Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia

Khalid S. Almulhim; Rasha AlSheikh; Moamen Abdalla; Rasha Haridy; Amr Bugshan; Stephen Smith; Mohammed Zeeshan; Moataz Elgezawi

doi:10.12688/f1000research.130981.1

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Research Article

Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia

[version 1; peer review: 2 approved with reservations]

Khalid S. Almulhim¹, Rasha AlSheikh¹, Moamen Abdalla², [...] Rasha Haridy³, Amr Bugshan⁴, Stephen Smith⁵, Mohammed Zeeshan⁶, Moataz Elgezawi ¹

Khalid S. Almulhim¹, Rasha AlSheikh¹, [...] Moamen Abdalla², Rasha Haridy³, Amr Bugshan⁴, Stephen Smith⁵, Mohammed Zeeshan⁶, Moataz Elgezawi ¹

PUBLISHED 03 Apr 2023

Author details Author details

¹ Restorative Dental Sciences, Imam Abdulrahman Bin faisal University, Dammam, Saudi Arabia, 1982, Saudi Arabia
² Substitutive Dental sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, 1982, Saudi Arabia
³ Clinical Dental sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia, Saudi Arabia
⁴ Biomedical dental sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
⁵ Preventive Dental Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
⁶ Medical Education, Imam Abdulrahman Bin Faisal University, Dmmam, Saudi Arabia

Khalid S. Almulhim
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Rasha AlSheikh
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Software, Validation, Writing – Original Draft Preparation

Moamen Abdalla
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Rasha Haridy
Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Amr Bugshan
Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Stephen Smith
Roles: Formal Analysis, Funding Acquisition, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Mohammed Zeeshan
Roles: Formal Analysis, Methodology, Validation, Writing – Original Draft Preparation

Moataz Elgezawi
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background: Esthetic anterior composite restorations are very challenging. They constitute a main part of the clinical practice of restoring teeth with resin composites. Distinctive variations in composite material selection and technique of application in anterior teeth exist when compared to the practice of restoring posterior teeth with resin composites. In a continuation of a previous assessment of class II resin composite practice, a cross-sectional survey study was performed to determine the awareness of general dental practitioners in Saudi Arabia about resin composite restorations in anterior teeth and to provide evidence-based recommendations to improve their practice.
Methods: A total of 500 dental practitioners from different provinces in Saudi Arabia were invited to participate in an online questionnaire which comprised four domains and included a total of sixteen questions addressing aspects regarding the selection of resin composites, cavity configuration, etching protocol, light-curing technique, liner application, application of poly-chromatic composite, as well as finishing and polishing procedures. Chi square testing and descriptive statistics were used to analyze the attained data.
Results: From 250 respondents, the greatest participation was from the Eastern and Middle provinces of Saudi Arabia. Female dentists participated less than males. There was no general agreement between participants regarding the resin composite material or the employed technique of application in restoring anterior tooth defects. Respondents indicated that discoloration and hypersensitivity were the most common reasons for patient’s dissatisfaction with resin composites in anterior teeth.
Conclusions: Dental practitioners are highly encouraged to improve their clinical practice of restoring anterior teeth using resin composites with the focus upon continuous education programs, online webinars, and workshops.

Keywords

Keywords: cross-sectional survey; resin composite; anterior teeth; general dentists; Saudi Arabia.

Corresponding author: Moataz Elgezawi

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2023 Almulhim KS et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Almulhim KS, AlSheikh R, Abdalla M et al. Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia [version 1; peer review: 2 approved with reservations]. F1000Research 2023, 12:359 (https://doi.org/10.12688/f1000research.130981.1) First published: 03 Apr 2023, 12:359 (https://doi.org/10.12688/f1000research.130981.1) Latest published: 20 Sep 2023, 12:359 (https://doi.org/10.12688/f1000research.130981.2)

Introduction

The main objective of the modern practice of restorative dentistry is the reestablishment of optimum esthetics and effective biofunction of hard structural tooth defects in an evidence-based and patient-centered manner with long term clinical durability.¹ The central focus for dental clinicians, researchers as well as patients constitutes the optimization of procedural outcomes when restoring defective anterior teeth into esthetically pleasing, biologically healthy and mechanically sound integral units of the dental arch.²^–⁴

Presently, direct resin composites are the principle and most widely used option for restoring anterior teeth as they can produce restorations with optimum esthetics and effective biomechanical rehabilitation with long-term clinical reliability and patient satisfaction.⁵ Furthermore, they can conserve and reinforce sound tooth structure.⁶^–¹⁰ Modern resin composites have particularly upgraded optical properties, surface finish color stability, wear resistance, flexure strength and fracture toughness.¹¹ In comparison to the indirect options of dental ceramics, direct resin composites are timesaving, less costly and allow for repairable options.¹²^–¹⁴

Restoration of defects in the esthetic zone is challenging. According to World Dental Federation (FDI) commission 2-95, the quality of the restoration is directly related to the utilized materials, to the clinician's individual skills and preferences as well as to patient’s particular oral environment and post-operative care.²^,³ Operator related factors have been considered as being instrumental in determining the quality and clinical performance of dental restorations. This includes procedural excellence variations, clinical judgement, and differences between operators regarding cavity design, material selection and manipulation.¹⁵

Various resin composite materials are currently available in the market with variations in composition, clinical performance and application technique as recommended by manufacturers.¹⁶^–¹⁸ Micro-filled, micro-hybrid, nano-hybrid, flowable, incremental, and bulk-fill composites are amongst the available resin composites widely used in restoring tooth defects.¹⁶^–¹⁸

Restoring anterior tooth shape and optical characteristics involve a variety of procedural techniques which are determined by the material used, extent of the defect and operator preference.¹⁹^,²⁰ Anterior tooth defects may be small or extensive, resulting from caries or non-carious developmental defects, as well as traumatic lesions. Freehand, palatal putty index and different matricing techniques have been suggested for restoring anterior tooth defects, especially involving the incisal angle or extensive coronal tooth structure defects.¹⁹^,²⁰

Natural teeth consist of translucent enamel and relatively opaque dentin which is influenced by the pulp and investing gingiva.²¹ This necessitates a polychromatic manner of restoring anterior tooth defects requiring consideration of tooth optical characteristics and chameleon effects.²²^,²³ Individual shading patterns and translucency variability of teeth are demanding. A single shade mono-laminal versus different shade multilaminate techniques have been alternatively implemented to optimize results that will match tooth optical characteristics when restoring anterior tooth defects.²⁴^,²⁵ Dentists differ in their judgment regarding the necessity of using an intermediate liner beneath resin composites in anterior teeth.²⁶ Moreover, they differ in selecting a particular brand of resin composite material and a specific restoration technique for a particular clinical situation when restoring anterior tooth defects.

This cross-sectional survey was therefore designed to investigate the current clinical practices of general dental practitioners in Saudi Arabia regarding the restoration of anterior tooth defects using resin composites. In our previous publication, class II resin composite practices of general dental practitioners in Saudi Arabia were assessed.²⁷ The objective of the current study was to assess the knowledge and attitude of general dental practitioners in Saudi Arabia toward anterior resin composites.

Methods

General non-university governmental hospitals in each of the following Saudi provinces; North, Middle, East, West, and South were considered in the study. The hospitals were enumerated in sequence according to the number of available dental units. The first five hospitals with the largest number of dental units in each of the study provinces with the largest number of appointed dentists were selected for the study and included 500 dental practitioners. The study was conducted over a period of four months starting mid-September 2021. E-mail addresses of general dentists were collected through administrative contacts in hospitals included in the study after explaining the study objective. Personal data including names, gender or years of employment were not available to the study investigators prior to sending the invitations, and all e-mail invitations were anonymous. Potential sources of bias were minimized by avoiding leading answers, extreme answers, questions framing, question order bias and sampling bias.

This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator.

The validity and reliability of the questions were tested for content validation. Ten experts were invited to validate each question of the survey before the beginning of the study using the following scale: the question is not relevant, the question is somewhat relevant, the question is quite relevant, or the question is highly relevant. The experts ranked all questions as either relevant or highly relevant. Therefore, no modifications were made in the designed questions.

The questionnaire comprised four domains; the first domain focused on the demographic data of the participants. Demographic data included age, gender, and city of appointment. The second domain targeted the professional record (profession duration and frequency of utilizing anterior composite resin restorations). The third domain addressed the individual personal preferences in the selection and utilization of resin composites for restoring anterior tooth structure defects. The fourth domain investigated patients' feedback regarding previously placed resin composite restorations. Moreover, it considered suggestions for anterior resin composites practice improvement. The questionnaire included a total of 18 questions of which 3 questions allowed two optional answers while the rest of the questions included more than two optional answers. Chi square testing using SPSS 27 software at a level of significance of p ≤ 0.05 and descriptive statistics were employed in analyzing the received responses. Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis.

Table 1. Hospitals targeted.

Hospital targeted	Kingdom region
Arar Central Hospital	North
Turaif General Hospital
Prince Abdulaziz Bin Musaad Hospital
Rafha Central Hospital
Alwiqela General Hospital
Dammam Central Hospital	Eastern
Qatif Central Hospital
King Fahad Specialist Hospital
Jubail General Hospital
Kafji General Hospital
General Hospital at King Saud Medical City	Middle
Braidah General Hospital
AlAflaj General Hospital
Arras General Hospital
King Saud Hospital at Unnizah
AlKhakeer General Hospital	South
King Khalid Hospital In Najran
Najran General Hospital
Sharourah General Hospital
Sharourah Armforce Hospital
King Fahad Hospital Jeddah	West
King Abdulaziz Hospital Makkah
King Fahad Hospital Almaddinah
Rabigh General Hospital
Noor Specialist Hospital

Ethics statement

This research received an ethical approval (IRB-2022-02-102) from IRB Committee, Imam Abdulrahman Bin Faisal University.

During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes. The IRB approval of Imam Abdulrahman bin Faisal University deemed this method of implied consent as sufficient.

Results

Out of the 500 email invitations, 250 responses were obtained. The questionnaire domains, questions, answers, and relative responses in percentages and the P values are depicted in Tables 2-4 and Figures 1-2: Responses with different upper-case letters in each question have statistically significant difference (p ≤ 0.05). Domain 1 comprised the demographics of participants (n=250), see Table 2.

Table 2. Demographics of partcipants.

Questions	Modalities	Respondent	Response in %
1. Age	23-30	47	19
	31-39	101	40
	40-49	69	28
	Above 50	32	13
	Non-respondents	1	0
2. Gender	Male	169	68
	Female	80	32
	Non-respondents	1	0
3. Status	General dentist	171	68
	Resident	19	8
	Specialist	48	19
	Consultant	9	4
	Non-respondents	3	1
4. Where you have been practicing in Saudi Arabia	Eastern province	79	32
	Western province	55	22
	Middle province	68	27
	Northern province	21	8
	Southern province	22	9
	Non-respondents	5	2

Domain 2 comprised the dentists’ professional records (profession duration and frequency of utilizing anterior composite resin restorations).

Questions	Modalities	Respondent	Response in %
5. How long have you been practicing dentistry? (n=250)	<5	47	19
	5–10	55	22
	10–15	52	21
	15<	91	36

6. How many resin composite restorations in anterior teeth do you place per week? (n=250)

Domain 3 comprised the individual personal preferences in the selection and utilization of resin composites for restoring anterior tooth structure defects (n=250), Table 3.

Table 3. Personal Preference for anterior resin Composite restorations.

Questions		Modalities	Respondent	Percentages	P-values
7. What is the isolation technique that you usually use?		Rubber dam isolation	180	73 ^a	< 0.001
7. What is the isolation technique that you usually use?		Cotton rolls isolation	67	27 ^b	< 0.001
8. What is the most frequent type of composite resin restoration you practice?		Class III	161	64 ^a	<0.001
		Class IV	116	46 ^a
		Class V	147	59 ^a
		Buildup	120	48 ^a
		Laminate	27	11 ^b
		Other	18	7 ^b
9. What is the type of resin composite material you use to restore each class?	Class V	Micro-filled	69	28 ^a	0.02
		Micro-hybrid	40	16 ^a
		Flowable	64	26 ^a
		Nano-hybrid	70	28 ^a
		Any composite	6	2 ^b
		Non-respondents	1	0 ^b
	Class III	Micro-filled	68	27 ^a	0.019
		Micro-hybrid	80	32 ^a
		Nano-hybrid	91	37 ^a
		Any composite	8	3 ^b
		Non-respondents	3	1 ^b
	Class IV	Micro-filled	65	26 ^a	<0.001
		Micro-hybrid	83	33 ^a
		Nano-hybrid	82	33 ^a
		Other	14	6 ^b
		Non-respondents	6	2 ^b
10. Type of etching/adhesive system you use:		Self-adhesive	58	23 ^a	<0.001
		(selective) Self-etching	78	31 ^a
		Total etching	112	45 ^a
		Non-respondents	2	1 ^b
11. Type of light-curing unit you use:		QTH (quarz Tungsten halogen)	80	32 ^a	<0.001
		LED Blue light	161	65 ^a
		Laser	3	1 ^b
		Plasma Arch	5	2 ^b
		Non-respondents	1	0 ^b
12. Duration of curing per layer:		10 sec.	43	17 ^a	<0.001
		20 sec.	136	54 ^a
		30 sec.	37	15 ^a
		40 sec.	27	11 ^a
		More than 40 sec.	4	2 ^b
		Non-respondents	3	1 ^b
13. In class IV restorations, what is the technique that you use?		Freehand technique	108	43 ^a	<0.001
		Palatal putty index technique	26	10 ^a
		Both alternatives	114	46 ^a
		Non-respondents	2	1 ^b
14. Do you usually use a liner under a composite restoration?		No	27	11 ^a	<0.001
		Sometimes	138	55 ^a
		Most of the times	83	33 ^a
		Non-respondents	2	1 ^b
15. In class IV restorations, do you use a polychromatic approach in the form of enamel and dentin shades?		Yes	125	50 ^a	<0.001
		No	120	48 ^a
		Non-respondents	5	2
16. The technique used for finishing and polishing of the composite resin restoration		Soflex	82	33 ^a	0.01
		White stones	133	53 ^a
		Finishing carbide burs	117	47 ^a
		Polishing rubber burs with paste (e.g., enhance)	118	47 ^a
		Finishing/Polishing strips	173	69 ^a
		Non-respondents	2	1 ^b

Domain 4 comprised anterior composites failure & suggestion for practice improvement (n=250) Table 4.

Table 4. Failure of anterior composites & Suggestion for practice improvement.

Questions	Modalities	Respondent	Response in %
17. What are the principal forms of failure and patient dissatisfaction with old resin composite restorations in anterior teeth?	Hypersensitivity	17	7 ^b	<0.001
	Discoloration	183	73 ^a
	Recurrent caries	27	11 ^b
	Shape and form	8	3 ^b
	Chipped/Fractured	13	5 ^b
	Non-respondents	2	1 ^b
18. How can the practice of anterior composites be improved?	Continuous education programs workshops, online webinars	170	69 ^a	<0.001
	Direct clinical training at respective hospitals and assisting senior specialist	78	31 ^a
	Non-respondents	2	1 ^b

Figure 1. Duration of practice of dentistry.

