Considerations of the classification and treatment for fused teeth / 中华口腔医学杂志

Fused teeth were a phenomena of teeth anomalies in shape, which can affect the dental teeth both in primary and permanent dentition. Fused teeth do not only cause problems on crowding of dentition, abnormal occlusion and aesthetic, but also increase risks of dental caries, endodontics diseases, periapical diseases and periodontal diseases. Fusion of deciduous teeth may lead to abnormality of subsequent permanent teeth. Treatment of fused teeth may require multidisciplinary approach in endodontics, periodontics, oral and maxillofacial surgery, prosthodontics and orthodontics. The aim of the present article is to review the etiology, classification, clinical manifestations and treatment of fused teeth in order to provide dental clinicians with a reference of clinical management for fused teeth.

Study on the sterilization effect of plasma jet and plasma activated water on Streptococcus mutans / 生物医学工程学杂志

To explore the effects of plasma jet (PJ) and plasma activated water (PAW) on the sterilization of Streptococcus mutans ( S. mutans) and compare the advantages and disadvantages of the two methods, so as to provide a basis for plasma treatment of dental caries and to enrich the treatment means of dental caries, an atmospheric pressure plasma excitation system was built, and the effects of PJ and PAW on the sterilization rate of S. mutans and the changes of temperature and pH during treatment were studied under different excitation voltage ( U e ) and different excitation time ( t e ). The results showed that in the PJ treatment, the difference in the survival rate of S. mutans between the treatment group and the control group was statistically significant ( P = 0.007, d=2.66) when U e = 7 kV and t e = 60 s, and complete sterilization was achieved at U e = 8 kV and t e = 120 s in the PJ treatment. In contrast, in the PAW treatment, the difference in the survival rate of S. mutans between the treatment group and the control group was statistically significant ( P = 0.029, d = 1.71) when U e = 7 kV and t e = 30 s, and complete sterilization was achieved with PAW treatment when U e = 9 kV and t e = 60 s. Results of the monitoring of temperature and pH showed that the maximum temperature rise during PJ and PAW treatment did not exceed 4.3 °C, while the pH value after PAW treatment would drop to a minimum of 3.02. In summary, the optimal sterilization parameters for PJ were U e =8 kV and 90 s < t e ≤ 120 s, while the optimal sterilization parameters for PAW were U e = 9 kV and 30 s< t e ≤ 60 s. Both treatment methods achieved non-thermal sterilization of S. mutans, where PJ required only a smaller U e to achieve complete sterilization, while at pH < 4.7, PAW only required a shorter t e to achieve complete sterilization, but its acidic environment could cause some chemical damage to the teeth. This study can provide some reference value for plasma treatment of dental caries.

Materiales bioactivos para restauraciones directas en dientes posteriores / Bioactive materials for direct restorations in posterior teeth

Se trata de paciente femenino de 22 años de edad, en quien se realizó una restauración en un molar siguiendo la filosofía de mínima intervención desde el diagnóstico hasta la obturación con un material bioactivo. Los objetivos del tratamiento fueron devolver la funcionalidad y estética de dicho molar, pero sobre todo brindar una protección a largo plazo mediante la liberación y recarga de iones de calcio, fosfato y flúor proporcionado por el material bioactivo (AU)

t is about a female patient of twenty-two years, in which a restoration was made in a molar following the philosophy of minimal intervention from diagnosis to filling with a bioactive material. The objectives of the treatment were to restore the functionality and aesthetics, but mainly to provide long-term protection through the release and recharge of calcium, phosphate and fluoride ions provided by the bioactive material used (AU)

Abordagem conservadora de lesões cariosas profundas: uma revisão de literatura / Conservative approach to deep carious lesions: a literature review

O presente trabalho tem como objetivo realizar uma revisão de literatura e discutir os mais atuais conceitos sobre abordagem conservadora de lesões cariosas profundas, facilitando o manejo clínico. Para que essa abordagem conservadora seja implementada, é imprescindível que se conheça a composição estrutural e funcional do biofilme para, assim, entender a evolução da doença cárie que acomete a estrutura dentária. No entanto, quando se trata de um dente com lesão de cárie ativa com grande comprometimento de esmalte e dentina, procedimentos operatórios mais invasivos e restauradores podem ser necessários, mesmo que fundamentados na maior preservação possível de estrutura dentária. As evidências mais atuais encontradas na literatura recomendam a remoção seletiva do tecido cariado que consiste na dentina infectada, ou seja, clinicamente amolecida, e restauração definitiva na mesma sessão. Portanto, desde que o dente apresente vitalidade pulpar clinicamente confirmada, acredita-se que a preservação estratégica da dentina, poderá aumentar as chances de sucesso no tratamento, evitando possível exposição da polpa dentária. Adicionalmente, ao optar por práticas conservadoras no contexto da Odontologia de mínima intervenção, resultará em um significativo aumento na longevidade das restaurações sempre associando promoção de saúde ao paciente(AU)

