Is scanning under rubber dam isolation a feasible approach for the execution of indirect restorations? / O escaneamento sob isolamento absoluto é uma técnica viável para execução de restaurações indiretas?

Objective: The aim of the study was to report the aplicability of intraoral scanning while rubber dam isolation is in place. Material and Methods: Female patient, 50 years old, required restorative procedures on teeth 35 and 37. An intraoral scan was initially performed on both arches. Isolation was carried out from 33 to 37, tooth preparation and immediate dentin sealing were carried out. A new scan with the rubber dam in place was performed and a CAD/CAM lithium disilicate hybrid block was digitally designed, milled, crystallized and cemented under the tooth surface with the rubber dam still in position. After completing this stage, the rubber dam was removed, the occlusion was verified, presenting excellent aesthetic and functional results. Results: The absolute isolation process used in the present study works as an excellent device for gingival retraction. Conclusion: The absolute isolation can be recommended in clinical activities of intraoral scanning favoring the quality of the final result of treatments (AU)

Objetivo: O objetivo do estudo foi relatar a aplicabilidade do escaneamento intraoral sob isolamento absoluto. Material e Métodos: Paciente do sexo feminino, 50 anos, necessitou de procedimentos restauradores nos dentes 35 e 37. Uma varredura intraoral foi inicialmente realizada em ambos os arcos. O isolamento absoluto foi feito de 33 a 37, permitindo a realização do preparo dentário e selamento imediato da dentina. Um novo escaneamento com o dique de borracha colocado foi realizado e um bloco híbrido de dissilicato de lítio CAD/CAM foi projetado digitalmente, fresado, cristalizado e cimentado sob a superfície dentária ainda com o dique de borracha em posição. Após a finalização dessa etapa, o dique de borracha foi removido, a oclusão foi verificada apresentando ótimos resultados estéticos e funcionais. Resultados: O isolamento absoluto utilizado no presente estudo funciona como um excelente dispositivo para retração gengival. Conclusão: O isolamento absoluto pode ser recomendado em atividades clínicas de escaneamento intraoral favorecendo a qualidade do resultado final dos tratamentos (AU)

Aislación relativa comparada con absoluta en restauraciones de resina compuesta en pacientes con dentición permanente / Relative isolation versus rubber dam isolation for composite resin restorations in patients with permanent dentition

RESUMEN: Introducción: La técnica de restauración con resina compuesta requiere un adecuado control de la humedad durante el procedimiento. Para ello, puede realizarse aislación relativa (con tórulas de algodón y eyector de saliva) o aislación absoluta con goma dique de la o las piezas dentarias. Sin embargo, no está claro cuál de estos protocolos sería más efectivo. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos tres revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que realizar aislación relativa comparado con aislación absoluta podría aumentar el riesgo de falla de restauración a los 6 meses, pero la certeza de la evidencia es baja. No es posible establecer con claridad si la aislación relativa disminuye el riesgo de falla de la restauración a 10 años, debido a que la certeza de la evidencia existente ha sido evaluada como muy baja. No se encontraron estudios que evaluaran los desenlaces caries secundaria, sensibilidad postoperatoria y tinción.

ABSTRACT: Introduction: Resin composite restorations technique requires effective control of moisture during the procedure. Isolation and moisture control can be performed by relative isolation (use of cotton rolls combined with aspiration by saliva ejector) or rubber dam isolation. However, there is uncertainty regarding which one of these protocols would be most beneficial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified three systematic reviews including two studies overall, of which all were randomized trials. We conclude that relative isolation may increase the risk of failure of the restorations at 6 months. We are uncertain whether relative reduces the risk of failure of the restorations at 10 years as the certainty of the evidence has been assessed as very low. No studies were found that looked at secondary caries, post-operative sensitivity or stained margins.

