Morphological evaluation of dental diseases in Parion chamber tomb (OM 5) Roman people / Evaluación morfológica de enfermedades dentales en la tumba de la cámara de Parion (OM 5) del pueblo romano

SUMMARY: Most of the dental diseases occur due to tooth or jaw morphology or nutritional habits. Anatomical differences in the teeth and jaws of men and women can cause different dental diseases between the sexes. In this study, 33 skeletons obtained from the excavation of the ancient city of Parion, which are dated to the late Roman period, were examined. Dental diseases and possible causes were investigated on a total of 33 skeletons. In the evaluations, it was evaluated that some diseases were caused by the difference between the sexes, while some were classified as nutritional diseases. The rates of tooth decay are different between men and women with Parion. It has been determined that the most important reason for this is the different morphological structure of the jaws and teeth, but the nutritional differences also cause this. Other dental and jaw diseases were also evaluated in the Parion population.

RESUMEN: La mayoría de las enfermedades dentales se deben a la morfología de los dientes o la mandíbula o a los hábitos nutricionales. Las diferencias anatómicas en los dientes y las mandíbulas de hombres y mujeres pueden causar diferentes enfermedades dentales entre los sexos. En este estudio, se examinaron 33 esqueletos obtenidos de la excavación de la antigua ciudad de Parion, que datan del período romano tardío. Se investigaron las enfermedades dentales y las posibles causas en un total de 33 esqueletos. En las evaluaciones, se determinó que algunas enfermedades fueron causadas por la diferencia entre los sexos, mientras que otras fueron clasificadas como enfermedades nutricionales. Además se encontraron diferentes estimaciones de caries entre hombres y mujeres. Se analizó que la razón más importante de esto es la diferencia de la estructura morfológica de los maxilares y los dientes, sin embargo las diferencias nutricionales también es un factor que se debe considerar. Se evaluaron además, otras enfermedades dentales y de la mandíbula en la población de Parion.

Caries en la tercera edad en una universidad de la ciudad de Puebla 2017-2018 / Caries in the third age in a university of the City of Puebla 2017-2018

La caries es una infección que afecta a cualquier persona sin importar edad, género o clase social. Es importante enfocar la atención odontológica a pacientes de tercera edad ya que tienden a un crecimiento anual de 3.8% de la población mexicana. Actualmente, se han realizado campañas de salud bucal para esta población; a pesar de los múltiples esfuerzos realizados para la prevención y erradicación de dicha enfermedad existe un descuido en los tratamientos para pacientes de la tercera edad, lo cual puede favorecer la pérdida de dientes. El objetivo del estudio fue determinar la prevalencia y severidad de caries en adultos mayores en la clínica de odontología de la Universidad Popular Autónoma del Estado de Puebla (UPAEP). Se realizó un estudio descriptivo, retrospectivo; se revisaron 345 expedientes de pacientes de tercera edad del 2017 al 2018, que asistieron por primera vez a consulta. Se obtiene la prevalencia y severidad a través del índice CPOD (cariados, perdidos y obturados). La prevalencia de dientes cariados fue 79%; se obtuvo un CPOD de 18.63 (alto riesgo). Se concluye el implementar medidas preventivas que impacten en mayor dimensión a la caries, para su disminución o erradicación en pacientes geriátricos (AU)

Caries is an infection that affects anyone regardless of their age, gender or social class. It is, however, important to focus dental care on elderly patients as that part of the Mexican population is growing at 3.8% annually. Currently, oral health campaigns have been carried out for this population, but despite the multiple efforts undertaken for prevention and eradication of the disease, treatment for elderly patients is often overlooked. The consequence of this lack of treatment can be the loss of teeth. The objective of this study is to determine the prevalence and severity of caries in elderly patients at the dental clinic of the Universidad Popular Autónoma del Estado de Puebla (UPAEP). A descriptive, retrospective study was carried out where the records of 345 elderly, first-time patients were reviewed for the 2017-2018 period. The prevalence and severity of caries was determined using the DMFT index (decay, missing, filled). The prevalence of carious teeth was 79% with a DMFT of 18.63 indicating high risk. We conclude that preventive measures should be implemented to impact and decrease caries in geriatric patients (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.

Caries and premature loss of the first permanent molar in grade school children, and parents' knowledge level, in Vargas state, Venezuela / Caries y pérdida prematura del primer molar permanente en niños de escuela primaria, y nivel de conocimiento de los padres, en el estado de Vargas, Venezuela

Introduction: The first permanent molars are the most affected due to age of eruption and their anatomical characteristics. Objective: to determine the prevalence of caries and premature loss of the first permanent molar in a group of grade school children 6 - 12 years of age, and to determine the level of prevention knowledge of the parents, in Vargas state, Venezuela. Materials and Methods: observational study with 182 children between 6 and 12 years old who underwent a clinical evaluation. The parents were asked about their knowledge regarding caries, methods of prevention and chronology of eruption of the child's first permanent molar. Study was approved by the Bioethics Committee of the Faculty of Dentistry at Universidad Santa María. Results: 6.60% of children presented caries in tooth 16, 6.08% in tooth 26, 24.85% in the tooth 36 and 15.62% in tooth 46. Regarding premature loss, 0.55% had lost tooth 26, 4.95% tooth 36 and 4.40% tooth 46. None presented loss of tooth 16. It was observed that 90.11% of parents had knowledge about dental caries and 44.51% knew how to prevent them. However, only 12.09% knew the age of eruption of the first molar and only 7.69% knew that it has no predecessor. Conclusions: The highest percentage of caries was in tooth 36. The lower molars were the most commonly extracted. The majority of parents demonstrated to have little knowledge about caries and permanent first molars.

Introducción: Los primeros molares permanentes son los más afectados debido a la edad de erupción y a sus características anatómicas. Objetivo: determinar la prevalencia de caries y pérdida prematura del primer molar permanente en un grupo escolares de 6 ­ 12 años y el nivel de conocimiento en prevención de los padres, Estado Vargas, Venezuela. Materiales y Métodos: estudio observacional con 182 niños entre 6 y 12 años a los que se les realizó una evaluación clínica. Se interrogó a los padres sobre el nivel de conocimiento de la caries, métodos de prevención y cronología de erupción del primer molar permanente. Se contó con el aval de Bioética de la Facultad de Odontología de la Universidad Santa María. Resultados: El 6,60% presentó caries en la UD 16, el 6,08% en la UD26, el 24,85% en la UD 36 y el 15,62% en la UD 46. Respecto a la pérdida prematura, el 0,55% había perdido la UD 26, el 4,95% la UD 36 y el 4,40% la UD 46. Ninguno presentó pérdida de la UD 16. Se observó que el 90,11% de los padres tenía conocimiento sobre la caries dental y el 44,51% conocía los medios para prevenirlas. Sin embargo, solo el 12,09% conocía la edad de erupción del primer molar y únicamente el 7,69% sabía que no tiene antecesor. Conclusiones: El mayor porcentaje de caries lo tuvo UD-36. Los molares inferiores fueron los más extraídos. La mayoría de los padres demostró poseer escasos conocimientos sobre caries y primeros molares permanentes.

