Survival rate of primary molar restorations is not influenced by hand mixed or encapsulated GIC: 24 months RCT.

BACKGROUND: Glass ionomer cements (GIC) have been considered the top option to restore primary teeth by dentists. The most common supply forms are hand mixed and encapsulated GIC. There is a lack of information about the impact of different GIC supply forms on restoration survival. METHODS: This randomized clinical trial compared the survival rate of occlusal and occlusoproximal restorations in primary molars using two glass ionomer cements versions: hand-mixed (H/M) and encapsulated (ENC) after 24 months. Children aged 3-10 years who presented dentin caries lesions in primary molars were selected at School of Dentistry, University of São Paulo, Brazil. They were randomly assigned to groups: H /M (Fuji IX®, GC Europe) or ENC (Equia Fill®, GC Europe). The occurrence of restoration failure was evaluated by two blinded and calibrated examiners. The analyses were performed in Stata 13 (StataCorp, USA). To evaluate the primary outcome (restoration survival), we  performed a survival analysis. Additionally an intention to treat (ITT) analysis were done at 24 months of follow-up. Cox Regression with shared frailty was performed to assess association between restoration failure and independent variables (α = 5%). RESULTS: A total of 324 restorations were performed in 145 children. The survival for H/M group was 58.2% and 60.1% for ENC, with no difference (p = 0.738). Occlusoproximal restorations had lower survival rate when compared to occlusal ones (HR = 3.83; p < 0.001). CONCLUSIONS: The survival rate in primary molars is not influenced by the different supply forms of GIC. Also, occlusoproximal restorations present reduced performances when compared to occlusal cavities. TRIAL REGISTRATION: This randomized clinical trial was registered on ClinicalTrials.Gov on 10/15/2014 under protocol (NCT02274142).

Scientific evidence for the management of dentin caries lesions in pediatric dentistry: A systematic review and network meta-analysis.

BACKGROUND: A systematic quantitative evaluation of the available evidence of the treatment for caries lesions in primary teeth that considers how different caries progressions lead to the need for distinct interventions might provide additional useful information for clinical evidence-based decision making. The aim of this systematic review and network meta-analysis was to verify the effect of the treatments on caries lesion arrestment (CLA) or the success rate (SR) of dentin caries lesion treatments in the primary teeth. METHODS: A search was conducted using the MEDLINE/PubMed, Web of Science and Scopus databases through December 2017. The primary search terms used in combination were primary teeth, caries lesion and restoration. The grey literature was also screened, as were the reference lists of eligible studies. A search of prospective studies with at least 12 months of follow up that compared different techniques was performed. The exclusion criteria were the absence of a comparison group; no evaluation of different restorative techniques; the evaluation of other outcomes unrelated to this review; and the recruitment of specific patient. The risk of bias was evaluated by the tools: the Cochrane Handbook for Systematic Reviews of Interventions and ROBINS-I. A network meta-analyses and meta-analyses were conducted considering CLA or SR as outcomes according to the surface involved and the depth of progression. RESULTS: Of the 1671 potentially eligible studies, 15 were included. For occlusal surfaces, only two studies presented data regarding the outer half of the dentin, with conventional restorative treatment (CRT) using composite resin showing superior results; five studies presented data regarding the depth of caries lesions, and CRT with compomer resulted in the best results. Seven studies considered occlusoproximal surfaces, and the Hall technique showed the best SR among the evaluated treatments. Finally, two annual applications of silver diamine fluoride showed the best nonrestorative approach to arrest caries lesions on occlusal and smooth surfaces. DISCUSSION/CONCLUSIONS: The treatments for dentin caries lesions in primary teeth depend on the depth of progression and the surface involved. However, few of the included studies provided evidence to strongly recommend the best treatment option. OTHER: Funding: FAPESP; Systematic review registration number-PROSPERO CRD42016037784.

Management of dental caries among children: a look at the cost-effectiveness.

INTRODUCTION: Dental caries is the most prevalent non-communicative disease worldwide. Although the etiological factors are well known for years, reducing the number of decayed and missing teeth in children still remains as a barrier. Preventive and curative options are numerous but little is known about their economical advantages. Selecting the intervention that offers the best balance of effectiveness and financial resources becomes crucial in the current situation of budget restrictions worldwide. AREAS COVERED: This expert review summarizes available evidence on cost-effectiveness analyses of preventive and curative measures to manage dental caries in children. EXPERT COMMENTARY: Preventive measures have been more extensively studied than dental caries treatment. Only water fluoridation and tooth brushing are well-established as cost-effective preventive approaches. Despite the increasing number of cost analysis treatment studies in the literature, most of them focus on the cost description, with no correlation to the intervention effectiveness. There is a current need of well-designed and well-reported cost-effectiveness regarding dental caries management.

