Contenidos Mínimos de Cariología e indicadores de aplicación clínica en el Currículo de Pregrado para las Escuelas Dentales Chilenas / Minimum Contents of Cariology and Indicators of Clinical Application in the Undergraduate Curriculum for Chilean Dental Schools

RESUMEN Objetivo: El objetivo fue definir los contenidos mínimos y sus indicadores de aplicación clínica en el currículo de cariología para las escuelas de odontología chilenas. Metodología: Basados en los 5 dominios curriculares internacionales, se elaboró un documento que define los contenidos e indicadores de aplicación clínica para la enseñanza de cariología en Chile. Posteriormente, profesores de cariología de 20 de 21 escuelas de odontología chilenas (95%), sesionaron para revisar, retroalimentar y elaborar el documento final, denominado "Listado de contenidos mínimos e indicadores de aplicación clínica" en cariología para estudiantes de pregrado de odontología en Chile. Resultados: Se definieron 23 contenidos y 31 indicadores de aplicación clínica para la enseñanza de la cariología. La cantidad de contenidos e indicadores separados por dominio fueron respectivamente: conocimiento de base: 5 y 7; riesgo/detección y diagnóstico: 6 y 6; toma de decisiones/manejo preventivo no operatorio: 5 y 5; decisión de tratamiento operatorio: 4 y 9 y cariología basada en la evidencia: 3 y 4. Conclusiones: Se definieron los contenidos mínimos que tributan a cada dominio y sus indicadores de aplicación clínica para la enseñanza de la cariología en Chile.

ABSTRACT: The objective: was to define the minimum contents and their indicators of clinical application in the cariology curriculum for the Chilean Dental Schools. Methodology: Based on the 5 international curricular domains, a document defining the contents and indicators of clinical application for the teaching of cariology in Chile was elaborated. Later, cariology professors from 20 out of the 21 Chilean Dentistry Schools (95%) met to review, feedback and elaborate the final document, called "List of minimum contents and indicators of clinical application" in cariology for undergraduate dentistry students in Chile. Results: Twenty-three contents and 31 indicators of clinical application for the teaching of cariology were agreed upon. The amount of contents and indicators separated by domain respectively were: basic knowledge: 5 and 7; risk/detection and diagnosis: 6 and 6; decision making/non-operative preventive management: 5 and 5; decision of operative treatment: 4 and 9 and evidence-based cariology: 3 and 4. Conclusions: The minimum contents for each domain and its clinical application indicators for the teaching of cariology in Chile were defined.

12 Years of Repair of Amalgam and Composite Resins: A Clinical Study.

OBJECTIVE: The objective of this study was to clinically evaluate repaired posterior amalgam and composite restorations over a 12 year period, investigate the influence of repair in the survival of restorations, and compare their behavior with respect to controls. METHODS: Thirty-four patients, 18 to 80 years of age with 167 restorations, 67 composite resin (RC), and 100 amalgam (AM) restorations, participated. Restorations with localized, marginal, anatomical deficiencies and/or secondary caries, and "clinically judged" suitable for repair or replacement according to US Public Health Service (USPHS) criteria, were randomly assigned to four groups: repair (n=35, 20 AM, 15 RC), replacement (n=43, 21 AM, 22 RC), positive control (n=71, 49 AM, 22 RC), or negative control (n=18, 10 AM, 8 RC). The quality of the restorations was blind scored according to the modified USPHS criteria. Two examiners scored them at initial status (κ=0.74) and after one to five, 10, and 12 years (κ=0.88). Wilcoxon and Mann-Whitney tests provided for comparisons within the same group and between years, respectively. RESULTS: After 12 years, all groups behaved similarly in marginal adaptation, marginal stain, teeth sensitivity, anatomic form, and luster ( p≥0.05). Better behavior in roughness was observed in replaced RC ( p=0.049). CONCLUSIONS: Given that most clinical parameters investigated were similar between all groups during the follow-up, the repair of RC and AM restorations is a good clinical option because it is minimally invasive and can consistently increase the longevity of restorations.

Effect of Refurbishing Amalgam and Resin Composite Restorations After 12 Years: Controlled Clinical Trial.

OBJECTIVES: The aim of this study was to clinically evaluate posterior amalgam and resin composite restorations refurbished over a period of 12 years by investigating the influence of refurbishing on the survival of restorations and comparing their behaviors with respect to controls. METHODS AND MATERIALS: Thirty-four patients were enrolled, ages 18 to 80 years, with 174 restorations, 48 restorations of resin composite (RC), and 126 restorations of amalgam (AM). Restorations with localized defects in anatomy, roughness, luster, or marginal staining that were clinically judged as suitable for refurbishing according to US Public Health Service (USPHS) Ryge criteria were assigned to group A-refurbishing (n=85; 67 AM, 18 RC)-or group B-control (n=89; 59 AM, 30 RC); the quality of the restorations was evaluated blindly according to the modified USPHS criteria. Two observers conducted evaluations at the initial state (k=0.74) and after one to five, 10, and 12 years (k=0.88). Wilcoxon, Friedman, and Mantel-Cox tests were performed to compare the groups, respectively. RESULTS: After 12 years, both groups experienced a similar decline, except for an evidently better performance in marginal adaptation in RC control (p=0.043) and in anatomy in AM refurbished (p=0.032). CONCLUSIONS: After 12 years, no difference was found in the clinical condition and longevity of the refurbished restorations compared to the control group.

