Overview of glottic laryngeal cancer treatment recommendation changes in the NCCN guidelines from 2011 to 2022.

BACKGROUND: The treatment of glottic cancer remains challenging, especially with regard to morbidity reduction and larynx preservation rates. The National Comprehensive Cancer Network (NCCN) has published guidelines to aid decision-making about this treatment according to the tumor site, clinical stage, and patient medical status. AIM: The present review was conducted to identify changes in the NCCN guidelines for glottic cancer treatment made between 2011 and 2022 and to describe the published evidence concerning glottic cancer treatment and oncological outcomes in the same time period. METHODS AND RESULTS: Clinical practice guidelines for head and neck cancer published from 2011 up to 2022 were obtained from the NCCN website (www.NCCN.org). Data on glottic cancer treatment recommendations were extracted, and descriptive analysis was performed. In addition, a review of literature registered in the PubMed database was performed to obtain data on glottic cancer management protocols and treatment outcomes from randomized controlled trials, systematic reviews, and meta-analyses published from 2011 to 2022. In total, 24 NCCN guidelines and updates and 68 relevant studies included in the PubMed database were identified. The main guideline changes made pertained to surgical and systemic therapies, the consideration of adverse features, and new options for the treatment of metastatic disease at initial presentation. Early-stage glottic cancer received the most research attention, with transoral endoscopic laser surgery and radiotherapy assessed and compared as the main treatment modalities. Reported associations between treatment types and survival rates for this stage of glottic cancer appear to be similar, but functional outcomes can be highly compromised. CONCLUSION: NCCN panel members provide updated recommendations based on currently accepted treatment approaches for glottic cancer, constantly reviewing new surgical and non-surgical techniques. The guidelines support decision-making about glottic cancer treatment that should be individualized and prioritize patients' quality of life, functionality, and preferences.

Porosity and pore size distribution in high-viscosity and conventional glass ionomer cements: a micro-computed tomography study.

OBJECTIVES: This study aimed to compare and evaluate the porosity and pore size distribution of high-viscosity glass ionomer cements (HVGICs) and conventional glass ionomer cements (GICs) using micro-computed tomography (micro-CT). MATERIALS AND METHODS: Forty cylindrical specimens (n = 10) were produced in standardized molds using HVGICs and conventional GICs (Ketac Molar Easymix, Vitro Molar, MaxxionR, and Riva Self-Cure). The specimens were prepared according to ISO 9917-1 standards, scanned in a high-energy micro-CT device, and reconstructed using specific parameters. After reconstruction, segmentation procedures, and image analysis, total porosity and pore size distribution were obtained for specimens in each group. After checking the normality of the data distribution, the Kruskal-Wallis test followed by the Student-Newman-Keuls test was used to detect differences in porosity among the experimental groups with a 5% significance level. RESULTS: Ketac Molar Easymix showed statistically significantly lower total porosity (0.15%) than MaxxionR (0.62%), Riva (0.42%), and Vitro Molar (0.57%). The pore size in all experimental cements was within the small-size range (< 0.01 mm3), but Vitro Molar showed statistically significantly more pores/defects with a larger size (> 0.01 mm3). CONCLUSIONS: Major differences in porosity and pore size were identified among the evaluated GICs. Among these, the Ketac Molar Easymix HVGIC showed the lowest porosity and void size.

Resin infiltration for approximal caries lesions in primary and permanent teeth: case reports

Introduction: Minimally invasive dentistry aims to preserve the tooth structure and to achieve this, improved dental materials can be used. Among these, Icon®was developed for infiltration of non-cavitated enamel carious lesions or those located in the external third of dentin. Objective: To report two clinical cases in which Icon® was used to treat interproximal caries lesions in primary and permanent teeth. Case report: Two patients (10 and 13 years) attended the Pediatric Dental Clinic and the clinical and radiographic examination revealed non-cavitated enamel carious lesions and outer third of dentin on teeth 54 distal (D) and 55 mesial (M) (Patient 1), and teeth 24D and 25M (Patient 2), respectively. To restore the lesions, a resin infiltrant (Icon®) was used under rubber dam isolationand according to the manufacturer's recommendations. Results: The patients were assessed immediately after restoration, when complete sealing of the lesion was observed. Patient 1 returned for clinical and radiographic evaluation after 3 months and patient 2 returned after one month, where arrest of the carious lesions was detected. Conclusion: It is concluded that Icon® can be a good option of minimally invasive restorative material, with good applicability in Pediatric Dentistry.

