Survival rate of the Hall technique compared with resin composite restoration in multi-surface cavities in primary teeth: a 1-year randomized clinical trial

Abstract Background Hall technique (HT) has been indicated for teeth with dentinal caries lesion; however, extensive cavities, with more than two surfaces still seem challenging for restorative treatment in pediatric dentistry, resulting in a higher failure rate and an increased need for retreatment. Objectives To compare the survival rate of the Hall technique preformed metal crown (HT) with resin composite restoration (RC) for multi-surface cavitated caries lesions in primary molars. Methodology In this multicenter two-arm randomized clinical trial, children between 4 and 9 years of age with at least one primary molar with cavitated caries lesion involving more than two surfaces, including one buccal or palatal/lingual surface, were selected from 17 Brazilian cities. A total of 364 teeth were allocated into two groups: (1) teeth treated with selective caries removal and RC and (2) treated with the HT. The survival rate was assessed at 6 and 12 months after the interventions. Survival analysis was performed with the Kaplan‒Meier method. Cox regression was used to determine the influence of explanatory variables on the survival rate (α=5%). Results After 12 months, 292 teeth were re-evaluated. A total of 358 teeth were re-evaluated at least once during the study and included in the survival analysis. The HT (87.8%) resulted in a higher survival rate than RC restoration (75.7%) (p=0.004). Conclusion HT has a higher survival rate than RC as a treatment for multi-surface cavitated caries lesions in primary teeth. ClinicalTrials.gov: NCT02782390

Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCT

Abstract: The aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate.

Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial

Abstract: This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.

Use of intrarradicular pins in primary teeth: case report of one year of accompanying / Uso de pinos intrarradiculares em dentes decíduos: relato de caso de um ano de acompanhamento

ABSTRACT Primary teeth have an important role in the growth and development of the child, besides being important for the good performance of masticatory function, phonation, occlusion and aesthetics, are the best space maintainers and eruption guide for the permanent successor. For anterior region, there are different alternatives of rehabilitation treatment, however, it is up to the professional to choose the best option. Objective To present a therapeutic management of upper incisors affected by carious lesion with intrarradicular pin in early childhood. Case report: male patient, with 2 years and 7 months of age and significant loss of dental structure at an early stage. In the impossibility of performing direct restoration, we opted for the rehabilitation with the use of glass fiber pins for intraradicular reinforcement and composite resin restorations in order to restore shape, function and aesthetics. Conclusion The use of fiberglass intra-radicular pins associated with direct restoration of composite resin is a recommended technique for the reconstruction of anterior teeth with great destruction.

RESUMO Os dentes decíduos possuem um papel importante no crescimento e desenvolvimento da criança, além de serem importantes para o bom desempenho da função mastigatória, fonação, oclusão e estética, são os melhores mantenedores de espaço e guia de erupção para o sucessor permanente. Para região anterior, existem diferentes alternativas de tratamento reabilitador, porém, cabe ao profissional escolher a melhor opção Objetivo Apresentar uma conduta terapêutica dos incisivos superiores acometidos por lesão de cárie com pino intrarradicular na primeira infância. Relato do caso: paciente do sexo masculino, com 2 anos e 7 meses de idade e perda significante de estrutura dentária de forma precoce. Na impossibilidade de ser realizado restauração direta, optou-se pela reabilitação com o uso de pinos de fibra de vidro para reforço intrarradicular e restaurações em resina composta em para restabelecimento da forma, função e estética. Conclusão A utilização de pinos intraradiculares de fibra de vidro associada a restauração direta de resina composta é uma técnica recomendada para a reconstrução de dentes decíduos anteriores com grande destruição.

Do Different Proportions of Antibiotics in the CTZ Paste Interfere with the Antimicrobial Action? In Vitro Study

Abstract Objective: To evaluate the antimicrobial action of the CTZ paste in three different proportions by diffusion in agar with the microorganisms: Enterococcus faecalis,Escherichia coli, and Candida albicans. Material and Methods: Three different proportions of antibiotics were tested: GROUP A - CTZ paste in the ratio of 33.33% chloramphenicol + 33.33% tetracycline + 33.33% zinc oxide, mixed with 2 drops of eugenol (1:1:1 ratio); GROUP B - CTZ paste in the proportion of 25% chloramphenicol + 25% tetracycline + 50% zinc oxide, mixed with 2 drops of eugenol (1: 1: 2 ratio); GROUP C - CTZ paste with 13% chloramphenicol + 13% tetracycline + 74% Zinc Oxide, mixed with 2 drops of eugenol (1:1:6 ratio); PC GROUP - Positive Control (0.12% Chlorhexidine); and NC GROUP - Negative Control (0.9% Saline solution). Data were analyzed through descriptive statistics (means and standard deviation). The one-way ANOVA and Tukey's test were used, with a significance level of 5% Results: No statistical differences for Enterococcus faecalis between groups A, B, and C (p = 0.1986) were found. There were statistical differences for Escherichia coli between groups B and C (p = 0.029), and for Candida albicans between groups A and C (p = 0.006). Groups A, B, and C had significant differences with both Positive and Negative Controls for all the microorganisms Conclusion: The three different ratios of CTZ paste showed antimicrobial efficacy against Enterococcus faecalis,Escherichia coli, and Candida albicans microorganisms.

