Diagnostic Strategies for Restorations Management: A 70-Month RCT.

We aimed to evaluate the impact of 2 visual diagnostic strategies for assessing secondary caries and managing permanent posterior restorations on long-term survival. We conducted a diagnostic cluster-randomized clinical trial with 2 parallel groups using different diagnostic strategies: (C+AS) based on caries assessment, marginal adaptation, and marginal staining aspects of the FDI (World Dental Federation) criteria and (C) based on caries assessment using the Caries Associated with Restorations or Sealants (CARS) criteria described by the International Caries Detection and Assessment System (ICDAS). The treatment for the restoration was conducted based on the decision made following the allocated diagnostic strategy. The restorations were then clinically reevaluated for up to 71 mo. The primary outcome was restoration failure (including tooth-level failure: pain, endodontic treatment, and extraction). Cox regression analyses with shared frailty were conducted in the intention-to-treat population, and hazard ratios (HRs) and 95% confidence intervals (95% CIs) were derived. We included 727 restorations from 185 participants and reassessed 502 (69.1%) restorations during follow-up. The evaluations occurred between 6 and 71 mo. At baseline, C led to almost 4 times fewer interventions compared with the C+AS strategy. A total of 371 restorations were assessed in the C group, from which 31 (8.4%) were repaired or replaced. In contrast, the C+AS group had 356 restorations assessed, from which 113 (31.7%) were repaired or replaced. During follow-up, 34 (9.2%) failures were detected in the restorations allocated to the C group and 30 (8.4%) allocated to the C+AS group in the intention-to-treat population, with no significant difference between the groups (HR = 0.83; 95% CI = 0.51 to 1.38; P = 0.435, C+AS as reference). In conclusion, a diagnostic strategy focusing on marginal defects results in more initial interventions but does not improve longevity over the caries-focused strategy, suggesting the need for more conservative approaches.

Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network meta-analysis.

BACKGROUND: This systematic review and network meta-analysis aimed to compare the clinical efficacy of bioactive and conventional restorative materials in controlling secondary caries (SC) and to provide a classification of these materials according to their effectiveness. METHODS: A search was performed in Pubmed, Web of Science, Embase, BBO, Lilacs, Cochrane Library, Scopus, IBECS and gray literature. Clinical trials were included, with no language or publication date limitations. Paired and network meta-analyses were performed with random-effects models, comparing treatments of interest and classifying them according to effectiveness in the permanent and deciduous dentition and at 1-year or 2/more years of follow-up. The risk of bias and certainty of evidence were evaluated. RESULTS: Sixty-two studies were included in the qualitative syntheses and 39 in the quantitative ones. In permanent teeth, resin composite (RC) (RR = 2.00; 95%CI = 1.10, 3.64) and amalgam (AAG) (RR = 1.79; 95%CI = 1.04, 3.09) showed a higher risk of SC than Glass Ionomer Cement (GIC). In the deciduous teeth, however, a higher risk of SC was observed with RC than with AAG (RR = 2.46; 95%CI = 1.42, 4.27) and in GIC when compared to Resin-Modified Glass Ionomer Cement (RMGIC = 1.79; 95%CI = 1.04, 3.09). Most randomized clinical trials studies showed low or moderate risk of bias. CONCLUSION: There is a difference between bioactive restorative materials for SC control, with GIC being more effective in the permanent teeth and the RMGIC in the deciduous teeth. Bioactive restorative materials can be adjuvants in the control of SC in patients at high risk for caries.

Accuracy of Two Visual Criteria for the Assessment of Caries around Restorations: A Delayed-Type Cross-Sectional Study.

The aim of this study was to compare the performance of two visual criteria used for the detection of caries around restorations in permanent teeth. In this delayed-type cross-sectional study, the study sample was randomly allocated to one of two visual criteria for the assessment of restorations as follows: (a) International Dental Federation (FDI) criteria, considers marginal staining, marginal adaptation, and caries recurrence and (b) Caries Associated with Restorations or Sealants (CARS) criteria, defined by the International Caries Classification and Management System. A calibrated examiner assessed the restorations using two reference standards as follows: (i) for restorations requiring operative interventions (repair/replacement), the restoration was partially or totally removed and the presence or absence of carious tissue was assessed; and (ii) for restorations requiring nonoperative intervention, follow-up for a period of 1 year was recommended to allow identification of the presence of new lesions not detected at baseline. The sensitivity, specificity, area under receiver operating characteristic curve (Az), and accuracy of the criteria were assessed. The study included 305 restorations. The FDI marginal staining parameter had the lowest Az value (Az = 0.501), while similar sensitivity was observed between the CARS (62.0%), FDI presence of caries (65.0%), and FDI marginal adaptation (74.0%) parameters. CARS exhibited the highest specificity (88.3%) and accuracy (85.6%). The CARS criteria exhibited better specificity and accuracy in detecting caries around restorations, followed by the FDI criteria for caries recurrence and marginal adaptation. Considering marginal staining or combining multiple marginal features to assess secondary caries resulted in an increased risk of false-positive outcomes and overtreatment.

