Use of bulk fill resin composite and universal adhesive for restoring primary teeth after selective carious tissue removal to soft dentin: A randomized clinical trial.

PURPOSE: To investigate the survival of adhesive restorations after selective carious tissue removal to soft dentin in primary molars. METHODS: This two-arm randomized clinical trial included 62 subjects (5.9 years ± 1.7) and 144 primary molars presenting deep active dentin carious lesions. The sample was randomly assigned based on restorative material: universal adhesive (Scotchbond Universal) plus bulk fill resin composite (Filtek Bulk Fill Posterior Restorative) and resin-modified glass-ionomer cement (Vitremer). Two operators performed all restorative procedures. Restorations were evaluated at 6, 12, and 18 months using the FDI World Dental Federation criteria. Survival estimates for restorations' longevity were evaluated with Kaplan-Meier method. Multivariate Cox regression analysis with shared frailty was used to assess the factors associated with failures (P< 0.05). RESULTS: Restorative material did not influence the restorations' survival (HR 1.56 95% CI 0.78-3.13; P= 0.12). The survival rates at 18 months of follow-up were 62.9% and 76.8% (AFR: 26.6% and 16.1%) for resin-modified glass-ionomer cement and bulk fill resin composite restorations, respectively (long-rank P= 0.14). Boys had higher risk of failure in their restorations (HR: 2.64, 95% CI: 1.29-5.40). Restorations performed by a less experienced operator had 3.26 times more risk of failure (P= 0.001). CLINICAL SIGNIFICANCE: The effectiveness of resin-modified glass-ionomer cement (Vitremer) and bulk fill resin composite (Filtek Bulk Fill Posterior Restorative) restorations after selective removal of carious tissue to soft dentin in primary molars was similar at 18 months of follow-up.

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.

Survival and Associated Risk Factors of Selective Caries Removal Treatments in Primary Teeth: A Retrospective Study in a High Caries Risk Population.

OBJECTIVE: The aim of this retrospective study was to analyze the survival probability of selective caries removal (SCR) treatments in the primary teeth of children with high caries experience and factors potentially associated with treatment failure. METHODS: The sample included SCR treatments conducted in anterior and posterior teeth without sedation or general anesthesia among children attending a university dental service. Kaplan-Meier survival analysis was used to estimate the longevity of restorations and multivariate Cox regression with shared frailty was used to assess risk factors. RESULTS: A total of 284 SCR treatments in 88 children (aged 5.2 ± 1.91 years) with high caries experience (mean dmft/DMFT = 11.1 ± 5.04) were analyzed. The 3-year survival reached 48.8%, with an annual failure rate of 21.2%. Restorative failures (n = 60) were found more frequently compared to pulp complications (n = 12). SCR performed in anterior primary teeth were more prone to failure (hazard ratio = 3.6, 95% CI: 1.94; 6.71). Patients with a higher amount of visible plaque experienced more failures in SCR treatments (hazard ratio 3.0, 95% CI:1.27; 7.07). CONCLUSIONS: In this retrospective study, SCR showed restricted survival when compared to other prospective clinical trials. Patient-related factors, especially the young age and high caries experience of the children, may represent a challenge for restoration survival. Regardless of the caries removal technique or restorative material, cariogenic biofilm has a negative effect on the survival of restorations, probably by acting directly on material deterioration and, particularly, on the development of new caries lesions of rapid progression.

Impacto da cárie dentária, maloclusão e hábitos orais na qualidade de vida relacionada à saúde oral em crianças pré-escolares / Impact of dental caries, malocclusion and oral habits on the oral health-related quality of life of preschool children

RESUMO Introdução As doenças e desordens bucais, bem como hábitos orais, podem causar impacto na qualidade de vida das crianças. Objetivo Associar a cárie dentária, maloclusão e hábitos orais com a qualidade de vida de crianças pré-escolares. Métodos Estudo transversal com 93 crianças de 3 a 5 anos de idade, acometidas, ou não, por lesões de cárie não tratadas. Os responsáveis responderam ao questionário sobre hábitos orais e ao Questionário sobre a Qualidade de Vida Relacionada à Saúde Bucal de Crianças na Idade Pré-escolar (B-ECOHIS). Um odontopediatra avaliou a gravidade das lesões de cárie e a presença de alterações oclusais. O nível de significância utilizado foi de 5%. Resultados O B-ECOHIS evidenciou impacto na qualidade de vida, conforme o aumento da idade, nos domínios dos sintomas, aspectos psicológicos, autoimagem e interação social e de função familiar. A cárie dentária apresentou impacto sobre a qualidade de vida das crianças e de seus familiares, especialmente em relação aos domínios dos sintomas e limitações. Hábitos de respiração oronasal e chupeta também evidenciaram efeitos negativos na qualidade de vida das crianças e de seus familiares. Não foi observada associação entre maloclusão e qualidade de vida relacionada à saúde oral. Conclusão A cárie dentária, os hábitos de sução de chupeta e de respiração oronasal demonstraram impacto negativo na qualidade de vida relacionada à saúde oral das crianças.

