Métodos químico-mecânicos para a remoção do tecido cariado / Chemical-mechanical methods for the removal of caries

Há algumas décadas, o tratamento da cárie preconizava a remoção dos tecidos cariados baseados em princípios de extensão para prevenção por meio de instrumentos rotatórios de corte e desgaste. Atualmente, novos materiais foram introduzidos no mercado com a utilização de produtos a base de aminoácidos com hidróxido de sódio ou papaína, os quais são indicados para remoção química - mecânica da cárie sem a necessidade de anestesia e equipamentos rotatórios. Esses materiais possibilitam preparos ultraconservadores. Portanto, o objetivo deste trabalho foi discutir, por meio de uma revisão de literatura, a efetividade dos métodos químico-mecânicos para remoção do tecido cariado.

Effect of monomer content in the monomer-polymer ratio on complete denture teeth displacement.

The purpose of the study was to verify the linear displacement of teeth in maxillary complete dentures influenced by different monomer-polymer ratios - according to the manufacturer's instructions, with 25% excess or 25% less monomer content - in the conventional and microwaved polymerization techniques. Wax base plates and wax planes were made on edentulous maxillary stone casts according to traditional method. The set was assembled in semi-adjustable articulator with a lower toothed stone cast as guide to mounting of the maxillary artificial teeth. Impressions were taken from this tooth arrangement with silicone and the mold was used to standardize the mounting of the teeth of all dentures. Referential points were made on the artificial teeth for linear measurements with optical microscope before processing of the dentures and after deflasking. Denture bases were conventionally packed with acrylic resin according to the monomer-polymer ratio protocol. Tooth displacement data were submitted to ANOVA and Tukey test (α=0.05). There were no statistically significant differences (p>0.05) between the group with monomer content recommended by the manufacturer and groups with 25% more and 25% less monomer, in both conventional and microwaved polymerizations. Excess or less monomer in the monomer-polymer ratio and polymerization types did not change the linear distance between teeth.

Effect of monomer content in the monomer-polymer ratio on complete denture teeth displacement

The purpose of the study was to verify the linear displacement of teeth in maxillary complete dentures influenced by different monomer-polymer ratios - according to the manufacturer's instructions, with 25 percent excess or 25 percent less monomer content - in the conventional and microwaved polymerization techniques. Wax base plates and wax planes were made on edentulous maxillary stone casts according to traditional method. The set was assembled in semi-adjustable articulator with a lower toothed stone cast as guide to mounting of the maxillary artificial teeth. Impressions were taken from this tooth arrangement with silicone and the mold was used to standardize the mounting of the teeth of all dentures. Referential points were made on the artificial teeth for linear measurements with optical microscope before processing of the dentures and after deflasking. Denture bases were conventionally packed with acrylic resin according to the monomer-polymer ratio protocol. Tooth displacement data were submitted to ANOVA and Tukey test (α=0.05). There were no statistically significant differences (p>0.05) between the group with monomer content recommended by the manufacturer and groups with 25 percent more and 25 percent less monomer, in both conventional and microwaved polymerizations. Excess or less monomer in the monomer-polymer ratio and polymerization types did not change the linear distance between teeth.

O propósito neste estudo foi verificar a movimentação linear de dentes em prótese total superior confeccionada com resina acrílica, proporcionada com conteúdo de monômero indicado pelo fabricante, com 25 por cento de excesso ou com 25 por cento a menos de monômero, nas técnicas de polimerização convencional e por microondas. Foram confeccionados 30 modelos, representando uma arcada maxilar desdentada com rebordo normal. As bases de prova e os planos de orientação foram confeccionados em cera e o conjunto montado em articulador semi-ajustável relacionado com um modelo inferior dentado. Depois da montagem dos dentes artificiais, a prótese foi moldada com silicone para duplicação das demais próteses. Foram confeccionados pontos referenciais para mensurações das distâncias entre os dentes, as quais foram analisadas com microscópio comparador linear antes e depois da desinclusão das próteses. As resinas acrílicas foram prensadas de modo convencional, alterando somente o conteúdo de monômero na proporção monômero-polímero recomendada pelo fabricante. Os dados da distância entre os dentes foram submetidos à análise de variância e ao teste de Tukey (5 por cento). Não houve diferença estatística entre os grupos com quantidade de monômero recomendada pelo fabricante e os grupos com 25 por cento a mais ou 25 por cento a menos de monômero, tanto na polimerização convencional como por microondas. A alteração do conteúdo de monômero e o tipo de polimerização (convencional ou por microondas) não exerceram influência na movimentação dental nas distâncias transversal e ântero-posterior.

[Oral condition, habits and treatment necessity of institutionalized elders in Araras (SP, Brazil)]. / Condição bucal, hábitos e necessidade de tratamento em idosos institucionalizados de Araras (SP, Brasil).