Custo benefício do ionômero de vidro encapsulado usado como material restaurador para Tratamento Restaurador Atraumático (ART): relato de caso / Cost-effective of the glass ionomer cement encapsulated used as filling material for Atraumatic Restorative Treatment (ART): case report

Objetivo ­ Relatar o caso clínico de uma criança submetido ao Tratamento Restaurador Atraumático (ART) utilizando como material restaurador o CIV nas duas versões (pó-líquido e encapsulado). Além disso, promover uma discussão a respeito das vantagens e desvantagens relacionadas a manipulação manual e mecânica do material restaurador. Paciente de 7 anos de idade portador de cárie dentária foi tratado de acordo com ART e recebeu uma restauração com CIV de alta viscosidade do tipo pó-líquido e um selante com CIV encapsulado. O material encapsulado apresenta custo inicial mais elevado entretanto, as propriedades físicas e mecânicas ficam asseguradas e esperase um reflexo positivo na longevidade clínica das restaurações. Desta maneira, os reparos podem ser menos frequentes diminuindo o custo a longo prazo. O Cimento de Ionômero de Vidro encapsulado facilita o processo restaurador e minimiza os erros de dosagem e manipulação. Entretanto, o custo é elevado quando comparado ao mesmo material do tipo pó-líquido. Estudos clínicos randomizados longitudinais são necessários para esclarecer se a diferença inicial de custo da versão encapsulada é compensada a longo prazo.

Objective ­ Report a case of a child submitted to ART using GIC as restorative material in both versions (powder-liquid and encapsulated). Moreover, promote a discussion of the advantages and disadvantages related to manual and mechanical manipulation of the restorative treatment. Patient 7-year-old with dental caries was treated according to ART and received a restoration with CIV high viscosity powderliquid type and a sealant with encapsulated CIV. The encapsulated material has higher initial cost however, the physical and mechanical properties are guaranteed and a positive reflection on the clinical performance of restorations is expected. Thus, repairs can be less frequent reducing the long term cost. The glass ionomer cement encapsulated facilitates the restorative process and minimizes the dosage and manipulation mistakes. However, the cost is high when compared to the same material as the powder-liquid type. Longitudinal randomized clinical studies are expected to clarify whether the initial cost difference of the encapsulated version is compensated over time.

ART is an alternative for restoring occlusoproximal cavities in primary teeth - evidence from an updated systematic review and meta-analysis.

BACKGROUND: A previous systematic review showed that atraumatic restorative treatment (ART) can be an option to restore the occlusoproximal cavities in primary teeth; however, few studies fulfilled the criteria of inclusion to generate a high level of evidence. AIM: To update the existing systematic review and address questions regarding survival rate of ART restorations compared to the conventional approach in occlusoproximal cavities in primary molars. DESIGN: The search was extended beyond the original search through the PubMed/MEDLINE database up to February 2016. Furthermore, Web of Science and EMBASE were searched. The inclusion criteria were subjects related to the scope of the systematic review. After selection by title and abstract, potentially eligible articles were read in full and included in accordance with exclusion criteria. Meta-analysis was carried out with the outcome being the survival rate of restorations. RESULTS: The search strategy identified 560 potentially relevant studies, in addition to 127 from the original systematic review. A total of four articles were included in the qualitative and quantitative analyses. Meta-analysis showed no statistically significant difference between ART and conventional approaches in survival rate of occlusoproximal cavities (OR = 0.887, 95% CI: 0.574-1.371). CONCLUSION: ART restorations have similar survival rate compared to conventional treatment and can be considered an option to restore occlusoproximal cavities in primary molars.

Impact of the radiographic examination on diagnosis and treatment decision of caries lesions in primary teeth--the Caries Detection in Children (CARDEC-01) trial: study protocol for a randomized controlled trial.

BACKGROUND: Although most clinical guidelines throughout the world indicate that clinicians take two bitewings for detecting caries lesions in primary molars of all children, evidence for this recommendation is essentially based on cross-sectional studies performed in laboratory settings or using convenience samples. The benefits and impact of performing radiographs on diagnosis and treatment decision of caries lesions in primary teeth, mainly considering relevant outcomes for patients, have not been evaluated yet. Thus, the aim of this randomized clinical trial will be to evaluate the impact of performing radiographic examination adjunct to the visual inspection for detecting and making treatment decision regarding caries lesions in primary teeth compared with visual inspection performed alone. We will consider different outcomes related to children's health and welfare. METHODS/DESIGN: To reach this objective, 250 children ages 3 to 6 years who sought dental treatment in our dental school will be randomly allocated in two groups according to the diagnostic strategy used for caries detection: visual inspection performed alone or visual inspection associated to radiographic examination. Two trained and calibrated examiners will carry out the examinations and elaborate the treatment decision plan. Then, children will be treated and followed up for 2 years, with evaluations after 12 and 24 months after the inclusion of children in the study. Children will also return after 6 and 18 months to reinforce the preventive orientations. Primary outcome will be the number of dental surfaces in need of dental treatment at the follow-up. Secondary outcomes will be the components of the primary outcome separately, as well as, proportion of false-positive results, the oral health-related quality of life, cost-efficacy, cost-adjusted life years, and number of new lesions in the first permanent molars. DISCUSSION: Our working hypothesis is that radiographic examination would actually exert little influence on patient-centered outcomes, and visual inspection would be enough as diagnostic strategy for caries detection in primary teeth. TRIAL REGISTRATION: NCT02078453. Registered 4 March 2015.

