How combining different caries lesions characteristics may be helpful in short-term caries progression prediction: model development on occlusal surfaces of primary teeth.

BACKGROUND: Few studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status. METHODS: The occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions. RESULTS: 205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959-0.966) than those combining parameters (AIC:365-393, C:0.958-0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91). CONCLUSIONS: Univariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.

Dientes primarios verdes por hiperbilirubinemia / Dentes decíduos verdes por hiperbilirubinemia / Green deciduous teeth due to hyperbilirubinemia

Definida como una concentración sérica de bilirrubina, la hiperbilirrubinemia es una condición rara y puede ser causada por cualquier factor que eleve la carga de bilirrubina a ser metabolizada por el hígado. Así, la bilirrubina se distribuye por los tejidos corporales y se acumula en los tejidos duros, incluso, en los dientes primarios. El objetivo de este trabajo es relatar un caso clínico sobre la repercusión severa de la hiperbilirrubinemia en dientes primarios y sus manifestaciones bucales en la primera infancia, como dientes verdosos. Paciente del sexo masculino, 3 años y 8 meses, estuvo en clínica odontológica para evaluación de "manchas verdes en los dientes". En su historia médica se observó que nació prematuro y tuvo complicaciones posparto que evolucionaron para sepsis Dientes primarios verdes por hiperbilirrubinemiaIvana Aguiar Raposo,1..... Ronilza Matos,2.....• Marta Verônica Souto de Araujo,3..... •Tamara Kerber Tedesko,4.....José Carlos Pettorossi Imparato,5..... Revista de Odontopediatría Latinoamericana¹ São Leopoldo Mandic Campinas, Sao Paulo, Brasil.2 Universidade Paulista. 3 Universidade Federal de Pernambuco.4 Universidade Federal de Santa Maria.5 Universidade São Paulo - USP.Casos ClínicosDOI: 10.47990/alop.v11i2.304y, como consecuencia del uso de varios medicamentos, desarrolló un cuadro de hiperbilirrubinemia. El examen clínico dental constató la presencia de manchas verdes en los 20 dientes primarios, ausencia de lesión de caries, encías sanas y buena condición de higiene bucal. Se concluye que los altos niveles de bilirrubina desarrollados por el niño prematuro asociados a septicemia pueden llevar a la pigmentación verde (coloración intrínseca) en los dientes primarios durante el periodo de calcificación de los mismos (odontogénesis), incluso a la afectación de los dientes permanentes. Por eso, es relevante el conocimiento de la historia médica del niño desde el nacimiento para el establecimiento del diagnóstico y pronóstico de las alteraciones dentales

Defined as a serum bilirubin concentration, hyperbilirubinemia is a rare condition and can be caused by any factor that raises the bilirubin load to be metabolized by the liver. Thus, bilirubin is distributed throughout the body's tissues and accumulates in hard tissues, including primary teeth. The aim of this work is to report a clinical case about the severe repercussion of hyperbilirubinemia in primary teeth, and its early childhood manifestations, such as greenish teeth. A male patient, 3 years and 8 months old, attended the dental clinic for evaluation of "green spots on teeth". Medical history revealed that the child had premature birth and postpartum complications that evolved into sepsis, and due to the use of several drugs, developed hyperbilirubinemia. The dental clinical examination showed the presence of green spots on all 20 deciduous teeth, absence of carious lesions, healthy gums and good oral hygiene conditions. We conclude

Conservative approach for molar-incisor hypomineralization: a case report and 7-year follow-up.

