A clinical report of functional and esthetic oral rehabilitation in a high-caries-risk child: one-year follow-up / Caso clínico de reabilitação oral estética e funcional em criança de alto risco à cárie: um ano de acompanhamento

Este caso discutiu a abordagem multidisciplinar da reabilitação oral estética e funcional de uma criança com alto risco à cárie com perda prematurade dentes decíduos devido a complicações do tratamento endodôntico associado a cárie dentária generalizada. O paciente foi diagnosticado com mordida aberta anterior e deglutição atípica. O mesmo apresentou ansiedade e baixa auto-estima devido ao comprometimento estético. Combinação de procedimentos clínicos direcionados, com ênfase e foco no cuidado bucal domiciliar e o envolvimento ativo dos pais fez parte do processo de tratamento integral do paciente. Este foi examinado mensalmente por um odontopediatria, o qual orientou sobre hábitos alimentares, exposição a fluoretos, presença de biofilme, prevalência de cárie e má oclusão. Evidente melhora foi observada na função mastigatória,estética facial e comportamento psicológico aos 12 meses de acompanhamento clínico do caso.

This case discusses a multi-disciplinary approach to oral functional and esthetic rehabilitation on a high-caries-risk child with prematurely lost primary teeth due to endodontic complications associatedwith wide-spread dental caries. The patient was diagnosed with an anterior open bite and atypical swallowing. He exhibited anxiety and low selfesteemdue to esthetic impairment. A combination of targeted clinical procedures, a focus on oral home care and active parental involvement was integral to the treatment process. The patient was examined monthly by a pediatric dentist regarding dietary habits, fluoride exposure, biofilm= presence, caries prevalence, and malocclusion. Improvement was evident in patient’s masticatory function, facial esthetics, and psychological behavior at a 12-month follow-up evaluation.

Atraumatic restorative treatment in Brazilian schoolchildren: 12 months preliminary clinical results / Tratamento restaurador atraumático em escolares brasileiros: 12 meses de resultados clínicos preliminares

Objective: To evaluate the clinical efficacy between two GICs, Fuji IX (GC Int. Corp.) and Ketac Molar (3M ESPE), used in Atraumatic Restorative Treatments (ART). Materials & Methods: A total of 82 children aged among 6-9 years old were included in this study. The materials employment criteria application followed the “split mouth” design, 71 restorations and 98 sealants were carried out with the Fuji IX in the left hemi arches and 70 restorations and 99 sealants were carried out with the Ketac Molar in theright hemi arches. The procedures were conducted in a school that did not have dental equipment. Previously to the restorative procedure, the children were supervised during tooth brushing. A trained dentist carried out all the restorations and sealants at the school playground with natural light and the teeth were isolated with cotton rolls. The performance of the restorations and sealants was evaluated by visual inspection in a 12 months preliminary follow up by one blinded trained examiner. Results: No significant difference was shown between the success rate of the GICs Fuji IX and Ketac Molar for the restorations (p > 0.05) and sealants (p > 0.05). Regardless of the material, the success rates were 82% for the sealants, 76% for the class I and 73% for the class II restorations. Conclusion: The GICs had a good performance and ART preliminary results provided curative and preventive treatments for patients who do not have access to conventional treatment.

Objetivo: Avaliar a eficácia clínica entre dois CIVs, Fuji IX (GC Int. Corp.) e Ketac Molar (3M ESPE), utilizados no Tratamento RestauradorAtraumático (TRA). Material e Métodos: 82 crianças com idade entre 6-9 anos foram incluídas no estudo. A utilização dos materiais seguiu o desenho de boca dividida, 71 restaurações e 98 selantes foram realizados com Fuji IX nas hemi arcadas esquerdas e 70 restaurações e 99 selantes foram realizados com Ketac Molar nas hemi arcadas direitas. Os procedimentos foram realizados em uma escola sem consultório odontológico. Previamente aos procedimentos, as crianças escovaram os dentes sob supervisão. Um dentista treinado realizou todas as restaurações e selantes no pátio da escola com luz natural e os dentes foram isolados com rolos de algodão. A performance das restaurações e selantes foram avaliadas por inspeção visual em 12 meses de acompanhamento por um examinador treinado e cego. Resultados: Não se observou diferença significante entre as taxas de sucesso do CIVs Fuji IX e Ketac Molar para restaurações (p > 0,05) e selantes (p > 0,05). Independente do material, a taxa de sucesso foi 82% para selantes, 76% para restaurações classe I e 73% para classe II. Conclusão: Os CIVs tiveram uma boa performance e os resultados preliminares do TRA promoveram tratamentos curativos e preventivos para pacientes que não tem acesso ao tratamento convencional.

One-year clinical evaluation of oral rehabilitation after the loss of multiple primary teeth.

This article describes a one-year follow-up of the prosthetic rehabilitation of a child who lost multiple primary teeth due to widespread dental caries. Clinical and radiographic examinations indicated the need for all primary teeth to be extracted. Following the extractions, complete maxillary and mandibular removable prostheses with individualized occlusion and age-appropriate artificial teeth were fitted for functional and esthetic rehabilitation. The treatment improved the patient's speech, masticatory function, and facial esthetics, contributing to the development of normal dietary habits and social integration.

Influence of NaOCl irrigation and water storage on the degradation and microstructure of the resin/primary dentin interface.

