Microhardness and chemical analysis of high-viscous glass-ionomer cement after 10 years of clinical service as ART restorations.

OBJECTIVES: The aim of this study was to evaluate the Knoop microhardness (KHN) and chemical composition of high-viscous glass-ionomer cement (HVGIC) after 10 years of clinical service. METHODS: Six HVGIC samples were cut from 10-year ART restorations. The sections were embedded in acrylic moulds with their longitudinal profile exposed. KHN was determined by performing three sequences of five indentations at 10, 30, 50, 70 and 90 µm of HVGIC outer surface. For the control group (n=6), HVGIC specimens were stored in distilled water for 24 months. Hardness measurements were taken at days 7, 30, 60, 120, 180, 360, and 720. For chemical analysis using SEM-EDX, 10-year and control specimens were dehydrated and coated with carbon. Data were analysed using T-test and ANOVA/Tukey's test (p<0.05). RESULTS: A significant KHN increase was observed in the control group up to the 180-day period. From this point the values stabilized and no more significant differences were found between the 10-year and the control KHN values. No statistical differences were observed amongst the KHN from inner distances compared to the outer surface of the 10-year HVGIC specimens. In one 10-year specimen, SEM-images identified the transformation of HVGIC in an altered layer with no glass filler particles detectable, and raised Ca, K and P contents. CONCLUSIONS: KHN values of ten-year HVGIC specimens were similar to the control group values at 180-day storage period. Except for one 10-year specimen in that an altered layer could be seen, chemical composition was similar amongst the depths evaluated.

Ten-year survival of ART restorations in permanent posterior teeth.

This study evaluated the 10-year clinical performance of high-viscosity glass-ionomer cement placed in posterior permanent teeth by means of the Atraumatic Restorative Treatment (ART) approach. One operator placed 167 single- and 107 multiple-surface restorations in 43 high-risk caries pregnant women (mean decayed teeth = 9.8 ± 5.5). Examinations were performed at 1-, 2-, and 10-year intervals according to ART criteria. In the last evaluation, the US Public Health Service (USPHS) criteria were also used. After 10 years, 129 restorations (47.1%) were evaluated and achieved a cumulative survival rate of 49.0% (SE 7.2%). The 10-year survival of single- and multiple-surface ART restorations assessed using the ART criteria were 65.2% (SE 7.3%) and 30.6% (SE 9.9%), respectively. This difference was significant (jackknife SE of difference; p < 0.05). Using the USPHS criteria, the 10-year survival of single- and multiple-surface ART restorations were 86.5% and 57.6%, respectively. The primary causes of failure were total loss (9.3%) and marginal defects (5.4%). The survival rates observed, especially for the single-surface restorations, confirm the potential of the ART approach for restoring and saving posterior permanent teeth.

Prenatal dental care: evaluation of professional knowledge of obstetricians and dentists in the cities of Londrina/PR and Bauru/SP, Brazil, 2004.

The purpose of this study was to assess the current knowledge and recommendations of obstetricians and dentists as to the dental care to pregnant patients in the cities of Londrina/PR and Bauru/SP, Brazil. Questionnaires were distributed to professionals of both cities, arguing on the following issues: oral health during pregnancy; contact between prenatal care and dental care providers; prenatal fluoride supplementation; selection of therapeutic agents for local anesthesia, pain control and treatment of infection; and dental procedures that can be performed during each trimester. Data were analyzed by frequency of responses and statistical analyses were carried out using X(2) (type of workplace/service) and t test (time since graduation), significant if p<0.05. Seventy-nine obstetricians and 37 dentists responded the questionnaires. Most physicians referred the patient to dental care only when a source of dental problem was mentioned, limiting the adoption of a preventive approach. Forty-three percent of dentists and 34% of obstetricians did not know the potential contribution of periodontal infection as a risk factor for preterm low birth-weight babies. There was divergence from scientific literature as to the recommendation of local anesthetics (dentists and obstetricians), prenatal fluoride supplementation (obstetricians) and dental radiographs (dentists). The findings of this survey with dentists and obstetricians showed that dental management during pregnancy still presents some deviations from scientific literature recommendations, indicating the need to update these health care professionals in order to establish guidelines for prenatal dental care.

