Methodological quality of network meta-analysis in dentistry: a meta-research

Abstract This meta-research aimed to provide an overview of the methodological quality and risk of bias of network meta-analyses (NMA) in dentistry. Searches for NMA of randomized clinical trials with clinical outcomes in dentistry were performed in databases up to January 2022. Two reviewers independently screened titles/abstracts, selected full texts, and extracted the data. The adherence to PRISMA-NMA reporting guideline, the AMSTAR-2 methodological quality tool, and the ROBIS risk of bias tool were assessed in the studies. Correlation between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results was also investigated. Sixty-two NMA studies were included and presented varied methodological quality. According to AMSTAR-2, half of the NMA presented moderate quality (n = 32; 51.6%). The adherence to PRISMA-NMA also varied. Only 36 studies (58.1%) prospectively registered the protocol. Other issues lacking of reporting were data related were data related to the NMA geometry and the assessment of results consistency, and the evaluation of risk of bias across the studies. ROBIS assessment showed a high risk of bias mainly for domains 1 (study eligibility criteria) and 2 (identification and selection of studies). Correlation coefficients between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results showed moderate correlation (rho < 0.6). Overall, NMA studies in dentistry were of moderate quality and at high risk of bias in several domains, especially study selection. Future reviews should be better planned and conducted and have higher compliance with reporting and quality assessment tools.

Survival rate of the Hall technique compared with resin composite restoration in multi-surface cavities in primary teeth: a 1-year randomized clinical trial

Abstract Background Hall technique (HT) has been indicated for teeth with dentinal caries lesion; however, extensive cavities, with more than two surfaces still seem challenging for restorative treatment in pediatric dentistry, resulting in a higher failure rate and an increased need for retreatment. Objectives To compare the survival rate of the Hall technique preformed metal crown (HT) with resin composite restoration (RC) for multi-surface cavitated caries lesions in primary molars. Methodology In this multicenter two-arm randomized clinical trial, children between 4 and 9 years of age with at least one primary molar with cavitated caries lesion involving more than two surfaces, including one buccal or palatal/lingual surface, were selected from 17 Brazilian cities. A total of 364 teeth were allocated into two groups: (1) teeth treated with selective caries removal and RC and (2) treated with the HT. The survival rate was assessed at 6 and 12 months after the interventions. Survival analysis was performed with the Kaplan‒Meier method. Cox regression was used to determine the influence of explanatory variables on the survival rate (α=5%). Results After 12 months, 292 teeth were re-evaluated. A total of 358 teeth were re-evaluated at least once during the study and included in the survival analysis. The HT (87.8%) resulted in a higher survival rate than RC restoration (75.7%) (p=0.004). Conclusion HT has a higher survival rate than RC as a treatment for multi-surface cavitated caries lesions in primary teeth. ClinicalTrials.gov: NCT02782390

Associated factors and treatment options for sleep bruxism in children: an umbrella review

Abstract Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options.

A importância dos estudos clínicos randomizados e seu impacto na tomada de decisão clínica / The importance of randomized clinical trials and their impact on clinical decision making

Os ensaios clínicos randomizados (ECRs) são considerados o padrão ouro e o mais alto nível de evidência científica para estudos de intervenção, precedidos apenas pela síntese dos mesmos (revisões sistemáticas). Tanto os responsáveis pela tomada de decisões, quanto os desenvolvedores de diretrizes precisam usar tais estudos, bem como suas sínteses, para desenvolver diretrizes clínicas de alta qualidade para auxiliar os profissionais na tomada de decisões. Portanto, os ECRs precisam ser bem delineados para minimizar o risco de viés, a fim de construir evidências científicas confiáveis em relação aos benefícios e efeitos colaterais das intervenções clínicas, bem como para garantir a transparência na concepção da metodologia de estudo e na comunicação dos resultados. Ensaios clínicos mal delineados representam um risco para a prática clínica, assim como desperdício de tempo, esforço e recursos financeiros na ciência. Este comentário visa destacar e discutir questões relacionadas à qualidade dos ECRs e seu efeito na tomada de decisões clínicas, bem como enfatizar a conscientização sobre a necessidade de avaliar criteriosamente os ensaios clínicos que serão utilizados para embasar a prática clínica.

