Clinical effect of microscopic periapical surgery combined with MTA apical filling in treatment of chronic apical periodontitis / 口腔疾病防治

Objective @#To observe the clinical effect of microscopic periapical surgery combined with (mineral trioxide aggregate (MTA) apical filling in treatment of chronic apical periodontitis. @*Methods@#A total of 64 patients with 91 teeth of chronic apical periodontitis, which couldn't be treated with root canal treatment, were selected and randomly assigned into two groups. 32 patients with 43 teeth in the control group were treated with traditional surgery combined with amalgam filling. 32 patients with 48 teeth in the experimental group were treated with microsurgical apical surgery combined with MTA apical filling. Patients were followed for 12 months. The healing of periapical lesionwere assessed by clinical symptoms and X-ray examination every three months.@*Results @# In the experimental group, 27 cases cured, 17 cases improved, the success rate was 91.67% (44/48). In the control group, 19 cases cured, 12 cases improved, the success rate was 72.09% (31/43). The success rate in experimental group was significantly higher than the control group (χ2 = 5.997, P = 0.014). @*Conclusion@# Effect of microscopic periapical surgerycombined with MTA apical filling in treatment of chronic periapical periodontitis is satifactory.

Evaluation of compressive load required to fracture premolar restored with different restorative materials-an in vitro.

Background: Restored teeth are generally weaker than sound teeth due to loss of tooth structure caused by caries and restorative procedures. The loss of both tooth structures as a result treatment will increase the likelihood of fractures during functional loading. Objective: To evaluate the fracture resistance of premolars with class II disto occlusal preparations restored with light cured composite with light cured composites layered incrementally and silver amalgam in comparison with intact and unrestored teeth. Material and methods: 50 freshly extracted premolars were randomly divided into 5 groups of 10 teeth each. All the 50 specimens were then subjected to a compressive load in a Universal Testing Machine (Hounsfield). The loads required to fracture the teeth were recorded and the data, obtained were subjected to statistical analysis and the following results were arrived. Result: Teeth restored with light cured composite incrementally placed in oblique layers produced a higher fracture resistance than any other group and showed the closest value to the intact teeth. This was followed in descending order by light, cured composite placed in horizontal increments and silver amalgam. Conclusion: Result concluded that teeth restored with light cured composite incrementally placed in oblique layers produced a higher fracture resistance than any other group and showed the closest value to the intact teeth.

Frecuencia de restauraciones plásticas directas en dientes posteriores en tres centros públicos de Asunción / Frecuency of direct plastic restorations in posteriorteeth in three public centers in Asunción

En la selección del material de restauración, para rehabilitar una pieza dentaria posterior que ha sufrido una lesión, el operador puede optar entre la amalgama o la resina compuesta, equilibrando las ventajas y desventajas de cada una. Este estudio de enfoque mixto, de diseño descriptivo, retrospectivo y transversal, tuvo como objetivo determinar la frecuencia en el uso de los biomateriales restauradores en dientes posteriores. Se utilizó un cuestionario aplicado a una muestra de 164 sujetos tratados previamente en tres centros póblicos de referencia en Asunción en 2.013 y 2.014. El trabajo se complementó con una técnica cualitativa, la entrevista a grupo focal, en dos grupos distintos; por un lado a docentes y por el otro, a comerciantes de artículos dentales. Se observó que la resina es el material de uso más frecuente (77,7%) seguido del ionómero de vidrio (18,4%), siendo la amalgama el menos utilizado (4,2%). Docentes y comerciantes entrevistados coincidieron en opinar que la resina es el material más utilizado por el factor estético, y que la amalgama se halla francamente en desuso, sea por su falta de estética o por efectos tóxicos, aunque pocos docentes conocían los criterios actuales sobre los efectos adversos de amalgamas y resinas, emitidos por entes sanitarios internacionales. Se propone tener en cuenta estos resultados para la reorientación del curriculum en la educación odontológica respecto a los biomateriales restauradores si fuese necesario, sobre fundamentos válidos y coherentes con las necesidades del contexto.

In selecting restorative material to rehabilitate a posterior tooth that has suffered alesion, the operator can opt between the amalgam and the composite resin, taking theadvantages and disadvantages of each into consideration. This study of mixed approachhad a descriptive, retrospective and transversal design, and the objective of determiningthe frequency of use of restorative biomaterials on posterior teeth. A questionnaire appliedto a sample of 164 subjects previously treated in three referential public centers inAsunción in 2013-and 2014 was used. The study was complemented wit a qualitativetechnique, the Focus Group Interview, applied to two different groups: faculties on onehand and dental articles sellers on the other hand. It was found that resin is the mostfrequently used material (77.7%), followed by glass ionomer (18.4%), with amalgambeing the least used (4.2%). Interviewed faculties and sellers coincided in stating thatresin is the most frequently used material due to the aesthetic factor, and that the amalgam has frankly fallen into disuse whether by its lack of aesthetic or by its toxic effects,though few professors actually knew current criteria about the adverse effects of amalgamsand resins issued by international sanitary entities. It is proposed to take theseresults into account for the reorientation of the curricula in the odontological educationabout restorative biomaterials, if necessary, based on valid grounds, consistent with thecontext needs.

