ABSTRACT
Abstract A multicenter, randomized controlled clinical trial evaluated the effectiveness of two treatments for deep caries lesions in permanent molars - selective caries removal (SCR) to soft dentin with restoration in a single visit, and stepwise excavation (SW) - regarding pulp vitality for a 5-year follow-up period. The present study aimed to determine the cost-effectiveness of these treatments. Treatments were conducted in two Brazilian cities (Brasília and Porto Alegre). At baseline, 299 permanent molars (233 patients) were treated and 229 teeth (174 patients) were evaluated after 5 years. The discounted cash flow method was adopted. The total cost of each treatment was calculated, and the failure cost (endodontic treatment + restoration) was added to the final cost, according to the 5-year failure rates of each therapy (20% for SCR and 44% for SW). A public health service unit composed of three dentists in 4-hour work shifts was used to calculate the monetary value of the treatments, assuming a total of 528 treatments/month. Considering the 229 teeth evaluated after 5 years (115 SCR and 114 SW), SCR provided savings of 43% (amalgam) and 41% (resin composite) per treatment, compared to SW. The SCR technique provides benefits for public finances (direct economy) and for public health services (increase in the number of treatments performed). Considering that maximizing profit and reducing costs are powerful motivating factors for adopting a certain treatment, this study provides data to better support the decision-making process, regarding the management of deep caries lesions in permanent molars.
Subject(s)
Humans , Health Promotion , Oral Health , Brazil , Dental Caries , Health Status DisparitiesABSTRACT
O objetivo deste ensaio clínico controlado randomizado multicêntrico foi avaliar a efetividade da remoção parcial de dentina cariada seguida de restauração em única sessão (RPDC) em lesões de cárie profundas no Brasil (Porto Alegre e Brasília) após dois anos de acompanhamento. Critérios de inclusão: pacientes com ≥ seis anos de idade apresentando molares permanentes com lesões profundas primárias, ausência de alteração periapical, sensibilidade pulpar, ausência de dor espontânea e sensibilidade à percussão negativa. Os indivíduos foram randomicamente atribuídos ao grupo teste - RPDC, ou grupo controle - tratamento expectante (TE). O TE consistiu na remoção parcial de dentina cariada, capeamento pulpar indireto com cimento de hidróxido de cálcio, restauração provisória com cimento de óxido de zinco e eugenol, reabertura da cavidade após 60 dias, remoção da dentina cariada remanescente amolecida e restauração. Cada grupo foi dividido de acordo com o material restaurador: amálgama ou resina. Avaliações clínicas e radiográficas foram realizadas anualmente. Os desfechos considerados foram sensibilidade pulpar ao teste frio e ausência de alteração periapical. Foram executados 299 tratamentos, 153 RPDC e 146 TE. Não houve diferença entre os grupos em relação às características basais. Após dois anos de acompanhamento, foram avaliadas 181 restaurações e a taxa de sobrevivência dos tratamentos RPDC e TE foram 95,45% e 80,85%, respectivamente (p=0,001). Razões dos insucessos: pulpites, osteíte, hiperemia, necroses, extração e fratura da restauração. Nenhuma variável foi significativamente associada ao desfecho. A partir destes resultados, é possível concluir que a RPDC é um tratamento mais efetivo que o TE.