Randomized clinical trials (RCTs) are considered the gold standard and the highest level of scientific evidence, preceded only by systematic reviews with or without meta-analysis. Both policy makers and guideline developers need to use such studies, as well as systematic reviews of RCTs, to develop high-quality clinical guidelines to assist dentists in making clinical decisions. Therefore, randomized controlled trials need to be well designed and have a reduced number of systematic errors to build reliable scientific evidence regarding the benefits and side effects of clinical interventions, as well as to ensure transparency in the design of study methodology and reporting of results, all of which will reduce potential biases. Poorly designed clinical trials pose a risk to clinical practice, as well as a waste of time and effort for dentists and even a waste of resources in science. This commentary aims to highlight and discuss problems related to the quality of randomized controlled clinical trials and their effect on dental surgeons' clinical decision making, as well as emphasizing the importance of choosing high quality clinical trials as a basis for their clinical practice.

Pulp vitality of primary molars with deep caries treated with ART restorations: 2-year RCT

Abstract: The aim of this study was to compare the pulp vitality of primary teeth with deep caries treated with two restorative techniques. The restoration survival rate was also evaluated as a secondary outcome. Children aged from 4 to 8 years with at least one deep carious lesion in molars were selected at the Ibirapuera University dental clinic. One hundred and eight deciduous molars were allocated into two groups: (1) restoration with calcium hydroxide cement lining followed by filling with high-viscosity glass ionomer cement (CHC+HVGIC) or (2) restoration with HVGIC. Pulp vitality and restoration survival were evaluated at 6, 12, and 24 months. Intent-to-treat analysis was used for pulp vitality, and survival analysis was performed with the Kaplan-Meier method (α=5%). Results: At 24 months, 86 restorations were evaluated, and 91 were evaluated at least once during the study. There was no significant difference between the restorative treatments regarding pulp vitality (CHC +HVGIC=70% and HVGIC=68.5%) (OR=1.091; CI95%=0.481-2.475). However, HVGIC (73%) restorations showed a higher survival rate than CHC+HVGIC (50%) (p=0.021). Thus, it can conclude that deep caries in primary molars should be restored with HVGIC, since the technique results in similar pulp vitality to the CHC +HVGIC, but with a higher restoration survival rate.

Lesion sterilization and tissue repair of primary molar to the eruption of its permanent successor: a case report / Esterilização da lesão e reparação de tecidos de molar decíduo: relato de caso clínico até a erupção do permanente sucessor

The aim of this study is to report a clinical case of lesion sterilization and tissue repair in primary molar, with follow-up until the eruption of the permanent successor. A 6-year-old male patient came to the Pediatric Dentistry Clinic at Faculdade Sao Leopoldo Mandic in Campinas-SP, with his mother, complaining of "caries in several teeth". On clinical examination, it was found that tooth 85 had a severe carious lesion with pulp involvement and fistula. Radiographically, radiolucency was observed in the furcation region. It was then decided to perform lesion sterilization and tissue repair of the tooth with CTZ paste. After 6 months of the procedure, the tooth was clinically and radiographically normal and after 3 years it was observed that tooth 85 was in complete root resorption. After extraction, the permanent successor erupted naturally without clinical or radiographic alterations. It can be concluded that the present clinical case demonstrated success in the use of CTZ paste in the lesion sterilization and tissue repair of primary molars, until the complete eruption of the permanent successor. (AU)

