Risk of failure of repaired versus replaced defective direct restorations in permanent teeth: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to systematically review the literature to compare the risk of failure of repaired and replaced defective direct resin composite and amalgam restorations performed in permanent teeth. MATERIALS AND METHODS: The PubMed/MEDLINE, Scopus, Lilacs, BBO, Web of Science, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL) databases, and gray literature were searched to identify longitudinal clinical studies related to the research question. No publication year or language restriction was considered. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and certainty of evidence. A meta-analysis was performed using a fixed effects model at a 5% significance level. RESULTS: From 1224 potentially eligible studies, thirteen were selected for full-text analysis, and three were included in the systematic review and meta-analysis. There was no difference in the risk of failure of repaired and replaced defective direct restorations (RR: 1.21, 95% CI: 0.51-2.83), either for resin composite (p = 0.97) or amalgam (p = 0.51) restorations. The risk of bias was high and the certainty of evidence was very low. CONCLUSION: Based on the very low certainty of evidence, the repair of direct restorations does not present a significant difference in the risk of failure when compared to replacements in permanent teeth. CLINICAL RELEVANCE: Restoration repair is a procedure that is included in the minimal intervention principle for improvement of tooth longevity in that the risk of failure of repaired partially defective restorations in permanent teeth seems similar to that of replacement. Further studies are required before definitive conclusions can be drawn.

Influence of the chemomechanical and mechanical carious tissue removal on the risk of restorative failure: a systematic review and meta-analysis.

OBJECTIVE: To summarize and evaluate critically the results of clinical trials comparing the risk of failure of restorations after chemomechanical and mechanical carious tissue removal. MATERIALS AND METHODS: The PubMed/MEDLINE, EMBASE, Scopus, LILACS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases, and grey literature were searched to identify studies related to the research question and published up to January 2022. Two authors independently selected the studies, extracted the data, and assessed the risk of bias and the certainty of evidence. Meta-analysis was performed using a random effects model to compare the effect of chemomechanical and mechanical excavation on the outcome (restorative failure), considering the type of carious tissue removal (selective and complete) as subgroups. RESULTS: From 443 potentially eligible studies, 58 clinical studies were selected for full-text analysis, and 6 were included in the review. There was no statistically significant difference in the risk for failure of restorations performed after chemomechanical and mechanical excavation (RR: 1.26, 95% CI 0.93; 1.72, p = 0.14) either for complete (p = 0.97) or selective (p = 0.11) carious tissue removal. The heterogeneity found was null. The risk of bias was high and the certainty of evidence was low. CONCLUSION: Based on the low certainty of evidence, the risk of failure of restorations performed after chemomechanical and mechanical carious tissue removal is similar. CLINICAL RELEVANCE: Chemomechanical carious tissue removal may be performed before restoration placement, without jeopardizing the short-term longevity. Further studies are required before definitive conclusions can be drawn.

Erosive Tooth Wear and Erosive Esophagitis in Children: An Observational Study in Porto Alegre, Brazil.

The aim of this study was to establish and compare the prevalence and severity of erosive tooth wear (ETW) in children with and without erosive esophagitis. Children aged 5-12 years, scheduled for upper digestive endoscopy at the Pediatric Gastroenterology Service of the Children's Hospital Santo Antonio, Porto Alegre, Brazil, were eligible to participate in this study. Patients who presented erosive esophagitis at endoscopy were defined as gastroesophageal reflux disease (GERD) carriers, and the severity was described according to the Los Angeles classification. The oral cavity examination was performed by a trained and calibrated dentist and ETW was classified using the Basic Erosive Wear Examination (BEWE) index. Parents/guardians answered a questionnaire about the patients' diets and frequency of consumption of acidic foods and beverages. A total of 110 children were included in the study. Erosive esophagitis was observed in 24 patients (21.8%) and all of them (100%) presented ETW, showing a statistically significant association between these 2 conditions (p < 0.05). Among children who did not present with erosive esophagitis (n = 86), 54 (64.3%) had an ETW risk level of none according to their BEWE scores (0-2). The results of this study showed a statistically significant association between erosive esophagitis and ETW, thus it can be concluded that it is important to recognize groups at risk of ETW and act together with medical professionals to ensure adequate oral health for these patients.

Repair increases the survival of failed primary teeth restorations in high-caries risk children: a university-based retrospective study.

