Pasado, presente y futuro de la cariología

Presentamos una breve revisión de la evolución de los conceptos asociados a la epidemiología, diagnóstico, etiología y tratamiento de la caries para proveer una actualización y orientación a los profesionales odontológicos. El término caries incluye la patología y su signo clínico. La patología involucra una disbiosis del biofilm normal bucal que responde de manera dinámica a la dieta rica en azúcares, metabolizando ácidos que generan la lesión de caries. Actualmente el diagnóstico comienza con la evaluación del riesgo cariogénico seguido de la detección de lesiones y la evaluación de su actividad. Para el tratamiento se indican aquellas intervenciones que permiten el control de la actividad del biofilm y recuperar los tejidos dentarios dañados mediante intervención mínima. En el futuro, intervenciones que reduzcan el consumo de azúcar, unido al conocimiento del microbioma, al uso de inteligencia artificial y uso de materiales biomiméticos permitirán un manejo personalizado para mantener y recuperar la salud oral individual. Finalmente, para trasladar los avances científicos de la cariología a la práctica clínica se requieren urgentes cambios en la educación y el contexto en que luego trabaja un profesional odontológico.

We present a brief review of the evolution of the concepts associated with the epidemiology, diagnosis, etiology and treatment of caries, to provide an update and orientation for dental professionals. The term "caries" includes the disease and its clinical sign. The disease involves a dysbiosis of the normal oral biofilm that responds dynamically to a sugar-rich diet, metabolizing acids that result in caries lesions. Currently, the diagnosis begins with the evaluation of cariogenic risk, followed by the detection of lesions and the evaluation of their activity. For the treatment, interventions allowing the control of biofilm activity and the recovery of damaged dental tissues through minimal intervention are indicated. In the future, interventions reducing sugar consumption, together with the knowledge of the microbiome, the use of artificial intelligence and the use of biomimetic materials will allow for a personalized management to maintain and recover individual oral health. Finally, to transfer the scientific advances made in cariology to the clinical practice, urgent changes are required in education and in the context in which the dental professional works.

Ultrasound device as a minimally invasive approach for caries dentin removal

Abstract The aim of this study was to evaluate the efficacy of an ultrasound device and the dentin surface morphology after removal of the caries dentin lesions by removal rate and scanning electron microscopy (SEM). The Knoop hardness test on the bovine dentin blocks (n = 20, 4x4x2mm) was performed to standardize the samples and only those with 38 ± 2 KHN were included. The dentin blocks were submitted to induction of artificial caries lesions, using the bacterial model. Strains of Streptococcus mutans and Lactobacillus acidophilus were used for 7 days. The caries dentin lesion was removed for 1 min, according to two methods: G1 - carbide bur under low-speed rotation (control group) and G2 - ultrasound device under refrigeration. For the removal rate, the samples were weighed 3 times: T0 (before induction), T1 (after induction) and T2 (after removal). Morphology evaluation of the residual dentin surface was performed by SEM. Data normality was verified by Shapiro-Wilk test (p ≥ 0.240). T-test for independent samples was applied to evaluate the removal rate. A significance level of 5% was adopted. G2 provided lower removal rate than G1 (G1: 3.68 mg and G2 = 2.26 mg). SEM images showed different morphological characteristics between the groups. G2 showed absent of smear layer, while G1 showed a visible smear layer over the surface. We concluded that ultrasound device provides minimally invasive removal with residual dentin exhibiting open dentin tubules and no smear layer formation and no bacteria, which infer the removal of the infected tissue.

Resumo O objetivo deste estudo foi avaliar a eficácia de um dispositivo ultrassônico e a morfologia da superfície dentinária após a remoção da dentina cariada por meio da taxa de remoção e imagens de microscopia eletrônica de varredura (MEV). Foi realizado o teste de dureza Knoop nas amostras de dentina bovina (n = 20, 4x4x2mm) afim de padronizar as amostras e foram incluídas apenas aquelas com 38 ± 2 KHN. As amostras de dentina foram submetidas à indução de lesões artificiais de cárie, utilizando-se modelo biológico contendo cepas de Streptococcus mutans e Lactobacillus acidophilus durante por 7 dias. As lesões foram removidas por 1 min, de acordo com dois métodos: G1 - fresa esférica sob baixa rotação (grupo controle) e G2 - dispositivo ultrassônico sob refrigeração. Para a taxa de remoção, as amostras foram pesadas em três tempos: T0 (antes da indução), T1 (após a indução) e T2 (após a remoção). A avaliação morfológica da superfície residual da dentina foi realizada por MEV. A normalidade dos dados foi verificada pelo teste de Shapiro-Wilk (p ≥ 0,240). Teste T para amostras independentes foi aplicado para avaliar a taxa de remoção. Foi adotado nível de significância de 5%. G2 apresentou menor taxa de remoção que G1 (G1: 3,68 mg e G2 = 2,26 mg). As imagens de MEV mostraram características morfológicas diferentes entre os grupos. G2 mostrou ausência de smear layer, enquanto G1 mostrou grande quantidade de smear layer sobre a superfície. Com base neste estudo in vitro, o dispositivo de ultrassom promoveu remoção minimamente invasiva e dentina residual exibindo túbulos dentinários abertos e mínima formação de smear layer.