O objetivo desse estudo é relatar o caso clínico de esterilização da lesão e reparação de tecidos em molar decíduo com pasta CTZ, com acompanhamento até a erupção do pré-molar sucessor. Paciente do sexo masculino, 6 anos de idade, apresentou-se à Clínica de Odontopediatria da Faculdade São Leopoldo Mandic em Campinas-SP, acompanhado de sua mãe, queixando-se de "cárie em vários dentes". Ao exame clínico, verificou-se que o dente 85 apresentava lesão de cárie severa com envolvimento pulpar e fístula. Radiograficamente, observou-se radiolucidez na região de furca. Optou-se, então, por realizar a esterilização da lesão e reparação de tecidos do dente com pasta CTZ. Após 6 meses da realização do procedimento, o dente apresentava-se clinica e radiograficamente normal e após 3 anos observou-se que o elemento 85 estava em rizólise completa. Feita a extração, o permanente sucessor erupcionou naturalmente sem alterações clínicas ou radiográficas. Pode-se concluir que o presente caso clínico demonstrou sucesso do emprego da pasta CTZ na esterilização da lesão e reparação de tecidos de molar decíduo, até completa erupção do permanente sucessor. (AU)

Pain perception of children after restorative treatments Atraumatic restorative treatment versus chemomechanical removal – A noninferiority randomized clinical trial

Background: Atraumatic restorative treatment (ART) and chemomechanical removal of dental caries have been shown to be safe and effective restorative procedures. However, current literature lacks well-design studies comparing the pain perceived by infants using ART and chemo-mechanical removal techniques. Aims: To compare pain perception of children of two techniques (ART vs. chemomechanical removal) of restorative treatments for dental caries removal. Settings and Design: A randomized clinical trial with two parallels arms (1:1) was conducted in the cities of Manaus (AM) and Uberlândia (MG), Brazil. Methods: Children between 4 and 9 years old were selected. In both groups - ART (n = 20) and chemomechanical caries removal (Papaya® gel) (n = 20) - oximeter measurements (heart rate and blood oxygenation) were performed before the intervention and until the complete removal of the infected caries dentin. At the end of the treatment, a Wong-Baker scale was used to assess pain perception during the procedure. An independent researcher measured, in minutes, the duration of each technique. Statistical Analysis: Poisson regression analysis was used to evaluate the association between the outcome and the explicative variables. Results: No statistical difference in pain perception between the two procedures of carious tissue removal was observed. By contrast, a lower heart rate was observed when chemomechanical removal was used (P = 0.013). Conclusion: Children that underwent chemomechanical caries removal presented lower heart rate compared to those who underwent ART. However, both techniques showed minimal or absent perceived pain.

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.

Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial

Abstract: This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.

Use of intrarradicular pins in primary teeth: case report of one year of accompanying / Uso de pinos intrarradiculares em dentes decíduos: relato de caso de um ano de acompanhamento

ABSTRACT Primary teeth have an important role in the growth and development of the child, besides being important for the good performance of masticatory function, phonation, occlusion and aesthetics, are the best space maintainers and eruption guide for the permanent successor. For anterior region, there are different alternatives of rehabilitation treatment, however, it is up to the professional to choose the best option. Objective To present a therapeutic management of upper incisors affected by carious lesion with intrarradicular pin in early childhood. Case report: male patient, with 2 years and 7 months of age and significant loss of dental structure at an early stage. In the impossibility of performing direct restoration, we opted for the rehabilitation with the use of glass fiber pins for intraradicular reinforcement and composite resin restorations in order to restore shape, function and aesthetics. Conclusion The use of fiberglass intra-radicular pins associated with direct restoration of composite resin is a recommended technique for the reconstruction of anterior teeth with great destruction.

RESUMO Os dentes decíduos possuem um papel importante no crescimento e desenvolvimento da criança, além de serem importantes para o bom desempenho da função mastigatória, fonação, oclusão e estética, são os melhores mantenedores de espaço e guia de erupção para o sucessor permanente. Para região anterior, existem diferentes alternativas de tratamento reabilitador, porém, cabe ao profissional escolher a melhor opção Objetivo Apresentar uma conduta terapêutica dos incisivos superiores acometidos por lesão de cárie com pino intrarradicular na primeira infância. Relato do caso: paciente do sexo masculino, com 2 anos e 7 meses de idade e perda significante de estrutura dentária de forma precoce. Na impossibilidade de ser realizado restauração direta, optou-se pela reabilitação com o uso de pinos de fibra de vidro para reforço intrarradicular e restaurações em resina composta em para restabelecimento da forma, função e estética. Conclusão A utilização de pinos intraradiculares de fibra de vidro associada a restauração direta de resina composta é uma técnica recomendada para a reconstrução de dentes decíduos anteriores com grande destruição.

