How different attributes are weighted in professionals' decision-making in Pediatric Dentistry-a protocol for guiding discrete choice experiment focused on shortening the evidence-based practice implementation for dental care.

BACKGROUND: Important evidence has been constantly produced and needs to be converted into practice. Professional consumption of such evidence may be a barrier to its implementation. Then, effective implementation of evidence-based interventions in clinical practice leans on the understanding of how professionals value attributes when choosing between options for dental care, permitting to guide this implementation process by maximizing strengthens and minimizing barriers related to that. METHODS: This is part of a broader project investigating the potential of incorporating scientific evidence into clinical practice and public policy recommendations and guidelines, identifying strengths and barriers in such an implementation process. The present research protocol comprises a Discrete Choice Experiment (DCE) from the Brazilian oral health professionals' perspective, aiming to assess how different factors are associated with professional decision-making in dental care, including the role of scientific evidence. Different choice sets will be developed, either focusing on understanding the role of scientific evidence in the professional decision-making process or on understanding specific attributes associated with different interventions recently tested in randomized clinical trials and available as newly produced scientific evidence to be used in clinical practice. DISCUSSION: Translating research into practice usually requires time and effort. Shortening this process may be useful for faster incorporation into clinical practice and beneficial to the population. Understanding the context and professionals' decision-making preferences is crucial to designing more effective implementation and/or educational initiatives. Ultimately, we expect to design an efficient implementation strategy that overcomes threats and potential opportunities identified during the DCEs, creating a customized structure for dental professionals. TRIAL REGISTRATION: https://osf.io/bhncv .

Prevalence of Bruxism in Children and Adolescents with Cerebral Palsy: Systematic Review and Meta-analysis.

AIMS: To perform a systematic review and meta-analysis compiling data on the prevalence of bruxism in children and adolescents with cerebral palsy. METHODS AND RESULTS: Searches were carried out in PubMed/Medline, Web of Science, and Scopus databases to identify the articles published by February 2023. Two independent reviewers, and in duplicate, employed a two-stage process to select publications. The same two reviewers performed the data extraction. Studies were included when the following eligibility criteria were met: performed in children and/or adolescents with cerebral palsy and reporting bruxism. Potentially eligible studies were read in full and excluded that: not presented numerical data on the prevalence of bruxism; not reported how the bruxism was assessed; not reported data about the cerebral palsy; and not an observational study. The risk assessment of bias was assessed by the Newcastle- Ottawa Scale. After reading the titles and abstracts of the 358 identified articles, eight articles from 1966 to 2020 were included. The main reason for not including the studies was not to report data about bruxism (59.3%), and 44.5% were excluded for not reporting data from patients with cerebral palsy. The studies were carried out in schools, university hospitals, or centers for patients with special needs (Brazil, the United States, and Egypt). The pooled prevalence of bruxism in children and adolescents with cerebral palsy was 46% (95%CI: 0.38-0.55) after removing one study. CONCLUSION: The pooled prevalence of bruxism in children with cerebral palsy can be considered high since almost half of the studied population is affected by this condition. PROSPERO #CRD42021225781.

Survival rate of the Hall technique compared with resin composite restoration in multi-surface cavities in primary teeth: a 1-year randomized clinical trial.

BACKGROUND: Hall technique (HT) has been indicated for teeth with dentinal caries lesion; however, extensive cavities, with more than two surfaces still seem challenging for restorative treatment in pediatric dentistry, resulting in a higher failure rate and an increased need for retreatment. OBJECTIVES: To compare the survival rate of the Hall technique preformed metal crown (HT) with resin composite restoration (RC) for multi-surface cavitated caries lesions in primary molars. METHODOLOGY: In this multicenter two-arm randomized clinical trial, children between 4 and 9 years of age with at least one primary molar with cavitated caries lesion involving more than two surfaces, including one buccal or palatal/lingual surface, were selected from 17 Brazilian cities. A total of 364 teeth were allocated into two groups: (1) teeth treated with selective caries removal and RC and (2) treated with the HT. The survival rate was assessed at 6 and 12 months after the interventions. Survival analysis was performed with the Kaplan‒Meier method. Cox regression was used to determine the influence of explanatory variables on the survival rate (α=5%). RESULTS: After 12 months, 292 teeth were re-evaluated. A total of 358 teeth were re-evaluated at least once during the study and included in the survival analysis. The HT (87.8%) resulted in a higher survival rate than RC restoration (75.7%) (p=0.004). CONCLUSION: HT has a higher survival rate than RC as a treatment for multi-surface cavitated caries lesions in primary teeth. ClinicalTrials.gov: NCT02782390.

