Periodontal status among 12-year-old schoolchildren: a population-based cross-sectional study in Quito, Ecuador

Abstract This study aimed to estimate the prevalence and extent of bleeding on probing and calculus in 12-year-old schoolchildren of Quito, Ecuador, and evaluate the associated factors. We conducted an epidemiological survey with a representative sample of 1,100 12-year-old schoolchildren from public schools in the urban area of Quito, Ecuador. We assessed the periodontal health using the Community Periodontal Index (CPI). The prevalence and extent of the periodontal condition was based on the presence of at least one site with bleeding on probing (BOP), and the presence of dental calculus was also evaluated. We used univariate and multiple multilevel Poisson regression analyses to verify the association between the independent variables and the number of sextants with BOP and calculus. The prevalence of BOP and calculus was 92% and 69.9%, respectively. The adjusted mean of the affected sextants was 4.3 and 2.2 for BOP and calculus, respectively. The mother's schooling and malocclusion were associated with the number of sextants with bleeding. The mother's schooling and dental caries experience were associated with calculus. Gingival bleeding and the presence of dental calculus are highly prevalent in 12-year-old schoolchildren from Quito. Gingival bleeding is associated with maternal education and malocclusion, and dental calculus is associated with maternal education and dental caries.

Methodological quality of network meta-analysis in dentistry: a meta-research

Abstract This meta-research aimed to provide an overview of the methodological quality and risk of bias of network meta-analyses (NMA) in dentistry. Searches for NMA of randomized clinical trials with clinical outcomes in dentistry were performed in databases up to January 2022. Two reviewers independently screened titles/abstracts, selected full texts, and extracted the data. The adherence to PRISMA-NMA reporting guideline, the AMSTAR-2 methodological quality tool, and the ROBIS risk of bias tool were assessed in the studies. Correlation between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results was also investigated. Sixty-two NMA studies were included and presented varied methodological quality. According to AMSTAR-2, half of the NMA presented moderate quality (n = 32; 51.6%). The adherence to PRISMA-NMA also varied. Only 36 studies (58.1%) prospectively registered the protocol. Other issues lacking of reporting were data related were data related to the NMA geometry and the assessment of results consistency, and the evaluation of risk of bias across the studies. ROBIS assessment showed a high risk of bias mainly for domains 1 (study eligibility criteria) and 2 (identification and selection of studies). Correlation coefficients between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results showed moderate correlation (rho < 0.6). Overall, NMA studies in dentistry were of moderate quality and at high risk of bias in several domains, especially study selection. Future reviews should be better planned and conducted and have higher compliance with reporting and quality assessment tools.

Associated factors and treatment options for sleep bruxism in children: an umbrella review

Abstract Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options.

Retención del conocimiento de estudiantes después de una capacitación teórico-laboratorial para detección de caries / Retenção de conhecimento de graduandos após 1. 5 ano de treinamento teórico-laboratorial para detecção de cárie / Students' knowledge retention after theoretical-laboratory training for caries detection in pediatric dentistry. 1. 5 Year-assessment

Este estudio evaluó la retención de conocimientos, de estudiantes de pregrado expuestos a una actividad educativa de detección de lesiones de caries. Estudiantes de Odontología de los últimos años fueron invitados a participar del estudio. Ellos recibieron la capacitación 1 año y medio antes. Para evaluar su retención de conocimientos se realizaron evaluaciones teóricas y prácticas para dimensionar los conocimientos, habilidades y actitudes de los estudiantes. Cada prueba se valoró entre 0 a 10. Análisis de regresión multinivel se usaron para ver la asociación entre el desempeño de los estudiantes y su percepción sobre la importancia de la actividad. Otras peculiaridades relacionadas al desempeño en temas específicos y diferentes tipos de evaluación también fueron estudiadas. 302 estudiantes fueron evaluados. En promedio, los estudiantes tuvieron una nota 6.68 para la teórica y 5.5 para la práctica, con desviación estándar de 1.88 y de 2.27, respectivamente. La percepción de los estudiantes sobre la actividad didáctica fue asociada a su desempeño. En la evaluación teórica, los estudiantes fueron peores al relacionar la condición clínica con la histológica (21% de aciertos) y al justificar su conducta frente a lesiones inactivas (36% de aciertos). En la evaluación práctica, el 70-90% de los estudiantes demostraron tener capacidad para detectar, valorar la actividad y tomar decisiones clínicas sobre lesiones iniciales y severas. Solo 50% detectó correctamente lesiones moderadas y 32% sabe su manejo. Concluimos que la retención de conocimientos de los alumnos en mediano plazo es moderada está dentro de lo esperado.