Ansiedade dos bebês durante o tratamento restaurador atraumático (ART) / Anxiety in babies during atraumatic restorative treatment (ART)

O objetivo foi avaliar o nível de ansiedade dos bebês comparando o ART com a abordagem restauradora convencional. Os dados analisados são referentes à clínica de pesquisa em ART da Fousp. Foram 9 pacientes divididos em 2 grupos: Grupo ART (11 restaurações atraumáticas em 4 bebês) e Grupo Convencional (10 restaurações convencionais em 5 bebês). O nível de ansiedade foi avaliado por meio do registro do comportamento pelo índice de Venham. As avaliações foram realizadas nos seguintes momentos: início do tratamento, isolamento/anestesia local, remoção do tecido cariado, momento da restauração, final da sessão. Em geral, as médias se mostraram mais elevadas nas crianças submetidas ao tratamento convencional, entretanto não houve diferença estatisticamente significante na comparação das duas abordagens restauradoras. O comportamento dos bebês durante as abordagens restauradoras (ART e convencional) é semelhante. Porém, por apresentar evidência científica de efetividade restauradora e reduzir o tempo de tratamento, o Tratamento Restaurador Atraumático está indicado para bebês.

The objective was to assess the level of anxiety in babies comparing ART with conventional restorative approach. The data analyzed refer to a clinical research in ART of FOUSP. Nine patients were divided into 2 groups: Group ART (11 atraumatic restorations in 4 babies) and Conventional Group (10 conventional restorations in 5 babies). The anxiety was assessed by recording the behavior throuh Venham index. Evaluations were performed at the following times: baseline, local anestesia/rubber dam, caries removal, restore time, end of treatment. In general, the averages were more elevated in children undergoing conventional treatment, however there was no statistically significant difference when comparing the two restorative approaches. The babies behavior during the restorative approaches (ART and conventional) is similar. However, because it presents scientific evidence of restorative effectiveness and reduces the time of treatment, the Atraumatic Restorative Treatment is indicated for babies.

Proposal of e-learning strategy to teach Atraumatic Restorative Treatment (ART) to undergraduate and graduate students.

BACKGROUND: The aim of this study was to evaluate e-learning strategy in teaching Atraumatic Restorative Treatment (ART) to undergraduate and graduate students. The sample comprised 76 participants-38 dental students and 38 pediatric dentistry students-in a specialization course. To evaluate knowledge improvement, participants were subjected to a test performed before and after the course. RESULTS: A single researcher corrected the tests and intraexaminer reproducibility was calculated (CCI = 0.991; 95% IC = 0.975-0.996). All students improved their performances after the e-learning course (Paired t-tests p < 0.001). The means of undergraduate students were 4.7 (initial) and 6.4 (final) and those of graduate students were 6.8 (initial) and 8.2 (final). The comparison of the final evaluation means showed a statistically significant difference (t-tests p < 0.0001). CONCLUSIONS: The e-learning strategy has the potential of improving students' knowledge in ART. Mature students perform better in this teaching modality when it is applied exclusively via distance learning.

Reflexão sobre o comportamento dos bebês durante atendimento odontológico: relato de caso clínico / Reflection on the behavior of infants during dental care: clinical case report

O presente trabalho teve como objetivo realizar uma discussão sobre o comportamento dos bebês durante o atendimento odontológico e relatar o caso clínico de um bebê que teve seu comportamento monitorado por meio de uma escala comportamental durante o atendimento. Um paciente de três anos, portador de cárie, teve seu tratamento monitorado utilizando o índice modificado de Venham, em três momentos distintos da sessão. O paciente obteve os seguintes escores de Venham: 4 e 5 na primeira e segunda sessão, 1 e 2 na terceira e quinta sessão, 5 na quarta e sexta sessão. O comportamento do bebê frente ao atendimento odontológico tende a melhorar conforme o tratamento avança, entretanto, algumas vezes, o bebê tem reações inesperadas, intercalando bons e maus momentos, que não são justificados pelo nível de complexidade dos procedimentos clínicos aos quais está sendo submetido. O uso do índice modificado de Venham para o monitoramento do comportamento durante o atendimento odontológico de bebês tem sua efetividade limitada em função das reações conflitantes dos bebês e subjetividade do avaliador. Sendo assim, é fundamental que o profissional domine as questões técnicas para atender de forma eficaz e rápida e que mantenha a tranquilidade independentemente do comportamento apresentado pelo paciente

This study aimed to review the literature regarding the babies' behavior during dental treatment and report a case of a baby who had his behavior monitored during the treatment through a behavioral scale. A patient three years and seven months old, with caries had his treatment monitored using the modified Venham Index in three different moments of the session. The patient received the following scores: 4 and 5 in the first and second sessions, 1 and 2 in the third and fifth sessions, 5 in the fourth session. The babv's behavior during dental care tends to improve as the treatment progresses, however, sometimes the baby has unexpected reactions, alternating good and bad moments, which are not justified by the levei of complexity of clinical procedures which are being submitted. The use of the modified Venham Index to monitoring babies' behavior during treatment has limited effectiveness due to the babies conflicting reactions and the evaluator subjectivity. Therefore, it is essential that the professional knows how to properly perform the techniques to care safely and and being able to maintain tranquility regardless of the behavior exhibited by the patient

Combination effect of fluoride dentifrices and varnish on deciduous enamel demineralization.