Introdução: A odontologia minimamente invasiva visa maior preservação da estrutura dentária e novos materiais odontológicos vêm sendo utilizados para este fim. Dentre esses, o Icon® foi desenvolvido para infiltração de lesões de cárie não cavitadas localizadas em esmalte e/ou no terço externo de dentina. Objetivo: Relatar dois casos clínicos em que se utilizou o Icon® para tratamento de lesões de cárie interproximais em dentes decíduos e permanentes. Relato do caso: Dois pacientes (10 e 13 anos) compareceram à clínica de Odontopediatriada FO-UFRJ e ao exame clínico e radiográfico foram diagnosticadas lesões cariosas não cavitadas no terço externo de dentina e no esmalte dentário, nos dentes 54 distal (D) e 55 mesial (M) (Paciente 1) e dentes 24D e 25M (Paciente 2), respectivamente. Para restauração das lesões, foi utilizado o infiltrante de resina Icon® sob isolamento absoluto e de acordo com as recomendações do fabricante. Resultados: Os pacientes foram avaliados imediatamente após a restauração e observou-se um completo selamento da lesão. O paciente 1 retornou para avaliação clínica e radiográfica após 3 meses e o paciente 2 após 1 mês. Em ambos foi detectada paralisação da lesão cariosa. Conclusão: Conclui-se que o Icon® representa uma boa opção de material restaurador minimamente invasivo e com boa aplicabilidade em Odontopediatria.

Impact of mesiodens management on the oral health-related quality of life of a child: a case report

Introduction: Mesiodens is a supernumerary tooth present in the anterior maxilla. Children with teeth alterations that could affect their facial features may experience harassment and teasing, leading to difficulties in social interaction. Objective: To report a clinical case of treatment in a pediatric patient with mesiodens. Additionally, we aimed to correlate the mesiodens to the quality of life and happiness through the Child Perceptions Questionnaire (CPQ8-10) and the Subjective Happiness Scale (SHS). Case report: A 7-year-old patient complaining about a tooth between the upper central incisors and esthetical problems his tooth caused, according to his grandmother. In the initial session, the CPQ8-10 and the SHS were applied. The treatment performed was mesiodent extraction and follow-up. Four months after extraction, teeth 11 and 21 spontaneously repositioned, without the need for orthodontic intervention. The initial results (22 points in CPQ8-10 and mean 2.5 in the ESF) showed a negative impact on quality of life. Six months after the initial session, the questionnaires were reapplied and an improvement in the results was observed (7 points in CPQ8-10 and mean 5.25 in SHS). Conclusion: The correct diagnosis and the best moment for treatment were keys for preventing occlusal problems in a patient with mesiodens. Additionally, mesiodens treatment significantly improved the child's quality of life and perceived happiness.

Introdução: Mesiodente é um dente supranumerário presente na maxila anterior. Crianças com alterações nos dentes que podem afetar suas características faciais podem sofrer bullying e dificuldades de interação social. Objetivo: Relatar um caso clínico de tratamento em um paciente com mesiodente. Adicionalmente, correlacionar o tratamento do mesiodente ao impacto na qualidade de vida e felicidade por meio do Child Perceptions Questionnaire (CPQ8-10) e da Escala Subjetiva de Felicidade (ESF). Relato do caso: Paciente de 7 anos tinha como queixa um dente entre os incisivos centrais superiores e diagnóstico de mesiodente. O paciente relatou sofrer bullying por conta disso. Na consulta inicial foram aplicados o CPQ8-10 e o ESF. O tratamento realizado foi exodontia do mesiodente e acompanhamento. Quatro meses após a exodontia houve aproximação espontânea dos dentes 11 e 21, sem a necessidade de intervenção ortodôntica. Os resultados iniciais (22 pontos no CPQ8-10 e média 2,5 no ESF) mostraram impacto negativo na qualidade de vida. Seis meses após a consulta inicial os questionários foram reaplicados e uma melhora nos resultados foi percebida (7 pontos no CPQ8-10 e média 5,25 no SHS). Conclusão: O diagnóstico correto e o melhor momento para o tratamento foram fundamentais para prevenir problemas oclusais. Além disso, o tratamento melhorou significativamente a qualidade de vida da criança e a felicidade percebida.

Aesthetic perceptions and social judgments about different enamel opacities.