Root Resorption of the Permanent Central Incisor through Ectopic Eruption of the Maxillary Canine.

Although ectopic eruption of the maxillary canine has a low prevalence, a late diagnosis can have serious consequences. A careful clinical examination, assisted with radiographic examination, ensures early diagnosis, facilitates planning, and minimizes possible adverse consequences. This study reports a case of ectopic eruption of the permanent maxillary canine, with complete root resorption of the central permanent incisor, the consequences of which caused functional, aesthetic, and psychological harms to the patient. The procedures used included canine ectopic remodeling of the ectopic canine in the central incisor and orthodontic correction, which treated the anomaly and rebuilt the patient's self-esteem.

Dimensions of Occlusoproximal Cavitated Carious Lesions as a Cut-Off Point for Restorative Decision in Primary Teeth

ABSTRACT Objective: To investigate whether the dimensions of cavitated dentin carious lesions on the occlusoproximal surfaces of primary teeth could predict the location of cement-enamel junction (CEJ). Material and Methods: Two hundred extracted primary molars were selected and digital images were obtained. The teeth were set in arch models for clinical measurement. The cervical-occlusal (CO) and buccal-lingual/palatal (BL/P) cavities' dimensions were obtained by digital (Image J) and clinical (periodontal millimeter probe) assessments. The cervical margin location was also determined. The thresholds (cut-off points) were determined by sensitivity, specificity and the areas under the receiver operating characteristics curves (Az) for the two methods. Pearson's correlation coefficient was used to investigate the correlation between clinical and digital measurements. Logistic regression analysis was performed to evaluate the association between the dimensions and cervical margin location. Results: There was a strong correlation between methods for all measurements (CO: r=0.90, VL/P: r=0.95). Cavities with BL/P distance higher than 4.5 mm and CO dimension higher than 3.5 mm had a lower chance of presenting the cervical limit above the CEJ, irrespective of the measurement method. Conclusion: CO and VL/P dimensions could be used to predict the CEJ location and, ultimately, as a clinical parameter for restorative decision-making.

Survival rate of the Hall technique compared with resin composite restoration in multi-surface cavities in primary teeth: a 1-year randomized clinical trial

Abstract Background Hall technique (HT) has been indicated for teeth with dentinal caries lesion; however, extensive cavities, with more than two surfaces still seem challenging for restorative treatment in pediatric dentistry, resulting in a higher failure rate and an increased need for retreatment. Objectives To compare the survival rate of the Hall technique preformed metal crown (HT) with resin composite restoration (RC) for multi-surface cavitated caries lesions in primary molars. Methodology In this multicenter two-arm randomized clinical trial, children between 4 and 9 years of age with at least one primary molar with cavitated caries lesion involving more than two surfaces, including one buccal or palatal/lingual surface, were selected from 17 Brazilian cities. A total of 364 teeth were allocated into two groups: (1) teeth treated with selective caries removal and RC and (2) treated with the HT. The survival rate was assessed at 6 and 12 months after the interventions. Survival analysis was performed with the Kaplan‒Meier method. Cox regression was used to determine the influence of explanatory variables on the survival rate (α=5%). Results After 12 months, 292 teeth were re-evaluated. A total of 358 teeth were re-evaluated at least once during the study and included in the survival analysis. The HT (87.8%) resulted in a higher survival rate than RC restoration (75.7%) (p=0.004). Conclusion HT has a higher survival rate than RC as a treatment for multi-surface cavitated caries lesions in primary teeth. ClinicalTrials.gov: NCT02782390

Primary tooth restoration with colored compomer: case report / Restauração de dente decíduo com compômero colorido: relato de caso