Figure 2. Frequency of practice of resin composite restorations in anterior teeth per week.

Discussion

This study analyzed the current practice of restoring anterior tooth defects with direct resin composites by dentists in Saudi Arabia. This cross-sectional survey was utilized to collect and analyze dental practitioners’ responses at one single time. The study was designed and conducted over a period of four months which was initiated in mid-September 2021. The number of anticipated participants at the time of the study design as well as the number of respondents to the survey could have affected the results of the survey. A broader study outcome could have been provided if greater population sizes and larger numbers of respondents were utilized.²⁸^,²⁹ The inclusion of general governmental hospitals granting dental treatments completely free of charge to patients is another possible limitation of the current study. The flow of patients seeking free dental treatments versus the availability of time and facilities may also have had an influence. Study outcomes in this study could have been expanded by the addition of private dental centers and clinics as well as university clinics and hospitals. This would thus have included general dentists exposed to socioeconomically different patients and distinctive facilities. The current survey was conducted as an online questionnaire. This method facilitated the ease of collecting data instead of utilizing a physical paper method. Invitations to participants was sent via e-mail. E-mail addresses of the general dentists in the included hospitals were anonymously collected through administrative contacts after explaining the study objective. Participants were anonymously and voluntarily invited to participate in the survey without any bias and with assurance of confidentiality so as to follow ethical guidelines. To assure reliability and validity of questions, ten experts in restorative dentistry were requested to validate the questionnaire before starting the survey. All invited experts validated questions as either highly relevant or relevant.²⁸ Participants were from all Saudi Arabia provinces, with the highest participation from the Eastern and Middle provinces. Though it was not anticipated for gender to have any impact on the collected data, it was included in the general demographic information. Most of the dental schools in the Kingdom are segregated with more male schools available compared to female’s, that said, more female dentists have graduated from King Saud University since 1982³⁰ and later from other universities with the number continuing to increase. The results from our study showed that male dentist’s participation was more than females which is in line with a previous study.²⁷

Data from the Saudi Commission for Health Specialties in 2016 shows that 70.27 % of licensed dentists are registered as general dentists in Saudi Arabia, therefore the current study design targeted general dentists who constitute the greatest fraction of licensed dentists in Saudi Arabia.²⁷ The used population size and distribution in the current study was previously used in a cross-sectional survey that studied class II resin composites practice of general dentists in Saudi Arabia.³¹

In a former survey-based study performed in southern Brazil, a sample size of 276 dentists and descriptive statistics were used to draw the study conclusions about the clinical practice of general dentists in anterior composite restorations.³ The study revealed that most dentists in southern Brazil use hybrid composite, simplified adhesives, LED light curing and immediate polishing while only few dentists use of rubber dam isolation.³

A recent systematic review that studied the clinical reliability of anterior composites has summarized the factors influencing the quality and evaluation process of restorations. The first group of factors are restoration related (material type, composition, insertion technique, curing mode, finishing and polishing, shading concept, and accuracy). The second group is preparation related (form and configuration, volume, margin design, and proximal extension). The third group is operator related (experience, skills, and handling). The environment in terms of public academic centers, private centers, public social centers, multiple or single operator practice was listed as the fourth group.⁷^,³²^,³³

In designing the questionnaire of the current study and the targeted population, the previous factors were considered.

Modern resin composite formulations include developments and modifications in materials technology regarding the structural components of resin matrix, fillers, coupling agents, photo initiator as well as shading and color pigments.³⁴^–³⁸ This has greatly influenced the physico-mechanical and biological properties of different brands of resin composites which eventually impact clinical application techniques and final clinical behavior during function in the oral cavity. Bulk-fill, self-adhesive, single shade, self-healing, and antibacterial composites are examples of such recent developments. Similarly, modern finishing and polishing tools of resin composites have also become available in the market. The increasing demand from patients for excellent esthetic quality has been met with distinctive clinical application techniques utilizing direct resin composites for restoring defects of particularly anterior teeth, this by means of combining art with knowledge and color selection.⁵ Based on the natural layering concept, a polychromatic layering technique has been suggested.³⁹ An example of this practice is the utilization of palatal indices to optimize the designed form and contours.⁴⁰

Isolation of the operative field and control of moisture during various operative restorative procedures are essential for developing optimum physical and mechanical properties of the restoration. This is particularly true for resin composite restorations in anterior teeth where developing optimum adhesion and superior esthetics is mandatory for clinical reliability and patient satisfaction. In agreement with previous studies, rubber dam followed by cotton rolls isolation were the two methods of operative field isolation used by participants of the current survey.⁴¹

Assessing the ability to reliably restore esthetics is a principal aspect of the current cross-sectional study. The chameleon effect has been reported by manufacturers of resin composites as a property of the material to adapt to the color of the surrounding tooth tissues. The color adjustment potentials of resin composites have been reported to be influenced by the material type, the cavity design, and configurations as well as the substrate surrounding the restoration. Understanding the optical characteristics of teeth and properties of incident light is essential for optimum shade selection and faithful restoration of esthetic derangements.⁴² Making use of the optical illusion phenomenon is essential for optimum esthetic outcomes and excellence in restoring anterior tooth form, contour, and emergence profile. Accordingly, the best esthetic outcomes are achievable when scientific knowledge is coupled with artistic potential.⁴³ Consequently, dentists should be continuously updated in materials and color selection technologies so as to be able to select and implement the best application technique for each clinical indication. Selection of the most appropriate brand of resin composite material, adhesive approach and insertion technique for a specific clinical case is crucial for a clinically satisfactory result, particularly when restoring deranged esthetics in anterior tooth defects. This should be based on thorough knowledge of color dimensions, optical properties, principles, and technologies of shade selection,⁴⁴ familiarity of the respective material properties, indications and contraindications, comprehensive esthetic analysis including tooth forms, alignment, symmetry, the correlation with adjacent and opposing teeth,⁴⁵ and in addition, the clinical factors related to the specific lesion or tooth defect.⁴⁶ Moreover, full recognition of complex oral environmental factors influencing decision making in the designing of treatment plans has a major influence on the quality and clinical reliability of the final anterior resin composite restoration and is mandatory for assuring patient satisfaction.¹⁷^,¹⁸^,⁴⁷^,⁴⁸ The third domain of our questionnaire therefore aimed to study the awareness of general dentists concerning the different composite classes of material and the respective clinical indications. Participants were asked about class V resin composite restorations for restoring cervical tooth defects including abfraction lesions. These restorations are used to restore cervical tooth defects where the greatest flexure of teeth occurs during functioning, and includes higher risks of developing tooth cracking, abfraction defects and loss of retention with the usage of rigid and higher inorganic filler containing restorations. Accordingly, the need for more flexible and less filler containing restorations that yield upon repeated flexure at cervical locations, including having superior surface finish ability and polish ability, is clearly advocated in these cases. Our results showed that for class V lesions, 28% of participants use microfilled resin composites while 28% apply nanohybrid composites, 26% use flowable composites and 16% insert micro-hybrid composite, raising strong concerns.

Because of their initial low viscosity and high post gel flexibility, many previous studies have recommended the use of flowable composites for restoring non-carious cervical tooth defects.⁴⁹ Nevertheless, our collected data indicated that in class III restorations, 37 % work with nano-hybrid, and 28% of participants use micro-filled, and 32% use micro-hybrid composites. In a randomized clinical control trial over 12 months,⁵⁰ micro-hybrid resin composite was found to provide the best color match over microfilled and nanohybrid composite while microfilled and nanofilled composite showed better 12-month surface quality than microhybrid composite.

Our results for class IV restorations where high strength resin composite materials are highly recommended, showed that 33% of the respondents employ nano-hybrid while another 33% use micro-hybrid resin composites, and 26% used microfilled composite, 16% use other resin composite classes, and 2% of non-respondents, deserves attention. In a comprehensive metanalysis,⁵¹ the main reason for replacement of class IV resin composites was bulk fracture which occurred more frequently with microfilled composite than with hybrid and macrofilled composites.

The literature shows that there is no one single class of resin composite for all purposes and that it is the responsibility of the restorative dentist to select the most appropriate type of composite for a particular indication. In response to the current questionnaire, many dentists indicated that selection of composite material conforms to sound and relevant evidence-based criteria for selection in respective clinical situations. On the other hand, other responses indicated unjustified selections with poor clinical relevance and judgement.

The survey indicated a clear variation between respondents regarding the specific adhesive regularly used. The easier and less time-consuming usage of self-etching adhesives have apparently played a role in individual operator preference at the expense of the proven long-term clinical reliability and more consistent performance of total-etch adhesives. This might explain that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively. This is in line with a similar study³ finding.

Presently, most resin-based composites are visible light-activated materials. This allows for more controlled and command curing and adequate working time before curing, while at the same time requiring incremental placement of material into the prepared cavity to ensure an optimum degree of curing.⁵²^–⁵⁴ Adequate light curing is crucial to achieve the desired biomechanical and biocompatibility properties of the resin composite material. Adequate curing requires appropriate criteria of light intensity, curing time, direction of the curing light and proximity of the light curing source to the surface of the curing resin composite.⁵⁵^–⁵⁷ Dental light-curing units are handheld devices that are used for the polymerization of visible light-activated dental materials. Different light-curing units of variable technologies are currently available in the market. Each has specific set-up and light intensity output. Respondents showed variation in their practice of light curing and specific curing devices.⁵⁸ It is evident that light curing awareness and practices need urgent reconsideration and correction in many cases. LED followed by QTH are the most widely used light curing devices while Laser and Plasma Arch are the least used light curing devices. This is in line with many pervious reports indicating the popularity of LED and QTHs.⁵⁹ A previous study found LED units to have higher curing light intensity than that of QTH. Moreover, it reported that QTHs have greater frequency than LEDs.⁶⁰ Due to the higher radiant emmitance of plasma arch light and argon ion laser, less light curing time is needed. However, greater polymerization shrinkage stresses and marginal discrepancies were reported with this mode of light curing.⁵⁸

Previous reports have advocated that in anterior teeth with extensive loss of coronal tooth structure involving the incisal edge, the controlled application of resin composite restorations using a palatal putty consistency rubber base index is more recommended than the freehand application. Cumulating evidence indicates that the palatal index technique allows multiple chromatic layering, leading to improved tooth optical characteristics in addition to optimizing the restoration of tooth form and contours with a minimal need for occlusal adjustment.⁶¹^–⁶⁴ The results of the current survey indicated that 46% of participants used both techniques while only 10% exclusively used the palatal index technique. This contradicts evidence-based research and therefore reflects the need for practice correction. Moreover, the survey indicated that many dental practitioners in Saudi Arabia should consider changing their practice from using single shades of resin composite to the polychromatic approach of applying several shades of resin composite when restoring anterior tooth defects, so as to achieve the best esthetic quality. A previous report described the multiple layering approach using different enamel and dentin composite shades, a palatal hybrid composite layer, and a buccal microfilled composite with selective addition of transparent and white spot characters as a biomimetic direct composite stratification technique duplicating the physical and optical properties of natural teeth in class IV restorations.⁶⁵

Finishing and polishing of resin composites are essential for long-term clinical reliability and esthetically pleasing restorations. Smooth surfaces will not accumulate plaque and stains with subsequent discoloration and secondary decay.⁶⁶ Respondents commonly selected various tools in finishing and polishing resin composite rather than using one single tool for finishing and polishing, thereby reflecting the general keenness of respondents to perform optimum finishing and polishing procedures. Finishing and polishing strips were the preferred tools for 69% of respondents that might be related to their ease of usage, especially with class III restorations. Participants also reported other tools like white stones, Soflex, and impregnated rubber tips and polishing paste as other validated options which are in line with previous studies.⁶⁷^–⁶⁹ The current survey responses from dentists in Saudi Arabia showed that discoloration is most common form of failure and patient dissatisfaction of resin composites in anterior teeth, which is generally in line with previous outcomes of systematic reviews listing reasons for failure of resin composite restorations.⁷⁰ Accordingly, upon restoring anterior tooth defects with resin composites, clinical practices of dentists in Saudi Arabia should confirm superior long-term pleasing esthetics and minimization of future caries recurrence. Furthermore, it is recommended that dental practitioners in Saudi Arabia implement clinical protocols that will prevent or minimize post-restoration hypersensitivity, ensure best tooth form, and provide durable structural integrity without chipping or fracture of the restored anterior tooth. The current survey outcomes have also identified the need for dental practitioners in Saudi Arabia to upgrade their awareness and to modify their practices of resin composite restorations in anterior tooth defects. Participation in continuous dental educational and training programs is strongly suggested. Improving the clinical skills and broadening the experiences of undergraduates and recent graduates in complex esthetic resin composite restorative techniques under close supervision of senior clinical experts is vital.⁷¹

Conclusions

In consideration and within the limitations of this study, the following conclusions can be made:

1- Dental practitioners in Saudi Arabia are not consistent in their clinical practice of restoring anterior tooth defects using resin composites, regardless of the location of their practice or length of their clinical experience.
2- Improvement in clinical practice and awareness of resin composite restorations in anterior teeth appears to be of high necessity for some dental practitioners in Saudi Arabia. Dental practitioners should actively and dynamically be familiar with updates in resin composites technologies and clinical techniques of restoring anterior teeth through continuous education programs, workshops, and online webinars.

Data availability

Zenodo: Toward esthetically and biomechanically reliable anterior resin composite restorations: current clinical experiences among dental practitioners in Saudi Arabia. https://doi.org/10.5281/zenodo.7738566.

This project contains the following underlying data:

- Responses collected-Anterior Composite.xlsx

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgement

The authors would like to thank the experts who validated the questions of this survey: Dr Dalia Kaisarly, Dr Stephen Smith, Dr Hala Bahgat, Zahraa Aldawakhly, Dr Murad Benhameurlaine, Dr Dana Alsenan, Dr Amal Elsawi, Dr Abeer Elembabi, Dr Khalid Almas and Dr Mohamed Gad.

