Cost-effectiveness of selective caries removal versus stepwise excavation for deep caries lesions.

A multicenter, randomized controlled clinical trial evaluated the effectiveness of two treatments for deep caries lesions in permanent molars - selective caries removal (SCR) to soft dentin with restoration in a single visit, and stepwise excavation (SW) - regarding pulp vitality for a 5-year follow-up period. The present study aimed to determine the cost-effectiveness of these treatments. Treatments were conducted in two Brazilian cities (Brasília and Porto Alegre). At baseline, 299 permanent molars (233 patients) were treated and 229 teeth (174 patients) were evaluated after 5 years. The discounted cash flow method was adopted. The total cost of each treatment was calculated, and the failure cost (endodontic treatment + restoration) was added to the final cost, according to the 5-year failure rates of each therapy (20% for SCR and 44% for SW). A public health service unit composed of three dentists in 4-hour work shifts was used to calculate the monetary value of the treatments, assuming a total of 528 treatments/month. Considering the 229 teeth evaluated after 5 years (115 SCR and 114 SW), SCR provided savings of 43% (amalgam) and 41% (resin composite) per treatment, compared to SW. The SCR technique provides benefits for public finances (direct economy) and for public health services (increase in the number of treatments performed). Considering that maximizing profit and reducing costs are powerful motivating factors for adopting a certain treatment, this study provides data to better support the decision-making process, regarding the management of deep caries lesions in permanent molars.

Cost-effectiveness of selective caries removal versus stepwise excavation for deep caries lesions

Abstract A multicenter, randomized controlled clinical trial evaluated the effectiveness of two treatments for deep caries lesions in permanent molars - selective caries removal (SCR) to soft dentin with restoration in a single visit, and stepwise excavation (SW) - regarding pulp vitality for a 5-year follow-up period. The present study aimed to determine the cost-effectiveness of these treatments. Treatments were conducted in two Brazilian cities (Brasília and Porto Alegre). At baseline, 299 permanent molars (233 patients) were treated and 229 teeth (174 patients) were evaluated after 5 years. The discounted cash flow method was adopted. The total cost of each treatment was calculated, and the failure cost (endodontic treatment + restoration) was added to the final cost, according to the 5-year failure rates of each therapy (20% for SCR and 44% for SW). A public health service unit composed of three dentists in 4-hour work shifts was used to calculate the monetary value of the treatments, assuming a total of 528 treatments/month. Considering the 229 teeth evaluated after 5 years (115 SCR and 114 SW), SCR provided savings of 43% (amalgam) and 41% (resin composite) per treatment, compared to SW. The SCR technique provides benefits for public finances (direct economy) and for public health services (increase in the number of treatments performed). Considering that maximizing profit and reducing costs are powerful motivating factors for adopting a certain treatment, this study provides data to better support the decision-making process, regarding the management of deep caries lesions in permanent molars.

Partial caries removal in deep lesions: 19-30 months follow-up study / Remoção Parcial de Dentina Cariada em Lesões Profundas: estudo de 19-30 meses de acompanhamento

O objetivo deste ensaio clínico controlado randomizado multicêntrico foi avaliar a efetividade da remoção parcial de dentina cariada seguida de restauração em única sessão (RPDC) em lesões de cárie profundas no Brasil (Porto Alegre e Brasília) após dois anos de acompanhamento. Critérios de inclusão: pacientes com ≥ seis anos de idade apresentando molares permanentes com lesões profundas primárias, ausência de alteração periapical, sensibilidade pulpar, ausência de dor espontânea e sensibilidade à percussão negativa. Os indivíduos foram randomicamente atribuídos ao grupo teste - RPDC, ou grupo controle - tratamento expectante (TE). O TE consistiu na remoção parcial de dentina cariada, capeamento pulpar indireto com cimento de hidróxido de cálcio, restauração provisória com cimento de óxido de zinco e eugenol, reabertura da cavidade após 60 dias, remoção da dentina cariada remanescente amolecida e restauração. Cada grupo foi dividido de acordo com o material restaurador: amálgama ou resina. Avaliações clínicas e radiográficas foram realizadas anualmente. Os desfechos considerados foram sensibilidade pulpar ao teste frio e ausência de alteração periapical. Foram executados 299 tratamentos, 153 RPDC e 146 TE. Não houve diferença entre os grupos em relação às características basais. Após dois anos de acompanhamento, foram avaliadas 181 restaurações e a taxa de sobrevivência dos tratamentos RPDC e TE foram 95,45% e 80,85%, respectivamente (p=0,001). Razões dos insucessos: pulpites, osteíte, hiperemia, necroses, extração e fratura da restauração. Nenhuma variável foi significativamente associada ao desfecho. A partir destes resultados, é possível concluir que a RPDC é um tratamento mais efetivo que o TE.