OBJECTIVES: We investigated factors associated with failure of adhesive restorations in primary teeth and whether repair may increase the survival of failed restorations placed in high-caries risk children. MATERIALS AND METHODS: The sample comprised children who attended a university dental service to perform restorative treatment in primary teeth. Data were collected retrospectively from clinical records to assess the longevity of restorations. The outcomes were calculated in two levels: "Success" (Level 1)-when any re-intervention was considered as failure; "Survival" (Level 2)-when repaired restorations were considered clinically acceptable. The Kaplan-Meier survival test was used to analyze the longevity of restorations. Multivariate Cox regression with shared frailty was used to assess factors associated with failures (p < 0.05). RESULTS: A total of 584 primary teeth restorations (178 patients) were included in the analysis. The longevity of restorations up to 36 months (Level 1) was 34.8% (AFR 29.6%). Multi-surface restorations showed significantly more failures than single-surface ones (HR 1.69; 95% CI 1.18, 2.41), and endodontically treated teeth presented more failures compared to vital teeth (HR 2.22; 95% CI 1.35, 3.65). There was an increase in restoration survival when repair was not considered as failure (p < 0.001). The survival of repaired restorations (Level 2) reached 43.7% (AFR 24.1%). CONCLUSIONS: Adhesive restorations placed in primary teeth of high-caries risk children showed restricted longevity; however, the repair of failed restorations has increased its survival over time. CLINICAL RELEVANCE: Repair is a more conservative and technically simple procedure that increases the survival of failed restorations in primary teeth.

Hypoxia upregulates the expression of the pluripotency markers in the stem cells from human deciduous teeth.

OBJECTIVES: Cultivation under hypoxia promotes different responses in the mesenchymal stem cells and it has been producing promising results for clinical applications. Pulp tissue from deciduous teeth is a source of stem cells which has a high proliferative potential but this is usually discarded. This study has evaluated the effects of hypoxia on proliferation, apoptosis, and the expression of the pluripotency-related genes of the stem cells from human exfoliated deciduous teeth (SHED). MATERIALS AND METHODS: The cells were isolated from dental pulp (n = 5) and characterized as mesenchymal stem cells, in accordance with the International Society for Cell Therapy. The cells were cultivated under hypoxia (3% oxygen) and compared to the normoxia cells (21% oxygen). The proliferation rate was evaluated by the Ki67 antibody for up to 7 days, while the metabolic activity was measured by the wst-8 assay for up to 14 days. The apoptotic cells were analyzed by Annexin V and propidium iodide staining at 24 h and 4 and 7 days. The expression of the pluripotent genes (OCT4, SOX2, and NANOG) was quantified by qPCR after 24 h, or 7 days, when cultivated under hypoxia or normoxia. RESULTS: No differences in the metabolic activity, the proliferation rate, and the apoptosis of SHED when cultivated under hypoxia or normoxia (p > 0.05) were observed. The expression of the pluripotent genes was significantly higher after 24 h and 7 days of the cells that were exposed to hypoxia (p < 0.01). CONCLUSION: These findings have indicated an increase of the pluripotency-related genes within 7 days as being the main advantage of SHED culture under hypoxia. CLINICAL RELEVANCE: Hypoxia culture may help maintain the quiescent state of the SHED, which could be advantageous for their future clinical applications.

Prevalence of defective restorations and factors associated with re-intervention in primary teeth: A retrospective university-based study.

AIM: This retrospective study investigated the prevalence of defective restorations in a public dental service and factors associated with re-intervention in primary teeth. DESIGN: The sample consisted of all clinical records (census) of children presenting restorations in primary teeth, who had undergone dental treatment in a public set during 1-year period. For analysis, only restorations presenting defects related to esthetic, functional, or biological reasons at first clinical examination were included. The outcome 'Success' was set when the restoration received no treatment (monitored), refurbishing, sealing of margins, or was repaired. Otherwise, 'Failure' was set whenever the restoration was either replaced or if another treatment affecting the restoration was necessary (endodontic treatment or tooth extraction). Poisson regression model was used to assess the prevalence of patient- and tooth-related factors that may influence the re-intervention decision (repair or replacement). RESULTS: From a total of 302 restorations placed in 114 children, 37.7% presented some type of defect. Restorations with recurrent caries were more frequently present in caries-active patients (P = 0.03) and were frequently replaced (95% CI, 1.05-3.22, RR = 1.84, P = 0.03). CONCLUSION: Presence of recurrent caries influences the re-intervention decision, leading to restoration replacement in most cases.

