Omar Shaalan

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.

Objectives: To compare the remineralization potential of Curodont Repair Fluoride Plus Versus CPP -ACP in management of white spot lesions.
Methodology: 48 white spot lesions in patients received randomly two types of remineralizing agents, either Curodont Repair Flouride Plus (self-assembling peptide p11-4) or MI paste daily use, both materials were applied according to the manufacturer’s instructions. White spot lesions were evaluated before and after 1, 4, and 6 months follow up periods by assessors to assess remineralization potential using ICDAS II Criteria and digital photographs using analysis software to get the percentage of white spot lesions. Results: According to ICDAS II, intergroup comparison between both materials have shown no statistically significant difference, Intragroup comparisons within Curodont Repair Fluoride Plus have shown statistically significant difference between different follow-up periods (P < 0.0001). Curodont Repair Fluoride Plus had 25% less risk for (ICDAS 1and 2) than CPP-ACP after 6 months (RR= 0.75, 95% CI, P=0.2498). According to the photographic analysis, Two-way ANOVA revealed statistically significant effect of material and follow-up on WSL % (P<0.001). Conclusions: Curodont Repair Flouride Plus is a biomimetic remineralizing agent that provides a therapeutic option for enamel regeneration. Curodont repair fluoride plus provided a better chance for complete healing of incipient lesions.

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. Diagnostic 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.

Aim: To evaluate shade matching potential of monochromatic layering technique (Filtek Universal) compared to polychromatic layering technique (Filtek Z350XT) in restoration of fractured incisal angle. Materials and Methods: A total of 26 patients received 26 class IV restorations divided randomly between groups (n = 13) using either; monochromatic layering technique (Filtek Universal) or polychromatic layering technique (Filtek Z350XT) in a parallel study design with superiority framework. After preparation, class IV resin composite restorations were performed according to manufacturers’ instructions. Shade matching of class IV restorations was evaluated by two blinded and calibrated assessors using the modified USPHS criteria and digital photography at baseline and after three-days. Association between the layering technique for restoration of fractured incisal angle and shade matching potential was done using the chi square test; statistical significance was set at P ≤ 0.05. Results: Inter-group comparison between layering techniques for shade matching using the modified USPHS criteria have shown statistically significant difference at baseline (P = 0.0001), while there was no statistically significant difference after 3 days (P = 0.2864). Intra-group comparison between follow-up periods within monochromatic layering technique have revealed statistically significant difference (P = 0.0001), while within polychromatic layering technique there was no statistically significant difference (P = 0.2864). Inter-group comparison between both layering techniques using digital photography have shown no statistically significant difference at baseline (P = 0.3592), while after 3 days there was statistically significant difference (P = 0.0071). Intra-group comparison between follow-up periods within monochromatic layering technique have shown statistically significant difference (P = 0.0002), while within polychromatic layering technique there was no statistically significant difference (P = 0.3592). Conclusions: Monochromatic resin composite restorations showed satisfactory shade matching potential when compared to polychromatic resin composite restorations.

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. Materials 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.

Aim: The current study was conducted to evaluate the caries prevention potential of pearl powder against Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) in enamel white spot lesions. Methodology: Thirty subjects were randomized into two equal groups (n=15). Group 1 (intervention group) received pearl powder gel, while group 2 (Control group) received Casein Phosphopeptide-Amorphous Calcium Phosphate (GC Tooth-Mousse). The participants were instructed to use pea size amount of pearl powder gel or GC Tooth-Mousse on the teeth surfaces using their finger twice daily after brushing with fluoride-free toothpaste for the first three months, followed by the use of fluoride containing tooth paste for the next 3 month. Quantitative changes of white spot lesions were measured at baseline, three, six, nine, and twelve months using DIAGNOdent pen 2910 (KaVo, Biberach and der Riss, Germany). Data for quantitative changes of white spot lesions were recorded and analysed for each group. Results: No statistically significant difference was found in overall DIAGNOdent pen mean readings between pearl powder gel and GC Tooth-Mousse groups at P=0.145. On the other hand, the intragroup comparison within both groups showed statistically significant difference between baseline, three, and six months follow-up periods, while after nine and twelve months there was no statistically significant difference among both groups. Conclusions: Pearl powder gel seem to have a caries prevention efficacy similar to GC Tooth-Mousse and may be considered as promising natural and bioavailable material in reducing the progression of enamel WSLs.

