Fluoruro de estaño en el control de cavidades sin restauración en dientes temporales / Stannous fluoride in nonrestorative cavity control in primary teeth

Introducción: el control de cavidades sin restauración (NRCC, por sus siglas en inglés), es una opción de tratamiento conservador y no invasivo para dentina cariosa, sobre todo en dentición temporal. Una de las estrategias del NRCC es la remineralización. El fluoruro de estaño (FDE) puede considerarse, como una opción viable ya que existe evidencia de su eficacia cariostática. Objetivo: valorar al FDE como remineralizante alternativo en dentina de molares temporales, asociado al NRCC. Material y métodos: se efectuó un estudio clínico, epidemiológico, y descriptivo con preescolares voluntarios de 3 a 5 años de edad con consentimiento firmado de participación en el estudio, y que presentaron molares con ICDAS 5 y 6. La aplicación del FDE a 0.8%, la evaluación de la dureza de la dentina con los criterios de Nyvad, y el diagnóstico del estado pulpar, la efectuó un operador entrenado para esta finalidad. Se aplicó un análisis estadístico descriptivo y uno no paramétrico. Resultados: el efecto cariostático producido por el FDE a 0.8%, sobre dentina afectada de molares temporales de niños mexicanos fue estadísticamente significativo durante cinco meses. Conclusiones: la aplicación de fluoruro de estaño puede considerarse como una alternativa de tratamiento cariostático asociado al NRCC para niños de 3 a 5 años de edad (AU)

Introduction: nonrestorative cavity control (NRCC), is a conservative and non-invasive treatment option for carious dentin, especially in primary dentition. One of the NRCC strategies is remineralization. Stannous Fluoride (SDF) can be considered as a viable option since there is evidence of its cariostatic efficacy. Objective: to evaluate FDE as an alternative remineralizing agent in the dentin of primary molars, associated with NRCC. Material and methods: a clinical, epidemiological, and descriptive study was carried out with preschool volunteers aged 3 to 5 years with signed consent to participate in the study, and who presented molars with ICDAS 5 and 6. The application of FDE at 0.8%, the evaluation of dentin hardness with the Nyvad criteria, and the diagnosis of pulp status, was carried out by an operator trained for this purpose. A descriptive and non-parametric statistical analysis was applied. Results: the cariostatic effect produced by 0.8% FDE on affected dentin of primary molars of Mexican children was statistically significant for five months. Conclusions: the application of stannous fluoride can be considered as an alternative cariostatic treatment associated with NRCC for children 3 to 5 years of age (AU)

Desenvolvimento e caracterização fisico-química de um selante resinoso com propriedades antimicrobianas associadas à incorporação do extrato do caule de Schinopsis brasiliensis (Braúna) / Development and physicochemical characterization of a resinous sealant with antimicrobial properties associated with the incorporation of Schinopsis brasiliensis (Braúna) stem extract

