Use of rubber dam versus cotton roll isolation on composite resin restorations' survival in primary molars: 2-year results from a non-inferiority clinical trial.

BACKGROUND: This non-inferiority randomised clinical trial aimed to evaluate the survival of direct bulk fill composite resin restorations in primary molars using different methods of moisture control: rubber dam isolation (RDI-local anaesthesia and rubber dam) and cotton roll isolation (CRI-cotton roll and saliva ejector). Secondary outcomes included baseline and 2-year incremental cost, self-reported child's pain scores and patient behaviour during the restorative procedure. METHODS: A total of 174 molars (93 children) with dentine caries lesions were randomly allocated to study groups (RDI or CRI) and restored with bulk fill composite resin by trained operators. Two blinded examiners assessed the restorations for up to 24 months. Wong-baker faces and Frankl's behaviour rating scales were used for accessing the child's pain and behaviour, respectively. The primary outcome (restoration survival) was analysed using the two-sample non-inferiority test for survival data using Cox Regression (non-inferiority/alternative hypothesis HR > 0.85; CI = 90%). Bootstrap Linear regression was used for cost analysis and logistic regression for pain and behaviour analysis (α = 5%). RESULTS: After 2-years, 157 restorations were evaluated (drop-out = 9.7%). The survival rate was RDI = 60.4% and CRI = 54.3%. The non-inferiority hypothesis was accepted by the Cox Regression analysis (HR = 1.33; 90% CI 0.88-1.99; p = 0.036). RDI was 53% more expensive when compared to the CRI group. No differences were found between the groups regarding pain (p = 0.073) and behaviour (p = 0.788). CONCLUSION: Cotton roll isolation proved to be non-inferior when compared to rubber dam for composite restorations longevity in primary molars. Furthermore, the latest presented the disadvantage of higher cost and longer procedure time. Clinical Significance The moisture control method does not influence the longevity of composite restorations in primary molars. Cotton roll isolation proved to be non-inferior to rubber dam isolation and is a viable option for restoring primary molars. Clinical trial registration registered NCT03733522 on 07/11/2018. The present trial was nested within another clinical trial, the CARies DEtection in Children (CARDEC-03-NCT03520309).

Manejo dental de paciente con Síndrome de Hallervorden-Spatz: reporte de caso / Manejo odontológico de paciente com síndrome de Hallervorden-Spatz: relato de caso / Dental management of a patient with Hallervorden-Spatz syndrome: case report

El Síndrome de Hallervorden-Spatz es una afección neurodegenerativa rara, autosómica recesiva, caracterizada por depósitos en gran cantidad de hierro en los ganglios de base, lo que ocasiona gran pérdida motora y mental. Presenta dos formas de manifestación: la clásica, que aparece en la infancia a lo largo de la primera década de vida, y la atípica, cuyas manifestaciones clínicas aparecen de forma tardía, entre la segunda y tercera décadas de vida. El objetivo del presente estudio es describir un caso clínico de tratamiento endodóntico, en ambulatorio, de una paciente del sexo femenino, de 28 años, con manifestaciones clásicas de dicho síndrome, con cambio de color en el elemento 11 y lesión periapical, que justifica la indicación de endodoncia. La atención odontológica de una enfermedad neurodegenerativa rara, realizada en forma ambulatoria, requiere el conocimiento del dentista para que se conduzca de forma eficiente y segura

A síndrome de Hallervorden-Spatz é uma afecção neurodegenerativa rara, autossômica recessiva, caracterizada por depósitos em grande quantidade de ferro nos gânglios de base, o que ocasiona grande perda motora e mental. Apresenta duas formas de manifestações: a clássica, que surge na infância na primeira década de vida; e a atípica, cujas manifestações clínicas surgem mais tardiamente, entre a segunda e terceira décadas de vida. O objetivo desse estudo foi descrever um caso clínico de tratamento endodôntico, ambulatorial, de uma paciente do sexo feminino, 28 anos, com manifestações clássicas da síndrome, apresentando mudança de cor no elemento 11 com lesão periapical, justificando a indicação para endodontia. O atendimento odontológico de uma doença neurodegenerativa rara; realizado em ambiente ambulatorial, requer o conhecimento do dentista para que seja conduzido de forma eficiente e segura.