Seal, replacement or monitoring amalgam restorations with occlusal marginal defects? Results of a 10-year clinical trial.

The aim of this prospective and blind clinical trial was to assess the effectiveness of sealing localized marginal defects of amalgam restoration that were initially scheduled to be replaced. A cohort of twenty six patients with 60 amalgam restorations (n=44Class I and n=16Class II), that presented marginal defects deviating from ideal (Bravo) according to USPHS criteria, were assigned to either sealing or replacement groups: A: sealing n=20, Replacement n=20, and no treatment (n=20). Two blind examiners evaluated the restorations at baseline (K=0.74) and after ten years (K=0.84) according with USPHS criteria, in four parameters: marginal adaptation (MA), secondary caries (SC), marginal staining (MS) and teeth sensitivity (TS). Multiple comparison of restorations degradation/upgrade was analyzed by Friedman test and the comparisons within groups were performed by Wilcoxon test. After 10 years, 44 restorations were assessed (73.3%), Group A: n=14 and Group B: n=16; and Group C: n=14 sealing and replacement amalgam restorations presented similar level of quality in MA (p=0.76), SC (p=0.25) and TS (p=0.52), while in MS (p=0.007) presented better performance in replacement group after 10-years. Most of the occlusal amalgam restorations with marginal gaps showed similar long term outcomes than the restorations were sealed, replaced, or not treated over a 10-year period. Most of the restorations of the three groups were clinically acceptable, under the studied parameters. All restorations had the tendency to present downgrade/deterioration over time.

Salivary Urease and ADS Enzymatic Activity as Endogenous Protection against Dental Caries in Children.

UNLABELLED: The aim of this cross sectional study was to evaluate the ureolytic and arginolytic activities of saliva in children and associate them with their caries status. STUDY DESIGN: 65, 8 year old children, were randomly selected. The ureolytic and arginolytic activity of non stimulated saliva was studied and associated with DMFT and dmft index. Saliva of children were sampled under fasting conditions; Children refrained from any oral hygiene procedures during the 12 hours that preceded the sample collection. Caries activity was scored and divided in 3 groups: Group A: Index zero: without lesions; Group B: Moderate Index: 1 to 3 enamel caries lesions; and Group C: High Index: more than 4 dentin caries lesions. RESULTS: DMFT scores were moderate: 0.4(±0.79) and dmft: 2.78(±2.45). Results expressed in µmol/min/mg/protein, for urease activity were statistically significant (p=0.048): Group A= 0.69 (±0.7); Group B= 0.45 (±0.43); and Group C= 0.39 (±0.55). The arginine deiminase activity was not statistically significant (p=0.16): Group A= 2.53 (±1.42), Group B= 2.31 (±1.57) and Group C= 1.97 (±2.0). CONCLUSION: Higher levels of ureolytic (statistically significant) and arginolytic activity (trend) in saliva were associated with lower DMFT/dmft scores in 8 year old children. There was a higher production of ammonia from the arginine deiminase system than the urease enzyme in saliva (p>0.05).

Longitudinal results of a 10-year clinical trial of repair of amalgam restorations.

The aim of this prospective, blind, and randomized clinical trial was to assess the effectiveness of repair of localized clinical defects in amalgam restorations that were initially scheduled for replacement. A cohort of 20 patients with 40 (Class I and Class II) amalgam restorations that presented one or more clinical features that deviated from the ideal (Bravo or Charlie) according to US Public Health Service criteria, were randomly assigned to either the repair or the replacement group-A: repair, n = 19; and B: replacement, n = 21. Two examiners who had calibration expertise evaluated the restorations at baseline and 10 years after according to seven parameters: marginal occlusal adaptation, anatomic form, surface roughness, marginal staining, contact, secondary caries, and luster. After 10 years, 30 restorations (75%) were evaluated (Group A: n = 17; Group B: n = 13). Repaired and replaced amalgam restorations showed similar survival outcomes regarding marginal defects and secondary caries in patients with low and medium caries risk, and most of the restorations were considered clinically acceptable after 10 years. Repair treatment increased the potential for tooth longevity, using a minimally interventional procedure. All restorations trend to downgrade over time.

Sealing composite with defective margins, good care or over treatment? Results of a 10-year clinical trial.

PURPOSE: The objective of this study was to clinically evaluate sealed composite restorations after 10 years and compare their behavior with respect to controls. METHODS AND MATERIALS: The cohort consisted of 20 patients aged 18 to 80 years with 80 composite restorations. All participants in the sealing and no-treatment groups presented with clinical features for the marginal adaptation that deviated from the ideal and were rated Bravo (United States Public Health Service criteria). Composites with Alfa values for the marginal adaptation were used as the positive control. RESULTS: The marginal adaptation behavior was similar between the sealing and control (+) groups, with a high frequency of Bravo values in the 10th year (80% and 51%, respectively). Most of the no-treatment (-) group maintained the Bravo values (91%) for 10 years, although some restorations (9%) progressed to Charlie values. The anatomy parameter differed significantly between the first and 10th years, with deterioration in all three groups (p<0.05). The secondary caries parameter had a similar behavior in the three groups (p>0.05). CONCLUSIONS: Sealing the margins of the composite resin restorations had no significant effect compared with the control groups, under the conditions of this study. Sealing the restorations substantially improved the marginal staining and marginal adaptation parameters, although by the tenth year they were similar to the group without intervention.

