Association between phenotypic and genotypic characteristics and disease severity in individuals with cystic fibrosis / Associação entre as características fenotípicas, genotípicas e a gravidade da doença em indivíduos com fibrose cística

Abstract Objective: To analyze the association between phenotypic and genotypic characteristics and disease severity in individuals with cystic fibrosis treated at a reference center in Minas Gerais, Brazil. Methods: This is a retrospective study that collected clinical and laboratory data, respiratory and gastrointestinal manifestations, type of treatment, Shwachman-Kulczycki score, and mutations from the patients' medical records. Results: The sample included 50 participants aged one to 33 years, 50% of whom were female. Out of the one hundred alleles of the Cystic Fibrosis Transmembrane Conductance Regulator gene, the most prevalent mutations were DeltaF508 (45%) and S4X (18%). Mutation groups were only associated with pancreatic insufficiency (p=0.013) and not with disease severity (p=0.073). The latter presented an association with colonization by Pseudomonas aeruginosa and Staphylococcus aureus (p=0.007) and with underweight (p=0.036). Death was associated with age at diagnosis (p=0.016), respiratory symptomatology (p=0.013), colonization (p=0.024), underweight (p=0.017), and hospitalization (p=0.003). Conclusions: We could identify the association of mutations with pancreatic insufficiency; the association of Staphylococcus aureus colonization and underweight with disease severity; and the lack of association between mutations and disease severity. Environmental factors should be investigated more thoroughly since they seem to have an important effect on disease severity.

RESUMO Objetivo: Analisar a associação entre as características fenotípicas, genotípicas e a gravidade da doença em indivíduos com fibrose cística atendidos em um centro de referência de Minas Gerais, Brasil. Métodos: Trata-se de um estudo retrospectivo, em que os dados clínicos, laboratoriais, as manifestações respiratórias e gastrointestinais, o tipo de tratamento, o escore de Shwachman-Kulczycki e as mutações foram coletados dos prontuários de registros dos pacientes. Resultados: A amostra incluiu 50 participantes, de um a 33 anos de idade, sendo 50% do sexo feminino. Do total de cem alelos do gene Cystic Fibrosis Transmembrane Conductance Regulator, as mutações mais prevalentes foram Delta F508 (45%) e S4X (18%). Os grupos de mutações apresentaram associação somente (p=0,013) com a insuficiência pancreática e não com a gravidade da doença (p=0,073). Esta última apresentou associação com a colonização por Pseudomonas aeruginosa e Staphylococcus aureus (p=0,007) e com baixo peso (p=0,036). O óbito foi associado com a idade no diagnóstico (p=0,016), a sintomatologia respiratória (p=0,013), a colonização (p=0,024), o baixo peso (p=0,017) e a ocorrência de internação (p=0,003). Conclusões: Foi possível observar associação entre as mutações e a presença de insuficiência pancreática; entre a colonização por Staphylococcus aureus e o baixo peso com a gravidade da doença; e ausência de associação entre as mutações e a gravidade da doença. Os fatores ambientais merecem ser investigados mais detalhadamente, pois parecem apresentar impacto importante na gravidade da doença.

Association between phenotypic and genotypic characteristics and disease severity in individuals with cystic fibrosis.

OBJECTIVE: To analyze the association between phenotypic and genotypic characteristics and disease severity in individuals with cystic fibrosis treated at a reference center in Minas Gerais, Brazil. METHODS: This is a retrospective study that collected clinical and laboratory data, respiratory and gastrointestinal manifestations, type of treatment, Shwachman-Kulczycki score, and mutations from the patients' medical records. RESULTS: The sample included 50 participants aged one to 33 years, 50% of whom were female. Out of the one hundred alleles of the Cystic Fibrosis Transmembrane Conductance Regulator gene, the most prevalent mutations were DeltaF508 (45%) and S4X (18%). Mutation groups were only associated with pancreatic insufficiency (p=0.013) and not with disease severity (p=0.073). The latter presented an association with colonization by Pseudomonas aeruginosa and Staphylococcus aureus (p=0.007) and with underweight (p=0.036). Death was associated with age at diagnosis (p=0.016), respiratory symptomatology (p=0.013), colonization (p=0.024), underweight (p=0.017), and hospitalization (p=0.003). CONCLUSIONS: We could identify the association of mutations with pancreatic insufficiency; the association of Staphylococcus aureus colonization and underweight with disease severity; and the lack of association between mutations and disease severity. Environmental factors should be investigated more thoroughly since they seem to have an important effect on disease severity.