Treatment of Riga-Fede disease using laser therapy: clinical case report / Tratamento de lesão de Riga-Fede com laserterapia: relato de caso clínico

ABSTRACT Neonatal teeth arise in the oral cavity in up to 30 days of life. Early eruption of teeth associated with dental trauma on the ventral surface of the tongue during breastfeeding may lead to a set of signs and symptoms called the Riga-Fede lesion, which manifests as a chronic ulceration on the ventral surface of the tongue. Establishing the treatment plan is a challenging task. The pediatric dentist and pediatrician, should act in promoting health and recovery of the baby with the disease, taking care not to neglect the weight loss in newborns. The aim of this study was to demonstrate the clinical implications of a Riga-Fede lesion and treatment approach using laser therapy. A 43-day-old child was referred to pediatric dentistry, presenting weight loss and a congenital lingual injury caused by a neonatal tooth. The treatment, after radiographic examination was extraction of tooth 71, topical application of Triacinolone acetonide and laser therapy. Laser therapy has been shown to be a possible treatment option for Riga-Fede lesions, reducing the healing time to four days, allowing the return to feeding and improvement in the pain symptoms from the first day of application.

RESUMO Os dentes neonatais surgem na cavidade oral em até 30 dias de vida. A erupção precoce dos dentes associado ao trauma dental na língua durante a amamentação pode levar a um conjunto de sinais e sintomas chamado de lesão de Riga-Fede, que se manifesta como uma ulceração crônica no ventre da língua. O estabelecimento do plano de tratamento é uma resolução desafiadora. O odontopediatra, bem como o pediatra, deve atuar na promoção de saúde e recuperação do bebê com a doença instalada, com o cuidado de não negligenciar a perda de peso em neonatos. O objetivo desse trabalho foi demonstrar as implicações clínicas de uma lesão de Riga-Fede e abordagem de tratamento utilizando a laserterapia. Uma criança de 43 dias foi encaminhada para tratamento com odontopediatra, apresentando perda de peso e uma lesão no ventre lingual ocasionada por um dente neonatal. O tratamento efetuado, após exame radiográfico, foi a exodontia do elemento dental 71, aplicação tópica de Triacinolona acetonida e laserterapia. A laserterapia mostrou-se uma possível opção de tratamento para lesões de Riga-Fede, reduzindo o tempo de cicatrização para quatro dias, possibilitando o retorno à alimentação e melhora da sintomatologia dolorosa desde o primeiro dia da aplicação.

Evaluation of the relationship between the cost and properties of glass ionomer cements indicated for atraumatic restorative treatment

The aim of this study was to evaluate microshear bond strength (μSBS), water sorption and solubility of glass ionomer cements (GIC) indicated for atraumatic restorative treatment (ART). Cylindrical specimens (6x2.4 mm) were used to test the sorption and solubility of each GIC (n = 5). The specimens were weighed before and after immersion in water and desiccation. For the μSBS test, 60 primary molars were ground to obtain flat surfaces from both enamel and dentin. The teeth were then assigned to the tested GIC (n = 10) groups, namely Fuji IX - FIX, Ketac Molar - KM and Maxxion R – MX. The exposed surfaces were pre-treated with GIC liquid. Polyethylene tubes were placed on the pre-treated surface and filled with one of the GIC. After 24 h, the specimens were submitted to the μSBS test. The failure mode was assessed using a stereomicroscope (400x magnification). The powder to liquid ratio and cost of material were also determined (n = 3). The data were analyzed by ANOVA and Tukey's post hoc test. Linear regression was used to determine the relation between cost and the other variables. Overall, MX showed lower μSBS values (enamel: 3.93 ± 0.38; dentin: 5.04 ± 0.70) than FIX (enamel: 5.95 ± 0.85; dentin: 7.01 ± 1.06) and KM (enamel: 5.91 ± 0.78; dentin: 6.88 ± 1.35), as well as higher sorption and solubility. The regression analyses showed a significant and positive correlation between cost and μSBS in enamel (R2 = 0.62; p < 0.001) and dentin (R2 = 0.43; p < 0.001); and a negative correlation between cost and water sorption (R2 = 0.93; p < 0.001) and solubility (R2 = 0.79; p < 0.001). In conclusion, the materials indicated for ART exhibit distinct physical and mechanical properties; in addition, low-priced materials may interfere with GIC properties.

