Immediate dentin sealing (IDS) involves applying an adhesive system to dentin directly after tooth preparation, before impression. This was considered an alternate to delayed dentin sealing (DDS), a technique in which hybridization is performed following the provisional phase and just before the indirect restoration luting procedure. This study aimed to compare the bond strength of restorations to dentin of the IDS and the DDS techniques throughout a systematic review and meta-analysis. The following PICOS framework was used: population, indirect restorations; intervention, IDS; control, DDS; outcomes, bond strength; and study design, in vitro studies. PubMed (MedLine), The Cochrane Library, ISI Web of Science, Scielo, Scopus, and Embase were screened up to January 2022 by two reviewers (L.H. and R.B.). In vitro papers studying the bond strength to human dentin of the IDS technique compared to the DDS technique were considered. Meta-analyses were carried out by using a software program (Review Manager v5.4.1; The Cochrane Collaboration). Comparisons were made by considering the adhesive used for bonding (two-step etch-and-rinse, three step etch-and-rinse, one-step self-etch, two-step self-etch, and universal adhesives). A total of 3717 papers were retrieved in all databases. After full-text assessment, 22 potentially eligible studies were examined for qualitative analysis, leaving a total of 21 articles for the meta-analysis. For the immediate bond strength, regardless of the adhesive strategy used, the IDS technique improved the bond strength of restorations to the dentin (p < 0.001). Taking into account the subgroup analysis, it seems that the use of the IDS technique with a two-step etch-and-rinse or a one-step self-etch adhesive system does not represent any advantage over the DDS technique (p = 0.07, p = 0.15). On the other hand, for the aged bond strength, regardless of the adhesive strategy used, the IDS technique improved the bond strength of restorations to the dentin (p = 0.001). The subgroups analysis shows that this improvement is observed only when a three-step etch-and-rinse adhesive system (p < 0.001) or when a combination of an adhesive system plus a layer of flowable resin (p = 0.01) is used. The in vitro evidence suggests that the use of the IDS technique improves the bond strength of dentin to resin-based restorations regardless of the adhesive strategy used. The use of a three-step etch-and-rinse adhesive system or the combination of an adhesive system plus a layer of flowable resin seems to considerably enhance the bond strength in the long term.

Purpose: The aim of this study was to determine whether there are differences in the distribution of various indicators of oral health among elderly people with and without multimorbidity (ie, two or more chronic diseases). Subjects and methods: A cross-sectional, comparative study was conducted using a sample of Mexican elderly individuals aged ≥60 years. The average age of the cohort was 79.06±9.78 years, and 69.1% were women. The variables indicating oral health were as follows: functional dentition, edentulism, hyposalivation, xerostomia, root caries and periodontitis. The multimorbidity variable was operationally categorized as follows: 0= subjects with no chronic disease or one chronic disease and 1= subjects with two or more chronic diseases. Questionnaires were used to collect information on various variables regarding general health. Likewise, the participants underwent a clinical oral examination. The analysis was performed using Stata 11.0. Results: The overall prevalence of multimorbidity was 27.3%. The prevalences of various oral health indicators were as follows: without functional dentition 89.9%; hyposalivation 59.7%; edentulism 38.9% and self-reported xerostomia 25.2%. Dental caries were observed in 95.3% of the subjects, and the prevalence of severe periodontitis was 80%. We found a significant difference only in edentulism; its prevalence was higher among subjects with multimorbidity (55.3% vs 32.7%, P=0.015) than among those without multimorbidity. Conclusion: The presence of edentulism in this sample of Mexican older adults was higher in subjects with multimorbidity. Multimorbidity and oral diseases constitute a true challenge in elderly people, because they affect quality of life and are associated with high health care costs.

Aim: The objective of this study was to estimate the Out-Of-Pocket Expenditures (OOPEs) incurred by households on dental care, as well as to analyze the sociodemographic, economic, and oral health factors associated with such expenditures. Method: A cross-sectional study was conducted among 763 schoolchildren in Mexico. A questionnaire was distributed to parents to determine the variables related to OOPEs on dental care. The amounts were updated in 2017 in Mexican pesos and later converted to 2017 international dollars (purchasing power parities–PPP US $). Multivariate models were created: a linear regression model (which modeled the amount of OOPEs), and a logistic regression model (which modeled the likelihood of incurring OOPEs). Results: The OOPEs on dental care for the 763 schoolchildren were PPP US $53,578, averaging a PPP of US $70.2 ± 123.7 per child. Disbursements for treatment were the principal item within the OOPEs. The factors associated with OOPEs were the child’s age, number of dental visits, previous dental pain, main reason for dental visit, educational level of mother, type of health insurance, household car ownership, and socioeconomic position. Conclusions: The average cost of dental care was PPP US $70.2 ± 123.7. Our study shows that households with higher school-aged children exhibiting the highest report of dental morbidity—as well as those without insurance—face the highest OOPEs. An array of variables were associated with higher expenditures. In general, higher-income households spent more on dental care. However, the present study did not estimate unmet needs across the socioeconomic gradient, and thus, future research is needed to fully ascertain disease burden.

