Resin infiltration in white spot lesions caused by orthodontic hypomineralisation: a minimally invasive therapy.

Objective White spot lesions are characterised by the presence of clinically detectable opaque lesions due to enamel demineralisation. These frequently present in patients following fixed orthodontic treatment, mostly due to the prolonged accumulation of bacterial plaque on the dental surface. When remineralisation is not achieved through good oral hygiene and prophylaxis with fluoride products, the infiltration of lesions with low-viscosity photopolymerised resin has proved to be a valid micro-invasive alternative compared to traditional conservative therapy.Clinical considerations A case series will be presented, where the chosen approach was resin infiltration, a micro-invasive and aesthetic technique.Clinical significance Infiltrative resin therapies are single-session procedures that reduce the need for more invasive therapies such as the use of rotary instruments for greater patient comfort. The need for periodic fluoride applications is also avoided. This approach increases the durability of the infiltrated lesion without compromising its mechanical properties and impedes the development of recurrent or secondary caries.Conclusions Resin infiltration might be considered as a routine procedure in the treatment of post-eruptive hypomineralised lesions. This follows the line of thought of minimally invasive dentistry, is an excellent treatment option and prevents the lesion's progression.

Dental caries, diabetes mellitus, metabolic control and diabetes duration: A systematic review and meta-analysis.

OBJECTIVE: To analyze articles aimed at evaluating the association between diabetes, metabolic control, diabetes duration, and dental caries. OVERVIEW: A systematic search in PubMed, Cochrane Library, Embase, and Web of Science was conducted to retrieve papers in English, Portuguese, and Spanish, up to April 2019. The research strategy was constructed considering the "PECO" strategy. Only quantitative observational studies were analyzed. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. The meta-analyses were performed based on random-effects models using the statistical platform R. A total of 69 articles was included in the systematic review and 40 in the meta-analysis. Type 1 diabetics have a significantly higher DMFT compared to controls. No significant differences were found between type 2 diabetics and controls and between well-controlled and poorly controlled diabetics. Concerning diabetes duration, all authors failed to find differences between groups. CONCLUSION: Although there is still a need for longitudinal studies, the meta-analysis proved that type 1 diabetics have a high dental caries risk. CLINICAL SIGNIFICANCE: It is necessary to be aware of all risk factors for dental caries that may be associated with these patients, making it possible to include them into an individualized prevention program.

Oral Health of Portuguese Children with Type 1 Diabetes: A Multiparametric Evaluation.

OBJECTIVE: To perform a multiparametric evaluation of the oral health of 36 children with type 1 diabetes. STUDY DESIGN: A group of type 1 diabetic children and a sex-age-matched control group were formed. Seven parameters were evaluated: probing depth, bleeding on probing, plaque index (O'Laery index), calculus index (according to Ramfjord), dental caries (using ICDAS), salivary pH and unstimulated salivary flow rate. Statistical analysis was performed and the significance level was set at 5%. RESULTS: Both groups consisted of 36 children with a mean age of 13 years. With regard to bleeding on probing, plaque index and calculus index, higher values were obtained in the diabetic group and the differences between groups were statistically significant for all three parameters. Concerning dental caries and salivary parameters, there were no significant differences between groups. However, a statistically significant correlation between salivary parameters and metabolic control was found. CONCLUSION: This study suggests that type 1 diabetic children are associated with some risk factors related to periodontal disease and dental caries. The proven relationship between diabetes and oral health complications imposes the need for these patients to be integrated into preventive dental programs from a young age.

Chlorhexidine mouthwash as an anticaries agent: A systematic review.

OBJECTIVE: To evaluate the effectiveness of chlorhexidine mouthwashes on the reduction of cariogenic bacteria on patients with moderate to high risk for dental caries. DATA SOURCES: A systematic review of the literature was performed using Cochrane Library, Embase, PubMed, Scopus and Web of Science. The search was limited to articles in English, Spanish, and Portuguese, published until January 2017. The research question was formulated following the PICO strategy. The risk of bias was evaluated using the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. CONCLUSION: All the authors found statistically significant differences in Streptococcus mutans levels during and after the use of a chlorhexidine mouthwash. Although the results are suggestive, there is a clear need for the development of new studies with higher quality and with longer follow-ups, in order to assess whether the results translate into less development of dental caries and, consequently, whether or not these products should be incorporated into prevention protocols.