Este estudo avaliou a retenção de conhecimento, em médio prazo, de graduandos expostos a uma atividade educativa de detecção de cárie. Esta é uma parte do estudo multicêntrico IuSTC. Alunos dos últimos anos foram convidados a participar e passaram pela atividade. Foram avaliados quanto à retenção do conhecimento após 1,5 ano. Avaliações teóricas e práticas (pontuadas de 0 a 10) foram preparadas para avaliar conhecimento, habilidades e atitudes. Os escores foram definidos como desfechos. Análises de regressão multinível testaram a associação entre a performance dos alunos e sua percepção sobre a importância da atividade dentro do seu currículo. Particularidades relacionadas à performance em tópicos específicos e diferentes tipos de avaliação também foram explorados. 302 alunos participaram das avaliações. Em média, os alunos tiveram medias (desvio-padrão (DP), de 6,68 (1,88) teórica e 5,5 (2,27) prática. A percepção dos alunos esteve associada com sua performance. Na avaliação teórica, os alunos tiveram pior performance ao relacionar a condição clínica com a histológica (21% de acertos) ou em justificar a conduta frente a lesões inativas (36% de acertos). Na avaliação prática, 70-90% dos alunos demonstraram habilidade de detectar, avaliar atividade e tomar decisões clínicas frente a lesões iniciais e severas, enquanto 50% avaliaram adequadamente as lesões moderadas e apenas 32% demonstrou atitude correta do manejo. Em conclusão, a retenção do conhecimento dos alunos está dentro do esperado em uma análise de médio prazo. Para alguns tópicos (por exemplo, relacionados a prática e justificativa de atitudes), a performance dos alunos tende a ser pior.

This study aimed to evaluate undergraduate students' medium-term knowledge retention after a learning activity related to caries lesions detection. This study is part of the IuSTC multicenter study. Last-years dental students were invited to participate and were exposed to the teaching activity. Their knowledge retention after 1.5 year was assessed. Theoretical and practical tests (scored 0 to 10) were prepared to evaluate knowledge, abilities and attitudes The scores were set as outcomes. Multilevel regression analyses were used to assess the association between students' performance and his/her perception about the importance of such learning activity in curriculum. Particularities related to students' performance in specific topics and types of evaluations were also explored. 302 students participated. On average, students achieved 6.68 (SD=1.88) in theoretical and 5.5 (SD=2.27) in practical assessment. Student's perception was associated with their performance. In theoretical test, students performed worse (21% of correct answers) in linking clinical and histological condition or justifying clinical decision-making for inactive lesions (36% of correct answers). In the practical test, 70-90% demonstrated ability to detect, assess activity and make the decision about management of initial or severe lesions, while 50% of students could assess adequately moderate caries lesions and only 32% demonstrated correct attitude related to their management. Undergraduate students' knowledge retention related to the detection of caries lesions is moderate in a medium-term analysis. It is noted that for some topics (e.g. not related to practice/justification of attitudes), the students' performance tends to be worse.

