System dynamics modeling for tooth decay treatment in Brazilian children

Abstract Prevention and health promotion are considered important strategies to control oral diseases. Dental caries is preventable disease and remains the most common chronic disease that affects mainly low income children and still considered the main cause of tooth loss in adulthood in Brazil. The aim of this study is to present a System Dynamics model (SDM) specifically developed with the Stella Architect software to estimate the cost and clinical hours required to control the evolution of dental caries in preschool children in Maringá, Brazil. Two main strategies to control caries were considered in the model: the application of fluoride varnish on teeth presenting white spots, and the use of Atraumatic Restorative Treatment (ART) in cavitated carious lesions without pulp involvement. The parameters used in the model were: number of people covered by a local oral health team = 4,000; number of children up to 5 years = 7% of the population; children's decayed, missing, filled teeth (dmft) index = 2.4; time/cost of 4 applications of fluoride varnish = 5 minutes/US$ 0.716; and time/cost of each ART restoration = 15 minutes/US$ 1.475. The SDM generated an estimated total cost of US$698.00, and a total of 112 clinical hours to treat the population in question. The use of the SDM presented here has the potential to assist decision making by measuring the material and human resources required to prevent and control dental caries at an early age.

Fluoruro diamino de plata comparado con técnica de restauración atraumática para el tratamiento de caries cavitadas en dentición primaria y mixta primera fase / Silver diamine fluoride compared to atraumatic restorative technique for the treatment of caries in primary and mixed first phase dentition

INTRODUCCIÓN: Las lesiones de caries cavitadas en dentición primaria y mixta requieren un tratamiento oportuno, para evitar así la progresión de la caries. El fluoruro diamino de plata ha surgido como una alternativa a la técnica de restauración atraumática debido a su fácil aplicación. Sin embargo, aún existe incertidumbre en relación a su efectividad y seguridad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos diez revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos ensayos aleatorizados. Concluimos que el fluoruro diamino de plata en comparación a la técnica de restauración atraumática podría aumentar el arresto de caries en dentición primaria y mixta primera fase, pero la certeza de la evidencia ha sido evaluada como baja. Por otra parte, el tratamiento con fluoruro diamino de plata comparado con la técnica de restauración atraumática (ART) probablemente aumenta el riesgo de eventos adversos

INTRODUCTION: Cavitated carious lesions in primary and mixed dentition require prompt treatment to control caries progression. Silver diamine fluoride has emerged as an alternative to the atraumatic restorative technique due to its easy application. However, there is still uncertainty regarding its effectiveness and safety. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a metanalysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified ten systematic reviews, including two studies overall, which are randomized trials. We concluded that silver diamine fluoride compared to the atraumatic restorative technique may increase the arrest of caries in primary and mixed first phase dentition, however, the certainty of the evidence has been assessed as low. On the other hand, treatment with silver diamine fluoride compared to the atraumatic restorative technique (ART) probably increases the risk of adverse events.

Does low-cost GIC have the same survival rate as high-viscosity GIC in atraumatic restorative treatments? A RCT

Abstract Atraumatic Restorative Treatment (ART) is one of the strategies used to control dental caries; it involves hand instruments for removal of carious tissue, and restorations using high-viscosity Glass Ionomer Cement (GIC). The present controlled clinical trial aimed to evaluate the performance of low-cost GIC indicated for ART in primary teeth, compared with high-viscosity GIC, after one year of follow-up. Two-to six-year-old children with dentin caries lesions on one or two surfaces of anterior and posterior teeth were selected. The children were randomly assigned to 2 groups according to the restorative material used: G1 (control) - Ketac Molar®; G2 (experimental) - Vitro Molar®. Treatments were performed in a school setting, following the guidelines of the ART. A total of 728 restorations were performed in 243 children. Descriptive analysis and Poisson regression were applied, with a significance level of p < 0.05. After 12 months, 559 (76.8%) restorations were re-evaluated. The success rate was evaluated by the prevalence ratio (PR), associated with restorations performed in primary second molars (PR = 1.21; 95%CI = 1.03-1.42), and with small (PR = 1.35; 95%CI = 1.14-1.60) or medium cavities (PR = 1.29; 95%CI = 1.08-1.55), using Ketac Molar® material (PR= 1.07; 95%CI = 1.01-1.15), considering p < 0.05. Small or medium restorations in primary second molars performed with high-viscosity GIC (Ketac Molar®) were more successful than restorations performed with low-cost GIC indicated for ART.

