Periodontal status among 12-year-old schoolchildren: a population-based cross-sectional study in Quito, Ecuador

Abstract This study aimed to estimate the prevalence and extent of bleeding on probing and calculus in 12-year-old schoolchildren of Quito, Ecuador, and evaluate the associated factors. We conducted an epidemiological survey with a representative sample of 1,100 12-year-old schoolchildren from public schools in the urban area of Quito, Ecuador. We assessed the periodontal health using the Community Periodontal Index (CPI). The prevalence and extent of the periodontal condition was based on the presence of at least one site with bleeding on probing (BOP), and the presence of dental calculus was also evaluated. We used univariate and multiple multilevel Poisson regression analyses to verify the association between the independent variables and the number of sextants with BOP and calculus. The prevalence of BOP and calculus was 92% and 69.9%, respectively. The adjusted mean of the affected sextants was 4.3 and 2.2 for BOP and calculus, respectively. The mother's schooling and malocclusion were associated with the number of sextants with bleeding. The mother's schooling and dental caries experience were associated with calculus. Gingival bleeding and the presence of dental calculus are highly prevalent in 12-year-old schoolchildren from Quito. Gingival bleeding is associated with maternal education and malocclusion, and dental calculus is associated with maternal education and dental caries.

Accuracy of arch expansion with two thermoplastic materials in Invisalign® patients: EX30® and SmartTrack®

ABSTRACT Objective: The purpose of this retrospective study was to compare accuracy of arch expansion using two different thermoplastic materials in Invisalign aligners: EX30® (Polyethylene Terephthalate Glycol, or PETG) and SmartTrack® (polyurethane). Methods: The study sample comprised 65 adult patients consecutively treated with Invisalign from two private practices: group 1 - treated with EX30® (358 teeth) and group 2 - treated with SmartTrack® (888 teeth). Six hundred and twenty-three measurements were assessed in three digital models throughout treatment: model 1 - initial, model 2 - predicted tooth position, and model 3 - achieved position. Sixteen reference points per arch were marked and, after best alignment, 2 points per tooth were copied from one digital model to another. Linear values of both arches were measured for canines, premolars, and first molars: on lingual gingival margins and cusp tips of every tooth. Comparisons were performed by Wilcoxon and Mann-Whitney test. Results: Both termoplastic materials presented significant differences between predicted and achieved values for all measurements, except for the lower molar cusp tip in the SmartTrack® group. There is no statistical difference in the accuracy of transverse expansion between these two materials. Overall accuracy for EX30® aligners in maxilla and mandible were found to be 37 and 38%, respectively; and Smarttrack® presented an overall accuracy of 56.62% in the maxilla and 68.72% in the mandible. Conclusions: It is not possible to affirm one material expands better than the other. Further controlled clinical studies should be conducted comparing SmartTrack® and EX30® under similar conditions.

RESUMO Objetivo: O objetivo deste estudo retrospectivo foi comparar a acurácia na expansão da arcada utilizando alinhadores Invisalign com dois tipos de material termoplástico: EX30® (Polietileno Tereftalato Glicol, ou PETG) e SmartTrack® (poliuretano). Método: A amostra desse estudo incluiu 65 pacientes adultos tratados consecutivamente em dois consultórios particulares: grupo 1 - tratado com EX30® (358 dentes), e grupo 2 - tratado com SmartTrack® (888 dentes). Foram avaliadas 623 medidas em três pares de modelos digitais, ao longo do tratamento: modelo 1 - inicial, modelo 2 - posição dentária planejada, modelo 3 - posição alcançada. Foram marcados 16 pontos de referência por arcada e, após o bestfit, 2 pontos por arcada foram copiados de um modelo digital para o outro. Medidas lineares de ambas as arcadas foram aferidas para caninos, pré-molares e primeiros molares, localizadas na margem gengival lingual e ponta de cúspide de todos os dentes. Foram realizadas comparações usando os testes Wilcoxon e Mann-Whitney. Resultados: Ambos os materiais termoplásticos apresentaram diferenças significativas entre os valores planejados e alcançados em todas as medidas, exceto na ponta de cúspide dos primeiros molares inferiores do grupo SmartTrack®. Não houve diferença estatística entre esses dois materiais quanto à acurácia da expansão transversa. Em termos gerais, a acurácia dos alinhadores EX30® na maxila e mandíbula foi de 37% e 38%, respectivamente. O grupo SmartTrack® apresentou acurácia de 56,62% e 68,72% na maxila e mandíbula, respectivamente. Conclusões: Não foi possível afirmar que um material expande melhor que o outro. Estudos clínicos controlados futuros devem ser conduzidos comparando SmartTrack® e EX30® sob condições similares.