This paper aims to conduct a literature review and discuss the most current concepts on conservative approach to deep carious lesions in permanent posterior teeth, facilitating clinical management. For this conservative approach to be implemented, it is essential to know the structural and functional composition of the biofilm in order to understand the evolution of the caries disease that affects the dental structure. However, when it comes to a tooth with an active caries lesion with major enamel and dentin compromise, more invasive and restorative surgical procedures may be necessary, even if based on the greatest possible preservation of the dental structure. The most current findings in the literature recommend the selective removal of carious tissue consisting of infected dentin, that is, clinically softened, and definitive restoration in the same session. Therefore, as long as the tooth has clinically confirmed pulp vitality, it is believed that the strategic preservation of dentin may increase the chances of successful treatment, avoiding possible exposure of the dental pulp. Additionally, when opting for conservative practices in the context of Minimally Invasive Dentistry, it will result in a significant increase in the longevity of restorations, always associating health promotion to the patient(AU)

Effect of liners on composite resin microleakage after selective carious lesion removal: an experimental study / Efecto de los recubrimiento en la microfiltración de resina compuesta después de la eliminación selectiva de lesiones cariosas: un estudio experimental

Objetive: To evaluate microleakage of composite resins (CR) placed over different cavitary liners after managing deep caries lesions through selective removal of soft carious tissue to soft dentin (SRCT-S). Material and Methods: Fifty four human teeth were collected for microleakage testing. Each assay comprised ICDAS 5 or ICDAS 6 carious lesions and sound teeth for controls. Sound teeth were prepared with cavities that mirrored the carious teeth cavities, which were prepared with SRCT-S. Sound and carious teeth were further randomly assigned to one of the three experimental groups: Group A: universal adhesive (UA) + CR, Group B: glass ionomer cement liner + UA + CR, and Group C: calcium hydroxide + UA+ CR. Occlusal microleakage (OM) and cervical microleakage (CM) was classified within one of 5 depth categories. ANOVA and Chi-square tests were computed (p<0.05). Results: OM and CM were similarly distributed across subgroups (p>0.05). All Group C samples with carious lesions presented some degree of microleakage. However, no statistically significant differences were observed between groups and within each group (p>0.05). Conclusion: Teeth restored with CR after SRCT-S using calcium hydroxide as a liner material seem to exhibit higher microleakage than those restored using glass ionomer or UA alone. Further clinical research is needed to deepen these findings. Clinical significance: The application of calcium hydroxide as a liner under a composite resin may reduce the longevity of a restoration after performing selective or partial removal of carious tissues. Clinicians should rethink the need of using calcium hydroxide for this application, albeit the lack of clinical evidence.

Objetivo: Evaluar la microfiltración de resinas compuestas (RC) colocadas sobre diferentes liners cavitarios después del manejo de lesiones de caries profundas mediante la remoción selectiva de tejido cariado blando hasta dentina blanda (SRCT-S). Material y Métodos: Se recolectaron 54 dientes humanos para pruebas de microfiltración. Cada ensayo comprendía lesiones cariosas ICDAS 5 o ICDAS 6 y dientes sanos para los controles. Se prepararon dientes sanos con cavidades que reflejaban las cavidades de los dientes cariados, que se prepararon con SRCT-S. Los dientes sanos y cariados se asignaron al azar a uno de los tres grupos experimentales: Grupo A: adhesivo universal (AU) + RC, Grupo B: revestimiento de cemento de ionómero de vidrio + AU + RC, y Grupo C: hidróxido de calcio + AU+ RC. La microfiltración oclusal (MO) y la microfiltración cervical (MC) se clasificaron dentro de una de las 5 categorías de profundidad. Se calcularon las pruebas ANOVA y Chi-cuadrado (p<0,05). Resultados: La MO y MC se distribuyeron de manera similar en los subgrupos (p> 0,05). Todas las muestras del Grupo C con lesiones cariosas presentaron algún grado de microfiltración. Sin embargo, no se observaron diferencias estadísticamente significativas entre grupos y dentro de cada grupo (p>0,05). Conclusión: Los dientes restaurados con RC después de SRCT-S usando hidróxido de calcio como material de revestimiento parecen exhibir una mayor microfiltración que aquellos restaurados usando ionómero de vidrio o AU solo. Se necesita más investigación clínica para profundizar estos hallazgos. Relevancia clínica: la aplicación de hidróxido de calcio como revestimiento debajo de una resina compuesta puede reducir la longevidad de una restauración después de realizar la eliminación selectiva o parcial de los tejidos cariados. Los médicos deberían reconsiderar la necesidad de usar hidróxido de calcio para esta aplicación, aunque no haya evidencia clínica.

Atención odontológica humanizada a un paciente con neurofibromatosis tipo 1 atendido en una clínica de odontología de especialización infantil: reporte de Caso / Humanized dental care for a patient with type 1 neurofibromatosis attended in a specialized children's dentistry clinic: case report / Atendimento odontológico humanizado a paciente com neurofibromatose tipo 1 atendido em ambulatório especializado de odontologia infantil: relato de caso

Este trabajo tiene como objetivo relatar el abordaje individualizado, inclusivo y humanizado de un niño de 4 años y tres meses, con diagnóstico de neurofibromatosis tipo 1, atendido en la Carrera de Especialización en Odontopediatría de la Escuela de Graduados, Facultad de Odontología, Universidad de la Repú blica, Montevideo, Uruguay. En el examen clínico se pudo observar cicatrices derivadas del tratamiento quirúrgico del neurofibroma plexiforme en la zona cervical y la presencia de hipotonicidad muscular oral. Al examen clínico intraoral, se observaron amplias zonas desdentadas a consecuencia de exodoncias de quince dientes deciduos. Presentaba lesiones activas de caries en los dientes remanentes, acompañado de biopelícula generalizada y sangrado gingival provocado. Se realizó un abordaje integral del paciente y la terapia rehabilitadora mediante el uso de prótesis parcial removible superior e inferior. Concluímos que el tratamiento odontológico educativo, preventivo, restaurador y rehabilitador fue satisfactorio y la empatía, como proceso dinámico, involucró mecanismos cognitivos, afectivos y conductuales, y fue reconocida por sus efectos positivos en la promoción de la salud bucal del paciente.