Can repair increase the longevity of composite resins? Results of a 10-year clinical trial.

OBJECTIVES: The aim of this double-blind clinical trial was to assess the longevity of repairs to localized clinical defects in composite resin restorations that were initially planned to be treated with a restoration replacement. METHODS: Twenty-eight patients aged 18-80 years old with 50 composite resin restorations (CR) were recruited. The restorations with localized, marginal, anatomical deficiencies and/or secondary caries adjacent to CR that were "clinically judged" to be suitable for repair or replacement according to the USPHS criteria were randomly assigned to Repair (n=25) or Replacement (n=25) groups, and the quality of the restorations was scored according to the modified USPHS criteria. The restorations were blind and two examiners scored them at baseline (Cohen Kappa agreement score 0.74) and at ten years (Cohen Kappa agreement score 0.87) restorations. Wilcoxon tests were performed for comparisons within the same group (95% CI), and Friedman tests were utilized for multiple comparisons between the different years within each group. RESULTS: Over the decade, the two groups behaved similarly on the parameters of marginal adaptation (MA) (p>0.05), secondary caries (SC) (p>0.05), anatomy (A) (p<0.05), and colour (C) (p>0.05). CONCLUSIONS: Given that the MA, SC, A and C parameters behaved similarly in both groups, the repair of composite resins should be elected when clinically indicated, because it is a minimally invasive treatment that can consistently increase the longevity of restorations. CLINICAL SIGNIFICANCE: The repair of defective composite resins as an alternative treatment to increase their longevity proved to be a safe and effective treatment in the long term.

Relationship between disk position and degenerative bone changes in temporomandibular joints of young subjects with TMD. An MRI study.

UNLABELLED: This study determines the frequency and relationship between disk position and degenerative bone changes in temporomandibular joints in children and adolescent patients with internal derangement. Study design: TMJ, MRI of 88 patients were analyzed (average age: 14.7 years-old, range age: 10-18 years-old), female n = 65 (73.9%) and male n = 23 (26.1%). Images obtained were used to determine the frequency of disk position, joint effusion (JE) and degenerative bone changes (OA). Images were assessed by a calibrated radiologist (Kappa = 0.82). RESULTS: No significant association was found between disk displacement with reduction and degenerative bone changes (Chi2 = 9.894; OR = 0.375; p = 0.0017), nor disk without displacement (Chi2 = 9.448; OR = 0.223; p = 0.0021). A significant association was found between disk displacement without reduction and degenerative bone changes (Chi2 = 30.951; OR = 6.304; p = 0.0001). CONCLUSIONS: There is a significant association between disk displacement without reduction and degenerative bone changes (p = 0.0001) in children and adolescent patients with TMD.

Low Concentration H(2)O(2)/TiO_N in Office Bleaching: A Randomized Clinical Trial.

OBJECTIVES: The purpose of this randomized double-blinded clinical trial was to test the efficacy and tooth sensitivity promoted by the use of an in-office 15% H(2)O(2) bleaching agent containing nanoparticles of TiO_N photocatalyzed with LED/laser light (HP15) and a control of 35% H2O2 (HP35). METHODS: Forty healthy volunteers, both sexes, aged 18 to 25 yr, were randomly distributed in 2 groups: HP15 (n = 20) was treated in 3 sessions of 48 min each, and HP35 (n = 20) was treated in 3 sessions of 45 min each. The efficacy (E) was evaluated by ΔE values measured via reflectance spectroscopy. The tooth sensitivity (S) was analyzed by visual analog scale (low, average, high, very high). The absolute risk reduction and the number needed to treat index were calculated. The data were analyzed by mixed repeated measures analysis of variance with Bonferroni-correction t test (α = 0.05). RESULTS: For the efficacy, significant differences were found for number of bleaching sessions (p = .0001; [Formula: see text] = 0.73 and π = 1.000) and for the interaction of number of sessions and bleaching protocols (p = .0001; [Formula: see text] = 0.319 and π = 1.000. The tooth sensitivity level showed significant differences only between the bleaching protocols. Absolute risk reduction calculated was 52% and number needed to treat, 1.92. CONCLUSIONS: The bleaching agent with the lower concentration (HP15) promoted lower levels of tooth sensitivity and presented greater efficacy compared to the control (HP35) in patients between 18 and 25 yr old. The limitation of short-term evaluation did not provide information about the longevity of the tooth bleaching (Brazilian Clinical Trials Registry Re Bec no. U1111-1150-4466).

Evaluation of dental restorations: a comparative study between clinical and digital photographic assessments.

