The Effectiveness of Lingual Frenectomy and Myofunctional Therapy for Children: A Randomized Controlled Clinical Trial.

Purpose: To evaluate the effectiveness of lingual frenectomy, as a standalone treatment or in association with myofunctional therapy, on the general and functional aspects of six- to 12-year-old children with anomalies in the lingual frenulum.
Methods: This randomized controlled clinical trial involved 40 children diagnosed with altered lingual frenulum. Children who received a frenectomy were evaluated 15 and 30 days after the procedure. After 15 days, the children were randomized into two groups: a group that received isotonic tongue exercises (Study Group [SG]) and a group that did not receive isotonic tongue exercises (Control Group [CG]). The outcome evaluator was blinded to group assignment. Statistical tests were used to compare between and within groups (P <0.05).
Results: There were 20 children in each group. SG children improved significantly when compared to CG subjects regarding tongue mobility (P =0.016), maximum mouth opening (MMO; P =0.024), and MMO with the tip of the tongue touching the incisive papilla (P =0.026).
Conclusion: Frenectomy associated with myofunctional therapy benefitted tongue mobility.

Pulp Vitality and Longevity of Adhesive Restorations Are Not Affected by Selective Carious Removal: A Multicenter Clinical Trial.

The aim of this multicenter randomized clinical trial was to evaluate the pulp vitality and survival rate of adhesive restorations performed on posterior deciduous teeth after non-selective (NSCR) or selective (SCR) carious tissue removal over 33 months. One hundred and seven children (average age 4-8 years, SD 1.4) with at least two active moderate cavitated lesions in dentin were included. Teeth were randomized and submitted to NSCR or SCR before composite resin restoration. Restorations were clinically and radiographically assessed at baseline, 6, 12, 18, 24, and 33 months by a blinded, trained, and calibrated operator in each center. The characteristics of the restorations were recorded according to FDI criteria and were considered as restorative failures when scores 4 or 5 were presented. Pulp vitality was measured by clinical and radiographic examinations, and those teeth that presented any signs or symptoms of irreversible pulpitis or pulp necrosis were considered as failure. Data were analyzed by a Cox regression model with shared frailty, considering two outcomes: pulp and restorative. A total of 278 restorations (137 after NSCR and 141 after SCR) were performed at baseline in four different centers and there was no loss in the follow-up period. Survival rate was 97.1 and 87.1% for pulp and for restorative outcome, respectively. The overall annual failure rate was 7%. There were no differences in the failure risk according to the treatment group, center, and all the clinical and demographic variables, regardless of outcome. Composite restorations of active moderate deep carious lesions performed on posterior primary teeth show satisfactory survival for restorative and pulp outcome after a 33-month follow-up, regardless of the technique executed for carious tissue removal.

Erosive Tooth Wear and Erosive Esophagitis in Children: An Observational Study in Porto Alegre, Brazil.

The aim of this study was to establish and compare the prevalence and severity of erosive tooth wear (ETW) in children with and without erosive esophagitis. Children aged 5-12 years, scheduled for upper digestive endoscopy at the Pediatric Gastroenterology Service of the Children's Hospital Santo Antonio, Porto Alegre, Brazil, were eligible to participate in this study. Patients who presented erosive esophagitis at endoscopy were defined as gastroesophageal reflux disease (GERD) carriers, and the severity was described according to the Los Angeles classification. The oral cavity examination was performed by a trained and calibrated dentist and ETW was classified using the Basic Erosive Wear Examination (BEWE) index. Parents/guardians answered a questionnaire about the patients' diets and frequency of consumption of acidic foods and beverages. A total of 110 children were included in the study. Erosive esophagitis was observed in 24 patients (21.8%) and all of them (100%) presented ETW, showing a statistically significant association between these 2 conditions (p < 0.05). Among children who did not present with erosive esophagitis (n = 86), 54 (64.3%) had an ETW risk level of none according to their BEWE scores (0-2). The results of this study showed a statistically significant association between erosive esophagitis and ETW, thus it can be concluded that it is important to recognize groups at risk of ETW and act together with medical professionals to ensure adequate oral health for these patients.

