Impact of the undergraduate clinical teaching-learning process on caries detection and treatment decision-making

Aim: The aim of this study was to evaluate caries diagnosis and treatment decisions made by undergraduate dental students based on ICDAS or Nyvad criteria. Methods: Twelve students analyzed 90 digital photographs of permanent teeth at different clinical stages of carious lesion development and chose among different treatments in three different assessments: when there was no knowledge of the criteria (described as "No knowledge (N)"; when there was theoretical knowledge of the criteria (described as "Theoretical knowledge (T)" and when there was theoretical knowledge, clinical experience about dental caries and the criteria (described as "Theoretical and clinical knowledge (TC)". For "T" and "TC" the students were randomized into two experimental groups ­ ICDAS or Nyvad (experimental units: 6 students/group). The reference standard was established cooperatively by two experienced researchers. Criteria performance was evaluated by sensitivity, specificity, AUC, and Kappa statistics. Treatment decision was described in percentage by contingency tables and Spearman's correlation with the reference standard. Results: The first assessment demonstrated a high percentage of operative treatment even for initial enamel lesions based on ICDAS criteria and treatment was proposed for both active and inactive lesions, according to the Nyvad criteria. In the second assessment, the students continued recommending treatments for initial or inactive lesions, but less frequently. In the third assessment, treatment decisions presented greater cohesion in relation to the assigned classification criterion. The criteria presented no differences between them in terms of diagnostic in the third assessment. Conclusion: Clinical experience may improve caries detection and treatment decisions with the use of ICDAS and Nyvad criteria

Inheritance pattern of molar-incisor hypomineralization

Abstract The aim of this study was to investigate the segregation patterns of molar incisor hypomineralization (MIH) in families, given the evidence that its etiology is influenced by genetics. Clinically, MIH may be detected in parents and/or siblings of MIH-affected children. Our study included children with at least one first permanent molar affected by MIH (proband) and their first-degree relatives (parents and siblings). The participants were examined clinically to detect MIH, according to the European Academy of Paediatric Dentistry criteria (2003). A total of 101 nuclear families (391 individuals) were studied. Proband diagnosis was followed by MIH classification of the subject, his parents and siblings, as affected, unaffected, or unknown. Segregation analysis was performed using the multivariate logistic regression model of the Statistical Analysis for Genetic Epidemiology package, and segregation models (general transmission, environmental, major gene, dominant, codominant and recessive models). The Akaike information criterion (AIC) was used to evaluate the most parsimonious model. In all, 130 affected individuals, 165 unaffected individuals, and 96 unknown individuals were studied. Severe MIH was found in 50.7% of the cases. A segregation analysis performed for MIH revealed the following different models: environmental and dominance (p = 0.05), major gene (p = 0.04), codominant (p = 0.15) and recessive models (p = 0.03). According to the AIC values, the codominant model was the most parsimonious (AIC = 308.36). Our results suggest that the codominant model could be the most likely for inheriting MIH. This result strengthens the evidence that genetic factors, such as multifactorial complex defect, influence MIH.

In vivo effect of fluoride combined with amoxicillin on enamel development in rats

Abstract Some evidence in vitro suggested that amoxicillin and fluoride could disturb the enamel mineralization. Objective: To assess the effect of amoxicillin and of the combination of amoxicillin and fluoride on enamel mineralization in rats. Methodology: In total, 40 rats were randomly assigned to four groups: control group (CG); amoxicillin group (AG - amoxicillin (500 mg/kg/day), fluoride group (FG - fluoridated water (100 ppm -221 mg F/L), and amoxicillin + fluoride group (AFG). After 60 days, the samples were collected from plasma and tibiae and analyzed for fluoride (F) concentration. The incisors were also collected to determine the severity of fluorosis using the Dental Fluorosis by Image Analysis (DFIA) software, concentration of F, measurements of enamel thickness, and hardness. The data were analyzed by ANOVA, Tukey's post-hoc test, or Games-Howell post-hoc test (α=0.05). Results: Enamel thickness of the incisors did not differ statistically among the groups (p=0.228). Groups exposed to fluoride (AFG and FG) have higher F concentrations in plasma, bone and teeth than those not exposed to fluoride (CG and AG). The groups showed a similar behavior in the DFIA and hardness test, with the FG and AFG groups showing more severe fluorosis defects and significant lower hardness when compared with the AG and CG groups, with no difference from each other. Conclusion: The rats exposed to fluoride or fluoride + amoxicillin developed dental fluorosis, while exposure to amoxicillin alone did not lead to enamel defects.