Pulp Revascularization or Apexification for the Treatment of Immature Necrotic Permanent Teeth: Systematic Review and Meta-Analysis.

This systematic review and meta-analysis assessed clinical, radiographic and functional retention outcomes in immature necrotic permanent teeth treated either with pulp revascularization or apexification after a minimum of three months to determine which one provides the best results. The literature was screened via PubMed/MEDLINE and Embase databases up to June 2017 to select observational studies that compared pulp revascularization and apexification treatments assessing clinical, radiographic and functional retention outcomes. Two reviewers independently performed screening and evaluation of articles. A total of 231 articles were retrieved from databases, wherein only four articles were selected for full-text analyses. After exclusion criteria, three studies remained in quantitative and qualitative analyses. Pooled-effect estimates were obtained comparing clinical and radiographic outcomes ('overall outcome') and functional retention rates between apexification and pulp revascularization treatment. The meta-analysis comparing apexification vs. revascularization for 'overall outcome' (Z=0.113, p=0.910, RR=1.009, 95%CI:0.869-1.171) and functional retention rates (Z=1.438, p=0.150, RR=1.069, 95%CI:0.976-1.172) showed no statistically significant differences between the treatments. All studies were classified as high quality. The current literature regarding the clinical, radiographic and functional retention outcomes in immature necrotic permanent teeth treated either with pulp revascularization or apexification is limited. Based on our meta-analysis, the results do not favor one treatment modality over the other.

Patient- and treatment-related factors may influence the longevity of primary teeth restorations in high caries-risk children: A university-based retrospective study.

PURPOSE: To evaluate the longevity and factors associated with failure of primary teeth restorations placed in high caries-risk children. METHODS: The sample was comprised of children treated in a University Dental Service. Patients' records were screened retrospectively to determine whether they had received restorative treatment in primary teeth presenting cavitated caries lesions. Kaplan-Meier estimator and Multivariate Cox regression analysis with shared frailty were used to assess restorations' survival and factors associated with failure, respectively. RESULTS: 123 high caries-risk children (10.3±4 DMF-T) with 316 restorations were analyzed. The 3-year survival reached 53.4% (AFR=18.8%). Restorations placed without rubber dam (P= 0.04), over selective caries removal (P= 0.03), with calcium hydroxide liner (P< 0.01) and glass-ionomer cement (P= 0.04) presented lower survival rates. Caries-controlled patients presented significantly (P= 0.03) higher rates of restoration survival (77.7%) than caries-active patients (49.9%). The adjusted model showed that restorations placed in teeth after selective caries removal showed 3.41 times higher risk of failure compared with restorations over complete caries removal (95%CI:1.37-8.46). CLINICAL SIGNIFICANCE: Adhesive restorations placed in high-caries experience patients have limited survival rates. Some treatment-related factors may influence the performance of these restorations. A strict preventive regimen to control dental caries activity must be followed in order to increase the restoration survival.

Survival and Associated Risk Factors of Selective Caries Removal Treatments in Primary Teeth: A Retrospective Study in a High Caries Risk Population.

OBJECTIVE: The aim of this retrospective study was to analyze the survival probability of selective caries removal (SCR) treatments in the primary teeth of children with high caries experience and factors potentially associated with treatment failure. METHODS: The sample included SCR treatments conducted in anterior and posterior teeth without sedation or general anesthesia among children attending a university dental service. Kaplan-Meier survival analysis was used to estimate the longevity of restorations and multivariate Cox regression with shared frailty was used to assess risk factors. RESULTS: A total of 284 SCR treatments in 88 children (aged 5.2 ± 1.91 years) with high caries experience (mean dmft/DMFT = 11.1 ± 5.04) were analyzed. The 3-year survival reached 48.8%, with an annual failure rate of 21.2%. Restorative failures (n = 60) were found more frequently compared to pulp complications (n = 12). SCR performed in anterior primary teeth were more prone to failure (hazard ratio = 3.6, 95% CI: 1.94; 6.71). Patients with a higher amount of visible plaque experienced more failures in SCR treatments (hazard ratio 3.0, 95% CI:1.27; 7.07). CONCLUSIONS: In this retrospective study, SCR showed restricted survival when compared to other prospective clinical trials. Patient-related factors, especially the young age and high caries experience of the children, may represent a challenge for restoration survival. Regardless of the caries removal technique or restorative material, cariogenic biofilm has a negative effect on the survival of restorations, probably by acting directly on material deterioration and, particularly, on the development of new caries lesions of rapid progression.

