Evidence-practice gap in treatment decisions about defective composite and amalgam restorations among Brazilian dentists

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). This study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap

Reparación de defecto localizado en restauración de amalgama como tratamiento de mínima intervención en cariología / Repair of a localized defect in a restoration with amalgam filling as minimal intervention treatment in cariology

Introducción: La reparación de restauraciones ha sido estudiada desde muy recientemente, pero a pesar de haber demostrado efectividad y mejoras en la terapéutica de la caries dental, aún tiene seguidores y detractores, lo que justifica la necesidad de estudios que sigan avalando tales prácticas. Objetivo: Describir, a través de la presentación de un caso, la reparación de un defecto localizado en una restauración de amalgama como tratamiento de mínima intervención en cariología. Presentación del caso: Paciente femenina de 16 años con antecedentes de salud acude a consulta refiriendo una pequeña fractura de restauración en diente 4.6 desde hace varias semanas. La regularización del defecto en la restauración, la mínima preparación cavitaria, la eliminación del fragmento de la base intermedia, la protección del complejo dentino-pulpar y el llenado de la cavidad resultante, fueron los primeros pasos de una técnica que se cumplimentó luego del pulido final de la interface tejido dentario-restauración y se evolucionó cinco años después. Se evidenció el estado y presencia de la reparación de la restauración realizada, sin fracturas añadidas, microfiltraciones, sintomatologías, desplazamientos ni pérdidas de la continuidad. Conclusiones: La reparación del defecto localizado de amalgama se realizó con el fin de preservar los tejidos dentarios no afectados como lo dicta la mínima intervención en cariología. Cinco años más tarde, la evolución evidencia una práctica que se tradujo en resultados satisfactorios e incremento de la calidad de vida de la paciente(AU)

Introduction: Restoration repair has been studied recently; but, even when it has demonstrated effectiveness and improvements in the therapy of dental caries, it still has followers and detractors that justify the need for studies that continue supporting such practices. Objective: To describe, through a case presentation, the repair of a defect located in a restoration with amalgam filling as minimal intervention treatment in cariology. Case presentation: Sixteen-year-old female patient with health history that went to the clinic reporting a small fracture of a restoration performed in tooth 4.6 several weeks ago. The regularization of the defect in the restoration, minimum cavity preparation, elimination of the fragment of the intermediate base, protection of the dentin-pulp complex, and filling of the resulting cavity were the first steps of a technique that was completed after the final polishing of the dental tissue/restoration interface that was evolved five years later. The status and presence of the restoration repair performed without added fractures, microfiltration, symptomatology, displacement or loss of continuity was evidenced. Conclusions: The repair of the localized defect in a restoration with amalgam filling was performed with the aim of preserving the unaffected dental tissues as dictated by minimal intervention in cariology. Five years later, the patient´s evolution shows a practice that resulted in satisfactory results and an increase in the patient's quality of life(AU)

Retrospective study of dental treatment under general anesthesia of 62 disabled children and adolescents / 北京大学学报(医学版)

OBJECTIVE@#To retrospectively figure out the oral health status, treatment and follow-ups after dental treatment under general anesthesia (DGA) of disabled children or adolescents.@*METHODS@#Clinical data of disabled children or adolescents and normal children as control received DGA in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology from August 2008 to September 2015 were recorded, including: gender, birth date, treatment date, disability type, oral health status before treatment, treatment content and follow-ups (in 1 year). Differences among ages and disabilities were analyzed statistically.@*RESULTS@#Sixty-two disabled patients and fifty-seven controls were recruited, mean aged (9.38±5.22) years and (3.00±1.41) years. Most patients had 10 to 15 problem teeth with which the mean number of the disabled children and adolescents was (11.79±4.98) while that of the normal controls was (12.40±4.11). Caries, pulpitis, periapical periodontitis, dental trauma and developmental tooth anomalies of the disabled patients accounted for 67.56%, 13.54%, 15.15%, 1.07%, and 2.68%, respectively and the DMFT/dmft index was 11.55±5.56 while in the control group those were at 65.35%,19.09%,14.14%,0,1.41% and 12.23±4.42. The DMFT/dmft index of the disabled patients in the group 6-12 years (8.35±4.69) was significantly less than that of the other three groups (P<0.01) while no differences were found in disabilities (P=0.239). Resin restoration, pit and fissure sealant, preventive resin restoration, pulpotomy, pulpectomy/RCT, extraction and crown of the disabled patients were performed as 52.71%, 7.24%, 8.56%, 0.72%, 17.13%, 10.01% and 3.62% respectively whereas those made up as 56.31%, 1.27%, 0.13%, 2.29%, 19.87%, 7.90% and 12.23% in the control group. Thirty-five (56.45%) disabled patients and forty-three (75.44%) controls recalled. Problem teeth within one year after operation in diabled patients and controls were both nearly twice as much as the number within half a year. Restoration loss/fractured mainly occurred in anterior primary teeth while secondary/ recurrent caries and pulpitis/perapical periodontitis mostly occurred in primary molars.@*CONCLUSION@#Oral health status in our disabled children and adolescents is poor. Though dental treatment under GA is an effective way to improve the oral health of disabled children and adolescents, periodic follow-ups and family oral health care are equal important for oral health maintenance.