Orofacial Manifestations of Fetal Alcohol Syndrome: Two Case Reports and a Scoping Review.

Purpose: Fetal alcohol syndrome (FAS) results from the teratogenic effects of alcohol on the fetus. Oral manifestations are commonly found in FAS and contribute to the diagnosis. The purpose of this study was to provide a review of the literature and describe two cases of FAS.
Methods: Electronic searches were conducted in August 2021 in multiple databases. The cases of two children with FAS are reported.
Results: One hundred sixty-six articles were included. The oral features frequently reported were micrognathia, cleft palate, high arched palate, maxillary hypoplasia, prognathia and crowding. The first patient had systemic and orofacial changes, such as delayed physical and cognitive development, micrognathia, tooth impaction, malocclusion and enamel hypoplasia. The second child had cognitive, and speech and behavioral deficits, but no oral and dental abnormalities.
Conclusion: Dentists should be aware of clinical findings since they may take part in the diagnosis and management of FAS.

Meanings and practices of oral health: a qualitative study with mothers of disabled children / Significados e práticas de saúde bucal: um estudo qualitativo com mães de crianças com deficiência

The aim of this study was to understand the meanings and oral health practices of ten mothers of disabled children between the ages of zero and three years. The qualitative method was used. The data was collected by means of a semi-structured interview and were recorded, transcribed and analysed using the Thematic Content Analysis. Regarding to the oral health care of the mothers, three reported difficult and traumatising experiences and three did not have much contact with dentists during their childhood. Regarding to the children, the age of their first visit to the dentist varied from three months to two years and six months, and the reason for this appointment for seven children was referral by their doctor or by the Association of Parents and Friends of the Exceptional. Seven mothers reported that they brushed the teeth of their children at least twice a day and only two cited the importance of regular dental appointments. For two mothers, the meaning of oral health was to have a perfect smile and for four others, maintain oral hygiene. Half of the mothers related oral health to general health. All reported that dental caries is related to diet and lack of care regarding to oral hygiene. It was possible to conclude that for this group of mothers, oral health has an important meaning and that oral health practices are based on a healthy diet and brushing. Although mothers of disabled children have presented positive attitudes, in general, the results indicated limited knowledge about oral health. The results showed the importance of considering the point of view of the mothers as data of analysis bringing greater proximity with the reality studied. More qualitative studies should be conducted in order to collaborate with the improvement of the oral condition of disabled children

O objetivo deste estudo foi conhecer os significados e as práticas de saúde bucal de dez mães de crianças com deficiência de zero a três anos de idade. Foi utilizado o método qualitativo. Os dados foram coletados por meio de entrevista semiestruturada, que foram gravadas, transcritas e analisadas pela Análise de Conteúdo Temático. Com relação aos cuidados de saúde bucal das mães, três relataram experiências difíceis e traumatizantes e três que não tiveram muito contato com o dentista na infância. Com relação às crianças, a idade da primeira visita ao dentista variou de três meses a dois anos e seis meses e o motivo desta consulta para sete crianças foi por encaminhamento médico ou da Associação de Pais e Amigos dos Excepcionais. Sete mães relataram que escovam os dentes de seus filhos pelo menos duas vezes ao dia e apenas duas citaram a importância de consultas periódicas com o dentista. Para duas mães, a saúde bucal significa ter um sorriso perfeito e para quatro ter higiene bucal. Metade das mães relacionaram a saúde bucal com a saúde geral. Todas relataram que a cárie dentária está relacionada com a dieta e com a falta de cuidado com a higiene bucal. Foi possível concluir que para este grupo de mães, a saúde bucal tem um significado importante e que as práticas de saúde bucal se baseiam em uma dieta saudável e a realização da escovação. Embora as mães de crianças com deficiência tenham apresentado atitudes positivas, em geral, os resultados indicaram um conhecimento limitado sobre saúde bucal. Os resultados evidenciam a importância de considerar o ponto de vista do participante, pois os dados de análise trazem maior proximidade com a realidade estudada. Mais estudos qualitativos devem ser conduzidos com o intuito de colaborar com a melhora da condição bucal das crianças com deficiência.