Sealing efficacy of system B versus Thermafil and Guttacore obturation techniques evidenced by scintigraphic analysis.

BACKGROUND: This study compared root canal sealing ability, filled by Continuous Wave compaction and two carrier-based obturation systems, using the nuclear medicine approach. MATERIAL AND METHODS: Fifty-five single-rooted extracted teeth were selected. The crowns were sectioned and each tooth was instrumented using rotary Protaper® Universal system. The roots were divided into 3 experimental groups and two control groups. Forty-five root canals were filled, using Continuous Wave, GuttaCore or Thermafil system and TopSeal sealer. Ten teeth were used as control. On the 7th days the apices were submersed in a solution of sodium pertechnetate 99mTc for 3 hours and the radioactivity was counted. RESULTS: Although apical leakage in the Continuous Wave group was lower compared with GuttaCore and Thermafil groups, there was no statistical difference (p>0.05). CONCLUSIONS: System B, GuttaCore and Thermafil techniques showed a similar sealing effect. Key words:Continuous wave compaction, Gutta percha core-carrier, leakage, nuclear medicine.

Portuguese Dentists' Attitudes Towards Their Role in Addressing Obesity.

PURPOSE: To determine Portuguese dentists' role in addressing obesity. MATERIALS AND METHODS: For this pilot study, the original version of the Dentists' Role In Addressing Obesity questionnaire was translated from English into Portuguese and validated to ensure that it was culturally adapted for Portuguese dentists. The questionnaire was distributed to a random sample of 400 Portuguese dentists. SPSS Statistics 20 was used to analyse the survey sampling design and assess respondents' attitudes and opinions, outcome expectations and self-efficacy both as ordinal and dichotomised variables. The analysis was a descriptive statistic based on frequencies, without symmetry test. RESULTS: In all, 141 dentists responded. Overall, 22.0% of respondents offered a form of counseling services and 58.9% reported that they were interested in offering obesity-related services. A paucity of trained personnel (58.9%) was cited by the respondents as a major barrier, followed by patients' rejection of weight-loss advice (32.6%) and fears of offending patients (29.1%). 92% of respondents agreed that dentists would be more willing to intervene if obesity were linked to oral disease. CONCLUSION: Healthcare providers must coordinate prevention and interventional efforts for maximum effect. Given the positioning of dentists willing to assist in such an effort, it appears reasonable for experts in obesity intervention in conjunction with dental educators to develop intervention models to be implemented within the scope of the dental practice.

The effect of Emdogain gel on periodontal regeneration in autogenous transplanted dog's teeth.

AIM: The aim of this study was to assess the enamel matrix derivative (EMD) as biomaterial used in autogenous tooth transplantation. MATERIAL AND METHODS: The study consisted of 3 beagle dogs, 5 months old, in which six incisors and six premolars were transplanted to mechanically prepared recipient alveolar sockets. One group of teeth was transplanted to a recipient bed, with EMD in the root surface. The second groups of teeth were transplanted using saline solution in the root surface. Every week, clinical examinations were done. Nine weeks later, the animals were killed and the specimens decalcified and prepared for histological and imunohistochemical analysis. Periodontal healing was evaluated by undertaking histomorphometric investigation and analyzed using the Mann- Whitney test (P = 0.05). RESULTS: In both groups, all the transplanted teeth survived. Between the experimental groups, there was statistically significant difference in the complete healing (P = 0.004). There was statistically significant difference between the treatment group in the occurrence of inflammatory root resorption (P = 0.015) and the occurrence of replacement root resorption (P = 0.041). CONCLUSIONS: Emdogain gel used on the surface of transplanted teeth improves the occurrence of complete healing and reduces root resorption.

