America is set to experience more severe storms, hurricanes, floods, droughts, heat waves, and wi... more America is set to experience more severe storms, hurricanes, floods, droughts, heat waves, and wildfires. 2) The coasts, similar to those worldwide, will be inundated by rising sea levels. 3) There are, consequently, many serious public health and welfare implications for environmental justice (EJ) communities due to global warming. While all risks will affect the low-income earners more acutely, risks that will undoubtedly yield disproportionate adverse impact are the consequences of heat extremes, increased pollution-related illnesses, and, for native communities in particular, loss of land and livelihoo
To evaluate the fracture resistance (FR), and push-out bond strengths (BS) of custom-made CAD/CAM... more To evaluate the fracture resistance (FR), and push-out bond strengths (BS) of custom-made CAD/CAM post-and-cores manufactured with different esthetic materials. 90 single-rooted extracted teeth were selected, endodontically treated and prepared to receive the posts. The specimens were randomly divided into three equal groups according to the material: hybrid ceramic Vita Enamic (HC); nano-ceramic resin composite Lava Ultimate (RC); and experimental epoxy-resin reinforced by glass-fiber (FG). The post-and-cores were manufactured using CAD/CAM and cemented using a self-adhesive resin cement (Rely X Unicem2). A subgroup of 30 specimens (n=10) was subjected to fatigue (1,000,000 cycles at 5 Hz) and then to the FR test. Another subgroup with 60 specimens was submitted to the BS test, with and without fatigue. Data were submitted to analysis of variance (FR - one-way ANOVA; BS - two-way ANOVA) and Tukey's test (α= 0.05). The FR values (mean±SD, in Newtons) were 414.5±83.9 (HC), 621.3±...
Optical impressions can offer many advantages over conventional impressions because they do not u... more Optical impressions can offer many advantages over conventional impressions because they do not undergo dimensional change and are not susceptible to damage from handling; need less armamentarium (no need for trays, adhesives, and dispensers); provide immediate on-screen feedback; they increase the scope of planning and diagnosis; permit easier communication with the dental laboratory with no cross infection risk; and allow easier duplication, storage, and retrievability. Furthermore, optical impressions allow chairside fabrication of definitive restorations in a single appointment. 1 However, optical impressions have some limitations, such as the size of the scanning wand, which can create problems for patients with limited mouth opening, the procedure learning curve, and the difficulty in scanning subgingival margins. 1 Although optical impressions have advantages, their adoption in daily dental practice and the shift toward a complete digital workflow are contingent upon the ability of complete arch optical impressions to replicate oral and dental structures at a Supported by 2014 Ralph Phillips Student Research Award from the Academy of Operative Dentistry (to M.A.A.). Cerec Omnicam provided by Dentsply Sirona USA. Materials provided by Kettenbach USA and Dentsply USA.
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 2017
In the direct-indirect composite technique, composite is applied to a nonretentive tooth preparat... more In the direct-indirect composite technique, composite is applied to a nonretentive tooth preparation (eg, a noncarious cervical lesion or a veneer/inlay/onlay preparation) without any bonding agent, sculpted to a primary anatomic form, and light-cured. The partially polymerized restoration is then removed from the preparation and finished and tempered extraorally chairside. The finished inlay is bonded to the preparation using a resin-based luting agent. Advantages of this technique include enhanced physical and mechanical properties afforded by the extraoral chairside tempering process because of increased monomer conversion, and greater operator control over the final marginal adaptation, surface finishing and polishing, and anatomy of the restoration, given that these elements are defined outside of the patient's mouth. The direct-indirect approach also affords enhanced gingival health and patient comfort. This article presents a clinical case in which the direct-indirect com...
The shifted angular spectrum method allows a reduction of the number of samples required for nume... more The shifted angular spectrum method allows a reduction of the number of samples required for numerical off-axis propagation of scalar wave fields. In this work, a modification of the shifted angular spectrum method is presented. It allows a further reduction of the spatial sampling rate for certain wave fields. We calculate the benefit of this method for spherical waves. Additionally, a working implementation is presented showing the example of a spherical wave propagating through a circular aperture.