Prevalence and Severity of Dental Caries and Fluorosis in 8 Year-old Children With or Without Fluoride Supplementation / Prevalencia y Severidad de Caries Dental y Fluorosis en Niños de 8 Años con o Sin Suplementos de Flúor

ABSTRACT: One of the most effective and studied measures in the prevention of caries is the use of fluoride, which has the property to reduce their incidence and severity. In Chile, 75 % of the population receives it the drinking water. In 1984, WHO recommended the use of milk as an alternative vehicle. In Chile, the Fluoridated School Feeding Program (FSFP) was introduced in 1994, using this alternative in rural areas without fluoride in water. The objective of the study was to compare prevalence and severity of dental caries and dental fluorosis in 8-year-old children of four state schools: two with fluoride supplementation in drinking water or milk and two without any fluoride program. Epidemiological, descriptive, comparative, observational and cross-sectional study with a sample of 140 8-year-old children, with no systemic diseases and who had lived in the same place since birth: 50 schoolchildren from an area with fluoridated water; 40 from an area with fluoridated milk and 50 from a zone without supplementation of F. The percentage of caries-free children was obtained with the methodology described by the WHO, for severity the dmft and DMFT indexes were used. To quantify the prevalence and severity of dental fluorosis, Dean Index was used. 38 % of the children were caries-free in the community with fluoridated water (CFW); 0 % in the community with fluoridated milk (FSFP) and 10 % in the community with no fluoride program established (CNF). The difference between CFW with CNF is statistically significant (p<0.05). The prevalence of fluorosis is significantly higher for CFW (48.8 %) than FSFP (35 %) and CNF (16 %). Conclusion: The contribution of fluoride in drinking water causes a decrease in the prevalence and severity of dental caries in children of 8 years of age, and an increase in the prevalence of dental fluorosis.

RESUMEN: Una de las medidas más efectivas y estudiadas en la prevención de caries es el uso de fluoruros, que tiene la propiedad de reducir su incidencia y severidad. 75 % de la población chilena lo recibe al incluirlo en el agua potable. La OMS en 1984 recomendó el uso de leche como un vehículo alternativo. En Chile, el Programa de Alimentación Escolar con leche fluorada fue implementado en 1994 como alternativa en zonas rurales sin fluoruro en el agua. El objetivo de este estudio fue comparar la prevalencia y severidad de la caries dental y la fluorosis dental en niños de 8 años en tres escuelas públicas, con suplementación de fluoruro en el agua potable o en la leche y con aquella que no tiene ningún programa de fluoración. Estudio epidemiológico, descriptivo, comparativo, observacional y de corte transversal con una muestra de 140 niños de 8 años, sin enfermedades sistémicas y que han vivido en el mismo lugar desde su nacimiento: 50 escolares en el área con agua fluorada, 40 en el área con leche fluorada y 50 en la zona sin suplementación de fluoruro. El porcentaje de niños libres de caries fue obtenido con la metodología descrita por la OMS, usando índices ceo-d y CPO-D para evaluar severidad. Para cuantificar la prevalencia y severidad de la fluorosis dental se ocupó el índice de Dean. Niños libres de caries fueron 38 % en la comunidad con agua fluorada (CWF); 0 % en la comunidad con leche fluorada (FSFP) y 10 % en la comunidad sin programa de fluoración (CNF). La diferencia entre CWF y CNF es estadísticamente significativa (p<0,05). La prevalencia de fluorosis es significativamente mayor en CWF (48,8 %) que FSFP (35 %) y CNF (16 %). La contribución del fluoruro en el agua potable causa una disminución en la prevalencia y severidad de la caries dental en niños de 8 años, y un aumento en la prevalencia de fluorosis dental.

Histopathological Analysis of Sealant Infiltration in White Spot Enamel Lesions (WSEL) / Análisis Histopatológico de Infiltración de Sellante en Lesiones de Mancha Blanca en Esmalte (LMBE)

ABSTRACT: The use of resin sealants has shown partial infiltration of White-Spot Enamel Lesions in vitro (WSEL). The aim of the present study was to perform a morphological evaluation of natural WSEL when infiltrated using a commercially available sealant (Concise, 3M- ESPE). 20 bicuspids extracted for orthodontic reasons from patients ranging 18 to 30 years old, which had WSEL, were used in this study. The patients agreed to donate their teeth by signing a written consent. Every WSEL was assessed microscopically (Stereo Zeiss Axiscop) and then photographed (ProScope HR microscope). Prior to applying the sealant the lesion was etched using phosphoric acid at 37 % (3M-ESPE, St Paul, MN, USA.) for 30 seconds, washed for 40 seconds and then air-dried. The sealant was marked with rhodamine B (1mg/ml) and was applied according to the manufacturer directions. A specimen of approximately 100 mm was obtained for every WSEL by cutting perpendicularly through the lesion (Isomet 1000, Buehler Co.) and grinding (600 grit). The specimens were evaluated using: clear camp, polarized light, and epifluorescence microscopy. Images were taken of each specimen for every microscopic evaluation using a slide film (Kodak Ektachrome film 400 ASA). The images were digitalized by scanning at 1200 dpi resolution (Epson Filmscan 200) and then saved as JPEG and TIFF files. The sealant infiltration into The WSEL was assessed by means of analysis, processing and digital superimposing using Adobe Photoshop 7.0 and Matrox Inspector 1.07. It was concluded that the sealant infiltrated the whole body zone of the lesion. The depth of penetration of sealants into White Spot Enamel Lesion plays an important role in the control of caries lesion progression.

RESUMEN: El uso de sellantes de resina ha demostrado lograr la infiltración parcial de lesiones de mancha blanca en esmalte in vitro (LMBE). El objetivo del presente estudio fue realizar una evaluación morfológica de la infiltración a LMBE naturales utilizando un sellante disponible comercialmente (Concise, 3M-ESPE). Se utilizaron en este estudio, 30 bicúspides extraídos por razones de ortodoncia en pacientes que tenían entre 18 a 30 años de edad, y presentaban LMBE. Los pacientes aceptaron donar sus dientes firmando un consentimiento informado. Cada LMBE se evaluó microscópicamente (Stereo Zeiss Axiscop) y luego se fotografió (microscopio ProScope HR). Antes de aplicar el sellante, la lesión se grabó usando ácido fosfórico al 37 % (3M-ESPE, St Paul, MN, EE. UU.) durante 20 segundos, luego se lavó durante 40 segundos y finalmente se secó con aire de jeringa triple. El sellante se marcó con rodamina B (1 mg / ml) y se aplicó siguiendo las instrucciones del fabricante. Se obtuvo una muestra de aproximadamente 100 mm para cada LMBE cortando perpendicularmente a través de la lesión (Isomet 1000, Buehler Co.) y trituración (grano 600). Las muestras se evaluaron usando: campo claro, luz polarizada y microscopía de epifluorescencia. Se tomaron imágenes de cada espécimen para la evaluación microscópica usando una película deslizante (Kodak Ektachrome film 400 ASA). Las imágenes se digitalizaron escaneando a una resolución de 1200 ppp (Epson Filmscan 200) y luego se guardaron como archivos JPEG y TIFF. La infiltración del sellante en las LMBE se evaluaron mediante análisis, procesamiento y superposición digital utilizando Adobe Photoshop 7.0 y Matrox Inspector 1.07. Se concluyó que el sellante infiltró toda la zona del cuerpo de la lesión. La capacidad de penetración en profundidad de los sellantes en Lesiones de Mancha Blanca del Esmalte desempeñan un rol importante en el control de la progresión de las lesiones de caries.