Clinical Accuracy of Two Different Criteria for the Detection of Caries Lesions around Restorations in Primary Teeth.

This is a delayed-type cross-sectional prospective accuracy study nested in a randomized clinical trial. The aim was to investigate the diagnostic accuracy of two visual criteria for caries lesions detection around restorations in primary teeth: the International Dental Federation (FDI) criteria, considering adaptation, staining, and the presence of caries, and the Caries Associated with Restorations and Sealants (CARS) system. For this, one examiner made the diagnosis and subsequent treatment decision using visual assessment in 163 children (3-10 years old) with both FDI and CARS criteria. The order of criteria used was defined by randomization. The reference standard was composed of two approaches: (1) the presence of carious tissue after restoration removal and (2) the presence of caries lesions after 6 and 12 months of follow-up. Sensitivity, specificity, and accuracy parameters were calculated at the dentin threshold. Poisson multilevel regression analyses were performed to evaluate the association of the diagnostic methods and other explanatory variables with the outcomes. Of the 651 restorations included, 480 were evaluated by the reference standard methods and were analyzed. The CARS system presented higher accuracy (0.721) than those obtained with FDI recurrence of caries (0.702), FDI marginal adaptation (0.700), and FDI marginal staining criteria (0.681). The FDI marginal staining showed the study's lowest sensitivity (0.280) and accuracy (0.681) values. The specificity values of FDI recurrence of caries and FDI marginal adaptation were lower than the CARS system. Restorations assessed after the follow-up period resulted in lower sensitivity but higher specificity than those replaced after initial evaluation. In conclusion, the CARS system is more accurate in detecting caries around restorations in primary teeth than the FDI system, in general. However, the FDI recurrence of caries and FDI marginal adaptation present similar performance to the CARS system when the dentin threshold is considered. On the other hand, marginal staining is not an accurate parameter to evaluate caries around restorations.

Comparison of two clinical approaches based on visual criteria for secondary caries assessments and treatment decisions in permanent posterior teeth.

BACKGROUND: This cross-sectional study aimed to compare two clinical approaches based on visual criteria for secondary caries assessments and treatment decisions in permanent posterior teeth. METHODS: The two clinical visual criteria tested for the assessments of restored teeth were: FDI criteria-based on the caries presence, marginal adaptation and staining criteria, adapted from the FDI (International Dental Federation) criteria and CARS criteria-"Caries Associated with Restorations or Sealants" (CARS) criteria described by the International Caries Classification and Management System. Adults were randomized according to the criteria. One calibrated examiner assessed the restorations and assigned the treatment according to the criteria. The primary outcome was replacement indication. RESULTS: A total of 185 patients were included, totalling 718 restorations. The strongest correlation founded between the methods was for the presence of caries lesions (Rho = 0.829). A moderate correlation (Rho = 0.420) was founded between the treatment decisions proposed by the CARS and by the FDI criteria. The multilevel regression analysis showed that the FDI criteria indicated five times more replacements when compared to the CARS (< 0.001). Also, using the FDI criteria restorations were 2.7 times more related to caries around restorations (p < 0.001) compared to the other criterion. CONCLUSIONS: The visual criteria used on the restoration's assessment directly influences the treatment decision to intervene or not on the restoration. The use of a minimally invasive based approach for assessing secondary caries may prevent overtreatment.

El ciclo repetitivo en la Odontología Restauradora / The repetitive cycle in Restorative Dentistry

Los cambios en la vida, así como también en el campo de la Odontología, deben ser para mejorar siempre en todos los aspectos posibles. Y muchos de los cambios recientes en la Odontología Restauradora están encaminados a la utilización de materiales estéticos para remplazo de restauraciones metálicas previas, sin generar certeza total de ser mejores opciones. Esto ha generado un marcado incremento en la tendencia a practicar, más enfáticamente, el remplazo de restauraciones previas (AU)

Changes in life, as so in the field of Dentistry, should always be for the improvement on most possible aspects. Many of the recent changes in Restorative Dentistry are focus on the use of cosmetic materials to replace previous metallic restorations, without total certainty of being better options. This has generated a marked increase in the tendency to practice, more emphatically, the replacement of previous restorations (AU)

Knowledge about composite restorations repair vs replacement- a survey among a subpopulation of saudi dental students / Conhecimento sobre reparo e substituição de restaurações de resina - uma pesquisa entre uma subpopulação de estudantes sauditas de odontologia