Aspectos técnicos dos tratamentos endodônticos realizados por cirurgiões-dentistas da PMESP: avaliação por meio de questionário / Technical aspects of endodontic treatments performed by PMESP dentists: evaluation by means of a questionnaire

Introdução: De todas as especialidades na Odontologia, uma das mais favorecidas nos últimos anos com o desenvolvimento de novas tecnologias tem sido a Endodontia. Objetivo: O presente estudo visou obter informações sobre os aspectos técnicos dos tratamentos endodônticos realizados por cirurgiões-dentistas da Polícia Militar do Estado de São Paulo (PMESP), dando ênfase aos materiais, técnicas e equipamentos empregados. Métodos: Um questionário com 25 questões de múltipla escolha foi enviado aos 147 dentistas da PMESP, e o critério de inclusão foi que os profissionais realizassem tratamentos endodônticos. Resultados: A análise estatística foi feita por meio do teste qui-quadrado, com p<0,05. Entre os 42 profissionais avaliados, 59,5% eram do sexo masculino, o dique de borracha foi utilizado em 54,8% dos casos, o comprimento de trabalho foi obtido por meio de radiografias em 71,4%, o sensor digital foi utilizado em 28,6%, a magnificação visual foi utilizada em 23,8% e a técnica de condensação lateral foi a mais utilizada, com 90,2%. Outra análise foi realizada com 10 especialistas do Centro Odontológico da PMESP que efetuavam unicamente tratamento endodôntico, sendo que 50% eram do sexo masculino e tratavam mais de 15 casos/mês: o dique de borracha foi utilizado em 80% dos casos; o comprimento de trabalho foi obtido com localizador foraminal em 50% dos casos; o sensor digital foi utilizado em 90%, assim como o motor elétrico; a técnica de condensação lateral foi utilizada em 60% dos casos e o ultrassom, em 20%. Conclusões: Conclui-se que os especialistas utilizaram mais as novas tecnologias, e que o ultrassom e a magnificação visual foram pouco utilizados em ambos os grupos (AU).

Introduction: Of all the specialties in dentistry, one of the most favored in recent years with the development of new technologies has been endodontics. Objective: This study aimed to obtain information on the technical aspects of endodontic treatments performed by dentists from the Military Police of the State of São Paulo, emphasizing the materials, equipment, and techniques used. Methods: A questionnaire with 25 multiple choice questions was sent to 147 dentists from PMESP and the inclusion criterion was professionals who performed endodontic treatment. Results: The statistical analysis was done through the chi-square test, with p< 0.05. The professionals evaluated 59.5% were male, the rubber dam was used in 54.8% of the cases, the working length by means of radiographs was obtained in 71.4%, the digital sensor was used in 28.6%, the visual magnification was used in 23.8% and the lateral condensation technique was the most used with 90.2%. Another analysis was performed with 10 specialists of the Dental Center who performed only endodontic treatment, 50% were male, treated more than 15 cases/month, the rubber dike was used in 80% of the cases, the working length was performed in 50% of the cases by foraminal locator, the digital sensor was used in 90%, as well as the electric motor, the technique of lateral condensation was used in 60% of the cases and ultrasound 20%. Conclusion: It was concluded that the specialists used more new technologies and that the use of ultrasound and visual magnification was little used in both groups (AU).

Emprego do isolamento absoluto em Endodontia: uma análise da percepção do paciente e do cirurgião-dentista do noroeste do Paraná / Use of absolute isolation in Endodontics: an analysis of the perception of the patient and the dentist of northwestern Paraná/Brazil

O isolamento absoluto é um procedimento indispensável no tratamento odontológico, principalmente em Endodontia. Contudo, certos profissionais ainda relutam em usá-lo. Objetivo: O presente estudo teve como objetivo entrevistar profissionais, acadêmicos de Odontologia e pacientes, visando avaliar a percepção de cada grupo com relação à eficácia e segurança do lençol de borracha, por meio do percentual de respostas dadas às perguntas. Métodos: Foram elaborados questionários a serem respondidos por 50 acadêmicos do último ano do curso de Odontologia da UNIPAR, 50 cirurgiões-dentistas e 100 pacientes de clínicas particulares e da clínica odondológica da UNIPAR da cidade de Umuarama, no Paraná. Após a coleta de todos os questionários distribuídos, as respostas apresentadas foram tabuladas e analisadas. Resultados: 66% dos odontólogos e 74% dos estudantes de Odontologia entrevistados relataram que sempre fazem o uso do isolamento absoluto, citando como pontos negativos da sua utilização o tempo para aplicação, a intolerância a ele por parte do paciente, e a falta de treinamento. Ainda, 52% dos pacientes de clínicas particulares e 54% dos pacientes da clínica odontológica da UNI- PAR consideraram o isolamento absoluto desconfortável; porém, apenas 6% e 10%, respectivamente, assinalaram que não gostariam que o isolamento absoluto fosse utilizado na próxima consulta. Conclusões: O isolamento absoluto tem uma grande aprovação pelos profissionais, acadêmicos e pacientes. Uma maioria significativa de cirurgiões-dentistas e acadêmicos de Odontologia tem em- pregado o isolamento absoluto rotineiramente na prática endodôntica. Os pacientes consideram o isolamento absoluto desconfortável; apesar disso, preferem que se faça uso dele durante o tratamento odontológico (AU).