Introdução: os selantes resinosos possuem atividade preventiva e terapêutica da cárie dentária oclusal através da criação de uma barreira física que impede a adesão de biofilme. Não existem relatos destes materiais com propriedades antimicrobianas e, neste ensejo, a adição de princípios ativos obtidos de fitoterápicos configura como uma opção possível para resolver esta limitação. Objetivos: avaliar o potencial antimicrobiano do selante Fluroshield® enriquecido com o extrato do caule de Schinopsis brasiliensis (Braúna), bem como, a liberação do princípio ativo, grau de conversão, resistência de união imediata ao esmalte e padrão de falha dos materiais experimentais. Metodologia: trata-se de um estudo experimental in vitro. As cascas da Braúna foram secas a 40 ± 1 °C e o extrato etanólico foi obtido por percolação do pó da casca da Schinopsis brasiliensis. O selante comercial Fluroshield® (Dentsply) foi enriquecido com as proporções em massa (g) [0% (Controle), 20%, 10%, 5%, 2,5% e 1,25%]. Foi realizada a avaliação da Atividade antimicrobiana, a liberação do princípio ativo foi aferida através de Ultra Cromatografia Líquida de Alta Performance (UHPLC), o grau de conversão (GC) através do Micro-Raman, a resistência de união (RU) imediata ao esmalte foi avaliada através do microcisalhamento e padrão de fratura através de análise em estereomicroscópio. Os valores finais foram submetidos aos testes de normalidade Shapiro-Wilky (p > 0,05) e Levene. Os dados paramétricos foram submetidos a análise de variância (ANOVA one-way) com pós-teste de Tukey (p <0,05) e os não paramétricos através do teste de Kruskal-Wallis com pós-teste de Dunn's através do software GraphPad Prism 8 e Microsoft Excel 2018. Resultados: materiais com maior % de extrato apresentaram menor GC, não houve diferença estatisticamente significativa para RU entre os diferentes grupos, o padrão de fratura predominante foi adesiva, houve liberação do princípio ativo em meio aquoso em todos os materiais e os grupos com 20% e 10% de extrato em massa foram capazes de inibir a formação de biofilme de maneira semelhante ao controle positivo (clorexidina 0,12%). Conclusão: a adição do extrato de Schinopsis brasiliensis em concentrações entre 10% e 20% apresenta-se como uma alternativa promissora para a obtenção de propriedades antimicrobianas em selantes resinosos (AU).

Introduction: dental sealants have a preventive and therapeutic activity in the prevention and treatment of dental caries. However, there are no reports of these materials with antimicrobial properties and the addition of phytotherapy molecules would be an option to solve this limitation. Objectives: to evaluate the antimicrobial properties of the Fluroshield™ sealant with the addition of the stem extract of Schinopsis brasiliensis (Braúna), as well as the potential for releasing the active ingredient, degree of conversion and immediate enamel bond strength. Methodology: this is an experimental in vitro study. Braúna barks were dried at 40 ± 1 °C and the ethanolic extract was obtained by percolation of Schinopsis brasiliensis bark powder. The commercial sealant Fluroshield™ was enriched with the proportions by mass (g) [0% (Control), 20%, 10%, 5%, 2.5% and 1.25%]. The evaluation of the Inhibition of Biofilm Formation was carried out, the release of the active principle was measured with Ultra High Performance Liquid Chromatography (UHPLC), the immediate bond strength (BS) to the dental tissue was evaluated with microshear and the degree of conversion (DC) with Micro-Raman. Final values were submitted to Shapiro-Wilky (p > 0.05) and Levene normality tests. Parametric data were submitted to analysis of variance (one-way ANOVA) with Tukey's post-test (p <0.05) and nonparametric data through the Kruskal-Wallis test with Dunn's post-test using the GraphPad Prism software 8 and Microsoft Excel 2018. Results: materials with a higher % of extract had a lower DC, there was no statistically significant difference for BS between the different groups, there was release of the active principle in all materials and groups with 20% and 10 % of extract by mass were able to inhibit biofilm formation similarly to the positive control (0.12% chlorhexidine). Conclusion: the addition of Schinopsis brasiliensis extract in concentrations between 10% and 20% is a promising alternative for obtaining antimicrobial properties in resin sealants (AU).

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.

Meta-analysis of prevalence and filling rate of dental caries in preschool children in China / 华西口腔医学杂志