Clinical wear of approximal glass ionomer restorations protected with a nanofilled self-adhesive light-cured protective coating

Abstract High viscous glass ionomer cement (GIC) has gained popularity as a restorative material; however, high wear is pointed as one of the major drawbacks of this material. Protective surface coatings were developed to protect GIC from water contamination with the additional advantage of occluding any surface cracks or porosities commonly found in this material, possibly resulting in an increased wear resistance of the restorations. Objective: The objective of this study was to investigate the clinical wear of GIC approximal restorations in primary molars protected either with a nanofilled self-adhesive light-cured protective coating (NPC) or with petroleum jelly. Material and Methods: Approximal caries lesions in primary molars from 32 schoolchildren previously enrolled in another clinical trial were included in this investigation. GIC restorations were performed according to the Atraumatic Restorative Treatment approach and protected with either petroleum jelly or a NPC. Impressions of the restored hemiarch were done after 1 day and 6, 12, 24 and 36 months. The impressions were scanned in a 3-D appliance and the obtained images were superimposed using an appropriate computer software. Two-way ANOVA for repeated measures and Tukey's post-hoc test were used to analyze the wear of restorations (α=5%). Results: A significant difference was found between the two groups, with a wear protection offered by the application of a NPC. Conclusion: These results suggest that the application of a NPC has a protective effect on the clinical wear of approximal GIC restorations in primary teeth.

Randomized clinical trial of encapsulated and hand-mixed glass-ionomer ART restorations: one-year follow-up

Abstract Objective This prospective, randomized, split-mouth clinical trial evaluated the clinical performance of conventional glass ionomer cement (GIC; Riva Self-Cure, SDI), supplied in capsules or in powder/liquid kits and placed in Class I cavities in permanent molars by the Atraumatic Restorative Treatment (ART) approach. Material and Methods A total of 80 restorations were randomly placed in 40 patients aged 11-15 years. Each patient received one restoration with each type of GIC. The restorations were evaluated after periods of 15 days (baseline), 6 months, and 1 year, according to ART criteria. Wilcoxon matched pairs, multivariate logistic regression, and Gehan-Wilcoxon tests were used for statistical analysis. Results Patients were evaluated after 15 days (n=40), 6 months (n=34), and 1 year (n=29). Encapsulated GICs showed significantly superior clinical performance compared with hand-mixed GICs at baseline (p=0.017), 6 months (p=0.001), and 1 year (p=0.026). For hand-mixed GIC, a statistically significant difference was only observed over the period of baseline to 1 year (p=0.001). Encapsulated GIC presented statistically significant differences for the following periods: 6 months to 1 year (p=0.028) and baseline to 1 year (p=0.002). Encapsulated GIC presented superior cumulative survival rate than hand-mixed GIC over one year. Importantly, both GICs exhibited decreased survival over time. Conclusions Encapsulated GIC promoted better ART performance, with an annual failure rate of 24%; in contrast, hand-mixed GIC demonstrated a failure rate of 42%.

In vitro and in vivo evaluations of glass-ionomer cement containing chlorhexidine for Atraumatic Restorative Treatment

Abstract Objectives: Addition of chlorhexidine has enhanced the antimicrobial effect of glass ionomer cement (GIC) indicated to Atraumatic Restorative Treatment (ART); however, the impact of this mixture on the properties of these materials and on the longevity of restorations must be investigated. The aim of this study was to evaluate the effects of incorporating chlorhexidine (CHX) in the in vitro biological and chemical-mechanical properties of GIC and in vivo clinical/ microbiological follow-up of the ART with GIC containing or not CHX. Material and Methods: For in vitro studies, groups were divided into GIC, GIC with 1.25% CHX, and GIC with 2.5% CHX. Antimicrobial activity of GIC was analyzed using agar diffusion and anti-biofilm assays. Cytotoxic effects, compressive tensile strength, microhardness and fluoride (F) release were also evaluated. A randomized controlled trial was conducted on 36 children that received ART either with GIC or GIC with CHX. Saliva and biofilm were collected for mutans streptococci (MS) counts and the survival rate of restorations was checked after 7 days, 3 months and one year after ART. ANOVA/Tukey or Kruskal-Wallis/ Mann-Whitney tests were performed for in vitro tests and in vivo microbiological analysis. The Kaplan-Meier method and Log rank tests were applied to estimate survival percentages of restorations (p<0.05). Results: Incorporation of 1.25% and 2.5% CHX improved the antimicrobial/anti-biofilm activity of GIC, without affecting F release and mechanical characteristics, but 2.5% CHX was cytotoxic. Survival rate of restorations using GIC with 1.25% CHX was similar to GIC. A significant reduction of MS levels was observed for KM+CHX group in children saliva and biofilm 7 days after treatment. Conclusions: The incorporation of 1.25% CHX increased the in vitro antimicrobial activity, without changing chemical-mechanical properties of GIC and odontoblast-like cell viability. This combination improved the in vivo short-term microbiological effect without affecting clinical performance of ART restorations.