Aesthetical perception of dental fluorosis in a Colombian low income community / Percepção estética da fluorose dentária em uma comunidade colombiana de baixa renda / Percepción estética de la fluorosis dental en una comunidad colombiana de bajos ingresos

Abstract Introduction and objective: The Dental Fluorosis (DF) is a development defect of enamel resulting from overexposure to fluoride and can aesthetically compromise the patient. This study aims to investigate the relationship between aesthetic perception and dental fluorosis (DF) in a low-income community with high DF prevalence. Materials and methods: A cross-sectional study was conducted with 171 Colombian schoolchildren aged 8 to 12 years living in low socioeconomic community (El Cedro, district of Ayapel, Córdoba, Colombia). After receiving authorization, the students were examined for DMFT and dmft indexes (WHO criteria), and for DF (TF index). The aesthetic perceptions were verified by the Child Perceptions Questionnaire About Tooth Appearance (CQATA). Data analysis was carried out using descriptive statistics, the chi-square test, the Student´s t-test, the one-way ANOVA test, and linear regression at a significance level of p ≤ 0.05. Results: The prevalence of DF in this sample was 84.8% (n=145). Only the presence of caries (DMFT/ deft≠ 0) had a significant impact on aesthetic perceptions. A significantly lower rate was found in girls for the report of pleasant color domain. The number of teeth affected by DF had a significant positive correlation with mean overall perception of dental health. Conclusion: The presence of mild DF in children with low socioeconomic status, from a population with a high prevalence of the condition, did not seem to have an impact on the report of pleasant color of teeth domain.

Resumo Introdução e Objetivo: A fluorose dentária (FD) é um defeito de desenvolvimento do esmalte decorrente da sobre-exposição ao flúor e pode comprometer esteticamente o paciente. O presente estudo se propõe a investigar a relação entre percepção estética e fluorose dentária em uma comunidade de baixa renda com alta prevalência de FD. Materiais e métodos: Foi realizado um estudo transversal com 171 escolares colombianos de 8 a 12 anos de idade, moradores de uma comunidade de baixa renda (El Cedro, distrito de Ayapel, Córdoba, Colômbia). Após receber autorização, os estudantes foram examinados para os índices CPOD e ceod (OMS) e para o FD (TF index). As percepções estéticas foram verificadas pelo "Child Perception Questionaire about Teeth Appearence" (CQATA). A análise dos dados foi realizada por meio de estatística descritiva, teste do qui-quadrado, teste t de Student, teste ANOVA one-way e regressão linear em nível de significância de p ≤ 0,05. Resultados: A prevalência de FD nesta amostra foi de 84,8% (n = 145). Apenas a presença de cáries (CPOD/cpod≠0) teve um impacto significativo nas percepções estéticas. Uma taxa significativamente menor foi encontrada em meninas para o relato de domínio de cor agradável. O número de dentes afetados pela FD teve correlação positiva significativa com a percepção geral da saúde bucal. Conclusão: A presença de FD leve em crianças com baixo nível socioeconômico, de uma população com alta prevalência da doença, não parece ter impacto na satisfação com a coloração dos dentes.

Resumen Introducción y objetivo: La fluorosis dental (FD) es un defecto en el desarrollo del esmalte como resultado de la sobreexposición al fluoruro y puede comprometer estéticamente al paciente. Este estudio tiene como objetivo investigar la relación entre la percepción estética y la fluorosis dental en una comunidad de bajos ingresos económicos y con alta prevalencia de FD. Materiales y métodos: Se realizó un estudio transversal con 171 escolares de 8 a 12 años que viven en una comunidad socioeconómica baja (El Cedro, distrito de Ayapel, Córdoba, Colombia). Los estudiantes fueron examinados para caries dentaria (índices DMFT y dmft (criterios de la OMS) y para el fluorosis dentaria (índice TF). La percepción estética se verifico con el cuestionario sobre percepciones de los niños sobre la apariencia de los dientes (CQATA). El análisis de los datos se realizó mediante estadísticas descriptivas y las pruebas de chi cuadrado, t de Student, ANOVA de una vía y la regresión lineal (p ≤ 0.05). Resultados: La prevalencia de FD fue de 84.8% (n = 145). Solo la presencia de caries (DMFT/deft ≠ 0) tuvo un impacto significativo en las percepciones estéticas. Se encontró una tasa significativamente más baja en las niñas para el informe acerca de color agradable. La cantidad de dientes afectados por FD tuvo una correlación positiva significativa con la percepción general de la salud dental. Conclusión: La presencia de FD leve en niños con bajo nivel socioeconómico, en una población con una alta prevalencia de este defecto de esmalte, no pareció tener tuvo un impacto en la aceptción aceptar la apariencia del color de los dientes.

The effect of amoxicillin on dental enamel development in vivo

Abstract The exposure to amoxicillin has been associated with molar incisor hypomineralization. This study aimed to determine if amoxicillin disturbs the enamel mineralization in in vivo experiments. Fifteen pregnant rats were randomly assigned into three groups to received daily phosphatase-buffered saline or amoxicillin as either 100 or 500 mg/kg. Mice received treatment from day 13 of pregnancy to day 40 postnatal. After birth, the offsprings from each litter continued to receive the same treatment according to their respective group. Calcium (Ca) and phosphorus (P) content in the dental hard tissues were analyzed from 60 upper first molars and 60 upper incisors by the complexometric titration method and colorimetric analysis using a spectrophotometer at 680 nm, respectively. Lower incisors were analyzed by X-ray microtomography, it was measured the electron density of lingual and buccal enamel, and the enamel and dentin thickness. Differences in Ca and P content and electron density among the groups were analyzed by one-way ANOVA. There was no significant difference on enamel electron density and thickness among the groups (p > 0.05). However, in incisors, the higher dose of amoxicillin decreased markedly the electron density in some rats. There were no statistically significant differences in Ca (p = 0.180) or P content (p = 0.054), although the higher dose of amoxicillin could affect the enamel in some animals. The amoxicillin did not significantly alter the enamel mineralization and thickness in rats.