Hallervorden-Spatz syndrome is a rare, autosomal recessive neurodegenerative disorder characterized by large deposits of iron in the basal ganglia, which causes great motor and mental loss. It presents two forms of manifestations: the classic, which arises in childhood in the first decade of life; and the atypical, whose clinical manifestations appear later, between the second and third decades of life. The objective of this study was to describe a clinical case of endodontic outpatient treatment of a female patient, 28 years old, with classic manifestations of the syndrome, showing color change in element 11 with periapical lesion, justifying the indication for endodontics. The dental care of a rare neurodegenerative disease in an outpatient setting requires the dental surgeon's knowledge so that it is conducted efficiently and safely.

Impact of non-restorative cavity control on proximal carious lesions of anterior primary teeth on the tooth survival and patient-centered outcomes (CEPECO 2): study protocol for a non-inferiority randomized clinical trial.

BACKGROUND: Studies have questioned the necessity of restoring cavitated carious lesion on primary teeth, once the control of biofilm is the most important factor to arrest these lesions. This randomized clinical trial aimed to compare the survival of teeth treated with a non-restorative cavity control (NRCC) compared to resin composite restorations (RCR) on proximal carious lesion in anterior primary teeth, as well as the impact of these treatments on patient-centered outcomes. METHODS: A randomized clinical trial with two parallels arms (1:1) will be conducted. Children between 3 and 6 years old will be selected from the Center of Clinic Research of Pediatric Dentistry of Ibirapuera University (UNIB), a dental trailer (FOUSP) located on Educational Complex Professor Carlos Osmarinho de Lima, the Pediatric Dentistry Clinic of Santa Cecília University and from the Pediatric Dentistry Clinic of University Center UNINOVAFAPI. One hundred and forty-eight teeth will be randomly distributed in two experimental groups: (1) Selective removal of carious tissue and RCR; or (2) NRCC through cavity enlargement using a metallic sandpaper. The primary outcome will be tooth survival after 6, 12, 18 and 24 months. The duration and the cost of dental treatments will be considered for the estimation of the cost-effectiveness of the evaluated treatments. The discomfort reported by the participants will be measured after each treatment using the FIS scale. The participants' satisfaction and perception of the parents/legal guardians will be evaluated through questionnaires. For the primary outcome, Kaplan-Meier's survival and Long-Rank test will be used for comparison between the two groups. All the variables will be modeled by Cox regression with shared fragility. Significance will be considered at 5%. DISCUSSION: The NRCC could be an option to manage carious lesions on proximal surfaces of primary teeth, and the approach could be well accepted by the children and parents/legal guardians. Trial registration Clinicaltrials.gov registration: NCT03785730, Registered on December 18th 2018, first participant recruited 30/04/2019, https://clinicaltrials.gov/ct2/show/NCT03785730 . Ethics Reference No: 91569118.8.0000.5597. Trial Sponsor: Universidade Ibirapuera. The Trial was prospectively registered.

What is the most accurate method for detecting caries lesions? A systematic review.

OBJECTIVE: To perform a systematic review and meta-analysis of the performance of different methods for detecting carious lesions in permanent and primary teeth, considering all types of tooth surface. METHODS: Two reviewers searched PubMed, Embase, Scopus and other sources up to November 2020 to identify published and nonpublished studies in English. We focused on three caries detection methods: visual inspection (VI), radiographic (RX) and fluorescence-based (LF). We included studies investigating at least one of these methods which (a) assessed the accuracy of the method in detecting caries lesions; (b) considered occlusal, proximal or free smooth surfaces in primary or permanent teeth; (c) used a reference standard other than one of the three methods; and (d) reported data on sample size and accuracy. Multilevel analyses, meta-regressions and comparisons of bivariate summary receiver operating characteristics curves were undertaken. RESULTS: Two hundred and forty manuscripts from 14 129 articles initially identified met the inclusion criteria. VI was better than RX on occlusal surfaces at all caries lesion thresholds and proximal surfaces of permanent teeth only at all lesion thresholds in laboratory setting. LF was slightly better than VI for advanced lesions on occlusal surfaces of permanent teeth in the clinical setting and for all lesions on proximal surfaces of permanent teeth in the laboratory setting. Still, LF was worse than VI for advanced occlusal lesions in permanent teeth in the laboratory setting. Although LF showed slightly better performance than VI with advanced lesions, the latter had significantly higher specificity than other methods in all settings. CONCLUSION: Visual caries detection alone is adequate for most patients in daily clinical practice regardless of tooth type or surface.

