The "Phase Down" of Dental Amalgam Restorations - What are the Criteria for Replacement and Indication?

ABSTRACT Objective: To guide professionals about the criteria for replacing amalgam restorations and inform them about the new guidelines regarding the use/indication of this (amalgam) material after the Minamata Convention - COP-4. Material and Methods: The articles were selected from the databases (PubMed, Scielo, Bireme), and relevant articles on the subject between the years 2003-2021 were selected. Recently, social media have been flooded with dental treatments that aim to perform restorations only with composite resins or other types of esthetic material and completely replace all dental amalgam restorations, irrespective of their time in place, size, and functionality. Results: Although improperly, it has been noted that this information reaches patients, and they are led to believe in the inaccurate data that is passed on, such as, for example, (that amalgam leads to) permanent contamination by mercury, causing systemic problems and the loss of the tooth. Conclusion: The "phase down" of amalgam in research and teaching has previously been observed in several countries worldwide; however, its use is still necessary given particular circumstances, which, theoretically, make it a material with exact indication.

Amalgam x Composite Resin: supplies and restorative procedures more performed among Oral Health Teams in Brazil

Abstract This study aimed to compare the availability of supplies and amalgam and composite resin restorations among Oral Health Teams (OHT) in Brazilian regions. Secondary data were extracted from Modules I and II of the 1st (2012) and V and VI of the 2nd (2014) and 3rd cycle (2017) of the external evaluation of the National Program for Access and Quality in Primary Care2. The proportions between regions and cycles were compared using the Chi-square test with the z-test adjusted by the Bonferroni method (p<0.05). Among 2012, 2014, and 2017 there was a significant reduction in the proportion of OHT that performed amalgam restorations (87.5%, 89.2%, and 80.2%; p<0.001) and an increase in resin composite (92.5 %, 97.7%, and 99.0%; p<0.001), with the same trend in Brazilian regions (p<0.001). Amalgamator availability decreased among 2012 (99.0%), 2014 (98.4%) and 2017 (85.6%) (p<0.001). Amalgam availability was lower in 2017 (80.1%), compared to 2012 (87.5%) and 2014 (97.5%) (p<0.001). The availability of light curing decreased between 2012 (99.0%), 2014 (98.4%) and 2017 (85.6%) (p<0.001), being less available in the North (95.7%) (p<0.001). The light-curing resin increased between 2012 (94.1%), 2014 (96.6%) and 2017 (97.0%) (p<0.001), with no increase only in the North (p=0.134). While there was a reduction in supplies and amalgam restoration, there was an increase in supplies and resin composite restorations in the period evaluated in all Brazilian regions. However, regional disparities are still evident, with fewer supplies of restorative services in the North region.

Resumo Este estudo objetivou comparar a disponibilidade de fornecimentos e restaurações de amálgama e resina composta entre as Equipas de Saúde Oral (OHT) por regiões brasileiras. Os dados secundários foram extraídos dos módulos I e II do 1º (2012) e V e VI do 2º (2014) e 3º ciclo (2017) da avaliação externa do Programa Nacional de Acesso e Qualidade em Cuidados Primários. As proporções entre regiões e ciclos foram comparadas utilizando o teste Qui-quadrado com o teste z ajustado pelo método de Bonferroni (p<0,05). Entre 2012, 2014, e 2017 houve uma redução significativa na proporção de OHT que realizou restaurações de amálgama (87,5%, 89,2%, e 80,2%; p<0,001) e um aumento na resina composta (92,5%, 97,7%, e 99,0%; p<0,001), com a mesma tendência nas regiões brasileiras (p<0,001). A disponibilidade de amalgamadores diminuiu entre 2012 (99,0%), 2014 (98,4%) e 2017 (85,6%) (p<0,001). A disponibilidade de amálgama foi menor em 2017 (80,1%), em comparação com 2012 (87,5%) e 2014 (97,5%) (p<0,001). A disponibilidade de polimerização por luz diminuiu entre 2012 (99,0%), 2014 (98,4%) e 2017 (85,6%) (p<0,001), estando menos disponível no Norte (95,7%) (p<0,001). A resina fotopolimerizadora aumentou entre 2012 (94,1%), 2014 (96,6%) e 2017 (97,0%) (p<0,001), sem aumento apenas no Norte (p=0,134). Embora tenha havido uma redução nos fornecimentos e restauração de amálgamas, houve um aumento nos fornecimentos e restaurações de resina composta no período avaliado em todas as regiões brasileiras. Contudo, as disparidades regionais são ainda evidentes, com menos oferta de serviços de restauração na região Norte.

Cost-effectiveness of selective caries removal versus stepwise excavation for deep caries lesions

Abstract A multicenter, randomized controlled clinical trial evaluated the effectiveness of two treatments for deep caries lesions in permanent molars - selective caries removal (SCR) to soft dentin with restoration in a single visit, and stepwise excavation (SW) - regarding pulp vitality for a 5-year follow-up period. The present study aimed to determine the cost-effectiveness of these treatments. Treatments were conducted in two Brazilian cities (Brasília and Porto Alegre). At baseline, 299 permanent molars (233 patients) were treated and 229 teeth (174 patients) were evaluated after 5 years. The discounted cash flow method was adopted. The total cost of each treatment was calculated, and the failure cost (endodontic treatment + restoration) was added to the final cost, according to the 5-year failure rates of each therapy (20% for SCR and 44% for SW). A public health service unit composed of three dentists in 4-hour work shifts was used to calculate the monetary value of the treatments, assuming a total of 528 treatments/month. Considering the 229 teeth evaluated after 5 years (115 SCR and 114 SW), SCR provided savings of 43% (amalgam) and 41% (resin composite) per treatment, compared to SW. The SCR technique provides benefits for public finances (direct economy) and for public health services (increase in the number of treatments performed). Considering that maximizing profit and reducing costs are powerful motivating factors for adopting a certain treatment, this study provides data to better support the decision-making process, regarding the management of deep caries lesions in permanent molars.

