Influence of the FDI criteria in the restorations' evaluation and treatment decision in primary molars / Influência dos critérios da FDI na avaliação de restaurações e decisão de tratamento em molares decíduos

Objective: This study investigated the impact of FDI criteria for evaluating restorations on examiners' decision-making compared with their previous personal judgment in primary teeth. Secondly, the possible factors related to changes when using the criteria, including the examiners' experience were explored. Material and Methods: A cross-sectional study in a dental office setting was conducted selecting 27 resin composite restorations placed in primary molars in 11 children. Examinations of the restorations were performed by five undergraduate and five graduate dental students. First, the evaluations were performed based on personal judgment, and 2 weeks later, with FDI criteria. All examiners underwent training to use the FDI criteria after the first evaluation. The consensus of two benchmark examiners was considered to be the reference standard. Initially, a descriptive analysis was performed. Multiple Poisson regressions analyses were used to identify possible associated factors with outcomes - to be less or more invasive based on the FDI criteria than personal judgment. Results: The use of the FDI criteria changed the examiners' decisions in approximately 15% of the cases. Irrespective of examiners' experience, there was a trend of false results (compared to the reference examiners) when a change in the treatment decision was registered by using the FDI criteria. Examiners chose a less invasive option when assessing multi surface restorations with FDI criteria (PR=2.04, 95%CI=1.03-4.05; p=0.04). Examiners who spent more time for evaluation with FDI criteria were more invasive (PR=1.001, 95%CI=1.0001-1.002; p=0.03). Students were more invasive with the FDI criteria when examined children with higher dmf-t (PR=1.16, 95%CI=1.01-1.32; p=0.03). Conclusion: The use of the FDI criteria negatively influenced the restorations' evaluation and treatment decision in primary molars by undergraduate and graduate students.(AU)

Objetivo: Este estudo investigou o impacto dos critérios da FDI para avaliar restaurações na tomade de decisão feita pelos examinadores em comparação ao seu julgamento pessoal prévio em dentes decíduos. Secundariamente, foram explorados os possíveis fatores relacionados com mudanças causadas pelo uso dos critérios, incluindo a experiência dos examinadores. Material e Métodos: Um estudo transversal em ambiente de consultório odontológico foi conduzido selecionando 27 restaurações de resina composta realizado em molares decíduos em 11 crianças. As avaliações das restaurações foram realizadas por cinco estudantes de Graduação e cinco de Pós-graduação em Odontologia. As avaliações foram realizadas com base no julgamento pessoal e, duas semanas depois, com os critérios da FDI. Todos os examinadores foram treinados para utilizar os critérios da FDI após a primeira avaliação. O consenso de dois examinadores "padrão-ouro" foi considerado o padrão de referência. Inicialmente, uma análise descritiva foi realizada. Análises de regressão múltipla de Poisson foram utilizadas para identificar possíveis fatores associados com os desfechos ­ ser mais ou menos invasivo com o uso dos critérios da FDI em relação ao julgamento pessoal. Resultados: A utilização dos critérios do FDI alterou as decisões dos examinadores em aproximadamente 15% dos casos. Independente da experiência dos examinadores, houve uma tendência de resultados falsos (em comparação com os examinadores de referência) quando uma mudança na decisão de tratamento foi registrada usando os critérios da FDI. Os examinadores escolheram uma opção menos invasiva quando avaliaram restaurações envolvendo múltiplas superfícies com os critérios da FDI (RP = 2,04, IC 95% = 1,03-4,05; p = 0,04). Os examinadores que levaram mais tempo para avaliação das restaurações foram mais invasivos com o uso dos critérios da FDI (RP = 1,001, IC 95% = 1,0001-1,0002; p = 0,03). Os alunos foram mais invasivos com o uso dos critérios da FDI quando examinaram crianças com maior experiência de cárie (RP = 1,16, IC 95% = 1,01-1,32; p = 0,03). Conclusão: O uso dos critérios da FDI influenciou negativamente a avaliação das restaurações e decisão de tratamento em dentes decíduos realizada por estudantes de graduação e pós-graduação. (AU)

Can be Grandmother as Childs Daytime Caregiver a Risk Factor for Higher Caries Experience in Early Childhood? A Retrospective Study