How researchers should select the best outcomes for randomised clinical trials in paediatric dentistry?

Randomised clinical trial (RCT) is the best study design to evaluate the effect of the treatment and preventive healthcare procedures. The effects of the tested treatments on patient's health are compared in terms of outcomes, which are used to evaluate the participants' health changes. However, these outcomes should be relevant for the target population. In that way, RCTs represent the type of primary study design that provides the most reliable evidence to implement therapies into the clinical practice. In this review, an outline of some aspects related to the choice of RCTs' outcomes was presented, focusing on the conduction of relevant trials in Paediatric Dentistry. The importance and necessity of defining a primary outcome were addressed, preferentially a clinically relevant endpoint. The patients should perceive this outcome, and changes in this variable should reflect directly patient's health improvement or impairment. Moreover, considerations about the objective or subjective variables, use of surrogate outcomes, and the increasing tendency to develop core outcome sets were also presented in this review. The main idea of this manuscript is the RCTs must evaluate outcomes relevant to the children's oral health in order to contribute to the implementation of treatments in the evidence-based health practice.

Is it necessary to pre-treat Dentine before GIC Restorations? Evidence from an in Vitro Study.

The aim of this study was to assess the influence of different pre-treatment approaches on glass ionomer cement (GIC) bond strength (BS) to dentine. Sixty bovine incisors were allocated into six groups according to substrate - sound or caries-affected dentine; and substrate pre-treatment approach - no conditioning (control), polyacrylic acid for 10 s and phosphoric acid for 7 s. Teeth in the caries-affected dentine group were previously submitted to cariogenic pH-cycling challenge. After dentine pre-treatment, according to experimental groups, polyethylene tubes were placed on flat dentine surfaces and filled with GIC. Teeth were stored in distilled water for 24 h at 37 °C and then submitted to microshear test (0.5 mm/min). Failure pattern analysis was performed under stereomicroscope (400x). Data were analysed using two-way ANOVA and Tukey's test (α=5%). Statistically significant differences were found for the pre-treatment approach, regardless of substrate (p<0.001). The polyacrylic acid group and control group had similar BS values, and were both better than the phosphoric acid group. In general, GIC had better bonding performance in sound dentine than in caries-affected dentine. In conclusion, dentine pre-treatment with polyacrylic acid did not improve the performance of GIC restoration on clinically relevant substrates.

O objetivo deste estudo foi avaliar a influência de diferentes pré-tratamentos na resistência de união (RU) de cimentos de ionômero de vidro (CIV) a dentina. Sessenta incisivos bovinos foram alocados em 6 grupos de acordo com o substrato ­ hígido ou cariado; e com a abordagem de pré-tratamento ­ sem condicionamento (controle), ácido poliacrílico por 10 s, e ácido fosfórico por 7 s. Os dentes pertencentes aos grupos de dentina cariada foram previamente submetidos ao desafio cariogênico por meio da ciclagem de pH. Após o prétratamento da dentina, de acordo com os grupos experimentais, tubos de polietileno foram colocados sobre superfícies planas de dentina e preenchidos com CIV. Os dentes foram armazenados em água destilada por 24 h a 37°C e então submetidos ao teste de microcisalhamento (0,5 mm/min). A análise do padrão de fratura foi realizada em estereomicroscópio (400x). Os dados obtidos foram analisados usando ANOVA de dois fatores e teste de Tukey (α=5%). Diferença estatisticamente significante foi encontrada para as diferentes abordagens de pré-tratamento, independente do substrato (p<0,001). Aplicação de ácido poliacrílico resultou em valores de RU similares aos do grupo controle. Entretanto, ambos os grupos mostraram um melhor desempenho quando comparado a aplicação de ácido fosfórico. De forma geral, CIV apresentou melho5 desempenho adesivo em dentina sadia quando comparada a dentina cariada. Em conclusão, o pré-tratamento em dentina com ácido poliacrílico não melhora o desempenho das restaurações de CIV em substratos clinicamente relevantes.

