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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.

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.

Objetivo: Evaluar la resistencia de unión al desalojo de sellantes resinosos en cavidades en dentina de diámetros diferentes. Material y métodos: Se realizó un estudio S. mutans aleatorio, doble ciego, con 60 incisivos bovinos (n = 10 cuerpos de prueba por grupo) que recibieron un corte en sentido longitudinal, utilizando disco de corte diamantado de alta concentración doble cara, para obtención de una lámina de esmalte / dentina de 1 mm de espesor. A continuación, fueron confeccionadas restauraciones con dos diferentes sellantes resinosos - Fluroshield® (padrón oro) e Ionoseal® - en cavidades con diámetros de 3, 4 y 5 mm. Después de 2 meses de almacenamiento en Originalagua, los especímenes fueron sometidos a la prueba de resistencia de desalojo Resultados: Los sellantes evaluados presentaron valores de resistencia de unión similares (p = 0,357). De la misma forma, el diámetro de las cavidades no interfirió en los valores de resistencia de unión de los sellantes resinosos evaluados (p = 0,068). Conclusión: Podemos sugerir que es posible sellar lesiones cavitadas en la mitad externa de dentina con diámetros de 3, 4 y 5 mm con diferentes sellantes resinosos, ya que estos materiales presentaron resistencias similares cuando se aplican a la prueba desalojo.

Com o avanço da odontologia, os profissionais estão cada vez mais a procura de materiais restauradores com boas propriedades, que facilitem a execução do procedimento e estabeleça a longevidade do tratamento. Inúmeros materiais restauradores estão presentes na prática odontológica desde o amálgama até o surgimento dos materiais restauradores estéticos. A preocupação com a adesão desses materiais estão presentes na prática clínica de odontopediatria, devido a pequena estrutura do dente decíduo, que dificulta a longevidade das restaurações. O objetivo deste estudo foi avaliar a resistência de união por meio de push-out entre três materiais restauradores - Resina Alkasite, Resina Composta Bulkfill flow e Cimento de Ionômero de Vidro Modificado por resina - indicados na Odontopediatria, em dentina de molares decíduos. Nesse trabalho foi realizado um estudo in vitro randomizado, cego (examinador), no qual foram preparados cavidades em 18 molares decíduos e preenchidas com diferentes materiais restauradores: GRA - Resina Alkasite com fotopolimerização (n=6); GCIV - Cimento de Ionômero de Vidro Modificado por Resina (n=6); GRB - Resina Composta Bulkfill Flow (n=6). O teste push-out foi utilizado para avaliar a resistência de união. A análise de variância mostrou haver diferença significante entre os materiais restauradores (p=0,007). Assim concluímos que a resistência de união à dentina de molares decíduos com uso da resina bulkfill flow, é superior aos materiais restauradores testados e que entre o cimento de ionômero de vidro modificado por resina e a resina alkasite, não há diferença significativa de resultado.

O absenteísmo por doenças é reconhecido como um problema de saúde pública mundial, tendo grandes impactos econômicos e sociais. Ademais, informações a respeito destas condições em bombeiros, políciais e outros profissionais de serviços armados são muito escassas. Desta forma, o presente estudo teve como objetivo analisar os afastamentos odontológicos do quadro de servidores da Polícia Militar do Estado de São Paulo em 2017. Para isso, foram coletados os dados demográficos, funcionais e relacionados ao tipo de afastamento (plataforma logística SIGs – Saúde) para cálculo das razões de chances entre as variáveis sócio-demográficas e funcionais e convalescença (afastamentos de até 10 dias). Foi calculado também o índice de gravidade, de frequência e de duração média das ausências odontológicas, bem como o comparativo com os afastamentos por motivos médicos no mesmo período. Foram identificados 80.928 afastamentos relacionados a condições bucais. As características funcionais, sócio-demográficas e da doença odontológica estiveram associadas a convalescença, ou seja, policiais acima de 50 anos, do interior de SP e afastados por lesões de cárie, condições pulpares ou doença periodontal estiveram associados à presença de afastamento de até 10 dias. Na Polícia Militar, em 2017, houve uma média de perda de serviço de 2h/pessoa/ano exclusivamente por motivo odontológico. A duração média das ausências foi de 2,21 dias. Assim, parece que quanto maior a idade e mais distante da capital paulista, maior o número de dias de absenteísmo. Ademais, o envelhecimento no contexto ocupacional é um forte fator para o absenteísmo. Cárie e doença periodontal também estão altamente relacionadas ao absenteísmo quando comparadas às demais doenças odontológicas.

There is a lack of evidence about the best approach for cavitated caries lesions with the possibility of pulpal involvement in primary teeth. Thus, the present authors aimed to verify the best treatment for deep caries lesions with or without pulp involvement in primary teeth. The search was conducted in MEDLINE/Pubmed and Web of Science databases until May 2020. Studies that compared techniques to manage deep caries lesions with at least 12 months of follow-up were included. The risk of bias was evaluated using the RoB tool. Network meta-analysis and pairwise meta-analyses were conducted considering the treatment clinical success as an outcome, according to the pulp health condition. From 491 potentially eligible studies, 9 were included. For deep caries lesions with pulp vitality, the Hall Technique presented the highest probability of success (78%). In the event of accidental pulp exposure, pulpectomy presented a 76% chance of providing the best clinical results. For pulp necrosis, no difference was observed between a pulpectomy and non-instrumented endodontic treatment (RR = 0.69; 95%CI: 0.21–2.33) Thus, it was concluded that the Hall Technique may be a better option for deep caries lesions with pulp vitality. In cases of accidental pulp exposure of vital teeth during caries removal, a pulpectomy may be considered the best option. However, there are insufficient studies to build up evidence about the best treatment option when irreversible pulpitis or pulp necrosis is present.

Dental surgeons need in-depth knowledge of the bone tissue status and gingival morphology of atrophic maxillae. The aim of this study is to describe preoperative virtual planning of placement of 5 implants and to compare the plan with the actual surgical results. Three-dimensional (3D) planning of rehabilitation using software programs enables surgical guides to be specially designed for the implant site and manufactured using 3D printing. A patient with 5 teeth missing was selected for this study. The patient's maxillary region was scanned with cone-beam computed tomography (CBCT), and a cast model was produced. After virtual planning using ImplantViewer, 5 implants were placed using a printed surgical guide. Two weeks after the surgical procedure, the patient underwent another CBCT scan of the maxilla. Statistically significant differences were detected between the virtually planned positions and the actual positions of the implants, with a mean deviation of 0.36 mm in the cervical region and 0.7 mm in the apical region. The surgical technique used enables more accurate procedures compared with the conventional technique. Implants can be better positioned, with a high level of predictability, reducing both operating time and patient discomfort.

Objective The aim of this study was to systematically review the literature regarding the prevalence of periodontal diseases and dental caries in patients with leukemia. Methods An electronic search for observational studies on oral health outcomes in patients with leukemia was performed on Medline/PUBMED, Embase, Web of Science, and Science Direct databases up to April 2020. Dental caries and periodontal diseases were assessed using the following standardized parameters, respectively: mean number of decayed, missing and filled teeth (DMFT), and presence of marginal inflammation (gingivitis) or clinical attachment loss (periodontitis). Two independent reviewers conducted all phases of review. Included studies reporting similar outcomes were subjected to random-effects meta-analysis. Results From 1,246 retrieved references, 39 were included. Most studies were cross-sectional investigations involving young patients with acute lymphoblastic leukemia. Nine studies presented high risk of bias and were not included on quantitative analyses. All studies in the meta-analysis (n = 14) were conducted with children/teenagers with acute leukemia. Pooled gingivitis prevalence in patients before and during leukemia treatment was 85% (95%CI 75, 97%; 4 studies) and 82% (95%CI 71, 94%; 6 studies), respectively. Pooled DMFT means were 2.28 (95%CI 1.31, 3.25; 7 studies) and 3.65 (95%CI 1.45, 5.86; 5 studies) respectively for patients during and after leukemia treatment. Studies regarding periodontitis prevalence were too few to run a meta-analysis. Conclusions Based on cross-sectional data, young people with acute leukemia have high prevalence of gingivitis and caries experience. These findings indicate that the effect of leukemia on oral health still needs to be better investigated.