Molar-incisor hypomineralization (MIH) can result in minor injuries or major structural loss, especially in incisors and molars. Patients with MIH seek dental treatment early, usually in childhood. Choosing the best treatment option during this stage can be a challenge. Because these patients still present a mixed dentition, the use of prosthetic appliances is not usually the best option. This case report with a 7-year follow-up presents an overview of a conservative approach for the restoration of teeth affected by MIH. A 10-year-old girl presented with permanent molars and incisors that exhibited qualitative defects of enamel characteristic of MIH. During the restoration phase, direct resin-modified glass ionomer cement (RMGIC) restorations were placed in all 4 first molars with the aid of acetate crowns, which were used to facilitate reconstruction of the tooth morphology. The maxillary incisors were previously treated by another dentist, and the mandibular incisors were treated later, since they were not the main complaint of the patient at the time. During 7 years of follow-up, the RMGIC restorations proved to be a good option, presenting greater longevity in a molar with minor structural defects and requiring repair or replacement in molars with larger structural defects. Despite some failures and the necessity for new restorations, the patient conveyed satisfaction with the treatment and reported no tooth sensitivity, and there was no recurrence of caries. During this follow-up period, the defective mandibular incisors were treated first with enamel microabrasion, which proved esthetically unsatisfactory, and then with direct composite resin veneers. The results in this patient suggest that use of RMGIC may be a feasible conservative option for tooth restoration in young patients with a mixed dentition when permanent molars exhibit extensive structural loss associated with MIH.

Association between quantitative measures obtained using fluorescence-based methods and activity status of occlusal caries lesions in primary molars.

BACKGROUND: Fluorescence-based methods (FBM) can add objectiveness to diagnosis strategy for caries. Few studies, however, have focused on the evaluation of caries activity. AIM: To evaluate the association between quantitative measures obtained with FBM, clinical parameters acquired from the patients, caries detection, and assessment of activity status in occlusal surfaces of primary molars. DESIGN: Six hundred and six teeth from 113 children (4-14 years) were evaluated. The presence of a biofilm, caries experience, and the number of active lesions were recorded. The teeth were assessed using FBM: DIAGNOdent pen (Lfpen) and Quantitative light-induced fluorescence (QLF). As reference standard, all teeth were evaluated using the ICDAS (International Caries Detection and Assessment System) associated with clinical activity assessments. Multilevel regressions compared the FBM values and evaluated the association between the FBM measures and clinical variables related to the caries activity. RESULTS: The measures from the FBM were higher in cavitated lesions. Only, ∆F values distinguished active and inactive lesions. The LFpen measures were higher in active lesions, at the cavitated threshold (56.95 ± 29.60). Following regression analyses, only the presence of visible biofilm on occlusal surfaces (adjusted prevalence ratio = 1.43) and ∆R values of the teeth (adjusted prevalence ratio = 1.02) were associated with caries activity. CONCLUSION: Some quantitative measures from FBM parameters are associated with caries activity evaluation, which is similar to the clinical evaluation of the presence of visible biofilm.

Do the ball-ended probe cause less damage than sharp explorers?-An ultrastructural analysis.

BACKGROUND: No evidence about damage caused by ball-ended probes on tooth is available. No study compared probing defects caused by ball-ended probes with sharp explorers during tactile examinations of primary teeth. This exploratory study aimed to compare ultrastructural defects caused by ball-ended probes with sharp explorers during tactile examinations of primary teeth. METHODS: Forty-nine primary extracted teeth were tactile examined as performed for caries activity assessment. Surfaces were randomly divided into groups based on probe type (ball-ended probe or sharp explorer). Two examiners probed different surfaces using the sharp explorer and the ball-ended probe. The order for examination was randomly determined. Images were captured using environmental scanning electron microscopy (ESEM) before and after probing. Two external examiners evaluated independently the ESEM images and scored them as: 0) no damage, 1) slight marks, 2) distinct marks, 3) marks with discontinuity, 4) enamel break-offs. Multilevel Poisson regression models were used to analyze associations between probing ultrastructural damage and surface type, baseline condition and probe type. Prevalence ratios (PR) were calculated with 95 % confidence interval (CI). RESULTS: The most common defects observed on the dental surfaces were probing marks without discontinuity (scores 1 and 2). Ball-ended probes caused significantly less severe damage than sharp explorers (PR: 0.28; CI: 0.11-0.76, p = 0.01). CONCLUSION: Ball-ended probes cause less damage than sharp explorers when probing gently dental surfaces of primary teeth.