References

1. Blatz MB, Chiche G, Bahat O, et al.: Evolution of Aesthetic Dentistry. J. Dent. Res. 2019; 98 (12): 1294–1304. Publisher Full Text
2. Demarco FF, Collares K, Correa MB, et al.: Should my composite restorations last forever? Why are they failing? Braz. Oral Res. 2017; 31(suppl 1): e56. PubMed Abstract | Publisher Full Text
3. Demarco FF, Baldissera RA, Madruga FC, et al.: Anterior composite restorations in clinical practice: findings from a survey with general dental practitioners. J. Appl. Oral Sci. 2013; 21(6): 497–504. PubMed Abstract | Publisher Full Text | Free Full Text
4. El Gezawi MF, Al-Harbi FA: Reliability of bonded MOD restorations in maxillary premolars: microleakage and cusp fracture resistance. Acta Stomatol. Croat. 2012; 46(1): 31–42.
5. Nahsan FP, Mondelli RF, Franco EB, et al.: Clinical strategies for esthetic excellence in anterior tooth restorations: understanding color and composite resin selection. J. Appl. Oral Sci. 2012; 20(2): 151–156. PubMed Abstract | Publisher Full Text | Free Full Text
6. Mackenzie L, Banerjee A: Minimally invasive direct restorations: a practical guide. Br. Dent. J. 2017; 223(3): 163–171. Publisher Full Text
7. Dietschi D, Shahidi C, Krejci I: Clinical performance of direct anterior composite restorations: a systematic literature review and critical appraisal. Int. J. Esthet. Dent. 2019; 14(3): 252–270. PubMed Abstract
8. Loomans BAC, Kreulen CM, Huijs-Visser HECE, et al.: Clinical performance of full rehabilitations with direct composite in severe tooth wear patients: 3.5 Years results. J. Dent. 2018; 70: 97–103. PubMed Abstract | Publisher Full Text
9. Massano G, Comba A, Garombo E, et al.: Direct Composite Restorations of Anterior Teeth: A Retrospective Clinical Study. J. Adhes. Dent. 2019; 21(5).
10. Pedreira PRM, Damasceno J, Pierote J, et al.: Minimally invasive aesthetic rehabilitation in composite resin: report of two clinical cases. Braz. Dent. Sci. 2019; 22 (1): 135–142. Publisher Full Text
11. Elfakhri F, Alkahtani R, Li C, et al.: Influence of filler characteristics on the performance of dental composites: A comprehensive review. Ceram. Int. 2022; 48: 27280–27294. Publisher Full Text
12. Reddy Y, Dhaded SV: Direct composite veneers -restoring esthetics by procuring patient demand: a case report. Int. J. Dent. Mater. 2019; 01 (03): 93–96. Publisher Full Text
13. Gouveia THN, Theobaldo JD, Vieira-Junior WF, et al.: Esthetic smile rehabilitation of anterior teeth by treatment with biomimetic restorative materials: a case report. Clin. Cosmet. Investig. Dent. 2017; 9: 27–31. PubMed Abstract | Publisher Full Text | Free Full Text
14. Frese C, Schiller P, Staehle HJ, et al.: Recontouring teeth and closing diastemas with direct composite buildups: a 5-year follow-up. J. Dent. 2013; 41(11): 979–985. Publisher Full Text
15. Jokstad A, Bayne S, Blunck U, et al.: Quality of dental restorations FDI Commission Project 2–95. Int. Dent. J. 2001; 51 (3): 117–158. PubMed Abstract | Publisher Full Text
16. Zhou X, Huang X, Li M, et al.: Development and status of resin composite as dental restorative materials. J. Appl. Polym. Sci. 2019; 136 (44): 48180. Publisher Full Text
17. Ferracane JL: Resin composite--state of the art. Dent. Mater. 2011; 27(1): 29–38. PubMed Abstract | Publisher Full Text
18. Anusavice K: Phillips science of dental material. 11th ed.St. Louis: Elsevier Science; 2013; pp. 399–441.
19. Ferraro MR: Multiple Diastema Closure and Malposition Camouflage using Direct Composite Restorations. J. Adhes. Dent. 2019; 21(5).
20. Souza E: Clinical Application of Dental Composites for Direct Restorations. Dental Composite Materials for Direct Restorations. Springer; 2018; pp. 305–319.
21. Dietschi D, Ardu S, Krejci I: A new shading concept based on natural tooth color applied to direct composite restorations. Quintessence Int. 2006; 37(2): 91–102. PubMed Abstract
22. Villarroel M, Fahl N, De Sousa AM, et al.: Direct esthetic restorations based on translucency and opacity of composite resins. J. Esthet. Restor. Dent. 2011; 23(2): 73–87. PubMed Abstract | Publisher Full Text
23. Paravina RD, Westland S, Kimura M, et al.: Color interaction of dental materials: blending effect of layered composites. Dent. Mater. 2006; 22(10): 903–908. PubMed Abstract | Publisher Full Text
24. Bhuvaneswaran M, Doss N: The Role of Colors and Tints in Composite Restorations. J. Cosmet. Dent. 2020; 35(4).
25. Detrik G, Thomas R, Detrik D: A Return to Direct Resin Artistry: The Lumisynchroma Layering Technique. J. Cosmet. Dent. 2018; 34(1).
26. Kominami N, Shimada Y, Hosaka K, et al.: The effect of flowable composite lining and dentin location on microtensile bond strength and internal fracture formation. Dent. Mater. J. 2019; 38: 798–805. Publisher Full Text
27. AlBaker AM, Al-Ruthia YSH, AlShehri M, et al.: The characteristics and distribution of dentist workforce in Saudi Arabia: a descriptive cross-sectional study. Saudi Pharm. J. 2017; 25(8): 1208–1216. PubMed Abstract | Publisher Full Text | Free Full Text
28. Haridy R, Abdalla MA, Kaisarly D, et al.: A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications. J. Dent. Educ. 2021; 85(4): 483–493. PubMed Abstract | Publisher Full Text | Free Full Text
29. Alassaf A, Almulhim B, Alghamdi SA, et al.: Perceptions and Preventive Practices Regarding COVID-19 Pandemic Outbreak and Oral Health Care Perceptions during the Lockdown: A Cross-Sectional Survey from Saudi Arabia. Healthcare. Multidisciplinary Digital Publishing Institute; 2021; Vol. 9. : p. 959.
30. Shaker RE, Babgi AA: Women in dentistry: A perspective on major universities in Saudi Arabia. Part 2: Analysis and statistical data. Saudi Dent. J. 2009; 21(3): 107–112. PubMed Abstract | Publisher Full Text | Free Full Text
31. AlSheikh R, Almulhim KS, Abdulkader M, et al.: Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia. Int. J. Dent. 2022; 2022: 2691376–2691378. PubMed Abstract | Publisher Full Text | Free Full Text
32. Kaisarly D, El Gezawi M, Nyamaa I, et al.: Effects of boundary condition on shrinkage vectors of a flowable composite in experimental cavity models made of dental substrates. Clin. Oral Investig. 2019; 23(5): 2403–2411. PubMed Abstract | Publisher Full Text
33. Kaisarly D, El Gezawi M, Xu X, et al.: Shrinkage vectors of a flowable composite in artificial cavity models with different boundary conditions: Ceramic and Teflon. J. Mech. Behav. Biomed. Mater. 2018; 77: 414–421. Publisher Full Text
34. Poitevin A, De Munck J, Van Ende A, et al.: Bonding effectiveness of self-adhesive composites to dentin and enamel. Dent. Mater. 2013; 29(2): 221–230. Publisher Full Text
35. Kobayashi S, Nakajima M, Furusawa K, et al.: Color adjustment potential of single-shade resin composite to various-shade human teeth: Effect of structural color phenomenon. Dent. Mater. J. 2021; 40(4): 1033–1040. PubMed Abstract | Publisher Full Text
36. Huyang G, Debertin AE, Sun J: Design and development of self-healing dental composites. Mater. Des. 2016; 94: 295–302. PubMed Abstract | Publisher Full Text | Free Full Text
37. Pratap B, Gupta RK, Bhardwaj B, et al.: Resin based restorative dental materials: Characteristics and future perspectives. Jpn. Dent. Sci. Rev. 2019; 55(1): 126–138. PubMed Abstract | Publisher Full Text | Free Full Text
38. Beyth N, Farah S, Domb AJ, et al.: Antibacterial dental resin composites. React. Funct. Polym. 2014; 75: 81–88. Publisher Full Text
39. Dietschi D, Fahl N: Shading concepts and layering techniques to master direct anterior composite restorations: an update. Br. Dent. J. 2016; 221(12): 765–771. PubMed Abstract | Publisher Full Text
40. Gao Y, Li J, Dong B, et al.: Direct composite resin restoration of a class IV fracture by using 3D printing technology: A clinical report. J. Prosthet. Dent. 2021; 125(4): 555–559. Publisher Full Text
41. Wang Y, Li C, Yuan H, et al.: Rubber dam isolation for restorative treatment in dental patients. Cochrane Database Syst. Rev. 2016; 9(9): CD009858. PubMed Abstract | Publisher Full Text | Free Full Text
42. Schmeling M: Color Selection and Reproduction in Dentistry Part 2: Light Dynamics in Natural Teeth. Odovtos-Int. J. Dent. Sc. 2016; 18(2): 23–40. Publisher Full Text
43. Ismail EH, Paravina RD: Color adjustment potential of resin composites: Optical illusion or physical reality, a comprehensive overview. J. Esthet. Restor. Dent. 2022; 34(1): 42–54. PubMed Abstract | Publisher Full Text
44. Chu SJ, Trushkowsky RD, Paravina RD: Dental color matching instruments and systems. Review of clinical and research aspects. J. Dent. 2010; 38(Suppl 2): e2–e16. PubMed Abstract | Publisher Full Text
45. Fradeani M: Evaluation of dentolabial parameters as part of a comprehensive esthetic analysis. Eur. J. Esthet. Dent. 2006; 1(1): 62–69. PubMed Abstract
46. McLaren EA, Rifkin R: Macroesthetics: facial and dentofacial analysis. J. Calif. Dent. Assoc. 2002; 30(11): 839–847. PubMed Abstract | Publisher Full Text
47. Lutz F, Phillips RW: A classification and evaluation of composite resin systems. J. Prosthet. Dent. 1983; 50(4): 480–488. Publisher Full Text
48. Prakash V, Banu S, Sukumaran V, et al.: Comparision of True Nano with Microhybrid and Nanocluster Composite Before and After Tooth Brushing. Biosci. Biotechnol. Res. Asia. 2016; 13(4): 2365–2370. Publisher Full Text
49. Kubo S, Yokota H, Hayashi Y: Three-year clinical evaluation of a flowable and a hybrid resin composite in non-carious cervical lesions. J. Dent. 2010; 38(3): 191–200. Publisher Full Text
50. Loguercio AD, Lorini E, Weiss RV, et al.: A 12-month clinical evaluation of composite resins in class III restorations. J. Adhes. Dent. 2007; 9(1): 57–64. PubMed Abstract
51. Heintze SD, Rousson V, Hickel R: Clinical effectiveness of direct anterior restorations--a meta-analysis. Dent. Mater. 2015; 31(5): 481–495. PubMed Abstract | Publisher Full Text
52. Chandrasekhar V, Rudrapati L, Badami V, et al.: Incremental techniques in direct composite restoration. J. Conserv. Dent. 2017; 20(6): 386–391. PubMed Abstract | Publisher Full Text
53. Mahn E: Clinical criteria for the successful curing of composite materials. Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral. 2013; 6(3): 148–153. Publisher Full Text
54. Stein PS, Sullivan J, Haubenreich JE, et al.: Composite resin in medicine and dentistry. J. Long-Term Eff. Med. Implants. 2005; 15(6): 641–654. PubMed Abstract | Publisher Full Text
55. Strazzi-Sahyon HB, Passos Rocha E, Gonçalves Assunção W, et al.: Influence of Light-Curing Intensity on Color Stability and Microhardness of Composite Resins. Int. J. Periodontics Restorative Dent. 2020; 40(1): 129–134. PubMed Abstract | Publisher Full Text
56. Par M, Marovic D, Attin T, et al.: The effect of rapid high-intensity light-curing on micromechanical properties of bulk-fill and conventional resin composites. Sci. Rep. 2020; 10(1): 1–10.
57. Pirmoradian M, Hooshmand T, Jafari-Semnani S, et al.: Degree of conversion and microhardness of bulk-fill dental composites polymerized by LED and QTH light curing units. J. Oral Biosci. 2020; 62(1): 107–113. PubMed Abstract | Publisher Full Text
58. Scotti N, Baldi A, Vergano EA, et al.: Light-Curing Units. Modern Operative Dentistry. Springer; 2020; pp. 435–464. Publisher Full Text
59. Lima AF, de Andrade KM , da Cruz Alves LE , et al.: Influence of light source and extended time of curing on microhardness and degree of conversion of different regions of a nanofilled composite resin. Eur. J. Dent. 2012; 06(2): 153–157. Publisher Full Text
60. Omidi BR, Gosili A, Jaber-Ansari M, et al.: Intensity output and effectiveness of light curing units in dental offices. J. Clin. Exp. Dent. 2018; 10(6): e555–e560. Publisher Full Text
61. Paolone G: Direct composite restorations in anterior teeth. Managing symmetry in central incisors. Int. J. Esthet. Dent. 2014; 9(1): 12–25.
62. Korkut B: Smile makeover with direct composite veneers: A two-year follow-up report. J. Dent. Res. Dent. Clin. Dent. Prospects. 2018; 12(2): 146–151. Publisher Full Text
63. Ammannato R, Ferraris F, Allegri M: The “index cutback technique”: A three-dimensional guided layering approach in direct class IV composite restorations. Int. J. Esthet. Dent. 2017; 12: 450–466.
64. Espíndola-Castro LF, de Melo Monteiro GQ , Ortigoza LS, et al.: Multidisciplinary Approach to Smile Restoration: Gingivoplasty, Tooth Bleaching, and Dental Re-anatomization. Compend. Contin. Educ. Dent (Jamesburg, NJ: 1995). 2019; 40(9): 590–599.
65. Ardu S, Krejci I: Biomimetic direct composite stratification technique for the restoration of anterior teeth. Quintessence Int. 2006; 37(3): 167–174. PubMed Abstract
66. Carneiro P, Ramos T, de Azevedo C , et al.: Influence of finishing and polishing techniques and abrasion on transmittance and roughness of composite resins. Oper. Dent. 2016; 41(6): 634–641. PubMed Abstract | Publisher Full Text
67. Jang J, Kim H, Shin S, et al.: Clinical effectiveness of different polishing systems and self-etch adhesives in class V composite resin restorations: two-year randomized controlled clinical trial. Oper. Dent. 2017; 42(1): 19–29. Publisher Full Text
68. Daud A, Gray G, Lynch CD, et al.: A randomised controlled study on the use of finishing and polishing systems on different resin composites using 3D contact optical profilometry and scanning electron microscopy. J. Dent. 2018; 71: 25–30. Publisher Full Text
69. Babina K, Polyakova M, Sokhova I, et al.: The Effect of Finishing and Polishing Sequences on The Surface Roughness of Three Different Nanocomposites and Composite/Enamel and Composite/Cementum Interfaces. Nanomaterials (Basel). 2020; 10(7). PubMed Abstract | Publisher Full Text | Free Full Text
70. Demarco FF, Collares K, Coelho-de-Souza FH, et al.: Anterior composite restorations: A systematic review on long-term survival and reasons for failure. Dent. Mater. 2015; 31(10): 1214–1224. Publisher Full Text
71. Elgezawi M, Hassan K, Alagl A, et al.: Complexity of comprehensive care treatments in undergraduate dental programs: The benefits of observing and assisting experienced faculty members. Saudi Dent. J. 2017; 29(4): 161–166. PubMed Abstract | Publisher Full Text | Free Full Text

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Version 2

VERSION 2 PUBLISHED 03 Apr 2023

Author details Author details

Rasha AlSheikh
Roles: Data Curation, Formal Analysis, Investigation, Methodology, Software, Validation, Writing – Original Draft Preparation

Rasha Haridy
Roles: Conceptualization, Data Curation, Investigation, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing

Stephen Smith
Roles: Formal Analysis, Funding Acquisition, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Mohammed Zeeshan
Roles: Formal Analysis, Methodology, Validation, Writing – Original Draft Preparation

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

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Published: 20 Sep 2023, 12:359

https://doi.org/10.12688/f1000research.130981.2

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Published: 03 Apr 2023, 12:359

https://doi.org/10.12688/f1000research.130981.1

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Almulhim KS, AlSheikh R, Abdalla M et al. Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia [version 1; peer review: 2 approved with reservations]. F1000Research 2023, 12:359 (https://doi.org/10.12688/f1000research.130981.1)

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Reviewer Report 10 Aug 2023

Nesrine A. Elsahn, Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates; Operative Dentistry, Cairo University, Giza, Giza Governorate, Egypt

Approved with Reservations

https://doi.org/10.5256/f1000research.143783.r186405

The article presents a comprehensive and well-executed study that investigates the awareness of dental practitioners in Saudi Arabia about resin composite restorations in anterior teeth. The authors have clearly outlined the research problem, framed it within the relevant literature and the methodology employed is appropriate for addressing the research questions posed. Moreover, the study provided evidence-based recommendations to improve anterior restorations in Saudi Arabia. However, the authors need to address the following points and answer the following questions.

