of nanohybrid composite resin (n=18) or conventional, nanohybrid composite resin incrementation (n=18). The restorations were assessed over a period of 12 months using the modified USPHS criteria. The criteria evaluated were: fracture and retention, marginal integrity, marginal discoloration, anatomic form, proximal contact, surface texture, radiographic evaluation, postoperative sensitivity and secondary caries. Results: There was no statistically or clinically significant difference between fiber-reinforced resin composite and conventional incremental resin composite. There was no risk for failure regarding all the evaluated modified USPHS criteria for both materials after 12 months (RR= 1(95% CI 0.0209 to 47.8503; P =1.0000)). Conclusion: The biomimetic approach utilizing a fiber reinforced resin composite dentine substitute showed a comparable clinical performance to nanohybrid resin composite incrementation. Bulk fill fiber reinforced resin composite is an efficient alternative in restoration of deep proximal cavities in posterior teeth. Further long-term studies are necessary to confirm these results.

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BACKGROUND: Although visual inspection is the preferred route in everyday clinical practise for detecting early caries lesions, novel technologies like light fluorescence-based devices (Vista Proof iX HD smart) have been developed to enhance early caries detection. MATERIAL AND METHODS: Occlusal surface of 45 molar and 49 premolar teeth from 34 adult participants who fulfilled the eligibility criteria were examined by two observers using three diagnostic methods. Examination was performed visually using the International Caries Detection and Assessment System (ICDAS-II) followed by Vista Proof. Fissurotomy was applied for histological validation. Intra- and inter-observer agreement were measured for ICDAS-II and light-induced fluorescence camera using Kappa test. The overall diagnostic accuracy parameters, area under the receiver operating characteristic curve (AUC-ROC) and 95% confidence interval (95% CI) of the (AUC) for caries detection by Vista Poof were evaluated. RESULTS: For ICDAS-II and Vista Proof methods, there was almost perfect intra- and inter-observer agreement. Based on ICDAS-II as a reference standard 1, Vista Proof showed a low level of agreement in enamel carious lesion detection with low sensitivity value of 48%, high specificity of 100%, and AUC was 0.112, while a high level of agreement in dentin carious lesion detection with high sensitivity value of 100%, low specificity of 48% and AUC was 0.888. Based on fissurotomy as reference standard 2, Vista Proof showed a high level of agreement in dentin carious lesion detection with high sensitivity value of 95% and 0% specificity and AUC was 0.814. CONCLUSIONS: Quantitative light-induced fluorescence camera with reference to ICDAS-II is considered as an accurate diagnostic modality for detection of early occlusal caries. Histological findings validate the diagnostic accuracy of the camera in dentin. Key words:Histological validation, Initial caries, ICDAS, Light induced fluorescence, Vista Cam.

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PURPOSE: To evaluate the difference between ICCMS and CAMBRA models on treatment plan of young adults. SETTINGS AND DESIGN: A total of 104 young adult patients were randomly divided into two groups, either ICCMS or CAMBRA. PATIENTS AND METHODS: Patients were examined according to the criteria of the ICDAS-II and caries risk was analyzed according to CAMBRA and divided into two equal groups according to treatment protocol. Caries incidence was assessed according to ICDAS-II criteria after 6 and 12 months. Statistical analysis used Chi-square test. A value of P ≤ 0.05 was considered statistically significant. Relative risk (RR) was used to determine the clinical significance. RESULTS: The current study has revealed no statistically significant difference between both caries risk assessment models tested at baseline (P = 0.317), 6 months (P = 0.164) and 1 year (P = 0.287). Intra-group assessment of CAMBRA group showed a statistically significant difference in ICDAS scores (P = 0.002) after 12 months in high- and moderate-risk groups while low-risk group did not show statistically significant difference in ICDAS scores between different follow-up periods (P = 0.593) and (P = 1.000), respectively. ICCMS groups did not show statistically significant differences in any group along follow-up periods. CONCLUSION: ICCMS and CAMBRA were equivalent in preventing new decay. The ICCMS treatment plan is a safe approach and its preventive products are available over the counter. However, it is more complicated than CAMBRA. While CAMBRA is simpler, it is less comprehensive, some of its products are not available over the counter worldwide (e.g. Duraphat 5000 ppm) and some of them may be accompanied by several side effects (e.g. chlorhexidine mouthwash), which may weaken its management protocol.

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BACKGROUND: Self-adhering flowable composite (SAFC) simplified restorative procedures, especially when compared to conventional techniques. Self-adhering composite revolutionized restorative dentistry by merging advances of adhesive and restorative materials to generate the so-called "eighth generation." AIMS: The objective of this clinical trial was to assess the clinical performance of SAFC compared to conventional flowable composite in minimally invasive occlusal cavities. SETTINGS AND DESIGN: A total of 18 patients with conservative occlusal cavities received randomly two types of restorations in a split-mouth design. MATERIALS AND METHODS: Vertise™ Flow or Filtek™ Z350XT Flowable was applied according to the manufacturer's instructions. All restorations were evaluated at baseline and after 24 months, respectively, by two blinded assessors using modified USPHS criteria. STATISTICAL ANALYSIS USED: Chi-square test was used for intragroup comparison between time points and intergroup comparison within each time point. A value of P ≤ 0.05 was considered statistically significant. Relative risk was used to determine the clinical significance. RESULTS: The results of the current study have revealed no statistically significant difference between both materials for all tested outcomes at baseline and after 24 months. CONCLUSIONS: SAFC revealed satisfactory clinical performance in restoration of minimally invasive occlusal cavities after 24-month follow-up.

