ART restorations for occluso-proximal cavities in primary molars: a two-year survival and cost analysis of an RCT comparing two GIC brands

Abstract There are many glass ionomer cements available on the Brazilian market for Atraumatic Restorative Treatment (ART), however, there is still a gap in the literature regarding their cost-effectiveness. Objectives To evaluate the influence of restorative materials (Ketac Molar, 3M ESPE; and Vitro Molar, Nova DFL) in the two-year survival rate and cost-effectiveness of occluso-proximal ART restorations in primary molars. Methodology A total of 117 children (aged four to eight years) with at least one occluso-proximal carious lesion in primary molars were selected and randomly divided in treatment groups (KM or VM) in this parallel randomized controlled trial. Treatments followed ART premises and were conducted in public schools by trained operators in Barueri, Brazil. A trained, calibrated, and blinded examiner performed the evaluations after two, six, 12, and 24 months (k=0.92). Kaplan-Meier survival analysis was used to estimate restoration survival and Cox regression was used to test the association with clinical factors (α=5%). For cost analysis, material and professional costs were considered. Monte Carlo analysis was used to generate a cost-effectiveness plane and bootstrapping was used to compare material costs over the years. Results The overall survival rate was 36.9% after two years (48.6% for KM and 25.4% for VM). Restorations with VM failed more than those with KM (HR=1.70; 95% CI=1.06-2.73; p=0.027). VM presented lower initial cost, but no difference was observed between groups considering the two-year incremental cost. Conclusion After a two-year evaluation, KM proved to be a better option than VM for occluso-proximal ART restorations in primary molars. ClinicalTrials.gov: NCT02267720

Clinical wear of approximal glass ionomer restorations protected with a nanofilled self-adhesive light-cured protective coating

Abstract High viscous glass ionomer cement (GIC) has gained popularity as a restorative material; however, high wear is pointed as one of the major drawbacks of this material. Protective surface coatings were developed to protect GIC from water contamination with the additional advantage of occluding any surface cracks or porosities commonly found in this material, possibly resulting in an increased wear resistance of the restorations. Objective: The objective of this study was to investigate the clinical wear of GIC approximal restorations in primary molars protected either with a nanofilled self-adhesive light-cured protective coating (NPC) or with petroleum jelly. Material and Methods: Approximal caries lesions in primary molars from 32 schoolchildren previously enrolled in another clinical trial were included in this investigation. GIC restorations were performed according to the Atraumatic Restorative Treatment approach and protected with either petroleum jelly or a NPC. Impressions of the restored hemiarch were done after 1 day and 6, 12, 24 and 36 months. The impressions were scanned in a 3-D appliance and the obtained images were superimposed using an appropriate computer software. Two-way ANOVA for repeated measures and Tukey's post-hoc test were used to analyze the wear of restorations (α=5%). Results: A significant difference was found between the two groups, with a wear protection offered by the application of a NPC. Conclusion: These results suggest that the application of a NPC has a protective effect on the clinical wear of approximal GIC restorations in primary teeth.

Longevidade de restaurações ART em cavidades ocluso-proximais utilizando diferentes técnicas de inserção e proteção superficial / Proximal ART restorations using different insertion techniques and surface protection materials

O objetivo desta pesquisa foi avaliar a longevidade de restaurações ocluso-proximais realizadas pelo Tratamento Restaurador Atraumático (ART) com duas formas de inserção do cimento de ionômero de vidro (CIV - técnica convencional e técnica em duas camadas), assim como avaliar a influência do tipo de proteção superficial (vaselina sólida e resina fluida com nanopartículas - G-Coat Plus® - GC Corp). Além disso, investigou-se o desgaste clínico das restaurações convencionais de ART protegidas com vaselina sólida e G-Coat Plus®. Lesões de cárie ocluso-proximais em molares decíduos de 208 crianças foram selecionadas e divididas aleatoriamente em quatro grupos: grupo 1, inserção do CIV de maneira convencional e proteção superficial realizada com vaselina; grupo 2, inserção do CIV pela técnica em duas camadas e proteção superficial realizada com vaselina; grupo 3, inserção do CIV de maneira convencional e proteção superficial realizada com G-Coat Plus®; grupo 4, inserção do CIV pela técnica em duas camadas e proteção superficial realizada com G-Coat Plus®. As restaurações foram avaliadas clinicamente após 1, 6, 12, 18, 24 e 36 meses. Adicionalmente, 32 crianças foram selecionadas (16 pertencentes ao grupo 1 e 16 pertencentes ao grupo 3) para serem submetidas a impressões do hemi-arco envolvendo a restauração realizada com moldeira parcial e silicona de adição, para posterior obtenção de modelos com o uso de resina ortoftálica. As moldagens foram realizadas 1 dia após a realização das restaurações (baseline) e durante as avaliações de 6, 12, 18, 24 e 36 meses...