Dental behavior management of a patient with osteogenesis imperfecta type V: case report / Abordagem odontológica de paciente com osteogênese imperfeita tipo V: relato de caso

Aim: the aim of this study is to report a case of a four-year-old male patient diagnosed with Osteogenesis Imperfecta (OI) type V and the dental care performed. Material and method: the patient has been monitored by a multidisciplinary team composed by Pediatric Dentistry, Nurse and Nutritionist at a Special Patients Center in Dentistry Hospital on the Federal University of Uberlândia since one month of life. It was reported that a child had already suffered several bone fractures and currently he has been using calcium carbonate, D vitamin and pamidronate. Results: the proposed intervention was dental preventive strategies by parental education, caries risk assessment and controlling the dental biofilm with professional prophylaxis. But, due to the uncooperative behavior, it was used the active protective stabilization technique and mouth opener. Conclusion: it was concluded that due to the bone fragility and the risk of fractures, it is important a careful placement of the patient on the dental chair. Also, the correct use of basic auxiliary devices and advanced techniques of behavior management were relevant.

Objetivo: relatar caso de paciente do sexo masculino, com quatro anos de idade, diagnosticado com Osteogênese Imperfeita (OI) tipo V e os cuidados odontológicos realizados. Material e método: O paciente foi acompanhado por equipe multidisciplinar composta por Odontopediatra, Enfermeira e Nutricionista de um Centro Especial de Pacientes do Hospital Odontológico da Universidade Federal de Uberlândia desde um mês de vida. Foi relatado que a criança já havia sofrido várias fraturas ósseas e atualmente está usando carbonato de cálcio, vitamina D e pamidronato. Resultado: a intervenção proposta foi de estratégias preventivas odontológicas por educação dos pais, avaliação do risco de cárie e controle do biofilme dental com profilaxia profissional. Porém, devido ao comportamento não cooperativo, utilizou-se a técnica de estabilização protetora ativa e o abridor de boca. Conclusão: concluiu-se que, devido à fragilidade óssea e ao risco de fraturas, é importante uma colocação cuidadosa do paciente na cadeira odontológica. Além disso, o uso correto de dispositivos auxiliares básicos e técnicas avançadas de gerenciamento de comportamento foram relevantes.

Importance of Deciduous Teeth: Maternal Perceptions and Early Childhood Caries

Objective: To assess the perception of mothers on the importance of deciduous teeth and correlate with eating habits, oral hygiene and infant oral health status (presence or absence of early childhood caries - ECC). Material and Methods: Study's participants were 80 mothers of children of both genders, from two to five years old, with and without severe ECC. The mothers were divided into two groups according to the child's oral health. A questionnaire at the form of an interview was applied to mothers with questions on sociodemographic characteristics, eating habits and oral hygiene, and the importance of primary teeth. Mothers were asked to respond according to a Likert scale modified "strongly agree", "partially agree", "partially disagree" and "strongly disagree". The data about oral health status of the child (absence or presence of ECC) were collected from dental records. Results: It was observed that in relation to scores of oral hygiene and eating habits and the importance of primary teeth, the predominance was observed of scores above 10 points, 56.3%, 93.8% e 92.5%, respectively. For the two groups there was no significant difference. Conclusion: The largest number of preschool children's mothers that have ECC do not know the importance of primary tooth and the important functions it performs. There was no correlation between eating habits, oral hygiene and infant oral health status.