Longevity and associated risk factors in adhesive restorations of young permanent teeth after complete and selective caries removal: a retrospective study.

OBJECTIVE: The aim of this retrospective university-based study has been to evaluate the longevity and factors associated with failures of adhesive restorations performed in deep carious lesions of permanent molars after complete (CCR) and selective caries removal (SCR). MATERIALS AND METHODS: The sample was composed of composite resin and resin-modified glass ionomer cement (RMGIC) restorations placed in permanent molars of children attending a university dental service who were followed up for up to 36 months. Information collected retrospectively from clinical records was used for analyzing data. The following factors were investigated: gender, caries experience, visible plaque and gingival bleeding indexes, operator's experiences, number of restored surfaces, and type of capping and restorative materials. The Kaplan-Meier survival test was used to analyze the longevity of the restorations. Multivariate Cox regression analysis with shared frailty was used to assess the factors associated with failures (p < 0.05). RESULTS: Four hundred seventy-seven restorations carried out in 297 children (9.1 ± 1.7 years) were included in the analysis. The survival of the restorations reached 57.9 % up to 36 months follow-up with an overall annual failure rate of 16.7 %. There was no difference in restoration longevity when CCR or SCR was performed (p = 0.163); however, CCR presented more pulp exposure (p < 0.001). Multi-surface restorations showed more failures than single-surface (HR 3.22, 95 % CI 1.49; 6.97), and teeth restored with RMGIC had a lower survival rate than those restored with composite resin (HR 4.11, 95 % CI 1.91; 8.81). Patients with evidence of gingivitis had more risk of failure in their restorations (HR 2.88, 95 % CI 1.33; 6.24). CONCLUSION: Overall, adhesive restorations performed in young permanent molars of high caries risk children presented limited survival, regardless of the caries removal technique. Risk factors for failure were identified as multi-surface fillings, RMGIC restorative material, and poor oral hygiene, reflected by gingival bleeding. CLINICAL RELEVANCE: Composite fillings associated with a strict caries preventive regimen may play an important role in the survival of restorations placed in high caries risk children.

A comparative evaluation of endodontic treatments for immature necrotic permanent teeth based on clinical and radiographic outcomes: a systematic review and meta-analysis.

BACKGROUND: Dental trauma and deep caries are frequent findings in children and adolescents that may lead to pulp necrosis in young permanent teeth. As a consequence, the root stops its development, and managing these immature teeth becomes challenging due to the presence of open apexes and fragile dentinal walls. AIM: We aimed to carry out a systematic review including a meta-analysis to compare the endodontic treatments available in the management of immature necrotic permanent teeth and determine which one provides the best clinical and radiographic outcomes. DESIGN: The literature was screened via PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials databases until August 2015 to select randomized clinical trials that compared at least two different treatments regarding immature necrotic permanent teeth comprising clinical and radiographic success as outcome. Two reviewers independently performed the screening and evaluation of the articles. A total of 648 studies were retrieved from the databases, in which only 14 were selected to full-text analysis by the appliance of inclusion criteria. After the exclusion criteria, the remaining seven studies had their data extracted and assessed for bias risk. Pooled-effect estimates were obtained comparing clinical and radiographic success rates among MTA Versus other treatments. RESULTS: Evaluation of clinical (Z = 2.32, P = 0.02, OR = 5.37, 95% CI: 1.29-22.23, I = 0%) and radiographic (Z = 2.45, P = 0.01, OR = 4.31, 95% CI: 1.34-13.82, I = 0%) outcomes favored the MTA (control group) when compared to other endodontic treatments (P < 0.05). No evidence of heterogeneity was detected among the studies (I < 50%), whereas a moderate risk of bias was identified in five of them. CONCLUSIONS: Although almost all of the identified studies presented moderate risk of bias, MTA apexification seems to produce overall better clinical and radiographic success rates among the endodontic treatment available in immature necrotic permanent teeth.