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.

A infraoclusão de dentes decíduos pode ocorrer devido a fusão anatômica do cemento dentário com o osso alveolar, situação que denominamos como anquilose dentária. Esse evento, comum em molares decíduos, pode causar prejuízo no desenvolvimento da oclusão. O objetivo desse trabalho foi relatar a reabilitação de um molar decíduo infra-ocluído utilizando uma banda ortodôntica sobre o dente, cimento de ionômero de vidro modificado por resina encapsulado (Riva Ligh Cure, SDI, Brasil) e seu acompanhamento durante doze meses. Paciente de nove anos, do sexo feminino, compareceu ao consultório acompanhado de sua mãe com uma queixa estética. Após diagnostico de anquilose, foi realizada a restauração no elemento dentário em sessão única e realizado acompanhamento clínico e radiográfico durante doze meses. Ao final desse período observamos que o dente tratado permaneceu restaurado o que proporcionou a esfoliação das raízes do dente decíduo e consequentemente a erupção do dente permanente. Diante disso, concluímos que é possível tratar molares decíduos em infraoclusão com cimento de ionômero de vidro modificado por resina, no intuito de facilitar a realização do procedimento em sessão única e diminuir os riscos associados a um dente anquilosado não tratado precocemente.

Purpose: To evaluate bond stability of restorative materials to eroded primary teeth after aging. Methods: 120 primary molars were assigned into 12 groups, in according to substrate – enamel or dentin, precondition of substrate – sound or eroded, and restorative material – resin composite/adhesive system-RC, high-viscosity glass ionomer cement–HVGIC or resin-modified GIC–RMGIC. Eroded groups were subjected to erosive challenge prior to bonding procedures. Polyethylene tubes were placed on flat surfaces of substrates and filled up with one of materials. After 24 h, half of the specimens were submitted to microshear bond strength (BS) test, and the other half after 12 months. Results: Generally, sound substrates resulted in higher BS values than eroded ones, with exception of HVGIC that obtained similar performance in both substrates. Furthermore, the storage period negatively influenced BS values for RC groups on dentin assessment. The other groups did not show reduction in BS values after 12 months. RC showed better bonding performance than others materials. Conclusion: Previously eroded substrates result in the worst performance of RC and RMGIC. Moreover, the water storage affects the bonding stability of RC to dentin. On the other hand, HVGIC is not affected by precondition of substrate neither storage.

Dental caries is the most prevalent non-communicative disease worldwide. Although the etiological factors are well known for years, reducing the number of decayed and missing teeth in children still remains as a barrier. Preventive and curative options are numerous but little is known about their economical advantages. Selecting the intervention that offers the best balance of effectiveness and financial resources becomes crucial in the current situation of budget restrictions worldwide.This expert review summarizes available evidence on cost-effectiveness analyses of preventive and curative measures to manage dental caries in children.Preventive measures have been more extensively studied than dental caries treatment. Only water fluoridation and tooth brushing are well-established as cost-effective preventive approaches. Despite the increasing number of cost analysis treatment studies in the literature, most of them focus on the cost description, with no correlation to the intervention effectiveness. There is a current need of well-designed and well-reported cost-effectiveness regarding dental caries management.

The purpose of this study is to perform a systematic review on the use of lasers in oral surgery for bone healing. Selection of articles was carried out by two evaluators in Pubmed and Web of Science databases for published articles and OpenGray for gray literature. Search strategy was developed based on the PICO Question "Does the use of lasers after oral surgery improve bone healing?". Eligibility criteria were: being on laser; evaluate bone healing; involve oral surgery; do not be about implant, periodontics, orthodontics, osteonecrosis or radiotherapy, nor revisions, clinical cases, etc. Data were collected from each article in a structured spreadsheet and a descriptive analysis was performed. Risk assessment of bias of the articles was carried out through the tool elaborated by the Cochrane collaboration. A total of 827 potentially relevant references were identified. No articles were found in OpenGray. Eleven articles met the eligibility criteria and were included in the systematic review. Most of studies were in vivo and in jaw, being conducted with low-power lasers which were applied immediately after the surgical procedure of extraction. Neoformation and bone density were the outcomes of choice and there was a tendency of increase in bone density, neoformation, regeneration, mineralization, or bone condensation when laser was applied. Regarding the bias risk assessment, studies were not clear in reporting most of the parameters. Low-power laser therapy seems to reduce time of bone healing in oral surgery, although there are no defined protocols and the level of evidence is still considered weak.

Background: A previous systematic review showed that atraumatic restorative treatment (ART) can be an option to restore the occlusoproximal cavities in primary teeth; however, few studies fulfilled the criteria of inclusion to generate a high level of evidence. Aim: To update the existing systematic review and address questions regarding survival rate of ART restorations compared to the conventional approach in occlusoproximal cavities in primary molars. Design: The search was extended beyond the original search through the PubMed/MEDLINE database up to February 2016. Furthermore, Web of Science and EMBASE were searched. The inclusion criteria were subjects related to the scope of the systematic review. After selection by title and abstract, potentially eligible articles were read in full and included in accordance with exclusion criteria. Meta-analysis was carried out with the outcome being the survival rate of restorations. Results: The search strategy identified 560 potentially relevant studies, in addition to 127 from the original systematic review. A total of four articles were included in the qualitative and quantitative analyses. Meta-analysis showed no statistically significant difference between ART and conventional approaches in survival rate of occlusoproximal cavities (OR = 0.887, 95% CI: 0.574–1.371). Conclusion: ART restorations have similar survival rate compared to conventional treatment and can be considered an option to restore occlusoproximal cavities in primary molars.

Objective: To evaluate the factors related to the time of exclusive breastfeeding (EBF) in infants from Para de Minas and Tres Coracoes (Minas Gerais) and Brumado (Bahia), Brazil. Material and Methods: All mothers attended in public and private hospitals of these cities between June and December 2012 (n=156) were invited to answer an interview related to EBF. Data were collected: (1) at maternity ward; (2) at 4 and (3) 6 months of the infant's life. In (2) and (3), data were collected by phone. Data were recorded in the SPSS software, and descriptive analyses and association of exposure and outcome variables related to the practice of EBF were performed. The chi-square test was used, considering p

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.

Objective To evaluate the influence of previous conditioning with different materials on the bond strength in dentin, or clinical performance of restorations with glass-ionomer cements (GICs). Methodology: Articles published until February 04, 2020 were searched for in the PubMed and Scopus databases. Gray literature was fetched through the OpenGray platform. The references of the included articles were checked manually. Eligibility criteria (1) be about GICs; (2) test surface conditioning for GICs; (3) be about dentin; and (4) be an intervention study (clinical or laboratorial). Two reviewers participated in the entire process, independently, using structured tables in Excel spreadsheets. Direct and network meta-analyses were performed through mixed treatment comparisons (MTCs) to verify the best conditioning treatment, besides the evaluation of methodological quality and risk of bias. Results 2791 articles were pre-nominated and after the eligibility criteria were applied, 30 articles were selected to perform this study. One clinical study and all in vitro studies presented a high risk of bias. Regarding direct comparisons, in restorations with self-cure GIC, the only possible comparison was between polyacrylic acid and non-previous dentin conditioning, and there was no difference between them. Regarding the use of resin-modified GIC, in the direct comparison between non-previous conditioning and use of polyacrylic acid, a favorable difference toward the use of polyacrylic acid was found. In the subgroup of comparison between non-previous treatment and primer, a favorable difference toward the use of primer was found. In the comparison subgroups between phosphoric acid and non-treatment, cavities conditioners and non-treatment, and phosphoric acid and polyacrylic acid, no statistically significant differences were verified. In the network analysis, considering direct and indirect meta-analyses for resin-modified GICs, it was found that the best conditioning for dentin prior to resin-modified GIC fillings is with phosphoric acid, followed by the cavity conditioners; and the worst is not to perform any type of conditioning. Conclusion Prior conditioning does not interfere with the bond strength of self-cure GICs to the sound dentin of permanent teeth, while conditioning dentin with phosphoric acid improves the bond strength of resin-modified GICs to the sound dentin after 24 h, used in permanent teeth. However, the risk of bias is high, the level of evidence is moderate, and the degree of recommendation is weak.