ABSTRACT Introduction Oral diseases and disorders as well as oral habits can impact the quality of life of children. Purpose To associate the dental caries, malocclusion and oral habits with the quality of life of preschool children. Methods Cross-sectional study with 93 children from three to five years of age who have or have not been affected by untreated carious lesions. Parents answered the questionnaire on oral habits and quality of life instrument related to oral health denominated Early Childhood Oral Health Impact Scale (B-ECOHIS). A pediatric dentist assessed the severity of the carious lesions and the presence of occlusal disorders. The level of significance used was 5%. Results The B-ECOHIS demonstrated impact on quality of life with increasing age in the fields of symptoms, psychological aspects, self-image and social interaction and family function. Dental caries were shown to have an impact on the quality of life of children and their families, especially in relation the domains of symptoms and limitations. Oronasal breathing and pacifier habits negatively impacted the quality of life of children and their families. There was no association between malocclusion and quality of life related to oral health. Conclusion The dental caries, the pacifier suction habits and oronasal breathing demonstrated negative impact on quality of life related to oral health of children.

Perfil mastigatório em crianças de três a cinco anos de idade / Masticatory profile in children from three to five-years old

RESUMO: Objetivo: descrever o perfil mastigatório em crianças de três a cinco anos de idade, correlacionando-o com a idade cronológica, gênero, hábitos orais, introdução alimentar e aspectos dentários. Métodos: estudo transversal realizado com 60 crianças de ambos os gêneros. Um odontopediatra avaliou o aspecto dentário, seguida da avaliação da mastigação realizada por uma fonoaudióloga, utilizando-se pão francês e o protocolo elaborado para este estudo. A coleta de dados da mastigação foi realizada por meio de registro em vídeo e posterior análise por avaliadores cegos. Os responsáveis responderam o questionário sobre os hábitos orais e introdução alimentar. Resultados: nos 10 itens avaliados na mastigação ocorreu alternância entre o padrão esperado para todas as váriaveis. Foi observada diferença estatística entre a postura de lábios das crianças de três e quatro anos quando comparadas com as de cinco anos de idade (p<0,001). Os movimentos mandibulares predominantes do tipo rotatório evoluíram conforme o aumento da idade (p=0,008). Não foi encontrada associação entre os aspectos dentários e a mastigação das crianças. Foi verificada associação entre: a mastigação de meninas e meninos (p=0,001); a evolução mastigatória conforme a idade (p=0,008); apresentar hábitos orais para o item modo de corte (p=0,003) e ser respirador oronasal foi fator significante para a criança realizar a mastigação de boca aberta (p=0,01) e para realizar os movimentos mandibulares de maceração predominantemente (p=0,04). Conclusão: para a amostra estudada, o modo mastigatório apresentou-se gradativo em sua evolução e aperfeiçoamento. Foi encontrada diferenciação na mastigação conforme a idade, gênero, hábitos orais e modo respiratório.

ABSTRACT: Purpose: to describe the characteristics of the chewing profile in children from 3 to 5-years old, correlating it with the chronological age, gender, oral habits, feeding introduction and dental aspects of them. Methods: transversal study performed with 60 children of both genders. A pediatric dentistry dental aspects evaluated, followed by evaluation of chewing performed by a speech therapist using French bread and the elaborate protocol for this study. Data analysis was carried through visual observation and video recording and late analysis by blind raters. The responsible answered a questionnaire about the oral habits and food introduction. Results: at the 10 items evaluated chewing occurred toggle between the standard expected for all variables. A statistical difference between the posture of lips of three- and four years compared to the five years of age (p<0.001). The predominant mandibular movements of the rotary type evolved with increasing age (p=0.008). No association was found between dental aspects and mastication of children. Association was found between: girls and boys chewing characteristics (p<0.001); mastication evolution according to age (p=0,008); to present oral habits for the item cut so (p=0.003) and was mixed respiratory significant factor in the child hold his mouth open chewing (p=0.01) and to carry out the jaw movements of maceration predominantly (p=0,04). Conclusion: for the studied sample, the chewing so presented itself gradually in its evolution and improvement. Found in chewing differentiation according to age, gender, oral habits and breathing mode.

