Efficacy of 1.23% acidulated phosphate fluoride gel on non-cavitated enamel lesions: a randomized clinical trial.

A randomized controlled parallel clinical trial was conducted to evaluate the efficacy of the association of 1.23% topical professional acidulated phosphate fluoride (APF) gel with oral hygiene and dietary instructions on the arrest of active non-cavitated lesions in permanent, mixed, and temporary dentition in children between 3 and 12 years of age. Ninety-eight caries-active children were randomly divided into two groups: a fluoride gel group (n = 49) and a non-fluoridated gel group (n = 49). Each group received up to eight weekly applications of gel, weekly professional toothbrushing with oral hygiene instructions and dietary counselling. Caries lesions were assessed qualitatively through visual-tactile criteria performed in three stages: initial, intermediate, and final. Regression models were applied to identify risk indicators for caries control. Between-group comparison regarding the time taken to arrest the lesions was performed using Chi-squared and Fisher's exact tests. Seventeen children did not receive the allocated intervention, and one was lost to follow-up (n = 80). There was no difference between the control and placebo groups regarding the time to the arrest of the lesion (p >.05). The treatments showed similar results without significant statistical difference (p = 0.33; 95%CI: 0.32-1.48). No adverse effects were observed. It can be concluded that no additional effect of the association of 1.23% APF gel with oral hygiene using fluoride dentifrice and dietary instructions on the arrest of active non-cavitated lesions could be established. We can also confirm the importance of toothbrushing frequency and, consequently, the visible plaque reduction in the control of caries activity. RBR-37V5S3.

Estudo retrospectivo da efetividade de uma abordagem de tratamento não invasiva para inativação de lesões de cárie dentária não cavitadas em pacientes infantis / Effectiveness of a non-invasive treatment protocol for incipient enamel carious lesions in a child population: a retrospective study

Objetivo: Avaliar a efetividade de uma abordagem de tratamento não invasiva para a inativação de lesões não cavitadas de dentes decíduos e permanentes realizada na Clínica Infanto-Juvenil (CIJ) da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul (FO-UFRGS), identificando os fatores clínicos do paciente e associando-os ao sucesso clínico do tratamento. Métodos: Foram incluídos 55 prontuários de pacientes que receberam instruções de higiene bucal, controle de dieta e aplicações tópicas de flúor (ATF) na CIJ da FO-UFRGS entre 2016 e 2018. Foram coletados dados demográficos e clínicos referentes a avaliação da atividade de cárie dentária na consulta inicial e após o tratamento realizado: índice de placa visível (IPV), índice de sangramento gengival (ISG) e o número médio de dentes permanentes cariados, perdidos e restaurados (CPO-D) e/ou número médio de dentes decíduos cariados, extraídos ou com indicação de extração e restaurados (ceo-d). Na análise estatística foram utilizados os testes Qui-quadrado de Pearson, Exato de Fisher e Wilcoxon, nível de significância: p < 0,05. Resultados: Não houve diferença estatisticamente significativa quando se comparou as variáveis idade, sexo, IPV, ISG e ceo-d/CPO-D com o sucesso do tratamento. Houve diferença estatisticamente significativa comparando o IPV inicial com o final (p = 0,016) e número de lesões não cavitadas ativas inicial e final (p < 0,001), mas não houve diferença para o ISG inicial e final (p = 0,324). Conclusão: Baseado nos achados da redução do IPV e da redução no número de lesões não cavitadas ativas ao final do tratamento, sugere-se que a abordagem de tratamento não invasiva para inativação de lesões de cárie dentária não cavitadas aplicada na CIJ da FO-UFRGS é efetiva.

Aim: To evaluate the effectiveness of a non-invasive treatment on the arrest of non-cavitated caries lesions of primary and permanent teeth performed at the Pediatric Clinic (PC) at the Dental Teaching Hospital of the Federal University of Rio Grande do Sul (DT-UFRGS), identifying the patient's clinical factors and associating them with the clinical success of the treatment. Methods: This study included 55 patient's medical records who received oral hygiene instructions, diet control, and topical fluoride applications (TFA) at the PC of DT-UFRGS between 2016 and 2018. Demographic and clinical data regarding the evaluation of caries activity in the initial visit and after the performed treatment were collected: visible plaque index (VPI), gingival bleeding index (GBI), and DMF-T caries index (average number of decayed, missing, and restored permanent teeth), and/or dmf-t (average number of decayed, extracted or with recommendation for extraction, and restored deciduous teeth). Pearson's Chi-square, Fisher's Exact, and Wilcoxon tests were used for statistical analysis, significance level: p < 0.05. Results: No significant difference was observed when the variables of age, gender, VPI, CBI, DMF-T/dmf-t were compared with treatment success. A statistically significant difference was found when comparing the initial with the final VPI (p = 0.016), as well as the number of initial and final active non-cavitated carious lesions (p < 0.001), but no difference was identified for the initial and final GBI (p = 0.324). Conclusion: Based on the findings of VPI reduction and reduction in the number of active non-cavitated carious lesions upon completion of treatment, it is suggested that the non-invasive treatment for arrestment of non-cavitated carious lesions applied at the PC of DT-UFRGS is effective.