Influence of caries risk on the retention of a resin-modified glass ionomer used as occlusal sealant: a clinical trial / Influência do risco de cárie na retenção de um ionômero de vidro modificado por resina usado como selante oclusal: ensaio clínico

Introduction: Little is known whether caries risk influence occlusal sealants retention. Objective: To determine the retention rates (RR) of the resin-modified glass ionomer cement used as occlusal sealant in permanent first molars of 6-8-year old schoolchildren and to analyze the influence of caries risk at baseline on the RR of the sealant, over a 24-month period. Material and method: The sealant application was performed in a dental office at the beginning of the study, after children being allocated into high caries risk group (HR) and low caries risk group (LR). The examinations were performed by the same calibrated dentist at 0, 6, 12, 18 and 24 months. Retention rates were estimated, the Kaplan-Meier method was used to estimate the survival probabilities; and the comparison between HR and LR groups was evaluated by Wilcoxon and log-rank test. Result: The results showed that 14% of sealed teeth showed total loss (16% for HR and 12% for LR) and 46% showed partial loss during the study (51% for HR and 41% for LR), in relation to the baseline sample. No difference could be demonstrated by the survival analysis between HR and LR groups (p>0.05). Conclusion: Caries risk did not influence the retention rates of a resin-modified glass ionomer cement used as occlusal sealant in 6-8-year old schoolchildren.

Introdução: Pouco se sabe sobre a influência do risco de cárie na retenção de selantes oclusais. Objetivo: Avaliar as taxas de retenção de um cimento de ionômero de vidro modificado por resina utilizado como selante oclusal em primeiros molares permanentes de escolares de 6-8 anos, e analisar a influência do risco de cárie na taxa de retenção do selante, durante um período de 24 meses. Material e método: A aplicação do selante foi realizada em consultório odontológico no início do estudo, após as crianças serem alocados no grupo de alto risco (AR) ou baixo risco (BR) de cárie. Os exames foram realizados pelo mesmo dentista calibrado em 0, 6, 12, 18 e 24 meses. As taxas de retenção foram estimadas e o método de Kaplan-Meier foi utilizado para estimar as probabilidades de sobrevivência. A comparação entre os grupos AR e BR foi avaliada pelos testes de Wilcoxon e log-rank. Resultado: Os resultados mostraram que 14% dos dentes selados apresentaram perda total (16% para AR e 12% para BR) e 46% apresentaram perda parcial durante o estudo (51% de AR e 41% para BR), em relação a amostra no início do estudo. Nenhuma diferença pode ser demonstrada pela análise de sobrevivência entre os grupos AR e BR (p> 0,05). Conclusão: O risco de cárie não influenciou as taxas de retenção de um cimento de ionômero de vidro modificado por resina usado como selante oclusal em escolares de 6-8 anos de idade.

Survival of sealants in molars affected by molar-incisor hypomineralization: 18-month follow-up

Abstract The objective of this study was to evaluate the clinical survival of sealants applied in first permanent molars (FPMs) affected by molar-incisor hypomineralization (MIH), at 18 months of follow-up. Forty-one first permanent molars were selected from 21 children, 6–8 years of age. MIH was classified by one calibrated examiner (kappa = 0.80) according to EAPD criteria. The inclusion criteria were fully erupted FPMs with MIH or sound FPMs (without MIH) for which sealant treatment was indicated. The FPMs were assigned to two groups: CG (control group) and HG (MIH group). Both groups were treated with sealant (FluroShield). Clinical follow-up was performed from baseline to 18 months to assess anatomical form, marginal adaptation, retention and presence of caries, according to criteria set by the United States Public Health Service-Modified, and was conducted by a blinded examiner (kappa = 0.80). The actuarial method was used to evaluate the survival of the sealants. The survival rates for the groups were compared using Fisher’s exact test (α = 5%). The cumulative survival rates were 81% at 1 month, 68.8% at 6 months, 68.8% at 12 months, and 62.6% at 18 months for CG, and 88% at 1 month, 84% at 6 months, 76% at 12 months, and 72% at 18 months for HG. No significant difference was found between the groups. The sealants in molars affected by MIH presented a survival rate similar to the sealants in the control, suggesting that sealants may be an adequate approach for preventing carious lesions in MIH-affected molars.

Perfil do atendimento odontológico no Serviço de Urgência para crianças e adolescentes da Faculdade de Odontologia de Araraquara (FOAr) - UNESP / Treatment profile at dental urgent care clinic for children and teenagers from Faculdade de Odontologia de Araraquara (FOAr) - UNESP