Efficacy evaluation of pepsin enzyme-based gel in chemo-mechanical caries removal on primary anterior teeth: a randomized controlled clinical study / Avaliação da eficácia do gel à base de enzima pepsina na remoção químico-mecânica da cárie em dentes anteriores decíduos: um estudo clínico controlado randomizado

Objective: To evaluate the efficacy of a new pepsin enzyme-based gel compared with Carisolv as a CMCR agent. Clinical and radiographical evaluations of recurrent caries were made 3 and 6 months after treatment. Material and Methods: A split-mouth designed randomized controlled clinical study was carried out on 40 primary anterior teeth of children aged between 4-7 years. Pepsin enzyme-based gel and Carisolv solution were applied to carious lesions until complete removal of caries. The efficacy of both agents was evaluated by the number of application times to remove all caries. Recurrent caries were evaluated clinically and radiographically after 3 and 6 months of treatment. Results: Results showed no statistically significant differences in the efficacy of caries removal by the number of application times (P = 0.919). Concerning recurrent caries, clinical and radiographical evaluation after three and six months showed no statistically significant differences between the two groups (P = 0.574, P = 0.547, respectively). Conclusion: Pepsin enzyme-based gel can be considered similar to Carisolv gel regarding its efficacy as a CMCR agent for small carious lesions on primary anterior teeth in children aged 4-7 years old. (AU)

Objetivo: avaliar a eficácia de um novo gel a base de enzima pepsina comparada com o Carisolv como um agente na remoção químico-mecânica da cárie. Avaliações clínicas e radiográficas de cárie recorrente foram feitas em 3 e 6 meses apos o tratamento. Material e Métodos: um estudo clínico controlado randomizado de boca-dividida foi realizado em 40 dentes deciduos anteriores de crianças com idade entre 4-7 anos. Gel à base de enzima pepsina e a soluçao de Carisolv foram aplicados sobre a lesão cariosa até a completa remoção da carie. A eficácia de ambos agentes foi avaliada pelo número de tempo de aplicações para a remoção de todo tecido cariado. Cárie recorrente foi avaliada clinicamente e radiograficamente após 3 e 6 meses de tratamento. Resultados: Não houve diferença significativa na eficácia de remoção de cárie pelo número de tempo de aplicação (P = 0.919). Em relação à cárie recorrente, avaliação clínica e radiográfica apos 3 e 6 meses mostraram que não houve diferença estatisticamente significante entre os 2 grupos (P = 0.574, P = 0.547, respectivamente). Conclusão: o gel à base de enzima pepsina pode ser considerado similar ao gel Carisolv em relação a sua eficácia como um agente químico-mecânico na remoção da cárie para lesões cariosas pequenas em dentes anteriores decíduos em crianças entre 4-7 anos de idade.(AU)

Acessos endodônticos: o que todo endodontista deve saber / Endodontic accesses: what every endodontist should know

Introdução: Os acessos endodônticos minimamente invasivos (AEMI) surgiram com o intuito de, por meio da preservação de estrutura dentária, manter a resistência à fratura de dentes tratados endodonticamente. A partir do primeiro estudo, em 2010, vários trabalhos foram desenvolvidos buscando entender qual a influência dos AEMI na resistência à fratura de dentes tratados endodonticamente. No entanto, interferências coronárias causadas pelos AEMI poderiam prejudicar a realização dos procedimentos subsequentes à cavidade de acesso, como a localização, instrumentação, limpeza, descontaminação e obturação dos canais radiculares. Objetivo: Com base nessa premissa, a presente revisão teve como objetivo responder algumas perguntas para que o clínico entenda quais são as principais modalidades de AEMI, os impactos da sua abordagem no tratamento endodôntico e o verdadeiro papel do tratamento endodôntico na perda dos elementos dentários. Resultados: Considerando os dados disponíveis até o presente momento, faltam evidências robustas para apoiar a alegação de que os AEMIs preservem a resistência à fratura dos elementos tratados endodonticamente melhor do que nos dentes acessados de maneira tradicional. Além disso, cavidades de acesso minimamente invasivas podem interferir em outras etapas do tratamento endodôntico, podendo torná-lo imprevisível. Conclusão: Dessa forma, pode-se concluir que há uma falta de evidências que apoiem a utilização de cavidades de acesso minimamente invasivas na prática clínica de rotina e/ou no processo de formação de alunos de graduação e pós-graduação (AU).

