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.

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).

Conocimiento teórico y aplicación de la odontología mínimamente invasiva en el área de restaurativa de la Facultad de Odontología de la Universidad de El Salvador / Theoretical knowledge and application of minimally invasive dentistry in the restorative area of the Faculty of Dentistry of the University of El Salvador

Objetivo: El presente estudio nace con la finalidad de determinar si existe conocimiento teórico y práctico sobre Odontología Mínimamente Invasiva (OMI) por parte de los estudiantes programados en el área de restaurativa de la Clínica Intramural de la Facultad de Odontología de la Universidad de El Salvador (FOUES).Metodología: Para poder indagar se crearon los instrumentos cédula de entrevista y guía de observación para aplicarlas en dichos estudiantes. En la cédula de entrevista se elaboraron preguntas básicas sobre OMI regidas sobre sus tres campos básicos de aplicación como lo son Diagnóstico, Prevención y Tratamiento, en la cual se recolectó el conocimiento teórico que dichos estudiantes tienen sobre OMI. En la guía de observación se contempló qué tipo de métodos diagnósticos, instrumental y protocolo utilizó el estudiante; así como también qué medidas de prevención realizó y recomendó al paciente. Resultados: A nivel general, los/as estudiantes poseen un conocimiento sobre OMI deficiente; de acuerdo con el resultado de la aplicación del modelo econométrico, obtienen una puntuación de 5.3 ( promedio del conocimiento teórico y aplicación sobre OMI ). La mayor deficiencia se observa en la educación y promoción de la salud, a nivel teórico y de aplicación; y en el diagnóstico, en lo que a la aplicación de OMI se refiere. Conclusión: En general, puede afirmarse que la población en estudio no logra alcanzar los niveles básicos de la filosofía OMI, aún cuando "aparentemente", existen fortalezas en algunas áreas teóricas y prácticas, pero que al conjugarlas entre sí, denotan serias y profundas contradicciones.

Objective: The present study was born with the purpose of determining if there is theoretical and practical knowledge about Minimally Invasive Dentistry (OMI) by the students programmed in the restorative area of ​​the Intramural Clinic of the Faculty of Dentistry of the University of El Salvador (FOUES). Methodology: In order to investigate, the interview certificate and observation guide instruments were created to apply them to said students. In the interview card, basic questions were elaborated on OMI governed by its three basic fields of application such as Diagnosis, Prevention and Treatment, in which the theoretical knowledge that these students have on OMI was collected. The observation guide considered what type of diagnostic methods, instruments and protocol the student used; as well as what prevention measures he carried out and recommended to the patient. Results: At a general level, students have a deficient knowledge about OMI; According to the result of the application of the econometric model, they obtain a score of 5.3 (average of theoretical knowledge and application of OMI). The greatest deficiency is observed in health education and promotion, at a theoretical and application level; and in the diagnosis, as far as the application of OMI is concerned. Conclusion: In general, it can be affirmed that the population under study does not achieve the basic levels of the OMI philosophy, even though "apparently" there are strengths in some theoretical and practical areas, but that when combined with each other, they denote serious and deep contradictions. .

Odontología mínimamente invasiva. Investigación documental / Minimally invasive dentistry. Documentary research

Objetivo: Estimular en los estudiantes y odontólogos, un pensamiento más crítico y preventivo al momento de tomar una decisión en el tratamiento de una lesión cariosa, teniendo en cuenta la preservación de mayor estructura dentaria a través de la investigación documental sobre "Odontología Mínimamente Invasiva". Materiales y Métodos: La investigación se enmarca en un diseño de tipo documental. Su ejecución inició con una búsqueda de artículos y capítulos referentes al tema en revistas y libros especializados en Odontología Preventiva y Cariología; se revisaron bases de datos bibliográficos biomédicos en Internet y consulta directa en la Biblioteca de la Facultad de Odontología de la Universidad de El Salvador; concluida la recopilación de información, se procedió a seleccionarla en base a respaldo científico y grado de actualización, posteriormente se hicieron las traducciones respectivas, se analizó cada artículo y se procedió a la estructuración del trabajo final considerando un orden lógico y apegado a los objetivos propuestos. Las conclusiones se obtuvieron en base al análisis de la evidencia científica consultada y considerando los objetivos de la investigación. Resultados: Veinticinco libros referentes a prevención, cariología, anatomía dental, operatoria dental, adhesión en odontología restauradora, patología bucal, periodoncia y de historia de la odontología; treinta y dos artículos de revistas odontológicas; doce journals. Publicados por diferentes investigadores y dos direcciones de internet fueron consultados, analizados y considerados para elaborar la investigación.

Objective: To stimulate in students and dentists, a more critical and preventive thinking when making a decision in the treatment of a carious lesion, taking into account the preservation of greater dental structure through documentary research on "Minimally Invasive Dentistry" . Materials and Methods: The research is framed in a documentary-type design. Its execution began with a search for articles and chapters on the subject in specialized magazines and books on Preventive Dentistry and Cariology; Biomedical bibliographic databases were reviewed on the Internet and direct consultation in the Library of the Faculty of Dentistry of the University of El Salvador; Once the collection of information was concluded, it was selected based on scientific support and degree of updating, subsequently the respective translations were made, each article was analyzed and the final work was structured considering a logical order and attached to the proposed objectives . The conclusions were obtained based on the analysis of the scientific evidence consulted and considering the objectives of the research. Results: Twenty-five books referring to prevention, cariology, dental anatomy, dental surgery, adhesion in restorative dentistry, oral pathology, periodontics and the history of dentistry; thirty-two articles from dental journals; twelve journals. Published by different researchers and two internet addresses were consulted, analyzed and considered to develop the research.