Background: Atraumatic restorative treatment (ART) and chemomechanical removal of dental caries have been shown to be safe and effective restorative procedures. However, current literature lacks well-design studies comparing the pain perceived by infants using ART and chemo-mechanical removal techniques. Aims: To compare pain perception of children of two techniques (ART vs. chemomechanical removal) of restorative treatments for dental caries removal. Settings and Design: A randomized clinical trial with two parallels arms (1:1) was conducted in the cities of Manaus (AM) and Uberlândia (MG), Brazil. Methods: Children between 4 and 9 years old were selected. In both groups - ART (n = 20) and chemomechanical caries removal (Papaya® gel) (n = 20) - oximeter measurements (heart rate and blood oxygenation) were performed before the intervention and until the complete removal of the infected caries dentin. At the end of the treatment, a Wong-Baker scale was used to assess pain perception during the procedure. An independent researcher measured, in minutes, the duration of each technique. Statistical Analysis: Poisson regression analysis was used to evaluate the association between the outcome and the explicative variables. Results: No statistical difference in pain perception between the two procedures of carious tissue removal was observed. By contrast, a lower heart rate was observed when chemomechanical removal was used (P = 0.013). Conclusion: Children that underwent chemomechanical caries removal presented lower heart rate compared to those who underwent ART. However, both techniques showed minimal or absent perceived pain.

The aim of this study was to evaluate by scanning electron microscope (SEM) photomicrographs the influence of application of halogen light-curing for fastening the set reaction of high-viscosity glass ionomer cements (GIC) by assessing the material/dentin interface. Twelve human primary canines were assigned in four groups (n = 3) according to the GIC (Fuji IX, GC or Maxxion R, FGM) and application of halogen light-curing (60 sec or control-no external energy). Blocks with approximately 6 mm of height were buildup on previously pre-treated dentin surface in according to the experimental group. After storage at 37 °C, 100% humidity for 48 h, the specimens were then sectioned in slices with 1-mm thick. The slices were qualitative analyzed using SEM to evaluate possible structural changes. Two examiners independently evaluated the images in order to observe the spherical hollow spaces of each tooth. The photomicrographs revealed the presence of spherical hollow spaces in all experimental groups. However, in both groups that received halogen light-curing application, it was possible to observe that the presence of these hollow spaces decreased in size and quantity. It can be concluded that the halogen light-curing application positively decreases in size and quantity in the presence of spherical hollow spaces in GIC.

This study aimed to conduct a systematic review of the literature published from 2000 to August 2015, to investigate the effect of photobiomodulation (PBM) therapy on dentoalveolar-derived mesenchymal stem cells (ddMSCs), assessing whether a clear conclusion can be reached from the data presented.Systematic reviews provide the best evidence on the effectiveness of a procedure and permit investigation of factors that may influence the performance of a method. To the best of our knowledge, no previous systematic review has evaluated the effects of PBM only on ddMSCs.The search was conducted in PubMed /MEDLINEFrom the initial 3467 potentially relevant articles identified, 6 were excluded because they were duplicates, and 3453 were considered ineligible based on the inclusion criteria. Therefore, eight articles remained, and these were fully analyzed in order to closely check exclusion criteria items. Only one of them was excluded because the cultured cells studied were not characterized as stem cells. Finally, seven articles served as the basis for this systematic review.PBM therapy has no deleterious effects on ddMSCs. Although no other clear conclusion was obtained because of the scarce number of publications, the results of these studies are pointing to an important tendency of PBM therapy to improve ddMSCs' viability and proliferation.

SummaryBackground Individuals with special needs are often affected by oral disorders such as dental caries and periodontal disease. Current data regarding prevalence of these conditions in individuals with autism spectrum disorders (ASD) are controversial. Aim To conduct a systematic review and meta-analysis to verify the prevalence of dental caries and periodontal disease in individuals with ASD, especially children and young adults. Design Searches were conducted through MEDLINE/PubMed, Web of Science, and Scopus databases in December 2015. Studies were included if fulfilled the following eligibility criteria: to evaluate the oral health status of individuals with ASD; to be an observational study; and to assess the prevalence of dental caries and/or periodontal disease. Meta-analyses were conducted considering prevalence of dental caries and periodontal disease in individuals as outcome. Results Search strategy identified 928 potentially relevant articles and seven of them were included in this review. All included studies reported dental caries prevalence, and the pooled prevalence was 60.6% (95% CI: 44.0–75.1). Moreover, only three studies showed prevalence of periodontal disease, resulting in pooled prevalence of 69.4% (95% CI: 47.6–85.0). Conclusion Prevalence of dental caries and periodontal disease in children and young adults with ASD can be considered as high, pointing to the need for oral health policies focused on these individuals.

Background Fluoride released from glass ionomer cements (GICs) is capable of preventing caries lesions. However, the preventive effect in margins of occlusal and occlusoproximal restorations have not been proved. The aim of this study was to evaluate the ability of GIC to prevent caries lesions in margins of occlusal and occlusoproximal restorations in primary teeth compared with that of other restorative materials. Types of Studies Reviewed The authors conducted a literature search in PubMed and MEDLINE to verify the clinical trials available on the outcome of caries lesions. The inclusion criteria were that the subject related to the scope of this systematic review, the study had a follow-up, and the study was not performed in specific groups. The authors performed all meta-analyses by considering the secondary caries rates for the restorations in clinical trials. Results The search strategy identified 450 potentially relevant studies, and the authors included 8 of them in the review. The main reasons for exclusion were that the studies were not related to the scope of this review or were not longitudinal trials. The secondary caries rate of the occlusal restorations was not different among the restorative materials (odds ratio, 1.2; 95% confidence interval, 0.5-3.1). For occlusoproximal analysis, GIC was associated significantly with better ability to prevent caries lesions (odds ratio, 1.7; 95% confidence interval, 1.2-2.5). Conclusions and Practical Implications Because new caries lesions in the margins of restorations are the main reason for failure and replacement of restorations in primary teeth, it is important to know whether there is a benefit in using GICs in both occlusal and occlusoproximal cavities.

Purpose To evaluate the effect of Nd:YAG laser irradiation and erosive challenge on bond strength of two adhesive systems to dentin. Methods Twenty bovine incisors were cut and grounded to obtain eighty slabs of flat dentin. Specimens were allocated into eight groups, based on: adhesive system—a two-step etch-and-rinse and a two-step self-etch; laser irradiation—Nd:YAG (1 W/10 Hz) or control (no laser irradiation); and erosive challenge after restorative procedure—presence or absence of erosive challenge. Nd:YAG laser groups were submitted to laser irradiation before the restorative procedure. Blocks of composite resin were built up on the bonded surfaces with a Southern Dental Industries device to perform shear bond strength (SBS) test. After, each specimen of erosive challenge, groups were subjected to immersion in Sprite Zero® (20 ml/2 h/24 °C/under agitation). The SBS test (0.5 mm/min) was performed after 24 h of water storage at 37 °C. Failure mode was evaluated with a stereomicroscope (X400). Data were analyzed with three-way ANOVA and Tukey’s post hoc tests (α=0.05). Results The etch-and-rinse adhesive system presented higher bond strength values than self-etch adhesive. Laser irradiation increased the bond strengths values when erosive challenge was present. The predominant failure mode observed was adhesive. Conclusions The irradiation of Nd:YAG laser positively influences the bond strength values when erosive challenges are present. Moreover, the etch-and-rinse adhesive system is a better option to be used in dentin in this clinical condition.