The aim of this study was to evaluate the anticaries potential of 500 or 1100 ppm F dentifrices combined with fluoride varnish using a pH-cycling regimen. Seventy primary canines were covered with nail polish, leaving a 4×4 mm window on their buccal surface, and randomly assigned into 7 groups (n = 10): S: sound enamel not submitted to the pH-cycling regimen or treatment; N: negative control, submitted to the pH-cycling regimen without any treatment; D1 and D2: subjected to the pH-cycling regimen and treated twice daily with 1100 or 500 ppm F dentifrice, respectively; VF: fluoride varnish (subjected to F-varnish before and in the middle of the pH-cycling regimen); and VF+D1 and VF+D2. After 10 days, the teeth were sectioned, and enamel demineralization was assessed by cross-sectional hardness at different distances from the dental surface. Data were analyzed using a two-way ANOVA followed by Tukey's test. Dentifrice with 1100 ppm F and the combination of F-varnish with the dentifrices significantly reduced enamel demineralization compared with the negative control (p < 0.05), but the isolated effects of F-varnish and dentifrice with low concentration were not significant (p > 0.05). The effect of combining F-varnish with the dentifrices was not greater than the effect of the dentifrices alone (p < 0.05). The data suggest that the combination of F-varnish with dentifrices containing 500 and 1100 ppm F is not more effective in reducing demineralization in primary teeth than the isolated effect of dentifrice containing 1100 ppm F.

E-learning used in a training course on atraumatic restorative treatment (ART) for Brazilian dentists.

The purpose of this study was to assess the benefits of using e-learning resources in a dental training course on Atraumatic Restorative Treatment (ART). This e-course was given in a DVD format, which presented the ART technique and philosophy. The participants were twenty-four dentists from the Brazilian public health system. Prior to receiving the DVD, the dentists answered a questionnaire regarding their personal data, previous knowledge about ART, and general interest in training courses. The dentists also participated in an assessment process consisting of a test applied before and after the course. A single researcher corrected the tests, and intraexaminer reproducibility was calculated (kappa=0.89). Paired t-tests were carried out to compare the means between the assessments, showing a significant improvement in the performance of the subjects on the test taken after the course (p<0.05). A linear regression model was used with the difference between the means as the outcome. A greater improvement on the test results was observed among female dentists (p=0.034), dentists working for a shorter period of time in the public health system (p=0.042), and dentists who used the ART technique only for urgent and/or temporary treatment (p=0.010). In conclusion, e-learning has the potential of improving the knowledge that dentists working in the public health system have about ART, especially those with less clinical experience and less knowledge about the subject.

Combination effect of fluoride dentifrices and varnish on deciduous enamel demineralization

The aim of this study was to evaluate the anticaries potential of 500 or 1100 ppm F dentifrices combined with fluoride varnish using a pH-cycling regimen. Seventy primary canines were covered with nail polish, leaving a 4×4 mm window on their buccal surface, and randomly assigned into 7 groups (n = 10): S: sound enamel not submitted to the pH-cycling regimen or treatment; N: negative control, submitted to the pH-cycling regimen without any treatment; D1 and D2: subjected to the pH-cycling regimen and treated twice daily with 1100 or 500 ppm F dentifrice, respectively; VF: fluoride varnish (subjected to F-varnish before and in the middle of the pH-cycling regimen); and VF+D1 and VF+D2. After 10 days, the teeth were sectioned, and enamel demineralization was assessed by cross-sectional hardness at different distances from the dental surface. Data were analyzed using a two-way ANOVA followed by Tukey's test. Dentifrice with 1100 ppm F and the combination of F-varnish with the dentifrices significantly reduced enamel demineralization compared with the negative control (p < 0.05), but the isolated effects of F-varnish and dentifrice with low concentration were not significant (p > 0.05). The effect of combining F-varnish with the dentifrices was not greater than the effect of the dentifrices alone (p < 0.05). The data suggest that the combination of F-varnish with dentifrices containing 500 and 1100 ppm F is not more effective in reducing demineralization in primary teeth than the isolated effect of dentifrice containing 1100 ppm F.

Dureza knoop de três cimentos de ionômeros de vidro / Knoop hardness of three glass ionomer cements

Objetivo: Avaliar a dureza Knoop de três cimentos de ionômero de vidro (CIV) nacionais após 24 horas e 7 dias. Método: Os materiais foram dosados e manipulados de acordo com as instruções dos fabricantes e divididos em grupos (n=10): G1: Vidrion R® - SS White (convencional), G2: Vitro Molar® - DFL (alta viscosidade) e G3: Maxxion R® - FGM (alta viscosidade). A seguir os corpos de prova foram confeccionados em moldes de PVC. Após 10 minutos imersos em solução oleosa (Vaselina Líquida), a 37ºC por 24 horas, as superfícies foram polidas com lixa de granulação 600 (Buehler), em máquina politriz Aropol 2V (Arotec). O teste de dureza foi realizado em durômetro Pantec (digital microhardness Tester HVS-1000) com 25g de carga e 30s, com penetrador tipo Knoop. Em cada amostra foram realizadas três indentações e repetidas após uma semana, mantidas as mesmas condições. Resultados: As médias da dureza Knoop (e desvios-padrão) foram: após 24 horas G1:47,65 (20,1), G2:52,06 (10,6) e G3: 72,43 (17,4); após uma semana G1: 74,25 (16,5), G2: 87,55 (12,1) e G3: 132,17 (39,7). Após análise de Variância e complementação pelo teste de Tukey, foi constatada diferença estatística significante para os valores de dureza do G3 em relação ao G1 e G2 (p<0,05) e também nas leituras da dureza após 24 horas e uma semana. Conclusão: O cimento de ionômero de vidro de alta viscosidade Maxxion R apresenta propriedade mecânica superior quando comparado aos cimentos Vidrion R e Vitro Molar. O tempo aumenta a dureza desses três cimentos de ionômero de vidro nacionais.