Repair increases the survival of failed primary teeth restorations in high-caries risk children: a university-based retrospective study.

OBJECTIVES: We investigated factors associated with failure of adhesive restorations in primary teeth and whether repair may increase the survival of failed restorations placed in high-caries risk children. MATERIALS AND METHODS: The sample comprised children who attended a university dental service to perform restorative treatment in primary teeth. Data were collected retrospectively from clinical records to assess the longevity of restorations. The outcomes were calculated in two levels: "Success" (Level 1)-when any re-intervention was considered as failure; "Survival" (Level 2)-when repaired restorations were considered clinically acceptable. The Kaplan-Meier survival test was used to analyze the longevity of restorations. Multivariate Cox regression with shared frailty was used to assess factors associated with failures (p < 0.05). RESULTS: A total of 584 primary teeth restorations (178 patients) were included in the analysis. The longevity of restorations up to 36 months (Level 1) was 34.8% (AFR 29.6%). Multi-surface restorations showed significantly more failures than single-surface ones (HR 1.69; 95% CI 1.18, 2.41), and endodontically treated teeth presented more failures compared to vital teeth (HR 2.22; 95% CI 1.35, 3.65). There was an increase in restoration survival when repair was not considered as failure (p < 0.001). The survival of repaired restorations (Level 2) reached 43.7% (AFR 24.1%). CONCLUSIONS: Adhesive restorations placed in primary teeth of high-caries risk children showed restricted longevity; however, the repair of failed restorations has increased its survival over time. CLINICAL RELEVANCE: Repair is a more conservative and technically simple procedure that increases the survival of failed restorations in primary teeth.

Maternal characteristics, home environment, and other factors associated with traumatic dental injuries in preschool children.

BACKGROUND/AIMS: The importance of external factors such as maternal and home characteristics on traumatic dental injuries needs to be investigated. The aim of this study was to evaluate the association between maternal and home characteristics and dental trauma in preschool children. MATERIAL AND METHODS: This cross-sectional study using a cluster random sample evaluated children between 3 and 4 years of age from Porto Alegre, Brazil. Mothers completed the Brazilian version of the Beck Depression and Anxiety Inventories (BDI and BAI). They answered questions about sociodemographics, maternal behaviors, and home characteristics. Dental trauma was assessed by the Children's Dental Health Survey criteria. Malocclusion and deleterious habits were also assessed. The multinomial logistic regression model was used to investigate the association of exploratory variables with different categories of dental trauma. Odds ratios (OR) and 95% confidence intervals were calculated. RESULTS: A total of 163 pairs of children and mothers agreed to participate (78.4% response rate). The prevalence of dental trauma was 49.8%. Mother's work outside the home, overjet, and anterior crossbite were associated with the occurrence of enamel trauma, while having a younger mother, families having more siblings, and having a mother with university education were associated with increased odds of dentin/pulp trauma. CONCLUSION: Depression and anxiety in the mothers were not associated with dental trauma, while malocclusion characteristics were more relevant for less severe, enamel trauma. Socioeconomic and home environment characteristics played a role in more severe, dentin/pulp trauma.

Does selective carious tissue removal of soft dentin increase the restorative failure risk in primary teeth?: Systematic review and meta-analysis.

BACKGROUND: The authors conducted a systematic review of randomized controlled trials comparing the risk of experiencing restoration failure in primary teeth after complete and selective carious tissue removal of soft dentin. METHODS: The authors searched electronic databases (PubMed [MEDLINE], Scopus, Cochrane Central Register of Controlled Trials) and the ClinicalTrials.gov Web site with manual searching and cross-referencing for trials reporting restoration failure after follow-up of 6 months or longer. Two reviewers independently selected studies, extracted data, and assessed the risk of bias and quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. The authors performed intention-to-treat and per-protocol meta-analyses and calculated odds ratios (OR) as effect estimates in the random-effects model. RESULTS: From 327 potentially eligible studies, the authors selected 23 for full-text screening and included 4. Results showed increased risk of experiencing restoration failure (intention-to-treat analysis, OR [95% confidence interval] 1.74 [1.01 to 3.00], and per-protocol analysis, OR [95% confidence interval] 1.79 [1.04 to 3.09]) after selective carious tissue removal of soft dentin. The risk of bias was high, and the quality of evidence was low. CONCLUSIONS: Selective carious tissue removal of soft dentin may increase the risk of experiencing restoration failure in primary teeth. However, the evidence level is insufficient for definitive conclusions. PRACTICAL IMPLICATIONS: Patients with restorations performed after selective carious tissue removal of soft dentin should have shorter recall visit intervals to evaluate the restorations' quality and control caries disease, allowing for more conservative approaches, such as repair, in cases of defective restorations.