This study evaluated bond strengths of orthodontic brackets to instrumented and uninstrumented en... more This study evaluated bond strengths of orthodontic brackets to instrumented and uninstrumented enamel using self-etching adhesive systems when compared to a total-etch adhesive system. The adhesive remnant index (ARI) was also determined after debonding. 140 bovine incisors were included in acrylic resin, and divided randomly in two groups: instrumented vs. uninstrumented enamel. For the instrumented enamel, specimens had their facial enamel ground flat to 600-grit. In each group, specimens were subdivided into four experimental subgroups according to the adhesive technique used: Transbond Plus, Adper Prompt L-Pop, iBond, and Adper Single Bond, applied following manufacturers' instructions. Orthodontic brackets were bonded to the treated instrumented or uninstrumented enamel with Transbond XT light-cured resin-based composite cement, and the bond strength was tested in shear mode after 7 days. One group where no etch and no adhesive were used served as a control. ARI scores were...
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 2005
Composite resins are increasingly used for the restoration of anterior and posterior teeth. Altho... more Composite resins are increasingly used for the restoration of anterior and posterior teeth. Although adhesives and composites have become easier to use than earlier generations of these materials, the use of composite resins is still technique-sensitive. This article reviews the current recommendations for the use of direct composite resins and summarizes the technique for both anterior and posterior restorations.
This study evaluated the influence of (1) different dentin treatments and (2) storage time on den... more This study evaluated the influence of (1) different dentin treatments and (2) storage time on dentin shear bond strengths. Two hundred and twenty-five bovine incisors were collected, ground to expose a flat dentin surface and randomly divided into three groups according to dentin surface treatment: (1) Total etch + Single Bond; (2) Total etch + collagen depletion with 10% NaOCl + Single Bond and (3) No etch + experimental self-etching adhesive. Composite was applied to the treated surfaces using a 3 x 5 mm cylindrical Teflon matrix and was light-cured. Each group was further stratified in five subgroups according to storage time in water at 37 degrees C: 1 day, 7 days, 30 days, 6 months and 12 months. Shear bond strengths (SBS) were determined and expressed in MPa. Data was analyzed for statistical significance with two-way ANOVA and Tukey's test (p=0.05). No interaction was observed between surface treatment and storage time. Storage time did not significantly affect bond stren...
Quintessence international (Berlin, Germany : 1985), 1996
A new technique for the performance of resin composite direct restorations on posterior teeth is ... more A new technique for the performance of resin composite direct restorations on posterior teeth is presented. A clear acrylic resin matrix, fabricated prior to the preparation of the occlusal and proximal surfaces, is employed. The matrix allows the fast and accurate reproduction of the anatomic details from the original occlusal surface of the tooth, as well as the marginal ridges in the case of Class II (occlusoproximal) restorations. Advantages and limitations of the procedure are discussed.
Aim: To evaluate the influence of finishing and polishing techniques on the surface roughness of ... more Aim: To evaluate the influence of finishing and polishing techniques on the surface roughness of two composite resins (CRs) subjected to bleaching procedure. Methods: Forty-eight CR specimens were divided into six groups (n=8). For G1 to G3, a microhybrid CR (Opallis; FGM) was used, and G4 to G6, received a nanohybrid CR (Brilliant NewLine; Coltène/Whaledent). All specimens were subjected to bleaching procedure with 35% hydrogen peroxide (two 45-min applications, with a 5-day interval). The surface roughness of all specimens was evaluated before and after the bleaching and/or finishing/polishing (Ra parameter) by a roughness meter. After bleaching, the groups were subjected to finishing and polishing procedures: G2 and G5-felt discs + diamond pastes; and G3 and G6-silicon rubber tips. The control groups (G1 and G4) had no finishing or polishing treatment after bleaching. Data were analyzed by ANOVA and Tukey's posttest, and t test for paired samples (α=0.05). Results: bleaching treatment increased Ra values for the nanohybrid CR specimens, but both finishing/polishing techniques were able to reduce these values; for the microhybrid specimens, only finishing/polishing with silicon rubber tips decreased the roughness values. Conclusions: For both microhybrid and nanohybrid CRs, the silicon rubber tips were effective to reduce the surface roughness after bleaching procedure.