The aim of this multicenter randomized controlled clinical trial was to evaluate the effectiveness of partial caries removal followed by restoration in a single session (PDR) for deep caries lesions in Brazil (Porto Alegre and Brasilia) after 2-year follow-up. Inclusion criteria: patients with ≥ six years old presenting permanent molars with primary deep lesion, absence of periapical alterations, pulp sensitivity, absence of spontaneous pain and negative percussion test. The subjects were randomly assigned to test group - PDR, or control group - stepwise excavation (SW). SW consisted of partial removal of carious dentine, indirect pulp capping with calcium hydroxide cement, temporary filling, cavity re-opening after 60 days, removal of the remaining soft carious dentine and filling. Each group was divided according to the filling material: amalgam or resin. Clinical and radiographic evaluations were performed in annual basis. The outcomes were considered as pulp sensibility to cold test and absence of periapical alterations. There were performed 299 treatments, 153 PDR and 146 SW. There were no differences between the groups regarding baseline characteristics. After 2 years of follow-up, 204 restorations were evaluated and the therapy survival rates of PDR and SW were 95.45% and 80.85%, respectively (p=0.001). Reasons for failure: pulpitis, osteitis, hyperemia, necrosis, extraction and restoration fracture.. None variable was significantly associated with the outcome. From these results, it is possible to conclude that the PDR is a more successful treatment than SW.

Atenção odontológica a gestantes usuárias do SUS: diferenças entre dois grupos / Dental care in pregnancy SUS users: differences between two groups

Introdução: Em 2004, o Ministério da saúde propõe a reorganização da política da saúde bucal, baseando-se nas especificidades próprias dos ciclos e condições de vida. Em relevo, encontra-se a saúde da mulher e a importância do desenvolvimento de programas de prevenção e promoção de saúde bucal durante a gestação. Objetivo: Estudo transversal descritivo sobre atenção odontológica a gestantes usuárias do SUS, atendidas em unidades de saúde da família e livre demanda, de Dourados-MS. Materiais e métodos: Foram entrevistadas 82 gestantes atendidas na saúde da família e 168 em unidades livre demanda, através de questionário. Resultados:Os perfis socioeconômicos dos grupos estudados são semelhantes. Observou-se maiores frequências para consulta odontológica (34,2%), orientação em saúde bucal (50%) e orientação para visita ao dentista (65%) no grupo de gestantes da saúde da família. Os cirurgiões dentistas foram os que mais orientaram visita ao consultório odontológico (38%) a gestantes unidades de livre demanda, mas estas encontram barreiras para atendimento odontológico (57,7%). Conclusão:Os resultados demonstram que a implantação da saúde bucal na saúde da família teve impacto positivo sobre a atenção odontológica oferecida a gestantes destas unidades, principalmente quanto ao serviço odontológico e orientações sobre saúde bucal. É necessário investir na educação continuada e incentivar ampla discussão, com os profissionais que prestam assistência pré-natal, em ambas as unidades de saúde, sobre a relevância da promoção e atenção em saúde bucal nesta fase, como forma de proteção a estas mulheres e seus bebês. Novos estudos devem ser realizados em longo prazo, para verificar se o modelo de saúde da família desencadeará a gestantes maior acessibilidade à saúde bucal.

Introduction: In 2004, the Ministry of Health proposes the reorganization of the politics of oral, based on the specific characteristics of cycles and living conditions. In relief is the health of women and the importance of developing prevention programs and promotion of oral health during pregnancy. Objective: Cross-sectional descriptive study dental care to pregnant women SUS users received care in family health and demand, in Dourados-MS. Methods: We interviewed 82 pregnant women in family health units and 168 on demand, through a questionnaire. Results: The socio-economic profiles of the groups are similar. Observed frequencies were higher dental visit (34,2%), had guidance in oral health (50%) and orientation visit to the dentist (65%) in group of pregnant women in family health. The dentist were most likey guided visit to the dentist (38%) pregnant women on demand, but these are barriers to dental care (57,7%). Conclusion: The results show that the implementation of oral health in the health of the family had a positive impact on dental care offered to women of these units, especially for the dental services and guidance on oral health. We must invest in continuing education and encourage wide discussion with profissionals who provide prenatal care in both health centers on the relevance of promotion and oral health care at this stage as a way to protect these women an their babies. Further studies should be carried ou in the long run, to check whether the model of family health women will unleash greater accessibility to oral health

Use of Diagnodent for diagnosis of non-cavitated occlusal dentin caries.