Accuracy of Invisalign® aligners in adult patients: a retrospective study of angular tooth movements

ABSTRACT Objective: This retrospective study aimed to assess the predictability of Invisalign® aligners regarding rotational, mesio-distal and buccal-lingual tip movements. Methods: Two materials were included in the analysis - EX30, used until 2013; and SmartTrack, in current use. The study comprised 56 adult patients treated with Invisalign Comprehensive. Data sample were assessed on three sets of digital models; model 1 - initial, model 2 - predicted, and model 3 - achieved. Sixty reference points were marked in each dental arch, and two reference planes assisted the superimposition. The degree of rotation, mesio-distal and buccal-lingual tip was obtained via trigonometric calculations, through a previously published validated method. The accuracy of outcomes was compared according to the types of tooth movement and teeth groups,and the influence of predetermined variables on movement accuracy was also investigated. Results: Rotation and mesio-distal tip did not present any significant difference when comparing EX30 and SmartTrack groups. Only buccal-lingual tip presented a significant difference, incisor and canine groups treated with EX30 aligners presented an increase in accuracy (p= 0.007 and p = 0.007, respectively). For each additional degree planned for rotation movements, there was an increase of 0.35° in the discrepancy, and an increase of 0.40° and 0.41° for mesio-distal and buccal-lingual tip, respectively. EX30 and SmartTrack discrepancies were compared by multilevel linear regression. Conclusion: EX30 aligners reached higher accuracy for buccal-lingual tip in anterior teeth. However, for rotation and mesio-distal tip, SmartTrack and EX30 are similarly accurate. The total amount of planned movement has a significant impact on accuracy rates, with a decrease in accuracy for every additional degree.

RESUMO Objetivo: Esse estudo retrospectivo teve como objetivo aferir a previsibilidade dos alinhadores Invisalign em relação aos movimentos de rotação e inclinações mesiodistal e vestibulolingual. Material e Métodos: Foram incluídos dois materiais nessa análise: EX30®, utilizado até 2013; e SmartTrack®, atualmente em uso. Esse estudo avaliou 56 pacientes tratados com Invisalign Comprehensive. Os dados foram avaliados em três pares de modelos digitais; modelo 1 - inicial, modelo 2 - planejado, e modelo 3 - alcançado. Foram marcados 60 pontos de referência em cada arcada, sendo a sobreposição realizada com auxílio de planos de referência. O grau de rotação e inclinações mesiodistal e vestibulolingual foi obtido por cálculos de trigonometria, usando um método validado publicado anteriormente. Os resultados foram comparados de acordo com os tipos de movimento dentário e grupos de dentes, também foi investigada a influência de variáveis predeterminadas na confiabilidade dos movimentos. Resultados: Os movimentos de rotação e inclinação mesiodistal não apresentaram diferença estatística, quando comparados os grupos EX30® e SmartTrack®. Somente a inclinação vestibulolingual apresentou diferença estatisticamente significativa, sendo que os grupos de incisivos e caninos tratados com alinhadores EX30® apresentaram um aumento na previsibilidade(p= 0,007 e p= 0,007, respectivamente). Para cada grau adicional planejado para movimento de rotação, ocorreu um aumento de 0,35° na discrepância, e aumentos de 0,40° e 0,41° para as inclinações mesiodistal e vestibulolingual, respectivamente. As discrepâncias entre EX30® e SmartTrack® foram comparadas por regressão linear multinível. Conclusão: Os alinhadores EX30® alcançaram maior previsibilidade para a inclinação vestibulolingual em dentes anteriores. No entanto, para rotação e inclinação mesiodistal, SmartTrack® e EX30® apresentaram previsibilidade similar. A quantidade total de movimento planejado apresenta influência significativa nas taxas de previsibilidade, com diminuição na acurácia para cada grau adicional.

Does bullying due to oral conditions influence cigarette smoking in adolescents? A structural equation modeling.

This study aimed to explore the pathways that can influence cigarette smoking among adolescents. This population-based cohort followed a random sample of 12-year-old adolescents from southern Brazil for 6 years. Regular cigarette smoking was assessed through a self-reported question, previously used in the Brazilian National Survey of Scholar Health. We also gathered data on bullying, dental caries at baseline, incidence of caries, sex, friend network, and Sense of Coherence (SOC). Socioeconomic and demographic characteristics were also collected. Structural equation modeling was used to evaluate the pathways. Of the 1,134 adolescents examined at baseline, 768 were re-evaluated (67.7% retention rate). The prevalence of smoking was 37.6%. This prevalence was directly affected by low SOC (SC: -0.14, p < 0.01), low household income (SC: -0.12, p < 0.01), and male sex (SC: 0.15, p < 0.01). Presence of dental caries at baseline indirectly influenced the occurrence of dental bullying at follow-up via the incidence of dental caries (SC: 0.01, p < 0.05). Dental bullying indirectly influenced cigarettes consumption via SOC (SC: 0.62, p < 0.05). Friend network also indirectly influenced the consumption of cigarettes via SOC (SC: 0.32, p < 0.05). Psychosocial factors influence adolescent cigarette consumption through its higher direct and indirect effects (via bullying). In addition, behavioral, sociodemographic, and clinical factors also influence the occurrence of smoking.