Medidas antropométricas orofaciais em crianças de três a cinco anos de idade / Anthropometrical orofacial measurement in children from three to five years old

OBJETIVO: obter as medidas antropométricas orofaciais em crianças pré-escolares de três a cinco anos e realizar a correlação com idade cronológica, gênero, raça e hábitos orais. MÉTODOS: estudo transversal com 93 crianças selecionadas por meio de amostra de conveniência consecutiva. Os responsáveis responderam a um questionário sobre os hábitos orais e as crianças foram submetidas a uma avaliação odontológica e antropométrica da face. O nível de significância utilizado foi p<0,05. RESULTADOS: as médias das medidas antropométricas orofaciais foram descritas. Houve diferença estatística nas medidas de altura da face (p<0,001), terço médio da face (p<0,001), canto externo do olho até a comissura labial esquerda/direita (p<0,001) e lábio inferior (p=0,015) nas faixas etárias. O gênero masculino apresentou medidas superiores na altura de face (p=0,003), terço inferior da face (p<0,001), lábio superior (p=0,001) e lábio inferior (p<0,001). Não houve diferença estatisticamente significante na altura do lábio superior em sujeitos não brancos (p=0,03). A presença de hábitos orais não influenciou os resultados. O aleitamento materno exclusivo por seis meses influenciou o aumento da medida de terço médio (p=0,022) e da altura da face (p=0,037). CONCLUSÃO: as médias descritas neste estudo foram superiores aos padrões encontrados em outros estudos. As médias orofaciais aumentaram conforme a idade. Houve superioridade nas medidas para o gênero masculino e para as crianças não brancas, mas não para presença de hábitos orais. .

PURPOSE: to obtain the orofacial anthropometric measurements in preschool children from three to five years old and analyze the connection of these data with chronological age, gender, race, and oral habits. METHODS: this consisted on a transversal study with 93 children selected through consecutive convenience sample. Parents answered a questionnaire about the oral habits and children underwent odontological and orofacial anthropometric evaluation. The significance level was set at <0.05. RESULTS: the averages of orofacial anthropometric measurements were described. There were statistical differences in measures of middle third of the face (p<0.001), lower face (p<0.001), face height (p<0.001) and lower lip (p=0.015) across the age groups. Males showed higher mesures in height of the face (p=0.003), lower face (p<0.001), upper lip (p=0.001) and lower lip (p<0.001) than females. There was no statistically significant difference in the height of the upper lip in non-white subjects (p=0.03). The presence of oral habits did not influence the outcomes. The exclusive breastfeeding for six months influenced the rise of the middle third (p=0.022) and height of the face (p=0.037). CONCLUSION: the measurements described in this study were higher than those found in other studies. The orofacial measurement increased with age. The measures were higher on males and non-white children, but not for the presence of oral habits. .

Outcomes of one-step incomplete and complete excavation in primary teeth: a 24-month randomized controlled trial.

AIM: To compare 24-month pulp health outcomes of partial caries removal (PCR) and total caries removal (TCR) with composite restoration in primary molars. METHODS: 48 children aged 3-8 years with at least one molar with a deep carious lesion were included. 120 teeth were randomized to control (TCR; n = 54; 69% class II) and test (PCR; n = 66; 63% class II) groups. Total absence of carious tissue was confirmed using a blunt-tipped probe in the TCR group. For PCR, excavation was stopped when hardened, dried dentin with a leathery consistency was achieved. Pulpotomy was performed in cases of pulp exposure. RESULTS: Pulp exposure occurred in 2 and 27.5% of teeth treated with PCR and TCR, respectively (p < 0.01). The operative time was significantly higher for TCR than PCR. Success rates were 92 and 96% in the PCR and TCR groups, respectively (p = 0.34). The success rate tended to be lower in occlusoproximal (92%) than in occlusal (100%) lesions (p = 0.08). CONCLUSION: The clinical and radiographic success rates of PCR and TCR in primary teeth with deep carious lesions were high and did not differ significantly, indicating that PCR is a reliable minimally invasive approach in primary teeth and that the retention of carious dentin does not interfere with pulp vitality. Moreover, PCR provided other clinically relevant advantages over TCR, especially lower incidence of pulp exposure and lower operative time.