Effect of calcium hydroxide as intracanal medication on the apical sealing ability of mineral trioxide aggregate (MTA): an in vitro apexification model / Efeito da medicação intracanal de hidróxido de cálcio na capacidade seladora do mineral trióxido agregado (MTA): um modelo de apicificação in vitro

Objective - To evaluate the effect of calcium hydroxide premedication on the apical seal of White MTA, placed as an apical barrier in permanent teeth with simulated immature apices. Furthermore, we intended to compare potential changes, under the influence of calcium hydroxide, in the apical seal of MTA over time. Methods - Thirty-four single-rooted extracted teeth were prepared in order to simulate a divergent open apex. Two experimental groups of 10 teeth were created: group 1 (G1) and group 2 (G2) with and without calcium hydroxide intracanal medication previous to the placement of MTA apical plug. Two control groups, positive and negative, each with 7 teeth were created. On the 7th and on the 28th day after placement of the MTA apical plug, the apices of the teeth were submersed in a solution of sodium pertechnetate (99mTcO4Na) for 3 hours. The radioactivity was measured using a gamma camera. Results - Results revealed statistically significant differences between the 2 control groups and the 2 experimental groups with respect to the microleakage. Within the experimental groups no statistically significant differences were found; nor between the two observed periods. Conclusion - Based on the results obtained in this study, it was concluded that intracanal medication with calcium hydroxide did not affect the sealing ability of WMTA, placed as an apical plug, neither on the 7th, nor on the 28th day.

Objetivo - Avaliar o efeito do hidróxido de cálcio como medicação intracanal, no selamento apical do MTA branco, colocado como uma barreira apical em dentes permanentes com ápices imaturos simulados. Métodos - Trinta e quatro dentes unirradiculares extraídos foram preparados para simular um ápice aberto divergente. Foram separados em dois grupos experimentais (n=10): G1 e G2 com e sem medicação intracanal de hidróxido de cálcio antes da colocação do tampão apical com o MTA e dois grupos controle, positivos e negativos (n=7 em cada). Em 7 e 28 dias após a colocação do tampão apical de MTA, os ápices dos espécimes foram submersos em uma solução de pertecnetato de sódio (99mTcO4Na) por 3 horas. A radioatividade foi medida usando uma câmara gama. Resultados - Os resultados revelaram diferenças estatisticamente significativas entre os grupos controle e os grupos experimentais com relação a microinfiltração. Não houve diferença entre os grupos experimentais nos dois períodos. Conclusão - Com base nos resultados obtidos neste estudo, concluiu-se que a medicação intracanal com hidróxido de cálcio não influenciou na capacidade seladora do MTA.

Evaluation of dentin formed in autogenous tooth transplantation in the dog: a comparison between one- and two-stage surgical techniques.

This study was designed to compare the thickness of dentin formed associated with autogenous tooth transplantation in dogs, using either one- or two-stage surgical techniques. The study consisted of three Beagles, older than 5 months, in which six incisors and six premolars were transplanted to mechanically prepared recipient sockets. One group was transplanted using a one-stage method to recipient beds prepared immediately before transplantation. The second groups of teeth were transplanted using a two-stage method in which the recipient beds were prepared and left to heal for 7 days before transplantation. Dogs were injected with xylenol orange, calcein and oxytetracycline at 2 days before, 3 and 9 weeks after transplantation, respectively, for vital staining. Clinical examinations were carried out every week, and the animals were euthanized 9 weeks later. The jaws were resected, fixed in formaldehyde and embedded in resin. Undemineralized sections were cut and examined by fluorescent microscopy. The thickness of dentin formed in the third week after transplantation and 9 weeks was evaluated by undertaking histomorphometric analysis and analysed using the Mann-Whitney U test (P = 0.05). All the transplanted teeth in both groups survived, and the dentin was formed. No statistically significant difference was found in the thickness of dentin formed in the third week and formed in the third to ninth week between the treatment groups (P = 0.999 and P = 0.998, respectively). This study demonstrated that there was no difference between the two surgical techniques in terms of the thickness of dentin formed in transplanted teeth.

