Articles and issues

Background. Early childhood caries remains highly prevalent in India, and many affected children have limited access to restorative care. Silver diamine fluoride (SDF) and sodium fluoride varnish are both used to arrest cavitated lesions, but direct comparisons in Indian preschool populations are scarce. Methods. In this examiner-blinded, parallel-group randomized controlled trial, children aged 36–71 months with at least one active cavitated dentin lesion were recruited from 24 anganwadi centers and preschools in Chennai and allocated to 38% SDF applied every 6 months or 5% sodium fluoride varnish applied every 3 months. The primary outcome was lesion arrest at 12 months, assessed by visual-tactile examination and analyzed with generalized estimating equations to account for clustering within children. Results. A total of 222 children with 979 lesions were randomized, and 205 (92.3%) completed follow-up. At 12 months, 71.9% of lesions treated with SDF and 43.2% of those treated with varnish were arrested (adjusted odds ratio 3.24, 95% CI 2.31–4.55; p < 0.001). All lesions were arrested in 46.2% versus 18.8% of children, respectively. New lesion development did not differ between groups. Parental satisfaction with appearance was lower in the SDF group (68.3% vs 89.1%), and adverse events were mild and transient. Conclusions. Semiannual 38% SDF arrested substantially more cavitated lesions than quarterly fluoride varnish over 12 months. Its low cost and simplicity support its use in community programs for preschool children in India, provided that parents are counseled about permanent black staining.

Introduction. External cervical resorption (ECR), also termed invasive cervical resorption, is an aggressive, often asymptomatic form of root resorption whose true extent is difficult to assess on periapical radiographs. Cone-beam computed tomography (CBCT) allows three-dimensional classification of the lesion and guides the choice between external repair, root canal treatment and extraction. Case presentation. A 29-year-old woman with a history of orthodontic treatment and dental trauma was referred with a pink discoloration at the cervical margin of her maxillary right central incisor. The tooth was asymptomatic and responded normally to sensibility tests, but a subgingival cavitation bled profusely on probing to a depth of 4 mm. A periapical radiograph showed an irregular radiolucency superimposed on the root canal. Limited field-of-view CBCT revealed a lesion extending 3.8 mm apical to the cementoenamel junction with a circumferential spread of about 150°, separated from the canal by an intact radiopaque layer (class 2Bd). The lesion was treated by flap surgery, curettage, application of 90% trichloroacetic acid and restoration with a tricalcium silicate liner and resin-modified glass ionomer cement, without root canal treatment. At 18 months the tooth remained vital and asymptomatic, probing depths were 2 mm without bleeding, and CBCT showed no recurrence. Conclusion. CBCT-based classification identified a restorable lesion with an intact pericanalar barrier, allowing conservative external repair and preservation of pulp vitality. CBCT should be considered whenever ECR is suspected.

Background. Monolithic zirconia and lithium disilicate are the materials most widely used for single crowns made with digital workflows, but their long-term clinical performance has rarely been compared. Objective. To compare the 5-year survival and complication rates of tooth-supported monolithic zirconia and lithium disilicate single crowns. Methods. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Web of Science were searched from January 2008 to December 2025 for randomized trials and prospective cohort studies with a mean follow-up of at least 4 years. Risk of bias was assessed with RoB 2 and the Newcastle–Ottawa Scale. Five-year survival and complication rates were estimated with random-effects Poisson regression, and trials comparing the two materials directly were pooled as risk ratios. Results. Eight studies (three randomized trials and five prospective cohort studies) reporting on 1,277 crowns in 926 patients were included. Estimated 5-year survival was 97.5% (95% CI 95.9–98.5) for monolithic zirconia and 96.6% (95% CI 95.0–97.6) for lithium disilicate (p = 0.31). In the randomized trials, the risk of failure did not differ between materials (risk ratio 1.44, 95% CI 0.47–4.42; I² = 0%). Ceramic fracture was more frequent with lithium disilicate (1.5% vs 0.3%; p = 0.044), whereas loss of retention was more frequent with monolithic zirconia (2.3% vs 0.8%; p = 0.024). Conclusions. Both materials show high and comparable 5-year survival as single crowns. Their different complication profiles, rather than survival, should guide material selection and cementation, although the certainty of the evidence is low.