Background. Studies have suggested that in the presence of approximal cavities, the approximal surface in contact with this one shows a higher risk in the development of caries lesions.Aim. To evaluate the ability of dental materials to prevent and to arrest caries lesion in approximal surfaces in contact with occlusoproximal restorations.Design. Two independent reviewers performed a literature search in PubMed through November 2014. The inclusion criteria were: (1) subject related to the scope of this systematic review, (2) study with follow-up, (3) not performed in specific groups, (4) to have a comparison group. After selection by title and abstract, potentially eligible articles were read in full. Meta-analysis was carried out considering the outcome as caries lesion progression or arrestment.Results. The search strategy identified 772 potentially relevant studies, and 10 of them were included in the review (six laboratory studies and four longitudinal trials). For the longitudinal clinical trials, no difference was verified among the materials (OR = 0.680,95%CI:0.233–1.983). When a meta-analysis was performed for laboratory studies, GIC was significantly associated with better ability to arrest caries lesions (OR = 0.153,95%CI:0.060–0.391).Conclusions. In laboratory studies, GIC shows better ability to arrest caries lesion in approximal adjacent surfaces, but this ability was not confirmed in longitudinal clinical trials.

La Displasia Ectodérmica es una anomalía determinada por factores genéticos capaz de alterar sus estructuras derivadas como los dientes, piel, pelo, uñas, glándulas sudoríparas y sebáceas. Existen muchas variaciones de Displasia Ectodér-mica, pero la Displasia Ectodérmica Hipohidrótica o Anidrótica ligada al cromosoma X es la forma más conocida donde el cuidado odontológico representa una etapa muy importante del tratamiento. Este trabajo, tuvo como objetivo relatar un caso clínico de un paciente de sexo masculino de 2 años de edad y portador de Displasia Ectodérmica Hipohidrótica. Su tratamiento consistió en la confección de una prótesis total en ambos arcos dentales con la intención de mejorar sus condi-ciones estéticas, funcionales y psicológicas. Su madre acudió a la clínica de bebés de la Universidad Santa Cecília (UNI-SANTA) refiriendo “falta de los dientes de mi hijo desde el nacimiento”. Como resultado, se recuperaron las funciones estéticas, funcionales y psicológicas del paciente. Frente a lo expuesto se puede concluir que el diagnóstico y tratamiento precoz son factores importantes para mejorar las funciones mencionadas en niños con Displasia Ectodérmica, permitiendo su desarrollo físico, emocional y social. Además, la instalación de una prótesis total permitió una mejora en la alimentación y remoción del hábito de succión digital del paciente aquí presentado, constituyendo una alternativa satisfactoria en el tratamiento rehabilitador.

El Síndrome de Prader-Willi (PWS) es una enfermedad genética compleja que afecta el apetito, crecimiento, metabolis-mo, función y comportamiento cognitivo. Está caracterizada por el bajo tono muscular, baja estatura, desarrollo sexual incompleto y problemas de conducta. El portador de este síndrome presenta características relacionadas a estados crónicos de insaciabilidad y de metabolismo lento que lo puede inducir a comer en exceso poniendo en riesgo su vida debido a la obesidad. Las alteraciones en la conducta son frecuentes dificultando el tratamiento odontológico de forma ambulatoria. Este es el reporte de caso de una paciente de 11 años de edad, diagnosticada con PWS, que presentó obesidad de alto ries-go y alteraciones severas en la conducta. Al examen clínico fueron observadas lesiones de caries dental, periodontitis y necesidad de extracciones dentarias. La paciente fue condicionada a través de las técnicas de Ludoterapia e Clownterapia durante 6 sesiones, permitiendo que los tratamientos fueran realizados. Estas dos terapias disminuyeron la ansiedad y fa-cilitaron el vínculo con el profesional, demostrando que son eficaces en el control de la conducta de pacientes pediátricos con alteraciones severas de conducta.

Background Due to the lack of evidence to determine the best treatment for deep cavitated caries lesions in primary molars, the search for an effective restorative technique, which results in a minimal discomfort to patients, and reduce the time needed for the treatment, becomes relevant. The objective of this randomized clinical trial was to evaluate if high-viscosity glass ionomer cement (HVGIC) restorations is noninferior to restoration with calcium hydroxide cement associated with HVGIC for treatment of deep lesions in primary molars, as well as the impact of the treatments on cost and discomfort of the patient. Methods A non-inferiority randomized clinical trial with two parallels arms (1:1) will be conducted. Children with 4 to 8 years will be selected at Clinic of Pediatric Dentistry at Ibirapuera University. 108 teeth will be randomized into two groups: (1) Calcium hydroxide cement associated with HVGIC and (2) HVGIC restoration. Primary outcome will be considered the pulp vitality and to be evaluated after 6, 12, 18 and 24 months by two calibrated examiners. Survival of restorations will also be evaluated in the equal intervals. The duration of dentals treatment and the cost of all materials used will be considered for estimating of cost-efficacy of each treatment. Individual discomfort will be measured after each dental procedure using the Wong-Baker’s Facial Scale. For the primary outcome, Kaplan-Meier survival and the long-rank test will be used to comparison between the groups. Cox regression will be performed to assess the influence of variables on the outcome. For all analyzes, the significance level is set at 5%. Discussion Based on the philosophy of ART, our hypothesis is that the HVGIC restoration is a possible approach to restore the deep caries lesion with pulp vitality without the use of rubber dam and anesthesia. Trial registration Clinicaltrials.gov registration NCT02903979. Registered on June 9th 2016. Electronic supplementary material The online version of this article (10.1186/s12903-018-0703-3) contains supplementary material, which is available to authorized users.

Objetivo: Determinar el perfil de los problemas orales en lactantes y preescolares atendidos en el servicio de urgencias de la Clínica de Especialidades infantil/ Clínica de Bebés de la Universidad Estatal de Londrina, Brasil. Materiales y métodos: Estudio retrospectivo donde se analizaron 776 historias clínicas de pacientes en el rango de edad de 0 a 72 meses, atendidos entre abril de 2007 a abril de 2008. Los datos recolectados fueron: Género, edad, lugar de residencia, ocupación y grado de escolaridad de los padres, motivo de consulta, dientes involucrados e intervenciones realizadas. Se utilizó la prueba de Chi2 (χ2) y un nivel de significancia de 5% para la asociación entre variables. Resultados: Se observó una mayor proporción de pacientes de género masculino en la búsqueda del servicio (55,5%) y la mayoría de pacientes se ubicaron en el rango de edad de 0 a 24 meses (27,3%). Se verificó que el 62,9% residían en la zona urbana y la mayoría de los padres/responsables habían cursado secundaria completa (30,5% padres, 33,8% madres). Los motivos de consulta más frecuentes en la atención fueron caries dental (38,9%) siendo el dolor la queja principal (42,0%) y trauma dental (28,9%). Los dientes más afectados por caries fueron los segundos molares inferiores primarios y, por trauma los incisivos centrales superiores primarios. Dentro de las intervenciones más comunes se encontraron el tratamiento endodóntico (16,0%) y la adecuación del medio bucal (15,1%). Se encontró una asociación estadísticamente significativa entre escolaridad de la madre y motivo de consulta en el servicio de urgencias (p=0,001). Conclusión: El servicio analizado es necesario y útil, sin embargo, la resolución de problemas orales en la población infantil de Londrina, ocurrirá por medio de una reorganización de los servicios odontológicos actuales.