Limas endodônticas: esterilizar ou descartar

Objetivo: o objetivo desse trabalho foi comparar, qualitativa e quantitativamente, a presença de matéria orgânica em limas endodônticas depois de utilizadas, descontaminadas e esterilizadas. Métodos: foram usadas 30 limas tipo K #30, das quais 5 serviram como grupo controle positivo e 5 como negativo. Instrumentaram-se 10 molares suínos pela técnica Crown-Down, inserindo uma lima por canal num total de 25 limas. As limas do grupo 1 (n=10) foram esterilizadas em autoclave. As limas do grupo 2 (n=10) foram colocadas em banho de ultrassom com solução enzimática e posteriormente esterilizadas em autoclave. As do grupo 3 (n=5) foram utilizadas, mas não foram esterilizadas; e as do grupo 4(n=5) não foram utilizadas nem esterilizadas. As limas experimentais e de controle foram posteriormente coradas com solução de Van Gieson, observadas ao microscópio óptico e atribuído um valor representativo da quantidade de matéria orgânica ainda existente na lima, de acordo com uma escala previamente estabelecida. Essa quantificação foi realizada nos terços apical, médio e cervical da parte ativa de cada lima, e foram elaboradas tabelas comparativas entre os diferentes grupos. Resultados:os resultados demonstraram que ambos os grupos experimentais apresentaram resultados significativamente inferiores aos das limas do grupo controle positivo.Conclusão: comparando-se os grupos experimentais,as limas imersas em banho de ultrassom com solução enzimática apresentaram valores inferiores aos daquelas que não foram submetidas a esse procedimento.

Autogenous tooth transplantation: Evaluation of pulp tissue regeneration

Objective: The aim of this study was to assess the pulp survival that occur in transplants of autologous teeth, by comparing two surgical techniques: the conventional technique (autotransplantation for newly formed alveoli),and an alternative technique, (autotransplants for alveoli in the initial phase of healing). In each surgical techniques were applied, randomly, either saline solution or Emdogain®.Study Design:The study group comprised 26 patents, in which 28 teeth were transplanted to recipient socketsprepared mechanically. Of the 28 teeth transplanted, 4 were intentional replants, and of the remainer, 11 had the apex closed and 13 open. The mean age at the time of transplantation was 22.34±8.14 years (mean ± SD). The transplantation were performed by the same operator, with the informed consent of the patient and authorized by the ethical committee of the hospital. Clinical and radiological examinations were performed during 24 to 65months (48±12.96; MED±SD), from 10 days, 1 month, 3 months, 6 months and annually to 5.6 years.Results: Only two transplanted teeth were lost, due persistent apical periodontitis, and one transplanted patient with open apex missed the treatment. In the teeth with pulp, we needed to perform root canal therapy in 9. In the73% of the teeth with closed apex, we needed to perform root canal treatment, with no statistically significant difference found among closed apex and root canal therapy (p=0.083). In only 8% of the teeth with open apex did weneed to perform root canal treatment, with an association between open apex and root canal therapy (p=0.0002).The overall success rate was 98% with significant difference for losses (p=0.0001).Conclusions: Although not a frequent procedure, it was concluded that autotransplanted teeth, performed with appropriate surgical care had a good prognosis, and can render a very useful service to the patients (AU)

Autogenous tooth transplantation: evaluation of pulp tissue regeneration.