Carious deciduous teeth are a potential source for dental pulp stem cells.

OBJECTIVE: The objectives of this study are to isolate, cultivate, and characterize stem cells from the pulp of carious deciduous teeth (SCCD) and compare them to those retrieved from sound deciduous teeth (SHED--stem cells from human exfoliated deciduous teeth). MATERIAL AND METHODS: Cells were obtained of dental pulp collected from sound (n = 10) and carious (n = 10) deciduous human teeth. Rate of isolation, proliferation assay (0, 1, 3, 5, and 7 days), STRO-1, mesenchymal (CD29, CD73, and CD90) and hematopoietic surface marker expression (CD14, CD34, CD45, HLA-DR), and differentiation capacity were evaluated. RESULTS: Isolation success rates were 70 and 80 % from the carious and sound groups, respectively. SCCD and SHED presented similar proliferation rate. There were no statistical differences between the groups for the tested surface markers. The cells from sound and carious deciduous teeth were positive for CD29, CD73, and CD90 and negative for CD14, CD34, CD45, and HLA-DR and were capable of differentiating into osteogenic, chondrogenic, and adipogenic lineages. CONCLUSION: SCCD demonstrated a similar pattern of proliferation, immunophenotypical characteristics, and differentiation ability as those obtained from sound deciduous teeth. These SCCD represent a feasible source of stem cells. CLINICAL RELEVANCE: Decayed deciduous teeth have been usually discarded once the pulp tissue could be damaged and the activity of stem cells compromised. These findings show that stem cells from carious deciduous teeth can be applicable source for cell-based therapies in tissue regeneration.

Clinical and radiographic outcomes of partial caries removal restorations performed in primary teeth.

PURPOSE: To analyze the outcomes of partial caries removal (PCR) restorations in primary teeth. METHODS: The sample of this retrospective study comprised primary teeth that had been treated with PCR by undergraduate students and were selected from the dental records of patients who were receiving treatment at the School of Dentistry, Federal University of Rio Grande do Sul - Brazil (UFRGS), from 2007 to 2012. Records containing clinical and/or radiographic follow-up data of restorations with PCR in primary teeth were included in the analysis. Factors potentially associated with treatment failure were investigated, such as the number of surfaces restored, type of capping material and restorative material used, the presence of visible plaque, and the gingival bleeding index. RESULTS: The sample comprised 254 teeth in 118 subjects; the follow-up period ranged from 1 to 50 months. The overall success rate for PCR was 80.3% (204/254). A significant association was found between high final visible plaque index and PCR failure (P = 0.002).

Serum-containing medium effect on isolation rate of dental pulp cells from cryopreserved intact deciduous teeth.

OBJECTIVES: To isolate cells from pulp of intact cryopreserved deciduous teeth. The null hypothesis raised here is to find no difference in the establishment of cell culture after cryopreservation (1) using culture medium supplemented with different concentrations of fetal bovine serum (FBS); and (2) between teeth with different stages of physiological root resorption. STUDY DESIGN: Intact deciduous teeth with different root resorption stages were cryopreserved using FBS and Dimethyl Sulfoxide (DMSO) medium (9:1) in a progressive freezing process, by placing the samples in the refrigerator (4 degrees C/60 min) and subsequently transferring them to a -80 degrees C freezer (controlled device -1 degrees C/min/24 hours), and finally into liquid nitrogen (-196 degrees C/30 days). After the thawing process, the cell isolation was performed by enzymatic digestion (type I collagenase). The cells were re-suspended into the culture medium with 10% (G1) or 20% (G2) of FBS. Microscopic analysis was performed after 30 days to visualize the cell attachment. RESULTS: The culture establishment rate was higher in G2 (75%) than G1 (12.5%) (p = 0.041). There was no difference between the different stages of root resorption. CONCLUSIONS: It was possible to establish cell cultures from the pulp of intact cryopreserved deciduous teeth. The use of 20% FBS after thawing improved the culture rate.

Restoration-repair potential of resin-modified glass ionomer cement.