One-year aging effects on microtensile bond strengths of composite and repairs with different surface treatments

Abstract The present study aimed to evaluate effects of different surface treatments and aging of composite cylinders on bond strength of composite resin repair. Thirty-two composite cylinders were produced and divided into four groups according to type of surface treatment and storage time of composite cylinder and repair. Cylinder surface of control group (Gcontrol) received no treatment before composite repair. Other groups were sandblasted with aluminum oxide (GAl2O3), followed by silane (GAl2O3sil) or adhesive (GAl2O3ad). Composite cylinders were stored in artificial saliva for either 24 hours or 1 year. Repairs were performed and stored in artificial saliva for 24 hours or 1 year and repair strength was evaluated using microtensile bond strength test. Data were submitted to Student’s t test, two-way ANOVA, and post hoc test for storage time and treatment (α = 0.05). Gcontrol group showed lower values of aging of composite cylinder and storage time of repair (24 hours or 1 year for both) compared with other groups (p < 0.05). GAl2O3ad and GAl2O3sil groups did not exhibit decreased microtensile bond strength with aged repairs (1 year; p > 0.05). Polymer degradation was significant for composite cylinders during the first year of storage in Gcontrol, GAl2O3, and GAl2O3ad groups (p < 0.05). In GAl2O3sil group, storage time of composite cylinders was not significant (p > 0.05). Aging of composite resin influenced bond strength of restoration repair for up to 1 year. Sandblasting with Al2O3, followed by application of silane layer, produced high bond strength after composite or repair aging.

Efeito de diferentes sistemas de obturação na resistência à fratura de raízes tratadas endodonticamente / The Influence of different obturation systems on the fracture resistance of endodontically treated roots

Objective: This study aimed to compare the fracture resistance of endodontically treated roots filled by different obturation systems. Material and methods: Ninety-six maxillary central incisors were used and decoronated, retaining 12 mm of the roots. On the basis of obturation systems, the roots were randomly divided into 4 groups (n=24): Group1 (COGR): control group (unprepared, unfilled), Group 2 (AVGR): ActiV GP points/ActiV GP sealer, Group 3 (GPGR): Gutta percha points / AH plus sealer, and Group4 (GAGR): Gutta percha points/ActiV GP sealer. The last three groups were obturated with the single cone technique. The roots were then stored in 100% relative humidity at 37 °C for 2 weeks. A vertical compressive force was exerted in a universal testing machine until fracture occurred. Data were statistically analyzed using one-way ANOVA. Results: Mean (SD) failure loads for groups ranged from 920.51 ± 210.37 to 1113.44 ± 489.42 N. The fracture resistance between the different study groups indicated no statistical difference (p>0.05). Conclusions: ActiV GP system did not exert a significant effect on the fracture resistance of endodontically treated teeth.(AU)

Objective: Comparar a resistência à fratura de raízes tratadas endodonticamente obturadas através de diferentes sistemas. Materiais e Métodos: Noventa e seis incisivos centrais superiores foram utilizados, tiveram as coroas removidas, restando 12 mm de raíz. De acordo com o sistema de obturação, as raízes foram divididas em 4 grupos (n=24): Grupo1 (COGR): grupo controle (sem preparo, sem preenchimento), Grupo2 (AVGR): cones ActiV GP / cimento ActiV GP, Grupo3 (GPGR): cones de guta percha / cimento AH plus, e Grupo4 (GAGR): cones de guta percha / cimento ActiV GP. Os últimos três grupos foram obturados através da técnica de cone único. As raízes foram armazenadas em 100% de umidade relativa a 37 °C durante 2 semanas. Uma força compressiva vertical foi aplicada através de uma máquina de ensaio universal até ocorrer fratura. Os dados foram analisados estatisticamente através de ANOVA ­ 1 fator. Resultados: A carga média (SD) obtida no momento da falha variou entre 920.51 ± 210.37 até 1113.44 ± 489.42 N. A resistência à fratura entre os diferentes grupos estudados não indicaram diferença estatística. Conclusão: O sistema ActiV GP não exerceu um efeito significante na resistência à fratura em dentes tratados endodonticamente.(AU)

