Wear profile of canal wall surfaces and bond strength of endodontic sealers after in situ acid challenge.

AIM: To evaluate the wear of root wall surfaces, the bond strength of sealers to dentine and the demineralization around root filling materials after canals were exposed to acid challenge in situ. METHODOLOGY: Eighty-seven roots of mandibular incisors were selected. Thirty-two were used in the laboratory bond strength study (n = 8), and 55 in the in situ study (n = 11). Root canals were prepared biomechanically and then filled with gutta-percha and AH Plus, MTA Fillapex, Sealapex or Endofill. For 14 days, 11 participants used intra-oral devices with five sterilized roots (four experimental and one control - only canal prepared). Drops of sucrose were dripped onto roots allowing the accumulation of biofilm on canal surfaces. Roots were removed, sectioned and analysed for the following: bond strength of filling material using a push-out test and also wear profile and dentine demineralization using confocal microscopy. Bond strength (MPa) was evaluated by two-way anova and Tukey test (α = 0.05), and wear profile was assessed by Kruskal-Wallis and t-tests (α = 0.05). RESULTS: AH Plus had the highest bond strength values. Intermediate results were found in roots with MTA Fillapex and Endofill, whilst Sealapex had inferior results (P < 0.05). No significant differences were found amongst root thirds (P > 0.05). For wear profile, samples were associated with degradation of the filling materials after exposure to the oral environment (P < 0.05). Roots had signs of demineralization around the filling material when Sealapex and Endofill were used. CONCLUSIONS: Sealers were not able to prevent degradation of the adhesive interface and dentine. AH Plus and MTA Fillapex had superior bond strength to dentine and less intense demineralization around the root filling.

Use of pit-and-fissure sealants

BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits-and-fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the U.S. market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of non-cavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. Conclusions and practical implications: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians re-orient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents

New proposal of silver diamine fluoride use in arresting approximal caries: study protocol for a randomized controlled trial.

BACKGROUND: Approximal surfaces are a challenge to caries lesions control. Silver diamine fluoride (SDF) is a simple,low-cost and promisor intervention for arresting caries lesions, but it has never been tested on approximal surfaces. Our aim is to evaluate the efficacy and cost-efficacy of SDF in arresting initial lesions compared to resin infiltration and exclusively flossing (control group). Our second aim is to assess discomfort and satisfaction regarding interventions. METHODS/DESIGN: This is a randomized clinical trial, double-blinded, placebo-controlled study. Children/adolescents presenting at least one approximal initial caries lesion in primary molars/permanent premolars and molars will be included. Surfaces with advanced dentine lesions identified by radiography and participants who refuse to participate or present negative behaviors will be excluded. A minimum sample size of 504 surfaces will be required for each subgroup. Individuals will be randomly allocated in three groups of interventions: SDF, resin infiltration, and control group. Depending on the allocation, the patients will receive the active treatment and respective placebo therapies. All patients will be oriented to daily flossing the included surfaces. Our primary outcome will be caries progression by clinical and radiographic examinations. Appointments will be timed and costs of materials will be considered to calculate cost-efficacy. Patient discomfort will be assessed after interventions. Parent and patient satisfaction with the treatment will be collected after treatment and in the last follow-up visit. Individuals will be assessed at 1 and 3 months after treatment to evaluate dental biofilm and at 6, 12, and 24 months to assess caries progression by visual examination and/or radiography. Multilevel analyses will be used to verify if the type of treatment influenced on the tested outcomes. Costs will be compared and analyses of cost-efficacy will be performed. Poisson analysis will test the association between intervention and reported discomfort and satisfaction. DISCUSSION: Our hypothesis is that SDF is the most cost-efficacious option from all tested interventions. If our hypothesis is confirmed, the use of SDF in private and public contexts could represent an easier and effective option in the treatment of enamel approximal caries in children/adolescents. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01477385), Initial release: 11/16/2011: last update: 06/02/2014.

Avaliação do selamento de lesões de cárie comparado à restauração com resina composta em dentes decíduos / Sealing dentinal caries lesion and restoring treatment in deciduous teeth: a longitudinal evaluation

O objetivo do presente estudo “in vivo" foi verificar o efeito do selante de fóssulas e fissuras no controle de lesões cariosas oclusais comparado ao tratamento restaurador. Vinte dentes decíduos foram selecionados e divididos em: grupo I – selante resinoso e grupo II –restauração com resina composta, após remoção parcial de tecido cariado. Após 12 meses, 8dentes foram excluídos da pesquisa. Os resultados demonstraram que 83% dos dentes do grupoI apresentaram retenção completa do material e em 100% dos casos observou-se ausência de progressão da lesão. 100% dos molares pertencentes ao grupo II apresentaram retenção completa do material, e em 100% dos casos houve ausência de progressão da lesão. Concluiu-se queos selantes de fóssulas e fissuras constituem uma alternativa conservadora ao tratamento restaurador, propiciando a paralisação de lesões de cárie em estágio inicial em dentina, além de preservação da estrutura dental.