Introduction: Rubber dam isolation is a mandatory procedure in dental treatment, especially in Endodontics. However, some professionals still refuse to employ it. Aim: This study interviewed dental professionals, dental students and patients, evaluating the perception of each group concerning the efficacy and safety of rubber dam by the percentage of responses to the questions. Methods: The questionnaires were responded by 50 students of the last year of Dentistry course at Unipar, 50 dental professionals and 100 patients from private clinics and the dental clinic of Unipar, at the city of Umuarama in Paraná. After collection of all submitted questionnaires, the responses were tabulated and analyzed. Results: 66% of dental professionals and 74% of dental students interviewed reported that they always use rubber dam isolation, mentioning as negative aspects for not using it the time required for placement, patient refusal and lack of training. Among the patients, 52% from private clinics and 54% from the dental clinic of Unipar considered the rubber dam uncomfortable, yet only 6% and 10%, respectively, indicated they would not like to use the rubber dam on the following session. Conclusions: Rubber dam isolation has great acceptance by professionals, students and patients. A significant part of dental professionals and students have been using the rubber dam routinely in the endodontic practice. The patients consider the rubber dam uncomfortable, notwithstanding they prefer to use it during dental treatment (AU).

A influência do isolamento absoluto no sucesso de restaurações diretas e tratamento endodôntico: uma revisão de literatura / The influence of absolute insulation on the success of direct restrictions and endodontical treatment: a literature review

A longevidade das restaurações de resina composta, assim como o tratamento endodôntico, depende, principalmente, de uma cavidade livre de contaminação por saliva e/ou microrganismos. Dessa forma, o isolamento absoluto surge como um meio de minimizar estes riscos. Diante disso, esse artigo tem como objetivo realizar uma revisão de literatura para descrever a influência do isolamento absoluto em restaurações diretas de resina composta e no tratamento endodôntico. A busca dos artigos foi realizada a partir do portal eletrônico PubMed e das bases de dados Web of Science e SCOPUS. Como critérios de inclusão, tivemos: artigos publicados nos últimos 10 anos, na língua inglesa. Artigos sem versão em inglês, teses e dissertações foram excluídos. A busca inicial gerou um total de 148 artigos, após a triagem por meio da leitura dos títulos e resumos, sessenta e um estudos foram considerados como potencialmente elegíveis. Após a leitura dos textos completos, vinte e um foram selecionados para esta revisão. A análise dos artigos mostrou que a utilização do isolamento absoluto influenciou significativamente no sucesso em longo prazo das restaurações adesivas, principalmente as estéticas anteriores, e no tratamento endodôntico, devido a um melhor controle da saliva quando comparado ao isolamento relativo, além de promover proteção dos tecidos moles, melhor visualização e evitar acidentes. Conclui-se que adotar essa estratégia é extremamente importante para eliminar os riscos de contaminação do conduto radicular e das restaurações de resina composta aumentando assim o sucesso clínico destes procedimentos(AU)