Generalidades sobre la mínima intervención en cariología / General remarks about minimal intervention dentistry

Introducción: los tratamientos de la caries dental con mínima intervención incorporan a la ciencia estomatológica: detección, diagnóstico y tratamientos a niveles microscópicos. Objetivo: caracterizar, a través de una revisión bibliográfica, la mínima intervención en el tratamiento de la caries dental. Métodos: se realizó una revisión de la literatura científica sobre mínima intervención en cariología, a través de los buscadores de información y plataformas: SciELO, Hinari, y Medline. Se revisaron 25 revistas de impacto. Se incluyó artículos en idioma inglés y español. Los descriptores empleados para la búsqueda fueron: mínima intervención,odontología/estomatología mínimamente invasiva, cariología, mínima intervención en cariología, tratamiento actual de la caries dental, filosofía mínima intervención, las combinaciones entre ellos y su equivalente en inglés. Se obtuvo 204 artículos; luego de ser filtrados quedaron 32 publicaciones científicas y un libro, que enfocaban esta temática de manera más integral. El 97 por ciento de la bibliografía correspondía a publicaciones realizadas durante los últimos 5 años. Integración de la información: se realiza análisis sobre la prevención, remineralización y tratamientos con técnicas de mínima intervención para la remoción de la caries dental. Conclusiones: la mínima intervención propicia el actuar científicamente de acuerdo a la etapa del proceso caries dental. Es una concepción teórica con herramientas para la práctica encaminada a preservar la mayor cantidad posible de tejido dental de manera que los dientes tengan mayor funcionabilidad(AU)

Introduction: minimal intervention treatments for dental caries enrich dental practice by incorporating detection, diagnosis and microscopic techniques into it. Objective: characterize minimal intervention in the treatment of dental caries by means of a bibliographic review about the subject. Methods: a review was conducted of the literature about minimal intervention in dentistry, using the search engines and platforms SciELO, Hinari and Medline. Twenty-five high impact journals were reviewed. The papers included were in English or Spanish. The descriptors used in the search wereminimal intervention, minimally invasive dentistry, cariology, minimal intervention dentistry, current treatments for dental caries and minimal intervention philosophy, as well as combinations thereof and their counterparts in Spanish. 204 papers were obtained. After being filtered, the sample was composed of 32 scientific journals and one book, i.e. the materials that approached the topic in a more comprehensive manner. 97 percent of the bibliography reviewed had been published in the last five years. Data integration: an analysis was conducted about prevention, remineralization and minimal intervention techniques for the removal of dental caries. Conclusions: Minimal intervention dentistry is characterized by adopting a position in which intervention or preparation of dental tissue is the last choice of therapy resorted to after applying a whole set of prevention and remineralization techniques(AU)

Repairabilitiy of aged resin composites mediated by different restorative systems / Reparo de resinas compostas envelhecidas e mediadas por diferentes materiais restauradores

The aim of this study was to evaluate the shear bond strengthof resin composite repairs with and without aging of thesurface to be repaired, using different adhesive systems andresin composites. Ninety specimens were prepared: 10 for theControl Group (GC - without repair); 40 for Group I (GI -repairs after 7 days) and 40 for Group II (GII - repairs after180 days). Groups I and II were divided into 4 subgroups of10 specimens each, according to the adhesive system andcomposite resin used: A) Adper Scotch Bond Multipurpose +Filtek Z350 XT; B) Adper Single Bond Plus + Filtek Z350 XT;C) Adper Scotch Bond Multipurpose + Esthet-X; D) AdperSingle Bond Plus + Esthet-X. The specimens were tested forshear strength in a universal testing machine. The resultswere analyzed by two-factor one-way ANOVA and Fisher’spost hoc tests (alpha=0.05). The control group had betterperformance than the other groups. There was no significantdifference when comparing different adhesive systems andcomposite resins. Repairs performed at 7 days were betterthan those performed at 180 days. The composite repairsdecreased the mechanical strength of the restoration. Agingof the resin substrate may decrease repair bond strength overtime, regardless of the type of adhesive systems and resin composites used.

