The management of occlusal caries still remains a major challenge for researchers as well as for general practitioners. The present paper reviews and discusses the most up-to-date knowledge and evidence of the biological principles guiding diagnosis, risk assessment, and management of the caries process on occlusal surfaces. In addition, it considers the whole spectrum of the caries process on occlusal surfaces, ranging from the molecular ecology of occlusal biofilms to the management of deep occlusal caries lesions. Studies using molecular methods with focus on biofilms in relation to occlusal caries should explore the relationship between the function and the structural composition of these biofilms to understand the role of occlusal biofilms in caries development. State-of-the-art measures to evaluate risk for occlusal caries lesion activity, caries incidence, and progression should include the assessment of the occlusal biofilm and the stage of tooth eruption. Careful clinical examination of non-cavitated lesions, including assessment of the lesion activity status, remains the major tool to determine the immediate treatment need and to follow on the non-operative treatment outcome. Even medium occlusal caries lesions in the permanent dentition may be treated by non-invasive fissure sealing. By extending the criteria for non-invasive treatments, traditional restoration of occlusal surfaces can be postponed or even avoided, and the dental health in children and adolescents can be improved. Selective removal (incomplete) to soft dentin in deep carious lesions has greater success rates than stepwise excavation. Selective (complete) removal to firm dentin has a lower success rate due to increased pulp exposure.

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Occlusal Caries: Biological Approach for Its Diagnosis and Management

Objective. To assess the ability of multivariate models and single factors to correctly identify future caries development in pre-school children and schoolchildren/adolescents. Study design. A systematic literature search for relevant papers was conducted with pre-determined inclusion criteria. Abstracts and full-text articles were assessed independently by two reviewers. The quality of studies was graded according to the QUADAS tool. The quality of evidence of models and single predictors was assessed using the GRADE approach. Results. Ninety original articles fulfilled the inclusion criteria. Seven studies had high quality, 35 moderate and the rest poor quality. The accuracy of multivariate models was higher for pre-school children than for schoolchildren/adolescents. However, the models had seldom been validated in independent populations, making their accuracy uncertain. Of the single predictors, baseline caries experience had moderate/good accuracy in pre-school children and limited accurac...

Caries risk assessment. A systematic review

Tooth-coloured restorative materials are being used increasingly more often in Class II preparations in permanent teeth. Using a practice-based study design, we aimed to assess the survival time of Class II restorations and to identify factors relevant to their longevity. Class II restorations (n = 4,030), consisting of resin composites (81.5%), compomers (12.7%), amalgams (4.6%), and glass-ionomer cement restorations (1.2%), were placed in 1,873 patients with a median age of 15 yr. In total, 92.7% of restorations were placed due to primary caries and 5.8% were replacements. After an average follow-up period of 4.6 yr, 61.6% of the restorations were successful, 11.2% had failed, and 27.2% were not available for evaluation (owing to patient drop-out). The mean annual failure rate was 2.9% for resin-composite restorations and 1.6% for amalgams. For resin-composite restorations, secondary caries was the most common reason for replacement (73.9%), followed by loss (8.0%), fracture (5.3%), and marginal defects (2.4%). Multilevel Cox-regression analyses identified young age of the patient, high previous caries experience, deep cavities, and saucer-shaped preparation technique as predisposing to shorter longevity of resin-composite restorations. One brand of resin composite had a shorter survival time than the others.

Longevity of posterior dental restorations and reasons for failure

Resin infiltration is an innovative approach to arrest progression of caries lesions. The aim of this randomized split-mouth placebo-controlled clinical trial was to assess whether resin infiltration of proximal lesions is more effective than non-operative measures alone with respect to the inhibition of caries progression. In 22 young adults, 29 pairs of interproximal lesions with radiological extension into the inner half of enamel or the outer third of dentin were randomly allocated to two treatment groups. In the test group, lesions were infiltrated (Icon, pre-product; DMG). A placebo treatment was performed in the control group. All participants received instructions for diet, flossing, and fluoridation. The primary outcome after 18 months was radiographic lesion progression (assessed by digital subtraction radiography). No unwanted effects could be observed. In the effect group, 2/27 lesions (7%) and in the control group 10/27 lesions (37%) showed progression (p = 0.021; McNemar). Infiltration of interproximal caries lesions is efficacious in reducing lesion progression.

Resin Infiltration of Caries Lesions an Efficacy Randomized Trial

Background: 
Posterior maxillae are often difficult to treat owing to the sinus antrum. Placing implants in remaining bone regions in the atrophic maxilla, without performing sinus grafting, is a challenge. Immediate function adds to this challenge.

Purpose: 
The purpose of this study was to suggest and evaluate a simplified treatment concept for the rehabilitation of the atrophic maxilla using tilted implants subjected to immediate/early function.

Materials and Methods: 
Eighteen patients were included in the study. Sixty implants were placed to support 19 fixed partial or full-arch prostheses. Immediate/early function was applied. The patients were followed for a minimum of 1 year after prosthesis connection. Stability measurements and radiographic evaluation of the change of the marginal bone level were performed.

Results: 
One axial and one tilted implant failed in one patient, giving a cumulative survival rate of 96.7%. No failure of provisional prostheses occurred. The mean marginal bone resorption recorded after 1 year was low (0.82 mm for axial implants and 0.34 mm for tilted implants).

Conclusion: 
The results of the present study suggest that tilted implants placed in immediate function may be a viable treatment approach for the rehabilitation of the atrophied maxilla. Simplified treatment procedures, reduced surgical invasion, shorter treatment time, and reduced costs constitute some of the benefits for the patient and the clinician.

Simplified treatment of the atrophic posterior maxilla via immediate/early function and tilted implants: A prospective 1-year clinical study.

The objectives were (1) to assess caries development, including the incidence and rate of lesion progression, in a Swedish cohort from adolescence to young adulthood and (2) to compare the caries inci

Caries Incidence and Lesion Progression from Adolescence to Young Adulthood: A Prospective 15-Year Cohort Study in Sweden

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Caries Incidence and Lesion Progression from Adolescence to Young Adulthood: A Prospective 15-Year Cohort Study in Sweden