The longevity of composite resin restorations as well as endodontic treatment depends mainly on a cavity free of contamination by saliva and / or microorganisms. In this way, absolute isolation emerged as a means of minimizing these risks. Therefore, this article aims to perform a literature review to describe the influence of absolute insulation on direct composite resin restorations and endodontic treatment. The articles search was carried out from the electronic portal PubMed and the databases EBSCO and SCOPUS. As inclusion criteria, we had: articles published in the last 10 years in the English language. Articles without English version, theses and dissertations were excluded. The initial search generated a total of 148 articles, after screening by reading the titles and abstracts, sixty one studies were considered as potentially eligible. After reading the entirety of manuscripts, twenty one were included in this review. The analysis of the articles showed that the use of absolute isolation significantly influenced the long-term success of adhesive restorations and endodontic treatment, due to a better control of the saliva when compared to the relative isolation, besides promoting protection of the soft tissues, better visualization and to avoid accidents. It is concluded that adopting this strategy is extremely important to eliminate the risks of root canal contamination and composite resin restorations, thus increasing the clinical success of these procedures(AU)

A CAD/CAM-based strategy for concurrent endodontic and restorative treatment

This case report describes a technique in which endodontic treatment and permanent indirect restoration were completed in the same clinical appointment with the aid of a computer-aided design/computer-aided manufacturing (CAD/CAM) system. Two patients were diagnosed with irreversible pulpitis of the mandibular first molar. After access preparation, root canals were located, irrigation was performed until bleeding ceased, and the coronal tooth structure was prepared for indirect restoration. Then, utilizing an interim 3-mm build-up of the endodontic access cavity, a hemi-arch digital scan was performed with an intraoral scanner. Subsequent to digital scanning, restoration design was performed simultaneously with the endodontic procedure. The root canals were shaped using the Race system under irrigation with 2.5% sodium hypochlorite followed by root canal filling. The pulp chamber was subsequently filled with a 3-mm-thick composite resin restoration mimicking the interim build-up previously utilized to facilitate block milling in the CAD/CAM system. Clinical try-in of the permanent onlay restoration was followed by acid etching, application of a 5th generation adhesive, and cementation of the indirect restoration. Once the restoration was cemented, rubber dam isolation was removed, followed by occlusal adjustment and polishing. After 2 years of follow-up, the restorations were esthetically and functionally satisfactory, without complications.

Periodontal healing following non-surgical repair of an old perforation with pocket formation and oral communication

Iatrogenic perforations negatively impact the outcome of endodontic treatments. Studies on prognostic factors showed that perforations in the coronal third of the root with periodontal pocket formation have an unfavorable prognosis. A 36-year-old female was referred for endodontic evaluation of tooth #13 with a history of an iatrogenic perforation, happened 3 years ago. There was a sinus tract associated with perforation, 10 mm probing on the mesial and mesio-palatal, bleeding on probing, radiolucent lesion adjacent to the perforation and complete resorption of the interdental bone between teeth #13 and #12. After the treatment options were discussed, she chose to save the tooth. The tooth was accessed under rubber dam isolation, the perforation site was cleaned and disinfected using 0.5% sodium hypochlorite and sealed with calcium-enriched mixture cement. Eighteen months after treatment the tooth was functional and asymptomatic. The probing depths were normal without bleeding on probing. Radiographically, the interdental crestal bone formed between teeth #13 and #12. Despite all negative prognostic factors in this case (i.e., perforations in the coronal third, pocket formation, and radiolucent lesion), healing was unexpectedly achieved via non-surgical repair of the perforation. Further research on biological aspects of healing in the periodontium following iatrogenic perforations are recommended.

Algunas consideraciones sobre el aislamiento absoluto / Some considerations on absolute isolation

El aislamiento absoluto es un procedimiento clínico que contribuye a mejorar los procederes en la operatoria dental, rehabilitación, odontopediatría y endodoncia, pues propicia un ambiente adecuado para los materiales de restauración, así como en la seguridad del paciente. Con el fin de promover su uso en la práctica se realizó una revisión bibliográfica que incluye la historia, elementos del aislamiento absoluto, recomendaciones y evidencia científica sobre su uso.

Absolute isolation is a clinical procedure that contributes to improve procedures in the dental operative, rehabilitation, Odontopediatrics and Endodontics, because it propitiates an appropriate atmosphere for the restoration materials, as well as in the patient's security. With the purpose of promoting their use in practice a literature review was carried out that includes the history, elements of the absolute isolation, recommendations and scientific evidence on their use.