The aim of this multicenter randomized controlled clinical trial was to evaluate the effectiveness of partial caries removal followed by restoration in a single session (PDR) for deep caries lesions in Brazil (Porto Alegre and Brasilia) after 2-year follow-up. Inclusion criteria: patients with ≥ six years old presenting permanent molars with primary deep lesion, absence of periapical alterations, pulp sensitivity, absence of spontaneous pain and negative percussion test. The subjects were randomly assigned to test group - PDR, or control group - stepwise excavation (SW). SW consisted of partial removal of carious dentine, indirect pulp capping with calcium hydroxide cement, temporary filling, cavity re-opening after 60 days, removal of the remaining soft carious dentine and filling. Each group was divided according to the filling material: amalgam or resin. Clinical and radiographic evaluations were performed in annual basis. The outcomes were considered as pulp sensibility to cold test and absence of periapical alterations. There were performed 299 treatments, 153 PDR and 146 SW. There were no differences between the groups regarding baseline characteristics. After 2 years of follow-up, 204 restorations were evaluated and the therapy survival rates of PDR and SW were 95.45% and 80.85%, respectively (p=0.001). Reasons for failure: pulpitis, osteitis, hyperemia, necrosis, extraction and restoration fracture.. None variable was significantly associated with the outcome. From these results, it is possible to conclude that the PDR is a more successful treatment than SW.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Composite Resins , Dental Amalgam , Dental Caries , Dental Restoration, Permanent , Dental Restoration, Temporary , DentinSubject(s)
Humans , Health Promotion , Oral Health , Public Health Dentistry , Brazil , Health PolicySubject(s)
Humans , Health Promotion , Health Facilities, Proprietary/organization & administration , Health Facility Planning/trends , Health Policy/trends , Oral Health , Public Sector/organization & administration , Brazil , Mouth Diseases/therapy , National Health Programs/organization & administration , Public HealthABSTRACT
The purpose of this study was to evaluate the use of a laser fluorescence device for detection of occlusal caries in permanent teeth. One hundred and ninety-nine non-cavitated teeth from 26 patients aged 10 to 13 years were selected. After dental prophylaxis, two previously calibrated dentists examined the teeth. Visual inspection, radiographic examination and laser measurements were performed under standardized conditions. The validation method was cavity preparation with a small cone-shaped diamond bur, when the two examiners agreed about the presence of dentin caries. It was found that the laser detection method produced high values of sensitivity (0.93) and specificity (0.75) and a moderate positive predictive value (0.63). The laser device showed the lowest value of likelihood ratio (3.68). Kappa coefficient showed good repeatability for all methods. Although the laser device had an acceptable performance, this equipment should be used as an adjunct method to visual inspection to avoid false positive results.
Subject(s)
Adolescent , Child , Humans , Dental Caries/diagnosis , Dentin/pathology , Lasers , Dental Caries/pathology , Dental Caries , Dental Cavity Preparation/instrumentation , Dental Cavity Preparation/methods , Dental Enamel/pathology , Dental Fissures/diagnosis , Dental Fissures/pathology , Dental Fissures , Dentin , Fluorescence , Predictive Value of Tests , Radiography, Bitewing , Sensitivity and Specificity , Tooth Discoloration/diagnosis , Tooth Discoloration/pathology , Tooth DiscolorationABSTRACT
O objetivo deste estudo foi avaliar a microinfiltraçäo marginal em preparos classe II utilizando-se 3 novas marcas comerciais de resinas chamadas "condensáveis" - Definite (Degussa), Solitaire (Kulzer) e P60 (3M), associadas ou näo com resina de baixa viscosidade (Flow It - Jeneric/Pentron) - em 72 dentes recém-extraídos. Após os procedimentos de preparo, restauraçäo, acabamento, ciclagem térmica e imersäo em nitrato de prata a 50 por cento, os dentes foram seccionados longitudinalmente e avaliados através de lupa estereocópica, seguindo-se a análise estatística dos dados. Os seguintes resultados foram obtidos na superfície de esmalte: o grupo P60 + Flow It foi superior aos grupos Definite, Solitaire e Solitaire + Flow It. O grupo P60 foi melhor que o grupo Solitaire + Flow It. Em cemento, os grupos Definite + Flow It e P60 + Flow It foram superiores aos grupos Solitaire e Solitaire + Flow It
Subject(s)
Composite Resins , Dental LeakageABSTRACT
O propósito deste estudo foi avaliar histologicamente a resposta pulpar de dentes anteriores permanentes, em primatas (Cebus appela), após aplicação de dois diferentes sistemas adesivos (Single Bond-3M Dental Co. e Etch & Prime 3.0 Degussa Hüls) em relação ao controle (cimento de hidróxido de cálcio, Dycal-Kerr associado a cimento de ionômero de vidro, Vitremer-3M Dental Co.). Foram preparadas cavidades de classe V vestibulares, profundas, sem exposição pulpar clinicamente visível. A análise foi efetuada decorrido o tempo experimental de 60 dias utilizando microscopia óptica e coloração de hematoxilina e eosina. O exame histopatológico não demonstrou diferenças entre os sistemas Single Bond (3M dental Co.) e Etch & Prime 3.0 (Degussa Hüls). Não foi observada resposta inflamatória, resultado semelhante ao encontrado no grupo controle