Resistencia a la compresión de Biodentine®: mezcla manual vs. Mecánica / Compressive strength of Biodentine®: mechanical vs. manual mix

INTRODUCCIÓN: La incorporación de innovaciones tecnológicas en determinados materiales dentales, especialmente aquellos que requieren de aparatología específica para su uso y/o cuya pre-dosificación implica el descarte de una porción de su contenido, está condicionada por la relación costo-beneficio del producto. Según las instrucciones del fabricante, las cápsulas del silicato tricálcico Biodentine® (Septodont) deben activarse mediante el uso de mezcladores mecánicos luego de adicionar las proporciones exactas del líquido ad-hoc, utilizando la totalidad de cada cápsula de polvo y su respectiva ampolla del líquido, con un excedente de material considerable, según su indicación. Si bien es posible realizar la mezcla del cemento en forma manual prescindiendo de un amalgamador, una modificación en las recomendaciones del fabricante podría alterar las propiedades del material. OBJETIVO: Determinar si existen diferencias en la resistencia compresiva de Biodentine® según el método de mezcla utilizado: con activación mecánica y con mezcla manual. MATERIALES Y METODOS: Se confeccionaron probetas cilíndricas de 6 mm de alto por 4 mm de diámetro (n=6) para los dos grupos de estudio A) Biodentine® / Mezcla manual y B) Biodentine® / Mezcla mecánica. Las muestras fueron sometidas a la aplicación de una fuerza continua en máquina universal de ensayos Digimess RS-8000-5 a una velocidad de carrera de 1 mm/min hasta su ruptura. Se compararon los valores obtenidos entre los grupos mediante test de Student, determinando diferencias significativas para valores de p>0,05. RESULTADOS: Los valores medios obtenidos y su desviación estándar fueron A) 52.6 (16.3) MPa y B) 65.7 (30.6) MPa respectivamente. La distribución de valores de resistencia a la compresión según el grupo de estudio fue levemente superior en el grupo B, aunque las diferencias no fueron significativas (p=3,77). CONCLUSIONES: La mezcla manual no disminuye significativamente la resistencia a la compresión de Biodentine® en comparación al cemento mezclado mecánicamente.

INTRODUCTION: Economic circumstances may create difficulties in access to certain dental materials, especially those that a part of their content has to be disposed after mixing. According to the manufacturers´ instructions, capsules of tri-calcium silicate Biodentine® (Septodont) ought to be activated using a mechanical mixer after addition of the liquid accordingly. The whole content of a capsule is then used before the setting of the material. Aim: To compare the effect of the mixing mode on the compressive strength of Biodentine®, mixed manually and using a mechanical mixer. OBJECTIVE: To compare the effect of the mixing mode on the compressive strength of Biodentine®, mixed manually and using a mechanical mixer. MATERIALS AND METHODS Two groups were defined, A) Biodentine® / Manual mix and B) Biodentine® / Mechanical mix, with n = 6 cylindric specimens each of 6 mm height and 4 mm diameter. Samples were tested using a universal testing machine Digimess RS-8000-5 at a crosshead speed of 1 mm/min until fracture. Obtained values were compared using the Student-t test with a significance of p>0,05. RESULTS: Mean values were A) 52.6 (16.3) MPa and B) 65.7 (30.6) MPa respectively, finding no significant differences between the two groups (p=3,77). CONCLUSION: Compressive strength is not affected in Biodentine® when mixed manually compared to mechanical mixing.

Three-year survival of ART high-viscosity glass-ionomer and resin composite restorations in people with disability.

OBJECTIVES: To assess the 3-year cumulative survival rate of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability. MATERIALS AND METHODS: Patients referred for restorative care to the Haemophilia Foundation special care service were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. Treatment was provided as selected unless this option proved clinically unfeasible when an alternative technique was proposed. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). After 6, 12, 24 and 36 months, two independent, trained and calibrated examiners evaluated restoration survival using established ART codes. The proportional hazard model with frailty corrections gave survival estimates over 3 years. RESULTS: Sixty-six patients (13.6 ± 7.8 years) with 16 different disability profiles participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). Altogether, 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). The 3-year cumulative survival rates and jackknife standard errors for the 182 ART and 116 CRT restorations were 94.8 ± 2.1 and 82.8 ± 5.3%, respectively (p = 0.01). CONCLUSIONS: The 3-year follow-up results confirm that ART is an effective treatment protocol. CLINICAL RELEVANCE: Patients with disability, many of whom have difficulty coping with CRT, may benefit from the ART approach.

A Global Oral Health Survey of professional opinion using the International Classification of Functioning, Disability and Health.