PURPOSE: To evaluate the influence of NaOCl irrigation and water storage on the degradation and microstructure of the resin/dentin interface of primary teeth bonded with three different adhesive systems using the microtensile bond strength test (µTBS) and scanning electron microscopy (SEM). MATERIALS AND METHODS: Ninety sound primary molars were used. Eighteen groups were formed according to different adhesive systems (Adper Single Bond 2, SB; Clearfil Protect Bond, CP; Adper Prompt L-Pop, APL) with or without 0.5% NaOCl irrigation and water-storage time (24 h, 45 days, 90 days). The middle dentin was exposed. In the NaOCl group, NaOCl irrigation was performed for 30 min, and all groups were restored with composite (Charisma). Sticks with a 1-mm2 cross-sectional area were prepared for the µTBS test. The data were analyzed by ANOVA and Tukey's test (p < 0.05). The failure modes, presence or absence of resin tags, and the resin/ dentin interface were evaluated by SEM, and data were analyzed using Cochran-Mantel-Haenszel statistics (p < 0.05). RESULTS: The µTBS of APL was significantly lower than the other groups regardless of treatment and storage time. A significant decrease of µTBS values after 90 days of water storage occurred only in the non-NaOCl irrigation groups. After 90 days of storage, resin tags partially disappeared in APL and CP, and in SB, 100% of the resin tags remained. CONCLUSION: The choice of adhesive system is one of the factors when bonding to primary dentin is considered. In this study, the etch-and-rinse and the two-bottle self-etching adhesive system produced the highest µTBS values irrespective of prior NaOCl irrigation even up to 90 days of water storage.

Análise atuarial em um estudo comparativo de dois cimentos de ionômero de vidro utilizados na técnica de TRA: avaliação direta e indireta após 3 e 6 meses / Actuarial analysis in a comparative study of two glass ionomer cements used in the ART technique: direct and indirect evaluation after 3 and 6 months

O objetivo deste estudo foi avaliar in vivo, direta e indiretamente, o desempenho clínico de dois cimentos de ionômero de vidro de alta resistência - Ketac Molar (3M) e Fuji IX (GC Int. Corp.) - utilizados no Tratamento Restaurador Atraumático. Um total de 82 crianças entre 6 e 9 anos de idade foram incluídas no estudo. O desempenho das restaurações e dos selantes foi avaliado no baseline, 3 e 6 meses após a realização dos procedimentos. As alterações das restaurações e selantes foram comparadas entre os materiais e entre os períodos de avaliação. A análise da chance acumulada de sucesso para as restaurações foi maior para Classe I do que para Classe II utilizando-se o Fuji IX, sendo verifcado similar desempenho para as restaurações em Ketac Molar, porém com menor chance de ocorrência de sucesso. Não houve diferença no desempenho dos materiais utilizados tanto nas restaurações Classe I e Classe II como nos selantes. Concluiu-se que ambos os cimentos após 3 e 6 meses obtiveram alto índice de sucesso, exceto em restauração Classe II, não havendo diferença estatística entre os materiais. Apesar de ter havido perda precoce do selante para ambos os materiais, houve alta taxa de sucesso em relação à prevenção de lesões de cárie.

The objectives of this study were to evaluate in vivo, directly and indirectly, the clinical performance of two glass ionomer cements of high resistance, Ketac Molar (3M) and Fuji IX (GC Int. Corp.) used in the Atraumatic Restorative Treatment. A total of 82 children age between 6 and 9 years old had been included in this study. The performance of the restorations and the sealants was evaluated in baseline, 3 and 6 months after the accomplishment of the procedures. The alterations of the restorations and sealants had been compared between the materials and periods of evaluation. The analysis of the accumulated rate of success for the restorations was higher for Class I than those for Class II using Fuji IX, being verifed similar performance for the restorations using Ketac Molar, however with less chance of possibility of success. There was not difference in the performance of the materials used in the restorations Class I, II and in the sealants. It was concluded that both cements after 3 and 6 months showed high rate of success, except in Class II, did not showing signifcant statistically difference between the materials. Although of early loss of the sealant for both the materials, it was observed high rate of success in relation to the prevention of caries lesion.

Effect of sodium hypochlorite on dentine mechanical properties. A review.

OBJECTIVES: The aim of this study was to carry out a review on the effect of sodium hypochlorite (NaOCl) on the mechanical properties of root dentine. DATA/SOURCES: The authors searched the Cochrane Library, Embase, PubMed and the Web of Science for papers published from 1984 to 2008. The main search terms used were: dentine, root canal dentine, sodium hypochlorite, mechanical analysis, elastic modulus, hardness, roughness, flexural strength, compressive strength. STUDY SELECTION: The inclusion criteria were studies that evaluated the effect of NaOCl solution, used as an irrigant in endodontics, on the mechanical properties of root dentine. Those studies that were considered to be unrelated to the question addressed, that had investigated NaOCl as a deproteinizing agent, had not evaluated the effect of NaOCl on the mechanical properties of dentine, and that indirectly verified the effect of NaOCl on endodontically treated teeth were excluded. The selected papers were assigned to a score (A-C), according to predetermined criteria. A total of 16 papers were selected, and nine papers were included in the critical appraisal. Five papers were classified as grade A, 4 as grade B, and no paper was classified as grade C. CONCLUSIONS: Based on this review, the authors suggest that there is strong evidence showing that sodium hypochlorite adversely alters the mechanical properties of root dentine, when used as an endodontic irrigant.