Manejo de cárie radicular: um guia para o dentista brasileiro baseado na tradução e adaptação cultural do consenso internacional/ORCA E EFCD / Management of root caries: a guide for the Brazilian dentist based on the translation and cultural adaptation of the international consensus/ORCA and EFCD

Objetivo: A cárie radicular é um problema da Odontologia moderna, porém é notável a falta de diretrizes sobre o seu manejo. Objetivamos elaborar e adaptar um guia a partir da tradução das recomendações do consenso in-ternacional European Organization for Caries Research (ORCA) e European Federation of Conservative Dentistry (EFCD) para as tomadas de decisão clínica na intervenção do processo de cárie na pessoa idosa, com foco na cárie radicular. Materiais e métodos: O protocolo de tradução das recomendações do consenso internacional consistiu nas etapas: (1) tradução inicial, (2) síntese da tradução, (3) retradução, (4) revisão por comitê de especialistas, com adaptação cultural. A partir da tradução, foi desenvolvido um guia com diretrizes para tratamento de cárie radicular no Brasil. Resultados: Para prevenção de novas lesões é recomendada a escovação diária com dentifrício >1.500ppm/F. Dentifrícios com 5.000ppm/F ou vernizes (>20.000ppm/F) podem ser indicados para paralisar lesões radiculares ativas e para prevenção em pessoas idosas com alta suscetibilidade à cárie radicular, e o Diamino Fluoreto de Prata (>30%) para paralisar lesões ativas. Intervenções invasi-vas diretas são indicadas dependendo da situação clínica. Discussão: Nota-se uma falta de interesse em estudos primários sobre tratamentos para cárie radicular, criando assim uma lacuna em relação ao seu manejo, que reflete no nível de evidência detectado pelo consenso. Conclusão: Guias clíni-cos são importantes para reduzir a lacuna entre a pesquisa e a prática clínica. Essa tradução para o português facilitará o acesso dos dentistas bra-sileiros em relação a evidência consolidada até o momento para o manejo de cárie radicular.

Aim: Root caries are a problem in modern dentistry, but the lack of guidelines regarding their management is notable. We aim to develop and adapt a guide based on the translation of the recommendations of the international consensus as outlined by the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) for clinical decision-making in the intervention of the caries process in the elderly, with a focus on root caries. Materials and methods: The protocol for translating the recommendations of the international consensus consisted of the following steps: (1) initial translation, (2) synthesis of the translation, (3) back-translation, (4) review by an expert committee with cultural adaptation. Based on the translation, a guide was developed with guidelines for the treatment of root caries in Brazil. Results: To prevent new lesions, daily brushing with toothpaste >1,500ppm/F is recommended. Toothpaste with 5,000ppm/F or varnishes (>20,000ppm/F) may be recommended to paralyze active root lesions and for prevention in elderly people with high susceptibility to root caries, and Silver Diamine Fluoride (>30%) to paralyze active lesions. Direct invasive interventions are indicated depending on the clinical situation. Discussion: There is a lack of interest in primary studies on treatments for root caries, thus creating a gap in relation to its management, which is reflected by the level of evidence detected in the consensus. Conclusion: Clinical guidelines are important to reduce the gap between research and clinical practice. This translation into Portuguese will facilitate access by Brazilian dentists to the consolidated evidence gathered to date for the management of root caries.

Traumatic dental injuries in the primary dentition and sequelae in the permanent dentition: a 7-year retrospective study / Lesões dentárias traumáticas na dentição decídua e sequelas na dentição permanente: um estudo retrospectivo de 7 anos