ABSTRACT In pediatric dentistry, restorative treatment requires a material with good mechanical properties, ease of handling, and usability. For the restoration of deciduous teeth, colored compomers are an alternative material for motivating children in dental treatment and, consequently, behavior management. This study aimed to provide information about colored compomers by presenting a case of restoration in a deciduous molar with a five-year follow-up. Additionally, the study highlights the child's motivation toward dental treatment and oral care, thus offering an alternative to other restorative materials for clinicians to consider. The treatment plan for tooth 75 was selective removal of decayed tissue and restoration with compomer blue- colored Twinkly Star. The restoration was performed without anesthesia under relative isolation following the clinical protocol recommended by the manufacturer. As a result, it was observed that the restoration in colored Twinky Star compomer remained aesthetically and functionally satisfactory after five years. In addition, it was favorable for the child's collaboration in dental treatment. It is concluded that colored Twinky Star compomer can be a viable alternative for restoring deciduous teeth, contributing to children's dental treatment and oral care motivation.

RESUMO Em Odontopediatria, o tratamento restaurador exige um material que tenha boas propriedades mecânicas, facilidade de manipulação e de uso. Para a restauração de dentes decíduos, os compômeros coloridos são uma alternativa de material para a motivação de crianças no tratamento odontológico e consequentemente manejo de comportamento. Sabendo da necessidade de conhecer melhor os compômeros coloridos, o objetivo deste estudo foi relatar um caso de restauração com compômero colorido em molar decíduo com acompanhamento de cinco anos, bem como a motivação da criança perante o tratamento odontológico e cuidados bucais a fim de apresentar ao clínico uma alternativa a outros materiais restauradores. O plano de tratamento para este dente 75 foi remoção seletiva de tecido cariado e restauração com compômero colorido twinky star na cor azul. A restauração foi feita sem anestesia sob isolamento relativo seguindo o protocolo clínico preconizado pelo fabricante. Como resultado observou-se que a restauração em compômero Twinky Star colorido manteve-se satisfatória tanto estética quanto funcionalmente após cinco anos. Além disso, mostrou-se favorável para a colaboração da criança no tratamento odontológico. Conclui-se que o uso do compômero Twinky Star colorido pode ser uma alternativa viável para restauração de dente decíduo, contribuindo para a motivação de crianças no tratamento odontológico e cuidados bucais.

Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials.

AIMS: The purpose of this systematic review was to evaluate the cost-effectiveness and acceptance of children and their parents of the Hall technique (HT) for dental rehabilitation in pediatric dentistry. BACKGROUND: The approach of the HT is that of minimally invasive treatment of the dental element and is used exclusively on primary molars. Various studies in the literature point to HT as a restorative option well accepted by children and parents and quite predictable, with low retreatment rates and good cost-effectiveness for the management of primary molars with carious lesions. However, no systematic review in the literature has approached randomized clinical trials on these topics to produce a high level of evidence and help establish clinical HT protocols. REVIEW RESULTS: Eight articles were selected for the systematic review. The HT was more cost-effective than procedures using other restorative materials. Regarding acceptance, in terms of esthetics, high percentages of satisfaction were reported for parents and children, with a divergence between studies in the comparison of esthetic preference with atraumatic restorative treatment. However, when considering crown cementation pain, comfort, anxiety, preference, and satisfaction, the HT was generally better evaluated when compared to other restorative materials. CONCLUSION: The HT is an excellent restorative option when considering cost-effectiveness and acceptance and is recommended for use in daily clinical practice. CLINICAL SIGNIFICANCE: Results indicate that HT is superior to other restorative materials regarding its acceptance by children and parents in terms of pain, comfort, anxiety, and crown preference and satisfaction. There were also high percentages of satisfaction with esthetics. Hall technique may initially appear expensive for dentists, but its effectiveness over time and the lesser need for consultations and reinventions ensure better cost-benefit than other restorative materials. How to cite this article: Valentim FB, Moreira KMS, Carneiro VC, et al. Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials. J Contemp Dent Pract 2023;24(12):1016-1025.

Orthodontic bracket bonding techniques and adhesion failures: A systematic review and meta-analysis.