Materiais restauradores em odontopediatria: preferência de pais e crianças e análise bibliométrica-altimétrica / Restorative materials in pediatric dentistry: children's and adults' preference and bibliometric-altmetric analysis

Atualmente, diversos materiais restauradores encontram-se disponíveis para aplicabilidade em Odontopediatria. Os avanços dos materiais restauradores conduzem à necessidade de novos estudos nessa temática. O presente estudo apresenta duas propostas de investigação: 1) Estudo transversal com objetivo de avaliar a preferência de pais/responsáveis e crianças quanto ao emprego do compômero colorido (Twinky Star®, Voco, Alemanha); 2) Estudo bibliométrico altimétrico com objetivo de analisar 50 artigos mais citados referente aos materiais restauradores utilizados em Odontopediatria e o alcance dessa informação científica nas mídias on-line. O estudo transversal envolveu 260 pares de pais/responsáveis e crianças de 5 a 11 anos de idade de dois serviços de saúde da região metropolitana de Belo Horizonte-MG. Exame quanto à cárie dentária foi realizado por examinadora calibrada para o critério da Organização Mundial da Saúde. Um manequim odontológico contendo restaurações com compômeros coloridos e materiais convencionais (resina composta, ionômero de vidro e amálgama) foi apresentado aos participantes do estudo e realizou-se inquérito sobre a preferência dos materiais dentários. O Questionário de Estilo e Dimensões dos Pais (PSDQ) e o Eysenck Personality Questionnaire Junior (EPQ-J) foram aplicados, este último apenas para pais/responsáveis de crianças de 5 e 6 anos de idade. Análises descritivas, bivariadas e regressão multivariada de Poisson foram realizadas. A maioria dos pais/responsáveis (74,2%) preferiu materiais convencionais. A idade da criança (p=0,006), a renda familiar (p= 0,001) e o nível de escolaridade (p< 0,001) associaram se a essa escolha. A análise multivariada demonstrou que crianças menores de 7 anos apresentaram 1,20 vezes maior probabilidade de escolher compômeros coloridos do que seus pares mais velhos (p< 0,001), assim como pais/responsáveis com menos de 11 anos de escolaridade e cujos filhos eram menores de 7 anos apresentaram 2,17 e 1,74 maior probabilidade para escolher compômeros coloridos, respectivamente. Concluiu-se que responsáveis com maior escolaridade apresentaram maior resistência às restaurações coloridas e crianças menores de 7 anos aceitaram melhor este material. O estudo bibliométrico-altimétrico adotou estratégia de busca em três bases (Web of Science, Scopus e Google Scholar), independente da data de publicação. Após seleção dos artigos por um grupo de cinco pesquisadores, em março de 2023, foram incluídos estudos que avaliassem qualquer material restaurador empregado em dentes decíduos e analisados dados referentes ao título, número de citações, país/continente, autoria, periódico, instituição, desenho do estudo, tipo de material restaurador, e escore altimétrico. Os artigos, publicados entre 1991 a 2002, apresentaram variação de citações de 19 a 113. Os autores com maior número de citações foram Qvist V e Teglers PT. O estudo experimental foi o principal delineamento de estudo observado e o cimento de ionomero de vidro foi o material mais reportado. A Europa foi o continente, e o Brasil, o país com maior número de citações. O escore altimétrico esteve presente em 23 artigos, com ênfase para dois artigos (43/6º e 73/7º). Concluiu-se que o cimento de ionômero de vidro foi o material mais estudado. Ficou evidente o distanciamento entre a posição dos trabalhos nas análises bibliométrica e altimétrica, apontando necessidade de disseminação da informação além dos círculos acadêmicos.