Objective: The purpose of this study was to evaluate the knowledge among dental students at King Khalid University, Jazan University, and Najran University in the kingdom of Saudi Arabia about when to repair or replace defective direct composite restoration. Materials and Methods: A questionnaire-based survey was formulated, pursuing the information about management (repair/replacement) of defective composite restorations and distributed among 200 dental students of three universities in the southern region of the kingdom of Saudi Arabia. The data were collected with the help of an online questionnaire. Data entry and the analysis were done using the statistical software package SPSS version 20.0. It was presented using descriptive statistics in the form of frequencies and percentages for qualitative variables, and range means and standard deviations for age, quantitative variable. Analytic statistics were done using Chi-Square tests (χ2) to test the significant difference between categorical variables. The level of significance, the p-value was 0.01(p<0.01). Results: The decision to choose between composite repair or replacement was influenced by whether this topic was taught to them at various undergraduate levels during Bachelor of Dental Surgery. The reason associated with the decision to repair defective composite restorations, 76% reported as cost-effective followed by Increased longevity (71%), the permanent filling (70%), patient's preference for repair (65%), and least time consuming (50%). 67% participants preferred significantly (p<0.001) repair due to secondary caries in the previously restored tooth with composite, followed by the small surface defect in a composite restoration (65%), risk of pulpal damage significantly (p<0.001) in a defective composite restoration (62.5%) and more invasive and destructive treatment option (35%). More than half of respondents 123 (61.5%) reported that they were not taught about composite repair during the Bachelor of Dental Surgery. Conclusion: It is suggested with the help of our study that didactic and clinical training components regarding composite repair should be seriously included in the teaching curriculum of dental institutions as it is in the best interest of the patient. Dental students should be provided with clinical training on this topic so that they can follow proper decision-making protocols available during repair or replacement of defective resin composite restorations. Other researches in the future can be carried out for refining the guidelines and techniques utilized for composite repair. (AU)

Objetivo: O objetivo deste estudo foi avaliar o conhecimento entre estudantes de odontologia da King Khalid University, Jazan University e Najran University, no reino da Arábia Saudita, sobre quando reparar ou substituir restaurações de resina composta direta defeituosas. Material e Métodos: Foi formulada uma pesquisa baseada em questionário, buscando informações sobre o manejo (reparo / substituição) de restaurações de resina composta e distribuída entre 200 estudantes de odontologia de três universidades da região sul do reino da Arábia Saudita. Os dados foram coletados com o auxílio de um questionário online. A entrada e análise dos dados foram feitas com o software estatístico SPSS versão 20.0. Foi apresentado por meio de estatística descritiva na forma de frequências e percentuais para as variáveis qualitativas, e amplitude de médias e desvios-padrão para a idade, variável quantitativa. A estatística analítica foi feita usando testes de qui-quadrado (χ2) para testar a diferença significativa entre as variáveis categóricas. Ao nível de significância, o valor de p foi de 0,01 (p <0,01). Resultados: A decisão de escolher entre o reparo ou substituição do compósito foi influenciada pelo fato de este tópico ter sido ensinado a eles em vários níveis de graduação durante o Bacharelado em Odontologia. O motivo associado à decisão de reparar restaurações de resina composta defeituosas, 76% relataram como custo-benefício seguido por maior longevidade (71%), restauração definitva (70%), preferência do paciente para reparo (65%) e menos demorado ( 50%). Sessenta e sete por cento dos participantes preferiram o reparo significativamente (p <0,001) devido a cárie secundária no dente previamente restaurado com resina composta, seguido pelo pequeno defeito de superfície em uma restauração composta (65%), risco de dano pulpar significativamente (p <0,001) em um restauração de resina composta com defeito (62,5%) e opção de tratamento mais invasiva e destrutiva (35%). Mais da metade dos entrevistados, 123 (61,5%) relataram que não foram ensinados sobre reparo de resina composta durante o Bacharelado em Odonotlogia. Conclusão: É sugerido com a ajuda de nosso estudo que os componentes do treinamento didático e clínico sobre reparo de resina composta devem ser seriamente incluídos no currículo de ensino de instituições odontológicas, pois é do interesse do paciente. Os estudantes de odontologia devem receber treinamento clínico sobre este tópico para que possam seguir os protocolos de tomada de decisão adequados disponíveis durante o reparo ou substituição de restaurações de resina composta com defeito. Outras pesquisas no futuro podem ser realizadas para refinar as diretrizes e técnicas utilizadas para reparo de resina (AU)

Study protocol for a diagnostic randomized clinical trial to evaluate the effect of the use of two clinical criteria in the assessment of caries lesions around restorations in adults: the Caries Cognition and Identification in Adults (CaCIA) trial.