A importância dos estudos clínicos randomizados e seu impacto na tomada de decisão clínica / The importance of randomized clinical trials and their impact on clinical decision making

Os ensaios clínicos randomizados (ECRs) são considerados o padrão ouro e o mais alto nível de evidência científica para estudos de intervenção, precedidos apenas pela síntese dos mesmos (revisões sistemáticas). Tanto os responsáveis pela tomada de decisões, quanto os desenvolvedores de diretrizes precisam usar tais estudos, bem como suas sínteses, para desenvolver diretrizes clínicas de alta qualidade para auxiliar os profissionais na tomada de decisões. Portanto, os ECRs precisam ser bem delineados para minimizar o risco de viés, a fim de construir evidências científicas confiáveis em relação aos benefícios e efeitos colaterais das intervenções clínicas, bem como para garantir a transparência na concepção da metodologia de estudo e na comunicação dos resultados. Ensaios clínicos mal delineados representam um risco para a prática clínica, assim como desperdício de tempo, esforço e recursos financeiros na ciência. Este comentário visa destacar e discutir questões relacionadas à qualidade dos ECRs e seu efeito na tomada de decisões clínicas, bem como enfatizar a conscientização sobre a necessidade de avaliar criteriosamente os ensaios clínicos que serão utilizados para embasar a prática clínica.

Randomized clinical trials (RCTs) are considered the gold standard and the highest level of scientific evidence, preceded only by systematic reviews with or without meta-analysis. Both policy makers and guideline developers need to use such studies, as well as systematic reviews of RCTs, to develop high-quality clinical guidelines to assist dentists in making clinical decisions. Therefore, randomized controlled trials need to be well designed and have a reduced number of systematic errors to build reliable scientific evidence regarding the benefits and side effects of clinical interventions, as well as to ensure transparency in the design of study methodology and reporting of results, all of which will reduce potential biases. Poorly designed clinical trials pose a risk to clinical practice, as well as a waste of time and effort for dentists and even a waste of resources in science. This commentary aims to highlight and discuss problems related to the quality of randomized controlled clinical trials and their effect on dental surgeons' clinical decision making, as well as emphasizing the importance of choosing high quality clinical trials as a basis for their clinical practice.

Reparar ou substituir? quando e como intervir em restaurações defeituosas / Repair or replace? when and how to intervene in defective restorations

A alta prevalência de cárie ao redor do mundo faz com que os tratamentos restauradores figurem entre os procedimentos mais executados pelos cirurgiõesdentistas. Também é bastante comum os profissionais relatarem novas lesões de cárie ao redor das restaurações ou até mesmo fraturas parciais ou totais das mesmas, fatores que podem ser considerados como "falhas" do procedimento restaurador. Diante dessas situações, a maioria dos profissionais entende que é necessário realizar a substituição completa da restauração. No entanto, existem outras técnicas mais conservadoras e que podem ser tão efetivas quanto a substituição/troca, como por exemplo a realização de reparo das restaurações apresentando defeitos. O objetivo deste artigo é apresentar de forma clara e objetiva aos clínicos que se deparam diariamente com este cenário, qual seria o melhor momento para intervir, e quais as alternativas de tratamento, baseadas na melhor evidência científica disponível, a se realizar frente às falhas dos procedimentos restauradores, sempre alinhadas com a filosofia de Mínima Intervenção.

The high prevalence of caries worldwide makes restorative treatments some of the most commonly performed dental treatments. It is pretty common to find new caries lesions around the restorations or even partial or total fractures, factors that can be considered a "failure" for the restorative procedure. In these situations, most professionals understand that it is necessary to replace the restoration, but other more conservative techniques are as effective as a replacement, such as repairing the restorations. This article aims to present a clear and evidence-based when is the best time to intervene and what is the best treatment to be carried out in case of failure of the restorative procedures, in line with Minimal Intervention principles.

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

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.

Does the school environment exert influence on quality of life related to traumatic dental injury in children?