Children's Anxiety during Dental Treatment with Minimally Invasive Approaches: Findings of an Analytical Cross-sectional Study

Objective: To assess children's anxiety before, during and after dental treatment with minimally invasive approaches: Atraumatic Restorative Treatment (ART) and Silver diamine fluoride (SDF) application. Material and Methods: This analytical crosssectional study, in which 1306 children were initially examined, and from these, those that had at least one deciduous molar with dentin caries (score 5 ICDAS) were selected, being indicated to ART and SDF treatments. The final sample consisted of 94 children, 46 girls and 48 boys, aged between 6 and 8 years old. Each child received an ART or SDF procedure, and in all interventions, operators and treatments were randomized. Dental anxiety was assessed by facial image scale (FIS) before, during and after minimally invasive approaches. Results: Dental anxiety prevalence was of 34% before the minimally invasive approaches. Children showed a higher anxiety level during interventions (ART and SDF). And, after the service was finished, there was an increase in children with high anxiety, which ranged from 3.1% (before treatment) to 9.6% (after treatment). However, there was no statistically significant difference in the anxiety related to the types of treatment and conformation of the cavities (class I and II). Conclusion: Both child groups had higher anxiety levels during treatments, both in ART and SDF approaches.

One year Survival Rate of Ketac Molar versus Vitro Molar for Occlusoproximal ART Restorations: a RCT

Abstract Good survival rates for single-surface Atraumatic Restorative Treatment (ART) restorations have been reported, while multi-surface ART restorations have not shown similar results. The aim of this study was to evaluate the survival rate of occluso-proximal ART restorations using two different filling materials: Ketac Molar EasyMix (3M ESPE) and Vitro Molar (DFL). A total of 117 primary molars with occluso-proximal caries lesions were selected in 4 to 8 years old children in Barueri city, Brazil. Only one tooth was selected per child. The subjetcs were randomly allocated in two groups according to the filling material. All treatments were performed following the ART premises and all restorations were evaluated after 2, 6 and 12 months. Restoration survival was evaluated using Kaplan-Meier survival analysis and Log-rank test, while Cox regression analysis was used for testing association with clinical factors (α = 5%). There was no difference in survival rate between the materials tested, (HR = 1.60, CI = 0.98-2.62, p = 0.058). The overall survival rate of restorations was 42.74% and the survival rate per group was Ketac Molar = 50,8% and Vitro Molar G2 = 34.5%). Cox regression test showed no association between the analyzed clinical variables and the success of the restorations. After 12 months evaluation, no difference in the survival rate of ART occluso-proximal restorations was found between tested materials.

3-year survival rates of retained composite resin and ART sealants using two assessment criteria

Abstract The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin (CR) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment (ART) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years. This cluster-randomized controlled clinical trial consisted of 123 schoolchildren, 6–7-years-old. At baseline, high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants. Evaluations were performed after 0.5, 1, 2 and 3 years. Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided. The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material. Data were analysed according to the PHREG model with frailty correction, Wald-test, ANOVA and t-test, using the Jackknife procedure. The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years. A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations. Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional. The modified retention assessment criterion should be used in future sealant-retention studies.