BACKGROUND: The assessment of restored teeth in dentistry remains a challenge, mainly related to the detection of caries around restorations. There is a diversity of clinical criteria available to assess the caries lesions, resulting in differences in the dentists' diagnosis and treatment decisions. In addition, there is a lack of evidence regarding the best criteria to detect caries lesions around the restorations. Thus, the present protocol aims to evaluate the effect of using 2 visual criteria to assess restored teeth on the outcomes related to oral health in adults. METHODS: The design protocol of the Caries Cognition and Identification in Adults trial correspond to a triple-blind randomized, controlled clinical trial with parallel-groups. Two groups will be compared: patients who will receive the diagnosis and treatment decision according to FDI (World Dental Federation) criteria-FDI group; and patients who will receive diagnosis and treatment decision according to the "Caries Associated with Restorations or Sealants" criteria defined by the International Caries Classification and Management System (ICCMS group). The participants will be followed up after 6, 12, 18, 24, and 60 months, and the restoration failure will be the primary outcome. The analysis will be conducted through Cox regression with shared frailty. The impact of oral health on quality of life and the cost-effectiveness of the methods used will be the secondary outcomes. Two-tailed analyzes will be used, considering a level of significance of 5%. DISCUSSION: This is the first clinical trial to assess the effect of using two visual methods to detect caries lesions around restorations on the outcomes related to oral health in adults. The findings of this study will define what is the best diagnostic strategy for the assessment of caries around restorations in permanent teeth. Trial registration NCT03108586 (registered 11 April 2017).

Evaluation of the efficiency of fluoride-releasing adhesives for preventing secondary caries in-vitro: a systematic review and meta-analysis.

AIM: To evaluate the efficiency of fluoride-releasing adhesives for the prevention of secondary caries on in-vitro tests. MATERIALS AND METHODS: This study was performed according to the PRISMA checklist. The bibliographic research was performed to identify in-vitro studies between January 2000 and September 2017. The selected studies were submitted to bias risk assessment and data extraction. In the meta-analysis the data were evaluated using Review Manager Software. RESULTS: The 11 studies that met all inclusion criteria showed that the most common risks of bias were: absence of the sample size calculation description, absence of the single operator protocol and blind operation of the test machine. The meta-analysis was performed with six studies that used polarised light microscopy in order to quantify the mineral content of dentine and presented the values as means and standard deviations. CONCLUSIONS: Most of the authors presented that the fluoride-containing adhesive systems had a significant effect to reduce in-vitro secondary caries. The meta-analysis did not present statistical difference between fluoride-free and fluoride-containing adhesive systems. The artificial caries challenge methodology may have affected the results.

Minimal Gap Size and Dentin Wall Lesion Development Next to Resin Composite in a Microcosm Biofilm Model.

This in vitro study investigated the development of dentin wall lesions next to resin composite containing very small gap sizes using an in vitro biofilm model, and evaluated whether a relevant threshold for the gap size could be established. Microcosm biofilms were grown for 14 days within small interfacial gaps between dentin-resin composite discs under intermittent cariogenic challenge. The factor under study was gap size: samples were either restored with composite resin without adhesive procedure (no intentional gap; no bonding [NB] group) or with intentional gaps of 30, 60, or 90 µm, or with complete adhesive procedure (no gap; bonding [B] group). Secondary caries wall lesion progression was measured in lesion depth (LD) and mineral loss (ML) using transversal wavelength independent microradiography at 3 locations: outer surface lesion and wall lesions at 200 and 500 µm distance from gap entrance. Results from linear regression analysis showed that the presence of an intentional gap (30, 60, and 90 µm) affected the secondary caries progression at 200 µm from the gap entrance (p ≤ 0.013). The NB group did not show significant wall lesion development (ML and LD, p ≥ 0.529). At 500 µm distance almost no wall caries development was observed. In conclusion, dentin wall lesions developed in minimal gap sizes, and the threshold for secondary wall lesion development was a gap of around 30 µm in this microcosm biofilm model.

