OBJECTIVES
Resin-based dental materials are not inert in the oral environment, and may release components, initially due to incomplete polymerization, and later due to degradation. Since there are concerns regarding potential toxicity, more precise knowledge of the actual quantity of released eluates is necessary. However, due to a great variety in analytical methodology employed in different studies and in the presentation of the results, it is still unclear to which quantities of components a patient may be exposed. The objective of this meta-analytical study was to review the literature on the short- and long-term release of components from resin-based dental materials, and to determine how much (order of magnitude) of those components may leach out in the oral cavity.


METHODS
Out of an initial set of 71 studies, 22 were included. In spite of the large statistical incertitude due to the great variety in methodology and lack of complete information (detection limits were seldom mentioned), a meta-analytical mean for the evaluated eluates was calculated. To relate the amount of potentially released material components with the size of restorations, the mean size of standard composite restorations was estimated using a 3D graphical program.


RESULTS
While the release of monomers was analyzed in many studies, that of additives, such as initiators, inhibitors and stabilizers, was seldom investigated. Significantly more components were found to be released in organic than in water-based media. Resin-based dental materials might account for the total burden of orally ingested bisphenol A, but they may release even higher amounts of monomers, such as HEMA, TEGDMA, BisGMA and UDMA. Compared to these monomers, similar or even higher amounts of additives may elute, even though composites generally only contain very small amounts of additives. A positive correlation was found between the total quantity of released eluates and the volume of extraction solution.


SIGNIFICANCE
There is a clear need for more accurate and standardized analytical research to determine the long-term release from resin-based materials. Several guidelines for standardization are proposed.

How much do resin-based dental materials release? A meta-analytical approach (vol 27 pg 723, 2011)

Background Mucogingival deformities, and gingival recession in particular, are a group of conditions that affect a large number of patients. Since life expectancy is rising and people are retaining more teeth both gingival recession and the related damages to the root surface are likely to become more frequent. It is therefore important to define anatomic/morphologic characteristics of mucogingival lesions and other predisposing conditions or treatments that are likely to be associated with occurrence of gingival recession. Objectives Mucogingival defects including gingival recession occur frequently in adults, have a tendency to increase with age, and occur in populations with both high and low standards of oral hygiene. The root surface exposure is frequently associated with impaired esthetics, dentinal hypersensitivity and carious and non-carious cervical lesions. The objectives of this review are as follows (1) to propose a clinically oriented classification of the main mucogingival conditions, recession in particular; (2) to define the impact of these conditions in the areas of esthetics, dentin hypersensitivity and root surface alterations at the cervical area; and (3) to discuss the impact of the clinical signs and symptoms associated with the development of gingival recessions on future periodontal health status. Results An extensive literature search revealed the following findings: 1) periodontal health can be maintained in most patients with optimal home care; 2) thin periodontal biotypes are at greater risk for developing gingival recession; 3) inadequate oral hygiene, orthodontic treatment, and cervical restorations might increase the risk for the development of gingival recession; 4) in the absence of pathosis, monitoring specific sites seems to be the proper approach; 5) surgical intervention, either to change the biotype and/or to cover roots, might be indicated when the risk for the development or progression of pathosis and associated root damages is increased and to satisfy the esthetic requirements of the patients. Conclusions The clinical impact and the prevalence of conditions like root surface lesions, hypersensitivity, and patient esthetic concern associated with gingival recessions indicate the need to modify the 1999 classification. The new classification includes additional information, such as recession severity, dimension of the gingiva (gingival biotype), presence/absence of caries and non-carious cervical lesions, esthetic concern of the patient, and presence/absence of dentin hypersensitivity.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jcpe.12948

Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations

Anterior composite restorations: A systematic review on long-term survival and reasons for failure.