UNLABELLED: The aim of this study was to compare the efficacy of a direct clinical evaluation method with an indirect digital photographic method in assessing the quality of dental restorations. Seven parameters (color, occlusal marginal adaptation, anatomy form, roughness, occlusal marginal stain, luster, and secondary caries) were assessed in 89 Class I and Class II restorations from 36 adults using the modified US Public Health Service/Ryge criteria. Standardized photographs of the same restorations were digitally processed by Adobe Photoshop software, separated into the following four groups and assessed by two calibrated examiners: Group A: The original photograph displayed at 100%, without modifications (IMG100); Group B: Formed by images enlarged at 150% (IMG150); Group C: Formed by digital photographs displayed at 100% (mIMG100), with digital modifications (levels adjustment, shadow and highlight correction, color balance, unsharp Mask); and Group D: Formed by enlarged photographs displayed at 150% with modifications (mIMG150), with the same adjustments made to Group C. Photographs were assessed on a calibrated screen (Macbook) by two calibrated clinicians, and the results were statistically analyzed using Wilcoxon tests (SSPS 11.5) at 95% CI. RESULTS: The photographic method produced higher reliability levels than the direct clinical method in all parameters. The evaluation of digital images is more consistent with clinical assessment when restorations present some moderate defect (Bravo) and less consistent when restorations are clinically classified as either satisfactory (Alpha) or in cases of severe defects (Charlie). CONCLUSION: The digital photographic method is a useful tool for assessing the quality of dental restorations, providing information that goes unnoticed with the visual-tactile clinical examination method. Additionally, when analyzing restorations using the Ryge modified criteria, the digital photographic method reveals a significant increase of defects compared to those clinically observed with the naked eye. Photography by itself, without the need for enlargement or correction, provides more information than clinical examination and can lead to unnecessary overtreatment.

Clasificación y significado clínico de las diferentes formulaciones de las cerámicas para restauraciones dentales / Classification and clinical significance of different formulations of ceramics for dental restorations

Durante los últimos 40 años las cerámicas dentales han presentado significativos avances tecnológicos, desde la porcelana feldespática a las cerámicas basadas en zirconio, mejorando sus propiedades mecánicas aumentando aproximadamente en casi 10 veces la resistencia a la flexión y a la fractura. Característica importante, común a todos los sistemas cerámicos es la proporción de la fase vítrea y cristalina y el grado de porosidad dado que ambas afectan las propiedades ópticas y mecánicas de la restauración. Para la mejor comprensión de la diversidad de cerámicas desarrolladas durante los últimos años se proponen dos clasificaciones, una basada en su composición, que permite relacionar el material con sus propiedades físicas y otra basada en el método de fabricación que define las opciones de manejo y que adicionalmente, permite conocer con mayor facilidad las ventajas y limitaciones de las cerámicas dentales además de ayudar a definir la selección del material más indicado para cada requerimiento clínico.

During the last 40 years, dental ceramics had showed significant technological advances, from feldsphatics porcelain to ceramics based on zirconio, improving mechanicals properties, reaching close to 10 foils of flexural and fracture strength. Important characteristics, common to all ceramic systems, are glass phase and crystalline phase proportion, and the amount of porosity, because both affect the mechanicals and optical properties of the final restorations. For better understanding of the wide ceramics options, we propose two ceramics classifications based on composition, which associate the material with their physical properties and the fabrication method, which define the laboratory options and give information related to ceramics advantages and limitations, those information help to make the ceramic selection for each especial clinical requirement.

Manifestaciones óseas de las enfermedades degenerativas de la articulación temporomandibular disfuncionada estudio tomográfico / Bone manifestations of degenerative diseases in temporomandibular joint with internal derangements tomography study

El objetivo del presente estudio retrospectivo fue determinar el tipo y frecuencia de las alteraciones óseas degenerativas en la Articulaciones Temporo-Mandibulares (ATM) de pacientes con diagnóstico clínico de Trastorno Temporomandibular (TTM) por medio de Tomografía Computarizada (TAC). Se reclutaron 180 pacientes consecutivos que clínicamente presentan TTM de las ATM. Los criterios de exclusión fueron: pacientes menores de 16 años, pacientes mayores de 65 años, pacientes portadores de prótesis dentarias removibles, enfermedades sistémicas como artritis por microcristales de ácido úrico, osteoartrosis sistémica, hiperlaxitud-ligamentaria, malformaciones anatómicas, enfermedades quísticas, tumorales, historia de trauma o cirugía de las ATM. Todos los pacientes fueron examinados por medio de TAC. Los estudios imagenológicos de las ATM formaron los siguientes seis Grupos: A: Aplanamiento de Vertiente anterior de Cóndilo; B: Aplanamiento de Apófisis transversa del temporal; C: Erosiones e irregularidades de las corticales de las superficies óseas Funcionales; D: Osteofitos; E: Quístes Subcondrales; F: Resorción Condilar Progresiva. Los datos fueron analizados estadísticamente por medio del programa SPSS v15.0. Total de ATM examinadas: n=360; Total de ATM con alteraciones degenerativas: n=192(53,3%); Aplanamiento condilar n=169(88%); Aplanamiento de la apófisis transversa del temporal n=84(43%); Erosiones corticales: n=98(51%); Osteofitos: n=11(5,7%); Quistes Subcondrales n=35(18,2%) y Resorción Condilar Progresiva n=3(1,5%). Las alteraciones óseas de mayor frecuencia en la ATM disfuncionada fueron: Aplanamiento de ápex condilar, erosiones y aplanamiento de Apófisis transversa del temporal en orden decreciente. Menores manifestaciones fueron Quistes subcondrales, Osteofitos y Resorción Condilar Progresiva.