Objective: To evaluate the Knoop microhardness of three national glass ionomer cements (GIC) after 24 hours and 7 days. Methods: The materials were dispensed and mixed according to the manufacturers' instructions and divided in groups (n=10): G1: Vidrion R© - SS White (conventional), G2: Vitro Molar© - DFL (high viscosity) and G3: Maxxion R© - FGM (high viscosity). The specimens were fabricated using PVC molds. After 10 minutes, they were immersed in an oily solution (liquid petroleum jell) at 37oC during 24 hours and the surfaces were polished with 600-grit silicon carbide paper (Buehler) in a polishing machine (Aropol 2V, Arotec). Microhardness test was performed in a digital microhardness tester (Pantec HVS-1000) using a Knoop indenter with 25 g load during 30 seconds. Three indentations were made in each specimen and repeated after 1 week, under the same conditions. Results: Knoop microhardness means (and standard deviations) were: after 24 hours - G1: 47.65 (20.1). G2:52.06 (10.6) and G3: 72.43 (17.4); after 1 week - G1: 74.25 (16.5). G2: 87.55 (12.1) and G3: 132.17 (39.7). Statistical analysis by ANOVA and Tukey's test revealed significant difference (p<0.05) between G3 and groups G1 and G2 as well as between the microhardness readings obtained after 24 hours and after 1 week. Conclusion: The high-viscosity GIC Maxxion R presented higher mechanical property than the GICs Vidrion R and Vitro Molar. The microhardness of these three national GICs increased with time.

Confecção de anteparo para restauração estética de dente permanente traumatizado / Mock-up for esthetics restorative treatment in traumatized permanent teeth

Lesões traumáticas em dentes anteriores se apresentam na clínica odontológica com frequência podendo, muitas vezes, gerar necessidade de tratamento restaurador. O pre- sente trabalho apresenta um caso clínico de trauma em criança de dez anos de idade com fratura de esmalte e dentina no dente 11. Foi realizada a confecção de um anteparo para auxiliar na restauração direta deste dente, posteriormente à moldagem da arcada superior. O anteparo proporcionou resultado final satisfatório e com melhor estética. Portanto, conclui-se que a confecção de anteparo para restauração direta em dentes anteriores traz vantagens no tempo gasto para realização do procedimento clínico, além de resultado satisfatório e estético.

Traumatic injuries are common in dental clinic and usually require restorative treatment. This paper presents a case of trauma with enamel-dentin fracture without pulpal involvement of permanent central incisor (11) in a ten years old patient. After taking im- pression of upper arch, we performed the construction of a mock-up to assist the direct restorative treatment. The mock-up provided satisfactory result with better aesthetics. Therefore, we conclude that the mock-up construction for direct restorative treatment to dental fractures of anterior teeth provides advantages such as reduction in clinical time and satisfactory aesthetics results.

Liberação e reincorporação de fluoreto de cimentos de ionômero de vidro utilizados no tratamento restaurador atraumático / Fluoride release and uptake of glass ionomer cements indicated for atraumatic restorative treatment

Objetivo: avaliar a capacidade de liberação e reincorporação de fluoreto dos CIVs de alta viscosidade. Métodos: Corpos de prova cilíndricos preparados com 5 materiais diferentes (n=3) - Vidrion R (controle), Vidrion N, Chem Flex, Fuji IX e Ketac Molar ART - foram mantidos em recipientes contendo água deionizada por 28 dias, trocados a cada 24 horas. Passado este período, foram mergulhados por 3 minutos em recipientes com dentifrício fluoretado (1100 ppm) diluído em água deionizada, voltando para novos recipientes com água deionizada. Esse procedimento repetiu-se durante 3 dias, totalizando 31 dias de experimento. A quantidade de íons flúor foi medida em cada um dos recipientes utilizados durante o experimento por meio de eletrodo específico para detecção do íon, acoplado a potenciômetro. Os dados foram submetidos à análise de variância e ao teste LSD, com 5% de significância. Resultados: o material que liberou a maior quantidade de íons flúor no período estudado foi o Vidrion R, apresentando diferença estatisticamente significante em relação aos demais materiais em todos os dias (p < 0,05). Entre o 28o e 31o dias, o material que liberou a maior quantidade de fluoreto foi o Vidrion R e o que liberou menor quantidade foi o Ketac Molar ART (p < 0,05). O material Vidrion N foi o único que não conseguiu absorver o fluoreto advindo do dentifrício. Conclusão: os cimentos indicados para o uso no ART parecem liberar menor quantidade de íons fluoreto quando comparados ao cimento convencional.