Currently, an arsenal of restorative materials is available for applicability in pediatric dentistry. The advances in restorative materials conducted to need for further studies in this thematic. The present study presents two investigation proposals: 1) Cross-sectional study aiming to evaluate the preference of parents and children regarding the use of colored compomer (Twinky Star®, Voco, Germany); 2) Bibliometric-altmetric study aiming to analyze the 50-most cited papers regarding to restorative materials used in pediatric dentistry and the dissemination of scientific information in online media. The cross-sectional study included 260 pairs of caregivers/children aged 5 to 11, in two public health services, in the metropolitan region of Belo Horizonte-MG. Examination for dental caries was performed by an examiner calibrated to the criteria of the World Health Organization. A dental mannequin containing colored compomers restorations and conventional materials (composite resin, glass ionomer cement and dental amalgam) was presented to the population and a survey was conducted about the preference of dental materials. Parents' Style and Dimensions Questionnaire (PSDQ) and Eysenck Personality Questionnaire Junior (EPQ-J) were applied, the last one only for parents/caregivers of children aged 5 to 6. Descriptive, bivariate and Poisson regression analyzes were performed. Most adults (74.2%) preferred conventional materials. Family income (p= 0.001) and education level (p< 0.001) were associated with its choice. Age up to 7 (p< 0.001) associated with children's choice for colored restorations (72.3%). Children younger than 7 had 1.20 higher probability to choose colored compomers than their older pairs, while adults with children younger than 7 and less than 11 years of schooling had 1.74 and 2.17 higher probability to choose colored compomers, respectively. It was concluded that caregivers with higher educational level showed greater resistance to use of colored restorations and children younger than 7 had better acceptance of colored material. The bibliometrics-altmetrics study adopted a search strategy in three databases (Web of Science, Scopus and Google Scholar), independent of the year of publication. After selection of papers by a panel of five researchers, in March 2023, any restorative material used in deciduous teeth was included and data about the title, number of citations, country/continent, authorship, journal, design of the study, type of restorative material, university and altmetrics score were analyzed. The papers, published between 1991 and 2002, ranged from 19 to 113 citations. The authors with the highest number of citations were Qvist V and Teglers PT. The experimental study was the main study design observed. Analyzing the continent and country with the highest number of citations, Europe highlighted and Brazil was predominant. The altmetric score was present in 23 papers, emphasizing two articles (43/6th and 73/7th). It was concluded that glass ionomer cement was the most studied material. A gap between the position of the papers correlating the bibliometrics and altmetrics analyzes was evident, demonstrating the need to disseminate the information beyond academic circles.

Assessment of Bite Forces in Restored Teeth with Different Commonly Used Restorative Materials: A Comparative Study

ABSTRACT Objective: To evaluate and compare bite force (BF) in permanent first molars restored with glass ionomer cement (GIC), composite and amalgam, and normal contralateral permanent first molars. Material and Methods: BF was recorded in decayed permanent first molars, which were filled with GIC (n=30), composite (n=30), and amalgam (n=30), and in healthy contralateral first molars (n=90) with Force Transducer Occlusal Force Meter and compared. Results: BF was significantly higher in normal teeth on the contralateral side compared to teeth restored with GIC and composite. However, in patients with amalgam restoration, though it was less compared to that on the contralateral side, it was not statistically significant (p>0.05). Conclusion: Restoring teeth with various filling materials may improve bite force. In the present study, it was found that the teeth restored with amalgam had higher bite forces in comparison to the other restorative materials used. However, it was not comparable to that observed in the normal tooth (control) on the contralateral side.

Evaluation of Microleakage at the Junction Between Combined Amalgam/Composite Resin Restorations Using Different Bonding Systems in Class II Cavities

Abstract Objective: To evaluate the microleakage at the junction between amalgam-composite resin restorations using different bonding systems. Material and Methods: In this in-vitro study, standard class II cavities were prepared on 40 human maxillary premolars. The axial and gingival floor depths of the cavities were 2 mm and 1 mm below (cementoenamel junction), respectively. The samples were divided into 4 groups (n = 10). In all groups, a layer of 1-mm thick amalgam was used as a coating for the initial part of the gingival floor. In group 1, no bonding system was used for amalgam restoration. In group 2, G-Premio Bond was applied. G-Premio bond + alloy primer and single bond + alloy primer were used in group 3 and group 4, respectively. The rest of the cavities in all groups were then repaired using FiltekZ250 composite. The samples were thermocycled at 500 rpm and immersed in 1% methylene blue solution for 24 hours to allow dye penetration. Once cut, the samples were placed under a stereomicroscope (40X) to determine the microleakage rate. Data analysis was carried out using post-hoc and Chi-square tests (p<0.05). Results: The highest and lowest microleakage rate was related to groups 1 and 3, respectively. There was a significant difference between groups (1,2) and (1,3), and (1,4), and groups (2,3) (p<0.05). Conclusion: The use of alloy primer and bonding could reduce the microleakage between the two restorations (AU).

Glass ionomer heated or not to identify bone defect created in rat calvaria / Ionômero de vidro aquecido ou não para identificação de defeitos ósseos criados em calvárias de ratos

Introduction: Some experimental models have been used to evaluate the use of biomaterials in bone regeneration. Among them are the critical size defects (CSD) created in rat calvaria. An experimental model has been described in the literature, in which "L" markings are performed on the margins of the bone defects in order to assist in the precise identification of these defects during laboratory processing and analysis of the results. In the proposed model, the "L" markings are filled with amalgam. Objective: The purpose of the present study was to evaluate the amalgam replacement of an experimental bony defect model in rat calvaria by heated or unheated glass ionomer. Material and method: 24 rats were used. A 5 mm CSD was created at each animal calvaria. Two "L" shaped markings were made 2 mm from the margins of the bone defect, filled with amalgam (Group AM), heated glass ionomer cement (Group GIh) or not (Group GI). The animals were euthanized 15 days postoperatively. The areas of the surgical defect and the L-shaped marking were histomorphometrically analyzed and the data were analyzed statistically (p <0.05). Result: There were no significant clinical, histological or methodological differences among the experimental groups. Conclusion: It can be concluded that GI can replace AM in the proposed experimental model and GI heating did not promote additional benefits.

