Case Report: a 5-Year Follow-up of Proximal Caries Lesion Diagnosis / Diagnóstico de Lesões Cariosas Proximais - Relato de Caso: 5 Anos de Acompanhamento

This clinical case was aimed at reporting and discussing diagnostic methods for early detection and preventive treatment of proximal carious lesions. The patient presented to the dental clinic seeking treatment of a problem she reported as being "dental caries". The patient's orthodontist diagnosed dental caries, by means of radiographic exam. There was no evidence of any proximal carious lesion in the intraoral examination. The bitewing radiographs presented a radiolucent area limited to enamel in the mesial of maxillary left-second-bicuspid. For the purpose of confirming the intraoral diagnosis, an immediate tooth separation was performed. The immediate separation was unable to provide sufficient access; thus, the slow separation approach was performed. After 24-hours, tooth separation of 1mm was obtained, providing enough access for clinical examination. The proximal areas were evaluated by transillumination and impression taking. During the visual inspection, an area of enamel staining was observed, with no roughness due to tactile inspection and the evaluation by transillumination and impression showed no cavitation. The following preventive treatment plan was endorsed: oral hygiene instructions with emphasis to the importance of flossing the proximal areas, and healthy dietary habits. After a 5-years period of follow-up, the enhanced oral hygiene and heathy dietary habits were observed. A clinical examination with immediate tooth separation and bitewing radiographs was performed and showed no cavitation. The combination of methods for detecting carious lesions in proximal surfaces was effective in obtaining a diagnosis of caries in the permanent dentition. The absence of cavitated lesions must be indicative of preventive treatment. (AU).

Este caso clínico objetivou relatar e discutir os métodos diagnósticos para detecção e tratamento preventivo de lesões cariosas proximais. A paciente procurou atendimento restaurador com queixa de cárie diagnosticada por exame radiográfico realizado após término de seu tratamento ortodôntico. Ao exame clínico não havia suspeita de lesão cariosa. A avaliação radiográfica revelou, na face mesial do dente 25, presença de área radiolúcida limitada à metade externa do esmalte. Para confirmação do diagnóstico realizou-se a separação interdentária imediata, porém como a mesma não permitiu adequada visualização foi realizada a separação mediata e após 24 horas obteve-se adequada separação (1 mm) para o exame clínico. Em seguida, a superfície proximal foi avaliada por transiluminação e moldagem. Durante a inspeção visual foi constatada área de manchamento do esmalte, com ausência de rugosidade pela inspeção tátil e a avaliação tanto por transiluminação da superfície proximal, quanto por moldagem revelou ausência de cavitação. Devido o diagnóstico obtido o seguinte tratamento preventivo foi indicado: reforço de higiene oral com ênfase na importância do uso do fio dental e hábitos dietéticos saudáveis. Após 5 anos de acompanhamento melhoria da higiene oral e hábitos dietéticos foram constatados. O exame clínico com separação interdentária imediata e exame radiográfico revelaram ausência de cavitação. Conclui-se que a combinação de métodos de detecção de lesões cariosas proximais foi efetivo no diagnóstico da cárie dentária na dentição permanente. O resultado deste relato de caso mostrou que a ausência de lesões cariosas cavitadas deve ser um indicativo de tratamento preventivo.(AU).

Nine-year clinical evaluation of composite resins in Class III restorations / Avaliação de nove anos de restaurações de classe III em resina composta

The aim of this study was to evaluate thenine-year clinical performance of Class III composite restorations using two microhybrid anterior composite resins [Magic™-Vigodent/(F) and Z100™-3M ESPE/(Z)]. Material and Methods: The study was a randomized controlled trial, following the splitmouth design. Seventy restorations were placed, thirty-five for each resin composite into 35 patients. The restorations were placed by one operator according to the manufacturers’ specifications. Two independent evaluators conducted the clinical evaluation using modified USPHS criteria. After nine years, 56 restorations (28F-28Z) were evaluated. Data were analyzed using Chi-square, Exact Fisherand McNemar tests (p < 0.05). Results: Nopost operative sensitivity, secondary caries and loss of anatomic form was observed after nine-years for both composites. There were no significant differences between the two composites tested at baseline and after nine-years. Significant differen ces for Z and Frestorations between baseline and nine-year with respect to color matching and for F regarding themarginal integrity were detected. Conclusion: The clinical performance of both materials was consideredacceptable after the 9-year evaluation...