Objective The aim of this systematic review was to evaluate the most appropriate hydrogel scaffold type (natural, synthetic or hybrid) to be applied with stem cells for dental pulp regeneration. The findings should help clinicians make an informed choice about the appropriate scaffold to be applied for this approach. Design Three electronic databases were searched (Medline, Web of Science and Scopus). The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Results From 4990 potentially relevant studies initially identified, 18 papers fulfilled the eligibility criteria and were considered for this review. Natural scaffolds were applied in most studies. Collagen was the most studied scaffold. In 5 of 10 studies, only growth factors were added to the constructs. Even without growth factors, these scaffolds containing stem cells were able to support the formation of dentin. The synthetic scaffolds were the least studied. Only 4 studies were selected, and in 3 of them, the same scaffold (Puramatrix) was evaluated. Puramatrix by itself was unable to form dental pulp when dental pulp stem cells were not present. Synthetic and hybrid hydrogels were unable to attract stem cells from the host. The presence of growth factors in these constructs seems to be of relevance since dental pulp tissue formation was achieved only when the hybrid scaffold was applied with growth factors. Conclusion All types of hydrogel-based scaffolds, when containing mesenchymal stem cells, are able to form connective tissue with different degrees of similarity to dental pulp. However, current data is too heterogeneous to compare and identify the advantages of any specific scaffold.

With the aim of providing dental treatment in field conditions, where no electricity or running water was available, the atraumatic restorative treatment (ART) was developed. Nowadays, numerous clinical trials and systematic reviews show its efficacy not only under those conditions but also as a treatment option for pediatric dentistry dental offices. Besides dental hygiene and sugar consumption advice, ART involves restorations using only hand instruments for carious tissue removal and also pit and fissure sealants. To ensure the restoration and sealant survival, high-viscosity glass ionomer cement must be used, followed by the finger-press technique. ART has been shown to be a less painful, effective, and child-friendly treatment, with comparable survival to conventional treatment. This chapter provides an overview of the ART technique, clinical indications, and the current scientific evidence to support its use.

Some microorganisms are associated with the formation and deposition of pigmentation on dental surfaces, and its localization, intensity and recurrence persistence can introduce aesthetic disorders. Carbamide peroxide is a bleaching agent that also presents antimicrobial properties. This case report addresses a ten-year clinical follow-up, showing a possible influence of a bleaching procedure protocol on alterations of oral microbiota. Although a bleaching treatment does not have the purpose to alter the oral microbiota, a drastic reduction and recurrence of black tooth stains was observed in this case.

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 Sao 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 Sao 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 Sao Paulo is high, and carpal tunnel syndrome is the most common self-reported joint damage.

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

Aim This in vitro study compared the mineral loss of natural and artificially-created caries-affected dentin in primary and permanent teeth using the same protocol to induce caries lesions. Materials and methods Twenty molars presenting natural occlusal dentin caries lesions (10 primary–PriC and 10 permanent– PermC; control group), and 20 sound molars (10 primary – PripH and 10 permanent–PermpH; experimental group), were selected. Occlusal cavities were prepared in teeth of the experimental group that were submitted to pH-cycling for 14 days to simulate caries-affected dentin. All specimens were longitudinally sectioned and prepared in order to obtain Knoop microhardness values from 15 to 250 ìm depth, starting in bottom of center of natural lesions or cavities. The microhardness (KHN) data were submitted to three-way repeated measures analysis of variance (ANOVA) and Tukey's tests (α = 0.05). Results Considering all depths, there was no statistically significant differences (p > 0.05) between the mineral loss of the control (PriC = 30.9 ± 6.4 and PermC = 40.8 ± 8.6) and experimental (PripH = 27.3 ± 11.1 and PermpH = 35.5 ± 14.0) groups, neither between primary and permanent teeth. Conclusion The mineral loss of the artificially-created cariesaffected dentin is similar to that from naturally developed dentin caries lesions. Clinical significance The pH-cycling model may be a suitable method to simulate caries-affected dentin in both permanent and primary teeth. How to cite this article Lenzi TL, Soares FZM, Tedesco TK, de Oliveira Rocha R. Is It Possible to induce Artificial Caries-affected Dentin using the Same Protocol to Primary and Permanent Teeth? J Contemp Dent Pract 2015;16(8):638-642.

Objective: this study aims to evaluate the prevalence of anterior open bite and its association with deleterious oral habits, such as use of pacifier, finger-sucking habit and baby bottle in preschool children. Material and Methods: a cross-sectional study was carried out with 142 children, aged three to five years old, from 9 schools in the city of Nova Venécia, ES, Brazil. A properly calibrated examiner conducted the examination of occlusion under natural light and with the aid of medical examination stick. In addition, a semi-structured form with closed questions on deleterious oral habits in children was sent to parents/guardians. The sociodemographic, economic and anterior open bite data was verified through the Fisher exact test and the odds ratio values were calculated with 95% confidence interval. Results: it was found a prevalence of 31.69% (45) of anterior open bite. Moreover, 45.8% (65) of the children had a pacifier sucking habit, 14.8% (21) finger sucking habit and 73.9% (105) used baby bottle. Children with habit of pacifier sucking showed 5.58 (2.54-12.24) more likely to have anterior open bite than children without the habit. Preschool children with finger sucking habit showed 3.55 (1.37-9.21) more likely to have malocclusion. Children who used baby bottle presented 2.29 (1.06-4.97) more likely to have anterior open bite. Conclusion: high prevalence of anterior open bite is observed in the studied population and it is associated with the pacifier sucking habit, finger sucking habit and use of a baby bottle. Objetivo: este estudo tem como objetivo avaliar a prevalência de mordida aberta anterior e sua associação com hábitos orais deletérios, como uso de chupeta, hábito de sucção de dedo e mamadeira em pré-escolares. Material e Métodos: foi realizado um estudo transversal com 142 crianças de três a cinco anos de nove escolas da cidade de Nova Venécia, ES. Um examinador devidamente calibrado realizou o exame de oclusão sob luz natural e com auxílio de exame médico. Além disso, um formulário semiestruturado com perguntas fechadas sobre hábitos orais deletérios em crianças foi enviado aos pais / responsáveis. Os dados sociodemográficos, econômicos e mordida aberta anterior foram verificados por meio do teste exato de Fisher e os valores de probabilidade foram calculados com intervalo de confiança de 95%. Resultados: foi encontrada uma prevalência de 31,69% (45) de mordida aberta anterior. Além disso, 45,8% (65) das crianças tinham hábito de sucção de chupeta, 14,8% (21) hábitos de sucção de dedo e 73,9% (105) usavam mamadeira. Crianças com hábito de chupar chupeta apresentaram 5,58 (2,54-12,24) mais chances de ter mordida aberta anterior do que crianças sem o hábito. Crianças pré-escolares com hábito de sucção de dedo mostraram 3,55 (1,37-9,21) mais chances de apresentar má oclusão. Crianças que usaram mamadeira apresentaram 2,29 (1,06-4,97) mais chances de ter mordida aberta anterior. Conclusão: alta prevalência de mordida aberta anterior é observada na população estudada e está associada ao hábito de sucção de chupeta, hábito de sucção de dedo e uso de mamadeira.

Introduction Despite the widespread acceptance of \udconventional treatment using composite resin in primary \udteeth, there is limited evidence that this approach is the \udbest option in paediatric clinics. Atraumatic restorative \udtreatment (ART) using high-viscosity glass ionomer \udcement has gradually become more popular because it \udperforms well in clinical studies, is easy to handle and \udis patient friendly. Therefore, the aim of this randomised \udclinical trial study is to compare the restoration longevity \udof conventional treatment using composite resin with that \udof ART in posterior primary teeth. As secondary outcomes, \udcost-efficacy and patient self-reported discomfort will also \udbe tested.\udMethods and analysis Children aged 3–6 years \udpresenting with at least one occlusal and/or occlusalproximal cavity will be randomly assigned to one of \udtwo groups according to the dental treatment: ART \ud(experimental group) or composite resin restoration \ud(control group). The dental treatment will be performed \udat a dental care trailer located in an educational complex \udin Barueri/SP, Brazil. The unit of randomisation will be the \udchild. A sample size of 240 teeth with occlusal cavities \udand 188 teeth with occlusal-proximal cavities has been \udcalculated. The primary outcome will be restoration \udlongevity, which will be clinically assessed after 6, 12, \ud18 and 24 months by two examiners. The duration of the \uddental treatment and the cost of all materials used will \udbe considered when estimating the cost-efficacy of each \udtreatment. Individual discomfort will be measured after \udeach dental procedure using the Facial Scale of WongBaker.\udEthics and dissemination This clinical trial was \udapproved by the local ethics committee from the \udFaculty of Dentistry of the University of São Paulo \ud(registration no. 1.556.018). Participants will be \udincluded after their legal guardians have signed an \udinformed consent form containing detailed information \udabout the research.