Introdução: Alguns modelos experimentais têm sido usados para avaliar o uso de biomateriais na regeneração óssea. Entre eles estão os defeitos de tamanho crítico (DTC) criados em calvárias de ratos. Um modelo experimental foi descrito na literatura onde marcações em L são realizadas nas margens do defeito ósseo para auxiliar na identificação precisa desses defeitos durante o processamento laboratorial e análise dos resultados. No modelo experimental proposto, as marcações em "L" são preenchidas com amálgama. Objetivo: Avaliar a substituição do amálgama por ionômero de vidro aquecido ou não em um modelo experimental para identificação de defeito ósseo criado em calvária de ratos. Material e método: Foram utilizados 24 ratos. Um DTC de 5 mm de diâmetro foi criado na calvária de cada animal. Duas marcações em "L" foram realizadas a 2 mm das margens do defeito ósseo, preenchidas com amálgama (Grupo AM), ionômero de vidro aquecido (Grupo CIVaq) ou não (Grupo CIV). Os animais foram eutanasiados aos 15 dias pós-operatórios. A área do defeito cirúrgico e das marcações em "L" foram histomorfometricamente avaliadas e os dados estatisticamente analisados (p<0,05). Resultado: Não houve diferença estatisticamente significativa entre os grupos experimentais para as análises metodológicas, clínicas ou histomorfométrica realizadas. Conclusão: Dentro dos limites deste estudo, pode-se concluir que CIV pode substituir o AM no modelo experimental proposto e o aquecimento do CIV não promoveu benefícios adicionais.

Recomendaciones sobre la reparación de restauraciones de amalgama / Recommendations about the repair of dental amalgam restorations

Introducción: La reparación de restauraciones de amalgama, los materiales, las caras de los dientes de preferencia para realizarlas y su controversia con la contraparte de realizar reemplazos, es algo que amerita atención por los investigadores para lograr definiciones y protocolos precisos. Objetivo: Sistematizar sobre las recomendaciones de la literatura con respecto a la reparación de restauraciones de amalgama. Métodos: Se realizó una revisión cualitativa. Se plantearon criterios de inclusión y exclusión para la selección de los artículos. La búsqueda se realizó en Scopus y Pubmed. De las investigaciones resultantes de la búsqueda fueron decantados los artículos que no coincidían con el problema de investigación en cuestión, luego los que no cumplían los criterios de inclusión y exclusión. Se realizó una evaluación de la calidad y validez de los artículos seleccionados para ser incluidos en esta investigación y, finalmente, se le dio lectura a los textos completos y resúmenes para extraer los datos necesarios para completar la base de datos de la investigación. Quedaron un total de 27 artículos que fueron tamizados en una base de datos Excel, la que luego se exportó al software SPSS para su procesamiento estadístico. Resultados: El 44,4 por ciento y 55,6 por ciento de los artículos recomiendan reparar las restauraciones con amalgama y resina compuesta, respectivamente. Casi la mitad de los artículos (48,1 por ciento) no precisaron una cara del diente susceptible o no para realizar reparaciones. El 44,4 por ciento concluyen con que es un tratamiento recomendable. Conclusiones: Es recomendable realizar reparaciones de restauraciones de amalgama con amalgama dental y con resina compuesta. No está claramente definido cuál cara del diente es susceptible o no a recibir reparaciones y es un tratamiento que puede formar parte del arsenal terapéutico de los odontólogos(AU)

Introduction: The repair of amalgam restorations, the materials used, the tooth sides preferred to perform them, and the controversy with the replacement option, are all topics deserving the attention of researchers with a view to achieving accurate definitions and protocols. Objective: Systematize the recommendations available in the literature about the repair of amalgam restorations. Methods: A qualitative review was carried out. Inclusion and exclusion criteria were established for the selection of papers. The search was conducted in Scopus and Pubmed. Papers not related to the research problem at hand were the first to be discarded. Then those not meeting the inclusion and exclusion criteria. An evaluation was performed of the quality and validity of the remaining papers, and finally their full texts and abstracts were read to retrieve the data required to complete the database of the study. The 27 papers thus obtained were sifted in an Excel database, which was then exported to the SPSS software for statistical processing. Results: 44.4 percent and 55.6 percent of the papers recommend to repair restorations with amalgam and composite resin, respectively. Almost half (48.1 percent) do not state any preference for a specific tooth side to perform the repair. 44.4 percent recommend the treatment. Conclusions: It is advisable to perform repairs of amalgam restorations with dental amalgam and with composite resin. It is not clearly defined which tooth side is preferred to undergo the repair. This treatment may be part of the therapeutic arsenal of dentists(AU)

Tatuaje de amalgama: Pigmentación exógena más común de la cavidad oral / Amalgam tattoo: Most common exogenous pigmentation of the oral cavity

Resumen El propósito de este estudio es analizar las características clínicas de la pigmentación de amalgama en la cavidad oral, comúnmente, denominada también tatuaje de amalgama, el objetivo es aumentar el conocimiento de esta entidad patológica y diferenciarla de otras lesiones de mayor importancia clínica.

Abstract The purpose of this study is to analyze the clinical characteristics of amalgam pigmentation in the oral cavity, commonly known as amalgam tattoo, in order to increase the knowledge of this pathological entity and to differentiate it from other important lesions.