Objective: This study aimed to evaluate the fluoride release and uptake capability of high-viscous glass ionomer cements. Methods: Cylindrical specimens prepared with five different materials (n=3) - Vidrion R (control), Vidrion N, Chem Flex, Fuji IX and Ketac Molar ART - were maintained in individual containers with deionized water for 28 days. Every 24 hours, the water was changed, and after that, the specimens were immersed for 3 minutes in containers with 1100 ppm fluoridated dentifrice diluted in deionized water, before turning to new containers with deionized water. This procedure was repeated for 3 days, totalizing 31 days of experiment. The amount of fluoride ions was measured in the containers used during the experiment with specific electrode for ion detection coupled to a potentiometer. Data were submitted to analysis of variance and LSD test, (alpha=5%). Results: Vidrion R presented the highest level of fluoride release during the studied period and this difference was statistically significant for all days of experiment. Between the 28th and 31st days, the material which released the highest amount of fluoride was also Vidrion R and the one which released the smaller amount of fluoride was Ketac Molar ART. Vidrion N was not able to be recharged with fluoride from the fluoridated dentifrice. Conclusion: Glass ionomer cements suitable for use in ART seem to release fewer amounts of fluoride ions when compared to conventional (low strength) glass ionomer cement.

Aspecto emocional dos bebês envolvidos no Tratamento Restaurador Atraumático (ART): estudo clínico piloto / Emotional aspects in todlers involved in the Atraumatic Restorative Treatment (ART): pilot study

Objetivo - Estudos clínicos que envolvem bebês e Tratamento Restaurador Atraumático (ART) são necessários para a construção da evidência científica no que se refere à busca por tratamento odontológico eficiente que envolva níveis reduzidos de estresse para esta faixa etária. O propósito deste estudo piloto foi avaliar o grau de desconforto envolvido no atendimento odontológico em bebês comparando a técnica do ART com a abordagem convencional que envolve utilização de técnicas anestésicas e isolamento absoluto. Métodos - Foram selecionadas 2 crianças com aproximadamente 30 meses apresentando, pelo menos, dois molares com lesão de cárie oclusal em dentina. Dois dentes, um de cada criança, foram tratados segundo o ART e os outros dois dentes foram tratados de maneira convencional, caracterizando um estudo do tipo split-mouth. A extensão do desconforto foi avaliada por meio da medição da frequência cardíaca e registrando o comportamento geral do bebê de acordo com escala modificada de Venham10 (1980). Resultados - Foi constatado que na maior parte do tempo os bebês apresentaram frequência cardíaca superior ao considerado normal para esta faixa etária, evidenciando a ansiedade relacionada ao tratamento odontológico. Além disso, observaram-se valores de batimento cardíaco semelhantes ou inferiores para as sessões nas quais o tratamento utilizado foi o ART e os valores da escala modificada de Venham foram semelhantes ou inferiores para o tratamento convencional. Conclusão - Considerando a frequência cardíaca como critério de avaliação de estresse menos subjetivo, conclui-se que os bebês submetidos ao ART apresentam menor desconforto emocional quando comparado ao tratamento convencional.

Objective - Clinical studies involving babies and Atraumatic Restorative Treatment (ART) is needed for the scientific evidence construction regarding an efficient dental treatment involving low levels of stress on this special age. The purpose of this pilot study was to evaluate the degree of discomfort involved in dental care in babies comparing ART with conventional approach. Methods - Two children about 30 months with at least two molars with occlusal caries in dentin were selected. Two teeth, one for each child, were treated according to ART and the other two teeth were treated in the conventional manner, featuring a split-mouth study. The extent of discomfort was assessed by measuring heart rate and recording the general behavior of the baby according to the Venham's10 (1980) scale modified. The records of heart rate and behavior of the child were performed by the same researcher who did not participate actively in clinical procedures. Results - It was found that most of the time the babies heart rate had exceeded normal levels for this age group, highlighting the anxiety related to dental treatment. In addition, we observed heart rate values similar or inferior to the sessions when ART was used and Venham's scale values similar or inferior to conventional treatment. Conclusion - Considering the heart rate as a criterion for evaluation of stress less subjective, it was concluded that babies undergoing Atraumatic Restorative Treatment have less emotional distress when compared to conventional treatment.