Efeito de diferentes modelos de envelhecimento na resistência de união em dentina decídua hígida e cariada / Different degradations models to evaluate bond strength in sound and caries primary dentin

A resistência de união (RU) dos materiais deve ser avaliada após a degradação da interface adesiva, tentando simular um processo que ocorre naturalmente ao longo do tempo na cavidade bucal. O presente estudo avaliou a degradação da interface adesiva em diferentes materiais utilizando o modelo de envelhecimento in vitro e in situ em dentina hígida e cariada. Noventa segundos molares decíduos hígidos e sem defeitos de esmalte, foram aleatoriamente divididos em dois grupos de acordo com o substrato a ser testado (hígido e com lesão de cárie induzida). A seguir, cada um dos grupos foi subdividido aleatoriamente de acordo com o material restaurador (n=15): resina composta associada ao sistema adesivo - RC, cimento de ionômero de vidro modificado por resina - CIVMR e cimento de ionômero de vidro de alta viscosidade - CIVAV. A superfície da dentina foi preparada e com o auxílio de cânulas de polietileno, foram confeccionados os espécimes com os materiais restauradores. Partes de um mesmo dente foram submetidas a cada envelhecimento: in vitro (24 horas e 6 meses) - armazenados em água destilada à 37°C; e in situ (uso de dispositivo intraoral palatino por voluntários em uma fase experimental de 7 dias). Os espécimes foram submetidos ao teste de microcisalhamento (MPa) para avaliação da RU, seguido de análise do padrão de fratura em estereomicroscópio (400X). Os dados foram submetidos a análise de variância de medidas repetidas seguida pelo teste de Bonferroni (? = 5%). De forma geral, o armazenamento por seis meses em água degradou o grupo CIVMR em dentina hígida (<0,001) e RC em dentina cariada (p=0,007), para os outros materiais não houve diferença estatística (p=1,00)...

Materials bond strength (BS) should be evaluated after degradation of the adhesive interface, simulating the intra-oral enviroment. This study assessed the degradation of the bonding interface of differents materials using in vitro and in situ models of aging in sound and caries - affected primary dentin. Ninety sound second primary molars without enamel defects were randomly assigned into two groups (sound and induced carious) according to the substrate to be tested. Then each group was subdivided according to the restorative material (n=15): composite resin associated with the adhesive system - CR, resin-modified glass ionomer cement - RMGIC or high-viscous glass ionomer cement- HVGIC. Dentin surface was prepared and with the aid of polyethylene tubes specimens of each restorative materials were prepared. Parts of a same tooth were subjected to in vitro and in situ models of aging. For in vitro model, the specimens were stored in distilled water at 37°C during 24 hours per 6 months; and for in situ model an intraoral palatal device was confectioned and used by volunteers in an experimental phase for 7 days.Specimens were submitted to microshear test (MPa) for BS evaluation and then stereomicroscopy (400X) analys of failure mode. Data were analyzed by repeated measures ANOVA for followed by Bonferroni test (? = 5%). In general, the storage for six months in distilled water degraded the RMGIC group in sound dentin (<0.001) and RC group in caries-affect dentin substrate (p = 0.007), for the others materials there was no statistical difference (p = 1.00)...

Reabilitacão estética e funcional em, paciente com cárie severa da infância: relato de caso / Esthetic and functional rehabilitation in patient with severe childhood caries: case report

A Cárie Precoce da Infância (CPI) é uma doença de etiologia multifatorial que acomete crianças na fase pré-escolar, sendo sua forma mais agressiva denominada como Cárie Severa da Infância (CSI). O presente trabalho teve como objetivo descrever o caso clínico de reabilitação estética e funcional de paciente do gênero feminino, 3 anos e 6 meses de idade, acometida por CSI. Uma etapa inicial de adequação do meio bucal envolveu drenagem de abscesso periapical no elemento 61, tratamento endodôntico dos incisivos superiores, vedamento das cavidades e realização de selantes com cimento de ionômero de vidro (CIV) de alta viscosidade, além de orientações acerca da importância de bons hábitos alimentares e é de higienização na paralisação da doença cárie, utilizando-se de abordagens motivacionais e buscando a conscientização do núcleo familiar quanto a sua responsabilidade no controle da mesma. A reconstrução cá estética dos incisivos superiores se deu por meio do uso de retentores intrarradiculares e resina composta, com o auxílio de matrizes anatômicas de celuloide, tendo sido utilizada também a resina para a restauração dos molares inferiores. O tratamento proposto permitiu restabelecer a função mastigatória e a estética do sorriso, bem como ocasionou na satisfação com o resultado obtido, demonstrada pela criança e por seus familiares. O tratamento reabilitador em crianças acometidas pela doença CSI pode ser realizado em ambiente ambulatorial e com o uso de técnicas restauradoras diretas, sendo possível obter resultado estético satisfatório e promover a saúde e o bem-estar geral para o paciente e seu núcleo familiar.