This study aimed to evaluate adolescents' aesthetic perceptions and their social judgments regarding different enamel opacities. Sample size was calculated and resulted in the inclusion of 100 adolescents (aged 10 to 15 years) from a public school in Jequié, Bahia, Brazil. Images of enamel opacities were manipulated to create aesthetic enamel defects, such as enamel color changes (unilateral and bilateral white opacity, unilateral and bilateral yellowish opacity, and unilateral and bilateral yellowish opacity with loss of structure). The images of the opacities were based on Fédération Dentaire Internationale's Developmental Defects of Enamel (DDE) Index. Aesthetic perception and social judgments were evaluated using a validated questionnaire with 12 questions (six positive and six negative points) on social aspects, considering the six manipulated images and the control. The photographic analyses were projected one-by-one by computer to adolescents individually in a classroom. Participants had one minute to observe each image and answer the questionnaire. The data were analyzed by descriptions, and the Friedman Wilcoxon test (p < 0.05). The results indicate that all opacities negatively impacted social judgment (p < 0.001). The enamel aesthetic defects most affecting an individual's perception were bilateral yellow opacity with or without loss of structure (p < 0.001). Regarding social judgment, all participants showed a negative perception of all the tested opacity types (p < 0.001). In conclusion, even opacities presenting only a color change caused aesthetic dissatisfaction to the individuals and changes in their social judgment toward others. Color changes in dental enamel have several aesthetic consequences.

Aesthetic perceptions and social judgments about different enamel opacities

Abstract This study aimed to evaluate adolescents' aesthetic perceptions and their social judgments regarding different enamel opacities. Sample size was calculated and resulted in the inclusion of 100 adolescents (aged 10 to 15 years) from a public school in Jequié, Bahia, Brazil. Images of enamel opacities were manipulated to create aesthetic enamel defects, such as enamel color changes (unilateral and bilateral white opacity, unilateral and bilateral yellowish opacity, and unilateral and bilateral yellowish opacity with loss of structure). The images of the opacities were based on Fédération Dentaire Internationale's Developmental Defects of Enamel (DDE) Index. Aesthetic perception and social judgments were evaluated using a validated questionnaire with 12 questions (six positive and six negative points) on social aspects, considering the six manipulated images and the control. The photographic analyses were projected one-by-one by computer to adolescents individually in a classroom. Participants had one minute to observe each image and answer the questionnaire. The data were analyzed by descriptions, and the Friedman Wilcoxon test (p < 0.05). The results indicate that all opacities negatively impacted social judgment (p < 0.001). The enamel aesthetic defects most affecting an individual's perception were bilateral yellow opacity with or without loss of structure (p < 0.001). Regarding social judgment, all participants showed a negative perception of all the tested opacity types (p < 0.001). In conclusion, even opacities presenting only a color change caused aesthetic dissatisfaction to the individuals and changes in their social judgment toward others. Color changes in dental enamel have several aesthetic consequences.

Mineral density changes in bovine carious dentin after treatment with bioactive dental cements: a comparative micro-CT study.

OBJECTIVES: To evaluate the potential of conventional glass ionomer cement (GIC), Biodentine™, MTA, and Portland cement to induce mineral density changes in carious dentin compared to zinc oxide eugenol control cement (ZOE). MATERIALS AND METHODS: Fifty blocks of bovine root dentin were prepared and a biofilm model using ATCC strains of S.mutans, S.sobrinus, and L.casei was used to promote artificial dentin lesions. After demineralization, the blocks were randomly divided into the five cement groups. Half of the surface of each specimen received the tested material and the other half was covered with wax (control). Samples were stored in phosphate buffered saline solution for 30 days and after that were scanned in a micro-CT with standardized parameters. Dentin mineral density changes were calculated using differences in plot profiles of the exposed and control carious dentin. Friedman's test, followed by Wilcoxon signed-rank test was used with 5% significance. RESULTS: Mean ΔZ values for the cements were 48.63 ± 19.09 for the control (ZOE), 63.31 ± 32.59 for Biodentine™, 114.63 ± 72.92 for GIC, 109.56 ± 66.28 for MTA, and 106.88 ± 66.02 for Portland cement. All cements showed a statistically significant increase in ΔZ values compared to the control, but Biodentine™ values were statistically significantly lower compared to GIC and the other calcium silicate cements. CONCLUSIONS: Tested materials present potential to induce mineral density changes in carious bovine dentin. MTA, Portland, and GIC showed higher bioactivity potential than Biodentine™. CLINICAL RELEVANCE: Based on minimally invasive concept, materials with remineralization potential can be used to preserve diseased but still repairable dental tissue.