Métodos complementares na detecção de lesões de cárie em dentes decíduos são realmente necessários? / Are adjunct methods for the detection of caries lesions in primary teeth really necessary?

O presente estudo teve como objetivo avaliar, em termos de probabilidade, o impacto da realização de métodos complementares para a detecção de lesões de cárie em superfícies proximais e oclusais de dentes decíduos, comparado à inspeção visual. Para isso, 1.213 superfícies proximais de 126 crianças e 407 superfícies oclusais de 68 crianças foram examinadas através dos métodos de inspeção visual, exame radiográfico e fluorescência a laser. A validação das superfícies proximais foi realizada após separação temporária. Nas superfícies oclusais, o padrão de referência foi a confirmação da presença de lesão após tratamento operatório. Utilizando análise bayesiana, foram calculadas as probabilidades pós-teste com a aplicação da inspeção visual, e depois com a utilização dos métodos complementares. A probabilidade pré-teste foi de 4,2% e 5,2% para superfícies proximais e oclusais, respectivamente. Um resultado negativo obtido com a inspeção visual levou a probabilidade de ter uma lesão para porcentagens bem baixas, principalmente na superfície oclusal. Nesses casos, mesmo com resultados positivos obtidos com os métodos complementares, a probabilidade de haver uma lesão ainda foi baixa (em torno de 50%, no caso do exame radiográfico positivo em superfícies proximais). A realização da radiografia para confirmar lesões detectadas pelo exame visual em superfície oclusal poderia aumentar a certeza da presença da lesão, evitando tratamento operatório desnecessário. Portanto, pode-se concluir que os métodos complementares não possuem grande utilidade na detecção de lesões de cárie em dentes decíduos, e o exame visual realizado isoladamente já seria suficiente para um diagnóstico acurado.

The present study aimed to evaluate, in terms of probability, the impact of performing adjunct methods of caries lesions detection in proximal and occl usa I surfaces of primary teeth, cornpared to the visual inspection. For this, 1,213 proximalsurfaces of 126 children and 407 occlusalsurfaces of 68 children were examined through visual inspection, radiographic and laser fluorescence methods. The validation for proximalsurfaces was performed after temporary separation.ln the occlusal surfaces the reference standard was the confirmation of the presence of the lesion after operative treatment. Using Bayesian analysis post -test probabilities after performing the visual inspection were calculated. After that, these figures were computed after performing the adjunct caries detection methods. Pre-test probability was 4.2% and 5.2% for proximal and occl usa I surfaces, respectivelv A negative result obtained with visual inspection reduced the post-test probability to very low values, mainly at occlusal surfaces. On these occasions, even with positive results obtained by adjunct methods, the post-test probability of having a carieslesion was stilllow (around 50% in case of a positive result obtained by radiographic method in proximalsurfaces). Performing radiography to confirm carieslesions detected by visual inspection could increase the confidence concerned the presence of the lesion, avoiding unnecessary operative treatment. Therefore, it was concluded thal the adjunct methods do not have great utility in detecting caries lesions in primary teeth, and that the visual inspection performed alone is enough to reach an accurate diagnosis.

Influence of cross-infection control methods on performance of pen-type laser fluorescence in detecting occlusal caries lesions in primary teeth.

The aim of this in vitro study was to determine the influence of cross-infection control methods, as probe tip autoclaving and polyvinyl chloride (PVC) wrapping, on the performance of laser fluorescence device (DIAGNOdent pen--LFpen) on occlusal surfaces of primary molars. One experienced examiner carried out all examinations (n = 78). For the probe tip autoclaving study, 62 sites (sample A, 40 teeth) were used. The sites were assessed with LFpen using tips in six different conditions: without autoclaving and after autoclaving for 10, 20, 30, 40, and 50 cycles of 10 min. For the PVC wrapping study, we selected other 58 sites (sample B, 38 teeth). The sites were assessed with the LFpen device in two conditions: with and without PVC wrapping. The teeth were sectioned and histologically assessed for caries depth. LFpen values, sensitivity, and specificity were compared among the different conditions. The LF readings were slightly higher after successive examinations, independently of autoclaving. In both studies, no statistical differences in the sensitivity and specificity were observed for all conditions. In conclusion, probe tip autoclaving and PVC wrapping do not influence the performance of LFpen device on occlusal surfaces of primary molars.