An overview on rubber dam application in dental treatments / 中华口腔医学杂志

Rubber dam technique is the a method used in dentistry to isolate the operation field from the rest of mouth with rubber sheet. Rubber dam can protect both patients and dental workers effectively and provide patients with more professional, safe and comfortable experience. In recent years, this technique has gradually gained more and more recognition by dentists. However, the prevalence of using rubber dam technique in our country is still relatively low compared with those in developed countries. This condition involves many factors and need to be paid enough attention. This review summarized the current situation of rubber dam usage in various countries, the technique's application field, the effect analysis, the influencing factors and the modified products.

¿Por qué hacerlo? Simplemente porque es un procedimiento lógico y necesario / Why to do it? Just because is a logical and necessary procedure

En la odontología, el aislamiento absoluto del campo operatorio facilita y aumenta la eficacia de todos los procedimientos clínicos. Un campo operatorio seco y libre de contaminación protege al paciente, al profesional y al personal auxiliar. En general, el profesional, por incapacidad o impericia, recurre con frecuencia a excusas, sin comprender que su uso es lógico e insustituíble. La caída de instrumentos y la ingestión o la aspiración de cuerpos extraños que tienen origen dental constituyen la segunda causa médica más común de este tipo de accidentes. Teniendo en cuenta todos los cuidados y las precauciones que se toman para combatir y/o prevenir la infección microbiana durante un tratamiento endodóntico, resulta paradójico que muchas veces, en la reconstrucción posendodóntica, se trabaje sin efectuar la aislación absoluta...

Uma nova opção para o isolamento absoluto em endodontia / A new option for absolute isolation in endodontics

Introdução: o isolamento absoluto continua sendo um procedimento indispensável no tratamento odontológico, principalmente em Dentística e Endodontia, apesar da relutância de certos profissionais em usá-lo. Inúmeros tipos de lençol estão disponíveis no mercado, apresentando características técnicas e aspectos distintos entre si. O OptiDam® é um modelo de dique tridimensional que apresenta a vantagem de exercer baixa tensão sobre o grampo de isolamento, além de ficar justaposto à mucosa, afastando os tecidos moles de forma satisfatória. Objetivo: o presente trabalho relata a aplicação clínica do OptiDam por meio da descrição de dois casos clínicos. Resultados: ficou evidente a superioridade, em relação ao conforto para o paciente, e a facilidade de aplicação por parte do profissional, contudo, demonstrando desvantagens em relação ao custo e no momento da realização das tomadas radiográficas. Conclusão: o OptiDam® mostrou-se clinicamente viável, apesar das dificuldades observadas

Do Clinical Experience Time and Postgraduate Training Influence the Choice of Materials for Posterior Restorations? Results of a Survey with Brazilian General Dentists

The aims of this study were to evaluate the materials available for posterior restorations and to assess whether clinical experience time and post-graduate training influence dentists' choices. A cross-sectional study was conducted using a questionnaire with closed questions applied to dentists (n=276) of a mid-sized city of the southern Brazil. Information was collected regarding sociodemographic variables, level of specialization, time since graduation and working place. In addition, options regarding posterior restorations including the first choice of material, type of composite resin (if used) and use of rubber dam were also collected data. Data were submitted to descriptive analysis and the associations were evaluated using chi-square and Fisher's exact tests (α=0.05). The response rate was 68% (187). Direct composite resin was broadly indicated (73.2%) as the first-choice for posterior restorations. Most professionals used microhybrid composite (74.5%) and 42.6% of the participants used rubber dam for placement of posterior composite restorations. Dentists with more time of clinical practice used less composite (p=0.014). Specialists used more frequently rubber dam to restore posterior teeth than did non-specialists (p=0.006). The results of this survey revealed that direct composite was the first choice of dentists for posterior restorations; microhybrid was the preferred type of composite and the use of rubber dam for composite resin placement in posterior teeth was not frequent; time since graduation and level of specialization affected dentists' choices.