Accuracy of visual and image-based ICDAS criteria compared with a micro-CT gold standard for caries detection on occlusal surfaces

Abstract The aim of this study was to check the in vitro accuracy of ICDAS criteria on digital images compared to visual examination for the diagnosis of occlusal caries against a micro-CT gold standard. ICDAS was scored in 40 extracted permanent molars by means of visual inspection and stereomicroscopic images. Visual examinations were performed in duplicate and at a one-week interval by three different calibrated examiners. The analysis of digital images by ICDAS criteria was also performed in duplicate, 1 month after visual examinations. The detection methods were compared by means of sensitivity, specificity, area under the curve, predictive positive and negative values, and accuracy for two different thresholds (1- sound vs. carious teeth; 2- tooth requiring operative vs. non-operative treatment). Sensitivity and accuracy values for threshold 1 in the visual ICDAS and image-based ICDAS methods were high for sensitivity (0.93 and 0.97) and for accuracy (0.83 and 0.85), but low for specificity (0.55 for both methods). Specificity values for threshold 2 were 0.77 and 0.82, while sensitivity was 0.33 and 0.28 for each method. Spearman's rank correlation coefficient was 0.53 and 0.43 (p<0.05) for visual and image-based ICDAS compared to the gold standard scores. Both visual and image-based ICDAS scores were similar to each other in terms of diagnostic accuracy when compared to the micro-CT gold standard. Low specificity for the presence of caries and sensitivity for the detection of caries requiring operative treatment were found.

Autopercepción del impacto de caries dental en escolares de Machángara - Ecuador 2016 / Impact of dental caries self-pereived in schoolchildren from Machangara - Ecuador 2016

Objetivos: Determinar la autopercepción de caries dental en escolares de 6 años en la parroquia Machángara de la ciudad de Cuenca. Materiales y métodos: La investigación fue de tipo cuantitativo, diseño descriptivo, técnica observacional transversal retrospectiva, con una muestra de 104 escolares de 6 años de edad. Los datos se ingresaron al programa estadístico Epinfo ver. 7.2. Resultados: El 48% de escolares tuvieron una respuesta positiva de impacto de autopercepción de caries dental. Según la gestión escolar, las escuelas fiscales presentaron el 74% de autopercepción, en tanto que las fiscomisionales un 26%. El sexo femenino tuvo más impacto de percepción con el 58%, mientras que el sexo masculino el 42%. La muestra total estuvo conformada por el 42% de niños y 58% de niñas. El 74% de escolares asisten a escuelas fiscales y el 26% a escuelas fiscomisionales. Conclusiones: La autopercepción de caries dental en escolares de 6 años en la parroquia Machángara de la ciudad de Cuenca tuvo un impacto general del 48%. No se observa diferencia significativa de percepción de caries entre las instituciones fiscomisionales y fiscales. El sexo femenino predominó en el impacto de autopercepción que el masculino. (AU)

Objectives: To determine the self-perception of dental caries in 6-year-old schoolchildren in the Machángara parish of the city of Cuenca. Material and methods: The research was of quantitative type, descriptive design, retrospective transversal observational technique, with a sample of 104 schoolchildren aged 6 years. Data were entered into the statistical program Epinfo ver. 7.2. Results: 48% of schoolchildren had a positive self-perceived impact of dental caries. According to school management, the fiscal schools presented 74% self-perception, while the fiscomisionales 26%. The female sex had more impact of perception with 58%, while the male sex had 42%. The total sample consisted of 42% of children and 58% of girls. 74% of schoolchildren attend tax schools and 26% go to scomision schools. Conclusions: The self-perception of dental caries in 6-year-old schoolchildren in the Machángara parish of the city of Cuenca had a general impact of 48%. There is no significant difference in caries perception between fiscomisional and fiscal institutions. The female sex predominated in the impact of self-perception than the male. (AU)

A Longitudinal Study of Early Childhood Caries and Associated Factors in Brazilian Children

Abstract Early childhood caries (ECC) affects children all over the world and has high prevalence and severity in preschool children. Different social, biological and behavioral factors compose a network of causal factors for ECC. The aim was to evaluate the association between socioeconomic variables and caries at baseline, and the presence of Streptococcus mutans and Lactobacillus spp. microorganisms with the progression of caries lesions after two years of follow-up in a group of children. At baseline, 163 children (3-4 years old) living in the areas of 12 primary care services of the Hospital Group Conceição (GHC, Porto Alegre, RS, Brazil) were evaluated. After two years, 119 children were re-evaluated. Clinical examinations were conducted by calibrated examiners using the ICDAS criteria. A sociodemographic questionnaire was applied to the children’s parents and saliva samples were collected from the children for microbiological analysis. Descriptive statistics and multivariate Poisson regression analysis were performed in the statistical analysis. The factors associated with the caries progression were marital status of mothers (p=0.040), higher S. mutans counts (p=0.031) and the presence of cavitated lesions at baseline (p<0.001). The caries lesions progression in preschool children enrolled in primary health care was directly associated with marital status, presence of cavitated lesions at baseline and higher S. mutans counts at two-year follow-up.

Resumo A cárie precoce na infância (CPI) acomete crianças em todo o mundo e apresenta alta prevalência e severidade em pré-escolares. Diferentes fatores sociais, biológicos e comportamentais constituem uma rede de fatores causais da CPI. O objetivo deste estudo foi avaliar a associação entre as variáveis socioeconômicas e presença de cárie na linha de base e a presença de Streptococcus mutans e Lactobacillus spp. com a progressão de lesões de cárie após dois anos de acompanhamento em um grupo de crianças. Na avaliação inicial, foram avaliadas 163 crianças (3-4 anos de idade) pertencentes a 12 unidades básicas de saúde do Grupo Hospitalar Conceição (GHC, Porto Alegre, RS, Brasil). Após dois anos, foram reavaliadas 119 crianças. Os exames clínicos foram realizados por examinadores calibrados usando os critérios ICDAS. Um questionário sociodemográfico foi aplicado aos pais das crianças e amostras de saliva foram coletadas de crianças para análise microbiológica. Foram realizadas estatísticas descritivas e regressão multivariada de Poisson na análise estatística. Os fatores associados com a progressão de cárie foram o estado marital das mães (p=0,040) e a presença de lesões cavitadas no início do estudo e uma maior contagem de S. mutans (p=0,031) após dois anos de acompanhamento. A progressão de cárie em pré-escolares pertencentes às unidades de atenção primária em saúde foi diretamente associada com o estado marital das mães, presença de lesões cavitadas na linha de base e maior contagem de S. mutans após dois anos de acompanhamento.

