Radiolucent halos beneath composite restorations do not justify restoration replacement.

PURPOSE: To determine the correlation between the presence of radiolucent areas (RA) beneath composite restorations and gaps and remaining demineralized tissue (RDT). METHODS: 50 extracted teeth (sound and carious) were studied. After caries removal, cavities were filled. Artificial cavities were created and filled in the sound teeth. Samples were sectioned and analyzed with stereomicroscopy. RESULTS: Gap/RDT was observed in 38.9% [95% confidence interval (CI) =28.2-50.5] and 68.9% (95% CI = 57-78.6) of sound and carious teeth, respectively, (P = 0.001). Gap/RDT was associated with RA (P < 0.001). Sensitivity, specificity, predictive positive values (PPV), predictive negative value, and accuracy for carious teeth were 77.1% (95% CI = 63.7-87.3), 54.5% (95% CI = 33.8-74.1), 78.7% (95% CI = 65.3- 88.7), 52.2% (95% CI = 32.1-71.7), and 70% (95% CI = 58.5-79.8), and for sound teeth were 73.7% (95% CI = 62.9-82.6), 59.1% (95% CI = 47.0-70.4), 67.5% (95% CI = 56.9-76.9), 66.1% (95% CI = 53.4-77.3), and 66.9% (95% CI = 58.9-74.3). Only the PPV differed between the sound and carious teeth (P = 0.024).There was a correlation between radiolucency and gap/RDT, but a high number of false positives were found.

A randomized clinical trial on the sealing of occlusal carious lesions: 3-4-year results.

This randomized clinical trial aimed to assess the efficacy of sealing occlusal carious lesions in permanent teeth. The sample consisted of 54 occlusal carious lesions in permanent molars and premolars of 49 patients aged 8-43 years (median: 19 years). The inclusion criteria comprised the presence of a cavity with no access allowing biofilm control. The maximum depth of the lesion was the middle third of the dentin thickness, as assessed by bitewing radiography. The teeth were randomly assigned to sealant treatment (n = 28) or restorative treatment (n = 26). Clinical and radiographic examinations were performed after 1 year and after 3-4 years. The outcomes depended on the clinical performance of the sealant/restoration and the control of caries progression observed radiographically. Survival analysis was performed to assess success rates. Over the 3-4 years of monitoring, 2 sealants were totally lost, 1 needed repair, and 1 showed caries progression, totaling 4 failures in the sealant group. In the restoration group, 1 failure was observed (in need of repair). The success rates were 76% and 94% in the sealant and the restoration groups, respectively (p > 0.05). The sealing of occlusal carious lesions in permanent teeth succeeded in controlling caries over a 3-4-year period. However, sealed carious lesions require patient compliance in attending regular follow-ups to control the occurrence of clinical failures of the sealants.

Effects of lactose-containing stevioside sweeteners on dental biofilm acidogenicity.

The aim of this study was to evaluate the effect of a commercial lactose-containing stevioside sweetener on biofilm acidogenicity in vivo. Nine volunteers refrained from brushing their teeth for 3 days in five phases. On the 4th day of each phase, the pH of the biofilm was measured by the "Strip method". Interproximal plaque pH was measured before and up to 60 minutes after a 10 mL mouthrinse for 1 minute with the test solutions: I - sweetener with 93% lactose and 7% stevioside; II - sweetener with 6.8% saccharin, 13.6% cyclamate, and 0.82% stevioside; III - 18% sucrose solution (positive control); IV - mineral water (negative control); and V- 93% lactose solution. The results revealed that the most pronounced pH fall was found with sucrose (positive control), followed by the 93% lactose solution, the sweetener with lactose + stevioside, the sweetener with saccharin + cyclamate + stevioside, and finally water (negative control). According to the area under the curve, the two sweeteners containing stevioside were significantly different, and the sweetener with lactose + stevioside was significantly different from water but not from sucrose. The critical pH for dentin demineralization (pH ≤ 6.5) was reached by all volunteers after rinsing with sucrose solution, lactose solution, and the stevioside + lactose sweetener. Analysis of the data suggests that lactose-containing stevioside sweeteners may be cariogenic, especially to dentin.