Correlations between dental assistance/oral health and clinical intercurrences in an end-stage kidney disease patients: a historical cohort study.

BACKGROUND: The aim of this study was to correlate the self-report oral health, oral hygiene and dental assistance with clinic intercurrences with hospitalization in adults in End-Stage Kidney Disease patients. METHODS: Seventy-seven patients were interviewed during dialysis therapy concerning their self-report oral health, oral hygiene habits and available dental assistance. Clinical intercurrences were assessed in clinical records. Pearson correlations and linear regression tests were applied for statistical analysis. RESULTS: There was a strong negative correlation between the number of brushing times/day and patient hospitalization; there was a negative correlation between oral health and patient hospitalization, there was a positive correlation between the number of teeth in the mouth and oral diseases. CONCLUSIONS: The study shows an important correlation between oral health, oral hygiene habits, dental assistance and clinical intercurrences with hospitalization in dialysis patients. The results are weighty to establish protocols that can, directly improve, critical health outcomes of end-stage kidney disease patients under dialysis treatment.

Is it necessary to pre-treat Dentine before GIC Restorations? Evidence from an in Vitro Study / É necessário pré tratar a dentina antes das restaurações de CIV? Evidência de um estudo in vitro

ABSTRACT The aim of this study was to assess the influence of differentpretreatmentapproaches on glass ionomer cement (GIC)bond strength (BS) to dentine. Sixty bovine incisors wereallocated into six groups according to substrate - sound orcariesaffecteddentine; and substrate pretreatmentapproach -no conditioning (control), polyacrylic acid for 10 s andphosphoric acid for 7 s. Teeth in the cariesaffecteddentinegroup were previously submitted to cariogenic pHcyclingchallenge. After dentine pretreatment,according to experi mentalgroups, polyethylene tubes were placed on flat dentinesurfaces and filled with GIC. Teeth were stored in distilledwater for 24 h at 37 °C and then submitted to microshear test(0.5 mm/min). Failure pattern analysis was performed understereomicroscope (400x). Data were analysed using twowayANOVA and Tukey's test (α=5%). Statistically significantdifferences were found for the pretreatmentapproach,regardless of substrate (p<0.001). The polyacrylic acid groupand control group had similar BS values, and were both betterthan the phosphoric acid group. In general, GIC had betterbonding performance in sound dentine than in cariesaffecteddentine. In conclusion, dentine pretreatmentwith polyacrylicacid did not improve the performance of GIC restoration onclinically relevant substrates.

RESUMO O objetivo deste estudo foi avaliar a influência de diferentesprétratamentosna resistência de união (RU) de cimentos deionômero de vidro (CIV) a dentina. Sessenta incisivos bovinosforam alocados em 6 grupos de acordo com o substrato -hígido ou cariado; e com a abordagem de prétratamento-sem condicionamento (controle), ácido poliacrílico por 10 s, eácido fosfórico por 7 s. Os dentes pertencentes aos grupos dedentina cariada foram previamente submetidos ao desafiocariogênico por meio da ciclagem de pH. Após o prétratamentoda dentina, de acordo com os grupos experimentais,tubos de polietileno foram colocados sobre superfícies planas dedentina e preenchidos com CIV. Os dentes foram armazenadosem água destilada por 24 h a 37°C e então submetidos ao testede microcisalhamento (0,5 mm/min). A análise do padrão defratura foi realizada em estereomicroscópio (400x). Os dadosobtidos foram analisados usando ANOVA de dois fatores e testede Tukey (α=5%). Diferença estatisticamente significante foiencontrada para as diferentes abordagens de prétratamento,independente do substrato (pp<0,001). Aplicação de ácidopoliacrílico resultou em valores de RU similares aos do grupocontrole. Entretanto, ambos os grupos mostraram um melhordesempenho quando comparado a aplicação de ácidofosfórico. De forma geral, CIV apresentou melho5 desempenhoadesivo em dentina sadia quando comparada a dentinacariada. Em conclusão, o prétratamentoem dentina comácido poliacrílico não melhora o desempenho das restauraçõesde CIV em substratos clinicamente relevantes.