Objective: Traumatic dental injuries (TDIs) affect the aesthetics and function of primary teeth and can cause sequelae in their permanent successors. This study assessed the distribution of TDIs and sequelae in the primary dentition and the respective permanent dentition in children treated at the Dental Trauma Centre in Brazil. Material and Methods: This cross-sectional study was conducted by collecting data from 256 dental records over 7 years. Descriptive statistical analyses and the Fisher exact test were used (p=0.05). Results: Sixty-two patients presented with trauma in the deciduous teeth. TDIs were observed mostly in boys (64.50%) and in the 2 to 4-year age group (44.10%); most injuries occurred from fall from the child's own height (40.30%) and at home (71.20%). The most common type of trauma was subluxation (22.90%). The most prevalent clinical and radiographic sequelae were mobility (45.60%) and periapical lesion (31.80%), respectively. Regarding the permanent dentition, the most frequent sequela was hypomineralization (33.30%). Conclusion:According to this study, TDIs in deciduous teeth made up 29.24% of all the cases in the Dental Trauma Program. The major type of trauma in children was subluxation, with sequelae in both dentitions. Follow-up after trauma is important to the maintenance of primary dentition and to prevent and treat possible sequelae in the permanent dentition.(AU)

Objetivo: Lesões dentárias traumáticas (TDIs) afetam a estética e a função dos dentes decíduos e podem causar sequelas em sucessores permanentes. Este estudo avaliou a distribuição das TDIs e sequelas na dentição decídua e sua respectiva dentição permanente em crianças atendidas no Centro de Trauma Odontológico no Brasil. Material e Métodos: Trata-se de um estudo transversal realizado por meio da coleta de dados de 256 prontuários odontológicos ao longo de 7 anos. Foram utilizadas análises estatísticas descritivas e teste exato de Fisher (p <0,05). Resultados:Sessenta e dois pacientes apresentaram trauma na dentição decídua. As TDIs foram observadas principalmente em meninos (64,50%) e na faixa etária de 2 a 4 anos (44,10%); a maioria das lesões ocorreu por queda da própria altura (40,30%) e em casa (71,20%). O tipo de trauma mais comum foi a subluxação (22,90%). As sequelas clínicas e radiográficas mais prevalentes foram mobilidade (45,60%) e lesão periapical (31,80%), respectivamente. Em relação à dentição permanente, a sequela mais frequente foi a hipomineralização (33,30%). Conclusão: De acordo com este estudo, as TDIs em dentes decíduos foram de 29,24% de todos os casos do Programa de Trauma Dental. O principal tipo de trauma em crianças foi a subluxação, com sequelas em ambas as dentições. O acompanhamento após o trauma é importante para a manutenção da dentição decídua e para prevenir e tratar possíveis sequelas na dentição permanente. (AU)

Impact of dental treatment and the severity of traumatic dental injuries on the quality of life of Brazilian schoolchildren.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are most prevalent during adolescence and infancy, and they have an important impact on the oral health-related quality of life (OHRQoL). The aim of this study was to assess the effect of dental treatment and the severity of TDI on the OHRQoL of schoolchildren in public schools in Brazil. MATERIALS AND METHODS: This cross-sectional study evaluated schoolchildren aged 11 to 14 years in Brasilia, Brazil. The criteria used for the examinations were TDI-O'Brien criteria; Dental caries-DMFT criteria; and malocclusion-the Dental Aesthetic Index. The impact of oral health on the children's quality of life was assessed with the Child Perceptions Questionnaire (CPQ11-14 ) that was completed by the children while on the school premises. Socio-demographic information was also collected from the parents. Statistical analysis was performed using non-parametric and association tests, as well as linear regression. RESULTS: A total of 20.2% of the students had some TDI in their permanent anterior teeth; 20% of traumatized teeth were treated, and 80% were not treated. Sorting by severity, 75.1% of the schoolchildren had a TDI involving only the enamel, and 24.9% had a TDI extending beyond the enamel. Significant differences were observed between the severity of a TDI and the total scores of CPQ11-14 (Kruskal-Wallis; p = 0.0026), emotional well-being (p = 0.0006), and social well-being (p = 0.0001) when the group with TDI extending beyond the enamel was compared with the other groups (control and with TDI involving only the enamel), even after adjustment for socio-demographic and clinical variables. For oral symptoms and functional limitation, no differences were observed among the groups. CONCLUSIONS: Dental trauma and fractures extending beyond the enamel, treated or not, have a negative impact on the OHRQoL of schoolchildren, suggesting effects on self-perception and in the social and emotional spheres.

Restorations after selective caries removal: 5-Year randomized trial.