A randomized clinical trial on the sealing of occlusal carious lesions: 3-4-year results

Abstract This randomized clinical trial aimed to assess the efficacy of sealing occlusal carious lesions in permanent teeth. The sample consisted of 54 occlusal carious lesions in permanent molars and premolars of 49 patients aged 8–43 years (median: 19 years). The inclusion criteria comprised the presence of a cavity with no access allowing biofilm control. The maximum depth of the lesion was the middle third of the dentin thickness, as assessed by bitewing radiography. The teeth were randomly assigned to sealant treatment (n = 28) or restorative treatment (n = 26). Clinical and radiographic examinations were performed after 1 year and after 3–4 years. The outcomes depended on the clinical performance of the sealant/restoration and the control of caries progression observed radiographically. Survival analysis was performed to assess success rates. Over the 3-4 years of monitoring, 2 sealants were totally lost, 1 needed repair, and 1 showed caries progression, totaling 4 failures in the sealant group. In the restoration group, 1 failure was observed (in need of repair). The success rates were 76% and 94% in the sealant and the restoration groups, respectively (p > 0.05). The sealing of occlusal carious lesions in permanent teeth succeeded in controlling caries over a 3–4-year period. However, sealed carious lesions require patient compliance in attending regular follow-ups to control the occurrence of clinical failures of the sealants.

Protocolo de atendimento à saúde bucal de bebês em atenção primária à saúde / Oral health care protocol for babies in the primary health care system

O objetivo do presente estudo foi a elaboração de um protocolo de atendimento odontológico para crianças de 0 a 3 anos de idade. O estudo foi realizado por meio de uma revisão de literatura baseada nos tratamentos utilizados em crianças, de acordo com a presença ou não de fatores de risco de atividade de cárie. Foram utilizados artigos científicos publicados em periódicos coletados em bases de dados online no portal da Biblioteca Virtual em Saú- de (Bireme), Pubmed e Cochrane, no período de 1990 a 2012. Os critérios de inclusão utilizados no estudo foram pesquisas que abordassem os tratamentos em crianças de 0 a 3 anos disponíveis na literatura. Os critérios de exclusão foram todos os artigos que relatavam atendimento em crianças acima de três anos e que não foram realizados no período padronizado. O protocolo de atendimento apresentado neste trabalho foi baseado na identificação da presença ou não de fatores de risco de atividade de cárie. As crianças que apresentavam fatores de risco para a doença realizavam tratamento educativo, preventivo e restaurador, enquanto as que não apresentavam participavam do tratamento educativo, estabelecidos pelo protocolo. A periodicidade das consultas odontológicas era definida de acordo com a gravidade do risco da doença. O protocolo proposto é um instrumento que deve ser validado nas equipes de saúde da família, podendo ser alterado, de acordo com as práticas diárias do serviço.

The aim of this study was the development of a dental care protocol for children 0-3 years old. The study was conducted through a literature review based on treatments used with children according to the presence or absence of risk factors for caries activity. This study used scientific articles published in journals listed in online databases at the Virtual Health Library (BIREME) portal, PubMed, and Cochrane from 1990 to 2012. The inclusion criteria used in this investigation were studies available in the literature that addressed the treatments used for children 0-3 years of age. Exclusion criteria were all articles that reported treating children over three years old, and those not conducted in the period established. The treatment protocol presented in this paper was based on the identification of the presence or absence of risk factors for caries activity. The children who presented risk factors for the disease underwent educational, preventive, and restorative treatments, while those who did not participated in the educational treatment established by the protocol. The frequency of dental visits was set according to the severity of disease risk. The proposed protocol is a tool that must be validated in family health teams and can be changed according to the daily practices of the service.

Trauma ocular contuso envolvendo o segmento posterior: qual a melhor conduta? / Blunt ocular trauma involving the posterior segment: which the best conduct?