Comment #1: The highlighted parts in the following paragraphs contain information that was stated twice. The authors have to revise and rephrase these parts to avoid repetition.

"This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator."

"During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes."

Comment #2: Why was the Nanofilled composite not listed as an option to restore different classes of anterior tooth defects?

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.
The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.
The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Comment #4: In question 8, what does option build-up mean or represent? Was it clarified for the participants?

Comment #5: In question 10, the authors mentioned in the discussion that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively.

The authors used the correct terminology for the adhesive strategies in the discussion. Meanwhile, in Table 3 question 10, the authors used a different terminology for the adhesive types (self-adhesive, selective self-etching, total-etching). The answer options for question 10 need to be replaced by the correct terminology for adhesive strategies. Otherwise, the authors need to clarify in the text the adhesive strategies' terms they used.

Comment# 6: Why the statistical analysis was done only for domains 3 and 4?

Comment #7: The authors used reference 65 to describe the multiple-layering approach. Please add a recent reference that introduces the latest techniques and composite materials used in the multiple-layering approach.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Adhesive Dentistry, Restorative Dentistry, Dental Materials.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Author Response 06 Oct 2023

Moataz Elgezawi, Restorative Dental Sciences, Imam Abdulrahman Bin faisal University, Dammam, 1982, Saudi Arabia

06 Oct 2023

Author Response
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to ... Continue reading
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to improve the quality of the article. The authors have tackled each comment and respectively responded to. All changes in the manuscript were red highlighted. Moreover, below is a detailed response consistently progressing with both reviewers. Kindly refer to our response below:

Reviewer 2, Dr Nesrine Alsahn

Comment #1: The highlighted parts in the following paragraphs contain information that was stated twice. The authors have to revise and rephrase these parts to avoid repetition.

"This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator."
Response:
"During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes."

The paragraphs were revised and rewritten.
(See the word doc attached)

The first highlighted sentence was deleted, and the second sentence was modified.

Comment #2: Why was the Nanofilled composite not listed as an option to restore different classes of anterior tooth defects?

Response:
Because of the close similarity of clinical performance of nanofilled and nanohybrid composites with no superiority over nanohybrid composites regarding surface polishability , wear and gloss stability indicated in a recent systematic review and meta analysis and following a similar pervious survey conducted in Brazil, nanofilled composites were not listed in our study as a separate option in our questionnaire. Moreover, we have used the categories of composite materials usually provided by suppliers to our selected governmental hospitals included in the study
(added to the Discussion section)
References:

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis

Anterior composite restorations in clinical practice: Findings from a survey with general dental practitioners

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.

The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.

The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Response:
-Domains 5 & 6 were combined and presented using table 3
-Rest of tables numbers were adjusted accordingly.

- Done

- Done table 3.

Comment #4: In question 8, what does option build-up mean or represent? Was it clarified for the participants?

Response:
In our questionnaire, the option ‘build up’ was employed to describe a large resin composite restoration used for restoring grossly mutilated anterior teeth including incisor teeth with incisal edge fracture involving more than 1/3 of the coronal tooth structure or with bilateral incisal angle involvements extending at least to the middle third of the crown or anterior teeth with bilateral complex class III cavities involving greater than 1/3 of coronal tooth structure. This was clearly stated in the online link at the beginning of the questionnaire.
(added to discussion section)

Comment #5: In question 10, the authors mentioned in the discussion that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively.

The authors used the correct terminology for the adhesive strategies in the discussion. Meanwhile, in Table 3,question 10, the authors used a different terminology for the adhesive types (self-adhesive, selective self-etching, total-etching). The answer options for question 10 need to be replaced by the correct terminology for adhesive strategies. Otherwise, the authors need to clarify in the text the adhesive strategies' terms they used.

Response:
Adjusted

Comment# 6: Why the statistical analysis was done only for domains 3 and 4?

Response:
In the current study, all questionnaire domains were subjects of descriptive statistics using percentages and histograms. Furthermore, domains 3 and 4 were subjects of chi square testing since they are testing the actual clinical practice and individual practice preference. In our previous questionnaire study testing that tested the practice of resin composite light curing using similar population, demographic factors of age, gender, location, and duration of practice did not have a significant influence when analyzed using chi square testing.

Comment #7: The authors used reference 65 to describe the multiple-layering approach. Please add a recent reference that introduces the latest techniques and composite materials used in the multiple-layering approach.

Response:
Done (added: Ajay Singh Rao, Shreya Bhor, Nimisha Shah, Naveen Chhabra: Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study. J Oral Biol Craniofac Res. 2022;12(5):552-556. doi: 10.1016/j.jobcr.2022.07.007.)

Reviewer 1 Dr. Hatem El-Damanhouri:

Comment #1- More details of the sample size calculation method are required.

Response:

In the current study, the targeted population, selected hospitals, and sample size calculation followed the same methodology detailed in our previously published studies.

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

Comment #2- For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.

Response:
The literature has listed experts opinion as a satisfactory tool to pretest the reliability and validity of a survey questionnaire.
“ An Examination of Questionnaire Evaluation by Expert Reviewers
Kristen Olson”
Olson reported that despite the efforts spent to select reviewers of same background skills, disagreements among raters were found which did not adversely affect the outcome. In our study and following our previously published surveys, we did not perform inter raters agreement testing since all our invited experts evaluated all questions as highly relevant or relevant.
References:

An Examination of Questionnaire Evaluation by Expert Reviewers, Kristen Olson

A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Comment #3-Please explain why the Chi-square test was used and whether the assumption of the test was met or not.

Response:
Following many previous similar survey studies , the current study used Descriptive statistics in the form of percentages and histograms to summarise the survey qualitative data. Moreover, Chi square test using received frequencies was employed to analyze the study qualitative data at a level of significance (P <0.05)
In the present study, all Chi square test assumptions listed by Mary L. McHugh biomedica, 2013 were met.
References:

Puja C. Yavagal, Hitashi Singla,Prevalence of dental caries based on personality types of 35–44 years old residents in Davangere city, Journal of Oral Biology and Craniofacial Research,Volume 7, Issue 1,2017, Pages 32-35.

Aksha Sharen, Hima Sandeep: survey on indirect tooth coloured restorations among dental students and specialist. Journal of Pharmaceutical Negative Results. 2022, 13 (3).

Singh RP, Gopalakrishnapillai AC, Bhat N, Pawar A. Perception of Dental and Medical Teaching Faculty Regarding Mobile Dental Application. J Pharm Bioallied Sci. 2019 Nov;11(Suppl 3):S530-S539. doi: 10.4103/jpbs.JPBS_261_18. PMID: 31920270; PMCID: PMC6896578.

Comment #4-Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.
Response:
Deleted
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to improve the quality of the article. The authors have tackled each comment and respectively responded to. All changes in the manuscript were red highlighted. Moreover, below is a detailed response consistently progressing with both reviewers. Kindly refer to our response below:

Reviewer 2, Dr Nesrine Alsahn

Comment #1: The highlighted parts in the following paragraphs contain information that was stated twice. The authors have to revise and rephrase these parts to avoid repetition.

"This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator."
Response:
"During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes."

The paragraphs were revised and rewritten.
(See the word doc attached)

The first highlighted sentence was deleted, and the second sentence was modified.

Comment #2: Why was the Nanofilled composite not listed as an option to restore different classes of anterior tooth defects?

Response:
Because of the close similarity of clinical performance of nanofilled and nanohybrid composites with no superiority over nanohybrid composites regarding surface polishability , wear and gloss stability indicated in a recent systematic review and meta analysis and following a similar pervious survey conducted in Brazil, nanofilled composites were not listed in our study as a separate option in our questionnaire. Moreover, we have used the categories of composite materials usually provided by suppliers to our selected governmental hospitals included in the study
(added to the Discussion section)
References:

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis

Anterior composite restorations in clinical practice: Findings from a survey with general dental practitioners

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.

The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.

The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Response:
-Domains 5 & 6 were combined and presented using table 3
-Rest of tables numbers were adjusted accordingly.

- Done

- Done table 3.

Comment #4: In question 8, what does option build-up mean or represent? Was it clarified for the participants?

Response:
In our questionnaire, the option ‘build up’ was employed to describe a large resin composite restoration used for restoring grossly mutilated anterior teeth including incisor teeth with incisal edge fracture involving more than 1/3 of the coronal tooth structure or with bilateral incisal angle involvements extending at least to the middle third of the crown or anterior teeth with bilateral complex class III cavities involving greater than 1/3 of coronal tooth structure. This was clearly stated in the online link at the beginning of the questionnaire.
(added to discussion section)

Comment #5: In question 10, the authors mentioned in the discussion that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively.

The authors used the correct terminology for the adhesive strategies in the discussion. Meanwhile, in Table 3,question 10, the authors used a different terminology for the adhesive types (self-adhesive, selective self-etching, total-etching). The answer options for question 10 need to be replaced by the correct terminology for adhesive strategies. Otherwise, the authors need to clarify in the text the adhesive strategies' terms they used.

Response:
Adjusted

Comment# 6: Why the statistical analysis was done only for domains 3 and 4?

Response:
In the current study, all questionnaire domains were subjects of descriptive statistics using percentages and histograms. Furthermore, domains 3 and 4 were subjects of chi square testing since they are testing the actual clinical practice and individual practice preference. In our previous questionnaire study testing that tested the practice of resin composite light curing using similar population, demographic factors of age, gender, location, and duration of practice did not have a significant influence when analyzed using chi square testing.

Comment #7: The authors used reference 65 to describe the multiple-layering approach. Please add a recent reference that introduces the latest techniques and composite materials used in the multiple-layering approach.

Response:
Done (added: Ajay Singh Rao, Shreya Bhor, Nimisha Shah, Naveen Chhabra: Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study. J Oral Biol Craniofac Res. 2022;12(5):552-556. doi: 10.1016/j.jobcr.2022.07.007.)

Reviewer 1 Dr. Hatem El-Damanhouri:

Comment #1- More details of the sample size calculation method are required.

Response:

In the current study, the targeted population, selected hospitals, and sample size calculation followed the same methodology detailed in our previously published studies.

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

Comment #2- For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.

Response:
The literature has listed experts opinion as a satisfactory tool to pretest the reliability and validity of a survey questionnaire.
“ An Examination of Questionnaire Evaluation by Expert Reviewers
Kristen Olson”
Olson reported that despite the efforts spent to select reviewers of same background skills, disagreements among raters were found which did not adversely affect the outcome. In our study and following our previously published surveys, we did not perform inter raters agreement testing since all our invited experts evaluated all questions as highly relevant or relevant.
References:

An Examination of Questionnaire Evaluation by Expert Reviewers, Kristen Olson

A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Comment #3-Please explain why the Chi-square test was used and whether the assumption of the test was met or not.

Response:
Following many previous similar survey studies , the current study used Descriptive statistics in the form of percentages and histograms to summarise the survey qualitative data. Moreover, Chi square test using received frequencies was employed to analyze the study qualitative data at a level of significance (P <0.05)
In the present study, all Chi square test assumptions listed by Mary L. McHugh biomedica, 2013 were met.
References:

Puja C. Yavagal, Hitashi Singla,Prevalence of dental caries based on personality types of 35–44 years old residents in Davangere city, Journal of Oral Biology and Craniofacial Research,Volume 7, Issue 1,2017, Pages 32-35.

Aksha Sharen, Hima Sandeep: survey on indirect tooth coloured restorations among dental students and specialist. Journal of Pharmaceutical Negative Results. 2022, 13 (3).

Singh RP, Gopalakrishnapillai AC, Bhat N, Pawar A. Perception of Dental and Medical Teaching Faculty Regarding Mobile Dental Application. J Pharm Bioallied Sci. 2019 Nov;11(Suppl 3):S530-S539. doi: 10.4103/jpbs.JPBS_261_18. PMID: 31920270; PMCID: PMC6896578.

Comment #4-Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.
Response:
Deleted
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 06 Oct 2023

Moataz Elgezawi, Restorative Dental Sciences, Imam Abdulrahman Bin faisal University, Dammam, 1982, Saudi Arabia

06 Oct 2023

Author Response
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to ... Continue reading
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to improve the quality of the article. The authors have tackled each comment and respectively responded to. All changes in the manuscript were red highlighted. Moreover, below is a detailed response consistently progressing with both reviewers. Kindly refer to our response below:

Reviewer 2, Dr Nesrine Alsahn

Comment #1: The highlighted parts in the following paragraphs contain information that was stated twice. The authors have to revise and rephrase these parts to avoid repetition.

"This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator."
Response:
"During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes."

The paragraphs were revised and rewritten.
(See the word doc attached)

The first highlighted sentence was deleted, and the second sentence was modified.

Comment #2: Why was the Nanofilled composite not listed as an option to restore different classes of anterior tooth defects?

Response:
Because of the close similarity of clinical performance of nanofilled and nanohybrid composites with no superiority over nanohybrid composites regarding surface polishability , wear and gloss stability indicated in a recent systematic review and meta analysis and following a similar pervious survey conducted in Brazil, nanofilled composites were not listed in our study as a separate option in our questionnaire. Moreover, we have used the categories of composite materials usually provided by suppliers to our selected governmental hospitals included in the study
(added to the Discussion section)
References:

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis

Anterior composite restorations in clinical practice: Findings from a survey with general dental practitioners

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.