Memory in children with symptomatic temporal lobe epilepsy.

In children with temporal lobe epilepsy (TLE), memory deficit is not so well understood as it is in adults. The aim of this study was to identify and describe memory deficits in children with symptomatic TLE, and to verify the influence of epilepsy variables on memory. We evaluated 25 children with TLE diagnosed on clinical, EEG and MRI findings. Twenty-five normal children were compared with the patients. All children underwent a neuropsychological assessment to estimate intellectual level, attention, visual perception, handedness, and memory processes (verbal and visual: short-term memory, learning, and delayed recall). The results allowed us to conclude: besides memory deficits, other neuropsychological disturbances may be found in children with TLE such as attention, even in the absence of overall cognitive deficit; the earlier onset of epilepsy, the worse verbal stimuli storage; mesial lesions correlate with impairment in memory storage stage while neocortical temporal lesions correlate with retrieval deficits.

Memory in children with symptomatic temporal lobe epilepsy / Memoria em criancas com epilepsia de lobo temporal sintomatica

In children with temporal lobe epilepsy (TLE), memory deficit is not so well understood as it is in adults. The aim of this study was to identify and describe memory deficits in children with symptomatic TLE, and to verify the influence of epilepsy variables on memory. We evaluated 25 children with TLE diagnosed on clinical, EEG and MRI findings. Twenty-five normal children were compared with the patients. All children underwent a neuropsychological assessment to estimate intellectual level, attention, visual perception, handedness, and memory processes (verbal and visual: short-term memory, learning, and delayed recall). The results allowed us to conclude: besides memory deficits, other neuropsychological disturbances may be found in children with TLE such as attention, even in the absence of overall cognitive deficit; the earlier onset of epilepsy, the worse verbal stimuli storage; mesial lesions correlate with impairment in memory storage stage while neocortical temporal lesions correlate with retrieval deficits.

Em crianças com epilepsia de lobo temporal (ELT) os problemas de memória não são tão bem compreendidos como em adultos. O objetivo desse estudo foi identificar e descrever déficits de memória em crianças com ELT sintomática e verificar a influência de variáveis da epilepsia na memória. Avaliamos 25 crianças com ELT com diagnóstico baseado em aspectos clínicos, eletrencefalográficos e de neuroimagem. Vinte e cinco crianças normais foram comparadas com os pacientes. Todas as crianças foram submetidas à avaliação neuropsicológica para estimar nível intelectual, atenção, percepção visual, dominância manual, e processos de memória (verbal e visual: memória a curto prazo, aprendizado e recuperação tardia). Os resultados nos permitiram concluir que: além de déficit de memória, outros distúrbios neuropsicológicos podem ser encontrados em crianças com ELT, tais como déficit de atenção, mesmo na ausência de déficit cognitivo global; quanto mais precoce o início da epilepsia, pior o armazenamento verbal; lesões mesiais se correlacionam com prejuízo no armazenamento de memória enquanto lesões temporais neocorticais se correlacionam com prejuízos de evocação.

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).

Tratamento minimamente invasivo em caso de hipoplasia de esmalte: relato de caso / Minimally invasive treatment of enamel hypoplasia: Case report

O aparecimento de crianças com defeitos na formação do esmalte é uma rotina em consultórios osontopediátricos. Portanto, suas causas, giagnóstico e tratamento são de grande importância na prática clínica. Estudos dessas patologias são vistos em várias áreas da Odontologia, citando inúmeras causas e tratamentos propostos. Nesse estudo, abordou-se um relato de caso de tratamento estético, minimamente invasivo de hipoplasia de esmalte. Ela se apresentou com colaboração amarelo-castanha, em um dente anterossuperior permanente. A criança possuía 9 anos de idade, com histórico de trauma no dente decíduo subjacente (dente 61), envolvendo luxação intrusiva do dente aos 3 anos de idade, sendo essa a provável causa do defeito do esmalte no seu sucessor permanente (dente 21). Para tanto, um tratamento restaurador sem desgaste de esmalte foi feito com uso de corantes e resinas compsotas, utilziando a técncia incremental, mascarando completamente a lesão hipoplásica subjacente, sem necessidade de microabrsão ou desgaste para obtenção de tratamento restaurador estético satisfatório