Abstract The aim of this cross-sectional study was to assess whether favorable factors related to school characteristics have a positive effect on the impact of traumatic dental injury (TDI) on oral health-related quality of life (OHRQoL). An epidemiological survey of oral health was conducted with 12-year-old schoolchildren from Quito, Ecuador. Children were examined for TDI, dental caries, and malocclusion. Individual socioeconomic data were also collected. Information on the physical environment, health practices, and occurrence of negative episodes at school was collected from the school coordinators. The Child Perceptions Questionnaire 11-14 (CPQ11-14) was used to evaluate the OHRQoL (outcome variable). Multilevel Poisson regression analysis was conducted. Severe TDI was associated with higher CPQ11-14 scores, even in the multiple model adjusted for oral health conditions, sex, individual socioeconomic variables, and school-related variables. Children from schools that had an appropriate tooth-brushing environment for their students exhibited a lower impact on OHRQoL, even after adjustment for the occurrence of TDI and other variables. A favorable school environment may exert a positive effect on OHRQoL, independent of the occurrence of TDI.

Management of deep caries lesions with or without pulp involvement in primary teeth: a systematic review and network meta-analysis

Abstract: There is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21-2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insufficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.

Is it necessary to pre-treat Dentine before GIC Restorations? Evidence from an in Vitro Study / É necessário pré tratar a dentina antes das restaurações de CIV? Evidência de um estudo in vitro

ABSTRACT The aim of this study was to assess the influence of differentpretreatmentapproaches on glass ionomer cement (GIC)bond strength (BS) to dentine. Sixty bovine incisors wereallocated into six groups according to substrate - sound orcariesaffecteddentine; and substrate pretreatmentapproach -no conditioning (control), polyacrylic acid for 10 s andphosphoric acid for 7 s. Teeth in the cariesaffecteddentinegroup were previously submitted to cariogenic pHcyclingchallenge. After dentine pretreatment,according to experi mentalgroups, polyethylene tubes were placed on flat dentinesurfaces and filled with GIC. Teeth were stored in distilledwater for 24 h at 37 °C and then submitted to microshear test(0.5 mm/min). Failure pattern analysis was performed understereomicroscope (400x). Data were analysed using twowayANOVA and Tukey's test (α=5%). Statistically significantdifferences were found for the pretreatmentapproach,regardless of substrate (p<0.001). The polyacrylic acid groupand control group had similar BS values, and were both betterthan the phosphoric acid group. In general, GIC had betterbonding performance in sound dentine than in cariesaffecteddentine. In conclusion, dentine pretreatmentwith polyacrylicacid did not improve the performance of GIC restoration onclinically relevant substrates.

RESUMO O objetivo deste estudo foi avaliar a influência de diferentesprétratamentosna resistência de união (RU) de cimentos deionômero de vidro (CIV) a dentina. Sessenta incisivos bovinosforam alocados em 6 grupos de acordo com o substrato -hígido ou cariado; e com a abordagem de prétratamento-sem condicionamento (controle), ácido poliacrílico por 10 s, eácido fosfórico por 7 s. Os dentes pertencentes aos grupos dedentina cariada foram previamente submetidos ao desafiocariogênico por meio da ciclagem de pH. Após o prétratamentoda dentina, de acordo com os grupos experimentais,tubos de polietileno foram colocados sobre superfícies planas dedentina e preenchidos com CIV. Os dentes foram armazenadosem água destilada por 24 h a 37°C e então submetidos ao testede microcisalhamento (0,5 mm/min). A análise do padrão defratura foi realizada em estereomicroscópio (400x). Os dadosobtidos foram analisados usando ANOVA de dois fatores e testede Tukey (α=5%). Diferença estatisticamente significante foiencontrada para as diferentes abordagens de prétratamento,independente do substrato (pp<0,001). Aplicação de ácidopoliacrílico resultou em valores de RU similares aos do grupocontrole. Entretanto, ambos os grupos mostraram um melhordesempenho quando comparado a aplicação de ácidofosfórico. De forma geral, CIV apresentou melho5 desempenhoadesivo em dentina sadia quando comparada a dentinacariada. Em conclusão, o prétratamentoem dentina comácido poliacrílico não melhora o desempenho das restauraçõesde CIV em substratos clinicamente relevantes.