The aim of this study was to check the oral condition of the elderly citizens from the city of Araras (São Paulo, Brazil), and to evaluate treatment needs for this population. 118 volunteers were interviewed and 112 were examined, all of them with age above 60 years. The research was accomplished through a previous 14 question questionnaire that evaluated the patient general health, besides verified the self-knowledge of their oral health in addition to an intraoral physical exam, observing the oral conditions of the patients. In order to verify cavities prevalence, it was used an advocated criterion and index by WHO. It was observed that the systemic diseases that presented most prevalence were insomnia (40.67%), followed by visual disturbances (36.44%) and arthritis (33.05%). In relation to the self-knowledge of the volunteers as to their oral condition, it was noticed that 90.67% of the individuals thought that oral condition does not affect their quality of life. With the intraoral exam, it was obtained a DMF-T media equals to 30.6 with the lost component contributing to 93.9% of the cavities prevalence value (p = 28.7). This population requires special care focused on the oral health because besides having a high DMF-T, they also present inadequate oral health self-knowledge.

Condição bucal, hábitos e necessidade de tratamento em idosos institucionalizados de Araras (SP, Brasil) / Oral condition, habits and treatment necessity of institutionalized elders in Araras (SP, Brazil)

O objetivo deste trabalho foi verificar a condição bucal de idosos institucionalizados na cidade de Araras (SP) e também avaliar a necessidade de tratamento dessa população. Metodologia: foram entrevistados 118 voluntários e examinados 112 idosos institucionalizados, acima de 60 anos, em Araras. A pesquisa foi realizada através de um questionário prévio com 14 questões para avaliar a saúde geral do paciente, além de verificação da autopercepção de saúde bucal e de exame físico intraoral, observando as condições bucais dos pacientes. Para conhecer a prevalência de cárie dentária, foram utilizados critérios e índices preconizados pela Organização Mundial da Saúde (OMS). Resultados: observou-se que as doenças sistêmicas que apresentaram maior prevalência foram a insônia (40,67 por cento), seguida de distúrbios visuais (36,44 por cento) e artrite (33,05 por cento). Em relação à autopercepção dos voluntários quanto à sua condição bucal, notou-se que 90,67 por cento dos indivíduos acham que a condição bucal não afeta a sua qualidade de vida. Com o exame intraoral, obteve-se um CPO-D médio igual a 30,6 com o componente perdido contribuindo com 93,9 por cento do valor da prevalência de cárie (p= 28,7). Conclusão: essa população precisa de cuidados especiais voltados à saúde bucal, pois além de possuir um CPO-D alto apresenta autopercepção inadequada de saúde bucal.

The aim of this study was to check the oral condition of the elderly citizens from the city of Araras (São Paulo, Brazil), and to evaluate treatment needs for this population. 118 volunteers were interviewed and 112 were examined, all of them with age above 60 years. The research was accomplished through a previous 14 question questionnaire that evaluated the patient general health, besides verified the self-knowledge of their oral health in addition to an intraoral physical exam, observing the oral conditions of the patients. In order to verify cavities prevalence, it was used an advocated criterion and index by WHO. It was observed that the systemic diseases that presented most prevalence were insomnia (40,67 percent), followed by visual disturbances (36,44 percent) and arthritis (33,05 percent). In relation to the self-knowledge of the volunteers as to their oral condition, it was noticed that 90,67 percent of the individuals thought that oral condition does not affect their quality of life. With the intraoral exam, it was obtained a DMF-T media equals to 30,6 with the lost component contributing to 93,9 percent of the cavities prevalence value (p= 28,7). This population requires special care focused on the oral health because besides having a high DMF-T, they also present inadequate oral health self-knowledge.

Effect of a papain-based gel for chemomechanical caries removal on dentin shear bond strength.

PURPOSE: The aim of this study was to assess the shear bond strength of an adhesive restorative system on sound and demineralized dentin after the use of a papain-based agent. METHODS: Forty human dentin slabs were randomly distributed into 4 groups: (1) sound dentin slabs that received an application of papain-based gel (N=10); (2) sound dentin slabs that did not receive a papain-based gel application (N=10); (3) demineralized slabs that received an application of the agent (N=10); and (4) demineralized slabs that did not receive an application of the agent (N=10). After manual excavation and use of the chemomechanical agent, the slabs were restored with a total etch adhesive system and microhybrid resin composite. The test specimens were individually stored in a damp environment for 7 days, and the shear bond strength test was performed using a universal test machine at a speed of 0.5 mm/min. The fragments were observed under a stereoscopic microscope to assess the fracture mode. RESULTS: Fracture mode assessment showed adhesive and cohesive type fractures in resin for all the groups. The analysis of variance and the Tukey test showed that there were no differences in the shear bond strength means among the groups (P>.05). CONCLUSIONS: The use of a papain-based gel to remove dental caries did not interfere in the bond strength of restorative materials to dentin.