Children with enamel defects are very common in Pediatric Dentistry. Therefore, its causes, diagnoses and treatments are very important in the day by day clinic. A lot of studies about these pathologies are seen in different areas of dentistry, related to find different causes and proposing treatments. At this study we aim to show a case report about a minimally invasive treatment in a case of enamel hypoplasia in an anterior permanent teeth in a children with 9 years old, with a esthetic complain. These hypoplasia has a yellow, almost brown color, presented in the vestibular face of the tooth 21, with an earlier history of intrusive luxation of tooth 61 at 3 years old, having no immediate treatment for the trauma. Being these trauma the possible cause of the enamel defect. As a treatment for this case, a restorative treatment was chosen without enamel removal,using composite resins, masquerading all de lesion, without need of microabrasion for esthetic treatment, achieving satisfactory esthetic

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.

Avaliação clínica e laboratorial da dentina de dentes decíduos após remoção parcial de tecido cariado / Clinical and laboratorial evaluation of the primary teeth dentin after partial caries removal

O objetivo desse estudo foi investigar longitudinalmente o desempenho clínico e radiográfico da Remoção Parcial de Tecido Cariado (RPTC) em dentes decíduos e avaliar a dentina cariada remanescente através da microdureza após sua esfoliação. A amostra desse estudo provém de um ensaio clínico randomizado controlado realizado em 20 pacientes com idade entre 4 e 7 anos. Trinta e nove molares decíduos com lesões cariosas agudas profundas, sem sinais de patologia pulpar irreversível foram submetidos à RPTC. Os dentes foram divididos em dois grupos de acordo com material forrador utilizado: hidróxido de cálcio (HC) - 20 dentes ou guta-percha (GP) - 19 dentes e restaurados com resina composta. Após 36 meses de acompanhamento, 29 dentes (15 pacientes) foram reavaliados; desses, 23 dentes obtiveram sucesso cínico e radiográfico: 11 HC (73,3%) e 12 GP (85,7%). O sucesso total nessa etapa da avaliação foi de 79,3% e não houve diferença entre os materiais capeadores. Esses dentes continuaram em avaliação até sua esfoliação (37 a 71 meses de permanência em boca), quando 18 dentes (6 HC e 12 GP) foram coletados para análise laboratorial. O objetivo dessa análise foi verificar se a RPTC viabilizou a remineralização da dentina cariada remanescente em molares decíduos. Os 18 dentes submetidos à RPTC foram agrupados (grupo tratado). Além disso, selecionou-se dez molares decíduos hígidos e dez, com lesões cariosas agudas profundas em dentina para os grupos controle, positivo e negativo, respectivamente. As restaurações do grupo tratado foram removidas e a profundidade da cavidade medida. Nos dentes do grupo controle positivo, foram realizados preparos cavitários oclusais em até 4 mm de profundidade (semelhante ao grupo tratado), e no grupo controle negativo, realizou-se a RPTC in vitro.

Todos os dentes foram preparados para análise de microdureza, que foi realizada em três pontos lineares da cavidade, distante 100μm entre si e nas profundidades de 10, 35, 60, 85 e 110 μm, totalizando 15 indentações por amostra. Além disso, a espessura da dentina remanescente foi medida (μm) para aferir a profundidade das cavidades. A espessura da dentina remanescente foi semelhante para os três grupos (médias: 921, 852, 833 μm,hígido, cariado e tratado, respectivamente; p≤0,01). Os valores de microdureza knoop obtidos mostraram diferença significativa entre os três grupos (hígido, cariado e tratado) em todas as profundidades: 10 μm (54,8; 12,5; 38,3), 35μm (62,0; 13,0; 38,0), 60μm (56,8; 12,3; 39,1), 85μm (58,9; 13,0; 40,3), 110μm (55,7; 14,2; 42,0), p≤0,01. Houve aumento da dureza nos dentes tratados comparados aos cariados em todas as profundidades investigadas (p≤0,01), sugerindo ganho mineral após o tratamento.

Distribution of regional gray matter abnormalities in a pediatric population with temporal lobe epilepsy and correlation with neuropsychological performance.