OBJECTIVES@#This study aims to understand the prevalence and treatment status of dental caries in preschool children aged 3-5 years in China among the past five years.@*METHODS@#Databases including CNKI, WanFang data, VIP, MEDLINE, EMBASE were systematically searched for the epidemiological literature of dental caries in preschool children in China from 2017 to 2022 for Meta-analysis. Subgroup analysis was carried out by sex, age, geographical region, ethnology, and residence.@*RESULTS@#The Meta-analysis enrolled 27 literatures, including 72 788 preschool children; of which, 38 344 children had dental caries. The merged prevalence of dental caries in preschool children was 59.3% (95%CI: 54.6%-63.9%), and the merged filling rate of caries was 5.7% (95%CI: 2.5%-8.8%). In the subgroup analysis, the merged prevalence rates of caries in children aged 3, 4, and 5 years were 46.9% (95%CI: 42.5%-51.4%), 59.0% (95%CI: 55.1%-62.8%), and 67.3% (95%CI: 62.5%-72.2%), respectively, and the difference was significant. In addition, significant differences were found among different regions. The merged prevalence of dental caries in preschool children was the highest in northwest China (68.6%, 95%CI: 55.5%-81.8%) and the lowest in central China (49.1%, 95%CI: 47.3%-51.0%). The merged prevalence of dental caries was not significantly different among preschool children of different genders, ethnicities, and residence.@*CONCLUSIONS@#The prevalence of dental caries in preschool children aged 3-5 years in China is high and continuously increases. The oral health of preschool children should be comprehensively strengthened, and a three-level strategy should be implemented to prevent diseases.

Evidence-practice gap in treatment decisions about defective composite and amalgam restorations among Brazilian dentists

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). This study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap

Association of Oral Health-Related Quality of Life with the Longevity of ART-Restorations in Children

ABSTRACT Objective: To evaluate the association of oral health-related quality of life (OHRQoL) with the longevity of ART-restorations in children after 18 months. Material and Methods: A longitudinal clinical study with 62 six- to seven-year-old children, both genders, 31 of whom underwent four weeks of oral health education strategy (OHES) followed by ART (GOHES+ART) and the others only ART (GART). The Brazilian short-version of the Child Perceptions Questionnaire (16-CPQ8-10) was used to evaluate the OHRQoL and the perception of change in oral health was assessed by a single question. Data was analyzed using Mann-Whitney, Wilcoxon and Friedman's tests. Results: After 18 months, GOHES+ART reported a greater impairment on OHRQoL, mainly in oral symptoms domain (p<0.05). In this period, greater impairment of oral symptoms was reported in children with failed restorations and with treatment considered to have a minor failure (p<0.05). In inter-group analysis, the GOHES+ART, with 2 to 4 restorations, Class I, of small size, located in the upper arch and with a smaller failure, reported more oral symptoms than the GART. Conclusion: In the long-term, children submitted to OHES followed by ART reported more oral symptoms. Factors such as number, class, size and location of the restorations need to be considered for the implementation of an efficient and effective oral health program, as well as for greater longevity of ART-restorations.

Grado de microfiltración en ionómero de vidrio y resina compuesta nanoparticulada en lesiones cervicales no cariosas / Degree of microleakage in glass ionomer and nanoparticulate composite resin in non-carious cervical lesions

Introducción: El grado de microfiltración en el ionómero de vidrio y la resina compuesta nanoparticulada en lesiones cervicales no cariosas es de gran importancia para elegir el material restaurador más adecuado para cada caso clínico. Objetivo: Describir el grado de microfiltración en ionómero de vidrio y resina compuesta nanoparticulada en lesiones cervicales no cariosas. Métodos: Se realizó una revisión bibliográfica, correspondiente al nivel exploratorio, en busca de responder cinco preguntas científicas sobre el tema. Se identificaron 62 artículos de las bases de datos de Google Académico o Scopus entre 2015 y 2022. Resultados: Los estudios consultados sugieren que la resina compuesta nanoparticulada es una opción de restauración efectiva y estética en odontología, especialmente en casos de cavidades de alta carga mecánica y estética dental. Los estudios de casos que se revisan demuestran que el grado de microfiltración en las lesiones cervicales no cariosas puede ser significativamente mayor en las restauraciones con ionómero de vidrio en comparación con las resinas compuestas nanoparticuladas. Conclusiones: Se concluye que el elemento fundamental en el tratamiento es realizar un correcto diagnóstico, determinando las necesidades para mejorar la salud dental y realizar una correcta planificación, por lo que es necesario conocer los diferentes tipos de tratamientos con la finalidad de seleccionar el más adecuado, que cumpla con las características biológicas, mecánicas y estéticas, ya que uno de los objetivos fundamentales de cualquier tratamiento es devolver la función y la estética de modo satisfactorio y con la mayor durabilidad posible.