The objective of the present study was to determine frequency of bone degeneratives diseases in the Temporo Mandibular joint, clinically diagnosed as Temporo Mandibular Disorders (TMD), by CT scan, before treatment. Were recruited 180 consecutives patients that clinically presented TMD. They were examined by CT scan. The exclusion criteria were: patients below 16 years and above 65 years of age, patients using removable dental prosthetics, patients that presented systemic disease such as Gout Disease, Osteoarthrosis and hypermobility, anatomic structural alterations, Cyst or Tumour disease and TMJ surgery. The TMJ images studies formed the following six groups: A: Flattened of condyle apex; B: Flattened of protuberance of the Temporal Bone; C: Erosions and irregularities of cortical bone in functional area; D: Osteophytes; Sub-chondral Cysts; E: Progressive Condyle Reabsorption. Data were analyzed by SPSS v15.0 software. Total Examined TMJ: n=360; Degenerative Bone Disease manifestations in TMJ: 192 (53,3%); Flattened of functional area of mandibular condyle n=169 (88%); Flattened of temporal Bone n=84 (43%); Erosions and irregularities of cortical bone: n=98 (51%); Osteophytes: n=11 (5,7%); Subchondral cysts: n=35 (18,2%) and Progressive Condyle Reabsorption n=3 (1,5%). The most frequent bone alterations in DTM were: Flattened of apex condyle, cortical erosions and irregularities and temporal bone flattened. Lower manifestations were subchondral cysts, osteophytes and avascular necrosis, when DTM are studied by CT scan.

Modelo de conductancia hidráulica de la dentina humana ex vivo / Hydraulic conductance model of ex vivo human dentin

El objetivo principal de este trabajo fue montar y probar un modelo experimental para medir la conductancia hidráulica de la dentina ex vivo. Diecisiete terceros molares sanos, con indicación de exodoncia, de donantes sanos de edades entre 15 y 30 años fueron obtenidos mediante consentimiento informado. Luego de limpiarlos, desinfectarlos, incluirlos en resina epóxica y cortarlos se obtuvieron 17 muestras de dentina, correspondiente a un disco de resina con un corte coronal de diente que presenta dentina expuesta en ambas caras de éste. Tres equipos para medir la conductancia hidráulica de la dentina fueron armados siguiendo la descripción del modelo de Pashley. Las muestras fueron instaladas en una cámara de difusión, conectada mediante tubos de silicona a una pipeta graduada y una columna de agua de 20cm. Mediante el desplazamiento de una burbuja de agua al interior de la pipeta, se midió la conductancia hidráulica de cada muestra, 3 veces los días 14, 21, 28 y 35 postextracción. Los datos fueron tabulados y analizados estadísticamente. No existe diferencia en la tasa de flujo de una muestra medida en los tres equipos (p=0.5937). No existe diferencia en las mediciones de la conductancia hidráulica de 13 muestras de dentina humana medida en los días 14, 21, 28 y 35 postextracción (p=0.0704). Es posible montar un modelo experimental para estudiar la conductancia hidráulica de la dentina ex vivo, basado en el modelo de Pashley y col. El modelo pareciera ser confiable, pero es necesaria más investigación para poder validar su confiabilidad.

The main objective of this work was to mount and test an experimental model to measure the hydraulic conductance of ex vivo dentin. Seventeen healthy third molars, with indication of extraction of healthy donors aged between 15 and 30 years were obtained by informed consent. After cleaning them, disinfecting them, including them in resin epoxy and cutting them, there were 17 samples of dentin, corresponding to a disk of resin with a coronal section of tooth showing the dentin exposed on both sides of it. Three machines to measure the hydraulic conductance of the dentin were assembled according to the description of the model of Pashley. Samples were installed in a Chamber of diffusion, connected by using silicone tubes to a graduated transfer pipette and a 20cm water column. Through the displacement of a bubble of water in the inside of the pipette, the hydraulic conductance of each sample was measured 3 times on the 14th, 21st, 28th and 35th day post extraction. The data were tabulated and analyzed statistically. There is no SS difference in the rate of flow of a measured sample in the three machines (p=0.5937). There is no SS difference in measurements of the hydraulic conductance of 13 samples of human dentin measured in days 14, 21, 28 and 35 postextraction (p=0.0704). It is possible to mount an experimental model to study the hydraulic conductance of dentin ex vivo, based on the model of Pashley. The model seems to be reliable, but more research is needed in order to validate its reliability.

Effects of light activation, agent concentration, and tooth thickness on dental sensitivity after bleaching.