The microbiota of the human metaorganism is not a mere bystander. These microbes have coevolved with us and are pivotal to normal development and homoeostasis. Dysbiosis of the GI microbiota is associated with many disease susceptibilities, including obesity, malignancy, liver disease and GI pathology such as IBD. It is clear that there is direct and indirect crosstalk between this microbial community and host immune response. However, the precise mechanism of this microbial influence in disease pathogenesis remains elusive and is now a major research focus. There is emerging literature on the role of the microbiota in the pathogenesis of autoimmune disease, with clear and increasing evidence that changes in the microbiota are associated with some of these diseases. Examples include type 1 diabetes, coeliac disease and rheumatoid arthritis, and these contribute significantly to global morbidity and mortality. Understanding the role of the microbiota in autoimmune diseases may offer novel insight into factors that initiate and drive disease progression, stratify patient risk for complications and ultimately deliver new therapeutic strategies. This review summarises the current status on the role of the microbiota in autoimmune diseases.

/pdf/does-the-microbiota-play-a-role-in-the-pathogenesis-of-38xjgktx64.pdf

Does the microbiota play a role in the pathogenesis of autoimmune diseases

Background: Rheumatoid arthritis (RA) and periodontitis are both chronic inflammatory disease which demonstrate similarities in terms of mechanism, histopathology and demography. An association between these conditions has been demonstrated previously but has been called into question more recently. Methods: The published databases MEDLINE, EMBASE and PsycINFO were searched using search terms related to RA and periodontitis. Articles were selected if they included data on the number of people with RA diagnosed with periodontitis (or periodontal disease parameters) compared to a control comparison group. Review articles, case reports, animal model studies, non-English language and articles with unavailable abstracts were excluded. Data was extracted, critically appraised using the Downs and Black tool and a random effect Mantel-Haenszel meta-analysis was performed. Results: 21 papers met the eligibility criteria and provided data for the meta-analysis; 17 studies (including a total of 153,492 participants) comparing RA to healthy controls and 4 (including a total of 1378 participants) comparing RA to osteoarthritis (OA). There was a significantly increased risk of periodontitis in people with RA compared to healthy controls (RR: 1.13; 95% CI: 1.04, 1.23; p=0.006; N: 153,277) with a significantly raised mean probing depth, risk of bleeding on probing (BOP) and absolute value of clinical attachment loss in those with rheumatoid arthritis. When comparing RA and OA, there was no significant difference in the prevalence of periodontitis, however the risk of BOP was greater in OA than RA. Conclusion: The significant association between RA and periodontitis is supported by the results of our systematic review and meta-analysis of studies comparing RA to healthy controls. In our meta-analysis, however, this is not replicated when comparing RA to OA controls.

/pdf/hand-to-mouth-a-systematic-review-and-meta-analysis-of-the-3bhj04z7lj.pdf

Hand to Mouth: A Systematic Review and Meta-Analysis of the Association between Rheumatoid Arthritis and Periodontitis.

Objective. Patients with RA suffer from a higher risk of periodontal attachment loss and increased oral inflammation. We hypothesize that there are pathogenetic and immunological interactions between these diseases that go beyond impaired manual dexterity accompanying advanced RA. The primary objective of the present study was to determine whether a loss of alveolar bone can be detected in RA patients during the early course of the disease. Methods. In this cross-sectional, epidemiological casecontrol study, 22 patients with early RA (ERA) were compared with 22 matched healthy controls. Oral and periodontal status, clinical activity, and sociodemographic parameters were determined. Oral microbiota were analysed using real-time quantitative PCR specific for leading oral pathogens. Results. More advanced forms of periodontitis were found in ERA patients compared with controls. ERA patients had a greater number of missing teeth [ERA 5.7 (S.D. 5.0), controls 1.9 (S.D. 1.0), P = 0.002], deeper periodontal pockets [clinical attachment level: ERA 3.4 (S.D. 0.5 mm), controls 2.7 (S.D. 0.3 mm), P < 0.000], and greater bleeding on probing [ERA 18.6% (S.D. 9.0%), controls 10.5% (S.D. 5.1%), P = 0.001] despite comparable oral hygiene. Tannerella forsythia (6.77-fold, P = 0.033) subgingivally and Streptococcus anginosus (3.56-fold, P = 0.028) supragingivally were the characteristic pathogens in ERA. Conclusion. Increased loss of periodontal attachment and alveolar bone can be detected in patients with ERA, therefore we propose that the consulting rheumatologists inform the patients that they have a higher risk of periodontal disease. It would be beneficial if these patients were referred directly for intensive dental care.