Prenatal dental care: evaluation of professional knowledge of obstetricians and dentists in the cities of Londrina/PR and Bauru/SP, Brazil, 2004

The purpose of this study was to assess the current knowledge and recommendations of obstetricians and dentists as to the dental care to pregnant patients in the cities of Londrina/PR and Bauru/SP, Brazil. Questionnaires were distributed to professionals of both cities, arguing on the following issues: oral health during pregnancy; contact between prenatal care and dental care providers; prenatal fluoride supplementation; selection of therapeutic agents for local anesthesia, pain control and treatment of infection; and dental procedures that can be performed during each trimester. Data were analyzed by frequency of responses and statistical analyses were carried out using X2 (type of workplace/service) and t test (time since graduation), significant if p<0.05. Seventy-nine obstetricians and 37 dentists responded the questionnaires. Most physicians referred the patient to dental care only when a source of dental problem was mentioned, limiting the adoption of a preventive approach. Forty-three percent of dentists and 34% of obstetricians did not know the potential contribution of periodontal infection as a risk factor for preterm low birth-weight babies. There was divergence from scientific literature as to the recommendation of local anesthetics (dentists and obstetricians), prenatal fluoride supplementation (obstetricians) and dental radiographs (dentists). The findings of this survey with dentists and obstetricians showed that dental management during pregnancy still presents some deviations from scientific literature recommendations, indicating the need to update these health care professionals in order to establish guidelines for prenatal dental care.

Research proposal: evaluation of ART in adult patients.

The primary objective of the Atraumatic Restorative Treatment (ART) is to reduce the indication of tooth extraction by means of a low-cost technique. Considering the difficulties of Brazilian public services to meet the demand of care of the low-income population, with lack of care to the adult population, which usually receives only emergency care, the aim of this study is to assess the performance of high-viscosity glass ionomer cements accomplished by the modified atraumatic restorative treatment in one- and multiple-surface cavities, compared to the conventional restorative approach. It will be analyzed the clinical performance of the materials; cost (material and human resources); patient satisfaction with the treatment received; and preventive effect of treatment.

Research proposal: evaluation of ART in adult patients

The primary objective of the Atraumatic RestorativeTreatment (ART) is to reduce the indication of tooth extraction by means of a low-cost technique. Considering the difficulties of Brazilian public services to meet the demand of care of the low-income population, with lack of care to the adult population, which usually receives only emergency care, the aim of this study is to assess the performance of high-viscosity glass ionomer cements accomplished by the modified atraumatic restorative treatment in one- and multiple-surface cavities, compared to the conventional restorative approach. It will be analyzed the clinical performance of the materials; cost (material and human resources); patient satisfaction with the treatment received; and preventive effect of treatment.

O objetivo primeiro do Tratamento Restaurador Atraumático (TRA) é reduzir a indicação de extrações dentárias através de uma técnica operatória de baixo custo. Considerando as dificuldades do Serviço de Saúde Pública do Brasil de suprir a demanda de serviço requerida pela população adulta de baixa renda, que usualmente recebe atendimento emergencial, o objetivo deste estudo é avaliar a performance clínica de um cimento de ionômero de vidro de alta viscosidade empregado através da técnica atraumática modificada em cavidades de uma e de múltiplas superfícies, comparativamente à abordagem restauradora convencional. Serão analisados a performance clínica dos materiais; o custo (material e recursos humanos); a satisfação do paciente com o tratamento recebido; e o impacto preventivo do tratamento.

Effect of different finishing and polishing techniques on the surface roughness of microfilled, hybrid and packable composite resins.