The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.

The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Response:
-Domains 5 & 6 were combined and presented using table 3
-Rest of tables numbers were adjusted accordingly.

- Done

- Done table 3.

Comment #4: In question 8, what does option build-up mean or represent? Was it clarified for the participants?

Response:
In our questionnaire, the option ‘build up’ was employed to describe a large resin composite restoration used for restoring grossly mutilated anterior teeth including incisor teeth with incisal edge fracture involving more than 1/3 of the coronal tooth structure or with bilateral incisal angle involvements extending at least to the middle third of the crown or anterior teeth with bilateral complex class III cavities involving greater than 1/3 of coronal tooth structure. This was clearly stated in the online link at the beginning of the questionnaire.
(added to discussion section)

Comment #5: In question 10, the authors mentioned in the discussion that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively.

The authors used the correct terminology for the adhesive strategies in the discussion. Meanwhile, in Table 3,question 10, the authors used a different terminology for the adhesive types (self-adhesive, selective self-etching, total-etching). The answer options for question 10 need to be replaced by the correct terminology for adhesive strategies. Otherwise, the authors need to clarify in the text the adhesive strategies' terms they used.

Response:
Adjusted

Comment# 6: Why the statistical analysis was done only for domains 3 and 4?

Response:
In the current study, all questionnaire domains were subjects of descriptive statistics using percentages and histograms. Furthermore, domains 3 and 4 were subjects of chi square testing since they are testing the actual clinical practice and individual practice preference. In our previous questionnaire study testing that tested the practice of resin composite light curing using similar population, demographic factors of age, gender, location, and duration of practice did not have a significant influence when analyzed using chi square testing.

Comment #7: The authors used reference 65 to describe the multiple-layering approach. Please add a recent reference that introduces the latest techniques and composite materials used in the multiple-layering approach.

Response:
Done (added: Ajay Singh Rao, Shreya Bhor, Nimisha Shah, Naveen Chhabra: Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study. J Oral Biol Craniofac Res. 2022;12(5):552-556. doi: 10.1016/j.jobcr.2022.07.007.)

Reviewer 1 Dr. Hatem El-Damanhouri:

Comment #1- More details of the sample size calculation method are required.

Response:

In the current study, the targeted population, selected hospitals, and sample size calculation followed the same methodology detailed in our previously published studies.

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

Comment #2- For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.

Response:
The literature has listed experts opinion as a satisfactory tool to pretest the reliability and validity of a survey questionnaire.
“ An Examination of Questionnaire Evaluation by Expert Reviewers
Kristen Olson”
Olson reported that despite the efforts spent to select reviewers of same background skills, disagreements among raters were found which did not adversely affect the outcome. In our study and following our previously published surveys, we did not perform inter raters agreement testing since all our invited experts evaluated all questions as highly relevant or relevant.
References:

An Examination of Questionnaire Evaluation by Expert Reviewers, Kristen Olson

A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Comment #3-Please explain why the Chi-square test was used and whether the assumption of the test was met or not.

Response:
Following many previous similar survey studies , the current study used Descriptive statistics in the form of percentages and histograms to summarise the survey qualitative data. Moreover, Chi square test using received frequencies was employed to analyze the study qualitative data at a level of significance (P <0.05)
In the present study, all Chi square test assumptions listed by Mary L. McHugh biomedica, 2013 were met.
References:

Puja C. Yavagal, Hitashi Singla,Prevalence of dental caries based on personality types of 35–44 years old residents in Davangere city, Journal of Oral Biology and Craniofacial Research,Volume 7, Issue 1,2017, Pages 32-35.

Aksha Sharen, Hima Sandeep: survey on indirect tooth coloured restorations among dental students and specialist. Journal of Pharmaceutical Negative Results. 2022, 13 (3).

Singh RP, Gopalakrishnapillai AC, Bhat N, Pawar A. Perception of Dental and Medical Teaching Faculty Regarding Mobile Dental Application. J Pharm Bioallied Sci. 2019 Nov;11(Suppl 3):S530-S539. doi: 10.4103/jpbs.JPBS_261_18. PMID: 31920270; PMCID: PMC6896578.

Comment #4-Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.
Response:
Deleted
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to improve the quality of the article. The authors have tackled each comment and respectively responded to. All changes in the manuscript were red highlighted. Moreover, below is a detailed response consistently progressing with both reviewers. Kindly refer to our response below:

Reviewer 2, Dr Nesrine Alsahn

Comment #1: The highlighted parts in the following paragraphs contain information that was stated twice. The authors have to revise and rephrase these parts to avoid repetition.

"This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator."
Response:
"During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes."

The paragraphs were revised and rewritten.
(See the word doc attached)

The first highlighted sentence was deleted, and the second sentence was modified.

Comment #2: Why was the Nanofilled composite not listed as an option to restore different classes of anterior tooth defects?

Response:
Because of the close similarity of clinical performance of nanofilled and nanohybrid composites with no superiority over nanohybrid composites regarding surface polishability , wear and gloss stability indicated in a recent systematic review and meta analysis and following a similar pervious survey conducted in Brazil, nanofilled composites were not listed in our study as a separate option in our questionnaire. Moreover, we have used the categories of composite materials usually provided by suppliers to our selected governmental hospitals included in the study
(added to the Discussion section)
References:

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis

Anterior composite restorations in clinical practice: Findings from a survey with general dental practitioners

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.

The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.

The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Response:
-Domains 5 & 6 were combined and presented using table 3
-Rest of tables numbers were adjusted accordingly.

- Done

- Done table 3.

Comment #4: In question 8, what does option build-up mean or represent? Was it clarified for the participants?

Response:
In our questionnaire, the option ‘build up’ was employed to describe a large resin composite restoration used for restoring grossly mutilated anterior teeth including incisor teeth with incisal edge fracture involving more than 1/3 of the coronal tooth structure or with bilateral incisal angle involvements extending at least to the middle third of the crown or anterior teeth with bilateral complex class III cavities involving greater than 1/3 of coronal tooth structure. This was clearly stated in the online link at the beginning of the questionnaire.
(added to discussion section)

Comment #5: In question 10, the authors mentioned in the discussion that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively.

The authors used the correct terminology for the adhesive strategies in the discussion. Meanwhile, in Table 3,question 10, the authors used a different terminology for the adhesive types (self-adhesive, selective self-etching, total-etching). The answer options for question 10 need to be replaced by the correct terminology for adhesive strategies. Otherwise, the authors need to clarify in the text the adhesive strategies' terms they used.

Response:
Adjusted

Comment# 6: Why the statistical analysis was done only for domains 3 and 4?

Response:
In the current study, all questionnaire domains were subjects of descriptive statistics using percentages and histograms. Furthermore, domains 3 and 4 were subjects of chi square testing since they are testing the actual clinical practice and individual practice preference. In our previous questionnaire study testing that tested the practice of resin composite light curing using similar population, demographic factors of age, gender, location, and duration of practice did not have a significant influence when analyzed using chi square testing.

Comment #7: The authors used reference 65 to describe the multiple-layering approach. Please add a recent reference that introduces the latest techniques and composite materials used in the multiple-layering approach.

Response:
Done (added: Ajay Singh Rao, Shreya Bhor, Nimisha Shah, Naveen Chhabra: Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study. J Oral Biol Craniofac Res. 2022;12(5):552-556. doi: 10.1016/j.jobcr.2022.07.007.)

Reviewer 1 Dr. Hatem El-Damanhouri:

Comment #1- More details of the sample size calculation method are required.

Response:

In the current study, the targeted population, selected hospitals, and sample size calculation followed the same methodology detailed in our previously published studies.

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

Comment #2- For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.

Response:
The literature has listed experts opinion as a satisfactory tool to pretest the reliability and validity of a survey questionnaire.
“ An Examination of Questionnaire Evaluation by Expert Reviewers
Kristen Olson”
Olson reported that despite the efforts spent to select reviewers of same background skills, disagreements among raters were found which did not adversely affect the outcome. In our study and following our previously published surveys, we did not perform inter raters agreement testing since all our invited experts evaluated all questions as highly relevant or relevant.
References:

An Examination of Questionnaire Evaluation by Expert Reviewers, Kristen Olson

A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Comment #3-Please explain why the Chi-square test was used and whether the assumption of the test was met or not.

Response:
Following many previous similar survey studies , the current study used Descriptive statistics in the form of percentages and histograms to summarise the survey qualitative data. Moreover, Chi square test using received frequencies was employed to analyze the study qualitative data at a level of significance (P <0.05)
In the present study, all Chi square test assumptions listed by Mary L. McHugh biomedica, 2013 were met.
References:

Puja C. Yavagal, Hitashi Singla,Prevalence of dental caries based on personality types of 35–44 years old residents in Davangere city, Journal of Oral Biology and Craniofacial Research,Volume 7, Issue 1,2017, Pages 32-35.

Aksha Sharen, Hima Sandeep: survey on indirect tooth coloured restorations among dental students and specialist. Journal of Pharmaceutical Negative Results. 2022, 13 (3).

Singh RP, Gopalakrishnapillai AC, Bhat N, Pawar A. Perception of Dental and Medical Teaching Faculty Regarding Mobile Dental Application. J Pharm Bioallied Sci. 2019 Nov;11(Suppl 3):S530-S539. doi: 10.4103/jpbs.JPBS_261_18. PMID: 31920270; PMCID: PMC6896578.

Comment #4-Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.
Response:
Deleted
Competing Interests: No competing interests were disclosed. Close
Report a concern

Views

Reviewer Report 28 Jul 2023

Hatem M. El-Damanhoury, Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates

Approved with Reservations

https://doi.org/10.5256/f1000research.143783.r186404

This is a well-written manuscript, that investigated the awareness of general dental practitioners in Saudi Arabia about resin composite restorations in anterior teeth using a cross-sectional survey study design.
The sample size and methodology is appropriate, the statistical analysis is suitable for the data type and the presentation of the results is adequate to draw conclusions.
A few points have to be addressed by the authors before accepting this manuscript for indexing:

More details of the sample size calculation method are required.
For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.
Please explain why the Chi-square test was used and whether the assumption of the test was met or not.
Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Restorative Dentistry

CITE

Report a concern

Author Response 06 Oct 2023

Moataz Elgezawi, Restorative Dental Sciences, Imam Abdulrahman Bin faisal University, Dammam, 1982, Saudi Arabia

06 Oct 2023

Author Response
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to ... Continue reading
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to improve the quality of the article. The authors have tackled each comment and respectively responded to. All changes in the manuscript were red highlighted. Moreover, below is a detailed response consistently progressing with both reviewers. Kindly refer to our response below:

Reviewer 2, Dr Nesrine Alsahn

Comment #1: The highlighted parts in the following paragraphs contain information that was stated twice. The authors have to revise and rephrase these parts to avoid repetition.

"This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator."
Response:
"During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes."

The paragraphs were revised and rewritten.
(See the word doc attached)

The first highlighted sentence was deleted, and the second sentence was modified.

Comment #2: Why was the Nanofilled composite not listed as an option to restore different classes of anterior tooth defects?

Response:
Because of the close similarity of clinical performance of nanofilled and nanohybrid composites with no superiority over nanohybrid composites regarding surface polishability , wear and gloss stability indicated in a recent systematic review and meta analysis and following a similar pervious survey conducted in Brazil, nanofilled composites were not listed in our study as a separate option in our questionnaire. Moreover, we have used the categories of composite materials usually provided by suppliers to our selected governmental hospitals included in the study
(added to the Discussion section)
References:

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis

Anterior composite restorations in clinical practice: Findings from a survey with general dental practitioners

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.

The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.

The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Response:
-Domains 5 & 6 were combined and presented using table 3
-Rest of tables numbers were adjusted accordingly.

- Done

- Done table 3.

Comment #4: In question 8, what does option build-up mean or represent? Was it clarified for the participants?

Response:
In our questionnaire, the option ‘build up’ was employed to describe a large resin composite restoration used for restoring grossly mutilated anterior teeth including incisor teeth with incisal edge fracture involving more than 1/3 of the coronal tooth structure or with bilateral incisal angle involvements extending at least to the middle third of the crown or anterior teeth with bilateral complex class III cavities involving greater than 1/3 of coronal tooth structure. This was clearly stated in the online link at the beginning of the questionnaire.
(added to discussion section)

Comment #5: In question 10, the authors mentioned in the discussion that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively.

The authors used the correct terminology for the adhesive strategies in the discussion. Meanwhile, in Table 3,question 10, the authors used a different terminology for the adhesive types (self-adhesive, selective self-etching, total-etching). The answer options for question 10 need to be replaced by the correct terminology for adhesive strategies. Otherwise, the authors need to clarify in the text the adhesive strategies' terms they used.

Response:
Adjusted

Comment# 6: Why the statistical analysis was done only for domains 3 and 4?

Response:
In the current study, all questionnaire domains were subjects of descriptive statistics using percentages and histograms. Furthermore, domains 3 and 4 were subjects of chi square testing since they are testing the actual clinical practice and individual practice preference. In our previous questionnaire study testing that tested the practice of resin composite light curing using similar population, demographic factors of age, gender, location, and duration of practice did not have a significant influence when analyzed using chi square testing.

Comment #7: The authors used reference 65 to describe the multiple-layering approach. Please add a recent reference that introduces the latest techniques and composite materials used in the multiple-layering approach.

Response:
Done (added: Ajay Singh Rao, Shreya Bhor, Nimisha Shah, Naveen Chhabra: Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study. J Oral Biol Craniofac Res. 2022;12(5):552-556. doi: 10.1016/j.jobcr.2022.07.007.)

Reviewer 1 Dr. Hatem El-Damanhouri:

Comment #1- More details of the sample size calculation method are required.

Response:

In the current study, the targeted population, selected hospitals, and sample size calculation followed the same methodology detailed in our previously published studies.

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

Comment #2- For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.

Response:
The literature has listed experts opinion as a satisfactory tool to pretest the reliability and validity of a survey questionnaire.
“ An Examination of Questionnaire Evaluation by Expert Reviewers
Kristen Olson”
Olson reported that despite the efforts spent to select reviewers of same background skills, disagreements among raters were found which did not adversely affect the outcome. In our study and following our previously published surveys, we did not perform inter raters agreement testing since all our invited experts evaluated all questions as highly relevant or relevant.
References:

An Examination of Questionnaire Evaluation by Expert Reviewers, Kristen Olson

A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Comment #3-Please explain why the Chi-square test was used and whether the assumption of the test was met or not.

Response:
Following many previous similar survey studies , the current study used Descriptive statistics in the form of percentages and histograms to summarise the survey qualitative data. Moreover, Chi square test using received frequencies was employed to analyze the study qualitative data at a level of significance (P <0.05)
In the present study, all Chi square test assumptions listed by Mary L. McHugh biomedica, 2013 were met.
References:

Puja C. Yavagal, Hitashi Singla,Prevalence of dental caries based on personality types of 35–44 years old residents in Davangere city, Journal of Oral Biology and Craniofacial Research,Volume 7, Issue 1,2017, Pages 32-35.

