TRA associado ou não ao Brix3000, tendências mundiais e o conhecimento sobre técnicas de mínima intervenção para o controle da cárie dentária / ART associated or not with Brix3000, world trends and knowledge of minimal interventional dentistry for the control of dental caries

A presente dissertação foi dividida em três estudos: o primeiro avaliou o Tratamento Restaurador Atraumático (TRA) associado ou não ao Brix3000™ quanto ao tempo de tratamento, experiência de dor e aceitabilidade de crianças (n=20) de 3-9 anos em um ensaio clínico controlado e randomizado. O tempo foi cronometrado do início ao fim do tratamento. A experiência de dor foi avaliada pela versão revisada da escala "Face, Legs, Activity, Cry, Consolability" (FLACC-r) e a aceitabilidade por uma escala facial hedônica. O grupo TRA + Brix3000™ gastou 4 minutos a mais (13,14±4,0 min) que o grupo TRA (9,8±2,7 min) (p=0,03). Não houve diferença quanto à aceitabilidade e à dor (p>0,05). O segundo estudo caracterizou a literatura científica mundial sobre produtos de remoção químico-mecânica de tecido cariado (RQMTC), por meio de mineração de dados bibliométricos, metodológicos e dos resultados de 397 artigos. Houve maior número de publicações entre 2011- 2020, no Journal of Dental Research, desenvolvidos no Brasil e Índia. Estudos in vitro foram mais prevalentes, seguidos dos estudos clínicos. Nestes últimos, Carisolv™ e Papacarie™ foram os produtos mais utilizados, prescritos para uso isolado e comparados ao uso de brocas. Os produtos para RQMTC foram mais estudados em crianças, cujos dentes foram restaurados com o cimento de ionômero de vidro, nos quais o tempo gasto e dor foram os principais desfechos. Observou-se que a RQMTC demanda maior tempo, entretanto, promove redução de ansiedade, dor e necessidade de anestesia local. O estudo 3 avaliou o conhecimento de dentistas brasileiros sobre odontologia de mínima intervenção (OMI) pelo desenvolvimento, validação e aplicação de uma escala de conhecimento (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS), de 12 itens (0-12 pontos). Quanto maior a pontuação, maior o conhecimento do dentista. Dados sociodemográficos e de formação acadêmica foram coletados. A escala (α=0,72; ICC=0,85) foi aplicada por meio da plataforma Survey Monkey™ a 637 dentistas que demostraram ter conhecimento médio de 7,4±2,5 sobre OMI. As maiores pontuações foram alcançadas por mulheres (7,8±2,4; p=0,00); profissionais com mais de 10 anos de formados (7,6±2,6; p=0,02); em faculdades públicas (7,8±2,4; p=0,00), atuando no setor público (7,9±2,3; p=0,00) ou acadêmico (8,8±2,3; p=0,04). Pontuações maiores foram alcançadas por especialistas em Odontopediatria (9,2±1,6) e menores por Cirurgiões buco-maxilo-faciais (3,1±2,1). Houve maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. Técnica de Hall, infiltrante resinoso e RQMTC foram as técnicas menos conhecidas. Com a presente dissertação, concluiu-se que o TRA associado ao Brix3000™ demandou mais tempo de tratamento, sem diferença quanto à aceitabilidade e à dor. Os estudos com produtos para RQMTC aumentaram ao longo dos anos, principalmente em países em desenvolvimento. Os estudos clínicos com crianças tendem a avaliar o tempo gasto e a dor em comparação ao uso de brocas e, a RQMTC reduz ansiedade, dor e necessidade de anestesia, embora aumente o tempo de tratamento. Foi constatada suficiente evidência psicométrica da escala MIDDeC-KS. As maiores pontuações foram alcançadas por profissionais do gênero feminino e especialistas em Odontopediatria, com maior conhecimento sobre controle de dieta, biofilme e aplicação tópica de flúor. (AU)