Background: This systematic review compared the bonding failures of orthodontic brackets bonded by indirect or direct techniques. Data sources: The searched databases were Cochrane Library, LILACS, BBO, PubMed, Scopus, Web of Science. Material and Methods: A search for randomized clinical trials comparing the two techniques was carried out to answer the research question: When considering orthodontic bracket bonding on permanent teeth, does the indirect technique reduce the number of bonding failures compared to the direct one over time? The quality of the included papers was assessed with Cochrane risk of bias tool and the quality of evidence with GRADE. Results: From 3096 articles identified, seven were included in the systematic review (five at unclear; two at low risk of bias). Meta-analysis was carried out according to the follow-up periods (0-6 months and 12-15 months). Results: In the first period, bonding techniques were similar with regard to adhesion failures (RR = 0.59; 95% CI 0.10-3.62; p = 0.00001; I2 = 92%); in the 12-to-15-month period, the direct bonding technique proved to be superior (RR = 1.44; 95% CI 1.05 - 1.99; p = 0.41; I2 = 0%). The quality of evidence was classified as low for the 0-6 months follow-up and high for the 12 months. Conclusions: Based on the absence of heterogeneity and the high quality of evidence, it is concluded that the direct bracket bonding technique has a lower failure rate than the indirect technique in the long term (12-15 months). Key words:Orthodontic brackets, fixed orthodontics, systematic review.

Alterações na clínica odontológica decorrentes da Pandemia: a mínima intervenção como a primeira opção em Odontopediatria / Changes in the dental clinic resulting from the Pandemic: minimal intervention as the first option in Pediatric Dentistry

A pandemia pelo novo coronavírus impactou a prática clínica odontológica, trazendo a necessidade de consultas mais rápidas, por vezes remotas, e com diminuição na produção de aerossóis, com o intuito de diminuir a disseminação do vírus Sars-CoV-2. Desta maneira, as técnicas abrangidas pela filosofia da Mínima Intervenção (MI) ganharam destaque pois, além dos benefícios para o momento pandêmico atual, são técnicas pautadas em evidências científicas e que podem ser oferecidas com segurança e de maneira integral à saúde bucal dos pacientes. Neste comentário, nós retomamos como o odontopediatra pode agir de maneira minimamente invasiva desde o diagnóstico ao tratamento mais complexo, além de educar o paciente e envolver a família na mudança comportamental, compreendendo seu papel na conquista da saúde bucal. A odontologia de Mínima Intervenção oferece ao paciente, em qualquer idade ou etapa de desenvolvimento, uma abordagem na qual sua família compreende os riscos e benefícios do plano de tratamento e participa das decisões para a construção de uma nova realidade em saúde.

The pandemic caused by the new coronavirus has impacted clinical dental practice, bringing the need for faster consultations, sometimes remote, and with a decrease in the production of aerosols, in order to reduce the spread of the Sars-CoV-2 virus. In this way, the techniques covered by the philosophy of Minimum Intervention (MI) gained prominence because, in addition to the benefits for the current pandemic moment, they are techniques based on scientific evidence and that can be offered safely and in an integral way to the oral health of patients. In this commentary, we revisit how pediatric dentists can act in a minimally invasive way from diagnosis to more complex treatment, in addition to educating the patient and involving the family in behavioral change, understanding their role in achieving oral health. Minimal Intervention Dentistry offers patients, at any age or stage of development, an approach in which their family understands the risks and benefits of the treatment plan and participates in decisions to build a new health reality.

Clinical Accuracy of Two Different Criteria for the Detection of Caries Lesions around Restorations in Primary Teeth.

This is a delayed-type cross-sectional prospective accuracy study nested in a randomized clinical trial. The aim was to investigate the diagnostic accuracy of two visual criteria for caries lesions detection around restorations in primary teeth: the International Dental Federation (FDI) criteria, considering adaptation, staining, and the presence of caries, and the Caries Associated with Restorations and Sealants (CARS) system. For this, one examiner made the diagnosis and subsequent treatment decision using visual assessment in 163 children (3-10 years old) with both FDI and CARS criteria. The order of criteria used was defined by randomization. The reference standard was composed of two approaches: (1) the presence of carious tissue after restoration removal and (2) the presence of caries lesions after 6 and 12 months of follow-up. Sensitivity, specificity, and accuracy parameters were calculated at the dentin threshold. Poisson multilevel regression analyses were performed to evaluate the association of the diagnostic methods and other explanatory variables with the outcomes. Of the 651 restorations included, 480 were evaluated by the reference standard methods and were analyzed. The CARS system presented higher accuracy (0.721) than those obtained with FDI recurrence of caries (0.702), FDI marginal adaptation (0.700), and FDI marginal staining criteria (0.681). The FDI marginal staining showed the study's lowest sensitivity (0.280) and accuracy (0.681) values. The specificity values of FDI recurrence of caries and FDI marginal adaptation were lower than the CARS system. Restorations assessed after the follow-up period resulted in lower sensitivity but higher specificity than those replaced after initial evaluation. In conclusion, the CARS system is more accurate in detecting caries around restorations in primary teeth than the FDI system, in general. However, the FDI recurrence of caries and FDI marginal adaptation present similar performance to the CARS system when the dentin threshold is considered. On the other hand, marginal staining is not an accurate parameter to evaluate caries around restorations.