Amalgam allergy and Burning Mouth Syndrom: treatment and 25 years recall / Alergia ao amálgama e Síndrome da ardência bucal: tratamento e 25 anos de proservação

Background: Burning mouth syndrome (BMS) is a non-neuropathic chronic orofacial pain condition, characterized by the presence of burning/warm sensation without specific mucosal lesions. Objective: The aim of the present clinical case report is to describe the positive outcome of dental treatment of a patient with BMS and followed up for 25 years. Data Treatment: This report describes the case of a 50-year-old black woman sought treatment for burning, and persistent swelling of tong (24h/day) occurring over years. Clinical evaluation of the oral environment revealed the tongue with cracking, darkened points areas, surrounded by whitish areas. Twelve teeth presented extensive amalgam restorations. Patch testing revealed a very strong hypersensitivity to Amalgam. All amalgam restorations were substituted by composite resin restorations. Results and Conclusion: Burning sensation disappeared completely after these restorations had been changed. After 25-year follow-up period, it was observed that burning sensation has never been felt anymore. Clinical Significance: Burning mouth syndrome is a chronic orofacial pain, usually without specific mucosal lesions. The etiology is complex and multifactorial and the treatment should be made specifically for each pacient. (AU)

Introdução: A síndrome de ardência bucal (SAB) é uma condição de dor orofacial crônica não neuropática, caracterizada pela presença de sensação de queimação/calor sem lesões específicas da mucosa. Objetivo: Oobjetivo do presente relato de caso clínico é descrever a evolução positiva do tratamento odontológico de uma paciente com SAB e o retorno após 25 anos. Tratamento dos Dados: Este relato descreve o caso de uma mulher negra de 50 anos que buscou tratamento por queimadura e edema persistente da língua (24h/dia) ocorrendo ao longo dos anos. A avaliação clínica da cavidade bucal revelou a língua com áreas fissuradas e áreas com pontos escurecidos circundadas por áreas esbranquiçadas. Doze dentes apresentavam restaurações extensas de amálgama de prata. O teste de contato revelou hipersensibilidade muito forte ao amálgama de prata. Todas as restaurações de amálgama de prata foram substituidas por restaurações de resina composta. Resultados e Conclusão: A sensação de queimação desapareceu completamente após a substituição das restaurações. Após um periodo de 25 anos, observou-se que a sensação de queimação nunca foi mais relatada. Significado Clínico: a síndrome da ardência bucal é uma dor orofacial crônica, geralmente sem lesões específicas da mucosa. A etiologia é complexa e multifatorial e o tratamento deve ser feito especificamente para cada paciente.(AU)

The protective role of selenium against dental amalgam-induced intracellular oxidative toxicity through the TRPV1 channel in DBTRG glioblastoma cells

Abstract Objective The exposure to mercury (Hg) from dental amalgams is a suspected causative factor in neurological diseases. This study investigated the toxic effects of two different amalgam compositions related to Hg and the protective effects of selenium against the toxic effects of Hg through the TRPV1 channel in the human DBTRG glioblastoma cell line. Methodology Six groups of the cells were organized. Analyses of cell viability, apoptosis, caspase 3 and caspase 9 activities, mitochondrial membrane depolarization, reactive oxygen species (ROS) production, and Western Blotting for protein expression levels were performed. Results Cell viability values were lower in amalgam with high copper (HCu) and low copper (LCu) groups independently of time but were increased by selenium and capsazepine (p<0.001 and p<0.05). Conversely, apoptosis rates, caspase 3 and caspase 9 expression, ROS formation, mitochondrial membrane depolarization, and protein expression levels were higher in the HCu and LCu groups but were decreased by selenium (p<0.001 and p<0.05). Conclusions Selenium combined with an amalgam of either HCu or LCu decreases the toxic effects created by Hg in human DBTRG glioblastoma cells.

Perspectivas del Uso de la Amalgama Dental bajo el Convenio de Minamata: Tendencias Nacionales e Internacionales / Perspectives of the Use of Dental Amalgam Under the Minamata Convention: National and International Tendencies / Perspectivas para o uso de amálgama dental sob a Convenção de Minamata: tendências nacionais e internacionais

Resumen El objetivo de este artículo de revisión es abordar el tema de la amalgama dental en relación con el Convenido de Minamata Sobre el Mercurio. Las decisiones que, al amparo de dicho convenio, se vienen tomando en el mundo, incluyendo Colombia, y que afectan la continuidad de la amalgama como material de restauración dental, siendo esto agravado por los altos niveles de prevalencia de la caries dental a nivel global. Se revisa la posición de algunas organizaciones internacionales y sus decisiones basadas en lo que la evidencia científica disponible muestra sobre la toxicidad y biocompatibilidad de la amalgama, y sus posibles materiales de reemplazo. Se revisa el panorama nacional y el impacto de las decisiones gubernamentales sobre la profesión odontológica.

Abstract The aim of this review article is to address the issue of dental amalgam in relation to the Minamata Convention on Mercury. The decisions that, under this convention, are being taken in the world, including Colombia, and which affect the continuity of amalgam as dental restoration material, this is being aggravated due to the high levels of prevalence of dental caries globally. The position of some international organizations, their decisions based on the available scientific evidence about the toxicity and biocompatibility of amalgam, and its possible replacement materials are reviewed. The national landscape and the impact of government decisions on the dental profession are reviewed.