Effect of bleaching agents on black tooth stains caused by chromogenic bacteria: 10 years follow-up case report / Efeito de agentes clareadores na pigmentação extrínseca causada por bactérias cromogênicas: 10 anos de acompanhamento de caso

ABSTRACT Some microorganisms are associated with the formation and deposition of pigmentation on dental surfaces, and its localization, intensity and recurrence persistence can introduce aesthetic disorders. Carbamide peroxide is a bleaching agent that also presents antimicrobial properties. This case report addresses a ten-year clinical follow-up, showing a possible influence of a bleaching procedure protocol on alterations of oral microbiota. Although a bleaching treatment does not have the purpose to alter the oral microbiota, a drastic reduction and recurrence of black tooth stains was observed in this case.

RESUMO Alguns microrganismos são associados com a formação e deposição de pigmentação sobre a superfície dental, sendo que a localização, intensidade e persistência de recorrência dessas pigmentações podem levar a problemas estéticos. O peróxido de carbamida é um agente clareador no qual também mostra propriedades antimicrobianas. Este relato de caso trata de um acompanhamento de dez anos mostrando uma possível influência de um clareamento dental em alterações na microbiota. Embora o clareamento dental não tenha a finalidade de alterar a microbiota bucal, neste relato foi observado a redução na quantidade e recorrência de manchas extrínsecas negras.

Factors Related to the Practice of Exclusive Breastfeeding in Different Cities of the States Minas Gerais and Bahia, Brazil

Objective: To evaluate the factors related to the time of exclusive breastfeeding (EBF) in infants from Pará de Minas and Três Corações (Minas Gerais) and Brumado (Bahia), Brazil. Material and Methods: All mothers attended in public and private hospitals of these cities between June and December 2012 (n=156) were invited to answer an interview related to EBF. Data were collected: (1) at maternity ward; (2) at 4 and (3) 6 months of the infant's life. In (2) and (3), data were collected by phone. Data were recorded in the SPSS software, and descriptive analyses and association of exposure and outcome variables related to the practice of EBF were performed. The chi-square test was used, considering p <0.05. Results: The total of women was in (1) 156, (2) 104 and (3) 123, and the EBF rate was 50.0%, 39.0% and 4.8%, respectively. In (1) mothers with lower schooling level have opted for EBF more frequently. In (1), the use of bottle did not interfere in EBF; on the other hand, in (2) and (3), the use of bottle has decreased the frequency of EBF (p < 0.05). Conclusion: The ideal frequency of EBF recommended by WHO to the six months of the infant's life is not followed in the evaluated cities. In addition, EBF can be influenced by the use of bottle and maternal schooling level.

E-learning Activities to Complement Education in Cariology for Undergraduate Students

Objective: To evaluate activities performed in an e-learning platform after 2-year of implementation in terms of contents and functionality. Material and Methods: Elearning courses were prepared and created by two lecturers. Contents were intended for last year undergraduate students attending the pediatric dentistry discipline, and included different topics considered as relevant to the area. Given tele-courses from 2010-2012 as well as statistics and contents, provided by the platform, were collected for analysis. Results: Five tele-courses were proposed and the total participation was 322 students (mean-per-course±SD=64.4±17.2). On average, 15 tutors/course accompanied the process. Caries lesion detection and fluoride therapy were discussed in all modules, but different activities were focused in various aspects. Other topics were also included: caries activity (60%), caries risk assessment, oral hygiene and clinical examination (40%). Two lecturers were responsible for preparing exercises and tutors helped in the creation, revision and correction. The main type of validation was open questions (83%). A High level of students' access was observed during the 2-year-period (mean-per-course±SD=21372±6775,2). More than 32000 external visits of the topics were also seen. On average, 14 tutor/student feedbacks were sent per student in each tele-course. Conclusion: The use of an e-learning system has been used especially to complementing teaching in caries detection and management using fluorides. Telecourses have been highly accessed by undergraduate students and also, external participants.

