Low-cost glass ionomer cement as ART sealant in permanent molars: a randomized clinical trial

Clinical trials are normally performed with well-known brands of glass ionomer cement (GIC), but the cost of these materials is high for public healthcare in less-affluent communities. Given the need to research cheaper materials, it seems pertinent to investigate the retention rate of a low-cost GIC applied as atraumatic restorative treatment (ART) sealants in two centers in Brazil. Four hundred and thirty-seven 6-to-8-year-old schoolchildren were selected in two cities in Brazil. The children were randomly divided into two groups, according to the tested GIC applied in the first permanent molars. The retention rate was evaluated after 3, 6 and 12 months. Kaplan-Meier survival analysis and the log-rank test were performed. The variables were tested for association with sealant longevity, using logistic regression analyses (α = 5%). The retention rate of sealants after 12 months was 19.1%. The high-cost GIC brand presented a 2-fold-more-likely-to-survive rate than the low-cost brand (p < 0.001). Significant difference was also found between the cities where the treatments were performed, in that Barueri presented a higher sealant survival rate than Recife (p < 0.001). The retention rate of a low-cost GIC sealant brand was markedly lower than that of a well-known GIC sealant brand.

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

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

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

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

Erosive potential of different types of grape juices

The purpose of the present study was to evaluate the erosive potential of different types (concentrated and powdered) and commercial brands of industrialised grape juices. The pH of all five fruit drinks was measured at two time points: immediately after preparation and 24 hours later. Sixty specimens of bovine enamel were randomly allocated and immersed in different types of grape juice (n = 10) for 10 minutes four times a day for fifteen days. The enamel alteration was analysed using surface Knoop microhardness (KHN) and surface roughness (Ra) tests at baseline and on the 5th, 10th and 15th days of the experiment. Two way ANOVA, Tukey's post hoc and Pearson's correlation tests were used for statistical analysis (α = 5%). The grape juices presented pH values ranging from 2.9 to 3.5. All of the tested juices promoted significant enamel mineral loss (p < 0.05) on the first evaluation (5th day of immersion) and produced a significant increase in the mean roughness from the 10th day on when compared to the control group (p < 0.05). By the 15th day, all of the beverages had produced surface roughnesses that were significantly higher than that of the control group. The results suggest that all grape juices, regardless of their commercial presentation, present erosive potential.

Eroded dentin does not jeopardize the bond strength of adhesive restorative materials

This in vitro study evaluated the bond strength of adhesive restorative materials to sound and eroded dentin. Thirty-six bovine incisors were embedded in acrylic resin and ground to obtain flat buccal dentin surfaces. Specimens were randomly allocated in 2 groups: sound dentin (immersion in artificial saliva) and eroded dentin (pH cycling model - 3× / cola drink for 7 days). Specimens were then reassigned according to restorative material: glass ionomer cement (KetacTM Molar Easy Mix), resin-modified glass ionomer cement (VitremerTM) or adhesive system with resin composite (Adper Single Bond 2 + Filtek Z250). Polyethylene tubes with an internal diameter of 0.76 mm were placed over the dentin and filled with the material. The microshear bond test was performed after 24 h of water storage at 37ºC. The failure mode was evaluated using a stereomicroscope (400×). Bond strength data were analyzed with two-way ANOVA and Tukey's post hoc tests (α = 0.05). Eroded dentin showed bond strength values similar to those for sound dentin for all materials. The adhesive system showed the highest bond strength values, regardless of the substrate (p < 0.0001). For all groups, the adhesive/mixed failure prevailed. In conclusion, adhesive materials may be used in eroded dentin without jeopardizing the bonding quality. It is preferable to use an etch-and-rinse adhesive system because it shows the highest bond strength values compared with the glass ionomer cements tested.

Reparo de restauração de amálgama em dente decíduo: relato de caso clínico / Repair of defective amolgam restorotion in primary tooth: a case report

A substituição de restaurações tem sido uma abordagem frequente entre os Cirurgiões Dentistas e, muitas vezes, são desnecessárias, levando à perda de estrutura dentária sadia e ao ciclo restaurador repetitivo. Este artigo relata um caso clínico de reparo de restauração de amálgama em dente decíduo, com 30 meses de acompanhamento clínico e radiográfico e avaliação da interface reparada em microscopia eletrônica de varredura (MEV), após esfoliação fisiológica do elemento dentário. A ausência de lesão de cárie secundária e integridade da restauração reparada observados neste caso sustentam o emprego do reparo de restaurações de amálgama que apresentem defeitos, a fim de preservar estrutura dentária sadia e aumentar a longevidade destas restaurações.

Restoration replacement has been a frequent approach among clinicians and many timesare unnecessary, leading to sound dental structure loss and cycle of rerestoration. This paper resports a clinical case of restorative repair of amalgam restoration after 30 months follow up. After physiologic exfoliation, tooth was longitudinally sectioned at restoration center and analyzed in scanning electron microscope (SEM). Clinical and radiographic examination demonstrated absence of secondary caries lesion and integrity of the repaired restoration. Repair of defectives restorations is an effective way to preserve and treat existing restorations, increasing their longevity.