Estruturação e avaliação de curso de extensão em tratamento restaurador atraumático (ART) utilizando a educação a distância / Development and evaluation of extension course in atraumatic restorative treatment (ART) using distance education

O objetivo deste estudo longitudinal prospectivo foi desenvolver um curso de extensão usando recursos da educação a distância (EAD) e avaliar seu potencial no desenvolvimento das competências necessárias para a execução do Tratamento Restaurado Atraumático (ART) nos cirurgiões-dentistas. O curso aborda filosofia e técnica do ART utilizando diferentes recursos como computação gráfica em três dimensões, filmagens clínicas, imagens de fotografias e radiografias intrabucais e entrevistas com especialistas no assunto. O curso tem aproximadamente 40 minutos e é apresentado em formato de DVD, que em função disso, proporciona alta acessibilidade e baixa interatividade. A amostra consistiu de 68 cirurgiões-dentistas divididos em 2 grupos: Grupo Diadema - 44 profissionais da população de cirurgiõesdentistas da rede pública de Diadema/SP (perda amostral de 38,9%) e Grupo USP- 24 profissionais da rede pública de 7 cidades próximas à São Paulo envolvidos em parceria científica entre as prefeituras e a disciplina de Odontopediatria da FOUSP (perda amostral 7,7%). Inicialmente os cirurgiões-dentistas responderam questionário que abordou conhecimento prévio, credibilidade e interesse na capacitação relativos ao ART. Na seqüência, os participantes foram submetidos ao processo de avaliação que consistiu na aplicação de prova setorizada (setores 1, 2 e 3) em dois momentos distintos: antes e depois dos profissionais terem passado pela capacitação à distância (avaliação inicial e final). A correção das provas foi realizada por 2 pesquisadoras (grau de concordância inter-examinadores CCI=0,970; 95%IC=0,916-0,989 e intraexaminadora CCI=0,991; 95%IC=0,975-0,996)...

The aim of this prospective longitudinal study was to develop an extension course based on distance learning and evaluate its potential in developing necessary skills for Atraumatic Restorative Treatment (ART) implementation. The course teaches philosophy and technique using different resources such as computer graphics in three dimensions, clinical films, photographs and radiographs, and interviews with experts. The course takes approximately 40 minutes and is presented in DVD format providing high availability and low interactivity. The study sample consisted of 68 dentists and was assigned into 2 groups: Diadema Group - 44 professionals from public health system in Diadema / SP (dropout 38.9%) and USP Group - 24 professionals from 7 different cities close to São Paulo involved in a scientific partnership between municipalities and discipline of Pediatric Dentistry from FOUSP (7.7% dropout). Initially the dentists answered a questionnaire focused in baseline knowledge, credibility and interest in receive training in ART. Subsequently, participants underwent an assessment process that consisted of sectorized evaluation (sectors 1, 2 and 3) at two different times: before and after the extension course (baseline and final assessment)...

Efetividade do aparelho de fluorescência a laser no monitoramento da desmineralização e remineralização de lesões de cárie em superfície oclusal: estudo in situ / Effectiveness of laser fluorescence device in monitoring demineralization and remineralization of occlusal caries lesions: in situ study

Introdução - O objetivo deste estudo in situ foi avaliar a efetividade do aparelho de fluorescênciaa laser (FL-DIAGNOdent) no monitoramento da des/remineralização de lesões de cárie iniciais em superfícies oclusais. Material e Métodos - Oito voluntários utilizaram um dispositivo intrabucal contendo quatro blocos de superfícies oclusais hígidas de pré-molares, sob tela para promover retenção de placa. As superfícies oclusais foram submetidas à medição com o FL. Os voluntários gotejaram solução de sacarose a 20%, oito vezes ao dia, durante 14 dias. Após esse período, foi realizada nova medição com o FL e dois blocos foram removidos dos dispositivos. Os voluntários continuaram a utilizar os aparelhos durante mais vinte e oito dias, higienizando as amostras no dispositivo sem a tela, com dentifrício fluoretado de 1100 ppm. Foi realizada a remoção dos blocos, e nova medição com FL. Todas as superfícies oclusais foram seccionadas e submetidas ao teste de dureza Knoop de seção transversal. Foi realizada ANOVA e teste de Tukey, além de teste de correlação de Pearson para os valores de dureza e do FL. Resultados - Em relação ao teste de dureza, houve diferença estatisticamente significante entre os grupos de desmineralização (261,6 ±29,9 KNHx?m) e remineralização (302,1 ± 32,2 KNHx?m, p = 0,016). Não houve diferença nos valores do FL (des:3,9 ± 2,2; re: 3,8 ± 2,0, p > 0,05) e não houve correlação significante entre as medidasdo FL e de dureza (r = ?0,145). Conclusão - Pode-se concluir que o aparelho FL não é eficaz em monitorar o processo de remineralização utilizando um estudo in situ.

Introduction - The aim of this in situ study was to evaluate the effectiveness of the laser fluorescence device (DIAGNOdent) in monitoring the demineralization and remineralization of occlusal caries surfaces. Material and Methods - Eight volunteers were selected for the study, and used an intrabucal appliance with four sterilized blocks of occlusal sound surfaces from premolar teeth.The occlusal surfaces were measured with a DIAGNOdent laser. During a period of fourteen days the volunteers drop a 20% sucrose solution on the blocks eight times a day, and used non-fluoride dentifrice. After this period, a new measurement with the DIAGNOdent was carried out and twoblocks were removed for Knoop microhardness test to verify surface demineralization. The volunteers brushed the remaining surfaces with fluoride dentifrice (1100 ppm) in the device without the plastic mesh for more twenty eight days. After this period, new measurement of the remaining surfaces in the device were carried through with DIAGNOdent. The surfaces were removed after that. All the occlusal surfaces were submitted to the Knoop cross-sectional microhardness test. Results - The effectiveness of the DIAGNOdent in monitoring the demineralization and the remineralization was evaluated. In Knoop hardness test, there was statistically significant difference between demineralization and remineralization groups (p = 0,016). There was negative correlation (r = ?0,1448) between the DIAGNOdent values and the Knoop hardness test. Conclusion - It was concluded that remineralization process was efficient in this study, although the DIAGNOdent laser can not monitor little mineral alterations.