The purpose of this study was to evaluate the use of a laser fluorescence device for detection of occlusal caries in permanent teeth. One hundred and ninety-nine non-cavitated teeth from 26 patients aged 10 to 13 years were selected. After dental prophylaxis, two previously calibrated dentists examined the teeth. Visual inspection, radiographic examination and laser measurements were performed under standardized conditions. The validation method was cavity preparation with a small cone-shaped diamond bur, when the two examiners agreed about the presence of dentin caries. It was found that the laser detection method produced high values of sensitivity (0.93) and specificity (0.75) and a moderate positive predictive value (0.63). The laser device showed the lowest value of likelihood ratio (3.68). Kappa coefficient showed good repeatability for all methods. Although the laser device had an acceptable performance, this equipment should be used as an adjunct method to visual inspection to avoid false positive results.

Use of diagnodent® for diagnosis of non-cavitated occlusal dentin caries

The purpose of this study was to evaluate the use of a laser fluorescence device for detection of occlusal caries in permanent teeth. One hundred and ninety-nine non-cavitated teeth from 26 patients aged 10 to 13 years were selected. After dental prophylaxis, two previously calibrated dentists examined the teeth. Visual inspection, radiographic examination and laser measurements were performed under standardized conditions. The validation method was cavity preparation with a small cone-shaped diamond bur, when the two examiners agreed about the presence of dentin caries. It was found that the laser detection method produced high values of sensitivity (0.93) and specificity (0.75) and a moderate positive predictive value (0.63). The laser device showed the lowest value of likelihood ratio (3.68). Kappa coefficient showed good repeatability for all methods. Although the laser device had an acceptable performance, this equipment should be used as an adjunct method to visual inspection to avoid false positive results.

Avaliação dos métodos mecânico e quimiomecânico na remoção de dentina cariada - acompanhamento de um ano / Evaluation of mechanical and chemomechanical methods for caries removal - one year follow up

Os objetivos deste estudo in vivo foram comparar a efetividade da remoção de tecido cariado pelo método mecânico e quimiomecânico, verificar o grau de aceitaçao do Carisolv pelos pacientes e avaliar a evolução dos casos pelos períodos de 3, 6 e 12 meses. Foram selecionados 27 dentes permandentes posteriores com lesão cariosa em dentina. Os dentes foram divididos em dois grupos, G1 (14 dentes) e G2 (13 dentes), que responderam à remoção dos tecidos cariado com o método convencional (broca e colher de dentina) e com Carisolv respectivamente. Após o tratamento, todos os pacientes foram submetidos a questionário de avaliação. Os dados mostraram que o Carisolv foi considerado o método mais confortável pela maioria dos paicentes. Na avaliação dos casos pelos períodos de 3 meses, 6 meses e 1 no não foram encontradas alterações clínicas ou radiográficas. Concliu-se que os métodos convencional e quimiomecânico foram igualmente efetivos na remoção de dentina cariada. No período de 1 ano não foram observadas reações adversas em nenhum dos grupos, porém o Carisolv apresentou maior grau de aceitação pelos pacientes

Microinfiltraçäo marginal em preparos de classe II restaurados com resinas condensáveis / Microleakage in class II composite restorations using condensable resins

O objetivo deste estudo foi avaliar a microinfiltraçäo marginal em preparos classe II utilizando-se 3 novas marcas comerciais de resinas chamadas "condensáveis" - Definite (Degussa), Solitaire (Kulzer) e P60 (3M), associadas ou näo com resina de baixa viscosidade (Flow It - Jeneric/Pentron) - em 72 dentes recém-extraídos. Após os procedimentos de preparo, restauraçäo, acabamento, ciclagem térmica e imersäo em nitrato de prata a 50 por cento, os dentes foram seccionados longitudinalmente e avaliados através de lupa estereocópica, seguindo-se a análise estatística dos dados. Os seguintes resultados foram obtidos na superfície de esmalte: o grupo P60 + Flow It foi superior aos grupos Definite, Solitaire e Solitaire + Flow It. O grupo P60 foi melhor que o grupo Solitaire + Flow It. Em cemento, os grupos Definite + Flow It e P60 + Flow It foram superiores aos grupos Solitaire e Solitaire + Flow It

Avaliaçäo histológica da resposta pulpar ao uso de adesivos dentinários em cavidades profundas

O propósito deste estudo foi avaliar histologicamente a resposta pulpar de dentes anteriores permanentes, em primatas (Cebus appela), após aplicação de dois diferentes sistemas adesivos (Single Bond-3M Dental Co. e Etch & Prime 3.0 Degussa Hüls) em relação ao controle (cimento de hidróxido de cálcio, Dycal-Kerr associado a cimento de ionômero de vidro, Vitremer-3M Dental Co.). Foram preparadas cavidades de classe V vestibulares, profundas, sem exposição pulpar clinicamente visível. A análise foi efetuada decorrido o tempo experimental de 60 dias utilizando microscopia óptica e coloração de hematoxilina e eosina. O exame histopatológico não demonstrou diferenças entre os sistemas Single Bond (3M dental Co.) e Etch & Prime 3.0 (Degussa Hüls). Não foi observada resposta inflamatória, resultado semelhante ao encontrado no grupo controle