Avaliação longitudinal do comportamento dos bebês durante o atendimento odontológico preventivo / Assessment of longitudinal behavior of babies during preventive dental appointments

Introdução: com o aumento do atendimento odontológico direcionado aos bebês, gerou a necessidade de ampliar o conhecimento quanto ao comportamento destes no ambiente odontológico. Objetivo: avaliar o comportamento de bebês durante a assistência odontológica preventiva por três sessões. Material e Método: foram selecionados bebês, entre três e 18 meses, que nunca haviam recebido atendimento odontológico e o comportamento foi avaliado de acordo com a Ohio State University Behavioral Profile (OSUBRS), e classificados em: A= comportamento quieto; B = choro, mas sem movimento de interrupção; C = movimento de interrupção, mas sem choro e D = choro com movimentos de interrupção. O comportamento foi avaliado nos seguintes momentos: durante o posicionamento da criança, exame clínico e higiene bucal em três sessões, com intervalos trimestrais. Resultados: na primeira consulta foram atendidos 45 bebês, sendo que 44,44%, 6,67%, 13,33% e 35,56% dos bebês apresentaram comportamento A, B, C e D, respectivamente. Para a segunda consulta, compareceram 26 bebês, e o comportamento A, B, C e D foi observado em 23,08%, 11,54%, 34,62% e 30,76% dos bebês, respectivamente. Na terceira consulta, retornaram 13 bebês e o comportamento A foi observado em 28,57% e D em 71,43% dos bebês. Houve diferença estatisticamente significante do comportamento durante a limpeza bucal em relação ao posicionamento e exame clínico (p = 0,032) e na primeira consulta, nos bebês acima de 8 meses em todos os momentos (p<0,05). Conclusão: com o decorrer das consultas, o comportamento quieto diminuiu e o comportamento com choro e movimentos de interrupção aumentou.

Introduction: with the increase of the dental care directed to the babies, it generated a need to increase the knowledge about their behavior in the dental environment. Objective: to evaluate the behavior of babies during a preventive dental care for three sessions. Material and Methods: three to 18-month-old infants were selected who never received dental care and the behavior was assessed according to a behavioral profile of Ohio State University (OSUBRS), and classified into: A = quiet behavior; B = cry, but no interruption movement; C = interruption movement, but no crying and D = crying with interruption movements. The behavior was evaluated by moments, during the positioning of the child, clinical examination and oral hygiene in three sessions, with quarterly intervals. Results: at the first visit, 45 babies were attended, with 44.44%, 6.67%, 13.33% and 35.56% of the babies presenting behavior A, B, C and D, respectively. For a second visit, 26 babies attended, and behavior A, B, C and D were observed in 23.08%, 11.54%, 34.62% and 30.76% of the babies, respectively. In the third dental visit, return 13 babies and behavior A observed in 28.57% and D in 71.43% of the babies. There was a statistically significant difference in behavior during oral cleaning in relation to positioning and clinical examination (p = 0.032) and in the first visit, infants over 8 months at all times (p>0.05). Conclusion: during the course of the visits, the quiet behavior decreased and the behavior with crying and interruption movements increased.

Students' perceptions on diagnosis and treatment of occlusal surface of first molars

Introduction: Accurate diagnosis of dental caries is a fundamental requirement in health care. Objective: The aim of this study was to evaluate the opinions of undergraduates concerning different conditions of the occlusal surface of permanent first molar. Material and methods: Two experienced and trained examiners, using visual and radiographic examinations, classified five occlusal surfaces of permanent first molars. The surfaces were photographed and presented to students with a questionnaire about classification of occlusal surfaces, methods used to aid caries diagnosis and type of treatment to be applied. The answers were classified as correct and incorrect and submitted to Chi-square test (p < 0.05). Results: The results showed a higher percentage of correct answers regarding to dentine caries (87.95%) and no caries (84.34%). For all surface conditions, the methods most commonly used to aid diagnose were professional prophylaxis, good lighting, drying and dental probe. Considering the treatment, a greater number of correct answers were obtained for the surface with dentine caries, with indication of conventional (65.06%) and/or preventive restoration (33.73%) and no caries without treatment need or sealant (53.01%). For students at 6th, 7th and 8th semesters, the percentage of correct answers for classification and treatment was 72.31%, 58.33% and 62.94%, respectively, without statistically significant differences (p < 0.05). Conclusion: It was concluded that the opinion of students differed regarding to the diagnosis and treatment mainly when the occlusal surface showed early stages of dental caries.