O objetivo deste estudo foi avaliar as possíveis opções restauradoras para dentes posteriores. Além disso, foi avaliada a possível relação entre tempo de formação e grau de formação profissional com suas escolhas. Este estudo transversal foi realizado a partir de questionários respondidos por cirurgiões-dentistas da cidade de Pelotas/RS. Foram avaliadas variáveis sociodemográficas, nível de especialização e ano de graduação. Além disso, foram obtidas informações sobre a primeira opção restauradora para dentes posteriores, tipo de resina composta e uso de isolamento absoluto. Dados foram submetidos à análise descritiva, e as associações foram testadas por meio do teste de Chi-quadrado ou do teste exato de Fisher, quando apropriado. A taxa de resposta foi de 68%. Os cirurgiões-dentistas, em sua maioria, escolheram o uso de resina composta como a primeira opção restauradora para dentes posteriores. Em relação ao tipo de resina usada, a maioria dos profissionais escolheu a resina microhíbrida; e apenas 42.6% utilizou isolamento absoluto para a realização da restauração posterior. Cirurgiões-dentistas com mais tempo de graduação utilizaram menos resina composta para dentes posteriores (p=0.014). Cirurgiões-dentistas que frequentaram cursos de pós-graduação usaram mais isolamento absoluto (p=0.006). Restauração direta de resina composta foi a primeira opção de tratamento restaurador para dentes posteriores; resina composta microhíbrida foi o tipo de resina preferido pelos cirurgiões-dentistas e o uso de isolamento absoluto para realização de restaurações posteriores não foi frequente. Tempo desde a graduação e grau de especialização influenciaram a escolha dos cirurgiões-dentistas.

Conservative approach of a symptomatic carious immature permanent tooth using a tricalcium silicate cement (Biodentine): a case report

The restorative management of deep carious lesions and the preservation of pulp vitality of immature teeth present real challenges for dental practitioners. New tricalcium silicate cements are of interest in the treatment of such cases. This case describes the immediate management and the follow-up of an extensive carious lesion on an immature second right mandibular premolar. Following anesthesia and rubber dam isolation, the carious lesion was removed and a partial pulpotomy was performed. After obtaining hemostasis, the exposed pulp was covered with a tricalcium silicate cement (Biodentine, Septodont) and a glass ionomer cement (Fuji IX extra, GC Corp.) restoration was placed over the tricalcium silicate cement. A review appointment was arranged after seven days, where the tooth was asymptomatic with the patient reporting no pain during the intervening period. At both 3 and 6 mon follow up, it was noted that the tooth was vital, with normal responses to thermal tests. Radiographic examination of the tooth indicated dentin-bridge formation in the pulp chamber and the continuous root formation. This case report demonstrates a fast tissue response both at the pulpal and root dentin level. The use of tricalcium silicate cement should be considered as a conservative intervention in the treatment of symptomatic immature teeth.

Isolamento do Campo Operatório: Panorama de Utilização em Consultórios e Clínicas Privadas de Belo Horizonte, MG, Brasil / Rubber Dam: Use in Private Clinics in Belo Horizonte, MG, Brazil

Objetivo: verificar a utilização de isolamento em consultórios e clínicas privadas em Belo Horizonte, observando-se: tipo, procedimentos executados com isolamento e o motivo da escolha; além de fatores como: tempo de formação dos cirurgiões-dentistas (CDs), classe econômica dos pacientes e presença de pessoal auxiliar (ASB). Método: a amostra elegível foi formada por CDs atuantes na região Centro-Sul da cidade. A amostra final de conveniência foi de 115 CDs que responderam a um instrumento de coleta de dados com questões descritivas e objetivas. Os dados foram analisados descritivamente e pelo teste Qui-quadrado (p≤0,05).Resultados: dos CDs que participaram da pesquisa, 55% eram do gênero feminino; 63,5% tinham entre 23 e 35 anos; 39% tinham menos de cinco anos de atividade profissional e 59% eram especialistas. Eram da região Central 69% e Sul 31%; têm ASB 66% dos CDs. Os pacientes foram classificados em classe econômica A (11%), B (30%), C (34%), D (16%) e E (9%). Relataram utilizar algum tipo de isolamento 82% dos CDs (36% relativo; 28% absoluto; e 36% ambos). O grau de aceitação dos pacientes quanto aos métodos de controle de umidade foi considerado alto para 52% dos CDs. O principal motivo para escolha doisolamento absoluto foi o controle de infecção (27%) e para o relativo foi a praticidade (24%). O isolamento absoluto é utilizado principalmente na endodontia (38%) e o relativo em restaurações (33%). Gênero (p=0,6483), tempo de atividade (p=0,2576), especialidade (p=0,0733) e presença de ASB (p=0,4127), não influenciaram significativamente na escolha do tipo de isolamento. Conclusão: a maioria dos CDs relatou utilizar algum tipo de isolamento do campo operatório e aponta como principais vantagens a biossegurança, a praticidade e melhor qualidade dos procedimentos executados