Abstract Objective: To investigate the association between child's daytime caring person and risk for higher early childhood caries (ECC) experience. Material and Methods: The sample consisted of all clinical records (census) of children (0-3 years old) attended in a public dental clinic, which contained information about caries experience and child's daytime caring person (mother, grandmother or others). Caries experience was dichotomized as dmft ≤ 2 or dmft >2. Data were analyzed by the chi-square (α = 0.05). Binary logistic regression models were built. Results: From a total of 310 children, 19% of children had the grandmother as daytime caring person. There was no association between child's daytime caring person and caries experience (p=0.32). Logistic regression analysis showed that low daytime caregiver schooling (OR: 5.76 95%CI 1.18-28.18; p=0.02) and child's age (OR: 1.14 95% CI 1.09-1.19; p=0.00) were risk factors, and breastfeeding duration (> 9 months - OR: 0.38 95% CI 0.21-0.68; p=0.00), no nocturnal feeding (OR: 0.50 95% CI 0.27-0.91; p=0.02), and absence of sugar consumption between main meals (OR: 0.50 95% CI 0.28-0.89; p=0.02) were protection factors for ECC. Conclusion: A higher caries experience in early childhood is not associated to child's daytime caring person. On the other hand, the higher caries experience is associated with low caregiver schooling and older children.

Shortening of etching time of the dentin in primary teeth restorations: a randomized clinical trial

Abstract The aim of this study was to investigate the influence of shortening of etching time for dentin on the restoration survival after selective carious tissue removal in primary molars. This two-arm randomized clinical trial included sixty-two subjects (5-8 year-old) and 100 primary molars presenting moderate dentin carious lesions on occlusal surface. The sample was randomly assigned into groups previously to adhesive application (Adper Single Bond 2; 3M ESPE): etching time recommended by manufacturer (15 s) or reduced (7 s). Resin composite (Filtek Bulk Fill Posterior Restorative; 3M ESPE) was inserted in a single increment for all restorations. Restorations were evaluated at 1, 6, 12, and 18 months using FDI criteria. Survival estimates for restorations' longevity were evaluated with Kaplan-Meier method. Multivariate Cox regression analysis with shared frailty was used to assess the factors associated with failures (p < 0.05). The etching time did not influence the restorations' survival (HR 0.35 95%CI 0.11-1.12; p = 0.06). Mean estimated time of survival was 17.6 months (95%CI, 17.2-17.9). The survival rates at the 18-month follow-up were 75.7% and 91.4% (AFR: 16.9% and 5.7%) when primary dentin was acid etched for 15 and 7 s, respectively (log-rank p = 0.06). In conclusion, the etching time for dentin did not influence the clinical behavior of adhesives restorations. However, there was a tendency for better clinical outcome when using etching time of 7 s.

Is there a best conventional material for restoring posterior primary teeth? A network meta-analysis

Abstract This study aimed to compare the longevity of different conventional restorative materials placed in posterior primary teeth. This systematic review was conducted following the PRISMA statement and registered in PROSPERO (CRD42016035775). A comprehensive electronic search without date or language restrictions was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, Turning Research Into Practice (TRIP) and Clinical Trials databases up to January 2017, selecting randomized clinical trials that assessed the longevity of at least two different conventional restorative materials performed in primary molars. Seventeen studies were included in this systematic review. Pairwise and network meta-analyses were performed and relative risks and 95% confidence intervals (CI) calculated. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Restorations of primary molars with conventional glass ionomer cement showed increased risk of failure than compomer, resin-modified glass ionomer cement, amalgam, and composite resin. Risk of bias was low in most studies (45.38% of all items across studies). Pediatric dentists should avoid conventional glass ionomer cement for restoring primary molars.

Materials used for indirect pulp treatment in primary teeth: a mixed treatment comparisons meta-analysis

Abstract: This study aimed to systematically review the literature to address the question regarding the influence of different materials in the clinical and radiographic success of indirect pulp treatment in primary teeth. A literature search was carried out for articles published prior to January 2017 in PubMed/MEDLINE, CENTRAL, Scopus, TRIP and ClinicalTrials databases; relevant articles included randomized clinical trials that compared materials used for indirect pulp treatment in primary teeth. Two reviewers independently selected the studies and extracted the data. The effects of each material on the outcome (clinical and radiographic failures) were analyzed using a mixed treatment comparisons meta-analysis. The ranking of treatments according to their probability of being the best choice was also calculated. From 1,088 potentially eligible studies, 11 were selected for full-text analysis, and 4 were included in the meta-analysis. In all papers, calcium hydroxide liner was used as the control group versus an adhesive system, resin-modified glass ionomer cement or placebo. The follow-up period ranged from 24 to 48 months, with dropout rates of 0-25.7%. The material type did not significantly affect the risk of failure of the indirect pulp treatment. However, calcium hydroxide presented a higher probability of failure. In conclusion, there is no scientific evidence showing the superiority of any material used for indirect pulp treatment in primary teeth.