Using information and communication technologies (ICTs) to solve the repressed demand for primary dental care in the Brazilian Unified Health System due to the COVID-19 pandemic: a randomized controlled study protocol nested with a before-and-after study including economic analysis.

BACKGROUND: With the COVID-19 pandemic, thousands of children had their dental care interrupted or postponed, generating a pent-up demand for primary care. To minimize the impact of this outage, information and communication technologies (ICT) could be an alternative. The aim of this study is to elucidate the impact of implementing the ICTs in primary dental care for children on resolving the pent-up demand for primary dental care to children in the national health system service (SUS) due to the COVID-19 pandemic. METHODS: Different research strategies are being proposed to demonstrate such effect and extrapolating findings to a real-world context to guide further research, practice and policies: two clinical trials (one randomized controlled by the waiting list trial (RCT) and a before-and-after study), one simulation study to prospect trial results to a broader population and three economic evaluations using different effects. Children enrolled in a reference dental unit will be invited to participate in the before-and-after study for trials. The first 368 families will be randomized for the RCT to the intervention vs waiting list. All participants will receive the intervention, but the waiting list group will be assessed before the intervention is available for them. The intervention comprises standardized non-face-to-face primary dental care using the V4H platform. The problem-solving and the family's perception will be the primary outcomes set for the before-and-after study and RCT, respectively. They will be measured 2 weeks after randomization. Based on trial findings, we will develop theoretical models to estimate how the intervention could benefit the population included in the national health system.  Three economic evaluations will be carried out considering different trial effects (cost-effectiveness analyses). A societal perspective and the pandemic time horizon will be considered. Possible social impact (inequalities) will also be explored. DISCUSSION: This ongoing trial may be an essential contribution to clarify positive and negative aspects related to the use of technologies for non-face-to-face dental care for children. Trial products may bring relevant contributions to the pandemic context and the post-pandemic period. Potential benefits may be feasible to implement and preserve in the health system even in the post-pandemic period. Trial registration Clinicaltrials.gov registration NCT04798599 (registered March 2021).

ART restorations for occluso-proximal cavities in primary molars: a two-year survival and cost analysis of an RCT comparing two GIC brands

Abstract There are many glass ionomer cements available on the Brazilian market for Atraumatic Restorative Treatment (ART), however, there is still a gap in the literature regarding their cost-effectiveness. Objectives To evaluate the influence of restorative materials (Ketac Molar, 3M ESPE; and Vitro Molar, Nova DFL) in the two-year survival rate and cost-effectiveness of occluso-proximal ART restorations in primary molars. Methodology A total of 117 children (aged four to eight years) with at least one occluso-proximal carious lesion in primary molars were selected and randomly divided in treatment groups (KM or VM) in this parallel randomized controlled trial. Treatments followed ART premises and were conducted in public schools by trained operators in Barueri, Brazil. A trained, calibrated, and blinded examiner performed the evaluations after two, six, 12, and 24 months (k=0.92). Kaplan-Meier survival analysis was used to estimate restoration survival and Cox regression was used to test the association with clinical factors (α=5%). For cost analysis, material and professional costs were considered. Monte Carlo analysis was used to generate a cost-effectiveness plane and bootstrapping was used to compare material costs over the years. Results The overall survival rate was 36.9% after two years (48.6% for KM and 25.4% for VM). Restorations with VM failed more than those with KM (HR=1.70; 95% CI=1.06-2.73; p=0.027). VM presented lower initial cost, but no difference was observed between groups considering the two-year incremental cost. Conclusion After a two-year evaluation, KM proved to be a better option than VM for occluso-proximal ART restorations in primary molars. ClinicalTrials.gov: NCT02267720