Breakdown of demarcated opacities related to molar-incisor hypomineralization: a longitudinal study.

OBJECTIVES: This prospective longitudinal study aimed to evaluate if the occurrence of post-eruptive breakdown of demarcated opacities in hypomineralized teeth is influenced by the color or location of the opacity. MATERIALS AND METHODS: Patients diagnosed with molar-incisor hypomineralization (MIH) between 2012 and 2014 were eligible. Two calibrated examiners performed the initial and follow-up evaluations according to European Academy of Paediatric Dentistry (EAPD) criteria. Sixty-five patients were included. Fifty-eight (89.2%), with a mean age of 8.8 years (SD: 1.4), were reassessed after 1 year. Two hundred and nine of 1155 tooth surfaces were considered for the study: 86 with white opacity (OP-W), 91 with yellow opacity (OP-Y), and 32 with enamel breakdown (EB). RESULTS: From the OP-W, OP-Y, and EB, 14, 27.5, and 46.9% worsened to breakdown exposing dentin, atypical restoration, or extraction (DB + RA or EXT), respectively. Yellow opacities tended to be more prone to breakdown than white opacities. The occurrence of EB, DB + AR, or EXT was not influenced by the location (p = 0.25). CONCLUSIONS: The color of the opacity seems to play an important role on the occurrence of fracture and should be considered as a potential predictor. CLINICAL RELEVANCE: Dentists should be aware that demarcated opacities related to MIH tend to fracture over time. Moreover, children with MIH should be seen at shorter intervals.

Integrated treatment between orthodontics and pediatric dentistry using the ulectomy technique: case report

Introduction: In the pediatric dental clinic the impacted teeth can be observedeventually, which can lead to the development of occlusion disorders. Objective:This study aimed to report a clinical case in which the surgical technique ofulectomy was used in conjunction with orthodontic treatment to aid the eruptionof a maxillary central incisor. Case Report: Male patient, 13 years old, Angle ClassI in the mixed dentition stage, with the tooth 21 impacted and reduced space forits eruption due to the migration of adjacent teeth. Fixed appliance was mountedwith Edgewise brackets using 0.20" stainless steel archwire with tight omega andactive spring between teeth 11 and 22 to recover the space of 21, but the passiveeruption was not observed. A fibrous gingival tissue was found, which by palpationrevealed the incisal edge of the tooth 21. The patient was referred to a pediatricdental clinic for a ulectomy. The minimally invasive surgical procedure consistedof the excision of the gingival tissue that covered the crown of the tooth 21 allowingits eruption in the dental arch. After the surgery, the teeth erupted and correctiveorthodontic treatment continued. Conclusion: The ulectomy technique associatedwith orthodontic treatment allowed to reestablish conditions for the developmentof dentition with satisfactory aesthetic and functional characteristics.

Introdução: Eventualmente na clínica odontológica, pode ser observada aimpacção de dentes, que pode acarretar transtornos para o desenvolvimento daoclusão. Objetivo: Objetivou-se relatar um caso clínico no qual a técnica cirúrgicade ulectomia foi utilizada, associada ao tratamento ortodôntico para auxiliar aerupção dentária de um incisivo central superior. Relato de Caso: Paciente dosexo masculino, 13 anos de idade, Classe I de Angle na fase de dentição mista, comdente 21 incluso e espaço reduzido para sua erupção em função da migração dosdentes adjacentes. Foi montado aparelho fixo com bráquetes prescrição Edgewise,utilizando arco 0,20" aço inoxidável com ômega justo e mola ativa entre osdentes 11 e 22 para recuperação do espaço do 21, mas não observou-se a erupçãopassiva. Constatou-se presença de tecido gengival fibroso que, ao toque,evidenciava a borda incisal do referido dente. O paciente foi encaminhado paraclínica de Odontopediatria para a realização da ulectomia. O procedimentocirúrgico minimamente invasivo, consistiu na exérese do tecido gengival querevestia a coroa do dente 21 não irrompido, permitindo sua erupção no arcodentário. Após a cirurgia, o dente irrompeu e o tratamento ortodôntico corretivoprosseguiu. Conclusão: A técnica da ulectomia associada ao tratamentoortodôntico permitiu restabelecer condições para desenvolvimento da dentiçãocom características estético-funcionais satisfatórias.