Objectives: The objectives of this longitudinal study were to evaluate safety and determine patie... more Objectives: The objectives of this longitudinal study were to evaluate safety and determine patients' satisfaction and perceptions of a Nightguard Vital Bleaching (NGVB) technique. Methods: Thirty-one participants who had completed previous NGVB studies using 10% ...
The Journal of the American Dental Association, 2007
ABSTRACT The Centers for Disease Control and Prevention has adopted guidelines for infection cont... more ABSTRACT The Centers for Disease Control and Prevention has adopted guidelines for infection control of extracted teeth used for research and teaching, requiring that teeth be sterilized before use. The authors conducted a study to test the null hypothesis that the storage medium and sterilization method have no effect on composite-to-dentin bond strengths. The authors collected 170 bovine incisors, cleaned them and placed them randomly into one of six storage media at 37 degrees C for 60 days: distilled water (dH(2)O), 0.9 percent sodium chloride, 0.5 percent chloramine-T, 5.25 percent sodium hypochlorite (NaClO), 2 percent glutaraldehyde and 10 percent formalin. For sterilization, they autoclaved a subset of 10 specimens from every sample, while they stored another subset of 10 specimens from every sample (except for the 10 percent formalin sample) in 10 percent formalin for 14 days. The authors then embedded the specimens in epoxy and ground flat the facial surface to expose middle-depth dentin, which they polished to 600 grit. They used a dental adhesive to apply composite to the exposed dentin. The authors tested the composite-to-dentin shear bond strength 24 hours after bonding. They analyzed the data using global analysis of variance and, when appropriate, multiple post hoc tests (P = .05). Storage in NaClO resulted in significantly lower bond strength than that of the other treatment specimens. Sterilization with the autoclave negatively affected the bond strength of specimens stored initially in dH(2)O or 10 percent formalin, while sterilization with formalin alone had no significant effect on bond strengths. Storing bovine teeth in 5.25 percent NaClO may negatively affect composite-to-dentin bond strengths. Immersion in 10 percent formalin might be the best option for storage and sterilization of bovine teeth that are to be used in dental bonding studies in vitro.
As the number of dental-related randomized clinical trials (RCTs) increases, there is a need for ... more As the number of dental-related randomized clinical trials (RCTs) increases, there is a need for literature to help investigators inexperienced in conducting RCTs design and implement studies. This commentary describes four "lessons learned," or considerations important in the planning and initial implementation of RCTs in dentistry that to our knowledge have not been discussed in the general dental literature describing trial techniques. These considerations are 1) preparing or securing a thorough systematic review, 2) developing a comprehensive set of study documents, 3) designing and testing multiple recruitment strategies, and 4) employing a run-in period prior to enrollment. Attention to these considerations in the planning phases of a dental RCT can help ensure that the trial is clinically relevant while also maximizing the likelihood that its implementation will be successful.
The study aims to determine a) the extent of agreement between visual-tactile caries examination ... more The study aims to determine a) the extent of agreement between visual-tactile caries examination (VTE) and radiographic examination (RE) in detecting presumptive caries lesions on occlusal and proximal surfaces of posterior teeth of UNC Xylitol for Adult Caries Trial participants; and b) the additional caries diagnostic yield obtained by adding RE to VTE. Data consisted of surface-level visual-tactile and radiographic classification of disease (cavitated and noncavitated caries lesions) or nondisease (sound surfaces). Participants (n = 114, adults with ≥12 erupted teeth and 1-10 caries lesions) received baseline VTE by a trained and calibrated examiner, and had interproximal radiographs obtained within 7 months before or after the VTE. Radiographs were assessed independently by two trained and calibrated examiners masked with respect to VTE results. The diagnostic threshold was surface-level disease/nondisease status. Kappa statistics provided an estimate of VTE-RE agreement on diseased surfaces. The additional diagnostic yield of the RE over VTE was calculated as the additional lesions detected radiographically as a percentage of the total number of lesions detected by VTE. Four-hundred ninety-four (51 occlusal, 433 proximal) lesions were detected; of these, 81 (2 occlusal, 79 proximal) lesions were detected by both VTE and RE. Kappa statistics were 0.18 (all surfaces), 0.04 (occlusal), and 0.18 (proximal). The additional diagnostic yield was 69 percent (all surfaces), 55 percent (occlusal), and 71 percent (proximal). There is poor agreement between VTE and RE to detect caries in posterior teeth of caries-active adults. However, an RE performed within 7 months of a VTE adds caries diagnostic yield in a clinical trial, especially on proximal surfaces.