Prevalence of defective restorations and factors associated with re-intervention in primary teeth: A retrospective university-based study.

AIM: This retrospective study investigated the prevalence of defective restorations in a public dental service and factors associated with re-intervention in primary teeth. DESIGN: The sample consisted of all clinical records (census) of children presenting restorations in primary teeth, who had undergone dental treatment in a public set during 1-year period. For analysis, only restorations presenting defects related to esthetic, functional, or biological reasons at first clinical examination were included. The outcome 'Success' was set when the restoration received no treatment (monitored), refurbishing, sealing of margins, or was repaired. Otherwise, 'Failure' was set whenever the restoration was either replaced or if another treatment affecting the restoration was necessary (endodontic treatment or tooth extraction). Poisson regression model was used to assess the prevalence of patient- and tooth-related factors that may influence the re-intervention decision (repair or replacement). RESULTS: From a total of 302 restorations placed in 114 children, 37.7% presented some type of defect. Restorations with recurrent caries were more frequently present in caries-active patients (P = 0.03) and were frequently replaced (95% CI, 1.05-3.22, RR = 1.84, P = 0.03). CONCLUSION: Presence of recurrent caries influences the re-intervention decision, leading to restoration replacement in most cases.

Caries progression as a risk factor for increase in the negative impact on OHRQOL-a longitudinal study.

OBJECTIVES: The aim of this study is to evaluate the association between caries lesions progression and oral health-related quality of life (OHRQoL) among Brazilian preschools, after 2 years. MATERIALS AND METHODS: At baseline, 163 children (3-4 years old) enrolled in 12 public primary care services in Porto Alegre/RS-Brazil were evaluated. After 2 years, 119 children were re-evaluated. Calibrated examiners employing the ICDAS criteria conducted clinical examinations. A socio-demographic questionnaire and the Brazilian version of the Early Childhood Oral Health Impact Scale were applied to the parents of the children at baseline and 2-year follow-up. Data analysis was performed using a hierarchical approach based in a conceptual framework testing by Poisson regression. RESULTS: The number of surfaces that progressed from baseline to 2-year follow-up was associated with an increased negative impact on OHRQoL. CONCLUSIONS: Caries progression increased the negative impact on OHRQoL. CLINICAL RELEVANCE: The progression of caries lesions could negative impact on OHRQoL in Brazilian preschoolers.

Carious deciduous teeth are a potential source for dental pulp stem cells.

OBJECTIVE: The objectives of this study are to isolate, cultivate, and characterize stem cells from the pulp of carious deciduous teeth (SCCD) and compare them to those retrieved from sound deciduous teeth (SHED--stem cells from human exfoliated deciduous teeth). MATERIAL AND METHODS: Cells were obtained of dental pulp collected from sound (n = 10) and carious (n = 10) deciduous human teeth. Rate of isolation, proliferation assay (0, 1, 3, 5, and 7 days), STRO-1, mesenchymal (CD29, CD73, and CD90) and hematopoietic surface marker expression (CD14, CD34, CD45, HLA-DR), and differentiation capacity were evaluated. RESULTS: Isolation success rates were 70 and 80 % from the carious and sound groups, respectively. SCCD and SHED presented similar proliferation rate. There were no statistical differences between the groups for the tested surface markers. The cells from sound and carious deciduous teeth were positive for CD29, CD73, and CD90 and negative for CD14, CD34, CD45, and HLA-DR and were capable of differentiating into osteogenic, chondrogenic, and adipogenic lineages. CONCLUSION: SCCD demonstrated a similar pattern of proliferation, immunophenotypical characteristics, and differentiation ability as those obtained from sound deciduous teeth. These SCCD represent a feasible source of stem cells. CLINICAL RELEVANCE: Decayed deciduous teeth have been usually discarded once the pulp tissue could be damaged and the activity of stem cells compromised. These findings show that stem cells from carious deciduous teeth can be applicable source for cell-based therapies in tissue regeneration.