Desenvolvimento de material didático dinâmico em odontopediatria para utização na teleodontologia: utilização do software Macromedia Flash / Development of pediatric dentistry educational materials for use in teledentistry: use of macromedia flash software

Atualmente, a internet está sendo utilizada como recurso didático de auxílio às aulas presenciais ou para realização de disciplinas à distância. Na Odontologia, assim como em outras áreas, a Teleducação vem avançando e ocupando espaço nos cursos de graduação e pós-graduação. A Teleodontologia amplia as condições de aprendizagem do aluno, facilitando o contato com diferentes materiais e trazendo oportunidade de escolha do momento de estudo. A preparação de material didático pelos tutores deve ser prioridade, como forma de estimular o aprendizado do aluno. Este trabalho descreve a utilização do software Macromedia Flash® para desenvolvimento de material didático dinâmico relativo à progressão da lesão de cárie e traumatismo dentário, executado por duas alunas da turma de pós-graduação em Odontopediatria da Faculdade de Odontologia da USP...

Currently, websites are being widely used as a resource to support traditional teaching lessons or for long distance teaching. In dentistry, as well as in other areas, teleeducation is moving forward and taking up space in undergraduate and graduate courses. Teledentistry extends the student's learning, since it enables contact with different materials and offers the opportunity to study at the most appropriate moment. The development of dynamic educational material by tutors should be a priority, as a way to stimulate student's learning. This paper describes the use of Macromedia Flash® software used to development educational materials on the progression dental carious lesions and dental trauma. These were developed by two pediatric dentistry is graduate students at the Faculty of Dentistry at USP...

Estudo histopatológico de lesões da furca de molares decíduos / Histopathological study of furcation lesions on primary molars

Objetivo: Estudar histopatologicamente os tecidos presentes nas áreas de reabsorção na região de furca de dentes decíduos com processos patológicos pulpares e imagem radiográfica radiolúcida sugestiva de lesão inter-radicular. Método: Foram selecionados vinte molares decíduos com sinal clínico de envolvimento carioso, como destruição coronária ou restauração extensa associada à imagem radiográfica radiolúcida na região de furca sugerindo a presença de lesão periapical ou inter-radicular crônica. Os dentes extraídos sob anestesia local foram imediatamente fixados em solução formol a 10%, durante 24 horas. A seguir, sofreram descalcificação em solução de ácido fórmico 5%, permanecendo em agitação constante por aproximadamente quinze dias, até que se completasse a descalcificação, que era verificada periodicamente pelométodo radiográfico. Os fragmentos foram então processados para inclusão em parafina, dos quais foram realizados cortes semi-seriados de 5 micrômetros. Para análise morfológica, após montagem dos cortes nas lâminas estes foram corados em hematoxilina e eosina. Para a análise microscópica utilizou-se aumento de 40 e 100 vezes. Os achados foram documentados em fotomicrografias. Resultados: Após avaliação histopatológica verificou-se que na furca os elementos celulares encontrados na maioria dos casos caracterizavam um processo inflamatório crônico inespecífico. Em 45% da amostra foi observada a presença do epitélio odontogênico em proliferação, estimulado pelo processo inflamatório local, formando cordões anastomosados, demonstrando potencial cístico para as lesões associadas com processos patológicos pulpares. Conclusão: Nas lesões localizadas na região de furca de molares decíduos observa-se elementos celulares relacionados ao processo inflamatório crônico inespecífico e é freqüente a presença de remanescentes do epitélio odontogênico tanto latente como em proliferação.

Objective: To evaluate histopathologically the tissues present in resorption areas on the furcation region of primary teeth with pathological pulpal processes and radiolucent radiographic images suggestive of an interadicular lesion. Method: This study used 20 primary molars with clinical signs of caries, such as coronal destructi on or an extensive restoration associated with a radiolucent radiographic image on the furcation region, suggestive of a chronic periapical orinteradicular lesion. The teeth extracted under local anesthesia were immediately fixed in a 10% formalin solution for 24 hours, and then decalcified in a 5% formic acid solution and kept under continuous agitation for approximately 15 days, until complete decalcification, which was periodically checked radiographically. The decalcified fragments were then processed for inclusion in paraffin and semi-serially cut in 5 microns thick slices. After preparation of slides, the cuts were stained with hematoxylin and eosin for histopathologic analysis. For the microscopic analysis were used 40X and 100X magnifications. The findings were documented on photomicrographs. Results: The cell elements found in the furcation region characterized an unspecific chronic inflammatory process in most cases. As much as 45% of the samples presented proliferating odontogenic epithelium stimulated by the local inflammatory process, forming anastomosed chords and showing a cystic potential for lesions associated with pulpal pathologic processes. Conclusion: In the lesions located in the furcation regions of primary molars, there were cell elements related to an unspecific chronic inflammatory process and the presence of odontogenic epithelial rests either latent or proliferating was frequent.