The influence of interdental spacing on the detection of proximal caries lesions in primary teeth

The aim of this study was to investigate the influence of interdental spacing on the performance of proximal caries detection methods in primary molars. In addition, aspects related to temporary tooth separation with orthodontic separators were evaluated. The proximal spaces between the posterior primary teeth (n = 344) of 76 children (4-12 years old) were evaluated before and after temporary separation. Stainless steel strips with different standardized thicknesses were used to measure the presence of biological spacing and the spacing obtained after temporary separation with orthodontic rubber rings. First, the presence of proximal caries lesions was assessed by visual inspection, bitewing radiographs and a pen-type laser fluorescence device (DIAGNOdent pen). Visual inspection after temporary separation with separators was the reference standard method in checking the actual presence of caries. Multilevel analyses were performed considering different outcomes: the performance of the methods in detecting caries lesions and the spacing after temporary separation. The spacing did not influence the performance of the caries detection methods. The maximum spacing obtained with temporary tooth separation was 0.80 mm (mean ± standard deviation = 0.46 ± 0.13 mm). The temporary separation was more effective in the upper arch and less effective when an initial biological interdental spacing was present. The biological interdental spacing does not influence the performance of proximal caries detection methods in primary molars, and temporary tooth separation provides spacing narrower than 1.0 mm.

The influence of interdental spacing on the detection of proximal caries lesions in primary teeth.

The aim of this study was to investigate the influence of interdental spacing on the performance of proximal caries detection methods in primary molars. In addition, aspects related to temporary tooth separation with orthodontic separators were evaluated. The proximal spaces between the posterior primary teeth (n = 344) of 76 children (4-12 years old) were evaluated before and after temporary separation. Stainless steel strips with different standardized thicknesses were used to measure the presence of biological spacing and the spacing obtained after temporary separation with orthodontic rubber rings. First, the presence of proximal caries lesions was assessed by visual inspection, bitewing radiographs and a pen-type laser fluorescence device (DIAGNOdent pen). Visual inspection after temporary separation with separators was the reference standard method in checking the actual presence of caries. Multilevel analyses were performed considering different outcomes: the performance of the methods in detecting caries lesions and the spacing after temporary separation. The spacing did not influence the performance of the caries detection methods. The maximum spacing obtained with temporary tooth separation was 0.80 mm (mean ± standard deviation = 0.46 ± 0.13 mm). The temporary separation was more effective in the upper arch and less effective when an initial biological interdental spacing was present. The biological interdental spacing does not influence the performance of proximal caries detection methods in primary molars, and temporary tooth separation provides spacing narrower than 1.0 mm.

Children's discomfort in assessments using different methods for approximal caries detection.

Because discomfort caused by different approximal caries detection methods can influence their performance, the assessment of this discomfort is important. Thus, this study aimed to evaluate the discomfort reported by children after the use of different diagnostic methods to detect approximal caries lesions in primary teeth: visual inspection, bitewing radiography, laser fluorescence (DIAGNOdent pen - LFpen) and temporary separation with orthodontic rubbers. Seventy-six children aged 4 to 12 years were examined using these methods. Their discomfort was assessed using the Wong-Baker scale and compared among the methods. Visual inspection caused less discomfort than did other methods. Radiography and the LFpen presented similar levels of discomfort. Older children reported higher discomfort using temporary separation, whereas younger children reported less discomfort with the LFpen. In conclusion, radiographic, temporary separation and LFpen methods provoke higher discomfort than visual inspection.