UNLABELLED: Examining three bleaching systems, this in vivo clinical trial evaluated the relationship among tooth sensitivity, light activation, and agent concentration, and it correlated dental sensitivity with tooth thickness. MATERIALS AND METHODS: Eighty-seven volunteer patients were included. Inclusion criteria were the presence of anterior teeth without restorations as well as the absence of a previous bleaching experience and absence of noncarious cervical lesions or dental pain. Exclusion criteria included pregnancy or breastfeeding, a maximum of TF3 hypoplasia, tetracycline-fluorosis stains, malpositioned teeth, orthodontic treatment, periodontal disease, and/or analgesic/anti-inflammatory intake. Patients were randomly assigned to three bleaching groups: Group A (n=25) was treated with 15% H2O2 and nitrogenous-titanium-dioxide and was light activated (Lase Peroxide Lite, DMC, SaoCarlos, Sao Paulo, Brazil); Group B (n=27) was treated with 35% H2O2 and was light activated (Lase Peroxide Sensy, DMC); and Group C (n=35) was treated with 35% H2O2 (White Gold Office, Dentsply, 38West Clark Ave., Milford, USA) without light activation. Tooth sensitivity (TS) was self-reported by the patients using the visual analog scale (VAS) at baseline (TS0), immediately after treatment (TSI), and at seven days after treatment (TS7). In 46 patients, tooth thickness was determined by computed tomography. TS0, TSI, and TS7 were compared between the A and B groups to determine the effect of concentration and between the B and C groups to determine the effect of light using analysis of covariance. The correlation between tooth thickness and TSI was determined by Spearman Rho test (SPSS 15). RESULTS: Eighty-seven patients were evaluated at baseline, and 61 were evaluated at seven days. Separated by groups, tooth sensitivity, expressed as VAS value at the time points TS0, TSI, and TS7, respectively, were as follows: Group A: 13.76 ± 13.53, 24.40 ± 25.24, and 5.94 ± 5.5; Group B: 15.07 ± 18.14, 42.4 ± 31.78, and 8.68 ± 17.99; and Group C: 10.80 ± 14.83, 31.51 ± 29.34, and 7.24 ± 9.2. Group A showed significantly lower tooth sensitivity than group B at TSI (p=0.032). No differences were observed in the tooth sensitivities between groups B and C. No correlation was encountered between tooth thickness and tooth sensitivity immediately after treatment (Rho=-0.088, p=0.563). The median tooth thickness was 2.78 ± 0.21 mm. CONCLUSIONS: Increases in the concentration of bleaching agents directly affect tooth sensitivity, and LED/laser activation and tooth thickness are not correlated with tooth sensitivity after dental bleaching.

Minimal invasive treatment for defective restorations: five-year results using sealants.

Replacement of dental restorations has been the traditional treatment for restorations that are defective. In this five-year randomized clinical trial, restorations with localized marginal defects were treated with sealants. Thirty-two patients (mean age, 26.8 years) with 126 Class I and Class II restorations with defective margins (amalgam n=69 and resin-based composite n=57) were recruited. Treatment was seal with pit and fissure sealant on localized marginal defects (group A: n=43) and was compared with total restoration replacement (group B: n=40) and untreated restorations (group C: n=43) as negative and positive controls. Restorations were assessed by two examiners using the modified US Public Health Service criteria, observing five clinical parameters: marginal adaptation, roughness, marginal stain, teeth sensitivity, and secondary caries at baseline and at five years after treatment. At the five-year recall examination, 23 patients with 90 restorations (71.4% recall rate) were examined. A significant improvement was observed in the marginal adaptation of the restorations in group A compared with group B. None of the treated group showed trends to downgrade in any parameter. Tooth sensitivity and secondary caries showed a low frequency in all groups. No significant difference in marginal adaptation of the restorations was found between amalgam and resin-based composite restorations (p=0.191). This study demonstrated that marginal sealing of restorations is a minimally invasive treatment that may be used instead of the replacement of restorations with localized marginal defects.

Manifestaciones óseas de las enfermedades degenerativas de la articulación temporomandibular (ATM) disfuncionada: estudio tomográfico / Bone manifestation of degenerative disease in temporomandibular joint (TMJ) with internal deragements: tomography study

El objetivo del presente estudio retrospectivo fue determinar el tipo y frecuencia de las alteraciones óseas degenerativas en la Articulaciones Temporo-Mandibulares (ATM) de pacientes con diagnóstico clínico de Trastorno Temporomandibular (TTM) por medio de Tomografía Computada (TAC). Se reclutaron 180 pacientes consecutivos que clínicamente presentan TTM de las ATM. Los criterios de exclusión fueron: pacientes menores de 16 años, pacientes mayores de 65 años, pacientes portadores de prótesis dentarias removibles, enfermedades sistémicas como artritis por microcristales de ácido úrico, osteoartrosis sistémica, hiperlaxitud-ligamentaria, malformaciones anatómicas, enfermedades quísticas, tumorales, historia de trauma o cirugía de las ATM. Todos los pacientes fueron examinados por medio de TAC. Los estudios imagenológicos de las ATM formaron los siguientes seis Grupos: A: Aplanamiento de Vertiente anterior de Cóndilo; B: Aplanamiento de Apófisis transversa del temporal; C: Erosiones e irregularidades de las corticales de las superficies óseas Funcionales; D: Osteofitos; E: Quístes Subcondrales; F: Resorción Condilar Progresiva. Los datos fueron analizados estadísticamente por medio del programa SPSS v15.0. Total de ATM examinadas: n=360; Total de ATM con alteraciones degenerativas: n=192(53,3%); Aplanamiento condilar n=169(88%); Aplanamiento de la apófisis transversa del temporal n=84(43%); Erosiones corticales: n=98(51%); Osteofitos: n=11(5,7%); Quístes Subcondrales n=35(18,2%) y Resorción Condilar Progresiva n=3(1,5%). Las alteraciones óseas de mayor frecuencia en la ATM disfuncionada fueron: Aplanamiento de ápex condilar, erosiones y aplanamiento de Apófisis transversa del temporal en orden decreciente. Menores manifestaciones fueron Quístes subcondrales, Osteofitos y Resorción Condilar Progresiva