Estudo clínico randomizado de restaurações classe II de ART com e sem retenções proximais em dentes decíduos / Randomized clinical trial of multiple surface ART restorations with and without proximal retentions in primary teeth

O tratamento restaurador atraumático constitui-se numa abordagem de cuidados minimamente invasivos que objetivam a prevenção e interrupção da progressão da cárie dentária. Não existe na literatura estudo clínico randomizado em dentes decíduos comparando restaurações de classe II de ART, com e sem retenções adicionais. O objetivo deste trabalho foi avaliar o efeito de sulcos de retenção proximal sobre as taxas de sobrevida das restaurações classe II de ART em dentes decíduos, usando cimento de ionômero de vidro de alta viscosidade e alta resistência flexural. Foram incluídas 183 crianças com idade entre 4 a 7 anos, com boa saúde geral, 1 a 4 cavidades de classe II em molares decíduos sem envolvimento pulpar ou dor de dente. Dessas crianças, 300 dentes foram randomizados e distribuídos em dois grupos, conforme o índice de cárie da criança e o tamanho da cavidade a ser restaurada. Os grupos foram: controle restaurações de ART classe II convencionais (Grupo 1, n=150) e teste restaurações de ART classe II contendo sulcos de retenção proximais (Grupo 2, n=150). Cada um dos grupos seguiu procedimentos clínicos padronizados. No grupo teste as retenções foram realizadas com colher de dentina modificada no ângulo gengivovestibular/ lingual até 0,5 mm da junção amelo-dentinária da margem oclusal. Após 6 e 12 meses 130 restaurações do Grupo 1 e 110 restaurações do Grupo 2 foram examinadas de forma cega utilizando os critérios do ART Frencken adaptado e do USPHS modificado. Para a taxa de sobrevida das restaurações foi utilizado o teste de Kaplan-Meier (p<0,05). Não houve diferença significativa entre os grupos (p=0,70) utilizando os critérios do ART, sendo que as taxas de sobrevida encontradas para ambos os grupos foram superiores a 90%. O mesmo resultado foi observado em todos os critérios (cor, descoloração marginal, recidiva de cárie, forma anatômica, integridade marginal e textura superficial) USPHS (p>0,05). Os principais motivos de falhas das restaurações foram perda total ou parcial da restauração (84%), seguido de inflamação pulpar (16%). Conclui-se que as restaurações classe II de ART com sulcos de retenção proximal apresentaram taxa de sobrevida semelhantes às restaurações sem retenção após 6 e 12 meses.(AU)

The atraumatic restorative treatment is an approach of minimally invasive care that aims to prevent and interrupt the progression of dental caries. There is no randomized clinical trial in primary teeth with multiple surface ART restorations, with and without additional retentions. The aim of this study was to evaluate the effect of proximal retention grooves on the survival rates of occlusoproximal ART restorations in primary teeth using high viscosity glass ionomer cement with high flexural strength. A total of 183 children aged 4 to 7 years, with good general health, 1 to 4 occlusoproximal cavities in primary molars without pulp involvement or tooth pain were included. Of these children, three hundred teeth were randomized and alocated into two groups, according to the child's caries index and the size of the cavity to be restored. The groups were: control - conventional occlusoproximal ART restorations (Group 1, n=150) and test - occlusoproximal ART restorations containing proximal retention grooves (Group 2, n=150). The procedures of both groups followed standardized steps. In the test group the retentions were performed with a modified dentin spoon at the gingival-vestibular / lingual angle up to 0.5 mm from the amelodentin junction of the occlusal margin. After 6 and 12 months 130 restorations in Group 1 and 110 restorations in Group 2 were examined (blind) using the modified ART Frencken criteria and the modified USPHS criteria. The Kaplan-Meier test was performed for the survival rate of the restorations (p<0.05). There was no significant difference between groups (p=0.70) using the ART criteria, and the survival rates found for both groups were greater than 90%. The same results was observed for all USPHS criteria (color, marginal discoloration, secondary decay, anatomical form, marginal integrity and surface texture) (p>0.05). The main reasons for restorations failure were total or partial loss of restoration (84%), followed by pulpal inflammation (16%). It was concluded that multiple surface ART restorations with proximal retention grooves presented similar survival rates to non-grooves restorations after 6 and 12 months.(AU)

Avaliação clínica randomizada de restaurações de classe II em dentes permanentes de ART e de resina composta / Randomized clinical trial of class II restorations of ART and composite resin in permanent teeth