Introdução: Atendimentos de urgência são uma prática comum em Odontopediatria, porém pouco se sabe sobre o perfil desses atendimentos. Objetivo: Avaliar o perfil dos atendimentos de urgência de crianças de 0 a 13 anos de idade realizados na Clínica Infantil da FOAr, no período de 1997 a 2012, a fim de se quantificarem os pacientes e os procedimentos realizados no Serviço, além de identificar os tratamentos mais realizados. Material e método: Neste estudo transversal observacional, os relatórios desse Serviço, fornecidos pelo Sistema Integrado de Clínicas, foram analisados quanto ao número de pacientes, aos atendimentos e ao tipo de procedimentos realizados. Os procedimentos foram classificados em sete categorias: Diagnóstico, Preventivos, Anestesia, Endodônticos, Restauradores, Cirúrgicos e Outros. Esses dados foram tabulados e submetidos a uma análise descritiva. Resultado: De 1997 a 2012, foi atendido um total de 13.849 pacientes e foram realizados 25.786 atendimentos e 86.279 procedimentos. Houve diminuição do número de pacientes atendidos a partir de 2001, mas o número de consultas e de procedimentos não diminuiu na mesma proporção. Observou-se que, durante o período de 2007 a 2012, os procedimentos de diagnóstico foram os mais realizados, seguidos pelos preventivos. Dentre os procedimentos operatórios, o mais realizado foi o restaurador, seguido dos endodônticos. Procedimentos cirúrgicos estão entre os menos realizados. Conclusão: Conclui-se que houve uma mudança no perfil dos atendimentos dentro desse Serviço. Apesar de haver uma redução no número de pacientes atendidos, o número de consultas e a quantidade de procedimentos realizados permaneceram estáveis. Os procedimentos realizados estão de acordo com o perfil do Serviço de Urgência.

Introduction: Urgency care is a common practice in pediatric dentistry but little is known about the profile of these visits. Objective: To evaluate the profile of patients aged between 0 and 13 years assisted at the Urgency Unit offered by FOAr, from 1997 to 2012, in order to quantify patients and procedures performed and identify the most frequently treatments performed. Material and method: In this observational transversal study, the reports of urgency service provided by the Integrated Clinical System were analyzed for the number of patients, treatments and type of procedures performed. The procedures were classified into seven categories: Diagnosis, Preventive, Anesthesia, Endodontic, Restorative, Surgical and Others. The data were organized and analyzed descriptively. Results: From 1997 to 2012, a total of 13,849 patients were treated in 25,786 visits and 86,279 procedures were conducted. A decrease in the number of patients assisted was observed. However, the number of appointments and the number of procedures did not decrease at the same ratio. Diagnosis procedures were the most frequent procedure performed, followed by preventive procedures. Restorative and endodontic treatments were the most frequent operative procedure performed. Dental surgeries were done less frequently. Conclusion: A profile change in the dental urgent treatment was observed throughout the years. Despite a reduction in the number of patients assisted, the number of visits and the amount of procedures performed remained stable. The procedures performed are in agreement with the profile of a dental urgent care clinic.

Desempenho de métodos baseados em indução de fluorescência na avaliação da remoção de dentina cariada / Performance of fluorescence-based methods in evaluating dentin caries removal

Introdução: Critérios clínicos vêm sendo utilizados para determinação da presença de tecido cariado remanescente, mas geram dúvidas, tornando-se relevante a utilização de métodos que auxiliem na determinação da presença de cárie dentária remanescente. Objetivo: Avaliar in vitro a eficácia de métodos de indução de fluorescência no diagnóstico da remoção de tecido cariado artificial dentinário. Material e método: O esmalte oclusal de 94 terceiros molares humanos hígidos foi removido, expondo a dentina subjacente, para indução microbiológica de lesão de cárie artificial. Após a remoção do tecido cariado induzido, o remanescente dentinário foi avaliado por dois examinadores com DIAGNOdent, DIAGNOdent pen e Quantitative Light-Induced Fluorescence (QLF). Após todas as avaliações, secções dos dentes foram observadas e fotografadas em lupa estereoscópica com 30× de aumento por um examinador independente. As imagens foram analisadas no software Image J, permitindo a quantificação de tecido remanescente em milímetros quadrados. Foi calculada a reprodutibilidade interexaminador através de coeficiente intraclasse, sensibilidade, especificidade e área sob a curva ROC, e o teste de McNemar (p< 0,05) foi aplicado para comparação dos diferentes métodos. Resultado: Dos 94 dentes, 51 (54,2%) apresentaram remanescente de tecido cariado. Os valores de sensibilidade, especificidade e área sobre a curva ROC foram semelhantes para os três grupos (p> 0,05). Os valores de reprodutibilidade variaram entre 0,952 e 0,978. Conclusão: Dentre os métodos utilizados, o DIAGNOdent e o DIAGNOdent pen apresentaram melhor desempenho na avaliação da presença de cárie artificial remanescente quando comparados ao QLF.

Introduction: Clinical criteria have been used for the determination of the presence of residual caries, however in a subjective manner. Then the use of auxiliary methods that assist in determination of the remaining presence of caries can be considered for this purpose. Objective: Evaluate the in in vitro efficacy fluorescence induction methods in the diagnosis of removing artificial dentinal caries. Material and method: Ninety-four thirds sound human molars without occlusal enamel were used for microbiological artificial caries lesion induction. The decayed tissue was removed and the remaining dentin evaluated by two examiners with DIAGNOdent, DIAGNOdent pen and Quantitative Light-Induced Fluorescence - QLF. After all assessments, sections of the specimens were observed and photographed in stereoscopic lens with 30× increase by an independent examiner. These images were analyzed with Image J software, allowing quantitation of remaining caries tissue in mm2. The inter-examiner reliability, sensitivity, specificity, and area under the ROC curve was calculated and the McNemar test (p< 0.05) was used to compare the different among methods. Result: Of the 94 teeth, 51 (54.2%) had residual caries. The sensitivity, specificity, and area under the ROC curve were similar for the three methods (p> 0.05). The inter-examiner agreement ranged between 0.952 and 0.978. Conclusion: Among the methods used, the DIAGNOdent, DIAGNOdent pen showed better performance in residual caries detection after dentin caries removal when compared to QLF.