The objective of the present study was to determine frequency of bone degeneratives diseases in the Temporo Mandibular joint, clinically diagnosed as Temporo Mandibular Disorders (TMD), by CT scan, before treatment. Were recruited 180 consecutives patients that clinically presented TMD. They were examined by CT scan. The exclusion criteria were: patients below 16 years and above 65 years of age, patients using removable dental prosthetics, patients that presented systemic disease such as Gout Disease, Osteoarthrosis and hypermobility, anatomic structural alterations, Cyst or Tumour disease and TMJ surgery. The TMJ images studies formed the following six groups: A: Flattened of condyle apex; B: Flattened of protuberance of the Temporal Bone; C: Erosions and irregularities of cortical bone in functional area; D: Osteophytes; Sub-chondral Cysts; E: Progressive Condyle Reabsorption. Data were analyzed by SPSS v15.0 software. Total Examined TMJ: n=360; Degenerative Bone Disease manifestations in TMJ: 192 (53,3%); Flattened of functional area of mandibular condyle n=169 (88%); Flattened of temporal Bone n=84 (43%); Erosions and irregularities of cortical bone: n=98 (51%); Osteophytes: n=11 (5,7%); Subchondral cysts: n=35 (18,2%) and Progressive Condyle Reabsorption n=3 (1,5%). The most frequent bone alterations in DTM were: Flattened of apex condyle, cortical erosions and irregularities and temporal bone flattened. Lower manifestations were subchondral cysts, osteophytes and avascular necrosis, when DTM are studied by CT scan

Prevalencia de caries, pérdida de dientes y necesidad de tratamiento en población adulta Mapuche-Huilliche de Isla Huapi / Prevalence of caries, teeth loss and treatment needs in adult Mapuche-Huilliche population in Isla Huapi

Objetivo: El objetivo de este estudio transversal fue evaluar el estado de salud oral y cuantificar la prevalencia de caries dental, pérdida de dientes y necesidad de tratamiento en la población adulta de etnia Mapuche-Huilliche que habita la Isla Huapi. Método: Se examinó una muestra representativa de 64 habitantes adultos de la Isla Huapi, constituida por 31 hombres y 33 mujeres de entre 25 a 82 años de edad, que tenían a lo menos un apellido de origen Mapuche-Huilliche. Todos los individuos, previa firma de un consentimiento informado, fueron examinados por un solo dentista calibrado durante el mes de agosto 2009. Los datos fueron registrados en una ficha diseñada especialmente y analizados estadísticamente usando los test T de Student y ANOVA. Resultados: El promedio del índice COPD de la muestra fue 14.59. Todos los individuos tenían historia de caries. De los que conservaban dientes, el 71.43 por ciento tenían caries sin tratar, con un promedio de 1.25. El 98.43 por ciento de los individuos de la muestra presentaban algún grado de desdentamiento, el 12.5 por ciento eran edéntulos. El 100 por ciento de la población necesitaba atención odontológica, ya fuera para operatoria o prótesis. Conclusiones: Esta población presenta un gran daño en cuanto a su salud oral, especialmente debido a pérdida de dientes. La magnitud del daño e importancia del entorno social como determinante en la generación de éste, obliga a enfrentar el problema y buscar soluciones desarrollando y aplicando programas gubernamentales de promoción y atención en salud oral a toda la población.

Objectives: The aim of this cross- sectional study was to assess oral health status and quantify prevalence of dental caries, teeth loss and treatment needs in an ethnic group of Mapuche-Huilliche adult population in Isla Huapi. Method: A representative sample of 64 adult inhabitants of Isla Huapi was selected. 31 men and 33 women aged 25 to 82 years of age who had at least one Mapuche-Huilliche surname, after signing an informed consent, individuals were examined by a calibrated examiner during August 2009. Data were recorded and analyzed statistically using T Student and ANOVA tests. Results: The DMFT index average of the sample was 14.59. All individuals had caries experience. Untreated caries were found in a 71.43 percent of individuals retaining teeth, with an average of 1.25 each. 98.43 percent of the individuals had some degree of edentulism, 12.5 percent were edentulous. 100 percent of the population needed either restorative or prosthetic dental care. Conclusions: This population has a high degree of damage in their oral health, especially due to teeth loss, which could be explained by their limited access to preventive and restorative dental care. The extent of the damage and the importance of the social environment as a determiner in the generation of it, will mean addressing the problem and seeking solutions by developing and implementing government programs for the promotion and oral health care to the entire population.