This in vitro study aimed to evaluate the repair bond strength of resin-modified glass ionomer cement using either the same material or a universal adhesive in the etch-and-rinse and self-etch modes plus resin composite. Twenty-four resin-modified glass ionomer cement blocks were stored in distilled water for 14 d and thermocycled. Sandpaper ground specimens were randomly assigned to three experimental groups according to the repair protocol: resin-modified glass ionomer cement (Riva Light Cure, SDI) and universal adhesive (Scotchbond Universal Adhesive, 3M Oral Care) in etch-and-rinse or self-etch modes and nanohybrid resin composite (Z350 XT, 3M Oral Care). After 24 h of water storage, the blocks were sectioned, and bonded sticks were subjected to the microtensile bond strength (µTBS) test. One-way ANOVA and Tukey's test were used to analyze the data. The failure mode was descriptively analyzed. The highest µTBS values were obtained when the resin-modified glass ionomer cement was repaired using the same material (p < 0.01). In addition, the mode of application of the universal adhesive system did not influence the repair bond strength of the resin-modified glass ionomer cement. Adhesive/mixed failures prevailed in all groups. Repair of resin-modified glass ionomers with the same material appears to be the preferred option to improve bond strength.

Randomized clinical trial of adhesive restorations in primary molars. 18-month results.

PURPOSE: To evaluate the clinical performance of adhesive restorations of resin composite and resin-modified glass-ionomer cements in primary molars. METHODS: This randomized clinical trial included subjects (5-9 year-old children) selected at two university centers (UFRGS and UNIFRA). The sample consisted of 132 primary molars presenting active cavitated carious lesions (with radiographic involvement of the inner half of the dentin), located on the occlusal and occlusal-proximal surface. The sample was randomly divided into three groups, according to the restorative material: (G1) universal restorative system (Adper Single Bond 2 system and Filtek Z350); (G2): Resin-modified glass-ionomer cement (Vitremer); and (G3): Low shrink restorative system (Filtek P90). The restorations were clinically and radiographically followed every 6 months for up to 18 months using the USPHS modified criteria for clinical evaluation. Survival estimates for restoration longevity were evaluated using the Kaplan-Meier method. Log-rank test (P< 0.05) was used to compare the differences in the success rate according to the type of the restorative material. RESULTS: The type of restorative material used did not influence the longevity of the restorations. After clinical follow-up, there was no statistical difference in the rates of success for the three materials used to restore active cavitated carious lesions in primary molars. The survival rates for the follow-up were similar regarding the number of restored surfaces and the caries removal technique (partial or complete). Mean estimated time of survival was 17.2 months (95% CI: 16.7-17.7). Estimated survival rates of the restorations were 100%, 98%, 88% and 65% at 1, 6, 12 and 18 months of clinical evaluations, respectively.

Is there a better interceptive treatment for unerupted palatally displaced canines? A network meta-analysis.

This systematic review aimed to investigate if there is a better interceptive treatment for palatally displaced canines (PDC) in the mixed dentition stage. The PubMed/MEDLINE, CENTRAL, Scopus, and EMBASE databases were searched for randomized clinical trials related to the research topic. The gray literature and reference lists were also assessed. Network meta-analysis was conducted to analyze the effects of different approaches on PDC eruption. The surface under the cumulative ranking area was calculated to rank the treatments. The certainty of the evidence was evaluated using the GRADE approach. Of the 892 eligible studies, 18 were selected for full-text analysis and 9 for meta-analysis, involving 506 participants and 730 PDC, to compare 9 approaches. The proportion of erupted PDC was significantly higher for all interceptive treatments compared with control (no intervention). Furthermore, the proportion of erupted PDC was higher in patients subjected to rapid maxillary expansion (RME) than those who underwent double extraction of primary canine and primary molar (relative risk (RR) = 2.68 ICr95%: 1.12-9.35). A higher proportion of erupted PDC was found for RME (RR = 3.07 ICr95%: 1.31-10.67), RME plus use of transpalatal arch (TA) plus extraction of primary canine(s) (EC) (RR = 1.43 ICr95%: 1.09-1.95), EC plus use of cervical pull headgear (RR = 1.38 ICr95%: 1.11-1.79), and EC plus use of TA (RR = 1.36 ICr95%: 1.00-1.9) than for EC. RME was most likely to be considered as the best interceptive treatment. Overall, the certainty of the evidence was considered low due to imprecision and indirectness. In conclusion, no intervention in the mixed dentition stage is the worst choice for PDC.

Effectiveness of non-operative approaches in active enamel carious lesions: a retrospective longitudinal study.