Remoção de mucocele com laser diodo: relato de caso clínico em paciente infantil / Mucocele removal with laser diode: case report on child patient

A mucocele é uma das lesões benignas que mais afeta a cavidade bucal. O laser de diodo de alta potência é uma opção que substitui ou associa procedimentos complementares aos processos convencionais,tendo mais conforto pós-cirúrgico. O objetivo deste trabalho foi relatar o caso clínico de remoção de mucocele de lábio inferior em paciente infantil utilizando laser de diodo de alta potência. Paciente do sexo feminino, 8 anos de idade, compareceu à clínica de Odontopediatria da Faculdade de Odontologia São Leopoldo Mandic, em Campinas, relatando incômodo no lábio inferior, com a presença de uma “bolinha”. Ao exame clínico observou-se tumefação de consistência mole, flutuante, translúcida, com coloração similar à mucosa bucal. Após diagnóstico, o tratamento baseou-se na remoção cirúrgica com auxílio de laser de diodo de alta potência. Inicialmente foi realizada a anestesia infiltrativa ao redor da lesão, e então a remoção cirúrgica foi conduzida, juntamente com as glândulas acessórias para evitar recidiva, com uso do laser de diodo de alta potência. Ao fim do procedimento foi possível observar que a paciente saiu satisfeita, sendo o prognóstico favorável. No retorno de 30 dias, observou-se que não houve recidiva da lesão. O laser dediodo de alta potência, uma vez que apresenta uma série de benefícios, como excelente hemostasia, sem a necessidade de sutura, redução do edema e dor, cicatrização mais rápida e redução do tempo para realizar o procedimento, parece ser uma opção para remoção de mucocele em Odontopediatria.

Mucocele is a benign lesion that affects the oral cavity. The high power diode laser is an option as anadditional method or as a substitute to conventional procedures, with more post-surgical comfort. The objective of this study was to report a case of lower lip mucocele removal in a child patient using highpower diode laser. A female patient, 8 years old, attended the Clinic of Pediatric Dentistry, São Leopoldo Mandic School of Dentistry in Campinas, reporting discomfort in the lower lip, with the presence of a“ball”. On clinical examination it was observed swelling of soft consistency, floating, translucent, with coloring similar to the buccal mucosa. After diagnosis, the treatment was based on surgical removal with high power diode laser assistance. Initially infiltration anesthesia around the lesion was performed,and then the surgical removal was conducted, along with the accessory glands to prevent recurrence,with high power diode laser use. At the end of the procedure it was observed that the patient leftsatisfied, with a favorable prognosis. At the 30-day post-operative return, it was observed that there was no recurrence. The high power diode laser, since it presents a series of benefits such as excellen the mostasis, without the need for sutures, reduction of swelling and pain, faster healing, reducing the time to perform the procedure, it seems to be an option for removal of mucocele in pediatric dentistry.

Hábitos bucais deletérios e suas consequências em Odontopediatria / Deleterious oral habits and its consequences in Pediatric Dentistry

Objetivo: O objetivo deste trabalho foi revisar a literatura vigente sobre os hábitos bucais deletérios e suas consequências em Odontopediatria. Material e Métodos: Para isso, foi realizada uma busca nas bases de dados Bireme e Pubmed/MEDLINE, utilizando como palavras-chave: sistema estomatognático, hábitos bucais e Odontopediatria. Resultados: Pode-se observar que os hábitos bucais (nutritivos e não nutritivos) encontram-se diretamente relacionados com as funções do sistema estomatognático, acarretando em inadequações no posicionamento dos maxilares, lábios, língua e palato, alterações no desenvolvimento e posição dos dentes, problemas de fala e na respiração e alterações nos movimentos necessários para mastigar e deglutir os alimentos. Conclusão: Conclui-se que é de extrema importância um diagnóstico precoce e um trabalho multidisciplinar para uma possível remoção do hábito bucal deletério e suas consequências.