Influencia de la orientación de los túbulos dentinarios en la resistencia al cizallamiento: estudio in-vitro de dos sistemas adhesivos / Influence of the orientation of the dentinal tubules in the shear strength: in-vitro study two adhesive systems

La unión adhesiva es requisito básico para retener y sellar las restauraciones de resina compuesta. Determinar la influencia de la dirección de los túbulos dentinarios en la resistencia al cizallamiento de 2 sistemas adhesivos y determinar tipo de fractura. 40 terceros molares humanos sanos, fueron divididos a la mitad, montados en acrílico y desgastados con papel de lija, bajo agua para exponer los túbulos dentinarios transversalmente (especímenes #1 al #40) y longitudinalmente (especímenes del #41 al #80). Se separaron en 4 grupos, tratados con: Grupo A (especímenes #1 al #20): adhesivo de dos etapas, One Coat Bond® (Coltene®), Grupo B (especímenes #21 al #40): adhesivo autograbante, Adper® Prompt® (3M® ESPE®), Grupo C (especímenes #41 al #60): One Coat Bond® y Grupo D (especímenes #61 al #80): Adper® Prompt®. Sobre los adhesivos se construyeron cilindros de resina restauradora Filtek® Supreme (3M® ESPE®). Los especímenes fueron sometidos a pruebas de cizallamiento en una máquina de ensayos universal Instrom®. Los datos fueron analizados estadísticamente por medio del test t de Student. Resultados: Grupo A: 16,9 Mpa (± 8,8), Grupo B: 20,2 Mpa (± 9,12), Grupo C: 14,2 Mpa (± 7,4) y Grupo D: 11,9 Mpa (± 6,11). La dirección de los túbulos dentinarios afecta directamente los valores de resistencia al cizallamiento sólo en el adhesivo autograbante (p=0,002). El adhesivo de dos tiempos mostró valores similares en ambas direcciones de los túbulos (p=0,297). Al MEB la fractura mixta fue la observada con mayor frecuencia (60%)

The adhesion is a basic requirement to seal and retain the resin based composite restorations. To determine the influence of the dentin tubules orientations in shear bond strength (SBS) of 2 adhesive systems and to determine the type of fracture. Method: 80 specimens were obtained from 40 healthy human third molars, they were mounted in acrylic molds and polished under tap water - SiC paper 400 grit - to expose the dentin tubules cross section (specimen #1 - #40) and lengthwise of them (#41 - #80). Four groups were formed and treated with: Group A (specimens #1- #20): One Coat Bond® (Coltene®) a two step adhesive; Group B (specimens #21 - #40): Adper® Prompt® (3M® ESPE®) a self-etch adhesive; Group C (specimens #41 - #60): One Coat Bond® and Group D (specimens #61 - #80): Adper® Prompt®. After the adhesive procedures, a composite cylinder, Filtek® Supreme (3M® ESPE®) was built for SBS test, that was carried out in an Instrom® Universal Testing Machine. The Bond Strength data were analyzed with t-test. Group A: 16.9 Mpa (±8,8), Group B: 20.2 Mpa (±9, 12), Group C: 14.2 Mpa (±7, 4) and Group D: 11.9 Mpa (±6, 11). It was concluded that dentin tubules orientation affects the SBS only in the self-etch adhesive (p=0.002). Two step adhesive showed similar SBS in both tubule orientations (p=0.297). Observation by SEM showed the mix fracture was the most frequent (60%)

Prevalence of oral pathologic findings in an ancient pre-Columbian archeological site in the Atacama Desert.

OBJECTIVE: To determine the prevalence of oral pathologic findings in an ancient culture that inhabited the Atacama Desert. MATERIALS AND METHODS: A systematic examination was performed on the remains of 83 individuals unearthed from a prehistoric burial ground. A total of 57 skeletal remains achieved appropriate inclusion criteria, from which estimated age at death, gender, ante- and postmortem tooth loss, prevalence and location of caries, apical periodontitis sequela, alveolar bone resorption and attrition were recorded. RESULTS: From the analyzed skeletal remains (13 male, 22 female and 22 not identifiable), the mean age estimated was 29.9 +/- 13.8 years. A total of 89.4% of them presented permanent dentition with a mean ante-mortem tooth loss of 9.0 teeth and a postmortem mean tooth loss of 14.4 teeth per subject. In all, 46.4% of the postmortem remaining permanent teeth (n = 237) showed caries lesions. Interproximal caries was most frequently observed (31.5%), followed by occlusal (25.9%) and cervical caries (19.4%). Root remnants were found in 23.1% of the cases. In addition, 58.0% of the adults presented attrition, 26.0% signs of apical periodontitis and 44.0% loss of alveolar bone support >5 mm. CONCLUSION: The remains of jaws and teeth of the individuals examined in this study presented sequelae of severe oral health damage due to caries and periodontal disease.