OBJECTIVE: To compare the survival of restorations placed in deep caries lesions after selective caries removal to soft dentin (SCRSD) over a 5-year period. A secondary aim was to investigate whether the material (amalgam or resin composite) affected the survival of restorations. METHODS: This study used data derived from a multicenter randomized controlled clinical trial (Clinical trials registration NCT00887952). Inclusion criteria were: patients with permanent molars presenting occlusal or proximal deep caries lesions (≥1/2 of the dentin thickness on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions. The teeth were randomized into SCRSD and restoration in a single visit or stepwise excavation (SW). Each of these groups was divided according to the filling material: amalgam (AM) or resin composite (RC). Survival analyses were performed to estimate therapy success rates over 5 years (adjusted Weibull regression model). RESULTS: 172 restorations were evaluated, 95 from SCRSD group and 77 from SW group, being 61 AMG and 111 RC. The 5-year survival analysis showed similar success rates for SW (76 %) and SCRSD (79 %) as well as for AM and RC (p > 0.05). CONCLUSION: This study showed that, after a 5-year follow-up period, the presence of decayed tissue beneath restorations in deep caries lesions did not seem to affect restoration survival. Amalgam and resin composite restorations had similar survival rates, irrespective of the caries removal technique used - SCRSD or SW. CLINICAL SIGNIFICANCE: Selective caries removal to soft dentin can be used in the management of deep caries to avoid pulp exposure and preserve tooth structure without affecting restoration longevity.

Reattachment of fractured teeth using a multimode adhesive: Effect of different rewetting solutions and immersion time.

BACKGROUND/AIMS: Following coronal tooth fracture, keeping the fragment hydrated is of the utmost importance in the tooth fragment bonding technique. The aim of this study was to evaluate the effects of different immersion times in different storage media on multimode adhesive bonding between reattached fragments and teeth. MATERIALS AND METHODS: A total of 195 bovine incisors were fractured and randomized into the following storage groups (n = 15): G0-control group (sound tooth); GA-saline solution: for 1 hour (A1) or 24 hours (A2); GB-artificial saliva: for 1 hour (B1) or 24 hours (B2); GC-coconut water: for 1 hour (C1) or 24 hours (C2); GD-tap water: for 1 hour (D1) or 24 hours (D2); GE-milk: for 1 hour (E1) or 24 hours (E2); GF-dry (dehydration): for 1 hour (F1) or 24 hours (F2). Tooth fragments were then reattached using a multimode adhesive in a self-mode technique with a flowable resin composite. Fracture resistance was evaluated in a universal testing machine under a compressive load (1 mm/min). The data were submitted to two-way analysis of variance and the post hoc Tukey test (5%). RESULTS: The group submitted to the dehydration factor (GF) exhibited a mean value of 599.1 ± 144.2 N, while those submitted to all hydration protocols (GA, GB, GC, GD, GE) exhibited a mean value of 751.8 ± 285.4 N. Dehydration significantly affected the fracture strength values (P = .005). No significant interaction between the rewetting solutions was observed (P > .05). CONCLUSIONS: Hydration of the tooth fragment increased fracture resistance, regardless of the storage solution and/or immersion time.

In vitro tooth reattachment techniques: A systematic review.

BACKGROUND/AIMS: Fragment reattachment is a procedure that offers advantages, such as preservation of tooth structure and maintenance of color, shape, and translucency of the original tooth. The aim of this study was to analyze the reattachment techniques used to restore anterior teeth fractured by trauma. MATERIALS AND METHODS: The PubMed, LILACS, Web of Science, Cochrane, and Scopus databases were searched in October 2016, and the search was updated in February 2017. A search of the gray literature was performed in Google Scholar and OpenGrey. Reference lists of eligible studies were evaluated to identify additional studies. Two authors assessed studies for inclusion and extracted the data. In vitro studies that evaluated permanent human teeth fractured by trauma were included. RESULTS: Twenty-one studies remained after screening. The bond strength between the fragment and the crown was evaluated in 119 experimental groups. Ten different techniques were evaluated as follows: no preparation, chamfer, bevel, anchors, overcontour, internal groove, no preparation associated with chamfer after reattachment, fragment dentin removal associated with chamfer after reattachment, bevel associated with overcontour, and groove associated with shoulder. Five different materials were used to reattach the fragment: bonding system, luting composite resin, flowable composite, microhybrid composite, and nanocomposite. CONCLUSION: Fragment reattachment using a technique with no preparation and an adhesive system associated with an intermediate composite with good mechanical properties can restore part of the resistance of the fractured tooth.