OBJECTIVE: The goals of the work described here were to determine if hippocampal and extrahippocampal atrophy in children with temporal lobe epilepsy (TLE) follows a pattern similar to that in adult patients, and to assess the clinical and neuropsychological relevance of regional brain atrophy in pediatric TLE. METHODS: Children with symptomatic TLE (n=14: 9 with mesial TLE due to hippocampal atrophy and 5 with TLE due to neocortical lesions), healthy children (n=14), and 9 adults with mesial temporal lobe epilepsy (MTLE) were compared using voxel-based morphometry (VBM) of brain magnetic resonance imaging (MRI). The children underwent a comprehensive neuropsychological battery. RESULTS: Children with MTLE with unilateral hippocampal atrophy (n=9) exhibited a significant reduction in gray matter in the hippocampus ipsilateral to the seizure origin and significant atrophy in the ipsilateral cingulate gyrus and contralateral middle frontal lobe. Children with TLE (n=14) exhibited a significant reduction in the gray matter of the ipsilateral hippocampus and parahippocampal gyrus. There was a correlation between gray matter volume in children with TLE and scores on several neuropsychological tests. Atrophy in pediatric patients with MTLE was less extensive than that in adults, and involved the hippocampi and the frontal cortex. CONCLUSIONS: Similar to adult MTLE, pediatric MTLE is associated with hippocampal and extrahippocampal cell loss. However, children display less intense quantifiable gray matter atrophy, which affects predominantly frontal lobe areas. There was a significant association between volume of gray matter in medial temporal and frontal regions and scores on neuropsychological tests. In childhood, TLE and the concomitant cognitive/behavior disturbances are the result of a damaged neural network.

Frontal lobe dysfunction in children with temporal lobe epilepsy.

There is evidence that adults with temporal lobe epilepsy present executive impairments. However, there is limited information in children, especially when using a comprehensive neuropsychologic battery. We aimed to: 1) investigate the presence and severity of executive dysfunctions in children with temporal lobe epilepsy, and 2) determine the implications of clinical variables (including etiology) in the occurrence and severity of executive dysfunction, using eight paradigms. Thirty-one children with temporal lobe epilepsy were evaluated and compared with 21 age-matched controls. Patients with temporal lobe epilepsy had significantly worse performance than controls. Intragroup analysis indicated that patients with symptomatic epilepsy were more impaired than those with cryptogenic epilepsy. In the former group, patients with mesial lesions performed worse than those with lateral lesions. Regarding the severity of executive dysfunction, 83.87% manifested severe to moderate executive impairment. Early age of onset, longer duration of epilepsy, and use of polytherapy were correlated with worse executive dysfunction. These findings indicated the presence of frontal lobe dysfunction in children with temporal lobe epilepsy, with worse performance in those with mesial temporal lobe epilepsy, early onset, longer duration of disease, and use of polytherapy. Our study corroborates the hypothesis that temporal lobe epileptogenic activity affects the extratemporal regions that mediate attentional and executive functions.

Clinical and radiographic evaluation of indirect pulp treatment in primary molars: 36 months follow-up.

PURPOSE: To evaluate the clinical and radiographic changes in primary teeth submitted to indirect pulp treatment (IPT) over a 36-month period. METHODS: Thirty-nine primary molars with deep caries, but without preoperative signs and symptoms of irreversible pulpits, received IPT. The teeth were randomly divided into two groups, according to the material used for protection of the dentin-pulp complex: (1) a calcium hydroxide liner (Hydro C) and (2) a gutta-percha sheet. Both groups were restored with Z250 resin-based composite. RESULTS: After 36 months, Group 1 showed a success rate of 73.3% and Group 2, 85.7%. The overall success rate was 79.3%, with no statistically significant difference between the groups (P = 0.36).

Interictal EEG in temporal lobe epilepsy in childhood.

The authors clarified the value of interictal discharges and verified which extratemporal regions may also show epileptiform activity in temporal lobe epilepsy (TLE) in childhood. Thirty consecutive patients aged 3 to 18 years (mean age = 12.16 years; 16 male) with TLE associated with hippocampal atrophy were studied. Each patient had 1 to 15 interictal EEG recordings (mean: 5.6; total = 192 EEGs). Video-EEG monitoring was performed in 20 patients. All patients had MRI. The findings were compared with a control group of 53 consecutive TLE adult outpatients with hippocampal atrophy. Each adult patient underwent 3 to 21 routine EEGs (mean: 10.67; total = 566). Interictal EEGs of children with TLE showed extratemporal epileptiform discharges more frequently than EEGs of adults with TLE. Frontal, parietal, and occipital discharges were more frequently seen in children (P < 0.05). These results suggest a close interaction between temporal and other cerebral regions in children with epilepsy and provide further evidence of the existence of neural networks.