Shortening of etching time of the dentin in primary teeth restorations: a randomized clinical trial

Abstract The aim of this study was to investigate the influence of shortening of etching time for dentin on the restoration survival after selective carious tissue removal in primary molars. This two-arm randomized clinical trial included sixty-two subjects (5-8 year-old) and 100 primary molars presenting moderate dentin carious lesions on occlusal surface. The sample was randomly assigned into groups previously to adhesive application (Adper Single Bond 2; 3M ESPE): etching time recommended by manufacturer (15 s) or reduced (7 s). Resin composite (Filtek Bulk Fill Posterior Restorative; 3M ESPE) was inserted in a single increment for all restorations. Restorations were evaluated at 1, 6, 12, and 18 months using FDI criteria. Survival estimates for restorations' longevity were evaluated with Kaplan-Meier method. Multivariate Cox regression analysis with shared frailty was used to assess the factors associated with failures (p < 0.05). The etching time did not influence the restorations' survival (HR 0.35 95%CI 0.11-1.12; p = 0.06). Mean estimated time of survival was 17.6 months (95%CI, 17.2-17.9). The survival rates at the 18-month follow-up were 75.7% and 91.4% (AFR: 16.9% and 5.7%) when primary dentin was acid etched for 15 and 7 s, respectively (log-rank p = 0.06). In conclusion, the etching time for dentin did not influence the clinical behavior of adhesives restorations. However, there was a tendency for better clinical outcome when using etching time of 7 s.

How can we associate an economic evaluation with a clinical trial?

Abstract Economic evaluations in Dentistry have been increasing in recent years. They are a relevant contribution if an economic issue exists. Knowing if a new intervention is an efficient way of allocating available (and scarce) resources (the concept of opportunity costs), a well-designed economic evaluation may be helpful. One option is to conduct a trial-based economic analysis, which extracts a considerable board of information from a trial. This approach produces a more controlled result since many sources of variations might be reduced. On the other hand, some aspects could not be predicted directly from the trial or even extrapolated. Thus, combining model-based analysis may be an idea. In this paper, we intended to discuss important aspects to be considered by researchers in further economic evaluations. This paper will be systematically divided into sessions related to the study design as time horizon and perspective, health effects, costs, and data analysis. In the end, we expect the reader could be able to plan a trial-based economic evaluation, which should be a careful, meticulous, quite laborious and especially transparent process.

Choosing the Criteria for Clinical Evaluation of Composite Restorations: An Analysis of Impact on Reliabilty and Treatment Decision

Abstract Objective: To assess the reproducibility of two clinical criteria for the evaluation of restorations in primary teeth and the impact on treatment decision. Material and Methods: A cross-sectional study was performed selecting 71 resin-based composite restorations placed in primary molars of children who had sought dental treatment at a dental school. Two trained examiners evaluated independently the restorations using modified FDI and USPHS criteria. All restorations were assessed separately with each system in random order to avoid memory bias. Kappa statistics were used to determine inter-examiner reliability considering each parameter of both criteria and score final about treatment decision. McNemar test was used to compare the treatment decision with two criteria. The significance level was set at 5%. Results: Kappa values ranged from 0.28 to 0.93 with USPHS and 0.28 to 0.88 with FDI, considering each parameter separately. Inter-examiner agreement for treatment decision was excellent for both criteria (Kappa: 0.85-0.90). For clinical decision-making, no difference between criteria was found, irrespective of examiner. Conclusion: Low inter-examiner agreement for evaluation of each parameter of USPHS and FDI criteria does not reflect on reproducibility for treatment decision. Both criteria may be suitable for evaluation of composite restorations in primary teeth.