Prevalence of dental trauma in disabled persons seen at the dental clinic for special-needs patients of the Catholic University of Brasília (UCB) / Prevalência de traumatismo dentário em pacientes com deficiência atendidos na clínica de pacientes especiais da Universidade Católica de Brasília (UCB)

Introduction: In Brazil, dental trauma (DT) is considered a public health problem. However, few studies in the literature report the prevalence of DT in disabled persons (DP). Objective: The aim of this study was to assess the prevalence of DT among DP seen at the Dental Clinic for Special-Needs Patients (COPE) of the Catholic University of Brasília. Material and method: A retrospective, descriptive study analyzing 73 medical charts of DP seen at the COPE between 2014 and 2016 was conducted. Clinical and sociodemographic data were collected. The t-test was used to check for significant differences between the categories of the variables analyzed. The Statistical Package for Social Sciences (SPSS), version 23.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses (p < 0.05). Result: A DT prevalence of 33/73 (45.2%) was found among DP. The predominant type of fracture was crown fracture (26/33-78.8%). The majority of patients were over 20 years old (63/73 - 86.3%), at a proportion significantly higher than those for the other age categories (p < 0.008). The patients in the sample had a variety of diseases, predominantly in the following categories: mental (22/73- 30.1%), multiple (19/73-26%), and systemic (14/73-19.2%). Conclusion: A high prevalence of DT was found in DP, with the majority of cases being related to mental and multiple diseases. Further research is needed to assess the prevalence of DT in this patient group throughout the Federal District.

Introdução: No Brasil, o traumatismo dentário (TD) é considerado um problema de saúde pública. No entanto, poucos estudos na literatura relatam a prevalência de TD em pessoas com deficiência (PD). Objetivo: O objetivo deste trabalho foi avaliar a prevalência de TD em PD atendidas na Clínica de Pacientes Especiais da Universidade Católica de Brasília (COPE). Material e método: Este estudo seguiu um delineamento descritivo e retrospectivo, e foi realizado por meio da análise de 73 prontuários de PD atendidas na COPE entre 2014 e 2016. Foram coletados dados sociodemográficos e clínicos. O teste t foi utilizado entre as proporções para determinar se houve diferenças significativas entre as categorias das variáveis analisadas. O programa "Statistical Package for Social Sciences" (SPSS), versão 23.0 (IBM Corporation, Armonk, NY, EUA) foi utilizado nas análises (p<0,05). Resultado: Encontrou-se uma prevalência de TD de 33/73 (45,2%) entre os PD. A fratura predominante foi a do tipo coronária, com uma frequência de 26/33 (78,8%). A maioria dos pacientes tinha acima de 20 anos, com uma frequência de 63/73 (86,3%), significativamente maior do que as frequências das outras categorias (p < 0,008). Os pacientes da amostra apresentavam doenças variadas, sendo as mais prevalentes as das categorias mental, com frequência de 22/73 (30,1%), múltipla com 19/73 (26%), e sistêmica com 14/73 (19,2%). Conclusão: Foi encontrada uma alta prevalência de TD em PD, sendo a maioria dos casos relacionados a doenças mentais e múltiplas. Futuras pesquisas são necessárias para avaliar a prevalência de TD nesse grupo de pacientes em todo o Distrito Federal.

Remote diagnosis of traumatic dental injuries using digital photographs captured via a mobile phone.