Partial caries removal in deep lesions: 19-30 months follow-up study / Remoção Parcial de Dentina Cariada em Lesões Profundas: estudo de 19-30 meses de acompanhamento

O objetivo deste ensaio clínico controlado randomizado multicêntrico foi avaliar a efetividade da remoção parcial de dentina cariada seguida de restauração em única sessão (RPDC) em lesões de cárie profundas no Brasil (Porto Alegre e Brasília) após dois anos de acompanhamento. Critérios de inclusão: pacientes com ≥ seis anos de idade apresentando molares permanentes com lesões profundas primárias, ausência de alteração periapical, sensibilidade pulpar, ausência de dor espontânea e sensibilidade à percussão negativa. Os indivíduos foram randomicamente atribuídos ao grupo teste - RPDC, ou grupo controle - tratamento expectante (TE). O TE consistiu na remoção parcial de dentina cariada, capeamento pulpar indireto com cimento de hidróxido de cálcio, restauração provisória com cimento de óxido de zinco e eugenol, reabertura da cavidade após 60 dias, remoção da dentina cariada remanescente amolecida e restauração. Cada grupo foi dividido de acordo com o material restaurador: amálgama ou resina. Avaliações clínicas e radiográficas foram realizadas anualmente. Os desfechos considerados foram sensibilidade pulpar ao teste frio e ausência de alteração periapical. Foram executados 299 tratamentos, 153 RPDC e 146 TE. Não houve diferença entre os grupos em relação às características basais. Após dois anos de acompanhamento, foram avaliadas 181 restaurações e a taxa de sobrevivência dos tratamentos RPDC e TE foram 95,45% e 80,85%, respectivamente (p=0,001). Razões dos insucessos: pulpites, osteíte, hiperemia, necroses, extração e fratura da restauração. Nenhuma variável foi significativamente associada ao desfecho. A partir destes resultados, é possível concluir que a RPDC é um tratamento mais efetivo que o TE.

The aim of this multicenter randomized controlled clinical trial was to evaluate the effectiveness of partial caries removal followed by restoration in a single session (PDR) for deep caries lesions in Brazil (Porto Alegre and Brasilia) after 2-year follow-up. Inclusion criteria: patients with ≥ six years old presenting permanent molars with primary deep lesion, absence of periapical alterations, pulp sensitivity, absence of spontaneous pain and negative percussion test. The subjects were randomly assigned to test group - PDR, or control group - stepwise excavation (SW). SW consisted of partial removal of carious dentine, indirect pulp capping with calcium hydroxide cement, temporary filling, cavity re-opening after 60 days, removal of the remaining soft carious dentine and filling. Each group was divided according to the filling material: amalgam or resin. Clinical and radiographic evaluations were performed in annual basis. The outcomes were considered as pulp sensibility to cold test and absence of periapical alterations. There were performed 299 treatments, 153 PDR and 146 SW. There were no differences between the groups regarding baseline characteristics. After 2 years of follow-up, 204 restorations were evaluated and the therapy survival rates of PDR and SW were 95.45% and 80.85%, respectively (p=0.001). Reasons for failure: pulpitis, osteitis, hyperemia, necrosis, extraction and restoration fracture.. None variable was significantly associated with the outcome. From these results, it is possible to conclude that the PDR is a more successful treatment than SW.

Remoção parcial de tecido cariado em lesões de cárie profundas de dentes permanentes / Partial removal of carious dentine in deep caries lesion in the permanent dentition

The partial removal of carious dentine was studied by means of a literature review and a multicenter randomized controlled clinical trial. The clinical trial compared the effectiveness of an alternative treatment for deep caries lesions and the stepwise excavation in Public Health Services in Brazil. The treatment consists of partial removal of carious dentine followed by restoration in one session. A cost-effectiveness analysis the two treatments was performed. The clinical performance of amalgam and resin restorations placed in deep caries lesions with or without decayed tissue beneath them was also evaluated. Inclusion criteria: patients with ¡Ý nine years old, permanent molars with deep caries lesions and absence of periapical alterations, pulp sensitivity; absence of spontaneous pain; negative percussion test. The subjects were assigned to: test-group - partial removal of carious dentine (PDR) and restoration, and control-group - stepwise excavation (SW). SW consists of partial removal of carious tissue, indirect pulp capping with calcium hydroxide cement; temporary filling; cavity re-opening after 60 days, removal of the remaining soft carious...