Sumário O objetivo deste artigo de revisão é abordar a questão da amálgama dental em relação ao Acordo de Minamata sobre Mercúrio. As decisões que, sob este acordo, estão sendo tomadas no mundo, incluindo a Colômbia, e que afetam a continuidade do amálgama como material de restauração dentária, agravadas pelos altos níveis de prevalência mundial de cárie dentária. A posição de algumas organizações internacionais e suas decisões são revisadas com base no que as evidências científicas disponíveis mostram sobre a toxicidade e biocompatibilidade do amálgama e seus possíveis materiais de substituição. A paisagem nacional e o impacto das decisões do governo na profissão odontológica são revistos.

Mercury Loss From Dental Amalgam Fillings

Abstract Objective: To compare the amount of mercury in new and old dental amalgam restorations. Material and Methods: This study analyzed twenty samples of dental amalgam restorations, dividing into two groups. Group 1 consisted of samples of new dental amalgam restoration (n=10) and group 2 consisted of samples of old dental amalgam restoration (5-years old) (n=10). In each group, the mercury involved in the dental amalgam restoration was calculated using the cloud point extraction (CPE) method. The new dental amalgam restorations are taken from the patients' mouth after condensation and analyzed directly after setting. The old dental amalgam restorations are removed from the patients' mouth, after 5 years of use by the patients, and then they are analyzed. The independent-samples t-test was used to analyze the differences (p<0.05). Results: For new amalgam restorations, the mean of mercury was 0.1281 µg/mL, while for old restorations it was 0.1029 µg/mL. There was a significant difference between the new and old amalgam restorations in the amount of mercury available (p<0.001). Conclusion: There is a significant loss of mercury over a five years period in the patient mouth.

Qualitative and quantitative analysis of Mercury ions on the surface of amalgam restorations after home bleaching / Análise qualitativa e quantitativa de íons Mercúrio na superfície de restaurações de amálgama após o clareamento caseiro

ABSTRACT Objective The bleaching agents may interact with restorative materials, such as dental amalgam, providing an increase mercury ions (Hg) release, whose toxic effect is known. Whereas many patients have amalgam restorations (AR) and seek bleaching treatments, the present study aimed to evaluate in vitro the amount of Hg released from AR made with spherical alloy, after being subjected to different concentrations of carbamide peroxide (CP) for home bleaching. Methods 40 class I AR were prepared in bovine teeth. Afterthe restoration, the samples were randomly allocated into 4 groups (n = 10): C (control group), CP10 (CP 10%) CP15 (CP 15%) CP20 (CP 20%) and its treatments were simulated for 14 days for 6 hours daily. The Hg ions released was measured by energy dispersive X-ray spectroscopy (EDS) and surface changes were assessed in the Scanning Electron Microscope (SEM). Hg levels (percent mass) were recorded and the differences were statistically analyzed using the Kruskal-Wallis test and Dunn's "Post hoc" test. Results Statisticalanalysis showed the bleaching treatment resulted in a higher Hg release (p <0.05), although no visible changes were identified in micrographs when comparing the control group with the other groups (CP10, CP15, CP20). Conclusion Increased Hg release may be observed during simulated home bleaching.

RESUMO Objetivo Os agentes clareadores podem interagir com materiais restauradores, como o amálgama, proporcionando um aumento na liberação de íons de mercúrio (Hg), cujo efeito tóxico é conhecido. Considerando que muitos pacientes possuem restaurações de amálgama (AR) e buscam tratamentos clareadores, o presente estudo teve como objetivo avaliar in vitro a quantidade de Hg liberado a partir da AR confeccionada com liga tipo esférica, após serem submetidas a diferentes concentrações de peróxido de carbamida (PC) para clareamento caseiro. Métodos 40 AR foram confeccionadas em dentes bovinos classe I. Após a restauração, as amostras foram distribuídas aleatoriamente em 4 grupos (n = 10): C (grupo controle), CP10 (PC 10%) CP15 (PC 15%) CP20 (PC 20%) e seus tratamentos foram simulados por 14 dias, por 6 horas diárias. Os íons de mercúrio liberados foram medidos por espectroscopia de energia dispersiva de raios-X (EDS) e as mudanças de superfície foram avaliadas pelo Microscópio Eletrônico de Varredura (MEV). Resultados A análise estatística demonstrou que o tratamento clareador resultou em uma liberação de íons mercúrio (p <0,05), embora nenhuma alteração visível tenha sido identificada nas micrografias quando compara-se o grupo C com os outros grupos (CP10, CP15, CP20). Conclusão Pode-se observar aumento da liberação de mercúrio durante o clareamento caseiro simulado.

Reparación de defecto localizado en restauración de amalgama como tratamiento de mínima intervención en cariología / Repair of a localized defect in a restoration with amalgam filling as minimal intervention treatment in cariology

Introducción: La reparación de restauraciones ha sido estudiada desde muy recientemente, pero a pesar de haber demostrado efectividad y mejoras en la terapéutica de la caries dental, aún tiene seguidores y detractores, lo que justifica la necesidad de estudios que sigan avalando tales prácticas. Objetivo: Describir, a través de la presentación de un caso, la reparación de un defecto localizado en una restauración de amalgama como tratamiento de mínima intervención en cariología. Presentación del caso: Paciente femenina de 16 años con antecedentes de salud acude a consulta refiriendo una pequeña fractura de restauración en diente 4.6 desde hace varias semanas. La regularización del defecto en la restauración, la mínima preparación cavitaria, la eliminación del fragmento de la base intermedia, la protección del complejo dentino-pulpar y el llenado de la cavidad resultante, fueron los primeros pasos de una técnica que se cumplimentó luego del pulido final de la interface tejido dentario-restauración y se evolucionó cinco años después. Se evidenció el estado y presencia de la reparación de la restauración realizada, sin fracturas añadidas, microfiltraciones, sintomatologías, desplazamientos ni pérdidas de la continuidad. Conclusiones: La reparación del defecto localizado de amalgama se realizó con el fin de preservar los tejidos dentarios no afectados como lo dicta la mínima intervención en cariología. Cinco años más tarde, la evolución evidencia una práctica que se tradujo en resultados satisfactorios e incremento de la calidad de vida de la paciente(AU)