Introduction: The degree of microleakage in glass ionomer and nanoparticulated composite resin in non-carious cervical lesions is of great importance for choosing the most suitable restorative material for each clinical case. Objective: To describe the degree of microleakage in glass ionomer and nanoparticulated composite resin in non-carious cervical lesions. Methods: A literature review, corresponding to the exploratory level, was carried out to answer five scientific questions on the subject. Sixty-two articles were identified from Academic Google or Scopus databases between 2015 and 2022. Results: The studies consulted suggest that nanoparticulated composite resin is an effective and esthetic restorative option in dentistry, especially in cases of cavities with high mechanical load and dental esthetics. The case studies reviewed demonstrate that the degree of microleakage in non-carious cervical lesions can be significantly higher in glass ionomer restorations compared to nanoparticulated composite resins. Conclusions: It is concluded that the fundamental element in treatment is to carry out a correct diagnosis, determining the needs to improve dental health and to carry out correct planning, so it is necessary to know the different types of treatments with the aim of selecting the most suitable one, which complies with the biological, mechanical and esthetic characteristics, since one of the fundamental objectives of any treatment is to restore function and esthetics in a satisfactory way and with the greatest possible durability.

Estrategias para la reproducción del color en restauraciones del sector anterior informadas por estudiantes de la Facultad de Odontología de la Universidad de Buenos Aires / Strategies for color reproduction in anterior restorations informed by students of the Faculty of Dentistry, University of Buenos Aires

El objetivo de este estudio fue valorar las estrategias empleadas, por estudiantes de la Facultad de Odon-tología de la Universidad de Buenos Aires para la re-producción del color en restauraciones del sector anterior según autorreporte. Materiales y Métodos: Se confeccionó un formulario en Google Forms (F) que los alumnos completaron en sus celulares con la información correspondiente a cada restaura-ción terminada. Resultados (IC95%): Se registraron 97 restauraciones en el sector anterior. El 57,73 % (47,79 - 67,09) proximales no involucraban el ángu-lo incisal y el 21,65 % (14,62 - 30,84) sí. Un 11,34 % (6,45 - 19,17) localizada en el tercio cervical. En el 93,81 % (87,15 - 97,13) se utilizó al menos una capa de composite de opacidad esmalte (E) mientras que en el 77,32 % (68,04 - 84,52) al menos una de dentina (D). En el 73,19 % (63,63 - 81,01) se utilizaron al me-nos dos opacidades E y D. Los colores de E más utili-zados fueron A2 y A3, 31,87 % (23,19 - 42,01) y 37,36 % (28,12 - 47,62) respectivamente, y el A3 de D 54,67 % (43,45 - 65,43). Tres fueron las estrategias princi-pales para la combinación de colores y opacidades: el empleo de colores iguales en ambas opacidades, y el uso de opacos de mayor o de menor intensidad; entre las que no se encontró ninguna predominante. Conclusiones: A partir de los resultados del presente estudio se puede concluir que en la mayoría de las restauraciones del sector anterior se emplean com-posites de al menos dos opacidades y que no hay una estrategia de asociación de opacidad y color predominante (AU)