Photobiomodulation for the management of xerostomia and oral mucositis in patients with cancer: a randomized clinical trial.

To evaluate the applicability of photobiomodulation therapy (PBM-T) in the management of xerostomia and OM. Fifty-three patients with head and neck squamous cell carcinoma were randomized into two groups: Sham and PBM-T. The Sham group received artificial saliva and laser simulation, while the PBM-T group received artificial saliva and PBM-T. Xerostomia-related quality of life (QoL), the presence or absence of OM lesions, the decayed-missing-filled teeth (DMFT) index, and periodontal charts were evaluated. The results of the QoL questionnaire, DMFT index, and periodontal chart were analyzed with the Kruskal-Wallis test, followed by the Student-Newman-Keuls test, while OM findings were compared using the Mann-Whitney test. QoL scores significantly increased in the Sham group (p < 0.0001), denoting more severe xerostomia symptoms (p = 0.0074), and decreased in the PBM-T group, indicating no or very mild xerostomia. Higher grades of OM were found in the Sham group than the PBM-T group (p = 0.0001). There was no significant difference in DMFT index or periodontal charts between the groups (p > 0.05). PBM-T improved QoL in patients with head and neck cancer treated with radiotherapy, whether as radiation alone or as an adjunct to chemotherapy and surgery.

Does bullying due to oral conditions influence cigarette smoking in adolescents? A structural equation modeling

Abstract This study aimed to explore the pathways that can influence cigarette smoking among adolescents. This population-based cohort followed a random sample of 12-year-old adolescents from southern Brazil for 6 years. Regular cigarette smoking was assessed through a self-reported question, previously used in the Brazilian National Survey of Scholar Health. We also gathered data on bullying, dental caries at baseline, incidence of caries, sex, friend network, and Sense of Coherence (SOC). Socioeconomic and demographic characteristics were also collected. Structural equation modeling was used to evaluate the pathways. Of the 1,134 adolescents examined at baseline, 768 were re-evaluated (67.7% retention rate). The prevalence of smoking was 37.6%. This prevalence was directly affected by low SOC (SC: -0.14, p < 0.01), low household income (SC: -0.12, p < 0.01), and male sex (SC: 0.15, p < 0.01). Presence of dental caries at baseline indirectly influenced the occurrence of dental bullying at follow-up via the incidence of dental caries (SC: 0.01, p < 0.05). Dental bullying indirectly influenced cigarettes consumption via SOC (SC: 0.62, p < 0.05). Friend network also indirectly influenced the consumption of cigarettes via SOC (SC: 0.32, p < 0.05). Psychosocial factors influence adolescent cigarette consumption through its higher direct and indirect effects (via bullying). In addition, behavioral, sociodemographic, and clinical factors also influence the occurrence of smoking.

Impact of dental caries severity and activity on oral health-related quality of life among children aged 8-11 years

Abstract Caries disease can lead to strong impact in terms of pain and suffering, to functional impairment, and to negative effects on quality of life. Studies have demonstrated that the impact on quality of life increases with dental caries severity, and few studies have assessed the relationship between caries activity and children's oral health-related quality of life (OHRQoL). This cross-sectional study aimed to assess the impact of dental caries severity and activity on the OHRQoL of schoolchildren. The study was conducted with a sample of children aged 8 to 11 years from Pelotas, southern Brazil. Children answered the Child Perceptions Questionnaire 8-10, and socioeconomic data were collected. Children's dental caries (Kappa value of 0.95), PUFA, traumatic dental injuries, and malocclusion were examined. The Mann-Whitney, Kruskal-Wallis, and Poisson regression tests were performed. A total of 119 children were included. Children with initial (mean ratio (MR) of 1.92; 95% confidence interval (95% CI) of 1.05-3.48), moderate (MR: 2.66; 95%CI: 1.44-4.90), and severe carious lesions (MR: 2.65; 95%CI: 1.46-4.79) had a greater impact on OHRQoL compared with those without carious lesions (p =0 .047). Children with active carious lesions exhibited a greater impact on OHRQoL (MR:1.53 and 95%CI: 1.11-2.11) when compared to those without active lesions (p = 0.019). The findings demonstrate an association between dental caries severity and activity and the OHRQoL of school-aged children.