The aim of this research was to evaluate the survival rate of occluso-proximal restorations performed by the Atraumatic Restorative Treatment (ART) with two different insertion techniques of the glass ionomer cement (GIC - conventional technique and bilayer technique), and assess the influence of the type of surface protection (petroleum jelly and a nanofilled particles coating for GIC - G-Coat Plus® - GC Corp). Furthermore, we investigated the clinical wear of conventional ART-restorations protected with petroleum jelly and G-Coat Plus®. Occluso-proximal caries lesion in primary molars from 208 schoolchildren were selected and randomly assigned into four groups: group 1, conventional GIC insertion protected with petroleum jelly; G2, bi-layer technique protected with petroleum jelly; G3 conventional GIC insertion protected with G-Coat Plus®; G4, bi-layer technique protected with G-Coat Plus®. The restorations were clinically evaluated after 1, 6, 12, 18, 24 and 36 months. Additionally, 32 children were selected (16 from group 1 and 16 from group 3) to have impressions of the hemi-arc involving the restoration accomplished. The impressions were carried out 1 day after treatment and during the assessment periods of 6, 12, 18, 24 and 36 months...

Epidemiological study of traumatic dental injuries in 5- to 6-year-old Brazilian children

Monitoring traumatic dental injury (TDI) in primary teeth through epidemiological cross-sectional surveys provides descriptive information relevant to the development of public policies focused on the prevention of such injuries for the target population. The aim of this study was to assess the prevalence of TDI in 5- to 6-year-old Brazilian children and its association with biological and socioeconomic factors. A total of 684 children aged 5 to 6 years old, from 11 public schools in the city of Barueri (Brazil) were evaluated. Clinical examinations were carried out in the schools, by two trained and calibrated examiners. Gauze and a mouth mirror were used for the examinations. The reported TDIs were classified according to the Andreasen (2007) criteria for primary teeth. The results showed that 52.3% of the children had TDI. Enamel fracture (63.4%) was the most frequently observed sign of TDI, and the most affected teeth were the primary maxillary central incisors (26.9% maxillary right central incisor and 24% maxillary left central incisor). There was no association between the presence of TDI and biological or socioeconomic factors. In conclusion, the prevalence of TDI was high and had no statistically significant association with biological and socioeconomic factors.

Low-cost glass ionomer cement as ART sealant in permanent molars: a randomized clinical trial

Clinical trials are normally performed with well-known brands of glass ionomer cement (GIC), but the cost of these materials is high for public healthcare in less-affluent communities. Given the need to research cheaper materials, it seems pertinent to investigate the retention rate of a low-cost GIC applied as atraumatic restorative treatment (ART) sealants in two centers in Brazil. Four hundred and thirty-seven 6-to-8-year-old schoolchildren were selected in two cities in Brazil. The children were randomly divided into two groups, according to the tested GIC applied in the first permanent molars. The retention rate was evaluated after 3, 6 and 12 months. Kaplan-Meier survival analysis and the log-rank test were performed. The variables were tested for association with sealant longevity, using logistic regression analyses (α = 5%). The retention rate of sealants after 12 months was 19.1%. The high-cost GIC brand presented a 2-fold-more-likely-to-survive rate than the low-cost brand (p < 0.001). Significant difference was also found between the cities where the treatments were performed, in that Barueri presented a higher sealant survival rate than Recife (p < 0.001). The retention rate of a low-cost GIC sealant brand was markedly lower than that of a well-known GIC sealant brand.

Remoção cirúrgica de fibroma lingual e gengival em crianças / Surgical removal of tongue and gingival fibroma in children

Fibroma é um tumor benigno em que ocorre uma hiperplasia tecidual. Seu nome é característico por apresentar um grande número de células gigantes. O objetivo desse artigo é sequenciar a abordagem de remoção cirúrgica até o encaminhamento para avaliação histológica de dois fibromas, diagnosticados na língua e mucosa gengival em crianças de tenra idade. O prognóstico de cura em caso de presença do fibroma está relacionado à sua correta remoção feita cirurgicamente. Nos casos descritos, a resolução dos tumores foi observada após o período de proservação e cicatrização cirúrgicos.