Análise laboratorial e avaliação econômica do cimento de ionômero de vidro / Laboratory analysis and economic evaluation of glass ionomer cements

Resumo: O objetivo desta tese foi analisar o cimento ionômero de vidro (CIV) quanto às suas características laboratoriais e seu custo-efetividade (CE). O estudo 1 avaliou a recuperação da densidade mineral da dentina cariada de dentes bovinos após a aplicação de materiais à base de silicato de cálcio e CIV comparado ao cimento de óxido de zinco e eugenol (OZE) por meio de micro-CT. Como resultado, todos os cimentos testados aumentaram a densidade mineral em relação ao OZE, porém, enquanto o BiodentineTM apresentou resultados inferiores, o CIV, o MTA e Portland apresentaram um potencial remineralizador semelhante e melhor. O estudo 2 objetivou caracterizar e comparar o grau de porosidade e a distribuição do tamanho dos poros de quatro CIVs. Os espécimes foram preparados de acordo com as normas ISO 9917-1 e escaneados em micro-CT. Observou-se que o grau de porosidade e a distribuição do tamanho de poros dos CIVs testados não foram semelhantes. Dentre grupos de CIVs restauradores de alta e baixa viscosidade, o Ketac MolarTM Easymix apresentou menor porosidade. O estudo 3 foi delineado como uma revisão sistemática onde avaliou-se a efetividade clínica e o custo-efetividade do CIV comparado a outros materiais/intervenções. Com base no PICO, ensaios clínicos randomizados (ECR) contendo análises de CE em pacientes que receberam qualquer tipo de tratamento dentário com CIV comparado a outros tratamentos e materiais foram incluídos. A análise qualitativa foi realizada para cada ensaio clínico randomizado e para a análise econômica. A qualidade da evidência e força de recomendação foram determinadas com o GRADE. Os dados de CE apresentaram alto risco de viés em alguns domínios. A maioria dos ECR apresentaram baixo risco de viés. Na análise econômica, o CIV apresentou-se como o material com melhor CE. Na meta-análise, o CIV e outros materiais/técnicas apresentaram risco semelhante de falhas, apesar do tempo de acompanhamento. De acordo com o GRADE, para 36 meses de acompanhamento, a certeza da evidência foi alta. Assim, o CIV é eficaz em comparação com outros materiais ou técnicas e apresenta o melhor CE. Conclui-se, então, que o CIV pode ser considerado um material de excelência em Odontologia, tanto em análises laboratoriais quanto na avaliação econômica, quando comparado a outros materiais e técnicas. (AU)

Abstract: The aim of this thesis was to analyze the glass ionomer cement (GIC) regarding its laboratorial characteristics and its cost-effectiveness (CE). Study 1 evaluated carious dentin recovery of mineral density in bovine teeth after application of calcium silicate-based materials and GIC compared to zinc oxide eugenol cement (ZOE) using the micro-CT. As a result, all the tested cements increased mineral density in relation to ZOE. BiodentineTM presented lower mineral density changes, however GIC, MTA and Portland showed a similar and higher remineralization potential. Study 2 aimed to characterize and compare the degree of porosity and the pore size distribution of four GICs. The specimens were prepared according to ISO 9917-1 standards and scanned in a micro-CT. The degree of porosity and the pore size distribution of the tested GICs were not similar. Among groups of high and low viscosity restorative GICs, Ketac MolarTM Easymix presented lower porosity. Study 3 was designed as a systematic review to evaluate the clinical efficacy and costeffectivity of GIC compared to other materials / interventions. Based on PICO, randomized controlled trials (RCTs) containing EC analyzes including patients receiving any type of dental treatment with GIC compared to other treatments and materials were included. Qualitative analysis was performed for each randomized clinical trial and for economic analysis. The quality of evidence and strength of recommendation were determined with GRADE. EC data presented a high risk of bias in some domains. Most RCTs were at low risk of bias. Regarding the economic analysis, GIC was the material with the best CE. In the meta-analysis, the GIC and other materials/techniques presented a similar risk of failure, despite the follow-up time. According to GRADE, for 36 months of follow-up, the certainty of the evidence was high, showing that GIC may be considered effective compared to other materials or techniques and presents the best CE. It is concluded that GICs represents a material of excellence in dentistry, both in laboratory analysis and in economic evaluation, when compared to other materials and techniques. (AU)

Success frequency of root canal filling materials most used in pediatric dentistry