Behavior guidance techniques in Pediatric Dentistry: attitudes of parents of children with disabilities and without disabilities.

This study compared the parental acceptance of pediatric behavior guidance techniques (BGT). Forty parents of children without disabilities (Group A) and another 40 parents of children with disabilities (Group B) were selected. Each BGT was explained by a single examiner and it was presented together with a photograph album. After that parents evaluated the acceptance in: totally unacceptable, somewhat acceptable, acceptable, and totally acceptable. Results indicated that in Group A, the BGT based on communicative guidance was accepted by most participants. In Group B, just one mother considered totally unacceptable the voice control method and other two, tell-show-do. For both groups, the general anesthesia was the less accepted BGT. There was statistically significant difference in acceptance for protective stabilization with a restrictive device in Group B. Children's parents with and without disabilities accepted behavioral guidance techniques, but basic techniques showed higher rates of acceptance than advanced techniques.

Perception of parents of children with and without disabilities about teething disturbances and practices adopted

Aim: To evaluate and compare the perception of parents of children with and without disabilitiesabout the occurrence of local and systemic manifestations during the eruption of primary teeth and toinvestigate the parents’ practices used to alleviate teething disturbances. Methods: A cross-sectionalstudy was conducted in a sample of parents of children without disabilities (GI) and parents of childrenwith disabilities (GII) treated at a University Pediatric Dentistry Clinic. Data from GI and GII werecollected using a structured questionnaire applied during an interview with the parents, and wereanalyzed using descriptive statistics. Mann-Whitney and Wilcoxon tests were employed and the levelof significance was set at p<0.05. Results: The questionnaires were filled out by 86 parents, being45 in GI and 41 in GII. For GI, the most frequent local manifestations were edema around the tooth(84.44%) and increased suction (75.56%); and for GII were edema and erythema around the tooth(78.05% and 70.73%, respectively). The most frequent systemic manifestations, according to parentsof both groups, were irritability and fever. There was no statistically significant difference betweengroups (p<0.05). It was observed that 46.66% and 68.3% of parents of GI and GII, respectively,adopted different practices to alleviate teething disturbances. Conclusions: During primary teetheruption, local and systemic manifestations may occur and different practices were adopted by theInterviewed parents, mainly those with children with disabilities.

Avaliação do tratamento odontológico de pacientes com necessidades especiais sob anestesia geral / Analysis of dental treatment provided under general anesthesia in patients with special needs

Objetivo: A proposta deste estudo foi avaliar o tratamento odontológico de pacientes com necessidades especiais sob anestesia geral. Material e método: Foram selecionados prontuários de pacientes assistidos no período de 2006 a 2007, cujos tratamentos foram realizados em centro cirúrgico e registrados os seguintes dados: gênero, idade, condição médica do paciente, risco anestésico (classificação conforme American Society of Anesthesiology- ASA) e os procedimentos odontológicos. Foram analisados 144 prontuários, entretanto 25 foram excluídos, totalizando 119. Resultado: Em relação ao gênero, observou-se que 56,30% eram do gênero masculino e 43,70% do feminino. Quanto à idade, houve maior prevalência de pacientes na faixa etária de 21 a 30 anos (30,25%). A paralisia cerebral (48,74%) e deficiência mental (25,21%) foram as condições médicas mais frequentes, seguidas das síndromes (10,09%), autismo (4,20%) e transtornos psiquiátricos (3,36%). A maioria dos pacientes (98,32%) foi classificada como ASA II. Nos 119 prontuários constatou-se que: em 92 pacientes (77,31%) foram realizadas 501 restaurações; em 89 (74,79%) 602 extrações; em 69 (57,83%) raspagem supra / subgengival; em 37 (31,09%) 100 selantes de fossas e fissuras; em 2 (1,68%) 4 pulpotomias; em 1 (0,84%) 1 pulpectomia, e em 1 (0,84%) gengivectomia. As consultas de revisão para manutenção preventiva foram realizadas principalmente em ambulatório (83,10%). Conclusão: Os resultados mostraram que há uma grande demanda de tratamento cirúrgico-restaurador nos pacientes especiais evidenciando a necessidade de uma prática baseada em promoção de saúde bucal.