Chemomechanical versus drilling methods for caries removal: an in vitro study

The purpose of this study was to compare the performance of chemomechanical caries removal (CMCR) with that of conventional drilling for efficacy of caries removal, time spent, morphological changes and microhardness of surface dentin, and microleakage of subsequent restorations. Forty-six carious deciduous molars were randomly divided into two groups: one each for caries removal by (1) CMCR and by (2) drilling. The completeness of caries removal was evaluated by visual and tactile criteria and a caries detector device. Twenty teeth in each group were restored with glass ionomer (GI) and subjected to thermocycling before undergoing microleakage and microhardness tests. In each group, three restored teeth were used for polarized light microscopic analysis, and three unrestored teeth for scanning electron microscopy (SEM). There was no significant difference in the completeness of caries removal between groups. However, time spent for caries removal by CMCR was significantly longer than that required for drilling. Restorations in the CMCR group had significantly more microleakage than those in the drilling group. Dentin hardness of the cavity floor after CMCR was also significantly lower. Microscopic analyses showed roughened and irregular dentin surfaces in the CMCR group, unlike the smooth surfaces observed in the drilling group. In conclusion, CMCR was as efficacious as drilling in term of completeness of caries removal, but required longer excavation times and resulted in lower microhardness of residual dentin as well as more microleakage after restorations with GI. Further laboratory and clinical evaluations on the efficiency and performance of CMCR for the durability of subsequent restorations are required.

Validation of micro-computed tomography for occlusal caries detection: an in vitro study

Conventional methods of caries detection, including the gold standard of histological examination, have certain disadvantages that must be addressed prior to validating any other diagnostic technique—current or new. Here we evaluated the validity of micro-computed tomography (micro-CT) as an alternative gold-standard technique for caries detection. Sixty teeth with suspected occlusal caries were chosen from a pool of teeth extracted for orthodontic, periodontal, or surgical reasons. Identical reference points were marked on photographs taken for teeth and were used to evaluate each method. Dimensions of caries were assessed by two calibrated examiners using the ICDAS-II visual examination system, bitewing radiographs, and micro-CT. The teeth included in the study were selected randomly from solution before all measurements. For micro-CT, the device was set to 50 kV, 800 µA, pixel size 15 µm (at 1024 × 1024 resolution), and 1° rotation step. NRecon software (SkyScan) was used to obtain reconstructed images. For each diagnostic method, results were compared with histology results using the McNemar test. Receiver operator characteristic (ROC) analysis was also performed for each method (Z-test; p < 0.05). Besides showing a high correlation with histology results, micro-CT yielded the greatest values at the D3 threshold; moreover, accuracy and area under the ROC curve (AUC) values were greatest at the D1threshold. Our results indicate that micro-CT performs as well as or better than histological examination for the purpose of comparing methods for caries detection.

Measuring color change of tooth enamel by in vitro remineralization of white spot lesion / Medición del cambio de coloración del esmalte dental en la remineralización in vitro de la lesión incipiente de caries

Abstract: objective colour determination is based on calculating the colorimetricdistance (Delta E) within a colour space. So far, the most used colour space in dentistry is CIE L*a*b (Comission Internationale de l´Éclairage). CIE L*C*h* has been recently developed, showing a better correlation with the perception of the human eye. Objective: To determine the ability of an in vitro remineralisation substance to blend the colour of white spot lesions (WSL) with sound enamel, determining Delta E by using the CIE L*C*h* colour space. Methods: In vitro WSL was generated by immersing 10 samples obtained from human third molars in a demineralization solution for 72h. Amorphous calcium phosphate stabilized by casein phosphopeptide (CPP-ACP) was then applied for 60 days while maintaining the samples in artificial saliva at 37ºC. To evaluate the colour of enamel, images were taken from the samples placed in specifically designed silicone moulds after generating the WSL (pre-stage) and after remineralisation by scanning, applying the colorimetric distance equation (Delta E*CMC) according to the Colour Measurement Committee. Results: Treatment with CPP-ACP caused a significant Delta E decrease with respect to the pre-stage (p smaller than 0.001), while the analysis of parameters that make up the colour showed a reduction in the difference of hue (Delta H) (p smaller than 0.001) and brightness (Delta L) (p smaller than 0.01) after applying CPP-ACP. Discussion: CPP-ACP penetrated to the depth of the white spot lesion, making its appearance similar to that of the sound enamel, probably because of the formation of different mineral phases than that of the original structure, although pores were not completely filled.

Resumen: la determinación objetiva del color se basa en el cálculo de la distancia colorimétrica (Delta E) dentro de un espacio cromático. Hasta el momento el más usado en odontología ha sido CIE L*a*b (Comission Internationale de l´Éclairage). Recientemente se ha desarrollado CIE L*C*h*, que tiene mayor correspondencia con la percepción del ojo humano. Objetivo: evaluar la capacidad de una sustancia remineralizante de mimetizar el color de la mancha blanca (MB) in vitro con el esmalte sano, determinando Delta E mediante el espacio cromático CIE L*C*h*. Método: se generó la MB in vitro sumergiendo 10 muestras obtenidas de terceros molares humanos en solución desmineralizante durante 72 h., luego se aplicó pasta con fosfato de calcio amorfo estabilizado por fosfopéptidos de caseína (CPP-ACP) durante 60 días manteniendo las muestras en saliva artificial a 37ºC. Para evaluar el color, se obtuvieron imágenes de las muestras ubicadas en moldes de silicona confeccionadas ad hoc luego de generar la MB (etapa pre) y del protocolo remineralizante (etapa post) mediante escáner y se aplicó la ecuación de Distancia colorimétrica según Color Measurement Committee. (Delta E*CMC). Resultados: el tratamiento con CPP-ACP provocó una disminución significativa de Delta E respecto de la etapa pre (p menor que 0,001) mientras que el análisis de los parámetros que componen el color mostró disminución en la diferencia del tono (Delta H) (p menor que 0,001) y la luminosidad ( Delta L ) (p menor que 0,01) luego de aplicar CPP-ACP. Discusión: CPP-ACP penetró a la profundidad de la lesión, acercando la apariencia de la MB a la del esmalte sano, probablemente por la formación de fases minerales distintas a las de la estructura original aun cuando lo poros no hayan sido completamente rellenados.

Urgencias por caries dental en pacientes de 4 a 12 años. Municipio Píritu, Venezuela: 2011 / Dental caries urgencies in patients aged 4 to 12 years. Municipality of Píritu, Venezuela: 2011

Se realizó un estudio observacional, descriptivo y transversal en los pacientes que acudieron a la clínica odontológica de Píritu, estado Falcón, Venezuela, en el período de junio a diciembre de 2011, y resultaron ser urgencia por caries dental. Con el objetivo de identificar el comportamiento de la misma, en las edades de 4 a 12 años, se clasificó la caries dental según localización y profundidad de las lesiones, se diagnosticó las patologías pulpares agudas encontradas con mayor frecuencia, y los factores de riesgo. Con una muestra dirigida de 160 niños; la información se obtuvo a través de diferentes técnicas, tales como: interrogatorio a pacientes y familiares, observación clínica extraoral e intraoral, palpación, exploración y percusión de los dientes. Como resultados se obtuvieron: mayor porcentaje en el sexo masculino y en el grupo 7 a 9 años, mayor aporte de los casos la pulpitis transitoria, donde las caras de los dientes más afectadas resultaron las caras oclusales y dentina superficial, los factores de riesgo más relacionados con la aparición de la caries, fueron placa dentobacteriana y dieta cariogénica.