ABSTRACT A randomized clinical trial of the anti-caries efficacy of 5000 compared to 1450 ppm flu... more ABSTRACT A randomized clinical trial of the anti-caries efficacy of 5000 compared to 1450 ppm fluoridated toothpaste on root caries lesions in elderly disabled nursing home residents. Ekstrand KR, Poulsen JE, Hede B, Twetman S, Qvist V, Ellwood RP. Caries Res 2013;47(5):391-98. André V. Ritter, DDS, MS, MBA PURPOSE/QUESTION: Is 5000 ppm fluoridated toothpaste used twice daily more efficacious than 1450 ppm fluoridated toothpaste used twice daily for controlling root caries progression in elderly disabled nursing home residents? This study was supported by a donation from Colgate Palmolive, manufacturer of the two toothpaste interventions This was a randomized clinical trial done with a convenience sample, with elements of comparative effectiveness design Level 2: Limited-quality, patient-oriented evidence Not applicable.
Journal of Esthetic and Restorative Dentistry, 2009
A n d r é V. R i t t e r , D D S , M S * Dental erosion caused by either extrinsic or intrinsic s... more A n d r é V. R i t t e r , D D S , M S * Dental erosion caused by either extrinsic or intrinsic sources of acids is an increasing clinical problem that can lead to dental hypersensitivity and poor tooth contours. Extreme cases of dental erosion can even lead to substantial compromise of function and need of extensive oral rehabilitation. Gastroesophageal reflux disease (GERD) has been found to be a common cause of dental erosion. In many cases, the dental team may be the first health care provider to make
America is set to experience more severe storms, hurricanes, floods, droughts, heat waves, and wi... more America is set to experience more severe storms, hurricanes, floods, droughts, heat waves, and wildfires. 2) The coasts, similar to those worldwide, will be inundated by rising sea levels. 3) There are, consequently, many serious public health and welfare implications for environmental justice (EJ) communities due to global warming. While all risks will affect the low-income earners more acutely, risks that will undoubtedly yield disproportionate adverse impact are the consequences of heat extremes, increased pollution-related illnesses, and, for native communities in particular, loss of land and livelihoo
To evaluate the fracture resistance (FR), and push-out bond strengths (BS) of custom-made CAD/CAM... more To evaluate the fracture resistance (FR), and push-out bond strengths (BS) of custom-made CAD/CAM post-and-cores manufactured with different esthetic materials. 90 single-rooted extracted teeth were selected, endodontically treated and prepared to receive the posts. The specimens were randomly divided into three equal groups according to the material: hybrid ceramic Vita Enamic (HC); nano-ceramic resin composite Lava Ultimate (RC); and experimental epoxy-resin reinforced by glass-fiber (FG). The post-and-cores were manufactured using CAD/CAM and cemented using a self-adhesive resin cement (Rely X Unicem2). A subgroup of 30 specimens (n=10) was subjected to fatigue (1,000,000 cycles at 5 Hz) and then to the FR test. Another subgroup with 60 specimens was submitted to the BS test, with and without fatigue. Data were submitted to analysis of variance (FR - one-way ANOVA; BS - two-way ANOVA) and Tukey's test (α= 0.05). The FR values (mean±SD, in Newtons) were 414.5±83.9 (HC), 621.3±...