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OBJECTIVES: To evaluate the effect of probiotic bacteria in yogurt on Streptococcus mutans (MS) count, plaque adherence and salivary pH compared to xylitol-containing chewing gum in geriatric patients. MATERIALS AND METHODS: Total number of 96 high caries risk geriatric patients were randomized into two equal groups (n=48). Group 1 (intervention group) received probiotic yogurt (Activia, Danone) once per day, and group 2 (control group) received xylitol chewing gum (Trident original) three times per day. The primary outcome was salivary Streptococcus mutans count and secondary outcomes were interdental plaque Streptococcus mutans count, salivary pH and bacterial adherence. RESULTS: For Streptococcus mutans count in saliva and plaque, a statistically significant reduction in the level of MS over all the examined follow up periods of the study in probiotic yogurt group as well as xylitol gum group was found. An intergroup comparison for salivary MS count showed statistically significant difference between the two materials in a two week and a three month period of time and there was no statistically significant difference between both materials at one month time period. Salivary pH results showed statistically significant increase in pH in both groups along the follow-up periods. Bacterial adherence results showed statistically significant reduction in both groups. CONCLUSIONS: Probiotic yogurt is an effective antibacterial agent against salivary and plaque bacteria in geriatric patients.

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OBJECTIVES: This study aimed to investigate the techniques of matricing used by Egyptian dentists, and evaluate the influence of these techniques on the reproduction of optimum proximal contacts for posterior proximal resin composite restorations. MATERIAL AND METHODS: An online questionnaire was developed and sent to 785 dentists via e-mail and social media platforms. The survey asked the participants about the following: the highest academic degree achieved and their experience, techniques of matricing used, brands of matricing systems used, assessment of proximal contact points, their evaluation of the contact points they reproduced, and their assessment of the restorations' emergence profiles. RESULTS: A total of 415 dentists participated in the study (response rate 52.8%). 308, (74%), dentists preferred using the sectional matrix system, while 107 dentists, (26%), preferred using the circumferential matrix system. One hundred twenty-six dentists, (31%), reported that the circumferential matrix systems reproduced optimum contacts, 105 dentists, (25%), reported tight contacts and 184 dentists, (44%), reported open contacts. However, for the sectional matrix systems, the optimum contacts were reported by 279 dentists, (67%), tight contacts by 109 dentists, (26%), and open contacts by 27 dentists, (7%). There was a statistically significant difference between the sectional matrix systems and the circumferential matrix systems regarding the tightness of the proximal contact points (P<0.0001). CONCLUSIONS: Egyptian dentists preferred using the sectional matrix systems. The survey indicated that optimum contact points were highly associated with the sectional matrix systems, while poor (open and tight) contacts were highly associated with the circumferential matrix systems.

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BACKGROUND: Self-adhering flowable composite (SAFC) minimized the time-consuming application procedures encountered with the traditional adhesive systems and restorative materials. Self-adhering composite combines the merits of both adhesive and restorative material technologies (8th generation) in a single product, bringing new horizons, and ambitions to restorative procedures. AIM: The aim of this study was to evaluate the clinical performance of SAFC compared to conventional flowable composite in conservative Class I cavities. MATERIALS AND METHODS: In a split-mouth design, after cavity preparation, 18 patients with conservative Class I cavities received randomly two pairs of restorations, either Vertise™ flow or Filtek™ Z350 XT Flowable combined with Scotchbond™ Universal Etchant and Single Bond Universal, all materials were applied according to the manufacturer's instructions. Restorations were evaluated at baseline and after 6 months by two calibrated assessors using the modified United States Public Health Service criteria measuring (retention, postoperative hypersensitivity, color match, marginal adaptation, and marginal discoloration). STATISTICAL ANALYSIS: Chi-square test was used to compare between flowable composite materials after different follow-up periods, Wilcoxon signed-rank test was used to explore changes over follow-up periods. A value of P ≤ 0.05 was considered statistically significant. Results: At baseline and 6 months, there was no statistically significant difference between both materials for all tested outcomes. CONCLUSIONS: SAFC has shown clinical performance similar to conventional flowable composite after 6 months of clinical service.

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The purpose of this systematic review was to evaluate clinical performance of flowable composite in carious and noncarious lesions. An electronic search was conducted using specific databases (PubMed, Embase, Cochrane Library, and LILACS) through March 2017. Clinical trials for restoration of carious and noncarious lesions were included with no date restrictions; follow-up was 6 months at least and dental restorations were evaluated using the United States Public Health Service criteria. The systematic search generated 908 papers, of which 35 papers were included for full-text review. Inclusion criteria were met by eight papers, six papers were for noncarious lesions and two papers were for restoration of carious lesions. The results of this review have shown no statistical or clinical difference between flowable and conventional composites for all tested outcomes in both carious and noncarious lesions. Both materials have shown clinically acceptable scores for all criteria, with no evidence of clinically unacceptable scores except in retention, with a retention rate of 83% in both materials after 36 months. Flowable composites had clinical efficacy after 3 years of service similar to that of conventional composite in both carious and noncarious lesions, these results are based on low quality of evidence. Based on the available literature and the best available evidence, flowable composites can be used in restoration of noncarious cervical lesions and minimally invasive occlusal cavities.