Este trabalho tem como objetivo relatar uma abordagem odontológica individualizada, inclusiva e humanizada, enfatizando a importância do tratamento de uma criança de 4 anos e três meses, com diagnóstico de neurofibromatose tipo 1, que foi encaminhada e tratada en la clínica de la Carrera de Especialización en Odontopediatria de la Escuela de Graduados, Facultad de Odontología, Universidad de la República. O exame clínico revelou cicatrizes decorrentes do tratamento cirúrgico do neurofibroma plexiforme que acometia o pescoço da criança e hipotonicidade muscular oral. Ao exame clínico intraoral, quinze dentes decíduos estavam ausentes e cinco com lesões de cárie na primeira infância, além de presença generalizada de biofilme microbiano nas superfícies dentais e sangramento gengival provocado. Foi realizado tratamento odontológico necessário ao paciente, com os devidos cuidados e terapia reabilitadora com prótese parcial removível superior e inferior. Concluímos que o tratamento odontológico educacional, preventivo, restaurador e reabilitador foi satisfatório e a empatia, como processo dinâmico, envolveu mecanismos cognitivos, afetivos e comportamentais e foi reconhecida por seus efeitos positivos na promoção da saúde bucal do paciente.

This paper aims to report an individualized, inclusive, and humanized dental approach, emphasizing the importance of treating a child aged four years and three months with neurofibromatosis type 1. The patient was referred and treated at the Clinic of the Specialization Course in Pediatric Dentistry of the Graduate School, School of Dentistry, Universidad de la República, Montevideo, Uruguay. The clinical examination revealed scars from the surgical treatment of the plexiform neurofibroma and neck and oral muscle hypotonicity. The intraoral clinical examination showed large edentulous areas as 15 deciduous teeth were missing. The patient had active carious lesions, generalized microbial biofilm on the tooth surfaces, and gingival bleeding. A comprehensive treatment was provided, as well as restorative therapy with upper and lower removable partial dentures. We conclude that the dental educational, preventive, restorative, and rehabilitation treatment was satisfactory. Furthermore, empathy, as a dynamic process, involved cognitive, affective, and behavioral mechanisms. It also helped enhance the patient's oral health.

Efficacy of Resin Infiltration and Fluoride Casein Phosphopeptide Amorphous Calcium Phosphate Varnish on Non-cavitated Active White Spot Lesions in Children: A Randomized Clinical Trial

Abstract Objective: To compare the efficacy of resin infiltration and fluoride casein phosphopeptide amorphous calcium phosphate varnish on non-cavitated active white spot lesions in 5-8 years old children. Material and Methods: 60 non-cavitated active white spot lesions in 60 patients with ICDAS II score 2 from both genders in the age range of 5 to 8 years were taken. Thirty lesions were treated by resin infiltration (Group 1) and 30 by Fluoride CPP-ACP varnish (Group 2). Resin infiltration was performed on the same day, while Fluoride CPP-ACP varnish was applied once a week for 4 weeks. The follow-up was done at 3, 6 months, and 12 months. Results: At 3, 6, and 12 months change in mean ICDAS II Score in group 1 was 1.5±0.5,1.13±0.73 and 0.9±0.88, respectively, while in group 2, it was observed to be 0.30±0.59, 0.4±0.89 and 0.06±0.82, respectively (p<0.001). Conclusion: Resin infiltration was more successful than Fluoride CCP-ACP varnish in active non-cavitated white spot lesions (AU).

Comparación del desempeño técnico-asistencial en programas escolares con diferentes modalidades de implementación / Comparison of technical-assisstance performance in school programs with different implementation modalities

Se comparó el desempeño técnico-asistencial de 2 programas de atención odontológica con iguales protocolos de atención y diferente modalidad de implementación. Ambos programas se caracterizaron por un perfil preventivo-promocional; uso de protocolos validados según riesgo biológico, atención odontológica adaptada a sedes no convencionales, recursos asignados por método de necesidades; ejecución por recurso humano pre-profesional supervisado y modulación por altas. La modalidad de implementación difirió en la densidad/concentración de las actividades realizadas: en el Programa Extensivo (PE) las acciones se implementaron con frecuencia semanal; en el Programa Intensivo (PI) las acciones se concentraron en una semana en el año. Cobertura anual: PE = 120 escolares de 6 a 9 años de edad; PI = 180 escolares y preescolares de 3 a 12 años de edad. Se midió la cantidad de prestaciones, sesiones y tiempo -en minutos- hasta alcanzar el Alta Básica Operativa (ABO). Para comparar grupos (PI y PE) se utilizaron los tests: U de Mann Whitney, t de Student para mues-tras independientes, chi cuadrado y comparación de proporciones. La razón de prestaciones/sesión fue significativamente mayor (p=0,000) en el programa intensivo. El número de prestaciones hasta el alta (ABO) y la razón tiempo/sesión no mostraron diferencias entre programas (p=0,8 p=0,087), mientras que se evidenció una mayor razón tiempo/prestación y tiempo en alcanzar el alta (ABO) en la modalidad extensiva (p=0,000). La modalidad intensiva mostró mayor eficiencia en el desempeño técnico asistencial que la extensiva (AU)