Objective: The purpose of this study was to evaluate the dental treatment of patients with special needs under general anesthesia. Material and method: Dental records of patients whose treatments had been performed in surgical center between 2006 and 2007 were selected, and the following data were registered: gender, age, medical conditions, anesthetic risk (classification of the American Society of Anesthesiology -ASA) and dental procedures. 144 dental records were analyzed, but 25 were excluded, totalizing 119. Result: Concerning to the gender, it was noticed that 56.30% were male and 43.70% female. Related to the age, it was observed a higher prevalence of patients of 21 to 30 years old (30.25%). The cerebral palsy (48.74%) and developmental disability (25.21%) were the most frequent medical conditions, followed by the syndromes (10.09%), autism spectrum disorders (4.20%) and psychiatric illness (3.36%). The majority of the patients (98.32%) was classified as ASA II. In the 119 dental records it was noticed that: in 92 patients (77.31%) 501 dental restorations were performed; in 89 (74.79%) 602 dental extractions; in 69 (57.83%) supra/subgingival scalling; in 37 (31.09%) 100 pit and fissure sealants; in 2 (1.68%) 4 pulpotomies; in 1 (0.84%) 1 pulpectomy and in 1 (0.84%) gengivectomy. The follow up appointments were carried out mainly in an ambulatory setting (83.10%). Conclusion: The results showed that there is a great demand for surgical and restorative treatment for patients with special needs, thus evidencing the need of a practice based on oral health promotion.

Resin-modified glass ionomer cement and a resin-based material as occlusal sealants: a longitudinal clinical performance.

PURPOSE: The aim of this study was to compare retention, effectiveness in caries prevention and superficial characteristics in 2 different materials used as an occlusal sealant. METHODS: The sample consisted of 108 school children with a mean age of 7.5+/-1.25 years, in which 364 first permanent molars were divided into 6 groups: (1) group 1=Delton + rubber dam (used only for this group); (2) group 2=Delton + cotton rolls; (3) group 3=Prime & Bond 2.1 + Delton; (4) group 4=Vitremer with a 0.25:1 powder/liquid proportion; (5) group 5=Primer + Vitremer with a 0.25:1 powder/liquid proportion; and (6) group 6=Vitremer with a 1:1 powder/liquid proportion. RESULTS: After 12 months, the total retention rate for groups 6, 1, 2, 3, 4, and 5 was, respectively: 92%, 79%, 67%, 52%, 41% and 12%. For the 3 occlusal areas, retention was: 97%, 92%, 86%, 77%, 69%, and 36%. For the modified criterion, the proportion test showed a statistically significant difference (P<.05) between: groups 1 and 4; groups 6 and 2; and group 3, 4, and 5 with all others groups. Considering the total of 3 areas, there was a statistically significant difference (P<.05) between: groups 1 and 6 with groups 3 and 4; group 2 with group 4; and groups 6 and 5 with the others. CONCLUSION: The resin-modified glass ionomer cement may be a promising alternative as an occlusal sealant.

Atendimento Odontológico ao paciente com anemia falciforme: revisão de literatura / Dental management of sickle cell anemia patient: literature review

A Anemia Falciforme é um tipo hereditário de doença hemolítica crônica, causada por uma modificação físico-química da molécula de hemoglobina, que provoca, em situações de baixa tensão de oxigênio, distorções na forma normal da hemácia, conferindo-lhe forma de foice. Como conseqüência deste processo de falcização, as células vermelhas tornam-se mais rígidas e apresentam dificuldades para atravessar os vasos sanguíneos, o que resulta em aumento da viscosidade do sangue, levando à obstrução dos vasos e causando hipóxia tecidual. Este evento, referido como crise vaso-oclusiva, é caracterizado por dor severa, que pode persistir por três a quatro dias. A desidratação, o estresse, o frio e infecções podem desencadear estas crises e fatores como alimentação e higienização bucal inadequadas e condições socioeconômicas desfavoráveis podem influenciar no equilíbrio do pacinete. Portanto, considerando que pacientes falciformes apresentam muitos problemas médicos, os quais podem interferir no tratamento odontológico, a prevenção das doenças bucais torna-se fundamental. Desta forma, o objetivo deste estudo é apresentar uma revisão de literatura sobre Anemia Falciforme, enfatizando as condutas a serem observadas durante o atendimento odontológico.