Molar incisor hypomineralization (MIH): conservative treatment management to restore affected teeth

The purpose of this study was to evaluate the 12-month clinical performance of glass ionomer restorations in teeth with MIH. First permanent molars affected by MIH (48) were restored with glass ionomer cement (GIC) and evaluated at baseline, at 6 and at 12 months, by assessing tooth enamel breakdown, GIC breakdown and caries lesion associations. The data were analyzed using the chi-square test and actuarial survival analysis. The likelihood of a restored tooth remaining unchanged at the end of 12 months was 78%. No statistically significant difference was observed in the association between increased MIH severity and caries at baseline (p > 0.05) for a 6-month period, or between increased MIH severity and previous unsatisfactory treatment at baseline (p > 0.05) for both a 6- and 12-month period. A statistically significant difference was observed in the association between increased MIH severity and extension of the restoration, involving 2 or more surfaces (p < 0.05) at both periods, and between increased MIH severity and caries at baseline (p < 0.05) at a 12-month period. Because the likelihood of maintaining the tooth structures with GIC restorations is high, invasive treatment should be postponed until the child is sufficiently mature to cooperate with the treatment, mainly of teeth affected on just one face.

Molar-incisor hypomineralization in schoolchildren of Manaus, Brazil

To analyze the prevalence and severity of Molar Incisor Hypomineralization (MIH) and its relationship with dental caries in public school children in Manaus/AM.Material and Methods:Overall, 2,062 primary school children aged 6-10 years were examined to obtain MIH, DMFT, dmft and DDE indexes. The participation of five schools in each district of the city of Manaus was randomly determined, totaling 40 schools, and in each of them, two classes of each grade of elementary school in two shifts were selected, totaling 10 classes. Clinical examinations were conducted by two previously calibrated examiners in school environment under natural lighting. Data collected were submitted to descriptive statistical analysis by Chi-square, Fisher's Exact and Mann-Whitney tests at 5% significance level. Results:The prevalence of MIH in Manaus was 9.12% and no significant association with gender and age of schoolchildren was found. The mandibular arch was the most affected, with greaternumber of teeth being affected on the left side. The most frequently affected teeth were the mandibular permanent first molars, followed by maxillary counterparts and maxillary/mandibular central incisors. The most frequent diagnosis was mild MIH. The DMFT of children with MIH was 1.58 and dmft was 2.47, higher than those of the unaffected group. A correlation was found between DDE and MIH. Conclusion:Earlydiagnosis of MIH is imperative, since children affected show high risk for the development of dental caries...

Accuracy of radiographic examination in determining the depth ofapproximal carious lesions in primary molars / Desempenho do exame radiográfico na determinação da profundidade de lesões de cárie proximais em molares decíduos

Objective: The purpose of this study was to evaluate the accuracy of the depth of carious lesions on bitewing radiographs. Methods: Recently extracted primary molars had their proximal surfaces evaluated visually (EC) and classified as healthy surface (0), signs that suggest thepresence of carious lesions in enamel (1), signs of a superficial lesion in dentin (2) and carious lesions in deep dentin (3). Results: The results were obtained by consensus between the investigators. The gold standard was determined by histological analysis. The valuesof sensitivity, specificity, accuracy and area under the ROC (Receiver Operating Characteristic) curve were evaluated. There was equilibriumbetween sensitivity (76.92% EC and 88.46% ER) and specificity (95.83% EC and 95.83% ER). Accuracy was 86.01% (EC) and 88.46% (ER).The Spearman correlation test was used to prove the correlation between clinical and radiographic examinations (0.886), for clinical andhistological (0.736) and for radiographic and histological analysis (0.843).Conclusion: The radiographic examination showed better performance in detection of proximal caries in primary teeth.

Objetivo: Avaliar a exatidão da profundidade da lesão de cárie em radiografias interproximais. Métodos: Molares decíduos recentemente extraídos tiveram suas superfícies proximais avaliadas visualmente (exame clínico) e classificados como superfície hígida (0), sinais que sugerem presença de lesão de cárie em esmalte (1), sinais de lesão superficial em dentina (2) e cavidades sugerindo lesões profundas em dentina (3). As superfícies dentárias foram também examinadas em radiografias interproximais (exame radiográfico) e classificadas como ausência de radiolucidez (0), lesão de cárie em esmalte (1), lesão de cárie superficial em dentina (2) e lesão de cárie em dentina profunda (3).Resultados: Os resultados foram obtidos por meio de consenso entre os examinadores. O padrão ouro foi determinado pela análise histológica. Foram avaliados os valores de sensibilidade, especificidade, acurácia e área sob a curva Receiver Operating Characteristic. Observou-se um equilíbrio entre os valores de sensibilidade (76,9% exame clínico e 88,4% exame radiográfico) e especificidade (95,8% exame clínico e 95,8% exame radiográfico). A acurácia foi de 86,0% (exame clínico) e 88,4% (exame radiográfico). O teste de correlação de Spearman foi utilizado paraa comprovação da correlação entre os exames clínico e radiográfico (0,89), para clínico e histológico (0,7) e para os exames radiográfico ehistológico (0,8). Conclusão: O exame radiográfico apresentou melhor desempenho na detecção da lesão de cárie proximal em dentes decíduos.