Extraction of supernumerary teeth in a hospital setting: case report in pediatric dentistry / Exodontia de dentes supranumerários em ambiente hospitalar: relato de caso na Odontopediatria

ABSTRACT The diagnosis and treatment of supernumerary teeth pose a challenge for dental clinicians and pediatric dentists. These teeth are asymptomatic and may cause the delayed eruption of the permanent dentition, altered bone growth and ectopic positioning. This paper reports a case of the surgical removal of supernumerary teeth in the anterior region of the maxilla of a child under general anesthesia in a hospital setting. A six-year-old female patient visited a private dental office in the city of Garanhuns, Brazil, accompanied by her mother, who reported a tooth with a "strange shape" in the anterior region as the main complaint and also reported that her daughter's first dental experience was negative. The clinical examination and imaging tests were performed under general anesthesia to confirm the diagnosis. In view of the patient's dental and behavioral history, surgical treatment was performed in a hospital setting and assisted by a multidisciplinary team. Care in the hospital setting was found to be feasible, providing greater comfort for uncooperative patients.

RESUMO Os dentes supranumerários representam um desafio para clínicos e odontopediatras quanto ao diagnóstico e tratamento. São assintomáticos, podendo gerar atraso na dentição permanente, alteração do crescimento ósseo e posicionamento ectópico. Assim, o presente trabalho teve como objetivo apresentar um relato de caso de remoção cirúrgica de dentes supranumerários na região anterior da maxila de um paciente infantil, em ambiente hospitalar sob anestesia geral. O paciente do sexo feminino, 6 anos, compareceu ao consultório apresentando como queixa a presença de um dente "estranho" na região anterior. Foram realizados o exame clínico e exames de imagem com a confirmação do diagnóstico de dentes supranumerários na região do incisivo central superior direito (11) e do incisivo central superior esquerdo (21). Tendo em vista o histórico odontológico e comportamental da paciente, optou-se em realizar o tratamento cirúrgico em ambiente hospitalar, auxiliado por equipe multidisciplinar. Dessa forma, ao final dos procedimentos foi verificado que o atendimento em ambiente hospitalar é viável para maior conforto do paciente não colaborador.

Aesthetic-functional rehabilitation of deciduous anterior teeth without removal of carious tissue: series of clinical cases / Reabilitação estético-funcional em dentes anteriores decíduos sem remoção de tecido cariado: série de casos clínicos

ABSTRACT The treatment of cavity carious lesions in anterior deciduous teeth is a frequent demand in the pediatric dentistry clinic, since the control of the disease in early childhood still presents itself as an inter-factor challenge in child health care. While the scientific evidence on the minimally invasive principles of approach in Dentistry is presented at an increasing level, the alternatives for restorative treatment in anterior deciduous teeth still face the low availability of reports that associate minimal intervention with the aesthetic needs inherent to the treatment. Thus, this article presents a series of cases in which direct restorations in composite resin, without removing carious tissue using polyvinyl matrices, were treatment alternatives for moderate and severe caries lesions in anterior deciduous teeth. It was observed, therefore, that the use of this artifact helped the rehabilitation of compromised dental elements with speed and satisfactory 50 result, suggesting that this is an appropriate approach for application in Pediatric Dentistry, 51 since it offers resistance, durability, besides providing aesthetics and functionality, it presents lower cost and agility as it eliminates the laboratory phase.

RESUMO O tratamento de lesões cavitadas de cárie em dentes decíduos anteriores é uma demanda frequente na clínica de odontopediatria, visto que o controle da doença na primeira infância ainda se apresenta como um desafio interfatorial nos cuidados em saúde infantil. Enquanto a evidência científica nos princípios minimamente invasivos de abordagem em Odontologia apresenta-se em nível crescente, as alternativas para tratamento restaurador em dentes decíduos anteriores ainda esbarram na baixa disponibilidade de relatos que associem a mínima intervenção às necessidades estéticas inerentes ao tratamento. Assim, este artigo apresenta uma série de casos em que as restaurações diretas em resina composta, sem a remoção de tecido cariado utilizando matrizes de polivinila foram alternativas de tratamento para lesões de cárie moderadas e severas em dentes decíduos anteriores. Observou-se que o uso desse artefato auxiliou a reabilitação dos elementos dentários comprometidos com rapidez e resultado satisfatório, sugerindo que essa é uma abordagem adequada para aplicação em Odontopediatria, já que oferece resistência, durabilidade, além de proporcionar estética e funcionalidade, apresenta menor custo e agilidade na medida que dispensa a fase laboratorial.