Optical impressions can offer many advantages over conventional impressions because they do not u... more Optical impressions can offer many advantages over conventional impressions because they do not undergo dimensional change and are not susceptible to damage from handling; need less armamentarium (no need for trays, adhesives, and dispensers); provide immediate on-screen feedback; they increase the scope of planning and diagnosis; permit easier communication with the dental laboratory with no cross infection risk; and allow easier duplication, storage, and retrievability. Furthermore, optical impressions allow chairside fabrication of definitive restorations in a single appointment. 1 However, optical impressions have some limitations, such as the size of the scanning wand, which can create problems for patients with limited mouth opening, the procedure learning curve, and the difficulty in scanning subgingival margins. 1 Although optical impressions have advantages, their adoption in daily dental practice and the shift toward a complete digital workflow are contingent upon the ability of complete arch optical impressions to replicate oral and dental structures at a Supported by 2014 Ralph Phillips Student Research Award from the Academy of Operative Dentistry (to M.A.A.). Cerec Omnicam provided by Dentsply Sirona USA. Materials provided by Kettenbach USA and Dentsply USA.
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 2017
In the direct-indirect composite technique, composite is applied to a nonretentive tooth preparat... more In the direct-indirect composite technique, composite is applied to a nonretentive tooth preparation (eg, a noncarious cervical lesion or a veneer/inlay/onlay preparation) without any bonding agent, sculpted to a primary anatomic form, and light-cured. The partially polymerized restoration is then removed from the preparation and finished and tempered extraorally chairside. The finished inlay is bonded to the preparation using a resin-based luting agent. Advantages of this technique include enhanced physical and mechanical properties afforded by the extraoral chairside tempering process because of increased monomer conversion, and greater operator control over the final marginal adaptation, surface finishing and polishing, and anatomy of the restoration, given that these elements are defined outside of the patient's mouth. The direct-indirect approach also affords enhanced gingival health and patient comfort. This article presents a clinical case in which the direct-indirect com...
The shifted angular spectrum method allows a reduction of the number of samples required for nume... more The shifted angular spectrum method allows a reduction of the number of samples required for numerical off-axis propagation of scalar wave fields. In this work, a modification of the shifted angular spectrum method is presented. It allows a further reduction of the spatial sampling rate for certain wave fields. We calculate the benefit of this method for spherical waves. Additionally, a working implementation is presented showing the example of a spherical wave propagating through a circular aperture.
This study evaluated bond strengths of orthodontic brackets to instrumented and uninstrumented en... more This study evaluated bond strengths of orthodontic brackets to instrumented and uninstrumented enamel using self-etching adhesive systems when compared to a total-etch adhesive system. The adhesive remnant index (ARI) was also determined after debonding. 140 bovine incisors were included in acrylic resin, and divided randomly in two groups: instrumented vs. uninstrumented enamel. For the instrumented enamel, specimens had their facial enamel ground flat to 600-grit. In each group, specimens were subdivided into four experimental subgroups according to the adhesive technique used: Transbond Plus, Adper Prompt L-Pop, iBond, and Adper Single Bond, applied following manufacturers' instructions. Orthodontic brackets were bonded to the treated instrumented or uninstrumented enamel with Transbond XT light-cured resin-based composite cement, and the bond strength was tested in shear mode after 7 days. One group where no etch and no adhesive were used served as a control. ARI scores were...
Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995), 2005
Composite resins are increasingly used for the restoration of anterior and posterior teeth. Altho... more Composite resins are increasingly used for the restoration of anterior and posterior teeth. Although adhesives and composites have become easier to use than earlier generations of these materials, the use of composite resins is still technique-sensitive. This article reviews the current recommendations for the use of direct composite resins and summarizes the technique for both anterior and posterior restorations.
This study evaluated the influence of (1) different dentin treatments and (2) storage time on den... more This study evaluated the influence of (1) different dentin treatments and (2) storage time on dentin shear bond strengths. Two hundred and twenty-five bovine incisors were collected, ground to expose a flat dentin surface and randomly divided into three groups according to dentin surface treatment: (1) Total etch + Single Bond; (2) Total etch + collagen depletion with 10% NaOCl + Single Bond and (3) No etch + experimental self-etching adhesive. Composite was applied to the treated surfaces using a 3 x 5 mm cylindrical Teflon matrix and was light-cured. Each group was further stratified in five subgroups according to storage time in water at 37 degrees C: 1 day, 7 days, 30 days, 6 months and 12 months. Shear bond strengths (SBS) were determined and expressed in MPa. Data was analyzed for statistical significance with two-way ANOVA and Tukey's test (p=0.05). No interaction was observed between surface treatment and storage time. Storage time did not significantly affect bond stren...