M.I.H. (Hipomineralização Molar Incisivo) - Um dos defeitos de esmalte mais desafiadores na Odontopediatria / MIH (Molar-Incisor Hypomineralization) - One of the enamel defects most challenging in Pediatric Dentistry

Um dos grandes desafios atuais da Odontologia é o tratamento dos pacientes com o defeito de esmalte conhecido como Hipomineralização Molar-Incisivo (HMI), que está intimamente relacionado com o desenvolvimento de lesão cariosa. Os fatores etiológicos envolvidos ainda não estão totalmente elucidados. Alterações sistêmicas que sensibilizam os ameloblastos no período entre o último trimestre gestacional e os três primeiros anos de vida podem estar associadas ao defeito do esmalte. Contudo, existe uma grande questão na literatura com relação a um possível padrão genético de transmissibilidade, pois a HMI pode se tratar de uma condição autossômica recessiva ou até mesmo, uma forma desconhecida de amelogênese imperfeita. Diante da complexidade de variáveis que envolvem a referida condição, o intuito do presente artigo é relatar as características da doença no sentido de contribuir para o seu diagnóstico, por meio da apresentação de dois casos acompanhados na Clínica de Pós-Graduação da Faculdade de Odontologia de Araraquara-Unesp.

One of the main challenges of Dentistry is the treatment of patients with a enamel defects known as Molar-Incisor Hypomineralization (MIH), which is closely related to the developmentof caries lesions. The etiological factors involved are not yet fully elucidated.Systemic conditions that sensitize the ameloblasts in the period between the last trimester of pregnancy and the first three years of life may be associated with enamel defects. However, there is a big issue in the literature regarding a possible genetic pattern of transmission, because the HMI can deal with an autosomal recessive condition or evenan unknown amelogenesis imperfecta form. Given the complexity of variables involving this condition, the aim of this paper is to report the disease characteristics in order to contribute to the diagnosis, by presenting two cases followed at the Graduate Clinic atAraraquara School of Dentistry -UNESP.

Hipomineralización incisivo y molar: diagnóstico diferencial / Incisor and molar Hypomineralization: differential diagnosis

La hipomineralización de primeros molares frecuentemente es acompañada con una hipomineralización de incisivos (HIM - Hipomineralización Incisivo y Molar) esto es comúnmente encontrado en la práctica clínica. El esmalte hipomineralizado es frágil, puede fracturarse y dejar expuesta la dentina, causando sensibilidad dental y aumento del riesgo de caries. La prevalencia de HIM varía de 3,6 a 25% en el norte de Europa, siendo considerada un problema de salud pública. En cuanto a los factores etiológicos los datos no son definidos, por lo cual causas sistémicas parecen importantes. Los posibles factores etiológicos de este cambio son a menudo relacionados con problemas en el embarazo y enfermedades de la infancia en los tres primeros años de vida. El HIM es frecuentemente confundido con otros defectos del esmalte como amelogénesis imperfecta, la fluorosis y la hipoplasia, sin embargo, detalles sobre las características clínicas de esta condición pueden diferenciarlo de otros defectos del esmalt

Hypomineralized first molar often in combination with hypomineralized incisors (MIH - molar incisor hypomineralization) is a common finding in everyday practice. In this condition, hypomineralized dental enamel is fragile and soft, and it can break easily leading to an exposed dentin, and causing dental sensitivity and progression of caries lesions. The prevalence of MIH range from 3.6 to 25% in North of Europe that consider this condition a public health problem. No conclusive information was reported about the etiologic factors of MIH, however, systemic causes seem to be of importance. Several aetiological factors are mentioned as the cause of this condition and they are frequently associated with complications during pregnancy and childhood diseases during the first three years of life. MIH is frequently misinterpreted as fluorosis, hypoplasia or amelogénesis imperfect, however, this condition presents defined clinical aspects that can distinct it from the other defects

Redução do medo durante o tratamento odontológico utilizando pontas ultrassônicas / Minimizing fear during dental treatment using ultrasonic points

Nos últimos anos, novas tecnologias têm sido desenvolvidas para confecção de preparos cavitários, dentre as quais se destacam as pontas de diamante CVDentus® (CVDVale, São José dos Campos, Brasil). Estas pontas são produzidas por deposição química a partir da fase de vapor, formando uma pedra única de diamante, com maior durabilidade que as pontas diamantadas convencionais. Acopladas ao aparelho de ultrassom apresentam diversas aplicações clínicas em Odontologia com vantagens em relação aos instrumentos rotatórios convencionais, como menor pressão, ruído, vibração e aquecimento, além de reduzir a necessidade do uso de anestesia local, colaborando para diminuição do medo e ansiedade do paciente. O objetivo deste trabalho é apresentar tratamento odontológico restaurador completo, realizado com este sistema, em um paciente infantil com história anterior de comportamento não cooperador. A utilização desta nova tecnologia ofereceu maior conforto ao paciente, possibilitando o seu recondicionamento ao tratamento odontológico, além de ter favorecido a realização de preparos cavitários conservadores.