Dental caries is a widespread issue impacting global oral health. White spot lesions, the earliest stage of caries, compromise enamel’s esthetics and integrity. Remineralization therapies, both fluoride and non-fluoride based, aim to restore enamel, but limited comparative data exist on their effects on lesion depth and microhardness. Thus, the aim of this systematic review was to evaluate the efficacy of remineralizing agents on lesion depth and microhardness of human teeth. The literature search included the following five databases: PubMed, Web of Science, Scielo, SCOPUS, and EMBASE from the period 2012 to October 2022. Studies evaluating lesion depth and microhardness in human teeth after the application of a remineralizing agent were considered for review. The meta-analysis was performed using RevMan 5.4 (The Cochrane Collaboration, Copenhagen, Denmark). A random effect model was used to pool estimate of effect and its 95% confidence intervals (CIs) for surface microhardness and depth lesion. Subgroup analyses were performed considering the presence of fluoride or not in the remineralization agent. Thirty-three studies were included in the qualitative review. Of these, twenty-six studies were included in the meta-analysis. The main risks of bias associated with the studies included a lack of blinding of the test operator and failure to obtain sample size. To conclude, fluorinated agents are more effective in remineralizing artificially induced white spot lesion than non-fluoride remineralizing agents.

The aim of this investigation was to conduct a systematic review and meta-analysis to determine the necessity of a white diet during or following a bleaching procedure. This systematic review and meta-analysis followed the PRISMA guidelines meticulously. The research question was: Is a white diet necessary during and/or after a bleaching treatment? In vitro studies or clinical trials reporting the color change in bleached enamel after the use of a free-staining diet were considered for full-text review. For the analyses, a random-effects model was employed. Statistical significance was defined as a p-value < 0.05. A total of 17 documents were eligible for qualitative analysis: 5 clinical trials and 12 in vitro studies. Only data from the clinical trials were included in the meta-analysis. For at-home bleaching, differences in the color among the subjects were not statistically significant during the first (p = 0.64), second (p = 0.26) or third (p = 0.43) weeks of treatment. Also, the color difference one month after finishing the bleaching treatment were not statistically significant (p = 0.27). The color difference one month after finishing an in-office treatment showed that the restrictions on diet did not significantly improve the bleaching outcomes (p = 0.90). According to the findings of this review, dietary restrictions are not necessary during or after bleaching procedures.

Background: Accuracy of optical impressions—defined by the intraoral scanner (IOS)’s trueness and precision per International Organization for Standardization (ISO) standards—is influenced by both operator- and patient-related factors. Thus, this in vitro study aimed to (1) evaluate how scanning distance affects the accuracy of three different intraoral scanners (IOSs), and (2) identify the optimal scanning distance for each scanner. Methods: A maxillary arch model was obtained using polyvinyl siloxane impression material and poured with Type IV stone (Octa-rock royal^®, Kulzer, Germany). Using three different types of IOSs—the trios 3 shape (TRIOS ^® cart, 3Shape, Copenhagen, Denmark); the Helios 500 (Eighteeth ^®, Changzhou, China); and the Heron (3Disc ^®, Herndon, VA 20170, USA)—ten scans were performed with each of the IOSs with five predetermined distances: 0 mm, 2.5 mm, 5 mm, 7.5 mm, and 10 mm. Spacers of varying heights were designed using Meshmixer version 3.5 (Autodesk, Inc., Mill Valley, CA, USA) and three-dimensional printed with the Form 2 printer (Formlabs, Somerville, MA, USA). The scanned data was processed using Geomagic Control X (Version 16.0.2.16496, 3D Systems, Wilsonville, OR, USA). Statistical analyses were performed using R Statistical Software (version 4.2.2), with significance set at α = 0.05. Results: Scanning distance significantly influenced scan accuracy for all three scanners. The 3Disc scanner (3Disc, Herndon, VA, USA) demonstrated the highest accuracy at a 7.5 mm distance, while both the Helios 500 (Eighteeth, Changzhou, China) and Trios 3 (3Shape, Copenhagen, Denmark) scanners achieved their best accuracy at a 5 mm distance, as indicated by the lowest root mean square (RMS) values (p < 0.05). Conclusions: To conclude, each IOS has an optimal scanning distance for best accuracy. Trios 3 (3Shape, Copenhagen, Denmark) outperformed the others in both trueness and precision. Future studies should examine these effects under full-arch and clinical conditions.