Este estudo avaliou a efetividade de restaurações de classe II por meio da técnica do Tratamento Restaurador Atraumático (ART), com retenções adicionais nas caixas proximais, em dentes permanentes, usando cimento de ionômero de vidro (CIV) de alta viscosidade, em comparação com restaurações convencionais de resina composta. Um exame epidemiológico foi realizado em uma população maior e representativa dos participantes da pesquisa. Cento e trinta e três participantes, de 8 a 28 anos, com boa saúde geral com uma a duas cavidades de classe II em dentes permanentes sem comprometimento pulpar e dor de dente foram incluídos neste estudo, com aprovação pelo Comitê de Ética sob o número: CAAE: 24012913.0.1001.5417. Foram feitas setenta e sete restaurações com cada material restaurador (Equia Fil-GC Corporation e Z350-3M). As restaurações foram avaliadas aos 6, 12 e 24 meses pelos critérios do ART e do Serviço de Saúde Pública dos Estados Unidos (USPHS) modificado. Correlação de Spearman e Regressão Linear Múltipla foram realizados entre as variáveis dor de dente, índice de placa visível (IPV), índice de sangramento gengival (ISG) e os índices CAST (The Caries Assessment Sprectrum and Treatment) e CPOD (contagem de dentes cariados, perdidos e restaurados) dos participantes do levantamento epidemiológico por meio do programa Statistica 7.1. Quanto à efetividade restauradora, os dados foram analisados, utilizando o programa SPSS 23.0, por meio dos testes de Mann-Whitnney, Qui-quadrado, Exato de Fisher, Qui-quadrado com tendência linear e Regressão logística pelo método Enter, quando pertinentes (p<0,050). O Teste de Kaplan-Meier avaliou as taxas de sobrevida das restaurações em relação ao critério do ART e USPHS modificado. O teste de Log-Rank comparou as curvas de sobrevida. Do índice CAST (1,53; 2,17) foi possível extrair o CPOD (0,58; 1,32) o qual apresentou menor especificidade e sensibilidade no registro da cárie. As taxas de sucesso para as restaurações de resina composta foram de 100% (6 meses), 98,7% (12 meses) e 91,5% (24 meses) para ambos os critérios de avaliação e para as restaurações de ART foram as mesmas para 6 meses (98,7%) e 12 meses (95,8%) e para 24 meses foram de 92% quando utilizado o critério do USPHS modificado e 90,3% quando utilizado o critério do ART, não sendo observada diferença estatística (p=0,466). As variáveis sexo, localidade, idade, CPOD, IPV, ISG, dor de dente, oclusão, contato proximal, tamanho da cavidade, anestesia e cooperação do paciente não apresentaram associação estatística com as taxas de sucesso das restaurações (p>0,050). Após 24 meses, as variáveis IPV e ISG não apresentaram odds ratio (OR) estatisticamente significante para as restaurações de ART (p>0,050). As restaurações de ART apresentaram uma sobrevida inferior pelo critério do ART (83,7%) quando comparado à sobrevida pelo critério do USPHS modificado (87,8%), após 24 meses (p=0,051). A sobrevida das restaurações de resina composta foi de 90,7% para ambos os critérios de avaliação. Conclui-se que não há diferença na taxa de sucesso de restaurações de classe II de ART com CIV de alta viscosidade, em dentes permanentes, com sulcos de retenção proximais, em comparação com restaurações de classe II de resina composta, após 24 meses.(AU)