Number of dentists in the neighborhood and incidence of dental caries in the children permanent dentition

Abstract This study aimed to evaluate the influence of the number of dentists in the neighborhood on the incidence of dental caries in the children permanent dentition. This cohort began in 2010 (T1) with a random sample of 639 children (1 to 5 years-old) followed for 7 years, in southern Brazil. The follow-up reassessment (T2) took place in 2017. Untreated dental caries was evaluated at T2 through the Decayed, Missing, and Filled surfaces index (DMF-S). The number of dentists in the neighborhood was obtained from the city's official database and used as a contextual variable. Socioeconomic, demographic, and oral health variables at the individual level were evaluated at T1. A multilevel Poisson regression was performed to evaluate the influence of the predictor variables in the incidence of untreated dental caries. From 639 children at T1, 449 were reassessed at T2 (a 70.3% retention rate). The mean of decayed surfaces at T2 was 0.92 (SE 0.01). The greater the number of dentists in the neighborhoods where the children lived, the lower the incidence of dental caries. Children with low socioeconomic status, who have not routinely visited the dentist in the last 6 months, who presented a experience of dental caries, and whose parents perceived their oral health as fair/poor showed a higher incidence of surfaces with untreated dental caries. As conclusion, children who live in neighborhoods with fewer dentists have a higher incidence of untreated dental caries in permanent dentition.

Resumo Este estudo teve como objetivo avaliar a influência do número de cirurgiões-dentistas do bairro na incidência de cárie dentária na dentição permanente. Esta coorte teve início em 2010 (T1) com uma amostra aleatória de 639 crianças (1 a 5 anos) acompanhadas por 7 anos, no sul do Brasil. A reavaliação (T2) ocorreu em 2017. A cárie dentária não tratada foi avaliada no T2 por meio do índice de superfícies cariadas, perdidas e obturadas (CPO-S). O número de dentistas do bairro foi obtido no banco de dados oficial da cidade e usada como uma variável contextual. Variáveis socioeconômicas, demográficas e de saúde bucal no nível individual foram avaliadas no T1. Foi realizada uma análise de regressão de Poisson multinível para avaliar a influência das variáveis preditoras na incidência de cárie dentária não tratada. Das 639 crianças no T1, 449 foram reavaliadas no T2 (taxa de retenção de 70,3%). A média das superfícies cariadas no T2 foi de 0,92 (EP 0,01). Quanto maior o número de dentistas nos bairros em que as crianças residiam, menor era a incidência de cárie dentária. Crianças com baixo nível socioeconômico, que não consultaram rotineiramente o dentista nos últimos 6 meses, que apresentaram experiência de cárie dentária e cujos pais perceberam sua saúde bucal como regular/ruim apresentaram maior incidência de superfícies com cárie dentária não tratada. Como conclusão, crianças que moram em bairros com menos dentistas têm maior incidência de cárie não tratada na dentição permanente.

Stainless steel crown vs bulk fill composites for the restoration of primary molars post-pulpectomy: 1-year survival and acceptance results of a randomized clinical trial.

BACKGROUND: A key factor for the success and longevity of the endodontic treatment is sealing of the cavity after restorative treatment. AIM: The aim of this randomised clinical trial was to evaluate the 1-year survival of endodontic treatment in primary molars restored with stainless steel crowns (SSCs) and bulk fill composite resin (BF). As a secondary outcome, the acceptance of both children and parents was evaluated. DESIGN: Ninety-one 3- to 8-year-old children with at least one primary molar requiring endodontic treatment were selected. Participants were randomized to SSC or BF and evaluated after 1, 3, 6, and 12 months. An acceptance questionnaire was completed immediately after the treatment. The primary outcome was the endodontic treatment success, evaluated in the intention-to-treat (ITT) population using the Kaplan-Meier and non-inferiority Cox regression analyses, with a non-inferiority limit of 15%. Sensitivity analysis between the success rates after 1 year was performed using Miettinen-Nurminen's method. The Mann-Whitney test was used to compare the treatment acceptance (α = 5%). RESULTS: The survival rate after 1 year was BF = 75% and SSC = 88% (HR = 1.41; 90% CI 0.57-3.43). ITT analysis showed a success rate of BF = 86.7% and SSC = 82.6% (RR = 0.95; 0.78-1.16). The non-inferiority hypothesis between the survival of endodontic treatment could not be proved in both analyses (P > .05). The overall acceptance scores did not differ between the restorative groups (P > .05). CONCLUSION: This study failed to show non-inferiority of BF compared with the SSC. The materials were well accepted by both children and their parents.