The aim of this “in vivo" study was to verify the effect of pit and fissure sealants to control the initial caries injuries compared with the restorative treatment. Twenty deciduous teeth had been selected and divided in: group I – resinous sealant and group II – restoration with composite resin, after the partial removal of the carious dentin. After 12 months of attendance 8 teeth were excluded of the research. The results showed that 83% of the deciduous molars from group I presented complete material retention and in 100% of cases a non-progression ofinjury was observed. For group II, complete material retention was observed in 100% of theteeth and in 100% of the cases there were non-progression of the injury. We conclude that thepit and fissures sealants constitute a more conservative treatment then restoration, propitiating the stoppage of injuries of initial caries lesions and preservation of the dental structure.

Selantes de fóssulas e fissuras: critérios para o uso, métodos e técnicas de aplicação e controle preferidos por odontopediatras de Minas Gerais / Pit and fissure sealants: usage criteria, methods, and application and control techniques preferred by pediatric dentists in Minas Gerais

Este estudo investigou as técnicas de aplicação de selantes de fóssulas e fissuras preferidas por odontopediatras de Minas Gerais. Enviou-se um questionário fechado aos 586 especialistas registrados no CRO-MG. As questões abordaram os critérios de seleção dos dentes, e os métodos e as técnicas preferidas para a utilização, aplicação e avaliação dos selantes. Foram devolvidos 160 questionários (27,3 por cento) do total encaminhado. De acordo com os resultados, 85,6 por cento dos odontopediatras selariam dentes livres de cárie e 40,6 por cento selariam superfícies com lesão de cárie incipiente. O selante branco e o fluoretado (38,7 por cento e 62,5 por cento, respectivamente) foram os preferidos pelos odontopediatras. Para os dentes em erupção, o cimento de ionômero de vidro (CIV) foi indicado por 57,5 por cento dos odontopediatras. O isolamento do campo operatório com rolos de algodão é o preferido (85,0 por cento dos odontopediatras). Para a limpeza das fóssulas e fissulas, pedra pomes com escova de Robson é utilizada por 78,75 por cento dos especialistas. A grande maioria (70 por cento) não realiza preparo da superfície com instrumentos rotatórios. Concluiu-se que há enorme variação tanto nos critérios de seleção dos dentes quanto nas formas de aplicação dos selantes, sugerindo a necessidade de um protocolo de indicação e técnicas de aplicação e controle deste material, a fim de aumentar o sucesso na clínica diária

Inflammatory response to calcium hydroxide based root canal sealers / Resposta inflamatória a selantes do canal radicular contendo hidróxido de calcio

This study evaluated the inflammatory response to Sealapex, CRCS, Apexit, and Sealer 26 in the subcutaneous tissue and in peritoneal cavity of Balb/c mice. The inflammatory response of subcutaneous tissue was analyzed after 2, 4, 8, and 16 days. Intense neurotrophilia was seen in response to all sealers during the initial periods. Differences among them related to the presence of necrosis and the number of inflammatory cells. In the intermediate phase marked differentiation of cells of the mononucleate phagocytic system into macrophages, epithelioid cells and multinucleate giant cells were observed with Sealapex. This response was less intense with CRCS and Apexit. Tissue necrosis was observed only at tissue sealer interfaces and only during the initial period with Sealapex but was seen throughout the experiment with all other sealers. The animals were injected in the peritoneal cavity with solutions containing the sealers and five mice from each group were killed 6 and 24h, and 5 and 15 days later. During the initial periods (6 and 24h) there was an intense migration of polymorphonuclear leukocytes to the peritoneal cavity in response to all sealers compared to the control. This migration was more intense or Sealer 26 and Apexit. An increase in mononucleate cell number was observed after 6 and 24h and 5 days for all sealers and no differences were observed in relation to the control after 15 days

Interferência oclusal artificialmente provocada e dor / Occlusal interference artificially caused and pain

Vinte pacientes foram passíveis de colocação, em seus primeiros molares inferiores esquerdos, de uma quantidade em excesso de material selante usualmente utilizado em Odontopediatria, criando uma interferência oclusal a fechamento em posição intercuspal (máxima intercuspidação). Durante dez (10) dias os pacientes foram observados quanto ao eventual parecimento de sintomatologia, a qual, quando presente foi registrada em ficha especial com uma gradação de intensidade de 1 a 10. Os resultados mostraram a ocorrência de uma sintomatologia dolorosa bastante elevada nos primeiros dias, alterando-se com o decorrer do tempo de observação. Os resultados obtidos parecem confirmar achados anteriores que mostram que a aplicação de forças inusitadas sobre os dentes ou sua provocação, influenciam o nível de secreções psicoendócrinas, bem como mobilizam trajetórias neuropeptidérgicas na polpa humana, e determinam sintomatologia dolorosa variável em intensidade, duração e localização, no sistema estomatognático