We carried out a cross sectional, descriptive, observational study in patients assisting the odontological clinic of Píritu, Falcon State, Venezuela, in the period from June to December 2011, who were dental caries urgencies; the aim was identifying caries behavior in ages from 4 to 12 years; dental caries were classified according to the lesions location and deepness; the most frequently found acute pulpy pathologies, and the risk factors were diagnosed. With a directed sample of 160 children, the information was obtained using different techniques, like patients and relatives questioning, extra oral and intra oral observation, groping, and teeth exploration and percussion. As a result we found a higher percent of the male gender and the age group from 7 to 9 years; most of the cases were transitory pulp diseases, and the most affected teeth sides were the occlusal sides and surface dentina; the most common risk factors associated to caries appearing were dental bacterial plaque and cariogenic diet.

Molecular and Structural Evaluation of Dentin Caries-Like Lesions Produced by Different Artificial Models

This study evaluated structural and molecular issues of dentin caries-like lesions produced by different artificial models (ACL) compared with natural caries lesions (NCL). One hundred twenty-four sound occlusal dentin blocks and 47 carious blocks were obtained and surface hardness was analyzed (SH1). They were assigned to groups according to ACL: GB: Biological; GC: Chemical; GIS: In situ; GNC: natural caries (control). Blocks from groups 1, 2 and 3 were submitted to caries lesion induction. NCL and ACL blocks were submitted to surface hardness (SH 2), FT-Raman and µEDXRF analysis. All blocks were longitudinally sectioned and one of the halves was submitted to cross-sectional hardness (CSH) and the other to SEM analysis. SH1 and SH2 data were submitted to t test (unpaired and paired, respectively), CSH and SEM data to two-way and one-way ANOVA respectively, and Tukey and t tests, respectively (p<0.05). Data from FT-Raman/µEDXRF were submitted to one-way ANOVA and Dunnett multiple-comparisons test (a=0.05). GB and GNC showed lowest SH2 values that were significantly different from GC and GIS. Regarding CSH, GB and GNC showed no significant difference between them. SEM showed similar caries lesion depth for GB and GNC, being significantly higher than for GC and GIS. µEDXRF showed similar values of calcium and phosphate for GB and GNC; GNC values were significantly different from GIS. No significant difference was found among the groups concerning phosphate, carbonate and CH bonds values. For collagen type I, GC values were significantly different compared to other groups. It may be concluded that caries-like lesions produced by GB were the closest model to NCL.

Este estudo avaliou as características estruturais e moleculares da lesão de cárie artificial em dentina produzidas por diferentes modelos artificiais (LCA) comparados à lesão de cárie natural (LCN). Cento e vinte e quatro blocos de dentina oclusal hígida e 47 blocos cariados foram obtidos e a dureza superficial foi analisada (SH1). Eles foram divididos em grupos de acordo com os modelos de LCA: GB: Biológico; GQ: Químico; GIS: In situ; GCN: lesão de cárie natural (controle). Blocos dos grupos 1, 2 e 3 foram submetidos à produção da lesão de cárie. Blocos de dente contendo LCA e LCN foram submetidos à análise de dureza superficial (SH2), análise FT-Raman e µEDXRF. Em seguida, todos os blocos foram seccionados longitudinalmente e uma das metades foi submetida à análise da dureza transversal (CSH) e outra à análise em microscopia eletrônica de varredura (MEV). Dados da SH1 e SH2 foram submetidos ao teste t (não-pareado e pareado, respectivamente). Dados do CSH e MEV foram submetidos à ANOVA a um fator e teste Tukey e ANOVA a um fator e teste t, respectivamente (p<0,05). Dados do FT-raman/µEDXRF foram submetidos a ANOVA a um fator e teste de Dunnett para múltiplas comparações (p<0,05). GB e GCN apresentaram os menores valores de SH2 que foram significativamente diferentes de GC e GIS. Quanto a CSH, GB e GCN mostraram nenhuma diferença significativa entre eles. SEM mostrou profundidade de lesão de cárie semelhante para GB e GCN, sendo significativamente maior que para GC e GIS. µEDXRF mostrou valores similares de cálcio e fosfato para GB e GCN, enquanto os valores do GCN foram significativamente diferentes em relação ao GIS. Nenhuma diferença significativa foi encontrada entre os grupos em relação aos valores de fosfato, carbonato e ligações CH. Para o colágeno tipo I, os valores do GC foram significativamente diferentes em comparação aos outros grupos. Pode-se concluir que a cárie artificial produzida pelo GB foi o mais próximo da LCN.

A subjetividade do diagnóstico em Endodontia - relato de caso / The subjectivity of diagnosis in Endodontics - case report

Na Endodontia, em algumas situações, o diagnóstico é bastante subjetivo. Apesar dos fenômenos necróticos e degenerativos estarem presentes na necrose parcial pulpar, ainda podem ser observados filetes nervosos em algumas partes do tecido pulpar. Embora seja necessário o acompanhamento da vitalidade pulpar dos dentes submetidos ao tratamento ortodôntico, deve-se considerar a subjetividade do teste de vitalidade e o diagnóstico só será concluído quando do acesso a câmara pulpar. O objetivo deste estudo é relatar um caso de necrose pulpar parcial ocasionada por uma cárie profunda associada ao emprego de forças excessivas durante o tratamento ortodôntico.

In some situations diagnosis in Endodontic is a very subjective procedure. Despite the presence of necrosis and degenerative phenomena are present in partial pulp necrosis, nerve fibers can still be observed in some parts of the pulp tissue. While it is necessary to monitor the pulp vitality of the teeth subjected to orthodontic treatment, one should take into account the subjectivity of the vitality test and the diagnosis must be completed only when the pulp chamber is opened. The objective of this study was to report a case of partial pulp necrosis caused by deep tooth decay associated to excessive force during orthodontic treatment.

Utilização de métodos baseados em fluorescência para avaliação da atividade de lesoes de cárie oclusais em molares decíduos / Use of Fluorescence-based methods to assess the caries activity on occlusal surfaces of primary molars

O objetivo do presente estudo in vivo foi avaliar a associação de parâmetros obtidos por diferentes métodos baseados em fluorescência com a detecção da atividade de cárie em superfície oclusal de molares decíduos, incluindo a avaliação da fluorescência vermelha emitida pelo biofilme nesse processo diagnóstico. Para tanto, foram selecionadas 606 molares decíduos de 113 crianças entre 4 e 14 anos. As crianças foram avaliadas quanto à presença de biofilme, experiência de cárie e número de lesões ativas. A presença de biofilme fluorescente no vermelho foi também avaliada com um aparelho de quantificação da fluorescência induzida por luz (QLF do inglês, Quantitative Light-induced Fluorescence). Após profilaxia, também com o QLF, foram avaliados a fluorescência do dente no verde (F e Q) e no vermelho (R), além da avaliação com o DIAGNOdent pen. Para determinação do primeiro padrão de referência, todos os dentes foram avaliados por 2 examinadores utilizando o sistema ICDAS associado à avaliação da atividade de cárie baseado nas características clínicas das lesões. Para a segunda etapa da pesquisa, foram selecionados 50 molares decíduos exfoliados ou extraídos logo após os exames. Esse dentes foram seccionados e validados histologicamente por 2 examinadores de acordo com a profundidade e atividade das lesões, esse último avaliado com auxílio de um corante indicador de pH. Análises de regressão linear de multinível foram realizadas para a comparação entre as medidas obtidas com os métodos baseados na fluorescência nos dentes classificados pelo exame visual como sadios ou com lesões ativas ou inativas. Para avaliação da associação dos parâmetros avaliados pelos métodos baseados na fluorescência e de outras variáveis explanatórias, foram realizadas análises de multinível de Poisson.