Objective: The aim of this study was to investigate the use of isolation in offices and private clinics in Belo Horizonte, it was observed: the type, procedures performed in isolation and the reason for their choices. In addition to those factors were also observed the duration of the dentistsÆ training, the patientsÆ economic class and the presence of an office assistant.Method: The eligible sample consisted of active dentist in the southcenter region of the town. The final sample of convenience was 115 professionals who answered to an instrument data collection with descriptive and objective questions. The results were analyzed descriptively and by Qui-Square test (p≤0,05).Results: Among the dentist in the survey 55% were female, 63.5% were between 23 and 35 years old, 39% had less than five years of professional activity and 59% were specialists; 69% were from the central region and 31% from the south; 66% of the dentists have assistant in office. Patients were classified according to their economic class; class A (11%), B (30%), C (34%), D (16%) and E (9%). 82% of the dentists reported the use of some type of insulation, (36% relative, 28% absolute, and 36% both). The degree of the patientsÆ acceptance to methods of moisture control was considered high, for 52% of the professionals. The main reason for choosing the absolute isolation was the control of infection (27%) and the relative was the practicality (24%). The rubber dam is mainly used in endodontics (38%) and the relative isolation is used in restorations (33%). The gender (p=0.6483), professional activity time (p=0.2576), training (p=0.0733) and presence of an office assistant (p=0.4127) havenÆt significant influence in the type of isolation choice. Conclusion: The most of dentists reported using some type of isolation of the operative field and indicated that the main advantages are the biosafety, practicality and quality of procedures performed

Deglutição acidental de uma lima Protaper® durante o tratamento do canal

Objetivo: demonstrar para o clínico geral a importância do uso do lençol de borracha durante o tratamento endodôntico e descrever o monitoramento empregado no caso de um paciente que ingeriu acidentalmente uma lima rotatória Protaper® S1 (Dentsply Maillefer, Suíça) durante o preparo dos canais. Relato do caso: um paciente de 28 anos de idade foi submetido ao tratamento endodôntico sem isolamento absoluto e, durante o preparo químico cirúrgico do canal, engoliu uma lima Protaper® S1. Foi acompanhado até o hospital onde, a princípio, foi realizada uma endoscopia gastro intestinal alta e uma tomografia computadorizada. Permaneceu assintomático após essas duas intervenções iniciais,sendo monitorado durante quatro dias, através de radiografias de tórax e abdômen, até a eliminação desse corpo estranho. Conclusão: os clínicos gerais que fazem Endodontia devem estar atentos aos riscos envolvidos na deglutição e/ou aspiração acidental de corpos estranhos durante o tratamento endodôntico, bem como saber evitar esse tipo de problema adotando uma medida simples: a utilização do lençol de borracha

Análise morfológica e morfométrica da camada híbrida formada por adesivo autocondicionante na presença de sangue / Morphological and morphometrical analisys of a self-etching adhesive system hybrid layer formed in the presence of blood