Objective: The aim of this study was to review the current literature about the deleterious oral habits and their consequences in Pediatric Dentistry. Material and Methods: For that, a search was performed in the Bireme and Pubmed/MEDLINE databases, using the keywords: stomatognathic system, oral habit and pediatric dentistry. Results: It was observed that oral habits (nutritious and non-nutritious) are directly related to the functions of stomatognathic system, causing consequences such as inadequacy in the positioning of the jaws, lips, tongue and palate, changes in development and position of teeth, speech problems and breathing and changes in the necessary movements to chew and swallow food. Conclusion: It can be concluded that is extremely important an early diagnosis and multidisciplinary work for possible removal of deleterious oral habits and their consequences.

Abordagem multidisciplinar de mordida aberta anterior associada à sucção digital: caso clínico / Multidisciplinary performance to anterior open bite associated with finger sucking: case report

Este estudo tem como objetivo relatar o caso clínico de uma paciente com mordida aberta anterior(MAA) associada ao hábito bucal deletério (HBD) de sucção digital e a importância da interação entre profissionais no tratamento integral. Paciente (9 anos) e sua responsável procuraram atendimento com queixa de hábito de sucção digital prolongado, MAA, ausência de alguns dentes e mal posicionamento dentário, o que comprometia negativamente a estética e autoestima da paciente. Diagnosticou-se crescimento facial equilibrado, MAA, atresia dento alveolar superior, discrepância negativa e dentes 11 e 12 com atraso na irrupção. O tratamento consistiu na instalação do disjuntor de Haas associado à grade palatina para obter a expansão rápida da maxila e corrigir a atresia do arco superior, a fim de anular a discrepância negativa. Concomitantemente realizou-se o acompanhamento e tratamento psicológico e fonoaudiológico.A grade palatina, adaptada com barreira de acrílico, evitou que a língua interpusesse entre os incisivos,o que propiciou a irrupção dos mesmos. Entretanto a paciente ausentou-se por dois meses e retornou ao hábito de sucção digital. Diante disto, indicou-se um bihélice com grade para expansão dento alveolare a paciente manteve o tratamento fonoaudiológico e psicológico. Foi realizado também o acompanhamento para monitoramento da irrupção dentária e desenvolvimento da oclusão. Por meio deste estudo,conclui-se que a intervenção na MAA requer abordagem multidisciplinar a fim de restabelecer a oclusão,propiciar melhora na autoestima e consequentemente na qualidade de vida da criança.

The purpose of this study is to report to the clinical case of a patient with anterior open bite (AOB)associated to the oral deleterious habit of digital suction and the importance of interaction between professionals in the comprehensive treatment. Patient (9 years of age) and its guardian searched dental carewith main complaint of prolonged digital suction, AOB, absence of some teeth and bad dental positioning, which compromised negatively the aesthetic and self es teem of the patient. Balanced facial growth, AOB,upper alveolar dental atresia, negative discrepancy and teeth 11 and 12 with delayed eruption were diagnosed.The treatment consisted in installation of Hass expander associated to palatine grating in order toobtain a fast maxilla expansion and to correct the upper arch atresia that so neutralize the negative discrepancy. Concurrently, held the monitoring and psychological and speech treatment were performed. The palatine grating, adapted with acrylic barrier, prevented the tongue to be positioned between the incisors,which favored their eruption. However, the patient was absent for 2-month and the habit of digital suction was reestablished. In view of this, bi-helix with grating for expansion of the alveolar dental region was indicated and the patient continued speech therapy and psychological treatment. The follow-up to monitoring of the dental eruption and developing of the occlusion were conducted. By means of this study, it was concluded that the OPB intervention require multidisciplinary approach with the purpose of reestablishing the occlusion, propitiating improvement in the selfesteem and consequently in the child quality of life.