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.

Objectives: This study was carried out to evaluate the clinical performance of bioactive versus fluoride releasing resin-based pits and fissure sealants in molars in high caries risk patients regarding retention and caries incidence. Material and methods: A total of 38 participants received 38 pits and fissure sealants randomly using either; BioCoat™ by Premier® (Plymouth Meeting, Pennsylvania,USA) or Clinpro™ by 3M™ ESPE (St.Paul, Minnesota,USA) , all materials were utilized obeying manufacturers’ instructions. Sealants were evaluated using Simonsen’s criteria for retention and using VistaProof fluorescent camera for caries detection around sealants or in presealed fissures by two blinded assessors after 6-and 12-months. Chi square test was used to associate between the type of sealants and their clinical performance. Relative risk was used to assess the clinical significance. Survival rate was analysed using Kaplan-meier and Log-rank test Results: For retention, comparison between both sealants have shown no statistically significant difference throughout different follow up periods; baseline, 6 and 12 months (P = 1.0000, P = 0.9277 and P = 0.3185) respectively. There was 16% less risk for failure in retention for Biocoat sealant when compared to Clinpro sealant after 12 months (RR= 0.8366(95% CI 0.4306 to 1.6252; P =0.5985). Regarding caries incidence, there was no statistically significant difference between two groups within follow up periods; baseline and 6 months (P = 1.0000 and P = 0.1396) respectively, while after 12 months there was statistically significant difference (P = 0.0303). There was 89.5% less risk for caries incidence for Biocoat sealant when compared to Clinpro sealant after 12 months (RR= 0.1049(95% CI 0.006097 to 1.8062; P =0.1205) Conclusions: Both Clinpro™ and BioCoat™ showed similar successful clinical performance after 6-months-time interval while BioCoat™ had superior caries inhibition after 12 months.

Aim: This study aimed to evaluate the clinical performance of nano-hydroxyapatite reinforced glass ionomer (Carbomer) vs. conventional high viscosity glass-ionomer cement (Fuji IX) in root caries of geriatric patients. Materials and Methods: The current trial is a randomized controlled trial, with two parallel groups and a 1:1 allocation ratio. A total of 22 participants were recruited using convenience sampling and received 44 restorations randomly using either Carbomer or Fuji IX. After cavity preparation, restorative materials were applied according to manufacturers’ instructions. Restorations were evaluated using modified United States Public Health Service criteria by two blinded assessors after 1, 3, 6, and 9 months and 1 year. The chi square test was used to associate between the type of restorative material, either Carbomer or Fuji IX, and clinical performance. A P-value ≤ 0.05 was considered statistically significant. Results: After 1 year, no statistically significant difference was found between both materials for marginal staining, surface texture, marginal adaptation, secondary caries, post-operative sensitivity, color match, and retention (P = 0.4885, P = 0.1320, P = 0.3483, P = 0.9170, P = 0.7518, P = 0.1043, and P = 0.2998, respectively), whereas there was statistically significant difference between both materials for anatomical contour after 12 months (P = 0.0477). Conclusion: Both Carbomer™ and Fuji IX showed similar and successful clinical performance in the purpose of restoring root surface of permanent teeth in geriatric patients.

Aims and Objectives: To evaluate the effectiveness of using dissolving xylitol chewable tablets versus xylitol chewing gum in geriatric bedridden patients in decreasing bacterial count in both saliva and interdental plaque as well as in increasing salivary pH. Materials and Methods: Overall, 98 patients were included in this randomized clinical trial and they were divided into two groups (n = 49). Group 1 (intervention group) received xylitol chewable tablets (Listerine Ready Tabs), and group 2 (Control group) received xylitol chewing gum (Trident Original). The primary outcome was salivary mutans streptococci count, and secondary outcomes were interdental plaque mutans streptococci count (both were assessed through plate culturing on MSBA media) and salivary pH (measured by a pH meter). All outcomes were assessed at baseline, after 5 min, and after 15 days. Friedmann test was used to show the effect of follow-up periods followed by a multiple comparison with Dunn Bonferroni correction. Mann-Whitney test was used to compare between tested groups for all examined variables. Results: Regarding MS count in both saliva and interdental plaque, there was a statistically significant difference between both groups at baseline and after 5 min; however, after 15 days, there was no statistically significant difference between both groups. Regarding salivary pH, there was no statistically significant difference at baseline and after 5 min between both groups; however, after 15 days, there was a statistically significant difference between both groups. Conclusion: Both xylitol dissolving chewable tablet and xylitol chewing gum have potent antibacterial effects and enhanced salivary pH in geriatric bedridden patients.