Na segunda etapa, após determinação dos melhores pontos de corte, valores de sensibilidade, especificidade, acurácia e as áreas sob as curvas ROC (Az) de cada método foram calculados em três limiares de detecção. Para avaliação do desempenho dos métodos em detectar a atividade de cárie, os parâmetros de Diagnostic Odds Ratio (DOR), acurácia e Az foram calculados. A reprodutibilidade das avaliações do padrão de referência obtiveram valores de kappa maiores que 0,86. Os valores de F e Q do QLF (fluorescência verde) foram significantemente maiores nas lesões inativas do que nas ativas, tanto em lesões não-cavitadas, como nas cavitadas. Com o DIAGNOdent pen, somente na avaliação de lesões cavitadas, as medidas em lesões ativas diferiram significantemente das lesões inativas. No geral, a presença de biofilme visível sobre a superfície oclusal dos molares decíduos e R do dente (fluorescência vermelha obtida com o QLF) mostraram associação significante com a atividade de cárie. O exame visual, o DIAGNOdent pen e os valores de Q mostraram maior sensibilidade na detecção de lesões iniciais em esmalte. Para lesões em dentina o QLF mostrou menor especificidade do que o exame de inspeção visual. Os valores de DOR e Az mostraram similaridade entre os métodos para diferenciação de lesões ativas e inativas. Embora o QLF e DIAGNOdent pen mostrem bom desempenho na avaliação da atividade de cárie em molares decíduos, não mostram vantagens quando comparados à utilização da inspeção visual ou à simples avaliação da presença de biofilme visível.

The aim of this in vivo study was to evaluate the association of parameters obtained with fluorescence-based methods and the assessment of caries lesions activity in occlusal surfaces of primary molars, including the evaluation of red fluorescence emitted by the biofilm in this diagnosis process. Occlusal surfaces of 606 primary molars from 113 children aged 4-14 years were selected. The presence of biofilm, caries experience and the number of active lesions were evaluated. The presence of red fluorescent biofilm was also assessed by QLF (Quantitative Light-induced Fluorescence). After dental cleaning procedure, the green (F e Q) and red (R) fluorescence were evaluated with the QLF. The DIAGNOdent pen was also employed. For the first reference standard, all teeth were evaluated by 2 examiners using ICDAS associated with the caries activity assessment based on clinical characteristics of the lesions. For the second phase, 50 exfoliated or extracted primary molars were selected. Then, these teeth were sectioned and histologically validated by 2 examiners regarding depth and activity of the lesions; the latter using a pH detector dye. Multilevel linear regression analyses were carried out to compare the values of the fluorescence-based methods on the teeth classified by visual inspection as sound, with active or inactive lesions. Multilevel Poisson analysis evaluated the association of the parameters assessed by the fluorescencebased methods and explanatory variables. On the second phase, after obtaining the best cut-off points, the sensitivity, specificity, accuracy and area under ROC curve (Az) were calculated at three thresholds. The performance of the methods in detecting caries activity was evaluated by Diagnostic Odds Ratio (DOR), accuracy and Az values calculated.

Nociones periodontales prácticas para un tratamiento integral / Practical periodontal knowledge for a comprehensive dentistry

La investigación ha estimulado un cambio de los enfoques tradicionales de los tratamientos, haciendo hincapié en la amplia variación de la susceptibilidad individual a las enfermedades periodontales y pérdida de los dientes. Hace más de 40 años se estableció científicamente la relación causal entre la biopelícula y la gingivitis. En los últimos años ha surgido evidencia, desafiando los conceptos tradicionales en la cual se basan abordajes para el tratamiento de enfermedad periodontal. La comprensión genética está comenzando a explicar las diferencias del huésped a esta susceptibilidad y también la posibilidad de respuesta satisfactoria al tratamiento. Ahora se confirman los efectos del estrés psicológico y el tabaco. Hoy el sueño de regeneración periodontal con inserción del tejido conjuntivo es una realidad. También se proporciona a los clínicos medios más eficaces de detección, prevención y tratamiento de la periodontitis, algunos ya actualmente disponibles; un enfoque más acorde de ser los médicos de la cavidad bucal. Nos acercaremos a enfermedades bucales utilizando un modelo más biológico de la gestión de la salud-enfermedad. El objetivo de este estudio es actualizarnos, basados en la evidencia, principios de la terapia periodontal y su relación con la clínica Odontológica integral

Research is stimulating our traditional approaches to treatment needs by emphasizing the wide variation in individual susceptibility to periodontal diseases and tooth loss. Over 40 years ago, the causative relationship between dental plaque and gingivitis was scientifically established. In recent years, evidence has emerged challenging the traditional concepts of periodontal disease upon which approaches to treatment are based. Genetic understanding is beginning to explain host differences in this susceptibility and also the potential for satisfactory treatment response. The effects of psychological stress and tobacco smoking are now confirmed. Today the dream of periodontal regeneration with connective tissue attachment is a reality. It do provide clinicians with more effective means of detection, prevention, and treatment of periodontitis, some of them are currently available; an approach more befitting physicians of the oral cavity. We will approach oral diseases using a more biological model of health- disease management. The objective of this study is to update us, based on the existing evidence, principles of periodontal therapy and its relationship with the clinical comprehensive dentistry

Utilização de métodos baseados em fluorescência para avaliação da atividade de lesoes de cárie oclusais em molares decíduos / Use of Fluorescence-based methods to assess the caries activity on occlusal surfaces of primary molars

O objetivo do presente estudo in vivo foi avaliar a associação de parâmetros obtidos por diferentes métodos baseados em fluorescência com a detecção da atividade de cárie em superfície oclusal de molares decíduos, incluindo a avaliação da fluorescência vermelha emitida pelo biofilme nesse processo diagnóstico. Para tanto, foram selecionadas 606 molares decíduos de 113 crianças entre 4 e 14 anos. As crianças foram avaliadas quanto à presença de biofilme, experiência de cárie e número de lesões ativas. A presença de biofilme fluorescente no vermelho foi também avaliada com um aparelho de quantificação da fluorescência induzida por luz (QLF do inglês, Quantitative Light-induced Fluorescence). Após profilaxia, também com o QLF, foram avaliados a fluorescência do dente no verde (F e Q) e no vermelho (R), além da avaliação com o DIAGNOdent pen. Para determinação do primeiro padrão de referência, todos os dentes foram avaliados por 2 examinadores utilizando o sistema ICDAS associado à avaliação da atividade de cárie baseado nas características clínicas das lesões. Para a segunda etapa da pesquisa, foram selecionados 50 molares decíduos exfoliados ou extraídos logo após os exames. Esse dentes foram seccionados e validados histologicamente por 2 examinadores de acordo com a profundidade e atividade das lesões, esse último avaliado com auxílio de um corante indicador de pH. Análises de regressão linear de multinível foram realizadas para a comparação entre as medidas obtidas com os métodos baseados na fluorescência nos dentes classificados pelo exame visual como sadios ou com lesões ativas ou inativas. Para avaliação da associação dos parâmetros avaliados pelos métodos baseados na fluorescência e de outras variáveis explanatórias, foram realizadas análises de multinível de Poisson.