Tactile perception of roughness to assess activity in artificial initial caries lesions with a novel force-controlled probe

Abstract Roughness-tactile perception is part of activity assessment in initial-caries-lesions. Hypothesizing that a probe's design influences this examiner's assessment, four probes were designed. The aims of this study were to select the probe with highest inter-/intra-examiners' roughness-assessment agreement and to determine its diagnostic accuracy on artificial initial-caries lesions. A pilot study was conducted with trained dentists to select one controlled-pressure probe design (n = 4) by assessing roughness on known-roughness metal plaques with 5-point Likert scale. Diagnostic accuracy of roughness assessment was conducted with the selected controlled-pressure probe and the WHO-probe on sound and artificial initial-caries-lesion (n = 20) human enamel blocks. Intra-class correlation coefficients (ICCs) and quadratic weighted-Kappa scores were used to assess examiners' reproducibility and Multilevel Poisson models to determine diagnostic accuracy between both probes controlling for confounding variables. The probe design with the highest inter/intra-examiner's agreement (ICC = 0.96) was selected for subsequent analyses. Unadjusted sensitivity, specificity and accuracy values were for the controlled-pressure and the WHO probes: 71.1%,90.6%,81.2%, and 67.4%,84.6%,75.8%, respectively (p > 0.05). Examiner remained the most important factor influencing diagnostic accuracy. While this study did not show significantly higher diagnostic accuracy of the designed controlled-pressure vs. the WHO-probe when used by trained dentists, all over roughness-assessment accuracy and reproducibility were high.

Does the school environment exert influence on quality of life related to traumatic dental injury in children?

Abstract The aim of this cross-sectional study was to assess whether favorable factors related to school characteristics have a positive effect on the impact of traumatic dental injury (TDI) on oral health-related quality of life (OHRQoL). An epidemiological survey of oral health was conducted with 12-year-old schoolchildren from Quito, Ecuador. Children were examined for TDI, dental caries, and malocclusion. Individual socioeconomic data were also collected. Information on the physical environment, health practices, and occurrence of negative episodes at school was collected from the school coordinators. The Child Perceptions Questionnaire 11-14 (CPQ11-14) was used to evaluate the OHRQoL (outcome variable). Multilevel Poisson regression analysis was conducted. Severe TDI was associated with higher CPQ11-14 scores, even in the multiple model adjusted for oral health conditions, sex, individual socioeconomic variables, and school-related variables. Children from schools that had an appropriate tooth-brushing environment for their students exhibited a lower impact on OHRQoL, even after adjustment for the occurrence of TDI and other variables. A favorable school environment may exert a positive effect on OHRQoL, independent of the occurrence of TDI.

Three-dimensional evaluation of dental decompensation and mandibular symphysis remodeling on orthodontic-surgical treatment of Class III malocclusion.

INTRODUCTION: The purposes of this research were to identify the buccolingual inclinations of the mandibular teeth and the mandibular symphysis remodeling that result from the orthodontic decompensation movement. METHODS: The sample consisted of 30 adults with Class III dentofacial deformity, who had presurgical orthodontic treatment. Three-dimensional images were generated by cone-beam computed tomography scans at 2 different times (initial and before orthognathic surgery). Three-dimensional virtual models were obtained and superimposed using automated voxel-based registration at the mandible to evaluate B-point displacement, mandibular molar and incisor decompensation movement, and symphysis inclination and thickness. The 3-dimensional displacements of landmarks at the symphysis were quantified and visualized with color-coded maps using 3D Slicer (version 4.0; www.slicer.org) software. RESULTS: The measurements showed high reproducibility. The patients presented mandibular incisor proclination, which was consistent with the movement of tooth decompensation caused by the presurgical orthodontic treatment. Statistically significant correlations were found between the inclination of the mandibular incisors, symphysis inclination, and B-point displacement. Regarding the thickness of the symphysis and the inclination of the incisors, no statistically significant correlation was found. CONCLUSIONS: The buccolingual orthodontic movement of the mandibular incisors with presurgical leveling is correlated with the inclination of the mandibular symphysis and repositioning of the B-point but not correlated to the thickness of the symphysis.

Management of deep caries lesions with or without pulp involvement in primary teeth: a systematic review and network meta-analysis

Abstract: 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.

