Diagnostic reliability of a simplified epidemiologic tool to detect high-risk overjet for dental trauma / Confiabilidade diagnóstica de um instrumento simplificado para o exame epidemiológico de overjet de risco para traumatismo dentário

To evaluate the diagnostic reliability of a simplified tool to detect high-risk overjet for dental trauma, using wooden tongue depressors and comparing it to the conventional method as recommended by the WHO (1997). Material and Methods: The study population was composed of131 volunteers divided into two groups according to the overjet measurement in terms of risk for traumatic dental injury (G1: risk absent and G2: riskpresent). Overjet measurements were taken basedon the upper and lower permanent incisors. The distance between the most prominent labial surfaceand its corresponding counter part was measuredusing both the conventional and the simplified tool. The measurements were taken independently and on separate occasions by two previously calibrated dental surgeons (Kappa = 0.86). The gold standard method, as recommended by the WHO (1997), was performed by an external examiner using WHO probes. The simplified method, based on pencilmarkedwooden tongue depressors was carried outin a blind manner by the other examiner. Sensitivity, specificity, positive and negative predictive values were calculated for the classification of riskfor dental trauma in terms of overjet using the simplified method and compared to the conventional method for reliability, which proved reliable and reproducible. Results: the results revealed high values for sensitivity (S = 1), specificity (E = 0.93), positive (PPV = 0.95) and negative predictive value(NPV = 1). Conclusion: This study demonstrated that the examination using the simplified tool was reliable in identifying high-risk overjet, thus offeringan alternative to the conventional examination in situations where the method recommended by the World Health Organization is unavailable...

Objetivo: Avaliar a confiabilidade diagnóstica de um instrumento simplificado para a identificação do overjet de risco para traumatismo dentário utilizando espátulas de madeira adaptadas, estabelecendo como comparação a metodologia convencional preconizada pela OMS (1997). Material e Métodos: A amostra foi composta por 131 voluntários divididos em dois grupos de acordo com a medida do overjet em relação ao risco de traumatismo (G1: ausência de risco e G2: presença de risco). Para a mensuração do overjet foram avaliados os incisivos permanentes superiores e inferiores. A distância entre a superfície vestibular mais proeminente e sua correspondente foi aferida de duas formas, pelo instrumento convencional, com o uso da sonda OMS e pela simplificada, com o uso da espátula de madeira adaptada, realizados independentemente e em momentos distintos por duas cirurgiãs-dentistas previamente calibradas (Kappa = 0,86). A metodologia preconizada pela OMS(1997), padrão-ouro, foi executada por examinadora alheia ao estudo. A metodologia simplificada, baseada no uso de espátulas de madeira marcadas à grafite, foi efetivada pela outra examinadora que, de forma cega,realizou os exames clínicos. Foram calculados os valores da sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo para a classificação do risco de traumatismo em função do overjet pelo método simplificado, tendo como comparação a metodologia convencional. Resultados: Os resultados revelaram altos valores para a sensibilidade (S = 1), a especificidade (E =0,93) e para os valores preditivos, positivo (VPP = 0,95) e negativo (VPN = 1) e para a confiabilidade, mostrando-se confiável e reprodutível. Conclusão: O estudo comprovou que o exame com o instrumento simplificado apresentou confiabilidade diagnóstica para a identificação do overjet de risco, constituindo-se uma alternativa para o exame convencional em situações em que a metodologia preconizada pela Organização Mundial da Saúde...

Small cross-sectional survey of composite restoration attributes associated with choices for replacement

The aim of this work was to present a small cross-sectional survey of composite restoration clinical attributes associated with choices for replacement. Ninety-four composite fillings selected to be replaced were included in this study. A questionnaire was filled out after each procedure in order to assess the clinical conditions that indicated the restoration replacement (marginal staining, unsatisfactory restoration anatomy, marginal fracture, fractured restoration body, painful symptoms, dental fracture, composite discoloration and/or restoration displacement). These conditions could be combined. The chi-square and Exact Fisher tests were performed to analyze the different variables (p < 0.05). The results showed that composite shade discoloration was the main cause of restoration replacement (63.8 percent). Marginal staining (50 percent), unsatisfactory restoration anatomy (50 percent), marginal fracture (14.9 percent), painful symptoms (8.5 percent), fractured restoration body (4.3 percent), dental fracture (1.1 percent) and total displacement of the restoration (1.1 percent) were conditions that could be associated. The main cause of dental composite restoration replacement was material shade mismatch with the dental structure (anterior teeth) or marginal staining and unsatisfactory restoration shape (posterior teeth). Marginal staining and composite shade discoloration contrasting with dental structure were related to the presence of caries.