Introduction: Restoration repair has been studied recently; but, even when it has demonstrated effectiveness and improvements in the therapy of dental caries, it still has followers and detractors that justify the need for studies that continue supporting such practices. Objective: To describe, through a case presentation, the repair of a defect located in a restoration with amalgam filling as minimal intervention treatment in cariology. Case presentation: Sixteen-year-old female patient with health history that went to the clinic reporting a small fracture of a restoration performed in tooth 4.6 several weeks ago. The regularization of the defect in the restoration, minimum cavity preparation, elimination of the fragment of the intermediate base, protection of the dentin-pulp complex, and filling of the resulting cavity were the first steps of a technique that was completed after the final polishing of the dental tissue/restoration interface that was evolved five years later. The status and presence of the restoration repair performed without added fractures, microfiltration, symptomatology, displacement or loss of continuity was evidenced. Conclusions: The repair of the localized defect in a restoration with amalgam filling was performed with the aim of preserving the unaffected dental tissues as dictated by minimal intervention in cariology. Five years later, the patient´s evolution shows a practice that resulted in satisfactory results and an increase in the patient's quality of life(AU)

La amalgama dental en el futuro / Dental amalgam in the future

Las convenciones internacionales relacionadas con las posibles consecuencias ambientales del empleo del mercurio a las que ha adherido la República Argentina llevan a la paulatina desaparición de la posibilidad del empleo de este elemento. Consecuentemente, se genera la necesidad de reducir y, en última instancia, eliminar el uso de productos médicos que lo contengan, como es el caso de la amalgama dental. Se requiere de la decisión conjunta de las comunidades académica y asistencial para definir estrategias a aplicar en la reducción gradual del uso de la amalgama dental. La forma de hacerlo y la tecnología para su reemplazo aún son inciertas (AU)

International conventions related to the possible environmental consequences of the use of mercury that the Argentine Republic has subscribed lead to the gradual disappearance of the possibility of using this element. Consequently, there is a need to reduce and ultimately eliminate the use of medical products that contain it, as is the case with dental amalgam. The joint decision of academic and healthcare communities is required to define strategies to be applied in the gradual reduction of the use of dental amalgam. The way to do it and the technology for its replacement still remain uncertain (AU)

Validação de um manual de brinquedos e brincadeiras para estimulação do desenvolvimento de crianças com deficiência auditiva: descrição de um processo / Validation of a manual of toys and games to stimulate the development of children with hearing loss: a description of a process

Introdução: uma superfície polida aumenta a resistência, a compressão, a corrosão e as fraturas marginais do amálgama. Objetivo: o presente estudo avalia a eficácia de quatro técnicas de polimento em restaurações de amálgama quanto à capacidade de promover lisura superficial nas mesmas, e se entre elas, existe, alguma mais eficaz em comparação às demais. Método: neste experimento, realizaram- -se polimentos em 60 corpos de prova de amalgama divididos em 4 grupos, de acordo com a técnica de polimento: taça de borracha +pedra pomes; pontas de silicone abrasiva; pontas de silicone abrasiva + pedra pomes; taça de borracha, pedra pomes + pontas de silicone abrasiva. Mensurou-se a rugosidade superficial em micrômetros, computando os dados em Microsoft Excel e submetendo-os ao teste de Kruskal-Wallis. Resultados e Conclusão: após a avaliação dos resultados, constatou-se que houve diferença estatisticamente significante entre uma das técnicas em relação às dos demais grupos: o tratamento feito com o grupo pontas de silicone abrasivas apresentou a melhor lisura de superfície.

Introduction: a polished surface increases the compression resistance, corrosion and marginal fractures of amalgam. Objective: the present study evaluates the effectiveness of four techniques for polishing in amalgam restorations, as well as its ability to promote surface smoothness in it, and if among them is there any more effective when compared to another. Methods: in the experimental phase, was carried out polishes in 60 specimens of amalgam, divided into four groups by the technique of polishing: rubber cup and pumice stone; abrasive silicone tips; abrasive silicone tips and pumice stone; rubber cup, pumice stone and abrasive silicone. Surface roughness was measured in micrometres, computing the data in Microsoft Excel and subjecting it to the Kruskal-Wallis test. Results and conclusion: the evaluation of the results showed that there was a difference statistically significant between one of the techniques regarding the other ones: the treatment done by the group of abrasive silicone tips presented the best smoothness of the surface.