Survival rate of pulpectomy in primary teeth using Feapex® paste: a clinical study in infants / Sobrevida de pulpectomia em dentes decíduos utilizando pasta Feapex®: um estudo clínico em bebês

Objective: The aim of this clinical study was to evaluate the survival rate of a new pulpectomy protocol using 2% chlorhexidine digluconate gel and Feapex® paste for endodontic treatment in primary teeth. Material and Methods: A total of 105 pulpectomies were performed in anterior and posterior teeth of 48 infants (1-3 years old) with high caries experience with irreversible pulpitis or pulp necrosis. All treatments were performed by dental surgeons with no specialization in Pediatric Dentistry, under local anesthesia and rubberdam isolation. Manual files were used in conjunction with 2% chlorherixidine gel for root canal instrumentation, and Feapex® paste was used as a obturation material. The clinical and radiographic outcomes were collected by one trained independent evaluator with a follow-up period of 24months. Success was determined by the absence of pain, pathological mobility, pathologic bone rarefaction, pathological root resorption and soft tissue pathology around the affected tooth Survival of the endodontic treatment was evaluated by estimating survival rates through Kaplan-Meier curves. Cox Regression analysis with shared fragility were performed to evaluate the association between the independent variables to endodontic treatment failure (α=5%). Results: After 24 months, the treatment survival was 86% (SE=0.03). Root resorption at baseline was associated with a higher risk of failure (HR=2.81; CI=1.12-7.08; p=0.027). The survival rate of the endodontic treated teeth due to dental trauma was 100%, while teeth with dental caries had lower survival rate (85.05%; p<0.001*). Other variables analyzed included gender, age of the child, tooth position (incisor/molar), restoration type, obturation quality, and caries experience were not associated with treatment failure (p>0.05). Conclusion: The new protocol using 2% chlorhexidine digluconate and Feapex® presented a high survival rate and can be considered as a suitable protocol for pulpectomy in primary teeth.Trial Registration: REBEC (RBR-282s2f) (AU)

Objetivo: Avaliar a sobrevida de um novo protocolo para tratamento endodôntico (pulpectomia) em dentes decíduos utilizando gel de digluconato de clorexidina 2% e pasta Feapex®. Material e Métodos: Um total de 105 pulpectomias foram realizadas em dentes anteriores e posteriores diagnosticados com pulpite irreversível ou necrose pulpar em 48 crianças (1-3 anos de idade) com alta experiência de cárie. Todos os tratamentos foram realizados por cirurgiões-dentistas clínicos gerais, sob anestesia local e isolamento absoluto. Limas manuais foram utilizadas em conjunto com cloroherixidina 2% gel para instrumentação dos canais radiculares e pasta Feapex® foi utilizada como material de obturação. Os resultados clínicos e radiográficos foram coletados por um avaliador independente treinado com um período de acompanhamento de 24 meses. O sucesso foi determinado pela ausência de dor, mobilidade patológica, rarefação óssea patológica, reabsorção radicular patológica e ausência de fístula/abscesso ao redor do dente tratado. A sobrevida do tratamento endodôntico foi estimativa utilizando curvas de Kaplan-Meier. Análise de regressão de Cox com fragilidade compartilhada foi realizada para avaliar a associação entre as variáveis independentes com a falha do tratamento endodôntico (α = 5%). Resultados: Após 24 meses, a sobrevida do tratamento foi de 86% (EP = 0,03). A reabsorção radicular no início do estudo foi associada a um maior risco de falha (HR= 2,81; IC= 1,12-7,08; p= 0,027). Dentes tratados endodonticamente devido ao traumatismo dentário na dentição decídua apresentaram taxa de sobrevida de 100%, enquanto dentes com comprometimento pulpar devido à cárie dentária tiveram menor sobrevida (85,05%; p<0,001 *). Todas as outras variáveis analisadas como sexo, idade da criança, dente (incisivo/molar), tipo de restauração, qualidade da obturação e experiência de cárie não foram associadas à falha do tratamento (p> 0,05). Conclusão: O novo protocolo utilizando digluconato de clorexidina 2% e Feapex® apresentou alta sobrevida e pode ser considerado um protocolo adequado para pulpectomia em dentes decíduos.Registro do estudo clínico: REBEC (RBR-282s2f). (AU)

Physicochemical properties and filling capacity of an experimental iodoform-based paste in primary teeth

Abstract In this study, we evaluated the physicochemical properties (PCP; radiopacity, flow, pH, and solubility) and the quality of root canal filling provided by an experimental industrialized paste (EP), with the same active ingredients as those of the Guedes Pinto paste, compared with the Vitapex® paste. PCP were analyzed according to the ANSI/ADA laboratory testing methods for endodontic filling and sealing materials. To analyze filling capacity, 120 artificial primary teeth (60 maxillary incisors [MIs] and 60 mandibulary molars [MMs]) were endodontically treated. The teeth were divided into eight groups based on the dental group (MIs or MMs), filling material (Vitapex® or EP), and insertion method (syringe or lentulo). The Image J® software was used to analyze the initial an final digital radiographies of each tooth, measuring and comparing root canal and void areas. The percentage of filling failure areas was obtained. Data were submitted to ANOVA and Tukey test of mean comparison. Regarding PCP, both pastes presented results according the ANSI/ADA standards. Flow capacity: Vitapex: 19.6 mm, EP: 25 mm (p < 0.01); radiopacity: Vitapex: 4.47 mmAl, EP: 6.06 mmAl (p < 0.01); pH after 28 days: Vitapex: 7.79, EP: 8.19 (p = 0.12); and solubility after 28 days: Vitapex: 2.68%, EP: 2.89% (p > 0.05). Regarding filling capacity analysis, EP demonstrated 12.5% of failure against 31.5% of Vitapex (p < 0.01). Compared to Vitapex, EP presented statistically significantly better results in flow, radiopacity, pH, and filling capacity. Molars presented more filling failures than incisors. The insertion method using a syringe and a thin tip was significantly better than that using Lentulo spiral carriers.