Aim: To compare technical-care performance of 2 dental care programs with the same care protocols and different implementation modalities. Both programs shared the following features: preventive-promotional profile; use of validated clinical protocols according to biological risk, dental care adapted to non-conventional settings, allocation of resources by needs method; supervised pre-professional human resource and modulation by discharges. The implementation mode differed in the density/concentration of the activities: in the extensive program (EP) the actions were implemented on a weekly basis along the year; in the intensive program (IP) the actions were concentrated in one week in the year. Annual coverage of the programs: 180 schoolchildren and preschoolers (3 -12 years old); EP = 120 schoolchildren (6 - 9 years old). We measured the following variables: the number of dental services performed, the number of sessions and the time, in minutes, to reach the basic operating discharge (BOD). We used the following tests to compare groups (IP and EP): Mann Whitney U; Student's t for independent samples, chi square and comparison of proportions test. The action per session ratio was significantly higher (p=0.000) in the intensive program. The number of actions performed until discharge (BOD) and the time per session ratio did not show differences between programs (p=0.8 p=0.087). In the extensive mode, compared to intensive mode, it took longer to reach discharge (BOD) (p=0.000) The program implemented with intensive modality (PI) showed greater efficiency regarding technical-care performance when compared to the extensive mode (AU)

O tratamento da lesão de cárie dentária não cavitada é efetivo? Uma revisão sistemática / Is the treatment of non-cavitated dental caries lesion effective? A systematic review

Os métodos contemporâneos de diagnóstico e tratamento de cárie preconizam uma distinção entre lesões cavitadas e não cavitadas, ativas e inativas e, quando possível, intervenções minimamente invasivas. A pergunta de pesquisa desta revisão sistemática foi: O tratamento de lesões não cavitadas de cárie é efetivo em impedir o aparecimento de cavidade dentária, restauração, dor de dente ou perda de dente, em indivíduos com dentes decíduos ou permanentes?. Foi feita uma busca bibliográfica nas principais bases de dados até o ano de 2020. Duas revisoras selecionaram os estudos e extraíram os dados independentemente. Nos casos em que houve discordância, uma terceira revisora foi consultada e a disputa foi resolvida por consenso. A análise de risco de viés foi executada utilizando-se a ferramenta RoB2 e avaliação de certeza da evidência utilizando o sistema GRADE. Foram obtidos 4.108 títulos, e após a remoção dos títulos duplicados e da aplicação dos critérios de exclusão, selecionou-se 19 estudos. Nenhum estudo apresentou o risco para o indivíduo de desenvolver pelo menos um evento relacionado aos desfechos de interesse, por isso não foi possível realizar metanálise de risco. Dez estudos apresentaram os resultados em número médio de lesões cavitadas em dentina ou restauradas por indivíduo, permitindo que fossem feitas metanálises de diferenças nas médias. Várias combinações foram feitas, uma vez que alguns estudos apresentavam mais de uma intervenção a ser comparada com placebo ou higiene bucal. Os resultados das metanálises foram semelhantes, com a estimativa pontual da diferença na média variando entre -0,22 e -0,27 nas diversas metanálises executadas. Ou seja, em média, por indivíduo, houve entre menos 0,22 e menos 0,27 dente com cavidade de cárie em dentina (ou com restauração) no grupo que recebeu tratamento em comparação com o grupo que recebeu o placebo ou nenhum tratamento. O Índice de Higgins (I2) nos diz a proporção da variabilidade nas estimativas de efeito que pode ser atribuída à heterogeneidade entre os estudos e não ao acaso. Com base neste índice, a heterogeneidade foi substancial em todas as metanálises, variando entre 69% e 76%. Conclusão: nenhum estudo avaliou a efetividade do tratamento não invasivo de lesões não cavitadas (mancha branca) em evitar dor ou perda de dente. Poucos estudos avaliaram a efetividade do tratamento em evitar cavidades ou restaurações. Dentre esses poucos estudos, o tratamento teve um efeito relativamente modesto. O risco de viés nos estudos incluídos foi, de uma forma geral, alto ou moderado e a certeza da evidência foi baixa. Pesquisas sobre cárie dentária devem incluir desfechos verdadeiros para que seja possível conhecer a efetividade das diferentes intervenções precoces em evitar cavidades em dentina, restaurações, dor e perda de dentes.