Aksha Sharen, Hima Sandeep: survey on indirect tooth coloured restorations among dental students and specialist. Journal of Pharmaceutical Negative Results. 2022, 13 (3).

Singh RP, Gopalakrishnapillai AC, Bhat N, Pawar A. Perception of Dental and Medical Teaching Faculty Regarding Mobile Dental Application. J Pharm Bioallied Sci. 2019 Nov;11(Suppl 3):S530-S539. doi: 10.4103/jpbs.JPBS_261_18. PMID: 31920270; PMCID: PMC6896578.

Comment #4-Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.
Response:
Deleted
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to improve the quality of the article. The authors have tackled each comment and respectively responded to. All changes in the manuscript were red highlighted. Moreover, below is a detailed response consistently progressing with both reviewers. Kindly refer to our response below:

Reviewer 2, Dr Nesrine Alsahn

Comment #1: The highlighted parts in the following paragraphs contain information that was stated twice. The authors have to revise and rephrase these parts to avoid repetition.

"This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator."
Response:
"During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes."

The paragraphs were revised and rewritten.
(See the word doc attached)

The first highlighted sentence was deleted, and the second sentence was modified.

Comment #2: Why was the Nanofilled composite not listed as an option to restore different classes of anterior tooth defects?

Response:
Because of the close similarity of clinical performance of nanofilled and nanohybrid composites with no superiority over nanohybrid composites regarding surface polishability , wear and gloss stability indicated in a recent systematic review and meta analysis and following a similar pervious survey conducted in Brazil, nanofilled composites were not listed in our study as a separate option in our questionnaire. Moreover, we have used the categories of composite materials usually provided by suppliers to our selected governmental hospitals included in the study
(added to the Discussion section)
References:

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis

Anterior composite restorations in clinical practice: Findings from a survey with general dental practitioners

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.

The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.

The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Response:
-Domains 5 & 6 were combined and presented using table 3
-Rest of tables numbers were adjusted accordingly.

- Done

- Done table 3.

Comment #4: In question 8, what does option build-up mean or represent? Was it clarified for the participants?

Response:
In our questionnaire, the option ‘build up’ was employed to describe a large resin composite restoration used for restoring grossly mutilated anterior teeth including incisor teeth with incisal edge fracture involving more than 1/3 of the coronal tooth structure or with bilateral incisal angle involvements extending at least to the middle third of the crown or anterior teeth with bilateral complex class III cavities involving greater than 1/3 of coronal tooth structure. This was clearly stated in the online link at the beginning of the questionnaire.
(added to discussion section)

Comment #5: In question 10, the authors mentioned in the discussion that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively.

The authors used the correct terminology for the adhesive strategies in the discussion. Meanwhile, in Table 3,question 10, the authors used a different terminology for the adhesive types (self-adhesive, selective self-etching, total-etching). The answer options for question 10 need to be replaced by the correct terminology for adhesive strategies. Otherwise, the authors need to clarify in the text the adhesive strategies' terms they used.

Response:
Adjusted

Comment# 6: Why the statistical analysis was done only for domains 3 and 4?

Response:
In the current study, all questionnaire domains were subjects of descriptive statistics using percentages and histograms. Furthermore, domains 3 and 4 were subjects of chi square testing since they are testing the actual clinical practice and individual practice preference. In our previous questionnaire study testing that tested the practice of resin composite light curing using similar population, demographic factors of age, gender, location, and duration of practice did not have a significant influence when analyzed using chi square testing.

Comment #7: The authors used reference 65 to describe the multiple-layering approach. Please add a recent reference that introduces the latest techniques and composite materials used in the multiple-layering approach.

Response:
Done (added: Ajay Singh Rao, Shreya Bhor, Nimisha Shah, Naveen Chhabra: Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study. J Oral Biol Craniofac Res. 2022;12(5):552-556. doi: 10.1016/j.jobcr.2022.07.007.)

Reviewer 1 Dr. Hatem El-Damanhouri:

Comment #1- More details of the sample size calculation method are required.

Response:

In the current study, the targeted population, selected hospitals, and sample size calculation followed the same methodology detailed in our previously published studies.

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

Comment #2- For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.

Response:
The literature has listed experts opinion as a satisfactory tool to pretest the reliability and validity of a survey questionnaire.
“ An Examination of Questionnaire Evaluation by Expert Reviewers
Kristen Olson”
Olson reported that despite the efforts spent to select reviewers of same background skills, disagreements among raters were found which did not adversely affect the outcome. In our study and following our previously published surveys, we did not perform inter raters agreement testing since all our invited experts evaluated all questions as highly relevant or relevant.
References:

An Examination of Questionnaire Evaluation by Expert Reviewers, Kristen Olson

A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Comment #3-Please explain why the Chi-square test was used and whether the assumption of the test was met or not.

Response:
Following many previous similar survey studies , the current study used Descriptive statistics in the form of percentages and histograms to summarise the survey qualitative data. Moreover, Chi square test using received frequencies was employed to analyze the study qualitative data at a level of significance (P <0.05)
In the present study, all Chi square test assumptions listed by Mary L. McHugh biomedica, 2013 were met.
References:

Puja C. Yavagal, Hitashi Singla,Prevalence of dental caries based on personality types of 35–44 years old residents in Davangere city, Journal of Oral Biology and Craniofacial Research,Volume 7, Issue 1,2017, Pages 32-35.

Aksha Sharen, Hima Sandeep: survey on indirect tooth coloured restorations among dental students and specialist. Journal of Pharmaceutical Negative Results. 2022, 13 (3).

Singh RP, Gopalakrishnapillai AC, Bhat N, Pawar A. Perception of Dental and Medical Teaching Faculty Regarding Mobile Dental Application. J Pharm Bioallied Sci. 2019 Nov;11(Suppl 3):S530-S539. doi: 10.4103/jpbs.JPBS_261_18. PMID: 31920270; PMCID: PMC6896578.

Comment #4-Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.
Response:
Deleted
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 06 Oct 2023

Moataz Elgezawi, Restorative Dental Sciences, Imam Abdulrahman Bin faisal University, Dammam, 1982, Saudi Arabia

06 Oct 2023

Author Response
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to ... Continue reading
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to improve the quality of the article. The authors have tackled each comment and respectively responded to. All changes in the manuscript were red highlighted. Moreover, below is a detailed response consistently progressing with both reviewers. Kindly refer to our response below:

Reviewer 2, Dr Nesrine Alsahn

Comment #1: The highlighted parts in the following paragraphs contain information that was stated twice. The authors have to revise and rephrase these parts to avoid repetition.

"This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator."
Response:
"During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes."

The paragraphs were revised and rewritten.
(See the word doc attached)

The first highlighted sentence was deleted, and the second sentence was modified.

Comment #2: Why was the Nanofilled composite not listed as an option to restore different classes of anterior tooth defects?

Response:
Because of the close similarity of clinical performance of nanofilled and nanohybrid composites with no superiority over nanohybrid composites regarding surface polishability , wear and gloss stability indicated in a recent systematic review and meta analysis and following a similar pervious survey conducted in Brazil, nanofilled composites were not listed in our study as a separate option in our questionnaire. Moreover, we have used the categories of composite materials usually provided by suppliers to our selected governmental hospitals included in the study
(added to the Discussion section)
References:

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis

Anterior composite restorations in clinical practice: Findings from a survey with general dental practitioners

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.

The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.

The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Response:
-Domains 5 & 6 were combined and presented using table 3
-Rest of tables numbers were adjusted accordingly.

- Done

- Done table 3.

Comment #4: In question 8, what does option build-up mean or represent? Was it clarified for the participants?

Response:
In our questionnaire, the option ‘build up’ was employed to describe a large resin composite restoration used for restoring grossly mutilated anterior teeth including incisor teeth with incisal edge fracture involving more than 1/3 of the coronal tooth structure or with bilateral incisal angle involvements extending at least to the middle third of the crown or anterior teeth with bilateral complex class III cavities involving greater than 1/3 of coronal tooth structure. This was clearly stated in the online link at the beginning of the questionnaire.
(added to discussion section)

Comment #5: In question 10, the authors mentioned in the discussion that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively.

The authors used the correct terminology for the adhesive strategies in the discussion. Meanwhile, in Table 3,question 10, the authors used a different terminology for the adhesive types (self-adhesive, selective self-etching, total-etching). The answer options for question 10 need to be replaced by the correct terminology for adhesive strategies. Otherwise, the authors need to clarify in the text the adhesive strategies' terms they used.

Response:
Adjusted

Comment# 6: Why the statistical analysis was done only for domains 3 and 4?

Response:
In the current study, all questionnaire domains were subjects of descriptive statistics using percentages and histograms. Furthermore, domains 3 and 4 were subjects of chi square testing since they are testing the actual clinical practice and individual practice preference. In our previous questionnaire study testing that tested the practice of resin composite light curing using similar population, demographic factors of age, gender, location, and duration of practice did not have a significant influence when analyzed using chi square testing.

Comment #7: The authors used reference 65 to describe the multiple-layering approach. Please add a recent reference that introduces the latest techniques and composite materials used in the multiple-layering approach.

Response:
Done (added: Ajay Singh Rao, Shreya Bhor, Nimisha Shah, Naveen Chhabra: Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study. J Oral Biol Craniofac Res. 2022;12(5):552-556. doi: 10.1016/j.jobcr.2022.07.007.)

Reviewer 1 Dr. Hatem El-Damanhouri:

Comment #1- More details of the sample size calculation method are required.

Response:

In the current study, the targeted population, selected hospitals, and sample size calculation followed the same methodology detailed in our previously published studies.

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

Comment #2- For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.

Response:
The literature has listed experts opinion as a satisfactory tool to pretest the reliability and validity of a survey questionnaire.
“ An Examination of Questionnaire Evaluation by Expert Reviewers
Kristen Olson”
Olson reported that despite the efforts spent to select reviewers of same background skills, disagreements among raters were found which did not adversely affect the outcome. In our study and following our previously published surveys, we did not perform inter raters agreement testing since all our invited experts evaluated all questions as highly relevant or relevant.
References:

An Examination of Questionnaire Evaluation by Expert Reviewers, Kristen Olson

A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Comment #3-Please explain why the Chi-square test was used and whether the assumption of the test was met or not.

Response:
Following many previous similar survey studies , the current study used Descriptive statistics in the form of percentages and histograms to summarise the survey qualitative data. Moreover, Chi square test using received frequencies was employed to analyze the study qualitative data at a level of significance (P <0.05)
In the present study, all Chi square test assumptions listed by Mary L. McHugh biomedica, 2013 were met.
References:

Puja C. Yavagal, Hitashi Singla,Prevalence of dental caries based on personality types of 35–44 years old residents in Davangere city, Journal of Oral Biology and Craniofacial Research,Volume 7, Issue 1,2017, Pages 32-35.

Aksha Sharen, Hima Sandeep: survey on indirect tooth coloured restorations among dental students and specialist. Journal of Pharmaceutical Negative Results. 2022, 13 (3).

Singh RP, Gopalakrishnapillai AC, Bhat N, Pawar A. Perception of Dental and Medical Teaching Faculty Regarding Mobile Dental Application. J Pharm Bioallied Sci. 2019 Nov;11(Suppl 3):S530-S539. doi: 10.4103/jpbs.JPBS_261_18. PMID: 31920270; PMCID: PMC6896578.

Comment #4-Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.
Response:
Deleted
The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to improve the quality of the article. The authors have tackled each comment and respectively responded to. All changes in the manuscript were red highlighted. Moreover, below is a detailed response consistently progressing with both reviewers. Kindly refer to our response below:

Reviewer 2, Dr Nesrine Alsahn

Comment #1: The highlighted parts in the following paragraphs contain information that was stated twice. The authors have to revise and rephrase these parts to avoid repetition.

"This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator."
Response:
"During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes."

The paragraphs were revised and rewritten.
(See the word doc attached)

The first highlighted sentence was deleted, and the second sentence was modified.

Comment #2: Why was the Nanofilled composite not listed as an option to restore different classes of anterior tooth defects?

Response:
Because of the close similarity of clinical performance of nanofilled and nanohybrid composites with no superiority over nanohybrid composites regarding surface polishability , wear and gloss stability indicated in a recent systematic review and meta analysis and following a similar pervious survey conducted in Brazil, nanofilled composites were not listed in our study as a separate option in our questionnaire. Moreover, we have used the categories of composite materials usually provided by suppliers to our selected governmental hospitals included in the study
(added to the Discussion section)
References:

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis

Anterior composite restorations in clinical practice: Findings from a survey with general dental practitioners

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.

The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.

The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Response:
-Domains 5 & 6 were combined and presented using table 3
-Rest of tables numbers were adjusted accordingly.

- Done

- Done table 3.

Comment #4: In question 8, what does option build-up mean or represent? Was it clarified for the participants?

Response:
In our questionnaire, the option ‘build up’ was employed to describe a large resin composite restoration used for restoring grossly mutilated anterior teeth including incisor teeth with incisal edge fracture involving more than 1/3 of the coronal tooth structure or with bilateral incisal angle involvements extending at least to the middle third of the crown or anterior teeth with bilateral complex class III cavities involving greater than 1/3 of coronal tooth structure. This was clearly stated in the online link at the beginning of the questionnaire.
(added to discussion section)

Comment #5: In question 10, the authors mentioned in the discussion that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively.

The authors used the correct terminology for the adhesive strategies in the discussion. Meanwhile, in Table 3,question 10, the authors used a different terminology for the adhesive types (self-adhesive, selective self-etching, total-etching). The answer options for question 10 need to be replaced by the correct terminology for adhesive strategies. Otherwise, the authors need to clarify in the text the adhesive strategies' terms they used.

Response:
Adjusted

Comment# 6: Why the statistical analysis was done only for domains 3 and 4?

Response:
In the current study, all questionnaire domains were subjects of descriptive statistics using percentages and histograms. Furthermore, domains 3 and 4 were subjects of chi square testing since they are testing the actual clinical practice and individual practice preference. In our previous questionnaire study testing that tested the practice of resin composite light curing using similar population, demographic factors of age, gender, location, and duration of practice did not have a significant influence when analyzed using chi square testing.

Comment #7: The authors used reference 65 to describe the multiple-layering approach. Please add a recent reference that introduces the latest techniques and composite materials used in the multiple-layering approach.

Response:
Done (added: Ajay Singh Rao, Shreya Bhor, Nimisha Shah, Naveen Chhabra: Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study. J Oral Biol Craniofac Res. 2022;12(5):552-556. doi: 10.1016/j.jobcr.2022.07.007.)

Reviewer 1 Dr. Hatem El-Damanhouri:

Comment #1- More details of the sample size calculation method are required.