Cost analysis of endodontic treatment in primary teeth: results from a randomized clinical trial.

This study compared the cost of endodontic treatment in primary teeth involving a technique that does not require root canal instrumentation using antibiotic paste (CTZ) with that of the instrumented technique using iodoform paste (GP). This study is part of a randomized, controlled, parallel arm, noninferiority, 1:1 allocation, blinded (patient) multioperator study of 52 primary incisors of children aged 3 to 6 years with caries lesion and pulp involvement. Each technique was performed according to the creators' descriptions. The cost was assessed by analyzing the costs of capital, dental supplies, and professional labor according to the time taken to perform the procedure and the CHEERS guidelines were used to report the cost assessment. Endodontic treatment with CTZ had a 58.33% lower execution cost than GP (US$6.73 and US$16.15, respectively). The t-test showed significant differences between groups regarding treatment time and total cost (p < 0.0001). The CTZ technique seems to be more economically viable than GP for endodontic treatment of primary teeth, requiring a shorter treatment time and lower costs.

Use of flowable resin composite as an intermediate layer in class II restorations: a systematic review and meta-analysis.

OBJECTIVE: To investigate the influence of an intermediate layer of a flowable resin composite in class II resin composite restorations. MATERIALS AND METHODS: The authors searched MEDLINE via PubMed, Scopus, LILACS, Embase, and Web of Science electronic databases, and the ClinicalTrials.gov website to identify laboratory and clinical studies that evaluated class II cavities with resin composite restorations with or without an intermediate layer of flowable resin composite. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and the quality of the evidence. Meta-analyses were performed using RevMan5.3 with fixed-effects model comparing bond strength (MPa), fracture strength (Newton), and clinical (number of failures) outcomes between restorative techniques (with or without flowable resin composite as an intermediate layer). RESULTS: From 1707 potentially eligible studies, 140 in vitro studies and 14 clinical studies were selected for full-text analysis, and 11 were included in the systematic review, being 7 in vitro and 4 clinical studies. There was no statistically significant difference between the restorative techniques considering the outcomes evaluated. The heterogeneity found was null. The risk of bias was classified as medium for in vitro studies and unclear in most clinical studies. The quality of the evidence of the clinical studies was low. CONCLUSION: The use of flowable resin composite as an intermediate layer does not improve the effectiveness of the class II restorations based on laboratory and clinical outcomes. CLINICAL RELEVANCE: Flowable resin composite as an intermediate layer may be used for class II restorations; however, this technique does not improve the effectiveness of the class II restorations.

Bonding Performance of Universal and Contemporary Adhesives in Primary Teeth: A Systematic Review and Network Meta-Analysis of In Vitro Studies.

Purpose: To systematically review the literature to compare the bond strength of universal adhesives with etch-and-rinse and self-etch systems to primary teeth. Methods: The search was carried out in PubMed® /MEDLINE, Scopus® , LILACS, Embase® , and Web of Science™ databases with no restrictions. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Direct comparisons among universal adhesive in etch-and-rinse (UER) and self-etch (USE) modes and etch-and-rinse (ER) and self-etch (SE) systems were performed considering different substrates (sound enamel and dentin, and carious dentin) through meta-analyses of random effects. A mixed treatment comparisons meta-analysis was also performed comparing the bond strength of all adhesive approaches on sound dentin. Results: From 3,276 potentially eligible studies, 18 were selected for full-text analysis, and eight were included in the systematic review. All studies included in the meta-analyses evaluated a mild universal adhesive (Scotchbond™ Universal). In direct comparisons, there was no difference between USE and SE to sound enamel (mean difference [MD] equals 5.22; 95 percent confidence interval [95% CI] equals -9.09 to 19.52). In carious dentin, the results favored only ER over USE (MD equals -3.88; 95% CI equals -7.40 to -0.37). In sound dentin, the bond strength values of UER were higher than ER (MD equals 5.50; 95% CI equals 4.03 to 6.96). The rank probability showed that the best treatment on sound dentin was UER. Conclusion: Pooled in vitro data suggest that a mild universal adhesive system can substitute the etch-and-rinse and self-etch systems for restoring primary teeth.