Objective: This clinical trial was conducted to compare the efficacy of fluoride varnish containing xylitol coated calcium and phosphate or potassium nitrate gel versus conventional fluoride varnish in the management of hypersensitivity of non-carious exposed root surfaces in adult patients. Material and Methods: 35 patients having 105 hypersensitive teeth were randomly allocated to be treated either using Embrace varnish (PULPDENT Corporation, Watertown, MA, USA) or UltraEz gel (Ultradent Products Inc. South Jordan, UT, USA) or Fluoride varnish FluoroDose (Centrix Inc., Milford, Connecticut, USA), all agents were used according to the manufacturers’ instructions. Hypersensitivity scores were assessed using the visual analogue scale (VAS), after applying different stimuli. The assessment was done at baseline, after 4 hours of application, after two days, then after 4, 8 and 12 months. Results: UltraEZ gel showed the best immediate relief with a significant difference from other treatment methods, fluoride varnish showed the best relief at both short and long term follow up periods. Embrace varnish showed the least success in reducing hypersensitivity. Conclusions: Fluoride varnish showed the best reduction in hypersensitivity values while UltraEZ showed the best immediate relief and Embrace varnish showed the least efficacy.

Aim: The aim of this study was to evaluate the remineralization potential of pearl powder on early (‘white spot') lesions in enamel compared to casein phosphopeptide-amorphous calcium phosphate . Methodology: Twenty Patients who had post orthodontic white spot lesions (57 subjects) were included and were randomly allocated in two groups receiving either CPP-ACP as a control (29 subjects) or pearl powder gel (28 subjects), they used it twice daily for three months. The white spot lesions were assessed clinically at baseline, 3,6,9 and 12 months using the Clinical index used for visual evaluation of white spot lesions and photographic image analysis to detect the change in color and area of the white spot lesions. Parametric data were analyzed for intergroup comparisons using independent t-test and for intragroup comparisons using repeated measures ANOVA followed by Bonferroni post hoc test. Non-parametric data were analyzed using Mann-Whitney U test for intergroup comparisons and Friedman's test followed by Nemenyi post hoc test for intragroup comparisons. The significance level was set at p≤0.05 within all tests. Results: A significant improvement of the clinical WSL-scores was found over time in both groups, with no statistically significant difference (p<0.01). As for the photographic image analysis, the color change and area of WSLs significantly improved after12 months with no statistical difference observed between both groups. Conclusions: The Pearl powder had a similar remineralization potential when compared to CPP-ACP on the early enamel white spot lesions after 12 months.

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 “8th 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. Methods and Material: Vertise™ flow or Filtek™ Z350XT Flowable were 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 (RR) 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 months follow-up.

Aim: the current study was conducted to compare technique sensitivity and gingival health of carious and non-carious cervical lesions performed using subgingival clamps and retraction cords. Methodology: 24 teeth with carious or non-carious cervical lesions were divided randomly into 2 groups receiving one of the two gingival retraction techniques, either subgingival clamp (KSK clamp #44) or retraction cord (Ultrapak E), technique sensitivity was evaluated at baseline (before application) and immediately after application while gingival health was evaluated before and immediately after application, 2 weeks, 1 and 4 months. Statistical analysis was done using t-test, Chi-square test, Kruskal-Wallis test and Mann-Whitney test where significance level was set at P ≤ 0.05. Results: There was a statistical significant difference between retraction cord and subgingival clamp regarding time of application and gingival laceration, where retraction cord took longer application time (p=0.01) and subgingival clamp showed higher laceration frequency (P=0.033). Regarding patient satisfaction, isolation from crevicular fluids, need for local anesthesia, pink esthetic score, gingival bleeding and sensitivity, there was no statistical significant difference between both groups. Conclusion: Technique sensitivity and long term gingival health were the same for both groups except that subgingival clamp provided minimal chairside time and care should be taken upon clamp application to avoid gingival laceration.