The aim of the study was to investigate the effectiveness of non-invasive and micro-invasive treatments in active enamel carious lesions in high-caries-risk children. Clinical records of children treated in a dental school setting were retrospectively screened for active enamel carious lesions treated non-invasively (topical fluoride applications, oral hygiene instruction, or dietary guidance) or micro-invasively (sealant). The control of active carious lesions was set as the main outcome established by the combination of inactivation and non-progression of the lesions based on Nyvad and ICDAS criteria, respectively. Individual and clinical factors associated with the outcome were analyzed by Poisson regression. The sample consisted of 105 high-caries-risk children with a mean age of 8.3 (± 2.4) years. From a total of 365 active enamel carious lesions, most lesions (84.1%) were active non-cavitated carious lesions (ICDAS scores 1 and 2) and only 15.9% presented localized enamel breakdown (ICDAS score 3). Of these, 72.6% were inactivated and 92.1% did not progress (mean time of 6.5 ± 4.1 months). The prevalence of controlled carious lesions was higher among children older than 6 years (PR:1.43; 95%CI:1.00-2.03; p = 0.04) and in those with better biofilm control (PR:0.99; 95%CI: 0.98-0.99; p = 0.03). Non-operative approaches are effective for controlling active enamel carious lesions. The majority of active enamel carious lesions became inactive and did not progress after treatment. Caries control was associated with older children and better biofilm control.

Influence of gaps in adhesive restorations in the development of secondary caries lesions: an in situ evaluation.

PURPOSE: To investigate in situ the influence of gaps in the development of secondary caries lesion in adhesive restorations. METHODS: 10 volunteers utilized intra-oral appliances, containing three human dental blocks (enamel and dentin), representing the three different groups (two restored, one sound): (1) restored with resin composite using the total acid etch adhesive technique (37% H3PO4 + Single Bond + Z250); (2) restored with resin composite but without acid etching (Single Bond + Z250); (3) and sound blocks (control group). The dental blocks (n=30) were randomly positioned inside the intra-oral appliances, and covered by a porous tissue (gabardine base) to induce a cariogenic biofilm. The volunteers used the appliances 24 hours daily for a 28-day period, removing just during meals and oral hygiene. Eight times a day, a 20% sucrose solution was dripped onto the blocks. Five minutes later, the appliance was washed with distilled water and replaced in the oral environment. After the experimental period, the dental blocks were removed from the appliance and examined by visual examination to detect the presence or the absence of an active carious lesion (kappa= 0.89). Posteriorly, they were prepared for the polarized light microscopy examination, which was performed to describe enamel surface characteristics on the restored and unrestored blocks with active caries lesion (kappa= 1). RESULTS: The visual examination demonstrated that almost all (29/30) of the blocks showed non-cavitated active caries lesion on the enamel surface. The microscopic evaluation showed non-cavitated caries lesions on enamel surfaces for all groups. In the restored blocks (with and without the total etch technique), the demineralization was first identified as an outer lesion that follows the enamel prism directions, and in some cases, reached the cavity walls. The results showed that caries lesion development adjacent to the restoration was determined by the cariogenic challenge of the oral environment, instead of the restoration adhesive quality, and the wall lesion was determined by the prism orientation, regardless of the presence of gaps.

Dentin microhardness of primary teeth undergoing partial carious removal.

AIM: To evaluate the dentin microhardness of primary teeth undergoing indirect pulp capping (IPC) after partial caries removal. MATERIALS: Primary molars were treated with IPC, restored with self-etching primer (Clearfil SE Bond; CSE), and filled with composite resin (Filtek Z250) with (n = 10) or without (n = 7) a calcium hydroxide base liner (Dycal; Dy). After tooth exfoliation, the microhardness of the demineralized dentin remaining under the restoration (n = 17) was analyzed and compared with that of sound and carious primary dentin (n = 20). Microhardness measurements were obtained from the deepest portion of the cavity until the roof of the pulp chamber. Data were analyzed by Kruskal-Wallis test (p < 0.05). RESULTS: There was no difference in microhardness values at all depths between the treated groups (DY and CSE), but when the exfoliated carious teeth were included, the CSE had significantly higher values at 35-microm depth. This difference was only detected in the DY group after a depth of 200 microm. At 700 microm, there was no difference in microhardness values between all 4 groups. CONCLUSIONS: Primary teeth that underwent IPC showed the same microhardness, regardless of the capping material used.