Introduction: There is no consensus on the literature about the best root canal filling material for primary teeth. Objective: The aim of this study was to describe the root canal filling materials most widely used in clinical pediatric dentistry, showing the observed success rates. Sources of data: A search, limited to the last 10 years and, no language restriction, was performed in October 2018 in the PubMed, Cochrane and LILACS databases using the terms "pulpectomy" and "primary teeth". This narrative literature review included clinical and randomized controlled trials conducted on children who had undergone pulpectomy as root canal therapy, with at least six months of clinical and radiographic follow-up. Synthesis of data: A total of 254 papers were retrieved from the databases. After applying the inclusion and exclusion criteria, 25 papers were included in this review. Zinc oxide and eugenol (ZOE) based paste was still the most widely used root canal filling material for primary teeth in pediatric clinical research, showing an overall clinical and radiographic success ranging from 63.3% to 93.3%. Conclusion: ZOE based paste is still the most used material for root canal filling in primary teeth, although there is a trend in the use of iodoform with calcium hydroxide pastes, which show high frequencies of success.

Introdução: Não há consenso na literatura quanto ao material obturador ideal para canais radiculares de dentes decíduos. Objetivo : O objetivo deste estudo foi descrever os materiais obturadores para canais radiculares mais utilizados na clínica Odontopediátrica, mostrando os índices de sucesso observados. Fonte dos dados : Uma busca, limitada aos últimos 10 anos e sem restrição de idioma, foi realizada em outubro de 2018 nas bases de dados PubMed, Cochrane e LILACS usando os termos "pulpectomy" e "primary teeth". Esta revisão narrativa da literatura incluiu estudos clínicos controlados randomizados em crianças submetidas a pulpectomia como tratamento endodôntico, com, no mínimo, seis meses de acompanhamento clínico e radiográfico. Síntese dos dados : Foram recuperados nas bases de dados 254 artigos. Após a aplicação dos critérios de inclusão e exclusão um total de 25 artigos foram incluídos nesta revisão. A pasta à base de óxido de zinco e eugenol (OZE) foi o material obturador mais utilizado para canais radiculares de dentes decíduos em pesquisa clínica Odontopediátrica, mostrando sucesso clínico e radiográfico geral que variou de 63,3% a 93,3%. Conclusão : A pasta à base de óxido de zinco e eugenol é o material mais utilizado para a obturação de canais radiculares de dentes decíduos, embora exista uma tendência para a utilização de pastas à base de iodofórmio com hidróxido de cálcio, que apresentam altas frequências de sucesso.

Bulk-fill resins in pediatric dentistry: case reports with six-month follow-up

Introduction: Minimally invasive dental procedures are aimed at recovering function and aesthetics in a practical manner, providing excellent treatment options. Bulk-fill composites offer some benefits, such as placement in single increments up to 4-mm thickness, decreased polymerization shrinkage, and general reduction in clinical time, while keeping aesthetic properties similar to those of conventional composite resins. Objective: To report two clinical cases of class I restorations in permanent molars with dentin carious lesions (ICDAS 4) treated with bulk-fill composites using the occlusal stamp technique. Cases were followed up for 6 months and the restorations were evaluated according to the World Dental Federation (FDI) and Public Health Service (USPHS) criteria. Case report: Restorations were performed using the following materials: Case 1 ­ Filtek ™ bulk-fill flowable resin (3M ESPE) associated with Filtek Z350 XT resin (3M ESPE); Case 2 - Filtek bulk- ill packable resin (3M ESPE). Three blinded evaluators assessed the materials and techniques in the follow-up period. Results: Case 1 achieved the lowest scores by the FDI and USPHS criteria, presenting better aesthetic, functional, and biological properties. Conclusion: Both treatments were clinically satisfactory after 6 months. Bulk-fill composites are good materials, allowing for a fast, effective, and quality treatment for the pediatric patient.