Aim: In clinical practice, obtaining physiologic proximal contact points is essential for protection of balance and harmony of the stomatognathic system. Consequently, challenges have emerged due to the technique sensitivity of the restorative procedures of posterior proximal resin composite restorations. This study aimed at assessing the influence of different matricing techniques; either sectional matrix or circumferential matrix and operator experience; either undergraduate students or postgraduate dentists on reproduction of optimum proximal contacts for posterior proximal resin composite restorations. Materials and Methods: A total of 60 patients were enrolled; after class II cavity preparation, matrix systems were applied by undergraduate students or postgraduate dentists, by using either sectional matrix or circumferential matrix systems. Cavity preparations were restored by using resin composite restorations according to manufacturers' instructions. Tightness of proximal contacts was evaluated by using dental floss according to FDI recommendations to be either optimum, tight, or open contact. Chi-square test was used to compare between groups; P value ≤ 0.05 was considered statistically significant. Relative risk (RR) was used to determine the clinical significance. Results: There was a statistically significant difference between the sectional matricing technique and the circumferential matricing technique (P < 0.0001). There was less risk of poor proximal contact (tight or open) with the sectional matrix system, and the risk was 70% less than the circumferential matrix. Conclusions: Optimum contact points were highly associated with the sectional matrix system. Open and tight contacts were highly associated with the circumferential matrix system regardless of operator experience.

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. Material 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.

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.

Aim: Glass ionomer is a well-known name in caries management and control. Meanwhile, the dark side in its history is being limited as an interim restoration inside patient mouth. The recently introduced glass ionomer with glass hybrid technology could be a new breakthrough in its future. The aim of this study was to evaluate the clinical performance of glass hybrid glass ionomer compared to conventional high-viscosity glass ionomer in class I cavities in patients with high caries risk. Materials and Methods: In a split-mouth design, 31 high caries risk patients with class I cavities received randomly two pairs of restorations, either EQUIA Forte (glass ionomer with glass hybrid technology) or EQUIA Fil (conventional high-viscosity glass ionomer); both materials were applied according to manufacturer’s instructions. Restorations were evaluated at baseline (1 week) and after 1 year by two blinded assessors using Federation Dentaire Internationale criteria for assessment of dental restoration measuring (functional properties and biological properties). Results: Chi-square test was used to compare the difference between glass-ionomer restorative materials at the base line and after 1 year. A value of P ≤ 0.05 was considered statistically significant. There was no statistically significant difference between both materials for all tested outcomes with 100% success rate (score 1 or 2). Conclusion: Glass hybrid glass-ionomer restoration has shown clinical performance similar to conventional high-viscosity glass-ionomer restoration in class I cavities in patients with high caries risk after 1 year of clinical service.

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 dentists (74%) 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.

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.

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.

This study was performed to evaluate microshear bond strength of self adhering flowable composite to enamel compared with flowable composite after different surface pretreatments. M & M: Sixteen molars were selected, enamel surfaces were flattened. Teeth were randomly divided into two main groups according to type of restorative material ; flowable composite R1 and self adhering flowable composite R2, then each group was subdivided to four subgroups according to surface pretreatments ( without surface treatment P0, etching only P1, self etch adhesive P2, etch & rinse adhesive P3). Teeth were restored for microshear bond strength testing using universal testing machine; load was applied till specimen’s fail. Results: Flowable composite with surface treatment P3 has the highest bond strength to enamel, while least bond strength was for self adhering composite with surface treatment P2and P0. Conclusion: For better bond strength of self adhering flowable composite it’s recommended that it is preceded with etching when bonded to enamel.