Complications following replantation of primary teeth: a case report / Complicações após reimplante de dentes decíduos: um relato de caso clínico

Abstract Introduction: the avulsion of primary teeth is a disturbing and unexpected event. Description: this report describes the clinical case of a three-year-old child who suffered an avulsion and replantation of the primary upper central incisors at the site of the injury. The guardians sought treatment for the child at the Federal University of Minas Gerais after the replantation. Four months later, the child suffered a new trauma and the replanted teeth presented advanced mobility, root resorption and fistula. The clinical conduct was extraction and rehabilitation with a fixed esthetic maintainer. Discussion: the literature describes two treatment options for avulsion of primary incisors: replantation and non-replantation. According to a recent systematic review, the difficulty in obtaining a consensus regarding the best clinical conduct is due, in part, to the scarcity of publications that present not only follow-ups with clinical success, but also with failures. The outcomes of replantation can be influenced by several factors. The time elapsed between replantation and splinting, and the new episode of trauma, negatively influenced the prognosis in the present case, leading to failure. Replantation of primary incisors is not yet evidence-based treatment. Therefore, this option must be chosen with caution and in ideal situations. It requires constant clinical and radiographic monitoring for evaluation of outcomes.

Resumo Introdução: a avulsão de dentes decíduos é um evento perturbador e inesperado. Descrição: o presente relato descreve o caso clínico de uma criança de três anos que sofreu avulsão e reimplante dos incisivos centrais superiores decíduos no local do acidente. Os responsáveis procuraram atendimento para a criança na Universidade Federal de Minas Gerais após reimplante. Quatro meses depois, a criança sofreu novo trauma e os dentes reimplantados apresentavam mobilidade avançada, reabsorção radicular e fístula. A conduta clínica foi extração e reabilitação com mantenedor estético fixo. Discussão: a literatura descreve duas opções de tratamento para avulsão de incisivos decíduos: o reimplante e o não reimplante. De acordo com revisão sistemática recente, a dificuldade de se obter um consenso sobre a melhor conduta clínica se deve, em parte, à escassez de publicações que apresentem não apenas acompanhamentos com sucesso clínico, mas também com falhas. O reimplante pode ser influenciado por vários fatores. O tempo decorrido entre o reimplante e a contenção, e o novo episódio de trauma, influenciaram negativamente o prognóstico do presente caso, levando ao insucesso. O reimplante de incisivos decí- duos ainda não é um tratamento baseado em evidências. Portanto, essa opção deve ser escolhida com cautela e em situações ideais. Requer monitoramento clínico e radiográfico para constante avaliação do desfecho.

Photodynamic therapy associated final irrigation in root canals of the primary teeth.

The aim of this study was to analyze, in vitro, the reduction of Enterococcus faecalis in root canals of primary teeth after final irrigation and photodynamic therapy (PDT) use. Twenty primary molars were contaminated with Enterococcus faecalis. The teeth were randomly distributed into four groups according to the irrigation solutions and PDT use: G1 (Saline solution and no PDT use), G2 (17 % EDTA and no PDT use), G3 (Saline solution and PDT use) and G4 (17 % EDTA and PDT use). For PDT, 0.005 % toluidine blue was chosen as the photosensitizer, which was inserted in the canals with sterile paper cones. Bacterial counts were performed with a BHI test in blood agar plate, where bacteria were collected inside the canal for 30 s using sterile paper cones. The collection took place before and after the irrigation and PDT protocols. The samples were diluted, spread onto a blood agar plate and then incubated at 37 °C for 24 h. There was a reduction of the microbiota from the irrigation solutions before and after the final irrigation for all groups. It was observed a statistically significant reduction (p < 0,05) when PDT was used (97.6 % at the saline solution and 89.8 % at the 17 % EDTA) when compared to the groups with no PDT use. Our data demonstrated that PDT, according to the parameters used, increased the disinfection performance of the solutions tested in the root canals of primary teeth.