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The Minamata Convention and the phase down of dental amalgam
Oral health is a neglected area of global health, although oral disease is one of the most common public health issues worldwide. Despite advances in modern dentistry, untreated dental caries in permanent teeth was reported as the most prevalent of the 328 conditions assessed in 2016 Global Burden of Disease Study. The restorative model for managing dental caries was developed in the 1900s, alongside dental amalgam as one of the restorative materials commonly used to treat dental caries. Together they still provide the backbone of oral health services in most countries today. A shift away from the restorative model and the widespread use of dental amalgam was perhaps unimaginable even a decade ago, despite the World Health Organization (WHO) calling for oral health to be incorporated into policies for the integrated prevention and treatment of chronic noncommunicable and communicable diseases, and into maternal and child health policies. The Minamata Convention on Mercury (2013) is an international legally binding treaty that aims to protect the human health and the environment from anthropogenic emissions and releases of mercury and mercury compounds. The convention addresses mercury-added products, including dental amalgam, which is made of approximately 50% of elemental mercury by weight, and proposes nine measures to phase down the use of dental amalgam. These measures show the interconnected and interdependent nature of phasing down dental amalgam, and reinforce the need for a multipronged approach as called for by WHO. The implementation of the convention and its provision for dental amalgam can catalyse the shift away from the restorative model of care and the use of mechanically retained filling materials, such as dental amalgam, towards preventive and minimal intervention dentistry that predominantly uses adhesive dental materials. Implementation will also provide an opportunity to strengthen oral health promotion and oral disease prevention within an integrated, people-centred model of health services.
Journal Article
Impact of implant abutment materials on force damping response and marginal fit of implant supported restoration
Background
The marginal fit and force-damping response of implant-supported restorations play critical roles in the long-term success of dental implants. This study evaluates the effect of implant abutment materials— resin-ceramic material, lithium disilicate, PEEK, and Titanium- on implant-supported restorations' marginal fit and force-damping response. The study offers novel insights into stress distribution and marginal gaps, aiming to optimize implant-supported restoration outcomes.
Methods
Forty implant abutments were divided into four equal groups: Shofu HC, Tessera, BioHPP, and Titanium. Vertical marginal gap measurements were taken using a digital microscope before and after Cementation, and force damping was assessed using a custom impact test machine. Non-metal abutments were custom-fabricated using STL files and a CAD/CAM machine (CEREC MC X5, Dentsply Sirona) for Tessera (MT/LT-BL2), Shofu HC Block (A3-LT/M), a resin hybrid ceramic (61% zirconium silicate, 39% nano-filler composite), and BioHPP (bredent GmbH & Co KG). Quantitative data were expressed as mean ± SD and analyzed using ANOVA with post hoc Tukey test. Normality was confirmed with the Shapiro–Wilk test, and differences between groups were assessed with an unpaired Student's t-test.
Results
Before Cementation, the Biohpp group demonstrated the highest marginal gap (35.49 ± 2.31 µm), followed by Titanium (31.05 ± 1.87 µm) and Shofu HC Block (29.35 ± 1.72 µm). Tessera exhibited the lowest marginal gap (23.70 ± 2.99 µm) (
P
< 0.001). After Cementation, marginal gaps increased across all groups, with Biohpp (46.47 ± 3.10 µm) and Titanium (38.43 ± 2.25 µm) showing the most significant gaps, while Tessera continued to demonstrate the lowest (30.80 ± 1.64 µm) (
P
< 0.001). In force damping tests, Shofu HC Block recorded the lowest impact force (0.804 ± 0.034 N), followed by Biohpp (0.866 ± 0.027 N) and Tessera (0.920 ± 0.029 N). Titanium exhibited the highest force (0.970 ± 0.033 N), with all results showing statistical significance (
P
< 0.001).
Conclusions
Lithium disilicate exhibited the smallest marginal gap before and after Cementation, while PEEK showed the largest, followed by Titanium and resin-ceramic material. Resin-ceramic material had the highest shock absorption for force damping, followed by PEEK and Lithium disilicate, while Titanium recorded the highest impact force, indicating the least damping ability.