Na segunda etapa, após determinação dos melhores pontos de corte, valores de sensibilidade, especificidade, acurácia e as áreas sob as curvas ROC (Az) de cada método foram calculados em três limiares de detecção. Para avaliação do desempenho dos métodos em detectar a atividade de cárie, os parâmetros de Diagnostic Odds Ratio (DOR), acurácia e Az foram calculados. A reprodutibilidade das avaliações do padrão de referência obtiveram valores de kappa maiores que 0,86. Os valores de F e Q do QLF (fluorescência verde) foram significantemente maiores nas lesões inativas do que nas ativas, tanto em lesões não-cavitadas, como nas cavitadas. Com o DIAGNOdent pen, somente na avaliação de lesões cavitadas, as medidas em lesões ativas diferiram significantemente das lesões inativas. No geral, a presença de biofilme visível sobre a superfície oclusal dos molares decíduos e R do dente (fluorescência vermelha obtida com o QLF) mostraram associação significante com a atividade de cárie. O exame visual, o DIAGNOdent pen e os valores de Q mostraram maior sensibilidade na detecção de lesões iniciais em esmalte. Para lesões em dentina o QLF mostrou menor especificidade do que o exame de inspeção visual. Os valores de DOR e Az mostraram similaridade entre os métodos para diferenciação de lesões ativas e inativas. Embora o QLF e DIAGNOdent pen mostrem bom desempenho na avaliação da atividade de cárie em molares decíduos, não mostram vantagens quando comparados à utilização da inspeção visual ou à simples avaliação da presença de biofilme visível.

The aim of this in vivo study was to evaluate the association of parameters obtained with fluorescence-based methods and the assessment of caries lesions activity in occlusal surfaces of primary molars, including the evaluation of red fluorescence emitted by the biofilm in this diagnosis process. Occlusal surfaces of 606 primary molars from 113 children aged 4-14 years were selected. The presence of biofilm, caries experience and the number of active lesions were evaluated. The presence of red fluorescent biofilm was also assessed by QLF (Quantitative Light-induced Fluorescence). After dental cleaning procedure, the green (F e Q) and red (R) fluorescence were evaluated with the QLF. The DIAGNOdent pen was also employed. For the first reference standard, all teeth were evaluated by 2 examiners using ICDAS associated with the caries activity assessment based on clinical characteristics of the lesions. For the second phase, 50 exfoliated or extracted primary molars were selected. Then, these teeth were sectioned and histologically validated by 2 examiners regarding depth and activity of the lesions; the latter using a pH detector dye. Multilevel linear regression analyses were carried out to compare the values of the fluorescence-based methods on the teeth classified by visual inspection as sound, with active or inactive lesions. Multilevel Poisson analysis evaluated the association of the parameters assessed by the fluorescencebased methods and explanatory variables. On the second phase, after obtaining the best cut-off points, the sensitivity, specificity, accuracy and area under ROC curve (Az) were calculated at three thresholds. The performance of the methods in detecting caries activity was evaluated by Diagnostic Odds Ratio (DOR), accuracy and Az values calculated.

Efeito de materiais restauradores em contato proximal com lesões de cárie em dentes decíduos / Mineral content of enamel carious lesions in approximal contact with different restorative materials in primary teeth

Por ser comum a existência de lesão de mancha branca em superfícies proximais adjacentes à lesões de cárie já cavitadas, este estudo teve como objetivo investigar o efeito terapêutico de materiais que liberam flúor sobre lesões com as quais estejam em contato proximal, in vitro (I) e in situ (II). Para o estudo I, 130 blocos de esmalte obtidos de caninos decíduos passaram pelo processo de indução de lesão de cárie por ciclagem de pH, durante 10 dias. As medições do conteúdo mineral foram realizadas por meio da análise de fluorescência induzida pela luz (QLF e VistaProof), no momento inicial (esmalte hígido) e após a formação das lesões de mancha branca. Dez espécimes foram recolhidos e seccionados transversalmente, no centro da lesão, para análise de dureza transversal (Shimadzu Micro Hardness tester, 25g, 15s). Posteriormente, blocos cilíndricos foram preparados com 6 diferentes materiais restauradores (n=20): resina composta (Z350®), cimento de ionômero de vidro (CIV) de alta viscosidade (Ketac Molar® e Riva Self Cure®), CIV modificado por resina (Vitremer®), CIV modificado por resina nanoparticulado (Ketac Nano®) e resinas compostas modificadas por poliácidos (Dyract Extra®). Cada bloco de esmalte foi unido a um bloco de material, de modo que a face da lesão e a do material simulassem o ponto de contato existente em uma restauração ocluso-proximal. Estes conjuntos sofreram então novo desafio cariogênico (ciclagem de pH) durante 7 (n=10) ou 14 dias (n=10). Após o desafio, os 120 espécimes foram recolhidos e novamente analisados com relação à fluorescência induzida. Em seguida, foram seccionados transversalmente no centro da lesão para que fosse feita a análise de dureza transversal. Para o estudo II, os espécimes foram preparados de maneira semelhante ao estudo I, porém, para a etapa do desafio cariogênico (após o contato com os materiais restauradores), os 120 espécimes foram inseridos em dispositivos intra-orais.

Dez voluntários utilizaram os dispositivos em duas fases (7 e 14 dias), com intervalo de 1 semana entre elas. Os voluntários gotejaram solução de sacarose 20%, 8 vezes/dia e utilizaram dentifrício fluoretado (1.450 ppm) 3 vezes/dia durante o estudo. Ao final de ambos os estudos, todos os espécimes foram recolhidos e analisados com relação ao conteúdo mineral pelos métodos de fluorescência induzida e pelo teste de microdureza transversal. Para análise de normalidade e homogeneidade dos dados obtidos foram utilizados os testes de Anderson-Darling e Levene, respectivamente. Para o estudo I, ANOVA de dois fatores com teste complementar de Tukey não demonstrou diferença entre os valores obtidos com o QLF para os diferentes grupos e tempos após desafio (=0,05). Para os valores de dureza, no entanto, o mesmo teste confirmou que há menor perda mineral para as lesões em contato com o CIV de alta viscosidade, quando comparado com a resina composta e com o resinas compostas modificadas por poliácidos. Após 14 dias de desafio, o CIV de alta viscosidade mostra-se superior também aos CIVs modificados por resina e compômer. Para o estudo II, análise de multinível demonstrou haver maior perda para aquelas lesões em contato com a resina composta e o resinas compostas modificadas por poliácidos, para os valores obtidos com o QLF, enquanto que para os valores de dureza o mesmo teste demonstra que os CIVs de alta viscosidade desempenham melhor performance comparado a todos os outros grupos de materiais, independente do tempo de desafio. Os valores obtidos com o equipamento Vista Proof não diferiram estatisticamente com relação aos grupos ou períodos experimentais, em ambos os estudos, de acordo com os testes de Mann-Whitney e Kruskal-Wallis (=0,05). Embora diferentes materiais liberadores de flúor possam reduzir a progressão de lesões de cárie quando em contato proximal, o CIV de alta viscosidade mostra-se com uma melhor opção para este fim.