Clinical and radiographic outcomes of partial caries removal restorations performed in primary teeth.

PURPOSE: To analyze the outcomes of partial caries removal (PCR) restorations in primary teeth. METHODS: The sample of this retrospective study comprised primary teeth that had been treated with PCR by undergraduate students and were selected from the dental records of patients who were receiving treatment at the School of Dentistry, Federal University of Rio Grande do Sul - Brazil (UFRGS), from 2007 to 2012. Records containing clinical and/or radiographic follow-up data of restorations with PCR in primary teeth were included in the analysis. Factors potentially associated with treatment failure were investigated, such as the number of surfaces restored, type of capping material and restorative material used, the presence of visible plaque, and the gingival bleeding index. RESULTS: The sample comprised 254 teeth in 118 subjects; the follow-up period ranged from 1 to 50 months. The overall success rate for PCR was 80.3% (204/254). A significant association was found between high final visible plaque index and PCR failure (P = 0.002).

Randomized clinical trial of adhesive restorations in primary molars. 18-month results.

PURPOSE: To evaluate the clinical performance of adhesive restorations of resin composite and resin-modified glass-ionomer cements in primary molars. METHODS: This randomized clinical trial included subjects (5-9 year-old children) selected at two university centers (UFRGS and UNIFRA). The sample consisted of 132 primary molars presenting active cavitated carious lesions (with radiographic involvement of the inner half of the dentin), located on the occlusal and occlusal-proximal surface. The sample was randomly divided into three groups, according to the restorative material: (G1) universal restorative system (Adper Single Bond 2 system and Filtek Z350); (G2): Resin-modified glass-ionomer cement (Vitremer); and (G3): Low shrink restorative system (Filtek P90). The restorations were clinically and radiographically followed every 6 months for up to 18 months using the USPHS modified criteria for clinical evaluation. Survival estimates for restoration longevity were evaluated using the Kaplan-Meier method. Log-rank test (P< 0.05) was used to compare the differences in the success rate according to the type of the restorative material. RESULTS: The type of restorative material used did not influence the longevity of the restorations. After clinical follow-up, there was no statistical difference in the rates of success for the three materials used to restore active cavitated carious lesions in primary molars. The survival rates for the follow-up were similar regarding the number of restored surfaces and the caries removal technique (partial or complete). Mean estimated time of survival was 17.2 months (95% CI: 16.7-17.7). Estimated survival rates of the restorations were 100%, 98%, 88% and 65% at 1, 6, 12 and 18 months of clinical evaluations, respectively.

Incomplete caries removal and indirect pulp capping in primary molars: a randomized controlled trial.

PURPOSE: To compare the effect of incomplete caries removal (ICR) and indirect pulp capping (IPC) with calcium hydroxide (CH) or an inert material (wax) on color, consistency and contamination of the remaining dentin of primary molars. METHODS: This double-blind, parallel-design, randomized controlled trial included 30 children presenting one primary molar with deep caries lesion. Children were randomly assigned after ICR to receive IPC with CH or wax. All teeth were then restored with resin composite. Baseline dentin color and consistency were evaluated after ICR, and dentin samples were collected for contamination analyses using scanning electron microscopy. After 3 months, restorations were removed and the three parameters were re-evaluated. In both groups, dentin became significantly darker after 3 months. RESULTS: No cases of yellow dentin were observed after 3 months with CH compared to 33.3% of the wax cases (P < 0.05). A statistically significant difference over time was observed only for CH regarding consistency. CH stimulated a dentin hardening process in a statistically higher number of cases than wax (86.7% vs. 33.3%; P = 0.008). Contamination changed significantly over time in CH and wax without significant difference between groups. It was concluded that CH and wax arrested the carious process of the remaining carious dentin after indirect pulp capping, but CH showed superior dentin color and consistency after 3 months.