This study evaluated the effectiveness of Class II restorations through the Atraumatic Restorative Treatment (ART) technique, with additional retentions in the proximal boxes, in permanent teeth, using high viscosity glass ionomer cement (HVGIC), as compared to restorations of composite resin. An epidemiological examination was conducted in a larger and representative population of the participants of study. One hundred and thirty three participants, aged 8 to 28 years, with good general health with 1 to 2 class II cavities in permanent teeth without pulp involvement and tooth pain were included in this study, with was approved by the Ethics Committee under the number: CAAE: 24012913.0.1001.5417. Seventy-seven restorations were made with each restorative material (Equia Fil-GC Corporation and Z350-3M). Restorations were evaluated at 6, 12, and 24 months by the criteria of ART and the modified United States Public Health Service (USPHS). Spearman Correlation and Multiple Linear Regression were performed between the variables tooth pain, visible plaque index (VPI), gingival bleeding index (GBI) and the CAST (The Caries Assessment Sprectrum and Treatment) and DMFT (Decayed, Missing and Filled teeth) obtained at the epidemiological survey using the Statistica program 7.1. As for restorative effectiveness, data were analyzed using the Mann-Whitnney, Chi-square, Fisher's Exact, Chi-square tests with linear trend and Logistic Regression by Enter method, where relevant (p<0.050). The Kaplan-Meier test evaluated the survival rates of the restorations in relation to the ART and modified USPHS criteria. The Log-Rank test compared the survival curves. From the CAST index (1.53; 2.17) it was possible to extract the DMFT (0.58; 1.32) which presented lower specificity and sensitivity in caries detection. The success rates for composite resin restorations were 100% (6 months), 98.7% (12 months) and 91.5% (24 months) for both assessment criteria and for ART restorations were the same for 6 months (98.7%) and 12 months (95.8%) and for 24 months were 92% when using the criteria of modified USPHS and 90.3% when using the criteria of ART, and no statistical difference was observed (p=0.466). The variables gender, locality, age, DMFT, VPI, GBI, toothache, occlusion, proximal contact, cavity size, anesthesia and cooperation of the participant did not present a statistical association with the success rates of the restorations (p>0.050). After 24 months, the VPI and GBI variables did not present a statistically significant odds ratio (OR) for ART restorations (p>0.050). ART restorations presented a lower survival rate by the criteria of ART (83.7%) when compared to the criteria of USPHS modified (87.8%), after 24 months (p=0.051). The survival of composite resin restorations was 90.7% for both evaluation criteria. It was concluded that there is no difference in the success rate of class II restorations of ART with HVGIC, in permanent teeth, with proximal retention grooves, compared to class II resin composite restorations, after 24 months.(AU)

Clinical outcome of root caries restorations using ART and rotary techniques in institutionalized elders

Abstract The aim of this study was to compare the clinical performance of root caries restorations after a six-month period using two methods, a conventional technique with rotary instruments and an atraumatic restorative technique (ART), in an institutionalized elderly population in the city of Bogotá, Colombia. Root caries represents a multifactorial, progressive, chronic lesion with softened, irregular and darkened tissue involving the radicular surface; it is highly prevalent in the elderly, especially in those who are physically or cognitively impaired. A quasi-experimental, double-blind, longitudinal study was carried out after cluster randomization of the sample. Two different experienced dentists, previously trained, performed the restorations using each technique. After six months, two new investigators performed a blind evaluation of the condition of the restorations. The results showed a significantly higher rate of success (92.9%) using the conventional technique (p < 0.03). However, we concluded that ART may have been the preferred technique in the study population because 81% of those restorations survived or were successful during the observation period.

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.

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.

Uso de seringas para inserção no ART: ensaio clínico randomizado / Use of syringes for insertion in ART: randomized clinical trial

O ART é considerado uma das abordagens minimamente invasivas no conceito de Odontologia de Mínima Intervenção, e se baseia principalmente na remoção de tecido cariado com os instrumentos manuais e restauração da cavidade com cimento de ionômero de vidro de alta viscosidade. O objetivo deste estudo foi avaliar a influência da técnica de inserção do material restaurador no sucesso das restaurações atraumáticas em superfícies proximais, em dentes decíduos. A amostra foi composta por 90 pacientes, com idades entre 6 a 10 anos (8,7 ± 1,51). Um total de 90 restaurações foram realizadas por único operador treinado, de acordo com o manual da Organização Mundial de Saúde (OMS). O material restaurador utilizado foi o cimento de ionômero de vidro de alta viscosidade (KetacTM Molar Easy Mix, 3M ESPE), o qual foi inserido através de uma espátula de inserção (G1); seringa Centrix e ponta Accudose Agulha (G2); e seringa modificada (G3). As restaurações foram avaliadas após 6 e 12 por dois examinadores treinados e calibrados (Kappa=0,74), através de fotografias padronizadas, de acordo com os critérios de Roeleveld et al., 2006. Foi aplicado o teste estatístico Qui-quadrado para avaliação de possíveis diferenças entre os tempos e as técnicas de inserção. Não houve diferença estatisticamente significativa quanto aos critérios de sucesso/insucesso clínico entre os métodos de inserção testados, nos dois tempos (p>0,05). Conclui-se que a utilização de técnicas alternativas de inserção do ionômero de vidro não aumenta a taxa de sucesso de restaurações proximais em dentes decíduos.