Introdução: A evolução dos procedimentos operatórios minimamente invasivos possibilitou a recuperação da função e estética com praticidade, proporcionando tratamentos de excelência. Resinas bulk-fill apresentam vantagens: inserção em incrementos únicos de até quatro milímetros, menor contração de polimerização e redução do tempo clínico, mantendo propriedades estéticas semelhantes às resinas compostas convencionais. Objetivo : Relatar dois casos clínicos de restaurações classe I em lesão cariosa em dentina não cavitada (ICDAS 4), em molares permanentes, com resina bulk-fill utilizando a técnica da réplica oclusal. Adicionalmente, foi realizado o acompanhamento dos casos após seis meses, avaliando-se de acordo com os critérios World Dental Federation (FDI) e Public Health Service (USPHS). Relato : As restaurações foram realizadas utilizando-se os materiais: Caso 1: resina Filtek bulk-fill flow (3M ESPE) associada à resina de cobertura Filtek Z350 XT (3M ESPE); Caso 2: resina Filtek bulk-fill condensável (3M ESPE). Avaliações foram conduzidas por três avaliadores cegos em relação aos materiais e técnicas. Resultados : Caso 1 apresentou menores pontuações nos critérios FDI e USPHS, com melhores propriedades estéticas, funcionais e biológicas, comparado ao Caso 2. Conclusão : Ambos os tratamentos apresentaram resultados clínicos satisfatórios após 6 meses de avaliação. Resinas bulk- ill possibilitam um tratamento rápido, eficaz e de qualidade.

Avaliação de fatores preditores, do perfil microbiológico salivar e da ocorrência de fratura pós-eruptiva do esmalte em pacientes com hipomineralização de molares e incisivos / Evaluation of predictor factors, microbiological profile in saliva and post-eruptive enamel breakdown in patients with Molar-incisor hypomineralization

O objetivo do presente trabalho foi realizar avaliações de etiologia, perfil microbiológico e longitudinal, visando observar fatores relacionados à ocorrência de hipomineralização de molares e incisivos (HMI), o risco de cárie e a evolução clínica dos defeitos de esmalte. No estudo 1(caso-controle) se investigou-se a presença de hipomineralização de molares decíduos (HMD) pode ser utilizada como um preditor clínico de HMI em 162 pacientes (65 casos e 97 controles) com idade entre 5-12 anos, como também a associação entre HMI e fatores como baixo peso ao nascer e uso de antibióticos durante o primeiro ano de vida. Como resultado, a presença de HMD desempenha um importante papel como preditor, aumentando em 2,77 vezes a chance de ocorrência de HMI (IC 95%: 1,20 ­ 6,39). Embora HMI seja mais frequente em crianças com baixo peso ao nascimento (p: 0,036), este fator pode não aumentar as chances de ocorrência de HMI significantemente (OR: 2,82; IC 95%: 1,00 ­ 7,66). O uso de antibióticos durante o primeiro ano de vida aumentou em 2,97 a chance de desenvolver HMI (OR: 2,97; IC 95%: 1,43 ­ 6,16). Já no estudo 2 avaliou-se o risco de cárie em 20 pacientes com HMI severa (7-13 anos), observando a correlação da contagem de Streptococcus mutans (SM) e de Lactobacillus spp., do fluxo salivar e da experiência de cárie na dentição decídua com o índice CPO. O grupo apresentou CPO-D e CPO-S médiosde 2,8 (DP: 1,1) e7,3 (DP: 4,7), respectivamente. Cada dente cariado apresentava, em média, 2,5 (DP: 1,1) superfícies afetadas. Em relação ao componente "cariado" ­ cárie ativa ­ do CPO, observou-se uma média de 1,9 (DP: 2,0). Todos os pacientes apresentaram boa capacidade tampão da saliva, e não houve diferença estatisticamente significante no CPO-D ou no CPO-S médios em relação às variáveis analisadas. No estudo 3 foi realizada uma avaliação longitudinal da evolução da HMI em 58 crianças com média de idade de 8,8 anos, observando a coloração, localização e incidência de força sobre cada superfície dentária, de modo a estimar o risco de fratura pós-eruptiva. Considerando a fratura em dentina (FD) como desfecho, 14% das opacidades branco-creme (OP-BC), 26,9% das opacidades amarelo-marrons (OP-AM) e 46,9% das fraturas em esmalte (FE) evoluíram. A progressão foi significativamente mais frequente dentre as OP-AM em comparação com as OP-BC, sendo altamente significativa quando se considerou fratura a partir da FE (p<0,0003). Já a progressão para FE não foi estatisticamente diferente entre superfícies expostas ou não expostas ao atrito mastigatório tanto para as OP-BC (p=0,15), como para as OP-AM (p=0,51). O mesmo ocorreu quando se considerou a progressão para FD dentre as OP-BC (p=0,36), OP-AM (p=0,82) ou FE (p=0,27). A chance de ocorrência de fratura das opacidades demarcadas foi 3,55 (IC 95%: 1,75 ­ 7,20) e 2,27 (IC 95%: 1,06 ­ 4,86) vezes mais alta quando a opacidade era amarela-marrom, considerando FE e FD, respectivamente. Com base nos resultados, HMI ainda representa um desafio na clínica odontológica e o conhecimento dos fatores apresentados podem auxiliar no estabelecimento de tratamentos adequados com bons prognósticos.