/pdf/oral-status-in-patients-with-early-rheumatoid-arthritis-a-1eaa1lpr7w.pdf

Oral status in patients with early rheumatoid arthritis: a prospective, case–control study

Recontouring teeth and closing diastemas with direct composite buildups: A 5-year follow-up

The aim of this investigation was to give insights into the impact of endurance training on oral health, with regard to tooth erosion, caries, and salivary parameters. The study included 35 triathletes and 35 non-exercising controls. The clinical investigation comprised oral examination, assessment of oral status with special regard to caries and erosion, saliva testing during inactivity, and a self-administered questionnaire about eating, drinking, and oral hygiene behavior. In addition, athletes were asked about their training habits and intake of beverages and sports nutrition. For saliva assessment during exercise, a subsample of n = 15 athletes volunteered in an incremental running field test (IRFT). Athletes showed an increased risk for dental erosion (P = 0.001). No differences were observed with regard to caries prevalence and salivary parameters measured during inactivity between athletes and controls. Among athletes, a significant correlation was found between caries prevalence and the cumulative weekly training time (r = 0.347, P = 0.04). In athletes after IRFT and at maximum workload, saliva flow rates decreased (P = 0.001 stimulated; P = 0.01 unstimulated) and saliva pH increased significantly (P = 0.003). Higher risk for dental erosions, exercise-dependent caries risk, and load-dependent changes in saliva parameters point out the need for risk-adapted preventive dental concepts in the field of sports dentistry.

Effect of endurance training on dental erosion, caries, and saliva.

Provided that moisture control is possible, today's resin composite materials can be applied successfully in the restorative treatment of extensively decayed teeth. This suggests that restorative margins will be increasingly located below the cementoenamel junction, probably invading biological width. The recently introduced technique of proximal box elevation (PBE) offers the possibility of performing a stepwise elevation of deep proximal cavities to create more favorable preparation margins for direct or indirect restorations. Clinical instructions for the restoration of extensively damaged teeth are given through this presentation. A two-step R2-technique will be shown, and a critical review of the dogma of biological width will be presented.

Proximal box elevation with resin composite and the dogma of biological width: clinical R2-technique and critical review.

Background The authors conducted a literature review to determine how dentofacial esthetics can be evaluated in restorative dentistry and which quantifiable clinical parameters can be used for this assessment of dentofacial esthetics. Types of Studies Reviewed The authors selected 35 studies that focused on assessment strategies for dental professionals. The primary inclusion criteria were intraoral and extraoral esthetic assessment methods and indexes or rating scales evaluating esthetics in restorative dentistry. Results The studies' protocols and assessment methods were heterogeneous. The authors grouped the studies into six categories according to topic: golden proportion, soft-tissue measurement, smile and smile line assessment, orofacial indexes and scales, incisor proportion and angulation, and facial esthetics. These categories included various esthetic parameters, including the smile line, lip line, incisal offset, location of dental and facial midline, incisor angulations and width to height ratios of the maxillary anterior teeth, gingival contour, and root coverage and papilla height. These parameters should be considered when providing dental treatment in the anterior area, as they allow for quantification and objective judgment. Clinical Implications The findings of this review might increase interest in a comprehensive dental esthetic index that allows for objective quantification and intrastudy and interstudy comparison of dental treatment outcomes.

https://jada.ada.org/article/S0002-8177(14)60843-6/pdf

Cornelia Frese

Papers

Oral status in patients with early rheumatoid arthritis: a prospective, case–control study

Recontouring teeth and closing diastemas with direct composite buildups: A 5-year follow-up

Effect of endurance training on dental erosion, caries, and saliva.

Proximal box elevation with resin composite and the dogma of biological width: clinical R2-technique and critical review.

The assessment of dentofacial esthetics in restorative dentistry: A review of the literature