Esthetic improvement following enamel microabrasion on fluorotic teeth: a case report.

Enamel microabrasion is a proven method of removing intrinsic and superficial defects from teeth, establishing esthetics with minimal loss of dental enamel. This article reports one case in which two different microabrasion techniques were used to remove fluorotic stains from teeth.

Cárie precoce na infância: relato de caso clínico / Early childhood caries: clinical case report

Cárie precoce na infância (CPI) é um termo aplicado à cárie que incide muito precocemente na vida do indivíduo, tendo características de cárie rampante. Este artigo discute os principais fatores associados à CPI e sua prevenção, relata as condições bucais de uma criança, apresentando a doença e o seu tratamento

Selamento de fossas e fissuras: avaliação longitudinal da retenção e da eficácia na inibição da cárie oclusal do primeiro molar permanente / Pit and fissure sealants: longitudinal evaluation of the retention and effectiveness in preventing occlusal caries of permanent first molar

Os objetivos deste estudo clínico foram avaliar e comparar a retenção, a eficácia na inibição da instalação da cárie oclusal e as características marginais e superficiais de dois diferentes materiais seladores, Delton (Dentsply Ind. e Com. Ltda.), usado sozinho e associado a um adesivo dentinário (Prime & Bond 2.1 - Dentsply Ind. e Com. Ltda.) e o Vitremer (3M Dental Products) usado em diferentes proporções pó:liquido 1/4:1 (com e sem "primer") e 1:1 (sem "primer"), por um período de 12 meses. Participaram desse estudo, 108 crianças de 5 a 10 anos de idade apresentando no mínimo dois primeiros molares permanentes hígidos e/ou com lesões na forma de manchas (branca e escura). Elas foram divididas aleatoriamente em seis grupos, com a média dos índices ceo-s e CPO-S semelhantes, num total de 364 dentes: Grupo I (controle) - Delton; Grupo II - Delton; Grupo III - Prime & Bond 2.1 + Delton; Grupo IV - Vitremer 1/4:1; Grupo V - "Primer" + Vitremer 1/4:1, e Grupo VI - Vitremer 1:1. O selamento foi realizado sob isolamento relativo para todos os grupos, exceto para o grupo controle, após uma profilaxia prévia com jato de bicarbonato e água (Profident - Dabi-Atlante) e condicionamento com gel de ácido fosfórico a 37% (Dentsply Ind. e Com. Ltda.) por 15 segundos. Após 6 e 12 meses, a avaliação clínica foi realizada por dois examinadores calibrados, pelo critério modificado (Ryge & Snyder), e quanto à retenção nas áreas mésio-oclusal (MO), centro-oclusal (CO) e disto-oclusal (DO). Doze dentes do grupo IV foram analisados em MEV (DSM 940 A -ZEISS). A retenção total (RT) pelo critério modificado aos 12 meses, para os grupos VI, I, II, III, IV e V, foi respectivamente de: 91,67%, 79,41%, 66,67%, 52,08%, 41,18% e 11,67%, e pela somatória das três áreas (MO+CO+DO) foi 97,22%, 92,16%, 86,27%, 77,08%, 68,63% e 35,56%. O teste de proporções (p < 0,05) mostrou uma diferença E.S entre: o grupo V com todos os outros grupos; o grupo VI com os grupos II e III, e o grupo IV com os grupos I e VI, pelo critério modificado. Considerando a somatória das três áreas, houve diferença estatística entre o grupo V com todos os outros, o grupo II com os grupos IV e VI e os grupos I e VI com os grupos III e IV. Após a análise dos resultados obtidos nas condições experimentais deste estudo, pôde-se concluir que: aos 12 meses, nenhum material apresentou perda total; o Vitremer 1:1 e o diluído a 1/4:1 associado ao "primer" apresentaram respectivamente, os melhores e os piores resultados de RT; o Delton sob isolamento absoluto e o Vitremer 1:1 apresentaram valores semelhantes de RT; a associação do Delton ao Prime & Bond 2.1 não aumentou o seu grau de retenção. Foram observadas alterações superficiais e marginais em todos os grupos, sem prejuízo para o selamento.