Sobrevida de resina compuesta y cemento de ionómero de vidrio de bajo costo para TRA: 1 año de seguimiento de un ensayo clínico aleatorizado / Sobrevivência da resina composta e do cimento do ionômero de vidro de baixo custo para ART: 1 ano de acompanhamento de um ensaio clínico randomizado / Survival of composite resin and low cost glass ionomer cement for ART: 1 year fo-llow-up of a randomized clinical trial

Objetivo: Evaluar la longevidad de restauraciones de Tratamiento Restaurador Atraumático (TRA), utilizando dos mate-riales diferentes: un Cemento de Ionómero de Vidrio (CIV) de bajo costo y una Resina Compuesta de nanopartículas (RC), en cavidades ocluso-proximales de molares temporales. Materiales y métodos: Un total de 83 dientes fueron selecciona-dos en 43 niños de siete a diez años de edad, que presentaron al menos una lesión de caries ocluso proximal, en la ciudad de Cosmópolis / SP, Brasil. Los pacientes fueron asignados en dos grupos: CIV de bajo costo (Vitromolar - Nova DFL) y resina compuesta de nanopartículas (RC) (Filtek Z350 XT - 3M ESPE). Todos los procedimientos se realizaron de acuerdo con los principios del TRA. Las restauraciones fueron evaluadas después de 3, 6, 9 y 12 meses por un examinador entrena-do. Para verificar la tasa de sobrevida de las restauraciones utilizamos el análisis de sobrevida de Kaplan-Meier y la prueba de Log-Rank; y, para evaluar la asociación entre el resultado y las variables del paciente se aplicó la prueba de regresión de Cox. El nivel de significancia para todas las pruebas fue del 5%. Resultados: Después de 12 meses de seguimiento, la sobrevida global de las restauraciones fue de 75,3%. Las tasas de sobrevida del CIV y de la RC fueron 62.2% y 93.7%, respectivamente. El análisis estadístico mostró diferencias significativas entre los materiales, donde la RC tuvo un mejor desempeño (HR = 0.15, IC 0.03 a 0.68, p = 0.014) que el CIV de bajo costo. No se encontraron diferencias estadísticas para otras variables (p >0.05). Conclusión: La utilización de resina compuesta de nanopartículas en las restauraciones de TRA tuvo un mejor rendimiento en comparación con el cemento de ionómero de vidrio de bajo costo, después de una evaluación de 12 meses. Registro de prueba: REBEC (Registro Brasileño de Ensayos Clínicos) # RBR-8sw24r.

Objective: To evaluate the longevity of ART restorations using two different materials: a low-cost Glass Ionomer Cement (GIC) and nanoparticle Composite Resin (CR) in occlusal-proximal cavities of primary molars. Material and methods: A total of 83 teeth were selected among 43 children, aged seven to ten years old, which presented at least one multi-sur-face caries lesion, in the city of Cosmópolis/SP, Brazil. Patients were allocated into two groups: low cost GIC (Vitromo-lar ­ Nova DFL) and nanoparticle composite resin (CR) (Filtek Z350 XT ­ 3M ESPE). All procedures were performed according to ART guidelines. The restorations were evaluated after 3, 6, 9 and 12 months by a trained examiner. To verify the survival rate of the restorations we used Kaplan-Meier survival analysis and log-rank test. To evaluate the association between the outcome and patient variables was applied Cox regression test. The significance level for all tests was 5%. Results: After 12 months of follow-up, overall survival of the restorations was 75.3%. The GIC and CR survival rates were 62.2%, 93.7%, respectively. Statistical analysis showed significant differences between materials, where the CR performed better (HR = 0.15, CI 0.03 to 0.68; p = 0.014) than low cost GIC. No statistical differences were found for other variables (p >0.05). Conclusion: The use of nanoparticle composite resin in ART restorations performed better when compared to low cost glass ionomer cement after 12 months evaluation. Trial registration: REBEC (Registro Brasileiro de Ensaios Clínicos) # RBR-8sw24r.