Quintessence international (Berlin, Germany : 1985), 1996
A new technique for the performance of resin composite direct restorations on posterior teeth is ... more A new technique for the performance of resin composite direct restorations on posterior teeth is presented. A clear acrylic resin matrix, fabricated prior to the preparation of the occlusal and proximal surfaces, is employed. The matrix allows the fast and accurate reproduction of the anatomic details from the original occlusal surface of the tooth, as well as the marginal ridges in the case of Class II (occlusoproximal) restorations. Advantages and limitations of the procedure are discussed.
Aim: To evaluate the influence of finishing and polishing techniques on the surface roughness of ... more Aim: To evaluate the influence of finishing and polishing techniques on the surface roughness of two composite resins (CRs) subjected to bleaching procedure. Methods: Forty-eight CR specimens were divided into six groups (n=8). For G1 to G3, a microhybrid CR (Opallis; FGM) was used, and G4 to G6, received a nanohybrid CR (Brilliant NewLine; Coltène/Whaledent). All specimens were subjected to bleaching procedure with 35% hydrogen peroxide (two 45-min applications, with a 5-day interval). The surface roughness of all specimens was evaluated before and after the bleaching and/or finishing/polishing (Ra parameter) by a roughness meter. After bleaching, the groups were subjected to finishing and polishing procedures: G2 and G5-felt discs + diamond pastes; and G3 and G6-silicon rubber tips. The control groups (G1 and G4) had no finishing or polishing treatment after bleaching. Data were analyzed by ANOVA and Tukey's posttest, and t test for paired samples (α=0.05). Results: bleaching treatment increased Ra values for the nanohybrid CR specimens, but both finishing/polishing techniques were able to reduce these values; for the microhybrid specimens, only finishing/polishing with silicon rubber tips decreased the roughness values. Conclusions: For both microhybrid and nanohybrid CRs, the silicon rubber tips were effective to reduce the surface roughness after bleaching procedure.
Objectives: The objectives of this longitudinal study were to evaluate safety and determine patie... more Objectives: The objectives of this longitudinal study were to evaluate safety and determine patients' satisfaction and perceptions of a Nightguard Vital Bleaching (NGVB) technique. Methods: Thirty-one participants who had completed previous NGVB studies using 10% ...
The Journal of the American Dental Association, 2007
ABSTRACT The Centers for Disease Control and Prevention has adopted guidelines for infection cont... more ABSTRACT The Centers for Disease Control and Prevention has adopted guidelines for infection control of extracted teeth used for research and teaching, requiring that teeth be sterilized before use. The authors conducted a study to test the null hypothesis that the storage medium and sterilization method have no effect on composite-to-dentin bond strengths. The authors collected 170 bovine incisors, cleaned them and placed them randomly into one of six storage media at 37 degrees C for 60 days: distilled water (dH(2)O), 0.9 percent sodium chloride, 0.5 percent chloramine-T, 5.25 percent sodium hypochlorite (NaClO), 2 percent glutaraldehyde and 10 percent formalin. For sterilization, they autoclaved a subset of 10 specimens from every sample, while they stored another subset of 10 specimens from every sample (except for the 10 percent formalin sample) in 10 percent formalin for 14 days. The authors then embedded the specimens in epoxy and ground flat the facial surface to expose middle-depth dentin, which they polished to 600 grit. They used a dental adhesive to apply composite to the exposed dentin. The authors tested the composite-to-dentin shear bond strength 24 hours after bonding. They analyzed the data using global analysis of variance and, when appropriate, multiple post hoc tests (P = .05). Storage in NaClO resulted in significantly lower bond strength than that of the other treatment specimens. Sterilization with the autoclave negatively affected the bond strength of specimens stored initially in dH(2)O or 10 percent formalin, while sterilization with formalin alone had no significant effect on bond strengths. Storing bovine teeth in 5.25 percent NaClO may negatively affect composite-to-dentin bond strengths. Immersion in 10 percent formalin might be the best option for storage and sterilization of bovine teeth that are to be used in dental bonding studies in vitro.