Fibroma is a benign tumor that occurs the hyperplasia of the tissue. Its name is characteristic for having a large number of giant cells. The purpose of this article is to sequence the approach of surgical removal until referral for histological evaluation of two fibroma diagnosed on the tongue and gingival in children an early age. The prognosis for the cure in case of presence of fibroma is related to its correct removal taken surgically. On the presented cases, the resolution of the tumors was observed after the proservation and healing surgical.

Avaliações clínica e radiográfica do selamento de lesões de cárie / Sealing dentinal caries lesion clinical and radiographic assessment

O objetivo do presente estudo in vivo foi verificar o efeito da aplicação do selante de fóssulas e fissuras no controle de lesões cariosas oclusais em metade externa de dentina comparado ao tratamento restaurador com resina composta. Trinta e seis dentes decíduos foram selecionados e divididos aleatoriamente em: Grupo 1 - aplicação de selante resinoso e Grupo 2 - restauração com resina composta, após remoção parcial de tecido cariado. Os dentes foram avaliados clínica e radiograficamente nos períodos de seis, 12 e 18 meses após o tratamento. Os resultados demonstraram, após a análise dos dados com o teste Wilcoxon, que não houve diferença estatística entre os períodos analisados (p>0,05), assim como, após a utilização do teste de Mann Whitney, não houve diferença entre G1 e G2 (p>0,05). Concluiu-se que os selantes de fóssulas e fissuras constituem uma alternativa conservadora ao tratamento restaurador, propiciando a paralisação de lesões de cárie que atingem a metade externa de dentina, concomitante a preservação de tecido dental hígido.

Avaliação do selamento de lesões de cárie comparado à restauração com resina composta em dentes decíduos / Sealing dentinal caries lesion and restoring treatment in deciduous teeth: a longitudinal evaluation

O objetivo do presente estudo “in vivo" foi verificar o efeito do selante de fóssulas e fissuras no controle de lesões cariosas oclusais comparado ao tratamento restaurador. Vinte dentes decíduos foram selecionados e divididos em: grupo I – selante resinoso e grupo II –restauração com resina composta, após remoção parcial de tecido cariado. Após 12 meses, 8dentes foram excluídos da pesquisa. Os resultados demonstraram que 83% dos dentes do grupoI apresentaram retenção completa do material e em 100% dos casos observou-se ausência de progressão da lesão. 100% dos molares pertencentes ao grupo II apresentaram retenção completa do material, e em 100% dos casos houve ausência de progressão da lesão. Concluiu-se queos selantes de fóssulas e fissuras constituem uma alternativa conservadora ao tratamento restaurador, propiciando a paralisação de lesões de cárie em estágio inicial em dentina, além de preservação da estrutura dental.

The aim of this “in vivo" study was to verify the effect of pit and fissure sealants to control the initial caries injuries compared with the restorative treatment. Twenty deciduous teeth had been selected and divided in: group I – resinous sealant and group II – restoration with composite resin, after the partial removal of the carious dentin. After 12 months of attendance 8 teeth were excluded of the research. The results showed that 83% of the deciduous molars from group I presented complete material retention and in 100% of cases a non-progression ofinjury was observed. For group II, complete material retention was observed in 100% of theteeth and in 100% of the cases there were non-progression of the injury. We conclude that thepit and fissures sealants constitute a more conservative treatment then restoration, propitiating the stoppage of injuries of initial caries lesions and preservation of the dental structure.

Avaliação de radiografias panorâmicas objetivando o cotejamento entre os motivos da solicitação e eventuais achados radiográficos / Analysis of panoramic radiography for evaluation of requests and eventual radiological findings / Analysis of panoramic radiography for evaluation of requests and eventual radiological findings

Introdução - O objetivo deste trabalho foi avaliar a possível relação entre a solicitação das radiografias panorâmicas e eventuais achados radiográficos. Material e Métodos - Foram avaliadas 215 radiografias panorâmicas, considerando-se achados apenas aqueles que não foram os motivadores do pedido do exame. Resultados - Do total de radiografias, 56,8% apresentavam achados radiográficos. Conclusão - Pode-se afirmar que as radiografias panorâmicas, quando associadas a um correto exame clínico apresentam grande valor na avaliaçnao do estado do paciente.

Introduction - The aim of this study was to analyse a possible relation between radiography requests and eventual radiological findings. Material and Methods - Were evaluated 215 panoramic radiographies, being considered radiological findings only those which had no relation with the cause of the exam request. Results - From all radiographies evaluated, 56,8% presented radiological findings. Conclusion - The panoramic radiography is important to analyse the patient's oral health, when associated to a correct clinical exam bond strength to composite resin than the enamel bleached using 10% carbamide peroxide.