BACKGROUND: Intra-oral photographs have been aided diagnosis of several pathologies in teledentistry. Mobile phone cameras may produce high-quality photographs, presenting itself as a viable tool for remote diagnosis of traumatic dental injuries. AIM: To evaluate the levels of interexaminer agreement in cases of traumatic dental injuries when comparing diagnoses conducted in person and remotely. MATERIAL AND METHODS: The sample included 40 patients with 73 traumatized teeth, and a total of 90 diagnoses, who had presented to two dental clinics, one private, and the other public, in Brazil's Federal District. The dental history and clinical examination data were registered in electronic forms, and digital photographs were captured with a mobile phone camera and uploaded to a cloud drive. Six remote examiners formulated their diagnoses based solely on photographic analysis. Thereafter, they were provided with additional clinical data and asked to provide a second round of diagnoses. These diagnoses were compared to those conducted in person, which were considered the gold standard. The data were analyzed with Gwet's AC1 interexaminers' measure to evaluate the agreement between the in-surgery and remote diagnoses. RESULTS: The levels of interexaminer agreement between the in-surgery and remote diagnoses formulated exclusively with images were 0.83 or higher (95% confidence interval: 0.73-0.91), and 0.93 or higher (95% confidence interval: 0.88-0.97), when clinical information was available. CONCLUSION: The precision of the remote diagnoses was comparable to the diagnoses conducted in person. The levels of interexaminer agreement were higher when clinical data were included with the images. Mobile phones may be an effective tool for capturing images that assist in the remote diagnosis of traumatic dental injuries.

Bonding to dentin as a function of air-stream temperatures for solvent evaporation

This study evaluated the influence of solvent evaporation conditions of acid-etching adhesives. The medium dentin of thirty extracted human third molars was exposed and bonded to different types of etch-and-rinse adhesives: 1) Scotchbond Multi-Purpose (SBMP) ; water-based; 2) Adper Single Bond 2 (SB) ; ethanol/water-based, and 3) Prime & Bond 2.1 (PB) ; acetone-based. Solvents were evaporated at air-drying temperatures of 21ºC or 38ºC. Composite buildups were incrementally constructed. After storage in water for 24 h at 37ºC, the specimens were prepared for bond strength testing. Data were analyzed by two-way ANOVA and Tukey's test (5%). SBMP performed better when the solvents were evaporated at a higher temperature (p < 0.05). Higher temperatures did not affect the performance of SB or PB. Bond strength at room temperature was material-dependent, and air-drying temperatures affected bonding of the water-based, acid-etching adhesive.

Bonding to dentin as a function of air-stream temperatures for solvent evaporation.

This study evaluated the influence of solvent evaporation conditions of acid-etching adhesives. The medium dentin of thirty extracted human third molars was exposed and bonded to different types of etch-and-rinse adhesives: 1) Scotchbond Multi-Purpose (SBMP) ; water-based; 2) Adper Single Bond 2 (SB) ; ethanol/water-based, and 3) Prime & Bond 2.1 (PB) ; acetone-based. Solvents were evaporated at air-drying temperatures of 21ºC or 38ºC. Composite buildups were incrementally constructed. After storage in water for 24 h at 37ºC, the specimens were prepared for bond strength testing. Data were analyzed by two-way ANOVA and Tukey's test (5%). SBMP performed better when the solvents were evaporated at a higher temperature (p < 0.05). Higher temperatures did not affect the performance of SB or PB. Bond strength at room temperature was material-dependent, and air-drying temperatures affected bonding of the water-based, acid-etching adhesive.

Effectiveness of immediate bonding of etch-and-rinse adhesives to simplified ethanol-saturated dentin.

This study examined the immediate bond strength of etch-and-rinse adhesives to demineralized dentin saturated with either water or absolute ethanol. The research hypothesis was that there would be no difference in bond strength to dentin between water or ethanol wet-bonding techniques. The medium dentin of 20 third molars was exposed (n = 5). The dentin surface was then acid-etched, left moist and randomly assigned to be saturated via either water wet-bonding (WBT) or absolute ethanol wet-bonding (EBT). The specimens were then treated with one of the following etch-and-rinse adhesive systems: a 3-step, water-based system (Adper Scotchbond Multipurpose, or SBMP) or a 2-step, ethanol/water-based system (Adper Single Bond 2, or SB). Resin composite build-ups were then incrementally constructed. After water storage for 24 h at 37°C, the tensile strength of the specimens was tested in a universal testing machine (0.5 mm/min). Data were analyzed by two-way ANOVA and Tukey's test (a = 5%). The failure modes were verified using a stereomicroscope (40'). For both adhesives, no significant difference in bond strength was observed between WBT and EBT (p > 0.05). The highest bond strength was observed for SB, regardless of the bonding technique (p < 0.05). No significant interaction between adhesives and bonding techniques was noticed (p = 0.597). There was a predominance of adhesive failures for all tested groups. The EBT and WBT displayed similar immediate bond strength means for both adhesives. The SB adhesive exhibited higher means for all conditions tested. Further investigations are needed to evaluate long-term bonding to dentin mediated by commercial etch-and-rinse adhesives using the EBT approach.