Clinically relevant outcomes in dental clinical trials: challenges and proposals

Abstract The impact of clinical trials on patient care depends on the outcomes that they evaluate. In Dentistry, many trials use outcomes that are important to clinicians, but not to the patients. Thus, the aim of the present manuscript is to present an overview of the limitations, challenges, and proposals on the use of clinically relevant outcomes (CRO) in dental trials. Clinically relevant outcomes are variables that directly measure how the patient feels, functions, or survives. Some CROs, such as tooth loss, implant failure, and restorations failure require many years to occur and the number of events is low. The adoption of these variables as primary outcomes results in challenges for the researchers, such as use of large sample sizes and long follow-up periods. Surrogate outcomes, such as biomarkers, radiographic measurements and indexes, are frequently used to replace CROs. However, they present many limitations, since the effect of the treatment on a surrogate does not necessarily reflect a change in the clinical outcome. Some proposals for the adoption of CROs are presented, such as the development of core outcome sets within each dental specialties and the organization of multi-center clinical trials.

Choosing the Criteria for Clinical Evaluation of Composite Restorations: An Analysis of Impact on Reliabilty and Treatment Decision

Abstract Objective: To assess the reproducibility of two clinical criteria for the evaluation of restorations in primary teeth and the impact on treatment decision. Material and Methods: A cross-sectional study was performed selecting 71 resin-based composite restorations placed in primary molars of children who had sought dental treatment at a dental school. Two trained examiners evaluated independently the restorations using modified FDI and USPHS criteria. All restorations were assessed separately with each system in random order to avoid memory bias. Kappa statistics were used to determine inter-examiner reliability considering each parameter of both criteria and score final about treatment decision. McNemar test was used to compare the treatment decision with two criteria. The significance level was set at 5%. Results: Kappa values ranged from 0.28 to 0.93 with USPHS and 0.28 to 0.88 with FDI, considering each parameter separately. Inter-examiner agreement for treatment decision was excellent for both criteria (Kappa: 0.85-0.90). For clinical decision-making, no difference between criteria was found, irrespective of examiner. Conclusion: Low inter-examiner agreement for evaluation of each parameter of USPHS and FDI criteria does not reflect on reproducibility for treatment decision. Both criteria may be suitable for evaluation of composite restorations in primary teeth.

Exploring the association between genetic and environmental factors and molar incisor hypomineralization: evidence from a twin study.

BACKGROUND: The etiology of molar-incisor hypomineralization (MIH) remains unknown. Studies indicate that it is multifactorial, and that genetic and environmental factors are involved. Research with twins provides important subsidy to investigate the Influence of genetics and environmental factors that act during pregnancy on the etiology of alterations. AIM: This cross-sectional study evaluated the agreement of molar incisor hypomineralization (MIH) between monozygotic and dizygotic twin pairs and the association with environmental factors. DESIGN: The sample consisted of 167 pairs of twins (8-15 years old), 94 monozygotic and 73 dizygotic. The parents answered a questionnaire on sociodemographic data and pre-, peri-, and postnatal health. A dental examination was performed by two calibrated examiners (Kappa ≥0.88) for MIH diagnosis, following the criteria proposed by the European Academy of Pediatric Dentistry in 2003. RESULTS: The prevalence of MIH was 29.3%. There was greater concordance of MIH between monozygotic twins for affected first molars and permanent incisors (P = 0.0012) and pairs of twins assessed (P = 0.0211). The presence of MIH was associated with family income between one and two wages (P = 0.009, prevalence ratio [PR] = 3.82, confidence interval [CI 95%] 1.40-10.44), above two wages (P = 0.007, PR = 4.60, 95% CI: 1.51-14.05), and gestational hemorrhage (P = 0.032, PR = 5.70, 95% CI: 1.16-28.14). CONCLUSIONS: The greater concordance in the diagnosis of MIH among monozygotic twins indicates a genetic influence, although environmental factors, such as family income and hemorrhage during pregnancy, are also associated with the occurrence of MIH.