Objetivo: O objetivo deste estudo foi avaliar após nove anos a performance clínica de restaurações de classe III em resina composta, utilizando-se duas resinas microhíbridas para dentes anteriores [Magic-Vigodent/(F) e Z100-3M ESPE/(Z)]. Material e Métodos: Trata-se de um estudo clínico controlado aleatório, o qual utilizou o desenho de boca dividida.Setenta restaurações foram realizadas em trinta e cinco pacientes, sendo trinta e cinco para cada resina composta. As restaurações foram realizadas por um único operador seguindo as especificações dos fabricantes. Dois avaliadores independentes avaliaram as restaurações utilizando-se o critério USPHS modificado. Após nove anos, 56 restaurações(38F – 28Z) foram avaliadas. Os dados foram analisados por meio dos testes Qui-quadrado, Exato de Fisher e McNemar (p < 0,05). Resultados: Não foram detectados sensibilidade pós-operatória, cárie secundária e perda de forma anatômica no período analisado para ambas resinas. Não houve diferenças entre o período inicial e de nove anos para as resinas testadas, exceto para Z e F foram em relação à a cor e para a integridade do material para F. Conclusão: O comportamento clínico das duas resinas testadas foi considerado adequado após nove anos de avaliação...

Influence of the powder/liquid ratio and storage time of conventional glass ionomer cements in diametral tensile strength

Introduction: The Glass Ionomer Cements (GICs) are the most versatile dental material with extensive clinical indication. However, the mechanical strength of conventional GICs (C-GICs) is still unsatisfactory under areas of masticatory forces. Objective: To evaluate the influence of C-GIC proportioning system (powder-liquid and encapsulated) and storage period (1h, 24h and 7 days) on Diametral Tensile Strength (DTS). Material and methods: The two variables were tested in relation to C-GIC (Riva Self Cure, SDI, Australia). The following proportioning systems were tested: powder-liquid by weight (g:g) and powder-liquid by volume (flat scoop: drop) and encapsulated system (pre-dosed capsules). Five C-GIC specimens were prepared, according to ISO specification #9917 for each variable to be studied. The specimens were stored in plastic containers containing distilled water and kept at 37ºC and 100% humidity until the mechanical testing in a universal testing machine (Instron Corp., USA) at a speed 0.5 mm/min. The data were submitted to two-way ANOVA and Tukey test for multiple comparisons (α = 0.05). Results: The proportioning system (P < 0.0001) and storage time (P < 0.0001) were significant predictors of DTS, however with no interaction between these factors. Conclusion: The DTS of C-GICs was influenced by storage time (1 hour < 24 hours < 7 days) and by the proportioning system only for the initial period of its setting reaction.

Clinical effectiveness of light-curing units of the School of Dentistry of the Federal University of Goias

Introduction: The clinical longevity of the procedures is directly associated to the adequate activation (photopolymerization) of adhesive restorative materials. Objective: To evaluate and compare by allocation the conservation status and power density of the light-curing units available at the School of Dentistry of the Federal University of Goias (FO/FUG) for clinical care. Material and methods: The following information and specific techniques of all light sources existing at FO/UFG, available for clinical care in 2011, were collected: dental/ambulatory clinic where they are located, type of source [device of halogen light and light-emitting diode (LED)], brand, parallelism test (halogen light sources), state of conservation of the light transmitter tip, density of the potency/intensity/irradiance in mW/cm2 and acquisition date. The data obtained were submitted to one-way ANOVA (Analysis of Variance) and Turkey test for multiple comparisons (P < 0.05). Results: In the second half of 2011, FO/UFG had 20 light sources (04 halogens and 16 LEDs), of which 90% were found in inadequate condition and 55% of those with power density less than 300 mW/cm2. There was no statistically significant difference in the power density between halogen and LED sources tested (P = 0.526). Likewise, no statistical difference was observed between the power density of the light sources (LED) placed at the Clinic II and III (P = 0.479). Also there was no statistically significant difference between the light sources (LED Halogen X) at the Clinic I (P = 0.943). Conclusion: The light sources regardless of the clinic in which they were located presented mostly with inadequate clinical effectiveness in terms of their conservation status and power density.

Clinical evaluation of multiple-surface ART restorations: three-year follow-up / Avaliação clínica de restaurações de ART de superfícies múltiplas: acompanhamento de três anos

Objective: To evaluate the performance of multiple-surface restorations made with two different glass-ionomer cements (GICs) in permanent teeth using the Atraumatic Restorative Treatment (ART). Material and methods: A total of 60 restorations were placed in schoolchildren (9-16 years of age) by two dentists using standard ART procedures. The restorations were randomly divided into two groups. Thirty cavities were filled with high-viscosity GIC (Ketac Molar-3M ESPE) and 30 cavities were filled with resin-modified GIC (Fuji VIII-GC Corp.). Two calibrated independent examiners carried out the evaluation according to ART criteria. Data were statistically analyzed using multiple logistic regression models to evaluate the variables associated with the success (GIC, operator, Class type). The 95% Confidence Intervals (CI) for success were based on the binomial distribution. A difference was statistically significant if p < 0.05. Results: In a 3-year follow-up, 57 restorations were evaluated. In the Ketac Molar group, 3 restorations were not evaluated, 21 were considered successful and 6 unsuccessful. In the Fuji VIII group, 28 restorations were considered successful and 2 unsuccessful. The logistic regression model showed that the combination of the variables was only statistically significant in relation to survival of ART restorations (p = 0.036). There were no statistically significant differences between the groups taking each variable into account. The best performance included the combination: Fuji VIII, operator B and Class I involving two or more tooth surfaces. Conclusion: The clinical performance of the multiplesurface ART restorations of both materials was considered satisfactory with a high success rate after 3 years.