Children's discomfort in assessments using different methods for approximal caries detection

Because discomfort caused by different approximal caries detection methods can influence their performance, the assessment of this discomfort is important. Thus, this study aimed to evaluate the discomfort reported by children after the use of different diagnostic methods to detect approximal caries lesions in primary teeth: visual inspection, bitewing radiography, laser fluorescence (DIAGNOdent pen - LFpen) and temporary separation with orthodontic rubbers. Seventy-six children aged 4 to 12 years were examined using these methods. Their discomfort was assessed using the Wong-Baker scale and compared among the methods. Visual inspection caused less discomfort than did other methods. Radiography and the LFpen presented similar levels of discomfort. Older children reported higher discomfort using temporary separation, whereas younger children reported less discomfort with the LFpen. In conclusion, radiographic, temporary separation and LFpen methods provoke higher discomfort than visual inspection.

Conhecimento dos cirurgiões-dentistas frente aos cuidados com a saúde bucal de crianças em idade pré-escolar / Knowledge of dentists compared to oral health care for children in preschool

Objetivo - Avaliar o nível de conhecimento dos cirurgiões-dentistas, exceto odontopediatras, frente aos cuidados com a saúde bucal de crianças em idade pré-escolar. Métodos - Foram questionados 137 cirurgiões-dentistas que não possuíam nenhum curso de pós-graduação em Odontopediatria. Foram coletados dados referentes à região que se formou; se realizou curso de especialização ou não; se o entrevistado tinha filho e a idade do mesmo na primeira visita ao cirurgião-dentista; qual a idade ideal para iniciar a limpeza na cavidade do bebê, qual o tipo de dentifrício e sua quantidade para diferentes faixas etárias, indicação ou não de chupeta ou mamadeira e a idade da remoção do habito. Resultados - Verificou-se que a maioria (62%) dos cirurgiões-dentistas fez graduação na região sudeste; 53% já eram especialistas; 33% têm filhos; 75% levariam seus filhos ao cirurgião-dentista entre zero até um ano de idade; 84% afirmaram que a idade ideal para iniciar a limpeza na cavidade bucal do bebê é antes do irrompimento do primeiro dente; 89% dos entrevistados não indicam dentifrícios para bebês edêntulos; 84% dos entrevistados indicam para pacientes entre quatro e seis anos dentifrício com flúor; 37% indicam a remoção da chupeta até dois anos de idade; 72% dos cirurgiões-dentistas indicam o bico da mamadeira ortodôntico e 36% indicam a remoção da mamadeira precocemente. Conclusão - A maioria dos cirurgiões-dentistas têm conhecimento suficiente para orientar os pais quanto aos hábitos de higiene, prevenção e remoção de hábitos deletérios das crianças, apesar de não serem da área de Odontopediatria.

Objective - This study assessed the level of knowledge of dentists compared to oral health care for children in preschool. Methods - We questioned 137 dentists who did not have any postgraduate course in Pediatric Dentistry. Data were collected regarding the region that was formed, held a specialist course or not, whether the respondent had a son the same age and in first visit to the dentist, which is the ideal age to start cleaning the cavity of the baby, which type and quantity of toothpaste for different age groups, indicating whether or not a pacifier or bottle and removing the old habit. Results - We found that most (62%) of dentists had graduated from the southeast, and 53% were specialists, 33% have children, 75% would take their children to the dentist between zero to one year of age; 84% said the ideal age to start cleaning the baby's oral cavity before the first tooth eruption, 89% of respondents did not indicate toothpaste for babies, 84% of respondents indicated for patients between four and six years with fluoride toothpaste, 37% indicate the removal of the pacifier after two years of age, 72% of dentists indicate the orthodontic nipple of the bottle and 36% indicate the removal of the bottle early. Conclusion - Most dentists have enough knowledge to guide parents as to hygiene, prevention and removal of harmful habits of children, although not in the area of Pediatric Dentistry.