Effectiveness of clobazam as add-on therapy in children with refractory focal epilepsy.

The objective of this study was to evaluate the safety and efficacy of clobazam in children with refractory focal epilepsy. We investigated 100 consecutive patients concerning etiology of epilepsy, previously used antiepileptic drugs, seizure frequency and adverse events. Clobazam was introduced as add-on therapy in patients with previous failure of at least two monotherapies. Mean age was eight years-old and 39 patients were girls. Clobazam mean dosage was 23.6 mg/day. Mean use of clobazam was 18.6 months. Twenty-two patients had adverse events. Twenty-six patients became seizure-free, 11 had an improvement of >75% and in 58 there was no modification in seizure frequency. Five patients had an increase in seizure frequency. Clobazam efficacy lasted for more than one year in 42% of the seizure-free patients. Clobazam seems to be safe and effective in the treatment of focal epilepsy in childhood and should be considered in patients with refractory seizures.

Effectiveness of clobazam as add-on therapy in children with refractory focal epilepsy / Eficácia do clobazam como terapia adjuvante em crianças com epilepsia focal refratária

The objective of this study was to evaluate the safety and efficacy of clobazam in children with refractory focal epilepsy. We investigated 100 consecutive patients concerning etiology of epilepsy, previously used antiepileptic drugs, seizure frequency and adverse events. Clobazam was introduced as add-on therapy in patients with previous failure of at least two monotherapies. Mean age was eight years-old and 39 patients were girls. Clobazam mean dosage was 23.6 mg/day. Mean use of clobazam was 18.6 months. Twenty-two patients had adverse events. Twenty-six patients became seizure-free, 11 had an improvement of >75 percent and in 58 there was no modification in seizure frequency. Five patients had an increase in seizure frequency. Clobazam efficacy lasted for more than one year in 42 percent of the seizure-free patients. Clobazam seems to be safe and effective in the treatment of focal epilepsy in childhood and should be considered in patients with refractory seizures.

O objetivo deste estudo foi avaliar a segurança e eficácia do clobazam em crianças com epilepsia focal refratária. Nós investigamos 100 pacientes consecutivos em relação à etiologia da epilepsia, uso prévio de drogas anti-epilépticas, freqüência de crises e eventos adversos. Clobazam foi introduzido como terapia adjuvante em pacientes que não responderam a pelo menos duas monoterapias. A idade média foi 8 anos e 39 pacientes eram do sexo feminino. A dose média de clobazam foi 23,6 mg/dia. O uso médio de clobazam foi por 18,6 meses. Vinte e dois pacientes tiveram eventos adversos. Vinte e seis pacientes tornaram-se livres de crises, 11 tiveram melhora > 75 por cento e em 58 não houve modificação na freqüência de crises. Cinco pacientes tiveram aumento na freqüência de crises. A eficácia do clobazam permaneceu por mais de um ano em 42 por cento dos pacientes sem crises. Clobazam parece ser seguro e eficaz no tratamento de epilepsia focal na infância e deve ser considerado em pacientes com crises refratárias.

Interictal electroencephalographic findings in children and adults with temporal lobe tumors.

OBJECTIVE: To characterize clinical and interictal electroencephalographic aspects of children and adults with temporal lobe epilepsy (TLE) due to tumoral lesions. METHOD: We performed a retrospective analysis of the clinical and interictal electroencephalographic aspects of 16 children (64 exams) and 12 adults (78 exams) with lesions in the temporal lobe. RESULTS: The most frequent etiologies were gangliogliomas, DNETs, followed by astrocytomas. Auras occurred in both groups, the most common being epigastric sensation. Other findings such as myoclonias, behavioral arrest and vomiting were more frequent in children. Temporal epileptiform and nonepileptiform activities, mostly unilateral, were found in both groups. Extratemporal epileptiform activities (frontal, parietal, central, occipital and generalized) were also found equally in both groups. CONCLUSION: Our data show that children and adults with TLE due to expansive lesions present with similar EEG findings.