Avaliar a longevidade das restaurações Tratamento Restaurador Atraumático (ART) utilizando dois materiais diferentes: Cimento de Ionómero de vidro (CIV) de baixo custo e de uma Resina Composta de nanopartículas (RC), em cavidades ocluso proximais de molares decíduos. Materiais e métodos: Um total de 83 dentes foram selecionados em 43 crianças de sete a dez anos de idade que tiveram pelo menos uma lesão de cárie oclusal proximal, na cidade de Cosmópolis / SP, Brasil. Os pacientes foram distribuídos em dois grupos: CIV de baixo custo (Vitromolar - Nova DFL) e resina composta de nanopartículas (RC) (Filtek Z350 XT - 3M ESPE). Todos os procedimentos foram realizados em conformidade com os princípios do ART. As restaurações foram avaliadas após 3, 6, 9 e 12 meses, por um examinador treinado. Para verificar a taxa de sobrevivência das restaurações, usamos análise de sobrevivência de Kaplan-Meier e teste log-rank; e para avaliar a associação entre o desfecho e as variáveis do paciente testou-se pela regressão de Cox. O nível de significância para todos os testes foi de 5%. Resultados: Após 12 meses de acompanhamento, a sobrevida global das restaurações foi de 75,3%. As taxas de sobrevida de CIV e RC foram 62,2% e 93,7% respectivamente. A análise estatística mostrou diferenças significativas entre os materiais onde a RC mostrou melhores resultados (HR = 0,15, IC 0,03-0,68, p = 0,014) do que o CIV de baixo custo. Não há diferenças estatísticas para as outras variáveis (p> 0,05). Conclusão: A utilização de restaurações de resina composta de nanopartículas teve um melhor desempenho em comparação com o cimento de ionómero de vidro de baixo custo, depois de uma avaliação de 12 meses. Registro de ensaio: REBEC (Registro Brasileiro de Ensaios Clínicos) # RBR-8sw24r.

Custo benefício do ionômero de vidro encapsulado usado como material restaurador para Tratamento Restaurador Atraumático (ART): relato de caso / Cost-effective of the glass ionomer cement encapsulated used as filling material for Atraumatic Restorative Treatment (ART): case report

Objetivo ­ Relatar o caso clínico de uma criança submetido ao Tratamento Restaurador Atraumático (ART) utilizando como material restaurador o CIV nas duas versões (pó-líquido e encapsulado). Além disso, promover uma discussão a respeito das vantagens e desvantagens relacionadas a manipulação manual e mecânica do material restaurador. Paciente de 7 anos de idade portador de cárie dentária foi tratado de acordo com ART e recebeu uma restauração com CIV de alta viscosidade do tipo pó-líquido e um selante com CIV encapsulado. O material encapsulado apresenta custo inicial mais elevado entretanto, as propriedades físicas e mecânicas ficam asseguradas e esperase um reflexo positivo na longevidade clínica das restaurações. Desta maneira, os reparos podem ser menos frequentes diminuindo o custo a longo prazo. O Cimento de Ionômero de Vidro encapsulado facilita o processo restaurador e minimiza os erros de dosagem e manipulação. Entretanto, o custo é elevado quando comparado ao mesmo material do tipo pó-líquido. Estudos clínicos randomizados longitudinais são necessários para esclarecer se a diferença inicial de custo da versão encapsulada é compensada a longo prazo.

Objective ­ Report a case of a child submitted to ART using GIC as restorative material in both versions (powder-liquid and encapsulated). Moreover, promote a discussion of the advantages and disadvantages related to manual and mechanical manipulation of the restorative treatment. Patient 7-year-old with dental caries was treated according to ART and received a restoration with CIV high viscosity powderliquid type and a sealant with encapsulated CIV. The encapsulated material has higher initial cost however, the physical and mechanical properties are guaranteed and a positive reflection on the clinical performance of restorations is expected. Thus, repairs can be less frequent reducing the long term cost. The glass ionomer cement encapsulated facilitates the restorative process and minimizes the dosage and manipulation mistakes. However, the cost is high when compared to the same material as the powder-liquid type. Longitudinal randomized clinical studies are expected to clarify whether the initial cost difference of the encapsulated version is compensated over time.

