Estudo clínico randomizado de restaurações classe II de ART com e sem retenções proximais em dentes decíduos / Randomized clinical trial of multiple surface ART restorations with and without proximal retentions in primary teeth

O tratamento restaurador atraumático constitui-se numa abordagem de cuidados minimamente invasivos que objetivam a prevenção e interrupção da progressão da cárie dentária. Não existe na literatura estudo clínico randomizado em dentes decíduos comparando restaurações de classe II de ART, com e sem retenções adicionais. O objetivo deste trabalho foi avaliar o efeito de sulcos de retenção proximal sobre as taxas de sobrevida das restaurações classe II de ART em dentes decíduos, usando cimento de ionômero de vidro de alta viscosidade e alta resistência flexural. Foram incluídas 183 crianças com idade entre 4 a 7 anos, com boa saúde geral, 1 a 4 cavidades de classe II em molares decíduos sem envolvimento pulpar ou dor de dente. Dessas crianças, 300 dentes foram randomizados e distribuídos em dois grupos, conforme o índice de cárie da criança e o tamanho da cavidade a ser restaurada. Os grupos foram: controle restaurações de ART classe II convencionais (Grupo 1, n=150) e teste restaurações de ART classe II contendo sulcos de retenção proximais (Grupo 2, n=150). Cada um dos grupos seguiu procedimentos clínicos padronizados. No grupo teste as retenções foram realizadas com colher de dentina modificada no ângulo gengivovestibular/ lingual até 0,5 mm da junção amelo-dentinária da margem oclusal. Após 6 e 12 meses 130 restaurações do Grupo 1 e 110 restaurações do Grupo 2 foram examinadas de forma cega utilizando os critérios do ART Frencken adaptado e do USPHS modificado. Para a taxa de sobrevida das restaurações foi utilizado o teste de Kaplan-Meier (p<0,05). Não houve diferença significativa entre os grupos (p=0,70) utilizando os critérios do ART, sendo que as taxas de sobrevida encontradas para ambos os grupos foram superiores a 90%. O mesmo resultado foi observado em todos os critérios (cor, descoloração marginal, recidiva de cárie, forma anatômica, integridade marginal e textura superficial) USPHS (p>0,05). Os principais motivos de falhas das restaurações foram perda total ou parcial da restauração (84%), seguido de inflamação pulpar (16%). Conclui-se que as restaurações classe II de ART com sulcos de retenção proximal apresentaram taxa de sobrevida semelhantes às restaurações sem retenção após 6 e 12 meses.(AU)

The atraumatic restorative treatment is an approach of minimally invasive care that aims to prevent and interrupt the progression of dental caries. There is no randomized clinical trial in primary teeth with multiple surface ART restorations, with and without additional retentions. The aim of this study was to evaluate the effect of proximal retention grooves on the survival rates of occlusoproximal ART restorations in primary teeth using high viscosity glass ionomer cement with high flexural strength. A total of 183 children aged 4 to 7 years, with good general health, 1 to 4 occlusoproximal cavities in primary molars without pulp involvement or tooth pain were included. Of these children, three hundred teeth were randomized and alocated into two groups, according to the child's caries index and the size of the cavity to be restored. The groups were: control - conventional occlusoproximal ART restorations (Group 1, n=150) and test - occlusoproximal ART restorations containing proximal retention grooves (Group 2, n=150). The procedures of both groups followed standardized steps. In the test group the retentions were performed with a modified dentin spoon at the gingival-vestibular / lingual angle up to 0.5 mm from the amelodentin junction of the occlusal margin. After 6 and 12 months 130 restorations in Group 1 and 110 restorations in Group 2 were examined (blind) using the modified ART Frencken criteria and the modified USPHS criteria. The Kaplan-Meier test was performed for the survival rate of the restorations (p<0.05). There was no significant difference between groups (p=0.70) using the ART criteria, and the survival rates found for both groups were greater than 90%. The same results was observed for all USPHS criteria (color, marginal discoloration, secondary decay, anatomical form, marginal integrity and surface texture) (p>0.05). The main reasons for restorations failure were total or partial loss of restoration (84%), followed by pulpal inflammation (16%). It was concluded that multiple surface ART restorations with proximal retention grooves presented similar survival rates to non-grooves restorations after 6 and 12 months.(AU)

Pit and Fissure Sealants with Different Materials: Resin Based x Glass Ionomer Cement ­ Results after Six Months