Current evidence of tissue engineering for dentine regeneration in animal models: a systematic review.

Aim: The aim of this study is to verify the type of scaffold effect on tissue engineering for dentine regeneration in animal models. Materials & methods: Strategic searches were conducted through MEDLINE/PubMed, Web of Science and Scopus databases. The studies were included with the following eligibility criteria: studies evaluating dentine regeneration, and being an in vivo study. Results: From 1392 identified potentially relevant studies, 15 fulfilled the eligibility criteria. All studies described characteristics of neoformed dentine, being that the most reported reparative dentine formation. Most of included studies presented moderate risk of bias. Conclusion: Up to date scientific evidence shows a positive trend to dentine regeneration when considering tissue engineering in animal models, regardless the type of scaffolds used.

Effects of manufacturing methods on the survival rate of ceramic and indirect composite restorations: A systematic review and meta-analysis.

OBJECTIVES: To evaluate the survival rate of ceramic and indirect composite inlays, onlays, and overlays manufactured according to different methods (CAD/CAM, pressable, and stratified). MEDLINE, EMBASE, and Cochrane Library databases were searched for published articles. Risk of bias, data extraction, subgroup analysis, meta-analysis, and GRADE was performed. MATERIALS AND METHODS: Prospective, retrospective, or RCT studies, without restriction of language, from 1983 to 2019, with follow-up ≥5 years, reporting survival rates were screened independently by two reviewers in accordance with eligibility criteria. RESULTS: A total of 13 articles (12 for ceramic, one for indirect composite) met the inclusion criteria. No articles were included regarding crystalline ceramic. The estimated cumulative survival rate for CAD/CAM was 97% after 5 years and 89% after 10 years; for pressable was 95% after 5 years, and for stratified was 88% after 5 years and 93% after 10 years. CONCLUSIONS: Regardless of the manufacturing method, vitreous ceramic inlays, onlays, and overlays showed high survival, providing evidence that these restorations are a safe treatment. CLINICAL RELEVANCE: Vitreous ceramic inlays, onlays, and overlays showed high survival, regardless of the manufacturing method, providing evidence that these restorations are a safe treatment.

Does Acid Challenge Affect the Properties and Bond Stability of Restorative Materials on Primary Teeth?

PURPOSE: To evaluate the effect of acidic challenge (AC) on the properties and bond stability of restorative materials to primary enamel and dentin. MATERIALS AND METHODS: One hundred twenty primary molars were assigned to 12 groups according to substrate (enamel or dentin), restorative material (composite, high-viscosity glass ionomer cement [HV-GIC] or resin-modified glass-ionomer cement [RM-GIC]), and immersion after restoration (control [saline solution/7 days] or AC [cola-based drink/5 min/3x per day/7 days]). Twenty-four hours after the restorative procedure, specimens were submitted to one of the proposed challenges. Half of the specimens were immediately subjected to the microshear bond strength test, and the other half after 12 months. To determine flexural strength flexural strength and superficial roughness (SR), 30 specimens were built up. After 24 h, the first measurement of SR from 10 specimens was performed. Specimens were then immersed in one of proposed challenges and SR was measured again. Subsequently, flexural strength testing was performed. Bond strength, surface roughness, and flexural strength data were subjected to ANOVA and Tukey's test. RESULTS: Composite showed the highest bond strengths compared to the others materials on both substrates. The storage period negatively influenced the bond strength only for composite groups in dentin. AC after restoration negatively influenced bond strength when the materials were evaluated in eroded dentin. AC affected the second SR measurement, showing increased SR for all restorative materials. AC did not affect flexural strength. CONCLUSION: The acidic challenge jeopardizes the surface roughness and bond strength of restorations to eroded dentin.

Tooth color changes and sensitivity in patients undergoing dental bleaching with 10% hydrogen peroxide using customized trays or strips: a randomized clinical trial.