Caries activity and the presence of adjacent caries lesions on resin composite restorations in primary teeth.

PURPOSE: To clinically evaluate the status of caries lesions adjacent to restorations (AdjCL) in primary molars, and its relationship to the child's carious activity and marginal restoration integrity. METHODS: Three independent examiners (trained, calibrated and blinded) evaluated 64 randomly selected restorations (occlusal and occluso-proximal) by the AdjCL status (kappa = 0.844), the restoration marginal integrity (kappa = 1) and the radiographic presence of lesions in the occlusal restoration margins (kappa = 1). One of the examiners also evaluated the child's carious activity (kappa = 1). The variables were related to the outcome through Chi-square and Fisher's Exact analysis (alpha = 5%). RESULTS: A prevalence of 40.63% AdjCL (88.46% inactive) was seen, with no significant association to the child's carious activity (P = 0.23). The association of the absence of AdjCL and the presence of marginal integrity was statistically significant (P = 0.013). Also, the presence of AdjCL occurred especially around older restorations (P = 0.044).

Influence of gaps in adhesive restorations in the development of secondary caries lesions: an in situ evaluation.

PURPOSE: To investigate in situ the influence of gaps in the development of secondary caries lesion in adhesive restorations. METHODS: 10 volunteers utilized intra-oral appliances, containing three human dental blocks (enamel and dentin), representing the three different groups (two restored, one sound): (1) restored with resin composite using the total acid etch adhesive technique (37% H3PO4 + Single Bond + Z250); (2) restored with resin composite but without acid etching (Single Bond + Z250); (3) and sound blocks (control group). The dental blocks (n=30) were randomly positioned inside the intra-oral appliances, and covered by a porous tissue (gabardine base) to induce a cariogenic biofilm. The volunteers used the appliances 24 hours daily for a 28-day period, removing just during meals and oral hygiene. Eight times a day, a 20% sucrose solution was dripped onto the blocks. Five minutes later, the appliance was washed with distilled water and replaced in the oral environment. After the experimental period, the dental blocks were removed from the appliance and examined by visual examination to detect the presence or the absence of an active carious lesion (kappa= 0.89). Posteriorly, they were prepared for the polarized light microscopy examination, which was performed to describe enamel surface characteristics on the restored and unrestored blocks with active caries lesion (kappa= 1). RESULTS: The visual examination demonstrated that almost all (29/30) of the blocks showed non-cavitated active caries lesion on the enamel surface. The microscopic evaluation showed non-cavitated caries lesions on enamel surfaces for all groups. In the restored blocks (with and without the total etch technique), the demineralization was first identified as an outer lesion that follows the enamel prism directions, and in some cases, reached the cavity walls. The results showed that caries lesion development adjacent to the restoration was determined by the cariogenic challenge of the oral environment, instead of the restoration adhesive quality, and the wall lesion was determined by the prism orientation, regardless of the presence of gaps.

Dentin microhardness of primary teeth undergoing partial carious removal.

AIM: To evaluate the dentin microhardness of primary teeth undergoing indirect pulp capping (IPC) after partial caries removal. MATERIALS: Primary molars were treated with IPC, restored with self-etching primer (Clearfil SE Bond; CSE), and filled with composite resin (Filtek Z250) with (n = 10) or without (n = 7) a calcium hydroxide base liner (Dycal; Dy). After tooth exfoliation, the microhardness of the demineralized dentin remaining under the restoration (n = 17) was analyzed and compared with that of sound and carious primary dentin (n = 20). Microhardness measurements were obtained from the deepest portion of the cavity until the roof of the pulp chamber. Data were analyzed by Kruskal-Wallis test (p < 0.05). RESULTS: There was no difference in microhardness values at all depths between the treated groups (DY and CSE), but when the exfoliated carious teeth were included, the CSE had significantly higher values at 35-microm depth. This difference was only detected in the DY group after a depth of 200 microm. At 700 microm, there was no difference in microhardness values between all 4 groups. CONCLUSIONS: Primary teeth that underwent IPC showed the same microhardness, regardless of the capping material used.