Objective: To compare the retention and superficial characteristics between a new resin-modified glass ionomer sealant and resin sealant. In addition, the teeth sealed were compared to partially erupted first molars (control group) without sealing in relation to the incidence of dental caries. Material and Methods: Initially, 31 children aged 6-8 years participated in this study. The study children showed caries history, but had at least two healthy first molars. A total of 114 teeth were randomly divided into three groups: Clinpro (n=36), Fluroshield (n=38), and control (n=40). The two sealants were applied under relative isolation after previous prophylaxis and enamel etching with phosphoric acid 35% (15s). Clinical evaluation was performed by two calibrated examiners. They evaluated the retention and surface characteristics of the occlusal surface. Results: Fluroshield® showed significantly greater retention than ClinproTM Varnish® XT (p=0.002). However, the performance analysis of the success and failure of retention presented no significant difference between the materials (p=0.141). Concerning to the surface characteristics, Fluroshield performed better than Clinpro after analyzing the marginal deterioration, marginal discoloration, and superficial discoloration (p<0.05). The surface texture of the materials under study was similar (p=0.071). Sealed groups (Clinpro=Fluroshield) showed similar performance in the prevention of dental caries, which was significantly lower than that of control group (p=0.001). Conclusion: Both sealants, Fluroshield® and Clinpro TM Varnish® XT were effective in preventing caries lesion within 6 months, although Fluroshield sealant showed better clinical retention.

Impact of Saliva and Intraoral Appliance on Erosion Lesions Rehardening Ability - A Pilot Study

Objective: To evaluate the ability of different periods of salivary exposure and two different removable appliances to rehardening initial erosive lesions. Material and Methods: This randomized, single blind in situ study was conducted with 2 crossover phases. The factors under study were: period of salivary exposure (15 minutes, 30 minutes, 1 hour and 2 hours) and type of oral appliance (maxillary or mandibular). Two hundred enamel blocks were selected by initial surface hardness (SHi). Enamel blocks were demineralized in vitro (0.05M citric acid; pH2.5 for 15 seconds), surface hardness (SHd) was remeasured and 160 blocks were selected and randomized among groups. Thus, there were 2 blocks per period of salivary exposure in each type of oral appliance for each one of the 10 volunteers. In each phase, one of the removable appliances was tested. The response variable was percentage of surface hardness recovery (%SHR=[(SHf-SHd)/SHi)]x100). Two-way ANOVA and Tukey's post hoc test were applied adopting 5% of significance. Results: No difference was found among oral appliances on enamel rehardening (p>0.01). Salivary exposure of 2 hours promoted similar enamel rehardening when compared to 1 hour (p>0.05), which showed similar rehardening to 30 min. All mentioned period of salivary exposure promoted superior rehardening than 15 min (p>0.01). Conclusion: The salivary time exposure between erosive attacks might be 2 hours to achieve a feasible maximum rehardening. In addition, both maxillary and the mandibular appliance have presented a similar rehardening ability.

Changes in Oral Health-related Behavior of Infants following a Preventive Program of Continuing Education Directed to their Parents

To evaluate changes in oral health-related behavior of infants following preventive program of continuing education directed to their parents.Material and Methods:We analyzed 53 dental files of infants aged up to 36 months, who participated in the Prevention and Education Program of the Infants Clinic, School of Dentistry of Bauru (USP), and attended at least 2 visits with a maximum of 4 missing appointments. Initially an educational lecture was conducted, pointing issues related to diet and oral hygiene. At the following visit, the professional filled in a form with questions about diet and hygiene performed at home. The following information was extracted from dental files: reason of the first visit, age, number of teeth, number of visits, missing appointments, and dietary and oral hygiene risk factors. The data were tabulated and analyzed using descriptive statistics comparing the information obtained from the first visit to that of the last one.Results:The reason for the first visit was dental caries prevention (88.68%) followed by dental trauma (7.55%), and needed of curative treatment (3.77%). The mean age of the sample was 14.85 months, the tooth number mean was 12.64 at first visit, the mean number of visits was 7 and the mean missing appointments was 0.83. The percentage of infants with inadequate diet and hygiene habits was 88.68% and 62.26%, and only 12.762% and 57.57% of these have changed their habits, respectively.Conclusion:After the preventive program of continuing education, the dietary habits showed were more difficult to change in relation to hygiene ones...