Objective: To evaluate activities performed in an e-learning platform after 2-year of implementation in terms of contents and functionality. Material and Methods: E-learning courses were prepared and created by two lecturers. Contents were intended for last year undergraduate students attending the pediatric dentistry discipline, and included different topics considered as relevant to the area. Given tele-courses from 2010-2012 as well as statistics and contents, provided by the platform, were collected for analysis. Results: Five tele-courses were proposed and the total participation was 322 students (mean-per-course±SD=64.4±17.2). On average, 15 tutors/course accompanied the process. Caries lesion detection and fluoride therapy were discussed in all modules, but different activities were focused in various aspects. Other topics were also included: caries activity (60%), caries risk assessment, oral hygiene and clinical examination (40%). Two lecturers were responsible for preparing exercises and tutors helped in the creation, revision and correction. The main type of validation was open questions (83%). A High level of students’ access was observed during the 2-year-period (mean-per-course±SD=21372±6775,2). More than 32000 external visits of the topics were also seen. On average, 14 tutor/student feedbacks were sent per student in each tele-course. Conclusion: The use of an e-learning system has been used especially to complementing teaching in caries detection and management using fluorides. Tele-courses have been highly accessed by undergraduate students and also, external participants.

Purpose To evaluate the effect of 2 years of water aging on microtensile bond strength (μTBS) of an etch-and-rinse and a self-etch adhesive system to sound (S) and artificial caries-affected primary dentin (CAD). Methods Occlusal cavities were prepared in 24 primary molars. Half of the specimens were submitted to a pH-cycling model to simulate artificial caries-affected dentin. Teeth were randomly restored either with two-step etch-and-rinse adhesive Adper Single Bond 2 (SB) or two-step self-etch system Adper SE Plus (SE). After 24 h of storage, the teeth were sectioned into two halves. One half was sectioned into sticks (0.8 mm2) to be tested immediately under μTBS testing. The same procedure was performed in the other half after storage in distilled water for 2 years (2 y). Data were analyzed by three-way repeated measures ANOVA and Tukey tests (α=0.05). Results The μTBS values of both adhesive systems significantly decreased after 2 years aging (SB: S – 38.4%, CAD – 23.9%; SE: S – 17.1%, CAD – 15.7%) (p Conclusion The degradation of the resin-dentin bonds occurred after 2 years of water aging, regardless of the substrate condition or type of adhesive. However, the etch-and-rinse adhesive system is preferable due to the highest μTBS in both periods.

This study evaluated the effect of 2% chlorhexidine digluconate (CHX) on immediate and six-month bond strength (μTBS) and nanoleakage (NL) of an etch-and-rinse adhesive system to sound and caries-affected primary dentin. Flat dentin surfaces from 20 primary molars were assigned to according to substrate (sound dentin and caries-affected dentin — pH-cycling for 14 days) and treatment (control — C and CHX – 2% CHX for 60 s after acid etching). After adhesive (Adper Single Bond) application, composite buildups were constructed and sectioned to obtain bonded sticks (0.8 mm 2 ) to be subjected to microtensile testing immediately or after six-month of water aging. Two sticks from each tooth at each time were immersed in silver nitrate solution to assess nanoleakage (NL) qualitatively. The μTBS means were analyzed by three-way repeated measures ANOVA and Tukey׳s tests ( α =0.05). After six-month of water aging, significant reductions in μTBS values were observed only in C groups, irrespective of substrate. The values obtained to caries-affected dentin were lower compared with sound dentin. NL was more evident in C groups, mainly after six-month and was not influenced by substrate. Chlorhexidine prevents the bond degradation and reduces the nanoleakage of an etch-and-rinse adhesive system to sound and caries-affected primary dentin after six-month of water aging.

Purpose To evaluate the 2-year microtensile bond strength (μTBS) of different glass ionomer cements (GIC): high viscosity (HV), resin modified (RM) with and without nanoparticles to sound and caries-affected primary dentin. Method Thirty-six second primary molars were prepared and randomly divided into six groups (n=6) according to the combination of the main factors substrate (sound and caries-affected dentin) and GIC type (KetacTM Molar Easy Mix (KM-HV, 3M ESPE), Vitremer (VT–RM, 3M ESPE) and GIC with nanoparticles KetacTM Nano (KN-RM, 3M ESPE)). After storage for 24 h in distilled water at 37 °C, the teeth were sectioned into two halves. One half was further sectioned into beams with a cross sectional area of about 0.8 mm2 to be tested immediately under μTBS testing. The same procedure was performed in the other teeth halves after storage in distilled water for 2-year. The failure mode was assessed using stereomicroscope (400×). Data were subjected to three-way repeated measures ANOVA followed by the post-hoc Tukey's test (α=0.05). Results There was no statistical difference between sound and caries-affected dentin irrespective of the water storage time. After 2-year, only the VT-RM material showed stable bond strength values. Conclusion Water aging for 2-year does not jeopardize the bond strength of resin-modified GIC without nanoparticles to sound and caries-affected dentin of primary teeth.

PurposeTo evaluate the bond longevity of glass ionomer cement (GIC) to sound and artificially carious dentin, using a high viscosity material with regular consistency and using a flowable GIC, after one year water storage.Material and methodsSixty bovine incisors were polished to obtain flat buccal dentin. Thirty teeth were submitted to pH-cycling model to simulate artificial caries. Teeth from both dentin conditions (sound and caries) were randomly reassigned according to the powder/liquid ratio of the GIC (n=15): (1) regular (1:1) and (2) flowable GIC (1:2). Polyethylene tubes with internal diameter of 0.76 mm were placed over the pre-treated dentin and filled up with GIC (KetacTM Molar Easy Mix, 3M ESPE), immediately protected with a layer of petroleum jelly. Half of the specimens were evaluated by microshear bond strength test after 24 h, the other half was evaluated one year later, after water storage at 37 °C. Data (MPa) were analyzed with 3-way repeated measures ANOVA and Tukey׳s post-hoc tests (α=0.05).ResultsStatistical analysis revealed reduction of GIC bonding effectiveness after one year of water storage (5.4±1.4 to 3.4±1.3 MPa) (pConclusionsBoth powder/liquid ratio of GIC show similar reduction of bonding effectiveness after one year, especially in artificially carious dentin substrate.