As the number of dental-related randomized clinical trials (RCTs) increases, there is a need for ... more As the number of dental-related randomized clinical trials (RCTs) increases, there is a need for literature to help investigators inexperienced in conducting RCTs design and implement studies. This commentary describes four "lessons learned," or considerations important in the planning and initial implementation of RCTs in dentistry that to our knowledge have not been discussed in the general dental literature describing trial techniques. These considerations are 1) preparing or securing a thorough systematic review, 2) developing a comprehensive set of study documents, 3) designing and testing multiple recruitment strategies, and 4) employing a run-in period prior to enrollment. Attention to these considerations in the planning phases of a dental RCT can help ensure that the trial is clinically relevant while also maximizing the likelihood that its implementation will be successful.
The study aims to determine a) the extent of agreement between visual-tactile caries examination ... more The study aims to determine a) the extent of agreement between visual-tactile caries examination (VTE) and radiographic examination (RE) in detecting presumptive caries lesions on occlusal and proximal surfaces of posterior teeth of UNC Xylitol for Adult Caries Trial participants; and b) the additional caries diagnostic yield obtained by adding RE to VTE. Data consisted of surface-level visual-tactile and radiographic classification of disease (cavitated and noncavitated caries lesions) or nondisease (sound surfaces). Participants (n = 114, adults with ≥12 erupted teeth and 1-10 caries lesions) received baseline VTE by a trained and calibrated examiner, and had interproximal radiographs obtained within 7 months before or after the VTE. Radiographs were assessed independently by two trained and calibrated examiners masked with respect to VTE results. The diagnostic threshold was surface-level disease/nondisease status. Kappa statistics provided an estimate of VTE-RE agreement on diseased surfaces. The additional diagnostic yield of the RE over VTE was calculated as the additional lesions detected radiographically as a percentage of the total number of lesions detected by VTE. Four-hundred ninety-four (51 occlusal, 433 proximal) lesions were detected; of these, 81 (2 occlusal, 79 proximal) lesions were detected by both VTE and RE. Kappa statistics were 0.18 (all surfaces), 0.04 (occlusal), and 0.18 (proximal). The additional diagnostic yield was 69 percent (all surfaces), 55 percent (occlusal), and 71 percent (proximal). There is poor agreement between VTE and RE to detect caries in posterior teeth of caries-active adults. However, an RE performed within 7 months of a VTE adds caries diagnostic yield in a clinical trial, especially on proximal surfaces.
ABSTRACT A randomized clinical trial of the anti-caries efficacy of 5000 compared to 1450 ppm flu... more ABSTRACT A randomized clinical trial of the anti-caries efficacy of 5000 compared to 1450 ppm fluoridated toothpaste on root caries lesions in elderly disabled nursing home residents. Ekstrand KR, Poulsen JE, Hede B, Twetman S, Qvist V, Ellwood RP. Caries Res 2013;47(5):391-98. André V. Ritter, DDS, MS, MBA PURPOSE/QUESTION: Is 5000 ppm fluoridated toothpaste used twice daily more efficacious than 1450 ppm fluoridated toothpaste used twice daily for controlling root caries progression in elderly disabled nursing home residents? This study was supported by a donation from Colgate Palmolive, manufacturer of the two toothpaste interventions This was a randomized clinical trial done with a convenience sample, with elements of comparative effectiveness design Level 2: Limited-quality, patient-oriented evidence Not applicable.
Journal of Esthetic and Restorative Dentistry, 2009
A n d r é V. R i t t e r , D D S , M S * Dental erosion caused by either extrinsic or intrinsic s... more A n d r é V. R i t t e r , D D S , M S * Dental erosion caused by either extrinsic or intrinsic sources of acids is an increasing clinical problem that can lead to dental hypersensitivity and poor tooth contours. Extreme cases of dental erosion can even lead to substantial compromise of function and need of extensive oral rehabilitation. Gastroesophageal reflux disease (GERD) has been found to be a common cause of dental erosion. In many cases, the dental team may be the first health care provider to make
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