Estudo retrospectivo da efetividade de uma abordagem de tratamento não invasiva para inativação de lesões de cárie dentária não cavitadas em pacientes infantis / Effectiveness of a non-invasive treatment protocol for incipient enamel carious lesions in a child population: a retrospective study

Objetivo: Avaliar a efetividade de uma abordagem de tratamento não invasiva para a inativação de lesões não cavitadas de dentes decíduos e permanentes realizada na Clínica Infanto-Juvenil (CIJ) da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul (FO-UFRGS), identificando os fatores clínicos do paciente e associando-os ao sucesso clínico do tratamento. Métodos: Foram incluídos 55 prontuários de pacientes que receberam instruções de higiene bucal, controle de dieta e aplicações tópicas de flúor (ATF) na CIJ da FO-UFRGS entre 2016 e 2018. Foram coletados dados demográficos e clínicos referentes a avaliação da atividade de cárie dentária na consulta inicial e após o tratamento realizado: índice de placa visível (IPV), índice de sangramento gengival (ISG) e o número médio de dentes permanentes cariados, perdidos e restaurados (CPO-D) e/ou número médio de dentes decíduos cariados, extraídos ou com indicação de extração e restaurados (ceo-d). Na análise estatística foram utilizados os testes Qui-quadrado de Pearson, Exato de Fisher e Wilcoxon, nível de significância: p < 0,05. Resultados: Não houve diferença estatisticamente significativa quando se comparou as variáveis idade, sexo, IPV, ISG e ceo-d/CPO-D com o sucesso do tratamento. Houve diferença estatisticamente significativa comparando o IPV inicial com o final (p = 0,016) e número de lesões não cavitadas ativas inicial e final (p < 0,001), mas não houve diferença para o ISG inicial e final (p = 0,324). Conclusão:Baseado nos achados da redução do IPV e da redução no número de lesões não cavitadas ativas ao final do tratamento, sugere-se que a abordagem de tratamento não invasiva para inativação de lesões de cárie dentária não cavitadas aplicada na CIJ da FO-UFRGS é efetiva.

Aim: To evaluate the effectiveness of a non-invasive treatment on the arrest of non-cavitated caries lesions of primary and permanent teeth performed at the Pediatric Clinic (PC) at the Dental Teaching Hospital of the Federal University of Rio Grande do Sul (DT-UFRGS), identifying the patient's clinical factors and associating them with the clinical success of the treatment. Methods: This study included 55 patient's medical records who received oral hygiene instructions, diet control, and topical fluoride applications (TFA) at the PC of DT-UFRGS between 2016 and 2018. Demographic and clinical data regarding the evaluation of caries activity in the initial visit and after the performed treatment were collected: visible plaque index (VPI), gingival bleeding index (GBI), and DMF-T caries index (average number of decayed, missing, and restored permanent teeth), and/or dmf-t (average number of decayed, extracted or with recommendation for extraction, and restored deciduous teeth). Pearson's Chi-square, Fisher's Exact, and Wilcoxon tests were used for statistical analysis, significance level: p < 0.05. Results: No significant difference was observed when the variables of age, gender, VPI, CBI, DMF-T/dmf-t were compared with treatment success. A statistically significant difference was found when comparing the initial with the final VPI (p = 0.016), as well as the number of initial and final active non-cavitated carious lesions (p < 0.001), but no difference was identified for the initial and final GBI (p = 0.324). Conclusion: Based on the findings of VPI reduction and reduction in the number of active non-cavitated carious lesions upon completion of treatment, it is suggested that the non-invasive treatment for arrestment of non-cavitated carious lesions applied at the PC of DT-UFRGS is effective.

Pulp Revascularization or Apexification for the Treatment of Immature Necrotic Permanent Teeth: Systematic Review and Meta-Analysis.

This systematic review and meta-analysis assessed clinical, radiographic and functional retention outcomes in immature necrotic permanent teeth treated either with pulp revascularization or apexification after a minimum of three months to determine which one provides the best results. The literature was screened via PubMed/MEDLINE and Embase databases up to June 2017 to select observational studies that compared pulp revascularization and apexification treatments assessing clinical, radiographic and functional retention outcomes. Two reviewers independently performed screening and evaluation of articles. A total of 231 articles were retrieved from databases, wherein only four articles were selected for full-text analyses. After exclusion criteria, three studies remained in quantitative and qualitative analyses. Pooled-effect estimates were obtained comparing clinical and radiographic outcomes ('overall outcome') and functional retention rates between apexification and pulp revascularization treatment. The meta-analysis comparing apexification vs. revascularization for 'overall outcome' (Z=0.113, p=0.910, RR=1.009, 95%CI:0.869-1.171) and functional retention rates (Z=1.438, p=0.150, RR=1.069, 95%CI:0.976-1.172) showed no statistically significant differences between the treatments. All studies were classified as high quality. The current literature regarding the clinical, radiographic and functional retention outcomes in immature necrotic permanent teeth treated either with pulp revascularization or apexification is limited. Based on our meta-analysis, the results do not favor one treatment modality over the other.