The aim of this study was to assess the strategies that students from the Facultad de Odontología, Universidad de Buenos Aires claim to use for color reproduction in anterior restorations. Materials and Methods: A form was created in Google Forms (F) and students were instructed to complete on 40REV FAC ODONTOL, UNIV BUENOS AIRES 2023 VOL 38 N° 90RepRoducción del coloR en RestauRaciones del sectoR anteRioRFosas y fisurasProximales sin compromiso de ánguloProximales con compromiso de ánguloTercio cervicalcaras libres706050403020100% (IC95%)57,73%21,65%11,34%9,28%their cell phones with the corresponding information about each completed restoration. Results(95CI%):97 restorations were recorded in the anterior sector of which 57.73 % (47.79 - 67.09) were proximal and 21.65 % (14.62 - 30.84) that involved the incisal edge.11.34 %(6.45 - 19.17) were located in the cervical third of the vestibular surfaces. In 97.94 % of the restorations Brilliant New Generation (Coltene) the chosen composite, in 93.81 % (87.15 - 97.13) enamel opacity composite (E) was used at least for one layer, while in 77.32 % (68. 04 - 84.52) at least one layer of dentin (D) was applied. In 73.19 % (63.63 - 81.01) at least two opacities E and D were required. The most used E shades were A2 and A3, 31.87 % (23.19 - 42, 01) and 37.36 % (28.12 - 47.62) respectively, and A3 of D shades 54.67 % (43.45 - 65.43). Three core strategies were identified: the use of the same colors in both opacities, and the use of opaque of greater or lesser intensity; among which no predominance was found. Conclusions: Within the conditions of this study, it can be concluded that composites of at least two opacities are used in most anterior sector restorations and that there is no predominant opacity and color association strategy (AU)

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)

Pasado, presente y futuro de la cariología / Past, Present, and Future of Cariology

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

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

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.

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.

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).

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.

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.

Perfil de caries de la infancia temprana / Profile of early childhood caries

La Caries de la Infancia Temprana (CIT) se ha descrito como una patología de origen multifactorial en niños hasta los 71 meses de edad. Se considera como Ca-ries de la Infancia Temprana Severa (CITS) cuando a los 3 años el índice ceod es ≥ 4; a los 4 años, ≥ 5, y a los 5 años ≥ 6. La rehabilitación de las lesiones provo-cadas por esta patología puede ser compleja debido a la calidad y cantidad de estructura remanente y a la edad de los pacientes afectados. Objetivos: Estimar la frecuencia de CIT y CITS en niños menores a 72 me-ses que concurrieron para su atención, e identificar el tipo de práctica realizada, y la adhesión al trata-miento. Métodos: Diseño retrospectivo observacional sobre las historias clínicas de pacientes menores a 72 meses asistidos por los cursantes de la Especiali-zación en Odontopediatría, entre febrero 2021 y julio 2022. Resultados: La muestra quedó constituida por 101 niños, de 46+13,5 meses. El 91% presentó CITS. La totalidad de los pacientes mantuvieron lactancia nocturna prolongada después del año, siendo en el 72,3% a libre demanda durante el sueño, en un perío-do de 23+6 meses. Se registró un total de 1010 lesio-nes de caries. El 29,3% de los pacientes abandonaron el tratamiento. Conclusiones: La mayor parte de los niños presentaron Caries de la Infancia Temprana Severa, con altos valores de patología y lactancia noc-turna prolongada a libre demanda después del año Los tratamientos recomendados en estos casos son muy prolongados y requieren de prácticas invasivas, complejas y de alto costo, lo que provoca el abandono del tratamiento (AU)

Early childhood caries (ECC) is defined as a multifactorial disease in children 71 months of age or younger. When the dmft index is ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) it is referred to as Severe early childhood caries (SECC). Management of ECC is complex due to the quality and quantity of remaining structure of teeth at an early age. Objectives: To estimate the frequency of ECC and SECC in children < 72 months of age undergoing comprehensive treatment, to identify the type of treatment provided and treatment compliance. Methods: Retrospective observational design on dental records of patients under 72 months of age treated by Pediatric Dentistry Specialty Program students between February 2021 and July 2022. Results: The sample included 101 children, mean age 46+13.5 months, 91% of patients with SECC. All patients were fed nightly for over 1 year, 72.3% of whom were fed nightly on demand over a period of 23±6 months. A total of 1010 caries lesions were detected. 29.3% of children discontinued treatment. Conclusions: Most of the children presented severe early childhood caries with high values of pathology and prolonged nocturnal breastfeeding on demand after one year. The recommended treatments in these cases are very long and require invasive, complex and expensive practices, which causes abandonment of the treatment (AU)

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)