Response:

In the current study, the targeted population, selected hospitals, and sample size calculation followed the same methodology detailed in our previously published studies.

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

Comment #2- For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.

Response:
The literature has listed experts opinion as a satisfactory tool to pretest the reliability and validity of a survey questionnaire.
“ An Examination of Questionnaire Evaluation by Expert Reviewers
Kristen Olson”
Olson reported that despite the efforts spent to select reviewers of same background skills, disagreements among raters were found which did not adversely affect the outcome. In our study and following our previously published surveys, we did not perform inter raters agreement testing since all our invited experts evaluated all questions as highly relevant or relevant.
References:

An Examination of Questionnaire Evaluation by Expert Reviewers, Kristen Olson

A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Comment #3-Please explain why the Chi-square test was used and whether the assumption of the test was met or not.

Response:
Following many previous similar survey studies , the current study used Descriptive statistics in the form of percentages and histograms to summarise the survey qualitative data. Moreover, Chi square test using received frequencies was employed to analyze the study qualitative data at a level of significance (P <0.05)
In the present study, all Chi square test assumptions listed by Mary L. McHugh biomedica, 2013 were met.
References:

Puja C. Yavagal, Hitashi Singla,Prevalence of dental caries based on personality types of 35–44 years old residents in Davangere city, Journal of Oral Biology and Craniofacial Research,Volume 7, Issue 1,2017, Pages 32-35.

Aksha Sharen, Hima Sandeep: survey on indirect tooth coloured restorations among dental students and specialist. Journal of Pharmaceutical Negative Results. 2022, 13 (3).

Singh RP, Gopalakrishnapillai AC, Bhat N, Pawar A. Perception of Dental and Medical Teaching Faculty Regarding Mobile Dental Application. J Pharm Bioallied Sci. 2019 Nov;11(Suppl 3):S530-S539. doi: 10.4103/jpbs.JPBS_261_18. PMID: 31920270; PMCID: PMC6896578.

Comment #4-Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.
Response:
Deleted
Competing Interests: No competing interests were disclosed. Close
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Version 2

VERSION 2 PUBLISHED 03 Apr 2023

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Version 2 (revision) 20 Sep 23	read	read
Version 1 03 Apr 23	read	read

Hatem M. El-Damanhoury, University of Sharjah, Sharjah, United Arab Emirates
Nesrine A. Elsahn, Ajman University, Ajman, United Arab Emirates; Cairo University, Giza, Egypt

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05 Oct 2023 | for Version 2

Hatem M. El-Damanhoury, Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates

11 Views Cite this report Responses(0)

Approved

The authors addressed all the reviewer's comments, and no further changes are required.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Restorative Dentistry

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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29 Sep 2023 | for Version 2

Nesrine A. Elsahn, Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates; Operative Dentistry, Cairo University, Giza, Giza Governorate, Egypt

8 Views Cite this report Responses(0)

Approved

I have no further comments to make.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Adhesive Dentistry, Restorative Dentistry, Dental Materials.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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10 Aug 2023 | for Version 1

Nesrine A. Elsahn, Department of Clinical Sciences, College of Dentistry, Ajman University, Ajman, United Arab Emirates; Operative Dentistry, Cairo University, Giza, Giza Governorate, Egypt

20 Views Cite this report Responses(1)

Approved With Reservations

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.
The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.
The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Adhesive Dentistry, Restorative Dentistry, Dental Materials.

Respond to this report

Responses (1)

Author Response

06 Oct 2023

Moataz Elgezawi, Restorative Dental Sciences, Imam Abdulrahman Bin faisal University, Dammam, 1982, Saudi Arabia

The Authors would like to thank both reviewers, Dr. Nesrine A. Elsahn and Dr. Hatem M. El.Damanhoury for the time they gave to provide their constructive feedback and comments to improve the quality of the article. The authors have tackled each comment and respectively responded to. All changes in the manuscript were red highlighted. Moreover, below is a detailed response consistently progressing with both reviewers. Kindly refer to our response below:

Reviewer 2, Dr Nesrine Alsahn

Comment #1: The highlighted parts in the following paragraphs contain information that was stated twice. The authors have to revise and rephrase these parts to avoid repetition.

"This cross-sectional study was conducted utilizing an online uploaded survey questionnaire using Google’s free online survey platform. E-mail invitations stated clearly that participation was anonymous and voluntary and that participants were free to leave the survey or to skip any questions. The targeted population of 500 resulted in a calculated sample size of 218 dentists. Calculations were performed at the 95% confidence level using a free online sample size calculator."
Response:
"During the research, participants were invited to join the survey through emails that clarified the objectives of the study and included necessary information and that joining the survey is anonymous and voluntary. The invite explained that by completing the survey, they were consenting to participate in the study. Participants were informed that they could leave the study at any step if they did not wish to continue, and that the data collected would be used for research purposes."

The paragraphs were revised and rewritten.
(See the word doc attached)

The first highlighted sentence was deleted, and the second sentence was modified.

Comment #2: Why was the Nanofilled composite not listed as an option to restore different classes of anterior tooth defects?

Response:
Because of the close similarity of clinical performance of nanofilled and nanohybrid composites with no superiority over nanohybrid composites regarding surface polishability , wear and gloss stability indicated in a recent systematic review and meta analysis and following a similar pervious survey conducted in Brazil, nanofilled composites were not listed in our study as a separate option in our questionnaire. Moreover, we have used the categories of composite materials usually provided by suppliers to our selected governmental hospitals included in the study
(added to the Discussion section)
References:

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis
Anterior composite restorations in clinical practice: Findings from a survey with general dental practitioners

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.
The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.
The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Response:
-Domains 5 & 6 were combined and presented using table 3
-Rest of tables numbers were adjusted accordingly.

- Done

- Done table 3.

Comment #4: In question 8, what does option build-up mean or represent? Was it clarified for the participants?

Response:
In our questionnaire, the option ‘build up’ was employed to describe a large resin composite restoration used for restoring grossly mutilated anterior teeth including incisor teeth with incisal edge fracture involving more than 1/3 of the coronal tooth structure or with bilateral incisal angle involvements extending at least to the middle third of the crown or anterior teeth with bilateral complex class III cavities involving greater than 1/3 of coronal tooth structure. This was clearly stated in the online link at the beginning of the questionnaire.
(added to discussion section)

Comment #5: In question 10, the authors mentioned in the discussion that only 45% of participants use total-etch adhesives, while 31% and 23% used self-etching and selective etching technology, respectively.

The authors used the correct terminology for the adhesive strategies in the discussion. Meanwhile, in Table 3,question 10, the authors used a different terminology for the adhesive types (self-adhesive, selective self-etching, total-etching). The answer options for question 10 need to be replaced by the correct terminology for adhesive strategies. Otherwise, the authors need to clarify in the text the adhesive strategies' terms they used.

Response:
Adjusted

Comment# 6: Why the statistical analysis was done only for domains 3 and 4?

Response:
In the current study, all questionnaire domains were subjects of descriptive statistics using percentages and histograms. Furthermore, domains 3 and 4 were subjects of chi square testing since they are testing the actual clinical practice and individual practice preference. In our previous questionnaire study testing that tested the practice of resin composite light curing using similar population, demographic factors of age, gender, location, and duration of practice did not have a significant influence when analyzed using chi square testing.

Comment #7: The authors used reference 65 to describe the multiple-layering approach. Please add a recent reference that introduces the latest techniques and composite materials used in the multiple-layering approach.

Response:
Done (added: Ajay Singh Rao, Shreya Bhor, Nimisha Shah, Naveen Chhabra: Comparative evaluation of aesthetic outcome of direct polychromatic composite layering and the "index cut-back technique" for restoring class IV defects using a newly patented simulated 3D printed mould: An in vitro study. J Oral Biol Craniofac Res. 2022;12(5):552-556. doi: 10.1016/j.jobcr.2022.07.007.)

Reviewer 1 Dr. Hatem El-Damanhouri:

Comment #1- More details of the sample size calculation method are required.

Response:

In the current study, the targeted population, selected hospitals, and sample size calculation followed the same methodology detailed in our previously published studies.

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

Comment #2- For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.

Response:
The literature has listed experts opinion as a satisfactory tool to pretest the reliability and validity of a survey questionnaire.
“ An Examination of Questionnaire Evaluation by Expert Reviewers
Kristen Olson”
Olson reported that despite the efforts spent to select reviewers of same background skills, disagreements among raters were found which did not adversely affect the outcome. In our study and following our previously published surveys, we did not perform inter raters agreement testing since all our invited experts evaluated all questions as highly relevant or relevant.
References:

An Examination of Questionnaire Evaluation by Expert Reviewers, Kristen Olson
A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications
Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Comment #3-Please explain why the Chi-square test was used and whether the assumption of the test was met or not.

Response:
Following many previous similar survey studies , the current study used Descriptive statistics in the form of percentages and histograms to summarise the survey qualitative data. Moreover, Chi square test using received frequencies was employed to analyze the study qualitative data at a level of significance (P <0.05)
In the present study, all Chi square test assumptions listed by Mary L. McHugh biomedica, 2013 were met.
References:

Puja C. Yavagal, Hitashi Singla,Prevalence of dental caries based on personality types of 35–44 years old residents in Davangere city, Journal of Oral Biology and Craniofacial Research,Volume 7, Issue 1,2017, Pages 32-35.

Aksha Sharen, Hima Sandeep: survey on indirect tooth coloured restorations among dental students and specialist. Journal of Pharmaceutical Negative Results. 2022, 13 (3).

Singh RP, Gopalakrishnapillai AC, Bhat N, Pawar A. Perception of Dental and Medical Teaching Faculty Regarding Mobile Dental Application. J Pharm Bioallied Sci. 2019 Nov;11(Suppl 3):S530-S539. doi: 10.4103/jpbs.JPBS_261_18. PMID: 31920270; PMCID: PMC6896578.

Comment #4-Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.
Response:
Deleted

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

14 Views

28 Jul 2023 | for Version 1

Hatem M. El-Damanhoury, Department of Preventive and Restorative Dentistry, University of Sharjah, Sharjah, United Arab Emirates

14 Views Cite this report Responses(1)

Approved With Reservations

More details of the sample size calculation method are required.
For the validity and reliability of the questions, it is recommended to run an inter-examiner agreement test.
Please explain why the Chi-square test was used and whether the assumption of the test was met or not.
Please delete the sentence "Minitab statistical software is an example of free online software that can be used to perform similar statistical analysis", as it is not needed, and adds nothing to the manuscript.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Restorative Dentistry

Respond to this report

Responses (1)

Author Response

06 Oct 2023

Moataz Elgezawi, Restorative Dental Sciences, Imam Abdulrahman Bin faisal University, Dammam, 1982, Saudi Arabia

Nanofilled/nanohybrid and hybrid resin-based composite in patients with direct restorations in posterior teeth: A systematic review and meta-analysis
Anterior composite restorations in clinical practice: Findings from a survey with general dental practitioners

Comment #3: In Domain 2:

There is no table number or legend/ header for the information related to questions 5 and 6. If the authors decided to present this part in a table, a table number must be given and all the changes required in the following tables’ numbering and in the text must be done.
The sample size (n=250) has to be written before the table for questions 5 and 6, as it was done for the other tables, not at the end of the questions.
The authors didn’t include answer options, participants’ responses, or relative responses in percentages for question #6. Although this information was presented in Figure 2, the authors have either to present domain 2 in figures only or to use figures and a table, provided that the table is written following the same format used for the other tables.

Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia

An Examination of Questionnaire Evaluation by Expert Reviewers, Kristen Olson
A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications
Toward optimum light curing of Resin Composite Restorations: A survey on Current Awareness and Practice among General Dentists in Saudi Arabia

Puja C. Yavagal, Hitashi Singla,Prevalence of dental caries based on personality types of 35–44 years old residents in Davangere city, Journal of Oral Biology and Craniofacial Research,Volume 7, Issue 1,2017, Pages 32-35.

Aksha Sharen, Hima Sandeep: survey on indirect tooth coloured restorations among dental students and specialist. Journal of Pharmaceutical Negative Results. 2022, 13 (3).

Singh RP, Gopalakrishnapillai AC, Bhat N, Pawar A. Perception of Dental and Medical Teaching Faculty Regarding Mobile Dental Application. J Pharm Bioallied Sci. 2019 Nov;11(Suppl 3):S530-S539. doi: 10.4103/jpbs.JPBS_261_18. PMID: 31920270; PMCID: PMC6896578.

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] 1. Blatz MB, Chiche G, Bahat O, et al.: Evolution of Aesthetic Dentistry. J. Dent. Res. 2019; 98 (12): 1294–1304. Publisher Full Text

[2] 2. Demarco FF, Collares K, Correa MB, et al.: Should my composite restorations last forever? Why are they failing? Braz. Oral Res. 2017; 31(suppl 1): e56. PubMed Abstract | Publisher Full Text

[3] 3. Demarco FF, Baldissera RA, Madruga FC, et al.: Anterior composite restorations in clinical practice: findings from a survey with general dental practitioners. J. Appl. Oral Sci. 2013; 21(6): 497–504. PubMed Abstract | Publisher Full Text | Free Full Text

[4] 4. El Gezawi MF, Al-Harbi FA: Reliability of bonded MOD restorations in maxillary premolars: microleakage and cusp fracture resistance. Acta Stomatol. Croat. 2012; 46(1): 31–42.

[5] 5. Nahsan FP, Mondelli RF, Franco EB, et al.: Clinical strategies for esthetic excellence in anterior tooth restorations: understanding color and composite resin selection. J. Appl. Oral Sci. 2012; 20(2): 151–156. PubMed Abstract | Publisher Full Text | Free Full Text

[6] 6. Mackenzie L, Banerjee A: Minimally invasive direct restorations: a practical guide. Br. Dent. J. 2017; 223(3): 163–171. Publisher Full Text

[7] 7. Dietschi D, Shahidi C, Krejci I: Clinical performance of direct anterior composite restorations: a systematic literature review and critical appraisal. Int. J. Esthet. Dent. 2019; 14(3): 252–270. PubMed Abstract

[8] 8. Loomans BAC, Kreulen CM, Huijs-Visser HECE, et al.: Clinical performance of full rehabilitations with direct composite in severe tooth wear patients: 3.5 Years results. J. Dent. 2018; 70: 97–103. PubMed Abstract | Publisher Full Text

[9] 9. Massano G, Comba A, Garombo E, et al.: Direct Composite Restorations of Anterior Teeth: A Retrospective Clinical Study. J. Adhes. Dent. 2019; 21(5).