Contemporary methods of diagnosing and treating caries advocate a distinction between cavitated and non-cavitated, active and inactive lesions and, when possible, minimally invasive interventions. The research question of this systematic review was: Is the treatment of non-cavitated caries lesions effective in preventing the appearance of dental cavity, restoration, toothache or tooth loss, in individuals with deciduous or permanent teeth?. A bibliographic search was carried out in the main databases until the year 2020. Two reviewers independently selected the studies and extracted the data. In cases where there was disagreement, a third reviewer was consulted and the dispute was resolved by consensus. Bias risk analysis was performed using the RoB2 tool and evidence certainty assessment using the GRADE system. A total of 4,108 titles were obtained, which after removing duplicate titles and applying the exclusion criteria, 19 studies were selected. No study presented the risk for the individual of developing at least one event related to the outcomes of interest, so it was not possible to perform a risk meta-analysis. Ten studies presented the results in terms of the average number of cavitated or restored dentin lesions per individual, allowing meta-analyses of differences in averages to be performed. Various combinations were made, as some studies had more than one intervention to be compared with placebo or oral hygiene. The results of the meta-analyses were similar, with the point estimate of the difference in the mean varying between -0.22 and -0.27 in the various meta-analyses performed. That is, on average, per individual, there were between 0.22 and 0.27 fewer teeth with dentin (or filled) carious cavity in the group that received treatment compared to the group that received the placebo or no treatment. The Higgins Index (I2) tells us the proportion of variability in effect estimates that can be attributed to heterogeneity across studies rather than chance. Based on this index, heterogeneity was substantial in all meta-analyses, ranging from 69% to 76%. Conclusion: no study has evaluated the effectiveness of non-invasive treatment of non-cavitated lesions (white spot) in preventing pain or tooth loss. Few studies have evaluated the effectiveness of the treatment in preventing cavities or restorations. Among these few studies, treatment had a relatively modest effect. The risk of bias in the included studies was generally high or moderate and the certainty of evidence was low. Research on dental caries must include true outcomes so that it is possible to know the effectiveness of different early interventions in preventing dentin cavities, restorations, pain and tooth loss.

Research progress in vital pulp therapy in mature permanent teeth with carious pulp exposure / 中华口腔医学杂志

Vital pulp therapy(VPT)is an important pathway to preserve and maintain pulp tissue in a healthy state. VPT has been improved recently as the new progress achieved in pathobiology, bioactive materials and clinical research. The present review summarizes the clinical outcomes and prognostic factors of VPT, including direct pulp capping, partial pulpotomy and full pulpotomy in mature permanent teeth with carious pulp exposure, and briefly introduces the new progress in this field.

Decisions about the diagnostic and treatment criteria of dental caries among a group of dental students, faculty staff and dentists within the city of Medellin, Colombia / Decisiones sobre los criterios de diagnóstico y tratamiento de la caries dental entre un grupo de estudiantes de odontología, profesores y odontólogos de la ciudad de Medellín, Colombia

Objective: To analyze the criteria for diagnosis and treatment decision-making in relation to dental caries in different participants (teachers of dentistry, dental students at dental schools, and dentists practicing at public oral health services) in the city of Medellin (Colombia). Material and Methods: A cross-sectional study was applied in the period September 2015-december 2016 by means of an international validated questionnaire in 340 participants (dental teachers: 69, dental students: 193, dentists: 78). The survey addressed several topics related to detection and restorative threshold, preferences of preparation type, restorative materials used and opinions about diagnosis and treatment for dental caries. A descriptive analysis was carried out and Chi square tests were applied to observe statistically significant differences between the study variables.Results: 340 participants were surveyed among teachers who teach cariology, health care dentists, and undergraduate final-year students. Most participants were women (70%). The age mean was higher for DDSs (46 ± 9 years). On average, practicing dentists and dental teachers had a work experience of 21 ± 9 years. In case of treatment decisions, the majority of the surveyed would use immediate operative restorative treatment for advanced carious lesions (inner one-third of the dentin for approximal and grade 5 for occlusal). In addition, respondents reported different cavities diagnosis for clinical occlusal cases and some significant statistically differences were found for restorative treatment decisions and type of materials according to the type of participant. Conclusion: Criteria for diagnosis and treatment of dental caries differed among the student, dentist and dental teachers with variety in diagnosis and treatment concepts. However, a conservative tendency for restorative treatment decisions was observed. Strategies for incorporating non-restorative and minimal measures in professional practice should be considered in curricula of universities.

Objetivo: Analizar los criterios para la toma de decisiones diagnósticas y terapéuticas en relación a la caries dental en diferentes participantes (docentes, estudiantes de odontología de las facultades de odontología y odontólogos de los servicios públicos de salud bucal) de la ciudad de Medellín (Colombia). Material y Métodos: Se aplicó un estudio transversal en el período septiembre 2015 - diciembre 2016 mediante cuestionario internacional validado en 340 participantes (profesores de odontología: 69, estudiantes de odontología: 193, odontólogos: 78). La encuesta abordó varios temas relacionados con la detección y el umbral de restauración, las preferencias del tipo de preparación, los materiales de restauración utilizados y las opiniones sobre el diagnóstico y el tratamiento de la caries dental. Se realizó un análisis descriptivo y se aplicaron pruebas de Chi cuadrado para observar diferencias estadísticamente significativas entre las variables de estudio. Resultados: Se encuestó a 340 participantes entre profesores que imparten clases de cariología, odontólogos y estudiantes de último año de pregrado. La mayoría de los participantes eran mujeres (70%). La edad media fue mayor para los odontólogos (46 ± 9 años). En promedio, los odontólogos y los profesores de odontología tenían una experiencia laboral de 21 ± 9 años. En caso de decisiones de tratamiento, la mayoría de los encuestados utilizaría tratamiento restaurador quirúrgico inmediato para lesiones cariosas avanzadas (tercio interno de la dentina para proximal y grado 5 para oclusal). Además, los encuestados informaron diferentes diagnósticos de caries para los casos clínicos oclusales y se encontraron algunas diferencias estadísticamente significativas para las decisiones de tratamiento restaurativo y el tipo de materiales según el tipo de participante. Conclusion: Los criterios para el diagnóstico y tratamiento de la caries dental fueron diferentes entre los estudiantes, odontólogos y profesores de odontología con variedad en los conceptos de diagnóstico y tratamiento. Sin embargo, se observó una tendencia conservadora para las decisiones de tratamiento restaurativo. Las estrategias para incorporar medidas mínimas y no restaurativas en la práctica profesional deben ser consideradas en los planes de estudio de las universidades.