Lisura superficial do amálgama frente a técnicas de polimento / Amalgam surface smoothness as regards techniques of polishing

Introdução: uma superfície polida aumenta a resistência, a compressão, a corrosão e as fraturas marginais do amálgama. Objetivo: o presente estudo avalia a eficácia de quatro técnicas de polimento em restaurações de amálgama quanto à capacidade de promover lisura superficial nas mesmas, e se entre elas, existe, alguma mais eficaz em comparação às demais. Método: neste experimento, realizaram- -se polimentos em 60 corpos de prova de amalgama divididos em 4 grupos, de acordo com a técnica de polimento: taça de borracha +pedra pomes; pontas de silicone abrasiva; pontas de silicone abrasiva + pedra pomes; taça de borracha, pedra pomes + pontas de silicone abrasiva. Mensurou-se a rugosidade superficial em micrômetros, computando os dados em Microsoft Excel e submetendo-os ao teste de Kruskal-Wallis. Resultados e Conclusão: após a avaliação dos resultados, constatou-se que houve diferença estatisticamente significante entre uma das técnicas em relação às dos demais grupos: o tratamento feito com o grupo pontas de silicone abrasivas apresentou a melhor lisura de superfície.

Introduction: a polished surface increases the compression resistance, corrosion and marginal fractures of amalgam. Objective: the present study evaluates the effectiveness of four techniques for polishing in amalgam restorations, as well as its ability to promote surface smoothness in it, and if among them is there any more effective when compared to another. Methods: in the experimental phase, was carried out polishes in 60 specimens of amalgam, divided into four groups by the technique of polishing: rubber cup and pumice stone; abrasive silicone tips; abrasive silicone tips and pumice stone; rubber cup, pumice stone and abrasive silicone. Surface roughness was measured in micrometres, computing the data in Microsoft Excel and subjecting it to the Kruskal-Wallis test. Results and conclusion: the evaluation of the results showed that there was a difference statistically significant between one of the techniques regarding the other ones: the treatment done by the group of abrasive silicone tips presented the best smoothness of the surface.

Reação liquenoide oral ao amálgama: uma lesão ainda vista / Oral lichenoid reaction to amalgam: a lesion still seen

O amálgama dental ainda é amplamente utilizado na prática odontológica, apesar do acordo assinado na Convenção de Minamata, na qual 140 países comprometeram-se a reduzir o uso do mercúrio. O uso desse material restaurador pode desencadear reações liquenoides orais (RLO) cujas lesões apresentam semelhanças clínicas e histológicas com líquen plano oral (LPO), dificultando o diagnóstico. Aqui relatamos o caso de uma paciente do sexo feminino, de 72 anos, que foi encaminhada com uma lesão na mucosa bucal esquerda, com 10 meses de evolução e queixa de dor. A lesão era adjacente ao segundo molar inferior esquerdo que tinha uma restauração de amálgama. A paciente não apresentava doença sistêmica ou hábitos deletérios e não estava usando drogas continuamente. O diagnóstico clínico presuntivo foi RLO versus LPO. Sessenta dias após a substituição da restauração do amálgama, observou-se a regressão completa da lesão e o diagnóstico final de RLO foi realizado. A avaliação clínica associada aos resultados obtidos após a substituição do material suspeito pode ser suficiente para estabelecer o diagnóstico, embora em alguns casos seja necessária a avaliação histopatológica.

Dental amalgam is still widely used in dental practice, despite the agreement signed at the Minamata Convention, in which 140 countries have committed to reducing the use of mercury. The use of this restorative material may trigger oral lichenoid reactions (OLR) whose lesions show clinical and histological similarities with oral lichen planus (OLP), making diagnosis difficult. Here we report the case of a female patient, 72-year-old, who was referred with a lesion in the left buccal mucosa, with 10 months of evolution and complaint of pain. The lesion was adjacent to the second lower left molar which had an amalgam restoration. The patient had no systemic disease or deleterious habits and was not using drugs continuously. The presumptive clinical diagnosis were OLR versus OLP. Sixty days after the replacement of amalgam restoration the complete regression of the lesion was observed and the final diagnosis of OLR was done. Clinical assessment associated with the results obtained after the replacement of suspect material may be sufficient to establish the diagnosis, although in some cases it may be necessary histopathological evaluation.

Utilization Of Samanya Shodhana In The Purification Of Excess Mercury Obtained From Dental Operatory- A Preliminary Study

Background: Concerns about toxicity of mercury and disposal of excessive mercury has led to decreased usage of mercury in dental profession but still tooth colored restorative materials are not affordable by all the classes of any society. The disposal of excess mercury has always been a matter of concern. Thus, in the present study, we attempted to evaluate a simple procedure from Rasa Shastra using lime powder, garlic and rock salt for recycling of excess mercury obtained from dental operatory. Materials and methods: The excess mercury was recycled by the standard procedure explained in Ayurveda texts (Samanya shodhana) using Sudha churna (lime powder), Lashuna kalka (paste of Allium sativum L.) and Saindhava lavanaa (rock salt). The commercially available mercury and recycled mercury was analyzed by inductively coupled plasma mass spectrometry (ICP-MS) for the detection of elements in ppm level. Results: It was found that the excess impure mercury contained 5138 ppm, 2866.1 ppm and 0.371 ppm of Silver, Copper and Tin respectively. After Shodhana, the level of silver, tin and copper were markedly reduced. Purified mercury showed a level of 119.5ppm silver, 0.5324 ppm copper and 0.3233 ppm tin. Conclusion: Samanya shodhana is a simple promising procedure which can be used for mercury recycling. The procedure doesnot require sophisticated equipments and maneuver. Further, the materials used in the procedure are easily available and affordable at low cost.