This in vitro study evaluated the influence of two devices for application of shear load in microshear tests on bond strength and fracture pattern of primary enamel and dentin. Eighty primary molars were selected and flat enamel (40 teeth sectioned mesio-distally) and dentin (40 teeth sectioned transversally) surfaces were obtained. Both surfaces were polished to standardize the smear layer. Two-step etch-and-rinse adhesive systems (Adper Single Bond and XP Bond) were used. Polyethylene tubes was placed over the bonded surfaces and filled with composite resin. The microshear testing was performed after storage in water (24 h/37 °C) using two devices for application of microshear loads: a notched rod (Bisco Shear Bond Tester) or a knife edge (Kratos Industrial Equipment). Failure modes were evaluated using a stereomicroscope. Bond strength data were subjected to ANOVA and chi-square test to compare the failure mode distributions (α=0.05). No significant differences were observed between the groups for dentin and enamel bond strength or fracture patterns (p>0.05). The predominant failure mode was adhesive/mixed. In conclusion, the devices for application of shear loads did not influence the bond strength values, regardless of adhesive system and substrate. Este estudo in vitro avaliou a influência de dois dispositivos para aplicação de força de cisalhamento em testes de resistência de união ao microcisalhamento e no padrão de fratura em dentina e esmalte de dentes decíduos. Oitenta molares decíduos foram selecionados e superficies planas em esmalte (40 dentes seccionados no sentido mésio-distal) e dentina (40 dentes seccionados transversalmente) foram obtidas. Ambas as superficies foram abrasionadas para padronização da lama dentinária. Dois sistemas adesivos de condicionamento ácido prévio (Adper Single Bond e XP Bond) foram utilizados. Tubos de polietileno foram colocados sobre as superficies, nas quais já haviam sido aplicados os sistemas adesivos, e preenchidos com resina composta. O teste de resistência de união ao microcisalhamento foi realizado após armazenamento dos espécimes em água (24 h/37 °C) utilizando dois dispositivos para a aplicação das forças de cisalhamento: cisalha côncava (Bisco Shear Bond Tester) e cisalha plana (Kratos Industrial Equipment). O padrão de fratura foi avaliado usando estereomicroscópio. Os dados de resistência de união foram submetidos à ANOVA e o teste quiquadrado foi utilizado para comparar a distribuição dos padrões de fratura (α=0,05). Não foram observadas diferenças estatisticamente significantes entre os grupos, tanto para a resistência de união a dentina e esmalte quanto para o padrão de fratura (p>0,05). O modo de falha predominante foi adesiva/mista. Em conclusão, os dispositivos para aplicação de força de cisalhamento não influenciam os valores de resistência de união, independente do sistema adesivo e substrato.

Background The association of preoperative pain and indirect pulp treatment in permanent teeth is still unknown. This study aimed to evaluate the influence of preoperative pain in the success rate of indirect pulp capping. Methods The sample of this retrospective study was constituted for 133 teeth treated in a Private clinic in Joinvile, Brazil, by one experienced dentist between 2007 and 2012. Data related to clinical and demographic variables that could influence in the success rate of indirect pulp capping were also collected, such patient age and sex, type of teeth and arch. Chi‑square test was used to evaluate the association between preoperative pain with postoperative one and success of the treatment. Logistic regression was performed to identify significant clinical and demographical factors associated with the success of the indirect pulp capping. Results The overall success rate was 100% in the absence of preoperative pain. However, when the preoperative pain was present, the failure rate was 18.3%. Statistical analysis showed significant association between preoperative pain and postoperative one and failure rate of the indirect pulp capping. The other independent variables were not associated with the success rate of the treatment. Conclusions The presence of preoperative pain is associated with the decrease of the success rate of indirect pulp capping.

The aim of this study was to evaluate by scanning electron microscope (SEM) photomicrographs the influence of application of halogen light-curing for fastening the set reaction of high-viscosity glass ionomer cements (GIC) by assessing the material/dentin interface. Twelve human primary canines were assigned in four groups (n = 3) according to the GIC (Fuji IX, GC or Maxxion R, FGM) and application of halogen light-curing (60 sec or control-no external energy). Blocks with approximately 6 mm of height were buildup on previously pre-treated dentin surface in according to the experimental group. After storage at 37 °C, 100% humidity for 48 h, the specimens were then sectioned in slices with 1-mm thick. The slices were qualitative analyzed using SEM to evaluate possible structural changes. Two examiners independently evaluated the images in order to observe the spherical hollow spaces of each tooth. The photomicrographs revealed the presence of spherical hollow spaces in all experimental groups. However, in both groups that received halogen light-curing application, it was possible to observe that the presence of these hollow spaces decreased in size and quantity. It can be concluded that the halogen light-curing application positively decreases in size and quantity in the presence of spherical hollow spaces in GIC.

The aim of this in vitro study was to evaluate the pH effect of doxycycline solutions on the immediate dentin bond strength of a total-etch adhesive system. Twenty human molars were divided into 4 groups (n = 5) after acid etching according to surface treatment: 10% acidic doxycycline, 10% neutral doxycycline, 2% chlorhexidine, and control. Composite resin blocks were made and subjected to microtensile testing. Mean bond strength values were submitted to a 1-way analysis of variance and a Tukey test (α = 0.05). No statistically significant differences between the experimental groups were found (P = 0.093). The chlorhexidine group showed the highest number of pretesting failures. The application of either acidic or neutral doxycycline solution prior to the dentin adhesive did not influence the bond strength of the total-etch adhesive system evaluated.

Este estudo avaliou o efeito do desafio erosivo nas propriedades e na estabilidade de união de materiais restauradores ao esmalte e dentina decídua. Duzentos e quarenta molares decíduos foram alocados em 24 grupos, de acordo com substrato - esmalte ou dentina, condição prévia do substrato - hígido ou erodido, material restaurador - resina composta associada ao sistema adesivo - RC, cimento de ionômero de vidro de alta viscosidade - CIVAV, ou modificado por resina - CIVMR, e tratamento após procedimento adesivo - controle (imersão em solução salina/7dias) ou desafio erosivo (imersão em bebida a base de cola por 5 min/3x ao dia/7 dias). Os dentes dos grupos esmalte e dentina erodidos foram submetidos ao desafio erosivo previamente aos procedimentos restauradores. Cânulas de polietileno foram posicionadas sobre superfícies planas dos substratos pré-tratados, para então serem preenchidas por um dos materiais avaliados. Após armazenamento por 24h a 37°C, os espécimes foram submetidos a um dos tratamentos propostos. Metade dos espécimes foi submetida imediatamente ao teste de microcisalhamento e a outra metade após 12 meses de armazenamento em água a 37ºC. Posteriormente, a análise do padrão de fratura foi realizada em estereomicroscópio (400X). Para a análise de resistência à flexão (RF) e rugosidade superficial (RS), trinta corpos de prova foram confeccionados (10x2x1mm). Após armazenamento por 24h, a leitura inicial de RS de dez corpos de prova selecionados aleatoriamente foi obtida. Os corpos de prova foram então imersos em um dos tratamentos propostos - desafio erosivo ou solução salina, para então ser realizada a segunda leitura. Decorrido esta análise, os corpos de prova foram submetidos ao teste de RF (1mm/min). Os valores de resistência de união (RU), bem como de RS e RF obtidos foram submetidos a Análise de Variância e Teste de Tukey (?=5%). Análise de Weibull foi também conduzida considerando os valores de RF. De forma geral, os substratos hígidos resultaram em maiores valores de RU do que os erodidos, com exceção do CIVAV que obteve desempenho similar em ambos substratos. Além disso, o tempo influenciou negativamente a RU somente para os grupos de RC quando da avaliação em dentina. Os demais grupos não apresentaram redução nos valores após 12 meses de armazenamento em água. RC apresentou melhor desempenho adesivo do que os demais materiais avaliados, tanto em 24 horas quanto após 12 meses. O desafio erosivo após o procedimento adesivo apenas influenciou negativamente a RU quando os materiais foram avaliados em dentina erodida. Em relação a RS, menores valores foram obtidos para RC. Além disso, o desafio erosivo influenciou os valores de leitura final, resultando em maior RS para todos os materiais restauradores. Já para a RF, RC demonstrou maiores valores de RF, módulo de Weibull e resistência característica do que os demais materiais. Ademais, o desafio erosivo não afetou estes parâmetros. Em conclusão, o desafio erosivo influencia negativamente a RS e RU a dentina erodida. Os substratos previamente erodidos resultam em pior desempenho da RC e CIVMR. Além disso, o armazenamento em água afeta a estabilidade de união a dentina de RC. This study evaluated the effect of erosive challenge on the properties and bond stability of restorative materials to primary enamel and dentin. Two hundred and forty primary molars were assigned into 24 groups, in according to the substrate - enamel or dentin, the precondition of substrate - sound or eroded, the restorative material - resin composite associated to adhesive system - RC, high-viscous glass ionomer cement- HVGIC or resin-modified glass ionomer cement - RMGIC, e the treatment after restorative procedure - control (immersion in saline solution/7 days) or erosive challenge (immersion in cola-based drink for 5 min/3x per day/7 days). Teeth from the eroded dentin and enamel groups were subjected to erosive challenge prior to bonding procedures. Polyethylene tubes were placed on flat surfaces of the pretreated substrates, and then were filled up with one of evaluated materials. After storage for 24h at 37ºC, the specimens were submitted to one of the proposed treatments. Half of the specimens were immediately submitted to the microshear bond strength test, and the other half after 12 months of water storage at 37ºC. Subsequently, the failures pattern evaluation was performed in stereomicroscopy (400X). For the assessment of flexural strength (FS) and superficial roughness (SR), thirty specimens were built up (10x2x1mm). After storage for 24h, the first reading of SR from ten specimens randomly selected was obtained. Specimens were immersed in one of proposed treatments - erosive challenge or saline solution, to then be performed the second reading. After this assessment, specimens were submitted to FS (1mm/min). The bond strength (BS) values, as well as SR and FS obtained were submitted to analysis of variance and Tukey\'s test (?=5%). Weibull analysis was also performed considering the FS values. Generally, the sound substrates resulted in higher BS values than eroded ones, with exception of the HVGIC that obtained similar performance in both substrates. Furthermore, the storage time negatively influenced the BS values for the RC groups on dentin assessment. The other groups did not show reduction in BS values after 12 months of water storage. RC showed better bonding performance than others evaluated materials, in both at 24 hours as for 12 months at 37ºC. Erosive challenge after bonding procedure only negatively influenced the BS values when the materials were evaluated in eroded dentin. In relation to SR, lower values were obtained to RC. Moreover, erosive challenge affected the second reading, resulting in increased SR for all restorative materials. For FS, RC showed higher values of FS, Weibull modulus and characteristic strength than other materials. Furthermore, immersion in erosive challenge did not affect these parameters. In conclusion, erosive challenge negatively influences SR and BS to eroded dentin. Previously eroded substrate result in the worst performance of RC and RMGIC. Moreover, the water storage affects the bonding stability of RC to dentin.