Evaluation of the relationship between the cost and properties of glass ionomer cements indicated for atraumatic restorative treatment

The aim of this study was to evaluate microshear bond strength (μSBS), water sorption and solubility of glass ionomer cements (GIC) indicated for atraumatic restorative treatment (ART). Cylindrical specimens (6x2.4 mm) were used to test the sorption and solubility of each GIC (n = 5). The specimens were weighed before and after immersion in water and desiccation. For the μSBS test, 60 primary molars were ground to obtain flat surfaces from both enamel and dentin. The teeth were then assigned to the tested GIC (n = 10) groups, namely Fuji IX - FIX, Ketac Molar - KM and Maxxion R – MX. The exposed surfaces were pre-treated with GIC liquid. Polyethylene tubes were placed on the pre-treated surface and filled with one of the GIC. After 24 h, the specimens were submitted to the μSBS test. The failure mode was assessed using a stereomicroscope (400x magnification). The powder to liquid ratio and cost of material were also determined (n = 3). The data were analyzed by ANOVA and Tukey's post hoc test. Linear regression was used to determine the relation between cost and the other variables. Overall, MX showed lower μSBS values (enamel: 3.93 ± 0.38; dentin: 5.04 ± 0.70) than FIX (enamel: 5.95 ± 0.85; dentin: 7.01 ± 1.06) and KM (enamel: 5.91 ± 0.78; dentin: 6.88 ± 1.35), as well as higher sorption and solubility. The regression analyses showed a significant and positive correlation between cost and μSBS in enamel (R2 = 0.62; p < 0.001) and dentin (R2 = 0.43; p < 0.001); and a negative correlation between cost and water sorption (R2 = 0.93; p < 0.001) and solubility (R2 = 0.79; p < 0.001). In conclusion, the materials indicated for ART exhibit distinct physical and mechanical properties; in addition, low-priced materials may interfere with GIC properties.

Efeito do desafio erosivo nas propriedades e na estabilidade de união de materiais restauradores ao esmalte e dentina de dentes decíduos / Effect of erosive challenge on the properties and bond stability of restorative materials to enamel and dentin of primary teeth

Este estudo avaliou o efeito do desafio erosivo nas propriedades e na estabilidade de união de materiais restauradores ao esmalte e dentina decídua. Duzentos e quarenta molares decíduos foram alocados em 24 grupos, de acordo com substrato - esmalte ou dentina, condição prévia do substrato - hígido ou erodido, material restaurador - resina composta associada ao sistema adesivo - RC, cimento de ionômero de vidro de alta viscosidade - CIVAV, ou modificado por resina - CIVMR, e tratamento após procedimento adesivo - controle (imersão em solução salina/7dias) ou desafio erosivo (imersão em bebida a base de cola por 5 min/3x ao dia/7 dias). Os dentes dos grupos esmalte e dentina erodidos foram submetidos ao desafio erosivo previamente aos procedimentos restauradores. Cânulas de polietileno foram posicionadas sobre superfícies planas dos substratos pré-tratados, para então serem preenchidas por um dos materiais avaliados. Após armazenamento por 24h a 37°C, os espécimes foram submetidos a um dos tratamentos propostos. Metade dos espécimes foi submetida imediatamente ao teste de microcisalhamento e a outra metade após 12 meses de armazenamento em água a 37ºC. Posteriormente, a análise do padrão de fratura foi realizada em estereomicroscópio (400X). Para a análise de resistência à flexão (RF) e rugosidade superficial (RS), trinta corpos de prova foram confeccionados (10x2x1mm). Após armazenamento por 24h, a leitura inicial de RS de dez corpos de prova selecionados aleatoriamente foi obtida. Os corpos de prova foram então imersos em um dos tratamentos propostos - desafio erosivo ou solução salina, para então ser realizada a segunda leitura. Decorrido esta análise, os corpos de prova foram submetidos ao teste de RF (1mm/min). Os valores de resistência de união (RU), bem como de RS e RF obtidos foram submetidos a Análise de Variância e Teste de Tukey (?=5%). Análise de Weibull foi também conduzida considerando os valores de RF...