ART is considered one of the minimally invasive operative approaches in the concept of Minimal Intervention Dentistry, once it involves the removal of soft dentin with hand instruments, followed by filling the cavity with a high viscous glass ionomer cement. The aim of this study was to evaluate the influence of insertion technique on the success rate of proximal atraumatic restorative restorations in primary teeth. The sample comprised of 90 children with ages ranging from 6 to 10 (mean age 8.7±1.51 years). A total of 90 ART restorations were placed by one trained dentist according to World Health Organization (WHO) manual. The restorative material used was a high-viscosity glass-ionomer (KetacTM Molar Easy Mix, 3M ESPE) which was placed into the cavities in a using an insertion spatula (G1); a Centrix syringe injector and Accudose needle (G2); and a modified syringe (G3). The restorations were assessed 6 and 12 months after placement by two calibrated examiners (Kappa=0.74), through standard photographs, according Roeleveld et al. (2006) criteria. The chi-square test was used to evaluate differences between the insertion techniques and the periods tested. There was no difference between the insertion techniques tested, over the two periods evaluated, considering the clinical criteria for success/failure. It was concluded that using alternative insertion methods of glass ionomer cement did not improve success rate of proximal atraumatic restorative restorations in primary teeth.

Ansiedade dos bebês durante o tratamento restaurador atraumático (ART) / Anxiety in babies during atraumatic restorative treatment (ART)

O objetivo foi avaliar o nível de ansiedade dos bebês comparando o ART com a abordagem restauradora convencional. Os dados analisados são referentes à clínica de pesquisa em ART da Fousp. Foram 9 pacientes divididos em 2 grupos: Grupo ART (11 restaurações atraumáticas em 4 bebês) e Grupo Convencional (10 restaurações convencionais em 5 bebês). O nível de ansiedade foi avaliado por meio do registro do comportamento pelo índice de Venham. As avaliações foram realizadas nos seguintes momentos: início do tratamento, isolamento/anestesia local, remoção do tecido cariado, momento da restauração, final da sessão. Em geral, as médias se mostraram mais elevadas nas crianças submetidas ao tratamento convencional, entretanto não houve diferença estatisticamente significante na comparação das duas abordagens restauradoras. O comportamento dos bebês durante as abordagens restauradoras (ART e convencional) é semelhante. Porém, por apresentar evidência científica de efetividade restauradora e reduzir o tempo de tratamento, o Tratamento Restaurador Atraumático está indicado para bebês.

The objective was to assess the level of anxiety in babies comparing ART with conventional restorative approach. The data analyzed refer to a clinical research in ART of FOUSP. Nine patients were divided into 2 groups: Group ART (11 atraumatic restorations in 4 babies) and Conventional Group (10 conventional restorations in 5 babies). The anxiety was assessed by recording the behavior throuh Venham index. Evaluations were performed at the following times: baseline, local anestesia/rubber dam, caries removal, restore time, end of treatment. In general, the averages were more elevated in children undergoing conventional treatment, however there was no statistically significant difference when comparing the two restorative approaches. The babies behavior during the restorative approaches (ART and conventional) is similar. However, because it presents scientific evidence of restorative effectiveness and reduces the time of treatment, the Atraumatic Restorative Treatment is indicated for babies.

Hipomineralização de molar-incisivo [HMI): relato de caso e acompanhamento de tratamento restaurador / Molar incisor hypomineratization (MIH): case report and restorative tratment follow-up

Introdução: Hipomineralização molar incisivo (HMI) é a displasia do esmalte dos dentes que afeta um ou mais primeiros molares permanentes frequentemente associados aos incisivos permanentes. Pacientes com essa alteração apresentam vários problemas clínicos, que podem incluir um desgaste dentário acentuado, perda do esmalte, aumento da suscetibilidade à cárie e sensibilidade dentária. O tratamento da hipomineralização molar-incisivo dependerá da gravidade do dente afetado, abrangendo desde medidas preventivas até procedimentos restauradores complexos. Objetivos: Relatar um caso de um paciente infantil, 7 anos, gênero feminino, diagnosticada com HMI. Além, disso, descrever a abordagem terapêutica, tratamento restaurador e acompanhamento de 28 meses. Conclusão: Pacientes com hipomineralização molar-incisivo necessitam de acompanhamento longitudinal para prevenir perda de estrutura dentária e manutenção do tratamento restaurador.