Assessment of oxidative stress in saliva of children with dental erosion / Avaliação do estresse oxidativo da saliva de crianças com erosão dentária

ABSTRACT Objective To evaluate oxidative stress in saliva of children with dental erosion as compared to children with no erosion. Methods One single examiner, trained and prepared to make diagnosis of dental erosion according to the Basic Erosive Wear Examination index, selected 40 children aged 4 to 6 years, who attended a pediatric dentistry prevention clinic. Two groups were formed - one comprising children with dental erosion (n=22), and another with no dental erosion (n=18). The quantity of dental biofilm was verified using the Simplified Index of Oral Hygiene, and unstimulated saliva was collected for biochemical analyses. The following were assessed in saliva: flow rate, buffering capacity, pH, and total protein concentration. Malondialdehyde levels were also verified to determine oxidative stress and total antioxidant status. Results The quantity of biofilm was smaller in children with mean dental erosion±standard deviation (0.76±0.25), as compared to those with no dental erosion (1.18±0.28). There was no statistical difference in saliva parameters of oxidative stress in children with dental erosion. Conclusion The activity of oxidative stress in saliva did not influence dental erosion process when in its early stages.

RESUMO Objetivo Avaliar o estresse oxidativo da saliva de crianças que possuíam erosão dentária, comparadas àquelas que não apresentavam esta situação. Métodos Um único examinador, treinado e calibrado para o diagnóstico de erosão dentária, segundo o índice de Basic Erosive Wear Examination, selecionou 40 crianças de 4 a 6 anos de idade que frequentavam uma clínica de prevenção de odontopediatria. Dois grupos foram formados - um com aquelas que apresentavam erosão (n=22) e outro sem erosão (n=18). A quantidade do biofilme dental foi obtida utilizando o Índice de Higiene Oral Simplificado, tendo sido feita a coleta de saliva não estimulada para as análises bioquímicas. O fluxo salivar, a capacidade tampão da saliva, o pH salivar e a proteína total da saliva foram avaliados. Também foi verificado o valor do malondialdeído para determinação do estresse oxidativo e o total antioxidante. Resultados A quantidade de biofilme foi menor nas crianças, com erosão dentária média±desvio padrão (0,76±0,25) comparadas àquelas sem erosão dentária (1,18±0,28). Não houve diferença estatística nos parâmetros salivares de estresse oxidativo em crianças com erosão dentária. Conclusão A ação do estresse oxidativo na saliva não influenciou na erosão dentária, quando ainda nos estágios iniciais.

Influence of Electroacupuncture and Laser-Acupuncture on Treating Paresthesia in Patients Submitted to Combined Orthognathic Surgery and Genioplasty.

Objective: The goal of this research was to observe the influence of electroacupuncture (EA) and laser-acupuncture on the return of tactile/pain sensitivity in patients who underwent orthognathic surgery. Materials and Methods: Thirty volunteers subjected to orthognathic surgery were evaluated and randomly divided into 2 groups, in which 3 treatments were evaluated: control (n = 30) (G0, medication + placebo laser treatment) and 2 experimental treatments (n = 15) (G1, medication + EA) or G2 (medication + laser-acupuncture). The control group had n = 30 because for each experimental treatment conducted on a volunteer's hemi-face, there was a control treatment on the other hemi-face. In G1, medication was given with EA, with needles placed at predetermined points (ST 4 [Dicang], M-HN-18 [Jiachengjiang], CV 24 [Chengjiang], ST 5 [Daying], ST 6 [Jiache], and point A1 [YNSA]). For electrostimulation, the device used delivered transcutaneous electrical nerve stimulation of a burst type, with intensity and frequency variations of T = 220 ms and F = 4 Hz (30 minutes, 2 × /week). In G2, in addition to the medication, laser irradiation (at 780 nm) was applied on acupuncture points (at 0.04 cm2, 70 mW, 6 s/point, 0.42 J/point, 10 J/cm2, 2 × /week). All volunteers were evaluated before and during the 4 months following the surgery. Tactile sensitivity was assessed by mechanical brushing (brush #s 2 and 12) and by a 2-point discrimination test, using a bow compass. A pain test was performed with a pulp electrical test that stimulates intact nerves of the dentin-pulp complex. A Kaplan-Meier test was performed, and survival curves were plotted for comparison between groups. Cox regression analysis was also conducted (α = 0.05). Results: There were no statistically significant differences among the groups for the 2-point discrimination test (brushes #2 and #12) on the buccal mucosa region and for the pulp test on all evaluated regions. However, the tactile test using brush #12 revealed significant differences between G1 and the other groups when considering the lower lip (P = 0.024) and chin (P = 0.028) areas. Conclusions: Only EA was able to influence-using the brushing test (brush #12)-the return of tactile sensitivity on the chin and lower lip positively after combined orthognathic surgery and genioplasty.