Efeito do preparo cavitário com laser de Er:YAG e materiais que liberam flúor na prevenção de lesões de cárie / Effect of cavity preparation with Er:YAG laser and fluoride releasing materials on the prevention of caries lesion

O objetivo desse estudo foi avaliar a influência da técnica de preparo cavitário e de materiais restauradores contendo flúor na prevenção da secundária. Dentes humanos foram seccionados em 72 blocos e distribuídos em dois grupos. Cavidades com 1,6 mm de diâmetro foram preparadas com pontas diamantadas ou laser de Er:YAG laser (6 Hz, 300 mJ, 47 J.cm elevado a 2). Cada grupo foi dividido em três subgrupos e restaurados com cimento de ionômero de vidro, ionômero de vidro modificado por resina ou uma resina composta. Os espécimes foram termociclados e submetidos a ciclagem de pH. As lesões de cárie artificial foram ranqueadas utilizando uma escala ordinal por inspeção visual. Os testes de Kruskal-Wallis e Dunn (α = 0,05) não demonstraram diferenças no desenvolvimento de lesões entre as cavidades resturadas com o mesmo material e preparadas com pontas diamantadas ou laser de Er:YAG laser. O laser de Er:YAG utilizado para o preparo cavitário com 6 Hz, 300 mJ, 47 J.cm elevado a 2 não demonstrou a habilidade de garantir maior ácido resistência aos preparo.

The objective of this study was to evaluate the influence of the cavity preparation technique and fluoride-containing restorative materials on the prevention of the secondary caries. Human teeth were sectioned into 72 blocks and distributed into 2 groups. Cavities measuring 1.6 mm were performed with diamond burs or Er:YAG laser (6 Hz, 300 mJ, 47 J.cm to the -2 power). Each group was divided into 3 sub-groups, and restored with a glass-ionomer cement, resinmodified glass-ionomer, or composite resin. The specimens were thermal cycled and submitted to pH cycling. Artificial caries were scored using an ordinal scale based on visual inspection. Kruskal-Wallis and Dunn test ((α = 0,05) showed no differences in the caries lesion development between the cavities restored with the same material and prepared with diamond burs or Er:YAG laser. The Er:YAG laser used for cavity preparation used with 6 Hz, 300 mJ, 47 J.cm to the -2 power did not show the ability to guarantee significantly more acid-resistance against acid challenge.

Three-year clinical performance of composite restorations placed by undergraduate dental students

This retrospective study evaluated the clinical performance and the reasons for failure of anterior and posterior composite restorations placed by undergraduate dental students over a 3-year period. All cavities were restored using Prime & Bond 2.1 and TPH (Dentsply), according to the manufacturer's indications. One hundred and two patients who had received composite restorations by third and forth year undergraduate students were recalled and examined to analyze the quality of the restorations. The restorations were evaluated using the modified USPHS system. Two hundred and fifty-six composite restorations, 170 in anterior teeth and 86 in posterior teeth, were evaluated. Eighty-five percent of the restorations were considered satisfactory after 3 years. Class II and class IV restorations presented the highest prevalence of failure. Loss of the restoration and deficient marginal adaptation were the main causes of failure. No restoration failed due to secondary caries. Most restorations placed by dental students were considered satisfactory after long-term evaluation. Failure was more prevalent in larger restorations and was not associated with secondary caries.

Este estudo retrospectivo avaliou o comportamento clínico e as razões de falhas de restaurações de resina composta em dentes anteriores e posteriores, realizadas por alunos de graduação em odontologia, após 3 anos de acompanhamento. Cento e dois pacientes que tiveram restaurações de resina composta colocadas por alunos do terceiro ou quarto ano foram rechamados e examinados para analisar a qualidade das restaurações. Todas as cavidades foram restauradas utilizando Prime & Bond 2.1 e TPH (Dentsply), de acordo com as orientações do fabricante. As restaurações foram avaliadas utilizando o sistema USPHS modificado. Duzentas e cinquenta e seis restaurações de resina composta, 170 em dentes anteriores e 86 em posteriores foram avaliadas. Destas restaurações, 85 por cento foram consideradas satisfatórias após 3 anos. Cavidades de classe II e classe IV apresentaram maior prevalência de falhas. Perda de restaurações e adaptação marginal deficiente foram as maiores causas de falhas. Nenhuma restauração falhou em decorrência de cárie secundária. Em conclusão, restaurações de resina composta feitas por estudantes de odontologia foram na sua maioria consideradas satisfatórias após 3 anos. Falhas das restaurações foram mais prevalentes em restaurações maiores e não esteve associada com cárie secundária.

Characteristics of secondary caries lesion around composite resin restorations / Características da cárie secundária adjacente a restaurações de resinacomposta

Objetivo: O objetivo deste estudo foi analisar as características de cárie secundária e sua relação com a presença de restaurações com defeitos marginais como gap, degrau negativa (NL, a falta de material restaurador) e degrau positiva (PL, saliência). Materiais e Métodos: Oitenta superfícies proximais de restaurações de resina classe II foram fotografados e analisados utilizando um microscópio estereoscópico (X40). Foi registrada a presença de cáries secundárias externas, gaps, NL, PL e após a remoção de restaurações, a presença de lesão interna. Todos os exames foram realizados em 10 pontos bem definidos. Resultados: A prevalência de cárie secundária e gap foram associados com margem gengival. As restaurações com defeitos marginais (NL e PL) não foram associados a qualquer local específico (vestibular, lingual ou gengival). Observou-se uma relação entre esses defeitos com a prevalência de cárie secundária. A presença da lesão interna foi associada com lesão externa. Embora, em 141 pontos foi observada lesão interna, sem a presença de lesão externa. A maioria destas lesões mostraram envolvimento de esmalte interno. Apenas 8 por cento tinham desmineralização restrito a dentina, que poderia sugerir cárie residuais.