The aims of this study were to evaluate and to compare the retention, the effectiveness in preventing occlusal caries and the marginal and superficial characteristics of two different sealant materials, Delton (Dentsply Ind. e Com. Ltda.), used with and without dentin adhesive (Prime & Bond 2.1 - Dentsply Ind. e Com. Ltda.) and Vitremer (3M Dental Products) used in two different powder:liquid proportions 1/4:1 (with and without primer) and 1:1 (without primer) for 12 months. 108 children 5-10 years old at least with two sound and unsealed permanent first molars, with similar means of dmfs and DMFS indexes, total of 364 teeth, were divided into 6 groups: Group I (control - rubber dam) - Delton; Group II - Delton; Group III - Delton + Prime & Bond 2.1; Group IV - Vitremer 1/4:1; Group V - Primer + Vitremer 1/4:1, e Group VI - Vitremer 1:1. The sealing was applied after a prophylaxis with air-polishing jet (Profident - Dabi-Atlante), acid-etching with 37% phosphoric acid for (Dentsply Ind e Com. Ltda.) 15 seconds, with cotton rolls, except for group I. The sealants were evaluated at 6 and 12 months for two calibrated examiners, using a modified criteria (Ryge & Snyder) and the retention at mesio-occlusal (MO), centro-occlusal (CO), disto-occlusal (DO) areas. Twelve teeth of group IV were analyzed in SEM (DSM 940 A - ZEISS) after 12 months. The total retention for the modified criteria for the groups VI, I, II, III, IV and V was respectively: 91,67%, 79,41%, 66,67%, 52,08%, 41,18% e 11,67% and for the three areas (MO + CO + DO) was: 97,22%, 92,16%, 86,27%, 77,08%, 68,63% and 35,56%. Proportion test at p < 0.05 showed a statistically significant difference between: group V with the others; group VI with groups II and III, and group IV with groups I and VI, for modified criteria. Considering the total of the three areas, there was a significant difference between: group V with the others; group II with groups IV and groups I and VI with groups III and IV. After the analyses of the results, the conclusions were: after 12 months none of the material showed total loss; Vitremer 1:1 and 1/4:1 associated with "primer" showed respectively the best and the worst results of total retention; Delton under rubber dam and Vitremer 1:1 showed similar rate of total retention; the association of Delton with Prime & Bond 2.1 did not increase the retention rate. In all the groups the superficial and marginal alterations were observed without damage for the sealing.

In vitro evaluation of the marginal microleakage of class II amalgam restoration associated with dentin adhesive / Avaliaçäo in vitro da microinfiltraçäo marginal de restauraçäo de amálgama classe II associada a adesivos dentinários

A microinfiltraçäo marginal de restaurantes de amálgama classe II (Dispersalloy), associada ao verniz convencional (Copalite) e a dois adesivos dentinários (Scotchbond Multi-uso Plus e Multi Bond Alpha), foi avaliada e comparada in vitro através de dois métodos: escores e medidas lineares. Foram utilizados 45 pré-molares hígidos que receberam duas cavidades independentes M e D. Após a restauraçäo, foram submetidos à termociclagem e armazenados em uma soluçäo defucsina básica a 0,5 por cento durante 24 horas. A análise da infiltraçäo do corante permitiu concluir que nenhum dos três sistemas restauradores foi capaz de eliminar a microinfiltraçäo marginal. No entanto, ela foi menor e estatisticamente significante para as restauraçäo associadas aos adesivos dentinários, quando comparadas àquelas com o verniz cavitário. O método das medidas lineares foi mais sensível do que o de escores