Journal Article
Revised FDI criteria for evaluating direct and indirect dental restorations—recommendations for its clinical use, interpretation, and reporting
ObjectivesThe FDI criteria for the evaluation of direct and indirect dental restorations were first published in 2007 and updated in 2010. Meanwhile, their scientific use increased steadily, but several questions from users justified some clarification and improvement of the living document.Materials and methodsAn expert panel (N = 10) initiated the revision and consensus process that included a kick-off workshop and multiple online meetings by using the Delphi method. During and after each round of discussion, all opinions were collected, and the aggregated summary was presented to the experts aiming to adjust the wording of the criteria as precisely as possible. Finally, the expert panel agreed on the revision.ResultsSome categories were redefined, ambiguities were cleared, and the descriptions of all scores were harmonized to cross-link different clinical situations with possible management strategies: reviewing/monitoring (score 1–4), refurbishment/reseal (score 3), repair (score 4), and replacement (score 5). Functional properties (domain F: fracture of material and retention, marginal adaptation, proximal contact, form and contour, occlusion and wear) were now placed at the beginning followed by biological (domain B: caries at restoration margin, hard tissue defects, postoperative hypersensitivity) and aesthetic characteristics (domain A: surface luster and texture, marginal staining, color match).ConclusionThe most frequently used eleven categories of the FDI criteria set were revised for better understanding and handling.Clinical relevanceThe improved description and structuring of the criteria may help to standardize the evaluation of direct and indirect restorations and may enhance their acceptance by researchers, teachers, and dental practitioners.
Journal Article
The tales teeth tell : development, evolution, behavior
\"Why do anthropologists study teeth? Teeth contain detailed records of growth, health, and diet, as well as our evolutionary history. So what are the tales teeth tell? The French naturalist George Cuvier famously remarked, \"Show me your teeth and I will tell you who you are.\" In this book, we will explore the intimate precision, striking beauty, and integrative power of incremental growth rhythms in teeth. We will also consider the surprising records of behavior that remain on their surfaces for millennia. For example, the plaque our hygienists carefully remove traps food particles, bacteria, and DNA from our own cells in a sticky layer that can fossilize over time into dental calculus. While calculus doesn't show the same faithful records as enamel and dentine, it captures human activity after our teeth finish growing, continuing the story of our behavior and health into adulthood and old age. We'll learn how complementary clues such as microscopic scratches and pits formed during chewing have spawned serious debates about the evolution of the human diet. And we'll see how evidence from teeth may point to the uniqueness of our own species, Homo sapiens, with our long childhoods, remarkably diverse diets, and complex behaviors\"-- Provided by publisher.
Book
When to intervene in the caries process? An expert Delphi consensus statement
ObjectivesTo define an expert Delphi consensus on when to intervene in the caries process and on existing carious lesions using non- or micro-invasive, invasive/restorative or mixed interventions.MethodsNon-systematic literature synthesis, expert Delphi consensus process and expert panel conference.ResultsCarious lesion activity, cavitation and cleansability determine intervention thresholds. Inactive lesions do not require treatment (in some cases, restorations will be placed for reasons of form, function and aesthetics); active lesions do. Non-cavitated carious lesions should be managed non- or micro-invasively, as should most cavitated carious lesions which are cleansable. Cavitated lesions which are not cleansable usually require invasive/restorative management, to restore form, function and aesthetics. In specific circumstances, mixed interventions may be applicable. On occlusal surfaces, cavitated lesions confined to enamel and non-cavitated lesions radiographically extending deep into dentine (middle or inner dentine third, D2/3) may be exceptions to that rule. On proximal surfaces, cavitation is hard to assess visually or by using tactile methods. Hence, radiographic lesion depth is used to determine the likelihood of cavitation. Most lesions radiographically extending into the middle or inner third of the dentine (D2/3) can be assumed to be cavitated, while those restricted to the enamel (E1/2) are not cavitated. For lesions radiographically extending into the outer third of the dentine (D1), cavitation is unlikely, and these lesions should be managed as if they were non-cavitated unless otherwise indicated. Individual decisions should consider factors modifying these thresholds.ConclusionsComprehensive diagnostics are the basis for systematic decision-making on when to intervene in the caries process and on existing carious lesions.Clinical relevanceCarious lesion activity, cavitation and cleansability determine intervention thresholds. Invasive treatments should be applied restrictively and with these factors in mind.
Journal Article