Over the last few years, new technologies have been developed to making cavity preparations, among which the diamond burs CVDentus® (CVDentus, São José dos Campos, Brazil) are outstanding. These points are produced by chemical deposition from the vapor phase, forming a single diamond stone, with greater durability than the conventional diamond burs. Coupled to the ultrasound appliance, they have several clinical applications in Dentistry with advantages over conventional rotary instruments, such as lower pressure, noise, vibration and heat, as well as reducing the need to use local anesthesia, contributing to minimize patient's fear and anxiety. The aim of this study was to present the complete restorative dental treatment performed with this system in a child patient with a prior history of non-cooperative behavior. The use of this new technology offered the patient greater comfort, making it possible recondition the patient's attitude to dental treatment, in addition to favoring conservative cavity preparations to be made.

Digital versus conventional radiography for determination of primary incisor length

Aim: This in vitro study evaluated the accuracy of primary incisor lengths determined by digital and conventional radiography compared to the actual tooth length. Methods: Twenty extracted primary maxillary incisors were mounted in acrylic blocks. Tooth length was estimated by using a straight-line measurement provided by the distance measurement tool of a digital dental imaging system (Computed Dental Radiography, Schick Technologies Inc.) and conventional E-speed film radiographs by using a digital caliper. Two operators familiar with both radiographic methods performed the estimates. The estimated tooth lengths were compared to the actual tooth lengths measured with the digital caliper. Data were statistically analyzed by Dahlberg’s equation, paired t test, Pearson’s correlation coefficient and ANOVA at 5% significance level. Results: There were no statistically significant differences (p = 0.85) between tooth length estimated on digital and conventional radiographs. Admitting as clinically acceptable a 0.5-mm discrepancy between the actual tooth lengths and the radiographically estimated lengths, 60% of the radiographic measurements were considered as accurate. When the acceptable difference range was 1.0 mm, the accuracy of the radiographic measurements increased to 100%. Conclusions: Digital and conventional radiography provided similar tooth length measurements and were equivalent to the actual tooth lengths.

Panorama atual da utilização do amálgama aderido: avaliação entre cirurgiões-dentistas / Current view on the use of the bonded amalgam technique: an evaluation among dentists

O objetivo deste trabalho foi avaliar, pela aplicação de um questionário específico, o conhecimento e a utilização da técnica do amálgama aderido pelos cirurgiões-dentistas. Seiscentos e cinco profissionais (clínico geral e/ou especialista em Odontopediatria e/ou Dentística) participaram da pesquisa durante o 24º Congresso Internacional de Odontologia de São Paulo. A análise descritiva dos dados evidenciou que 404 cirurgiões-dentistas conheciam a técnica e, destes, 57,8% a aprenderam durante a graduação e 21,8%, em cursos de atualização e/ou aperfeiçoamento. Dentre os que conheciam a técnica, apenas 107 (26,6%) a utilizavam, principalmente em situações clínicas envolvendo grande perda da estrutura dentária (45,79%), em pacientes de baixo poder econômico (26,16%) e em pacientes de alto risco à cárie (30,84%). A falta de experiência clínica (38,98%) e o comprometimento estético (33,22%) foram as principais razões para a não utilização da técnica. O cimento de ionômero de vidro (50%) e o sistema adesivo (38,5%) foram os materiais mais empregados em associação ao amálgama. Conclui-se que o fato dos profissionais conhecerem a técnica do amálgama aderido não significou que a utilizam.

The aim of this study was to evaluate, through the application of a specific questionnaire, dentists knowledge and the use of the bonded amalgam technique. Six hundred and five professionals (general dental practitioner and/or specialist in Pediatric Dentistry and/or Operative Dentistry) had participated of the research during the 24th International Congress of Dentistry of São Paulo. The descriptive analysis of the data evidenced that 404 dentists knew the technique, and from this amount, 57.8% had learned it during graduation and 21.8% in refinementor update courses. Amongst the ones that knew the technique, only 107 (26.6%) used it, mainly in clinical situations involving great loss of dental structure (45.79%), in patients of lower economical classes (26.16%) and in patients of high caries risk (30.84%). The lack of clinicalexperience (38.98%) and the aesthetic involvement (33.22%) were the main reasons for not using the technique. The glass ionomer cement (50%) and the adhesive system (38.5%) had been the most used materials in association to the amalgam. It was concluded that despite the majority of the interviewed professionals knew the technique, few of them have been using it.