Performance of fluorescence-based and conventional methods of occlusal caries detection in primary molars - an in vitro study.

AIM: This in vitro study aimed to test the performance of fluorescence-based methods in detecting occlusal caries lesions in primary molars compared to conventional methods. DESIGN: Two examiners assessed 113 sites on 77 occlusal surfaces of primary molars using three fluorescence devices: DIAGNOdent (LF), DIAGNOdent pen (LFpen), and fluorescence camera (VistaProof-FC). Visual inspection (ICDAS) and radiographic methods were also evaluated. One examiner repeated the evaluations after one month. As reference standard method, the lesion depth was determined after sectioning and evaluation in stereomicroscope. The area under the ROC curve (Az), sensitivity, specificity, and accuracy of the methods were calculated at enamel (D1) and dentine caries (D3) lesions thresholds. The intra and interexaminer reproducibility were calculated using the intraclass correlation coefficient (ICC) and kappa statistics. RESULTS: At D1, visual inspection presented higher sensitivities (0.97-0.99) but lower specificities (0.18-0.25). At D3, all the methods demonstrated similar performance (Az values around 0.90). Visual and radiographic methods showed a slightly higher specificity (values higher than 0.96) than the fluorescence based ones (values around 0.88). In general, all methods presented high reproducibility (ICC higher than 0.79). CONCLUSIONS: Although fluorescence-based and conventional methods present similar performance in detecting occlusal caries lesions in primary teeth, visual inspection alone seems to be sufficient to be used in clinical practice.

Uso da secagem prolongada como uma alternativa de aprimoramento do método de fluorescência a laser na avaliação da atividade de lesões de cárie em dentes decíduos: estudo in vivo / Use of prolonged drying as an alternative to improve the laser fluorescence method to assess activity caries lesions in primary teeth: an in vivo study

O presente trabalho objetivou testar o uso da secagem prolongada (30s) na tentativa de melhorar a habilidade do método de fluorescência a laser em avaliar a atividade de lesões de cárie oclusais em dentes decíduos. Noventa e três crianças, com idade entre 4 e 14 anos, concluíram todas as fases deste estudo. Um examinador, previamente treinado, realizou as medições, após secagem prévia por 3 segundos (controle) e 30 segundos, com o aparelho de fluorescência a laser (Ddpen) nas superfícies oclusais dos molares decíduos selecionados (n=515). Para a validação concorrente, os dentes previamente selecionados foram classificados por dois examinadores quanto à presença e atividade das lesões de cárie através do critério de inspeção visual ICDAS e a avaliação da atividade das lesões foi realizada através da ponderação mental das características clinicas da lesões. Para a validação preditiva, após 1 ano do exame inicial, 19 crianças foram reexaminados pelos métodos descritos acima. Com o intuito de verificar a habilidade do método em diferenciar lesões ativas e inativas, foram consideradas as medições após 3 s e 30 s de secagem, além da diferença entre essas medidas (DIF 30s-3s). Para isso, foram utilizadas análises de regressão linear multinível. Para a validação preditiva, modelos de regressão logística foram usados e o risco relativo com intervalo de confiança de 95% foi calculado. Houve discreta diferença entre os dois tempos de secagem (3s e 30s). Para as lesões clinicamente em esmalte, não houve diferença na magnitude das leituras do DDpen, independentemente do tempo de secagem utilizado. Entretanto, quando foi considerado somente lesões não cavitadas, observaram-se, em média, maiores leituras para as lesões de cárie inativas do que para as ativas, efeito que desapareceu quando a análise foi ajustada pela pigmentação das lesões não cavitadas. A DIF 30s-3s não contribuiu na diferenciação de lesões inativas e ativas, nem considerando lesões clinicamente em esmalte, nem apenas as lesões não cavitadas. As lesões cavitadas ativas tiveram maior leitura de fluorescência a laser que as lesões inativas. Na validação preditiva, as medidas de fluorescência a laser também não foram associadas à progressão das lesões, nem à alteração do status de atividade. Isso foi válido para ambos os tempos de secagem e para a DIF 30s-3s. Conclui-se que a fluorescência a laser é capaz de diferenciar, quanto à atividade, apenas lesões de cárie cavitadas, independente do tempo de secagem utilizado e que a medida da diferença entre as leituras obtidas após secagem de 3s e 30s não auxilia na classificação do status de atividade das lesões de cárie não cavitadas.