El ciclo repetitivo en la Odontología Restauradora / The repetitive cycle in Restorative Dentistry

Los cambios en la vida, así como también en el campo de la Odontología, deben ser para mejorar siempre en todos los aspectos posibles. Y muchos de los cambios recientes en la Odontología Restauradora están encaminados a la utilización de materiales estéticos para remplazo de restauraciones metálicas previas, sin generar certeza total de ser mejores opciones. Esto ha generado un marcado incremento en la tendencia a practicar, más enfáticamente, el remplazo de restauraciones previas (AU)

Changes in life, as so in the field of Dentistry, should always be for the improvement on most possible aspects. Many of the recent changes in Restorative Dentistry are focus on the use of cosmetic materials to replace previous metallic restorations, without total certainty of being better options. This has generated a marked increase in the tendency to practice, more emphatically, the replacement of previous restorations (AU)

Mantenedor de espacio funcional elaborado con corona de NuSmile / Elaborated functional space maintainer with zirconia NuSmile crown

La caries de la infancia temprana, al igual que otras formas de caries, se caracteriza por ser multifactorial, infecciosa y de rápida evolución. Puede presentarse como lesiones cavitadas o no cavitadas, se diagnostica principalmente en menores de seis años en la superficies de los dientes anterosuperiores, debido a que son los primeros órganos dentales en erupcionar y tienen mayor contacto con el estímulo cariogénico. En casos severos pueden llegar a ocasionar la pérdida de órganos dentales, influyendo en la salud general del paciente y repercutiendo en su autoestima y desarrollo psicosocial. Para devolver las características y funciones perdidas en ausencia de algún órgano dental, se recurre a sustituirlo mediante aparatología, mayormente en forma de un mantenedor de espacio funcional. Las necesidades estéticas individuales de cada caso generan diversas alternativas para adaptarnos a la situación del paciente (AU))

Early childhood caries, like other forms of caries, is characterized by being multifactorial, infectious, and rapidly evolving. It can present as cavitated or uncavitated lesions, it is mainly diagnosed in children under six years of age on the surfaces of the anterior superior teeth, because they are the first dental organs to erupt and have greater contact with the cariogenic stimulus. In severe cases they can cause the loss of dental organs, influencing the general health of the patient and impacting on their self-esteem and psychosocial development. In order to restore the lost features and functions in the absence of any dental organ, it is resorted to by means of appliances, mostly in the form of a functional space maintainer. The individual aesthetic needs of each case generate various alternatives to adapt to the patient's situation (AU)

Diseño y validación de un instrumento sobre las capacidades cognitivo-prácticas para el tratamiento con mínima intervención de la caries dental en la carrera de Estomatología / Design and validation of a tool about cognitive-practical capacities for the minimal intervention treatment of dental caries in undergraduate dental training

Introducción : El desarrollo científico-tecnológico en el tratamiento de la caries dental hace necesario la sistematización del proceso de enseñanza-aprendizaje y una didáctica apropiada que permita que los educandos adquieran conocimientos y habilidades para su ejercicio. Objetivo : Diseñar y validar un instrumento para la medición de la correspondencia del plan de estudios y de la estrategia didáctica con las capacidades cognitivo-prácticas necesarias para el tratamiento de mínima intervención de la caries dental en la carrera de Estomatología. Métodos : Estudio de desarrollo tecnológico en el que participaron 28 expertos seleccionados sobre la base de su trayectoria docente, científica y experiencia en el tema. Los mismos ofrecieron sus opiniones a través de cuestionarios autogestionados respecto a la claridad, coherencia, precisión, relevancia y presentación del instrumento mencionado. Se empleó la Razón de validez de contenido, por el método de Tristán y el índice de validación de contenido. Resultados : La totalidad de los ítems fueron válidos en los 4 criterios medidos, por lo que coincidieron los índices de validación de contenido global y aceptable. El instrumento mostró coherencia, precisión y relevancia la claridad con cifras de índice de validación de contenido de 0,90; 0,93; 0,92; y 0,94, respectivamente. Conclusiones : Se diseñó y validó un instrumento efectivo en contenido y presentación, por lo que está disponible para continuar con la siguiente etapa para su aprobación final(AU)