OBJECTIVES: The concept of oral health is frequently reduced to the absence of disease, despite existing conceptual models exploring the wider determinants of oral health and quality of life. The International Classification of Functioning, Disability and Health (ICF) (WHO) is designed to qualify functional, social and environmental aspects of health. This survey aimed to reach a consensual description of adult oral health, derived from the ICF using international professional opinion. METHODS: The Global Oral Health Survey involved a two-round, online survey concerning factors related to oral health including functioning, participation and social environment. Four hundred eighty-six oral health professionals from 74 countries registered online. Professionals were pooled into 18 groups of six WHO world regions and three professional groups. In a randomised stratification process, eight professionals from each pool (n=144) completed the survey. The first round consisted of eight open-ended questions. Open expression replies were analysed for meaningful concepts and linked using established rules to the ICF. In Round 2, items were rated for their relevance to oral health (88% response rate). RESULTS: Eighty-nine ICF items and 30 other factors were considered relevant by at least 80% of participants. International professionals reached consensus on a holistic description of oral health, which could be qualified and quantified using the ICF. CONCLUSIONS: These results represent the first step towards developing an ICF Core Set in Oral Health, which would provide a practical tool for reporting outcome measures in clinical practice, for research and epidemiology, and for the improvement of interdisciplinary communication regarding oral health. CLINICAL SIGNIFICANCE: Professional consensus reached in this survey is the foundation stone for developing an ICF Core Set in Oral Health, allowing the holistic aspects of oral health to be qualified and quantified. This tool is necessary to widen our approach to clinical decision making, measurement of clinical outcomes, research and epidemiology.

One year survival of ART and conventional restorations in patients with disability.

BACKGROUND: Providing restorative treatment for persons with disability may be challenging and has been related to the patient's ability to cope with the anxiety engendered by treatment and to cooperate fully with the demands of the clinical situation. The aim of the present study was to assess the survival rate of ART restorations compared to conventional restorations in people with disability referred for special care dentistry. METHODS: Three treatment protocols were distinguished: ART (hand instruments/high-viscosity glass-ionomer); conventional restorative treatment (rotary instrumentation/resin composite) in the clinic (CRT/clinic) and under general anaesthesia (CRT/GA). Patients were referred for restorative care to a special care centre and treated by one of two specialists. Patients and/or their caregivers were provided with written and verbal information regarding the proposed techniques, and selected the type of treatment they were to receive. Treatment was provided as selected but if this option proved clinically unfeasible one of the alternative techniques was subsequently proposed. Evaluation of restoration survival was performed by two independent trained and calibrated examiners using established ART restoration assessment codes at 6 months and 12 months. The Proportional Hazard model with frailty corrections was applied to calculate survival estimates over a one year period. RESULTS: 66 patients (13.6 ± 7.8 years) with 16 different medical disorders participated. CRT/clinic proved feasible for 5 patients (7.5%), the ART approach for 47 patients (71.2%), and 14 patients received CRT/GA (21.2%). In all, 298 dentine carious lesions were restored in primary and permanent teeth, 182 (ART), 21 (CRT/clinic) and 95 (CRT/GA). The 1-year survival rates and jackknife standard error of ART and CRT restorations were 97.8 ± 1.0% and 90.5 ± 3.2%, respectively (p = 0.01). CONCLUSIONS: These short-term results indicate that ART appears to be an effective treatment protocol for treating patients with disability restoratively, many of whom have difficulty coping with the conventional restorative treatment. TRIAL REGISTRATION NUMBER: Netherlands Trial Registration: NTR 4400.

Suitability of ART approach for managing caries lesions in people with disability-Experts' opinion.

OBJECTIVE: This study aimed to obtain the opinions of experts in Special Care Dentistry (SCD) regarding the suitability of the Atraumatic Restorative Treatment (ART) approach for the treatment of carious lesions in persons with disability. MATERIAL AND METHODS: Thirty expert participants from around the world, joining the SCD Task Force meeting, Education Committee of the International Association of Disability and Oral Health (Antalya, Turkey, 2011), completed a questionnaire survey. Frequency distributions of variables were analysed using Chi-Square test for differences between variables. RESULTS: All respondents reported having full or moderate knowledge of ART (23.3% and 63.3%, respectively) and 66.7% indicated that they felt the technique was useful for this population. However, only 50% of respondents used the technique regularly in their practice and five (16.7%) replied that they would never use it, even if a favourable evidence base for ART use in this population became available. The barriers to the introduction of ART to SCD are discussed and the need for training and further research highlighted. CONCLUSIONS: Barriers to the implementation of ART in practice were placement of the restoration under difficult conditions and the dentist's pre-conception of the technique as being 'lower quality dentistry'. Experts suggested that some of these barriers might be overcome by improving the evidence base in favour of the technique, specifically in the population with disability.