The aim of the current study was to test the use of an extended drying period (30s), in order to improve the laser fluorescence ability for assessing active and inactive occlusal caries lesions in primary teeth. Ninety-three children, aged 4- 14 yrs-old, were involved in all steps of the study. One examiner, previously trained, performed measurements with laser fluorescence (Ddpen), after 3s and 30 s of previous air-drying, on the occlusal surfaces of selected primary molars (n=515). For the concurrent validation, all previously selected teeth were classified using the ICDAS and the lesion activity assessment was performed through mental weighing of clinical characteristics. For the predictive validation, 19 children were evaluated again following the same criteria mentioned above. Measurements collected after 3 and 30 s of air-drying, and also the difference between them (DIF 30s-3s) were calculated, aiming to verify the ability of the method to differentiate active and inactive lesions. For this, multilevel linear regression analyses were performed. For the predictive validation, logistic regression models were considered and the relative risk with a confidence interval of 95% was also calculated. A slight difference between values was found, for both drying periods (3s and 30s). Concerning the lesions that were clinically classified in enamel, no significant statistical difference was observed on laser fluorescence readings, independently of air-drying time. However, when considering only non-cavitaded lesions, higher mean readings were observed for the inactive lesions than for the active ones. However, this effect disappeared when adjusting the analysis for the stained non-cavitaded lesions. The DIF 30s-3s did not contribute to distinguishing active and inactive lesions. Active cavitated lesions presented higher DDpen readings than inactive cavitated lesions. In the predictive validation, the measurements of laser fluorescence were not also associated to the greatest risk of progression or changes in the status of the activity. It was concluded that the Ddpen is suitable to differentiate cavitated active and inactive lesions independently of the drying period, and that the difference measurement between the obtained readings after 3s and 30s of air-drying does not help in caries activity assessment of noncavitated caries lesions.

Capeamento pulpar indireto com sistema adesivo e resina composta: 42 meses de acompanhamento / Indirect pulp therapy using adhesive resin system: case report with 42 months of follow-up

O capeamento pulpar indireto (CPI) é um tratamento conservador realizado na tentativa de manutenção da integridade e vitalidade pulpar. Consiste na manutenção do tecido cariado afetado no fundo de uma cavidade profunda visando evitar uma possível exposição pulpar. As bactérias que permanecem no tecido dentinário remanescente tendem a diminuir sua atividade, desde que seja mantido isolado dos fatores etiológicos envolvidos na doença cárie. O objetivo deste trabalho foi relatar a realização de um caso clínico de capeamento pulpar indireto em molar decíduo empregando sistema adesivo, bem como seu acompanhamento clínico e radiográfico. Após 42 meses, evidenciou-se o sucesso clínico e radiográfico do caso, enfatizando a aplicabilidade dessa técnica minimamente invasiva para dentes decíduos com lesões de cárie profundas.

The indirect pulp therapy (IPT) is a minimally invasive procedure adopted for primary molars with deep caries in order to maintain the pulp integrity. It consists in selective caries removal of severely demineralized and denatured dentin present on the pulp wall of deep cavities and preventing pulp exposure. The residual bacteria on the treated dentine surface tend to reduce their metabolic activity since the local aetiological factors are controlled. This paper aims to report an indirect pulp therapy in a primary molar using adhesive resin system and its clinical and radiographic follow-up. After 42 months, clinical and radiographic success was observed, emphasizing the efficacy of this minimally invasive technique, specially considering primary teeth.