Introduction: Scientific and technological development in the treatment of dental caries requires systematization of the teaching-learning process and an appropriate methodology fostering the acquisition of knowledge and skills necessary for professional practice. Objective: Design and validate a tool to measure the correspondence of the curriculum and the didactic strategy to the cognitive-practical capacities required for the minimal intervention treatment of dental caries in undergraduate dental training. Methods: A technological development study was conducted with 28 experts selected for their teaching experience, their scientific background and their knowledge about the topic. The experts contributed their opinions through self-administered questionnaires about the clarity, coherence, accuracy, relevance and layout of the tool. Use was made of content validity ratio by the Tristan method and the content validation index. Results: All the items were found to be valid in terms of the four criteria measured, showing agreement between global and acceptable content validation indices. The tool exhibited coherence, accuracy, relevance and clarity, with content validation index values of 0.90, 0.93, 0.92 and 0.94, respectively. Conclusions: A tool was designed and validated which is effective for its content and presentation. It is therefore available for final validation(AU)

Manejo e integración estomatológica del paciente pediátrico con trastorno de Asperger / Management and dental integration of the pediatric patient with Asperger disorder

Trastorno neurológico enmarcado dentro de los trastornos de espectro autista (TEA) cuyas manifestaciones se reflejan en los ámbitos de la comunicación, interacción e imaginación social. Se clasifica en el manual diagnóstico y estadístico de trastornos mentales (DSM IV), se caracteriza por un mayor o menor grado de deterioro en las habilidades de lenguaje y comunicación, así como patrones repetitivos o restrictivos de pensamiento y comportamiento. El síntoma más distintivo es el interés obsesivo en un solo objeto o tema y la exclusión de cualquier otro pero siempre conservando habilidades de lenguaje. El pronóstico es bueno, debido a la compensación cognitiva, el enfoque repetitivo y restrictivo a actividades humanas productivas o generadoras de deferencias particulares, aunque no hay tratamiento específico, sino más bien interdisciplinario e individualizado, éste consiste en manejar los síntomas conductuales y la comorbilidad de forma independiente ya sea farmacológica o intervencionista. Paciente masculino de cinco años de edad, con un peso de 26 kg, cuadro de inmunizaciones completas, previamente diagnosticado con trastorno de Asperger (2015); caries dental de diversos grados, manejo estomatológico para su rehabilitación. El objetivo de este reporte es dar a conocer los cuidados para el tratamiento dental en pacientes con este trastorno (AU)

Neurological disorder known as autism spectrum disorders (ASD) whose main manifestations are reflected in the areas of communication, interaction and social imagination. It was first classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM lV), characterized by a greater or lesser degree of deterioration in language and communication skills, as well as repetitive patterns or restrictive of thought and behavior. The most distinctive symptom is obsessive interest in a single object or topic and the exclusion of any other, but always retaining language skills. The prognosis is good in most of the cases, due to the cognitive compensation, the repetitive and restrictive approach to productive or deferential human activities, although there is no specific treatment, but rather interdisciplinary and individualized, this consists of managing behavioral symptoms and comorbidity independently either pharmacologically or interventionally. Male patient with five years old and weight of 26 kg, complete immunization chart, previously diagnosed with Asperger's disorder (2015); with dental caries of various degrees implementing dental management. The objective of this report is to make aware of the care and behavior management for dental treatment in patients with this Disorder (AU)

Non-invasive and micro-invasive treatments to arrest active occlusal carious lesions in erupting permanent molars: A randomized clinical trial

Abstract: This study aimed to evaluate the efficacy of non-invasive and micro-invasive treatments on the arrest of occlusal enamel carious lesions in erupting permanent molars. This two-arm randomized clinical trial included 27 subjects, aged 5-11 years, with 64 erupting permanent molars presenting active occlusal enamel carious lesions (as assessed by the International Caries Detection and Assessment System [ICDAS]; scores 1-3). The sample was randomly assigned into two treatment groups: 1) resin-modified glass ionomer cement sealant (Clinpro XT Varnish; 3M ESPE) and 2) 4-week topical fluoride varnish application (Duraphat; Colgate). All children and parents received oral hygiene and dietary instructions. Teeth were evaluated at baseline and 3, 6, 9, and 12 months regarding the eruption stage, biofilm accumulation, as well as severity and activity of the carious lesions. The Kaplan-Meier method was used to evaluate the survival estimates for inactivation of the carious lesions for both treatment groups. Multivariate Cox regression models with shared frailty were performed to identify factors associated with the outcome (p < 0.05). After 12 months, 22% and 3% of the lesions treated with topical fluoride varnish and sealant, respectively remained active. The adjusted model demonstrated that younger children had a higher probability of active enamel carious lesions arresting (hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.22-0.78; p=0.01). However, the probability of active enamel carious lesions arresting after sealant application was 8.85 times higher compared with fluoride varnish applications (p=0.01). Sealing is a more effective approach than fluoride varnish for arresting occlusal enamel carious lesions in erupting permanent molars.