Objective: The aim of this study was to analyze the features of secondary caries and their relationship with the presence of restorations marginal defects as gap, negative ledge (NL, lack of restorative material) and positive ledge (PL, overhang). Materials and methods: Eighty proximal surfaces of Class II resin restorations were photographed and analyzed using a stereomicroscope (X40). It was recorded the presence of external secondary caries, gaps, NL, PL and after the restorations removal, the presence of internal lesion. All the exams were done in 10 welldefined points. Results: The prevalence of secondary caries and gap were associated with gingival margin. The restorations marginal defects (NL and PL) were not associated with any specific location (buccal, lingual or gingival). It was observed a relationship between these defects with secondary caries prevalence (gap: p= 0.004; NL and PL: p= 0.017). This association could be explained by the biofilm accumulation usually observed in the interface tooth surface/ restoration marginal defects. The presence of internal lesion was associated with external lesion. Although, in 141 points was observed internal lesion without the presence of external lesion. The majority of these lesions showed internal enamel involvement. Only 8 percent had demineralization restricted to dentine, which could suggest residual caries. Conclusion: The results of this study showed that secondary caries lesion frequently began externally on the interface tooth/restoration, where diagnose, control and arrestment of the lesions is possible.

Histological features of initial secondary caries adjacent to composite resin restorations / Características Histológicas da Lesão Inicial da Cárie Secundária Adjacente a Restaurações de Resina Composta

O objetivo deste estudo foi analisar morfologicamente o início da lesão de cárie secundária. Trinta e três superfícies proximais adjacentes a restaurações de resina classe II foram examinadas ao estereomicroscópio (40x) para a presença de carie e gap. Sessenta sítios (39 sadios, 7 com lesões, 14 adjacentes a lesões) foram preparados para exame utilizando microscopia de luz polarizada. As lesões foram observadas em 52,7% dos corte úmidos e 85,0% dos cortes secos. Os cortes secos demonstraram lesões maiores. Analises posteriores foram realizadas nos cortes secos. Cem por cento das secções observadas no estereomicroscópio, 87,2% das lesões hígidas, e 71,4% dos sítios adjacentes a lesões demonstraram áreas desmineralizadas. A análise morfológica indicou que a lesão cariosa inicia na superfície de esmalte externa na interface entre dente e restauração. Dois padrões distintos de desenvolvimento de carie foram observados, relacionados à direção dos prismas de esmalte: (1) a direção dos prismas no esmalte adjacente foi paralela à parede da cavidade (a parte mais profunda da penetração da cárie foi localizada na parede da cavidade), e (2) a direção dos prismas corria na direção apical (a parte mais profunda da penetração da cárie foi obliqua à parede da cavidade). O padrão 1 pode ser confundido por uma parede da lesão. A prevalência de lesões adjacentes às restaurações foi similar em sítios com (85,7%) e sem (84,0%) gaps. Os achados suportam o pressuposto de que o inicio da lesão de cárie secundária in vivo não está relacionado à presença de um gap e segue a direção dos prismas de esmalte.

The aim was to analyze morphologically the initiation of secondary caries lesion. 33 proximal surfaces adjacent to Class II resin restorations were examined by stereomicroscope (x40) for the presence of caries and gap. 60 sites (39 sound, 7 with lesions, 14 adjacent to lesions) were prepared for examination using polarized light microscopy. Lesions were observed in 52.7% of the wet sections and 85.0% of the dried sections. Dried ground sections displayed larger lesions. Further analyses were performed on dried sections. 100% of ground sections from the stereomicroscope carious sites, 87.2% from sound sites, and 71.4% from sites adjacent to lesions displayed demineralized areas. Morphological analysis indicated that caries lesion initiates at the external enamel surface in the interface between tooth and restoration. Two distinct patterns of caries development were observed, related to the direction of enamel rods: (1) the direction of the rods in the adjacent enamel was parallel to the cavity wall (the deepest part of caries penetration was located at the cavity wall), and (2) the direction of the rods ran in the apical direction (the deepest part of caries penetration was oblique to the cavity wall). The pattern 1 could be mistaken for a wall lesion. The prevalence of lesions adjacent to restorations was similar in the sites with (85.7%) and without (84.0%) gaps. The findings support the assumption that secondary caries initiation in vivo is not related to the presence of a gap and follows the direction of the enamel rods.