Effectiveness of immediate bonding of etch-and-rinse adhesives to simplified ethanol-saturated dentin

This study examined the immediate bond strength of etch-and-rinse adhesives to demineralized dentin saturated with either water or absolute ethanol. The research hypothesis was that there would be no difference in bond strength to dentin between water or ethanol wet-bonding techniques. The medium dentin of 20 third molars was exposed (n = 5). The dentin surface was then acid-etched, left moist and randomly assigned to be saturated via either water wet-bonding (WBT) or absolute ethanol wet-bonding (EBT). The specimens were then treated with one of the following etch-and-rinse adhesive systems: a 3-step, water-based system (Adper Scotchbond Multipurpose, or SBMP) or a 2-step, ethanol/water-based system (Adper Single Bond 2, or SB). Resin composite build-ups were then incrementally constructed. After water storage for 24 h at 37°C, the tensile strength of the specimens was tested in a universal testing machine (0.5 mm/min). Data were analyzed by two-way ANOVA and Tukey's test (a = 5%). The failure modes were verified using a stereomicroscope (40'). For both adhesives, no significant difference in bond strength was observed between WBT and EBT (p > 0.05). The highest bond strength was observed for SB, regardless of the bonding technique (p < 0.05). No significant interaction between adhesives and bonding techniques was noticed (p = 0.597). There was a predominance of adhesive failures for all tested groups. The EBT and WBT displayed similar immediate bond strength means for both adhesives. The SB adhesive exhibited higher means for all conditions tested. Further investigations are needed to evaluate long-term bonding to dentin mediated by commercial etch-and-rinse adhesives using the EBT approach.

Evidências e perspectivas das fontes de luz LED na fotoativação de materiais resinosos / Evidences and perspectives of the LED sources in the photocuring of resinous materials

A qualidade da luz emitida pela unidade fotopolimerizadora é fator primordial para uma maior longevidade clínica das restaurações adesivas. Neste contexto, os aparelhos à base de LED (Luz Emitida por Diodo) aparecem como uma nova opção dentre os diversos sistemas de polimerização disponíveis atualmente. Apesar da falta de homogeneidade nas conclusões obtidas quanto a sua viabilidade na cura de materiais fotossensíveis, há evidências científicas que o caracterizam como uma alternativa promissora para a efetivação da polimerização. Desta maneira, propõe-se neste estudo elucidar características concernentes ao LED, ressaltando-se as limitações, vantagens e possíveis controvérsias provenientes do seu uso, por intermédio de análise bibliográfica e interpretação dos resultados obtidos na literatura consultada.

The clinical performance of light polymerized dental composites is greatly influenced by the quality of the light curing unit used. A recent number of studies proposes and demonstrates the use of LED (Light Emitting Diodes) as an alternative source for curing resins. However, its effectiveness is still unclear and controversial. The present review investigated evidence for application of blue LED technology on cure dental materials.

Recuperação estética do sorriso através de colagem autógena de fragmento dentário e restauração com resina composta: caso clínico / Smile recovery through esthetic rehabilitation treatment with autogenous fragment bonding and composite resins restoration: a clinical case

Os autores relatam, por meio de um caso clínico, o tratamento preconizado para a recuperação do sorriso de um paciente jovem, comprometido por fratura coronária oblíqua envolvendo o terço médio e incisivo-mesial do incisivo central superior esquerdo, e incisivo central superior direito, associado a esmalte hipoplásico, manchado e com presença de cárie. Os dentes comprometidos, estética e funcionalmente, foram tratados através da técnica de colagem autógena de fragmento dentário e restauração adesiva direta com resina composta. O plano de tratamento e os procedimentos operatórios estão descritos a seguir