ABSTRACT
OBJECTIVES: This systematic review aimed to verify if there is difference in the longevity of minimally invasive techniques compared to the complete replacement for the treatment of defective direct restorations in permanent teeth. DATA: The data included randomized controlled clinical trials comparing the clinical performance of defective dental restorations treated by a complete replacement technique or minimally invasive techniques on permanent teeth. Evaluation of the risk of bias was performed using the Cochrane Collaboration common scheme for bias and the evidence was qualified using the GRADE tool. SOURCE: A comprehensive search was performed in the electronic databases: PubMed, Scopus, ISI Web of Science, The Cochrane Library, LILACS, BBO, SIGLE, followed by manual search in the reference lists of the included studies, without any restrictions. STUDY SELECTION: From 5554 retrieved studies, 10 met the eligibility criteria and were submitted to data extraction and quality assessment. The repair technique presented similar results to replacement and superior results when compared to sealing. In addition, refurbishment demonstrated to be a useful treatment for localized anatomical form defects. All the studies presented low risk of bias and high quality evidence for repair and refurbishment and moderate for the sealing technique. CONCLUSIONS: The direct restorations treated by the repair, seal and refurbishment techniques did not present a significant difference in clinical longevity in comparison to the replacement technique in permanent teeth with overall moderate quality of evidence. CLINICAL SIGNIFICANCE: The present findings demonstrated that the best treatment for defective restorations is conservative management. The evidence demonstrated here helps and encourages clinicians during the decision-making process. Moreover, it suggests not replacing imperfect restorations, but to managing them in a minimally invasive way, allowing the structure to be preserved.
Subject(s)
Dental Restoration, Permanent , Dentition, Permanent , Dental Restoration, Permanent/standards , Humans , Minimally Invasive Surgical Procedures , TimeABSTRACT
Objetivos: esta revisão sistemática teve como objetivo verificar se há diferença na longevidade clínica das restaurações defeituosas em dentes permanentes tratadas pela técnica da substituição e técnicas alternativas. Fontes: foram realizadas buscas eletrônicas nas bases de dados PubMed, The Cochrane Library, Web of Science, Scopus, LILACS, BBO, seguida de busca manual nas listas de referências dos estudos incluídos, sem restrições de idioma, ano de publicação e local onde o estudo foi realizado. Dados: foram incluídos onze ensaios clínicos controlados randomizados e quasi randomizados que compararam o desempenho clínico das restaurações defeituosas tratadas através da técnica da substituição ou técnicas alternativas em dentes permanentes, e tempo de acompanhamento de ao menos 2 anos. A qualificação do risco de viés foi realizada com a ferramenta sugerida pela Colaboração Cochrane e dados como material utilizado, tratamento e principais resultados foram extraídos. Resultados: após a remoção das duplicatas, 5.554 estudos foram selecionados para a leitura dos títulos e resumos. Após as fases de leitura de títulos, resumos, íntegra e qualificação do risco de viés, nove preencheram os critérios de elegibilidade e mais dois foram adicionados por busca manual, gerando um total de onze artigos para a análise desta revisão sistemática. Conclusão: as restaurações defeituosas tratadas pelas técnicas da substituição e reparo não apresentaram diferença significativa na longevidade clínica na maioria dos estudos longitudinais avaliados, sendo ambas as técnicas indicadas para o tratamento de restaurações defeituosas em dentes permanentes; o reparo, contudo, gerou maior preservação da estrutura dental remanescente. O acabamento e o selamento não apresentaram longevidade clínica adequada e, portanto, foram consideradas técnicas alternativas contra-indicadas. Significância Clínica: A Odontologia contemporânea é baseada em restaurações minimamente invasivas. A indicação de uma técnica mais conservadora deve ter vantagem inquestionável. Estudos em geral, mostraram-se contraditórios quando compararam a técnica da substituição e as técnicas alternativas para o tratamento de restaurações defeituosas em dentes permanentes. Assim, esta revisão sistemática foi conduzida para responder a esta pergunta mediante a avaliação de estudos clínicos somente longitudinais. (AU)
Objectives: this systematic review aimed to verify if there is difference in the clinical longevity of the defective restorations in permanent teeth treated by the replacement technique and alternative techniques. Source: we searched the databases PubMed, The Cochrane Library, Web of Science, Scopus, LILACS, BBO, followed by manual search in the reference lists of included studies, without language restrictions, year of publication and place where the study was performed. Data: we included eleven randomized and quasi-randomized controlled clinical trials comparing the clinical performance of defective dental restorations treated by replacement technique or alternative techniques on permanent teeth, and follow-up time of at least 2 years. The risk of bias qualification was performed using the tool suggested by the Cochrane Collaboration and data such as material used, treatment and the main results were extracted. Results: after the removal of duplicates, 5,554 studies were selected for the reading of titles and abstracts. After the reading, titling, summarizing, and bias risk qualification phases, nine met the eligibility criteria and two more were added by manual search, generating a total of eleven articles for the analysis of this Systematic Review. Conclusions: the defective restorations treated by the replacement and repair techniques did not present significative difference in clinical longevity in most of the longitudinal studies evaluated, both techniques being indicated for the treatment of defective restorations in permanent posterior teeth; the repair, however, presented increased remanescent dental structure preservation. Refurbishment and sealing did not present adequate clinical longevity and were, therefore, considered contraindicated alternative techniques. Clinical Significance: Contemporary dentistry is based on minimally invasive restorations. The indication of a more conservative technique should have an unquestionable advantage. Studies in general have been contradictory when comparing the substitution technique and alternative techniques for the treatment of defective restorations in permanent teeth. Thus, this systematic review was conducted to answer this question through the evaluation of of only clinical longitudinal studies. (AU)
Subject(s)
Dentition, Permanent , Dental Restoration Failure , Dental Restoration Repair/methods , Review Literature as TopicABSTRACT
O bruxismo é uma parafunção muito comum na população e não há um consenso sobre uma etiologia específica, sendo considerado assim de natureza multifatorial. Entre os fatores etiológicos encontra-se a atuação dos neurotransmissores: noradrenalina, serotonina e, principalmente, a dopamina, devido a sua função, entre outras, de inibir movimentos musculares espontâneos. Com base na revisão da literatura confrontamos dados que pudessem ajudar a comprovar a influência dos neurotransmissores na gênese da parafunção e como drogas que atuam nos mesmos receptores desses neurotransmissores apresentam relevância para o desencadeamento ou atenuação dos episódios de bruxismo.
Bruxism is a common parafunction found in the population and there is no consensus about a specific etiology, being considered as multifactorial. Among the etiological factors its possible to find the performance of the following neurotransmitters: norepinephrine, serotonin and especially dopamine, due to its function, among others, is to inhibit spontaneous muscle movements. Based on the literature, we were able to confront data that could help proving the influence of neurotransmitters in the genesis of this parafunction and how drugs that act on the same receptors of these neurotransmitters are relevant for triggering or mitigating episodes of bruxism.