Introduction: Molar incisor hypomineralization (MIH) is defined as the enamel dysplasia that affects one or more first permanent molars and frequently permanent incisors. These patients have several oral health problems that may include increased tooth wear, loss of enamel, higher susceptibility to dental caries and tooth sensitivity. The treatment of molar incisor hypomine-ralization depends on the severity of the affected teeth, including preventive measures as well as extensive restorative procedures. Objectives: To present a case report of a patient, female, diagnosed at 7 years old with MIH and to describe restorative procedures with a 28-months follow-up period. Conclusion: MIH Patients require longitudinal follow-up to prevent loss of tooth structure and maintenance of restorative treatment.

Randomized controlled clinical trial of long-term chemo-mechanical caries removal using PapacarieTM gel

Objectives: Compare the effectiveness of PapacarieTM gel for the chemo-mechanical removal of carious lesions on primary teeth to conventional caries removal with a low-speed bur with regard to execution time, clinical aspects and radiographic findings. Material and Methods: A randomized controlled clinical trial with a split-mouth design was carried out. The sample was composed of 20 children aged four to seven years, in whom 40 deciduous teeth were randomly divided into two groups: chemo-mechanical caries removal with PapacarieTM and removal of carious dentin with a low-speed bur. Each child underwent both procedures and served as his/her own control. Restorations were performed with glass ionomer cement. The time required to perform the procedure was also analyzed. The patients underwent longitudinal clinical and radiographic follow-up of the restorations. Results: No statistically significant difference between groups was found regarding the time required to perform the procedures and the radiographic follow up. Statistically significant differences between groups were found in the clinical evaluation at 6 and 18 months after treatment. Conclusion: PapacarieTM is as effective as the traditional method for the removal of carious dentin on deciduous teeth, but offers the advantages of the preservation of sound dental tissue as well as the avoidance of sharp rotary instruments and local anesthesia. .

Permanencia de restauraciones oclusales realizadas con técnica restaurativa atraumática (TRA) en dientes permanentes / Survival of atraumatic restorative treatment (ART) restorations in permanent teeth

El tratamiento restaurador atraumático (TRA) ha sido incorporado a la práctica clínica como un método definitivo o provisional para controlar los altos niveles de caries. Es de especial utilidad cuando se necesita prestar atención a comunidades aisladas con difícil acceso al sistema de salud público. El objetivo fue determinar la permanencia y estado de restauraciones realizadas con técnica restaurativa atraumática en dientes permanentes de niños entre 6 - 16 años en la comuna de Curarrehue, Región de la Araucanía, Chile. La población blanco la conformaron 249 niños entre 3 y 16 años residentes en la ciudad de Curarrehue. Luego de 7 meses de realizadas las obturaciones se realizó un examen clínico a los participantes, donde se evaluaron las restauraciones de acuerdo a los criterios establecidos por Frencken para la evaluación del TRA. Se examinaron 172 dientes restaurados con TRA; 142 estaban presentes exitosamente, correspondiente a un 82% de permanencia. En relación al estado de las restauraciones, 58% se encontraron óptimos, 24% aceptables y 18% no aceptable. El TRA es una herramienta útil para el control de la caries dental en poblaciones aisladas o con menor acceso a una atención odontológica

The atraumatic restorative treatment (ART) has been incorporated into clinical practice as a definitive and/or provisional method to control high levels of caries. It is particularly useful when you need to deliver care to isolated communities with limited access to public health care system. The aim of the study was to determine the permanence and status of fillings made with atraumatic restorative technique in permanent teeth of children aged 6-16 years in the commune of Curarrehue, Araucanía Region, Chile. The target population consisted of 249 children between 3 and 16 years living in Curarrehue. Seven months after performing fillings, a clinical examination was performed to participants where restorations were evaluated according to the criteria established by Frencken to evaluate the ART. One hundred seventy-two teeth restored with ART were examined, 142 of these restorations were successful, corresponding to 82% of permanence. Furthermore, regarding the status of the restorations, 58% were found to be in optimal condition, 24% were considered acceptable and 18% were considered unacceptable. According to observations during the course of this work, it becomes apparent that ART is a useful tool for the control of dental caries in isolated populations or with less access to dental care