The aim of this study was to evaluate microshear bond strength (μSBS), water sorption and solubility of glass ionomer cements (GIC) indicated for atraumatic restorative treatment (ART). Cylindrical specimens (6x2.4 mm) were used to test the sorption and solubility of each GIC (n = 5). The specimens were weighed before and after immersion in water and desiccation. For the μSBS test, 60 primary molars were ground to obtain flat surfaces from both enamel and dentin. The teeth were then assigned to the tested GIC (n = 10) groups, namely Fuji IX - FIX, Ketac Molar - KM and Maxxion R – MX. The exposed surfaces were pre-treated with GIC liquid. Polyethylene tubes were placed on the pre-treated surface and filled with one of the GIC. After 24 h, the specimens were submitted to the μSBS test. The failure mode was assessed using a stereomicroscope (400x magnification). The powder to liquid ratio and cost of material were also determined (n = 3). The data were analyzed by ANOVA and Tukey's post hoc test. Linear regression was used to determine the relation between cost and the other variables. Overall, MX showed lower μSBS values (enamel: 3.93 ± 0.38; dentin: 5.04 ± 0.70) than FIX (enamel: 5.95 ± 0.85; dentin: 7.01 ± 1.06) and KM (enamel: 5.91 ± 0.78; dentin: 6.88 ± 1.35), as well as higher sorption and solubility. The regression analyses showed a significant and positive correlation between cost and μSBS in enamel (R2 = 0.62; p < 0.001) and dentin (R2 = 0.43; p < 0.001); and a negative correlation between cost and water sorption (R2 = 0.93; p < 0.001) and solubility (R2 = 0.79; p < 0.001). In conclusion, the materials indicated for ART exhibit distinct physical and mechanical properties; in addition, low-priced materials may interfere with GIC properties.

AIM: To evaluate in vitro the erosive effects of beverages in the presence or absence of caries simulation (acidogenic challenge) on the microhardness of primary enamel. METHODS: Forty human primary teeth were submitted to the erosive effects: 3×20-min-long daily immersion in fresh orange juice (orange group), strawberry yogurt drink (yog group), or cola soft drink (cola group) separately or in combination with acidogenic challenge (pH cycling for 10 days). Specimens were also submitted to acidogenic challenge alone, and in the negative control group specimens were not submitted to any treatment. Mineral loss was evaluated by cross-sectional microhardness determination. The data (Knoop hardness numbers, KHN) were subjected to 2-way analysis of variance and Tukey’s post hoc test (α = 0.05%). RESULTS: All the test beverages significantly reduced the sample cross-sectional enamel hardness (KHN ± SD, 235.93 ± 18.15, 257.23 ± 21.79, and 253.23 ± 13.86 in the orange, yog, and cola groups, espectively) compared to samples in the negative control group (290.27 ± 3.92). In vitro acidogenic challenge exacerbated the mineral loss induced by all beverages (166.02 ± 4.28,190.43 ± 17.55, and 198.39 ± 21.39 in the orange, yog, and cola groups combined to acidogenic challenge, respectively) compared to acidogenic challenge alone. CONCLUSIONS: All beverages exhibited erosive effects on primary enamel. Simulated caries challenge considerably exacerbated the enamel softening of primary teeth.

Aim To systematically review the literature for in vitro studies that evaluated the immediate or after ageing bond strength of etch-and-rinse and self-etch adhesive systems to enamel and dentin of primary teeth. Design The search was conducted in PubMed/MEDLINE, Cochrane, SciELO, Lilacs, and Scopus databases with no publication year or language limits, following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. From 459 potentially eligible studies, 39 were selected for full-text analysis, and 5 were identified in reference lists, with 36 considered in the meta-analysis. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Pooling bond strength data was calculated using random effects analysis method, comparing two categories of adhesives (etch-and-rinse versus self-etch systems) when applied in different types and conditions of substrate (α = 0.05). Results No statistical significant difference in bond strength between both categories was observed in caries-affected dentin at immediate evaluation and in sound dentin after ageing. Etch-and-rinse adhesives, however, performed better in sound enamel and dentin substrates considering immediate bond strength. None study assessed the long-term adhesive effectiveness to sound or demineralized enamel. Conclusion Although the articles included in this meta-analysis showed high heterogeneity and high risk of bias, the in vitro literature suggests superior performance of etch-and-rinse adhesives in primary teeth in comparison with self-etch systems.

Made available in DSpace on 2015-10-21T13:10:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-07-11. Added 1 bitstream(s) on 2015-10-22T09:53:02Z : No. of bitstreams: 1 WOS000357714400002.pdf: 402357 bytes, checksum: 6470b3cb384b7e3a347ff6c1967382b3 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background: To investigate the influence of chemical and microbiological methods of caries induction on bond degradation of adhesive systems to primary dentin.Methods: Flat dentin surfaces from 36 primary molars were assigned to three groups (n = 12) according to method to induce caries-affected dentin: (1) control (sound dentin); (2) pH-cycling; and (3) microbiological caries induction model. Teeth were submitted to caries induction for 14 days for both methods, and the sound dentin was stored in distilled water during the same period. Specimens from each experimental group were then randomly reassigned to two subgroups (n = 6) according to the adhesive system tested: two-step etch-and-rinse adhesive (Adper Single Bond 2 - SB) or two-step self-etch system (Clearfil SE Bond - CSEB). Composite buildups were constructed and sectioned to obtain bonded sticks to be subjected to microtensile (mu TBS) testing immediately or after 12 months of water aging. The mu TBS means were analyzed by three-way repeated measures ANOVA and Tukey's tests (alpha = 0.05).Results: The mu TBS values obtained to artificially-created caries-affected dentin were lower compared with sound dentin, but were not affected by method of caries induction. Water storage for 12 months reduced bond strengths, except to CSEB bonded to sound dentin.Conclusion: Chemical and microbiological methods affect similarly the stability of resin-dentin bonds in primary teeth. Universidade de São Paulo, Departamento de Odontopediatria, Faculdade de Odontologia Universidade Estadual Paulista, Departamento de Clínica Infantil, Faculdade de Odontologia de Araraquara FAPESP: 2009/16579-0