This dissertation was divided into three studies: the first evaluated the Atraumatic Restorative Treatment (ART) associated or not with Brix3000 ™ in terms of treatment time, pain experience and acceptability of children (n=20) aged 3-9 years through a randomized controlled clinical trial. The time was calculated from the beginning to the end of the treatment. Pain experience was assessed by the revised version of the "Face, Legs, Activity, Chy, Consolability" (FLACC-r) scale and acceptability by a hedonic facial scale. The ART + Brix3000 ™ group spent 4 minutes longer (13.14±4.0 min) than the ART group (9.8±2.7 min) (p=0.03). There was no difference regarding acceptability and pain (p>0.05). The second study characterized the world scientific literature on chemical-mechanical carious tissue removal (CMCTR) products, through bibliometric, methodological and results data mining of the 397 articles. There was a greater number of publications between 2011-2020, in the Journal of Dental Research, which were developed in Brazil and India. In vitro studies were more prevalent, followed by clinical studies. In the latter, Carisolv ™ and Papacarie ™ were the most used products prescribed for isolated use and compared to the use of drills. CMCTR products have been most studied in children whose teeth were restored with glass ionomer cement, in which time spent and pain were the main outcomes. Clinical application of CMCTR takes more treatment time but can also reduce patient anxiety, pain and need for anesthesia Study 3 assessed the knowledge of Brazilian dentists about minimal intervention dentistry (MID) through the development, validation, and application of a 12-item (0-12 points) knowledge scale (Minimal Interventional Dentistry for Dental Caries Knewlodge Scale - MIDDeC-KS). The higher the score, the greater the knowledge of the dentist. Gender, educational level, specialty, academic training institutions and workplace were collected. The final scale (α=0.72; ICC=0.85) was applied through the Survey Monkey™ platform to 637 dentists who demonstrated an average knowledge of 7.4±2.5 about MID. The highest scores were achieved by women (7.8±2.4; p=0.00); professionals with more than 10 years of graduation (7.6±2.6; p=0.02); in public colleges (7.8±2.4; p=0.00), working in the public sector (7.9±2.3; p=0.00) or academic (8.8±2.3; p =0.04). Higher scores were achieved by specialists in Pediatric Dentistry (9.2±1.6) and lowest by maxillofacial surgeons (3.1±2.1). There was greater knowledge about diet and biofilm control, as well as topical application of fluoride. Hall technique, resin infiltration and CMCTR were the least known MID techniques. With the present master thesis, it was concluded that ART associated with Brix3000™ required more treatment time, with no difference in terms of acceptability and pain. Studies with products for CMCTR have increased over the years, mainly in developing countries. The clinical studies with children tend to assess the time spent and pain compared to the use of drills. CMCR clinical application reduces anxiety, pain and need for anesthesia, despite increase treatments' time Sufficient psychometric evidence of the MIDDeC-KS scale was observed. The highest scores were achieved by women, specialists in Pediatric Dentistry, with more knowledge about diet control, biofilm, and topical fluoride application. (AU)

What is different in operative dentistry?

There have been both large and small changes in operative dentistry in the last 30 years. Extension for prevention is no longer the mantra. The design features of amalgam preparations have moved into the smallest preparations possible to gain full access to the carious dentin. The default Class 2 amalgam or resin composite is a slot preparation with no preparation of the occlusal fissures. Class 1 fissure caries once implied the entire fissure system was to be cut out. Now only the known carious portions of the fissure are cut away, the tooth is restored, and the remaining fissures in that tooth are sealed. Resin composite preparations have no depth requirements and saucer shaped boxes are more favorable for lowering shrinkage strains on the bonded walls. Re-mineralization of proximal lesions that can be seen on a radiograph is now a proven successful service for many lesions that are at or just into the dentin by radiographic interpretation. The largest paradigm shift has been in the decision that in vital teeth with normal pulps soft dentin can be left over a vital asymptomatic pulp with every expectation that the direct restoration will be successful long term.

Evolution of the the ART approach: highlights and achievements.