This study examined the average surface roughness (Ra, microm) of 2 microfilled (Durafill and Perfection), 1 hybrid (Filtek Z250) and 2 packable composite resins (Surefil and Fill Magic), before (baseline) and after eight different finishing and polishing treatments. The surface roughness was assessed using a profilometer. Ten specimens of each composite resin were randomly subjected to one of the following finishing/polishing techniques: A -- carbide burs; B -- fine/extrafine diamond burs; C -- Sof-Lex aluminum oxide discs; D -- Super-Snap aluminum oxide discs; E -- rubber polishing points + fine/extrafine polishing pastes; F -- diamond burs + rubber polishing points + fine/extrafine polishing pastes; G -- diamond burs + Sof-Lex system; H -- diamond burs + Super-Snap system. Data were analyzed using two-way ANOVA and Tukey's HSD test. Significant differences (p<0.05) were detected among both the resins and the finishing/polishing techniques. For all resins, the use of diamond burs resulted in the greatest surface roughness (Ra: 0.69 to 1.44 microm). The lowest Ra means were obtained for the specimens treated with Sof-Lex discs (Ra: 0.11 to 0.25 microm). The Ra values of Durafill were lower than those of Perfection and Filtek Z250, and these in turn had lower Ra than the packable composite resins. Overall, the smoothest surfaces were obtained with the use the complete sequence of Sof-Lex discs. In areas that could not be reached by the aluminum oxide discs, the carbide burs and the association between rubber points and polishing pastes produced satisfactory surface smoothness for the packable and hybrid composite resins, respectively.

Effect of different finishing and polishing techniques on the surface roughness of microfilled, hybrid and packable composite resins

Este estudo avaliou a rugosidade superficial (Ra, µm) de 2 resinas compostas microparticuladas (Durafill; Perfection), 1 híbrida (Filtek Z250) e 2 compactáveis (Surefil; Fill Magic), antes (baseline) e após a realização de 8 técnicas de acabamento e polimento. A rugosidade foi avaliada com rugosímetro. Dez espécimes de cada resina foram submetidos aos seguintes procedimentos: A - brocas cabide; B - pontas diamantadas fina/extrafina; C - sistema Sof-Lex; D - sistema Super-Snap; E - pontas de borracha + pastas de polimento; F - pontas diamantadas + pontas de borracha + pastas de polimento; G - pontas diamantadas + Sof-Lex; H - pontas diamantadas + Super-Snap. Os dados foram submetidos à análise de variância a dois critérios e teste de Tukey. Foi observada diferença estatisticamente significante (p<0.05) tanto entre as resinas compostas quanto entre as técnicas de acabamento/polimento. Para todas as resinas, a maior rugosidade foi produzida com o emprego das pontas diamantadas (Ra: 0.69-1.44 µm). O menor valor de rugosidade foi obtido com o sistema Sof-Lex (Ra: 0.11- 0.25 µm). A Durafill apresentou melhor lisura que a Perfection e a Z250, que apresentaram melhor lisura que as resinas compactáveis. A seqüência completa de discos Sof-Lex produziu a melhor lisura para todas as resinas. Em áreas sem acesso aos discos, as pontas de borracha e pastas de polimento produziram lisura de superfície satisfatória para as resinas híbridas enquanto as brocas carbide produziram polimento adequado para as resinas compactáveis.

Effect of caries preventive measures directed to expectant mothers on caries experience in their children.

The aim of this prospective study was to determine the effectiveness of caries preventive measures started during pregnancy on the caries experience of first-time mothers and their infants. Eighty-one pregnant women with low social background were selected on the basis of the presence of active carious lesions and were randomly divided into control (38) and experimental (43) groups. The initial dental status (DMFS and white spot lesions) was established through clinical examination. The prophylactic measures were repeated during pregnancy and 6 and 12 months after delivery. Both groups received primary care intervention. They were instructed in relation to the etiologic factors of dental caries and received oral hygiene kits. Oral hygiene instructions were reinforced through interactive brushing. The experimental group also received antimicrobial treatment (topical application of NaF and iodine solution immediately after prophylaxis and 3 and 5 days later) and restorative care using glass ionomer cement. By the time the children were 2 years of age, 33.3% of the infants in the control group and 14.7% in the experimental group had caries activity. A significant difference in caries prevalence was observed between children with and without visible dental plaque. The mean number of tooth surfaces with carious lesions (including areas of demineralization) was higher among the children in the control group compared to the experimental group (6.3 x 3.2), however, with no statistical significance. Maternal caries increase was a significant factor influencing the caries experience of the children. These data support the evidence of an association between caries prevalence in young children and clinical (dental plaque) and maternal factors.

Prevalence of black tooth stains and dental caries in Brazilian schoolchildren.