Objetivo: Avaliar o comportamento clínico de restaurações de superfícies múltiplas, realizadas com dois cimentos de ionômero de vidro (CIVs) em dentes permanentes, utilizando-se o Tratamento Restaurador Atraumático (ART). Material e Métodos: 60 restaurações foram realizadas em escolares (idade entre 9 - 16 anos) por dois dentistas utilizando-se os procedimentos convencionais do AR. As restaurações foram distribuídas aleatoriamente em dois grupos. Trinta cavidades foram restauradas com CIV de alta viscosidade (Ketac Molar - 3M ESPE) e 30, com CIV modificado por resina (Fuji VIII-GC Corp.). Dois avaliadores calibrados e independentes realizaram a avaliação segundo os critérios do ART. Os resultados foram submetidos à análise estatística utilizando-se modelos de regressão logística múltipla, avaliando-se o sucesso em função das variáveis associadas (CIV, operador e tipo de cavidade). Intervalos de confiança de 95% para o sucesso foram baseados na distribuição binomial. Diferenças estatisticamente significantes ocorreram se p < 0,05. Resultados: Em 3 anos de acompanhamento 57 restaurações foram avaliadas. No grupo do Ketac Molar, 3 restaurações não foram avaliadas, 21 obtiveram sucesso e 6 falharam. No grupo do Fuji VIII, 28 restaurações obtiveram sucesso e 2 falharam. A combinação de variáveis foi somente significante em relação à sobrevida das restaurações (p = 0,036). Não houve diferenças entre os grupos considerando-se cada variável independentemente. A combinação apresentando melhor desempenho foi: Fuji VIII, operador B e Classe I envolvendo duas ou mais superfícies dentárias. Conclusão: O desempenho clínico de restaurações de ART de superfícies múltiplas foi considerado satisfatório para ambos os materiais testados, apresentando altos índices de sucesso após três anos.

Indirect pulp treatment in a permanent molar: case reort of 4-year follow-up

This case report describes th Indirect Pulp Treatment (IPT) of deep caries lesion in a permanent molar. A 16-year-old male patient reported discomfort associated with thermal stimulation on the permanent mandibular left first molar. The radiographs revealed a deep distal caries lesion, very close to the pulp, absence of radiolucencies in the periapical region, and absence of periodontal space thickening. Pulp sensitivity was confirmed by thermal pulp vitality tests. Based on the main complaint and the clinical and radiographic examinations, the treatment plan was established to preserve pulp vitality. Clinical procedures consisted of removing the infected dentin and lining the caries-affected dentin with calcium hydroxide paste. The tooth was provisionally sealed for approximately 60 days. After this period, tooth vitality was confirmed, the remaining carious dentin was removed, and the tooth was restored. At 4-year follow-up, no clinical or radiographic pathological findings were found.

Comparasion of two minimally invasive methods on the longevity of glass ionomer cement restorations: short-term results of a pilot study

The purpose of this study was to evaluate the clinical performance of glass ionomer cement (GIC) restorations comparing two minimally invasive methods in permanent teeth after 12 months. Fifty pregnant women (second trimester of pregnancy), mean age 22 ± 5.30 years, were treated by two previously trained operators. The treatment approaches tested were: chemomechanical method (CarisolvTM; MediTeam) and atraumatic restorative treatment (ART). A split-mouth study design was used in which the two treatments were randomly placed in 50 matched pairs of permanent teeth. The chemomechanical method (CM) was the test group and the ART was the control group. The treatments were performed in Public Health Centers. The tested restorative material was a high-strength GIC (Ketac Molar; 3M/ESPE). The restorations were placed according to the ART guidelines. Two calibrated independent examiners evaluated the restorations in accordance with ART criteria. The inter-examiner kappa was 0.97. Data were analyzed using 95 percent confidence interval on the binomial distribution and Fisher's exact test at 5 percent significance level. In a 12-month follow-up, 86 percent of the restorations were evaluated. In the test group (CM), 100 percent (CI=93.3-100 percent) of the restorations were considered successful. In the control group (ART) 97.6 percent (CI=87.4-99.9 percent) of the restorations were considered successful and 2.4 percent unsuccessful (marginal defect >0.5 mm). There was no statistically significant difference between the 12-mounth success rate for both groups (Fisher's exact test: P=0.49) and between the two operators (Fisher's exact test: P=1.00). Both minimally invasive methods, chemomechanical method and ART, showed a similar clinical performance after 12 months of follow up.