Diagnóstico de cárie secundária e substituição de restauração / Diagnosis of secondary caries and substitution of restoration

O objetivo deste estudo foi avaliar o grau de concordância entre Odontopediatras e Clínicos gerais quando ao diagnóstico de cárie secundária e substituição de restaurações em molares decíduos. Para isso, examinaram um quarenta (40) molares decíduos restaurados. Em seguida responderam a um questionário com três perguntas: 1. Em sua opinião existe cárie neste dente? 2. Em sua opinião essa restauração deveria ser substituída? 3. Caso sua resposta seja positiva, qual ou quais os motivos da substituição? O teste Kappa evidenciou um nível de concordância leve 0,14 (p<0,05) entre os Odontopediatras e Clínicos quanto ao diagnóstico de cárie secundária. Quanto a decisão de substituir ou não a restauração e qual o motivo, a concordância foi sofrível 0,28 (p<0,05) e 0,32 (p<0,05), respectivamente. Concluiu-se que entre os Odontopediatras e os Clínicos gerais houve divergência quanto ao diagnóstico e decisão de substituição de restauração; a cárie secundária foi o principal motivo da substituição. Existe a necessidade de estabelecer critérios para o diagnóstico de cárie secundária e substituição de restaurações.

The aim of this study was to evaluate the agreement degree between Pedodontist and General Dentist about the diagnosis of secondary caries and the restoration replacement in primary molars. One group of Pedodontist and another group of general practioners evaluated 40 restored primary molars. In the following stepe each examinator had to answer a questionary, which had three questions: 1. In your opinion, is there caries in this tooth? 2. In your opinion, should this restoration be replaced? 3. If your answer is positive, what are the reasons for the replacement? The Kappa statistics indicated a light level of agreement 0,14 (p<0,05) between Pedodontist and General Practitioners about the diagnosis of secondary caries. About the replacement decision of the restoration and the reason for it, the agreement was critical 0,28 (p<0,05) and 0,32 (p<0,05), respectively. It was concluded that there was divergency about the diagnosis and the replacement decision of restoration among the Pedodontists and Clinical Practitioners; the secondary caries was the main reason for the replacement. There is a need to establish criterials to judge the diagnosis of secondary caries and replace the restorations.

Caries secundaria

La caries secundaria también denominada caries recurrente constituye una de las razones principales de reemplazo de las restauraciones. Es una lesión de caries que se localiza adyacente a una restauración, y puede originarse como una lesión externa y /o lesión de pared. El diagnóstico clínico, esta basado en la presencia de pigmentación y brecha marginal, ambos signos no son criterios absolutos para el diagnóstico de caries secundaria. En la siguiente revisión se exponen estudios recientes de la asociación entre caries secundaria con los siguientes aspectos: brecha marginal, pigmentación marginal, dentina afectada y material restaurador.

The secondary or recurrent caries is one of the main reasons for replacement of restorations. The lesion secondary caries occurs at the margin of an existing restoration, and consist of two parts, an outer lesion and/or a wall lesion. The clinical diagnosis, is based on the presence of staining and ditching marginal, both signs are not absolute criteria for the diagnosis of secondary caries. The next literature review presents recent studies of the association between secondary caries to the following: marginal ditching, marginal staining, affected dentin and restorative material.

Validity of staining and marginal ditching as criteria for diagnosis of secondary caries around occlusal amalgam restorations: an in vitro study

This study determined the validity of marginal ditching and staining as criteria for the diagnosis of secondary caries around amalgam restorations. One hundred and twenty-four Class I amalgam restorations on extracted human teeth were submitted to standardized clinical examinations. A calibrated examiner recorded the presence of ditching in the tooth/restoration interface, the occurrence of bluish-grey staining on the occlusal surface, and their relationship with the presence and severity of secondary carious lesions. Examinations were repeated after 4 days to calculate the intra-examiner reliability. Stereomicroscopic inspection of the serial tooth sections was used as the gold-standard. Six teeth were lost during the study. Of the 118 remaining teeth, 19 (16 percent) showed occlusal bluish-grey staining and 26 showed more than 0.20 mm wide marginal ditches. Of the latter, 14 presented narrow ditches (0.20-0.45 mm), while 12 presented wide ditches (0.45 mm). The evaluation criteria presented low sensitivity and positive predictive values. Positive and negative likelihood ratios showed that the criteria exhibited, indistinctly, the same odds to determine a positive or negative result for a diseased or healthy tooth. It was concluded that marginal ditching and staining were not valid criteria for the diagnosis of secondary caries around occlusal amalgam restorations.