Objectives: This study was performed to evaluate micro-shear bond strength (µSBS) of self adhering flowable composite (SAC) to dentin compared to conventional flowable composite after different surface pre-treatments.
Methods: Sixteen freshly extracted sound human molars were selected; occlusal surfaces were ground flat to expose dentin using model trimmer then finished with 600-grit silicon carbide paper. Teeth were randomly divided into two main groups according to restorative material; flowable composite R1 (Filtek™ Z350 XT Flowable, 3M ESPE) and self adhering flowable composite R2(Fusio™Liquid Dentin, Pentron), then each group was subdivided into four subgroups according to surface pre-treatments (without pre-treatment P0, etching only P1 (Scotchbond™ Universal Etchant, 3M ESPE), self-etch adhesive P2 (Single Bond Universal, 3M ESPE, self-etch mode) and etch-and-rinse adhesive P3 (Single Bond Universal, etch-and-rinse mode). Teeth were restored for µSBS testing using universal testing machine, shear load at crosshead speed of 0.5 mm/min was applied till debonding and failure modes were analyzed.
Results: Two way-ANOVA showed that restorative materials and surface pre-treatments had significant effect on mean µSBS at P ≤0.001. Mean µSBS values (in MPa) were: R2 P2 (17.80±1.43), R1P2 (16.80±1.17), R1 P3 (16.10±0.99), R2 P3(15.95±1.06), R2 P0 (15.17±1.42), R2 P1 (14.66±1.52) and R1 P0 and R1 P1 had premature failure (0.0±0.0).Failure modes revealed that conventional flowable composite failure modes were 20% mixed, 35% adhesive, 45% cohesive within composite, while SAC failure modes were 12.5% mixed, 47.5% adhesive, 40.0% cohesive within composite.
Conclusions: SAC produced comparable results to conventional flowable composite, bonding performance of SAC to dentin was enhanced by preceding it with self-etch adhesive. SAC simplified the procedure of applying flowable composite with comparable results to standard techniques and requires further clinical investigations to recommend its usage in clinical situations.

This study was conducted to evaluate microshear bond strength of self adhering flowable composite to enamel and dentin, without surface treatment and after different surface treatment protocols compared to flowable composite.
Thirty two carious free extracted molars were selected in the current study. The teeth were wet ground to expose fresh flat enamel or dentin surfaces where each surface will carry five specimens. Teeth were randomly divided into two main groups according to restorative tested material; either flowable composite (Filtek™ Z350 XT Flowable) or self-adhering composite (Fusio™Liquid Dentin). Each group was divided into four subgroups according to surface pretreatment; either without any surface treatment, with acid etching only, with self etching adhesive system and with etch and rinse bonding system. Each subgroup was divided into two classes according to type of substrate; either enamel or dentin. Sixteen subgroups were created (n=10) with a total number of 160 specimens.
A plastic tube (tygon tube), 0.7 mm in diameter and 1mm in length was held securely and immobilized using cotton pliers on the indicated substrate with or without surface treatment, then was restored for microshear bond strength testing according to manufacturer instructions. Microshear bond strength test was conducted immediately after 24 hours using universal testing machine at crosshead speed of 0.5 mm/min till specimens fail, bond strength was calculated and failure modes were analyzed.
The results showed that Filtek™ Z350 XT Flowable with surface treatment using etch and rinse bonding system has the highest statistically significant bond strength to enamel, while least statistically significant bond strength was for Fusio™Liquid Dentin with surface treatment using self etch system and without any surface pretreatment. In dentin, the highest statistically significant bond strength was for Fusio™Liquid Dentin with surface treatment using self etch system, while the least bond strength was for Fusio™Liquid Dentin with etching only and Fusio™Liquid Dentin without surface treatment, in addition applying Filtek™ Z350 XT Flowable without surface treatment following manufacturer instructions showed premature failure for both enamel and dentin.
In the present study, the failure mode was either cohesive within composite, adhesive or mixed failure type. The results of comparison between failure modes revealed that there was no statistically significant difference between them, so it could not be stated that the bond strength values correlate with the failure types.
Under the limitations of this study the following conclusions were derived:
1- When applied according to manufacturers’ instructions self adhering flowable composite produced comparable results to conventional flowable composite combined with either etch-and-rinse and self-etch adhesive system for dentin substrate.
2- Enhancing bonding performance of self adhering flowable composite to enamel could be achieved with preceding it with etching or etch-and-rinse adhesive, while for dentin bonding performance can be enhanced by preceding it with self-etch adhesive.
3- Still etch and rinse adhesive system is the gold standard technique when bonding to enamel.

Clinical recommendations:
Self adhering flowable composite simplified the procedure of applying flowable composite material with comparable results to standard techniques and requires further clinical investigations to recommend its usage in clinical situations.