OBJECTIVE: The aim of this study was to assess the pulp survival that occur in transplants of autologous teeth, by comparing two surgical techniques: the conventional technique (autotransplantation for newly formed alveoli), and an alternative technique, (autotransplants for alveoli in the initial phase of healing). In each surgical techniques were applied, randomly, either saline solution or Emdogain®. STUDY DESIGN: The study group comprised 26 patents, in which 28 teeth were transplanted to recipient sockets prepared mechanically. Of the 28 teeth transplanted, 4 were intentional replants, and of the remainer, 11 had the apex closed and 13 open. The mean age at the time of transplantation was 22.34 ± 8.14 years (mean ± SD). The transplantation were performed by the same operator, with the informed consent of the patient and authorized by the ethical committee of the hospital. Clinical and radiological examinations were performed during 24 to 65 months (48 ± 12.96; MED ± SD), from 10 days, 1 month, 3 months, 6 months and annually to 5.6 years. RESULTS: Only two transplanted teeth were lost, due persistent apical periodontitis, and one transplanted patient with open apex missed the treatment. In the teeth with pulp, we needed to perform root canal therapy in 9. In the 73% of the teeth with closed apex, we needed to perform root canal treatment, with no statistically significant difference found among closed apex and root canal therapy (p=0.083). In only 8% of the teeth with open apex did we need to perform root canal treatment, with an association between open apex and root canal therapy (p=0.0002). The overall success rate was 98% with significant difference for losses (p=0.0001). CONCLUSIONS: Although not a frequent procedure, it was concluded that autotransplanted teeth, performed with appropriate surgical care had a good prognosis, and can render a very useful service to the patients.

Quantitative scintigraphic analysis of pulp revascularization in autotransplanted teeth in dogs.

OBJECTIVE: The purpose of this study was to evaluate the pulpal changes associated with autogenous single-rooted immature tooth transplantation in dogs, using either one, or two-stage surgical techniques. METHODS: Teeth from 3 beagle dogs, 5 months old, were extracted and transplanted to mechanically prepared recipient sockets. Group (A), where the teeth were transplanted using a one-stage method to recipient beds prepared immediately before transplantation. Group (B), where the teeth were transplanted using a two-stage method in which the recipient beds were prepared and left to heal for 7 days before transplantation. Clinical examinations were done every week during 9 weeks. After 9 weeks, the animals were injected with 99(m)Technetium hydroxylmethylene diphosphonate (99(m)Tc-HMDP) and 3h after injection, a whole body scintigraphic acquisition was performed. After scintigraphic acquisition the animals were euthanized and the teeth extracted and its radioactivity counted in a well counter calibrated to 99(m)Tc. With the data obtained, the percentage of activity injected was calculated for each tooth. The data for each group of teeth were evaluated and analyzed using the Mann-Whitney test (p=0.05). RESULTS: All the transplanted teeth in both groups survived. No statistically significant difference was found in the absorption of the 99(m)Tc-HMDP, between the treatment groups (p=0.464) and between them and the control group (Group A vs. control p=0.713 and Group B vs. control p=0.157). CONCLUSIONS: This study demonstrated that there was no difference between the two surgical techniques in terms of the pulp revascularization in transplanted teeth.

Histological evaluation of periodontal regeneration in autogenous tooth transplantation in the dog: a comparison between one and two-stage surgical techniques, a pilot study.

OBJECTIVE: To compare the periodontal regeneration, associated with autogenous tooth transplantation in dogs, using either one- or two-stage surgical techniques. METHODS: The study group consisted of three Beagles, older than 5 months, in which six incisors and six premolars were transplanted to mechanically prepared recipient sockets. One group was transplanted using a one-stage method to recipient beds prepared immediately before transplantation. The second group of teeth were transplanted using a two-stage method in which the recipient beds were prepared and left to heal for 7 days before transplantation. Clinical examinations were done every week and the animals were euthanized 9 weeks later. Subsequently, decalcified sections were prepared for routine and immunohistochemical histological evaluation. Periodontal healing was evaluated by undertaking histomorphometric analysis and analyzed using the Mann-Whitney test (P = 0.05). RESULTS: All the transplanted teeth in both groups survived. No statistically significant difference was found in the complete healing between the treatment groups (P = 0.053). There was no difference between the occurrence of inflammatory root resorption (P = 0.135) and replacement root resorption (P = 0.081). CONCLUSIONS: This study demonstrated that there was no difference between the two surgical techniques in terms of preventing root resorption in transplanted teeth.