This study evaluated the correlation between the presence of black extrinsic tooth stains and caries in Brazilian schoolchildren. The target population consisted of 263 children aged 6-12 years. Clinical examinations were performed by four dentists calibrated for the World Health Organization criteria for caries diagnosis. The c(2) test was used to compare the prevalence of caries between groups of children with and without black tooth stains. Spearman's correlation test was used to analyze the relationship between the presence of black stains and caries severity. Black stains were observed in 14.8% of the children. The number of children with caries-free permanent dentition was not statistically different between groups. The mean DMF-T was 1.46 +/- 1.39 for children with black stains and 2.42 +/- 2.09 for children without black stains. A negative correlation was observed between the presence (r = -0.16; p<0.05) and severity (r = -0.15; p<0.01) of black stains and DMF-T.

Prevalence of black tooth stains and dental caries in Brazilian schoolchildren

O presente estudo avaliou a correlação entre a presença de manchas extrínsecas pretas no esmalte dental e experiência de cárie de escolares brasileiros. A população alvo consistiu de 263 crianças com idades entre 6 e 12 anos. Os exames clínicos foram realizados por quatro dentistas calibrados de acordo com o critério da Organização Mundial de Saúde para diagnóstico de cárie. O teste c2 foi usado para comparar a prevalência de cárie entre crianças com e sem manchas pretas no esmalte. O teste de correlação de Spearman foi usado para analisar a relação entre a presença de mancha preta e a severidade da doença cárie. A presença de manchas pretas foi diagnosticada em 14,8 por cento das crianças. O número de crianças livre de cárie na dentição permanente não foi estatisticamente diferente entre os grupos. O CPO-D médio foi 1,46 ± 1,39 para crianças com manchas pretas e 2,42 ± 2,09 para crianças sem mancha. Observou-se correlação negativa entre a presença (r = -0,16; p<0,05) e severidade (r = -0,15; p<0,01) da mancha preta e o CPO-D.

Effect of caries preventive measures directed to expectant mothers on caries experience in their children

The aim of this prospective study was to determine the effectiveness of caries preventive measures started during pregnancy on the caries experience of first-time mothers and their infants. Eighty-one pregnant women with low social background were selected on the basis of the presence of active carious lesions and were randomly divided into control (38) and experimental (43) groups. The initial dental status (DMFS and white spot lesions) was established through clinical examination. The prophylactic measures were repeated during pregnancy and 6 and 12 months after delivery. Both groups received primary care intervention. They were instructed in relation to the etiologic factors of dental caries and received oral hygiene kits. Oral hygiene instructions were reinforced through interactive brushing. The experimental group also received antimicrobial treatment (topical application of NaF and iodine solution immediately after prophylaxis and 3 and 5 days later) and restorative care using glass ionomer cement. By the time the children were 2 years of age, 33.3 percent of the infants in the control group and 14.7 percent in the experimental group had caries activity. A significant difference in caries prevalence was observed between children with and without visible dental plaque. The mean number of tooth surfaces with carious lesions (including areas of demineralization) was higher among the children in the control group compared to the experimental group (6.3 x 3.2), however, with no statistical significance. Maternal caries increase was a significant factor influencing the caries experience of the children. These data support the evidence of an association between caries prevalence in young children and clinical (dental plaque) and maternal factors

Avaliaçäo da efetividade de um programa de saúde bucal direcionado a gestantes sobre a experiência de cárie de seus filhos / Effect of caries-preventive measures directed to expectant mothers on caries experience in their children