Análise do perfil da manifestação e tratamento de lesões de cárie em crianças de 0 a 10 anos, participantes de um programa de prevenção / Analysis of the profile of the manifestation and treatment of caries lesions in children from 0 to 10 years old, participating in a prevention program

O objetivo dessa pesquisa foi analisar o perfil da manifestação de lesões de cárie em pacientes de 0 a 10 anos de idade atendidos em um Programa Odontológico Educativo Preventivo (POEP). Neste projeto as crianças foram atendidas dos 0 aos 5 anos de idade na Bebê-Clínica (BC) e dos 5 aos 10 anos na Clínica de Prevenção (CP). Foram analisados 754 prontuários e destes, selecionados 381, cujas crianças apresentaram lesão de cárie dentária. Dados como sexo, dente acometido, tipo de lesão, tratamento realizado e data da ocorrência foram registrados em planilha do Microsoft Excel 2010. Análises estatísticas descritivas e inferenciais foram realizadas pelo programa Sigma Plot 12.0. Foram utilizados os testes Qui-Quadrado e de Mann-Whitney, ambos com nível de significância de 5%. Dos prontuários selecionados, 178 (47%) eram de crianças do sexo masculino e 203 (53%) do sexo feminino. Um total de 1375 lesões foram registradas e o grupo de dentes mais acometido foi o de molares decíduos inferiores (31,4%). O dente 55 foi o mais frequente (10,1%) e a superfície oclusal, a mais envolvida (41%). Na BC o grupo de dentes mais acometido foi o de molares inferiores (37%), sendo os dentes 75 e 51 os mais frequentes, ambos com 9,7%, e a superfície vestibular, a mais afetada, com um total de 172 (45%) ocorrências. Na CP prevaleceram os molares decíduos superiores com 33% do total, sendo o dente 55 o mais afetado (11,8%) e a face oclusal, a mais acometida, com 447 (45%) ocorrências. Em relação ao tipo de lesão, tanto na BC quanto na CP prevaleceu a cárie cavitada em esmalte com 47% e 71%, respectivamente. O tipo de tratamento mais realizado foi o tratamento restaurador na BC (50,6%) e na CP (90,5%). Conclui-se durante o POEP que a lesão de cárie ocorreu com maior frequência em dentes posteriores, sendo o dente 55 o mais afetado (10,1%) e a superfície oclusal a mais acometida (41%). Entretanto, considerando separadamente as fases BC e CP, os resultados diferiram para o dente e superfície mais afetados(AU)

The aim of this research was to analyze the profile of the manifestation of caries lesions in patients aged 0 to 10 years old treated in a Preventive Dental Education Program (POEP). In this project, children were assisted from 0 to 5 years of age at the Baby-Clinic (BC) and from 5 to 10 years at the Prevention Clinic (CP). A total of 754 medical records were analyzed, and of these, 381 were selected, whose children had dental caries lesions. Data such as sex, affected tooth, type of injury, treatment performed and date of occurrence were recorded in a Microsoft Excel 2010 spreadsheet. Descriptive and inferential statistical analyzes were performed using the Sigma Plot 12.0 program. The Chi-Square and Mann-Whitney tests were used, both with a significance level of 5%. Of the selected records, 178 (47%) were from male children and 203 (53%) were female. A total of 1375 injuries were recorded and the group of teeth most affected was the lower primary molars (31.4%). Tooth 55 was the most frequent (10.1%) and the occlusal surface was the most involved (41%). In BC, the group of teeth most affected was the lower molars (37%), with teeth 75 and 51 being the most frequent, both with 9.7%, and the buccal surface, the most affected, with a total of 172 (45%) occurrences. In PC, the upper primary molars prevailed with 33% of the total, with tooth 55 being the most affected (11.8%) and the occlusal surface being the most affected, with 447 (45%) occurrences. Regarding the type of lesion, both in BC and PC, cavitated enamel caries prevailed with 47% and 71%, respectively. The most common type of treatment was restorative treatment in BC (50.6%) and CP (90.5%). It was concluded during the POEP that dental caries lesions occurred more frequently in posterior teeth, with tooth 55 being the most affected (10.1%) and the occlusal surface being the most affected (41%). However, considering BC and CP phases separately, the results differed for the most affected tooth and surfasse(AU)

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

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

Methods for Caries Prevention in Children Reported by Dentists from a Brazilian Community

ABSTRACT Objective: To describe the dental practice patterns related to caries prevention in children aged 6-18 years and associated factors. Material and Methods: Dentists (n=162) from Araraquara, Brazil, completed two paper questionnaires: (1) one about characteristics of their practice and their patient population; and (2) a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" Questionnaire from the National Dental Practice-Based Research Network. Regression analyses were used for data analysis (p<0.05). Results: Dentists reported using in-office fluoride (IOF) and dental sealants (DS) in 74.2% and 45.1% of their pediatric patients, respectively. Regression analysis showed that female dentists (p=0.035 for DS; p=0.044 for IOF; p=0.011 for non-prescription fluoride rinse), those with advanced degrees (p=0.032 for prescription of fluoride), those who graduated from a private dental school (p=0.018 for chlorhexidine rinse), those who provided caries prevention regimens (p<0.001 for DS; p=0.004 for IOF; p=0.013 for non-prescription fluoride rinse), those with a greater percentage of patients interested in a caries prevention regimen (p=0.007 for non-prescription fluoride rinse), those working in a private practice model (p=0.047 for prescription of fluoride) were more likely to recommend some type of preventive methods to their pediatric patients. Conclusion: Dentists reported recommending IOF to most of their pediatric patients. Certain dentists', practices', and patients' characteristics were associated to some caries prevention regimens recommended by dentists.