The aim of the present study was to evaluate the etiology, microbiological profile and longitudinal follow up to observe molar-incisor hypomineralization (MIH) related factors, caries risk and clinical evolution of enamel defects. In the study 1 (case-control), the presence of deciduous molar hypomineralization (DMH) as a predictor for MIH was analyzed in 162 patients (65 case and 97 controls), with age between 5-12 years old, as well as the association between HMI and risk factors as low birth weight and antibiotics intake during the first year of life. As a result, DMH plays an important role as a predictor, increasing in 2.77 times de chance of MIH occurrence (95% CI: 1.20 ­ 6.39). Although MIH is more frequent in children with low birth weight (p: 0.0036), this factor could not increase significantly the chance of MIH occurrence (OR: 2.82; 95% CI: 1.00 ­ 7.66). Antibiotics intake during the first year of life showed an increased chance of MIH occurrence in 2.97 times (95% CI: 1.43 ­ 6.16). In the study 2, the analysis of caries risk in 20 patients with severe MIH (7-1 years old) was made to observe the association between Streptococcus mutans (SM) and Lactobacillus spp. counts, salivary flow and caries experience in deciduous teeth with DMF index. The study group showed 2.8 (SD: 1.1) and 7.3 (SD: 4.7) DMF-T and DMF-S, respectively. Each caries tooth had 2.5 (SD: 1.1) affected surface. Analyzing only the decayed component of DMF index, a mean of 1.9 (SD: 2.0) of decayed surface was observed. All patients showed good salivary buffer capacity and there were no statistical difference between DMF-T and DMF-S related to the variables. In study 3, MIH longitudinal evaluation was performed in 58 children with mean age of 8.8 years, observing the color, location and force incidence to estimate the risk of post-eruptive fracture in those affected teeth. Considering dentine fracture (FD) as outcome, 14% of white-cream (OP-BC), 26.9% of yellow-brown (OP-AM) opacities and 46.9% of enamel fracture broke. Progression was significantly frequent in OP-AM, compared to OP-BC, and highly significant when fracture was considered from FE (p<0.0003). Progression to FE was not statistically different between surfaces under masticatory forces or not for OP-BC (p=0.15), and for OP-AM (p=0.51). The same happened considering progression to FD in OP-BC (p=0.36), OP-AM (p=0.82) or FE (p=0.27). The chance of fracture occurrence from demarcated opacities was 3.55 (95% CI: 1.75 ­ 7.20) and 2.27 (95% CI: 1.06 ­ 4.86) times higher when OP-AM, considering FE and FD, respectively. Based on these results, MIH remains a challenge in clinical dentistry and the knowledge of these factors can help to establishment appropriated treatments and good prognosis.

Colonização bacteriana em próteses dentárias e métodos de higienização / Bacterial colonization of denture and sanitation methods

Este artigo tem como objetivo fazer uma revisão de literatura, analisando a microbiologia do biofilme presente nas próteses totais e seus diversos métodos de higienização para prevenir algumas patologias que estão relacionadas com sua formação. Foi utilizado o banco de dados Pubmed e os descritores prosthodontics, microbiology, denture e biofilm. Dentre todos os estudos avaliados, a utilização do hipoclorito de sódio, a 2% e a 0,05%, associado ou não ao sabão de coco, se apresenta como uma forma eficaz de higienização da prótese, diminuindo o biofilme e algumas espécies patogênicas. Concluímos que a indicação do agente de limpeza protética deve ir ao encontro da necessidade do paciente, sendo sempre um com o melhor custo benefício, de fácil utilização e biocompatível.

This article aims to make a literature review, analyzing microbiology of this biofilm in complete dentures and its various cleaning methods to prevent some diseases that are related to their training. We used the Pubmed database and prosthodontics descriptors, microbiology, and denture biofilm. Among all the studies evaluated the use of sodium hypochlorite, 2% and 0.05%, with or without the coconut soap, is presented as an effective way of cleaning the prosthesis, reducing the biofilm and some pathogenic species. We conclude that the indication of prosthetic cleaning agent should meet the needs of the patient, always one with the best value for money, easy to use and biocompatible.