Este estudo determinou a validade de fendas marginais e manchamentos oclusais como critérios para o diagnóstico de cárie adjacente a restaurações de amálgama. Cento e vinte e quatro dentes humanos extraídos, restaurados com amálgama Classe I, foram submetidos a exame clínico em condições padronizadas. Um examinador treinado registrou a presença de fendas na interface dente/restauração, a ocorrência de manchamento cinza-azulado na superfície oclusal e sua relação com a presença e severidade de lesões secundárias de cárie. Os exames foram repetidos após 4 dias para cálculo da confiabilidade intraexaminador. A inspeção de cortes seriados ao estereomicroscópio foi utilizada como padrão-ouro. Seis dentes foram perdidos durante o estudo. Dos 118 restantes, 19 (16 por cento) apresentaram manchamento oclusal cinza/azulado e 26 apresentavam fendas marginais com largura superior a 0,20 mm, sendo que destes 14 tinham fendas estreitas e 12 fendas amplas. Os critérios de avaliação apresentaram valores de sensibilidade e preditivo positivo extremamente baixos, enquanto a razão de verossimilhança positiva e a razão de verossimilhança negativa evidenciaram que os critérios apresentaram a mesma chance de determinar um resultado positivo ou negativo para um dente doente ou hígido, indistintamente. Pode ser concluído que fendas/valamentos e manchamentos oclusais não se mostraram como critérios válidos para determinar presença de cárie adjacente a restaurações de amálgama.

Avaliação in vitro da progressão e inibição da cárie dental. Observação dos efeitos dos materiais sob ação de luz polarizada / Avaliation in vitro the progretion and inibition the dental carie. Observation the effect this material action of light polarized

Com o objetivo de avaliar a capacidade de inibição e/ou progressão de cárie secundária in vitro, através de ciclagem de desmineralização e remineralização, foram confeccionados 60 corpos de prova, que foram distribuídos em 6 grupos de estudos, os quais receberam o emprego dos seguintes materiais: resina composta TPH (Grupo 1); híbrido de ionômero/resina FUJI II L.C. (Grupo 2); resina composta fluoretada (Grupo 3); iônomero DYRACT (Grupo 4); GS 80, amálgama (Grupo 5) e CHELON-FIL ionômero convencional (Grupo 6). Após a realização das restaurações, cada grupo foi imerso em 100 ml de solução desmineralizante, pelo tempo de 4 horas e, por 20 horas, em 20 ml de solução remineralizante, durante 28 dias. Posterior a execução da ciclagem térmica, os cropos de prova foram fixados individualmente em blocos de resina acrílica, para em seguida serem seccionados em uma cortadeira metalográfica BUEHLER - Modelo ISOMET, e lixados manualmente, em lixas d'água até a expessura aproximada de 100 um, quando então os cortes obtidos foram montados em lâmina de vidro, contendo água deionizada, protegidos por uma lamínula de vidro, que teve suas extremidades vedadas com bálsamo do Canadá. Decorrido 48 horas, os espécimes foram analisados, avaliados e fotografados, quanto à capacidade de inibição e/ou progressão da lesão cariosa secundária, e de acordo com as regiões consideradas, ou seja, na interface dente/restauração e à distância de 100, 200 e 300 um da mesma. Os resultados demonstraram que, isoladamente, o material ionomérico CHELON FIL apresentou o melhor resultado, para todas as posições consideradas, e que as interações dos materiais: resinoso, ionomérico resinoso, compômero e amálgama dental, com todas as posições propostas, tenderam a apresentar o mesmo nível de comportamento, quanto ao controle do desenvolvimento de lesão cariosa, à medida que as posições, ora consideradas, se distanciavam da interface dente/restauração, porém inferiores às apresentadas pelas interações com o material apenas ionomérico

It was analysed the inibition and/or progretion capacity of in vitro secondary caries, by remineralization and demineralization ciclyng. This they were employed sixteen specimens in this study, that were distributed in six groups, which received thee follow materials: TPH composite resin (G1), FUJI II L.C. hibrid ionomer-resin (G2), fluoreted composite resin TETRIC (G3), Dyract compomer (G4), GS 80 amalgam (G5) and CHELON FIL conventional ionomer (G6). After the carring out of restourations, each group were in used 100 ml of demineralizant solution, by four hours and by twenty hours, in 20 ml of remineralizant solution, during twenty-eight days. Posteriorof thermic ciclyng, each specimens weds fixed in resin acrylic blocks and then cut in a metalographic BUEHLER-ISOMET cutting machine. After they were grounded at a 100 um of thickness. Immediatly after imersion of tooth section in a shear glass, it was analysed and photographed, by acoording with the inibition and projection of secundary caries lesion, in the considered regions, in other words, in the interface tooth/restoration and at 100, 200 and 300 um of this region