This study evaluated the effect of erosive challenge on the properties and bond stability of restorative materials to primary enamel and dentin. Two hundred and forty primary molars were assigned into 24 groups, in according to the substrate - enamel or dentin, the precondition of substrate - sound or eroded, the restorative material - resin composite associated to adhesive system - RC, high-viscous glass ionomer cement- HVGIC or resin-modified glass ionomer cement - RMGIC, e the treatment after restorative procedure - control (immersion in saline solution/7 days) or erosive challenge (immersion in cola-based drink for 5 min/3x per day/7 days). Teeth from the eroded dentin and enamel groups were subjected to erosive challenge prior to bonding procedures. Polyethylene tubes were placed on flat surfaces of the pretreated substrates, and then were filled up with one of evaluated materials. After storage for 24h at 37ºC, the specimens were submitted to one of the proposed treatments. Half of the specimens were immediately submitted to the microshear bond strength test, and the other half after 12 months of water storage at 37ºC. Subsequently, the failures pattern evaluation was performed in stereomicroscopy (400X). For the assessment of flexural strength (FS) and superficial roughness (SR), thirty specimens were built up (10x2x1mm). After storage for 24h, the first reading of SR from ten specimens randomly selected was obtained. Specimens were immersed in one of proposed treatments - erosive challenge or saline solution, to then be performed the second reading. After this assessment, specimens were submitted to FS (1mm/min)...

Effect of Two Microshear Test Devices on Bond Strength and Fracture Pattern in Primary Teeth

This in vitro study evaluated the influence of two devices for application of shear load in microshear tests on bond strength and fracture pattern of primary enamel and dentin. Eighty primary molars were selected and flat enamel (40 teeth sectioned mesio-distally) and dentin (40 teeth sectioned transversally) surfaces were obtained. Both surfaces were polished to standardize the smear layer. Two-step etch-and-rinse adhesive systems (Adper Single Bond and XP Bond) were used. Polyethylene tubes was placed over the bonded surfaces and filled with composite resin. The microshear testing was performed after storage in water (24 h/37 °C) using two devices for application of microshear loads: a notched rod (Bisco Shear Bond Tester) or a knife edge (Kratos Industrial Equipment). Failure modes were evaluated using a stereomicroscope. Bond strength data were subjected to ANOVA and chi-square test to compare the failure mode distributions (α=0.05). No significant differences were observed between the groups for dentin and enamel bond strength or fracture patterns (p>0.05). The predominant failure mode was adhesive/mixed. In conclusion, the devices for application of shear loads did not influence the bond strength values, regardless of adhesive system and substrate.

Este estudo in vitro avaliou a influência de dois dispositivos para aplicação de força de cisalhamento em testes de resistência de união ao microcisalhamento e no padrão de fratura em dentina e esmalte de dentes decíduos. Oitenta molares decíduos foram selecionados e superficies planas em esmalte (40 dentes seccionados no sentido mésio-distal) e dentina (40 dentes seccionados transversalmente) foram obtidas. Ambas as superficies foram abrasionadas para padronização da lama dentinária. Dois sistemas adesivos de condicionamento ácido prévio (Adper Single Bond e XP Bond) foram utilizados. Tubos de polietileno foram colocados sobre as superficies, nas quais já haviam sido aplicados os sistemas adesivos, e preenchidos com resina composta. O teste de resistência de união ao microcisalhamento foi realizado após armazenamento dos espécimes em água (24 h/37 °C) utilizando dois dispositivos para a aplicação das forças de cisalhamento: cisalha côncava (Bisco Shear Bond Tester) e cisalha plana (Kratos Industrial Equipment). O padrão de fratura foi avaliado usando estereomicroscópio. Os dados de resistência de união foram submetidos à ANOVA e o teste quiquadrado foi utilizado para comparar a distribuição dos padrões de fratura (α=0,05). Não foram observadas diferenças estatisticamente significantes entre os grupos, tanto para a resistência de união a dentina e esmalte quanto para o padrão de fratura (p>0,05). O modo de falha predominante foi adesiva/mista. Em conclusão, os dispositivos para aplicação de força de cisalhamento não influenciam os valores de resistência de união, independente do sistema adesivo e substrato.

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.