Assessment of Glass Ionomer Cements (GIC) Restorations after Acidic Erosive Challenges: An in vitro Study

Objective: To analyze the marginal adaptation of two different Glass Ionomer Cements (GIC) after erosive challenges. Material and Methods: Sixty sound extracted primary canines were selected and class V cavities were made. Teeth were allocated into 6 groups according to restorative material: 1) high-viscosity GIC (Ketac™Molar Easymix) and 2) resin-modified GIC with nanoparticles (Ketac™N100), low pH beverage erosive challenge (Orange juice and Coca-Cola) or distilled water as control. Thereafter the sample was restored and subjecting to thermocycling. The sample was immersed for a 10-days period for the erosive simulation and then embedded in methylene blue solution during 4 hours. Finally teeth were sectioned for further analysis. Marginal adaptation test was performed by two trained examiners using the Salama et al. criteria. Descriptive and Kruskal-Wallis test (α=5%) were used to analyze the data. Results: The groups treated with Ketac™Molar EasyMix were similar in terms of marginal sealing ability when submitted to Orange juice and Coca-Cola but significantly worse than water. For samples restored with the Ketac™N100 the worst results were found in the Coca-Cola group. Conclusion: Erosive challenges with acidic drinks affected the marginal adaptation of the tested GIC.

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.

Conservative treatment of deep dentin lesions in primary molars: case-series

To carry out a descriptive analysis of a case-series in which the indirect pulp capping (IPC) has been performed for treating primary molars with extensive caries lesions in dentin, in the Private of Specialization in Pediatric Dentistry. Material and Methods:Asingle calibrated examiner evaluated the medical records of 155 patients aged 2 to 13 years attended at the Foundation for Scientific and Technological Development of Dentistry (FUNDECTO) partnership the University of São Paulo (USP) in 2011-2013 in search of extensive caries lesions treated during this period. Were found only 20 deep caries lesions and with satisfactory clinical and radiographic documentation. Then, the materials and techniquesused were collected, as well as instant success described after treatment and observation for no progression of the disease (pain, abscess or fistula). Results:The 20 lesions evaluated reached at least 2/3 of the dentin thickness and were active. In 70% of cases, the restorations were carried out with high viscosity or encapsulated glass ionomer cement, and in 30% of case with light-cured resin. In only one case was used calcium hydroxide cement as liner material before inserting resin. In the teeth treated, only three cases were considered failures. Conclusion:Regardless of the restorative material used and the technique employed, good immediate success rates of the conservative treatment in deep dentin lesions were found, which consequently reduces the risk of exposure and pulp intervention...

Prevalence of dental caries in preschool children by icdas diagnostic methodology

To evaluate the prevalence of caries with the ICDAS index (International Caries Detection and Assessment System) using different cut-off points in children from public and private institutions as well as to associate the presence of caries with socioeconomic indicators, sex, age, type of school (urban or rural) and also family health program with dentist's presence at the school. Material and Methods:An analytical cross-sectional study with a stratified sample (n = 612) in children ranging from three to six years old, in public and private institutions of the city of Barras, State of Piaui, Brazil. The clinical examination was based on ICDAS criteria, and a questionnaire for socioeconomic and educational level data was also applied. Different cut-offpoints were used, as follows: cut-off point 1 (scores 0 and 1 considered as healthy and scores 2-6 classified as decayed); cut-off point 2 (scores from 0 to 2 classified as healthy, scores 3 to 6 as decayed) and cut-off point 3 (0 to 3 healthy, 4 to 6 decayed). Univariate and Multiple Poisson regression analysis were performed, with 5% significance level.Results:For cut-off point 1, the prevalence was 68.8%; Cut-off point 2, 67.9% and at the cut-off point 3, 60.6%. An association was found in the prevalence of caries with the child's age (p = 0.004), school zone (urban or rural) (p = 0.004) and the presence of the dentist at school (p = 0.001).Conclusion:Taking into account the various cut-off points, the prevalence of caries in preschool children was considered high. The presence of caries lesions is more likely to occur in five year-old boys living in the countryside...