O objetivo deste estudo longitudinal foi avaliar a efetividade de um programa de saúde bucal, iniciado durante a gestaçäo, sobre a experiência de cárie de primigestas e seus filhos. Oitenta e uma gestantes, pertencentes a classes sociais pouco favorecidas, foram selecionadas com base no diagnóstico clínico de lesöes de cárie ativas em superfícies dentárias livres e proximais (SC inicial 13,98). A condiçäo dentária inicial foi estabelecida através do índice CPOS e do diagnóstico das lesöes de mancha branca. A condiçäo periodontal foi avaliada a partir do índice ICNTP. O fluxo salivar e a capacidade tampäo da saliva também foram analisados. Sessenta e quatro pares mäe-filho finalizaram o estudo, estando 34 no grupo experimental e 30 no grupo controle. Setenta e cinco por cento das mäes tinham entre 14 e 20 anos no início do estudo e foram classificadas como adolescentes. Ambos os grupos receberam uma abordagem educativa (informaçäo sobre a etiologia, transmissäo e prevençäo da doença cárie, instruçöes de higiene oral e aconselhamento sobre dieta). O grupo experimental recebeu adicionalmente tratamento com anti-microbianos (profilaxia profissional e aplicaçöes tópicas de flúor gel e soluçäo a base de iodo) e adequaçäo bucal utilizando cimento de ionômero de vidro. A prevalência de crianças cárie-ativas com a idade de dois anos foi de 33,3 por cento no grupo controle e 14,7 por cento no grupo experimental. Foi observada diferença significativa na prevalência de cárie entre crianças com e sem placa dentária visível (p = 0,032). O número médio de superfícies com lesöes de cárie (incluindo as desmineralizaçöes) foi maior para as crianças do grupo controle quando comparadas às do grupo teste (6,3 x 3,2), porém sem atingir significância estatística. Cinco crianças no grupo controle exibiram seis ou mais superfícies dentárias cariadas. Esta situaçäo näo foi observada em criança alguma do grupo experimental. O incremento de cárie na dentiçäo da mäe foi computado ao longo do estudo e apresentou correlaçäo significativa com a incidência de cárie na dentiçäo das crianças (p = 0,0009). Estes dados suportam a evidência de associaçäo entre a incidência de cárie na primeira infância e a presença de placa, assim como a influência significativa de fatores maternos

Brasileiros comem cada vez mais e com pior qualidade / Brazilian people eat more and with worst quality

As mudanças nos hábitos alimentares, com a substituição crescente das tradicionais refeições por "fast food, não só fizeram explodir a obesidade no país como aumentaram os riscos de cáries dentárias. Paradoxalmente, cresce a incidência no Brasil de certas deficiências nutricionais

Avaliaçäo in vitro da microinfiltraçäo em cavidades de classe V restauradas com diferentes combinaçöes de resina composta e cimento de ionômero de vidro / In vitro evaluation of marginal leakage in class V restorations using different combinations of composite resin and glass ionomer cement

O propósito deste estudo foi comparar o padräo de microinfiltraçäo em restauraçöes classe V usando diferentes combinaçöes de cimento ionomérico/resina composta. Cinqüenta cavidades foram preparadas nas superfícies vestibular e lingual de caninos e de pré-molares recém-extraídos. A margem gengival dos preparos estendeu-se até a dentina/cemento, e a margem oclusal localizou-se em esmalte. As cavidades foram restauradas como se segue: cimentos ionoméricos restauradores modificados por componentes resinosos (Fuji II LC e Vitremer); sistema adesivo/resina composta (Scotchbond Multi-Uso/Silux Plus); técnica do sanduíche empregando-se o sistema adesivo/resina composta descrito, com um cimento ionomérico forrador (Vitrebond e GC Lining LC). Os espécimes foram armazenados em água destilada, polidos, submetidos à ciclagem térmica e imersos em fucsina. A extensäo de penetraçäo do corante foi classificada segundo o critério de escores, e os dados foram analisados estatisticamente, näo sendo observadas diferenças significativas tanto entre materiais como entre margens

Bond strength between resin composite and etched and Non-etched Glass Ionomer / Resistência à união entre resina composta e ionômero de vidro condicionado e não condicionado

The authors evaluated, in vitro, the effects of etching glass ionomer cements prior to the application of a bonding agent and a resin composite on the bond strength of the glass ionomer/resin composite interface. Six glass ionomer cements were tested using the same bonding agent/resin composite system (Scotchbond Multipurpose/Z 100). For each material, 16 specimens were prepared and divided into two groups. Eight of the specimens were not etched while eight were etched with 37 percent phosphoric acid for 15 seconds. All the materials were used according to the manufactures'instructions. Glass ionomer cylinders were prepared and were mounted in an assembly apparatus and the bonding agent/resin composite transferred to a demarcated area on the cement surface. The specimens were stored for 24 hours in distilled water at 37ºC and thermocycled. After thermocycling, the specimens were placed in a testing machine and a shear load applied with a knife-edged rod at the glass ionomer/resin composite interface. The shear bond strength was calculated and expressed in MPa. Data were analyzed by ANOVA and the Tukey-Kramer test. There were no significant differences among the shear bond strengths of the resin composite to etched and non-etched glass ionomer cements