Este estudo objetivou analisar, por meio de microscopia eletrônica de varredura (MEV), a interface adesiva de restaurações realizadas com sistema adesivo autocondicionante de dois passos (Clearfill SE Bond, Kuraray Co., Ltd., Osaka, Japão), contaminadas por sangue em dois momentos diferentes, recebendo essa contaminação dois tratamentos distintos. Quinze molares humanos foram divididos em cinco grupos experimentais (n = 3): G1 - controle (sem contaminação); G2 - contaminação antes do primer, com lavagem e secagem; G3 - contaminação antes do primer com secagem; G4 - contaminação após bond fotopolimerizado com lavagem e secagem; G5 - contaminação após bond fotopolimerizado com secagem. Os dentes tiveram sua superfície oclusal seccionada e lixada para obtenção de dentina plana. Os espécimes foram contaminados, de acordo com os grupos experimentais, e então foram restaurados e preparados para análise em MEV. Os resultados obtidos foram descritos de duas formas: análise morfológica, na qual foram observadas alterações na formação da camada híbrida (CH) em grupos com a presença do contaminante, e análise morfométrica, em que os dados foram analisados estatisticamente, e pode-se constatar uma relação entre a presença do contaminante e a diminuição do tamanho de tags, em µm, quando comparados ao grupo controle (p ≤ 0, 05). Adicionalmente, foi observado que o tratamento de lavagem com água não foi suficiente para restabelecer a formação de CH semelhante à observada em G1.

A survey of cross-infection control procedures: knowledge and attitudes of Turkish dentists

OBJECTIVES: The objective of this study was to investigate the knowledge, attitudes and behavior of Turkish dentists in Samsun City regarding cross-infection control. MATERIAL AND METHODS: A questionnaire was designed to obtain information about procedures used for the prevention of cross-infection in dental practices and determine the attitudes and perceptions of respondent dental practitioners to their procedures. The study population included all dentists in the city of Samsun, Turkey, in April 2005 (n=184). The questionnaire collected data on sociodemographic characteristics, knowledge and practice of infection control procedures, sterilization, wearing of gloves, mask, use of rubber dam, method of storing instruments and disposal methods of contaminated material, etc. Questionnaire data was entered into a computer and analyzed by SPSS statistical software. RESULTS: From the 184 dentists to whom the questionnaires were submitted, 135 participated in the study (overall response rate of 73.36 percent). As much as 74.10 percent dentists expressed concern about the risk of cross-infection from patients to themselves and their dental assistants. Forty-three percent of the participants were able to define "cross-infection" correctly. The greatest majority of the respondents (95.60 percent) stated that all patients have to be considered as infectious and universal precautions must apply to all of them. The overall responses to the questionnaire showed that the dentists had moderate knowledge of infection control procedures. CONCLUSIONS: Improved compliance with recommended infection control procedures is required for all dentists evaluated in the present survey. Continuing education programs and short-time courses about cross-infection and infection control procedures are suitable to improve the knowledge of dentists.

A survey on the use of composite resin in Class II restoration in Korea / 대한치과보존학회지

The purpose of this study was to assess the current materials, methods and difficulties according to the year of licence and educational background of Korean dentists in Class II direct composite resin restorations. Total 17 questions were included in the questionnaire. Questions were broadly divided into two parts; first, operator's information, and second, the materials and methods used in Class II posterior composite restoration. The questionnaire was sent to dentists enrolled in Korean Dental Association via e-mail. Total 12,193 e-mails were distributed to dentists, 2,612 e-mails were opened, and 840 mails (32.2%) were received from respondents. The data was statically analyzed by chi-square test using SPSS(v. 12.0.1, SPSS Inc, Chicago, IL, USA). Male dentists among respondents was 79%. 60.3% of the respondents acquired their licences recently (1998-2007), and 77% practiced in private offices. 83.4% have acquired their knowledge through school lectures, conferences and seminars. For the Class II restorations, gold inlays were preferred by 65.7% of respondents, while direct composite resin restorations were used by 12.1% amalgam users were only 4.4% of respondents. For the restorative technique, 74.4% of respondents didn't use rubber dam as needed. For the matrix, mylar strip (53.4%), metal matrix (33.8%) and Palodent system (6.5%) were used. 99.6% of respondents restored the Class II cavity by incremental layering. Obtaining of the tight interproximal contact was considered as the most difficult procedure (57.2%) followed by field isolation (21%). Among various bonding systems, 22.6% of respondents preferred SE Bond and 20.2% used Single Bond. Z-250 was used most frequently among a variety of composite resins.