The Early Childhood Caries (ECC) is a multifactorial disease that affects preschool children, being its most aggressive form known as Severe Childhood Caries (SCC). The present work aimed to describe the c1inical case of aesthetic and functional rehabilitation of a female patient, 3 years and 6 months of age, affected by SCC An initial step of adequacy of oral environment involved the draining of periapical abscess on the element 61, endodontic treatment of upper incisors, sealing ofthe cavities and realization of sealants with glass ionomer cement (GIC) of high viscosity, as well as guidelines about the importance of good eating habits and sanitation in the stoppage of caries across motivational approaches and seeking family's awareness about their responsibility in the management of dental cáries Aesthetic reconstruction of upper incisors came de through the usage of intra-radicular posts and composite resin, with the aid of strip crowns. It was used the same resin for the restoration of lower molars. The proposed treatment allowed to re-establishment of the masticatory function and smile's aesthetics, thus promoting the satisfaction with the result obtained, demonstrated by the child and her family Rehabilitation treatment in children affected by SCC can be perfomed in dental office and with the use of direct restorative techniques. being possible to obtain satisfactory aesthetic result and promote the general health and well-being to the patient and the family.

Fluoride concentration in the top-selling Brazilian toothpastes purchased at different regions

To be relevant in terms of public health, widely-used toothpastes should have at least 1,000 ppm of soluble fluoride (F) concentration. Thus, the concentrations of total fluoride (TF) and total soluble fluoride (TSF) in the top-selling Brazilian toothpastes were evaluated. Samples (n=3) from toothpastes Colgate Anti-cáries®, Colgate Total 12 Clean Mint®, Colgate Tripla Ação Menta Original®, Colgate Tripla Ação Menta Suave® and Sorriso Dentes Brancos® were obtained from each of the five regions of the country. The concentrations of TF and TSF were analyzed with ion-specific electrode calibrated with F standards and the results were expressed in ppm (µg F/g). All toothpastes showed TF concentration lower than 1,500 ppm F (1,388.2 ± 25.8 to 1,483.2 ± 98.2). The TSF values were higher than 1,000 ppm F and ranged from 1,035.5 ± 61.5 to 1,221.8 ± 35.2 for calcium carbonate/monofluorophosphate-based toothpastes and from 1,455.6 ± 12.5 to 1,543.0 ± 147.3 for silica/sodium fluoride-based toothpaste. Top-selling Brazilian toothpastes presented available fluoride concentration to control caries regardless of the region where they are purchased.

Para ter relevância em termos de saúde pública, os cremes dentais amplamente utilizados pela população devem ter fluoreto (F) solúvel numa concentração mínima de 1.000 ppm F. Assim, as concentrações de fluoreto total (FT) e flureto solúvel total (FST) nos cremes dentais mais vendidos no Brasil foram avaliados. Os cremes dentais (n=3) Colgate Anti-cáries®, Colgate Total 12 Clean Mint®, Colgate Tripla Ação Menta Original®, Colgate Tripla Ação Menta Suave® e Sorriso Dentes Brancos® foram obtidos nas cinco regiões do país. As concentrações de FT e FST foram analisadas com eletrodo íon-específico calibrado com padrões de F e os resultados foram expressos em ppm (µg F/g). Todos os cremes dentais apresentaram concentração de FT inferior a 1.500 ppm F (1.388,2 ± 25,8 a 1.483,2 ± 98,2). Os valores de FST foram superiores a 1.000 ppm F e variaram de 1.035,5 ± 61,5 a 1.221,8 ± 35,2 para cremes dentais a base de carbonato de cálcio/monofluorfosfato e de 1.455,6 ± 12,5 a 1.543,0 ± 147,3 para o creme dental à base de sílica/fluoreto de sódio. Os cremes dentais mais vendidos no Brasil apresentaram concentração de fluoreto solúvel para controlar cárie, independentemente da região onde foram comprados.