Vertical alveolar growth in subjects with infraoccluded mandibular deciduous molars.

INTRODUCTION: Our objective was to compare vertical alveolar growth in areas adjacent to infraoccluded deciduous molars with growth in areas of deciduous molars and normal occlusion for a period of at least 1 year by using digital subtraction radiography. METHODS: This case-control study included 40 pairs of panoramic radiographs of growing patients with infraoccluded deciduous molars and 40 pairs of radiographs of patients without infraoccluded deciduous molars. One radiograph at baseline was obtained at diagnosis, and the other at least 1 year later. The subjects and the controls were matched according to chronologic age and time interval between the 2 radiographs. The 2 groups were compared with regard to vertical alveolar growth and vertical tooth movement. Measurements were assessed by using nonparametric tests (Mann-Whitney and Friedman) and a multiple comparison test. Significance was set at 5%. RESULTS: A statistically significant difference was observed between the groups with regard to vertical alveolar growth measured on the bone crest between the first permanent molars and second premolars. CONCLUSIONS: Vertical alveolar growth between the first permanent molar and the second premolar adjacent to the infraoccluded teeth was smaller than in areas adjacent to teeth with normal occlusion.

Radiographic evaluation of alveolar bone height in the primary dentition: a retrospective follow-up study.

PURPOSE: The aim of this retrospective follow-up study was to verify the distance between the cementoenamel junction (CEJ) and the alveolar bone crest (ABC) in bitewing radiographs. METHODS: Radiographs were digitized and divided into groups by: age, proximal crown surface status (sound→sound and unsound→unsound), tooth, and timing of radiograph. The CEJ-ABC distances were measured on the distal surface of the first primary molar and/or the mesial surface of the second lower primary molar, using the Image Tool software. RESULTS: The results revealed interactions between the following variables: timing of radiograph-age, age-tooth, timing of radiograph - proximal crown surface status and age- proximal crown surface status. It has been detected that CEJ-ABC distances have significantly increased with time, particularly in terms of assessment of primary lower first molars. However, this increase is greater in unsound when compared to sound surfaces. CONCLUSION: This study suggests that an increase in the CEJ-ABC distance is directly associated with aging in a normal periodontium in the primary dentition and that the presence of unsound surfaces can be a risk indicator for the development of alveolar bone loss.

Indirect pulp treatment in primary teeth: 4-year results.

PURPOSE: To evaluate clinical and radiographic outcomes of indirect pulp treatment (IPT) in primary molars after long-term function (up to 60 months). METHODS: Teeth with deep carious lesions without signs and symptoms of irreversible pulpitis were divided by random allocation into two groups, according to the capping material utilized over demineralized dentin: experimental group (1): self-etching adhesive system (Clearfil SE Bond); and control group (2): calcium hydroxide liner (Dycal). Both groups were filled with resin composite (Z250) and submitted to a clinical and radiographic monitoring period until exfoliation. RESULTS: After the follow-up period (up to 60 months), no statistical difference was found between groups (P= 0.514). The overall success rate reached 78%. The failures occurred after the first year period recall.

Pulp therapy in primary teeth--profile of teaching in Brazilian dental schools.

This study investigates the profile of teaching primary tooth pulp therapy practiced by Brazilian dental schools. A multiple-choice questionnaire was sent by e-mail to 191 dental schools in Brazil, addressed to the pediatric dentistry Chairperson. The two-part survey consisting of multiple-choice questions regarding specific materials and techniques on pulp therapies, moreover, hypothetical clinical scenarios were presented so that the respondents could guide the treatment approach. The questionnaires were returned by 46.5% of the dental schools. Ninety-five percent of surveyed schools teach IPT for the treatment of deep carious lesions in dentin and indicate the calcium hydroxide as capping material (59.3%). The direct pulp capping is taught by 68.7% of schools and calcium hydroxide (97%) was the capping material most indicated. Pulpotomy is taught in 98.7% of schools and formocresol (1:5 dilution) was the medicament of choice (50%). All schools taught pulpectomy and Iodoform paste was the filling material preferred (55%). The results showed a lack of consensus in certain modalities and techniques for primary tooth pulp therapy taught by Brazilian dental schools.