Introdução: Trauma ocular contuso envolvendo o segmento posterior geralmente implica em mau prognóstico.Com o surgimento de técnicas cirúrgicas modernas houve uma mudança dramática no manejo dos olhos severamente traumatizados. Há controvérsias quanto ao melhor momento para realização da cirurgia de vitrectomia após um trauma ocular e quais casos se beneficiariam desse procedimento assim como do buckle de esclera. Objetivo: Relatar um caso de trauma ocular contuso envolvendo o segmento posterior e através de revisão bibliográfica descrever qual a melhor conduta nesse tipo de trauma, enfatizando controversas existentes na literatura quanto ao papel do buckle de esclera, da vitrectomia e o melhor momento para realização da vitrectomia.Metodologia: Será realizado um relato de caso de trauma ocular contuso envolvendo o segmento posterior.Foi ainda realizada uma revisão da literatura através dos seguintes portais de pesquisa: PubMed, Portal Capese Bireme. Conclusão: A conduta no trauma contuso envolvendo o segmento posterior deve ser adotada de acordo com as manifestações clínicas apresentadas. Nos casos em que os meios oculares estão opacos impossibilitando a visualização do segmento posterior, a realização da vitrectomia precocemente poderá ser útil. O papel do buckle de esclera ainda é inconclusivo. A realização de um estudo clínico, multicêntrico, randomizado com um tempo deacompanhamento mais prolongado é necessária.

Introduction: Blunt ocular trauma involving the posterior segment generally implies in bad prognostic. Withthe sprouting of modern surgical techniques there was a dramatical change in the handling of the severely traumatized eyes. There are controversies about the optimummoment for accomplishment of the vitrectomy surgery and wich cases would have benefit from this procedureas well as from the scleral buckling.Objective: To report a case of blunt ocular trauma involving the posterior segment and to demonstrate throughbibliographical revision which is the best management in this type of trauma, emphasizing controversies existingin the literature about the role of the scleral buckling, the role of the vitrectomy and the optimum moment foraccomplishment of the vitrectomy.Methodology: It is a case report about blunt ocular trauma involving the posterior segment. There was alsodone a revision of the literature carried through the following vestibules of research: PubMed, Portal Capesand Bireme. Conclusion: The management for cases of bluntocular trauma involving the posterior segment should be taken in accordance with the clinical manifestations presented. In the cases where the ocular media are opaque disabling the visualization of the posterior segment, itseems that early vitrectomy surgery can be useful. The role of the scleral buckling is still inconclusive. A multicentric, randomized, clinical trial seems justified.

Diagnóstico pré-natal de hérnia diafragmática congênita por Imagem de Ressonância Magnética / Prenatal diagnostic of congenital diaphragmatic hernia

Introdução: A Hérnia Diafragmática Congênita (HDC) é a falha no fechamento do músculo diafragmático, ocasionando a migração de estruturasabdominais para o tórax, podendo causar hipoplasia pulmonar. O diagnóstico pré-natal se faz necessário para avaliação de malformações, aconselhamento familiar e caso seja preciso o encaminhamento para centrosespecializados. Em relação à ultra-sonografia quando utilizada como método de rastreamento apresenta o índice de falha diagnóstica de 41%. Já a ressonância magnética devido a melhor precisão da imagem, permite uma melhorvisualização anatômica, com achados mais precisos de herniações e uma boa acurácia em relação ao grau dehipoplasia pulmonar; no entanto com indicações restritas e selecionadas para realização do exame. A imagem porressonância magnética possibilitou que a cirurgia fetal aumentasse para até 75% a sobrevida dos fetos de altorisco com indicação para o procedimento.Objetivo: Através de uma revisão bibliográfica, avaliar o papel da imagem por ressonância magnética (IRM) no diagnóstico fetal de hérnia diafragmática. Métodos: Foi realizada uma extensa revisão utilizando os sites de pesquisa: Medline, Scielo e Cochrane. A pesquisa incluiu somente artigoscompreendidos no período de janeiro de 1996 a agosto de 2006. Conclusão: Na suspeita de Hérnia DiafragmáticaCongênita, está indicada a solicitação de ressonância magnética para confirmar o posicionamento dos órgãos abdominais, detectar o grau de hipodesenvolvimentopulmonar e avaliar anomalias associadas. Não é utilizado como método de rastreamento devido à sua restrita disponibilidade, alto custo e a segurança do método que ainda está em discussão.