Introduction: Minimally invasive access cavities emerged aiming to maintain the fracture resistance of endodontically treated teeth through the preservation of dental structure. Starting with the first study in 2010, several others were developed to evaluate the influence of minimally invasive access cavities in the fracture resistance of endodontically treated teeth. However, the coronal interference caused by those access cavities could impair the subsequent procedures of root canal treatment, such as the location, instrumentation, cleaning, disinfection and filling of the root canals. Objective: Based on this premise, the aim of the present review was to answer some questions so that the clinician knows the main modalities of minimally invasive access cavities, the impacts of this approach and the real role of endodontic treatment in the tooth loss. Results: Considering the available data, there is a lack of robust evidence in literature to support the claim that the minimally invasive access cavities preserve the fracture resistance of endodontically treated teeth better than the traditional one. In addition, these access cavities can interfere in other stages of endodontic treatment, making it unpredictable. Conclusion: Thus, it can be concluded that there is a lack of evidence to support the use of minimally invasive access cavities in routine clinical practice and/or in the process of training undergraduate and graduate students (AU).

Remoción selectiva comparado con remoción total para caries dentinarias profundas / Selective removal compared to complete removal for deep carious lesions

INTRODUCCIÓN La caries dental ha sido convencionalmente manejada mediante la remoción no selectiva del tejido carioso (remoción total), sin embargo, los efectos adversos de este procedimiento han promovido la utilización de técnicas de remoción de caries conservadoras (remoción selectiva), pero aún existe controversia respecto a su efectividad. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metaanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos siete revisiones sistemáticas que en conjunto incluyeron siete estudios primarios, todos ellos correspondientes a ensayos aleatorizados. Concluimos que la remoción selectiva de caries podría disminuir la necesidad de tratamiento de endodoncia y el riesgo de exposición pulpar en dientes con caries profundas, pero la certeza de la evidencia es baja. No existe claridad de que la remoción selectiva de caries disminuya el riesgo de aparición de signos y síntomas de patología pulpar y el riesgo de fracaso de las restauraciones ya que la certeza de la evidencia es muy baja.

INTRODUCTION Dental caries have been conventionally managed by non-selective removal of carious tissue (total complete removal); however, the adverse effects of this procedure have promoted the use of conservative caries removal techniques (selective removal), but there is still controversy regarding its effectiveness. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including seven studies overall, of which all were randomized trials. We concluded that selective caries removal may decrease the need for root canal treatment and the risk of pulp exposure in teeth with deep caries, but the certainty of the evidence is low. It is not clear whether the selective removal of caries reduces the risk of appearance of signs and symptoms of pulp disease and the risk of restorations failure, as the certainty of the evidence is very low.

Odontología estética mínimamente invasiva / Minimally invasive esthetic dentistry

La odontología de mínima invasión se ha convertido en la filosofía de tratamiento dental más aceptada en la actualidad. La posibilidad de incorporarla se ha debido en gran medida a la aparición de nuevos materiales dentales que se adhieren a la estructura dental, a técnicas más conservadoras de estructura dental sana y sobre todo a una nueva forma de pensar tanto de clínicos como de los mismos pacientes. La odontología estética contemporánea se ha visto infl uenciada por este nuevo paradigma. El tratamiento de pigmentaciones dentales también se ha visto benefi ciado por esta nueva tendencia y nuevos materiales han aparecido recientemente que conservan la mayor cantidad de tejido dental sano sin necesidad de preparaciones no conservadoras. Lo más importante al incorporar estas nuevas tecnologías es la realización de un diagnóstico adecuado entendiendo la causa que origina esta condición y así poder implementar el mejor tratamiento posible (AU)

Minimally invasive dentistry has become the standard of care most widely accepted today. This trend has been posible in great extent to the advent of new dental materials that adhere to dental structure, more conservative techniques of healthy dental tissue but mainly from clinicians and patients with a new way of thinking. Contemporary esthetic dentistry has been influenced by this new paradigm. Treatment of dental stainings has also been infl uenced by this new trend and new materials have recently surfaced that keep healthy dental tissue without the need of non conservative preparations. The most important aspect in order to incorporate this new technologies is a correct diagnosis understanding the cause that originated this condition in order to implement the best posible treatment (AU)

Management of dental erosion induced by gastro-esophageal reflux disorder with direct composite veneering aided by a flexible splint matrix

Dental erosion is frequently overlooked in clinical practice. The management of erosion-induced damage to the dentition is often delayed, such that extensive occlusal rehabilitation is required. These cases can be diagnosed by a careful clinical examination and a thorough review of the patient's medical history and/or lifestyle habits. This case report presents the diagnosis, categorization, and management of a case of gastro-esophageal reflux disease-induced palatal erosion of the maxillary teeth. The early management of such cases is of utmost importance to delay or prevent the progression of damage both to the dentition and to occlusal stability. Non-invasive adhesively bonded restorations aid in achieving this goal.

Minimally invasive root canal therapy / 口腔疾病防治

@#Minimally invasive root canal therapy should be defined as a discipline which adhere to a concept of preserving the healthy tooth structure as much as possible during all the root canal therapy procedure. In the past 15 years, the concept of minimally invasive has spread and developed fast throughout the diagnosis and treatment of endodontics, which made the root canal therapy (RCT) procedure safer, more accurate and efficient. Minimally invasive endodontics rely on the development of various kinds of therapeutic devices and materials, including the 3D image auxiliary equipment, operation microscope, the NiTi instrument systems and the disinfection and obturation material. Minimally invasive endodontics is a therapeutic concept of the modern root canal therapy which redefined the standard of what a successful RCT is.