Avaliar a resistência de união ao cisalhamento de reparos deresina composta com e sem envelhecimento da superfície a serreparada, utilizando diferentes sistemas adesivos. Noventacorpos de prova foram confeccionados sendo: 10 para o GrupoControle (GC - sem reparo); 40 para o Grupo I (GI - reparosapós 7 dias) e 40 para o Grupo II (GII – reparos após 180 dias).Para os reparos, os grupos GI e GII foram subdivididos em 4subgrupos com 10 corpos de prova, variando o sistema adesivoe a resina composta: A) Adper Scotch Bond Multipurpose+Filtek Z350XT; B)Adper Single Bond Plus+ Filtek Z350XT;C)Adper Scotch Bond Multipurpose+ Esthet-X; D) AdperSingle Bond Plus+ Esthet-X. Os corpos de prova foramsubmetidos a uma força de cisalhamento em uma máquina deensaio universal (EMIC). Os resultados foram analisados peloteste estatístico Anova dois fatores, seguido pelo teste deFisher ́s. Observou-se melhor comportamento do grupocontrole sobre os demais grupos, além disso, os reparosrealizados aos 7 dias foram superiores aos dos realizados em180 dias. Não houve diferença significativaquando secomparou diferentes sistemas adesivos e resinas compostas.Os reparos de resina composta diminuem a resistênciamecânica da restauração.O envelheci mento do substrato deresina pode diminuir a resistência ao reparo ao longo dotempo, independentemente do tipo de sistemas adesivos eresinas compostas utilizados.

Avaliacão clínica de restauracões de resina composta em molares decíduos estudo piloto / A clinical evaluation of composite restorations in primary molars - an interim study

As restaurações de resina composta têm sido amplamente utilizadas na Clínica Infantil, pois além de preservarem a estrutura dental sadia são mais estéticas e o seu desgaste é semelhante ao desgaste fisiológico do dente decíduo. Objetivos: avaliar o comportamento e a longevidade das restaurações realizadas com resina composta em dentes decíduos posteriores utilizando os métodos USPHS e FDI. Materiais e Métodos: foram selecionadas 09 crianças que possuíam 34 restaurações eclusas ou ocluso-proximal em molares decíduos, realizadas no curso de graduação da Universidade Luterana do Brasil Cachoeira do Sul/RS com as resinas Charisma®, Filtekl P60, Filtekl Z250 XT. As restaurações foram avaliadas por um examinador cego para os objetivos do estudo, segundo critérios dos métodos USPHS e FOI. A análise estatística foi realizada com o teste Kruskal-Wallis, com nível de significãncia 5%. Resultados: as 34 restaurações feitas com as três resinas compostas não apresentaram diferenças em relação à maioria dos critérios nos dois métodos empregados. Apenas para o critério manchamento superficial houve diferença entre as resinas compostas (p=0,006), sendo que a resina Filtek P60 demonstrou maior manchamento superficial do que as resinas Charisma e Filtek Z250. Conclusões: as três resinas compostas mostraram-se satisfatórias durante o período de tempo avaliado, confirmando a sua indicação para tratamentos restauradores dos dentes decíduos. As resinas Charisma e Filtek Z250 apresentaram melhor desempenho em relação ao manchamento superficial do que a Filtek P60. Os dois métodos de avaliação clínica podem ser utilizados para avaliação de restaurações em dentes decíduos, sendo o método FDI mais completo e promissor.

The composite resins have been widely used in Pediatric Dentistry, because they preserve the health dental structure, are more esthetics and their abrasion levei is similar that of the deciduous teeth. Objectives: to evaluate the behavior and the longevity of the composite resins fillings in posterior deciduous teeth using the USPHS and FDI methods. Materiais and methods: 09 children were selected who had 34 restorations (occlusal and occlusoproximal) in primary molars performed by undergraduate students of Lutheran University of Brazil Cachoeira do Sul/RS with Charisma®, Filtekl P60, Filtekl Z250 XT composite resins). The restorations were evaluated by an examiner blinded to the study objectives, through USPHS and FDI methods criteria. Statistical analysis was performed by the Kruskal-Wallis test, with the significance level set at 5%. Results: the 3 composite resins did not show any difference regarding to majority of criteria employed in the two methods. For the superficial staining criterion there was statistically significant difference among the composite resins (p=0,OO6), being Filtek P60 the resin that showed worst superficial staining than Charisma and Filtek Z250. Conclusions: the composite resins evaluated were satisfactory and available to fill deciduous teeth. lhe composite resins Charisma and Filtek Z250 showed better performance than Filtek P60 in relation to superficial staining criterion. The two evaluation methods can be used to evaluate restorative procedures in deciduous teeth, being FOI method the most complete and promising though.