Introduction: Congenital Diaphragmatic Hernia is the imperfection of closing of this muscle and it takes the migration of abdominal structures for the thorax, causing pulmonar hipoplasia. Prenatal diagnostic is useful for family counseling, to evaluation of malformations associated and, if necessary, guiding for specializedcenter. In relation to the ultrasonografy when used as screening method it presents a fail diagnostic in 41%Already the magnetic resonance which had the best precision of the image, allows one better anatomical visualization with more findings of herniations and a good accuracy in relation to the pulmonary hipoplasia degree however with restricted and selected indications for accomplishment of the exam Magnetic ResonanceImaging made possible that the fetal surgery increase to 75% fetus surl of high risc with indication to the procedure. Objective: Through a bibliographic revision to evaluate the role of Magnetic Resonance Imaging in fetal diagnostic of Congenital Diaphragmatic Hernia. Methodos: We realize a revision utilizing sites like:Medline, Scielo and Cochrane. We include in this research articles between January 1996 to August 2006 period.Conclusion: In the suspicion of congenital Diafragmatic Hernia, the request of magnetic resonance is indicated to confirm the positioning of the abdominal structures, to detect the degree of pulmonary hipodevelopment and to evaluate anomalies associates.It is not used as method of screening because it has a restricted availability, high cost and the security of the method that still is in quarrel.

Complicações da Embolização das Artérias Uterinas no Tratamento do Leiomioma / Complications of the embolization of the uterine arteries as a treatment of leiomyoma

Introdução: Mioma uterino é o tumor benigno mais comum do trato genital feminino. As principais queixas de pacientes com miomatose são: sensação de massa pélvica e sangramento uterino irregular. A miomatose apresenta várias alternativas terapêuticas, entre elas, a embolização das artérias uterinas, a qual vem sendo muito discutida nos últimos anos por ser um método menos invasivo que a técnica cirúrgica.Objetivo: O objetivo deste estudo é revisar e demonstrar as possíveis complicações da embolização das artérias uterinas para o tratamento dos leiomiomas. Métodos: Foi realizada revisão da literatura através de portais de pesquisa como Portal Capes, PubMed, Cochrane e Bireme. Foram incluídos os artigos publicados nos últimos quinze anos, incluindo artigos originais, revisões e metanálises. Foi também realizada uma revisão da literatura através de livros cuja publicação ocorreu a partir do ano de 1998.Conclusão: A embolização das artérias uterinas pode resultar em complicações como: insuficiência ovariana, dor abdominal, infecção, prolapso transcervical do mioma, entre outros, porém, estas não apresentam taxas de incidência significativas. No entanto, maiores estudos são necessários para determinar o risco benefício da realização da embolização das artérias uterinas em relação as suas complicações.

Introduction: Uterine myoma is the most common benign tumor of the feminine genital tract. The main complaints of patients with myomatosis are: sensation of pelvic mass and irregular uterine bleeding. There are several therapeutical alternatives for myomatosis, among them, there is the embolization of the uterine arteries, which has been much discussed in recent years for being a method less invasive than the surgical technique.Objective: The objective of this study is to review and to demonstrate the possible complications of the embolization of the uterine arteries as a treatment of leiomyomas. Methods: A review of the literature was carried through research vestibules such as Vestibule Capes, PubMed, Cochrane and Bireme. It was included articles published in the last fifteen years, including original articles, revisions and methanalysis. Also a review of the literature was carried through books which have been published since the year of 1998. Conclusion: The embolization of the uterine arteries can result in complications such as: ovarian insufficiency, abdominal pain, infection, transcervical prolapse of myoma, among others, however, these do not present significant incidence rates. Thus, greater studies are necessary to determine the risk benefit of the accomplishment of the embolization of the uterine arteries over its complications.