Atraumatic Restorative Treatment (ART) was initiated in the mid-eighties in Tanzania in response to an inappropriately functioning community oral health programme that was based on western health care models and western technology. The approach has evolved to its present standing as an effective minimal intervention approach mainly because the originators anticipated the great potential of ART to alleviate inequality in oral health care, and because they recognised the need to carry out research to investigate its effectiveness and applicability. Twenty-five years later, ART was accepted by the World Health Organisation (1994) and the FDI World Dental Federation (2002). It is included in textbooks on cariology, restorative dentistry and minimal intervention dentistry. It is being systematically introduced into public oral health service systems in a number of low- and middle income countries. Private practitioners use it. Many publications related to aspects of ART have been published and many more will follow. To achieve quality results with ART one has to attend well-conducted and sufficiently long training courses, preferably in combination with other caries preventive strategies. ART should, therefore, not be considered in isolation and must be part of an evidence-based approach to oral health with a strong foundation based on prevention.

Two decades of ART: improving on success through further research.

UNLABELLED: Since the introduction of the Atraumatic Restorative Treatment (ART) approach over twenty years ago, more than 190 research publications have appeared. The last research agenda defining research priorities for ART was published in 1999. The objective of the present work was to review existing research in the context of future research priorities for ART. MATERIAL AND METHODS: An internet survey was conducted amongst those who had published on ART or were known to be working on the ART approach, to solicit their views as to areas of future ART research. Three broad categories were defined, namely: 1. Basic and laboratory research; 2. Clinical research, and, 3. Community, Public Health, Health Services Research. RESULTS: A 31% response rate was achieved. The study identified a number of new areas of research as well as areas where additional research is required. These are expressed as recommendations for future ART research. CONCLUSIONS: The ART approach is based on a robust, reliable and ever-growing evidence base concerning its clinical applications which indicates that it is a reliable and quality treatment approach. In common with all other oral health care procedures, targeted applied research is required to improve the oral health care offered.

Evolution of the the ART approach: highlights and achievements

Atraumatic Restorative Treatment (ART) was initiated in the mid-eighties in Tanzania in response to an inappropriately functioning community oral health programme that was based on western health care models and western technology. The approach has evolved to its present standing as an effective minimal intervention approach mainly because the originators anticipated the great potential of ART to alleviate inequality in oral health care, and because they recognised the need to carry out research to investigate its effectiveness and applicability. Twenty-five years later, ART was accepted by the World Health Organisation (1994) and the FDI World Dental Federation (2002). It is included in textbooks on cariology, restorative dentistry and minimal intervention dentistry. It is being systematically introduced into public oral health service systems in a number of low- and middle income countries. Private practitioners use it. Many publications related to aspects of ART have been published and many more will follow. To achieve quality results with ART one has to attend well-conducted and sufficiently long training courses, preferably in combination with other caries preventive strategies. ART should, therefore, not be considered in isolation and must be part of an evidence-based approach to oral health with a strong foundation based on prevention.

Two decades of ART: improving on success through further research

Since the introduction of the Atraumatic Restorative Treatment (ART) approach over twenty years ago, more than 190 research publications have appeared. The last research agenda defining research priorities for ART was published in 1999. The objective of the present work was to review existing research in the context of future research priorities for ART. MATERIAL AND METHODS: An internet survey was conducted amongst those who had published on ART or were known to be working on the ART approach, to solicit their views as to areas of future ART research. Three broad categories were defined, namely: 1. Basic and laboratory research; 2. Clinical research, and, 3. Community, Public Health, Health Services Research. RESULTS: A 31 percent response rate was achieved. The study identified a number of new areas of research as well as areas where additional research is required. These are expressed as recommendations for future ART research. CONCLUSIONS: The ART approach is based on a robust, reliable and ever-growing evidence base concerning its clinical applications which indicates that it is a reliable and quality treatment approach. In common with all other oral health care procedures, targeted applied research is required to improve the oral health care offered.