[10] 10. Pedreira PRM, Damasceno J, Pierote J, et al.: Minimally invasive aesthetic rehabilitation in composite resin: report of two clinical cases. Braz. Dent. Sci. 2019; 22 (1): 135–142. Publisher Full Text

[11] 11. Elfakhri F, Alkahtani R, Li C, et al.: Influence of filler characteristics on the performance of dental composites: A comprehensive review. Ceram. Int. 2022; 48: 27280–27294. Publisher Full Text

[12] 12. Reddy Y, Dhaded SV: Direct composite veneers -restoring esthetics by procuring patient demand: a case report. Int. J. Dent. Mater. 2019; 01 (03): 93–96. Publisher Full Text

[13] 13. Gouveia THN, Theobaldo JD, Vieira-Junior WF, et al.: Esthetic smile rehabilitation of anterior teeth by treatment with biomimetic restorative materials: a case report. Clin. Cosmet. Investig. Dent. 2017; 9: 27–31. PubMed Abstract | Publisher Full Text | Free Full Text

[14] 14. Frese C, Schiller P, Staehle HJ, et al.: Recontouring teeth and closing diastemas with direct composite buildups: a 5-year follow-up. J. Dent. 2013; 41(11): 979–985. Publisher Full Text

[15] 15. Jokstad A, Bayne S, Blunck U, et al.: Quality of dental restorations FDI Commission Project 2–95. Int. Dent. J. 2001; 51 (3): 117–158. PubMed Abstract | Publisher Full Text

[16] 16. Zhou X, Huang X, Li M, et al.: Development and status of resin composite as dental restorative materials. J. Appl. Polym. Sci. 2019; 136 (44): 48180. Publisher Full Text

[17] 17. Ferracane JL: Resin composite--state of the art. Dent. Mater. 2011; 27(1): 29–38. PubMed Abstract | Publisher Full Text

[18] 18. Anusavice K: Phillips science of dental material. 11th ed.St. Louis: Elsevier Science; 2013; pp. 399–441.

[19] 19. Ferraro MR: Multiple Diastema Closure and Malposition Camouflage using Direct Composite Restorations. J. Adhes. Dent. 2019; 21(5).

[20] 20. Souza E: Clinical Application of Dental Composites for Direct Restorations. Dental Composite Materials for Direct Restorations. Springer; 2018; pp. 305–319.

[21] 21. Dietschi D, Ardu S, Krejci I: A new shading concept based on natural tooth color applied to direct composite restorations. Quintessence Int. 2006; 37(2): 91–102. PubMed Abstract

[22] 22. Villarroel M, Fahl N, De Sousa AM, et al.: Direct esthetic restorations based on translucency and opacity of composite resins. J. Esthet. Restor. Dent. 2011; 23(2): 73–87. PubMed Abstract | Publisher Full Text

[23] 23. Paravina RD, Westland S, Kimura M, et al.: Color interaction of dental materials: blending effect of layered composites. Dent. Mater. 2006; 22(10): 903–908. PubMed Abstract | Publisher Full Text

[24] 24. Bhuvaneswaran M, Doss N: The Role of Colors and Tints in Composite Restorations. J. Cosmet. Dent. 2020; 35(4).

[25] 25. Detrik G, Thomas R, Detrik D: A Return to Direct Resin Artistry: The Lumisynchroma Layering Technique. J. Cosmet. Dent. 2018; 34(1).

[26] 26. Kominami N, Shimada Y, Hosaka K, et al.: The effect of flowable composite lining and dentin location on microtensile bond strength and internal fracture formation. Dent. Mater. J. 2019; 38: 798–805. Publisher Full Text

[27] 27. AlBaker AM, Al-Ruthia YSH, AlShehri M, et al.: The characteristics and distribution of dentist workforce in Saudi Arabia: a descriptive cross-sectional study. Saudi Pharm. J. 2017; 25(8): 1208–1216. PubMed Abstract | Publisher Full Text | Free Full Text

[28] 28. Haridy R, Abdalla MA, Kaisarly D, et al.: A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: Alternatives and implications. J. Dent. Educ. 2021; 85(4): 483–493. PubMed Abstract | Publisher Full Text | Free Full Text

[29] 29. Alassaf A, Almulhim B, Alghamdi SA, et al.: Perceptions and Preventive Practices Regarding COVID-19 Pandemic Outbreak and Oral Health Care Perceptions during the Lockdown: A Cross-Sectional Survey from Saudi Arabia. Healthcare. Multidisciplinary Digital Publishing Institute; 2021; Vol. 9. : p. 959.

[30] 30. Shaker RE, Babgi AA: Women in dentistry: A perspective on major universities in Saudi Arabia. Part 2: Analysis and statistical data. Saudi Dent. J. 2009; 21(3): 107–112. PubMed Abstract | Publisher Full Text | Free Full Text

[31] 31. AlSheikh R, Almulhim KS, Abdulkader M, et al.: Toward a Clinically Reliable Class II Resin Composite Restoration: A Cross-Sectional Study into the Current Clinical Practice among Dentists in Saudi Arabia. Int. J. Dent. 2022; 2022: 2691376–2691378. PubMed Abstract | Publisher Full Text | Free Full Text

[32] 32. Kaisarly D, El Gezawi M, Nyamaa I, et al.: Effects of boundary condition on shrinkage vectors of a flowable composite in experimental cavity models made of dental substrates. Clin. Oral Investig. 2019; 23(5): 2403–2411. PubMed Abstract | Publisher Full Text

[33] 33. Kaisarly D, El Gezawi M, Xu X, et al.: Shrinkage vectors of a flowable composite in artificial cavity models with different boundary conditions: Ceramic and Teflon. J. Mech. Behav. Biomed. Mater. 2018; 77: 414–421. Publisher Full Text

[34] 34. Poitevin A, De Munck J, Van Ende A, et al.: Bonding effectiveness of self-adhesive composites to dentin and enamel. Dent. Mater. 2013; 29(2): 221–230. Publisher Full Text

[35] 35. Kobayashi S, Nakajima M, Furusawa K, et al.: Color adjustment potential of single-shade resin composite to various-shade human teeth: Effect of structural color phenomenon. Dent. Mater. J. 2021; 40(4): 1033–1040. PubMed Abstract | Publisher Full Text

[36] 36. Huyang G, Debertin AE, Sun J: Design and development of self-healing dental composites. Mater. Des. 2016; 94: 295–302. PubMed Abstract | Publisher Full Text | Free Full Text

[37] 37. Pratap B, Gupta RK, Bhardwaj B, et al.: Resin based restorative dental materials: Characteristics and future perspectives. Jpn. Dent. Sci. Rev. 2019; 55(1): 126–138. PubMed Abstract | Publisher Full Text | Free Full Text

[38] 38. Beyth N, Farah S, Domb AJ, et al.: Antibacterial dental resin composites. React. Funct. Polym. 2014; 75: 81–88. Publisher Full Text

[39] 39. Dietschi D, Fahl N: Shading concepts and layering techniques to master direct anterior composite restorations: an update. Br. Dent. J. 2016; 221(12): 765–771. PubMed Abstract | Publisher Full Text

[40] 40. Gao Y, Li J, Dong B, et al.: Direct composite resin restoration of a class IV fracture by using 3D printing technology: A clinical report. J. Prosthet. Dent. 2021; 125(4): 555–559. Publisher Full Text

[41] 41. Wang Y, Li C, Yuan H, et al.: Rubber dam isolation for restorative treatment in dental patients. Cochrane Database Syst. Rev. 2016; 9(9): CD009858. PubMed Abstract | Publisher Full Text | Free Full Text

[42] 42. Schmeling M: Color Selection and Reproduction in Dentistry Part 2: Light Dynamics in Natural Teeth. Odovtos-Int. J. Dent. Sc. 2016; 18(2): 23–40. Publisher Full Text

[43] 43. Ismail EH, Paravina RD: Color adjustment potential of resin composites: Optical illusion or physical reality, a comprehensive overview. J. Esthet. Restor. Dent. 2022; 34(1): 42–54. PubMed Abstract | Publisher Full Text

[44] 44. Chu SJ, Trushkowsky RD, Paravina RD: Dental color matching instruments and systems. Review of clinical and research aspects. J. Dent. 2010; 38(Suppl 2): e2–e16. PubMed Abstract | Publisher Full Text

[45] 45. Fradeani M: Evaluation of dentolabial parameters as part of a comprehensive esthetic analysis. Eur. J. Esthet. Dent. 2006; 1(1): 62–69. PubMed Abstract

[46] 46. McLaren EA, Rifkin R: Macroesthetics: facial and dentofacial analysis. J. Calif. Dent. Assoc. 2002; 30(11): 839–847. PubMed Abstract | Publisher Full Text

[47] 47. Lutz F, Phillips RW: A classification and evaluation of composite resin systems. J. Prosthet. Dent. 1983; 50(4): 480–488. Publisher Full Text

[48] 48. Prakash V, Banu S, Sukumaran V, et al.: Comparision of True Nano with Microhybrid and Nanocluster Composite Before and After Tooth Brushing. Biosci. Biotechnol. Res. Asia. 2016; 13(4): 2365–2370. Publisher Full Text

[49] 49. Kubo S, Yokota H, Hayashi Y: Three-year clinical evaluation of a flowable and a hybrid resin composite in non-carious cervical lesions. J. Dent. 2010; 38(3): 191–200. Publisher Full Text

[50] 50. Loguercio AD, Lorini E, Weiss RV, et al.: A 12-month clinical evaluation of composite resins in class III restorations. J. Adhes. Dent. 2007; 9(1): 57–64. PubMed Abstract

[51] 51. Heintze SD, Rousson V, Hickel R: Clinical effectiveness of direct anterior restorations--a meta-analysis. Dent. Mater. 2015; 31(5): 481–495. PubMed Abstract | Publisher Full Text

[52] 52. Chandrasekhar V, Rudrapati L, Badami V, et al.: Incremental techniques in direct composite restoration. J. Conserv. Dent. 2017; 20(6): 386–391. PubMed Abstract | Publisher Full Text

[53] 53. Mahn E: Clinical criteria for the successful curing of composite materials. Revista Clínica de Periodoncia, Implantología y Rehabilitación Oral. 2013; 6(3): 148–153. Publisher Full Text

[54] 54. Stein PS, Sullivan J, Haubenreich JE, et al.: Composite resin in medicine and dentistry. J. Long-Term Eff. Med. Implants. 2005; 15(6): 641–654. PubMed Abstract | Publisher Full Text

[55] 55. Strazzi-Sahyon HB, Passos Rocha E, Gonçalves Assunção W, et al.: Influence of Light-Curing Intensity on Color Stability and Microhardness of Composite Resins. Int. J. Periodontics Restorative Dent. 2020; 40(1): 129–134. PubMed Abstract | Publisher Full Text

[56] 56. Par M, Marovic D, Attin T, et al.: The effect of rapid high-intensity light-curing on micromechanical properties of bulk-fill and conventional resin composites. Sci. Rep. 2020; 10(1): 1–10.

[57] 57. Pirmoradian M, Hooshmand T, Jafari-Semnani S, et al.: Degree of conversion and microhardness of bulk-fill dental composites polymerized by LED and QTH light curing units. J. Oral Biosci. 2020; 62(1): 107–113. PubMed Abstract | Publisher Full Text

[58] 58. Scotti N, Baldi A, Vergano EA, et al.: Light-Curing Units. Modern Operative Dentistry. Springer; 2020; pp. 435–464. Publisher Full Text

[59] 59. Lima AF, de Andrade KM , da Cruz Alves LE , et al.: Influence of light source and extended time of curing on microhardness and degree of conversion of different regions of a nanofilled composite resin. Eur. J. Dent. 2012; 06(2): 153–157. Publisher Full Text

[60] 60. Omidi BR, Gosili A, Jaber-Ansari M, et al.: Intensity output and effectiveness of light curing units in dental offices. J. Clin. Exp. Dent. 2018; 10(6): e555–e560. Publisher Full Text

[61] 61. Paolone G: Direct composite restorations in anterior teeth. Managing symmetry in central incisors. Int. J. Esthet. Dent. 2014; 9(1): 12–25.

[62] 62. Korkut B: Smile makeover with direct composite veneers: A two-year follow-up report. J. Dent. Res. Dent. Clin. Dent. Prospects. 2018; 12(2): 146–151. Publisher Full Text

[63] 63. Ammannato R, Ferraris F, Allegri M: The “index cutback technique”: A three-dimensional guided layering approach in direct class IV composite restorations. Int. J. Esthet. Dent. 2017; 12: 450–466.

[64] 64. Espíndola-Castro LF, de Melo Monteiro GQ , Ortigoza LS, et al.: Multidisciplinary Approach to Smile Restoration: Gingivoplasty, Tooth Bleaching, and Dental Re-anatomization. Compend. Contin. Educ. Dent (Jamesburg, NJ: 1995). 2019; 40(9): 590–599.

[65] 65. Ardu S, Krejci I: Biomimetic direct composite stratification technique for the restoration of anterior teeth. Quintessence Int. 2006; 37(3): 167–174. PubMed Abstract

[66] 66. Carneiro P, Ramos T, de Azevedo C , et al.: Influence of finishing and polishing techniques and abrasion on transmittance and roughness of composite resins. Oper. Dent. 2016; 41(6): 634–641. PubMed Abstract | Publisher Full Text

[67] 67. Jang J, Kim H, Shin S, et al.: Clinical effectiveness of different polishing systems and self-etch adhesives in class V composite resin restorations: two-year randomized controlled clinical trial. Oper. Dent. 2017; 42(1): 19–29. Publisher Full Text

[68] 68. Daud A, Gray G, Lynch CD, et al.: A randomised controlled study on the use of finishing and polishing systems on different resin composites using 3D contact optical profilometry and scanning electron microscopy. J. Dent. 2018; 71: 25–30. Publisher Full Text

[69] 69. Babina K, Polyakova M, Sokhova I, et al.: The Effect of Finishing and Polishing Sequences on The Surface Roughness of Three Different Nanocomposites and Composite/Enamel and Composite/Cementum Interfaces. Nanomaterials (Basel). 2020; 10(7). PubMed Abstract | Publisher Full Text | Free Full Text

[70] 70. Demarco FF, Collares K, Coelho-de-Souza FH, et al.: Anterior composite restorations: A systematic review on long-term survival and reasons for failure. Dent. Mater. 2015; 31(10): 1214–1224. Publisher Full Text

[71] 71. Elgezawi M, Hassan K, Alagl A, et al.: Complexity of comprehensive care treatments in undergraduate dental programs: The benefits of observing and assisting experienced faculty members. Saudi Dent. J. 2017; 29(4): 161–166. PubMed Abstract | Publisher Full Text | Free Full Text

Toward esthetically and biomechanically reliable anterior resin composite restorations: Current clinical experiences among dental practitioners in Saudi Arabia

Abstract

Keywords

Introduction

Methods

Table 1. Hospitals targeted.

Ethics statement

Results

Table 2. Demographics of partcipants.

Table 3. Personal Preference for anterior resin Composite restorations.

Table 4. Failure of anterior composites & Suggestion for practice improvement.

Figure 1. Duration of practice of dentistry.

Figure 2. Frequency of practice of resin composite restorations in anterior teeth per week.

Discussion

Conclusions

Data availability

Acknowledgement

References

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