BACKGROUND: This paper aimed to compare the tooth color changes and sensitivity in patients undergoing dental bleaching with 10% hydrogen peroxide using customized trays or strips as delivering systems. METHODS: A total of 50 patients aged between 18-30 years old were assigned into two groups (N.=25) according to the bleaching treatment: tray (TB) or strips (SB). For both techniques, the patients underwent a 30-minute application of 10% hydrogen peroxide twice a day for seven days. Tooth color was evaluated before, 3 and 7 days of treatment, and 14 days after bleaching using a tooth color shade guide (VITA® shade). Tooth sensitivity was assessed using the Visual Analogue Scale (VAS). The values obtained from the color changes and tooth sensitivity were statistically analyzed (α=5%). RESULTS: For both groups, there was a significant difference on the tooth color before and after bleaching (P<0.001), although there was no significant difference between them (P=0.4215). The SB group exhibited a lower frequency of sensitivity (50.2%) compared to the TB group (70.2%) (P<0.001). However, the highest number of individuals reporting score 1 of sensitivity was found in the SB group (37.3%) compared to the TB group (20.9%) (P<0.001). For the other scores, there were no differences between the SB and TB groups, with results of 9.8% and 8.4% for score 2 (P=0.744) and 2.7% and 0.5% for score 3 (P=0.122). CONCLUSIONS: The bleaching effect of 10% hydrogen peroxide is not influenced by the delivering system (tray or strips). Even though the technique with strips was associated to a lower frequency of dental sensitivity, the peak level of pain was greater when compared to the technique using trays.

A self-report joint damage and musculoskeletal disorders data among dentists: a cross-sectional study.

BACKGROUND: Musculoskeletal disorders (MSD) are an occupational health problem that demands a high cost and may also reduce the quality of life and productivity of the dentists. The aim of this study was to evaluate the prevalence of MSD and its association with self-reported joint damage in dentists from São Paulo (Brazil). METHODS: This was a cross-sectional study performed from two self-administered questionnaires - the Nordic Musculoskeletal Questionnaire and the other containing demographic and occupational data - in 6072 dentists. Between April and May 2014, 5885 questionnaires were distributed via e-mail through São Paulo Regional Board of Dentistry (CRO-SP) and 187 in Congress and public offices. Multivariable logistic regression was used to assess the association between explanatory variables (sex, age, level of education, duration of practice in years, number of patients seen per day, previous receipt of information about ergonomics, physical activity, and the presence of joint damage) and MSD. RESULTS: Two hundred eighty-six valid questionnaires were returned. The prevalence of MSD was 63.6% (N.=182). Multivariable logistic regression showed that only the factor of self-reported joint damage has a significant association with MSD (OR 0.001; 95% CI: 0.000-0.007). Concerning the self-reported joint damage (60.1%), the carpal tunnel syndrome was the most frequent (13.2%). CONCLUSIONS: The prevalence of MSD in dentists from São Paulo is high, and carpal tunnel syndrome is the most common self-reported joint damage.

Bond Strength of High-Viscosity Glass Ionomer Cements is Affected by Tubular Density and Location in Dentin?

This study evaluated the influence of tubular density of different dentin depths and location on the bond strength of high-viscosity glass ionomer cements (GIC). A total of 20 molars were selected and assigned into six experimental groups, considering two different high-viscosity GICs-Fuji IX (FIX) or Ketac Molar (KM), and dentin location-proximal, occlusal superficial, or occlusal deep dentin (n=10). Teeth were cut and a topographical analysis of four sections per group was performed to obtain data about the tubular density of each different dentin location and depths by laser scanning confocal microscopy (100×). Polyethylene tubes were placed over the pretreated surfaces and filled with one of the GICs. Microshear bond strength (µSBS) test was performed after storage in distilled water (24 h at 37°C). Failure modes were evaluated using a stereomicroscope (400×). Multilevel regression analysis was performed to compare the results at a significance level set at 5%. The tubule density was inversely proportional to the bond strength for both GICs (p<0.05). Adhesive/mixed failure prevailed in all experimental groups. Proximal (30036.5±3433.3) and occlusal superficial 29665.3±1434.04 dentin shows lower tubule density, resulting in a better GIC bonding performance (proximal: FIX-3.61±1.05; KM-3.40±1.62; occlusal superficial: FIX-4.70±1.85; KM-4.97±1.25). Thus, we can concluded that the lowest tubule density in proximal and occlusal superficial dentin results in a better GIC bond strength performance.