This study investigated the possibility of caries lesions arrest when in approximal contact with fluoride-releasing restorative materials, in vitro (I) and in situ (II). White-spot lesions were initially formed in 130 primary enamel specimens via a pH cycling regimen during 10 days. Light-induced fluorescence images (QLF and Vista Proof) were made of each enamel slab at the beginning and after the lesions induction to assess the mineral loss/gain of the artificial caries lesions. Ten specimens were collected and transversally cut for microhardness analysis. The rest of them were put in contact with cylindrical blocks of 6 different materials (n=20): composite resin (Z350®), high viscous glass ionomer (GIC) (Ketac Molar® and Riva Self Cure®), resin-modified GIC (Vitremer®), resin- modified nano-ionomer (Ketac Nano®) and compomer (Dyract Extra®). These settings were designed to simulate the contact point between the restoration and the approximal lesion. For the study I, they were subjected to a new cariogenic challenge (pH cycling) for 7 (n=10) or 14 days (n=10). For the study II, the specimens were prepared in a similar manner and a randomized double-blind in situ design was conducted in two phases (7/14 days) for the subsequent cariogenic challenge. Ten volunteers wore palatal devices containing 6 specimens (caries lesion + restorative). The volunteers used fluoride dentifrice 3x/day and a 20% sucrose solution was dripped onto the slabs 8x /day. At the end of both studies, specimens were collected for mineral analysis by fluorescence methods and traversal microhardnes. Distribution of data and equality of variances were determined using KolmogorovSmirnov and Levene tests.

Efeito da condição do substrato e do tempo de condicionamento na estabilidade da união de sistemas adesivos à dentina de dentes decíduos / Effect of substrate condition and etching time on the bonds stability of adhesive systems to dentin of primary teeth

Este estudo objetivou investigar a influência da redução do tempo de condicionamento na união de sistemas adesivos à dentina hígida e afetada por cárie de dentes decíduos, por meio de testes de microtração, nanoinfiltração e avaliação micromorfológica da interface adesiva. A superfície dentinária de 48 segundos molares decíduos foi exposta e os dentes divididos aleatoriamente em 8 grupos experimentais de acordo com o substrato (dentina hígida e afetada por cárie ciclagem de pH por 14 dias), sistema adesivo (Adper Single Bond 2 adesivo convencional de dois passos e Clearfil SE Bond - sistema autocondicionante de dois passos) e tempo de condicionamento (recomendado pelo fabricante e metade do tempo). Desta forma, o adesivo Adper Single Bond 2 foi aplicado à dentina após condicionamento com ácido fosfórico a 35% por 15 ou 7 segundos e o agente de união do Clearfil SE Bond após 20 ou 10 segundos de aplicação do primer. Blocos de resina composta (Filtek Z250) foram confeccionados e, após 24 horas de armazenamento em água destilada, os dentes foram seccionados para obtenção de espécimes com área de secção transversal de aproximadamente 0,8 mm2. Metade dos espécimes foi submetida imediatamente ao teste de microtração e a outra metade após 12 meses de armazenamento em água destilada. O padrão de fratura foi avaliado em estereomicroscópio com aumento de 400x. Dois espécimes de cada dente nos respectivos períodos de armazenamento foram imersos em nitrato de prata amoniacal por 24 horas e revelados (8 horas) para avaliação da nanoinfiltração em microscopia eletrônica de varredura. Adicionalmente, dois dentes para cada grupo experimental (n=16) foram preparados como descrito para o teste de microtração e seccionados perpendicularmente à interface adesiva, após 24 horas, para análise da micromorfologia e espessura da camada híbrida.

Os valores de resistência de união, expressos em megapascal (MPa), foram submetidos à Análise de Variância (ANOVA) e teste de Tukey ( = 0,05). As demais avaliações foram descritivas. Os sistemas adesivos apresentaram valores similares de resistência de união imediata. Decréscimo dos valores de resistência de união ocorreu após 12 meses de armazenamento em água, exceto para o adesivo Clearfil SE Bond em substrato hígido. A adesão à dentina afetada foi menor em comparação à dentina hígida. A nanoinfiltração também foi mais pronunciada neste substrato. O tempo de condicionamento influenciou apenas a adesão do sistema adesivo Adper Single Bond 2. Maiores valores de resistência de união e menor infiltração de nitrato de prata na interface adesiva foram observados quando o tempo de condicionamento ácido foi reduzido pela metade, independente do substrato. Camadas híbridas mais finas foram produzidas quando a dentina decídua foi condicionada por 7 segundos, especialmente em dentina afetada. Predomínio de fratura adesiva/mista foi observado para todos os grupos experimentais. Em conclusão, o efeito da redução no tempo de condicionamento é material dependente e resulta em maior estabilidade da união de sistema adesivo convencional de dois passos à dentina hígida e afetada de dentes decíduos.

This study aimed to investigate the influence of shortening the etching time on bond of adhesive systems to sound and caries-affected dentin of primary teeth by microtensile and nanoleakage tests, and micromorphological evaluation of the adhesive interface. The dentinal surface of 48 second primary molars was exposed and the teeth were randomly assigned to 8 experimental groups according to substrate (sound and caries-affected dentin - pH-cycling for 14 days), adhesive system (Adper Single Bond 2 two-step etch-and-rinse adhesive system and Clearfil SE Bond two step self-etch adhesive system) and etching time (recommend by manufacturers and half-reduced time). Thus, the adhesive Adper Single Bond 2 was applied to dentin after 35% phosphoric acid etching for 15 or 7 seconds, and the bond of Clearfil SE Bond after 20 or 10 seconds of primer application. Composite resin blocks (Filtek Z250) were built and, after 24 hours of storage in distilled water, the teeth were sectioned to obtain specimens with cross-sectional area of approximately 0.8 mm2. Half of the specimens were immediately subjected to microtensile test and the other half after 12 months of storage in distilled water. The fracture pattern was evaluated with a stereomicroscope at 400x magnification. Two specimens from each tooth in the respective storage periods were immersed in ammoniacal silver nitrate for 24 hours and revealed (8 hours) to evaluate the nanoleakage in scanning electron microscope. Additionally, two teeth for each experimental group (n=16) were prepared as described for the microtensile test and perpendicularly sectioned to the adhesive interface, after 24 hours, for analysis of micromorphology and thickness of the hybrid layer.

Bond strength values, expressed in megapascal (MPa), were submitted to Analysis of Variance (ANOVA) and Tukeys tests ( = 0.05). Other evaluations were descriptive. The adhesive systems presented similar immediate bond strength values. A decrease in bond strength values occurred after 12 months of water storage, except for Clearfil SE Bond in sound substrate. Bonding to caries-affected dentin was lower compared to sound dentin. The nanoleakage was also more pronounced in this substrate. Etching time only influenced the bonding of the adhesive system Adper Single Bond 2. Higher bond strength values and lower infiltration of silver nitrate into adhesive interface were observed when the etching time was half-reduced, irrespective of the substrate. Thinner hybrid layers were produced when the primary dentin was acid etched for 7 seconds, especially in caries-affected dentin.