Remoção de tecido cariado com pontas CVD ultra-sônicas como estratégia de manejo da criança / Caries removal with ultrasonic diamond tips CVD as strategy of child management / Caries removal with ultrasonic diamond tips CVD as strategy of child management

A cárie precoce da infância normalmente acomete os incisivos superiores e molares decíduos em crianças de tenra idade, tornando o tratamento extremamente difícil. As pontas de diamante CVD ultra-sônicas podem ser empregadas como uma alternativa ao instrumento rotatório convencional para a confecção dos preparos cavitários em situações como a descrita acima, uma vez que proporciona segurança e conforto ao paciente, além de simples e fácil execução. O objetivo desse trabalho é relatar um caso de uma paciente de 3 anos de idade, que apresentava lesão de cárie nos dentes 51, 52 e 62, cujo tratamento foi o emprego da ponta de diamante CVD ultra-sônica para remoção do tecido cariado seguido de reabilitação estética utilizando a técnica da matriz plástica. Foi observado que esta nova tecnologia para confecção de preparos cavitários se mostrou efetiva para preparar dentes acometidos por cárie de mamadeira com segurança, promovendo maior conforto e ausência de sintomatologia dolorosa em paciente de pouca idade.

Early childhood caries normally attack primary maxillary incisors and primary molars in children of low age, becoming the treatment extremely difficult. The ultrasonic diamond tips CVD can be used as an alternative to the conventional rotatory instrument for cavity preparation in situations as the described above, since provides security and comfort to the patient, beyond simple and easy execution. This article reports a case of a 3 years old patient that presented caries lesions in teeth 51, 52 and 62, whose treatment was the use of the ultrasonic diamond tip CVD for caries removal followed of aesthetic rehabilitation using resin composite strip crowns. It was observed that this new technology for cavities preparation showed effectiveness to prepare with safety teeth attacked by nursing bottle caries, promoting comfort and absence of painful symptomatology in patient of little age.

Influencia de la técnica de preparación de cavidades sobre la microfiltración marginal / Influence of cavity preparation technique on marginal microleakage

El objetivo de este trabajo fue el de evaluar la microfiltración marginal producida en cavidades cuya profundidad alcanzaba a la dentina en dientes bovinos. Con esta finalidad fueron confeccionadas cavidades utilizando dos sistemas diferentes de preparación: punta diamantada CVD ultrasónica y puntas diamantadas en alta rotación. Una vez terminada la preparación de las cavidades estas fueron restauradas con resina compuesta para a seguir, los cuerpos de prueba ser almacenados en una solución de suero fisiológico durante una semana tiempo después del cual fueron preparados para realizar a los ciclos térmicos correspondientes para posteriormente realizar su inmersión en una solución de fucsina básica a 0.5 por ciento. Los cuerpos de prueba fueron cortados y lijados para poder observarlos en el microscopio óptico. La medición cuantitativa de la microfiltración marginal fue realizada por medio de la imagen digitalizada y de un software específico. Al someter los resultados al análisis estadístico de Mann-Whitney fue comprobada una acentuada infiltración marginal en ambos grupos sin mostrar diferencia estadística significativa entre ellos, sugiriendo como consecuencia que la técnica de preparación cavitaria no tuvo influencia sobre la microfiltración marginal en restauraciones de resina compuesta

The aim of this study was to evaluate the marginal microleakage in cavities with depth in bovine tooth dentin. Cavities preparation were made in two groups using conventional diamond burs associated with air turbine and ultrasonic CVD diamond tip with ultrasound. Cavities were restored with composite resin and after thermocycled, teeth were immersed in basic fucsin, sectioned, sandpapered and analyzed by an optical microscope. Microleakage quantitative evaluation was obtained through a digitalized image and a software program. Mann-Whitney test showed high amount of marginal microleakage in both groups without any statistically significant difference, suggesting that cavity preparation technique had no influence on marginal microleakage of composite resin restorations

Avaliação da superfície de materiais resinosos expostos ao óxido de alumínio / Evaluation of resinous material surfaces exposed to aluminum oxide powder

O objetivo deste estudo foi avaliar o efeito da deposição de óxido de alumínio sobre restaurações resinosas adjacentes a área tratada pelo sistema de abrasão a ar. Foram utilizados 10 terceiros molares devidamente seccionados e incluído sem cera utilidade deixando exposta a face vestibular. Em cada espécime confeccionou-se com a caneta de alta rotação,4 preparos cavitários de aproximadamente 2mm de diâmetro, eqüidistantes de uma linha central demarcada na cera. As 40 cavidades foram restauradas aleatoriamente com resina composta (Silux-3M) e selante resinoso (Fluoroshield-Dentsply). Em seguida, réplicas de cada espécime foram obtidas pela moldagem com silicone (Imprint II-3M) e modeloem resina epóxi (Stycast 1266- Emerson & Cummings). Na seqüência, foram feitas 2 aplicações de 15s do jato abrasivona parte central dos espécimes, utilizando-se o aparelho PrepStar® regulado a 80 psi, com ponta ativa de 45º e 0,48mmde diâmetro interno posicionada a 5mm da superfície. Ao final de cada aplicação, as superfícies foram lavadas, seca se moldadas novamente. Todas as réplicas foram avaliadas em MEV por 2 examinadores calibrados que fizeram uma avaliação cega quanto ao tipo de restauração. Os dados tabulados em escores foram analisados estatisticamente por análise de variância de Friedman. Os resultados evidenciaram que não houve diferença estatística significativa entre as superfícies das restaurações analisadas antes e após a utilização do jato abrasivo (p>0,05). Uma vez que o jato de óxidode alumínio não foi aplicado diretamente sobre as restaurações, provavelmente a baixa energia cinética das partículas periféricas não foi capaz de produzir alterações em suas superfícies.