Randomized clinical study comparing metallic and glass fiber post in restoration of endodontically treated teeth.

Background: Post-retained crowns are indicated for endodontically treated teeth (ETT) with severely damaged coronal tissue. Metallic custom and prefabricated posts have been used over the years, however, due to unacceptable color, extreme rigidity and corrosion, fiber posts, which are flexible, aesthetically pleasing and have modulus of elasticity comparable with dentin were introduced. Aim: To compare clinical performance of metallic and glass fiber posts in restoration of ETT. Materials and Methods: 40 ETT requiring post retained restorations were included. These teeth were randomly allocated into 2 groups. Twenty teeth were restored using a glass fiber-reinforced post (FRP) and 20 others received stainless steel parapost (PP), each in combination with composite core buildups. Patients were observed at 1 and 6 months after post placement and cementation of porcelain fused to metal (PFM) crown. Marginal gap consideration, post retention, post fracture, root fracture, crown fracture, crown decementation and loss of restoration were part of the data recorded. All teeth were assessed clinically and radiographically. Fisher's exact test was used for categorical values while log-rank test was used for descriptive statistical analysis. Results: One tooth in the PP group failed, secondary to decementation of the PFM crown giving a 2.5% overall failure while none in the FRP group failed. The survival rate of FRP was thus 100% while it was 97.5% in the PP group. This however was not statistically significant (log-rank test, P = 0.32). Conclusion: Glass FRPs performed better than the metallic post based on short-term clinical performance.

Evaluation of various concentrations of alkaline surface treatment on interfacial bond strengths of amalgam bonded to amalgam

This study was done to assess the influence of alkaline surface modification on interfacial bond strength of existing fractured [old] amalgam restoration bonded to fresh amalgam. Old and Fresh amalgam interfaced samples were prepared by applying a 4-methacryloyloxyethy trimellitate anhydride [4-META] containing adhesive. The adhesive used was Amalgabond [Parkell, Farmingdale, NY 11735, USA]. Four concentrations of calcium hydroxide Ca[OH][2] solutions were used as a surface modifiers for old amalgam to increase the pH of the amalgam surfaces. The concentrations used were 2.5, 5, 10 and 15%. Direct measurement of the interfacial bond strength was carried out using an electromechanical universal tensile testing machine at crosshead speed of 10mm per minute. Results show that all the calcium hydroxide modified samples produced the increased tensile bond strength [TBS] as compared to their control group. The highest values of bond strength were achieved using 15% Ca[OH][2] solution as surface modifier. Pretreatment of fractured amalgam with calcium hydroxide improves the bond strength of 4-META adhesives. Its use in repair of amalgam may therefore be considered

Effects of different surface treatments and accelerated artificial aging on the bond strength of composite resin repairs

The purpose of the present study was to assess the bond strength of composite resin repairs subjected to different surface treatments and accelerated artificial aging. 192 cylindrical samples (CSs) were prepared and divided into 24 groups (n = 8). Half of the CSs were stored in water for 24 h, and the other half were subjected to C-UV accelerated aging for non-metallic specimens. The treatments were phosphoric acid + silane + adhesive (PSA); phosphoric acid + adhesive (PA); diamond bur + phosphoric acid + silane + adhesive (DPSA); diamond bur + phosphoric acid + adhesive (DPA); air abrasion + phosphoric acid + silane + adhesive (APSA); and air abrasion + phosphoric acid + adhesive (APA). The repair was performed and the specimens were again aged as described above. A control group (n = 8) was established and did not receive any type of aging or surface treatment. The specimens were loaded to failure in shear mode with a crosshead speed of 0.5 mm/min until fracture. Data were analyzed by one-way ANOVA/Tukey's test (p < 0.05). No statistically significant differences were found among DPSA, DPA, APSA, APA, and the control group. The aged PSA and PA achieved low bonding values and were statistically different from the control group, whereas the non-aged PSA and PA presented no statistically significant difference from the control group. Repairs with the proposed surface treatments were viable on both recent and aged restorations; however, phosphoric acid + adhesive alone were effective only on recent restorations.