Is Atraumatic restorative treatment an option for restoring occlusoproximal caries lesions in primary teeth? A systematic review and meta-analysis.

BACKGROUND: Atraumatic restorative treatment (ART) has demonstrated good longevity when used for single-surface restorations, but lower success rates are reported for occlusoproximal surfaces. AIM: This systematic review and meta-analysis aimed to verify the pooled success rate of occlusoproximal ART restorations in primary teeth considering the outcomes: longevity, pulp damage, or caries lesion progression. DESIGN: Literature searching was carried out on the studies reporting clinical trials indexed in PubMed and in English language, comprising the outcomes. A meta-analysis was undertaken considering the results from reviewed studies. RESULTS: An initial search resulted in 126 articles, and three of them were finally selected. The main reasons for excluding articles were the absence of control group, as amalgam, composite resin, or compomer restorations to be compared with ART (hand excavation + high-viscous GIC). The pooled estimate (odds ratio; 95% confidence interval) for ART approach success was 1.04 (0.65-1.66). CONCLUSION: Atraumatic restorative treatment restorations performed with high-viscous GIC present similar survival/success rates to conventional approach using composite resin or amalgam for occlusoproximal restorations in primary teeth and can be suggested as a good option for occlusoproximal cavities in primary molars. In addition, further randomized controlled clinical investigations concerning occlusoproximal restorations in primary teeth are still necessary.

Comparison of dentin root canal permeability and morphology after irradiation with Nd:YAG, Er:YAG, and diode lasers.

The aim of this study was to compare the effects of Nd:YAG, Er:YAG, and diode lasers on the morphology and permeability of root canal walls. The three laser wavelengths mentioned interact differently with dentin and therefore it is possible that the permeability changes caused will determine different indications during endodontic treatment. Twenty-eight human single-rooted teeth were instrumented up to ISO 40 and divided into four groups: group C, control (GC), non-laser irradiated; group N (GN), irradiated with Nd:YAG laser; group E (GE), with Er:YAG laser and group D (GD) with diode laser. After that, the roots were filled with a 2% methylene blue dye, divided into two halves and then photographed. The images were analyzed using Image J software and the percentage of dye penetration in the cervical, middle, and apical root thirds were calculated. Additional scanning electron microscopy (SEM) analyses were also performed. The analysis of variance (ANOVA) showed significant permeability differences between all groups in the middle and cervical thirds (p < 0.05). The Tukey test showed that in the cervical third, GN presented means of dye penetration statistically significantly lower than all of the other groups. In the middle third, GE and GD showed statistically higher dye penetration means than GC and GN. SEM analysis showed melted surfaces for GN, clean wall surfaces with open dentinal tubules for GE, and mostly obliterated dentinal tubules for GD. Er:YAG (2,094 nm) laser and diode laser (808 nm) root canal irradiation increase dentinal permeability and Nd:YAG (1,064 nm) laser decreases dentin permeability, within the studied parameters.

Evaluation of the furcation area permeability of deciduous molars treated by neodymium:yttrium-aluminum-garnet laser or adhesive.

The purpose of this in vitro study was to compare the effects of a self-etch adhesive system and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser application on the dentinal permeability of the furcation area of primary molars. After endodontic access, 39 extracted human deciduous molars were divided into three groups: control group (CG), no treatment; adhesive group (AG), self-etching adhesive was applied to the furcation area; laser group (LG), specimens were irradiated with Nd:YAG laser. To evaluate dentin permeability of the furcation area, we immersed the specimens in 0.5 % methylene blue dye for 4 h. Then, they were longitudinally sectioned into two halves and photographed. The images were analyzed by two qualified evaluators using TpsDig software to calculate the percentage of the dye penetration area in comparison with the total furcation area. Additional analyses by scanning electron microscopy (SEM) were performed. The analysis of variance (ANOVA), complemented by Student's t-test, showed that mean dye penetration in the LG was statistically significant lower than that in all the other groups (P < 0.05). The SEM analysis showed mostly dentinal tubules obliterated by smear layer in the CG; in the AG the smear layer was modified by the adhesive, and, in the LG, melted surfaces were observed. It can be concluded that the Nd:YAG laser was capable of reducing the dentinal permeability of the furcation area of deciduous molars.